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Polio WP, Hajek B, Brolin TJ, Mihalko WM, Singhal K, Hughes S, Nelson A, Hayes T, Chiu CY, Bernholt DL, Azar FM, Throckmorton TW. Muscle activation patterns during active external rotation after reverse total shoulder arthroplasty: an electrophysiological study of the teres minor and associated musculature. J Shoulder Elbow Surg 2024; 33:583-592. [PMID: 37778657 DOI: 10.1016/j.jse.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Preoperative teres minor insufficiency has been identified as a risk factor for poor restoration of external rotation (ER) after reverse total shoulder arthroplasty (RTSA). However, there has been little investigation regarding muscle activation patterns generating ER. This prospective study sought to determine the timing and activation levels of the shoulder girdle musculature during ER in well-functioning RTSAs with an intact teres minor using a lateralized design. METHODS Patients who underwent RTSA ≥1 year previously with functional ER, an American Shoulder and Elbow Surgeons (ASES) score >70, superior rotator cuff deficiency, and an intact teres minor were identified. Electrophysiological and kinematic analyses were performed during ER in the modified neutral position (arm at side with 90° of elbow flexion) and in abduction (AB) (shoulder abducted 90° with 90° of elbow flexion). Dynamometer-recorded torque and position were pattern matched to electromyography during ER. The root-mean-square and integrated electromyography (in microvolts × milliseconds with standard deviation [SD]), as well as median frequency (MF) (in hertz with SD), were calculated to determine muscle recruitment. Pair-wise t test analysis compared muscle activation (P < .05 indicated significance). RESULTS After an a priori power analysis, 16 patients were recruited. The average ASES score, visual analog scale pain score, and ASES subscore for ER in AB ("comb hair") were 87.7, 0.5, and 2.75 of 3, respectively. In AB, muscle activation began with the upper trapezius, middle trapezius, and latissimus dorsi, followed by the anterior deltoid activating to neutral. With ER beyond neutral, the teres major (9.6 μV × ms; SD, 9.2 μV × ms) initiated ER, followed by the teres minor (14.1 μV × ms; SD, 18.2 μV × ms) and posterior deltoid (11.1 μV × ms; SD, 9.3 μV × ms). MF analysis indicated equal contributions of the teres major (1.1 Hz; SD, 0.5 Hz), teres minor (1.2 Hz; SD, 0.4 Hz), and posterior deltoid (1.1 Hz; SD, 0.4 Hz) in ER beyond neutral. In the modified neutral position, the upper trapezius and middle trapezius were not recruited to the same level as in AB. For ER beyond neutral, the teres major (9.5 μV × ms [SD, 9 μV × ms]; MF, 1.1 Hz [SD, 0.5 Hz]), teres minor (11.4 μV × ms [SD, 15.1 μV × ms]; MF, 1.1 Hz [SD, 0.5 Hz]), and posterior deltoid (8.5 μV × ms [SD, 8 μV × ms]; MF, 1.2 Hz [SD, 0.3 Hz]) were activated in similar sequence and intensity as AB. No differences in muscle activation duration or intensity were noted among the teres major, teres minor, and posterior deltoid (P > .05). CONCLUSION Active ER after RTSA is complex and is not governed by a single muscle-tendon unit. This study establishes a sequence, duration, and intensity of muscle activation for ER in well-functioning RTSAs. In both tested positions, the teres major, teres minor, and posterior deltoid function equally and sequentially to power ER.
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Affiliation(s)
- William P Polio
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA
| | - Blake Hajek
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Tyler J Brolin
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA
| | - William M Mihalko
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA
| | - Kunal Singhal
- Department of Physical Therapy, College of Rehabilitation Sciences, University of St. Augustine for Health Sciences, Austin, TX, USA
| | - Shannon Hughes
- Department of Physical Therapy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alexis Nelson
- College of Graduate Health Sciences in the Biomedical Sciences Program, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Tristan Hayes
- Biostats, Epidemiology, and Research Design (BERD) Clinic, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Chi-Yang Chiu
- Biostats, Epidemiology, and Research Design (BERD) Clinic, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David L Bernholt
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA
| | - Frederick M Azar
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA
| | - Thomas W Throckmorton
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA.
