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.     

STUDIES OF CALCIUM AND PHOSPHORUS METABOLISM : V. A STUDY OF THE BONE TRABECUL? AS A READILY AVAILABLE RESERVE SUPPLY OF CALCIUM.

1. Bone trabeculae are easily depleted by the prolonged administration of parathormone, long continued negative calcium balance and growth. 2. A long continued high calcium diet results in a rapid accumulation of the trabeculae. 3. Alizarin red, as has previously been shown in the literature, is deposited in newly formed bone. Its use has made clear that easily mobilizable calcium is not deposited in the shafts of adult animals, but in the trabeculae of bone. 4. The bone trabeculae therefore serve as the storehouse of readily available calcium. 5. The shafts have a slow progressive exchange of inorganic salts and are not influenced except in the case of unusual body demands. 6. It is suggested that the absence of trabeculae in premature infants and their depletion at the end of 4 months in a normal baby might well be an etiological factor in rickets. 7. In our observations, parathormone administration to growing or adult cats has been without effect. 8. Daily injections of parathormone in growing rats results in an increased number of trabeculae and smaller bones.     

A PILOT STUDY OF CORE STABILITY AND ATHLETIC PERFORMANCE: IS THERE A RELATIONSHIP?

Study Design:

Correlation study

Objectives:

To objectively evaluate the relationship between core stability and athletic performance measures in male and female collegiate athletes.

Background:

The relationship between core stability and athletic performance has yet to be quantified in the available literature. The current literature does not demonstrate whether or not core strength relates to functional performance. Questions remain regarding the most important components of core stability, the role of sport specificity, and the measurement of core stability in relation to athletic performance.

Methods:

A sample of 35 volunteer student athletes from Asbury College (NAIA Division II) provided informed consent. Participants performed a series of five tests: double leg lowering (core stability test), the forty yard dash, the T-test, vertical jump, and a medicine ball throw. Participants performed three trials of each test in a randomized order.

Results:

Correlations between the core stability test and each of the other four performance tests were determined using a General Linear Model. Medicine ball throw negatively correlated to the core stability test (r –0.389, p=0.023). Participants that performed better on the core stability test had a stronger negative correlation to the medicine ball throw (r =–0.527). Gender was the most strongly correlated variable to core strength, males with a mean measurement of double leg lowering of 47.43 degrees compared to females having a mean of 54.75 degrees.

Conclusions:

There appears to be a link between a core stability test and athletic performance tests; however, more research is needed to provide a definitive answer on the nature of this relationship. Ideally, specific performance tests will be able to better define and to examine relationships to core stability. Future studies should also seek to determine if there are specific sub-categories of core stability which are most important to allow for optimal training and performance for individual sports.     

MANAGING BEREAVEMENT IN THE CLASSROOM: A CONSPIRACY OF SILENCE?

The ways in which teachers in British schools manage bereaved children are underreported. This article reports the impact of students' bereavement and their subsequent management in primary and secondary school classrooms in Southeast London. Thirteen school staff working in inner-city schools took part in in-depth interviews that focused on the impact of bereaved children on the school and how teachers responded to these children. All respondents had previously had contact with a local child bereavement service that aims to provide support, advice, and consultancy to children, their parents, and teachers. Interviews were audiotaped, transcribed verbatim, and analyzed using ATLAS-ti. Three main themes were identified from analysis of interview data. Firstly, British society, culture, local communities, and the family were significant influences in these teachers' involvement with bereaved students. Secondly, school staff managed bereaved students through contact with other adults and using practical classroom measures such as "time out" cards and contact books. Lastly, teachers felt they had to be strong, even when they were distressed.Surprise was expressed at the mature reaction of secondary school students to deaths of others. The article recommends that future research needs to concentrate on finding the most effective way of supporting routinely bereaved children, their families, and teachers.     

