Direct comparison of umbilical cord blood versus bone marrow-derived endothelial precursor cells in mediating neovascularization in response to vascular ischemia.

Endothelial precursor cells (EPCs) cultured from adult bone marrow (BM) have been shown to mediate neovasculogenesis in murine models of vascular injury. We sought to directly compare umbilical cord blood (UCB)- and BM-derived EPC surface phenotypes and in vivo functional capacity. UCB and BM EPCs derived from mononuclear cells (MNC) were phenotyped by surface staining for expression of stromal (Stro-1, CXCR4, CD105, and CD73), endothelial (CD31, CD146, and vascular endothelial [VE]-cadherin), stem cell (CD34 and CD133), and monocyte (CD14) surface markers and analyzed by flow cytometry. The nonobese diabetic/severe combined immunodeficiency murine model of hind-limb ischemia was used to analyze the potential of MNCs and culture-derived EPCs from UCB and BM to mediate neovasculogenesis. Histologic evaluation of the in vivo studies included capillary density as a measure of neovascularization. Surface CXCR4 expression was notably higher on UCB-derived EPCs (64.29%+/-7.41%) compared with BM (19.69%+/-5.49%; P=.021). Although the 2 sources of EPCs were comparable in expression of endothelial and monocyte markers, BM-derived EPCs contained higher proportions of cells expressing stromal cell markers (CD105 and CD73). Injection of UCB- or BM-derived EPCs resulted in significantly improved perfusion as measured by laser Doppler imaging at days 7 and 14 after femoral artery ligation in nonobese diabetic/severe combined immunodeficiency mice compared with controls (P<.05). Injection of uncultured MNCs from BM or UCB showed no significant difference from control mice (P=.119; P=.177). Tissue samples harvested from the lower calf muscle at day 28 demonstrated increased capillary densities in mice receiving BM- or UCB-derived EPCs. In conclusion, we found that UCB and BM-derived EPCs differ in CXCR4 expression and stromal surface markers but mediate equivalent neovasculogenesis in vivo as measured by Doppler flow and histologic analyses.     

Sex-Positivity,Medical Mistrust,and PrEP Conspiracy Beliefs Among HIV-Negative Cisgender Black Sexual Minority Men in Atlanta,Georgia

Because the public health response to the disproportionate HIV burden faced by Black sexual minority men (BSMMM) has focused on sexual risk reduction and disease prevention, other vital components of sexual health (e.g., intimacy, pleasure, benefits of sex) have been often overlooked. Sex-positive describes a more open, holistic approach toward sex and sexuality that prioritizes these other components, though such an approach is rarely applied to BSMM's sexual health. For sex-positive BSMM, risk/preventive discourse may foster or exacerbate medical mistrust as a reaction to the dissonance between how these men view sexual health and how the medical establishment views it, which may discourage sexual healthcare-seeking. We assessed sex-positivity and its association with medical mistrust and PrEP conspiracy beliefs among 206 HIV-negative cisgender BSMM in Atlanta, Georgia. We performed exploratory factor analytic procedures on responses to a sex-positivity scale, followed by multivariable linear regressions to determine sex-positivity’s associations with medical mistrust and PrEP conspiracy beliefs. We extracted two sex-positivity factors: sexual freedom (α?=?0.90), reflecting openness toward casual sex and rejection of sexual mores, and essence of sex (α?=?0.77), reflecting the intimate, relational, and pleasurable qualities of sex. Sexual freedom was independently associated with perceived provider deception (β?=?0.19, CI?=?0.04, 0.34). Essence of sex was independently associated with PrEP conspiracy beliefs (β?=?0.16, CI?=?0.02, 0.31) and marginally associated with perceived provider deception (β?=?0.14, CI?=???0.00, 0.29). Healthcare providers and public health practitioners may cultivate greater trust with BSMM by incorporating a sex-positive approach into patient/participant interactions, clinical decision-making, and interventions. Improving access to sexual pleasure acknowledges BSMM’s right to optimal, holistic sexual health.

     

Induced Pluripotent Stem Cells: The Most Versatile Source for Stem Cell Therapy

Cell therapy has existed since the first bone marrow transplant in the 1950s involving identical twins. The blood-forming stem cells were used to restore healthy blood cells for the twin with leukemia. It was not until 1968 that genetic matching (known as human leukocyte antigen matching) was known to be important, and not until 1973 that bone marrow transplants were performed from non–twin-related and nonrelated donors. The most important application of human stem cells is for the generation of cells and tissues for cell-based therapies. Currently, donated organs and tissues are often the only option to replace diseased, injured, or destroyed tissue. The availability for these transplantable tissues and organs is very limited, however. To satisfy the demand for a source for these cells and tissues, induced pluripotent stem cells that have been differentiated into specific cell types can serve as a renewable source of replacement cells and tissues. A bank of suitable human leukocyte antigen–matched cells will be an important source providing immediate availability of cells that are readily scalable, economical, and well characterized. Areas of active pursuit with stem cell therapy is being investigated for treating diseases such as macular degeneration, spinal cord injury, stroke, burns, heart disease, diabetes, osteoarthritis, rheumatoid arthritis, and neurodegenerative diseases. This article describes the advantages and hurdles for the use of induced pluripotent cells as the starting material for a source of replacement cells for regenerative medicine.     

