The Impact of Stool Consistency on Bowel Movement Satisfaction in Patients With IBS-C or CIC Treated With Linaclotide or Other Medications: Real-World Evidence From the CONTOR Study

GOALS

This study aimed to characterize the impact of stool consistency on patient-reported bowel movement (BM) satisfaction in patients with irritable bowel syndrome with constipation (IBS-C) or chronic idiopathic constipation, with a focus on linaclotide.

BACKGROUND

As new medications for constipation become available, understanding patients' perceptions of treatment effects may help clinicians manage patient expectations and inform clinical decision-making.

MATERIALS AND METHODS

Data were derived from the Chronic Constipation and IBS-C Treatment and Outcomes Real-world Research Platform (CONTOR) study from 2 patient-reported 7-day daily BM diaries to create a dataset of 2922 diaries representing 26,524 BMs for 1806 participants. Binary variables were created for: medication(s) used in the past 24 hours and categorization of BMs as loose or watery stools (LoWS), hard or lumpy stools (HoLS), or intermediate (neither LoWS nor HoLS). The relationship between stool consistency, medication use, and BM satisfaction was analyzed using logistic regression with SEs corrected for repeated observations.

RESULTS

BMs characterized as intermediate stools and LoWS were satisfactory more often (61.2% and 51.2%, respectively) than HoLS (19.4%). Participants who reported taking linaclotide rated a similar proportion of BMs as satisfactory when described as LoWS (65.6%) or intermediate (64.1%). Linaclotide use was associated with higher odds of BMs being reported as satisfactory compared with nonlinaclotide use (odds ratio: 1.23, P<0.05).

CONCLUSIONS

Overall, CONTOR participants were more likely to report BMs classified as LoWS or intermediate as satisfactory, versus HoLS. Participants taking linaclotide were more likely to be satisfied, particularly those reporting LoWS, versus those not taking linaclotide.

Affective disorders in epilepsies: a neuropsychiatric review

Psychiatry and neurology are well-established as separate disciplines and they may view an issue of mutual concern, such as affective disorder in people with epilepsy, from such different premises that the important synthesis of behavioural neurology, or neuropsychiatry, will be made ineffective. Nosological problems stemming from the use of diagnostic manuals are discussed and revealed in case reports. Reports of affective disorder in persons with brain disorders are relatively rare, possibly as a consequence of nosological problems which stem from a maintenance of a tradition of "functional" disorder. New cases of bipolar disorder and organic mania are given with commentary on the preponderant lateralization of cerebral dysfunction to the right cerebral hemisphere in manic cases.

The effects of femoral graft placement on in vivo knee kinematics after anterior cruciate ligament reconstruction

Achieving anatomical graft placement remains a concern in Anterior Cruciate Ligament (ACL) reconstruction. The purpose of this study was to quantify the effect of femoral graft placement on the ability of ACL reconstruction to restore normal knee kinematics under in vivo loading conditions. Two different groups of patients were studied: one in which the femoral tunnel was placed near the anterior and proximal border of the ACL (anteroproximal group, n=12) and another where the femoral tunnel was placed near the center of the ACL (anatomic group, n=10) MR imaging and biplanar fluoroscopy were used to measure in vivo kinematics in these patients during a quasi-static lunge. Patients with anteroproximal graft placement had up to 3.4mm more anterior tibial translation, 1.1mm more medial tibial translation and 3.7° more internal tibial rotation compared to the contralateral side. Patients with anatomic graft placement had motion that more closely replicated that of the intact knee, with anterior tibial translation within 0.8mm, medial tibial translation within 0.5mm, and internal tibial rotation within 1°. Grafts placed anteroproximally on the femur likely provide insufficient restraint to these motions due to a more vertical orientation. Anatomical femoral placement of the graft is more likely to reproduce normal ACL orientation, resulting in a more stable knee. Therefore, achieving anatomical graft placement on the femur is crucial to restoring normal knee function and may decrease the rates of joint degeneration after ACL reconstruction.

Precurrent self-prompting operants in children: "Remembering"

IN EXPERIMENT I, ONE OF THREE FORMS OF COLLATERAL BEHAVIOR WAS TRAINED: Differential collateral behavior specific in form to one of two discriminative stimuli; Common collateral behavior of a single form regardless of the stimulus; or Nondifferential collateral behavior of either form regardless of the stimulus. Children were next given a short-delay matching-to-sample task in which the discriminative stimuli served as samples, and the children's previously trained collateral behavior terminated the delay and presented the comparison stimuli. Subjects engaging in sample-specific collateral behavior immediately acquired matching. Subjects engaging in sample-nonspecific collateral behavior failed to acquire matching or did so gradually. In Experiment II the minimal delay in the matching task was varied in a mixed sequence, first with collateral behavior required, and then with collateral behavior prohibited. When emitting collateral behavior Common and Nondifferential subjects showed delay-related decrements in matching while Differential subjects did not. When not emitting collateral behavior all subjects showed delay-related decrements in matching. Common and Nondifferential subjects matched more accurately when prohibited from emitting collateral behavior. Differential subjects matched more accurately when emitting collateral behavior. The results accord with Skinner's (1953, 1968) analysis of precurrent operants.

Biosynthesis of storage lipids in plant cell and embryo cultures

The biosynthesis of storage lipids in plant cell and embryo cultures is discussed in the light of their significance in the breeding of agriculturally important oil seed crops. After a short introduction to the biosynthesis of storage lipids, i.e. triacylglycerols and wax esters, this review covers the occurrence and biosynthesis of storage lipids in plant cell and embryo cultures. Plant cells in culture generally contain low levels of both unusual fatty acids and triacylglycerols indicating that these cells are quite different from cells of oil storage tissues. There are a few exceptions to this rule which demonstrate that induction of genes involved in the expression of fatty acid modification and triacylglycerol assembly is possible in plant cell cultures. Such biosynthetically active plant cells may be of particular interest in future studies of storage lipid assembly. Both somatic and gametophytic embryos of oil plants exhibit high capacities for storage lipid biosynthesis and accumulation in vitro compared to cultured plant cells. Above all, the microspore-derived embryo system is recommended to both plant breeders and plant biochemists for the selection and multiplication of plants of superior quality.