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Head PL, Kasser R, Appling S, Cappaert T, Singhal K, Zucker-Levin A. The influence of jump-landing direction on dynamic postural stability following anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2024; 112:106195. [PMID: 38320469 DOI: 10.1016/j.clinbiomech.2024.106195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/06/2023] [Accepted: 01/31/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Traditional testing prior to return to sport following anterior cruciate ligament reconstruction typically involves jump-landing tasks in the forward direction. As injury is most likely the result of multiplanar neuromuscular control deficits, assessment of dynamic postural stability using landing tasks that require multiplanar stabilization may be more appropriate. The purpose of this study was to examine how dynamic postural stability is affected when performing jump-landing tasks in three different directions. METHODS Fifteen athletes [11 females (18.0 ± 3.0 years) and 4 males (18.5 ± 3.1 years)] following anterior cruciate ligament reconstruction performed a series of single-limb jump-landing tasks in 3 directions. Individual directional stability indices and a composite dynamic postural stability index were calculated using ground reaction force data and were compared using separate one-way repeated measures ANOVAs. FINDINGS All directional stability indices demonstrated a significant main effect for jump-landing direction (medial-lateral P < 0.001, η2p = 0.95; anterior-posterior P < 0.001, η2p = 0.97; vertical P = 0.021, η2p = 0.24). The diagonal jump-landing direction produced increased medial-lateral stability and vertical stability scores, while the forward and diagonal jump-landing directions produced increased anterior-posterior stability scores. There was no significant effect for the composite dynamic stability index score. INTERPRETATION Jump-landing direction affects dynamic postural stability in all 3 planes of movement in athletes following anterior cruciate ligament reconstruction. Results indicate the potential need to incorporate multiple jump-landing directions to better assess dynamic postural stability prior to return to sport.
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Affiliation(s)
- Penny L Head
- University of Tennessee Health Science Center, Department of Physical Therapy, 930 Madison Avenue, Memphis, TN 38163, USA.
| | - Richard Kasser
- University of Tennessee Health Science Center, Department of Physical Therapy, 930 Madison Avenue, Memphis, TN 38163, USA
| | - Susan Appling
- Ohio State University, Department of Physical Therapy, 516 Atwell Hall, 453 W. 10(th) Avenue, Columbus, OH 43210, USA
| | - Thomas Cappaert
- Rocky Mountain University of Health Professions, 1800 S. Novell Place, Provo, UT 84606, USA
| | - Kunal Singhal
- University of St. Augustine for Health Sciences, 5401 LaCrosse Avenue, Austin, TX 78739, USA
| | - Audrey Zucker-Levin
- University of Saskatchewan, School of Rehabilitation Science, Health Sciences E-Wing, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada
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Pitts J, Singhal K, Apte Y, Patel P, Kannan L, Bhatt T. The Effect of Cognitive Task, Gait Speed, and Age on Cognitive-Motor Interference during Walking. Sensors (Basel) 2023; 23:7368. [PMID: 37687823 PMCID: PMC10490746 DOI: 10.3390/s23177368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/09/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023]
Abstract
Dual-tasking can cause cognitive-motor interference (CMI) and affect task performance. This study investigated the effects of age, gait speed, and type of cognitive task on CMI during gait. Ten younger and 10 older adults walked on a pressure-sensitive GAITRite walkway which recorded gait speed and step length. Participants walked at a slow, preferred, or fast speed while simultaneously completing four cognitive tasks: visuomotor reaction time (VMRT), serial subtraction (SS), word list generation (WLG), and visual Stroop (VS). Each combination of task and speed was repeated for two trials. Tasks were also performed while standing. Motor and cognitive costs were calculated with the formula: ((single-dual)/single × 100). Higher costs indicate a larger reduction in performance from single to dual-task. Motor costs were higher for WLG and SS than VMRT and VS and higher in older adults (p < 0.05). Cognitive costs were higher for SS than WLG (p = 0.001). At faster speeds, dual-task costs increased for WLG and SS, although decreased for VMRT. CMI was highest for working memory, language, and problem-solving tasks, which was reduced by slow walking. Aging increased CMI, although both ages were affected similarly by task and speed. Dual-task assessments could include challenging CMI conditions to improve the prediction of motor and cognitive status.
