The Urban Built Environment and Associations with Women’s Psychosocial Health

The determinants that underlie a healthy or unhealthy pregnancy are complex and not well understood. We assess the relationship between the built environment and maternal psychosocial status using directly observed residential neighborhood characteristics (housing damage, property disorder, tenure status, vacancy, security measures, violent crime, and nuisances) and a wide range of psychosocial attributes (interpersonal support evaluation list, self-efficacy, John Henryism active coping, negative partner support, Perceived Stress Scale, perceived racism, Center for Epidemiologic Studies—Depression) on a pregnant cohort of women living in the urban core of Durham, NC, USA. We found some associations between built environment characteristic and psychosocial health varied by exposure categorization approach, while others (residence in environments with more rental property is associated with higher reported active coping and negative partner support) were consistent across exposure categorizations. This study outlines specific neighborhood characteristics that are modifiable risk markers and therefore important targets for increased research and public health intervention.     

Psychometric Properties of the Rosenberg Self-Esteem Scale in African American Single Mothers

The Rosenberg Self-Esteem (RSE) Scale is a commonly used measure of global self-esteem, an important element of mental health. The purpose of this cross sectional secondary analysis was to examine the psychometric properties of the scale in a sample of 98 African American single mothers. The RSE Scale showed adequate internal consistency with an alpha coefficient of .83. Two factors that accounted for a total of 54.7% of the variance were extracted. Self-esteem showed a strong negative relationship with both depressive symptoms and negative thinking. This study provides support for the internal consistency of the RSE Scale and partial support for its construct validity in this population. The RSE appears to represent a bidimensional construct of self-esteem for African American women, with the cultural influences of racial esteem and the rejection of negative stereotypes forming a separate and distinct aspect of this concept. The RSE Scale should be used and interpreted with caution in this population given these findings.     

The coracoacromial arch: MR evaluation and correlation with rotator cuff pathology

The relative prevalence of various acromial shapes, appearance of the coracoacromial ligament and enthesophytes along the inferior aspect of the acromioclavicular joint in patients with and without rotator cuff tears were evaluated. Of 76 patients with clinical instability and impingement, 31 had a normal rotator cuff and 45 demonstrated a partial or full tear of the supraspinatus tendon at surgery. Results were compared with those from magnetic resonance (MR) scans of 57 asymptomatic volunteers. Of the 45 patients with a supraspinatus tear, 38% (17) had a flat acromial undersurface (type I), 40% (18) had a concave acromial undersurface (type II), 18% (8) had an anteriorly hooked acromion (type III), and 4% (2) had an inferiorly convex acromion (type IV). Among the 31 patients with a normal rotator cuff at surgery and the 57 asymptomatic volunteers, the respective prevalences of the type I acromion were 39% (12) and 44% (25), of type II 48% (15) and 35% (20), type III 3% (1) and 12% (7), and type IV 10% (3) and 9% (5). Shoulders with surgically proven rotator cuff tears showed a tendential association with a type III acromion (8/45) and statistically significant associations with a thickened coracoacromial ligament (17/45) and acromioclavicular enthesophytes (18/45). For the association between inferiorly directed acromioclavicular joint enthesophytes and rotator cuff tears, age appears to be a confounding factor. The type IV acromion, newly classified by this study, does not have a recognizable association with rotator cuff tears. Assessment of the osseous-ligamentous coracoacromial outlet by may prove helpful to the orthopedic surgeon in patients for whom surgical decompression is contemplated.     

Brown-colored semen in men with spinal cord injury.

The interesting condition of brown-colored semen has often been observed during assisted ejaculation of men with spinal cord injury (SCI). This condition has not been reported in the literature, and its cause is unknown. To investigate this condition, the present study examined the incidence and quality of brown semen and its relationship to level of SCI, time since SCI, number of successive ejaculations, ejaculation frequency, and ejaculation method in a total of 664 semen specimens from 162 SCI men. In addition, a microscopic evaluation was performed on brown semen specimens from SCI men, not-brown specimens from SCI men, and normally colored specimens from normal men. The results showed that 27% of SCI subjects had brown semen on at least one ejaculation. There was no difference between men producing and men not producing brown semen in age, level of injury, or years postinjury. The duration of an ejaculation, number of successive ejaculations, and frequency of ejaculation were not associated with occurrence of brown semen. Sperm concentration and sperm motility were not significantly different in brown and not-brown specimens. Specimens from subjects who produced brown semen had similar pH but lower volume than specimens from subjects who did not produce brown semen. Brown semen had a thin consistency more often than not-brown semen. Brown specimens contained intact red blood cells (RBCs) and/or heme pigment more often than not-brown specimens; however, one half and one third of the specimens, respectively, contained neither RBCs nor heme pigment. The cause of brown semen is unknown but may relate to seminal-vesicle dysfunction.     

