Anatomical factors influencing patellar tracking in the unstable patellofemoral joint

Purpose

The current study was performed to relate anatomical parameters to in vivo patellar tracking for pediatric patients with recurrent patellar instability.

Methods

Seven pediatric patients with recurrent patellar instability that failed conservative treatment were evaluated using computational reconstruction of in vivo patellofemoral function. Computational models were created from high-resolution MRI scans of the unloaded knee and lower-resolution scans during isometric knee extension at multiple flexion angles. Shape matching techniques were applied to replace the low-resolution models of the loaded knee with the high-resolution models. Patellar tracking was characterized by the bisect offset index (lateral shift) and lateral tilt. Anatomical parameters were characterized by the inclination of the lateral ridge of the trochlear groove, the tibial tuberosity–trochlear groove distance, the Insall–Salvati index and the Caton–Deschamps index. Stepwise multivariable linear regression analysis was used to relate patellar tracking to the anatomical parameters.

Results

The bisect offset index and lateral tilt were significantly correlated with the lateral trochlear inclination (p ≤ 0.002) and TT–TG distance (p < 0.05), but not the Insall–Salvati index or the Caton–Deschamps index. For both the bisect offset index and lateral tilt, the standardized beta coefficient, used to identify the best anatomical predictors of tracking, was larger for the lateral trochlear inclination than the TT–TG distance.

Conclusion

For this population, the strongest predictor of lateral maltracking that could lead to patellar instability was lateral trochlear inclination.

Level of evidence

Diagnostic study, Level II.     

Socioeconomic differences in cardiometabolic factors: social causation or health-related selection? Evidence from the Whitehall II Cohort Study, 1991-2004

In this study, the health-related selection hypothesis (that health predicts social mobility) and the social causation hypothesis (that socioeconomic status influences health) were tested in relation to cardiometabolic factors. The authors screened 8,312 United Kingdom men and women 3 times over 10 years between 1991 and 2004 for waist circumference, body mass index, systolic and diastolic blood pressure, fasting glucose, fasting insulin, serum lipids, C-reactive protein, and interleukin-6; identified participants with the metabolic syndrome; and measured childhood health retrospectively. Health-related selection was examined in 2 ways: 1) childhood health problems as predictors of adult occupational position and 2) adult cardiometabolic factors as predictors of subsequent promotion at work. Social causation was assessed using adult occupational position as a predictor of subsequent change in cardiometabolic factors. Hospitalization during childhood and lower birth weight were associated with lower occupational position (both P's ≤ 0.002). Cardiometabolic factors in adulthood did not consistently predict promotion. In contrast, lower adult occupational position predicted adverse changes in several cardiometabolic factors (waist circumference, body mass index, fasting glucose, and fasting insulin) and an increased risk of new-onset metabolic syndrome (all P's ≤ 0.008). These findings suggest that health-related selection operates at younger ages and that social causation contributes to socioeconomic differences in cardiometabolic health in midlife.     

Phase II trial of neoadjuvant exemestane in combination with celecoxib in postmenopausal women who have breast cancer

Purpose

Within breast tissue, aromatase expression and activity is increased by prostaglandin E2, providing a rationale for combining the COX-2 inhibitor celecoxib with an aromatase inhibitor. To evaluate the effect of these drugs on aromatase and other biomarkers, a phase II trial of neoadjuvant exemestane followed sequentially by celecoxib plus exemestane was performed.

Methods

Postmenopausal women with estrogen receptor (ER) and/or progesterone (PR) positive stages II-III breast cancers received 8 weeks of exemestane 25 mg daily, followed by 8 weeks of exemestane 25 mg daily and celecoxib 400 mg twice daily. Core biopsies were collected pretreatment, after 8 weeks of exemestane, and at definitive breast cancer surgery. A tissue microarray was constructed and immunohistochemistry (IHC) for aromatase, ER, PR, HER-2, Ki-67, and COX-2 was performed.

Results

Twenty-two women were enrolled. Celecoxib was discontinued in 4 (18%) women for toxicity (all grade 1 and 2) and 2 (9%) developed serious cardiac events occurring at 1 and 4 months after completing treatment. By US, there were 8 (36%)-partial responses and 12 (55%)-stable disease. There were no pathological complete responses (pCR). There were statistically significant decreases in ER (P = .003), PR (P = .002), Ki-67 (P < .001), and COX-2 (P = .004) expression. No significant differences in aromatase or HER-2 expression were observed (P = .13 and P = .39, respectively).

