Motion Abnormalities Research Articles

The Effect of Hip Offset and Spinopelvic Abnormalities on the Risk of Dislocation Following Total Hip Arthroplasty.

Previous studies have demonstrated that patients with abnormal spinopelvic motion are at increased risk of dislocation. However, little is known about the effect of hip offset on dislocation risk following total hip arthroplasty (THA) in patients with abnormal spinopelvic motion. The purpose of this study is to investigate the prevalence of under-restored hip offset and spinopelvic abnormalities in a series of THA patients treated for recurrent instability. This is a retrospective review of consecutive patients treated for hip instability following primary THA (THA+I) from 2012 to 2020. Patient demographics, surgical variables, and radiographic parameters were recorded. THA+I patients were compared to an age-matched and gender-matched control THA population without hip instability (THA). Univariate analyses were performed to compare differences between groups. Thirty-three THA+I patients (44 hips) were compared to 44 THA patients (44 hips). THA+I patients had a higher prevalence of spinopelvic pathology (odds ratio [OR] 7.80, 95% confidence interval [CI] 2.59-23.50, P < .001). The majority of acetabular components were placed within the Lewinnek safe zone (86.4% THA+I vs 72.7% THA; P= .119). THA+I patients were at greater risk of markedly under-restored hip offset (Δoffset ≤ 3 mm; OR 6.34, 95% CI 2.20-18.30, P= .001) and small (<32 mm) femoral head diameter (OR 4.38, 95% CI 1.53-12.53, P= .006) compared to THA patients. Lumbar degenerative disease and under-restoration of hip offset were present in a high proportion of patients with hip instability. Although multiple factors may contribute to THA instability, these data suggest that restoration of offset is essential, particularly in patients with spinopelvic pathology, and may be more important than historically described acetabular targets. Level III.

Modular dual-mobility articulations in patients with adverse spinopelvic mobility

Aims Adverse spinal motion or balance (spine mobility) and adverse pelvic mobility, in combination, are often referred to as adverse spinopelvic mobility (SPM). A stiff lumbar spine, large posterior standing pelvic tilt, and severe sagittal spinal deformity have been identified as risk factors for increased hip instability. Adverse SPM can create functional malposition of the acetabular components and hence is an instability risk. Adverse pelvic mobility is often, but not always, associated with abnormal spinal motion parameters. Dislocation rates for dual-mobility articulations (DMAs) have been reported to be between 0% and 1.1%. The aim of this study was to determine the early survivorship from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) of patients with adverse SPM who received a DMA. Methods A multicentre study was performed using data from 227 patients undergoing primary total hip arthroplasty (THA), enrolled consecutively. All the patients who had one or more adverse spine or pelvic mobility parameter had a DMA inserted at the time of their surgery. The mean age was 76 years (22 to 93) and 63% were female (n = 145). At a mean of 14 months (5 to 31) postoperatively, the AOANJRR was analyzed for follow-up information. Reasons for revision and types of revision were identified. Results The AOANJRR reported two revisions: one due to infection, and the second due to femoral component loosening. No revisions for dislocation were reported. One patient died with the prosthesis in situ. Kaplan-Meier survival rate was 99.1% (95% confidence interval 98.3 to 100) at 14 months (number at risk 104). Conclusion In our cohort of patients undergoing primary THA with one or more factor associated with adverse SPM, DM bearings conferred stability at two years’ follow-up. Cite this article: Bone Joint J 2022;104-B(7):820–825.

Correlation of resting scapular position and functional throwing performance index among amateur basketball players

Background: Scapular dyskinesis is prevalent in 54.5% of overhead athletes. Scapular dyskinesis is abnormal positioning of the scapula over the thorax and also abnormal motions of the scapula. Any alterations to the normal scapular position may alter the accuracy of striking and serving in basketball players. This study aims to find out the relation between the resting scapular position and the throwing accuracy of players. Results: The research suggests that there is a moderate correlation present between the resting scapular position and the throwing accuracy of the players. Conclusion: In this study, results state that the resting position of the scapula plays an important role in power generation and biomechanics of throwing in overhead athletes affecting the throwing accuracy of players.

