Clinical application of foot strike run retraining for military service members with chronic knee pain.

INTRODUCTION: Military training is associated with a high incidence of knee pain. Conversion from a rearfoot to non-rearfoot strike during running is effective at reducing knee pain in research environments. The purpose of this report was to demonstrate run retraining as a clinical intervention for service members with knee pain. METHODS: Sixteen service members with running-related chronic knee pain underwent run retraining that converted foot strike from a rearfoot to a non-rearfoot strike using real-time visual feedback. The Lower Extremity Functional Scale (LEFS) and Numerical Pain Rating Scale (NPRS) for knee pain during running were assessed pretraining, at the final training session and at a 1-month follow-up. During running, foot inclination angle and vertical ground reaction force (VGRF) average loading rate were measured pretraining and at 1 month of follow-up. RESULTS: Service members underwent 7.4±1.0 training sessions over the course of 15.8±4.6 days. LEFS improved by 8±6 points immediately after retraining, with an overall improvement of 10±6 points from pretraining to 1-month follow-up (p<0.01). NPRS improved by 2.0±0.4 points immediately after retraining, with an overall improvement of 2.0±0.4 points from pretraining to 1-month follow-up (p<0.01). Conversion to a non-rearfoot strike pattern was apparent at follow-up for all but two patients. VGRF average loading rate decreased by 56%±17% (p<0.01) from pretraining to 1-month follow-up. CONCLUSIONS: Knee pain and function improved as a result of non-rearfoot strike run retraining, which supports the clinical use of this evidence-based intervention.

External cervical resorption: part 2 - management.

Effective management of external cervical resorption (ECR) depends on accurate assessment of the true nature and accessibility of ECR; this has been discussed in part 1 of this 2 part article. This aim of this article was firstly, to review the literature in relation to the management of ECR and secondly, based on the available evidence, describe different strategies for the management of ECR. In cases where ECR is supracrestal, superficial and with limited circumferential spread, a surgical repair without root canal treatment is the preferred approach. With more extensive ECR lesions, vital pulp therapy or root canal treatment may also be indicated. Internal repair is indicated where there is limited resorptive damage to the external aspect of the tooth and/or where an external (surgical) approach is not possible due to the inaccessible nature of subcrestal ECR. In these cases, root canal treatment will also need to be carried out. Intentional reimplantation is indicated in cases where a surgical or internal approach is not practical. An atraumatic extraction technique and short extraoral period followed by 2-week splinting are important prognostic factors. Periodic reviews may be indicated in cases where active management is not pragmatic. Finally, extraction of the affected tooth may be the only option in untreatable cases where there are aesthetic, functional and/or symptomatic issues.

Prevention of mother to child transmission of HIV infection in Pacific countries.

INTRODUCTION: A generalized epidemic of HIV infection has been evolving in Papua New Guinea over the last decade, whereas in other Pacific Island countries and territories (PICT) HIV transmission has generally been less widespread. Programmes to detect HIV infection in pregnant women and to prevent mother to child transmission (MTCT) during either delivery or breast-feeding can decrease the incidence of infection in infants. The limited health infrastructure present in some PICT may delay the implementation of effective programmes to decrease MTCT of HIV. METHODS: We used a standardized questionnaire to survey health-care providers in 22 PICT for information on the epidemiology of HIV infection and strategies used during 2004 to prevent MTCT of HIV infection in their country. We supplemented these survey responses with data obtained from regional organizations supporting national responses to HIV. RESULTS: We obtained responses from 21 PICT. The reported prevalence of known HIV infection was >150 per 100 000 persons in Papua New Guinea, approximately 100 per 100 000 persons in French Polynesia, Guam, New Caledonia and Tuvalu and <50 per 100 000 persons in the remaining 14 PICT. Other than in Papua New Guinea, where an estimated 500 pregnant women had HIV infection diagnosed in 2004, reported HIV infection among pregnant women was rare. Ten PICT reported that an HIV antibody test was offered as a routine component of antenatal care and 11 reported that antiretroviral medications were available for the prevention of MTCT of HIV infection. CONCLUSION: The prevalence of HIV infection differs greatly between PICT with a varying risk of MTCT of HIV infection. Successful prevention of MTCT of HIV infection throughout the PICT will require improved uptake of antenatal HIV antibody testing and better access to antiretroviral medications.

