Technical means for objectification of medical treatments in the area of the deep stabilisation spinal system

Information regarding two versions of an instrument called a muscle dynamometer, which enables detailed information about muscle activity in the deep stabilisation spinal system (DSSS), presented in this article. The MD01 (muscle dynamometer ver. 01) is a simple electromechanical instrument that allows measurement of muscle activity in two areas of the lumbar spine region. Measurements on patients have confirmed the usefulness of quantifying the initial state of a patient before rehabilitation as well as monitoring rehabilitation treatment; the MD01 is a suitable device for obtaining these measurements. However, a new and improved version of the MD01, the MD02, has been developed. The MD02 allows measurements in four different body regions and now has a PC interface, which allows achieving of patient information and data export for use with statistical software.     

Ordinary least squares regression is indicated for studies of allometry

When it comes to fitting simple allometric slopes through measurement data, evolutionary biologists have been torn between regression methods. On the one hand, there is the ordinary least squares (OLS) regression, which is commonly used across many disciplines of biology to fit lines through data, but which has a reputation for underestimating slopes when measurement error is present. On the other hand, there is the reduced major axis (RMA) regression, which is often recommended as a substitute for OLS regression in studies of allometry, but which has several weaknesses of its own. Here, we review statistical theory as it applies to evolutionary biology and studies of allometry. We point out that the concerns that arise from measurement error for OLS regression are small and straightforward to deal with, whereas RMA has several key properties that make it unfit for use in the field of allometry. The recommended approach for researchers interested in allometry is to use OLS regression on measurements taken with low (but realistically achievable) measurement error. If measurement error is unavoidable and relatively large, it is preferable to correct for slope attenuation rather than to turn to RMA regression, or to take the expected amount of attenuation into account when interpreting the data.     

A device for assessment of hand and wrist coronal plane strength

Diagnostic and rehabilitative assessments of hand function commonly omit measurement of twisting strength even though many activities of daily living require turning handles, lids, and objects of many sizes. A simple device to quantify twisting strength was designed and constructed to establish normative data and test hypotheses about hand function. The instrument is easy to use and includes an electronic torsional load cell and disks of several sizes. Tests were conducted on the dominant and nondominant hands of 64 normal subjects and 13 arthritic patients with arthritis of the thumb carpometacarpal joint. Hands were tested with disks ranging in diameter from 2.5 to 12.5 cm. A three-way repeated measures analysis showed that gender (p < 0.001), handedness (p < 0.001), and disk size (p < 0.001) had significant effects. There was no difference between radial and ulnar deviation strengths (p = 0.365). The arthritic group had significantly reduced strength (p < 0.02). Nine subjects were tested twice, with 1 day between tests: no differences occurred between the first and second testing (p = 0.930). The ability to distinguish the test groups with reproducible results proves that the device fulfills all basic requirements; continued testing and development are warranted.     

The induction of apoptosis by methotrexate in activated lymphocytes as indicated by fluorescence hyperpolarization: a possible model for predicting methotrexate therapy for rheumatoid arthritis patients

The objectives of this study were to test the in vitro response of healthy non-activated, activated, and rheumatoid arthritis (RA) lymphocytes to methotrexate (MTX), and design an in vitro model for predicting the efficiency of MTX treatment for RA patients. Considering the RA profile of clonal-expanded CD4(+) T cells, phytohemagglutinin-activated mononuclear cells taken from healthy donors were incubated with different concentrations of MTX. The MTX-immunosuppressive effect was tested by fluorescence intensity measurements, including PI assay and annexin V assay. For simple detection, we used the Individual Cell Scanner (IC-S), which enables the measurement of early events in individual cells. Healthy mononuclear cells (MNC), and MNC derived from RA patients, were tested by the IC-S while utilizing fluorescence polarization (FP) measurements of fluorescein diacetate (FDA) as an established marker of activation or suppression. In healthy activated MNC, we found that MTX, through its early incubation period, interferes with the activation signal obtained by PHA and exerts an apoptotic signal, which is noted by increases in the FP. Comparing our model to six long-standing RA patients and five newly-diagnosed patients revealed significant differences in the FP measurements, including fluorescence depolarization as an early established measurement of lymphocyte activation, and hyperpolarization as a measurement of an early immunosuppressive effect. We conclude that MTX, an effective therapy for RA patients, could easily be tested by fluorescence polarization measurements of FDA before (or during) clinical use in order to predict its efficiency on a specific RA patient. Moreover, the FP measurements can be used for the diagnosis, and making timing and dosage decisions.     

