Kinematic Investigation of Healthy, Arthritic, and Postsurgery Thumbs: Is the Metacarpophalangeal Joint the Gateway to Carpometacarpal Arthritis?

The thumb carpometacarpal (CMC) joint is one of the most likely joints to develop osteoarthritis (OA). If conservative treatments fail to alleviate symptoms, surgery may be pursued. Kinematic outcomes of CMC surgery techniques have been described, but current tools have limitations in capturing motion abilities. The goals of this study were (1) develop a new and robust set of kinematic outcome measures, and apply them to (2) a cohort of younger and older control individuals without CMC OA to determine age and sex-related changes, and (3) a cohort of participants with CMC OA before, 3 months, and 6 months after undergoing thumb ligament reconstruction with tendon interposition surgery to detect the impacts of surgery. 52 (26 males, 26 females) control and 18 (3 males, 15 females) surgical participants were tested. Kinematics were investigated using motion capture by mapping the three-dimensional motion space of the whole thumb, and two-dimensional motion boundaries of the metacarpal (MC) and proximal phalange (PP). Visual analog pain score was recorded. Older control participants had shifted regions of motion compared to younger participants (p ≤ 0.027), suggesting asymptomatic CMC wear. Control females had 31% more metacarpophalangeal (MCP) motion than control males (p = 0.013), which could alter loading paths through the CMC joint and increase OA risk. Pain at 6 months postsurgery was 72% less than presurgery (p < 0.001), but motion abilities were 20-28% less than presurgery (p ≤ 0.074) and 24-40% less than control participants (p ≤ 0.066). These techniques have the possibility of identifying presymptomatic motion changes, including those at the metacarpophalangeal joint in CMC OA progression.

The Female Thumb Carpometacarpal Joint: Motion and Force Changes Due to Arthritis and Surgical Intervention

Thumb carpometacarpal (CMC) osteoarthritis (OA) has been one of the most common locations of hand OA. CMC OA disproportionately occurs in females over males. In severe cases, surgical intervention may be needed. However, to determine the effects of surgical treatment, normative, pre-, and postsurgery function must be understood. The goals of this work were to compare the thumb motion and force abilities of older healthy (OH) females without CMC OA to those of females with CMC OA and who received ligament reconstruction with tendon interposition (LRTI) surgery at time points presurgery, 3- and 6-months postsurgery. On average, CMC OA participants 3- and 6-months postsurgery showed 35.6% and 32.9% less overall metacarpal motion compared to presurgery, 31.9% and 29.1% less than OH, and exhibited altered motion. Metacarpal flexion/extension and abduction/adduction ranges were 51.9 deg and 43.4 deg for OH, 52.9 deg and 40.3 deg presurgery, 39.9 deg and 33.5 deg at 3-months, and 42.6 deg and 32.7 deg at 6-months postsurgery. On average, participants had increased force generation at 6-months postsurgery compared to presurgery, and 20% of participants returned to the level of OH females. These data sets highlight changes in thumb metacarpal movement and thumb force generation due to disease and surgical intervention. This work has the ability to support both surgeons and patients through improved outcome assessments as well as additional data to inform the decision process on intervention.

A review of the literature pertaining to the efficacy, safety, educational requirements, uses and usage of mechanical adjusting devices: Part 2 of 2

