THE R?LE OF THE THEBESIAN VESSELS IN THE CIRCULATION OF THE HEART

In summary, evidence has been presented to show a direct connection other than through the capillaries between the coronary arteries and the chambers of the heart. This connection was shown by perfusion, injections and serial sections to be through the Thebesian veins. Communications between the larger coronary veins and the Thebesian veins were also demonstrated by the same methods. Serial sections through Thebesian veins have shown capillaries draining directly into them. Under certain conditions it has been shown that as much as 90 per cent of the arterial flow may escape via the Thebesian vessels. Lastly, in the event of gradual closure of the orifices of the coronary arteries, the Thebesian vessels can supply the heart muscle with sufficient blood to enable it to maintain an efficient circulation.     

THE FACTORIAL STRUCTURE OF THE ARABIC VERSION OF THE REVISED COLLETT–LESTER FEAR OF DEATH SCALE

A sample of 209 volunteer Kuwaiti undergraduates responded to an Arabic version of the Revised Collett–Lester Fear of Death Scale with 4 subscales: Death of Self, Dying of Self, Death of Others, and Dying of Others. Reliabilities of the 4 subscales and of the grand total score ranged from 0.75 to 0.92, which is considered adequate. A 4-factor solution was congruent with the allocation of items to 2 subscales (i.e. Dying of Self and Death of Others), whereas the theorized factor structure of the other 2 subscales were only partially supported by empirical analyses. The intercorrelations between the 4 total subscale scores yielded a general factor of death and dying, denoting good factorial validity of the scale.     

THE R?LE OF THE RETICULO-ENDOTHELIAL SYSTEM IN IMMUNITY : I. THE R?LE OF THE RETICULO-ENDOTHELIAL SYSTEM IN THE PRODUCTION OF DIPHTHERIA ANTITOXIN.

1. Following massive doses of India ink injected intravenously into guinea pigs before a subcutaneous injection of diphtheria toxin-antitoxin mixture, no antitoxin was found in the blood serum for 3 weeks, as indicated by intracutaneous tests, whereas an appreciable amount could be detected in non-blocked, immunized control animals. 2. During the 4th week following immunization, the titer of the serum of blocked animals equaled that of non-blocked controls within the limits of the intracutaneous test dose. 3. The smaller doses of India ink used in these experiments, given before immunization, had no stimulating effect on the production of diphtheria antitoxin but, on the contrary, also inhibited the appearance of this antibody, although to a less extent.     

DOES THE INGESTION OF ALCOHOL INFLUENCE THE DEVELOPMENT OF ARTERIOSCLEROSIS IN FOWLS?

The effect of alcohol ingestion upon the development of naturally occurring and stilbestrol-induced arteriosclerosis was studied in the domestic fowl. In two experiments, a 15 per cent ethyl alcohol solution was used for drinking purposes, and in a third experiment wine containing 12 per cent of it was administered. The caloric intake of both food and alcohol was carefully controlled by pair-feeding, a glucose solution being used for drinking purposes to equalize the caloric intakes of the control birds with those of the alcohol-treated birds. A total of 224 cockrels was studied, and the period of observation for each experiment lasted 12 months. The degree of arteriosclerosis in the thoracic and abdominal aortas was determined in the gross and microscopically, and the degree of lipide infiltration was determined microscopically. The gross grading of arteriosclerotic lesions agreed closely with the microscopic analysis of intimal thickening and lipide infiltration of the arterial wall. The gross gradings were subjected to a critical statistical analysis which allowed precise statements to be made on the probability that a real effect would be overlooked. This analysis yielded no evidence that alcohol or the wine used had affected the degree of gross arteriosclerosis or lipide infiltration.     

THE FACTORIAL STRUCTURE OF THE REVISED COLLETT–LESTER FEAR OF DEATH SCALE

In a study of 144 college students, the factorial structure of the Collett–Lester Fear of Death Scale matched the face content of the subscales quite closely, ameliorating the criticism of the scale by R. A. Neimeyer et al. (2003) Neimeyer, R. A., Moser, R. P. and Wittkowski, J. 2003. Assessing attitudes toward dying and death. Omega, 47: 45–76. [Web of Science ®] , [Google Scholar].     

