Standard Limb Research Articles

Assessing the impact of upper limb disability following stroke: a qualitative enquiry using internet-based personal accounts of stroke survivors

Purpose: Upper limb disability following stroke may have multiple effects on the individual. Existing assessment instruments tend to focus on impairment and function and may miss other changes that are personally important. This study aimed to identify personally significant impacts of upper limb disability following stroke. Methods: Accounts by stroke survivors, in the form of web-based diaries (blogs) and stories, were sought using a blog search engine and in stroke-related web-sites. Thematic analysis using the World Health Organisation’s International Classification of Functioning Disability and Health (ICF) was used to identify personal impacts of upper limb disability following stroke. Results: Ninety-nine sources from at least four countries were analysed. Many impacts were classifiable using the ICF, but a number of additional themes emerged, including emotional, cognitive and behavioural changes. Blogs and other web-based accounts were easily accessible and rich sources of data, although using them raised several methodological issues, including potential sample bias. Conclusions: A range of impacts was identified, some of which (such as use of information technology and alienation from the upper limb) are not addressed in current assessment instruments. They should be considered in post-stroke assessments. Blogs may help in the development of more comprehensive assessments.Implications for RehabilitationA comprehensive assessment of the upper limb following stroke should include the impact of upper limb problems on social participation, as well as associated emotional, cognitive and behavioural changes.Using personalised assessment instruments alongside standardised measures may help ensure that these broader domains are considered in discussions between clinicians and patients.Rehabilitation researchers should investigate whether and how these domains could be addressed and operationalised in standard upper limb assessment instruments.

Involvement of the Paraventricular Nucleus in the Occurrence of Arrhythmias in Middle Cerebral Artery Occlusion Rats

Ischemic stroke complicating with arrhythmia is one of the main causes of sudden death. To investigate the association between ischemic stroke-induced arrhythmia and the activity of paraventricular nucleus (PVN), we used Fos protein as an objective indicator to illustrate the functional state of PVN neurons in middle cerebral artery occlusion (MCAO) rats, in single intracerebroventricular injection of l-glutamate rats and in application of MK-801 before l-glutamate injection and MCAO rats. The standard limb II electrocardiography was continuously recorded by a biological signal collecting and processing system. The experimental cerebral ischemic animal model was established by occluding the right middle cerebral artery. The Fos protein expression was detected by immunohistochemistry and Western blot. The incidence of arrhythmia was significantly higher than that of controls (75.89% versus 0%), and Fos protein expression in the PVN also increased significantly in MCAO rats; both of them could be blocked by prior application ofMK-801. Intracerebroventricular injection of l-glutamate induced changes in Fos protein expression and arrhythmia similar to that in the stroke, which could also be blocked by prior application of MK-801. It was concluded that activation of the PVN in MCAO rats is likely mediated by glutamate via activation of N-methyl-D-aspartic acid (NMDA) receptors, which causes arrhythmias.

The role of mitochondrial ATP-sensitive potassium channels on cardiovascular effects of thiopental and ketamine in rats.

We aimed to investigate whether mitochondrial ATP-sensitive potassium (mitoKATP) channels play any role on cardiovascular effects of thiopental (TP) or ketamine (K) anesthesia in rats. mitoKATP channels are the end-effectors of cardioprotection induced by some anesthetics. TP and K are the most frequently used anesthetics with their own cardiovascular effects in experimental studies. To the best of our knowledge, there is no study investigating the cardiovascular effects of TP and K associated with mitoKATP channels. The experimental groups: TP control, K/Xylazine (X) control, TP+5-hydroxydecanoate (5-HD; mitoKATP channel blocker) and K/X+5-HD. Mean arterial blood pressure (MABP), heart rate (HR) and standard limb lead II ECG were recorded and arrhythmia parameters were evaluated. Blockage of mitoKATP channels by 5-HD increased MABP and decreased HR in the TP+5-HD and K/X+5-HD groups, respectively. 5-HD caused an increase in ventricular ectopic beat (VEB) incidence. Moreover, VEB incidence was significantly different in TP+5-HD (100%) than K/X+5-HDgroup (66.6%) and ventricular tachycardia was only seen in TP+5-HD (incidence was 88.3%). mitoKATP channels play different roles in influencing cardiovascular effects of K/X and TP anesthesia in rats. The differences in hemodynamic parameters and arrhythmia scores of these anesthetics should be considered when they are used in an experimental study associated with mitoKATP channels (Fig. 3, Ref. 35).

