Sublingual gland involvement in systemic Wegener's granulomatosis: a case report

Wegener's granulomatosis is a systemic vasculitis characterized by necrosis, granulomatosis and inflammation. The usual targets are extra-oral, although salivary gland involvement has been recognized, usually confined to parotid and submandibular glands. A case report is presented of sublingual gland presentation, confirmed on biopsy, which proceeded to systemic involvement. Some evidence suggests that salivary gland involvement, if recognized, may lead to an early diagnosis and the potential for earlier therapeutic intervention.

Changes in endothelial, leucocyte and platelet markers following contrast medium injection during angiography in patients with peripheral artery disease

Peripheral artery angiography, a common diagnostic procedure, may cause early and late adverse reactions, such as anaphylaxis, thrombosis and possible progression of the underlying arterial disease. To test the hypothesis that radiographic contrast medium may contribute to these events by adversely affecting the endothelium, leucocytes and/or platelets, 19 subjects undergoing angiography for the investigation and/or treatment of lower limb atherosclerosis were recruited. Blood was obtained from the external iliac vein before, and at serial intervals after, the injection of radiographic contrast medium into the ipsilateral femoral artery for diagnostic use. Markers of endothelial cell injury (von Willebrand factor (vWf)), platelet activation (soluble P-selectin) and leucocyte activation (neutrophil elastase and soluble L-selectin) were measured in citrated plasma. Soluble intercellular adhesion molecule-1 (sICAM-1) and thromboxane B(2), which are non-specific markers of inflammation, were also measured. Compared with the sample prior to angiography, levels of soluble L-selectin and sICAM-1 were reduced (p<0.02) immediately after passage of the last bolus of contrast medium. 15 min later, levels returned to normal but the level of vWf had increased (p<0.02). After 30 min, only levels of thromboxane B(2) were increased (p<0.05). The following day both vWf (p<0.01) and soluble P-selectin (p<0.05) were increased. These data point to both early and late effects of contrast medium on markers of endothelial, platelet and leucocyte function.

Normative data for passive ankle plantarflexion--dorsiflexion flexibility

OBJECTIVE

To describe the normal distribution parameters for measures of passive ankle plantarflexion-dorsiflexion flexibility obtained from a large sample of able-bodied young adult subjects.

DESIGN

Seven variables were assessed and descriptive analyses were conducted.

BACKGROUND

While assessment of plantarflexion-dorsiflexion flexibility is an important component of a clinical examination of plantarflexion contracture, there is limited normative data available that can be used as a reference for clinical decision-making.

METHODS

Data were collected from 300 able-bodied male and female subjects aged between 15 and 34 years. Both ankles were measured. Load-displacement curves were collected using a manually controlled instrumented footplate. Six variables were extracted from these curves: passive torque at zero and 10 deg, passive stiffness at zero and 10 deg, and two coefficients from an equation fitted to the curve (i.e., k and b). The seventh variable, passive dorsiflexion range of motion, was quantified using a clinical procedure.

RESULTS

Flexibility variables did not differ between the left and right ankles, nor between the dominant and non-dominant legs. All variables were normally distributed. These distributions can, therefore, be adequately described using their mean and standard deviation values.

CONCLUSIONS

This study has substantially increased the available database on plantarflexion-dorsiflexion flexibility and forms the basis of norm-referenced clinical tests.

A sensitive, single-tube assay to measure the enzymatic activities of influenza RNA polymerase and other poly(A) polymerases: application to kinetic and inhibitor analysis

We describe a fast and robust new assay format to measure poly(A) polymerase (PAP) activity in a microtiter plate format. The new assay principle uses only natural nucleotide triphosphates and avoids a labour-intensive filtration step. A coupled enzymatic system combining PAP and reverse transcriptase forms the basis of the assay. The PAP generates a poly(A) tail on a RNA substrate and the reverse transcriptase is used to quantify the polyadenylated RNA by extension of a biotinylated oligo-dT primer. We demonstrate the principle of the assay using influenza virus RNA polymerase and yeast PAP as examples. A specific increase in the K(m) value for ATP and the observation of burst kinetics in the polyadenylation dependent, but not in the polyadenylation independent, assay suggest that a rate limiting step of influenza polymerase activity occurs after transcription elongation. Yeast PAP was used to validate the assay as an example of a template independent PAP. The new yeast PAP assay was approximately 100-fold more sensitive than the conventional TCA precipitation assay for yeast PAP, but the kinetic analysis of the PAP reaction gave similar results in both assays. The two enzymes show important differences with respect to inhibition by 3'-deoxy-ATP. Whereas the K(i) value for 3'-deoxy-ATP (105-117 microM) is similar to the K(m) value for ATP (186 microM) in the case of influenza RNA polymerase, the K(i) value for 3'-deoxy-ATP (0.4-0.6 microM) is approximately 100-fold lower than the K(m) value for ATP (50 microM) in the case of yeast PAP.

Quality of life in asthma: a comparison of community and hospital asthma patients

This study compares the quality of life of a community sample of people with asthma in South Australia, using population norms, people suffering from other chronic diseases, and a sample of asthma patients from two hospital clinics. A representative population survey was performed by trained interviewers in spring 1995 of 3001 respondents aged > or = 15 years. A physician's diagnosis of current asthma was reported by 299 (9.9%). The hospital clinic sample had a physician's diagnosis and lung function evidence of asthma (n = 293). All completed the SF-36 health survey. Standardized SF-36 scores, adjusted for age, sex, and social class, were significantly lower for respondents with asthma, compared with population norms, across all subscales of the SF-36 (p < 0.05). Physical component summary (PCS) and mental component summary (MCS) scores were not significantly different in people in the community sample with asthma from scores in people with diabetes and arthritis. PCS and MCS scores did not differ for those with similar symptom frequency in the community and hospital asthma samples, except that hospital patients with frequent symptoms had significantly lower MCS scores (p < 0.01). Asthma has a major impact on the health-related quality of life in the community, comparable to other chronic diseases. The SF-36 performs uniformly in asthma in different situations.

