المؤلفون: Pan, Jing¹ (AUTHOR), Fu, Wei¹ (AUTHOR), Lv, Jinmiao¹ (AUTHOR), Tang, Huiyi¹ (AUTHOR), Huang, Zhiguan² (AUTHOR), Zou, Yu¹ (AUTHOR), Zhang, Xiaohui¹ (AUTHOR) Sportsmedzxh@sina.com, Liao, Bagen¹ (AUTHOR) Bagenliao@sina.com

المصدر: BMC Musculoskeletal Disorders. 4/6/2024, Vol. 25 Issue 1, p1-8. 8p.

مصطلحات موضوعية: *KNEE osteoarthritis, *RECTUS femoris muscles, *ANKLE joint, *KNEE joint, *GROUND reaction forces (Biomechanics)

مستخلص: Background: Knee osteoarthritis (KOA) is a prevalent and debilitating condition that markedly affects the sit-to-stand (STS) activity of patients, a prerequisite for daily activities. Biomechanical recognition of movements in patients with mild KOA is currently attracting attention. However, limited studies have been conducted solely on the observed differences in sagittal plane movement and muscle activation. Aim: This study aimed to identify three-dimensional biomechanical and muscle activation characteristics of the STS activity in patients with mild KOA. Methods: A cross-sectional study was conducted to observe the differences between patients with mild KOA and a control group (CG). It was conducted to observe the differences in muscle activation, including root mean square (RMS%) and integrated electromyography (items), kinematic parameters like range of motion (ROM) and maximum angular velocity, as well as dynamic parameters such as joint moment and vertical ground reaction force (vGRF). Results: Patients with mild KOA had a higher body mass index and longer task duration. In the sagittal plane, patients with KOA showed an increased ROM of the pelvic region, reduced ROM of the hip–knee–ankle joint, and diminished maximum angular velocity of the knee–ankle joint. Furthermore, patients with KOA displayed increased knee–ankle joint ROM in the coronal plane and decreased ankle joint ROM in the horizontal plane. Integrated vGRF was higher in both lower limbs, whereas the vGRF of the affected side was lower. Furthermore, patients showed a decreased peak adduction moment (PADM) and increased peak external rotation moment in the knee joint and smaller PADM and peak internal rotation moment in the ankle joint. The affected side exhibited decreased RMS% and iEMG values of the gluteus medius, vastus medialis, and vastus lateralis muscles, as well as a decreased RMS% of the rectus femoris muscle. Conversely, RMS% and iEMG values of the biceps femoris, lateral gastrocnemius, and medial gastrocnemius muscles were higher. Conclusion: The unbalanced activation characteristics of the anterior and posterior muscle groups, combined with changes in joint moment in the three-dimensional plane of the affected joint, may pose a potential risk of injury to the irritated articular cartilage. [ABSTRACT FROM AUTHOR]

المؤلفون: Hu, Xiongke^1,2 (AUTHOR), Tan, Qian^1,2 (AUTHOR), Mei, Haibo^1,2 (AUTHOR), Mo, Shasha¹ (AUTHOR), Liu, Kun^1,2 (AUTHOR) kunliu1@sina.com

المصدر: BMC Musculoskeletal Disorders. 6/13/2023, Vol. 24 Issue 1, p1-7. 7p.

مصطلحات موضوعية: *IDIOPATHIC femoral necrosis, *RECTUS femoris muscles, *DYSPLASIA, *FEMUR head, *JOINT capsule, *ACETABULUM (Anatomy), *SURGICAL complications, ACETABULUM surgery

مستخلص: Objectives: To investigate the clinical efficacy and safety of open reduction through anterior minimally invasive approach in the treatment of children with developmental dysplasia of the hip. Method: A total of 23 patients (25 hips) less than 2 years with developmental dysplasia of the hip treated by open reduction through anterior minimally invasive approach were treated in our hospital from August 2016 to March 2019. Through the anterior minimally invasive approach, we enter from the gap between sartorius muscle and tensor fasciae lata without cutting off rectus femoris muscle, which can effectively expose the joint capsule and reduce the damage to medial blood vessels and nerves. The operation time, incision length, intraoperative bleeding, hospital stay and surgical complications were observed. The progression of developmental dysplasia of the hip and avascular necrosis of the femoral head were evaluated by imaging examination. Result: All patients were performed with follow-up visit for an average of 22 months. The average incision length was 2.5 cm, the average operation time was 26 min, the average intraoperative bleeding was 12ml, and the average hospital stay was 4.9 days. All patients received concentric reduction immediately after operation, and no re-dislocation occurred. At the last follow-up visit, the acetabular index was (25.8 ± 6.4°). During the follow-up visit, X-ray showed avascular necrosis of the femoral head in 4 hips (16%). Conclusion: open reduction through anterior minimally invasive approach can achieve good clinical effect in the treatment of infantile developmental dysplasia of the hip. [ABSTRACT FROM AUTHOR]

