Assessment of the knowledge, attitudes and practices toward respiratory tract infections among the Trinidadian population

Respiratory Tract Infections (RTIs) are currently at the forefront of discussions as the world battles the COVID-19 pandemic. It is important that more awareness is raised on RTIs, their causes, the different types, how they are contracted and spread and complications of and risk factors for RTIs. Prevention measures towards RTIs should also be assessed and encouraged, such as proper hand washing, mask wearing, sneezing and coughing etiquette as well as vaccination. Therefore, this investigation was undertaken to assess the knowledge, attitudes, and practices towards Respiratory Tract Infections (RTIs) among Trinidadian population.

Associations of physical activity levels and screen time with oral glucose tolerance test profiles in Singaporean women of reproductive age actively trying to conceive: the S-PRESTO study.

AIM: To examine the associations of physical activity and screen time, a proxy for sedentary behaviour, with fasting and post-load glucose levels in Singaporean women enrolled in a multi-ethnic Asian preconception study. METHODS: Moderate and vigorous physical activity and screen time (television and other electronic devices) were self-reported by women enrolled in the S-PRESTO cohort. Fasting, 30-min and 120-min glucose levels before and during a 75-g oral glucose tolerance test were measured. Associations of physical activity and screen time with glucose levels were analysed using multivariable linear marginal regression. RESULTS: A total of 946 women aged 31.4±3.7 years were examined, of whom 72% were of Chinese, 15.5% were of Malay, 9.3% were of Indian and 3.2% were of mixed ethnicity. A total of 32% of women reported being active, 36% watched television ≥2 h/day and 26% used electronic devices ≥3 h/day. In adjusted models, vigorous, but not moderate, physical activity was associated with lower overall glucose levels, and was associated more strongly with post-challenge than fasting glucose levels. Compared to women not engaging in vigorous physical activity, those engaging in physical activity ≥75 min/week had lower mean fasting [-0.14 (95% CI -0.28, -0.01) mmol/l], 30-min [0.35 (95% CI -0.68, -0.02) mmol/l] and 120-min [-0.53 (95% CI -0.16, -0.90) mmol/l] glucose levels (overall P value=0.05). We found no associations of screen time with glucose levels. CONCLUSIONS: Independently of the time spent in non-vigorous physical activity and using screens, engaging in vigorous physical activity may be a modifiable factor to improve glucose regulation in women of Asian ethnicity who are attempting to conceive.

Female adiposity and time-to-pregnancy: a multiethnic prospective cohort.