SIDELINE MANAGEMENT OF ACUTE DISLOCATION OF THE GLENOHUMERAL JOINT‐ A UNIQUE APPROACH TO ATHLETE SELF‐REDUCTION

The acute anterior dislocation of the glenohumeral joint (GHJ) poses a challenge to sports medicine providers at all levels and in all settings. This macrotraumatic injury occurs in athletes who participate in a wide variety of sports, most typically as a result of contact or collision mechanisms. Quick and effective relocation of the GHJ is an important skill for on the sideline or on the field management of this type of dislocation when appropriate and allowable by facility protocol. This clinical suggestion describes one possible technique for athlete self‐reduction that may be appropriate in some circumstances. This is in contrast to forcible reduction by the health professional, which is outside of the scope of this clinical commentary.

Level of Evidence:

5     

A SURVEY OF EXERCISE‐RELATED LEG PAIN IN COMMUNITY RUNNERS

Purpose/Background:

Exercise‐related leg pain (ERLP) is a common problem in runners. The purposes of this study were to 1) report ERLP occurrence among adult community runners; 2) determine ERLP impact on daily activities; and 3) determine if there is a relationship between ERLP occurrence and selected potential risk factors including sex, age, years of running, ERLP history, body mass index (BMI), orthotic use, menstrual function, and training variables.

Methods:

Community runners registered for a local race were invited to complete a questionnaire including demographics and potential risk factors. Analyses of differences (t‐test) and relationships (Chi‐square) were conducted and relative risk (RR) values were calculated.

Results:

225 registered runners (105 male, 120 female) participated; 63.6% reported ERLP history, and 35.1% reported ERLP in the 3 months preceding the race with bilateral medial ERLP as the most common presentation. Of the 79 runners who experienced ERLP during the 3 months preceding the race, ERLP caused 41.8% to reduce their running and interfered with walking or stair climbing in < 10%. Chi square analyses showed no significant association of sex, menstrual function, orthotic use, or BMI with ERLP occurrence. Significant associations were observed between ERLP history and ERLP occurrence in the previous year (RR=3.39; 2.54‐4.52 95% CI), and between ERLP in the 3 months preceding the race and both years running and training mileage. Greater ERLP occurrence was observed in runners with less than 3 years experience (RR = 1.53; 1.08‐2.17 95% CI) and runners who ran fewer than 15 miles/week (RR = 1.47; 1.04‐2.08 95% CI). Those runners with < 3 years running experience and a race pace of 9 min/mile or > were at greater risk for ERLP when compared to other participants (RR=1.53; 1.07‐2.18 95% CI).

Conclusion:

Interfering ERLP was common among this group of community runners. Risk factors included ERLP history, training mileage < 15 miles/week, and < 3 years running experience. Further investigation is warranted to identify factors which may increase a community runner''s risk of developing ERLP.

Level of Evidence:

2b.     

FOLLOW-UP OF BREAST CANCER: TIME FOR A NEW APPROACH?

After treatment for breast cancer women are monitored for recurrent disease by means of routine hospital-based follow-up appointments. The aim of this study is to determine the efficiency of this system, by establishing how recurrence presents to our hospital. The study comes at a time of increasing pressure on breast clinics from new patient referrals and the need, since April 1999, to see all cases classified as urgent within two weeks of referral. A consecutive series of 643 patients who presented with operable breast cancer between 1992 and 1998 were reviewed. Details about the 108 patients who had locoregional or metastatic relapse were obtained from our breast cancer database and their clinical records. Full data were available on 104 patients: 77 (74%) were seen at expedited (interval) appointments and a further 18 (17.3%) drew attention to symptoms at a routine visit. Two cases of locoregional recurrence were revealed by surveillance imaging. Unsuspected disease, locoregional in all cases, was detected on examination in 7 (6.7%) patients. The median time to presentation of recurrence was 19 months for metastatic and 18 months for locoregional disease. Breast cancer recurrence usually presents to an interval clinic. Most cases that are confirmed following a routine review are already symptomatic. Long-term routine hospital follow-up after treatment for breast cancer appears inefficient and unnecessary. Following liaison with local general practitioners we propose to discharge patients from routine review after two years. Thereafter they will have scheduled appointments with their GPs with immediate access to specialist review in the breast care unit if required.     