The Stagger-grid: A grid of 3D stellar atmosphere models

We compute the emergent stellar spectra from the UV to far infrared for different viewing angles using realistic 3D model atmospheres for a large range in stellar parameters to predict the stellar limb darkening. We have computed full 3D LTE synthetic spectra based on 3D radiative hydrodynamic atmosphere models from the Stagger-grid. From the resulting intensities at different wavelength, we derived coefficients for the standard limb darkening laws considering a number of often-used photometric filters. Furthermore, we calculated theoretical transit light curves, in order to quantify the differences between predictions by the widely used 1D model atmosphere and our 3D models. The 3D models are often found to predict steeper limb darkening compared to the 1D models, mainly due to the temperature stratifications and temperature gradients being different in the 3D models compared to those predicted with 1D models based on the mixing length theory description of convective energy transport. The resulting differences in the transit light curves are rather small; however, these can be significant for high-precision observations of extrasolar transits, and are able to lower the residuals from the fits with 1D limb darkening profiles. We advocate the use of the new limb darkening coefficients provided for the standard four-parameter non-linear power law, which can fit the limb darkening more accurately than other choices.

Detection of atrial fibrillation using contactless facial videoplethysmography

Background: Lead reversal and lead mismatch can simulate ECG abnormalities such as ectopic beats, intraventricular conduction disturbances, chamber enlargement or ventricular pre-excitation. Further simulation or concealing of myocardial ischemia or infarction might be seen on the ECG trace as well which might lead to thewrong decision of therapy. Lead reversal such as right arm (RA) and left arm (LA) usually can be detected by an experienced ECG reader or by computer algorithms. In such cases, a second ECG can be taken. Lead reversal has been reported to occur in 0.4–4% of all cases in standard 12-lead ECGs. Methods: We performed a retrospective analysis of 532 16-lead ECGs including standard 12-lead plus right precordial leads V3r and V4r as well as the posterior leads V8 and V9. The ECGs were acquired from chest pain patients at an emergency department. The ECG device did not give any feedback to the user with respect to lead reversal or lead mismatch at all before, during or after acquisition. A lead reversal detection module based on correlation analysis of 3 subsets within the acquired 16 ECG leads was investigated. The numbers of possible lead reversal in each subset were computed. Results: We found in 24 cases possible lead reversal in the standard limb leads (I, II, III, aVR, aVL, aVF), 40 in the standard chest leads (V1–V6) subset of the standard 12-lead, 99 in the subset of V3r and V4r and 43 in the V8 and V9 subset. Therefore, the amount of possible lead reversal found was 5%, 8%, 19% and 8% in the corresponding lead subset with the highest number in the right precordial leads V3r and V4r. Conclusions: Lead reversal might be much higher than estimated. Clinically accepted lead systems that are known and used since some time such as the standard 12-lead system give compared to the combinations of possible mistakes the lowest relative lead reversal number.

Detection performance of an automatic lead reversal detection module

Background: Lead reversal and lead mismatch can simulate ECG abnormalities such as ectopic beats, intraventricular conduction disturbances, chamber enlargement or ventricular pre-excitation. Further simulation or concealing of myocardial ischemia or infarction might be seen on the ECG trace as well which might lead to thewrong decision of therapy. Lead reversal such as right arm (RA) and left arm (LA) usually can be detected by an experienced ECG reader or by computer algorithms. In such cases, a second ECG can be taken. Lead reversal has been reported to occur in 0.4–4% of all cases in standard 12-lead ECGs. Methods: We performed a retrospective analysis of 532 16-lead ECGs including standard 12-lead plus right precordial leads V3r and V4r as well as the posterior leads V8 and V9. The ECGs were acquired from chest pain patients at an emergency department. The ECG device did not give any feedback to the user with respect to lead reversal or lead mismatch at all before, during or after acquisition. A lead reversal detection module based on correlation analysis of 3 subsets within the acquired 16 ECG leads was investigated. The numbers of possible lead reversal in each subset were computed. Results: We found in 24 cases possible lead reversal in the standard limb leads (I, II, III, aVR, aVL, aVF), 40 in the standard chest leads (V1–V6) subset of the standard 12-lead, 99 in the subset of V3r and V4r and 43 in the V8 and V9 subset. Therefore, the amount of possible lead reversal found was 5%, 8%, 19% and 8% in the corresponding lead subset with the highest number in the right precordial leads V3r and V4r. Conclusions: Lead reversal might be much higher than estimated. Clinically accepted lead systems that are known and used since some time such as the standard 12-lead system give compared to the combinations of possible mistakes the lowest relative lead reversal number.