STUDY QUESTION: Are higher overall and central adiposity associated with reduced fecundability, measured by time-to-pregnancy (TTP), in Asian women? SUMMARY ANSWER: Higher overall adiposity, but not central adiposity, was associated with longer TTP in Asian women. WHAT IS KNOWN ALREADY: High body mass index (BMI) has been associated with a longer TTP, although the associations of body composition and distribution with TTP are less clear. There are no previous studies of TTP in Asian women, who have a relatively higher percentage of body fat and abdominal fat at relatively lower BMI. STUDY DESIGN, SIZE, DURATION: Prospective preconception cohort using data from 477 Asian (Chinese, Malay and Indian) women who were planning to conceive and enrolled in the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO) study, 2015-2017. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women's mean age was 30.7 years. Overall adiposity was assessed by BMI, sum of 4-site skinfold thicknesses (SFT) and total body fat percentage (TBF%, measured using air displacement plethysmography); central adiposity was assessed by waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and A body Shape Index (ABSI). Pregnancy occurring within one year from recruitment was ascertained by ultrasonography. Those who did not conceive within one year of recruitment, were lost to follow-up, or initiated fertility treatment were censored. TTP was measured in cycles. Discrete-time proportional hazards models were used to estimate the fecundability ratio (FR) and 95% confidence interval (CI) for each anthropometric measure in association with fecundability, adjusting for confounders. MAIN RESULTS AND THE ROLE OF CHANCE: Compared to women with a normal BMI of 18.5-22.9 kg/m2, women with higher BMI of 23-27.4 and ≥27.5 kg/m2 showed lower FR of 0.66 (95% CI 0.45, 0.97) and 0.53 (0.31, 0.89), respectively. Compared to women in the lowest quartile of SFT (25-52.9 mm), those in the highest quartile of ≥90.1 mm showed lower FR of 0.58 (95% CI 0.36, 0.95). Compared to women in the lowest quartile of TBF% (13.6-27.2%), those in the upper two quartiles of 33.0-39.7% and ≥39.8% showed lower FR of 0.56 (95% CI 0.32, 0.98) and 0.43 (0.24, 0.80), respectively. Association of high BMI with reduced fecundability was particularly evident among nulliparous women. Measures of central adiposity (WC, WHR, WHtR, ABSI) were not associated with fecundability. LIMITATIONS REASONS FOR CAUTION: Small sample size could restrict power of analysis.The analysis was confined to planned pregnancies, which could limit generalizability of findings to non-planned pregnancies, estimated at around 44% in Singapore. Information on the date of last menstrual period for each month was not available, hence the accuracy of self-reported menstrual cycle length could not be validated, potentially introducing error into TTP estimation. Measures of exposures and covariates such as cycle length were not performed repeatedly over time; cycle length might have changed during the period before getting pregnant. WIDER IMPLICATIONS OF THE FINDINGS: Other than using BMI as the surrogate measure of body fat, we provide additional evidence showing that higher amounts of subcutaneous fat that based on the measure of SFT at the sites of biceps, triceps, suprailiac and subscapular, and TBF% are associated with longer TTP. Achieving optimal weight and reducing total percentage body fat may be a potential intervention target to improve female fertility. The null results observed between central adiposity and TTP requires confirmation in further studies. STUDY FUNDING/COMPETING INTEREST(S): This research is supported by Singapore National Research Foundation under its Translational and Clinical Research Flagship Programme and administered by the Singapore Ministry of Health's National Medical Research Council, (NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014). Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. Y.S.C., K.M.G., F.Y. and Y.S.L. have received reimbursement to speak at conferences sponsored by companies selling nutritional products. Y.S.C., K.M.G. and S.Y.C. are part of an academic consortium that has received research funding from Abbott, Nutrition, Nestle and Danone. Other authors declared no conflicts of interest. TRIAL REGISTRATION NUMBER: N/A.

Characteristics associated with the consumption of malted drinks among Malaysian primary school children: findings from the MyBreakfast study.

BACKGROUND: The consumption of beverages contributes to diet quality and overall nutrition. Studies on malted drinks, one of the widely consumed beverage choices among children in Asia, however, have received limited attention. This study aimed to examine the prevalence of malted drink consumption and explored associations of sociodemographic characteristics, nutrient intakes, weight status and physical activity levels with malted drink consumption among primary school children in Malaysia. METHODS: Data for this analysis were from the MyBreakfast Study, a national cross-sectional study conducted from April to October 2013 throughout all regions in Malaysia. A total of 2065 primary school children aged 6 to 12 years were included in the present analysis. Data on two days 24-h dietary recall or record, anthropometry, physical activity and screen time were recorded. Associations between malted drink consumption and related factors were examined using binary logistic regression, adjusting for region, area, gender, ethnicity and household income. RESULTS: Among children aged 6 to 12 years, 73.5% reported consuming malted drinks for at least once per week. Consumption of malted drinks was significantly associated with region (χ(2) = 45.64, p < 0.001), gender (χ(2) = 4.41, p = 0.036) and ethnicity (χ(2) = 13.74, p = 0.008). Malted drink consumers had similar total energy intake but higher micronutrient intakes compared to non-consumers. High physical activity level (OR = 1.77, 95% CI = 1.06, 2.99) and lower screen time during weekends (OR = 0.93, 95% CI = 0.86, 0.99) were independently associated with malted drink consumption among 6 to 9 year-old children, but not among 10 to 12 year-old children. No association was observed between malted drink consumption and weight status. CONCLUSIONS: Malted drink consumption is prevalent among Malaysian primary school children, particularly higher among boys, indigenous children and those who lived in the East Coast region of Malaysia. Consuming malted drinks is associated with higher micronutrient intakes and higher levels of physical activity, but not with body weight status.

