bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing Foot Temperature Using Infrared Thermography
Authors: Sun Pi-Chang , Jao Shyh-Hua Eric , Cheng Cheng-Kung
Published: January 2017

Background: Previous reports recommended using skin temperature as a guide to monitor neuropathic feet during their rehabilitation course. However, the diagnostic usefulness was limited because of poor thermal measurement and procedures. The purpose of this study was to propose a standardized protocol to quantify foot temperature. Methods: An infrared image system was used to measure skin temperature. The first experiment was conducted on 16 healthy volunteers to study temperature variation with respect to time. This study mapped out six subregions of anatomic interest over the sole, and average temperature values for each were studied. The second experiment was conducted on 62 diabetic patients, with and without sympathetic skin response (SSR), to study proposed sole temperature normalization with respect to forehead temperature for clinical diagnosis. Results: In the first experiment, the temperature in each plantar subregion varied as a function of time. In the sole area, the highest temperature was noted in the arch region (29.3 ± 0.9 degrees C). The toes had the lowest temperature value (26.2 ± 1.2 degrees C) in all areas. Equilibrium was reached after 15 minutes for the mean plantar temperature (27.8 ± 1.0 degrees C). In the second experiment, the diabetic patients without SSR had a slightly higher mean plantar temperature (27.6 ± 1.8 degrees C) than those with SSR (26.8 ± 2.2 degrees C), but the difference was not statistically significant ( p > 0.05). The SSR-absent group (0.19) and the SSR-present group (0.24) had significant differences in their normalized temperatures as proposed ( p < 0.05). Conclusions: The mean temperature of the entire plantar area was found to be more stable than the individual subregions, serving as a more practical indicator for thermoregulatory functions. The study also found that the overall mean plantar temperature stabilized after 15 minutes, and, thus, this time was recommended for clinical thermographic measurements. The normalized temperature may have more useful application than the plantar absolute temperature, as exemplified by the better correlation in diabetic feet. The mean plantar temperature, the wait time to start measurement, and the proposed normalization are believed to play important roles in neuropathic foot disorders.
A Metatarsal Equivalent to the Metacarpal Index in Marfan Syndrome
Authors: Pradhan Ben B. , Bhasin Meenakshi , Otsuka Norman Y.
Published: January 2017

Background: Foot problems are common in patients with Marfan syndrome because of the ligamentous laxity that affects the weightbearing joints most. Such patients frequently are seen by their general practitioners or podiatrists. Educating primary health care providers about a metatarsal index, if it is sufficiently sensitive and specific, may help patients get early and appropriate workup for connective tissue disorders. Methods: A metatarsal equivalent to the metacarpal index (MCI) in the hand was evaluated as a diagnostic tool for Marfan syndrome (and possibly other connective tissue disorders). Fifty-six patients were studied. Sixteen had a genetic diagnosis of Marfan syndrome. There were 20 controls each for the MCI and the metatarsal index (MTI). Hand and foot radiographs were reviewed. Results: The average MCI in patients with Marfan syndrome was 9.8 compared to 7.6 in the control group ( p < 0.0005). The average MTI was 12.7 and 9.8, respectively ( p < 0.0005). An MCI value of 8.5 and an MTI value of 10.5 had the best statistical profiles (combination of sensitivity and specificity) in diagnosing Marfan syndrome in our study population. Conclusion: The MTI as a screening tool for Marfan syndrome is as effective as, if not more than, the well-recognized MCI.
Independent Evaluation of a Recently Described Achilles Tendon Repair Technique
Authors: Calder J.D.F. , Saxby T.S.
Published: January 2017

Background: We investigated a previously reported technique for the repair of acute Achilles tendon ruptures using the percutaneous Achillon® suture system (Intega Life Sciences Corporation, Plainsboro, NJ). Methods: Twenty-five patients with Achilles tendon ruptures were studied prospectively with a minimum of 12 months followup. A single 2- to 3-cm horizontal incision and the Achillon® suture system were used. Early rehabilitation and an active range-of-motion brace were instituted. Results: There were no wound problems, sural nerve injuries, or reruptures. All patients were able to return to their previous sporting activities by 6 months. Conclusions: This independent study confirms that the technique offers patients a safe operative procedure for repair of acute Achilles tendon ruptures that allows early active rehabilitation.
Distal Fibular Length Needed for Ankle Stability
Authors: Uchiyama Eiichi , Suzuki Daisuke , Kura Hideji , Yamashita Toshihiko , Murakami Gen
Published: January 2017

Background: The fibula is commonly used for bone grafts. Previous clinical and biomechanical studies have suggested that the length of the residual portion of the distal part of the fibula has an important effect on the long-term stability of the ankle joint. However, we cannot find clear-cut guidelines for the amount of bone that can be harvested safely. Methods: Using six normal fresh-frozen cadaver legs, motions of the tibia, talus and calcaneus were measured. The fibula was cut sequentially 3 cm from the proximal tip of the fibula and distally 10 cm, 6 cm, and 4 cm from the distal tip of the lateral malleolus. The angular motion of each bone was measured while a medial and lateral traction force of 19.6 N was applied to the proximal tibia. Angles of the tibia, talus, and calcaneus were measured. Results: Sequential resection of the fibula increased the inversion angles of the ankle joint. The proximal 3-cm cut increased the inversion angle from 42.1 ± 6.2 degrees to 49.6 ± 3.6 degrees, and the distal 4-cm cut increased the angle from 57.6 ± 6.6 degrees to 67.4 ± 5.9 degrees. The rotational angles were almost constant with sequential resections of the fibula; however, the distal 4-cm cut increased the rotational angle from 11.3 ± 25.1 degrees to 78.7 ± 37.5 degrees. Conclusions: The whole fibula including the head is essential for the stability of the ankle joint complex, and the distal fibula is responsible for stabilizing the ankle mortise during external rotation and inversion. We recommend fixation of the syndesmosis or bracing to prevent ankle joint instability with rotation of the talus in the mortise, especially when the distal fibula is shortened 6 cm or more.
Increased Passive Ankle Stiffness and Reduced Dorsiflexion Range of Motion in Individuals With Diabetes Mellitus
Authors: Rao Smita R. , Saltzman Charles L. , Wilken Jason , Yak H. John
Published: January 2017