Reference values of six-limb-lead electrocardiogram in conscious Labrador retriever dogs.

Breed-wise standard electrocardiographic values in dogs have been reported as there is variation in body and chest conformation, which limits the application of data of one breed for other breed. Labrador retrievers being originated from hunting dogs, their electrocardiogram (ECG) values might be different from standard normal range of other dog breeds. So, the purpose of the present study was to determine the standard ECG of Labrador retrievers and to check effect of body weight, gender and breed upon different ECG parameters. Six-lead ECGs, three bipolar standard limb leads (I, II and III) and three augmented unipolar limb leads (aVR, aVL and aVF), were taken from 24 Labrador retrievers positioned in right lateral recumbency without any chemical restraint. Amplitude and duration of P wave and QRS complex, PR interval, QT interval and mean electrical axis and heart rate were measured in each recording. Non-significant effect of gender and body weight was seen on all the ECG waves. Deep Q waves in Leads I, II and aVF and variation in relation to QRS pattern were noted. It was concluded that retrievers had a specific shape of QRS complex which must be considered when evaluating a patient suspected of having cardiac disease. However, amplitude and durations of different ECG waves in all the six leads were statistically not affected by gender or body weight.

Does the length of the biliary limb influence medium-term laboratory remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass in morbidly obese patients?

IntroductionThe Roux-en-Y gastric bypass (RYGB) is an effective treatment of morbid obesity leading to type 2 diabetes mellitus (T2DM) resolution. However, evidence demonstrates that standard limb lengths can have a limited impact on long-term weight loss and durable T2DM remission.AimThe authors evaluated the impact of biliary limb (BL) length on the T2DM laboratory markers in 2-year follow-up.Material and methodsThe data of 93 obese patients with T2DM who underwent RYGB between 2008 and 2010 were collected from prospectively designed database. The length of BL was standard in one group of 51 patients (S-BL: 50–75 cm) and longer in another group of 42 patients (L-BL: 100–150 cm). The laboratory parameters defining T2DM remission – fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) – were measured 3, 6, 12 and 24 months after surgery.ResultsThe average level of FPG and HbA1c remained non-diabetic 24 months after the RYGB in both groups. A statistical difference was not observed in direct FPG, HbA1c, ΔFPG and ΔHbA1c comparisons at any follow-up point. However, a significantly higher proportion of patients in L-BL than in S-BL reached the laboratory remission criteria without anti-diabetic medicaments. Additional analysis revealed a strong correlation between the measured T2DM parameters and length of the common limb (CL) in both groups.ConclusionsA longer BL can intensify the anti-diabetic effect of RYGB. The length of CL rather than BL influences the medium-term T2DM remission. Long-term observation is needed to fully assess whether introduced technical aspects of RYGB provide a durable effect of T2DM resolution.

Randomized Trial of a Robotic Assistive Device for the Upper Extremity During Early Inpatient Stroke Rehabilitation

Background. A recent Cochrane Review showed that early robotic training of the upper limb in stroke survivors can be more effective than other interventions when improving activities of daily living involving the arm function is the aim of therapy. Objective. We tested for efficacy of the study a protocol which involved the use of the NeReBot therapy in partial substitution of standard upper limb rehabilitation in post–acute stroke patients. Methods. In this dose-matched, randomized controlled clinical trial, 34 hemiparetic participants with movement against gravity in shoulder, elbow, and wrist muscle groups were enrolled within 15 days of the onset of stroke. All participants received a total daily rehabilitation treatment for 120 minutes, 5 days per week for 5 weeks. The control group received standard therapy for the upper limb. The experimental group received standard therapy (65% of exercise time) associated with robotic training (35% of exercise time). Muscle tone (Modified Ashworth Scale), strength (Medical Research Council), and synergism (Fugl-Meyer motor scores) were measured at impairment level, whereas dexterity (Box and Block Test and Frenchay Arm Test) and activities of daily living (Functional Independence Measure) were measured at activity level. All assessments were performed at baseline, at the end of therapy (time T1), at 3 months (time T2), and at 7 months (time T3) after entry. All between-group analyses were tested using nonparametric test with Bonferroni’s adjustments for multiple testing. Results. No significant between-group differences were found with respect to demographic characteristics, motor, dexterity, and ADLs at baseline, postintervention (T1) and at follow-up (T2 and T3). Conclusions. The robot therapy by NeReBot did not lead to better outcomes compared with conventional inpatient rehabilitation.

