A no-name tuberculosis tracking system

Foreign-born persons from countries where tuberculosis (TB) is endemic make up a significant percentage of poultry industry workers in Delaware, a leading poultry-producing state. Many of these workers enter the United States without documentation and assume multiple identities, making it difficult for public health staff to investigate TB contacts who work in the poultry plants. The Sussex County Health Unit of the Delaware Division of Public Health developed a no-name TB tracking system to facilitate identification and treatment of poultry plant workers with TB infection and disease in a high-risk population whose members assume one or more aliases. Completion rates for treatment of latent TB infection in this group increased from 48% to 64% 2 years after the program's implementation.     

Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: a randomized controlled trial

Context  Extracorporeal shock wave therapy (ESWT) has been used to treat calcific tendonitis of the shoulder, but trials of ESWT for this purpose have had methodological deficiencies and thus there is limited evidence for its effectiveness. Objective  To determine whether fluoroscopy-guided ESWT improves function, reduces pain, and diminishes the size of calcific deposits in patients with chronic calcific tendonitis of the shoulder. Design, Setting, and Participants  Double-blind, randomized, placebo-controlled trial conducted between February 1997 and March 2001 among 144 patients (of 164 screened) recruited from referring primary care physicians, orthopedic surgeons, and sports physicians in 7 orthopedic departments in Germany and Austria. Interventions  Either high-energy ESWT, low-energy ESWT, or placebo (sham treatment). The 2 ESWT groups received the same cumulative energy dose. Patients in all 3 groups received 2 treatment sessions approximately 2 weeks apart, followed by physical therapy. Main Outcome Measures  The primary end point was the change in the mean Constant and Murley Scale (CMS) score from baseline to 6 months after the intervention. Secondary end points were changes in the mean CMS scores at 3 and 12 months, as well as changes in self-rated pain and radiographic change in size of calcific deposits at 3, 6, and 12 months. Results  Of 144 patients enrolled, all completed treatment as randomized and 134 completed the 6-month follow-up. Both high-energy and low-energy ESWT resulted in significant improvement in the 6-month mean (95% confidence interval [CI]) CMS score compared with sham treatment (high-energy ESWT: 31.0 [26.7-35.3] points; low-energy ESWT: 15.0 [10.2-19.8] points; sham treatment: 6.6 [1.4-11.8] points; P<.001 for both comparisons). Patients who received high-energy ESWT also had significant 6-month CMS improvements compared with those who received low-energy ESWT (P<.001). We found similar results for both the 3-month and 12-month CMS comparisons, as well as for self-rated pain and radiographic changes at 3, 6, and 12 months. Conclusions  Both high-energy and low-energy ESWT appeared to provide a beneficial effect on shoulder function, as well as on self-rated pain and diminished size of calcifications, compared with placebo. Furthermore, high-energy ESWT appeared to be superior to low-energy ESWT.      

Influence of distribution of lean body mass on resting metabolic rate after weight loss and weight regain: comparison of responses in white and black women

BACKGROUND: Little is known about the effect of weight change on regional lean body mass (LBM) distribution or on racial differences in resting metabolic rate (RMR). OBJECTIVE: The study compared total and regional LBM patterns in white and black women after weight loss and regain and assessed the influence of regional LBM on variances in RMR. DESIGN: Eighteen white and 22 black women who did not differ in age, weight, and height were studied 3 times: in the overweight state, after weight reduction to the normal-weight state, and after 1 y without intervention. Total and regional lean and fat masses were assessed by dual-energy X-ray absorptiometry. RESULTS: White and black women did not differ significantly in mean (+/- SD) weight loss (13.4 +/- 3.6 and 12.7 +/- 3.2 kg, respectively) and regain (6.1 +/- 5.5 and 6.4 +/- 5.4 kg, respectively). Black subjects had significantly less trunk LBM and significantly more limb LBM at each time point (P < 0.05). In both races, weight regain was associated with significant increases in limb LBM (P < 0.05) but not in trunk LBM (P = 0.21). RMR, adjusted for total LBM and fat mass, was significantly higher in white women after weight loss (P < 0.01) and regain (P < 0.01). However, no racial difference was found when RMR was adjusted for LBM distribution. CONCLUSIONS: In both races, trunk LBM decreased with weight loss and remained lower, despite significant weight regain, which potentially reflected decreased organ mass. Regional LBM distribution explained the racial difference in RMR.     