Background: The purpose of our study was to compare ankle range of motion and stiffness in individuals with and without diabetes mellitus using a reliable and valid technique and to document the effect of knee flexion and severity of pathology on ankle range of motion and stiffness. Methods: Twenty-five individuals with diabetes mellitus and 64 nondiabetic individuals, similar in age and gender profile, participated in this study. Results: Results revealed that individuals with diabetes mellitus had both significantly lower peak dorsiflexion range of motion (5.1 and 11.5 degrees, p < 0.001) and higher passive ankle stiffness (0.016 and 0.008 Nm/kg/degree, p < 0.01) than non-diabetic individuals. In individuals with diabetes mellitus, a positive relationship between glycemic control and duration of diabetes mellitus and ankle stiffness (( r 2 = 0.48 and 0.24 respectively, p < 0.01 for both) was found. Conclusion: While decreased range of motion and increased stiffness in the diabetes mellitus population seem clinically intuitive, as far as we know this is the first study to confirm the concurrent existence of both these findings in the plantarflexors in individuals with diabetes mellitus. We applied a reliable and valid technique, one that allowed control of confounding factors such as knee flexion position and differences in determination of end range of motion, and documented a mean 41% loss in dorsiflexion excursion. Changes in the muscle, stemming from underlying pathology, are hypothesized to account for a significant part of the lost range of motion. Changes in ankle range of motion and stiffness may have important implications in plantar loading and ulcer formation.
The Relationship Between the Hindfoot Angle and the Medial Longitudinal Arch of the Foot
Authors: Kanatli Ulunay , Gözil Rabet , Besli Köksal , Yetkin Haluk , Bölükbasi Selcuk
Published: January 2017

Introduction: The relationship of hindfoot valgus and the medial longitudinal arch (MLA) is a well-known parameter for the evaluation of the foot deformities. In this study, we evaluated the relationship between the hindfoot angle and the MLA and the effect of these parameters on the development and general joint laxity of the subjects. Methods: Two-hundred-sixty-one volunteers who had no foot pain or major foot deformity were examined. The age range of the volunteers was 4 to 20 years. For each subject, the right foot was evaluated for the clinical hindfoot angle and footprint analysis. General ligamentous laxity also was recorded. Arch index and valgus index were used for the evaluation of the footprint analysis, and the valgus angle was measured clinically. Results: The average heel valgus angle for all subjects was 5.2 (SD 3.3) degrees. The means of valgus index and arch index were 3.34 (SD, 5.6) and 0.7 (SD, 0.2), respectively. Although there was a positive correlation between the valgus angle and valgus index ( p = 0.027), the arch index was not found to be correlated with these values. Positive correlation between joint laxity and arch height also was demonstrated ( p < 0.05). Conclusions: We concluded that the hindfoot angle and MLA height must be considered separately in clinical practice, particularly in the management of childhood pes planus.
Radiographic Comparison of Standing Medial Cuneiform Arch Height in Adults With and Without Acquired Flatfoot Deformity
Authors: Arangio George A. , Wasser Thomas , Rogman Albéric
Published: January 2017

Background: Adult acquired flatfoot (AAF) is characterized by decreased arch height, talar depression, medial arch depression and elongation, and forefoot abduction. We have measured standing arch height in AAF patients and in a control group of patients using the standing lateral medial cuneiform arch height radiographic measurement. Methods: Fifteen (25 feet) patients were selected with the clinical diagnosis of symptomatic AAF with no secondary diagnoses. A control group consisted of 36 (72 feet) patients with no foot deformities or prior foot surgeries. Arch height was measured in millimeters using the standing medial cuneiform height on the lateral radiographic view. Results: The mean standing medial cuneiform arch height in the control group was 18.38 mm. The mean arch height in the AAF group was 11.04 mm ( p < 0.001). There were no differences between right and left feet in the control group or symptomatic and contralateral feet in the AAF group. Body mass index (BMI) in the control group was 26.17 and in the AAF 33.74. ( p = 0.007). Conclusion: These data provide a control value for the arch height using the medial cuneiform as reference. The decrease in arch height is a strong indicator of AAF. A study with larger numbers of patients is necessary.
Malreduction of the Tibiofibular Syndesmosis in Ankle Fractures
Authors: Gardner Michael J. , Demetrakopoulos Demetris , Briggs Stephen M. , Helfet David L. , Lorich Dean G.
Published: January 2017

