Character and Citizenship Education: Conversations between Personal and Societal Values

ERIC Educational Resources Information Center

Sim, Jasmine B.-Y.; Low, Ee Ling

2012-01-01

The theme of this special issue is "Character and Citizenship Education: Conversations between Personal and Societal Values." Character education and citizenship education, taken separately or as a single entity are currently riding high on the political and educational policy agendas of several governments (Arthur, 2003; Berkowitz & Bier, 2007;…

Emergency department management of pain and anxiety related to orthopedic fracture care: a guide to analgesic techniques and procedural sedation in children.

PubMed

Kennedy, Robert M; Luhmann, Jan D; Luhmann, Scott J

2004-01-01

Orthopedic fractures and joint dislocations are among the most painful pediatric emergencies. Safe and effective management of fracture-related pain and anxiety in the emergency department reduces patient distress during initial evaluation and often allows definitive management of the fracture. No consensus exists on which pharmacologic regimens for procedural sedation/analgesia are safest and most effective. For some children, control of fracture pain is the primary goal, whereas for others, relief from anxiety is an additionally important objective. Furthermore, strategies for the management of fracture pain may vary by fracture location and patient characteristics; thus, no single regimen is likely to provide the best means of analgesia and anxiolysis for all patients. Effective analgesia can be provided by local or regional anesthesia, such as hematoma, Bier, or nerve blocks. Alternatively, induction of deep sedation with analgesic agents such as ketamine or fentanyl, often combined with sedative-anxiolytic agents such as midazolam, may be used to manage distress associated with fracture reduction. A combination of local anesthesia with moderate sedation, for example nitrous oxide, is another attractive option.

Awake Fibreoptic Intubation for Forearm Injury in a Patient with Occipito-Cervical Fixator

PubMed Central

Akkaya, Akcan; Yıldız, İsa; Demirhan, Abdullah; Tekelioğlu, Ümit Yaşar; Koçoğlu, Hasan

2013-01-01

A 23-year-old male patient with occipitocervical fixator was scheduled for surgery due to injury to the right forearm. The patient’s thyromental distance was 5 cm, mouth opening grade II, sternomental distance 10 cm and Mallampati score 4. Loss of extension and rotation movements of the head was assessed as difficult intubation criteria. Anaesthetic procedures are almost always difficult in patients with occipitocervical fixation; the limited cervical extension complicated both intubation and ventilation. In this report, application of general anaesthesia using awake fibreoptic bronchoscopic intubation (FOB) is described. After routine monitoring of vital signs and premedication, hypopharyngeal topical anaesthesia was accomplished by instilling 10% lidocaine spray twice via the appropriate nostril. Superior laryngeal nerve block was performed with local anaesthetic infiltration of tissues 1 cm below the greater horns of the hyoid bone. Lingual and pharyngeal branches of the glossopharyngeal nerve were blocked. Transtracheal block was performed. Following completion of local anaesthesia, the patient was intubated using the awake FOB technique, on 5 L min−1 of 100% O2. After muscle relaxation, the patient underwent a microsurgical operation to repair eight tendons, one artery, and one nerve. Surgery lasted for 5 hours. When the extubation criteria were met, the patient was extubated. In cases of occipitocervical fixation, which causes severe limitation of neck movements, the use of awake fibreoptic intubation should be considered. PMID:27366367

[Dorsal capsular imbrication for dorsal instability of the distal radioulnar joint].

PubMed

Unglaub, F; Manz, S; Bruckner, T; Leclère, F M; Hahn, P; Wolf, M B

2013-12-01

To stabilize the distal radioulnar joint (DRUJ) by performing dorsal capsular imbrication in patients presenting with dorsal instability. The goal was to reduce pain and prevent the occurrence of posttraumatic arthrosis. Posttraumatic dorsal instability of the DRUJ with missing block while performing translational activities in the DRUJ or subluxation while actively rotating the forearm. Cases, in which other stabilizing techniques, such as, sutures of the triangular fibrocartilage complex failed. DRUJ arthrosis, previous surgical interventions to the capsule area of the DRUJ, instabilities due to osseous reasons (malposition or pseudarthrosis) should already have been treated. Dorsal approach and opening of the 5th extensor compartment to expose the dorsal joint capsule. A longitudinal division of the capsule was performed and sufficient tissue on the radial and ulnar border was retained to ensure a solid suture technique. Then 2 U-shaped sutures using FiberWire suture material were made. Correction of the malposition and repositioning the forearm into supination. Tightening of the prepared capsule sutures and closing of the retinaculum with a resorbable suture. Patients wore a long-arm cast with the forearm being in supination for a period of 4 weeks. Following cast removal, patients wore a forearm splint for a period of 4 weeks to limit forearm pronation/supination at 45°. Full load on the wrist was allowed after 12 weeks. The subjective and functional outcomes of 20 patients having received capsular imbrication using this technique were good and entailed no significant complications. The postoperative DASH was 15.8 points. Of the 20 patients, 17 patients (85%) had a reduction of pain. Symptoms of DRUJ instability could be reduced in 18 patients (90%). Pronation/supination of the wrist was not restricted postoperatively.

Cold-induced vasoconstriction at forearm and hand skin sites: the effect of age.

PubMed

Kingma, B R M; Frijns, A J H; Saris, W H M; van Steenhoven, A A; van Marken Lichtenbelt, W D

2010-07-01

During mild cold exposure, elderly are at risk of hypothermia. In humans, glabrous skin at the hands is well adapted as a heat exchanger. Evidence exists that elderly show equal vasoconstriction due to local cooling at the ventral forearm, yet no age effects on vasoconstriction at hand skin have been studied. Here, we tested the hypotheses that at hand sites (a) elderly show equal vasoconstriction due to local cooling and (b) elderly show reduced response to noradrenergic stimuli. Skin perfusion and mean arterial pressure were measured in 16 young adults (Y: 18-28 years) and 16 elderly (E: 68-78 years). To study the effect of local vasoconstriction mechanisms local sympathetic nerve terminals were blocked by bretylium (BR). Baseline local skin temperature was clamped at 33 degrees C. Next, local temperature was reduced to 24 degrees C. After 15 min of local cooling, noradrenaline (NA) was administered to study the effect of neural vasoconstriction mechanisms. No significant age effect was observed in vasoconstriction due to local cooling at BR sites. After NA, vasoconstriction at the forearm showed a significant age effect; however, no significant age effect was found at the hand sites. [Change in CVC (% from baseline): Forearm Y: -76 +/- 3 vs. E: -60 +/- 5 (P < 0.01), dorsal hand Y: -74 +/- 4 vs. E: -72 +/- 4 (n.s.), ventral hand Y: -80 +/- 7 vs. E: -70 +/- 11 (n.s.)]. In conclusion, in contrast to results from the ventral forearm, elderly did not show a blunted response to local cooling and noradrenaline at hand skin sites. This indicates that at hand skin the noradrenergic mechanism of vasoconstriction is maintained with age.

Sonographic identification of peripheral nerves in the forearm

PubMed Central

Jackson, Saundra A.; Derr, Charlotte; De Lucia, Anthony; Harris, Marvin; Closser, Zuheily; Miladinovic, Branko; Mhaskar, Rahul; Jorgensen, Theresa; Green, Lori

2016-01-01

Background: With the growing utilization of ultrasonography in emergency medicine combined with the concern over adequate pain management in the emergency department (ED), ultrasound guidance for peripheral nerve blockade in ED is an area of increasing interest. The medical literature has multiple reports supporting the use of ultrasound guidance in peripheral nerve blocks. However, to perform a peripheral nerve block, one must first be able to reliably identify the specific nerve before the procedure. Objective: The primary purpose of this study is to describe the number of supervised peripheral nerve examinations that are necessary for an emergency medicine physician to gain proficiency in accurately locating and identifying the median, radial, and ulnar nerves of the forearm via ultrasound. Methods: The proficiency outcome was defined as the number of attempts before a resident is able to correctly locate and identify the nerves on ten consecutive examinations. Didactic education was provided via a 1 h lecture on forearm anatomy, sonographic technique, and identification of the nerves. Participants also received two supervised hands-on examinations for each nerve. Count data are summarized using percentages or medians and range. Random effects negative binomial regression was used for modeling panel count data. Results: Complete data for the number of attempts, gender, and postgraduate year (PGY) training year were available for 38 residents. Nineteen males and 19 females performed examinations. The median PGY year in practice was 3 (range 1–3), with 10 (27%) in year 1, 8 (22%) in year 2, and 19 (51%) in year 3 or beyond. The median number (range) of required supervised attempts for radial, median, and ulnar nerves was 1 (0–12), 0 (0–10), and 0 (0–17), respectively. Conclusion: We can conclude that the maximum number of supervised attempts to achieve accurate nerve identification was 17 (ulnar), 12 (radial), and 10 (median) in our study. The only significant association was found between years in practice and proficiency (P = 0.025). We plan to expound upon this research with an additional future study that aims to assess the physician's ability to adequately perform peripheral nerve blocks in efforts to decrease the need for more generalized procedural sedation. PMID:27904260

Microcirculatory Impairment Following Focal and Global Cerebral Ischemia in the Rat.

DTIC Science & Technology

1982-02-08

THI 4 AGE (Won Dal. BIer SECURITY CLASSIFICATION OF THIS PAGE (When Data Entered) anti-inflammatory drugs (indomethacin, ibuprofen, flurbiprofen ...ibuprofen, flurbiprofen ), prostacyclin, antiserum against presumptive factor- Vill antigen, glass-wool filtration of blood, and alteration of arterial...used in these studies were indomethacin (WSD L-590, 226), ibuprofen (Upjohn U-IS, 573), flurbiprofen (Upjohn U-27, 182), and prostacyclin (Upjohn U

Validity and everyday clinical applicability of lumbar muscle fatigue assessment methods in patients with chronic non-specific low back pain: a systematic review.

PubMed

Villafañe, Jorge H; Gobbo, Massimiliano; Peranzoni, Matteo; Naik, Ganesh; Imperio, Grace; Cleland, Joshua A; Negrini, Stefano

2016-09-01

This systematic literature review aimed at examining the validity and applicability in everyday clinical rehabilitation practise of methods for the assessment of back muscle fatiguability in patients with chronic non-specific low back pain (CNSLBP). Extensive research was performed in MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, Physiotherapy Evidence Database (PEDro) and Cochrane Central Register of Controlled Trials (CENTRAL) databases from their inception to September 2014. Potentially relevant articles were also manually looked for in the reference lists of the identified publications. Studies examining lumbar muscle fatigue in people with CNSLBP were selected. Two reviewers independently selected the articles, carried out the study quality assessment and extracted the results. A modified Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) scale was used to evaluate the scientific rigour of the selected works. Twenty-four studies fulfilled the selection criteria and were included in the systematic review. We found conflicting data regarding the validity of methods used to examine back muscle fatigue. The Biering-Sorensen test, performed in conjunction with surface electromyography spectral analysis, turned out to be the most widely used and comparatively, the most optimal modality currently available to assess objective back muscle fatigue in daily clinical practise, even though critical limitations are discussed. Future research should address the identification of an advanced method for lower back fatigue assessment in patients with CNSLBP which, eventually, might provide physical therapists with an objective and reliable test usable in everyday clinical practise. Implications for Rehabilitation Despite its limitations, the Biering-Sorensen test is currently the most used, convenient and easily available fatiguing test for lumbar muscles. To increase validity and reliability of the Biering-Sorensen test, concomitant activation of synergistic muscles should be taken into account. Pooled mean frequency and half-width of the spectrum are currently the most valid electromyographic parameters to assess fatigue in chronic non-specific low back pain. Body mass index, grading of pain and level of disability of the study population should be reported to enhance research quality.

Cold-induced vasoconstriction at forearm and hand skin sites: the effect of age

PubMed Central

Frijns, A. J. H.; Saris, W. H. M.; van Steenhoven, A. A.; van Marken Lichtenbelt, W. D.

2010-01-01

During mild cold exposure, elderly are at risk of hypothermia. In humans, glabrous skin at the hands is well adapted as a heat exchanger. Evidence exists that elderly show equal vasoconstriction due to local cooling at the ventral forearm, yet no age effects on vasoconstriction at hand skin have been studied. Here, we tested the hypotheses that at hand sites (a) elderly show equal vasoconstriction due to local cooling and (b) elderly show reduced response to noradrenergic stimuli. Skin perfusion and mean arterial pressure were measured in 16 young adults (Y: 18–28 years) and 16 elderly (E: 68–78 years). To study the effect of local vasoconstriction mechanisms local sympathetic nerve terminals were blocked by bretylium (BR). Baseline local skin temperature was clamped at 33°C. Next, local temperature was reduced to 24°C. After 15 min of local cooling, noradrenalin (NA) was administered to study the effect of neural vasoconstriction mechanisms. No significant age effect was observed in vasoconstriction due to local cooling at BR sites. After NA, vasoconstriction at the forearm showed a significant age effect; however, no significant age effect was found at the hand sites. [Change in CVC (% from baseline): Forearm Y: −76 ± 3 vs. E: −60 ± 5 (P < 0.01), dorsal hand Y: −74 ± 4 vs. E: −72 ± 4 (n.s.), ventral hand Y: −80 ± 7 vs. E: −70 ± 11 (n.s.)]. In conclusion, in contrast to results from the ventral forearm, elderly did not show a blunted response to local cooling and noradrenalin at hand skin sites. This indicates that at hand skin the noradrenergic mechanism of vasoconstriction is maintained with age. PMID:20300768

[Efficacy and safety of ultrasound-guided or neurostimulator-guided bilateral axillary brachial plexus block].

PubMed

Xu, C S; Zhao, X L; Zhou, H B; Qu, Z J; Yang, Q G; Wang, H J; Wang, G

2017-10-17

Objective: To explore the efficacy and safety of bilateral axillary brachial plexus block under the guidance of ultrasound or neurostimulator. Methods: From February 2012 to April 2014, 120 patients undergoing bilateral hand/forearm surgery in Beijing Jishuitan Hospital were enrolled and anaesthetized with bilateral axillary brachial plexus block. All patients were divided into two groups randomly using random number table: the ultrasound-guided group (group U, n =60) and the neurostimulator-guidedgroup (group N, n =60). The block was performed with 0.5% ropivacaine. Patients' age, sex and operation duration were recorded. Moreover, success rate, performance time, onset of sensor and motor block, performance pain, patient satisfaction degree and the incidence of related complications were also documented. Venous samples were collected at selected time points and the total and the plasma concentrations of ropivacaine were analyzed with HPLC. Results: The performance time, the onset of sensor block and the onset of motor block of group U were (8.2±1.5), (14.2± 2.2)and (24.0±3.5)min respectively, which were markedly shorter than those in group N( (14.6±3.9), (19.9±3.8), (28.8±4.2)min, respectively), and the differences were statistically significant( t =11.74, 10.09, 6.73, respectively, all P <0.01). The performance pain score of group N was (25.5± 13.2), which was obviously more serious than group U (31.7± 11.2) and a significant statistical difference was detected ( t =2.856, P <0.05). The patient satisfaction degree of group U was 95.0%, which was significantly higher than group N (83.3%) and a markedly statistical difference was detected (χ(2)=4.227, P <0.05). Fifty min after performance, the total plasma concentration of ropivacaine of group U was(1.76±0.48)mg/L, which was significantly lower than group N (1.88±0.53)mg/L and a significant statistical difference was detected ( t =2.43, P <0.05), while no significant differences were detected at the other time points between two groups ( P >0.05). No analgesic was superadded and no other anesthesia methods were applied. No complications were detected perioperatively. Conclusions: The bilateral axillary brachial plexus block under the guidance of ultrasound or neurostimulator are both effective and safe for bilateral hand/forearm surgery. However, the ultrasound-guided block may be more clinically beneficial because of its shorter performance time, rapid onset and higher patient satisfaction degree.

Hawaii Play Fairway Analysis: Hawaiian Place Names

DOE Data Explorer

Nicole Lautze

2015-11-15

Compilation of Hawaiian place names indicative of heat. Place names are from the following references: Pukui, M.K., and S.H. Elbert, 1976, Place Names of Hawaii, University of Hawaii Press, Honolulu, HI 96822, 289 pp. ; Bier, J. A., 2009, Map of Hawaii, The Big Island, Eighth Edition, University of Hawaii Press, Honolulu, HI  96822, 1 sheet.; and Reeve, R., 1993, Kahoolawe Place Names, Consultant Report No. 16, Kahoolawe Island Conveyance Commission, 259 pp.

Can we use lower volume of local anesthetic for infraclavicular brachial plexus nerve block under ultrasound guidance in children?

PubMed

Ince, Ilker; Aksoy, Mehmet; Dostbil, Aysenur; Tuncer, Kutsi

2017-09-01

To determine if the infraclavicular brachial plexus block can be applied with lower volume of local anesthetic. Randomised, double-blinded clinical trial. 60 patients aged 5-15years with ASA I-II who underwent emergent or elective arm, forearm or hand operations were included in the study. Patients were divided into two groups randomly; standard volume local anesthetic administered group (Group S, n=30) and low volume anesthetic administered group (Group L, n=30). Postoperative pain scores, sensory and motor block durations were noted. Pain scores (Wong-Baker Face Scale) were evaluated and the results were detected to be similar at all times (30min, 1, 2, 4, 8, 12, 24h). Durations of motor block were 168(±16) minutes and 268(±15) minutes in Group L and Group S respectively and the difference was statistically significant (p<0.001). Durations of sensory block were 385(±26) and 402(±39) in Group L and Group S respectively and no statistically significant difference was detected (p=0.064). Similar block success, postoperative sensory block durations and pain scores could be obtained during infraclavicular brachial plexus in pediatric patients with lower local anesthetic volumes. Copyright © 2016 Elsevier Inc. All rights reserved.

Effect of fluoroquinolone on the enhanced nitric oxide-induced peripheral vasodilation seen in cirrhosis.

PubMed

Chin-Dusting, J P; Rasaratnam, B; Jennings, G L; Dudley, F J

1997-12-01

In patients with cirrhosis, portosystemic shunts allow intestinal bacteria and endotoxin to enter the systemic circulation. Endotoxemia may induce increased synthesis of nitric oxide, thereby contributing to arterial vasodilation. To test the hypothesis that the antibiotic norfloxacin blocks the effects of nitric oxide. Placebo-controlled, double-blind, crossover study. Alfred Hospital, Melbourne, Australia. 9 patients with alcohol-related cirrhosis and 10 healthy controls. Norfloxacin, 400 mg twice daily, for 4 weeks. Peripheral blood flow was measured by using forearm venous occlusion plethysmography. Basal forearm blood flow was higher in patients with cirrhosis than in controls (3.69 +/- 0.27 mL/100 mL per minute and 2.47 +/- 0.40 mL/100 mL per minute; P = 0.014) but returned toward normal after norfloxacin was given (2.64 +/- 0.31 mL/100 mL of tissue per minute in patients with cirrhosis). Responses to NG-monomethyl-L-arginine were greater in patients with cirrhosis but returned to normal after norfloxacin was given. Bacterial endotoxemia in patients with cirrhosis induces increased synthesis of nitric oxide that can be corrected with norfloxacin.

Does regional loss of bone density explain low trauma distal forearm fractures in men (the Mr F study)?

PubMed

Hanusch, B C; Tuck, S P; McNally, R J Q; Wu, J J; Prediger, M; Walker, J; Tang, J; Piec, I; Fraser, W D; Datta, H K; Francis, R M

2017-10-01

The pathogenesis of low trauma wrist fractures in men is not fully understood. This study found that these men have lower bone mineral density at the forearm itself, as well as the hip and spine, and has shown that forearm bone mineral density is the best predictor of wrist fracture. Men with distal forearm fractures have reduced bone density at the lumbar spine and hip sites, an increased risk of osteoporosis and a higher incidence of further fractures. The aim of this case-control study was to investigate whether or not there is a regional loss of bone mineral density (BMD) at the forearm between men with and without distal forearm fractures. Sixty-one men with low trauma distal forearm fracture and 59 age-matched bone healthy control subjects were recruited. All subjects underwent a DXA scan of forearm, hip and spine, biochemical investigations, health questionnaires, SF-36v2 and Fracture Risk Assessment Tool (FRAX). The non-fractured arm was investigated in subjects with fracture and both forearms in control subjects. BMD was significantly lower at the ultradistal forearm in men with fracture compared to control subjects, in both the dominant (mean (SD) 0.386 g/cm 2 (0.049) versus 0.436 g/cm 2 (0.054), p < 0.001) and non-dominant arm (mean (SD) 0.387 g/cm 2 (0.060) versus 0.432 g/cm 2 (0.061), p = 0.001). Fracture subjects also had a significantly lower BMD at hip and spine sites compared with control subjects. Logistic regression analysis showed that the best predictor of forearm fracture was ultradistal forearm BMD (OR = 0.871 (0.805-0.943), p = 0.001), with the likelihood of fracture decreasing by 12.9% for every 0.01 g/cm 2 increase in ultradistal forearm BMD. Men with low trauma distal forearm fracture have significantly lower regional BMD at the ultradistal forearm, which contributes to an increased forearm fracture risk. They also have generalised reduction in BMD, so that low trauma forearm fractures in men should be considered as indicator fractures for osteoporosis.

78 FR 68907 - Agency Information Collection (Elbow and Forearm Conditions Disability Benefits Questionnaire...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-15

... Forearm Conditions Disability Benefits Questionnaire) Under OMB Review AGENCY: Veterans Benefits... Control No. 2900- NEW (Elbow and Forearm Conditions Disability Benefits Questionnaire)'' in any... Benefits Questionnaire)''. SUPPLEMENTARY INFORMATION: Title: Elbow and Forearm Conditions Disability...

X-Ray Exam: Forearm

MedlinePlus

... Staying Safe Videos for Educators Search English Español X-Ray Exam: Forearm KidsHealth / For Parents / X-Ray Exam: Forearm What's in this article? What ... Have Questions Print What It Is A forearm X-ray is a safe and painless test that ...

The influence of cold on the recovery of three neuromuscular blocking agents in man.

PubMed

England, A J; Wu, X; Richards, K M; Redai, I; Feldman, S A

1996-03-01

The Arrhenius hypothesis suggests that change in temperature has a less marked effect on the rate of physical processes than on biological reactions. We have investigated the process underlying recovery from neuromuscular block in man by studying the effect of cooling on the rate of recovery from depolarising and non-depolarising block. Vecuronium, rocuronium and decamethonium (C10) neuromuscular block were investigated using the isolated forearm technique on awake human volunteers. In these experiments, one arm was cooled whilst the other was used as control. Moderate hypothermia decreased the rate of recovery from all three agents, but this was significantly less marked with the depolarising drug. The mean Q10 (the anticipated change in rate of a reaction across of 10 degrees C temperature gradient) of the rate of recovery for vecuronium was 3.21, rocuronium 2.86 and decamethonium 1.29. This suggests a different process in the recovery of these two types of drug. According to the Arrhenius hypothesis this would suggest that the recovery from non-depolarising drugs is likely to involve a biochemical mechanism and that recovery from decamethonium is controlled by a physical process.

Residual Upper Arm Motor Function Primes Innervation of Paretic Forearm Muscles in Chronic Stroke after Brain-Machine Interface (BMI) Training

PubMed Central

Curado, Marco Rocha; Cossio, Eliana Garcia; Broetz, Doris; Agostini, Manuel; Cho, Woosang; Brasil, Fabricio Lima; Yilmaz, Oezge; Liberati, Giulia; Lepski, Guilherme

2015-01-01

Background Abnormal upper arm-forearm muscle synergies after stroke are poorly understood. We investigated whether upper arm function primes paralyzed forearm muscles in chronic stroke patients after Brain-Machine Interface (BMI)-based rehabilitation. Shaping upper arm-forearm muscle synergies may support individualized motor rehabilitation strategies. Methods Thirty-two chronic stroke patients with no active finger extensions were randomly assigned to experimental or sham groups and underwent daily BMI training followed by physiotherapy during four weeks. BMI sessions included desynchronization of ipsilesional brain activity and a robotic orthosis to move the paretic limb (experimental group, n = 16). In the sham group (n = 16) orthosis movements were random. Motor function was evaluated with electromyography (EMG) of forearm extensors, and upper arm and hand Fugl-Meyer assessment (FMA) scores. Patients performed distinct upper arm (e.g., shoulder flexion) and hand movements (finger extensions). Forearm EMG activity significantly higher during upper arm movements as compared to finger extensions was considered facilitation of forearm EMG activity. Intraclass correlation coefficient (ICC) was used to test inter-session reliability of facilitation of forearm EMG activity. Results Facilitation of forearm EMG activity ICC ranges from 0.52 to 0.83, indicating fair to high reliability before intervention in both limbs. Facilitation of forearm muscles is higher in the paretic as compared to the healthy limb (p<0.001). Upper arm FMA scores predict facilitation of forearm muscles after intervention in both groups (significant correlations ranged from R = 0.752, p = 0.002 to R = 0.779, p = 0.001), but only in the experimental group upper arm FMA scores predict changes in facilitation of forearm muscles after intervention (R = 0.709, p = 0.002; R = 0.827, p<0.001). Conclusions Residual upper arm motor function primes recruitment of paralyzed forearm muscles in chronic stroke patients and predicts changes in their recruitment after BMI training. This study suggests that changes in upper arm-forearm synergies contribute to stroke motor recovery, and provides candidacy guidelines for similar BMI-based clinical practice. PMID:26495971

Residual Upper Arm Motor Function Primes Innervation of Paretic Forearm Muscles in Chronic Stroke after Brain-Machine Interface (BMI) Training.

PubMed

Curado, Marco Rocha; Cossio, Eliana Garcia; Broetz, Doris; Agostini, Manuel; Cho, Woosang; Brasil, Fabricio Lima; Yilmaz, Oezge; Liberati, Giulia; Lepski, Guilherme; Birbaumer, Niels; Ramos-Murguialday, Ander

2015-01-01

Abnormal upper arm-forearm muscle synergies after stroke are poorly understood. We investigated whether upper arm function primes paralyzed forearm muscles in chronic stroke patients after Brain-Machine Interface (BMI)-based rehabilitation. Shaping upper arm-forearm muscle synergies may support individualized motor rehabilitation strategies. Thirty-two chronic stroke patients with no active finger extensions were randomly assigned to experimental or sham groups and underwent daily BMI training followed by physiotherapy during four weeks. BMI sessions included desynchronization of ipsilesional brain activity and a robotic orthosis to move the paretic limb (experimental group, n = 16). In the sham group (n = 16) orthosis movements were random. Motor function was evaluated with electromyography (EMG) of forearm extensors, and upper arm and hand Fugl-Meyer assessment (FMA) scores. Patients performed distinct upper arm (e.g., shoulder flexion) and hand movements (finger extensions). Forearm EMG activity significantly higher during upper arm movements as compared to finger extensions was considered facilitation of forearm EMG activity. Intraclass correlation coefficient (ICC) was used to test inter-session reliability of facilitation of forearm EMG activity. Facilitation of forearm EMG activity ICC ranges from 0.52 to 0.83, indicating fair to high reliability before intervention in both limbs. Facilitation of forearm muscles is higher in the paretic as compared to the healthy limb (p<0.001). Upper arm FMA scores predict facilitation of forearm muscles after intervention in both groups (significant correlations ranged from R = 0.752, p = 0.002 to R = 0.779, p = 0.001), but only in the experimental group upper arm FMA scores predict changes in facilitation of forearm muscles after intervention (R = 0.709, p = 0.002; R = 0.827, p<0.001). Residual upper arm motor function primes recruitment of paralyzed forearm muscles in chronic stroke patients and predicts changes in their recruitment after BMI training. This study suggests that changes in upper arm-forearm synergies contribute to stroke motor recovery, and provides candidacy guidelines for similar BMI-based clinical practice.

Flow dependence of forearm noradrenaline overflow, as assessed during mental stress and sodium nitroprusside infusion.

PubMed

Lindqvist, M; Melcher, A; Hjemdahl, P

1999-01-01

To evaluate the influence of blood flow on measurements of regional sympathetic nerve activity by radiotracer methodology ([3H]noradrenaline). Ten healthy men were studied under two conditions of elevated forearm blood flow: mental stress (Stroop colour word conflict test) and an intra-arterial infusion of sodium nitroprusside. Arterial blood pressure was measured invasively and forearm blood flow with strain-gauge plethysmography. Arterial and venous plasma adrenaline and noradrenaline were measured with high-performance liquid chromatography, and regional and total noradrenaline spillover were calculated. During mental stress, mean arterial pressure increased by 17%, heart rate by 16 beats/min, forearm blood flow by 117%, while forearm vascular resistance decreased by 44% (P < 0.001 for all). Sodium nitroprusside increased forearm blood flow dose-dependently, but elicited only minor effects on systemic haemodynamics. Mental stress increased arterial plasma noradrenaline by 52% (P < 0.001), and total body noradrenaline spillover by 75% (P < 0.001). During sodium nitroprusside infusion, arterial plasma noradrenaline increased only slightly and total body noradrenaline spillover was unaffected Forearm noradrenaline overflow increased from 5.4 +/- 0.9 to 16.9 +/- 2.6 pmol/min per I (P < 0.001) during mental stress and from 6.6 +/- 0.8 to 16.9 +/- 3.7 pmol/min per I (P < 0.001) during the second dose-step of sodium nitroprusside infusion. By intra-individual comparisons of forearm noradrenaline overflow increases during mental stress and during sodium nitroprusside infusion, with similar forearm blood flow increases, the flow dependence of forearm noradrenaline overflow was estimated. During mental stress, about 60% (median value, range 29-112%) of the increase in forearm noradrenaline overflow was attributed to the increase in forearm blood flow, whereas 40% was considered to reflect increased sympathetic nerve activity. There seems to be a considerable flow dependence of the regional overflow of noradrenaline, that is, a component of simple wash-out of noradrenaline from the forearm tissues during vasodilation. However, the present results still indicate that sympathetic nerve activity in the forearm is increased during mental stress, justifying the radiotracer technique for semiquantitative measurements, also during vasodilation.

Multiple forearm robotic elbow configuration

DOEpatents

Fisher, John J.

1990-01-01

A dual forearmed robotic elbow configuration comprises a main arm having a double elbow from which two coplanar forearms depend, two actuators carried in the double elbow for moving the forearms, and separate, independent end effectors, operated by a cable carried from the main arm through the elbow, is attached to the distal end of each forearm. Coiling the cables around the actuators prevents bending or kinking when the forearms are rotated 360 degrees. The end effectors can have similar or different capabilities. Actuator cannisters within the dual elbow are modular for rapid replacement or maintenance. Coarse and fine resolver transducers within the actuators provide accurate position referencing information.

Passive stiffness of coupled wrist and forearm rotations.

PubMed

Drake, Will B; Charles, Steven K

2014-09-01

Coordinated movement requires that the neuromuscular system account and compensate for movement dynamics. One particularly complex aspect of movement dynamics is the interaction that occurs between degrees of freedom (DOF), which may be caused by inertia, damping, and/or stiffness. During wrist rotations, the two DOF of the wrist (flexion-extension and radial-ulnar deviation, FE and RUD) are coupled through interaction torques arising from passive joint stiffness. One important unanswered question is whether the DOF of the forearm (pronation-supination, PS) is coupled to the two DOF of the wrist. Answering this question, and understanding the dynamics of wrist and forearm rotations in general, requires knowledge of the stiffness encountered during rotations involving all three DOF (PS, FE, and RUD). Here we present the first-ever measurement of the passive stiffness encountered during simultaneous wrist and forearm rotations. Using a wrist and forearm robot, we measured coupled wrist and forearm stiffness in 10 subjects and present it as a 3-by-3 stiffness matrix. This measurement of passive wrist and forearm stiffness will enable future studies investigating the dynamics of wrist and forearm rotations, exposing the dynamics for which the neuromuscular system must plan and compensate during movements involving the wrist and forearm.

Kinesthetic perceptions of earth- and body-fixed axes.

PubMed

Darling, W G; Hondzinski, J M

1999-06-01

The major purpose of this research was to determine whether kinesthetic/proprioceptive perceptions of the earth-fixed vertical axis are more accurate than perceptions of intrinsic axes. In one experiment, accuracy of alignment of the forearm to earth-fixed vertical and head- and trunk-longitudinal axes by seven blindfolded subjects was compared in four tasks: (1) Earth-Arm--arm (humerus) orientation was manipulated by the experimenter; subjects aligned the forearm parallel to the vertical axis, which was also aligned with the head and trunk longitudinal axis; (2) Head--head, trunk, and upper-limb orientations were manipulated by the experimenter, subjects aligned the forearm parallel to the longitudinal axis of the head using only elbow flexion/extension and shoulder internal/external rotation; (3) Trunk--same as (2), except that subjects aligned the forearm parallel to the trunk-longitudinal axis; (4) Earth--same as (2), except that subjects aligned the forearm parallel to the earth-fixed vertical. Head, trunk, and gravitational axes were never parallel in tasks 2, 3, and 4 so that subjects could not simultaneously match their forearm to all three axes. The results showed that the errors for alignment of the forearm with the earth-fixed vertical were lower than for the trunk- and head-longitudinal axes. Furthermore, errors in the Earth condition were less dependent on alterations of the head and trunk orientation than in the Head and Trunk conditions. These data strongly suggest that the earth-fixed vertical is used as one axis for the kinesthetic sensory coordinate system that specifies upper-limb orientation at the perceptual level. We also examined the effects of varying gravitational torques at the elbow and shoulder on the accuracy of forearm alignment to earth-fixed axes. Adding a 450 g load to the forearm to increase gravitational torques when the forearm is not vertical did not improve the accuracy of forearm alignment with the vertical. Furthermore, adding small, variably sized loads (between which the subjects could not distinguish at the perceptual level) to the forearm just proximal to the wrist produced similar errors in aligning the forearm with the vertical and horizontal. Forearm-positioning errors were not correlated with the size of the load, as would be expected if gravitational torques affected forearm-position sense. We conclude that gravitational torques exerted about the shoulder and elbow do not make significant contributions to sensing forearm-orientation relative to earth-fixed axes when the upper-limb segments are not constrained by external supports.

Blood pressure measurement in obese patients: comparison between upper arm and forearm measurements.

PubMed

Pierin, Angela M G; Alavarce, Débora C; Gusmão, Josiane L; Halpern, Alfredo; Mion, Décio

2004-06-01

It is well known that blood pressure measurement with a standard 12-13 cm wide cuff is erroneous for large arms. To compare arm blood pressure measurements with an appropriate cuff and forearm blood pressure measurements (BPM) with a standard cuff, and both measurements by the Photopletismography (Finapres) method. One hundred and twenty-nine obese patients were studied (body mass index=40+/-7 kg/m2). The patients had three arm BPM taken by an automatic oscillometric device using an appropriate cuff and three forearm BPM with a standard cuff in the sitting position after a five-minute rest. Data were analysed by the analysis of variance. The correction values were obtained by the linear regression test. Systolic and diastolic arm BPM with an appropriate cuff were significantly lower (p<0.05) than forearm BPM with a standard cuff. The measurements obtained by Finapres were significantly lower (p<0.05) than those found for forearm systolic and diastolic blood pressures and upper arm diastolic blood pressure. The equation to correct BPM in forearm in obese patients with arm circumference between 32-44 cm was: systolic BPM=33.2+/-0.68 x systolic forearm BPM, and diastolic BPM=25.2+0.59 x forearm diastolic BPM. This study showed that forearm blood pressure measurement overestimates the values of arm blood pressure measurement. In addition, it is possible to correct forearm BPM with an equation.

Squared ligament of the elbow: anatomy and contribution to forearm stability.

PubMed

Otayek, Salma; Tayeb, Abd-el-Kader Ait; Assabah, Bouchra; Viard, Brice; Dayan, Romain; Lazure, Thierry; Soubeyrand, Marc

2016-03-01

The present study describes the macroscopic and microscopic features of the squared ligament of the elbow (SLE). In addition, the SLE biomechanical behavior and contribution to the forearm stability were also examined. Ten forearms from freshly frozen cadavers were used for this work. Each forearm was mounted in an experimental frame for quantification of longitudinal and transverse stability. Macroscopic features and biomechanical behavior were analyzed on dynamic videos obtained during forearm rotation. Then, the SLE was harvested from the 10 forearms for microscopic analysis on histological slices stained with hematoxylin-eosin-saffron. Two main SLE configurations were identified. One in which the SLE had three distinct bundles (anterior, middle, posterior) and another in which it was homogeneous. The anterior part of the SLE had a mean length of 11.2 mm (±2.4 mm) and a mean width of 1.2 mm (±0.2 mm) while the posterior part had a mean length of 9.9 mm (±2.2 mm) and a mean width of 1 mm (±0.2 mm). Microscopic examination showed that the SLE is composed of a thin layer of arranged collagen fibers. During forearm rotation, the SLE progressively tightens upon pronation and supination by wrapping around the radial neck. Tightening of the SLE during forearm rotation provides transverse and longitudinal stability to the forearm, mainly in maximal pronation and supination. The SLE is a true ligament and provides forearm stability when it is stretched in pronation and supination.

Comparison of forearm and upper arm blood pressures.

PubMed

Singer, A J; Kahn, S R; Thode, H C; Hollander, J E

1999-01-01

In the prehospital setting it is not always feasible to obtain blood pressure (BP) readings from the upper arm. This study was performed to compare BPs obtained from subjects' forearms and upper arms in order to assess the utility of forearm BP as a surrogate for standard BP. The authors performed a prospective, cross-sectional, convenience study in a sample of ambulatory university ED patients, where each subject had sequential determinations of left upper arm and forearm BPs with an automated monitor at ED triage. The order of measurement was determined by the day of the week. Demographic and clinical data were also recorded. The main outcome measure was the correlation between upper arm and forearm systolic and diastolic BPs. Pearson's correlation coefficient and Student's t-test were used to analyze the data. 151 patients were enrolled. The mean age was 35.3+/-15.7 years; 40% were female and 78% were white. The mean forearm and upper arm systolic BPs were 129.8+/-20.7 mm Hg and 126.2+/-17.6 mm Hg (p = 0.002). The mean forearm and upper arm diastolic BPs were 80.7+/-14.5 mm Hg and 76.8+/-13.4 mm Hg (p<0.001). The correlations between forearm and upper arm systolic and diastolic BPs were 0.75 (p<0.001) and 0.72 (p<0.001). The differences between forearm and upper arm systolic and diastolic BPs were within 20 mm Hg in 86% and 94% of patients, respectively. Forearm BP is a fairly good predictor of standard upper arm BP in most patients. Forearm BP may be used when measurement of upper arm BP is not feasible.

Oral vitamin C enhances the adrenergic vasoconstrictor response to local cooling in human skin.

PubMed

Yamazaki, Fumio

2012-05-01

Local administration of ascorbic acid (Asc) at a supraphysiological concentration inhibits the cutaneous vasoconstrictor response to local cooling (LC). However, whether orally ingesting Asc inhibits the LC-induced vasoconstrictor response remains unknown. The purpose of the present study was to examine the acute influence of oral Asc on the adrenergic vasoconstrictor response to LC in human skin. In experiment 1, skin blood flow (SkBF) was measured by laser-Doppler flowmetry at three sites (forearm, calf, palm). The three skin sites were locally cooled from 34 to 24°C at -1°C/min and maintained at 24°C for 20 min before (Pre) and 1.5 h after (Post) oral Asc (2-g single dose) or placebo supplementation. Cutaneous vascular conductance (CVC) was calculated as the ratio of SkBF to blood pressure and expressed relative to the baseline value before LC. Oral Asc enhanced (P < 0.05) the reductions in CVC in the forearm (Pre, -50.3 ± 3.3%; Post, -57.8 ± 2.2%), calf (Pre, -52.6 ± 3.7%; Post, -66.1 ± 4.3%), and palm (Pre, -46.2 ± 6.2%; Post, -60.4 ± 5.6%) during LC. The placebo did not change the responses at any site. In experiment 2, to examine whether the increased vasoconstrictor response caused by oral Asc is due to the adrenergic system, the release of neurotransmitters from adrenergic nerves in forearm skin was blocked locally by iontophoresis of bretylium tosylate (BT). Oral Asc enhanced (P < 0.05) the reductions in CVC at untreated control sites but did not change the responses at BT-treated sites during LC. In experiment 3, to further examine whether adrenergically mediated vasoconstriction is enhanced by oral Asc, 0.1 mM tyramine was administered using intradermal microdialysis in the forearm skin at 34°C in the Pre and Post periods. Oral Asc increased (P < 0.05) the tyramine-induced reduction in CVC. These findings suggest that oral Asc acutely enhances the cutaneous vasoconstrictor responses to LC through the modification of adrenergic sympathetic mechanisms.

Level of Agreement Between Forearm and Upper Arm Blood Pressure Measurements in Patients With Large Arm Circumference.

PubMed

Watson, Sheri; Aguas, Marita; Colegrove, Pat; Foisy, Nancy; Jondahl, Bonnie; Anastas, Zoe

2017-02-01

The purpose of the study was to determine if forearm blood pressures (BPs) measured in three different locations agree with the recommended upper arm location for noninvasive BP measurement. A method-comparison design was used. In a convenience sample of postanesthesia care unit patients with large upper arm circumference, BP's were obtained in three different forearm locations (lower forearm, middle forearm, and upper forearm) and compared to upper arm BP using an automated BP measuring device. The level of agreement (bias ± precision) between each forearm location and the upper arm BP was calculated using standard formulas. Acceptable levels of agreement based on expert opinion were set a priori at bias and precision values of less than ±5 mm Hg (bias) and ±8 mm Hg (precision). Forty-eight postanesthesia patients participated in the study. Bias and precision values were found to exceed the acceptable level of agreement for all but one of the systolic and diastolic BP comparisons in the three forearm BP locations. Fifty-six percent of all patients studied had one or more BP difference of at least 10 mm Hg in each of the three forearm locations, with 10% having one or more differences of at least 20 mm Hg. The differences in forearm BP measurements observed in this study indicate that the clinical practice of using a forearm BP with a regular-sized BP cuff in place of a larger sized BP cuff placed on the upper arm in postanesthesia care unit patients with large arm circumferences is inappropriate. The BPs obtained at the forearm location are not equivalent to the BPs obtained at the upper arm location. Copyright © 2015 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Spatial and physical frames of reference in positioning a limb.

PubMed

Garrett, S R; Pagano, C; Austin, G; Turvey, M T

1998-10-01

Splints attached to the right forearm were used to rotate the forearm's physical reference frame, as defined by the eigenvectors of its inertia tensor, relative to its spatial reference frame. In two experiments, when subjects were required to orient the forearm parallel to, or at 45 degrees to, the environmental horizontal, they produced limb orientations that were systematically deflected from the forearm's longitudinal spatial axis in the direction of the forearm's physical axes. The position sense seems to be based on inertial eigenvectors rather than on joint angles or gravitational torques.

Dexmedetomidine as an adjuvant to 0.5% ropivacaine in ultrasound-guided axillary brachial plexus block.

PubMed

Koraki, E; Stachtari, C; Kapsokalyvas, I; Stergiouda, Z; Katsanevaki, A; Trikoupi, A

2018-06-01

The aim of this study was to elucidate the effect of dexmedetomidine added to ropivacaine on the onset and duration of sensory and motor block and duration of analgesia of ultrasound-guided axillary brachial plexus block. Thirty-seven ASA physical status I-II patients with elective forearm and hand surgery under ultrasound-guided axillary brachial plexus block were randomly divided into 2 groups. Patients in ropivacaine-dexmedetomidine group (group RD, n = 19) received 15 mL of 0.5% ropivacaine with 100 μg (1 mL) dexmedetomidine, and patients in ropivacaine group (group R, n = 18) received 15 mL of 0.5% ropivacaine with 1 mL of normal saline. Onset time and duration of sensory and motor block and duration of analgesia were assessed. Duration of sensory block (U-value = 35, P < .001), duration of motor block (P = .001) and duration of analgesia (P < .001) were extended in group RD compared to group R. Onset time of sensory block in group RD was significantly faster than in group R (U-value = 65.5, P = .001). Onset time of motor block showed no significant difference between the 2 groups (U-value = 116.5, P = .096). Adverse reactions were reported only in group RD (bradycardia in 2 and hypotension in 3 patients). Our study indicated that dexmedetomidine 100 μg as adjuvant on ultrasound-guided axillary plexus block significantly prolonged the duration of sensory block and analgesia, as well as accelerated the time to onset of sensory block. These results should be weighed against the increased risks of motor block prolongation, transient bradycardia and hypotension and allow for attentive optimism, only if prolonged clinical trials provide a definitive answer. © 2017 John Wiley & Sons Ltd.

Forearm training attenuates sympathetic responses to prolonged rhythmic forearm exercise

NASA Technical Reports Server (NTRS)

Sinoway, L.; Shenberger, J.; Leaman, G.; Zelis, R.; Gray, K.; Baily, R.; Leuenberger, U.

1996-01-01

We previously demonstrated that nonfatiguing rhythmic forearm exercise at 25% maximal voluntary contraction (12 2-s contractions/min) evokes sympathoexcitation without significant engagement of metabolite-sensitive muscle afferents (B.A. Batman, J.C. Hardy, U.A. Leuenberger, M.B. Smith, Q.X. Yang and L.I. Sinoway. J. Appl. Physiol. 76: 1077-1081, 1994). This is in contrast to the sympathetic nervous system responses observed during fatiguing static forearm exercise where metabolite-sensitive afferents are the key determinants of sympathetic activation. In this report we examined whether forearm exercise training would attenuate sympathetic nervous system responses to rhythmic forearm exercise. We measured heart rate, mean arterial blood pressure (MAP), muscle sympathetic nerve activity (microneurography), plasma norepinephrine (NE), and NE spillover and clearance (tritiated NE kinetics) during nonfatiguing rhythmic forearm exercise before and after a 4-wk unilateral forearm training paradigm. Training had no effect on forearm mass, maximal voluntary contraction, or heart rate but did attenuate the increase in MAP (increase in MAP: from 15.2 +/- 1.8 before training to 11.4 +/- 1.4 mmHg after training; P < 0.017), muscle sympathetic nerve activity (increase in bursts: from 10.8 +/- 1.4 before training to 6.2 +/- 1.1 bursts/min after training; P < 0.030), and the NE spillover (increases in arterial spillover: from 1.3 +/- 0.2 before training to 0.6 +/- 0.2 nmol.min-1.m-2 after training, P < 0.014; increase in venous spillover: from 2.0 +/- 0.6 before training to 1.0 +/- 0.5 nmol.min-1.m-2 after training, P < 0.037) seen in response to exercise performed by the trained forearm. Thus forearm training reduces sympathetic responses during a nonfatiguing rhythmic handgrip paradigm that does not engage muscle metaboreceptors. We speculate that this effect is due to a conditioning-induced reduction in mechanically sensitive muscle afferent discharge.

In vivo gliding and contact characteristics of the sigmoid notch and the ulna in forearm rotation.

PubMed

Chen, Yan Rong; Tang, Jin Bo

2013-08-01

To investigate shifting of the contact center over the surfaces of 2 opposing bones of the distal radioulnar joint during forearm rotation. We recruited 8 volunteers and used their right wrists. Serial computed tomography scans were obtained with the forearm at neutral position and 6 other positions of forearm rotation. We reconstructed 3-dimensional images and mapped contact regions of both the sigmoid notch and ulnar head by calculating the shortest distance between the 2 opposing bones. The center of contact was also defined and plotted against the distal radioulnar joint rotation to determine the sliding distance over the surfaces of the 2 bones. During forearm rotation, the maximal sliding of the sigmoid notch over the ulnar head was 7.4 mm in forearm pronation and 9.2 mm in forearm supination, which occurred in volar-dorsal direction primarily. Sliding of the ulnar head over the sigmoid notch was more limited, measuring 4.7 mm during pronation and 2.3 mm during supination. Most of the motion occurred between 30° pronation and 60° supination. In the proximal-distal direction, the contact site of the sigmoid notch with the ulnar head translated distally 1.6 mm during pronation and proximally 0.7 mm during supination. During forearm rotation, the sigmoid notch slides substantially against the ulnar head at each part of the forearm rotation arc. The sliding of the ulnar head over the sigmoid notch is smaller, most of which is at the range from moderate forearm pronation to slight supination. The contact site of the sigmoid notch with the ulnar head moves slightly distally during forearm pronation and proximally during supination. The in vivo findings provide more detailed information and insight into distal radioulnar joint motion kinematics. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Forearm Torque and Lifting Strength: Normative Data.

PubMed

Axelsson, Peter; Fredrikson, Per; Nilsson, Anders; Andersson, Jonny K; Kärrholm, Johan

2018-02-10

To establish reference values for new methods designed to quantitatively measure forearm torque and lifting strength and to compare these values with grip strength. A total of 499 volunteers, 262 males and 237 females, aged 15 to 85 (mean, 44) years, were tested for lifting strength and forearm torque with the Kern and Baseline dynamometers. These individuals were also tested for grip strength with a Jamar dynamometer. Standardized procedures were used and information about sex, height, weight, hand dominance, and whether their work involved high or low manual strain was collected. Men had approximately 70% higher forearm torque and lifting strength compared with females. Male subjects aged 26 to 35 years and female subjects aged 36 to 45 years showed highest strength values. In patients with dominant right side, 61% to 78% had a higher or equal strength on this side in the different tests performed. In patients with dominant left side, the corresponding proportions varied between 41% and 65%. There was a high correlation between grip strength and forearm torque and lifting strength. Sex, body height, body weight, and age showed a significant correlation to the strength measurements. In a multiple regression model sex, age (entered as linear and squared) could explain 51% to 63% of the total variances of forearm torque strength and 30% to 36% of lifting strength. Reference values for lifting strength and forearm torque to be used in clinical practice were acquired. Grip strength has a high correlation to forearm torque and lifting strength. Sex, age, and height can be used to predict forearm torque and lifting strength. Prediction equations using these variables were generated. Normative data of forearm torque and lifting strength might improve the quality of assessment of wrist and forearm disorders as well as their treatments. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Thalamic pain alleviated by stellate ganglion block: A case report.

PubMed

Liao, Chenlong; Yang, Min; Liu, Pengfei; Zhong, Wenxiang; Zhang, Wenchuan

2017-02-01

Thalamic pain is a distressing and treatment-resistant type of central post-stroke pain. Although stellate ganglion block is an established intervention used in pain management, its use in the treatment of thalamic pain has never been reported. A 66-year-old woman presented with a 3-year history of severe intermittent lancinating pain on the right side of the face and the right hand. The pain started from the ulnar side of the right forearm after a mild ischemic stroke in bilateral basal ganglia and left thalamus. Weeks later, the pain extended to the dorsum of the finger tips and the whole palmar surface, becoming more severe. Meanwhile, there was also pain with similar characteristics emerging on her right face, resembling atypical trigeminal neuralgia. Thalamic pain was diagnosed. After refusing the further invasive treatment, she was suggested to try stellate ganglion block. After a 3-day period of pain free (numerical rating scale: 0) postoperatively, she reported moderate to good pain relief with a numerical rating scale of about 3 to 4 lasting 1 month after the first injection. Pain as well as the quality of life was markedly improved with less dose of analgesic agents. Stellate ganglion block may be an optional treatment for thalamic pain.

Interosseous Ligament and Transverse Forearm Stability: A Biomechanical Cadaver Study.

PubMed

Gutowski, Christina J; Darvish, Kurosh; Ilyas, Asif M; Jones, Christopher M

2017-02-01

The interosseous ligament (IOL) is known to be an important longitudinal stabilizer of the forearm. We hypothesize that it may also contribute to transverse stability, with pronosupination tensioning of the radius relative to the ulna. Therefore, when injured, we predict the interosseous space should widen in the transverse plane, enough to be appreciable on plain radiographs. A measurable difference in interosseous space, comparing an injured with an uninjured forearm, can potentially be of diagnostic and clinical value. Ten fresh-frozen cadaver arms (from 5 individuals) were radiographed in 6 different positions of forearm supination, first in an uninjured state and then with the IOL sectioned, both partially (central band only) and completely. The transverse interosseous distance was measured on radiographs using edge detection software and compared using analysis of variance and contrast analysis. The maximum range of pronosupination was also compared before and after injury, using a paired t test. Average maximum supination increased from 84° to 106°, and pronation from 69° to 84°, after the IOL was sectioned completely. Sectioning of the IOL led to a statistically significant increase in the interosseous distance, a minimum of 2 mm, in all but one forearm position. The IOL of the forearm plays an important role in providing transverse stability to the radius and ulna. When the IOL is sectioned, the forearm exhibits increased pronosupination range of motion. Radiographs of bilateral forearms taken in identical rotational position can reliably differentiate between an intact and torn IOL in cadavers. The IOL's stabilizing role during forearm rotation suggests a novel strategy for diagnosing forearm IOL injury using comparative radiographic measurements. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Effects of the forearm support band on wrist extensor muscle fatigue.

PubMed

Knebel, P T; Avery, D W; Gebhardt, T L; Koppenhaver, S L; Allison, S C; Bryan, J M; Kelly, A

1999-11-01

A crossover experimental design with repeated measures. To determine whether the forearm support band alters wrist extensor muscle fatigue. Fatigue of the wrist extensor muscles is thought to be a contributing factor in the development of lateral epicondylitis. The forearm support band is purported to reduce or prevent symptoms of lateral epicondylitis but the mechanism of action is unknown. Fifty unimpaired subjects (36 men, 14 women; mean age = 29 +/- 6 years) were tested with and without a forearm support band before and after a fatiguing bout of exercise. Peak wrist extension isometric force, peak isometric grip force, and median power spectral frequency for wrist extensor electromyographic activity were measured before and after exercise and with and without the forearm support band. A 2 x 2 repeated measures multivariate analysis of variance was used to analyze the data, followed by univariate analysis of variance and Tukey's multiple comparison tests. Peak wrist extension isometric force, peak grip isometric force, and median power spectral frequency were all reduced after exercise. However, there was a significant reduction in peak grip isometric force and peak wrist extension isometric force values for the with-forearm support band condition (grip force 28%, wrist extension force 26%) compared to the without-forearm support band condition (grip force 18%, wrist extension force 15%). Wearing the forearm support band increased the rate of fatigue in unimpaired individuals. Our findings do not support the premise that wearing the forearm support band reduces muscle fatigue in the wrist extensors.

In vivo three-dimensional elbow biomechanics during forearm rotation.

PubMed

Omori, Shinsuke; Miyake, Junichi; Oka, Kunihiro; Tanaka, Hiroyuki; Yoshikawa, Hideki; Murase, Tsuyoshi

2016-01-01

It is unclear how elbow kinematics changes during forearm rotation. This study investigated in vivo 3-dimensional elbow kinematics during forearm rotation. We studied 12 normal elbows using in vivo 3-dimensional computed tomography data in maximum forearm supination, neutral, and maximum pronation with the elbows in extension. We measured the motion of the radius and ulna relative to the humerus using a markerless bone registration technique and the contact area of the radiocapitellar joint, proximal radioulnar joint, and ulnohumeral joint using a proximity mapping method. When the forearm rotated from the supinated position to the pronated position, the radius showed significant varus rotation, internal rotation, and extension relative to the humerus. The center of the radial head significantly translated anteriorly, proximally, and laterally. The ulna significantly rotated in valgus, and the deepest point on the sagittal ridge of the trochlear notch translated medially with forearm pronation. The contact area of the radiocapitellar joint was largest in pronation. The contact area of the proximal radioulnar joint was largest in supination. The contact area of the ulnohumeral joint showed no significant change during forearm rotation. In pronation, because of the proximal migration of the radial head, the radiocapitellar joint was most congruent compared with other positions. The proximal radioulnar joint was most congruent in supination. The ulnohumeral joint congruency was not affected by forearm rotation. This study provides useful information for understanding 3-dimensional elbow motion and joint osseous stability related to forearm rotation. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Within arm's reach: Measuring forearm length to assess growth patterns in captive bonobos and chimpanzees.

PubMed

Behringer, Verena; Stevens, Jeroen M G; Kivell, Tracy L; Neufuss, Johanna; Boesch, Christophe; Hohmann, Gottfried

2016-09-01

Bonobos and chimpanzees are known to differ in various morphological traits, a dichotomy that is sometimes used as an analogy for evolutionary splits during human evolution. The aim of our study was to measure the forearm length of immature and adult bonobos and adult chimpanzees to assess the extent of age-related changes of forearm length in bonobos and sex-dimorphism in bonobos and chimpanzees. As a proxy of somatic growth we measured forearm length of captive bonobos and chimpanzees ranging in age from 1 to 55 years. Measures were taken from subjects inserting their arms into a transparent Plexiglas® tube, a novel technique facilitating repeated measures of nonanesthetized apes in captivity. Measures from adult females (>12 years) showed that bonobos exceed chimpanzees in terms of forearm length and that sexual dimorphism in forearm length is pronounced in chimpanzees, but not in bonobos. Forearm length increased significantly with chronological age in bonobos. Validation tests revealed that the device generates useful data on morphometric dimensions. In most primates, sexual dimorphism in body size is male-biased and the differences in forearm length in chimpanzees follow this trend. Given that males of the two species did not differ in forearm length, the absence/presence of sexual dimorphism of this trait must be due to differences in somatic growth in females. Our novel method offers an alternative to obtain morphometric measures and facilitates longitudinal studies on somatic growth. Am J Phys Anthropol 161:37-43, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Clinical comparison of automatic, noninvasive measurements of blood pressure in the forearm and upper arm.

PubMed

Schell, Kathleen; Bradley, Elisabeth; Bucher, Linda; Seckel, Maureen; Lyons, Denise; Wakai, Sandra; Bartell, Deborah; Carson, Elizabeth; Chichester, Melanie; Foraker, Teresa; Simpson, Kathleen

2005-05-01

When the upper arm (area from shoulder to elbow) is inaccessible and/or a standard-sized blood pressure cuff does not fit, some healthcare workers use the forearm to measure blood pressure. To compare automatic noninvasive measurements of blood pressure in the upper arm and forearm. A descriptive, correlational comparison study was conducted in the emergency department of a 1071-bed teaching hospital. Subjects were 204 English-speaking patients 6 to 91 years old in medically stable condition who had entered the department on foot or by wheelchair and who had no exclusions to using their left upper extremity. A Welch Allyn Vital Signs 420 series monitor was used to measure blood pressure in the left upper arm and forearm with the subject seated and the upper arm or forearm at heart level. Pearson r correlation coefficients between measurements in the upper arm and forearm were 0.88 for systolic blood pressure and 0.76 for diastolic blood pressure (P < .001 for both). Mean systolic pressures, but not mean diastolic pressures, in the upper arm and forearm differed significantly (t = 2.07, P = .04). A Bland-Altman analysis indicated that the distances between the mean values and the limits of agreement for the 2 sites ranged from 15 mm Hg (mean arterial pressure) to 18.4 mm Hg (systolic pressure). Despite strict attention to correct cuff size and placement of the upper arm or forearm at heart level, measurements of blood pressure obtained noninvasively in the arm and forearm of seated patients in stable condition are not interchangeable.

Tissue temperature profile in the human forearm during thermal stress at thermal stability.

PubMed

Ducharme, M B; VanHelder, W P; Radomski, M W

1991-11-01

The purpose of the present study was to investigate the effect of a range of water temperatures (Tw from 15 to 36 degrees C) on the tissue temperature profile of the resting human forearm at thermal stability. Tissue temperature (Tti) was continuously monitored by a calibrated multicouple probe during 3 h of immersion of the forearm. The probe was implanted approximately 9 cm distal from the olecranon process along the ulnar ridge. Tti was measured every 5 mm, from the longitudinal axis of the forearm (determined from computed tomography scanning) to the skin surface. Along with Tti, skin temperature (Tsk), rectal temperature (Tre), and blood flow were measured during the immersions. For all temperature conditions, the temperature profile inside the limb was linear as a function of the radial distance from the forearm axis (P less than 0.001). Temperature gradient measured in the forearm ranged from 0.2 +/- 0.1 degrees C C cm (Tw = 36 degrees C) to 2.3 +/- 0.5 degrees C cm (Tw = 15 degrees C). The maximal Tti was measured in all cases at the longitudinal axis of the forearm and was in all experimental conditions lower than Tre. On immersion at Tw less than 36 degrees C, the whole forearm can be considered to be part of the shell of the body. With these experimental data, mathematical equations were developed to predict, with an accuracy of at least 0.6 degrees C, the Tti at any depth inside the forearm at steady state during thermal stress.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term results of forearm lengthening and deformity correction by the Ilizarov method.

PubMed

Orzechowski, Wiktor; Morasiewicz, Leszek; Krawczyk, Artur; Dragan, Szymon; Czapiński, Jacek

2002-06-30

Background. Shortening and deformity of the forearm is most frequently caused by congenital disorders or posttraumatic injury. Given its complex anatomy and biomechanics, the forearm is clearly the most difficult segment for lengthening and deformity correction.
Material and methods. We analyzed 16 patients with shortening and deformity of the forearm, treated surgically, using the Ilizarov method in our Department from 1989 to 2001. in 9 cases 1-stage surgery was sufficient, while the remaining 7 patients underwent 2-5 stages of treatment. At total of 31 surgical operations were performed. The extent of forearm shortening ranged from 1,5 to 14,5 cm (5-70%). We development a new fixator based on Schanz half-pins.
Results. The length of forearm lengthening per operative stage averaged 2,35 cm. the proportion of lengthening ranged from 6% to 48% with an average of 18,3%. The mean lengthening index was 48,15 days/cm. the per-patient rate of complications was 88% compared 45% per stage of treatment, mostly limited rotational mobility and abnormal consolidation of regenerated bone.
Conclusions. Despite the high complication rate, the Ilizarov method is the method of choice for patients with forearm shortenings and deformities. Treatment is particularly indicated in patients with shortening caused by disproportionate length of the ulnar and forearm bones. Treatment should be managed so as cause the least possible damage to arm function, even at the cost of limited lengthening. Our new stabilizer based on Schanz half-pins makes it possible to preserve forearm rotation.

The Effect of Supination and Pronation on Wrist Range of Motion

PubMed Central

Kane, Patrick M.; Vopat, Bryan G.; Got, Christopher; Mansuripur, Kaveh; Akelman, Edward

2014-01-01

Wrist range of motion (ROM) is a combination of complex osseous articulations and intricate soft tissue constraints. It has been proposed that forearm rotation contributes significantly to carpal kinematics. However, no studies have investigated whether supination or pronation influence this course of motion. The purpose of this study is to examine whether supination and pronation affect the mechanical axis of the wrist. After being screened for gross anatomic abnormalities, six upper extremity cadaver specimens (three matched pairs) were fixed to a custom-designed jig that allows 24 different directions of wrist motion. Each specimen was tested in three separate forearm positions: neutral, full supination, and full pronation. Moments of ± 2 Nm were applied, and the applied moment versus wrist rotation data were recorded. Forearm position did not significantly (p > 0.31) affect the ROM values of the wrist. In forearm neutral, supination, and pronation positions the envelope of wrist ROM values was ellipsoidal in shape, consistent with prior neutral forearm biomechanical testing. The major axis of the ellipse was oriented in a radial extension to ulnar flexion direction, with the largest ROM in ulnar flexion. We hypothesized that forearm position would influence wrist ROM. However, our biomechanical testing showed no statistically significant difference in the orientation of the mechanical axis nor the passive ROM of the wrist. The primary passive mechanical axis in all three forearm positions tested (neutral, supination, and pronation) was aligned with radial extension and ulnar flexion. Although it has been shown that forearm position affects various radioulnar, radiocarpal, and ulnocarpal ligamentous tensions and lengths, it appears that wrist ROM is independent of forearm position. Consequently we feel our biomechanical testing illustrates that wrist ROM is primarily dependent on the osseous articulations of the carpus. Additionally, given that no change is observed in wrist ROM relative to forearm position, the significance of the contribution of the distal radioulnar joint (DRUJ) to wrist kinematics is debatable. PMID:25097812

Epidemiology of forearm fractures in adults in Denmark: national age- and gender-specific incidence rates, ratio of forearm to hip fractures, and extent of surgical fracture repair in inpatients and outpatients.

PubMed

Abrahamsen, B; Jørgensen, N R; Schwarz, P

2015-01-01

National epidemiological studies of forearm fractures are scarce. We examined in- and outpatient rates in Denmark, including anatomical location, surgery, hospitalization ratio, recurrent fractures, and ratio of forearm to hip fractures. This may be useful for triangulation in countries with less detailed information. Rates were higher than previously estimated. Despite a significant contribution to the overall burden of osteoporotic, nonvertebral fractures, relatively little information is available about age- and gender-specific incidence rates for many countries including Denmark. We used national individual patient data on inpatient and outpatient treatment to calculate rates of forearm fractures, taking readmissions into account, with subtables for distal and proximal fractures. We also calculated ratios of forearm to hip fractures that may be useful when imputing forearm fracture rates from other administrative sources. In addition, we report the rates of hospital admission and the rates of surgical treatment, allowing readers to extrapolate from the number of admissions or surgical procedures to incidence rates, should their data sources be less comprehensive. Forearm fracture rates were 278 per 100,000 patient years in men aged 50+ and 1,110 per 100,000 in women aged 50+. The female to male incidence rate ratio was 4.0 for the age group 50+ but close to unity in persons aged 40 or under. Two thirds of patients were treated on an outpatient basis with little difference across age and gender strata. Four out of five fractures were treated conservatively. The rate of forearm fractures in Denmark was somewhat higher in both genders than recently imputed from hip fracture rates and were close to the rates previously reported in studies from Norway and Sweden. The rates of forearm fracture in Denmark are higher than previously estimated and very similar to the high risk reported from studies in Norway and Sweden.

[Homolateral Monteggia and Galeazzi fractures: a case report and review of the literature].

PubMed

Kanso, I; Tawil, H J; Lignac, F

2002-05-01

We report a very rare case of Monteggia and Galeazzi fractures of the same forearm in a 23-year-old female traffic accident victim. Fractures of the two forearm bones were reduced and fixed with a solid assembly. Dislocation of the radial head reduced spontaneously. Inferior radioulnar instability was treated by blocking the joint with a K wire for one month. At 24 months, outcome was satisfactory with 40 degrees pronation and 70 degrees supination. Elbow and wrist flexion-extension and muscle force were the same as on the healthy side. Surgery is indicated in this rare association in adults. As it is very important to restore exactly the anatomy with solid fixation of the ulna to achieve and maintain reduction of the radial head. Surgical exploration of the humeroradial joint is not required unless reduction cannot be achieved. The same is true for fixation of the radius after Galeazzi fracture. If an inferior radioulnar instability persists, we propose temporary stabilization with a K wire. Our experience with this case would argue against first intention resection of the distal portion of the ulna as proposed by Hughston. We prefer to postpone resection which would be performed only in case of bothersome instability. A Sauvé-Kapandji procedure would then be a possible solution.

Chronic inflammatory pure sensory polyradiculoneuropathy: a rare CIDP variant with unusual electrophysiology.

PubMed

Rajabally, Yusuf A; Wong, Siew L

2012-03-01

We describe a patient presenting with progressive upper limb numbness and sensory ataxia of the 4 limbs. Motor nerve conduction studies were completely normal. Sensory electrophysiology showed reduced/absent upper limb sensory action potentials (SAPs). In the lower limbs, SAPs were mostly normal. Sensory conduction velocities were normal. Forearm sensory conduction blocks were present for both median nerves on antidromic testing. The maximal recordable sural SAP was preserved in comparison to maximal recordable radial SAP, consistent with an "abnormal radial normal sural" pattern. Somatosensory evoked potentials were unrecordable for tibial and median nerves. Cerebrospinal fluid protein was raised (0.99 g/L). The patient worsened on oral corticosteroids but subsequently made substantial functional recovery on intravenous immunoglobulins. This case is different to those previously reported of sensory chronic inflammatory demyelinating polyradiculoneuropathy, given its exclusive sensory electrophysiologic presentation, presence of predominant upper limb reduced sensory amplitudes, and detection of sensory conduction blocks. These electrophysiologic features were of paramount importance in establishing diagnosis and effective therapy.

Minimum effective volume of mepivacaine for ultrasound-guided supraclavicular block

PubMed Central

Song, Jae Gyok; Kang, Bong Jin; Park, Kee Keun

2013-01-01

Background The aim of this study was to estimate the minimum effective volume (MEV) of 1.5% mepivacaine for ultrasound-guided supraclavicular block by placing the needle near the lower trunk of brachial plexus and multiple injections. Methods Thirty patients undergoing forearm and hand surgery received ultrasound-guided supraclavicular block with 1.5% mepivacaine. The initial volume of local anesthetic injected was 24 ml, and local anesthetic volume for the next patient was determined by the response of the previous patient. The next patient received a 3 ml higher volume in the case of the failure of the previous case. If the previous block was successful, the next volume was 3 ml lower. MEV was estimated by the Dixon and Massey up and down method. MEV in 95, 90, and 50% of patients (MEV95, MEV90, and MEV50) were calculated using probit transformation and logistic regression. Results MEV95 of 1.5% mepivacaine was 17 ml (95% confidence interval [CI], 13-42 ml), MEV90 was 15 ml (95% CI, 12-34 ml), and MEV50 was 9 ml (95% CI, 4-12 ml). Twelve patients had a failed block. Three patients received general anesthesia. Nine patients could undergo surgery with sedation only. Only one patient showed hemi-diaphragmatic paresis. Conclusions MEV95 was 17 ml, MEV90 was 15 ml, and MEV50 was 9 ml. However, needle location near the lower trunk of brachial plexus and multiple injections should be performed. PMID:23904937

Teaching Strategies for the Forearm Pass in Volleyball

ERIC Educational Resources Information Center

Casebolt, Kevin; Zhang, Peng; Brett, Christine

2014-01-01

This article shares teaching strategies for the forearm pass in the game of volleyball and identifies how they will help students improve their performance and development of forearm passing skills. The article also provides an assessment rubric to facilitate student understanding of the skill.

Comparison of Nerve Stimulation-guided Axillary Brachial Plexus Block, Single Injection versus Four Injections: A Prospective Randomized Double-blind Study.

PubMed

Badiger, Santoshi V; Desai, Sameer N

2017-01-01

A variety of techniques have been described for the axillary block using nerve stimulator, either with single injection, two, three, or four separate injections. Identification of all the four nerves is more difficult and time-consuming than other methods. Aim of the present study is to compare success rate, onset, and duration of sensory and motor anesthesia of axillary block using nerve stimulator, either with single injection after identification of any one of the four nerves or four separate injections following identification of each of nerve. Prospective, randomized, double-blind study. Patients undergoing forearm and hand surgeries under axillary block. One hundred patients, aged 18-75 years, were randomly allocated into two groups of 50 each. Axillary block was performed under the guidance of nerve stimulator with a mixture of 18 ml of 1.5% lignocaine and 18 ml of 0.5% bupivacaine. In the first group ( n = 50), all 36 ml of local anesthetic was injected after the identification of motor response to any one of the nerves and in Group 2, all the four nerves were identified by the motor response, and 9 ml of local anesthetic was injected at each of the nerves. The success rate of the block, onset, and duration of sensory and motor block was assessed. Categorical variables were compared using the Chi-square test, and continuous variables were compared using independent t -test. The success rate of the block with four injection technique was higher compared to single-injection technique (84% vs. 56%, P = 0.02). Four injection groups had a faster onset of sensory and motor block and prolonged duration of analgesia compared to single-injection group ( P < 0.001). There were no significant differences in the incidence of accidental arterial puncture and hemodynamic parameter between the groups. Identification of all the four nerves produced higher success rate and better quality of the block when compared to single-injection technique.

An electromyographic study of the effect of hand grip sizes on forearm muscle activity and golf performance.

PubMed

Sorbie, Graeme G; Hunter, Henry H; Grace, Fergal M; Gu, Yaodong; Baker, Julien S; Ugbolue, Ukadike Chris

2016-01-01

The study describes the differences in surface electromyography (EMG) activity of two forearm muscles in the lead and trail arm at specific phases of the golf swing using a 7-iron with three different grip sizes among amateur and professional golfers. Fifteen right-handed male golfers performed five golf swings using golf clubs with three different grip sizes. Surface EMG was used to measure muscle activity of the extensor carpi radialis brevis (ECRB) and flexor digitorum superficialis (FDS) on both forearms. There were no significant differences in forearm muscle activity when using the three golf grips within the group of 15 golfers (p > 0.05). When using the undersize grip, club head speed significantly increased (p = 0.044). During the backswing and downswing phases, amateurs produced significantly greater forearm muscle activity with all three grip sizes (p < 0.05). In conclusion, forearm muscle activity is not affected by grip sizes. However, club head speed increases when using undersize grips.

78 FR 36308 - Proposed Information Collection (Elbow and Forearm Conditions Disability Benefits Questionnaire...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-17

... and Forearm Conditions Disability Benefits Questionnaire) Activity: Comment Request AGENCY: Veterans... Questionnaire)'' in any correspondence. During the comment period, comments may be viewed online through the... INFORMATION: Title: Elbow and Forearm Conditions Disability Benefits Questionnaire, VA Form 21-0960M-4. OMB...

Effect of hexamethonium on the vascular response to noradrenaline in man

PubMed Central

Hodge, R. L.; Whelan, R. F.

1962-01-01

Intra-arterial infusion of hexamethonium into the brachial artery had no potentiating effect on the constrictor response of the vessels of the forearm or hand to noradrenaline given by the same route. The response of the hand vessels to intravenous infusion of noradrenaline was enhanced after intra-arterial hexamethonium, but this was attributed to entry of the blocking agent into the general circulation resulting in blockade of baroreceptor reflexes since the potentiation was seen to an equal degree on both sides. It is concluded that if increased sensitivity to noradrenaline plays a part in the phenomenon of tolerance to hexamethonium this must be a slowly developing effect. PMID:13907950

Free radial forearm adiposo-fascial flap for inferior maxillectomy defect reconstruction

PubMed Central

Thankappan, Krishnakumar; Trivedi, Nirav P.; Sharma, Mohit; Kuriakose, Moni A.; Iyer, Subramania

2009-01-01

A free radial forearm fascial flap has been described for intraoral reconstruction. Adiposo-fascial flap harvesting involves few technical modifications from the conventional radial forearm fascio-cutaneous free flap harvesting. We report a case of inferior maxillectomy defect reconstruction in a 42-year-old male with a free radial forearm adiposo-fascial flap with good aesthetic and functional outcome with minimal primary and donor site morbidity. The technique of raising the flap and closing the donor site needs to be meticulous in order to achieve good cosmetic and functional outcome. PMID:19881028

Forearm and upper-arm oscillometric blood pressure comparison in acutely ill adults.

PubMed

Schell, Kathleen; Morse, Kate; Waterhouse, Julie K

2010-04-01

When patients' upper arms are not accessible and/or when cuffs do not fit large upper arms, the forearm site is often used for blood pressure (BP) measurement. The purpose of this study is to compare forearm and upper-arm BPs in 70 acutely ill adults, admitted to a community hospital's 14-bed ICU. Using Philips oscillometric monitors, three repeated measures of forearm and upper-arm BPs are obtained with head of bed flat and with head of bed elevated at 30 degrees. Arms are resting on the bed. Paired t tests show statistically significant differences in systolic BPs, diastolic BPs, and mean arterial pressures in the supine and head-elevated positions. Bland-Altman analyses indicate that forearm and upper-arm oscillometric BPs are not interchangeable in acutely ill adults.

[The repair of bulky tissue defect of forearm with skin flaps].

PubMed

Huang, Xiaoyuan; Long, Jianhong; Xie, Tinghong; Zhang, Minghua; Zhang, Pihong; Yang, Xinghua; Zhong, Keqin

2002-12-01

To evaluate the repairing methods of bulky tissue defect of forearm with flaps. Twenty-one burned patients with wounds in the forearm were enrolled in this study. The injury causes were high-voltage electricity, hot press or crush injury. After local debridement, the forearm defects were repaired with pedicled complex flaps, latissimus dorsi musculocutaneous island flaps or large thoraco-abdominal flaps immediately. All the flaps survived very well with satisfactory results except for 1 patient in whom local ischemic necrosis and sub-flap infection at the distal end of the flap occurred. Early debridement followed by skin flaps with pedicles or musculocutaneous flaps transfer could be simple, safe and reliable treatment strategies in the management of bulky tissue defects of the forearm due to burn, electric injury, or other devastating injuries.

Inconsistency between simultaneous blood pressure measurements in the arm, forearm, and leg in anesthetized children.

PubMed

Keidan, Ilan; Sidi, Avner; Ben-Menachem, Erez; Tene, Yael; Berkenstadt, Haim

2014-02-01

To determine the accuracy and precision of simultaneous noninvasive blood pressure (NIBP) measurement in the arm, forearm, and ankle in anesthetized children. Prospective, randomized study. University medical center. 101 ASA physical status 1 and 2 children (aged 1-8 yrs) scheduled for elective surgery with general anesthesia. Simultaneous NIBP measurements were recorded at the arm, forearm, and ankle at 5-minute intervals. The systolic blood pressure difference between the arm-forearm or the arm-ankle was within the ± 10% range in 63% and 29% of measurements, and within the ± 20% range in 85% and 67% of measurements, respectively. The diastolic blood pressure difference between the arm-forearm or the arm-ankle was within the ± 10% range in 42% and 44% and within the ± 20% range in 67% and 74% of measurements, respectively. In patients in whom the initial three NIBP measurements were within the ± 20% range between the forearm and arm, 86% of the subsequent measurements were also within that limit. Forearm and ankle NIBP measurements are unreliable and inconsistent with NIBP measured in the arm of anesthetized children. These alternative BP measurement sites are not reliable in accuracy (comparison with reference "gold" standard) and precision (reproducibility). Copyright © 2014 Elsevier Inc. All rights reserved.

Peri-procedural protocols for interventional pain management techniques: a survey of US pain centers.

PubMed

Ahmed, Shihab U; Tonidandel, William; Trella, Jason; Martin, Nicole M; Chang, Yuchiao

2005-04-01

Interventional techniques are now an integral part of chronic pain management. As new procedures are arising at a rapid pace, decisions regarding patient safety and comfort are becoming more challenging. No peri-procedural consensus protocol currently addresses issues such as 1. nulla per os (NPO) status, 2. sedation, 3. monitoring, or 4. recovery. In establishing safety guidelines for interventional pain procedures, the knowledge of current peri-procedural protocols is required. To survey interventional pain practices and to obtain current peri-procedural protocols. We faxed a one-page questionnaire to 105 United States pain practices identified using the directory of the American Pain Society. Fifty-seven academic and private pain practices (54%) responded and were included in the analysis. Monitoring devices such as electrocardiogram (EKG), blood pressure, and pulse oximetry are not universally employed for cervical or lumbar spinal procedures. Even procedures that are often performed by anesthesiologists in operating rooms, such as Bier blocks, are not monitored in a uniform manner when performed in pain clinics. Establishment of intravenous access for procedures also varies among practitioners. Most (72%) practices had treated patients with vasovagal reactions over the past 12 months, but only 42% had simulated cardiac arrests to prepare for these situations. While various trends in peri-procedural care are observable, standards of care are not well established. In order to minimize complications associated with interventional pain management techniques, the pain management community should agree on safety guidelines for all procedures, much as these advocated by the American Society of Anesthesiology for surgical anesthetic care.

Accuracy of radiographs in assessment of displacement in lateral humeral condyle fractures.

PubMed

Knutsen, Ashleen; Avoian, Tigran; Borkowski, Sean L; Ebramzadeh, Edward; Zionts, Lewis E; Sangiorgio, Sophia N

2014-02-01

Determining the magnitude of displacement in pediatric lateral humeral condyle fractures can be difficult. The purpose of this study was to (1) assess the effect of forearm rotation on true fracture displacement using a cadaver model and to (2) determine the accuracy of radiographic measurements of the fracture gap. A non-displaced fracture was created in three human cadaveric arms. The specimens were mounted on a custom apparatus allowing forearm rotation with the humerus fixed. First, the effect of pure rotation on fracture displacement was simulated by rotating the forearm from supination to pronation about the central axis of the forearm, to isolate the effects of muscle pull. Then, the clinical condition of obtaining a lateral oblique radiograph was simulated by rotating the forearm about the medial aspect of the forearm. Fracture displacements were measured using a motion-capture system (true-displacement) and clinical radiographs (apparent-displacement). During pure rotation of the forearm, there were no significant differences in fracture displacement between supination and pronation, with changes in displacement of <1.0 mm. During rotation about the medial aspect of the forearm, there was a significant difference in true displacements between supination and pronation at the posterior edge (p < 0.05). Overall, true fracture displacement measurements were larger than apparent radiographic displacement measurements, with differences from 1.6 to 6.0 mm, suggesting that the current clinical methods may not be sensitive enough to detect a displacement of 2.0 mm, especially when positioning the upper extremity for an internal oblique lateral radiograph.

Clinical comparison of automatic, noninvasive measurements of blood pressure in the forearm and upper arm with the patient supine or with the head of the bed raised 45 degrees: a follow-up study.

PubMed

Schell, Kathleen; Lyons, Denise; Bradley, Elisabeth; Bucher, Linda; Seckel, Maureen; Wakai, Sandra; Carson, Elizabeth; Waterhouse, Julie; Chichester, Melanie; Bartell, Deborah; Foraker, Theresa; Simpson, E Kathleen

2006-03-01

Noninvasive measurement of blood pressure in the forearm is used when the upper arm is inaccessible and/or when available blood pressure cuffs do not fit a patient's arm. Evidence supporting this practice is limited. To compare noninvasive measurements of blood pressure in the forearm and upper arm of medical-surgical inpatients positioned supine and with the head of the bed raised 45 degrees . Cuff size was selected on the basis of forearm and upper arm circumference and manufacturers' recommendations. With a Welch Allyn Vital Signs 420 Series monitor, blood pressures were measured in the forearm and then in the upper arm of 221 supine patients with their arms resting at their sides. Patients were repositioned with the head of the bed elevated 45 degrees and after 2 minutes, blood pressures were measured in the upper arm and then the forearm. Starting position was alternated on subsequent subjects. Paired t tests revealed significant differences between systolic and diastolic blood pressures measured in the upper arm and forearm with patients supine and with the head of the bed elevated 45 degrees . The Bland-Altman procedure revealed that the distances between the mean values and the limits of agreement were from 15 to 33 mm Hg for individual subjects. Noninvasive measurements of blood pressure in the forearm and upper arm cannot be interchanged in medical-surgical patients who are supine or in patients with the head of the bed elevated 45 degrees .

Estimation of distal arm joint angles from EMG and shoulder orientation for transhumeral prostheses.

PubMed

Akhtar, Aadeel; Aghasadeghi, Navid; Hargrove, Levi; Bretl, Timothy

2017-08-01

In this paper, we quantify the extent to which shoulder orientation, upper-arm electromyography (EMG), and forearm EMG are predictors of distal arm joint angles during reaching in eight subjects without disability as well as three subjects with a unilateral transhumeral amputation and targeted reinnervation. Prior studies have shown that shoulder orientation and upper-arm EMG, taken separately, are predictors of both elbow flexion/extension and forearm pronation/supination. We show that, for eight subjects without disability, shoulder orientation and upper-arm EMG together are a significantly better predictor of both elbow flexion/extension during unilateral (R 2 =0.72) and mirrored bilateral (R 2 =0.72) reaches and of forearm pronation/supination during unilateral (R 2 =0.77) and mirrored bilateral (R 2 =0.70) reaches. We also show that adding forearm EMG further improves the prediction of forearm pronation/supination during unilateral (R 2 =0.82) and mirrored bilateral (R 2 =0.75) reaches. In principle, these results provide the basis for choosing inputs for control of transhumeral prostheses, both by subjects with targeted motor reinnervation (when forearm EMG is available) and by subjects without target motor reinnervation (when forearm EMG is not available). In particular, we confirm that shoulder orientation and upper-arm EMG together best predict elbow flexion/extension (R 2 =0.72) for three subjects with unilateral transhumeral amputations and targeted motor reinnervation. However, shoulder orientation alone best predicts forearm pronation/supination (R 2 =0.88) for these subjects, a contradictory result that merits further study. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effects of endothelium-derived nitric oxide on skin and digital blood flow in humans.

PubMed

Coffman, J D

1994-12-01

The effects of NG-monomethyl-L-arginine (L-NMMA) on total finger and forearm, and dorsal finger and forearm skin, blood flows were studied in the basal state and during reflex sympathetic vasoconstriction in normal subjects. Total flows were measured by venous occlusion plethysmography and skin flows by laser-Doppler flowmetry (LDF). L-NMMA in doses of 2, 4, and 8 microM/min given by constant infusion via a brachial artery catheter significantly decreased finger blood flow, forearm blood flow, and vascular conductances. At 8 microM/min, total finger blood flow decreased 38.4% and forearm blood flow decreased 24.8%. Dorsal finger and forearm skin LDF were also significantly decreased (25 and 37% at 8 microM/min). Body cooling significantly decreased finger blood flow (73.6%), vascular conductance, and finger LDF (59.7%). L-NMMA had no effect on total finger blood flow or dorsal finger LDF during body cooling. Nitric oxide or related compounds contribute to the basal dilator tone of the dorsal finger and forearm skin but not during reflex sympathetic vasoconstriction.

Resistance exercise with different volumes: blood pressure response and forearm blood flow in the hypertensive elderly

PubMed Central

Brito, Aline de Freitas; de Oliveira, Caio Victor Coutinho; Brasileiro-Santos, Maria do Socorro; Santos, Amilton da Cruz

2014-01-01

Background The purpose of this study was to evaluate the effect of two sessions of resistance exercise with different volumes on post-exercise hypotension, forearm blood flow, and forearm vascular resistance in hypertensive elderly subjects. Methods The study was conducted with ten hypertensive elderly (65±3 years, 28.7±3 kg/m2) subjected to three experimental sessions, ie, a control session, exercise with a set (S1), and exercise with three sets (S3). For each session, the subjects were evaluated before and after intervention. In the pre-intervention period, blood pressure, forearm blood flow, and forearm vascular resistance were measured after 10 minutes of rest in the supine position. Thereafter, the subjects were taken to the gym to perform their exercise sessions or remained at rest during the same time period. Both S1 and S3 comprised a set of ten repetitions of ten exercises, with an interval of 90 seconds between exercises. Subsequently, the measurements were again performed at 10, 30, 50, 70, and 90 minutes of recovery (post-intervention) in the supine position. Results Post-exercise hypotension was greater in S3 than in S1 (systolic blood pressure, −26.5±4.2 mmHg versus −17.9±4.7 mmHg; diastolic blood pressure, −13.8±4.9 mmHg versus −7.7±5 mmHg, P<0.05). Similarly, forearm blood flow and forearm vascular resistance changed significantly in both sessions with an increase and decrease, respectively, that was more evident in S3 than in S1 (P<0.05). Conclusion Resistance exercises with higher volume were more effective in causing post-exercise hypotension, being accompanied by an increase in forearm blood flow and a reduction of forearm vascular resistance. PMID:25540580

Cooling hyperthermic firefighters by immersing forearms and hands in 10 degrees C and 20 degrees C water.

