A Mass-Producible Washable Smart Garment with Embedded Textile EMG Electrodes for Control of Myoelectric Prostheses: A Pilot Study

Electromyography (EMG) is the resulting electrical signal from muscle activity, commonly used as a proxy for users’ intent in voluntary control of prosthetic devices. EMG signals are recorded with gold standard Ag/AgCl gel electrodes, though there are limitations in continuous use applications, with potential skin irritations and discomfort. Alternative dry solid metallic electrodes also face long-term usability and comfort challenges due to their inflexible and non-breathable structures. This is critical when the anatomy of the targeted body region is variable (e.g., residual limbs of individuals with amputation), and conformal contact is essential. In this study, textile electrodes were developed, and their performance in recording EMG signals was compared to gel electrodes. Additionally, to assess the reusability and robustness of the textile electrodes, the effect of 30 consumer washes was investigated. Comparisons were made between the signal-to-noise ratio (SNR), with no statistically significant difference, and with the power spectral density (PSD), showing a high correlation. Subsequently, a fully textile sleeve was fabricated covering the forearm, with 14 textile electrodes. For three individuals, an artificial neural network model was trained, capturing the EMG of 7 distinct finger movements. The personalized models were then used to successfully control a myoelectric prosthetic hand.

Prevalence of Musculoskeletal Disorders and Self-Reported Pain in Artisanal Fishermen from a Traditional Community in Todos-os-Santos Bay, Bahia, Brazil

Musculoskeletal disorders (MSDs) can be characterized from their occupational etiology and their occurrence; their chronicity generates negative repercussions for the health of workers, especially of artisanal fishing. To investigate the prevalence of generalized musculoskeletal disorders by body region and self-reported pain in a fishing population of northeastern Brazil, an epidemiological cross-sectional study was carried out in Santiago do Iguape, Bahia-Brazil, in 2017. The Brazilian version of the Nordic Musculoskeletal Questionnaire (NMQ), in addition to a questionnaire containing the socio-demographic and labor conditions were applied to a random stratified sample of 248 artisanal fisheries. There were 170 female shellfish gatherers and 78 fishermen, with a mean age of 36.7 years (SD = 10.5 years) and 43.3 years (SD = 11.8 years), respectively. The beginning of the labor activity was initiated at approximately 11 years of age. The average weekly income varied from 17.64 USD to 29.10 USD. The prevalence of MSD independent of occupation occurred in at least one body region in 93.5% and the presence of musculoskeletal pain/discomfort over the last seven days in 95.2% of the fishing workers. The highest prevalence of MSD was found in shellfish gatherers in: lower back (86.4%), wrist and hand (73.5%), and upper back (66.8%). In relation to the presence of pain in the last year, the frequency of pain was greater in the fishermen compared to the shellfish gatherers. The generalized severity of the MSD in 93.5% of this community of fishermen is evident, with emphasis in the following regions: lower back, wrist and hand and upper back in both groups, with occurrence of pain in more than one body region at the same time.

Automatic body region localization in 3D-CT images based on the improved YOLO model

Automatic body region localization in medical three-dimensional (3D)-CT images is a critical step of computerized body-wide Automatic Anatomy Recognition (AAR) system, which can be applied for radiotherapy planning and interest slices retrieving. Currently, the complex internal structure of human body and time consuming computation are the main challenges for the localization. Therefore, this paper introduces and improves the YOLO-v3 model into the body region localization for these problems. First, seven categories of body regions in a CT volume image I are defined based on the modification version of our previous work. Second, an improved YOLO-v3 model is trained to classify each axial slice into one of the seven categories. Then, the effectiveness of the proposed method is evaluated on 3D-CT images that collected from 220 subjects. The experimental results demonstrate that the slice localizing error is less than 3 NoS (Number of slices), which is competitive to the state-of-the-art methods. Beyond this, our method is simple and computationally efficient owing to its less training time, and the average computational time for localizing a volume CT images is about 3 second, which shows potential for a further application.

Medicolegal Aspects of Victims of Assault Admitted to a Tertiary Care Hospital in Sri Lanka

Introduction: Violence with physical assault is a common cause of morbidity and mortality prevalent but not limited to underdeveloped countries. The opinion of the forensic expert is often indispensable in such cases to determine the penalties. This study was planned to describe the pattern of presentation of the victims and evaluate the strengths and limitations in formulating a scientific medicolegal opinion based on the findings of the victim. Methods: A retrospective descriptive study based on the case records of the victims of assault admitted to Colombo North Teaching Hospital, Ragama, Sri Lanka, was conducted for four years. Results: Out of the 400 victims, the majority (72% n = 290) were males and of the age-group of 21 to 40 (n = 216). The reason for assault in the majority was sudden provocation (n = 99, 25%), followed by previous long-duration enmity (n = 89, 22%). The majority (83%) had isolated blunt force trauma, and the injuries were nongrievous (74%). Defense injuries were significantly associated with attempted defense (p = 0.000) and sharp force trauma (p = 0.002). The underlying reason for the assault was not significantly associated with the causative weapon (p = 0.228) or body region injured (p = 0.195). Conclusions: Even though the presentation and the pattern of injures are definitely of value in formulating a scientific opinion, the study identified the limitations of the forensic experts, and the need for a holistic approach at the investigations was highlighted.

