Gender differences in three dimensional gait analysis data from 98 healthy Korean adults

OBJECTIVES: The research hypothesis was that healthy adults would walk differently according to their gender when walked barefoot at their comfortable speed. The aim of this study was to prove the hypothesis in healthy Korean adults. DESIGN: Between-gender statistical comparisons of the gait analysis data including spatiotemporal, three-dimensional joint kinematic and kinetic data. BACKGROUND: There have been few attempts to identify the significant gender differences in gait pattern and to explore their possible causes. METHODS: Healthy 98 Korean adults (47 females and 51 males) volunteered. Gait analysis data was obtained with opto-electric system and force plates. Normalization was used to avoid the body size effect. Gender difference was tested with independent t-test, ancova, and two-way repeated anova. RESULTS: Females were shorter, both in height and leg length ( P < 0.05 ). The cadence and pelvic width were as great as in males. They walked slower than males due to shorter stride length ( P < 0.05 ). The females had still shorter stride length and narrower step width ( P < 0.05 ), and they walked as fast as the males. Females walked with their pelvis tilted more anteriorly and more up and down oblique motion, hip joints more flexed-adducted-internally rotated, knee joint in more valgus angles ( P = 0.05 ). CONCLUSIONS: The gait analysis data had significant gender differences. We assume that the difference is due to gender features of the gait-related anatomy and habits. Comparison with other research shows some evidence for racial differences.     

Gender differences in pattern of hip and lumbopelvic rotation in people with low back pain

BACKGROUND: Findings from previous studies suggest gender may affect the pattern of hip and lumbopelvic motion during a multi-segmental movement. To date, no studies have examined movement patterns and low back pain symptom behavior during hip lateral rotation. METHODS: Forty-six people (27 males and 19 females) with low back pain were examined. Three-dimensional kinematic data and low back pain symptoms were recorded during active hip lateral rotation. Percent of maximum lumbopelvic rotation was calculated for each 10% increment of maximum active hip lateral rotation. FINDINGS: Men exhibited a greater percent of maximum lumbopelvic rotation (mean 49.3, SD 13.3) during the first 60% of hip lateral rotation than women (mean 36.2, SD 16.4) (P < 0.01). Nineteen (70.4%) of the men and seven (36.8%) of the women had pain with the hip lateral rotation test (P = 0.02). INTERPRETATION: Men exhibited more lumbopelvic rotation in the early part of hip lateral rotation than women, and hip lateral rotation was more likely to be associated with symptoms in men than women. Greater lumbopelvic motion, earlier in hip lateral rotation, may make men more vulnerable to low back pain associated with hip lateral rotation. Factors that contribute to these gender differences should be investigated further.     

Gender differences in adverse drug reactions: analysis of spontaneous reports to a Regional Pharmacovigilance Centre in France

The aim of this study was to investigate putative gender-related differences in adverse drug reactions (ADRs). Data were ADRs recorded in the database of the French Midi-Pyrénées Pharmacovigilance Centre in 1998. A total of 927 ADRs were spontaneously reported to the Centre in 1998, of which 53.1% were in females (difference vs. males not statistically significant). There was no statistically significant difference in the incidence of reported ADRs in males (3.6/10,000 inhabitants) vs. females (3.9/10,000 inhabitants) for the total population of the Midi-Pyrénées area. The number of reported ADRs was similar across different age groups (10-year age ranges). However, 'serious' ADRs were more frequently reported in males in the 0-9 and 60-69 age groups (and in females between 20 and 29 years old). There were significantly more neuropsychiatric (69 vs. 43, P = 0.05) and fewer cardiovascular (8 vs. 2, P = 0.05) ADRs reported in females than in males. ADRs were more frequently reported in females for some classes of drugs (such as genito-urinary, sex hormone, antineoplastic, antiparasitic and respiratory drugs). These results confirm that female gender is a risk factor for the development of ADRs.     

