Composition and adaptation of human myotendinous junction and neighboring muscle fibers to heavy resistance training.

The myotendinous junction (MTJ) is a common site of strain injury and yet understanding of its composition and ability to adapt to loading is poor. The main aims of this study were to determine the profile of selected collagens and macrophage density in human MTJ and adjoining muscle fibers, and to investigate whether heavy exercise loading would alter this profile. Fifteen individuals scheduled for anterior cruciate ligament repair surgery were randomized into three groups: control, acute or 4 weeks heavy resistance training. MTJ samples were collected from the semitendinosus and gracilis muscles and were sectioned and stained immunohistochemically for collagen types I, III, VI, XII, XIV, XXII, Tenascin-C and CD68. Macrophage density and distribution was evaluated and the amount of each collagen type in muscle and MTJ was graded. Collagen XXII was observed solely at the MTJ, while all other collagens were abundant at the MTJ and in muscle perimysium or endomysium. The endomysial content of collagen XIV, macrophages and Tenascin-C increased following 4 weeks of training. These findings illustrate the heterogeneity of collagen type composition of human MTJ. The increase in collagen XIV following 4 weeks of training may reflect a training-induced protection against strain injuries in this region.

The human myotendinous junction: an ultrastructural and 3D analysis study.

The myotendinous junction (MTJ) is a specialized structure in the musculotendinous system, where force is transmitted from muscle to tendon. Animal models have shown that the MTJ takes form of tendon finger-like processes merging with muscle tissue. The human MTJ is largely unknown and has never been described in three dimensions (3D). The aim of this study was to describe the ultrastructure of the human MTJ and render 3D reconstructions. Fourteen subjects (age 25 ± 3 years) with isolated injury of the anterior cruciate ligament (ACL), scheduled for reconstruction with a semitendinosus/gracilis graft were included. Semitendinosus and gracilis tendons were stripped as grafts for the ACL reconstruction. The MTJ was isolated from the grafts and prepared for transmission electron microscopy (TEM) and focused ion beam/scanning electron microscopy. It was possible to isolate recognizable MTJ tissue from all 14 patients. TEM images displayed similarities to observations in animals: Sarcolemmal evaginations observed as finger-like processes from the tendon and endomysium surrounding the muscle fibers, with myofilaments extending from the final Z-line of the muscle fiber merging with the tendon tissue. The 3D reconstruction revealed that tendon made ridge-like protrusions, which interdigitiated with groove-like indentations in the muscle cell.

Sensitivity of immunochemical faecal occult blood testing for detecting left- vs right-sided colorectal neoplasia.

BACKGROUND: Faecal occult blood tests (FOBTs) are used for colorectal cancer (CRC) screening. We aimed to assess the sensitivity of an immunochemical FOBT for detecting advanced colorectal neoplasia in the left vs the right colon and to explore reasons for potential differences in site-specific test performance. METHODS: We prospectively measured faecal occult blood levels by a quantitative immunochemical FOBT (RIDASCREEN) in 2310 average-risk subjects undergoing screening colonoscopy. We compared diagnostic performance for subjects with left- vs right-sided advanced neoplasia, as well as patient characteristics and adenoma characteristics that have been suggested to impact faecal haemoglobin levels. RESULTS: Sensitivities for subjects with left- vs right-sided advanced neoplasia were 33% (95% confidence interval (CI), 26-41%) and 20% (CI, 11-31%) (P=0.04) at a specificity of 95% (overall sensitivity: 29%) and the areas under the receiver-operating characteristics curve were 0.71 (CI, 0.69-0.72) and 0.60 (CI, 0.58-0.63), respectively. Pedunculated shape was strikingly more common in participants with left- vs right-sided advanced neoplasia (47% vs 14%). In logistic regression analyses adjusted for site, pedunculated shape was statistically significantly associated with test sensitivity (P=0.04). CONCLUSIONS: The immunochemical FOBT in our study was more sensitive for detecting subjects with left- vs right-sided advanced colorectal neoplasia. Our findings may stimulate further diagnostic research in the field as well as modelling analyses to estimate the potential effect of site-specific test performance on the effectiveness of annual or biennial FOBT-based screening programmes, in particular with respect to protection from right-sided CRC.

