bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Risk of Mortality Associated With Selective and Combined Elevation in Office, Home, and Ambulatory Blood Pressure
Authors: Mancia Giuseppe , Facchetti Rita , Bombelli Michele , Grassi Guido , Sega Roberto
Published: March 2006

In the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study, office, home, and ambulatory blood pressure (BP) values were measured contemporaneously between 1990 and 1993 in a large population sample (n=2051). Cardiovascular (CV) and non-CV death certificates were collected over the next 148 months, which allowed us to assess the prognostic value of selective and combined elevation in these 3 BPs over a long follow-up. There were 69 CV and 233 all-cause deaths. Compared with subjects with normal office and 24-hour BP, the hazard ratio for CV death showed a progressive increase in those with a selective office BP elevation (white-coat hypertension), a selective 24-hour BP elevation (masked hypertension), and elevation in both office and 24-hour BP. This was the case also when the above conditions were identified by office versus home BP values. Selective elevation in home versus ambulatory BP or vice versa also carried an increased risk. There was indeed a progressive increase in both CV and all-cause mortality risk from subjects in whom office, home, and ambulatory BP were all normal to those in whom 1, 2, or all 3 BPs were elevated, regardless of which BP was considered. The trends remained significant after adjustment for age and gender, as well as, in most instances, after further adjustment for other cardiovascular risk factors. Thus, white-coat hypertension and masked hypertension, both when identified by office and ambulatory or by office and home BPs, are not prognostically innocent. Indeed, each BP elevation (office, home, or ambulatory) carries an increase in risk mortality that adds to that of the other BP elevations.
Association of Hemoglobin Delivery With Left Ventricular Structure and Function in Hypertensive Patients
Authors: Narayan Puneet , Papademetriou Vasilios , Wachtell Kristian , Gerdts Eva , Boman Kurt , Nieminen Markku S. , de Simone Giovanni , Dahlöf Björn , Fyhrquist Frej , Hoieggen Aud , Devereux Richard B.
Published: March 2006

Several studies have shown associations of high levels of hemoglobin (Hgb) or blood viscosity with cardiac events and with left ventricular (LV) hypertrophy (LVH). To assess the relations of LV mass and function with Hgb delivery (ie, the physiological carrier of oxygen), we calculated the product of Hgb concentration and Doppler-derived cardiac output in 864 hypertensive participants with electrocardiographic LVH (359 women) in the Losartan Intervention for End Point Reduction in Hypertension echocardiography substudy. Among women, Hgb delivery was positively related to internal dimension, septal and posterior wall thicknesses, LV mass, endocardial and midwall fractional shortening, and peak A wave velocity and negatively to total peripheral resistance index, E/A ratio, deceleration time, and the isovolumic relaxation time. Among men, Hgb delivery was positively related to LV internal dimension, LV mass, and A velocity, and negatively to LV midwall shortening, relative wall thickness, peripheral resistance index, and E/A ratio. In multivariable analyses that adjusted for age, diastolic blood pressure, body mass index, and total cholesterol, hemoglobin delivery in women was related positively to LV fractional shortening, midwall shortening, LV mass mitral valve A velocity, and LV internal dimension and negatively to mitral valve deceleration time and isovolumic relaxation time. Among men, Hgb delivery had positive independent relations to mitral valve A velocity, LV internal dimension, midwall shortening, and LV mass and negative relations to the E/A ratio and relative wall thickness. Thus, in hypertensive LVH, higher oxygen delivery capacity is associated with higher LV mass and impaired early diastolic LV filling.
Polymorphism in Endothelin-Related Genes Limits Exercise-Induced Decreases in Arterial Stiffness in Older Subjects
Authors: Iemitsu Motoyuki , Maeda Seiji , Otsuki Takeshi , Sugawara Jun , Tanabe Takumi , Jesmin Subrina , Kuno Shinya , Ajisaka Ryuichi , Miyauchi Takashi , Matsuda Mitsuo
Published: March 2006

Increase in arterial stiffness is associated with aging, which is improved by regular exercise. Endothelin (ET) system has crucial roles in regulating vascular tone and in the progression of atherosclerosis. We hypothesized that molecular variations (ie, gene polymorphisms) in ET-related gene might affect exercise-induced improvement in arterial stiffness with age in human subjects. The present study provides a cross-sectional investigation of 191 healthy middle-aged and older (65±1 years) human subjects to clarify the relationship between the regular exercise-induced improvement of arterial stiffness and the gene polymorphisms of ET converting enzyme (ECE)-1, ECE-2, ET-A receptor (ET-A), and ET-B receptor (ET-B). The study subjects were divided into active and inactive groups based on the median value (186 kcal/d) of energy expenditure. Brachial-ankle arterial pulse wave velocity (baPWV) was used to evaluate arterial stiffness. All individuals were genotyped for 4 different polymorphisms of the ET system: 2013(+289)A/G in intron 17 of ECE-1, 669(+17)T/C in intron 5 of ECE-2, 958A/G in exon 6 of ET-A, and 831A/G in exon 4 of ET-B. The baseline baPWV was significantly lower in the active group without any change in blood pressure. Polymorphisms in ECE-1 influenced basal blood pressure. Polymorphisms in ECE-1 and ECE-2 had no effect on baPWV between active and inactive groups. However, polymorphisms in both ET-A and ET-B affected baPWV in the 2 groups. The present results suggest that differences in ET-A and ET-B polymorphisms may influence the response of the vascular wall to exercise whereas ECE-1 polymorphisms may affect basal blood pressure.
Emergence of Novel Genetic Effects on Blood Pressure and Hemodynamics in Adolescence
Authors: Kupper Nina , Ge Dongliang , Treiber Frank A. , Snieder Harold
Published: March 2006