المؤلفون: Wang, Feng, Zhou, Ting, Zhou, Chen Xu, Zhang, Quan Bing, Wang, Hua, Zhou, Yun

المصدر: BMC Musculoskeletal Disorders; 8/4/2023, Vol. 24 Issue 1, p1-13, 13p

مصطلحات موضوعية: SKELETAL muscle, MUSCULAR atrophy, RECTUS femoris muscles, EPICATECHIN, MITOCHONDRIA formation, TRANSMISSION electron microscopes, MUSCULAR hypertrophy

مستخلص: Background: Recent studies have shown that immobilization enhances reactive oxygen species (ROS) production and mitophagy activity in atrophic skeletal muscle. However, there are relatively few studies examining the biological changes and underlying mechanisms of skeletal muscle during remobilization. In this study, we aimed to investigate the effects of remobilization on skeletal muscle and explore the role of BNIP3-dependent mitophagy in this process. Methods: Thirty rats were randomly divided into six groups based on immobilization and remobilization time: control (C), immobilization for two weeks (I-2w), and remobilization for one day (R-1d), three days (R-3d), seven days (R-7d), and two weeks (R-2w). At the end of the experimental period, the rectus femoris muscles were removed and weighed, and the measurements were expressed as the ratio of muscle wet weight to body weight (MWW/BW). Sirius Red staining was performed to calculate the values of cross-sectional area (CSA) of rectus femoris. Oxidative fluorescent dihydroethidium was used to evaluate the production of ROS, and the levels of superoxide dismutase (SOD) were also detected. The morphological changes of mitochondria and the formation of mitophagosomes in rectus femoris were examined and evaluated by transmission electron microscope. Immunofluorescence was employed to detect the co-localization of BNIP3 and LC3B, while Western blot analysis was performed to quantify the levels of proteins associated with mitophagy and mitochondrial biogenesis. The total ATP content of the rectus femoris was determined to assess mitochondrial function. Results: Within the first three days of remobilization, the rats demonstrated decreased MWW/BW, CSA, and ATP concentration, along with increased ROS production and HIF-1α protein levels in the rectus femoris. Results also indicated that remobilization triggered BNIP3-dependent mitophagy, supported by the accumulation of mitophagosomes, the degradation of mitochondrial proteins (including HSP60 and COX IV), the elevation of BNIP3-dependent mitophagy protein markers (including BNIP3, LC3B-II/LC3B-I, and Beclin-1), and the accumulation of puncta representing co-localization of BNIP3 with LC3B. Additionally, PGC-1α, which is involved in the regulation of mitochondrial biogenesis, was upregulated within the first seven days of remobilization to counteract this adverse effect. Conclusion: Our findings suggested that BNIP3-denpendent mitophagy was sustained activated at the early stages of remobilization, and it might contribute to the worsening of skeletal muscle atrophy. [ABSTRACT FROM AUTHOR]

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المؤلفون: Ong, Michael Tim-yun, Chi-wai Man, Gene, He, Xin, Yu, Mingqian, Lau, Lawrence Chun-man, Qiu, Jihong, Wang, Qianwen, Ho-pak, Jeremy, Liu, Chi-yin Choi, Ben, Ng, Jonathan Patrick, Shu-hang Yung, Patrick

المصدر: BMC Musculoskeletal Disorders; 6/22/2023, Vol. 24 Issue 1, p1-8, 8p

مصطلحات موضوعية: ANTERIOR cruciate ligament surgery, KNEE pain, PATELLOFEMORAL joint, RECTUS femoris muscles, VASTUS medialis, VASTUS lateralis, LEG exercises