Polymorphisms for vinyl chloride metabolism in French vinyl chloride workers

Genetic polymorphisms of aldehyde dehydrogenase 2 (ALDH2) and cytochrome P450 2E1 (CYP2E1) have been shown to influence the degree of genetic damage in Taiwanese workers exposed to the carcinogen - vinyl chloride(VC). Certain French VC workers have been found to express biomarkers of mutant forms of cancer-related proteins (ras-p21 and p53) that have been related to their exposure. ALDH2 and CYP2E1 polymorphisms were investigated in 211 of these workers in an attempt to correlate differences in VC metabolic capacity with differences in the presence of these biomarkers. All of the workers were found to have the normal, wild-type ALDH2 gene, and none of them were found to be homozygous for the variant CYP2E1 allele. Sixteen workers were found to be heterozygous for the variant CYP2E1 allele. After adjusting for age, smoking, drinking and cumulative VC exposure, the odds ratio for the presence of either the mutant ras-p21 or the mutant p53 biomarker in these heterozygous workers was found to be statistically significantly increased in comparison to their homozygous, wild-type counterparts (OR = 5.05; 95% CI = 1.10-23.25). However, as opposed to the case in Taiwanese workers, these polymorphisms are relatively uncommon, and thus differences in ALDH2 and CYP2E1 can account for only a small proportion of the variability in mutagenic response to VC exposure in a Caucasian population.     

Does donor site reconstruction following anterior cervical surgery diminish postoperative pain?

Many attempts have been made at donor site reconstruction to reduce postoperative pain following anterior cervical surgery. This study is a comparative analysis of the outcome of 46 patients undergoing single-level anterior corpectomy and fusion using iliac crest autograft performed by one surgeon (N.E.E.). Twenty-three patients had no donor site reconstruction, whereas the more recent 23 patients had iliac crest reconstruction using a MacroPore sheet (MacroPore, Inc., San Diego, CA) and Inductive Conductive Matrix (ICM, Sofamor Danek, Memphis, TN). Bodily Pain, assessed on the Short Form-36, obtained up to 12 months postoperatively, failed to demonstrate better pain relief following donor site reconstruction. Multiplanar CT studies obtained 6 months postoperatively documented 100% donor site fusion for the 23 reconstructed patients. Although iliac crest reconstruction failed to reduce Bodily Pain, it did result in 100% fusion.     

An orally bioavailable oxime ether capsid binder with potent activity against human rhinovirus

A series of capsid-binding compounds was screened against human rhinovirus (HRV) using a CPE based assay. The ethyl oxime ether 14 was found to have outstanding anti-HRV activity (median IC(50) 4.75 ng/mL), and unlike the equivalent ethyl ester compound 3 (Pirodavir), it has good oral bioavailability, making it a promising development candidate. Compound 14 illustrates that an oxime ether group can act as a metabolically stable bioisostere for an ester functionality.     

Effects of cannabinoid receptor ligands on psychosis-relevant behavior models in the rat

