Association of fall rate and functional status by APOE genotype in cancer survivors after exercise intervention.

PURPOSE/OBJECTIVES: Cancer treatment survivors often report impaired functioning and increased falls. Not all survivors experience the same symptom burden, suggesting individual susceptibilities. APOE genotype is a potential genetic risk factor for cancer treatment related side effects. Lifestyle factors such as physical activity can mitigate the effect of APOE genotype on measures of clinical interest in individuals without a history of cancer. We tested the hypothesis that APOE genotype influences cancer treatment related side effects and symptoms as well as response to exercise intervention. MATERIALS AND METHODS: Data from a subsample of a study of fall prevention exercise in post-treatment female cancer survivors aged 50-75 years old (https://clinicaltrials.gov NCT01635413) were used to conduct a secondary data analysis. ApoE genotype was determined by serum sampling. Physical functioning, frequency of falls, and symptom burden were assessed using survey instruments. RESULTS: Data from 126 female cancer survivors a median of 49 months out from cancer diagnosis were analyzed. ApoE4 carriers trended toward a higher fall rate at baseline (p = 0.059), but after exercise intervention had a fall rate lower than E4 non-carriers both immediately after structured intervention (p = 0.013) and after 6 months of follow up (p = 0.002). E2 carriers did not show improved measures of depressive symptoms and self-report disability after exercise intervention. E3 homozygotes showed increased self report physical activity after the 6 month exercise intervention, but E4 and E2 carriers did not. CONCLUSIONS: APOE genotype may modulate cancer treatment related side effects and symptoms and response to exercise intervention.

Assessment of Radiation Doses Delivered to Organs at Risk Among Patients With Early-Stage Favorable Hodgkin Lymphoma Treated With Contemporary Radiation Therapy.

Importance: Response-adapted randomized trials have used positron emission tomography-computed tomography to attempt to identify patients with early-stage favorable Hodgkin lymphoma (ESFHL) who could be treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) without radiation therapy (RT). While maximal efficacy is demonstrated with combined modality therapy, RT is often omitted in fear of late adverse effects; however, the application of modern RT could limit these toxic effects. Objective: To determine the radiation doses delivered to organs at risk with modern involved-site RT among patients with ESFHL treated with 20 Gy after 2 cycles of ABVD. Design, Setting, and Participants: This case series included 42 adult patients with ESFHL (according to the German Hodgkin Study Group criteria) who were treated between 2010 and 2019, achieved complete response by positron emission tomography-computed tomography (1-3 on 5-point scale) following 2 cycles of ABVD, and then received consolidative RT. The study was conducted at a single comprehensive cancer center. Exposures: 2 cycles of chemotherapy followed by 20-Gy involved-site RT. Main Outcomes and Measures: The medical records of patients with ESFHL were examined. Organs at risk were contoured, and doses were calculated. Progression-free survival, defined from date of diagnosis to disease progression, relapse, or death, and overall survival were estimated using the Kaplan-Meier method. Results: The cohort comprised 42 patients with ESFHL (median [range] age at diagnosis, 35 [18-74] years; 18 [43%] women; 24 [57%] with stage II disease). At a median follow-up of 44.6 (95% CI, 27.6-61.6) months, the 3-year progression-free survival and overall survival rates were 91.2% (95% CI, 74.9%-97.1%) and 97.0% (95% CI, 80.4%-99.6%), respectively. The mean heart dose was less than 5 Gy (mean, 0.8 Gy; SD, 1.5 Gy; range, 0-4.8 Gy) in all patients. The mean (SD) breast dose for both breasts was 0.1 (0.2) Gy (left breast range, 0-1.0 Gy; right breast range, 0-0.9 Gy). Conclusions and Relevance: In this study, combined modality therapy with 2 cycles of ABVD and 20 Gy for ESFHL was highly effective and avoided excess doses to organs at risk, which may limit long-term toxic effects.

ADVERSE EVENTS ASSOCIATED WITH THERAPEUTIC DRY NEEDLING.

