bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance on the Single-Leg Squat Task Indicates Hip Abductor Muscle Function
Authors: Crossley Kay M. , Zhang Wan-Jing , Schache Anthony G. , Bryant Adam , Cowan Sallie M.
Published: February 2011

Background: Contemporary clinical expertise and emerging research in anterior knee pain indicate that treatment of hip muscle function will result in greater effects, if such treatments can be provided to those with hip muscle dysfunction. Thus, it is imperative to develop and evaluate a clinical assessment tool that is capable of identifying people with poor hip muscle function.

Hypothesis: The clinical assessment of single-leg squat performance will have acceptable inter- and intrarater reliability. Furthermore, people with good performance on the single-leg squat will have better hip muscle function (earlier onset of gluteus medius activity and greater lateral trunk, hip abduction, and external rotation strength) than people with poor performance.

Study Design: Cohort study (diagnosis); Level of evidence, 2.

Methods: A consensus panel of 5 experienced clinicians developed criteria to rate the performance of a single-leg squat task as “good,” “fair,” or “poor.” The panel rated the performance of 34 asymptomatic participants (mean ± SD: age, 24 ± 5 y; height, 1.69 ± 0.10 m; weight, 65.0 ± 10.7 kg), and these ratings served as the standard. The ratings of 3 different clinicians were compared with those of the consensus panel ratings (interrater reliability) and to their own rating on 2 occasions (intrarater reliability). For the participants rated as good performers (n = 9) and poor performers (n = 12), hip muscle strength (hip abduction, external rotation, and trunk side bridge) and onset timing of anterior (AGM) and posterior gluteus medius (PGM) electromyographic activity were compared.

Results: Concurrency with the consensus panel was excellent to substantial for the 3 raters (agreement 87%-73%; κ = 0.800-0.600). Similarly, intrarater agreement was excellent to substantial (agreement 87%-73%; κ = 0.800-0.613). Participants rated as good performers had significantly earlier onset timing of AGM (mean difference, –152; 95% confidence interval [CI], –258 to –48 ms) and PGM (mean difference, –115; 95% CI, –227 to –3 ms) electromyographic activity than those who were rated as poor performers. The good performers also exhibited greater hip abduction torque (mean difference, 0.47; 95% CI, 0.10-0.83 N·m·Bw−1) and trunk side flexion force (mean difference, 1.08; 95% CI, 0.25-1.91 N·Bw−1). There was no difference in hip external rotation torque ( P > .05) between the 2 groups.

Conclusion: Targeted treatments, although considered ideal, rely on the capacity to identify subgroups of people with chronic anterior knee pain who might respond optimally to a given treatment component. Clinical assessment of performance on the single-leg squat task is a reliable tool that may be used to identify people with hip muscle dysfunction.
Knee Laxity Control in Revision Anterior Cruciate Ligament Reconstruction Versus Anterior Cruciate Ligament Reconstruction and Lateral Tenodesis
Authors: Colombet Philippe
Published: February 2011

Background: Rotational laxity control is one of the different options to improve functional results after anterior cruciate ligament reconstruction. Lateral extra-articular tenodesis has been proposed to reduce the rotational laxity, especially in challenging situations such as revision reconstruction after biological failure. We currently lack the practical clinical tools to objectively assess knee rotational laxities.

Hypothesis: Addition of a lateral tenodesis to anatomic single-bundle anterior cruciate ligament reconstruction with hamstring tendon graft could improve the knee laxity control, particularly the internal rotation, compared with a standard single-bundle anterior cruciate ligament reconstruction.

Study Design: Controlled laboratory study.

Methods: Twenty patients underwent navigated anatomic anteromedial bundle revision anterior cruciate ligament reconstruction with addition of percutaneous extra-articular tenodesis using the same hamstring tendon graft. The navigation was used to optimize femoral and tibial tunnel positions and to measure the knee kinematics in response to the anterior drawer test, Lachman test, maximum internal/external rotation test, and pivot-shift test. All patients underwent revision after failure without any technical error found or new trauma. Two sequential reconstruction protocols were used to assess the contribution of the extra-articular tenodesis and single anteromedial bundle anterior cruciate ligament reconstruction to restrain tibial translations and coupled axial rotation occurring with the manually performed clinical laxity tests. In group A, the intra-articular reconstruction was fixed first and then the lateral tenodesis was fixed, and in group B, the protocol was reversed. Measurements were performed before the reconstruction, after the first part was fixed, and after the second part was fixed in each protocol.

Results: At 90° of flexion, addition of lateral tenodesis had a significant effect on coupled internal rotation ( P = .003). Addition of the intra-articular reconstruction to lateral tenodesis had a significant effect ( P = .001) in reducing anterior tibial translation of the medial compartment, and the effect was also significant ( P = .0001) in reduction of lateral compartment translation. For the rotational envelope, lateral tenodesis had a significant effect ( P = .0001) in reducing maximum internal rotation at 90° of flexion.

