Six-Minute Walk Test: Reference Values and Prediction Equation in Healthy Boys Aged 5 to12 Years

OBJECTIVE

This study aimed to (1) generate normative data in healthy boys aged 5–12 years for the six-minute walk test (6MWT), an outcome measure currently used in clinical trials in Duchenne muscular dystrophy (DMD), (2) to describe the relation with anthropometric variables and myometry, and (3) to compare our data with published equations.

METHODS

The 6MWT was conducted in 442 boys according to a standardized protocol, as currently used in clinical trials in DMD. Maximal voluntary isometric contractions for knee flexion and extension were recorded with a hand-held myometer.

RESULTS

The 6MWD increased significantly with age, from 478.0±44.1 m at age 5, to 650.0±76.8 m at age 12, with the steepest increase between 5 and 8 years. Age- and height related percentile curves of the 6MWD were developed. Correlations with anthropometric variables were fair to good (age r = 0.60, height r = 0.57, weight r = 0.44). Myometric variables (knee flexors and extensors) showed correlations of 0.46 and 0.50 respectively. When dividing into two age categories (5–8 years, 9–12 years), these magnitudes of correlations only applied to the younger age group. Additionally, predicted values were calculated according to available reference equations (Geiger and Ben Saad), indicating an overestimation by those equations. Finally, the Geiger equation was refitted to our population.

CONCLUSION

The percentile curves according to age and height provide a useful tool in the assessment of ambulatory capacity in boys aged 5 to 12 years. Significant correlations with anthropometric variables and myometry were only found in the 5–8 years age group. The Geiger prediction equation, currently used to assess ambulatory capacity in DMD was refitted to obtain a more accurate prediction model based on a large sample with a homogenous distribution across the age categories 5 to 12 years and applying the methodology as currently used in clinical trials in DMD.     

Fast Soft Tissue Deformation and Stump-Socket Interaction Toward a Computer-Aided Design System for Lower Limb Prostheses

Prosthetic technology is rapidly advancing but there's a catch. Regardless the technology or the material used, a minimum cost is still high. One of the problems relates to the fact that the conventional socket fabrication process is still used. This method is based on subjective estimations of the involved specialists and feedbacks of the patients. This process consumes remarkable amount of time, manpower and materials. Research works are needed to design new efficient and low-cost alternative techniques for the socket design. This technique should definitely be based on CAD-CAM methods. Therefore, the first step toward this objective is to establish an accurate numeric model for evaluating and optimizing the design process. In this present work, we developed a new approach to simulate the stump soft tissue deformation and stump-socket interaction using Mass-Spring System (MSS) approach and a point-to-surface contact formulation.A novel Mass-Spring System with corrective spring (MSS-CS) model was developed and evaluated. A node-to-surface contact formulation was also integrated and evaluated. The MSS-CS model and contact formulation were evaluated with primitive geometrical object and a stump-socket model. Moreover, a finite element model of the stump-socket interaction was also developed using Abaqus to evaluate the proposed approach.Obtained results show that the proposed contact formulation has a very good precision level and the contact pressures on the interface between the elastic and rigid bodies are very close to the analytical solutions. The comparison with Abaqus showed a qualitative concordance for the contact pressure. However, quantitative deviation remains high [25-50]% at the peak contact pressure due to different contact formulations. In particular, our MSS-CS approach is more efficient than Abaqus simulation in term of computational time and cost.A novel approach was proposed to model soft tissue deformation and stump-socket interaction in an efficient and accurate manner. As perspectives, this present approach for a real-time simulation of the stump-socket interaction could be used in a real-time CAD-CAM platform to provide a cost-effective socket manufacturing process.     

