Effects of dietary calcium fructoborate supplementation on joint comfort and flexibility and serum inflammatory markers in dogs with osteoarthritis.

Our objective was to evaluate the short-term effects of calcium fructoborate (CFB) on gait, joint range of motion, serum inflammatory markers, and owner perception of pain in client-owned dogs. We used 59 osteoarthritic dogs with impairment, with dogs being randomly assigned to 4 treatments: placebo (60 mg fructose; = 15), low dose (69 mg CFB; = 14), high dose (127 mg CFB; = 14), or combination (69 mg CFB, 500 mg glucosamine hydrochloride and 200 mg chondroitin sulfate; = 16). Dogs up to 22.9 kg received 1 capsule/d, while dogs weighing 23 to 50 kg received 2 capsules/d. A physical examination, radiographs, goniometry measurements, gait analysis, blood sample collection, and a canine brief pain inventory questionnaire were performed on d 0 and 28. Change from baseline values were statistically analyzed among groups. After 28 d, dogs fed the low and high doses had an improved ( < 0.05) ability to rise from a lying position compared to placebo. Dogs fed the high dose also had a greater ( = 0.05) increase in soluble receptor for advanced glycation end products concentration than dogs fed the placebo. Sub-analysis of only large dogs (> 23 kg) showed that dogs fed the low dose had decreased ( < 0.05) pain severity score and pain at its worst compared to dogs fed the placebo. Large dogs fed the low dose also were shown to improve ( < 0.05) in their ability to rise from a lying position compared to dogs fed the placebo. Overall, CFB supplementation was well-tolerated and may aid in mitigating joint discomfort in dogs.

A challenging case of limb salvage requiring a combination of composite fixation and masquelet technique to address significant segmental bone loss.

Cases of limb salvage following skeletal trauma involving significant bone loss pose a particular challenge to the reconstructive surgeon. Certain techniques for addressing this complex issue have been advanced in recent years and have met with considerable success. The Masquelet technique involves a staged procedure in which a temporary skeletal stabilization is paired with implantation of an antibiotic spacer and left in place for 6-8 weeks, during which time a "pseudomembrane" forms around the cement spacer. During the second stage of the procedure, the pseudomembrane is incised, the antibiotic spacer removed, and bone graft is placed. We present a case of significant segmental femur loss in a 19-year-old male opting for limb salvage in which a 17-centimeter segmental loss of bone was essentially regrown using a combination of the Masquelet technique with supplemental endosteal fixation.

Tumours with elevated levels of the Notch and Wnt pathways exhibit efficacy to PF-03084014, a γ-secretase inhibitor, in a preclinical colorectal explant model.

BACKGROUND: Dysregulation of the Notch pathway has been identified to play an important role in the development and progression of colorectal cancer (CRC). In this study, we used a patient-derived CRC explant model to investigate the efficacy of the clinical γ-secretase inhibitor (GSI) PF-03084014. METHODS: A total of 16 CRC explants were treated with PF-03084014. Knockdown of RBPjκ gene was used to determine the specificity of PF-03084014. Evaluation of the Notch and Wnt pathways in CRC explant tumours was performed by gene array and immunoblotting. RESULTS: We identified a subset of CRC tumours that exhibited elevations of the Notch and Wnt pathways sensitive to PF-03084014. Treatment with the GSI resulted in a significant reduction in cleaved Notch, Axin2 (Wnt-dependent gene) and active ß-catenin. In addition, knockdown of the RBPjκ gene showed that PF-03084014 has specificity for the Notch pathway in an HCT116 cell line xenograft model. Finally, an increase in apoptosis was observed in CRC001- and CRC021-sensitive tumours. CONCLUSION: This study provides evidence that inhibition of γ-secretase may be beneficial in a subset of patients with elevated levels of the Wnt and Notch pathways.

Third molar-related morbidity in deployed Service personnel.

