Reliability, validity, and responsiveness of four knee outcome scales for athletic patients

BACKGROUND

Many patient-based knee-rating scales are available for the evaluation of athletic patients. However, there is little information on the measurement properties of these instruments and therefore no evidence to support the use of one questionnaire rather than another. The goal of the present study was to determine the reliability, validity, and responsiveness of four knee-rating scales commonly used for the evaluation of athletic patients: the Lysholm scale, the subjective components of the Cincinnati knee-rating system, the American Academy of Orthopaedic Surgeons sports knee-rating scale, and the Activities of Daily Living scale of the Knee Outcome Survey.

METHODS

All patients in the study had a disorder of the knee and were active in sports (a Tegner score of 4 points). Forty-one patients who had a knee disorder that had stabilized and who were not receiving treatment were administered all four questionnaires at baseline and again at a mean of 5.2 days (range, two to fourteen days) later to test reliability. Forty-two patients were administered the scales at baseline and at a minimum of three months after treatment to test responsiveness. The responses of 133 patients at baseline were studied to test construct validity.

RESULTS

The reliability was high for all scales, with the intraclass correlation coefficient ranging from 0.88 to 0.95. As for construct validity, the correlations among the knee scales ranged from 0.70 to 0.85 and those between the knee scales and the physical component scale of the Short Form-36 (SF-36) and the patient and clinician severity ratings ranged from 0.59 to 0.77. Responsiveness, measured with the standardized response mean, ranged from 0.8 for the Cincinnati knee-rating system to 1.1 for the Activities of Daily Living scale.

CONCLUSIONS

All four scales satisfied our criteria for reliability, validity, and responsiveness, and all are acceptable for use in clinical research.

Globalization of antimicrobial resistance: epidemiological challenges

Globalization of antimicrobial resistance is a reality, but before the relative impact of global versus local spread of resistant microorganisms can be quantified, surveillance capacity and information transfer must be greatly enhanced.

Flavonoids protect neurons from oxidized low-density-lipoprotein-induced apoptosis involving c-Jun N-terminal kinase (JNK), c-Jun and caspase-3

Oxidative stress has been associated with neuronal loss in neurodegenerative diseases and during age-associated cognitive decline. Flavonoids have been proposed to play a useful role in protecting the central nervous system against oxidative and excitotoxic stress, although the mechanism of action is unknown. Using oxidized low-density lipoprotein (oxLDL) as the oxidative insult we investigated the mechanism of neurotoxicity and attempted to identify possible sites of action of two of the most potent protective flavonoids, epicatechin and kaempferol, in cultured primary neurons. Using cultured striatal neurons and selective phosphospecific antibodies we addressed the potential role of extracellular signal-regulated kinases 1/2 (ERK1/2) and c-Jun N-terminal kinase (JNK). OxLDL stimulated a Ca(2+)-dependent activation of both ERK1/2 and JNK that was strongly inhibited by pre-treatment with low micromolar concentrations of epicatechin. Neurotoxicity induced by oxLDL, however, was neither reduced nor enhanced by inhibiting ERK1/2 activation with mitogen-activated protein kinase kinase (MEK) inhibitors, suggesting that this cascade is unlikely to be involved in either oxLDL toxicity or the protective effects of flavonoids. oxLDL caused a sustained activation of JNK that resulted in the phosphorylation of the transcription factor c-Jun, which was abolished in neurons pre-treated with flavonoids. Furthermore, oxLDL induced the cleavage of procaspase-3 and increased caspase-3-like protease activity in neurons, an effect which was strongly inhibited by pre-exposure to either epicatechin or kaempferol. In addition, a caspase-3 inhibitor reduced oxLDL-induced neuronal death, implicating an apoptotic mechanism. A major in vivo metabolite of epicatechin, 3'-O-methyl-epicatechin was as effective as epicatechin in protecting neurons. Thus dietary flavonoids might have potential as protective agents against neuronal apoptosis through selective actions within stress-activated cellular responses, including protein kinase signalling cascades.