Conclusion: Addition of an extra-articular procedure provided no significant improvement to anterior tibial translation and improved internal tibial rotation control only at 90° of flexion.
Bone Marrow–Derived Mesenchymal Stem Cells Transduced With Scleraxis Improve Rotator Cuff Healing in a Rat Model
Authors: Gulotta Lawrence V. , Kovacevic David , Packer Jonathan D. , Deng Xiang Hua , Rodeo Scott A.
Published: February 2011

Background: Rotator cuffs heal through a scar tissue interface after repair that makes them prone to failure. Scleraxis (Scx) is a basic helix-loop-helix transcription factor that is thought to direct tendon development during embryogenesis. The purpose of this study was to determine if the application of mesenchymal stem cells (MSCs) transduced with adenoviral-mediated scleraxis (Ad-Scx) could improve regeneration of the tendon-bone insertion site in a rat rotator cuff repair model.

Hypothesis: Bone marrow–derived cells transduced with Scx would improve the structure of the healing tendon-bone interface and result in increased tendon attachment strength.

Study Design: Controlled laboratory study.

Methods: Sixty Lewis rats underwent unilateral detachment and repair of the supraspinatus tendon. Thirty animals received MSCs in a fibrin glue carrier, and 30 received Ad-Scx-transduced MSCs. Animals were sacrificed at 2 weeks and 4 weeks and evaluated for the presence of fibrocartilage and collagen fiber organization at the insertion. Biomechanical testing was performed to determine the structural and material properties of the repaired tissue. Statistical analysis was performed with a Wilcoxon rank sum test with significance set at P = .05.

Results: There were no differences between the Scx and MSC groups in terms of histologic appearance at 2 weeks. However, the Scx group had higher ultimate stress-to-failure (2.6 ± 0.9 vs 1.7 ± 0.3 MPa; P = .03) and stiffness (8.4 ± 2.9 vs 5.0 ± 1.9 N/mm; P = .01) compared with the MSC group. At 4 weeks, the Scx group had more fibrocartilage (728.7 ± 50.4 vs 342.6 ± 217.0 mm2; P = .04), higher ultimate load to failure (26.7 ± 4.6 vs 20.8 ± 4.4 N; P = .01), higher ultimate stress to failure (4.7 ± 1.3 vs 3.5 ± 1.0 MPa; P < .04), and higher stiffness values (15.3 ± 3.4 vs 9.3 ± 2.2 N/mm; P < .001) as compared with the MSC group.

Conclusion: Mesenchymal stem cells genetically modified with Scx can augment rotator cuff healing at early time points.

Clinical Relevance: Biologic augmentation of acutely injured rotator cuffs with Scx-transduced MSCs may improve rotator cuff tendon healing and reduce the incidence of re-tears. However, further studies are needed to determine if this remains safe and effective in larger models.
Influence of Cold Water Immersion on Limb and Cutaneous Blood Flow at Rest
Authors: Gregson Warren , Black Mark A. , Jones Helen , Milson Jordon , Morton James , Dawson Brian , Atkinson Greg , Green Daniel J.
Published: February 2011

Background: Cold water immersion reduces exercise-induced muscle damage. Benefits may partly arise from a decline in limb blood flow; however, no study has comprehensively investigated the influence of different degrees of cooling undertaken via cold water immersion on limb blood flow responses.

Purpose: To determine the influence of cold (8°C) and cool (22°C) water immersion on lower limb and cutaneous blood flow.

Study Design: Controlled laboratory study.

Methods: Nine men were placed in a semireclined position and lowered into 8°C or 22°C water to the iliac crest for two 5-minute periods interspersed with 2 minutes of nonimmersion. Rectal and thigh skin temperature, deep and superficial muscle temperature, heart rate, mean arterial pressure, thigh cutaneous blood velocity (laser Doppler), and superficial femoral artery blood flow (duplex ultrasound) were measured during immersion and for 30 minutes after immersion. Indices of vascular conductance were calculated (flux and blood flow/mean arterial pressure).

Results: Reductions in rectal temperature (8°C, 0.2° ± 0.1°C; 22°C, 0.1° ± 0.1°C) and thigh skin temperature (8°C, 6.2° ± 0.5°C; 22°C, 3.2° ± 0.2°C) were greater in 8°C water than in 22°C ( P < .01). Femoral artery conductance was reduced to a similar extent immediately after immersion (~30%) and 30 minutes after immersion (~40%) under both conditions ( P < .01). In contrast, there was less thigh cutaneous vasoconstriction during and after immersion in 8°C water compared with 22°C ( P = .01).

Conclusion: These data suggest that immersion at both temperatures resulted in similar whole limb blood flow but, paradoxically, more blood was distributed to the skin in the colder water. This suggests that colder temperatures may be associated with reduced muscle blood flow, which could provide an explanation for the benefits of cold water immersion in alleviating exercise-induced muscle damage in sports and athletic contexts.

Clinical Relevance: Colder water temperatures may be more effective in the treatment of exercise-induced muscle damage and injury rehabilitation because of greater reductions in muscle blood flow.
Epidemiology of Muscle Injuries in Professional Football (Soccer)
Authors: Ekstrand Jan , Hägglund Martin , Waldén Markus
Published: February 2011

Background: Muscle injuries constitute a large percentage of all injuries in football.

Purpose: To investigate the incidence and nature of muscle injuries in male professional footballers.

Study Design: Cohort study; Level of evidence, 2.

