Effect of histamine H1-and H2-receptor blockade on canine gastric acid secretion

In dogs with gastric fistulae and Heidenhain pouches, inhibition of histamine-stimulated gastric acid secretion by the histamine H₂-receptor antagonist metiamide is not increased by the addition of a histamine H₁-receptor antagonist (mepyramine maleate). Under the conditions of this study there is no evidence for the presence of histamine H₁-receptor sites on the gastric parietal cell.Financial assistance was provided by the South African Medical Research Council.     

Kinesio Tape and Shoulder-Joint Position Sense

Context

Joint position sense (JPS) is a key neuromuscular factor for developing and maintaining control of muscles around a joint. It is important when performing specialized tasks, especially at the shoulder. No researchers have studied how Kinesio Tape (KT) application affects JPS.

Objective

To investigate the effects of KT application and no tape on shoulder JPS at increasing shoulder elevations in athletes.

Design

Cross-sectional study.

Setting

University laboratory.

Patients or Other Participants

A total of 27 healthy athletes who did not participate in overhead sports (age = 20.44 ± 1.05 years, height = 175.02 ± 11.67 cm, mass = 70.74 ± 9.65 kg) with no previous pathologic shoulder conditions volunteered for the study. All participants were from 1 university.

Intervention(s)

Shoulder JPS was assessed at increasing elevations with and without KT application. Participants attempted to actively replicate 3 target positions with and without the KT and without visual guidance.

Main Outcome Measure(s)

We examined absolute and variable repositioning errors at increasing shoulder-elevation levels with and without KT application.

Results

Data revealed an interaction between tape and position for absolute error (F_2,52 = 4.07, P = .02); simple effects revealed an increase in error, with KT demonstrating a 2.65° increase in error at 90° of elevation compared with no tape (t₂₆ = 2.65, P = .01). The effect size was medium (ω² = .135). Variable error showed no interaction of tape and position (F_2,52 = .709, P = .50). Further analysis of simple effects was not needed. However, we still calculated the effect size and observed small effect sizes for tape (ω² = .002), position (ω² = .072), and tape by position (ω² = .027).

Conclusions

At 90° of elevation, shoulder JPS was impaired by the application of KT.Key Words: proprioception, taping, shoulder, neuromuscular, rehabilitation

Key Points

• Short-term Kinesio-Tape application to the shoulder reduced joint position sense acuity at 90° of elevation but did not affect JPS at 50° or 110°.
• Kinesio Tape may negatively affect shoulder joint position sense, especially as the shoulder position approaches 90° of elevation.

