Novel Vitamin D3 Hydroxymetabolites Require Involvement of the Vitamin D Receptor or Retinoic Acid-Related Orphan Receptors for Their Antifibrogenic Activities in Human Fibroblasts

We investigated multiple signaling pathways activated by CYP11A1-derived vitamin D3 hydroxymetabolites in human skin fibroblasts by assessing the actions of these molecules on their cognate receptors and by investigating the role of CYP27B1 in their biological activities. The actions of 20(OH)D3, 20,23(OH)2D3, 1,20(OH)2D3 and 1,20,23(OH)3D3 were compared to those of classical 1,25(OH)2D3. This was undertaken using wild type (WT) fibroblasts, as well as cells with VDR, RORs, or CYP27B1 genes knocked down with siRNA. Vitamin D3 hydroxymetabolites had an inhibitory effect on the proliferation of WT cells, but this effect was abrogated in cells with silenced VDR or RORs. The collagen expression by WT cells was reduced upon secosteroid treatment. This effect was reversed in cells where VDR or RORs were knocked down where the inhibition of collagen production and the expression of anti-fibrotic genes in response to the hydroxymetabolites was abrogated, along with ablation of their anti-inflammatory action. The knockdown of CYP27B1 did not change the effect of either 20(OH)D3 or 20,23(OH)2D3, indicating that their actions are independent of 1α-hydroxylation. In conclusion, the expression of the VDR and/or RORα/γ receptors in fibroblasts is necessary for the inhibition of both the proliferation and fibrogenic activity of hydroxymetabolites of vitamin D3, while CYP27B1 is not required.

Association between glycaemic control and quality of life in diabetes mellitus

BACKGROUND

Relationship between quality of life (QOL) and haemoglobin A1c (HbA1c) amongst diabetics in the community setting is unclear.

AIMS

Assess the association between QOL and change in HbA1c in diabetic patients over one year.

SETTINGS AND DESIGN

Cohort study of patients from four community clinics in California, USA.

METHODS

Diabetic patients identified from databases using International Classification of Disease (ICD-9) codes were asked to complete Short Form 36 (SF-36), which measures health-related QOL, and invited to attend monthly diabetes workshops. From December 2000 to December 2001, data were collected on multiple parameters, including HbA1c. SF-36 surveys were re-collected at project termination.

STATISTICAL ANALYSIS

Regression analysis was used to correlate change in HbA1c with change in QOL physical component summary (PCS) and mental component summary (MCS) scores, while considering potential confounders.

RESULTS

Of 1679 eligible patients, 380 completed SF-36 at project initiation. 243 of those completed SF-36 at project termination. Pre and post HbA1c data were available for 170 of the 243 who completed SF-36 at both times. Average MCS increased by 8.46% and PCS decreased by 2.24%. After adjustment, a 5% decrease in HbA1c values was associated with a 1% increase in MCS. No association between changes in HbA1c and PCS was observed.

CONCLUSIONS

Association between better HbA1c and improved mental, but not physical, QOL may reflect physical inconvenience of increased regimen complexity and mental empowerment from proactive disease management. Larger cohort studies with longer follow-up are needed to further elucidate the relationship between glycemic control and QOL.

Effects of mercuric chloride on the regulation of expression of the acute phase response components alpha(1)-acid glycoprotein and C/EBP transcription factors

We have previously shown that in response to treatment with HgCl(2), the adult mouse liver exhibits both transcriptional and translational regulation of the acute phase response genes. In this study we asked whether the heavy metal treatment affects the regulation of the C/EBP transcription factors which play a key role in regulation of the acute phase response gene. Our studies have shown that the AGP gene is transcriptionally activated while transcription of the CCAAT/enhancer-binding trans-activating protein (C/EBP)alpha gene is slightly down-regulated and that of the C/EBPbeta gene does not respond. Both the C/EBPalpha and C/EBPbeta mRNAs produce multiple isoforms possibly by alternative translation initiation (ATI) of multiple internal AUG initiation sites. The C/EBPbeta mRNA appears to be stabilized. Although similar regulatory processes occur in response HgCl(2) vs. LPS, our data suggest that the translational processes (ATI) are differentially affected. In addition, a major difference lies in the fact that the C/EBPbeta gene is not transcriptionally activated by HgCl(2). Our data show decreased binding activity and pool levels of the C/EBPalpha isoform (p42(C/EBPalpha)) and increased binding activity and pool levels of C/EBPbeta isoform (p35(C/EBPbeta)) in response to HgCl(2). We propose that this isoform may be involved in the regulation of AGP gene expression in response to heavy metals and that there is a significant difference between the HgCl(2)-mediated and LPS-mediated inflammatory response.

