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Aims The aim of this study was to assess and compare active rotation of the forearm in normal subjects after the application of a short-arm cast (SAC) in the semisupination position and a long-arm cast (LAC) in the neutral position. A clinical study was also conducted to compare the functional outcomes of using a SAC in the semisupination position with those of using a LAC in the neutral position in patients who underwent arthroscopic triangular fibrocartilage complex (TFCC) foveal repair. Methods A total of 40 healthy right-handed volunteers were recruited. Active pronation and supination of the forearm were measured in each subject using a goniometer. In the retrospective clinical study, 40 patients who underwent arthroscopic foveal repair were included. The wrist was immobilized postoperatively using a SAC in the semisupination position (approximately 45°) in 16 patients and a LAC in 24. Clinical outcomes were assessed using grip strength and patient-reported outcomes. The degree of disability caused by cast immobilization was also evaluated when the cast was removed. Results Supination was significantly more restricted with LACs than with SACs in the semisupination position in male and female patients (p < 0.001 for both). However, pronation was significantly more restricted with SACs in the semisupination position than with LACs in female patients (p = 0.003) and was not significantly different in male patients (p = 0.090). In the clinical study, both groups showed improvement in all parameters with significant differences in grip strength, visual analogue scale scores for pain, modified Mayo Wrist Score, the Disability of the Arm, Shoulder, and Hand (DASH) score, and the Patient-Rated Wrist Evaluation (PRWE) score. No significant postoperative differences were noted between LACs and SACs in the semisupination position. However, the disability caused by immobilization in a cast was significantly higher in patients who had a LAC on the dominant hand (p < 0.001). Conclusion We found that a SAC in the semisupination position is as effective as a LAC in restricting pronation of the forearm. In addition, postoperative immobilization with a SAC in the semisupination position resulted in comparable pain scores and functional outcomes to immobilization with a LAC after TFCC foveal repair, with less restriction of daily activities. Therefore, we recommend that surgeons consider using a SAC in the semisupination position for postoperative immobilization following TFCC foveal repair for dorsal instability of the distal radioulnar joint. Cite this article: Bone Joint J 2022;104-B(2):249–256.

Limb disuse has profound negative consequences on both vascular and skeletal muscle health. The purpose of this investigation was to determine whether repeated application of passive heat, applied to the knee extensor muscles, could mitigate the detrimental effects of limb disuse on vascular function. This was a randomized, single-blinded placebo controlled trial. Twenty-one healthy volunteers (10 women, 11 men) underwent 10 days of unilateral lower limb immobilization and were randomized to receive either a daily 2 h sham (Imm) or heat treatment (Imm+H) using pulsed shortwave diathermy. Vascular function was assessed with Doppler ultrasound of the femoral artery and the passive leg movement technique. Biopsies of the vastus lateralis were also collected before and after the intervention. In Imm, femoral artery diameter (FAD) and PLM-induced hyperaemia (HYP) were reduced by 7.3% and 34.3%, respectively. Changes in both FAD (4% decrease; P = 0.0006) and HYP (7.8% increase; P = 0.003) were significantly attenuated in Imm+H. Vastus lateralis capillary density was not altered in either group. Immobilization significantly decreased expression of vascular endothelial growth factor (P = 0.006) and Akt (P = 0.001), and increased expression of angiopoietin 2 (P = 0.0004) over time, with no differences found between groups. Immobilization also upregulated elements associated with remodelling of the extracellular matrix, including matrix metalloproteinase 2 (P = 0.0046) and fibronectin (P = 0.0163), with no differences found between groups. In conclusion, limb immobilization impairs vascular endothelial function, but daily muscle heating via diathermy is sufficient to counteract this adverse effect. These are the first data to indicate that passive muscle heating mitigates disuse-induced vascular dysfunction. KEY POINTS: Limb disuse can be unavoidable for many of reasons (i.e. injury, bed rest, post-surgery), and can have significant adverse consequences for muscular and vascular health. We tested the hypothesis that declines in vascular function that result from lower limb immobilization could be mitigated by application of passive heat therapy. This report shows that 10 days of limb immobilization significantly decreases resistance artery diameter and vascular function, and that application of passive heat to the knee extensor muscle group each day for 2 h per day is sufficient to attenuate these declines. Additionally, muscle biopsy analyses showed that 10 days of heat therapy does not alter capillary density of the muscle, but upregulates multiple factors indicative of a vascular remodelling response. Our data demonstrate the utility of passive heat as a therapeutic tool to mitigate losses in lower limb vascular function that occur from disuse.

The study compared immobilisation of blesbok (

Objectives To compare re-rupture rate, functional and quality-of-life outcomes, return to sports and work, complications, and resource use in patients treated non-surgically with different rehabilitation regimens for Achilles tendon rupture. Design Systematic review and meta-analysis. Methods We performed a systematic literature search in PubMed, Embase, Scopus and the Cochrane Library through May 2020 to identify randomized controlled trials (RCTs) that included patients treated non-surgically for Achilles tendon rupture. All analyses were stratified according to rehabilitation protocols. Results Eight RCTs with a total of 978 patients were included. There was no significant difference about re-rupture rate (P = 0.38), return to sports (P = 0.85) and work (P = 0.33), functional outcome (P = 0.34), quality of life (P = 0.50), and complication rate (P = 0.29) between early weight bearing with functional ankle motion and traditional ankle immobilisation with non-weight bearing. Similarly, no significant difference in re-rupture rate (P = 0.88), return to sports (P = 0.45) and work (P = 0.20), functional outcome (P = 0.26), and complication rate (P = 0.49) was seen between ankle immobilisation with non-weight bearing and early weight bearing without functional ankle motion. Conclusions Traditional ankle immobilisation with non-weight bearing was not found to be superior to early weight bearing with or without functional ankle motion for patients treated non-surgically for Achilles tendon rupture. Clinicians may consider early weight bearing in functional brace as a safe and cost-effective alternative to non-weight bearing with plaster casting.