Bovine kidney tissue/biological fluid correlation for penicillin.

Penicillin is one of the most commonly misused drugs in steers and dairy cows. In the US, at slaughter the tolerance is 50 ng/g in kidney and other edible tissues. If the tolerance is exceeded, the carcass may not be used for human food. A preslaughter test for penicillin in an easily accessible biological fluid is needed to predict if the concentration of penicillin is below tolerance in the kidney before the bovine is slaughtered. In this study, 12 steers were injected three times with the approved dose (7000 IU) of penicillin at 12-h intervals. Blood and urine samples were collected at intervals after the final dose of penicillin. At each sampling point, one kidney biopsy sample was collected by laparoscopic surgery in the live animal. Another kidney sample was collected at slaughter. Correlations between plasma and kidney concentrations and between urine and kidney concentrations were determined. These correlations predict with 95% confidence that 99% of the animals will have kidney tissue below penicillin tolerance when the plasma concentration of penicillin is below 0.4 ng/mL and/or the urine penicillin concentration is below 140 ng/mL.

Monitoring Chinese hamster ovary cell culture by the analysis of glucose and lactate metabolism.

Monitoring cell growth is crucial to the success of an animal cell culture process that can be accomplished by a variety of direct or indirect methodologies. Glucose is a major carbon and energy source for cultured mammalian cells in most cases, but glycolytic metabolism often results in the accumulation of lactate. Glucose and lactate levels are therefore routinely measured to determine metabolic activities of a culture. Typically, neither glucose consumption rate nor lactate accumulation rate has a direct correlation with cell density due to the changes in culture environment and cell physiology. We discovered that although the metabolic rate of glucose or lactate varies depending on the stages of a culture, the cumulative consumption of glucose and lactate combined (Q(GL)) exhibits a linear relationship relative to the integral of viable cells (IVC), with the slope indicating the specific consumption rate of glucose and lactate combined (q(GL)). Additional studies also showed that the q(GL) remains relatively constant under different culture conditions. The insensitivity of the q(GL) to process variations allows a potentially easy and accurate determination of viable cell density by the measurement of glucose and lactate. In addition, the more predictable nature of a linear relationship will aid the design of better forward control strategies to improve cell culture processes.

An electronic database for outcome studies that includes digital radiographs.

We report on acquisition of key data from the clinical medical record, surgical data, radiologic studies, and patient surveys for a novel digital total hip arthroplasty (THA) registry that includes electronic capture of digital radiographic images into a database on an internet platform for query. We now have the ability to collect demographic and operative data, including the operative note, discharge summary, surgery data, and Digital Imaging Communications in Medicine (DICOM) radiology images. Steps are being completed to assemble office encounters, hospital procedural codes, and implant bar codes. Two examples include a THA surgery record and a THA outcome study with plain radiograph set. Analysis of such data could suggest ways to improve clinical practice.

Development and improvement of a serum-free suspension process for the production of recombinant adenoviral vectors using HEK293 cells.

Human Embryonic Kidney 293 (HEK293) cells were adapted into a serum-free suspension medium through steps of gradual serum weaning for the production of adenoviral (AdV) gene therapy vectors. The presence of sodium heparin in the medium formulation reduced cell clumping dramatically in suspension culture. The adapted cells were ready to grow either in serum-containing medium as an attached culture or in serum-free medium in suspension culture. A scalable production process was developed in shake flasks and was then evaluated in stirred tank bioreactors. This process includes a growth phase in batch-mode followed by a production phase involving medium perfusion and supplementation. Fortification with calcium chloride post viral inoculation resulted in an increase in virus production by at least one fold. Addition of stimulating agents such as sodium butyrate, N-acetyl-L-cysteine (NAC), dimethyl sulfoxide(DMSO), or ethyl alcohol post infection was shown to further improve virus production in a dose-dependent manner. The serum-free suspension process described here should be suitable for the manufacturing of other E1-deleted AdV vectors and could potentially be used for the production of recombinant proteins by HEK293 cells.

Biomass and aggregation analysis of human embryonic kidney 293 suspension cell cultures by particle size measurement.