Self-reported comorbid pains in severe headaches or migraines in a US national sample

Aims.— To compare prevalence of self‐reported comorbid temporomandibular joint muscle disorder‐type, neck, back, and joint pains in people with severe headache or migraine; and analyze these self‐reported pains in the 2000‐2005 US National Health Interview Survey by gender and age for non‐Hispanic whites, Hispanics, and non‐Hispanic blacks (African Americans). Methods.— National Health Interview Survey data included information on gender, age, race, ethnicity, health status, and common pain types: severe headache or migraine, temporomandibular joint muscle disorder‐type, neck, and low back in the last 3 months, as well as prior‐month joint pains. Analyses included survey prevalence estimation and survey logistic regression to obtain odds ratios and 95% confidence intervals. Results.— The study included 189,967 adults: 48% males, 52% females; 73% white, 12% Hispanic, and 11% black. Of the entire sample, 29,712 (15%) reported severe headache or migraine, and 19,228 (64%) had severe headache or migraine with at least 1 comorbid pain. Two or more comorbid pains were reported in 10,200 (33%), with no gender difference, and with Hispanics (n = 1847 or 32%) and blacks (n = 1301 or 30%) less likely to report 2 or more comorbid pains than whites (n = 6747 or 34%) (odds ratio = 0.91, P = .032; OR = 0.82, P < .001, respectively). This group also reported significantly lower ratings of self‐rated health (P < .001). Differences in type of comorbid pain by age patterns were found. Conclusions.— Severe headache or migraine is often associated with other common pains, seldom existing alone. Two or more comorbid pains are common, similarly affecting gender and racial/ethnic groups.     

Intrapartum fetal head position I: comparison between transvaginal digital examination and transabdominal ultrasound assessment during the active stage of labor.

OBJECTIVE: To test the null hypothesis that no correlation exists between transvaginal digital and the gold standard technique of transabdominal suprapubic ultrasound assessments of fetal head position during labor. A secondary objective was to compare the performance of attending physicians vs. senior residents in depicting fetal head position by transvaginal digital examination in comparison with ultrasound, respectively. METHODS: Consecutive patients in active labor at term with normal singleton cephalic-presenting fetuses were included. All participants had ruptured membranes, cervical dilation > or = 4 cm and fetal head at ischial spine station -2 or lower. Transvaginal sterile digital examinations were performed by either senior residents or attending physicians and followed immediately by transverse suprapubic transabdominal ultrasound assessments. Examiners were blinded to each other's findings. Power-analyses dictated number of subjects required. Statistical analyses included Chi-square, Cohen's Kappa test and logistic regression analysis. P < 0.05 was considered statistically significant. RESULTS: One hundred and two patients were studied (n = 102). In only 24% of patients (n = 24), transvaginal digital examinations were consistent with ultrasound assessments (P = 0.002, 95% confidence interval, 16-33). Logistic regression revealed that cervical effacement (P = 0.03) and ischial spine station (P = 0.01) significantly affected the accuracy of transvaginal digital examination. Parity, gestational age, combined spinal epidural anesthesia, cervical dilation, birth weight and examiner experience did not significantly affect accuracy of the examination. The accuracy of the transvaginal digital exams was increased to 47% (n = 48) (95% confidence interval, 37-57) when fetal head position at transvaginal digital examination was recorded as correct if reported within +/- 45 degrees of the ultrasound assessment. The rate of agreement between the two assessment methods for attending physicians vs. residents was 58% vs. 33%, respectively (P = 0.02) with the +/- 45 degrees analysis. CONCLUSIONS: Using ultrasound assessment as the gold standard, our data demonstrate an overall high rate of error (76%) in transvaginal digital determination of fetal head position during active labor, consistent with the null hypothesis. Attending physicians exhibited an almost two-fold higher success rate in depicting correct fetal head position by physical examination vs. residents in the +/- 45 degrees analysis. Intrapartum ultrasound increases the accuracy of fetal head position assessment during active labor and may serve as an educational tool for physicians in training.     