Background The best treatment for acute Achilles tendon ruptures remains controversial. No cohort studies have compared different immobilisation durations after open surgery. This retrospective cohort study aimed to determine the optimal duration of immobilisation after this surgery. Methods A total of 266 patients with acute Achilles tendon rupture were divided into 4 groups (A, B, C, and D) according to immobilisation duration of 0, 2, 4, and 6 weeks, respectively. All patients underwent the same suture technique with a similar rehabilitation protocol and were examined clinically at 2, 4, 6, 8, 10, 12, 14, 16, 24, and 48 weeks, with a final follow-up at a mean of 22.3 months postoperatively. The primary outcome was the time of return to light sports activity (LSA). Secondary outcomes included range of motion (ROM) and single-legged heel rise height (SHRH). Data on operation time, complications, visual analogue pain scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, and Achilles tendon Total Rupture score (ATRS) were also collected. Demographic baseline data were analysed using one-way analysis of variance; outcome parameters were analysed using Kruskal-Wallis H test, and complications were analysed using Fisher’s exact test. Statistical significance was considered at P ≤ 0.05. Results VAS scores decreased significantly, reaching 0 in all groups after 12 weeks. The AOFAS and ATRS scores were significantly different between the groups from weeks 2 to 12 (P<0.001) and weeks 2 to 16 (P<0.001), respectively. All the mean scores showed better results in group B than in the other groups. In terms of recovery time of ROM, SHRH, and LSA, groups A and B were significantly faster than groups C and D (P<0.001). There were 13 (13/266, 4.9%) complications: 5 superficial infections, 3 deep venous thrombosis, and 5 trauma-related re-ruptures. On the last follow-up, all complications had recovered. There were no significant differences in complications between the groups. Conclusions Immobilisation for 2 weeks after this open surgery is the best choice for early rehabilitation and weight-bearing while minimising pain and other complications.

Aims Reduced physical activity increases the risk of heart failure; however, non‐invasive methodologies detecting subclinical changes in myocardial function are not available. We hypothesized that myocardial, left ventricular, systolic strain measurements could capture subtle abnormalities in myocardial function secondary to physical inactivity. Methods and results In the AGBRESA study, which assessed artificial gravity through centrifugation as potential countermeasure for space travel, 24 healthy persons (eight women) were submitted to 60 day strict −6° head‐down‐tilt bed rest. Participants were assigned to three groups of eight subjects: a control group, continuous artificial gravity training on a short‐arm centrifuge (30 min/day), or intermittent centrifugation (6 × 5 min/day). We assessed cardiac morphology, function, strain, and haemodynamics by cardiac magnetic resonance imaging (MRI) and echocardiography. We observed no differences between groups and, therefore, conducted a pooled analysis. Consistent with deconditioning, resting heart rate (∆8.3 ± 6.3 b.p.m., P

Introduction Developmental dysplasia of the hip (DDH), neurogenic dysplasia of the hip (NDH), and Perthes disease often require surgical treatment. Spica casting is a common postoperative immobilization. The purpose of this study was to evaluate the complications related to the immobilization. Materials and methods In a retrospective analysis, we included 83 patients (95 hips), who underwent hip reconstructive surgery between 2008 and 2018. We had 43 female and 40 male patients. Age reached from 3 months to 19 years. All patients were treated with a spica cast postoperatively for a 6-week protocol. Complications were analyzed using the full medical documentation and classified according to Clavien–Dindo. Results We had complications in 23 patients (27.7%). We counted superficial skin lesions in seven, deep skin lesions in three, spasticity of adductors in three, subluxation in two, infection of the plate in one, fracture of the plate in one, compliance problem in one, dislocations of the cast in two, reluxation in one, delayed bone healing in one and spasticity of knee flexors in one case. According to the classification of Clavien–Dindo, we were able to count ten type I, four type II, nine type III, zero type IV and zero type V adverse events. Conclusion The usage of a spica cast after hip reconstructive surgery is still the most popular way of aftertreatment. It has a low complication rate, which may be lowered by well-applied casts and foam padding. Known complications such as spasticity in patients with cerebral palsy, skin lesions, and pressure sores should be observed and avoided. Shorter protocols for immobilization with the usage of foam padding and foam splints lead to less complications. Clinical relevance Evidence level level IV, case series

Objective To determine the cardiopulmonary effects of etorphine and thiafentanil for immobilization of blesbok. Study design Blinded, randomized, two-way crossover study. Animals A group of eight adult female blesbok. Methods Animals were immobilized twice, once with etorphine (0.09 mg kg–1) and once with thiafentanil (0.09 mg kg–1) administered intramuscularly by dart. Immobilization quality was assessed and analysed by Wilcoxon signed-rank test. Time to final recumbency was compared between treatments by one-way analysis of variance. Cardiopulmonary effects including respiratory rate (ƒR), arterial blood pressures and arterial blood gases were measured. A linear mixed model was used to assess the effects of drug treatments over the 40 minute immobilization period. Significant differences between treatments, for treatment over time as well as effect of treatment by time on the variables, were analysed (p Results There was no statistical difference (p = 0.186) between treatments for time to recumbency. The mean ƒR was lower with etorphine (14 breaths minute–1) than with thiafentanil (19 breaths minute–1, p = 0.034). The overall mean PaCO2 was higher with etorphine [45 mmHg (6.0 kPa)] than with thiafentanil [41 mmHg (5.5 kPa), p = 0.025], whereas PaO2 was lower with etorphine [53 mmHg (7.1 kPa)] than with thiafentanil [64 mmHg (8.5 kPa), p Conclusions Both drugs caused clinically relevant hypoxaemia; however, it was less severe with thiafentanil. Ventilation was adequate. Hypertension was greater and immobilization scores were lower with thiafentanil.

Noninvasive image guided breast brachytherapy (NIBB) is a novel approach to delivery of accelerated partial breast irradiation (APBI) that may hold advantages over established techniques. NIBB is not invasive but maintains a high level of precision by using breast immobilization via breast compression and image guidance; it therefore does not require large planning tumor volume margins. We present the primary outcomes of this prospective phase 2 study (BrUOG Br-251).Eligible patients with early-stage breast cancer underwent NIBB APBI using a dose 34 Gy in 10 fractions delivered daily or twice a day. Treatment was delivered using an Ir-192 high-dose-rate source via specialized applicators. Two orthogonal treatment axes were used for each fraction. The primary endpoints were late toxicity and cosmesis assessed at 2 and 5 years. Toxicity was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events v3.0. Cosmesis was assessed using the NRG/Radiation Therapy Oncology Group scale. Ipsilateral breast tumor recurrence was defined as any recurrence or new primary in the treated breast.Forty patients underwent protocol treatment. Median patient age was 68 years (50-92 years). Mean tumor size was 1.1 cm (0.3-3.0 cm). Among the cohort, 62.5% had invasive carcinoma and 37.5% had ductal carcinoma in situ. Thirty-nine percent elected to receive hormone therapy. No grade ≥3 late toxicities were observed at any time point. Grade 2 toxicity was 5% and 10% at 2 and 5 years, respectively. Telangiectasia grade 1 and 2 occurred in 27.5% and 5%, respectively. Breast separation of7 cm was associated with telangiectasia (P.01). The rate of good to excellent cosmetic outcome was 95% at 2 years and 100% at 5 years. With a median follow-up of 68 months, the actuarial 5-year freedom from ipsilateral breast tumor recurrence was 93.3% (±4.8%), and overall survival was 93.7% (±4.4%).NIBB to deliver APBI is well tolerated with a low incidence of significant late toxicity and has favorable cosmetic outcomes. Continued evaluation of the NIBB APBI technique in a larger cohort is warranted.

