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It is well known that scoliosis adversely affects the functions of the upper extremities. However, the acute effect of rigid braces, which are widely used in the conservative treatment of scoliosis, on upper-extremity functionality remains unknown. The aim of this study was to investigate the acute effect of a rigid thoracolumbosacral brace use on upper-extremity functionality in individuals with adolescent idiopathic scoliosis (AIS). Thirty-eight individuals diagnosed with AIS participated in this cross-sectional study, with a mean age of 14.55 ± 1.90 years and a range of 10–18 years. The upper-extremity functionality was assessed using the Nine-Hole Peg Test and handgrip strength, with assessments conducted under both in-brace (with their own braces) and out-of-brace conditions. Nine-Hole Peg Test durations of the AIS patients for the nondominant side were significantly lower for in-brace conditions compared with out-of-brace conditions (p =.049, effect size = 0.136). The grip strength of the nondominant side was significantly higher for in-brace conditions compared with out-of-brace conditions (p =.025, effect size = 0.365). A weak negative correlation was found between the degree of curvature and the grip strength of the dominant side for in-brace conditions (r = −.323, p =.048). It was concluded that the brace had a positive effect on upper-extremity functionality on the nondominant side by both shortening the Nine-Hole Peg Test duration and increasing grip strength. In AIS patients, the brace may positively affect daily living by improving the functionality of the nondominant extremity. [ABSTRACT FROM AUTHOR]

This study focused on explicit instruction and evaluated the differences in task performance between participants who were instructed to employ the change and those who were not. Ninety-three healthy young adults were assigned to the accurate information group (AG; n = 31), misinformation group (MG; n = 31), and non-information group (NG; n = 31). All participants manipulated a mouse to track a moving target on a screen with a cursor. The cursor was rotated to 60° in the clockwise direction from the actual mouse position during the 1st to 5th blocks (i.e., motor adaptation task). Subsequently, in the 6th block (i.e., transfer task), we gradually changed the angle of rotation from 60° to 80° to prevent from noticing the change. Participants in the AG were instructed accurate experimental information. Participants in the MG were instructed that the angle of rotation was 60° during the 1st to 6th blocks. Participants in the NG were instructed to manipulate the cursor movement only. The results indicated that an average error distance in the AG was significantly lower than that in the NG in the 6th block. This study suggested that explicit instruction may impair the transfer of motor adaptation in this setting. [ABSTRACT FROM AUTHOR]

This study evaluated the antiseptic effect of 0.25% chlorhexidine nanoemulsion (NM-Cl) on cat skin and compare its effect with that of 2.0% chlorhexidine digluconate (CS-Cl). NM-Cl was synthesized using the spontaneous emulsification method, and physical and chemical properties were analyzed. The antiseptic effects of NM-Cl and CS-Cl were randomly tested on the thoracic limbs of 10 healthy male cats. After a wide trichotomy of the thoracic limbs, NM-Cl was randomly applied to the trichotomy area of the right (n = 5) or left (n = 5) thoracic limbs. Then, a catheter was inserted aseptically in the cephalic vein. Subsequently, the same procedure was performed using CS-Cl on the contralateral limb. Cutaneous microbiota swab samples were obtained before antisepsis (Tpre); immediately after antisepsis (Tpost); and 4, 8, and 24 h after antisepsis. The collected samples were immediately inoculated on blood agar plates and incubated at 35 ºC ± 2 ºC in aerobiosis. Colony-forming units (CFUs) were manually counted after 24 h of inoculation. The Kruskal–Wallis and Mann–Whitney U tests were performed between groups and within the same group at different sample times, respectively. The NM-Cl and CS-Cl groups showed a reduction in CFUs between Tpre and Tpost in all animals (P < 0.001). Both formulations presented an antiseptic effect 24 h of antisepsis (P < 0.05), and no difference was observed between formulations at different times (P < 0.05). With a lower concentration of chlorhexidine than CS-Cl, NM-Cl presents effective antiseptic action and prolonged residual effect in antisepsis for cat venipuncture. [ABSTRACT FROM AUTHOR]

Aim: To examine factors associated with lower urinary tract symptoms (LUTS) and lower urinary tract dysfunction (LUTD) in children with Duchenne muscular dystrophy (DMD). Methods: This cross‐sectional study included 45 individuals diagnosed with DMD between the ages of 5 and 18 years. LUTS were evaluated with the Dysfunctional Voiding and Incontinence Scoring System, functional levels with the Brooke Upper Extremity Functional Classification and the Vignos Scale, lumbar lordosis angle with a bubble inclinometer, pelvic inclination angles with a digital inclinometer, and muscle strength with a hand‐held dynamometer. Results: The mean age of the children was calculated as 9.00 ± 3.32 years, body weight as 31.10 ± 12.59 kg, and height as 125.87 ± 18.46 cm. LUTD was detected in 20 children (44.44%). There was an association between high LUTD severity and low strength of the following muscles: bilateral hip flexor (Dominant: r = −0.338, p = 0.023; nondominant: r = −0.411, p = 0.005), quadriceps femoris (Dominant: r = −0.445, p = 0.002; nondominant: r = −0.504, p < 0.001), elbow flexor (Dominant: r = −0.461, p = 0.001; nondominant: r = −0.455, p = 0.002), and elbow extensor (Dominant: r = −0.442, p = 0.002; nondominant: r = −0.450, p = 0.002). Upper extremity functionality level was significantly higher in the LUTD‐negative group (p = 0.004). There was no relationship between lumbar lordosis and pelvic inclination angles and LUTS symptoms (p > 0.05). Conclusion: To provide the adequate care for bladder health in children with DMD, it is essential to focus on parameters that will increase functionality and independence in this population. [ABSTRACT FROM AUTHOR]

Background: Longevity is increasing worldwide due to improvements in healthcare and living standards. Aging is often associated with disability and multiple health concerns. To address these challenges, effective interventions are essential. This study investigated potential age-related declines in gait, balance, and strength. We also sought to assess any relationships between these three parameters and explore potential differences between women and men. Methods: Healthy individuals over 50 years of age were recruited for this cross-sectional study. Upper extremity (grip) strength and lower extremity (knee) strength of the dominant side were measured. Static balance was performed on the force plate in different situations each for 30 seconds: bilateral stance with eyes open, bilateral stance with eyes closed, as well as dominant leg and non-dominant leg unilateral stance with eyes open. Gait was measured during level walking using an optical motion capture system. Additionally, the dynamic stability margin (DSM) was calculated for the level walking trials. Results: The study results indicated that gait parameters were not significantly affected by age (p≥0.12), while knee and grip strength, along with several balance parameters, showed a significant decline with age. All individuals were able to maintain their bipedal balance, but their center of pressure movement increased significantly by age (p≤0.028). Z-scores were calculated to compare significant age parameters. Unipedal stance time was found to be the most affected by age compared to other contributing factors (p≤0.001). The duration of unipedal balance showed the most significant change per decade (non-dominant: -0.62 SDs; dominant: -0.53 SDs), while strength measures exhibited the lowest amount of change per decade (grip strength: -0.34 SDs; knee strength: -0.26 SDs). Sex differences were observed exclusively in strength parameters, with no discernible impact on the decline in balance parameters. Conclusions: These findings suggest that the duration of unipedal stance can serve as a reliable and gender-independent measure of neuromuscular aging for both elderly male and female subjects. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONThis meta-analysis aimed to quantify the effect of serious games over conventional therapy on upper-limb activity, balance, gait, fatigue, and cognitive functions in people with multiple sclerosis.Search strategies were developed for PubMed, Embase, Cochrane Library, and Scopus. Studies were selected if participants were adults with multiple sclerosis; the intervention consisted of a virtual reality serious game-based program; the control group received conventional therapy; outcomes included upper limb activity, balance, gait, fatigue, or cognitive functions; and used a randomized controlled trial design. Data were synthesized using a standardized mean difference with a random-effects model.From 2532 studies, seventeen trials were selected (n = 740). Overall, serious games programs effect on upper limb activity, gait, verbal memory, verbal fluency and attention seemed neutral. Balance functions appeared to be improved by semi-immersive virtual reality serious games (SMD = 0.48;95%CI = 0.12–0.84;p = 0.01;I2=0%), fatigue by treadmill serious games (SMD = 0.80;95%CI = 0.40–1.20;p < 0.001) and visuo-spatial memory by semi-immersive virtual reality general cognitive serious games (SMD = 0.35;95%CI = 0.04–0.65;p = 0.03;I2=0%).This review suggests, with a very-low-to-low certainty of evidence, that while some specific serious games may improve balance, fatigue and visuo-spatial memory, their overall effect on upper limb activity, gait, and other cognitive functions appears neutral.Serious games may enhance engagement and adherence to rehabilitation by making the process more interactive and motivating.Their design, which often includes adaptive difficulty levels and relevant feedback, can provide a tailored and dynamic rehabilitation experience for people with multiple sclerosis.Some specific serious games programs involving the use of semi- and non-immersive virtual reality devices seem to lead to benefits in balance, fatigue and visuo-spatial memory.Serious games’ overall effect on activity, gait and other cognitive functions does not seem superior to conventional therapy.Serious games may enhance engagement and adherence to rehabilitation by making the process more interactive and motivating.Their design, which often includes adaptive difficulty levels and relevant feedback, can provide a tailored and dynamic rehabilitation experience for people with multiple sclerosis.Some specific serious games programs involving the use of semi- and non-immersive virtual reality devices seem to lead to benefits in balance, fatigue and visuo-spatial memory.Serious games’ overall effect on activity, gait and other cognitive functions does not seem superior to conventional therapy. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONThe aim of this study was to investigate the efficacy of manual lymphatic drainage (MLD) combined with repetitive transcranial magnetic stimulation (rTMS) on the recovery of upper limb in patients with post-stroke complex regional pain syndrome (CRPS).This pilot study was conducted with 54 patients with post-stroke CRPS. Patients were randomized into three groups: the MLD combined with rTMS group (MLD + rTMS group), the rTMS group and the sham-rTMS group. The results of numeric rating scale (NRS), volumetric measurement, Fugl-Meyer assessment of upper extremity (FMA-UE), CRPS severity score (CSS), generalized anxiety disorder-7 (GAD-7) and patient health questionnaire-9 (PHQ-9) before and after the intervention were analyzed.Fifty-four participants (37 males, 17 females; mean age 66.11 ± 8.43 years; range, 18 to 85) were included in the study. Among groups, improvements were statistically significant with superiority of rTMS + MLD group after treatment (p < 0.05). NRS, GAD-7, and PHQ-9 in the rTMS + MLD group improved more significantly than those in the rTMS group (p < 0.05).MLD combined with rTMS has an add-on efficacy on the basis of rTMS therapy in post-stroke patients, especially in pain. MLD could also have an effect on anxiety and depression.The unclear pathogenesis of complex regional pain syndrome (CRPS) necessitates clinicians to implement tailored rehabilitation measures for its diverse symptoms.The central-peripheral rehabilitation model of manual lymphatic drainage combined with repetitive transcranial magnetic stimulation could help to further improve pain in post-stroke CRPS patients.The unclear pathogenesis of complex regional pain syndrome (CRPS) necessitates clinicians to implement tailored rehabilitation measures for its diverse symptoms.The central-peripheral rehabilitation model of manual lymphatic drainage combined with repetitive transcranial magnetic stimulation could help to further improve pain in post-stroke CRPS patients. [ABSTRACT FROM AUTHOR]