مستخلص: Background: Persistent anterior knee pain and subsequent patellofemoral joint (PFJ) osteoarthritis (OA) are common symptoms after anterior cruciate ligament reconstruction (ACLR). Quadriceps weakness and atrophy is also common after ACLR. This can be contributed by arthrogenic muscle inhibition and disuse, caused by joint swelling, pain, and inflammation after surgery. With quadriceps atrophy and weakness are associated with PFJ pain, this can cause further disuse exacerbating muscle atrophy. Herein, this study aims to identify early changes in musculoskeletal, functional and quality of health parameters for knee OA after 5 years of ACLR. Methods: Patients treated with arthroscopically assisted single-bundle ACLR using hamstrings graft for more than 5 years were identified and recruited from our clinic registry. Those with persistent anterior knee pain were invited back for our follow-up study. For all participants, basic clinical demography and standard knee X-ray were taken. Likewise, clinical history, symptomatology, and physical examination were performed to confirm isolated PFJ pain. Outcome measures including leg quadriceps quality using ultrasound, functional performance using pressure mat and pain using self-reported questionnaires (KOOS, Kujala and IKDC) were assessed. Interobserver reproducibility was assessed by two reviewers. Results: A total of 19 patients with unilateral injury who had undergone ACLR 5-years ago with persistent anterior knee pain participated in this present study. Toward the muscle quality, thinner vastus medialis and more stiffness in vastus lateralis were found in post-ACLR knees (p < 0.05). Functionally, patients with more anterior knee pain tended to shift more of their body weight towards the non-injured limb with increasing knee flexion. In accordance, rectus femoris muscle stiffness in the ACLR knee was significantly correlated with pain (p < 0.05). Conclusion: In this study, it was found that patients having higher degree of anterior knee pain were associated with higher vastus medialis muscle stiffness and thinner vastus lateralis muscle thickness. Similarly, patients with more anterior knee pain tended to shift more of their body weight towards the non-injured limb leading to an abnormal PFJ loading. Taken together, this current study helped to indicate that persistent quadriceps muscle weakness is potential contributing factor to the early development of PFJ pain. [ABSTRACT FROM AUTHOR]

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المؤلفون: Li, Xuefeng, Li, Jinyu, Qing, Liang, Wang, Haonan, Ma, Huijun, Huang, Peng

المصدر: BMC Musculoskeletal Disorders; 5/8/2023, Vol. 24 Issue 1, p1-14, 14p

مصطلحات موضوعية: ANTERIOR cruciate ligament surgery, QUADRICEPS muscle, BLOOD flow, POSTOPERATIVE period, ISOKINETIC exercise, RECTUS femoris muscles

مستخلص: Background: More than 2 million anterior cruciate ligament (ACL) injuries occur worldwide each year. Most surgeons suggest that athletes and active persons with significant knee functional demands, including cutting motions, require and should be offered ligament reconstruction surgery. Despite concentrated rehabilitation efforts, deficits in quadriceps size and strength can persist for years after surgery. Blood flow restriction (BFR) training can help overcome disuse muscular atrophy in the mid-term postoperative period after anterior cruciate ligament reconstruction (ACLR) surgery. The purpose of this study was to evaluate the effects of quadriceps training with different levels of blood flow restriction on quadriceps strength and thickness of participants after ACLR. Methods: In this study, 30 post-ACL reconstruction participants were randomly divided into three groups (control, 40% Arterial Occlusion Pressure [AOP] and 80% AOP groups). All patients were subjected to different levels of BFR, combined with conventional quadriceps rehabilitation, for 8 weeks. Assessments included scaled maximal isokinetic knee extension strength at 60°/s and 180°/s, the sum of the thickness of the affected femoris rectus and vastus intermedius, Y-balance test performance, and International Knee Documentation Committee questionnaire responses before and after the intervention. Results: In total, 23 participants completed the entire study. The 80% AOP compression group showed an increase in quadriceps femoris muscle strength and muscle thickness (p < 0.01). As compared with the control group, outcome indicators in the 40% AOP and 80% AOP group were improved (p < 0.05). After 8 weeks of experimental BFR intervention, the results were better for the 80% AOP compression group than for the 40% AOP compression group in quadriceps peak torque to body weight at 60°/s and 180°/s angular velocity, as well as the sum of the thickness of the rectus femoris and vastus intermedius. Conclusion: The combination of BFR and low-intensity quadriceps femoris training can effectively improve the muscle strength and thickness of knee extensors in participants with ACLR and help reduce the difference between the healthy and surgical sides of the knee joint while improving knee-joint function. Choosing quadriceps training with 80% AOP compression intensity could provide the most benefits. Meanwhile, BFR can accelerate the rehabilitation process of patients and allow early entry into the next rehabilitation cycle. Registration: Trial registration Chinese Clinical Trial Registry, registration number ChiCTR2100050011, date of registration: 15/08/2021. [ABSTRACT FROM AUTHOR]

