Urinary CTX-II concentrations are elevated and associated with knee pain and function in subjects with ACL reconstruction.

OBJECTIVE: Post-traumatic knee osteoarthritis (OA) is prevalent after anterior cruciate ligament reconstruction (ACLR). Biomarkers that identify individuals likely to develop OA, especially symptomatic OA, can help target preventative and therapeutic strategies. This study examined the magnitude and change over time in urinary CTX-II (uCTX-II) concentrations shortly after ACL reconstruction, and, secondarily, the associations with knee pain and function. DESIGN: Subjects were 28 patients with ACLR and 28 age- and sex-matched controls (CNTRL). Testing was conducted at four time points spaced 4 weeks apart (4, 8, 12 and 16 weeks post-operative in ACLR). Measures included demographics, urine samples, Numeric Pain Rating Scale (NPRS) and International Knee Documentation Committee Subjective Knee Form (IKDC-SKF). uCTX-II concentrations were determined with competitive enzyme-linked immunosorbent assay (ELISA). uCTX-II concentrations at each time point in ACLR were compared to the mean concentration over time in CNTRL, with and without adjustment for body mass index (BMI). Changes over time in each measure and correlations between the slopes of change were examined. RESULTS: uCTX-II concentrations were significantly higher in ACLR than CNTRL through 16 weeks post-operative when adjusted for BMI. In ACLR, uCTX-II concentrations significantly decreased over time, and the slope was associated with NPRS (r = 0.406, P = 0.039) and IKDC-SKF (r = -0.402, P = 0.034) slopes. CONCLUSION: uCTX-II concentrations shortly after ACLR were elevated compared to CNTRL and declined over time. Decreasing uCTX-II concentrations were associated with decreasing knee pain and improving function. uCTX-II may have a role as a prognostic marker following ACLR and warrants further investigation.

PP069. The expressions of B7-H1 and B7-H4 co-stimulatory molecules on myeloid and lymphoid dendritic cells in pre-eclampsia and normal pregnancy. The expressions of B7-H1 and B7-H4 co-stimulatory moleculeson myeloid and lymphoid dendritic cells in pre-eclampsia and normal pregnancy.

INTRODUCTION: Pre-eclampsia (PE) is a common obstetric syndrome affecting about 5-10% of pregnant women. The syndrome is a leading cause of maternal and fetal morbidity and mortality, even in developed world. The etiology and pathogenesis of this syndrome are not fully understood. There are many studies describing alterations in the innate and adaptive immune system which may have an influence on the onset of this disorder. It was suggested that activation of cell-mediated immunity may play the key role in the etiology of pre-eclampsia. OBJECTIVES: The purpose of our study was to estimate the expressions of B7-H1 and B7-H4 costimulatory molecules on myeloid and lymphoid DCs (CD1c(+), BDCA-2(+)) in the peripheral blood of patients with pre-eclampsia and normal pregnant women in the third trimesters of physiological pregnancy. METHODS: Thirty three patients with pre-eclampsia and 26 normal pregnant women were included in the study. Dendritic cells were isolated from peripheral blood, stained with monoclonal antibodies against blood dendritic cell antigens and B7-H1 and B7-H4 molecules and estimated using flow cytometry. RESULTS: The expressions of B7-H1 molecule on CD1c(+) myeloid DCs and B7-H4 molecule on BDCA-2(+) lymphoid DCs did not differ in pre-eclampsia and healthy third trimester pregnant women. The expressions of B7-H4 molecule on CD1c(+) myeloid DCs and B7-H1 molecule on BDCA-2(+) lymphoid DCs were significantly higher in peripheral blood of patients with pre-eclampsia in comparison with the control group. CONCLUSION: It seems possible that higher expressions of B7-H4 molecule on CD1c(+) myeloid DCs and B7-H1 molecule on lymphoid BDCA-2(+) DCs in pre-eclampsia may be the tolerogenic mechanism secondary to the pro-inflammatory response which is observed in this syndrome.

Intertask comparison of frontal plane knee position and moment in female athletes during three distinct movement tasks.