Changes in steroid hormone profiles and ovarian histology during salmon pituitary-induced vitellogenesis and ovulation in female New Zealand longfinned eels, Anguilla dieffenbachii gray

To assess whether induced vitellogenesis in longfinned eels mimics that in naturally maturing conspecifics, female eels were artificially matured and steroid hormone status and oocyte cytology during oogenesis were evaluated. Successful induction of vitellogenesis was evident from the presence of yolk granules in the ooplasm of salmon pituitary homogenate (SPH)-injected, but not saline-, 17-hydroxyprogesterone-, and/or gonadotropin-releasing hormone-treated fish. In SPH-treated females, the migratory nucleus stage was reached after 33-53 days, followed by ovulation around 30 hours after induction of final maturation and ovulation. Only a portion of the germ cells matured, although resumption of vitellogenesis was seen in the majority of oocytes. In contrast, in ovaries of saline-injected controls, the most advanced oocytes were early vitellogenic. Atretic follicles were observed in ovaries of all eels, but abundance was greater in controls than in SPH-treated fish. SPH injections elevated plasma levels of estradiol-17beta and androgens, but not pregnenes, from within three days of treatment. Our results indicate that sex steroid levels in midvitellogenic hormone-treated females are similar to those in wild midvitellogenic females. In contrast, differences in yolk morphology of midvitellogenic follicles were seen between SPH-treated and wild females, especially in the second crop of midvitellogenic-sized oocytes measuring 300-400 microm in diameter. We discuss whether the observed differences affect egg quality, and perhaps explain the short life span of captive-bred eel larvae. J. Exp. Zool. 289:119-129, 2001.

Effects of age on the posttranscriptional regulation of CCAAT/enhancer binding protein alpha and CCAAT/enhancer binding protein beta isoform synthesis in control and LPS-treated livers

The CCAAT/enhancer binding protein alpha (C/EBPalpha) and CCAAT/enhancer binding protein beta (C/EBPbeta) mRNAs are templates for the differential translation of several isoforms. Immunoblotting detects C/EBPalphas with molecular masses of 42, 38, 30, and 20 kDa and C/EBPbetas of 35, 20, and approximately 8.5 kDa. The DNA-binding activities and pool levels of p42(C/EBPalpha) and p30(C/EBPalpha) in control nuclear extracts decrease significantly whereas the binding activity and protein levels of the 20-kDa isoforms increase dramatically with LPS treatment. Our studies suggest that the LPS response involves alternative translational initiation at specific in-frame AUGs, producing specific C/EBPalpha and C/EBPbeta isoform patterns. We propose that alternative translational initiation occurs by a leaky ribosomal scanning mechanism. We find that nuclear extracts from normal aged mouse livers have decreased p42(C/EBPalpha) levels and binding activity, whereas those of p20(C/EBPalpha) and p20(C/EBPbeta) are increased. However, translation of 42-kDa C/EBPalpha is not down-regulated on polysomes, suggesting that aging may affect its nuclear translocation. Furthermore, recovery of the C/EBPalpha- and C/EBPbeta-binding activities and pool levels from an LPS challenge is delayed significantly in aged mouse livers. Thus, aged livers have altered steady-state levels of C/EBPalpha and C/EBPbeta isoforms. This result suggests that normal aging liver exhibits characteristics of chronic stress and a severe inability to recover from an inflammatory challenge.