Hysteria. Pretending to be sick and its consequences

Hysteria, as it involves the medical profession, is a form of sickness that is defined as being without disease or illness. This lack of a biomedical explanation has limited progress in its understanding. In this essay we propose that hysteria might be better thought of as a form of pretending, elaborated in transaction with the medical system. In medicine, to pretend usually means to deceive. From the perspective of play, however, pretend is a state more akin to acting, magic, belief, and hypnosis. We provide a number of reasons why sickness is an attractive focus for pretending. We show how enactments of sickness can be scripted by a group of involved persons, each contributing from their own perspective, as occurs in the parlour game of 'Consequences', except in hysteria the consequences are often dire.

Prospective evaluation of arthroscopic stabilization of acute, initial anterior shoulder dislocations in young athletes. Two- to five-year follow-up

From March 1992 to November 1998, 57 patients sustained 58 acute, initial, traumatic anterior shoulder dislocations at the United States Military Academy. Six patients selected nonoperative treatment. Three patients underwent primary open repair after diagnostic arthroscopy revealed no Bankart lesion amenable to repair with the bioabsorbable tissue tack. The remaining 48 patients with 49 anterior dislocations were treated with arthroscopic primary repair. There were 45 men and 3 women with an average age of 20 years (range, 17 to 23) and an average follow-up of 37 months (range, 24 to 60). The average Rowe score was 92 (range, 30 to 100). The average single assessment numeric evaluation patient rating was 95.5% (range, 50% to 100%). The average Short Form-36 score (physical function) for the stable shoulders was 99 (range, 95 to 100). Forty-three shoulders remained stable (88%). There were six failures (12%). Factors associated with failure included a history of bilateral shoulder instability, a 2+ sulcus sign, and poor capsulolabral tissue at the time of repair. All patients with stable shoulders returned to their preinjury levels of athletic activity. With follow-up of 5 years, we have observed significantly better results compared with nonoperative treatment in young, active adults at the United States Military Academy.

Arterial complications and total knee arthroplasty

Arterial complications after total knee arthroplasty (TKA) are rare; however, the sequelae can be disastrous. Infection and the need for amputation or vascular reconstructive surgery are not uncommon. A thorough preoperative assessment can identify at-risk patients, many, if not all, of whom have preexisting peripheral arterial disease. In the presence of peripheral arterial disease, the use of a tourniquet during TKA has been implicated in subsequent arterial complications. Following the guidelines that have been established regarding preoperative assessment, the role of the vascular surgeon, and the use of a tourniquet before and during TKA can assist the orthopaedic surgeon in assessing candidates for TKA and reducing the risk of arterial complications.

Seed-specific over-expression of an Arabidopsis cDNA encoding a diacylglycerol acyltransferase enhances seed oil content and seed weight

We recently reported the cloning and characterization of an Arabidopsis (ecotype Columbia) diacylglycerol acyltransferase cDNA (Zou et al., 1999) and found that in Arabidopsis mutant line AS11, an ethyl methanesulfonate-induced mutation at a locus on chromosome II designated as Tag1 consists of a 147-bp insertion in the DNA, which results in a repeat of the 81-bp exon 2 in the Tag1 cDNA. This insertion mutation is correlated with an altered seed fatty acid composition, reduced diacylglycerol acyltransferase (DGAT; EC 2.3.1.20) activity, reduced seed triacylglycerol content, and delayed seed development in the AS11 mutant. The effect of the insertion mutation on microsomal acyl-coenzyme A-dependent DGAT is examined with respect to DGAT activity and its substrate specificity in the AS11 mutant relative to wild type. We demonstrate that transformation of mutant AS11 with a single copy of the wild-type Tag1 DGAT cDNA can complement the fatty acid and reduced oil phenotype of mutant AS11. More importantly, we show for the first time that seed-specific over-expression of the DGAT cDNA in wild-type Arabidopsis enhances oil deposition and average seed weight, which are correlated with DGAT transcript levels. The DGAT activity in developing seed of transgenic lines was enhanced by 10% to 70%. Thus, the current study confirms the important role of DGAT in regulating the quantity of seed triacylglycerols and the sink size in developing seeds.

Patients' aims for epilepsy surgery: desires beyond seizure freedom

PURPOSE

To evaluate prospectively patient's aims for epilepsy surgery as previously outlined theoretically by Taylor et al. (Epilepsia 1997;3:625-30).

METHODS

Ninety-three consecutive patients were interviewed by a psychiatrist as part of their evaluation for epilepsy surgery. Open-ended questions about the patient were asked, and carers' aims or ambitions for change as a result of putative relief of seizures were elicited. The interviewer aimed to obtain a maximum of five aims for later follow-up purposes. These questions were part of an extensive psychiatric interview that is described.

RESULTS

The aims of 69 patients or carers were analyzed. The 204 statements of aims were grouped into 59 categories initially. The five most frequently cited constituted 50% of all the aims listed. These aims were desire for work, driving of motor vehicles, independence, socializing, and freedom from drugs. The patients rarely identified a desire for improvement in cognitive functioning as an aim for epilepsy surgery. A final analysis into six categories showed that changes in social process predominated, even over changes in personal behavior.

CONCLUSIONS

The social and personal aims to accompany relief of epilepsy identified by patients are consistent with the literature on psychosocial adjustment to epilepsy.

Outcome after thrombolysis and selective thoracic outlet decompression for primary axillary vein thrombosis

PURPOSE

Treatment for primary subclavian-axillary vein thrombosis (SAVT) at our institution consists of thrombolysis and anticoagulation for 3 months. Thoracic outlet decompression has been performed for a small number of patients. We wanted to review the functional outcomes of patients treated in such a manner.

MATERIAL AND METHODS

The records of all patients treated for a first episode of SAVT at our hospital over the past 10 years were reviewed. Demographics, comorbidities, method of diagnosis, and treatment for SAVT were recorded. Long-term follow-up was obtained by chart review and asking patients to complete the DASH (disabilities of the arm, shoulder and hand) questionnaire that was developed by the American Academy of Orthopedic Surgeons.

RESULTS

Twenty-eight patients, 20 men and eight women, with a mean age of 36 were treated during the study period. The median time between onset of symptoms and treatment was 5.5 (range, 1-100) days. All patients had confirmation of the diagnosis by venography. Twenty-five patients received thrombolytic treatment with catheter-directed infusions of urokinase; in the other three patients the vein was chronically occluded. Twelve patients had some degree of residual stenosis and were treated with percutaneous transluminal angioplasty after thrombolysis. During the study period two patients underwent decompressive surgery. Twenty-one patients responded to the DASH questionnaire a mean of 2.9 years (range, 2 months to 8 years) after the episode of SAVT. Six (28%) of 21 patients were completely symptom free, 13 patients (62%) had DASH scores consistent with mild symptoms, and two patients had more severe symptoms. Twenty percent (4 of 21) of patients report some difficulty with work.