Gender differences in dynamic frontal plane knee posture during functional tasks contribute to increased anterior cruciate ligament injury risk in female athletes. Many tasks have been used to assess frontal plane movement patterns, but few studies compare patterns across tasks or evaluate the influence of static alignment on dynamic postures. The purpose of our study was to (1) establish the intertask differences in frontal plane knee posture during step down, single leg land, and drop vertical jump tasks; (2) determine intra-athlete correlations in knee posture across tasks; and (3) investigate the intra-athlete correlations between frontal plane knee posture while standing and during movement. Thirty-seven female athletes from high demand sports participated in a motion analysis assessment. Substantial differences in the frontal plane knee angles and moments occurred between tasks. However, there were strong relationships in frontal plane knee angles (r=0.72-0.76) and moderate to good relationships in knee moments across tasks (r=0.426-0.627). No relationship existed between the standing and dynamic knee abduction angles (r<0.06). Female athletes who demonstrate at-risk knee position and loading are likely to do so across tasks. The lack of relationship between static and dynamic frontal plane knee posture suggests that neuromuscular mechanisms contribute to the consistency in movement patterns across tasks.

Dynamic postural control but not mechanical stability differs among those with and without chronic ankle instability.

The purpose of this investigation was to compare dynamic postural control and mechanical ankle stability among patients with and without chronic ankle instability (CAI) and controls. Seventy-two subjects were divided equally into three groups: uninjured controls, people with previous ankle injury but without CAI, and people with CAI. Subjects completed a single-leg hop-stabilization task, and then had an anterior drawer test and lateral ankle radiograph performed bilaterally. The dynamic postural stability index was calculated from the ground reaction forces of the single-leg hop-stabilization task. Ankle joint stiffness (N/m) was measured with an instrumented arthrometer during the anterior drawer test, and fibula position was assessed from the radiographic image. Patients with previous ankle injuries but without CAI demonstrated higher frontal plane dynamic postural stability scores than both the uninjured control and CAI groups (P<0.01). Patients with and without CAI had significantly higher sagittal plane dynamic postural stability scores (P<0.01) and increased ankle joint stiffness (P=0.045) relative to the control group. The increased frontal plane dynamic postural control may represent a component of a coping mechanism that limits recurrent sprains and the development of CAI. Mechanical stability alterations are speculated to result from the initial ankle trauma.

Concentration of TGF-beta1 in the supernatant of peripheral blood mononuclear cells cultures from patients with early disseminated and chronic lyme borreliosis.

PURPOSE: The aberrant inflammatory response is probably involved in the pathogenesis of chronic Lyme borreliosis, including chronic Lyme arthritis and neuroborreliosis. Transforming growth factor-beta 1 (TGF-beta1) is an important anti-inflammatory and immunomodulatory cytokine and its deficient synthesis is linked to exaggerated inflammation and immune response. MATERIAL AND METHODS: Peripheral blood mononuclear cells (PBMC) from 25 patients with Lyme borreliosis and 6 controls were incubated for 7 days with suspension of Borrelia afzeli, B. garinii and B. burgdorferi sensu stricto spirochetes. TGF-beta1 concentration in culture supernatants was measured with ELISA. Results were analyzed according to disease duration (group I--chronic borreliosis, n=20; group II--early borreliosis, n=5) and clinical form (LA--arthritis, NB--neuroborreliosis). RESULTS: TGF-beta1 concentration was increased in supernatants of PBMC cultures of patients with early neuroborreliosis, in comparison with chronic borreliosis and controls. In chronic, but not in early borreliosis, there was a tendency for decrease of TGF-beta1 synthesis under stimulation with B. burgdorferi spirochetes. CONCLUSIONS: Impaired synthesis of TGF-beta1 by mononuclear cells seems to be present in patients with chronic forms of Lyme borreliosis when compared to those with early stage of the disease. It may be a factor contributing to the persistence of inadequate inflammatory response in patients in whom chronic form of the disease develops.

Elucidation of a potentially destabilizing control strategy in ACL deficient non-copers.