A conditional Markov model for clustered progressive multistate processes under incomplete observation

Clustered progressive chronic disease processes arise when interest lies in modeling damage in paired organ systems (e.g., kidneys, eyes), in diseases manifest in different organ systems, or in systemic conditions for which damage may occur in several locations of the body. Multistate Markov models have considerable appeal for modeling damage in such settings, particularly when patients are only under intermittent observation. Generalizations are necessary, however, to deal with the fact that processes within subjects may not be independent. We describe a conditional Markov model in which the clustering in processes within subjects is addressed by the use of multiplicative random effects for each transition intensity. The random effects for the different transition intensities may be correlated within subjects, but are assumed to be independent for different subjects. We apply the mixed Markov model to a motivating data set of patients with psoriatic arthritis, and characterize the progressive course of damage in joints of the hand. A generalization to accommodate a subpopulation of "stayers" and extensions which facilitate regression are indicated and illustrated.     

An electronic processor for use with a whole body plethysmograph to determine specific airways conductance

The panting manoeuvre traces produced by a whole body plethysmograph during the measurement of specific airways conductance (sGaw) are traditionally analysed by hand. Since this technique is tedious and time consuming it is prone to error, as well as suffering from considerable inter-observer variability. We describe a new inexpensive analogue electronic processor which rapidly produces readouts of sGaw and overcomes many of the problems associated with hand analysis. The system takes as its inputs the mouth flow and plethysmograph volume outputs from a pressure-corrected flow-displacement whole body plethysmograph, but it could be adapted for use with other types of plethysmograph. Since the processor is intended mainly for use during serial measurements of sGaw it does not carry out an unnecessary correction for flowmeter resistance. Using an electronic simulator of sGaw signals the output of the processor was found to be linear to better than 2% of full scale and to be insensitive to drift on the volume signal. The system has been comprehensively evaluated using signals from both normal subjects and patients. The processor output was found to agree well with the results of hand analysis, an agreement which was comparable with that obtained from computer based systems. For the normal subjects the equal value line adequately described the relationship between the processor and hand estimates of sGaw. However, for patients the slope of the best fit line was 18% less than unity but the correlation coefficient was high: 0.95. Reproducibility was found to be better than 3%. The coefficient of variation of sGaw determinations was less using the processor than using hand analysis, with the respective mean values for normals being 10.2% and 12.9% and for patients 8.8% and 13.2%. This processor is easy to use and gives reliable and repeatable results, which are available immediately after the end of a panting manoeuvre.     

Gastrointestinal ischemia monitoring through impedance spectroscopy as a tool for the management of the critically ill

Impedance spectroscopy (IS) has been proposed as a tool for monitoring mucosal tissue ischemia and damage in the gut of critically ill patients resulting from shock and hypoperfusion. A specific device and system have been developed and tested for this specific application over the past 12 years by our research group. This paper reviews previously published studies as well as unpublished experimental results, and puts the whole in context and perspective to help understand this technology. Results presented include summaries of gastric reactance measurement understanding, in vivo measurements in animal models, clinical significance of the measurement, and future perspectives of clinical use of this technology. All of the experimental work done to date has been designed to determine the evolving device prototypes’ performance and limitations from an instrumentation point of view. Although there are still questions to be answered with regard to the IS measurement, we conclude that we have reached enough confidence in the measurement and the device’s performance and safety to begin clinically oriented research to learn how this technology may be useful in the diagnosis and management of different populations of the critically ill.     

