The effect of medial patellar taping on pain, strength and neuromuscular recruitment in subjects with and without patellofemoral pain

Objectives

Patellar taping is used by clinicians to reduce pain, increase strength and enhance neuromuscular recruitment in patients with patellofemoral pain. This study explored the effect of medial patellar taping on these parameters in physically active subjects with and without patellofemoral pain.

Study design

A placebo-controlled clinical trial with randomised interventions.

Setting

Sport Science Institute of South Africa.

Participants

Fifteen subjects with patellofemoral pain (experimental group) and 20 subjects without patellofemoral pain (healthy cohort).

Methods

Pain perception, quadriceps force output and electromyographic (EMG) data were collected during maximal quadriceps strength testing and submaximal step testing for each intervention.

Intervention

Subjects were tested during three different knee taping conditions: (1) no tape; (2) placebo tape; and (3) medial tape, in a randomised order.

Main outcome measures

Visual analogue scale (VAS), isokinetic and isometric force output, and EMG analysis.

Results

Medial patellar tape did not result in a significant reduction in pain during the step testing (step-up) in the group with patellofemoral pain (no tape condition: mean VAS 1.0, 95% confidence interval 0.30-1.70; taped condition: mean VAS 1.07, 95% confidence interval 0.22-1.91) or an increase in quadriceps force output. However, there was a significant decrease in EMG activity of the vastus medialis oblique in both groups during the closed chain step test (e.g. group with patellofemoral pain, no tape condition: mean 77%, 95% confidence interval 62-92%; taped condition: mean 64%, 95% confidence interval 53-75%, P < 0.05).

Conclusion

Although taping did not reduce pain in the patellofemoral pain group, it did enhance the efficiency of the vastus medialus oblique. Future studies should determine whether there are clinical benefits to these findings.     

The effectiveness of music in relieving pain in cancer patients: A randomized controlled trial

Objectives

To examine effects of sedative music on cancer pain.

Design

A randomized controlled trial.

Settings

Two large medical centers in Kaoshiung City, in southern Taiwan.

Participants

126 hospitalized persons with cancer pain.

Methods

Participants were randomly assigned to an experimental (n = 62) or a control group (n = 64), with computerized minimization, stratifying on gender, pain, and hospital unit. Music choices included folk songs, Buddhist hymns (Taiwanese music), plus harp, and piano (American). The experimental group listened to music for 30 min; the control group rested in bed. Sensation and distress of pain were rated on 100 mm VAS before and after the 30-min test.

Results

Using MANCOVA, there was significantly less posttest pain in the music versus the control group, p < .001. Effect sizes were large, Cohen's d = .64, sensation, d = .70, distress, indicating that music was very helpful for pain. Thirty minutes of music provided 50% relief in 42% of the music group compared to 8% of the controls. The number needed to treat (NNT) to find one with 50% sensation relief was three patients. More patients chose Taiwanese music (71%) than American music (29%), but both were liked and effective.

Conclusions

Offering a choice of familiar, culturally appropriate music was a key element of the intervention. Findings extend the Good and Moore theory (1996) to cancer pain. Soft music was safe, effective, and liked by participants. It provided greater relief of cancer pain than analgesics alone. Thus nurses should offer calming, familiar music to supplement analgesic medication for persons with cancer pain.     

Training program and additional electric muscle stimulation for patellofemoral pain syndrome: a pilot study

Bily W, Trimmel L, Mödlin M, Kaider A, Kern H. Training program and additional electric muscle stimulation for patellofemoral pain syndrome: a pilot study.

Objectives

To evaluate the beneficial effect of training in patients with patellofemoral pain syndrome (PFPS) and influence of additional electric muscle stimulation (EMS) of the knee extensor muscles.

Design

A randomized clinical trial.

Setting

Supervised physiotherapy (PT) training and home-based EMS.

Participants

Patients (N=38; 14 men, 24 women) with bilateral PFPS.

Interventions

One group (PT) received supervised PT training for 12 weeks. The other received PT and EMS. The stimulation protocol was applied to the knee extensors for 20 minutes, 2 times daily, 5 times a week for 12 weeks at 40Hz, with a pulse duration of .26ms, at 5 seconds on and 10 seconds off. Maximal tolerable stimulation intensity was up to 80mA.

Main Outcome Measures

Patellofemoral pain assessment with visual analog scale during activities of daily life, Kujala patellofemoral score, and isometric strength measurement before and after 12 weeks treatment as well as after 1 year.