Arterial and venous thrombi can coexist without preexisting conditions, such as malignant disease, thrombotic predisposition, or arteriovenous shunt. We herein report a case of acute cerebral infarction and pulmonary thromboembolism in the absence of underlying disease. A 71-year-old woman presented with left hemiplegia. On an examination, her oxygen saturation was 91% on ambient air despite the absence of chest symptoms and clear lung fields on a chest radiograph. The patient was finally diagnosed with acute cerebral infarction caused by large artery atherosclerosis and acute pulmonary thromboembolism due to deep vein thrombosis, consequent to immobilization for three days after the onset of cerebral infarction.

The immobilization of patients with a bite block (BB) carries the risk of interpersonal infection, particularly in the context of pandemics such as COVID-19. Here, we compared the intra-fractional patient setup error (intra-SE) with and without a BB during fractionated intracranial stereotactic irradiation (STI). Fifteen patients with brain metastases were immobilized using a BB without a medical mask, while 15 patients were immobilized without using a BB and with a medical mask. The intra-SEs in six directions (anterior–posterior (AP), superior–inferior (SI), left–right (LR), pitch, roll, and yaw) were calculated by using cone-beam computed tomography images acquired before and after the treatments. We analyzed a total of 53 and 67 treatment sessions for the with- and without-BB groups, respectively. A comparable absolute mean translational and rotational intra-SE was observed (P > 0.05) in the AP (0.19 vs 0.23 mm with- and without-BB, respectively), SI (0.30 vs 0.29 mm), LR (0.20 vs 0.29 mm), pitch (0.18 vs 0.27°), roll (0.23 vs 0.23°) and yaw (0.27 vs 22°) directions. The resultant planning target volume (PTV) margin to compensate for intra-SE was

BACKGROUND: In people with chronic low back pain (cLBP) and active discopathy, glucocorticoid intradiscal injection (GC IDI) reduces LBP in the short-term. Lumbosacral immobilization may be useful to obtain long-term results. OBJECTIVE: To assess the feasibility of a lumbosacral immobilization using a pantaloon cast following GC IDI in people with cLBP sand active discopathy. METHODS: We conducted a retrospective feasibility study. Participants were allocated to experimental or control groups by preferences. The experimental group received lumbosacral immobilization using a custom-made pantaloon cast worn continuously for one week following a GC IDI of 25 mg of prednisolone acetate. The control group received GC IDI alone. The primary endpoint was the feasibility of lumbosacral immobilization assessed by the rate of refusal and early withdrawal of the cast. RESULTS: Twelve patients were offered lumbosacral immobilization following GC IDI: the rate of refusal was 3/12 (25.0%) and was 3/9 (33.3%) of early withdrawal. Mean (95% CI) acceptability of the procedure was 55.0 (26.9–83.1)/100 in the experimental group (N= 6) and 61.6 (25.1–98.2)/100 in the control group (N= 6). CONCLUSIONS: We found high rates of refusal and early withdrawal of the lumbosacral immobilization using a pantaloon cast following GC IDI in people with nonspecific cLBP and active discopathy.

This study aimed to investigate the effects of blood flow restriction (BFR) combined with electrical muscle stimulation (EMS) on skeletal muscle mass and strength during a period of limb disuse.Thirty healthy participants (22 ± 3 yr; 23 ± 3 kg·m-2) were randomly assigned to control (CON; n = 10), BFR alone (BFR; n = 10), or BFR combined with EMS (BFR + EMS; n = 10). All participants completed unloading of a single leg for 14 d, with no treatment (CON), or while treated with either BFR or BFR + EMS (twice daily, 5 d·wk-1). BFR treatment involved arterial three cycles of 5-min occlusion using suprasystolic pressure, each separated by 5 min of reperfusion. EMS (6 s on, 15 s off; 200 μs; 60 Hz; 15% maximal voluntary contraction [MVC]) was applied continuously throughout the three BFR cycles. Quadriceps muscle mass (whole-thigh lean mass via dual-energy x-ray absorptiometry and vastus lateralis [VL] muscle thickness via ultrasound) and strength (via knee extension MVC) were assessed before and after the 14-d unloading period.After limb unloading, whole-thigh lean mass decreased in the control group (-4% ± 1%, P0.001) and BFR group (-3% ± 2%, P = 0.001), but not in the BFR + EMS group (-0.3% ± 3%, P = 0.8). VL muscle thickness decreased in the control group (-4% ± 4%, P = 0.005) and was trending toward a decrease in the BFR group (-8% ± 11%, P = 0.07) and increase in the BFR + EMS group (+5% ± 10%, P = 0.07). Knee extension MVC decreased over time (P0.005) in the control group (-18% ± 15%), BFR group (-10% ± 13%), and BFR + EMS group (-18% ± 15%), with no difference between groups (P0.5).Unlike BFR performed in isolation, BFR + EMS represents an effective interventional strategy to attenuate the loss of muscle mass during limb disuse, but it does not demonstrate preservation of strength.

Aims This exploratory randomized controlled trial (RCT) aimed to determine the splint-related outcomes when using the novel biodegradable wood-composite splint (Woodcast) compared to standard synthetic fibreglass (Dynacast) for the immobilization of undisplaced upper limb fractures in children. Methods An exploratory RCT was performed at a tertiary paediatric referral hospital between 1 June 2018 and 30 September 2019. The intention-to-treat population consisted of 170 patients (mean age 8.42 years (SD 3.42); Woodcast (WCG), n = 84, 57 male (67.9%); Dynacast (DNG), n = 86, 58 male (67.4%)). Patients with undisplaced upper limb fractures were randomly assigned to WCG or DNG treatment groups. Primary outcome was the stress stability of the splint material, defined as absence of any deformations or fractures within the splint during study period. Secondary outcomes included patient satisfaction and medical staff opinion. Additionally, biomechanical and chemical analysis of the splint samples was carried out. Results Of the initial 170 patients, 168 (98.8%) completed at least one follow-up, and were included for analysis of the primary endpoint. Both treatment groups were well-matched regarding to age, sex, and type and localization of the fracture. Splint breakage occurred in three patients (3.6%; 95% confidence interval (CI), 0.007% to 0.102%) in the WCG and in three children (3.5%, 95% CI 0.007% to 0.09%) in the DNG (p > 0.99). The incidence of splint-related adverse events did not differ between the WCG (n = 21; 25.0%) and DNG (n = 24; 27.9%; p = 0.720). Under experimental conditions, the maximal tensile strength of Dynacast samples was higher than those deriving from Woodcast (mean 15.37 N/mm² (SD 1.37) vs 10.75 N/mm² (SD 1.20); p = 0.002). Chemical analysis revealed detection of polyisocyanate-prepolymer in Dynacast and polyester in Woodcast samples. Conclusion Splint-related adverse events appear similar between WCG and DNG treatment groups during the treatment of undisplaced forearm fractures. Cite this article: Bone Joint J 2020;102-B(10):1405–1411.