Methods: Fifty-one football teams, comprising 2299 players, were followed prospectively during the years 2001 to 2009. Team medical staff recorded individual player exposure and time-loss injuries. The first-team squads of 24 clubs selected by the Union of European Football Associations as belonging to the best European teams, 15 teams of the Swedish First League, and another 15 European teams playing their home matches on artificial turf pitches were included. A muscle injury was defined as “a traumatic distraction or overuse injury to the muscle leading to a player being unable to fully participate in training or match play.”

Results: In total, 2908 muscle injuries were registered. On average, a player sustained 0.6 muscle injuries per season. A squad of 25 players can thus expect about 15 muscle injuries per season. Muscle injuries constituted 31% of all injuries and caused 27% of the total injury absence. Ninety-two percent of all muscle injuries affected the 4 major muscle groups of the lower limbs: hamstrings (37%), adductors (23%), quadriceps (19%), and calf muscles (13%). Sixteen percent of the muscle injuries were reinjuries. These reinjuries caused significantly longer absences than did index injuries. The incidence of muscle injury increased with age. When separated into different muscle groups, however, an increased incidence with age was found only for calf muscle injuries and not for hamstring, quadriceps, or hip/groin strains.

Conclusion: Muscle injuries are a substantial problem for players and their clubs. They constitute almost one third of all time-loss injuries in men’s professional football, and 92% of all injuries affect the 4 big muscle groups in the lower limbs.
Subscapularis Function and Structural Integrity After Arthroscopic Repair of Isolated Subscapularis Tears
Authors: Bartl Christoph , Salzmann Gian M. , Seppel Gernot , Eichhorn Stefan , Holzapfel Konstantin , Wörtler Klaus , Imhoff Andreas B.
Published: February 2011

Background: Results of arthroscopic repair of isolated subscapularis tendon tears have not been widely studied. A detailed evaluation of subscapularis function with subscapularis strength quantification has not been performed to date.

Purpose: To evaluate postoperative subscapularis muscle function and to assess the clinical outcome and structural tendon integrity with postoperative magnetic resonance imaging after arthroscopic repair of isolated subscapularis tears.

Study Design: Case series; Level of evidence, 4.

Methods: In a prospective study, isolated subscapularis tendon tears in 21 patients were treated with an all-arthroscopic repair. The average age of the study population was 43 years. The mean interval between trauma and surgery was 5.8 months. In 19 patients, a traumatic event caused the onset of symptoms. Subscapularis muscle function was assessed with specific clinical tests and the Constant scoring system. Postoperative subscapularis strength was evaluated with a custom-made electronic force measurement plate. All patients underwent postoperative magnetic resonance imaging to assess structural integrity of the repair.

Results: The average duration of follow-up was 27 months. The Constant score increased from 50 points preoperatively to 82 points postoperatively ( P < .01). Most positive preoperative lift-off and belly-press tests were reversed by surgery, with a rate of 5 (24%) persistent positive tests after surgery. In operated shoulders, subscapularis strength in the belly-press (65 vs 87 N; P < .05) and the lift-off position (44 vs 68 N; P < .05) was significantly reduced compared with the contralateral shoulder. Magnetic resonance imaging revealed an intact repair in 20 patients. Atrophy of the upper subscapularis muscle portion was present in about one-fourth of the patients and in all patients with a positive postoperative belly-press test.

Conclusion: Arthroscopic repair of isolated subscapularis tendon tears achieves substantial improvement of shoulder function and a low rerupture rate. Despite excellent clinical results, a significant postoperative subscapularis strength deficit compared with the contralateral shoulder persists that can be quantified with use of the force measurement plate. Atrophy of the upper subscapularis muscle is present in 25% of the patients in the postoperative course.
Pitfalls in Measuring Cerebrospinal Fluid Glycine Levels in Infants With Encephalopathy
Authors: Aburahma Samah , Khassawneh Mohammad , Griebel May , Sharp Gregory , Gibson James
Published: February 2011

In encephalopathic infants, cerebrospinal fluid hyperglycinemia and elevated cerebrospinal fluid to plasma glycine ratio are considered pathognomonic of nonketotic hyperglycinemia. To evaluate the significance of cerebrospinal fluid hyperglycinemia and elevated cerebrospinal fluid to plasma glycine ratio in acutely encephalopathic infants, a retrospective chart review of all cases of isolated elevation of cerebrospinal fluid glycine levels at Arkansas Children’s Hospital from January 1995 to December 2000 was performed. Twenty-two patients (14 males) were included. The most common diagnosis was hypoxic ischemic encephalopathy (n = 8). Nine patients had elevated cerebrospinal fluid to plasma glycine ratio, which was transient in 7 patients. This study shows that elevated cerebrospinal fluid to plasma glycine ratio can be encountered in a variety of clinical conditions. The significance of this observation in light of the poor prognosis of nonketotic hyperglycinemia and the possible role of glycine in the mechanism of ischemic neuronal injury is addressed.
‘On Periodical Depressions and their Pathogenesis’ by Carl Lange (1886)
Authors: Schioldann Johan
Published: February 2011