Occurrence and spread in Italy of Aedes albopictus, with implications for its introduction into other parts of Europe.

Aedes albopictus is considered second only to Ae. aegypti in its importance to man as a disease vector of dengue and dengue hemorrhagic fever. The first sighting in 1979 of the vector species in Europe came from Albania; however, it was only when Ae. albopictus was introduced into Italy in 1990, through the importation of used tires, followed by its subsequent spread, that the species was considered as a threat to public health. At the close of 1995, Ae. albopictus infestations have been reported from 10 Italian regions and 19 provinces. The risk for greater distribution of Ae. albopictus in Europe can potentially be projected, based on well-established criteria such as: where the winter monthly mean temperature is 0 degree C, where at least 50 cm of mean annual rainfall occurs, and where the mean summer temperature is approximately 20 degrees C. Those countries where climatic conditions meet such criteria and that may be vulnerable to a potential introduction of Ae. albopictus include Spain, Portugal, Greece, Turkey, France, Albania, and the former Republic of Yugoslavia. The Italian plan of action, established for the surveillance and control of Ae. albopictus, is presented in detail.

Global distribution and continuing spread of Aedes albopictus.

Aedes albopictus ranks second only to Ae. aegypti in importance to man as a vector of dengue and dengue haemorrhagic fever (DHF) which viruses place at risk a potential population of 2 billion people living in tropical and sub-tropical regions. Due to its predilection for breeding in a plethora of habitat within urban and suburban environs as well as peri-rural areas it is spreading rapidly where suitable breeding is available. It exhibits strain differences ranging from the cold-hardy to tropic loving, yet despite limited flight range, it has spread beyond the Orient to China, the Pacific, the Indian Ocean islands, the Americas, parts of continental Africa and into southern Europe. This has been done principally by means of transport of eggs in used tyres via rapid air and sea transport. Egg positive used tyres, when shipped, and later rehydrated by rainfall, produce adult mosquitoes within a few days rapidly infesting new areas. Although dengue and other vector-borne arboviral diseases have not been in Europe in epidemic form for many decades, travelers do not infrequently return from dengue endemic areas with dengue and other similar infections. Aedes albopictus is a potential vector of a number of arboviruses and can transmit them in a vertical or transvenereal manner in nature, thereby providing a means for their maintenance and transmission. Where Ae. albopictus newly occurs, the affected populace immediately are aware of a new daytime, nuisance biting mosquito and complaints addressed to local mosquito control authorities increase significantly. The biological characteristics of the mosquito make its spread within Europe highly probable. The paper offers several avenues to be pursued to reduce the global spread of Ae. albopictus, when examined within the context of Europe and the wider world community.

Vector-borne disease problems in rapid urbanization: new approaches to vector control.

Owing to population growth, poor levels of hygiene, and increasing urban poverty, the urban environment in many developing countries is rapidly deteriorating. Densely packed housing in shanty towns or slums and inadequate drinking-water supplies, garbage collection services, and surface-water drainage systems combine to create favourable habitats for the proliferation of vectors and reservoirs of communicable diseases. As a consequence, vector-borne diseases such as malaria, lymphatic filariasis and dengue are becoming major public health problems associated with rapid urbanization in many tropical countries. The problems in controlling these diseases and eliminating vectors and pests can be resolved by decision-makers and urban planners by moving away from the concept of "blanket" applications of pesticides towards integrated approaches. Sound environmental management practices and community education and participation form the mainstay of some of the most outstanding successes in this area. On the basis of these examples, it is argued that the municipal authorities need to apply a flexible methodology, which must be based on the possibilities of mobilizing community resources, with minimal reliance on routine pesticidal spraying. In this way, vector control becomes a by-product of human development in the city environment. This is now a true challenge.