PubMed

Giesbrecht, Gordon G; Jamieson, Christopher; Cahill, Farrell

2007-06-01

Firefighters experience significant heat stress while working with heavy gear in a hot, humid environment. This study compared the cooling effectiveness of immersing the forearms and hands in 10 and 20 degrees C water. Six men (33 +/- 10 yr; 180 +/- 4 cm; 78 +/- 9 kg; 19 +/- 5% body fat) wore firefighter 'turn-out gear' (heavy clothing and breathing apparatus weighing 27 kg) in a protocol including three 20-min exercise bouts (step test, 78 W, 40 degrees C air, 40% RH) each followed by a 20-min rest/cooling (21 degrees C air); i.e., 60 min of exercise, 60 min of cooling. Turn-out gear was removed during rest/cooling periods and subjects either rested (Control), immersed their hands in 10 or 20 degrees C water (H-10, H-20), or immersed their hands and forearms in 10 or 20 degrees C water (HF-10, HF-20). In 20 degrees C water, hand immersion did not reduce core temperature compared with Control; however, including forearm immersion decreased core temperature below Control values after both the second and final exercise periods (p < 0.001). In 10 degrees C water, adding forearm with hand immersion produced a lower core temperature (0.8 degrees C above baseline) than all other conditions (1.1 to 1.4 degrees C above baseline) after the final exercise period (p < 0.001). Sweat loss during Control (1458 g) was greater than all active cooling protocols (1146 g) (p < 0.001), which were not different from each other. Hand and forearm immersion in cool water is simple, reduces heat strain, and may increase work performance in a hot, humid environment. With 20 degrees C water, forearms should be immersed with the hands to be effective. At lower water temperatures, forearm and/or hand immersion will be effective, although forearm immersion will decrease core temperature further.

Autogenous forearm loop arteriovenous fistula creation.

PubMed

Tang, Weng Jun; Mat Saad, Arman Zaharil

2018-03-01

Arteriovenous fistula is a lifeline for end-stage kidney disease patients on dialysis. The quality of the vein and artery to be used plays a crucial role in attaining a functioning, reliable and long-lasting arteriovenous fistula. The aim of the study is to present an alternative for haemodialysis access to preserve the upper arm vasculature for future use - the forearm loop arteriovenous fistula. From October 2015 to September 2016, 202 patients with chronic kidney disease (CKD), stages 4 and 5, underwent arteriovenous fistula creation at the Universiti Sains Malaysia Hospital, Malaysia. Nine patients, with severe atherosclerosis of the distal artery, but with satisfactory veins, underwent forearm loop arteriovenous fistula creation. Maturation of the fistula was based on the classification by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI). All nine patients who underwent forearm loop arteriovenous fistula have had diabetes mellitus for more than 10 years. Only one fistula failed to mature within 6 weeks. Two arteriovenous fistulas thrombosed at 3 and 5 months, respectively, after the commencement of haemodialysis. However, the other six matured fistulas are still functioning well after a year of regular usage. Distal forearm arteries in diabetics may be severely atherosclerotic. Forearm loop arteriovenous fistula can be considered as the primary access for cases decided as inconvenient for fistula creation due to severe occlusive atherosclerotic disease of the forearm arteries; in order to preserve upper arm veins for future access procedures.

Comparison of bedside assessed arm and leg fluid filtration determined by venous congestion plethysmography in perioperative cancer patients

PubMed Central

Hunsicker, Oliver; Heinig, Sandra; Dathe, Jana-Jennifer; Krannich, Alexander; Spies, Claudia; Feldheiser, Aarne

2017-01-01

Abstract In recent years, pathophysiology and clinical impact of microvascular fluid filtration has regained interest. As the latest data in surgical patients have been published almost 20 years ago, there is need for further research to better understand fluid filtration during the perioperative period. Venous congestion plethysmography (VCP) provides a rapid and noninvasive method, which has been shown suitable for the assessment of fluid filtration in limbs. Fluid filtration assessed by VCP can be obtained from forearm and calf measurement sites, while in many clinical situations a reduced access to the patient often restricts the measurements to patient's forearm. We aimed to investigate if fluid filtration obtained from forearm and calf measurement site is interchangeable in nonsedated perioperative patients. Fluid filtration by VCP was obtained simultaneously from forearm and calf in patients with ovarian cancer at 4 time points during the perioperative course and assessed by the difference of volume changes of the limb between third and sixth minutes (VC6-3min) during venous congestion. VC6-3min obtained from forearm and calf measurement sites was compared with respect to agreement and evaluated regarding the association with the presence of leg edema. A total of 74 paired measurements were analyzed in 29 patients. Forearm VC6-3min was significantly higher than calf VC6-3min (median [25th; 75th quartile], 0.6 (0.4; 0.9) vs 0.4 [0.3; 0.6] %, P = 0.008). Bland–Altman and Polar analysis revealed a poor agreement between forearm and calf VC6-3min at predefined time points and changes of VC6-3min during the perioperative course (bias +0.23%, limits of agreement [LOA] −1.1% to 1.6%; angular bias −2.5°, radial LOA −82° to +77°). Forearm VC6-3min was significantly increased in patients with presence of leg edema (0.7 (0.5; 1.0) vs 0.5 (0.4; 0.6) %, P < 0.001) while calf VC6-3min did not differ in patients with and without edema. This study indicates that forearm and calf measurement sites are not interchangeable when bedside assessing fluid filtration by VCP in nonsedated perioperative patients. Considering that only forearm fluid filtration was related to the presence of edema, forearm measurement site should be chosen as a primary site for assessing fluid filtration. PMID:28248863

Effect of elbow and forearm position on contact pressure between the extensor origin and the lateral side of the capitellum.

PubMed

Tanaka, Yoshitaka; Aoki, Mitsuhiro; Izumi, Tomoki; Wada, Takuro; Fujimiya, Mineko; Yamashita, Toshihiko

2011-01-01

Bone-to-tendon contact in the origin of the common extensor tendons is considered to be one of the causes of lateral epicondylitis. Some factors, including elbow and forearm position, varus stress to the elbow, or contraction of the wrist extensor tendons, are considered to affect this bone-to-tendon contact. However, no studies have evaluated the effect of the elbow and forearm position on bone-tendon interface. The purpose of this study is to evaluate the effect of the position of the elbow and forearm on the contact pressure of the tendinous origin of the common wrist and finger extensors. We used 8 fresh cadaveric upper extremities. Contact pressure between the origin of the common extensor tendons and the lateral side of the capitellum was measured with a pressure sensor and was compared among various conditions, including elbow flexion angle (0°, 30°, 60°, and 90°), forearm rotation position (neutral and 81.5° pronation position), and varus stress load of the elbow (none, gravity on the forearm, and gravity on the forearm +1.96 Nm). Contact pressure was also measured during tension force of the extensor carpi radialis longus, extensor carpi radialis brevis, and extensor digitorum communis by 0, 9.8, and 19.6 N. Contact pressure was significantly increased with the elbow extension position, forearm pronation position, and varus stress to the elbow under tension of the extensor carpi radialis longus or extensor carpi radialis brevis. This study provides data about the amount of contact pressure between bone and tendon at the origin of the common extensor tendons in the elbow. This information may lead to a better understanding of, and better treatment for, lateral epicondylitis. Copyright © 2011. Published by Elsevier Inc.

Forehead versus forearm skin vascular responses at presyncope in humans

PubMed Central

Gagnon, Daniel; Matthew Brothers, R.; Ganio, Matthew S.; Hastings, Jeffrey L.

2014-01-01

Facial pallor is commonly observed at presyncope in humans, suggestive of reductions in facial skin blood flow (SkBF). Yet, cutaneous vasoconstriction is usually minimal at presyncope when measured at the forearm. We tested the hypothesis that reductions in forehead SkBF at presyncope are greater than in the forearm. Forehead and forearm SkBF (laser-Doppler) and blood pressure (Finometer or radial artery catheterization) were measured during lower body negative pressure (LBNP) to presyncope in 11 normothermic and 13 heat-stressed subjects (intestinal temperature increased ∼1.4°C). LBNP reduced mean arterial pressure from 91 ± 5 to 57 ± 7 mmHg during normothermia (P ≤ 0.001) and from 82 ± 5 to 57 ± 7 mmHg during heat stress (P ≤ 0.001). During normothermia, LBNP decreased forehead SkBF 55 ± 14% compared with 24 ± 11% at the forearm (P = 0.002), while during heat stress LBNP decreased forehead SkBF 39 ± 11% compared with 28 ± 8% in the forearm (P = 0.007). In both conditions, most (≥68%) of the decreases in SkBF were due to decreases in blood pressure. However, a greater contribution of actively mediated reductions in SkBF was observed at the forehead, relative to the forearm during normothermia (32 ± 13% vs. 11 ± 11%, P = 0.031) and heat stress (30 ± 13% vs. 10 ± 13%, P = 0.004). These data suggest that facial pallor at presyncope is due to a combination of passive decreases in forehead SkBF secondary to reductions in blood pressure and to active decreases in SkBF, the latter of which are relatively greater than in the forearm. PMID:25100073

[Kinematics of the triangular fibrocartilage complex during forearm rotation in vivo].

PubMed

Xu, Jing; Tang, Jin-bo; Jia, Zhong-zheng; Xie, Ren-guo

2009-11-01

To investigate three-dimensional kinematics of the superficial and deep portion of triangular fibrocartilage complex (TFCC) in different parts of the forearm rotation. Six wrists of 6 volunteers were used to obtain CT scans at different positions of the wrist. The wrists were scanned from 90 degrees of pronation to 90 degrees of supination at an interval of 30 degrees. The 3-dimensional radius and ulna were reconstructed with customized software and changes in length of the superficial and deep portion of TFCC during forearm rotation. In forearm pronation, the superficial dorsal portion and the deep palmar portion of the TFCC were tight. While the superficial palmar portion and the deep dorsal potion of the TFCC were lax. In supination, the changes in length of all these fibers were reverse. In forearm rotation one portion fibers of dorsal TFCC and one portion fibers of palmar TFCC are tight, and this mechanism controls stability during DRUJ rotation.

Carotid baroreceptor influence on forearm vascular resistance during low level lower body negative pressure

NASA Technical Reports Server (NTRS)

Thompson, Cynthia A.; Ludwig, David A.; Convertino, Victor A.

1991-01-01

The degree of forearm vasoconstriction induced by low levels of lower body negative pressure (LBNP) provides a measure of the responsiveness of the cardiopulmonary baroreflex. The validity of this measurement is based on the assumption that this vasoconstriction response is not influenced by unloading of carotid baroreceptors. To test the hypothesis that arterial baroreceptor unloading does not alter the degree of forearm vascular resistance during low levels of LBNP, 12 subjects were exposed to -15 and -20 mm Hg LBNP with and without additional artificial (+ 10 mm Hg neck pressure) unloading of the carotid baroreceptors. There was no measurable influence of carotid unloading on forearm vascular resistance at either level of LBNP. It is concluded that forearm vascular resistance measured during cardiopulmonary baroreceptor unloading is unaffected by carotid baroreceptor unloading within the magnitude encountered during low levels of LBNP.

Isometric endurance of the back extensors in school-aged adolescents with and without low back pain.

PubMed

Johnson, Olubusola E; Mbada, Chidozie E; Akosile, Christopher O; Agbeja, Oyinade A

2009-01-01

Studies on back extensor endurance in adolescents are scarce. This study sought to establish reference data and pattern of back extensor endurance in school-aged adolescents with and without low-back pain (LBP) from Nigeria. This study recruited 625 adolescents aged 11 to 19 years from eight randomly selected secondary schools. The modified Biering-Sørensen test of Static Muscular Endurance (BSME) was used to assess isometric endurance of the back extensors. Demographic and anthropometric data were collected. A modified LBP questionnaire was used to assess the presence of LBP. Descriptive and inferential analyses were used to analyze data. Significance was set at 0.05 alpha-level. The mean isometric holding time (IHT) of all the participants was 132.9 $\\pm$ 65.6. Males had significantly higher significant (p=0.026) IHT than females. Adolescents without LBP had a higher significant IHT (p=0.042) than those with reported history of previous LBP and those with present LBP (p=0.000) respectively. Using percentile values, poor endurance was defined as IHT that is < 90.0 s and < 67 s for males and females respectively; medium endurance was defined as IHT that ranged between 90 and 193 s and 67 and 170 s for males and females respectively while good endurance was defined as IHT that is > 193 s and > 170 s for males and females respectively. IHT was significantly related to each of body mass index, hip circumference and waist-to-hip ratio (p < 0.05). Isometric back extensors endurance in Nigerian adolescents was comparable to the original Biering-Sørensen mean value. Majority of the participants had medium endurance performance with the back endurance pattern in the ratio 1:2:1. Male had higher isometric back extensors endurance than females. Decreased isometric back extensors endurance was associated with the presence of LBP in adolescents.

Forearm Compartment Syndrome: Evaluation and Management.

PubMed

Kistler, Justin M; Ilyas, Asif M; Thoder, Joseph J

2018-02-01

Compartment syndrome of the forearm is uncommon but can have devastating consequences. Compartment syndrome is a result of osseofascial swelling leading to decreased tissue perfusion and tissue necrosis. There are numerous causes of forearm compartment syndrome and high clinical suspicion must be maintained to avoid permanent disability. The most widely recognized symptoms include pain out of proportion and pain with passive stretch of the wrist and digits. Early diagnosis and decompressive fasciotomy are essential in the treatment of forearm compartment syndrome. Closure of fasciotomy wounds can often be accomplished by primary closure but many patients require additional forms of soft tissue coverage procedures. Copyright © 2017 Elsevier Inc. All rights reserved.

Limb venous distension evokes sympathetic activation via stimulation of the limb afferents in humans.

PubMed

Cui, Jian; McQuillan, Patrick M; Blaha, Cheryl; Kunselman, Allen R; Sinoway, Lawrence I

2012-08-15

We have recently shown that a saline infusion in the veins of an arterially occluded human forearm evokes a systemic response with increases in muscle sympathetic nerve activity (MSNA) and blood pressure. In this report, we examined whether this response was a reflex that was due to venous distension. Blood pressure (Finometer), heart rate, and MSNA (microneurography) were assessed in 14 young healthy subjects. In the saline trial (n = 14), 5% forearm volume normal saline was infused in an arterially occluded arm. To block afferents in the limb, 90 mg of lidocaine were added to the same volume of saline in six subjects during a separate visit. To examine whether interstitial perfusion of normal saline alone induced the responses, the same volume of albumin solution (5% concentration) was infused in 11 subjects in separate studies. Lidocaine abolished the MSNA and blood pressure responses seen with saline infusion. Moreover, compared with the saline infusion, an albumin infusion induced a larger (MSNA: Δ14.3 ± 2.7 vs. Δ8.5 ± 1.3 bursts/min, P < 0.01) and more sustained MSNA and blood pressure responses. These data suggest that venous distension activates afferent nerves and evokes a powerful systemic sympathoexcitatory reflex. We posit that the venous distension plays an important role in evoking the autonomic adjustments seen with postural stress in human subjects.

Research, design & development project Myoelectric Prosthesis of Upper Limb

NASA Astrophysics Data System (ADS)

Galiano, L.; Montaner, E.; Flecha, A.

2007-11-01

A Research Design and Development Project was developed of a myoelectric prosthesis for a pediatric patient presenting congenital amputation of the left forearm below the elbow. A multidisciplinary work-team was formed for this goal, in order to solve the several (/various) aspects regarding this project (mechanical, ergonomics, electronics, physical). The prosthesis as an electromechanical device was divided in several blocks, trying to achieve a focused development for each stage, acording to requisites. A mechanical prototype of the prothesis was designed and built along with the circuitry needed for EMG aquisition, control logic and drivers. Having acomplished the previuos stages, the project is now dealing with the definitions of the interface between the prosthesis and the patient, with promising perspectives.

Forearm Flexor Injuries Among Major League Baseball Players: Epidemiology, Performance, and Associated Injuries.

PubMed

Hodgins, Justin L; Trofa, David P; Donohue, Steve; Littlefield, Mark; Schuk, Michael; Ahmad, Christopher S

2018-06-01

Despite evidence highlighting the importance of the forearm flexor muscles of elite baseball players, no studies have reported on the epidemiology of flexor strains and their associated outcomes. To examine the incidence, associated injuries, and outcomes associated with forearm flexor injuries among major and minor league baseball players. Cohort study; Level of evidence, 3. Injury data attributed to forearm flexor injuries among Major League Baseball (MLB) and minor league teams between 2010 and 2014 were obtained from the professional baseball Health and Injury Tracking System. This analysis included the number of players injured, seasonal timing of injury, days spent on the disabled list (DL), preinjury performance data, and subsequent injuries. A total of 134 and 629 forearm flexor injuries occurred in MLB and the minor leagues, respectively. The mean player age was 28.6 and 22.8 years in the MLB and minor leagues, respectively. The mean time spent on the DL for MLB players was 117.0 days, as opposed to 93.9 days in the minor leagues ( P = .272). Interestingly, pitcher performance declined in all categories examined leading up to the season of injury, with significant differences in walks plus hits per inning pitched ( P = .04) and strike percentage ( P = .036). Of MLB players with a forearm injury, subsequent injuries included 50 (37.3%) shoulder, 48 (35.8%) elbow, and 24 (17.9%) forearm injuries. Among injured minor league players, subsequent injuries included 170 (27.0%) shoulder, 156 (24.8%) elbow, and 83 (13.2%) forearm injuries. These rates of subsequent injuries were significantly higher compared with the rates of injuries sustained among players without forearm injuries in both leagues ( P < .001). Finally, 26 (19.4%) MLB and 56 (8.9%) minor league players required an ulnar collateral ligament reconstruction, rates that were significantly higher compared with players without a flexor strain ( P < .001). Flexor-pronator injuries are responsible for considerable time spent on the DL for elite players in MLB and the minor leagues. The most significant findings of this investigation illustrate that a flexor strain may be a significant risk factor for subsequent upper extremity injuries, including an ulnar collateral ligament tear.

The effect of topically applied tissue expanders on radial forearm skin pliability: a prospective self-controlled study

PubMed Central

2014-01-01

Background The use of pre-operatively applied topical tissue expansion tapes have previously demonstrated increased rates of primary closure of radial forearm free flap donor sites. This is associated with a reduced cost of care as well as improved cosmetic appearance of the donor site. Unfortunately, little is known about the biomechanical changes these tapes cause in the forearm skin. This study tested the hypothesis that the use of topically applied tissue expansion tapes will result in an increase in forearm skin pliability in patients undergoing radial forearm free flap surgery. Methods Twenty-four patients scheduled for head and neck surgery requiring a radial forearm free flap were enrolled in this prospective self-controlled observational study. DynaClose tissue expansion tapes (registered Canica Design Inc, Almonte, Canada) were applied across the forearm one week pre-operatively. Immediately prior to surgery, the skin pliability of the dorsal and volar forearm sites were measured with the Cutometer MPA 580 (registered Courage-Khazaka Electronic GmbH, Cologne, Germany) on both the treatment and contralateral (control) arms. Paired t-tests were used to compare treatment to control at both sites, with p < 0.025 defined as statistically significant. Results There was a statistically significant increase in pliability by a mean of 0.05 mm (SD = 0.09 mm) between treatment and control arms on the dorsal site (95% CI [0.01, 0.08], p = 0.018). This corresponded to an 8% increase in pliability. In contrast, the volar site did not show a statistically significant difference between treatment and control (mean difference = 0.04 mm, SD = 0.20 mm, 95% CI [−0.04, 0.12], p = 0.30). Conclusions This result provides evidence that the pre-operative application of topical tissue expansion tapes produces measurable changes in skin biomechanical properties. The location of this change on the dorsal forearm is consistent with the method of tape application. While this increase in skin pliability may account for the improved rate of primary donor site closure reported using this technique, the results did not reach our definition of clinical significance. PMID:24739510

Nalbuphine as an adjuvant to 0.25% levobupivacaine in ultrasound-guided supraclavicular block provided prolonged sensory block and similar motor block durations (RCT).

PubMed

Abdelhamid, Bassant Mohamed; Omar, Heba

2018-05-28

Prolonged postoperative analgesia with early motor recovery for early rehabilitation is a challenge in regional block. The purpose of this study is to evaluate the effect of adding 20 mg nalbuphine to 25 ml of 0.25% levobupivacaine in supraclavicular brachial plexus block. One hundred thirty-five (135) patients scheduled for hand and forearm surgeries with supraclavicular block were randomly allocated into three equal groups. Group L received 25 ml of 0.5% levobupivacaine + 1 ml normal saline; group H received 25 ml of 0.25% levobupivacaine + 1 ml normal saline; and group N received 25 ml of 0.25% levobupivacaine + 1 ml (20 mg) nalbuphine. Onset time and duration of sensory and motor block, and time to first analgesic dose were recorded. Sensory block onset was comparable between the three groups. Motor block onset in group L and group N was comparable (13.16 ± 3.07 and 13.84 ± 3.05 min, respectively) and was shorter than that in group H (15.71 ± 2 0.91 min). Sensory block duration in group L and group N was comparable (522.22 ± 69.57 and 533.78 ± 66.03 min, respectively) and was longer than that in group H (342.67 ± 92.80 min). Motor block duration in group N and group H was comparable (272.00 ± 59.45 and 249.78 ± 66.01 min, respectively) and was shorter than that in group L (334.67 ± 57.90 min). Time to first analgesic dose was significantly longer in group N (649.78 ± 114.76 min) than that of group L and group H (575.56 ± 96.85 and 375.56 ± 84.49 min, respectively) and longer in group L when compared to group H. Adding 20 mg nalbuphine to 25 ml of 0.25% levobupivacaine in supraclavicular block provided prolonged duration of sensory block with similar duration of motor block.

Treatment of plastic deformation of the forearm in young adults with double-level osteotomies: case reports.

PubMed

Moon, Edward S; Howlett, John; Wiater, Brett P; Trumble, Thomas E

2011-04-01

Plastic deformation of the forearm is a rare injury in young adults that occurs when a slow bending or rotational force is applied to the arm, most commonly in the setting of an industrial workplace accident. There are currently no guidelines for treatment of the residual forearm deformity that often results in limitations of forearm supination and pronation. We present 2 cases demonstrating that deformity correction with single cortex, double-level osteotomies combined with rigid plate fixation and early range of motion exercise that results in good functional outcomes. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Reversed Palmaris Longus Muscle Causing Volar Forearm Pain and Ulnar Nerve Paresthesia.

PubMed

Bhashyam, Abhiram R; Harper, Carl M; Iorio, Matthew L

2017-04-01

A case of volar forearm pain associated with ulnar nerve paresthesia caused by a reversed palmaris longus muscle is described. The patient, an otherwise healthy 46-year-old male laborer, presented after a previous unsuccessful forearm fasciotomy for complaints of exercise exacerbated pain affecting the volar forearm associated with paresthesia in the ulnar nerve distribution. A second decompressive fasciotomy was performed revealing an anomalous "reversed" palmaris longus, with the muscle belly located distally. Resection of the anomalous muscle was performed with full relief of pain and sensory symptoms. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Theoretical and experimental separation dynamics in capillary zone electrophoresis

NASA Technical Reports Server (NTRS)

Thormann, Wolfgang; Michaud, Jon-Pierre; Mosher, Richard A.

1986-01-01

The mathematical model of Bier et al. (1983) is used in a computer aided analysis of the conditions in capillary zone electrophoresis (ZE) under which sample zones migrate noninteractively with the carrier electrolyte. The monitoring of sample zones with a capillary analyzer that features both on-line conductivity and UV detection at the end of the separation trough is discussed. Data from a ZE analysis of a 5-component mixture are presented, and it is noted that all five components can be monitored via their conductivity change if enough sample is present. It is suggested from the results that the concentration ratio of background buffer to sample should be a minimum of 100:1 to effectively apply the plate concept to ZE.

Low-pressure sequential compression of lower limbs enhances forearm skin blood flow.

PubMed

Amah, Guy; Voicu, Sebastian; Bonnin, Philippe; Kubis, Nathalie

2016-12-01

We investigated whether forearm skin blood flow could be improved when a multilayer pulsatile inflatable suit was applied at a low pressure to the lower limbs and abdomen. We hypothesized that a non-invasive purely mechanical stimulation of the lower limbs could induce remote forearm blood flow modifications. The pulsatile suit induced a sequential compartmentalized low compression (65 mmHg), which was synchronized with each diastole of the cardiac cycle with each phase evolving centripetally (lower limbs to abdomen). Modifications of the forearm skin blood flow were continuously recorded by laser Doppler flowmetry (LDF) at baseline and during the pulsatile suit application. Endothelium-dependent and endothelium-independent vasodilations of the forearm skin microcirculation were measured by LDF in response to a local transdermal iontophoretic application of acetylcholine (ACh-test) and to hyperthermia (hyperT- test). Twenty-four healthy volunteers, 12 men and 12 women (43±14 years) were included in the study. LDF responses increased 1) under pulsatile suit (97±106%, p.

Aging curve of neuromotor function by pronation and supination of forearms using three-dimensional wireless acceleration and angular velocity sensors.

PubMed

Kaneko, M; Okui, H; Hirakawa, G; Ishinishi, H; Katayama, Y; Iramina, K

2012-01-01

We have developed an evaluation system for pronation and supination of forearms. The motion of pronation and supination of the forearm is used as a diagnosis method of developmental disability, etc. However, this diagnosis method has a demerit in which diagnosis results between doctors are not consistent. It is hoped that a more quantitative and simple evaluation method is established. Moreover it is hoped a diagnostic criteria obtained from healthy subjects can be established to diagnose developmental disorder patients. We developed a simple and portable evaluation system for pronation and supination of forearms. Three-dimensional wireless acceleration and angular velocity sensors are used for this system. In this study, pronation and supination of forearms of 570 subjects (subjects aged 6-12, 21-100) were examined. We could obtain aging curves in the neuromotor function of pronation and supination. These aging curves obtained by our developed system, has the potential to become diagnostic criteria for a developmental disability, etc.

Anatomical study of the forearm and hand nerves of the domestic cat ( Felis catus), puma ( Puma concolor) and jaguar ( Panthera onca).

PubMed

Sánchez, H L; Silva, L B; Rafasquino, M E; Mateo, A G; Zuccolilli, G O; Portiansky, E L; Alonso, C R

2013-04-01

The innervation of the forearm and hand regions of cats has not been well described despite its importance for any surgery or any neurological disorder. It is probably the main area where disorders of peripheral nerves in this species are observed. In felines, the forelimbs facilitate the jump and represent the most important way for capturing prey. The main muscles and nerves involved in this activity are located in the region of the forearm and hand. The aim of the present study was to provide a detailed description of the innervation of the forearm and hand regions of the jaguar and puma, in comparison with that of the domestic cat, contributing thus with the anatomical knowledge of the area for applying it to surgery and pathology. The forearms of three pumas and two jaguars (all of them fixed in formalin) and of six domestic cats (fresh) were dissected. The nerves path and their forearm distribution patterns of all three species were described. The analysed results indicate that the observed variations between species are minimal; thus, the anatomy described for domestic cats can be widely applied to American wild felids. © 2012 Blackwell Verlag GmbH.

Evaluation of Persistent Antimicrobial Effects of an Antimicrobial Formulation

PubMed Central

Ferrara, Michael S.; Courson, Ron; Paulson, Daryl S.

2011-01-01

Context: Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is becoming more prevalent in healthy athletic populations. Various preventive measures have been proposed, but few researchers have evaluated the protective effects of a prophylactic application of a commercially available product. Objective: To compare the persistent antimicrobial properties of a commercially available antimicrobial product containing 4% chlorhexidine gluconate (Hibiclens) with those of a mild, nonmedicated soap (Dr. Bronner's Magic Soap). Design: Cross-sectional study. Setting: Microbiology laboratory, contract research organization. Patients or Other Participants: Twenty healthy human volunteers. Intervention(s): The test and control products were randomly assigned and applied to both forearms of each participant. Each forearm was washed for 2 minutes with the test or control product, rinsed, and dried. At, 1, 2, and 4 hours after application, each forearm was exposed to MRSA for approximately 30 minutes. Main Outcome Measure(s): Differences in numbers of MRSA recovered from each forearm, test and control, at each postapplication time point were compared. Results: Fewer MRSA (P < .0001) were recovered from the forearms treated with the test product (4% chlorhexidine gluconate) than from the forearms treated with the control product (nonmedicated soap). Conclusions: The 4% chlorhexidine gluconate product demonstrated persistent bactericidal activity versus MRSA for up to 4 hours after application. PMID:22488188

Ultrasound-guided diagnosis of fractures of the distal forearm in children.

PubMed

Herren, C; Sobottke, R; Ringe, M J; Visel, D; Graf, M; Müller, D; Siewe, J

2015-06-01

Distal radius and forearm fractures are injuries that are frequently seen in trauma surgery outpatient clinics. Usually, the wrist is X-rayed in 2 planes as standard diagnostic procedure. In contrast, we evaluate in our study the accuracy of ultrasonography (US) in diagnosing these fractures. This prospective study includes the patients who presented at two trauma surgery clinics with a presumptive diagnosis of distal radius or forearm fracture between January and December 2012. After a clinical examination, US imaging of the distal forearm was first carried out on 6 standardized planes followed by radiographs of the wrist made in two planes. The age limit was set at the end of 11 years. In total, 201 patients between 4 and 11 years of age were recruited with an average age of 9.5 years at the time of the trauma. There were 104 (51.7%) fractures distributed as follows: 89 (85.9%) injuries of the distal radius, 9 (8.7%) injuries of the distal ulna, and 6 (5.8%) combined injuries (radius and ulna). Sixty-five greenstick fractures were detected. Surgery was necessary in 34 cases. Specificity and sensitivity of ultrasound diagnosis were 99.5%. Ultrasound imaging is suitable to demonstrate fractures of the distal forearm. It is a highly sensitive procedure in detecting distal forearm fractures. In our opinion, a negative result in ultrasound may reduce the need for further radiographs in children with distal forearm lesions. But in any doubtful situation the need for conventional radiographs remains. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Superior Patency of Upper Arm Arteriovenous Fistulae in High Risk Patients

PubMed Central

Chiulli, Larissa C; Vasilas, Penny; Dardik, Alan

2011-01-01

Background Despite an increased propensity to primary failure in forearm arteriovenous fistulae compared to upper arm fistulae, forearm fistulae remain the preferred primary access type for chronic hemodialysis patients. In a high risk patient population with multiple medical comorbidities associated with requirement for intravenous access we compared the rates of access failure in forearm and upper arm fistulae. Materials and Methods The records of all patients having primary native arteriovenous fistulae placed between 2004 and 2009 at the VA Connecticut Healthcare system were reviewed (n=118). Primary and secondary patency of upper arm and forearm fistulae were evaluated using Kaplan-Meier survival analysis. The effects of medical comorbidities on access patency were analyzed with Cox regression. Results The median time to primary failure of the vascular access was 0.288 years in the forearm group compared to 0.940 years in the upper arm group (p=0.028). Secondary patency was 52% at 4.9 years in upper arm fistulae compared to 52% at 1.1 years in the forearm group (p=0.036). There was no significant effect of patient comorbidities on fistula failure; however, there was a trend toward upper arm surgical site as a protective factor for primary fistula patency (Hazard Ratio=0.573, p=0.076). Conclusions In veterans needing hemodialysis, a high risk population with extensive comorbid factors often requiring intravascular access, upper arm fistulae are not only a viable option for primary vascular access, but are likely to be a superior option to classic forearm fistulae. PMID:21571318

Impact of beverage consumption, age, and site dependency on dual energy X-ray absorptiometry (DEXA) measurements in perimenopausal women: a prospective study.

PubMed

Lo, Huan-Chu; Kuo, Duen-Pang; Chen, Yen-Lin

2017-08-01

The aim of this study was to determine the best site for bone mineral density (BMD) measurements based on T -scores, age, and beverage consumption. In this prospective study, 271 women stratified by age (average age: 61.9 years) underwent dual energy X-ray absorptiometry (DEXA) scanning of their lumbar spine, hips, and forearms. Osteoporosis was defined as a BMD of 2.5 standard deviations or more below the mean peak bone mass based on a reference population of adult women (translated as a T -score ≤ -2.5), as measured by DEXA. Participants were also evaluated regarding alcohol and caffeine consumption by a semiquantitative questionnaire. A significant discrepancy was observed in the classification of osteoporosis at different locations, with hip and forearm showing the best correlation (Pearson's r = 0.627, p < 0.001). In addition, for participants over 50 years of age, hip and forearm showed the best correlation. Significant correlations were also noted between forearm T -scores and caffeine consumed and, to a lesser extent, the level of alcohol consumption. In the group ≤ 50 years of age, lumbar spine and forearm T -scores were only associated with alcohol consumption. In the group over 50 years of age, hip and forearm T -scores were only associated with caffeine consumption. Bone mineral density measurements at the hip and forearm correlated with caffeine consumption in elderly Taiwanese women. This is an important finding since age and caffeine consumption are known risk factors for osteoporosis.

Characterization of evoked tactile sensation in forearm amputees with transcutaneous electrical nerve stimulation

NASA Astrophysics Data System (ADS)

Chai, Guohong; Sui, Xiaohong; Li, Si; He, Longwen; Lan, Ning

2015-12-01

Objective. The goal of this study is to characterize the phenomenon of evoked tactile sensation (ETS) on the stump skin of forearm amputees using transcutaneous electrical nerve stimulation (TENS). Approach. We identified the projected finger map (PFM) of ETS on the stump skin in 11 forearm amputees, and compared perceptual attributes of the ETS in nine forearm amputees and eight able-bodied subjects using TENS. The profile of perceptual thresholds at the most sensitive points (MSPs) in each finger-projected area was obtained by modulating current amplitude, pulse width, and frequency of the biphasic, rectangular current stimulus. The long-term stability of the PFM and the perceptual threshold of the ETS were monitored in five forearm amputees for a period of 11 months. Main results. Five finger-specific projection areas can be independently identified on the stump skin of forearm amputees with a relatively long residual stump length. The shape of the PFM was progressively similar to that of the hand with more distal amputation. Similar sensory modalities of touch, pressure, buzz, vibration, and numb below pain sensation could be evoked both in the PFM of the stump skin of amputees and in the normal skin of able-bodied subjects. Sensory thresholds in the normal skin of able-bodied subjects were generally lower than those in the stump skin of forearm amputees, however, both were linearly modulated by current amplitude and pulse width. The variation of the MSPs in the PFM was confined to a small elliptical area with 95% confidence. The perceptual thresholds of thumb-projected areas were found to vary less than 0.99 × 10-2 mA cm-2. Significance. The stable PFM and sensory thresholds of ETS are desirable for a non-invasive neural interface that can feed back finger-specific tactile information from the prosthetic hand to forearm amputees.

Hemodynamic and neurohumoral effects of various grades of selective adenosine transport inhibition in humans. Implications for its future role in cardioprotection.

PubMed

Rongen, G A; Smits, P; Ver Donck, K; Willemsen, J J; De Abreu, R A; Van Belle, H; Thien, T

1995-02-01

In 12 healthy male volunteers (27-53 yr), a placebo-controlled randomized double blind cross-over trial was performed to study the effect of the intravenous injection of 0.25, 0.5, 1, 2, 4, and 6 mg draflazine (a selective nucleoside transport inhibitor) on hemodynamic and neurohumoral parameters and ex vivo nucleoside transport inhibition. We hypothesized that an intravenous draflazine dosage without effect on hemodynamic and neurohumoral parameters would still be able to augment the forearm vasodilator response to intraarterially infused adenosine. Heart rate (electrocardiography), systolic blood pressure (Dinamap 1846 SX; Critikon, Portanje Electronica BV, Utrecht, The Netherlands) plasma norepinephrine and epinephrine increased dose-dependently and could almost totally be abolished by caffeine pretreatment indicating the involvement of adenosine receptors. Draflazine did not affect forearm blood flow (venous occlusion plethysmography). Intravenous injection of 0.5 mg draflazine did not affect any of the measured hemodynamic parameters but still induced a significant ex vivo nucleoside-transport inhibition of 31.5 +/- 4.1% (P < 0.05 vs placebo). In a subgroup of 10 subjects the brachial artery was cannulated to infuse adenosine (0.15, 0.5, 1.5, 5, 15, and 50 micrograms/100 ml forearm per min) before and after intravenous injection of 0.5 mg draflazine. Forearm blood flow amounted 1.9 +/- 0.3 ml/100 ml forearm per min for placebo and 1.8 +/- 0.2, 2.0 +/- 0.3, 3.8 +/- 0.9, 6.3 +/- 1.2, 11.3 +/- 2.2, and 19.3 +/- 3.9 ml/100 ml forearm per min for the six incremental adenosine dosages, respectively. After the intravenous draflazine infusion, these values were 1.6 +/- 0.2 ml/100 ml forearm per min for placebo and 2.1 +/- 0.3, 3.3 +/- 0.6, 5.8 +/- 1.1, 6.9 +/- 1.4, 14.4 +/- 2.9, and 23.5 +/- 4.0 ml/100 ml forearm per min, respectively (Friedman ANOVA: P < 0.05 before vs after draflazine infusion). In conclusion, a 30-50% inhibition of adenosine transport significantly augments the forearm vasodilator response to adenosine without significant systemic effects. These results suggest that draflazine is a feasible tool to potentiate adenosine-mediated cardioprotection in man.

The influence of cooling forearm/hand and gender on estimation of handgrip strength.

PubMed

Cheng, Chih-Chan; Shih, Yuh-Chuan; Tsai, Yue-Jin; Chi, Chia-Fen

2014-01-01

Handgrip strength is essential in manual operations and activities of daily life, but the influence of forearm/hand skin temperature on estimation of handgrip strength is not well documented. Therefore, the present study intended to investigate the effect of local cooling of the forearm/hand on estimation of handgrip strength at various target force levels (TFLs, in percentage of MVC) for both genders. A cold pressor test was used to lower and maintain the hand skin temperature at 14°C for comparison with the uncooled condition. A total of 10 male and 10 female participants were recruited. The results indicated that females had greater absolute estimation deviations. In addition, both genders had greater absolute deviations in the middle range of TFLs. Cooling caused an underestimation of grip strength. Furthermore, a power function is recommended for establishing the relationship between actual and estimated handgrip force. Statement of relevance: Manipulation with grip strength is essential in daily life and the workplace, so it is important to understand the influence of lowering the forearm/hand skin temperature on grip-strength estimation. Females and the middle range of TFL had greater deviations. Cooling the forearm/hand tended to cause underestimation, and a power function is recommended for establishing the relationship between actual and estimated handgrip force. Practitioner Summary: It is important to understand the effect of lowering the forearm/hand skin temperature on grip-strength estimation. A cold pressor was used to cool the hand. The cooling caused underestimation, and a power function is recommended for establishing the relationship between actual and estimated handgrip force. Manipulation with grip strength is essential in daily life and the workplace, so it is important to understand the influence of lowering the forearm/hand skin temperature on grip-strength estimation. Females and the middle range of TFL had greater deviations. Cooling the forearm/hand tended to cause underestimation, and a power function is recommended for establishing the relationship between actual and estimated handgrip force. It is important to understand the effect of lowering the forearm/hand skin temperature on grip-strength estimation. A cold pressor was used to cool the hand. The cooling caused underestimation, and a power function is recommended for establishing the relationship between actual and estimated handgrip force

Neurostimulation in ultrasound-guided infraclavicular block: a prospective randomized trial.

PubMed

Dingemans, Emmanuel; Williams, Stephan R; Arcand, Geneviève; Chouinard, Philippe; Harris, Patrick; Ruel, Monique; Girard, François

2007-05-01

Ultrasound guidance (USG) for infraclavicular blocks provides real time visualization of the advancing needle and local anesthetic distribution. Whether visualization of local anesthetic spread can supplant neurostimulation as the end point for local anesthetic injection during USG block has never been formally evaluated. Therefore, for this prospective randomized study, we recruited 72 patients scheduled for hand or forearm surgery and compared the speed of execution and quality of USG infraclavicular block with either USG alone (Group U) or USG combined with neurostimulation (Group S). In Group U, local anesthetic was deposited in a U-shaped distribution posterior and to each side of the axillary artery using as few injections as possible (1, 2, and 3 injections in 29, 6, and 3 patients, respectively). In Group S, a single injection was made after obtaining a distal motor response with a stimulating current between 0.3 and 0.6 mA. The anesthetic solution consisted of 0.5 mL/kg of lidocaine 1.5%, bupivacaine 0.125%, and epinephrine 1:200 000 (final concentrations). Procedure times were significantly shorter in Group U compared with Group S (3.1 +/- 1.6 min and 5.2 +/- 4.7 min, respectively; P = 0.006). In Group S, anesthetic spread was mainly anterior to the axillary artery in 37% of patients and mainly posterior in 63% of patients. Thirty minutes after the injection, 86% of patients in Group U had complete sensory block in the musculocutaneous, median, radial, and ulnar nerve territories compared with 57% in Group S (P = 0.007). Patients blocked in Group U with a single injection had the same rate of complete block (86%) as those blocked with more than one injection (86%). Block supplementation rates were 8% in Group U versus 26% in Group S (P = 0.049). Block failure occurred in one patient in Group S because of an inability to obtain a distal stimulation after 20 min. We conclude that USG infraclavicular block is more rapidly performed and yields a higher success rate when visualization of local anesthetic spread is used as the end point for injection. Posterolateral spread of local anesthetic around the axillary artery predicts successful block, circumventing the need for direct nerve visualization.

Does oxygen delivery explain interindividual variation in forearm critical impulse?

PubMed

Kellawan, J Mikhail; Bentley, Robert F; Bravo, Michael F; Moynes, Jackie S; Tschakovsky, Michael E

2014-11-01

Within individuals, critical power appears sensitive to manipulations in O2 delivery. We asked whether interindividual differences in forearm O2 delivery might account for a majority of the interindividual differences in forearm critical force impulse (critical impulse), the force analog of critical power. Ten healthy men (24.6 ± 7.10 years) completed a maximal effort rhythmic handgrip exercise test (1 sec contraction-2 sec relaxation) for 10 min. The average of contraction impulses over the last 30 sec quantified critical impulse. Forearm brachial artery blood flow (FBF; echo and Doppler ultrasound) and mean arterial pressure (MAP; finger photoplethysmography) were measured continuously. O2 delivery (FBF arterial oxygen content (venous blood [hemoglobin] and oxygen saturation from pulse oximetry)) and forearm vascular conductance (FVC; FBF·MAP(-1)) were calculated. There was a wide range in O2 delivery (59.98-121.15 O2 mL·min(-1)) and critical impulse (381.5-584.8 N) across subjects. During maximal effort exercise, O2 delivery increased rapidly, plateauing well before the declining forearm impulse and explained most of the interindividual differences in critical impulse (r(2) = 0.85, P < 0.01). Both vasodilation (r(2) = 0.64, P < 0.001) and the exercise pressor response (r(2) = 0.33, P < 0.001) independently contributed to interindividual differences in FBF. In conclusion, interindividual differences in forearm O2 delivery account for most of the interindividual variation in critical impulse. Furthermore, individual differences in pressor response play an important role in determining differences in O2 delivery in addition to vasodilation. The mechanistic origins of this vasodilatory and pressor response heterogeneity across individuals remain to be determined. © 2014 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

Does oxygen delivery explain interindividual variation in forearm critical impulse?

PubMed Central

Kellawan, J. Mikhail; Bentley, Robert F.; Bravo, Michael F.; Moynes, Jackie S.; Tschakovsky, Michael E.

2014-01-01

Abstract Within individuals, critical power appears sensitive to manipulations in O2 delivery. We asked whether interindividual differences in forearm O2 delivery might account for a majority of the interindividual differences in forearm critical force impulse (critical impulse), the force analog of critical power. Ten healthy men (24.6 ± 7.10 years) completed a maximal effort rhythmic handgrip exercise test (1 sec contraction‐2 sec relaxation) for 10 min. The average of contraction impulses over the last 30 sec quantified critical impulse. Forearm brachial artery blood flow (FBF; echo and Doppler ultrasound) and mean arterial pressure (MAP; finger photoplethysmography) were measured continuously. O2 delivery (FBF arterial oxygen content (venous blood [hemoglobin] and oxygen saturation from pulse oximetry)) and forearm vascular conductance (FVC; FBF·MAP−1) were calculated. There was a wide range in O2 delivery (59.98–121.15 O2 mL·min−1) and critical impulse (381.5–584.8 N) across subjects. During maximal effort exercise, O2 delivery increased rapidly, plateauing well before the declining forearm impulse and explained most of the interindividual differences in critical impulse (r2 = 0.85, P < 0.01). Both vasodilation (r2 = 0.64, P < 0.001) and the exercise pressor response (r2 = 0.33, P < 0.001) independently contributed to interindividual differences in FBF. In conclusion, interindividual differences in forearm O2 delivery account for most of the interindividual variation in critical impulse. Furthermore, individual differences in pressor response play an important role in determining differences in O2 delivery in addition to vasodilation. The mechanistic origins of this vasodilatory and pressor response heterogeneity across individuals remain to be determined. PMID:25413323

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fryburg, D.A.; Barrett, E.J.; Louard, R.J.

To assess the effect of fasting on muscle protein turnover in the basal state and in response to insulin, we measured forearm amino acid kinetics, using (3H)phenylalanine (Phe) and (14C)leucine (Leu) infused systemically, in eight healthy subjects after 12 (postabsorptive) and 60 h of fasting. After a 150-min basal period, forearm local insulin concentration was selectively raised by approximately 25 muU/ml for 150 min by intra-arterial insulin infusion (0.02 mU.kg-1. min-1). The 60-h fast increased urine nitrogen loss and whole body Leu flux and oxidation (by 50-75%, all P less than 0.02). Post-absorptively, forearm muscle exhibited a net release ofmore » Phe and Leu, which increased two- to threefold after the 60-h fast (P less than 0.05); this effect was mediated exclusively by accelerated local rates of amino acid appearance (Ra), with no reduction in rates of disposal (Rd). Local hyperinsulinemia in the postabsorptive condition caused a twofold increase in forearm glucose uptake (P less than 0.01) and completely suppressed the net forearm output of Phe and Leu (P less than 0.02). After the 60-h fast, forearm glucose disposal was depressed basally and showed no response to insulin; in contrast, insulin totally abolished the accelerated net forearm release of Phe and Leu. The action of insulin to reverse the augmented net release of Phe and Leu was mediated exclusively by approximately 40% suppression of Ra (P less than 0.02) rather than a stimulation of Rd. We conclude that in short-term fasted humans (1) muscle amino acid output accelerates due to increased proteolysis rather than reduced protein synthesis, and (2) despite its catabolic state and a marked impairment in insulin-mediated glucose disposal, muscle remains sensitive to insulin's antiproteolytic action.« less

Evaluation of Bone Atrophy After Treatment of Forearm Fracture Using Nonlinear Finite Element Analysis: A Comparative Study of Locking Plates and Conventional Plates.

PubMed

Matsuura, Yusuke; Rokkaku, Tomoyuki; Suzuki, Takane; Thoreson, Andrew Ryan; An, Kai-Nan; Kuniyoshi, Kazuki

2017-08-01

Forearm diaphysis fractures are usually managed by open reduction internal fixation. Recently, locking plates have been used for treatment. In the long-term period after surgery, some patients present with bone atrophy adjacent to the plate. However, a comparison of locking and conventional plates as a cause of atrophy has not been reported. The aim of this study was to investigate long-term bone atrophy associated with use of locking and conventional plates for forearm fracture treatment. In this study we included 15 patients with forearm fracture managed by either locking or conventional plates and with more than 5 years of follow-up. Computed tomographic imaging of both forearms was performed to assess bone thickness and local bone mineral density and to predict bone strength without plate reinforcement based on finite element analysis. Mean patient age at surgery was 48.0 years. Eight patients underwent reduction with fixed locking plates and were followed up for a mean of 79.5 months; the remaining 7 patients were treated with conventional plates and were followed up for a mean of 105.0 months. Compared with the conventional plate group, the locking plate group had the same fractured limb-contralateral limb ratio of cortex bone thickness, but had significantly lower ratios of mineral density adjacent to the plate and adjusted bone strength. This study demonstrated bone atrophy after locking plate fixation for forearm fractures. Treatment plans for forearm fracture should take into consideration the impact of bone atrophy long after plate fixation. Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Control and postural thixotropy of the forearm muscles: changes caused by cold.

PubMed

Lakie, M; Walsh, E G; Wright, G W

1986-01-01

The forearm was cooled in water at 5-10 degrees C while wrist biodynamics were investigated. Pronounced loosening following a perturbation (thixotropy) was no longer seen. The wrist became stiffer for large or moderate but not small movements; EMG activity did not increase. Cooling the wrist alone, or opposite forearm, was without effect. The ability to make rapid reciprocating movements was reduced and muscle relaxation time was increased. Single movements were not affected.

Control and postural thixotropy of the forearm muscles: changes caused by cold.

PubMed Central

Lakie, M; Walsh, E G; Wright, G W

1986-01-01

The forearm was cooled in water at 5-10 degrees C while wrist biodynamics were investigated. Pronounced loosening following a perturbation (thixotropy) was no longer seen. The wrist became stiffer for large or moderate but not small movements; EMG activity did not increase. Cooling the wrist alone, or opposite forearm, was without effect. The ability to make rapid reciprocating movements was reduced and muscle relaxation time was increased. Single movements were not affected. PMID:3958734

Sympathetic and cardiovascular responses to venous distension in an occluded limb.

PubMed

Cui, Jian; Leuenberger, Urs A; Gao, Zhaohui; Sinoway, Lawrence I

2011-12-01

We recently showed that a fixed volume (i.e., 40 ml) of saline infused into the venous circulation of an arterially occluded vascular bed increases muscle sympathetic nerve activity (MSNA) and blood pressure. In the present report, we hypothesized that the volume and rate of infusion would influence the magnitude of the sympathetic response. Blood pressure, heart rate, and MSNA were assessed in 13 young healthy subjects during forearm saline infusions (arrested circulation). The effects of different volumes of saline (i.e., 2%, 3%, 4%, or 5% forearm volume at 30 ml/min) and different rates of infusion (i.e., 5% forearm volume at 10, 20, or 30 ml/min) were evaluated. MSNA and blood pressure responses were linked with the infusion volume. Infusion of 5% of forearm volume evoked greater MSNA responses than did infusion of 2% of forearm volume (Δ11.6 ± 1.9 vs. Δ3.1 ± 1.8 bursts/min and Δ332 ± 105 vs. Δ38 ± 32 units/min, all P < 0.05). Moreover, greater MSNA responses were evoked by saline infusion at 30 ml/min than 10 ml/min (P < 0.05). Sonographic measurements confirmed that the saline infusions induced forearm venous distension. The results suggest that volume and rate of saline infusion are important factors in evoking sympathetic activation. We postulate that venous distension contributes to cardiovascular autonomic adjustment in humans.

Human forearm metabolism during progressive starvation.

PubMed

Owen, O E; Reichard, G A

1971-07-01

Forearm muscle metabolism was studied in eight obese subjects after an overnight, 3 and 24 day fast. Arterio-deep-venous differences of oxygen, carbon dioxide, glucose, lactate, pyruvate, free fatty acids, acetoacetate, and beta-hydroxybutyrate with simultaneous forearm blood flow were measured. Rates of metabolite utilization and production were thus estimated. Oxygen consumption and lactate and pyruvate production remained relatively constant at each fasting period. Glucose, initially the major substrate consumed, showed decreased consumption after 3 and 24 days of fasting. Acetoacetate and beta-hydroxybutyrate consumption after an overnight fast was low. At 3 days of fasting with increased arterial concentrations of acetoactate and beta-hydroxybutyrate, consumption of these substrates rose dramatically. At 24 days of fasting, despite further elevation of arterial levels of acetoacetate and beta-hydroxybutyrate, the utilization of acetoacetate did not increase further and if anything decreased, while five out of eight subjects released beta-hydroxybutyrate across the forearm. Acetoacetate was preferentially extracted over beta-hydroxybutyrate. At 24 days of starvation, free fatty acids were the principal fuels extracted by forearm muscle; at this time there was a decreased glucose and also ketone-body consumption by skeletal muscle.

Subcutaneous Injection of Oxyfluorfen Herbicide to the Forearm: Case Report.

PubMed

Couceiro, José; Garcia-Portal, Gonzalo; Garcia, Olga

2017-10-01

Background  Oxyfluorfen, a commercially available pesticide, commonly used for weed control in crop production, has been studied in terms of its toxicity, its carcinogenic properties, and its teratogenicity. We have found no reports, however, of the effects produced by an oxyfluorfen injection to the upper limb. Methods  We present the case of a 40 years old psychiatric patient, who reportedly injected her forearm accidentally while fumigating her garden. She was treated with irrigation and open forearm fasciectomy. Results  At 6 months, the patient had some tenderness at the scar; she wanted no further procedures done. Conclusion  Oxyfluorfen appeared to produce a chemical burn to the forearm tissues including the fascia, removal of the chemical product, and a limited fasciectomy, resulted in a favorable outcome.

Subcutaneous Injection of Oxyfluorfen Herbicide to the Forearm: Case Report

PubMed Central

Couceiro, José; Garcia-Portal, Gonzalo; Garcia, Olga

2017-01-01

Background  Oxyfluorfen, a commercially available pesticide, commonly used for weed control in crop production, has been studied in terms of its toxicity, its carcinogenic properties, and its teratogenicity. We have found no reports, however, of the effects produced by an oxyfluorfen injection to the upper limb. Methods  We present the case of a 40 years old psychiatric patient, who reportedly injected her forearm accidentally while fumigating her garden. She was treated with irrigation and open forearm fasciectomy. Results  At 6 months, the patient had some tenderness at the scar; she wanted no further procedures done. Conclusion  Oxyfluorfen appeared to produce a chemical burn to the forearm tissues including the fascia, removal of the chemical product, and a limited fasciectomy, resulted in a favorable outcome. PMID:29276772

Model-based sensorimotor integration for multi-joint control: development of a virtual arm model.

PubMed

Song, D; Lan, N; Loeb, G E; Gordon, J

2008-06-01

An integrated, sensorimotor virtual arm (VA) model has been developed and validated for simulation studies of control of human arm movements. Realistic anatomical features of shoulder, elbow and forearm joints were captured with a graphic modeling environment, SIMM. The model included 15 musculotendon elements acting at the shoulder, elbow and forearm. Muscle actions on joints were evaluated by SIMM generated moment arms that were matched to experimentally measured profiles. The Virtual Muscle (VM) model contained appropriate admixture of slow and fast twitch fibers with realistic physiological properties for force production. A realistic spindle model was embedded in each VM with inputs of fascicle length, gamma static (gamma(stat)) and dynamic (gamma(dyn)) controls and outputs of primary (I(a)) and secondary (II) afferents. A piecewise linear model of Golgi Tendon Organ (GTO) represented the ensemble sampling (I(b)) of the total muscle force at the tendon. All model components were integrated into a Simulink block using a special software tool. The complete VA model was validated with open-loop simulation at discrete hand positions within the full range of alpha and gamma drives to extrafusal and intrafusal muscle fibers. The model behaviors were consistent with a wide variety of physiological phenomena. Spindle afferents were effectively modulated by fusimotor drives and hand positions of the arm. These simulations validated the VA model as a computational tool for studying arm movement control. The VA model is available to researchers at website http://pt.usc.edu/cel .

Efficacy of Ultrasound-Guided Axillary Brachial Plexus Block for Analgesia During Percutaneous Transluminal Angioplasty for Dialysis Access

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chiba, Emiko, E-mail: chibaemi23@comet.ocn.ne.jp; Hamamoto, Kohei, E-mail: hkouhei917@gmail.com; Nagashima, Michio, E-mail: nagamic00@gmail.com

PurposeTo evaluate the efficacy and safety of ultrasound (US)-guided axillary brachial plexus block (ABPB) for analgesia during percutaneous transluminal angioplasty (PTA) for dialysis access.Subjects and MethodsTwenty-one patients who underwent PTA for stenotic dialysis access shunts and who had previous experience of PTA without sedation, analgesia, and anesthesia were included. The access type in all patients was native arteriovenous fistulae in the forearm. Two radiologists performed US-guided ABPB for the radial and musculocutaneous nerves before PTA. The patients’ pain scores were evaluated using a visual analog scale (VAS) after PTA, and these were compared with previous sessions without US-guided ABPB. Themore » patient’s motor/sensory paralysis after PTA was also examined.ResultsThe mean time required to achieve US-guided ABPB was 8 min. The success rate of this procedure was 100 %, and there were no significant complications. All 21 patients reported lower VAS with US-guided ABPB as compared to without the block (p < 0.01). All patients expressed the desire for an ABPB for future PTA sessions, if required. Transient motor paralysis occurred in 8 patients, but resolved in all after 60 min.ConclusionUS-guided ABPB is feasible and effective for analgesia in patients undergoing PTA for stenotic dialysis access sites.Level of EvidenceLevel 4 (case series).« less

DEET Insect Repellent: Effects on Thermoregulatory Sweating and Physiological Strain

DTIC Science & Technology

2011-01-01

local measures of mean sweat rate of upper arm and forearm during 70 min of cycling exercise in *44C. They reported a significant increase in rectal...right arm of four volunteers and the left arm of the remaining five. The mid-point of the ventral forearm , between the antecubital space and the wrist...acclimation (45_C, 20% rh; 545 watts; 100 min/day) and performed three trials: control (CON); DEET applied to forearm (DEETLOC, 12 cm2 ); and DEET

Dynamic injury tolerances for long bones of the female upper extremity

PubMed Central

DUMA, STEFAN M.; SCHREIBER, PHIL H.; McMASTER, JOHN D.; CRANDALL, JEFF R.; BASS, CAMERON R.; PILKEY, WALTER D.

1999-01-01

This paper presents the dynamic injury tolerances for the female humerus and forearm derived from dynamic 3-point bending tests using 22 female cadaver upper extremities. Twelve female humeri were tested at an average strain rate of 3.7±1.3%/s. The strain rates were chosen to be representative of those observed during upper extremity interaction with frontal and side airbags. The average moment to failure when mass scaled for the 5th centile female was 128±19 Nm. Using data from the in situ strain gauges during the drop tests and geometric properties obtained from pretest CT scans, an average dynamic elastic modulus for the female humerus was found to be 24.4±3.9 GPa. The injury tolerance for the forearm was determined from 10 female forearms tested at an average strain rate of 3.94±2.0%/s. Using 3 matched forearm pairs, it was determined that the forearm is 21% stronger in the supinated position (92±5 Nm) versus the pronated position (75±7 Nm). Two distinct fracture patterns were seen for the pronated and supinated groups. In the supinated position the average difference in fracture time between the radius and ulna was a negligible 0.4±0.3 ms. However, the pronated tests yielded an average difference in fracture time of 3.6±1.2 ms, with the ulna breaking before the radius in every test. This trend implies that in the pronated position, the ulna and radius are loaded independently, while in the supinated position the ulna and radius are loaded together as a combined structure. To produce a conservative injury criterion, a total of 7 female forearms were tested in the pronated position, which resulted in the forearm injury criterion of 58±12 Nm when scaled for the 5th centile female. It is anticipated that these data will provide injury reference values for the female forearm during driver air bag loading, and the female humerus during side air bag loading. PMID:10386782

Evidence-based Comprehensive Approach to Forearm Arterial Laceration

PubMed Central

Thai, Janice N.; Pacheco, Jose A.; Margolis, David S.; Swartz, Tianyi; Massey, Brandon Z.; Guisto, John A.; Smith, Jordan L.; Sheppard, Joseph E.

2015-01-01

Introduction Penetrating injury to the forearm may cause an isolated radial or ulnar artery injury, or a complex injury involving other structures including veins, tendons and nerves. The management of forearm laceration with arterial injury involves both operative and nonoperative strategies. An evolution in management has emerged especially at urban trauma centers, where the multidisciplinary resource of trauma and hand subspecialties may invoke controversy pertaining to the optimal management of such injuries. The objective of this review was to provide an evidence-based, systematic, operative and nonoperative approach to the management of isolated and complex forearm lacerations. A comprehensive search of MedLine, Cochrane Library, Embase and the National Guideline Clearinghouse did not yield evidence-based management guidelines for forearm arterial laceration injury. No professional or societal consensus guidelines or best practice guidelines exist to our knowledge. Discussion The optimal methods for achieving hemostasis are by a combination approach utilizing direct digital pressure, temporary tourniquet pressure, compressive dressings followed by wound closure. While surgical hemostasis may provide an expedited route for control of hemorrhage, this aggressive approach is often not needed (with a few exceptions) to achieve hemostasis for most forearm lacerations. Conservative methods mentioned above will attain the same result. Further, routine emergent or urgent operative exploration of forearm laceration injuries are not warranted and not cost-beneficial. It has been widely accepted with ample evidence in the literature that neither injury to forearm artery, nerve or tendon requires immediate surgical repair. Attention should be directed instead to control of bleeding, and perform a complete physical examination of the hand to document the presence or absence of other associated injuries. Critical ischemia will require expeditious surgical restoration of arterial perfusion. In a well-perfused hand, however, the presence of one intact artery is adequate to sustain viability without long-term functional disability, provided the palmar arch circulation is intact. Early consultation with a hand specialist should be pursued, and follow-up arrangement made for delayed primary repair in cases of complex injury. Conclusion Management in accordance with well-established clinical principles will maximize treatment efficacy and functional outcome while minimizing the cost of medical care. PMID:26759666

Decreased active vasodilator sensitivity in aged skin.

PubMed

Kenney, W L; Morgan, A L; Farquhar, W B; Brooks, E M; Pierzga, J M; Derr, J A

1997-04-01

Older men and women respond to local and reflex-mediated heat stress with an attenuated increase in cutaneous vascular conductance (CVC). This study was performed to test the hypothesis that an augmented or sustained noradrenergic vasoconstriction (VC) may play a role in this age-related difference. Fifteen young (22 +/- 1 yr) and 15 older (66 +/- 1 yr) men exercised at 50% peak oxygen uptake in a 36 degrees C environment. Skin perfusion was monitored at two sites on the right forearm by laser-Doppler flowmetry: one site pretreated with bretylium tosylate (BT) to block the local release of norepinephrine and thus VC and an adjacent control site. Blockade of reflex VC was verified during whole body cooling using a water-perfused suit. CVC (perfusion divided by mean arterial pressure) at each site was reported as a percentage of the maximal CVC (%CVCmax) induced at the end of each experiment by prolonged local heating at 42 degrees C. Neither age nor BT affected the %CVCmax (75-86%) attained at high core temperatures. During the early rise phase of CVC, the %CVCmax-change in esophageal temperature (delta T(es)) curve was shifted to the right in the older men (effective delta T(es) associated with 50% CVC response for young, 0.22 +/- 0.04 and 0.39 +/- 0.04 degrees C and for older, 0.73 +/- 0.04 and 0.85 +/- 0.04 degrees C at control and BT sites, respectively). BT had no interactive effect on this age difference, suggesting a lack of involvement of the VC system in the attenuated CVC response of individuals over the age of 60 yr. Additionally, increases in skin vascular conductance were quantitatively compared by measuring increases in total forearm vascular conductance (FVC, restricted to the forearm skin under these conditions). After the initial approximately 0.2 degrees C increase in T(es), FVC was 40-50% lower in the older men (P < 0.01) for the remainder of the exercise. Decreased active vasodilator sensitivity to increasing core temperature, coupled with structural limitations to vasodilation, appears to limit the cutaneous vascular response to exertional heat stress in older subjects.

Finding the Center of Volume of the Forearm

NASA Astrophysics Data System (ADS)

Klein, Stacy S.; Roselli, Robert J.

2008-04-01

A typical first-year physics course teaches students about the center of mass using both regular and irregularly shaped objects. Students often suspend an object in each of two dimensions from a string with the intersection determining the center of mass of the object. While these methods can be effective, they are not particularly exciting or motivating. Wouldn't it be more interesting to find the center of mass of a body part, such as the forearm? Through a series of simple measurements and assumptions, students can generate a first-order approximation of the center of volume and center of mass of their forearm. Comparisons can be made between the muscular forearm of the football player in the class with the scrawniest arm in the room, creating a deeper understanding of center of mass and how it relates to the human body.

Double-layered collagen graft to the radial forearm free flap donor sites without skin graft.

PubMed

Park, Tae-Jun; Kim, Hong-Joon; Ahn, Kang-Min

2015-12-01

Radial forearm free flap is the most reliable flap for intraoral soft tissue reconstruction after cancer ablation surgery. However, unesthetic scar of the donor site and the need for a second donor site for skin graft are major disadvantages of the forearm flap. The purpose of this study was to report the clinical results of double-layered collagen graft to the donor site of the forearm free flap without skin graft. Twenty-two consecutive patients who underwent oral cancer ablation and forearm reconstruction between April 2010 and November 2013 were included in this study. Male to female ratio was 12:10, and average age was 61.0 years old (27-84). Double-layered collagen was grafted to the donor site of the forearm free flap and healed for secondary intention. Upper silicone had been trimmed at the periphery during secondary intention, and dry dressing was used. Postoperative scar healing and esthetic results and function were evaluated. An average follow-up period was 34.9 months. The scar area was decreased to 63.9 % in average. The complete healing was obtained between 1.5 and 3 months according to the defect size. There was no functional defect or impairment 3 months after operation. All patients were satisfied with the esthetic results. Three patients died of recurred cancer. Double-layered collagen graft was successfully performed in this study. Without the thigh skin graft, patients had experienced less painful postoperative healing periods and discomfort.

Limb neurovascular control during altered otolithic input in humans

NASA Technical Reports Server (NTRS)

Monahan, Kevin D.; Ray, Chester A.

2002-01-01

Head-down rotation (HDR), which activates the vestibulosympathetic reflex, increases leg muscle sympathetic nerve activity (MSNA) and produces calf vasoconstriction with no change in either cardiac output or arterial blood pressure. Based on animal studies, it was hypothesized that differential control of arm and leg MSNA explains why HDR does not alter arterial blood pressure. Fifteen healthy subjects were studied. Heart rate, arterial blood pressure, forearm and calf blood flow, and leg MSNA responses were measured during HDR in these subjects. Simultaneous recordings of arm and leg MSNA were obtained from five of the subjects. Forearm and calf blood flow, vascular conductances, and vascular resistances were similar before HDR, as were arm and leg MSNA. HDR elicited similar significant increases in leg (Delta 6 +/- 1 bursts min(-1); 59 +/- 16 % from baseline) and arm MSNA (Delta 5 +/- 1 bursts min(-1); 80 +/- 28 % from baseline). HDR significantly decreased calf (-19 +/- 2 %) and forearm vascular conductance (-12 +/- 2 %) and significantly increased calf (25 +/- 4 %) and forearm vascular resistance (15 +/- 2 %), with 60 % greater vasoconstriction in the calf than in the forearm. Arterial blood pressure and heart rate were not altered by HDR. These results indicate that there is no differential control of MSNA in the arm and leg during altered feedback from the otolith organs in humans, but that greater vasoconstriction occurs in the calf than in the forearm. These findings indicate that vasodilatation occurs in other vascular bed(s) to account for the lack of increase in arterial blood pressure during HDR.

Electromyographic Comparison of Forearm Muscle Movements for Fine Skin Suturing Between an Enlarged Pen Needle Holder and a Webster Needle Holder

PubMed Central

Ohata, Erika; Matsuo, Kiyoshi; Ban, Ryokuya; Shiba, Masato; Yasunaga, Yoshichika

2013-01-01

Background: For surgical suturing, a Webster needle holder uses wrist supinating with supinator and extrinsic muscles, whereas a pen needle holder uses finger twisting with intrinsic and extrinsic muscles. Because the latter is better suited to microsurgery, which requires fine suturing with less forearm muscle movement, we have recently adopted an enlarged pen needle holder scaled from a micro needle holder for fine skin suturing. In this study, we assessed whether the enlarged pen needle holder reduced forearm muscle movement during fine skin suturing as compared with the Webster needle holder. Methods: A fine skin-suturing task was performed using pen holding with the enlarged micro needle holder or scissor holding with the Webster needle holder by 9 experienced and 6 inexperienced microsurgeons. The task lasted for 60 seconds and was randomly performed 3 times for each method. Forearm flexor and extensor muscular activities were evaluated by surface electromyography. Results: The enlarged pen needle holder method required significantly less forearm muscle movement for experienced microsurgeons despite it being their first time using the instrument. There was no significant difference between 2 methods for inexperienced microsurgeons. Conclusions: Experienced microsurgeons conserved forearm muscle movement by finger twisting in fine skin suturing with the enlarged pen needle holder. Inexperienced microsurgeons may benefit from the enlarged pen needle holder, even for fine skin suturing, to develop their internal acquisition model of the dynamics of finger twisting. PMID:23691259

Electromyographic comparison of forearm muscle movements for fine skin suturing between an enlarged pen needle holder and a webster needle holder.

PubMed

Ohata, Erika; Matsuo, Kiyoshi; Ban, Ryokuya; Shiba, Masato; Yasunaga, Yoshichika

2013-01-01

For surgical suturing, a Webster needle holder uses wrist supinating with supinator and extrinsic muscles, whereas a pen needle holder uses finger twisting with intrinsic and extrinsic muscles. Because the latter is better suited to microsurgery, which requires fine suturing with less forearm muscle movement, we have recently adopted an enlarged pen needle holder scaled from a micro needle holder for fine skin suturing. In this study, we assessed whether the enlarged pen needle holder reduced forearm muscle movement during fine skin suturing as compared with the Webster needle holder. A fine skin-suturing task was performed using pen holding with the enlarged micro needle holder or scissor holding with the Webster needle holder by 9 experienced and 6 inexperienced microsurgeons. The task lasted for 60 seconds and was randomly performed 3 times for each method. Forearm flexor and extensor muscular activities were evaluated by surface electromyography. The enlarged pen needle holder method required significantly less forearm muscle movement for experienced microsurgeons despite it being their first time using the instrument. There was no significant difference between 2 methods for inexperienced microsurgeons. Experienced microsurgeons conserved forearm muscle movement by finger twisting in fine skin suturing with the enlarged pen needle holder. Inexperienced microsurgeons may benefit from the enlarged pen needle holder, even for fine skin suturing, to develop their internal acquisition model of the dynamics of finger twisting.

Bilateral changes in forearm oxygen consumption at rest and after exercise in patients with unilateral repetitive strain injury: a case-control study.

PubMed

Brunnekreef, Jaap J J; Thijssen, Dick H J; Oosterhof, Jan; Hopman, Maria T E

2012-04-01

Case-control study. To investigate whether oxygen consumption and blood flow at rest and after exercise are lower in the affected arm of patients with repetitive strain injury (RSI) compared to controls, and lower in the healthy nonaffected forearm within patients with unilateral RSI. RSI is considered an upper extremity overuse injury. Despite the local presentation of complaints, RSI may be represented by systemic adaptations. Insight into the pathophysiology of RSI is important to better understand the development of RSI complaints and to develop effective treatment and prevention strategies. Twenty patients with unilateral RSI and 20 gender-matched control subjects participated in this study. Forearm muscle blood flow and oxygen consumption were measured using near-infrared spectroscopy at baseline and immediately after isometric handgrip exercises at 10%, 20%, and 40% of the individual maximal voluntary contraction. Unilateral RSI resulted in a lower oxygen consumption and blood flow in the affected forearm at baseline and lower oxygen consumption after incremental handgrip exercises compared to controls (P<.05). In addition, exercise-induced blood flow and oxygen consumption in the nonaffected forearm in patients with RSI were similarly reduced. Blood flow and oxygen consumption after exercise are similarly attenuated in the affected and nonaffected arms of patients with unilateral RSI. Our findings suggest that, despite the unilateral character in clinical symptoms, RSI demonstrates systemic adaptations in forearm blood flow and oxygen consumption at rest and after exercise.

Carotid-cardiac baroreflex influence on forearm vascular resistance during low level LBNP

NASA Technical Reports Server (NTRS)

Ludwig, David

1990-01-01

Twelve healthy males were tested at low levels of lower body negative pressure (LBNP) with and without artificial stimulation of the carotid-cardiac baroreceptors. The carotid-cardiac baroreceptors were stimulated by applying a pressure of 10 mmHg to the carotid artery via a pressurized neck chamber. During the procedure, forearm blood flow (FBF) and forearm vascular resistance (FVR) were measured using a Whitney mercury silastic strain gauge technique. FBF decreased while FVR increased with increased intensity of LBNP. Both FBF and FVR were unaffected by carotid-cardiac baroreceptor stimulation.

Minor Morbidity with Emergency Tourniquet Use to Stop Bleeding in Severe Limb Trauma: Research, History, and Reconciling Advocates and Abolitionists

DTIC Science & Technology

2011-07-01

unknown. If we say these 13 limbs had only one tourniquet per limb, then the total number of tourniquets was 875. The body regions ( forearm , arm ...leg, thigh) where the tourniquets were applied to the 651 limbs included 436 thighs, 162 arms , 46 legs, 13 forearms , 8 limbs where the tourniquets...I body region ( forearm 0113, thigh 2/436, leg, 1146, and arm : 6/162). The overall rate of side-by-side use was 20% (93 • of 461 limbs). There

Dual intersection syndrome of the forearm: a case report

PubMed Central

Zhari, Bouchra; Edderai, Meryem; Boumdine, Hassan; Amil, Touriya; En-nouali, Hassan

2015-01-01

The intersection syndrome, described since the 19th century, is an uncommon disorder associated with rubbing at the crossing point between the first dorsal compartment muscles and the radial wrist extensor muscles. Imaging modalities used to diagnosis this syndrome includes ultrasonography and magnetic resonance imaging. We reported a case of a 60-year-old man presented to our formation with painful swelling on the dorsum of the wrist and forearm. An MRI and an ultrasound were performed, and objectified a dual cross syndrome of the forearm. PMID:26587172

Design and analysis of coiled fiber reinforced soft pneumatic actuator.

PubMed

Singh, Gaurav; Xiao, Chenzhang; Hsiao-Wecksler, Elizabeth T; Krishnan, Girish

2018-04-18

Fiber reinforced elastomeric enclosures (FREEs) are soft pneumatic actuators that can contract and generate forces upon pressurization. Typical engineering applications utilize FREEs in their straight cylindrical configuration and derive actuation displacement and forces from their ends. However, there are several instances in nature, such as an elephant trunk, snakes and grapevine tendrils, where a spiral configuration of muscle systems is used for gripping, thereby establishing a mechanical connection with uniform force distribution. Inspired by these examples, this paper investigates the constricting behavior of a contracting FREE actuator deployed in a spiral or coiled configuration around a cylindrical object. Force balance is used to model the blocked force of the FREE, which is then related to the constriction force using a string model. The modeling and experimental findings reveal an attenuation in the blocked force, and thus the constriction force caused by the coupling of peripheral contact forces acting in the spiral configuration. The usefulness of the coiled FREE configuration is demonstrated in a soft arm orthosis for crutch users that provides a constriction force around the forearm. This design minimizes injury risk by reducing wrist load and improving wrist posture.

Quantifying Forearm Muscle Activity during Wrist and Finger Movements by Means of Multi-Channel Electromyography

PubMed Central

Gazzoni, Marco; Celadon, Nicolò; Mastrapasqua, Davide; Paleari, Marco; Margaria, Valentina; Ariano, Paolo

2014-01-01

The study of hand and finger movement is an important topic with applications in prosthetics, rehabilitation, and ergonomics. Surface electromyography (sEMG) is the gold standard for the analysis of muscle activation. Previous studies investigated the optimal electrode number and positioning on the forearm to obtain information representative of muscle activation and robust to movements. However, the sEMG spatial distribution on the forearm during hand and finger movements and its changes due to different hand positions has never been quantified. The aim of this work is to quantify 1) the spatial localization of surface EMG activity of distinct forearm muscles during dynamic free movements of wrist and single fingers and 2) the effect of hand position on sEMG activity distribution. The subjects performed cyclic dynamic tasks involving the wrist and the fingers. The wrist tasks and the hand opening/closing task were performed with the hand in prone and neutral positions. A sensorized glove was used for kinematics recording. sEMG signals were acquired from the forearm muscles using a grid of 112 electrodes integrated into a stretchable textile sleeve. The areas of sEMG activity have been identified by a segmentation technique after a data dimensionality reduction step based on Non Negative Matrix Factorization applied to the EMG envelopes. The results show that 1) it is possible to identify distinct areas of sEMG activity on the forearm for different fingers; 2) hand position influences sEMG activity level and spatial distribution. This work gives new quantitative information about sEMG activity distribution on the forearm in healthy subjects and provides a basis for future works on the identification of optimal electrode configuration for sEMG based control of prostheses, exoskeletons, or orthoses. An example of use of this information for the optimization of the detection system for the estimation of joint kinematics from sEMG is reported. PMID:25289669

Reproducibility of forearm vasodilator response to intra-arterial infusion of calcitonin gene-related peptide assessed by venous occlusion plethysmography

PubMed Central

Vanmolkot, Floris H M; de Hoon, Jan N J M

2005-01-01

Aims To assess the reproducibility of the forearm blood flow (FBF) response to intra-arterial infusion of calcitonin-gene related peptide (CGRP), measured by venous occlusion plethysmography. In addition, to compare different ways of expressing the FBF response and perform sample size calculations. Methods On two separate visits, CGRP (10 ng min−1 dl−1 forearm) was infused for 45 min into the brachial artery of six healthy subjects. Reproducibility was assessed by calculating mean difference, repeatability coefficient, within-subject coefficient of variation (WCV) and intraclass correlation coefficient. Results CGRP increased FBF from 2.8 ± 0.4 and 3.2 ± 0.7 (at baseline) to 15.4 ± 1.4 and 15.2 ± 1.5 ml min−1 dl−1 forearm (at 45 min) on visits 1 and 2, respectively (P < 0.0001 for both visits). Mean difference in FBF at 45 min between both visits was 0.3 ml min−1 dl−1 forearm (repeatability coefficient: 4.1 ml min−1 dl−1 forearm). This FBF response appeared to be more reproducible when expressed as absolute FBF in the infused arm (WCV 11%) compared with absolute FBF-ratio between both arms (WCV 37%), percentage change from baseline in FBF in the infused arm (WCV 29%) and percentage change from baseline in FBF-ratio (WCV 40%). When expressed as absolute FBF, a sample size of five (95% confidence interval: 2–12) subjects gives 90% power at a type I error probability of 0.05 to detect a 25% shift in FBF response. Conclusions Intra-arterial infusion of CGRP results in a forearm vasodilator response which is reproducible between days. This response is most reproducible when expressed as absolute FBF. The presented methodology provides a suitable pharmacodynamic model to assess the in vivo activity of CGRP-receptor antagonists in a small number of subjects. PMID:15801933

Current paediatric orthopaedic practice in hereditary multiple osteochondromas of the forearm: a systematic review

PubMed Central

EL-Sobky, Tamer A.; Samir, Shady; Atiyya, Ahmed Naeem; Mahmoud, Shady; Aly, Ahmad S.; Soliman, Ramy

2018-01-01

Introduction: This systematic review aims to answer three research questions concerning the management of hereditary multiple osteochondromas of forearm in children: What is the best available evidence for the currently employed surgical procedures? What patient characteristics are associated with better prognosis? What disease characteristics are associated with better prognosis? Methods: We searched the literature using three major databases with no publication date restrictions. To enhance search sensitivity and maintain precision we used keywords/subject terms correlating with patient population, problem and interventions. We used strict inclusion/exclusion criteria to improve validity evidence. Results: The search process yielded 34 eligible studies with a total of 282 patients (315 forearms). We comprehensively analysed study and patient demographics and interventions and outcomes. Eleven studies (32%) had a long-term follow-up and 31 studies (91%) were retrospective. Of the total number of forearms, ulnar lengthening +/− associated procedures was used in 210 forearms (66.7%), isolated osteochondroma excision in 65 forearms (20.6%) and isolated distal radius hemiepiphysiodesis in 15 forearms (4.7%) among others. Discussion: Ulnar lengthening can restore radiologic anatomy, improve appearance and to a lesser extent objective clinical parameters like joint range of motion on the short/intermediate term. Isolated osteochondroma excision can relief pain and satisfy cosmetic concerns occasionally. There is poor evidence to suggest that surgery improves quality of life or function. Predictors of surgical success in regard to patient and disease characteristics remain elusive. Natural history and prospective randomized control studies where the control group receives no treatment should be rethought. They have the potential for bias control and identification of the ideal surgical candidate. The complex interplay between the confounding variables has undermined the capability of most studies to provide well-grounded evidence to support and generalize their conclusions. Valid quality of life scales should supplement objective outcome measures. PMID:29565244

Rotationally Actuated Prosthetic Hand

NASA Technical Reports Server (NTRS)

Norton, William E.; Belcher, Jewell G., Jr.; Carden, James R.; Vest, Thomas W.

1991-01-01

Prosthetic hand attached to end of remaining part of forearm and to upper arm just above elbow. Pincerlike fingers pushed apart to degree depending on rotation of forearm. Simpler in design, simpler to operate, weighs less, and takes up less space.

Refractures of the paediatric forearm with the intramedullary nail in situ.

PubMed

van Egmond, Pim W; van der Sluijs, Hans A; van Royen, Barend J; Saouti, Rachid

2013-09-24

Forearm fractures in children are common. When conservative treatment fails, internal fixation with Elastic Stable Intramedullary Nailing (ESIN) become the first choice in the operative treatment of diaphyseal forearm shaft fractures. Refractures with the intramedullary nail in situ are known to occur but formal guidelines to guide management in such fractures are lacking. We present a well-documented case of a radius midshaft refracture in a 12-year-old boy with the intramedullary nail in situ, managed by closed reduction. Literature is reviewed for this type of complication, the treatment of 30 similar cases is discussed and a treatment strategy is defined. The refracture of the paediatric forearm fracture with the intramedullary nail in situ is a rare, but probably under recognised complication which is observed in approximately 2.3% of the study population. Closed reduction may be considered in these cases.

The effects of cold immersion and hand protection on grip strength.

PubMed

Vincent, M J; Tipton, M J

1988-08-01

The maximal voluntary grip strength (MVGS) of male volunteers was examined following a series of five intermittent 2 min cold water (5 degrees C) immersions of the unprotected hand or forearm. MVGS changes due to wearing a protective glove were also investigated. The surface electrical activity over the hand flexor muscles was recorded, as was the skin temperature of the hand and forearm. MVGS decreased significantly (p less than 0.01) following hand immersions (16%) and forearm immersion (13%). The majority of these reductions occurred during the first 2-min period of immersion. The effect of wearing a glove after unprotected hand cooling also produced significant (p less than 0.01) MVGS reductions which averaged 14%. These reductions were in addition to those caused by hand cooling. We conclude that both hand and forearm protection are important for the maintenance of hand-grip strength following cold water immersion.

Shooting performance is related to forearm temperature and hand tremor size.

PubMed

Lakie, M; Villagra, F; Bowman, I; Wilby, R

1995-08-01

The changes in postural tremor of the hand and the subsequent effect on shooting performance produced by moderate cooling and heating of the forearm were studied in six subjects. Cooling produced a large decrease in tremor size of the ipsilateral hand, whereas warming the limb produced an increase in tremor size. Cooling or warming the forearm did not change the peak frequency of tremor significantly, which was quite stable for each subject. The improvement in shooting performance after cooling the forearm, as measured by grouping pattern of the shots, reached statistical significance and warming caused a significant worsening. This measure of performance was shown to correlate (r = 0.776) inversely with tremor size. The causes and implications of these changes are discussed. It is suggested that local cooling may be useful for people who wish temporarily to reduce tremor in order to improve dexterity for shooting and for other purposes.

Phalloplasty in Female-to-Male Transsexuals by Gottlieb and Levine's Free Radial Forearm Flap Technique-A Long-Term Single-Center Experience Over More than Two Decades.

PubMed

Wirthmann, Anna E; Majenka, Pawel; Kaufmann, Melanie C; Wellenbrock, Sascha V; Kasper, Lara; Hüttinger, Susanne; Djedovic, Gabriel; Bozkurt, Ahmet; Sohn, Michael; Rieger, Ulrich M

2018-05-01

 The free radial forearm flap phalloplasty is the most utilized method for penile reconstruction. Among the techniques described in the literature, evidence for the flap design after Gottlieb and Levine is poor.  From January 1993 until December 2015, 402 phalloplasties were performed in our clinic. Among the 247 free radial forearm flap phalloplasties, 232 free radial forearm flap phalloplasties were performed after Gottlieb and Levine in 229 patients. Operation and patient-specific characteristics were evaluated.  This study presents the highest number of free radial forearm flap phalloplasties after Gottlieb and Levine. The rate of total flap failure was 3%; 46% of the patients were heavy smokers. Urinary fistulae and strictures are common. The revision rate for urinary fistulae and/or strictures was 1.3 per patient. The number of postoperative complications, such as bleeding (14.2%), thrombosis of the flap requiring revision (11.2%), or delayed wound healing (16.8%) was considering the high rate of nicotine abuse (45.9%) reasonable.  The free radial forearm phalloplasty in the design by Gottlieb and Levine is well established at our institution and has proven safe and reliable since 1993. The operative results are satisfactory for both patients and surgeons even in the presence of relevant comorbidities and heavy smoking. We acknowledge the long ordeal and psychological pressure that our patients suffer from, before presenting in our outpatient clinic. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Does fluoroscopy improve outcomes in paediatric forearm fracture reduction?

