Tendinopathy: a review of the pathophysiology and evidence for treatment.

The understanding of tendinopathy has evolved over the past several decades. Initially thought to be a primarily inflammatory process, histologic evaluation has revealed that there is an absence of inflammatory cells, and rather, tendinopathy is more of a degenerative process. Various types of medications, rehabilitation, modalities, injections, and minimally invasive procedures have been described as treatment for this condition. The purpose of our article is to describe the pathophysiology of tendinopathy as currently understood and the evidence for the various available treatments. We performed a literature search to determine the types of reviews that have been performed previously regarding treatment for tendinopathy, and summarized these reviews. We then performed a systematic review of randomized controlled trials for treating patients with tendinopathy. It is our hope that our review of trial data will help providers to determine optimal management for their patients with tendinopathy.

Femoral Neck Stress Fractures and Imaging Features of Femoroacetabular Impingement.

BACKGROUND: Prior literature has suggested an association between the radiographic signs of femoroacetabular impingement (FAI) and femoral neck stress fractures (FNSF) or femoral neck stress reactions (FNSR). At the time of the writing of this article, no study has described the association of FAI and FNSF/FNSR along with the need for surgical intervention and outcomes. OBJECTIVE: To determine the prevalence of radiographic features of FAI in patients diagnosed with FNSF. DESIGN: Retrospective case series. SETTING: Tertiary care, institutional setting. PATIENTS: A medical records search program (Stanford Translational Research Integrated Database Environment, Stanford University, California) was used to retrospectively search for patients 18-40 years old with a history of FNSF or FNSR. The records were obtained from the period July 25, 2003, to September 23, 2011. METHODS: For assessment of risk factors, plain radiographs and magnetic resonance imaging studies were reviewed for features of cam or pincer FAI. Medical records were reviewed to determine whether patients required operative intervention. MAIN OUTCOME MEASURES: Incidence of abnormal alpha (α) angle, abnormal anterior offset ratio, abnormal femoral head-neck junction, coxa profunda, positive crossover sign, and abnormal lateral center-to-edge angle. RESULTS: Twenty-one female and 3 male participants (mean age 27 years, range 19-39 years) were identified with magnetic resonance imaging evidence of femoral neck stress injury. Cam morphology was seen in 10 patients (42%). Pincer morphology could be assessed in 18 patients, with coxa profunda in 14 (78%) and acetabular retroversion in 6 (14%). Features of combined pincer and cam impingement were observed in 4 patients (17%). Seven patients (29%) had operative intervention, with 3 (12%) requiring internal fixation of their femoral neck fractures, and all had radiographic evidence of fracture union after surgery. Four patients (17%) had persistent symptoms after healing of their FNSF with conservative treatment and eventually required surgery for FAI, 3 had no pain at final follow-up 1 year post-surgery, and one patient was lost to follow-up. CONCLUSION: The results of the current study suggest that patients in the general population with femoral neck stress injuries have a higher incidence of bony abnormalities associated with pincer impingement, including coxa profunda and acetabular retroversion, although it is unclear whether pincer FAI is a true risk factor in the development of FNSF.

Noninvasive diagnosis of dysfunctions in patients after organ transplantation by monitoring the redox potential of blood serum.

BACKGROUND: The problem of noninvasive diagnosis of transplant dysfunction in patients is one of the most complex problems in transplantology at the present time. Because transplanted organs can be ischemic, the measurement of redox potential (RP) in blood serum reflects the prooxidant-antioxidant balance in the organism. It was hypothesized that certain dysfunctions and postoperative complications in transplant patients may be accompanied by a change in the RP of blood plasma. METHODS: Monitoring of the RP in the blood serum of patients was performed as a noninvasive method of diagnosis of transplant dysfunctions. The RP values were measured in blood serum of 63 apparently healthy subjects. Monitoring of blood serum RP was performed in 64 liver transplant patients, 59 kidney allotransplantation patients and six lung transplant patients. A total of 1,759 measurements were performed in 192 total subjects. Statistical analysis of RP values was performed using the Statistica 6.0 software package. RESULTS AND CONCLUSION: The proposed method is based on the electrochemical measurement of the open-circuit potential of the platinum electrode immersed in blood serum because the measured value reflects the state of equilibrium between prooxidant and antioxidant systems of the organism. Shifts in values of the RPs (open circuit potentials) observed in the course of monitoring are significantly different in patients with transplant dysfunction compared to patients with unremarkable recoveries. The analysis of monitoring allows for the development of certain diagnostic and prognostic criteria of transplant dysfunction. It is important that the proposed method is noninvasive, simple, and inexpensive.

Determinants of physical activity in America: a first characterization of physical activity profile using the National Health and Nutrition Examination Survey (NHANES).

OBJECTIVES: To develop and implement methodologies for characterizing accelerometry-derived patterns of physical activity (PA) in the United States in relation to demographics, anthropometrics, behaviors, and comorbidities using the National Health and Nutrition Examination Survey (NHANES) dataset. DESIGN: Retrospective analysis of nationally representative database. SETTING: Computer-generated modeling in silico. PARTICIPANTS: A total of 6329 adults in the United States from the NHANES 2003-2004 database. METHODS: To discover subtle multivariate signal in the dynamic and noisy accelerometry data, we developed a novel approach, termed discretized multiple adaptive regression and implemented the algorithm in SAS 9.2 (SAS Institute, Cary, NC). MAIN OUTCOME MEASUREMENTS: Demographic, anthropometric, comorbidity, and behavioral variables. RESULTS: The intensity of PA decreased with both increased age and increased body mass index. Both greater education and greater income correlate with increased activity over short durations and reduced activity intensity over long durations. Numerous predictors demonstrated effects within activity ranges that may be masked by use of the standard activity intensity intervals. These include age, one of the most robust variables, where we discovered decreasing activities inside the moderate activity range. It also includes gender, where women compared with men have increased proportions of active times up to the center of light activity range, and income greater than $45,000, where a complex effect is seen with little correspondence to existing cut-points. CONCLUSIONS: The results presented in this study suggest that the method of multiple regression and heat map visualization can generate insights otherwise hidden in large datasets such as NHANES. A review of the provided heat maps reveals the trends discussed previously involving demographic, anthropometric, comorbidity, and behavioral variables. It also demonstrates the power of accelerometry to expose alterations in PA. Ultimately, this study provides a US population-based norm to use in future studies of PA.