Preoperative evaluation of pleural adhesions with dynamic chest radiography: a retrospective study of 146 patients with lung cancer

To assess the utility of dynamic chest radiography (DCR) during the preoperative evaluation of pleural adhesions. Sequential chest radiographs of 146 patients with lung cancer were acquired during forced respiration using a DCR system. The presence of pleural adhesions and their grades were determined by retrospective surgery video assessment (absent: 121, present: 25). The maximum inspiration to expiration lung area ratio was used as an index for air intake volume. A ratio of ≥0.65 was regarded as insufficient respiration. Two radiologists assessed the images for pleural adhesions based on motion findings. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared for each adhesion grade and patient group (patients with sufficient/insufficient respiration). Pearson's chi-squared test compared the group. Statistical significance was set at p<0.05. DCR correctly identified 22/25 patients with pleural adhesions, with 20 false-positive results (sensitivity, 88%; specificity, 83.5%; PPV, 52.4%; NPV, 97.12%). Although the diagnostic performances for the various adhesion grades were similar, specificity in patients with sufficient respiration increased to 93.9% (31/33), identifying all cases except for those with loose adhesions. DCR images revealed restricted and/or distorted motions in lung structures and structural tension in patients with pleural adhesions. DCR could be a useful technique for routine preoperative evaluation of pleural adhesions. Further development of computerised methods can assist in the quantitative assessment of abnormal motion findings.

Dynamic Standing Exercise using the Innowalk Device in Patients with Genetic and Acquired Motor Impairments.

For individuals with motor impairments, dynamic standing has been proposed as an opportunity for regular daily physical activity. The aim of this study was to analyse patient characteristics, indications, intensity of usage, desired objectives and outcomes of dynamic standing in daily clinical practice in order to form the basis for research regarding this treatment option. Data were analysed from standardized questionnaires completed prospectively before supply of a home-based medical device for dynamic standing (Innowalk; Made for Movement GmbH, Langenhagen, Germany) and at the time of individual adaptations. In a retrospective chart analysis, records of 46 patients (50% cerebral palsy; 50% diverse syndromes) were evaluated. The Innowalk had been prescribed for either home-based use (n = 31), in therapeutic institutions (n = 8), or other settings (n = 7). Dynamic standing was performed for 10-30 min as a single session (n = 8) or for 20-60 min 11 [4-21] weeks in 36 patients. Improvements were found for: passive assisted motion (79%), stimulation of intestinal functions (71%), body stability (64%), joint mobility (56%), secure means of allowing supine position (52%), and revision of abnormal motion patterns (48%). Thus, this systematic approach shows usage patterns, indications, desired goals and clinical outcome of dynamic standing in daily clinical practice and forms the basis for the design of a prospective, randomized controlled trial.

Smart Phone-Based Motion Capture and Analysis: Importance of Operating Envelope Definition and Application to Clinical Use

Human movement is vital for life, with active engagement affording function, limiting disease, and improving quality; with loss resulting in disability; and the treatment and training leading to restoration and enhancement. To foster these endeavors a need exists for a simple and reliable method for the quantitation of movement, favorable for widespread user availability. We developed a Mobile Motion Capture system (MO2CA) employing a smart-phone and colored markers (2, 5, 10 mm) and here define its operating envelope in terms of: (1) the functional distance of marker detection (range), (2) the inter-target resolution and discrimination, (3) the mobile target detection, and (4) the impact of ambient illumination intensity. MO2CA was able to detect and discriminate: (1) single targets over a range of 1 to 18 ft, (2) multiple targets from 1 ft to 11 ft, with inter-target discrimination improving with an increasing target size, (3) moving targets, with minimal errors from 2 ft to 8 ft, and (4) targets within 1 to 18 ft, with an illumination of 100–300 lux. We then evaluated the utility of motion capture in quantitating regional-finger abduction/adduction and whole body–lateral flex motion, demonstrating a quantitative discrimination between normal and abnormal motion. Overall, our results demonstrate that MO2CA has a wide operating envelope with utility for the detection of human movements large and small, encompassing the whole body, body region, and extremity and digit movements. The definition of the effective operating envelope and utility of smart phone-based motion capture as described herein will afford accuracy and appropriate use for future application studies and serve as a general approach for defining the operational bounds of future video capture technologies that arise for potential clinical use.