PubMed

Menachem, S; Sharfman, Z T; Perets, I; Arami, A; Eyal, G; Drexler, M; Chechik, O

2016-06-01

To compare the radiographic results of paediatric forearm fracture reduced with and without fluoroscopic enhancement to investigate whether fractures reduced under fluoroscopic guidance would have smaller residual deformities and lower rates of re-reduction and surgery. A retrospective cohort analysis was conducted comparing paediatric patients with acute forearm fracture in two trauma centres. Demographics and radiographic data from paediatric forearm fractures treated in Trauma Centre A with the aid of a C-arm fluoroscopy were compared to those treated without fluoroscopy in Trauma Centre B. Re-reduction, late displacement, post-reduction deformity, and need for surgical intervention were compared between the two groups. The cohort included 229 children (175 boys and 54 girls, mean age 9.41±3.2 years, range 1-16 years) with unilateral forearm fractures (83 manipulated with fluoroscopy and 146 without). Thirty-four (15%) children underwent re-reduction procedures in the emergency department. Fifty-three (23%) children had secondary displacement in the cast, of which 18 were operated on, 20 were re-manipulated, and the remaining 15 were kept in the cast with an acceptable deformity. Twenty-nine additional children underwent operation for reasons other than secondary displacement. There were no significant differences in re-reduction and surgery rates or in post-reduction deformities between the two groups. The use of fluoroscopy during reduction of forearm fractures in the paediatric population apparently does not have a significant effect on patient outcomes. Reductions performed without fluoroscopy were comparably accurate in correcting deformities in both coronal and sagittal planes. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Augmented sympathetic vasoconstriction in exercising forearms of postmenopausal women is reversed by oestrogen therapy

PubMed Central

Fadel, Paul J; Wang, Zhongyun; Watanabe, Hitoshi; Arbique, Debbie; Vongpatanasin, Wanpen; Thomas, Gail D

2004-01-01

Sympathetic vasoconstriction is normally attenuated in exercising muscles of young men and women. Recent evidence indicates that such modulation, termed functional sympatholysis, may be impaired in older men. Whether a similar impairment occurs in older women, and what role oestrogen deficiency might play in this impairment, are not known. Based on the strong positive correlation between circulating oestrogen levels and functional sympatholysis previously reported in female rats, we hypothesized that sympatholysis would be impaired in oestrogen-deficient postmenopausal women, and that this impairment would be reversed by oestrogen replacement. To test these hypotheses, we measured vasoconstrictor responses in the forearms of pre- and postmenopausal women using near infrared spectroscopy to detect decreases in muscle oxygenation in response to reflex activation of sympathetic nerves evoked by lower body negative pressure (LBNP). In eight premenopausal women, LBNP decreased muscle oxygenation by 20 ± 1% in resting forearm, but only by 3 ± 2% in exercising forearm (P < 0.05). In contrast, in eight postmenopausal women, LBNP decreased muscle oxygenation by 15 ± 3% in resting forearm, and by 12 ± 4% in exercising forearm (P > 0.05). After 1 month of transdermal oestradiol replacement in these women, the normal effect of exercise to blunt sympathetic vasoconstriction was restored (rest, −19 ± 3%; exercise, −2 ± 3%; P < 0.05). These data indicate that functional sympatholysis is impaired in oestrogen-deficient postmenopausal women. The effect of short-term unopposed oestrogen replacement to correct this impairment implicates a role for oestrogen in the sympathetic neural control of muscle haemodynamics during exercise. PMID:15498809

Which factors affect limitation of pronation/supination after forearm fractures in children? A prospective multicentre study.

PubMed

Colaris, Joost W; Allema, Jan Hein; Reijman, Max; de Vries, Mark R; Ulas Biter, L; Bloem, Rolf M; van de Ven, Cees P; Verhaar, Jan A N

2014-04-01

Both-bone forearm fractures in children frequently result in a limitation of pronation/supination, which hinders daily activities. The purpose of this prospective multicentre study was to investigate which clinical factors are related to the limitation of pronation/supination in children with a both-bone forearm fracture. In four Dutch hospitals, consecutive children (<16 years) who sustained a both-bone forearm fracture were included. Children were followed up for 6-9 months and data from questionnaires, physical examination and X-rays were collected. Univariate and multivariate logistic regression analyses were used to assess the relationship between limitation of pronation/supination (≥20°) and several clinical factors. A group of 410 children with both-bone forearm fractures were included, of which 10 children missed the final examination (follow-up rate of 97.6%). We found that a re-fracture (odds ratio (OR) 11.7, 95% confidence interval (CI) 1.2; 118.5), a fracture in the diaphysis (OR 3.3, 95% CI 1.4; 7.9) and less physiotherapy during follow-up (OR 0.90, 95% CI 0.82; 0.98) were independently associated with a limitation of pronation/supination of 20° or more. These findings imply that a re-fracture and a diaphyseal located fracture were associated independently of each other with a limitation of pronation/supination in children with a both-bone forearm fracture. Furthermore, in children with severe limitation extensive physiotherapy is associated with better functional outcome. Copyright © 2013 Elsevier Ltd. All rights reserved.

Comparison study of upper arm and forearm non-invasive blood pressures in adult Emergency Department patients.

PubMed

Schimanski, Karen; Jull, Andrew; Mitchell, Nancy; McLay, Jessica

2014-12-01

Forearm blood pressures have been suggested as an alternative site to measure blood pressures when the upper arm is unavailable. However there is little evidence utilising clinical populations to support this substitution. To determine agreement between blood pressures measured in the left upper arm and forearm using a singular oscillometric non-invasive device in adult Emergency Department patients. The secondary objective was to explore the relationship of blood pressure differences with age, sex, ethnicity, smoking history and obesity. Single centre comparison study. Adult Emergency Department, Tertiary Trauma Centre. Forty-four participants who met inclusion/exclusion criteria selected sequentially from the Emergency Department arrival board. A random assignment of order of measurement for left upper arm and forearm blood pressures was utilised. Participants were eligible if they were aged 18 years or older, had been assigned an Australasian Triage Scale code of 2, 3, 4, or 5, were able to consent, and able to have blood pressures measured on their left arm whilst lying at a 45° angle. The Bland-Altman method of statistical analysis was used, with the level of agreement for clinical acceptability for the systolic, diastolic and mean arterial pressure defined as ±10 mmHg. The forearm measure overestimated systolic (mean difference 2.2 mmHg, 95% limits of agreement ±19 mmHg), diastolic (mean difference 3.4 mmHg, 95% limits of agreement ±14.4 mmHg), and mean arterial pressures (mean difference 4.1 mmHg, 95% limits of agreement ±13.7 mmHg). The systolic measure was not significantly different from zero. Evidence of better agreement was found with upper arm/forearm systolic measures below 140 mmHg compared to systolic measures above 140 mmHg using the Levene's test (p=0.002, F-statistic=11.09). Blood pressure disparity was not associated with participant characteristics. Forearm measures cannot routinely replace upper arm measures for blood pressure measurement. If the clinical picture requires use of forearm blood pressure, the potential variance from an upper arm measure is ±19 mmHg for systolic pressure, although the variability may be close to ±10 mmHg if the systolic blood pressure is below 140 mmHg. Copyright © 2014 Elsevier Ltd. All rights reserved.

Tourniquet application after local forearm warming to improve venodilation for peripheral intravenous cannulation in young and middle-aged adults: A single-blind prospective randomized controlled trial.

PubMed

Yamagami, Yuki; Tomita, Kohei; Tsujimoto, Tomomi; Inoue, Tomoko

2017-07-01

Local forearm warming before tourniquet application is often used to promote venodilation for peripheral intravenous cannulation; however, few studies have compared the effect of tourniquet application with and without local warming on vein size. To evaluate the effectiveness of tourniquet application after local forearm warming with that of tourniquet application alone in young and middle-aged adults. A single-blind, prospective, parallel group, randomized controlled trial. A national university in Japan. Seventy-two volunteers aged 20-64 years. Participants were randomly allocated to one of two groups: tourniquet application for 30s after forearm application of a heat pack warmed to 40°C±2°C for 15min (active warming group; n=36) or tourniquet application for 30s after applying a non-warmed heat pack for 15min (passive warming group; n=36). The primary outcomes were vein cross-sectional area on the forearm, measured after the intervention by blinded research assistants using ultrasound. Secondary outcomes were shortest diameter, and longest diameter of vein on the forearm, forearm skin temperature, body temperature, pulse, systolic blood pressure, and diastolic blood pressure. All outcomes were assessed at the same site before and immediately after the intervention, once per participant. Vein cross-sectional area, shortest vein diameter, and longest vein diameter were significantly increased in the active warming group compared with the passive warming group (p <0.01). Tourniquet application after local warming was superior to tourniquet application alone in increasing vein cross-sectional, shortest diameter, and longest diameter (between-group differences of 2.2mm 2 , 0.5mm, and 0.5mm, respectively), and in raising skin temperature (between-group difference: 5.2°C). However, there were no significant differences in body temperature, pulse, or systolic or diastolic blood pressure between the groups. There were no adverse events associated with either intervention. Tourniquet application after local warming was associated with increased forearm vein size when compared with tourniquet application alone, and was demonstrated as being safe. Thus, with demonstrable effects on vein size, we recommend local warming before tourniquet application as a safe and effective technique for improving venodilation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Extensive forearm deep venous thrombosis following a severe infliximab infusion reaction.

PubMed

Ryan, Barbara M; Romberg, Marielle; Wolters, Frank; Stockbrugger, Reinhold W

2004-09-01

Here we describe a patient with Crohn's disease who developed a severe infliximab infusion reaction (IIR), complicated 1 day later by severe swelling of the forearm and hand ipsilateral to the site of infliximab infusion. This proved to be extensive forearm deep venous thrombosis. The site of thrombosis and the chronological relationship with the IIR implicates a hypersensitivity to infliximab in the causation of the venous thrombosis in this case. With an increasing trend towards re-treating patients with known IIRs, clinicians should be aware of this potentially serious and previously unreported complication.

Recovery of nerve injury-induced alexia for Braille using forearm anaesthesia.

PubMed

Björkman, Anders; Rosén, Birgitta; Lundborg, Göran

2008-04-16

Nerve injuries in the upper extremity may severely affect hand function. Cutaneous forearm anaesthesia has been shown to improve hand sensation in nerve-injured patients. A blind man who lost his Braille reading capability after an axillary plexus injury was treated with temporary cutaneous forearm anaesthesia. After treatment sensory functions of the hand improved and the patient regained his Braille reading capability. The mechanism behind the improvement is likely unmasking of inhibited or silent neurons, but after repeated treatment sessions at increasing intervals the improvement has remained at 1-year follow-up, implying a structural change in the somatosensory cortex.

Longitudinal instability of the forearm.

PubMed

Phadnis, J; Watts, A C

2016-10-01

The Essex Lopresti lesion is a rare triad of injury to the radial head, interosseous membrane of the forearm and distal radio-ulnar joint, which results in longitudinal instability of the radius. If unrecognized this leads to chronic pain and disability which is difficult to salvage. Early recognition and appropriate treatment is therefore desirable to prevent long-term problems. The aim of this article is to review the pathoanatomy of longitudinal radius instability and use the existing literature and authors' experience to provide recommendations for recognition and treatment of acute and chronic forearm instability, including description of the author's technique for interosseous membrane reconstruction.

Central Band Interosseous Membrane Reconstruction For Forearm Longitudinal Instability.

PubMed

Adams, Julie E; Culp, Randall W; Osterman, A Lee

2016-08-01

The Essex-Lopresti injury results from injuries to the stabilizing structures of the forearm, the radial head, the interosseous membrane, and the triangular fibrocartilage complex. We describe principles in approaching the patient with an acute or chronic Essex-Lopresti injury and describe surgical techniques to address these challenging cases both in the acute and chronic setting and describe outcomes of these techniques. Further research into the role of the interosseous ligament in providing longitudinal and transverse stability to the forearm is likely to change our understanding of the Essex-Lopresti injury and alter management strategies.

Co-infection of Scedosporium apiospermum and Mycobacterium chelonae in an immunocompetent host.

PubMed

Kim, Ji Seok; Choi, Misoo; Nam, Chan Hee; Kim, Jee Young; Hong, Seung Phil; Kim, Myung Hwa; Park, Byung Cheol

2014-10-01

A 75-year-old man presented with multiple, scaly, erythematous, grouped papules, nodules and plaques with tenderness ranging from the right forearm to hand dorsum and the right lower leg for 2-3 months. Five months prior to presentation, the patient had received an antibiotic skin test on his right forearm. Lesions appeared approximately 2-3 months after the antibiotic skin test, slowly progressing without clinical improvement. Culture for fungus on the right forearm revealed growth of Scedosporium apiospermum. The tissue acid-fast bacilli (AFB) culture for the right forearm and right leg revealed growth of non-tuberculous mycobacteria which was Mycobacterium chelonae, and subsequent tissue polymerase chain reaction of both sites reported positive signs of M. chelonae. On diastase periodic acid-Schiff stain of the biopsy specimen of the right forearm, fungal hyphae were found while rod-shaped bacilli could be seen in AFB stain for the biopsy specimen of the right leg. The patient was treated with oral clarithromycin and ciprofloxacin along with an oral antifungal agent for 13 weeks. After the treatment, the lesions subsided and left a scar. We report a rare case of co-infection of S. apiospermum and M. chelonae in an immunocompetent host. © 2014 Japanese Dermatological Association.

Blood flow dynamics in heart failure

NASA Technical Reports Server (NTRS)

Shoemaker, J. K.; Naylor, H. L.; Hogeman, C. S.; Sinoway, L. I.

1999-01-01

BACKGROUND: Exercise intolerance in heart failure (HF) may be due to inadequate vasodilation, augmented vasoconstriction, and/or altered muscle metabolic responses that lead to fatigue. METHODS AND RESULTS: Vascular and metabolic responses to rhythmic forearm exercise were tested in 9 HF patients and 9 control subjects (CTL) during 2 protocols designed to examine the effect of HF on the time course of oxygen delivery versus uptake (protocol 1) and on vasoconstriction during exercise with 50 mm Hg pressure about the forearm to evoke a metaboreflex (protocol 2). In protocol 1, venous lactate and H+ were greater at 4 minutes of exercise in HF versus CTL (P<0.05) despite similar blood flow and oxygen uptake responses. In protocol 2, mean arterial pressure increased similarly in each group during ischemic exercise. In CTL, forearm blood flow and vascular conductance were similar at the end of ischemic and ambient exercise. In HF, forearm blood flow and vascular conductance were reduced during ischemic exercise compared with the ambient trial. CONCLUSIONS: Intrinsic differences in skeletal muscle metabolism, not vasodilatory dynamics, must account for the augmented glycolytic metabolic responses to moderate-intensity exercise in class II and III HF. The inability to increase forearm vascular conductance during ischemic handgrip exercise, despite a normal pressor response, suggests that enhanced vasoconstriction of strenuously exercising skeletal muscle contributes to exertional fatigue in HF.

An EMG-CT method using multiple surface electrodes in the forearm.

PubMed

Nakajima, Yasuhiro; Keeratihattayakorn, Saran; Yoshinari, Satoshi; Tadano, Shigeru

2014-12-01

Electromyography computed tomography (EMG-CT) method is proposed for visualizing the individual muscle activities in the human forearm. An EMG conduction model was formulated for reverse-estimation of muscle activities using EMG signals obtained with multi surface electrodes. The optimization process was calculated using sequential quadratic programming by comparing the estimated EMG values from the model with the measured values. The individual muscle activities in the deep region were estimated and used to produce an EMG tomographic image. For validation of the method, isometric contractions of finger muscles were examined for three subjects, applying a flexion load (4.9, 7.4 and 9.8 N) to the proximal interphalangeal joint of the middle finger. EMG signals in the forearm were recorded during the tasks using multiple surface electrodes, which were bound around the subject's forearm. The EMG-CT method illustrates the distribution of muscle activities within the forearm. The change in amplitude and area of activated muscles can be observed. The normalized muscle activities of all three subjects appear to increase monotonically with increases in the load. Kinesiologically, this method was able to estimate individual muscle activation values and could provide a novel tool for studying hand function and development of an examination for evaluating rehabilitation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Mobility of the forearm in the raccoon (Procyon lotor), raccoon dog (Nyctereutes procyonoides) and red panda (Ailurus fulgens).

PubMed

Kamioka, Minao; Sasaki, Motoki; Yamada, Kazutaka; Endo, Hideki; Oishi, Motoharu; Yuhara, Kazutoshi; Tomikawa, Sohei; Sugimoto, Miki; Oshida, Tatsuo; Kondoh, Daisuke; Kitamura, Nobuo

2017-01-24

The ranges of pronation/supination of forearms in raccoons, raccoon dogs and red pandas were nondestructively examined. Three carcasses of each species were used for CT analysis, and the left forearms were scanned with a CT scanner in two positions: maximal supination and maximal pronation. Scanning data were reconstructed into three-dimensional images, cross-sectional images were extracted at the position that shows the largest area in the distal part of ulna, and then, the centroids of each cross section of the radius and ulna were detected. CT images of two positions were superimposed, by overlapping the outlines of each ulna, and then, the centroids were connected by lines to measure the angle of rotation, as an index of range of mobility. The measurements in each animal were analyzed, using the Tukey-Kramer method. The average angle of rotation was largest in raccoons and smallest in raccoon dogs, and the difference was significant. In the maximally pronated forearm of all species, the posture was almost equal to the usual grounding position with palms touching the ground. Therefore, the present results demonstrate that the forearms of raccoons can supinate to a greater degree from the grounding position with palms on the ground, as compared with those of raccoon dogs and red pandas.

Paediatric forearm fractures: functional outcome of conservative treatment.

PubMed

Tarmuzi, Nazari Ahmad; Abdullah, Shalimar; Osman, Zulkiflee; Das, Srijit

2009-01-01

Forearm fractures are common in the paediatric age group. Closed reduction and casting are the primary means of treatment in over 90% of these fractures. Resultant deformities are usually a product of indirect trauma involving angular loading combined with rotational deformity and fragment displacement. Retrospectively, 48 patients aged between 4 to 12 years with forearm fractures, were treated conservatively with closed reduction and a cast during a 2-year period. Functional outcomes were measured in terms of pronation and supination. All fractures united before the final visit. Most forearm bone fractures were complete fractures at the mid shaft. Eighty-six percent of the patients had excellent functional outcomes and none had poor outcomes. There were significantly reduced angles of deformities before and after treatment (p < 0.05). Radiographically, in the frontal plane, 57.1% of radius and 73.9% of ulnar fractures achieved perfect reduction (i.e. a degree of deformity of less than 5 degrees). However, in the lateral plane, there were fewer perfect reductions for the radius and ulna, at 14.6% and 54.3%, respectively. All except for one patient were satisfied with the outcomes. The level of fracture did not influence the outcomes. Conservative treatment is still an acceptable form of treatment especially for stable forearm fractures in children achieving excellent outcomes (Tab. 1, Fig. 7, Ref. 20).

Effects of combined wrist flexion/extension and forearm rotation and two levels of relative force on discomfort.

PubMed

Khan, Abid Ali; O'Sullivan, Leonard; Gallwey, Timothy J

2009-10-01

This study investigated perceived discomfort in an isometric wrist flexion task. Independent variables were wrist flexion/extension (55%, 35% flexion, neutral, 35% and 55% extension ranges of motion (ROM)), forearm rotation (60%, 30% prone, neutral, 30% and 60% supine ROM) and two levels of flexion force (10% and 20% maximum voluntary contraction (MVC)). Discomfort was significantly affected by flexion force, forearm rotation and a two-way interaction of force with forearm rotation (each p < 0.05). High force for 60%ROM forearm pronation and supination resulted in increasingly higher discomfort for these combinations. Flexion forces were set relative to the MVC in each wrist posture and this appears to be important in explaining a lack of significant effect (p = 0.34) for flexion/extension on discomfort. Regression equations predicting discomfort were developed and used to generate iso-discomfort contours, which indicate regions where the risk of injury should be low and others where it is likely to be high. Regression equations predicting discomfort and iso-discomfort contours are presented, which indicate combinations of upper limb postures for which discomfort is predicted to be low, and others where it is likely to be high. These are helpful in the study of limits for risk factors associated with upper limb musculoskeletal injury in industry.

Evidence that the human cutaneous venoarteriolar response is not mediated by adrenergic mechanisms

NASA Technical Reports Server (NTRS)

Crandall, C. G.; Shibasaki, M.; Yen, T. C.

2002-01-01

The venoarteriolar response causes vasoconstriction to skin and muscle via local mechanisms secondary to venous congestion. The purpose of this project was to investigate whether this response occurs through alpha-adrenergic mechanisms. In supine individuals, forearm skin blood flow was monitored via laser-Doppler flowmetry over sites following local administration of terazosin (alpha(1)-antagonist), yohimbine (alpha(2)-antagonist), phentolamine (non-selective alpha-antagonist) and bretylium tosylate (inhibits neurotransmission of adrenergic nerves) via intradermal microdialysis or intradermal injection. In addition, skin blood flow was monitored over an area of forearm skin that was locally anaesthetized via application of EMLA (2.5 % lidocaine (lignocaine) and 2.5 % prilocaine) cream. Skin blood flow was also monitored over adjacent sites that received the vehicle for the specified drug. Each trial was performed on a minimum of seven subjects and on separate days. The venoarteriolar response was engaged by lowering the subject's arm from heart level such that the sites of skin blood flow measurement were 34 +/- 1 cm below the heart. The arm remained in this position for 2 min. Selective and non-selective alpha-adrenoceptor antagonism and presynaptic inhibition of adrenergic neurotransmission did not abolish the venoarteriolar response. However, local anaesthesia blocked the venoarteriolar response without altering alpha-adrenergic mediated vasoconstriction. These data suggest that the venoarteriolar response does not occur through adrenergic mechanisms as previously reported. Rather, the venoarteriolar response may due to myogenic mechanisms associated with changes in vascular pressure or is mediated by a non-adrenergic, but neurally mediated, local mechanism.

Visual appearance of a virtual upper limb modulates the temperature of the real hand: a thermal imaging study in Immersive Virtual Reality.

PubMed

Tieri, Gaetano; Gioia, Annamaria; Scandola, Michele; Pavone, Enea F; Aglioti, Salvatore M

2017-05-01

To explore the link between Sense of Embodiment (SoE) over a virtual hand and physiological regulation of skin temperature, 24 healthy participants were immersed in virtual reality through a Head Mounted Display and had their real limb temperature recorded by means of a high-sensitivity infrared camera. Participants observed a virtual right upper limb (appearing either normally, or with the hand detached from the forearm) or limb-shaped non-corporeal control objects (continuous or discontinuous wooden blocks) from a first-person perspective. Subjective ratings of SoE were collected in each observation condition, as well as temperatures of the right and left hand, wrist and forearm. The observation of these complex, body and body-related virtual scenes resulted in increased real hand temperature when compared to a baseline condition in which a 3d virtual ball was presented. Crucially, observation of non-natural appearances of the virtual limb (discontinuous limb) and limb-shaped non-corporeal objects elicited high increase in real hand temperature and low SoE. In contrast, observation of the full virtual limb caused high SoE and low temperature changes in the real hand with respect to the other conditions. Interestingly, the temperature difference across the different conditions occurred according to a topographic rule that included both hands. Our study sheds new light on the role of an external hand's visual appearance and suggests a tight link between higher-order bodily self-representations and topographic regulation of skin temperature. © 2017 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

Effect of virtual reality-based rehabilitation on upper-extremity function in patients with brain tumor: controlled trial.

PubMed

Yoon, Jisun; Chun, Min Ho; Lee, Sook Joung; Kim, Bo Ryun

2015-06-01

The aim of this study was to evaluate the benefit of virtual reality-based rehabilitation on upper-extremity function in patients with brain tumor. Patients with upper-extremity dysfunction were divided into age-matched and tumor type-matched two groups. The intervention group performed the virtual reality program 30 mins per session for 9 sessions and conventional occupational therapy 30 mins per session for 6 sessions for 3 wks, whereas the control group received conventional occupational therapy alone 30 mins per session for 15 sessions for 3 wks. The Box and Block test, the Manual Function test, and the Fugl-Meyer scale were used to evaluate upper-extremity function. The Korean version of the Modified Barthel Index was used to assess activities of daily living. Forty patients completed the study (20 for each group). Each group exhibited significant posttreatment improvements in the Box and Block test, Manual Function test, Fugl-Meyer scale, and Korean version of the Modified Barthel Index scores. The Box and Block test, the Fugl-Meyer scale, and the Manual Function test showed greater improvements in shoulder/elbow/forearm function in the intervention group and hand function in the control group. Virtual reality-based rehabilitation combined with conventional occupational therapy may be more effective than conventional occupational therapy, especially for proximal upper-extremity function in patients with brain tumor. Further studies considering hand function, such as use of virtual reality programs that targeting hand use, are required.

Effect of combined opioid receptor and α2-adrenoceptor blockade on anxiety and electrically evoked startle responses.

PubMed

Vo, Lechi; Drummond, Peter D

2017-06-01

The R3 component of the electrically evoked blink reflex may form part of a startle reaction. Acoustic startle responses are augmented by yohimbine, an α 2 -adrenoceptor antagonist that blocks α 2 -autoreceptors, and are potentiated by opioid receptor blockade. To investigate these influences on electrically evoked startle responses, 16 mg yohimbine, with (16 participants) or without 50 mg naltrexone (23 participants), was administered in separate double-blind placebo-controlled cross-over experiments. In each experiment, R3 (a probable component of the startle response) was examined before and after high-frequency electrical stimulation of the forearm, a procedure that initiates inhibitory pain controls. Anxiety and somatic symptoms were greater after yohimbine than placebo, and were potentiated by naltrexone. Pain ratings for the electrically evoked startle stimuli decreased after high-frequency electrical stimulation in the placebo session but remained stable after drug administration. Yohimbine with naltrexone, but not yohimbine alone, also blocked an inhibitory effect of high-frequency electrical stimulation on electrically evoked sharp sensations and R3. Together, the findings suggest that adding naltrexone to yohimbine potentiated anxiety and blocked inhibitory influences of high-frequency electrical stimulation on electrically evoked sensations and startle responses. Thus, opioid peptides could reduce activity in nociceptive and startle-reflex pathways, or inhibit crosstalk between these pathways. Failure of this inhibitory opioid influence might be important in chronically painful conditions that are aggravated by startle stimuli.

The effects of workplace stressors on muscle activity in the neck-shoulder and forearm muscles during computer work: a systematic review and meta-analysis.

PubMed

Eijckelhof, B H W; Huysmans, M A; Bruno Garza, J L; Blatter, B M; van Dieën, J H; Dennerlein, J T; van der Beek, A J

2013-12-01

Workplace stressors have been indicated to play a role in the development of neck and upper extremity pain possibly through an increase of sustained (low-level) muscle activity. The aim of this review was to study the effects of workplace stressors on muscle activity in the neck-shoulder and forearm muscles. An additional aim was to find out whether the muscles of the neck-shoulder and the forearm are affected differently by different types of workplace stressors. A systematic literature search was conducted on studies investigating the relation between simulated or realistic workplace stressors and neck-shoulder and forearm muscle activity. For studies meeting the inclusion criteria, a risk of bias assessment was performed and data were extracted for synthesis. Results were pooled when possible and otherwise described. Twenty-eight articles met the inclusion criteria, reporting data of 25 different studies. Except for one field study, all included studies were laboratory studies. Data of 19 articles could be included in the meta-analysis and revealed a statistically significant, medium increase in neck-shoulder and forearm muscle activity as a result of workplace stressors. In subgroup analyses, we found an equal effect of different stressor types (i.e. cognitive/emotional stress, work pace, and precision) on muscle activity in both body regions. In conclusion, simulated workplace stressors result in an increase in neck-shoulder and forearm muscle activity. No indications were found that different types of stressors affect these body regions differently. These conclusions are fully based on laboratory studies, since field studies on this topic are currently lacking.

Comparisons of bone mineral density and bone quality in adult rock climbers, resistance-trained men, and untrained men.

PubMed

Sherk, Vanessa D; Bemben, Michael G; Bemben, Debra A

2010-09-01

The nature of muscular contractions and episodes of impact loading during technical rock climbing are often varied and complex, and the resulting effects on bone health are unclear. The purpose of this study was to compare total body, lumbar spine, proximal femur, and forearm areal bone mineral density (aBMD) and tibia and forearm bone quality in male rock climbers (RC) (n = 15), resistance trained men (RT) (n = 16), and untrained male controls (CTR) (n = 16). Total body, anteroposterior (AP) lumbar spine, proximal femur, and forearm aBMD and body composition were measured using dual-energy X-ray absorptiometry (DXA) (Lunar Prodigy, v. 10.50.086; GE Healthcare, Waukesha, Wisconsin, U.S.A.). Volumetric BMD (vBMD), bone content, bone area, and muscle cross-sectional area (MCSA) of the tibia and forearm were measured using pQCT (peripheral quantitative computed tomography; Stratec XCT 3000, Pforzheim, Germany). No significant group differences were seen in bone-free lean body mass. CTR had significantly (p < 0.05) greater body fat % than RC and RT and significantly (p < 0.05) greater fat mass than RC. Lumbar spine and femoral neck aBMD were significantly (p < 0.05) greater in RT compared to both RC and CTR. RC had significantly (p < 0.05) lower aBMD at the 33% radius site than CTR. Forearm MCSA was significantly (p < 0.05) lower in CTR than in the other groups. No significant differences were seen between groups for vBMD or bone area of the tibia and forearm. In conclusion, resistance-trained men had higher bone density at the central skeletal sites than rock climbers; however, bone quality variables of the peripheral limbs were similar in rock climber and resistance-trained groups.

Differences in humeral retroversion in dominant and nondominant sides of young baseball players.

PubMed

Kurokawa, Daisuke; Yamamoto, Nobuyuki; Ishikawa, Hiroaki; Nagamoto, Hideaki; Takahashi, Hiroyuki; Muraki, Takayuki; Tanaka, Minoru; Sato, Katsumi; Itoi, Eiji

2017-06-01

The relationship between the disabled throwing shoulder and humeral retroversion has recently attracted a great deal of attention. However, none of the previous studies clarified when the side-to-side difference of humeral retroversion in young baseball players would start. This study aimed to clarify when the difference of humeral retroversion in the dominant and nondominant sides appeared in baseball players. The bicipital-forearm angle in bilateral shoulders of 172 elementary school baseball players was measured by ultrasound. The bicipital-forearm angle was defined as an angle between the perpendicular line to the bicipital groove and the ulnar long axis with the elbow flexed at 90°. The correlation between the bicipital-forearm angle and the grade and the difference of the bicipital-forearm angle between the dominant and nondominant sides were analyzed. In the nondominant shoulders, the bicipital-forearm angle increased with the grade in school (r = 0.32, P < .0001), but this was not observed in the dominant shoulders. In the fourth to sixth graders, the bicipital-forearm angles were significantly smaller in the dominant shoulders than in the nondominant shoulders. Our findings indicated that humeral retroversion decreased with age in the nonthrowing side but not in the throwing side and that the side-to-side difference of humeral retroversion in the baseball players became obvious from the fourth grade. We assume that the repetitive throwing motion restricts the physiologic humeral derotation process and the difference became apparent from the fourth grade when the growth spurt begins in boys. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Allometric associations between body size, shape, and 100-m butterfly speed performance.

PubMed

Sammoud, Senda; Nevill, Alan M; Negra, Yassine; Bouguezzi, Raja; Chaabene, Helmi; Hachana, Younés

2018-05-01

This study aimed to estimate the optimal body size, limb-segment length, and girth or breadth ratios associated with 100-m butterfly speed performance in swimmers. One-hundred-sixty-seven swimmers as subjects (male: N.=103; female: N.=64). Anthropometric measurements comprised height, body-mass, skinfolds, arm-span, upper-limb-length, upper-arm, forearm, hand-lengths, lower-limb-length, thigh-length, leg-length, foot-length, arm-relaxed-girth, forearm-girth, wrist-girth, thigh-girth, calf-girth, ankle-girth, biacromial and biiliocristal-breadths. To estimate the optimal body size and body composition components associated with 100-m butterfly speed performance, we adopted a multiplicative allometric log-linear regression model, which was refined using backward elimination. Fat-mass was the singularly most important whole-body characteristic. Height and body-mass did not contribute to the model. The allometric model identified that having greater limb segment length-ratio (arm-ratio = [arm-span]/[forearm]) and limb girth-ratio (girth-ratio = [calf-girth]/[ankle-girth]) were key to butterfly speed performance. A greater arm-span to forearm-length ratio and a greater calf to ankle-girth-ratio suggest that a combination of larger arm-span and shorter forearm-length and the combination of larger calves and smaller ankles-girth may benefit butterfly swim speed performance. In addition having greater biacromial and biliocristal breadths is also a major advantage in butterfly swimming speed performance. Finally, the estimation of these ratios was made possible by adopting a multiplicative allometric model that was able to confirm, theoretically, that swim speeds are nearly independent of total body size. The 100-m butterfly speed performance was strongly negatively associated with fat mass and positively associated with the segment length ratio (arm-span/forearm-length) and girth ratio (calf-girth)/(ankle-girth), having controlled for the developmental changes in age.

Intercostal and forearm muscle deoxygenation during respiratory fatigue in patients with heart failure: potential role of a respiratory muscle metaboreflex.

PubMed

Moreno, A M; Castro, R R T; Silva, B M; Villacorta, H; Sant'Anna Junior, M; Nóbrega, A C L

2014-11-01

The purpose of this study was to determine the effect of respiratory muscle fatigue on intercostal and forearm muscle perfusion and oxygenation in patients with heart failure. Five clinically stable heart failure patients with respiratory muscle weakness (age, 66 ± 12 years; left ventricle ejection fraction, 34 ± 3%) and nine matched healthy controls underwent a respiratory muscle fatigue protocol, breathing against a fixed resistance at 60% of their maximal inspiratory pressure for as long as they could sustain the predetermined inspiratory pressure. Intercostal and forearm muscle blood volume and oxygenation were continuously monitored by near-infrared spectroscopy with transducers placed on the seventh left intercostal space and the left forearm. Data were compared by two-way ANOVA and Bonferroni correction. Respiratory fatigue occurred at 5.1 ± 1.3 min in heart failure patients and at 9.3 ± 1.4 min in controls (P<0.05), but perceived effort, changes in heart rate, and in systolic blood pressure were similar between groups (P>0.05). Respiratory fatigue in heart failure reduced intercostal and forearm muscle blood volume (P<0.05) along with decreased tissue oxygenation both in intercostal (heart failure, -2.6 ± 1.6%; controls, +1.6 ± 0.5%; P<0.05) and in forearm muscles (heart failure, -4.5 ± 0.5%; controls, +0.5 ± 0.8%; P<0.05). These results suggest that respiratory fatigue in patients with heart failure causes an oxygen demand/delivery mismatch in respiratory muscles, probably leading to a reflex reduction in peripheral limb muscle perfusion, featuring a respiratory metaboreflex.

Failure of vascular autoregulation in the upper limb with increased +Gz acceleration.

PubMed

Green, N D C; Brown, M D; Coote, J H

2007-08-01

Forearm pain occurring during high +Gz exposure has been linked with vascular distension from elevated transmural pressure of hydrostatic origin and is exacerbated by positive pressure breathing (PBG). We postulated that at high vascular transmural pressure vascular autoregulation might be overcome and be associated with worsened pain. Six volunteers were studied at +4, +5, +6, and +7 Gz on a human centrifuge. Forearm vascular resistance (FVR) was assessed by Doppler ultrasound resistive index (RI), and superficial forearm venous pressure (FVP) was measured via an indwelling catheter. Pain rating was assessed by numerical scale. The left arm was located at heart level (control position), or on the throttle (test position). Runs were completed with and without positive pressure breathing for G protection (PBG); subjects wore full coverage anti-G trousers and chest counter-pressure. In the test position, pain increased with increasing acceleration (P < 0.0001), and was more severe with PBG at +5 Gz and +7 Gz (P < 0.05). FVP rose substantially more in the test than control position (238 +/- 17 mmHg vs. 61 +/- 8 mmHg at +7 Gz, P < 0.0001) but the presence or absence of PBG had no effect on the FVP increase during acceleration in either position. In the test position, RI fell with increasing acceleration above +5 Gz (P < 0.0001), and the fall was greater with PBG (P < 0.05). Forearm pain was thus associated with a decrease in FVR and an increase in vascular transmural pressure. PBG exacerbated forearm pain and prompted a greater fall in RI, but had no effect on FVP response. These findings support FVR but not forearm venous distension in the aetiology of +Gz arm pain.

Telemetered electromyography of the supinators and pronators of the forearm in gibbons and chimpanzees: implications for the fundamental positional adaptation of hominoids.

PubMed

Stern, J T; Larson, S G

2001-07-01

Extant apes are similar to one another, and different from monkeys, in features granting them greater range of forearm rotation and greater size of the muscles that produce this motion. Although these traits may have been independently acquired by the various apes, the possibility arises that such features reflect adaptation to the stem behavior of the hominoid lineage. Anticipating that knowledge of forearm rotatory muscle recruitment during brachiation, vertical climbing, arm-hanging during feeding, and voluntary reaching might point to this stem behavior, we undertook telemetered electromyographic experiments on the supinator, pronator quadratus, ulnar head of pronator teres, and a variety of other upper limb muscles in two gibbons and four chimpanzees. The primary rotator muscles of the hominoid forearm were recruited at high levels in a variety of behaviors. As had been suspected by previous researchers, the supinator is usually active during the support phase of armswinging, but we observed numerous instances of this behavior during which the muscle was inactive. No other muscle took over its role. Kinetic analyses are required to determine how apes can execute body rotation of armswinging without active muscular effort. The one behavior that is common to most extant apes, is rare in monkeys, and which places a consistently great demand on the primary forearm rotatory muscles, is hang-feeding. The muscles of the supporting limb are essential to properly position the body; those of the free limb are essential for grasping food. Since the greater range of forearm rotation characterizing apes is also best explained by adaptation to this behavior, we join previous authors who assert that it lies at the very origin of the Hominoidea. Copyright 2001 Wiley-Liss, Inc.

Simultaneous multi-depth assessment of tissue oxygen saturation in thenar and forearm using near-infrared spectroscopy during a simple cardiovascular challenge

PubMed Central

2009-01-01

Introduction Hypovolemia and hypovolemic shock are life-threatening conditions that occur in numerous clinical scenarios. Near-infrared spectroscopy (NIRS) has been widely explored, successfully and unsuccessfully, in an attempt to use it as an early detector of hypovolemia by measuring tissue oxygen saturation (StO2). In order to investigate the measurement site dependence and probe dependence of NIRS in response to hemodynamic changes, such as hypovolemia, we applied a simple cardiovascular challenge: a posture change from supine to upright, causing a decrease in stroke volume (as in hypovolemia) and a heart rate increase in combination with peripheral vasoconstriction to maintain adequate blood pressure. Methods Multi-depth NIRS was used in nine healthy volunteers to assess changes in StO2 in the thenar and forearm in response to the hemodynamic changes associated with a posture change from supine to upright. Results A posture change from supine to upright resulted in a significant increase (P < 0.001) in heart rate. Thenar StO2 did not respond to the hemodynamic changes following the posture change, whereas forearm StO2 did. Forearm StO2 was significantly lower (P < 0.001) in the upright position compared to supine for all probing depths. Conclusions The primary findings in this study were that forearm StO2 is a more sensitive parameter to hemodynamic changes than thenar StO2 and that the depth at which StO2 is measured is of minor influence. Our data support the use of forearm StO2 as a sensitive parameter for the detection of central hypovolemia and hypovolemic shock in (trauma) patients. PMID:19951389

Effect of forearm axially rotated posture on shoulder load and shoulder abduction / flexion angles in one-armed arrest of forward falls.

PubMed

Hsu, Hsiu-Hao; Chou, You-Li; Lou, Shu-Zon; Huang, Ming-Jer; Chou, Paul Pei-Hsi

2011-03-01

Falling onto the outstretched hand is the most common cause of upper extremity injury. This study develops an experimental model for evaluating the shoulder load during a simulated forward fall onto one hand with three different forearm axially rotated postures, and examines the shoulder abduction angle and shoulder flexion angle in each case. Fifteen healthy young male subjects with an average age of 23.7 years performed a series of one-armed arrests from a height of 5 cm onto a force plate. The kinematics and kinetics of the upper extremity were analyzed for three different forearm postures, namely 45° externally rotated, non-rotated, and 45° internally rotated. The shoulder joint load and shoulder abduction/flexion angles were significantly dependent on the rotational posture of the forearm. The shoulder medio-lateral shear forces in the externally rotated group were found to be 1.61 and 2.94 times higher than those in the non-rotated and internally rotated groups, respectively. The shoulder flexion angles in the externally rotated, non-rotated and internally rotated groups were 0.6°, 8.0° and 19.2°, respectively, while the corresponding shoulder abduction angles were 6.1°, 34.1° and 46.3°, respectively. In falls onto the outstretched hand, an externally rotated forearm posture should be avoided in order to reduce the medio-lateral shear force acting on the shoulder joint. In falls of this type, a 45° internally rotated forearm posture represents the most effective fall strategy in terms of minimizing the risk of upper extremity injuries. Copyright © 2010 Elsevier Ltd. All rights reserved.

Effect of Positioning of the ROI on BMD of the Forearm and Its Subregions.

PubMed

Rosen, Elizabeth O; McNamara, Elizabeth A; Whittaker, LaTarsha G; Malabanan, Alan O; Rosen, Harold N

2018-03-21

Inconsistent positioning of patients and region of interest (ROI) is known to influence the precision of bone mineral density (BMD) measurements in the spine and hip. However, it is unknown whether minor shifts in the positioning of the ROI along the shaft of the radius affect the measurement of forearm BMD and its subregions. The ultradistal (UD-), mid-, one-third, and total radius BMDs of 50 consecutive clinical densitometry patients were acquired. At baseline the distal end of the ROI was placed at the tip of the ulnar styloid as usual, and then the forearm was reanalyzed 10 more times, each time shifting the ROI 1 mm proximally. No corrections for multiple comparisons were necessary since the differences that were significant were significant at p < 0.001. The UD-radius BMD increased as the ROI was shifted proximally; the increase was significant when shifted even 1 mm proximally (p < 0.001). These same findings held true for the mid- and total radius bone density, though the percent increase with moving proximally was significantly greater for the UD radius than for the other subregions. However, there was no significant change in the one-third radius BMD when shifted proximally 1-10 mm. Minor proximal shifts of the forearm ROI substantially affect the BMD of the UD-, mid- and total radius, while having no effect on the one-third radius BMD. Since the one-third radius is the only forearm region usually reported, minor proximal shifts of the ROI should not influence forearm BMD results significantly. Copyright © 2018 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Comparison of upper arm and forearm blood pressure.

PubMed

Domiano, Kathy L; Hinck, Susan M; Savinske, Debra L; Hope, Kathryn L

2008-11-01

The upper arm is the primary site used to obtain a blood pressure measurement (BPM); however, when it is not possible to use the upper arm, the forearm is a commonly used alternate site. This study determines if there is a significant difference between upper arm and forearm BPMs among adults and examines the relationship of participant characteristics to the BPM difference. A convenience sample was recruited from a low-income, independent-living, 104-apartment complex in the Midwest. Of the 106 participants, 64% were female and 89% were White. Ages ranged from 20 to 85 years (M = 50.7). The investigators calculated the BMIs (range = 18 to 42, M = 29.3, SD = 5.4) for the 89% (n = 94) of participants who reported their weight. The forearm tended to have higher BPMs than the upper arm (M difference = 4.0 mm Hg systolic, 2.3 mm Hg diastolic). However, site differences were greatest for men, obese adults, and middle aged (36 to 65) adults.

No effect of forearm band and extensor strengthening exercises for the treatment of tennis elbow: a prospective randomised study.

PubMed

Luginbühl, Rolf; Brunner, Florian; Schneeberger, Alberto G

2008-01-01

The objective of this prospective randomised study was to analyse the effect of the forearm support band and of strengthening exercises for the treatment of tennis elbow. Twenty-nine patients with 30 tennis elbows were randomised into 3 groups of treatment: (I) forearm support band, (II) strengthening exercises and (III) both methods. The patients had a standardised examination at their first visit, and then after 6 weeks, 3 months and 1 year. At the latest follow-up, there was a significant improvement of the symptoms compared to before treatment (p<0.0001), considering all patients independently of the methods of treatment. However, no differences in the scores were found between the 3 groups of treatment (p=0.27), indicating that no beneficial influence was found either for the strengthening exercises or for the forearm support band. Improvement seems to occur with time, independent of the method of treatment used.

Effect of ambient temperature on the thermal profile of the human forearm, hand, and fingers

NASA Technical Reports Server (NTRS)

Montgomery, L. D.; Williams, B. A.

1976-01-01

Forearm, hand, and finger skin temperatures were measured on the right and left sides of seven resting men. The purpose was to determine the bilateral symmetry of these segmental temperature profiles at ambient temperatures from 10 to 45 C. Thermistors placed on the right and left forearms, hands, and index fingers were used to monitor the subjects until equilibration was reached at each ambient temperature. Additionally, thermal profiles of both hands were measured with copper-constantan thermocouples. During one experimental condition (23 C ambient), rectal, ear canal, and 24 skin temperatures were measured on each subject. Average body and average skin temperatures are given for each subject at the 23 C ambient condition. Detailed thermal profiles are also presented for the dorsal, ventral, and circumferential left forearm, hand, and finger skin temperatures at 23 C ambient. No significant differences were found between the mean skin temperatures of the right and left contralateral segments at any of the selected ambient temperatures.

Effect of the Mandibular Orthopedic Repositioning Appliance (MORA) on Forearm Muscle Activation and Grasping Power during Pinch and Hook Grip.

PubMed

Lee, Sang-Yeol; Park, Yi-Jeong; Park, Hye-Min; Bae, Hae-Jin; Yu, Min-Ji; Choi, Hee-Won; Hwang, Na-Young

2014-02-01

[Purpose] This study verified the changes in muscle activities and grasping power during maximal isometric exercise of the forearm and masseter muscle with and without a mandibular orthopedic repositioning appliance (MORA). It also offers basic data for defining the correlation of function of hand with mouth. [Methods] EMG was used to measure masticatory muscle, flexor bundle and extensor bundle activities with or without MORA while subjects performed the hook grip and pinch grip. The measuring tool used for measuring grip strength was the same as that used for measuring pinch and hook strength. The subjects were 28 healthy young adults. [Result] Muscle activity and grasping power significantly increased when wearing the MORA. [Conclusion] The result indicates that wearing MORA can increase muscle activity and grasping power of forearm and masseter muscle. We think wearing MORA might help improve the function of the forearm because it activates the function of the masseter.

Forearm versus upper arm grafts for vascular access.

PubMed

Gage, Shawn M; Lawson, Jeffrey H

2017-03-06

Forearm and upper arm arteriovenous grafts perform similarly in terms of patency and complications. Primary patency at 1 year for forearm arteriovenous grafts versus upper arm grafts ranges from 22%-50% versus 22%-42%, and secondary patency at 1 year ranges from 78%-89% versus 52%-67%), respectively. Secondary patency at 2 years, ranges from 30%-64% versus 35%-60% for forearm and upper arteriovenous graft, respectively. Ample pre-operative planning is essential to improved clinical success and the decision to place a graft at one location versus the other should be based solely on previous access history, physical exam, appropriate venous imaging, and other factors that make up the clinical picture. Operative implant strategies and risk of complications are very similar between the two configurations. Postoperative ischemia due to steal syndrome is a potential complication that requires immediate attention. Utilization of the proximal radial or ulnar artery for inflow for the graft can minimize risk of clinically relevant steal syndrome.

Bone loss from the hand in women following distal forearm fracture.

PubMed

Ingle, B M; Eastell, R

2001-01-01

Bone loss occurs after distal forearm fracture, but it is unclear if this bone loss is fully recovered. We designed a cross-sectional study to evaluate the time course of the bone loss from the hand after distal forearm fracture. We identified 40 women who had a fracture of the distal forearm within the previous 4.5 years. Their ages ranged from 42 to 81 (mean 64 years) and time since fracture 6 to 54 (mean 28 months). These were compared with 95 women (mean age 67, range 57 to 80 years) from a population-based cohort. Lumbar spine (LS) and hand bone mineral density (BMD) were measured in all subjects using a Hologic QDR 1000/W densitometer. Ultrasound of the fingers of both hands was measured in the forearm fracture group using a DBM Sonic 1200 R model. Compared to controls, LS BMD was decreased by 6.4% (p<0.001), non-fractured hand by 3.2% (p<0.001) and the fractured hand by 6.1% (p<0.001) in the forearm fracture group. The mean difference in bone density between the fractured and non-fractured hand was 0.0207 g/cm2, the average value for the non-fractured hand being 0.304 g/cm2. The decement in hand BMD was equivalent to 6.2% (p<0.0001). The difference in hand BMD between the fractured and non-fractured side was greatest when the time since fracture was short; there was no further difference in hand BMD after 2 years. Ultrasound showed a mean difference of 18.7 m/s in amplitude-dependent speed of sound (AD-SoS) with the average value being 1893 m/s. A 1.0% decrease was observed in the fractured hand AD-SoS (p<0.05). A strong relationship was observed between AD-SoS and BMD in both hands (r = 0.70, p<0.001). We conclude that distal forearm fracture results in a significant decrease in hand BMD that is partially reversible. The decrease in hand BMD is reflected in the ultrasound properties of the finger phalanx.

Sleep-Disordered Breathing Exacerbates Muscle Vasoconstriction and Sympathetic Neural Activation in Patients with Systolic Heart Failure.

PubMed

Lobo, Denise M L; Trevizan, Patricia F; Toschi-Dias, Edgar; Oliveira, Patricia A; Piveta, Rafael B; Almeida, Dirceu R; Mady, Charles; Bocchi, Edimar A; Lorenzi-Filho, Geraldo; Middlekauff, Holly R; Negrão, Carlos E

2016-11-01

Sleep-disordered breathing (SDB) is common in patients with heart failure (HF), and hypoxia and hypercapnia episodes activate chemoreceptors stimulating autonomic reflex responses. We tested the hypothesis that muscle vasoconstriction and muscle sympathetic nerve activity (MSNA) in response to hypoxia and hypercapnia would be more pronounced in patients with HF and SDB than in patients with HF without SDB (NoSBD). Ninety consecutive patients with HF, New York Heart Association functional class II-III, and left ventricular ejection fraction ≤40% were screened for the study. Forty-one patients were enrolled: NoSDB (n=13, 46 [39-53] years) and SDB (n=28, 57 [54-61] years). SDB was characterized by apnea-hypopnea index ≥15 events per hour (polysomnography). Peripheral (10% O 2 and 90% N 2 , with CO 2 titrated) and central (7% CO 2 and 93% O 2 ) chemoreceptors were stimulated for 3 minutes. Forearm and calf blood flow were evaluated by venous occlusion plethysmography, MSNA by microneurography, and blood pressure by beat-to-beat noninvasive technique. Baseline forearm blood flow, forearm vascular conductance, calf blood flow, and calf vascular conductance were similar between groups. MSNA was higher in the SDB group. During hypoxia, the vascular responses (forearm blood flow, forearm vascular conductance, calf blood flow, and calf vascular conductance) were significantly lower in the SDB group compared with the NoSDB group (P<0.01 to all comparisons). Similarly, during hypercapnia, the vascular responses (forearm blood flow, forearm vascular conductance, calf blood flow, and calf vascular conductance) were significantly lower in the SDB group compared with the NoSDB group (P<0.001 to all comparisons). MSNA were higher in response to hypoxia (P=0.024) and tended to be higher to hypercapnia (P=0.066) in the SDB group. Patients with HF and SDB have more severe muscle vasoconstriction during hypoxia and hypercapnia than HF patients without SDB, which seems to be associated with endothelial dysfunction and, in part, increased MSNA response. © 2016 American Heart Association, Inc.

A Distal Forearm Fracture in Childhood Is Associated With an Increased Risk for Future Fragility Fractures in Adult Men, but Not Women

PubMed Central

Amin, Shreyasee; Melton, L Joseph; Achenbach, Sara J; Atkinson, Elizabeth J; Dekutoski, Mark B; Kirmani, Salman; Fischer, Philip R; Khosla, Sundeep

2014-01-01

Distal forearm fractures are among the most common fractures during childhood, but it remains unclear whether they predict an increased fracture risk later in life. We studied a population-based cohort of 1776 children ≤18 years of age, from Olmsted County, MN, USA, who had a distal forearm fracture in 1935–1992. Incident fractures occurring at age ≥35 years were identified through review of complete medical records using the linkage system of the Rochester Epidemiology Project. Observed nonpathologic fractures resulting from no more than moderate trauma (fragility fractures) were compared with expected numbers estimated from fracture site–specific incidence rates, based on age, sex, and calendar year, for Olmsted County (standardized incidence ratios [SIR]). In 1086 boys (mean ± SD age; 11 ± 4 years) and 690 girls (10 ± 4 years) followed for 27,292 person-years after the age of 35 years, subsequent fragility fractures were observed in 144 (13%) men and 74 (11%) women. There was an increased risk for future fragility fractures in boys who had a distal forearm fracture (SIR, 1.9; 95% CI, 1.6–2.3) but not girls (SIR, 1.0; 95% CI, 0.8–1.2). Fragility fractures at both major osteoporotic (hip, spine, wrist, and shoulder) sites (SIR, 2.6; 95% CI, 2.1–3.3) and remaining sites (SIR, 1.7; 95% CI, 1.3–2.0) were increased in men, irrespective of age at distal forearm fracture as boys. A distal forearm fracture in boys, but not girls, is associated with an increased risk for fragility fractures as older adults. It is necessary to determine whether the increased fractures observed in men is due to persistent deficits of bone strength, continued high fracture risk activity, or both. Until then, men should be asked about a childhood distal forearm fracture and, if so, warrant further screening and counseling on measures to optimize bone health and prevent fractures. PMID:23456800

Deficits in distal radius bone strength, density and microstructure are associated with forearm fractures in girls: an HR-pQCTstudy

PubMed Central

Määttä, M.; Macdonald, H. M.; Mulpuri, K.

2016-01-01

Summary Forearm fractures are common during growth. We studied bone strength in youth with a recent forearm fracture. In girls, suboptimal bone strength was associated with fractures. In boys, poor balance and physical inactivity may lead to fractures. Prospective studies will confirm these relationships and identify targets for prevention strategies. Introduction The etiology of pediatric forearm fractures is unclear. Thus, we examined distal radius bone strength, microstructure, and density in children and adolescents with a recent low- or moderate-energy forearm fracture and those without forearm fractures. Methods We assessed the non-dominant (controls) and non-fractured (cases) distal radius (7 % site) using high-resolution peripheral quantitative computed tomography (HR-pQCT) (Scanco Medical AG) in 270 participants (girls: cases n=47, controls n=61 and boys: cases n=88, controls n=74) aged 8–16 years. We assessed standard anthropometry, maturity, body composition (dual energy X-ray absorptiometry (DXA), Hologic QDR 4500 W) physical activity, and balance. We fit sex-specific logistic regression models for each bone outcome adjusting for maturity, ethnicity, height, and percent body fat. Results In girls, impaired bone strength (failure load, ultimate stress) and a high load-to-strength ratio were associated with low-energy fractures (odds ratios (OR) 2.8–4.3). Low total bone mineral density (Tt.BMD), bone volume ratio, trabecular thickness, and cortical BMD and thickness were also associated with low-energy fractures (ORs 2.0–7.0). In boys, low Tt.BMD, but not bone strength, was associated with low-energy fractures (OR=1.8). Boys with low-energy fractures had poor balance and higher percent body fat compared with controls (p<0.05). Boys with fractures (both types) were less active than controls (p<0.05). Conclusions Forearm fracture etiology appears to be sex-specific. In girls, deficits in bone strength are associated with fractures. In boys, a combination of poor balance, excess body fat, and low physical activity may lead to fractures. Prospective studies are needed to confirm these relationships and clarify targets for prevention strategies. PMID:25572041

Depressive symptoms are not associated with forearm bone accrual during adolescence.

PubMed

Lourenço, Sara; Lucas, Raquel; da Silva, Daniele Ferreira; Ramos, Elisabete; Barros, Henrique

2014-01-01

Although depression has been associated to worst bone physical properties in adulthood, this study showed that depressive symptoms were not significantly associated to bone mineral density measured at the forearm during adolescence. Depressive conditions have been related to the reduction of bone mineral density (BMD) in adulthood. Though it is possible to hypothesize that depressive symptoms present similar effects in bone mineral accrual during adolescence, such association is poorly researched. Therefore, we aimed to study the relation between depressive symptoms and forearm BMD during adolescence. The study is based on the Epidemiological Health Investigation of Teenagers cohort that sampled adolescents born in 1990 and enrolled in public and private schools of Porto during the 2003/2004 academic year. At baseline (n = 2,160) and at 17 years of age (n = 1,716), depressive symptoms were evaluated using the Beck Depression Inventory-II (BDI-II). BMD (grams per square centimetre) was measured at the non-dominant forearm using dual-energy X-ray absorptiometry. Sex-specific crude and adjusted linear regression coefficients (β) and the corresponding 95 % confidence intervals (95 % CIs) were calculated to estimate the cross-sectional and prospective associations between depressive symptoms and forearm BMD. In both sexes, in early and late adolescence, depressive symptoms presented no statistically significant association with forearm BMD (β Girls13 = 0.09, 95 % CI = -0.43 to 0.61; β Girls17 = 0.10, 95 % CI = -0.43 to 0.64; β Boys13 = -0.10, 95 % CI = -0.96 to 0.76; β Boys17 = 0.49, 95 % CI = -0.96 to 1.93). Similarly, there were no significant associations between depressive symptoms and the annual forearm BMD change during adolescence in girls and boys (β Girls_BDI-II_13-17_remained_lowest = -0.85, 95 % CI = -4.62 to 2.92 vs. β Girls_BDI-II_13-17_remained_highest = -1.87, 95 % CI = -5.06 to 1.31; β Boys_BDI-II_13-17_remained_lowest = 0.48, 95 % CI = -5.30 to 6.26 vs. β Boys_BDI-II_13-17_remained_highest = 1.36, 95 % CI = -3.25 to 5.97). Depressive symptoms, with the range of severity observed in the general adolescent population, were not associated with changes in forearm bone mineral density during adolescence. Further research based on measurements of different skeletal sites is needed in order to detect a systemic effect of depression on growing bone.

Bone mineral density at distal forearm in men over 40 years of age in Mae Chaem district, Chiang Mai Province, Thailand: a pilot study.

PubMed

Tungjai, Montree; Kaewjaeng, Siriprapa; Jumpee, Chayanit; Sriburee, Sompong; Hongsriti, Pongsiri; Tapanya, Monruedee; Maghanemi, Utumma; Ratanasthien, Kwanchai; Kothan, Suchart

2017-09-01

To study the prevalence of bone mineral density (BMD) and osteoporosis in the distal forearm among Thai men over 40 years of age in Mae Chaem District, Chiang Mai Province, Thailand. The subjects in this study were 194 Thai men, aged between 40 and 87 years who resided in Mae Chaem District, Chiang Mai Province, Thailand. Self-administered questionnaires were used for receiving the demographic characteristics information. BMD was measured by peripheral dual energy X-ray absorptiometry at the nondominant distal forearm in all men. The BMD was highest in the age-group 40-49 years and lowest in the age-group 70-87 years. The average T-score at the distal forearm was also highest in the age-group 40-49 years and lowest in the age-group 70-87 years. The BMD decreased as a function of age-group (p < .05). In contrast, the BMD increased as a function of weight (p < .05). Height had weak impact on the BMD in the distal forearm (p > .05). The percentage of osteopenia and osteoporosis are increased as a function of age-group in, while decreased in that of normal bone density. We found the prevalence of osteoporosis in men who resided in Mae Chaem District, Chiang Mai Province, Thailand.

Modulatory Effects of the Ipsi and Contralateral Ventral Premotor Cortex (PMv) on the Primary Motor Cortex (M1) Outputs to Intrinsic Hand and Forearm Muscles in Cebus apella

PubMed Central

Quessy, Stephan; Côté, Sandrine L.; Hamadjida, Adjia; Deffeyes, Joan; Dancause, Numa

2016-01-01

The ventral premotor cortex (PMv) is a key node in the neural network involved in grasping. One way PMv can carry out this function is by modulating the outputs of the primary motor cortex (M1) to intrinsic hand and forearm muscles. As many PMv neurons discharge when grasping with either arm, both PMv within the same hemisphere (ipsilateral; iPMv) and in the opposite hemisphere (contralateral; cPMv) could modulate M1 outputs. Our objective was to compare modulatory effects of iPMv and cPMv on M1 outputs to intrinsic hand and forearm muscles. We used paired-pulse protocols with intracortical microstimulations in capuchin monkeys. A conditioning stimulus was applied in either iPMv or cPMv simultaneously or prior to a test stimulus in M1 and the effects quantified in electromyographic signals. Modulatory effects from iPMv were predominantly facilitatory, and facilitation was much more common and powerful on intrinsic hand than forearm muscles. In contrast, while the conditioning of cPMv could elicit facilitatory effects, in particular to intrinsic hand muscles, it was much more likely to inhibit M1 outputs. These data show that iPMv and cPMv have very different modulatory effects on the outputs of M1 to intrinsic hand and forearm muscles. PMID:27473318

Exogenous NO administration and alpha-adrenergic vasoconstriction in human limbs.

PubMed

Rosenmeier, Jaya B; Fritzlar, Sandy J; Dinenno, Frank A; Joyner, Michael J

2003-12-01

Nitric oxide (NO) is capable of blunting alpha-adrenergic vasoconstriction in contracting skeletal muscles of experimental animals (functional sympatholysis). We therefore tested the hypothesis that exogenous NO administration can blunt alpha-adrenergic vasoconstriction in resting human limbs by measuring forearm blood flow (FBF; Doppler ultrasound) and blood pressure in eight healthy males during brachial artery infusions of three alpha-adrenergic constrictors (tyramine, which evokes endogenous norepinephrine release; phenylephrine, an alpha1-agonist; and clonidine, an alpha2-agonist). To simulate exercise hyperemia, the vasoconstriction caused by the alpha-agonists was compared during adenosine-mediated (>50% NO independent) and sodium nitroprusside-mediated (SNP; NO donor) vasodilation of the forearm. Both adenosine and SNP increased FBF from approximately 35-40 to approximately 200-250 ml/min. All three alpha-adrenergic constrictor drugs caused marked reductions in FBF and calculated forearm vascular conductance (P < 0.05). The relative reductions in forearm vascular conductance caused by the alpha-adrenergic constrictors during SNP infusion were similar (tyramine, -74 +/- 3 vs. -65 +/- 2%; clonidine, -44 +/- 6 vs. -44 +/- 6%; P > 0.05) or slightly greater (phenylephrine, -47 +/- 6 vs. -33 +/- 6%; P < 0.05) compared with the responses during adenosine. In conclusion, these results indicate that exogenous NO sufficient to raise blood flow to levels simulating those seen during exercise does not blunt alpha-adrenergic vasoconstriction in the resting human forearm.

Maternal Dietary Patterns during Pregnancy in Relation to Offspring Forearm Fractures: Prospective Study from the Danish National Birth Cohort

PubMed Central

Petersen, Sesilje B.; Rasmussen, Morten A.; Olsen, Sjurdur F.; Vestergaard, Peter; Mølgaard, Christian; Halldorsson, Thorhallur I.; Strøm, Marin

2015-01-01

Limited evidence exists for an association between maternal diet during pregnancy and offspring bone health. In a prospective study, we examined the association between dietary patterns in mid-pregnancy and offspring forearm fractures. In total, 101,042 pregnancies were recruited to the Danish National Birth Cohort (DNBC) during 1996–2002. Maternal diet was collected by a food frequency questionnaire. Associations were analyzed between seven dietary patterns extracted by principal component analysis and offspring first occurrence of any forearm fracture diagnosis, extracted from the Danish National Patient Register, between time of birth and end of follow-up (<16 year) (n = 53,922). In multivariable Cox regression models, offspring of mothers in the fourth vs. first quintile of the Western pattern had a significant increased risk (Hazard ratio, 95% confidence interval: 1.11, 1.01–1.23) of fractures, and there was a borderline significant positive trend (p = 0.06). The other dietary patterns showed no associations and neither did supplementary analyses of macro- and micronutrients or single food groups, except for the intake of artificially sweetened soft drinks, which was positively associated with offspring forearm fractures (p = 0.02). In the large prospective DNBC high mid-pregnancy consumption of Western diet and artificially sweetened soft drinks, respectively, indicated positive associations with offspring forearm fractures, which provides interesting hypotheses for future research. PMID:25849947

Treatment of Wound Healing Disorders of Radial Forearm Free Flap Donor Sites Using Cold Atmospheric Plasma: A Proof of Concept.

PubMed

Hartwig, Stefan; Doll, Christian; Voss, Jan Oliver; Hertel, Moritz; Preissner, Saskia; Raguse, Jan Dirk

2017-02-01

The treatment of wound healing disturbances of the radial forearm free flap donor site after reconstructive surgery is typically long and burdensome and often requires additional surgery. Cold atmospheric plasma is a promising approach to overcome these impairments. The aim of this proof of concept study was to evaluate the clinical outcome of plasma irradiation in patients with wound healing disorders with exposed brachial tendons of the radial forearm. Four patients (mean age 64.2 years, range 44 to 80) who had undergone radial forearm free flap procedures and developed wound healing disturbance leading to exposed flexor tendons were included in the present prospective case series. In addition to routine wound care, all sites were irradiated with cold atmospheric plasma. The primary outcome variable was complete wound closure. In all patients, complete wound repair in terms of the absence of tendon exposure was observed within a mean treatment time of 10.1 weeks (range 4.9 to 16). No undesirable side effects were observed, and no inflammation or infection occurred. Cold atmospheric plasma could offer a reliable conservative treatment option for complicated wound healing disturbances. This was exemplarily shown in the case of radial forearm free flap donor site morbidity with exposed flexor tendons in the present study. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Design of a Model of Forearm Bone Fractures for Educational Purposes

ERIC Educational Resources Information Center

Jastaniah, Saddig; Hamdan, Abdulrahman; Alhadrami, Abdullah; Almatrafi, Talal; Arif, Ahmed; Almalki, Hassan

2016-01-01

This work explores a new approach to demonstrate possible forearm fractures in humans as an educating means for student radiographers. The Design of abnormal bones are not normally available as phantoms; the manufacturer usually produces normal human musculoskeletal models for educational purposes. Hence fractures and abnormalities are usually…

Functional anatomy of the distal radioulnar joint in health and disease.

PubMed

Lees, V C

2013-04-01

The distal radioulnar joint (DRUJ) is critical to the function of the forearm as a mechanical unit. This paper is concerned with the concepts and observations that have changed understanding of the function of the DRUJ, notably with respect to the biomechanics of this joint. The DRUJ has been shown to be important in acting to distribute load and removal of the ulna head leads to the biomechanical equivalent of a one-bone forearm. The soft tissues with topographical relations to the distal forearm and DRUJ have also been investigated in our experimental series with findings including the description of a clinical disorder termed subluxation-related ulna neuropathy syndrome.

Reconstruction of Thermographic Signals to Map Perforator Vessels in Humans

PubMed Central

Liu, Wei-Min; Maivelett, Jordan; Kato, Gregory J.; Taylor, James G.; Yang, Wen-Chin; Liu, Yun-Chung; Yang, You-Gang; Gorbach, Alexander M.

2013-01-01

Thermal representations on the surface of a human forearm of underlying perforator vessels have previously been mapped via recovery-enhanced infrared imaging, which is performed as skin blood flow recovers to baseline levels following cooling of the forearm. We noted that the same vessels could also be observed during reactive hyperaemia tests after complete 5-min occlusion of the forearm by an inflatable cuff. However, not all subjects showed vessels with acceptable contrast. Therefore, we applied a thermographic signal reconstruction algorithm to reactive hyperaemia testing, which substantially enhanced signal-to-noise ratios between perforator vessels and their surroundings, thereby enabling their mapping with higher accuracy and a shorter occlusion period. PMID:23667389

Post-dural puncture headache

PubMed Central

Ghaleb, Ahmed; Khorasani, Arjang; Mangar, Devanand

2012-01-01

Since August Bier reported the first case in 1898, post-dural puncture headache (PDPH) has been a problem for patients following dural puncture. Clinical and laboratory research over the last 30 years has shown that use of smaller-gauge needles, particularly of the pencil-point design, are associated with a lower risk of PDPH than traditional cutting point needle tips (Quincke-point needle). A careful history can rule out other causes of headache. A postural component of headache is the sine qua non of PDPH. In high-risk patients < 50 years, post-partum, in the event a large-gauge needle puncture is initiated, an epidural blood patch should be performed within 24–48 hours of dural puncture. The optimum volume of blood has been shown to be 12–20 mL for adult patients. Complications caused by autologous epidural blood patching (AEBP) are rare. PMID:22287846

Postdural Puncture Headache

PubMed Central

Ghaleb, Ahmed

2010-01-01

Postdural puncture headache (PDPH) has been a problem for patients, following dural puncture, since August Bier reported the first case in 1898. His paper discussed the pathophysiology of low-pressure headache resulting from leakage of cerebrospinal fluid (CSF) from the subarachnoid to the epidural space. Clinical and laboratory research over the last 30 years has shown that use of small-gauge needles, particularly of the pencil-point design, is associated with a lower risk of PDPH than traditional cutting point needle tips (Quincke-point needle). A careful history can rule out other causes of headache. A postural component of headache is the sine qua non of PDPH. In high-risk patients , for example, age < 50 years, postpartum, large-gauge needle puncture, epidural blood patch should be performed within 24–48 h of dural puncture. The optimum volume of blood has been shown to be 12–20 mL for adult patients. Complications of AEBP are rare. PMID:20814596

[Anticipatory postural adjustment in bimanual unloading: role of the motor cortex in motor learning].

PubMed

Kazennikov, O V; Solopova, I A; Talis, V L; Ioffe, M E

2006-01-01

The role of the motor cortex was investigated during learning unusual postural adjustment. Healthy subjects held their right (postural) forearm in a horizontal position while supporting a 1-kG load via an electromagnet. The postural forearm position was perturbed by the load release triggered by other elbow voluntary movement. Repetition of the imposed unloading test resulted in a progressive reduction of the maximal forearm rotation, accompanied by the anticipatory decrease in m. biceps brachii activity (learning). Control situation consisted of the voluntary forearm loading. Using the transcranial magnetic stimulation we examined changes in the motor evoked potential of the m. biceps brahii at the beginning and at the end of learning. The evoked potential amplitude did not significantly change in process of the decrease of m. biceps brachii activity. At the end of learning, motor evoked potential / baseline electromyogram ratio increased as compared to the beginning of learning and to the control situation. The results highlight the fundamental role of the motor cortex in suppression of synergies which interfere with formation of a new coordination during motor learning.

Forearm vasodilatation following release of venous congestion

PubMed Central

Caro, C. G.; Foley, T. H.; Sudlow, M. F.

1970-01-01

1. The volume rate of forearm blood flow was measured with a mercury-in-rubber strain gauge, or with a water-filled plethysmograph, from 1 sec after termination of a 2-3 min period of venous congestion. 2. When congesting pressure had been less than 18 mm Hg, average post-congestion flow (five subjects) was constant during approx. 10 sec and not significantly different from resting flow. 3. When congesting pressure had been 30 mm Hg, average post-congestion flow (eight subjects) was 26% higher than resting, during 3-4 sec after release of congestion, but rose to 273% of resting during 4-6 sec after release of congestion. 4. In other studies forearm vascular resistance had been found normal or increased during such venous congestion, and theoretical studies here indicated that passive mechanical factors could not account for the delayed occurrence of high post-congestion flow. 5. It appears, therefore, that the forearm vascular bed dilates actively shortly after release of substantial venous congestion. It would seem more likely that a myogenic mechanism, rather than a metabolic one, is responsible. PMID:5532541

Postanesthesia patients with large upper arm circumference: is use of an "extra-long" adult cuff or forearm cuff placement accurate?

PubMed

Watson, Sheri; Aguas, Marita; Bienapfl, Tracy; Colegrove, Pat; Foisy, Nancy; Jondahl, Bonnie; Yosses, Mary Beth; Yu, Larissa; Anastas, Zoe

2011-06-01

The purpose of this study was to determine if blood pressure (BP) measured in the forearm or with an extra-long BP cuff in the upper arm accurately reflects BP measured in the upper arm with an appropriately sized BP cuff in patients with large upper arm circumference. A method-comparison design was used with a convenience sample of 49 PACU patients. Noninvasive blood pressures were obtained in two different locations (forearm; upper arm) and in the upper arm with an extra-long adult and recommended large adult cuff sizes. Data were analyzed by calculating bias and precision for the BP cuff size and location and Student's t-tests, with P < .0125 considered significant. Significantly higher forearm systolic (P < .0001) and diastolic (P < .0002) BP measurements were found compared to BP obtained in the upper arm with the reference standard BP cuff. Significantly higher systolic (t(48df) = 5.38, P < .0001), but not diastolic (t(48df) = 4.11, P < .019), BP differences were found for BP measured with the extra-long cuff at the upper arm site compared to the upper arm, reference standard BP. Findings suggest that the clinical practice of using the forearm or an extra-long cuff in the upper arm for BP measurement in post anesthesia patients with large upper arm circumferences may result in inaccurate BP values. Copyright © 2011 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Examination of the pronator quadratus muscle during hardware removal procedures after volar plating for distal radius fractures.

PubMed

Nho, Jae-Hwi; Gong, Hyun Sik; Song, Cheol Ho; Wi, Seung Myung; Lee, Young Ho; Baek, Goo Hyun

2014-09-01

It is not clear whether the pronator quadratus (PQ) muscle actually heals and provides a meaningful pronation force after volar plating for distal radius fractures (DRFs). We aimed to determine whether the length of the PQ muscle, which is dissected and then repaired during volar plating for a DRF, affects the forearm rotation strength and clinical outcomes. We examined 41 patients who requested hardware removal after volar plating. We measured the isokinetic forearm rotation strength and clinical outcomes including grip strength, wrist range of motion, and disabilities of the arm, shoulder and hand (DASH) scores at 6 months after fracture fixation. During the hardware removal surgery, which was performed at an average of 9 months (range, 8.3 to 11.5 months) after fracture fixation, we measured the PQ muscle length. The average PQ muscle length was 68% of the normal muscle length, and no significant relationship was found between the PQ muscle length and the outcomes including isokinetic forearm rotation strength, grip strength, wrist range of motion, and DASH scores. This study demonstrates that the length of the healed PQ muscle does not affect isokinetic forearm rotation strength and clinical outcomes after volar plating for DRFs. The results of this study support our current practice of loose repair of the PQ that is performed by most of the surgeons to prevent tendon irritation over the plate, and suggest that tight repair of the PQ is not necessary for achieving improved forearm function.

Changes in forearm muscle temperature alter renal vascular responses to isometric handgrip.

PubMed

Kuipers, Nathan T; Sauder, Charity L; Kearney, Matthew L; Ray, Chester A

2007-12-01

The purpose of the present study was to examine the effect of heating and cooling the forearm muscles on renal vascular responses to ischemic isometric handgrip (IHG). It was hypothesized that heating and cooling the forearm would augment and attenuate, respectively, renal vascular responses to IHG. Renal vascular responses to IHG were studied during forearm heating at 39 degrees C (n = 15, 26 +/- 1 yr) and cooling at 26 degrees C (n = 12, 26 +/- 1 yr). For a control trial, subjects performed the experimental protocol while the forearm was normothermic (approximately 34 degrees C). Muscle temperature (measured by intramuscular probe) was controlled by changing the temperature of water cycling through a water-perfused sleeve. The experimental protocol was as follows: 3 min at baseline, 1 min of ischemia, ischemic IHG to fatigue, and 2 min of postexercise muscle ischemia. At rest, renal artery blood velocity (RBV; Doppler ultrasound) and renal vascular conductance (RVC = RBV/mean arterial blood pressure) were not different between normothermia and the two thermal conditions. During ischemic IHG, there were greater decreases in RBV and RVC in the heating trial. However, RBV and RVC were similar during postexercise muscle ischemia during heating and normothermia. RVC decreased less during cooling than in normothermia while the subjects performed the ischemic IHG protocol. During postexercise muscle ischemia, RVC was greater during cooling than in normothermia. These results indicate that heating augments mechanoreceptor-mediated renal vasoconstriction whereas cooling blunts metaboreceptor-mediated renal vasoconstriction.

Incidence of Connected Consciousness after Tracheal Intubation: A Prospective, International, Multicenter Cohort Study of the Isolated Forearm Technique.

PubMed

Sanders, Robert D; Gaskell, Amy; Raz, Aeyal; Winders, Joel; Stevanovic, Ana; Rossaint, Rolf; Boncyk, Christina; Defresne, Aline; Tran, Gabriel; Tasbihgou, Seth; Meier, Sascha; Vlisides, Phillip E; Fardous, Hussein; Hess, Aaron; Bauer, Rebecca M; Absalom, Anthony; Mashour, George A; Bonhomme, Vincent; Coburn, Mark; Sleigh, Jamie

2017-02-01

The isolated forearm technique allows assessment of consciousness of the external world (connected consciousness) through a verbal command to move the hand (of a tourniquet-isolated arm) during intended general anesthesia. Previous isolated forearm technique data suggest that the incidence of connected consciousness may approach 37% after a noxious stimulus. The authors conducted an international, multicenter, pragmatic study to establish the incidence of isolated forearm technique responsiveness after intubation in routine practice. Two hundred sixty adult patients were recruited at six sites into a prospective cohort study of the isolated forearm technique after intubation. Demographic, anesthetic, and intubation data, plus postoperative questionnaires, were collected. Univariate statistics, followed by bivariate logistic regression models for age plus variable, were conducted. The incidence of isolated forearm technique responsiveness after intubation was 4.6% (12/260); 5 of 12 responders reported pain through a second hand squeeze. Responders were younger than nonresponders (39 ± 17 vs. 51 ± 16 yr old; P = 0.01) with more frequent signs of sympathetic activation (50% vs. 2.4%; P = 0.03). No participant had explicit recall of intraoperative events when questioned after surgery (n = 253). Across groups, depth of anesthesia monitoring values showed a wide range; however, values were higher for responders before (54 ± 20 vs. 42 ± 14; P = 0.02) and after (52 ± 16 vs. 43 ± 16; P = 0.02) intubation. In patients not receiving total intravenous anesthesia, exposure to volatile anesthetics before intubation reduced the odds of responding (odds ratio, 0.2 [0.1 to 0.8]; P = 0.02) after adjustment for age. Intraoperative connected consciousness occurred frequently, although the rate is up to 10-times lower than anticipated. This should be considered a conservative estimate of intraoperative connected consciousness.

Posterior interosseous nerve localization within the proximal forearm - a patient normalized parameter.

PubMed

Kamineni, Srinath; Norgren, Crystal R; Davidson, Evan M; Kamineni, Ellora P; Deane, Andrew S

2017-04-18

To provide a "patient-normalized" parameter in the proximal forearm. Sixty-three cadaveric upper extremities from thirty-five cadavers were studied. A muscle splitting approach was utilized to locate the posterior interosseous nerve (PIN) at the point where it emerges from beneath the supinator. The supinator was carefully incised to expose the midpoint length of the nerve as it passes into the forearm while preserving the associated fascial connections, thereby preserving the relationship of the nerve with the muscle. We measured the transepicondylar distance (TED), PIN distance in the forearm's neutral rotation position, pronation position, supination position, and the nerve width. Two individuals performed measurements using a digital caliper with inter-observer and intra-observer blinding. The results were analyzed with the Wilcoxon-Mann-Whitney test for paired samples. In pronation, the PIN was within two confidence intervals of 1.0 TED in 95% of cases (range 0.7-1.3 TED); in neutral, within two confidence intervals of 0.84 TED in 95% of cases (range 0.5-1.1 TED); in supination, within two confidence intervals of 0.72 TED in 95% of cases (range 0.5-0.9 TED). The mean PIN distance from the lateral epicondyle was 100% of TED in a pronated forearm, 84% in neutral, and 72% in supination. Predictive accuracy was highest in supination; in all cases the majority of specimens (90.47%-95.23%) are within 2 cm of the forearm position-specific percentage of TED. When comparing right to left sides for TEDs with the signed Wilcoxon-Mann-Whitney test for paired samples as well as a significance test (with normal distribution), the P -value was 0.0357 (significance - 0.05) indicating a significant difference between the two sides. This "patient normalized" parameter localizes the PIN crossing a line drawn between the lateral epicondyle and the radial styloid. Accurate PIN localization will aid in diagnosis, injections, and surgical approaches.

Interactions of mean body and local skin temperatures in the modulation of human forearm and calf blood flows: a three-dimensional description.

PubMed

Caldwell, Joanne N; Matsuda-Nakamura, Mayumi; Taylor, Nigel A S

2016-02-01

The inter-relationships between mean body and local skin temperatures have previously been established for controlling hand and foot blood flows. Since glabrous skin contains many arteriovenous anastomoses, it was important to repeat those experiments on non-glabrous regions using the same sample and experimental conditions. Mild hypothermia (mean body temperature 31.4 °C), normothermia (control: 36.0 °C) and moderate hyperthermia (38.3 °C) were induced and clamped (climate chamber and water-perfusion garment) in eight males. Within each condition, five localised thermal treatments (5, 15, 25, 33, 40 °C) were applied to the left forearm and right calf. Steady-state forearm and calf blood flows were measured (venous occlusion plethysmography) for each of the resulting 15 combinations of clamped mean body and local skin temperatures. Under the normothermic clamp, cutaneous blood flows averaged 4.2 mL 100 mL(-1) min(-1) (±0.28: forearm) and 5.4 mL 100 mL(-1) min(-1) (±0.27: calf). When mildly hypothermic, these segments were unresponsive to localised thermal stimuli, but tracked those changes when normothermic and moderately hyperthermic. For deep-body (oesophageal) temperature elevations, forearm blood flow increased by 5.1 mL 100 mL(-1) min(-1) °C(-1) (±0.9) relative to normothermia, while the calf was much less responsive: 3.3 mL 100 mL(-1) min(-1) °C(-1) (±1.5). Three-dimensional surfaces revealed a qualitative divergence in the control of calf blood flow, with vasoconstrictor tone apparently being released more gradually. These descriptions reinforce the importance of deep-tissue temperatures in controlling cutaneous perfusion, with this modulation being non-linear at the forearm and appearing linear for the calf.

The effect of repeated laser stimuli to ink-marked skin on skin temperature-recommendations for a safe experimental protocol in humans.

PubMed

Madden, Victoria J; Catley, Mark J; Grabherr, Luzia; Mazzola, Francesca; Shohag, Mohammad; Moseley, G Lorimer

2016-01-01

Background. Nd:YAP laser is widely used to investigate the nociceptive and pain systems, generating perpetual and laser-evoked neurophysiological responses. A major procedural concern for the use of Nd:YAP laser stimuli in experimental research is the risk of skin damage. The absorption of Nd:YAP laser stimuli is greater in darker skin, or in pale skin that has been darkened with ink, prompting some ethics boards to refuse approval to experimenters wishing to track stimulus location by marking the skin with ink. Some research questions, however, require laser stimuli to be delivered at particular locations or within particular zones, a requirement that is very difficult to achieve if marking the skin is not possible. We thoroughly searched the literature for experimental evidence and protocol recommendations for safe delivery of Nd:YAP laser stimuli over marked skin, but found nothing. Methods. We designed an experimental protocol to define safe parameters for the use of Nd:YAP laser stimuli over skin that has been marked with black dots, and used thermal imaging to assess the safety of the procedure at the forearm and the back. Results. Using thermal imaging and repeated laser stimulation to ink-marked skin, we demonstrated that skin temperature did not increase progressively across the course of the experiment, and that the small change in temperature seen at the forearm was reversed during the rest periods between blocks. Furthermore, no participant experienced skin damage due to the procedure. Conclusion. This protocol offers parameters for safe, confident and effective experimentation using repeated Nd:YAP laser on skin marked with ink, thus paving the way for investigations that depend on it.

Virtual Reality Anatomy: Is It Comparable with Traditional Methods in the Teaching of Human Forearm Musculoskeletal Anatomy?

ERIC Educational Resources Information Center

Codd, Anthony M.; Choudhury, Bipasha

2011-01-01

The use of cadavers to teach anatomy is well established, but limitations with this approach have led to the introduction of alternative teaching methods. One such method is the use of three-dimensional virtual reality computer models. An interactive, three-dimensional computer model of human forearm anterior compartment musculoskeletal anatomy…

The Effect of Movement Imagery Training on Learning Forearm Pass in Volleyball

ERIC Educational Resources Information Center

Ay, Khitam Mousa; Halaweh, Rami Saleh; Al-Taieb, Mohammad Abu

2013-01-01

This study investigates the effect of movement imagery on learning the forearm pass in volleyball. Twenty four mail students from Physical Education Factuly at Jordan University (19 ± 0.5) years of age. After Completed the Movement Imagery Questionnaire-Revised (MIQ-R; Hall & Martin, 1997) the subjects randomly divided into two groups,…

Folliculotropic mycosis fungoides and a leonine clinical appearance of the face.

PubMed

Ito, Tomonobu; Yamamoto, Toshiyuki; Matsumoto, Yuka; Wakamatsu, Junko; Kato, Yukihiko; Tsuboi, Ryoji

2008-09-15

A 73-year-old man presented with a two year history of multiple nodules and follicular papules accompanied by slight itching on the face and the forearm. A physical examination showed multiple, soft, erythematous nodules on the forehead, cheek, and jaw, contributing to a generally leonine appearance of the face. Histopathological examination from the forehead revealed dense, massive concentrations of atypical lymphocytes in the dermis, and the forearm showed infiltration of atypical lymphocytes predominantly around the follicles. We diagnosed this condition as folliculotropic cutaneous T cell lymphoma (CTCL). EPOCH therapy was very effective and the lesions of the forehead and forearm showed a decrease in tumor elevation; the histology showed a precipitous decrease in the number of the atypical lymphocytes.

[Temperature sensitivity and the indicators of respiration in humans in the normal state and during local cooling].

PubMed

Kozyreva, T V; Simonova, T G

1991-01-01

The examination has shown that people who have many cold spots on the forearm possess high ventilation volume and breathing frequency and low value of oxygen utilization. These facts can evidence for the effect of cold skin receptors on the respiratory patterns. The skin temperature, at which the maximal cooling-induced changes of respiratory parameters are observed depends on the dynamic activity of cold skin thermoreceptors: the greater number of cold spots in the hand and forearm, the lesser cooling is necessary to cause the maximal increase of oxygen consumption and change of respiratory volume. The latter increased in the case of hand cooling and decreased in the case of the forearm cooling.

Forearm articular proportions and the antebrachial index in Homo sapiens, Australopithecus afarensis and the great apes.