Restraint as misregulation in drinking and eating

The present study was designed to increase our understanding of the co-morbidity between problem drinking and binge eating. The study investigated both consummatory behaviors in relation to restrained drinking, restrained eating, and a general measure of self-control. The participants were a sample of 658 boys and 414 girls aged between 14 and 17 years. The dimension of restraint, which best predicted the two problem behaviors when examined separately for both boys and girls, was cognitive and emotional preoccupation (CEP) about controlling one's consummatory intake. In addition, evidence was found linking both problem drinking and binge eating to restraint and poor general self-control. The struggle with self-control and the high emphasis on CEP about controlling one's consummatory intake, which characterise restrained drinking and restrained eating, closely resembles Baumeister and Heatherton's notion of misregulation [Psychol. Inquiry 7 (1996) 1.]. Discussed are the similarities between restraint and misregulation, and the kinds of strategies that can be used to improve self-control.

Trichostatin A, an inhibitor of histone deacetylase, inhibits hypoxia-induced angiogenesis

Trichostatin A (TSA), a hydroxamate-type inhibitor of mammalian histone deacetylases has been reported to inhibit angiogenesis both in vitro and in vivo. TSA inhibits hypoxia-induced production of the angiogenic mediator vascular endothelial cell growth factor (VEGF) by tumour cells and also inhibits directly endothelial cell migration and proliferation. HDAC inhibitors such as TSA are currently of major interest as potential anticancer therapeutics, largely because of their well-documented properties of inhibiting proliferation and inducing apoptosis of tumour cells. The finding that HDAC appears to be a critical regulator of angiogenesis in addition to tumour cell growth will heighten interest in the development of HDAC inhibitors as potential anticancer drugs.

Toxicity characterisation of organic contaminants in stormwaters from an agricultural headwater stream in south east England

The transient movement of pesticides at biologically active concentrations during storm events is considered to be a cause of biological impoverishment in some headwater streams. The programme of work described sought to identify compounds that are the cause of toxic effects during such events. Along with targeted pesticide analysis, toxicity identification evaluation (TIE) procedures were used to identify compounds with a demonstrated toxic effect. These procedures were specifically directed towards isolating and attributing toxicity to classes of organic contaminants in samples collected from an English headwater stream during a storm event. The organic load was isolated by means of solid-phase extraction (SPE). Bioassay of the SPE extract at x 100 whole water concentrations confirmed that the samples contained substances toxic to Daphnia magna, although the raw samples were not toxic. Targeted pesticide analysis identified simazine and diuron as the major pesticides present and, using a toxicity unit (TU) approach. were shown to be responsible for a significant amount of the observed concentrate toxicity during a runoff event. However, they were not present in sufficient quantities to be totally responsible for a more toxic later event. By simplification of the SPE isolate using reverse-phase HPLC, fractions from which were tested for toxicity, the cause of concentrate toxicity in the later event was isolated to two discrete fractions. GC-MS analysis of these fractions identified nonylphenol. endosulfan sulphate and pendimethalin as present, with the majority of toxicity attributed to nonylphenol (NP). The main advantage of the TIE approach is that it allows biological active compounds with a demonstrated effect to be identified that may not be selected by more traditional techniques.

Staphylococcus aureus fibronectin binding proteins are essential for internalization by osteoblasts but do not account for differences in intracellular levels of bacteria

Staphylococcus aureus is a major pathogen of bone that has been shown to be internalized by osteoblasts via a receptor-mediated pathway. Here we report that there are strain-dependent differences in the uptake of S. aureus by osteoblasts. An S. aureus septic arthritis isolate, LS-1, was internalized some 10-fold more than the laboratory strain 8325-4. Disruption of the genes for the fibronectin binding proteins in these two strains of S. aureus blocked their ability to be internalized by osteoblasts, thereby demonstrating the essentiality of these genes in this process. However, there were no differences in the capacity of these two strains to bind to fibronectin or osteoblasts. Analysis of the kinetics of internalization of the two strains by osteoblasts revealed that strain 8325-4 was internalized only over a short period of time (2 h) and to low numbers, while LS-1 was taken up by osteoblasts in large numbers for over 3 h. These differences in the kinetics of uptake explain the fact that the two strains of S. aureus are internalized by osteoblasts to different extents and suggest that in addition to the fibronectin binding proteins there are other, as yet undetermined virulence factors that play a role in the internalization process.

