Conservative management of De Quervain's tendinopathy with an orthopedic manual physical therapy approach emphasizing first CMC manipulation: a retrospective case series.

De Quervain's tendinopathy (DQT) is a musculoskeletal disorder that limits hand function of affected individuals. Management of DQT can include splinting, activity modification, medications, corticosteroid injections, physical therapist management, and surgery. There is limited evidence to support the combination of manual therapy and exercise interventions within an Orthopedic Manual Physical Therapy (OMPT) approach when managing patients with DQT. Three patients identified with DQT underwent a multi-modal treatment regimen including carpometacarpal (CMC) thrust and non-thrust manipulation, end range radiocarpal mobilization, mobilization with movement (MWM), strengthening exercises, and grip proprioception training. Outcomes were assessed using the numeric pain rating scale (NPRS), Jamar hand dynamometer grip strength, and the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire. These measures were administered at baseline and discharge. Each patient demonstrated improvements in all outcome measures and required ten visits or less to reach a satisfactory outcome. The NPRS improved by a mean of 7.1 points on a 0-10 scale, Quick DASH improved by an average of 37.1%, and grip strength improved by a mean of 27.6 pounds. Each patient was able to return to daily tasks without pain and all improvements were maintained at six month follow-up. An impairment based OMPT management approach was effective in managing three patients with DQT. The inclusion of first CMC manipulation within this multi-modal approach may enhance conservative management of patients with DQT. Because a cause and effect relationship cannot be inferred from a case series, further research is recommended to investigate the efficacy of this management approach.

Fatal bronchial asthma with bilateral lung collapse.

Fatal bronchial asthma is classically characterized in pathology textbooks and journal articles as associated with lung hyperinflation at autopsy. The following is a report of a case of fatal bronchial asthma associated instead with bilateral lung collapse. This manifestation of asthma at autopsy has not been previously reported, to my knowledge. A 31-year-old man with a history of recurrent asthma was found in an unresponsive state in his automobile after a low-speed collision. Medical personnel during the resuscitation noted a decrease in breath sounds bilaterally and some wheezing. There was no escaping air with needle thoracostomies at the outset. Cardiac monitoring demonstrated pulseless electrical activity during most of the 30-minute resuscitation attempt. An autopsy disclosed collapsed lungs bilaterally. Microscopic examination of the lungs disclosed the characteristic histopathologic features of bronchial asthma.

The crystal structure of the cytosolic exopolyphosphatase from Saccharomyces cerevisiae reveals the basis for substrate specificity.

Inorganic long-chain polyphosphate is a ubiquitous linear polymer in biology, consisting of many phosphate moieties linked by phosphoanhydride bonds. It is synthesized by polyphosphate kinase, and metabolised by a number of enzymes, including exo- and endopolyphosphatases. The Saccharomyces cerevisiae gene PPX1 encodes for a 45 kDa, metal-dependent, cytosolic exopolyphosphatase that processively cleaves the terminal phosphate group from the polyphosphate chain, until inorganic pyrophosphate is all that remains. PPX1 belongs to the DHH family of phosphoesterases, which includes: family-2 inorganic pyrophosphatases, found in Gram-positive bacteria; prune, a cyclic AMPase; and RecJ, a single-stranded DNA exonuclease. We describe the high-resolution X-ray structures of yeast PPX1, solved using the multiple isomorphous replacement with anomalous scattering (MIRAS) technique, and its complexes with phosphate (1.6 A), sulphate (1.8 A) and ATP (1.9 A). Yeast PPX1 folds into two domains, and the structures reveal a strong similarity to the family-2 inorganic pyrophosphatases, particularly in the active-site region. A large, extended channel formed at the interface of the N and C-terminal domains is lined with positively charged amino acids and represents a conduit for polyphosphate and the site of phosphate hydrolysis. Structural comparisons with the inorganic pyrophosphatases and analysis of the ligand-bound complexes lead us to propose a hydrolysis mechanism. Finally, we discuss a structural basis for substrate selectivity and processivity.

Heritability of arterial stiffness in black and white American youth and young adults.