PubMed

Williams, Frank L'Engle; Cunningham, Deborah L; Amaral, Lia Q

2015-12-01

When hominin bipedality evolved, the forearms were free to adopt nonlocomotor tasks which may have resulted in changes to the articular surfaces of the ulna and the relative lengths of the forearm bones. Similarly, sex differences in forearm proportions may be more likely to emerge in bipeds than in the great apes given the locomotor constraints in Gorilla, Pan and Pongo. To test these assumptions, ulnar articular proportions and the antebrachial index (radius length/ulna length) in Homo sapiens (n=51), Gorilla gorilla (n=88), Pan troglodytes (n=49), Pongo pygmaeus (n=36) and Australopithecus afarensis A.L. 288-1 and A.L. 438-1 are compared. Intercept-adjusted ratios are used to control for size and minimize the effects of allometry. Canonical scores axes show that the proximally broad and elongated trochlear notch with respect to size in H. sapiens and A. afarensis is largely distinct from G. gorilla, P. troglodytes and P. pygmaeus. A cluster analysis of scaled ulnar articular dimensions groups H. sapiens males with A.L. 438-1 ulna length estimates, while one A.L. 288-1 ulna length estimate groups with Pan and another clusters most closely with H. sapiens, G. gorilla and A.L. 438-1. The relatively low antebrachial index characterizing H. sapiens and non-outlier estimates of A.L. 288-1 and A.L. 438-1 differs from those of the great apes. Unique sex differences in H. sapiens suggest a link between bipedality and forearm functional morphology. Copyright © 2015 Elsevier GmbH. All rights reserved.

Pigmentation in African American skin decreases with skin aging.

PubMed

Chien, Anna L; Suh, Jean; Cesar, Sabrina Sisto Alessi; Fischer, Alexander H; Cheng, Nancy; Poon, Flora; Rainer, Barbara; Leung, Sherry; Martin, Jo; Okoye, Ginette A; Kang, Sewon

2016-10-01

Tristimulus colorimetry, which uses the Commission Internationale de l'Eclairage L*a*b* model to quantify color, has previously been used to analyze pigmentation and erythema in human skin; however, colorimetry of African American skin is not well characterized. We sought to analyze skin color patterns in African Americans and compare them with those of Caucasians. Colorimetry readings of the sun-protected buttock and sun-exposed back of forearm were taken from 40 Caucasian and 43 African American participants from March 2011 through August 2015. African American participants also completed a lifestyle questionnaire. Correlation coefficients, paired t tests, and multivariable linear regression analyses were used for statistical comparisons. Forearm skin was lighter in African Americans ages 65 years and older versus 18 to 30 years (P = .02) but darker in Caucasians ages 65 years or older versus 18 to 30 years (P = .03). In African Americans ages 18 to 30 years, the buttock was darker than the forearm (P < .001), whereas in Caucasians the buttock was lighter than the forearm (P < .001). A lighter forearm than buttock was correlated with supplement use, smoking (ages 18-30 years), and less recreational sun exposure (ages ≥65 years) in African Americans. Our study was limited by the sample size and focal geographic source. Pigmentation patterns regarding sun-protected and sun-exposed areas in African Americans may differ from that of Caucasians, suggesting that other factors may contribute to skin pigmentation in African Americans. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

[Dynamic radioulnar convergence after Darrach operation, soft tissue stabilizing operations of the distal ulna and ulnar head prosthesis implantation--an experimental biomechanical study].

PubMed

Sauerbier, M; Hahn, M E; Fujita, M; Neale, P G; Germann, G; An, K N; Berger, R A

2002-08-01

The most common method of treating the arthrotic distal radioulnar joint (DRUJ) is resection of the entire ulnar head (Darrach procedure). Complications related to instability of the distal forearm resulting from loss of the ulnar head are usually manifested by pain and weak grip strength and have remained the drawbacks of this procedure. In an attempt to mechanically stabilize the distal forearm, an endoprosthesis was developed to replace the ulnar head after Darrach resection. The purpose of this study was to: 1) evaluate the dynamic effects of the Darrach procedure on radioulnar convergence; and 2) evaluate the mechanical efficacy of two soft tissue stabilizing techniques (Pronator quadratus advancement flap and ECU/FCU tenodesis) for the unstable distal ulnar stump and 3) the stability after the implantation of an ulnar head endoprosthesis following a Darrach resection on radioulnar convergence. With a dynamic PC-controled forearm simulator the rotation of 7 fresh-frozen cadaver upper extremities was actively and passively performed while loading relevant muscles. Resultant total forearm torque and the 3-dimensional kinematics of the ulna, radius and third metacarpal were recorded simultaneously. The implantation of the ulnar head endoprosthesis effectively restored the stability of the DRUJ. There were significantly better results after the implantation of the prosthesis compared with the Darrach and the soft tissue stabilization procedures. This study provides laboratory validity to the option of implanting an ulnar head endoprosthesis as an attempt to stabilize the distal forearm after Darrach resection in lieu of performing soft tissue stabilization techniques.

Mechanical interaction between neighboring muscles in human upper limb: Evidence for epimuscular myofascial force transmission in humans.

PubMed

Yoshitake, Yasuhide; Uchida, Daiki; Hirata, Kosuke; Mayfield, Dean L; Kanehisa, Hiroaki

2018-06-06

To confirm the existence of epimuscular myofascial force transmission in humans, this study examined if manipulating joint angle to stretch the muscle can alter the shear modulus of a resting adjacent muscle, and whether there are regional differences in this response. The biceps brachii (BB: manipulated muscle) and the brachialis (BRA: resting adjacent muscle) were deemed suitable for this study because they are neighboring, yet have independent tendons that insert onto different bones. In order to manipulate the muscle length of BB only, the forearm was passively set at supination, neutral, and pronation positions. For thirteen healthy young adult men, the shear modulus of BB and BRA was measured with shear-wave elastography at proximal and distal muscle regions for each forearm position and with the elbow joint angle at either 100° or 160°. At both muscle regions and both elbow positions, BB shear modulus increased as the forearm was rotated from a supinated to pronated position. Conversely, BRA shear modulus decreased as function of forearm position. The effect of forearm position on shear modulus was most pronounced in the distal muscle region when the elbow was at 160°. The observed alteration of shear modulus of the resting adjacent muscle indicates that epimuscular myofascial force transmission is present in the human upper limb. Consistent with this assertion, we found that the effect of muscle length on shear modulus in both muscles was region-dependent. Our results also suggest that epimuscular myofascial force transmission may be facilitated at stretched muscle lengths. Copyright © 2018 Elsevier Ltd. All rights reserved.

A Longitudinal Acoustic Study of the Effects of the Radial Forearm Free Flap Reconstruction on Sibilants Produced by Tongue Cancer Patients

ERIC Educational Resources Information Center

Laaksonen, Juha-Pertti; Rieger, Jana; Harris, Jeffrey; Seikaly, Hadi

2011-01-01

Acoustic properties of 980 tokens of sibilants /s, z, [approximately]/ produced by 17 Canadian English-speaking female and male tongue cancer patients were studied. The patients had undergone tongue resection and tongue reconstruction with a radial forearm free flap (RFFF). The spectral moments (mean, skewness) and frication duration were analysed…

Circadian rhythms and fractal fluctuations in forearm motion

NASA Astrophysics Data System (ADS)

Hu, Kun; Hilton, Michael F.

2005-03-01

Recent studies have shown that the circadian pacemaker --- an internal body clock located in the brain which is normally synchronized with the sleep/wake behavioral cycles --- influences key physiologic functions such as the body temperature, hormone secretion and heart rate. Surprisingly, no previous studies have investigated whether the circadian pacemaker impacts human motor activity --- a fundamental physiologic function. We investigate high-frequency actigraph recordings of forearm motion from a group of young and healthy subjects during a forced desynchrony protocol which allows to decouple the sleep/wake cycles from the endogenous circadian cycle while controlling scheduled behaviors. We investigate both static properties (mean value, standard deviation), dynamical characteristics (long-range correlations), and nonlinear features (magnitude and Fourier-phase correlations) in the fluctuations of forearm acceleration across different circadian phases. We demonstrate that while the static properties exhibit significant circadian rhythms with a broad peak in the afternoon, the dynamical and nonlinear characteristics remain invariant with circadian phase. This finding suggests an intrinsic multi-scale dynamic regulation of forearm motion the mechanism of which is not influenced by the circadian pacemaker, thus suggesting that increased cardiac risk in the early morning hours is not related to circadian-mediated influences on motor activity.

Clinical disorders and pressure-pain threshold of the forearm and hand among automobile assembly line workers.

PubMed

Byström, S; Hall, C; Welander, T; Kilbom, A

1995-12-01

The prevalence of forearm and hand disorders was examined by questionnaire and clinical examination in 199 automobile assembly line workers and in 186 controls. The pressure-pain threshold, hand grip force and hand anthropometry were also studied. There was an increased prevalence of de Quervain's disease for male automobile assembly line workers, and of carpal tunnel syndrome in female workers. The prevalence of symptoms in the forearm and hand during the last 7 days were twice as high among automobile assembly line workers than controls for both men and women. The occurrence of symptoms in the last 7 days was associated with de Quervain's disease, carpal tunnel syndrome and sick-leave due to forearm or hand problems, and it also influenced activities of daily living. Hand grip strength and anthropometrics were not associated with findings in the clinical examination or the occurrence of symptoms in the last 7 days. Low pressure-pain threshold was not associated with findings in the clinical examination, except for reported occurrence of symptoms in the last 7 days for women. Pressure-pain threshold as an indicator of tissue damage is discussed.

Proximal forearm extensor muscle strain is reduced when driving nails using a shock-controlled hammer.

PubMed

Buchanan, Kimberly A; Maza, Maria; Pérez-Vázquez, Carlos E; Yen, Thomas Y; Kijowski, Richard; Liu, Fang; Radwin, Robert G

2016-10-01

Repetitive hammer use has been associated with strain and musculoskeletal injuries. This study investigated if using a shock-control hammer reduces forearm muscle strain by observing adverse physiological responses (i.e. inflammation and localized edema) after use. Three matched framing hammers were studied, including a wood-handle, steel-handle, and shock-control hammer. Fifty volunteers were randomly assigned to use one of these hammers at a fatiguing pace of one strike every second, to seat 20 nails in a wood beam. Magnetic resonance imaging was used to scan the forearm muscles for inflammation before the task, immediately after hammering, and one to two days after. Electromyogram signals were measured to estimate grip exertions and localized muscle fatigue. High-speed video was used to calculate the energy of nail strikes. While estimated grip force was similar across the three hammers, the shock-control hammer had 40% greater kinetic energy upon impact and markedly less proximal extensor muscle edema than the wood-handle and steel-handle hammers, immediately after use (p<.05). Less edema observed for the shock-control hammer suggests that isolating handle shock can mitigate strain in proximal forearm extensor muscles. Copyright © 2016 Elsevier Ltd. All rights reserved.

Site, gender and age variation in normal skin colour on the back and the forearm: tristimulus colorimeter measurements.

PubMed

Fullerton, A; Serup, J

1997-02-01

To study whether anatomical location and age and gender of subjects had any influence on the objective skin colour measurements. Baseline colour in prone position was measured with the Minolta ChromaMeter® in the upper, middle and lower level of the upper back and on the forearm of 168 volunteers. These two sites are commonly used in skin testing. Higher basal a* and lower basal L* levels were found on the upper scapular region compared to the lower scapular region and the subscapular region. The basal b* level showed no variation relative to site. The basal a* and the basal b* levels were lower on the forearm compared to the upper back while the basal L* level was higher. Females above 65 years showed a less coloured skin with lower values as compared to those of younger age. Females were found to have a generally lower basal a* level than males both on the upper back and forearm skin. These relatively major differences and sources of variation have to be considered when planning irritancy studies where colour differences between erythema and normal skin is used.

Supinator Extender (SUE): a pneumatically actuated robot for forearm/wrist rehabilitation after stroke.

PubMed

Allington, James; Spencer, Steven J; Klein, Julius; Buell, Meghan; Reinkensmeyer, David J; Bobrow, James

2011-01-01

The robot described in this paper, SUE (Supinator Extender), adds forearm/wrist rehabilitation functionality to the UCI BONES exoskeleton robot and to the ArmeoSpring rehabilitation device. SUE is a 2-DOF serial chain that can measure and assist forearm supination-pronation and wrist flexion-extension. The large power to weight ratio of pneumatic actuators allows SUE to achieve the forces needed for rehabilitation therapy while remaining lightweight enough to be carried by BONES and ArmeoSpring. Each degree of freedom has a range of 90 degrees, and a nominal torque of 2 ft-lbs. The cylinders are mounted away from the patient's body on the lateral aspect of the arm. This is to prevent the danger of a collision and maximize the workspace of the arm robot. The rotation axis used for supination-pronation is a small bearing just below the subject's wrist. The flexion-extension motion is actuated by a cantilevered pneumatic cylinder, which allows the palm of the hand to remain open. Data are presented that demonstrate the ability of SUE to measure and cancel forearm/wrist passive tone, thereby extending the active range of motion for people with stroke.

Transplantation of severed digits to forearm stump for restoration of partial hand function.

PubMed

Cheng, G L; Pan, D D; Qu, Z Y

1985-10-01

Three cases of mutilating injury of the distal end of the forearm, wrist, and palm treated by transplantation of severed digits to the forearm stump are reported. Follow-up examinations made at 1 year and 4 months to 31/2 years postoperatively revealed fair sensory and motor functions. The functional result is better than that obtained after Krukenberg's operation or prosthesis fitting, and is comparable to that of "hand" reconstruction by autotransplantation of toes. Since this procedure can fulfill the basic requirements of hand function by reconstruction, namely, good sensibility; basic motor functions of pinching, grasping, and powerful gripping; and acceptable outward appearance, and can be accomplished in a one-stage operation without sacrificing toes, it should be considered as first choice whenever a suitable case is encountered.

Surface Electromyography of the Forearm Musculature During the Windmill Softball Pitch

PubMed Central

Remaley, D. Trey; Fincham, Bryce; McCullough, Bryan; Davis, Kirk; Nofsinger, Charles; Armstrong, Charles; Stausmire, Julie M.

2015-01-01

Background: Previous studies investigating the windmill softball pitch have focused primarily on shoulder musculature and function, collecting limited data on elbow and forearm musculature. Little information is available in the literature regarding the forearm. This study documents forearm muscle electromyographic (EMG) activity that has not been previously published. Purpose: Elbow and upper extremity overuse injuries are on the rise in fast-pitch softball pitchers. This study attempts to describe forearm muscle activity in softball pitchers during the windmill softball pitch. Overuse injuries can be prevented if a better understanding of mechanics is defined. Study Design: Descriptive laboratory study. Methods: Surface EMG and high-speed videography was used to study forearm muscle activation patterns during the windmill softball pitch on 10 female collegiate-level pitchers. Maximum voluntary isometric contraction of each muscle was used as a normalizing value. Each subject was tested during a single laboratory session per pitcher. Data included peak muscle activation, average muscle activation, and time to peak activation for 6 pitch types: fastball, changeup, riseball, curveball, screwball, and dropball. Results: During the first 4 phases, muscle activity (seen as signal strength on the EMG recordings) was limited and static in nature. The greatest activation occurred in phases 5 and 6, with increased signal strength, evidence of stretch-shortening cycle, and different muscle characteristics with each pitch style. These 2 phases of the windmill pitch are where the arm is placed in the 6 o’clock position and then at release of the ball. The flexor carpi ulnaris signal strength was significantly greater than the other forearm flexors. Timing of phases 1 through 5 was successively shorter for each pitch. There was a secondary pattern of activation in the flexor carpi ulnaris in phase 4 for all pitches except the fastball and riseball. Conclusion: During the 6 pitches, the greatest muscular activity was in phases 5 and 6. Flexor carpi ulnaris activity was greatest among the muscles tested. The riseball had the highest peak activity, but the curveball and dropball had the highest average signal strength. This muscle activity correlates with increasing distraction in the elbow, suggesting that flexor muscles act to counterdistract the elbow as they do for the baseball pitch. Clinical Relevance: Windmill pitchers are unique among overhead athletes as they throw, on average, more pitches per overhead athlete. Understanding the mechanics and physiology of the elbow in windmill pitchers is crucial to prevention and treatment of these increasingly common elbow injuries. This study establishes baseline data that will be useful to further prevent windmill pitch elbow injury. PMID:26535372

Initial years of recreational artistic gymnastics training improves lumbar spine bone mineral accrual in 4- to 8-year-old females.

PubMed

Laing, Emma M; Wilson, Alissa R; Modlesky, Christopher M; O'Connor, Patrick J; Hall, Daniel B; Lewis, Richard D

2005-03-01

Gymnasts' bone mineral characteristics are generally not known before starting their sport. Prepubertal females who enrolled in beginning artistic gymnastics (n = 65) had lower bone mineral than controls (n = 78). However, 2 years of gymnastics participation versus no participation led to a significantly greater accrual of forearm bone area and lumbar spine areal BMD. The skeletal response to exercise in children compared with adults is heightened because of the high bone turnover rate and the ability of bone to change its size and shape. Whereas child gymnasts generally have greater rates of bone mineral accrual compared with nongymnasts, it is unknown if some of these skeletal advantages are present before the onset of training or are caused entirely by training. Changes in bone area (BA; cm2), BMC (g), and areal BMD (aBMD; g/cm2) over 24 months were examined in prepubertal females, 4-8 years of age, who selected to perform recreational gymnastics (GYM; n = 65), nongymnastic activities, or no organized activity (CON; n = 78). Participants had essentially no lifetime history of organized athletic participation (< 12 weeks). Pubertal maturation was assessed annually by a physician. Total body, lumbar spine, total proximal femur, and forearm BA, BMC, and aBMD were measured every 6 months using DXA (Hologic QDR-1000W). Independent samples t-tests determined baseline group differences. Nonlinear mixed effects models were used to model 24-month changes in bone data. In subset analyses, high-level gymnasts advancing to competition (HLG; n = 9) were compared with low-level nonadvancing gymnasts (LLG; n = 56). At baseline, GYM were shorter, lighter, and had lower BA, BMC, and aBMD compared with CON (p < 0.05), whereas HLG did not differ significantly in these measurements compared with LLG (p > 0.05). Controlling for differences in race, baseline measures of body mass, height, and calcium intake, and change in breast development beyond stage II at 24 months, GYM had greater long-term (asymptotic) mean responses for total body aBMD and forearm BMC (p < 0.04) and greater rates of increase in the mean responses of lumbar spine aBMD and forearm BA compared with CON over 24 months. Over time, forearm BA increased to a greater extent in HLG compared with LLG (p < 0.01). Females participating in recreational gymnastics initiated during childhood have enhanced bone mineral gains at the total body, lumbar spine, and forearm over 24 months. Higher-level training promotes additional gains in forearm BA.

49 CFR 572.15 - General description.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Assembly SA 103C 030 Torso Assembly SA 103C 041 Upper Arm Assembly Left SA 103C 042 Upper Arm Assembly Right SA 103C 051 Forearm Hand Assembly Left SA 103C 052 Forearm Hand Assembly Right SA 103C 061Upper Leg Assembly Left SA 103C 062 Upper Leg Assembly Right SA 103C 071 Lower Leg Assembly Left SA 103C 072...

49 CFR 572.15 - General description.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Assembly SA 103C 030 Torso Assembly SA 103C 041 Upper Arm Assembly Left SA 103C 042 Upper Arm Assembly Right SA 103C 051 Forearm Hand Assembly Left SA 103C 052 Forearm Hand Assembly Right SA 103C 061Upper Leg Assembly Left SA 103C 062 Upper Leg Assembly Right SA 103C 071 Lower Leg Assembly Left SA 103C 072...

49 CFR 572.15 - General description.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Assembly SA 103C 030 Torso Assembly SA 103C 041 Upper Arm Assembly Left SA 103C 042 Upper Arm Assembly Right SA 103C 051 Forearm Hand Assembly Left SA 103C 052 Forearm Hand Assembly Right SA 103C 061Upper Leg Assembly Left SA 103C 062 Upper Leg Assembly Right SA 103C 071 Lower Leg Assembly Left SA 103C 072...

49 CFR 572.15 - General description.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Assembly SA 103C 030 Torso Assembly SA 103C 041 Upper Arm Assembly Left SA 103C 042 Upper Arm Assembly Right SA 103C 051 Forearm Hand Assembly Left SA 103C 052 Forearm Hand Assembly Right SA 103C 061Upper Leg Assembly Left SA 103C 062 Upper Leg Assembly Right SA 103C 071 Lower Leg Assembly Left SA 103C 072...

Speech after Radial Forearm Free Flap Reconstruction of the Tongue: A Longitudinal Acoustic Study of Vowel and Diphthong Sounds

ERIC Educational Resources Information Center

Laaksonen, Juha-Pertti; Rieger, Jana; Happonen, Risto-Pekka; Harris, Jeffrey; Seikaly, Hadi

2010-01-01

The purpose of this study was to use acoustic analyses to describe speech outcomes over the course of 1 year after radial forearm free flap (RFFF) reconstruction of the tongue. Eighteen Canadian English-speaking females and males with reconstruction for oral cancer had speech samples recorded (pre-operative, and 1 month, 6 months, and 1 year…

RETARDED GROWTH OF BONES OF THE FOREARM IN A GIRL FOLLOWING RADIUM THERAPY OF SKIN HEMANGIOMA (in Russian)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mirimova, T.D.

1960-07-01

A 9-month-old girl was subjected to radium therapy of skin hemangioma in the region of the forearm. Thirteen years afterwards there was revealed a considerable impairment in the growth and development of long bones that were within the field of the irradiation, resulting in the formation of a deformed shortened hand with restricted functions. (auth)

Prior ankle fractures in postmenopausal women are associated with low areal bone mineral density and bone microstructure alterations.

PubMed

Biver, E; Durosier, C; Chevalley, T; Herrmann, F R; Ferrari, S; Rizzoli, R

2015-08-01

In a cross-sectional analysis in postmenopausal women, prior ankle fractures were associated with lower areal bone mineral density (BMD) and trabecular bone alterations compared to no fracture history. Compared to women with forearm fractures, microstructure alterations were of lower magnitude. These data suggest that ankle fractures are another manifestation of bone fragility. Whether ankle fractures represent fragility fractures associated with low areal bone mineral density (aBMD) and volumetric bone mineral density (vBMD) and/or bone microstructure alterations remains unclear, in contrast to the well-recognised association between forearm fractures and osteoporosis. The objective of this study was to investigate aBMD, vBMD and bone microstructure in postmenopausal women with prior ankle fracture in adulthood, compared with women without prior fracture or with women with prior forearm fractures, considered as typically of osteoporotic origin. In a cross-sectional analysis in the Geneva Retirees Cohort study, 63 women with ankle fracture and 59 with forearm fracture were compared to 433 women without fracture (mean age, 65 ± 1 years). aBMD was measured by dual-energy X-ray absorptiometry; distal radius and tibia vBMD and bone microstructure were measured by high-resolution peripheral quantitative computed tomography. Compared with women without fracture, those with ankle fractures had lower aBMD, radius vBMD (-7.9%), trabecular density (-10.7%), number (-7.3%) and thickness (-4.6%) and higher trabecular spacing (+14.5%) (P < 0.05 for all). Tibia trabecular variables were also altered. For 1 standard deviation decrease in total hip aBMD or radius trabecular density, odds ratios for ankle fractures were 2.2 and 1.6, respectively, vs 2.2 and 2.7 for forearm fracture, respectively (P ≤ 0.001 for all). Compared to women with forearm fractures, those with ankle fractures had similar spine and hip aBMD, but microstructure alterations of lower magnitude. Women with ankle fractures have lower aBMD and vBMD and trabecular bone alterations, suggesting that ankle fractures are another manifestation of bone fragility.

Point-of-care Ultrasound for Nonangulated Distal Forearm Fractures in Children: Test Performance Characteristics and Patient-centered Outcomes.

PubMed

Poonai, Naveen; Myslik, Frank; Joubert, Gary; Fan, Josiah; Misir, Amita; Istasy, Victor; Columbus, Melanie; Soegtrop, Robert; Goldfarb, Alex; Thompson, Drew; Dubrovsky, Alexander Sasha

2017-05-01

Distal forearm fractures are the most common fracture type in children. Point-of-care-ultrasound (POCUS) is increasingly being used, and preliminary studies suggest that it offers an accurate approach to diagnosis. However, outcomes such as pain, satisfaction, and procedure duration have not been explored but may be salient to the widespread acceptance of this technology by caregivers and children. Our objectives were to examine the test performance characteristics of POCUS for nonangulated distal forearm injuries in children and compare POCUS to x-ray with respect to pain, caregiver satisfaction, and procedure duration. We conducted a cross-sectional study involving children aged 4-17 years with a suspected nonangulated distal forearm fracture. Participants underwent both x-ray and POCUS assessment. The primary outcome was sensitivity between POCUS and x-ray, the reference standard. Secondary outcomes included self-reported pain using the Faces Pain Scale-Revised, caregiver satisfaction using a five-item Likert scale, and procedure duration. POCUS was performed in 169 children of whom 76 were diagnosed with a fracture including 61 buckle fractures. Sensitivity of POCUS for distal forearm fractures was 94.7% (95% confidence interval [CI] = 89.7-99.8) and specificity was 93.5% (95% CI = 88.6-98.5). POCUS was associated with a significantly lower median (interquartile range [IQR]) pain score compared to x-ray: 1 (0-2) versus 2 (1-3), respectively (median difference = 0.5; 95% CI = 0.5-1; p < 0.001) and no significant difference in median (IQR) caregiver satisfaction score: 5 (0) versus 5 (4-5), respectively (median difference = 0, 95% CI = 0, p = 1.0). POCUS was associated with a significantly lower median (IQR) procedure duration versus x-ray: 1.5 (0.8-2.2) minutes versus 27 (15-58) minutes, respectively (median difference = 34.1, 95% CI = 26.8-41.5, p < 0.001). Our findings suggest that POCUS assessment of distal forearm injuries in children is accurate, timely, and associated with low levels of pain and high caregiver satisfaction. © 2016 by the Society for Academic Emergency Medicine.

Quantitative trait loci on chromosomes 2p, 4p, and 13q influence bone mineral density of the forearm and hip in Mexican Americans.

PubMed

Kammerer, Candace M; Schneider, Jennifer L; Cole, Shelley A; Hixson, James E; Samollow, Paul B; O'Connell, Jeffrey R; Perez, Reina; Dyer, Thomas D; Almasy, Laura; Blangero, John; Bauer, Richard L; Mitchell, Braxton D

2003-12-01

We performed a genome scan using BMD data of the forearm and hip on 664 individuals in 29 Mexican-American families. We obtained evidence for QTL on chromosome 4p, affecting forearm BMD overall, and on chromosomes 2p and 13q, affecting hip BMD in men. The San Antonio Family Osteoporosis Study (SAFOS) was designed to identify genes and environmental factors that influence bone mineral density (BMD) using data from large Mexican-American families. We performed a genome-wide linkage analysis using 416 highly polymorphic microsatellite markers spaced approximately 9.5 cM apart to locate and identify quantitative trait loci (QTL) that affect BMD of the forearm and hip. Multipoint variance components linkage analyses were done using data on all 664 subjects, as well as two subgroups of 259 men and 261 premenopausal women, from 29 families for which genotypic and phenotypic data were available. We obtained significant evidence for a QTL affecting forearm (radius midpoint) BMD in men and women combined on chromosome 4p near D4S2639 (maximum LOD = 4.33, genomic p = 0.006) and suggestive evidence for a QTL on chromosome 12q near locus D12S2070 (maximum conditional LOD = 2.35). We found suggestive evidence for a QTL influencing trochanter BMD on chromosome 6 (maximum LOD = 2.27), but no evidence for QTL affecting the femoral neck in men and women combined. In men, we obtained evidence for QTL affecting neck and trochanter BMD on chromosomes 2p near D2S1780 (maximum LOD = 3.98, genomic p = 0.013) and 13q near D13S788 (maximum LOD = 3.46, genomic p = 0.039), respectively. We found no evidence for QTL affecting forearm or hip BMD in premenopausal women. These results provide strong evidence that a QTL on chromosome 4p affects radius BMD in Mexican-American men and women, as well as evidence that QTL on chromosomes 2p and 13q affect hip BMD in men. Our results are consistent with some reports in humans and mice. J Bone Miner Res 2003;18:2245-2252

Human vascular renin-angiotensin system and its functional changes in relation to different sodium intakes.

PubMed

Boddi, M; Poggesi, L; Coppo, M; Zarone, N; Sacchi, S; Tania, C; Neri Serneri, G G

1998-03-01

A growing body of evidence supports the existence of a tissue-based renin-angiotensin system (RAS) in the vasculature, but the functional capacity of vascular RAS was not investigated in humans. In 28 normotensive healthy control subjects, the metabolism of angiotensins through vascular tissue was investigated in normal, low, and high sodium diets by the measurement of arterial-venous gradient of endogenous angiotensin (Ang) I and Ang II in two different vascular beds (forearm and leg), combined with the study of 125I-Ang I and 125I-Ang II kinetics. In normal sodium diet subjects, forearm vascular tissue extracted 36+/-6% of 125I-Ang I and 30+/-5% of 125I-Ang II and added 14.9+/-5.1 fmol x 100 mL(-1) x min(-1) of de novo formed Ang I and 6.2+/-2.8 fmol x 100 mL(-1) x min(-1) of Ang II to antecubital venous blood. Fractional conversion of 125I-Ang I through forearm vascular tissue was about 12%. Low sodium diet increased (P<.01) plasma renin activity, whereas de novo Ang I and Ang II formation by forearm vascular tissue became undetectable. Angiotensin degradation (33+/-7% for Ang I and 30+/-7% for Ang II) was unchanged, and vascular fractional conversion of 125I-Ang I decreased from 12% to 6% (P<.01). In high sodium diet subjects, plasma renin activity decreased, and de novo Ang I and Ang II formation by forearm vascular tissue increased to 22 and 14 fmol x 100 mL(-1) x min(-1), respectively (P<.01). Angiotensin degradation did not significantly change, whereas fractional conversion of 125I-Ang I increased from 12% to 20% (P<.01). Leg vascular tissue functional activities of RAS paralleled those of forearm vascular tissue both at baseline and during different sodium intake. These results provide consistent evidence for the existence of a functional tissue-based RAS in vascular tissue of humans. The opposite changes of plasma renin activity and vascular angiotensin formation indicate that vascular RAS is independent from but related to circulating RAS.

Pediatric fractures during skateboarding, roller skating, and scooter riding.

PubMed

Zalavras, Charalampos; Nikolopoulou, Georgia; Essin, Daniel; Manjra, Nahid; Zionts, Lewis E

2005-04-01

Skateboarding, roller skating, and scooter riding are popular recreational and sporting activities for children and adolescents but can be associated with skeletal injury. The purpose of this study is to describe the frequency and characteristics of fractures resulting from these activities. Fractures from skateboarding, roller skating, and scooter riding compose a considerable proportion of pediatric musculoskeletal injuries. Case series; Level of evidence, 4. Demographic data and injury characteristics were analyzed for all patients who presented to the pediatric fracture clinic of the level I trauma center from January 2001 to May 2002 after sustaining fractures due to skateboarding, roller skating, and scooter riding. Among a total of 2371 fractures, the authors identified 325 fractures (13.7%) that occurred during one of these activities. There were 187 patients (mean age, 13 years; 95% male) who sustained 191 skateboard-related fractures, 64 patients (mean age, 10.8 years; 54% male) who sustained 65 fractures while roller skating, and 66 patients (mean age, 9.7 years; 64% male) who sustained 69 fractures while riding a scooter. The forearm was fractured most often, composing 48.2% of skate-boarding fractures, 63.1% of roller-skating fractures, and 50.7% of fractures due to scooter riding. Of the forearm fractures, 94% were located in the distal third. In the skateboarding group, 10 of 191 (5.2%) fractures were open injuries of the forearm, compared to 6 of 2046 (0.3%) fractures caused by other mechanisms of injury (significant odds ratio, 18.8). Skateboarding, roller-skating, and scooter-riding accidents result in a large proportion of pediatric fractures. An open fracture, especially of the forearm, was more likely to be caused by skateboarding than by other mechanisms of injury. Use of wrist and forearm protective equipment should be considered in all children who ride a skateboard.

Echogenicity and ultrasound visibility of peripheral nerves of the upper extremity.

PubMed

Stolz, Lori A; Acuna, Josie Galarza; Gaskin, Kevin; Murphy, Amanda M; Friedman, Lucas; Stears-Ellis, Summer; Javedani, Parisa; Stolz, Uwe; Adhikari, Srikar

2018-05-02

Regional anesthesia with ultrasound-guidance is an excellent option for pain control if nerves are adequately visualized. Gender, body mass index (BMI), history of diabetes, neck and forearm circumference may affect echotexture and visualization. This study evaluates patient characteristics for their ability to predict the echogenicity or visibility of upper extremity peripheral nerves. This is a prospective observational study. A convenience sample of adult emergency department patients were enrolled. Gender, BMI, history of diabetes, neck circumference and arm circumference were recorded. Sonographic images of the brachial plexus at interscalene and supraclavicular levels, the median, the radial and ulnar nerves were recorded. Three reviewers independently graded the echogenicity and visibility using subjective scales. 395 peripheral nerves were included. Nerves of the forearm (median, ulnar, radial nerves) were found to be more echogenic (OR=9.3; 95% CI: 5.7, 15.3) and visible (OR=10.0; 6.3, 16.0) than more proximal nerves (brachial plexus at interscalene and supraclavicular levels). Gender, BMI, and history of diabetes mellitus were not significantly related to nerve visibility (p=0.9, 0.2, 0.2, respectively) or echogenicity (p=0.3, 0.8, 0.3). Neck circumference was not related to visibility or echogenicity of proximal nerves. Increased forearm circumference improved echogenicity (OR=1.25; 1.09, 1.43) but not visibility of forearm nerves. Gender, BMI and presence of diabetes were not related to echogenicity or visibility of upper extremity nerves. Increasing forearm circumference was associated with increased echogenicity of the adjacent nerves, but not visibility. Neck circumference was not associated with either nerve visibility or echogenicity of brachial plexus nerve bundles.

The utility of dual-energy X-ray absorptiometry, calcaneal quantitative ultrasound, and fracture risk indices (FRAX® and Osteoporosis Risk Assessment Instrument) for the identification of women with distal forearm or hip fractures: A pilot study.

PubMed

Esmaeilzadeh, Sina; Cesme, Fatih; Oral, Aydan; Yaliman, Ayse; Sindel, Dilsad

2016-08-01

Dual-energy X-ray absorptiometry (DXA) is considered the "gold standard" in predicting osteoporotic fractures. Calcaneal quantitative ultrasound (QUS) variables are also known to predict fractures. Fracture risk assessment tools may also guide us for the detection of individuals at high risk for fractures. The aim of this case-control study was to evaluate the utility of DXA bone mineral density (BMD), calcaneal QUS parameters, FRAX® (Fracture Risk Assessment Tool), and Osteoporosis Risk Assessment Instrument (ORAI) for the discrimination of women with distal forearm or hip fractures. This case-control study included 20 women with a distal forearm fracture and 18 women with a hip fracture as cases and 76 age-matched women served as controls. BMD at the spine, proximal femur, and radius was measured using DXA and acoustic parameters of bone were obtained using a calcaneal QUS device. FRAX® 10-year probability of fracture and ORAI scores were also calculated in all participants. Receiver operating characteristic (ROC) analysis was used to assess fracture discriminatory power of all the tools. While all DXA BMD, and QUS variables and FRAX® fracture probabilities demonstrated significant areas under the ROC curves for the discrimination of hip-fractured women and those without, only 33% radius BMD, broadband ultrasound attenuation (BUA), and FRAX® major osteoporotic fracture probability calculated without BMD showed significant discriminatory power for distal forearm fractures. It can be concluded that QUS variables, particularly BUA, and FRAX® major osteoporotic fracture probability without BMD are good candidates for the identification of both hip and distal forearm fractures.

Decreased cardiopulmonary baroreflex sensitivity in Chagas' heart disease.

PubMed

Consolim-Colombo, F M; Filho, J A; Lopes, H F; Sobrinho, C R; Otto, M E; Riccio, G M; Mady, C; Krieger, E M

2000-12-01

No study has been performed on reflexes originating from receptors in the heart that might be involved in the pathological lesions of Chagas' heart disease. Our study was undertaken to analyze the role of cardiopulmonary reflex on cardiovascular control in Chagas' disease. We studied 14 patients with Chagas' disease without heart failure and 12 healthy matched volunteers. Central venous pressure, arterial blood pressure, heart rate, forearm blood flow, and forearm vascular resistance were recorded during deactivation of cardiopulmonary receptors. By reducing central venous pressure by applying -10 and -15 mm Hg of negative pressure to the lower body, we observed (a) a similar decrease of central venous pressure in both groups; (b) a marked increase in forearm vascular resistance in the control group but a blunted increase in the Chagas' group; and (c) no significant changes in blood pressure and heart rate. To analyze cardiopulmonary and arterial receptors, we applied -40 mm Hg of lower-body negative pressure. As a consequence, (a) central venous pressure decreased similarly in both groups; (b) blood pressure was maintained in the control group, whereas in patients with Chagas' disease, a decrease in systolic and mean arterial pressure occurred; (c) heart rate increased in both groups; and (d) forearm vascular resistance increased significantly and similarly in both groups. Unloading of receptors with low levels of lower-body negative pressure did not increase forearm vascular resistance in patients with Chagas' disease, which suggests that the reflex mediated by cardiopulmonary receptors is impaired in patients with Chagas' disease without heart failure. Overall control of circulation appears to be compromised because patients did not maintain blood pressure under high levels of lower-body negative pressure.

Forearm Vascular Reactivity and Arterial Stiffness in Asymptomatic Subjects from the Community

PubMed Central

Malik, A. Rauoof; Kondragunta, Venkateswarlu; Kullo, Iftikhar J.

2010-01-01

Vascular reactivity may affect the stiffness characteristics of the arterial wall. We investigated the association between forearm microcirculatory and conduit artery function and measures of arterial stiffness in 527 asymptomatic non-Hispanic white adults without known cardiovascular disease. High-resolution ultrasonography of the brachial artery (ba) was performed to assess forearm microcirculatory function (ba blood flow velocity, local shear stress, and forearm vascular resistance at rest and during reactive hyperemia) and conduit artery function (ba flow-mediated dilatation baFMD and ba nitroglycerin-mediated dilatation baNMD). Arterial stiffness was assessed by cuff-derived brachial pulse pressure and aortic pulse wave velocity (aPWV) measured by applanation tonometry. In regression analyses that adjusted for heart rate, mean arterial pressure, height, cardiovascular risk factors, and hypertension medication and statin use, higher baseline ba systolic velocity and systolic shear stress were associated with greater pulse pressure (P=0.0002 and P=0.006, respectively) and higher aPWV (each P<0.0001). During hyperemia, lower ba mean velocity and lower mean shear stress were associated with higher pulse pressure (P=0.045 and P=0.036, respectively) while both systolic and mean velocity (P<0.0001 and P=0.002, respectively) and systolic and mean shear stress (P<0.0001 and P=0.003, respectively) were inversely associated with aPWV. baFMD was not associated with pulse pressure but was inversely associated with aPWV (P=0.011). baNMD was inversely associated with pulse pressure (P=0.0002) and aPWV (P=0.008). Our findings demonstrate that impaired forearm microvascular function (in the form of elevated resting blood flow velocity and impaired flow reserve) and impaired brachial artery reactivity are associated with increased arterial stiffness. PMID:18426995

Failure of systemic hypoxia to blunt α-adrenergic vasoconstriction in the human forearm

PubMed Central

Dinenno, Frank A; Joyner, Michael J; Halliwill, John R

2003-01-01

Systemic hypoxia in humans evokes forearm vasodilatation despite significant reflex increases in sympathetic vasoconstrictor nerve activity and noradrenaline spillover. We sought to determine whether post-junctional α-adrenergic vasoconstrictor responsiveness to endogenous noradrenaline release is blunted during systemic hypoxia. To do so, we conducted a two-part study in healthy young adults. In protocol 1, we measured forearm blood flow (FBF; venous occlusion plethysmography) and calculated the vascular conductance (FVC) responses to brachial artery infusions of two doses of tyramine (evokes endogenous noradrenaline release) in 10 adults during normoxia and mild systemic hypoxia (85 % O2 saturation; pulse oximetry of the earlobe). Systemic hypoxia evoked significant forearm vasodilatation as indicated by the increases in FBF and FVC (∼20–23 %; P < 0.05). The low and high doses of tyramine evoked significant reductions in FVC (vasoconstriction) that were similar in magnitude during normoxia (−29 ± 3 and −53 ± 4 %) and mild hypoxia (−35 ± 4 and −58 ± 3 %; P = 0.33). In protocol 2, forearm vasoconstrictor responses to the high dose of tyramine were determined in eight young adults during normoxia and during graded levels of systemic hypoxia (85, 80 and 75 % O2 saturation). The reductions in FVC were similar during normoxia (−59 ± 2 %) and the three levels of hypoxia (85 % O2 saturation, −64 ± 3 %; 80 % O2 saturation, −62 ± 1 %; 75 % O2 saturation, −61 ± 3 %; P = 0.37). In both protocols, the tyramine-induced increases in deep venous noradrenaline concentrations were similar during normoxia and all levels of hypoxia. Our results demonstrate that post-junctional α-adrenergic receptor vasoconstrictor responsiveness to endogenous noradrenaline release is not blunted during mild-to-moderate systemic hypoxia in healthy humans. PMID:12730336

Exercise-mediated vasodilation in human obesity and metabolic syndrome: effect of acute ascorbic acid infusion.

PubMed

Limberg, Jacqueline K; Kellawan, J Mikhail; Harrell, John W; Johansson, Rebecca E; Eldridge, Marlowe W; Proctor, Lester T; Sebranek, Joshua J; Schrage, William G

2014-09-15

We tested the hypothesis that infusion of ascorbic acid (AA), a potent antioxidant, would alter vasodilator responses to exercise in human obesity and metabolic syndrome (MetSyn). Forearm blood flow (FBF, Doppler ultrasound) was measured in lean, obese, and MetSyn adults (n = 39, 32 ± 2 yr). A brachial artery catheter was inserted for blood pressure monitoring and local infusion of AA. FBF was measured during dynamic handgrip exercise (15% maximal effort) with and without AA infusion. To account for group differences in blood pressure and forearm size, and to assess vasodilation, forearm vascular conductance (FVC = FBF/mean arterial blood pressure/lean forearm mass) was calculated. We examined the time to achieve steady-state FVC (mean response time, MRT) and the rise in FVC from rest to steady-state exercise (Δ, exercise - rest) before and during acute AA infusion. The MRT (P = 0.26) and steady-state vasodilator responses to exercise (ΔFVC, P = 0.31) were not different between groups. Intra-arterial infusion of AA resulted in a significant increase in plasma total antioxidant capacity (174 ± 37%). AA infusion did not alter MRT or steady-state FVC in any group (P = 0.90 and P = 0.85, respectively). Interestingly, higher levels of C-reactive protein predicted longer MRT (r = 0.52, P < 0.01) and a greater reduction in MRT with AA infusion (r = -0.43, P = 0.02). We concluded that AA infusion during moderate-intensity, rhythmic forearm exercise does not alter the time course or magnitude of exercise-mediated vasodilation in groups of young lean, obese, or MetSyn adults. However, systemic inflammation may limit the MRT to exercise, which can be improved with AA. Copyright © 2014 the American Physiological Society.

Prosthetic elbow joint

NASA Technical Reports Server (NTRS)

Weddendorf, Bruce C. (Inventor)

1994-01-01

An artificial, manually positionable elbow joint for use in an upper extremity, above-elbow, prosthetic is described. The prosthesis provides a locking feature that is easily controlled by the wearer. The instant elbow joint is very strong and durable enough to withstand the repeated heavy loadings encountered by a wearer who works in an industrial, construction, farming, or similar environment. The elbow joint of the present invention comprises a turntable, a frame, a forearm, and a locking assembly. The frame generally includes a housing for the locking assembly and two protruding ears. The forearm includes an elongated beam having a cup-shaped cylindrical member at one end and a locking wheel having a plurality of holes along a circular arc on its other end with a central bore for pivotal attachment to the protruding ears of the frame. The locking assembly includes a collar having a central opening with a plurality of internal grooves, a plurality of internal cam members each having a chamfered surface at one end and a V-shaped slot at its other end; an elongated locking pin having a crown wheel with cam surfaces and locking lugs secured thereto; two coiled compression springs; and a flexible filament attached to one end of the elongated locking pin and extending from the locking assembly for extending and retracting the locking pin into the holes in the locking wheel to permit selective adjustment of the forearm relative to the frame. In use, the turntable is affixed to the upper arm part of the prosthetic in the conventional manner, and the cup-shaped cylindrical member on one end of the forearm is affixed to the forearm piece of the prosthetic in the conventional manner. The elbow joint is easily adjusted and locked between maximum flex and extended positions.

Intramedullary fixation of forearm fractures with new locked nail.

PubMed

Bansal, Himanshu

2011-09-01

Lack of availability of interlocked nails made plate osteosynthesis the first choice of treatment of forearm fractures inspite of more surgical exposure, periosteal stripping and big skin incision subsequent scar along with higher risk of refracture on implant removal. We hereby report the first 12 cases with 19 forearm bone fractures internally fixed by indegenous interlocked nail. Existing square nails were modified to have a broad proximal end of 5.5 mm with a hole for locking screw of 2.5 mm. The nail has a distal hole of 1/1.2/1.5 mm in 2.5/3/3.5 mm diameter nail, respectively. A new method of distal locking with a clip made of k wire is designed. The clip after insertion into the bone and hole in nail and opposite cortex snuggly fits the bone providing a secure locking system. Twelve skeletally mature patients, mean age 32 years (range 24-45 years) with 19 diaphyseal fractures of the forearm were treated with this indigenously made new nail. The patient were evaluated for fracture union, functional recovery and complications. The functional outcome was assessed by disabilities of arm, shoulder and hand questionnaire (DASH score). Time to radiographic union ranged between 12 and 28 weeks, with a 100% union rate. Complications were minimal, with mild infection in open fracture (n=1) and delayed union (n=1) in patient with comminuted fracture of the ulna only. The clinical results were excellent. The DASH score ranged between 0 and 36 points. This new interlocking nail may be considered as an alternative to plate osteosynthesis for fractures of the forearm in adults. The advantages are benefit of closed reduction, smaller residual scar, reduced cost and early union with allowance of immediate movements.

Forearm lengthening by distraction osteogenesis: A report on 5 limbs in 3 cases.

PubMed

Tonogai, Ichiro; Takahashi, Mitsuhiko; Tsutsui, Takahiko; Goto, Tomohiro; Hamada, Daisuke; Suzue, Naoto; Matsuura, Tetsuya; Yasui, Natsuo; Sairyo, Koichi

2015-01-01

Radioulnar length discrepancy causes pain and decreases function of the wrist, forearm, and elbow. Limb lengthening, which has been used in the treatment of various deformities of the forearm, is necessary to restore balance between the ulna and radius. We treated 5 limbs in 3 patients (2 boys, 1 girl; mean age 9.3 years old) with radioulnar length discrepancy by distraction osteogenesis of either the ulna or radius using external fixators. We dissected the interosseous membrane between the ulna and radius in 3 limbs in 2 cases and did not do so in 2 limbs of 1 case. These cases include 2 cases with hereditary multiple exostoses, and 1 case with multiple epiphyseal dysplasia. The results were investigated and evaluated in this study, using appropriate clinical and radiographic parameters, noting the state of the interosseous membrane, which has an important role in forearm stability. The mean fixation period was 113 days. The mean distraction distance was 22.8 mm. The mean follow-up period was 637.7 days. The mean ulnar shortening and radial articular angle respectively improved from 7.4 mm and 30.2° preoperatively to -0.1 mm and 34.8° postoperatively. Balance between the ulna and radius was restored, and the results showed significant improvements in range of motion of the joints. However, 2 unintended radial head subluxations occurred in 2 limbs without dissection of the interosseous membrane. In addition, a keloid remained in 1 limb due to pin site infection. Forearm lengthening by distraction osteogenesis was useful in our cases. It is important to recognize the function of the interosseous membrane when lengthening is performed by osteotomy of the proximal ulna by gradual distraction with an external fixator.

Exercise-mediated vasodilation in human obesity and metabolic syndrome: effect of acute ascorbic acid infusion

PubMed Central

Limberg, Jacqueline K.; Kellawan, J. Mikhail; Harrell, John W.; Johansson, Rebecca E.; Eldridge, Marlowe W.; Proctor, Lester T.; Sebranek, Joshua J.

2014-01-01

We tested the hypothesis that infusion of ascorbic acid (AA), a potent antioxidant, would alter vasodilator responses to exercise in human obesity and metabolic syndrome (MetSyn). Forearm blood flow (FBF, Doppler ultrasound) was measured in lean, obese, and MetSyn adults (n = 39, 32 ± 2 yr). A brachial artery catheter was inserted for blood pressure monitoring and local infusion of AA. FBF was measured during dynamic handgrip exercise (15% maximal effort) with and without AA infusion. To account for group differences in blood pressure and forearm size, and to assess vasodilation, forearm vascular conductance (FVC = FBF/mean arterial blood pressure/lean forearm mass) was calculated. We examined the time to achieve steady-state FVC (mean response time, MRT) and the rise in FVC from rest to steady-state exercise (Δ, exercise − rest) before and during acute AA infusion. The MRT (P = 0.26) and steady-state vasodilator responses to exercise (ΔFVC, P = 0.31) were not different between groups. Intra-arterial infusion of AA resulted in a significant increase in plasma total antioxidant capacity (174 ± 37%). AA infusion did not alter MRT or steady-state FVC in any group (P = 0.90 and P = 0.85, respectively). Interestingly, higher levels of C-reactive protein predicted longer MRT (r = 0.52, P < 0.01) and a greater reduction in MRT with AA infusion (r = −0.43, P = 0.02). We concluded that AA infusion during moderate-intensity, rhythmic forearm exercise does not alter the time course or magnitude of exercise-mediated vasodilation in groups of young lean, obese, or MetSyn adults. However, systemic inflammation may limit the MRT to exercise, which can be improved with AA. PMID:25038148

Evidence for repetitive load in the trapezius muscle during a tapping task.

PubMed

Tomatis, L; Müller, C; Nakaseko, M; Läubli, T

2012-08-01

Many studies describe the trapezius muscle activation pattern during repetitive key-tapping focusing on continuous activation. The objectives of this study were to determine whether the upper trapezius is phasically active during supported key tapping, whether this activity is cross-correlated with forearm muscle activity, and whether trapezius activity depends on key characteristic. Thirteen subjects (29.7 ± 11.4 years) were tested. Surface EMG of the finger's extensor and flexor and of the trapezius muscles, as well as the key on-off signal was recorded while the subject performed a 2-min session of key tapping at 4 Hz. The linear envelopes obtained were cut into single tapping cycles extending from one onset to the next onset signal and subsequently time-normalized. Effect size between mean range and maximal standard deviation was calculated to determine as to whether a burst of trapezius muscle activation was present. Cross-correlation was used to determine the time-lag of the activity bursts between forearm and trapezius muscles. For each person the mean and standard deviation of the cross-correlations coefficient between forearm muscles and trapezius were determined. Results showed a burst of activation in the trapezius muscle during most of the tapping cycles. The calculated effect size was ≥0.5 in 67% of the cases. Cross-correlation factors between forearm and trapezius muscle activity were between 0.75 and 0.98 for both extensor and flexor muscles. The cross-correlated phasic trapezius activity did not depend on key characteristics. Trapezius muscle was dynamically active during key tapping; its activity was clearly correlated with forearm muscles' activity.

Hand and finger dexterity as a function of skin temperature, EMG, and ambient condition.

PubMed

Chen, Wen-Lin; Shih, Yuh-Chuan; Chi, Chia-Fen

2010-06-01

This article examines the changes in skin temperature (finger, hand, forearm), manual performance (hand dexterity and strength), and forearm surface electromyograph (EMG) through 40-min, 11 degrees C water cooling followed by 15-min, 34 degrees C water rewarming; additionally, it explores the relationship between dexterity and the factors of skin temperature, EMG, and ambient condition. Hand exposure in cold conditions is unavoidable and significantly affects manual performance. Two tasks requiring gross and fine dexterity were designed, namely, nut loosening and pin insertion, respectively. The nested-factorial design includes factors of gender, participant (nested within gender), immersion duration, muscle type (for EMG), and location (for skin temperature). The responses are changes in dexterity, skin temperature, normalized amplitude of EMG, and grip strength. Finally, factor analysis and stepwise regression are used to explore factors affecting hand and finger dexterity. Dexterity, EMG, and skin temperature fell with prolonged cooling, but the EMG of the flexor digitorum superficialis remained almost unchanged during the nut loosening task. All responses but the forearm skin temperature recovered to the baseline level at the end of rewarming. The three factors extracted by factor analysis are termed skin temperature, ambient condition, and EMG. They explain approximately two thirds of the variation of the linear models for both dexterities, and the factor of skin temperature is the most influential. Sustained cooling and warming significantly decreases and increases finger, hand, and forearm skin temperature. Dexterity, strength, and EMG are positively correlated to skin temperature. Therefore, keeping the finger, hand, and forearm warm is important to maintaining hand performance. The findings could be helpful to building safety guidelines for working in cold environments.

The impact of different cooling modalities on the physiological responses in firefighters during strenuous work performed in high environmental temperatures.

PubMed

Barr, David; Reilly, Thomas; Gregson, Warren

2011-06-01

This study investigated the impact of ice vests and hand/forearm immersion on accelerating the physiological recovery between two bouts of strenuous exercise in the heat [mean (SD), 49.1(1.3)°C, RH 12 (1)]. On four occasions, eight firefighters completed two 20-min bouts of treadmill walking (5 km h, 7.5% gradient) while wearing standard firefighter protective clothing. Each bout was separated by a 15-min recovery period, during which one of four conditions were administered: ice vest (VEST), hand/forearm immersion (W), ice vest combined with hand/forearm immersion (VEST + W) and control (CON). Core temperature was significantly lower at the end of the recovery period in the VEST + W (37.97 ± 0.23°C) and W (37.96 ± 0.19°C) compared with the VEST (38.21 ± 0.12°C) and CON (38.29 ± 0.25°C) conditions and remained consistently lower throughout the second bout of exercise. Heart rate responses during the recovery period and bout 2 were similar between the VEST + W and W conditions which were significantly lower compared with the VEST and CON which did not differ from each other. Mean skin temperature was significantly lower at the start of bout 2 in the cooling conditions compared with CON; these differences reduced as exercise progressed. These findings demonstrate that hand/forearm immersion (~19°C) is more effective than ice vests in reducing the physiological strain when firefighters re-enter structural fires after short rest periods. Combining ice vests with hand/forearm immersion provides no additional benefit.

Comparison of skin hydration evaluation sites and correlations among skin hydration, transepidermal water loss, SCORAD index, Nottingham Eczema Severity Score, and quality of life in patients with atopic dermatitis.

PubMed

Hon, Kam-lun Ellis; Wong, Kin Yee; Leung, Ting-Fan; Chow, Chung-Mo; Ng, Pak-Cheung

2008-01-01

Atopic dermatitis (AD) is characterized by dryness of the skin, pruritus and involvement of the skin flexures. Skin hydration (SH) and integrity, as measured by transepidermal water loss (TEWL), are important parameters for objectively quantifying AD research. To evaluate if sites in the forearm are equivalent to the antecubital fossa for standard SH and TEWL measurements; and to determine the correlations among these measurements and scores of disease severity and quality of life. We evaluated SH and TEWL under standardized conditions at three common measurement sites in the forearm (antecubital flexure, 2 cm below the antecubital flexure, mid-forearm), and determined the SCORing Atopic Dermatitis (SCORAD) score, Nottingham Eczema Severity Score (NESS), and Children's Dermatology Life Quality Index (CDLQI). Significant correlations between clinical scores, SH, and TEWL were obtained at a site 2 cm below the antecubital fossa (r = -0.553, p < 0.001 for SH and SCORAD; r = 0.596, p < 0.001 for TEWL and SCORAD). SH and TEWL were also correlated with long-term severity of AD as measured by NESS (r = -0.494, p = 0.001 for SH; r = 0.430, p = 0.004 for TEWL), while TEWL was significantly correlated with CDLQI (r = 0.323, p = 0.035). Overall, similar significant correlations were obtained at the mid-forearm, but less so at the antecubital fossa. In AD research, three sites on the forearm appear to be convenient for determination of SH and TEWL. This is the first report to demonstrate that significant correlations are obtained among acute and chronic scores of AD disease severity, quality of life, and the bioengineering parameters.

Three-dimensional model simulation and reconstruction of composite total maxillectomy defects with fibula osteomyocutaneous flap flow-through from radial forearm flap.

PubMed

He, Yue; Zhu, Han Guang; Zhang, Zhi Yuan; He, Jie; Sader, Robert

2009-12-01

A total maxillectomy always causes composite defects of maxilla, zygomatic bone, orbital floor or rim, and palatal and nasal mucosa lining. This leads to significant functional and cosmetic consequences after ablative surgery. The purpose of this clinical study was to preliminarily 3-dimensionally reconstruct the defect of total maxillectomy with sufficient bone support and soft tissue lining. Three-dimensional model simulation technique and free fibula osteomyocutaneous flap flow-through from radial forearm flap were used to reconstruct a total maxillectomy defect for a 21-year-old female patient. Preoperatively, the 3-dimensional (3D) simulated resin models of skeleton and fibula were used to design the osteotomies and bone segment replacement. At surgery, a 22-cm-length free fibula was divided into 4 segments to make 1 maxilla skeletal framework in the schedule of the preoperative model surgical planning with a radial forearm flap flow-through for the free fibula flap with skin paddle to repair the palatal and nasal region. Free fibula and radial forearm flap were alive, and the patient was satisfied with the results both esthetically and functionally after dental rehabilitation which was carried out 6 months after surgery. This preliminarily clinical study and case demonstrated that: the fibula osteomyocutaneous flap is an ideal donor site in 3D total maxillectomy defect reconstruction, because of its thickness, length, and bone uniformity which makes ideal support for dental rehabilitation; the flow-through forearm radial flap not only serves as the vascular bridge to midface reconstruction, but also provides sufficient soft tissue cover for the intraoral defect; and the 3D model simulation and preoperative surgical planning are effective methods to refine reconstruction surgery, shorten the surgical time, and predict the outcome after operation.

Evaluation of physiological standard pressures of the forearm flexor muscles during sport specific ergometry in sport climbers

PubMed Central

Schoeffl, V; Klee, S; Strecker, W

2004-01-01

Background: Chronic exertional compartment syndromes (CECS) are well known in sports medicine. Most commonly affected is the tibialis anterior muscle compartment in runners and walkers. Only a few cases of CECS of the forearm flexor muscles have been reported. Objectives: To determine pressure levels inside the deep flexor compartment of the forearms during a sport specific stress test. Method: Ten healthy, high level climbers were enrolled in a prospective study. All underwent climbing specific ergometry, using a rotating climbing wall (step test, total climbing time 9–15 minutes). Pressure was measured using a slit catheter placed in the deep flexor compartment of the forearm. Pressure, blood lactate, and heart rate were recorded every three minutes and during recovery. Results: In all the subjects, physical exhaustion of the forearms defined the end point of the climbing ergometry. Blood lactate increased with physical stress, reaching a mean of 3.48 mmol/l. Compartment pressure was related to physical stress, exceeding 30 mm Hg in only three subjects. A critical pressure of more than 40 mm Hg was never observed. After the test, the pressure decreased to normal levels within three minutes in seven subjects. The three with higher pressure levels (>30 mm Hg) required a longer time to recover. Conclusions: For further clinical and therapeutic consequences, an algorithm was derived. Basic pressure below 15 mm Hg and stress pressure below 30 mm Hg as well as pressures during the 15 minute recovery period below 15 mm Hg are physiological. Pressures of 15–30 mm Hg during recovery suggest high risk of CECS, and pressures above 30 mm Hg confirm CECS. PMID:15273176

Validation of the Leap Motion Controller using markered motion capture technology.

PubMed

Smeragliuolo, Anna H; Hill, N Jeremy; Disla, Luis; Putrino, David

2016-06-14

The Leap Motion Controller (LMC) is a low-cost, markerless motion capture device that tracks hand, wrist and forearm position. Integration of this technology into healthcare applications has begun to occur rapidly, making validation of the LMC׳s data output an important research goal. Here, we perform a detailed evaluation of the kinematic data output from the LMC, and validate this output against gold-standard, markered motion capture technology. We instructed subjects to perform three clinically-relevant wrist (flexion/extension, radial/ulnar deviation) and forearm (pronation/supination) movements. The movements were simultaneously tracked using both the LMC and a marker-based motion capture system from Motion Analysis Corporation (MAC). Adjusting for known inconsistencies in the LMC sampling frequency, we compared simultaneously acquired LMC and MAC data by performing Pearson׳s correlation (r) and root mean square error (RMSE). Wrist flexion/extension and radial/ulnar deviation showed good overall agreement (r=0.95; RMSE=11.6°, and r=0.92; RMSE=12.4°, respectively) with the MAC system. However, when tracking forearm pronation/supination, there were serious inconsistencies in reported joint angles (r=0.79; RMSE=38.4°). Hand posture significantly influenced the quality of wrist deviation (P<0.005) and forearm supination/pronation (P<0.001), but not wrist flexion/extension (P=0.29). We conclude that the LMC is capable of providing data that are clinically meaningful for wrist flexion/extension, and perhaps wrist deviation. It cannot yet return clinically meaningful data for measuring forearm pronation/supination. Future studies should continue to validate the LMC as updated versions of their software are developed. Copyright © 2016 Elsevier Ltd. All rights reserved.

Differences in childhood adiposity influence upper limb fracture site

PubMed Central

Moon, Rebecca J; Lim, Adelynn; Farmer, Megan; Segaran, Avinash; Clarke, Nicholas MP; Dennison, Elaine M; Harvey, Nicholas C; Cooper, Cyrus; Davies, Justin H

2015-01-01

Introduction Although it has been suggested that overweight and obese children have an increased risk of fracture, recent studies in post-menopausal women have shown that the relationship between obesity and fracture risk varies by fracture site. We therefore assessed whether adiposity and overweight/obesity prevalence differed by upper limb fracture site in children. Methods Height, weight, BMI, triceps and subscapular skinfold thickness (SFT) were measured in children aged 3-18 years with an acute upper limb fracture. Data was compared across three fracture sites (hand, forearm and upper arm/shoulder [UA]), and to published reference data. Results 401 children (67.1% male, median age 11.71 years (range 3.54-17.27 years) participated. 34.2%, 50.6% and 15.2% had fractures of the hand, forearm and UA, respectively. Children with forearm fractures had higher weight, BMI and SFT z-scores than those with UA fractures (p<0.05 for all). SFT z-scores were also higher in children with forearm fractures compared to hand fractures, but children withor hand and UA fractures did not differ. Overweight and obesity prevalence was higher in children with forearm fractures (37.6%) than those with UA fractures (19.0%, p=0.009). This prevalence was also higher than the published United Kingdom population prevalence (27.9%, p=0.003), whereas that of children with either UA (p=0.13) or hand fractures (29.1%, p=0.76) did not differ. The differences in anthropometry and overweight/obesity were similar for boys, but not present in girls. Conclusion Measurements of adiposity and the prevalence of overweight/obesity differ by fracture site in children, and in particular boys, with upper limb fractures. PMID:26027507

Involvement of α2-adrenoceptors in inhibitory and facilitatory pain modulation processes.

PubMed

Vo, L; Drummond, P D

2016-03-01

In healthy humans, high-frequency electrical stimulation (HFS) of the forearm not only produces hyperalgesia at the site of stimulation but also reduces sensitivity to pressure-pain on the ipsilateral side of the forehead. In addition, HFS augments the ipsilateral trigeminal nociceptive blink reflex and intensifies the ipsilateral component of conditioned pain modulation. The aim of this study was to determine whether α2-adrenoceptors mediate these ipsilateral nociceptive influences. The α2-adrenoceptor antagonist yohimbine was administered to 22 participants in a double-blind, placebo-controlled crossover study. In each session, thermal and mechanical sensitivity in the forearms and forehead was assessed before and after HFS. In addition, the combined effect of HFS and yohimbine on the nociceptive blink reflex and on conditioned pain modulation was explored. In this paradigm, the conditioning stimulus was cold pain in the ipsilateral or contralateral temple, and the test stimulus was electrically evoked pain in the forearm. Blood pressure and electrodermal activity increased for several hours after yohimbine administration, consistent with blockade of central α2-adrenoceptors. Yohimbine not only augmented the nociceptive blink reflex ipsilateral to HFS but also intensified the inhibitory influence of ipsilateral temple cooling on electrically evoked pain at the HFS-treated site in the forearm. Yohimbine had no consistent effect on primary or secondary hyperalgesia in the forearm or on pressure-pain in the ipsilateral forehead. These findings imply involvement of α2-adrenoceptors both in ipsilateral antinociceptive and pronociceptive pain modulation processes. However, a mechanism not involving α2-adrenoceptors appears to mediate analgesia in the ipsilateral forehead after HFS. © 2015 European Pain Federation - EFIC®

Outcomes of Internal Fixation in a Combat Environment

DTIC Science & Technology

2010-01-01

analyzed. Forty-seven patients had internal fixation performed on 50 fractures in a combat theater hospital. Hip, forearm, and ankle fractures made up the...limited number of fracture patterns associated with a significant risk of failure if definitive treatment is delayed (4). Because of the limited...Injuries Hip, forearm, and ankle fractures made up the majority of internal fixation cases with 14 (28%), 14 (28%), and 10 TABLE 1 Mechanism of

Prosthetic Hand With Two Gripping Fingers

NASA Technical Reports Server (NTRS)

Norton, William E.; Belcher, Jewell B.; Vest, Thomas W.; Carden, James R.

1993-01-01

Prosthetic hand developed for amputee who retains significant portion of forearm. Outer end of device is end effector including two fingers, one moved by rotating remaining part of forearm about its longitudinal axis. Main body of end effector is end member supporting fingers, roller bearing assembly, and rack-and-pinion mechanism. Advantage of rack-and-pinion mechanism enables user to open or close gap between fingers with precision and force.

Virtual reality anatomy: is it comparable with traditional methods in the teaching of human forearm musculoskeletal anatomy?

PubMed

Codd, Anthony M; Choudhury, Bipasha

2011-01-01

The use of cadavers to teach anatomy is well established, but limitations with this approach have led to the introduction of alternative teaching methods. One such method is the use of three-dimensional virtual reality computer models. An interactive, three-dimensional computer model of human forearm anterior compartment musculoskeletal anatomy was produced using the open source 3D imaging program "Blender." The aim was to evaluate the use of 3D virtual reality when compared with traditional anatomy teaching methods. Three groups were identified from the University of Manchester second year Human Anatomy Research Skills Module class: a "control" group (no prior knowledge of forearm anatomy), a "traditional methods" group (taught using dissection and textbooks), and a "model" group (taught solely using e-resource). The groups were assessed on anatomy of the forearm by a ten question practical examination. ANOVA analysis showed the model group mean test score to be significantly higher than the control group (mean 7.25 vs. 1.46, P < 0.001) and not significantly different to the traditional methods group (mean 6.87, P > 0.5). Feedback from all users of the e-resource was positive. Virtual reality anatomy learning can be used to compliment traditional teaching methods effectively. Copyright © 2011 American Association of Anatomists.

Corticomotor excitability of arm muscles modulates according to static position and orientation of the upper limb.

PubMed

Mogk, Jeremy P M; Rogers, Lynn M; Murray, Wendy M; Perreault, Eric J; Stinear, James W

2014-10-01

We investigated how multi-joint changes in static upper limb posture impact the corticomotor excitability of the posterior deltoid (PD) and biceps brachii (BIC), and evaluated whether postural variations in excitability related directly to changes in target muscle length. The amplitude of individual motor evoked potentials (MEPs) was evaluated in each of thirteen different static postures. Four functional postures were investigated that varied in shoulder and elbow angle, while the forearm was positioned in each of three orientations. Posture-related changes in muscle lengths were assessed using a biomechanical arm model. Additionally, M-waves were evoked in the BIC in each of three forearm orientations to assess the impact of posture on recorded signal characteristics. BIC-MEP amplitudes were altered by shoulder and elbow posture, and demonstrated robust changes according to forearm orientation. Observed changes in BIC-MEP amplitudes exceeded those of the M-waves. PD-MEP amplitudes changed predominantly with shoulder posture, but were not completely independent of influence from forearm orientation. Results provide evidence that overall corticomotor excitability can be modulated according to multi-joint upper limb posture. The ability to alter motor pathway excitability using static limb posture suggests the importance of posture selection during rehabilitation aimed at retraining individual muscle recruitment and/or overall coordination patterns. Published by Elsevier Ireland Ltd.

An Exoskeleton Robot for Human Forearm and Wrist Motion Assist

NASA Astrophysics Data System (ADS)

Ranathunga Arachchilage Ruwan Chandra Gopura; Kiguchi, Kazuo

The exoskeleton robot is worn by the human operator as an orthotic device. Its joints and links correspond to those of the human body. The same system operated in different modes can be used for different fundamental applications; a human-amplifier, haptic interface, rehabilitation device and assistive device sharing a portion of the external load with the operator. We have been developing exoskeleton robots for assisting the motion of physically weak individuals such as elderly or slightly disabled in daily life. In this paper, we propose a three degree of freedom (3DOF) exoskeleton robot (W-EXOS) for the forearm pronation/ supination motion, wrist flexion/extension motion and ulnar/radial deviation. The paper describes the wrist anatomy toward the development of the exoskeleton robot, the hardware design of the exoskeleton robot and EMG-based control method. The skin surface electromyographic (EMG) signals of muscles in forearm of the exoskeletons' user and the hand force/forearm torque are used as input information for the controller. By applying the skin surface EMG signals as main input signals to the controller, automatic control of the robot can be realized without manipulating any other equipment. Fuzzy control method has been applied to realize the natural and flexible motion assist. Experiments have been performed to evaluate the proposed exoskeleton robot and its control method.

Dual pathology proximal median nerve compression of the forearm.

PubMed

Murphy, Siun M; Browne, Katherine; Tuite, David J; O'Shaughnessy, Michael

2013-12-01

We report an unusual case of synchronous pathology in the forearm- the coexistence of a large lipoma of the median nerve together with an osteochondroma of the proximal ulna, giving rise to a dual proximal median nerve compression. Proximal median nerve compression neuropathies in the forearm are uncommon compared to the prevalence of distal compression neuropathies (eg Carpal Tunnel Syndrome). Both neural fibrolipomas (Refs. 1,2) and osteochondromas of the proximal ulna (Ref. 3) in isolation are rare but well documented. Unlike that of a distal compression, a proximal compression of the median nerve will often have a definite cause. Neural fibrolipoma, also called fibrolipomatous hamartoma are rare, slow-growing, benign tumours of peripheral nerves, most often occurring in the median nerve of younger patients. To our knowledge, this is the first report of such dual pathology in the same forearm, giving rise to a severe proximal compression of the median nerve. In this case, the nerve was being pushed anteriorly by the osteochondroma, and was being compressed from within by the intraneural lipoma. This unusual case highlights the advantage of preoperative imaging as part of the workup of proximal median nerve compression. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

3D Measurement of Forearm and Upper Arm during Throwing Motion using Body Mounted Sensor

NASA Astrophysics Data System (ADS)

Koda, Hideharu; Sagawa, Koichi; Kuroshima, Kouta; Tsukamoto, Toshiaki; Urita, Kazutaka; Ishibashi, Yasuyuki

The aim of this study is to propose the measurement method of three-dimensional (3D) movement of forearm and upper arm during pitching motion of baseball using inertial sensors without serious consideration of sensor installation. Although high accuracy measurement of sports motion is achieved by using optical motion capture system at present, it has some disadvantages such as the calibration of cameras and limitation of measurement place. Whereas the proposed method for 3D measurement of pitching motion using body mounted sensors provides trajectory and orientation of upper arm by the integration of acceleration and angular velocity measured on upper limb. The trajectory of forearm is derived so that the elbow joint axis of forearm corresponds to that of upper arm. Spatial relation between upper limb and sensor system is obtained by performing predetermined movements of upper limb and utilizing angular velocity and gravitational acceleration. The integration error is modified so that the estimated final position, velocity and posture of upper limb agree with the actual ones. The experimental results of the measurement of pitching motion show that trajectories of shoulder, elbow and wrist estimated by the proposed method are highly correlated to those from the motion capture system within the estimation error of about 10 [%].

Individuals with chronic hemiparetic stroke can correctly match forearm positions within a single arm

PubMed Central

Gurari, Netta; Drogos, Justin M.; Dewald, Julius P.A.

2017-01-01

Objective Previous studies determined, using between arms position matching assessments, that at least one-half of individuals with stroke have an impaired position sense. We investigated whether individuals with chronic stroke who have impairments mirroring arm positions also have impairments identifying the location of each arm in space. Methods Participants with chronic hemiparetic stroke and age-matched participants without neurological impairments (controls) performed a between forearms position matching task based on a clinical assessment and a single forearm position matching task, using passive and active movements, based on a robotic assessment. Results 12 out of our 14 participants with stroke who had clinically determined between forearms position matching impairments had greater errors than the controls in both their paretic and non-paretic arm when matching positions during passive movements; yet stroke participants performed comparable to the controls during active movements. Conclusions Many individuals with chronic stroke may have impairments matching positions in both their paretic and non-paretic arm if their arm is moved for them, yet not within either arm if these individuals control their own movements. Significance The neural mechanisms governing arm location perception in the stroke population may differ depending on whether arm movements are made passively versus actively. PMID:27866116

Comparison of spectroscopically measured finger and forearm tissue ethanol concentration to blood and breath ethanol measurements

NASA Astrophysics Data System (ADS)

Ridder, Trent D.; Hull, Edward L.; Ver Steeg, Benjamin J.; Laaksonen, Bentley D.

2011-02-01

Previous works investigated a spectroscopic technique that offered a promising alternative to blood and breath assays for determining in vivo alcohol concentration. Although these prior works measured the dorsal forearm, we report the results of a 26-subject clinical study designed to evaluate the spectroscopic technique at a finger measurement site through comparison to contemporaneous forearm spectroscopic, venous blood, and breath measurements. Through both Monte Carlo simulation and experimental data, it is shown that tissue optical probe design has a substantial impact on the effective path-length of photons through the skin and the signal-to-noise ratio of the spectroscopic measurements. Comparison of the breath, blood, and tissue assays demonstrated significant differences in alcohol concentration that are attributable to both assay accuracy and alcohol pharmacokinetics. Similar to past works, a first order kinetic model is used to estimate the fraction of concentration variance explained by alcohol pharmacokinetics (72.6-86.7%). A significant outcome of this work was significantly improved pharmacokinetic agreement with breath (arterial) alcohol of the finger measurement (mean kArt-Fin = 0.111 min-1) relative to the forearm measurement (mean kArt-For = 0.019 min-1) that is likely due to the increased blood perfusion of the finger.

Evaluation of a dynamic arm support for seated and standing tasks: a laboratory study of electromyography and subjective feedback.

PubMed

Odell, Dan; Barr, Alan; Goldberg, Robert; Chung, Jeffrey; Rempel, David

2007-04-01

The goal of this study was to determine whether a new dynamic arm support system reduced shoulder and arm muscle load for seated and standing hand/ arm tasks. The new system provides support for both horizontal and vertical arm motion. A total of 11 participants performed ten tasks (five seated and five standing) both with and without the arm support. Outcomes were assessed with electromyography and subjective feedback. Muscle activity was measured over the dominant side supraspinatus, triceps and forearm extensor muscles. Significant (p < 0.01) reductions in static muscle activity were observed in one of ten tasks performed with the support device for the supraspinatus muscle, in five tasks for the triceps and in one task for forearm extensor muscles. Likewise, a significant improvement in subjective measures was reported with the support device for 'ease of task' for two of ten tasks, for 'forearm comfort' for three of ten tasks and for 'shoulder effort' for six of ten tasks. The results suggest that a dynamic forearm support may improve subjective comfort and reduce static muscle loads in the upper extremity for tasks that involve horizontal movement of the arms. For rapid motions, the value of the support is limited due to internal inertia and friction.

Mutations in FOXC2 in humans (lymphoedema distichiasis syndrome) cause lymphatic dysfunction on dependency.

PubMed

Mellor, Russell H; Tate, Naomi; Stanton, Anthony W B; Hubert, Charlotte; Mäkinen, Taija; Smith, Alberto; Burnand, Kevin G; Jeffery, Steve; Levick, J Rodney; Mortimer, Peter S

2011-01-01

Human lymphoedema distichiasis syndrome (LDS) results from germline mutations in transcription factor FOXC2. In a mouse model, lack of lymphatic and venous valves is observed plus abnormal smooth muscle cell recruitment to initial lymphatics. We investigated the mechanism of lymphoedema in humans with FOXC2 mutations, specifically the effect of gravitational forces on dermal lymphatic function. We performed (1) quantitative fluorescence microlymphangiography (FML) on the skin of the forearm (non-swollen region) at heart level, and the foot (swollen region) below heart level (dependent) and then at heart level, and (2) immunohistochemical staining of microlymphatics in forearm and foot skin biopsies, using antibodies to podoplanin, LYVE-1 and smooth muscle actin. FML revealed a marked reduction in fluid uptake by initial lymphatics in the LDS foot during dependency, yet normal uptake (similar to controls) in the same foot at heart level and in LDS forearms. In control subjects, dependency did not impair initial lymphatic filling. Immunohistochemical microlymphatic density in forearm and foot did not differ between LDS and controls. FOXC2 mutations cause a functional failure of dermal initial lymphatics during gravitational stress (dependency), but not hypoplasia. The results reveal a pathophysiological mechanism contributing to swelling in LDS. Copyright © 2011 S. Karger AG, Basel.

Allopurinol improves endothelial dysfunction in chronic heart failure.

PubMed

Farquharson, Colin A J; Butler, Robert; Hill, Alexander; Belch, Jill J F; Struthers, Allan D

2002-07-09

Increased oxidative stress in chronic heart failure is thought to contribute to endothelial dysfunction. Xanthine oxidase produces oxidative stress and therefore we examined whether allopurinol improved endothelial dysfunction in chronic heart failure. We performed a randomized, placebo-controlled, double-blind crossover study on 11 patients with New York Heart Association class II-III chronic heart failure, comparing 300 mg allopurinol daily (1 month) versus placebo. Endothelial function was assessed by standard forearm venous occlusion plethysmography with acetylcholine, nitroprusside, and verapamil. Plasma malondialdehyde levels were also compared to assess significant changes in oxidative stress. Allopurinol significantly increased the forearm blood flow response to acetylcholine (percentage change in forearm blood flow [mean+/-SEM]: 181+/-19% versus 120+/-22% allopurinol versus placebo; P=0.003). There were no significant differences in the forearm blood flow changes between the placebo and allopurinol treatment arms with regard to sodium nitroprusside or verapamil. Plasma malondialdehyde was significantly reduced with allopurinol treatment (346+/-128 nmol/L versus 461+/-101 nmol/L, allopurinol versus placebo; P=0.03), consistent with reduced oxidative stress with allopurinol therapy. We have shown that allopurinol improves endothelial dysfunction in chronic heart failure. This raises the distinct possibility that allopurinol might reduce cardiovascular events and even improve exercise capacity in chronic heart failure.

Analysis of a swimmer's hand and forearm in impulsive start from rest using computational fluid dynamics in unsteady flow conditions.

PubMed

Samson, M; Monnet, T; Bernard, A; Lacouture, P; David, L

2018-01-23

The propulsive forces generated by the hands and arms of swimmers have so far been determined essentially by quasi-steady approaches. This study aims to quantify the temporal dependence of the hydrodynamic forces for a simple translation movement: an impulsive start from rest. The study, carried out in unsteady numerical simulation, couples the calculation of the lift and the drag on an expert swimmer hand-forearm model with visualizations of the flow and flow vortex structure analysis. The results of these simulations show that the hand and forearm hydrodynamic forces should be studied from an unsteady approach because the quasi-steady model is inadequate. It also appears that the delayed stall effect generates higher circulatory forces during a short translation at high angle of attack than forces calculated under steady state conditions. During this phase the hand force coefficients are approximately twice as large as those of the forearm. The total force coefficients are highest for angles of attack between 40° and 60°. For the same angle of attack, the forces produced when the leading edge is the thumb side are slightly greater than those produced when the leading edge is the little finger side. Copyright © 2017 Elsevier Ltd. All rights reserved.

Non-contact wearable single forearm cardiac biopotential acquisition device

NASA Astrophysics Data System (ADS)

Gonçalves, Sérgio; Carneiro Martins, Raul

2013-09-01

In this work the authors propose a novel approach to obtain the electrocardiogram in the forearm using non-contact sensing. This new solution should be at same time portable, ergonomic and robust, enabling its use in different set of applications. A system of four electrodes was used in an adjustable sleeve to be wrapped in the forearm. No additional electrode references were used in other body parts. In order to increase the sensitivity of the system, an harmonium like approach was used in the design of the electrodes. The prototype was then compared with a similar system with a flat conformation. The developed prototype enabled the acquisition of an ECG signal in the forearm and the inclusion of the harmonium like electrode conformation resulted in a considerable increase of the sensitivity of the system. The acquired signal did not enable the identification of all characteristic cardiac waves. However, it was possible to identify clearly a signal pattern, characteristic of the QRS complex. The properties of the acquired signal restrict their use in rigorous electrocardiographic studies, allowing, however, its application in heart rate variability monitoring and biometric identification without the disadvantages usually associated with conventional electrodes. This makes it specially useful for man-machine interfaces and automated identification.

Reconstruction of the elbow and forearm for Ewing sarcoma of ulna: A new biological technique

PubMed Central

Puri, Ajay; Gulia, Ashish; Byregowda, Suman; Ramanujan, Vishnu

2016-01-01

Primary bone tumors around the elbow represent <1% of all the skeletal tumors. Surgery with or without adjuvant therapy (radiotherapy, chemotherapy) is the treatment of choice for malignant tumors. Reconstruction of the elbow and forearm in malignant tumors is challenging as it involves a complex interplay between multiple joints which need to be stabilized for the optimal functional outcome. We describe a new technique for the reconstruction of the elbow after resection of a proximal ulna tumor with articular radio-ulnar synostosis with the creation of a single bone forearm. We attempted to achieve a mobile elbow and stable wrist joint with the radio-ulnar union at the proximal articular surface of the ulna resulting in a single bone forearm. The procedure involves an oblique osteotomy preserving the olecranon process (after taking adequate margins based on oncological principles) and its articular cartilage along with the attachment of the triceps tendon. Then the radial head was partially denuded of its cartilage using a burr, leaving cartilage only on the volar side, and then fused to the remnant olecranon. Osteosynthesis was done using compression screw and tension band wiring. The advantages of this procedure are that the mobility at wrist and elbow are retained, it requires minimal hardware and allows for primary closure of the wound. PMID:27186061

Effect of limb cooling on peripheral and global oxygen consumption in neonates

PubMed Central

Hassan, I; Wickramasinghe, Y; Spencer, S

2003-01-01

Aim: To evaluate peripheral oxygen consumption (VO2) measurements using near infrared spectroscopy (NIRS) with arterial occlusion in healthy term neonates by studying the effect of limb cooling on peripheral and global VO2. Subjects and methods: Twenty two healthy term neonates were studied. Peripheral VO2 was measured by NIRS using arterial occlusion and measurement of the oxyhaemoglobin (HbO2) decrement slope. Global VO2 was measured by open circuit calorimetry. Global and peripheral VO2 was measured in each neonate before and after limb cooling. Results: In 10 neonates, a fall in forearm temperature of 2.2°C (mild cooling) decreased forearm VO2 by 19.6% (p < 0.01). Global VO2 did not change. In 12 neonates, a fall in forearm temperature of 4°C (moderate cooling) decreased forearm VO2 by 34.7% (p < 0.01). Global VO2 increased by 17.6% (p < 0.05). Conclusions: The NIRS arterial occlusion method is able to measure changes in peripheral VO2 induced by limb cooling. The changes are more pronounced with moderate limb cooling when a concomitant rise in global VO2 is observed. Change in peripheral temperature must be taken into consideration in the interpretation of peripheral VO2 measurements in neonates. PMID:12598504

Effect of limb cooling on peripheral and global oxygen consumption in neonates.

PubMed

Hassan, I A-A; Wickramasinghe, Y A; Spencer, S A

2003-03-01

To evaluate peripheral oxygen consumption (VO(2)) measurements using near infrared spectroscopy (NIRS) with arterial occlusion in healthy term neonates by studying the effect of limb cooling on peripheral and global VO(2). Twenty two healthy term neonates were studied. Peripheral VO(2) was measured by NIRS using arterial occlusion and measurement of the oxyhaemoglobin (HbO(2)) decrement slope. Global VO(2) was measured by open circuit calorimetry. Global and peripheral VO(2) was measured in each neonate before and after limb cooling. In 10 neonates, a fall in forearm temperature of 2.2 degrees C (mild cooling) decreased forearm VO(2) by 19.6% (p < 0.01). Global VO(2) did not change. In 12 neonates, a fall in forearm temperature of 4 degrees C (moderate cooling) decreased forearm VO(2) by 34.7% (p < 0.01). Global VO(2) increased by 17.6% (p < 0.05). The NIRS arterial occlusion method is able to measure changes in peripheral VO(2) induced by limb cooling. The changes are more pronounced with moderate limb cooling when a concomitant rise in global VO(2) is observed. Change in peripheral temperature must be taken into consideration in the interpretation of peripheral VO(2) measurements in neonates.

Temperature perception on the hand during static vs. dynamic contact with a surface

PubMed Central

Green, Barry G.

2010-01-01

Innocuous cooling or heating of the forearm can evoke nociceptive sensations such as burning, stinging, and pricking (‘low-threshold thermal nociception’, LTN) that are inhibited by dynamic contact. The present study investigated whether LTN can also be perceived on the hand, and if so, whether it is normally suppressed by active touching. Innocuous cold (28°, 25° and 18°C) and warm (38°, 40° and 43°C) temperatures were delivered to the distal metacarpal pads and intermediate and distal phalanges of the fingers via a handgrip thermode that subjects either statically held or actively grasped. The same temperatures were delivered to the forearm via another thermode that either rested on the arm or was touched to the arm. Subjects rated the intensity of thermal (warmth, cold) and nociceptive (e.g., burning) sensations and indicated the qualities of sensation experienced. The results showed that LTN can be perceived on the hand, although less frequently and less intensely than on the forearm. Dynamic contact inhibited nociceptive and thermal sensations on the hand, though less strongly than on the forearm. These findings indicate that temperature perception on the hand is attenuated and its quality changed when thermal stimulation is accompanied by dynamic tactile stimulation, as during haptic exploration. PMID:19525547

A prospective cohort study of acute kidney injury in multi-stage ultramarathon runners: the Biochemistry in Endurance Runner Study (BIERS).