Rodent jaws evolved structurally to support dual functionality, for either biting or chewing food. Rodent hands also function dually during food handling, for actively manipulating or statically holding food. How are these oral and manual functions coordinated? We combined electrophysiological recording of muscle activity and kilohertz kinematic tracking to analyze masseter and hand actions as mice of both sexes handled food. Masseter activity was organized into two modes synchronized to hand movement modes. In holding/chewing mode, mastication occurred as rhythmic (~5 Hz) masseter activity while the hands held food below the mouth. In oromanual/ingestion mode, bites occurred as lower-amplitude aperiodic masseter events that were precisely timed to follow regrips (by ~200 ms). Thus, jaw and hand movements are flexibly coordinated during food handling: uncoupled in holding/chewing mode and tightly coordinated in oromanual/ingestion mode as regrip-bite sequences. Key features of this coordination were captured in a simple model of hierarchically orchestrated mode-switching and intramode action sequencing. We serendipitously detected an additional masseter-related action, tooth sharpening, identified as bouts of higher-frequency (~13 Hz) rhythmic masseter activity, which was accompanied by eye displacement, including rhythmic proptosis, attributable to masseter contractions. Collectively, the findings demonstrate how a natural, complex, and goal-oriented activity is organized as an assemblage of distinct modes and complex actions, adapted for the divisions of function arising from anatomical structure. These results reveal intricate, high-speed coordination of disparate effectors and show how natural forms of dexterity can serve as a model for understanding the behavioral neurobiology of multi-body-part coordination. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to comprehensively review the effects of repetitive peripheral magnetic stimulation (rPMS) alone or in combination with repetitive transcranial magnetic stimulation (rTMS) on improving upper limb motor functions and activities of daily living (ADL) in patients with stroke, and to explore possible efficacy-related modulators. Methods: A literature search from 1st January 2004 to 1st June 2024 was performed to identified studies that investigated the effects of rPMS on upper limb motor functions and ADL in poststroke patients. Results: Seventeen studies were included. Compared with the control, both rPMS alone or rPMS in combination with rTMS significantly improved upper limb motor function (rPMS: Hedge's g = 0.703, p = 0.015; rPMS + rTMS: Hedge's g = 0.892, p < 0.001) and ADL (rPMS: Hedge's g = 0.923, p = 0.013; rPMS + rTMS: Hedge's g = 0.923, p < 0.001). However, rPMS combined with rTMS was not superior to rTMS alone on improving poststroke upper limb motor function and ADL (Hedge's g = 0.273, p = 0.123). Meta-regression revealed that the total pulses (p = 0.003) and the number of pulses per session of rPMS (p < 0.001) correlated with the effect sizes of ADL. Conclusions: Using rPMS alone or in combination with rTMS appears to effectively improve upper extremity functional recovery and activity independence in patients after stroke. However, a simple combination of these two interventions may not produce additive benefits than the use of rTMS alone. Optimization of rPMS protocols, such as applying appropriate dosage, may lead to a more favourable recovery outcome in poststroke rehabilitation. [ABSTRACT FROM AUTHOR]

ABSTRACT Anaplastic lymphoma kinase (ALK)‐positive histiocytosis has emerged as a clinically relevant diagnosis featuring a wide span of clinical presentations, which are unified by the presence of ALK‐positive histiocytes on histopathology and molecular drivers involving the ALK kinase gene. This report presents an adult case of multisystem ALK‐positive histiocytosis with xanthogranuloma‐like features on histopathology that was responsive to ALK inhibition, and includes a review of ALK‐positive histiocytoses with cutaneous involvement reported in the literature. A 56‐year‐old male developed a widespread eruption of red‐brown papules on the face, trunk, and upper extremities. Histopathological evaluation revealed a well‐circumscribed, nodular dermal infiltrate of epithelioid histiocytes with Touton giant cells, rare bizarre multinucleated cells, and focal emperipolesis. The lesional cells were positive for CD68 and ALK1 immunohistochemical stains, and negative for CD1a. Next‐generation sequencing identified a DCTN1::ALK fusion. On imaging, he was found to have bone, lung, soft tissue, and salivary gland involvement. ALK inhibition was initiated with alectinib, resulting in rapid improvement of cutaneous lesions and eventual complete resolution of abnormal imaging findings, which was sustained at 24 months of follow‐up. This case adds to the spectrum of ALK‐positive histiocytoses and further demonstrates the positive response with targeted therapy. [ABSTRACT FROM AUTHOR]

AbstractIndividuals post-stroke commonly demonstrate alterations in motor behavior with regard to both task performance and the motor strategies used in pursuit of task goals. We evaluated whether constraining postural sway (motor strategy) during practice would affect upper-limb precision aiming performance (task performance) and postural control adaptations. Adults with stroke stood on a force plate while immersed in a virtual scene displaying an anterior target. Participants aimed to position a virtual laser pointer (via handheld device) in the target. Participants then completed practice trials involving aiming at a lateral target. For this practice session, participants were randomized to either (a) a “constraint” group wherein they received physical constraint to limit postural sway, or (b) a “no-constraint” group. Task performance and postural control were assessed before and after practice, and transfer to another upper-limb task was evaluated. After practice, both groups improved paretic upper-limb performance. For the target task, the no-constraint group showed task-sensitive changes in postural control. The constraint group showed no changes in postural control. At transfer, the constraint group increased postural sway. Constraining postural sway after stroke should be carefully considered with the recognition that postural sway arises from exploratory movements involved in the discovery of adaptable motor solutions. [ABSTRACT FROM AUTHOR]