BACKGROUND: There is a paucity of literature about the adverse events associated with Therapeutic Dry Needling (TDN). Much of the literature surrounding adverse events associated with TDN has been extrapolated from the acupuncture literature. Given that acupuncture and TDN are distinctly different in their application and proposed mechanisms, adverse events associated with TDN should be examined specifically. PURPOSE: To determine and report the type of adverse events associated with the utilization of TDN. STUDY DESIGN: Prospective Questionnaire. METHODS: Four hundred and twenty physical therapists participated in this study. Information related to minor and major adverse events that occurred during 20,464 TDN treatment sessions was collected. Each physical therapist respondent was asked to fill out two weekly self-reported electronic surveys over a six-week period. One survey was related to "minor adverse events" (i.e. pain, bleeding, bruising), while the other was related to "major adverse events" (i.e. pneumothorax, excessive bleeding, prolonged aggravation). Following the six-week period, descriptive statistics were used to describe the adverse events (AE) associated with TDN and calculate the frequencies of those events. RESULTS: A total of 7,531 minor AE's were reported, indicating that 36.7% of the reported TDN treatments resulted in a minor AE. The top three minor AE's were bleeding (16%), bruising (7.7%), and pain during dry needling (5.9 %). The average ratio of minor AE's for all respondents across all weeks was 0.53 or approximately one event for every two patients. Twenty major AE's were reported out of the 20,494 treatments for a rate of <0.1% (1 per 1,024 TDN treatments). No associations were noted between the frequency of adverse events and the number of patients treated, practitioner age, level of education, years in practice, level of training or months experience with dry needling. CONCLUSION: Expected minor AE's such as mild bleeding, bruising, and pain during TDN were common and major AE's were rare. Physical therapists and other medical practitioners need to be aware of the risks of TDN. Based on the findings of this study the overall risk of a major adverse event during TDN is small. LEVEL OF EVIDENCE: 3, survey research.

Great toe drop following knee ligament reconstruction: A case report.

Case Description: A 17-year-old male post anterior cruciate ligament reconstruction complained of the inability to extend his great toe immediately following surgery. Background: Neurological injuries following knee arthroscopy have been reported to occur between 0.6%-2.5%. The most commonly injured nerves are the saphenous and common fibular nerve (CFN). Great toe-drop secondary to isolated denervation of the extensor hallucis longus (EHL), has only been reported one time in the literature. This report describes a case of isolated denervation of the EHL following knee cruciate ligament reconstruction. A detailed description of the anatomy of the CFN is reviewed as well as how electroneuromyographic (EMG/NCS) testing can assist in the diagnosis, prognosis, and intervention of this type of injury. Outcomes: EHL paralysis did not functionally limit the patient from participating in a post-surgical rehabilitation regime. The patient successfully completed his ACL reconstruction rehabilitation and was released to return to sporting activities 9 months postsurgery. Twelve months post-surgery, the patient regained full great toe extension and strength. Discussion: It is important to note that physical therapists can identify the need for, refer, and in some instances perform EMG/NCS testing on patients with neuromuscular disorders. Isolated injury of the CFN branch that innervates the EHL is extremely rare. Understanding the anatomy of the CFN and its branches is critical for the physical therapist when performing an examination and interpreting the findings. It is also important to understand the potential causes and management approaches following this type of injury.

Directing the Outcome of CO2 Reduction at Bismuth Cathodes Using Varied Ionic Liquid Promoters.

Ionic liquids (ILs) have been established as effective promoters for the electrocatalytic upconversion of CO2 to various commodity chemicals. Imidazolium ([Im]+) cathode combinations have been reported to selectively catalyze the 2e-/2H+ reduction of CO2 to CO. Recently our laboratory has reported energy-efficient systems for CO production featuring inexpensive bismuth-based cathode materials and ILs comprised of 1,3-dialkylimidazolium cations. As part of our ongoing efforts to understand the factors that drive CO2 reduction at electrode interfaces, we sought to evaluate the catalytic performance of alternative ILs in combination with previously described Bi cathodes. In this work, we demonstrate that protic ionic liquids (PILs) derived from 1,8-diazabicyclo[5.4.0]undec-7-ene (DBU) effectively promote the electrochemical reduction of CO2 to formate (HCOO-) with high selectivity. The use of PILs comprised of the conjugate acid of DBU, [DBU-H]+, efficiently catalyzed the reduction of CO2 to HCOO- (FEFA ≈ 80%) with significant suppression of CO production (FECO ≈ 20%) in either MeCN or MeCN/H2O (95/5) solution. When they were used in combination with [DBU-H]+-based PILs, Bi-based cathodes achieved current densities for CO2 reduction (j tot ≈ 25-45 mA/cm2) that are comparable to or greater than those reported with imidazolium ILs such as [BMIM]PF6. As we demonstrate herein, the selectivity of the 2e- reduction of CO2 toward HCOO- or CO can be dictated through the choice of the IL promoter present in the electrolysis solution, even in cases in which the same electrocatalyst material is studied. These findings highlight the tunability of bismuth/IL systems for the electrochemical reduction of CO2 with high efficiency and rapid kinetics.