Results

Thirty-six patients completed the 12-week follow-up. There was a statistically significant reduction of pain in both groups (PT group, P=.003; PT and EMS group, P<.001) and significant improvement of the Kujala score in both groups (PT group, P<.001; PT and EMS group, P<.001) after 12 weeks of treatment with improvement of function and reduction of pain at the 1-year follow-up. The difference between the 2 treatment groups was statistically not significant. We could not measure any significant change in isometric knee extensor strength in either group.

Conclusions

A supervised PT program can reduce pain and improve function in patients with PFPS. We did not detect a significant additional effect of EMS with the protocol described previously.     

Ankle positioning and knee perturbation affect temporal recruitment of the vasti muscles in people with patellofemoral pain

Objectives

To compare the temporal recruitment of the vastus medialis obliquus (VMO) and vastus lateralis (VL) during voluntary ankle movements and perturbed standing in people with patellofemoral pain, and to determine the effects of different reflex and voluntary postural exercise tasks on VMO facilitation.

Design

Repeated-measures design.

Participants

Twenty-three subjects with patellofemoral pain.

Interventions

Quadriceps reflex contraction in response to postero-anterior knee perturbations was measured with three crural muscle contraction conditions and three postural exercises (semi-squatting, tip-toeing and heel standing).

Main outcome measures

The electromyographic (EMG) onset time of the VMO and VL during each task was measured and compared across the different tasks.

Results

The mean EMG onset time of the VMO was later than that of the VL in the voluntary tasks such as tip-toeing (VMO 95.3 ms vs VL 36.4 ms, mean difference 58.9 ms, 95% confidence interval −33.7 to 151.5 ms), whereas earlier VMO activation was found in the perturbation tests such as toe standing (VMO 17.6 ms vs VL 22.9 ms, mean difference −5.3 ms, 95% confidence interval −25.3 to 14.7 ms).

Conclusion

These findings suggest the potential benefits of unexpected perturbation activities for facilitating VMO activation. The clinical applications of perturbation tasks in rehabilitation exercise programmes and the underlying mechanisms warrant further investigation.     

Pre-existing Health Conditions and Repeat Traumatic Brain Injury

Saunders LL, Selassie AW, Hill EG, Horner MD, Nicholas JS, Lackland DT, Corrigan JD. Pre-existing health conditions and repeat traumatic brain injury.

Objective

To assess and compare the effect of Pre-existing epilepsy/seizure disorder and drug/alcohol problem on the hazard of repeat traumatic brain injury (TBI) in persons with TBI who participated in a follow-up study.

Design

Retrospective cohort.

Setting

Acute care hospitals in South Carolina.

Participants

Participants were from the South Carolina Traumatic Brain Injury Follow-up Registry cohort of persons (N=2118) who were discharged from an acute care hospital in South Carolina and who participated in a year-1 follow-up interview.

Interventions

Not applicable.

Main Outcome Measures

Repeat TBI was defined by 2 isolated events of TBI in the same person at least 72 hours apart and recorded in hospital discharge or emergency department records from 1999 through 2005.

Results

A Cox proportional hazards model was used to assess the associations of Pre-existing epilepsy/seizure disorder and drug/alcohol problem with time to repeat TBI, controlling for other confounding factors. There were 2099 persons with information on both Pre-existing conditions. There were 147 (7%) persons who sustained repeat TBI after recruitment to the follow-up study, and 82 (3.9%) had a previous TBI before recruitment for which they were seen in the hospital discharge or emergency department since 1996. The hazard of repeat TBI for persons with Pre-existing epilepsy/seizure disorder was 2.3 times the hazard for those without (hazard ratio, 2.3; 95% confidence interval, 1.2-4.4; P=.011). Pre-existing drug/alcohol problem was not associated with repeat TBI. Other variables significantly associated with repeat TBI were having a prior TBI, being insured under Medicaid, and having no insurance.

Conclusions

Pre-existing epilepsy/seizure disorder predisposes to repeat TBI. Appropriate management of seizure control may be an important strategy to allay the occurrence of repeat TBI.     

Soluble CD40 ligand and soluble P-selectin levels in Gilbert's syndrome: A link to protection against atherosclerosis?

Objective

To investigate the role of CD40 ligand and P-selectin in the mechanism of decreased incidence of cardiovascular disease in Gilbert's syndrome (GS).