Prediction of Visceral Adipose Tissue Using Air Displacement Plethysmography in Children

Objective: To determine the ability of air displacement plethysmography (ADP) to predict visceral adipose tissue (VAT) volume in children. Research Methods and Procedures: Fifty‐five (33 boys/22 girls) white children 13 to 14 years old were studied. Anthropometric measures were collected for body mass, stature, BMI, and waist‐to‐hip ratio (WHR), and body fat percentage was estimated from triceps and subscapular skinfolds, bioelectrical impedance analysis, and ADP. VAT volume was determined using magnetic resonance imaging, using a multiple slice protocol at levels L1 to L5. Results: Boys had significantly (p ≤ 0.05) less VAT volume than girls [645.1 (360.5) cm³ vs. 1035.8 (717.3) cm³]. ADP explained the greatest proportion of the variance in VAT volume compared with the other anthropometric measures. Multiple regression analysis indicated that VAT volume was best predicted by ADP body fat percentage in boys [r² = 0.81, SE of the estimate (SEE) = 160.1, SEE coefficient of variation = 25%] and by WHR and BMI in girls (r² = 0.80, SEE = 337.71, SEE coefficient of variation = 33%). Discussion: Compared with the other anthropometric measures, ADP explains the greatest proportion of the variance in VAT volume in children 13 to 14 years old. For boys, ADP is the tool of choice to predict VAT volume, yet using the more simply collected measures of BMI and WHR is recommended for girls. However, large SE of the estimates remained, suggesting that if precision is needed, there is no surrogate for direct imaging of VAT.     

Modeling Soft Tissue Damage and Failure Using a Combined Particle/Continuum Approach

Biological soft tissues experience damage and failure as a result of injury, disease, or simply age; examples include torn ligaments and arterial dissections. Given the complexity of tissue geometry and material behavior, computational models are often essential for studying both damage and failure. Yet, because of the need to account for discontinuous phenomena such as crazing, tearing, and rupturing, continuum methods are limited. Therefore, we model soft tissue damage and failure using a particle/continuum approach. Specifically, we combine continuum damage theory with Smoothed Particle Hydrodynamics (SPH). Because SPH is a meshless particle method, and particle connectivity is determined solely through a neighbor list, discontinuities can be readily modeled by modifying this list. We show, for the first time, that an anisotropic hyperelastic constitutive model commonly employed for modeling soft tissue can be conveniently implemented within a SPH framework and that SPH results show excellent agreement with analytical solutions for uniaxial and biaxial extension as well as finite element solutions for clamped uniaxial extension in 2D and 3D. We further develop a simple algorithm that automatically detects damaged particles and disconnects the spatial domain along rupture lines in 2D and rupture surfaces in 3D. We demonstrate the utility of this approach by simulating damage and failure under clamped uniaxial extension and in a peeling experiment of virtual soft tissue samples. In conclusion, SPH in combination with continuum damage theory may provide an accurate and efficient framework for modeling damage and failure in soft tissues.     

帕瑞昔布钠用于下肢手术术后镇痛的安全性及其对阿片类药物用量的节俭作用

目的:探讨帕瑞昔布钠用于下肢手术术后镇痛的疗效、安全性及其对阿片类药物用量的节俭作用.方法:随机、双盲、安慰剂对照、平行分组研究,18-60岁、ASA Ⅰ或Ⅱ级、择期硬膜外腔阻滞下下肢手术病人,手术结束时,随机静脉注射帕瑞昔布钠40mg或生理盐水5ml,12h后再静脉注射帕瑞昔布钠40 mg或生理盐水5 ml,同时采用芬太尼进行病人自控静脉镇痛.观察术后2,4,8,12和24h的疼痛强度(VAS评分)、给药前后的生命体征、不良反应和生化检查指标、术后芬太尼用量、病人自控镇痛(PCA)有效次数.结果:共完成220例,其中采用帕瑞昔布钠116例,安慰剂104例.与安慰剂组相比,帕瑞昔布钠组术后2,4,8,12和24h VAS评分降低(P＜0.05),而有关不良反应和检查结果异常发生率的差异无统计学意义(P＞0.05),术后12h和24 h芬太尼用量明显减少(P＜0.05),术后12h和24hPCA有效次数降低(P＜0.05).结论:下肢手术后静脉给予帕瑞昔布钠40mg bid,镇痛效果佳,安全可靠,明显减少了术后芬太尼用量,提高病人术后镇痛质量.     

Prediction of Lead Intake and Tissue Lead Concentrations in Broiler Chickens Using Feather Lead Concentrations

Biological Trace Element Research - The present experiment was conducted to derive equations for predicting daily lead (Pb) intake and tissue Pb concentrations in broiler chickens using feather Pb...     