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Affiliation(s)
- Jessica Pitts
- Department of Physical Therapy, University of Illinois at Chicago, 1919 W Taylor St., Chicago, IL 60612, USA
| | - Kunal Singhal
- Department of Physical Therapy, University of St. Augustine for Health Sciences, Austin, TX 32086, USA
| | - Yashashree Apte
- Department of Physical Therapy, University of Illinois at Chicago, 1919 W Taylor St., Chicago, IL 60612, USA
| | - Prakruti Patel
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80521, USA
| | - Lakshmi Kannan
- Department of Physical Therapy, University of Illinois at Chicago, 1919 W Taylor St., Chicago, IL 60612, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, 1919 W Taylor St., Chicago, IL 60612, USA
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Mihalko WM, Johnson KC, Neiberg RH, Bahnson JL, Singhal K, Richey PA. The Association of Total Knee Arthroplasty With Weight Loss in the Look AHEAD (Action for Health in Diabetes) Clinical Trial. J Arthroplasty 2023; 38:S81-S87.e2. [PMID: 36933679 PMCID: PMC10200753 DOI: 10.1016/j.arth.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Patients who have obesity seldom lose weight after total knee arthroplasty (TKA). The Look AHEAD (Action for Health in Diabetes) trial randomized patients with type 2 diabetes who were overweight or had obesity to a 10-year intensive lifestyle intervention (ILI) or diabetes support and education (DSE). METHODS Of the total 5,145 participants enrolled who had a median 14-year follow-up, a subset of 4,624 met inclusion criteria. The ILI aimed at achieving and maintaining a 7% weight loss and included weekly counseling the first 6 months, with decreasing frequency thereafter. This secondary analysis was undertaken to determine what effects a TKA had on patients participating in a known successful weight loss program and specifically if there was a negative impact on weight loss or their Physical Component Score. RESULTS The analysis suggests that the ILI remained effective for maintaining or losing weight after TKA. Participants in ILI had significantly greater percent weight loss than those in DSE both before and after TKA (ILI-DSE before TKA: -3.6% (-5.0, -2.3); after TKA: -3.7% (-4.1, -3.3); both P < .0001). When comparing percent weight loss before to after TKA, there was no significant difference within either the DSE or ILI group (least square means ± standard error ILI: -0.36% ± 0.3, P = .21; DSE: -0.41% ± 0.29, P = .16). Physical Component Scores improved after TKA (P < .001), but no difference was found between TKA ILI and DSE groups before or after surgery. CONCLUSION Participants who had a TKA did not have an altered ability to adhere to intervention goals to maintain weight loss or obtain further weight loss. The data suggest patients who have obesity can lose weight after TKA on a weight loss program.
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Affiliation(s)
- William M. Mihalko
- University of Tennessee Health Science Center, Campbell Clinic Department of Orthopaedic Surgery, Memphis, TN
| | - Karen C. Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Rebecca H. Neiberg
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Judy L. Bahnson
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kunal Singhal
- Department of Physical Therapy, University of St. Augustine for Health Sciences, Austin, TX
| | - Phyllis A. Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
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Richey PA, Johnson KC, Neiberg RH, Bahnson JL, Singhal K, Coday M, Thomas F, Lewis CE, Mihalko WM. Association of the Intensive Lifestyle Intervention With Total Knee Replacement in the Look AHEAD (Action for Health in Diabetes) Clinical Trial. J Arthroplasty 2020; 35:1576-1582. [PMID: 32085906 PMCID: PMC7247950 DOI: 10.1016/j.arth.2020.01.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/21/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Evidence has established obesity as a risk factor for total knee replacement (TKR) due to osteoarthritis. Obesity is a risk factor for TKR. Randomized trials such as Look AHEAD (Action for Health in Diabetes) have shown long-term successful weight loss with an intensive lifestyle intervention (ILI). It is unknown, however, if intentional weight loss can reduce the risk of TKR. METHODS Look AHEAD randomized persons aged 45-76 with type 2 diabetes who had overweight or obesity to either an ILI to achieve/maintain 7% weight loss or to standard diabetes support and education (DSE). Reported knee pain was assessed using the Visual Analog Scale and Western Ontario McMaster University Osteoarthritis Index questionnaire in 5125 participants without previous TKR. Cox proportional hazard regression was used to model differences in risk of TKR in relation to randomization group assignment (ILI vs DSE) along with baseline body mass index category and baseline knee pain as potential confounders from baseline through Look AHEAD-Extension. RESULTS Baseline mean ± SD Western Ontario McMaster University Osteoarthritis Index knee pain scores did not differ by treatment assignment (ILI: 3.6 ± 2.9, DSE: 3.9 ± 3.0, P = .08); as expected due to randomization. During follow up, the 631 (12%) participants who reported having a TKR were more likely to have been heavier (P < .001) and older (P < .001) at enrollment, but risk of TKR did not differ by treatment group assignment (hazard ratio [HR] 1.07, 95% confidence interval [CI] 0.91-1.25, P = .43). Heterogeneity of treatment effect was observed according to baseline knee pain (interaction P = .02). In persons without knee pain at baseline, there was a 29% reduced risk of TKR in ILI compared to DSE (HR 0.71, 95% CI 0.52-0.96). However, in persons with knee pain at baseline, there was no statistically significant association of treatment assignment with respect to subsequent TKR incidence (HR 1.11, 95% CI 0.92-1.33). CONCLUSION Findings suggest that intensive lifestyle change including physical activity, dietary restriction and behavioral changes to achieve weight loss for prevention of TKR may be most effective in preventing TKR prior to the development of knee pain.
