The loss of extension test (LOE test): a new clinical sign for the anterior cruciate ligament insufficient knee

Background

This prospective study was created to evaluate the reliability of a new clinical test, which we termed the “loss of extension test” (LOE test). The LOE test investigates the loss of normal maximum passive extension (MPE) of the knee due to an anterior cruciate ligament tear in comparison to the normal MPE of the healthy knee.

Materials and methods

The study was divided into two consecutive parts. Part 1 was designed to assess the side-to-side difference in normal MPE in a healthy population. In part 1, 100 healthy adults were enrolled. Part 2 was designed to evaluate the LOE test reliability in injured knees. In part 2, we included 196 selected patients.

Results

In part 1, the average side-to-side difference in MPE in the healthy population was not statistically significant. In part 2, the overall average side-to-side difference in MPE of the injured group was 10.1 mm ± 14.1 (min −20; max 60), which was not statistically significant (p = 0.52). An anterior cruciate ligament (ACL) tear was found in 121 knees among 196 patients. The average side-to-side difference in MPE in the ACL-insufficient group was 16.9 mm ± 13.4 (min −20; max 60), which was statistically significant (p < 0.0001). The accuracy of the loss of extension test was 83.7 %, its specificity was 93.3 %, its sensitivity was 77.7 %, its positive predictive value was 95 %, and its negative predictive value was 72.2 %.

Conclusions

The reliability of the LOE test is comparable to those reported in the literature for the Lachman test and dynamic tests, so the LOE test could represent a useful tool for the diagnosis of the anterior cruciate ligament insufficient knee.

VO2 responses to running speeds above intermittent critical speed

The aim of this study was to examine whether intermittent critical speed (ICS) is the threshold velocity above which intermittent exercise leads to the attainment of VO(2max). After an incremental test, 7 active male subjects (49.7 ± 3.74 mL.min (- 1).kg (- 1)) performed 3 intermittent exercises until exhaustion at 100%, 110%, 120% of the velocity associated with VO(2max) to determine ICS. On 4 occasions, the subjects performed intermittent exercise tests until exhaustion at the velocity corresponding to 105% (IE(105)) and 110% (IE(110)) of ICS, and at a speed that was initially set at 125%ICS but which then decreased to 105%ICS (IE(125-105)) in one instance and to 110%ICS (IE(125-110)) in another. The intermittent exercises consisted of repeated 30-s runs alternated with 15-s passive rest intervals. At IE(125)-105, peak VO(2) was not different from VO(2max) but decreased significantly after the change of speed to 105%ICS. During IE(110), peak VO(2) value reached VO(2max) and also during the higher speed at IE(125-110), but did not change when the speed was lowered. These results demonstrated that during intermittent exercise just above ICS (105%) VO(2max) was not elicited, suggesting that ICS might not be the threshold speed above which VO(2max) can be reached.

Stroking parameters during continuous and intermittent exercise in regional-level competitive swimmers

This study aimed to determine whether maximal lactate steady state (MLSS) represents a boundary above which not only physiological but also technical changes occur. On different days, 13 male swimmers (23 ± 9 years) performed the following tests: 1) a 400-m all-out swim, to determine maximal aerobic speed (S-400); 2) a series of 30-min sub-maximal swims, to determine continuous MLSS (MLSSc), and; 3) a series of 12×150 s sub-maximal swims, to determine intermittent MLSS (MLSSi). Stroke rate (SR), distance per stroke cycle (DS) and stroke index (SI) were analyzed at and above (102.5%) MLSSc and MLSSi. MLSSi (1.17 ± 0.09 m.s (- 1)) was significantly higher than MLSSc (1.13 ± 0.08 m.s (- 1)) while blood lactate concentration (mmol.L (- 1)) was similar between the 2 conditions (4.3 ± 1.1 and 4.4 ± 1.5, respectively). The increase in SR and decreases in DS and SI were significant during MLSSi, 102.5% MLSSc and 102.5% MLSSi. During MLSSc, DS also decreased significantly (- 3.6%) but with no change in SR or SI. Thus, stroking technique of regional-level competitive swimmers changes over time when they swim at or above MLSS. This is the case during both continuous and intermittent swimming, despite steady state blood lactate concentrations.

