Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

A comparative meta-proteomic pipeline for the identification of plasmodesmata proteins and regulatory conditions in diverse plant species

BACKGROUND

A major route for cell-to-cell signalling in plants is mediated by cell wall-embedded pores termed plasmodesmata forming the symplasm. Plasmodesmata regulate the plant development and responses to the environment; however, our understanding of what factors or regulatory cues affect their structure and permeability is still limited. In this paper, a meta-analysis was carried out for the identification of conditions affecting plasmodesmata transport and for the in silico prediction of plasmodesmata proteins in species for which the plasmodesmata proteome has not been experimentally determined.

RESULTS

Using the information obtained from experimental proteomes, an analysis pipeline (named plasmodesmata in silico proteome 1 or PIP1) was developed to rapidly generate candidate plasmodesmata proteomes for 22 plant species. Using the in silico proteomes to interrogate published transcriptomes, gene interaction networks were identified pointing to conditions likely affecting plasmodesmata transport capacity. High salinity, drought and osmotic stress regulate the expression of clusters enriched in genes encoding plasmodesmata proteins, including those involved in the metabolism of the cell wall polysaccharide callose. Experimental determinations showed restriction in the intercellular transport of the symplasmic reporter GFP and enhanced callose deposition in Arabidopsis roots exposed to 75-mM NaCl and 3% PEG (polyethylene glycol). Using PIP1 and transcriptome meta-analyses, candidate plasmodesmata proteins for the legume Medicago truncatula were generated, leading to the identification of Medtr1g073320, a novel receptor-like protein that localises at plasmodesmata. Expression of Medtr1g073320 affects callose deposition and the root response to infection with the soil-borne bacteria rhizobia in the presence of nitrate.

CONCLUSIONS

Our study shows that combining proteomic meta-analysis and transcriptomic data can be a valuable tool for the identification of new proteins and regulatory mechanisms affecting plasmodesmata function. We have created the freely accessible pipeline PIP1 as a resource for the screening of experimental proteomes and for the in silico prediction of PD proteins in diverse plant species.

Plasmodesmata Structural Components and Their Role in Signaling and Plant Development

Plasmodesmata are plant intercellular channels that mediate the transport of small and large molecules including RNAs and transcription factors (TFs) that regulate plant development. In this review, we present current research on plasmodesmata form and function and discuss the main regulatory pathways. We show the progress made in the development of approaches and tools to dissect the plasmodesmata proteome in diverse plant species and discuss future perspectives and challenges in this field of research.

Plasma Membrane-Associated Receptor-like Kinases Relocalize to Plasmodesmata in Response to Osmotic Stress

Plasmodesmata act as key elements in intercellular communication, coordinating processes related to plant growth, development, and responses to environmental stresses. While many of the developmental, biotic, and abiotic signals are primarily perceived at the plasma membrane (PM) by receptor proteins, plasmodesmata also cluster receptor-like activities; whether these two pathways interact is currently unknown. Here, we show that specific PM-located Leu-rich-repeat receptor-like-kinases, Qiān Shŏu kinase (QSK1) and inflorescence meristem kinase2, which under optimal growth conditions are absent from plasmodesmata, rapidly relocate and cluster to the pores in response to osmotic stress. This process is remarkably fast, is not a general feature of PM-associated proteins, and is independent of sterol and sphingolipid membrane composition. Focusing on QSK1, previously reported to be involved in stress responses, we show that relocalization in response to mannitol depends on QSK1 phosphorylation. Loss-of-function mutation in QSK1 results in delayed lateral root (LR) development, and the mutant is affected in the root response to mannitol stress. Callose-mediated plasmodesmata regulation is known to regulate LR development. We found that callose levels are reduced in the qsk1 mutant background with a root phenotype resembling ectopic expression of PdBG1, an enzyme that degrades callose at the pores. Both the LR and callose phenotypes can be complemented by expression of wild-type and phosphomimic QSK1 variants, but not by phosphodead QSK1 mutant, which fails to relocalize at plasmodesmata. Together, the data indicate that reorganization of receptor-like-kinases to plasmodesmata is important for the regulation of callose and LR development as part of the plant response to osmotic stress.