Metastatic granulosa cell tumour of the diaphragm 15 years after the primary neoplasm

We present the case of a female patient who complained of dyspnoea and was found to have a pleural effusion. A tumour involving the right diaphragm was seen on CT and after excision this was shown to be a recurrent granulosa cell tumour, 15 years after the original ovarian lesion had been treated by oophrectomy and radiotherapy. The case and literature relating to such a rare intra-thoracic metastatic tumour is discussed.

Identification of the exported proteins of the oral opportunistic pathogen Actinobacillus actinomycetemcomitans by using alkaline phosphatase fusions

A phoA fusion library of Actinobacillus actinomycetemcomitans genomic DNA has been screened to identify genes encoding exported and secreted proteins. A total of 8,000 colonies were screened, and 80 positive colonies were detected. From these, 48 genes were identified with (i) more than half having homology to known or hypothetical Haemophilus influenzae genes, (ii) 14 having no ascribed function, and (iii) 4 having very limited or no homology to known genes. The proteins encoded by these genes may, by virtue of their presence on the cell surface, be novel virulence determinants.

Assessing herbicide concentrations in the saturated and unsaturated zone of a Chalk aquifer in southern England

The behavior of the herbicides isoproturon (IPU) and chlortoluron (CTU) in ground water and shallow unsaturated zone sediments were evaluated at a site situated on the Chalk in southern England. Concentrations of IPU in ground water samples varied from < 0.05 to 0.23 microgram/L over a five-year period of monitoring, and were found to correlate with application of the pesticide. Concentrations of pesticides in ground water samples collected during periods of rising water table were significantly higher than pumped samples and suggest that rapidly infiltrating recharge water contains higher herbicide concentrations than the native ground water. Significant variations in herbicide concentrations were observed over a three-month period in ground water samples collected by an automated system, with concentrations of IPU ranging from 0.1 to 0.5 microgram/L, and concentrations of a recent application of CTU ranging from 0.2 to 0.8 microgram/L. Different extraction methods were used to assess pore water concentrations of herbicides in the unsaturated zone, and samples were analyzed by standard HPLC analysis and immunoassay (ELISA) methods. These data indicated highly variable concentrations of herbicide ranging from 4 to 200 g/ha for HPLC and 0.01 to 0.04 g/ha for ELISA, but indicate a general pattern of decreasing concentrations with depth. The results of this study indicate that transport of IPU and CTU through the unsaturated zone to shallow ground water occurs and that this transport increases immediately following herbicide application. Measured concentrations of herbicides are generally lower than specified by the European Union Drinking Water Directive, but are observed to spike above this limit. These results imply that, while delivery of pesticides to ground water can occur as a result of normal agricultural practices, the impact on potable supplies is likely to be negligible due to the potential for degradation during the relatively long travel time through the unsaturated zone and high degree of dilution that occurs within the aquifer. As a result of the wide variation in concentrations detected by different techniques, it is suggested that for future site investigations more than one sampling strategy be employed to characterize the occurrence of pesticide residues and elucidate the transport mechanisms.

Dental caries-protective agents in milk and milk products: investigations in vitro

OBJECTIVES

To characterise and identify the anti-dental caries components that exist in milk and milk products.

METHODS

Standard enamel or hydroxyapatite demineralisation tests were devised to simulate the action of acid on tooth mineral, and they were used to show which constituents of milk possessed a potential protective action against acid attack.

RESULTS

Milk and milk products were fractionated and tested, revealing that minerals, including calcium and phosphorus, played a part in this protective process. The findings also drew attention to the effectiveness of minor milk protein or protein-associated components, the structures of which are mostly known, which were separated and characterised by gel electrophoresis as proteose-peptone fractions 3 and 5. The strength of adsorption of the protein or polypeptides in these fractions to dental enamel was measured and found to be sufficient to reduce the extent of demineralisation of enamel by acid buffer solutions.