PURPOSE: The purpose was to differentiate the dynamic knee stabilization strategies of potential copers (individuals who have the potential to compensate for the absence of an ACL without episodes of giving way after return to pre-injury activities) and non-copers (those who have knee instability following ACL rupture with return to pre-injury activities). METHODS: Twenty subjects with ACL rupture were assigned to potential coper (n=10) and non-coper (n=10) groups via a screening examination. Ten active people without lower extremity injury were also tested. Knee angle, tibial position and muscle activity data were collected while subjects stood in unilateral stance on a platform that moved horizontally in an anterior direction. Analysis included the preparation for platform movement; and monosynaptic, intermediate reflex and voluntary response intervals after platform movement. RESULTS: Non-copers showed greater knee flexion than uninjured subjects, and had a posterior tibial position and altered hamstring recruitment compared to the other groups. Potential copers demonstrated greater medial quadriceps activity while maintaining knee kinematics similar to uninjured subjects. Both potential copers and non-copers had greater co-contraction between medial hamstrings and quadriceps than uninjured subjects. All excitatory muscle activation occurred in the intermediate reflex interval. DISCUSSION AND CONCLUSIONS: Non-copers displayed aberrant muscle recruitment that may contribute to knee instability. Potential copers maintained normal tibial position using a strategy that permits quadriceps activation without excessive anterior tibial translation. Muscle recruitment in the intermediate reflex interval suggests neuromuscular training may influence the strategies.

Evidence for differential control of tibial position in perturbed unilateral stance after acute ACL rupture.

Functional outcomes in anterior cruciate ligament-deficient "potential copers" and "non-copers" may be related to their knee stabilization strategies. Therefore, the purpose of this study was to differentiate dynamic knee stabilization strategies of potential copers and non-copers through analysis of sagittal plane knee angle and tibia position during disturbed and undisturbed unilateral standing. Ten uninjured potential coper and non-coper subjects stood in unilateral stance on a platform that translated anteriorly, posteriorly and laterally. Knee angle and tibia position with reference to the femur were calculated before and after platform movement. During perturbation trials, potential copers maintained kinematics that were similar to uninjured subjects across conditions. Conversely, non-copers stood with greater knee flexion than uninjured subjects and a tibia position that was more posterior than the other groups. Both non-copers and potential copers demonstrated small changes in tibia position following platform movement, but direction of movement was not similar. The similarities between the knee kinematics of potential copers and uninjured subjects suggest that potential copers compensated well from their injury by utilizing analogous dynamic knee stabilization strategies. In comparison to the other groups, by keeping the knee in greater flexion and the tibia in a more posterior position, non-copers appear to constrain the tibia in response to a challenging task, which is consistent with a "stiffening strategy". Based on the poor functional outcomes of non-copers, a stiffening strategy does not lead to dynamic knee stability, and the strategy may increase compressive forces which could contribute to or exacerbate articular cartilage degeneration.

A degeneracy study in the circulant and bordered-circulant approach to birdcage and planar coils.

A method for finding closed-form solutions for the normal mode frequencies of systems with circulant 2pi/2 symmetry was investigated. This method is particularly good for questions of degeneracy that arise when one considers parallel imaging techniques like SENSE and SMASH in MRI. It is applicable to systems that include birdcage coils as well as planar coils with the appropriate rotational symmetry. A proof is given that complete degeneracy of all normal mode frequencies is impossible when all mutual inductive couplings are included. We tested the method against measurements made on a planar coil array and on an 8-element birdcage coil. The inclusion of the co-rotating end-ring mode changes the fundamental symmetry of the system from circulant to "bordered circulant". Closed-form solutions for the normal mode frequencies of a bordered circulant system are also given.

A degeneracy study in the circulant and bordered-circulant approach to birdcage and planar coils.

A method for finding closed-form solutions for the normal mode frequencies of systems with circulant (2 pi/n) symmetry was investigated. This method is particularly useful for questions of degeneracy that arise when one considers parallel imaging techniques like SENSE and SMASH in MRI. It is applicable to systems that include birdcage coils as well as planar coils with the appropriate rotational symmetry. A proof is given that complete degeneracy of all normal mode frequencies is impossible when all mutual inductive couplings are included. We tested the method against measurements made on a planar coil array and on an 8-element birdcage coil. The inclusion of the co-rotating end-ring mode changes the fundamental symmetry of the system from circulant to 'bordered circulant.' Closed-form solutions for the normal mode frequencies of a bordered circulant system are also given.