Callose-Regulated Symplastic Communication Coordinates Symbiotic Root Nodule Development

The formation of nitrogen-fixing nodules in legumes involves the initiation of synchronized programs in the root epidermis and cortex to allow rhizobial infection and nodule development. In this study, we provide evidence that symplastic communication, regulated by callose turnover at plasmodesmata (PD), is important for coordinating nodule development and infection in Medicago truncatula. Here, we show that rhizobia promote a reduction in callose levels in inner tissues where nodules initiate. This downregulation coincides with the localized expression of M. truncatula β-1,3-glucanase 2 (MtBG2), encoding a novel PD-associated callose-degrading enzyme. Spatiotemporal analyses revealed that MtBG2 expression expands from dividing nodule initials to rhizobia-colonized cortical and epidermal tissues. As shown by the transport of fluorescent molecules in vivo, symplastic-connected domains are created in rhizobia-colonized tissues and enhanced in roots constitutively expressing MtBG2. MtBG2-overexpressing roots additionally displayed reduced levels of PD-associated callose. Together, these findings suggest an active role for MtBG2 in callose degradation and in the formation of symplastic domains during sequential nodule developmental stages. Interfering with symplastic connectivity led to drastic nodulation phenotypes. Roots ectopically expressing β-1,3-glucanases (including MtBG2) exhibited increased nodule number, and those expressing MtBG2 RNAi constructs or a hyperactive callose synthase (under symbiotic promoters) showed defective nodulation phenotypes. Obstructing symplastic connectivity appears to block a signaling pathway required for the expression of NODULE INCEPTION (NIN) and its target NUCLEAR FACTOR-YA1 (NF-YA1) in the cortex. We conclude that symplastic intercellular communication is proactively enhanced by rhizobia, and this is necessary for appropriate coordination of bacterial infection and nodule development.

Emerging models on the regulation of intercellular transport by plasmodesmata-associated callose

The intercellular transport of molecules through membranous channels that traverse the cell walls-so-called plasmodesmata-is of fundamental importance for plant development. Regulation of plasmodesmata aperture (and transport capacity) is mediated by changes in the flanking cell walls, mainly via the synthesis/degradation (turnover) of the (1,3)-β-glucan polymer callose. The role of callose in organ development and in plant environmental responses is well recognized, but detailed understanding of the mechanisms regulating its accumulation and its effects on the structure and permeability of the channels is still missing. We compiled information on the molecular components and signalling pathways involved in callose turnover at plasmodesmata and, more generally, on the structural and mechanical properties of (1,3)-β-glucan polymers in cell walls. Based on this revision, we propose models integrating callose, cell walls, and the regulation of plasmodesmata structure and intercellular communication. We also highlight new tools and interdisciplinary approaches that can be applied to gain further insight into the effects of modifying callose in cell walls and its consequences for intercellular signalling.

Cardiac T2* magnetic resonance for prediction of cardiac complications in thalassemia major

BACKGROUND

The goal of this study was to determine the predictive value of cardiac T2* magnetic resonance for heart failure and arrhythmia in thalassemia major.

METHODS AND RESULTS

We analyzed cardiac and liver T2* magnetic resonance and serum ferritin in 652 thalassemia major patients from 21 UK centers with 1442 magnetic resonance scans. The relative risk for heart failure with cardiac T2* values <10 ms (compared with >10 ms) was 160 (95% confidence interval, 39 to 653). Heart failure occurred in 47% of patients within 1 year of a cardiac T2* <6 ms with a relative risk of 270 (95% confidence interval, 64 to 1129). The area under the receiver-operating characteristic curve for predicting heart failure was significantly greater for cardiac T2* (0.948) than for liver T2* (0.589; P<0.001) or serum ferritin (0.629; P<0.001). Cardiac T2* was <10 ms in 98% of scans in patients who developed heart failure. The relative risk for arrhythmia with cardiac T2* values <20 ms (compared with >20 ms) was 4.6 (95% confidence interval, 2.66 to 7.95). Arrhythmia occurred in 14% of patients within 1 year of a cardiac T2* of <6 ms. The area under the receiver-operating characteristic curve for predicting arrhythmia was significantly greater for cardiac T2* (0.747) than for liver T2* (0.514; P<0.001) or serum ferritin (0.518; P<0.001). The cardiac T2* was <20 ms in 83% of scans in patients who developed arrhythmia.