Multiple longitudinal studies have demonstrated reasonable stability of blood pressure (BP) levels and hemodynamics throughout childhood and adolescence and into adulthood. Part of this stability might be caused by genetic factors that are expressed steadily over time. We aimed to determine the relative contributions of genetic and environmental factors to the stability of BP and underlying hemodynamic characteristics between ages 14 and 18 years. In addition, potential ethnic differences were examined. To this end, resting levels of BP and impedance-derived hemodynamic variables were measured twice in >500 pairs of European American (EA) and African American (AA) twins, with an intervening period of 4.1 years. Structural equation modeling of the twin data on BP and underlying hemodynamic variables (adjusted for age, sex, and body mass index) showed that heritabilities were moderate to high (25% to 64%) and relatively stable over time. These genetic influences accounted for 60% to 100% of the phenotypic tracking correlations (range 0.39 to 0.62). Emergence of novel genetic influences accounted for a significant part of the variance (17% to 33%) at the second measurement occasion. There were significant ethnic differences for BP, with nonshared environmental influences becoming larger over time in AAs compared with EAs for both systolic and diastolic BP. In summary, novel genetic effects emerge during development into adulthood and explain a considerable part of the variation in BP and hemodynamics. Environmental influences become more important with age in AAs compared with EAs for both systolic and diastolic BP. Future elucidation of these environmental factors may help explain ethnic differences in hypertension risk.
Abdominal Aortic Aneurysm Is Associated With High Serum Levels of Tenascin-X and Decreased Aneurysmal Tissue Tenascin-X
Authors: Zweers Manon C. , Peeters Anita C.T.M. , Graafsma Sietze , Kranendonk Steef , van der Vliet J. Adam , den Heijer Martin , Schalkwijk Joost
Published: March 2006

Background—

Tenascin-X is a large extracellular matrix protein that is abundantly expressed in several connective tissues. A 140-kDa C-terminal fragment of tenascin-X is present in human serum. Complete deficiency of tenascin-X is associated with Ehlers-Danlos syndrome, and these patients show major connective tissue alterations in their skin, as well as blood vessel fragility. In this study, we investigated whether tenascin-X is present in normal human aorta and abdominal aortic aneurysm (AAA) tissues and whether an association exists between serum tenascin-X levels and AAA.

Methods and Results—

Five normal aortas and 5 AAA tissues were immunostained for tenascin-X and elastin. Tenascin-X was present throughout the entire aorta and was especially abundant near the elastic lamellae, whereas tenascin-X expression was strongly decreased in AAA tissue. Measurement of tenascin-X serum concentration by enzyme-linked immunosorbent assay (ELISA) in 87 AAA patients and 86 controls demonstrated an increasing risk for AAA with increasing tenascin-X serum concentrations. After adjustment for established risk factors, tenascin-X serum concentrations in the highest quartile were associated with a 5-fold increase in risk of AAA (odds ratio, 5.3; 95% confidence interval, 2.0 to 13.8).

Conclusions—

Tenascin-X expression is markedly decreased in AAA tissue, and AAA is associated with high serum concentrations of tenascin-X.
Effect of Clopidogrel Premedication in Off-Pump Cardiac Surgery
Authors: Kapetanakis Emmanouil I. , Medlam Diego A. , Petro Kathleen R. , Haile Elizabeth , Hill Peter C. , Dullum Mercedes K.C. , Bafi Ammar S. , Boyce Steven W. , Corso Paul J.
Published: March 2006

Background—

Premedication with clopidogrel has reduced thrombotic complications after percutaneous coronary revascularization procedures. However, because of the enhanced and irreversible platelet inhibition by clopidogrel, patients requiring surgical revascularization have a higher risk of bleeding complications and transfusion requirements. A principal benefit of surgical coronary revascularization without cardiopulmonary bypass is its lower hemorrhagic sequelae. The purpose of this study was to evaluate the effect of preoperative clopidogrel administration in the incidence of hemostatic reexploration, blood product transfusion rates, morbidity, and mortality in patients undergoing off-pump coronary artery bypass graft surgery using a large patient sample and a risk-adjusted approach.

Methods and Results—

Two hundred eighty-one patients (17.9%) did and 1291 (82.1%) did not receive clopidogrel before their surgery, for a total of 1572 patients undergoing isolated off-pump coronary artery bypass graft surgery between January 2000 and June 2002. Risk-adjusted logistic regression analyses and a matched pair analyses by propensity scores were used to assess the association between clopidogrel administration and reoperation as a result of bleeding, intraoperative and postoperative blood transfusions received, and the need for multiple transfusions. Hemorrhage-related preoperative risk factors identified in the literature and those found significant in a univariate model were used. The clopidogrel group had a higher likelihood of hemostatic reoperations (odds ratio [OR], 5.1; 95% confidence interval [CI], 2.47 to 10.47;
P
<0.01) and an increased need in overall packed red blood cell (OR, 2.6; 95% CI, 1.94 to 3.60;
P
<0.01), multiple unit (OR, 1.6; 95% CI, 1.07 to 2.48;
P
=0.02), and platelet (OR, 2.5; 95% CI, 1.77 to 3.66;
P
<0.01) transfusions. Surgical outcomes and operative mortality (1.4% versus 1.4%;
P
=1.00) were not statistically different.