Perturbing the Copper(III)-Hydroxide Unit through Ligand Structural Variation.

Two new ligand sets, (pipMe)LH2 and (NO2)LH2 ((pipMe)L = N,N'-bis(2,6-diisopropylphenyl)-1-methylpiperidine-2,6-dicarboxamide, (NO2)L = N,N'-bis(2,6-diisopropyl-4-nitrophenyl)pyridine-2,6-dicarboxamide), are reported which are designed to perturb the overall electronics of the copper(III)-hydroxide core and the resulting effects on the thermodynamics and kinetics of its hydrogen-atom abstraction (HAT) reactions. Bond dissociation energies (BDEs) for the O-H bonds of the corresponding Cu(II)-OH2 complexes were measured that reveal that changes in the redox potential for the Cu(III)/Cu(II) couple are only partially offset by opposite changes in the pKa, leading to modest differences in BDE among the three compounds. The effects of these changes were further probed by evaluating the rates of HAT by the corresponding Cu(III)-hydroxide complexes from substrates with C-H bonds of variable strength. These studies revealed an overarching linear trend in the relationship between the log k (where k is the second-order rate constant) and the ΔH of reaction. Additional subtleties in measured rates arise, however, that are associated with variations in hydrogen-atom abstraction barrier heights and tunneling efficiencies over the temperature range from -80 to -20 °C, as inferred from measured kinetic isotope effects and corresponding electronic-structure-based transition-state theory calculations.

Pushing the Limits of Delta Bonding in Metal-Chromium Complexes with Redox Changes and Metal Swapping.

Into the metalloligand Cr[N(o-(NCH2P((i)Pr)2)C6H4)3] (1, CrL) was inserted a second chromium atom to generate the dichromium complex Cr2L (2), which is a homobimetallic analogue of the known MCrL complexes, where M is manganese (3) or iron (4). The cationic and anionic counterparts, [MCrL](+) and [MCrL](-), respectively, were targeted, and each MCr pair was isolated in at least one other redox state. The solid-state structures of the [MCrL](+,0,-) redox members are essentially the same, with ultrashort metal-metal bonds between 1.96 and 1.74 Å. The formal shortness ratios (r) of these interactions are between 0.84 and 0.74 and are interpreted as triple to quintuple metal-metal bonds with the aid of theory. The trio of (d-d)(10) species [Cr2L](-) (2(red)), MnCrL (3), and [FeCrL](+) (4(ox)) are S = 0 diamagnets. On the basis of M-Cr bond distances and theoretical calculations, the strength of the metal-metal bond across the (d-d)(10) series increases in the order Fe < Mn < Cr. The methylene protons in the ligand are shifted downfield in the (1)H NMR spectra, and the diamagnetic anisotropy of the metal-metal bond was calculated as -3500 × 10(-36), -3900 × 10(-36), and -5800 × 10(-36) m(3) molecule(-1) for 2(red), 3, and 4(ox) respectively. The magnitude of diamagnetic anisotropy is, thus, affected more by bond polarity than by bond order. A comparative vis-NIR study of quintuply bonded 2(red) and 3 revealed a large red shift in the δ(4) → δ(3)δ* transition energy upon swapping from the (Cr2)(2+) to the (MnCr)(3+) core. Complex 2(red) was further investigated by resonance Raman spectroscopy, and a band at 434 cm(-1) was assigned as the Cr-Cr bond vibration. Finally, 4(ox) exhibited a Mössbauer doublet with an isomer shift of 0.18 mm/s that suggests a primarily Fe-based oxidation to Fe(I).

Linkage isomerism in transition-metal complexes of mixed (arylcarboxamido)(arylimino)pyridine ligands.

The synthesis of a series of asymmetric mixed 2,6-disubstituted (arylcarboxamido)(arylimino)pyridine ligands and their coordination chemistry toward a series of divalent first-row transition metals (Cu, Co, and Zn) have been explored. Complexes featuring both anionic N,N',N″-carboxamido and neutral O,N,N'-carboxamide coordination have been prepared and characterized by X-ray crystallography, cyclic voltammetry, and UV-visible and EPR spectroscopy. Specifically, (R)LM(X) (M = Cu; X = Cl(-), OAc(-)) and (R)L(H)MX2 (M = Cu, Co, Zn; X = Cl(-), SbF6(-)) complexes that feature N,N',N″- or O,N,N'-coordination are presented. Base-induced linkage isomerization from O,N,N'-carboxamide to N,N',N″-carboxamido coordination is also confirmed by multiple forms of spectroscopy.

Oxygen-promoted C-H bond activation at palladium.