The effects of prenatal oxidative stress levels on infant adiposity development during the first year of life.

Although numerous studies have been conducted to examine the causal factors of childhood obesity, the implications of intrauterine oxidative stress on early postnatal adiposity development remain to be elucidated. The Universiti Sains Malaysia Birth Cohort Study aimed to investigate the effects of prenatal oxidative stress levels on the development of infant adiposity during the first year of life. This study was conducted on the healthy pregnant women aged 19-40 years, from April 2010 to December 2012 in Kelantan, Malaysia. Maternal blood samples were drawn in the second trimester to analyse for oxidative stress markers. Infant anthropometric measurements were taken at birth, 2, 6 and 12 months of age. A total of 153 pregnant women and full-term infants were included in the analysis. Statistical test was conducted by using multiple linear regression. Through the infant first year of life, as maternal DNA damage level in the second trimester increased, infant weights at birth (ß=-0.122, P<0.001), 2 months (ß=-0.120, P=0013), 6 months (ß=-0.209, P=0.003) and 12 months of age (ß=-0.241, P=0.006) decreased after adjusting for confounders. Similar results were noted when infant body mass index-for-age Z-scores and triceps skinfold-for-age Z-scores were used as the adiposity indicators. In conclusion, the present study shows a consistent inverse association between maternal DNA damage and infant adiposity during the first year of life. These infants with reduced growth and adiposity in early postnatal life may have a high tendency to experience catch-up growth during childhood, which could be strongly associated with later obesity.

Development, validity and reproducibility of a food frequency questionnaire in pregnancy for the Universiti Sains Malaysia birth cohort study.

INTRODUCTION: This study aimed to develop and examine the validity and reproducibility of a semi-quantitative food frequency questionnaire (FFQ) among Malay pregnant women in Kelantan, Malaysia. METHODS: A total of 177 Malay pregnant women participated in the validation study while 85 of them participated in the reproducibility study which was carried out in the antenatal clinic of Universiti Sains Malaysia Hospital. The newly developed FFQ was validated against two 24-hour dietary recalls (DR). The FFQ was repeated 20 to 28 days apart. RESULTS: Results showed that the FFQ moderately over-estimated the nutrient and food intakes compared to the DR. Spearman correlation coefficients for nutrients ranged from 0.24 (fat) to 0.61 (calcium) and for foods, ranged from 0.13 (organ meats, onion and garlic) to 0.57 (malt drink). For nutrients, 72 to 85% of women were classified into the correct quartiles from the FFQ and the DR while for foods, 67 to 85% of women were classified correctly. Bland-Altman plot showed relatively good agreement between these two dietary methods. The intra-class correlation (ICC) was used to estimate reproducibility. It ranged from 0.75 (vitamin C) to 0.94 (phosphorus) for nutrients while it ranged from 0.73 (confectionary) to 0.96 (coffee) for foods. CONCLUSION: On average, at least 90% of pregnant women were correctly classified into the quartiles for nutrients and foods from the two sets of the FFQ. The FFQ presented acceptable reproducibility and appears to be a valid tool for categorising pregnant women according to dietary intake.

Granulomatous meningitis.

We report idiopathic hypertrophic pachymeningitis in a previously-healthy 34-year-old Filipino man, who presented with third and sixth cranial nerve palsies, headache, vomiting and left proptosis. Magnetic resonance imaging of the brain showed diffuse dural thickening and enhancement, with mild cerebrospinal fluid lymphocytosis and slight protein elevation. The patient was treated with anti-tuberculous medications and steroids, and made good recovery. We discuss the differential diagnoses and various diagnostic tests with respect to granulomatous inflammation of the meninges.