REACTIONS OF MONKEYS TO EXPERIMENTALLY INDUCED INFLUENZA VIRUS A INFECTION : AN ANALYSIS OF THE RELATIVE R?LES OF HUMORAL AND CELLULAR IMMUNITY UNDER CONDITIONS OF OPTIMAL OR DEFICIENT NUTRITION

1. Macaca mulatta monkeys on a normal diet have proved resistant to intranasal but not to intratracheal inoculation of influenza virus. 2. Neutralizing antibodies appeared 8 to 10 days after inoculation with either living or heat-inactivated virus. The antibodies were noted to be still present as long as 9 months after infection with living virus. 3. A specific granulopenic leucopenia characteristically followed primary influenza virus inoculation, regardless of altered conditions of diet, exposure, and route of inoculation, but it was not observed in monkeys previously infected with the same virus, all of which invariably survived. 4. Nutritional deficiency and exposure to cold increased the susceptibility of monkeys on intranasal instillation of the virus; the leucopenia was profound and fatalities frequently occurred even though neutralizing humoral antibodies developed as promptly and in relatively the same titer as under optimum nutritional conditions.     

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     

EFFECTS OF A DRY‐LAND STRENGTHENING PROGRAM IN COMPETITIVE ADOLESCENT SWIMMERS

Background

Shoulder pain is common in competitive young swimmers. A relationship between shoulder strength and shoulder soreness in competitive young swimmers may indicate need for strengthening.

Purpose

To determine if a shoulder exercise program will improve shoulder strength and decrease pain in competitive young swimmers.

Study Design

Randomized control

Methods

Participants (10 control, 11 experimental), randomly assigned to a control or experiment group, completed the 12 week program. Strength was measured prior to the study for shoulder flexion, abduction, external rotation, internal rotation, and extension on the dominant arm using handheld dynamometry. The experimental group was then assigned exercises to be performed three times per week. The control group was instructed not to perform the exercises. All participants were re‐tested at six and twelve weeks following initiation of the study.

Results

The changes in strength for each muscle group and pain were compared between groups using a mixed design two‐way ANOVA. The experimental group significantly increased external rotation strength compared to the control group. Shoulder soreness was not significantly different between groups.

Conclusion

Adolescents who perform shoulder strengthening significantly increased their external rotation strength compared to adolescents who only participated in a regular swimming regimen.     

VALIDATION OF A NEW METHOD FOR ASSESSING SCAPULAR ANTERIOR‐POSTERIOR TILT

Background:

Electromagnetic tracking systems have enabled some investigators and clinicians to measure tri‐planar scapular motion; yet, they are not practical and affordable options for all clinicians. Currently, the ability to affordably quantify scapular motion is limited to monitoring only the motion of scapular upward rotation, with use of a digital inclinometer.

Hypothesis/Purpose:

The objective of this study was to determine the criterion‐related validity of a modified digital inclinometer when used to measure the motion of scapular anterior‐posterior (AP) tilt.

Materials & Methods:

Thirteen volunteers, free from any history of shoulder injury, reported for a single testing session. Each subject underwent a brief shoulder and posture examination in order to confirm the absence of pathology. Subjects actively performed clinically relevant amounts of humeral elevation in the scapular plane while in a seated position. An electromagnetic tracking system (Ascension Technology, Burlington, VT) and a modified inclinometer (Pro 360, Baseline®, Fabrication Enterprises, White Plains, NY) were used to acquire scapular AP tilt over the same shoulder motions. Criterion‐related validity was determined using Pearson Product Moment correlations.

Results:

Correlation analyses revealed significant moderate to good associations (r = 0.63 to 0.86, p < 0.01) between scapular AP tilt measures obtained with a digital inclinometer and an electromagnetic tracking system.

Conclusions

A modified digital inclinometer is a moderately valid device to use for the quantification of scapular AP tilt. Further study is warranted to establish reliability and to validate use of the device in patients with shoulder injury or pathology. The modified inclinometer expands the clinician''s ability to quantify scapular kinematic motion during the clinical evaluation and rehabilitation process.

Level of Evidence:

Level 3     

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.     