The Value of Mitral valve E point septal separation as an index of assessment of left ventricular systolic function

Background and objectives: There are several methods of assessment of left ventricular function utilizing M-mode echocardiography, the most popular one being geometrically derived ejection fraction, for which its validity is compromised in case of abnormal geometry or regional wall motion abnormalities. Mitral valve E septal separation estimated by M mode echocardiography or cardiac magnetic resonance imaging can be used as an index of left ventricular systolic function assessment. The aim of this study is to assess the value of mitral valve E septal separation estimated by M mode echocardiography in evaluation of left ventricular systolic function in patients assessed in two hospitals in Erbil city. Methods: from March 2016 to May 2019, 564 patients were randomly selected in Rizgary and Erbil teaching hospitals were included in this study. For all cases; demographic data were recorded, echocardiography performed by cardiologists, ejection fraction estimated by the most appropriate method and mitral valve E septal separation estimated by M mode scanning. Results: Means of age, ejection fraction, mitral valve E septal separation were 52.4±14.8, 65.4±10.4% and 3.87±4.1 respectively. Male to female ratio was 0.64 (220/344). There was strong highly significant negative correlation between ejection fraction and E septal separation, value of 6.9 mm was the upper normal level representing ejection fraction of 55%. The sensitivity and specificity of mitral valve E septal separation more than 7 mm as a reference to low left ventricular systolic function were 100% and 99%. Conclusions: Mitral valve E septal separation is reliable and easily measurable index of assessment of left ventricular systolic function; value more than 7 mm is indicating abnormal systolic function with sensitivity of 100% and specificity of 99%.

Abnormal behavior detection of stationary objects in surveillance videos with visualization and classification

SUMMARYAnomaly detection in video systems has been popular over several years. It is still challenging to detect anomalies in a static object. To manage this objective, we focus on changes in the position of a stationary object in videos. In a normal scenario, the pixel values of the static object are fixed while in abnormal motion the fixed values change. We introduce a new concept to determine anomalies based on manual annotations in each video frame, only over a part of a static object in a frame such that it can be taken as a reference for the whole. Through color channel splitting we determine mask image, from which handcrafted features such as scratch area, perimeter, equivalent diameter and density are calculated. In the next step, we analyze frame‐wise changes in feature values using a linear regression model, feature values are constant when the object remains stationary while there is a rise or fall in values when an object changes location. We classify feature values through anomaly scores and thresholds. In this model, we are evaluating our proposed framework on 12 real‐time video datasets. Results are compared with existing techniques which are outperforming in terms of accuracy, mean square error and area under the curve.

Relevance of Scapulothoracic joint assessment for unknown shoulder pain

The scapulothoracic joint (STJ) is one of the four joints forming the shoulder complex with the glenohumeral, acromioclavicular, and sternoclavicular. Abnormal motion of the scapula during shoulder movement is defined as scapular dyskinesia a distinct entity in the orthopedic literature as a source of posterior shoulder pain. Several acute and chronic conditions affecting one or more of the joints of the shoulder complex can result in disorders of the scapular motion. This article aims to provide a comprehensive review of the anatomy and function of the STJ, to describe the MRI features of the internal derangements of this articulation including scapulothoracic bursitis (or snapping scapula syndrome), elastofibroma dorsi, and other tumor and tumor-like lesions.

Tracking Early Systolic Motion for Assessing Acute Response to Cardiac Resynchronization Therapy in Real Time.