The Roles of Monoarticular and Biarticular Muscles of the Lower Limbs in Terrestrial Locomotion

Specific features of the functioning of mono- and biarticular muscles were studied using a multijoint movement (a high jump) as an example. The powers of the knee and ankle joint extensors are insufficient for a strong and quick movement such as a high jump. Biarticular muscles (m. rectus femoris) transfer forces/powers from one joint to another, thereby compensating for the physiological shortcoming of monoarticular muscles, that is, a decrease in the tractive force with increasing contraction rate. In a high jump, a power of 300 W may be transferred from the hip to the knee joint via the m. rectus femoris; 230 W, from the knee to the hip joint via the hamstring muscle; 210 W, from the knee joint to the ankle via the m. gastrocnemius; and 15 W, from the metatarsophalangeal joint to the ankle via the mm. flexors.     

Soccer Player Characteristics in English Lower-League Development Programmes: The Relationships between Relative Age,Maturation, Anthropometry and Physical Fitness

The relative age effect (RAE) and its relationships with maturation, anthropometry, and physical performance characteristics were examined across a representative sample of English youth soccer development programmes. Birth dates of 1,212 players, chronologically age-grouped (i.e., U9’s-U18’s), representing 17 professional clubs (i.e., playing in Leagues 1 & 2) were obtained and categorised into relative age quartiles from the start of the selection year (Q1 = Sep-Nov; Q2 = Dec-Feb; Q3 = Mar-May; Q4 = Jun-Aug). Players were measured for somatic maturation and performed a battery of physical tests to determine aerobic fitness (Multi-Stage Fitness Test [MSFT]), Maximal Vertical Jump (MVJ), sprint (10 & 20m), and agility (T-Test) performance capabilities. Odds ratio’s (OR) revealed Q1 players were 5.3 times (95% confidence intervals [CI]: 4.08–6.83) more likely to be selected than Q4’s, with a particularly strong RAE bias observed in U9 (OR: 5.56) and U13-U16 squads (OR: 5.45–6.13). Multivariate statistical models identified few between quartile differences in anthropometric and fitness characteristics, and confirmed chronological age-group and estimated age at peak height velocity (APHV) as covariates. Assessment of practical significance using magnitude-based inferences demonstrated body size advantages in relatively older players (Q1 vs. Q4) that were very-likely small (Effect Size [ES]: 0.53–0.57), and likely to very-likely moderate (ES: 0.62–0.72) in U12 and U14 squads, respectively. Relatively older U12-U14 players also demonstrated small advantages in 10m (ES: 0.31–0.45) and 20m sprint performance (ES: 0.36–0.46). The data identify a strong RAE bias at the entry-point to English soccer developmental programmes. RAE was also stronger circa-PHV, and relatively older players demonstrated anaerobic performance advantages during the pubescent period. Talent selectors should consider motor function and maturation status assessments to avoid premature and unwarranted drop-out of soccer players within youth development programmes.     

应用新型静脉剥脱导管单次与分次手术治疗双下肢单纯性静脉曲张的疗 效对比

目的:对比分析应用新型静脉剥脱导管单次与分次手术治疗双下肢单纯性静脉曲张的疗效.方法:采用严格的纳入和排除标准选取我院2007年8月至2010年8月收治的双下肢单纯性静脉曲张患者53例,以接受采用法国Gamida公司新型静脉剥脱导管的大隐静脉高位结扎加剥脱手术次数不同分为两组.单次手术组:(28例)患者一次性接受双侧手术;分次手术组:(25例)患者接受单侧手术,1月后再入院接受对侧手术.结果:分次手术组两次手术时间总和较单次手术组手术时间长(P=0.034),而两组在术中失血量上无明显差异(P=0.550).两组临床治愈率及出现并发症的几率相当(P＞0.05),但分次手术组的住院时间及住院费用均明显高于单次手术组(P＜0.001).结论:应用新型静脉剥脱导管单次手术剥脱双下肢单纯性静脉曲张的疗效与分次手术相当,但在经济方面单次手术显示出明显的优势,值得推广.     

3D Printer Generated Tissue iMolds for Cleared Tissue Using Single- and Multi-Photon Microscopy for Deep Tissue Evaluation

Background

Pathological analyses and methodology has recently undergone a dramatic revolution. With the creation of tissue clearing methods such as CLARITY and CUBIC, groups can now achieve complete transparency in tissue samples in nano-porous hydrogels. Cleared tissue is then imagined in a semi-aqueous medium that matches the refractive index of the objective being used. However, one major challenge is the ability to control tissue movement during imaging and to relocate precise locations post sequential clearing and re-staining.

