The validity of clinical measures of patella position

Patellar taping is regarded as an important element of the treatment of patellofemoral joint pain. Key to the successful use of patellar taping is the assessment of patella position. The reliability and validity of the techniques used to assess patella position has been questioned. The aim of the study was to assess the validity of the clinical assessment technique of patella medio-lateral position and patella lateral tilt against the criterion measure of MRI. Twenty-four subjects eight females and 16 males had their patella position examined in the study (mean age 24.5+/-7.9 years, range 18-42 years). The study also assessed intra-tester reliability of the technique. A good correlation was found between the findings of the clinical test for medio-lateral position and the MRI measure (r=0.611, p=0.002). All of the subjects found to have a laterally tilted patella on clinical examination had a lateral patella tilt defined by PTA of greater than 5 degrees . Those subjects with a PTA of less than 5 degrees on clinical examination were assessed as having no degree of patella tilt. The study undertaken shows that when undertaken by an experienced manual therapist positional assessment of the patella can have strong criterion validity and intra-tester reliability.     

New technique for prostate volume assessment

Purpose

The prostate-specific antigen density (PSAD) helps distinguish between benign prostatic hyperplasia (BPH) and prostate cancer. Accurate prostate volume (PV) assessment is necessary for PSAD calculation and both BPH diagnosis and treatment response monitoring; therefore, accurate PV measurement is increasingly becoming an essential step in the urology.

Methods

Magnetic resonance imaging was used for PV estimation. A new technique based on single-class support-vector machines (S SVM) for accurate PV estimation was realized. Three estimation methods were compared; method 1: planimetry (reference), method 2: S SVM based, and method 3: prolate ellipsoid.

Results

Method 1 and method 2 depict a strong correlation (Spearman’s rank correlation coefficient ρ = 0.965, p > 0.001). The interrater reliability for method 1 and method 2 readings as expressed by the intraclass correlation coefficient (ICC) was 0.975 (p > 0.001). Comparison between method 3 and the two other methods shows ρ = 0.873 (p > 0.001), and ρ = 0.795 (p > 0.001), respectively. ICC was 0.54 and 0.505, respectively. The mean difference between method 1 and method 2 was ?0.05 ml. The limits of agreement with the 95 % confidence interval were ?3.8 to 3.7 ml. Comparing method 3 and the two other methods shows a worse agreement with mean difference of 8.6 ml (95 % confidence interval of 1.0–16.2 ml) and 8.6 ml (95 % confidence interval of ?0.7 to 18.0 ml), respectively.

Conclusions

The prostate volumes obtained by our technique agreed excellently with the planimetry (reference) method. This new technique would be clinically useful for urologists in prostate volumetric analysis.     

Allosteric interactions at adenosine A1 and A3 receptors: new insights into the role of small molecules and receptor dimerization

The purine nucleoside adenosine is present in all cells in tightly regulated concentrations. It is released under a variety of physiological and pathophysiological conditions to facilitate protection and regeneration of tissues. Adenosine acts via specific GPCRs to either stimulate cyclic AMP formation, as exemplified by G_s-protein-coupled adenosine receptors (A_2A and A_2B), or inhibit AC activity, in the case of G_i/o-coupled adenosine receptors (A₁ and A₃). Recent advances in our understanding of GPCR structure have provided insights into the conformational changes that occur during receptor activation following binding of agonists to orthosteric (i.e. at the same binding site as an endogenous modulator) and allosteric regulators to allosteric sites (i.e. at a site that is topographically distinct from the endogenous modulator). Binding of drugs to allosteric sites may lead to changes in affinity or efficacy, and affords considerable potential for increased selectivity in new drug development. Herein, we provide an overview of the properties of selective allosteric regulators of the adenosine A₁ and A₃ receptors, focusing on the impact of receptor dimerization, mechanistic approaches to single-cell ligand-binding kinetics and the effects of A₁- and A₃-receptor allosteric modulators on in vivo pharmacology.Linked ArticlesThis article is part of a themed section on Molecular Pharmacology of GPCRs. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2014.171.issue-5     

A mixed method study evaluating the integration of pregnancy weight gain charts into antenatal care

Monitoring pregnancy weight can reduce excess gestational weight gain (GWG), and is recommended in clinical practice guidelines as part of routine care. This study aimed to evaluate the implementation of routine weight monitoring using a pregnancy weight gain chart (PWGC), and assess health care professionals (HCPs) and pregnant women's attitudes and practices around its use. A semiquantitative survey was conducted with a consecutive sample of antenatal women at 16 and 36 weeks gestation. Women were weighed, and a PWGC audit done at 36 weeks gestation to assess adherence to chart use and GWG. A cross‐sectional survey of antenatal HCPs at the Australian facility assessed staff attitudes and practices relating to weight monitoring and PWGC use. Of the 291 women surveyed, 68% reported being given a PWGC. Of the audited PWGCs (n = 258), 54% had less than three weights recorded, 36% had errors, and 3% were unused. All HCPs surveyed (n = 42) were aware of the PWGC, 63% reported using it to track GWG regularly and 26% believed it to be only the woman's responsibility (i.e., not the midwife's role) to complete it. Seventy‐six percent reported they needed more training in counselling pregnant women, and insufficient time was a main barrier to weighing and conversing with women. It is feasible to implement a PWGC into routine antenatal care. Clarity over women's and HCPs responsibility for monitoring GWG and completion of the PWGC is needed. Training on correct PWGC use and counselling and workforce engagement are required to overcome barriers and support healthy GWG.     