Baclofen promotes alcohol abstinence in alcohol dependent cirrhotic patients with hepatitis C virus (HCV) infection

Hepatitis C virus (HCV) and alcoholic liver disease (ALD), either alone or in combination, count for more than two thirds of all liver diseases in the Western world. There is no safe level of drinking in HCV-infected patients and the most effective goal for these patients is total abstinence. Baclofen, a GABA(B) receptor agonist, represents a promising pharmacotherapy for alcohol dependence (AD). Previously, we performed a randomized clinical trial (RCT), which demonstrated the safety and efficacy of baclofen in patients affected by AD and cirrhosis. The goal of this post-hoc analysis was to explore baclofen's effect in a subgroup of alcohol-dependent HCV-infected cirrhotic patients. Any patient with HCV infection was selected for this analysis. Among the 84 subjects randomized in the main trial, 24 alcohol-dependent cirrhotic patients had a HCV infection; 12 received baclofen 10mg t.i.d. and 12 received placebo for 12-weeks. With respect to the placebo group (3/12, 25.0%), a significantly higher number of patients who achieved and maintained total alcohol abstinence was found in the baclofen group (10/12, 83.3%; p=0.0123). Furthermore, in the baclofen group, compared to placebo, there was a significantly higher increase in albumin values from baseline (p=0.0132) and a trend toward a significant reduction in INR levels from baseline (p=0.0716). In conclusion, baclofen was safe and significantly more effective than placebo in promoting alcohol abstinence, and improving some Liver Function Tests (LFTs) (i.e. albumin, INR) in alcohol-dependent HCV-infected cirrhotic patients. Baclofen may represent a clinically relevant alcohol pharmacotherapy for these patients.

Formaldehyde exposure and irritative effects on medical examiners, pathologic anatomy post-graduate students and technicians

BACKGROUND

Exposure to formaldehyde (FA) causes irritative effects and induces nasopharyngeal cancer; the International Agency for Research on Cancer (IARC, Lyon) classified FA as carcinogenic to humans, Group 1. Many studies have been published so far concerning the occupational exposure of industrial workers, embalmers, pathologists and anatomists to FA but very few data regarding medical examiners are available.

METHODS

To assess the extent to which subjects were exposed to FA, airborne concentrations of this chemical were measured by High Performance Liquid Chromatography (HPLC). In September-October 2006 we examined the personnel, which worked in an autopsy room (medical examiners) and in three laboratories of pathologic anatomy of the University Medical School of Bari, Policlinico Hospital, Southern Italy. Irritative effects were also investigated.

RESULTS

All the personal exposure data obtained exceeded the National Institute for Occupational Safety and Health Threshold Limit Value-Time Weighted Average (NIOSH TLV-TWA: 0.02 mg/m(3)) and, in a few cases, even the American Conference of Industrial Hygienists Threshold Limit Value-Ceiling level (ACGIH TLV-C: 0.37 mg/m(3)).

CONCLUSION

Irritative effects in more than 50% of the workers enrolled, increasing the risk of injuries.

Incidence of craving for and abuse of gamma-hydroxybutyric acid (GHB) in different populations of treated alcoholics: an open comparative study

Gamma-hydroxybutyric acid (GHB) is a drug currently used for the treatment of alcohol dependence. The aim of our study was to investigate the incidence of craving for and abuse of GHB in 47 patients enrolled and divided into four groups: group A (pure alcoholics), group B (alcoholics with a sustained full remission from cocaine dependence), group C (alcoholics with a sustained full remission from heroin dependence) and group D (alcoholics in a methadone maintenance treatment [MMT] programme). All patients were treated with an oral dose of GHB (50 mg/kg of body weight t.i.d.) for three months. Craving for GHB was statistically significant higher in group B than in group A (P < 0.001), C (P = 0.01) and D (P < 0.001), and in group C than in group D (P < 0.05). Abuse of GHB proved to be statistically significant higher in group B than in group A (P < 0.001) and D (P < 0.01), and in group C than in group A (P = 0.01) and D (P < 0.05). Thus, the administration of GHB in alcoholics with a sustained full remission from heroin or cocaine dependence is not recommended; however, this should not discourage physicians from using GHB for the treatment of pure alcoholics or alcohol dependents following a MMT.