Background: Diagnosis and reduction of syndesmosis injuries in ankle fractures can be challenging. Previous studies have demonstrated that standard radiographic measurements used to evaluate the integrity of the syndesmosis are inaccurate. The purpose of this study was to determine the adequacy of standard postoperative radiographic measurements in assessing syndesmotic reduction compared to CT and to determine the prevalence of postoperative syndesmotic malreduction in a patient cohort. Methods: Twenty-five patients with ankle fractures and syndesmotic instability who had open reduction and syndesmotic fixation were evaluated. All patients had a standard radiographic series postoperatively followed by a CT scan. Radiographic measurements were made by three observers to determine the tibiofibular relationship. Axial CT scan images were judged for quality of reduction of the syndesmosis by measuring the distance between the fibula and the anterior and posterior facets of the incisura. Differences between the anterior and posterior measurements of more than 2 mm were considered incongruous. Results: Six patients (24%) had evidence of postoperative diastasis using the radiographic criteria, four of whom had evidence of malreduction on postoperative CT scan. Conversely, 13 patients (52%) had incongruity of the fibula within the incisura on CT scan (average 3.6 mm, range 2.0 to 8.0 mm), only four of whom had one or more abnormal radiographic measurements. In 10 (77%) of the 13 malreductions seen on CT scan, the posterior measurement was greater, indicating that internal rotation or anterior translation of the fibula may have occurred. Sensitivity of radiographs was 31% and the specificity was 83% compared to CT. Conclusions: Many syndesmoses were malreduced on CT scan but went undetected by plain radiographs. Radiographic measurements did not accurately reflect the status of the distal tibiofibular joint in this series of ankle fractures. Furthermore, postreduction radiographic measurements were inaccurate for assessing the quality of the reduction. Although we did not seek to correlate functional outcomes, the known morbidity of postoperative syndesmotic malreduction should lead to heightened vigilance for assessing accurate syndesmosis reduction intraoperatively.
Cytokine-Induced Osteoclastic Bone Resorption in Charcot Arthropathy: An Immunohistochemical Study
Authors: Baumhauer Judith F. , J. O'Keefe Regis , Schon Lew C. , Pinzur Michael S.
Published: January 2017

Background: Charcot arthropathy is a chronic, progressive destructive process affecting bone architecture and joint alignment in people lacking protective sensation. The etiologic factors leading to progressive bone resorption have not been elucidated. The purpose of this study was to histologically examine surgical specimens with Charcot arthropathy for cell type and immunoreactivity of known cytokine mediators of bone resorption. Methods: Tissue samples of 20 specimens with known Charcot arthropathy were stained for Hematoxylin and Eosin (H&E) to quantify cell type. Nine of the specimens were stained with interleukin-1 (IL-1) antibody, nine with tumor necrosis factor (TNF) alpha antibody, and nine with interleukin-6 (IL-6) antibody. Distribution of staining was graded as focal (less than 10% of cells), moderate (10% to 50% of cells), and diffuse (more than 50% of cells) by two independent investigators. Inflammatory cells in tissue sections of rheumatoid synovium served as a positive control. Results: Osteoclasts were seen in excessive numbers lining the resorptive bone lacunae. There was a disproportionate increase in osteoclasts to osteoblasts in the Charcot-reactive bone. In each case, osteoclasts demonstrated immunoreactivity for IL-1, IL-6 and TNF-alpha with a grade of moderate or diffuse reactivity. Conclusion: The findings of excessive osteoclastic activity in the environment of cytokine mediators of bone resorption (IL-1, IL-6, and TNF-alpha) suggest enhanced bone resorption through the stimulation of osteoclastic progenitor cells as well as mature osteoclasts. Alteration in the synthesis, secretion, or activity of these important regulatory molecules through the use of pharmacologic agents may, in turn, alter bone remodeling and loss and lead to accelerated healing without collapse or malalignment.
The Frequency of Digital Artery Resection in Morton Interdigital Neurectomy
Authors: Su Edwin , Carlo Edwin Di , O'Malley Martin , Bohne Walther H.O. , Deland Jonathan T. , Kennedy John G.
Published: January 2017

Background: Operative strategies used in resecting the digital nerve in Morton neuroma emphasize retaining the digital artery. Concern over inadvertent resection of the digital vessel has prompted many surgeons to avoid adjacent interdigital neurectomies when more than one nerve is affected. Methods: The current study examined 674 consecutive pathologic specimens obtained after neurectomy. Results: The digital vessel was identified along with the resected nerve in 39% of specimens. No adverse effect was recorded from these arterial resections. Conclusion: Extensive collateralization of digital vessels is hypothesized to account for the lack of adverse sequelae.
Responsiveness of Two Methods for Measuring Foot and Ankle Volume
Authors: Henschke Nicholas , Boland Robert Anthony , Adams Roger David
Published: January 2017