CONCLUSIONS

Cardiac T2* magnetic resonance identifies patients at high risk of heart failure and arrhythmia from myocardial siderosis in thalassemia major and is superior to serum ferritin and liver iron. Using cardiac T2* for the early identification and treatment of patients at risk is a logical means of reducing the high burden of cardiac mortality in myocardial siderosis. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00520559.

African Leadership

This article provides an account of meanings and connotations of `African leadership' emerging from research with a cohort of participants on a Pan-African leadership development programme. We begin by reviewing current approaches to leadership, and how they have been applied to the study of leadership and management across cultures, before introducing the notion of the `African renaissance', which calls for a re-engagement with indigenous knowledge and practices. The findings from our study indicate a tension between accounts and representations of leadership and the potential for leadership development to act as a forum in which participants can work through these issues. In developing an Afro-centric perspective on leadership, we propose that development activities that promote relational, critical and constructionist perspectives on leadership, with an emphasis on dialogue and sharing experience, could be an important means for surfacing new insights and understandings. In particular, they offer a mechanism by which participants can enhance their sense of `self in community', generate shared understandings, challenge repressive power relations, and develop culturally appropriate forms of leadership behaviour. We conclude by proposing that further research is required on leadership in Africa that steps outside dominant methodological and empirical paradigms, and argue that such work holds great potential for generating insights not just relevant to leadership in Africa but to leadership studies in general.

CD147 is tightly associated with lactate transporters MCT1 and MCT4 and facilitates their cell surface expression

CD147 is a broadly expressed plasma membrane glycoprotein containing two immunoglobulin-like domains and a single charge-containing transmembrane domain. Here we use co-immunoprecipitation and chemical cross-linking to demonstrate that CD147 specifically interacts with MCT1 and MCT4, two members of the proton-linked monocarboxylate (lactate) transporter family that play a fundamental role in metabolism, but not with MCT2. Studies with a CD2-CD147 chimera implicate the transmembrane and cytoplasmic domains of CD147 in this interaction. In heart cells, CD147 and MCT1 co-localize, concentrating at the t-tubular and intercalated disk regions. In mammalian cell lines, expression is uniform but cross-linking with anti-CD147 antibodies caused MCT1, MCT4 and CD147, but not GLUT1 or MCT2, to redistribute together into 'caps'. In MCT-transfected cells, expressed protein accumulated in a perinuclear compartment, whereas co-transfection with CD147 enabled expression of active MCT1 or MCT4, but not MCT2, in the plasma membrane. We conclude that CD147 facilitates proper expression of MCT1 and MCT4 at the cell surface, where they remain tightly bound to each other. This association may also be important in determining their activity and location.

Chainsaw size for delimbing

New Zealand loggers commonly use chainsaws weighing up to 10 kg. Chainsaw work is both physically arduous and potentially dangerous. A contributing factor to the high injury rate of loggers could be the high physiological and biomechanical load of chainsaw work. This study investigated the comparative cardiovascular strain imposed on 11 chainsaw operators when delimbing (cutting branches) with chainsaws of small, medium and large capacity under controlled conditions. Chainsaw operator cardiovascular strain increased with greater chainsaw weight and was associated with two chainsaw operator anthropometric dimensions (arm length and bent elbow height).