Osteochondral fragments within equine joints are commonly encountered and may predispose to lameness and limitation to sport purposes. Factors leading to this condition include genetic, nutritional and environmental conditions. However, few studies have evaluated the impact of conformation traits and their correlation with osteochondrosis. This study, based on the radiographic screenings of young horses born in Wallonia (266 individuals, 532 forelimbs), evaluated the correlation between foot, fetlock conformations of the front limb, height at the withers and presence of osteochondral fragments. Moreover, for all traits significantly associated with the presence of osteochondral fragments, a Receiver Operator Characteristic (ROC) curve, area under the curve and optimal cut-off value were calculated to predict the occurrence of fragments. Mean dorsal hoof wall angle was 52.36°, dorsal and palmar angle of the third phalanx were respectively 49.83° and 2.99°, and dorsal metacarpophalangeal angle 147.99°. Moreover, the prevalence of upright feet, defined as having an inclined profile of >2° steeper in relation to its contralateral counterpart, was 24%. Increased palmar angle of the distal phalanx was significantly correlated (P < 0.05) with presence of fragments located at the dorso-proximal margin of the proximal phalanx. The associated area under the curve was 0.623 (95% CI: 0528–0.717, P < 0.05) and the optimal cut-off value to predict fragment occurrence was 2.95° (sensitivity 77.3%; specificity 52.9%). Furthermore, the third metacarpal bone diameter of the left forelimb and height at the withers were significantly (P < 0.05) correlated with the presence of osteochondral fragments in general and within tarsocrural and metatarsophalangeal joints specifically. The area under the curve was 0.585 (95% CI: 0.513–0.656, P < 0.05) with an optimal cut-off value of 152.5 cm (sensitivity 85.1%; specificity 31.2%) for height at the withers to predict presence of osteochondral fragment; to predict the occurrence of osteochondral fragment in any joint on the basis of the third metacarpal bone diameter, the area under the curve was 0.595 (95% CI: 0.524–0.667, P <0.05) and the optimal cut-off value 34.9 mm (sensitivity 52.5%; specificity 64.9%). This study provides information about phenotypic traits associated with osteochondral fragments in horses. Although the diagnostic accuracy of these traits to detect osteochondral fragment was limited, the identification of more phenotypic characteristics could, in the future, make it possible to generate models for accurately identifying individuals at high risk of osteochondral fragments on the basis of their phenotype. [ABSTRACT FROM AUTHOR]

Horseshoes used during racing are a major determinant of safety as they play a critical role in providing traction with the ground surface. Although excessive hoof slip is detrimental and can predispose to instabilities, falls and injuries, some slip is essential to dissipate energy and lower stresses on the limb tissues during initial loading. This study aimed to quantify hoof slip duration in retired Thoroughbred racehorses galloping over turf and artificial (Martin Collins Activ-Track) tracks at the British Racing School in the following four shoeing conditions: 1) aluminium; 2) steel; 3) GluShu (aluminium-rubber composite); and 4) barefoot. High-speed video cameras (Sony DSC-RX100M5) filmed 389 hoof-ground interactions from 13 galloping Thoroughbreds at 1000 frames per second. A marker wand secured to the lateral aspect of the hoof wall aided tracking of horizontal and vertical hoof position in Tracker software over time, so the interval of hoof displacement immediately following impact (hoof slip duration) could be identified. Data were collected from leading and non-leading forelimbs at speeds ranging from 24–56 km h-1. Linear mixed models assessed whether surface, shoeing condition or speed influenced hoof slip duration (significance at p≤0.05). Day and horse-jockey pair were included as random factors and speed was included as a covariate. Mean hoof slip duration was similar amongst forelimbs and the non-leading hindlimb (20.4–21.5 ms) but was shortest in the leading hindlimb (18.3±10.2 ms, mean ± 2.S.D.). Slip durations were 2.1–3.5 ms (p≤0.05) longer on the turf than on the artificial track for forelimbs and the non-leading hindlimb, but they were 2.5 ms shorter on the turf than on the artificial track in the leading hindlimb (p = 0.025). In the leading hindlimb, slip durations were also significantly longer for the aluminium shoeing condition compared to barefoot, by 3.7 ms. There was a significant negative correlation between speed and slip duration in the leading forelimb. This study emphasises the importance of evaluating individual limb biomechanics when applying external interventions that impact the asymmetric galloping gait of the horse. Hoof slip durations and the impact of shoe-surface effects on slip were limb specific. Further work is needed to relate specific limb injury occurrence to these hoof slip duration data. [ABSTRACT FROM AUTHOR]

Introduction/Aims Methods Results Discussion The hand‐held dynamometer (HHD) is a reliable and portable tool for quantitatively assessing muscle strength. However, a number of variables, including the strength of the tester, the adequacy of stabilization, and the selected testing position, can affect the reliability of the device. The objective of the present study was to examine the reproducibility and inter‐rater reliability of strength assessments using HHD with and without a stabilization device.Strength assessments were conducted with and without the stabilization device by two independent raters. Healthy volunteers with no history of musculoskeletal disorders were included in the study. The strength of the shoulder flexion, scapula elevation, knee extension, and hip abduction muscle groups was evaluated using HHD. The reliability of the measurements was evaluated using intra‐class correlation (ICC), standard error of measurement, and minimal detectable change.Fifty‐two healthy volunteers (age 21.51 ± 2.02 years) participated in the study. The reproducibility was found to be excellent (ICC = 0.89–0.99). While reliability between the assessors was good to excellent (ICC = 0.85–0.93), reliability between assessors and device was found moderate to good (ICC = 0.48–0.78).The strength values obtained for all directions of movement with the stabilization device were found to be significantly higher than those obtained without fixation of the HHD. It can be concluded that the data obtained from the assessors and HHD with stabilization device are not comparable. Moreover, the utilization of a stabilization device may serve to enhance the reliability of the measurements by eliminating the rater effect. [ABSTRACT FROM AUTHOR]

Objectives: The current study aimed to evaluate the effectiveness of using a vibration device to ease pain during upper extremity injections. Specifically, the study aims to compare the pain levels of patients who receive the injection with and without the use of vibration therapy. The results of this study may have implications for improving patient outcomes and satisfaction during routine injection procedures. Material and Methods: This randomized controlled trial included patients aged 18 years or older who were scheduled to receive an injection in the upper extremity. A total of 60 patients were enrolled and randomized to either the intervention group or the control group using a computer‑generated randomization sequence. The level of satisfaction and pain levels were assessed using a visual analog scale. The study was conducted in accordance with the Declaration of Helsinki and approved by the institutional review board. Results: The mean pain score immediately after the injection was 4.03 ± 2.11 out of 10 in the vibration group (n = 30), compared to 7.4 ± 1.37 out of 10 in the control group (n = 30) (P < 0.001). Patients in the vibration group also reported higher levels of satisfaction and comfort during the injection (P < 0.001). No adverse events were reported in either group. Conclusion: Our study proves that using a vibration device during upper extremity injections can effectively reduce postinjection pain and improve patient satisfaction. Further research is needed to explore this intervention’s long‑term effects and feasibility in different clinical settings. [ABSTRACT FROM AUTHOR]

Simple Summary: The Korean raccoon dog (Nyctereutes procyonoides koreensis) is an important species in Korea. However, there has been little research about its joint anatomy. In this study, we investigated the anatomy of the limb joints of the Korean raccoon dog using joint orientation angles, a method frequently used in humans, dogs, and cats. The findings of this study should be helpful not only for individual therapies, such as fracture repair, but also for comparative anatomy. Furthermore, this study is the first to measure joint orientation angles in wild animals such as the Korean raccoon dog, making it a useful reference for measurements in other wild canids. Studies are being conducted on the anatomical structures of various wild animals. Despite the ecological importance of the Korean raccoon dog (Nyctereutes procyonoides koreensis), limited research has been conducted on its anatomical structure. This study is the first to establish a reference range for joint orientation angles in the limbs of the Korean raccoon dog. Joint orientation angles are an unexplored concept not only in Korean raccoon dogs but also in other wildlife. However, they are important in the examination of the skeletal anatomy of humans and companion animals, such as dogs and cats. Because this type of measurement is still emerging in wildlife research, we applied the methodology used in the domestic dog (Canis lupus familiaris). Angles were measured between the mechanical or anatomical axis and the joint orientation lines in the thoracic and pelvic limbs of Korean raccoon dogs. No significant differences were observed between the sexes or between the left and right sides. These findings are consistent with those observed in domestic dogs. Based on this study, a reference range of joint orientation angles could be established for Korean raccoon dogs. [ABSTRACT FROM AUTHOR]

Background: High-energy distal radius fractures have not been as well studied as the more common osteoporotic fractures. Differences between these two groups of fractures have implications on the prevention and clinical management of such injuries. Methods: A retrospective review was conducted of all patients in our institution who presented with distal radius fractures within the period of a year. Demographic data, injury mechanism, fracture classification, associated injuries and work-related status were obtained and analysed. Results: High energy fractures made up 27.1% of the cases. Falls from height were the most common cause, followed by motor vehicle accidents. These high-energy fractures were more commonly seen in males, younger patients (average age 41 vs. 61 years), and in workplace accidents. These injuries were also more likely to be bilateral and associated with an additional ipsilateral upper extremity injury. The high-energy group was also more likely to have an AO type B fracture. Conclusions: A substantial proportion of distal radius fractures seen in our population are high-energy injuries. Their contrasting patient and injury profiles suggest that they should be considered separately from osteoporotic fractures. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

