Search results for: forearm SEMG

Authors: Vladyslav Povoroznyuk, Larysa Martynyuk, Iryna Syzonenko, Liliya Martynyuk

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Osteoporosis is one of the important problems in postmenopausal women due to an increased risk of sudden and unexpected fractures. This study is aimed to determine the connection between bone mineral density (BMD) and trabecular bone score (TBS) in Ukrainian women suffering from metabolic syndrome. Participating in the study, 566 menopausal women aged 50-79 year-old were examined and divided into two groups: Group A included 336 women with no obesity (BMI ≤ 29.9 kg/m²), and Group B – 230 women with metabolic syndrome (diagnosis according to IDF criteria, 2005). Dual-energy X-ray absorptiometry was used for measuring of lumbar spine (L1-L4), femoral neck, total body and forearm BMD and bone quality indexes (last according to Med-Imaps installation). Data were analyzed using Statistical Package 6.0. A significant increase of lumbar spine (L1-L4), femoral neck, total body and ultradistal radius BMD was found in women with metabolic syndrome compared to those without obesity (p < 0.001) both in their totality and in groups of 50-59 years, 60-69 years, and 70-79 years. TBS was significantly higher in non-obese women compared to metabolic syndrome patients of 50-59 years and in the general sample (p < 0.05). Analysis showed significant positive correlation between body mass index (BMI) and BMD at all levels. Significant negative correlation between BMI and TBS (L1-L4) was established. Despite the fact that BMD indexes were significantly higher in women with metabolic syndrome, the frequency of vertebral and non-vertebral fractures did not differ significantly in the groups of patients.

Keywords: bone mineral density, trabecular bone score, metabolic syndrome, fracture

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Authors: Elizabeta Sivevska, Sunchica Petrovska, Vaska Antevska, Lidija Todorovska, Sanja Manchevska, Beti Dejanova, Ivanka Karagjozova, Jasmina Pluncevic Gligoroska

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Introduction: Body composition plays an important role in the selection of young soccer players and it is associated with their successful performance. The most commonly used model of body composition divides the body into two compartments: fat components and fat-free mass (muscular and bone components). The aims of the study were to determine the body composition parameters of young male soccer players and to show the differences in age groups. Material and methods: A sample of 52 young male soccer players, with an age span from 9 to 14 years were divided into two groups according to the age (group 1 aged 9 to 12 years and group 2 aged 12 to 14 years). Anthropometric measurements were taken according to the method of Mateigka. The following measurements were made: body weight, body height, circumferences (arm, forearm, thigh and calf), diameters (elbow, knee, wrist, ankle) and skinfold thickness (biceps, triceps, thigh, leg, chest, abdomen). The measurements were used in Mateigka’s equations. Results: Body mass components were analyzed as absolute values (in kilograms) and as percentage values: the muscular component (MC kg and MC%), the bone component (BCkg and BC%) and the body fat (BFkg and BF%). The group up to 12 years showed the following mean values of the analyzed parameters: MM=21.5kg; MM%=46.3%; BC=8.1kg; BC%=19.1%; BF= 6.3kg; BF%= 15.7%. The second group aged 12-14 year had mean values of body composition parameters as follows: MM=25.6 kg; MM%=48.2%; BC = 11.4 kg; BC%=21.6%; BF= 8.5 kg; BF%= 14. 7%. Conclusions: The young soccer players aged 12 up to 14 years who are in the pre-pubertal phase of growth and development had higher bone component (p<0.05) compared to younger players. There is no significant difference in muscular and fat body component between the two groups of young soccer players.

Keywords: body composition, young soccer players, body fat, fat-free mass

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Authors: Joanna Maj

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Body machine interfaces (BMIs) afford users a non-invasive way coordinate movement. Vibrotactile stimulation has been incorporated into BMIs to allow feedback in real-time and guide movement control to benefit patients with cognitive deficits, such as stroke survivors. To advance research in this area, we examined vibrational discrimination thresholds at four body locations to determine suitable application sites for future multi-channel BMIs using vibration cues to guide movement planning and control. Twelve healthy adults had a pair of small vibrators (tactors) affixed to the skin at each location: forearm, shoulders, torso, and knee. A "standard" stimulus (186 Hz; 750 ms) and "probe" stimuli (11 levels ranging from 100 Hz to 235 Hz; 750 ms) were delivered. Probe and test stimulus pairs could occur sequentially or simultaneously (timing). Participants verbally indicated which stimulus felt more intense. Stimulus order was counterbalanced across tactors and body locations. Probabilities that probe stimuli felt more intense than the standard stimulus were computed and fit with a cumulative Gaussian function; the discrimination threshold was defined as one standard deviation of the underlying distribution. Threshold magnitudes depended on stimulus timing and location. Discrimination thresholds were better for stimuli applied sequentially vs. simultaneously at the torso as well as the knee. Thresholds were small (better) and relatively insensitive to timing differences for vibrations applied at the shoulder. BMI applications requiring multiple channels of simultaneous vibrotactile stimulation should therefore consider the shoulder as a deployment site for a vibrotactile BMI interface.

