Differences in the radiological characteristics between post-traumatic and non-traumatic knee osteoarthritis.

Osteoarthritis (OA) of the knee can be defined as primary (non-traumatic) or secondary (post-traumatic). Both non-traumatic OA and post-traumatic OA have been described predominantly in the medial compartment of the knee. The objective of this study was to compare the location of structural radiographic changes in non-traumatic OA and post-traumatic OA. A non-traumatic cohort, consisting of 155 patients suffering from chronic knee pain without known major injuries, was compared with a post-traumatic cohort, consisting of 176 patients, all of whom had sustained an anterior cruciate ligament injury while playing soccer. A standardized weight-bearing knee radiography of the tibiofemoral joint was performed. Joint space narrowing (JSN) and osteophytes were graded according to the radiographic atlas of the Osteoarthritis Research Society International. JSN and osteophytes were located predominantly in the medial compartment in the non-traumatic cohort. In the post-traumatic cohort, structural changes were evenly distributed between the lateral and the medial compartments. We were thus able to demonstrate radiological differences between post-traumatic and non-traumatic OA.

The effect of eight weeks of exercise on knee adduction moment in early knee osteoarthritis--a pilot study.

OBJECTIVE: Reduced muscle function, causing greater knee joint load, is a potentially modifiable risk factor of knee osteoarthritis (OA). Exercise is an important treatment of knee OA, but the effect on joint load has not been determined. The aim of this study was to investigate the effect of exercise on knee adduction moment during one-leg rise and gait. DESIGN: Patients below age 65 with early signs of radiographic knee OA, from a population-based cohort on OA development, were invited to participate in the study. They defined their most symptomatic knee as the index knee. Knee adduction moment during one-leg rise from a stool (48cm), and during gait was assessed using a three-dimensional motion analysis system, before and after eight weeks of supervised exercise. RESULTS: Thirteen patients, seven women, mean age 54.5, 12/13 with Kellgren and Lawrence grade I or II, took part in the study. Peak knee adduction moment during one-leg rise was reduced by 0.08 (95% CI 0.01;0.16) Nm/kg, or 14%, for the index knee, and 0.05 (95% CI -0.04;0.14), or 8% for the opposite knee after eight weeks. The reductions in peak adduction moment during gait were smaller and not significant. CONCLUSIONS: This study indicates that peak knee adduction moment could be reduced by supervised, individualized exercise in middle-aged patients presenting early signs of knee osteoarthritis, suggesting further investigation of this area. Peak adduction moment during one-leg rise seems to be more sensitive to deviations and change than peak adduction moment during gait in this population.

Knee kinematics and kinetics during gait, step and hop in males with a 16 years old ACL injury compared with matched controls.

The objective of this study was to compare subjects who sustained an ACL injury during soccer 16 years ago with a control group with regard to knee kinematics and kinetics of gait, step activity and cross over hop. Secondly, in the injured subjects, the purpose was to study the impact on kinematics and kinetics of characteristics such as operative status, meniscal resection, being symptomatic, having knee extensor weakness and of having radiographic knee OA. Data from a 3-dimensional gait analysis system (VICON) were used to calculate kinetics and kinematics during gait, step activity and cross over hop of 12 male subjects who had an anterior cruciate ligament injury 16 years earlier. Twelve uninjured subjects matched for age, sex, BMI and activity level served as controls. No significant differences in knee kinematics and kinetics between the ACL group and the control group were found. The variability of some parameters of step and all parameters of hop activity was generally larger in the ACL injured subjects compared with the controls. The ACL injured subjects had a significantly worse clinical status compared with the controls. Reduced knee extension strength was associated with joint moment reductions especially during step activity and cross over hop. Despite a significantly worse clinical status, as determined by self-report and isokinetic strength testing, no significant differences were seen in knee joint kinetics and kinematics in an ACL injured group 16 years after injury compared with a matched control group. The variation was larger among the ACL injured subjects indicating the need for larger study groups in gait and movement analysis in long-term follow-up of ACL injury.

High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes.

