The mend of the bend-flexor pollicis longus tendon has an additional pulley distal to its point of angulation

The tendon of flexor pollicis longus angulates at the trapezio-metacarpal joint level. The degree of angulation varies with extent of radial/ulnar deviation (Rack and Ross [1984] J. Physiol. 351:99–110). We report a fibrous pulley at this level that helps stabilize the tendon and facilitates its action. The morphology of the pulley is described. We believe that it has an important role to play in the unique function of the tendon facilitating the movement of the thumb perpendicular to the plane of the thumbnail. Clin. Anat. 21:427–432, 2008. © 2008 Wiley-Liss, Inc

Hand arthritis in systemic lupus erythematosus: an ultrasound pictorial essay.

A small minority of systemic lupus erythematosus (SLE) patients may develop a deforming arthritis, typically with a non-erosive (Jaccoud's) pattern, although erosive features indistinguishable from rheumatoid arthritis may also occur. High-resolution ultrasonography (HRUS) allows detailed 'real time' imaging of joint and tendon morphostructural changes involving the hand in patients with several rheumatic diseases. The main aim of this pictorial essay is to provide the first descriptive HRUS and power Doppler (PD) findings of joint and tendon involvement of the hand and wrist in patients with SLE arthritis. Seventeen patients with SLE and hand involvement were examined. HRUS of the wrist, 2nd and 3rd MCP joints, 3rd PIP joint and 2nd, 3rd and 4th finger flexor tendons were studied in the dominant hand for each patient. Sixteen (94%) patients had joint effusion or synovial hypertrophy in the wrist. Twelve (71%) patients had joint effusion or synovial hypertrophy in 2nd or 3rd MCPJs. Eight (47%) patients had erosion at 2nd or 3rd MCPJs. In three cases erosions were not present radiologically. Eleven (65%) patients had evidence of tenosynovitis. In SLE, HRUS with PD detects a high prevalence of inflammatory pathology in the tendons and synovium of the hand and wrist, and a high prevalence of MCP joint erosions. HRUS offers a sensitive, real-time and readily repeatable assessment of soft-tissue, inflammatory and bony changes in SLE hands.

Brain activity during ankle proprioceptive stimulation predicts balance performance in young and older adults

Proprioceptive information from the foot/ankle provides important information regarding body sway for balance control, especially in situations where visual information is degraded or absent. Given known increases in catastrophic injury due to falls with older age, understanding the neural basis of proprioceptive processing for balance control is particularly important for older adults. In the present study, we linked neural activity in response to stimulation of key foot proprioceptors (i.e., muscle spindles) with balance ability across the lifespan. Twenty young and 20 older human adults underwent proprioceptive mapping; foot tendon vibration was compared with vibration of a nearby bone in an fMRI environment to determine regions of the brain that were active in response to muscle spindle stimulation. Several body sway metrics were also calculated for the same participants on an eyes-closed balance task. Based on regression analyses, multiple clusters of voxels were identified showing a significant relationship between muscle spindle stimulation-induced neural activity and maximum center of pressure excursion in the anterior-posterior direction. In this case, increased activation was associated with greater balance performance in parietal, frontal, and insular cortical areas, as well as structures within the basal ganglia. These correlated regions were age- and foot-stimulation side-independent and largely localized to right-sided areas of the brain thought to be involved in monitoring stimulus-driven shifts of attention. These findings support the notion that, beyond fundamental peripheral reflex mechanisms, central processing of proprioceptive signals from the foot is critical for balance control.

Granular anchors under vertical loading - axial pull

Granular anchors are a relatively new concept in ground engineering with relatively little known regarding their load–displacement behaviour, failure modes, ultimate pullout capacity and also potential applications. A granular anchor consists of three main components: a base plate; tendon and compacted granular backfill. The tendon is used to transmit the applied load to the base plate which compresses the granular material to form the anchor. A study of the load–displacement response and ultimate pullout capacity of granular anchors constructed in intact lodgement till and made ground deposits is reported in this paper. Parallel tests were also performed on cast insitu concrete anchors which are traditionally used for anchoring purposes. A new method of analysis for the determination of the ultimate pullout capacity of granular anchors is presented and verified experimentally, with the dominant mode of failure controlled by the column length to diameter ratio. Granular anchors with L/D > 7 principally failed on bulging whereas short granular anchors failed on shaft resistance, with the latter mobilising similar pullout capacities as conventional concrete anchors.