Evidence for posttranscriptional regulation of C/EBPalpha and C/EBPbeta isoform expression during the lipopolysaccharide-mediated acute-phase response

The mRNAs of the CCAAT/enhancer-binding trans-activator proteins (C/EBPalpha and C/EBPbeta) serve as templates for the differential translation of several isoforms which have specific transcriptional regulatory functions. By using an oligonucleotide corresponding to the C/EBP binding site of the mouse alpha1-acid glycoprotein promoter, we detected multiple forms of C/EBPalpha and C/EBP++ beta proteins in the mouse liver that have DNA-binding activity. By using specific antisera, we detected C/EBPalphas with molecular masses of 42, 38, 30, and 20 kDa that have DNA-binding activity. The pool levels of the 42- and 30-kDa isoforms were high in control nuclear extracts and decreased significantly after lipopolysaccharide (LPS) treatment. The binding activity and protein levels of the 20-kDa isoform are low in controls and increase dramatically after LPS treatment. C/EBPbeta isoforms with molecular masses of 35, 20, and 16 kDa were also detected. The 35-kDa pool level did not change whereas the 20-kDa isoform was strongly induced in response to LPS. Western (immunoblot) and Southwestern (DNA-protein) analyses show that p42 C/EBPalpha forms specific complexes with the alpha1-acid glycoprotein oligonucleotide in control nuclear extract and that p20 C/EBP beta forms complexes in LPS-treated liver. Our studies suggest that synthesis of specific C/EBPalpha and C/EBPbeta isoforms occurred in the normal liver in vivo and that LPS mediated a differential initiation and inhibition of translation at specific AUG sites within each mRNA. The qualitative and quantitative changes in C/EBPalpha and C/EBPbeta isoform pool levels suggest that LPS or an LPS-stimulated factor can regulate the selection of AUG start sites for both activation and repression of translation. This regulation appears to involve an LPS-mediated down-regulation of initiation at the first AUG codon of the 42-kDa C/EBPalpha and dramatic translational up-regulation at the fifth AUG codon of the 20-kDa C/EBPalpha and the third AUG codon of the 20-kDa C/EBPbeta. These regulatory events suggest the existence of proteins that may act as translational trans-acting factors.

Injuries in adolescent and preadolescent boys at two large wrestling tournaments

We evaluated injury patterns at two wrestling tournaments involving 1742 participants, aged 6 to 16 years. The overall injury rate was 12.7%. Injuries requiring withdrawal from the tournament occurred in 4.6% of the participants. Of all participants, 3% sustained an injury in their first match, and 1.1% sustained an injury during their first match that required withdrawal from the tournament. Primary areas of injury were the upper extremity (33%) and the neck and back (24%). Wilcoxon rank-sum tests revealed that increasing age and increasing weight were correlated with injury, whereas multiple logistic regression analysis revealed that only increasing age was correlated with injury. These findings suggest the need for medical supervision at large wrestling tournaments, where it is likely that severe injuries will occur. In addition, older wrestlers and perhaps heavier wrestlers are at an increased risk for injury.

Kinetic chain exercise in knee rehabilitation

Rehabilitation is recognised as a critical component in the treatment of the anterior cruciate ligament (ACL) injured athlete, and has been the subject of intense research over the past decade. As a result, sound scientific principles have been applied to this realm of sports medicine, and have improved the outcome of both surgical and nonsurgical treatment. Possibly the most intriguing of these principles is the use of the kinetic chain concept in exercise prescription following ACL reconstruction. The hip, knee, and ankle joints when taken together, comprise the lower extremity kinetic chain. Kinetic chain exercises like the squat recruit all 3 links in unison while exercises such as seated quadriceps extensions isolate one link of the chain. Biomechanical assessment with force diagrams reveals that ACL strain is reduced during kinetic chain exercise by virtue of the axial orientation of the applied load and muscular co-contraction. Additionally, kinetic chain exercise through recruitment of all hip, knee, and ankle extensors in synchrony takes advantage of specificity of training principles. More importantly, however, it is the only way to reproduce the concurrent shift of 'antagonistic' biarticular muscle groups that occurs during simultaneous hip, knee, and ankle extension. Incoordination of the concurrent shift fostered by exercising each muscle group in isolation may ultimately hamper complete recovery. Modifying present day leg press and isokinetic equipment will allow clinicians to make better use of kinetic chain exercise and allow safe isokinetic testing of the ACL reconstructed knee. Reconstruction of the ACL with a strong well placed graft to restore joint kinematics, followed by scientifically sound rehabilitation to improve dynamic control of tibial translation, will improve the outcome after ACL injury.