Information and patient participation in screening for prostate cancer

The purpose of this study was to determine if providing men with information about screening for prostate cancer would enable them to assume a more active role in decision making with their family physician, and lower levels of anxiety and decisional conflict. Men were recruited from one family medical clinic in Winnipeg, Manitoba. One hundred men scheduled for a periodic health examination (PHE) were randomly assigned to receive verbal and written information either prior to the PHE, or following the second interview. Men completed measures of preferred decisional role and anxiety prior to the PHE; and assumed decisional role, decisional conflict, and anxiety post PHE. Results demonstrated that men who received the information prior to the PHE assumed a significantly more active role in making a screening decision, and had lower levels of decisional conflict post PHE. The two groups did not differ with regard to levels of state anxiety. Providing men with information enables them to make informed screening decisions with their family physicians.

Development of a soy food frequency questionnaire to estimate isoflavone consumption in US adults

OBJECTIVE

To develop a dietary assessment instrument to measure soy food consumption and isoflavone intake and test it for reliability.

DESIGN

A soy food frequency questionnaire, designed for use in this study, was administered twice to participants, separated by a 2-week interval. The questionnaire was tested for reproducibility of estimates of soy food consumption and isoflavone (genistein and daidzein) intake.

SUBJECTS/SETTING

A convenience sample of 51 faculty, staff, and students was recruited from a naturopathic university.

STATISTICAL ANALYSES PERFORMED

Intraclass correlation coefficients were used to assess reproducibility of estimates of soy food intake and genistein and daidzein intake.

RESULTS

Correlation coefficients comparing mean soy food servings per month between the 2 administrations of the questionnaire ranged from 0.50 for soy yogurt to 0.89 for tempeh. Correlation coefficients for genistein and daidzein intake estimated by the 2 administrations of the questionnaire were the same: 0.89. Mean intake (+/- standard deviation) of genistein and daidzein was 7 +/- 10 and 4 +/- 6 mg/day, respectively. Fifteen soy foods contributed 95% of the total genistein and daidzein intake: tofu, soy yogurt, tempeh, soy milk, low-fat tofu, soy flour, miso, soy protein isolate, low-fat soy milk, veggie soy burger, textured vegetable protein, miso soup, cooked soybeans, soy hot dogs, and natto (fermented soy beans).

APPLICATIONS

The soy food frequency questionnaire developed in this study provided highly reproducible estimates of soy food consumption and isoflavone intake. This instrument may be a useful tool in studies of the associations between isoflavone exposure and risk for chronic disease.

Use of an international faculty/student exchange program as a process to establish and improve graduate education and research within an allied health discipline

It has been recognized in the allied health professions that allied health disciplines must enhance and increase their research and scholarly activity. If faculty/staff are to be judged in the academic environment in which they work, their efforts to conduct research must be supported. Recognition for academic scholarship measured by the performance of research and scholarly activity is often difficult for faculty/staff to attain because of increased demands for scheduled time devoted to classroom instruction and student advising. This inability for faculty/staff to engage in research and scholarly activity often is enhanced by the lack of proper and adequate facilities and equipment. Also important is the role of graduate education, which itself, provides a stimulus for the performance of research and scholarly activity. This article reports outcomes achieved by an international faculty/staff-student program that provides an opportunity for faculty/staff and students within an allied health discipline to conduct research and scholarly activity. This program could serve as a model to identify the strengths and benefits that can be achieved by such programs. This program is capable of improving the research and scholarly activity of all academic units within an allied health discipline.

Inclusive dielectron cross sections in p + p and p + d interactions at beam energies from 1.04 to 4.88 GeV

Measurements of dielectron production in p + p and p + d collisions with beamkinetic energies from 1.04 to 4.88 GeV are presented. The differential cross section is presented as a function of invariant pair mass, transverse momentum, and rapidity. The shapes of the mass spectra and their evolution with beam energy provide information about the relative importance of the various dielectron production mechanisms in this energy regime. The p + d to p + p ratio of the dielectron yield is also presented as a function of invariant pair mass, transverse momentum, and rapidity. The shapes of the transverse momentum and rapidity spectra from the p + d and p + p systems are found to be similar to one another for each of the beam energies studied. The beam energy dependence of the integrated cross sections is also presented.

Needs-based planning: the case of Manitoba

OBJECTIVE

To illustrate the use of needs-based planning in the identification of physician surpluses and deficits and of resource misallocations within a provincial medical system at a time when provincial governments and medical associations across the country are faced with funding constraints for physician services.