Dynamic knee stability: current theory and implications for clinicians and scientists.

We will discuss the mechanisms by which dynamic knee stability may be achieved and relate this to issues that interest clinicians and scientists concerned with dynamic knee stability. Emphasis is placed on the neurophysiologic evidence and theory related to neuromuscular control. Specific topics discussed include the ensemble firing of peripheral mechanoreceptors, the potential for muscle stiffness modulation via force and length feedback, postural control synergies, motor programs, and the neural control of gait. Factors related to answering the difficult question of whether or not knee ligament injuries can be prevented during athletic activities are discussed. Prevention programs that train athletes to perform their sport skills in a safe fashion are put forth as the most promising prospect for injury prevention. Methods of assessing neuromuscular function are reviewed critically and the need for future research in this area is emphasized. We conclude with a brief review of the literature regarding neuromuscular training programs.

Biomechanical evidence supporting a differential response to acute ACL injury.

OBJECTIVE: To describe movement patterns in people with complete anterior cruciate ligament rupture objectively identified as good candidates for non-operative management of the injury. DESIGN: Involved side kinematics and kinetics were compared to the uninvolved side and to uninjured subjects. BACKGROUND: High-level athletes with anterior cruciate ligament rupture and poor dynamic stability (non-copers) have movement alterations, including less knee flexion and a decreased internal knee extensor moment during loading response, that are not seen in those with excellent knee stability (copers). Our screening exam can identify people with good rehabilitation potential for non-operative management of anterior cruciate ligament injury (potential copers), but the movement strategies of these individuals are unknown. METHODS: Sagittal plane kinematics and kinetics during the stance phase of walking and jogging were collected from 11 subjects who had an acute anterior cruciate ligament rupture and met the criteria of the screening exam, and were compared to 10 uninjured subjects, who we studied previously. Variables were those in which non-copers differed from uninjured subjects. RESULTS: The potential copers flexed their involved knee less than uninjured subjects and their uninvolved side during walking. Potential copers, compared to uninjured subjects, also had a lower vertical ground reaction force during loading response, a lower knee support moment, and an increased ankle support moment during walking. In jogging, the involved knee angle at initial contact was more extended compared to uninjured subjects, and the amount of knee flexion was less than the uninvolved side. No differences in kinetics were present during jogging. CONCLUSIONS: This study provides evidence that the potential copers identified by the screening examination have movement patterns that are consistent with people who have more knee stability than non-copers. RELEVANCE: Although potential copers have developed some characteristics of a successful stabilization strategy, the presence of kinematic alterations indicates that they may benefit from training programs designed to enhance dynamic knee stability.

First cases of acute human granulocytic ehrlichiosis in Poland.

The first three cases of acute human granulocytic ehrlichiosis in Poland are described. Blood samples were tested by an indirect immunofluorescence method to detect specific serum antibodies, and the polymerase chain reaction was used to detect ehrlichial DNA. Additionally, peripheral blood smears were examined for the presence of morulae. According to criteria of the Centers for Disease Control and Prevention, all three cases can be classified as confirmed granulocytic ehrlichiosis. Using the criteria recommended by a consensus group, however, two cases can be classified as confirmed granulocytic ehrlichiosis and one case as probable granulocytic ehrlichiosis.

[Value of ultrasound in diagnosis of appendicitis]. / Stellenwert der Sonographie bei der Diagnostik der Appendizitis.

The diagnostics of acute appendicitis is also a challenge for a surgeon today. The question of suitable, supplement diagnostics methods is topical. Experience with percutan sonography in the hand of surgeon in one-year-study are demonstrated and possibilities, problems and views should be to show. In skilled hand the sonography is an easy, little burden and helpful method to determinate right lower pain.

The isolation of Borrelia burgdorferi spirochetes from clinical material in cell line cultures.