In vivo EPR tooth dosimetry for triage after a radiation event involving large populations

The management of radiation injuries following a catastrophic event where large numbers of people may have been exposed to life-threatening doses of ionizing radiation will rely critically on the availability and use of suitable biodosimetry methods. In vivo electron paramagnetic resonance (EPR) tooth dosimetry has a number of valuable and unique characteristics and capabilities that may help enable effective triage. We have produced a prototype of a deployable EPR tooth dosimeter and tested it in several in vitro and in vivo studies to characterize the performance and utility at the state of the art. This report focuses on recent advances in the technology, which strengthen the evidence that in vivo EPR tooth dosimetry can provide practical, accurate, and rapid measurements in the context of its intended use to help triage victims in the event of an improvised nuclear device. These advances provide evidence that the signal is stable, accurate to within 0.5 Gy, and can be successfully carried out in vivo. The stability over time of the radiation-induced EPR signal from whole teeth was measured to confirm its long-term stability and better characterize signal behavior in the hours following irradiation. Dosimetry measurements were taken for five pairs of natural human upper central incisors mounted within a simple anatomic mouth model that demonstrates the ability to achieve 0.5 Gy standard error of inverse dose prediction. An assessment of the use of intact upper incisors for dose estimation and screening was performed with volunteer subjects who have not been exposed to significant levels of ionizing radiation and patients who have undergone total body irradiation as part of bone marrow transplant procedures. Based on these and previous evaluations of the performance and use of the in vivo tooth dosimetry system, it is concluded that this system could be a very valuable resource to aid in the management of a massive radiological event.     

Evaluation of the iPhone with an acrylic sleeve versus the Scoliometer for rib hump measurement in scoliosis

ABSTRACT: BACKGROUND: Vertebral rotation found in structural scoliosis contributes to trunkal asymmetry which is commonly measured with a simple Scoliometer device on a patient's thorax in the forward flexed position. The new generation of mobile 'smartphones' have an integrated accelerometer, making accurate angle measurement possible, which provides a potentially useful clinical tool for assessing rib hump deformity. This study aimed to compare rib hump angle measurements performed using a Smartphone and traditional Scoliometer on a set of plaster torsos representing the range of torsional deformities seen in clinical practice. METHODS: Nine observers measured the rib hump found on eight plaster torsos moulded from scoliosis patients with both a Scoliometer and an Apple iPhone on separate occasions. Each observer repeated the measurements at least a week after the original measurements, and were blinded to previous results. Intra-observer reliability and inter-observer reliability were analysed using the method of Bland and Altman and 95% confidence intervals were calculated. The Intra-Class Correlation Coefficients (ICC) were calculated for repeated measurements of each of the eight plaster torso moulds by the nine observers. RESULTS: Mean absolute difference between pairs of iPhone/Scoliometer measurements was 2.1 degrees, with a small (1 degrees) bias toward higher rib hump angles with the iPhone. 95% confidence intervals for intra-observer variability were +/- 1.8 degrees (Scoliometer) and +/- 3.2 degrees (iPhone). 95% confidence intervals for inter-observer variability were +/- 4.9 degrees (iPhone) and +/- 3.8 degrees (Scoliometer). The measurement errors and confidence intervals found were similar to or better than the range of previously published thoracic rib hump measurement studies. CONCLUSIONS: The iPhone is a clinically equivalent rib hump measurement tool to the Scoliometer in spinal deformity patients. The novel use of plaster torsos as rib hump models avoids the variables of patient fatigue and discomfort, inconsistent positioning and deformity progression using human subjects in a single or multiple measurement sessions.     

Percentile benchmarks in patients with rheumatoid arthritis: Health Assessment Questionnaire as a quality indicator (QI)