The early diversification of tetrapods into terrestrial environments involved adaptations of their locomotor apparatus that allowed for weight support and propulsion on heterogeneous surfaces. Many lineages subsequently returned to the water, while others conquered the aerial environment, further diversifying under the physical constraints of locomoting through continuous fluid media. While many studies have explored the relationship between locomotion in continuous fluids and body mass, none have focused on how continuous fluid media have impacted the macroevolutionary patterns of limb shape diversity.We investigated whether mammals that left terrestrial environments to use air and water as their main locomotor environment experienced constraints on the morphological evolution of their forelimb, assessing their degree of morphological disparity and convergence. We gathered a comprehensive sample of more than 800 species that cover the extant family‐level diversity of mammals, using linear measurements of the forelimb skeleton to determine its shape and size.Among mammals, fully aquatic groups have the most disparate forelimb shapes, possibly due to the many different functional roles performed by flippers or the relaxation of constraints on within‐flipper bone proportions. Air‐based locomotion, in contrast, is linked to restricted forelimb shape diversity. Bats and gliding mammals exhibit similar morphological patterns that have resulted in partial phenotypic convergence, mostly involving the elongation of the proximal forelimb segments.Thus, whereas aquatic locomotion drives forelimb shape diversification, aerial locomotion constrains forelimb diversity. These results demonstrate that locomotion in continuous fluid media can either facilitate or limit morphological diversity and more broadly that locomotor environments have fostered the morphological and functional evolution of mammalian forelimbs. Read the free Plain Language Summary for this article on the Journal blog. [ABSTRACT FROM AUTHOR]

A comprehensive description of the histology of 10 postcranial bones taken from Liaoningvenator curriei (holotype: DNHM D3012) is presented. Corresponding bone samples were sectioned to a thickness of 30 micrometres. The sections were then examined using transmitted and crossed-polarised light microscopes and photographed using an adapted camera and associated capture software. The study reveals that DNHM D3012 was a subadult approaching adulthood, certainly in its fifth year at the time of death. The comparisons of the different sections revealed that in L. curriei (DNHM D3012), the bones from forelimb elements grew faster than those from hind limb elements, this growth strategy likely being linked to its ground-dwelling locomotion. Interspecific comparisons with those other deinonychosaurs and basal avialans suggest that L. curriei (DNHM D3012) exhibits a transitive growth pattern between basalmost, smaller forms of troodontid, and more derived forms that got larger by extending the period of fast growth. [ABSTRACT FROM AUTHOR]

We present a case of a 58-year-old male who presented following 4 months of progressively worsening right upper extremity pain. Initial pathology demonstrated pleomorphic chondroblasts with increased mitotic activity indicating an intermediate grade (Grade 2) clear cell chondrosarcoma of the proximal humerus. Following surgical resection, the primary lesion demonstrated aggressive behavior and early metastasis to the cervical and thoracic spine. The patient unfortunately expired 30 months after initial presentation. Although clear cell chondrosarcoma has been historically regarded as low grade, we present a unique example of an aggressive clinical course of clear cell chondrosarcoma. [ABSTRACT FROM AUTHOR]

Traumatic upper extremity injuries are a common cause of emergency department visits, comprising between 10-30% of traumatic injury visits. Timely and accurate evaluation is important to prevent severe complications such as permanent deformities, ischemia, or even death. Computed tomography (CT) and CT angiography (CTA) are the favored non-invasive imaging techniques for assessing upper extremity trauma, playing a crucial role in both the treatment planning and decision-making processes for such injuries. In CT postprocessing, a novel 3D rendering method, cinematic rendering (CR), employs sophisticated lighting models that simulate the interaction of multiple photons with the volumetric dataset. This technique produces images with realistic shadows and improved surface detail, surpassing the capabilities of volume rendering (VR) or maximal intensity projection (MIP). Considering the benefits of CR, we demonstrate its use and ability to achieve photorealistic anatomic visualization in a series of 11 cases where patients presented with traumatic upper extremity injuries, including bone, vascular, and skin/soft tissue injuries, adding to diagnostic confidence and intervention planning. [ABSTRACT FROM AUTHOR]

Ballistic shields protect users from a variety of threats, including projectiles. Shield back-face deformation (BFD) is the result of the shield deflecting or absorbing a projectile and deforming toward the user. Back-face deformation can result in localized blunt loading to the upper extremity, where the shield is supported by the user. Two vulnerable locations along the upper extremity were investigated—the wrist and elbow—on eight postmortem human subjects (PMHS) using a pneumatic impacting apparatus for investigating the fracture threshold as a result of behind shield blunt trauma (BSBT). Impacting parameters were established by subjecting an augmented WorldSID anthropomorphic test device (ATD) positioned behind a ballistic shield to ballistic impacts. These data were used to form the impact parameters applied to PMHS, where the wrist most frequently fractured at the distal radius and the elbow most frequently fractured at the radial head. The fracture threshold for the wrist was 5663±1386 N (mean±standard deviation), higher than the elbow at 4765±894 N (though not significantly, p = 0.15). The failure impact velocity for wrist impacts was 17.7±2.1 m/s, while for the elbow, the failure impact velocity was 19.5±0.9 m/s. An approximate 10% risk of fracture threshold was identified on the modified WorldSID ATD (no flesh analogue included) to inform future protective standards. [ABSTRACT FROM AUTHOR]

Upper extremity infections are frequently seen, especially in individuals with weakened immune system, posttraumatic events, and after surgery procedures. If not properly treated, such conditions can lead to serious consequences, such as movement impairment, amputation, and even mortality. These infections have the potential to spread extensively from their initial site of entry, traversing interconnected spaces either intra or extra-compartmental. Understanding the relevant anatomy is crucial to assess location and stage of infection, since surgical intervention and intravenous antibiotics are usually required. In this article, the authors provide a comprehensive review of the imaging findings of upper extremity infection, focusing on magnetic resonance imaging (MRI). Furthermore, this article sheds light on the pivotal role of radiology in managing hand, elbow, and shoulder infections offering an overview of available treatment options. Key findings: Various types of infections affecting the upper extremity will be discussed, including infectious tenosynovitis, deep space infections, septic arthritis, and osteomyelitis. Authors also highlight anatomical spaces, common pathogens, spread routes, and key radiological features of these conditions. [ABSTRACT FROM AUTHOR]

An 11‐year‐old Belgian shepherd presented with progressive right thoracic limb lameness. Computed tomography and magnetic resonance imaging revealed a brachial plexus neoplasm and cytology was suggestive of a sarcoma. The patient underwent forequarter amputation and hemilaminectomy of the fifth cervical to first thoracic vertebrae with nerve root transection. Histopathology confirmed extraskeletal osteosarcoma. Twelve months post‐operatively, the dog was exercising normally, and computed tomography did not identify local recurrence or metastatic disease. This is the first recorded case of canine brachial plexus extraskeletal osteosarcoma. [ABSTRACT FROM AUTHOR]

This study investigated alterations in functional connectivity (FC) within cortico–basal ganglia–thalamo–cortical (CBTC) circuits and identified critical connections influencing poststroke motor recovery, offering insights into optimizing brain modulation strategies to address the limitations of traditional single‐target stimulation. We delineated individual‐specific parallel loops of CBTC through probabilistic tracking and voxel connectivity profiles‐based segmentation and calculated FC values in poststroke patients and healthy controls, comparing with conventional atlas‐based FC calculation. Support vector machine (SVM) analysis distinguished poststroke patients from controls. Connectome‐based predictive modeling (CPM) used FC values within CBTC circuits to predict upper limb motor function. Poststroke patients exhibited decreased ipsilesional connectivity within the individual‐specific CBTC circuits. SVM analysis achieved 82.8% accuracy, 76.6% sensitivity, and 89.1% specificity using individual‐specific parallel loops. Additionally, CPM featuring positive connections/all connections significantly predicted Fugl‐Meyer assessment of upper extremity scores. There were no significant differences in the group comparisons of conventional atlas‐based FC values, and the FC values resulted in SVM accuracy of 75.0%, sensitivity of 67.2%, and specificity of 82.8%, with no significant CPM capability. Individual‐specific parallel loops show superior predictive power for assessing upper limb motor function in poststroke patients. Precise mapping of the disease‐related circuits is essential for understanding poststroke brain reorganization. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to provide information on the training profile and characteristics of injuries sustained by obstacle course racing competitors. Methods: This research is a nationwide cross-sectional, self-administered online survey conducted in 2023. Results: We analyzed the data collected from 201 obstacle course racing participants (mean age: 33.8 ± 7.1 years; 60.7% men). On average, athletes had 2.9 ± 2.4 years of obstacle course racing experience and participated in approximately four races in the previous year. Most of these races covered distances of 5–10 km (65.2%). Among the participants, 28.4% reported injuries, with the upper extremities being the most frequently affected. Approximately 19% of these injuries required medical supervision, and 2% led to hospitalization. Conclusion: Injury risk in obstacle course racing participants was associated with participation in a higher number of obstacle course racing competitions, reduced time between these competitions and having performed specific obstacle training. [ABSTRACT FROM AUTHOR]