Keywords: electromyography, electromyogram, neuromuscular disorders, biomedical instrumentation, controls engineering

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Authors: Jasmina Pluncevic Gligoroska, Sanja Manchevska, Vaska Antevska, Lidija Todorovska, Beti Dejanova, Sunchica Petrovska, Ivanka Karagjozova, Elizabeta Sivevska

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Introduction: Anthropometric measurements are integral part of regular medical examinations of athletes. In addition to the quantification of the size of the body, these measurements indicate the quality of the physical status, because of its association with sports performance. The purpose of this study was to examine whether there are differences in anthropometric parameters and body mass components in female athletes who participate in two different types of sports. Methods: A total of 27 athletes, 15 handball players and 12 basketball players, at the average age of 22.7 years (age span from 17 to 30 years) entered the study. Anthropometric method by Matiegka was used for determination of body components. Sixteen anthropometric measures were taken: height, weight, four diameters of joints, four circumferences of limbs and six skin folds. Results: Handball players were 169.6±6.7 cm tall and 63,75±7.5 kg heavy. Their average relative muscle mass (absolute mass in kg) was 51% (32.5kg), while bone component was 16.8% (10.7kg) and fat component was 14.3% (7.74kg). The basketball players were 177.4±8.2cm tall and 70.37±12.1kg heavy. Their average relative muscle mass (absolute mass in kg) was 51.9 % (36.6kg), bone component was 16.37% (11.5kg) and fat component was 15.36% (9.4kg). The comparison of anthropometric values showed that basketball players were statistically significantly higher and heavier than handball players (p<0.05). Statistically significant difference (p<0.05) was observed in the range of upper leg circumference (higher in basketball players) and the forearm skin fold (higher in the basketball players). Conclusion: Handball players and basketball players significantly differed in basic anthropometric measures (height and weight), but the body components had almost identical values. The anthropometric measurements that have been taken did not show significant difference between handball and basketball female players despite the different physical demands of the games.

Keywords: anthropometry, body components, basketball, handball female players

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Authors: Vladyslav Povoroznyuk, Larysa Martynyuk, Iryna Syzonenko, Liliya Martynyuk

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Medical, social, and economic relevance of osteoporosis is caused by reducing quality of life, increasing disability and mortality of the patients as a result of fractures due to the low-energy trauma. This study is aimed to examine the associations of metabolic syndrome components, bone mineral density (BMD) and trabecular bone score (TBS) in menopausal women with non-vertebral fractures. 1161 menopausal women aged 50-79 year-old were examined and divided into three groups: A included 419 women with increased body weight (BMI - 25.0-29.9 kg/m²), B – 442 females with obesity (BMI >29.9 kg/m²)i and C – 300 women with metabolic syndrome (diagnosis according to IDF criteria, 2005). BMD of lumbar spine (L1-L4), femoral neck, total body and forearm was investigated with usage of dual-energy X-ray absorptiometry. The bone quality indexes were measured according to Med-Imaps installation. All analyses were performed using Statistical Package 6.0. BMD of lumbar spine (L1-L4), femoral neck, total body, and ultradistal radius was significant higher in women with obesity and metabolic syndrome compared to the pre-obese ones (p<0.001). TBS was significantly higher in women with increased body weight compared to obese and metabolic syndrome patients. Analysis showed significant positive correlation between waist circumference, triglycerides level and BMD of lumbar spine and femur. Significant negative association between serum HDL level and BMD of investigated sites was established. The TBS (L1-L4) indexes positively correlated with HDL (high-density lipoprotein) level. Despite the fact that BMD indexes were better in women with metabolic syndrome, the frequency of non-vertebral fractures was significantly higher in this group of patients.