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المؤلفون: Li, Wei, Zhang, De-Bao, Xu, Sheng-Ming, Bi, Huang-Yi, Gu, Gui-Shan

المصدر: BMC Musculoskeletal Disorders; 2/7/2023, Vol. 24 Issue 1, p1-10, 10p

مصطلحات موضوعية: SURGICAL site infections, RANGE of motion of joints, RECTUS femoris muscles, VASTUS medialis, JOINT stiffness

مستخلص: Objective: A combination of lateral soft tissue release, medial soft tissue contraction, vastus medialis anterior placement, medial patellofemoral ligament reconstruction, and rectus femoris insertion reconstruction are introduced in the treatment of habitual patellar dislocation in adolescents. Methods: A retrospective analysis was performed on 12 patients (17 knees) with habitual patellar dislocation and unclosed epiphyses who underwent surgical treatment at the First Hospital of Jilin University from May 2017 to November 2021. The Lysholm scores and Q angle were collected preoperatively and at final follow-up and were compared. Results: Twelve patients (4 boys and 8 girls) aged 10–15 years were retrospectively analysed, who followed up for an average of 21 months (5–48 months). The range of motion of the knee joint returned to normal in all patients, and no cases of complications including surgical site infection, joint stiffness, or patellar re-dislocation occurred. The mean Lysholm scores and Q angles improved from 73.9, and 19.6° preoperatively to 91.7, and 13.9° at the final follow-up, respectively. Conclusion: The preliminary effect of the combination surgery for habitual patellar dislocation in adolescents was satisfactory. [ABSTRACT FROM AUTHOR]

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المؤلفون: Bates, Alexander Vernon^1,2 (AUTHOR) alexandervbates@gmail.com, McGregor, Alison¹ (AUTHOR), Alexander, Caroline M.^1,2,3 (AUTHOR) alexandervbates@gmail.com

المصدر: BMC Musculoskeletal Disorders. 1/29/2021, Vol. 22 Issue 1, p1-10. 10p.

مصطلحات موضوعية: *JOINT hypermobility, *RECTUS femoris muscles, *VASTUS medialis, *VASTUS lateralis, *TIBIALIS anterior, *JOINT pain, *EHLERS-Danlos syndrome, *ANKLE, *LEG, *KINEMATICS, *KNEE

مستخلص: Background: Joint Hypermobility Syndrome (JHS) is a Heritable Disorder of Connective tissue characterised by joint laxity and chronic widespread arthralgia. People with JHS exhibit a range of other symptoms including balance problems. To explore balance further, the objective of this study is to compare responses to forward perturbations between three groups; people who are hypermobile with (JHS) and without symptoms and people with normal flexibility.Methods: Twenty-one participants with JHS, 23 participants with Generalised Joint Hypermobility (GJH) and 22 participants who have normal flexibility (NF) stood on a platform that performed 6 sequential, sudden forward perturbations (the platform moved to the anterior to the participant). Electromyographic outcomes (EMG) and kinematics for the lower limbs were recorded using a Vicon motion capture system. Within and between group comparisons were made using Kruskal Wallis tests.Results: There were no significant differences between groups in muscle onset latency. At the 1st perturbation the group with JHS had significantly longer time-to-peak amplitude than the NF group in tibialis anterior, vastus medialis, rectus femoris, vastus lateralis, and than the GJH group in the gluteus medius. The JHS group showed significantly higher cumulative joint angle (CA) than the NF group in the hip and knee at the 1st and 2nd and 6th perturbation, and in the ankle at the 2nd perturbation. Participants with JHS had significantly higher CA than the GJH group at the in the hip and knee in the 1st and 2nd perturbation. There were no significant differences in TTR.Conclusions: The JHS group were able to normalise the timing of their muscular response in relation to control groups. They were less able to normalise joint CA, which may be indicative of impaired balance control and strength, resulting in reduced stability. [ABSTRACT FROM AUTHOR]