Lateralized and Segmental Overgrowth in Children

Congenital disorders of lateralized or segmental overgrowth (LO) are heterogeneous conditions with increased tissue growth in a body region. LO can affect every region, be localized or extensive, involve one or several embryonic tissues, showing variable severity, from mild forms with minor body asymmetry to severe ones with progressive tissue growth and related relevant complications. Recently, next-generation sequencing approaches have increased the knowledge on the molecular defects in LO, allowing classifying them based on the deranged cellular signaling pathway. LO is caused by either genetic or epigenetic somatic anomalies affecting cell proliferation. Most LOs are classifiable in the Beckwith–Wiedemann spectrum (BWSp), PI3KCA/AKT-related overgrowth spectrum (PROS/AROS), mosaic RASopathies, PTEN Hamartoma Tumor Syndrome, mosaic activating variants in angiogenesis pathways, and isolated LO (ILO). These disorders overlap over common phenotypes, making their appraisal and distinction challenging. The latter is crucial, as specific management strategies are key: some LO is associated with increased cancer risk making imperative tumor screening since childhood. Interestingly, some LO shares molecular mechanisms with cancer: recent advances in tumor biological pathway druggability and growth downregulation offer new avenues for the treatment of the most severe and complicated LO.

Firearm Injuries to the Wrist and Hand in Children and Adults: An Epidemiologic Study

Background: Gunshot wounds (GSWs) to the wrist and hand are a major health and economic burden in the United States. There are few studies examining the circumstances and epidemiological factors surrounding these injuries. This study assesses the epidemiological factors, as well as the shooting circumstances, injury details, and surgical management of wrist and hand GSWs in children and adults. Methods: Medical records and radiographs were reviewed for all patients with ballistic injury to the wrist or hand treated at an urban academic level 1 trauma center from 2016 to 2019. Fisher exact and Pearson χ2 tests were used to assess differences between groups. Results: Two hundred forty-nine victims (29 children, 220 adults) with complete documentation were identified. Among 180 victims with known shooting circumstances, 132 (70%) were shot by another person and 110 (65%) were injured by intentional gunfire. Eighty-seven victims (35%) suffered a concurrent GSW to another body region. Metacarpal fracture was the most commonly diagnosed bony injury (37%), followed by proximal phalanx fracture (25%). One hundred twenty-nine victims (52%) underwent surgery following their injuries. Nerve discontinuity was diagnosed in 27 victims (11%), while 20 victims (8%) had vascular disruption. There was no significant difference between children and adult victims’ type of fracture, concurrent injuries, rates of surgery, or in the most common fracture fixation method. Conclusions: Most wrist and hand GSW victims were injured due to intentional, non-self-inflicted gunfire. Most patients present with hand fractures, and fortunately, nerve and vascular disruptions are uncommon.

Reference phantom selection in pediatric computed tomography using data from a large, multicenter registry

Background Radiation dose metrics vary by the calibration reference phantom used to report doses. By convention, 16-cm diameter cylindrical polymethyl-methacyrlate phantoms are used for head imaging and 32-cm diameter phantoms are used for body imaging in adults. Actual usage patterns in children remain under-documented. Objective This study uses the University of California San Francisco International CT Dose Registry to describe phantom selection in children by patient age, body region and scanner manufacturer, and the consequent impact on radiation doses. Materials and methods For 106,837 pediatric computed tomography (CT) exams collected between Jan. 1, 2015, and Nov. 2, 2020, in children up to 17 years of age from 118 hospitals and imaging facilities, we describe reference phantom use patterns by body region, age and manufacturer, and median and 75th-percentile dose–length product (DLP) and volume CT dose index (CTDIvol) doses when using 16-cm vs. 32-cm phantoms. Results There was relatively consistent phantom selection by body region. Overall, 98.0% of brain and skull examinations referenced 16-cm phantoms, and 95.7% of chest, 94.4% of abdomen and 100% of cervical-spine examinations referenced 32-cm phantoms. Only GE deviated from this practice, reporting chest and abdomen scans using 16-cm phantoms with some frequency in children up to 10 years of age. DLP and CTDIvol values from 16-cm phantom-referenced scans were 2–3 times higher than 32-cm phantom-referenced scans. Conclusion Reference phantom selection is highly consistent, with a small but significant number of abdomen and chest scans (~5%) using 16-cm phantoms in younger children, which produces DLP values approximately twice as high as exams referenced to 32-cm phantoms