A method has been developed to monitor the cell growth of aggregated human embryonic kidney 293 (HEK293) suspension cultures by measuring cumulative particle volume and the particle size distribution. This method employs a particle size analyzer that determines the size of individual particles by detecting their light obscuration (blockage) or scattering. Cell counts derived from the cumulative volume of the cell particle correlate well with manual cell counts from a hemacytometer at different stages of growth. This correlation was further confirmed by quantifying total cellular protein of the samples. Simultaneously, the aggregation state of the samples can also be monitored and mathematically described. Results from this study demonstrate that this simple and reproducible method allows the direct measurement of cumulative cell volume and the degree of cell aggregation, as well as an indirect assessment of cell counts.

Response to criticisms of the US FDA parametric approach for withdrawal time estimation: rebuttal and comparison to the nonparametric method proposed by Concordet and Toutain.

The benefits and drawbacks of using nonparametric methods for estimating product withdrawal times have been debated for many years. This issue was recently revived by Concordet & Toutain (1997a, b) when they described a nonparametric method for withdrawal time estimation. The authors urged the international adoption of this approach, basing their recommendation on three fundamental concerns: (1) the lack of a consistent official procedure for determining a withdrawal time within the European Union (EU); (2) the need to identify a statistical method for improving the international harmonization of withdrawal times for new chemical entities; and (3) a lack of confidence in the robustness of the US Food and Drug Administration/Center for Veterinary Medicine (US FDA) procedure, particularly with respect to minor violations in the underlying parametric assumptions. Due to the critical nature of these issues, the US FDA considers it vital to respond to these concerns. This paper provides a description of the US FDA parametric procedure. We also examine the statistical concerns expressed by Concordet and Toutain, identifying the reasons for our confidence in the US FDA parametric approach. Finally, using their Monte Carlo simulation models, we generate additional datasets to explore the behaviour of their nonparametric procedure and evaluate its ability to support US FDA regulatory activities.

Dengue surveillance in the Pacific Islands.

Adequate monitoring of dengue activity can be achieved using a combination of mosquito vector surveillance, fever surveillance, sentinel clinicians and laboratory screening. An apparent increase in fever cases or clinically suspected DF should prompt a careful clinical and laboratory investigation. If an outbreak of dengue is confirmed, health authorities will need to implement emergency community-wide control strategies. Laboratories will quickly feel the burden of clinical monitoring of cases admitted with DHF/DSS. Surveillance can change to clinical case definitions as health workers become familiar with the presenting features of DF and DHF/DSS. Criteria for hospital referral and admission must be well understood. Routine laboratory and sentinel surveillance may resume as the epidemic wanes, and should then continue indefinitely to monitor any resurgence of dengue activity.

Antibiotic residues in milk samples obtained from cows after treatment for papillomatous digital dermatitis.

OBJECTIVE: To determine whether there would be detectable antibiotic residues in milk obtained from dairy cattle with papillomatous digital dermatitis (PDD) after topical treatment with oxytetracycline. DESIGN: Randomized controlled clinical trial. ANIMALS: 28 lactating Holstein cows with PDD. PROCEDURE: Cows were assigned to 2 treatment groups. Treatment 1 (n = 16) consisted of spraying of PDD lesions with 15 ml of a solution containing 100 mg of oxytetracycline/ml; lesions were sprayed twice daily for 7 days, using a garden sprayer. Treatment 2 (n = 12) consisted of a one-time application of a bandage that consisted of cotton soaked with 20 ml of a solution containing 100 mg of oxytetracycline/ml. Milk samples were obtained before and after treatment and assayed for tetracycline content by use of high-performance liquid chromatography and a commercially available tetracycline screening test. RESULTS: None of the cows in either treatment group had violative residues of oxytetracycline in milk samples. CONCLUSIONS AND CLINICAL RELEVANCE: Producers treating lactating cows that have PDD, via topical application of oxytetracycline solution at the concentrations reported in this study, have a low risk of causing violative antibiotic residues in milk.

Effect of PGG-glucan on the rate of serious postoperative infection or death observed after high-risk gastrointestinal operations. Betafectin Gastrointestinal Study Group.