PubMed

Lipman, Grant S; Krabak, Brian J; Waite, Brandee L; Logan, Sarah B; Menon, Anil; Chan, Garrett K

2014-01-01

The purpose of the study was to evaluate the prevalence of acute kidney injury (AKI) during a multi-stage ultramarathon foot race. A prospective observational study was taken during the Gobi 2008; Sahara 2008; and Namibia 2009 RacingThePlanet 7-day, 6-stage, 150-mile foot ultramarathons. Blood was analyzed before, and immediately after stage 1 (25 miles), 3 (75 miles), and 5 (140 miles). Creatinine (Cr), glomerular filtration rate (GFR), and incidence of AKI were calculated and defined by RIFLE criteria. Thirty participants (76% male, mean age 40 + 11 years) were enrolled. There were significant declines in GFR after each stage compared with the pre-race baseline (p < 0.001), with the majority of participants (55-80%) incurring AKI. The majority of study participants encountered significant renal impairment; however, no apparent cumulative effect was observed, with resolution of renal function to near baseline levels between stages.

Inferring Ancient Technology and Practices of the Elite Maya Kingship Through the Application of Materials Engineering Characterization Modalities

NASA Astrophysics Data System (ADS)

Cheung, Kristina Alyssa

This project focuses on the characterization of materials from burial offerings and painted decoration in a royal Maya tomb at El Zotz, Guatemala, and their association with mortuary rituals. Archaeological findings included vessels, jade masks, organic materials (wood, cord, and textiles), specular hematite cubes, shells with powdered cinnabar, green (malachite) painted stucco assumed to have decorated the wooden bier where the king was resting, and caches of lip-to-lip Aguila Orange bowls containing human phalanges. This paper describes findings from non-invasive and non-destructive analytical techniques including XRF, VPSEM-EDS, and XRD, emphasizing the potential of these combined technologies in the identification of organic and inorganic markers to infer burial customs. The nature and location of the findings, the evidence of pigment coloration on the bones employing hematite and cinnabar, and the indication of exposure of the bones to high temperatures suggest highly complex, even protracted mortuary practices of Maya elite.

Fractionation of mineral species by electrophoresis

NASA Technical Reports Server (NTRS)

Dunning, J. D.; Herren, B. J.; Tipps, R. W.; Snyder, R. S.

1982-01-01

The fractionation of fine-grained aggregates into their major components is a problem in many scientific areas including earth and planetary science. Electrophoresis, the transport of electrically charged particles, immersed in a suspension medium, by a direct current field (Bier, 1959), was employed in this study as a means of separating simulated lunar soil into its constituent minerals. In these tests, conducted in a static analytical cylindrical microelectrophoresis apparatus, samples of simulated lunar soil and samples of pure mineral constituents were placed in the chamber; the electrophoretic mobilities of the lunar soil and the individual mineral constituents were measured. In most of the suspension buffers employed separability was indicated, on the basis of differences in mobility, for all the constituent mineral species except ilmenite and pyroxene, which were not efficiently separable in any of the buffers. Although only a few suspension media were employed, the success of this initial study suggests that electrophoresis may be an important mineral fractionation option in fine-grained aggregate processing.

Maintained Hand Function and Forearm Bone Health 14 Months After an In-Home Virtual-Reality Videogame Hand Telerehabilitation Intervention in an Adolescent With Hemiplegic Cerebral Palsy

PubMed Central

Golomb, Meredith R.; Warden, Stuart J.; Fess, Elaine; Rabin, Bryan; Yonkman, Janell; Shirley, Bridget; Burdea, Grigore C.

2015-01-01

Virtual reality videogames can be used to motivate rehabilitation, and telerehabilitation can be used to improve access to rehabilitation. These uses of technology to improve health outcomes are a burgeoning area of rehabilitation research. So far, there is a lack of reports of long-term outcomes of these types of interventions. The authors report a 15-year-old boy with hemiplegic cerebral palsy and epilepsy because of presumed perinatal stroke who improved his plegic hand function and increased his plegic forearm bone health during a 14-month virtual reality videogame hand telerehabilitation intervention. A total of 14 months after the intervention ended, repeat evaluation demonstrated maintenance of both increased hand function and forearm bone health. The implications of this work for the future of rehabilitation in children with neurological disabilities are discussed in this article. PMID:21383228

Maintained hand function and forearm bone health 14 months after an in-home virtual-reality videogame hand telerehabilitation intervention in an adolescent with hemiplegic cerebral palsy.

PubMed

Golomb, Meredith R; Warden, Stuart J; Fess, Elaine; Rabin, Bryan; Yonkman, Janell; Shirley, Bridget; Burdea, Grigore C

2011-03-01

Virtual reality videogames can be used to motivate rehabilitation, and telerehabilitation can be used to improve access to rehabilitation. These uses of technology to improve health outcomes are a burgeoning area of rehabilitation research. So far, there is a lack of reports of long-term outcomes of these types of interventions. The authors report a 15-year-old boy with hemiplegic cerebral palsy and epilepsy because of presumed perinatal stroke who improved his plegic hand function and increased his plegic forearm bone health during a 14-month virtual reality videogame hand telerehabilitation intervention. A total of 14 months after the intervention ended, repeat evaluation demonstrated maintenance of both increased hand function and forearm bone health. The implications of this work for the future of rehabilitation in children with neurological disabilities are discussed in this article.

Commercial golf glove effects on golf performance and forearm muscle activity.

PubMed

Sorbie, Graeme G; Darroch, Paul; Grace, Fergal M; Gu, Yaodong; Baker, Julien S; Ugbolue, Ukadike C

2017-01-01

The study aimed to determine whether or not commercial golf gloves influence performance variables and forearm muscle activity during golf play. Fifteen golfers participated in the laboratory based study, each performing 8 golf swings with a Driver and 7-iron whilst wearing a glove and 8 without wearing the glove. Club head speed, ball speed and absolute carry distance performance variables were calculated. Surface electromyography was recorded from the flexor digitorum superficialis and extensor carpi radialis brevis on both forearm muscles. Club head speed, ball speed and absolute carry distance was significantly higher when using the Driver with the glove in comparison to the Driver without the glove (p < 0.05). No significant differences were evident when using the 7-iron and no significant differences were displayed in muscle activity in either of the conditions. Findings from this study suggest that driving performance is improved when wearing a glove.

Forearm fracture bending risk functin for the 50th percentile male.

PubMed

Santago, Anthony C; Cormier, Joseph M; Duma, Stefan M; Yoganandan, Narayan; Pintar, Frank A

2008-01-01

The increase in upper extremity injuries in automobile collisions, because of the widespread implantation of airbags, has lead to a better understanding of forearm injury criteria. Risk functions for upper extremity injury that can be used in instrumented upper extremities would be useful. This paper presents a risk function for forearm injury for the 50th percentile male based on bending fracture moment data gathered from previous studies. The data was scaled using two scaling factors, one for orientation and one for mass, and the Weibull survival analysis model was then used to develop the risk function. It was determined that a 25% risk of injury corresponds to an 82 Nm bending load, a 50% risk of injury corresponds to a 100 Nm bending load, and a 75% risk of injury corresponds to a 117 Nm bending load. It is believed the risk function can be used with an instrumented upper extremity during vehicle testing.

The impact of computer display height and desk design on 3D posture during information technology work by young adults.

PubMed

Straker, L; Burgess-Limerick, R; Pollock, C; Murray, K; Netto, K; Coleman, J; Skoss, R

2008-04-01

Computer display height and desk design to allow forearm support are two critical design features of workstations for information technology tasks. However there is currently no 3D description of head and neck posture with different computer display heights and no direct comparison to paper based information technology tasks. There is also inconsistent evidence on the effect of forearm support on posture and no evidence on whether these features interact. This study compared the 3D head, neck and upper limb postures of 18 male and 18 female young adults whilst working with different display and desk design conditions. There was no substantial interaction between display height and desk design. Lower display heights increased head and neck flexion with more spinal asymmetry when working with paper. The curved desk, designed to provide forearm support, increased scapula elevation/protraction and shoulder flexion/abduction.

Dynamic and predictive links between touch and vision.

PubMed

Gray, Rob; Tan, Hong Z

2002-07-01

We investigated crossmodal links between vision and touch for moving objects. In experiment 1, observers discriminated visual targets presented randomly at one of five locations on their forearm. Tactile pulses simulating motion along the forearm preceded visual targets. At short tactile-visual ISIs, discriminations were more rapid when the final tactile pulse and visual target were at the same location. At longer ISIs, discriminations were more rapid when the visual target was offset in the motion direction and were slower for offsets opposite to the motion direction. In experiment 2, speeded tactile discriminations at one of three random locations on the forearm were preceded by a visually simulated approaching object. Discriminations were more rapid when the object approached the location of the tactile stimulation and discrimination performance was dependent on the approaching object's time to contact. These results demonstrate dynamic links in the spatial mapping between vision and touch.

In Vivo Noninvasive Analysis of Human Forearm Muscle Function and Fatigue: Applications to EVA Operations and Training Maneuvers

NASA Technical Reports Server (NTRS)

Fotedar, L. K.; Marshburn, T.; Quast, M. J.; Feeback, D. L.

1999-01-01

Forearm muscle fatigue is one of the major limiting factors affecting endurance during performance of deep-space extravehicular activity (EVA) by crew members. Magnetic resonance (MR) provides in vivo noninvasive analysis of tissue level metabolism and fluid exchange dynamics in exercised forearm muscles through the monitoring of proton magnetic resonance imaging (MRI) and phosphorus magnetic resonance spectroscopy (P-31-MRS) parameter variations. Using a space glove box and EVA simulation protocols, we conducted a preliminary MRS/MRI study in a small group of human test subjects during submaximal exercise and recovery and following exhaustive exercise. In assessing simulated EVA-related muscle fatigue and function, this pilot study revealed substantial changes in the MR image longitudinal relaxation times (T2) as an indicator of specific muscle activation and proton flux as well as changes in spectral phosphocreatine-to-phosphate (PCr/Pi) levels as a function of tissue bioenergetic potential.

Two dimensional microcirculation mapping with real time spatial frequency domain imaging

NASA Astrophysics Data System (ADS)

Zheng, Yang; Chen, Xinlin; Lin, Weihao; Cao, Zili; Zhu, Xiuwei; Zeng, Bixin; Xu, M.

2018-02-01

We present a spatial frequency domain imaging (SFDI) study of local hemodynamics in the human finger cuticle of healthy volunteers performing paced breathing and the forearm of healthy young adults performing normal breathing with our recently developed Real Time Single Snapshot Multiple Frequency Demodulation - Spatial Frequency Domain Imaging (SSMD-SFDI) system. A two-layer model was used to map the concentrations of deoxy-, oxy-hemoglobin, melanin, epidermal thickness and scattering properties at the subsurface of the forearm and the finger cuticle. The oscillations of the concentrations of deoxy- and oxy-hemoglobin at the subsurface of the finger cuticle and forearm induced by paced breathing and normal breathing, respectively, were found to be close to out-of-phase, attributed to the dominance of the blood flow modulation by paced breathing or heartbeat. Our results suggest that the real time SFDI platform may serve as one effective imaging modality for microcirculation monitoring.

Intramedullary nail fixation of non-traditional fractures: Clavicle, forearm, fibula.

PubMed

Dehghan, Niloofar; Schemitsch, Emil H

2017-06-01

Locked intramedullary fixation is a well-established technique for managing long-bone fractures. While intramedullary nail fixation of diaphyseal fractures in the femur, tibia, and humerus is well established, the same is not true for other fractures. Surgical fixations of clavicle, forearm and ankle are traditionally treated with plate and screw fixation. In some cases, fixation with an intramedullary device is possible, and may be advantageous. However, there is however a concern regarding a lack of rotational stability and fracture shortening. While new generation of locked intramedullary devices for fractures of clavicle, forearm and fibula are recently available, the outcomes are not as reliable as fixation with plates and screws. Further research in this area is warranted with high quality comparative studies, to investigate the outcomes and indication of these fractures treated with intramedullary nail devices compared to intramedullary nail fixation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Assessment of forearm and plantar foot load in the elderly using a four-wheeled walker with armrest and the effect of armrest height.

PubMed

Ko, Chang-Yong; Kim, Sol-Bi; Choi, Hyuk-Jae; Chang, Yunhee; Kang, Sungjae; Heo, Yoon; Ryu, Jeicheong; Kim, Gyoosuk; Mun, Museong

2014-01-01

Patients with hand and/or wrist pathology are recommended to have a four-wheeled walker with an arm rest (FWW-AR) rather than a standard walker or a standard four-wheeled walker (FWW). However, only a few quantitative studies have been performed to compare upper and lower extremity weight bearing. The aim of this study was to evaluate forearm and foot weight bearing using a FWW-AR and the effect of the armrest height. Eleven elderly women (mean age 80.1±5.3 years; mean height 148.5±4.0 cm; mean weight 51.2±9.0 kg) were enrolled. The subjects walked with an FWW-AR, with the elbow in either 90 degree (D90) or 130 degree (D130) flexion, for a distance of 10 m. Surface electromyographic signals were recorded for the upper, middle, and lower trapezius, anterior deltoid, and erector spinae muscles; walking velocity was measured with the subjects weight bearing on their feet and forearms while walking. Simultaneously, the maximum plantar and forearm loads during walking with an FWW-AR were measured. The normalized foot plantar loads were lower at D90 than at D130, while the normalized forearm load was higher at D90 than at D130 (all P<0.05; left foot, 7.9±0.1 N/kg versus 8.8±0.1 N/kg; right foot, 8.6±0.2 N/kg versus. 9.6±0.1 N/kg; left forearm, 1.8±0.5 N/kg versus 0.8±0.2 N/kg; and right forearm, 2.0±0.5 N/kg versus 1.0±0.2 N/kg, respectively). The surface electromyographic activity of the muscles involved in shoulder elevation and the walking velocity were both lower with the elbow at D90 than at D130 (all P<0.05; left upper trapezius, 98.7%±19.5% versus 132.6%±16.9%; right upper trapezius, 83.4%±10.6% versus 108.1%±10.5%; left anterior deltoid, 94.1%±12.8% versus 158.6%±40.4%; right anterior deltoid, 99.1%±15.0% versus 151.9%±19.4%; and velocity, 0.6±0.1 m/sec versus 0.7±0.1 m/sec, respectively). Weight bearing on the lower extremities is significantly reduced when the upper extremities are supported during walking with an FWW-AR. Furthermore, the weight bearing profile is dependent on the armrest height.

Where Is the Ulnar Styloid Process? Identification of the Absolute Location of the Ulnar Styloid Process Based on CT and Verification of Neutral Forearm Rotation on Lateral Radiographs of the Wrist.

PubMed

Shin, Seung-Han; Lee, Yong-Suk; Kang, Jin-Woo; Noh, Dong-Young; Jung, Joon-Yong; Chung, Yang-Guk

2018-03-01

The location of the ulnar styloid process can be confusing because the radius and the hand rotate around the ulna. The purpose of this study was to identify the absolute location of the ulnar styloid process, which is independent of forearm pronation or supination, to use it as a reference for neutral forearm rotation on lateral radiographs of the wrist. Computed tomography (CT) images of 23 forearms taken with elbow flexion of 70° to 90° were analyzed. The axial CT images were reconstructed to be perpendicular to the distal ulnar shaft. The absolute location of the ulnar styloid process in this study was defined as the position of the ulnar styloid process on the axial plane of the ulnar head relative to the long axis of the humeral shaft with the elbow set in the position for standard lateral radiographs of the wrist. To identify in which direction the ulnar styloid is located on the axial plane of the ulnar head, the angle between "the line of humeral long axis projected on the axial plane of the ulna" and "the line passing the center of the ulnar head and the center of the ulnar styloid" was measured (ulnar styloid direction angle). To identify how volarly or dorsally the ulnar styloid should appear on the true lateral view of the wrist, the ratio of "the volar-dorsal diameter of the ulnar head" and "the distance between the volar-most aspect of the ulnar head and the center of the ulnar styloid" was calculated (ulnar styloid location ratio). The mean ulnar styloid direction angle was 12° dorsally. The mean ulnar styloid location ratio was 1:0.55. The ulnar styloid is located at nearly the ulnar-most (the opposite side of the humerus with the elbow flexed) and slightly dorsal aspects of the ulnar head on the axial plane. It should appear almost midway (55% dorsally) from the ulnar head on the standard lateral view of the wrist in neutral forearm rotation. These location references could help clinicians determine whether the forearm is in neutral or rotated position on an axial CT/magnetic resonance imaging scan or a lateral radiograph of the wrist.

The impact of maternal adiposity specialization on infant birthweight: upper versus lower body fat.

PubMed

Sundermann, Alexandra C; Abell, Troy D; Baker, Lisa C; Mengel, Mark B; Reilly, Kathryn E; Bonow, Michael A; Hoy, Gregory E; Clover, Richard D

2016-11-01

The specialization of human fat deposits is an inquiry of special importance in the study of fetal growth. It has been theorized that maternal lower-body fat is designated specifically for lactation and not for the growth of the fetus. Our goal was to compare the contributions of maternal upper-body versus lower-body adiposity to infant birth weight. We hypothesized that upper-body adiposity would be strongly associated with infant birth weight and that lower-body adiposity would be weakly or negligibly associated with infant birth weight-after adjusting for known determinants. In this prospective cohort study, 355 women initiated medical pre-natal care during the first trimester of pregnancy at The University of Oklahoma Health Sciences Center during 1990-1993. Maternal anthropometric measurements were assessed at the first clinic visit: (a) height; (b) weight; (c) circumferences of the upper arm, forearm, and thigh; and, (d) skin-fold measurements of the bicep, subscapular region, and thigh. Infant birth weight was regressed on known major determinants to create the foundational model. Maternal anthropometric variables subsequently were added one at a time into this multiple regression model. The highest contribution by a single anthropometric variable to infant birthweight was, in order: subscapular skin-fold, forearm circumference, and thigh circumference. With one upper-body (subscapular skin-fold) and one lower-body (circumference of the thigh) adiposity measure in the model, the z-score regression coefficient (s.e.) was 85.7g (30.8) [p=0.0057] for maternal subscapular skin-fold and 19.0g (31.6) [p=0.5477] for circumference of the thigh. When the second-best upper-body contributor to infant birthweight (circumference of the forearm) was entered with one lower-body measure into the model, the z-score regression coefficient (s.e.) was 77.5g (38.5) [p=0.0451] for maternal forearm circumference and 14.1g (38.5) [p=0.7146] for circumference of the thigh. When both subscapular skinfold and forearm circumference were added to the model in place of BMI, the explained variance (r 2 =0.5478) was similar to the model using BMI (r 2 =0.5487). Upper-body adiposity - whether operationalized by subscapular skin-fold or circumference of the forearm - was a markedly larger determinant of infant birth weight than lower-body adiposity. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Compression of the median nerve in the proximal forearm by a giant lipoma: A case report

PubMed Central

2008-01-01

Background Compression of the median nerve by a tumour in the elbow and forearm region is rare. We present a case of neuropathy of the median nerve secondary to compression by giant lipoma in the proximal forearm. Case presentation A 46-year-old man presented with a six month history of gradually worsening numbness and paresthesia on the palmar aspect of the left thumb and thenar eminence. Clinical examination reveals a hypoaesthesia in the median nerve area of the left index and thumb compared to the contralateral side. Electromyography showed prolonged sensory latency in the distribution of the median nerve corresponding to compression in the region of the pronator teres (pronator syndrome). Radiological investigations were initially reported as normal. Conservative treatment for one month did not result in any improvement. Surgical exploration was performed and a large intermuscular lipoma enveloped the median nerve was found. A complete excision of the tumour was performed. Postoperative revaluation the X-ray of the elbow was seen to demonstrate a well-circumscribed mass in the anterior aspect of the proximal forearm. At follow-up, 14 months after surgery, the patient noted complete return of the sensation and resolution of the paresthesia. Conclusion In case of atypical findings or non frequent localization of nerve compression, clinically interpreted as an idiopathic compression, it is recommended to make a pre-operative complementary Ultrasound or MRI study. PMID:18541043

Age and gender differences in mechanically induced intraoral temporal summation and conditioned pain modulation in healthy subjects.

PubMed

Khan, Junad; Korczeniewska, Olga; Benoliel, Rafael; Kalladka, Mythili; Eliav, Eli; Nasri-Heir, Cibelle

2018-04-13

The aim of this study was to investigate intraoral temporal summation (TS) and conditioned pain modulation (CPM) and compare the outcome with TS and CPM induced in the forearm. In addition, we aimed to study the effect of age and gender on intraoral and forearm TS and CPM. Mechanical stimulation was induced with # 5.46 von Frey filament applying 26 grams of force. A single stimulus, followed by a train of 30 successive stimuli, was applied intraorally and to the dominant forearm. CPM was assessed with the TS test as the painful stimulus and with immersion of the nondominant hand in a hot water bath as the conditioning stimulus. Gender was significantly associated with TS but not with CPM measures. Females had significantly lower mean TS measured in the face and in the dominant forearm compared with males. Age was significantly associated with CPM, but not with TS measures. In both sites examined, older patients had significantly lower mean CPM compared with younger patients. Mechanical TM elicited in the oral cavity can be used as test stimulus for CPM testing. Intraoral modulation, both TS and CPM, has an extent similar to that of the standard cutaneous extremity. TS was lower in females, and CPM was reduced with age. Copyright © 2018 Elsevier Inc. All rights reserved.

Phase synchronization of oscillations in cardiovascular and respiratory systems in humans

NASA Astrophysics Data System (ADS)

Tankanag, Arina V.; Grinevich, Andrey A.; Tikhonova, Irina V.; Chaplygina, Alina V.; Chemeris, Nikolay K.

2017-04-01

Phase synchronization between blood flow oscillations of left and right forearm skin sites, heart rate variability (HRV) and breath rate were studied from healthy volunteers at rest. The degree of synchronization between the phases of the analyzed signals was estimated from the value of the wavelet phase coherence. High medians of values of phase wavelet coherence function were obtained for the endothelial, neurogenic, myogenic and cardiac intervals. Significant phase synchronization were demonstrated between HRV and skin blood flow oscillations in both left and right forearms in a wide frequency range from 0.04 to 0.4 Hz. Six participants exhibited low phase synchronization (< 0.5) between the breath rate and HRV, while nine participants had high phase synchronization (> 0.5). This distribution was not affected by the sex or sympathovagal status of volunteers. Participants with low phase synchronization between breath rate and HRV featured low phase synchronization (< 0.5) between breath rate and blood flow oscillations in both forearms. Contrariwise, in subjects with high phase synchronization between respiratory rhythm and HRV both low and high phase synchronization between breath rate and blood flow oscillations in both forearms was observed. The results obtained allow us to suggest that the organism possesses a mechanism mediating the synchronization of blood flow oscillations in the skin microvasculature with all other periodical processes across the cardiovascular system, in particular, with HRV and breath rate over a wide frequency range.

Comparison of pQCT parameters between ulna and radius in retired elite gymnasts: the skeletal benefits associated with long-term gymnastics are bone- and site-specific.

PubMed

Ducher, G; Hill, B L; Angeli, T; Bass, S L; Eser, P

2009-01-01

To compare the skeletal benefits associated with gymnastics between ulna and radius. 19 retired artistic gymnasts, aged 18-36 years, were compared to 24 sedentary women. Bone mineral content (BMC), total and cortical bone area (ToA, CoA), trabecular and cortical volumetric density (TrD, CoD) and cortical thickness (CoTh) were measured by pQCT at the 4% and 66% forearm. At the 4% site, BMC and ToA were more than twice greater at the radius than ulna whereas at the 66% site, BMC, ToA, CoA, CoTh and SSIpol were 20 to 51% greater at the ulna than radius in both groups (p<0.0001). At the 4% site, the skeletal benefits in BMC of the retired gymnasts over the non-gymnasts were 1.9 times greater at the radius than ulna (p<0.001), with enlarged bone size at the distal radius only. In contrast, the skeletal benefits at the 66% site were twice greater at the ulna than radius for BMC and CoA (p<0.01). Whereas the skeletal benefits associated with long-term gymnastics were greater at the radius than ulna in the distal forearm, the reverse was found in the proximal forearm, suggesting both bones should be analysed when investigating forearm strength.

An assessment of the relationship between congenital transverse deficiency of the forearm and symbrachydactyly.

PubMed

Kallemeier, Patricia M; Manske, Paul R; Davis, Benjamin; Goldfarb, Charles A

2007-11-01

A relationship between symbrachydactyly and transverse deficiency has been suggested but has not been critically investigated or established by scientific studies. The purpose of this investigation was to evaluate a large group of patients with transverse deficiency of the forearm for clinical and radiologic features typically seen in patients with symbrachydactyly. A retrospective review of the medical records of 291 patients with a diagnosis of upper-extremity transverse deficiency at the level of the forearm was performed. Patient charts, photographs, and radiographs were evaluated for manifestations of symbrachydactyly; specifically, we clinically assessed for the presence of nubbins and skin invaginations and radiologically assessed for hypoplasia of the proximal radius and ulna. Two hundred seven patients had soft tissue nubbins at the end of their amputation stumps including 38 with the additional finding of skin invagination at the distal end. Another 36 extremities had a skin invagination alone. Twenty-nine of the extremities without nubbins or skin invaginations had hypoplasia of the proximal radius and ulna. Thus, 272 of the 291 extremities with transverse deficiency had manifestations of symbrachydactyly. The majority of patients with the diagnosis of transverse deficiency have soft tissue nubbins, skin invaginations, or hypoplasia of the proximal radius and ulna at the end of their amputation stumps. These clinical and radiologic features support the concept that transverse deficiency through the forearm represents a proximal continuum of symbrachydactyly.

Sympathetic vascular transduction is augmented in young normotensive blacks

NASA Technical Reports Server (NTRS)

Ray, Chester A.; Monahan, Kevin D.

2002-01-01

The purpose of the present study was to determine sympathetic vascular transduction in young normotensive black and white adults. We hypothesized that blacks would demonstrate augmented transduction of muscle sympathetic nerve activity (MSNA) into vascular resistance. To test this hypothesis, MSNA, forearm blood flow, heart rate, and arterial blood pressure were measured during lower body negative pressure (LBNP). At rest, no differences existed in arterial blood pressure, heart rate, forearm blood flow, and forearm vascular resistance (FVR). Likewise, LBNP elicited comparable responses of these variables for blacks and whites. Baseline MSNA did not differ between blacks and whites, but whites demonstrated greater increases during LBNP (28 +/- 7 vs. 55 +/- 18%, 81 +/- 21 vs. 137 +/- 42%, 174 +/- 81 vs. 556 +/- 98% for -5, -15, and -40 mmHg LBNP, respectively; P < 0.001). Consistent with smaller increases in MSNA but similar FVR responses during LBNP, blacks demonstrated greater sympathetic vascular transduction (%FVR/%MSNA) than whites (0.95 +/- 0.07 vs. 0.82 +/- 0.07 U; 0.82 +/- 0.11 vs. 0.64 +/- 0.09 U; 0.95 +/- 0.37 vs. 0.35 +/- 0.09 U; P < 0.01). In summary, young whites demonstrate greater increases in MSNA during baroreceptor unloading than age-matched normotensive blacks. However, more importantly, for a given increase in MSNA, blacks demonstrate greater forearm vasoconstriction than whites. This finding may contribute to augmented blood pressure reactivity in blacks.

Strength and fatigability of selected muscles in upper limb: assessing muscle imbalance relevant to tennis elbow.

PubMed

Alizadehkhaiyat, O; Fisher, A C; Kemp, G J; Frostick, S P

2007-08-01

The aetiology of tennis elbow has remained uncertain for more than a century. To examine muscle imbalance as a possible pathophysiological factor requires a reliable method of assessment. This paper describes the development of such a method and its performance in healthy subjects. We propose a combination of surface and fine-wire EMG of shoulder and forearm muscles and wrist strength measurements as a reliable tool for assessing muscle imbalance relevant to the pathophysiology of tennis elbow. Six healthy volunteers participated. EMG data were acquired at 50% maximal voluntary isometric contraction from five forearm muscles during grip and three shoulder muscles during external rotation and abduction, and analysed using normalized median frequency slope as a fatigue index. Wrist extension/flexion strength was measured using a purpose-built dynamometer. Significant negative slope of median frequency was found for all muscles, with good reproducibility, and no significant difference in slope between the different muscles of the shoulder and the wrist. (Amplitude slope showed high variability and was therefore unsuitable for this purpose.) Wrist flexion was 27+/-8% stronger than extension (mean+/-SEM, p=0.006). This is a reliable method for measuring muscle fatigue in forearm and shoulder. EMG and wrist strength studies together can be used for assessing and identifying the muscle balance in the wrist-forearm-shoulder chain.

Combined Endovascular Treatment with Distal Radial Artery Coil Embolization and Angioplasty in Steal Syndrome Associated with Forearm Dialysis Fistula.

PubMed

Tercan, Fahri; Koçyiğit, Ali; Güney, Bünyamin

2016-09-01

The present study was performed to define the results of the endovascular treatment with angioplasty and distal radial artery embolization in ischemic steal syndrome associated with forearm arteriovenous accesses. The cases referred to our interventional radiology unit with symptoms and physical examination findings suggestive of ischemic steal syndrome were retrospectively evaluated first by Doppler ultrasonography, and then by angiography. Cases with proximal artery stenosis were applied angioplasty, and those with steal syndrome underwent coil embolization to distal radial artery. Of 589 patients who underwent endovascular intervention for dialysis arteriovenous fistulae (AVF)-associated problems, 6 (1.01 %) (5 female, 1 males; mean age 62 (range 41-78) with forearm fistula underwent combined endovascular treatment for steal syndrome. In addition to steal phenomenon, there were stenosis and/or occlusion in proximal radial and/or ulnar artery in 6 patients concurrently. Embolization of distal radial artery and angioplasty to proximal arterial stenoses were performed in all patients. Ischemic symptoms were eliminated in all patients and the AVF were in use at the time of study. In one patient, ischemic symptoms recurring 6 months later were alleviated by repeat angioplasty of ulnar artery. In palmar arch steal syndrome affecting forearm fistulae, combined distal radial embolization and angioplasty is also an effective treatment method in the presence of proximal radial and ulnar arterial stenoses and occlusions.

A rare cause of forearm pain: anterior branch of the medial antebrachial cutaneous nerve injury: a case report.

PubMed

Yildiz, Necmettin; Ardic, Füsun

2008-04-21

Medial antebrachial cutaneous nerve (MACN) neuropathy is reported to be caused by iatrogenic reasons. Although the cases describing the posterior branch of MACN neuropathy are abundant, only one case caused by lipoma has been found to describe the anterior branch of MACN neuropathy in the literature. As for the reason for the forearm pain, we report the only case describing isolated anterior branch of MACN neuropathy which has developed due to repeated minor trauma. We report a 37-year-old woman patient with pain in her medial forearm and elbow following the shaking of a rug. Pain and symptoms of dysestesia in the distribution of the right MACN were found. Electrophysiological examination confirmed the normality of the main nerve trunks of the right upper limb and demonstrated abnormalities of the right MACN when compared with the left side. Sensory action potential (SAP) amplitude on the right anterior branch of the MACN was detected to be lower in proportion to the left. In the light of these findings, NSAI drug and physical therapy was performed. Dysestesia and pain were relieved and no recurrence was observed after a follow-up of 14 months. MACN neuropathy should be taken into account for the differential diagnosis of the patients with complaints of pain and dysestesia in medial forearm and anteromedial aspect of the elbow.

A rare cause of forearm pain: anterior branch of the medial antebrachial cutaneous nerve injury: a case report

PubMed Central

2008-01-01

Introduction Medial antebrachial cutaneous nerve (MACN) neuropathy is reported to be caused by iatrogenic reasons. Although the cases describing the posterior branch of MACN neuropathy are abundant, only one case caused by lipoma has been found to describe the anterior branch of MACN neuropathy in the literature. As for the reason for the forearm pain, we report the only case describing isolated anterior branch of MACN neuropathy which has developed due to repeated minor trauma. Case presentation We report a 37-year-old woman patient with pain in her medial forearm and elbow following the shaking of a rug. Pain and symptoms of dysestesia in the distribution of the right MACN were found. Electrophysiological examination confirmed the normality of the main nerve trunks of the right upper limb and demonstrated abnormalities of the right MACN when compared with the left side. Sensory action potential (SAP) amplitude on the right anterior branch of the MACN was detected to be lower in proportion to the left. In the light of these findings, NSAI drug and physical therapy was performed. Dysestesia and pain were relieved and no recurrence was observed after a follow-up of 14 months. Conclusion MACN neuropathy should be taken into account for the differential diagnosis of the patients with complaints of pain and dysestesia in medial forearm and anteromedial aspect of the elbow. PMID:18426569

Forearm arterial anatomy and flow characteristics: a prospective observational study.

PubMed

Pancholy, Samir B; Heck, Laura A; Patel, Tejas

2015-04-01

Morphometric data on Caucasian radial and ulnar arteries are limited, with no data on flow interdependence in the forearm arterial circuit. A total of 250 upper extremities in 125 patients were evaluated. Ultrasonography was performed and radial and ulnar artery lumen diameters were measured. Ulnar artery (UA) was compressed at the level of the wrist, and flow parameters in radial artery (RA) were recorded using duplex Doppler ultrasound. Radial and ulnar artery diameters were comparable at the level of the distal forearm (RA = 2.03 ± 0.28 mm, UA = 2.07 ± 0.27 mm; P=.14). There was no significant difference in radial or ulnar artery diameter between the dominant upper extremity and the non-dominant upper extremity. Upon compression of the ulnar artery, radial artery velocity-time integral (VTI) increased from 8.4 ± 3.8 cm to 12.8 ± 5.5 cm, which was statistically significant (P<.001). There was a significant inverse correlation between radial artery diameter and the magnitude of increase in radial VTI observed with UA compression (r² = 0.106; P<.001). RA diameter at the level of the distal forearm is comparable to UA. RA-VTI and likely flow significantly increase by compression of the UA. The smaller the radial artery, the larger the increase in radial artery flow with ulnar compression.

Augmenting forearm crutches with wireless sensors for lower limb rehabilitation

NASA Astrophysics Data System (ADS)

Merrett, Geoff V.; Ettabib, Mohamed A.; Peters, Christian; Hallett, Georgina; White, Neil M.

2010-12-01

Forearm crutches are frequently used in the rehabilitation of an injury to the lower limb. The recovery rate is improved if the patient correctly applies a certain fraction of their body weight (specified by a clinician) through the axis of the crutch, referred to as partial weight bearing (PWB). Incorrect weight bearing has been shown to result in an extended recovery period or even cause further damage to the limb. There is currently no minimally invasive tool for long-term monitoring of a patient's PWB in a home environment. This paper describes the research and development of an instrumented forearm crutch that has been developed to wirelessly and autonomously monitor a patient's weight bearing over the full period of their recovery, including its potential use in a home environment. A pair of standard forearm crutches are augmented with low-cost off-the-shelf wireless sensor nodes and electronic components to provide indicative measurements of the applied weight, crutch tilt and hand position on the grip. Data are wirelessly transmitted between crutches and to a remote computer (where they are processed and visualized in LabVIEW), and the patient receives biofeedback by means of an audible signal when they put too much or too little weight through the crutch. The initial results obtained highlight the capability of the instrumented crutch to support physiotherapists and patients in monitoring usage.

Comparing two methods to record maximal voluntary contractions and different electrode positions in recordings of forearm extensor muscle activity: Refining risk assessments for work-related wrist disorders.

PubMed

Dahlqvist, Camilla; Nordander, Catarina; Granqvist, Lothy; Forsman, Mikael; Hansson, Gert-Åke

2018-01-01

Wrist disorders are common in force demanding industrial repetitive work. Visual assessment of force demands have a low reliability, instead surface electromyography (EMG) may be used as part of a risk assessment for work-related wrist disorders. For normalization of EMG recordings, a power grip (hand grip) is often used as maximal voluntary contraction (MVC) of the forearm extensor muscles. However, the test-retest reproducibility is poor and EMG amplitudes exceeding 100% have occasionally been recorded during work. An alternative MVC is resisted wrist extension, which may be more reliable. To compare hand grip and resisted wrist extension MVCs, in terms of amplitude and reproducibility, and to examine the effect of electrode positioning. Twelve subjects participated. EMG from right forearm extensors, from four electrode pairs, was recorded during MVCs, on three separate occasions. The group mean EMG amplitudes for resisted wrist extension were 1.2-1.7 times greater than those for hand grip. Resisted wrist extension showed better reproducibility than hand grip. The results indicate that the use of resisted wrist extension is a more accurate measurement of maximal effort of wrist extensor contractions than using hand grip and should increase the precision in EMG recordings from forearm extensor muscles, which in turn will increase the quality of risk assessments that are based on these.

Insulin action in adipose tissue and muscle in hypothyroidism.

PubMed

Dimitriadis, George; Mitrou, Panayota; Lambadiari, Vaia; Boutati, Eleni; Maratou, Eirini; Panagiotakos, Demosthenes B; Koukkou, Efi; Tzanela, Marinela; Thalassinos, Nikos; Raptis, Sotirios A

2006-12-01

Although insulin resistance in thyroid hormone excess is well documented, information on insulin action in hypothyroidism is limited. To investigate this, a meal was given to 11 hypothyroid (HO; aged 45 +/- 3 yr) and 10 euthyroid subjects (EU; aged 42 +/- 4 yr). Blood was withdrawn for 360 min from veins (V) draining the anterior abdominal sc adipose tissue and the forearm and from the radial artery (A). Blood flow (BF) in adipose tissue was measured with 133Xe and in forearm with strain-gauge plethysmography. Tissue glucose uptake was calculated as (A-V)glucose(BF), lipoprotein lipase as (A-V)Triglycerides(BF), and lipolysis as [(V-A)glycerol(BF)]-lipoprotein lipase. The HO group had higher glucose and insulin levels than the EU group (P < 0.05). In HO vs. EU after meal ingestion (area under curve 0-360 min): 1) BF (1290 +/- 79 vs. 1579 +/- 106 ml per 100 ml tissue in forearm and 706 +/- 105 vs. 1340 +/- 144 ml per 100 ml tissue in adipose tissue) and glucose uptake (464 +/- 74 vs. 850 +/- 155 micromol per 100 ml tissue in forearm and 208 +/- 42 vs. 406 +/- 47 micromol per 100 ml tissue in adipose tissue) were decreased (P < 0.05), but fractional glucose uptake was similar (28 +/- 6 vs. 33 +/- 6% per minute in forearm and 17 +/- 4 vs. 14 +/- 3% per minute in adipose tissue); 2) suppression of lipolysis by insulin was similar; and 3) plasma triglycerides were elevated (489 +/- 91 vs. 264 +/- 36 nmol/liter.min, P < 0.05), whereas adipose tissue lipoprotein lipase (42 +/- 11 vs. 80 +/- 21 micromol per 100 ml tissue) and triglyceride clearance (45 +/- 10 vs. 109 +/- 21 ml per 100 ml tissue) were decreased in HO (P < 0.05). In hypothyroidism: 1) glucose uptake in muscle and adipose tissue is resistant to insulin; 2) suppression of lipolysis by insulin is not impaired; and 3) hypertriglyceridemia is due to decreased clearance by the adipose tissue.

Presence of cardiovascular structural changes in essential hypertensive patients with coronary microvascular disease and effects of long-term treatment.

PubMed

Virdis, A; Ghiadoni, L; Lucarini, A; Di Legge, V; Taddei, S; Salvetti, A

1996-04-01

In asymptomatic essential hypertensive patients with angiographically normal coronary arteries and without left ventricular hypertrophy, dipyridamole-induced ischemic-like ST segment depression may be a marker of coronary microvascular disease. In this study we evaluated, first, whether this cardiac abnormality is linked to structural or functional vascular abnormalities, and second, the effect of antihypertensive treatment by 12-month administration of the angiotensin converting enzyme (ACE) inhibitor captopril (50 mg twice a day orally). In essential hypertensives with dipypridamole echocardiography stress test (DET) (DET+, n = 8) and without (DET-, n = 8) ST segment depression greater than 0.1 mV during intravenous dipyridamole infusion (0.84 mg/kg over 10 min), we studied the forearm blood flow (FBF, venous plethysmography, mL/100) modifications induced by intrabrachial acetylcholine (Ach) (0.15, 0.45, 1.5, 4.5, 15 micrograms/100 mL/min x 5 min each), an endothelium-dependent vasodilator, and by sodium nitroprusside (SNP) (1, 2, 4 micrograms/100 mL/min x 5 min each), a smooth muscle cell relaxant compound. Minimal forearm vascular resistances (MFVR), an index of arteriolar structural changes, were also calculated. Both Ach and SNP caused greater vasodilation in DET- as compared to DET+ while MFVRs were lower in DET- compared to DET+. After treatment, both DET+ and DET- patients showed a significant and similar reduction in blood pressure and left ventricular mass index, while vasodilation to acetylcholine and sodium nitroprusside was increased only in the DET+ group. In addition, forearm minimal vascular resistances were significantly reduced only in DET+ patients, who showed disappearance of dipyridamole-induced ischemic-like ST segment depression. In conclusion, these data confirm that essential hypertensive patients with microvascular coronary disease are characterized by the presence of structural changes in the forearm vascular bed. Our results also indicate that both cardiac and forearm vascular abnormalities can be reversed by antihypertensive treatment with an ACE inhibitor.

Comparison of responses evoked by mild indirect cooling and by sound in the forearm vasculature in patients with homozygous sickle cell disease and in normal subjects.

PubMed

Mohan, J S; Marshall, J M; Reid, H L; Thomas, P W; Hambleton, I; Serjeant, G R

1998-02-01

In normal individuals, novel or noxious stimuli commonly evoke the pattern of the alerting or defence response which includes cutaneous vasoconstriction, but vasodilatation in forearm skeletal muscle. We have compared cardiovascular responses evoked by sound and by indirect cooling in 60 patients with homozygous sickle cell (SS) disease and in 30 control subjects with normal haemoglobin genotype (AA). A sound of 90 dB, 1 kHz for 30s evoked an increase in hand and forearm cutaneous vascular resistance (HCVR and FCVR) in SS patients and an increase in HCVR in AA subjects, as assessed from Doppler flowmetry. Meanwhile, a decrease in forearm vascular resistance (FVR) assessed by venous occlusion plethysmography, occurred in 14 out of 30 AA subjects and 25 out of 60 SS patients, indicating vasodilatation in forearm muscle; an increase in FVR occurred in the remainder. The proportions of SS patients and AA subjects who showed an increase in FVR (53% vs 57%) were not significantly different. Cooling increased HCVR and FCVR in SS patients and increased FCVR in AA subjects; a decrease in FVR indicating vasodilatation, occurred in 12 out of 30 AA subjects, but in only 10 out of 60 SS patients. The proportion of SS patients who showed an increase in FVR to cooling was greater than in AA subjects (83% vs 60%, P < 0.05). Thus, SS patients are just as capable of showing the muscle vasodilatation of the alerting response to sound as AA subjects. That few SS patients showed muscle vasodilatation in response to cooling is consistent with the view that reflex vasoconstrictor responses to cooling are particularly strong in SS patients. This, in turn, is consistent with our hypothesis that the reflex vasoconstrictor response to cooling acts as a trigger for the painful crisis of SS disease by diverting blood flow away from active bone marrow.

Nitric oxide-dependent modulation of sympathetic neural control of oxygenation in exercising human skeletal muscle

PubMed Central

Chavoshan, Bahman; Sander, Mikael; Sybert, Troy E; Hansen, Jim; Victor, Ronald G; Thomas, Gail D

2002-01-01

Nitric oxide (NO) attenuates α-adrenergic vasoconstriction in contracting rodent skeletal muscle, but it is unclear if NO plays a similar role in human muscle. We therefore hypothesized that in humans, NO produced in exercising skeletal muscle blunts the vasoconstrictor response to sympathetic activation. We assessed vasoconstrictor responses in the microcirculation of human forearm muscle using near-infrared spectroscopy to measure decreases in muscle oxygenation during reflex sympathetic activation evoked by lower body negative pressure (LBNP). Experiments were performed before and after NO synthase inhibition produced by systemic infusion of NG-nitro-l-arginine methyl ester (l-NAME). Before l-NAME, LBNP at −20 mmHg decreased muscle oxygenation by 20 ± 2 % in resting forearm and by 2 ± 3 % in exercising forearm (n = 20), demonstrating metabolic modulation of sympathetic vasoconstriction. As expected, l-NAME increased mean arterial pressure by 17 ± 3 mmHg, leading to baroreflex-mediated supression of baseline muscle sympathetic nerve activity (SNA). The increment in muscle SNA in response to LBNP at −20 mmHg also was attenuated after l-NAME (before, +14 ± 2; after, +8 ± 1 bursts min−1; n = 6), but this effect of l-NAME was counteracted by increasing LBNP to −40 mmHg (+19 ± 2 bursts min−1). After l-NAME, LBNP at −20 mmHg decreased muscle oxygenation similarly in resting (−11 ± 3 %) and exercising (−10 ± 2 %) forearm (n = 12). Likewise, LBNP at −40 mmHg decreased muscle oxygenation both in resting (−19 ± 4 %) and exercising (−21 ± 5 %) forearm (n = 8). These data advance the hypothesis that NO plays an important role in modulating sympathetic vasoconstriction in the microcirculation of exercising muscle, because such modulation is abrogated by NO synthase inhibition with l-NAME. PMID:11927694

Impact of a community-based osteoporosis and fall prevention program on fracture incidence.

PubMed

Grahn Kronhed, Ann-Charlotte; Blomberg, Carina; Karlsson, Nadine; Löfman, Owe; Timpka, Toomas; Möller, Margareta

2005-06-01

Associations between a 10-year community-based osteoporosis and fall prevention program and fracture incidence amongst middle-aged and elderly residents in an intervention community are studied, and comparisons are made with a control community. A health-education program was provided to all residents in the intervention community, which addressed dietary intake, physical activity, smoking habits and environmental risk factors for osteoporosis and falls. Both communities are small, semi-rural and situated in Ostergotland County in southern Sweden. The analysis is based on incidences of forearm fractures in the population 40 years of age or older, and hip fractures in the population 50 years of age or older. Data for three 5-year periods (pre-, early and late intervention) are accumulated and compared. In the intervention community, forearm fracture incidence decreased in women. There are also tendencies towards decreasing forearm fracture incidence in men, and towards decreasing trochanteric hip fracture incidences in women and in men in the late intervention period. No such changes in fracture incidences are found in the control community. Cervical hip fracture incidence did not change in the intervention and the control communities. Although the reported numbers of fractures are small (a total of 451 forearm and 357 hip fractures), the numbers are based on total community populations and thus represent a true difference. The decrease in forearm fracture incidence among women, and the tendency towards decreasing trochanteric hip fractures, in contrast to the absence of change in cervical hip fractures, might be mainly due to a more rapid effect of fall preventive measures than an increase in bone strength in the population. For the younger age groups an expected time lag between intervention and effect might invalidate the short follow-up period for outcome measurements. Thus, the effect of the 10-year intervention program on fracture incidence should be followed during an extended post-intervention period.

Biometrical characteristics and physiological responses to a local cold exposure of the extremities.

PubMed

Savourey, G; Sendowski, I; Bittel, J

1996-01-01

The aim of this study was firstly to describe the physiological responses observed in 19 subjects during immersion of the arm up to the elbow in water at 5 degrees C (5 min) followed by a 10-min recovery and secondly, to correlate the observed physiological responses with biometrical characteristics of the subjects (maximal oxygen uptake, VO2max, percentage fat content of whole body, BF, and arm, forearm and hand skinfold thickness). The results showed that the time courses of changes in forearm and hand skin temperature were different compared to those of finger skin temperatures both during local cooling and during rewarming (P < 0.05). Cardiovascular responses (heart rate, systolic and diastolic blood pressures) and finger skin temperatures were not related to the biometrical characteristics of the subjects. However, at the end of the immersion, decreased hand skin temperature was correlated to VO2max (r = 0.45, P < or = 0.05) whereas decreased forearm skin temperature was correlated both to VO2max (r = 0.44, P < or = 0.05) and to skinfold thickness (r = -0.44, P < or = 0.05) but not to BF. During the beginning of the recovery period only, outside, inside forearm and hand skin temperatures were related to VO2max (r = 0.54, P < or = 0.05; r = 0.66, P < or = 0.01 and r = 0.45, P < or = 0.05, respectively) and all the skinfold thicknesses (r = -0.47 to -0.71, P < or = 0.05). It was concluded that the local skin temperature profiles differed according to the upper limb segment both during cooling and during early rewarming. Moreover, VO2max and upper limb skinfold thickness but not BF did influence the forearm and hand skin temperature changes during cooling and early rewarming but not the finger skin temperature changes and cardiovascular responses.

The effect of soft tissue distraction on deformity recurrence after centralization for radial longitudinal deficiency.

PubMed

Manske, M Claire; Wall, Lindley B; Steffen, Jennifer A; Goldfarb, Charles A

2014-05-01

To assess recurrence and complications in children with radial longitudinal deficiency treated with or without external fixator soft tissue distraction prior to centralization. Thirteen upper extremities treated with centralization alone were compared with 13 treated with ring fixator distraction followed by centralization. Resting wrist position between the 2 groups was compared before surgery, approximately 2 years after surgery (midterm), and at final follow-up, which was at a mean of 10 years for the centralization-alone group and 6 years for the distraction group. Radiographs were reviewed for hand-forearm angle, hand-forearm position, volar carpal subluxation, ulnar length, and physeal integrity. The clinical resting wrist position was improved significantly after surgery and at final follow-up in both groups, but recurrence was worse at final follow-up in the distraction group patients. Radiographically, in the centralization alone group, the hand-forearm angle improved from 53° before surgery to 13° at midterm but worsened to 27° at final follow-up. In the distraction group, the hand-forearm angle improved from 53° before surgery to 21° at midterm but worsened to 36° at final follow-up. The hand-forearm position improved between preoperative and final assessment in both groups, but at final follow-up, the centralization-alone group had a significantly better position. Volar subluxation was 4 mm improved in the centralization alone group and 2 mm worse in the distraction group at final follow-up. Centralization, with or without distraction with an external fixator, resulted in improved alignment of the wrist. Distraction facilitated centralization, but it did not prevent deformity recurrence and was associated with a worse final radial deviation and volar subluxation position compared with wrists treated with centralization alone. Therapeutic III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Functional outcomes of "floating elbow" injuries in adult patients.

PubMed

Yokoyama, K; Itoman, M; Kobayashi, A; Shindo, M; Futami, T

1998-05-01

To assess elbow function, complications, and problems of floating elbow fractures in adults receiving surgical treatment. Retrospective clinical review. Level I trauma center in Kanagawa, Japan. Fourteen patients with fifteen floating elbow injuries, excluding one immediate amputation, seen at the Kitasato University Hospital from January 1, 1984, to April 30, 1995. All fractures were managed surgically by various methods. In ten cases, the humeral and forearm fractures were treated simultaneously with immediate fixation. In three cases, both the humeral and forearm fractures were treated with delayed fixation on Day 1, 4, or 7. In the remaining two cases, the open forearm fracture was managed with immediate fixation and the humerus fracture with delayed fixation on Day 10 or 25. All subjects underwent standardized elbow evaluations, and results were compared with an elbow score based on a 100-point scale. The parameters evaluated were pain, motion, elbow and grip strength, and function during daily activities. Complications such as infections, nonunions, malunions, and refractures were investigated. Mean follow-up was forty-three months (range 13 to 112 months). At final follow-up, the mean elbow function score was 79 points, with 67 percent (ten of fifteen) of the subjects having good or excellent results. The functional outcome did not correlate with the Injury Severity Score of the individual patients, the existence of open injuries or neurovascular injuries, or the timing of surgery. There were one deep infection, two nonunions of the humerus, two nonunions of the forearm, one varus deformity of the humerus, and one forearm refracture. Based on the present data, we could not clarify the factors influencing the final functional outcome after floating elbow injury. These injuries, however, potentially have many complications, such as infection or nonunion, especially when there is associated brachial plexus injury. We consider that floating elbow injuries are severe injuries and that surgical stabilization is needed; beyond that, there are no specific forms of surgical treatment to reliably guarantee excellent results.

Radiographic evaluation of acute distal radius fracture stability: A comparative cadaveric study between a thermo-formable bracing system and traditional fiberglass casting.

PubMed

Santoni, Brandon G; Aira, Jazmine R; Diaz, Miguel A; Kyle Stoops, T; Simon, Peter

2017-08-01

Distal radius fractures are common musculoskeletal injuries and many can be treated non-operatively with cast immobilization. A thermo-formable brace has been developed for management of such fractures, but no data exist regarding its comparative stabilizing efficacy to fiberglass casting. A worst-case distal radius fracture was created in 6 cadaveric forearms. A radiolucent loading fixture was created to apply cantilever bending/compression loads ranging from 4.5N to 66.7N across the simulated fracture in the: (1) non-stabilized, (2) braced; and (3) casted forearms, each forearm serving as its own control. Fracture fragment translations and rotations were measured radiographically using orthogonal radiographs and a 2D-3D, CT-based transformation methodology. Under 4.5N of load in the non-stabilized condition, average sagittal plane rotation and 3D center of mass translation of the fracture fragment were 12.3° and 5.3mm, respectively. At the 4.5N load step, fragment rotation with the brace (avg. 0.0°) and cast (0.1°) reduced sagittal plane rotation compared to the non-stabilized forearm (P<0.001). There were no significant differences in measured sagittal plane fracture fragment rotations or 3D fragment translations between the brace or cast at any of the four load steps (4.5N, 22.2N, 44.5N, and 66.7N, P≥0.138). In this in vitro radiographic study utilizing 6 cadaveric forearms with simulated severe-case, unstable and comminuted distal radius fractures, the thermo-formable brace stabilized the fracture in a manner that was not radiographically or biomechanically different from traditional fiberglass casting. Study results support the use of the thermo-formable brace clinically. Copyright © 2017 Elsevier Ltd. All rights reserved.

Forearm muscle oxygenation decreases with low levels of voluntary contraction

NASA Technical Reports Server (NTRS)

Murthy, G.; Kahan, N. J.; Hargens, A. R.; Rempel, D. M.

1997-01-01

The purpose of our investigation was to determine if the near infrared spectroscopy technique was sensitive to changes in tissue oxygenation at low levels of isometric contraction in the extensor carpi radialis brevis muscle. Nine subjects were seated with the right arm abducted to 45 degrees, elbow flexed to 85 degrees, forearm pronated 45 degrees, and wrist and forearm supported on an armrest throughout the protocol. Altered tissue oxygenation was measured noninvasively with near infrared spectroscopy. The near infrared spectroscopy probe was placed over the extensor carpi radialis brevis of the subject's right forearm and secured with an elastic wrap. After 1 minute of baseline measurements taken with the muscle relaxed, four different loads were applied just proximal to the metacarpophalangeal joint such that the subjects isometrically contracted the extensor carpi radialis brevis at 5, 10, 15, and 50% of the maximum voluntary contraction for 1 minute each. A 3-minute recovery period followed each level of contraction. At the end of the protocol, with the probe still in place, a value for ischemic tissue oxygenation was obtained for each subject. This value was considered the physiological zero and hence 0% tissue oxygenation. Mean tissue oxygenation (+/-SE) decreased from resting baseline (100% tissue oxygenation) to 89 +/- 4, 81 +/- 8, 78 +/- 8, and 47 +/- 8% at 5, 10, 15, and 50% of the maximum voluntary contraction, respectively. Tissue oxygenation levels at 10, 15, and 50% of the maximum voluntary contraction were significantly lower (p < 0.05) than the baseline value. Our results indicate that tissue oxygenation significantly decreases during brief, low levels of static muscle contraction and that near infrared spectroscopy is a sensitive technique for detecting deoxygenation noninvasively at low levels of forearm muscle contraction. Our findings have important implications in occupational medicine because oxygen depletion induced by low levels of muscle contraction may be directly linked to muscle fatigue.

Evidence for cyclooxygenase-dependent sweating in young males during intermittent exercise in the heat

PubMed Central

Fujii, Naoto; McGinn, Ryan; Stapleton, Jill M; Paull, Gabrielle; Meade, Robert D; Kenny, Glen P

2014-01-01

Our recent work implicated nitric oxide (NO) in the control of sweating during intermittent exercise; however, it is unclear if cyclooxygenase (COX) is also involved. On separate days, ten healthy young (24 ± 4 years) males cycled in the heat (35°C). Two 30 min exercise bouts were performed at either a moderate (400 W, moderate heat load) or high (700 W, high heat load) rate of metabolic heat production and were followed by 20 and 40 min of recovery, respectively. Forearm sweating (ventilated capsule) was evaluated at four skin sites that were continuously perfused via intradermal microdialysis with: (1) lactated Ringer solution (Control), (2) 10 mm ketorolac (a non-selective COX inhibitor), (3) 10 mm NG-nitro-l-arginine methyl ester (l-NAME; a non-selective NO synthase inhibitor) or (4) a combination of 10 mm ketorolac + 10 mml-NAME. During the last 5 min of the first exercise at moderate heat load, forearm sweating (mg min−1 cm−2) was equivalently reduced with ketorolac (0.54 ± 0.08), l-NAME (0.55 ± 0.07) and ketorolac+l-NAME (0.56 ± 0.08) compared to Control (0.67 ± 0.06) (all P < 0.05). Similar results were obtained for the second exercise at moderate heat load (all P < 0.05). However, forearm sweating was similar between the four sites during exercise at high heat load and during recovery regardless of exercise intensity (all P > 0.05). We show that (1) although both COX and NO modulate forearm sweating during intermittent exercise bouts in the heat at a moderate heat load, the effects are not additive, and (2) the contribution of both enzymes to forearm sweating is less evident during intermittent exercise when the heat load is high and during recovery. PMID:25326453

Posterior interosseous nerve localization within the proximal forearm - a patient normalized parameter

PubMed Central

Kamineni, Srinath; Norgren, Crystal R; Davidson, Evan M; Kamineni, Ellora P; Deane, Andrew S

2017-01-01

AIM To provide a “patient-normalized” parameter in the proximal forearm. METHODS Sixty-three cadaveric upper extremities from thirty-five cadavers were studied. A muscle splitting approach was utilized to locate the posterior interosseous nerve (PIN) at the point where it emerges from beneath the supinator. The supinator was carefully incised to expose the midpoint length of the nerve as it passes into the forearm while preserving the associated fascial connections, thereby preserving the relationship of the nerve with the muscle. We measured the transepicondylar distance (TED), PIN distance in the forearm’s neutral rotation position, pronation position, supination position, and the nerve width. Two individuals performed measurements using a digital caliper with inter-observer and intra-observer blinding. The results were analyzed with the Wilcoxon-Mann-Whitney test for paired samples. RESULTS In pronation, the PIN was within two confidence intervals of 1.0 TED in 95% of cases (range 0.7-1.3 TED); in neutral, within two confidence intervals of 0.84 TED in 95% of cases (range 0.5-1.1 TED); in supination, within two confidence intervals of 0.72 TED in 95% of cases (range 0.5-0.9 TED). The mean PIN distance from the lateral epicondyle was 100% of TED in a pronated forearm, 84% in neutral, and 72% in supination. Predictive accuracy was highest in supination; in all cases the majority of specimens (90.47%-95.23%) are within 2 cm of the forearm position-specific percentage of TED. When comparing right to left sides for TEDs with the signed Wilcoxon-Mann-Whitney test for paired samples as well as a significance test (with normal distribution), the P-value was 0.0357 (significance - 0.05) indicating a significant difference between the two sides. CONCLUSION This “patient normalized” parameter localizes the PIN crossing a line drawn between the lateral epicondyle and the radial styloid. Accurate PIN localization will aid in diagnosis, injections, and surgical approaches. PMID:28473958

Effect of voluntary hypocapnic hyperventilation on the relationship between core temperature and heat loss responses in exercising humans.

PubMed

Fujii, Naoto; Honda, Yasushi; Komura, Ken; Tsuji, Bun; Sugihara, Akira; Watanabe, Kazuhito; Kondo, Narihiko; Nishiyasu, Takeshi

2014-12-01

Two thermolytic thermoregulatory responses, cutaneous vasodilation and sweating, begin when core temperature reaches a critical threshold, after which response magnitudes increase linearly with increasing core temperature; thus the slope indicates response sensitivity. We evaluated the influence of hypocapnia induced by voluntary hyperventilation on the core temperature threshold and sensitivity of thermoregulatory responses. Ten healthy males performed 15 min of cycling at 117 W (29.5°C, 50% RH) under three breathing conditions: 1) spontaneous ventilation, 2) voluntary normocapnic hyperventilation, and 3) voluntary hypocapnic hyperventilation. In the hypocapnic hyperventilation trial, end-tidal CO2 pressure was reduced throughout the exercise, whereas it was maintained around the normocapnic level in the other two trials. Cutaneous vascular conductances at the forearm and forehead were evaluated as laser-Doppler signal/mean arterial blood pressure, and the forearm sweat rate was measured using the ventilated capsule method. Esophageal temperature threshold was higher for the increase in cutaneous vascular conductance in the hypocapnic than normocapnic hyperventilation trial at the forearm (36.88 ± 0.36 vs. 36.68 ± 0.34°C, P < 0.05) and forehead (36.89 ± 0.31 vs. 36.75 ± 0.31°C, P < 0.05). The slope relating esophageal temperature to cutaneous vascular conductance was decreased in the hypocapnic than normocapnic hyperventilation trial at the forearm (302 ± 177 vs. 420 ± 178% baseline/°C, P < 0.05) and forehead (236 ± 164 vs. 358 ± 221% baseline/°C, P < 0.05). Neither the threshold nor the slope for the forearm sweat rate differed significantly between the hypocapnic or normocapnic hyperventilation trials. These findings indicate that in exercising humans, hypocapnia induced by voluntary hyperventilation does not influence sweating, but it attenuates the cutaneous vasodilatory response by increasing its threshold and reducing its sensitivity. Copyright © 2014 the American Physiological Society.

Cyclooxygenase inhibition does not alter methacholine-induced sweating

PubMed Central

Fujii, Naoto; McGinn, Ryan; Paull, Gabrielle; Stapleton, Jill M.; Meade, Robert D.

2014-01-01

Cholinergic agents (e.g., methacholine) induce cutaneous vasodilation and sweating. Reports indicate that either nitric oxide (NO), cyclooxygenase (COX), or both can contribute to cholinergic cutaneous vasodilation. Also, NO is reportedly involved in cholinergic sweating; however, whether COX contributes to cholinergic sweating is unclear. Forearm sweat rate (ventilated capsule) and cutaneous vascular conductance (CVC, laser-Doppler perfusion units/mean arterial pressure) were evaluated in 10 healthy young (24 ± 4 yr) adults (7 men, 3 women) at four skin sites that were continuously perfused via intradermal microdialysis with 1) lactated Ringer (control), 2) 10 mM ketorolac (a nonselective COX inhibitor), 3) 10 mM NG-nitro-l-arginine methyl ester (l-NAME, a nonselective NO synthase inhibitor), or 4) a combination of 10 mM ketorolac + 10 mM l-NAME. At the four skin sites, methacholine was simultaneously infused in a dose-dependent manner (1, 10, 100, 1,000, 2,000 mM). Relative to the control site, forearm CVC was not influenced by ketorolac throughout the protocol (all P > 0.05), whereas l-NAME and ketorolac + l-NAME reduced forearm CVC at and above 10 mM methacholine (all P < 0.05). Conversely, there was no main effect of treatment site (P = 0.488) and no interaction of methacholine dose and treatment site (P = 0.711) on forearm sweating. Thus forearm sweating (in mg·min−1·cm−2) from baseline up to the maximal dose of methacholine was not different between the four sites (at 2,000 mM, control 0.50 ± 0.23, ketorolac 0.44 ± 0.23, l-NAME 0.51 ± 0.22, and ketorolac + l-NAME 0.51 ± 0.23). We show that both NO synthase and COX inhibition do not influence cholinergic sweating induced by 1–2,000 mM methacholine. PMID:25213633

Altered Blood Flow Response to Small Muscle Mass Exercise in Cancer Survivors Treated With Adjuvant Therapy.

PubMed

Didier, Kaylin D; Ederer, Austin K; Reiter, Landon K; Brown, Michael; Hardy, Rachel; Caldwell, Jacob; Black, Christopher; Bemben, Michael G; Ade, Carl J

2017-02-07

Adjuvant cancer treatments have been shown to decrease cardiac function. In addition to changes in cardiovascular risk, there are several additional functional consequences including decreases in exercise capacity and increased incidence of cancer-related fatigue. However, the effects of adjuvant cancer treatment on peripheral vascular function during exercise in cancer survivors have not been well documented. We investigated the vascular responses to exercise in cancer survivors previously treated with adjuvant cancer therapies. Peripheral vascular responses were investigated in 11 cancer survivors previously treated with adjuvant cancer therapies (age 58±6 years, 34±30 months from diagnosis) and 9 healthy controls group matched for age, sex, and maximal voluntary contraction. A dynamic handgrip exercise test at 20% maximal voluntary contraction was performed with simultaneous measurements of forearm blood flow and mean arterial pressure. Forearm vascular conductance was calculated from forearm blood flow and mean arterial pressure. Left ventricular ejection time index (LVETi) was derived from the arterial pressure wave form. Forearm blood flow was attenuated in cancer therapies compared to control at 20% maximal voluntary contraction (189.8±53.8 vs 247.9±80.3 mL·min -1 , respectively). Forearm vascular conductance was not different between groups at rest or during exercise. Mean arterial pressure response to exercise was attenuated in cancer therapies compared to controls (107.8±10.8 vs 119.2±16.2 mm Hg). LEVTi was lower in cancer therapies compared to controls. These data suggest an attenuated exercise blood flow response in cancer survivors ≈34 months following adjuvant cancer therapy that may be attributed to an attenuated increase in mean arterial pressure. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Long-term survival in bronchogenic carcinoma with a solitary metastasis.

PubMed

Shachor, J; Luria, H; Cordova, M; Bernheim, J; Griffel, B; Bruderman, I

1986-03-01

Partial resection of a huge anaplastic large cell carcinoma of the upper lobe of the right lung was performed in a 47-year-old patient in order to relieve symptoms of pulmonary hypertrophic osteoarthropathy. Several months later a solitary metastasis was noted in the muscles of the right forearm. The metastasis was resected and the forearm irradiated. The patient was further treated with injections of autologous tumour cell vaccine and BCG. Today, 7 years later, the patient is alive, without any signs of neoplastic disease.

The role of imaging in diagnosing diseases of the distal radioulnar joint, triangular fibrocartilage complex, and distal ulna.

PubMed

Squires, Judy H; England, Eric; Mehta, Kaushal; Wissman, Robert D

2014-07-01

The purpose of this article is to review the anatomy, biomechanics, and multimodality imaging findings of common and uncommon distal radioulnar joint (DRUJ), triangular fibrocartilage complex, and distal ulna abnormalities. The DRUJ is a common site for acute and chronic injuries and is frequently imaged to evaluate chronic wrist pain, forearm dysfunction, and traumatic forearm injury. Given the complex anatomy of the wrist, the radiologist plays a vital role in the diagnosis of wrist pain and dysfunction.

Osteoradionecrosis of the olecranon: treatment by radial forearm flap

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thornton, J.W.; Stevenson, T.R.; VanderKolk, C.A.

1987-12-01

Osteoradionecrosis of the olecranon is an unusual pathologic entity, treated best by debridement and wound closure using vascularized tissue. Local skin is often unavailable for flap design and transposition. The radial forearm flap can be isolated on a proximal vascular pedicle and transposed to cover the wound. In the case presented, healing was brisk and complete, allowing early elbow mobilization. Although the donor site is not easily concealed, no functional impairment results from flap elevation and all full-thickness wounds are confined to the involved extremity.

Skin and muscle components of forearm blood flow in directly heated resting man.

NASA Technical Reports Server (NTRS)

Detry, J.-M. R.; Brengelmann, G. L.; Rowell, L. B.; Wyss, C.

1972-01-01

Changes in forearm muscle blood flow (FMBF) during direct whole-body heating were measured in 17 normal subjects using three different methods. We conclude that FMBF is not increased by direct whole-body heating. Since renal and splanchnic blood flow fall 30% under these conditions, maximal total skin blood flow in 12 previously studied subjects can be estimated from the rise in cardiac output to be 7.6 L/min (3.0-11.1 L/min).

Intradermal administration of magnesium sulphate and magnesium chloride produces hypesthesia to mechanical but hyperalgesia to heat stimuli in humans

PubMed Central

Ushida, Takahiro; Iwatsu, Osamu; Shimo, Kazuhiro; Tetsunaga, Tomoko; Ikeuchi, Masahiko; Ikemoto, Tatsunori; Arai, Young-Chang P; Suetomi, Katsutoshi; Nishihara, Makoto

2009-01-01

Background Although magnesium ions (Mg2+) are known to display many similar features to other 2+ charged cations, they seem to have quite an important and unique role in biological settings, such as NMDA blocking effect. However, the role of Mg2+ in the neural transmission system has not been studied as sufficiently as calcium ions (Ca2+). To clarify the sensory effects of Mg2+ in peripheral nervous systems, sensory changes after intradermal injection of Mg2+ were studied in humans. Methods Magnesium sulphate, magnesium chloride and saline were injected into the skin of the anterior region of forearms in healthy volunteers and injection-induced irritating pain ("irritating pain", for short), tactile sensation, tactile pressure thresholds, pinch-pain changes and intolerable heat pain thresholds of the lesion were monitored. Results Flare formation was observed immediately after magnesium sulphate or magnesium chloride injection. We found that intradermal injections of magnesium sulphate and magnesium chloride transiently caused irritating pain, hypesthesia to noxious and innocuous mechanical stimulations, whereas secondary hyperalgesia due to mechanical stimuli was not observed. In contrast to mechanical stimuli, intolerable heat pain-evoking temperature was significantly decreased at the injection site. In addition to these results, spontaneous pain was immediately attenuated by local cooling. Conclusion Membrane-stabilizing effect and peripheral NMDA-blocking effect possibly produced magnesium-induced mechanical hypesthesia, and extracellular cation-induced sensitization of TRPV1 channels was thought to be the primary mechanism of magnesium-induced heat hyperalgesia. PMID:19715604

The effect of intravesical oxybutynin on the ice water test and on electrical perception thresholds in patients with neurogenic detrusor overactivity.

PubMed

Van Meel, Tom David; De Wachter, Stefan; Wyndaele, Jean Jacques

2010-03-01

The C-fiber-mediated bladder-cooling reflex and the determination of the current perception thresholds (CPTs) permit to investigate afferent LUT pathways. They have both been proposed to detect and differentiate neurologic bladder dysfunction. This study evaluates, prospectively, the effect of oxybutynin, an antimuscarinic with direct antispasmodic effect on smooth muscle, on repeated ice water test (IWT) and CPTs in patients with a known incomplete neurogenic bladder. Patients with a known incomplete lesion of the bladder innervation, detrusor overactivity during cystometric bladder filling and a continuous positive response to repeated IWT were included. After the initial tests, 30 mg intravesical oxybutynin (1 mg/ml) was instilled and left in the bladder for 15 min. Afterwards CPTs and IWT were re-assessed. After the drug application, the bladder-cooling reflex could not be initiated, even after three instillations, in 16/17 patients. The bladder CPT increased from 29.7 +/- 11.3 to 39.1 +/- 15.7 mA after oxybutynin (P = 0.001). No difference was found in CPT of the left forearm (P = 0.208). Intravesical oxybutynin blocks the bladder-cooling reflex and increases but does not block CPT sensation in the bladder in most patients with incomplete neurogenic lesion and detrusor overactivity. These results help explain the clinical effect of intravesical oxybutynin in neurogenic patients. They also indicate that a pharmacological local influence on C-fiber-related activity can give different clinical effects. (c) 2009 Wiley-Liss, Inc.

Variability of human brain and muscle optical pathlength in different experimental conditions

NASA Astrophysics Data System (ADS)

Ferrari, Marco; Wei, Qingnong; De Blasi, Roberto A.; Quaresima, Valentina; Zaccanti, Giovanni

1993-09-01

Pathlength can be evaluated by measuring the time taken from a picosecond (psec) near infrared (IR) laser pulse to cross tissue. Differential pathlength factor (DPF) is calculated by dividing the mean pathlength by the inter-fiber distance. Data on DPF variability on humans are scarce. We investigated the forehead and forearm DPF in resting conditions and dynamically during brain hypoxic hypoxia, muscle ischemia and voluntary isometric exercise. At 3 cm inter optode spacing DPF at 800 nm was 4.3 +/- 0.2 (n equals 14, mean +/- SD) on the forearm, and 6.5 +/- 0.5 (n equals 8) on the forehead. Brain, muscle, and breast DPF values were almost constant over the inter optode spacing 2.5 - 4 cm. DPF was roughly constant in the central region of forehead. DPF drastically decreased under the fronto- temporal junction for the presence of muscle in the optical field. DPF decreased 5 - 10% during forearm ischemia with and without maximal voluntary contraction and during brain hypoxic hypoxia.

Development of a Wearable Controller for Gesture-Recognition-Based Applications Using Polyvinylidene Fluoride.

PubMed

Van Volkinburg, Kyle; Washington, Gregory

2017-08-01

This paper reports on a wearable gesture-based controller fabricated using the sensing capabilities of the flexible thin-film piezoelectric polymer polyvinylidene fluoride (PVDF) which is shown to repeatedly and accurately discern, in real time, between right and left hand gestures. The PVDF is affixed to a compression sleeve worn on the forearm to create a wearable device that is flexible, adaptable, and highly shape conforming. Forearm muscle movements, which drive hand motions, are detected by the PVDF which outputs its voltage signal to a developed microcontroller-based board and processed by an artificial neural network that was trained to recognize the generated voltage profile of right and left hand gestures. The PVDF has been spatially shaded (etched) in such a way as to increase sensitivity to expected deformations caused by the specific muscles employed in making the targeted right and left gestures. The device proves to be exceptionally accurate both when positioned as intended and when rotated and translated on the forearm.

Comparison of anatomical, functional and regression methods for estimating the rotation axes of the forearm.

PubMed

Fraysse, François; Thewlis, Dominic

2014-11-07

Numerous methods exist to estimate the pose of the axes of rotation of the forearm. These include anatomical definitions, such as the conventions proposed by the ISB, and functional methods based on instantaneous helical axes, which are commonly accepted as the modelling gold standard for non-invasive, in-vivo studies. We investigated the validity of a third method, based on regression equations, to estimate the rotation axes of the forearm. We also assessed the accuracy of both ISB methods. Axes obtained from a functional method were considered as the reference. Results indicate a large inter-subject variability in the axes positions, in accordance with previous studies. Both ISB methods gave the same level of accuracy in axes position estimations. Regression equations seem to improve estimation of the flexion-extension axis but not the pronation-supination axis. Overall, given the large inter-subject variability, the use of regression equations cannot be recommended. Copyright © 2014 Elsevier Ltd. All rights reserved.

NIR time domain diffuse optical tomography experiments on human forearm

NASA Astrophysics Data System (ADS)

Zhao, Huijuan; Gao, Feng; Tanikawa, Yukari; Homma, Kazuhiro; Yamada, Yukio

2003-07-01

To date, the applications of near infrared (NIR) diffusion optical tomography (DOT) are mostly focused on the potential of imaging woman breast, human head hemodynamics and neonatal head. For the neonates, who are suffered from ischaemia or hemorrhages in brain, bedside monitoring of the cerebral perfusion situation, e.g., the blood oxygen saturation and blood volume, is necessary for avoiding permanent injure. NIR DOT is on the promising tools because it is noninvasive, smaller in size, and moveable. Prior to achieving the ultimate goal of imaging infant brain and woman breast using DOT, in this paper, the developed methodologies are justified by imaging in vivo human forearms. The absolute absorption- and scattering-coefficient images revealed the inner structure of the forearm and the bones were clearly distinguished from the muscle. The differential images showed the changes in oxy-hemoglobin, deoxy-hemoglobin and blood volume during the hand-gripping exercises, which are consistent with the physiological process reported on literatures.

Mechanical design of EFW Exo II: A hybrid exoskeleton for elbow-forearm-wrist rehabilitation.

PubMed

Bian, Hui; Chen, Ziye; Wang, Hao; Zhao, Tieshi

2017-07-01

The use of rehabilitation exoskeleton has become an important means for the treatment of stroke patients. A hybrid exoskeleton named EFW Exo II is developed for the motor function rehabilitation of elbow, forearm and wrist. The EFW Exo II is based on a parallel 2-URR/RRS mechanism and a serial R mechanism. It could fit both left and right arms for the symmetrical and open structure, and the distance between the elbow and wrist could automatically adjust for different forearm length. Details of the mechanical design are introduced. Brushless DC servo motors with planetary gear reducer are used as the actuators of the exoskeleton. Gear drive and belt drive are used for power transmission. A three dimensional force sensor is mounted in the handle to regulate the interaction between the exoskeleton and patient. The EFW Exo II can realize rehabilitation exercise for each joint and the ranges of motion meet the rehabilitation demands of daily living.

Measurement of SAR-induced temperature increase in a phantom and in vivo with comparison to numerical simulation

PubMed Central

Oh, Sukhoon; Ryu, Yeun-Chul; Carluccio, Giuseppe; Sica, Christopher T.; Collins, Christopher M.

2013-01-01

Purpose Compare numerically-simulated and experimentally-measured temperature increase due to Specific energy Absorption Rate (SAR) from radiofrequency fields. Methods Temperature increase induced in both a phantom and in the human forearm when driving an adjacent circular surface coil was mapped using the proton resonance frequency shift technique of Magnetic Resonance (MR) thermography. The phantom and forearm were also modeled from MR image data, and both SAR and temperature change as induced by the same coil were simulated numerically. Results The simulated and measured temperature increase distributions were generally in good agreement for the phantom. The relative distributions for the human forearm were very similar, with the simulations giving maximum temperature increase about 25% higher than measured. Conclusion Although a number of parameters and uncertainties are involved, it should be possible to use numerical simulations to produce reasonably accurate and conservative estimates of temperature distribution to ensure safety in MR imaging. PMID:23804188

The emerging trend of non-operative treatment in paediatric type I open forearm fractures.

PubMed

Zhang, H; Fanelli, M; Adams, C; Graham, J; Seeley, M

2017-08-01

Open fractures are considered an orthopaedic emergency and are generally an indication for operative debridement. Recent studies have questioned this approach for the management of Gustilo-Anderson Type I open fractures in the paediatric population. This meta-analysis studies the non-operative management of Type I open paediatric forearm fractures. An Ovid MEDLINE and PubMed database literature search was performed for studies that involved a quantified number of Gustilo-Anderson Type I open forearm fractures in the paediatric population, which were treated without operative intervention. A fixed-effect meta-analysis, weighting each study based on the number of patients, and a pooled estimate of infection risk (with 95% confidence interval (CI)) was performed. The search results yielded five studies that were eligible for inclusion. No included patients had operative debridement and all were treated with antibiotics. The number of patients in each study ranged from 3 to 45, with a total of 127 paediatric patients in the meta-analysis. The infection rate was 0% for all patients included. The meta-analysis estimated a pooled infection risk of 0% (95% CI 0 to 2.9). The five included studies had a total of 127 patients with no cases of infection after non-operative management of Type I open paediatric forearm fractures. The infection rate of Type I fractures among operatively managed patients is 1.9%. The trend in literature towards non-operative treatment of paediatric Type I open fractures holds true in this meta-analysis.

Role of nitric oxide in adenosine-induced vasodilation in humans

NASA Technical Reports Server (NTRS)

Costa, F.; Biaggioni, I.; Robertson, D. (Principal Investigator)

1998-01-01

Vasodilation is one of the most prominent effects of adenosine and one of the first to be recognized, but its mechanism of action is not completely understood. In particular, there is conflicting information about the potential contribution of endothelial factors. The purpose of this study was to explore the role of nitric oxide in the vasodilatory effect of adenosine. Forearm blood flow responses to intrabrachial adenosine infusion (125 microg/min) were assessed with venous occlusion plethysmography during intrabrachial infusion of saline or the nitric oxide synthase inhibitor NG-monomethyl-L-arginine (L-NMMA) (12.5 mg/min). Intrabrachial infusions of acetylcholine (50 microg/min) and nitroprusside (3 microg/min) were used as a positive and negative control, respectively. These doses were chosen to produce comparable levels of vasodilation. In a separate study, a second saline infusion was administered instead of L-NMMA to rule out time-related effects. As expected, pretreatment with L-NMMA reduced acetylcholine-induced vasodilation; 50 microg/min acetylcholine increased forearm blood flow by 150+/-43% and 51+/-12% during saline and L-NMMA infusion, respectively (P<.01, n=6). In contrast, L-NMMA did not affect the increase in forearm blood flow produced by 3 microg/min nitroprusside (165+/-30% and 248+/-41% during saline and L-NMMA, respectively) or adenosine (173+/-48% and 270+/-75% during saline and L-NMMA, respectively). On the basis of our observations, we conclude that adenosine-induced vasodilation is not mediated by nitric oxide in the human forearm.

Combined Endovascular Treatment with Distal Radial Artery Coil Embolization and Angioplasty in Steal Syndrome Associated with Forearm Dialysis Fistula

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tercan, Fahri, E-mail: ftercan@yahoo.com; Koçyiğit, Ali, E-mail: alkoc@yahoo.com; Güney, Bünyamin

PurposeThe present study was performed to define the results of the endovascular treatment with angioplasty and distal radial artery embolization in ischemic steal syndrome associated with forearm arteriovenous accesses.MethodThe cases referred to our interventional radiology unit with symptoms and physical examination findings suggestive of ischemic steal syndrome were retrospectively evaluated first by Doppler ultrasonography, and then by angiography. Cases with proximal artery stenosis were applied angioplasty, and those with steal syndrome underwent coil embolization to distal radial artery.ResultsOf 589 patients who underwent endovascular intervention for dialysis arteriovenous fistulae (AVF)-associated problems, 6 (1.01 %) (5 female, 1 males; mean age 62 (rangemore » 41–78) with forearm fistula underwent combined endovascular treatment for steal syndrome. In addition to steal phenomenon, there were stenosis and/or occlusion in proximal radial and/or ulnar artery in 6 patients concurrently. Embolization of distal radial artery and angioplasty to proximal arterial stenoses were performed in all patients. Ischemic symptoms were eliminated in all patients and the AVF were in use at the time of study. In one patient, ischemic symptoms recurring 6 months later were alleviated by repeat angioplasty of ulnar artery.ConclusionIn palmar arch steal syndrome affecting forearm fistulae, combined distal radial embolization and angioplasty is also an effective treatment method in the presence of proximal radial and ulnar arterial stenoses and occlusions.« less

Forearm Skin Blood Flow After Kinesiology Taping in Healthy Soccer Players: An Exploratory Investigation

PubMed Central

Woodward, Kirsty A.; Unnithan, Vish; Hopkins, Nicola D.

2015-01-01

Context Kinesiology tape (KT) has become popular among athletes for both injury prevention and rehabilitation due to its reported therapeutic effects, including facilitation of lymphatic flow and enhanced peripheral blood flow. However, evidence to support such claims is insufficient. Objective To determine whether KT improves skin blood flow (SkBF) responses in young, elite soccer players. Design Randomized crossover study. Setting Research laboratory. Patients or Other Participants Thirteen healthy, elite, adolescent male soccer players (age = 14.7 ± 0.6 years). Intervention(s) Participants completed 2 experimental trials; during trial 1, the volar aspect of the dominant forearm was taped. Forearm SkBF was measured within the taped area and 3 cm lateral to the taped area. During trial 2, no tape was applied to either site. Both trials were performed within 7 days. Main Outcome Measure(s) Baseline and maximal thermally (42°C) stimulated SkBF responses were assessed using laser Doppler flowmetry. Continuously measured SkBF and derived mean arterial pressure obtained at 5-minute intervals were used to calculate cutaneous vascular conductance (CVC), the primary outcome measure. Results No differences were observed for baseline SkBF or CVC between trials or measurement sites. After local heating, no differences were evident for SkBF or CVC between trials or measurement sites. Conclusions Our findings suggest that, in healthy, trained adolescent males, KT was not associated with increased forearm SkBF. PMID:26445024

Impairment of Lymph Drainage in Subfascial Compartment of Forearm in Breast Cancer-Related Lymphedema

PubMed Central

MELLOR, R.H.; COOK, G.J.; SVENSSON, W.E.; PETERS, A.M.; LEVICK, J.R.; MORTIMER, P.S.

2005-01-01

Background: In arm lymphedema secondary to axillary surgery and radiotherapy (breast cancer-related lymphedema), the swelling is largely epifascial and lymph flow per unit epifascial volume is impaired. The subfascial muscle compartment is not measurably swollen despite the iatrogenic damage to its axillary drainage pathway, but this could be due to its low compliance. Our aim was to test the hypothesis that subfascial lymph drainage too is impaired. Methods and Results: Quantitative lymphoscintigraphy was used to measure the removal rate constant (local lymph flow per unit distribution volume) for technetium-99m-human immunoglobulin G injected intramuscularly in the forearms of nine women with unilateral lymphedema. The removal rate constant was on average 31% lower in the ipsilateral swollen forearm than in the contralateral forearm (swollen arm: −0.096 ± 0.041% min−1, contralateralarm: −0.138 ± 0.037% min−1; mean ± SD, p = 0.037). The decrease in subfascial rate constant correlated strongly with increase in arm volume (r 0.88, p = 0.002), even though the swelling is mainly epifascial. There was no convincing evidence of dermal backflow. Conclusions: Lymph flow in the subfascial muscle compartment is decreased in breast cancer-related lymphedema. The correlation between impairment of subfascial drainage and epifascial arm swelling could be because both depend on the severity of axillary damage, or because loss of function in subfascial lymphatics impairs drainage from the epifascial to the subfascial system. PMID:15624420

Distortion of calculated whole-body hematocrit during lower-body immersion in water.

PubMed

Knight, D R; Santoro, T; Bondi, K R

1986-11-01

We found a difference between the venous hematocrits of immersed and nonimmersed arms during immersion of the lower body in cold water but not during a comparable exposure to warm water. Fourteen healthy men were exposed to three different experimental conditions: arm immersion, body immersion, and control. The men always sat upright while both upper extremities hung vertically at their sides. During arm immersion, one forearm was completely immersed for 30 min in either cold water (28 degrees C, n = 7) or warm water (38 degrees C, n = 7). This cold-warm water protocol was repeated on separate days for exposure to the remaining conditions of body immersion (immersion of 1 forearm and all tissues below the xiphoid process) and control (no immersion). Blood samples were simultaneously drawn from cannulated veins in both antecubital fossae. Hematocrit difference (Hct diff) was measured by subtracting the nonimmersed forearm's hematocrit (Hct dry) from the immersed forearm's hematocrit (Hct wet). Hct diff was approximately zero when the men were exposed to the control condition and body immersion in warm water. In the remaining conditions, Hct wet dropped below Hct dry (P less than 0.01, 3-way analysis of variance). The decrements of Hct diff showed there were differences between venous hematocrits in immersed and nonimmersed regions of the body, indicating that changes of the whole-body hematocrit cannot be calculated from a large-vessel hematocrit soon after immersing the lower body in cold water.