Development of a bovine collagen-apatitic calcium phosphate cement for potential fracture treatment through vertebroplasty

The aim of this study was to examine the potential of incorporating bovine fibres as a means of reinforcing a typically brittle apatite calcium phosphate cement for vertebroplasty. Type I collagen derived from bovine Achilles tendon was ground cryogenically to produce an average fibre length of 0.96 ± 0.55 mm and manually mixed into the powder phase of an apatite-based cement at 1, 3 or 5 wt.%. Fibre addition of up to 5 wt.% had a significant effect (P = 0.001) on the fracture toughness, which was increased by 172%. Adding =1 wt.% bovine collagen fibres did not compromise the compressive properties significantly, however, a decrease of 39-53% was demonstrated at =3 wt.% fibre loading. Adding bovine collagen to the calcium phosphate cement reduced the initial and final setting times to satisfy the clinical requirements stated for vertebroplasty. The cement viscosity increased in a linear manner (R = 0.975) with increased loading of collagen fibres, such that the injectability was found to be reduced by 83% at 5 wt.% collagen loading. This study suggests for the first time the potential application of a collagen-reinforced calcium phosphate cement as a viable option in the treatment of vertebral fractures, however, issues surrounding efficacious cement delivery need to be addressed. © 2012 Acta Materialia Inc.

Genetic screening protocol for familial hypercholesterolemia which includes splicing defects gives an improved mutation detection rate

Familial hypercholesterolemia (FH) is a common single gene disorder, which predisposes to coronary artery disease. In a previous study, we have shown that in patients with definite FH around 20% had no identifiable gene defect after screening the entire exon coding area of the low density lipoprotein receptor (LDLR) and testing for the common Apolipoprotein B (ApoB) R3500Q mutation. In this study, we have extended the screen to additional families and have included the non-coding intron splice regions of the gene. In families with definite FH (tendon xanthoma present, n = 68) the improved genetic screening protocol increased the detection rate of mutations to 87%. This high detection rate greatly enhances the potential value of this test as part of a clinical screening program for FH. In contrast, the use of a limited screen in patients with possible FH (n = 130) resulted in a detection rate of 26%, but this is still of significant benefit in diagnosis of this genetic condition. We have also shown that 14% of LDLR defects are due to splice site mutations and that the most frequent splice mutation in our series (c.1845 + 11 c > g) is expressed at the RNA level. In addition, DNA samples from the patients in whom no LDLR or ApoB gene mutations were found, were sequenced for the NARC-1 gene. No mutations were identified which suggests that the role of NARC-1 in causing FH is minor. In a small proportion of families (

Mutation screening and genotype:phenotype correlation in familial hypercholesterolaemia

The aim of this study was to develop a mutation screening protocol for familial hypercholesterolaemia (FH) patients and to assess genotype/phenotype effects in terms of pre-treatment lipid profiles and presentation of tendon xanthomata (TX). A total of 158 families with clinical definitions of possible (120) or definite (38) FH were studied using a tiered screening protocol. Mutations were identified in 52 families, 44 families showing 23 different LDLR gene defects and eight families showing the common Apo B100 gene defect R3500Q. LDLR defects were detected in various regions of the gene with 56% in the LDL binding domain (exons 2-6) and 37% in the EGF precursor homology domain (exons 7-14). The most common mutations were D461N(7), C210X(5), 932delA(5), and C163Y(4). Frameshift mutations accounted for 20% with nonsense 13%, mis-sense 35%, splice 3%, Apo B 13% and 2% large deletion, 13% of clinically definite FH remained undefined. In conclusion, DNA based diagnosis is possible in 79% (30/38) of clinically definite FH families and of the 120 possible FH families at the start of the screening program, 18% (22/120) now have defined mutations. Overall 60 families from the original 158 meet the clinical and/or genetic criteria for definite FH. Tendon xanthomata were present in only 58% (30/52) of genetically defined FH families, thus limiting its use as a strict diagnostic criteria. Families with low density lipoprotein receptor (LDLR) defects present with higher total and LDL cholesterol levels and a higher incidence of TX than do those with the common Apo B variant, and frameshift mutations appear to have the most severe presentation. Copyright (C) 1999 Elsevier Science Ireland Ltd.

