The effect of tactile and verbal guidance during scapulothoracic exercises: An EMG and kinematic investigation.

BACKGROUND: Clinician-led training through tactile and verbal guidance to improve muscle activity and joint motion are a common but understudied focus of therapeutic interventions for shoulder pain. The purpose of this study was to determine if clinician guidance changes scapulothoracic muscle activity and kinematics compared to unguided shoulder exercises. METHODS: Eleven participants with shoulder pain were studied. Electromyographic (EMG) sensors were placed on the serratus anterior and upper and lower trapezii. Scapulothoracic and sternoclavicular kinematics were collected using electromagnetic sensors. Five common resisted shoulder exercises were performed with the following guidance: unguided, combined (verbal and tactile cues), and verbal guidance only. One-way repeated measures ANOVAs determined the effect of guidance versus unguided conditions for each exercise. RESULTS: Nine of ten combinations of exercise and guidance techniques demonstrated a significant effect of guidance for either muscle activity or joint kinematics. The guidance condition with the most frequent significant improvements across all variables was the combined condition. The exercises with the most frequent significant improvements across all variables were the external rotation exercises. Variables improved most frequently were: upper:lower trapezius EMG ratio (up to 11%), sternoclavicular elevation (up to 6°) and scapulothoracic internal rotation positioning (up to 8°), and sternoclavicular retraction displacement (up to 5°). CONCLUSION: Shoulder muscle activity and kinematics during exercises can be modified by tactile and verbal guidance. Most improvements in muscle activity occurred with verbal guidance during external rotation exercises. Most improvements in joint positioning and movement occurred with combined guidance during external rotation exercises.

Biological evidence for dual antiangiogenic-antiaromatase activity of the VEGFR inhibitor PTK787/ZK222584 in vivo.

PURPOSE: Targeting vascular endothelial growth factor (VEGF) and estrogen receptor signaling pathways concomitantly may enhance benefit in estrogen receptor-positive breast cancer. We had shown previously that the VEGF receptor tyrosine kinase inhibitor PTK787/ZK222584 (PTK/ZK) is a competitive aromatase inhibitor in vitro. Here we investigated (a) whether PTK/ZK shows both antiangiogenic and antiaromatase inhibitory properties in vivo, and (b) whether the combination of PTK/ZK and letrozole is superior to letrozole alone. EXPERIMENTAL DESIGN: Estrogen-dependent human breast cancer cells engineered to express aromatase (MCF7 AROM 1 and BT474 AROM) were used. Mice were treated with vehicle, PTK/ZK (25, 50, or 100 mg/kg), letrozole, or PTK/ZK in combination with letrozole. RESULTS: In MCF7 AROM 1 tumors, all treatments induced growth suppression and were associated with a reduction in cell turnover index, a composite measurement of both proliferation and apoptosis. PTK/ZK significantly reduced vessel density. Whereas letrozole caused tumor regression, PTK/ZK stabilized tumor volumes. The growth suppressive and antiangiogenic effects of PTK/ZK were confirmed in BT474 AROM xenografts. The addition of PTK/ZK did not enhance the growth-suppressive effects of letrozole. However, PTK/ZK decreased progesterone receptor (PgR) and TFF1 expression and uterine weight, indicating that PTK/ZK decreases 17beta-estradiol (E2) signaling in vivo. CONCLUSION: The VEGF receptor inhibitor PTK/ZK showed effects on E2-dependent gene expression consistent with aromatase inhibition as well as antiangiogenesis in xenograft models of breast cancer. The combination with letrozole was not superior to letrozole alone. Overall, these results provide further support for a potential therapeutic approach of dual inhibition of VEGF and E2 signaling using a single agent.

Surfactant protein D regulates airway function and allergic inflammation through modulation of macrophage function.

The lung collectin surfactant protein D (SP-D) is an important component of the innate immune response but is also believed to play a role in other regulatory aspects of immune and inflammatory responses within the lung. The role of SP-D in the development of allergen-induced airway inflammation and hyperresponsiveness (AHR) is not well defined. SP-D levels progressively increased up to 48 hours after allergen challenge of sensitized mice and then subsequently decreased. The levels of SP-D paralleled the development of airway eosinophilia and AHR. To determine if this association was functionally relevant, mice were administered rat SP-D (rSP-D) intratracheally. When given to sensitized mice before challenge, AHR and eosinophilia were reduced by rSP-D in a dose-dependent manner but not by mutant rSP-D. rSP-D administration resulted in increased levels of interleukin (IL)-10, IL-12, and IFN-gamma in bronchoalveolar lavage fluid and reduced goblet cell hyperplasia. Culture of alveolar macrophages together with SP-D and allergen resulted in increased production of IL-10, IL-12, and IFN-gamma. These results indicate that SP-D can (negatively) regulate the development of AHR and airway inflammation after airway challenge of sensitized mice, at least in part, by modulating the function of alveolar macrophages.

Human surfactant protein D (SP-D) binds Mycoplasma pneumoniae by high affinity interactions with lipids.

Increasing evidence now identifies surfactant protein D (SP-D) as an important element of the innate immune system of the lung. In this study, we examined the interactions of rat and human SP-D with the human pathogen, Mycoplasma pneumoniae. Rat and human SP-D bound the organism with high affinity in a reaction that required Ca(2+) and was inhibited by EGTA. Membranes derived from the organism bound the proteins in a similar manner, except the rat SP-D also exhibited a significant level of Ca(2+)-independent binding. Pretreatment of membranes with proteases did not alter the Ca(2+)-dependent SP-D binding of membranes by either protein. Mannose, glucose, maltose, and inositol, at millimolar concentrations, competed for human SP-D binding to the bacterial membrane. Lipids extracted from membranes and separated by two-dimensional thin layer chromatography bound human SP-D with high affinity in a Ca(2+)-dependent reaction. A tandem mutant of SP-D with E321Q and N323D substitutions, failed to bind M. pneumoniae lipids, directly implicating the carbohydrate recognition domain in the interaction. The interaction of rat and human SP-D with M. pneumoniae was unaffected by the presence of surfactant lipids and the hydrophobic surfactant proteins. These findings demonstrate that M. pneumoniae is likely to be recognized by SP-D in the alveolar environment and that primary determinants recognized on the organism are lipid components of the cell membrane.