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Affiliation(s)
- Phyllis A Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN; Department of Physical Therapy, University of Tennessee Health Science Center, Memphis, TN
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Rebecca H Neiberg
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Judy L Bahnson
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kunal Singhal
- Department of Physical Therapy, University of Tennessee Health Science Center, Memphis, TN
| | - Mace Coday
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Fridtjof Thomas
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - William M Mihalko
- Department of Biomedical Engineering, University of Tennessee Health Science Center, Memphis, TN
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Pattanaik D, Gupta S, Islam S, Singhal K, Raza S. Conversion of Tuberculosis Screening Tests During Biologic Therapy Among Veteran Patient Population With Rheumatic Disease. ACR Open Rheumatol 2019; 1:542-545. [PMID: 31777837 PMCID: PMC6857984 DOI: 10.1002/acr2.11070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/16/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The optimal strategy to detect the development of tuberculosis (TB) in subjects receiving biologic agents is not clear. The recommendations vary because there is wide variation in the reported rate of seroconversion in various parts of the world. There is a scarcity of long-term studies regarding seroconversion of TB in the United States among these patients. METHODS This is a retrospective study among veteran populations with rheumatic diseases who received various biologic agents between 2003 and 2014. Subjects who had repeated TB screening tests and adequate follow-up periods were considered for the study. RESULTS Out of 298 subjects who received biologic agents, 123 were considered for the study. After the initial negative screening test by tuberculin skin test (TST), patients were screened on an average of 1.2 years for 4.3 to 12 years. A total of 420 tests were performed, which were combination of TST and QuantiFERON-TB gold in-Tube assay. Only 1 out of 123 subjects (0.8%) seroconverted to latent TB and was treated with isoniazid for 9 months. CONCLUSION Our results are in line with a few other studies reported from the United States. We conclude that in areas with low prevalence of TB the seroconversion rate is extremely low and annual testing is unnecessary in low-risk patient populations.
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Affiliation(s)
| | - Sandeep Gupta
- University of Tennessee Health Science CenterMemphisTennessee
| | - Syed Islam
- University of Tennessee Health Science CenterMemphisTennessee
| | - Kunal Singhal
- University of Tennessee Health Science CenterMemphisTennessee
| | - Syed Raza
- University of Tennessee Health Science CenterMemphisTennessee
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Head PL, Kasser R, Appling S, Cappaert T, Singhal K, Zucker-Levin A. Anterior cruciate ligament reconstruction and dynamic stability at time of release for return to sport. Phys Ther Sport 2019; 38:80-86. [PMID: 31071659 DOI: 10.1016/j.ptsp.2019.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Examine dynamic stability using Dynamic Postural Stability Index (DPSI) in athletes following anterior cruciate ligament reconstruction (ACLR) at time of release for return-to-sport (RTS), compared to matched controls. DESIGN Cross-sectional case-control study. SETTING Sports medicine clinic. SUBJECTS Fifteen ACLR athletes who had completed post-operative rehabilitation and were within 6 weeks following release to RTS were age-, gender-, and activity-matched to 15 healthy controls. MAIN OUTCOME MEASURES Ground reaction forces (GRFs) were collected using a portable force plate during stabilization from three different single-leg landing tasks. A composite DPSI was calculated using GRFs. RESULTS Compared to matched controls, ACLR athletes within 6 weeks of release for RTS did not significantly differ in dynamic postural stability and there were no significant differences between the involved and uninvolved limbs in the ACLR group. CONCLUSION Current findings indicate that dynamic postural stability, as measured using the DPSI, is not significantly different in ACLR subjects at time of release for RTS compared to matched controls. In addition, the DPSI was not significantly different between the involved and uninvolved limbs in the ACLR subjects. The results suggest that the post-ACLR rehabilitation program utilized may have adequately restored postural stability in this particular sample.
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Affiliation(s)
- Penny L Head
- University of Tennessee Health Science Center, 930 Madison Avenue, Suite 604, Memphis, TN, 38163, USA.