Methods

Using 3D printers, we designed tissue molds that fit precisely around the specimen being imaged. First, images are taken of the specimen, followed by importing and design of a structural mold, then printed with affordable plastics by a 3D printer.

Results

With our novel design, we have innovated tissue molds called innovative molds (iMolds) that can be generated in any laboratory and are customized for any organ, tissue, or bone matter being imaged. Furthermore, the inexpensive and reusable tissue molds are made compatible for any microscope such as single and multi-photon confocal with varying stage dimensions. Excitingly, iMolds can also be generated to hold multiple organs in one mold, making reconstruction and imaging much easier.

Conclusions

Taken together, with iMolds it is now possible to image cleared tissue in clearing medium while limiting movement and being able to relocate precise anatomical and cellular locations on sequential imaging events in any basic laboratory. This system provides great potential for screening widespread effects of therapeutics and disease across entire organ systems.

     

Association of Lean Tissue and Fat Mass with Bone Mineral Content in Children and Adolescents

Objectives: There has been uncertainty in the adult body composition literature about whether fat mass (FM) or fat free mass is a better predictor of bone mineral content and bone mineral density. This issue has recently also been raised in the pediatric literature. Based on suggested skeletal muscle–bone relationships, this study tested the hypothesis that in children and adolescents lean tissue mass (LTM) is a better predictor of total bone mineral content (TBMC) than is FM. Research Methods and Procedures: Subjects were 133 Italian children and adolescents, 5 to 17 years of age, undergoing a routine medical screen. FM (kilograms), LTM (kilograms), and TBMC (kilograms) were measured by DXA. Multiple regression analyses tested the independent association of FM and LTM with bone mineral content. Results: Regression analyses, adjusting for pubertal status and other covariates, showed that FM and LTM were independently associated with TBMC. These associations were similar for boys and girls. TBMC was more strongly associated with LTM than FM. Discussion: These observations support the hypothesis that in children and adolescents a close association exists between LTM, a measure of skeletal muscle, and skeletal characteristics.     

Soft Tissue Modelling of Cardiac Fibres for Use in Coupled Mechano-Electric Simulations

The numerical solution of the coupled system of partial differential and ordinary differential equations that model the whole heart in three dimensions is a considerable computational challenge. As a consequence, it is not computationally practical—either in terms of memory or time—to repeat simulations on a finer computational mesh to ensure that convergence of the solution has been attained. In an attempt to avoid this problem while retaining mathematical rigour, we derive a one dimensional model of a cardiac fibre that takes account of elasticity properties in three structurally defined axes within the myocardial tissue. This model of a cardiac fibre is then coupled with an electrophysiological cell model and a model of cellular electromechanics to allow us to simulate the coupling of the electrical and mechanical activity of the heart. We demonstrate that currently used numerical methods for coupling electrical and mechanical activity do not work in this case, and identify appropriate numerical techniques that may be used when solving the governing equations. This allows us to perform a series of simulations that: (i) investigate the effect of some of the assumptions inherent in other models; and (ii) reproduce qualitatively some experimental observations.     

Postabsorptive VLDL‐TG Fatty Acid Storage in Adipose Tissue in Lean and Obese Women

Adipose tissue lipoprotein lipase (LPL) is a necessary enzyme for storage of very‐low‐density lipoprotein–triglyceride (VLDL‐TG), but whether it is a rate‐determining step is unknown. To test this hypothesis we included 10 upper‐body obese (UBO), 11 lower‐body obese (LBO), and 8 lean women. We infused ex vivo‐labeled VLDL‐¹⁴C‐TG and then performed adipose tissue biopsies to understand the relationship between VLDL‐TG storage and LPL activity in femoral and upper‐body subcutaneous fat. Both fractional tracer storage and rate of storage of the VLDL‐TG tracer were evaluated. VLDL‐TG storage was also examined as a function of regional adipose tissue blood flow (ATBF), insulin, VLDL‐TG turnover, regional fat mass, fat‐free mass (FFM), and fat cell size. LPL activity per adipocyte was significantly greater in obese than lean women but not significantly different per gram lipid. Both VLDL‐TG fractional tracer storage per kg lipid and VLDL‐TG storage rate per kg lipid were similar in abdominal and femoral fat in all three groups and were not significantly different between groups. Multiple regression analysis identified FFM and femoral fat mass as significant independent predictors of VLDL‐TG fractional tracer storage and insulin as a significant predictor of VLDL‐TG fatty acid storage rate. LPL activity, ATBF, and VLDL‐TG turnover did not predict VLDL‐TG storage. We conclude that lower FFM and greater plasma insulin are associated with greater VLDL‐TG deposition in abdominal subcutaneous and femoral fat. Greater femoral fat mass signals greater femoral VLDL‐TG storage. We suggest that the differences in VLDL‐TG storage in abdominal and femoral fat that occur with progressive obesity are regulated through mechanisms other than LPL activity.     