A follow-up study on fall and fracture incidence in long-term care including the role of formal caregiver time on fall incidence rates.

OBJECTIVE: To examine the impact of a fall prevention programme over a 12 month follow-up period after the introduction of a RCT and to describe possible differences between incidence density rate of falls associated with caregiver time during weekends and ordinary working days. DESIGN: Prospective observational study, duration 12 months. SETTING: Six community nursing homes, Germany. PARTICIPANTS: Long-stay residents (n=881); 771 resident years; median age 85.0 years (min 60; max 101); 79.1% female. MEASUREMENTS: Incidence density rate of falls and fractures, staff time per resident. RESULTS: The incidence density rate over all days was 1367/1000 resident years (RY) for falls [95% confidence interval 1041;1693]. The incidence density rate of hip fractures was 29/1000 RY [95% confidence interval 12;45] and 29/1000 RY [95% confidence interval 12;45] for non-hip fractures. The incidence density rate showed similar results comparing weekends/ public holidays vs normal working days; falls 1193 vs 1447/ 1000 RY; hip fractures 25 vs 30/ 1000 RY and other fractures 16 vs 34/1000 RY. CONCLUSION: During the period, we observed a marked decline of the fracture rate compared with the controlled phase of the intervention trial. A lower number of nursing care hours on weekends was not associated with a higher incidence density rate for falls, fallers, or any type of fracture.

Risk indicators for falls in institutionalized frail elderly.

The aim of this study was to identify individual predisposing risk indicators for falls in a sample of institutionalized frail elderly in southern Germany. The design was a prospective observational study with a 1-year follow-up (October 1998-September 1999). The study population included 472 long-term-care residents whose mean age was 84 years; 77% were female. Risk indicators for accidental falls were analyzed by using logistic regression. Residents were found to have an incidence density rate of falls of 2,558 per 1,000 resident-years. Multiple logistic regression analysis revealed short-term memory loss, transfer assistance, urinary incontinence, positive fall history, and use of trunk restraints as predictors of falls. In a further logistic regression analysis, depressive symptoms, transfer assistance, urinary incontinence, and positive fall history were associated with frequent falls. Using these risk indicators as a screening procedure to identify fallers would be easy to administer and could be accomplished by nursing staff. Study results encourage specifically addressing urinary incontinence, cognitive impairment, use of restraints, depression, and transfer difficulties as modifiable predisposing risk factors for falls. Fall history represents an important nonmodifiable marker to identify residents at high risk.

[Surgical treatment for boutonniere deformity of the fingers. Retrospective study of 47 patients]. / Traitement chirurgical de la déformation en boutonnière des doigts longs. Etude d'une série rétrospective de 47 patients.

