An electromyographic analysis of shoulder muscle activation during push-up variations on stable and labile surfaces

Background:

Numerous exercises are used to strengthen muscles around the shoulder joint including the push-up and the push-up plus. An important consideration is the addition of surface instability in the form of swiss ball for rehabilitation and strength. The justification for the use of the swiss ball is based on its potential for increasing muscular demand required to maintain postural stability and for improving joint proprioception. Evidence for this is lacking in literature.

Purpose of the Study:

To compare the myoelectric amplitude of shoulder muscles during push-ups on labile and stable surface.

Study Design:

Same subject experimental study.

Materials and Methods:

Thirty healthy male subjects in the age group 20-30 years with a mean height of 173.65 cm (± SD 2.56) and a mean weight of 69.9 kg (±SD 0.2) were taken. Surface electromyogram was recorded from triceps, pectoralis major, serratus anterior and upper trapezius while performing push-up and push-up plus exercises, both on labile and stable surface.

Results:

Significant increase in muscle activity was observed in pectoralis major and triceps muscle (only during eccentric phase of elbow pushups), while serratus anterior and upper trapezius showed no change in activation level on swiss ball.

Conclusion:

The addition of a swiss ball is capable of influencing shoulder muscle activity during push-up variations, although the effect is task and muscle dependent.     

The management of abuse: 4. Abuse of vulnerable adults

Vulnerable adults include those who, for reasons of age or illness, are unable to protect themselves from significant harm. The role of the GDP and the dental team in the recognition and management of abuse of vulnerable adults is discussed. Information on the current legislation and protocols for referral are provided.     

Common Genetic Variation Near Melatonin Receptor MTNR1B Contributes to Raised Plasma Glucose and Increased Risk of Type 2 Diabetes Among Indian Asians and European Caucasians

OBJECTIVE

Fasting plasma glucose and risk of type 2 diabetes are higher among Indian Asians than among European and North American Caucasians. Few studies have investigated genetic factors influencing glucose metabolism among Indian Asians.

RESEARCH DESIGN AND METHODS

We carried out genome-wide association studies for fasting glucose in 5,089 nondiabetic Indian Asians genotyped with the Illumina Hap610 BeadChip and 2,385 Indian Asians (698 with type 2 diabetes) genotyped with the Illumina 300 BeadChip. Results were compared with findings in 4,462 European Caucasians.

RESULTS

We identified three single nucleotide polymorphisms (SNPs) associated with glucose among Indian Asians at P < 5 × 10⁻⁸, all near melatonin receptor MTNR1B. The most closely associated was rs2166706 (combined P = 2.1 × 10⁻⁹), which is in moderate linkage disequilibrium with rs1387153 (r² = 0.60) and rs10830963 (r² = 0.45), both previously associated with glucose in European Caucasians. Risk allele frequency and effect sizes for rs2166706 were similar among Indian Asians and European Caucasians: frequency 46.2 versus 45.0%, respectively (P = 0.44); effect 0.05 (95% CI 0.01–0.08) versus 0.05 (0.03–0.07 mmol/l), respectively, higher glucose per allele copy (P = 0.84). SNP rs2166706 was associated with type 2 diabetes in Indian Asians (odds ratio 1.21 [95% CI 1.06–1.38] per copy of risk allele; P = 0.006). SNPs at the GCK, GCKR, and G6PC2 loci were also associated with glucose among Indian Asians. Risk allele frequencies of rs1260326 (GCKR) and rs560887 (G6PC2) were higher among Indian Asians compared with European Caucasians.

CONCLUSIONS

Common genetic variation near MTNR1B influences blood glucose and risk of type 2 diabetes in Indian Asians. Genetic variation at the MTNR1B, GCK, GCKR, and G6PC2 loci may contribute to abnormal glucose metabolism and related metabolic disturbances among Indian Asians.The World Health Organization estimates that by 2025 there will be 57 million Indian Asians with type 2 diabetes, (1) by which time one-quarter of type 2 diabetic patients globally will be Indian Asian. Migration data among Indian Asians show that the prevalence of type 2 diabetes is ∼20% among Indian Asians in the U.K. and North America compared with ∼15% in urban Indian and ∼6% in rural India (2–5). Although these studies emphasize the importance of environmental triggers such as sedentary lifestyle and excess consumption of energy-dense foods, genetic factors are also likely to be important (6). Understanding the genetic mechanisms influencing glucose metabolism among Indian Asians may provide insight into the increased risk of type 2 diabetes among Indian Asians. Genome-wide association studies have recently identified common genetic variation in and around the genes GCK, GCKR, G6PC2, and MTNR1B as determinants of glucose levels in European populations (7–11). We have carried out a genome-wide association study of fasting plasma glucose levels in a population-based cohort of Indian Asian men and women.     

Transcatheter closure of postsurgical residual ventricular septal defects: Early and mid‐term results

Background: The incidence of residual ventricular septal defects (VSDs) after surgery is 5–25%. Redo surgery is associated with higher risks. Methods: Between January 2000 to December 2008, 170 patients underwent percutaneous VSD closure in our centre: 22(16M) of these had 23 closures for residual VSDs. Median age was 32.5 yrs (1.4–79). All patients had echocardiographic signs of left ventricle volume overload (Q_p/Q_s ≥ 1.5). Nine patients had previous VSD closure, 6 tetralogy of Fallot repair, and 7, other procedures. There were 15 muscular, 6 perimembranous and 2 apical VSDs. Results: Amplatzer VSD devices were used in all. Median VSD size was 8 mm (4.3–16). Median fluoroscopy time was 33 minutes (15–130). There were three adverse events: 1 ventricular fibrillation requiring DC cardioversion; 1 transient complete atrio‐ventricular block reverting to sinus rhythm at 24‐hours; one patient had transient atrial flutter during the procedure. All procedures were successful; no additional procedures were required. Trivial residual shunts were seen in 3 patients at follow‐up. There were no late events. One patient experienced arrhythmic death 5‐yrs after procedure. One patient was reoperated due to dehiscence of VSD patch 2‐yrs after the second successful percutaneous closure. Conclusions: Transcatheter closure of postsurgical residual VSD is safe and efficacious management option and obviates the need for further surgery and by‐pass. © 2009 Wiley‐Liss, Inc.     

Effect of different cuff widths on the motor nerve conduction of the median nerve: an experimental study

Background  

A bloodless operative field is considered mandatory for most surgical procedures on the upper and lower extremity. This is accomplished by using either an Esmarch bandage or a pneumatic tourniquet, but a number of complications are associated with both. Nerve palsy is one of the most frequently encountered complications of this procedure. Wider cuffs have been found to cause reduced risk of tourniquet induced injury to the underlying soft tissues than the narrower ones due to the fact that lower occlusion pressures are caused by the former. To address and investigate this question, conduction in the median nerve has been measured proximal to tourniquet as well as distal to the tourniquet. Parameters of nerve conduction measured are nerve conduction velocity, latency and amplitude.