Conclusions—

Clopidogrel administration in the cardiology suite increases the risk for hemostatic reoperation and the requirements for blood product transfusions during and after off-pump coronary artery bypass graft surgery.
Magnesium Intake and Incidence of Metabolic Syndrome Among Young Adults
Authors: He Ka , Liu Kiang , Daviglus Martha L. , Morris Steven J. , Loria Catherine M. , Van Horn Linda , Jacobs David R. , Savage Peter J.
Published: March 2006

Background—

Studies suggest that magnesium intake may be inversely related to risk of hypertension and type 2 diabetes mellitus and that higher intake of magnesium may decrease blood triglycerides and increase high-density lipoprotein (HDL) cholesterol levels. However, the longitudinal association of magnesium intake and incidence of metabolic syndrome has not been investigated.

Methods and Results—

We prospectively examined the relations between magnesium intake and incident metabolic syndrome and its components among 4637 Americans, aged 18 to 30 years, who were free from metabolic syndrome and diabetes at baseline. Metabolic syndrome was diagnosed according to the National Cholesterol Education Program/Adult Treatment Panel III definition. Diet was assessed by an interviewer-administered quantitative food frequency questionnaire, and magnesium intake was derived from the nutrient database developed by the Minnesota Nutrition Coordinating Center. During the 15 years of follow-up, 608 incident cases of the metabolic syndrome were identified. Magnesium intake was inversely associated with incidence of metabolic syndrome after adjustment for major lifestyle and dietary variables and baseline status of each component of the metabolic syndrome. Compared with those in the lowest quartile of magnesium intake, multivariable-adjusted hazard ratio of metabolic syndrome for participants in the highest quartile was 0.69 (95% confidence interval [CI], 0.52 to 0.91;
P
for trend <0.01). The inverse associations were not materially modified by gender and race. Magnesium intake was also inversely related to individual component of the metabolic syndrome and fasting insulin levels.

Conclusions—

Our findings suggest that young adults with higher magnesium intake have lower risk of development of metabolic syndrome.
Association Between Human Fetuin-A and the Metabolic Syndrome
Authors: Ix Joachim H. , Shlipak Michael G. , Brandenburg Vincent M. , Ali Sadia , Ketteler Markus , Whooley Mary A.
Published: March 2006

Background—

Fetuin-A is a multifunctional hepatic secretory protein that inhibits the action of insulin in experimental animals. We evaluated the association between human serum fetuin-A and the metabolic syndrome (MetS) in a cohort of persons with coronary artery disease.

Methods and Results—

We defined MetS by the National Cholesterol Education Program criteria among 711 nondiabetic outpatients with coronary artery disease. The mean age was 67 years, and 82% were male. We divided participants into quartiles by serum fetuin-A concentrations. A total of 45% of participants (80 of 177) in the highest quartile of fetuin-A had MetS compared with 24% of participants (42 of 177) in the lowest quartile (odds ratio, 2.7; 95% confidence interval, 1.7 to 4.2;
P
<0.001). This association persisted after adjustment for potential confounding variables, including hypertension, body mass index, and inflammatory biomarkers (adjusted odds ratio, 2.0; 95% confidence interval, 1.1 to 3.5;
P
=0.02). Higher fetuin-A quartiles were also strongly and independently associated with higher low-density lipoprotein, non–high-density lipoprotein (HDL), and triglyceride concentrations and lower HDL concentrations (all
P
<0.01).

Conclusions—

Higher human fetuin-A concentrations are strongly associated with MetS and an atherogenic lipid profile. Future studies should evaluate whether fetuin-A predicts coronary artery disease risk.
Plakophilin-2 Mutations Are the Major Determinant of Familial Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy
Authors: van Tintelen J.Peter , Entius Mark M. , Bhuiyan Zahurul A. , Jongbloed Roselie , Wiesfeld Ans C.P. , Wilde Arthur A.M. , van der Smagt Jasper , Boven Ludolf G. , Mannens Marcel M.A.M. , van Langen Irene M. , Hofstra Robert M.W. , Otterspoor Luuk C. , Doevendans Pieter A.F.M. , Rodriguez Luz-Maria , van Gelder Isabelle C. , Hauer Richard N.W.
Published: March 2006

Background—

Mutations in the plakophilin-2 gene (
PKP2
) have been found in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVC). Hence, genetic screening can potentially be a valuable tool in the diagnostic workup of patients with ARVC.

Methods and Results—

To establish the prevalence and character of
PKP2
mutations and to study potential differences in the associated phenotype, we evaluated 96 index patients, including 56 who fulfilled the published task force criteria. In addition, 114 family members from 34 of these 56 ARVC index patients were phenotyped. In 24 of these 56 ARVC patients (43%), 14 different (11 novel)
PKP2
mutations were identified. Four different mutations were found more than once; haplotype analyses revealed identical haplotypes in the different mutation carriers, suggesting founder mutations. No specific genotype-phenotype correlations could be identified, except that negative T waves in V
2
and V
3
occurred more often in
PKP2
mutation carriers (
P
<0.05). Of the 34 index patients whose family members were phenotyped, 23 familial cases were identified.
PKP2
mutations were identified in 16 of these 23 ARVC index patients (70%) with familial ARVC. On the other hand, no
PKP2
mutations at all were found in 11 probands without additional affected family members (
P
<0.001).