المؤلفون: Peiris, Waruna L.¹ (AUTHOR), Cicuttini, Flavia M.¹ (AUTHOR), Constantinou, Maria² (AUTHOR), Yaqobi, Abbas¹ (AUTHOR), Hussain, Sultana Monira¹ (AUTHOR), Wluka, Anita E.¹ (AUTHOR), Urquhart, Donna¹ (AUTHOR), Barrett, Rod³ (AUTHOR), Kennedy, Ben⁴ (AUTHOR), Wang, Yuanyuan¹ (AUTHOR) yuanyuan.wang@monash.edu

المصدر: BMC Musculoskeletal Disorders. 5/21/2020, Vol. 21 Issue 1, p1-7. 7p. 1 Color Photograph, 2 Charts.

مصطلحات موضوعية: *PSOAS muscles, *RECTUS femoris muscles, *OSTEOARTHRITIS, *FLEXOR muscles, *CROSS-sectional method, *MUSCLES, *MAGNETIC resonance imaging, *FEMORACETABULAR impingement

مستخلص: Background: To examine the associations between hip muscle cross-sectional area and hip pain and function in community-based individuals with mild-to-moderate hip osteoarthritis.Methods: This study included 27 participants with mild-to-moderate hip osteoarthritis. Cross-sectional area of hip muscles, including psoas major, rectus femoris, gluteus maximus, gluteus medius and minimus, adductor longus and magnus, obturator internus, and obturator externus, were measured from magnetic resonance images. Hip pain and function were evaluated using the Hip Disability and Osteoarthritis Outcome Score (HOOS) categorised into 5 subscales: pain, symptoms, activity of daily living, sport and recreation function, and hip-related quality of life (for each subscale 0 representing extreme problems and 100 representing no problems).Results: Mean age of the 27 participants was 63.2 (SD 7.6) years and 66.7% (n = 18) were female. After adjusting for age and gender, greater cross-sectional area of adductor longus and magnus was associated with a higher HOOS score in quality of life (regression coefficient 1.4, 95% confidence interval (CI) 0.2-2.7, p = 0.02), activity of daily living (regression coefficient 1.3, 95% CI 0.1-2.6, p = 0.04) and sport and recreation function (regression coefficient 1.6, 95% CI 0.1-3.0, p = 0.04). There was a trend towards an association between greater cross-sectional area of psoas major and a higher quality of life score (regression coefficient 3.6, 95% CI - 0.5 to 7.7, p = 0.08). The cross-sectional area of hip muscles was not significantly associated with HOOS pain or symptom score.Conclusion: Greater cross-sectional area of hip adductors was associated with better function and quality of life in individuals with mild-to-moderate hip osteoarthritis. Greater cross-sectional area of hip flexors might be associated with better quality of life. These findings, while need to be confirmed in longitudinal studies, suggest that targeting the hip adductor and flexor muscles may improve function and quality of life in those with mild-to-moderate hip osteoarthritis. [ABSTRACT FROM AUTHOR]

المؤلفون: Liu, A-Ying, Zhang, Quan-Bing, Zhu, Hua-Long, Xiong, Yong-Wei, Wang, Feng, Huang, Peng-Peng, Xu, Qi-Yu, Zhong, Hua-Zhang, Wang, Hua, Zhou, Yun

المصدر: BMC Musculoskeletal Disorders; 4/28/2022, Vol. 23 Issue 1, p1-12, 12p

مصطلحات موضوعية: MUSCULAR atrophy, ELECTRIC stimulation, RECTUS femoris muscles, SKELETAL muscle, KNEE joint, AUTOPHAGY