Stiffness properties of the human lumbar spine: a lumped parameter model

OBJECTIVE

To characterise with a mechanical model, the force-displacement response of the human lumbar spine to postero-anterior loading.

DESIGN

Single case with repetition.

BACKGROUND

Previous attempts to characterise the spine's force-displacement response have been simplistic and only considered the loading curve. These approaches ignored valuable information such as viscosity, non-linear elasticity and inertia of the lumbar spine.

METHODS

The Spinal Assessment Machine applied a postero-anterior load to the spines of 23 asymptomatic subjects and measured the force-displacement response. The data was analysed by two methods; by a traditional linear regression of part of the loading curve and by a new method where an equation including non-linear stiffness and damping was used to characterise the whole force-displacement relationship.

RESULTS

The equation developed was found to account for virtually all of the variance in the raw data (R2 > 0.993). Four elements derived by the equation determine the contributions of linear elasticity, non-linear elasticity, linear viscosity and non-linear viscosity to the overall stiffness.

CONCLUSIONS

Considering the excellent fit of the new equation to the raw data and its poor correlation with existing measures, it is proposed that the traditional measures provide an incomplete description of the force-displacement response. Relevance. Therapists use their perception of the force-displacement response of the spine to select the type of manipulative treatment to apply. To study this aspect of patient care, devices capable of measuring spinal stiffness have been developed, however to date the obtained data has been analysed only simply. A lumped parameter mechanical model incorporating non-linear damping and stiffness provides a more complete description of the force-displacement response and thus may offer added insight into the manipulative treatment of spinal pain.

A pilot study of chronomodulated infusional 5-fluorouracil chemoradiation for pancreatic cancer

BACKGROUND

Dose limiting acute toxicity from chemoradiation for pancreatic cancer occurs in 15% -20% of patients treated with post-operative adjuvant therapy. Reported here is a pilot study using chronomodulated infusional 5-fluorouracil (5-FU) chemoradiation (CIC) for pancreatic cancer, a treatment designed to reduce normal tissue toxicity and maintain efficacy, with specific evaluation of acute and late morbidity, patterns of disease progression, and survival.

PATIENTS AND METHODS

Twenty-three patients with adenocarcinoma of the pancreas were treated with 5-FU CIC between January 1997 and September 1999. The median age was 64, and there were 9 males and 14 females. Six patients were considered unresectable and seventeen others were treated post-operatively. The median external beam irradiation dose was 50.4 Gy. 5-FU infusion was given five days per week (300 mg/m2/d) and the median total dose was 8.4 g/m2. The chronomodulated 5-FU infusion consists of a low basal infusion rate for 16 hours followed by an eight-hour escalating-deescalating infusion peaking at 10 p.m. All patients were followed from the time of initial diagnosis until last follow-up or death; the median follow-up was 16 months.

RESULTS

No RTOG grade 3 or 4 hematologic toxicity occurred. Twelve of seventeen patients treated postoperatively have been controlled locally, and seven patients have no evidence of disease. The median survival is 28 months and one-year actuarial survival is 88% in the group of resected patients. The 6 patients treated for unresectable disease have a median survival of 13 months.

CONCLUSIONS

Acute toxicity of 5-FU CIC appears to be less frequent and less severe than that reported with flat infusional or bolus 5-FU based chemoradiation used for adjuvant post-operative therapy for pancreatic cancer. This method may warrant further examination, as it may be attractive for the elderly or those who cannot tolerate the toxicity associated with standard post-operative treatment protocols.

A randomized controlled trial of a passive accessory joint mobilization on acute ankle inversion sprains

BACKGROUND AND PURPOSE

Passive joint mobilization is commonly used by physical therapists as an intervention for acute ankle inversion sprains. A randomized controlled trial with blinded assessors was conducted to investigate the effect of a specific joint mobilization, the anteroposterior glide on the talus, on increasing pain-free dorsiflexion and 3 gait variables: stride speed (gait speed), step length, and single support time.

SUBJECTS

Forty-one subjects with acute ankle inversion sprains (<72 hours) and no other injury to the lower limb entered the trial.

METHODS

Subjects were randomly assigned to 1 of 2 treatment groups. The control group received a protocol of rest, ice, compression, and elevation (RICE). The experimental group received the anteroposterior mobilization, using a force that avoided incurring any increase in pain, in addition to the RICE protocol. Subjects in both groups were treated every second day for a maximum of 2 weeks or until the discharge criteria were met, and all subjects were given a home program of continued RICE application. Outcomes were measured before and after each treatment.

RESULTS

The results showed that the experimental group required fewer treatment sessions than the control group to achieve full pain-free dorsiflexion. The experimental group had greater improvement in range of movement before and after each of the first 3 treatment sessions. The experimental group also had greater increases in stride speed during the first and third treatment sessions. DISCUSSION AND CONCLUSION Addition of a talocrural mobilization to the RICE protocol in the management of ankle inversion injuries necessitated fewer treatments to achieve pain-free dorsiflexion and to improve stride speed more than RICE alone. Improvement in step length symmetry and single support time was similar in both groups.