高能震波治疗肌肉骨关节的慢性疼痛

背景目前有关用高能震波治疗肌肉骨关节慢性疼痛的报道不少,但其治疗的确切效果及作用机制不明确,有待进一步探讨.目的探讨高能震波对骨关节肌筋膜炎的治疗效果、作用机制及临床应用效应.设计以诊断为依据的非随机化同期对照研究.单位中山大学附属第一医院康复医学科.对象2001-07/2002-04中山大学第一附属医院康复科门诊救治的肌肉骨关节慢性疼痛患者90例,按就诊次序分为治疗组45例,男17例,女28例;平均年龄54岁;对照组45例,男15例,女30例,平均年龄63岁.方法治疗组采用体外冲击波治疗;对照组采用常规物理因子治疗.用简式MeGill疼痛问卷(MPQ)评估患者对疼痛的综合反应,并对肩关节活动范围及临床疗效进行评定.主要观察指标①两组治疗前后疼痛改善程度.②关节活动度的变化.③综合临床疗效.结果治疗组在治疗后感觉类,情感类,疼痛总分,目测类比定级(VAS),现有痛强度(PPI)方面与治疗前比较差异有显著性意义(t=5.69,5.67,7.06,8.37,6.21,P＜0.01).在感觉类,疼痛总分,VAS方面与对照组比较差异也有显著性意义(t=4.66,P＜0.01;t=2.52,3.40,P＜0.05).结论体外高能震波对骨关节肌筋膜炎等慢性疼痛疗效确切,临床应用上具有高效、快速、安全的特点.     

Sonographic early fetal gender assignment: a longitudinal study in pregnancies after in vitro fertilization.

OBJECTIVES: A longitudinal evaluation by sonography of external genitalia in human embryos/early fetuses with a known time from fertilization is lacking. Our aim was to assign by sonographic evaluation of external genitalia the early fetal gender in a cohort of pregnancies after in vitro fertilization. Sonographic examinations were performed in each case in three subsequent sessions over a period of time early in gestation in order to establish a temporal threshold, expressed in terms of days from fertilization, at which absolute accuracy in gender prediction is achievable. METHODS: Thirty-two fetuses were included in this prospective longitudinal study. Each was examined three times for gender assignment. The first observation was performed between 65 and 69 days from fertilization, the second between 70 and 74 days and the third between 75 and 79 days. Transvaginal and/or transabdominal sonography was used to detect the 'sagittal sign' as a marker of fetal gender. The results of ultrasound examinations were compared with gender at birth or with karyotype obtained from amniotic fluid cells or chorionic villus sampling. RESULTS: Fetal gender assignment was feasible in 29 out of 32 fetuses (90%) at the first examination and in all cases at the second and third examinations. Fetal gender prediction was correct in 76% of cases in which fetal gender was assigned (22/29) at the first examination; accuracy for males was 46% (6/13) and for females 100% (16/16). At the second and third examinations, accuracy for gender prediction achieved 100% for both genders. Concerning the temporal threshold, absolute accuracy in gender prediction was achieved at 69 days from fertilization, corresponding to 11+6 weeks based on the last menstrual period. CONCLUSION: This study provides important information about the earliest stage, expressed in terms of days from fertilization, at which it is possible to make a certain diagnosis of fetal gender by sonography.     

The influence of gender on knee kinematics, kinetics and muscle activation patterns during side-step cutting

BACKGROUND: It has been suggested that gender differences in the performance of athletic maneuvers is a contributory factor with respect to the disproportionate incidence of non-contact anterior cruciate ligament injury in female athletes. The purpose of this study was to evaluate gender differences in knee joint kinematics, kinetics and muscle activation during a side-step cutting. METHODS: Three-dimensional kinematics, ground reaction forces (2400 Hz) and electromyographic activity (surface electrodes) were recorded during the early deceleration phase of side-step cutting in 30 healthy collegiate soccer players (15 male, 15 female). Gender differences in knee joint kinematics, peak moments, net joint moment impulse and average muscle EMG intensity were evaluated with one-tailed t-tests. FINDINGS: No differences in kinematics were found. However, when compared to males, females demonstrated a smaller peak knee flexor moment (1.4 (0.8) vs. 2.1 (0.8) Nm/kg, P = 0.05) and a greater knee adductor moment (0.43 (0.5) vs. 0.01 (0.3) Nm/kg, P < 0.01) during early deceleration. In addition, females displayed greater average quadriceps EMG intensity than males (191% vs. 151% maximum voluntary isometric contraction, P = 0.02). INTERPRETATION: In general, females experienced increased frontal plane moments and decreased sagittal plane moments during early deceleration. These differences are suggestive of an "at risk" pattern in that frontal plane support of the knee is afforded primarily by passive structures (including the anterior cruciate ligament). Furthermore, increased quadriceps activity and smaller net flexor moments may suggest less sagittal plane protection (i.e., increased tendency towards anterior tibial translation).     