Conclusion

The addition of celecoxib to exemestane was tolerated by the majority of women and anti-tumor response was observed. Additional studies, including gene expression, are required to more fully understand the basis for the decreased expression of ER, PR, Ki-67, and COX-2.     

A clinico-epidemiological study of Chikungunya outbreak in Maharashtra State, India

The year 2006 witnessed an extensive outbreak of Chikungunya fever in Maharashtra state. Out of 6467 sera of suspected patients sent to National Institute of Virology, Pune, 804 were serologically confirmed. This retrospective study was carried out by interrogating all those patients for their sickness experience. Adult females from rural area were more affected than males. In 68.2% families, there were multiple cases. Fever and multiple joint involvement were almost invariable. In 36.5% patients, there was history of recurrence. Along with pain, slight swelling was noticed in 55% patients. The commonest joints involved were wrist, inter-phalangeal, elbow, knee and ankle, in that order. The pain and swelling persisted for more than a month. After health education during outbreak, there was positive improvement in behavior pertaining to source reduction of vector. Inter-personal communication was best remembered. In health education, the role of paramedical workers and government doctors was prominent.     

Negative aspects of close relationships as a predictor of increased body mass index and waist circumference: the Whitehall II study

Objectives. We investigated whether exposure to negative aspects of close relationships was associated with subsequent increase in body mass index (BMI) and waist circumference.Methods. Data came from a prospective cohort study (Whitehall II) of 9425 civil servants aged 35 to 55 years at baseline (phase 1: 1985–1988). We assessed negative aspects of close relationships with the Close Persons Questionnaire (range 0–12) at phases 1 and 2 (1989–1990). We measured BMI and waist circumference at phases 3 (1991–1994) and 5 (1997–1999). Covariates at phase 1 included gender, age, marital status, ethnicity, BMI, employment grade, smoking, physical activity, fruit and vegetable consumption, and common mental disorder.Results. After adjustment for sociodemographic characteristics and health behaviors, participants with higher exposure to negative aspects of close relationships had a higher likelihood of a 10% or greater increase in BMI and waist circumference (odds ratios per 1-unit increase 1.08 [95% confidence interval (CI) = 1.02, 1.14; P = .007] and 1.09 [CI = 1.04, 1.14; P ≤ .001], respectively) as well as a transition from the overweight (25 ≤ BMI < 30) to the obese (BMI ≥ 30) category.Conclusions. Adverse social relationships may contribute to weight gain.Obesity is a major public health concern because it is associated with numerous ill health conditions such as type 2 diabetes, coronary heart disease, hypertension, stroke, and certain forms of cancer.¹ Obesity rates have rapidly increased to epidemic proportions. In England, for example, 24% of men and 25% of women are obese (body mass index [BMI, defined as weight in kg divided by height in m²] ≥ 30).² The interplay among multiple factors—genetic factors, factors stemming from obesogenic environments, and individual, and cultural factors—is seen to be behind the obesity epidemic.³ However, increasing evidence suggests that social relationships may also play a role in determining weight gain.Stress associated with poor-quality relationships may contribute to weight gain via various mechanisms. Negative aspects of close relationships may induce negative feelings,⁴ which can increase physiological arousal either through activation of the hypothalamic–pituitary–adrenal axis or through the fight-or-flight response and the secretion of adrenal medullary hormones.⁵ Eating high-fat and high-carbohydrate caloric content “comfort food” may reduce biological stress system activity and the concomitant negative emotions.⁶ Some evidence also suggests an association between chronic life stress and a greater preference for energy- and nutrient-dense foods, namely those that are high in fat and sugar.⁷ In addition, there may be further effects via other unhealthy coping mechanisms such as physical inactivity.Childhood adversities related to close relationships, such as physical abuse, verbal abuse, humiliation, neglect, strict upbringing, physical punishment, conflict, or tension, have been associated with an increased risk of obesity in adulthood.⁸ However, limited and somewhat inconsistent evidence exists on the impact of negative aspects of close relationships in adulthood. One study revealed that heavier women had lower quality romantic relationships.⁹ Poor marital quality has also been associated with a higher risk of metabolic syndrome¹⁰ and obesity¹¹ in women. Strain in relations with family but not with one''s spouse or partner was associated with weight gain in women with high initial BMI.¹² In addition, some studies have revealed an association between reports of insufficient social support and increased risk of obesity,^13,14 but other studies suggest no such association.¹⁵With a few exceptions,^10–12 the evidence is cross-sectional or derived from short follow-ups. Such data leave open the possibility of reverse causality (i.e., obesity negatively influencing close relationships). Because the development of obesity has a relatively long induction period, it is plausible that prolonged exposure to problems in social relationships affects weight more than do short-term problems. Moreover, it might be more informative to look at weight gain rather than obesity status at 1 time point. We are not aware of previous studies examining the association between negative aspects of close relationships and weight gain. In addition, most of the earlier studies did not assess waist circumference, a measure of central obesity. Waist circumference is probably a better indicator of health risk than is BMI alone, especially when used in combination with BMI.¹⁶In this study using data from the Whitehall II cohort of British civil servants, we investigated the extent to which exposure to negative aspects of close relationships was associated with subsequent weight gain, as indicated by increase in BMI and waist circumference over a long follow-up period.     