Over the past decade, mechanical adjusting devices (MADs) were a major source of debate within the Chiropractors' Association of Saskatchewan (CAS). Since Saskatchewan was the only jurisdiction in North America to prohibit the use of MADs, the CAS established a committee in 2001 to review the literature on MADs. The committee evaluated the literature on the efficacy, safety, and uses of moving stylus instruments within chiropractic practice, and the educational requirements for chiropractic practice. Following the rating criteria for the evaluation of evidence, as outlined in the Clinical Guidelines for Chiropractic Practice in Canada (1994), the committee reviewed 55 articles - all of which pertained to the Activator. Of the 55 articles, 13 were eliminated from the final study. Of the 42 remaining articles, 6 were rated as class 1 evidence; 11 were rated as class 2 evidence and 25 were rated as class 3 evidence. In this article - the second in a series of two - we review the results of uses and usage, safety and educational requirements. Of the 30 articles designated under the category of usage, 3 were rated as Class 1 evidence; 9 studies were classified as Class 2 evidence and 18 were rated as Class 3 evidence. Overall the committee reached consensus that in clinical practice, there is broad application of these procedures. A minority report was written arguing that the reviewer was unable to reach a conclusion about the use of the Activator Instrument other than it is used as a clinical and research tool. Of the 16 studies that dealt either explicitly or implicitly with safety, 4 were Class 1 evidence; 3 were Class 2 evidence and 9 were Class 3 evidence. Overall the committee reached consensus that the evidence supports that the Activator instrument is safe and has no more relative risk than do manual HVLA procedures. A minority report was written arguing that there is no evidence either to support or refute the view that MAD is safe. Of the 5 studies that dealt with educational requirements, all were Class 3 evidence. Overall the committee reached consensus that there was no evidence in the literature with respect to educational requirements to form any conclusions. A minority report was written offering opinion that there is evidence with respect to educational requirements.

Response of very small (2 mm) porcine coronary arteries to balloon angioplasty and stent implantation

OBJECTIVE

To investigate the response of very small coronary arteries to stent deployment and balloon angioplasty.

SETTING

Normal porcine coronary arteries.

METHODS

24 pigs underwent intervention to two main coronary arteries, in segments 2.0 mm in diameter, with balloons whose diameter was 2.5 mm at standard pressure. Twelve arteries received a BiodivYsio small vessel (SV) stent; 12 an NIR SV stent; 12 standard BiodivYsio stent, and 12 balloon only. The arteries were harvested at 28 days, fixed, embedded in plastic, and cut and ground in cross section. The injury score and histomorphometry were assessed.

RESULTS

The BiodivYsio SV stent was associated with 20% less injury (p = 0.16), a 30% larger lumen (p = 0.13), and a 25% smaller neointima (p = 0.03) than the NIR SV stent, despite identical oversize. The standard BiodivYsio stent exhibited less recoil but 29% greater injury (p = 0.01), 59% more neointima (p = 0.00), and 18% less lumen (p = 0.27) than the BiodivYsio SV. Of all interventions, balloon only was associated with little injury, little neointima, major vessel shrinkage, and the largest lumen.

CONCLUSION

Despite uniform oversize dilatation, both injury and response varied widely in very small porcine coronary arteries, depending on whether a stent or balloon was used, the stent design, and the number and/or thickness of struts. The response to different stent designs is considerable and is related to the degree of injury.

A review of the literature pertaining to the efficacy, safety, educational requirements, uses and usage of mechanical adjusting devices: Part 1 of 2

Over the past decade, mechanical adjusting devices (MADs) were a major source of debate within the Chiropractors' Association of Saskatchewan (CAS). Since Saskatchewan was the only jurisdiction in North America to prohibit the use of MADs, the CAS established a committee in 2001 to review the literature on MADs. The committee evaluated the literature on the efficacy, safety, and uses of moving stylus instruments within chiropractic practice, and the educational requirements for chiropractic practice. Following the rating criteria for the evaluation of evidence, as outlined in the Clinical Guidelines for Chiropractic Practice in Canada (1994), the committee reviewed 55 articles - all of which pertained to the Activator. Of the 55 articles, 13 were eliminated from the final study. Of the 42 remaining articles, 6 were rated as class 1 evidence; 11 were rated as class 2 evidence and 25 were rated as class 3 evidence. In this article - the first in a series of two - the background and the methods utilized by the MAD committee's activities are described, as well as the results for the review of the literature on efficacy. Of the 21 articles related to efficacy, five were identified as Class 1 evidence; 4 were identified as Class 2 evidence; and 12 were identified as Class 3. Overall, the committee reached consensus that the MAD procedures using the Activator were as effective as manual (HVLA) procedures in producing clinical benefit and biological change. A minority report was also written, arguing that there was not enough evidence to support or refute the efficacy of MADs.