THE PRACTICE OF GOOD LEADERSHIP WITHIN THE MEDICAL PROFESSION

My university studies and postgraduate training equipped me to be a competent doctor and medical specialist,but in 1976 when I was 30 years old,I was invited to come to Melbourne to establish a Neonatal Intensive Care Unit in an university teaching hospital and to be its Director.I had never taken any leadership or management course to equip me to be a leader.Now over 30 years later,on the eve of my retirement from medicine,I look back to reflect on what kind of leader I was over the course of my medical career.What wisdom did I gain over the past 30 years on becoming a good leader,based on learning from the mistakes I had made in exercising the leadership roles I was given within the hospital and university,as well as in the national and international professional arenas? This essay begins with a general principle of good leadership followed by an examination of aspects of pride,power and submission,which if misused or abused,constitute a trilogy of harmful influences on the character of leaders and their wise exercise of good leadership.     

A STUDY OF THE PROTEOLYTIC FERMENTS OF THE LARGE LYMPHOCYTES IN A CASE OF ACUTE LEUK?MIA

The leucocytes of the blood of normal individuals and of patients showing a marked polymorphonuclear leucocytosis contain enzymes capable of digesting coagulated blood serum in neutral, alkaline or acid solutions. The cells in pus that is composed principally of polymorphonuclear leucocytes and the leucocytes of the circulating blood in myelogeneous leukæmia contain similar proteolytic enzymes, which act best when the reaction is alkaline. The leucocytes of the circulating blood and of the enlarged lymph nodes from a case of large cell, acute, lymphatic leukæmia contain proteolytic enzymes that act qualitatively in much the same way as the leucocytes of pus and as the white corpuscles of the blood in myelogenous leukæmia. These large lymphocytes in acute lymphatic leukæmia can be differentiated biologically from the small lymphocytes in chronic lymphatic leukæmia which possess no proteolytic enzymes, and from the large endothelioid cells of the hyperplastic lymph glands which are proteolytic only in the presence of acid. These results seem to show that the large cells of the so-called acute lymphatic leukæmia are not true lymphocytes, but are nearly related to the granular myelocytes and should probably be considered as the forerunners to these cells.     

THE INFLUENCE OF CHOLINE,CYSTINE, AND OF α-TOCOPHEROL UPON THE OCCURRENCE OF CEROID PIGMENT IN DIETARY CIRRHOSIS OF RATS

1. Five per cent l-cystine in a stock or low protein diet produces ceroid deposits in rat liver. This effect of l-cystine is much greater in low protein than in stock diets. 2. One per cent choline has an inhibiting effect on deposition of liver ceroid resulting from a low protein diet containing excess cystine. 3. The occurrence of ceroid pigment in the livers of rats on a low protein diet, with or without the addition of excess l-cystine, is transiently inhibited by the administration of α-tocopherol. Five per cent cod liver oil in the diet did not prevent this effect of α-tocopherol. 4. On low protein, vitamin E-deficient diets, there occurs after 4 months, a rapid and progressive weight loss. This does not happen when α-tocopherol is added to the diet.     

THE EFFECTS OF ANTICIPATION ON THE MECHANICS OF THE KNEE DURING SINGLE‐LEG CUTTING TASKS: A SYSTEMATIC REVIEW

Background

ACL injuries are common in sports, which has resulted in the development of risk screening and injury prevention programs to target modifiable neuromuscular risk factors. Previous studies which have analyzed single‐leg cutting tasks have reported that the anticipation status of the task (pre‐planned vs. unanticipated) has a significant effect on the mechanics of the knee.

Hypothesis/Purpose

The purpose of this systematic review is to assess the effect of anticipation on the mechanics of the knee in the sagittal, frontal, and transverse planes during tasks which athletes frequently perform during competition.