Disruption or laceration of the central slip of the extensor tendon at the proximal interphalangeal (PIP) joint with volar displacement of the lateral bands can result in the so-called boutonniere deformity which includes loss of extension at the PIP joint and compensatory hyperextension of the distal interphalangeal (DIP) joint. Many procedures has been described in the literature and no standard treatment can be recommended. The authors reports a series of 47 cases of posttraumatic boutonniere deformity. The mean follow-up was five years. Majority of patients were males (38 males). The mean age was 41 years-old (17-82 y.o.). The etiology was in 23 cases a missed subcutaneous disruption of the central slip of the extensor tendon and in 24 cases an inappropriate treatment of laceration of the extensor apparatus at the dorsal aspect of the PIP joint. The involved digit was in seven cases the index finger, in 14 cases the long finger, in 14 cases the ring finger and in 12 cases the little finger. It is essential to distinguish the supple boutonniere deformity without or after physical therapy (34 cases) and the stiff boutonniere deformity even after a hand physical therapy program (13 cases). Results were assessed on pain and active range of motion of the PIP joint as well as the range of motion of the DIP joint. Supple boutonniere deformities, except one treated by an isolated distal tenotomy of the extensor tendon (1/34), was treated by a procedure of reconstruction of the extensor apparatus including resection-suture of the central slip and redorsalisation of the lateral bands when there was a DIP hyperextension with a moderate flexion deformity of the PIP joint, and (33/34) with 90% of excellent and good results. Poor results (4/33) were due in two cases to the absence of physical therapy, in one case to septic osteoarthritis and in one to secondary rupture of the suture. For the 13 stiff boutonniere deformities, when the PIP flexion deformity was moderate, a distal tenotomy performed to correct the DIP hyperextension was satisfactory in three cases with a useful result (20 degrees-70 degrees). For destroyed PIP joint (osteoarthritis), two silicone spacers were implanted with also a satisfactory result (30 degrees-70 degrees). In the eight remaining cases, a teno-arthrolysis was performed combined with a reconstruction of the extensor apparatus as described. Six poor results were obtained with arthritic PIP joints (which should have required initially silicone implants), and two fair results (30 degrees-60 degrees) with non-destroyed PIP joints. Supple boutonniere deformity must always be treated by initial physical therapy. Surgical procedure with reconstruction of the extensor apparatus is satisfactory if the PIP joint is normal. When there is PIP osteoarthritis, it may be beneficial to perform a two-stage technique with tenoarthrolysis followed hand therapy and a secondary reconstruction of the extensor apparatus as these last procedure give satisfactory results on a supple boutonniere deformity.

Effects of a group exercise program on strength, mobility, and falls among fall-prone elderly men.

OBJECTIVES: This randomized controlled trial studied the effects of a low- to moderate-intensity group exercise program on strength, endurance, mobility, and fall rates in fall-prone elderly men with chronic impairments. METHODS: Fifty-nine community-living men (mean age = 74 years) with specific fall risk factors (i.e., leg weakness, impaired gait or balance, previous falls) were randomly assigned to a control group (n = 28) or to a 12-week group exercise program (n = 31). Exercise sessions (90 minutes, three times per week) focused on increasing strength and endurance and improving mobility and balance. Outcome measures included isokinetic strength and endurance, five physical performance measures, and self-reported physical functioning, health perception, activity level, and falls. RESULTS: Exercisers showed significant improvement in measures of endurance and gait. Isokinetic endurance increased 21% for right knee flexion and 26% for extension. Exercisers had a 10% increase (p < .05) in distance walked in six minutes, and improved (p < .05) scores on an observational gait scale. Isokinetic strength improved only for right knee flexion. Exercise achieved no significant effect on hip or ankle strength, balance, self-reported physical functioning, or number of falls. Activity level increased within the exercise group. When fall rates were adjusted for activity level, the exercisers had a lower 3-month fall rate than controls (6 falls/1000 hours of activity vs 16.2 falls/1000 hours, p < .05). DISCUSSION: These findings suggest that exercise can improve endurance, strength, gait, and function in chronically impaired, fall-prone elderly persons. In addition, increased physical activity was associated with reduced fall rates when adjusted for level of activity.

Chronic leptin administration increases insulin-stimulated skeletal muscle glucose uptake and transport.

Leptin, the product of the ob gene, has been shown to reduce fat mass, food intake, hyperglycemia, and hyperinsulinemia and to increase whole-body glucose disposal. However, it is unknown if leptin improves insulin action in skeletal muscle. Therefore, the purpose of this investigation was to determine if chronic leptin administration increases insulin-stimulated skeletal muscle glucose uptake and transport. Sixty-nine female Sprague-Dawley rats (240 to 250 g) were randomly assigned to one of three groups: (1) control, (2) pair-fed, and (3) leptin. All animals were subcutaneously implanted with miniosmotic pumps that delivered 0.5 mg leptin/kg/d to the leptin animals and vehicle to the control and pair-fed animals for 14 days. Following this 14-day period, all animals were subjected to hindlimb perfusion to determine the rates of skeletal muscle glucose uptake and 3-O-methyl-D-glucose (3-MG) transport under basal, submaximal (500 microU/mL), and maximal (10,000 microU/mL) insulin concentrations. Chronic leptin treatment significantly increased (P < .05) the rate of glucose uptake across the hindlimb by 27%, 32%, and 47% under basal, submaximal, and maximal insulin, respectively, compared with the control and pair-fed condition. However, when the submaximal rate of glucose uptake was expressed as a percentage of maximal insulin-stimulated glucose uptake, no differences existed among the groups, indicating that leptin treatment does not increase insulin sensitivity. Rates of 3-MG transport in the soleus, plantaris, and white and red portions of the gastrocnemius (WG and RG) were significantly increased (P < .05) in leptin animals under all perfusion conditions. 3-MG transport was not different between control and pair-fed animals. Collectively, these findings suggest that improvements in insulin-stimulated skeletal muscle glucose uptake and transport following chronic leptin treatment result from increased insulin responsiveness.