OBJECTIVE: To identify the consequences of an anterior cruciate ligament (ACL) tear in a cohort of male soccer players 14 years after the initial injury with respect to radiographic knee osteoarthritis and patient relevant outcomes. METHODS: Of 219 male soccer players with an ACL injury in 1986, 205 (94%) were available for follow up after 14 years; 75% of the cohort (154/205) answered mailed questionnaires (KOOS, SF-36, and Lysholm knee scoring scale) and 122 of these consented to weight bearing radiographs. RESULTS: Radiographic changes were found in 95 (78%) of the injured knees, while more advanced changes, comparable with Kellgren-Lawrence grade 2 or higher, were seen in 50 (41%). In the uninjured knees more advanced changes, comparable with Kellgren-Lawrence grade 2 or higher, were seen in five knees (4%). No differences were seen between surgically and conservatively treated players. The patient relevant outcome was affected and did not differ between subjects with and without radiographic changes. Eighty per cent reported reduced activity level. CONCLUSIONS: A high prevalence of radiographic knee osteoarthritis was seen in male soccer players 14 years after an ACL disruption. The injury and the osteoarthritis, irrespective of the treatment provided to these patients, often result in knee related symptoms that severely affect the knee related quality of life by middle age.

The need for routine pre-operative coagulation screening tests (prothrombin time PT/partial thromboplastin time PTT) for healthy children undergoing elective tonsillectomy and/or adenoidectomy.

In some medical centers, the routine pre-operative evaluation of healthy children undergoing elective tonsillectomy and/or adenoidectomy (T and A) includes coagulation screening tests (PT, prothrombin Time; PTT, partial thromboplastin time; and INR, international normalized ratio). In this retrospective study, we determined whether there is a positive correlation between prolonged PT/PTT/INR tests in healthy children, with no prior medical history of coagulation problems, and bleeding during surgery and/or bleeding in the month following surgery. We reviewed the records of 416 elective T and A surgeries performed at the Soroka University Medical Center in Beer-Sheva, Israel, over the course of 1999. One hundred and twenty-one (29.1%) patients had preoperative prolonged PT values but only four (3.3%) of these patients experienced light bleeding during surgery. Seven (5.8%) of the 121 patients with prolonged PT tests experienced bleeding episodes during the 1st month subsequent to the surgery. Of the 65 (15.6%) patients who had prolonged pre-operative INR values, only three (4.6%) experienced light bleeding during surgery. Two (3.1%) patients with prolonged INR values experienced light bleeding during the 1st month subsequent to surgery. Sixty-one (14.7%) patients had prolonged first preoperative PTT values, only five of whom (8.2%) experienced light bleeding during surgery. Two (3.3%) of the 61 with prolonged PTT values experienced light bleeding during the 1st month subsequent to surgery. We therefore concluded that pre-operative coagulation screening tests provide low sensitivity and low bleeding predictive value. As such, routine coagulation tests before T &A are not indicated unless a medical history of bleeding tendency is suspected.

Appropriateness of pediatric admissions to a tertiary care facility in Israel.

BACKGROUND: Appropriateness of hospital admission has both clinical and economic relevance, especially in light of the growing pressure for increased efficiency of health services utilization. In Israel, the number of referrals and use of the emergency room continue to rise along with an increase in hospital admissions and the number of inappropriate admissions. Using evaluation protocols, such as the Pediatric Appropriateness Evaluation Protocol, international studies have shown that 10-30% of hospital admissions are medically unnecessary. Inappropriate hospitalizations have an economic impact as well as medical and psychological effects on the child and the family. OBJECTIVES: To assess the extent and characteristics of inappropriate pediatric admissions to a tertiary care facility in Israel. METHODS: We conducted a prospective study using chart review of pediatric admissions to Soroka University Medical Center on 18 randomly selected days in 1993, and evaluated the appropriateness of admissions using the PAEP. RESULTS: Of the 221 pediatric admissions 18% were evaluated as inappropriate. The main reason for such an evaluation was that the problem could have been managed on an ambulatory basis. Inappropriate admissions were associated with hospitals stays of 2 or less days, children older than 1 year of age, Jewish children, and self-referrals to the pediatric emergency room. CONCLUSIONS: The assessment and identification of characteristics of inappropriate hospital admissions can serve as indicators of problems in healthcare management and as a basis for improving quality of care and developing appropriate medical decision-making processes.

Regulation of intra-Golgi membrane transport by calcium.