Background In this study, we aimed to analyze the hospitalization costs for immobile patients with hemorrhagic stroke (IHS) or ischemic stroke (IIS) in China and to determine the factors associated with hospitalization costs. Methods We evaluated patients with IHS and IIS hospitalized between November 2015 and July 2016 in six provinces or municipality cities of China. Linear regression analysis was used to examine the association with hospitalization costs and predictors. Results In total, 1573 patients with IHS and 3143 with IIS were enrolled and analyzed. For IHS and IIS, the average length of stay (LoS) was 17.40 ± 12.3 and 14.47 ± 11.55 days. The duration of immobility was 12.11 ± 9.98 and 7.36 ± 9.77 days, respectively. Median hospitalization costs were RMB 47000.68 (interquartile range 19,827.37, 91,877.09) for IHS and RMB 16578.44 (IQR 7020.13, 36,357.65) for IIS. In both IHS and IIS groups, medicine fees accounted for more than one-third of hospitalization costs. Materials fees and medical service fees accounted for the second and third largest proportions of hospital charges in both groups. Linear regression analysis showed that LoS, hospital level, and previous surgery were key determinants of hospitalization costs in all immobile patients with stroke. Subgroup analysis indicated that hospital level was highly correlated with hospitalization costs for IHS whereas pneumonia and deep vein thrombosis were key factors associated with hospitalization costs for IIS. Conclusions We found that hospitalization costs were notably higher in IHS than IIS, and medicine fees accounted for the largest proportion of hospitalization costs in both patient groups, perhaps because most patients ended up with complications such as pneumonia thereby requiring more medications. LoS and hospital level may greatly affect hospitalization costs. Increasing the reimbursement ratio of medical insurance for patients with IHS is recommended. Decreasing medicine fees and LoS, preventing complications, and improving treatment capability may help to reduce the economic burden of stroke in China.

Conducted electrical weapons (CEW) are ubiquitous in law enforcement given their unique ability to physically incapacitate violently resisting subjects. Early use of animal models to study CEW incapacitation effectiveness (e.g. porcine model with 4-limb strain gauges) proved to be poorly predictive of human incapacitation effectiveness. In a previously published human study, we developed a methodology for the prospective assessment of the incapacitation effectiveness of CEWs in highly motivated human subjects. Here we use this methodology in Part 1 to compare the incapacitation effectiveness of the newly released Axon® (formerly TASER® International) T(ASER) 7 to the TASER X26E, the “gold standard”, and the TASER X2, a current model. The T7 has a new “adaptive cross-connect” technology that may improve incapacitation effectiveness in the scenario of small spreads between probe pairs, a common cause of weapon “failure” in the field. In Part 2, we use our methodology to test the functionality of the T7 cross-connect technology by comparing different bay and probe configurations. This is the first published study in the literature comparing different CEW models using this human model. For Part 1, 29 subjects completed the study and had data available for analysis. For Part 2, 21 subjects completed the study and had data available for analysis. The subjects were motivated to complete the task of reaching a suspended martial arts dummy 3.4 m (11 ft) away while being exposed “under power” to the CEW. In Part 1, subjects were assigned to 1 of 6 groups with probe spreads of 10, 20, and 30 cm (4, 8, 12 in). Subjects were exposed to a “control” CEW (either the X2 or X26E) and the T7 on alternating sides. Exposures with the X2 and T7 included 2 bay-exposures. In Part 2, 21 subjects were assigned to 1 of 5 groups of different T7 bay and probe configurations all with a theoretical effective spread of 30 cm (12 in). Subjects were rated on their progress towards successfully reaching the dummy and on the extent of limb incapacitation using a quasi-blinded expert-observer scoring panel based on high-speed video review. In Part 1, all CEW models achieved maximal or near-maximal subject control with the 30 cm probe spread. With probe spreads of 10 and 20 cm the pooled data showed the T7 to be superior to the X2 for goal achievement (p

Venous thromboembolism (VTE) remains a major cause of morbidity and mortality in hospitalized medically ill patients. These patients constitute a heterogeneous population, whose VTE risk is dependent upon the acute medical illness, immobility status, and patient-specific risk factors that have been incorporated into individualized VTE risk assessment models. Randomized placebo-controlled trials (RCTs) have shown both efficacy and net clinical benefit of in-hospital thromboprophylaxis, which is supported by guideline recommendations. The data for extended posthospital discharge thromboprophylaxis are more nuanced. RCTs comparing standardized duration low-molecular weight heparin versus extended duration direct oral anticoagulants, such as betrixaban and rivaroxaban, have shown efficacy and net clinical benefit in select groups of high VTE and low-bleed risk populations of hospitalized medically ill patients. These oral agents are now approved for both in-hospital and extended thromboprophylaxis. However, the most recent guidelines do not recommend routine use of these agents for extended thromboprophylaxis. Longitudinal studies in medically ill patients have shown that the majority of VTE events occur in the posthospital discharge setting within 6 weeks of hospitalization. This, coupled with the short hospital length-of-stay and lack of routine postdischarge thromboprophylaxis in U.S. health care settings, has dampened quality improvement efforts aimed at reducing hospital-acquired VTE. The aim of this multidisciplinary document is to provide an evidence-based framework to guide clinicians in assessing VTE and bleeding risk in hospitalized medically ill patients using an individualized, risk-adapted, and patient-centered approach, with the aim of providing clinical pathways toward the use of appropriate type and duration of available thromboprophylactic agents.

Background:Immobilization of the cervical spine by Emergency Medical Services (EMS) personnel is a standard procedure. In most EMS, multiple immobilization tools are available.The aim of this study is the analysis of residual spine motion under different types of cervical spine immobilization.Methods:In this explorative biomechanical study, different immobilization techniques were performed on three healthy subjects. The test subjects’ heads were then passively moved to cause standardized spinal motion. The primary endpoints were the remaining range of motion for flexion, extension, bending, and rotation measured with a wireless human motion detector.Results:In the case of immobilization of the test person (TP) on a straight (0°) vacuum mattress, the remaining rotation of the cervical spine could be reduced from 7° to 3° by additional headblocks. Also, the remaining flexion and extension were reduced from 14° to 3° and from 15° to 6°, respectively. The subjects’ immobilization was best on a spine board using a headlock system and the Spider Strap belt system (MIH-Medical; Georgsmarienhütte, Germany). However, the remaining cervical spine extension increased from 1° to 9° if a Speedclip belt system was used (Laerdal; Stavanger, Norway). The additional use of a cervical collar was not advantageous in reducing cervical spine movement with a spine board or vacuum mattress.Conclusions:The remaining movement of the cervical spine is minimal when the patient is immobilized on a spine board with a headlock system and a Spider Strap harness system or on a vacuum mattress with additional headblocks. The remaining movement of the cervical spine could not be reduced by the additional use of a cervical collar.