Study Design

Systematic Review

Methods

The following databases were searched using relevant key words and search limits: Pub Med, SPORTDiscus, CINAHL, and Web of Science. A modified version of the Downs and Black checklist was used to assess the methodological quality of the articles by two independent reviewers.

Results

284 articles were identified during the initial database search. After a screening process, 34 articles underwent further review. Of these articles, 13 met the criteria for inclusion in this systematic review.

Conclusions

It appears that tasks which do not allow a subject to pre‐plan their movement strategy promote knee mechanics which may increase an athlete''s risk of injury.

Clinical Relevance

Clinicians involved in the development and implementation of ACL injury risk screening and prevention programs may want to consider incorporating tasks which do not allow time for pre‐planning. These unanticipated tasks may more closely mimic the demands of the sports environment and may promote mechanics which increase the risk of injury.

Level of Evidence

Level 1b     

THE R?LE OF THE MUCOID POLYSACCHARIDE (HYALURONIC ACID) IN THE VIRULENCE OF GROUP A HEMOLYTIC STREPTOCOCCI

1. A quantitative turbidimetric method for the estimation of hyaluronidase activity, based on the ability of the enzyme to decrease the capacity of the polysaccharide to precipitate acidified protein has been developed. Two units of hyaluronidase, by this method, are equivalent to one viscosity-reducing unit. 2. Hyaluronidase added to a phagocytic system containing defibrinated human blood, immune or non-immune, greatly increases the rate of phagocytosis of group A streptococci. Phagocytosis of Type I pneumococci is not affected by hyaluronidase under the same conditions. 3. The bactericidal activity of non-immune blood against group A streptococci is increased by hyaluronidase; the activity of immune blood is, however, somewhat inhibited by the enzyme. Killing of pneumococci is not affected by the presence of the enzyme. 4. Mice can be protected against group A streptococcal infection by frequent treatment with 200 turbidity-reducing units of hyaluronidase; the protective action of the enzyme is removed by heating at 60°C. for 1 hour. Mice infected with Type I pneumococcus and treated with hyaluronidase die somewhat sooner than the untreated controls.     

STUDIES ON THE MECHANISM OF IMMUNITY IN TUBERCULOSIS : THE R?LE OF EXTRACELLULAR FACTORS AND LOCAL IMMUNITY IN THE FIXATION AND INHIBITION OF GROWTH OF TUBERCLE BACILLI

1. The fate of bacilli of reinfection at the portal of entry and in metastatic foci, and also the associated host responses, are essentially similar in rabbits and guinea pigs. 2. However, in the guinea pig tubercle bacilli of reinfection are more effectively fixed at the portal of entry than in the rabbit. 3. The guinea pig fixes at the site of reinfection unrelated substances, such as trypan blue and agar particles, more effectively than the rabbit. 4. At the site of a local non-specific inflammation precipitins from the circulating blood accumulate in higher concentration in tuberculous guinea pigs than in tuberculous rabbits. 5. These differing fixing capacities of the two species are associated with differences of extracellular character in the inflammation resulting from reinfection. (a) In the guinea pig, whose tissues are highly sensitized and greatly injured by the tubercle bacillus, the lymphatics adjoining the site of reinfection become thrombosed. In the rabbit whose tissues are moderately sensitized and less injured by the tubercle bacillus the corresponding lymphatics remain open. (b) In the guinea pig the fibrinous network at the site of inflammation forms a fine sieve-like structure. In the rabbit this network forms a coarse sieve-like barrier. 6. In rabbits and guinea pigs primarily infected, the destruction of tubercle bacilli takes place first and most extensively at the portal of entry. At this time they are less effectively destroyed in the nearest metastatic foci. Simultaneously they are still growing without hinderance in such foci in remote internal organs. 7. The cell-free body fluids of normal animals support the growth of tubercle bacilli in vivo. The body fluids of tuberculous animals under the same conditions are bacteriostatic for this microorganism. 8. Tubercle bacilli often multiply by preliminary subdivision into non-acid-fast granules, from which the acid-fast rods sprout. This confirms the work of Kahn.     

