Generalizability of a Musculoskeletal Therapist Electronic Health Record for Modelling Outcomes to Work-Related Musculoskeletal Disorders

PURPOSE

Electronic Health Records (EHRs) can contain vast amounts of clinical information that could be reused in modelling outcomes of work-related musculoskeletal disorders (WMSDs). Determining the generalizability of an EHR dataset is an important step in determining the appropriateness of its reuse. The study aims to describe the EHR dataset used by occupational musculoskeletal therapists and determine whether the EHR dataset is generalizable to the Australian workers' population and injury characteristics seen in workers' compensation claims.

METHODS

Variables were considered if they were associated with outcomes of WMSDs and variables data were available. Completeness and external validity assessment analysed frequency distributions, percentage of records and confidence intervals.

RESULTS

There were 48,434 patient care plans across 10 industries from 2014 to 2021. The EHR collects information related to clinical interventions, health and psychosocial factors, job demands, work accommodations as well as workplace culture, which have all been shown to be valuable variables in determining outcomes to WMSDs. Distributions of age, duration of employment, gender and region of birth were mostly similar to the Australian workforce. Upper limb WMSDs were higher in the EHR compared to workers' compensation claims and diagnoses were similar.

CONCLUSION

The study shows the EHR has strong potential to be used for further research into WMSDs as it has a similar population to the Australian workforce, manufacturing industry and workers' compensation claims. It contains many variables that may be relevant in modelling outcomes to WMSDs that are not typically available in existing datasets.

Cyclin E and FGF8 are downstream cell growth regulators in distinct tumor suppressor effects of ANXA7 in hormone-resistant cancer cells of breast versus prostate origin

Tumor suppressor function of Annexin-A7 (ANXA7) was demonstrated by cancer-prone phenotype in Anxa7(+/-) mice and ANXA7 profiling in human cancers including prostate and breast. Consistent with its more evident in vivo tumor suppressor role in prostate cancer, wild-type(wt)-ANXA7 in vitro induced similar G2-arrests, but reduced survival more drastically in prostate cancer cells compared to breast cancer cells (DU145 versus MDA-MB-231 and -435). In all three hormone-resistant cancer cell lines, wt-ANXA7 abolished the expression of the oncogenic low-molecular weight (LMW) cyclin E which was for the first time encountered in prostate cancer cells. Dominant-negative nMMM-ANXA7 (which lacks phosphatidylserine liposome aggregation properties) failed to abrogate LMW-cyclin E and simultaneously induced fibroblast growth factor 8 (FGF8) in DU145 that was consistent with the continuing cell cycle progression and reduced cell death. Adenoviral vector alone induced FGF8 in MDA-MB-231/435 cell lines, but not in DU145 cells. Our data indicated that the LMW-Cyclin E expressions in breast cancer and prostate cancer cell-lines were differentially regulated by wild-type and dominant-negative ANXA7 isoforms, demonstrating a different survival mechanism utilized by breast cancer cells. Conventional tumor suppressor p53 failed to completely abolish FGF8 and LMW-cyclin E in breast cancer cells, which were eventually translated into their survival. Thus, ANXA7 tumor suppression could modulate FGF8 and cyclin E expression, and control implying more specific associations with the annexin properties of ANXA7 in prostate tumorigenesis.

Identification of seven loci affecting mean telomere length and their association with disease

Interindividual variation in mean leukocyte telomere length (LTL) is associated with cancer and several age-associated diseases. We report here a genome-wide meta-analysis of 37,684 individuals with replication of selected variants in an additional 10,739 individuals. We identified seven loci, including five new loci, associated with mean LTL (P < 5 × 10(-8)). Five of the loci contain candidate genes (TERC, TERT, NAF1, OBFC1 and RTEL1) that are known to be involved in telomere biology. Lead SNPs at two loci (TERC and TERT) associate with several cancers and other diseases, including idiopathic pulmonary fibrosis. Moreover, a genetic risk score analysis combining lead variants at all 7 loci in 22,233 coronary artery disease cases and 64,762 controls showed an association of the alleles associated with shorter LTL with increased risk of coronary artery disease (21% (95% confidence interval, 5-35%) per standard deviation in LTL, P = 0.014). Our findings support a causal role of telomere-length variation in some age-related diseases.

Identification of seven loci affecting mean telomere length and their association with disease

Interindividual variation in mean leukocyte telomere length (LTL) is associated with cancer and several age-associated diseases. We report here a genome-wide meta-analysis of 37,684 individuals with replication of selected variants in an additional 10,739 individuals. We identified seven loci, including five new loci, associated with mean LTL (P < 5 × 10(-8)). Five of the loci contain candidate genes (TERC, TERT, NAF1, OBFC1 and RTEL1) that are known to be involved in telomere biology. Lead SNPs at two loci (TERC and TERT) associate with several cancers and other diseases, including idiopathic pulmonary fibrosis. Moreover, a genetic risk score analysis combining lead variants at all 7 loci in 22,233 coronary artery disease cases and 64,762 controls showed an association of the alleles associated with shorter LTL with increased risk of coronary artery disease (21% (95% confidence interval, 5-35%) per standard deviation in LTL, P = 0.014). Our findings support a causal role of telomere-length variation in some age-related diseases.

Repeated replication and a prospective meta-analysis of the association between chromosome 9p21.3 and coronary artery disease

BACKGROUND

Recently, genome-wide association studies identified variants on chromosome 9p21.3 as affecting the risk of coronary artery disease (CAD). We investigated the association of this locus with CAD in 7 case-control studies and undertook a meta-analysis.