Exponential Gain and Saturation of a Self-Amplified Spontaneous Emission Free-Electron Laser

Self-amplified spontaneous emission in a free-electron laser has been proposed for the generation of very high brightness coherent x-rays. This process involves passing a high-energy, high-charge, short-pulse, low-energy-spread, and low-emittance electron beam through the periodic magnetic field of a long series of high-quality undulator magnets. The radiation produced grows exponentially in intensity until it reaches a saturation point. We report on the demonstration of self-amplified spontaneous emission gain, exponential growth, and saturation at visible (530 nanometers) and ultraviolet (385 nanometers) wavelengths. Good agreement between theory and simulation indicates that scaling to much shorter wavelengths may be possible. These results confirm the physics behind the self-amplified spontaneous emission process and forward the development of an operational x-ray free-electron laser.

TGFbeta is active, and correlates with activators of TGFbeta, following porcine coronary angioplasty

OBJECTIVE

Restenosis following angioplasty involves processes that may be influenced by local production of cytokines. We investigated the expression of active and total transforming growth factor beta (TGFbeta) following porcine coronary angioplasty (PTCA), and have correlated this with the expression of potential in vivo activators of TGFbeta: mannose-6-phosphate/insulin-like growth factor-II (M6P/IGF-II) receptor and thrombospondin-1.

METHODS

Oversized porcine PTCA was performed and the arteries excised after selected intervals. Levels of in situ active and total (active plus latent) TGFbeta were determined using a modified plasminogen activator-inhibitor/luciferase bioassay.

RESULTS

Levels of active TGFbeta significantly increased 2 h to 7 days after angioplasty, compared to non-injured controls. Levels returned to baseline by 28 days. Active TGFbeta in tissues adjacent to the injured artery did not change. Total TGFbeta was significantly higher than controls 2-6 h after injury. M6P/IGF-II receptor mRNA was upregulated between 6 h and 3 days after injury, with protein detectable at 3-28 days. Thrombospondin-1 was detected between 1 h and 14 days.

CONCLUSIONS

We conclude that balloon injury causes an early rapid increase in levels of active TGFbeta, that correlates with the expression of TGFbeta activators. Thus, TGFbeta is a good potential target for anti-restenotic therapies.

Observation of self-amplified spontaneous emission and exponential growth at 530 nm

Experimental evidence for self-amplified spontaneous emission (SASE) at 530 nm is reported. The measurements were made at the low-energy undulator test line facility at the Advanced Photon Source, Argonne National Laboratory. The experimental setup and details of the experimental results are presented, as well as preliminary analysis. This experiment extends to shorter wavelengths the operational knowledge of a linac-based SASE free-electron laser and explicitly shows the predicted exponential growth in intensity of the optical pulse as a function of length along the undulator.

p38 Mitogen-activated protein kinase mediates the transcriptional induction of the atrial natriuretic factor gene through a serum response element. A potential role for the transcription factor ATF6

In various cell types certain stresses can stimulate p38 mitogen-activated protein kinase (p38 MAPK), leading to the transcriptional activation of genes that contribute to appropriate compensatory responses. In this report the mechanism of p38-activated transcription was studied in cardiac myocytes where this MAPK is a key regulator of the cell growth and the cardiac-specific gene induction that occurs in response to potentially stressful stimuli. In the cardiac atrial natriuretic factor (ANF) gene, a promoter-proximal serum response element (SRE), which binds serum response factor (SRF), was shown to be critical for ANF induction in primary cardiac myocytes transfected with the selective p38 MAPK activator, MKK6 (Glu). This ANF SRE does not possess sequences typically required for the binding of the Ets-related ternary complex factors (TCFs), such as Elk-1, indicating that p38-mediated induction through this element may take place independently of such TCFs. Although p38 did not phosphorylate SRF in vitro, it efficiently phosphorylated ATF6, a newly discovered SRF-binding protein that is believed to serve as a co-activator of SRF-inducible transcription at SREs. Expression of an ATF6 antisense RNA blocked p38-mediated ANF induction through the ANF SRE. Moreover, when fused to the Gal4 DNA-binding domain, an N-terminal 273-amino acid fragment of ATF6 was sufficient to support trans-activation of Gal4/luciferase expression in response to p38 but not the other stress kinase, N-terminal Jun kinase (JNK); p38-activating cardiac growth promoters also stimulated ATF6 trans-activation. These results indicate that through ATF6, p38 can augment SRE-mediated transcription independently of Ets-related TCFs, representing a novel mechanism of SRF-dependent transcription by MAP kinases.