Design and methods

The soluble forms of CD40 ligand (sCD40L) and P-selectin (sP-selectin), and high sensitive C reactive protein (hs-CRP) levels were investigated in subjects with GS (n = 25) and compared to healthy controls (n = 53).

Results

sCD40L and hs-CRP levels were significantly lower in GS compared to the controls (0.33 ± 0.27 vs 0.71 ± 0.37 ng/mL, p < 0.001 and 0.51 ± 0.45 vs 1.16 ± 1.31 mg/L, p = 0.046, respectively). Both sCD40L and hs-CRP were negatively correlated with total bilirubin (r = − 0.5, p < 0.001 and r = − 0.34, p = 0.002, respectively). sP-selectin levels were lower in GS when compared to the controls but the difference did not reach statistical significance (p = 0.052). No correlation was found between the plasma levels of sCD40L, sP-selectin and hs-CRP.

Conclusion

These novel findings suggest that reduced sCD40L and hs-CRP concentrations may have a role in the mechanism of protection against atherosclerosis in GS.     

Increased palpation tenderness and muscle strength deficit in the prediction of tendon hypertrophy in symptomatic unilateral shoulder tendinopathy: an ultrasonographic study

Objective

In asymptomatic, normal tendons, the difference in tendon thickness between sides is less than 15%. In this study, three tests were used to examine differences between symptomatic and asymptomatic shoulders.

Design

Cross-sectional study. The three tests were performed in sequence. The observer was blinded in the maximal pain-free isometric force test.

Setting

Outpatient physiotherapy clinic at Bergen University College, Norway.

Participants

Sixty-four patients with an exclusive, tentative diagnosis of unilateral shoulder tendinopathy.

Main outcome measures

Differences in maximal pain-free isometric force, tendon pain pressure and tendon thickness measured by ultrasonography.

Results

This paper follows the STARD recommendations for papers on diagnostic accuracy. When cut-off values for within-subject side differences were selected at ≥0.8 mm for tendon thickness (TT_diff), ≥10 N for maximal pain-free isometric force (PFF_diff) and ≥0.6 kg for tendon pain pressure (PPT_diff), positive tests were found in 92% of patients. All three tests were sensitive for the detection of within-subject side differences with the selected cut-off values (TT_diff, n = 60/64; PPT_diff, n = 59/64; PFF_diff, n = 57/64; P > 0.35). There were strong agreements between the three tests: TT_diff and PFF_diff, 0.89; TT_diff and PPT_diff, 0.83; and PFF_diff and PPT_diff, 0.84. When both clinical tests were positive (PFF_diff and PPT_diff), the positive predictive value was excellent (94%) for finding increased tendon thickness in the symptomatic side on ultrasonography.

Conclusions

Within the limitations of this partially blinded study, patients with unilateral shoulder tendinopathy exhibited significant differences between sides in all three tests. The combination of the two clinical tests seems to be valid for the detection of unilateral shoulder tendinopathy if other diagnoses have been excluded.     

Pediatric Vasoocclusive Crisis and Weather Conditions

Background

Previous studies have demonstrated associations of frequency of vasoocclusive crisis with weather conditions in adults, although relationships have been inconsistent.

Objectives

Our objective was to determine if there is an association between weather conditions and pediatric emergency department (ED) visits, hospital admissions, and day and severity of pain precipitation for vasoocclusive crisis (VOC).

Methods

A retrospective observational study was performed at a large tertiary care pediatric center. We reviewed health records of all VOC patients under the age of 18 years with a chief complaint of pain and performed correlations between daily and average weekly and monthly weather conditions and frequency of painful crises.

Results

A total of 430 visits for VOC to the ED were documented from January 2005 to December 2006. Significant correlations were noted between the daily and weekly number of painful crises and colder temperatures (ρ = −0.11, p = 0.004 for daily data and r = 0.25, p = 0.01 weekly) and wind speed (ρ = 0.13, p < 0.001 and r = 0.25, p = 0.01). The monthly number of painful crises was moderately correlated with temperatures (r = −0.42, p = 0.04). The average monthly pain score was higher in more humid months (r = 0.44, p = 0.03).

Conclusion

We found significant correlations of VOC with weather conditions where colder temperatures and higher wind speed were associated with a higher incidence of VOC in children. Health care providers as well as parents should be aware of these findings and ensure that preventive measures are instituted in patients at risk.     