INTRODUCTION: The minimisation of disease and non-battle injury (DNBI) is essential for maintaining efficiency in a fighting force. Third molar-related morbidity is a common cause of DNBI. With extended lines of communication in current military deployments, travelling for dental care is often subject to significant danger. MATERIAL AND METHODS: Military dental officers in Afghanistan and Iraq recorded data on patients presenting with third molar pathology. Related previous history was obtained from the individual and from the military dental records. RESULTS: Three hundred and three individuals presented during the 23 month study period; 27.7% were unable to access care immediately, most commonly citing work pressure or lack of safe transport. Of those needing to travel, 70% were moved by helicopter. Pericoronitis was diagnosed in 84.4% of cases, 20.6% of these teeth being extracted; 53.5% of patients reported no prior symptoms, 22.7% with two or more episodes. There was documented evidence in military dental records of previous problems in 29.2% of cases. 11.3% had previously been listed for extraction of the presenting tooth. DISCUSSION: Dental treatment for troops in combat situations is fraught with difficulty. Special consideration must be given to the management of third molars in military personnel.

Using surface force apparatus, diffusion and velocimetry to measure slip lengths.

Determining the slip lengths for liquids flowing close to smooth walls is challenging. The reason lies in the fact that the scales that must be addressed range between a few and hundreds of nanometres. Several techniques have been used over the last few years. Here, we consider three of them based on surface force apparatus, diffusion and velocimetry, respectively. The descriptions offered here incorporate recent instrumental progress made in the field.

Emergent headaches during pregnancy: correlation between neurologic examination and neuroimaging.

BACKGROUND AND PURPOSE: Emergent evaluation of the pregnant headache patient requires rational selection of acute neuroimaging studies, yet guidelines do not exist. We investigated the demographic and clinical features that are predictive of intracranial pathologic lesions on neuroimaging studies in pregnant women with emergent headaches. MATERIALS AND METHODS: We conducted a retrospective review of demographic factors, clinical features, and radiologic findings in a consecutive case series of 63 pregnant women emergently evaluated with a chief complaint of headache, including those with previous headache histories. Clinical data were abstracted from emergency department records, hospital course, and discharge summaries. Multivariate logistic regression analysis examined predictors of intracranial pathologic lesions on emergent neuroimaging studies. RESULTS: Multiparous African American women constituted 63% of the case subjects. Headaches were frequently accompanied by photophobia (59%), nausea (52%), vomiting (37%), and occasionally with fever (11%), meningismus (9%), or seizures (7%). A total of 43% of case subjects had abnormal neurologic examination findings. Emergent neuroimaging, including noncontrast head CT and MR imaging, revealed an underlying headache etiology in 27%, including cerebral venous thrombosis, reversible posterior leukoencephalopathy, pseudotumor, and intracranial hemorrhage. The odds of having intracranial pathologic lesions on neuroimaging were 2.7 times higher in patients with abnormal results on neurologic examination (P=.085). CONCLUSIONS: Emergent neuroimaging studies may reveal an underlying headache etiology in 27% of pregnant women. Further research with a larger sample size is needed to determine what clinical factors are predictive of a pathologic condition on neuroimaging studies.

Expression of small heat shock-related protein 20 (HSP20) in rat myometrium is markedly decreased during late pregnancy and labour.

The underlying mechanisms regulating uterine contractions during labour are still poorly understood. Heat shock protein 20 (HSP20) is known to be present at high levels in smooth muscle and implicated in muscle relaxation, but HSP20 expression in the myometrium is completely undetermined. Since HSP20 has been implicated in smooth muscle relaxation, we hypothesized that HSP20 would be highly expressed in the rat myometrium during early and mid-pregnancy when the myometrium is relatively quiescent. Northern blot analysis particularly demonstrated that HSP20 mRNA detection was significantly decreased from day (d) 22 of pregnancy to 1-day post-partum (PP) compared with d6 (P < 0.05). HSP20 mRNA detection was also significantly decreased from d22 to d23 of gestation compared with non-pregnant (NP) samples. Immunoblot analysis showed that detection of HSP20 was significantly decreased at d23 compared with d12 and d15 (P < 0.05). HSP20 detection also significantly decreased at PP compared with d15 (P < 0.05). Immunofluorescence analysis demonstrated that after d15, plasma membrane-associated localization of HSP20 decreased markedly in both circular and longitudinal muscle layers. In addition, HSP20 was detectable near cell membranes at much higher levels in the longitudinal muscle layer of progesterone-treated pregnant rats (delayed labour) at all gestational time points examined, compared with controls. Our results demonstrate that HSP20 mRNA and protein are highly expressed during early and mid-pregnancy and then the expression markedly decreases during late pregnancy and labour. The observed patterns of HSP20 expression are consistent with a potential role for HSP20 in facilitating myometrium quiescence during early and mid-pregnancy.

