The addition of the Protonics brace system to a rehabilitation protocol to address patellofemoral joint syndrome

STUDY DESIGN: Randomized clinical trial. OBJECTIVES: To investigate the clinical efficacy of the addition of the Protonics system to a standard exercise-based patellofemoral rehabilitation protocol. BACKGROUND: The Protonics system has been suggested as an intervention for patients with patellofemoral pain syndrome (PFPS). However, the effects of this system have not been compared to the effects associated with traditional exercise-based rehabilitation alone. METHODS AND MEASURES: Seventeen of 34 females (mean age, 28 years; range, 13-55 years) diagnosed with PFPS were randomly assigned to wear the Protonics system while participating in a conventional exercise-based rehabilitation program. Functional and patient-reported outcome measures were evaluated, including Kujala score and the lateral step-up test. In addition, measurements of hip internal and external rotation, hip extension, and iliotibial band muscle length were compared between groups. RESULTS: Patients in both groups demonstrated improvement in Kujala score (P<.001), performance on the lateral step-up test (P<.001), and pain during the step-up test (P<.001) at the conclusion of the study. However, there was no difference between groups with respect to improvement in Kujala score (P = .33), step-up test performance (P = .47), or pain during the step-up test (P = .24). Patients using the Protonics system demonstrated greater gain in passive hip extension (P = .023) and increased hip external rotation motion (P = .017) at discharge versus patients treated with exercise alone. However, there was no difference in iliotibial band flexibility (P = .80) or hip internal rotation motion (P = .09) between groups. A greater proportion of patients in the Protonics group reported no pain with step-up testing at each 2-week interval. However, the 2.2 fewer visits required by patients in the Protonics group to meet discharge criteria did not achieve statistical significance (P = .08). CONCLUSIONS: Patients using the Protonics system demonstrated a shift in available hip rotation and increased passive hip extension flexibility. However, these changes were not outside the bounds of potential measurement error and did not translate into significant functional differences from a similar group treated with exercise alone. The economic implications of an average 2.2-visit decrease in treatment sessions per patient using the Protonics system are uncertain.     

Dissection of hypothalamic-pituitary-adrenal axis pathology in 1-month-abstinent alcohol-dependent men, part 2: response to ovine corticotropin-releasing factor and naloxone

BACKGROUND: Pituitary and adrenal responsiveness is suppressed in abstinent alcohol-dependent individuals. To clarify the specific organizational disruption in hypothalamic-pituitary-adrenal functioning during early abstinence, the authors separately assessed each level of the stress-response axis. In this second of a two-part study, ovine corticotropin-releasing factor (oCRH) was used to stimulate the pituitary corticotrophs, and naloxone was used to activate the axis at the hypothalamic level. In addition, pulsatile characteristics of corticotropin and cortisol were assessed over a 12-hr period (0800 to 2000 hr). METHODS: Eleven abstinent alcohol-dependent men and 10 healthy comparison participants were assessed. All participants were between the ages of 30 and 50 years, and alcohol-dependent patients were abstinent from 4 to 6 weeks. Basal concentrations of corticotropin and cortisol were obtained every 10 min from 0800 to 2000 hr and subjected to pulsatile analysis. Plasma corticotropin and cortisol concentrations were then obtained every 5 to 10 min after low-dose, intravenously administered doses of oCRH (0.4 microg/kg) or naloxone (0.125 mg/kg). Medications were administered at 2000 hr and the two challenge studies were separated by 48 hr. RESULTS: Pulsatile analysis revealed that the mean corticotropin amplitude was increased in alcohol-dependent patients relative to controls (p <0.05). Other pulsatile characteristics of corticotropin and all cortisol pulsatile measures were not significantly different between the two groups. The integrated cortisol response to oCRH was significantly lower in alcohol-dependent patients compared with controls (p <0.01), but the integrated corticotropin response was not significantly different. In contrast, neither the corticotropin nor the cortisol response to naloxone was significantly different between groups. CONCLUSIONS: Adrenocorticoid hyposensitivity persists after oCRH infusion for at least 1 month after cessation of drinking, whereas hyporesponsiveness of the pituitary corticotrophs to CRH seems to resolve with continued abstinence. The authors suggest that adrenocortical hyporesponsiveness during prolonged abstinence may impact relapse risk.     

Keratin 2e: a marker for murine nipple epidermis

Mesenchyme-derived signals influence the unique keratinization and appendage formation programs in specialized skin regions. Interactions between primary mammary mesenchyme and epidermal cells result in the formation of the nipple; however, it is unclear whether this represents a site of regionally specialized epidermis. We profiled the ultrastructure and keratin expression of the murine nipple, and the ventral skin of the K14-parathyroid hormone-related protein (PTHrP) transgenic mouse, which models nipple formation. We found the murine nipple and ventral K14-PTHrP epidermis display expanded suprabasal and granular layers, as well as a thickened cornified layer compared to ventral skin of wild-type littermates. We also observed increased levels of filaggrin in extracts from the ventral epidermis of the K14-PTHrP mouse when compared to that of wild-type littermates. Keratin 2e, previously reported to be expressed in various specialized epidermal sites in the mouse, is expressed in the nipple and the ventral skin of the K14-PTHrP mouse. Keratinocytes grown from the ventral epidermis of the K14-PTHrP mouse or wild-type littermates exhibited identical expression of epidermal markers in vitro, suggesting that the modulated differentiation profile observed in the nipple or the ventral K14-PTHrP skin was dependent on interactions with fibroblasts. The lack of appendages, altered stratification pattern and expression of a specialized keratin suggests that the murine nipple is an example of regionally specialized epidermis.     