An abnormal systolic motion is frequently observed in patients with left bundle branch block (LBBB), and it has been proposed as a predictor of response to cardiac resynchronization therapy (CRT). Our goal was to investigate if this motion can be monitored with miniaturized sensors feasible for clinical use to identify response to CRT in real time. Motion sensors were attached to the septum and the left ventricular (LV) lateral wall of eighteen anesthetized dogs. Recordings were performed during baseline, after induction of LBBB, and during biventricular pacing. The abnormal contraction pattern in LBBB was quantified by the septal flash index (SFI) equal to the early systolic shortening of the LV septal-to-lateral wall diameter divided by the maximum shortening achieved during ejection. In baseline, with normal electrical activation, there was limited early-systolic shortening and SFI was low (9 ± 8%). After induction of LBBB, this shortening and the SFI significantly increased (88 ± 34%, p < 0.001). Subsequently, CRT reduced it approximately back to baseline values (13 ± 13%, p < 0.001 vs. LBBB). The study showed the feasibility of using miniaturized sensors for continuous monitoring of the abnormal systolic motion of the LV in LBBB and how such sensors can be used to assess response to pacing in real time to guide CRT implantation.

Outcome of arthroscopic pectoralis minor release and scapulopexy for the management of scapulothoracic abnormal motion.

Management of persistent symptomatic scapulothoracic abnormal motion (STAM) in the absence of periscapular muscle paralysis may be challenging. This study reports the outcomes of arthroscopic pectoralis minor release and scapulopexy for the management of symptomatic STAM secondary to pectoralis minor hyperactivity and serratus anterior hypoactivity in the absence of periscapular paralysis. This was a retrospective cohort study with prospectively collected data of patients with symptomatic STAM secondary to pectoralis minor hyperactivity and serratus anterior hypoactivity. Surgery was indicated if patients failed 6 months of conservative management. Patient outcomes were assessed with shoulder range of motion (ROM) measurements, numerical pain scale, shoulder subjective value (SSV), and Constant score. Data were analyzed with Fischer's exact test for categorical variables and Student's t-test of unequal variance for continuous and categorical variables. Thirty-one consecutive patients were included in the study period between 2017 and 2020. Average age at the time of surgery was 24 years (range, 14-44 years), 80% of patients were female, and average follow-up after surgery was 23 months (range, 15-39 months). Thirteen patients also had a diagnosis of recurrent posterior instability. At final follow-up, 81% reported significant improvements in their STAM, as demonstrated by improved mean pain scale, ROM, SSV, and Constant scores. Pain improved from 6 (range, 4-10) to 2 (range, 1-4), SSV from 30% (range, 10%-40%) to 75% (range, 60%-100%), and Constant score from 49 (range, 43-61) preoperatively to 79 (range, 51-100) postoperatively (P < .01). All 13 patients with recurrent associated posterior instability had resolution of their instability. Flexion ROM improved from average 100° (range, 60°-150°) to 140° (range, 120°-160°). One patient had traumatic rupture of her scapulopexy 7 weeks postoperatively and underwent revision scapulopexy. Thirteen percent had minimal improvement after surgery and experienced recurrence 3 months postoperatively. In patients with symptomatic STAM secondary to pectoralis minor hyperactivity and serratus anterior hypoactivity, arthroscopic pectoralis minor release and scapulopexy is an effective surgical option.

A Case Report of Constrictive Pericarditis: Step by Step Surgical Treatment of the Disease, Complications and Long-Term Outcomes