Keywords: bone mineral density, trabecular bone score, metabolic syndrome, fracture

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Authors: K. Shyamnath, K. Suresh Kutty

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The purpose of the study was to find out the effect of three resistance training methods on performance-related variables of powerlifters. A total of forty male students (N=40) who had participated in Kannur University powerlifting championship were selected as subjects. The age group of the subjects ranged from 18 years old to 25 years old. The selected subjects were equally divided into four groups (n=10) of three experimental groups and a control group. The experimental Group I underwent traditional resistance training (TRTG), Group II underwent combined traditional resistance training and plyometrics (TRTPG), and Group III underwent combined traditional resistance training and resistance training with high rhythm (TRTHRG). Group IV acted as the control group (CG) receiving no training during the experimental period. The duration of the experimental period was sixteen weeks, five days per week. Powerlifting performance was assessed by the 1RM test in the squat, bench press and deadlift. Performance-related variables assessed were chest girth, arm girth, forearm girth, thigh girth, and calf girth. Pre-test and post-test were conducted a day before and two days after the experimental period on all groups. Analysis of covariance (ANCOVA) was applied to analyze the significant difference. The 0.05 level of confidence was fixed as the level of significance to test the F ratio obtained by the analysis of covariance. The result indicates that there is a significant effect of all the selected resistance training methods on the performance and selected performance-related variables of powerlifters. Combined traditional resistance training and plyometrics and combined traditional resistance training and resistance training with high rhythm proved better than the traditional resistance training in improving performance and selected performance-related variables of powerlifters. There was no significant difference between combined traditional resistance training and plyometrics and combined traditional resistance training and resistance training with high rhythm in improving performance and selected performance-related variables of powerlifters.

Keywords: girth, plyometrics, powerlifting, resistance training

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Authors: Gunilla Dahlgren, Per Liv, Fredrik Öhberg, Lisbeth Slunga Järvholm, Mikael Forsman, Börje Rehn

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Background: Accuracy of risk assessment tools in hand-repetitive work is important. This can support precision in the risk management process and for a sustainable working life for women and men equally. Musculoskeletal disorders, MSDs, from the hand, wrist, and forearm, are common in the working population. Women report a higher prevalence of MSDs in these regions. Objective: The objective of this study was to compare if women and men who performed the identical hand-intensive work task were rated equally using the Hand Activity Threshold Limit Value® (HA-TLV) when self-rated and observer-rated. Method: Fifty-six workers from eight companies participated, with various intensities in hand-repetitive work tasks. In total, 18 unique identical hand-intensive work tasks were executed in 28 pairs of a woman and a man. Hand activity and force levels were assessed. Each worker executed the work task for 15 minutes, which was also video recorded. Data was collected on workers who self-rated directly after the execution of the work task. Also, experienced observers performed ratings from videos of the same work tasks. For comparing means between women and men, paired samples t-tests were used. Results: The main results showed that there was no difference in self-ratings of hand activity level and force by women and men who executed the same work task. Further, there was no difference between observer ratings of hand activity level. However, the observer force ratings of women and men differed significantly (p=0.01). Conclusion: Hand activity and force levels are rated equally in women and men when self-rated, also by observers for hand activity. However, it is an observandum that observer force rating is rated higher for women and lower for men. This indicates the need of comparing force ratings with technical measures.

Keywords: gender, equity, sex differences, repetitive strain injury, cumulative trauma disorders, upper extremity, exposure assessment, workload, health risk assessment, observation, psychophysics

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Authors: Rozeena Baig, R. Rehana Rehman, Rifat Ahmed