Bilateral Forearm Transplantation in Mexico: 2-Year Outcomes.

PubMed

Iglesias, Martin; Butron, Patricia; Moran-Romero, Mario; Cruz-Reyes, Angel; Alberu-Gomez, Josefina; Leal-Villalpando, Paulino; Bautista-Zamudio, Jorge; Ramirez-Berumen, Maria; Lara-Hinojosa, Euridice; Espinosa-Cruz, Veronica; Gaytan-Cervantes, Rocio; Bravo-Ruiz, Leonardo; Rodriguez-Rojas, Elizabeth; Ramos-Peek, Jaime; Garcia-Alvarez, Miriam; Vega-Boada, Felipe; Sierra-Madero, Juan; Gamboa-Dominguez, Armando; Gonzalez-Sanchez, Judith; Contreras-Barbosa, Sarai; Navarro-Lara, Africa; Vazquez-Lamadrid, Jorge; Guzman-Gonzalez, Juan

2016-01-01

Patients with proximal forearm and arm transplantation have obtained and/or maintained function of the elbow joint and full active range of motion of the extrinsic muscles of the hand, but with diminished protective sensibility and a lack of good function of the intrinsic muscles. These patients have improved function, as measured by the Disabilities of the Arm, Shoulder and Hand questionnaire. We report the case of a 52-year-old man who suffered a high-voltage electrical burn requiring amputation of his upper limbs. He underwent bilateral proximal forearm transplantation in Mexico City in May 2012. At 2-year follow-up, immunosuppressive treatment has not led to metabolic, oncologic, or infectious complications. Keloid scars developed at the graft-recipient interface. There have been 4 acute rejections: the fourth was treated with methylprednisolone, rituximab, and immunoglobulin. Chronic rejection has not been detected. The extrinsic muscles of the wrist and digits have good function. Although the intrinsic muscles demonstrated electrical activity 15 months postoperatively, clinically, they are nonuseful. After 2 years, hand function is sufficient to allow the patient to grasp lightweight and medium-sized objects. The patient's Disabilities of the Arm, Shoulder and Hand questionnaire score improved from 50.00 points to 30.83 points, and his Hand Transplantation Score System rating is good, at 69/73 (right/left) of 100. The patient and his family are very satisfied with the functional and aesthetic outcomes. Upper arm or proximal forearm transplantation is a reconstructive option for patients who have experienced amputation because of trauma.

Forearm ischemia decreases endothelial colony-forming cell angiogenic potential.

PubMed

Mauge, Laetitia; Sabatier, Florence; Boutouyrie, Pierre; D'Audigier, Clément; Peyrard, Séverine; Bozec, Erwan; Blanchard, Anne; Azizi, Michel; Dizier, Blandine; Dignat-George, Françoise; Gaussem, Pascale; Smadja, David M

2014-02-01

Circulating endothelial progenitor cells and especially endothelial colony-forming cells (ECFCs) are promising candidate cells for endothelial regenerative medicine of ischemic diseases, but the conditions for an optimal collection from adult blood must be improved. On the basis of a recently reported vascular niche of ECFCs, we hypothesized that a local ischemia could trigger ECFC mobilization from the vascular wall into peripheral blood to optimize their collection for autologous implantation in critical leg ischemia. Because the target population with critical leg ischemia is composed of elderly patients in whom a vascular impairment has been documented, we also analyzed the impact of aging on ECFC mobilization and vascular integrity. After having defined optimized ECFC culture conditions, we studied the effect of forearm ischemia on ECFC numbers and functions in 26 healthy volunteers (13 volunteers ages 20-30-years old versus 13 volunteers ages 60-70 years old). The results show that forearm ischemia induced an efficient local ischemia and a normal endothelial response but did not mobilize ECFCs regardless of the age group. Moreover, we report an alteration of angiogenic properties of ECFCs obtained after forearm ischemia, in vitro as well as in vivo in a hindlimb ischemia murine model. This impaired ECFC angiogenic potential was not associated with a quantitative modification of the circulating endothelial compartment. The procedure of local ischemia, although reulting in a preserved endothelial reactivity, did not mobilize ECFCs but altered their angiogenic potential. Copyright © 2014 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

Cortical Porosity Identifies Women with Osteopenia at Increased Risk for Forearm Fractures

PubMed Central

Bala, Yohann; Zebaze, Roger; Ghasem-Zadeh, Ali; Atkinson, Elizabeth J.; Iuliano, Sandra; Peterson, James M.; Amin, Shreyasee; Bjørnerem, Åshild; Melton, L. Joseph; Johansson, Helena; Kanis, John A.; Khosla, Sundeep; Seeman, Ego

2014-01-01

Background Most fragility fractures arise among the many women with osteopenia, not the smaller number with osteoporosis at high risk for fracture. Thus, most women at risk for fracture assessed only by measuring areal bone mineral density (aBMD) will remain untreated. Methods We measured cortical porosity and trabecular bone volume/total volume (BV/TV) of the ultradistal radius (UDR) using high-resolution peripheral quantitative computed tomography, aBMD using densitometry, and 10-year fracture probability using the country-specific FRAX tool in 68 postmenopausal women with forearm fractures and 70 age-matched community controls in Olmsted County, Minnesota. Results Women with forearm fractures had 0.4 standard deviations (SD) higher cortical porosity and 0.6 SD lower trabecular BV/TV. Compact-appearing cortical porosity predicted fracture independent of aBMD; odds ratio [OR] 1.92 (95%CI, 1.10–3.33). In women with osteoporosis at the UDR, cortical porosity did not distinguish those with, from those without, fractures because high porosity was present in 92% and 86% of each group respectively. By contrast, in women with osteopenia at the UDR, high porosity of the compact-appearing cortex conferred an OR for fracture of 4.00 (95%CI, 1.15–13.90). Conclusion In women with osteoporosis, porosity is captured by aBMD and so measuring UDR cortical porosity does not improve diagnostic sensitivity. However, in women with osteopenia, cortical porosity was associated with forearm fractures. PMID:24519558

Two-stage distraction lengthening of the forearm.

PubMed

Taghinia, Amir H; Al-Sheikh, Ayman A; Panossian, Andre E; Upton, Joseph

2013-01-01

Single-stage lengthening of the forearm using callus distraction is well described; however, forearm lengthening using a 2-stage technique of distraction followed by bone grafting has received less attention. A 2-staged technique can be a better alternative in cases where the surgeon desires extensive lengthening. A retrospective review was undertaken of eleven 2-stage forearm lengthening procedures performed by 1 surgeon over a 15-year period. Indications were radial longitudinal deficiency (8 patients), neonatal ischemic contractures (2 patients), and septic growth arrest (1 patient). Average follow-up was 2.8 years. Distraction was performed on patients an average of 82 mm over an average duration of 24 weeks. Average time to union from the time of distractor removal and grafting was 87 days. Average healing index was 32.1 d/cm. Distraction problems were common and related to the length of time that the distractor was in place; they included pain, pin-related infections, and multiple mechanical device difficulties. Three patients had nonunion, and another had delayed union; however, additional procedures resulted in ultimate bony union in all patients. Demineralized bone matrix and autologous corticocancellous bone grafts yielded predictable healing and good functional results in short-distance distractions. For longer distractions, free vascularized fibula transfer produced the best outcomes. Intercalary cortical allografts did not heal well. Patients with neonatal Volkmann contractures had the most difficulty with distraction and healing, ultimately obtaining little to no lengthening and poor functional outcomes.

Effects of hyperoxia on thermoregulatory responses during feet immersion to hot water in humans.

PubMed

Yamashita, Kazuaki; Tochihara, Yutaka

2003-07-01

This study examined effects of hyperoxia on thermoregulatory responses. Eight healthy male students (23.5+/-1.8 yrs) were involved in this study. They immersed their legs in a hot water bath (42 degrees C) for 60 minutes in a climate chamber. The conditions of oxygen concentration of a chamber were set at 21% (control), 25% (25%O(2)), and 30% (30%O(2)). Ambient temperature and relative humidity was maintained at 25 degrees C and 50% in every condition, respectively. Measurements included rectal temperature (Tre), skin temperature at 7 sites, laser Doppler flowmeter (LDF) on the back and forearm as an index of skin blood flow, heart rate, local sweat rate (Msw) on the back and forearm, and total body weight loss (BWL). Increases of Tre at 25%O(2) and 30%O(2) tended to be lower during the immersion than in the control. Mean skin temperature (Tsk) of the control increased gradually after the onset of sweating, while the Tsks at 25%O(2) and 30%O(2) maintained a constant level during sweating. LDFs on the forearm at 25%O(2) and 30%O(2) showed lower increases compared with the control. No significant differences in Msw on the back and the forearm and BWL were seen among the conditions. These results suggested that hyperoxia could not affect sweating responses but elicit an inhibitory effect on thermoregulatory skin blood flow.

Long-term outcome of forearm flee-flap phalloplasty in the treatment of transsexualism.

PubMed

Leriche, Albert; Timsit, Marc-Olivier; Morel-Journel, Nicolas; Bouillot, André; Dembele, Diala; Ruffion, Alain

2008-05-01

To assess the long-term outcome of forearm free-flap phalloplasty in transsexuals, as obtaining a satisfying neophallus in female-to-male transsexuals is a surgical challenge. We analysed retrospectively 56 transsexuals who had a phalloplasty using a radial forearm free-flap in our department from 1986 to 2002. The complication rate was assessed by regular examination. Patient satisfaction was evaluated by a questionnaire about cosmetic aspects, sexual life and overall satisfaction. The mean follow up was 110 months; 53 of the 56 patients (95%) currently have a neophallus, after a mean of six surgical procedures. Satisfaction was assessed in 53 patients using a specific questionnaire: 51 (93%) of the patients reported that the phalloplasty allowed them to accord their physical appearance with their feeling of masculinity. There were flap complications in 14 patients (25%); three (5%) flaps were lost, with one each due to early haematoma, cellulitis and late arterial thrombosis. The other 11 flap complications were all transitory, e.g. infection, haematomas and vascular thrombosis. There were prosthesis complications in 11 of 38 patients (29%). Moreover, seven of 19 patients (37%) who had a urethroplasty presented with complex strictures and fistulae that led to perineal urethrostomy. Our study shows that phalloplasty with a forearm free-flap leads to good results in term of flap survival and patient satisfaction. However, there was a high rate of complications. Patients must be clearly informed that the procedure can seldom be achieved in one stage.

Intensive insulin treatment improves forearm blood flow in critically ill patients: a randomized parallel design clinical trial.

PubMed

Žuran, Ivan; Poredos, Pavel; Skale, Rafael; Voga, Gorazd; Gabrscek, Lucija; Pareznik, Roman

2009-01-01

Intensive insulin treatment of critically ill patients was seen as a promising method of treatment, though recent studies showed that reducing the blood glucose level below 6 mmol/l had a detrimental outcome. The mechanisms of the effects of insulin in the critically ill are not completely understood. The purpose of the study was to test the hypothesis that intensive insulin treatment may influence forearm blood flow independently of global hemodynamic indicators. The study encompassed 29 patients of both sexes who were admitted to the intensive care unit due to sepsis and required artificial ventilation as the result of acute respiratory failure. 14 patients were randomly selected for intensive insulin treatment (Group 1; blood glucose concentration 4.4-6.1 mmol/l), and 15 were selected for conventional insulin treatment (Group 2; blood glucose level 7.0 mmol/l-11.0 mmol/l). At the start of the study (t0, beginning up to 48 hours after admittance and the commencement of artificial ventilation), at 2 hours (t1), 24 hours (t2), and 72 hours (t3) flow in the forearm was measured for 60 minutes using the strain-gauge plethysmography method. Student's t-test of independent samples was used for comparisons between the two groups, and Mann-Whitney's U-test where appropriate. Linear regression analysis and the Pearson correlation coefficient were used to determine the levels of correlation. The difference in 60-minute forearm flow at the start of the study (t0) was not statistically significant between groups, while at t2 and t3 significantly higher values were recorded in Group 1 (t2; Group 1: 420.6 +/- 188.8 ml/100 ml tissue; Group 2: 266.1 +/- 122.2 ml/100 ml tissue (95% CI 30.9-278.0, P = 0.02); t3; Group 1: 369.9 +/- 150.3 ml/100 ml tissue; Group 2: 272.6 +/- 85.7 ml/100 ml tissue (95% CI 5.4-190.0, P = 0.04). At t1 a trend towards significantly higher values in Group 1 was noted (P = 0.05). The level of forearm flow was related to the amount of insulin infusion (r = 0.40). Compared to standard treatment, intensive insulin treatment of critically ill patients increases forearm flow. Flow increase was weakly related to the insulin dose, though not to blood glucose concentration. ISRCTN39026810.

Intensive insulin treatment improves forearm blood flow in critically ill patients: a randomized parallel design clinical trial

PubMed Central

2009-01-01

Introduction Intensive insulin treatment of critically ill patients was seen as a promising method of treatment, though recent studies showed that reducing the blood glucose level below 6 mmol/l had a detrimental outcome. The mechanisms of the effects of insulin in the critically ill are not completely understood. The purpose of the study was to test the hypothesis that intensive insulin treatment may influence forearm blood flow independently of global hemodynamic indicators. Methods The study encompassed 29 patients of both sexes who were admitted to the intensive care unit due to sepsis and required artificial ventilation as the result of acute respiratory failure. 14 patients were randomly selected for intensive insulin treatment (Group 1; blood glucose concentration 4.4-6.1 mmol/l), and 15 were selected for conventional insulin treatment (Group 2; blood glucose level 7.0 mmol/l-11.0 mmol/l). At the start of the study (t0, beginning up to 48 hours after admittance and the commencement of artificial ventilation), at 2 hours (t1), 24 hours (t2), and 72 hours (t3) flow in the forearm was measured for 60 minutes using the strain-gauge plethysmography method. Student's t-test of independent samples was used for comparisons between the two groups, and Mann-Whitney's U-test where appropriate. Linear regression analysis and the Pearson correlation coefficient were used to determine the levels of correlation. Results The difference in 60-minute forearm flow at the start of the study (t0) was not statistically significant between groups, while at t2 and t3 significantly higher values were recorded in Group 1 (t2; Group 1: 420.6 ± 188.8 ml/100 ml tissue; Group 2: 266.1 ± 122.2 ml/100 ml tissue (95% CI 30.9-278.0, P = 0.02); t3; Group 1: 369.9 ± 150.3 ml/100 ml tissue; Group 2: 272.6 ± 85.7 ml/100 ml tissue (95% CI 5.4-190.0, P = 0.04). At t1 a trend towards significantly higher values in Group 1 was noted (P = 0.05). The level of forearm flow was related to the amount of insulin infusion (r = 0.40). Conclusions Compared to standard treatment, intensive insulin treatment of critically ill patients increases forearm flow. Flow increase was weakly related to the insulin dose, though not to blood glucose concentration. Trial Registration Trial number: ISRCTN39026810. PMID:20003200

Single, double or multiple-injection techniques for non-ultrasound guided axillary brachial plexus block in adults undergoing surgery of the lower arm.

PubMed

Chin, Ki Jinn; Alakkad, Husni; Cubillos, Javier E

2013-08-08

Regional anaesthesia comprising axillary block of the brachial plexus is a common anaesthetic technique for distal upper limb surgery. This is an update of a review first published in 2006 and updated in 2011. To compare the relative effects (benefits and harms) of three injection techniques (single, double and multiple) of axillary block of the brachial plexus for distal upper extremity surgery. We considered these effects primarily in terms of anaesthetic effectiveness; the complication rate (neurological and vascular); and pain and discomfort caused by performance of the block. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE and reference lists of trials. We contacted trial authors. The date of the last search was March 2013 (updated from March 2011). We included randomized controlled trials that compared double with single-injection techniques, multiple with single-injection techniques, or multiple with double-injection techniques for axillary block in adults undergoing surgery of the distal upper limb. We excluded trials using ultrasound-guided techniques. Independent study selection, risk of bias assessment and data extraction were performed by at least two investigators. We undertook meta-analysis. The 21 included trials involved a total of 2148 participants who received regional anaesthesia for hand, wrist, forearm or elbow surgery. Risk of bias assessment indicated that trial design and conduct were generally adequate; the most common areas of weakness were in blinding and allocation concealment.Eight trials comparing double versus single injections showed a statistically significant decrease in primary anaesthesia failure (risk ratio (RR 0.51), 95% confidence interval (CI) 0.30 to 0.85). Subgroup analysis by method of nerve location showed that the effect size was greater when neurostimulation was used rather than the transarterial technique.Eight trials comparing multiple with single injections showed a statistically significant decrease in primary anaesthesia failure (RR 0.25, 95% CI 0.14 to 0.44) and of incomplete motor block (RR 0.61, 95% CI 0.39 to 0.96) in the multiple injection group.Eleven trials comparing multiple with double injections showed a statistically significant decrease in primary anaesthesia failure (RR 0.28, 95% CI 0.20 to 0.40) and of incomplete motor block (RR 0.55, 95% CI 0.36 to 0.85) in the multiple injection group.Tourniquet pain was significantly reduced with multiple injections compared with double injections (RR 0.53, 95% CI 0.33 to 0.84). Otherwise there were no statistically significant differences between groups in any of the three comparisons on secondary analgesia failure, complications and patient discomfort. The time for block performance was significantly shorter for single and double injections compared with multiple injections. This review provides evidence that multiple-injection techniques using nerve stimulation for axillary plexus block produce more effective anaesthesia than either double or single-injection techniques. However, there was insufficient evidence for a significant difference in other outcomes, including safety.

Low-Fatigue Hand Controller For Remote Manipulator

NASA Technical Reports Server (NTRS)

Maclaren, Brice; Mcmurray, Gary; Lipkin, Harvey

1993-01-01

Universal master controller used in brace mode, in which user's forearm rests atop upper (forearm) module. Alternatively, user manipulates hand controller in side mode, which gives greater latitude for motion but requires more muscular effort. Controller provides six degrees of freedom and reflects, back to user, scaled versions of forces experienced by manipulator. Manipulator designed to condense work space into user's natural work volume. Operated by both right-handed and left-handed users. Does not interfere with user's natural movements or obstruct line of sight. Controller compact and portable.

Extradigital glomic tumor of the forearm. About a case and review of literature.

PubMed

Lancien, U; Duteille, F; Perrot, P

2018-04-01

We report the clinical case of a 72-year-old man followed for 10years by a specialized pain center, for neuropathic pain poorly systematized, triggered by the contact of the anteromedial face of the right forearm. After surgical excision, histological analysis indicated a well-circumscribed nodule in the subcutaneous region, confirming that the mass was a glomus tumor. In this clinical case, surgical excision allowed an immediate disappearance of the pains without recurrence to this day. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Architectural properties of the neuromuscular compartments in selected forearm skeletal muscles

PubMed Central

Liu, An-Tang; Liu, Ben-Li; Lu, Li-Xuan; Chen, Gang; Yu, Da-Zhi; Zhu, Lie; Guo, Rong; Dang, Rui-Shan; Jiang, Hua

2014-01-01

The purposes f this study were to (i) explore the possibility of splitting the selected forearm muscles into separate compartments in human subjects; (ii) quantify the architectural properties of each neuromuscular compartment; and (iii) discuss the implication of these properties in split tendon transfer procedures. Twenty upper limbs from 10 fresh human cadavers were used in this study. Ten limbs of five cadavers were used for intramuscular nerve study by modified Sihler's staining technique, which confirmed the neuromuscular compartments. The other 10 limbs were included for architectural analysis of neuromuscular compartments. The architectural features of the compartments including muscle weight, muscle length, fiber length, pennation angle, and sarcomere length were determined. Physiological cross-sectional area and fiber length/muscle length ratio were calculated. Five of the selected forearm muscles were ideal candidates for splitting, including flexor carpi ulnaris, flexor carpi radials, extensor carpi radialis brevis, extensor carpi ulnaris and pronator teres. The humeral head of pronator teres contained the longest fiber length (6.23 ± 0.31 cm), and the radial compartment of extensor carpi ulnaris contained the shortest (2.90 ± 0.28 cm). The ulnar compartment of flexor carpi ulnaris had the largest physiological cross-sectional area (5.17 ± 0.59 cm2), and the ulnar head of pronator teres had the smallest (0.67 ± 0.06 cm2). Fiber length/muscle length ratios of the neuromuscular compartments were relatively low (average 0.27 ± 0.09, range 0.18–0.39) except for the ulnar head of pronator teres, which had the highest one (0.72 ± 0.05). Using modified Sihler's technique, this research demonstrated that each compartment of these selected forearm muscles has its own neurovascular supply after being split along its central tendon. Data of the architectural properties of each neuromuscular compartment provide insight into the ‘design’ of their functional capability. In addition to improving our understanding of muscle anatomy and function, elucidation of forearm neuromuscular compartments architecture may ultimately provide information useful for selection of muscle subdivisions used in tendon transfer. PMID:24836406

The relationship of maternal bone density with nutritional rickets in Nigerian children.

PubMed

Hsu, Jennifer; Fischer, Philip R; Pettifor, John M; Thacher, Tom D

2017-04-01

Factors that affect maternal bone mineral density may be related to the risk of nutritional rickets in their offspring. Our aim was to determine the relationship between maternal areal bone mineral density (aBMD) and rickets in Nigerian children. Using a case-control design, we measured forearm aBMD in 56 and 135 mothers of children with and without nutritional rickets, respectively. Active rickets was confirmed or excluded in all children radiographically. Using logistic regression, we assessed the association of maternal aBMD, adjusted for parity, pregnancy and lactation status, duration of most recent completed lactation, age of menarche, height, body mass index, and maternal age with nutritional rickets. The median (range) age of all mothers was 30years (17-47years), and parity was 4 (1-12). A total of 36 (19%) were pregnant and 55 (29%) were currently breast feeding. Mean (±SD) metaphyseal forearm aBMDs were 0.321±0.057 and 0.316±0.053g/cm 2 in mothers of children with and without rickets, respectively (P=0.60). Diaphyseal forearm aBMDs were 0.719±0.071 and 0.715±0.072g/cm 2 , respectively (P=0.69). In an adjusted analysis, maternal forearm aBMD, bone mineral content and bone area at metaphyseal and diaphyseal sites were not associated with rickets in the child. In the adjusted analysis, rickets was associated with shorter duration of most recently completed lactation (aOR 0.91 for each additional month; 95% CI 0.83-0.99), older maternal age (aOR 1.07 for each additional year; 1.00-1.14), and less frequent maternal use of lead-containing eye cosmetics (aOR 0.20; 95% CI 0.05-0.64), without any difference in maternal blood lead levels. Maternal age, parity, age of menarche, height, and body mass index were not associated with having had a child with rickets in multivariate analysis. Nutritional rickets in Nigerian children was not associated with maternal forearm aBMD. Other unidentified maternal characteristics and practices likely contribute to the risk of rickets in Nigerian children. Copyright © 2017 Elsevier Inc. All rights reserved.

The transverse force experienced by the radial head during axial loading of the forearm: A cadaveric study.

PubMed

Orbay, Jorge L; Mijares, Michael R; Berriz, Cecilia G

2016-01-01

When designing a radial head replacement, the magnitude and direction of forces applied across the proximal radio-ulnar joint (PRUJ) and the radiocapitellar joint must be included. These designs often focus on axial loads transmitted to the radial head by the capitellum; however, the radial head also bears a significant transverse force at the PRUJ. Load transmission by the central band of the interosseous ligament induces a force component in a lateral direction perpendicular to the axis of the limb, which is borne by the articular surfaces of the proximal and distal radio-ulnar joints. The objective of this study is to establish the relationship between distally applied axial forces and proximal transverse reaction forces. Five cadaveric, human forearms with intact interosseous membranes were used to measure the magnitude of transversely-directed forces experienced by the radial head during axial loading of the forearm at the lunate fossa. A Mark-10 test stand applied a gradual and continuous axial load on the articular surface of the distal radius. A Mark-10 force gauge measured the resultant transverse force experienced by the radial head in the proximal radioulnar joint. Classical mechanics and static force analysis were applied in order to predict lateral force values that would occur when the interosseous ligament is treated as the major load transmitter between the radius and ulna. Acquired data show that the radial head bears a force in the transverse direction that averages 18% (SD 3.89%) in magnitude of the axial force applied at the wrist. This figure is in close accordance with the predicted value of 22% that was calculated by way of free-body plotting. Physiologic forearm loading results in a clinically significant transverse force component transmitted through the interosseous ligament complex. The existence of transverse forces in the human forearm may explain clinical problems seen after radial head resection and suggest that radial head implants be designed to sustain substantial transverse forces. Basic science study, anatomical. Copyright © 2015 Elsevier Ltd. All rights reserved.

Diaphyseal Fractures of the Forearm in Adults, Plating Or Intramedullary Nailing Is a Better Option for the Treatment?

PubMed Central

Al-Sadek, Tabet A.; Niklev, Desislav; Al-Sadek, Ahmed

2016-01-01

BACKGROUND: Fractures of the radius and ulna occupy a large field of the modern traumatology. Therefore, these fractures are a major subject in modern orthopaedics and traumatology. The study of the mechanisms of the trauma, and the pathophysiological changes that occur are of great importance for the development of ever more efficient and varied ways of the treatment and prophylactics of this type of fracture. AIM: The aim of this paper was to study the pattern of the diaphyseal fractures of the forearm in adults, to decide the modalities of surgical management, to observe the period of fracture healing clinically and radiologically, as well to study the rehabilitation of the patients. MATERIAL AND METHODS: The present study included 45 cases of diaphyseal fractures of both bones forearm in adults presenting to the orthopaedic outpatient department. For all the patients a detailed history was taken. A thorough clinical examination was carried out, required X-rays were taken, and initial treatment was given and admitted as in all patients. After careful pre-operative planning and evaluation for anaesthetic fitness, patients were operated for the fractures of both bone forearms. Twenty-three cases with 46 fractures were treated by open reduction and rigid fixation with DCP & Semi-tubular plates and 22 cases with 44 fractures were treated by closed reduction and fixation with “Talwarkar” intramedullary square nails. RESULTS: United results were found in 100% of plating group vs. 86% in the nailing group. Delayed and non-union results were found in 9% of the nailing group only. Average time to union in weeks was 9.4 weeks in the plating group vs. 10.2 weeks in the nailing group. CONCLUSION: Open reduction and internal fixation with compression plates with strict adherence to surgical technique is the gold standard method of treatment in both bones forearm fractures with excellent results than closed reduction, internal fixation with “Talwarkar” square nails which is also again a simple method with better results than conservative methods. PMID:28028411

Wearing graduated compression stockings augments cutaneous vasodilation in heat-stressed resting humans.

PubMed

Fujii, Naoto; Nikawa, Toshiya; Tsuji, Bun; Kondo, Narihiko; Kenny, Glen P; Nishiyasu, Takeshi

2017-05-01

We investigated whether graduated compression induced by stockings enhances cutaneous vasodilation in passively heated resting humans. Nine habitually active young men were heated at rest using water-perfusable suits, resulting in a 1.0 °C increase in body core temperature. Heating was repeated twice on separate occasions while wearing either (1) stockings that cause graduated compression (pressures of 26.4 ± 5.3, 17.5 ± 4.4, and 6.1 ± 2.0 mmHg at the ankle, calf, and thigh, respectively), or (2) loose-fitting stockings without causing compression (Control). Forearm vascular conductance during heating was evaluated by forearm blood flow (venous occlusion plethysmography) divided by mean arterial pressure to estimate heat-induced cutaneous vasodilation. Body core (esophageal), skin, and mean body temperatures were measured continuously. Compared to the Control, forearm vascular conductance during heating was higher with graduated compression stockings (e.g., 23.2 ± 5.5 vs. 28.6 ± 5.8 units at 45 min into heating, P = 0.001). In line with this, graduated compression stockings resulted in a greater sensitivity (27.5 ± 8.3 vs. 34.0 ± 9.4 units °C -1 , P = 0.02) and peak level (25.5 ± 5.8 vs. 29.7 ± 5.8 units, P = 0.004) of cutaneous vasodilation as evaluated from the relationship between forearm vascular conductance with mean body temperature. In contrast, the mean body temperature threshold for increases in forearm vascular conductance did not differ between the Control and graduated compression stockings (36.5 ± 0.1 vs. 36.5 ± 0.2 °C, P = 0.85). Our results show that graduated compression associated with the use of stockings augments cutaneous vasodilation by modulating sensitivity and peak level of cutaneous vasodilation in relation to mean body temperature. However, the effect of these changes on whole-body heat loss remains unclear.

Is the quality of drinking water a risk factor for self-reported forearm fractures? Cohort of Norway.

PubMed

Dahl, C; Søgaard, A J; Tell, G S; Flaten, T P; Krogh, T; Aamodt, G

2013-02-01

Compared to pH ≥7.0 in Norwegian municipal drinking water, pH <7.0 increased the risk of forearm fractures in the population-based Cohort of Norway (CONOR; n = 127,272). The association was attenuated (p > 0.05) after adjustments for indicators of bacteria and organic matter, which may signify an association between poor drinking water and bone health. The Norwegian population has the highest rate of fractures ever reported. A large variation in fracture rate both between and within countries indicates that an environmental factor, such as the quality of drinking water, could be one of the causes of the disparities. Our aim was to investigate a possible association between pH (an important parameter for water quality) and self-reported forearm fracture and to examine whether other water quality factors could account for this association. Using Geographic Information Systems, information on the quality of drinking water was linked to CONOR (n = 127,272; mean age, 50.2 ± 15.8 years), a database comprising ten regional epidemiological health surveys from across the country in the time period 1994-2003. The highest risk of forearm fracture was found at a pH of around 6.75, with a decreasing risk toward both higher and lower pH values. The increased adjusted odds of forearm fracture in men consuming municipal drinking water with pH <7.0 compared to water with pH ≥7.0 was odds ratio (OR) = 1.19 (95 % CI, 1.14, 1.25), and the corresponding increased odds in women was OR = 1.14 (95 % CI, 1.08, 1.19). This association was attenuated (p > 0.05) after further adjustments for other water quality factors (color grade, intestinal enterococci, and Clostridium perfringens). Our findings indicate a higher risk of fracture when consuming water of an acidic pH; however, the risk does not only seem to be due to the acidity level per se, but also to other aspects of water quality associated with pH.

Peripheral tissue oximetry: comparing three commercial near-infrared spectroscopy oximeters on the forearm.

PubMed

Hyttel-Sorensen, Simon; Hessel, Trine Witzner; Greisen, Gorm

2014-04-01

Estimation of regional tissue oxygenation (rStO2) by near infrared spectroscopy enables non-invasive end-organ oxygen balance monitoring and could be a valuable tool in intensive care. However, the diverse absolute values and dynamics of different devices, and overall poor repeatability of measurements are a problem. The aim of the present study is to test the hypothesis that INVOS 5100C, FORE-SIGHT and NONIN EQUANOX 7600 have similar properties concerning absolute values, repeatability, and sensitivity to changes in rStO2. To test repeatability the sensors were repositioned 20 times during hemodynamic steady state on the adult forearm. Afterwards six vascular occlusions by inflation of an upper arm cuff were done to achieve low oxygenation in the forearm. Absolute values were compared by repeated-measures ANOVA, repeatability was estimated by the within-subject standard deviation, Sw, and response to changing oxygenation by the down slope of rStO2 during vascular occlusion in the respective arm. 10 healthy adults, 21-29 years old, with double skinfolds on the forearm less than 10 mm participated. The median rStO2 was 70.7% (interquartile range (IQR) 7.7%), 68.4% (IQR 8.4%), and 64.6% (IQR 4.8) with INVOS, NONIN, and FORE-SIGHT, respectively, the median rate of decline was 13.2%/min (IQR 9.6), 22.8 %/min (IQR 18.0), and 10.8%/min (IQR 6.0), and the same-site repeatability was 2.9% (95% CI 2.4-3.3), 4.6% (CI 3.9-5.3), and 2.0% (CI 1.7-2.3). INVOS gave significantly higher steady state values than FORE-SIGHT, and NONIN had the steepest decline in rStO2, but the poorest repeatability. Two measures of signal-to-noise were similar among devices. This suggests that good repeatability comes at the expense of low sensitivity to changes in oxygenation. Values of rStO2 on the forearm from INVOS, NONIN and FORE-SIGTH cannot be used interchangeably.

Rapid restoration of bone mass after surgical management of hyperthyroidism: A prospective case control study in Southern India.

PubMed

Karunakaran, Poongkodi; Maharajan, Chandrasekaran; Mohamed, Kamaludeen N; Rachamadugu, Suresh V

2016-03-01

The rate and the extent of bone remineralization at cancellous versus cortical sites after treatment of hyperthyroidism is unclear. Few studies have examined the effect of operative management of hyperthyroidism on recovery of bone mass. To evaluate prospectively the bone mineral density (BMD), bone mineral content (BMC), and bone areal size at the spine, hip, and forearm before and after total thyroidectomy. A prospective case control observational study from August 2011 to July 2014 in a single center. This study evaluated 40 overt hyperthyroid patients and 31 age-matched euthyroid controls who were operative candidates. Bone indices were measured at baseline and 6-month postoperatively using dual energy x-ray absorptiometry. Serum levels of alkaline phosphatase and 25-hydroxy vitamin D3 (25OHD) were assessed. Baseline BMD of hyperthyroid subjects at the spine, hip, and forearm were less than euthyroid controls (P = .001) with concomitant increases in serum alkaline phosphatase (mean ± SD, 143 ± 72 vs 72 ± 23 IU/L control; P < .001). The 25OHD level was 24.3 ± 10.6 and 26.1 ± 14.6 ng/mL in patients and controls, respectively. Among hyperthyroid patients, posttreatment BMD expressed as g/cm(2) were 0.97 ± 0.12 (vs pretreatment 0.91 ± 0.14; P = .001) at the spine, 0.87 ± 0.12 (vs pretreatment 0.80 ± 0.13; P = .001) at the hip, and 0.67 ± 0.09 (vs pretreatment 0.64 ± 0.11; P = .191) at the forearm. The percent change in BMD was greatest at spine (8.3%) followed by the hip (7.6%) and forearm (3.0%). Operative management with total thyroidectomy improved the bone loss associated with hyperthyroidism as early as 6 months postoperatively at the hip and spine despite concomitant vitamin D deficiency. Delayed recovery of bone indices at the forearm, a cortical bone, requires further long-term evaluation. Copyright © 2016 Elsevier Inc. All rights reserved.

No impaired hemoglobin oxygenation in forearm muscles of patients with chronic CRPS-1.

PubMed

Brunnekreef, Jaap J J; Oosterhof, Jan; Wolff, André P; Crul, Ben J P; Wilder-Smith, Oliver H G; Oostendorp, Rob A B

2009-01-01

Physiotherapy is considered an important treatment option in patients with upper limb complex regional pain syndrome type-1 (CRPS-1). In case of chronic CRPS-1, exercise therapy of the affected limb forms an important part of the physiotherapeutic program. We investigated whether muscle loading in chronic CRPS-1 patients is associated with impairments in muscle circulation of the forearm of the affected limb. Thirty patients with chronic CRPS-1 unilaterally affecting their upper limbs, and 30 age-matched and sex-matched control participants were included in this study. Local muscle blood flow and hemoglobin oxygenation were measured by near infrared spectroscopy within the muscles of the forearm at rest, after 1-minute isometric handgrip exercises, and after arterial occlusion. Main outcome parameters were: local muscle blood flow, O2 consumption (mVO2), and postischemic reoxygenation (ReOx). We found no differences in baseline muscle blood flow, mVO2, and ReOx between the affected CRPS-1, unaffected CRPS-1, and control arms. After exercise, mVO2 of the affected CRPS-1 arms was not different from the clinically unaffected CRPS-1 arms. Furthermore, in comparison with the control arms, unaffected CRPS-1 arms showed no difference in mVO2 or ReOx. Muscle loading does not seems to be related to impairments in muscle oxygen uptake in forearm muscles of upper limbs affected by chronic CRPS-1. Our results suggest that exercise therapy can be safely used in physiotherapeutic training programs for chronic CRPS-1 of the upper limb.

Water-displacement plethysmography: a technique for the simultaneous thermal manipulation and measurement of whole-hand and whole-foot blood flows.

PubMed

Caldwell, Joanne N; Taylor, Nigel A S

2014-09-01

The purpose of this project was to design, construct and validate water-displacement plethysmographs for the forearm, hand and foot that could clamp segmental skin temperature whilst simultaneously measuring cutaneous blood flow. Two experiments were performed. In the first, the forearm plethysmograph was validated against a mercury-in-silastic plethysmograph under thermoneutral conditions, with and without forearm heating. Cutaneous vascular conductance was elevated almost three-fold by this treatment, however, there were no significant differences between the two forms of plethysmography in either state (P > 0.05). In study two, hand and foot blood flows were measured under clamped thermoneutral conditions, but with three local skin temperature treatments (5, 25, 40 °C). The hand had significantly higher blood flows than the foot at both 25 °C (4.07 versus 2.20 mL.100 mL( - 1).min( - 1); P < 0.05) and 40 °C (8.20 versus 4.47 mL.100 mL( - 1).min( - 1); P < 0.05). The foot was maximally constricted during the two lower temperatures, yet the cutaneous thermal sensitivity of the hand was almost two-fold greater (P < 0.05). This evidence supports the significant role played by these appendages in heat loss and conservation, and these plethysmographs will now be used to map cutaneous vascular responses (forearm, hand, calf, foot) across combinations of core and local skin temperatures.

Rereduction for Redisplacement of Both-Bone Forearm Shaft Fractures in Children.

PubMed

Eismann, Emily A; Parikh, Shital N; Jain, Viral V

2016-06-01

There is a high rate of redisplacement after closed reduction and cast treatment of displaced both-bone forearm shaft fractures in children. Little evidence is available on the efficacy of rereduction of these redisplaced fractures. This study evaluates the impact of rereduction on radiographic outcomes and compares the cost to surgical stabilization. This retrospective study included 31 children (mean age, 6.3 y; 18 boys) treated with rereduction for redisplacement of a displaced both-bone forearm shaft fracture between 2008 and 2013. Angulation was measured on anteroposterior and lateral radiographs of the radius and ulna at injury, after reduction, at redisplacement, after rereduction, and at fracture union. Average procedure costs for rereduction and surgical stabilization were calculated. Initial reduction decreased apex volar angulation (initially >20 degrees) of both bones to a median of ≤2 degrees. After an average of 15 days (range, 4 to 35 d), apex volar angulation of the radius worsened to 9 degrees, and apex ulnar angulation worsened to >10 degrees for both bones. For every 5 days after initial reduction, apex ulnar angulation of the radius worsened by 4 degrees. Rereduction reduced apex ulnar and volar angulation of both bones to <5 degrees, which was maintained after cast removal. There were no complications. The average procedure cost for rereduction was $2056 compared with $4589 for surgical stabilization with or without implant removal. Rereduction of both-bone forearm shaft fractures after redisplacement following initial closed reduction had satisfactory radiographic outcomes and is a safe, effective, and less expensive option than surgical stabilization. Level IV-therapeutic.

Brachial artery vasodilatation during prolonged lower limb exercise: role of shear rate

PubMed Central

Padilla, Jaume; Simmons, Grant H.; Vianna, Lauro C.; Davis, Michael J.; Laughlin, M. Harold; Fadel, Paul J.

2012-01-01

We recently observed a marked increase in brachial artery (BA) diameter during prolonged leg cycling exercise. The purpose of the present study was to test the hypothesis that this increase in BA diameter during lower limb exercise is shear stress mediated. Accordingly, we determined whether recapitulation of cycling-induced BA shear rate with forearm heating, a known stimulus evoking shear-induced conduit artery dilatation, would elicit comparable profiles and magnitudes of BA vasodilatation to those observed during cycling. In 12 healthy men, BA diameter and blood velocity were measured simultaneously using Doppler ultrasonography at baseline and every 5 min during 60 min of either steady-state semi-recumbent leg cycling (120 W) or forearm heating. At the onset of cycling, the BA diameter was reduced (−3.9 ± 1.2% at 5 min; P < 0.05), but it subsequently increased throughout the remainder of the exercise bout (+15.1 ± 1.6% at 60 min; P < 0.05). The increase in BA diameter during exercise was accompanied by an approximately 2.5-fold rise in BA mean shear rate (P < 0.05). Similar increases in BA mean shear with forearm heating elicited an equivalent magnitude of BA vasodilatation to that observed during cycling (P > 0.05). Herein, we found that in the absence of exercise the extent of the BA vasodilator response was reproduced when the BA was exposed to comparable magnitudes of shear rate via forearm heating. These results are consistent with the hypothesis that shear stress plays a key role in signalling brachial artery vasodilatation during dynamic leg exercise. PMID:21784788

Past and current weight change and forearm bone loss in middle-aged women: the Nord-Trøndelag Health Study, Norway.

PubMed

Forsmo, Siri; Langhammer, Arnulf; Schei, Berit

2009-01-01

The aim of this study was to investigate the association between bone loss and weight change before and concurrently to the assessment of forearm bone loss over 4.6 years in a population-based cohort of middle-aged women followed for more than 15 years. Among 8,856 women aged 45 to 60 years attending the first Nord-Trøndelag Health Study study, Norway (1984-1986), a 35% random sample was invited for forearm densitometry at Nord-Trøndelag Health Study 2 (1995-1997), and 2,188 women (78%) attended. After an average period of 4.6 years, they were subsequently invited for follow-up densitometry in 2001, and 1,421 women (67.8%) met. Weight and height were measured on all three occasions. During the total period of observation since baseline (15.5 y), the mean weight had increased by 3.4 kg, mostly in the youngest women. Weight loss had an accelerating and weight gain a decelerating effect on bone loss, and this was observed both for weight change occurring before the bone mineral density follow-up and for concurrent weight change. The relationship between prior weight gain or loss and bone loss seemed to persist, independent of the weight change observed during the period of bone loss assessment. Despite no mechanical impact of body weight on the forearm, weight loss in midlife women seems to be associated with a long-lasting negative effect on bone and vice versa for weight gain. This is presumably explained by humoral factors.

Arm posture-dependent changes in corticospinal excitability are largely spinal in origin.

PubMed

Nuzzo, James L; Trajano, Gabriel S; Barry, Benjamin K; Gandevia, Simon C; Taylor, Janet L

2016-04-01

Biceps brachii motor evoked potentials (MEPs) from cortical stimulation are influenced by arm posture. We used subcortical stimulation of corticospinal axons to determine whether this postural effect is spinal in origin. While seated at rest, 12 subjects assumed several static arm postures, which varied in upper-arm (shoulder flexed, shoulder abducted, arm hanging to side) and forearm orientation (pronated, neutral, supinated). Transcranial magnetic stimulation over the contralateral motor cortex elicited MEPs in resting biceps and triceps brachii, and electrical stimulation of corticospinal tract axons at the cervicomedullary junction elicited cervicomedullary motor evoked potentials (CMEPs). MEPs and CMEPs were normalized to the maximal compound muscle action potential (Mmax). Responses in biceps were influenced by upper-arm and forearm orientation. For upper-arm orientation, biceps CMEPs were 68% smaller (P= 0.001), and biceps MEPs 31% smaller (P= 0.012), with the arm hanging to the side compared with when the shoulder was flexed. For forearm orientation, both biceps CMEPs and MEPs were 34% smaller (both P< 0.046) in pronation compared with supination. Responses in triceps were influenced by upper-arm, but not forearm, orientation. Triceps CMEPs were 46% smaller (P= 0.007) with the arm hanging to the side compared with when the shoulder was flexed. Triceps MEPs and biceps and triceps MEP/CMEP ratios were unaffected by arm posture. The novel finding is that arm posture-dependent changes in corticospinal excitability in humans are largely spinal in origin. An interplay of multiple reflex inputs to motoneurons likely explains the results. Copyright © 2016 the American Physiological Society.

Arm posture-dependent changes in corticospinal excitability are largely spinal in origin

PubMed Central

Nuzzo, James L.; Trajano, Gabriel S.; Barry, Benjamin K.; Gandevia, Simon C.

2016-01-01

Biceps brachii motor evoked potentials (MEPs) from cortical stimulation are influenced by arm posture. We used subcortical stimulation of corticospinal axons to determine whether this postural effect is spinal in origin. While seated at rest, 12 subjects assumed several static arm postures, which varied in upper-arm (shoulder flexed, shoulder abducted, arm hanging to side) and forearm orientation (pronated, neutral, supinated). Transcranial magnetic stimulation over the contralateral motor cortex elicited MEPs in resting biceps and triceps brachii, and electrical stimulation of corticospinal tract axons at the cervicomedullary junction elicited cervicomedullary motor evoked potentials (CMEPs). MEPs and CMEPs were normalized to the maximal compound muscle action potential (Mmax). Responses in biceps were influenced by upper-arm and forearm orientation. For upper-arm orientation, biceps CMEPs were 68% smaller (P = 0.001), and biceps MEPs 31% smaller (P = 0.012), with the arm hanging to the side compared with when the shoulder was flexed. For forearm orientation, both biceps CMEPs and MEPs were 34% smaller (both P < 0.046) in pronation compared with supination. Responses in triceps were influenced by upper-arm, but not forearm, orientation. Triceps CMEPs were 46% smaller (P = 0.007) with the arm hanging to the side compared with when the shoulder was flexed. Triceps MEPs and biceps and triceps MEP/CMEP ratios were unaffected by arm posture. The novel finding is that arm posture-dependent changes in corticospinal excitability in humans are largely spinal in origin. An interplay of multiple reflex inputs to motoneurons likely explains the results. PMID:26864764

Comparison of usual and alternative methods to measure height in mechanically ventilated patients: potential impact on protective ventilation.

PubMed

Bojmehrani, Azadeh; Bergeron-Duchesne, Maude; Bouchard, Carmelle; Simard, Serge; Bouchard, Pierre-Alexandre; Vanderschuren, Abel; L'Her, Erwan; Lellouche, François

2014-07-01

Protective ventilation implementation requires the calculation of predicted body weight (PBW), determined by a formula based on gender and height. Consequently, height inaccuracy may be a limiting factor to correctly set tidal volumes. The objective of this study was to evaluate the accuracy of different methods in measuring heights in mechanically ventilated patients. Before cardiac surgery, actual height was measured with a height gauge while subjects were standing upright (reference method); the height was also estimated by alternative methods based on lower leg and forearm measurements. After cardiac surgery, upon ICU admission, a subject's height was visually estimated by a clinician and then measured with a tape measure while the subject was supine and undergoing mechanical ventilation. One hundred subjects (75 men, 25 women) were prospectively included. Mean PBW was 61.0 ± 9.7 kg, and mean actual weight was 30.3% higher. In comparison with the reference method, estimating the height visually and using the tape measure were less accurate than both lower leg and forearm measurements. Errors above 10% in calculating the PBW were present in 25 and 40 subjects when the tape measure or visual estimation of height was used in the formula, respectively. With lower leg and forearm measurements, 15 subjects had errors above 10% (P < .001). Our results demonstrate that significant variability exists between the different methods used to measure height in bedridden patients on mechanical ventilation. Alternative methods based on lower leg and forearm measurements are potentially interesting solutions to facilitate the accurate application of protective ventilation. Copyright © 2014 by Daedalus Enterprises.

Specific endothelin ET(A) receptor antagonism does not modulate insulin-induced hemodynamic effects in the human kidney, eye, or forearm.

PubMed

Rab, Anna; Dallinger, Susanne; Polak, Kaija; Pleiner, Johannes; Polska, Elzbieta; Wolzt, Michael; Schmetterer, Leopold

2004-05-01

There is evidence that hyperinsulinemia may stimulate endothelin-1 (ET-1) generation or release, which may affect diabetic vascular complications. BQ-123, a specific ET(A) receptor antagonist, was used to investigate if insulin-induced vascular effects are influenced by an acute ET-1 release. Two randomized, placebo-controlled, double-blind, cross-over studies were performed. In protocol 1, 12 healthy subjects received, on separate study days, infusions of BQ-123 (60 microg/min for 30 min) during placebo clamp conditions, BQ-123 during euglycemic hyperinsulinemia (3 mU/kg/min for 390 min), or placebo during euglycemic hyperinsulinemia. Fundus pulsation amplitude (FPA) was measured to assess pulsatile choroidal blood flow, and mean flow velocity (MFV) of the ophtalmic artery was measured by color Doppler imaging. In protocol 2, eight healthy subjects received, on separate study days, intra-arterial infusions of BQ-123 (32 microg/min for 120 min) during placebo or insulin clamp. Forearm blood flow was measured with bilateral plethysmography, expressing the ratio of responses in the intervention arm and in the control arm. Insulin alone increased FPA (+10%, p < 0.001) and forearm blood flow (+19%). BQ-123 increased FPA, MFV, and forearm blood flow ratio in the absence and presence of exogenous insulin, but this effect was not different between normo- and hyperinsulinemic conditions. ET-1 plasma concentrations were not affected by insulin. In conclusion, these data do not support the concept that hyperinsulinemia increases ET-1 generation in healthy subjects. Our results, however, cannot necessarily be extrapolated to diabetic and obese subjects.

Ultrasound-guided axillary brachial plexus block versus local infiltration anesthesia for arteriovenous fistula creation at the forearm for hemodialysis in patients with chronic renal failure.

PubMed

Nofal, W H; El Fawal, S M; Shoukry, A A; Sabek, Eas; Malak, Wfa

2017-01-01

The primary failure rate for arteriovenous fistula (AVF) creation under local anesthesia for hemodialysis is about 30%. Axillary brachial plexus block (BPB) may improve blood flow through blood vessels used in fistula creation; it may improve the AVF blood flow and thus may reduce the primary failure rate after 3 months. Hundred and forty patients with chronic renal failure scheduled for AVF creation for hemodialysis were divided into two equal groups; Group 1 (AxBP-G) received ultrasound (US) guided axillary BPB, and Group 2 (LI-G) received local infiltration. We recorded the measurements of the brachial and radial arteries before and after anesthesia and the AVF blood flow in both groups at three different time points. Furthermore, the primary failure rate was recorded in each group and compared. After anesthesia, the mean radial artery blood flow in the AxBP-group was 3.52 ml/min more than the LI-group, and the brachial artery diameter was also 0.68 mm more than in the LI-group, both differences were statistically significant ( P < 0.05). There were significant increases ( P < 0.05) in the AVF blood flow in the AxBP-group more than the LI-group with mean differences of 29.6, 69.8, and 27.2 ml/min at 4 h, 1 week, and 3 months, respectively. The overall mean of AVF blood flow was 42.21 ml/min more in the AxBP group than the LI-group a difference which is statistically significant ( P < 0.001). The primary failure rate was 17% in the AxBP group versus 30% in the LI-group; however, this difference is not significant statistically ( P = 0.110). The US-guided axillary block increases AVF blood flow significantly more than local infiltration and nonsignificantly decreases the primary failure rate of the AVF after 3 months.

Role of route previewing strategies on climbing fluency and exploratory movements.

PubMed

Seifert, Ludovic; Cordier, Romain; Orth, Dominic; Courtine, Yoan; Croft, James L

2017-01-01

This study examined the role of route previewing strategies on climbing fluency and on exploratory movements of the limbs, in order to understand whether previewing helps people to perceive and to realize affordances. Eight inexperienced and ten experienced climbers previewed a 10 m high route of 5b difficulty on French scale, then climbed it with a top-rope as fluently as possible. Gaze behavior was collected from an eye tracking system during the preview and allowed us to determine the number of times they scanned the route, and which of four route previewing strategies (fragmentary, ascending, zigzagging, and sequence-of-blocks) they used. Five inertial measurement units (IMU) (3D accelerometer, 3D gyroscope, 3D magnetometer) were attached to the hip, both feet, and forearms to analyze the vertical acceleration and direction of each limb and hip during the ascent. We were able to detect movement and immobility phases of each IMU using segmentation and classification processes. Depending on whether the limbs and/or hip were moving, five states of behavior were detected: immobility, postural regulation, hold exploration, hold change, and hold traction. Using cluster analysis we identified four clusters of gaze behavior during route previewing depending on route preview duration, number of scan paths, fixations duration, ascending, zigzagging, and sequence-of-blocks strategies. The number of scan paths was positively correlated with relative duration of exploration and negatively correlated with relative duration of hold changes during the ascent. Additionally, a high relative duration of sequence-of-blocks strategy and zigzagging strategy were associated with a high relative duration of immobility during the ascent. Route previewing might help to pick up functional information about reachable, graspable, and usable holds, in order to chain movements together and to find the route. In other words, route previewing might contribute to perceiving and realizing nested affordances.

Supination and Pronation Strength Deficits Persist at 2-4 Years after Treatment of Distal Radius Fractures.

PubMed

Ploegmakers, Joris; The, Bertram; Wang, Allan; Brutty, Mike; Ackland, Tim

2015-10-01

Forearm rotation is a key function in the upper extremity. Following distal radius fracture, residual disability may occur in tasks requiring forearm rotation. The objectives of this study are to define pronation and supination strength profiles tested through the range of forearm rotation in normal individuals, and to evaluate the rotational strength profiles and rotational strength deficits across the testing range in a cohort of patients treated for distal radius fracture associated with an ulnar styloid base fracture. In a normative cohort of 29 subjects the supination strength profile showed an increasing linear relationship from supination to pronation. Twelve subjects were evaluated 2-4 years after anatomical open reduction and volar plate fixation of a distal radius fracture. The injured wrist was consistently weaker (corrected for hand dominance) in both supination and pronation strength in all testing positions, with the greatest loss in 60 degrees supination. Mean supination strength loss across all testing positions was significantly correlated with worse PRWE scores, highlighting the importance of supination in wrist function.

Viewing the body modulates tactile receptive fields.

PubMed

Haggard, Patrick; Christakou, Anastasia; Serino, Andrea

2007-06-01

Tactile discrimination performance depends on the receptive field (RF) size of somatosensory cortical (SI) neurons. Psychophysical masking effects can reveal the RF of an idealized "virtual" somatosensory neuron. Previous studies show that top-down factors strongly affect tactile discrimination performance. Here, we show that non-informative vision of the touched body part influences tactile discrimination by modulating tactile RFs. Ten subjects performed spatial discrimination between touch locations on the forearm. Performance was improved when subjects saw their forearm compared to viewing a neutral object in the same location. The extent of visual information was relevant, since restricted view of the forearm did not have this enhancing effect. Vibrotactile maskers were placed symmetrically on either side of the tactile target locations, at two different distances. Overall, masking significantly impaired discrimination performance, but the spatial gradient of masking depended on what subjects viewed. Viewing the body reduced the effect of distant maskers, but enhanced the effect of close maskers, as compared to viewing a neutral object. We propose that viewing the body improves functional touch by sharpening tactile RFs in an early somatosensory map. Top-down modulation of lateral inhibition could underlie these effects.

Kinesio arm taping as prophylaxis against the development of Erb's Engram.

PubMed

ElKhatib, Radwa S; ElNegmy, Emam H; Salem, Amina H; Sherief, AbdelAziz A

2013-11-01

An Erb's Engram is a common debility that develops in recovering children with Erb's palsy. The purpose of this study was to investigate the effect of kinesiotaping over the deltoid and the forearm on the development of proper upper extremity function in children recovering from Erb's palsy. Thirty patients with Erb's palsy participated for 3 months in this study and were equally divided into two groups; control group A and study group B. The two groups received the same designed physical therapy program, while group B along the program, received kinesiotaping over the deltoid and the forearm. The subjects were evaluated, pre and post-treatment, and scored functionally, using the Toronto Active Motion Scale, and objectively, using an EMG device utilized to obtain the percentages of degeneration of the deltoid and the biceps muscles. Post-treatment values of six out of nine measured variables, between the two groups, revealed significant difference in favor of group B. The obtained results strongly support the introduction of kinesiotaping of the deltoid and the forearm as an adjunct to the treatment program of Erb's palsied children.

Completed Ulnar Shaft Stress Fracture in a Fast-Pitch Softball Pitcher.

PubMed

Wiltfong, Roger E; Carruthers, Katherine H; Popp, James E

2017-03-01

Stress fractures of the upper extremity have been previously described in the literature, yet reports of isolated injury to the ulna diaphysis or olecranon are rare. The authors describe a case involving an 18-year-old fast-pitch softball pitcher. She presented with a long history of elbow and forearm pain, which was exacerbated during a long weekend of pitching. Her initial physician diagnosed her as having forearm tendinitis. She was treated with nonsurgical means including rest, anti-inflammatory medications, therapy, and kinesiology taping. She resumed pitching when allowed and subsequently had an acute event immediately ceasing pitching. She presented to an urgent care clinic that evening and was diagnosed as having a complete ulnar shaft fracture subsequently needing surgical management. This case illustrates the need for a high degree of suspicion for ulnar stress fractures in fast-pitch soft-ball pitchers with an insidious onset of unilateral forearm pain. Through early identification and intervention, physicians may be able to reduce the risk of injury progression and possibly eliminate the need for surgical management. [Orthopedics. 2017; 40(2):e360-e362.]. Copyright 2016, SLACK Incorporated.

Prehospital Dextrose Extravasation Causing Forearm Compartment Syndrome: A Case Report.

PubMed

Chinn, Matthew; Colella, M Riccardo

2017-01-01

A 57-year-old woman was found at home by paramedics to be hypoglycemic with altered mental status. She had multiple attempts at IV access and eventually a 22G IV was established and D50 was infused into her right forearm. Extravasation of the dextrose was noted after approximately 12 g of the medication was infused. She was given a dose of glucagon intramuscularly and her mental status improved. Shortly after her arrival to the emergency department, she was noted to have findings of compartment syndrome of her forearm at the site of the dextrose extravasation. She was evaluated by plastic surgery and taken to the operating room for emergent fasciotomy. She recovered well from the operation. D50 is well known to cause phlebitis and local skin necrosis as a complication. This case illustrates the danger of compartment syndrome after D50 extravasation. It is the first documented case of prehospital dextrose extravasation leading to compartment syndrome. There may be safer alternatives to D50 administration and providers must be acutely aware to monitor for D50 infusion complications.

Professional tennis players' serve: correlation between segmental angular momentums and ball velocity.

PubMed

Martin, Caroline; Kulpa, Richard; Delamarche, Paul; Bideau, Benoit

2013-03-01

The purpose of the study was to identify the relationships between segmental angular momentum and ball velocity between the following events: ball toss, maximal elbow flexion (MEF), racket lowest point (RLP), maximal shoulder external rotation (MER), and ball impact (BI). Ten tennis players performed serves recorded with a real-time motion capture. Mean angular momentums of the trunk, upper arm, forearm, and the hand-racket were calculated. The anteroposterior axis angular momentum of the trunk was significantly related with ball velocity during the MEF-RLP, RLP-MER, and MER-BI phases. The strongest relationships between the transverse-axis angular momentums and ball velocity followed a proximal-to-distal timing sequence that allows the transfer of angular momentum from the trunk (MEF-RLP and RLP-MER phases) to the upper arm (RLP-MER phase), forearm (RLP-MER and MER-BI phases), and the hand-racket (MER-BI phase). Since sequence is crucial for ball velocity, players should increase angular momentums of the trunk during MEF-MER, upper arm during RLP-MER, forearm during RLP-BI, and the hand-racket during MER-BI.

Effects of pretreatment with a urea-containing emollient on nickel allergic skin reactions.

PubMed

Kuzmina, Natalia; Nyrén, Miruna; Lodén, Marie; Edlund, Fredrik; Emtestam, Lennart

2005-01-01

The aim of this study was to evaluate the effect of a moisturizer containing urea on allergic contact dermatitis. Twenty-five nickel-sensitized patients and five controls (non-sensitized volunteers) applied such a moisturizer on the volar side of one forearm twice daily for 20 days, while the other forearm served as the control. After treatment with the moisturizer, patch tests with 0%, 0.5% and 2% NiSO4 in petrolatum were applied in a randomized manner on each arm. After 72 h, the skin reactions were blindly evaluated by clinical scoring and by measuring transepidermal water loss and electrical impedance. After treatment, the baseline transepidermal water loss values were lower and the baseline magnitude impedance index values were higher on the pretreated forearm. According to clinical scoring and measurements with the two physical measurement techniques, the degree of the patch test reactions was equal. All control subjects had negative nickel tests. We concluded that the skin reactivity to nickel in nickel-sensitized patients is not significantly affected by use of the urea-containing moisturizer.

Discrimination of Human Forearm Motions on the Basis of Myoelectric Signals by Using Adaptive Fuzzy Inference System

NASA Astrophysics Data System (ADS)

Kiso, Atsushi; Seki, Hirokazu

This paper describes a method for discriminating of the human forearm motions based on the myoelectric signals using an adaptive fuzzy inference system. In conventional studies, the neural network is often used to estimate motion intention by the myoelectric signals and realizes the high discrimination precision. On the other hand, this study uses the fuzzy inference for a human forearm motion discrimination based on the myoelectric signals. This study designs the membership function and the fuzzy rules using the average value and the standard deviation of the root mean square of the myoelectric potential for every channel of each motion. In addition, the characteristics of the myoelectric potential gradually change as a result of the muscle fatigue. Therefore, the motion discrimination should be performed by taking muscle fatigue into consideration. This study proposes a method to redesign the fuzzy inference system such that dynamic change of the myoelectric potential because of the muscle fatigue will be taken into account. Some experiments carried out using a myoelectric hand simulator show the effectiveness of the proposed motion discrimination method.

[Prevalence of osteoporosis and osteopenia among women over fifty years of age, from the city of Durango, Mexico, diagnosed by forearm-DEXA].

PubMed

González-Arellano, J Andrés; Milla-Villeda, Reynaldo H; Hernández-Vera, Gloria E; Cisneros-Pérez, Vicente; Lazalde, Brissia; Reyes, Miguel R

2007-01-01

To estimate the prevalence of osteopenia and osteporosis using distal forearm dual-energy X-ray absorptiometry among a random sample of women of 50 years or older living in the city of Durango, Mexico. 258 women participated in a cross-sectional study fielded at the Osteoporosis Clinic of Durango. Bone mineral density was determined by dual-energy X-ray absorptiometry. Scanning was performed on the distal third of the dominant forearm. Diagnosis of osteopenia and osteoporosis was based on the WHO criteria. Osteoporosis was diagnosed in 13.65% (95%CI: 9.6-18.5) and osteopenia in 30.12% (95% CI: 24.5-36.2) of participants. Mean age, weight, height and body mass index were 65 years, 60.5 kg, 147.8 cm and 28.3 kg/m2 respectively. Osteoporosis and osteopenia were a common diagnosis given the mean age of our sample. These results can be extrapolated to the general population thereby suggesting the need for preventive measures to decrease disease prevalence, especially considering the increase in life expectancy.

Differential involvement of forearm muscles in ALS does not relate to sonographic structural nerve alterations.

PubMed

Schreiber, Stefanie; Schreiber, Frank; Debska-Vielhaber, Grazyna; Garz, Cornelia; Hensiek, Nathalie; Machts, Judith; Abdulla, Susanne; Dengler, Reinhard; Petri, Susanne; Nestor, Peter J; Vielhaber, Stefan

2018-07-01

We aimed to assess whether differential peripheral nerve involvement parallels dissociated forearm muscle weakness in amyotrophic lateral sclerosis (ALS). The analysis comprised 41 ALS patients and 18 age-, sex-, height- and weight-matched healthy controls. Strength of finger-extension and -flexion was measured using the Medical Research Council (MRC) scale. Radial, median and ulnar nerve sonographic cross-sectional area (CSA) and echogenicity, expressed by the hypoechoic fraction (HF), were determined. In ALS, finger extensors were significantly weaker than finger flexors. Sonographic evaluation revealed peripheral nerve atrophy, affecting various nerve segments in ALS. HF was unaltered. This systematic study confirmed a long-observed physical examination finding in ALS - weakness in finger-extension out of proportion to finger-flexion. This phenomenon was not related to any particular sonographic pattern of upper limb peripheral nerve alteration. In ALS, dissociated forearm muscle weakness could aid in the disease's diagnosis. Nerve ultrasound did not provide additional information on the differential involvement of finger-extension and finger-flexion strength. Copyright © 2018 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

Forearm and hand arteries’ aneurysms – a case report of bilateral true ulnar artery aneurysm in the hypothenar eminence and systematic review of the literature.

PubMed

De Santis, F; Martini, G; Mani, G; Zywica, M; Zipponi, D

2013-06-01

Arterial aneurysms in the forearm, wrist and hand are relatively uncommon. Penetrating injuries, arterial traumas, infections and repetitive microtraumas represent the most frequent cause of these secondary aneurysms or pseudo-aneurysms, while true nontraumaticor infective peripheral aneurysms of the upper extremities are very rarely encountered. Over the last 20 years these have been reported only sporadically, both in adults and children. We describe a case of bilateral true idiopathic saccular artery aneurysms in the hypothenar eminence, treated with excision and arterial continuity restoration by primary end-to-end anastomosis on the left side and conservatively on the right. To our knowledge, no other similar case has been documented to date. Starting from this original case we conducted a systematic review of the literature via PubMed search on peripheral aneurysms of the forearm and hand arteries from 1933 to the present, including specifically true distal ulnar and radial artery aneurysms. Etiology, clinical characteristics and management of these rare pathological entities are extensively discussed.

Tracer kinetics of forearm endothelial function: comparison of an empirical method and a quantitative modeling technique.

PubMed

Zhao, Xueli; Arsenault, Andre; Lavoie, Kim L; Meloche, Bernard; Bacon, Simon L

2007-01-01

Forearm Endothelial Function (FEF) is a marker that has been shown to discriminate patients with cardiovascular disease (CVD). FEF has been assessed using several parameters: the Rate of Uptake Ratio (RUR), EWUR (Elbow-to-Wrist Uptake Ratio) and EWRUR (Elbow-to-Wrist Relative Uptake Ratio). However, the modeling functions of FEF require more robust models. The present study was designed to compare an empirical method with quantitative modeling techniques to better estimate the physiological parameters and understand the complex dynamic processes. The fitted time activity curves of the forearms, estimating blood and muscle components, were assessed using both an empirical method and a two-compartment model. Although correlational analyses suggested a good correlation between the methods for RUR (r=.90) and EWUR (r=.79), but not EWRUR (r=.34), Altman-Bland plots found poor agreement between the methods for all 3 parameters. These results indicate that there is a large discrepancy between the empirical and computational method for FEF. Further work is needed to establish the physiological and mathematical validity of the 2 modeling methods.

Valid screening questions useful to diagnose hand and forearm eczema are available in the Spanish language, a new tool for global research.

PubMed

Martí-Margarit, Anna; Manresa, Josep M; Herdman, Mike; Pujol, Ramon; Serra, Consol; Flyvholm, Mary-Ann; Giménez-Arnau, Ana M

2015-04-01

Hand eczema is an impacting cutaneous disease. Globally valid tools that help to diagnose hand and forearm eczema are required. To validate the questions to detect hand and/or forearm eczema included in the "Nordic Occupational Skin Questionnaire" (NOSQ-2002) in the Spanish language. A prospective pilot study was conducted with 80 employees of a cleaning company and a retrospective one involving 2,546 individuals. The responses were analysed for sensitivity, specificity and positive and negative predictive values. The final diagnosis according to the patients' hospital records, the specialty care records and the physical examination was taken as gold standard. The Dermatology Life Quality Index (DLQI) was also evaluated. Sensitivity and specificity, in a worst case scenario (WC) combining both questions, were 96.5% and 66.7%, respectively, and in a per protocol (PP) analysis, were 96.5% and 75.2%. The questions validated detected eczema effectively, making this tool suitable for use e.g. in multicentre epidemiological studies or clinical trials.

Diaphyseal forearm fractures, 20 years after surgical treatment. Is there still an indication for percutaneous fixation?

PubMed

Fernández-Marín, M R; Hidalgo-Pérez, M; Arias-Rodríguez, G; García-Mendoza, A; Prada-Chamorro, E; Domecq-Fernández de Bobadilla, G

This is a retrospective study of 98 diaphyseal forearm fractures in adults, treated by a percutaneous technique with intramedullar Kirchner wires. We reviewed 64 patients with 98 forearm fractures with a radiographic follow-up, assessing the presence of pseudarthrosis or delayed bone union and evaluating functional outcomes with the Anderson and the Disability of the Arm, Shoulder and Hand scale. Clinical and radiological bone union was achieved in an average of 12 weeks. We obtained 77% of excellent and good results following Anderson's scale. There were 4 cases of pseudarthrosis and 6 cases of delayed bone union. This surgical technique provides several advantages, such as a low incidence of complications and a total absence of infections, refractures and iatrogenic neurovascular injuries. It allows a lower hospital stay and a shortening of the surgery time compared with other techniques such as plates and intramedullary nails, that have similar results, in terms of bone union and functional outcomes, as we have verified from the published literature. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

A closed unventilated chamber for the measurement of transepidermal water loss.

PubMed

Nuutinen, Jouni; Alanen, Esko; Autio, Pekka; Lahtinen, Marjo-Riitta; Harvima, Ilkka; Lahtinen, Tapani

2003-05-01

Open chamber systems for measuring transepidermal water loss (TEWL) have limitations related to ambient and body-induced airflows near the probe, probe size, measurement sites and angles, and measurement range. The aim of the present investigation was to develop a closed chamber system for the TEWL measurement without significant blocking of normal evaporation through the skin. Additionally, in order to use the evaporimeter to measure evaporation rates through other biological and non-biological specimens and in the field applications, a small portable, battery-operated device was a design criteria. A closed unventilated chamber (inner volume 2.0 cm(3) was constructed. For the skin measurement, the chamber with one side open (open surface area 1.0 cm(2) is placed on the skin. The skin application time was investigated at low and high evaporation rates in order to assess the blocking effect of the chamber on normal evaporation. From the rising linear part of the relative humidity (RH) in the chamber the slope was registered. The slope was calibrated into a TEWL value by evaporating water at different temperatures and measuring the water loss of heated samples with a laboratory scale. The closed chamber evaporation technique was compared with a conventional evaporimeter based on an open chamber method (DermaLab), Cortex Technology, Hadsund, Denmark). The reproducibility of the closed chamber method was measured with the water samples and with volar forearm and palm of the hand in 10 healthy volunteers. The skin application time varied between 7 and 9 s and the linear slope region between 3 and 5 s at the evaporation rates of 3-220 g/m(2) h. A correlation coefficient between the TEWL value from the closed chamber measurements and the readings of the laboratory scale was 0.99 (P < 0.001). The reproducibility of the evaporation measurements with the water samples was 4.0% at the evaporation rate of 40 g/m(2) h. A correlation coefficient of the TEWL values between the closed chamber and open chamber measurements was 0.99 (P < 0.001) in the range where the response of a conventional evaporimeter was linear (until 120 g/m(2)h. With volar forearm and palm of the hand of 10 healthy volunteers the reproducibility of the measurements was 8.0 and 10.1%. The closed chamber technique solves the drawbacks related to open chamber evaporimeters. Especially, it extends the measurement range to high evaporation rates and TEWL measurements can be performed practically at any anatomical sites and measurement angle. By the use of a closed chamber the disturbance related to external or body-induced air flows on the measurement can be avoided.

A 61-year-old man with erythematous forearm papules three months after liver transplantation.

PubMed

Ayrapetyan, Mesrop; Googe, Paul B; Jolly, Puneet; Levinson, Kara; Popowitch, Elena; Lachiewicz, Anne M

2018-06-01

A 61-year-old Caucasian man presented with papules on his left forearm and hand three months after liver transplantation: images from physical exam, pathology, and microbiology are presented. Skin biopsy confirmed the presence of fungal elements within the hair shaft, which is consistent with Majocchi granuloma, also known as nodular granulomatous perifolliculitis. A combination of fungal culture, microscopic morphology, and gene sequencing was used to identify the causative organism. The patient recovered with appropriate systemic antifungal therapy. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A Case Study: Business Process Reengineering at Raymond W. Bliss Army Community Hospital

DTIC Science & Technology

1997-05-01

0.6545 $2,058 3 1.9635 $6,174 Tendonitis, myositis, 8 bursitis 0.6601 $2,076 3 1.9803 $6,227 Fx, sprain, strain, 8 disloc of forearm, hand, foot age 0... bursitis 0.6601 $1,230 2 1.3202 $2,461 Fx, sprain, strain, 8 disloc. of forearm, hand, foot age 0-1 0.3952 $737 13 5.1376 $9,577 Fx sprain, strain, disloc...myositis, & bursitis 0.6601 $1,696 3 1.9803 Fx, sprain, strain, Sdisloc. c-’oresrm. hand, foot age C 0.3952 $1.015 1 0.3952 Other skin, subcut

A new mini-invasive technique in treating pediatric diaphyseal forearm fractures by bioabsorbable elastic stable intramedullary nailing: a preliminary technical report.

PubMed

Sinikumpu, J-J; Keränen, J; Haltia, A-M; Serlo, W; Merikanto, J

2013-01-01

Operative treatment is often indicated in unstable pediatric diaphyseal forearm fractures. Recently minimally invasive reduction and elastic stable intramedullary nailing have been of increasing interest, instead of open reduction and internal fixation with plates. There are several disadvantages of metallic intramedullary implants, such as soft-tissue irritation and a risk of disturbing later imaging. Thus, they are generally removed in later operations. We aimed to develop a new technique to stabilize pediatric forearm fractures by the bioabsorbable intramedullary nailing. We developed a new, two-stage mini-invasive surgical technique to stabilize the unstable diaphyseal fractures in children. The procedure is bioabsorbable elastic stable intramedullary nailing. Ultra-high-strength bioabsorbable intramedullary nails of poly(lactide-co-glycolide) were manufactured for our purpose. The material has been widely proven to be biocompatible and stable enough for fracture treatment as screws and pins. We have used the new technique in the unstable both-bone diaphyseal forearm fractures in children between the ages of 5 and 15 years. We report the technique and our clinical experience in the series of those three cases that have been followed up for at least 12 months. The present series has been randomized for the procedure instead for titanium elastic stable intramedullary nailing, and the series represents a part of ongoing randomized trial. The reported cases operated by the new technique referred good union in the fractured bones and acceptable alignment in the follow-up. Removal of the implants was not required. No troubles with the procedure or implant per se were noticed, indicating good feasibility. One high-energy refracture occurred half year after the primary trauma. Traditional titanium implants were used to control the refracture. We report our preliminary experience of a new surgical mini-invasive procedure to stabilize the unstable pediatric forearm shaft fractures by bioabsorbable elastic stable intramedullary nailing. Our clinical experience suggests that the procedure combined with long-arm casting is feasible in treating the pediatric forearm fractures. The technique may bring benefits to handling these challenging fractures. The disadvantages of metallic implants may be avoided. In addition, removal of the implant will not be required. There was one refracture in the series, but it was due to new high-energy trauma. According to our understanding, it was not related to the type of former osteosynthesis. However, ignoring the good preliminary experience, still we do not have results of the superiority of the procedure over traditional elastic stable intramedullary nailing. Our ongoing randomized multicenter study is aimed to determine its long-term outcome against the present golden standard. Nevertheless, due to encouraging preliminary results, we see it necessary to report the technique.

Blood interference in fiber-optical based fluorescence guided resection of glioma using 5-aminolevulinic acid

NASA Astrophysics Data System (ADS)

Haj-Hosseini, Neda; Lowndes, Shannely; Salerud, Göran; Wårdell, Karin

2011-03-01

Fluorescence guidance in brain tumor resection is performed intra-operatively where bleeding is included. When using fiber-optical probes, the transmission of light to and from the tissue is totally or partially blocked if a small amount of blood appears in front of the probe. Sometimes even after rinsing with saline, the remnant blood cells on the optical probe head, disturb the measurements. In such a case, the corresponding spectrum cannot be reliably quantified and is therefore discarded. The optimal case would be to calculate and take out the blood effect systematically from the collected signals. However, the first step is to study the pattern of blood interference in the fluorescence spectrum. In this study, a fiber-optical based fluorescence spectroscopy system with a laser excitation light of 405 nm (1.4 J/cm2) was used during fluorescence guided brain tumor resection using 5-aminolevulinic acid (5-ALA). The blood interference pattern in the fluorescence spectrum collected from the brain was studied in two patients. The operation situation was modeled in the laboratory by placing blood drops from the finger tip on the skin of forearm and the data was compared to the brain in vivo measurements. Additionally, a theoretical model was developed to simulate the blood interference pattern on the skin autofluorescence. The blood affects the collected fluorescence intensity and leaves traces of oxy and deoxy-hemoglobin absorption peaks. According to the developed theoretical model, the autofluorescence signal is considered to be totally blocked by an approximately 500 μm thick blood layer.

Quantitative pilomotor axon reflex test: a novel test of pilomotor function.

PubMed

Siepmann, Timo; Gibbons, Christopher H; Illigens, Ben M; Lafo, Jacob A; Brown, Christopher M; Freeman, Roy

2012-11-01

Cutaneous autonomic function can be quantified by the assessment of sudomotor and vasomotor responses. Although piloerector muscles are innervated by the sympathetic nervous system, there are at present no methods to quantify pilomotor function. To quantify piloerection using phenylephrine hydrochloride in humans. Pilot study. Hospital-based study. Twenty-two healthy volunteers (18 males,4 females) aged 24 to 48 years participated in 6 studies. Piloerection was stimulated by iontophoresis of 1% phenylephrine. Silicone impressions of piloerection were quantified by number and area. The direct and indirect responses to phenylephrine iontophoresis were compared on both forearms after pre treatment to topical and subcutaneous lidocaine and iontophoresis of normal saline. Iontophoresis of phenylephrine induced piloerection in both the direct and axon reflex–mediated regions, with similar responses in both arms. Topical lidocaine blocked axon reflex–mediated piloerection post-iontophoresis (mean [SD], 66.6 [19.2] for control impressions vs 7.2 [4.3] for lidocaine impressions;P.001). Subcutaneous lidocaine completely blocked piloerection.The area of axon reflex–mediated piloerection was also attenuated in the lidocaine-treated region postiontophoresis (mean [SD], 46.2 [16.1]cm2 vs 7.2 [3.9]cm2; P.001). Piloerection was delayed in the axon reflex region compared with the direct region. Normal saline did not cause piloerection. Phenylephrine provoked piloerection directly and indirectly through an axon reflex–mediated response that is attenuated by lidocaine. Piloerection is not stimulated by iontophoresis of normal saline alone.The quantitative pilomotor axon reflex test (QPART) may complement other measures of cutaneous autonomic nerve fiber function.

[Not Available].

PubMed

Hainschitz, I; Rieger, K; Siegl, H

2002-06-01

In Austria an index of 3 μg/kg of Ochratoxin A for coffee, 0,3 μg/kg for fruit juices and 0,2 μg/kg for beer is discussed. The laboratory of the food inspection authority of the state of Vorarlberg investigated the contribution of selected foodstuffs to the daily OTA intake and compared it with the recommendation of the scientific food committee of the EC. The focal point of this study was on beverages (coffee, coffee substitutes, beer and fruit juices) and their ingredients.ZUSAMMENFASSUNG: Die Untersuchungsergebnisse von Bier, Fruchtsaft und Kaffee [Diagramm 1] zeigen, dass die Mehrzahl der Proben nur sehr schwach bis gar nicht belastet waren. Die OTA-Belastung lag bei der Mehrzahl der Proben unter der Nachweisgrenze von 0,3 μg/kg bzw. 0,01μg/1. Einzelne Proben waren aber erheblich belastet, sodass bei starkem Konsum (Fruchtsaft im Sommer) eine überschreitung der vom SCF vorgeschlagenen Höchstmenge nicht auszuschließen ist. Die Ergebnisse der Kaffeemitteluntersuchung [Diagramm 2] belegen eine höhere OTA-Belastung bei mehr als der Hälfte der Proben. Wenn die vom SCF vorgeschlagene Höchstaufnahme von 5 ng pro Tag und kg Körpergewicht zu Grunde gelegt wird, resultiert für eine 60 kg schwere Person ein Wert von 0,3 μg/Tag. Das bedeutet bei einem mit 100 μg/kg OTA kontaminierten Kaffeeersatz und dem Konsum nur einer Tasse (5 - 7 g Pulver), dass alleine aus dieser Quelle diese Höchstaufnahme deutlich überschritten wird. Der Eintrag über die restliche Nahrung wie Cerealien, die für etwa die Hälfte der OTA-Aufnahme verantwortlich sind, bleibt hier unberücksichtigt. Die Untersuchungen belegen, dass die Einhaltung der in österreich vorgeschlagenen Richtwerte bei Bier, Fruchtsäften und Kaffee keine Schwierigkeiten bereitet. Für Kaffeemittel und andere Trockenfrüchte als Weintrauben [3] wurde allerdings noch kein Richtwert vorgeschlagen. Die Ergebnisse belegen aber, dass gerade für Kaffemittel und verschiedene Trockenfrüchte vor dem Hintergrund fehlender Höchstwerte ein Richtwert in der Größenordnung von 3 μg/kg bzw. 10 μg/kg hilfreich wäre, bis die Festlegung der gemeinschaftsrechtlicher Höchstgehalte erfolgt. Mit Hinblick auf die in der Einleitung beschriebene toxische Wirkung von OTA ist es im Sinne eines vorbeugenden Verbraucherschutzes wichtig, diese hochbelasteten Chargen zu erkennen und aus dem Verkehr zu nehmen. Ursache für die OTA-Kontamination ist vor allem eine mangelhafte Produktionshygiene in den Erzeugerländern. Dort liegt auch das größte Potential für eine Verringerung der OTA-Belastung. Die überprüfung der Lebensmittel auf Ochratoxin A durch die amtliche Lebensmittelkontrolle ist ein notwendiger Beitrag zum Schutz der öffentlichen Gesundheit und zur weiteren Reduktion der Aufnahme.

[Effect of Subcutaneous Injection of Lidocaine in Zusanli (ST 36) and Jiaji (EX-B 2) Regions on Immune Function in Patients Undergoing Laparoscopic Cholecystectomy].

PubMed

Meng, Xin-liang; Qu, Qiang

2016-02-01

To observe the effect of acupoint injection of Lidocaine on serum IL-1β, TNF-α and T-lymphocyte subset activities in patients undergoing laparoscopic cholecystectomy (LC), so as to reveal its mechanisms underlying relieving postoperative pain and potentiating rehabilitation. Eighty patients scheduled for elective LC surgery (grade I or II, according to American Standards of Association, ASA) were randomly divided into four groups, namely intravenous analgesia (IVA) , right forearm-injection (forearm-), Jiaji (EX-B 2, Thorax 8)-injection (EX-B 2-1), and Zusanli-injection (ST 36-1), with 20 patients in each group. The conventional anesthetic induction and maintenance with Penehyclidine Hydrochloride, Midazolam, Sulfentanil, Propofol, Atracurium Besilate, and Remifentanil were same in all the 4 groups. For patients of the forearm-I, EX-B 2-I and ST 36-1 groups, 5% Lidocaine was injected into the subcutaneous layer of the anterior side of right forearm near the elbow, EX-B 2 and ST 36 regions, respectively. Analgesia pump (filled with Sulfentanil, Ramosetron + normal saline) was connected af- ter the tracheal extubation. The visual analog scale (VAS) was used to assess the patient's pain reaction after tracheal extubation (T 1), and 6 h (T 2), 24 h (T 3) and 48.h (T 4) after surgery. The times of RCA pressing and the total dose of Sufentanil in the process of postoperative analgesia were recorded as well. The contents of serum IL-1β and TNF-α were analyzed by ELISA, and the counts of CD4+ and CD+ T cells were detected by flow cytometry. Compared with T 1 in the same one group, the VAS scores at time-points of T 2, T 3 and T 4 after surgery of all the IVA, forearm-1, ST 36- and EX-B 2- groups were reduced significaantly (P < 0.05). The times of PCA-pump pressing and the doses of the administrated Sufentanil were considerably lower in the ST 36-1 and EX-B 2-I groups than in the IVA and forearm-I groups (P < 0.05). In comparison with pre-anesthesia in the same one group, serum TNF-α and IL-1β contents at T 1 were remarkably increased, while the ratios of CD⁴⁺/CD⁸⁺ at T 4 in the 4 groups were evidently down-regulated (P < 0.05). The contents of serum TNF-α and IL-1β at T 3 and T 4 were obviously lower in both ST 36-1 and EX-B 2-1 groups than in the IVA and forearm-I groups (P < 0.05). No significant differences were found among the 4 groups in the VAS scores at the 4 time-points, in the serum TNF-α and IL-1β contents at T 0 and T 1, in the counts of CD⁴⁺ and CD⁸⁺ T cells and ratios of CD⁴⁺/CD⁸⁺ at T 0, T 3 and T 4, and between the ST 36-1 and EX-B 2-groups in all the 8 indexes (P > 0.05). Acupoint injection of Lidocaine is effective in relieving pain in LC patients, which is demonstrated by reducing VAS score, PCA pump pressing times, and administrated Sufentanil dose, and may be associated with its effects in down-regulating serum TNF-α and IL-1β contents.

Differential Effects of Nebivolol vs Metoprolol on Functional Sympatholysis in Hypertensive Humans

PubMed Central

Price, Angela; Raheja, Prafull; Wang, Zhongyun; Arbique, Debbie; Adams-Huet, Beverley; Mitchell, Jere H.; Victor, Ronald G.; Thomas, Gail D.; Vongpatanasin, Wanpen

2013-01-01

In young healthy humans, sympathetic vasoconstriction is markedly blunted during exercise to optimize blood flow to the metabolically active muscle. This phenomenon known as functional sympatholysis is impaired in hypertensive humans and rats by angiotensin II-dependent mechanisms involving oxidative stress and inactivation of nitric oxide (NO). Nebivolol is a β1−adrenergic receptor blocker that has NO-dependent vasodilatory and antioxidant properties. We therefore asked if nebivolol would restore functional sympatholysis in hypertensive humans. In 21 subjects with stage I hypertension, we measured muscle oxygenation and forearm blood flow (FBF) responses to reflex increases in sympathetic nerve activity (SNA) evoked by lower body negative pressure (LBNP) at rest and during rhythmic handgrip exercise at baseline, after 12 weeks of nebivolol (5–20 mg/day), or metoprolol (100–300 mg/day), using a double-blind crossover design. We found that nebivolol had no effect on LBNP-induced decreases in oxygenation and FBF in resting forearm (from −29±5 to −30±5% and from −29±3 to −29±3%, respectively; p=NS). However, nebivolol attenuated the LBNP-induced reduction in oxygenation and FBF in exercising forearm (from −14±4% to −1±5% and from −15 ±2% to −6±2%, respectively, both p < 0.05). This effect of nebivolol on oxygenation and FBF in exercising forearm was not observed with metoprolol in the same subjects despite a similar reduction in BP. Nebivolol had no effect on SNA at rest or during handgrip, suggesting a direct effect on vascular function. Thus, our data demonstrate that nebivolol restored functional sympatholysis in hypertensive humans by a mechanism that does not involve β1-adrenergic receptors. PMID:23547240

Comparison of the mechanical properties of different skin sites for auricular and nasal reconstruction.