Preoperative right portal vein embolisation: indications and results

PURPOSE

The purpose of this retrospective study was to evaluate the efficacy of right portal vein embolisation (PVE) in inducing contralateral liver hypertrophy before extended hepatectomy.

MATERIALS AND METHODS

Twenty-six consecutive patients, 14 with liver metastases (ten from colorectal cancer; four from carcinoid tumours) and 12 with biliary cancers (ten Klatskin tumours; one gallbladder tumour; one intrahepatic cholangiocarcinoma) with insufficient predicted future remnant liver (FRL) underwent right PVE to induce hypertrophy of the contralateral hemiliver prior to surgical resection. Total liver volume, tumour volume and FRL volume were calculated on a 3D workstation. The ratio of the FRL to the total functional liver volume was <30% in all patients.

RESULTS

The FRL volume increased by 5%-25% (15% on average) after right PVE in patients with liver metastases and by 9%-19% (14% on average) in patients with biliary cancers. In all patients, the ratio of FRL to functional liver volume was >or=30% after right PVE. No postoperative deaths due to severe liver failure occurred in the 20 patients who underwent extended hepatectomy.

CONCLUSIONS

Right PVE extends the indications for hepatectomy in patients with liver metastases and those with biliary cancers who have an insufficient potential hepatic functional reserve.

[Risk factors for musculoskeletal complaints among microscope workers]

OBJECTIVES

To describe the prevalence of musculoskeletal complaints among microscope workers, and to investigate the relationship between complaints in different body regions and individual as well work-related factors.

METHODS

A detailed questionnaire on musculoskeletal symptoms was distributed to 176 microscope workers. The questionnaire contained questions on individual factors, workstation characteristics, work organization and psychosocial factors.

RESULTS

The 1-month prevalence of symptoms at any body site was 76,1%. Symptoms were most commonly reported at the neck (53,4%), followed by the lower back (39,2%), upper back (23,9%), shoulders (21%), hand/wrist (21%) and arms (6,3%). Female gender was associated with complaints in all sites except low back. Hours of microscope use was associated with neck, arm and hand/wrist pain, whereas duration of work time without breaks was associated with neck, low back, and arm pain. Poor workstation ergonomics was associated with symptoms in the neck, shoulders, upper and lower back. Work pace was also identified as a risk factor for low back complaints.

CONCLUSION

This study supports the need for ergonomic intervention at workplace and ergonomic training of microscope workers.

1-Aminocyclopentane-1,2,4-tricarboxylic acids screening on glutamatergic and serotonergic systems

Enantiopure constrained 1-aminocyclopentane-1,2,4-tricarboxylic acids containing the glutamic acid skeleton were prepared as two diastereomers characterized by having the carboxylic groups in position two and four cis-oriented to each other and trans with respect to 1-carboxylic group and all cis-oriented carboxylic groups, respectively. A biochemical screening of activity of the above amino acids was investigated on glutamate and 5-HT receptors to find a possible metabotropic agonist, acting on the serotoninergic system.

Alpha,gamma-diamino acids: asymmetric synthesis of new constrained 6-amino-3-azabicyclo[3.2.1]octane-6-carboxylic acids

The synthesis of two new diastereomeric 6-amino-3-azabicyclo[3.2.1]octane-6-carboxylic acids exo- and endo-8,9 is reported using exo- and endo-norbornene amino acids as chiral building blocks. This method provides a fast access to optically pure amino acids 8 and 9 which can be considered both alpha,gamma- and alpha,delta-diamino acids containing sterical constraints and characterized by alpha,alpha-disubstitution.