Background: Magnetic resonance imaging (MRI) is a noninvasive diagnostic tool that is commonly used to visualize soft tissues and anatomical structures. Many patients who undergo MRI scans experience anxiety. This multicenter study was conducted to assess anxiety levels experienced by patients who underwent MRI scans in the Palestinian radiology departments and identify the risk factors associated with higher levels of anxiety experienced by the patients. Methods: This multicenter cross-sectional study was conducted in the radiology departments of different hospitals in the West Bank of Palestine using a questionnaire. The questionnaire collected different demographic data of the patients. A 100-mm visual analog scale (VAS) was used to assess the level of anxiety experienced by the patients who received MRI scans. The data were analyzed using SPSS version 28. Results: A total of 383 patients participated in this study. Of the patients, 255 (66.6%) reported experiencing low, moderate, or high anxiety levels during the MRI scan. The median anxiety was 20.0 with an interquartile range (IQR) of 0.0–50.0 as measured using the 100-mm VAS. Higher anxiety levels were reported by the patients who were female (p-value < 0.001), unemployed (p-value = 0.009), and did not receive an MRI scan before (p-value = 0.001). In addition, the patients who received pelvis scans reported higher levels of anxiety compared to those who received scans for upper extremities (p-value = 0.031), abdomen (p-value = 0.033), pelvis (p-value = 0.043), and lower extremities (p-value = 0.016). In addition, the patients who received scans for the head/neck reported higher levels of anxiety compared to the patients who received scans for the lower extremities (p-value = 0.021). Conclusion: The findings of this study showed that a considerable proportion of the patients who received MRI scans in Palestinian hospitals experience anxiety. Radiologists and other decision-makers in the healthcare system should design effective measures to reduce anxiety and improve the experiences of patients who are female, unemployed, and those who are scheduled to receive MRI scans for the first time. Moreover, these interventions should particularly focus on the patients who are scheduled to receive scans for the pelvis and head/neck. [ABSTRACT FROM AUTHOR]

Background: Over 80% of people who experience a stroke present with residual impairment of the upper extremity, such as the shoulder, elbow, wrist, and hand. However, rarely do stroke rehabilitation practitioners (e.g., occupational therapists) use standardized outcome measures to objectively evaluate upper extremity function. Accordingly, the purpose of this project was to develop a bundle of implementation strategies that supports practitioners' adoption of the Fugl-Meyer Assessment of the Upper Extremity in stroke rehabilitation practice. Methods: We used tenets of Implementation Mapping to guide the development of our implementation strategy bundle. We partnered with one, large academic health system serving over 200 stroke patients annually through intensive rehabilitation care. Strategies were selected and developed through a multi-method process that included a review of the literature, qualitative input from our health system's practitioners and managers, and expert consultation. We also specified the hypothesized implementation "mechanisms" our strategies intended to change. Practitioners' adoption (yes/no) of the Fugl-Meyer Assessment was calculated by analyzing electronic health record documentation of the 6-month time frame before strategies were deployed compared to the 6-month time frame after deployment. Results: Practitioners were exposed to the following implementation strategies to support Fugl-Meyer adoption: conduct educational meetings, prepare outcome measure champions, provide equipment, develop training materials, and adapt documentation systems. In the 6-months before deployment of our implementation strategies, practitioners implemented the Fugl-Meyer with 14.8% of stroke patients. In the six months after deployment, adoption of the Fugl-Meyer increased to 73.8% (p <.001). Conclusions: When systematically developed in collaboration with health system partners, a bundle of implementation strategies may support outcome measure adoption in stroke rehabilitation. Improving the use of standardized outcome measures is of paramount importance in stroke rehabilitation to objectively monitor patients' progress or decline, to demonstrate the value of rehabilitation services for enhancing patients' recovery, and to advocate for continued reimbursement for rehabilitation care. Future opportunities lie in further specifying the mechanisms through which implementation strategies are intended to work and how those mechanisms contribute to strategy effectiveness. Trial registration: NCT registration: NCT04888416; May 06, 2021. [ABSTRACT FROM AUTHOR]

AbstracteHealth solutions at home are gaining interest and relevance in healthcare; however, they face challenges in sustaining motivation for therapy due to difficulties in creating meaningful connections between technology and people receiving care. In this article, we explore how embodied agents in eHealth interventions could be designed to establish a motivating relationship with people in the context of home-based stroke rehabilitation. We studied this potential by referring to the need for social relatedness in Self-Determination-Theory (SDT) and how this translates to the design of embodied agents’ characters, the collaborations they afford and the partnerships they establish over time. In co-creative ideation sessions with stroke survivors, this potential was explored, resulting in an interactive prototype of ‘Edo the Coach’, i.e. an embodied agent for home-based upper extremity stroke rehabilitation that was evaluated by stroke survivors in their home contexts. Based on the insights gained, we reflect on the potential of using SDT for designing embodied agents that foster motivational relationships between patient and agent as an answer to the growing demand for eHealth-supported self-care within an increasingly digitized healthcare context. [ABSTRACT FROM AUTHOR]

Pediatric spinal cord injury (SCI) most commonly affects the cervical region. Central cord syndrome most often occurs in the lower cervical injury due to hyperextension injury, while anterior cord syndrome is primarily due to vascular infarction after hyperextension injury. An unusual case of a pediatric patient who physically presented with central cord syndrome but radiologically had evidence of anterior spinal artery syndrome is described.A two-year-old male presented after a fall from three feet with flaccid upper extremities and dysesthesias but maintained functional strength in bilateral lower extremities. Although his clinical presentation was that of central cord syndrome, he was found to have an anterior spinal artery infarct spanning from C2-T3 with a ligamentous injury at C3 and an incidental finding of Chiari I malformation on MRI. Given the negative evaluation for a cardiac or hematologic source of embolus and normal angiography, it was theorized that compression of vertebral arteries by previously undiagnosed Chiari I malformation in the setting of trauma could have made the patient more vulnerable to this complication. During inpatient rehabilitation, he regained scapular movement and shoulder flexion. However, he regained distal movement in supination, wrist extension, and finger flexion instead of the more usual proximal-to-distal motor recovery observed in SCI. While he had a relative sparing of strength in his legs, he had impaired proprioception and balance, leading to gait impairment.This case highlights the complexity of pediatric cervical SCI diagnosis and prognostication. While classic SCI subtypes are well described, many pediatric and adult patients will present and recover in unexpected ways. All with SCI should be evaluated thoroughly for common etiologies and transitioned to rehabilitation therapies to assist in recovery. [ABSTRACT FROM AUTHOR]

Acquired angioedema with low C1‐inhibitor (AAE‐C1‐INH) is a rare disorder characterized by an acquired deficiency in the C1 esterase inhibitor (C1‐INH). This case report describes a 79‐year‐old patient presenting to the emergency department for painless swelling of his scrotum, penile shaft, and left lower and upper extremities with lab values consistent with acquired angioedema without identifiable lymphoreticular or rheumatic disorder on history, exam, or total body PET scan. Proper diagnosis of AAE‐C1‐INH is essential to prevent life‐threatening airway compromise, ensure proper therapy, and exclude lymphoreticular disorders as the etiology of AAE‐C1‐INH. [ABSTRACT FROM AUTHOR]