PubMed

Griffin, M F; Leung, B C; Premakumar, Y; Szarko, M; Butler, P E

2017-04-18

Autologous and synthetic nasal and auricular frameworks require skin coverage. The surgeon's decides on the appropriate skin coverage for reconstruction based on colour matching, subcutaneous tissue thickness, expertise and experience. One of the major complications of placing subcutaneous implants is the risk of extrusion (migration through the skin) and infection. However, knowledge of lessening the differential between the soft tissue and the framework can have important implications for extrusion. This study compared the mechanical properties of the skin commonly used as skin sites for the coverage in auricular and nasal reconstruction. Using ten fresh human cadavers, the tensile Young's Modulus of the skin from the forehead, forearm, temporoparietal, post-auricular and submandibular neck was assessed. The relaxation rate and absolute relaxation level was also assessed after 90 min of relaxation. The submandibular skin showed the greatest Young's elastic modulus in tension of all regions (1.28 MPa ±0.06) and forearm showed the lowest (1.03 MPa ±0.06). The forehead demonstrated greater relaxation rates among the different skin regions (7.8 MPa -07  ± 0.1). The forearm showed the lowest rate of relaxation (4.74 MPa -07  ± 0.1). The forearm (0.04 MPa ±0.004) and submandibular neck skin (0.04 MPa ±0.005) showed similar absolute levels of relaxation, which were significantly greater than the other skin regions (p < 0.05). This study provides an understanding into the biomechanical properties of the skin of different sites allowing surgeons to consider this parameter when trying to identify the optimal skin coverage in nasal and auricular reconstruction.

The Effect of Two Different Hand Exercises on Grip Strength, Forearm Circumference, and Vascular Maturation in Patients Who Underwent Arteriovenous Fistula Surgery

PubMed Central

Kong, Sangwon; Lee, Kyung Soo; Kim, Junho

2014-01-01

Objective To compare the effect of two different hand exercises on hand strength and vascular maturation in patients who underwent arteriovenous fistula surgery. Methods We recruited 18 patients who had chronic kidney disease and had undergone arteriovenous fistula surgery for hemodialysis. After the surgery, 10 subjects performed hand-squeezing exercise with GD Grip, and other 8 subjects used Soft Ball. The subjects continued the exercises for 4 weeks. The hand grip strength, pinch strength (tip, palmar and lateral pinch), and forearm circumference of the subjects were assessed before and after the hand-squeezing exercise. The cephalic vein size, blood flow velocity and volume were also measured by ultrasonography in the operated limb. Results All of the 3 types of pinch strengths, grip strength, and forearm circumference were significantly increased in the group using GD Grip. Cephalic vein size and blood flow volume were also significantly increased. However, blood flow velocity showed no difference after the exercise. The group using Soft Ball showed a significant increase in the tip and lateral pinch strength and forearm circumference. The cephalic vein size and blood flow volume were also significantly increased. On comparing the effect of the two different hand exercises, hand-squeezing exercise with GD Grip had a significantly better effect on the tip and palmar pinch strength than hand-squeezing exercise with Soft Ball. The effect on cephalic vein size was not significantly different between the two groups. Conclusion The results showed that hand squeezing exercise with GD Grip was more effective in increasing the tip and palmar pinch strength compared to hand squeezing exercise with soft ball. PMID:25379494

Sildenafil Increases Sympathetically Mediated Vascular Tone in Humans

PubMed Central

2013-01-01

BACKGROUND Sildenafil, a selective phosphodiesterase-type-5 (PDE-5) inhibitor, produces vasodilation that improves erectile dysfunction and pulmonary hypertension. Sildenafil could also cause baroreflex sympathetic activation that would enhance vascular tone and oppose direct vasodilation. We tested the hypothesis that sildenafil administration increases sympathetically mediated vascular tone in healthy middle-aged men. METHODS We randomized 9 healthy, middle-aged, male volunteers (mean age 45±2 years) in a double-blind, crossover fashion to receive a single oral dose of sildenafil 100mg or placebo on 2 separate study days. Hemodynamics and forearm blood flow responses were measured at baseline, at 30 and 45 minutes after study drug administration, and then during intra-arterial infusions of vasoactive drugs. After sildenafil and placebo administration, intrabrachial medications were infused to test forearm alpha receptor sensitivity (norepinephrine), cyclic-AMP–mediated vasodilation (isoproterenol), and sympathetically mediated vascular tone (phentolamine) (adenosine was a control vasodilator). Blood samples were taken before and 60 minutes after study drug administration and at the end of the intrabrachial infusions for measurement of plasma norepinephrine concentrations. RESULTS Forearm vascular responses to norepinephrine, isoproterenol, and adenosine were not different after placebo and sildenafil administration. Percentage reduction in forearm vascular resistance during phentolamine was significantly lower after sildenafil than placebo (−73% ± 3% vs −63% ± 3%; P = 0.0002). Sildenafil significantly increased plasma norepinephrine compared with placebo 60 minutes after study drug administration and at the end of the study session (P = 0.02). CONCLUSIONS Sildenafil increased sympathetically mediated vascular tone in middle-aged healthy men. Alpha-adrenergic–mediated vasoconstriction may offset vasodilation during PDE-5 inhibition and may explain the significant hypotension observed in patients taking alpha-blockers with sildenafil. PMID:23443723

Effects of glycolic acid on light-induced skin pigmentation in Asian and caucasian subjects.

PubMed

Tsai, T F; Bowman, P H; Jee, S H; Maibach, H I; Paul, B H

2000-08-01

Topical use of alpha-hydroxy acid (AHA) may increase skin photosensitivity, as demonstrated by increased numbers of sunburst cells. However, effects of AHA on tanning have not been studied. Our purpose was to study whether short-term use of glycolic acid hastens resolution of pre-existing light-induced pigmentation and whether the skin becomes tan more easily in Asian and Caucasian subjects after such treatment. Six Asian and six Caucasian volunteers received separate irradiations of UVB and UVA to both sides of the lower back. In a double-blind fashion, patients then applied a 10% glycolic acid gel, pH 3.52, to one side of the back, including the irradiated area, and the contralateral extensor forearms once daily for 7 days and then twice daily for 2 weeks. A placebo gel, pH 5.75, was applied to the opposite sides. The subjects returned for measurement of residual tanning with a colorimeter and received additional irradiation to forearms and a second site on the back. Resulting pigmentation was measured immediately after irradiation, at 2 hours, and at 1 week. Increased UVB-induced skin tanning occurred on the forearm and the lower back in both races in areas pretreated with glycolic acid. UVA also caused increased tanning, but only on the extensor forearms in Asian subjects. Treatment with glycolic acid for 3 weeks had no effect on pre-existing light-induced pigmentation. Short-term topical treatment of glycolic acid caused an increase in UVB tanning as well as in UVA tanning in some subjects, even in the absence of overt irritation. The inclusion of UVB, and even UVA, sunscreen in AHA products may be warranted.

Measures of total stress-induced blood pressure responses are associated with vascular damage.

PubMed

Nazzaro, Pietro; Seccia, Teresa; Vulpis, Vito; Schirosi, Gabriella; Serio, Gabriella; Battista, Loredana; Pirrelli, Anna

2005-09-01

The role of cardiovascular reactivity to study hypertension, and the assessment methods, are still controversial. We aimed to verify the association of hypertension and vascular damage with several measures of cardiovascular response. We studied 40 patients with normal-high (132 +/- 1/87 +/- 1 mm Hg) blood pressure (Group 1) and 80 untreated hypertensive subjects. Postischemic forearm vascular resistance (mFVR) served to differentiate hypertensive subjects (142 +/- 2/92 +/- 1 mm Hg v 143 +/- 2/94 +/- 2 mm Hg, P = NS) with a lower (Group 2) and higher (Group 3) hemodynamic index of vascular damage (4.8 +/- .05 v 6.3 +/- .09, P < .001). Reactivity was induced by Stroop (5') and cold pressor (90") tests. We measured muscular contraction and skin conductance as indices of emotional arousal, blood pressure, heart rate, forearm blood flow, and vascular resistance. Reactivity measures included: a) change from baseline, b) residualized score, c) cumulative change from baseline and residualized score, and d) total reactivity as area-under-the-curve (AUC), including changes occurring during baseline and recovery phases. The AUC of systolic blood pressure, diastolic blood pressure, and mFVR progressively increased in the groups (P < .001). Corrections of anthropometric and metabolic confounders were introduced in the Pearson equation between mFVR and reactivity measures. The AUC of SBP, DBP, and forearm blood flow and resistance demonstrated the highest (P < .001) correlation. On multiple regression analysis, AUC of SBP (beta = 0.634) and forearm blood flow (beta = -0.337) were predictive (P < .001) of vascular damage. Total blood pressure stress response, as AUC, including baseline and recovery phases, was significantly better associated with hypertension and vascular damage than the other reactivity measures studied.

Procedure Oriented Torsional Anatomy of the Forearm for Spasticity Injection.

PubMed

Chiou-Tan, Faye; Cianca, John; John, Joslyn; Furr-Stimming, Erin; Pandit, Sindhu; Taber, Katherine H

2015-01-01

: This is the second in a series of articles related to the concept of "torsional" anatomy. The objective of this article is to provide musculoskeletal ultrasound (MSKUS) anatomy of the forearm in the position of hemispastic flexion as a reference relevant to needle procedures. The MSKUS images were obtained in a healthy human subject. Marker dots were placed over common injection sites in the forearm for spasticity. The MSKUS probe was centered over each dot to obtain a cross-sectional view. A pair of MSKUS images was recorded for each site: the first in anatomic neutral and second in hemiparetic spastic position. The images were compared side to side. In addition, a video recording was made at each site to track the movement of the muscles and nerves during internal rotation. The pronator teres (PT) rotated medially and the brachialis and biceps tendon rotated in view. In addition, the median nerve became more superficial. The flexor carpi radialis rotated medially and was replaced by PT and the median nerve. The flexor carpi ulnaris and flexor digitorum profundus rotated medially and were replaced by the flexor carpi radialis, PT and median nerve. The flexor digitorum superficialis was replaced by the brachioradialis, extensor carpi radialis brevis, and radial nerve. The brachioradialis was replaced by the extensor carpi radialis brevis and extensor digitorum communis. Intended muscle targets rotate out of view and injection range. These are replaced by other muscles and nerves that could inadvertently be injected. This potentially could result in both increased complications and decreased efficacy of the procedure. It is hoped that this series of images will increase the accuracy and safety of needle placement for spasticity injections in the forearm.

Tribological testing of skin products: gender, age, and ethnicity on the volar forearm.

PubMed

Sivamani, Raja K; Wu, Gabriel C; Gitis, Norm V; Maibach, Howard I

2003-11-01

Few studies have focused on the simultaneous measurement of the friction and electrical properties of skin. This work investigates the feasibility of using these measurements to differentiate between the effects of chemicals commonly applied to the skin. In addition, this study also compares the condition of the skin and its response to application of chemicals across gender, ethnicity, and age at the volar forearm. Friction and electrical tests were performed on 59 healthy volunteers with the UMT Series Micro-Tribometer (UMT). A 13-mm-diameter copper cylindrical friction/electrical probe was pressed onto the skin with a weight of 20 g and moved across the skin at a constant velocity of 0.4 mm/s. Each volunteer served as his or her own control. The friction and electrical impedance measurements were performed for polyvinylidene chloride occlusion and for the application of glycerin and petrolatum. No differences were found across age, gender, or ethnicity at the volar forearm. Polyvinylidene chloride (PVDC) occlusion showed a small increase in the friction and a small decrease in the electrical impedance; petrolatum increased the friction by a greater amount but its effect on the impedance was comparable to PVDC occlusion; glycerin increased the friction by an amount comparable to petrolatum, but it decreased the impedance to a much greater degree than petrolatum or the PVDC occlusion. An amplitude/mean measurement of the friction curves of glycerin and petrolatum showed that glycerin has a significantly higher amplitude/mean than petrolatum. The properties of the volar forearm appear to be independent of age, gender, and ethnicity. Also, the simultaneous measurement of friction and electrical impedance was useful in differentiating between compounds administered to the skin.

Effects of Aged Stored Autologous Red Blood Cells on Human Endothelial Function

PubMed Central

Kanias, Tamir; Triulzi, Darrel; Donadee, Chenell; Barge, Suchitra; Badlam, Jessica; Jain, Shilpa; Belanger, Andrea M.; Kim-Shapiro, Daniel B.

2015-01-01

Rationale: A major abnormality that characterizes the red cell “storage lesion” is increased hemolysis and reduced red cell lifespan after infusion. Low levels of intravascular hemolysis after transfusion of aged stored red cells disrupt nitric oxide (NO) bioavailabity, via accelerated NO scavenging reaction with cell-free plasma hemoglobin. The degree of intravascular hemolysis post-transfusion and effects on endothelial-dependent vasodilation responses to acetylcholine have not been fully characterized in humans. Objectives: To evaluate the effects of blood aged to the limits of Food and Drug Administration–approved storage time on the human microcirculation and endothelial function. Methods: Eighteen healthy individuals donated 1 U of leukopheresed red cells, divided and autologously transfused into the forearm brachial artery 5 and 42 days after blood donation. Blood samples were obtained from stored blood bag supernatants and the antecubital vein of the infusion arm. Forearm blood flow measurements were performed using strain-gauge plethysmography during transfusion, followed by testing of endothelium-dependent blood flow with increasing doses of intraarterial acetylcholine. Measurements and Main Results: We demonstrate that aged stored blood has higher levels of arginase-1 and cell-free plasma hemoglobin. Compared with 5-day blood, the transfusion of 42-day packed red cells decreases acetylcholine-dependent forearm blood flows. Intravascular venous levels of arginase-1 and cell-free plasma hemoglobin increase immediately after red cell transfusion, with more significant increases observed after infusion of 42-day-old blood. Conclusions: We demonstrate that the transfusion of blood at the limits of Food and Drug Administration–approved storage has a significant effect on the forearm circulation and impairs endothelial function. Clinical trial registered with www.clinicaltrials.gov (NCT 01137656) PMID:26222884

Histamine-induced vasodilatation in the human forearm vasculature

PubMed Central

Sandilands, Euan A; Crowe, Jane; Cuthbert, Hayley; Jenkins, Paul J; Johnston, Neil R; Eddleston, Michael; Bateman, D Nicholas; Webb, David J

2013-01-01

Aim To investigate the mechanism of action of intra-arterial histamine in the human forearm vasculature. Methods Three studies were conducted to assess changes in forearm blood flow (FBF) using venous occlusion plethysmography in response to intra-brachial histamine. First, the dose–response was investigated by assessing FBF throughout a dose-escalating histamine infusion. Next, histamine was infused at a constant dose to assess acute tolerance. Finally, a four way, double-blind, randomized, placebo-controlled crossover study was conducted to assess FBF response to histamine in the presence of H1- and H2-receptor antagonists. Flare and itch were assessed in all studies. Results Histamine caused a dose-dependent increase in FBF, greatest with the highest dose (30 nmol min−1) infused [mean (SEM) infused arm vs. control: 26.8 (5.3) vs. 2.6 ml min−1 100 ml−1; P < 0.0001]. Dose-dependent flare and itch were demonstrated. Acute tolerance was not observed, with an increased FBF persisting throughout the infusion period. H2-receptor antagonism significantly reduced FBF (mean (95% CI) difference from placebo at 30 nmol min−1 histamine: −11.9 ml min−1 100 ml−1 (−4.0, −19.8), P < 0.0001) and flare (mean (95% CI) difference from placebo: −403.7 cm2 (−231.4, 576.0), P < 0.0001). No reduction in FBF or flare was observed in response to the H1-receptor antagonist. Itch was unaffected by the treatments. Histamine did not stimulate vascular release of tissue plasminogen activator or von Willebrand factor. Conclusion Histamine causes dose-dependent vasodilatation, flare and itch in the human forearm. H2-receptors are important in this process. Our results support further exploration of combined H1- and H2-receptor antagonist therapy in acute allergic syndromes. PMID:23488545

Age and Hydration dependence of jowl and forearm skin firmness in young and mature women.

PubMed

Mayrovitz, Harvey N; Wong, Jennifer; Fasen, Madeline

2017-12-27

Quantitative assessment of possible linkages between skin's firmness and water content is useful for cosmetic and clinical purposes and to better understand features of advancing age. Our goals were to characterize age-related differential features in skin firmness in women and determine the relationship between skin firmness and indices of skin water. Skin firmness was quantified using handheld devices that measure the force to indent skin 0.3 and 1.3 mm (F0.3 and F1.3). Skin hydration was quantified using handheld devices that measured tissue dielectric constant (TDC) at 300 MHz to skin depths of 0.5 and 2.0-2.5 mm. All parameters were measured bilaterally in the jowl area and volar forearm of 60 women grouped by age <45 years (YOUNG) and ≥45 years old (MATURE). All measured parameters were bilaterally symmetrical at jowl and forearm. Forearm and jowl indentation forces were greater in YOUNG with statistically significant declines with advancing age with regression relations most evident at shallower indentation depths (P < .001). Quantitative relations for arm and jowl were F 0.3 = 0.256 × AGE + 32.7 mN and F 0.3 = -0.07 × AGE + 17.7 mN. Firmness was related to TDC values only when indentation force and TDC were assessed on the arm at the shallowest skin depths, as weakly related to firmness and was observed to change with age only when measured to a depth of 0.5 mm represented by TDC5 = 0.096 × AGE + 32.7. Experimental finding show clear differences in skin firmness between age-groups with skin hydration playing a minor role. Possible explanations and suggestions for further studies are provided. © 2017 Wiley Periodicals, Inc.

[Symbrachydactyly--a roentgenographic and clinical study of 126 cases].

PubMed

Senrui, H

1984-07-01

One hundred and twenty-six cases of symbrachydactyly were analyzed roentgenographically and clinically. This curious anomaly of the hand is sporadic and of unknown etiology. It is predominantly one-sided, either isolated or combined with ipsilateral pectoral muscle defect (fifty-one cases). On X-ray pictures, the skeletal abnormalities of the hands ranged from mild involvement featured with hypoplastic or aplastic middle phalanges to the most severe involvement in which all the phalanges were missing, providing a continuous spectrum. Even in the mildly affected hands hypoplasia involves all the phalanges and metacarpals, most severely in the middle phanges followed by distal, proximal phalanges and metacarpals in turn. The forearms and arms are less affected than the hands. The tendency is observed in the severely affected hands. In the most severely affected hand all the digits are missing, but there exist several finger-buds which carry often nail rudiments. Synostosis is seen in the remaining hypoplastic metacarpals often and in carpals infrequently. Although remarkable shortening and curving forearm bones are observed often, the humeral involvement remains mild. Abnormalities of muscles and tendons are frequently observed in the hand and forearm. The anomaly is classified roentgenographically into three types: Type I (brachydactyly type) which is featured with fingers having three or two phalanges (fifty-four hands), Type II (partial ectrodactyly type) in which one to four digits have only one phalanx or none(thirty-nine hands), and Type III(total ectrodactyly type) in which all the digits have only one phalanx or none (thirty-five hands). The symbrachydactyly seems to be caused by a extensive defect in an undifferentiated mesenchyme of the arm bud at about developmental stage 16, which may later cause a failure of separation of skeletal and muscular tissues of the hand and forearm or an arrest in their development.

[Evaluation and Optimization of Microvascular Arterial Anastomoses by Transit Time Flow Measurement].

PubMed

Herberhold, S; Röttker, J; Bartmann, D; Solbach, A; Keiner, S; Welz, A; Bootz, F; Laffers, W

2016-03-01

INDRODUCTION: The regular application of transit time flow measurement in microvascular anastomoses during heart surgery has lead to improvements of the outcome of coronary artery bypass grafts. Our study was meant to discover whether this measurement method was also applicable for evaluation and optimization of microvascular arterial anastomoses of radial forearm flaps. In this prospective examination a combining ultrasound imaging and transit time flow measurement device (VeriQ, MediStim) was used during surgery to assess anastomotic quality of 15 radial forearm flaps. Pulsatility index (PI) and mean blood flow were measured immediately after opening the arterial anastomosis as well as 15 min afterwards. Furthermore, application time and description of handling were recorded seperately for every assessment. Mean blood flow immediately after opening the anastomosis and 15 min later were 3.9 and 3.4 ml/min resepectively showing no statistically significant difference (p=0.96). There was no significance in the increase of pulsatility index from 22.1 to 27.2 (p=0.09) during the same time range, either. Due to measurement results showing atypical pulse curves in 2 cases decision for surgical revision of the anastomoses was made. All forearm flaps showed good vascularisation during follow-up. Time for device set up, probe placement and measurements was about 20 min. Handling was described to be uncomplicated without exception. There were no noteworthy problems. Transit time flow measurement contributes to the improvement of anastomotic quality and therefore to the overall outcome of radial forearm flaps. The examined measurement method provides objective results and is useful for documentation purposes. © Georg Thieme Verlag KG Stuttgart · New York.

Parecoxib increases muscle pain threshold and relieves shoulder pain after gynecologic laparoscopy: a randomized controlled trial.

PubMed

Zhang, Hufei; Liu, Xinhe; Jiang, Hongye; Liu, Zimeng; Zhang, Xu-Yu; Xie, Hong-Zhe

2016-01-01

Postlaparoscopic shoulder pain (PLSP) remains a common problem after laparoscopies. The aim of this study was to investigate the correlation between pressure pain threshold (PPT) of different muscles and PLSP after gynecologic laparoscopy, and to explore the effect of parecoxib, a cyclooxygenase-2 inhibitor, on the changes of PPT. The patients were randomly allocated into two groups; group P and group C. In group P, parecoxib 40 mg was intravenously infused at 30 minutes before surgery and 8 and 20 hours after surgery. In group C, normal saline was infused at the corresponding time point. PPT assessment was performed 1 day before surgery and at postoperative 24 hours by using a pressure algometer at bilateral shoulder muscles (levator scapulae and supraspinatus) and forearm (flexor carpi ulnaris). Meanwhile, bilateral shoulder pain was evaluated through visual analog scale score at 24 hours after surgery. Preoperative PPT level of the shoulder, but not of the forearm, was significantly and negatively correlated with the intensity of ipsilateral PLSP. In group C, PPT levels of shoulder muscles, but not of forearm muscles, decreased after laparoscopy at postoperative 24 hours. The use of parecoxib significantly improved the decline of PPT levels of bilateral shoulder muscles (all P <0.01). Meanwhile, parecoxib reduced the incidence of PLSP (group P: 45% vs group C: 83.3%; odds ratio: 0.164; 95% confidence interval: 0.07-0.382; P <0.001) and the intensity of bilateral shoulder pain (both P <0.01). Preoperative PPT levels of shoulder muscles are closely associated with the severity of shoulder pain after gynecologic laparoscopy. PPT levels of shoulder muscles, but not of forearm muscles, significantly decreased after surgery. Parecoxib improved the decrease of PPT and relieved PLSP.

Evaluation of parathyroid autograft growth and function in hemodialysis patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Karsenty, G.; Petraglia, A.; Bourdeau, A.

1986-07-01

The aim of our study was to evaluate the function and growth of parathyroid tissue autografted into the forearm of hemodialysis patients using several presently available methods. In a dynamic study, the secretory function of autografted tissue was evaluated in seven patients using either zero calcium dialysate or calcium infusion. In an additional prospective study, seven patients had repeated determinations of plasma immunoreactive parathyroid hormone (iPTH) concentration on samples from both forearms, a radionuclide evaluation of autograft function using thallium-201 chloride, and real time ultrasonography. Light microscopy analysis was performed in two patients. The dynamic study demonstrated that induction ofmore » hypocalcemia was followed by an increase, and induction of hypercalcemia by a decrease in circulating iPTH in both forearms using three different radioimmunoassays similar to what has been reported for normal parathyroid tissue. A significant gradient (ie, greater than 2.0) of plasma iPTH concentration in samples from both forearms was observed in only three out of the seven patients of the prospective study. Two of these patients disclosed an increased uptake of /sup 201/TI chloride at the site of autografted tissue and had an echographically detectable mass. In both, hyperplastic parathyroid tissue was removed. At present, the remaining third patient does not have other features of recurrent hyperparathyroidism. In conclusion, autotransplanted parathyroid tissue of hemodialysis patients shows an adequate response to physiologic stimuli such as hypo- and hypercalcemia. Dynamic tests, therefore, appear to be a useful tool in the assessment of its function. In addition, radionuclide and echographic studies may be reliable adjuncts in the detection of marked parathyroid autograft hyperplasia.« less

Effect of repeated forearm muscle cooling on the adaptation of skeletal muscle metabolism in humans

NASA Astrophysics Data System (ADS)

Wakabayashi, Hitoshi; Nishimura, Takayuki; Wijayanto, Titis; Watanuki, Shigeki; Tochihara, Yutaka

2017-07-01

This study aimed to investigate the effect of repeated cooling of forearm muscle on adaptation in skeletal muscle metabolism. It is hypothesized that repeated decreases of muscle temperature would increase the oxygen consumption in hypothermic skeletal muscle. Sixteen healthy males participated in this study. Their right forearm muscles were locally cooled to 25 °C by cooling pads attached to the skin. This local cooling was repeated eight times on separate days for eight participants (experimental group), whereas eight controls received no cold exposure. To evaluate adaptation in skeletal muscle metabolism, a local cooling test was conducted before and after the repeated cooling period. Change in oxy-hemoglobin content in the flexor digitorum at rest and during a 25-s isometric handgrip (10% maximal voluntary construction) was measured using near-infrared spectroscopy at every 2 °C reduction in forearm muscle temperature. The arterial blood flow was occluded for 15 s by upper arm cuff inflation at rest and during the isometric handgrip. The oxygen consumption in the flexor digitorum muscle was evaluated by a slope of the oxy-hemoglobin change during the arterial occlusion. In the experimental group, resting oxygen consumption in skeletal muscle did not show any difference between pre- and post-intervention, whereas muscle oxygen consumption during the isometric handgrip was significantly higher in post-intervention than in pre-test from thermoneutral baseline to 31 °C muscle temperature ( P < 0.05). This result indicated that repeated local muscle cooling might facilitate oxidative metabolism in the skeletal muscle. In summary, skeletal muscle metabolism during submaximal isometric handgrip was facilitated after repeated local muscle cooling.

[Life experience of adults with unilateral agenesia of the forearm: effect of prosthesis on self image and social relations].

PubMed

Choumon, B; Fischer, S; Greco, J; Ritz, A; Bérard, C

2006-02-01

This study was devoted to better understanding how adults with agenesia of the forearm live their condition. The malformation studied was identical to that of a previous study in children. The present study was designed to provide professionals and parents with a reference system for making therapeutic decisions. An intensive survey using semi-directive interviews was conducted among adults aged 19 to 37 years, 12 women and 8 men, with unilateral agenesia of the forearm. The majority of the participants had an occupation and an active social and familial life. The survey revealed factors of limitation or progress, expectations and renouncements, marking the life experience of these persons. The prosthesis had a significant impact on their lives. Four types of life experience could be identified from the survey data. All four could be understood as a search for equilibrium between internal reality (desired self image) and external reality (image produced by the physical and human environment via the regards of others and obstacles encountered). Several modalities for using a prosthesis, several ways of coping with the absence of a hand, with or without a prosthesis, and several ways of constructing a self-representation were distinguished. Rather than a functional disability, agenesia was found to be perceived as a persistent problem in daily life, generating handicap- or discrimination-producing situations. Forearm agenesia creates a situation different from normal and as such makes the question of self-identity and social relations more complex than for others. The comments provided by these young adults who cope with the paradoxical condition of an amputated but functional body demonstrated the central role of the body.

Peroneal perforator-based peroneus longus tendon and sural neurofasciocutaneous composite flap transfer for a large soft-tissue defect of the forearm: A case report.

PubMed

Hayashida, Kenji; Saijo, Hiroto; Fujioka, Masaki

2018-01-01

We describe the use of a composite flap composed of a sural neurofasciocutaneous flap and a vascularized peroneus longus tendon for the reconstruction of severe composite forearm tissue defects in a patient. A 43-year-old man had his left arm caught in a conveyor belt resulting in a large soft-tissue defect of 18 × 11 cm over the dorsum forearm. The extensor carpi radialis, superficial radial nerve, and radial artery were severely damaged. A free neurofasciocutaneous composite flap measuring 16 × 11 cm was outlined on the patient's left lower leg to allow simultaneous skin, tendon, nerve, and artery reconstruction. The flap, which included the peroneus longus tendon, was elevated on the subfascial plane. After the flap was transferred to the recipient site, the peroneal artery was anastomosed to the radial artery in a flow-through manner. The vascularized tendon graft with 15 cm in length was used to reconstruct the extensor carpi radialis longus tendon defect using an interlacing suture technique. As the skin paddle of the sural neurofasciocutaneous flap and the vascularized peroneus longus tendon graft were linked by the perforator and minimal fascial tissue, the skin paddle was able to rotate and slide with comparative ease. The flap survived completely without any complications. The length of follow-up was 12 months and was uneventful. Range of motion of his left wrist joint was slightly limited to 75 degrees. This novel composite flap may be useful for reconstructing long tendon defects associated with extensive forearm soft tissue defects. © 2016 Wiley Periodicals, Inc.

Effect of voluntary hypocapnic hyperventilation on cutaneous circulation in resting heated humans.

PubMed

Fujii, Naoto; Honda, Yasushi; Delliaux, Stephane; Tsuji, Bun; Watanabe, Kazuhito; Sugihara, Akira; Kondo, Narihiko; Nishiyasu, Takeshi

2012-11-01

Hypocapnia attenuates the sweat response normally seen in hyperthermic resting subjects, but its effect on the blood flow response in their nonglabrous skin under the same hyperthermic conditions remains unclear. In the present study, we investigated whether hypocapnia induced by voluntary hyperventilation affects the blood flow response to heat stress in the nonglabrous skin of resting humans. Nine healthy male subjects were passively heated using legs-only hot water immersion and a water-perfused suit, which caused esophageal temperature (T(es)) to increase by as much as 1.0°C. During normothermia and at +0.6°C T(es) and +1.0°C T(es), the subjects performed two voluntary 7-min hyperventilation (minute ventilation = 40 l/min) trials (hypocapnic and eucapnic) in random order. End-tidal CO(2) pressure was reduced by 23-25 torr during hypocapnic hyperventilation, but it was maintained at the spontaneous breathing level during eucapnic hyperventilation. Cutaneous blood flow was evaluated as the cutaneous red blood cell flux in the forearm (CBF(forearm)) or forehead (CBF(forehead)) and was normalized to the normothermic spontaneous breathing value. Hypocapnic hyperventilation at +0.6°C T(es) was associated with significantly reduced CBF(forearm), compared with eucapnic hyperventilation, after 5-7 min of hyperventilation (395 to 429 vs. 487 to 525% baseline, P < 0.05). No significant difference in CBF(forehead) was seen during hypocapnic hyperventilation compared with eucapnic hyperventilation at +0.6°C T(es) or +1.0°C T(es). These results suggest that in resting humans, hypocapnia achieved through voluntary hyperventilation attenuates the increase in cutaneous blood flow elicited by moderate heat stress in the nonglabrous skin of the forearm, but not the forehead.

Beetroot-based gel supplementation improves handgrip strength, forearm muscle O2 saturation but not exercise tolerance and blood volume in jiu-jitsu athletes.

PubMed

de Oliveira, Gustavo Vieira; Nascimento, Luiz; Volino-Souza, Mônica; Mesquita, Jacilene; Alvares, Thiago

2018-03-22

The ergogenic effect of beetroot on the exercise performance of trained cyclists, runners, kayakers, and swimmers has been demonstrated. However, whether or not beetroot supplementation presents a beneficial effect on the exercise performance of jiu-jitsu athletes (JJA) remains inconclusive. Therefore, present study assessed the effect of beetroot-based gel (BG) supplementation on maximal voluntary contraction (MVC), exercise time until fatigue (ETF), muscle O2 saturation (SmO2), blood volume (tHb), and plasma nitrate and lactate in response to handgrip isotonic exercise (HIE) in JJA. In a randomized, crossover, double-blind design, 12 JJA performed three sets of HIE at 40% of the MVC until fatigue after 8 days (8th dose was offered 120 min previous exercise) of BG supplementation or a nitrate-depleted gel (PLA), and forearm SmO2 and tHb were continuously monitored by using near-infrared spectroscopy. Blood samples were taken before, immediately after exercise, and 20 min after exercise recovery in PLA and BG condition. MVC was evaluated at baseline and 20 min after HIE. There was a significant reduction in ∆MVC decline after HIE in BG condition. Forearm SmO2 during exercise recovery was significantly greater only after BG supplementation. No significant difference in ETF and tHb were observed between both BG and PLA in response to HIE. Plasma nitrate increased only after BG, whereas the exercise-induced increase in plasma lactate was significantly lower in BG when compared to PLA. In conclusion, BG supplementation may be a good nutritional strategy to improve forearm SmO2 and prevent force decline in response to exercise in JJA.

Effect of repeated forearm muscle cooling on the adaptation of skeletal muscle metabolism in humans.

PubMed

Wakabayashi, Hitoshi; Nishimura, Takayuki; Wijayanto, Titis; Watanuki, Shigeki; Tochihara, Yutaka

2017-07-01

This study aimed to investigate the effect of repeated cooling of forearm muscle on adaptation in skeletal muscle metabolism. It is hypothesized that repeated decreases of muscle temperature would increase the oxygen consumption in hypothermic skeletal muscle. Sixteen healthy males participated in this study. Their right forearm muscles were locally cooled to 25 °C by cooling pads attached to the skin. This local cooling was repeated eight times on separate days for eight participants (experimental group), whereas eight controls received no cold exposure. To evaluate adaptation in skeletal muscle metabolism, a local cooling test was conducted before and after the repeated cooling period. Change in oxy-hemoglobin content in the flexor digitorum at rest and during a 25-s isometric handgrip (10% maximal voluntary construction) was measured using near-infrared spectroscopy at every 2 °C reduction in forearm muscle temperature. The arterial blood flow was occluded for 15 s by upper arm cuff inflation at rest and during the isometric handgrip. The oxygen consumption in the flexor digitorum muscle was evaluated by a slope of the oxy-hemoglobin change during the arterial occlusion. In the experimental group, resting oxygen consumption in skeletal muscle did not show any difference between pre- and post-intervention, whereas muscle oxygen consumption during the isometric handgrip was significantly higher in post-intervention than in pre-test from thermoneutral baseline to 31 °C muscle temperature (P < 0.05). This result indicated that repeated local muscle cooling might facilitate oxidative metabolism in the skeletal muscle. In summary, skeletal muscle metabolism during submaximal isometric handgrip was facilitated after repeated local muscle cooling.

[Necrotizing fasciitis of the hand and forearm : Acute surgical treatment and defect reconstruction with MatriDerm® and split-thickness skin graft].

PubMed

Niedermueller, B; Singer, G; Pickl, P; Jesacher, M

2018-03-01

This case report describes a 55-year-old male patient with type II necrotizing fasciitis (NF) of the hand and forearm. The rapid progression of the tissue infection could be successfully stopped with radical surgical débridement and antibiotic therapy. For the reconstruction of the extensive loss of soft tissue a combination of split-thickness skin graft (STSG) and the synthetic dermal substitute MatriDerm® was used. In cases of NF, MatriDerm® and STSG provide a rapidly available and simple alternative to other reconstruction techniques.

Coccidioidomycosis.

PubMed

Laffer, Matthew; Ackerman, Lindsay

2018-01-01

A 23-year-old man presented with new-onset pruritic and painful urticarial lesions and targetoid erythematous plaques on both palms, the trunk, and the upper and lower extremities (Figure 1). Additionally, small pustules were discovered on the neck (Figure 2), and there with edematous erythematous vermillion lips with splaying onto the cutaneous lips without ulceration. The patient stated he had had a fever before the eruption, fatigue, chills, myalgias, and sore throat. A chest x-ray was obtained and showed bilateral infiltrates. Two 4-mm punch biopsies were performed on the left forearm and left side of the neck; a resulting section from the left forearm is shown in Figure 3.

Automatic gain control of neural coupling during cooperative hand movements.

PubMed

Thomas, F A; Dietz, V; Schrafl-Altermatt, M

2018-04-13

Cooperative hand movements (e.g. opening a bottle) are controlled by a task-specific neural coupling, reflected in EMG reflex responses contralateral to the stimulation site. In this study the contralateral reflex responses in forearm extensor muscles to ipsilateral ulnar nerve stimulation was analyzed at various resistance and velocities of cooperative hand movements. The size of contralateral reflex responses was closely related to the level of forearm muscle activation required to accomplish the various cooperative hand movement tasks. This indicates an automatic gain control of neural coupling that allows a rapid matching of corrective forces exerted at both sides of an object with the goal 'two hands one action'.

Cutaneous Curvularia infection of the forearm.

PubMed

Moody, Megan Nicole; Tschen, Jaime; Mesko, Michah

2012-02-01

Phaeohyphomycosis is the general term for infections caused by dematiaceous fungi. Although rare in humans, these infections are being reported at an increasing rate. Curvularia is a dematiaceous fungus that is ubiquitous among soil and vegetation in temperate areas and has only recently been revealed to cause human disease. Treatment guidelines have yet to be delineated due to the paucity of reported cases. We report the case of a 73-year-old man with chronic obstructive pulmonary disease, recent pneumonia caused by Actinomyces, and a localized plaque on his right lateral forearm extending to his medial arm caused by Curvularia species with complete resolution from itraconazole therapy.

Kinematic constraints associated with the acquisition of overarm throwing part II: upper extremity actions.

PubMed

Stodden, David F; Langendorfer, Stephen J; Fleisig, Glenn S; Andrews, James R

2006-12-01

The purposes of this study were to: (a) examine the differences within 11 specific kinematic variables and an outcome measure (ball velocity) associated with component developmental levels of humerus and forearm action (Roberton & Halverson, 1984), and (b) if the differences in kinematic variables were significantly associated with the differences in component levels, determine potential kinematic constraints associated with skilled throwing acquisition. Significant differences among component levels in five of six humerus kinematic variables (p <.01) and all five forearm kinematic variables (p < .01) were identified using multivariate analysis of variance. These kinematic variables represent potential control parameters and, therefore, constraints on overarm throwing acquisition.

Quantitative values of blood flow through the human forearm, hand, and finger as functions of temperature

NASA Technical Reports Server (NTRS)

Montgomery, L. D.

1974-01-01

A literature search was made to obtain values of human forearm, hand and finger blood flow as functions of environmental temperature. The sources used include both government and laboratory reports and the research presented in the open literature. An attempt was made to review many of the more quantitative noninvasive determinations and to collate the results in such a way as to yield blood flow values for each body segment as continuous functions of temperature. A brief review of the various ways used to measure blood flow is included along with an abstract of each work from which data was taken.

The biomechanical effect of arm mass on long jump performance: A case study of a paralympic upper limb amputee.

PubMed

Pradon, Didier; Mazure-Bonnefoy, Alice; Rabita, Giuseppe; Hutin, Emilie; Zory, Raphael; Slawinski, Jean

2014-06-01

The role of arm motion during the long jump has been well studied. The aim of this study was to quantify the effect of forearm mass on impulse and the kinematics of the flight phase in an upper limb amputee. A world-record paralympic long jumper carried out jumps in three conditions: wearing his usual forearm prosthesis and with 0.3 and 0.4 kg added mass. A motion capture system including force plates was used to record the jump. At take-off, the addition of 0.4 kg to the prosthesis decreased the vertical velocity of the centre of mass but increased horizontal velocity. These modifications were associated with an increase in landing distance and an improvement of the synchronization between arms. Increasing forearm mass appears to improve long jump performance. Further studies need to evaluate the optimal prosthetic mass for both training and competition. This biomechanical analysis of the long jump highlighted the effects of changing prosthesis mass on performance. This methodological approach may be useful in the context of sport and performance research. © The International Society for Prosthetics and Orthotics 2013.

Kinesio arm taping as prophylaxis against the development of Erb’s Engram

PubMed Central

ElKhatib, Radwa S.; ElNegmy, Emam H.; Salem, Amina H.; Sherief, AbdelAziz A.

2012-01-01

An Erb’s Engram is a common debility that develops in recovering children with Erb’s palsy. The purpose of this study was to investigate the effect of kinesiotaping over the deltoid and the forearm on the development of proper upper extremity function in children recovering from Erb’s palsy. Thirty patients with Erb’s palsy participated for 3 months in this study and were equally divided into two groups; control group A and study group B. The two groups received the same designed physical therapy program, while group B along the program, received kinesiotaping over the deltoid and the forearm. The subjects were evaluated, pre and post-treatment, and scored functionally, using the Toronto Active Motion Scale, and objectively, using an EMG device utilized to obtain the percentages of degeneration of the deltoid and the biceps muscles. Post-treatment values of six out of nine measured variables, between the two groups, revealed significant difference in favor of group B. The obtained results strongly support the introduction of kinesiotaping of the deltoid and the forearm as an adjunct to the treatment program of Erb’s palsied children. PMID:25685456

Altered thermoregulatory responses after 15 days of head-down tilt

NASA Technical Reports Server (NTRS)

Crandall, Craig G.; Johnson, John M.; Convertino, Victor A.; Raven, Peter B.; Engelke, Keith A.

1994-01-01

To determine whether extended exposure to a simulation of microgravity alters thermoregulatory reflex control of skin blood flow, six adult males were exposed to 15 days of 6 deg head-down tilt (HDT). On an ambulatory control day before HDT exposure and on HDT day 15 the core temperature of each subject was increased by 0.5 - 1.0 C by whole body heating with a water-perfused suit. Mean skin temperature, oral temperature (T (sub or)), mean arterial pressure, and forearm blood flow were measured throughout the protocol. Forearm vascular conductance (FVC) was calculated from the ratio of forearm blood flow to mean arterial pressure. After HDT exposure, the T(sub or) threshold at which reflex thermally induced increases in FVC began was elevated, whereas the slope of the T(sub or)-FVC relationship after this threshold was reduced. Moreover, normothermic FVC and FVC at the highest common T(sub or) between pre- and post-HDT trials were reduced after HDT. These data suggest that HDT exposure reduces thermoregulatory responses to heat stress. The mechanisms resulting in such an impaired thermoregulatory response are unknown but are likely related to the relative dehydration that accompanies this exposure.

Vibration-reducing gloves: transmissibility at the palm of the hand in three orthogonal directions.

PubMed

McDowell, Thomas W; Dong, Ren G; Welcome, Daniel E; Xu, Xueyan S; Warren, Christopher

2013-01-01

Vibration-reducing (VR) gloves are commonly used as a means to help control exposures to hand-transmitted vibrations generated by powered hand tools. The objective of this study was to characterise the vibration transmissibility spectra and frequency-weighted vibration transmissibility of VR gloves at the palm of the hand in three orthogonal directions. Seven adult males participated in the evaluation of seven glove models using a three-dimensional hand-arm vibration test system. Three levels of hand coupling force were applied in the experiment. This study found that, in general, VR gloves are most effective at reducing vibrations transmitted to the palm along the forearm direction. Gloves that are found to be superior at reducing vibrations in the forearm direction may not be more effective in the other directions when compared with other VR gloves. This casts doubts on the validity of the standardised glove screening test. Practitioner Summary: This study used human subjects to measure three-dimensional vibration transmissibility of vibration-reducing gloves at the palm and identified their vibration attenuation characteristics. This study found the gloves to be most effective at reducing vibrations along the forearm direction. These gloves did not effectively attenuate vibration along the handle axial direction.

Investigation of the relationship between anthropometric measurements and maximal handgrip strength in young adults.

PubMed

Eidson, Christopher A; Jenkins, Gavin R; Yuen, Hon K; Abernathy, Anne M; Brannon, Mary Beth; Pung, Anna R; Ward, Kiara D; Weaver, Tara E

2017-01-01

To identify physical measures that predict maximal handgrip strength (MHGS) and provide evidence for identifying lack of sincerity of effort when assessing upper extremity weakness. This study investigated anthropometric measurements associated with MHGS of healthy young adults. A convenience sample of 150 healthy adults ages 19 to 34 years old completed the MHGS assessment, which was measured using a Jamar dynamometer according to the protocol of the American Society of Hand Therapists, for both dominant and non-dominant hands. Several anthropometric data were collected, which included height, body weight, forearm length, forearm circumference, hand length, and hand width. Multivariable linear regression analysis indicated gender and hand width were uniquely and significantly associated with participants' MHGS for dominant and non-dominant hand and accounted for more than 60% of the variance, with R2 = 0.60, P < 0.001 for the dominant hand model and R2 = 0.64, P < 0.001 for the non-dominant hand model. Among the forearm and hand anthropometric measures, hand width is the best predictor of MHGS in both the non-dominant and dominant hands for healthy young adults.

Decreased muscle oxygenation and increased arterial blood flow in the non-exercising limb during leg exercise.

PubMed

Shiroishi, Kiyoshi; Kime, Ryotaro; Osada, Takuya; Murase, Norio; Shimomura, Kousuke; Katsumura, Toshihito

2010-01-01

We evaluated arterial blood flow, muscle tissue oxygenation and muscle metabolism in the non-exercising limb during leg cycling exercise. Ten healthy male volunteers performed a graded leg cycling exercise at 0, 40, 80, 120 and 160 watts (W) for 5 min each. Tissue oxygenation index (TOI) of the non-exercising left forearm muscle was measured using a near-infrared spatially resolved spectroscopy (NIR(SRS)), and non-exercising forearm blood flow ((NONEX)FBF) in the brachial artery was also evaluated by a Doppler ultrasound system. We also determined O(2) consumption of the non-exercising forearm muscle (NONEXV(O)(2mus)) by the rate of decrease in O(2)Hb during arterial occlusion at each work rate. TOI was significantly decreased at 160 W (p < 0.01) compared to the baseline. The (NONEX)V(O)(2mus) at each work rate was not significantly increased. In contrast, (NONEX)FBF was significantly increased at 120 W (p < 0.05) and 160 W (p < 0.01) compared to the baseline. These results suggest that the O(2) supply to the non-exercising muscle may be reduced, even though (NONEX)FBF increases at high work rates during leg cycling exercise.

Vascular conductance is reduced after menthol or cold application.

PubMed

Olive, Jennifer L; Hollis, Brandon; Mattson, Elizabeth; Topp, Robert

2010-09-01

To compare the effects of commercially sold menthol (3.5%) ointment and cold application on blood flow in the forearm. : Prospective counterbalanced design. University research laboratory. Twelve (6 men and 6 women) college-aged students. Each participant had blood flow measured in the brachial artery for 5 minutes before and 10 minutes after menthol ointment or cold application to the forearm. Blood velocity, arterial diameter size, and blood pressure were recorded during testing procedures. Vascular conductance was calculated based on these measures and used to describe limb blood flow. We observed a significant reduction (35%; P = 0.004) in vascular conductance within 60 seconds of menthol and cold application to the forearm. Vascular conductance remained significantly reduced for 10 minutes by approximately 19% after both menthol and cold application [F(2.313, 43.594) = 10.328, P < 0.0001]. There was no significant difference between conditions [F(1, 19) = 0.000, P = 0.945]. The application of a 3.5% menthol ointment significantly reduces conductance in the brachial artery within 60 seconds of application, and this effect is maintained for at least 10 minutes after application. The overall decline in conductance is similar between menthol ointment and cold application.

Short-term after-effect of forearm cast removal in children.

PubMed

Katz, Kalman; Weigl, Daniel; Becker, Tal; Attias, Joseph; Bar-On, Elhanan

2011-05-01

To investigate the sensation in the hand after forearm cast removal in children. The study group included 33 consecutive children who were treated nonoperatively for a forearm fracture at our center over a 1-year period. The children were asked to report any sensation in the ipsilateral hand after cast removal, and the findings were analyzed against background and fracture-related data. The patients ranged in age from 6 to 14 years (median 10.00 years). Seventeen had been immobilized in an above-elbow cast and the remainder in a below-elbow cast. All children treated with an above-elbow cast complained that after cast removal, the hand on that side felt limp, and they had to hold it with the contralateral hand. By contrast, only one child treated with a below-elbow cast reported this sensation (p = 0.0001, Fisher exact test). Orthopedic surgeons and rehabilitation unit staff should be aware of the possibility of a very short-term sensation of drooping and weakness of the hand after removal of an above-elbow cast in children and prepare the child and parents accordingly in order to lessen unnecessary anxiety.

Sonoanatomy of sensory branches of the ulnar nerve below the elbow in healthy subjects.

PubMed

Kim, Ki Hoon; Lee, Seok Jun; Park, Byung Kyu; Kim, Dong Hwee

2018-04-01

We identify sensory branches of the ulnar nerve-palmar ulnar cutaneous nerve (PUCN), dorsal ulnar cutaneous nerve (DUCN), and superficial sensory branch-using ultrasonography. In 60 forearms of 30 healthy adult volunteers, the origin and size of the PUCN, DUCN, and superficial sensory branch were measured by ultrasonography. The relative pathway of the DUCN to the ulnar styloid process was also investigated. The PUCN was observed in 47 forearms (78%), and the DUCN was observed in all forearms. Average distances from the pisiform to the origin of the PUCN and DUCN were 11.9 ± 1.4 and 7.0 ± 1.0 cm, respectively. Superficial and deep divisions split 0.9 ± 0.3 cm distal to the pisiform. Cross-sectional areas of the PUCN, DUCN, and superficial sensory branch were 0.3 ± 0.1, 1.5 ± 0.5, and 3.9 ± 1.0 mm 2 , respectively. Sensory branches of the ulnar nerve can be visualized by ultrasonography, helping to differentiate ulnar nerve injury originating at either wrist or elbow. Muscle Nerve 57: 569-573, 2018. © 2017 Wiley Periodicals, Inc.

Multifractal spectra of laser Doppler flowmetry signals in healthy and sleep apnea syndrome subjects

NASA Astrophysics Data System (ADS)

Buard, Benjamin; Trzepizur, Wojciech; Mahe, Guillaume; Chapeau-Blondeau, François; Rousseau, David; Gagnadoux, Frédéric; Abraham, Pierre; Humeau, Anne

2009-07-01

Laser Doppler flowmetry (LDF) signals give a peripheral view of the cardiovascular system. To better understand the possible modifications brought by sleep apnea syndrome (SAS) in LDF signals, we herein propose to analyze the complexity of such signals in obstructive SAS subjects, and to compare the results with those obtained in healthy subjects. SAS is a pathology that leads to a drop in the parasympathetic tone associated with an increase in the sympathetic tone in awakens SAS patients. Nine men with obstructive SAS and nine healthy men participated awaken in our study and LDF signals were recorded in the forearm. In our work, complexity of LDF signals is analyzed through the computation and analysis of their multifractal spectra. The multifractal spectra are estimated by first estimating the discrete partition function of the signals, then by determining their Renyi exponents with a linear regression, and finally by computing their Legendre transform. The results show that, at rest, obstructive SAS has no or little impact on the multifractal spectra of LDF signals recorded in the forearm. This study shows that the physiological modifications brought by obstructive SAS do not modify the complexity of LDF signals when recorded in the forearm.

Anatomical and Functional Images of in vitro and in vivo Tissues by NIR Time-domain Diffuse Optical Tomography

NASA Astrophysics Data System (ADS)

Zhao, Huijuan; Gao, Feng; Tanikawa, Yukari; Homma, Kazuhiro; Onodera, Yoichi; Yamada, Yukio

Near infra-red (NIR) diffuse optical tomography (DOT) has gained much attention and it will be clinically applied to imaging breast, neonatal head, and the hemodynamics of the brain because of its noninvasiveness and deep penetration in biological tissue. Prior to achieving the imaging of infant brain using DOT, the developed methodologies need to be experimentally justified by imaging some real organs with simpler structures. Here we report our results of an in vitro chicken leg and an in vivo exercising human forearm from the data measured by a multi-channel time-resolved NIR system. Tomographic images were reconstructed by a two-dimensional image reconstruction algorithm based on a modified generalized pulse spectrum technique for simultaneous reconstruction of the µa and µs´. The absolute µa- and µs´-images revealed the inner structures of the chicken leg and the forearm, where the bones were clearly distinguished from the muscle. The Δµa-images showed the blood volume changes during the forearm exercise, proving that the system and the image reconstruction algorithm could potentially be used for imaging not only the anatomic structure but also the hemodynamics in neonatal heads.

Portable and Reconfigurable Wrist Robot Improves Hand Function for Post-Stroke Subjects.

PubMed

Khor, Kang Xiang; Chin, Patrick Jun Hua; Yeong, Che Fai; Su, Eileen Lee Ming; Narayanan, Aqilah Leela T; Abdul Rahman, Hisyam; Khan, Qamer Iqbal

2017-10-01

Rehabilitation robots have become increasingly popular for stroke rehabilitation. However, the high cost of robots hampers their implementation on a large scale. This paper implements the concept of a modular and reconfigurable robot, reducing its cost and size by adopting different therapeutic end effectors for different training movements using a single robot. The challenge is to increase the robot's portability and identify appropriate kinds of modular tools and configurations. Because literature on the effectiveness of this kind of rehabilitation robot is still scarce, this paper presents the design of a portable and reconfigurable rehabilitation robot and describes its use with a group of post-stroke patients for wrist and forearm training. Seven stroke subjects received training using a reconfigurable robot for 30 sessions, lasting 30 min per session. Post-training, statistical analysis showed significant improvement of 3.29 points (16.20%, p = 0.027) on the Fugl-Meyer assessment scale for forearm and wrist components. Significant improvement of active range of motion was detected in both pronation-supination (75.59%, p = 0.018) and wrist flexion-extension (56.12%, p = 0.018) after the training. These preliminary results demonstrate that the developed reconfigurable robot could improve subjects' wrist and forearm movement.

Combined effect of repetitive work and cold on muscle function and fatigue.

PubMed

Oksa, Juha; Ducharme, Michel B; Rintamäki, Hannu

2002-01-01

This study compared the effect of repetitive work in thermoneutral and cold conditions on forearm muscle electromyogram (EMG) and fatigue. We hypothesize that cold and repetitive work together cause higher EMG activity and fatigue than repetitive work only, thus creating a higher risk for overuse injuries. Eight men performed six 20-min work bouts at 25 degrees C (W-25) and at 5 degrees C while exposed to systemic (C-5) and local cooling (LC-5). The work was wrist flexion-extension exercise at 10% maximal voluntary contraction. The EMG activity of the forearm flexors and extensors was higher during C-5 (31 and 30%, respectively) and LC-5 (25 and 28%, respectively) than during W-25 (P < 0.05). On the basis of fatigue index (calculated from changes in maximal flexor force and flexor EMG activity), the fatigue in the forearm flexors at the end of W-25 was 15%. The corresponding values at the end of C-5 and LC-5 were 37% (P < 0.05 in relation to W-25) and 20%, respectively. Thus repetitive work in the cold causes higher EMG activity and fatigue than repetitive work in thermoneutral conditions.

Muscle recruitment variations during wrist flexion exercise: MR evaluation

NASA Technical Reports Server (NTRS)

Fleckenstein, J. L.; Watumull, D.; Bertocci, L. A.; Nurenberg, P.; Peshock, R. M.; Payne, J. A.; Haller, R. G.; Blomqvist, C. G. (Principal Investigator)

1994-01-01

OBJECTIVE: Many exercise protocols used in physiological studies assume homogeneous and diffuse muscle recruitment. To test this assumption during a "standard" wrist flexion protocol, variations in muscle recruitment were assessed using MRI in eight healthy subjects. MATERIALS AND METHODS: Variations were assessed by comparing the right to the left forearms and the effect of slight (15 degrees) pronation or supination at the wrist. RESULTS: Postexercise imaging showed focal regions of increased signal intensity (SI), indicating relatively strong recruitment, most often in entire muscles, although occasionally only in subvolumes of muscles. In 15 of 26 studies, flexor carpi radialis (FCR) showed more SI than flexor carpi ulnaris, while in 11 studies SI in these muscles increased equivalently. Relatively greater FCR recruitment was seen during pronation and/or use of the nondominant side. Palmaris longus, a wrist flexor, did not appear recruited in 4 of 11 forearms in which it was present. A portion of the superficial finger flexor became hyperintense in 89% of studies, while recruitment of the deep finger flexor was seen only in 43%. CONCLUSION: Inter- and intraindividual variations in forearm muscle recruitment should be anticipated in physiological studies of standard wrist flexion exercise protocols.

Wearing graduated compression stockings augments cutaneous vasodilation but not sweating during exercise in the heat.

PubMed

Fujii, Naoto; Nikawa, Toshiya; Tsuji, Bun; Kenny, Glen P; Kondo, Narihiko; Nishiyasu, Takeshi

2017-05-01

The activation of cutaneous vasodilation and sweating are essential to the regulation of core temperature during exercise in the heat. We assessed the effect of graduated compression induced by wearing stockings on cutaneous vasodilation and sweating during exercise in the heat (30°C). On two separate occasions, nine young males exercised for 45 min or until core temperature reached ~1.5°C above baseline resting while wearing either (1) stockings causing graduated compression (graduate compression stockings, GCS), or (2) loose-fitting stockings without compression (Control). Forearm vascular conductance was evaluated by forearm blood flow (venous occlusion plethysmography) divided by mean arterial pressure to estimate cutaneous vasodilation. Sweat rate was estimated using the ventilated capsule technique. Core and skin temperatures were measured continuously. Exercise duration was similar between conditions (Control: 42.2 ± 3.6 min vs. GCS: 42.2 ± 3.6 min, P  = 1.00). Relative to Control, GCS increased forearm vascular conductance during the late stages (≥30 min) of exercise (e.g., at 40 min, 15.6 ± 5.6 vs. 18.0 ± 6.0 units, P  = 0.01). This was paralleled by a greater sensitivity (23.1 ± 9.1 vs. 32.1 ± 15.0 units°C -1 , P  = 0.043) and peak level (14.1 ± 5.1 vs. 16.3 ± 5.7 units, P  = 0.048) of cutaneous vasodilation as evaluated from the relationship between forearm vascular conductance with core temperature. However, the core temperature threshold at which an increase in forearm vascular conductance occurred did not differ between conditions (Control: 36.9 ± 0.2 vs. GCS: 37.0 ± 0.3°C, P  = 0.13). In contrast, no effect of GCS on sweating was measured (all P  > 0.05). We show that the use of GCS during exercise in the heat enhances cutaneous vasodilation and not sweating. © 2017 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.

Mechanical influences on skeletal muscle vascular tone in humans: insight into contraction-induced rapid vasodilatation

PubMed Central

Kirby, Brett S; Carlson, Rick E; Markwald, Rachel R; Voyles, Wyatt F; Dinenno, Frank A

2007-01-01

We tested the hypothesis that mechanical deformation of forearm blood vessels via acute increases in extravascular pressure elicits rapid vasodilatation in humans. In healthy adults, we measured forearm blood flow (Doppler ultrasound) and calculated forearm vascular conductance (FVC) responses to whole forearm compressions and isometric muscle contractions with the arm above heart level. We used several experimental protocols to gain insight into how mechanical factors contribute to contraction-induced rapid vasodilatation. The findings from the present study clearly indicate that acute increases in extravascular pressure (200 mmHg for 2 s) elicit a significant rapid vasodilatation in the human forearm (peak ΔFVC∼155%). Brief, 6 s sustained compressions evoked the greatest vasodilatation (ΔFVC∼260%), whereas the responses to single (2 s) and repeated compressions (five repeated 2 s compressions) were not significantly different (ΔFVC∼155%versus∼115%, respectively). This mechanically induced vasodilatation peaks within 1–2 cardiac cycles, and thus is dissociated from the temporal pattern normally observed in response to brief muscle contractions (∼4–7 cardiac cycles). A non-linear relation was found between graded increases in extravascular pressure and both the immediate and peak rapid vasodilatory response, such that the responses increased sharply from 25 to 100 mmHg, with no significant further dilatation until 300 mmHg (maximal ΔFVC∼185%). This was in contrast to the linear intensity-dependent relation observed with muscle contractions. Our collective findings indicate that mechanical influences contribute largely to the immediate vasodilatation (first cardiac cycle) observed in response to a brief, single contraction. However, it is clear that there are additional mechanisms related to muscle activation that continue to cause and sustain vasodilatation for several more cardiac cycles after contraction. Additionally, the potential contribution of mechanical influences to the total contraction-induced hyperaemia appears greatest for low to moderate intensity single muscle contractions, and this contribution becomes less significant for sustained and repeated contractions. Nevertheless, this mechanically induced vasodilatation could serve as a feedforward mechanism to increase muscle blood flow at the onset of exercise, as well as in response to changes in contraction intensity, prior to alterations in local vasodilating substances that influence vascular tone. PMID:17495044

Changes in bone mineral density 10 years after marked reduction of cadmium exposure in a Chinese population

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, Xiao; Zhu, Guoying, E-mail: zhugy@shmu.edu.cn; Jin, Taiyi

The main focus of this study was to evaluate the long-term effects of Cd on forearm bone mineral density after the cessation of the ingestion of Cd-polluted rice. A total of 458 persons (294 women, 164 men) from three Cd exposure areas (low, moderately, and heavy) participated in this study. Those living in the moderate and heavy exposure areas ceased ingesting Cd-polluted rice (0.51 and 3.7 mg/kg, respectively) in 1996 (10 years prior to present analysis). The participants completed a questionnaire and bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (DXA) at the proximal radius and ulna.more » The changes and change percentage in forearm bone density and the prevalence of osteoporosis between 1998 and 2006 were used as markers of bone recovery. The Cd concentrations in urine (UCd) and blood (BCd) in 1998 were used as Cd exposure markers. The values of the BMD change and change percentage of groups in which UCd was above 5 {mu}g/g creatinine ({mu}g/g crea) and BCd was above 10 {mu}g/L were significantly higher than those of the low-exposure groups (in women, p<0.001; in men, p>0.05). The BMD change and change percentage correlated positively with the UCd and BCd (in women, p<0.01; in men, p>0.05). Analysis of the Z-score revealed that the prevalence of osteoporosis in 2006 was higher than that in 1998 and increased along with the level of UCd and BCd in both women and men, especially for those subjects with the higher BCd [BCd>5 {mu}g/L, OR=3.45 (0.95-13.6); BCd>10 {mu}g/L, OR=4.51(1.57-13.54)] and UCd [UCd>10 {mu}g/g crea, OR=4.74 (1.82-12.81)] in women. It is concluded that decreasing dietary cadmium exposure at the population level is not associated with bone recovery at the individual level, and the adverse bone effects of Cd exposure persisted after the main source of Cd exposure had been blocked, especially in women.« less

The effects of vibratory stimulation employed to forearm and arm flexor muscles on upper limb function in patients with chronic stroke.

PubMed

Jung, Sang-Mi

2017-09-01

[Purpose] The purpose of this study was to investigate not only the effects of stimulatory vibration but also the retained effects 2 weeks after the last session of the intervention. [Subjects and Methods] Ten subjects with post-stroke hemiplegia were recruited in this study. The experimental group (EG) received vibratory stimulation for 30 minutes in each session, three times a week for 2 weeks. Grip strength (GS), box-and-block test (BBT), and Weinstein monofilament were used to assess hand strength, dexterity, and sensory in the affected hand, respectively. [Results] A significant difference was found between the pre- and post-follow-up BBT. Significant differences were found among the pre-posttest, post-follow-up test, and pre-follow-up test results for GS and BBT. [Conclusion] This study was conducted with 10 subjects, without a control group, to verify the pure effect of the intervention. As a result, significant positive effects were observed in the post-test and follow-up test of GS and BBT. Therefore, repeated vibratory stimulation influenced GS and BBT after the 2-week intervention and retained the effect for 2 more weeks.

PubMed Central

TARSITANO, A.; VIETTI, M.V.; CIPRIANI, R.; MARCHETTI, C.

2013-01-01

SUMMARY The aim of the present study is to assess functional outcomes after hemiglossectomy and microvascular reconstruction. Twenty-six patients underwent primary tongue microvascular reconstruction after hemiglossectomy. Twelve patients were reconstructed using a free radial forearm flap and 14 with an anterolateral thigh flap. Speech intelligibility, swallowing capacity and quality of life scores were assessed. Factors such as tumour extension, surgical resection and adjuvant radiotherapy appeared to be fundamental to predict post-treatment functional outcomes. The data obtained in the present study indicate that swallowing capacity after hemiglossectomy is better when an anterolateral thigh flap is used. No significant differences were seen for speech intelligibility or quality of life between free radial forearm flap and anterolateral thigh flap. PMID:24376292

Antimicrobial effects of an antiperspirant formulation containing aqueous aluminum chloride hexahydrate.

PubMed

Hölzle, E; Neubert, U

1982-01-01

To document deodorant efficacy the antimicrobial activity of a gelatinous antiperspirant formulation of aqueous aluminum chloride hexahydrate was investigated. In vitro assays demonstrated highly bactericidal activity on microorganisms comprising the resident axillary skin flora, including micrococcaceae and aerobic diphtheroid bacteria. Gram-negative bacteria and yeast were partially inhibited. In vivo experiments utilizing occlusive patches on forearm skin and bacterial sampling of the axilla showed pronounced bacteriostasis and persistence of aluminum chloride on the skin. Inhibition of microbial growth lasted more than 3 days after a single treatment of the axilla. Following repeated open applications to the volar aspect of the forearm, the skin remained virtually sterile for 3 days.

Wheelbarrow tire explosion causing trauma to the forearm and hand: a case report

PubMed Central

2009-01-01

Introduction Tire explosion injuries are rare, but they may result in a severe injury pattern. Case reports and statistics from injuries caused by exploded truck tires during servicing are established, but trauma from exploded small tires seems to be unknown. Case presentation A 47-year-old german man inflated a wheelbarrow tire. The tire exploded during inflation and caused an open, multiple forearm and hand injury. Conclusion Even small tires can cause severe injury patterns in the case of an explosion. High inflating pressures and low safety distances are the main factors responsible for this occurrence. Broad safety information and suitable filling devices are indispensable for preventing these occurrences. PMID:19946543

Skeletal Benefits of Pre-Menarcheal Gymnastics Are Retained After Activity Cessation

PubMed Central

Scerpella, Tamara A.; Dowthwaite, Jodi N.; Gero, Nicole M.; Kanaley, Jill A.; Ploutz-Snyder, Robert J.

2015-01-01

Mechanical loading during childhood and adolescence may yield skeletal benefits that persist beyond activity cessation and menarche. At 1 year pre- and 2 years post-menarche, non-dominant forearm areal bone mineral density (aBMD), bone mineral content (BMC) and projected area (area) were compared in gymnasts (n=9), ex-gymnasts (n=8) and non-gymnasts (n=13). At both observations, gymnasts and ex-gymnasts had higher forearm aBMD, BMC and area than non-gymnasts. gymnasts had higher post-menarcheal means than ex-gymnasts for all three parameters. Childhood mechanical loading yields skeletal advantages that persist at least 24 months after loading cessation and menarche. Continued post-menarcheal loading yields additional benefit. PMID:20332537

Intolerance of uncertainty and startle potentiation in relation to different threat reinforcement rates.

PubMed

Chin, Brian; Nelson, Brady D; Jackson, Felicia; Hajcak, Greg

2016-01-01

Fear conditioning research on threat predictability has primarily examined the impact of temporal (i.e., timing) predictability on the startle reflex. However, there are other key features of threat that can vary in predictability. For example, the reinforcement rate (i.e., frequency) of threat is a crucial factor underlying fear learning. The present study examined the impact of threat reinforcement rate on the startle reflex and self-reported anxiety during a fear conditioning paradigm. Forty-five participants completed a fear learning task in which the conditioned stimulus was reinforced with an electric shock to the forearm on 50% of trials in one block and 75% of trials in a second block, in counter-balanced order. The present study also examined whether intolerance of uncertainty (IU), the tendency to perceive or experience uncertainty as stressful or unpleasant, was associated with the startle reflex during conditions of low (50%) vs. high (75%) reinforcement. Results indicated that, across all participants, startle was greater during the 75% relative to the 50% reinforcement condition. IU was positively correlated with startle potentiation (i.e., increased startle response to the CS+ relative to the CS-) during the 50%, but not the 75%, reinforcement condition. Thus, despite receiving fewer electric shocks during the 50% reinforcement condition, individuals with high IU uniquely demonstrated greater defense system activation when impending threat was more uncertain. The association between IU and startle was independent of state anxiety. The present study adds to a growing literature on threat predictability and aversive responding, and suggests IU is associated with abnormal responding in the context of uncertain threat. Copyright © 2015 Elsevier B.V. All rights reserved.

Does chewing coca leaves influence physiology at high altitude?

PubMed

Casikar, V; Mujica, E; Mongelli, M; Aliaga, J; Lopez, N; Smith, C; Bartholomew, F

2010-07-01

Andean Indians have used coca leaves (Erythroxylon coca and related species) for centuries to enhance physical performance. The benefits and disadvantages of using coca leaf have been a subject of many political debates. The aim of this study was to investigate the effects of chewing coca leaves on biochemical and physiological parameters. Cutaneous microdialysis catheters were used to estimate systemic biochemical changes. We subjected 10 healthy adult males (local residents) in Cajamarca (Peru, altitude 2700 m) to a standardised exercise routine on a stationary cycle ergometer. The blood pressure, oxygen saturation (digital), pulse, VO2 max and ECG (Holter monitor) were recorded before the exercise. Cutaneous microdialysis catheters were introduced in the forearm. The subjects were given to chew 8 g of coca leaves with a small amount of lime. They were then placed on the cycle ergometer for 20 min. Blood pressure, oxygen saturation, pulse, ECG and VO2 max were recorded. Pyruvate, glucose, lactate, glycerol and glutamate levels were estimated. Oxygen saturation, blood pressure, and pulse rate did not show any significant changes between the two groups. Glucose levels showed hyperglycaemic response. Glycerol, Lactate and Pyruvate increased. Glutamate remained unchanged. Similar changes were not seen in the controls. These results suggest that coca leaves have blocked the glycolytic pathway of glucose oxidation resulting in accumulation of glucose and pyruvate. The energy requirement for exercise is being met with beta-oxidation of fatty acids. The glycerol released was also getting accumulated since its pathway for oxidation was blocked. These experimental findings suggest that chewing coca leaves is beneficial during exercise and that the effects are felt over a prolonged period of sustained physical activity.

Peripheral arteriovenous fistula as vascular access for long-term chemotherapy.

PubMed

Kovalyov, Oleksiy O; Kostyuk, Oleksandr G; Tkachuk, Tetyana V

To provide long-term vascular access in clinical oncology peripheral forearm veins (up to 95% of patients in Ukraine), central venous access and "complete implanted vascular systems" are used most often. Many oncology patients have contraindications to catheterization of superior vena cava. Besides, exploitation of central veins is associated with potential technical and infectious complications. The aim - to study short-term and long-term results of arteriovenous fistula exploitation as vascular access for continuous anticancer therapy. Peripheral venous bed status in 41 oncology patients taking long-term chemotherapy treatment is analyzed in the article. Doppler sonography, morphologic and immune histochemical analyses were used in the study. Doppler sonography found qualitative and quantitative changes in forearm veins at different time periods after initiation of chemotherapy in the majority of patients. The major morphologic manifestations of venous wall damage were chemical phlebitis, local or extended hardening of venous wall, venous thrombosis and extravasations with necrosis and subsequent paravasal tissue sclerosis. Alternative vascular access created in 12 patients completely met the adequacy criteria (safety, multiple use, longevity, realization of the designed therapy program). The conclusion was made about inapplicability of forearm veins for long-term administration of cytostatic agents. If it is impossible to use central veins, arteriovenous fistula can become an alternative vascular access.

Improvement of hand sensibility after selective temporary anaesthesia in combination with sensory re-education.

PubMed

Hassan-Zadeh, Roghiyeh; Lajevardi, Laleh; Esfahani, Ahmadreza Roofigari; Kamali, Mohammad

2009-01-01

The results of nerve repair in adults are often poor. The study aim was to investigate the effect of repeated sessions of cutaneous forearm anaesthesia of the injured limb, in combination with sensory re-education on the recovery of the tactile discrimination and perception of touch/pressure in the injured hand after median or ulnar nerve repair. A prospective, randomized, double-blind clinical trial was designed. During a 2-week period, a topical anaesthetic cream (Lidocaine-PTC, n = 6) or placebo (n = 7) was applied repeatedly (twice a week) with occlusive bandage for 1 hour on the flexor aspect of the forearm of the same side of the nerve injury and combined with sensory re-education. Assessments of sensory function were performed prior to the experiment and after the fourth application of Lidocaine-PTC/placebo. The patients were evaluated again 4 weeks after the last Lidocaine-PTC/placebo session. Touch perception measured with Semmes-Weinstein Monofilaments (SWM), improved significantly in the Lidocaine-PTC group (p = 0.005). In placebo group, no significant changes were seen. Two{-}point discrimination improved significantly only in the Lidocaine-PTC group (p = 0.005). This finding suggests that forearm deafferentation of injured limb in combination with sensory re-education can enhance sensory recovery after nerve repair.

Peripheral Intravenous Catheterisation in Obstetric Patients in the Hand or Forearm Vein: A Randomised Trial

PubMed Central

Tan, Peng Chiong; Mackeen, Anjana; Khong, Su Yen; Omar, Siti Zawiah; Azmi, M. A. Noor

2016-01-01

A peripheral intravenous catheter is often inserted as part of care during labour. The catheter is inserted into the back of the hand or lower forearm vein in usual practice. There is no trial data to guide the care provider on which is the better insertion site in any clinical setting. 307 women admitted to the labour ward who required insertion of intravenous catheter were randomised to back of hand or lower forearm vein catheter insertion. Catheter insertion is by junior to mid-grade providers. We evaluated insertion success at the first attempt, pain during insertion and catheter replacement due to malfunction as main outcomes. After catheter removal, we recorded patient satisfaction with site, future site preference and insertion site swelling, bruising, tenderness, vein thrombosis and pain. Insertion of a catheter into back of hand vein is more likely to be successful at the first attempt. Insertion pain score, catheter replacement rate, patient satisfaction, patient fidelity to site in a future insertion and insertion site complications rate are not different between trial arms. In conclusion, both insertion sites are suitable; the back of the hand vein maybe easier to cannulate and seems to be preferred by our frontline providers. PMID:26987593

Beneficial effects of softened fabrics on atopic skin.

PubMed

Hermanns, J F; Goffin, V; Arrese, J E; Rodriguez, C; Piérard, G E

2001-01-01

There is general concern about the possible cutaneous adverse effects of wearing garments treated with household laundry products, particularly on atopic skin. Our objective was to compare softened and non- softened fabrics in a forearm wet and dry test, under conditions simulating real-life conditions. Twenty atopic volunteers entered a single-blind 12-day (3 sessions per day) forearm wetting and drying test. Cotton fabrics were machine washed and liquid fabric conditioner was added or not to the final rinse. To simulate conditions of skin damage, a dilute solution of sodium lauryl sulphate was applied under occlusion to the forearm of each volunteer before the start of the study. Skin effects were evaluated by visual grading (redness, dryness and smoothness), squamometry and in vivo instrumental measurements (capacitance, transepidermal water loss and colorimetry). Rubbing of atopic skin with fabrics generally resulted in discrete to moderate alterations of the structure of the stratum corneum. Both for control and pre-irritated skin, all measured parameters indicated that softened fabric was less aggressive to the skin than unsoftened fabric. In the case of pre-irritated skin, the recovery of the skin was significantly faster when rubbed with softened than with unsoftened fabrics. In conclusion, softened fabrics help mitigate the skin condition in atopic patients. Copyright 2001 S. Karger AG, Basel.

The Analysis of Surface EMG Signals with the Wavelet-Based Correlation Dimension Method

PubMed Central

Zhang, Yanyan; Wang, Jue

2014-01-01

Many attempts have been made to effectively improve a prosthetic system controlled by the classification of surface electromyographic (SEMG) signals. Recently, the development of methodologies to extract the effective features still remains a primary challenge. Previous studies have demonstrated that the SEMG signals have nonlinear characteristics. In this study, by combining the nonlinear time series analysis and the time-frequency domain methods, we proposed the wavelet-based correlation dimension method to extract the effective features of SEMG signals. The SEMG signals were firstly analyzed by the wavelet transform and the correlation dimension was calculated to obtain the features of the SEMG signals. Then, these features were used as the input vectors of a Gustafson-Kessel clustering classifier to discriminate four types of forearm movements. Our results showed that there are four separate clusters corresponding to different forearm movements at the third resolution level and the resulting classification accuracy was 100%, when two channels of SEMG signals were used. This indicates that the proposed approach can provide important insight into the nonlinear characteristics and the time-frequency domain features of SEMG signals and is suitable for classifying different types of forearm movements. By comparing with other existing methods, the proposed method exhibited more robustness and higher classification accuracy. PMID:24868240

Vibration-reducing gloves: transmissibility at the palm of the hand in three orthogonal directions

PubMed Central

McDowell, Thomas W.; Dong, Ren G.; Welcome, Daniel E.; Xu, Xueyan S.; Warren, Christopher

2015-01-01

Vibration-reducing (VR) gloves are commonly used as a means to help control exposures to hand-transmitted vibrations generated by powered hand tools. The objective of this study was to characterise the vibration transmissibility spectra and frequency-weighted vibration transmissibility of VR gloves at the palm of the hand in three orthogonal directions. Seven adult males participated in the evaluation of seven glove models using a three-dimensional hand–arm vibration test system. Three levels of hand coupling force were applied in the experiment. This study found that, in general, VR gloves are most effective at reducing vibrations transmitted to the palm along the forearm direction. Gloves that are found to be superior at reducing vibrations in the forearm direction may not be more effective in the other directions when compared with other VR gloves. This casts doubts on the validity of the standardised glove screening test. Practitioner Summary This study used human subjects to measure three-dimensional vibration transmissibility of vibration-reducing gloves at the palm and identified their vibration attenuation characteristics. This study found the gloves to be most effective at reducing vibrations along the forearm direction. These gloves did not effectively attenuate vibration along the handle axial direction. PMID:24160755

Reconstruction of the first web space in symbrachydactyly using the reverse radial forearm flap.

PubMed

Gülgönen, Ayan; Güdemez, Eftal

2007-02-01

To present a new approach for the reconstruction of severe first web contractures using a distally based reverse radial forearm flap in symbrachydactyly patients. This study included 6 hands in 5 patients. Subjective evaluation included appearance, parent satisfaction (and patient satisfaction when appropriate), and ability to perform daily activities such as thumb-index grasp and pinch at follow-up evaluations. We measured the angle between the first and second rays using a goniometer at maximum radial abduction, and pinch and grasp strengths were evaluated as an objective assessment. The average follow-up period was 2 years. All parents and patients were happy with the aesthetic appearance. They were completely satisfied in their daily living activities. The average first web angle measurement was 56 degrees . An average of 39 degrees of improvement of web measurement was achieved. For the unilateral 4 patients, the average pinch strength measurement was 80% of the normal contralateral hand and the grip strength was 75% of the normal contralateral hand. The reverse radial forearm flap was found to be a safe and simple method in the reconstruction of severe first web contractures in symbrachydactyly patients. This method provided good coverage of appropriate thickness and skin quality, and supple soft tissue that filled the first web space. Therapeutic IV.

Patient specific pointer tool for corrective osteotomy: Quality of symmetry based planning and case study of ulnar reconstruction surgery.

PubMed

Mueller, Samuel; Kahrs, Lueder A; Gaa, Johannes; Ortmaier, Tobias; Clausen, Jan-Dierk; Krettek, Christian

2017-07-01

Malunion after forearm fractures are described to appear in 2% to 10% of cases. Reconstructive surgeries ensure adequate anatomical repositioning. Their importance derives from the fact that malunion can often lead to severe pain as well as deformities causing loss of function and aesthetic issues not only in the forearm, but also the wrist and elbow joint. In this paper a clinical case will be presented using a Patient Specific Instrument (PSI) as navigational aid for reconstructive surgery after malunion of a proximal ulnar fracture combined with allograft surgery of the radial head and radial condyle due to chronic traumatic radial head luxation (Monteggia fracture). A planning method based on symmetry is described and evaluated on twelve Computed Tomographic (CT) data sets of intact forearms. The absolute point to point deviation at distal end of the ulnar styloid process was used as a characteristic value for accuracy evaluation. It is 7.9±4.9mm when using only the proximal end of the ulna for registration. The simulated change of ulnar variance is -1.4±1.9mm. Design and concept of the PSI are proven in a clinical trial. Copyright © 2017 Elsevier Ltd. All rights reserved.

Cyclic motion encoding for enhanced MR visualization of slip interfaces.

PubMed

Mariappan, Yogesh K; Glaser, Kevin J; Manduca, Armando; Ehman, Richard L

2009-10-01

To develop and test a magnetic resonance imaging-based method for assessing the mechanical shear connectivity across tissue interfaces with phantom experiments and in vivo feasibility studies. External vibrations were applied to phantoms and tissue and the differential motion on either side of interfaces within the media was mapped onto the phase of the MR images using cyclic motion encoding gradients. The phase variations within the voxels of functional slip interfaces reduced the net magnitude signal in those regions, thus enhancing their visualization. A simple two-compartment model was developed to relate this signal loss to the intravoxel phase variations. In vivo studies of the abdomen and forearm were performed to visualize slip interfaces in healthy volunteers. The phantom experiments demonstrated that the proposed technique can assess the functionality of shear slip interfaces and they provided experimental validation for the theoretical model developed. Studies of the abdomen showed that the slip interface between the small bowel and the peritoneal wall can be visualized. In the forearm, this technique was able to depict the slip interfaces between the functional compartments of the extrinsic forearm muscles. Functional shear slip interfaces can be visualized sensitively using cyclic motion encoding of externally applied tissue vibrations. (c) 2009 Wiley-Liss, Inc.

Active upper limb prosthesis based on natural movement trajectories.

PubMed

Ramírez-García, Alfredo; Leija, Lorenzo; Muñoz, Roberto

2010-03-01

The motion of the current prostheses is sequential and does not allow natural movements. In this work, complex natural motion patterns from a healthy upper limb were characterized in order to be emulated for a trans-humeral prosthesis with three degrees of freedom at the elbow. Firstly, it was necessary to define the prosthesis workspace, which means to establish a relationship using an artificial neural network (ANN), between the arm-forearm (3-D) angles allowed by the prosthesis, and its actuators length. The 3-D angles were measured between the forearm and each axis of the reference system attached at the elbow. Secondly, five activities of daily living (ADLs) were analyzed by means of the elbow flexion (EF), the forearm prono-supination (FPS) and the 3-D angles, from healthy subjects, by using a video-based motion analysis system. The 3-D angles were fed to the prosthesis model (ANN) in order to analyze which ADLs could be emulated by the prosthesis. As a result, a prosthesis kinematics approximation was obtained. In conclusion, in spite of the innovative mechanical configuration of the actuators, it was possible to carry out only three of the five ADLs considered. Future work will include improvement of the mechanical configuration of the prosthesis to have greater range of motion.

Muscle- and Mode-Specific Responses of the Forearm Flexors to Fatiguing, Concentric Muscle Actions

PubMed Central

Hill, Ethan; Housh, Terry; Smith, Cory; Schmidt, Richard; Johnson, Glen

2016-01-01

Background: Electromyographic (EMG) and mechanomyographic (MMG) studies of fatigue have generally utilized maximal isometric or dynamic muscle actions, but sport- and work-related activities involve predominately submaximal movements. Therefore, the purpose of the present investigation was to examine the torque, EMG, and MMG responses as a result of submaximal, concentric, isokinetic, forearm flexion muscle actions. Methods: Twelve men performed concentric peak torque (PT) and isometric PT trials before (pretest) and after (posttest) performing 50 submaximal (65% of concentric PT), concentric, isokinetic (60°·s−1), forearm flexion muscle actions. Surface EMG and MMG signals were simultaneously recorded from the biceps brachii and brachioradialis muscles. Results: The results of the present study indicated similar decreases during both the concentric PT and isometric PT measurements for torque, EMG mean power frequency (MPF), and MMG MPF following the fatiguing workbout, but no changes in EMG amplitude (AMP) or MMG AMP. Conclusions: These findings suggest that decreases in torque as a result of fatiguing, dynamic muscle actions may have been due to the effects of metabolic byproducts on excitation–contraction coupling as indicated by the decreases in EMG MPF and MMG MPF, but lack of changes in EMG AMP and MMG AMP from both the biceps brachii and brachioradialis muscles.

Unsteady computational fluid dynamics in front crawl swimming.

PubMed

Samson, Mathias; Bernard, Anthony; Monnet, Tony; Lacouture, Patrick; David, Laurent

2017-05-01

The development of codes and power calculations currently allows the simulation of increasingly complex flows, especially in the turbulent regime. Swimming research should benefit from these technological advances to try to better understand the dynamic mechanisms involved in swimming. An unsteady Computational Fluid Dynamics (CFD) study is conducted in crawl, in order to analyse the propulsive forces generated by the hand and forearm. The k-ω SST turbulence model and an overset grid method have been used. The main objectives are to analyse the evolution of the hand-forearm propulsive forces and to explain this relative to the arm kinematics parameters. In order to validate our simulation model, the calculated forces and pressures were compared with several other experimental and numerical studies. A good agreement is found between our results and those of other studies. The hand is the segment that generates the most propulsive forces during the aquatic stroke. As the pressure component is the main source of force, the orientation of the hand-forearm in the absolute coordinate system is an important kinematic parameter in the swimming performance. The propulsive forces are biggest when the angles of attack are high. CFD appears as a very valuable tool to better analyze the mechanisms of swimming performance and offers some promising developments, especially for optimizing the performance from a parametric study.

Muscle Velocity and Inertial Force from Phase Contrast Magnetic Resonance Imaging

PubMed Central

Wentland, Andrew L.; McWalter, Emily J.; Pal, Saikat; Delp, Scott L.; Gold, Garry E.