Calcium cations play a critical role in regulating vesicular transport between different intracellular membrane-bound compartments. The role of calcium in transport between the Golgi cisternae, however, remains unclear. Using a well characterized cell-free intra-Golgi transport assay, we now show that changes in free Ca(2+) concentration in the physiological range regulate this transport process. The calcium-chelating agent 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid blocked transport with an IC(50) of approximately 0.8 mm. The effect of 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid was reversible by addition of fresh cytosol and was irreversible when performed in the presence of a Ca(2+) ionophore that depletes calcium from lumenal stores. We demonstrate here that intra-Golgi transport is stimulated by low Ca(2+) concentrations (20-100 nm) but is inhibited by higher concentrations (above 100 nm). Further, we show that calmodulin antagonists specifically block intra-Golgi transport, implying a role for calmodulin in mediating the effect of calcium. Our results suggest that Ca(2+) efflux from intracellular pools may play an essential role in regulating intra-Golgi transport.

A 56-kDa selenium-binding protein participates in intra-Golgi protein transport.

Transport of proteins between intracellular membrane compartments is a highly regulated process that depends on several cytosolic factors. By using the well characterized intra-Golgi cell-free transport assay, we purified from bovine brain cytosol a 56-kDa protein that shows a significant transport activity. Partial sequencing of four tryptic peptides obtained from the 56-kDa protein revealed its identity to a cytosolic protein previously characterized as a selenium-binding protein, SBP56. Recombinant SBP56 expressed in Escherichia coli exhibited transport activity when added to the cell-free intra-Golgi transport. Affinity purified anti-SBP56 polyclonal antibodies specifically inhibited intra-Golgi transport in vitro. Although SBP56 is predominantly localized in the cytosol, a significant amount is associated with membranes. Subcellular fractionation showed that this protein is peripherally associated with the Golgi membrane. The experiments presented in this study indicate that SBP56 participates in late stages of intra-Golgi protein transport.

GATE-16, a membrane transport modulator, interacts with NSF and the Golgi v-SNARE GOS-28.

Membrane proteins located on vesicles (v-SNAREs) and on the target membrane (t-SNAREs) mediate specific recognition and, possibly, fusion between a transport vesicle and its target membrane. The activity of SNARE molecules is regulated by several soluble cytosolic proteins. We have cloned a bovine brain cDNA encoding a conserved 117 amino acid polypeptide, denoted Golgi-associated ATPase Enhancer of 16 kDa (GATE-16), that functions as a soluble transport factor. GATE-16 interacts with N-ethylmaleimidesensitive factor (NSF) and significantly stimulates its ATPase activity. It also interacts with the Golgi v-SNARE GOS-28 in an NSF-dependent manner. We propose that GATE-16 modulates intra-Golgi transport through coupling between NSF activity and SNAREs activation.

ERG30, a VAP-33-related protein, functions in protein transport mediated by COPI vesicles.

Intracellular transport of newly synthesized and mature proteins via vesicles is controlled by a large group of proteins. Here we describe a ubiquitous rat protein-endoplasmic reticulum (ER) and Golgi 30-kD protein (ERG30)-which shares structural characteristics with VAP-33, a 33-kD protein from Aplysia californica which was shown to interact with the synaptic protein VAMP. The transmembrane topology of the 30-kD ERG30 corresponds to a type II integral membrane protein, whose cytoplasmic NH(2) terminus contains a predicted coiled-coil motif. We localized ERG30 to the ER and to pre-Golgi intermediates by biochemical and immunocytochemical methods. Consistent with a role in vesicular transport, anti-ERG30 antibodies specifically inhibit intra-Golgi transport in vitro, leading to significant accumulation of COPI-coated vesicles. It appears that ERG30 functions early in the secretory pathway, probably within the Golgi and between the Golgi and the ER.

A new look at low back complaints in primary care: a RAMBAM Israeli Family Practice Research Network study.

BACKGROUND: Low back pain (LBP) is one of the most frequent reasons patients seek consultations in primary care, and it is a major cause of disability. Our research examines the natural history of LBP and the prediction of chronicity in the context of patients presenting to family medicine clinics. METHODS: We performed a prospective cohort study of new episodes of LBP within the framework of a national family practice research network. The setting was 28 primary care family practice clinics located throughout Israel. Of 238 eligible subjects, 219 (92%) completed the study. RESULTS: During the 2-month study period, 2 subjects were referred to the emergency department and discharged, and 2 others were hospitalized. Forty-five percent did not require bed rest, and 38% of the employed were not absent from work. Seventy-one percent showed improvement in functional status; however, only 37% noted complete pain relief. Clinical and demographic data usually did not predict LBP-episode outcomes. The strongest predictors of chronicity were depression, history of job change due to LBP in the past, history of back contusion, lack of social support, family delegitimization of patient's pain, dissatisfaction with first office visit, family history of LBP or other chronic pain, coping style, and unemployment. CONCLUSIONS: The cohort patients displayed a relatively benign natural history of LBP, matched by benign clinical behavior from their physicians. In Israeli primary health care, acute LBP is infrequently associated with hospitalization or prolonged work absenteeism. Although most patients have functional improvement, pain often lingers. Almost all predictors of chronicity are psychosocial.