Carl Lange was the founding father of neurology in Denmark, authoring several pioneering works within this field; however, these remained largely unknown internationally as he did not have them translated into a major language. He became a pioneer of psychophysiology with his contribution to the so-called James-Lange theory of emotion. His treatise on ‘periodical depressions’ (‘the Lange theory of depressions’, 1886), is not only an early historical landmark but also a masterly ‘modern’ description concerning the nosology and nosography of recurrent depressions. Moreover, it is a landmark in the early history of lithium therapy, sadly ignored by Lange’s contemporaries, but which little more than half a century later, with Cade’s rediscovery of lithium’s therapeutic effect in mood disorders in 1949, ushered in modern psychopharmacology.
Insidious onset of massive painless ascites as initial manifestation of systemic lupus erythematosus
Authors: Forouhar-Graff H , Dennis-Yawingu KA , Parke AL
Published: February 2011

Ascites in systemic lupus erythematosus (SLE) had once been thought to only occur as a consequence of nephrotic syndrome, protein-losing enteropathy, constrictive pericarditis or Budd–Chiari syndrome. In more recent years, both acute and chronic lupus peritonitis have been documented as another major cause of lupus ascites. Acute lupus peritonitis with ascites tends to develop rapidly, is accompanied by significant abdominal pain and is often associated with other symptoms of lupus flares such as fevers, arthritis, and rashes. On the other hand, chronic lupus peritonitis with ascites develops over several months, is recurrent, and tends to be recalcitrant to treatment with systemic steroids. We present the case of an 18-year-old African-American female whose initial presentation of SLE was gradual onset of massive painless ascites accompanied by anorexia, nausea, vomiting, and diarrhea. The ascites responded well to steroids and immunosuppressive therapy and has not recurred.
Successful rituximab therapy in a lupus patient with diffuse alveolar haemorrhage
Authors: Pottier V , Pierrot M , Subra J-F , Mercat A , Kouatchet A , Parrot A , Augusto J-F
Published: February 2011

Diffuse alveolar haemorrhage (DAH) is a rare but life-threatening complication of systemic lupus erythematosus (SLE). Specific therapy is based on a heavy immunosuppressive treatment that usually associates corticosteroid and cyclophosphamide boluses and plasma exchange. Despite this treatment, an early mortality rate of 20–50% is reported in the literature. Immunosuppression-related complications are responsible for further mortality and morbidity. Rituximab, a specific anti-CD20 antigen B-cell antibody, has been used with success for the treatment of several refractory autoimmune disorders, but rarely for SLE-induced DAH. We report here the first case of SLE-induced DAH treated successfully with rituximab without cyclophosphamide administration in a patient intolerant to cyclophosphamide. We review the two other cases of SLE-induced DAH managed with rituximab as a part of the immunosuppressive regimen.
Acute pancreatitis in pediatric and adult-onset systemic lupus erythematosus: A comparison and review of the literature
Authors: Wang CH , Yao TC , Huang YL , Ou LS , Yeh KW , Huang JL
Published: February 2011

This study aimed to compare differences of acute pancreatitis between adult- and pediatric-onset systemic lupus erythematosus (SLE) patients and to clarify the risk factors for mortality. Medical records that carried the dual diagnosis of SLE and acute pancreatitis between 1991 and 2005 were reviewed. Forty-eight episodes of acute pancreatitis were identified in 13 pediatric-onset SLE (pSLE) and 27 adult-onset SLE (aSLE) patients. The prevalence was 1.34% overall, with higher prevalence in pSLE (5.22%) compared with aSLE (0.99%) ( p < 0.001). The SLEDAI score on presentation of acute pancreatitis was higher in pSLE (mean ± SD: 21.77 ± 13.09) than in aSLE patients (13.37 ± 8.32) ( p = 0.05). Eleven patients died during episodes of acute pancreatitis and mortality rate was significantly higher in pSLE than in the aSLE group (53.8% and 14.8%, respectively, p = 0.015). Mortality was associated with concurrent SLE symptoms ( p = 0.049), higher SLEDAI score at presentation of acute pancreatitis ( p = 0.011), severe acute pancreatitis ( p < 0.001), and the presence of complications ( p < 0.001). The multivariate logistic regression analysis showed that severity of acute pancreatitis was the most powerful risk factor for mortality in SLE patients with this disease. In summary, our results indicate that acute pancreatitis occurs more frequently, tends to be more severe, and is associated with higher mortality in pSLE patients when compared with aSLE patient.
Galectin-1-induced down-regulation of T lymphocyte activation protects (NZB x NZW) F1 mice from lupus-like disease
Authors: Liu SD , Lee S , Cava A La , Motran CC , Hahn BH , Miceli MC
Published: February 2011

Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by a hyperactive immune system, including activation of autoreactive T and B cells. These studies demonstrate that administration of recombinant galectin-1, a β-galactose binding protein, to SLE-prone (NZB × NZW) F1 mice reduced lymphocyte activation, inhibited serum anti-double-stranded DNA(dsDNA) IgG antibody production, decreased the incidence of proteinuria, and increased survival rate. In addition, recombinant galectin-1’-treated mice had a higher frequency of Foxp3 expression, which suggested an increase in the percentage of peripheral regulatory T cells. Consistent with the finding that there were fewer activated T lymphocytes, ex vivo T cells from mice treated with recombinant galectin-1 exhibited less proliferation in response to TCR stimulation. Furthermore, these cells were less efficient at lipid raft clustering in response to TCR/CD28 engagement, consistent with published reports that galectin-1 can reorganize the synaptic contact to interfere with TCR signaling and activation to prevent T cell activation. Aged galectin-1-deficient mice had higher serum levels of antibodies against dsDNA, elucidating a role for endogenous galectin-1 in decreasing susceptibility to autoimmunity. Together, the findings highlight galectin-1 as a novel potential therapeutic immune modulator for treatment of lupus-like disease.
Adaptive Energy Absorbers for Drop-induced Shock Mitigation
Authors: Wereley Norman M. , Choi Young-Tai , Singh Harinder J.
Published: February 2011

This study addresses the non-dimensional analysis of adaptive magnetorheological energy absorbers (MREAs) for drop-induced shock mitigation. The control objective to ensure that the payload mass comes to rest at the end of the available stroke of the MREA, that is, a ‘soft landing.’ The governing equation of motion of a single-degree-of-freedom system with an MREA was derived. The Bingham number was defined and its effect on the system response was examined. A comprehensive non-dimensional analysis was conducted using non-dimensional stroke, velocity and acceleration, where Bingham number and time constant were key parameters. An optimal Bingham number - based on drop velocity, payload mass, and passive damping - minimized the drop-induced shock loads transmitted to the payload by utilizing maximum damper stroke.
Effect of Telmisartan and Ramipril on Atrial Fibrillation Recurrence and Severity in Hypertensive Patients With Metabolic Syndrome and Recurrent Symptomatic Paroxysmal and Persistent Atrial Fibrillation
Authors: Fogari Roberto , Mugellini Amedeo , Zoppi Annalisa , Preti Paola , Destro Maurizio , Lazzari Pierangelo , Derosa Giuseppe
Published: February 2011

This study evaluated the effect of telmisartan, ramipril, and amlodipine on atrial fibrillation (AF) recurrence and severity in hypertensive patients with metabolic syndrome. A total of 391 hypertensive outpatients with metabolic syndrome, in sinus rhythm but with at least 2 episodes of AF in the previous 6 months were randomized to telmisartan, ramipril, or amlodipine for 1 year. At the first AF, ventricular rate (VR) and plasma cardiac troponin I (TnI) were evaluated. P-wave dispersion (PWD) and procollagen type I carboxy-terminal peptide (PIP) were evaluated before and after 12 months of treatment. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were similarly and significantly reduced by all treatments ( P < .001). In all, 49% of patients treated with amlodipine had a recurrence of AF as did 25.5% of patients with ramipril and 12.9% of patients with telmisartan ( P < .01 vs amlodipine and P < .05 vs ramipril). Ventricular rate and TnI at the first AF recurrence were significantly lower with telmisartan and ramipril than with amlodipine. P-wave dispersion was reduced by ramipril (−5.1 ms, P < .05) and even more by telmisartan (−11 ms, P < .01). Telmisartan and ramipril induced a similar PIP reduction (−52.8 and −49.8 µg/L, respectively, P < .01). These findings suggested that in these patients telmisartan was more effective than ramipril in reducing AF recurrence and severity as well as in improving PWD, despite a similar BP reduction and a similar improvement in cardiac fibrosis. This could be related to a specific effect of telmisartan on atrial electric remodeling.
A Pharmacist Care Program
Authors: Chan Chi-Wai , Siu Shing-Chung , Wong Carmen K. W. , Lee Vivian W. Y.
Published: February 2011

Objective: To investigate the effect of a pharmacist care program on cardiovascular risks in type 2 diabetic patients. Methods: A 9-month, prospective, randomized, controlled study was conducted in a public hospital in Hong Kong. Patients in the intervention group had regular drug-counseling sessions with pharmacists in addition to routine medical care, whereas patients in the control group received only routine medical care. The primary outcome was the change in coronary heart disease (CHD) risk. Results: A total of 105 patients completed the study. Patients in the intervention group had a statistically significant reduction in CHD risk compared to those in the control group (−1.64% ± 3.56%; n = 51 vs −0.01% ± 3.08%; n = 54, P = .013). For stroke, a reduction in risk was noted in the intervention group, while an increased risk was noted in the control group (−1.06% ± 1.82% vs 0.31% ± 2.51%, P = .002). In addition, hemoglobin A1c levels were significantly reduced in the intervention group compared with the control group (−1.57% ± 1.50% vs –0.40% ± 1.19%, P < .001); a similar profile was seen with low-density lipoprotein cholesterol (−0.36 ± 0.76 vs −0.03 ± 0.74, P = .026). Furthermore, there were nonsignificant improvements in high-density lipoprotein cholesterol, triglyceride, and blood pressure in the intervention group. The increased level of understanding regarding medications in the intervention group was statistically significant ( P < .001), yielding a better enhancement in compliance compared with patients in the control group (22.5% ± 13.4% vs 2.0% ± 5.0%, P < .001). Conclusion: The pharmacist care program implemented in this study demonstrated a significant cardiovascular risk reduction in type 2 diabetic patients; therefore such a program would be a valuable addition to a multidisciplinary care of diabetic patients.
Adenosine Receptor-Mediated Cardioprotection
Authors: McIntosh Victoria J. , Lasley Robert D.
Published: February 2011