Prevalence, morbidity and management of adult asthma in South Australia

This paper reviews asthma-related data obtained between 1987 and 1997 from self-report population surveys of adults in South Australia. A multistage, systematic, clustered area sample of adults (>15 years) was selected from a random sample of Australian Bureau of Statistics collector districts, and interviewed at home by trained health interviewers. The self-report prevalence of doctor-diagnosed asthma increased from 5.6% in 1987 to 12.2% in 1997. Morbidity measured as days lost from usual activities and nights awakened by asthma remained high, but hospitalization rates are trending down. The ownership of asthma action plans peaked in 1995 and has declined. The ownership of peak flow meters increased between 1992 and 1997, and the ownership of nebulisers remained constant. Evidence-based interventions are required to improve asthma management.

A strategy for modeling ground water rebound in abandoned deep mine systems

Discharges of polluted water from abandoned mines are a major cause of degradation of water resources worldwide. Pollution arises after abandoned workings flood up to surface level, by the process termed ground water rebound. As flow in large, open mine voids is often turbulent, standard techniques for modeling ground water flow (which assume laminar flow) are inappropriate for predicting ground water rebound. More physically realistic models are therefore desirable, yet these are often expensive to apply to all but the smallest of systems. An overall strategy for ground water rebound modeling is proposed, with models of decreasing complexity applied as the temporal and spatial scales of the systems under analysis increase. For relatively modest systems (area < 200 km2), a physically based modeling approach has been developed, in which 3-D pipe networks (representing major mine roadways, etc.) are routed through a variably saturated, 3-D porous medium (representing the country rock). For systems extending more than 100 to 3000 km2, a semidistributed model (GRAM) has been developed, which conceptualizes extensively interconnected volumes of workings as ponds, which are connected to other ponds only at discrete overflow points, such as major inter-mine roadways, through which flow can be efficiently modeled using the Prandtl-Nikuradse pipe-flow formulation. At the very largest scales, simple water-balance calculations are probably as useful as any other approach, and a variety of proprietary codes may be used for the purpose.

Rapid-sequence tandem transplant for children with high-risk neuroblastoma

BACKGROUND

The majority of patients with high risk neuroblastoma (NB) still relapse.

PROCEDURE

We designed a Phase II trial for children with advanced NB utilizing a program of induction chemotherapy followed by tandem high-dose chemoradiotherapy with stem cell rescue (HDC/SCR) in rapid sequence. Fifty-five patients were evaluable, ages 1-14 years, and 97 cycles of HDC/SCR have been completed to date. Pheresis was possible for every patient, despite their young age, with an average of 7.2 x 10(6) CD34+ cells/kg available to support each HDC/SCR cycle.

RESULTS

Engraftment was rapid, with median time to neutrophil engraftment of 11 days. Five patients who completed the first HDC course did not complete the second and there were four toxic deaths. With a median follow-up of 24 months from diagnosis, 38 of 55 patients (3-year EFS 59%) remain event-free. A subset of the patients received stem cells purged by CD34 selection. The engraftment and EFS of these patients are similar to the overall group.

CONCLUSION

This work demonstrates that a tandem transplant regimen for high-risk NB is a feasible treatment strategy in children and may improve disease-free survival.

Mode structure and ray dynamics of a parabolic dome microcavity

We consider the wave and ray dynamics of an electromagnetic field in a parabolic dome microcavity. The structure of the fundamental s wave involves a main lobe in which the electromagnetic field is confined around the focal point in an effective volume of the order of a cubic wavelength, while modes with finite angular momentum have a structure that avoids the focal area and have correspondingly larger effective volumes. The ray dynamics indicate that the fundamental s wave is robust with respect to small geometrical deformations of the cavity, while the higher order modes are unstable, giving rise to optical chaos. We discuss the incidence of these results on the modification of the spontaneous emission dynamics of an emitter placed in such a parabolic dome microcavity.

Comparing wobble board and jump-landing training effects on knee and ankle movement discrimination

The effects of two training programs on movement discrimination ability, at the ankle and knee, were assessed from the left and right lower limbs of forty-four football players. All players in three Under 18 Victorian Football League (VFL) squads were allocated to either wobble board training, jump landing training, or no-training conditions. Pre-tests to assess discrimination of extent for active movements made while standing were carried out on both ankles and knees of all subjects, using an automated device to accurately set the different movement stop points. Five distances were used, between 10.5 degrees and 14.5 degrees from horizontal for ankle inversion, and between 30.3 degrees and 31.7 degrees from vertical for knee flexion. From a series of 50 inversion movements and 50 knee flexion movements, matrices of absolute judgement by actual movement extent were produced. Non-parametric signal detection analysis was applied to the discrimination score. All subjects were retested after eight weeks. Improvement in discrimination of ankle movements into inversion from pre-test (0.65) to post test (0.70) for the wobble board trained group was significantly larger than the change in the jump-landing trained and the untrained groups (Jump Landing: Pretest: 0.64 to Post-test: 0.64 and Control; Pretest: 0.63 to Post-test: 0.64). Discrimination of knee flexion movements improved significantly from pre-test to post-test in all three groups. These data demonstrate that wobble board training can improve discrimination of discrete ankle inversion movements, an effect interpreted as enabling greater accuracy in the making of inversion movements in foot preparation prior to ground contact.

Magnitude estimation of manually assessed elastic stiffness: stability of the exponent

Magnitude estimations were obtained for manual assessments of pure elastic stiffness stimuli (metal springs). 20 subjects of varied experience in manual assessment of spinal stiffness volunteered to participate. The mean exponent of the power function relating perceived magnitude of elastic stiffness to measured physical magnitude was 1.65. Exponents varied across the 20 individuals but were stable across testing sessions held at least 2 weeks apart, and the size of the exponent was not related to prior experience.