Quadriceps strength and size was measured in a small group of subjects (n = 7) 1 to 5 years after full mobilisation following some form of unilateral lower limb trauma. The mean maximum voluntary isometric force (MVC) was significantly lower for the injured (I) compared to the uninjured (UI) leg (369 N +/- 139 vs. 535 N +/- 131, p less than 0.01). Electrical stimulation superimposed on the voluntary contractions demonstrated that all subjects were able to maximally activate the quadriceps of both legs. Mean quadriceps cross-sectional area (CSA) was significantly lower in the I (64 cm2 +/- 12.8) compared to the UI leg (80 +/- 12.8, p less than 0.01). One subject with marked unilateral weakness and wasting took part in a 3-month strength training study for the injured leg. After training the I/UI ratio had been restored to nearly 100% (94% MVC; 88% CSA). These results would suggest that longer and more intensive physiotherapy is required in the immediate post-injury period to restore muscle strength and size to severely atrophied muscle.

Patients who suffer hand burns are at a high contracture risk, partly due to numerous cutaneous functional units, or contracture risk areas, located within the hand. Patients who undergo split-thickness skin grafting are often immobilized postoperatively for graft protection. Recent practice at our burn center includes an early range of motion (EROM) following hand grafting to limit unnecessary immobilization. The purpose of this study was to determine whether EROM is safe to perform after hand grafting and if there is any clinical benefit. This retrospective, matched case–control study of adults compared patients who received EROM to subjects who received the standard 3 to 5 days of postoperative immobilization. Patients were evaluated for graft loss and range of motion. Seventy-one patients were included in this study: 37 EROM patients and 34 matched controls. Six patients experienced minor graft loss, three of these were not attributable to EROM. All graft loss was less than 1 cm and none required additional surgery. Significantly more patients who received EROM achieved full-digital flexion by the first outpatient visit (25/27 = 92.6% vs 15/22 = 68.2%; P = .028). Performing EROM does not cause an increase in graft loss. All areas of graft loss from the EROM group healed without intervention. There appears to be a benefit to EROM since there was a significant improvement in the patients’ ability to make a full fist at initial outpatient follow-up. Additional prospective analysis is needed to examine the true clinical utility of EROM in the hand and other contracture-prone areas.

Background Monteggia equivalent lesion represents a series of combined elbow and forearm injuries that resemble typical Monteggia fracture either in presentation or mechanism. The term has gradually evolved since its introduction, as sporadic case reports continued to complement it. The aim of this study was to present a furthermore type of that lesion which no previous study had reported and arouse pediatric orthopedists’ additional awareness of it. Case presentation A 11-year-old girl, whose injury pattern initially appeared to be a mild radial neck fracture with undisplaced proximal ulnar fracture, and without radial head dislocation, was treated with closed reduction and long-arm splint immobilization. Acceptable results were acquired at first-week follow-up, yet dramatic changes turned up 2 weeks later when the dislocated radial head was found. A further reduction to the fracture and joint site only resulted in a subluxated and incongruous radiocapitellar joint on the three-dimensional computed tomography (3D-CT). Then a definitive operation was performed, which involved a Boyd incision, correction of radial head tilting, opening wedge osteotomy of the proximal ulna and proper fixation respectively. And acceptable results were achieved 1 year later. Conclusions This case, with occult proximal ulna fracture, angulated radial neck fracture, subsequent radiocapitellar dislocation, and articular incongruity, was deemed as a rare Monteggia type-one equivalent fracture-dislocation variant rather than an ordinary radial neck fracture and it facilitates further understanding and management of the Monteggia fracture.

Objective To characterize and compare two intramuscular drug protocols using alfaxalone and alfaxalone–medetomidine combination for the field immobilization of free-ranging koalas. Study design Blinded, randomized, comparative field study. Animals A total of 66 free-ranging koalas from the Mount Lofty Ranges, South Australia. Methods Koalas were randomly allocated into two groups. Group A animals were given alfaxalone alone at 3.5 mg kg–1. Group AM animals were given alfaxalone 2 mg kg–1 and medetomidine 40 μg kg–1, reversed with atipamezole at 0.16 mg kg–1. Blinded operators recorded heart rate (HR), respiratory rate (fR), cloacal temperature, depth of sedation and times to: first effect, sedation suitable for clinical interventions, first arousal and full recovery. Data were analysed using independent t test, Mann–Whitney U test, chi-square analysis and log-rank test at 5% level of significance. Results Suitable immobilization for clinical examination and sample collection was achieved in all animals. In groups A and AM, median time to working depth was 6.5 minutes (range: 3.4–15) and 8.1 minutes (range: 4.3–24) and time to complete recovery was 66 minutes (range: 12–138) and 34 minutes (range: 4–84), respectively, following reversal. Time to first effect was significantly shorter in group A (p = 0.013), whereas time to full arousal was significantly shorter in group AM (p = 0.007) probably due to the administration of atipamezole. Maximum HR was 117 ± 28 beats minute–1 in group A, which was a significant increase from baseline values (p Conclusions and clinical relevance Both the protocols produced immobilization, enabling clinical examination and sample collection; however, protocol AM was more suitable for field work due to shorter recovery times.

Purpose The aim of this study was to investigate whether patient subjective and functional outcomes after Achilles tendon rupture (ATR) are related to deep venous thrombosis (DVT) during leg immobilization. Methods A cohort study with prospectively collected randomized data was conducted between 2010 and 2017. Two-hundred and fifty-one Patients with an Achilles tendon rupture (mean age = 41 ± 8), treated with uniform surgical techniques, were retrospectively analyzed. DVT incidence at 2 and 6 weeks was assessed using compression duplex ultrasound. At 12 months patient-reported outcomes were assessed using the Achilles tendon Total Rupture Score (ATRS), Foot- and Ankle Outcome Score (FAOS), Physical Activity Scale (PAS) and functional outcome with the calf-muscle endurance test. ANOVA analyses were used and adjusted for assumed confounding factors (patient age, sex, BMI and rehabilitation). Results The total DVT incidence was 122 out of 251 (49%). Patients suffering a DVT exhibited significantly lower ATRS at 1 year compared to patients without DVT (mean 76 vs 83, 95% CI 71–79 vs 80–87; p 80) compared to 51% (95% CI 41–61%) of the patients sustaining a DVT (p p p Conclusion Sustaining a DVT during leg immobilization significantly impairs patient-reported outcome at 1 year after surgical repair of ATR. Level of evidence III.