DESIGN

For each of 4 regions in Manitoba, the authors analysed residents' rates of physician visits (whether within the resident's own or another region). Residents' need for physician contact was estimated by means of a statistical analysis of the data on contacts in relation to age, sex and health-related indicators, and the rates of visits needed and actually made were compared.

PARTICIPANTS

All Manitoba residents.

OUTCOME MEASURES

Numbers of generalist physicians (general practitioners, family physicians, general internists and general pediatricians) needed to serve each region, and the extent of physician surplus and deficit in each region.

RESULTS

There appeared to be a surplus of physicians in most of urban Manitoba but deficits in northern Manitoba and some parts of the rural south. General internists and general pediatricians in Winnipeg provide a significant part of the ambulatory care that is provided by general practitioners in other parts of the province. The provincial government currently spends more per resident to provide physician services in areas of physician surplus than in areas of physician deficit, although the patterns are inconsistent.

CONCLUSIONS

Needs-based planning is possible. If provinces are intent on controlling physician numbers and expenditures, it makes sense to manage the implications of doing so.

Testing the relative conspicuity of safety garments for New Zealand forestry workers

The relative conspicuities of six test garments (fluorescent orange, green/red, high-contrast, fluorescent lime-yellow, white, black) were assessed to guide the selection process of a standard upper body safety garment to be used within the New Zealand logging industry. Six male and four female participants, aged between 18 and 26 years, volunteered to perform 10 trials each on a demanding, central (tracking) task, while peripherally searching colour slides for test garments displayed on each of eight positions, against a pine forest background typically found in the New Zealand forestry. During each trial, transparency luminance was first gradually increased from darkness to daylight and then decreased to darkness again within 180 s. A head mounted ASL eye tracking system (4000SU) recorded the eye line of gaze for each participant, enabling a rank order of detection to be obtained for the tested garments in each trial. The fluorescent lime-yellow, fluorescent orange and white test garments were detected earlier than any other test garments across all trials, and the fluorescent lime-yellow test garment was detected first with a higher frequency than the white test garment. It was concluded that while white may be the most visible colour in near darkness conditions, as it provides highest contrast, fluorescent lime-yellow stands out better in twilight and daylight conditions against the pine forest background. The results of this study led to the promotion of fluorescent lime-yellow as the standard safety colour used in upper body garments within the New Zealand forest industry.

Relationships between disability measures and nursing effort during medical rehabilitation for patients with traumatic brain and spinal cord injury

OBJECTIVE

The increasing use of disability measures requires that the validity of these instruments be adequately demonstrated. This study sought to evaluate the concurrent validity of one disability measure, the Functional Independence Measure (FIMSM) using minutes of care reported by nursing staff.

STUDY DESIGN

Correlational, cohort design.

SETTING

Eight inpatient medical rehabilitation hospitals that subscribe to the Uniform Data System for Medical Rehabilitation.

PATIENTS OR OTHER PARTICIPANTS

129 patients with traumatic brain injury (TBI) and 53 patients with traumatic spinal cord injury (SCI).

INTERVENTIONS

Routine rehabilitation care.

MAIN OUTCOME MEASURES

Patient-nurse contact times were recorded with a stop watch for a 24-hour period during the first and last weeks of inpatient rehabilitation. The FIM was also completed during the first and last weeks of rehabilitation.

RESULTS

Contact times declined from the first to last weeks of rehabilitation, concurrent with improving scores on motor and cognitive measures derived from the FIM. Statistically significant correlations between contact times and FIM measures were observed for medication dispensing, treatment provision, and teaching/activities of daily living at admission and discharge. Smaller and usually nonsignificant correlations were observed in activities that did not involve direct patient contact. Contact times increased exponentially as disability increased.

CONCLUSIONS

These results support the construct validity of the FIM by demonstrating strong relationships (r values in the range of .40 to .60) between burden of care and a measure of disability.

