Use of complementary and alternative medicine among patients with radiographic-confirmed knee osteoarthritis.

OBJECTIVE: To examine use of complementary and alternative medicine (CAM) among individuals with radiographic-confirmed osteoarthritis (OA) of the knee. METHODS: We included 2679 participants of the Osteoarthritis Initiative with radiographic tibiofemoral knee OA in at least one knee at baseline. Trained interviewers asked a series of specific questions relating to current OA treatments including CAM therapies (seven categories - alternative medical systems, mind-body interventions, manipulation and body-based methods, energy therapies, and three types of biologically based therapies) and conventional medications. Participants were classified as: (1) conventional medication users only, (2) CAM users only; (3) users of both; and (4) users of neither. Polytomous logistic regression identified correlates of treatment approaches including sociodemographics and clinical/functional correlates. RESULTS: CAM use was prevalent (47%), with 24% reporting use of both CAM and conventional medication approaches. Multi-joint OA was correlated with all treatments (adjusted odds ratios (aOR) conventional medications only: 1.62; CAM only: 1.37 and both: 2.16). X-ray evidence of severe narrowing (OARSI grade 3) was associated with use of glucosamine/chondroitin (aOR: 2.20) and use of both (aOR: 1.98). The Western Ontario and McMaster Universities (WOMAC)-Pain Score was correlated with conventional medication use, either alone (aOR: 1.28) or in combination with CAM (aOR: 1.41 per one standard deviation change). Knee Outcomes in Osteoarthritis Survey (KOOS)-Quality of Life (QOL) and Short Form (SF)-12 Physical Scale scores were inversely related to all treatments. CONCLUSION: CAM is commonly used to treat joint and arthritis pain among persons with knee OA. The extent to which these treatments are effective in managing symptoms and slowing disease progression remains to be proven.

Correction of flexible pes planus deformity: medial column stabilization procedure.

A review of five distinct medial column stabilization procedures sets forth criteria specific to certain presentations of pes planus deformity. The importance of considering the manifestation of the condition and its implications with regard to the overall health of the particular patient cannot be overemphasized. The collective goal of all such corrective procedures is identical; it is the variable factors particular to a specific presentation that dictate the preferred corrective action. The course selected by a physician with respect to surgical correction of flexible pes planus must be determined by taking both the procedure and the presentation of the condition under advisement.

Plasma observations near uranus: initial results from voyager 2.

Extensive measurements of low-energy positive ions and electrons in the vicinity of Uranus have revealed a fully developed magnetosphere. The magnetospheric plasma has a warm component with a temperature of 4 to 50 electron volts and a peak density of roughly 2 protons per cubic centimeter, and a hot component, with a temperature of a few kiloelectron volts and a peak density of roughly 0.1 proton per cubic centimeter. The warm component is observed both inside and outside of L = 5, whereas the hot component is excluded from the region inside of that L shell. Possible sources of the plasma in the magnetosphere are the extended hydrogen corona, the solar wind, and the ionosphere. The Uranian moons do not appear to be a significant plasma source. The boundary of the hot plasma component at L = 5 may be associated either with Miranda or with the inner limit of a deeply penetrating, solar wind-driven magnetospheric convection system. The Voyager 2 spacecraft repeatedly encountered the plasma sheet in the magnetotail at locations that are consistent with a geometric model for the plasma sheet similar to that at Earth.