Radial growth plate injury in a female gymnast

Radial growth plate injury is a cause of wrist pain in female gymnasts. The mechanism of injury and its relationship to dowel grips, now standard gymnastic equipment, are considered. An athlete's response to a treatment approach emphasizing moderation and protection is described.

Rehabilitative techniques for athletes after reconstruction of the anterior cruciate ligament

A wide spectrum of protocols is available for rehabilitation after anterior cruciate ligament reconstruction, and little agreement exists on the specifics of strengthening exercises or the sequence of activities. In this article, we discuss the current rehabilitative techniques used at the Mayo Clinic for athletes who have undergone anterior cruciate ligament reconstruction. These techniques are based on established principles of rehabilitation, clinical experience, and new information about the related biomechanics of the knee. An illustrative case reflects the benefits of this rehabilitation program, which lasts up to 1 year and is divided into five stages. The early stages focus on protected mobilization and a strengthening program that emphasizes closed rather than open kinetic chain exercises. Later, neuromuscular-proprioceptive training and sport-specific agility training redevelop the reaction time and the "coordination engrams" necessary for athletic competition. High-quality surgical care and a closely supervised rehabilitation program, based on kinesiologic and biomechanical factors as they pertain to the anterior cruciate ligament, are necessary for a successful outcome.

Therapeutic donor insemination with frozen semen

Although it is now accepted that cryopreserved semen must, on ethical and medicolegal grounds, be used for donor insemination many clinicians still believe that it has an unacceptably reduced fecundability rate as compared with fresh semen. We studied the outcome of 81 recipients who started therapeutic donor insemination (TDI) treatment during 1986 in a program that used exclusively cryopreserved semen; 55 had never undergone TDI and were receiving the first series (six cycles), 6 were receiving the second series (also six cycles), and 20 had achieved pregnancy through TDI previously and were starting the treatment again. Insemination with semen stored in 0.5-ml French straws was performed daily during the periovulatory period while the modified Insler score was 10 or greater out of 15. A total of 42 (52%) of the recipients became pregnant within six TDI cycles; 4 (10%) had a spontaneous abortion. An average of 4.8 straws were used per cycle among those who became pregnant and 5.1 per cycle among those who did not. On average 2.6 cycles were required to achieve pregnancy. The overall fecundability rate was 14.6%. We conclude that a TDI program involving exclusively frozen semen can be operated with a success rate comparable to rates achieved with fresh semen if a simple, established cryopreservation method and an uncomplicated clinical management protocol are used.

The psychological effects of sports injuries. Coping

Epidemiological reports of sports injury confirm a high incidence of injuries occurring at all levels of sport participation, ranging in severity from cuts and bruises to spinal cord injury. The psychosocial dynamics accompanying sport injury should be known to ensure psychological recovery, an important aspect in rehabilitating the injured athlete. Earlier studies demonstrating psychological differences between athletes and nonathletes indicated the need for actual research on the athlete's postinjury response in lieu of accepting the hypothesis that the emotional responses of athletes to injury parallels existing (i.e. terminally ill) 'loss of health models'. Recent research has shown that injured athletes experience simultaneous mood disturbance and lowered self-esteem. Due to a paucity of research on the coping methods of injured athletes, studies involving the coping methods of several nonathletic patient populations were reviewed. These patients benefitted primarily from a concrete, problem-focused, behaviourally orientated programme which minimises uncertainty. This approach is theoretically ideal for injured athletes, congruent with the goal setting and performance outcome emphasis common to exercise and sport training programmes but to date the effectiveness of these strategies for injured athletes have not been fully examined. Therefore, until such research is available, these coping strategies (also used for performance enhancement) are provided as therapeutic guidelines for dealing with the emotional distress experienced by injured athletes. Individual responses of injured athletes varied from those who took injury in stride to those who required psychiatric intervention. This marked individual variation in response underscores the importance of neither assuming mood disturbance nor overlooking a serious emotional response in the injured athlete. Awareness of the emotional responses of athletes to injury and employment of appropriate coping strategies should facilitate optimal rehabilitation and return to sport.