CONCLUSIONS

Thrombolysis, followed by selective thoracic outlet decompression on the basis of the severity of patients' symptoms can be used as a therapeutic approach to SAVT without undue morbidity. The DASH questionnaire is a useful tool to evaluate results after therapy for SAVT.

Predicting death from ruptured abdominal aortic aneurysms

BACKGROUND

We have previously reported preoperative and immediate postoperative formulae to estimate mortality in patients with ruptured abdominal aortic aneurysms (rAAA). In this study, we prospectively compared these formulae in patients with rAAA with their actual outcomes.

METHODS

Information was collected on 134 patients from two centers over a 3-year period. Preoperative mortality risk was estimated using coefficients for age, level of consciousness, and cardiac arrest. Mortality risk in the immediate postoperative state was based on the presence of coagulopathy, ischemic colitis, prolonged requirement for inotropes, time from arrival at hospital to surgery, patient age, perioperative myocardial infarction, renal failure, and pre-operative hemoglobin level.

RESULTS

The average age was 73 years (range 30 to 92 y) and 20 of 134 (15%) patients were women. Sixty-three patients (47%) survived. For patients with a calculated preoperative mortality risk of >90%, the sensitivity, specificity, and positive and negative predictive values were 25%, 98%, 95%, and 54%, respectively. For a mortality risk >80%, these values were 37%, 94%, 87%, and 57%, respectively. For patients with an estimated immediate postoperative mortality risk > or = 90%, the sensitivity, specificity, and positive and negative predictive values were 17%, 87%, 60%, and 49%, respectively. For a predicted mortality > or = 80%, these values were 22%, 84%, 60%, and 50%, respectively.

CONCLUSIONS

Our formula for predicting mortality for preoperative rAAA patients may be useful for patients with an estimated mortality risk >/=90%, based on the high positive predictive value. The formula for immediate postoperative rAAA patients was not useful in predicting death.

Molecular and immunohistochemical staging of men with seminal vesicle invasion and negative pelvic lymph nodes at radical prostatectomy

BACKGROUND

Patients with seminal vesicle invasion (SVI) at radical retropubic prostatectomy (RRP) have a poor prognosis. Routine microscopic examination of pelvic lymph nodes (LNs) can miss small metastases and, thereby, confuse tumor staging and clinical decision-making. The authors used immunohistochemical and molecular methods to examine archival paraffin-embedded LNs of men who had undergone RRP for clinically localized prostate carcinoma and who had tumors demonstrating SVI and negative LNs at surgery.

METHODS

Between June 1982 and June 1997, 2151 consecutive men underwent RRP for clinically localized prostate carcinoma. Of these, 109 (5.1%) tumors had SVI with negative LNs. The actuarial likelihood of having a tumor that was undetectable by testing prostate-specific antigen (PSA) 5 and 10 years after surgery was 45% and 29%, respectively, for men with isolated SVI. Archival LN specimens were available for 102 men who had isolated SVI. Reverse transcription polymerase chain reaction (RT-PCR) was performed for PSA and prostate-specific membrane antigen (PSMA). All specimens were examined concurrently by immunohistochemistry (IHC).

RESULTS

Careful reevaluation of pelvic LNs demonstrated metastases in 9 (8.8%) men originally classified as metastasis-free. Reevaluation by hematoxylin and eosin (H&E) staining identified three previously unrecognized cases of LN metastases. IHC identified six cases, three of which were missed by H&E. RT-PCR identified four cases, three of which were not revealed by other methods.

CONCLUSIONS

The poor prognosis of patients with SVI does not seem due to occult LN metastases. The low yield of unsuspected foci of prostate carcinoma in the LNs of men with SVI and negative LNs by routine staging does not justify IHC or molecular examination to find occult carcinoma.

Utility of the Arabidopsis FAE1 and yeast SLC1-1 genes for improvements in erucic acid and oil content in rapeseed

High-erucic acid (HEA) Brassica napus cultivars are regaining interest in industrial contexts. Erucic acid and its derivatives are important renewable raw materials utilized in the manufacture of plastic films, in the synthesis of Nylon 13,13, and in the lubricant and emollient industries. Theoretically, the highest level of erucic acid that can be achieved by means of classical breeding is 66 mol%; however, using new approaches on the basis of genetic engineering, it might be possible to develop a B. napus cultivar containing levels of erucic acid significantly above 66 mol% (>80 mol%). In an attempt to increase the amounts of very-long-chain fatty acids (VLCFAs), and erucic acid in particular, in Canadian HEA B. napus cultivars, we have focused on two targets using a transgenic approach. We examined both the role/function of the Arabidopsis thaliana FAE1 (fatty acid elongase) gene by expressing it under the control of the seed-specific napin promoter in B. napus germplasm with analysis of the changes in VLCFA content in the seed oil of transgenic lines, and the performance of the yeast SLC1-1 (sphingolipid compensation mutant) in B. napus cv. Hero transgenic progeny in the field. Here, we report analyses of the contents of 22:1, total VLCFAand oil in the seed oil, as well as seed yield of the field-grown FAE1 and SLC1-1 B. napus cv. Hero progeny.

Papillary urothelial hyperplasia is a clonal precursor to papillary transitional cell bladder cancer

Papilloma and papillary hyperplasia (PH) have been proposed to be the putative precursor lesions of papillary transitional-cell carcinoma of the urinary bladder. We examined 15 PH lesions and 4 papillomas for loss of heterozygosity (LOH) at 17 microsatellite markers on 9 chromosomal arms. Eight of 15 (53%) PHs were clonal, demonstrating LOH of at least 1 microsatellite marker. In contrast, none of the papillomas showed any genetic changes among the markers tested. In PH, chromosomal arm 9q was the most frequently lost (4/15), followed by 9p and 18q (n = 2) and, less frequently, 8p, 10q, 11p and 17p (n = 1). Furthermore, 2 hyperplastic lesions demonstrated LOH at 9q only, confirming the notion that allelic loss on chromosomal arm 9q is among the earliest events in bladder-cancer progression. In 1 patient, identical LOH patterns were observed between PH and a recurrent transitional-cell carcinoma. Our molecular data demonstrate that at least a proportion of PHs represent pre-cancerous lesions of the bladder that subsequently progress to papillary bladder cancer. Moreover, chromosomal arm 9q may harbor a tumor-suppressor gene(s) inactivated in the earliest stages of human bladder tumorigenesis.