Facilitating the restoration of upper limb functionality is a key objective of stroke rehabilitation. This study aimed to compare the effects of boxing and scapular stabilization training on scapular mobility, balance angle, muscle strength, motor function, and satisfaction in hemiparetic patients. A total of sixty patients were randomly assigned to one of three groups: the boxing group (BG; n = 20), the scapular stabilization group (SSG; n = 20), or the control group (CG; n = 20) which received no treatment at all. Each treatment group participated in three sessions per week for a total of eight weeks. The scapular mobility, balance angle (SBA), muscle strength, upper extremity motor functions (Manual Function Test-MFT), and treatment satisfaction were evaluated. The BG group showed greater improvements in the SBA (F = 59,951; p = 0.000; η2 = 0.682), mobility-frontal plane (F = 7998; p = 0.000; η2 = 0.222), mobility-sagittal plane (F = 91,632; p = 0.000; η2 = 0.766), and mobility-transverse plane (F = 48,713; p = 0.000; η2 = 0.635) than did the CG group. BG strengthened the serratus anterior (F = 42,227; p = 0.000; η2 = 0.601), while SSG strengthened the infraspinatus (F = 31,772; p = 0.000; η2 = 0.532) more than did CG. Compared with those in the SSG, supraspinatus (F = 52,589; p = 0.000; η2 = 0.653), upper trapezius (F = 42,890; p = 0.000; η2 = 0.605), anterior deltoideus (F = 30,844; p = 0.000; η2 = 0.524), latissimus dorsi (F = 84,345; p = 0.000; η2 = 0.751), MFTs (F = 52,363; p = 0.000; η2 = 0.652) and satisfaction (p = 0.008) were greater in the BG. Both approaches had a beneficial impact on the recovery process. However, boxing training was more effective than scapular stabilization training for several parameters. Clinical Trial Number: NCT05568173 date 5/10/2022. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify the type of veterinary care sought by handlers of injured agility dogs, the types of treatments the dogs received, and the timeframe for return to training and competition. Procedures: Owners of agility dogs completed an internet-based survey. They were instructed to report injuries that had kept the dog from training or competing for over a week, identify which area(s) of the body had been injured and answer questions about the most severe injury to each body part. Additional questions included if handlers had sought veterinary care, who primarily determined treatment, type of treatment(s), and length of time before the dog could return to full training and competition. Results: This sample included data on 1,714 total injuries from 1,256 unique dogs. Handlers sought veterinary care for over 80% of injuries across all anatomical locations. Handlers were most likely to seek specialty veterinary care for reported injuries to the stifle (71%), iliopsoas (63%) and tibia (61%), and least likely for reported injuries to the carpus (34%), metatarsus (33%) and metacarpus (22%). Treatment of reported injuries to the antebrachium and stifle were most likely to be directed by a veterinarian (>70%), while reported injuries of the thigh (51%) and hip (53%) were least likely. Rest was the most common treatment for all injuries. Return to sport within 3 months was common (>67%) for most perceived injury locations, though dogs with reported stifle injuries took longer to return to competition and had a higher rate of retirement. Conclusion and clinical relevance: Owners of agility dogs have a high rate of seeking veterinary care for injuries. Overall return to sport rates were high, with the stifle being the notable exception. Future studies regarding specific treatment of injuries in agility dogs, and how injuries and their treatment affect return to agility after injury are required to provide optimal care protocols for these canine athletes. [ABSTRACT FROM AUTHOR]

Introduction Recovering from neuromuscular injuries or conditions can be a challenging journey that involves complex surgeries and extensive physical rehabilitation. During this process, individuals often rely on orthotic devices to support and enable movement of the affected limb. However, users have criticized current commercially available powered orthotic devices for their bulky and heavy design. To address these limitations, we developed a novel powered myoelectric elbow orthosis. Materials and Methods The orthosis incorporates 3 mechanisms: a solenoid brake, a Bowden cable-powered constant torque elbow mechanism, and an extension limiter. The device controller and battery are in a backpack to reduce the weight on the affected arm. We performed extensive calculations and testing to ensure that the orthosis could withstand at least 15 Nm of elbow torque. We developed a custom software effectively control the orthosis, enhancing its usability and functionality. A certified orthotist fitted a subject who had undergone a gracilis free functioning muscle transfer surgery with the device. We studied the subject under Mayo clinic IRB no. 20-006849 and obtained objective measurements to assess the orthosis's impact on upper extremity functionality during daily activities. Results The results are promising since the orthosis significantly improved elbow flexion range of motion by 40° and reduced compensatory movements at the shoulder (humerothoracic joint) by 50°. Additionally, the subject was able to perform tasks which were not possible before, such as carrying a basket with weights, highlighting the enhanced functionality provided by the orthosis. Conclusion In brief, by addressing the limitations of existing devices, this novel powered myoelectric elbow orthosis offers individuals with neuromuscular injuries/conditions improved quality of life. Further research will expand the patient population and control mechanisms. [ABSTRACT FROM AUTHOR]

Three-dimensional (3D) motion analysis (MA) techniques are progressively being used in biomechanics research and for clinical applications to assess the risk of injuries. A marker-based 3D MA protocol has been developed to measure the upper and lower extremity (UE and LE) joints' active and passive ranges of motion (AROM and PROM) in children. The joints that were included in this protocol are shoulder, elbow, wrist, hip, knee and ankle. The anatomical joint coordinate systems (JCS) have been defined for the upper and lower extremities to standardize reporting. A marker placement model was defined according to the International Society of Biomechanics (ISB) recommendations and used to develop the protocol. The proposed movements will be captured and analyzed using the Motion Analysis Corporations 3D MA system integrated with Cortex software. The movements adopted in this study have been selected from various sources to incorporate all joint rotations while ensuring the isolation of each joint motion during the movements. It is recommended that future studies utilize this protocol to draw a relationship between the joints' range of motion (ROM) and the adjacent segments characteristics, i.e., segment length, joint stiffness, etc. [ABSTRACT FROM AUTHOR]

Introduction: Stroke-induced upper limb disabilities can be characterized by both motor impairments and activity limitations, commonly assessed using Fugl-Meyer Motor Assessment for Upper Extremity (FMMA-UE) and Action Research Arm Test (ARAT), respectively. The relationship between the two assessments during recovery is largely unstudied. Expectedly they diverge over time when recovery of impairment (restitution) plateaus, but compensationdriven improvements still occur. The objective of this study is to evaluate the alignment between FMMA-UE and ARAT in defining upper limb functional recovery categories by ARAT scores. We aimed to establish cut-off scores for both measures from the acute/early subacute, subacute and chronic stages of stroke recovery. Methods: Secondary analysis of four prospective cohort studies (acute/early subacute: n = 133, subacute: n = 113, chronic: n = 92) stages post-stroke. Receiver operating characteristic curves calculated the area under the curve (AUC) to establish optimal FMMA-UE cut-offs based on predefined ARAT thresholds distinguishing five activity levels from no activity to full activity. Weighted kappa was used to determine agreement between the two assessments. We used minimally clinically important difference (MCID) and minimal detectable change (MDC95) for comparison. Results: FMMA-UE and ARAT scores showed no relevant divergence across all recovery stages. Results indicated similar cut-off scores in all recovery stages with variability below MCID and MDC95 levels. Cut-off scores demonstrated robust AUC values from 0.77 to 0.86 at every recovery stage. Only in highly functional patients at the chronic stage, we found a reduced specificity of 0.55. At all other times sensitivity ranged between 0.68 and 0.99 and specificity between 0.71 and 0.99. Weighted kappa at the acute/early subacute, subacute and chronic stages was 0.76, 0.83, and 0.81, respectively. Discussion: Our research shows a strong alignment between FMMA-UE and ARAT cut-off scores throughout stroke recovery, except among the subgroup of highly recovered patients at the chronic stage. Discrepancies in specificity potentially stem from fine motor deficits affecting dexterity outcomes that are not captured by FMMA-UE. Additionally, the high congruence of both measures suggests they are not suited to distinguish between restitution and compensation. Calling for more comprehensive assessment methods to better understand upper limb functionality in rehabilitation. [ABSTRACT FROM AUTHOR]

Introduction: Work-related musculoskeletal disorders (WMSDs) remain a significant occupational health issue across various industries, particularly in manufacturing, where ergonomic risk factors (ERFs) are prevalent. These disorders can lead to long-term discomfort, disability, and reduced productivity, making the identification and mitigation of ERFs critical for safeguarding workers' health. This study aimed to determine the prominent ERFs and the prevalence of WMSDs among workers in a solvent manufacturer in Shah Alam. Materials and methods: This study was conducted among 130 workers of a solvent manufacturer. The selection of workstations was done by a stratified sampling method. A self-administered Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) was used to assess musculoskeletal discomfort among workers. In addition, Initial Ergonomic Assessment (IERA) was performed in all four departments to identify the prominent ERFs among the workers. The obtained data was analyzed using descriptive analysis, Chi-Square and Multiple Logistic Regression Results: Most of the participants were in the age range of 31 to 40 years old. Among the participants, the prominent ERFs were awkward posture, static and sustained work posture, forceful exertion and repetitive motion. The prevalence of WMSDs was 58.5%, with the highest was on the neck (40.8%) followed by right shoulder (28.5%), upper back (17.7%) and left shoulder (11.5%) respectively. The following ERFs were found to have a statistically significant association (p<0.05) with WMSDs: awkward posture (p= 0.000, OR=27.133), static and sustained work posture (p= 0.004, OR=2.985), forceful exertion (p= 0.033, OR=0.394) and repetitive motion (p= 0.033, OR=2.538). Conclusion: This study identified four prominent ERFs with neck being the most affected area with WMSDs among workers in the solvent manufacturing factory. The ERFs were highly associated with the prevalence of WMSDs which shows that it is critical to conduct further investigation and changes on the working methods to decrease the exposure level. An immediate intervention can be executed such as conducting ergonomics awareness training on proper working postures on a regular basis to ensure the reduction of ERFs among the workforces. It is recommended to use Rapid Upper Limb Assessment (RULA) to evaluate the exposure of individual workers to ERFs associated with upper extremity WMSDs. [ABSTRACT FROM AUTHOR]