Kienböck disease, osteonecrosis of the lunate, is a well-known but poorly understood complication seen by hand surgeons. This review presents the background and important patient-specific parameters of the disease and reviews the numerous treatment options that exist for the disease.

Trauma patients with a serious injury to the head or neck can remain immobilised with a cervical collar (C‐collar) device in situ and are subsequently exposed to device‐related skin integrity threats. This study aimed to determine the incidence and risk factors associated with the development of C‐collar‐related pressure injures (CRPIs) in an intensive care unit. This retrospective longitudinal cohort study was conducted in an Australian metropolitan intensive care unit. Following ethical approval, data from patients over 18 years, who received a C‐collar were retrieved over a 9‐year period. Chi square and t‐tests were used to identify variables associated with CRPI development. A logistic regression model was employed to analyse the risk factors. Data from 906 patients were analysed. Nine‐year pressure injury incidence was 16.9% (n = 154/906). Pressure injury development directly associated with a C‐collar increased by 33% with each repositioning episode (odds ratio 1.328, 95% confidence interval 1.024‐1.723, P = .033). Time in the C‐collar (10.4 to 2.5 days, P = .002) and length of stay in intensive care unit (ICU) (20.1 to 16.1 days, P

Abstract Background The aim of this study is to record the incidence of redisplacement after closed reduction and instant rigid cast immobilization and to identify possible risk factors that may be associated with the redisplacement. Methods We retrospectively reviewed paediatric patients who underwent closed reduction and instant rigid cast immobilization for simple distal radius fractures from 2014 to 2018. Patients were followed up at 1 week, 2 weeks, 3 weeks, and 6 weeks after casting. Redisplacement was diagnosed on the basis of image findings. Risk factors for redisplacement were evaluated in three aspects, which included patient-related, fracture-related, and cast-related factors. Results A total of 123 children were included in this study. During follow-up, 31 patients (25.2%) showed redisplacement after closed reduction and cast immobilization. Twenty-two redisplacements happened within 1 week after treatment, 8 redisplacements happened between 1 and 2 weeks, and only one redisplacement happened after 2 weeks. In the multivariate analysis, associated ulna fracture (OR, 4.278; 95% CI, 1.773–10.320), initial translation ≥ 50% (OR, 9.148; 95% CI, 3.587–23.332), and 3-point index ≥ 0.40 (OR, 1.280; 95% CI, 1.159–1.401) were three independent factors that correlated with the incidence of redisplacement during follow-up. Conclusions About a quarter of paediatric patients would develop redisplacement after reduction and immobilization with instant rigid cast. Patients with associated ulna fracture, severe initial translation, and high 3-point index have a higher risk to develop redisplacement.

Background To ensure precision of treatment, patients requiring radiation therapy for treatment of head and neck cancer (HNC) are stabilized using a fitted thermoplastic immobilization mask. Despite evidence that many patients experience significant anxiety when restrained in the mask, there is a lack of proven interventions to prevent or manage mask-related anxiety. The Promoting Action on Research Implementation in Health Services implementation framework promotes consideration of context and culture when developing interventions to ensure successful implementation if proven effective. Health professionals (HPs) play a crucial role in the management of patients' psychological concerns, yet no studies have explored their perspectives of mask anxiety and how it should be managed. The aim of this study, therefore, was to elicit and analyse HPs' perspectives of mask anxiety, using the Promoting Action on Research Implementation in Health Services framework, to guide the development of implementation-ready interventions to reduce mask anxiety. Methods Semistructured interviews were conducted with 20 HPs involved in the care of HNC patients, including radiation oncologists, radiation therapists, nurses, and psychologists, from nine hospitals in NSW, Australia. Framework analysis methods were used. Results Participants were on average 40 years old (range, 27–56), the majority were female (75%), and they had worked from 1 to 22 years with HNC patients. Six emergent themes were identified: (1) Mask anxiety is a significant problem but is easily missed; (2) Context matters; (3) Trust is critical; (4) Choice and control facilitate adjustment; (5) Psychological strategies are valued; and (6) Culture matters. Subgroup analysis also highlighted differences in perspectives between specialties. Conclusions Participants identified key principles underlying successful intervention. Two significant barriers to mask-anxiety intervention were identified: (1) a lack of empirical evidence surrounding its prevalence and predictors and (2) contextual and systematic hurdles making the health system potentially unresponsive to change. These data suggest a need for further descriptive studies and careful development of interventions which will address these hurdles.

To assess whether pulsed electromagnetic field therapy during cast immobilization of distal radius fractures has beneficial effects on pain and limb function, the study included 52 patients (mean age 60.8 ± 15.0 years) with distal radius fractures treated with cast immobilization. Patients were allocated to a pulsed electromagnetic field group (n = 27) or a control group (n = 25). Pain; forearm and arm circumference; range of motion; disabilities of the arm, shoulder, and hand score; and touch sensation were evaluated on the day of the plaster cast dressing and 3 and 6 weeks after. In comparison to the control group, the pulsed electromagnetic field group reported significant changes after 3 and 6 weeks of treatment: lower pain levels (p=0.0052;p<0.0001, respectively), greater mobility of upper-limb joints, improvement in exteroceptive sensation, and reduction in disability of the upper limb (disabilities of the arm, shoulder, and hand) (p=0.0003;p<0.0001, respectively). Our results suggest that early addition of pulsed electromagnetic field treatment, during cast immobilization of distal radius fractures, has beneficial effects on the pain, exteroceptive sensation, range of motion, and daily functioning of patients.