经腹部超声联合经阴道超声检查诊断妇产科急腹症

目的：探讨经腹部超声联合经阴道超声检查在妇产科急腹症诊断中的价值。方法：选择2013年1月～2016年6月经本院临床及病理确诊的妇产科急腹症患者110例为对象,所有患者均采用经腹部超声联合经阴道超声检查,比较超声检查诊断结果与临床病理诊断结果的符合率,并分析各类急腹症的超声影像表现。结果：经腹部超声联合经阴道超声检查诊断妇产科急腹症的符合率97.27%(107/110),与临床病理结果比较差异无统计学意义(P＞0.05);诊断异位妊娠的符合率96.77%(30/31),诊断宫内孕流产的符合率94.44%(17/18),诊断卵巢囊肿破裂的符合率93.33%(14/15),诊断急性盆腔炎、卵巢肿瘤蒂扭转、子宫内膜异位症、胎盘早剥的符合率均为100%(23/23、10/10、8/8、5/5),与临床病理结果比较差异无统计学意义(P＞0.05)。结论：经腹部超声联合经阴道超声检查在诊断妇产科急腹症中,与临床病理结果的符合率高,是一种可行的方案。     

Contextualized perceptions of movement as a source of expanded insight: People with multiple sclerosis' experience with physiotherapy

Real-time ultrasound imaging of the lumbar multifidus muscle was performed in 48 normal subjects (21 males, 27 females) aged 18-35 years. Measurements of multifidus cross-sectional area (CSA) and shape were symmetrical between the right and left sides of the spine. Muscle shape differed between the males and females. Two measurements (linear dimensions) of the muscle cross-section were closely correlated with CSA in both groups (males r=0.98; females r=0.93), but this relationship needs to be determined in wasted muscles where changes in shape may occur. Correlations between CSA and height and weight differed between males and females/Measurements were repeatable between days (CV = 6%) and between scans (CV = 4.9%). The present study indicates that real-time ultrasound may be clinically useful for measuring multifidus muscle wasting, but larger scale studies are required to establish definitive reference ranges of data in different age groups of normal subjects. Documentation of changes in symmetry of multifidus muscle size and shape with back pain could then be performed.     

Biometrical threshold of biparietal diameter for certain fetal sex assignment by ultrasound.

OBJECTIVES: The aim of this study was to establish the biometric threshold of biparietal diameter (BPD), assumed to be an independent variable of gestational age, at which 100% accuracy in the assessment of fetal sex by ultrasonography is achievable. METHODS: Transvaginal and/or transabdominal sonography was used for detecting the 'sagittal sign' as a marker of fetal sex in 385 fetuses with BPD between 18 and 29 mm. The results of ultrasound examination were compared with sex at birth or with karyotype obtained from amniotic fluid cells or chorionic villus sampling. RESULTS: Fetal sex assignment was feasible in 337 of 385 cases (87.5%). Of the 312 fetuses with known fetal sex outcome, 164 were males and 148 were females. An accuracy rate of 100% was achieved when a BPD of > or = 23 mm was obtained. CONCLUSION: This study provides important information about the earliest stage of fetal development, expressed in terms of BPD, at which a diagnosis of fetal sex can be made with 100% accuracy.     

超声检测宫颈长度预测早产的临床价值

目的探讨超声检测宫颈长度（cervicallength,CL）对先兆早产孕妇发生早产的预测价值。方法对2147例单胎先兆早产初产孕妇,分别经腹部、经阴道、经会阴超声检测CL,以CL〈2．6cm为宫颈缩短,追踪妊娠结局,比较三种方法对早产的预测价值。结果经腹部超声检测747例,CL〈2．6cm者早产率40．93％,CL≥2．6cm者早产率4．51％;经阴道超声检测689例,CL〈2．6cm者早产率69．85％,CL≥2．6cm者早产率1．45％;经会阴超声检测711例,CL〈2．6cm者早产率61．54％;CL≥2．6cm者早产率1．98％,三种检测方法检测的CL〈2．6cm组与CL≥2．6cm组的早产率差异均有统计学意义（P〈0．05）;经腹部、经阴道、经会阴超声测量预测早产的敏感性分别为78．57％、92．23％、89．72％,特异性分别为80．00％、93．00％、90．07％,阳性预测值分别为40．93％、69．85％、61．54％,阴性预测值分别为95．49％、98．55％、98．02％,经会阴、经阴道超声测量预测早产的敏感性、特异性、阳性预测值、阴性预测值均显著高于经腹部（P〈0．05）。结论超声检测CL对先兆早产孕妇发生早产有一定的预测意义。经会阴、经阴道超声预测早产的准确性优于经腹部超声。经会阴超声检测可以替代经阴道超声检测,从而提高患者治疗依从性。     