METHODS AND RESULTS

A single-nucleotide polymorphism (SNP), rs1333049, representing the 9p21.3 locus, was genotyped in 7 case-control studies involving a total of 4645 patients with myocardial infarction or CAD and 5177 controls. The mode of inheritance was determined. In addition, in 5 of the 7 studies, we genotyped 3 additional SNPs to assess a risk-associated haplotype (ACAC). Finally, a meta-analysis of the present data and previously published samples was conducted. A limited fine mapping of the locus was performed. The risk allele (C) of the lead SNP, rs1333049, was uniformly associated with CAD in each study (P<0.05). In a pooled analysis, the odds ratio per copy of the risk allele was 1.29 (95% confidence interval, 1.22 to 1.37; P=0.0001). Haplotype analysis further suggested that this effect was not homogeneous across the haplotypic background (test for interaction, P=0.0079). An autosomal-additive mode of inheritance best explained the underlying association. The meta-analysis of the rs1333049 SNP in 12,004 cases and 28,949 controls increased the overall level of evidence for association with CAD to P=6.04x10(-10) (odds ratio, 1.24; 95% confidence interval, 1.20 to 1.29). Genotyping of 31 additional SNPs in the region identified several with a highly significant association with CAD, but none had predictive information beyond that of the rs1333049 SNP.

CONCLUSIONS

This broad replication provides unprecedented evidence for association between genetic variants at chromosome 9p21.3 and risk of CAD.

Genomewide association analysis of coronary artery disease

BACKGROUND

Modern genotyping platforms permit a systematic search for inherited components of complex diseases. We performed a joint analysis of two genomewide association studies of coronary artery disease.

METHODS

We first identified chromosomal loci that were strongly associated with coronary artery disease in the Wellcome Trust Case Control Consortium (WTCCC) study (which involved 1926 case subjects with coronary artery disease and 2938 controls) and looked for replication in the German MI [Myocardial Infarction] Family Study (which involved 875 case subjects with myocardial infarction and 1644 controls). Data on other single-nucleotide polymorphisms (SNPs) that were significantly associated with coronary artery disease in either study (P<0.001) were then combined to identify additional loci with a high probability of true association. Genotyping in both studies was performed with the use of the GeneChip Human Mapping 500K Array Set (Affymetrix).

RESULTS

Of thousands of chromosomal loci studied, the same locus had the strongest association with coronary artery disease in both the WTCCC and the German studies: chromosome 9p21.3 (SNP, rs1333049) (P=1.80x10(-14) and P=3.40x10(-6), respectively). Overall, the WTCCC study revealed nine loci that were strongly associated with coronary artery disease (P<1.2x10(-5) and less than a 50% chance of being falsely positive). In addition to chromosome 9p21.3, two of these loci were successfully replicated (adjusted P<0.05) in the German study: chromosome 6q25.1 (rs6922269) and chromosome 2q36.3 (rs2943634). The combined analysis of the two studies identified four additional loci significantly associated with coronary artery disease (P<1.3x10(-6)) and a high probability (>80%) of a true association: chromosomes 1p13.3 (rs599839), 1q41 (rs17465637), 10q11.21 (rs501120), and 15q22.33 (rs17228212).

CONCLUSIONS

We identified several genetic loci that, individually and in aggregate, substantially affect the risk of development of coronary artery disease.

The epidemiology of golfrelated injuries in Australian amateur golfers - a multivariate analysis

Objective. To perform an epidemiological study in order to determine the golf-related injury locations, injury rates and possible risk factors for golf injury in amateur golfers across Australia. Method. A retrospective cross-sectional survey of Australian golf club members was used to collect data for the study. Chi-square testing was used to evaluate the association between golf injury and each possible risk factor at univariate level. All the possible risk factors were further examined in multivariate analysis using logistical regression. Results. There were 1 634 golfers included in the present study. Of these, 288 reported having had one or more golfrelated injuries in the previous year. The most common injury location was the lower back (25.3%), followed by the elbow (15.3%) and shoulder (9.4%). The most common injury mechanism was poor technique in execution of the golf swing (44.8%). Age, warm-up status, conditioning habits, wearing a golf glove/s and injury acquired in other sports / activities were significantly associated with risk of golf injury (p < 0.05). Equipment use such as type of golf club shaft used, type of shoes used and other factors studied were not statistically significant. Conclusion. The most injured sites identified in this study were the lower back, elbow and shoulder respectively. Risk of injury during golfing varied according to age group, warm-up status, conditioning habits, whether the player wore a golf glove/s, and whether the golfer had been injured in other activities. South African Journal of Sports Medicine Vol. 19 (1) 2007: pp. 12-19

Injury in rugby league

It was the purpose of this review to document the range, incidence, location and mechanism of injury occurring in the sport of rugby league. Rugby league is a collision sport played in Europe and the Pacific regions including Australia. The sport is well established and has competitions ranging from junior to elite professional. Due to the contact nature of the game, injury is relatively common. The most common injuries are musculotendinous in nature and afflict the lower limb more frequently than elsewhere. Despite the high incidence of minor (sprains/strains) to moderate musculoskeletal injury (fracture, ligament and joint injury) and minor head injuries such as lacerations, nasal fractures and concussions, rare more serious spinal cord and other injuries causing death have also been recorded. The literature on rugby league injury is small but growing and suffers from a lack of consistent definition of what an injury is, thereby causing variability in the nature and incidence/prevalence of injury. Information is lacking on the injury profiles of different age groups. Importantly, there has been little attempt to establish a coordinated injury surveillance program in rugby league in the junior or professional levels. The implementation of such programs would require a universal definition of injury and a focus on important events and competitions. The implementation could provide important information in the identification and prevention of risk factors for injury.