[Pd(P(Ar)(tBu)2)2] (1, Ar=naphthyl) reacts with molecular oxygen to form Pd(II) hydroxide dimers in which the naphthyl ring is cyclometalated and one equivalent of phosphine per palladium atom is released. This reaction involves the cleavage of both C-H and O-O bonds, two transformations central to catalytic aerobic oxidizations of hydrocarbons. Observations at low temperature suggest the initial formation of a superoxo complex, which then generates a peroxo complex prior to the C-H activation step. A transition state for energetically viable C-H activation across a Pd-peroxo bond was located computationally.

Preparation and properties of a monomeric high-spin Mn(V)-oxo complex.

Oxomanganese(V) species have been implicated in a variety of biological and synthetic processes, including their role as a key reactive center within the oxygen-evolving complex in photosynthesis. Nearly all mononuclear Mn(V)-oxo complexes have tetragonal symmetry, producing low-spin species. A new high-spin Mn(V)-oxo complex that was prepared from a well-characterized oxomanganese(III) complex having trigonal symmetry is now reported. Oxidation experiments with [FeCp(2)](+) were monitored with optical and electron paramagnetic resonance (EPR) spectroscopies and support a high-spin oxomanganese(V) complex formulation. The parallel-mode EPR spectrum has a distinctive S = 1 signal at g = 4.01 with a six-line hyperfine pattern having A(z) = 113 MHz. The presence of an oxo ligand was supported by resonance Raman spectroscopy, which revealed O-isotope-sensitive peaks at 737 and 754 cm(-1) assigned as a Fermi doublet centered at 746 cm(-1)(Δ(18)O = 31 cm(-1)). Mn Kß X-ray emission spectra showed Kß' and Kß(1,3) bands at 6475.92 and 6490.50 eV, respectively, which are characteristic of a high-spin Mn(V) center.

Di-µ-oxido-bis-[(1,4,8,11-tetra-aza-cyclo-tetra-decane-κN,N',N'',N''')dimangan-ese(III,IV)] bis-(tetra-phenyl-borate) chloride acetonitrile disolvate.

The title compound, [Mn(2)O(2)(C(10)H(24)N(4))(2)](C(24)H(20)B)(2)Cl·2CH(3)CN, is a mixed-valent Mn(III)/Mn(IV) oxide-bridged mangan-ese dimer with one chloride and two tetra-phenyl-borate counter-anions. There are two non-coordinated mol-ecules of acetonitrile in the formula unit. A center of inversion is present between the two metal atoms, and, consequently, there is no distinction between Mn(III) and Mn(IV) metal centers. In the Mn(2)O(2) core, the Mn-O distances are 1.817 (3) and 1.821 (3) Å. The cyclam ligand is in the cis configuration. The chloride counter-anion resides on a center of symmetry, whereas the tetra-phenyl-borate counter-anion is in a general position. The cyclam ligand is hydrogen bonded to the acetonitrile as well as to the chloride anion. One of the phenyl rings of the anion and the acetonitrile solvent molecule are each disordered over two sets of sites.

An anionic, tetragonal copper(II) superoxide complex.

Insight into copper-oxygen species proposed as intermediates in oxidation catalysis is provided by the identification of a Cu(II)-superoxide complex supported by a sterically hindered, pyridinedicarboxamide ligand. A tetragonal, end-on superoxide structure is proposed based on DFT calculations and UV-vis, NMR, EPR, and resonance Raman spectroscopy. The complex yields a trans-1,2-peroxodicopper(II) species upon reaction with [(tmpa)Cu(CH(3)CN)]OTf and, unlike other known Cu(II)-superoxide complexes, acts as a base rather than an electrophilic (H-atom abstracting) reagent in reactions with phenols.

Selected Musculoskeletal and Performance Characteristics of Members of a Women's Professional Football Team: Application of a Pre-participation Examination.

BACKGROUND: Although it is common practice to administer pre-participation examinations (PPE) of athletes prior to training, there are no clearly established formats. Elements integral to the PPE fall within the scope of physical therapist practice, and are often categorized as a form of primary prevention for musculoskeletal disorders as defined in the Guide to Physical Therapist Practice. PURPOSE: The purpose of this study is to describe the design and implementation of a PPE for a women's professional (gridiron) football team. The results and findings from this PPE provide one of the first musculoskeletal profiles and information about selected physical characteristics from members of a female professional football team. METHODS: Players from the Kentucky Karma women's football team, a member of the National Women's Football League (NWFA), volunteered to participate in a PPE. Of twenty-five eligible team members, thirteen consented to participate. The PPE consisted of a health history questionnaire, a musculoskeletal screening, and a series of physical performance and agility tests. RESULTS: The players' average (± SD) age, height, weight, body mass index (BMI), and body fat percentage were 29.6 (± 5.6) yrs., 1.66 (± .05) m, 66.8 (± 12.6) kg, 24.1 (± 3.7), and 27.4 (± 6.6) %, respectively. Commonly reported injuries were similar to those reported in men's collegiate football. CONCLUSION: This is one of the first papers to report on a model PPE for a women's professional football team. Future research is needed to establish a standard PPE, recognize common injuries, and develop prevention strategies unique to women's professional football.