Factors which contribute to fatigue associated with rheumatoid arthritis

The purpose of this research was to identify the factors which people with rheumatoid arthritis (RA) believed contributed to their fatigue. A second purpose was to examine the relationships among identified factors and the sensation of fatigue. One hundred people with RA were asked to identify verbally factors which they believed contributed to their fatigue. The three most frequently identified factors included RA disease activity, disturbed sleep and increased physical effort. These factors were operationalized and measured as joint pain using the Modified McGill Pain Inventory, fragmented sleep through overnight electroencephalographic (EEG) sleep studies, and reduced physical ability using walking time and grip strength measures. Fifteen of the original subjects with RA and 12 age and gender matched control subjects completed the second phase of the research. Five of the RA subjects were experiencing a disease flare while the remaining 10 were either in remission or their disease was midly active. Those subjects in flare had significantly (P less than 0.01) more joint pain, significantly (P less than 0.05) more fragmented sleep, and significantly reduced functional capacity as measured through walking time (P less than 0.05) and grip strength (P less than 0.05) when compared to non-flare and control subjects. Fatigue levels of the subjects in flare were positively correlated with joint pain (r = 0.62), fragmented sleep (r = 0.42) and grip strength of the right hand (r = 0.52) and left hand (r = 0.88). Fatigue levels of non-flare and control subjects were negatively correlated with the majority of measured variables.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevalence of clinical hypertension in patients with chronic pain compared to nonpain general medical patients

OBJECTIVES: In healthy individuals, elevated blood pressure is associated with diminished acute pain sensitivity. These cardiovascular/pain regulatory system interactions appear altered in patients with chronic pain; elevated blood pressure is associated with increased acute and chronic pain responsiveness. If these alterations reflect failure of overlapping systems modulating pain and blood pressure, it was expected that prevalence of clinical hypertension would be increased in the chronic pain population. METHODS: A retrospective review was conducted on randomly selected records of 300 patients with chronic pain (Pain) evaluated at a tertiary care pain center and 300 nonpain internal medicine (Medicine) patients seen at the same institution. RESULTS: Results revealed that 39% of the Pain group was diagnosed with clinical hypertension, compared with 21% of the Medicine group (P < 0.001). Analyses by sex revealed similar group differences in males (P < 0.05) and females (P < 0.001), although the difference in females was double in magnitude compared with males. In contrast to more frequent male hypertension in the general population and the Medicine sample, females were more often diagnosed with hypertension (41.2%) than males (35.6%) in the Pain group. Similar group differences were obtained for antihypertensive use (P < 0.001). Stepwise logistic regression in the Pain group revealed that chronic pain intensity was a significant predictor of hypertensive status independent of the effects of age, race/ethnicity, and parental hypertension (P < 0.05). DISCUSSION: These results suggest that chronic pain may be associated with increased risk of hypertension. Factors that may underlie this association are discussed.     