Conclusions—

PKP2
mutations can be identified in nearly half of the Dutch patients fulfilling the ARVC criteria. In familial ARVC, even the vast majority (70%) is caused by
PKP2
mutations. However, nonfamilial ARVC is not related to
PKP2
. The high yield of mutational analysis in familial ARVC is unique in inherited cardiomyopathies.
Idiopathic Epicardial Left Ventricular Tachycardia Originating Remote From the Sinus of Valsalva
Authors: Daniels David V. , Lu Yen-Yu , Morton Joseph B. , Santucci Peter A. , Akar Joseph G. , Green Alex , Wilber David J.
Published: March 2006

Background—

Despite the success of catheter ablation for treatment of idiopathic ventricular tachycardia (VT), occasional patients have been reported in whom VT could not be ablated from the right or left ventricular endocardium or from the aortic sinus of Valsalva (ASOV).

Methods and Results—

In 12 of 138 patients (9%) with idiopathic VT referred for ablation, an epicardial left ventricular site of origin was identified >10 mm from the ASOV. Coronary venous mapping demonstrated epicardial preceding endocardial activation by >10 ms (41±7 versus 15±11 ms before QRS onset;
P
<0.001). VT induction was facilitated by catecholamines and terminated by adenosine. Ablation through the coronary veins or via percutaneous transpericardial catheterization was successful in 9 patients; 2 required direct surgical ablation as a result of anatomic constraints. No ECG pattern was specific for epicardial VT. However, slowed initial precordial QRS activation, as quantified by a novel metric, the maximum deflection index, was more useful. A delayed precordial maximum deflection index ≥0.55 identified epicardial VT remote from the ASOV with a sensitivity of 100% and a specificity of 98.7% relative to all other sites of origin (
P
<0.001).

Conclusions—

Although clinically underrecognized, idiopathic VT may originate from the perivascular sites on the left ventricular epicardium. The mechanism is consistent with triggered activity. It is amenable to ablation by transvenous or transpericardial approaches, although technical challenges remain. Recognition of a prolonged precordial maximum deflection index and early use of transvenous epicardial mapping are critical to avoid protracted and unsuccessful ablation elsewhere in the ventricles.
Contemporary Definitions and Classification of the Cardiomyopathies
Authors: Maron Barry J. , Towbin Jeffrey A. , Thiene Gaetano , Antzelevitch Charles , Corrado Domenico , Arnett Donna , Moss Arthur J. , Seidman Christine E. , Young James B.
Published: March 2006

Classifications of heart muscle diseases have proved to be exceedingly complex and in many respects contradictory. Indeed, the precise language used to describe these diseases is profoundly important. A new contemporary and rigorous classification of cardiomyopathies (with definitions) is proposed here. This reference document affords an important framework and measure of clarity to this heterogeneous group of diseases. Of particular note, the present classification scheme recognizes the rapid evolution of molecular genetics in cardiology, as well as the introduction of several recently described diseases, and is unique in that it incorporates ion channelopathies as a primary cardiomyopathy.
Comparing the Incidence of Anterior Cruciate Ligament Injury in Collegiate Lacrosse, Soccer, and Basketball Players
Authors: Mihata Leanne C. S. , Beutler Anthony I. , Boden Barry P.
Published: March 2006

Background

Female college basketball and soccer athletes have higher rates of anterior cruciate ligament injury than do their male counterparts. Rates of anterior cruciate ligament injuries for women and men in collegiate lacrosse have not been examined. Understanding anterior cruciate ligament injury patterns in lacrosse, a full-contact sport for men and noncontact sport for women, could further injury prevention efforts.

Hypotheses

Female anterior cruciate ligament injury rates will decrease over time owing to longer participation in sports. Lacrosse anterior cruciate ligament injury rates will be lower than rates in basketball and soccer possibly owing to beneficial biomechanics of carrying a lacrosse stick.

Study Design

Cohort study (Prevalence); Level of evidence, 2.

Methods

Data from the National Collegiate Athletic Association Injury Surveillance System were analyzed to compare men's and women's anterior cruciate ligament injuries in basketball, lacrosse, and soccer over 15 years.

Results

Anterior cruciate ligament injury rates in women's basketball and soccer were 0.28 and 0.32 injuries per 1000 athlete exposures, respectively, and did not decline over the study period. In men's basketball, injury rate fluctuated between 0.03 and 0.13 athlete exposures. Rates of anterior cruciate ligament injury did not significantly change in men's soccer over the study period. The rate of anterior cruciate ligament injury in men's lacrosse (0.17 athlete exposures, P < .05) was significantly higher than in men's basketball (0.08 athlete exposures) and soccer (0.12 athlete exposures). Injury rate in women's lacrosse (0.18 athlete exposures, P < .05) was significantly lower than in women's basketball and soccer.