A comparison of the modern and classic golf swing: a clinician\'s perspective

Objective. There is little descriptive research on the motion the body displays during the golf swing. The purpose of this research is to review the modern golf swing and compare its motion to the classic golf swing. Discussion. The comparison revealed subtle but significant differences in the backswing and the follow-through positions. The potential implications for power and injury, particularly of the lower back, are discussed. The discussion describes a third swing, the hybrid swing, which is a combination of the classic and modern swing. The hybrid swing may potentially reduce the chances of sustaining a low back injury while still retaining the power of the modern swing. Conclusion. The golf swing has evolved over time as a result of a combination of advanced equipment, course design and human experimentation. The hybrid swing is being taught by some golf professionals as a balance between the power-potential of the modern swing and the ‘back-friendly\' nature of the classic swing, though no studies have so far been conducted on its efficacy. Further investigation into the three golf swings, classic, modern and hybrid, is required to determine which swing is the most effective while also being friendly to the body. Such research will make possible the development programmes aimed at reducing golf injury rates, particularly to the lower back. South African Journal of Sports Medicine Vol. 18 (3) 2006: pp. 80-91

Muscle activity during the golf swing

In the right hands, the golf swing is a motion that inspires looks of awe from the public. It is a complex movement of the whole body to generate power to a golf ball to propel the ball great distances with accuracy. This movement relies on the coordinated sequence of muscle activation to produce a fluid and reproducible movement. This paper reviews the literature on golf swing related muscle activity. The phases of this activity are discussed with a view to assisting the practitioner in understanding the swing. Such understanding may help in the management of the injured golfer.

Increase in Specific Proteins and mRNAs Following Transient Anoxia - Aglycaemia in Rat CA1 Hippocampal Slices

Incorporation of [35S]methionine into proteins and two-dimensional gel autoradiograms was used to characterize early post-anoxia - aglycaemia protein synthesis in the CA1 area of rat hippocampal slices maintained in vitro. We have compared the effects of 3 - 4 min and 5 - 10 min insults, since the former but not the latter produces a reversible block of synaptic transmission (see companion paper). An insult of between 3 min 30 s and 4 min induces a transient increase in the labelled proteins during the first hour of reoxygenation, as compared to control. The increase in protein synthesis is conspicuous for several proteins, including actin, alpha-tubulin and heat-shock proteins (hsp70c and hsp90), as determined by immunoblotting. In the case of alpha-tubulin, we show with in situ hybridization and polymerase chain reaction procedures that the increase in protein synthesis is associated with a marked increase in the expression of the corresponding messenger RNAs. The results demonstrate that, in addition to regulatory proteins such as hsps, the synthesis of several polypeptides, including those associated with the cytoskeleton, is altered in anoxic damage.

Ca2+-sensitive cytosolic nucleases prevent efficient delivery to the nucleus of injected plasmids

BACKGROUND

Efficient gene delivery by synthetic vectors is a major challenge in gene therapy. However, inefficient nuclear delivery of cDNA is thought to be a major limiting step in gene transfer using non-viral vectors. It is commonly thought that, in the cytosol, cDNA has to be released from its vector before importation to the nucleus. The stability of naked cDNA in the cytoplasm is not well established.

METHODS

cDNA plasmids, either free or complexed with poly(ethyleneimine) (PEI), were microinjected into the cytoplasm of mammalian cells and their turnover was assessed by fluorescence in situ hybridization (FISH). Incubations of cDNA plasmids in cytosolic extracts were also performed.

RESULTS

FISH experiments showed that naked cDNA rapidly fade with time when injected into the cytosol. Fading was not observed when naked cDNA plasmids were injected into the nucleus. Incubation of naked cDNA in a cytosolic fraction isolated from mammalian cells reproduced cDNA degradation as observed in microinjection experiments. Nuclease inhibitors, including aurin tricarboxylic acid or Zn2+, prevented in vitro cDNA degradation. The cytosolic nuclease activity was optimal at physiological pH and physiological Ca2+ concentration. By contrast, it was insensitive to Mg2+ or Na+ concentrations. Finally, cDNA complexation with PEI or addition of oligonucleotides prevented in vitro cDNA degradation.

CONCLUSION

Altogether, these experiments suggest that cDNA digestion by cytosolic nucleases occur when the decomplexed transgene is present in the cytosol. We propose that the inefficient transfer of cDNA into the nucleus during transfection with synthetic vectors may result from rapid digestion of naked cDNA by a Ca2+-sensitive cytosolic nuclease.

A randomized controlled trial of chiropractic spinal manipulative therapy for migraine

OBJECTIVE

To assess the efficacy of chiropractic spinal manipulative therapy (SMT) in the treatment of migraine.

DESIGN

A randomized controlled trial of 6 months' duration. The trial consisted of 3 stages: 2 months of data collection (before treatment), 2 months of treatment, and a further 2 months of data collection (after treatment). Comparison of outcomes to the initial baseline factors was made at the end of the 6 months for both an SMT group and a control group.

SETTING

Chiropractic Research Center of Macquarie University.

PARTICIPANTS

One hundred twenty-seven volunteers between the ages of 10 and 70 years were recruited through media advertising. The diagnosis of migraine was made on the basis of the International Headache Society standard, with a minimum of at least one migraine per month.

INTERVENTIONS

Two months of chiropractic SMT (diversified technique) at vertebral fixations determined by the practitioner (maximum of 16 treatments).

MAIN OUTCOME MEASURES

Participants completed standard headache diaries during the entire trial noting the frequency, intensity (visual analogue score), duration, disability, associated symptoms, and use of medication for each migraine episode.