Background: Measurements of volume are taken in the clinical environment to determine the extent of swelling and to evaluate the effects of treatment interventions. In the research setting, volume measurements are taken to determine experimental outcomes. Water displacement and figure-of-eight methods are highly reliable for measuring foot and ankle volumes, but the responsiveness of the two methods has not been compared. This study was designed to investigate effects of manipulating hydrostatic and blood pressures on foot and ankle volume and responsiveness of the two methods to induced changes in foot and ankle volume. Methods: Intervention effects on volume were compared using water displacement and tape (figure-of-eight) methods. Foot and ankle volume was measured in each of the 30 participants while they were supine, sitting, and sitting with a sphygmomanometer cuff inflated around the lower thigh to occlude blood flow into the leg. These variations allowed manipulation of the hydrostatic and blood pressures acting on the foot and ankle. Results: Data from the water displacement method showed that a significant increase in volume of 31 mL ( p < 0.002) occurred with the cuff in place, but this was not detected using the figure-of-eight method. No significant difference ( p > 0.136) between the sitting and supine positions was detected using either method. Conclusions: Limb dependency while sitting or lying had no effect on measures from either method, but volumetry had a higher responsiveness to changes induced by application of the cuff. This effect was interpreted as arterial leakage past the cuff. Clinical Relevance: The figure-of-eight tape method and the water displacement technique for measuring ankle and foot volume may not be interchangeable. Changes in volume of the ankle and foot are better measured by the water displacement technique, but for measurements of ankle volume alone, the tape method is appropriate. The responsiveness of the tape method to changes in volume is yet to be determined.
Intraoperative Pedography: A Validated Method for Static Intraoperative Biomechanical Assessment
Authors: Richter Martinus , Frink Michael , Zech Stefan , Vanin Nicolas , Geerling Jens , Droste Patrizia , Krettek Christian
Published: January 2017

Background: A new device was developed to perform intraoperative static pedography. The purpose of this study was to validate the introduced method by a comparison with the standard method for dynamic and static pedography. Methods: A device known as Kraftsimulator Intraoperative Pedographie® (KIOP®) was developed for intraoperative placement of standardized forces to the sole of the foot. Pedographic measurements were done with a custom-made mat that was inserted into the KIOP® (Pliance®, Novel Inc., St. Paul, MN, USA). Validation was done in two steps: (1) comparison of standard dynamic pedography walking on a platform, standard static pedography in standing on a platform, and pedography with KIOP® in supine position in 30 healthy volunteers, and (2) comparison of static pedography in standing position, pedography with KIOP® supine awake, and pedography with KIOP® supine with 30 patients under anesthesia. Individuals who had operative procedures at the knee or distal to the knee were excluded. The different measurements were compared (one-way ANOVA, t-test; significance level 0.05). Results: No significant differences were found among all measurements for the hindfoot compared to midfoot-forefoot force distribution. For the medial compared to lateral force distribution and the 10-region-mapping, significant differences were found when comparing all measurements (steps 1 and 2) and when comparing the measurements of step 1 only. No differences were found for these distributions when comparing the measurements of step 2 alone or when comparing the measurements of step 1 and 2 without the platform measurements of step 1 (dynamic walking pedography and static standing pedography). No significant differences in the force distributions were found in step 2 when comparing subjects without anesthesia, with general anesthesia, and with spinal anesthesia. Conclusions: The KIOP device allows a valid static intraoperative pedography measurement. No statistically significant force distribution differences were found between standing subjects and anesthetized subjects in the supine position.
A Comparison of the Tolerability and Efficacy of Lovastatin 20 mg and Fluvastatin 20 mg in the Treatment of Primary Hypercholesterolemia
Authors: Berger Marc L. , Wilson Helene M. , Liss Charles L.
Published: January 2017

Background: To compare the cholesterol-lowering potency of fluvastatin and lovastatin, a randomized, prospective. open-label parallel study was conducted in patients eligible for drug therapy by National Cholesterol Education Program guidelines. The study was conducted at eight centers in the United States.

Methods and Results: Patients were required to follow a cholesterol-lowering diet and were withdrawn from all lipid-lowering agents for 4 weeks prior to study entry. Patients were randomized to receive lovastatin 20 mg or fluvastatin 20 mg daily for 6 weeks. The two treatment groups were comparable with respect to demographic and clinical characteristics. Baseline lipid levels in the two groups were comparable. Lovastatin was significantly more effective than fluvastatin in lowering total cholesterol (-19.5% vs-12.8%, P <.001) and low-density lipoprotein cholesterol (-27.6% vs-18.2%. P <.001). Changes in high-density lipoprotein and triglyceride levels were comparable in the two groups. The differences in cholesterol lowering were similar in the three strata of coronary heart disease risk factor status as defined by the second NCEP Adult Treatment Panel. Both treatments were well tolerated.

Conclusions: Treatment of patients with combined hyperlipidemia and/or low high-density lipoprotein with combination low-dose simvastatin and niacin resulted in large reductions in total, low-density lipoprotein, and very low-density lipoprotein cholesterol and increases in HDL cholesterol. Although the combination was well tolerated in the current trial, its safety needs to be evaluated in larger trials of longer duration.
Atorvastatin, a New HMG-CoA Reductase Inhibitor as Monotherapy and Combined With Colestipol
Authors: Heinonen Therese M. , Schrott Helmut , McKenney James M. , Sniderman Allan D. , Broyles Frances E. , Zavoral James H. , Kivel Frances , Black Donald M.
Published: January 2017

Background: Atorvastatin, a new HMG-CoA reductase inhibitor in clinical development has demonstrated an acceptable safety profile and marked cholesterol and triglyceride reduction at doses ranging from 10-80 mg/day. Since bile acid sequestering resins are often used in combination with HMGRIs to enhance cholesterol reduction, this trial was conducted to explore the use of atorvastatin alone and combined with colestipol in patients with primary hyperlipidemia.

