Understanding the role of stimulation in reflexology: development and testing of a robotic device

Reflexology is a common choice of women with breast cancer as supportive care during treatment. It involves stimulation of specific locations of the feet called reflexes using a specialised walking motion with the thumb of the reflexologist. Reflexology has shown potential for the successful management of cancer and treatment-related symptoms and improvement in physical functioning; however to date, the mechanism of action for these improvements is unknown. One confounder to the study of reflexology is the 'human factor'. To study the effects of the stimulation of the reflexes independent of the 'human factor', there is a need for an alternative method for the delivery of reflexology. The objective of this work was to design and create a robotic reflexology device that would deliver a breast cancer-specific reflexology protocol to the feet of patients. A prototype robotic reflexology device was developed and tested for feasibility, safety and acceptability with breast cancer survivors (n= 13), and preliminary efficacy in symptom management and enhanced functional status with a sample of women undergoing chemotherapy for breast cancer (n= 13). Safety, feasibility and acceptability were established, and significant improvements from pre- to post-device-delivered reflexology were seen in symptom severity among women on chemotherapy.     

A key role for membrane transporter NKCC1 in mediating chondrocyte volume increase in the mammalian growth plate

The mechanisms that underlie growth plate chondrocyte volume increase and hence bone lengthening are poorly understood. Many cell types activate the Na‐K‐Cl cotransporter (NKCC) to bring about volume increase. We hypothesised that NKCC may be responsible for the volume expansion of hypertrophic chondrocytes. Metatarsals/metacarpals from 16 rat pups (P₇) were incubated in the presence/absence of the specific NKCC inhibitor bumetanide and measurement of whole‐bone lengths and histologic analysis of the growth plate were done after 24 hours. Fluorescent NKCC immunohistochemistry was visualised using a confocal laser scanning microscopy on seven rat tibial growth plates (P₇). Microarray analysis was performed on mRNA isolated from proliferative and hypertrophic zone cells of tibial growth plates from five rats of each of three ages (P_49/53/58). Exposure to bumetanide resulted in approximately 35% reduction (paired Student's t test, p < .05) of bone growth in a dose‐dependent manner; histologic analysis showed that a reduction in hypertrophic zone height was responsible. Quantification of fluorescence immunohistochemistry revealed a significant (paired Student's t test, p < .05) change in NKCC from the intracellular space of proliferative cells to the cytosolic membrane of hypertrophic zone cells. Further, microarray analysis illustrated an increase in NKCC1 mRNA between proliferative and hypertrophic cells. The increase in NKCC1 mRNA in hypertrophic zone cells, its cellular localization, and reduced bone growth in the presence of the NKCC inhibitor bumetanide implicate NKCC in growth plate hypertrophic chondrocyte volume increase. Further investigation is warranted to determine the regulatory control of NKCC in the mammalian growth plate and the possible detrimental effect on bone growth with chronic exposure to loop diuretics. © 2010 American Society for Bone and Mineral Research     

Teriparatide is safe and effectively increases bone biomarkers in institutionalized individuals with osteoporosis

Institutionalized adults with severe developmental disabilities have a high rate of minimal trauma and appendicular fracture. There is little information about osteoporosis treatment in this population. In this efficacy and safety study, men and women with severe developmental disabilities and osteoporosis received 20 mcg teriparatide subcutaneously daily for 18–24 months. Markers of bone formation [procollagen type 1 intact N-terminal propeptide (P1NP)] and resorption [C-telopeptide (CTx)] were measured at three-month intervals. Serum calcium was measured at two-week intervals for 12 weeks and thereafter at three-month intervals. Twenty-seven individuals received at least one injection. The incidence of hypercalcemia was 11.1% but was persistent and led to medication discontinuation in only one participant. Biomarkers of bone formation increased rapidly, doubling by three months. At 12 months, P1NP and CTx remained elevated from baseline; P1NP had risen from 66.95 ± 83.71 μg/l (mean ± SD) to 142.42 ± 113.85 μg/l (P = 0.05), and CTx had increased from 0.377 ± 0.253 to 1.016 ± 1.048 ng/ml (P = 0.01). The majority of participants had an increase in P1NP of over 10 μg/l. In conclusion, teriparatide is safe and effective in developmentally disabled institutionalized adults. Serial calcium measurements are warranted, particularly during the first three months of therapy.     

Embolic Protection Devices for Carotid Artery Stenting: Have They Made a Significant Difference in Outcomes?

Carotid angioplasty and stenting (CAS) is a valid alternative to conventional carotid endarterectomy for treatment of carotid artery stenosis in a select group of patients. Distal embolization of atherosclerotic debris and air causing neurologic deficits during CAS has been one of the most significant concerns limiting widespread application of CAS technology. A variety of distal embolic protection devices have been designed to minimize the risk of major embolization causing stroke. This review will examine the types of available devices, including strengths and weaknesses of each, and present the available evidence and rationale for their routine use during CAS.