Application of multiplex ligation-dependent probe analysis to define a small deletion encompassing PMP22 exons 4 and 5 in hereditary neuropathy with liability to pressure palsies

Hereditary neuropathy with liability to pressure palsies arises as a result of defects at the chromosome 17p11.2-12 locus and in 84% of cases a 1.5 Mb deletion containing the PMP22 gene is detected by analysis that utilises polymorphic (CA)_n repeat markers which flank this gene. We report the clinical and electrophysiological findings observed in a kindred with three members affected by HNPP due to a deletion containing exons 4 and 5 of the PMP22 gene. This small deletion cannot be detected using standard analysis with polymorphic (CA)_n repeat markers and a definitive diagnosis was made by multiplex ligation-dependent probe analysis of PMP22 exons 1A-5. MLPA can be readily utilised as a routine diagnostic laboratory test to detect the common HNPP 1.5 Mb deletion, as well as the reciprocal 1.5 Mb insertion observed in CMT1A, but has the advantage over other diagnostic techniques of being able to define single exon deletions.     

Hip strength in females with and without patellofemoral pain

STUDY DESIGN: Cross-sectional. OBJECTIVES: To determine if females with anterior knee pain are more likely to demonstrate hip abduction or external rotation weakness than a similar, asymptomatic, age-matched control group. BACKGROUND: Diminished hip strength has been implicated as being contributory to lower-extremity malalignment and patellofemoral pain. The identification of reliable and consistent patterns of weakness in this population may assist health care professionals establish a more effective treatment plan. METHODS AND MEASURES: Hip abduction and external rotation isometric strength measurements were recorded for the injured side of 15 female subjects with patellofemoral joint pain (mean +/- SD age, 15.7 +/- 2.7 years; age range, 12-21 years). These were compared with strength measurements from the corresponding hip of 15 age-matched female control subjects (mean +/- SD age, 15.7 +/- 2.7 years; age range, 12-21 years). All strength measurements were made using hand-held dynamometers. RESULTS: Subjects with patellofemoral pain demonstrated 26% less hip abduction strength (P<.001) and 36% less hip external rotation strength (P<.001) than similar age-matched controls. CONCLUSIONS: The results indicate that young women with patellofemoral pain are more likely to demonstrate weakness in hip abduction as well as external rotation than age-matched women who are not symptomatic.     

CDK1 and cyclin A expression is linked to cell proliferation and associated with prognosis in non-Hodgkin's lymphomas.

Cellular proliferation is regulated by several kinasic complexes associating cyclins and their catalytic subunits cyclin-dependent kinases (CDKs). In order to gain insight into the mechanisms underlying proliferation in non-Hodgkin's lymphoma (NHL), we examined the expression of certain cell cycle regulatory proteins normally expressed in lymphoid cells, cyclins A, B, D3 and E and cdk1, 2, 4, and 6. In 70 patients presenting a previously untreated lymphoma, cyclins and CDKs were studied by Western blotting and quantified by densitometry. Flow cytometry study of DNA content was carried out for all patients in order to study cell proliferation and level of ploidy. The results were analysed according to the histological types, the immunological phenotypes of the lymphomas and the outcome of the patients. Cdkl and cyclin A were correlated with the percentage of cells in S and S+G2/M phases, and significantly different according to the grade of malignancy, with the lowest expression in low-, and the highest in high-grade NHL according to the Working Formulation. In B-NHLs, cdk1, cyclin A, as well as cdk2, cyclin D3 and E expression was higher in the aneuploid than in the euploid group. Our results point to some particularities of cell cycle regulation in two lymphoma sub-types: 1) a low expression of cyclin D3 and cdk6 in mantle cell lymphomas and 2) a discrepancy between the high proliferative activity and the level of protein expression in Burkitt's lymphomas. CDK1 and cyclin A showed a significant prognostic value for achievement of complete remission (Cdk 1) and for both disease free (cyclin A) and overall survival (cyclin A and cdk1): low protein level was associated with the best prognosis in B-NHLs. Our results show that differential cell cycle regulating protein expression may be associated with different biological and clinical behaviour of NHLs and confirm the usefulness of the study of cell cycle regulation as a tool for understanding lymphoid malignancies.     

Myelodysplastic syndromes. A multiparametric study of prognostic factors in 336 patients

Two groups of patients with a myelodysplastic syndrome (MDS) were analyzed by univariate (log-rank test) and multivariate (logistic regression) analyses to detect the most important prognostic factors. By stepwise analysis, the variables found to have prognostic significance for death were as follows: age, percentage of marrow blasts, presence of circulating blasts, and number of platelets. The variables found significant for predicting progression to acute leukemia (AL) were as follows: hemoglobin level, percentage of marrow blasts, and presence of circulating blasts. The first group of 193 patients was used to build a prognostic index which reflected the probability of a given patient dying or progressing to AL within 6, 9, or 12 months. The application of this prognostic index to a test group of 143 patients was used to determine the expected error rate and the validity of the prediction rule.     

Eating Disorders and Disturbance in Children and Adolescents With Cystic Fibrosis

People with cystic fibrosis are considered at risk for developing anorexia (Raymond et al., 2000), but studies have used methodologically flawed measures. Using improved methodology, the current study examines the prevalence of eating disorders/disturbance in adolescents with CF. Method: 55 adolescents with CF, age range 11-17 years (mean 14.2 years) randomly selected were administered the Child Eating Disorder Examination (Bryant-Waugh, Cooper, Taylor, & Lask, 1996). Results: No participant met full criteria for a diagnosis of anorexia or bulimia. Of those with a BMI ≤ 17.5, 5% avoided weight gain. Fifty-three percent demonstrated disturbed eating attitudes and 16% disturbed eating behaviours. Discussion: The study finds that gold standard diagnostic methods indicate the prevalence of disturbed eating attitudes and behaviors in CF.