Athletes, especially those who participate in overhead activities, place much stress on their shoulder joints during activity, so they are at increased risk for developing shoulder injuries. Given that the shoulder allows for much mobility, stability is sacrificed; therefore, the shoulder is considered one of the most vulnerable joints in the body.¹ Numerous factors within the shoulder complex contribute to this lack of stability, including limited glenohumeral bony congruity, limited ligamentous support, and joint capsular laxity. However, stability is still needed to perform precise tasks for activities of daily living or sporting events.² Factors that provide stability to the joint include support of surrounding muscles, the intra-articular pressure of the joint, and the integration of the central nervous system with peripheral mechanoreceptors, a sensory system termed proprioception.³Proprioception is a specialized sensory capability that includes a person''s sense of movement, joint position, and tension.⁴ Joint position sense (JPS) consists of both static and dynamic abilities to detect the position of the joint in space.⁵ Researchers⁶ have suggested that increased muscle activation leads to increased afferent feedback from muscle spindles, resulting in enhanced JPS. The JPS is enabled via sensory feedback from peripheral receptors in sites such as skin, muscles, ligaments, and tendons that the central nervous system processes, and JPS is a key factor for controlling joint movement.⁴Investigators⁷ have observed that shoulder JPS improves as the shoulder-elevation angle approaches 90°. These results may indicate that as the elevation angle increases, the amount of gravitational torque increases, which increases muscle activation. Suprak et al⁷ hypothesized that this increase in muscle activation and the increase in activity from the musculotendinous mechanoreceptors contributed to improved JPS. Suprak et al⁸ supported these results, demonstrating that as resistance increased (via wrist weights) at a given shoulder position, shoulder repositioning error decreased. However, other authors⁵ have suggested that this effect of elevation on shoulder JPS may also be related to intrinsic factors of joint position, such as muscle-spindle and cutaneous-receptor activation.Researchers⁹ believe the application of tape may improve proprioceptive abilities by increasing stimulation of cutaneous mechanoreceptors within the skin, which increases pressure on underlying muscles and, therefore, affects the joint''s proprioception. Robbins et al¹⁰ reported that the application of ankle tape enhanced JPS when a person was on a surface with a slope greater than 10°. Traditional athletic tape can constrict joint range of motion (ROM) but can be a beneficial preventive measure; however, the integrity of the tape is not maintained for extended periods because of such extraneous factors as sweat, lotion, dirt, and hair. Therefore, the development of more specialized tapes that have longer-lasting effects and limit impairments has advanced in recent years. Effective tape application can last up to 1 to 2 days, and some of these specialty tapes can resist extraneous factors.Kinesio Tape (KT; Kinesio Precut, Albuquerque, NM) is a specialized elastic tape that mimics the elasticity of skeletal muscle as it stretches up to 140% of its original length, allowing for no ROM restrictions.^2,11 According to KT creator Kenzo Kase, it can strengthen an already weakened muscle by correcting the muscle''s function, improving circulation of blood and lymph, decreasing pain, repositioning subluxed joints, and improving joint position and kinesthetic awareness.¹² These effects allow the fascia and muscle to return to normal function by relieving the buildup of abnormal muscle tension and can improve joint function by increasing sensory mechanisms.^11,13The constant shear force produced by KT application against the skin leads to increased stimulation of the cutaneous mechanoreceptors.¹⁴ Murray¹⁴ observed an increase in electromyographic measurements after the application of KT to the thigh. He hypothesized that this increased mechanoreceptor activity would result in increased JPS acuity. His research also supported the claim that KT application to the thigh can improve active ROM of a joint compared with no tape.¹⁴ Murray¹⁴ asserted that KT can positively affect proprioception. However, other investigators¹¹ have demonstrated no effect of KT application on the ability to actively replicate a passive ankle position. This discrepancy in observations warrants further investigation given the popularity of KT use in athletics and rehabilitation. No one has examined how KT affects shoulder JPS. Therefore, the purpose of our study was to assess the effects of KT application on shoulder JPS at increasing shoulder elevations in athletes. We hypothesized that the application of KT (1) would result in enhanced shoulder JPS at all elevation angles tested and (2) would not alter the effect of increased JPS acuity with elevation.     

Multidisciplinary diabetes team care: the experiences of young adults with Type 1 diabetes

Background

This research examined whether young adults with Type 1 diabetes engage with the multidisciplinary consultation process and if not, then why.

Methods

We designed a web‐based self‐reported survey, available online from February to May 2011, for Australian adults 18–35 years with Type 1 diabetes. Respondents were asked about which clinicians they consulted to assist with self‐management. To expand on the results of the survey, we interviewed 33 respondents.

Results

Survey: Respondents (n = 150) consulted with the following clinicians: endocrinologist and diabetes educators: 23.3%; endocrinologist only: 18.0%; endocrinologist, diabetes educators and dieticians: 14.6%; endocrinologist, diabetes educators, dietician and general practitioners (GP): 11.3%; endocrinologist and GP: 10.6%; GP only: 4.6%; all clinicians recommended to assist with self‐management: 1.3%; 2.7% did not consult any clinician. Interview: Participants (n = 33) reported eight key disincentives to consultation with multidisciplinary clinicians. These were time constraints; provision of conflicting advice; inaccessibility of health services; variation in service standards; cost constraints; failure of clinicians to refer to other clinicians; lack of opportunity to build a therapeutic relationship; and failure of clinicians to engage in shared decision making.