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Background: Osteoporosis, characterized by low bone mineral density, poses a global health concern. Diagnosis increases the likelihood of developing osteoporosis, a multifactorial disorder marked by low bone mass, elevating the risk of fractures in the lumbar spine, femoral neck, hip, vertebras, and distal forearm, particularly in postmenopausal women due to bone loss influenced by various pathophysiological factors. Objectives: The aim is to investigate the association of serum cytokine, bone turnover marker, bone mineral density and TLR4 gene polymorphism in pre and post-menopausal women and to find if any of these can be the potential predictor of osteoporosis in postmenopausal women. Material and methods: The study participants consisted of Group A (n=91) healthy pre-menopausal women and Group B (n=102) healthy postmenopausal women having ≥ 5 years’ history of menopause. ELISA was performed for cytokine (TNFα) and bone turnover markers (carboxytelopeptides), respectively. Bone Mineral Density (BMD)was measured through a dual X-ray absorptiometry (DEXA) scan. Toll-like Receptors 4 (TLR4) gene polymorphisms (A896G; Asp299Gly) and (C1196T; Thr399Ile) were investigated by PCR and Sanger sequencing. Results: Statistical analysis reveals a positive correlation of age and BMI with T scores in the premenopausal group, whereas in post-menopausal group found a significant negative correlation between age and T-score at hip (r = - 0.352**), spine (r = - .306**), and femoral neck (r = - 0.344**) and a significant negative correlation of BMI with TNF-α (- 0.316**). No association and significant differences were observed for TLR4 genotype and allele frequencies among studied groups However, both SNPs exhibited significant association with each other. Conclusions: This study concludes that BMI, BMD and TNF-α are the potential predictors of osteoporosis in post-menopausal women. However, CTX and TLR4 gene polymorphism did not appear as potential predictors of bone loss in this study and apparently cannot help in predicting bone loss in post-menopausal women.

Keywords: osteoporosis, post-menopausal, pre-menopausal woemn, genetics mutaiont, TLR4 genepolymorphsum

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Authors: Adkham Paiziev, Fikrat Kerimov

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Near Infrared Spectroscopy (NIRS) is one of the biophotonic techniques which can be used to monitor oxygenation and hemodynamics in a variety of human tissues, including skeletal muscle. In the present work, we are offering tissue oximetry (OxyPrem) to measure hemodynamic parameters of skeletal muscles in rest and exercise. Purpose: - To elaborate the new wireless, portable, noninvasive, wearable NIRS device to measure skeletal muscle oxygenation during exercise. - To test this device on brachioradialis muscle of wrestler volunteers by using combined method of arterial occlusion (AO) and NIRS (AO+NIRS). Methods: Oxyprem NIRS device has been used together with AO test. AO test and Isometric brachioradialis muscle contraction experiments have been performed on one group of wrestler volunteers. ‘Accu- Measure’ caliper (USA) to measure skinfold thickness (SFT) has been used. Results: Elaborated device consists on power supply box, a sensor head and installed ‘Tubis’ software for data acquisition and to compute deoxyhemoglobin ([HHb), oxyhemoglobin ([O2Hb]), tissue oxygenation (StO2) and muscle tissue oxygen consumption (mVO2). Sensor head consists on four light sources with three light emitting diodes with nominal wavelengths of 760 nm, 805 nm, and 870 nm, and two detectors. AO and isometric voluntary forearm muscle contraction (IVFMC) on five healthy male subjects (23,2±0.84 in age, 0.43±0.05cm of SFT ) and four female subjects (22.0±1.0 in age and 0.24±0.04 cm SFT) has been measured. mVO2 for control group has been calculated (-0.65%/sec±0.07) for male and -0.69%/±0.19 for female subjects). Tissue oxygenation index for wrestlers in average about 75% whereas for control group StO2 =63%. Second experiment was connected with quality monitoring muscle activity during IVFMC at 10%,30% and 50% of MVC. It has been shown, that the concentration changes of HbO2 and HHb positively correlated to the contraction intensity. Conclusion: We have presented a portable multi-channel wireless NIRS device for real-time monitoring of muscle activity. The miniaturized NIRS sensor and the usage of wireless communication make the whole device have a compact-size, thus can be used in muscle monitoring.

Keywords: skeletal muscle, oxygenation, instrumentation, near infrared spectroscopy

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Authors: Oya Umit Yemisci, Nur Saracgil Cosar, Tubanur Ozturk Sisman, Selin Ozen