Classification of Lower Extremity Movement Patterns Based on Visual Assessment: Reliability and Correlation With 2-Dimensional Video Analysis

Context:

Abnormal movement patterns have been implicated in lower extremity injury. Reliable, valid, and easily implemented assessment methods are needed to examine existing musculoskeletal disorders and investigate predictive factors for lower extremity injury.

Objective:

To determine the reliability of experienced and novice testers in making visual assessments of lower extremity movement patterns and to characterize the construct validity of the visual assessments.

Design:

Cross-sectional study.

Setting:

University athletic department and research laboratory.

Patients or Other Participants:

Convenience sample of 30 undergraduate and graduate students who regularly participate in athletics (age = 19.3 ± 4.5 years). Testers were 2 experienced physical therapists and 1 novice postdoctoral fellow (nonclinician).

Main Outcome Measure(s):

We took videos of 30 athletes performing the single-legged squat. Three testers observed the videos on 2 occasions and classified the lower extremity movement as dynamic valgus, no change, or dynamic varus. The classification was based on the estimated change in frontal-plane projection angle (FPPA) of the knee from single-legged stance to maximum single-legged squat depth. The actual FPPA change was measured quantitatively. We used percentage agreement and weighted κ to examine tester reliability and to determine construct validity of the visual assessment.

Results:

The κ values for intratester and intertester reliability ranged from 0.75 to 0.90, indicating substantial to excellent reliability. Percentage agreement between the visual assessment and the quantitative FPPA change category was 90%, with a κ value of 0.85.

Conclusions:

Visual assessments were made reliably by experienced and novice testers. Additionally, movement-pattern categories based on visual assessments were in excellent agreement with objective methods to measure FPPA change. Therefore, visual assessments can be used in the clinic to assess movement patterns associated with musculoskeletal disorders and in large epidemiologic studies to assess the association between lower extremity movement patterns and musculoskeletal injury.Key Words: movement analysis, screening, athletic injuries, knee valgus

Key Points

• With training and the use of standardized techniques, both experienced and novice testers reliably classified lower extremity movement patterns based on visual assessment.
• Movement-pattern category-based visual assessments were in excellent agreement with objective methods to measure changes in frontal-plane projection angle.
• Visual assessment based on the methods described in this study may be used in the clinical setting, as well as in large epidemiologic studies and screening assessments for sport participation, to identify distinct categories of lower extremity movement patterns.

Abnormal movement patterns of the lower extremity have been implicated in noncontact anterior cruciate ligament (ACL) injuries¹ and other musculoskeletal problems, such as patellofemoral pain^2–4 and acetabular labral tears.⁵ In addition, correcting these abnormal movement patterns has been shown to prevent ACL injury⁶ and is proposed to reduce symptoms in people with preexisting pain conditions.^5,7,8 Thus, assessment of lower extremity movement patterns may be a way to guide treatment of existing musculoskeletal pain problems and to identify people at risk for future injury or musculoskeletal pain. To facilitate the examination of existing musculoskeletal disorders and the investigation of predictive factors of lower extremity injury, reliable, valid, and feasible methods to assess lower extremity movement patterns are needed.One method to assess lower extremity movement patterns is the Landing Error Scoring System (LESS).^9–11 The LESS uses a standard technique to make visual assessments of movement patterns during a drop vertical jump. The LESS is reliable and valid^9–11; however, the drop vertical jump is a relatively high-level activity and may not be the best way to assess movement patterns in patients with existing injury or in athletes whose sports do not involve landing from a jump. In addition, the drop vertical jump is a bilateral activity that may allow the participant to use 1 limb to compensate for the other. Visual assessment of the single-legged squat (SLSquat), a unilateral limb task, may provide an alternative to the LESS.We have developed standardized methods using a visual assessment of the frontal-plane projection angle (FPPA) to classify the lower extremity movement pattern during an SLSquat. The FPPA is a 2-dimensional (2-D) representation of the lower extremity position¹² and has been used to identify differences between men and women¹² and between women with patellofemoral pain and control participants^4,13 and to detect change in movement patterns after specific training.¹⁴ We established specific criteria to define the categories of lower extremity movement pattern based on the change in FPPA (FPPA change) during motion. The tester observes the angle formed between a line that bisects the thigh and a line that bisects the lower leg. During movement tests, the tester compares the FPPA at the start position with the FPPA at the end position. For example, to assess an SLSquat, the examiner compares the FPPA during the start position of single-legged stance with the end position of maximum squat depth. The difference observed in FPPA from the start to the end position can then be classified as dynamic valgus (change in the valgus direction), no change, or dynamic varus (change in the varus direction). We have used this assessment extensively in the clinical setting, but we have not assessed the rater reliability or the construct validity of our visual assessments.The purpose of this study was to assess the intratester and intertester reliability of 3 testers (2 experienced, 1 novice) categorizing the lower extremity movement pattern demonstrated during an SLSquat. A standardized protocol was used to assess videos of healthy participants performing the SLSquat. We hypothesized that the testers, both experienced and novice, would demonstrate good to excellent reliability using the standardized methods. In addition, we used the objective measure of quantifying FPPA as described by Willson and Davis¹² to determine the construct validity of our visual assessments. We hypothesized that we would see good to excellent agreement between our visual assessments and the quantitative FPPA change.     