| | - Richard Kasser
- University of Tennessee Health Science Center, 930 Madison Avenue, Suite 604, Memphis, TN, 38163, USA
| | - Susan Appling
- Ohio State University, 516 Atwell Hall, 453 W, 10th Avenue, Columbus, OH, 43210, USA
| | - Thomas Cappaert
- Rocky Mountain University of Health Professions, 122 East 1700 South, Bldg. 3, Provo, UT 84606, USA
| | - Kunal Singhal
- University of Tennessee Health Science Center, 930 Madison Avenue, Suite 604, Memphis, TN, 38163, USA
| | - Audrey Zucker-Levin
- University of Saskatchewan, 104 Clinic Place, Health Sciences E-Wing, Saskatoon, SK, S7N 2Z4, Canada
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Singhal K, Kim J, Casebolt J, Lee S, Han KH, Kwon YH. Gender difference in older adult's utilization of gravitational and ground reaction force in regulation of angular momentum during stair descent. Hum Mov Sci 2015; 41:230-9. [PMID: 25846952 DOI: 10.1016/j.humov.2015.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 01/14/2015] [Accepted: 03/09/2015] [Indexed: 11/25/2022]
Abstract
Angular momentum of the body is a highly controlled quantity signifying stability, therefore, it is essential to understand its regulation during stair descent. The purpose of this study was to investigate how older adults use gravity and ground reaction force to regulate the angular momentum of the body during stair descent. A total of 28 participants (12 male and 16 female; 68.5 years and 69.0 years of mean age respectively) performed stair descent from a level walk in a step-over-step manner at a self-selected speed over a custom made three-step staircase with embedded force plates. Kinematic and force data were used to calculate angular momentum, gravitational moment, and ground reaction force moment about the stance foot center of pressure. Women show a significantly greater change in normalized angular momentum (0.92Nms/Kgm; p=.004) as compared to men (0.45Nms/Kgm). Women produce higher normalized GRF (p=.031) during the double support phase. The angular momentum changes show largest backward regulation for Step 0 and forward regulation for Step 2. This greater difference in overall change in the angular momentum in women may explain their increased risk of fall over the stairs.
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Affiliation(s)
- Kunal Singhal
- Motion Analysis Laboratory, Department of Kinesiology, Texas Woman's University, 304 Administration Drive, P.O. Box 425589, Denton, TX 76204, United States.
| | - Jemin Kim
- Motion Analysis Laboratory, Department of Kinesiology, Texas Woman's University, 304 Administration Drive, P.O. Box 425589, Denton, TX 76204, United States
| | - Jeffrey Casebolt
- Motion Analysis Laboratory, Department of Kinesiology, Texas Woman's University, 304 Administration Drive, P.O. Box 425589, Denton, TX 76204, United States
| | - Sangwoo Lee
- Motion Analysis Laboratory, Department of Kinesiology, Texas Woman's University, 304 Administration Drive, P.O. Box 425589, Denton, TX 76204, United States
| | - Ki-Hoon Han
- Motion Analysis Laboratory, Department of Kinesiology, Texas Woman's University, 304 Administration Drive, P.O. Box 425589, Denton, TX 76204, United States
| | - Young-Hoo Kwon
- Motion Analysis Laboratory, Department of Kinesiology, Texas Woman's University, 304 Administration Drive, P.O. Box 425589, Denton, TX 76204, United States
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Kim J, Wilson MA, Singhal K, Gamblin S, Suh CY, Kwon YH. Generation of vertical angular momentum in single, double, and triple-turn pirouette en dehors in ballet. Sports Biomech 2014; 13:215-29. [PMID: 25325768 DOI: 10.1080/14763141.2014.933580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to investigate the vertical angular momentum generation strategies used by skilled ballet dancers in pirouette en dehors. Select kinematic parameters of the pirouette preparation (stance depth, vertical center-of-mass motion range, initial shoulder line position, shoulder line angular displacement, and maximum trunk twist angle) along with vertical angular momentum parameters during the turn (maximum momentums of the whole body and body parts, and duration and rate of generation) were obtained from nine skilled collegiate ballet dancers through a three-dimensional motion analysis and compared among three turn conditions (single, double, and triple). A one-way ('turn') multivariate analysis of variance of the kinematic parameters and angular momentum parameters of the whole body and a two-way analysis of variance ('turn' × 'body') of the maximum angular momentums of the body parts were conducted. Significant 'turn' effects were observed in the kinematic/angular momentum parameters (both the preparation and the turn) (p < 0.05). As the number of turns increased, skilled dancers generated larger vertical angular momentums by predominantly increasing the rate of momentum generation using rotation of the upper trunk and arms. The trail (closing) arm showed the largest contribution to whole-body angular momentum followed by the lead arm.