COMPREHENSIVE POST‐ARTHROSCOPIC MANAGEMENT OF A MIDDLE‐AGED ADULT WITH GLENOHUMERAL OSTEOARTHRITIS: A CASE REPORT

Comprehensive Arthroscopic Management (CAM) is a new glenohumeral debridement procedure developed as a joint preserving alternative to total shoulder arthroplasty (TSA). The procedure consists of several arthroscopic components including: A. scar tissue and chondral debridement, B. synovectomy, C. inferior humeral osteoplasty, D. capsular release, E. axillary nerve decompression, and F. tenodesis of the long head of the biceps. In this case, an active, middle age patient who failed physical therapy treatment and corticosteroid injections was evaluated and diagnosed with glenohumeral osteoarthritis. Anterior‐ posterior (AP) and axillary radiographs showed grade IV changes of the articular cartilage, confirming the diagnosis. The patient was not an ideal candidate for TSA because of her age, activity level, and concern for implant survival; therefore surgical intervention was performed using the CAM procedure. After the surgery, the patient demonstrated increased joint space as shown using radiographic imaging. The patient underwent intensive postoperative rehabilitation with a heavy emphasis on joint range of motion (ROM) and capsular mobility. By eight weeks she achieved 85% active ROM compared to her uninvolved shoulder, and a 55% improvement on the Pennsylvania Shoulder Score. Radiographic imaging provided an understanding of the severity of the arthritic changes present in this patient, identified the limited potential of continued conservative management, and showed structural changes that may be correlated with improved function following the surgical intervention. For patients less than 55 years of age diagnosed with severe glenohumeral osteoarthritis, the CAM procedure and intensive, motion focused therapy presents a promising treatment combination.

Level of Evidence:

IIIb     

TEST‐RETEST CONSISTENCY OF A POSTURAL SWAY ASSESSMENT PROTOCOL FOR ADOLESCENT ATHLETES MEASURED WITH A FORCE PLATE

Purpose/Background:

Postural control assessments can provide a powerful means of detecting concussion‐related neurophysiological abnormalities and are considered an important part of the concussion management processes. Studies with college athletes indicate that postural sway analyzed using complexity metrics may provide a sensitive and novel way to detect post‐concussion postural control impairments. The purpose of this study was to determine if a postural sway assessment protocol (PSAP) measured using a force plate system can serve as a reliable assessment tool for adolescent athletes.

Methods:

The short‐term and long‐term test‐retest reliability of the PSAP was examined in a group of adolescent female athletes under eyes open and eyes closed conditions. Detrended fluctuation analysis was used to evaluate the complexity of the times series data (i.e., degree of self‐similarity across time scales). Conventional measures of standard deviation and total path length (distance traveled by the center‐of‐pressure) were also assessed.

Results:

The complexity and conventional measures generally demonstrated good reliability coefficients for short‐term and long‐term test‐retest reliability with both eyes open and eyes closed conditions. Intra‐class Correlation Coefficient (ICC) values ranged from .38‐.90 The highest ICC values corresponded with the short‐term reliability for the eyes open condition, while the lower ICC values corresponded with the long‐term reliability for the eyes closed condition.

Conclusions:

The results of this study indicate that the PSAP demonstrated good short‐term and long‐term test‐retest reliability. In addition, no evidence of learning effects was elicited through this study. Future studies should further explore the validity and feasibility of the use of this protocol for different age groups, different types of athletes, and longitudinal evaluations of post‐concussion impairments.

Clinical Relevance:

This study provides preliminary support for the utility of a postural sway assessment protocol measured using a force plate for use with adolescent athletes.

Level of Evidence:

Level III     

WHAT ARE THE EFFECTS OF DIFFERENT MODES OF EXERCISE TRAINING FOR INTERMITTENT CLAUDICATION? - A COCHRANE REVIEW SUMMARY WITH COMMENTARY

The aim of this commentary is to discuss from a rehabilitation perspective the published Cochrane Review “Modes of exercise training for intermittent claudication”(1) by Jansen SCP et al¹, under the direct supervision of Cochrane Vascular. This Cochrane Corner is produced in agreement with the Journal of Rehabilitation Medicine by Cochrane Rehabilitation.Key words: Cochrane Review Summary, exercise training, intermittent claudication, systematic review, walking