RESULTS

The average response of the treatment group (n = 83) showed statistically significant improvement in migraine frequency (P < .005), duration (P < .01), disability (P < .05), and medication use (P< .001) when compared with the control group (n = 40). Four persons failed to complete the trial because of a variety of causes, including change in residence, a motor vehicle accident, and increased migraine frequency. Expressed in other terms, 22% of participants reported more than a 90% reduction of migraines as a consequence of the 2 months of SMT. Approximately 50% more participants reported significant improvement in the morbidity of each episode.

CONCLUSION

The results of this study support previous results showing that some people report significant improvement in migraines after chiropractic SMT. A high percentage (>80%) of participants reported stress as a major factor for their migraines. It appears probable that chiropractic care has an effect on the physical conditions related to stress and that in these people the effects of the migraine are reduced.

Bilateral simultaneous optic nerve dysfunction after periorbital trauma: recovery of vision in association with with chiropractic spinal manipulation therapy

OBJECTIVE

To discuss the recovery of optic nerve function after chiropractic spinal manipulation in a patient with loss of vision as a result of facial fracture from a fall.

CLINICAL FEATURES

In a fall down a stairwell, a 53-year-old woman with migraines fractured her right zygomatic arch, which was later treated surgically. Approximately 3 weeks after the accident, vision in her contralateral eye became reduced to light perception. Electrophysiologic studies revealed that the function of both optic nerves was diminished, the right significantly more than the left. Single photon emission tomography showed pancerebral ischemic foci.

INTERVENTION AND OUTCOME

Chiropractic spinal manipulation was used to aid recovery of vision to normal over a course of 20 treatment sessions. At times, significant improvement in vision occurred immediately after spinal manipulation. Progressive recovery of vision was monitored by serial visual field tests and by electrophysiologic studies. Unfortunately, the patient refused a further single photon emission tomographic study when visual recovery was complete.

CONCLUSION

This case report adds to previous accounts of progressive and expeditious recovery of optic nerve function in association with spinal manipulation therapy.

Gene expression in developing rat hippocampal pyramidal neurons appears independent of mossy fiber innervation

In the rat, neonatal gamma-irradiation of the hippocampus induces a selective destruction of dentate granule cells and prevents the development of the mossy fiber-CA3 pyramidal cell connection. In the absence of mossy fiber input, the CA3 pyramidal neurons exhibit morphological alterations and rats deprived of dentate granule cells fail to develop kainate-induced epileptic activity in the CA3 pyramidal neurons. Neonatal elimination of the granule cells also impairs learning and memory tasks in adult rats. In the present work, we assessed by in situ hybridization and semi-quantitative RT-PCR, whether in the pyramidal layers, the absence of mossy fiber input alters the expression of a number of genes involved in activity-dependent signal transduction, in GABAergic neurotransmitter signaling and in neurite development via microtubule organization. Surprisingly, we show that the expression and the developmentally regulated alternative splicing of the genes we examined in the developing hippocampus are not altered in the pyramidal neurons, whether the dentate granule afferents are present or absent. Our results suggest that in the CA3 pyramidal layer, the developmental expression patterns of the mRNAs we studied are independent of extrinsic cues provided by mossy fiber input.

The effect of upper cervical or sacroiliac manipulation on hip flexion range of motion

OBJECTIVES

To compare the effectiveness of an upper cervical manipulation and a manipulation of the sacroiliac joint for increasing hip range of motion.

DESIGN

Clinical cohort study.

SETTING

Macquarie University Centre for Chiropractic Outpatient Clinic.

SAMPLE

Fifty-two randomly chosen university students aged 18 to 34 yr.

METHOD

A reliable hand-held dynamometer was used to determine the end point of range of motion before and after the application of a treatment. Three groups of subjects were created: cervical manipulation, sacroiliac manipulation and sham/placebo. Range of motion of the hip in flexion (SLR) was used as the independent variable.

RESULTS

The two manipulative treatments resulted in increased flexion range of motion at the hip. Statistical analysis revealed that only the upper cervical manipulation procedure increased hip flexion range of motion significantly.

CONCLUSION

The results suggest that manual therapy of the neck may affect hip range of motion in normal adults. Findings such as these may indicate the existence of a link between the cervical spine and the lower extremity.

Polyethylenimine but not cationic lipids promotes transgene delivery to the nucleus in mammalian cells

The beta-galactosidase reporter gene, either free or complexed with various cationic vectors, was microinjected into mammalian cells. Cationic lipids but not polyethylenimine or polylysine prevent transgene expression when complexes are injected in the nucleus. Polyethylenimine and to a lesser extent polylysine, but not cationic lipids, enhance transgene expression when complexes are injected into the cytoplasm. This latter effect was independent of the polymer vector/cDNA ionic charge ratio, suggesting that nucleic acid compaction rather than surface charge was critical for efficient nuclear trafficking. Cell division was not required for nuclear entry. Finally, comparative transfection and microinjection experiments with various cell lines confirm that barriers to gene transfer vary with cell type. We conclude that polymers but not cationic lipids promote gene delivery from the cytoplasm to the nucleus and that transgene expression in the nucleus is prevented by complexation with cationic lipids but not with cationic polymers.

A dominant negative isoform of the long QT syndrome 1 gene product

Mutations in the KvLQT1 gene are the cause of the long QT syndrome 1. KvLQT1 gene product is associated with the regulator protein IsK to produce a component of the delayed rectifier K+ current in cardiac myocytes. We identified an N-terminal truncated isoform of the KvLQT1 gene product, referred to as isoform 2. In RNase protection assays, isoform 2 represented 28.1 +/- 0.6% of the total KvLQT1 expression in the human adult ventricle. COS-7 cells injected intranuclearly with KvLQT1 isoform 1 cDNA exhibited a fast-activating K+ current, whereas those injected with a KvLQT1 isoform 1 plus IsK cDNA showed a slow-activating K+ current. Cells injected with KvLQT1 isoform 2 plasmid showed no detectable K+ current. Those injected with a 1/1 isoform 2/isoform 1 ratio showed no detectable K+ current. Those injected with 1/5 and 2/5 ratios showed a K+ current with markedly reduced amplitude. Coexpression of the IsK regulator consistently reduced the dominant negative effects of isoform 2. Our results indicate that KvLQT1 isoform 2 exerts a pronounced negative dominance on isoform 1 channels and that the cardiac KvLQT1 K+ channel complex is composed of at least three different proteins as follows: isoform 1, isoform 2, and IsK.