Methods and Results: One hundred six patients with low-density lipoprotein (LDL) cholesterol > 4.1 mM/L (160 mg/dL) and plasma triglycerides < 3.9 mM/L (350 mg/dL) were randomized to treatment consisting of 20 g/day colestipol, 10 mg/day atorvastatin, or 10 mg/day atorvastatin plus 20 g/day colestipol for 12 weeks. Percent change from baseline in lipid variables was measured. The atorvastatin group showed a significant reduction in LDL cholesterol of 35% after 12 weeks. Combination therapy provided an additional 10% reduction in LDL cholesterol over that observed for atorvastatin alone. Twenty-one percent of all patients in the atorvastatin monotherapy group experienced associated adverse events compared with 60% in the combination therapy group. Ninety percent of atorvastatin monotherapy patients were compliant at every visit compared with 75% receiving combination therapy. Conclusions: Although the combination of atorvastatin plus colestipol was more effective in lowering LDL cholesterol than atorvastatin alone, atorvastatin 10 mg/day monotherapy provided a better safety profile and improved patient compliance. which may result in improved long-term cholesterol control.

Conclusions: Although the combination of atorvastatin plus colestipol was more effective in lowering LDL cholesterol than atorvastatin alone, atorvastatin 10 mg/day monotherapy provided a better safety profile and improved patient compliance. which may result in improved long-term cholesterol control.
Protective Effects of Ranolazine on Ventricular Fibrillation Induced by Activation of the ATP-Dependent Potassium Channel in the Rabbit Heart
Authors: Gralinski Michael R. , Chi Liguo , Park James L. , Friedrichs Gregory S. , Tanhehco Elaine J. , McCormack James G. , Lucchesi Benedict R.
Published: January 2017

Background: The authors studied the antifibrillatory effects of the adenosine-triphosphate (ATP)-sparing metabolic modulator ranolazine in a rabbit isolated heart model in which ventricular fibrillation occurs under conditions of hypoxia/reoxygenation in the presence of the ATP-dependent potassium channel opener pinacidil.

Methods and Results: Ten minutes after ranolazine or vehicle administration, addition of pinacidil (1.25 μM) to the buffer was followed by a 12-minute hypoxic period and 40 minutes of reoxygenation. At a reduced concentration of ranolazine (10 μM ), ventricular fibrillation occurred in 60% of the hearts. compared to 89% in the control group ( P = NS). In contrast, only three of nine hearts (33%) treated with 20 μM ranolazine developed ventricular fibrillation ( P <.05 vs vehicle). Hemodynamic parameters including coronary perfusion pressure, left ventricular developed pressure, and ±dP/dt were not affected by the presence of ranolazine in the perfusion medium. Ranolazine did not prevent or modify the negative inotropic or coronary vasodilator actions of pinacidil, suggesting a mechanism of action independent of potassium channel antagonism.

Conclusions: Ranolazine significantly reduced the incidence of ventricular fibrillation in the hypoxic/reoxygenated heart exposed to the ATP-dependent potassium channel opener, pinacidil. The reported ability of ranolazine to prevent the decrease in cellular ATP during periods of a reduced oxygen supply may account for its observed antifibrillatory action. By maintaining intracellular ATP, ranolazine may modulate or prevent further opening of the ATP-dependent potassium channel in response to hypoxia and/or pinacidil.
Evidence of Na Current Contribution to the Transient Outward Current in Cardiac Ventricular Myocytes
Authors: Boutjdir Mohamed , Zhang Zhi-Hao , Huang Boyu , Stergiopoulos Nicholas , El-Sherif Nabil
Published: January 2017

Background: To study the transient outward current (Ito) investigators often use sodium-free external solution to minimize the possible contamination of Ito by sodium current. Removal of extracellular sodium creates reversal of sodium gradient and thus possibly contributing to Ito mainly at positive potentials.

Methods and Results: To address this issue, whole-cell Ito was recorded in sodium-free choline chloride and cobalt solutions, from rat ventricular myocytes known to exhibit a prominent Ito. Depolarizing pulse to 40 mV from-100 mV holding potential every 10 seconds elicited a fast activating and time-dependent inactivating components. The activation of Ito was fast and complete within 10 ms at 40 mV. and the decay was rapid over the first 100 ms of the pulse and slower thereafter. External superfusion of the cell with 50 μM tetrodotoxin reversibly reduced Ito amplitude by 25% from 1.47 ± 0.2 to 1.1 ± 0.3 nA ( P <.04, n = 9). When sea anemone toxin (ATXII), known to selectively enhance INa by causing a delay in the inactivation gate, is applied to the cell, Ito amplitude increased in a time-and dose-dependent manner (EC50 = 86.4 nM). ATXII (100 nM) dramatically increased Itoamplitude at all voltages between-20 and 60 mV (from 1.51 ± 0.4 to 3.35 ± 0.8 nA at 40 mV, P <.003, n = 12). Superfusion of cells with 5 mM 4-AP resulted in 82% reduction in Ito amplitude at 40 mV (from 1.95 ± 0.5 to 0.37 ± 0.2 nA, P <.02, n = 8). Addition of ATXII to 4-AP containing solution increased peak Ito by 965% (from 0.37 ± 0.2 to 3.95 ± 0.9, n = 8, P <.0003). However, in 11 other cells, addition of tetrodotoxin (50 μM) to the ATXII-containing solution blocked ATXII-induced outward current (from 3.51 ± 0.64 nA to 1.60 ± 0.17 nA. P <.05). The conductance (GIto) was calculated by dividing peak Ito by (Vm-EK), with an EK of-75 mV. GIto was increased at all voltages (greater than-40 mV). Normalized GIto was fitted by Boltzmann equation and ATXII did not significantly modify V0.5 and k (from-20.5 ± 3.9 to-17.0 ± 3.5 mV for V0.5. and 12.2 ± 2.6 to 13.4 ± 2.1 mV for k. n = 4). Also, atropine (1 μM) did not have any significant effect on Ito (from 1.92 ± 0.15 nA to 1.85 ± 0.25 nA, n = 5).