THE DISTRIBUTION OF FRIEDL?NDER'S BACILLI OF DIFFERENT TYPES

In a study of the distribution of the specific types of Friedländer''s bacillus, it is shown that: (1) Of 80 strains 52 per cent belong to Type A, 15 per cent to Type B, 9 per cent to Type C, and 24 per cent to Group X. (2) Type A contains for the most part strains derived from diseases of man and more than 70 per cent are associated with pneumonia in man. (3) Type B includes the greatest number of strains from animal sources, while the heterogeneous strains comprising Group X come from the greatest variety of diseases. It was demonstrated that in a patient suffering with pneumonia due to Friedländer''s bacillus (Type A), a specific precipitin reaction of the urine occurred in the corresponding (Type A) immune serum. A study of the sugar fermentation reactions of Friedländer''s bacillus shows that (1) there is no correlation between serological type and fermentative activity; (2) the fermentation reactions are variable and therefore not reliable for distinguishing Friedländer''s bacillus from closely allied organisms; (3) the strains of Group X show the greatest variation in fermentation, and (4) of 15 strains unable to ferment lactose, 13 belong to Type A.     

CROSS‐CULTURAL ADAPTATION AND VALIDATION OF THE KOREAN VERSION OF THE CUMBERLAND ANKLE INSTABILITY TOOL

Background

The Cumberland Ankle Instability Tool (CAIT) is a valid and reliable patient reported outcome used to assess the presence and severity of chronic ankle instability (CAI). The CAIT has been cross‐culturally adapted into other languages for use in non‐English speaking populations. However, there are no valid questionnaires to assess CAI in individuals who speak Korean.

Purpose

The purpose of this study was to translate, cross‐culturally adapt, and validate the CAIT, for use in a Korean‐speaking population with CAI.

Study Design

Cross‐cultural reliability study.

Methods

The CAIT was cross‐culturally adapted into Korean according to accepted guidelines and renamed the Cumberland Ankle Instability Tool‐Korean (CAIT‐K). Twenty‐three participants (12 males, 11 females) who were bilingual in English and Korean were recruited and completed the original and adapted versions to assess agreement between versions. An additional 168 national level Korean athletes (106 male, 62 females; age = 20.3 ± 1.1 yrs), who participated in ≥ 90 minutes of physical activity per week, completed the final version of the CAIT‐K twice within 14 days. Their completed questionnaires were assessed for internal consistency, test‐retest reliability, criterion validity, and construct validity.

Results

For bilingual participants, intra‐class correlation coefficients (ICC_2,1) between the CAIT and the CAIT‐K for test‐retest reliability were 0.95 (SEM=1.83) and 0.96 (SEM=1.50) in right and left limbs, respectively. The Cronbach''s alpha coefficients were 0.92 and 0.90 for the CAIT‐K in right and left limbs, respectively. For native Korean speakers, the CAIT‐K had high internal consistency (Cronbach''s α=0.89) and intra‐class correlation coefficient (ICC_2,1 = 0.94, SEM=1.72), correlation with the physical component score (rho=0.70, p = 0.001) of the Short‐Form Health Survey (SF‐36), and the Kaiser‐Meyer‐Olkin score was 0.87.

Conclusions

The original CAIT was translated, cross‐culturally adapted, and validated from English to Korean. The CAIT‐K appears to be valid and reliable and could be useful in assessing the Korean speaking population with CAI.     