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Chronic autoimmune thyroiditis (AIT) may result in a wide spectrum of reversible abnormalities in the neuromuscular function. Usually, proximal muscle-related symptoms and neuropathic findings such as mild axonal peripheral neuropathy have been reported. Sympathetic skin responses are useful in evaluating sudomotor activity of the unmyelinated sympathetic fibers of the autonomic nervous system. Neurocognitive impairment may also be a prominent feature of hypothyroidism, particularly in elderly patients. Electromyographic reaction times as a highly sensitive parameter provides. Objective data concerning cognitive and motor functions. The aim of this study was to evaluate peripheral nerve functions, sympathetic skin response and electroneuromyographic (ENMG) reaction times in euthyroid and subclinically hypothyroid patients with a diagnosis of AIT and compare to those of a control group. Thirty-five euthyroid, 19 patients with subclinical hypothyroidism and 35 age and sex-matched healthy subjects were included in the study. Motor and sensory nerve conduction studies, sympathetic skin responses recorded from hand and foot by stimulating contralateral median nerve and simple reaction times by stimulating tibial nerve and recording from extensor indicis proprius muscle were performed to all patients and control group. Only median nerve sensory conduction velocities of the forearm were slower in patients with AIT compared to the control group (p=0.019). Otherwise, nerve conduction studies and sympathetic skin responses showed no significant difference between the patients and the control group. However, reaction times were shorter in the healthy subjects compared to AIT patients. Prolongation in the reaction times may be considered as a parameter reflecting the alterations in the cognitive functions related to the primary disease process in AIT. Combining sympathetic skin responses with more quantitative tests such as cardiovascular tests and sudomotor axon reflex testing may allow us to determine higher rates of involvement of the autonomic nervous system in AIT.

Keywords: sympathetic skin response, simple reaction time, chronic autoimmune thyroiditis

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Authors: Faruk Ortes, Derya Karabulut, Yunus Ziya Arslan

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Myoelectric features gathering from musculature environment are considered on a preferential basis to perceive muscle activation and control human arm prostheses according to recent experimental researches. EMG (electromyography) signal based human arm prostheses have shown a promising performance in terms of providing basic functional requirements of motions for the amputated people in recent years. However, these assistive devices for neurorehabilitation still have important limitations in enabling amputated people to perform rather sophisticated or functional movements. Surface electromyogram (EMG) is used as the control signal to command such devices. This kind of control consists of activating a motion in prosthetic arm using muscle activation for the same particular motion. Extraction of clear and certain neural information from EMG signals plays a major role especially in fine control of hand prosthesis movements. Many signal processing methods have been utilized for feature extraction from EMG signals. The specific objective of this study was to compare widely used time domain features of EMG signal including integrated EMG(IEMG), root mean square (RMS) and waveform length(WL) for prediction of externally applied forces to human hands. Obtained features were classified using artificial neural networks (ANN) to predict the forces. EMG signals supplied to process were recorded during only type of muscle contraction which is isometric and isotonic one. Experiments were performed by three healthy subjects who are right-handed and in a range of 25-35 year-old aging. EMG signals were collected from muscles of the proximal part of the upper body consisting of: biceps brachii, triceps brachii, pectorialis major and trapezius. The force prediction results obtained from the ANN were statistically analyzed and merits and pitfalls of the extracted features were discussed with detail. The obtained results are anticipated to contribute classification process of EMG signal and motion control of powered human arm prosthetics control.

Keywords: assistive devices for neurorehabilitation, electromyography, feature extraction, force estimation, human arm prosthesis

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Authors: Angelika Dierolf, K. Rischer, A. Gonzalez-Roldan, P. Montoya, F. Anton, M. Van der Meulen

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Placebo analgesia is a powerful cognitive endogenous pain modulation mechanism with high relevance in pain treatment. Older people would benefit, especially from non-pharmacologic pain interventions, since this age group is disproportionately affected by acute and chronic pain, while pharmacological treatments are less suitable due to polypharmacy and age-related changes in drug metabolism. Although aging is known to affect neurobiological and physiological aspects of pain perception, as for example, changes in pain threshold and pain tolerance, its effects on cognitive pain modulation strategies, including placebo analgesia, have hardly been investigated so far. In the present study, we are assessing placebo analgesia in 35 older adults (60 years and older) and 35 younger adults (between 18 and 35 years). Acute pain was induced with short transdermal electrical pulses to the inner forearm, using a concentric stimulating electrode. Stimulation intensities were individually adjusted to the participant’s threshold. Next to the stimulation site, we applied sham transcutaneous electrical nerve stimulation (TENS). Participants were informed that sometimes the TENS device would be switched on (placebo condition), and sometimes it would be switched off (control condition). In reality, it was always switched off. Participants received alternating blocks of painful stimuli in the placebo and control condition and were asked to rate the intensity and unpleasantness of each stimulus on a visual analog scale (VAS). Pain-related evoked potentials were recorded with a 64-channel EEG. Preliminary results show a reduced placebo effect in older compared to younger adults in both behavioral and neurophysiological data. Older people experienced less subjective pain reduction under sham TENS treatment compared to younger adults, as evidenced by the VAS ratings. The N1 and P2 event-related potential components were generally reduced in the older group. While younger adults showed a reduced N1 and P2 under sham TENS treatment, this reduction was considerably smaller in older people. This reduced placebo effect in the older group suggests that cognitive pain modulation is altered in aging and may at least partly explain why older adults experience more pain. Our results highlight the need for a better understanding of the efficacy of non-pharmacological pain treatments in older adults and how these can be optimized to meet the specific requirements of this population.

