Effects of prestretch intensity on mechanical efficiency of positive work and on elastic behavior of skeletal muscle in stretch-shortening cycle exercise

Mechanical efficiency of positive work (eta+) and elastic behavior of human skeletal muscles were investigated on a special sledge apparatus which allowed the use of the normal stretch-shortening cycle exercises. Twenty-five young men were investigated in a total of 92 exercise situations, in which the intensity of the prestretch (eccentric contraction) was different, but the shortening phase (concentric contraction) was kept constant in all conditions. The results demonstrated that eta+ was on the average 35.8% +/- 6.4% and correlated positively with the prestretch intensity (r = 0.413; P less than 0.001), reaching a highest individual value of 51.5%. Estimation performed on the elastic characteristics of the leg extensor muscles confirmed an earlier suggestion that the pure muscle elasticity plays an important role in potentiating performance in stretch-shortening cycle exercises. The analysis of the myoelectrical activity of the leg extensor muscles showed that the nervous system plays an essential role in regulating muscle stiffness and thus utilization of muscle elasticity in ballistic exercises.     

Frequency, urgency, and pelvic pain: Treating the pelvic floor versus the epithelium

For years the bladder epithelium has been the focus for diagnosing and treating the frequency, urgency, and pelvic pain of interstitial cystitis. However, many patients have not found symptom relief with these therapies. Pelvic floor dysfunction is often present in these patients, yet it is often untreated. Pelvic floor dysfunction may be related to abuse, past surgeries, or other causes. It is important to look outside of the bladder and explore other causes and treatments for this condition. Pelvic floor therapies should be a first line of treatment for those women with chronic pelvic pain related to pelvic floor dysfunction.     

Placing the Molteno implant in a long scleral tunnel to prevent postoperative tube exposure

PURPOSE: The purpose of this study was to retrospectively evaluate whether it is possible to decrease the risk of Molteno tube erosion through the conjunctiva by using a new technique where the silicone tube is inserted into a scleral tunnel instead of being covered only by the conjunctiva. METHODS: We reviewed Molteno implants carried out at the University Hospital of Oulu, in 332 patients who underwent traditional Molteno implantation between October 1986 and October 1998 and 92 patients who underwent surgery with the new technique between November 1998 and April 2001. RESULTS: With our former technique, conjunctival erosions occurred in 15 eyes of 15 patients (4.5%) after a median follow-up of 3.5 months (range 1-72 months); no conjunctival complications were discovered in patients who underwent surgery using the new technique during a median follow-up of 22 months (range 10-39 months). (p = 0.038, two-sample test of proportions). CONCLUSION: Inserting the Molteno tube into a scleral tunnel prevents tube extrusion through the conjunctiva in eyes with Molteno implants. The technique for making the scleral tunnel is described.     

Improving on National Quality Indicators of Breast Cancer Care in a Large Public Hospital as a Means to Decrease Disparities for African American Women

Background

In April 2007, the National Quality Forum (NQF) endorsed the first nationally recognized hospital-based performance measures for stage I, II, and III breast cancer. The purpose of this study was to document compliance with the 3 NQF breast quality indicators during 2 time intervals in a metropolitan public hospital.

Materials and Methods

Tumor registry and medical records were used to identify patient demographics and treatments before (2005–2006) and after (2008) implementations in 2007 as a result of the NQF audit. Program changes included: hiring a dedicated medical oncology nurse practitioner, requiring the radiation oncology case manager to attend weekly multidisciplinary conferences, educating Patient Navigators of the importance of multimodal care, and providing support groups for patients addressing importance of completion of all treatment options.

Results

A total of 213 female patients were diagnosed with and treated for stage I, II, or III breast cancer in 2005–2006 and 2008. Of these, 189 (89%) were African American (AA) women. Also, 70 patients of 86 (81.3%) received radiation therapy, 60 of 77 (77.9%) received or were considered for adjuvant chemotherapy, and 124 of 144 (86.1%) for hormonal therapy according to NQF indicators. After 2007, patients receiving radiation therapy increased from 75.8 to 95.8%. Patients receiving or considered for adjuvant chemotherapy or hormonal therapy increased from 73.7 to 93.7% and from 84.1 to 90.0%, respectively.

Conclusions

NQF breast cancer indicators provided a mechanism to improve compliance of multimodal treatment in our center. Raising awareness of these indicators in the multidisciplinary conference, hiring dedicated personnel, and educating patients has led to major improvements in breast cancer care.     

Matched unrelated umbilical cord blood transplantation for a patient with chemotherapy resistant Wilms tumor

We report a patient with chemotherapy refractory Wilms tumor who underwent an unrelated donor cord blood transplant for chemotherapy refractory disease. The preparative regimen consisted of busulfan, melphalan, and anti‐thymocyte globulin, and was well tolerated. This patient did not experience significant toxicity related to the chemotherapy regimen and did not develop any graft versus host disease from his HLA (A, B, DR) 6/6 matched cord blood transplant. Follow‐up CT scans 2 years post‐transplant have shown no evidence of disease progression, with only a few pulmonary nodules remaining, which are unchanged in size from his pre‐transplant CT scan. It is possible that high‐dose chemotherapy and stem cell transplantation can be curative in patients with tumors that are non‐responsive to conventional chemotherapy. Pediatr Blood Cancer. 2010;55:763–765. © 2010 Wiley‐Liss, Inc.     