Constrictive pericarditis (CP) is a chronic inflammation often characterized by chronic fibrosis, scaring, pericardial calcification, and associated with diastolic dysfunction, decreased cardiac output, and chronic heart failure. Early diagnosis of constrictive pericarditis is difficult due to absence of typical cardiopulmonary signs. In this case report, we present, a 20-years-old male. His initial disease and complains began with an increased size of the abdomen. Ultrasound showed a severe ascites with unknown cause for a long time. Only after a chest computed tomography and echocardiography was diagnosed constrictive pericarditis. Echocardiography confirmed the diagnosis of constrictive pericarditis, pericardial thickening and hyperechogenicity with abnormal myocardial wall motion, severe tricuspid valve insufficiency and moderate mitral valve insufficiency.MRI findings: irregular pericardial thickening with a maximum thickness of 4mm mostly effecting the right ventricle. Considering liver failure and, as a consequence, the presence of coagulopathy, it was decided to perform pericardectomy without the use of a heart-lung machine and without correction of valvular pathology. After the intervention, the patient retained severe tricuspid valve insufficiency and moderate mitral valve insufficiency, while the functional parameters of the liver progressively improved. Considering the unfavorable prognosis of the patient with tricuspid valve failure 3 weeks after pericardectomy, it was decided to perform mitral and tricuspid valve repair with the use of heart-lung machine, which was successfully done. The patient was discharged in satisfactory condition. At out-patient visit 42 days after the last surgical procedure the patient showed improvement of symptoms, normal sinus rhythm at examination, echocardiography found no signs of mitral valve failure and a minor residual tricuspid valve failure. Liver tests returned to normal on the 10-15th day.

Serratus anterior dysfunction examination: wall push-up or shoulder flexion resistance test?

BackgroundWall push-up is the most common examination used for the diagnosis of scapular winging secondary to serratus anterior dysfunction. The wall push-up test (WPUT) however may not be able to differentiate causes of scapulothoracic abnormal motion (STAM) or winging. We introduce a novel physical examination maneuver, the shoulder flexion resistance test (SFRT), and we propose that this test is more specific and accurate in determining serratus anterior dysfunction as the cause of STAM.MethodsFifty patients with STAM are included in this study. All patients underwent clinical scapular examination using both WPUT and SFRT. The SFRT is performed by resisting shoulder flexion while the elbow is fully extended at 30°, 60°, and 100°. All patients additionally received preoperative electromyography. All patients underwent exploration and intraoperative stimulation of the distal serratus anterior to characterize color, thickness, and contractility at the time of their arthroscopic pectoralis minor release and scapulopexy or tendon transfer if the serratus was paralyzed. The preoperative clinical examination findings were then correlated with intraoperative findings.ResultsAbnormal distal serratus anterior was seen intraoperatively in 5/50 patients (10%) with marked alterations in color, thickness, and contractility. All (n = 50) patients had positive WPUT manifested by increased winging of the scapula off the chest wall (STAM) with 45 false positive tests. The WPUT was 100% (95% confidence interval [CI] 47.82%-100%) sensitive but 0% (95% CI 0%-7.87%) specific for lower serratus anterior deficiency. The SFRT was 100% sensitive (95% CI 47.82%-100%) and 100% specific (95% CI 92.13%-100%) for serratus anterior dysfunction as the cause of STAM. Using area under the curve (AUC) of receiver operating characteristic (ROC) curves for WPUT and SFRT tests, WPUT had clinically insignificant accuracy (AUC 0.5) compared to the excellent accuracy (AUC 1.0) of SFRT.ConclusionSFRT is specific and accurate in determining serratus anterior dysfunction as a cause of STAM. Based on this study, the SFRT should replace the WPUT as the physical exam of choice to determine dysfunction of the serratus anterior muscle and guide operative management of STAM.

Reinforcement learning coupled with finite element modeling for facial motion learning