Gender differences in pressure pain threshold in healthy humans

AIMS OF INVESTIGATION: To quantify the magnitude of putative gender differences in experimental pressure pain threshold (PPT), and to establish the relevance of repeated measurements to any such differences. METHODS: Two separate studies were undertaken. A pressure algometer was used in both studies to assess PPT in the first dorsal interosseous muscle. Force was increased at a rate of 5 N /s. In study 1, two measurements were taken from 240 healthy volunteers (120 males, 120 females; mean age 25 years) giving a power for statistical analysis of beta=0.80 at alpha=0.01. In study two, 30 subjects (15 males, 15 females mean age 28 years) were randomly selected from study one. Fourteen repeated PPT measurements were recorded at seven, 10 min intervals. Mean PPT data for gender groups, from both studies, were analysed using analysis of covariance with repeated measures, and age as the covariate. RESULTS: The mean PPT for each of the two measurements in study one showed a difference between gender of 12.2 N (f=30.5 N, m=42.7 N) and 12.8 N (f=29.5 N, m=42.3 N), respectively, representing a difference of 28% with females exhibiting a lower threshold. In study two, the mean difference calculated from 14 PPT repeated measurements over a 1h period was comparable to that in study one at 12.3N (range 10.4-14.4 N) again females exhibited the lower threshold. The differences in mean PPT values between gender were found to be significant in both study one, at (P<0.0005, F=37.8, df=1) and study two (P=0.01, F=7.6, df=1). No significant differences were found in either study with repeated measurement (P=0.892 and P=0.280), or on the interaction of gender and repeated measurement after controlling for age (P=0.36 and P=0.62). CONCLUSION: Healthy females exhibited significantly lower mean PPTs in the first dorsal interosseous muscle than males, which was maintained for fourteen repeated measures within a 1 h period. This difference is likely to be above clinically relevant levels of change, and it has clear implications for the use of different gender subjects in laboratory based experimental designs utilising PPT as an outcome measure.     

腰椎小关节面硬化的X线研究

目的：探讨腰椎小关节面硬化发生发展的X线表现与腰痛间关系。材料与方法：选择腰椎平片中仅有小关节面硬化表现的腰痛病人240例,与无腰痛症的正常腰椎平片240例,分年龄段1：1配对对照。同时观察了12付正常腰椎标本X线片。结果：1、高年龄组腰椎小关节面硬化发生率高于低年龄组,且下位腰椎发生率明显高于上位腰椎（P＜0．05）。2、腰痛组与对照组小关节面硬化发生率统计结果差异显著（P＜0．05）。结论：下位腰椎小关节面硬化发生率早于上位腰椎且随年龄增长发生率呈上升趋势;单纯腰椎小关节面硬化可引起腰痛;腰椎小关节面硬化在性别间无明显差异。     

A preliminary evaluation of emergency ultrasound in the setting of an emergency medicine training program

In this article we seek to evaluate the diagnostic accuracy of emergency physicians performing emergency ultrasonography in the setting of an emergency medicine training program. A prospective observational study was performed at an inner city Level I trauma center with an emergency medicine residency training program. From July 1994 to December 1996 a convenience sample of ultrasound exams was recorded. The diagnostic quality ("acceptable or technically limited") was determined by a board-certified cardiologist or radiologist with fellowship training in ultrasonography. The emergency department interpretations were then compared to those of the blinded cardiologist or radiologist. Four hundred and fifty-six ultrasound examinations were videotaped and entered into the study; 408 (89%) of the studies performed were determined to be "acceptable." The diagnostic accuracy (sensitivity, specificity, positive and negative predictive values) of these studies were as follows: cardiac, to rule out effusion (n = 67; 0.83, 0.98, 0.88, 0.98); transabdominal, to rule out abdominal aortic aneurysms (AAA), cholelithiasis, or free peritoneal fluid (n = 263; 0.91, 0.89, 0.88, 0.92); renal, to rule out hydronephrosis (n = 45; 0.94, 0.96, 0.94, 0.96); pelvic, to rule in intrauterine pregnancy (n = 33; 1.0, 0.90, 0.96, 1.0). The 48 "technically limited studies" included: 39 transabdominal (33 gallbladder, 1 abdominal aortic aneurysm, 5 free peritoneal fluid), 6 cardiac, 2 renal, and 1 pelvic ultrasound. This study suggests that emergency physicians with a minimal amount of training display acceptable technical skill and interpretive acumen in their approach to emergency ultrasonography.     