Efficacy and safety of mu-opioid antagonists in the treatment of opioid-induced bowel dysfunction: systematic review and meta-analysis of randomized controlled trials.

CONTEXT: Opioid-induced bowel dysfunction (OBD) is characterized by constipation, incomplete evacuation, bloating, and increased gastric reflux. OBD occurs both acutely and chronically, in multiple disease states, resulting in increased morbidity and reduced quality of life. OBJECTIVE: To compare the efficacy and safety of traditional and peripherally active opioid antagonists vs conventional interventions for OBD. DESIGN: We searched MEDLINE, the Cochrane Central Register of Controlled Trials and EMBASE. Additional reports were identified from the reference lists of retrieved articles. STUDY SELECTION: Studies were included if they were randomized controlled trials that investigated the efficacy of mu-opioid antagonists for OBD. DATA EXTRACTION: Data were extracted by two independent investigators and included demographic variables, diagnoses, interventions, efficacy, and adverse events. RESULTS OF DATA SYNTHESIS: Twenty-two articles met inclusion criteria and provided data on 2,352 opioid antagonist-treated patients. The opioid antagonist investigated was alvimopan (eight studies), methylnaltrexone (six), naloxone (seven), and nalbuphine (one). Meta-analysis demonstrated that methylnaltrexone and alvimopan are efficacious in reversing opioid-induced increased gastrointestinal transit time and constipation, and that alvimopan is safe and efficacious in treating postoperative ileus. The incidence of adverse events with opioid antagonists was similar to placebo and generally reported as mild-to-moderate. CONCLUSIONS: Insufficient evidence exists for the safety or efficacy of naloxone or nalbuphine in the treatment of OBD. Long-term efficacy and safety of any of the opioid antagonists is unknown, as is the incidence or nature of rare adverse events. Alvimopan and methylnaltrexone both show promise in treating OBD, but further data will be required to fully assess their place in therapy.

Determining the minimal number of cyclic passive stretch repetitions recommended for an acute increase in an indirect measure of hamstring length.

The purpose of this study was to determine the minimal number of cyclic passive stretch repetitions required to induce an acute increase in hamstring length via an indirect measure of hamstring length. Eighteen healthy males (aged 19-37 years) were placed in a standardized position. Knee flexion range of motion (ROM) measurements were recorded following ten 15-second passive stretch repetitions. Analysis of variance measures (p < 0.05) and post hoc analysis showed that significant increases in knee extension ROM diminished at the fifth stretch repetition. The greatest single increase in knee extension ROM occurred after the first stretch. The results of this study indicate that passive stretching beyond five repetitions results in insignificant gains in hamstring length (measured via knee extension ROM) and are probably unnecessary.

Data sharing - a case of shared databases and community use of on-line GIS support systems.

Data management is becoming increasingly simple and complex at the same time. The challenge is to effectively use the increasing number of tools available to manage increasing amounts of environmental information for purposes of data capture, analysis, display, sharing and storage. Government is no longer the main collector and provider of data. Community groups possess vast amounts of data collected through daily work of monitoring the environment in their local community. The chief concerns are data access, sharing, integrity and comparability. The capacity of groups to sustain data management is the key to making the sharing possible. The Southeast Environmental Association has been working with Environment Canada to develop a community, on-line database that will be linked to other geo-spatial data sets to allow instant access to geo-referenced data.

Revocation of tax-exempt status, excise taxes, and other intermediate sanctions issues, plus income taxes: how the rules have changed after Caracci v. Commissioner.

This Article discusses Caracci v. Commissioner, in which the Tax Court imposed intermediate sanctions based on its finding that insiders caused three applicable tax-exempt organizations to sell assets to three for-profit entities owned and controlled by those same insiders. It explores the standards enumerated in Caracci, hypothesizes as to the pending appeal, and examines the guidance given by the decision's clarification of the intermediate sanctions provisions of the Internal Revenue Code.