Hyperexpression of recombinant CFTR in heterologous cells alters its physiological properties

We investigated whether high levels of expression of the cystic fibrosis transmembrane conductance regulator (CFTR) would alter the functional properties of newly synthesized recombinant proteins. COS-7, CFPAC-1, and A549 cells were intranuclearly injected with a Simian virus 40-driven pECE-CFTR plasmid and assayed for halide permeability using the 6-methoxy-N-(3-sulfopropyl)quinolinium fluorescent probe. With increasing numbers of microinjected pECE-CFTR copies, the baseline permeability to halide dose dependently increased, and the response to adenosine 3',5'-cyclic monophosphate (cAMP) stimulation decreased. In cells hyperexpressing CFTR, the high level of halide permeability was reduced when a cell metabolism poisoning cocktail was applied to decrease intracellular ATP and, inversely, was increased by orthovanadate. In CFPAC-1 cells investigated with the patch-clamp technique, CFTR hyperexpression led to a time-independent nonrectifying chloride current that was not sensitive to cAMP stimulation. CFPAC-1 cells hyperexpressing CFTR exhibited no outward rectifying chloride current nor inward rectifying potassium current either spontaneously or under cAMP stimulation. We conclude that hyperexpression of recombinant CFTR proteins modifies their properties inasmuch as 1) CFTR channels are permanently activated and not susceptible to cAMP regulation and 2) they lose their capacity to regulate heterologous ionic channels.

Wall perimetry in chiropractic

BACKGROUND

Wall perimetry is a method of examination that led to the initial appreciation of the "tunnel vision information." The visual field loss that wall perimetry indicates generally defines the overall characteristics of the dysfunction associated with 'tunnel vision.' Wall perimetry is an inexpensive, yet sensitive, preliminary screening test for perception abnormality in the outermost periphery of vision.

OBJECTIVE

To describe wall perimetry. The term "wall perimetry" denotes a simple preliminary method of examining the visual fields of chiropractic patients.

DISCUSSION

The test is described with reference to photographs. The patient stands 1 m from the corner of a room and is instructed to look directly at the junction of the walls, with the head remaining still and gaze fixed. Standing behind the patient, the examiner projects a target of light onto the wall and moves it until it is seen by the subject.

CONCLUSION

Chiropractors are encouraged to test appropriate patients by wall perimetry before spinal manipulation therapy. On the basis of existing experience, detection of patients with visual field loss is to be expected. From that point, formal examination of the visual fields using kinetic or static perimetry apparatus is recommended to further verify the "tunnel vision" discovery.

Developmentally regulated alternative splicing of mRNAs encoding N-terminal tau variants in the rat hippocampus: structural and functional implications

Tau protein variants are axonal microtubule-associated phosphoproteins whose expression correlates with developmentally regulated neurite outgrowth. A single gene encodes multiple tau transcripts via complex alternative splicing. We studied the expression of the mRNAs encoding N-terminal variants of tau, and we showed distinct alternative splicing of exons 2 and 3 in nervous tissues of the adult rat, including the inner ear, hippocampus, cortex, striatum, brainstem, cerebellum, olfactory bulb and retina. Using the reverse transcriptase-coupled polymerase chain reaction and in situ hybridization, we then focused our developmental study on hippocampal neurons, both in vivo and in vitro, to address the developmental and spatial expression of the alternatively spliced mRNAs encoding N-terminal variants of tau. Tau mRNAs devoid of exons 2 and 3 were present throughout development, although their levels decreased in adults. Those containing exon 2 but not exon 3 were already present in the hippocampus of newborn rats and their levels increased during the first postnatal week, mainly in the pyramidal cell layer. Tau RNAs containing exons 2 and 3 appeared at the end of this period in the pyramidal cell layer and in the dentate granule cells. Exon 2-containing mRNAs seemed to be associated with cells undergoing axonal sprouting, while exon 3-containing RNAs were expressed in mature neurons that had established their connections. The timing and pattern of tau alternative splicing were maintained in cultured hippocampal neurons, suggesting that splicing processes are independent of the organized connectivity and of the environmental cues provided in vivo. Secondary structure predictions of tau variants revealed that the insertion of the exon 3-encoded domain substantially modifies the secondary structure of the N-terminal region of tau. This N-terminal heterogeneity may confer distinct regulatory roles on the tau variants during ontogeny and may contribute to plasticity in the adult rat brain.

A study of two stretching techniques for improving hip flexion range of motion

OBJECTIVES

To compare the effectiveness of a spinal (suboccipital) stretching technique and a peripheral stretching technique.

DESIGN

Clinical cohort study.

SETTING

Macquarie University Centre for Chiropractic Outpatient Clinic.

METHOD

A reliable hand-held dynamometer was used to determine the end point of range of motion (ROM) before and after the application of a treatment. Three groups of subjects were treated: cervical stretch, hip stretch and sham/placebo. ROM of the hip in flexion (straight leg raise) was used as the independent variable.

SAMPLE

Sixty randomly allocated university students aged between 18 and 35 yr.

RESULTS

The two stretching treatments resulted in increased flexion ROM at the hip. Statistical analysis revealed that only the sub-occipital stretching procedure increased hip flexion ROM significantly.