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Affiliation(s)
- Jemin Kim
- a Biomechanics Laboratory, Texas Woman's University , Denton , TX , USA
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Jeans KA, Karol LA, Cummings D, Singhal K. Comparison of gait after Syme and transtibial amputation in children: factors that may play a role in function. J Bone Joint Surg Am 2014; 96:1641-7. [PMID: 25274789 DOI: 10.2106/jbjs.n.00192] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preservation of maximal limb length during amputation is often recommended to maximize the efficiency and symmetry of gait. The goals of this study were to determine (1) whether there are gait differences between children with a Syme (or Boyd) amputation and those with a transtibial-level amputation, and (2) whether the type of prosthetic foot affects gait and PODCI (Pediatric Outcomes Data Collection Instrument) outcomes. METHODS Sixty-four patients (age range, 4.7 to 19.2 years) with unilateral below-the-knee prosthesis use (forty-one in the Syme group and twenty-three in the transtibial group) underwent gait analysis and review of data for the involved limb. The twelve prosthetic foot types were categorized as designed for a high, medium, or low activity level (e.g., Flex foot, dynamic response foot, or SACH). Statistical analyses were conducted. RESULTS Kinematic differences of <4° in total prosthetic ankle motion and 8° in external hip rotation were seen between the Syme and transtibial groups. Ankle power was greater in the transtibial group, whereas the Syme group had greater coronal-plane hip power (p < 0.05). Prosthetic ankle motion was significantly greater in the high compared with the medium and low-performance feet. However, the PODCI happiness score was higher in patients with low compared with medium-performance feet (p < 0.05). CONCLUSIONS Small differences in prosthetic ankle motion and power were found between children with Syme and transtibial amputations. Ankle motion was greater in patients using high-performance feet (9% of the total cohort) compared with medium-performance (59%) and low-performance (31%) feet. Despite the increased ankle motion achieved with high-performance dynamic feet, this advantage was not reflected in peak power of the prosthetic ankle or the PODCI sports/physical functioning subscale. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kelly A Jeans
- Movement Science Laboratory (K.A.J.) and Departments of Orthopedics (L.A.K.) and Prosthetics (D.C.), Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219. E-mail address for K.A. Jeans:
| | - Lori A Karol
- Movement Science Laboratory (K.A.J.) and Departments of Orthopedics (L.A.K.) and Prosthetics (D.C.), Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219. E-mail address for K.A. Jeans:
| | - Donald Cummings
- Movement Science Laboratory (K.A.J.) and Departments of Orthopedics (L.A.K.) and Prosthetics (D.C.), Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219. E-mail address for K.A. Jeans:
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Singhal K, Kim J, Casebolt J, Lee S, Han KH, Kwon YH. Kinetic comparison of older men and women during walk-to-stair descent transition. Gait Posture 2014; 40:600-4. [PMID: 25082325 DOI: 10.1016/j.gaitpost.2014.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 07/01/2014] [Accepted: 07/07/2014] [Indexed: 02/02/2023]
Abstract
Stair walking is one of the most challenging tasks for older adults, with women reporting higher incidence of falls. The purpose of this study was to investigate the gender differences in kinetics during stair descent transition. Twenty-eight participants (12 male and 16 female; 68.5 and 69.0 years of mean age, respectively) performed stair descent from level walking in a step-over-step manner at a self-selected speed over a custom-made three-step staircase with embedded force plates. Kinematic and force data were combined using inverse dynamics to generate kinetic data for gender comparison. The top and the first step on the staircase were chosen for analysis. Women showed a higher trail leg peak hip abductor moment (-1.0 Nm/kg), lower trail leg peak knee extensor moment and eccentric power (0.74 Nm/kg and 3.15 W/kg), and lower peak concentric power at trail leg ankle joint (1.29 W/kg) as compared to men (p<0.05; -0.82 Nm/kg, 0.89 Nm/kg, 3.83 W/kg, and 1.78 W/kg, respectively). The lead leg knee eccentric power was also lower in women (p<0.05). This decreased ability to exert knee control during stair descent transition may predispose women to a higher risk of fall.
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Affiliation(s)
- Kunal Singhal
- Human Performance Lab, University of North Texas Health Science Center, USA.
| | - Jemin Kim
- Motion Analysis Laboratory, Department of Kinesiology, Texas Woman's University, USA
| | | | - Sangwoo Lee
- Motion Analysis Laboratory, Department of Kinesiology, Texas Woman's University, USA
| | - Ki Hoon Han
- Motion Analysis Laboratory, Department of Kinesiology, Texas Woman's University, USA
| | - Young-Hoo Kwon
- Motion Analysis Laboratory, Department of Kinesiology, Texas Woman's University, USA
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Kwon YH, Han KH, Como C, Lee S, Singhal K. Validity of the X-factor computation methods and relationship between the X-factor parameters and clubhead velocity in skilled golfers. Sports Biomech 2014; 12:231-46. [PMID: 24245049 DOI: 10.1080/14763141.2013.771896] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The purpose of this study was to assess the validity of the X-factor computation methods and to examine whether direct relationships exist between the X-factor parameters and the clubhead velocity in a group of skilled male golfers (n = 18, handicap = -0.6 +/- 2.1). Five driver trials were captured from each golfer using an optical motion capture system (250 Hz). Two plane-based methods (conventional vs. functional swing plane-based) and one Cardan rotation-based method (relative orientation) were used to compute select X-factor (end of pelvis rotation, top of backswing, ball impact (BI), and maximum), X-factor stretch (stretch and maximum stretch), and X-factor velocity (BI and maximum) parameters. The maximum clubhead velocity was extracted and normalized to golfer's body height to eliminate the effect of body size. A one-way repeated MANOVA revealed that the computation methods generated significantly different X-factor parameter values (p < 0.001). The conventional method provided substantially larger X-factor values than the other methods in the untwisting phase and the meaningfulness of select X-factor parameters generated by this method was deemed questionable. The correlation analysis revealed that the X-factor parameters were not directly related to the maximum clubhead velocity (both unnormalized and normalized).
