The regression model is not sufficiently accurate to predict skeletal medio-lateral for clinical purposes. Accuracy of the prediction could be improved with more accurate input data from computed tomography scans and use of other independent variables that explain the unique variance not already described by the participants' sex. Clinical relevance This pilot study demonstrates potential for the skeletal medio-lateral to be predicted using non-invasive anthropometric measurements. Given this proof of concept, future investigators should use more accurate input data from computed tomography scans and identify alternative independent variables that explain the variance in the skeletal medio-lateral not attributable to sex.
Functional brown adipose tissue (BAT) was identified in adult humans only in 2007 with the use of fluorodeoxyglucose positron emission tomography imaging. Previous studies have demonstrated a negative correlation between obesity and BAT presence in humans. It is proposed that BAT possesses the capacity to increase metabolism and aid weight loss. In rodents it is well established that BAT is stimulated by the sympathetic nervous system with the interscapular BAT being innervated via branches of intercostal nerves. Whilst there is evidence to suggest that BAT possesses beta-3 adrenoceptors, no studies have identified the specific nerve branch that carries sympathetic innervation to BAT in humans. The aim of this study was to identify and trace the peripheral nerve or nerves that innervate human BAT in the supraclavicular region. The posterior triangle region of the neck of cadaveric specimens were dissected in order to identify any peripheral nerve branches piercing and/or terminating in supraclavicular BAT. A previously undescribed branch of the cervical plexus terminating in a supraclavicular adipose depot was identified in all specimens. This was typically an independent branch of the plexus, from the third cervical spinal nerve, but in one specimen was a branch of the supraclavicular nerve. Histological analysis revealed the supraclavicular adipose depot contained tyrosine hydroxylase immunoreactive structures, which likely represent sympathetic axons. This is the first study that identifies a nerve branch to supraclavicular BAT-like tissue. This finding opens new avenues for the investigation of neural regulation of fat metabolism in humans.
Abstract-Accurate measurement of the pelvis is critical for well-fitting and comfortable ischial containment sockets. The "Skeletal Medial-Lateral (ML)" is intrusive and unreliable to measure in vivo. This study aimed to determine how accurately the Skeletal ML could be predicted and to identify which measurements were significant predictors. Computed tomography scans were randomly sampled from a cadaveric database (n = 200). Inclusion criteria were age > 20 yr; lower-limb alignment that replicated the anatomical position; and no evidence of osteological trauma, implants, or bony growths. Multivariate linear regression models were developed to predict the Skeletal ML based on a suite of independent variables, including sex, body mass, and distance between pelvic landmarks. The regression model explained 76% of the variance in the Skeletal ML (p < 0.001). Variables that contributed significantly to the prediction of the Skeletal ML (p < 0.05) included body mass, sex, inter-greater trochanter distance, pelvic depth, and age. Significant predictors of the Skeletal ML dimension characterize variation in subcutaneous adipose tissue thickness and pelvic morphology. The Skeletal ML could be predicted with relatively small errors (standard error of estimate = 7 mm) that could be easily and reliably adjusted during socket fitting. Further research is needed to test the predictive tool in a real-world setting.
Hip fracture remains a major cause of death and disability among older persons. Anatomical and biomechanical design considerations for shunting-type hip-protectors were investigated to address low user compliance among older-persons.Aims were to assess the hip muscle morphology as a load-attenuating medium during shunting: determine the material properties of skeletal muscle; and assess shunting-type hip-protector function in lateral falls.Low and high hip fracture risk groups were identified based on BMI. A three dimensional map was developed to measure muscle thickness at 15 points and volume (of gluteal and quadriceps) using CT. A new method was developed to measure material properties of skeletal muscle under fall conditions by impacting muscles in the in-situ state, substituting ovine for human specimens. Biomechanical kinematic data, the effect of specimen size and impact velocity were also analysed. Finite element simulations were then conducted to evaluate hip-protector function.Significant differences in muscle thickness were revealed between hip fracture risk groups. The strong relationship of muscle thickness to subjects’ body mass allowed development of mathematical models that estimate the maximum muscle thickness and muscle thickness based on location, both from subject mass. An average 17% increase in muscle volume was quantified for an equivalent 10 kg increase in subject mass. Males exhibited 3%–23% increased volume over females depending on the muscle. Material properties of skeletal muscle revealed an average Young’s Modulus of 0.06 MPa. Fall simulations quantified peak loads shunted to the iliac bone, greater trochanter and femoral shaft.FindingsSuggest reducing protector size for greater wearer acceptance may cause injury elsewhere, especially for lean individuals at high fracture risk. Rather, hip-protector design should be based more on individual body constitution to increase effectiveness and comfort, and therefore user compliance. Muscle size should be maintained to allow effective use of preventive strategies within normal anatomical limits.
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