Effects of taping on pain and function in patellofemoral pain syndrome: a randomized controlled trial

STUDY DESIGN: A randomized controlled trial. OBJECTIVES: To investigate the effectiveness of daily patella taping and exercise on pain and function in individuals with patellofemoral pain syndrome. BACKGROUND: Patella taping and muscle-strengthening programs are commonly used to treat patellofemoral pain syndrome. There is, however, little evidence for the effectiveness of these approaches. METHODS AND MEASURES: Twenty-four men and 6 women aged 17 to 25 years (mean +/- SD, 18.7 +/- 1.2 years) participated in the study. Subjects were randomly and exclusively assigned to 1 of 3 treatment groups: patella taping combined with a standardized exercise program, placebo patella taping and exercise program, or exercise program alone (n = 10 in each group). Taping was applied and exercises performed on a daily basis for 4 weeks. Outcome measures were visual analog scales for pain and the functional index questionnaire, recorded at weekly intervals by a therapist who was blinded to group allocation. RESULTS: Separate mixed-model ANOVAs, with repeated measures on time, indicated statistically significant improvements in pain and function over time for all groups (P<.01) and also significant differences between groups for all measures (P<.01). Separate independent samples t tests showed that the group receiving taping and exercises had better pain and function scores following treatment than the placebo taping-and-exercise group and the exercise-alone group. There were no significant differences between the placebo taping-and-exercise group and exercise-alone group at any time point. CONCLUSIONS: These findings indicate that over a period of 4 weeks a combination of daily patella taping and exercises was successful in improving pain and function in individuals with patellofemoral pain syndrome. The combination of patella taping and exercise was superior to the use of exercise alone.     

Age-related mineralization heterogeneity changes in trabecular bone of the proximal femur

Although there is extensive documentation in the literature regarding the importance of trabecular bone for proximal femoral integrity and fracture resistance, there remain gaps in our understanding of the basic mineral changes that may occur in trabecular bone attributable to aging. It is unclear what age-related changes take place in the trabecular bone of the proximal femur, a common fracture site in the elderly. It has been suggested that some explanation for conflicting reports on cancellous bone may be found at a microscopic level. The goal of this study was to document age-related changes in micromineralization in the proximal femur of Caucasian females using backscattered electron imaging technology. Proximal femurs were obtained from 11 young and 11 elderly females. Sections of bone from the superior and inferior neck and superior and inferior trochanter were analyzed in a scanning electron microscope using the backscatter technique to determine ash percent. Mean ash percent did not change with age in any of the four regions (P > 0.05). However, while the mean ash percent did not change, there was a dramatic increase in variability elderly age group and loss of mineral heterogeneity. This indicates that there are subpopulations with higher or lower ash percents than the mean in the elderly study group in this investigation. While variance changed dramatically, variance within individuals did not change significantly with age (P > 0.05). The results of this study suggest that changes in micromineralization may occur within an individual, adding a possible new dimension to our understanding of fracture risk in the elderly. Future studies should examine a longer population base to confirm this observation.     

Physical therapy and cognitive-behavioral treatment for complex regional pain syndromes

Complex regional pain syndromes (CRPS; type 1, reflex sympathetic dystrophy, and type 2, causalgia) involve persistent pain, allodynia, and vasomotor signs. We conducted a prospective, randomized, single-blind trial of physical therapy (PT) and cognitive-behavioral treatment for children and adolescents with CRPS. Children 8 to 17 years of age (n = 28) were randomly assigned to either group A (PT once per week for 6 weeks) or group B (PT 3 times per week for 6 weeks). Both groups received 6 sessions of cognitive-behavioral treatment. Assessments of pain and function were repeated at two follow-up time periods. Outcomes were compared at the three time points through the use of parametric or nonparametric analysis of variance and post hoc tests. All five measures of pain and function improved significantly in both groups after treatment, with sustained benefit evident in the majority of patients at long-term follow-up. Recurrent episodes were reported in 50% of patients, and 10 patients eventually received sympathetic blockade. Most children with CRPS showed reduced pain and improved function with a noninvasive rehabilitative treatment approach. Long-term functional outcomes were also very good.     

New Alström syndrome phenotypes based on the evaluation of 182 cases

BACKGROUND: Alstr?m syndrome is a recessively inherited genetic disorder characterized by congenital retinal dystrophy that leads to blindness, hearing impairment, childhood obesity, insulin resistance, and type 2 diabetes mellitus. We provide new details on cardiologic, hepatic, gastrointestinal, urologic, pulmonary, and neurobehavioral phenotypes in Alstr?m syndrome and describe the histopathologic findings in 5 individuals. METHODS: We obtained data on 182 patients from clinical examinations, medical record reviews, standardized questionnaires, and personal interviews with physicians and parents. RESULTS: Dilated cardiomyopathy occurred in 60% of patients. Age at onset was either during infancy, often before vision disturbances were noted, or in adolescence or adulthood. There is a risk of recurrence of infantile cardiomyopathy. Hyperinsulinemia (92%) developed in early childhood and progressed to type 2 diabetes mellitus in 82% of those older than 16 years. Hypertriglyceridemia (54%) precipitated pancreatitis in 8 patients. Urologic dysfunction and gastrointestinal disturbances occurred in 48% and 35% of patients, respectively. Fifty-three percent of patients had persistent pulmonary symptoms. Neurologic symptoms in 20% of patients included clonic tic and absence seizures. Developmental motor or language delays were observed in 46% of patients. Fibrotic infiltrations of multiple organs, that is, kidney, heart, liver, lung, urinary bladder, gonads, and pancreas, were observed. CONCLUSIONS: The wide-ranging and complex spectrum of phenotypes reported herein broadens those previously described for Alstr?m syndrome. These findings will aid physicians in making an early and accurate diagnosis and will help effect appropriate monitoring and treatment.     