Shown to be useful. Survey shows positive results for first-ever set of national physical activity guidelines

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Tandem high-dose therapy in rapid sequence for children with high-risk neuroblastoma

PURPOSE

Advances in chemotherapy and supportive care have slowly improved survival rates for patients with high-risk neuroblastoma. The focus of many of these chemotherapeutic advances has been dose intensification. In this phase II trial involving children with advanced neuroblastoma, we used a program of induction chemotherapy followed by tandem high-dose, myeloablative treatments (high-dose therapy) with stem-cell rescue (HDT/SCR) in rapid sequence.

PATIENTS AND METHODS

Patients underwent induction chemotherapy during which peripheral-blood stem and progenitor cells were collected and local control measures undertaken. Patients then received tandem courses of HDT/SCR, 4 to 6 weeks apart. Thirty-nine patients (age 1 to 12 years) were assessable, and 70 cycles of HDT/SCR were completed.

RESULTS

Pheresis was possible in the case of all patients, despite their young ages, with an average of 7.2 x 10(6) CD34(+) cells/kg available to support each cycle. Engraftment was rapid; median time to neutrophil engraftment was 11 days. Four patients who completed the first HDT course did not complete the second, and there were three deaths due to toxicity. With a median follow-up of 22 months (from diagnosis), 26 of 39 patients remained event-free. The 3-year event-free survival rate for these patients was 58%.

CONCLUSION

A tandem HDT/SCR regimen for high-risk neuroblastoma is a feasible treatment strategy for children and may improve disease-free survival.

Morphology and growth patterns of developing thalamocortical axons

It is increasingly evident that the actions of guidance factors depend critically on the cellular and molecular context in which they operate. For this reason we examined the growth cone morphology and behavior of thalamic fibers in the relatively natural environment of a slice preparation containing the entire pathway from thalamus to cortex. Axons were labeled with DiI crystals and imaged with a laser-scanning confocal microscope for up to 8 hr. Their behavior was analyzed in terms of morphology, extension rates, shape of trajectory, frequency of branching, and percentage of time spent in advance, pause, and retraction. Thalamic fibers had distinct and stereotyped growth patterns that related closely to their position; within the striatum growth cones were small and elongated, rarely extending filopodia or side branches. Axons grew quickly, in straight trajectories, with minimal pauses or retractions. When they reached the ventral intermediate zone, axons slowed down, often coming to a complete stop for up to several hours, and their growth cones became larger and more complex. During pauses there were continuous extensions and retractions of filopodia and/or side branches. When advance resumed, it was often to a different direction. These results demonstrate consistent regional variations in growth patterns that identify an unexpected decision region for thalamic axons. They provide the basis for examining the roles of guidance cues in an accessible yet intact preparation of the thalamocortical pathway and allow for an evaluation of previously suggested pathfinding mechanisms.

Home care by outreach nursing for chronic obstructive pulmonary disease

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow obstruction, worsening exercise performance and deterioration in health. It is associated with significant morbidity, mortality and costs to health care systems. Care strategies, such as outreach nursing in the community, may reduce this burden.

OBJECTIVES

To evaluate the effectiveness of outreach respiratory health care worker programmes for patients with COPD in terms of improving lung function, exercise tolerance and health related quality of life (HRQL) of patient and carer, and reducing mortality and hospital service utilisation.

SEARCH STRATEGY

A search was carried out using the Cochrane Airways Group database. Bibliographies of identified RCTs were searched for additional relevant RCTs. Authors of identified RCTS were contacted for other published and unpublished studies.

SELECTION CRITERIA

Only randomised control trials of patients with COPD were included. The intervention was an outreach nurse visiting patients in their homes, providing support, education, monitoring patient status and providing liaison with physicians. Interventions that used nurse practitioners who provided therapeutic intervention were also included. Studies in which the therapeutic intervention under test was physical training were not included.

DATA COLLECTION AND ANALYSIS

Data extraction and study quality assessment were performed independently by two reviewers. Where further or missing data was required, authors of studies were contacted.

MAIN RESULTS

Four studies were found. Three assessed mortality following twelve months of care (n=96, 152 and 301), and one after seven months(n=75). Meta-analysis demonstrated that mortality was not significantly reduced by the intervention, Peto Odds Ratio 0.72; 95 % confidence interval 0.43, 1.21. Post hoc subgroup analysis suggested that mortality was reduced by the outreach nursing programme in patients with less severe disease. Significant improvements in health related quality of life were reported in one study in moderate COPD, but not in a study in patients with severe disease. No changes in lung function or exercise performance were found in the studies where data were available. Hospital admissions were reported in only one study in patients with severe disease and no benefit was observed.

REVIEWER'S CONCLUSIONS

Patients with moderate COPD may have mortality and health related quality of life gains from a nursing outreach programme, but there are no data about reductions in hospital utilisation. Patients with severe COPD do not appear to have benefit from such programmes and one large study found no reduction in hospital admissions in such patients.

Ability to discriminate movements at the ankle and knee is joint specific

Measures of discrimination for movements of different extent at the ankle (inversion) and knee (flexion) were obtained for the right and left legs from 59 male footballers. The finding of significant association between discriminability scores at common joints was interpreted in terms of the motor program.