Recurrent shoulder instability after open reconstruction in athletes involved in collision and contact sports

The purpose of this study was to evaluate the incidence of recurrent instability in a group of young athletes who underwent open shoulder stabilization with a modified Bankart repair and anterior capsulorrhaphy. Recurrent dislocation was defined as an instability episode resulting in complete dislocation requiring manual reduction. Recurrent subluxation was defined as the subjective history of the shoulder "slipping or popping out" or pain and apprehension that caused cessation of athletics for at least 1 day. Sixty-six patients (64 men and 2 women) were included in the study. A collision sport precipitated instability in 53 patients and a contact sport in 13. The average follow-up was 47 months (range, 24 to 72). The average American Shoulder and Elbow Surgeons score was 95 points (range, 71 to 100). The average Rowe score was 80 points (range, 40 to 100). Two patients had experienced recurrent dislocation after surgery (3%). Eight patients (12%) had rare (fewer than three) episodes of postsurgical subluxation. Five patients (8%) had multiple recurrent subluxations after surgery. Postsurgical recurrent instability was significantly associated with preoperative episodes of subluxation. However, all patients with rare subluxation had an excellent functional result.

A prospective study of modified Ottawa ankle rules in a military population. Interobserver agreement between physical therapists and orthopaedic surgeons

To determine the necessity of ankle and foot radiographs, we used modified Ottawa Ankle Rules to evaluate all cadets seen with an acute ankle or midfoot injury at the United States Military Academy. This scoring system determines the need for radiographs. Each patient was independently examined and the decision rules were applied by a physical therapist and an orthopaedic surgeon. Ankle and foot radiographs were obtained for all subjects. Sensitivity, specificity, and the positive predictive value were calculated in 153 patients. There were six clinically significant ankle fractures and three midfoot fractures, for a total incidence of 5.8%. For physical therapists, the sensitivity was 100%, the specificity for ankle injuries was 40%, and the specificity for foot injuries was 79%. For orthopaedic surgeons, the sensitivity was also 100%, the specificity for ankle injuries was 46%, and the specificity for foot injuries was 79%. Interobserver agreement between the orthopaedic surgeons and physical therapists regarding the overall decision to obtain radiographs was high, with a kappa coefficient value of 0.82 for ankle injuries and 0.88 for foot injuries. There were no false-negative results. Use of the modified Ottawa Ankle Rules would have reduced the necessity for ankle and foot radiographs by 46% and 79%, respectively.

Carotid endarterectomy in octogenerians

PURPOSE

The purpose of this study was to determine the safety and efficacy of carotid endarterectomy (CEA) in octogenerians.

METHODS

The records of 59 CEA performed in 57 patients who were 80yr or older between April 1993 and September 1998 were reviewed. There were 33 males and 24 females with a mean age of 82. Forty-nine procedures (83%) were performed for symptomatic carotid stenosis. The perioperative mortality and morbidity including neurological events were recorded. Long term follow-up data was also obtained.

RESULTS

There were three perioperative deaths (5.1%) and three perioperative neurological events, including one stroke (1.7%) and two transient ischemic attacks (3.4%). The combined mortality and stroke rate was 6.8%. With a mean follow-up of 25+/-21months, Kaplan-Meier estimates of the 4-yr survival rate, freedom from stroke, and stroke free survival were 78, 94 and 75% respectively. For comparison, during the same time period, the same group of surgeons performed 597 CEA in patients less than 80yr of age. The perioperative mortality and stroke rate was 0.3 and 2.5% respectively, with a combined mortality and stroke rate of 2.7%. Perioperative mortality was significantly higher in patients over 80yr of age (P<0.01).

CONCLUSIONS

CEA in octogenerians is associated with a higher mortality rate than in younger patients. However, good long term survival and freedom from stroke make CEA beneficial in octogenerians. With careful patient selection and perioperative management, CEA in octogenerians is worthwhile and should be advised in selected patients.

Production of fatty acid components of meadowfoam oil in somatic soybean embryos

The seed oil of meadowfoam (Limnanthes alba) and other Limnanthes spp. is enriched in the unusual fatty acid Delta(5)-eicosenoic acid (20:1Delta(5)). This fatty acid has physical and chemical properties that make the seed oil of these plants useful for a number of industrial applications. An expressed sequence tag approach was used to identify cDNAs for enzymes involved in the biosynthesis of 20:1Delta(5)). By random sequencing of a library prepared from developing Limnanthes douglasii seeds, a class of cDNAs was identified that encode a homolog of acyl-coenzyme A (CoA) desaturases found in animals, fungi, and cyanobacteria. Expression of a cDNA for the L. douglasii acyl-CoA desaturase homolog in somatic soybean (Glycine max) embryos behind a strong seed-specific promoter resulted in the accumulation of Delta(5)-hexadecenoic acid to amounts of 2% to 3% (w/w) of the total fatty acids of single embryos. Delta(5)-Octadecenoic acid and 20:1Delta(5) also composed <1% (w/w) each of the total fatty acids of these embryos. In addition, cDNAs were identified from the L. douglasii expressed sequence tags that encode a homolog of fatty acid elongase 1 (FAE1), a beta-ketoacyl-CoA synthase that catalyzes the initial step of very long-chain fatty acid synthesis. Expression of the L. douglassi FAE1 homolog in somatic soybean embryos was accompanied by the accumulation of C(20) and C(22) fatty acids, principally as eicosanoic acid, to amounts of 18% (w/w) of the total fatty acids of single embryos. To partially reconstruct the biosynthetic pathway of 20:1Delta(5) in transgenic plant tissues, cDNAs for the L. douglasii acyl-CoA desaturase and FAE1 were co-expressed in somatic soybean embryos. In the resulting transgenic embryos, 20:1Delta(5) and Delta(5)-docosenoic acid composed up to 12% of the total fatty acids.