Conclusion

Our results indicate that high attrition rates of young adults with Type 1 diabetes from recommended diabetes health services is linked to the failure of those services to meet the needs and preferences of their patients. The identified needs and preferences included joint consultation with multi‐disciplinary team clinicians; flexible access to advice by email or telephone consultation; and shared decision making. Patient engagement in health‐service re‐design has implications for improved health‐service delivery and enhanced treatment outcomes.     

Esophageal tamponade in the management of acute variceal hemorrhage

Over a seven-year period, 138 patients with portal hypertension presented on 223 occasions with endoscopically proven acute variceal hemorrhage. Hemorrhage ceased spontaneously on 92 occasions (41%). On 126 occasions (57%) passage of the four-lumen modification of the Sengstaken-Blakemore tube was required, and hemorrhage was successfully controlled in 98%. Intubation was refused on five occasions (2%). Hemorrhage recurred during these 223 admissions on 47 occasions (21%); on 11 occasions a second rebleed occurred and on two occasions, a third. Tamponade was required during all of these rebleeds and arrest of hemorrhage was achieved in 87%. Hemorrhage in patients with poorer modified Child's grade was less likely to cease with intubation. The overall rate of control in the 186 episodes of hemorrhage requiring tamponade was 94%. There were 28 complications attributed to the use of tamponade in 186 episodes of hemorrhage (15%). On 12 occasions these complications proved fatal (6.4%). In four further patients failure of tamponade to control hemorrhage was fatal.     

Discriminant analysis of data in ulcer and nonulcer populations

The purpose of this study was to assess whether consideration of age and body weight measurements improved discrimination between normal subjects and duodenal ulcer subjects using the maximal acid output test. Seventy-seven male volunteers were the normal group, and 155 patients with surgically proven duodenal ulcers were the ulcer group. We found that the ratio of maximal acid output to actual weight gave the best discrimination between the two groups. Using this ratio, there were 45 hypersecretors in the ulcer group, and only 1 false-positive among the normal subjects. A graphic method is described which employs the ratio of acid to weight and can correctly classify two-thirds of the ulcer group. The disadvantage of this method, however, is that one-third of the control group in our series were misclassified as hypersecretors; therefore, the clinician must consider history and barium meal findings as well as this evaluation of the subject.Deceased.     

Percutaneous treatment of a popliteal bifurcation—The value of coronary devices and strategies

In this case report, we describe the use of coronary techniques and devices in the treatment of a complex popliteal artery bifurcation. In particular, we demonstrate that the Venture? wire control catheter is a useful tool not only in coronary lesions but also in wiring angulated peripheral lesions. © 2008 Wiley‐Liss, Inc.     

The gene triplet Rw W Ph controls murine haematopoiesis

Having shown a haematopoietic role for Patch (Ph), especially when doubly heterozygous with the mutant Wct (Loutit & Cattanach, 1983) we have similarly examined the Rw locus, the third member of the triplet. Mature Rw/+mice have a just detectable macrocytic anaemia. When doubly heterozygous with Wct and Wv the mild anaemia of these W mutants is exaggerated but with W19H (not anaemic as single heterozygote) red cell factors are as for Rw/+. Rw/+mice are strikingly more sensitive to the lethal effects of X-irradiation (MLD 6.66 +/- 0.10 Gy) on haematopoiesis than comparable +/+ mice (MLD 8 Gy). Those mice that do recover after X-irradiation do not exhibit the delay in recovery of erythropoiesis that is evident with characteristic W mutants in both single and double dose. Furthermore the double heterozygote Wct+/+Rw has a significantly lower MLD (5.19 +/- 0.17 Gy) for X-radiation than Wct/+ (MLD 6.48 +/- 0.24 Gy). We argue that all three loci W, Ph and Rw, influence haematopoietic stem cells, leading to increased radiosensitivity when deletions or mutant genes are present.