Growth inhibition by a triple ribozyme targeted to repetitive B2 transcripts.

The B2 family represents a group of short repetitive sequences that are found throughout the rodent genome and are analogous to the human Alu sequences. Certain B2 subfamilies are transcribed by RNA polymerase III (pol III), and this transcription is in part controlled by the retinoblastoma protein. In addition to their putative role in retrotranspositional events, these actively transcribed B2 RNAs show a predicted highly stable secondary structure. Although B2 transcripts are normally confined to the nucleus, they demonstrate altered compartmentation after carcinogen treatment, in cancers, and in immortalized and/or transformed cell lines, the significance of which is unclear. Because modulation of B2 transcripts did not seem feasible with an antisense approach, we designed a triple ribozyme (TRz) construct to down-regulate B2 transcripts. The B2-targeted TRz undergoes efficient self-cleavage, resulting in liberation of the internal hammerhead Rz, which we targeted to a single-stranded region of the consensus B2 sequence. The liberated internal targeted Rz was 20 times more active than the corresponding double-G mutant construct that could not undergo self-cleavage, and 5 times more active than the same Rz flanked by nonspecific vector sequences. The B2-targeted TRz was used to develop stable transfectant clones from an SV40-immortalized hepatocyte cell line. These transfectant clones all showed variably reduced growth rates, accompanied by significant reductions in both cytoplasmic and nuclear B2 RNA levels: linear regression analyses showed that their growth rates were directly related to residual cytoplasmic B2 levels. Reverse-transcription polymerase chain reaction (RT-PCR) analyses documented efficient self-liberation of the internal targeted Rz in vivo, and showed that the relative cytoplasmic expression levels generally paralleled the magnitude of the decrease in B2 transcripts. The RT-PCR analyses further demonstrated that up to 20% of the Rz was located in the nucleus, which presumably reflects competition between autocatalytic processing and nucleocytoplasmic transport of the initial TRz transcript.

[Rupture in the palm of a flexor tendon in a young man with osteogenesis imperfecta]. / Rupture à la paume d'un tendon fléchisseur chez un homme jeune atteint d'ostéogenèse imparfaite.

Flexor tendon rupture in the palm of the hand is very infrequent. It usually occurs in association with an underlying pathological condition. We report a case of hand tendon rupture in a patient with osteogenesis imperfecta (OI). This disease is typically characterised by brittle bones but other tissues rich in collagen, such as tendons, may also be involved. The ruptured tendon was diagnosed one month post-injury and was treated by tendon graft. Six months later, tenolysis was performed and one year post-injury flexion was still limited at the distal interphalangeal joint. Few cases of tendon lesions and OI have been reported in the literature. Rupture occurs at the bony insertion and the outcome is good the poor outcome in our case could be due to alteration of the collagen tissue of the tendon.

Self-transcendence in older men attending a prostate cancer support group.