Total Hip Arthroplasty in Patients 50 Years or Less : Do We Improve Activity Profiles?

The primary objective of this study was to use step activity monitoring to quantify activity changes after total hip arthroplasty in patients 50 years or less. Secondly, we investigated whether step activity measurements correlated with the Harris hip and UCLA scores. We prospectively analyzed 37 patients (age ≤ 50) treated with primary THA. Patient activity was recorded with a step activity monitor. Harris hip and UCLA scores were analyzed. Total daily stride counts increased by an average of 30.0%. Increases were noted in the percent of daily time spent at high, moderate and low activity. Increases in daily time spent at high activity moderately correlated with the UCLA activity score but did not correlate with the HHS. Both the UCLA score and the HHS did not correlate with mean daily strides. Following THA, patients ≤ 50 years of age increase their activity by taking more daily strides and improve their activity profile by spending more time at higher activity. Improvements in step activity moderately correlate with improvements in UCLA scores.     

Movement disorders in women: A review

The field of women's health developed based on the recognition that there are important sex‐based differences regarding several aspects of medical illnesses. We performed a literature review to obtain information about differences between women and men for neurological movement disorders. We identified important differences in prevalence, genetics, clinical expression, course, and treatment responses. In addition, we found that female life events, including menstruation, pregnancy, breast feeding, menopause, and medications prescribed to women (such as oral contraceptives and hormone‐replacement therapy), have significant implications for women with movement disorders. Understanding this biological sex‐specific information can help improve the quality and individualization of care for women with movement disorders and may provide insights into neurobiological mechanisms. © 2013 International Parkinson and Movement Disorder Society     

Utilization,Patient Characteristics,and Longitudinal Improvements among Patients from a Provincially Funded Transdiagnostic Internet-delivered Cognitive Behavioural Therapy Program: Observational Study of Trends over 6 Years

Objective:There is strong evidence supporting internet-delivered cognitive behaviour therapy (iCBT) and consequently growing demand for iCBT in Canada. Transdiagnostic iCBT that addresses both depression and anxiety is particularly promising as it represents an efficient method of delivering iCBT in routine care. The Online Therapy Unit, funded by the Saskatchewan government, has been offering transdiagnostic iCBT for depression and anxiety since 2013. In this article, to broadly inform implementation efforts, we examined trends in utilization, patient characteristics, and longitudinal improvements for patients receiving transdiagnostic iCBT over 6 years.Methods:Patients who completed telephone screening between November 2013 and December 2019 were included in this observational study. Patients provided demographics and mental health history at screening and completed measures at pre-treatment, post-treatment and at 3- to 4-month follow-up. Treatment engagement and satisfaction were assessed.Results:A total of 5,321 telephone screenings were completed and 4,283 of patients were accepted for treatment over the 6-year period (80.5% acceptance). The most common reason for referral to another service was high suicide risk/severe symptoms (47.1%). Examination of trends showed growing use of transdiagnostic iCBT over time (37% increase per year). There was remarkable stability in patient characteristics across years. Most patients were concurrently using medication (57.3%) with 11.9% reporting using iCBT while on a waiting list for face-to-face treatment highlighting the importance of integrating iCBT with other services. Consistent across years, large improvements in depression and anxiety symptoms were found and maintained at 3- to 4-month follow-up. There was strong patient engagement with iCBT and positive ratings of treatment experiences.Conclusions:As there is growing interest in iCBT in Canada, this large observational study provides valuable information for those implementing iCBT in terms of likely user characteristics, patterns of use, and improvements. This information has potential to assist with resource allocation and planning in Canada and elsewhere.     

Eating attitudes in urban and suburban adolescents

We administered the Eating Attitudes Test (EAT), Rosenberg Self-Esteem Scale, and Spielberger Trait Anxiety Inventory to two populations of high school students. The first group, 268 suburban females (mean age 16.2 years), completed their questionnaires in May 1988. The second population, 389 females and 281 males (mean age 16.0 years) in a city school with 92% black or Hispanic students, completed their questionnaires in February 1990 and were also measured for height and weight as part of a health screening. Scores of 21 or higher on the EAT-26 were achieved by 17.5% of the suburban females, 15.0% of the urban females, and 6.0% of the urban males. Significantly more suburban females (63%) considered themselves overweight, compared with both urban females (35%) and males (19%), yet only 14% of suburban females were calculated to be >10% over ideal body weight, compared with 45% of urban females and 39% of urban males. Contrary to expectations, self-esteem was higher and anxiety lower in the urban students than the suburban students; self-esteem and anxiety were each significantly correlated with higher EAT scores in both populations, but believing oneself overweight was correlated with higher EAT scores in only the suburban students. These data indicate that abnormal eating attitudes are present among both urban and suburban students but with important differences in their manifestations and implications. © 1994 by John Wiley & Sons, Inc.