An Analysis of Ketamine Doses Administrated to Nonintubated Casualties Prehospital

ABSTRACT Introduction Previous studies demonstrate that a significant proportion of casualties do not receive pain medication prehospital after traumatic injuries. To address possible reasons, the U.S. Military has sought to develop novel delivery methods to aid in administration of pain medications prehospital. We sought to describe the dose and route of ketamine administered prehospital to help inform materiel solutions. Materials and Methods This is a secondary analysis of a previously described dataset focused on prehospital data within the Department of Defense Trauma Registry from 2007 to 2020. We isolated encounters in which ketamine was administered along with the amount dosed and the route of administration in nonintubated patients. Results Within our dataset, 862 casualties met inclusion for this analysis. The median age was 28 and nearly all (98%) were male. Most were battle injuries (88%) caused by explosives (54%). The median injury severity score was 10 with the extremities accounting to the most frequent seriously injured body region (38%). The mean dose via intravenous route was 50.4 mg (n = 743, 95% CI 46.5-54.3), intramuscular was 66.7 mg (n = 234, 95% CI 60.3-73.1), intranasal was 56.5 mg (n = 10, 39.1-73.8), and intraosseous was 83.3 mg (n = 34, 66.3-100.4). Most had a medic or CLS in their chain of care (87%) with air evacuation as the primary mechanism of evacuation (86%). Conclusions The average doses administered were generally larger than the doses recommended by Tactical Combat Casualty Care guidelines. Currently, guidelines may underdose analgesia. Our data will help inform materiel solutions based on end-user requirements.

Do manual therapies have a specific autonomic effect? An overview of systematic reviews

Background The impact of manual therapy interventions on the autonomic nervous system have been largely assessed, but with heterogeneous findings regarding the direction of these effects. We conducted an overview of systematic reviews to describe if there is a specific autonomic effect elicited by manual therapy interventions, its relation with the type of technique used and the body region where the intervention was applied. Methods We conducted an overview according to a publicly registered protocol. We searched the Cochrane Database of Systematic Reviews, MEDLINE, EPISTEMONIKOS and SCOPUS, from their inception to march 2021. We included systematic reviews for which the primary aim of the intervention was to assess the autonomic effect elicited by a manual therapy intervention in either healthy or symptomatic individuals. Two authors independently applied the selection criteria, assessed risk of bias from the included reviews and extracted data. An established model of generalisation guided the data analysis and interpretation. Results We included 12 reviews (5 rated as low risk of bias according the ROBIS tool). The findings showed that manual therapies may have an effect on both sympathetic and parasympathetic systems. However, the results from included reviews were inconsistent due to differences in their methodological rigour and how the effects were measured. The reviews with a lower risk of bias could not discriminate the effects depending on the body region to which the technique was applied. Conclusion The magnitude of the specific autonomic effect elicited by manual therapies and its clinical relevance is uncertain. We point out some specific recommendations in order to improve the quality and relevance of future research in this field.

COMPARISON OF BONE PARAMETERS BY BODY REGION IN UNIVERSITY ATHLETES: SYSTEMATIC REVIEW

ABSTRACT Introduction: Bone mineral density (BMD) and bone mineral content (BMC) vary depending on the type of sport practiced and the body region, and their measurement can be an effective way to predict health risks throughout an athlete’s life. Objective: To describe the methodological aspects (measurement of bone parameters, body regions, precision errors and covariates) and to compare BMD and BMC by body region (total body, upper limbs, lower limbs and trunk) among university athletes practicing different sports. Methods: A search was performed on the databases PubMed, Web of Science, Scopus, ScienceDirect, EBSCOhost, SportDiscus, LILACS and SciELO. Studies were selected that: (1) compared BMD and BMC of athletes practicing at least two different sports (2) used dual-energy X-ray absorptiometry (DXA) to assess bone parameters (3) focused on university athletes. The extracted data were: place of study, participant selection, participants’ sex, sport practiced, type of study, bone parameters, DXA model, software used, scan and body regions, precision error, precision protocol, covariates and comparison of bone parameters between different sports by body region. Results: The main results were: 1) BMD is the most investigated bone parameter; 2) total body, lumbar spine and proximal femur (mainly femoral neck) are the most studied body regions; 3) although not recommended, the coefficient of variation is the main indicator of precision error; 4) total body mass and height are the most commonly used covariates; 5) swimmers and runners have lower BMD and BMC values; and 6) it is speculated that basketball players and gymnasts have greater osteogenic potential. Conclusions: Swimmers and runners should include weight-bearing exercises in their training routines. In addition to body mass and height, other covariates are important. The results of this review can help guide intervention strategies focused on preventing diseases and health problems during and after the athletic career. Level of evidence II; Systematic Review.