Boundary slip on smooth hydrophobic surfaces: intrinsic effects and possible artifacts.

We report an accurate determination of the hydrodynamic boundary condition of simple liquids flowing on smooth hydrophobic surfaces using a dynamic surface force apparatus equipped with two independent subnanometer resolution sensors. The boundary slip observed is well defined and does not depend on the scale of investigation from one to several hundreds of nanometers, nor on shear rate up to 5 x 10(3)s(-1). The slip length of 20 nm is in good agreement with theory and numerical simulations concerning smooth nonwetting surfaces. These results disagree with previous data in the literature reporting very high boundary slip on similar systems. We discuss possible origins of large slip length on smooth hydrophobic surfaces due to their contamination by hydrophobic particles.

Rheological properties of a highly confined film of a lyotropic lamellar phase.

We investigated the rheological properties of a thin film of a lyotropic lamellar phase with a Dynamic Surface Forces Apparatus. The minimum thickness of the film is varied between one to several tens of layers by confining the materials between solid surfaces. The rheometric properties are measured with the application of a small harmonic compression. These properties depend clearly on the smectic order of the material. Whole mechanical properties may be easily described by taking into account interactions between membranes and motion of the dislocation line loops. In particular, it is shown that at the dynamical frequencies investigated in this study, the solvent flows between membranes which remain undeformed. Consequences and perspectives of this study will be discussed.

Pharmaceutical care for elderly patients shared between community pharmacists and general practitioners: a randomised evaluation. RESPECT (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) [ISRCTN16932128].

BACKGROUND: This trial aims to investigate the effectiveness and cost implications of 'pharmaceutical care' provided by community pharmacists to elderly patients in the community. As the UK government has proposed that by 2004 pharmaceutical care services should extend nationwide, this provides an opportunity to evaluate the effect of pharmaceutical care for the elderly. DESIGN: The trial design is a randomised multiple interrupted time series. We aim to recruit 700 patients from about 20 general practices, each associated with about three community pharmacies, from each of the five Primary Care Trusts in North and East Yorkshire. We shall randomise the five resulting groups of practices, pharmacies and patients to begin pharmaceutical care in five successive phases. All five will act as controls until they receive the intervention in a random sequence. Until they receive training community pharmacists will provide their usual dispensing services and so act as controls. The community pharmacists and general practitioners will receive training in pharmaceutical care for the elderly. Once trained, community pharmacists will meet recruited patients, either in their pharmacies (in a consultation room or dispensary to preserve confidentiality) or at home. They will identify drug-related issues/problems, and design a pharmaceutical care plan in conjunction with both the GP and the patient. They will implement, monitor, and update this plan monthly. The primary outcome measure is the 'Medication Appropriateness Index'. Secondary measures include adverse events, quality of life, and patient knowledge and compliance. We shall also investigate the cost of pharmaceutical care to the NHS, to patients and to society as a whole.

Anticardiolipin antibody associated arterial thrombosis following fibula fracture.

A case is described of a 20-year-old college student in whom open reduction and internal fixation of a Weber B fibula fracture was complicated by arterial thrombosis and gangrene of the foot. The patient subsequently required a below-knee amputation. A hypercoagulability workup revealed the presence of an anticardiolipin antibody. Although this is an extremely unusual complication, young female patients with a positive personal or family history of early thrombotic events, such as DVT, multiple pregnancy loss, or early myocardial infarction, should be viewed as being at increased risk. Additional risk factors such as oral contraceptive use, should be sought during the initial history.

Is arrhythmia detection by automatic external defibrillator accurate for children?: sensitivity and specificity of an automatic external defibrillator algorithm in 696 pediatric arrhythmias.