Keywords: placebo analgesia, aging, acute pain, TENS, EEG

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Authors: Blair Arthur Agero Jr., Lucia Garcia Heras

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The triangular fibrocartilage complex (TFCC) is one of the crucial stabilizing ligaments of the wrist. The TFCC is also subject to excessive stress amongst performance athletes and enthusiasts. The excessive loading of the TFCC may lead to a partial or complete rupture that requires surgery. The recovery from an open TFCC surgical repair may take several months. Immobilization of the repaired wrist for a given period is part of all the current protocols in the post-surgical treatment. The immobilization to prevent the rotation of the forearm can last from six weeks to eight weeks with the wrist held in a neutral position. In all protocols reviewed, the pronosupination is only initiated between the 6th week and 8th week or even later after the cast is removed. The prolonged immobilization can cause stiffness of the wrist and hand. Furthermore, the entire period of post-surgical hand therapy has its economic impact, especially for performing athletes. However, delayed mobilization, specifically rotation of the wrist, is necessary to allow ligament healing. This study aims to report the effects of early mobilization of the wrist in athletes who had an open surgical repair of the TFCC. The surgery was done by the co-author, and the hand therapy was implemented by the main author. The cases documented spans from 2014 to 2019 and were all performed in Dubai, United Arab Emirates. All selected participants in this case study were provided with a follow-up questionnaire to ascertain their current condition since their surgery. The respondents reported high satisfaction in the results of their treatment and have verified zero re-rupture of their TFCC despite mobilizing and rotating the wrist at the third-week post-surgery during their hand therapy. There is also a negligible number of respondents who reported a limitation in their ranges of pronosupination. This case study suggests that early mobilization of the wrist after an open TFCC surgical repair can be more beneficial to the patient as opposed to the traditional treatment of prolonged immobilization. However, it should be considered that the patients selected in this case study are professional performance athletes and advanced fitness enthusiasts. Athletes are known to withstand vigorous physical stress in their training that may correlate to their ability to better cope with the progressive stress that was implemented during their hand therapy. Nevertheless, this approach has its merits, and application of it may be adjusted for patients with a similar injury and surgical procedure.

Keywords: hand therapy, performance athlete, TFCC repair, wrist ligament

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Authors: Samar Mousa, Ryan Kerstein, Mohanad Adam

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Regional anaesthesia has been associated with favourable outcomes in patients undergoing a wide range of surgeries. Beneficial effects have been demonstrated in terms of postoperative respiratory and cardiovascular endpoints, 7-day survival, time to ambulation and hospital discharge, and postoperative analgesia. Our project aimed at assessing the regional anaesthesia practice in the plastic surgery department of Buckinghamshire trust and finding out ways to improve the service in collaboration with the anaesthesia team. It is a retrospective study associated with a questionnaire filled out by plastic surgeons and anaesthetists to get the full picture behind the numbers. The study period was between 1/3/2022 and 23/5/2022 (12 weeks). The operative notes of all patients who had an operation under plastic surgery, whether emergency or elective, were reviewed. The criteria of suitable candidates for the regional block were put by the consultant anaesthetists as follows: age above 16, single surgical site (arm, forearm, leg, foot), no drug allergy, no pre-existing neuropathy, no bleeding disorders, not on ant-coagulation, no infection to the site of the block. For 12 weeks, 1061 operations were performed by plastic surgeons. Local cases were excluded leaving 319 cases. Of the 319, 102 patients were suitable candidates for regional block after applying the previously mentioned criteria. However, only seven patients had their operations under the regional block, and the rest had general anaesthesia that could have been easily avoided. An online questionnaire was filled out by both plastic surgeons and anaesthetists of different training levels to find out the reasons behind the obvious preference for general over regional anaesthesia, even if this was against the patients’ interest. The questionnaire included the following points: training level, time taken to give GA or RA, factors that influence the decision, percentage of RA candidates that had GA, reasons behind this percentage, recommendations. Forty-four clinicians filled out the questionnaire, among which were 23 plastic surgeons and 21 anaesthetists. As regards the training level, there were 21 consultants, 4 associate specialists, 9 registrars, and 10 senior house officers. The actual percentage of patients who were good candidates for RA but had GA instead is 93%. The replies estimated this percentage as between 10-30%. 29% of the respondents thought that this percentage is because of surgeons’ preference to have GA rather than RA for their operations without medical support for the decision. 37% of the replies thought that anaesthetists prefer giving GA even if the patient is a suitable candidate for RA. 22.6% of the replies thought that patients refused to have RA, and 11.3% had other causes. The recommendations were in 5 main accesses, which are protocols and pathways for regional blocks, more training opportunities for anaesthetists on regional blocks, providing a separate block room in the hospital, better communication between surgeons and anaesthetists, patient education about the benefits of regional blocks.