Localization of the gene for familial primary pulmonary hypertension to chromosome 2q31-32

Primary pulmonary hypertension (PPH), an often fatal disease, is characterized by elevated pulmonary artery pressures in the absence of a secondary cause. Endovascular occlusion in the smallest pulmonary arteries occurs by proliferation of cells and matrix, with thrombus and vasospasm. Diagnosis is often delayed because the initial symptoms of fatigue and dyspnea on exertion are nonspecific and definitive diagnosis requires invasive procedures. The average life expectancy after diagnosis is two to three years with death usually due to progressive right heart failure. The aetiology of the disease is unknown. Although most cases appear to be sporadic, approximately 6% of cases recorded in the NIH Primary Pulmonary Hypertension Registry are inherited in an autosomal dominant manner with reduced penetrance. Following a genome-wide search using a set of highly polymorphic short tandem repeat (STR) markers and 19 affected individuals from six families, initial evidence for linkage was obtained with two chromosome 2q markers. We subsequently genotyped patients and all available family members for 19 additional markers spanning approximately 40 centiMorgans (cM) on the long arm of chromosome 2. We obtained a maximum two-point lod score of 6.97 at theta = 0 with the marker D2S389; multipoint linkage analysis yielded a maximum lod score of 7.86 with the marker D2S311. Haplotype analysis established a minimum candidate interval of approximately 25 cM.

Linkage of combined factors V and VIII deficiency to chromosome 18q by homozygosity mapping

Combined Factors V and VIII deficiency is an autosomal recessive bleeding disorder identified in at least 58 families comprising a number of different ethnic groups. Affected patients present with a moderate bleeding tendency and have Factor V and Factor VIII levels in the range of 5-30% of normal. The highest frequency of the mutant gene is found in Jews of Sephardic and Middle Eastern origin living in Israel with an estimated disease frequency of 1:100,000. We sought to identify the gene responsible for combined Factors V and VIII deficiency using a positional cloning approach. Of 14 affected individuals from 8 unrelated Jewish families, 12 were the offspring of first-cousin marriages. After a genome-wide search using 241 highly polymorphic short tandem repeat (STR) markers, 13 of the 14 affected patients were homozygous for two closely linked 18q markers. Patients and all available family members were genotyped for 11 additional STRs spanning approximately 11 cM on the long arm of chromosome 18. Multipoint linkage analysis yielded a maximal log of the odds (LOD) score of 13.22. Haplotype analysis identified a number of recombinant individuals and established a minimum candidate interval of 2.5 cM for the gene responsible for combined Factors V and VIII deficiency. The product of this locus is likely to operate at a common step in the biosynthetic pathway for these two functionally and structurally homologous coagulation proteins. Identification of this gene should provide new insight into the biology of Factor V and Factor VIII production.

Polymorphism of adhesion molecule CD31 is not a significant risk factor for graft-versus-host disease

Mismatch between bone marrow transplant (BMT) patient and donor for an amino acid polymorphism within the adhesion molecule CD31 has recently been reported to increase risk for the development of graft-versus-host disease (GVHD). We further examined this association in a larger series of 301 BMT patients (227 with grade III/IV GVHD and 74 with grade 0 GVHD) and their HLA-identical sibling donors. CD31 genotypes were determined by polymerase chain reaction and restriction endonuclease digestion. The role of mismatch at the CD31 locus in the development of GVHD was assessed by analyzing the extent of CD31 identity and CD31 compatibility among the grade 0 GVHD and grade III/IV GVHD sibling pairs. No significant association between CD31 mismatch and the development of severe GVHD was detected in our overall patient population. Sixty-three percent of grade III/IV GVHD sibling pairs and 69% of grade 0 GVHD sibling pairs had CD31 genotypes that were identical (P = .36, odds ratio = 1.30). In addition, neither the grade 0 GVHD group (P = .10) nor the grade III/IV GVHD group (P = .27) differed significantly from the expected probability of identity between sibling pairs. Mismatch at the CD31 polymorphism between recipients and donors showed no consistent association with the development of GVHD. Current evidence does not support the value of CD31 mismatch in the selection of BMT donors.