BACKGROUND: Postoperative infections remain common after high-risk gastrointestinal procedures. PGG-glucan (Betafectin; Alpha Beta Technology Inc, Worcester, Mass), derived from yeast cell walls, promotes phagocytosis and intracellular killing of bacterial pathogens by leukocytes, prevents infection in an animal model of wound infection, and acts synergistically with antibiotics to reduce mortality in rat peritonitis. HYPOTHESIS: We hypothesized that infectious complications in these patients might be reduced by the administration of a nonspecific immune-enhancing agent. DESIGN: Multicenter, prospective, randomized, double-blind, placebo-controlled trial of 1249 patients prospectively stratified into colorectal or noncolorectal strata. SETTING: Thirty-nine medical centers throughout the United States. PATIENTS: Aged 18 years or older, scheduled for gastrointestinal procedure lasting 2 to 8 hours, with 2 or more defined risk factors. INTERVENTIONS: PGG-glucan, 0.5 mg/kg or 1.0 mg/kg, or placebo once preoperatively and 3 times postoperatively. All patients received standardized antibiotic prophylaxis. MAIN OUTCOME MEASURES: Serious infection or death within 30 days. RESULTS: All randomized patients revealed no difference in serious infections and deaths in the treated groups compared with placebo groups (15% vs 14%, P>.90). In the prospectively defined noncolorectal stratum (n = 391), PGG-glucan administration was associated with a statistically significant relative reduction (39%) in serious infections and death (placebo, 46 [36%] of 129 vs either PGG-glucan group, 29 [21%] of 132 and 28 [22%] of 130, P<.02). PGG-glucan reduced postoperative infection or death in malnourished patients having noncolorectal procedures (31 [44%] of 70, placebo group; 16 [24%] of 68, 0.5-mg/kg PGG-glucan group; 12 [17%] of 72, 1.0-mg/kg PGG-glucan group; P<.001). Study drug was stopped owing to adverse effects more frequently for patients receiving PGG-glucan than placebo (2%, 4%, and 7% for the placebo group, 0.5-mg/kg PGG-glucan group, and 1.0-mg/kg PGG-glucan group, respectively, P<.003). CONCLUSION: Perioperative administration of PGG-glucan reduced serious postoperative infections or death by 39% after high-risk noncolorectal operations.

Vaccine know-how. Kimberley immunisation study: community nurses immunisation education, knowledge and practice.

In the remote Kimberley Region of Western Australia, community nurses administer almost all childhood vaccines. This paper discusses the immunisation education, knowledge and practice of this group of nurses. This research was part of a larger Kimberley immunisation study. The first phase investigated the immunisation cover and timing of vaccine administration to children in the 0-18 month age group in the Kimberley Region of Western Australia. Phase two investigated immunisation education, knowledge and practice. The study findings suggest that community nurses are knowledgeable about vaccine administration, and administer vaccines appropriately to children with multiple infections, weight loss and failure to thrive. They are also 'active' in following up children due and overdue for vaccines. However, a lack of on-going nursing immunisation education was reported.

Travel health: perceptions and practices of travel consultants.

BACKGROUND: The global increase in international travel puts travelers at risk of travel-related morbidity and mortality. Prior to travel, most travelers have contact with a travel agency, thereby providing an opportunity for intervention. With this in mind we aimed to determine some of the travel-related health knowledge, practices and needs of travel consultants. METHODS: A cross sectional study was undertaken in which one travel consultant from each of 166 Western Australian travel agencies was asked to complete a self-administered questionnaire. RESULTS: One hundred and forty-five travel agencies (87%) agreed to participate in the study. Fifty-six percent indicated that they "usually" gave broad travel-related health guidelines and recommended their clients consult a medical practitioner. Almost all travel consultants reported discussing travel health insurance; very few provided information on sexually transmissible diseases, the risks associated with drug use, or first aid kits. Over 80% responded correctly to statements eliciting their knowledge on yellow fever, malaria, and food safety; the majority incorrectly answered questions on dengue fever and altitude sickness. Fifty-six percent of respondents thought that there was "not enough" readily accessible travel health information; 52% said they would like to be more involved in providing health information to their clients. CONCLUSIONS: Contact between travelers and travel agents offers an opportunity to promote awareness of travel-related health hazards. While travel consultants' health knowledge on some topics is adequate, in other areas it is inconsistent. Many travel consultants in Western Australia expressed a willingness to be involved in future health promotion activities. This participation may be best nurtured by providing travel consultants with: (1) better health education so they are able to identify high-risk travelers and destinations for medical referral; and, (2) health information in a format they feel comfortable distributing to their clients.