Emotional responses of athletes to injury

Increased participation in sports is associated with increased related injuries. This study was conducted to identify the emotional responses of athletes to injury and to determine which responses might interfere with rehabilitation and necessitate psychologic or psychiatric intervention. In 72 patients, follow-up surveillance was continued from the time of injury until resumption of sports activity. Patients completed the Emotional Responses of Athletes to Injury Questionnaire and the Profile of Mood States (POMS) test, and significant differences were found when the POMS scales of depression and anger were compared with college norms. Mean POMS scores were compared (by multivariate analysis of variance) by sex, age, and severity of injury. No gender differences were found, and only for anger were age groups significantly different (younger athletes were most angered). Three severity-of-injury groups (based on the duration of time the athlete was unable to participate in sports) were also compared. The most seriously injured group experienced significantly more tension, depression, and anger and less vigor than college norms, a mood disturbance that lasted 1 month. Emotional disturbance can occur after a sports-related injury, and its prompt recognition may facilitate the athlete's optimal rehabilitation and a safe return to participation in sports.

Viscoelastic shoe insoles: their use in aerobic dancing

To determine whether use of viscoelastic insoles would significantly decrease the frequency of musculoskeletal overuse injury in aerobic dancers, 139 high-level aerobic dancers were divided randomly into two groups. The control group received placebo foam insoles and test subjects were fitted with viscoelastic insoles. Subjects used these insoles during dance class for 15 weeks. Injury rates were low in both groups and no statistical difference was found. Pain syndromes were fewer in the group using viscoelastic insoles, but the difference was not statistically significant. About a third of dancers fitted with viscoelastic insoles and a tenth of placebo insert wearers found that the insoles made their shoes too tight to be comfortable. No conclusion can be drawn on whether shock-absorbing insoles decrease injuries from aerobic dancing, but use of viscoelastic insoles may improve comfort and provide pain relief for some high-level aerobic dancers if proper fit is achieved.

Anterior knee pain

Anterior knee pain is a common symptom, especially in adolescence, and often no specific cause is sought or identified. Physicians who treat patients with knee pain should understand the normal anatomic features and the biomechanics of the patellofemoral joint. We review this information and discuss important aspects of the physical examination and roentgenographic evaluation in patients with anterior knee pain. Once the clinical cause of anterior knee pain has been established, directed nonoperative treatment including physical therapy should be initiated. Surgical intervention is generally reserved for patients in whom nonoperative management is unsuccessful and identifiable abnormalities exist.

Musculoskeletal injuries in competitive swimmers

Competitive swimming is a rigorous sport being engaged in by an increasing number of young athletes. In swimmers, shoulder pain is the most common musculoskeletal complaint and is usually due to supraspinatus or biceps tendinitis. Glenohumeral instability (often multidirectional) can also be a cause of shoulder pain in swimmers and may be more common than has been reported. Surgical treatment is seldom indicated. Physical therapy modalities and training modifications are the mainstay of treatment. Medial knee pain in breaststroke swimmers and extensor tendon inflammation over the dorsum of the foot are less common injuries and respond to conservative therapy. These overuse syndromes are best prevented by proper training schedules, strength training, flexibility exercises, and avoidance of errors in stroke technique. The rehabilitation program for a competitive swimmer should be chosen with an understanding of the goals of the swimmer and the cooperation of the coach.

Current concepts in the rehabilitation of the injured athlete

A comprehensive approach to the rehabilitation of injured athletes necessitates that an injury be treated specifically with appropriate measures to achieve comfort and that early prescription of various exercises be designed to promote optimal healing and a return to function. In addition, the athlete must be assisted to regain and maintain a proper fitness level before returning to a sport. Finally, the prevention of athletic injuries becomes an ongoing concern that necessitates monitoring and education of those involved in sports activities.

DISCUSSION ON THE VALUE OF X-RAYS IN THE DIAGNOSIS OF DISEASES OF THE COLON

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A Discussion on Sarcomata and Myelomata of the Long Bones

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