Conclusion

There was no discernable change in rate of anterior cruciate ligament injury in men or women during the study period. Men's lacrosse is a high-risk sport for anterior cruciate ligament injury. Unlike basketball and soccer, the rates of anterior cruciate ligament injury are essentially the same in men's and women's lacrosse. The level of allowed contact in pivoting sports may be a factor in determining sport-specific anterior cruciate ligament risk.
Elongation and Structural Properties of Meniscal Repair Using Suture Techniques in Distraction and Shear Force Scenarios
Authors: Zantop Thore , Temmig Kira , Weimann Andre , Eggers Ann Kathleen , Raschke Michael J. , Petersen Wolf
Published: March 2006

Background

Most biomechanical studies on meniscal repairs have focused on testing distraction scenarios to evaluate structural properties of the repaired meniscus. An application of shear forces might replicate the in vivo situation more closely.

Hypothesis

In the shear force scenario, meniscal repair using a vertical suture technique will result in significantly less elongation when subjected to a cyclic loading protocol than that resulting from a horizontal suture technique.

Study Design

Controlled laboratory study.

Methods

In fresh-frozen porcine menisci (n = 10 in each group), horizontal and vertical 2.0 Ethibond suturing techniques were tested in distraction and shear force scenarios. Elongation after 1000 cycles between 5 and 20 N and the structural properties such as stiffness, yield load, maximum load to failure, and failure mode were evaluated using a testing machine at a rate of 12.5 mm/s.

Results

In the distraction force scenario, no statistically significant difference in elongation after cyclic loading was found between specimens repaired with vertical or horizontal suture techniques. After 1000 cycles of cyclic loading in the shear force scenario, the horizontal suturing revealed significantly less elongation (2.8 ± 1.1 mm) than did the vertical suture technique (4.6 ± 2.0 mm). No statistically significant difference in yield and maximum load was found (P > .05).

Conclusion

The results of the present study do not support the authors’ hypothesis. In the shear force test, horizontal sutures were superior to vertical suture techniques.

Clinical Relevance

Meniscal repair with horizontal suture techniques can withstand elongation due to shear forces more effectively than can vertical mattress sutures.
Medial Patellofemoral Ligament Reconstruction in Patients with Lateral Patellar Instability and Trochlear Dysplasia
Authors: Steiner Timothy M. , Torga-Spak Roger , Teitge Robert A.
Published: March 2006

Background

Reconstruction of the medial patellofemoral ligament has been proven to restore stability in patients with lateral patellar instability. No study to date has examined the results in a patient population with the predisposing factor of femoral trochlear dysplasia.

Hypothesis

Reconstruction of the medial patellofemoral ligament restores stability and provides pain relief in patients who have lateral patellar instability in association with trochlear dysplasia.

Study Design

Case series; Level of evidence, 4.

Methods

Thirty-four patients with chronic patellar instability and trochlear dysplasia were treated with medial patellofemoral ligament reconstruction using an adductor tendon autograft, bone–quadriceps tendon autograft, or bone–patellar tendon allograft. All patients were evaluated preoperatively and postoperatively with Kujala, Lysholm, and Tegner scores at a minimum of 24 months.

Results

Thirty-four patients were followed for a mean of 66.5 months (range, 24-130 months) after surgery. Kujala scores improved from 53.3 to 90.7, Lysholm scores improved from 52.4 to 92.1, and Tegner activity scores improved from 3.1 to 5.1. All improvements were highly statistically significant (P < .001). No statistical difference was found between the postoperative Lysholm, Kujala, and Tegner scores and the degree of dysplasia, graft type, or degree of symptoms. There were 85.3% and 91.1% good and excellent results based on Kujala and Lysholm scores, respectively. No recurrent dislocations have occurred.

Conclusion

Medial patellofemoral ligament reconstruction provides excellent long-term pain relief and functional return in patients with patellar instability and femoral trochlear dysplasia. In addition, reconstruction prevents recurrent dislocation, despite the diminished bony constraint of a dysplastic trochlea.
Arthroscopic Capsulolabral Reconstruction for Posterior Instability of the Shoulder
Authors: Bradley James P. , Baker Champ L. , Kline Alex J. , Armfield Derek R. , Chhabra Anikar
Published: March 2006

Background

There are few reports in the literature detailing arthroscopic treatment of unidirectional posterior shoulder instability.

Hypothesis

Arthroscopic capsulolabral reconstruction is effective in restoring stability and function and alleviating pain in athletes with symptomatic unidirectional posterior instability. This population has significant differences in glenoid and chondrolabral versions when compared with controls.

Study Design

Cohort study; Level of evidence, 2.

Methods

Ninety-one athletes (100 shoulders) with unidirectional recurrent posterior shoulder instability were treated with an arthroscopic posterior capsulolabral reconstruction and evaluated at a mean of 27 months postoperatively. A subset of 51 shoulders in contact athletes were compared with the entire group of 100 shoulders. Patients were evaluated prospectively with the American Shoulder and Elbow Surgeons scoring system. Stability, strength, and range of motion were evaluated preoperatively and postoperatively with standardized subjective scales. Forty-eight shoulders had magnetic resonance arthrograms performed and were available for review. The posterior inferior chondrolabral and bony glenoid versions were measured and compared with controls.

Results

At a mean of 27 months postoperatively, the mean American Shoulder and Elbow Surgeons score improved from 50.36 to 85.66 (P < .001). There were significant improvements in stability, pain, and function based on standardized subjective scales (P < .001). The contact athletes did not demonstrate any significant differences when compared with the entire cohort for any outcome measure. The results in the 71 shoulders followed for at least 2 years were similar to the overall group. On magnetic resonance arthrography, the shoulders with posterior instability were found to have significantly greater chondrolabral and osseous retroversion in comparison with controls (P < .001 and P = .008, respectively).