Conclusions: The results showed that, in sodium-free external solution, Ito is tetrodotoxin but not atropine sensitive. ATXII-induced Ito increase is 4-aminopyddine insensitive but tetrodotoxin sensitive. These data suggest that outward Na current due to reversal of Na gradient in the absence of external No contributes to Ito. Caution must be taken when studying kinetics and pharmacology of Ito in external sodium-free solutions.
Prevention of Restenosis by Local Drug Delivery
Authors: Makkar Raj R. , Eigler Neal , Litvack Frank , Forrester James S.
Published: January 2017

Local drug therapy for preventing restenosis after angioplasty has been investigated for over a decade. Biologically active agents ranging from drugs to genes can be delivered locally using a wide variety of catheters. Microspheres, liposomes, and polymers have been used to enhance drug retention at the delivery site. More recently stents have been investigated as devices to attain local drug delivery, either by coating with polymers, seeding with genetically modified cells or by using them as a source of local radiation. Though the best method of delivering agents locally remains undefined, this approach is likely to emerge as an essential mode of therapy in the near future.
Effects of Various Modalities of Oral Furosemide Administration in Mild or Severe Congestive Heart Failure
Authors: Cohen Natan , Dishi Victor , Zaidenstein Ronit , Soback Stefan , Weissgarten Joshua , Averbukh Zhan , Gips Marina , Blatt Alex , Berman Silvia , Modai David
Published: January 2017

Background: This study evaluated the optimal formulation (tablet vs solution) and frequency (once vs twice daily) of maintenance oral furosemide in compensated congestive heart failure (CHF).

Methods and Results: Eighteen patients with mild (group 1) and 18 with severe (group 2) CHF were studied. On 2 consecutive days each patient's individual fixed oral furosemide daily dosage was administered in tablet or solution in a crossover design. In an additional study. 14 patients with severe CHF received the daily dosage in tablet or solution form in two divided doses. Pharmacokinetic data were obtained in six randomly allocated patients of each group, during the once daily administration periods of either formulation. Twenty-four-hour urinary sodium and 12-hour volume were significantly greater in group 1 following furosemide solution versus tablets. In group 2, all parameters were comparable in response to single identical doses in tablets or solution. as well as to once versus twice daily administration of either formulation. These results coincided with a higher Cmax and a shorter tmax following solution.

Conclusions: A once-daily oral furosemide solution is more effective than the same dosage in tablet form in patients with mild, but not those with severe, CHF. In patients with severe CHF. the natriuretic and diuretic effects are similar whether oral furosemide in tablet or solution is administered in a once or twice daily schedule.
Vasodilation Effects and Action Mechanisms of TMB-8 on Basilar Artery in Rabbits
Authors: Xiao Jigao , Liu Shirley X. L. , Chen Zhou , Chiou George C. Y.
Published: January 2017

Background: 8-(N,N'-diethylamino)-n-octyl-3,4.5-trimethoxybenzoate (TMB-8) is a potent Ca2+-antagonist that can prevent/treat ischemic stroke and inhibit the contractility of smooth, skeletal. and cardiac muscles. Further studies are warranted to elucidate the efficacy of TMB-8 on rabbit basilar artery preparation and its action mechanisms on vascular smooth muscle cell cultures.

Methods and Results: Effects of TMB-8 on the contractility of rabbit's basilar artery in vitro and those on intracellular free Ca2+ concentrations. [Ca2+]i, were studies with isolated organ bath and Fura-2 methods. Histamine-induced concentration-response curves were shifted by TMB-8 in a mixed manner whereas those of norepinephrine and KCI were shifted in a non-competitive manner. In the presence of nifedipine or in a Ca2+-free medium, 2,5-di(tert-butyl)-1,4-benzohydroquinone (BHQ) (10 μM) induced an immediate transient contraction in rabbit basilar artery, whereas ryanodine showed a slow, weak. sustained contraction, followed by a weak, sustained relaxation. TMB-8 (30 μM) significantly inhibited these contractions of BHQ and ryanodine. Further, aminophylline enhanced the inhibitory action of TMB-8 on vasocontractions. suggesting that TMB-8's inhibitory actions may be related to the increase of cAMP level. The muscle contraction induced by BHQ was enhanced by pretreatment of the artery ring with TMB-8 for 15 minutes and then TMB-8 was rinsed out. These results indicate that TMB-8 pretreatment can increase Ca2+ sequestration into sarcoplasmic reticulum. which leads to a larger subsequent Ca2+ release by BHQ. KCI-induced increase of [Ca2+]i in vascular smooth muscle cells was reduced when the cells were bathed in the medium containing nifedipine. TMB-8 made further reduction on KCI-induced [Ca2+]i increase in nifedipine-containing solution, which had already blocked the voltage-operated Ca2+ entry.