THE R?LE OF THE RETICULO-ENDOTHELIAL SYSTEM IN IMMUNITY : VII. THE EFFECT OF LOCAL AND SYSTEMIC BLOCKADE ON THE TOXIC ACTION OF HETEROPHILE (FORSSMAN) SERA IN GUINEA PIGS

1. Guinea pigs blocked by intravenous injection of either India ink or trypan blue succumbed with fatal shock after the intravenous injection of heterophile immune serum, although the time of death was somewhat delayed as compared with normal controls. 2. Local blockade of the skin of guinea pigs with trypan blue inhibited completely the development of the characteristic skin reaction following intracutaneous injection of Forssman serum within the blocked area. 3. Infiltration of the skin of guinea pigs with India ink afforded no protection against the full development of the toxic skin reaction.     

WHAT IS THE RELEVANCE OF THE HOPE STUDY IN GENERAL PRACTICE?

The unique findings from the HOPE (Heart Outcomes Prevention Evaluation) study strongly support extending the use of the angiotensin-converting enzyme (ACE) inhibitor ramipril as a preventive agent for patients at high risk of cardiovascular events with normal left ventricular function. In addition, ramipril provides significant benefit in diabetic patients. These findings will impact on how ramipril is used in primary care, where ACE inhibitors are currently underprescribed. Patients reflecting the inclusion criteria of the HOPE study should be considered as suitable candidates for long-term ramipril therapy as an addition to their existing drug regimen. Screening should include control of kidney function (by serum creatinine), particularly within the first two weeks of treatment, in addition to regular monitoring of serum potassium. However, the HOPE study shows that ramipril is well tolerated at high doses and over a long treatment period. The effectiveness of therapy should also be regularly reviewed and dose adjustments made where necessary. If concern remains, referral to a specialist--a cardiologist or a diabetologist--may ultimately be necessary.     

THE EFFECT OF EXERCISE AND TIME ON THE HEIGHT AND WIDTH OF THE MEDIAL LONGITUDINAL ARCH FOLLOWING THE MODIFIED REVERSE‐6 AND THE MODIFIED AUGMENTED LOW‐DYE TAPING PROCEDURES

Purpose/Background:

No evidence exits regarding the magnitude of the change in foot posture following the “modified reverse‐6” (MR6) taping procedure, either alone or in combination with the “low‐dye” (LD) taping technique. The purpose of this study was to investigate the change in the height and width of the midfoot after application of the MR6 and the MR6 plus the LD (MR6+LD) taping technique and determine how long those changes last.

Methods:

Eleven individuals (2 female and 9 male) were recruited for this study and were tested under each of two experimental conditions, the MR6 and the MR6+LD taping technique. The order of testing for the two conditions was randomly determined. For each condition, the height and width of the midfoot at 50% of each subject''s foot length was initially measured and then again immediately following the application of the tape. These measurements were repeated four hours later immediately prior to running two miles on a treadmill, again immediately after running, and finally after another four hours.

Results:

The dorsal arch height increased significantly with both the MR6 and MR6+LD taping, but only the MR6+LD remained statistically greater after four hours, a bout of exercise and again at the end of the day. The mean width of the midfoot significantly decreased with both taping procedures. The change in the width of the midfoot remained significantly decreased in both taping conditions after exercise and throughout the day.

Conclusions:

Both taping procedures are able to significantly change the height and width of the medial longitudinal arch of the foot, but the change lasted longer when the two taping procedures were combined.

Levels of Evidence:

Level 3, Prospective Cohort Study     

THE R?LE OF THE RETICULO-ENDOTHELIAL SYSTEM IN IMMUNITY : II. THE COMPLEMENT TITER AFTER BLOCKADE AND THE PHYSIOLOGICAL REGENERATION OF THE RETICULO-ENDOTHELIAL SYSTEM AS MEASURED BY REDUCTION TESTS.

1. Intravenous injections of India ink into guinea pigs caused a decided drop in the complement titer which set in as early as 15 minutes after the injection, but did not reach its maximum for 3 hours. This drop was followed by a return to normal within the first 24 hours following the injection. 2. India ink mixed in vitro with guinea pig serum adsorbs the complement almost immediately to its full extent. 3. By means of reduction tests (methylene blue and nitroanthraquinone) it was shown that the respiration of the cells of the liver and spleen of guinea pigs was markedly impaired for the first 8 hours, following an intravenous injection of ink. Evidences of a return to normal functional vitality, however, became apparent by the end of the 1st day after the injection.     