Cognitive determinants of pain and disability in patients with chronic whiplash-associated disorder: A cross-sectional observational study

Objective

To delineate the relative extent to which specific cognitive factors are related to levels of pain and disability in patients with chronic whiplash-associated disorder.

Design

Cross-sectional observation study.

Setting

Three secondary care physiotherapy departments in the Greater Manchester region of the UK.

Participants

All patients with chronic whiplash-associated disorder referred to the participating departments were invited to take part in the study. In total, 124 patients were invited to participate, and 63 (51%) agreed to do so. Complete data were available for 55 (44%) of those invited to participate in the study.

Main outcome measures

Pain and disability, as assessed by the Neck Disability Index.

Results

Cognitive factors were strongly related to levels of disability (R² change = 0.39, P < 0.001). Specifically, greater catastrophising (β = 0.41, P < 0.01) and lower functional self-efficacy beliefs (β = −0.47, P < 0.001) were significantly related to greater levels of disability. Significant univariate correlations were seen between the cognitive factors and current pain intensity. However, no significant associations were seen between the cognitive factors and current pain intensity in the multivariate analysis.

Conclusions

Interventions which aim to reduce catastrophising and enhance functional self-efficacy beliefs should be included alongside conventional physiotherapy interventions when treating patients with chronic whiplash-associated disorder.     

Effects of an acute hamstring stretch in people with and without osteoarthritis of the knee

Objective

To compare the effects of an acute stretching intervention on knee extension range of motion, passive resistive torque and stiffness in subjects with osteoarthritis of the knee, and to compare these variables with subjects without osteoarthritis.

Design

Cross-sectional experimental study.

Setting

Human performance laboratory.

Participants

A total of 55 participants were recruited: 28 subjects (males and females) with osteoarthritis of the knee joint and 27 subjects of a similar age without osteoarthritis of the knee joint.

Intervention

Using the Kincom dynamometer, three 60-second stretches with 60 seconds of rest between stretches were applied to the hamstring muscle group.

Main outcome measures

Peak knee extension range of motion, peak passive torque and stiffness in the final 10% of knee extension range of motion.

Results

A significant (P < 0.05) increase in knee extension range of motion, peak passive torque and stiffness was observed in both groups. For knee extension range of motion, the mean difference for the osteoarthritis group and non-osteoarthritis group was 4.9 degrees [95% confidence interval (CI) 0.9 to 8.5] and 4.4 degrees (95% CI 1.8 to 6.8), respectively. For peak passive torque, the mean difference in the osteoarthritis group and the non-osteoarthritis group was 4.4 N m (95% CI 0.8 to 6.9) and 1.0 N m (95% CI −1.4 to 3.5), respectively. For stiffness in the final 10% of knee extension range of motion, the mean difference for the osteoarthritis group and the non-osteoarthritis group was 0.19 N m/degree (95% CI 0.08 to 0.3) and 0.04 N m/degree (95% CI −0.05 to 0.1), respectively. Stiffness in the final 10% of knee extension range of motion was significantly higher in the osteoarthritis group compared with the non-osteoarthritis group after stretching.

Conclusions

Elderly individuals with and without osteoarthritis of the knee are able to demonstrate immediate beneficial adaptations to a stretching intervention. This is important as stretching is often used in preparation for exercise programmes.     

The effect of a group education programme on pain and function through knowledge acquisition and home-based exercise among patients with knee osteoarthritis: A parallel randomised single-blind clinical trial

Objectives

To assess the effect of a group education programme on pain and function through knowledge acquisition and a home-based exercise programme.

Design

A parallel randomised single-blind clinical trial.

Participants

Fifty patients aged 65 years or over with knee osteoarthritis.

Interventions

The study group (n = 25) was given a group education programme once a week for 4 weeks, followed by a self-executed home-based exercise programme. The controls (n = 25) were given a brief course in short-wave diathermy treatment.

Main outcome measures

Patients were assessed before the intervention, after the intervention (4 weeks) and again 8 weeks later (follow-up) using the Western Ontario McMaster Osteoarthritis Index (WOMAC), the repeated sit-to-stand test and the get-up-and-go test.