Conclusion: These results indicate that (a) TMB-8 can enhance Ca2+ sequestration into sarcoplasmic reticulum, which leads to a larger amount of Ca2+ that can be released by BHQ; (b) TMB-8 can inhibit KCI-induced muscle contraction caused by the reduction of [Ca2+]i through saturation of Ca2+ inside the sarcoplasmic reticulum rather than a direct blockade of Ca2+-influx at cell membrane site; and (c) TMB-8 increases cAMP, which enhances Ca2+ uptake into the sarcoplasmic reticulum.
Atypical Antipsychotics and the Pharmacology of Olanzapine
Authors: Nihart Mary Ann
Published: January 2017

Atypical antipsychotics present exciting opportunities to improve the quality of life for many individuals who are experiencing the debilitating impact of schizophrenia, a syndrome with complex symptom presentations and unclear cause. In the past the antipsychotic efficacy was thought to correlate with the degree of dopamine blockade; this hypothesis has several limitations. Atypical antipsychotics hold promise for reduced side effects and improved efficacy in treating negative symptoms, possibly through the interactions of neurotransmitters such as serotonin and dopamine. Similar to clozapine, olanzapine (Zyprexa) has a bigh affinityfor a number of subtypes of dopamine receptors and other neurotransmitters. The interrelationship of its actions at multiple receptor sites may account for its improved efficacy in treating negative symptoms and its unique side effect profile.
The Effects of an Ambulatory Collaborative Practice Model on Process and Outcome of Care for Bipolar Disorder
Authors: Shea Nancy M. , McBride Linda , Gavin Christopher , Bauer Mark S.
Published: January 2017

BACKGROUND: Bipolar disorder is a chronic mental illness that affects 1% of the population. Persons with bipolar disorder have substantial rehabilitative potential although research has shown that such mood disorders are undertreated.

OBJECTIVES: The objective was to determine the effect of a high-intensity collaborative practice ambulatory program on process and outcome of care: specifically, patient satisfaction, intensity of medication treatment, and the amount and patterns of service use.

STUDY DESIGN: The Bipolar Disorders Program was structured for easy patient access by assigning clinical nurse specialists as primary caregivers to each patient supported by psychiatrist backup. The first 76 patients enrolled in the Bipolar Disorders Program who completed 6 months served as the sample. A quasiexperimental study was used. A mirror image design was used where relevant measurements before admission to the Bipolar Disorders Program were compared with data during the first 6 months of enrollment.

RESULTS: Patients showed significant increases in satisfaction with care, increases in intensity of medication treatment, and trends toward decreases in neuroleptic exposure. Annualized service use data revealed significant decreases in emergency department use, psychiatric triage use, and psychiatric hospitalization days.

CONCLUSIONS: These data indicated that high-intensity ambulatory treatment for bipolar disorder may have increased both treatment intensity and patient satisfaction and decreased use of costly mental health services.
Writing Pamphlets for Use in Mental Health Clinics
Authors: Kimmel Lee Harter
Published: January 2017

The process of developing customized pamphlets for use in mental health clinics is described. Content of "Facts About Sexuality," a pamphlet developedfor use in a Department of Veteran Affairs Psychiatric Outpatient Department, is reproduced in its entirety because no other pamphlets can be found that includes the entire array of sexuality issues seen in patients in a mental health clinic. To evaluate effectiveness of patient education materials, it is critical to assess patient comprehension, to monitor patient use of the referral sources listed and to assess behavior change.
Social Support, Stress, and Depression among Battered Women in the Judicial Setting
Authors: Constantino Rose E. , Bricker Patricia L.
Published: January 2017

BACKGROUND: Violence has become a major health problem. Battered women have increasingly entered the health care system for treatment ofphysical injuries, stressrelated illnesses, and psychiatric disorders.

OBJECTIVES: This study sought to measure the levels of social support, stress, and depression and to evaluate the relationship among these variables in battered women who were seeking a 'protection from abuse" order.

STUDY DESIGN: A descriptive cobort design was used.

RESULTS: The battered women exhibited high levels of stress and moderate-severe degrees of depression. The women werefound to experience suicidal ideation and disturbances in sleep and nutrition. Relationships among the variables revealed an inverse relationship between social support and stress as well as between social support and depression, suggesting that social support may modulate the negative effects of abuse. Younger women had higher levels of stress and lower social support, which may be reflective of a limited repertoire of coping strategies and an underdeveloped support system.

CONCLUSIONS: Social support interventions may be beneficial to battered women, particularly young women.
Variations in Smoking Policies on Psychiatric Units
Authors: Hamera Edna , Williams Gail J. , Pelan Jackie M. , Agnew Deborah
Published: January 2017

BACKGROUND: The high prevalence of smoking among clients with psychiatric disorders and the effect of smoking on metabolism of psychiatric medications has been documented. Implementation of inpatient smoking policies that alter smoking patterns may affect symptom presentation and medication metabolism.

OBJECTIVE: Variations in how smoking policies are implemented on psychiatric units are described.

DESIGN: A telephone survey of nurses working on 32 psychiatric units was used to collect information about how smoking policies were implemented.

RESULTS: Most (n = 23) units allowed smoking only in designated areas outside the facility. Smoking frequency varied widely, ranging from twice a day to anytime, and some units placed restrictions on the number of cigarettes that could be smoked at each opportunity.