CONCLUSIONS

The removal of lactose, fat, casein and other proteins had little influence on the protective effect of the milk fractions. Besides calcium and phosphorus, milk contains other more powerful protective factors, which were identified as proteose-peptone fractions 3 and 5. Details of their composition and the strength of their adherence to the surface of dental mineral are given.

Gender stereotypes and drinking cognitions as indicators of moderate and high risk drinking among young women and men

The study examined differences in gender stereotypes, restrained drinking and self-efficacy for alcohol refusal between moderate and high risk drinkers among a university sample of 301 women and 118 men. Both female and male high risk drinkers displayed a response conflict, typified by high scores on restrained drinking but low scores on self-efficacy. This pattern of response conflict was more pronounced for high risk drinking women, who also identified poorly with feminine traits (e.g. 'nurturing', 'love children', 'appreciative'). The findings are discussed in relation to society's double standard that accepts intoxication in men but condemns it in women.

Fractures about the orbit in professional American football players

A retrospective review was performed of records for players who suffered fractures about the orbit during participation in officially sponsored activities of the National Football League from 1980 to 1997. Clinical information was obtained on 19 of 29 players who sustained orbital fractures. The most common signs and symptoms included decreased visual acuity (74%, 14), decreased eye movement (42%, 8), hyphema (37%, 7), and infraorbital numbness (21%, 4). The mechanisms of injury were a digital poke (74%, 14) and blunt facial trauma (26%, 5). There were significantly more orbital fractures than zygomatic fractures suffered by offensive linemen as compared with all other positions. Fifteen of 19 players were managed with surgical reconstruction; 4 players were treated nonoperatively. The mean time from injury to surgical procedure was 7.7 days (range, 0 to 42). The mean interval to follow-up was 45.6 months (range, 3 to 146). At follow-up examination, eight (53%) of the patients treated surgically still reported diplopia with upper field gaze. Three of the four patients treated nonoperatively were asymptomatic. The mean time lost from games or practice was 25 days (range, 5 to 56). Ultimately, 17 (89%) players with orbital fractures were able to return to full football activities. Two patients were unable to resume their careers because of residual visual impairment.

Outbreak of human monkeypox, Democratic Republic of Congo, 1996 to 1997

Human monkeypox is a zoonotic smallpox-like disease caused by an orthopoxvirus of interhuman transmissibility too low to sustain spread in susceptible populations. In February 1997, 88 cases of febrile pustular rash were identified for the previous 12 months in 12 villages of the Katako-Kombe Health Zone, Democratic Republic of Congo (attack rate = 22 per 1,000; case-fatality rate = 3.7%). Seven were active cases confirmed by virus isolation. Orthopoxvirus- neutralizing antibodies were detected in 54% of 72 patients who provided serum and 25% of 59 wild-caught animals, mainly squirrels. Hemagglutination-inhibition assays and Western blotting detected antibodies in 68% and 73% of patients, respectively. Vaccinia vaccination, which protects against monkeypox, ceased by 1983 after global smallpox eradication, leading to an increase in the proportion of susceptible people.

Phenolic antioxidants attenuate neuronal cell death following uptake of oxidized low-density lipoprotein

Oxidative stress is implicated in neuronal loss associated with neurodegeneration such as in Parkinson's disease, Alzheimer's disease and age-related cognitive decline. Recent reports indicate that the consumption of flavonoid-rich fruits partly reverses the age-related neuronal and cognitive decline. In this study, cultured striatal neurons were exposed to oxidized lipids in the form of low-density lipoprotein (oxLDL) as a model for the induction of oxidative injury, and the abilities of phenolic antioxidants, flavonoids and hydroxycinnamic acid derivatives, to attenuate this neuronal damage were examined. OxLDL was demonstrated to enter neuronal cells and to be capable of eliciting neurotoxicity in a dose- and time-dependent manner, inducing DNA fragmentation and cell lysis. Flavonoids exert protective effects, which appear to be related to specific structural characteristics, particularly relevant being those defining their reduction potentials and partition coefficients. In summary, these data suggest a possible role for flavonoids in reducing neurodegeneration associated with chronic disorders in which oxidative stress is implicated.

