Musculoskeletal education in physical medicine and rehabilitation residency programs

OBJECTIVE: To characterize current musculoskeletal (MSK) education experiences in physical medicine and rehabilitation residency programs and to identify perceived barriers to providing more extensive MSK education experiences. In addition, to establish utilization patterns for the PASSOR Physical Examination Core Competencies List. DESIGN: Between March and November 2003, all 81 physical medicine and rehabilitation residency program directors were asked to complete an MSK education survey developed by the authors. RESULTS: A total of 69 of 81 program directors (86%) responded after multiple contacts. The most frequently utilized MSK education formats were MSK lecture series, MSK departmental conferences, and physical examination workshops. Potential barriers to expanded MSK education included money, time, and staff number. Given unlimited resources, most residency programs would greatly increase utilization of visiting lecturers, CD-ROMs/DVDs, objective structured clinical examinations, and physical examination videos. Of the 30 program directors who recalled receiving the Core Competencies List, only 40% (12 of 30) have formally integrated the list into their residency training. Barriers to implementation included logistical challenges and lack of direction regarding implementation. CONCLUSIONS: Residency program directors indicate a strong interest in expanding resident MSK education through the use of CD-ROMs/DVDs, physical examination videos, objective structured clinical examinations, and visiting lecturer programs. CD-ROMs/DVDs and videos represent particularly attractive educational formats for supplementing resident MSK education due to the advantages of central production, nominal costs, widespread distribution, multimedia capabilities, and accessibility. These educational formats should be considered for targeted educational initiatives to enhance resident MSK education, regardless of residency program size or resources.     

Taking a Toll on human disease: Toll-like receptor 4 agonists as vaccine adjuvants and monotherapeutic agents

Toll-like receptor (TLR) agonists are being developed for use as vaccine adjuvants and as stand-alone immunomodulators because of their ability to stimulate innate and adaptive immune responses. Among the most thoroughly studied TLR agonists are the lipid A molecules that target the TLR4 complex. One promising candidate, monophosphoryl lipid A, which is a derivative of lipid A from Salmonella minnesota, has proven to be safe and effective as a vaccine adjuvant in > 120,000 human doses. A new class of synthetic lipid A mimetics, the aminoalkyl glucosaminide 4-phosphates (AGPs), have been engineered specifically to target human TLR4 and are showing promise as vaccine adjuvants and as monotherapeutic agents capable of eliciting nonspecific protection against a wide range of infectious pathogens. In this review, the authors provide an update of the preclinical and clinical experiences with the TLR4 agonists, MPL (Corixa Corporation) adjuvant and the AGPs.     

Cryoablation treatment of benign breast lesions with 12-month follow-up

OBJECTIVE: Eighty percent of all breast biopsies reveal benign findings. The most common benign tumor is a fibroadenoma. Despite their benign nature, many women eventually choose to have their bothersome lumps surgically removed. We report the use of cryoablation to treat these benign breast lesions with minimum 12-month follow-up. METHODS: After receiving Institutional Review Board approval, a prospective nonrandomized trial was initiated in June 2000. Ultrasound-guided cryoablation of core biopsy-proven benign fibroadenomas, other benign breast nodules, or nodular fibrocystic change was performed on 78 lesions in 63 patients. Eighty-five percent of lesions treated were benign fibroadenomas. The cryoablation procedure consisted of a double freeze-thaw cycle that lasted between 6 and 30 minutes and was performed most often in an office setting. Each patient was serially evaluated for treatment efficacy, complications, and patient satisfaction. RESULTS: Sixty-four of 78 lesions (mean size 2.0 cm [range 0.8 to 4.2]) were followed-up for at least 12 months after cryoablation per protocol, which included 53 fibroadenomas. At 1 year, ultrasound tumor volume resorption was 88.3% overall (87.3% for fibroadenomas), and 73% of the entire group became nonpalpable to both clinician and patient (75% for fibroadenomas). Two of the fibroadenoma patients had their palpable residual nodule excised, both revealing necrotic debris and no viable tumor in the treated volume. Serial mammograms showed resorption of the lesion leaving minimal residual density without calcifications. Cosmesis was excellent with only a small scar remaining at the probe insertion site. There was no report of visual or palpable volumetric deficit. Patient satisfaction was good to excellent in 92% of cases. CONCLUSIONS: Cryoablation was successful in treating core biopsy-proven benign breast lesions in 63 patients. At 12 months, we found gradual resorption of treated tissue with no cosmetic deficit. Ultrasound-guided cryoablation is an effective and safe treatment for benign breast lesions, as seen at 12-month follow-up, and offers an office-based, minimally invasive alternative to surgical excision.     

Gadolinium-enhanced computed tomography angiography in multi-detector row computed tomography: initial observations

Rationale and Objectives. The feasibility of using gadolinium contrast medium for computed tomography angiography (CTA) in multi-detector row computed tomography and the effect of contrast medium dilution was investigated.Materials and Methods. Three pigs were each scanned in multiple sessions with injections of non-dilute and dilute contrast medium at a dose of 0.3 mmol/kg body weight. Non-spiral dynamic scanning at a fixed mid-abdominal aortic level and thoracoabdominal CTA were performed.Results. The magnitude of peak aortic enhancement was not significantly different between dilute and non-dilute contrast medium injections (P = .88), but the former showed earlier enhancement (mean of 2.3 seconds sooner, P < .01) than the latter. CT angiography with gadolinium contrast medium showed much lower enhancement than iodine contrast medium, but small vessels were readily identifiable.Conclusion. Gadolinium contrast medium combined with multi-detector row computed tomography may provide clinically useful CTA. Dilution of contrast medium shortens the enhancement time but has little effect on the magnitude.     

Using heart rate variability to stratify risk of obstetric patients undergoing spinal anesthesia

In this study, we evaluated whether point correlation dimension (PD2), a measure of heart rate variability, can predict hypotension accompanying spinal anesthesia for cesarean delivery. After the administration of spinal anesthesia with bupivacaine, hypotension was defined as systolic blood pressure 相似文献   

Halothane and propofol modulation of gamma-aminobutyric acidA receptor single-channel currents

Halothane and propofol enhance the activity of the gamma-aminobutyric acid (GABA) system, which is one of the most important systems in the mechanism of anesthesia. To determine whether halothane and propofol enhance GABAergic responses by the same mechanism, we performed single-channel patch-clamp experiments with rat cortical neurons in primary culture. Each of the open-time and closed-time distributions of GABA(A) receptor single channels was expressed by a sum of fast and slow time constants. Neither halothane nor propofol changed the single-channel conductance. Halothane increased the probability of the channel being open via a prolongation of the slow phase of open time, whereas propofol increased the channel open probability via a shortening of the slow phase of closed time. Thus, although both halothane and propofol augmented the channel open probability, thereby causing an increase in charge transfer during inhibitory transmitter action, they acted by different mechanisms.