The challenges of success: adolescents with perinatal HIV infection

The great success in the prevention and treatment of pediatric HIV in high resource countries, and now in low resource countries, has changed the face of the HIV epidemic in children from one of near certain mortality to that of a chronic disease. However, these successes pose new challenges as perinatally HIV‐infected youth survive into adulthood. Increased survival of HIV‐infected children is associated with challenges in maintaining adherence to what is likely life‐long therapy, and in selecting successive antiretroviral drug regimens, given the limited availability of pediatric formulations, limitations in pharmacokinetic and safety data of drugs in children, and the development of extensive drug resistance in multi‐drug‐experienced children. Pediatric HIV care must now focus on morbidity related to long‐term HIV infection and its treatment. Survival into adulthood of perinatally HIV‐infected youth in high resource countries provides important lessons about how the epidemic will change with increasing access to antiretroviral therapy for children in low resource countries. This series of papers will focus on issues related to management of perinatally infected youth and young adults.     

The systemic inflammatory response after spinal cord injury in the rat is decreased by α4β1 integrin blockade

Abstract The systemic inflammatory response syndrome (SIRS) follows spinal cord injury (SCI) and causes damage to the lungs, kidney, and liver due to an influx of inflammatory cells from the circulation. After SCI in rats, the SIRS develops within 12?h and is sustained for at least 3 days. We have previously shown that blockade of CD11d/CD18 integrin reduces inflammation-driven secondary damage to the spinal cord. This treatment reduces the SIRS after SCI. In another study we found that blockade of α4β1 integrin limited secondary cord damage more effectively than blockade of CD11d/CD18. Therefore we considered it important to assess the effects of anti-α4β1 treatment on the SIRS in the lung, kidney, and liver after SCI. An anti-α4 antibody was given IV at 2 h after SCI at the fourth thoracic segment and the effects on the organs were evaluated at 24 h post-injury. The migration of neutrophils into the lungs and liver was markedly reduced and all three organs contained fewer macrophages. In the lungs and liver, the activation of the oxidative enzymes myeloperoxidase (MPO), inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), and gp91(phox), the production of free radicals, lipid peroxidation, and cell death were substantially and similarly reduced. Treatment effects were less robust in the kidney. Overall, the efficacy of the anti-α4β1 treatment did not differ greatly from that of the anti-CD11d antibody, although details of the results differed. The SIRS after SCI impedes recovery, and attenuation of the SIRS with an anti-integrin treatment is an important, clinically-relevant finding.     

A CD11d Monoclonal Antibody Treatment Reduces Tissue Injury and Improves Neurological Outcome after Fluid Percussion Brain Injury in Rats

Abstract Traumatic brain injury (TBI) is an international health concern often resulting in chronic neurological abnormalities, including cognitive deficits, emotional disturbances, and motor impairments. An anti-CD11d monoclonal antibody that blocks the CD11d/CD18 integrin and vascular cell adhesion molecule (VCAM)-1 interaction following experimental spinal cord injury improves functional recovery, while reducing the intraspinal number of neutrophils and macrophages, oxidative activity, and tissue damage. Since the mechanisms of secondary injury in the brain and spinal cord are similar, we designed a study to evaluate fully the effects of anti-CD11d treatment after a moderate lateral fluid percussion TBI in the rat. Rats were treated at 2?h after TBI with either the anti-CD11d antibody or an isotype-matched control antibody 1B7, and both short (24- to 72-h) and long (4-week) recovery periods were examined. The anti-CD11d integrin treatment reduced neutrophil and macrophage levels in the injured brain, with concomitant reductions in lipid peroxidation, astrocyte activation, amyloid precursor protein accumulation, and neuronal loss. The reduced neuroinflammation seen in anti-CD11d-treated rats correlated with improved performance on a number of behavioral tests. At 24?h, the anti-CD11d group performed significantly better than the 1B7 controls on several water maze measures of spatial cognition. At 4 weeks post-injury the anti-CD11d-treated rats had better sensorimotor function as assessed by the beam task, and reduced anxiety-like behaviors, as evidenced by elevated-plus maze testing, compared to 1B7 controls. These findings suggest that neuroinflammation is associated with behavioral deficits after TBI, and that anti-CD11d antibody treatment is a viable strategy to improve neurological outcomes after TBI.     

International skeletal society outreach in Argentina

From June 28th to 29th, 2013, the Argentinian ISS Outreach Program took place in collaboration with the Centro de Diagnóstico Dr. Enrique Rossi in the city of Buenos Aires. A total of 690 participants attended. In the following report, we analyze the actual radiologic situation in this South American country. Outreach programs in a country such as Argentina are extremely valuable, as they provide a great opportunity for physicians that cannot travel overseas an attend international meetings such as RSNA, International Skeletal Society, or ARRS.     

Diabetic neuropathic foot ulcers and amputation

A neuropathic foot ulcer is a severe complication of diabetes that can result in a more severe complication, a lower extremity amputation. We conducted a cohort study of 24,616 individuals with a diabetic neuropathic foot ulcer treated within a multicenter wound care network. A total of 1653 (6.7%) individuals had an amputation and 46.3% of these amputations were of a toe or ray (minor amputation). In the more than 10-year follow-up period that we studied, the percentage of those who had an amputation varied between 5.6% and 8.4%. Of those who had an amputation, the percentage that had a minor amputation increased over time from 4.0% in the earliest years to more than 60% in the later years of observation. The single most important determinant of amputation was the observation of fascia, tendon, and bone at the initial assessment. In conclusion, about 7% of those with a diabetic neuropathic foot ulcer will have an amputation and in the past 10 years there has been a remarkable increase in the number of minor as compared to major amputations.