Physicians are in need of a simple objective, standardized tool to compare their patients with rheumatoid arthritis, as a group and individually, with national standards. The Disability Index of the Health Assessment Questionnaire (HAQ-DI) is a simple, robust tool that can fulfill these needs. However, use of this tool as a quality indicator (QI) is hampered by the unavailability of national reference values or benchmarks based on large, multicentric, heterogenous longitudinal patient cohorts. We utilized the 20-year longitudinal prospective data from 11 data banks of Arthritis Rheumatism and Aging Medical Information to calculate reference values for HAQ-DI. Overall, 6436 patients with rheumatoid arthritis were longitudinally followed for 32,324 person-years over the 20 years from 1981 to 2000. There were 64,647 HAQ-DI measurements, with an average of 19 measurements per person. Overall, 75% of patients were women and 89% were Caucasian; the median baseline age was 58.4 years and the median baseline HAQ-DI was 1.13. Few patients were treated with biologics. The HAQ-DI values had a Gaussian distribution except for the approximately 10% of observations showing no disability. Percentile benchmarks allow disability outcomes to be compared and contrasted between different patient populations. Reference values for the HAQ-DI, presented here numerically and graphically, can be used in clinical practice as a QI measure to track functional disability outcomes and to measure response to therapy, and by arthritis patients in self-management programs.     

Evaluation of a new measurement tool for facial paralysis reconstruction

Evaluation of facial movement, including distance and direction, is essential for anyone interested in facial paralysis reconstruction. The authors' goal was to develop a measurement system that is simple, uses commercially available equipment, takes little time, and provides meaningful and accurate measurements. This technique is called the facial reanimation measurement system. It involves placing dots around the patient's mouth and video recording the patient performing maximal effort smiles. Using a video editing program, one frame showing the patient at rest is overlaid with a second frame showing the patient's smile. This overlaid image is imported into Adobe PhotoShop, where measurements are obtained using tools available in the program. Twenty patients were used to test interrater and intrarater reliability of the facial reanimation measurement system. The accuracy of the measurement process was tested by comparing 10 known distances and angles with those obtained using the facial reanimation measurement system. Both intrarater and interrater reliability of the distance and angle measurements are highly accurate, with intraclass correlations greater than 0.9. The facial reanimation measurement system is accurate to within 0.6 mm and 2.0 degrees when compared with a "known" distance and angle. The facial reanimation measurement system has been used to measure smile movements of more than 200 patients and has been demonstrated to be valuable for detecting changes of facial movements over time. This system is simple and economical and only requires 20 minutes to perform. Although the authors demonstrated evaluation of smile movement, the system may be used to evaluate other movements, such as mouth puckering, eye closure, and forehead elevation.     

Magnetic enzyme membranes as active elements of electrochemical sensors: specific amino acid enzyme elctrodes.

The basic principle of the described magnetic enzyme electrodes is a kinetic accumulation of CO2 at the active layer electrode interface. The local pCO2 level is linked to three simultaneous phenomena: substrate diffusion in, enzyme reaction CO2 diffusion out. After a transient state there is a stationary state between the quantity of CO2 produced by the enzyme reaction and the CO2 diffusing from the active membrane to the bulk solution. Continuous determination of free amino acids in biological media is useful in biological processing, fermentation, medicine, pharmaceutical industries and biological research. No methods are presently available for any specific continuous measurement of lysine which is of nutritional importance in protein industrial syntheses; of phenylalanine and tyrosine which have to be monitored in several inborn diseases (phenylketonuria being the most important of them); of arginine and histidine which play a still imperfectly understood part in neurochemistry. The use of decarboxylase bearing membranes as sensors in such measurements could offer several novel advantages: (a) a simple device made of a currently manufactured electrode slightly modified by the use of an enzyme membrane; (b) The absence of any enzymic consumption due to the immobilization and the negligible consumption of substrate during the measurements; (c) The sensitivity which can be sharpened by a systematic study of the membrane parameters; (d) the continuous response of the electrode as long as it is in contact with the substrate solution; (e) the further feasibility as a miniature sensor. The magnetic device introduced allows obviously a convenient use of the enzyme electrode, the active part can be removed and replaced without disturbance for the pCO2 electrode itself. The enzyme electrodes are not only useful at the applied point of view but also at the fundamental point of view by allowing a direct measurement of an intra membrane concentration. The influence of simple structures on enzyme kinetics was studied with enzyme electrodes by our group, in the case of memory and oscillations obtained with enzyme systems.     