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Affiliation(s)
- Young-Hoo Kwon
- Biomechanics Laboratory, Texas Woman's University, Denton, TX 76204-5647, USA.
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Kwon YH, Como CS, Singhal K, Lee S, Han KH. Assessment of planarity of the golf swing based on the functional swing plane of the clubhead and motion planes of the body points. Sports Biomech 2012; 11:127-48. [DOI: 10.1080/14763141.2012.660799] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kant R, Singhal K, Shukla SK, Chandrashekar K, Saxena AK, Ranjan A, Raj P. Synthesis and Biological Activity of a Novel Compound: (C6F5)2SbPh. PHOSPHORUS SULFUR 2008. [DOI: 10.1080/10426500701841763] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- R. Kant
- a Department of Chemistry , Lucknow University , Lucknow , India
| | - K. Singhal
- a Department of Chemistry , Lucknow University , Lucknow , India
| | - Sanjeev K. Shukla
- b National Institute for Interdisciplinary Science and Technology , Trivandrum , India
| | | | - A. K. Saxena
- d Defence Material Stores, Research and Development Establishment , Kanpur , India
| | - A. Ranjan
- d Defence Material Stores, Research and Development Establishment , Kanpur , India
| | - P. Raj
- a Department of Chemistry , Lucknow University , Lucknow , India
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Kidwai M, Singhal K, Kukreja S. One-pot synthesis of novel substituted pyrrolo[2,3-d]pyrimidines using dry media. Heteroatom Chem 2007. [DOI: 10.1002/hc.20355] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Dussa CU, Singhal K. Bilateral simultaneous extensor mechanism disruption following simultaneous bilateral total knee replacement. Arch Orthop Trauma Surg 2005; 125:396-8. [PMID: 16034643 DOI: 10.1007/s00402-005-0826-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Indexed: 11/30/2022]
Abstract
Extensor disruptions of the knee following the total knee replacements are uncommon. We describe a case of postoperative bilateral simultaneous extensor mechanism disruption following simultaneous bilateral total knee replacement. On both sides, the patient sustained open wounds. The extensor mechanism was successfully repaired on both sides, but the outcome is less than satisfactory.
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Affiliation(s)
- C U Dussa
- Princess of Wales Hospital, Flat A-14, Room 80, Staff Accommodation, Bridgend, CF31 1RQ, UK.
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Calvo EJ, Etchenique R, Bartlett PN, Singhal K, Santamaria C. Quartz crystal impedance studies at 10 MHz of viscoelastic liquids and films. Faraday Discuss 1997. [DOI: 10.1039/a703551i] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lin JJ, Singhal K, Parton L, Cascio C, Patlak CS, Stewart CL. Correlations between plasminogen activator inhibitor-1 and peritoneal transport in pediatric CCPD patients. ARCH ESP UROL 1995; 15:246-51. [PMID: 7578502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Plasminogen activator inhibitor-1 (PAI-1) is an important regulator of plasminogen activators and has been shown to be involved in the accumulation of extracellular matrix (ECM) in various tissues. Since peritoneal ECM is a resistance site for peritoneal transport, the production and release of PAI-1 in the peritoneum may affect the peritoneal transport of water and small solutes. DESIGN The linear correlations between the dialysate PAI-1 levels and the variables of peritoneal transport during peritoneal equilibration tests (PET) were examined. SETTING A tertiary university hospital. PATIENTS Six stable pediatric patients (age 10.8 +/- 4 years) undergoing continuous cycler-assisted peritoneal dialysis were included. INTERVENTIONS None. RESULTS All data are mean +/- SD. There was a positive correlation between the infused volume and the net ultrafiltration (UF, 198 +/- 127 mL, r = 0.82, p < 0.05). The dialysate PAI-1 levels increased during the dwell time (2.44 +/- 2.23 ng/mL or 2.46 +/- 1.72 micrograms at 4 hours vs 0.04 +/- 0.1 ng/mL or 0.04 +/- 0.09 micrograms at 0 hour, p < 0.05). The saturation indices (dialysate/plasma ratio) of PAI-1 and albumin at 4 hours were 1.05 +/- 1.21 and 0.028 +/- 0.004, respectively. The changes from 0 hour dwell to 4 hour dwell in the dialysate PAI-1 concentration (PAI4-0, 2.4 +/- 2.2 ng/mL) or amount corrected to body surface area (APAI4-0/BSA, 2.61 +/- 2.11 micrograms/m2) negatively correlated with UF or UF/body surface area and positively correlated with the number of episodes of peritonitis. There was no correlation between PAI4-0,APAI4-0/BSA, or plasma PAI-1 concentration and the mass transfer coefficient and clearance of either urea or creatinine. CONCLUSIONS The elevated PAI-1 level during the PET was likely from the local production and release of PAI-1. It had an inverse relationship with the amount of ultrafiltration. Repeated inflammation of the peritoneum was associated with an increased production and release of PAI-1 into the peritoneum.