Adenosine is a purine nucleoside, which is produced primarily through the metabolism of adenosine triphosphate (ATP), therefore its levels increase during stressful situations when ATP utilization increases. Adenosine exerts potent cardioprotective effects on the ischemic/reperfused heart, reducing reversible and irreversible myocardial injury. Adenosine receptors (ARs) are G-protein-coupled receptors, and 4 subtypes exist—A1, A2A, A2B, and A3, all of which have been shown to be cardioprotective. Adenosine receptors are expressed on multiple cardiac cells, including fibroblasts, endothelial cells, smooth muscle cells, and myocytes. Activation of both A1 and A3 receptors prior to ischemia has been shown in multiple experimental models to reduce ischemia/reperfusion-induced cardiac injury. Additionally, activation of the A2A receptor at the onset of reperfusion has been shown to reduce injury. Most recently, there is evidence that the A2B receptor has cardioprotective effects upon its activation. However, controversy remains regarding the precise timing of activation of these receptors required to induce cardioprotection, as well as their involvement in ischemic preconditioning and postconditioning. Adenosine receptors have been suggested to reduce cell death through actions at the mitochondrial ATP-dependent potassium (KATP) channel, as well as protein kinase C and mitogen-activated protein kinase (MAPK) signaling. Additionally, the ability of ARs to interact has been documented, and several recent reports suggest that these interactions play a role in AR-mediated cardioprotection. This review summarizes the current knowledge of the cardioprotective effects of each AR subtype, as well as the proposed mechanisms of AR cardioprotection. Additionally, the role of AR interactions in cardioprotection is discussed.
Review of Contemporary Antiarrhythmic Drug Therapy for Maintenance of Sinus Rhythm in Atrial Fibrillation
Authors: Singla Sandeep , Karam Pascal , Deshmukh Abhishek J. , Mehta Jawahar , Paydak Hakan
Published: February 2011

Atrial fibrillation (AF) is the most common rhythm disturbance seen in clinical practice, and its prevalence and incidence are rising rapidly as the population ages with its attendant complications. Management of AF involves anticoagulation, and fortunately new drugs for long-term anticoagulation are now available. Maintenance of sinus rhythm, though intuitively better than rate control strategy, has not been shown to offer mortality benefit. Still, maintenance of sinus rhythm is considered an appropriate therapeutic strategy when symptoms are not adequately controlled with rate control. Though significant advances have been made in ablation techniques for AF, pharmacological therapy is still the first line of treatment for rate control and maintenance of sinus rhythm, given ease of use, noninvasive nature, and limited experience with catheter-based ablation techniques. Class IC and III agents (Vaughan Williams classification) form the backbone for pharmacological maintenance of sinus rhythm. Dronedarone, a recently approved class III agent, provides a significant advance because of its relatively safe side effect profile. Currently drugs with selective atrial channels blocking properties, like Vernakalant, are being tested in trials and may provide an opportunity to maintain sinus rhythm with limited toxicity. Large trials are also being conducted to better define the efficacy of catheter-based ablation strategy as first-line treatment. Here, we review the current status of commonly used antiarrhythmic medications for the maintenance of sinus rhythm in AF.
Trust, risk and the (mis)management of contingency and discretion through new information technologies in children’s services
Authors: Pithouse Andrew , Broadhurst Karen , Hall Chris , Peckover Sue , Wastell Dave , White Sue
Published: February 2011

• Summary: While UK social work’s core purpose in children’s services continues to invoke the ready virtues of universal care, protection from significant harm and a child rights led approach as foundational to effective intervention, there is a ‘real-world’ context of organizational practices that inevitably mediate who gets what services and why. This was ever thus. What has changed however is not so much the claims by social work to a virtuous purpose (the ethic of care offers a durable discourse from which to cast service users as worthy and our efforts as honourable) but that new risk-reduction technologies are exposing a worrying gap between the rhetoric of a humane-oriented project of care and the actionable decision-making of professionals drawing upon administrative targeting systems that seek to reduce organizational exposure to error, blame, reputational damage and unwanted external scrutiny.

• Findings: The article exposes a gap between core values and risk management by examining the erosion of trust in professional social work and consequent shift towards new information technologies which intend to generate system confidence, such as the Integrated Children’s System (ICS) which seeks to provide a more accountable management of contingency. Drawing on data from our recent multi-method research of frontline practice funded by the UK Economic and Social Research Council, we challenge the view that the uncertainty and ambiguity of risk-immersed social work can be more safely moderated by computer-based technologies for reporting and decision-making.

• Applications: The findings of this study suggest the need for significant reform of the ICS system. Our explorations in front line decision-making suggests that the IT workflow systems that channel and shape the way need is responded to in order to make actions and their often distributed ownership transparent and justifiable, have the unintended potential to obscure risk. We outline ways in which risk in its institutional and personal contexts in children’s services may become less evident and tractable to moderation by the ICS systems that seek this very purpose. In doing so we consider the balance between professional trust and system confidence and consider whether the time has come to shift the balance back to the former if we are to re-engage more fully with the occupation’s humane mission.
A parting of the ways? The diverging nature of mental health social work in the light of the new Acts in Scotland, and in England and Wales
Authors: Mackay Kathryn
Published: February 2011

•  Summary: This article uses the concept of citizenship to explore the recent mental health statutes within England and Wales and within Scotland. It argues that differences in the content, and practice context, herald a parting of the ways in mental health social work in the United Kingdom.