Microbiology in intraabdominal infections: what is the message for clinical studies? (Opinion paper).

Bacterial flora participating in intraabdominal infections are well known. Data are reviewed here documenting the constant antibiotic susceptibility of this flora despite many years of widespread use of antibiotics. The flaws inherent in the concept of "microbiologic efficacy" in evaluating antibiotic efficacy are examined. Among the possible results of a clinical trial, outcomes not in accord with antibiotic sensitivity data occur regularly. Factors such as host defense responses, source control and inoculum density also influence the outcome in a clinical trial but are not currently being measured. Recommendations for improved conduct of trails are made.

Role of biotin-containing membranes and nuclear distribution in differentiating human endometrial cells.

Human Ishikawa endometrial cells form domes when confluent monolayers are stimulated with fresh fetal bovine serum. Extensive structural and biochemical changes have been detected during the approximately 30 h differentiation period. The earliest detectable change involves the formation of multinucleated structures and the appearance of "granules" that stain for biotin within those structures. Nuclei become associated with each other and are ultimately enclosed within a biotin-containing membrane. Aggregated membrane-sheathed nuclei and the cells containing them begin to elevate from the dish as biotin staining becomes apparent in apical membranes. The elevated structures are called predomes and consist of one or more very large cells containing the sheathed nuclei. Apical membranes of these unusual cells extend far out into the medium in structures that resemble endometrial pinopods. A lumen under the elevated cells fills with transcytosed fluid. As differentiation proceeds, highly concentrated chromatin material that was flattened against apical and lateral membranes of the predome cells begins to disperse. Small mononuclear cells evolve from larger predome cells. Apical membranes of predome and dome cells continue to stain for biotin. Gel electrophoresis of SDS-solubilized biotin-containing membranes, followed by Western blot analysis using avidin-linked peroxidase, resulted in three stained bands with molecular weights similar to those of the mitochondrial carboxylases: propionyl carboxylase, methylmalonyl carboxylase, and pyruvate carboxylase.

Management of intrathoracic stomach with polypropylene mesh prosthesis reinforced transabdominal hiatus hernia repair.

BACKGROUND: Posterior cruroplasty repair of a large paraesophageal hiatus hernia has a higher than desirable rate of recurrence attributable to the inexorable cyclic negative intrathoracic pressure of respiration and positive intraabdominal pressure produced by straining, physical exertion, and coughing. To reduce the risk of recurrence after repair of a large hiatus hernia and intrathoracic stomach, we have used posterior cruroplasty reinforced with an onlay polypropylene mesh prosthesis. This paper reviews the feasibility of this technique. STUDY DESIGN: We did a retrospective review of 44 patients with large hiatus hernia and intrathoracic stomach who had posterior cruroplasty and onlay of polypropylene mesh prosthesis applied to the crura and adjacent diaphragm to repair the hiatal defect. RESULTS: Preoperative symptoms (mean duration, 26 months) included pain (33 patients), vomiting (21), dysphagia (19) and anemia (8). The typical patient (28 men and 16 women, mean age, 60) had two-thirds or more of the stomach above the diaphragm. Organoaxial gastric volvulus and herniated large or small bowel were present in 10 and 9 patients, respectively. A gastrostomy was performed for temporary drainage in 38 patients in addition to the hernia repair; 11 patients underwent a concomitant Nissen fundoplication. Postoperative complications included pleural effusion (four patients), atrial dysrhythmia (three patients), and superficial wound infection (two patients). Mean followup for 43 patients was 52 months. There have been no clinical recurrences. CONCLUSIONS: Mesh prosthesis reinforced hiatus hernia repair is effective, appears to have a low clinical recurrence rate, and should be an option in the treatment of a large hiatus hernia with intrathoracic stomach.