Keywords: regional anaesthesia, regional block, plastic surgery, general anaesthesia

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Authors: Alice Carter, Lucy Dumbell, Lorna Cameron, Victoria Lewis

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The Olympic discipline of eventing is the triathlon of equestrian sport, consisting of dressage, cross-country and show jumping. Falls on the cross-country are common and can be serious even causing death to rider. Research identifies an increased risk of a fall with an increasing number of obstacles and for jumping efforts later in the course suggesting fatigue maybe a contributing factor. Advice based on anecdotal evidence suggests riders undertake strength and conditioning programs to improve their ‘core’, thus improving their ability to maintain and control their riding position. There is little empirical evidence to support this advice. Therefore, the aim of this study is to investigate truck muscle fatigue and cognitive function during a simulated jumping test. Eight adult riders participated in a riding test on a Racewood Event simulator for 10 minutes, over a continuous jumping programme. The SEMG activity of six trunk muscles were bilaterally measured at every minute, and normalised root mean squares (RMS) and median frequencies (MDF) were computed from the EMG power spectra. Visual analogue scales (VAS) measuring Fatigue and Pain levels and Cognitive Function ‘tapping’ tests were performed before and after the riding test. Average MDF values for all muscles differed significantly between each sampled minute (p = 0.017), however a consistent decrease from Minute 1 and Minute 9 was not found, suggesting the trunk muscles fatigued and then recovered as other muscle groups important in maintaining the riding position during dynamic movement compensated. Differences between the MDF and RMS of different muscles were highly significant (H=213.01, DF=5, p < 0.001), supporting previous anecdotal evidence that different trunk muscles carry out different roles of posture maintenance during riding. RMS values were not significantly different between the sampled minutes or between riders, suggesting the riding test produced a consistent and repeatable effect on the trunk muscles. MDF values differed significantly between riders (H=50.8, DF = 5, p < 0.001), suggesting individuals may experience localised muscular fatigue of the same test differently, and that other parameters of physical fitness should be investigated to provide conclusions. Lumbar muscles were shown to be important in maintaining the position, therefore physical training program should focus on these areas. No significant differences were found between pre- and post-riding test VAS Pain and Fatigue scores or cognitive function test scores, suggesting the riding test was not significantly fatiguing for participants. However, a near significant correlation was found between time of riding test and VAS Pain score (p = 0.06), suggesting somatic pain may be a limiting factor to performance. No other correlations were found between the factors of participant riding test time, VAS Pain and Fatigue, however a larger sample needs to be tested to improve statistical analysis. The findings suggest the simulator riding test was not sufficient to provoke fatigue in the riders, however foundations for future studies have been laid to enable methodologies in realistic eventing settings.

Keywords: eventing, fatigue, horse-rider, surface EMG, trunk muscles

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Authors: Mylena McCoggle, Shyra Wilson, Andrea Rivera, Rocio Alba-Flores