Short-term (0-48 h) effects of maternal betamethasone administration on fetal heart rate and its variability

The short-term (0-48 h) effects of maternal betamethasone administration on computerized fetal heart rate (FHR) parameters were studied in 36 pregnancies at increased risk for preterm delivery. FHR was recorded for 90 min immediately before the start of betamethasone treatment and again at 6-h intervals during the next 48 h. Multiple linear regression models were used to assess the possible effects on FHR parameters of gestational age, time of day, clinical indication for treatment, and use of tocolytic drugs. Within 12 h after the start of treatment, significant increases occurred in FHR accelerations, and short- and long-term FHR variability (36%, 28%, and 22%, respectively), whereas basal FHR showed a 5% decrease. FHR variability was decreased by 10% at 42-48 h. The observed changes were more pronounced in older (29-33 wk of gestation) compared with younger fetuses (25-28 wk of gestation). Decelerations occurred only in 4 out of 11 compromised fetuses during betamethasone therapy. We conclude that there are significant changes in FHR parameters during the first 48 h after betamethasone administration. These changes are transient in normal fetuses. However, the compromised fetus may be adversely affected by betamethasone.     

Intensified chemotherapy without SCT in infant ALL: Results from COG P9407 (Cohort 3)

Background

Infants with acute lymphoblastic leukemia (ALL) present with aggressive disease and a poor prognosis. Early relapse within 6–9 months of diagnosis is common. Approximately 75% of infants have MLL‐rearranged (MLL‐R) ALL with event free survival (EFS) ranging from 20% to 30%. Children's Oncology Group (COG) P9407 used shortened (46 weeks), intensified therapy to address early relapse and poor EFS.

Procedure

P9407 therapy was modified three times for induction toxicity resulting in three cohorts of therapy. One hundred forty‐seven infants were enrolled in the third cohort.

Results

We report an overall 5‐year EFS and OS of 42.3 ± 6% and 52.9 ± 6.5% respectively. Poor prognostic factors included age ≤90 days at diagnosis, MLL‐R ALL and white cell count ≥50,000/μl. For infants ≤90 days of age, the 5‐year EFS was 15.5 ± 10.1% and 48.5 ± 6.7% for those >90 days (P < 0.0001). Among infants >90 days of age, 5‐year EFS rates were 43.8 ± 8% for MLL‐R versus 69.1 ± 13.6% for MLL‐germline ALL (P < 0.0001).

Conclusions

Age ≤90 days at diagnosis was the most important prognostic factor. Despite shortened therapy with early intensification, EFS remained less than 50% overall in MLL‐R ALL. Pediatr Blood Cancer 2015;62:419–426. © 2014 Wiley Periodicals, Inc.     

Assessing Potential Risk to Alligators, Alligator mississippiensis, from Nutria Control with Zinc Phosphide Rodenticide Baits

Nutria, Myocastor coypus, populations must be reduced when they cause substantial wetland damage. Control can include the rodenticide zinc phosphide, but the potential impacts to American alligators, Alligator mississippiensis, must be assessed. The mean amount of zinc phosphide per nutria found in nutria carcasses was 50 mg. Risk assessment determined that a conservative estimate for maximum exposure would be 173 mg zinc phosphide for a 28 kg alligator, or 6.2 mg/kg. Probit analysis found an LD₅₀ for alligators of 28 mg/kg. Our studies suggest that the use of zinc phosphide to manage nutria populations would pose only a small risk to alligators.     

Genetic and environmental influences on antisocial behavior and alcohol dependence from adolescence to early adulthood

Genetic and environmental influences on symptoms of adult antisocial behavior (AAB) and alcohol dependence at ages 17, 20, and 24 were examined cross-sectionally and longitudinally in 188 monozygotic and 101 dizygotic male twin pairs. A moderate genetic influence on both AAB and alcohol dependence was found at each age, with a substantial proportion of this influence common to the two disorders, suggesting they share susceptibility genes. Biometrical models showed that continuity effects accounted for most of the stable variance in symptoms of both AAB and alcohol dependence, indicating that genetic and environmental effects associated with each of these disorders were similar at each age. Significant cross-lag effects (effects of alcohol dependence contributing to variance in AAB and vice versa) were observed at ages 20 and 24 for both disorders. The largest and theoretically most interesting of these effects indicated that one sixth of the genetic influence on AAB at age 20 was due to genetic effects associated with alcohol dependence at age 17. Thus, alcohol dependence symptoms at age 17 in particular had an effect on antisocial behavior symptoms at age 20, suggesting that alcohol involvement in adolescence may ensnare otherwise desisting youth in persistent antisocial behavior.