Background and ObjectiveFacial palsy patients or patients with facial transplantation have abnormal facial motion due to altered facial muscle functions and nerve damage. Computer-aided system and physics-based models have been developed to provide objective and quantitative information. However, the predictive capacity of these solutions is still limited to explore the facial motion patterns with emerging properties. The present study aims to couple the reinforcement learning and the finite element modeling for facial motion learning and prediction. MethodsA novel modeling workflow for learning facial motion was developed. A physically-based model of the face within the Artisynth modeling platform was used. Information exchange protocol was proposed to link reinforcement learning and rigid multi-bodies dynamics outcomes. Two reinforcement learning algorithms (deep deterministic policy gradient (DDPG) and Twin-delayed DDPG (TD3)) were used and implemented to drive the simulations of symmetry-oriented and smile movements. Numerical outcomes were compared to experimental observations (Bosphorus database) for evaluation and validation purposes. ResultsAs result, after more than 100 episodes of exploring the environment, the agent starts to learn from previous trials and can find the optimal policy after more than 300 episodes of training. Regarding the symmetry-oriented motion, the muscle excitations predicted by the trained agent help to increase the value of reward from R = -2.06 to R = -0.23, which counts for ∼89% improvement of the symmetry value of the face. For smile-oriented motion, two points at the edge of the mouth move up 0.35 cm, which is within the range of movements estimated from the Bosphorus database (0.4 ± 0.32 cm). ConclusionsThe present study explored the muscle excitation patterns by coupling reinforcement learning with a detailed finite element model of the face. We developed, for the first time, a novel coupling scheme to integrate the finite element simulation into the reinforcement learning process for facial motion learning. As perspectives, this present workflow will be applied for facial palsy and facial transplantation patients to guide and optimize the functional rehabilitation program.

A novel use of cone beam CT: flexion and extension weight-bearing imaging to assess spinal stability

To assess spinal stability in different physiological positions whilst weight-bearing. A cone beam CT scanner (CBCT) was used to identify any abnormal motion in the spine in different physiological positions whilst weight-bearing. The lumbar spine was assessed in 6 different patients with a comfortable neutral standing position and standing flexion and extension images in selected patients. Seated, weight-bearing flexion and extension images of the cervical spine were obtained in a further patient. Clinical indications included stability assessment post-trauma, post-surgical fusion and back pain. The projection images were reconstructed using bone and soft tissue algorithms to give isotropic CT images which could be viewed as per conventional multi-detector CT images. The flexion and extension CBCT data were fused to give a representation of any spinal movement between the extremes of motion. The flexion and extension weight-bearing images gave anatomical detail of the spine. Detail of the surgical constructs was possible. Dynamic structural information about spinal alignment, facet joints, exit foramina and paraspinal musculature was possible. The effective dose from the neutral position was equal to that of supine, multi-detector CT. CBCT can be used to image the lumbar and cervical spine in physiological weight-bearing positions and at different extremes of spinal motion. This novel application of an existing technology can be used to aid surgical decision making to assess spinal stability and to investigate occult back and leg pain. Its use should be limited to specific clinical indications, given the relatively high radiation dose.

P377 CHALLENGING RISK STRATIFICATION IN BRUGADA SYNDROME: A CASE OF VENTRICULAR TACHYCARDIA IN A LOW–RISK PATIENT

Abstract A 22–year–old healthy athlete was referred to our hospital for electrocardiographic findings consistent with intermittent type–1 Brugada pattern. A routine electrocardiogram (ECG) performed during a check–up showed sinus rhythm, normal PR interval and QRS duration, rSR’ with a coved type ST–segment elevation in V2 lead (Figure 1).The patients denied history of syncope or palpitations and his family history did not show sudden cardiac death or Brugada syndrome (BrS). Transthoracic echocardiography was normal and a 12–lead Holter monitoring revealed the intermittence of the type–1 Brugada pattern. The patient was hospitalized for further investigation. On admission, ECG showed a type–2 Brugada pattern; therefore, Ajmaline challenge test (1 mg/kg injection in 10 minutes) was performed and resulted positive. Subsequently, the patient underwent an electrophysiological study (EPS) which was negative for induction of sustained arrhythmias. The protocol adopted consisted of double extrastimuli programmed electrical stimulation until refractoriness (drive 600/220 ms and 400/210 ms), at double sites (right ventricle apex and right ventricular outflow tract). Furthermore a genetic test was performed using next–generation sequencing, showing a heterozygous mutation in the SCN5A gene, encoding for sodium channel alpha subunit (variant c.5363delA), not previously described in the literature. Since the low arrhythmic risk, the patient was implanted with a loop recorder (ILR, Medtronic Reveal LINQ), entering a program of home monitoring. After a 15–months follow–up, an episode of ventricular polymorphic tachycardia lasting 2 minutes and 11 seconds, associated with lightheadedness and palpitations, was detected by the remote monitoring (Figure 2). The patient was therefore hospitalized. During the in–hospital stay a cardiac magnetic resonance was performed to exclude other underlying diseases, identifying an enlarged right ventricle (EDVi 114 ml/m2) and abnormal free wall motion (Figure 3), thus reaching one major criteria of arrhythmogenic cardiomyopathy (however not sufficient for the diagnosis). The patient was then implanted with a subcutaneous implantable cardiac defibrillator (Boston Scientific EMBLEM MRI S–ICD). We presented a case of complex arrhythmic risk stratification in a possible overlap of an arrhythmogenic cardiomyopathy and a Brugada Syndrome in a young athlete who experienced a sustained ventricular tachycardia during loop–recorder monitoring.