The plastidic phosphoglucomutase from Arabidopsis. A reversible enzyme reaction with an important role in metabolic control

An Arabidopsis cDNA (AtPGMp) encoding the plastidic phosphoglucomutase (PGM) predicted a 623-amino acid protein with an N-terminal sequence typical of a plastid signal peptide. Expression of a recombinant protein in Escherichia coli confirmed its enzyme activity. The recombinant enzyme had an apparent K(m) value of 98.5 microM and a V(max) of 4.48 micromol min(-1) (mg protein)(-1). The Calvin cycle intermediates fructose-1,6-bisphosphate and ribulose-1, 5-bisphosphate exerted an inhibitory effect on PGM activity, supporting its proposed involvement in controlling photosynthetic carbon flow. A point mutation was identified in the AtPGMp gene of the Arabidopsis pgm-1 mutant. The mutation in the mutant transcript generated a stop codon at about one third of the wild-type open reading frame, and thus rendered the polypeptide nonfunctional. Storage lipid analysis of the pgm-1 mutant seeds showed a 40% reduction in oil content compared with that of wild type. Our results indicate that plastidic PGM is an important factor affecting carbon flux in triacylglycerol accumulation in oilseed plants, most likely through its essential role in starch synthesis.

Comparison of the single assessment numeric evaluation method and the Lysholm score

The purpose of this study was to determine the correlation between the Lysholm knee score and the Single Assessment Numeric Evaluation method. Between March 1995 and December 1996, 201 followup examinations were performed on 130 college age patients who had undergone anterior cruciate ligament reconstructions. These 201 examinations were divided into five routine followup categories: 3 months, 6 months, 1 year, 2 years, and greater than 2 years. The Lysholm score from each patient's followup questionnaire was correlated with his or her Single Assessment Numeric Evaluation rating, as determined by his or her written response to the following question: On a scale from zero to 100, how would you rate your knee today (100 being normal)? All data were gathered prospectively. The mean Lysholm scores and Single Assessment Numeric Evaluation ratings ranged from 84.0 to 93.4 points and 80.0 to 93.3 points, respectively. The correlation coefficients between the Lysholm scores and the Single Assessment Numeric Evaluation ratings ranged from 0.58 to 0.87 points. The results of this study indicate that Single Assessment Numeric Evaluation ratings correlate well with measured Lysholm scores in patients with anterior cruciate ligament reconstruction. The Single Assessment Numeric Evaluation provides clinicians with an alternative mechanism to gather outcomes data with little demand on time and resources.

Assessment of patient waiting times for vascular surgery

OBJECTIVES

To assess patient waiting times for vascular surgery and to determine if complications of the disease develop while the patients are awaiting surgery.

DESIGN

Prospective cohort study.

SETTING

A university-affiliated tertiary care institution.

PATIENTS

All 554 patients who underwent scheduled vascular surgical procedures between April 1995 and October 1996.

OUTCOME MEASURES

A literature review carried out to develop guidelines for acceptable waiting times for surgery associated with various vascular disorders based on their natural history (benchmark target); actual waiting times, defined as the interval from the date each patient was booked for surgery to the date of admission to hospital for the procedure; the proportion of patients admitted within the benchmark targets; and whether prolonged waiting time placed patients at risk for complications of their disease.

RESULTS

Of the 554 patients, 382 (69%) were admitted within the benchmark waiting times. Of 84 patients having an abdominal aortic aneurysm, the aneurysm ruptured during the waiting period in 6, and 4 of them died, for a complication rate of 7% and a death rate of 5%. Two of the 6 aneurysms ruptured after the patient had waited longer than the target time. Three of 100 patients with symptomatic carotid artery stenosis awaiting admission for carotid endarterectomy suffered ischemic stroke, for a 3% complication rate; all had waited longer than the target period. One patient suffered occlusion of a femoropopliteal bypass graft while awaiting revision of a stenosed bypass graft.

CONCLUSIONS

This study suggests that although most patients are admitted for operation within the benchmark time, one-third are admitted late and may suffer serious complications of their disease while awaiting admission for the procedure.

Abdominal aortic aneurysm after pulmonary transplantation: a case report

We present the case of a 39-year-old man who underwent repair of a symptomatic 5-cm abdominal aortic aneurysm. This patient had received a bilateral lung transplant for cystic fibrosis 10 years before this event. He was receiving cyclosporine, prednisone, and azathioprine as immunosuppression therapy. To our knowledge, this is the first reported abdominal aortic aneurysm after lung transplantation, and we note that our patient had a rapidly enlarging aneurysm, as seen in recipients of heart transplants. We postulate that immunosuppression may be related to the development and/or rapid growth of abdominal aortic aneurysms.

Radiolabeling, stability, and body distribution in rats, of low molecular weight polylactide homopolymer and polylactide-polyethyleneglycol copolymer

In order to study its fate in vivo, a low molecular-weight polylactide homopolymer was derivatized with a p-methoxyphenyl moiety, so as to make it susceptible to radiolabeling with 125I. A low molecular weight polylactide-polyethyleneglycol copolymer capped with ap-methoxyphenyl residue was also synthesized. The derivatized polymers were successfully [125I]iodinated in organic medium. The radiolabeled products were freed from [125I]iodide by dialysis and shown to be stable for 24 h on incubation at 37 degrees C in buffered saline or in blood. On longer incubation at 37 degrees C in buffered saline the radiolabeled polylactide released [125I]iodide and [125I]iodinated 3-(p-methoxyphenyl)propionic acid. The radiolabeled copolymer was more stable on incubation at 37 degrees C in buffered saline, but some [125I]iodide was released. The tissue distribution of radioactivity was determined 5 min, 1, 5 and 24 h after injecting male rats with 125I-labeled homopolymer or copolymer. Intravenous, intraperitoneal and subcutaneous injection routes were employed. Further rats were injected with [125I]iodide, to aid interpretation of the data. After administration of labeled homopolymer, a high concentration of radioactivity was found in the liver tissue. The levels slowly decreased over 24 h, and the polymer was successively found in the small and large intestine and the faeces. This is probably indicative of excretion via the bile. Concurrently radioactivity was excreted in the urine. After administration of labeled copolymer, a high concentration of radioactivity was found in the liver and the residual soft tissue, the latter fraction containing two-thirds of the radioactivity one hour after injection. The precise tissue location that this result indicates was not identified. After 1 h radioactivity was excreted in the faeces, again probably via the bile, and in the urine. Tissue distributions after intraperitoneal or subcutaneous injections were concordant with the above results and interpretations, with the additional factor of slow clearance from the injection site.