BACKGROUND: Use of automatic external defibrillators (AEDs) in children aged <8 years is not recommended. The purpose of this study was to develop an ECG database of shockable and nonshockable rhythms from a broad age range of pediatric patients and to test the accuracy of the Agilent Heartstream FR2 Patient Analysis System for sensitivity and specificity. METHODS AND RESULTS: Children aged

Auditory integration training for children with autism: no behavioral benefits detected.

Auditory integration training and a control treatment were provided for 16 children with autism in a crossover experimental design. Measures, blind to treatment order, included parent and teacher ratings of behavior, direct observational recordings, IQ, language, and social/adaptive tests. Significant differences tended to show that the control condition was superior on parent-rated measures of hyperactivity and on direct observational measures of ear-occlusion. No differences were detected on teacher-rated measures. Children's IQs and language comprehension did not increase, but adaptive/social behavior scores and expressive language quotients decreased. The majority of parents (56%) were unable to report in retrospect when their child had received auditory integration training. No individual child was identified as benefiting clinically or educationally from the treatment.

A fast responding intra-arterial pH electrode for use in the peripheral artery of adult humans and large mammals: a technical development for use in research.

A rapidly responding intra-arterial pH electrode has been developed to provide a continuous record of arterial pH (pHa) in the radial artery of adult humans and large mammals. The current method for measuring pHa is discontinuous and is achieved by taking blood samples and subsequently measuring pHa in a blood gas analyser. The development of an intravascular electrode is needed for studies on the chemical control of pulmonary ventilation when a continuous record of pHa is required. It will be particularly useful in rapidly changing circumstances such as at the onset and termination of exercise and at sleep onset and arousal. The sensor of the electrode system described here consists of a pH sensitive plastic membrane adherent to the tip of a catheter. This catheter is threaded down a radial artery catheter and protrudes 2-3 mm into the arterial lumen. The electrode system has been used in patients in an intensive care unit and in patients undergoing sleep studies. No adverse complications have occurred. The records obtained showed that arterial pH faithfully followed changes in pulmonary ventilation.

Aortic pH oscillations in conscious humans and anaesthetised cats and rabbits.

Respiratory oscillations in arterial blood gas composition influence breathing in cats and dogs. Their role in the control of breathing in humans in less certain. To determine whether oscillations are very small or absent in mammals who are large or breathe fast, aortic pH oscillations, recorded with a tridodecylamine based hydrogen-ion selective electrode, were compared in humans (n = 13), cats (n = 7) and rabbits (n = 4) over a wide range of ventilation. For comparison, data were analysed in terms of the ratio of tidal volume to functional residual capacity (VT/FRC). During spontaneous breathing in rabbits, cats and humans (mean respiratory frequency fR = 61, 20.4 and and 17.5 min-1), mean VT/FRC were 1.35, 0.63 and 0.36 respectively. Corresponding pH amplitudes (pHamp) of 0.009 (0.004), 0.016 and 0.013 (0.005) pH units (mean +/- 1SD) were not significantly different. The pHamp decreased exponentially with increasing FR in each species and pHamp increased linearly with increasing VT in the 3 cats in which this was studied. The study confirms the dependence of pHamp on FR and VT and its comparability among species despite differences in body size. It also demonstrates that oscillations can be recorded in humans at FR in excess of 20 min-1.

Structural alteration of tonometer tips after repeated swabbing with disinfectants.

Our study was developed to measure the effect of swabbing on the integrity of Haag-Streit tonometer tips over time. The following solutions were used: hydrogen peroxide, dilute bleach, alcohol, phenol-phenate, and distilled water (as a control). The results show that swabbing causes surface scratching of tonometer tips after 1 year. The results also show that alcohol swabbing will lead to breakdown of the glue and warrant replacement of the tonometer tip after 2 years use.

Wound seeding associated with endometrial cancer.

We report a patient with well-differentiated adenocarcinoma of the endometrium who developed a recurrence in the anterior abdominal wall probably secondary to wound seeding at the time of her original surgery. She underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy. She then received 15 mCi of 32P for positive peritoneal washings. She was free of disease until 2 years later when a large lower incision mass developed. She had no evidence for intra-abdominal disease and a radical resection with a myocutaneous flap was undertaken. Radical resection for isolated metastases may be of benefit for patients with endometrial cancer. Patients with positive cytology should be observed closely for incisional recurrence.