The normal electrocardiogram in the clinically healthy Saanen goats

The purpose of this study was to establish normal reference electrocardiographic (ECG) values for standard limb lead II in Saanen goats. For this, were used 19 healthy adult female Saanen goats. And for reference values for the ECG parameters, were used 95% confidence level. The overall P, Q, R, S and T durations (seconds) were 0.03±0.01, 0.02±0.005, 0.03±0.014, 0.03±0.011, 0.06±0.014 respectively, and the reference values were 0.01-0.04, 0.01-0.02, 0.01-0.06, 0.02-0.04 and 0.04-0.08 respectively. The amplitudes (milivolts) of these waveforms were 0.1±0.031, 0.06±0.023, 0.44±0.312, 0.39±0.434, 0.26±0.164 (T negative) and 0.15±0.071 (T positive), respectively. The reference values were 0.05-0.15, 0.05-0.1, 0.05-1.2, 0.05-1.1 and -0.2-0.7 respectively. The PR and QT interval, the QRS complex and the ST segment durations (seconds) were 0.08±0.018, 0.26±0.03, 0.05±0.008, 0.15±0.041 respectively. The reference values were 0.06-0.12, 0.2-0.32, 0.04-0.07 and 0.11-0.26, respectively. It was possible to observe differences in ECG of Saanen goats regarding the amplitude and duration of the constituents when compared to the results of other breeds. Therefore it is necessary to conduct further studies to allow comparisons, detect and diagnose cardiac arrhythmias and help the development of therapies.

IMPLEMENTATION OF MULTIPLE-CHANNEL CAPACITIVE ECG MEASUREMENT BASED ON CONDUCTIVE FABRIC

Capacitive electrocardiogram (cECG) measurement is an attractive approach for long-term health monitoring. However, there is little literature available for the implementation of multiple-channel cECG system in standard limb leads. The circuit diagram for such a system is also rarely available in literature. This paper presents a multiple-channel limb-lead cECG system that utilized conductive fabrics as the capacitive sensors. The design criteria and the corresponding circuit diagram are described in detail. The proposed system also incorporates the capacitive driven-body (CDB) circuit to reduce the common-mode power-line interference (PLI). The presented system is verified to be stable by theoretic analysis and long-term experiments. The signals acquired by the presented system are competitive with those by commercially available electrocardiogram (ECG) machines. The feasible size and distance to the subject for the sensor made by conductive fabric have also been evaluated by a series of tests. From the test results, the sensor is suggested to be of greater than 60 cm2 in area and not more than 3 mm in distance for cECG measurement.

Actions of SMS-alerted lay rescuers and the impact of providing assistance in resuscitations in a Dutch out-of-hospital resuscitation system

Aim of the study: to develop new technologies to improve an intraaortic diastolic pressure during cardiopulmonary resuscitation of patients with cardiac arrest via to non-invasive femoral artery occlusion (NFAO) with cold protection of limbs.1–5 Methods: Clinical studies were conducted involving 11 adult patients with cardiac arrest and standard cardiopulmonary resuscitation (CPR). From this 6 patients was applied only CPR, the other 5 patients – CPR+NFAO. Results: Application of standard CPR it possible to restore spontaneous circulation in 4 of 6 patients. Restoration of spontaneous circulation was recorded at a mean of 17±12min (P≤0.05, n=4) after initiation of the CPR. Moreover, intraaortic diastolic pressure in survivors with standard CPR was able to raise up to 28±6mm Hg. The other 2 patients failed to restore spontaneous circulation within 30min of applying SPR, and an intraaortic diastolic pressure value of one of them does not exceed 12mmHg, another −17mm Hg during cardiopulmonary resuscitation. Resuscitation of patients in the other group supplemented with standard CPR simultaneous bilateral lower limb ischemia produced by a finger pressing on the skin and soft tissue in the groin area of projection of the femoral arteries. Our results demonstrated the ease, simplicity, high efficiency and safety of the proposed technology. In particular, the recovery using CPR+NFAO in the study group has restored spontaneous circulation in all 5 patients. Restoration of spontaneous circulation was recorded at a mean of 9±6min (P≤0.05, n=5). The value of an intraaortic diastolic pressure they had increased to 39±7mmHg. Conclusions: Double-sided limb ischemia applied simultaneously with standard CPR optimizes restoration of spontaneous circulation in patients with cardiac arrest.