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This work introduces the use of EMGs (electromyography) from muscle sensors to develop an Artificial Neural Network (ANN) for pattern recognition to control a small unmanned aerial vehicle. The objective of this endeavor exhibits interfacing drone applications beyond manual control directly. MyoWare Muscle sensor contains three EMG electrodes (dual and single type) used to collect signals from the posterior (extensor) and anterior (flexor) forearm and the bicep. Collection of raw voltages from each sensor were connected to an Arduino Uno and a data processing algorithm was developed with the purpose of interpreting the voltage signals given when performing flexing, resting, and motion of the arm. Each sensor collected eight values over a two-second period for the duration of one minute, per assessment. During each two-second interval, the movements were alternating between a resting reference class and an active motion class, resulting in controlling the motion of the drone with left and right movements. This paper further investigated adding up to three sensors to differentiate between hand gestures to control the principal motions of the drone (left, right, up, and land). The hand gestures chosen to execute these movements were: a resting position, a thumbs up, a hand swipe right motion, and a flexing position. The MATLAB software was utilized to collect, process, and analyze the signals from the sensors. The protocol (machine learning tool) was used to classify the hand gestures. To generate the input vector to the ANN, the mean, root means squared, and standard deviation was processed for every two-second interval of the hand gestures. The neuromuscular information was then trained using an artificial neural network with one hidden layer of 10 neurons to categorize the four targets, one for each hand gesture. Once the machine learning training was completed, the resulting network interpreted the processed inputs and returned the probabilities of each class. Based on the resultant probability of the application process, once an output was greater or equal to 80% of matching a specific target class, the drone would perform the motion expected. Afterward, each movement was sent from the computer to the drone through a Wi-Fi network connection. These procedures have been successfully tested and integrated into trial flights, where the drone has responded successfully in real-time to predefined command inputs with the machine learning algorithm through the MyoWare sensor interface. The full paper will describe in detail the database of the hand gestures, the details of the ANN architecture, and confusion matrices results.

Keywords: artificial neural network, biosensors, electromyography, machine learning, MyoWare muscle sensors, Arduino

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Authors: Ankita Baidya, Vanishri Ganakumar, Ranveer S. Jadon, Piyush Ranjan, Rita Sood

Abstract:

Septic embolism can have varied presentations and clinical considerations. Infected central venous catheters are commonly associated with septic emboli but peripheral vascular catheters are rarely implicated. We describe a rare case of septic pulmonary emboli related to infected peripheral venous cannulation caused by an unusual etiological agent. A young male presented with complaints of fever, productive cough, sudden onset shortness of breath and cellulitis in both the upper limbs. He was recently hospitalised for dengue fever and administered intravenous fluids through peripheral venous line. The patient was febrile, tachypneic and in respiratory distress, there were multiple pus filled bullae in left hand alongwith swelling and erythema involving right forearm that started at the site of cannulation. Chest examination showed active accessory muscles of respiration, stony dull percussion at the base of right lung and decreased breath sounds at right infrascapular, infraaxillary and mammary area. Other system examination was within normal limits. Chest X-ray revealed bilateral multiple patchy heterogenous peripheral opacities and infiltrates with right-sided pleural effusion. Contrast-enhanced computed tomography (CECT) chest showed feeding vessel sign confirming the diagnosis as septic emboli. Venous Doppler and 2D-echocardiogarm were normal. Laboratory findings showed marked leucocytosis (22000/mm3). Pus aspirate, blood sample, and sputum sample were sent for microbiological testing. The patient was started empirically on ceftriaxone, vancomycin, and clindamycin. The Pus culture and sputum culture showed Klebsiella pneumoniae sensitive to cefoperazone-sulbactum, piperacillin-tazobactum, meropenem and amikacin. The antibiotics were modified accordingly to antimicrobial sensitivity profile to Cefoperazone-sulbactum. Bronchoalveolar lavage (BAL) was done and sent for microbiological investigations. BAL culture showed Klebsiella pneumoniae with same antimicrobial resistance profile. On day 6 of starting cefoperazone-sulbactum, he became afebrile. The skin lesions improved significantly. He was administered 2 weeks of cefoperazone–sulbactum and discharged on oral faropenem for 4 weeks. At the time of discharge, TLC was 11200/mm3 with marked radiological resolution of infection and healed skin lesions. He was kept in regular follow up. Chest X-ray and skin lesions showed complete resolution after 8 weeks. Till date, only couple of case reports of septic emboli through peripheral intravenous line have been reported in English literature. This case highlights that a simple procedure of peripheral intravenous cannulation can lead to catastrophic complication of septic pulmonary emboli and widespread cellulitis if not done with proper care and precautions. Also, the usual pathogens in such clinical settings are gram positive bacteria, but with the history of recent hospitalization, empirical therapy should also cover drug resistant gram negative microorganisms. It also emphasise the importance of appropriate healthcare practices to be taken care during all procedures.

Keywords: antibiotics, cannula, Klebsiella pneumoniae, septic emboli

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