Glycation, glycoxidation, and cross-linking of collagen by glucose. Kinetics, mechanisms, and inhibition of late stages of the Maillard reaction

The Maillard or browning reaction between sugar and protein contributes to the increased chemical modification and cross-linking of long-lived tissue proteins in diabetes. To evaluate the role of glycation and oxidation in these reactions, we have studied the effects of oxidative and antioxidative conditions and various types of inhibitors on the reaction of glucose with rat tail tendon collagen in phosphate buffer at physiological pH and temperature. The chemical modifications of collagen that were measured included fructoselysine, the glycoxidation products N epsilon-(carboxymethyl)lysine and pentosidine and fluorescence. Collagen cross-linking was evaluated by analysis of cyanogen bromide peptides using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and by changes in collagen solubilization on treatment with pepsin or sodium dodecylsulfate. Although glycation was unaffected, formation of glycoxidation products and cross-linking of collagen were inhibited by antioxidative conditions. The kinetics of formation of glycoxidation products proceeded with a short lag phase and were independent of the amount of Amadori adduct on the protein, suggesting that autoxidative degradation of glucose was a major contributor to glycoxidation and cross-linking reactions. Chelators, sulfhydryl compounds, antioxidants, and aminoguanidine also inhibited formation of glycoxidation products, generation of fluorescence, and cross-linking of collagen without significant effect on the extent of glycation of the protein. We conclude that autoxidation of glucose or Amadori compounds on protein plays a major role in the formation of glycoxidation products and cross-liking of collagen by glucose in vitro and that chelators, sulfhydryl compounds, antioxidants, and aminoguanidine act as uncouplers of glycation from subsequent glycoxidation and cross-linking reactions.

Post-tensioning of glulam timber with steel tendons

This paper describes a series of four-point bending tests that were conducted, under service loads and to failure, on unreinforced, reinforced and post-tensioned glulam timber beams, where the reinforcing tendon used was 12 mm diameter toughened steel bar. The research was designed to evaluate the benefits offered by including an active reinforcement in contrast to the passive reinforcement typically used within timber strengthening works, in addition to establishing the effect that bonding the reinforcing tendon has on the materials performance.

The laboratory investigations established that the flexural strength and stiffness increased for both the reinforced and post-tensioned timbers compared to the unreinforced beams. The flexural strength of the reinforced timber increased by 29.4%, while the stiffness increased by 28.1%. Timber that was post-tensioned with an unbonded steel tendon showed a flexural strength increase of 17.6% and an increase in stiffness of 8.1%. Post-tensioned beams with a bonded steel tendon showed increases in flexural strength and stiffness of 40.1% and 30% respectively.

Post-tensioning glulam timber beams with basalt FRP tendons

Improvements in the structural performance of glulam timber beams by the inclusion of reinforcing materials can increase both the service performance and ultimate capacity. This paper describes a series of four-point bending tests conducted, under service loads and to failure, on unreinforced, reinforced and post-tensioned glulam timber beams, where the reinforcing tendon used is 12 mm dia. basalt fibre-reinforced polymer. The research is designed to evaluate the benefits offered by including an active reinforcement in contrast to the passive reinforcement typically used within timber strengthening works, in addition to establishing the effect that bonding the reinforcing tendon has on the material's performance. Further experimental tests have also been developed to investigate the long-term implications of this research, with emphasis placed upon creep and loss of post-tensioning; however, this is ongoing and is not presented in this paper. The laboratory investigations establish that the flexural strength and stiffness increase for both the unbonded and bonded post-tensioned timbers compared to the unreinforced and reinforced beams. Timber that is post-tensioned with an unbonded basalt fibre-reinforced polymer tendon shows a flexural strength increase of 2ṡ8% and an increase in stiffness of 8ṡ7%. Post-tensioned beams with a bonded basalt fibre-reinforced polymer tendon show increases in flexural strength and stiffness of 15ṡ4% and 11ṡ5% respectively.

POST-TENSIONING OF TIMBER BEAMS WITH BASALT FIBRE REINFORCED POLYMER

Improvements in the structural performance of glulam timber beams by the inclusion of reinforcing materials can improve both the service performance and ultimate capacity. In recent years research focusing on the addition of fibre reinforced polymers to strengthen members has yielded positive results. However, the FRP material is still a relatively expensive material and its full potential has not been realised in combination with structural timber. This paper describes a series of four-point bending tests that were conducted, under service and ultimate loads, on post-tensioned glulam timber beams where the reinforcing tendon used was 12 mm diameter Basalt Fibre Reinforced Polymer (BFRP). The research was designed to evaluate the additional benefits of including an active type of reinforcement, by post-tensioning the BFRP tendon, as opposed to the passive approach of simply reinforcing the timber beam.
From the laboratory investigations, it was established that there was a 16% increase in load carrying capacity, in addition to a 14% reduction in deflection under service loads when members containing the post-tensioned BFRP composite are compared with control timber specimens. Additionally a more favourable ductile failure mode was witnessed compared to the brittle failure of an unreinforced timber beam. The results support the assumption that by initially stressing the embedded FRP tendon the structural benefits experienced by the timber member increase in a number of ways, indicating that there is significant scope for this approach in practical applications.