Comparison of Intravenous Lipid Emulsion, Bicarbonate, and Tailored Liposomes in Rabbit Clomipramine Toxicity

Liposome (LIP)-like lipid dispersions have emerged as useful detoxification vehicles in vitro. The authors compare resuscitation with tailored LIPs, 20% intravenous lipid emulsion (ILE), and sodium bicarbonate (BIC), in a rabbit model of clomipramine toxicity. Sedated, instrumented New Zealand white rabbits underwent clomipramine infusion at 3.2mg/kg/min to 50% baseline mean arterial pressure (MAP) and then at 1.6mg/kg/min for 30minutes. BIC (3mL/kg 8.4%), ILE (3mL/kg 20%), or LIP (24mg/kg) were infused as rescue treatments at toxicity and were repeated at 10minutes (n=5 in each group). Thirty-minute MAP was greatest in ILE-treated animals: 61mmHg ILE (interquartile range [IQR]= 49 to 64mmHg), 43mmHg LIP (IQR= 36.5 to 49mmHg), and 10mmHg BIC (IQR= 10 to 44mmHg; all p=0.02). Two of the five BIC-treated animals survived to 30minutes, compared with all five of the ILE-treated animals and all five of the LIP-treated animals (p=0.044). Both ILE and LIPs improved hemodynamic recovery compared with bicarbonate in clomipramine-induced cardiotoxicity in rabbits. Greater 30-minute MAP was observed in the ILE group.

Comparison of the spatial QRS-T angle derived from the conventional 12-lead ECG using standard electrode positions with that derived from the Holter ECG using Mason Likar electrode positions

Methods: 12-lead ECGs were recorded simultaneously with standard limb lead positions using an ECG device and M-L lead positions using a 12-lead Holter recorder in 100 volunteers. Spatial QRS-T angles were calculated by 2 methods — a vector method within the Glasgow algorithm and a net amplitude method where net QRS [R amplitude minus Q or S amplitude (whichever is greater)] and T wave amplitudes were manually measured in derived orthogonal leads.

123 THE EFFECTS OF MULTI-LIMB REMOTE ISCHAEMIC PRECONDITIONING IN PATIENTS UNDERGOING CARDIAC BYPASS SURGERY

<h3>Introduction</h3> Remote ischaemic preconditioning (RIPC) has emerged as a non-invasive, low-cost therapeutic intervention for reducing peri-operative myocardial injury (PMI) in patients undergoing coronary artery bypass graft (CABG) and/or valve surgery. However, some studies have been neutral, suggesting that the standard single limb RIPC stimulus may be ineffective under certain conditions. We investigated the effect of increasing the strength of the RIPC stimulus in patients undergoing elective cardiac bypass surgery. <h3>Methods and results</h3> 180 consecutive patients undergoing elective CABG and/or valve surgery were randomised to receive either RIPC (2–5 min cycles of simultaneous upper arm and thigh cuff inflation and deflation, N=90) or control (uninflated cuffs placed on the upper arm and thigh for 20 min, N=90). Patients randomised to RIPC had less PMI (26% reduction in 72 h area-under-the-curve high-sensitivity Troponin T; p=0.003), reduced incidence of post-operative atrial fibrillation (AF, 11% RIPC vs 24% control; p=0.031), decreased the incidence of acute kidney injury (AKI, 7% RIPC vs 17% control; p=0.036), and shortened the stay on the intensive care unit (ICU, 2 days RIPC vs 3 days control; p=0.043). Interestingly, we found that in those patients who received IV GTN during surgery sustained less PMI, and RIPC was ineffective. <h3>Conclusions</h3> Multi-limb RIPC induced by simultaneous upper arm and leg cuff inflation reduced PMI, decreased the incidence of post-operative AF, reduced the incidence of AKI and shortened the ITU stay, in patients undergoing CABG and/or valve surgery.

