Effectiveness of maternity support belts in reducing low back pain during pregnancy: a review

Aims. This article aims to review the literature published to date on the types, current use, the biomechanical effects and adverse effects of maternity support belts for low back pain during pregnancy, to identify future research directions. Background. Lumbar/pelvic support belts are frequently recommended for the prevention and treatment of low back pain during pregnancy. Design. Systematic review. Methods. MEDLINE, CINAHL, the Cochrane Library and patents databases were electronically searched. Results. Maternity support belts belong to one of the four main types of maternity support garments, which are widely commercially‐available. Current research showed limited evidence in support of the commercial maternity products regarding the effectiveness in the prevention and/or treatment of low back pain during pregnancy, other than that from the manufacturers. However, potential stabilisation effect of maternity support belt was demonstrated in some studies. Adverse effects reported include increased pain, fetal heart rate changes, skin irritation and discomfort. Conclusions. There is insufficient scientific evidence to conclude that wearing maternity support belts reduces pregnancy‐related low back pain and/or pelvic girdle pain. Future research directions in the area of biomechanics and physiology are recommended. Relevance to clinical practice. This review provides comprehensive understanding of the effectiveness of maternity support belts for the relief of low back pain during pregnancy which will facilitate healthcare professionals in providing evidence‐based advice to their patients.     

Protein kinase C regulates the flow rate-dependent decline in human nasal ciliary beat frequency in vitro.

Cilia provide the driving force for mucociliary clearance, the process that removes mucus from the airways. Protein kinase C (PKC) plays a poorly understood regulatory role in phosphorylation-based signal transduction cascades, including the control of human mucociliary clearance, especially with respect to ciliary beat frequency (CBF). Ciliary studies minimize the importance of fluid flow, because it is generally accepted that flow increases CBF. Here, we studied postflow events by measuring CBF in vitro in volunteers. Rose chamber-loaded cells were pulsed for 5 minutes at 30 mL/h in medium-199 +/- PKC modulators at 20 degrees C. The 5-minute pulse precipitated a fall in CBF noted within 1 minute after flow (acute dip response [ADR] to 84 +/- 2% of preflow baseline). Thereafter, CBF rose to 8% below baseline for 30 minutes [postrecovery plateau at 92 +/- 3%]. Preincubation with 1 microM of phorbol 12-myristate 13-acetate (PMA), a PKC-activating phorbol ester attenuated the ADR (c. 95%) and restored the postrecovery plateau almost to baseline levels (98 +/- 0.7%; p > 0.10 compared with baseline CBF). With respect to the ADR, the PMA protective effect was lost in the presence of the selective PKC inhibitor myristoylated epidermal growth factor peptide 651d-658 (Myr-PKCI; 10 microM). Myr-PKCI alone changed the ADR pattern such that the CBF remained at 15% below preflow baseline. We conclude that CBF fall and recovery after a fluid pulse is regulated by PKC activity either directly or indirectly.     

Neutrophil function in neonates born to gestational diabetic mothers.

OBJECTIVE: To examine neutrophil functional activity in the cord blood of term neonates born to gestational diabetic mothers, in association with the type of diabetes and the development of neonatal hypoglycemia. METHODS: Neutrophil chemotaxis, random motility, and chemiluminescence was evaluated in the cord blood of 30 healthy term neonates: 12 were born to gestational diabetic mothers who received no-insulin (GDM-NI), eight to gestational diabetic mothers who received insulin (GDM), and 10 to mothers without diabetes (neonatal controls). In addition, the neutrophil functional activity in the peripheral venous blood of 10 healthy adults was analyzed. RESULTS: Neutrophil functional activity in the cord blood of the neonates with and without maternal gestational diabetes was significantly lower than that in adults. As compared to neonatal controls, neonates born to both groups of GDM had decreased chemotaxis, random motility, and chemiluminescence (GDM-NI: 52.8+/-2.1 microm, p<0.001, 42.1+/-4.4 microm, p<0.001, and 140.1+/-6.9 counts per minute (cpm) x 10(3), p<0.01, respectively, and GDM: 53.0+/-1.9 microm, p<0.01, 41.8+/-4.0 microm, p<0.001, and 143.0+/-6.8 cpm x 10(3), p<0.01, respectively). Unlike controls, a tight correlation was identified between the tested neutrophil parameters in the cord blood of neonates born to diabetic mothers (r=0.70 to 0.91). The prevalence of hypoglycemia after birth was almost equal (50.0 to 41.7%) in the two groups of neonates born to diabetic mothers. There were differences in the neutrophil functional activity in the cord blood of the neonates with and without hypoglycemia. CONCLUSION: Maternal gestational diabetes leads to impairment of cord blood neutrophil motility and postphagocytic bactericidal capacity independently from the insulin requirements for the maintenance of normoglycemia during pregnancy.     