Enhancement of protein vaccine potency by in vivo electroporation mediated intramuscular injection

Protein-based vaccines have emerged as a potentially promising approach for the generation of antigen-specific immune responses. However, due to their low immunogenicity, there is a need for innovative approaches to enhance protein-based vaccine potency. One approach to enhance protein-based vaccine potency is the employment of toll-like receptor ligands, such as CpG oligonucleotides, to activate the antigen-specific T cell immune responses. Another approach involves employing a method capable of improving the delivery of protein-based vaccine intramuscularly to lead to the slow release of the protein, resulting in improved vaccine potency. In the current study, we aimed to determine whether intramuscular injection of protein-based vaccines in conjunction with CpG followed by electroporation can lead to increased delivery of the protein-based vaccine into muscle cells, resulting in enhanced protein-based vaccine potency. We found that intramuscular injection followed by electroporation can effectively transduce the protein-based vaccine into the muscle cells. Furthermore, we found that intramuscular vaccination with OVA protein in combination with CpG followed by electroporation generates the best OVA-specific CD8+ T cell immune responses as well as the best protective and therapeutic antitumor effects in vaccinated mice. CD8+ T cells were found to play an important role in the observed protective antitumor effects generated by the vaccination. Similar results were observed using the HPV-16 E7 protein-based vaccination system. Thus, our data indicate that intramuscular administration of protein-based vaccines in conjunction with CpG followed by electroporation can significantly enhance the antigen-specific CD8+ T cell immune responses. The clinical implications of the study are discussed.     

Understanding the role of violence in incarcerated women's cervical cancer screening and history

In this exploratory study the authors investigated characteristics, including reported experiences of violence, related to incarcerated women's self-report of cervical cancer screening and cancer history and treatment. During a four month period in 2010, 204 women in Kansas City jails were surveyed. Multiple logistic regression models were used to examine the relations of socio-demographic and community characteristics and history of violence among the women to their cervical cancer screening, diagnosis, and treatment histories. Forty percent of the women in the current sample reported abnormal Pap histories, though only 6% of all Pap smears done in the U.S. are abnormal. Women who reported abuse histories in this study were found to be more likely to report having ever had an abnormal Pap smear (for physical abuse Odds Ratio [OR] = 6.05; CI 2.36, 15.54 and for past year intimate partner violence OR = 2.41; CI 1.09, 5.31). Participants who did not fear neighborhood violence were less likely to report an abnormal Pap history (OR = 0.57; CI 0.34, 0.96) and more likely to visit a family doctor for their Pap screenings (OR = 1.91; CI 1.01, 3.60). Women who perceived greater neighborhood violence had increased odds of reporting that they received Pap screenings in a hospital setting (OR = 1.47; CI 1.08, 2.00). Frequency of Pap screening did not differ in women who did and did not have fear of neighborhood violence. This study highlights the heightened cervical cancer risk experienced by women with criminal justice histories and suggests that violence at several levels has implications for cervical cancer prevention for these women.