Recognizing antiphospholipid syndrome. Case report: misdiagnosis delayed treatment

Family physicians should be aware of antiphospholipid syndrome, a rare and recently described disorder, but one that can be treated successfully. Physicians should have a high degree of suspicion in patients with thrombotic symptoms if they are to detect and treat this condition early.

Measuring the effectiveness of a pilot continuing medical education program

OBJECTIVE

To evaluate a learner-centred, small group CME program intended to improve the clinical performance of family physicians identified as having serious practice deficiencies by the University of Manitoba's Clinical Assessment and Enhancement Program.

DESIGN

Nonrandomized control trial in which data were collected from patients' charts and physician performance was evaluated. Differences in subjects' scores were tested at program entry and at 6 months and 18 months later using a two-way analysis of variance.

SETTING

Family medicine practices in Manitoba.

PARTICIPANTS

Fifteen family physicians: five study subjects and 10 control subjects. The five study subjects were identified as needing CME to improve their clinical performance. The 10 control subjects were randomly selected.

INTERVENTIONS

Participants attended a 10-session, learner-centred, small group CME program.

MAIN OUTCOME MEASURES

Clinical care, preventive care, charting, and the use of drugs were the variables assessed.

RESULTS

Study subjects' initial scores were much lower than those of controls, but improved significantly during the CME program.

CONCLUSION

A learner-centred, small group CME program can improve clinical performance.

Mixed anxiety-depression in a primary-care clinic

To determine the prevalence and clinical significance of a mixed anxiety-depressive (MAD) syndrome in primary care, a two-stage sampling design was applied to 796 consecutive clinic attendees without known psychiatric illness. Among 78 systematically interviewed subjects, 10.3% (n = 8) had a depressive disorder alone, 12.8% (n = 10) had an anxiety disorder alone, 19.2% (n = 15) had a comorbid anxiety and depressive disorder and 12.8% (n = 10) had a combination of subsyndromal anxiety and depressive features that fulfilled either ICD-10 or our own operational criteria for MAD. Patients with MAD rated their disability as being comparable to that of patients with anxiety or depressive disorders. These findings lend support to the notion that there is a sizeable subgroup of patients in primary care who appear to be suffering from a psychiatric syndrome with an admixture of subsyndromal depressive and anxiety features. Questions about the temporal stability of MAD and preferred approaches to treatment have yet to be answered.

Value of a second freeze-thaw cycle in cryotherapy of common warts

A study of open, randomized, parallel-group design was performed to investigate the impact of a second freeze-thaw cycle on the cure rate, at 3 months, from cryotherapy of common warts on the hands and feet. Cryotherapy was performed at 3-week intervals, and subjects were randomized to receive either one or two freeze-thaw cycles. In addition, all subjects used keratolytic wart paints throughout the study, and plantar warts were pared prior to freezing. Three hundred subjects were recruited. At 3 months, 124 were cured, 83 were not cured, and 93 had defaulted. Among those who did not default the cure rate was 57% from the single freeze technique, and 62% from the double freeze technique, a difference of 5% (P = 0.53, 95% CI-8.1-18.6). Separate analyses for subjects with warts on the hands and on the feet demonstrated no effect of double freezing on hand warts. In contrast, for plantar warts, the cure rate was 41% from single freezing and 65% for double freezing, a difference of 24% (P = 0.04, 95% CI 2.9-44.4). The use of a double freeze-thaw cycle confers little or no advantage over a single freeze in the treatment of hand warts, but may be considerably more effective for plantar warts.

The effect of spiked boots on logger safety, productivity and workload

Analysis of 1657 lost-time logging accidents in the New Zealand logging industry (1985-1991) indicates that 17.5% were as a result of slips, trips and falls and a total of 2870 days were lost. Most (56%) of these slipping, tripping and falling accidents occurred in the felling and delimbing phase of the logging operation, where 37% of the workforce are employed. In an attempt to reduce the number of slipping injuries to loggers employed in felling and delimbing, a study of the effectiveness of spike-soled (caulk) boots was undertaken. Four loggers were intensively observed at work, by continuous time-study methods, while wearing their conventional rubber-soled boots and then spike-soled boots. The number of slips, work methods used, physiological workload and productivity were compared for loggers wearing the two footwear types. Results indicated that spike-soled boots were associated with a significant reduction in the frequency of slips and had no adverse effect on work methods, physiological workload or productivity. Spike-soled boots are now being promoted for use by loggers in New Zealand as a simple method to reduce slipping, tripping and falling accidents.