PIP: Rural-urban migration and population growth are occurring more quickly now than ever before in history. These phenomena have resulted in overcrowded urbanization and increased densities of vectors which in turn have caused an increase in disease such as malaria and dengue and dengue hemorrhagic fever. Besides urban areas foster the breeding of mosquitoes, rats, and other pests. Further governmental services in both developed and developing countries have not been able to keep up with housing and sanitation needs. Moreover new migrants continue to move into temporary housing (slums) made of inferior materials with no services while the previous occupants improve their wages and move on to better housing. Thus little incentive exists to improve slums where sanitation is poor and disease common. In addition, many formerly rural people continue rural practices and traditions in urban areas such as patterns of water storage. Further people often try to control vectors by applying pesticides, but do so haphazardly and/or in an unsafe, uncontrolled manner. They even use empty pesticide containers for storing water or food. Besides insecticide resistance is spreading. WHO encourages governments to integrate disease control programs with primary health care, but most such integrated programs operate in developed countries. Integrated approaches include less dependence on pesticides; encouraging changes in human behavior; disseminating health messages; community participation, particularly the youth; mobilization of human and financial resources; and proper urban development, e.g., better quality housing and adequate sanitation and potable water.

Aedes aegypti infestation characteristics in several Caribbean countries and implications for integrated community-based control.

Periodic larval surveys for Aedes aegypti were conducted in 11 Caribbean countries between 1983 and 1989. On average, there were 24 potential larval habitats per house including 4.9 which held water at the time of examination. Breteau indices for the various islands ranged from 34.7 to 121.6. In descending order of importance, water storage drums, house plants, buckets, used tires and miscellaneous small discarded containers accounted for 84% of all foci. Highest rates of infestation were found in tires (38.4%) and drums (33.8%). For the development of integrated community-based vector control programs, not only should consideration be given to the larval ecology of Ae. aegypti, but also to the sociological significance of the various container habitats and the selection of control strategies most appropriate for their management.

Saint Lucia revisited.

The eastern Caribbean island of Saint Lucia is now famous in parasitological history as the setting for a major programme of schistosomiasis control'. Perhaps less well-known are the island's effective control of many intestinal parasites, and elimination of malaria, such that the current patterns of mortality and other demographic indicators now resemble those of industrialized countries. More recently, the island has become the focus for another community-based health programme as the Caribbean region again comes to grips with Aedes aegypti and its recently imported relative, Aedes albopictus, important vectors of yellow fever and dengue viruses (see Box 1).

The significance of the introduction of Aedes albopictus into the southeastern United States with implications for the Caribbean, and perspectives of the Pan American Health Organization.

The introduction and apparent infestation of Aedes albopictus into the Gulf States of Texas and Louisiana in the United States is viewed as the most singular medical entomological happening of this decade in the Americas. The implications for the Caribbean and other countries southward are serious, as the habitat described for this Stegomyia cousin of Ae. aegypti, is amply available in the Windward and Leeward islands of the Antilles. Studies from the Pacific and regions of Southeast Asia indicate that Ae. albopictus competes for the same peridomestic niches as Ae. aegypti and it has been found to be a competent vector of several dengue serotypes. In this presentation, a call is issued to the mosquito control and abatement programs in the Gulf States to take stringent measures to eliminate this new dengue vector before it becomes thoroughly established and spreads to other states as well as into countries of the Americas and into the West Indies.

Dengue hemorrhagic fever in Malaysia: the 1973 epidemic.

The first major Malaysian epidemic of dengue hemorrhagic fever with severe manifestations occurred in 1973, with 969 reported cases and 54 deaths. In a detailed study of 138 clinically diagnosed and laboratory confirmed cases at the General Hospital in Kuala Lumpur, hemorrhagic manifestations were observed in 68.7% and shock in 18.1% of the patients. The cases occurred mainly from May to September, largely in urban and suburban areas of the majority of the states in the country. A main focus of infection was Jinjang, a heavily populated outlying district of Kuala Lumpur, where unusually high incidences of morbidity, severe disease and mortality were seen. Severe disease was seen mostly in children under the age of 15 years, although a significant number of adults suffered milder illnesses. The Chinese population was chiefly affected, due to their living in crowded, low-income housing where the vector, Aedes aegypti, occurred in the greatest numbers. All four dengue types were recovered during the epidemic period, although dengue 3 (DEN-3) was incriminated as the major epidemic type. Entomological data revealed high indices of A. aegypti throughout the country and left little doubt that this epidemic was aegypti transmitted. Spraying and fogging operations were carried out in attempts to control vector populations.