•  Findings: The author focuses on three key differences: the reciprocity principle, the grounds for compulsory treatment and the place of social work within compulsory intervention to demonstrate how the statutes have led to more limited legal, procedural and social rights in England and Wales than in Scotland. The result for social work is that the practice context created in England and Wales may become more risk averse and that social work services may have a more residual role within statutory mental health work. The differences described in this article may also reflect increasing post-devolution divergence in the provision of social work services across the four countries that make up the United Kingdom.

•  Applications: Further research is needed to explore if these divergences, within mental health law and policy, are in practice supporting or limiting citizenship.
β3 Receptors: role in cardiometabolic disorders
Authors: Bhadada Shraddha V. , Patel Bhoomika M. , Mehta Anita A. , Goyal Ramesh K.
Published: February 2011

Pharmacological and molecular approaches have shown that an atypical β-adrenoceptor (AR), called β3-AR, that is distinct from β1-ARs and β2-ARs, exists in some tissues in heterogeneous populations such as β3a-ARs and β3b-ARs. β3-ARs belong to a superfamily of receptors linked to guanine nucleotide binding proteins (G proteins). The β3-AR gene contains two introns whereas the β1-AR and β2-AR genes are intronless, leading to splice variants. β3-ARs can couple to Gi and Gs and they are reported to be present in brown adipose tissue, vasculature, the heart, among other tissues. β3-ARs cause vasodilation of microvessels in the islets of Langerhans and may participate in the pathogenesis of cardiac failure, during which modification of β1-AR and β2-AR expression occurs. The development of β3-AR agonists has led to the elaboration of promising new drugs, including antiobesity and antidiabetic drugs. This article reviews the various pharmacological actions of β3-ARs and their clinical implications for diabetes and cardiovascular diseases.
Maternal Acculturation
Authors: Farokhi Moshtagh R. , Cano Stephanie M. , Bober-Moken Irene G. , Bartoloni Joseph A. , Cunningham Sue E. D. , Baez Martha X.
Published: February 2011

A mother’s cultural beliefs can affect her infant’s health, but the influence of acculturation of Mexican-American women on their young children’s oral health is unknown. The authors hypothesized that maternal acculturation impacts very young children’s oral health practices favoring, in particular, the mothers who are more Anglo-oriented. A convenience sample of 204 predominantly Mexican-American women attending the Women, Infants, and Children Clinic in San Antonio, Texas, completed the Knowledge, Attitudes, Beliefs, Social Support, and Self-Efficacy of Oral Health (KASE-OH) and Acculturation Questionnaires. Results indicated that mothers with strong Anglo orientation were more likely educated in the United States, first visited a dentist while in elementary school, and breast-fed their children. Children belonging to Anglo-oriented Mexican-American mothers had stronger oral health practices, were more likely to breast-feed, were exposed to more sugary and acidic drinks, consumed higher levels of candy, had Medicaid coverage, and had stronger supervisions of tooth brushing practices.
Comparative genomics allowed the identification of drug targets against human fungal pathogens
Authors: Abadio Ana Karina R , Kioshima Erika S , Teixeira Marcus M , Martins Natalia F , Maigret Bernard , Felipe Maria Sueli S
Published: February 2011

Background

The prevalence of invasive fungal infections (IFIs) has increased steadily worldwide in the last few decades. Particularly, there has been a global rise in the number of infections among immunosuppressed people. These patients present severe clinical forms of the infections, which are commonly fatal, and they are more susceptible to opportunistic fungal infections than non-immunocompromised people. IFIs have historically been associated with high morbidity and mortality, partly because of the limitations of available antifungal therapies, including side effects, toxicities, drug interactions and antifungal resistance. Thus, the search for alternative therapies and/or the development of more specific drugs is a challenge that needs to be met. Genomics has created new ways of examining genes, which open new strategies for drug development and control of human diseases.

Results

In silico analyses and manual mining selected initially 57 potential drug targets, based on 55 genes experimentally confirmed as essential for Candida albicans or Aspergillus fumigatus and other 2 genes (kre2 and erg6) relevant for fungal survival within the host. Orthologs for those 57 potential targets were also identified in eight human fungal pathogens (C. albicans, A. fumigatus, Blastomyces dermatitidis, Paracoccidioides brasiliensis, Paracoccidioides lutzii, Coccidioides immitis, Cryptococcus neoformans and Histoplasma capsulatum). Of those, 10 genes were present in all pathogenic fungi analyzed and absent in the human genome. We focused on four candidates: trr1 that encodes for thioredoxin reductase, rim8 that encodes for a protein involved in the proteolytic activation of a transcriptional factor in response to alkaline pH, kre2 that encodes for α-1,2-mannosyltransferase and erg6 that encodes for Δ(24)-sterol C-methyltransferase.