Results

At 4 weeks, there was a significant improvement in both groups in all outcome variables except the WOMAC stiffness score; for example, the WOMAC total score was reduced by a mean of 9.5 points [95% confidence interval (CI) −12.3 to −6.7]. However, at follow-up, patients in the study group demonstrated continued improvement in the get-up-and-go test and the WOMAC total, pain and disability scores, but no such improvement was noted among the controls. This difference was significant; for example, the difference in mean WOMAC total score between the groups was −9.0 points (95%CI −14.5 to −3.4).

Conclusion

A simple group education programme for patients with knee osteoarthritis is associated with improved functional abilities and pain reduction. Further study is required to determine if this positive effect can be maintained over a longer period.     

Does amplitude-modulated frequency have a role in the hypoalgesic response of interferential current on pressure pain sensitivity in healthy subjects? A randomised crossover study

Objective

To investigate the hypoalgesic effect of amplitude-modulated frequency during interferential current therapy using an experimentally induced mechanical pain model in normal subjects. This study examined pain pressure sensitivities achieved when the amplitude-modulated frequency parameter was present (100 Hz) and absent (0 Hz).

Design

Randomised controlled crossover trial with repeated measures.

Setting

University research laboratory.

Participants

Forty-six healthy volunteers (23 males, 23 females).

Interventions

Two interferential therapy protocols (with and without amplitude-modulated frequencies) were applied to the lumbar area on two different days.

Main outcome measures

Pressure pain thresholds over the lumbar area were measured before, during and after application of the interferential therapy protocols.

Results

A three-way analysis of variance with repeated measures failed to show any statistically significant difference between the two protocols in modifying pressure pain threshold values (mean difference 0.017 kg/cm², 95% confidence interval −0.384 to 0.350, P = 0.93). Statistically significant differences were identified (P < 0.001) between measurements, indicating a comparable decrease in pain sensitivity in both groups. However, the increase in pressure pain thresholds (0.76 kg/cm²) failed to reach a level of clinical importance.

Conclusions

The addition of an amplitude-modulated frequency parameter to interferential therapy did not influence mechanical pain sensitivity in healthy subjects. Amplitude-modulated frequency is therefore unlikely to have a physiological hypoalgesic effect.     

Does the Macroduct collection system reliably define sweat chloride concentration in subjects with intermediate results?

Objectives

The sweat test remains the current diagnostic gold standard for CF disease. Many CF testing centres have switched from the Gibson and Cooke to the Macroduct^®. Since the validity and sensitivity of Macroduct^® has not been tested in patients with intermediate sweat chloride concentrations, we compared both methods simultaneously including subjects expected to have intermediate results.

Design and methods

We prospectively evaluated controls, obligate heterozygotes, patients with CF and with an uncertain diagnosis of CF (congenital absence of the vas deferens, pancreatitis and sinopulmonary disease).

Results

We assessed 82 subjects (3.7-60.1 years); 14 healthy controls, 7 obligate heterozygotes, 20 CF (15 pancreatic insufficient, 5 pancreatic sufficient), and 41 with unproven diagnosis. Mean test difference was close to 0 (95% CI ± 20 mmol/L) and test values were highly correlated (r = 0.93, p ≤ 0.0001). Discrepancies between the two testing methods occurred in 22% of subjects.

Conclusion

Sweat chloride measured by Macroduct^® highly correlates with Gibson and Cooke for concentrations in all ranges, including the intermediate range. This study reveals the limitations of sweat testing for excluding a diagnosis of CF since 38% of subjects had intermediate range results.     

Soluble CD40 ligand, high sensitive C-reactive protein and fetuin-A levels in patients with essential thrombocythemia

Background

CD40 ligand (CD40L) is expressed on the surface of activated platelets and activated T lymphocytes. Circulating soluble CD40 ligand (sCD40L) is formed from these molecules proteolytically. Fetuin-A is a potent antiinflammatory cytokine.

Aim of the study

In this study, we aim to investigate sCD40L levels to determine whether there is platelet activation and to measure high sensitive C-reactive protein (hs-CRP) levels to demonstrate if this leads to an inflammatory process and also to study fetuin-A levels to see if there is any concomitant antiinflammatory event in patients with essential thrombocythemia (ET).

Methods

We compared 30 patients with essential thrombocythemia with 30 control subjects and in these patients we measured levels of sCD40L, hs-CRP and fetuin-A.