Scapulothoracic Bursitis or the Snapping Scapula Syndrome May Mimic with Shoulder Pain

Background: The scapulothorasic joint plays an important role in overall shoulder function by providing a stable base for glenohumeral rotation. Snapping scapula syndrome, a likely under diagnosed condition, can produce significant shoulder dysfunction in many patients. Because the precise origin is difficult to understand, sometimes mimic with shoulder pain. Dysfunctioning of any of muscles, ligament, bursa may cause abnormal scapular motion and predispose to scapulothoracic joint disorders. Accurate recognition of the syndrome may lead to prompt and long-term relief of symptoms by conservative or noninvesiveintervension treatment.Results:The causes of scapulothoracic bursitis and crepitus include direct or indirect trauma, overuse syndromes, glenohumeral joint dysfunction, boney abnormalities, muscle microtrauma or atrophy or fibrosis, and idiopathic causes. Scapulothoracic bursitis and crepitus remain primarily clinical diagnoses. However, imaging studies or local injections may also be helpful. The initial treatment of scapulothoracic bursitis and scapulothoracic crepitus should be conservative. Intevension procedure is best for treating modalitis for scapulothoracic dysfunction, most reports have demonstrated well to excellent outcomes in a significantly high percentage of patients.Conclusions:Clearly, the best initial approach to these conditions is a conservative treatment like nonsteroidal antiinflammatory drugs plan that combines scapular strengthening, postural reeducation, and core strength endurance. If an appropriate trial of nonoperative management proves unsuccessful, local non invesiveintervension can produce good results.

The role of electrocardiographic findings in pulmonary embolism risk assessment

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The electrocardiogram (ECG) is helpful in patients (P) with pulmonary embolism (PE), but it is not present in the existing risk prediction tools, such as the Pulmonary Embolism Severity Index (PESI). Intermediate risk PE encompasses a heterogeneous group of P, with different prognoses, some of whom will need fibrinolytic treatment. This study aims to determine the prognostic impact of ECG in intermediate-risk PE. Methods All P admitted for intermediate-risk PE in an Intensive Cardiac Care Unit between 2007 and 2016 were included. P were followed up for two years for all-cause mortality. Clinical and analytical variables, ECG, echocardiographic, and computed tomography (CT), were collected. Statistical analysis used chi-square and Mann-Whitney U tests, binary logistic regressions, Kaplan-Meier curves, and Cox regression. Results This study included 209 P: mean age 63±18years; 38.5% male. T-wave inversion in leads V1-V3 was present in 81 (38.8%), S1Q3T3 pattern in 51 (24.4%), incomplete right bundle branch block (RBBB) in 27 (12.9%), and complete RBBB in 22 (10.5%). T-wave inversion in leads V1-V3 was associated with syncope at presentation (p=0.032); presence of echocardiographic right ventricle dilation (p=0.003) and abnormal interventricular septal (IVS) motion (p=0.001). S1Q3T3 pattern was associated with syncope (p=0.028); higher heart rate at admission (p=0.001); higher troponin (p=0.013) and BNP (p=0.010) levels; abnormal IVS motion (p=0.004); and increased CT-derived right-to-left ventricle diameter (RV/LV) ratio (p=0.014). RBBB were associated with syncope (p=0.020); higher troponin and BNP levels (p=0.001); and increased RV/LV ratio (p=0.029). For each increase in the number of these ECG findings, there was an increase in the odds of fibrinolytic treatment (OR 1.573, 95%CI 1.150-2.151, p=0.005), and the number of ECG findings was a predictor of fibrinolysis independently from PESI (OR 1.535, p=0.008). In survival analysis, T-wave inversion in leads V1-V3 was associated with decreased survival during follow-up (x2=4.398; p=0.036), even after adjustment for PESI (OR 0.322, p=0.041). Conclusions ECG findings of PE were associated with clinical, analytical and imagiological risk features. They were also predictors of fibrinolysis, and T-wave inversion in leads V1-V3 was associated with decreased survival after adjustment for PESI. Therefore, in the future, incorporation of ECG findings in risk scores might allow better risk assessment in intermediate-risk PE.