Effects of antisense repression of an Arabidopsis thaliana pyruvate dehydrogenase kinase cDNA on plant development

Pyruvate dehydrogenase kinase (PDHK), a negative regulator of the mitochondrial pyruvate dehydrogenase (PDH) complex (mtPDC), plays a pivotal role in controlling mtPDC activity, and hence, the TCA cycle and cell respiration. This report describes the cloning of a pyruvate dehydrogenase kinase cDNA (AtPDHK) from Arabidopsis thaliana and focuses on the effects of antisense down-regulation of its expression on plant growth and development. The deduced amino acid sequence of AtPDHK exhibits extensive similarity to other plant and mammalian PDHKs, containing conserved domains typical of two-component histidine protein kinases. The Escherichia coli expressed AtPDHK specifically phosphorylated mammalian PDH E1 in a time-dependent manner. Antisense expression of the AtPDHK cDNA led to marked elevation of mtPDC activity in transgenic plants with increases ranging from 137% to 330% compared to control plants. Immunoblot analyses performed with a monoclonal antibody to the E1alpha mtPDH component (the subunit phosphorylated by PDHK) indicated that the increased mtPDC activity was not the result of an increase in the level of PDH protein. MtPDC from transgenic plants showed a reduced sensitivity to ATP-dependent inactivation compared to that observed in wild-type plants. Collectively, these data suggest that the antisense partial silencing of the negative regulator, PDHK, was responsible for the increased mtPDC activity observed in the antisense PDHK plants. Transgenic plants with partially repressed AtPDHK also displayed altered vegetative growth with reduced accumulation of vegetative tissues, early flower development and shorter generation time. The potential role for AtPDHK gene manipulation in crop improvement is discussed.

Treating children and adults: whose body is it anyway?

This essay, about the concept of treatment, is written by a psychiatrist who is monitoring extreme treatment situations, namely surgical treatment of epilepsy. It challenges the implicit assumption that persons consulting doctors necessarily want to be treated. A child may not be privy to, or wish to be party to, a treatment. The child, or the parent on behalf of the child, may not agree to the course of action that is in its best interest. One problem of treatment concerns who owns the body that is to be treated. Ultimately, the body belongs to the state and is merely tenanted by the child and managed by a parent on the state's behalf. But the body must, somehow, be owned if its sickness is to be acknowledged. The lack of real autonomy provides for the possibility of abuse including abusive therapies. "Abuse" is applicable only to abuse of trust. Autonomy is granted or conceded by parents and by the state but is never complete. Autonomy is confirmed by taking informed decisions about what will happen to the body. Treatment is a cost/benefit deal in which the precise aim to be achieved has to be described and accepted before treatment begins.

Physical training and injury in female cadets at the United States Military Academy

Women have been enrolled at the United States Military Academy (USMA) since 1976. All cadets are required to participate in a rigorous physical training curriculum with few differences for male and female cadets. The effect this physical training has on the health of women at West Point has been monitored closely. This paper will review the physical training program at USMA and the gender differences that exist. The health effects of this demanding physical training on women will also be discussed.

Intraoperative intraarterial urokinase in early postoperative stroke following carotid endarterectomy: a useful adjunct

The purpose of this study was to determine the efficacy of intraoperative intraarterial urokinase (UK) in patients who suffered an acute stroke immediately following carotid endarterectomy (CEA). From January 1995 to March 1998, 823 carotid endarterectomies were performed. The subsequent results showed that intraarterial UK in the setting of early post-CEA neurologic events appears to be safe and may be a useful adjunct to re-exploration in improving neurologic outcomes.

Anabolic-androgenic steroid administration causes hypertrophy of immobilized and nonimmobilized skeletal muscle in a sedentary rabbit model

Although the use of anabolic agents in athletics has generated extensive publicity and controversy, the potential therapeutic benefits of these drugs have not been fully investigated. This randomized, blinded experimental study investigated whether short-term administration of an anabolic-androgenic steroid can limit immobilization-induced muscle atrophy in a rabbit model. We casted one hindlimb each in 48 New Zealand White rabbits and randomly assigned the rabbits to two groups. The treated group received weekly intramuscular injections of the anabolic-androgenic steroid, nandrolone decanoate (15 mg/kg). Immobilization significantly decreased muscle weights in both the treated rabbits and controls. Compared with controls, the body weights of the treated rabbits increased significantly at 2, 4, and 8 weeks. At 4 and 8 weeks, wet weights, dry weights, and contractile forces were significantly greater in both the casted and noncasted tibialis anterior muscle-tendon units of the treated group. Dry weights and casted contractile forces of the extensor digitorum longus muscle unit at 4 weeks and all measures at 8 weeks were greater in the treated rabbits than in controls. These results are contrary to previously accepted views that anabolic-androgenic steroid use leads to muscle hypertrophy only in conjunction with strength training. This study adds to the growing evidence that anabolic-androgenic steroids can produce significant skeletal muscle hypertrophy in sedentary populations.

Aujeszky's disease in captive bears

Five of eight bears died during an outbreak of Aujeszky's disease in a travelling circus in the north of Spain. The bears had been fed on a diet which included raw pigs' heads. One of three Himalayan bears and a Kodiak bear died acutely with signs of the disease. One of four polar bears died acutely without signs, another died with signs of Aujeszky's disease while it was being treated, and a third died with enteritis and disseminated intestinal coagulation some time later without showing signs of the disease. A fourth polar bear recovered from the same gastrointestinal problem without showing signs of the disease. Although one of the two surviving Himalayan bears showed some signs referrable to Aujeszky's disease, the results of tests for neutralising antibodies were negative. Two of the polar bears, the Himalayan bear and the Kodiak bear were examined postmortem and three of them were examined histologically. No lesions referable to Aujeszky's disease were found. The tissues from one female polar bear were examined and shown to be positive for Aujeszky's disease virus by virus isolation, polymerase chain reaction, electron microscopy and fluorescent antibody tests. The DNA of the isolate was shown to be similar to that of the strains of the virus circulating in pigs in northern Spain some years earlier.

The Arabidopsis thaliana TAG1 mutant has a mutation in a diacylglycerol acyltransferase gene

In Arabidopsis thaliana (ecotype Columbia) mutant line AS11, an EMS-induced mutation at a locus on chromosome II results in a reduced diacylglycerol acyltransferase (DGAT; EC 2.3.1.20) activity, reduced seed triacylglycerol, an altered seed fatty acid composition, and delayed seed development. A mutation has been identified in AS11 in a gene, which we designated as TAG1, that encodes a protein with an amino acid sequence which is similar to a recently reported mammalian DGAT, and, to a lesser extent, to acyl CoA:cholesterol acyltransferases. Molecular analysis revealed that the mutant allele in AS11 has a 147 bp insertion located at the central region of intron 2. At the RNA level, an 81 bp insertion composed entirely of an exon 2 repeat was found in the transcript. While the seed triacylglycerol content is reduced by the lesion in AS11, there is no apparent effect on sterol ester content in the mutant seed. The TAG1 cDNA was over-expressed in yeast, and its activity as a microsomal DGAT confirmed. Therefore, the TAG1 locus encodes a diacylglycerol acyltransferase, and the insertion mutation in the TAG1 gene in mutant AS11 results in its altered lipid phenotype.