CONCLUSION

Manual therapy of the neck may have a role to play in the treatment of extraspinal, lower-limb musculoskeletal conditions.

Alpha-brain spectrin mRNA belongs to the population of intradendritically transported mRNAs

Brain spectrin is a cytoskeletal protein involved in neuronal polarization and differentiation. We have studied the intraneuronal expression of non-erythroid (NE) alpha-spectrin mRNA in the rat brain during the development of the CA3 pyramidal cells, and compared it with alpha-tubulin mRNA expression. In contrast to alpha-tubulin expression, which remains located in the neuronal somata, NE alpha-spectrin mRNA was present in the dendritic compartment during the first 2 weeks of life. NE alpha-Brain spectrin mRNA transport into the dendrites coincides with critical development events, including dendritic arborization, growth and synaptogenesis, and could be dependent on the appearance of synaptic activity at the mossy fibre/CA3 synapse.

On-line echocardiographic assessment of hemodynamic indexes by an adaptive Doppler analysis algorithm and signal/noise ratio calculation

Assessment of cardiac diseases commonly involves the use of spectral Doppler echocardiography. Its use, however, often requires manual digitization of various transvalvular flow profiles. A new approach has been developed for on-line analysis of Doppler data, which involves thresholding based on the signal/noise ratio, calculating instantaneous values, and plotting on the spectral display in real time. We examined the reliability of this new method in 32 patients with 59 various flow jets by comparing it with the data derived by manual analysis. Correlations between the algorithm analysis and manual analysis for peak velocity, peak gradient, velocity-time integral, and acceleration time were excellent. These indexes were obtained with the algorithm in a shorter time and with better reproducibility than with manual analysis. Thus this new adaptive Doppler analysis algorithm yields reliable on-line quantification of valuable hemodynamic variables and represents an advance in quantitative echocardiography.

Localization of mRNAs for adrenoleukodystrophy and the 70 kDa peroxisomal (PMP70) proteins in the rat brain during post-natal development

Adrenoleukodystrophy (ALD) is a genetic demyelinating disorder caused by the mutation of a gene encoding a 75-kDa peroxisomal protein (ALDP) that belongs to the superfamily of ATP binding casette (ABC) transporters. The PMP 70 gene codes for another peroxisomal ABC transporter that shows 38.5% amino acid identity with ALDP. ALDP and PMP70 have the structure of half transporter and could possibly heterodimerize to form a full transporter within the peroxisomal membrane. Using in situ hybridization histochemistry in rat brain, we demonstrate that ALD and PMP70 mRNAs have different spatial and temporal expression during postnatal development. Whereas expression of PMP 70 mRNA was low at birth and culminates between the 2nd and 3rd week in hippocampus and cerebellum, maximum expression of ALDP was found at birth in all brain areas and decreased thereafter. The absence of coordinated expression of ALD and PMP70 genes suggests therefore that ALD and PMP70 proteins are unlikely to function as exclusive and obligatory partners in the brain.

Cytosine arabinoside induces apoptosis in cerebellar neurons in culture

Cytosine arabinoside (AraC) is a pyrimidine antimetabolite that prevents cell proliferation by inhibiting DNA synthesis. We report that AraC kills cultured cerebellar neurons in a concentration-dependent fashion with an EC50 of approximately 60 microM when added shortly after seeding. This cell death has apoptotic features because we observed (1) morphology of apoptotic nuclei as judged by DNA staining with Hoechst 33258, (2) DNA fragmentation with typical ladder pattern on agarose gel, (3) positive nuclear labeling with a specific in situ DNA fragmentation staining, (4) prevention by deoxycytidine (IC50 = 1 microM), protein, and RNA synthesis inhibitors, and (5) release of DNA fragments in the incubating medium. We have also observed that several proteins were overexpressed in AraC-treated neurons by two-dimensional polyacrylamide gel electrophoresis. We conclude that AraC induces a signal that triggers a cascade of new mRNA and protein synthesis, leading to apoptotic cell death in cultured cerebellar granule cells.

Cervical radiculopathy: a case for ancillary therapies?

OBJECTIVE

To present two cases, one of a patient with a radicular syndrome and another of a patient with a pseudoradicular syndrome.

CLINICAL FEATURES

A 45-yr-old man visited one chiropractic clinic complaining of a "pinched nerve" in his neck, with pain and paresthesia in his left hand. He reported that these symptoms began after a work accident 1 month before, when he lifted a heavy object. Radiographs revealed disk space thinning at C4-5, C5-6 and C6-7. CT scans revealed foraminal narrowing with a minor disk bulging at the level of C5-6 and a large disk protrusion at C7-T1. The second patient is a 60-yr-old man with left shoulder and cervical spine pain. The patient stated that the shoulder pain felt like an ache and had begun 2 wk earlier when he had awakened with pain in the shoulder and a stiff neck. X-ray evaluation revealed a moderate level of degenerative change at the the C4-5, C5-6 and C7-T1 region.

CONCLUSION

This article identifies the similarities and variations between two syndromes receiving chiropractic intervention that included ancillary therapy. Certain conditions, including cervical radiculopathy, seem to respond well to chiropractic spinal manipulative therapy. However, in other conditions with similar symptomatology, appropriate referral may be necessary for the condition to respond. Alternatively, adjunctive or ancillary therapy may be indicated to improve the effect of the chiropractic intervention.