Gemcitabine, ifosfamide and paclitaxel in advanced/metastatic non-small cell lung cancer patients: a phase II study

Although platinum-based two-drug combinations represent the elective therapeutic approach for advanced/metastatic NSCLC, there is still interest in exploring the efficacy and tolerability of platinum-free combinations including third generation agents in selected NSCLC population. Based on the satisfying activity of gemcitabine (G), ifosfamide (I) and paclitaxel (T) as single agents in NSCLC, we have designed a phase II study to explore an alternative approach to platinum-containing regimens using a combination of these three drugs. To investigate the activity/toxicity of T 175 mg/m2 on day 1, I 3 g/m2 on day 1 (with Mesna uroprotection) and G 1,000 mg/m2 on day 1-8, every 3 weeks in the treatment of advanced/metastatic NSCLC, 46 patients (38 male, 8 female) with NSCLC were enrolled: mean age 58 (range 33-70); Stage IIIB/IV=15/31; ECOG PS 0-1/2=31/15;

HISTOLOGY

adenocarcinoma=20, squamous=14, large cell=3, NSCLC=8, adenosquamous=1. A total of 221 cycles have been administered (median number 4.8 for patients). In intent-to-treat analysis, partial response was achieved in 17 patients (36.95%), stable disease and progressive disease was detected in 16 (34.78%) and 10 (21.73%) patients, respectively. Time to progression was 30.9 weeks; median survival time was 42.7 weeks; the survival rates at 12 and 18 months were 34.79 and 15.21%, respectively. No toxic deaths occurred. No patients experienced grade 4 neutropenia and thrombocytopenia. Neutropenia grade 3 occurred in 10 patients (21.7%); Anemia grade 3 in 1 (2.1%); Thrombocytopenia grade 2 in two patients (4.3%) and grade 3 in one (2.1%). Peripheral neuropathy grade 1 occurred in ten (21.7%) and grade 2 in two patients (4.3%). Additional non-haematological toxicities were mild nausea, emesis and fatigue. GIT is well tolerated and active regimen in both advanced and metastatic NSCLC. These data suggest future investigations for GIT schedule as a possible alternative to platinum-based regimens in selected advanced/metastatic NSCLC patients where survival, tolerability and quality of life are the primary goals.

[Assessment of radiofrequency electromagnetic fields levels in the Taranto area]

Radiofrequencies are extremely common in telecommunication sectors, in industry, in medicine and domestic applications. We carried out an observed study focusing on the punctual monitoring of the electromagnetic fields generated by mobile phones handsets or by SRB radiobase stations (transmitters), installed in Taranto and throughout the borough council. The measurement campaigns have been done by ARPA Puglia, Provincial Department of Taranto from November 2005 until March 2007, on 108 transmitting stations, of which 72 are of single installation and 36 of multiple installations, with UMTS, GSM. DCS, DVB-H kind of communication. The monitoring has been done with Wandel & Goltermann EMR-300 devices; the registered frequency is within the interval between 100 KHz and 3GHz and measures have been obtained with precise time interval of 6 minutes. In most of the monitored areas the results respected limit values; only in 2 cases on 108 the attention value has been exceeded, both within borough council area. In the town of Taranto values over 6 V/m fixed by the actual rule haven't been registered in none of the 51 monitored stations. We can, therefore, define within the limits the expositions emitted by the radiobase stations and in the buildings nearby the antennas.

[Job strain and blood pressure levels in health care workers]

OBJECTIVE

The aim of this study was to investigate a possible association between job strain and blood pressure levels in a sample of X-ray technologists.

MATERIALS AND METHODS

A structured questionnaire S was administered to the participants, investigating individual factors and job characteristics. Job strain status was measured by means of questions derived from the Italian version of the Karasek Job Content Questionnaire. Systolic and diastolic blood pressure were then assessed during medical examination.

RESULTS

No significant association was found between job strain and blood pressure levels. In addition, no association was found between high job demans, low decision latitude and blood pressure levels.

CONCLUSIONS

In this study job strain was not associated with high blood pressure levels in X-ray technologists.

[Biological monitoring in workers exposed to inorganic arsenic in a disused industrial plant in the area of Manfredonia]

Inorganic arsenic and its methylated metabolities were measured in 108 spot urine samples obtained from the medical surveillance programme of workers exposed to inorganic Arsenic in July 2006. 15% of the samples showed levels higher than limit value of 35 microg/L (mean value 23,9 microg/L). After the improvement of the working conditions, in August-October 2006, we collected a urinary sample from each of the 108 workers enrolled. A questionnaire was also administrated, in order to investigate the influence of occupational and non occupational factors on the urinary arsenic excretion. The median value of urinary arsenic was 15,12 microg/L; among the 108 samples, 5% showed levels higher than limit value. A significant difference was observed in relation with sea-food consumption and aging stratification. In conclusion, we have described a significant reduction of urinary arsenic excretion between the two phases of biological monitoring, likely due to a proper hygienic work-related intervention.