Anterior shoulder instability in sport: current management recommendations

In the young athlete, anterior shoulder dislocations are common injuries that usually result in recurrent instability, and often require surgical treatment. Non-operative treatment remains the initial recommended course for most conditions. Operative treatment has advanced to more anatomical repairs, both open and arthroscopic. The purpose of this paper is to review the evaluation and treatment of anterior shoulder instability, to include acute dislocations, acute subluxations and recurrent instability.

Autistic spectrum disorders in childhood epilepsy surgery candidates

One third of children with autistic spectrum disorders (or pervasive developmental disorders) enter that state by regression from a more normal prior development at the onset of epilepsy or epileptiform abnormality in the electroencephalogram. In a very small proportion structural lesions of the temporal lobes are discovered. These form part of the sample of children coming to a surgical treatment programme. Ninety-eight child candidates for epilepsy surgery were seen by one neuropsychiatrist. Their psychiatric diagnoses were coded on DSM IV schedules. Other variables of interest were the age at onset of epilepsy; the nature, the side, and time of acquisition of the lesion; intelligence, and sex. There were 19 children with autistic spectrum disorders including eight with Asperger's syndrome. Ten of the children in the autistic group had right brain lesions; six were dysembryoplastic neuroepithelial tumours (DNETs); two were cortical dysplasias; one tuberous sclerosis; one hemi-cortical defect; and 1 mesial temporal sclerosis. Nine started epilepsy in their first year; nine had IQs in the retarded range; nine of the 11 were male. Six of eight Asperger's children had right brain lesions; two DNETs; four mesial temporal sclerosis; one Rasmussen encephalitis. Four started epilepsy in their first year; one was retarded; five were female. Children who had no, or other, psychiatric disorder also showed "mass" lesions, or temporal sclerosis but with different biases as to side, sex, and very early onset of epilepsy from the autistic spectrum group. Very early onset of epilepsy, with lesions of embryonal origin, in the right temporal lobe, strongly predisposed males towards autistic regression. Such patients should be referred very early for consideration of urgent surgical treatment.

New duplex ultrasound scan criteria for managing symptomatic 50% or greater carotid stenosis

PURPOSE

The North American Symptomatic Carotid Endarterectomy Trial (NASCET) showed that selected patients benefited from surgery when their carotid artery was 50% or more stenosed. This study assessed the accuracy of color-flow duplex ultrasound scanning (DUS) parameters to detect 50% or greater carotid artery stenosis and to determine the situations in which carotid endarterectomy (CEA) without angiography could be justified.

METHODS

From March 1, 1995, to December 1, 1995, all patients considered for CEA were studied with DUS and carotid angiography. Results of the two tests were blindly compared. DUS measurements of internal carotid artery (ICA) peak systolic velocity (PSV), end diastolic velocity, and ratio of the ICA to common carotid artery PSV (ICA/CCA) were subjected to receiver operator characteristic curve analysis to determine the most accurate criterion predicting 50% or greater angiographic stenosis. The criterion for identifying patients for CEA without angiography was selected from criteria with a high positive predictive value (PPV) and sensitivity.

RESULTS

A total of 188 carotid bifurcations were available for comparison. A PSV (ICA/CCA) of 2 or higher was the most accurate criterion for detection of 50% or greater stenosis, with an accuracy rate of 93% (sensitivity, 96%; specificity, 89%; PPV, 92%). A PSV (ICA/CCA) of 3.6 or higher was the best criterion for identifying candidates for CEA who had not undergone earlier angiography, with PPV, sensitivity, specificity, and accuracy rates of 98%, 77%, 98%, and 86%, respectively.

CONCLUSION

These redefined criteria detect the NASCET-defined threshold level of 50% or greater ICA stenosis, above which CEA results in stroke reduction. A management algorithm based on these criteria should help to minimize both angiography and unnecessary intervention.

CUT1, an Arabidopsis gene required for cuticular wax biosynthesis and pollen fertility, encodes a very-long-chain fatty acid condensing enzyme

Land plants secrete a layer of wax onto their aerial surfaces that is essential for survival in a terrestrial environment. This wax is composed of long-chain, aliphatic hydrocarbons derived from very-long-chain fatty acids (VLCFAs). Using the Arabidopsis expressed sequence tag database, we have identified a gene, designated CUT1, that encodes a VLCFA condensing enzyme required for cuticular wax production. Sense suppression of CUT1 in transgenic Arabidopsis plants results in waxless (eceriferum) stems and siliques as well as conditional male sterility. Scanning electron microscopy revealed that this was a severe waxless phenotype, because stems of CUT1-suppressed plants were completely devoid of wax crystals. Furthermore, chemical analyses of waxless plants demonstrated that the stem wax load was reduced to 6 to 7% of wild-type levels. This value is lower than that reported for any of the known eceriferum mutants. The severe waxless phenotype resulted from the downregulation of both the decarbonylation and acyl reduction wax biosynthetic pathways. This result indicates that CUT1 is involved in the production of VLCFA precursors used for the synthesis of all stem wax components in Arabidopsis. In CUT1-suppressed plants, the C24 chain-length wax components predominate, suggesting that CUT1 is required for elongation of C24 VLCFAs. The unique wax composition of CUT1-suppressed plants together with the fact that the location of CUT1 on the genetic map did not coincide with any of the known ECERIFERUM loci suggest that we have identified a novel gene involved in wax biosynthesis. CUT1 is currently the only known gene with a clearly established function in wax production.