Night splint treatment for plantar fasciitis. A prospective randomized study

A prospective randomized study of 116 patients with plantar fasciitis was performed to determine the effectiveness of adjuvant night splint therapy in relieving the acute symptoms of plantar fasciitis. Patients were randomized into one of two groups. Patients in Group 1 were treated with 1 month of oral antiinflammatory medication, Achilles stretching exercises, and shoe recommendations. Patients in Group 2 received identical treatment but also used a dorsiflexion night splint for 3 months. Blinded clinical review of patients was performed at 4, 6, and 12 weeks. Health status data Short Form 36 also was collected at these times and again at an average 19 months of followup. Overall, 68% of patients reported improvement with this nonoperative protocol for a 12-week period. No statistical difference was seen with the presence or absence of a night splint. In addition, no differences in improvement rates were observed with gender, duration of antecedent symptoms, the presence of bilateral symptoms, or the presence of a heel spur. Age older than 45 years did prove to be a statistically significant poor prognostic factor for improvement at the 12-week follow-up. Short Form 36 data obtained at baseline showed significantly lowered perception of health when compared with age matched controls. Patients in both treatment groups had significant improvement in Short Form 36 scores with 12 weeks of conservative care.

The effect of a respiratory home nurse intervention in patients with chronic obstructive pulmonary disease (COPD)

BACKGROUND

Chronic obstructive pulmomary disease (COPD) is associated with substantial mortality, morbidity, and costs to the health care system. With the increasing interest in outreach care programmes it is important to evaluate their impact upon patients and health services, for conditions such as COPD.

AIM

To determine the effectiveness of an outreach respiratory nurse in a shared care approach, with collaboration between general practitioners and hospital services, in the management of patients with severe COPD.

METHODS

Patients with severe COPD attending The Queen Elizabeth Hospital, Adelaide participated in a randomised controlled trial of a home based nursing intervention (HBNI) over 12 months with outcome measures including mortality rate, hospital service utilisation, FEV1 and health related quality of life (HRQL) using a modified Dartmouth Primary Care Co-operative Quality of Life questionnaire.

RESULTS

There were 48 subjects in each study arm, with no differences in mortality rate (eight deaths in the HBNI group and seven in the control group), hospital admissions, length of stay, number of outpatient and Emergency Service visits. The study had inadequate follow-up of FEV1 and HRQL within the control group. Within the HBNI group, a small improvement in HRQL (in three of ten indices measured) was demonstrated, despite a deterioration in FEV1 (11% reduction, p=0.04) compared to baseline. Quality of life of HBNI subjects' carers did not change.

CONCLUSION

An increased level of care given by an outreach respiratory nurse in a shared care approach for patients with severe COPD produced small improvements in HRQL but did not result in the prevention of deaths or reduced health care utilisation.

Sitting balance I: trunk-arm coordination and the contribution of the lower limbs during self-paced reaching in sitting

The effects of reach distance and type of task on the functional relationship between the trunk, upper limb segments and the lower limbs during self-paced reaching in sitting were examined. Two-dimensional kinematic, kinetic and electromyography (EMG) data were collected as six healthy subjects reached forward under three distance (60, 100, 140% arm's length) and two task (reaching to press a switch, reaching to grasp a glass) conditions. The results demonstrate that type of task affected primarily the temporal aspects of coordination, with the grasp task taking consistently longer than the press task. In contrast, reach distance affected both the spatio-temporal aspects of coordination between the trunk and arm segments and the active contribution of the lower limbs. As reach distance increased, the magnitude of trunk and upper-arm segmental motion increased, whereas forearm segmental motion decreased. However, at each reach distance the path of the hand was relatively straight and there was remarkable consistency in the relationship between trunk and arm segments both within and between subjects suggesting that despite the presence of redundant degrees of freedom, the individual uses a parsimonious coordinative pattern. The vertical ground reaction force (GRF) and EMG data demonstrated that the lower limbs actively contributed to support the body mass when the object was located at 140% arm's length.

Pre-emptive use of aerosolized ribavirin in the treatment of asymptomatic pediatric marrow transplant patients testing positive for RSV

Respiratory syncytial virus is a common virus which frequently causes severe lower tract disease in immunocompromised patients. The mortality rate in bone marrow transplant patients with lower tract disease varies from 31% to 100%, depending upon the treatment used, time before initiation of treatment, and whether patients are pre- or post-engraftment. Therapy with inhaled ribavirin has been used with limited success in decreasing mortality rate. Because of concern about conversion from upper respiratory tract disease to lower respiratory tract disease, we conducted a pilot study using aerosolized ribavirin in asymptomatic RSV-positive patients. Patients had NP washes performed on a weekly basis during the RSV season, for the presence of RSV. If patients were positive, but asymptomatic, and could have their transplant postponed, they were treated with ribavirin until negative. Patients who could not be postponed received aerosolized ribavirin, and began transplant conditioning. During this study, we performed 145 nasal aspirations for RSV on 25 patients; 10 aspirates were positive in seven asymptomatic patients. All positive events were successfully treated with ribavirin, which cleared the RSV for a minimum of 3 weeks. No patients became symptomatic. Thus, we conclude that ribavirin can clear asymptomatic infections in immunocompromised pediatric transplant patients.

Inter-segmental co-ordination in sit-to-stand: an age cross-sectional study

BACKGROUND AND PURPOSE

Being able to sit-to-stand (STS) effectively is an important functional skill, but there is little information available on the changes that occur with growth and maturity. This study aimed to investigate the inter-segmental co-ordination of STS in three different age groups (12-18 months, 4-5 years and 9-10 years).

METHOD

The children studied wore reflective markers and were videotaped as they stood up from a height-adjustable seat that straddled a forceplate. Segmental kinematics and vertical ground reaction force were determined from the co-ordinate and forceplate data.