BACKGROUND: Our objectives were to examine the heritability of arterial stiffness measured as pulse-wave velocity (PWV), and its dependence on ethnicity, gender, and blood pressure (BP). METHODS: As part of the Georgia Cardiovascular Twin Study, we measured aorto-radial (radial) and aorto-dorsalis-pedis (foot) PWV in 702 twins (41% black; 49% male) aged 12 to 30 years (mean age, 17.7 +/- 3.3 years), including monozygotic and dizygotic pairs of the same as well as opposite gender. Ethnicity and gender effects on genetic and environmental contributions to PWV were estimated by genetic model fitting. RESULTS: Diastolic BP was the most important hemodynamic predictor. The best-fitting models showed no ethnicity or gender differences in estimates of genetic and environmental influence, and indicated substantial heritabilities of 0.43 (95% confidence interval, 0.30 to 0.54) and 0.53 (95% confidence interval, 0.42 to 0.62) for radial and foot PWV, respectively. Over a quarter of these heritabilities (0.19 for radial PWV; 0.14 for foot PWV) could be attributed to genes that also influenced diastolic BP, as based on multivariate models. CONCLUSIONS: Individual differences in the arterial stiffness of youth and young adults are substantially heritable, and >25% of this heritability is explained by genes that also influence diastolic BP. Heritability estimates do not show any differences between blacks and whites or males and females.

The Richard Cory phenomenon: suicide and wealth in Kansas City, Missouri.

This case-control study investigates the relationship between suicide and wealth in Kansas City, Missouri. House and personal property appraisal data on all victims of suicide from 1998 and 2002 and victims from a control population of deaths reported to the Jackson County Medical Examiner during the same time interval were obtained from the Jackson County Government website. The controls were matched to suicide cases by race, gender, year of death, and age at death (+/- 1 year). Data from the 426 members of each group of suicides and controls indicate that suicide victims were: 1) 77% more likely than controls to have lived in houses rather than in apartments or trailers, 2) more likely than controls to have lived in more expensive houses (mean values dollar 70,143 versus dolllar 61,513 respectively, p = 0.04) and 3) more likely to have killed themselves because of factors other than financial strain (8.0% of suicides showed financial strain).

A case of tricuspid atresia with normally related great vessels and coarctation of the aorta.

Tricuspid atresia is a congenital cardiac anomaly that is most commonly associated with normally related great vessels and less commonly with transposition of the great vessels. When tricuspid atresia is associated with dextro-transposition of the great vessels, there is a high incidence of coarctation of the aorta. This report documents the rare case of a newborn male with tricuspid atresia and normally related great arteries with both pulmonary stenosis and coarctation of the aorta.

Diverse challenges in pediatric compounding: treating pulmonary hypertension, uncombable hair syndrome, and acanthamoeba keratitis.

The market for commercially manufactured drugs for pediatric patients is smaller than that for adults, and most of the medications currently used to treat children, including many over-the-counter products, have not been clinically studied in the pediatric population. Thus a customized medication that is formulated to meet the unique needs of the pediatric patient and that can be quickly adjusted to more effectively address a child's changing medical needs can be essential to a successful therapeutic outcome. Compounding pharmacists are often faced with the demand for a novel pediatric preparation that overcomes the patient's taste aversions or resistance to a particular dosage form, and successful treatment can depend on the compounder's problem-solving skills and therapeutic innovation. In this article, we describe the effective treatment of three children whose medical needs were unmet by manufactured medications. The formulations for the preparations used are also provided.

pH-regulated expression of the acid and alkaline extracellular proteases of Yarrowia lipolytica.

The pH-regulated expression of the acid (AXP) and alkaline (AEP) extracellular proteases of the yeast Yarrowia lipolytica 148 was analysed. Expression in batch and continuous cultures was determined at the mRNA level by Northern blotting, and at the enzyme level by enzyme assays and Western blotting. Culture pH regulated AEP and AXP expression predominantly at the level of mRNA content. Highest levels of AEP mRNA were detected at pH 6.5 whereas highest levels of AXP mRNA were detected at pH 5.5. At pH values either side of these maxima AEP and AXP expression were progressively down-regulated. For both enzymes, the variation in mRNA levels with culture pH occurred progressively rather than by discrete steps. AXP expression did not occur above pH 7.0. Some degree of AEP expression occurred at all pH values tested in two unrelated strains of Y. lipolytica.