It has been found that B. burgdorferi bacteria multiply in mouse fibroblasts. Mouse fibroblast of the L-929 cell line was inoculated with less than 10 up to 10(4) B. burgdorferi cells and incubated for 2-10 days at 35 degrees C in microaerophilic conditions. Within 2 days, visible growth was observed. The bacteria were present in growth medium and on/in mouse fibroblasts as revealed by the indirect immunofluorescence assay. At the same time, development of vacuolized fibroblastic giant cells was observed. Viable spirochetes were also detected in Eagle's medium from a L-929 fibroblast cell line culture, after approximately 2-5 days of incubation with blood, cerebro-spinal and synovial fluids of Lyme borreliosis patients. The bacteria were present in growth medium and on/in endothelial cells as revealed by the indirect immunofluorescence assay. The establishment of B. burgdorferi culture conditions in cell lines gives us a possibility to isolate the etiological agent of Lyme disease from patient blood, cerebrospinal and synovial fluids at different stages of infection. The high sensitivity of this procedure would be helpful in a proper identification of the infection as well as in the control of treatment effectiveness.

Epidemics of Q fever in Poland in 1992-1994.

From 1992 till the end of 1994, three epidemics of Q fever among people have been recognised in Poland. In 1992 the outbreak of Q fever was detected at the farm near Jawor in Legnica district. Coxiella burnetii infection was recognized serologically in 25 persons (27 tested). Titres of serum antibodies ranged from 8 to 256. It has been found that cattle were the source of human infection. C. burnetii strain has been isolated from the bull semen. In the same year, Q fever was recognized among 18 workers of the tannery in Myslenice, in Kraków district. Antibodies to C. burnetii, in titres from 8 to 2048, were detected in all 18 persons who had a contract with imported skins of wild animals. Serological tests performed again in 1994 showed that elevated titres of serum antibodies persisted in 10 of 14 persons and 9 of them developed phase I antibodies also. Since 1993 several cases of Q fever have been observed among people living in various regions of the country. Epidemiological investigations have revealed that infected patients are seasonal workers employed during the shearing time in Spain. Specific serum antibodies reached titre 512. The strains of C. burnetii were isolated from urine and semen of 2 patients.

[Use of indirect immunofluorescence and polymerase chain reaction (PCR) for detection of Borrelia burgdorferi in ticks]. / Zastosowanie odczynu immunofluorescencji posredniej i lancuchowej reakcji polimerazy (PCR) do wykrywania kretków Borrelia burgdorferi w kleszczach.

Material samples from 40 ticks, including 30 Ixodes ricinus and 10 Dermacentor reticulatus ticks were tested for presence of Borrelia burgdorferi infection with indirect immunofluorescence assay (IF) and polymerase chain reaction (PCR). Sensitivity of PCR in terms of minimum detectable number of in vitro cultivated spirochetes was a reproducible amplification when 50 spirochetes were added to the PCR mixture. The assay sensitivity was lower for B. burgdorferi in ticks and it was estimated on minimum 100 bacterial cells. B. burgdorferi DNA (16S rDNA) has been found in 10 I. ricinus ticks. Immunofluorescence has been observed in Immunofluorescence has been observed in 32 samples derived from 22 I. ricinus and 10 D. reticulatus ticks both incubated with immune serum for B. Burgdorferi as well as with normal serum. Our results indicate that due to very low specificity IF is not a usefull method for testing of tick material.

[Ticks as a reservoir of Borrelia burgdorferi and Coxiella burnetii on Polish terrain]. / Kleszcze jako rezerwuar Borrelia burgdorferi i Coxiella burnetii na terenie Polski.

The aim of performed studies was to recognize the distribution of Coxiella burnetii and Borrelia burgdorferi infected ticks in Poland. The 1580 ticks infesting animals and humans were collected in different parts of the country. They belonged to Ixodes ricinus, Dermacentor reticulatus and Argas reflexus species. Presence of B burgdorferi and C. burnetii DNA in ticks has been sought with polymerase chain reaction test (PCR). B. burgdorferi bacteria have been detected in 12 I. ricinus ticks (0.77%). Infected ticks were collected in Koszalin, Krosno and Suwalki voivodships. C. burnetii bacteria were found in 3 ticks from Kielce and Tarnobrzeg voivodships (0.19%). Obtained results indicate existence of natural reservoirs and vectors of C burnetii and B. burgdorferi in Poland. Since Q fever have not been recognized in central Poland until recently in can suggest diffusion of the C. burnetii reservoir to new regions. Presence of infected ticks in distant regions reflects wide distribution of these microorganisms all over the country.