Comparison of the Single Assessment Numeric Evaluation method and two shoulder rating scales. Outcomes measures after shoulder surgery

The purpose of this study was to determine the correlation between the Single Assessment Numeric Evaluation method and the Rowe and American Shoulder and Elbow Surgeons scores. Between April 1993 and December 1996, 209 follow-up examinations were performed on 163 United States Military Academy cadets after shoulder surgery. These 209 examinations were divided into five follow-up categories: 3 months, 6 months, 1 year, 2 years, and greater than 2 years. The Rowe and American Shoulder and Elbow Surgeons scores from each subject's follow-up questionnaire were correlated with his or her Single Assessment Numeric Evaluation rating, which is determined by the subject's written response to the following question: "How would you rate your shoulder today as a percentage of normal (0% to 100% scale with 100% being normal)?" Correlation coefficients between the Single Assessment Numeric Evaluation and the two scores were 0.51 to 0.79 for the Rowe score and 0.46 to 0.69 for the American Shoulder Elbow Surgeons score. The results of this study indicate that the Single Assessment Numeric Evaluation correlates well with these two scores after shoulder surgery. This study suggests that this new evaluation method provides clinicians with a mechanism to gather outcomes data with little demand on their time and resources.

Vascular trauma associated with fractures and dislocations

Vascular trauma occurs relatively infrequently in association with general orthopedic trauma but may be seen more often in injuries involving joint dislocations and areas in which vascular structures are tethered at the fracture site. The mechanisms of vascular trauma are identified, and the general principles in managing these injuries, including the operative approach to the injury itself and the options in repairing both arterial and venous injuries, are discussed. The role of fasciotomy and primary amputation are also reviewed. Several specific injuries, including pelvic fracture, knee dislocation, shoulder and upper limb injuries, complex tibial fractures, and iatrogenic injuries, are examined from diagnostic and management perspectives. Despite an ongoing evolution in the diagnosis and management of these often challenging injuries, the essential requirements for a good clinical outcome remain early recognition of the dysvascular limb and rapid institution of therapy.

Persistent disability associated with ankle sprains: a prospective examination of an athletic population

The purpose of this study was to examine a young athletic population to update the data regarding epidemiology and disability associated with ankle injuries. At the United States Military Academy, all cadets presenting with ankle injuries during a 2-month period were included in this prospective observational study. The initial evaluation included an extensive questionnaire, physical examination, and radiographs. Ankle sprain treatment included a supervised rehabilitation program. Subjects were reevaluated at 6 weeks and 6 months with subjective assessment, physical examination, and functional testing. The mean age for all subjects was 20 years (range, 17-24 years). There were 104 ankle injuries accounting for 23% of all injuries seen. There were 96 sprains, 7 fractures, and 1 contusion. Of the 96 sprains, 4 were predominately medial injuries, 76 were lateral, and 16 were syndesmosis sprains. Ninety-five percent had returned to sports activities by 6 weeks; however, 55% of these subjects reported loss of function or presence of intermittent pain, and 23% had a decrement of >20% in the lateral hop test when compared with the uninjured side. At 6 months, all subjects had returned to full activity; however, 40% reported residual symptoms and 2.5% had a decrement of >20% on the lateral hop test. Neither previous injury nor ligament laxity was predictive of chronic symptomatology. Furthermore, chronic dysfunction could not be predicted by the grade of sprain (grade I vs. II). The factor most predictive of residual symptoms was a syndesmosis sprain, regardless of grade. Syndesmosis sprains were most prevalent in collision sports. This study demonstrates that even though our knowledge and understanding of ankle sprains and rehabilitation of these injuries have progressed in the last 20 years, chronic ankle dysfunction continues to be a prevalent problem. The early return to sports occurs after almost every ankle sprain; however, dysfunction persists in 40% of patients for as long as 6 months after injury. Syndesmosis sprains are more common than previously thought, and this confirms that syndesmosis sprains are associated with prolonged disability.

Persistent disability associated with ankle sprains: a prospective examination of an athletic population

The purpose of this study was to examine a young athletic population to update the data regarding epidemiology and disability associated with ankle injuries. At the United States Military Academy, all cadets presenting with ankle injuries during a 2-month period were included in this prospective observational study. The initial evaluation included an extensive questionnaire, physical examination, and radiographs. Ankle sprain treatment included a supervised rehabilitation program. Subjects were reevaluated at 6 weeks and 6 months with subjective assessment, physical examination, and functional testing. The mean age for all subjects was 20 years (range, 17-24 years). There were 104 ankle injuries accounting for 23% of all injuries seen. There were 96 sprains, 7 fractures, and 1 contusion. Of the 96 sprains, 4 were predominately medial injuries, 76 were lateral, and 16 were syndesmosis sprains. Ninety-five percent had returned to sports activities by 6 weeks; however, 55% of these subjects reported loss of function or presence of intermittent pain, and 23% had a decrement of >20% in the lateral hop test when compared with the uninjured side. At 6 months, all subjects had returned to full activity; however, 40% reported residual symptoms and 2.5% had a decrement of >20% on the lateral hop test. Neither previous injury nor ligament laxity was predictive of chronic symptomatology. Furthermore, chronic dysfunction could not be predicted by the grade of sprain (grade I vs. II). The factor most predictive of residual symptoms was a syndesmosis sprain, regardless of grade. Syndesmosis sprains were most prevalent in collision sports. This study demonstrates that even though our knowledge and understanding of ankle sprains and rehabilitation of these injuries have progressed in the last 20 years, chronic ankle dysfunction continues to be a prevalent problem. The early return to sports occurs after almost every ankle sprain; however, dysfunction persists in 40% of patients for as long as 6 months after injury. Syndesmosis sprains are more common than previously thought, and this confirms that syndesmosis sprains are associated with prolonged disability.

Braced for impact: reducing military paratroopers' ankle sprains using outside-the-boot braces

BACKGROUND

Ankle injuries account for 30 to 60% of all parachuting injuries. This study was designed to determine if outside-the-boot ankle braces could reduce ankle sprains during Army paratrooper training.

METHODS

The randomized trial involved 777 volunteers from the U.S. Army Airborne School, Fort Benning, Ga. Of this group, 745 completed all study requirements (369 brace-wearers and 376 non-brace-wearers). Each volunteer made five parachute jumps, for a total of 3,674 jumps.

RESULTS

The incidence of inversion ankle sprains was 1.9% in non-brace-wearers and 0.3% in brace-wearers (risk ratio, 6.9; p = 0.04). Other injuries appeared unaffected by the brace. Overall, 5.3% of the non-brace group and 4.6% of the brace group experienced at least one injury. The risk ratio for injured individuals was 1.2:1 (non-brace to brace groups; p = 0.65).

CONCLUSION

Inversion ankle sprains during parachute training can be significantly reduced by using an outside-the-boot ankle brace, with no increase in risk for other injuries.