Background The arteriovenous access stage (AVAS) classification provides evaluation of upper extremity vessels for vascular access (VA) suitability. It divides patients into classes within three main groups: suitable for native fistula (AVAS1) or prosthetic graft (AVAS2), and patients not suitable for conventional native or prosthetic VA (AVAS3). We validated this system on a prospective dataset. Methods A prospective, international observational study (NCT04796558) involved 11 centres from 8 countries. Patient recruitment was from March 2021 to January 2024. Demographic data, risk factors, vessels parameters, VA types, AVAS class and early VA failure were collected. Percentage agreement was used to assess predictive ability of AVAS (comparison of AVAS and created VA) and consistency of AVAS assessment between evaluators. Pearson's Chi-squared test was used for comparison of early failure rate of conventional (predicted by AVAS) and unconventional (not predicted by AVAS) VA. Results From 1034 enrolled patients, 935 had arteriovenous fistula or graft, 99 patients did not undergo VA creation due opting for alternative renal replacement therapies, experiencing health complications, death or non-compliance. AVAS1 had 91.2%, AVAS2 7.2% and AVAS3 1.6% of patients. Agreement between evaluators was 89%. The most frequently created VAs were radial-cephalic (46%) and brachial-cephalic (27%) fistulae. The accuracy of AVAS versus created access was 79%. In comparison, VA predicted by clinicians versus created access was 62.1%. Inaccuracy of AVAS prediction was more common with higher AVAS classes, and the most common reason for inaccuracy was creation of distal VA despite less favourable anatomy (17%). Patients with unconventional VA had higher early failure rate than patients with conventional VA (20% vs 9.3%, respectively, P  = .002) Conclusion AVAS is effective in predicting VA creation, but overall accuracy is reduced at higher AVAS classes when the complexity of decision-making increases and proximal vessels require preservation. When AVAS was followed by clinicians, early failure was significantly decreased. [ABSTRACT FROM AUTHOR]

Fractures of long bones in limbs are rare traumatic events in horses. This study investigates whether the incidence and types of fractures can be related to the histomorphometric features of the radius and tibia, which experience different biomechanical stresses and exhibit varying incidences and types of fractures. Clinical observations suggest that, in adults, slightly transverse and comminuted fractures are present in the radius, while the tibia shows a higher frequency of longitudinal and spiral fractures. Microscopic observations reveal no apparent distinctive characteristics between the radius and tibia, whereas the histomorphometric data highlight differences in the osteon density, eccentricity, and diameters of the osteons and Haversian canals. To sum up, tibial osteons are more numerous and smaller than those in the radius, resulting in a 15% higher total extension of the cement line in the tibia compared to the radius. These histomorphometric differences are an evolutionary adaptation to the different biomechanical stresses that involve the thoracic and pelvic limbs. Our results could help better understand numerous clinical realities detectable through retrospective analyses and aid in evaluating a specific bone's predisposition towards traumatic events in all mammals, including humans. [ABSTRACT FROM AUTHOR]

Osteosynthesis is a surgical technique performed in bone fractures for the reduction of bone fragments and their stabilization in a suitable position, allowing the patient to recover their motor activity. This report deals with the case of a giant anteater in the municipality of Yopal, Colombia, which was admitted to the veterinary service due to a thoracic limb injury caused by a car accident. The treatment performed was surgical, after a fracture of the radio-ulnar diaphysis was diagnosed. Resolution was carried out through osteosynthesis of both bone structures with a double locking titanium plate system under an anesthetic plan of 4 mg/Kg ketamine, 0.025 mg/kg dexmedetomidine and 0.1 mg/Kg midazolam. Maintenance was performed with isoflurane at a rate of 3% at the beginning of anesthesia and 1.5% as maintenance. The reduction of the fracture using the aforementioned technique resulted in its effective stabilization. The real and growing problem of bone fractures affects different wild fauna that move in search of food, water or shelter, directly threatening biodiversity. [ABSTRACT FROM AUTHOR]

Birds have remarkable flight capabilities due to their adaptive wing morphology. However, studying live birds is time-consuming and laborious, and obtaining information about the complete wingbeat cycle is difficult. To address this issue and provide a complete dataset, we recorded comprehensive motion capture wing trajectory data from five free-flying pigeons (Columba livia). Five key motion parameters are used to quantitatively characterize wing kinematics: flapping, sweeping, twisting, folding and bending. In addition, the forelimb skeleton is mapped using an open-chain three-bar mechanism model. By systematically evaluating the relationship of joint degrees of freedom (DOFs), we configured the model as a 3-DOF shoulder, 1-DOF elbow and 2-DOF wrist. Based on the correlation analysis between wingbeat kinematics and joint movement, we found that the strongly correlated shoulder and wrist roll within the stroke plane cause wing flap and bending. There is also a strong correlation between shoulder, elbow and wrist yaw out of the stroke plane, which causes wing sweep and fold. By simplifying the wing morphing, we developed three flapping wing robots, each with different DOFs inside and outside the stroke plane. This study provides insight into the design of flapping wing robots capable of mimicking the 3D wing motion of pigeons. [ABSTRACT FROM AUTHOR]

Large bone defects of the distal radius and/or carpus following tumor resection, trauma, or infection are extremely rare. There are few case reports and series in the literature on the reconstruction approaches required in such cases. Therefore, large studies cannot be used to guide the therapeutic decisions of reconstructive plastic and hand surgeons. The objective of this study is to propose a treatment algorithm to predict the functional outcome and quality of life for the different techniques of free vascularized bone reconstruction in the interval between the distal radius, the carpus, and/or the proximal metacarpal. The algorithm was developed based on our own case studies and the few treatment approaches described in the literature. It can be applied to rare cases of massive bone defects in the wrist. The flowchart enables surgeons to develop an individualized reconstruction concept for various intervals of bone defects in the area of the distal radius and proximal metacarpal bones. Ultimately, the treatment algorithm aims to maximize future quality of life (QoL) and function of the distal upper extremity in rare cases of massive wrist-bone defects. [ABSTRACT FROM AUTHOR]

During routine dissection of the anterior compartment of the arm region, we encountered several variations in the muscular and neural structures in the right upper extremity of a female cadaver. We observed one superiorly positioned extramuscular head with fibers originating from both the biceps brachii (BB) and coracobrachialis (CB) muscles and one inferiorly positioned extramuscular head with fibers solely from the BB muscle. The musculocutaneous nerve did not penetrate the CB muscle, but instead provided a muscular branch that communicated with the median nerve (MN). Both the MN and brachial artery (BA) flow beneath the extra head. This case suggests that the described variations may contribute to the entrapment of the MN and compression of the BA. Understanding these variations is crucial before surgical intervention. The failure to recognize such anatomical nuances could lead to inadvertent nerve injury or compromised vascular perfusion, emphasizing the need for preoperative planning and intraoperative vigilance. [ABSTRACT FROM AUTHOR]

An 8‐year‐old female spayed German shepherd dog was presented for evaluation of a 1‐week history of right thoracic limb monoparesis. Magnetic resonance imaging (MRI) identified an intraparenchymal, T2 hypointense and T1 isointense, strongly heterogeneously contrast‐enhancing mass with moderate internal susceptibility artifact on T2* images at the level of the cranial extent of the C5 vertebral body. Euthanasia was elected after a rapid neurologic decline in the 24 hours after MRI. Necropsy and histopathology identified an intraparenchymal hemangiosarcoma arising from a hemangioma in the cervical spinal cord, with no evidence of neoplastic disease in any other examined organs. The spectrum of vasoproliferative disorders in the central nervous system in veterinary species has been codified recently, but hemangiosarcoma is considered metastatic to the central nervous system. Herein we describe the clinical, imaging, and histologic findings in a dog with a novel primary location of hemangiosarcoma in the cervical spinal cord. [ABSTRACT FROM AUTHOR]

The purpose of this study is to examine and characterize patterns of injury to the upper extremity caused by fireworks in a nationally representative sample of emergency department patients from 2011 to 2020. The National Electronic Injury Surveillance System was queried for upper-extremity injuries caused by fireworks between 2011 and 2020. One thousand two hundred fifty-one injuries were identified from the database representing 47,235 national cases that presented to emergency departments in the United States. Case frequency was stable during the period until 2020, which was nearly 70% higher than the previous 9-y average. Patients were generally young and male, with most cases in the 10-29-y age group and males over three times as likely to be injured as females. The most common injury was burn, and the week of July 4th accounted for 53% of cases alone. Diagnosis was also significantly associated with device type. These data can be used to target prevention measures and campaigns to specific patient populations most at risk of injury, specifically young males. They may also be used to highlight the impact of policy changes on availability of fireworks, the need for public health education coinciding with injury incidence peaks, and secondary pandemic effects. [ABSTRACT FROM AUTHOR]