Postoperative infection in cardiac surgery: the influence of a change in prophylactic antibiotic regimen

A total of 448 patients undergoing cardiovascular surgery were followed for the development of postoperative infection. Non-extracorporeal procedures were assigned to group 1 and open-heart procedures to group 2. The incidence of infection was compared in two groups who received prophylactic antibiotics. Patients (n = 253) received ampicillin alone (group 1) or in combination with gentamicin (group 2) for 7 days starting 1 day before the operation (period A). One hundred and ninety-five patients (period B) received cefazolin starting preoperatively 30 min before induction, alone (group 1) or in combination with gentamicin (Group 2) for 3 days. The percentage of patients developing infection in periods A and B for group 1 patients was 4.2% and 3.5% and for group 2 it was 25.8% and 18.7% respectively. The overall infection rate was 13%. The number of infection sites involved were 1.5 per infected patient. Urinary tract infections were the most frequent followed by endocarditis and other deep infections, wound infections and respiratory infection. Gram-negative rods were the predominant pathogens (Klebsiella spp. and Pseudomonas aeruginosa) during both periods (47 out of 70 isolates). Wound infections due to Gram-positive cocci were higher in period A (4/8) as compared to period B (1/5). During period B there were three cases of fungal endocarditis whereas no case occurred during period A. Although the incidence of infection was reduced during the period of cefazolin prophylaxis, the difference was not statistically significant.     

A dose-comparative endocrine-clinical study of leuprorelin in premenopausal breast cancer patients

Twelve premenopausal patients with advanced breast cancer were randomised to receive 3.75 or 7.5 mg of a slow release formulation of the luteinising hormone releasing hormone agonist leuprorelin once every 4 weeks. All patients were oestrogen receptor positive or unknown. Serum levels of gonadotrophins and oestrogens were suppressed markedly by both doses. All oestrogen values during treatment were within the postmenopausal range except for a single oestradiol level (274 pmol l-1) in one patient on the lower dose. There was no other indication that this lower dose was less effective as an oestrogen suppressant. There were two objective responders to the 3.75 mg dose and three to the 7.5 mg dose. Toxicity was confined almost entirely to hot flushes which occurred in 11/12 patients. We conclude that the slow release formulation of leuprorelin is effective in breast cancer treatment and that there is no major detriment to the use of the 3.75 rather than 7.5 mg dose.     

Evidence for a special relationship between proteolysis and single cell necrosis

A high rate of single cell necrosis is a common phenomenon in neoplastic and preneoplastic lesions, accounting for growth rates that are significantly less than the cell birth rate. We present data relating the process of protein turnover to single cell necrosis. Cells were labeled with 3H-leucine and 14C-thymidine; the loss of radioactivity from the cell protein and DNA was then measured for 3-6 days. Preliminary experiments showed that cell necrosis by freeze-thawing cells did not significantly contribute to the degradation of cell proteins. Similar results were observed with dying 3T3-SV40 cells at high density. L-cells, however, showed a progressive increase in cell loss as higher cell densities were attained on the monolayer. Although proteolysis remained constant in the culture, analysis of the cells recovered from the high density monolayers showed little loss of labeled protein after adjustment for loss of label in the DNA. Three possible explanations are proposed: DNA turns over with cell protein (unlikely), single cell necrosis involves a special mechanism that facilitates reutilization of amino acids, or single cell necrosis includes only cells that are selectively involved in protein turnover. A unique relationship between single cell necrosis and proteolysis is suggested.     

Effect of cystic fibrosis and non-cystic fibrosis plasma on 45Ca and 35SO4 uptake and retention by the small intestine at the cellular level in the guinea pig

A highly significant increase in net fluxes across the guinea-pig small intestine for both 45Ca2+ and 35SO4(2-), in the presence of cystic fibrosis plasma compared with non-cystic fibrosis plasma, was observed (p less than 0.001). In the presence of cystic fibrosis plasma, the nuclear, mitochondrial, microsomal and soluble fractions retained greater activity when compared with non-cystic fibrosis plasma. Of all the fractions, the nuclear fraction retained the highest activity both for 45Ca2+ and 35SO4(2-). These findings indicate that cystic fibrosis plasma increases the net fluxes and raises the retention of 45Ca2+ and 35SO4(2-) in guinea-pig small intestine at the cellular level.     

Why go endocapsular?

A prospective randomized clinical trial was carried out to compare the intercapsular or the endocapsular technique of IOL insertion and conventional posterior chamber IOL insertion after can opener capsulotomy. Age and sex matched groups of 76 patients each underwent surgery by the two techniques. The corneal and the uveal reaction was evaluated on the first day after the surgery and specular counts were done at six weeks. Though the difference between the two groups was not statistically significant, a trend in favour of intercapsular technique emerged strongly.