Strain Analysis in Patients at High-Risk for COPD Using Four-Dimensional Dynamic-Ventilation CT.

PurposeTo quantitatively identify abnormal lung motion in chronic obstructive pulmonary disease (COPD) using strain analysis, and further clarify the potential differences of deformation in COPD with different severity of airflow limitation.Materials and MethodsTotally, 53 patients at high-risk for COPD were enrolled in this study. All CT examinations were performed on a 320-row MDCT scanner, and strain measurement based on dynamic-ventilation CT data was performed with a computational fluid dynamics analysis software (Micro Vec V3.6.2). The strain-related parameters derived from the whole expiration phase (PSmax-all, PSmean-all, Speedmax-all), the first 2s of expiration phase (PSmax2s, PSmean2s, Speedmax2s) were divided respectively by the changes in lung volume to adjust for the degree of expiration. Spearman rank correlation analysis was used to evaluate associations between the strain-related parameters and various spirometric parameters. Comparisons of the strain-related parameters between COPD and non-COPD patients, between GOLD I (mild airflow restriction) and GOLD II–IV (moderate to severe airflow restriction) were made using the Mann–Whitney U-test. Receiver-operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance of the strain-related parameters for COPD. P <0.05 was considered statistically significant.ResultsStrain-related parameters demonstrated positive correlations with spirometric parameters (ρ=0.275~0.687, P<0.05), suggesting that heterogeneity in lung motion was related to abnormal spirometric results. Strain-related parameters can quantitatively distinguish COPD from non-COPD patients with moderate diagnostic significance with the AUC values ranged from 0.821 to 0.894. Furthermore, parameters of the whole expiration phase (PSmax-all, Speedmax-all) demonstrated significant differences (P=0.005; P=0.04) between COPD patients with mild and moderate to severe airflow limitation.ConclusionStrain-related parameters derived from dynamic-ventilation CT data covering the whole lung associated with lung function changes in COPD, reflecting the severity of airflow limitation in some degree, even though its utility in severe COPD patients remains to be investigated.

Forearm muscle activity estimation based on anatomical structure of muscles.

Estimation of muscle activity using surface electromyography (sEMG) is an important non-invasive method that can lead to a deeper understanding of motor-control strategies in humans. Measurement using multiple active electrodes is necessary to estimate not only surface muscle activity but also deep muscle activity in dynamic motion. In this paper, we propose a method for estimating muscle activity of dynamic motions based on anatomical knowledge of muscle structures. To estimate muscle activity, a large number of signal sources are set in the muscle model, and connections between the signal sources are defined a priori based on the anatomical structure of the muscles. The signal source activities are first estimated by minimizing the Kullback-Leibler divergence with a continuity cost. Then, the muscle activity is computed from the signal source activity. In the experiments, five healthy participants performed five types of motion and the forearm sEMG was measured with 20-channel active electrodes. The estimation results for these motions were visualized in four dimensions as the three-dimensional position of the muscle over time. The results showed that the estimation was accurate, with a reproduction rate of 95% for the measured sEMG and continuity of the muscle activity. In addition, the results suggest the advantage of the proposed method over the conventional approaches in terms of estimating the muscle activity for both dynamic and abnormal motions.