Bone marrow-derived myofibroblasts are present in adult human heart valves

BACKGROUND AND AIM OF THE STUDY: Endothelial, smooth muscle and cardiomyocyte chimerism has been shown to occur in the human heart. It is currently unknown whether the bone marrow contributes to cellular components of adult human heart valves. Here, it was determined whether bone marrow-derived smooth muscle-like cells (SMLC) are present in the heart valves of adult subjects. METHODS: By combining immunofluorescence staining and fluorescence in-situ hybridization (FISH) for X and Y chromosomes, the heart valves of gender-mismatched bone marrow transplant patients were examined for the presence of chimeric cells expressing calponin, a smooth muscle-specific protein. Concomitant staining for CD68 antigen was carried out to exclude cells of a monocytic lineage. RESULTS: The mean percentage of bone marrow-derived SMLC in valves was 0.28 +/- 0.03%, with the total proportion of chimeric cells estimated at 0.71 +/- 0.05%. The mean proportion of CD68+ cells was 0.33 +/- 0.05%. Not a single cell stained doubly for calponin and CD68 antigen. CONCLUSION: These data establish, for the first time, human bone marrow as a source of progenitor cells contributing to SMLC in adult human heart valves.     

Perceived barriers to health care access in a treated population

OBJECTIVE: Health care access may be a significant contributor to health outcome. However, few data exist on perception of barriers by patients in treatment, and attending a clinic visit does not mean that no barriers exist. Understanding barriers for treated populations is particularly important in optimizing care for high vulnerability populations, such as those with mental illness and the elderly. METHOD: A structured interview, demographic questionnaire, and SF-12 were administered to 324 veterans presenting for primary care or mental health appointments at a Veterans Affairs medical center. Principle components analysis was performed and relationships to vulnerability characteristics were identified. RESULTS: Most interview items showed modest mean levels but high variance. Responses were stable over three to six weeks. As hypothesized, perceived total barriers were greater in participants from several vulnerable populations: those receiving treatment for mental health problems, those with disabilities, and those with worse physical and mental function. Minority participants did not perceive greater barriers. An "inverted-U" relationship with age was found. Principal components analysis assigned 18 items across six clinically meaningful subscales. Participants with mental health treatment perceived greater barriers in three subscales including provider communication. Curvilinear relationships were again seen between subscales and age. CONCLUSIONS: Even individuals "in care" perceive barriers. Members of vulnerable populations, particularly those receiving mental health treatment, perceive greater barriers. Data support a multi-dimensional conceptualization of perceived barriers, and different subgroups experience different patterns of barriers.     

Social anxiety disorder in primary care

OBJECTIVE: To examine the prevalence, comorbidity, disability and mental health treatment associated with social anxiety disorder (SAD) in primary care, and to determine whether patients with SAD avoid seeking help from their primary care providers. DESIGN: We analyzed data from a health survey conducted on a systematic sample of patients. Data were then cross-linked to the practice's automated database in order to compare primary health care utilization by patients with SAD to that of patients with other psychiatric disorders and well controls. SETTING: Urban primary care practice at a teaching hospital. PATIENTS: A systematic sample (n=207) of primary care patients. MEASUREMENTS AND MAIN RESULTS: Patients were interviewed by mental health professionals using the Composite International Diagnostic Interview. Lifetime prevalence of SAD was 5.7%. Substance use disorders were far more common among patients with SAD than patients with other psychiatric disorders (33.3% vs. 3.3%, P=.01). Social anxiety disorder patients were functionally impaired and made fewer primary care visits per year (mean 4.1) compared to patients with other psychiatric disorders (mean 6.9; P=.016) or well controls (mean 6.4; P=.031); 41.7% reported receiving mental health treatment in the past year. CONCLUSION: Patients with SAD made fewer primary care visits compared to patients with other psychiatric disorders and well controls. These results, together with the high prevalence of substance use in SAD, and the finding that less than one half received past year mental health treatment, suggest substantial unmet need for care and are especially important in view of available effective treatments for SAD.     

Apple juice concentrate prevents oxidative damage and impaired maze performance in aged mice

Oxidative stress contributes to age-related cognitive decline. In some instances, consumption of fruits and vegetables rich in antioxidant can provide superior protection than supplementation with purified antioxidants. Our prior studies have shown that supplementation with apple juice concentrate (AJC) alleviates oxidative damage and cognitive decline in a transgenic murine model compromised in endogenous antioxidant potential when challenged with a vitamin-deficient, oxidative stress-promoting diet. Herein, we demonstrate that AJC, administered in drinking water, is neuroprotective in normal, aged mice. Normal mice aged either 9-10 months or 2-2.5 years were maintained for 1 month on a complete diet or a diet lacking folate and vitamin E and containing iron as a pro-oxidant, after which oxidative damage was assayed by thiobarbituric acid-reactive substances and cognitive decline as assayed by performance in a standard Y-maze. Mice 9-12 months of age were unaffected by the deficient diet, while older mice demonstrated statistically-increased oxidative damage and poorer performance in a Y maze test. Supplementation with AJC prevented these neurodegenerative effects. These data are consistent with normal aged individuals being susceptible to neurodegeneration following dietary compromise such as folate deficiency, and a hastened onset of neurodegeneration in those individuals harboring a genetic risk factor such as ApoE deficiency. These findings also support the efficacy of antioxidant supplementation, including consumption of antioxidant-rich foods such as apples, in preventing the decline in cognitive performance that accompanies normal aging.