Conclusion

Arthroscopic capsulolabral reconstruction is an effective, reliable treatment for symptomatic unidirectional recurrent posterior glenohumeral instability in an athletic population. Overall, 89% of patients were able to return to sport, with 67% of patients able to return to the same level postoperatively.
Autologous Osteochondral Mosaicplasty for Capitellar Osteochondritis Dissecans in Teenaged Patients
Authors: Iwasaki Norimasa , Kato Hiroyuki , Ishikawa Jyunichi , Saitoh Satoru , Minami Akio
Published: March 2006

Background

Autologous osteochondral mosaicplasty is a new technique to provide hyaline repair for articular defects. Although recent studies have reported the successful treatment of articular defects in the knee and ankle joints with this surgical procedure, little attention has been given to the surgical efficacy of mosaicplasty in the treatment of osteochondritis dissecans of the humeral capitellum.

Purpose

To clarify the clinical outcomes of mosaicplasty for teenaged patients with advanced lesions of capitellar osteochondritis dissecans.

Study Design

Case series; Level of evidence, 4.

Methods

Eight teenaged patients with advanced lesions of capitellar osteochondritis dissecans underwent mosaicplasties. All patients were baseball players who were affected on the right side, which was also their throwing side. The surgical technique involves obtaining small-sized cylindrical osteochondral grafts from the lateral periphery of the femoral condyles and transplanting them to prepared osteochondral defects. At a mean follow-up of 24 months, all patients were evaluated clinically and radiographically.

Results

Seven of the 8 patients were free from elbow pain, and the remaining patient had mild pain occasionally. The mean clinical score described by Timmerman and Andrews (a maximum of 200 points) significantly improved from 140 points to 183 points postoperatively. All patients except one had excellent or good clinical results. Radiographically, the graft incorporation and a normal contour of the subchondral cortex were found in all patients. Magnetic resonance imaging showed that the preoperative heterogeneity of the lesion had disappeared and the signal intensity returned to normal. Six of the 8 patients, including all 3 pitchers, returned to competitive-level baseball.

Conclusion

Mosaicplasty for advanced lesions of capitellar osteochondritis dissecans in teenaged baseball players can provide satisfactory clinical and radiographic results.
Tarsal Tunnel Syndrome in Athletes
Authors: Kinoshita Mitsuo , Okuda Ryuzo , Yasuda Toshito , Abe Muneaki
Published: March 2006

Background

The details of the occurrence of tarsal tunnel syndrome in athletes have not been well documented in the literature, and more data on tarsal tunnel syndrome related to sporting activity are necessary to enable better recognition of this condition.

Hypothesis

Sporting activities make athletes vulnerable to the occurrence of tarsal tunnel syndrome under specific conditions.

Study Design

Case series; Level of evidence, 4.

Methods

Between 1986 and 2002, 18 patients with tarsal tunnel syndrome related to sporting activities were surgically treated, of whom 15 patients (21 feet; mean age, 17.8 years) were competitive athletes and 3 were recreational sports amateurs (4 feet; mean age, 52.7 years). To assess the role of physical factors and sporting activities in making athletes vulnerable to the occurrence of tarsal tunnel syndrome, the authors reviewed the medical charts and evaluated the results of treatment. The mean duration of follow-up was 58.6 months.

Results

Activities that triggered tarsal tunnel syndrome were those that applied a heavy burden on the ankle joint such as sprinting, jumping, and performing ashibarai in judo under specific physical conditions. Predisposing underlying physical factors were flatfoot deformity and an existence of talocalcaneal coalition, accessory muscles, and bony fragments around the tarsal tunnel. The majority of patients were able to return to the same sport after treatment.

Conclusion

Tarsal tunnel syndrome occurs in athletes involved in strenuous sporting activities, especially when predisposing physical factors are present.
An in Vivo Injury Model of Posterolateral Knee Instability
Authors: LaPrade Robert F. , Wentorf Fred A. , Olson Erik J. , Carlson Cathy S.
Published: March 2006

Background

Posterolateral knee instability is a difficult clinical problem to diagnose and treat. To best evaluate its natural history and the effects of interventional treatments, it is important to develop an in vivo model in an attempt to validate human cadaveric and clinical observational studies.

Purpose

To develop an in vivo model of posterolateral knee instability in the rabbit and to determine the natural history of untreated posterolateral knee injuries at 6 months postoperatively.

Study Design

Controlled laboratory study.

Methods

The fibular collateral ligament and popliteus tendon were surgically transected in 1 knee in each of 10 skeletally mature New Zealand White rabbits, with the contralateral knee serving as a control knee. At 6 months postoperatively, the rabbits were euthanized, the knees were removed, and biomechanical testing of knee joint stability was performed. After biomechanical testing, histological sections of each proximal tibia and distal femur were evaluated, and each proximal tibia was graded using an osteoarthritis grading scheme.

Results

Biomechanical testing revealed a statistically significant difference in amount of rotation in the operated knees compared with the unoperated control knees to varus moments at 30°, 60°, and 90° and to external rotation torques at 30° and 60°. Morphological analysis revealed no significant difference in lesions of osteoarthritis in the medial compartment of the operated knees compared with the unoperated knees.