Copper coordination in blue proteins

The spectroscopic and electrochemical properties of blue copper proteins are strikingly different from those of inorganic copper complexes in aqueous solution. Over three decades ago this unusual behavior was ascribed to constrained coordination in the folded protein; consistent with this view, crystal structure determinations of blue proteins have demonstrated that the ligand positions are essentially unchanged on reduction as well as in the apoprotein. Blue copper reduction potentials are tuned to match the particular function of a given protein by exclusion of water from the metal site and strict control of the positions of axial ligands in the folded structure. Extensive experimental work has established that the reorganization energy of a prototypal protein, Pseudomonas aeruginosa azurin, is approximately 0.7 eV, a value that is much lower than those of inorganic copper complexes in aqueous solution. The lowered reorganization energy in the protein, which is attributable to constrained coordination, is critically important for function, since the driving forces for electron transfer often are low (approximately 0.1 eV) between blue copper centers and distant (>10 A) donors and acceptors.

Sex-role traits and self-monitoring as dimensions of control: women with bulimia nervosa vs. controls

OBJECTIVE

The study investigated sex-role traits and self-monitoring styles as two dimensions of self-control amongst women with bulimia nervosa and normal controls.

DESIGN AND METHODS

The participants were 30 women with bulimia nervosa and 40 normal controls who completed questionnaires, which assessed bulimic symptoms, sex-role traits, and Synder's Self-Monitoring Scale.

RESULTS

Women with bulimia nervosa were found to identify more strongly than controls with negative feminine traits and Other Directedness, a style of self-monitoring that focuses on pleasing others.

CONCLUSIONS

These findings reinforce the notion that women with bulimia nervosa lack assertiveness skills and that the strategies they have developed in their interactions with others can be described as a Negative Yielding style of self-control.

Management of unicompartmental arthritis in the anterior cruciate ligament-deficient knee

There exists a group of patients who are difficult to manage because they have both anterior knee instability secondary to anterior cruciate ligament deficiency and unilateral degenerative joint disease. A large majority of these patients report a history of previous meniscal injury or meniscectomy after knee trauma at a relatively young age. Active patients who report symptomatic knee instability or pain associated with athletics or activities of daily living after conservative treatment may be indicated for surgery. Current endoscopic methods of anterior cruciate ligament reconstruction result in low patient morbidity, the elimination of anterior knee instability, and a timely return of function. Osteotomies about the knee joint are an effective means of treating unicompartmental knee arthrosis. Long-term studies have demonstrated that knee osteotomy is a good surgical option for patients with unicompartmental arthritis who are considered too young for total knee arthroplasty. We describe a comprehensive treatment approach to the patient with anterior cruciate ligament deficiency and isolated medial or lateral osteoarthritis. An assessment of pain symptoms, instability symptoms, and lower extremity alignment is used to formulate a treatment plan.

Identification of a novel gene cluster encoding staphylococcal exotoxin-like proteins: characterization of the prototypic gene and its protein product, SET1

We report the discovery of a novel genetic locus within Staphylococcus aureus that encodes a cluster of at least five exotoxin-like proteins. Designated the staphylococcal exotoxin-like genes 1 to 5 (set1 to set5), these open reading frames have between 38 and 53% homology to each other. All five proteins contain consensus sequences that are found in staphylococcal and streptococcal exotoxins and toxic shock syndrome toxin 1 (TSST-1). However, the SETs have only limited overall sequence homology to the enterotoxins and TSST-1 and thus represent a novel family of exotoxin-like proteins. The prototypic gene in this cluster, set1, has been cloned and expressed. Recombinant SET1 stimulated the production of interleukin-1beta, interleukin-6, and tumor necrosis factor alpha by human peripheral blood mononuclear cells. PCR analysis revealed that set1 was distributed among other strains of S. aureus but not in the other staphylococcal species examined. Sequence analysis of the set1 genes from different strains revealed at least three allelic variants. The protein products of these allelic variants displayed a 100-fold difference in their cytokine-inducing potency. The distribution of allelic variants of the set genes among strains of S. aureus may contribute to differences in the pathogenic potential of this bacterium.