Isolation and characterization of a novel low molecular weight protein involved in intra-Golgi traffic.

Analysis of the cytosolic requirements for in vitro intra-Golgi transport led to the characterization of three proteins: N-ethylmaleimide-sensitive fusion protein (NSF), soluble NSF attachment protein (SNAP), and p115, all involved in the docking and fusion of transport vesicles to their target membranes. In the course of determining the minimal cytosolic requirements for intra-Golgi transport in vitro, we identified three additional factors that are sufficient to replace crude cytosol. We describe here the purification and characterization of one of these factors, a novel 16-kDa protein, p16, an essential factor for intra-Golgi protein transport. Based on transport activity, this purification procedure resulted in approximately 1,400-fold enrichment of p16 to apparent homogeneity. The activity of p16 could be observed in the absence of vesicle formation, suggesting that it may participate in the docking and fusion processes.

Planter foot pressures in pregnant women.

UNLABELLED: The physiological changes occurring during pregnancy may be responsible for the faulty foot position leading to backache and lower limb pain. We evaluated the changes in the plantar foot pressures during pregnancy. Twenty-eight, full-term, healthy, pregnant women, average age 28 years, were examined and evaluated clinically, and the plantar foot pressure distribution was measured statically and dynamically using the EMED system. Twenty-eight, non-pregnant women, average age 25 years, served as the control group. In the static measurements, the pregnant women had significantly lower maximal forefoot pressures and higher hindfoot pressures than the non-pregnant women. The area of the foot in contact with the measuring pressure plate was greater in the pregnant women than in the non-pregnant women. In the dynamic measurements, the maximal force in almost every area of interest was significantly higher. The total force exerted on the pressure plate at the instant of maximal force of every area of interest during the whole step was higher in the pregnant group. On the medial side of the forefoot there was a slight decrease in the contact time of the maximal force. The peak pressures were higher in the midfoot of both feet and on the lateral side of the right forefoot in the pregnant women. In the medial side of the forefoot, the peak pressures were lower in pregnant women. CONCLUSIONS: The pregnant woman has a different pattern of gait. There is an increase of load on the lateral side of the foot and the hindfoot. These changes may be responsible for the musculoskeletal complaints of lower limb pain in pregnant women.

Medical patients assessment protocol: a tool for evaluating the appropriateness of utilizing hospital-stay days for acute medical patients; development, reliability and applications.

An attempt was made to formulate a tool that, when compared to the appropriateness evaluation protocol (AEP) used for evaluating the utilization of hospital services for medical patients, would be an improvement. To establish this, a four-phase project was evolved, which included: (a) taxonomy definition of medical and nonmedical reasons for acute-care hospital bed utilization for a day of care, (b) use of the preliminary protocol by trained nurses to extend the range of clinical conditions included, (c) independent review of the protocol by three senior physicians, and (d) comparative interrater reliability and feasibility study between the new instrument-the medical patients assessment protocol (MPAP) and the AEP. We found the MPAP to have a higher inter-rater reliability than the AEP (kappa = 0.94 and 0.78, respectively), to be more clinically oriented, more comprehensive, and similar to the AEP regarding the time required for investigation of cases. Therefore, we recommend the use of the MPAP for management and quality control of medical hospitalized patients.

Use of EEG spectral edge as index of equipotency in a comparison of propofol and isoflurane for maintenance of general anaesthesia.