The differential effects of gender, anthropometry, and prior hormonal state on frontal plane knee joint stiffness

BACKGROUND: Gender differences in passive frontal plane knee stiffness may contribute to the increased anterior cruciate ligament injury rate in females. Gender-based stiffness differences have been attributed to anthropometric variations, but little data exist describing this relationship. Furthermore, sex hormone levels appear to influence joint stiffness, but the differential effects of instantaneous and prior hormonal concentrations remain unknown. This study sought to explore the effect of gender, prior hormonal status, and anthropometry on passive frontal plane knee joint stiffness. METHODS: Twelve males and 31 females participated. Females were grouped by hormonal contraceptive use (non users [n=11], monophasic contraceptive users [n=11], and triphasic contraceptive users [n=9]) and tested at the same point in the menstrual cycle. Subjects' right knee was passively stretched +/-7 degrees in the frontal plane at 3 degrees /s. Stiffness was estimated at three loading levels and normalized by body size to minimize anthropometric biases. A 4 (group)x3 (load) repeated measures analysis of variance was performed for both raw and normalized stiffness. Linear regression analyses were preformed between stiffness estimates and knee diameter and quadriceps femoris angle. FINDINGS: Males displayed significantly greater (P<0.05) frontal plane stiffness than females. When normalized, males displayed significantly greater stiffness in valgus (P<0.05), but not varus (P>0.05) than females. No significant effect (P>0.05) of prior hormonal state was found; however, when normalized, varus stiffness was significantly less for triphasic contraceptive users than the other female groups (P<0.05). Quadriceps femoris angle was negatively correlated and knee diameter was positively correlated to knee stiffness. INTERPRETATION: Consistent with earlier in vitro findings, our data may indicate that ligament material properties are gender specific. A deficit in passive knee joint stiffness may place a larger burden on the neuromuscular system to resist frontal plane loading in females.     

Nature and prevalence of pain in Fabry disease and its response to enzyme replacement therapy--a retrospective analysis from the Fabry Outcome Survey

BACKGROUND: Fabry disease is a multisystemic life-threatening lysosomal storage disorder caused by deficiency of alpha-galactosidase A. Symptoms of the disease may occur in different organs including kidney, heart, and the nervous system. OBJECTIVES: To evaluate the nature and prevalence of pain in a large cohort of patients with Fabry disease and to assess the effect of enzyme replacement therapy (ERT) with agalsidase alfa. METHODS: Retrospective analysis of the data of 752 patients with Fabry disease (393 females, 353 males) enrolled in the Fabry Outcome Survey, a multicentre database. RESULTS: The prevalence of pain in male patients was 81.4% (females 65.3%). Mean age at onset of pain was 14.8+/-1.0 year in males (females 19.8+/-1.4 y). Pain was most frequently reported in the hands (males 76%, females 60%) and feet (males 73%, females 52%), but often affected the whole body. Interference of pain with daily life was higher in females than in males, and was observed predominantly for general activities, mood, and normal work. Fifty-eight percent of the patients were on ERT with agalsidase alfa. At 24 and 36 months after commencement of ERT, pain severity classification shifted towards lower severity (P<0.05). Moreover, after 36 months, "average pain" and "pain now" were significantly reduced (P<0.05). CONCLUSIONS: Pain is one of the most prevalent symptoms in Fabry disease with onset early in childhood. ERT with agalsidase alfa significantly reduces pain in this debilitating disorder.     

Lower extremity mechanics of females with and without patellofemoral pain across activities with progressively greater task demands

BACKGROUND: Patellofemoral pain is commonly associated with lower extremity joint rotations that decrease retropatellar contact area and subsequently increase retropatellar stress during weightbearing activities. People with patellofemoral pain are thought to be capable of avoiding such harmful mechanics during activities with low external demands. However, this may not be possible during more demanding activities. The purpose of this study was to analyze lower extremity mechanics in females with and without patellofemoral pain during three different activities. Specifically, we sought to determine if differences between groups increase with increasingly demanding activities. METHODS: 20 females with patellofemoral pain and 20 healthy female controls performed single leg squats, running, and repetitive single leg jumps as their three-dimensional lower extremity mechanics were recorded. Transverse and frontal plane hip and knee kinematics were compared between groups for all activities. FINDINGS: Differences in the variables of interest between groups did not generally depend on the nature of the activity. The patellofemoral pain group performed all three activities with 4.3 degrees greater knee external rotation (P=0.06), 3.5 degrees greater hip adduction (P=0.012), and 3.9 degrees decreased hip internal rotation with respect to the control group (P=0.01). INTERPRETATION: These results suggest that females with patellofemoral pain do not employ different mechanics as demand of the activity increases. Rather, females with patellofemoral pain seem to demonstrate similar abnormal lower extremity mechanics across a variety of activities.