Development of Novel Post-Tensioned Glulam Timber Composites

Improvements in the structural performance of glulam timber beams by the inclusion of reinforcing materials can increase both the service performance and ultimate capacity. In recent years research focusing on the addition of fibre reinforced polymers (FRP) to strengthen members has yielded positive results. However, the FRP material is still relatively expensive and its full potential in combination with structural timber has not been realised. This paper describes a series of four-point bending tests that were conducted, under service loads and to failure, on unreinforced, reinforced and post-tensioned glulam timber beams, where the reinforcing tendon used was 12mm diameter basalt fibre reinforced polymer (BFRP). The research was designed to evaluate the benefits offered by including an active reinforcement in contrast to the passive reinforcement typically used within timber strengthening works, in addition to establishing the affect that bonding the reinforcing tendon has on the material’s performance. Further experimental tests have been developed to investigate the long-term implications of this research, with emphasis placed upon creep and loss of post-tensioning.
The laboratory investigations established that the flexural strength and stiffness increased for both the unbonded and bonded post-tensioned timbers compared to the unreinforced beams. Timber that was post-tensioned with an unbonded BFRP tendon showed a flexural strength increase of 2.8% and an increase in stiffness of 8.7%. Post-tensioned beams with a bonded BFRP tendon showed increases in flexural strength and stiffness of 16.6% and 11.5% respectively.

Paired associative transcranial alternating current stimulation increases the excitability of corticospinal projections in humans

Many types of non-invasive brain stimulation alter corticospinal excitability (CSE). Paired associative stimulation (PAS) has attracted particular attention as its effects ostensibly adhere to Hebbian principles of neural plasticity. In prototypical form, a single electrical stimulus is directed to a peripheral nerve in close temporal contiguity with transcranial magnetic stimulation delivered to the contralateral primary motor cortex (M1). Repeated pairing of the two discrete stimulus events (i.e. association) over an extended period either increases or decreases the excitability of corticospinal projections from M1, contingent on the interstimulus interval. We studied a novel form of associative stimulation, consisting of brief trains of peripheral afferent stimulation paired with short bursts of high frequency (≥80 Hz) transcranial alternating current stimulation (tACS) over contralateral M1. Elevations in the excitability of corticospinal projections to the forearm were observed for a range of tACS frequency (80, 140 and 250 Hz), current (1, 2 and 3 mA) and duration (500 and 1000 ms) parameters. The effects were at least as reliable as those brought about by PAS or transcranial direct current stimulation. When paired with tACS, muscle tendon vibration also induced elevations of CSE. No such changes were brought about by the tACS or peripheral afferent stimulation alone. In demonstrating that associative effects are expressed when the timing of the peripheral and cortical events is not precisely circumscribed, these findings suggest that multiple cellular pathways may contribute to a long term potentiation-type response. Their relative contributions will differ depending on the nature of the induction protocol that is used.

Mechanical properties and cellular response of novel electrospun nanofibers for ligament tissue engineering: Effects of orientation and geometry

Electrospun nanofibers are a promising material for ligamentous tissue engineering, however weak mechanical properties of fibers to date have limited their clinical usage. The goal of this work was to modify electrospun nanofibers to create a robust structure that mimics the complex hierarchy of native tendons and ligaments. The scaffolds that were fabricated in this study consisted of either random or aligned nanofibers in flat sheets or rolled nanofiber bundles that mimic the size scale of fascicle units in primarily tensile load bearing soft musculoskeletal tissues. Altering nanofiber orientation and geometry significantly affected mechanical properties; most notably aligned nanofiber sheets had the greatest modulus; 125% higher than that of random nanofiber sheets; and 45% higher than aligned nanofiber bundles. Modifying aligned nanofiber sheets to form aligned nanofiber bundles also resulted in approximately 107% higher yield stresses and 140% higher yield strains. The mechanical properties of aligned nanofiber bundles were in the range of the mechanical properties of the native ACL: modulus=158±32MPa, yield stress=57±23MPa and yield strain=0.38±0.08. Adipose derived stem cells cultured on all surfaces remained viable and proliferated extensively over a 7 day culture period and cells elongated on nanofiber bundles. The results of the study suggest that aligned nanofiber bundles may be useful for ligament and tendon tissue engineering based on their mechanical properties and ability to support cell adhesion, proliferation, and elongation.