Propofol and isoflurane were compared for haemodynamic stability and recovery time as main anaesthetic agents for maintenance in a total of 43 ASA I and II patients in uncomplicated operations lasting at least 30 min. The premedication (oral diazepam), induction (thiopentone-fentanyl-suxamethonium) and maintenance protocol (N2O-O2 2:1 litre min-1, fentanyl and vecuronium in incremental doses) were identical for all patients. In one group of 20 patients, propofol was used in continuous intravenous (i.v.) infusion (starting dose 3 mg kg-1 h-1), while in the second group of 23 patients, isoflurane was administered in a starting concentration of 1%. To improve the equipotency of the two agents in all cases the dose of the main anaesthetic was titrated to keep the EEG 90% spectral edge frequency (SEF-recorded by processed EEG monitor) between 8 and 12 Hz. Mean blood pressure (BP) and heart rate (HR) deviations of +/- 20% from the baseline were recorded. The incidence of mean blood pressure deviations/case in the propofol group was less than half of those occurring in the isoflurane group (0.45 vs. 0.96 P = 0.04). The mean duration of blood pressure deviation from baseline value was 5.5 min in the propofol group vs. 16.8 min in the isoflurane group (P = 0.01). The recovery intervals were significantly shorter in the propofol group (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Accuracy of blood glucose measured in the hospital].

Glucometer determination of capillary blood sugar (CBS) has replaced determination of glucose in the urine and in venous blood for monitoring and treating inpatient diabetics. CBS determinations were performed by 49 ward nurses chosen at random. Each performed 2 CBS measurements using an Ames Glucometer; glucose levels were also determined using a glucose-analyzer in blood obtained from the same finger puncture. Accuracy of technique was evaluated on a scale of 1 (inaccurate) to 5 (accurate) by the hospital diabetes nurse and a questionnaire was completed. A deviation of < 20% between Glucometer and glucose-analyzer results was considered satisfactory. 58% of nurses deviated by 20% or more. There was no significant correlation between accuracy of measurement and the nurse's age, seniority, department, source of instruction or number of weekly determinations. 71% of non-registered nurses and 45% of registered nurses tested inaccurately. There was a significant correlation between performance score given by the diabetes nurse and accuracy of measurement. We therefore conclude that the inaccuracy of Glucometer measurements by ward nurses is significant, registered nurses need to be trained and certified periodically in Glucometer use, an ongoing quality assurance program must be instituted on the wards, and "user-friendly" Glucometers are not suitable for ward use.

Control-related beliefs and sleep characteristics of posttraumatic stress disorder patients.

To examine correlations among chronic Posttraumatic Stress Disorder (PTSD), control-related beliefs, and sleep difficulties 7 PTSD casualities and 7 non-PTSD matched subjects were compared in their laboratory sleep patterns as well as in their beliefs about personal control over external and internal events in general and over sleep-related events in particular. Analyses indicated that PTSD casualties had poorer sleep and reported more doubts regarding their ability to control external and internal events than control subjects. Further, we found a significant association between perceived control and sleep difficulties. Results were discussed in terms of Horowitz's conception of intrapsychic processes related to PTSD.

Effects of chlorothiazide on 1,25-dihydroxyvitamin D3, parathyroid hormone, and intestinal calcium absorption in the rat.

Previous studies have shown that thiazide diuretic agents reverse secondary hyperparathyroidism and reduce circulating 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] and intestinal calcium absorption rates in patients with idiopathic hypercalciuria of the renal-leak variety. We have investigated whether thiazides can reverse the secondary increase in serum parathyroid hormone (PTH) and 1,25(OH)2D3 levels or intestinal calcium absorption induced by feeding rats a diet low in calcium (LCD, 0.02% calcium) but adequate in phosphorus and vitamin D. We found that LCD increased circulating immunoreactive PTH [chow vs. LCD, 0.52 +/- 0.06 vs. 1.06 +2- 0.1 (SE) ng/ml, P less than 0.001], 1,25(OH)2D3 (chow vs. LCD, 101 +/- 15 vs. 325 +/- 38 pg/ml, P less than 0.001), calcium uptake by everted gut sacs from duodenum, ileum, and descending colon, and net calcium absorption by descending colon studied in Ussing chambers in vitro. Chlorothiazide (CTZ) prevented the increase in PTH during LCD (chow + CTZ vs. LCD + CTZ, 0.69 +/- 0.07 vs. 0.73 +/- 0.06, NS) but not the increase in 1,25(OH)2D3 (chow + CTZ vs. LCD + CTZ, 88 +/- 10 vs. 277 +/- 31, P less than 0.002) or intestinal calcium transport. The drug caused no change in serum 1,25(OH)2D3 or intestinal calcium absorption in rats fed normal chow. In rats given exogenous 1,25(OH)2D3 to stimulate intestinal calcium absorption, CTZ reduced urine calcium excretion greatly but did not alter intestinal calcium absorption.