面部软组织厚度测量及其在面貌复原中的应用

软组织厚度作为颅骨面貌复原的基础, 具有重要的应用价值。本文借助计算机技术对西安地区132例成年人颅面数据样本开展软组织测量、分析及应用研究, 结果表明, 1)通过分析特征点处软组织厚度和面部软组织分布图, 发现面部软组织分布具有一定的规律, 额头区域软组织厚度薄且样本间差异小, 脸颊区域软组织厚且样本间差异大; 2)通过比较不同年龄段男性软组织厚度的均值, 发现20-30岁阶段软组织厚度均值最小, 50-60岁阶段软组织厚度均值其次, 30-40岁阶段软组织厚度均值最大, 但30-40岁和40-50岁两个年龄段的软组织厚度近似; 通过比较不同年龄段女性软组织厚度的均值, 发现20-30岁阶段软组织厚度均值最小, 30-40岁阶段软组织厚度均值其次, 40-50岁阶段的软组织厚度均值最大; 3)特征点处软组织厚度标准差可以反映面貌体态的差异, 因此根据10个脸颊特征点的软组织厚度均值和标准差实现面貌体态分类; 4)根据不同性别、年龄、体态对应的软组织平均厚度, 应用计算机技术实现给定颅骨的三维面貌复原, 复原结果相比于传统手工复原的结果更加科学。     

Mechanical Properties of Mesh Materials Used for Hernia Repair and Soft Tissue Augmentation

Background

Hernia repair is the most common surgical procedure in the world. Augmentation with synthetic meshes has gained importance in recent decades. Most of the published work about hernia meshes focuses on the surgical technique, outcome in terms of mortality and morbidity and the recurrence rate. Appropriate biomechanical and engineering terminology is frequently absent. Meshes are under continuous development but there is little knowledge in the public domain about their mechanical properties. In the presented experimental study we investigated the mechanical properties of several widely available meshes according to German Industrial Standards (DIN ISO).

Methodology/Principal Findings

Six different meshes were assessed considering longitudinal and transverse direction in a uni-axial tensile test. Based on the force/displacement curve, the maximum force, breaking strain, and stiffness were computed. According to the maximum force the values were assigned to the groups weak and strong to determine a base for comparison. We discovered differences in the maximum force (11.1±6.4 to 100.9±9.4 N/cm), stiffness (0.3±0.1 to 4.6±0.5 N/mm), and breaking strain (150±6% to 340±20%) considering the direction of tension.

Conclusions/Significance

The measured stiffness and breaking strength vary widely among available mesh materials for hernia repair, and most of the materials show significant anisotropy in their mechanical behavior. Considering the forces present in the abdominal wall, our results suggest that some meshes should be implanted in an appropriate orientation, and that information regarding the directionality of their mechanical properties should be provided by the manufacturers.     

Formalin-Induced Fluorescence Reveals Cell Shape and Morphology in Biological Tissue Samples

Ultramicroscopy is a powerful tool to reveal detailed three-dimensional structures of large microscopical objects. Using high magnification, we observed that formalin induces fluorescence more in extra-cellular space and stains cellular structures negatively, rendering cells as dark objects in front of a bright background. Here, we show this effect on a three-dimensional image stack of a hippocampus sample, focusing on the CA1 region. This method, called FIF-Ultramicroscopy, allows for the three-dimensional observation of cellular structures in various tissue types without complicated staining techniques.