RESULTS

Even at the earliest developmental stage the children had mastered the basic inter-segmental pattern observed in adults. The youngest children, however, were not able to end the movement in quiet standing; rather they raised up on their toes or took a step forward. Performance varied both within and between subjects. Although there was a similarity in the motor pattern used by the younger subjects to that of the older subjects, developmental trends were evident on the videotapes and on examination of the kinematic and kinetic variables. Movement time, amplitude and peak angular velocity of trunk flexion increased with age. Whereas the children in the older age groups displayed a pattern of vertical ground reaction force similar to that reported for adults, the youngest children tended to reach peak force gradually, often with fluctuations. Although there were characteristic trajectories in the phase-plane plots for each group, the overall trend was for the percentage of smooth plots representing a co-ordinated movement, to increase with age.

CONCLUSIONS

Differences in inter-segmental co-ordination between the ages studied may relate to the child's ability to control horizontal momentum and to balance.

Key to prolonging health and independence. Physical activity for older Canadians

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Revised Physical Activity Readiness Questionnaire

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Consumerism as a branding opportunity

Managing a customer portfolio at the individual level is the most difficult and most promising endeavor. An individual level consumer portfolio does not mean creating marketing materials and advertising campaigns customized for every member of your health plan. What it does mean is developing segmentation models based on consumer preferences extracted directly from your members, not socioeconomic or other demographic models. The most important information to extract is perceptions on how much and what kind of value members want from the organization.

Cementless revision of total hip arthroplasty using proximal porous-coated femoral implants

Thirty patients had 32 cementless total hip arthroplasty revisions and were evaluated postoperatively for clinical function (Harris Hip Score) and radiographic evidence of implant stability. Of the 26 femoral components revised, 16 were revised with anatomic long-stem femoral prostheses, and 10 were revised with straight mid-stem-length components. All components were collared and had circumferential proximal fiber-mesh porous coating. Seven of 16 patients had radiographic subsidence after revision with long-stem components (2 to 30 mm); 6 of 10 patients had subsidence after revision with mid-stem femoral components (2 to 25 mm). Of the 13 patients with femoral subsidence, 8 had calcar reconstruction with allograft bone; of the 13 patients without radiographic subsidence, 8 did not require calcar reconstruction. One of 27 fiber-mesh, porous-coated acetabular components migrated (30 mm). No components have been removed or revised. Even with circumferential proximal porous coating, femoral implant stability remains unpredictable in total hip arthroplasty revision.

Drosophila polo kinase is required for cytokinesis

A number of lines of evidence point to a predominance of cytokinesis defects in spermatogenesis in hypomorphic alleles of the Drosophila polo gene. In the pre-meiotic mitoses, cytokinesis defects result in cysts of primary spermatocytes with reduced numbers of cells that can contain multiple centrosomes. These are connected by a correspondingly reduced number of ring canals, structures formed by the stabilization of the cleavage furrow. The earliest defects during the meiotic divisions are a failure to form the correct mid-zone and mid-body structures at telophase. This is accompanied by a failure to correctly localize the Pavarotti kinesin- like protein that functions in cytokinesis, and of the septin Peanut and of actin to be incorporated into a contractile ring. In spite of these defects, cyclin B is degraded and the cells exit M phase. The resulting spermatids are frequently binuclear or tetranuclear, in which case they develop either two or four axonemes, respectively. A significant proportion of spermatids in which cytokinesis has failed may also show the segregation defects previously ascribed to polo1 mutants. We discuss these findings in respect to conserved functions for the Polo-like kinases in regulating progression through M phase, including the earliest events of cytokinesis.

Treatment of neonatal calf diarrhea with an oral electrolyte solution supplemented with psyllium mucilloid

Dairy calves under 14 days of age with naturally occurring, uncomplicated diarrhea were treated for 3 days with a hypertonic oral electrolyte solution with (n = 15) or without (n = 12) psyllium. Clinical response and clinical pathology data were compared between the 2 groups. Glucose absorption was evaluated on days 1 and 3 by measurement of plasma glucose and lactate and serum insulin concentrations for 4 hours after formula administration. On day 1, glucose, lactate, and insulin concentrations were lower in psyllium-fed calves than in control calves, with significant differences noted in glucose and lactate concentrations at several time points (P < 0.05). Plasma lactate concentrations were higher at several times in both treatment groups on day 3 than on day 1 (P < 0.05). Fecal consistency was markedly different in psyllium-fed calves as compared with control calves within 24 hours of psyllium supplementation. Fecal percent dry matter content was lower in psyllium-fed calves than in control calves at least once a day during supplementation and on day 3 compared with day 0 in the psyllium-fed calves (P < 0.05). There were no significant differences in clinical performance scores, hydration status, arterial blood gas, serum anion gap, electrolyte, or total CO2 concentrations. Addition of psyllium to an oral electrolyte solution resulted in immediate alterations in glucose absorption without impairing rehydration in diarrheic calves, but differences were transient and did not affect clinical outcome.

Procoagulant and proinflammatory activity in acute coronary syndromes

OBJECTIVES

Both the hemostatic and inflammatory system are thought to play a role in the pathogenesis of acute coronary syndromes. However, their respective contribution and interrelationship remain unclear, therefore, we studied the relationship between activation of the coagulation system and proinflammatory activity in ischemic coronary syndromes.

METHODS

Thrombin-antithrombin III (TAT), prothrombin fragments F1 + 2, fibrinopeptide A (FPA), interleukin-6 (IL-6) and interleukin-8 (IL-8) were measured in 50 patients with unstable angina (UA), 60 patients with acute myocardial infarction (AMI) and in 50 patients with stable angina (SA).