THE RELIABILITY OF THE VAIL SPORT TEST? AS A MEASURE OF PHYSICAL PERFORMANCE FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Purpose/Background:

The decision to return an athlete to sports following anterior cruciate ligament reconstruction can be controversial. The purposes of this study are 1) to describe a functional test (Vail Sport Test™) that includes the evaluation of muscle strength, endurance, power, and movement quality in those patients attempting to return to sports following ACL reconstruction and 2) to assess the reliability of the Vail Sport Test™.

Methods:

A prospective cohort study design. A total of 30 (12 F, 18 M) subjects (18.1±5.3 yrs) volunteered for the study. All subjects were post-operative ACL reconstruction (5.2±1.9 months) and were in the process of returning to sports. Each subject completed the Vail Sport Test™ and was videotaped from the anterior and lateral view. The videotape was then viewed and graded at two different points in time (48 hours apart) by three licensed physical therapists. Intraclass correlations (ICCs) were calculated to determine intra- and inter-rater reliability.

Results:

Intra-rater reliability was excellent with a range of .95 to 1.0. Reliability values between graders were .97 (ICC₂,k) and 1.55 (SEM).

Conclusions:

The results of this study suggest that the Vail Sport Test™ has excellent reliability when the same graders scored the test using video on repeated occasions. In addition, the test was reliable between different graders.

Level of Evidence:

Level 2b     

FROM THE EDITOR—INTRODUCTION OF GUEST EDITOR

A meta-analysis of 125 nurses in three types of nursing roles investigated whether these nurses received social support from their administrators, the types of social support received, and whether more or less social support from these managers was desired. The Arizona Social Support Interview Schedule (ASSIS) was used to assess these questions. Results showed that home health nurses received social participation and physical assistance, whereas staff nurses received positive feedback and physical assistance. Nursing faculty received little support from their managers. Social exchange theory predicts that intangibles such as social support should exist in equitable relationships. It is possible that the difference in the nurses' and administrators' statuses and power levels affected staff nurses' results. Mental health clinical nurse specialists can use these results to help nurses understand their work relationships.     

THE VALIDITY OF 2‐DIMENSIONAL MEASUREMENT OF TRUNK ANGLE DURING DYNAMIC TASKS

Purpose/Background:

Injury screening methods that use three‐dimensional (3D) motion analysis accurately predict the risk of injuries, yet are expensive. There is great need for valid, cost‐effective techniques that can be used in large‐scale assessments. Utilizing two‐dimensional (2D) measures of lateral trunk motion may identify athletes at risk for lower extremity injury. The purpose of this research was to determine the strength of the relationships between 2D and 3D calculations of lateral trunk angle for female athletes performing a single‐leg cross drop landing.

Methods:

Twenty‐one high‐school female volleyball players performed a single‐leg cross drop landing onto a force plate. The 3D angular trunk motion was calculated, and four different 2D measures of lateral trunk angle were calculated for both left and right landing leg. A one‐way multivariate analysis of variance was used to compare 2D measures to the 3D measurements, and Pearson correlations were used to determine the strength of these relationships.

Results:

The angle formed by the medial shoulder joint center, medial ASIS, and vertical line (LTA4) was similar to the 3D measures of lateral trunk angle during landing (r‐values ≥ 0.62; p‐values ≤ 0.003; mean differences, ‐1.0° to 1.2°).

Conclusions:

Given the recent focus on the role of the trunk in lower extremity injury, using the 2D LTA4 assessment may expand existing assessments into a composite model that can more accurately assess female athletes at risk for injury than models that do not include trunk analysis.

Clinical Relevance:

Existing models that enable clinicians to effectively identify female athletes at risk for lower extremity injury may be enhanced by including accurate assessments of lateral trunk motion.