Holding still and aiming reaches to spatial targets may depend on distinct neural circuits. Using automated homecage training and a sensitive joystick, we trained freely moving mice to contact a joystick, hold their forelimb still, and then reach to rewarded target locations. Mice learned the task by initiating forelimb sequences with clearly resolved submillimeter-scale micromovements followed by millimeter-scale reaches to learned spatial targets. Hundreds of thousands of trajectories were decomposed into millions of kinematic submovements, while photoinhibition was used to test roles of motor cortical areas. Inactivation of both caudal and rostral forelimb areas preserved the ability to produce aimed reaches, but reduced reach speed. Inactivation specifically of contralateral caudal forelimb area (CFA) additionally impaired the ability to aim corrective submovements to remembered locations following target undershoots. Our findings show that motor cortical inactivations reduce the gain of forelimb movements but that inactivation specifically of contralateral CFA impairs corrective movements important for reaching a target location. NEW & NOTEWORTHY: To test the role of different cortical areas in holding still and reaching to targets, this study combined home-cage training with optogenetic silencing as mice engaged in a learned center-out-reach task. Inactivation specifically of contralateral caudal forelimb area (CFA) impaired corrective movements necessary to reach spatial targets to earn reward. [ABSTRACT FROM AUTHOR]

Central cord syndrome (CCS) is the most prevalent and debated incomplete spinal cord injury (SCI) syndrome, with its hallmark feature being more pronounced weakness of the upper extremities than of the lower extremities. Varying definitions encapsulate multiple clinical features under the single umbrella term of CCS, complicating evaluation of its frequency, prognosis discussions, and outcomes research. Often, people with CCS are excluded from research protocols, as it is thought to have a favorable prognosis, but the vague nature of CCS raises doubts about the validity of this practice. The objective of this study was to categorize CCS into specific subsets with clear quantifiable differences, to assess whether this would enhance the ability to determine if individuals with CCS or its subsets exhibit distinct neurological and functional outcomes relative to others with incomplete tetraplegia. This study retrospectively reviewed individuals with new motor incomplete tetraplegia from traumatic SCI who enrolled in the Spinal Cord Injury Model Systems (SCIMS) database from 2010 to 2020. Through an assessment of the prevailing criteria for CCS, coupled with data analysis, we used two key criteria, including the severity of distal upper extremity weakness (i.e., hands and fingers) and extent of symmetry, to delineate three CCS subsets: full CCS, unilateral CCS, and borderline CCS. Of the 1490 participants in our sample, 17.5% had full, 25.6% had unilateral, and 9% had borderline CCS, together encompassing >50% of motor incomplete tetraplegia cases. Despite the increased sensitivity and specificity of these subsets compared with existing quantifiable criteria, substantial variability in clinical presentation was still observed. Overall, individuals meeting CCS subset criteria showed a higher likelihood of American Spinal Injury Association (ASIA) Impairment Scale (AIS) D grade than those with motor incomplete tetraplegia without CCS. Upper Extremity Motor Score (UEMS) for those with CCS was lower on admission, a difference that diminished by discharge, whereas their Lower Extremity Motor Score (LEMS) consistently remained higher than for those without CCS. However, these neurological distinctions did not result in significant functional differences, as lower and upper extremity functional outcomes at discharge were mostly similar, with some differences observed within those with AIS D grade. The AIS grade, rather than the diagnosis of CCS, remains the foremost determinant influencing neurological and functional outcomes. We recommend that future studies consider incorporating motor incomplete tetraplegia into their inclusion/exclusion criteria, instead of relying on criteria specific to CCS. Although there remains clinical value in characterizing an injury pattern as CCS and perhaps using the different subsets to better characterize the impairments, it does not appear to be a useful research criterion. [ABSTRACT FROM AUTHOR]

Cervical spinal cord injury (SCI) results in significant sensorimotor impairments below the injury level, notably in the upper extremities (UEs), impacting daily activities and quality of life. Regaining UE function remains the top priority for individuals post-cervical SCI. Recent advances in understanding adaptive plasticity within the sensorimotor system have led to the development of novel non-invasive neurostimulation strategies, such as spinal cord transcutaneous stimulation (scTS), to facilitate UE motor recovery after SCI. This comprehensive review investigates the neuromotor control of UE, the typical recovery trajectories following SCI, and the therapeutic potential of scTS to enhance UE motor function in individuals with cervical SCI. Although limited in number with smaller sample sizes, the included research articles consistently suggest that scTS, when combined with task-specific training, improves voluntary control of arm and hand function and sensation. Further, the reported improvements translate to the recovery of various UE functional tasks and positively impact the quality of life in individuals with cervical SCI. Several methodological limitations, including stimulation site selection and parameters, training strategies, and sensitive outcome measures, require further advancements to allow successful translation of scTS from research to clinical settings. This review also summarizes the current literature and proposes future directions to support establishing approaches for scTS as a viable neuro-rehabilitative tool. [ABSTRACT FROM AUTHOR]

A Shorthair castrated 8-year-old tomcat was brought to a veterinary hospital for slowly progressive onset of tetraplegia developing within last 14 days. The clinical and blood examinations at admission showed no abnormalities, the neurological examination showed severe cervical pain and tetraplegia with lower motor neuron deficits on thoracic limbs and normal withdrawal with increased patellar reflexes on pelvic limbs. Deep pain perception was present on all four limbs. The neuroanatomic localisation was C6-T2 lesion. Magnetic resonance imaging of the cervical spine demonstrated severe spondylosis deformans, degeneration of multiple IVD, and ventral extradural right sided spinal cord compression at the level C7-T1. Mildly hyperintense on T2-weighted and STIR, mildly hypointense on T1-weighted pre-contrast, and homogeneously contrast-enhancing mass on T1-weighted post-contrast images was observed at this area. This article describes an interesting case of a tumor in a cat localised in the cervicothoracic spinal segment extradurally compressing the spinal cord and causing severe neurological dysfunction. These clinical symptoms were successfully treated through a ventral slot surgery, the tumor was well circumscribed and comfortably removable through this approach. This rare tumor is considered benign and prognosis is favourable after surgical removal due to its non-invasive growth pattern. After surgery, the cat was observed continuously for a few months and the recovery was sufficient with no recurrence of neurological symptoms by now. This case is worth attention mainly because, despite the serious clinical presentation, it has a good long term prognosis and does not require a complex surgical approach. [ABSTRACT FROM AUTHOR]

Introduction: Osteogenesis imperfecta (OI) is a hereditary disorder primarily caused by mutations in type I collagen genes, resulting in bone fragility, deformities, and functional limitations. Studies on upper extremity deformities and associated functional impairments in OI are limited. This cross-sectional study aimed to evaluate upper extremity deformities and functional outcomes in OI. Methods: We included patients regardless of their OI subtypes with a minimum age of 7 years. Radiographic analysis of radial head dislocation, ossification of the interosseous membrane, and/or radioulnar synostosis of the forearm were performed, and deformity was categorized as mild, moderate, or severe. Clinical evaluation was performed using the Quick Disabilities of Arm, Shoulder, and Hand (qDASH) questionnaire and shoulder-elbow-wrist range of motion (ROM). Three-dimensional motion analysis of the upper limb was conducted using the Southampton Hand Assessment Procedure (SHAP). The SHAP quantifies execution time through the Linear Index of Function (LIF) and assesses the underlying joint kinematics using the Arm Profile Score (APS). Additionally, the maximum active Range of Motion (aRoM) was measured. Results: Fourteen patients aged 8 to 73 were included. Radiographic findings revealed diverse deformities, including radial head dislocation, interosseous membrane ossification, and radioulnar synostosis. Six patients had mild, six moderate, and two severe deformities of the upper extremity. Severe deformities and radial head dislocation correlated with compromised ROM and worse qDASH scores. The qDASH score ranged from 0 to 37.5 (mean 11.7). APS was increased, and LIF was reduced in OI-affected persons compared with non-affected peers. APS and LIF also varied depending on the severity of bony deformities. aRoM was remarkably reduced for pro-supination. Conclusion: Patients with OI showed variable functional impairment from almost none to severe during daily life activities, mainly depending on the magnitude of deformity in the upper extremity. Larger multicenter studies are needed to confirm the results of this heterogeneous cohort. Level of evidence: Retrospective clinical study; Level IV. [ABSTRACT FROM AUTHOR]