Earmuff effectiveness against chainsaw noise over a 12-month period

A study measuring the ability of new Peltor H7P3 Grade 4 helmet-mounted earmuffs to reduce the level of chainsaw noise reaching forestry workers' ears was undertaken over a one-year period. The objective was to establish effective replacement guidelines for earmuffs. The results showed that the earmuffs provided effective hearing protection for the subjects over the one-year test period. There were no statistically significant changes in field attenuation levels during the first 9 months. While the following three-month period (9-12 months) did experience a significant 3 dB(A) decrease, mean inside microphone noise level measured at the 12-month stage was 78.8 +/- 3.0 dB(A). This level is well under the damage risk criterion of Leq (8 hour) not exceeding 85 dB(A). It was noted during the study that a large proportion of the earmuffs would normally have been replaced before the 12-month stage owing to the discomfort associated with cushion deterioration. Results suggest that Peltor H7P3 grade 4 helmet-mounted earmuffs could be safely used as an effective form of chainsaw noise protection in a production forestry environment for a maximum period of 12 months before cushion replacement.

Management of recurrent dislocation of the patella following total knee arthroplasty

Fifteen knees with patellar dislocation after total knee arthroplasty had realignment of the extensor mechanism using a modification of the Trillat procedure. The onset of dislocation occurred on average 4.7 months from the time of surgery. After total knee arthroplasty the patients had an average range of motion of 109 degrees. All patients had medialization of the tibial tubercle and lateral release. No patient had a recurrent dislocation after a minimum 2-year follow-up period. The average knee score was 82 and the average flexion arc was 112 degrees. All but one of the osteotomies healed uneventfully.

The usefulness of MRI in evaluating menisci after meniscus repair

We reviewed magnetic resonance imaging (MRI) scans of 15 asymptomatic patients at 6 months to 1 year following meniscal repair procedures. All of the patients were found to have persistent MRI signals in the region of the repair. Nine of the 17 meniscal repairs in the 15 patients had persistent grade 3 signals. Arthrograms were performed on six patients (eight meniscal repairs). Seven of these postoperative menisci showed grade 3 signals on MRI. Only one meniscus was shown to have a complete tear by arthrogram. There were no false negative scans. The overall accuracy, defined as the percentage of postoperative menisci correctly diagnosed by MRI, was 38% (3/8). MRI is a useful preoperative diagnostic study following knee injury. This report demonstrates, however, that present MRI modalities are unable to distinguish between scar tissue of healed meniscal repairs and meniscal tears. Therefore, it is not a useful diagnostic tool in evaluating reinjury following successful meniscal repair.

The effect of methylprednisolone on lymphocyte phenotype and function in patients with multiple sclerosis

The extent to which symptomatic improvement in patients with multiple sclerosis treated with intravenous methylprednisolone depends on immunological actions of corticosteroids is unknown. In this study the effect of methylprednisolone on circulating T and B cell function has been assessed in vitro and in vivo. Low molar concentrations of methylprednisolone increased pokeweed mitogen-stimulated IgG synthesis by unfractionated lymphocytes in 20 patients with multiple sclerosis and 15 controls. Treatment with methylprednisolone was associated with increased IgG synthesis in a further cohort of 26 affected individuals although dose responsiveness to methylprednisolone was uninfluenced in these patients. Sequential concanavalin A-pokeweed mitogen-induced IgG synthesis by mononuclear cells was also stimulated by methylprednisolone. Phenotypic analysis of paired samples from 12 patients with multiple sclerosis, taken before and after treatment showed no alteration in CD4 or CD8 cells, their suppressor inducer or suppressor subpopulations or activated lymphocytes.