Preliminary Investigation: Acupoint-Skin Conductance in Stroke Survivors

It has been reported that patients with rheumatoid arthritis or asthma have skin conductance over the acupoints that is lower than that of their healthy counterparts; this has been regarded as indirect evidence of the existence of acupoints and the energy-based model of diseases. In order to investigate the potential application of acupoint-skin conductance measurement that may reflect pathology of ischemic stroke, the present study recruited 34 stroke survivors with hemiparesis, whose skin conductance of a hand acupoint and an adjacent non-acupoint and the finger temperature in both affected and unaffected hands were simultaneously measured; the data revealed that the skin conductance and finger temperature were statistically higher in the unaffected hand than that of the affected, and the skin conductance of the acupoint and the non-acupoint were comparable in the affected and unaffected hands respectively. We attribute the observed drop in the skin conductance to the diminished peripheral blood flow of the affected hand that is signified by relatively lower finger temperature. As such, it should be advisable when studying skin conductance over acupoints, monitoring the adjacent non-acupoint skin and local vascular circulation is essential.     

Development of a Device in Detection of Glaucoma for Rural Eye Care Using Additive Manufacturing and TRIZ

Purpose: The main purpose of this study is to develop a device for the indicative measurement of intraocular pressure (IOP) of eyeball, a key cause for glaucoma. In early diagnosis and treatment of glaucoma accurate measurement of IOP is important. The methods and devices which are available for the measurement of IOP have their own limitations which cause discomfort to the patients during measurement and needs anesthesia. There is a dare need of a device for the measurement of intraocular pressure by making the contact of plunger with closed eyelid eliminating the need of anesthesia and expert ophthalmologist. Method: Additive manufacturing (AM) is an era of technical development and innovation. Developing a device for detecting glaucoma by using AM and TRIZ ‘The theory of inventive problem solving’ (A Collaborative approach) can overcome the disadvantages that classic tonometer have. The field of Ophthalmology will be experiencing a paradigm shift towards the use of collaborative approach of TRIZ with AM. The developed new device was tested on 40 patient’s eye at Government Hospital Bhandara, (M. S.), India. The results of new device were cross verified by expert clinicians using calibrated Schiotz’s tonometer and digital palpation technique. Result: The developed new device was tested on patient’s eye through eyelid and results were compared with calibrated Schiotz’s tonometer. The results from the new device were found in good agreement with results from Schiotz’s tonometer with the average error of 0.033 ± 0.18 (mean ± SD) mm of Hg and mean relative error was -0.0018 ±0.0096 (mean ± SD). Conclusion: There is a substantial need for early detection and diagnosis of glaucoma in rural and remote areas (worldwide). A new device for detection of glaucoma using AM and TRIZ was introduced in this paper and measurements by the new device were by currently well accepted Schiotz’s tonometer. The new device will help the medical practitioners in rural and remote areas for early detection of glaucoma.     

南京地区女性手的测量

本文测量了南京地区180名女工的手,选择24项与机械设计、安全有关的项目,并对不同年龄组进行了比较,结果表明,不同年龄组手尺寸特征基本相似,唯某些项目仍然存在差异。     

Single-cell analysis of yeast, mammalian cells, and fungal spores with a microfluidic pressure-driven chip-based system.

BACKGROUND: Cytomics aims at understanding the function of cellular systems by analysis of single cells. Recently, there has been a growing interest in single cell measurements being performed in microfluidic systems. These systems promise to integrate staining, measurement, and analysis in a single system. One important aspect is the limitation of allowable cell sizes due to microfluidic channel dimensions. Here we want to demonstrate the broad applicability of microfluidic chip technology for the analysis of many different cell types. METHODS: We have developed a microfluidic chip and measurement system that allows flow cytometric analysis of fluorescently stained cells from different organisms. In this setup, the cells are moved by pressure-driven flow inside a network of microfluidic channels and are analyzed individually by fluorescence detection. RESULTS: We have successfully applied the system to develop a methodology to detect viable and dead cells in yeast cell populations. Also, we have measured short interfering RNA (siRNA) mediated silencing of protein expression in mammalian cells. In addition, we have characterized the infection state of Magnaportae grisea fungal spores. CONCLUSIONS: Results obtained with the microfluidic system demonstrate a broad applicability of microfluidic flow cytometry to measurement of various cell types.     