INTRODUCTION Immobility of the upper limbs has been associated with reduction of F-wave frequency. However, there are no similar studies on lower limb (LL) F-waves. We investigated the impact of LL rest on F-wave and H-reflex parameters. METHODS The LLs of 14 healthy participants were studied after 90 minutes rest. F-waves (frequency, latencies, chronodispersion, and mean amplitude) and H-reflexes (latency and recruitment curve) were investigated bilaterally. In seven participants the protocol was repeated, but the temperature of one limb was reduced. RESULTS Immobility only changed F-wave latencies, which increased significantly (mean value of 2 ms, P

Visceral hypersensitivity (VH) is common in irritable bowel syndrome (IBS), and female patients are more likely to seek healthcare services for IBS-related abdominal pain. Oestrogen has been reported to mediate pain modulation via its receptor, and mast cells are known to participate in the development of visceral hypersensitivity. Our previous studies showed that the G-protein-coupled oestrogen receptor (GPER, also known as GPR30) was expressed by mast cells in human colonic tissues and was associated with IBS type and severity of visceral pain. However, whether GPER is involved in oestrogen-dependent visceral hypersensitivity via mast cell degranulation is still unknown. Rats were subjected to wrap partial restraint stress to induce visceral hypersensitivity and were ovariectomized (OVX) to eliminate the effects of oestrogen on visceral hypersensitivity. OVX rats were treated with oestrogen, an oestrogen receptor α and β antagonist (ICI 182.780), a GPER antagonist (G15) or a GPER agonist (G1), to evaluate the effects of oestrogen via its receptor. The colorectal distention test was performed to assess visceral sensitivity. Immunofluorescence studies were performed to evaluate GPER and mast cell tryptase co-expression. Mast cell number with degranulation was detected by specific staining. Mast cell tryptase expression in rat colon was also investigated by Western blot and immunohistochemistry. Substance P and histamine expression were examined by ELISA. GPER was expressed by the majority of tryptase-positive mast cells in the colonic mucosa. Stressed rats showed increased visceral sensitivity, increased mast cell degranulation, mast cell tryptase expression, and increased colon histamine levels. Ovariectomy reduced stress-induced VH in female rats and decreased mast cell degranulation, mast cell tryptase expression, and histamine levels, whereas oestrogen replacement reversed these effects. In OVX rats, the GPER antagonist G15 counteracted the enhancing effects of oestrogen on stress-induced VH, mast cell degranulation, mast cell tryptase, and histamine expression, whereas VH was preserved after treatment with ICI 182.780. On the other hand, pretreatment with the selective GPER agonist G1 at doses between 1 and 20 μg/kg significantly increased VH, mast cell tryptase, and histamine expression in OVX-stressed rats, mimicking the effects of oestrogen. GPER plays a pivotal role in the regulation of mast cell degranulation, mast cell tryptase expression, and histamine levels and contributes to the development of colonic hypersensitivity in a female rat model of IBS.

Introduction Immobilisation may be necessary to ensure patient safety and examination success in paediatric medical imaging. Little guidance exists regarding the selection of different immobilisation methods. The purpose of this study was to explore radiographers’ selection of immobilisation methods in paediatric medical imaging and the influences on their choices. Methods Ethical approval was obtained. A mixed methods approach consisting of online questionnaire distribution followed by individual interviews was used to explore Australasian radiographers' self-reported patterns of immobilisation use and the underlying reasons and beliefs. Quantitative data were described using frequency data, with a Fisher's Exact test used to determine any association between demographic variables and immobilisation methods. Qualitative data were evaluated using content analysis. Results Sixty-five radiographers returned completed questionnaires, with seven participating in interviews. Psychological immobilisation methods were preferred to minimise patient pain and distress, but physical methods were considered more effective, with parental holding the most likely method to be used (63/65, 96.9%). Participants assumed certain methods to be more appropriate based on patient age and examination type, but adapted their choices based on many other factors, seeking to provide personalised care. Further training was strongly desired (48/64, 75.0%). Participants disagreed on whether introducing written guidance would be beneficial (33/62, 53.2%). Conclusion Choosing an immobilisation method appears to be a case-by-case activity requiring critical assessment of multiple factors in order to balance patient care with examination success. Implications for practice Improvements in quality and quantity of education are recommended to enhance radiographers’ ability to make choices based on all relevant factors.

Measurement of the renal resistive index (RRI) is one of the standard diagnostic procedures for assessing kidney disability clinically. This method is expected to be used for the same purpose in many kinds of animals, including monkeys utilized in conventional toxicology studies. To establish a practical RRI measurement procedure in cynomolgus monkeys (Macaca fascicularis), RRI was measured by ultrasonography in the spine position in conscious and ketamine-immobilized monkeys. The RRI of conscious monkeys and ketamine-immobilized monkeys could be measured consistently without excessive abdominal or thoracic movement. Consequently, the variability of the RRI in conscious monkeys was comparable to that in ketamine-anesthetized monkeys. No sex difference in RRI was noted between the two conditions. The mean values and SD of the RRI of 48 healthy monkeys (n=24/sex) were 0.55 ± 0.07 and 0.50 ± 0.05, under conscious and ketamine-immobilized conditions, respectively. The RRI of ketamine-immobilized monkeys was significantly lower than that of conscious monkeys, correlating with the decreased blood pressure and heart rate. In a monkey model of cisplatin-induced acute renal injury, which was characterized histopathologically by minimal to mild renal tubular necrosis and regeneration, the RRI was increased beyond the cut off value (mean + 2SD, 0.68) associated with the progression of renal pathogenesis. The present results suggest that ultrasonographic measurement of the RRI in conscious monkeys would be a useful tool in conventional toxicology studies evaluating drug-induced renal injury.

Background and Objectives: Joint immobilization after shoulder surgery can cause an imbalance in the periscapular muscles and affect the kinetic chain throughout the body. There is a difference in core muscle stability because of the asymmetry of the lower extremity muscles. However, the difference due to the asymmetry of the upper-extremity muscles has not been studied extensively. The purpose of this study is to investigate the effect of joint immobilization on the symmetry of the core muscles involved in proximal stability for distal mobility. Materials and Methods: Fifty-five patients who underwent arthroscopic shoulder surgery participated in this study. Core muscle asymmetry (CMA) was measured using a body tilt device. The evaluation variables were analyzed according to the surgical site based on the direction of the core muscle ratio and core muscle state ratio. Results: No differences in CMA were found based on the surgical site (p > 0.05). As a result of the additional subanalysis, significant differences in sex and postoperative day were established (p < 0.05). CMA was low during the intensive postoperative rehabilitation period. However, sex-related differences were greater in males than in females. Conclusions: The clinical results suggest that core muscle training is necessary to reduce CMA during rehabilitation after the immobilization period has elapsed.

Background: Contrast leakage after arthrography is common. We sought to investigate if immobilization could prevent it. Purpose: The purpose of this study was to determine the effects on contrast extravasation and image quality produced by strict immobilization of the shoulder between arthrography puncture and subsequent MR imaging. Material and methods: Fifty patients underwent shoulder MR arthrography using a standard shoulder puncture in the anteroinferior quadrant. Ten milliliters of contrast mixture of saline, iodinated contrast, and gadolinium contrast was injected by a senior musculoskeletal (MSK) radiologist using a 21G needle. Half of the patients were immediately immobilized using a shoulder sling, and the other half were allowed to move their shoulder and arm freely during the time before MR imaging. MR arthrography was performed with a 3 T system using standard T1 and PD weighted sequences. The MR images were reviewed independently by 2 MSK radiologists and graded for extravasation using a five-point scale (1: none, 2: less than 2 cm, 3: 2-5 cm, 4: 5-10 cm, 5: more than 10 cm) and for image quality using a 5 point scale (1: poor, 5: good). The Pearson correlation was calculated to assess the correlation between leakage and image quality. Results: There was no significant difference in amount of leakage between both groups, and global image quality was found equal in both groups. A negative correlation was found between leakage and quality assessment. Conclusion: This study shows that it cannot be avoided by strict shoulder immobilization and that it negatively affects image quality and interpretation.