Results

sCD40L levels were significantly higher in the ET group compared to the control group (30.6 ± 14.4 vs. 18.5 ± 8.9, p = 0.001). Although fetuin-A levels showed a slight trend to be increased in ET patients, the difference did not reach significance (4.5 ± 4.2 vs. 3.2 ± 2.1, p = 0.158). There were no statistically significant differences in hs-CRP levels (24.6 ± 4.9 vs. 25.0 ± 5.2, p = 0.750).

Conclusion

sCD40L was significantly higher in patients with an ET without any association with an inflammatory process and we believe this may be a marker of platelet regeneration.     

Study of patellar kinematics after reconstruction of the medial patellofemoral ligament

Background

Medial patellofemoral ligament reconstruction is currently the technique of choice for the treatment of patellar instability. But what should be the most appropriate graft tension for optimal restoration of patellofemoral kinematics?

Methods

Six freshly frozen cadaveric knees were studied, the three bone segments were respectively equipped with opto-reflective markers. The acquisitions were made using the Motion Analysis System®. Six successive acquisitions were performed for each knee under different levels of graft tension.

Findings

With an intact medial patellofemoral ligament, the medial patellar tilt increased up to a mean value of 2.02° (SD 3.1), the medial patellar translation gradually increased up to a mean value of 3.3 mm (SD 2.25) with a slight lateral rotation over the first 30° of knee flexion with a maximum mean value of 1.22° (SD 0.8) at 20° of knee flexion.Reconstruction of the medial patellofemoral ligament was performed using different levels of tension applied to the graft. Only 10 N of graft tension could restore normal patellar tilt, lateral shift and rotation, with results approximating those measured on healthy knee.

Interpretation

This study confirms the role of the medial patellofemoral ligament in providing adequate patellar stability during the first 30° of knee flexion. According to our findings, a 10 N tension applied to the graft appears sufficient to ensure proper control of patellar tracking whereas 20, 30 and 40 N of tension are excessive tension values inducing a major overcorrection in all studied parameters.     

Low back pain characteristics from undergraduate student to working nurse in Australia: a cross-sectional survey

Background

Nurses are known to be a high risk group for occupational low back pain (LBP). The periods of greatest risk for developing low back pain in this population are not well defined. Recent literature suggests current preventative strategies are not consistently effective in improving low back injury statistics among health care populations.

Objectives

To identify the relative contributions of age and occupational exposure on the prevalence, duration and severity of low back pain episodes among undergraduate nursing students and recently graduated nurses.

Design

Cross-sectional survey.

Settings

Two university undergraduate nursing schools and one public teaching hospital graduate nurse training program in Western Australia.

Participants

897 undergraduate nursing students (years 1, 2 and 3) and 111 graduate nurses recruited by personal invitation during lectures.

Methods

Using a modified version of the Nordic Low Back Questionnaire, information regarding low back pain episode prevalence, impact, duration, frequency and causes was obtained.

Results

Mean age was consistent across all groups (26.7 ± 9.0 years) and had no significant effect on lifetime low back pain prevalence (p = 0.30). Very high lifetime (79%), 12 month (71%) and 7 day (31%) low back pain prevalence rates were consistent across all 3 year groups of undergraduate nursing students, but were significantly higher after 12 months of full-time employment [lifetime (95.5%), 12 month (90%) and 7 day (39%)]. Around 60% of all respondents with low back pain utilised at least one of (a) treatment, (b) medication, or (c) a reduction in activity. Nursing students and graduate nurses attributed the majority of their low back pain to bending or lifting despite recent efforts to reduce manual workplace demands (lifting) on nurses. Strategies for managing low back pain differed between nursing students and graduate nurses.

Conclusions

These results may suggest a rise in occupational exposure from student to working nurse is the primary cause of the increase in low back pain. Increased exposure may be to physical as well as psychological stressors. Given that prevalence rates are very high prior to commencing work, nursing student populations should be a target group for low back pain preventative strategies.     

Implementation of newborn screening for Krabbe disease: Population study and cutoff determination

Objective

The aim of this study was to develop a newborn screening algorithm for Krabbe disease.

Design and methods

We measured the galactocerebrosidase activity of 139,074 anonymous newborns, 56 known carriers, and 16 Krabbe patients using a tandem mass spectrometry method. The activities were converted to percentages of daily mean activity (%DMA), and the results from diseased and normal populations were used to establish cutoffs.