CONCLUSION: The large variation in how smoking policies are implemented warrants further research. Smoking policies may alter smoking practices that affect psychotropic medication blood levels, side effects, and symptom presentation.
Difficult Decisions: Women of Childbearing Age, Mental Illness, and Psychopharmacologic Therapy
Authors: Wintz Celia Janet Boritz
Published: January 2017

The movement of the management of mental illness to community settings has provided an opportunity for persons with serious mental illness to engage in sexual activities, which often results in pregnancy. The need for psychotropic medication during pregnancy and lactation must be weighted against the possible teratogenic organic and behavioral effects of these drugs. A review of the literature presents the risk and benefit considerations of psychotropic drugs to inform care of pregnant and lactating mentally ill women. Although some psychotropic medications are clearly associated with teratogenic effects for offspring, many psychotropic drugs demonstrate no relationship with ill effects. Mental illness, pregnancy, and lactation can be managed in a safe manner if the clinician is knowledgeable about specific teratogenic drug effects and assists the client to make appropriate decisions.
Self-Medication With Alcohol and Drugs by Persons With Severe Mental Illness
Authors: Kasten Bethany Phoenix
Published: January 2017

People with serious mental illnesses are disproportionately likely to experience problems with substance abuse. Attempts to self-medicate symptoms of illness and uncomfortable adverse effects of psychiatric medications are widely assumed to be one of the factors contributing to the high rate of psychiatric illness and substance abuse comorbidity. In this article, biological and psychological theories about self-medication in people with serious mental illness are reviewed, and data from a recent study of recovering "dual diagnosis" patients are used to illustrate aspects of self-medication. Recommendations for nursing include assessing the immediate and long-term effects of substance use on psychiatric symptoms, assisting clients to find the most effective psychotropic medication regime, educating clients about drug/medication interactions, and screeningfor additional comorbid conditions.
Figurate Erythema: An Unusual Presentation of the Nonbullous Phase of Bullous Pemphigoid
Authors: Mussani Farheen , Siddha Sanjay , Rosen Cheryl F.
Published: January 2017

Background and Objective:

Bullous pemphigoid, an autoimmune disorder, most commonly presents as a bullous eruption in patients over the age of 60. There may be a prodromal urticarial or papular eruption that evolves to bullae.

Conclusion:

We report a 46-year-old woman with a figurate erythema presentation of bullous pemphigoid.
Lupus Erythematosus–Associated Primary and Secondary Anetoderma
Authors: Haider Mansoor , Alenazi Madallah , Almutawa Abdulmonem , Alfadley Abdullah
Published: January 2017

Background:

Anetoderma (focal loss of dermal elastic tissue) can either be primary, which is an idiopathic occurrence of anetoderma in normal areas of the skin, or secondary, which is preceded by an inflammatory dermatosis in the same location.

Objective:

Sporadic reports of lupus erythematosus-associated anetoderma have been described in the literature. All reported cases were positive for antiphospholipid antibodies. We present a patient with primary and secondary anetoderma with chronic lupus dermatitis and negative antiphospholipid antibodies.

Method and Results:

A middle-aged woman presented with a soft nodule with a wrinkled surface on her left arm and an erythematous atrophic plaque with a nodular surface on the chest. Skin biopsy from the left arm showed epidermal atrophy without inflammatory changes. Histologic findings of the lesion on the chest were consistent with chronic lupus dermatitis and secondary anetoderma. Laboratory investigations showed positive antinuclear antibody anti-double-stranded deoxyribonucleic acid (DNA) antibody but negative antiphospholipid antibodies.

Conclusion:

Primary and secondary anetodermas may occur in patients of lupus dermatitis without positive antiphospholipid antibodies.
Use of Mark-Recapture Techniques to Estimate the Size of Hard-to-Reach Populations
Authors: Bloor Michael , Wood Fiona , Palmer Stephen
Published: January 2017

Objectives:

To review the main problems associated with mark—recapture methods of population estimation, and to indicate some practical strategies for addressing these problems, with illustrations from a study of drug-use prevalence across Wales.

Methods:

Unnamed identifier data were collected in 1994 on 2610 drug users who were in contact with various agencies across Wales: the police, drug treatment agencies, needle exchanges, probation services, and agencies reporting to the Welsh Drugs Misuse Database.

Results:

Based on the dependency relationships between different agencies' datasets, different estimates of the ‘hidden’ populations (not in contact with agencies) were modelled for each county, for males and females, for injecting drug users and serious drug users, and for those under 25 and those over 25 years of age. Different models were also constructed for the same subpopulations, using different agency datasets and different criteria of overlap between them, yielding a total of 230 different models.

Conclusions:

The issues of sample heterogeneity and population definition are particularly intractable in mark—recapture studies. Sample heterogeneity may be partly addressed by separately modelling different subpopulations to check whether they show the same dependency relationships as the main population. Population definition may be partly addressed by restricting modelling to datasets thought to share roughly congruent population definitions.
The Genomic Revolution: Is the Real Risk Under-Investment Rather than Bankrupt Health Care Systems?
Authors: Danzon Patricia , Towse Adrian
Published: January 2017

There is an element of ‘scientific determinism’ in much of the discussion of the genomic revolution. Recognition of the potential for improving health is more than matched by worries about both the ability of health care systems to cope and the potential for genetic testing to lead to discrimination. There are five main uses for genomics in the development of human diagnostics and therapeutics: pharmacogenomics, gene therapy, pharmacogenetics, genetic testing of symptomatic or at risk people, and population genotyping. Although there are potential health gains, several concerns exist: health gain may increase funding pressures on health care systems; providing cost-effectiveness thresholds may mean drugs for some patient groups may not be developed; random population genetic testing will meet economic and ethical obstacles; and private sector patenting risks a loss of data and access to data, which will inhibit the development of potentially cost-effective tests and therapies.