Background Motor vehicle collisions remain a common cause of spinal cord injury. Biomechanical studies of spinal movement often lack “real world” context and applicability. Additional data may enhance our understanding of the potential for secondary spinal cord injury. We propose the metric ‘travel’ (total movement) and suggest that our understanding of movement related risk of injury could be improved if travel was routinely reported. We report maximal movement and travel for collar application in vehicle and subsequent self-extrication. Methods Biomechanical data on application of cervical collar with the volunteer sat in a vehicle were collected using Inertial Measurement Units on 6 healthy volunteers. Maximal movement and travel are reported. These data and a re-analysis of previously published work is used to demonstrate the utility of travel and maximal movement in the context of self-extrication. Results Data from a total of 60 in-vehicle collar applications across three female and three male volunteers was successfully collected for analysis. The mean age across participants was 50.3 years (range 28–68) and the BMI was 27.7 (range 21.5–34.6). The mean maximal anterior–posterior movement associated with collar application was 2.3 mm with a total AP travel of 4.9 mm. Travel (total movement) for in-car application of collar and self-extrication was 9.5 mm compared to 9.4 mm travel for self-extrication without a collar. Conclusion We have demonstrated the application of ‘travel’ in the context of self-extrication. Total travel is similar across self-extricating healthy volunteers with and without a collar. We suggest that where possible ‘travel’ is collected and reported in future biomechanical studies in this and related areas of research. It remains appropriate to apply a cervical collar to self-extricating casualties when the clinical target is that of movement minimisation.

OBJECTIVES With the Children with Hemiparesis Arm and Hand Movement Project (CHAMP) multisite factorial randomized controlled trial, we compared 2 doses and 2 constraint types of constraint-induced movement therapy (CIMT) to usual customary treatment (UCT). METHODS CHAMP randomly assigned 118 2- to 8-year-olds with hemiparetic cerebral palsy to one of 5 treatments with assessments at baseline, end of treatment, and 6 months posttreatment. Primary blinded outcomes were the assisting hand assessment; Peabody Motor Development Scales, Second Edition, Visual Motor Integration; and Quality of Upper Extremity Skills Test Dissociated Movement. Parents rated functioning on the Pediatric Evaluation of Disabilities Inventory-Computer Adaptive Test Daily Activities and Child Motor Activity Log How Often scale. Analyses were focused on blinded and parent-report outcomes and rank-order gains across all measures. RESULTS Findings varied in statistical significance when analyzing individual blinded outcomes. parent reports, and rank-order gains. Consistently, high-dose CIMT, regardless of constraint type, produced a pattern of greatest short- and long-term gains (1.7% probability of occurring by chance alone) and significant gains on visual motor integration and dissociated movement at 6 months. O’Brien’s rank-order analyses revealed high-dose CIMT produced significantly greater improvement than a moderate dose or UCT. All CIMT groups improved significantly more in parent-reported functioning, compared with that of UCT. Children with UCT also revealed objective gains (eg, 48% exceeded the smallest-detectable assisting hand assessment change, compared with 71% high-dose CIMT at the end of treatment). CONCLUSIONS CHAMP provides novel albeit complex findings: although most individual blinded outcomes fell below statistical significance for group differences, high-dose CIMT consistently produced the largest improvements at both time points. An unexpected finding concerns shifts in UCT toward higher dosages, with improved outcomes compared with previous reports.

The aim of this study was to compare the remaining motion of an immobilized cervical spine using an innovative cervical collar as well as two traditional cervical collars. The study was performed on eight fresh human cadavers. The cervical spine was immobilized with one innovative (Lubo Airway Collar) and two traditional cervical collars (Stifneck and Perfit ACE). The flexion and lateral bending of the cervical spine were measured using a wireless motion tracker (Xsens). With the Weinman Lubo Airway Collar attached, the mean remaining flexion was 20.0 ± 9.0°. The mean remaining flexion was lowest with the Laerdal Stifneck (13.1 ± 6.6°) or Ambu Perfit ACE (10.8 ± 5.8°) applied. Compared to that of the innovative Weinmann Lubo Airway Collar, the remaining cervical spine flexion was significantly decreased with the Ambu Perfit ACE. There was no significant difference in lateral bending between the three examined collars. The most effective immobilization of the cervical spine was achieved when traditional cervical collars were implemented. However, all tested cervical collars showed remaining motion of the cervical spine. Thus, alternative immobilization techniques should be considered.

Refereed/Peer-reviewed Radiotherapy is required to deliver an accurate dose to the tumor while protecting surrounding normal tissues. Breast cancer radiotherapy involves a number of factors that can influence patient setup and error management, including the immobilization device used, the verification system and the patient's treatment position. The aim of this review is to compile and discuss the setup errors that occur due to the above-mentioned factors. In view of this, a systematic search of the scientific literature in the Medline/PubMed databases was performed over the 1990–2021 time period, with 93 articles found to be relevant for the study. To be accessible to all, this study not only aims to identify factors impacting on patient setup analysis, but also seeks to evaluate the role of each verification device, board immobilization and position in influencing these errors.

Summary Several mouse in vivo neuronal recording techniques require head fixation. Head-fixed treadmill walking can be used to design tasks that enable the study of neural activity in the context of behavior. Here, we provide a detailed protocol for constructing a treadmill with tactile spatial cues, training mice on a rewarded behavioral task, and analyzing behavioral data. We discuss common problems and solutions we have developed to optimize training. Finally, we demonstrate how to test spatial memory performance using this task., Graphical abstract, Highlights • Protocol for a rewarded head-fixed treadmill task for mice • Assembly of treadmill and overview of a surgical procedure • Training of mice on head-fixed, rewarded spatial memory tasks • Analysis of reward search by spatial analysis of lick behavior along a treadmill, Several mouse in vivo neuronal recording techniques require head fixation. Head-fixed treadmill walking can be used to design tasks that enable the study of neural activity in the context of behavior. Here, we provide a detailed protocol for constructing a treadmill with tactile spatial cues, training mice on a rewarded behavioral task, and analyzing behavioral data. We discuss common problems and solutions we have developed to optimize training. Finally, we demonstrate how to test spatial memory performance using this task.