Conclusions

Although the presence of posterolateral knee instability was validated 6 months after surgery in this model, the authors did not identify significant differences in lesions of osteoarthritis in the operated knees compared with the unoperated control knees.

Clinical Significance

This study confirms that posterolateral knee instability can be created in an animal model. It also recapitulates the clinical observation in humans that untreated posterolateral knee injuries do not heal. Similar to animal models of medial collateral ligament sectioning, further studies to validate a posterolateral instability knee model may lead to interventional studies to determine the best way to treat this complex knee instability pattern.
Low-Intensity Pulsed Ultrasound Accelerates Bone-Tendon Junction Healing
Authors: Lu Hongbin , Qin Ling , Fok Pikkwan , Cheung Winghoi , Lee Kwongman , Guo Xia , Wong Wannar , Leung Kwoksui
Published: March 2006

Background

Low-intensity pulsed ultrasound has been demonstrated to be beneficial for accelerating fracture healing, delayed union, nonunion, and soft tissue repair.

Hypothesis

Low-intensity pulsed ultrasound accelerates healing of bone-to-tendon junction repair by promoting osteogenesis and tissue remodeling at the healing junction.

Study Design

Controlled laboratory study.

Methods

Standard partial patellectomy was conducted in forty-eight 18-week-old rabbits divided into an ultrasound treatment and control group. Daily ultrasound was delivered 3 days after surgery onto the patellar tendon–patella healing junction and continuously up to weeks 2, 4, 8, and 16 postoperatively, when the patella–patellar tendon complexes were harvested for radiographic, histologic, and biomechanical evaluations.

Results

Radiographic measurements showed significantly more newly formed bone at the patellar tendon–patella healing junction in the ultrasound group compared with the controls at week 8 (4.91 ± 2.74 mm2 vs 2.50 ± 1.83 mm2, P < .05) and week 16 (7.22 ± 2.34 mm2 vs 4.61 ± 2.22 mm2, P < .05) after partial patellectomy. Histologically, the ultrasound group at weeks 8 and 16 showed improved tissue integration, characterized by trabecular bone expansion from the remaining patella and regeneration of fibrocartilage layer at the patellar tendon–patella healing junction. Fluorescence microscopy revealed earlier bone formation in the ultrasound group when compared with the controls at week 8 (1.78 ± 0.32 vs 1.23 ± 0.43, P < .01) and week 16 (2.10 ± 0.67 vs 1.29 ± 0.35, P < .01). Mechanical testing showed significantly higher failure load and ultimate strength in the ultrasound group (300.2 ± 61.7 N and 7.10 ± 1.29 MPa, respectively) as compared with controls (222.3 ± 65.1 N and 5.26 ± 1.36 MPa, respectively) at week 16 (P < .05 for both).

Conclusion

Low-intensity pulsed ultrasound was able to accelerate bone-to-tendon junction repair.

Clinical Relevance

These results may help establish treatment efficacy for accelerating bone-to-tendon junction repair and facilitating earlier rehabilitation.
An Investigation of Urban Residents’ Loyalty to Tourism
Authors: Chen Joseph S.
Published: March 2006

This study explores urban residents’ loyalty to tourism development. Surveys with regard to perceptions of the effects of tourism development were mailed to Virginia residents. Responses to 210 questionnaires were analyzed. A factor analysis of 27 attitude items reveals a three-dimensional factor solution. The MANOVA procedure finds that respondents from different gender and age groups had different attitudes toward tourism development. A correspondence analysis further exhibits the attitudes toward tourism development between loyal and nonloyal residents. Loyal residents felt that total tourism benefits should outweigh the negative impacts; nonloyal residents were more concerned about the land value and traffic congestion. The implications for future studies are presented in the conclusion.
Rate Integrity in Convention Cities
Authors: Boger Carl A. , Abbott Je’Anna , Lin Li-Chun , Heinemann Amy
Published: March 2006

Potential hotel guests who are not participants in a convention are many times able to negotiate their rates whereas convention participants pay higher fixed rates. Convention participants may begin representing themselves as nonconvention participants to obtain these lower rates. This will reduce the number of rooms that can be counted toward a convention-room block and may reduce the hotel’s average daily rate or occupancy percentage. It is in the best interest of convention organizers and hotel executives if rate integrity exists among hotels in convention cities. This study compares the rate integrity between convention cities and provides suggestions on how convention organizers and hotel executives can avoid convention participants’ obtaining nonconvention rates.
U.S. Timeshare Purchasers: Who are they and why do they buy?
Authors: Ragatz Richard L. , Crotts John C.
Published: March 2006

Owners and recent purchasers of timeshare intervals were the focus of this study. Data from a survey of a large (N = 10,224) randomly selected sample of U.S. timeshare owners revealed that owners are primarily upper-middle-income, middle-to-upper-aged, and well-educated couples whose trips involving stays in timeshare are typically longer in duration and have a greater economic impact when compared to estimates of all vacation travelers. As the timeshare product has improved and as the concept has gained credibility and stature among affluent consumers, destinations marketing organizations should welcome timeshare owners—and the resorts that serve them—as an important part of their visitor mix.
An Explanation and Illustration of Cluster Analysis for Identifying Hospitality Market Segments
Authors: Jurowski Claudia , Reich Allen Z.
Published: March 2006