Studies of the birefringence and birefringence dispersion of polypeptides and proteins

An apparatus has been constructed which permits the polarimetric observation of streaming solutions of macromolecules. The apparatus is a streaming birefringence device allowing the usual measurements of birefringence parallel to the cylinder axis but which in addition transmits light in the radial direction. Installation of the apparatus between the polarizer and analyzer of a Rudolph polarimeter makes possible the measurement of changes in optical rotation, dichroism and birefringence. The present work is concerned with the latter effect. The systems studied were α-helical polyglutamic acid, paramyosin, and collagen (ichthyocol). The combined measurements of radial and axial birefringence completely determines the refractive index ellipsoid of the streaming fluid. This result in turn permits the testing of the Peterlin-Stuart distribution function for streaming in a Couette device, apart from a proportionality constant. The comparison between theory and experiment is very satisfactory provided the system is reasonably homogeneous with regard to molecular length and is sufficiently dilute. On the other hand, it is concluded that the Peterlin-Stuart optical factor seriously overestimates the “form” birefringence in agreement with recent results and conclusions of Taylor and co-workers. The apparatus permits the study of the dispersion of the birefringence in the radial direction. The dispersion of collagen follows a one-term Sellmeier formula and is dominated by absorption bands in the neighborhood of 2000 A. On the other hand, the dispersion of the α-helical systems is complex and requires a multiterm Sellmeier formula. This contrast between the two kinds of polypeptidc helices is similar to results obtained with other optical techniques and is attributed to the splitting of absorption bands in the α-helix.     

An investigation of ecological correlates with hand and foot morphology in callitrichid primates

Studies of primate taxonomy and phylogeny often depend on comparisons of limb dimensions, yet there is little information on how morphology correlates and contributes to foraging strategies and ecology. Callitrichid primates are ideal for comparative studies as they exhibit a range of body size, limb proportions and diet. Many callitrichid species exhibit a high degree of exudativory, and to efficiently exploit these resources, they are assumed to have evolved morphologies that reflect a level of dependence on these resources. We tested assumptions by considering measurements of limb proportion and frictional features of the volar surfaces in preserved specimens of 25 species with relation to published life history and ecological data. The degree of exudativory and utilization of vertical substrates during foraging were found to correlate both with size and with size‐corrected foot and hand dimensions. Smaller species, which engage in greater degrees of exudativory, had proportionally longer hands and feet and more curved claw‐like tegulae (nails) on their digits to facilitate climbing on vertical substrates. The density of patterned ridges (dermatoglyphs) on the volar surfaces of the hands and feet is higher in more exudativorous genera, suggesting a role in climbing on vertical tree trunks during foraging. Dermatoglyph comparisons suggest that ridges on the soles and palms may facilitate food procurement by enhancing frictional grip during exudate feeding. Volar pad features corroborate taxonomic relationships described from dental morphology. Am J Phys Anthropol 152:447–458, 2013. © 2013 Wiley Periodicals, Inc.     

Tools for high tibial wedge osteotomy

Surgical instruments are described which have been developed for use in high tibial wedge osteotomy. This operation is a treatment for degenerative arthritis of the knee in which one compartment of the joint is predominantly affected resulting in a deformity. Realignment of the bones alters the load distribution on the joint which can relieve pain. Tools have been designed to facilitate the removal of a wedge of bone cut at a precise angle calculated from load bearing radiographs. The tools are a marker pin guide and a saw guide; their use has resulted in accurate bone realignment confirmed by postoperative radiographs.     

On measuring head length in fishes, amphibians and reptiles and on modified calliper rules

The definition of head length in ichthyology and herpetology varies along four dimensions. Three may be taxon-dependent: (1) the point selected as 'the anterior end of the head' (2) the location of 'the posterior end of the head' and (3) the degree of inclusion of soft structures at the posterior end of the head. But (4) is technical and has caused much confusion: whether to measure parallel to the long axis, or 'point-to-point', at an angle to the axis. In order to facilitate measurements which are standardized in this dimension, modified calliper rules are introduced.