مستخلص: Background: The study aimed to investigate the effect of low-frequency electrical stimulation (LFES) on disuse muscle atrophy and its mechanism in a rabbit model of knee extension contracture.Methods: This study involved two experiments. In the time-point experiment, 24 rabbits were randomly divided into 4 groups: Control 1 (Ctrl1 group), immobilization for 2 weeks (I-2 group), immobilization for 4 weeks (I-4 group), and immobilization for 6 weeks (I-6 group). In the intervention experiment, 24 rabbits were randomly divided into 4 groups: Control 2 (Ctrl2 group), electrical stimulation (ESG group), natural recovery (NRG group), and electrical stimulation treatment (ESTG group). All intervention effects were assessed by evaluating the knee joint range of motion (ROM), cross-sectional area (CSA) of the rectus femoris muscle, and expression of autophagy-related proteins.Results: The time-point experiment showed that immobilization reduced the knee ROM, reduced the rectus femoris muscle CSA, and activated autophagy in skeletal muscle. The levels of five autophagy-related proteins [mammalian target of rapamycin (mTOR), phosphorylated mTOR (p-mTOR), autophagy-related protein 7 (Atg7), p62, and microtubule-associated protein light chain 3B-II (LC3B-II)] were significantly elevated in the skeletal muscle of the I-4 group. The intervention experiment further showed that LFES significantly improved the immobilization-induced reductions in ROM and CSA. Additionally, LFES resulted in a significant decrease in the protein expression of mTOR, p-mTOR, Atg7, p62, and LC3B-II in the rectus femoris muscle.Conclusions: LFES alleviates immobilization-evoked disuse muscle atrophy possibly by inhibiting autophagy in the skeletal muscle of rabbits. [ABSTRACT FROM AUTHOR]

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المؤلفون: Peng, Jianping, Xiao, Fei, Zhu, Junfeng, Shen, Chao, Li, Yang, Han, Xiuguo, Cui, Yimin, Chen, Xiaodong

المصدر: BMC Musculoskeletal Disorders; 4/8/2022, Vol. 23 Issue 1, p1-8, 8p

مصطلحات موضوعية: PATELLOFEMORAL joint, ACETABULUM surgery, KNEE joint, RECTUS femoris muscles, OSTEOTOMY, HIP joint

مستخلص: Background: Some patients with developmental dysplasia of the hip (DDH) complained of anterior knee pain (AKP) before and after Bernese periacetabular osteotomy (PAO) surgery. The purpose of this study was to (1) identify the characteristics of patellofemoral joint (PFJ) deformities in patients with DDH and (2) to determine the effects of PAO on the PFJ.Methods: Seventy patients (86 hips) were included in the DDH group. Thirty-three patients (33 knees) without AKP and hip pain were included in the control group. All patients underwent simultaneous CT scans of the hip and knee joints before PAO and after hardware removal surgery. The distance from the anterior inferior iliac spine to the ilioischial line (DAI), was measured in DDH patients. Imaging parameters of knees, including the sulcus angle (SA), femoral trochlear depth (FTD), patellar width (PW), tibial tuberosity-trochlear groove (TT-TG), patellar tilt angle (PTA) and lateral shift of the patella (LSP) were measured in patients in both the DDH and control group. TT-TG, PTA, and LSP of DDH patients were measured before PAO and after hardware removal. The DAI, PTA, LSP and TT-TG of all DDH patients before and after Bernese PAO were compared using paired t-tests. The FTD, PW, and SA of the DDH patients and the control group were analyzed using independent t-tests. PTA, TT-TG, and LSP between the control group and preoperative DDH patients, between the control group and post PAO patients were compared using independent t-tests.Results: The DAI changed from 4.04 ± 0.61 mm before PAO surgery to 5.44 ± 0.63 mm after PAO surgery. The SA of the DDH group (140.69 ± 11.30 degree) was greater than that of the control group (130.82 ± 6.43 degree). The FTD and the PW of the DDH group (5.45 ± 1.59 mm, 4.16 ± 0.36 mm) were smaller than that of the control group (7.39 ± 1.20 mm, 4.24 ± 0.38 mm). The changes in LSP, PTA, and TT-TG before and after surgery were not statistically significant. Both before and after PAO, there was no statistically significant difference in the parameters of LSP, PTA, and TT-TG compared with the control group.Conclusion: The knee joints of DDH patients presented a certain degree of femur trochlear groove dysplasia and patellofemoral instability. PAO surgery did not change PFJ stability, although the origination point of the rectus femoris muscle moved laterally during PAO surgery. [ABSTRACT FROM AUTHOR]

: Copyright of BMC Musculoskeletal Disorders is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)