Results

The absolute activities for the newborns ranged from 0.17 to 355 μmol/L h (N = 139,074) and activities for Krabbe-positive controls ranged from 0.08 to 0.48 μmol/L h (N = 16, n = 91 measurements) while activities for carriers ranged from 0.28 to 2.71 μmol/L h (N = 56, n = 72 measurements). Cutoffs were set based on results from Krabbe-positive and carrier controls and the newborn population distribution.

Conclusions

The algorithm and cutoffs we propose provided 100% detection of all positive controls with 60/100,000 screen positive results predicted. In the course of this study, one anonymous newborn was predicted to have Krabbe disease based on enzyme activity and subsequent DNA analysis.     

Evaluation of an interpersonal-psychotherapy-oriented childbirth education programme for Chinese first-time childbearing women: A randomised controlled trial

Objective

This study investigated the effects of an interpersonal-psychotherapy-oriented childbirth psychoeducation programme on postnatal depression, psychological well-being and satisfaction with interpersonal relationships in Chinese first-time childbearing women.

Method

A randomised, controlled trial was conducted in the maternity clinic of a regional hospital in China. The intervention was based on the principles of interpersonal psychotherapy, and consisted of two 90-min antenatal classes and a telephone follow-up within 2 weeks after delivery. One hundred and ninety-four first-time pregnant women were randomly assigned to the intervention group (n = 96) or a control group (n = 98). Outcomes of the study included symptoms of postnatal depression, psychological well-being and satisfaction with interpersonal relationships, which were measured by the Edinburgh Postnatal Depression Scale (EPDS), General Health Questionnaire (GHQ) and Satisfaction with Interpersonal Relationships Scale (SWIRS), respectively.

Results

Women receiving the childbirth psychoeducation programme had significantly better psychological well-being (t = −3.33, p = 0.001), fewer depressive symptoms (t = −3.76, p = 0.000) and better interpersonal relationships (t = 3.25, p = 0.001) at 6 weeks postpartum as compared with those who received only routine childbirth education.

Conclusion

An interpersonal-psychotherapy-oriented childbirth psychoeducation programme could be implemented as routine childbirth education with ongoing evaluation. Replication of this study with more diverse study groups, such as mothers with high risks to depression, those with multiple, complicated or multiparas pregnancies, would provide further information about the effects of the programme.     

Pain reduction of acupoint electrical stimulation for patients with spinal surgery: a placebo-controlled study

Background

Acupoint electrical stimulation (AES) is commonly used for pain management. However, its true or placebo effect to achieve pain relief needs to be verified.

Objective

This study aimed to examine the true effect of AES to reduce postoperative pain in patients with spinal surgery receiving patient-controlled analgesia (PCA).

Method

A placebo- and sham-controlled study was conducted. Participants were randomly assigned to intervention with AES at true acupoints (the AES group, n = 30), AES at sham acupoints (the sham group, n = 30), or no intervention with AES (the control group, n = 30). Outcomes were assessed according to the amount of pain experienced and analgesics used.

Results

There were significant differences among the three groups in pain relief across time, and the occurrence of PCA button pushed and amount of analgesics used. The beneficial effects of AES were discernible when compared to the sham and the control.

Conclusions

AES at the true acupoints effectively reduced postoperative pain and analgesic usage. AES has now been implemented into healthcare and it is recommended that nurses be provided with the opportunity to earn their AES skills. More studies evaluating the effects of AES over a longer period and on pain after different surgical procedures are suggested.     

Analytical investigation: assay of D-lactate in diabetic plasma and urine

Objective

In this study we developed a 96-micro plate enzymatic assay for d-lactate in plasma and urine.

Methods

d-lactate was assayed enzymatically with a UV-spectrophotometer in plasma from 38 and in urine from 37 diabetics and from 42 non-diabetic controls.

Results

The within-run coefficients of variations (CV) were 2.6% for plasma and 5.7% for urine. The between run CVs were 6.8% for plasma and 6.7% for urine. The mean recovery with standard deviation (S.D.) was 107.4 ± 7.3% for plasma and 100.1% ± 6.7% for urine. The plasma d-lactate in diabetics were (mean ± S.D.) 39.6 ± 23.7 μM. We found significant difference between the urinary d-lactate in controls and diabetics (18.2 ± 12.0 vs. 35.9 ± 24.2 μM/mM creatinine, p < 0.0001).

Conclusions

The assay proved reliable with acceptable precision and recovery. Results suggest that diabetics have elevated urinary and plasma d-lactate as compared to controls.