Self-transcendence has been shown to be related to well-being in older adults, women with breast cancer, women with AIDS, gay men with AIDS, and a healthy population. The purpose of this descriptive pilot study was to examine self-transcendence in another high-priority population: older men with prostate cancer. A convenience sample of 23 men, age 60 and older (M = 69), from three prostate cancer support groups completed Reed's Self-Transcendence Scale (STS) and a demographic data form. The men were predominantly white (82.6%), of the Catholic faith (56.5%), married (78.3%), and not working (87.0%). Over half (65.2%) had a college degree or higher; most viewed their health as good (69.6%) or excellent (21.7%); and the majority (56.5%) viewed their prostate cancer as affecting some of their daily activities. These men scored high on the STS (M = 50.07), which was consistent with previous findings in other populations. Findings of this study contribute to Reed's middle-range theory of self-transcendence. The discovery that self-transcendence is relevant to this group of older men with prostate cancer provides a basis for nurses to investigate the phenomenon in this population and help their clients explore the benefits of the self-transcendence resource.

Triple ribozyme-mediated down-regulation of the retinoblastoma gene.

We have been developing triple ribozyme (TRz) constructs which consist of two cis-acting ribozymes flanking an internal trans-acting ribozyme, which is targeted to a cellular RNA. Actions of the two cis-acting ribozymes efficiently liberate the internal ribozyme with minimal non-specific flanking sequences. The liberated internal targeted ribozyme shows substantially greater catalytic activity than TRz preparations, constructs which cannot undergo self-liberation or than single ribozymes with flanking vector sequences. Here we construct a TRz which was targeted to retinoblastoma gene (Rb) mRNA, which cleaved Rb target RNA in vitro as expected. A number of tetracycline-regulatable clones stably transfected with the Rb-targeted TRz were developed and analyzed. The internal targeted ribozymes were efficiently liberated in vivo and the stably transfected clones showed varied reductions in Rb mRNA, which were contingent upon ribozyme expression and catalytic activity. The two clones showing major reductions in Rb mRNA (and pRb) levels (>70% reduction) showed abnormal morphology, loss of contact inhibition and the ability to grow in soft agar, as well as altered compartmentation of repetitive B2 transcripts, a phenomenon previously associated with immortalization and/or transformation. TRz constructs coupled with tissue-specific promoters should allow development of in vivo models in which Rb function is markedly reduced in a tissue-specific manner.

Sprains of the radial collateral ligament of the metacarpophalangeal joint of the thumb. A series of 14 cases.

Fourteen surgically treated radial sprains of the M.P. joint of the thumb, are reported. 8 were recent cases, 6 were longstanding. At the time of surgery, the extensor head was severed in 4 cases, the APB tendon in 6 cases, the dorsal articular capsule in 9. The radial collateral ligament was elongated 6 times, ruptured 4 times, and presented bony avulsion in 4 cases. The mean postoperative immobilization was 37 days. 13 patients were reviewed with a mean follow-up of 22 months. Only eight were satisfied. The mean loss of motion was 27 degrees. The mean laxity, assessed on specific dynamic X-rays, was 6 degrees. 3 patients presented with radiographic arthritis, all of them with chondral lesions at the time of surgery. Despite the absence of Stener's lesion, the authors recommend surgery when volar subluxation or radial laxity is observed > 10 degrees.

A randomized trial of walking versus physical methods for chronic pain management.

We conducted a pilot study to evaluate a practical exercise program for elderly people with chronic musculo-skeletal pain. Thirty-three subjects (mean age, 73 years; 69% back pain; 24% knee pain; 9% hip pain) were randomly assigned to one of three groups. Group 1 received 6-week supervised program of walking. Group 2 received a pain education program that included instruction and demonstration of use of heat, cold, massage, relaxation and distraction. Group 3 received usual care. Outcomes including pain, self-reported health and functional status, and performance-based measures of functional status were evaluated at baseline, at two weeks and at eight weeks (end of study). Attendance was 100% for the education sessions and 93% for walking sessions. No injuries were sustained. Both intervention groups demonstrated significant improvements in pain (p < 0.05) and performance-based measures of functional status (p < 0.05), while the control group had no changes. These data suggest that patient education and fitness walking can improve overall pain management and related functional limitations among elderly people with chronic musculo-skeletal pain.