Positive association between a single abnormal glucose tolerance test value in pregnancy and subsequent abnormal glucose tolerance

OBJECTIVE

To study the prevalence of abnormal glucose tolerance among women with a single abnormal glucose tolerance test value in previous pregnancy and identify factors predictive of the later development of abnormal glucose tolerance in this group.

STUDY DESIGN

In all, 58 women with gestational diabetes, 66 with a single abnormal value in a glucose tolerance test, and 56 control women underwent a 75-g oral glucose tolerance test at a mean of 6.9 years from the index pregnancy.

RESULTS

Abnormal glucose tolerance was present in 34.5% of women with previous gestational diabetes and in 28.7% of women with 1 previous abnormal value, significantly different from the controls (9.7%). Independent risk factors that distinguished the subjects who later developed an abnormal glucose tolerance were prepregnancy BMI, parity > 1, and first-degree relatives affected by diabetes mellitus in the group with gestational diabetes, and prepregnancy BMI, maternal age, (> or = 30 y) and parity > 1 in the group with a single abnormal value. Prepregnancy BMI (> or = 26.9) proved to be the most predictive factor of abnormal glucose tolerance later in life.

CONCLUSION

Sicilian women with a single abnormal value at the glucose tolerance test in pregnancy have an increased likelihood of developing an abnormal glucose tolerance later in life, similar to gestational diabetes. Prepregnancy BMI was confirmed as the strongest predictive factor in both groups.

Review article: alcoholic liver disease--pathophysiological aspects and risk factors

BACKGROUND

Alcoholic liver disease has a known aetiology but a complex and incompletely known pathogenesis. It is an extremely common disease with significant morbidity and mortality, but the reason why only a relatively small proportion of heavy drinkers progress to advanced disease remains elusive.

AIM

To recognize the factors responsible for the development and progression of alcoholic liver disease, in the light of current knowledge on this matter.

METHODS

We performed a structured literature review identifying studies focusing on the complex pathogenetic pathway and risk factors of alcoholic liver disease. Results In addition to the cumulative amount of alcohol intake and alcohol consumption patterns, factors such as gender and ethnicity, genetic background, nutritional factors, energy metabolism abnormalities, oxidative stress, immunological mechanisms and hepatic co-morbid conditions play a key role in the genesis and progression of alcoholic liver injury.

CONCLUSIONS

Understanding the pathogenesis and risk factors of alcoholic liver disease should provide insight into the development of therapeutic strategies.

Phase II study of gefitinib in combination with docetaxel as first-line therapy in metastatic breast cancer

We have evaluated the activity and safety of gefitinib, a small-molecule epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, in combination with docetaxel as first-line treatment of women with metastatic breast cancer (MBC). In total, 41 patients with MBC were enrolled in a first-line combination therapy study with oral gefitinib (250 mg day⁻¹) and intravenous docetaxel (75 mg m⁻², the first 14 patients; or 100 mg m⁻², the following 27 patients, on day 1 of a 3-week cycle). Out of 41 patients, 38 received at least one cycle of therapy. There were no differences in activity or tolerability between the two docetaxel doses. G3/4 toxicities were neutropenia (49%), diarrhoea (10%), acne-like rash (5%), and anaemia (2%). Complete plus partial responses (CR+PR) were observed in 22 out of 41 patients with a 54% response rate (95% confidence interval (CI) 45–75%). The 22 patients that achieved a response following six cycles of docetaxel plus gefitinib continued gefitinib monotherapy (median duration, 24 weeks; range, 2–108+ weeks). Two patients with PR following combination therapy achieved a CR during gefitinib monotherapy. Complete plus partial responses correlated with oestrogen receptor (ER) status, since they occurred in 19 out of 27 (70%) patients with ER-positive tumours as compared to three out of 14 (21%) patients with ER-negative tumours (P=0.01).