RESULTS

FPA levels were significantly higher in patients with UA and AMI than in patients with SA (p = 0.0015 and p < 0.0001), and were higher in patients with AMI than UA (p = 0.0013). Plasma IL-6 concentrations were significantly higher in patients with UA and AMI than in patients with SA (p = 0.0020 and p < 0.001), and again were higher in AMI than UA (p = 0.001). Interestingly, FPA or IL-6 elevations on admission were found in different patients. In contrast, TAT, F1 + 2 and IL-8 levels were not different between the three groups.

CONCLUSIONS

IL-6 and FPA were shown to be independent predictive markers with equal discriminative power to distinguish stable (SA) from unstable (UA + AMI) patients. Moreover, hemostatic and inflammatory markers can be elevated independently in the acute phase of ischemic coronary syndromes.

Number of sampling movements and manual stiffness judgments

OBJECTIVE

It has been suggested that when using posteroanterior pressure to assess the stiffness of the spine, no more than two or three oscillations should be used. This study sought to examine this clinical impression by investigating the effect of the number of sampling movements on stiffness perception.

DESIGN

Perceptual study using a mechanical device to provide stiffness stimuli, with university staff and students as judges.

SETTING

University psychophysics laboratory.

INTERVENTIONS

In part 1, subjects were directed to sample the stimuli a prescribed number of times (either 1, 2, 3, 4 or 5 pushes), whereas in part 2, subjects were free to choose the number of sampling movements.

MAIN OUTCOME MEASURE

Measures of interstimulus discriminability and bias.

RESULTS

An inverted-U relationship between the number of directed sampling movements and stiffness discriminability was found, with three cycles providing best discriminability. When subjects were given a choice, most chose to use three cycles. The number of sampling movements had no effect on bias.

CONCLUSION

This study confirms the hypothesis under investigation and suggests that therapists will be maximally sensitive when using three testing cycles of posteroanterior pressure to assess stiffness.

Bone mineral density in children with myelomeningocele

BACKGROUND

Difficulties with ambulation in patients with myelomeningocele often lead to physical inactivity, osteoporosis, and subsequent development of pathologic fractures.

OBJECTIVE

The purpose of this study was to examine bone mineral density and biochemical markers of bone metabolism in patients with myelomeningocele.

DESIGN AND METHODS

A total of 35 patients between 6 and 19 years of age with myelomeningocele (ambulatory and nonambulatory) were randomly chosen at the Texas Scottish Rite Hospital for Children. We measured bone mineral density of the distal radius in these patients using single photon absorptiometry and measured the biochemical markers of bone metabolism including parathyroid hormone, 1,25 vitamin D, osteocalcin, urinary pyridinolines/deoxypyridinolines, and urinary calcium excretion.

RESULTS

Bone mineral density of the distal radius in the patients with myelomeningocele was approximately 1 to 2 standard deviation units below the mean of the normal population. There were no significant differences between ambulators and nonambulators. However, bone mineral density of the 8 patients who suffered multiple fractures (19) was significantly lower than that for those remaining patients without fractures. Elevated urinary pyridinoline levels, which indicate elevated bone reabsorption, were found more frequently in both non- and limited ambulators than in full-time ambulators. Urinary calcium excretion also was greater than twofold higher in nonambulatory patients versus ambulatory patients. There were no other differences in the biochemical markers of bone metabolism (osteocalcin, parathyroid hormone, 1,25 vitamin D, and urinary deoxypyridinolines) between ambulators and nonambulators. Bone mineral density rises in normal growing children 6 to 19 years of age. When the boys and girls were considered separately, bone mineral density rises with age in boys, but not in girls.

CONCLUSION

Patients with myelomeningocele have decreased bone mineral density and are at risk of suffering pathologic bone fractures. The measurement of bone mineral density may help to identify those patients at greatest risk of suffering multiple fractures. The urinary calcium excretion of nonambulators was higher than that of ambulators and likely contributes to their decreased bone mineral density. Bone mineral density increases with age in boys, but not in girls.

Mechanisms underlying the early establishment of thalamocortical connections in the rat

We labeled axonal projections using carbocyanine dyes in the developing rat brain to study cellular interactions that might underlie the establishment of thalamocortical connectivity. By embryonic day 14 (E14), groups of neurons in the ventral diencephalon and the primitive internal capsule have established projections to the dorsal thalamus, and thalamic fibers pass in topographic order among them. Simultaneously, axons from the early-born cells in both subplate and marginal zone (i.e., the original cortical preplate) establish an ordered array that fills the intermediate zone. Thalamic axons and preplate fibers meet in the lateral part of the internal capsule (at E15 for occipital cortex and dorsolateral thalamus). Subsequently, selective labeling of corresponding thalamic and early corticofugal projections reveals thalamic fibers growing in association with early corticofugal axons, right up to the cortical subplate. A small carbocyanine crystal implanted at any point in the cortex shortly after the arrival of thalamic axons (E16 for the occipital cortex) labels a single, tight bundle containing both descending and ascending fibers, rather than two separate tracts, providing further evidence for intimate topographic association of the two axon systems. Crystals placed in a row, parasagittally or coronally along the hemisphere, reveal separate, topographically distributed, discrete fiber bundles throughout the pathway, leading to spatially ordered groups of back-labeled thalamic cells. These results indicate that the topography of thalamic axons is maintained throughout the pathway and that they reach the cortex by associating with the projections of a number of preexisting cells, including the preplate scaffold.