N-Methyl-D-aspartate receptor subunits NR1 and NR2C are overexpressed in the inferior colliculus of audiogenic mice

Some non-DBA2 Albino Swiss mice exhibit noise induced epileptic seizures during a short period of postnatal development. Because N-methyl-D-aspartate (NMDA) glutamate ionotropic receptors are involved in the occurrence of audiogenic seizures, we investigated by in situ hybridization methods, the expression of the different subunits (NR1, NR2A, NR2B, NR2C) of this receptor in the central nucleus of the inferior colliculus (IC), a main relay of the auditory pathways. At postnatal day 20, the NR2C subunit is highly expressed in the IC of convulsive mice, while in non-convulsive mice a slight signal is only found for NR1, NR2A, and NR2B. In adult mice, the NR1 and NR2A signals are observed while the NR2B signal is almost undetectable. The audiogenic susceptibility may be related to the transient expression of the NR2C subunit during a brief neonatal period during which synaptic reorganization happens.

Molecular correlates between reactive and developmental plasticity in the rat hippocampus

Area CA3 of the hippocampus is the most epileptogenic structure of the brain. Various studies have shown that kainate-induced experimental epilepsy in rats and human cases of epilepsy are associated with sprouting of the mossy fibers of the dentate granule neurons and selective loss of pyramidal neurons, notably in the CA3-CA4 areas of Ammon's horn. In experimental models of epilepsy, brief seizure activity initiates a cascade of molecular alterations that will contribute to changes in the expression of numerous genes, which can last several weeks. The products of some of these genes will contribute to the permanent state of enhanced synaptic efficiency, to the sprouting and formation of novel excitatory synapses, and possibly to neuronal cell loss. The expression of genes encoding transcription factors and numerous growth factors is rapidly altered following seizure episodes. Based on observations in vivo and in vitro in cultured hippocampal neurons, it is hypothesized that an interplay between transcription and growth factors, because of their pleiotropic effects on the regulation of effector genes, may be instrumental in coupling transient extracellular stimuli to irreversible cellular alterations.

Cell death, gliosis, and synaptic remodeling in the hippocampus of epileptic rats

Seizures set in motion complex molecular and morphological changes in vulnerable structures, such as the hippocampal complex. A number of these changes are responsible for neuronal death of CA3 and hilar cells, which involves necrotic and apoptotic mechanisms. In surviving dentate granule cells seizures induce an increased expression of tubulin subunits and microtubule-associated proteins, suggesting that an overproduction of tubulin polymers would lead to a remodeling of mossy fibers (the axons of granule cells). In fact, these fibers sprout in the dentate gyrus to innervate granule cell dendrites, creating recurrent excitatory circuits. In contrast, terminal mossy fibers do not sprout in the CA3 field. Navigation of mossy fiber's growth cones may be facilitated by astrocytes, which would exert differential effects by producing and excreting cell adhesion and substrate molecules. In the light of the results discussed here, we suggest that in adult brain activated-resident astrocytes (nonproliferating, tenascin-negative, neuronal cell-adhesion molecule-positive astrocytes) could contribute to the process of axonal outgrowth and synaptogenesis in the dentate gyrus, while proliferating astrocytes, tenascin-positive, could impede any axonal rearrangement in CA3.

Decreased pentylenetetrazol-induced expression of zif/268 in NGF-transgenic mice

Expression of the proto-oncogene zif/268 was investigated by in situ hybridization in the hippocampus and cerebral cortex of nerve growth factor (NGF)-transgenic mice during pentylenetetrazol (PTZ)-induced seizures. NGF-transgenic mice displayed normal basal levels of zif/268 mRNA in cortex and hippocampal formation except for the dentate gyrus which contained significantly reduced levels. PTZ induced a similar transient increase of zif/268 mRNA in cortex and Ammon's horn of normal and NGF-transgenic mice. On the other hand, increase of zif/268 mRNA in the dentate gyrus was significantly lower in transgenic mice. Reduced PTZ-induced activation of zif268 may reflect a decreased sensitivity of NGF-transgenic animals to epilepsy by direct or indirect interaction of NGF with immediate early genes.

Kainate-induced apoptotic cell death in hippocampal neurons

We have examined the role apoptosis plays in epileptic brain damage using intra-amygdaloid injection of kainate. With the silver staining technique of Gallyas, argyrophylic (dying) neurons were observed, a few hours after the injection, in the amygdala and in the vulnerable pyramidal neurons of the hippocampal CA3 region. In both areas, cell death has apoptotic features, including: (i) nuclear chromatin condensation and marginalization with light and electron microscopy; (ii) DNA fragmentation with a typical ladder pattern on agarose gel electrophoresis; (iii) positive nuclear labelling with a selective in situ DNA fragmentation staining method. Combined in situ DNA labelling and silver staining showed that the DNA fragmentation occurred in dying neurons. CA1 or granule cells which do not degenerate following intra-amygdaloid injection of kainate were not stained with the in situ DNA labelling or the argyrophylic technique. Administration of diazepam blocked the kainate-induced seizures and prevented DNA fragmentation in CA3 but not in the amygdala. Therefore, apoptosis contributes to the local and distant damage induced by kainate.

Determination of cardiac output using acoustic quantification in critically ill patients

The reliability of automated acoustic quantification (AQ) in yielding real-time left ventricular (LV) area, volume, and ejection fraction has been validated. The purpose of this study was to explore the potential of AQ in providing accurate immediate determination of cardiac output in critically ill patients. A total of 48 patients were studied. One group consisted of 37 critically ill patients with indwelling Swan-Ganz catheters. In these patients, cardiac output by AQ, manual tracing of end-diastolic and end-systolic frames of 2-dimensional images, and thermodilution were measured. AQ was also compared with Doppler calculation of flow through the left and right ventricles in 11 additional patients. Adequate data for calculation of cardiac output with AQ were obtained in 78% of critically ill patients. There was an excellent correlation between AQ and off-line manual analysis for LV volumes (r = 0.94 and 0.91 for end-diastole and end-systole), ejection fraction (r = 0.85), and cardiac output (r = 0.93). AQ also correlated well with Doppler analysis (r = 0.97) and thermodilution technique (r = 0.95) in the determination of cardiac output. However, AQ slightly underestimated thermodilution measurements, with rather wide limits of agreement (-0.3 +/- 1.1 liter/min). There was a similar underestimation of cardiac output with manual analysis when compared with thermodilution. Given the absence of significant differences between AQ and manual analysis, this observation suggests that the bias is related to the echocardiographic determination of stroke volume, and not to errors from the automated border detection. It is concluded that AQ, besides providing information on LV volumes and ejection fraction, also can yield rapid measurements of cardiac output in most patients who are acutely ill.