2014-01-01

Purpose To evaluate velocity waveforms in muscle and to create a tool and algorithm for computing and analyzing muscle inertial forces derived from 2D phase contrast (PC) MRI. Materials and Methods PC MRI was performed in the forearm of four healthy volunteers during 1 Hz cycles of wrist flexion-extension as well as in the lower leg of six healthy volunteers during 1 Hz cycles of plantarflexion-dorsiflexion. Inertial forces (F) were derived via the equation F = ma. The mass, m, was derived by multiplying voxel volume by voxel-by-voxel estimates of density via fat-water separation techniques. Acceleration, a, was obtained via the derivative of the PC MRI velocity waveform. Results Mean velocities in the flexors of the forearm and lower leg were 1.94 ± 0.97 cm/s and 5.57 ± 2.72 cm/s, respectively, as averaged across all subjects; the inertial forces in the flexors of the forearm and lower leg were 1.9 × 10-3 ± 1.3 × 10-3 N and 1.1 × 10-2 ± 6.1 × 10-3 N, respectively, as averaged across all subjects. Conclusion PC MRI provided a promising means of computing muscle velocities and inertial forces—providing the first method for quantifying inertial forces. PMID:25425185

[Walking with canes and forearm-crutches (author's transl)].

PubMed

Bergmann, G; Kölbel, R; Rauschenbach, N; Rohlmann, A

1978-02-01

Partial weight bearing is frequently prescribed but cannot be controlled adequately. In a previous paper the change of forces at the hip joint as effected by a one sided cane was determined by instrumentation of the cane and a mechanical analysis of gait on a walkway. In the present study we looked at the conditions for control of partial weightbearing when two forearm crutches are used. Instrumented crutches and a forceplate were used. In walking with two forearm crutches the total of the ground reaction forces and the force pattern differ from those in free walking. The total of two crutch forces plus the force at the leg with partial weightbearing exceeds that caused by body weight alone. This is due to mass accelerations in a changed gait pattern. When the maximal leg force is reduced from 100% body weight to zero, the additional dynamic forces exceed those caused by body weight alone by 4%-19%. Only 2% of the additional dynamic forces act on the controlateral crutch while the rest is transmitted through the ipsilateral crutch. The crutch force pattern on the ipsilateral side depends more on individual gait characteristics than does that on the controlateral side. Load reduction is more pronounced in the late stages of the stand phase than in the early ones.

Is the Frequency in Somatosensory Electrical Stimulation the Key Parameter in Modulating the Corticospinal Excitability of Healthy Volunteers and Stroke Patients with Spasticity?

PubMed

Garcia, Marco Antonio Cavalcanti; Catunda, João Marcos Yamasaki; de Souza, Marcio Nogueira; Fontana, Ana Paula; Sperandei, Sandro; Vargas, Claudia D

2016-01-01

Somatosensory electrical stimulation (SES) has been proposed as an approach to treat patients with sensory-motor impairment such as spasticity. However, there is still no consensus regarding which would be the adequate SES parameters to treat those deficits. Therefore, the aim of this study was to evaluate the effects of applying SES over the forearm muscles at four different frequencies of stimulation (3, 30, 150, and 300 Hz) and in two intervals of time (5' and 30') by means of transcranial magnetic stimulation and Hoffmann's reflex (H-reflex) in healthy volunteers (Experiments  I and II). A group of stroke patients (Experiment  III) was also preliminary evaluated to ascertain SES effects at a low frequency (3 Hz) applied for 30' over the forearm spastic flexors muscles by measuring the wrist joint passive torque. Motor evoked potentials and the H-reflex were collected from different forearm and hand muscles immediately before and after SES and up to 5' (Experiment  I) and 10' (Experiments  I and II) later. None of the investigated frequencies of SES was able to operate as a key in switching modulatory effects in the central nervous system of healthy volunteers and stroke patients with spasticity.

Effect of cooling on thixotropic position-sense error in human biceps muscle.

PubMed

Sekihara, Chikara; Izumizaki, Masahiko; Yasuda, Tomohiro; Nakajima, Takayuki; Atsumi, Takashi; Homma, Ikuo

2007-06-01

Muscle temperature affects muscle thixotropy. However, it is unclear whether changes in muscle temperature affect thixotropic position-sense errors. We studied the effect of cooling on thixotropic position-sense errors induced by short-length muscle contraction (hold-short conditioning) in the biceps of 12 healthy men. After hold-short conditioning of the right biceps muscle in a cooled (5.0 degrees C) or control (36.5 degrees C) environment, subjects perceived greater extension of the conditioned forearm at 5.0 degrees C. The angle differences between the two forearms following hold-short conditioning of the right biceps muscle in normal or cooled conditions were significantly different (-3.335 +/- 1.680 degrees at 36.5 degrees C vs. -5.317 +/- 1.096 degrees at 5.0 degrees C; P=0.043). Induction of a tonic vibration reflex in the biceps muscle elicited involuntary forearm elevation, and the angular velocities of the elevation differed significantly between arms conditioned in normal and cooled environments (1.583 +/- 0.326 degrees /s at 36.5 degrees C vs. 3.100 +/- 0.555 degrees /s at 5.0 degrees C, P=0.0039). Thus, a cooled environment impairs a muscle's ability to provide positional information, potentially leading to poor muscle performance.

Muscle cooling delays activation of the muscle metaboreflex in humans.

PubMed

Ray, C A; Hume, K M; Gracey, K H; Mahoney, E T

1997-11-01

Elevation of muscle temperature has been shown to increase muscle sympathetic nerve activity (MSNA) during isometric exercise in humans. The purpose of the present study was to evaluate the effect of muscle cooling on MSNA responses during exercise. Eight subjects performed ischemic isometric handgrip at 30% of maximal voluntary contraction to fatigue followed by 2 min of postexercise muscle ischemia (PEMI), with and without local cooling of the forearm. Local cooling of the forearm decreased forearm muscle temperature from 31.8 +/- 0.4 to 23.1 +/- 0.8 degrees C (P = 0.001). Time to fatigue was not different during the control and cold trials (156 +/- 11 and 154 +/- 5 s, respectively). Arterial pressures and heart rate were not significantly affected by muscle cooling during exercise, although heart rate tended to be higher during the second minute of exercise (P = 0.053) during muscle cooling. Exercise-induced increases in MSNA were delayed during handgrip with local cooling compared with control. However, MSNA responses at fatigue and PEMI were not different between the two conditions. These findings suggest that muscle cooling delayed the activation of the muscle metaboreflex during ischemic isometric exercise but did not prevent its full expression during fatiguing contraction. These results support the concept that muscle temperature can play a role in the regulation of MSNA during exercise.

Biomechanical analysis of the sidearm throwing motion for distance of a flying disc: a comparison of skilled and unskilled ultimate players.

PubMed

Sasakawa, Kei; Sakurai, Shinji

2008-09-01

Joint angles of the throwing limb were examined from the acceleration phase up until release for the sidearm throwing motion when using a flying disc. 17 individuals (ten skilled, seven unskilled) threw a disc as far as possible ten times. Throwing motions were recorded using three-dimensional high-speed videography. The initial condition of disc release and joint angle kinematics of the upper limb during the throwing motion were obtained. Mean (+/- standard deviation) throwing distance and disc spin rate were significantly greater for skilled throwers (51.4 +/- 6.6 m, 12.9 +/- 1.3 rps) than for unskilled throwers (29.5 +/- 7.6 m, 9.4 +/- 1.3 rps), although there was no significant difference in initial velocity of the disc between the two groups (skilled: 21.7 +/- 1.7m/s; unskilled: 20.7 +/- 2.5m/s). A marked difference in motion of supination/pronation of the forearm before disc release was identified, with the forearm supinated in the final acceleration phase leading up to disc release for the unskilled participants, while the forearm was pronated in the same phase for the skilled participants. These differences in joint kinematics could be related to differences in disc spin rate, and thus led to the substantial differences in throwing distance.

Assessing localized skin-to-fat water in arms of women with breast cancer via tissue dielectric constant measurements in pre- and post-surgery patients.

PubMed

Mayrovitz, Harvey N; Weingrad, Daniel N; Lopez, Lidice

2015-05-01

Skin-to-fat tissue dielectric constant (TDC) values at 300 MHz largely depend on tissue water and provide a rapid way to assess skin water by touching skin with a probe for approximately 10 s. This method has been used to investigate lymphedema features accompanying breast cancer (BC), but relationships between TDC and nodes removed or symptoms is unclear. Our goals were: (1) to compare TDC values in BC patients prior to surgery (group A) and in patients who had BC-related surgery (group B) to determine if TDC of group B were related to nodes removed and reported symptoms and (2) to develop tentative lymphedema-detection thresholds. Arm volumes and TDC values of at-risk and contralateral forearms and biceps were determined in 103 women awaiting surgery for BC and 104 women who had BC-related surgery 26.3 ± 17.5 months prior to evaluation. Inter-arm ratios (at-risk/contralateral) were determined and patients answered questions about lymphedema-related symptoms. Inter-arm TDC ratios for group A forearm and biceps were respectively 1.003 ± 0.096 and 1.012 ± 0.143. Group B forearm ratios were significantly greater, and among group B patients who reported at least one symptom there was a significant correlation between TDC ratios and symptom burden and nodes removed. Inter-arm TDC ratios are significantly related to symptoms and nodes removed. Ratios increase with increasing symptom score and might be used to detect pre-clinical unilateral lymphedema using TDC ratio thresholds of 1.30 for forearm and 1.45 for biceps. Threshold confirmation awaits targeted prospective studies but can serve as guideposts to provide quantitative and easily done tracking assessments during follow-up visits.

Consider use of a collateral venous circuit before abandoning the arteriovenous fistula--the experience of a complex vascular access case.

PubMed

Gołębiowski, Tomasz; Kusztal, Mariusz; Wątorek, Ewa; Garcarek, Jerzy; Letachowicz, Krzysztof; Weyde, Wacław; Klinger, Marian

2014-07-01

We describe a 65-year-old woman with diabetes on hemodialysis maintenance, with a number of complications associated with high-flow arteriovenous fistula (AVF, anastomosis between brachial artery and medial vein of the forearm) requiring an extended diagnostic and individual approach. The patient was admitted to our hospital because of pain, edema of the limb, hand ischemia, and infection caused by steal syndrome. To reduce fistula flow, banding of the proximal cephalic vein was performed. Simultaneously because of necrosis, amputation of the fifth finger was necessary. Following this procedure, the cephalic vein on the arm thrombosed. The fistula was patent through the collateral circuit, which was diagnosed in detail during the late course. A long course of antibiotics and sessions in a hyperbaric chamber allowed limb rescue. Single-needle dialysis was carried out because of problems in finding an appropriate second place. After an episode of bleeding from the puncture site caused by ulceration, we were forced to search for an alternative needling point. On the basis of ultrasound scans, an anatomic schema of the blood circuit was created. The fistula demonstrated flow from the brachial artery resulting in retrograde flow in the section of the cephalic vein distal to the anastomosis in the upper forearm. This was then seen to drain in an antegrade direction via the median vein of the forearm after the 2 vessels connected in the mid forearm. Using the diagram, 2 alternative places for needling were found and it allowed the adequate hemodialysis to be continued. Complex and complicated cases associated with native AVF could be resolved using simple diagnostic tools to preserve the fistula use for hemodialysis. Both clinical examination and ultrasound scan with the Doppler option appear to be valuable methods for finding the optimal cannulation place. Copyright © 2014 Elsevier Inc. All rights reserved.

Osteoporosis and skeletal fractures in chronic liver disease.

PubMed Central

Diamond, T; Stiel, D; Lunzer, M; Wilkinson, M; Roche, J; Posen, S

1990-01-01

In order to determine the prevalence and severity of hepatic osteodystrophy by non-invasive means we compared 115 consecutive ambulant patients with histologically proven chronic liver disease to 113 age and sex matched control subjects. Methods used included the assessment of fracture prevalence rates, spinal radiography, and measurements of bone mineral density in the spine and the forearm. Spinal and peripheral fractures were more prevalent in the patients than in the control subjects (p less than 0.03 and p less than 0.01 respectively). The type of the underlying liver disease did not significantly affect the fracture prevalence rates, but alcoholic patients sustained more peripheral fractures than patients with other hepatic disorders (p less than 0.05). The bone mineral densities of the spines and the forearms were significantly reduced in male patients of all age groups and in female patients aged 60 years or more (p less than 0.001 for men and p less than 0.01 for women for both measurements). The prevalence rates of spinal and forearm osteoporosis were twice as high among patients with liver disease than in control subjects regardless of the definitions used. The presence of cirrhosis and hypogonadism were major risk factors for development of both spinal (Beta coef = 0.190 and 0.176; SE = 0.079 and 0.086 respectively) and forearm osteoporosis (Beta coef = 0.20 and 0.29; SE = 0.073 and 0.80 respectively). Spinal bone density was the predominant determinant of spinal fractures (Beta coef = -0.007; SE = 0.001), while hypogonadism (Beta coef = 0.363; SE = 0.075) and cirrhosis (Beta coef = 0.185; SE = 0.068) were the major predictors of peripheral fractures. The concentrations of serum calcium and serum vitamin D metabolites and the use of corticosteroids were apparently without effect on the prevalence of skeletal fractures or bone density. PMID:2318434

Hypoalgesia in response to transcutaneous electrical nerve stimulation (TENS) depends on stimulation intensity.

PubMed

Moran, Fidelma; Leonard, Tracey; Hawthorne, Stephanie; Hughes, Ciara M; McCrum-Gardner, Evie; Johnson, Mark I; Rakel, Barbara A; Sluka, Kathleen A; Walsh, Deirdre M

2011-08-01

Transcutaneous electrical nerve stimulation (TENS) is an electrophysical modality used for pain management. This study investigated the dose response of different TENS intensities on experimentally induced pressure pain. One hundred and thirty TENS naïve healthy individuals (18-64 years old; 65 males, 65 females) were randomly allocated to 5 groups (n = 26 per group): Strong Non Painful TENS; Sensory Threshold TENS; Below Sensory Threshold TENS; No Current Placebo TENS; and Transient Placebo TENS. Active TENS (80 Hz) was applied to the forearm for 30 minutes. Transient Placebo TENS was applied for 42 seconds after which the current amplitude automatically reset to 0 mA. Pressure pain thresholds (PPT) were recorded from 2 points on the hand and forearm before and after TENS to measure hypoalgesia. There were significant differences between groups at both the hand and forearm (ANOVA; P = .005 and .002). At 30 minutes, there was a significant hypoalgesic effect in the Strong Non Painful TENS group compared to: Below Sensory Threshold TENS, No Current Placebo TENS and Transient Placebo TENS groups (P < .0001) at the forearm; Transient Placebo TENS and No Current Placebo TENS groups at the hand (P = .001). There was no significant difference between Strong Non Painful TENS and Sensory Threshold TENS groups. The area under the curve for the changes in PPT significantly correlated with the current amplitude (r(2) = .33, P = .003). These data therefore show that there is a dose-response effect of TENS with the largest effect occurring with the highest current amplitudes. This study shows a dose response for the intensity of TENS for pain relief with the strongest intensities showing the greatest effect; thus, we suggest that TENS intensity should be titrated to achieve the strongest possible intensity to achieve maximum pain relief. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

A new clinical method for the assessment of penile endothelial function using the flow mediated dilation with plethysmography technique.

PubMed

Dayan, Lior; Greunwald, Illan; Vardi, Yoram; Jacob, Giris

2005-04-01

Penile endothelial function (EnF) is 1 of the major factors involved in the pathophysiology of erectile dysfunction. EnF assessment could offer crucial information on the etiology and degree of severity of cavernosal vascular pathology. In the present study we propose a new technique for the evaluation of penile EnF and test its applicability using strain gauge plethysmography. A total of 23 healthy subjects (13 younger and 10 older than 40 years) with no history of erectile dysfunction were studied. The flow mediated dilation technique was applied to the arm and penis in both age groups for the assessment of EnF. Baseline blood flow and the sequential flow recordings after rapid cessation of 5 minutes of ischemia were obtained in both organs. Baseline flow in the penis was significantly higher (approximately 3-fold) than that in the forearm and was not affected by age in either organ. Both measures of penile EnF, ie area under the flow-time curve (AUC) and maximal flow obtained after ischemia were significantly lower in the older group compared to the younger group (p <0.01 and p <0.02, respectively). Individual penile AUC and maximal flow were significantly correlated with age (r = 0.55, p <0.01 and r = 0.50, p <0.02, respectively). Finally a positive, significant correlation existed between penile and forearm AUC (p <0.05, r = 0.48). The implementation of the flow mediated dilation technique using mercury strain gauge plethysmography is simple and applicable for the assessment of penile EnF. Endothelial function parameters in the penis were found to correlate with those in the forearm, thus support for the validity of the technique is given. Further strength for the validity of this procedure in the penis comes from the comparison between the forearm and penis, and the relation to subject age.

Skin Barrier Function and Staphylococcus aureus Colonization in Vestibulum Nasi and Fauces in Healthy Infants and Infants with Eczema: A Population-Based Cohort Study.

PubMed

Berents, Teresa Løvold; Carlsen, Karin Cecilie Lødrup; Mowinckel, Petter; Skjerven, Håvard Ove; Kvenshagen, Bente; Rolfsjord, Leif Bjarte; Bradley, Maria; Lieden, Agne; Carlsen, Kai-Håkon; Gaustad, Peter; Gjersvik, Petter

2015-01-01

Atopic eczema (AE) is associated with Staphylococcus aureus (S. aureus) colonization and skin barrier dysfunction, often measured by increased transepidermal water loss (TEWL). In the present study, the primary aim was to see whether S. aureus colonization in the vestibulum nasi and/or fauces was associated with increased TEWL in infants with healthy skin and infants with eczema. Secondarily, we aimed to investigate whether TEWL measurements on non-lesional skin on the lateral upper arm is equivalent to volar forearm in infants. In 167 of 240 infants, recruited from the general population, TEWL measurements on the lateral upper arm and volar forearm, using a DermaLab USB, fulfilled our environmental requirements. The mean of three TEWL measurements from each site was used for analysis. The infants were diagnosed with no eczema (n = 110), possible AE (n = 28) or AE (n = 29). DNA samples were analysed for mutations in the filaggrin gene (FLG). Bacterial cultures were reported positive with the identification of at least one culture with S. aureus from vestibulum nasi and/or fauces. S. aureus colonization, found in 89 infants (53%), was not associated with increased TEWL (i.e. TEWL in the upper quartile), neither on the lateral upper arm or volar forearm (p = 0.08 and p = 0.98, respectively), nor with AE (p = 0.10) or FLG mutation (p = 0.17). TEWL was significantly higher on both measuring sites in infants with AE compared to infants with possible AE and no eczema. FLG mutation was significantly associated with increased TEWL, with a 47% difference in TEWL. We conclude that S. aureus in vestibulum nasi and/or fauces was not associated with TEWL, whereas TEWL measurements on the lateral upper arm and volar forearm appear equally appropriate in infants.

Prolonged forearm ischemia attenuates endothelium-dependent vasodilatation and plasma nitric oxide metabolites in overweight middle-aged men.

PubMed

Aboo Bakkar, Zainie; Fulford, Jonathan; Gates, Phillip E; Jackman, Sarah R; Jones, Andrew M; Bond, Bert; Bowtell, Joanna L

2018-05-21

Repeated cycles of endothelial ischemia-reperfusion injury and the resulting respiratory burst contribute to the irreversible pathophysiology of vascular diseases, and yet, the effects of ischemia reperfusion on vascular function, oxidative stress, and nitric oxide (NO) bioavailability have not been assessed simultaneously. Therefore, this study sought to examine the effects of prolonged forearm occlusion and subsequent reperfusion on NO-dependent brachial artery endothelial function. Flow-mediated dilatation was measured at baseline and 15, 30, and 45 min after 20-min forearm occlusion in 14 healthy, but physically inactive middle-aged men (53.7 ± 1.2 years, BMI: 28.1 ± 0.1 kg m -2 ). Venous blood samples collected from the occluded arm were analyzed for NO metabolites and markers of oxidative stress. FMD was significantly depressed after the prolonged occlusion compared to baseline, with a significant reduction 15-min post-occlusion (6.6 ± 0.7 to 2.9 ± 0.4%, p < 0.001); FMD remained depressed after 30 min (4.1 ± 0.6%, p = 0.001), but was not significantly different to baseline after 45-min recovery (5.4 ± 0.7%, p = 0.079). Plasma nitrate (main time effect: p = 0.015) and nitrite (main time effect: p = 0.034) concentrations were significantly reduced after prolonged occlusion. Plasma catalase activity was significantly elevated at 4- (p = 0.016) and 45-min (p = 0.001) post-occlusion, but plasma peroxiredoxin 2 and protein carbonyl content did not change. Prolonged forearm occlusion resulted in acute impairment of endothelium-dependent vasodilatation of the brachial artery for at least 30 min after reperfusion. We demonstrate that this vascular dysfunction is associated with oxidative stress and reduced NO bioavailability following reperfusion.

Adrenomedullin (ADM) in the human forearm vascular bed: effect of neutral endopeptidase inhibition and comparison with proadrenomedullin NH2-terminal 20 peptide (PAMP)

PubMed Central

Wilkinson, Ian B; McEniery, Carmel M; Bongaerts, Katherine H; MacCallum, Helen; Webb, David J; Cockcroft, John R

2001-01-01

Aims To compare the haemodynamic responses of proadrenomedullin N-terminal 20 peptide (PAMP) and adrenomedullin (ADM) in the forearm vascular bed of healthy male volunteers, and to investigate the role of neutral endopeptidase (NEP) in the metabolism of ADM. Methods On two separate occasions, ADM (1–30 pmol min−1) and PAMP (100–3000 pmol min−1) were infused into the brachial artery of eight male subjects, and forearm blood flow (FBF) assessed using venous occlusion plethysmography. In a second study, eight male subjects received the same doses of ADM, co-infused with either the NEP inhibitor thiorphan (30 nmol min−1) or the control vasoconstrictor noradrenaline (120 pmol min−1), on separate occasions. Both studies were conducted in a double-blind, randomized manner. Results ADM and PAMP produced a dose-dependent increase in FBF (P ≤ 0.002). Based on the dose producing a 50% increase in FBF, ADM was ∼60 times more potent than PAMP. Thiorphan and noradrenaline produced similar reductions in FBF of 14 ± 4% (mean ± s.e. mean) and 22 ± 6%, respectively (P = 0.4). However, the area under the dose–response curve was significantly greater during co-infusion of ADM with thiorphan than with noradrenaline (P = 0.028), as was the maximum increase in FBF ratio (2.1 ± 1.0 vs 1.2 ± 0.2; P = 0.030). Conclusions ADM and PAMP both produce a local dose-related vasodilatation in the human forearm, but PAMP is ∼60 times less potent than ADM. In addition, NEP inhibition potentiates the haemodynamic effects of ADM. These findings suggest that PAMP may not play a role in the physiological regulation of blood flow. However, in pathophysiological conditions such as hypertension and heart failure, NEP inhibition may exert a beneficial effect by increasing the biological activity of ADM. PMID:11488772

Upper limb joint muscle/tendon injury and anthropometric adaptations in French competitive tennis players.

PubMed

Rogowski, Isabelle; Creveaux, Thomas; Genevois, Cyril; Klouche, Shahnaz; Rahme, Michel; Hardy, Philippe

2016-01-01

The purpose of this study was to examine the relationship between the upper limb anthropometric dimensions and a history of dominant upper limb injury in tennis players. Dominant and non-dominant wrist, forearm, elbow and arm circumferences, along with a history of dominant upper limb injuries, were assessed in 147 male and female players, assigned to four groups based on location of injury: wrist (n = 9), elbow (n = 25), shoulder (n = 14) and healthy players (n = 99). From anthropometric dimensions, bilateral differences in circumferences and in proportions were calculated. The wrist group presented a significant bilateral difference in arm circumference, and asymmetrical bilateral proportions between wrist and forearm, as well as between elbow and arm, compared to the healthy group (6.6 ± 3.1% vs. 4.9 ± 4.0%, P < 0.01; -3.6 ± 3.0% vs. -0.9 ± 2.9%, P < 0.05; and -2.2 ± 2.2% vs. 0.1 ± 3.4%, P < 0.05, respectively). The elbow group displayed asymmetrical bilateral proportions between forearm and arm compared to the healthy group (-0.4 ± 4.3% vs. 1.5 ± 4.0%, P < 0.01). The shoulder group showed significant bilateral difference in elbow circumference, and asymmetrical bilateral proportions between forearm and elbow when compared to the healthy group (5.8 ± 4.7% vs. 3.1 ± 4.8%, P < 0.05 and -1.7 ± 4.5% vs. 1.4 ± 4.3%, P < 0.01, respectively). These findings suggest that players with a history of injury at the upper limb joint present altered dominant upper limb proportions in comparison with the non-dominant side, and such asymmetrical proportions would appear to be specific to the location of injury. Further studies are needed to confirm the link between location of tennis injury and asymmetry in upper limb proportions using high-tech measurements in symptomatic tennis players.

Quality of life after hip, vertebral, and distal forearm fragility fractures measured using the EQ-5D-3L, EQ-VAS, and time-trade-off: results from the ICUROS.

PubMed

Svedbom, Axel; Borgström, Fredrik; Hernlund, Emma; Ström, Oskar; Alekna, Vidmantas; Bianchi, Maria Luisa; Clark, Patricia; Curiel, Manuel Díaz; Dimai, Hans Peter; Jürisson, Mikk; Uusküla, Anneli; Lember, Margus; Kallikorm, Riina; Lesnyak, Olga; McCloskey, Eugene; Ershova, Olga; Sanders, Kerrie M; Silverman, Stuart; Tamulaitiene, Marija; Thomas, Thierry; Tosteson, Anna N A; Jönsson, Bengt; Kanis, John A

2018-03-01

The International Costs and Utilities Related to Osteoporotic fractures Study is a multinational observational study set up to describe the costs and quality of life (QoL) consequences of fragility fracture. This paper aims to estimate and compare QoL after hip, vertebral, and distal forearm fracture using time-trade-off (TTO), the EuroQol (EQ) Visual Analogue Scale (EQ-VAS), and the EQ-5D-3L valued using the hypothetical UK value set. Data were collected at four time-points for five QoL point estimates: within 2 weeks after fracture (including pre-fracture recall), and at 4, 12, and 18 months after fracture. Health state utility values (HSUVs) were derived for each fracture type and time-point using the three approaches (TTO, EQ-VAS, EQ-5D-3L). HSUV were used to estimate accumulated QoL loss and QoL multipliers. In total, 1410 patients (505 with hip, 316 with vertebral, and 589 with distal forearm fracture) were eligible for analysis. Across all time-points for the three fracture types, TTO provided the highest HSUVs, whereas EQ-5D-3L consistently provided the lowest HSUVs directly after fracture. Except for 13-18 months after distal forearm fracture, EQ-5D-3L generated lower QoL multipliers than the other two methods, whereas no equally clear pattern was observed between EQ-VAS and TTO. On average, the most marked differences between the three approaches were observed immediately after the fracture. The approach to derive QoL markedly influences the estimated QoL impact of fracture. Therefore the choice of approach may be important for the outcome and interpretation of cost-effectiveness analysis of fracture prevention.

Position sense at the human elbow joint measured by arm matching or pointing.

PubMed

Tsay, Anthony; Allen, Trevor J; Proske, Uwe

2016-10-01

Position sense at the human elbow joint has traditionally been measured in blindfolded subjects using a forearm matching task. Here we compare position errors in a matching task with errors generated when the subject uses a pointer to indicate the position of a hidden arm. Evidence from muscle vibration during forearm matching supports a role for muscle spindles in position sense. We have recently shown using vibration, as well as muscle conditioning, which takes advantage of muscle's thixotropic property, that position errors generated in a forearm pointing task were not consistent with a role by muscle spindles. In the present study we have used a form of muscle conditioning, where elbow muscles are co-contracted at the test angle, to further explore differences in position sense measured by matching and pointing. For fourteen subjects, in a matching task where the reference arm had elbow flexor and extensor muscles contracted at the test angle and the indicator arm had its flexors conditioned at 90°, matching errors lay in the direction of flexion by 6.2°. After the same conditioning of the reference arm and extension conditioning of the indicator at 0°, matching errors lay in the direction of extension (5.7°). These errors were consistent with predictions based on a role by muscle spindles in determining forearm matching outcomes. In the pointing task subjects moved a pointer to align it with the perceived position of the hidden arm. After conditioning of the reference arm as before, pointing errors all lay in a more extended direction than the actual position of the arm by 2.9°-7.3°, a distribution not consistent with a role by muscle spindles. We propose that in pointing muscle spindles do not play the major role in signalling limb position that they do in matching, but that other sources of sensory input should be given consideration, including afferents from skin and joint.

Monosynaptic Ia projections from intrinsic hand muscles to forearm motoneurones in humans.

PubMed

Marchand-Pauvert, V; Nicolas, G; Pierrot-Deseilligny, E

2000-05-15

Heteronymous Ia excitatory projections from intrinsic hand muscles to human forearm motoneurones (MNs) were investigated. Changes in firing probability of single motor units (MUs) in the flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), flexor digitorum superficialis (FDS), extensor carpi radialis (ECR), extensor carpi ulnaris (ECU) and extensor digitorum communis (EDC) were studied after electrical stimuli were applied to the median and ulnar nerve at wrist level and to the corresponding homonymous nerve at elbow level. Homonymous facilitation, occurring at the same latency as the H reflex, and therefore attributed to monosynaptic Ia EPSPs, was found in all the sampled units. In many MUs an early facilitation was also evoked by heteronymous low-threshold afferents from intrinsic hand muscles. The low threshold (between 0.5 and 0.6 times motor threshold (MT)) and the inability of a pure cutaneous stimulation to reproduce this effect indicate that it is due to stimulation of group I muscle afferents. Evidence for a similar central delay (monosynaptic) in heteronymous as in homonymous pathways was accepted when the difference in latencies of the homonymous and heteronymous peaks did not differ from the estimated supplementary afferent conduction time from wrist to elbow level by more than 0.5 ms (conduction velocity in the fastest Ia afferents between wrist and elbow levels being equal to 69 m s-1). A statistically significant heteronymous monosynaptic Ia excitation from intrinsic hand muscles supplied by both median and ulnar nerves was found in MUs belonging to all forearm motor nuclei tested (although not in ECU MUs after ulnar stimulation). It was, however, more often found in flexors than in extensors, in wrist than in finger muscles and in muscles operating in the radial than in the ulnar side. It is argued that the connections of Ia afferents from intrinsic hand muscles to forearm MNs, which are stronger and more widely distributed than in the cat, might be used to provide a support to the hand during manipulatory movements.

Temporal and spatiotemporal variability in comprehensive forearm skin microcirculation assessment during occlusion protocols.

PubMed

Strömberg, Tomas; Sjöberg, Folke; Bergstrand, Sara

2017-09-01

Forearm skin hyperemia during release after brachial occlusion has been proposed for evaluating peripheral arterial disease and endothelial dysfunction. We used a novel fiberoptic system integrating Laser Doppler Flowmetry and Diffuse Reflectance Spectroscopy for a comprehensive pointwise model based microcirculation characterization. The aim was to evaluate and compare the temporal and the spatiotemporal variabilities in forearm skin microcirculation parameters (speed resolved perfusion; low speed <1mm/s, Perf SR, <1 ; mid-speed 1-10mm/s, high speed >10mm/s, and total perfusion (Perf SR, tot ); the concentration and oxygenation of red blood cells, C RBC and S O2 ). Ten healthy subjects underwent arterial and venous forearm occlusions (AO, VO), repeated within one week. The repeatability was calculated as the coefficient of variation (CV) and the agreement as the intra-class correlation coefficient (ICC). The temporal CVs for conventional perfusion, Perf conv , Perf SR, tot , C RBC and S O2 were 14%, 12%, 9% and 9%, respectively, while the ICC were >0.75 (excellent). The perfusion measures generally had a higher spatiotemporal than temporal variability, which was not the case for S O2 and C RBC . The corresponding spatiotemporal CVs were 33%, 32%, 18% and 15%, respectively. During VO, C RBC had a CV<35% and ICC>0.40 (fair-good), and after release this was the case for C RBC (AO and VO), S O2 (VO) and Perf SR, <1 (VO). In conclusion, the skin microcirculation parameters showed excellent temporal repeatability, while the spatiotemporal repeatability especially for perfusion was poorer. The parameters with acceptable repeatability and fair-good agreement were: C RBC during and after release of VO, the Perf SR, <1 after release of VO, the S O2 and the C RBC after release of AO. However, the value of these parameters in discriminating endothelial function remains to be studied. Copyright © 2017 Elsevier Inc. All rights reserved.

Long-term Outcome of Peripherally Implanted Venous Access Ports in the Forearm in Female Cancer Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Klösges, Laura, E-mail: l.kloesges@uni-bonn.de; Meyer, Carsten, E-mail: carsten.meyer@ukb.uni-bonn.de; Boschewitz, Jack, E-mail: jack.boschewitz@ukb.uni-bonn.de

PurposeThe aim of this retrospective study was to analyze the long-term outcome of peripherally implanted venous access ports in the forearm at our institution in a female patient collective.MethodsBetween June 2002 and May 2011, a total of 293 female patients with an underlying malignancy had 299 forearm ports implanted in our interventional radiology suite. The mean age of the cohort was 55 ± 12 years (range 26–81 years). The majority of women suffered from breast (59.5 %) or ovarian cancer (28.1 %). Complications were classified as infectious complications, thrombotic and nonthrombotic catheter dysfunction (dislocation of the catheter or port chamber, fracture with/without embolization or kinking ofmore » the catheter, port occlusion), and others.ResultsWe analyzed a total of 90,276 catheter days in 248 port systems (47 patients were lost to follow-up). The mean device service interval was 364 days per catheter (range 8–2,132, median 223 days, CI 311–415, SD 404). Sixty-seven early (≤30 days from implantation) or late complications (>30 days) occurred during the observation period (0.74/1,000 catheter days). Common complications were port infection (0.18/1,000 days), thrombotic dysfunction (0.12/1,000 days), and skin dehiscence (0.12/1,000 days). Nonthrombotic dysfunction occurred in a total of 21 cases (0.23/1,000 days) and seemed to cumulate on the venous catheter entry site on the distal upper arm.ConclusionPeripherally implanted venous access ports in the forearm are a safe alternative to chest or upper-arm ports in female oncology patients. Special attention should be paid to signs of skin dehiscence and nonthrombotic dysfunction, especially when used for long-term treatment.« less

Prevalence of and referred pain from myofascial trigger points in the forearm muscles in patients with lateral epicondylalgia.

PubMed

Fernández-Carnero, Josué; Fernández-de-Las-Peñas, César; de la Llave-Rincón, Ana Isabel; Ge, Hong-You; Arendt-Nielsen, Lars

2007-05-01

Referred pain and pain characteristics evoked from the extensor carpi radialis brevis, extensor carpi radialis longus, extensor digitorum communis, and brachioradialis muscles was investigated in 20 patients with lateral epicondylalgia (LE) and 20-matched controls. Both groups were examined for the presence of myofascial trigger points (TrPs) in a blinded fashion. The quality and location of the evoked referred pain, and the pressure pain threshold (PPT) at the lateral epicondyle on the right upper extremity (symptomatic side in patients, and dominant-side on controls) were recorded. Several lateral elbow pain parameters were also evaluated. Within the patient group, the elicited referred pain by manual exploration of 13 out of 20 (65%) extensor carpi radialis brevis muscles, 12/20 (70%) extensor carpi radialis longus muscles, 10/20 (50%) brachioradialis muscles, and 5/20 (25%) extensor digitorum communis muscles, shares similar pain patterns as their habitual lateral elbow and forearm pain. The mean number of muscles with TrPs for each patient was 2.9 [95% confidence interval (CI) 1,4] of which 2 (95% CI 1,3) were active, and 0.9 (95% CI 0,2) were latent TrPs. Control participants only had latent TrPs (mean: 0.4; 95% CI 0,2). TrP occurrence between the 2 groups was significantly different for active TrPs (P<0.001), but not for latent TrPs (P>0.05). The referred pain pattern was larger in patients than in controls, with pain referral to the lateral epicondyle (proximally) and to the dorso-lateral aspect of the forearm in the patients, and confined to the dorso-lateral aspect of the forearm in the controls. Patients with LE showed a significant (P<0.001) lower PPT (mean: 2.1 kg/cm; 95% CI 0.8, 4 kg/cm) as compared with controls (mean: 4.5 kg/cm; 95% CI 3, 7 kg/cm). Within the patient group, PPT at the lateral epicondyle was negatively correlated with both the total number of TrPs (rs=-0.63; P=0.003) and the number of active TrPs (rs=-0.5; P=0.02): the greater the number of active TrPs, the lower the PPT at the lateral epicondyle. Our results suggest that in patients with LE, the evoked referred pain and its sensory characteristics shared similar patterns as their habitual elbow and forearm pain, consistent with active TrPs. Lower PPT and larger referred pain patterns suggest that peripheral and central sensitization exists in LE.

Variation of skin surface pH, sebum content and stratum corneum hydration with age and gender in a large Chinese population.

PubMed

Man, M Q; Xin, S J; Song, S P; Cho, S Y; Zhang, X J; Tu, C X; Feingold, K R; Elias, P M

2009-01-01

Evidence suggests the importance of skin biophysical properties in predicting diseases and in developing appropriate skin care. The results to date of studies on skin surface pH, stratum corneum (SC) hydration and sebum content in both genders and at various ages have been inconclusive, which was in part due to small sample size. Additionally, little is known about the skin physical properties of Asian, especially Chinese, subjects. In the present study, we assess the difference in skin surface pH, sebum content and SC hydration at various ages and in both genders in a large Chinese population without skin diseases. 713 subjects (328 males and 385 females) aged 0.5-94 years were enrolled in this study. The subjects were divided by age into 5 groups, i.e., 0-12, 13-35, 36-50, 51-70 and over 70 years old. A multifunctional skin physiology monitor was used to measure SC hydration, skin surface pH and sebum content on both the forehead and the forearms. In males, the highest sebum content was found on the forearm and the forehead in the age groups 36-50 (93.47 +/- 10.01 microg/cm(2)) and 51-70 years (9.16 +/- 1.95 microg/cm(2)), while in females, the highest sebum content was found on the forearm and the forehead in the age groups 13-35 (61.91 +/- 6.12 microg/cm(2)) and 51-70 years (7.54 +/- 2.55 microg/cm(2)). The forehead sebum content was higher in males aged 13-70 years than in age-matched females; the sebum content on the forehead in both males and females was higher than that on the forearm. Skin surface pH on the forehead of both males and females over the age of 70 years was higher than that in younger groups. SC hydration on the forehead in both males and females was lower above the age of 70, and the one in males aged 13-35 was higher than that in females (43.99 +/- 1.88 vs. 36.38 +/- 1.67 AU, p < 0.01). SC hydration on the forehead in both males and females did not significantly differ from that on the forearm. In a large Chinese cohort, the skin surface pH, sebum content and SC hydration vary with age, gender and body site. Copyright 2009 S. Karger AG, Basel.

Variation of Skin Surface pH, Sebum Content and Stratum Corneum Hydration with Age and Gender in a Large Chinese Population

PubMed Central

Man, M.Q.; Xin, S.J.; Song, S.P.; Cho, S.Y.; Zhang, X.J.; Tu, C.X.; Feingold, K.R.; Elias, P.M.

2009-01-01

Background and Objectives Evidence suggests the importance of skin biophysical properties in predicting diseases and in developing appropriate skin care. The results to date of studies on skin surface pH, stratum corneum (SC) hydration and sebum content in both genders and at various ages have been inconclusive, which was in part due to small sample size. Additionally, little is known about the skin physical properties of Asian, especially Chinese, subjects. In the present study, we assess the difference in skin surface pH, sebum content and SC hydration at various ages and in both genders in a large Chinese population without skin diseases. Methods 713 subjects (328 males and 385 females) aged 0.5–94 years were enrolled in this study. The subjects were divided by age into 5 groups, i.e., 0–12, 13–35, 36–50, 51–70 and over 70 years old. A multifunctional skin physiology monitor was used to measure SC hydration, skin surface pH and sebum content on both the forehead and the forearms. Results In males, the highest sebum content was found on the forearm and the forehead in the age groups 36–50 (93.47 ± 10.01 μg/cm2) and 51–70 years (9.16 ± 1.95 μg/cm2), while in females, the highest sebum content was found on the forearm and the forehead in the age groups 13–35 (61.91 ± 6.12 μg/cm2) and 51–70 years (7.54 ± 2.55 μg/cm2). The forehead sebum content was higher in males aged 13–70 years than in age-matched females; the sebum content on the forehead in both males and females was higher than that on the forearm. Skin surface pH on the forehead of both males and females over the age of 70 years was higher than that in younger groups. SC hydration on the forehead in both males and females was lower above the age of 70, and the one in males aged 13–35 was higher than that in females (43.99 ± 1.88 vs. 36.38 ± 1.67 AU, p < 0.01). SC hydration on the forehead in both males and females did not significantly differ from that on the forearm. Conclusions In a large Chinese cohort, the skin surface pH, sebum content and SC hydration vary with age, gender and body site. PMID:19648780

Ozone Modulation/Membrane Introduction Mass Spectrometry for Analysis of Hydrocarbon Pollutants in Air

NASA Astrophysics Data System (ADS)

Atkinson, D. B.

2001-12-01

Modulation of volatile hydrocarbons in two-component mixtures is demonstrated using an ozonolysis pretreatment with membrane introduction mass spectrometry (MIMS). The MIMS technique allows selective introduction of volatile and semivolatile analytes into a mass spectrometer via processes known collectively as pervaporation [Kotiaho and Cooks, 1992]. A semipermeable polymer membrane acts as an interface between the sample (vapor or solution) and the vacuum of the mass spectrometer. This technique has been demonstrated to allow for sensitive analysis of hydrocarbons and other non-polar volatile organic compounds (VOC`s) in air samples[Cisper et al., 1995] . The methodology has the advantages of no sample pretreatment and short analysis time, which are promising for online monitoring applications but the chief disadvantage of lack of a separation step for the different analytes in a mixture. Several approaches have been investigated to overcome this problem including use of selective chemical ionization [Bier and Cooks, 1987] and multivariate calibration techniques[Ketola et al., 1999] . A new approach is reported for the quantitative measurement of VOCs in complex matrices. The method seeks to reduce the complexity of mass spectra observed in hydrocarbon mixture analysis by selective pretreatment of the analyte mixture. In the current investigation, the rapid reaction of ozone with alkenes is used, producing oxygenated compounds which are suppressed by the MIMS system. This has the effect of removing signals due to unsaturated analytes from the compound mass spectra, and comparison of the spectra before and after the ozone treatment reveals the nature of the parent compounds. In preliminary investigations, ozone reacted completely with cyclohexene from a mixture of cylohexene and cyclohexane, and with β -pinene from a mixture of toluene and β -pinene, suppressing the ion signals from the olefins. A slight attenuation of the cyclohexane and toluene in those mixtures was also observed. Despite this problem, the hydrocarbon signal response can be calibrated and the method can be used for quantitative analysis of volatile hydrocarbon compounds in air samples. This methodology should augment the efficiency of the MIMS approach in online and onsite monitoring of VOC emissions. Bier, M.R., and R.G. Cooks, Membrane Interface for Selective Introduction of Volatile Compounds Directly into The Ionization Chamber of a Mass Spectrometer, Anal. Chem., 59 (4), 597, 1987. Cisper, M.E., C.G. Gill, L.E. Townsend, and P.H. Hemberger, On-Line Detection of Volatile Organic Compounds in Air at Parts-per-Trillion Levels by Membrane Introduction Mass Spectrometry, Anal. Chem., 67 (8), 1413-1417, 1995. Ketola, R.A., M. Ojala, and J. Heikkonen, A Non-linear Asymmetric Error Function-based Least Mean Square Approach for the Analysis of Multicomponent Mass Spectra Measured by Membrane Inlet Mass Spectrometry, Rapid Commun. Mass Spectrom., 13 (8), 654, 1999. Kotiaho, T., and R.G. Cooks, Membrane Introduction Mass Spectrometry in Environmental Analysis, in: J.J. Breen, M. J. Dellarco, (Eds), Pollution in Industrial processes, 126 pp., ACS Symp. Ser., Washington, D.C. 508, 1992.

Ergonomically neutral arm support system

DOEpatents

Siminovitch, Michael J; Chung, Jeffrey Y; Dellinges, Steven; Lafever, Robin E

2005-08-02

An ergonomic arm support system maintains a neutral position for the forearm. A mechanical support structure attached to a chair or other mounting structure supports the arms of a sitting or standing person. The system includes moving elements and tensioning elements to provide a dynamic balancing force against the forearms. The support structure is not fixed or locked in a rigid position, but is an active dynamic system that is maintained in equipoise by the continuous operation of the opposing forces. The support structure includes an armrest connected to a flexible linkage or articulated or pivoting assembly, which includes a tensioning element such as a spring. The pivoting assembly moves up and down, with the tensioning element providing the upward force that balances the downward force of the arm.

Morel-Lavallee Lesion: Case Report with Review of Literature.

PubMed

Padmanabhan, Elamparidhi; Rudrappa, Ramesh Kumar; Bhavishya, Talluri; Rajakumar, Sibhithran; Selvakkalanjiyam, Sivaranjinie

2017-07-01

Morel-Lavallee lesions are closed degloving soft tissue injuries which occur because of trauma and in which the skin and subcutaneous tissue are separated from superficial fascia. This shear trauma results in creation of a potential space filled with serosanguinous fluid, blood and necrotic fat. We discuss a case of 52-year-old female with history of trauma one week back, who presented with a boggy swelling over the postero-lateral aspect of proximal forearm and distal arm. Local examination showed fluctuating fluid collection. MRI showed variable intensity fluid collection in a potential space between the subcutaneous tissue and deep fascia in arm and forearm. Percutaneous decompression and evacuation of the collection with systemic antibiotic therapy resulted in rapid improvement.

Superficial ulnar artery perforator flap.

PubMed

Schonauer, Fabrizio; Marlino, Sergio; Turrà, Francesco; Graziano, Pasquale; Dell'Aversana Orabona, Giovanni

2014-09-01

Superficial ulnar artery is a rare finding but shows significant surgical implications. Its thinness and pliability make this flap an excellent solution for soft tissue reconstruction, especially in the head and neck region. We hereby report a successful free superficial ulnar artery perforator forearm flap transfer for tongue reconstruction. A 64-year-old man presenting with a squamous cell carcinoma of the left tongue underwent a wide resection of the tumor, left radical neck dissection, and reconstruction of the tongue and the left tonsillar pillar with the mentioned flap. No complications were observed postoperatively. The flap survived completely; no recurrence at 6 months of follow-up was detected. Superficial ulnar artery perforator flap has shown to be a safe alternative to other free tissue flaps in specific forearm anatomic conditions.

Quantitative Tester And Reconditioner For Hand And Arm

NASA Technical Reports Server (NTRS)

Engle, Gary; Bond, Malcolm; Naumann, Theodore

1993-01-01

Apparatus measures torques, forces, and motions of hand, wrist, forearm, elbow, and shoulder and aids in reconditioning muscles involved. Used to determine strengths and endurances of muscles, ranges of motion of joints, and reaction times. Provides quantitative data used to assess extent to which disuse, disease, or injury causes deterioration of muscles and of motor-coordination skills. Same apparatus serves as exercise machine to restore muscle performance by imposing electronically controlled, gradually increasing loads on muscles. Suitable for training and evaluating astronauts, field testing for workers' compensation claims, and physical therapy in hospitals. With aid of various attachments, system adapted to measure such special motions as pinching, rotation of wrist, and supination and pronation of the forearm. Attachments are gloves, wristlets, and sleeves.

SEFRE: Semiexoskeleton Rehabilitation System.

PubMed

Chonnaparamutt, Winai; Supsi, Witsarut

2016-01-01

SEFRE (Shoulder-Elbow-Forearm Robotics Economic) rehabilitation system is presented in this paper. SEFRE Rehab System is composed of a robotic manipulator and an exoskeleton, so-called Forearm Supportive Mechanism (FSM). The controller of the system is developed as the Master PC consisting of five modules, that is, Intelligent Control (IC), Patient Communication (PC), Training with Game (TG), Progress Monitoring (PM), and Patient Supervision (PS). These modules support a patient to exercise with SEFRE in six modes, that is, Passive, Passive Stretching, Passive Guiding, Initiating Active, Active Assisted, and Active Resisted. To validate the advantages of the system, the preclinical trial was carried out at a national rehabilitation center. Here, the implement of the system and the preclinical results are presented as the verifications of SEFRE.

Poikilodermatous changes on the forearms of a woman practicing aroma-therapy: extracervical poikiloderma of Civatte?*

PubMed Central

Katoulis, Alexandros; Makris, Michalis; Gregoriou, Stamatis; Rallis, Eustathios; Kanelleas, Antonis; Stavrianeas, Nicolaos; Rigopoulos, Dimitris

2014-01-01

We report the case of a 48-year-old, Caucasian female who presented with slowly progressing asymptomatic poikilodermatous changes of the extensor aspects of the forearms. She also had typical Poikiloderma of Civatte on the V of the neck and erythemato-telangiectatic rosacea of the central face. The patient had been practicing aroma-therapy for many years. Histologic examination revealed findings consistent with PC. Patch-testing revealed positive reactions to Fragrance mix and Nickel sulphate. Based on clinical and histological findings, a diagnosis of extracervical PC was suggested. PC with extra-cervical or extra-facial involvement is rare. In addition, this case supports the theory that contact sensitization to fragrances may contribute to the development of PC. PMID:25054757

Pain and paraesthesia produced by silicone ring and pneumatic tourniquets.

PubMed

Mohan, A; Baskaradas, A; Solan, M; Magnussen, P

2011-03-01

Twenty volunteers were recruited to compare a novel, silicone ring tourniquet (the Hemaclear® tourniquet) with a pneumatic tourniquet. After application of the tourniquets, the pain and paraesthesia experienced by the participants was scored at 1 minute, 5 minutes, and 10 minutes. This was repeated with the tourniquets on the forearm. On the upper arm, the silicone ring tourniquet was associated with a significantly lower pain score than the pneumatic tourniquet. The incidence of paraesthesia was also lower with the silicone ring tourniquet. When applied to the forearm, there was no statistically significant difference in pain scores between the two types of tourniquets. However the incidence of paraesthesia was again lower with the silicone ring tourniquet.

A spontaneous pre-anastomotic occlusion does not necessarily impair forearm native dialysis fistulas: echo-Doppler, 3D MR angiographic and digital subtraction angiographic imaging.

PubMed

Verbeeck, N; Pillet, J C; Prospert, E; McLntyre, D; Lamy, S

2013-01-01

Renal transplantation is the choice treatment of end-stage renal disease. When it is not indicated or not immediately feasible, hemodialysis must be performed, preferably via a native arteriovenous fistula in the forearm. A pre-anastomotic occlusion of this type of fistula is often accompanied by a thrombosis of its draining vein. In some instances, the venous segment may remain permeable thanks to the development of arterial collateral pathways and may even allow efficient dialysis without any clinical syndrome of distal steal. We present the echo-Doppler, magnetic and angiographic characteristics of three of these collateralized shunts that have remained functional, in one of the cases following a percutaneous dilation.

Head-down-tilt bed rest alters forearm vasodilator and vasoconstrictor responses

NASA Technical Reports Server (NTRS)

Shoemaker, J. K.; Hogeman, C. S.; Silber, D. H.; Gray, K.; Herr, M.; Sinoway, L. I.

1998-01-01

To test the hypothesis that head-down-tilt bed rest (HDBR) for 14 days alters vascular reactivity to vasodilatory and vasoconstrictor stimuli, the reactive hyperemic forearm blood flow (RHBF, measured by venous occlusion plethysmography) and mean arterial pressure (MAP, measured by Finapres) responses after 10 min of circulatory arrest were measured in a control trial (n = 20) and when sympathetic discharge was increased by a cold pressor test (RHBF + cold pressor test; n = 10). Vascular conductance (VC) was calculated (VC = RHBF/MAP). In the control trial, peak RHBF at 5 s after circulatory arrest (34.1 +/- 2.5 vs. 48.9 +/- 4.3 ml . 100 ml-1 . min-1) and VC (0.34 +/- 0.02 vs. 0.53 +/- 0.05 ml . 100 ml-1 . min-1 . mmHg-1) were reduced in the post- compared with the pre-HDBR tests (P < 0. 05). Total excess RHBF over 3 min was diminished in the post- compared with the pre-HDBR trial (84.8 vs. 117 ml/100 ml, P < 0.002). The ability of the cold pressor test to lower forearm blood flow was less in the post- than in the pre-HDBR test (P < 0.05), despite similar increases in MAP. These data suggest that regulation of vascular dilation and the interaction between dilatory and constrictor influences were altered with bed rest.

Local full-thickness skin graft of the donor arm--a novel technique for the reduction of donor site morbidity in radial forearm free flap.

PubMed

Riecke, B; Assaf, A T; Heiland, M; Al-Dam, A; Gröbe, A; Blessmann, M; Wikner, J

2015-08-01

A novel technique to reduce donor site morbidity after radial forearm free flap (RFFF) harvest, using a local full-thickness skin graft (FTSG), is described. Thirty consecutive patients undergoing RFFF for head and neck reconstruction were enrolled in a prospective study. Donor site defect closure was performed with spindle-shaped FTSGs excised from the wavelike skin incision made for the vascular pedicle. Both the removal site of the FTSG on the volar forearm and the covered RFFF donor site healed uneventfully in 29 cases, with no impairment of function related to the skin graft. No skin graft failure and no exposure, tenting, or adherence of the flexor tendons occurred. All patients expressed satisfaction with postoperative pain, the functional outcome, and cosmetic appearance. Primary donor site defect closure could be achieved in all cases with the use of a local FTSG. This graft can be gained at the access incision for the vascular pedicle, avoids expansion of the incision for a local flap technique, and does not prolong wound healing, and thus reduces both donor site and graft site morbidity of the RFFF. This technique leads to an inconspicuous aesthetic result with no apparent relevant functional deficits and avoids the need for a second donor site. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

The overarm-throwing pattern among U-14 ASA female softball players: a comparative study of gender, culture, and experience.

PubMed

Petranek, Laura Jones; Barton, Gina V

2011-06-01

A developmental description of overarm-throwing characteristics of U-14female ASA softballplayers is presented here. Comparisons were made between these athletes and teens of similar age in the United States (Runion, Roberton, & Langendorfe 2003) and in Germany (Ehl, Roberton, & Langendorfer, 2005). A majority of the softball players demonstrated the most advanced developmental levels for the backswing foot, humerus, and forearm components. Seventy percent (n = 26) demonstrated a Level 2 trunk, while 30% (n = 11) demonstrated a differentiated trunk, Level 3. The average throwing velocity was 62.58 ft/s (19.07 m/s). Comparisons were made to girls with less throwing experience in the United States (Runion et al.) and Germany (Ehl et al.); the softball players threw with greater velocity (9.12ft/s [2.77 m/s]and 15.89 ft/s [4.84 m/s], respectively) and demonstrated superior trunk, humerus, and forearm actions. The boys from both countries threw the ball faster than the softball players. Significant chi-square analyses found the softball players had superior humeral actions (Level 3) compared to the German boys and superior forearm actions (Level 3) compared to both groups of bays. Experience seems to have an impact when comparisons among girls are made; yet, explanations for differences seen between boys and girls still remain unclear and warrant further research.

Harmonic Scalpel versus electrocautery and surgical clips in head and neck free-flap harvesting.

PubMed

Dean, Nichole R; Rosenthal, Eben L; Morgan, Bruce A; Magnuson, J Scott; Carroll, William R

2014-06-01

We sought to determine the safety and utility of Harmonic Scalpel-assisted free-flap harvesting as an alternative to a combined electrocautery and surgical clip technique. The medical records of 103 patients undergoing radial forearm free-flap reconstruction (105 free flaps) for head and neck surgical defects between 2006 and 2008 were reviewed. The use of bipolar electrocautery and surgical clips for division of small perforating vessels (n = 53) was compared to ultrasonic energy (Harmonic Scalpel; Ethicon Endo-Surgery, Inc., Cincinnati, Ohio) (n = 52) free-tissue harvesting techniques. Flap-harvesting time was reduced with the use of the Harmonic Scalpel when compared with electrocautery and surgical clip harvest (31.4 vs. 36.9 minutes, respectively; p = 0.06). Two patients who underwent flap harvest with electrocautery and surgical clips developed postoperative donor site hematomas, whereas no donor site complications were noted in the Harmonic Scalpel group. Recipient site complication rates for infection, fistula, and hematoma were similar for both harvesting techniques (p = 0.77). Two flap failures occurred in the clip-assisted radial forearm free-flap harvest group, and none in the Harmonic Scalpel group. Median length of hospitalization was significantly reduced for patients who underwent free-flap harvest with the Harmonic Scalpel when compared with the other technique (7 vs. 8 days; p = 0.01). The Harmonic Scalpel is safe, and its use is feasible for radial forearm free-flap harvest.

Free Thyroid Transfer: A Novel Procedure to Prevent Radiation-induced Hypothyroidism

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harris, Jeffrey; Almarzouki, Hani; Department of Otolaryngology-Head and Neck Surgery, King Abdulaziz University, Jeddah

Purpose: The incidence of hypothyroidism after radiation therapy for head and neck cancer (HNC) has been found to be ≤53%. Medical treatment of hypothyroidism can be costly and difficult to titrate. The aim of the present study was to assess the feasibility of free thyroid transfer as a strategy for the prevention of radiation-induced damage to the thyroid gland during radiation therapy for HNC. Methods and Materials: A prospective feasibility study was performed involving 10 patients with a new diagnosis of advanced HNC undergoing ablative surgery, radial forearm free-tissue transfer reconstruction, and postoperative adjuvant radiation therapy. During the neck dissection,more » hemithyroid dissection was completed with preservation of the thyroid arterial and venous supply for implantation into the donor forearm site. All patients underwent a diagnostic thyroid technetium scan 6 weeks and 12 months postoperatively to examine the functional integrity of the transferred thyroid tissue. Results: Free thyroid transfer was executed in 9 of the 10 recruited patients with advanced HNC. The postoperative technetium scans demonstrated strong uptake of technetium at the forearm donor site at 6 weeks and 12 months for all 9 of the transplanted patients. Conclusions: The thyroid gland can be transferred as a microvascular free transfer with maintenance of function. This technique could represent a novel strategy for maintenance of thyroid function after head and neck irradiation.« less

Noninvasive monitoring of lactate dynamics in human forearm muscle after exhaustive exercise by (1)H-magnetic resonance spectroscopy at 7 tesla.

PubMed

Ren, Jimin; Dean Sherry, A; Malloy, Craig R

2013-09-01

Despite its importance in energy metabolism, lactate in human skeletal muscle has been difficult to detect by noninvasive (1)H-magnetic resonance spectroscopy mainly due to interference from large water and lipid signals. Long echo-time acquisitions at 7 T effectively attenuates the water and lipid signals in forearm muscle allowing direct observation of both lactate resonances, the methine at 4.09 ppm and the methyl at 1.31 ppm. Using this approach, we were able to monitor lactate dynamics at a temporal resolution of 32 s. While lactate was not detectable at rest, immediately after an acute period of exercise to fatigue the forearm muscle, lactate rose to a level comparable to that of creatine (∼30 mmol/kg wet weight). In a typical (1)H-magnetic resonance spectrum collected using a echo-time of 140 ms, the lactate methine and methyl resonances both appear as doublets with an unusually large splitting of ∼20 Hz due to residual dipolar coupling. During muscle recovery following exercise, the lactate signals decay rapidly with a time constant of t½ = 2.0 ± 0.6 min (n = 12 subjects). This fast and simple lactate detection method may prove valuable for monitoring lactate metabolism in cancer and in sports medicine applications. Copyright © 2012 Wiley Periodicals, Inc.

Effects of electrode size and spacing on sensory modalities in the phantom thumb perception area for the forearm amputees.

PubMed

Li, P; Chai, G H; Zhu, K H; Lan, N; Sui, X H

2015-01-01

Tactile sensory feedback plays a key role in accomplishing the dexterous manipulation of prosthetic hands for the amputees, and the non-invasive transcutaneous electrical nerve stimulation (TENS) of the phantom finger perception (PFP) area would be an effective way to realize sensory feedback clinically. In order to realize the high-spatial-resolution tactile sensory feedback in the PFP region, we investigated the effects of electrode size and spacing on the tactile sensations for potentially optimizing the surface electrode array configuration. Six forearm-amputated subjects were recruited in the psychophysical studies. With the diameter of the circular electrode increasing from 3 mm to 12 mm, the threshold current intensity was enhanced correspondingly under different sensory modalities. The smaller electrode could potentially lead to high sensation spatial resolution. Whereas, the smaller the electrode, the less the number of sensory modalities. For an Φ-3 mm electrode, it is even hard for the subject to perceive any perception modalities under normal stimulating current. In addition, the two-electrode discrimination distance (TEDD) in the phantom thumb perception area decreased with electrode size decreasing in two directions of parallel or perpendicular to the forearm. No significant difference of TEDD existed along the two directions. Studies in this paper would guide the configuration optimization of the TENS electrode array for potential high spatial-resolution sensory feedback.

Assessment of finger forces and wrist torques for functional grasp using new multichannel textile neuroprostheses.

PubMed

Lawrence, Marc; Gross, Gion-Pitschen; Lang, Martin; Kuhn, Andreas; Keller, Thierry; Morari, Manfred

2008-08-01

New multichannel textile neuroprotheses were developed, which comprise multiple sets of transcutaneous electrode arrays and connecting wires embroidered into a fabric layer. The electrode arrays were placed on the forearm above the extrinsic finger flexors and extensors. Activation regions for selective finger flexion and wrist extension were configured by switching a subset of the array elements between cathode, anode, and off states. We present a new isometric measurement system for the assessment of finger forces and wrist torques generated using the new neuroprostheses. Finger forces (from the middle phalanxes) were recorded using five load cells mounted on a "grasp handle" that can be arbitrarily positioned in space. The hand and the grasp handle were rigidly mounted to a 6-degree of freedom load cell, and the forces and torques about the wrist were recorded. A vacuum cushion was used to comfortably fixate the forearm. The position and orientation of the forearm, wrist, fingers, and handle were recorded using a new three-dimensional position measurement system (accuracy <+/-1 mm). The measurement system was integrated into the real-time multichannel transcutaneous electrode environment, which is able to control the spatiotemporal position of multiple activation regions. Using the combined system and textile neuroprosthesis, we were able to optimize the activation regions to produce selective finger and wrist articulation, enabling improved functional grasp.

Open segmental fracture of both bone forearm and dislocation of ipsilateral elbow with extruded middle segment radius

PubMed Central

Kumar, Pawan; Manjhi, Lal Bahadur; Rajak, Ramesh Lal

2013-01-01

Extruded middle segment of radius with open segmental fracture both bone forearm and dislocation of ipsilateral elbow is a rare injury. A 12-year-old child presented to us within 4 hours following fall from tree. The child's mother was carrying a 12-cm-long extruded soiled segment of radius. The extruded bone was thoroughly washed. The medullary cavity was properly syringed with antiseptic solution. The bone was autoclaved and put in the muscle plane of the distal forearm after debridement of the wound. After 5 days, a 2.5-mm K-wire was introduced by retrograde method into the proximal radius by passing through the extruded segment. Another 2.5-mm K-wire was passed in ulna. The limb was evaluated clinicoradiologically every 2 weeks. The wound was healed by primary intention. At 4 months, the reposed bone appeared less dense radiologically and K-wire seemed to be out of the bone. In the subsequent months, the roentgenograms show remodeling of the extruded fragment. After 20 weeks, the K-wires were removed (first ulnar and then radial). Complete union was achieved with full range of movement except loss of few degrees of extension of elbow and thumb. This case is reported to show a good outcome following successful incorporation of an extruded segment of radius in an open fracture. PMID:23798764

Electroencephalographic study showing that tactile stimulation by fabrics of different qualities elicit graded event-related potentials.

PubMed

Hoefer, D; Handel, M; Müller, K-M; Hammer, T R

2016-11-01

Neurophysiologic data on reactions of the human brain towards tactile stimuli evoked by fabrics moved on the skin are scarce. Furthermore, evaluation of fabrics' pleasantness using questionnaires suffers subjective biases. That is why we used a 64-channel electroencephalography (EEG) to objectively evaluate real-time brain reactions to fabric-skin interactions. Tactile stimuli were triggered by selected fabrics of different qualities, i.e. modal/polyamide single jersey, cotton double rib and a jute fabric, applied hidden to either the palm or forearm of 24 subjects via a custom-made fabric-to-skin applicator called SOFIA. One-way anova analysis was carried out to verify the EEG data. The modal/polyamide fabric applied to the forearm and palm led to slightly stronger emotional valence scores in the brain than the conventional or baseline fabric. Furthermore, the single jersey elicits significant higher event-related potential (ERP) signals in all subjects when applied to the forearm, suggesting less distraction and better cognitive resources during the fabric/skin interaction. The brain thus reacts with instantaneous ERP to tactile stimulation of fabrics and is able to discriminate different qualities via implicit preferences. The test procedure described here may be a tool to evaluate the fabric feel with the exclusion of subjective biases. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Acute effects of coffee on skin blood flow and microvascular function.

PubMed

Tesselaar, Erik; Nezirevic Dernroth, Dzeneta; Farnebo, Simon

2017-11-01

Studies on the acute effects of coffee on the microcirculation have shown contradicting results. This study aimed to investigate if intake of caffeine-containing coffee changes blood flow and microvascular reactivity in the skin. We measured acute changes in cutaneous vascular conductance (CVC) in the forearm and the tip of the finger, the microvascular response to transdermal iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP) and post-occlusive reactive hyperemia (PORH) in the skin, after intake of caffeinated or decaffeinated coffee. Vasodilatation during iontophoresis of ACh was significantly stronger after intake of caffeinated coffee compared to after intake of decaffeinated coffee (1.26±0.20PU/mmHg vs. 1.13±0.38PU/mmHg, P<0.001). Forearm CVC before and after PORH were not affected by caffeinated and decaffeinated coffee. After intake of caffeinated coffee, a more pronounced decrease in CVC in the fingertip was observed compared to after intake of decaffeinated coffee (-1.36PU/mmHg vs. -0.52PU/mmHg, P=0.002). Caffeine, as ingested by drinking caffeinated coffee acutely improves endothelium-dependent microvascular responses in the forearm skin, while endothelium-independent responses to PORH and SNP iontophoresis are not affected. Blood flow in the fingertip decreases markedly during the first hour after drinking caffeinated coffee compared to decaffeinated coffee. Copyright © 2017 Elsevier Inc. All rights reserved.

Mechanical energy and power flow of the upper extremity in manual wheelchair propulsion.

PubMed

Guo, Lan-Yuen; Su, Fong-Chin; Wu, Hong-Wen; An, Kai-Nan

2003-02-01

To investigate the characteristics of mechanical energy and power flow of the upper limb during wheelchair propulsion. Mechanical energy and power flow of segments were calculated. Very few studies have taken into account the mechanical energy and power flow of the musculoskeletal system during wheelchair propulsion. Mechanical energy and power flow have proven to be useful tools for investigating locomotion disorders during human gait. Twelve healthy male adults (mean age, 23.5 years) were recruited for this study. Three-dimensional kinematic and kinetic data of the upper extremity were collected during wheelchair propulsion using a Hi-Res Expert Vision system and an instrumented wheel, respectively. During the initiation of the propulsion phase, joint power is generated in the upper arm or is transferred from the trunk downward to the forearm and hand to propel the wheel forward. During terminal propulsion, joint power is transferred upward to the trunk from the forearm and upper arm. The rate of change of mechanical energy and power flow for the forearm and hand have similar patterns, but the upper arm values differ. Joint power plays an important role in energy transfer as well as the energy generated and absorbed by muscles spanning the joints during wheelchair propulsion. Energy and power flow information during wheelchair propulsion allows us to gain a better understanding of the coordination of the movement by the musculoskeletal system.

Position Sense in Chronic Pain: Separating Peripheral and Central Mechanisms in Proprioception in Unilateral Limb Pain.

PubMed

Tsay, Anthony J; Giummarra, Melita J

2016-07-01

Awareness of limb position is derived primarily from muscle spindles and higher-order body representations. Although chronic pain appears to be associated with motor and proprioceptive disturbances, it is not clear if this is due to disturbances in position sense, muscle spindle function, or central representations of the body. This study examined position sense errors, as an indicator of spindle function, in participants with unilateral chronic limb pain. The sample included 15 individuals with upper limb pain, 15 with lower limb pain, and 15 sex- and age-matched pain-free control participants. A 2-limb forearm matching task in blindfolded participants, and a single-limb pointer task, with the reference limb hidden from view, was used to assess forearm position sense. Position sense was determined after muscle contraction or stretch, intended to induce a high or low spindle activity in the painful and nonpainful limbs, respectively. Unilateral upper and lower limb chronic pain groups produced position errors comparable with healthy control participants for position matching and pointer tasks. The results indicate that the painful and nonpainful limb are involved in limb-matching. Lateralized pain, whether in the arm or leg, does not influence forearm position sense. Painful and nonpainful limbs are involved in bilateral limb-matching. Muscle spindle function appears to be preserved in the presence of chronic pain. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

A pilot study of a new spectrophotometry device to measure tissue oxygen saturation.

PubMed

Abel, Gemma; Allen, John; Drinnan, Michael

2014-09-01

Tissue oxygen saturation (SO2) measurements have the potential for far wider use than at present but are limited by device availability and portability for many potential applications. A device based on a small, low-cost general-purpose spectrophotometer (the Harrison device) might facilitate wider use. The aim of this study was to compare the Harrison device with a commercial instrument, the LEA O2C.Measurements were carried out on the forearm and finger of 20 healthy volunteers, using a blood pressure cuff on the upper arm to induce different levels of oxygenation. Repeatability of both devices was assessed, and the Bland-Altman method was used to assess agreement between them.The devices showed agreement in overall tracking of changes in SO2. Test-retest agreement for the Harrison device was worse than for O2C, with SD repeatability of 10.6% (forearm) or 18.6% (finger). There was no overall bias between devices, but mean (SD) difference of 1.2 (11.8%) (forearm) or 4.4 (11.5%) (finger) were outside of a clinically acceptable range.Disagreements were attributed to the stability of the Harrison probe and the natural SO2 variations across the skin surface increasing the random error. Therefore, though not equivalent to the LEA O2C, a probe redesign and averaged measurements may help establish the Harrison device as a low cost alternative.

Reliability and Validity Study of the Chamorro Assisted Gait Scale for People with Sprained Ankles, Walking with Forearm Crutches

PubMed Central

Ridao-Fernández, Carmen; Ojeda, Joaquín; Benítez-Lugo, Marisa; Sevillano, José Luis

2016-01-01

Objective The aim of this study was to design and validate a functional assessment scale for assisted gait with forearm crutches (Chamorro Assisted Gait Scale—CHAGS) and to assess its reliability in people with sprained ankles. Design Thirty subjects who suffered from sprained ankle (anterior talofibular ligament first and second degree) were included in the study. A modified Delphi technique was used to obtain the content validity. The selected items were: pelvic and scapular girdle dissociation(1), deviation of Center of Gravity(2), crutch inclination(3), steps rhythm(4), symmetry of step length(5), cross support(6), simultaneous support of foot and crutch(7), forearm off(8), facing forward(9) and fluency(10). Two raters twice visualized the gait of the sample subjects which were recorded. The criterion-related validity was determined by correlation between CHAGS and Coding of eight criteria of qualitative gait analysis (Viel Coding). Internal consistency and inter and intra-rater reliability were also tested. Results CHAGS obtained a high and negative correlation with Viel Coding. We obtained a good internal consistency and the intra-class correlation coefficients oscillated between 0.97 and 0.99, while the minimal detectable changes were acceptable. Conclusion CHAGS scale is a valid and reliable tool for assessing assisted gait with crutches in people with sprained ankles to perform partial relief of lower limbs. PMID:27168236

A Compact Forearm Crutch Based on Force Sensors for Aided Gait: Reliability and Validity.

PubMed

Chamorro-Moriana, Gema; Sevillano, José Luis; Ridao-Fernández, Carmen

2016-06-21

Frequently, patients who suffer injuries in some lower member require forearm crutches in order to partially unload weight-bearing. These lesions cause pain in lower limb unloading and their progression should be controlled objectively to avoid significant errors in accuracy and, consequently, complications and after effects in lesions. The design of a new and feasible tool that allows us to control and improve the accuracy of loads exerted on crutches during aided gait is necessary, so as to unburden the lower limbs. In this paper, we describe such a system based on a force sensor, which we have named the GCH System 2.0. Furthermore, we determine the validity and reliability of measurements obtained using this tool via a comparison with the validated AMTI (Advanced Mechanical Technology, Inc., Watertown, MA, USA) OR6-7-2000 Platform. An intra-class correlation coefficient demonstrated excellent agreement between the AMTI Platform and the GCH System. A regression line to determine the predictive ability of the GCH system towards the AMTI Platform was found, which obtained a precision of 99.3%. A detailed statistical analysis is presented for all the measurements and also segregated for several requested loads on the crutches (10%, 25% and 50% of body weight). Our results show that our system, designed for assessing loads exerted by patients on forearm crutches during assisted gait, provides valid and reliable measurements of loads.

A Compact Forearm Crutch Based on Force Sensors for Aided Gait: Reliability and Validity

PubMed Central

Chamorro-Moriana, Gema; Sevillano, José Luis; Ridao-Fernández, Carmen

2016-01-01

Frequently, patients who suffer injuries in some lower member require forearm crutches in order to partially unload weight-bearing. These lesions cause pain in lower limb unloading and their progression should be controlled objectively to avoid significant errors in accuracy and, consequently, complications and after effects in lesions. The design of a new and feasible tool that allows us to control and improve the accuracy of loads exerted on crutches during aided gait is necessary, so as to unburden the lower limbs. In this paper, we describe such a system based on a force sensor, which we have named the GCH System 2.0. Furthermore, we determine the validity and reliability of measurements obtained using this tool via a comparison with the validated AMTI (Advanced Mechanical Technology, Inc., Watertown, MA, USA) OR6-7-2000 Platform. An intra-class correlation coefficient demonstrated excellent agreement between the AMTI Platform and the GCH System. A regression line to determine the predictive ability of the GCH system towards the AMTI Platform was found, which obtained a precision of 99.3%. A detailed statistical analysis is presented for all the measurements and also segregated for several requested loads on the crutches (10%, 25% and 50% of body weight). Our results show that our system, designed for assessing loads exerted by patients on forearm crutches during assisted gait, provides valid and reliable measurements of loads. PMID:27338396

Evaluation of Haemoglobin and Cytochrome Responses During Forearm Ischaemia Using Multi-wavelength Time Domain NIRS.

PubMed

Lange, Frédéric; Dunne, Luke; Tachtsidis, Ilias

2017-01-01

We demonstrate the ability of a 16-wavelength time domain near-infrared spectroscopy system to monitor changes in oxy- and deoxy haemoglobin ([HbO 2 ] [HHb]) and the oxidation of cytochrome-c-oxidase ([oxCCO]), during forearm ischaemia. We tested two methods to retrieve the concentration changes. The first uses the measured changes in light attenuation and the modified Beer-Lambert law, and the second uses the absorption and scattering estimated by the measured time-point spread function. The system is able to retrieve the concentration changes with both methods, giving similar results. At the end of forearm ischaemia (t = 5 min), we measured an increase in [HHb] of 16.77 ± 2.52 and 16.37 ± 2.33 μMol, and a decrease in [HbO 2 ] of -6.12 ± 1.62 and -5.57 ± 2.02 μMol for method 1 and 2, respectively. At that same time, the changes in [oxCCO] were -0.36 ± 0.33 and -1.40 ± 1.20 μMol, for method 1 and 2, respectively. These small changes in [oxCCO], despite a huge change in haemoglobin, demonstrate the absence of crosstalk and are comparable to previous measurements using broadband NIRS.

Impact of tetrabenazine on gait and functional mobility in individuals with Huntington's disease.

PubMed

Kegelmeyer, Deb A; Kloos, Anne D; Fritz, Nora E; Fiumedora, Marianne M; White, Susan E; Kostyk, Sandra K

2014-12-15

Chorea may contribute to balance problems and walking difficulties that lead to higher fall rates in individuals with Huntington's disease (HD). Few studies have examined the effects of tetrabenazine (TBZ), an anti-choreic drug, on function and mobility in HD. The purpose of this study was to compare: 1) gait measures in forward walking, 2) balance and mobility measures, and 3) hand and forearm function measures on and off TBZ. We hypothesized that use of TBZ would improve gait, transfers and hand and forearm function. Eleven individuals with HD on stable doses of TBZ were evaluated while off medication and again following resumption of medication. Significant improvements were found on the Unified Huntington's Disease Rating Scale (UHDRS) motor scores, Tinetti Mobility Test (TMT) total (t=4.20, p=0.002) and balance subscale (t=-4.61, p=0.001) scores, and the Five Times Sit-to-Stand test (5TSST, t=3.20, p=.009) when on-TBZ compared to off-TBZ. Spatiotemporal gait measures, the Six Condition Romberg test, and UHDRS hand and forearm function items were not changed by TBZ use. Improved TMT and 5TSST performance when on drug indicates that TBZ use may improve balance and functional mobility in individuals with HD. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

Dystonias

MedlinePlus

... or walking some distance—or a worsening in handwriting after writing several lines. In other instances, the ... and sometimes the forearm, and only occurs during handwriting. Similar focal dystonias have also been called typist's ...

Histoplasma skin test

MedlinePlus

Histoplasmosis skin test ... health care provider cleans an area of your skin, usually the forearm. An allergen is injected just below the cleaned skin surface. An allergen is a substance that causes ...

Effects of wearing rubber gloves on activities of the forearm and shoulder muscles during different dishwashing stages

PubMed Central

Yoo, Won-Gyu

2015-01-01

[Purpose] The present study examined the effects of wearing rubber gloves on the activities of the forearm and shoulder muscles during two dishwashing stages. [Subjects] This study included 10 young females. [Methods] The participants performed two dishwashing stages (washing and rinsing) with and without rubber gloves. The activities of the wrist flexor and upper trapezius muscles were measured using wireless electromyography. [Results] During the washing stage, the activities of the wrist flexor and upper trapezius muscles were significantly greater without gloves than with gloves when performing the same tasks. However, during the rinsing stage, the activities of these muscles did not differ significantly according to the use of gloves. [Conclusion] Dishwashers should wear gloves during the washing stage to prevent wrist and shoulder pain. PMID:26311980

Peripheral vascular response to mild indirect cooling in patients with homozygous sickle cell (SS) disease and the frequency of painful crisis.

PubMed

Mohan, J; Marshall, J M; Reid, H L; Thomas, P W; Hambleton, I; Serjeant, G R

1998-02-01

1. In homozygous sickle cell (SS) disease, skin cooling is a common precipitating factor of the painful crisis which is associated with avascular necrosis of active bone marrow. Since skin cooling does not directly induce sickling, we have investigated the nature of the reflex vascular responses to mild cooling in SS patients in a steady state of the disease and compared them with their history of painful crises. 2. Experiments were performed in Jamaica on 60 male SS patients and 30 matched control subjects with normal haemoglobin (AA) genotype. Forearm blood flow (FBF) was measured by venous occlusion plethysmography and mean arterial pressure (MAP) by a Finapres device: forearm vascular resistance (FVR) was calculated as MAP/FBF. Cutaneous erythrocyte flux in forearm and hand was monitored by a laser Doppler meter. The contralateral hand was immersed in cool water at 16 degrees C for 2 min, 6 times, at random intervals of 0.5-3 min. 3. The first cool immersion evoked an increase in MAP, cutaneous vasoconstriction and a net increase in FVR in both AA and SS subjects. However, the direction of change in FVR varied between individuals such that 18 AA subjects showed an increase in FVR (constrictor group) while 12 showed a decrease in FVR, indicating vasodilatation in forearm muscle (dilator group). In contrast, 50 SS subjects showed an increase in FVR and only 10 showed a decrease in FVR. The proportion of subjects who showed net vasoconstriction was significantly greater in the SS than in the AA group (83% versus 60%, P = 0.03, chi 2 test). 4. By the sixth cool stimulus, the 'dilator' group of AA subjects showed no change in FVR while the 'dilator' group of SS patients showed an increase in FVR. We suggest that forearm muscle vasodilatation was the characteristic component of the alerting/defence response to novel or noxious stimuli which habituates on repetition. 5. In the whole group of SS patients, baseline values of cutaneous vascular resistance and FVR increased between stimuli, indicating persistent vasoconstriction, and the sixth cool stimulus still evoked cutaneous vasoconstriction and a net increase in FVR. In contrast, AA subjects showed an increase in baseline FVR between stimuli, but the sixth cool stimulus had no significant effect on cutaneous vascular resistances, or FVR. 6. In SS patients there were no associations between the direction of change in FVR evoked by the first cool stimulus and forearm circumference or skinfold thickness, concentrations of haemoglobin or fetal haemoglobin. However, the frequency of painful crises was significantly greater in the 'constrictor' group than in the 'dilator' group (0.36 versus 0.12/year, P = 0.04, Mann-Whitney test). 7. These results indicate that the primary reflex vasoconstrictor response evoked by mild cooling is stronger and more persistent in SS patients than in AA subjects and is particularly strong in SS patients who are most prone to painful crises. The results are consistent with the hypothesis that skin cooling may precipitate the painful crisis by causing reflex vasoconstriction in muscle, and possibly in bone marrow, so diverting blood flow away from the active marrow.

Habitual aerobic exercise does not protect against micro- or macrovascular endothelial dysfunction in healthy estrogen-deficient postmenopausal women.

PubMed

Santos-Parker, Jessica R; Strahler, Talia R; Vorwald, Victoria M; Pierce, Gary L; Seals, Douglas R

2017-01-01

Aging causes micro- and macrovascular endothelial dysfunction, as assessed by endothelium-dependent dilation (EDD), which can be prevented and reversed by habitual aerobic exercise (AE) in men. However, in estrogen-deficient postmenopausal women, whole forearm microvascular EDD has not been studied, and a beneficial effect of AE on macrovascular EDD has not been consistently shown. We assessed forearm blood flow in response to brachial artery infusions of acetylcholine (FBF ACh ), a measure of whole forearm microvascular EDD, and brachial artery flow-mediated dilation (FMD), a measure of macrovascular EDD, in 12 premenopausal sedentary women (Pre-S; 24 ± 1 yr; V̇o 2max = 37.5 ± 1.6 ml·kg -1 ·min -1 ), 25 estrogen-deficient postmenopausal sedentary women (Post-S; 62 ± 1 yr; V̇o 2max = 24.7 ± 0.9 ml·kg -1 ·min -1 ), and 16 estrogen-deficient postmenopausal AE-trained women (Post-AE; 59 ± 1 yr; V̇o 2max = 40.4 ± 1.4 ml·kg -1 ·min -1 ). FBF ACh was lower in Post-S and Post-AE compared with Pre-S women (135 ± 9 and 116 ± 17 vs. 193 ± 21 AUC, respectively, both P < 0.008), whereas Post-S and Post-AE women were not different (P = 0.3). Brachial artery FMD was 34% (5.73 ± 0.67%) and 45% (4.79 ± 0.57%) lower in Post-S and Post-AE, respectively, vs. Pre-S women (8.69 ± 0.95%, both P ≤ 0.01), but not different between Post-S and Post-AE women (P = 0.3). Post-AE women had lower circulating C-reactive protein and oxidized low-density lipoprotein compared with Post-S women (0.5 ± 0.1 vs. 1.1 ± 0.2 mg/l and 40 ± 4 vs. 55 ± 3 U/l, respectively, both P = 0.01), but these markers were not correlated to FBF ACh (P = 0.3) or brachial artery FMD (P = 0.8). These findings are consistent with the idea that habitual AE does not protect against age/menopause-related whole forearm micro- and macrovascular endothelial dysfunction in healthy nonobese estrogen-deficient postmenopausal women, despite being associated with lower systemic markers of inflammation and oxidative stress. This is the first study to demonstrate that habitual aerobic exercise may not protect against age/menopause-related whole forearm microvascular endothelial dysfunction in healthy nonobese estrogen-deficient postmenopausal women, consistent with recent findings regarding macrovascular endothelial function. This is in contrast to what is observed in healthy middle-aged and older aerobic exercise-trained men. Copyright © 2017 the American Physiological Society.

Histologic change of arteriovenous malformations of the face and scalp after free flap transfer.

PubMed

Tark, K C; Chung, S

2000-07-01

In three patients with long-standing vascular malformations of the face and scalp, radial forearm free flaps were transferred after a near-total excision of the lesion. All patients had typical high-flow malformations with thrill and bruit. The onset and progression of the malformations were analyzed through clinical and histologic studies. After free flap transfer, the vascular malformations were followed up grossly and histologically for between 4 and 9 years. There was no recurrence of arteriovenous malformation after free flap transfer. The portion of the residual lesion adjacent to the transferred free flap disappeared, and the remaining discoloration also vanished grossly. Histologic comparison of immediate postoperative and 4-month postoperative specimens from the margin and residual lesion using Victoria blue staining showed that the typical preoperative findings for arteriovenous malformation-an intermingling of thick-walled vessels with abundant elastic fibers and thin-walled vessels without elastic fibers-had undergone change, resulting in the disappearance of the thick-walled vessels and leaving only homogeneous, thin-walled vasculature. The highly vascularized free flap, which does not contain abnormal fistulas, impacted the histologic change of the arteriovenous malformation by blocking the vicious cycle of ischemia and anatomic replacement of disfigured skin and subcutaneous tissues.

Amputee skin condition: occlusion, stratum corneum hydration and free amino acid levels.

PubMed

Visscher, Marty O; Robinson, Marisa; Fugit, Benetta; Rosenberg, Richard J; Hoath, Steven B; Randall Wickett, R

2011-03-01

Patients with a prosthetic limb report negative skin effects, including irritation, rash and chafing, which can lead to infection, discomfort and reduced wear time to significantly impact normal activities. The aims were to examine the epidermal integrity (transepidermal water loss, TEWL), stratum corneum (SC) hydration [moisture accumulation rate (MAT)], friction and biomechanical properties in active below the knee amputees and to determine the effects of an inert sock liner on skin condition. The liner reduced hydration, TEWL and friction and increased elasticity versus the amputee's conventional skin care methods. Residual limb TEWL was increased and MAT was reduced versus the contralateral normal skin. In a second study, we hypothesized that complete occlusion would decrease free amino acids (FAA) and quantified them by high performance liquid chromatography in an adult volar forearm model. Occlusion with a water vapor impermeable wet dressing led to increased TEWL, erythema and dryness and reduced MAT versus normal skin, comparable to the results in the amputees. The FAA levels were significantly reduced for the occluded sites. The results suggest that residual limb occlusion in amputees may block the formation of FAA in the upper SC. Therapies based on replacement of water binding FAAs, may alleviate the consequences of long-term occlusion.