Effects of chloride ion channel and its blockers on myocardial ischemia reperfusion arrhythmias in rabbits

To explore the impact of chloride ion channel and its blockers 4, 4'-diisothiocyanostilbene-2, 2'-disulfonic acid (DIDS), cyanato-stilbene-2, 2'-disulfonic acid (SITS) and 5-nitro-2-(3-phenyl-propylamino) benzoic acid (NPPB) on arrhythmias caused by myocardial ischemia reperfusion. A total of 40 rabbits were divided into control, ischemia reperfusion, DIDS low-dose, DIDS high-dose, SITS low-dose, SITS high-dose, NPPB low-dose and NPPB high-dose groups. Myocardial ischemia reperfusion model was established by ligation of anterior descending coronary artery. And standard limb lead II of electrocardiogram (ECG) was continuously monitored during the experimental process. Then comparisons of heart rate, ECG P wave, R wave, T wave, ST segment changes and arrhythmias score were made between the above groups. During 30-minute ischemia, compared with the control group, all other groups showed significantly decreased heart rate ((199.8 ± 4.0) - (253.6 ± 2.1) vs (267.0 ± 3.4), all P < 0.01), elevated ECG P wave ((0.216 ± 0.019) - (0.356 ± 0.024) vs (0.186 ± 0.019), all P < 0.01), R wave ((0.564 ± 0.017) - (1.138 ± 0.048) vs (0.506 ± 0.018), all P < 0.01), T wave ((0.542 ± 0.013) - (0.856 ± 0.045) vs (0.278 ± 0.015), all P < 0.01) and ST segment ((0.326 ± 0.027) - (0.668 ± 0.054) vs (0.024 ± 0.023), all P < 0.01) and increased arrhythmia score ((1.4 ± 0.5) - (4.6 ± 0.5) vs (0.4 ± 0.5), all P < 0.01). Compared with the ischemia reperfusion group, the above indices significantly improved in the intervention groups (heart rate: (214.8 ± 3.4) - (246.8 ± 4.0) vs (199.8 ± 4.0), all P < 0.01; P wave: (0.216 ± 0.019) - (0.316 ± 0.011) vs (0.356 ± 0.024), all P < 0.01; R wave: (0.564 ± 0.017) - (0.980 ± 0.035) vs (1.138 ± 0.048), all P < 0.01; T wave: (0.542 ± 0.013) - (0.792 ± 0.026) vs (0.856 ± 0.045), all P < 0.01; ST segment: (0.326 ± 0.027) - (0.596 ± 0.018) vs (0.668 ± 0.054), all P < 0.01; arrhythmia score: (1.4 ± 0.5) - (3.8 ± 0.4) vs (4.6 ± 0.5), all P < 0.01). Among which, the DIDS group was the best, followed by the SITS group and then the NPPB group. And the high-dose subgroups were better than those of the low-dose subgroups. During 60-minute reperfusion, the decreased heart rate upswing significantly in each group and the elevated P wave, R wave, T wave and ST segment fell back gradually. The DIDS group showed the most obvious amplitude change, followed by the SITS group and then the NPPB group. And the high-dose subgroups were better than those of the low-dose subgroups. The arrhythmia score during reperfusion showed the same trend. Chloride ion channel is involved in the generation of myocardial ischemia reperfusion arrhythmia.Early application of chloride ion channel blockers DIDS, SITS and NPPB may improve the ECG manifestations and reduce the degree of reperfusion arrhythmia.

Effect of Fatigue on Tibial Rotation After Single- and Double-Bundle Anterior Cruciate Ligament Reconstruction