Conclusions

Our data show that the comparative genomics analysis of eight fungal pathogens enabled the identification of four new potential drug targets. The preferred profile for fungal targets includes proteins conserved among fungi, but absent in the human genome. These characteristics potentially minimize toxic side effects exerted by pharmacological inhibition of the cellular targets. From this first step of post-genomic analysis, we obtained information relevant to future new drug development.
General practitioners' and district nurses' conceptions of the encounter with obese patients in primary health care
Authors: Hansson Lena M , Rasmussen Finn , Ahlstrom Gerd I
Published: February 2011

Background

Primary health care specialists have a key role in the management of obesity. Through understanding how they conceive the encounter with patients with obesity, treatment may be improved. The aim of this study was thus to explore general practitioners' and district nurses' conceptions of encountering patients with obesity in primary health care.

Method

Data were collected through semi-structured interviews, and analysed using a phenomenographic approach. The participants were 10 general practitioners (6 women, 4 men) and 10 district nurses (7 women, 3 men) from 19 primary health care centres within a well-defined area of Sweden.

Results

Five descriptive categories were identified: Adequate primary health care, Promoting lifestyle change, Need for competency, Adherence to new habits and Understanding patient attitudes. All participants, independent of gender and profession, were represented in the descriptive categories. Some profession and gender differences were, however, found in the underlying conceptions. The general staff view was that obesity had to be prioritised. However, there was also the contradictory view that obesity is not a disease and therefore not the responsibility of primary health care. Despite this, staff conceived it as important that patients were met with respect and that individual solutions were provided which could be adhered to step-by-step by the patient. Patient attitudes, such as motivation to change, evasive behaviour, too much trust in care and lack of self-confidence, were, however, conceived as major barriers to a fruitful encounter.

Conclusions

Findings from this study indicate that there is a need for development and organisation of weight management in primary health care. Raising awareness of staff's negative views of patient attitudes is important since it is likely that it affects the patient-staff relationship and staff's treatment efforts. More research is also needed on gender and profession differences in this area.
Low prevalence of H. pylori Infection in HIV-Positive Patients in the Northeast of Brazil
Authors: Fialho Andréa BC , Braga-Neto Manuel B , Guerra Eder JC , Fialho André MN , Fernandes Karine C , Sun Juliana LM , Takeda Christianne FV , Silva Cícero IS , Queiroz Dulciene MM , Braga Lucia LBC
Published: February 2011

Background

This study conducted in Northeastern Brazil, evaluated the prevalence of H. pylori infection and the presence of gastritis in HIV-infected patients.

Methods

There were included 113 HIV-positive and 141 age-matched HIV-negative patients, who underwent upper gastrointestinal endoscopy for dyspeptic symptoms. H. pylori status was evaluated by urease test and histology.

Results

The prevalence of H. pylori infection was significantly lower (p < 0.001) in HIV-infected (37.2%) than in uninfected (75.2%) patients. There were no significant differences between H. pylori status and gender, age, HIV viral load, antiretroviral therapy and the use of antibiotics. A lower prevalence of H. pylori was observed among patients with T CD4 cell count below 200/mm3; however, it was not significant. Chronic active antral gastritis was observed in 87.6% of the HIV-infected patients and in 780.4% of the control group (p = 0.11). H. pylori infection was significantly associated with chronic active gastritis in the antrum in both groups, but it was not associated with corpus chronic active gastritis in the HIV-infected patients.

Conclusion

We demonstrated that the prevalence of H. pylori was significantly lower in HIV-positive patients compared with HIV-negative ones. However, corpus gastritis was frequently observed in the HIV-positive patients, pointing to different mechanisms than H. pylori infection in the genesis of the lesion.
Acute and second-meal effects of almond form in impaired glucose tolerant adults: a randomized crossover trial
Authors: Mori Alisa M , Considine Robert V , Mattes Richard D
Published: February 2011

Background

Nut consumption may reduce the risk of developing type 2 diabetes. The aim of the current study was to measure the acute and second-meal effects of morning almond consumption and determine the contribution of different nut fractions.

Methods

Fourteen impaired glucose tolerant (IGT) adults participated in a randomized, 5-arm, crossover design study where whole almonds (WA), almond butter (AB), defatted almond flour (AF), almond oil (AO) or no almonds (vehicle - V) were incorporated into a 75 g available carbohydrate-matched breakfast meal. Postprandial concentrations of blood glucose, insulin, non-esterified free fatty acids (NEFA), glucagon-like peptide-1 (GLP-1) and appetitive sensations were assessed after treatment breakfasts and a standard lunch.

Results

WA significantly attenuated second-meal and daylong blood glucose incremental area under the curve (AUCI) and provided the greatest daylong feeling of fullness. AB and AO decreased blood glucose AUCI in the morning period and daylong blood glucose AUCI was attenuated with AO. WA and AO elicited a greater second-meal insulin response, particularly in the early postprandial phase, and concurrently suppressed the second-meal NEFA response. GLP-1 concentrations did not vary significantly between treatments.

Conclusions

Inclusion of almonds in the breakfast meal decreased blood glucose concentrations and increased satiety both acutely and after a second-meal in adults with IGT. The lipid component of almonds is likely responsible for the immediate post-ingestive response, although it cannot explain the differential second-meal response to AB versus WA and AO.