Hierarchical clustering methods are presented using a simplified example. The article describes and explains six steps in the cluster analysis process: variable selection, data management, selection of clustering methods, deriving cluster solutions, validating results, and interpreting results. The article concludes by giving the reader an example of how each of the steps was processed in the identification and description of three market segments based on entertainment preferences. The purpose of the article is to encourage increased usage of this valuable means of revealing market niches by researchers in the field of hospitality.
An Exploratory Investigation into Behaviorally Based Success Characteristics of Foodservice Managers
Authors: Reynolds Dennis
Published: March 2006

This exploratory study qualitatively examines foodservice managers’ behaviorally based success characteristics as identified through interviews with executives from 17 leading chain-restaurant organizations. In addition, similarities and differences between these success characteristics and what the relevant literature describes as traits common to overall management success are compared. Results of this study suggest that unit-level managers in the chain-restaurant industry must possess a manifold set of characteristics similar to their brethren in nonhospitality fields. However, chain-restaurant managers may be differentiated in terms of an overarching focus on people—both customers and employees—and ethics.
Trade Dress and Consumer Perception of Product Similarity
Authors: Rutherford Denney G. , Perkins Andrew W. , Spangenberg Eric R.
Published: March 2006

A study was conducted to determine the level of perceived similarity by consumers among college students viewing two products with similar trade dress—the recently litigated Kendall-Jackson “Vintner’s Reserve” and Gallo “Turning Leaf” brands of Chardonnay table wine. Using an Internet-based data collection method, this study found only one significant difference out of several variables in a comparison between groups defined by their wine purchase frequency and wine knowledge. Perceived similarity is substantially apparent; consumers did not identify differences between the two brands based on their various components of trade dress. Based on these findings, the authors suggest that brand loyalty is less likely and switching behavior may become common in a market that includes such competitive behavior.
Changes in Hotel Guests’ Willingness to Pay as the Date of Stay Draws Closer
Authors: Schwartz Zvi
Published: March 2006

The literature on optimal room rate policies and the experience of many hoteliers suggest that guests’ willingness to pay increases as time draws closer to the date of stay. Traditionally, this phenomenon is explained through changes in market segmentation: Business travelers who tend to book closer to the date of stay are willing to pay more. It is argued in this study that the same customers are willing to pay more as the date of stay nears. A simple consumer decision model that explains this phenomenon is provided. The article examines the conditions that affect the increasing demand, and the relation between time and the increase. In a controlled experiment, subjects were asked to book a room and get the best deal they could find using a simulated Internet site that specialized in discount hotel reservations. The results indicate that although willingness to pay indeed increases as time nears the date of stay, the extent of the change depends on the customers’ search cost.
Brand Management in Hospitality: An Empirical Test of the Brisoux-Laroche Model
Authors: Laroche Michel , Parsa H. G.
Published: March 2006

Consumers’ brand selection process, purchase behavior, and their impact on brand management are least understood in the hospitality literature. This problem is complicated further by the fact that many hospitality companies prefer to develop and manage multiple brands for growth purposes. This study explores the selection process adopted by consumers in choosing a hospitality brand in multibrand situations. The Brisoux-Laroche’s (B-L) consumer behavior model of brand categorization was tested with 16 quick service restaurant brands. The B-L model was supported empirically. Further support for the model was provided by the assessment of net utility values for quality and price for the included brands. Results indicated that consumers use evoked, hold, foggy, and reject set in categorizing the available brands. Each of the awareness sets was further analyzed according to three subgroups of brands: leading, intermediate, and low market share. The findings supported the independent nature of these subgroups. Results are discussed in light of brand management in the hospitality field, and consumers’ brand choice process and managerial implications are presented.
Determinants of Mature Travelers’ Motorcoach Tour Satisfaction and Brand Loyalty
Authors: Hsu Cathy H. C.
Published: March 2006

This study investigated attributes influencing mature travelers’ satisfaction and brand loyalty of motorcoach tour operators and tour packages. Data were collected from 817 individuals 55 years and older who had taken a motorcoach tour during the previous 12 months. Respondents rated their satisfaction with 15 tour operator attributes and 40 tour package attributes. All attributes received ratings above 3.50, on a 5-point scale. Determinants of tour provider satisfaction, tour package satisfaction, tour provider loyalty, and tour package loyalty were identified using regression analyses. No significant differences in satisfaction or loyalty were found among demographic groups.
Social Acceptability’s Role in an Expanded Rational Expectations Model of Intention to Consume an Innovative Meat Product in a Restaurant Setting
Authors: Adams Charlie R. , Hoover Linda C. , Arnett Dennis B. , Thompson Leslie D.
Published: March 2006

American consumers expect variety in their food choices and dining experiences. Marketers and producers are using innovation to keep pace with consumers’ desires for new and unusual food items. Exotic game such as emu offers consumers new experiences and variety in their meat choices. Past research has indicated social acceptability may be an important component in marketing these new innovative meat products. This investigation used Sapp’s expanded rational expectations intention model, a depiction of Ajzen and Fishbein’s theory of reasoned action, to investigate consumers’ intentions to try an innovative meat product in a restaurant setting. The expanded model added social acceptability and knowledge as additional constructs to Ajzen and Fishbein’s rational expectations model. Social acceptability had significant causal path estimates for attitude, subjective norm, and intention. This study is further confirmation of social acceptability as a possible new addition to Ajzen and Fishbein’s theory.