Background: Fatigue is an extrinsic factor adversely affecting joint proprioception and neuromuscular response, thereby increasing anterior cruciate ligament (ACL) strain and injury risk. The effectiveness of the single- and double-bundle techniques for ACL reconstruction to control residual rotational knee laxity under fatigue has not been examined. Hypothesis: Fatigue results in a significant increase in tibial rotation angles and moments in both ACL-intact and single- and double-bundle ACL-reconstructed knees. The 2 groups with ACL-reconstructed knees will show no significant differences in tibial rotation angles and moments either pre- or postfatigue. Study Design: Controlled laboratory study. Methods: Twenty-four male patients who underwent successful single-bundle (n = 12) or double-bundle (n = 12) ACL reconstructions and 10 matched healthy controls were subjected to a standard lower limb muscle fatigue protocol using an isokinetic dynamometer. Three-dimensional motion analysis was used to measure tibial rotation and rotational knee moments in the pre- and postfatigue states, during a swinging maneuver on the weightbearing leg from a standing position with the knee in extension. Results: Tibial rotation of the single-bundle group significantly increased postfatigue (prefatigue 22° ± 10° vs 29° ± 15° postfatigue, P = .015). In contrast, the double-bundle group showed similar tibial rotation values pre- and postfatigue (16° ± 6° vs 18° ± 4°, P = .22). The double-bundle group showed a trend toward decreased tibial rotation values pre- and post-fatigue compared with controls (22 ± 4 and 23 ± 4) (P = .065 and .08, respectively). In the prefatigue state, rotational moments (N·mm/Kg) of the single-bundle (339 ± 148) and double-bundle (317 ± 97) groups were significantly lower than that of controls (465 ± 134) (P = .05 and .03, respectively). In the postfatigue state, an increase was observed in rotational moments of the single-bundle (388 ± 131) and double-bundle (408 ± 187) groups compared with prefatigue values, whereas a decrease was noted in the control group (411 ± 117). Conclusion: Single-bundle ACL-reconstructed knees demonstrate a reduced ability to resist rotational loads under fatigue. Double-bundle reconstructed knees had significantly better control of tibial rotation when fatigued. However, they demonstrate an excessive, yet not significant, reduction in tibial rotation compared with the intact knee, suggesting a possible overcorrection in rotational laxity.

Electrocardiographic diagnosis of left-ventricular hypertrophy

Electrocardiographic diagnosis of left-ventricular hypertrophy

Personal Identification Based on Vectorcardiogram Derived from Limb Leads Electrocardiogram

We propose a new method for personal identification using the derived vectorcardiogram (dVCG), which is derived from the limb leads electrocardiogram (ECG). The dVCG was calculated from the standard limb leads ECG using the precalculated inverse transform matrix. Twenty‐one features were extracted from the dVCG, and some or all of these 21 features were used in support vector machine (SVM) learning and in tests. The classification accuracy was 99.53%, which is similar to the previous dVCG analysis using the standard 12‐lead ECG. Our experimental results show that it is possible to identify a person by features extracted from a dVCG derived from limb leads only. Hence, only three electrodes have to be attached to the person to be identified, which can reduce the effort required to connect electrodes and calculate the dVCG.

Is Weight Loss Better Sustained with Long-Limb Gastric Bypass in the Super-Obese?

While some studies have shown that long-limb gastric bypass with Roux limb length of 150 to 200 cm can attain better weight loss outcomes in super-obese patients (BMI >50 kg/m(2)) than the standard limb gastric bypass with Roux limb length of 100 to 150 cm, other studies have not shown similar findings. Additionally, no study has demonstrated the optimal length of the Roux limb that will result in ideal weight loss. The purpose of this study is to compare the long-term weight loss and weight regain of standard limb length (SLL) and long limb length (LLL) gastric bypass in patients with BMI >50 kg/m(2). A total of 120 patients with BMI >50 kg/m(2) underwent either SLL (total bypass length = 200, biliopancreatic limb = 50-80 cm, Roux limb = 120-150 cm) or LLL (total bypass length = 250 biliopancreatic limb = 50-80 cm, Roux limb = 170-200 cm) RYGB. The excess weight loss (EWL), the weight regain, and the rate of complications were measured at 1-, 2-, and 3-year follow-up. Statistical comparisons were performed using t-test. There was no difference in patient demographics, pre-operative BMI, or comorbidities between the two groups: SLL (n = 55) and LLL (n = 65). In comparing standard- to long-limb cohorts, preoperative BMI was 56.1 ±5.34 vs. 57.5 ± 6.05 kg/m(2), respectively. There was no statistical difference in percent EWL at 1, 2, and 3 years between the two groups [55.2 vs. 55 (P = 0.933), 61.5 vs. 60.8 (P = 0.831), and 61.1 vs.60 (P = 0.932)]. There was no difference in percent weight regain between the two groups, 11.2 (SLL) and 5.2 (LLL) (P = 0.13). The rates of complications were similar in the two groups. There is no difference in weight loss or weight regain between the SLL and LLL RYGB. Longer-limb gastric bypass is not required in patients with BMI >50 kg/m(2) for them to obtain long-term, sustained weight loss.