The role of the first postmitotic cortical cells in the development of thalamocortical innervation in the reeler mouse

In the mutant mouse reeler, the tangential distribution of thalamocortical fibers is essentially normal, even though neurons of the cortical plate accumulate below the entire early-born preplate population (Caviness et al., 1998). This seems incompatible with the hypothesis that cells of the subplate (the lower component of the preplate in normal mammals) form an axonal scaffold that guides thalamic fibers and act as temporary targets for them (Blakemore and Molnár, 1990, Shatz et al., 1990). We used carbocyanine dyes to trace projections in wild-type and reeler mice between embryonic day 13 and postnatal day 3. Preplate formation and early extension of corticofugal fibers to form a topographic array are indistinguishable in the two phenotypes. So too are the emergence of thalamic axons in topographic order through the primitive internal capsule, their meeting with preplate axons, and their distribution over the preplate scaffold. Distinctive differences appear after the cortical plate begins to accumulate below the preplate of reeler, causing the preplate axons to form oblique fascicles, running through the cortical plate. Thalamic axons then pass through the plate within the same fascicles and accumulate in the "superplate" layer for approximately 2-3 d, before defasciculating and plunging down to terminate deep in the cortical plate, creating the curious "looping" pattern seen in the adult. Thus, thalamocortical innervation in reeler follows the same algorithm of development but in relation to the misplaced population of early-born neurons. Far from challenging the theory that preplate fibers guide thalamic axons, reeler provides strong evidence for it.

An investigation of the reliability and validity of posteroanterior spinal stiffness judgments made using a reference-based protocol

BACKGROUND AND PURPOSE

The reliability and criterion-related validity of ratings of posteroanterior (PA) spinal stiffness made using reference values for comparison have not been investigated. In this study, mechanical reference stimuli for points on an 11-point rating scale were used to determine whether using a reference scale may be feasible. Subjects. Five different raters took part in 2 studies in which they rated 40 subjects who were asymptomatic for low back pain.

METHODS

The interrater reliability of ratings was evaluated with intraclass correlation coefficients (ICCs) and standard errors of the measurement (SEMs). Criterion-related validity was evaluated by correlating judgments of PA spinal stiffness assessed manually with measurements of PA spinal stiffness provided by a mechanical device, the "Stiffness Assessment Machine" (SAM).

RESULTS

Although the reliability indices were generally high, with ICCs reaching .77 and with SEMs as low as 0.72 points, the evidence for criterion-related validity (i.e., the ability of the examiner to judge spinal stiffness levels) was not strong, with correlations reaching only .56.

CONCLUSIONS AND DISCUSSION

The reference-based protocol allows for more reliable measures of PA stiffness judgments than previous protocols have; however, the human ratings are not highly correlated with the SAM measures. The protocol will have clinical value if judgments made using it are shown to be reliable in clinically relevant subjects and to have validity for clinical management of patients.

Tardive dyskinesia in a chronically institutionalized population of elderly schizophrenic patients: prevalence and association with cognitive impairment

BACKGROUND

Chronically hospitalized geriatric inpatients with schizophrenia are at particular risk for both tardive dyskinesia (TD) and cognitive impairment but have been insufficiently studied in this regard. Similarly, the relationship between TD and cognitive impairment has not be adequately addressed in this population.

OBJECTIVES

(1) To determine the prevalence of TD in a cohort of chronically institutionalized schizophrenic geriatric inpatients. (2) To examine the relationship between the manifestations of TD in various body regions and several potentially related variables including current pharmacological regimen, age, age at first hospitalization and cognitive status.

METHOD

TD was assessed by the Modified Simpson Dyskinesia Scale and cognitive status by the Mini-Mental State Examination (MMSE). The relationship between manifestations of TD and other variables was examined by t-tests, ANOVA, MANOVA and correlational analysis.

RESULTS

The prevalence of TD was 60%. Prevalence increased with age but was not related to current antipsychotic or anticholinergic regimen. Mean MMSE score did not differ between groups of patients with and without TD as defined by the criteria of Schooler and Kane (1982); however, the mean MMSE score was significantly (p < 0.0004) lower in subjects with orofacial TD as defined by Waddington and Youssef (1996), and the difference was not entirely accounted for by the older age of the latter group.

CONCLUSIONS

TD and cognitive impairment both increase with age. However, TD alone does not account for the severity of cognitive impairment in this population. The present study provides further support for the hypothesis that the correlation between TD and cognitive impairment holds primarily for the orofacial manifestations of TD.

Low molecular weight heparin as an adjunct to thrombolysis for acute myocardial infarction: the FATIMA study. Fraxiparin Anticoagulant Therapy in Myocardial Infarction Study Amsterdam (FATIMA) Study Group

OBJECTIVE

To investigate the feasibility of fixed dose, weight adjusted subcutaneous low molecular weight heparin (LMWH), with monitoring of anti-Xa levels and assessment of coronary patency rates after three to five days, thereby giving an initial indication of its safety and efficacy.

DESIGN

In 30 patients with acute myocardial infarction, LMWH (nadroparine) was given as a body weight adjusted intravenous bolus with thrombolysis (rt-PA infusion) and in weight adjusted subcutaneous doses at six hours, and every 12 hours thereafter for 72 hours. The target range was defined prospectively as 0.35-0.70 anti-factor Xa activity (aXa) units. The aXa level was measured every six hours. Coronary angiography was performed in all patients within five days after the start of thrombolytic treatment to determine patency (TIMI 2 and 3 flow) of the infarct related artery.

RESULTS

The mean (SEM) aXa level over 72 hours was 0.52 (0.08) U/ml; from 12 hours onwards 88% of all aXa measurements were within the target range. At angiography, a patent infarct related artery was present in 24 of the 30 patients. No major bleeding complications occurred, though minor bleeding complications were observed in two patients.

CONCLUSIONS

This small study indicates that LMWH is feasible as an adjunct to thrombolysis in patients with acute myocardial infarction. The aXa levels were within the target range and patency rates at three to five days were around 80%, with no major bleeding complications.