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Affiliation(s)
- J J Lin
- Department of Pediatrics, State University of New York at Stony Brook, USA
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Raj P, Husain I, Singhal K. Synthesis and biological studies on some organo-tin and lead halo and mixed halo-pseudohalo anionic complexes. Arzneimittelforschung 1994; 44:178-81. [PMID: 8147952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Some new anionic complexes of organo-tin(IV) and lead (IV) isolated in combination of tetraorgano-ammonium phosphonium and stibonium cation(s). L[R4-nMXnY] and L2[R2MX2Y2], where R = C2H5, C4H9 or C6H5; M = Sn or Pb; X = Y = Cl = Br, I, N3, NCS; n = 1, 2 and L = R4M1 (M1 = N, P, Sb), whose structures were confirmed by correct elemental analyses, molar conductance values, van't Hoff factor and IR spectral studies, were synthesized and evaluated for anti-convulsant activity in vivo and antiviral and antibacterial activity in vitro. A few of them exhibited promising activity. In addition, the toxicity (ALD50) and effects on the central nervous system of these complexes have been studied in mice.
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Affiliation(s)
- P Raj
- Department of Chemistry, Lucknow University, India
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Middha VP, Singhal K. Radiographic assessment of cup migration in bipolar hip arthroplasty: intra-observer and interobserver errors and tolerance limits. Arch Orthop Trauma Surg 1992; 111:230-1. [PMID: 1622715 DOI: 10.1007/bf00571484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Statistical methods were used to calculate the possible observer error in measuring cup migration in bipolar hip arthroplasty from follow-up radiographs. Finding the "tolerance limits" by such methods helped in assigning the true significance of any observed change.
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Affiliation(s)
- V P Middha
- Department of Orthopaedic and Accident Surgery, Royal Liverpool Hospital, United Kingdom
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Abstract
Regression and clustering methods have both been used to explore the effects of explanatory variables on survival times for patients with cancer or other chronic diseases. This paper discusses effective and computationally feasible approaches for this task in situations where there are fairly large and complex data sets; the techniques stressed are all-subsets regression and a kind of recursive partition clustering. We compare the two approaches in a rather general way, in part by examining some survival data for patients with ovarian carcinoma, and conclude that both have strong points to recommend them.
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Affiliation(s)
- A Ciampi
- McGill University, Montreal, Quebec, Canada
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Singhal K, Siwach SB, Gupta DK, Gupta SP. A comparative study of captopril & propranolol in essential hypertension. J Assoc Physicians India 1987; 35:636-9. [PMID: 3325494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Lawless JF, Singhal K. Regression Methods and the Exploration of Large Medical Data Bases. Biostatistics 1987. [DOI: 10.1007/978-94-009-4794-8_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Fiserova-Bergerova V, Vlach J, Singhal K. Simulation and prediciton of uptake, distribution, and exhalation of organic solvents. Br J Ind Med 1974; 31:45-52. [PMID: 4821411 PMCID: PMC1009542 DOI: 10.1136/oem.31.1.45] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Fiserova-Bergerova, Vera, Vlach, J., and Singhal, K. (1974).British Journal of Industrial Medicine,31, 45-52. Simulation and prediction of uptake, distribution, and exhalation of organic solvents. Presented here is a theory and mathematical solution of the uptake, distribution, and excretion of inhaled lipid soluble noxious gases, which embraces the effects of metabolism. An electrical analogue was employed to explain the theory, since the analogue is described by the same set of differential equations, and much knowledge is available for the mathematical treatment of electrical networks. The model is used to calculate the uptake and exhalation curves of vapours, to explain what happens to the inhaled vapours in the body, and to predict their cumulation in the body in periodic situations such as occur in industrial exposure.
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Singhal K, Richter M. Cells involved in the immune response. I. The response of normal rabbit bone marrow cells to antigens in vitro. Int Arch Allergy Appl Immunol 1968; 33:493-500. [PMID: 5657244 DOI: 10.1159/000230064] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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