Abstract Rationale. Marijuana is known to have psychotropic effects in humans. In this study, we used rat models of sensorimotor gating, hyperactivity and stereotypy to explore whether CB₁ receptor stimulation or blockade induces behavioral changes consistent with psychotomimetic or antipsychotic agents, respectively. Objectives. We determined whether (a) the cannabinoid agonist CP 55940 decreased pre-pulse inhibition (PPI) as might be expected from a psychotomimetic agent, and (b) the selective CB₁ receptor antagonist, SR 141716A, had any effect on PPI on its own or following disruptions by psychotomimetic agents. In addition, we investigated the effects of SR 141716A on elevated levels of hyperactivity and stereotypy elicited by d-amphetamine. Methods. These studies were conducted in rats using standard methodologies for determination of PPI following acoustic stimuli, and d-amphetamine-induced hyperactivity and stereotypies. Results. Decreased startle responses to 120 dB stimuli were observed in rats treated with CP 55940 (0.1 mg/kg IP) in the absence and presence of a 73 dB pre-pulse. These effects were reversed by SR 141716A (5 and 10 mg/kg, respectively). SR 141716A (0.1, 5, 10 mg/kg) had no effect on PPI on its own or following disruptions by apomorphine, d-amphetamine or MK-801. Conversely, in separate experiments different antipsychotic agents reversed disruptions in PPI induced by d-amphetamine (haloperidol), apomorphine (haloperidol or clozapine) or MK-801 (clozapine or olanzapine). In addition, unlike haloperidol, SR 141716A (5 mg/kg) did not reverse d-amphetamine-mediated increases in hyperactivity or stereotypy. Conclusions. The CP 55940-mediated decreases in startle amplitude confound assessment of the effects of CB₁ receptor activation on PPI. The failure of SR 141716A to reverse disruptions in PPI, hyperactivity or stereotypy induced by non-cannabinoid psychotomimetic agents suggests that blockade of the CB₁ receptor on its own is not sufficient for antipsychotic therapy. Electronic Publication     

Effects of hyperglycemia and insulin therapy on outcome in a hyperglycemic septic model of critical illness

BACKGROUND: The effects of hyperglycemia and insulin therapy on septic outcome have not been well studied. METHODS: Septic hyperglycemia was induced by infusion of TPN (254 kcal/kg x d) immediately following cecal ligation and puncture (CLP) surgery in rats. Animals (N = 109) were monitored for blood glucose and followed for survival for 4 days. Separate cohorts (N = 36) were sacrificed at 22 hours post-CLP and analyzed for cytokines/chemokines, hormones, and organ damage markers. The effects of insulin treatment on 4 day survival were also examined (N = 60). RESULTS: Hyperglycemic septic animals had significantly higher blood glucose (p < 0.0001), plasma proinflammatory cytokine levels, serum organ damage markers (p < 0.05) and reduced mean survival time (p < 0.001). Insulin treatment (2 IU/kg/hr) resulted in significantly lower blood glucose (p < 0.01) and improved 4 day survival (p < 0.03). CONCLUSIONS: Hyperglycemia is associated with greater morbidity and mortality in sepsis. Insulin therapy significantly improved survival suggesting that management of hyperglycemia with insulin may improve outcome in septic patients.     

An assessment of recycled spectacles donated to a developing country

BACKGROUND: A rapid assessment methodology was used to determine the suitability of donated recycled spectacles for the Pacific nation of Tuvalu. METHODS: Spectacles (102) from a donated cache were examined. Those with astigmatism of > 1.00 D, anisometropia of > 0.50 D, significant central lens scratches, broken frame, poor cosmetic fit and comfort, or unsuitable frame appearance were excluded. The refractive errors (> or = +/-0.50 D distance or near) of 320 Tuvaluans were determined. RESULTS: Of the spectacles, 62.7% had > 1.00 DC and/or > 0.50 D anisometropia, 30% were broken and/or scratched and 50% were uncomfortable or cosmetically unacceptable. Only 13% were optically satisfactory, physically intact, and cosmetically appropriate. Of the people, 8.8% had > 1.00 DC and/or > 0.50 D anisometropia, requiring custom-made spectacles. A further 8.1% needed a -0.50 to -2.00 DS correction, for which there were no spectacles in this cache. For the other 83.1% (266), if the cache contained at least 5538 spectacles, each would eventually find a suitable pair. CONCLUSION: If the scheme to Tuvalu is typical, refractive error will remain largely uncorrected if only donated recycled spectacles are available. No amount of efficiency and effectiveness in the delivery chain can justify the output and outcome of this recycling scheme.