Developmental change of alpha-spectrin mRNA in the rat brain

Spectrin is a cytoskeletal protein considered to be a major component of intracellular cohesion. Using an in situ hybridization approach, we have investigated the developmental expression of the mRNA encoding the alpha-subunit of rat brain spectrins, from birth to adulthood. alpha-Subunit mRNA is detectable at birth, in brain areas with perinatal neurogenesis, such as the cerebral cortex, hippocampus, thalamus, and olfactory bulb. alpha-Brain-spectrin mRNA increases gradually during the first postnatal days to reach a plateau between the second and the third week of life. In the young adult brain, the level of alpha-brain spectrin mRNA decreased globally. This spacio-temporal distribution argues for the involvement of the mRNA in the synthesis of both the erythroid and non-erythroid brain spectrin isoforms. We have focused our attention on the hippocampal formation and the cerebellum. In both regions, in situ hybridization signal variations are superimposable with neuronal maturation gradients. This pattern of variation, coupled with the known interaction of brain spectrins with other cytoskeletal proteins, agrees with the notion that brain spectrins may be involved in neuronal differentiation by way of the cytoskeletal lattice organization.

Correlation between reactive sprouting and microtubule protein expression in epileptic hippocampus

Temporal lobe epilepsy in both human and rats is associated with a collateral sprouting of hippocampal mossy fibers (i.e. the axons of granule cells). This sprouting generates abnormal recurrent synaptic connections. We previously showed that in the experimental model of temporal lobe epilepsy induced by an intra-amygdaloid injection of kainate, the synaptic remodeling of mossy fibers was preceded by a transient increased expression of alpha-tubulin in granule cells. This suggests that an overproduction of tubulin polymers may be responsible, at least in part, for the elongation and side-branching of mossy fibers, which occurs 12-30 days after seizures. In the present study we show that this increased expression of alpha-tubulin is accompanied by an increased expression of the microtubule-associated proteins MAP2 and TAU. Thus, using in situ hybridization, we observe that MAP2 messenger RNA levels increased in granule cell bodies and dendrites from day 3 to two weeks after kainate treatment. This rise is associated with a concomitant transient increase of MAP2 immunoreactivity in the granule cell dendrites. TAU messenger RNA also increases in granule cell bodies, while TAU immunoreactivity increases in their axons, the mossy fibers. The time course of these changes parallels that of alpha-tubulin, and develops before and during the axonal mossy fiber sprouting. Since MAP2 and TAU are important for the initiation, elongation and stabilization of neurites, we suggest that the overexpression of these proteins via the formation of microtubules may play an important role in the sprouting of mossy fibers in epileptic rats.

Use of hippocampal slices to study mRNA changes in relation to synaptic plasticity

We have developed a method allowing suitable morphological conservation combined with in situ hybridization, on hippocampal slices used in conventional electrophysiological studies. After a bath application of kainate (KA, 750 nM, 2 min 15 s), electrical stimulation of the mossy fibre zone evoked epileptiform activity for up to 2 h. In situ hybridization performed on these slices showed a marked increased in expression of the transcription factor Zif/268 over the pyramidal and the granule cells and the surrounding neuropils. Bath application of tetraethylammonium (TEA, 25 mM, 10 min) elicited long-term potentiation in CA1 lasting up to 4 h. This was associated with enhanced expression of Zif/268 which returned to control values after 2 h 30 min. These observations suggest that slice preparations are suitable for the study of the role of neuronal activity in the regulation of gene expression.

Apoptosis associated DNA fragmentation in epileptic brain damage

We have examined the epileptic brain damage generated by intra-amygdaloid administration of kainic acid (KA). In the vulnerable CA3 region of the rat hippocampus, neurones developed apoptotic properties since, (i) their nuclei were positively stained with a selective in situ DNA fragmentation staining method; (ii) DNA cleavage into internucleosome-sized fragments was observed on agarose gels. Our results suggest that epileptic seizures generated in the amygdala by KA trigger apoptotic cell damage in pyramidal CA3 neurones.

[Activity of enkephalinase (EC.3.4.24.11). Neutral endopeptidase (NEP)in human digestive tract epithelial cells]

The activity was studied of enkephalinase (endopeptidase 24.11, neutral endopeptidase)--a membrane enzyme of epithelial cells within human digestive tract (in the stomach, duodenum, small intestine, ascending, descending and sigmoid colon, and rectum). The enzyme activity was determined by column method using the labelled substrate (H-D-AlaLeu)--enkephalin and the selective enkephalin inhibitor--thiorfan in the presence of bestatin and captopril--inhibitors of aminopeptidases and angiotensin converting enzyme respectively. The highest enkephalinase activity was found in the duodenal epithelium (77.3 8.0 fmol of the substrate/min/mg of protein) and in the small intestine (23.4 0.9 fmol/min/mg of protein) with its gradual decrease when progressing down the gastrointestinal tract. This result confirms the hypothesis of enkephalinase participation in protein hydrolysis processes.