Arterial complications associated with cardiac catheterization in pediatric patients with a previous history of kawasaki disease

Objectives : To determine whether patients with Kawasaki Disease (KD) undergoing percutaneous catheter angiography were at increased risk of arterial complications at the point of arterial access compared to patients with structural heart abnormalities, but normal vessels. Background : Systemic arterial damage can occur as a result of KD. Methods : Medical histories of all patients with KD undergoing percutaneous catheter angiography at The Hospital for Sick Children between January 1990 and August 2008 were reviewed. Results : A total of 44 patients with KD underwent 82 catheter procedures. Of these, 3 were associated with important arterial complications (2 males; age: 4 months, 3 and 17 years). All patients who experienced complications had multiple large and/or giant coronary artery aneurysms and two were within 3 months of the acute phase of KD. All patients developed pseudoaneurysms of the femoral artery which had been utilized for catheter access. All pseudoaneurysms were treated with ultrasound‐guided thrombin injection and compression, and resolved with no long‐term complications. One patient also developed a substantial arteriovenous fistula of the femoral circulation which had to be surgically repaired with no permanent sequela. Odds for arterial complications in patients with KD were 10.4 times greater (95%CI: 3.2–33.8) than that noted for the general pediatric cardiac catheterization population (3.6% vs. 0.4%, P < 0.0001) which indicates higher risk associated with arterial access in patients with KD. Conclusions : Greater care in obtaining arterial access for angiography is warranted, especially in the first month directly following the acute phase, possibly related to systemic arterial damage associated with KD. © 2009 Wiley‐Liss, Inc.     

Development and Implementation of a Proactive Geriatrics Consultation Model in Collaboration with Hospitalists

Acutely ill hospitalized older adults often experience a decline in function that may be preventable using a proactive, interdisciplinary, patient-centered approach. Hospitalists are treating an increasing number of these patients. A collaborative geriatrics consultation model to prevent functional decline and improve care for older patients with geriatrics syndromes was developed and implemented in partnership with a large hospitalist group in a community teaching hospital. A team of a geriatrician and a geriatrics nurse practitioner led the new consultation service. The team assisted with identifying cases, provided consultation early in the hospital stay, focused its evaluation on functional and psychosocial issues, and assisted in clinical management to optimize implementation of recommendations. In the first 4 years, the consultation service conducted 1,538 consultations in patients with a mean age of 81 (range 56–103). The most frequent geriatrics diagnoses were gait instability, delirium, and depression; recommendations usually included consulting physical therapy, increasing activity, and changing medications. The number of referrals and referring physicians grew steadily each year. Twenty-eight of 34 (82%) of the referring hospitalists completed a Web-based satisfaction questionnaire. All responding hospitalists agreed that proactive geriatrics consultation helped them provide better care; 96% rated the service as excellent. Analysis of hospital administrative data revealed a lower length of stay index and lower hospital costs in patients receiving a geriatrics consultation. The Proactive Geriatrics Consultation Service represents a promising model of collaboration between hospitalists and geriatricians for improving care of hospitalized older adults.     

Mitochondrial and liver oxidative stress alterations induced by N‐butyl‐N‐(4‐hydroxybutyl)nitrosamine: relevance for hepatotoxicity

The most significant toxicological effect of nitrosamines like N‐butyl‐N‐(4‐hydroxybutyl)nitrosamine (BBN) is their carcinogenic activity, which may result from exposure to a single large dose or from chronic exposure to relatively small doses. However, its effects on mitochondrial liver bioenergetics were never investigated. Liver is the principal organ responsible for BBN metabolic activation, and mitochondria have a central function in cellular energy production, participating in multiple metabolic pathways. Therefore any negative effect on mitochondrial function may affect cell viability. In the present work, ICR male mice were given 0.05% of BBN in drinking water for a period of 12 weeks and were sacrificed one week later. Mitochondrial physiology was characterized in BBN‐ and control‐treated mice. Transmembrane electric potential developed by mitochondria was significantly affected when pyruvate–malate was used, with an increase in state 4 respiration observed for pyruvate–malate (46%) and succinate (38%). A decrease in the contents of one subunit of mitochondrial complex I and in one subunit of mitochondrial complex IV was also observed. In addition, the activity of both complexes I and II was also decreased by BBN treatment. The treatment with BBN increases the susceptibility of liver mitochondria to the opening of the mitochondrial permeability transition pore. This susceptibility could be related with the increase in the production of H₂O₂ by mitochondria and increased oxidative stress confirmed by augmented susceptibility to lipid peroxidation. These results lead to the conclusion that hepatic mitochondria are one primary target for BBN toxic action during liver metabolism. Copyright © 2011 John Wiley & Sons, Ltd.