Examining the evidence for policy and environmental strategies to prevent childhood obesity in black communities: new directions and next steps.

Exposure to physical and policy environments that limit availability, affordability and appeal of healthy eating and active living options is higher for U.S. blacks than whites. This may contribute to high risk of obesity in black communities and limit effectiveness of preventive interventions. Here, we assess applicability to black Americans of findings from a prior evidence review system designed to accelerate the discovery and application of policy and environmental strategies for childhood obesity prevention and assess external validity. The database included 600 peer-reviewed articles reporting data from 396 sets of studies (study groupings) published from January 2000 through May 2009 and pertained to 24 types of policy and environmental strategies. Only 33 study groupings (~8%) included ≥ 50% black Americans or reported subgroup analyses. Of 10 evaluation studies for interventions rated as effective for all populations in the primary review, 8 suggested effectiveness of child-focused interventions in school or child care settings for obesity- or physical activity-related outcomes in black Americans. Overall findings highlight the need for rigorous evaluations of interventions that reach black children in community or institutional settings, and conceptual frameworks and research designs geared to identifying ethnic or ethnicity-income group differences in intervention effects.

The impact of change in pregnancy body mass index on the development of gestational hypertensive disorders.

OBJECTIVE: To examine the impact of change in body mass index (BMI) during pregnancy on the incidence of gestational hypertension/preeclampsia. STUDY DESIGN: This is a retrospective cohort study using linked California birth certificate and discharge diagnosis data from the year 2007. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated for the outcome of gestational hypertension/preeclampsia, as a function of a categorical change in pregnancy BMI: BMI loss (<-0.5), no change (-0.5 to 0.5), minimal (0.6 to 5), moderate (5.1 to 10) and excessive (>10). The impact of change in pregnancy BMI was evaluated for the entire cohort and then as a function of prepregnancy BMI category. Women with no change in pregnancy BMI served as the reference group. RESULT: The study population consisted of 436 414 women with singleton gestations. Overall, women with excessive BMI change had a nearly twofold increased odds of gestational hypertension/preeclampsia (aOR=1.94; 95% CI=1.72 to 2.20). By prepregnancy BMI class, overweight and obese women who had a moderate change in pregnancy BMI also had increased odds of developing gestational hypertension/preeclampsia with aOR ranging from 1.73 to 1.97. CONCLUSION: Regardless of prepregnancy BMI category, women with excessive BMI change have a higher chance of developing gestational hypertension/preeclampsia. Overweight and obese women with moderate BMI change may also be at increased risk.

Ligament balancing in computer-assisted total knee arthroplasty: improved clinical results with a spring-loaded tensioning device.

Total knee arthroplasty (TKA) remains one of the most successful procedures in orthopaedic surgery. Complications certainly exist and are often related to failure of knee ligament balance. This asymmetry subsequently leads to component mal-alignment and loosening often secondary to deviation of the lower extremity mechanical axis. Understanding knee mechanics is essential, and recent technological advances have begun to minimize postoperative problems. A tensioning device that respects the native patellofemoral anatomy as well as the natural ligamentous strains has been developed. The surgical integration of computer-assisted navigation has allowed for enhanced accuracy and subsequently better results. The purpose of the current paper is to discuss the evolution of an improved ligament tensioning device, in the setting of classic mechanical guidance versus computer assistance and its postoperative impact on total knee outcomes in terms of manipulation rates and two-year radiographic alignment data. Based on a single surgeon series, mechanically guided arthroplasties resulted in a 16 per cent manipulation rate. Computer assistance with spacer blocks decreased the manipulation rate to 14 per cent, while using a novel tensioner device further decreased the manipulation rate to 7 per cent, a significant difference of p < 0.01. Radiographic data illustrate all TKAs with the tensioner to be within 4 degrees of the desired position.

Ion concentrations from hip implants.

Total hip joint arthroplasty is performed in increasing numbers--about 0.16-0.2% of population per year in industrial countries. In most cases, an implant is a metallic component articulating with a metal, ceramic, or polyethylene liner, used in the hip, knee, and spine. The metal implants release ions in vivo. Toxic concentrations of ions can lead to many adverse physiological effects, including cytotoxicity, genotoxicity, carcinogenicity, and metal sensitivity. Reference levels of ion concentrations in body fluids and tissues determined by many studies are compiled, reviewed, and presented in this article. The concentrations of ions released from different alloys--including cobalt, chromium, nickel, molybdenum titanium, aluminum, and vanadium--are also presented. This article reviews the literature pertaining to clinical data on metal ion concentrations in patients with metal joint prostheses and laboratory data on the physiological effects of the metals.

Orthopedic personnel roles in the OR for computer assisted total knee arthroplasty.

The methods and problems associated with traditional total knee arthroplasty surgery and the development and advantages of computer-assisted surgery (CAS) are discussed in this article. In the next decade, CAS products have the potential to transform as many as 25% of all orthopedic surgical procedures from techniques that largely depend on line of sight and traditional instruments to techniques that use integrated surgical instruments and computer technology. This technology could revolutionize orthopedic surgery, the lives of patients, and the work of perioperative staff members during the next decade.

Increased histone acetyltransferase and lysine acetyltransferase activity and biphasic activation of the ERK/RSK cascade in insular cortex during novel taste learning.

Changes in gene expression are thought to be involved in neuronal plasticity associated with learning and memory. Although acetylation of lysine residues on histones by histone acetyltransferases (HAT) is an obligatory component of transcription, HAT activity has been largely ignored in studies of the nervous system. We developed a new model for studying novel taste learning using novel solid food presentation to nondeprived animals. Using this behavioral paradigm, we investigated short- and long-term regulation of lysine acetyltransferase activity and the ERK/mitogen-activated protein kinase (MAPK)/RSK cascade in insular cortex, a CNS region known to be crucial for the formation of novel taste memories. We observed that novel taste learning elicited biphasic (acute and long-lasting) activation of two distinct lysine acetyltransferase activities along with the ERK/MAPK cascade in insular cortex. In vitro studies revealed that the ERK cascade could regulate the lysine acetylation of a 42 kDa lysine acetyltransferase substrate, suggesting a causal relationship between ERK activation and lysine acetyltransferase activity in insular cortex. Overall, our studies reveal an unanticipated long-lasting activation of insular cortex signal transduction cascades in novel taste learning. Furthermore, our studies suggest the hypothesis that acute and long-term ERK activation and lysine-histone acetyltransferase activation may play a role in regulating gene expression in single-trial learning and long-term memory formation.

Activation of ERK/MAP kinase in the amygdala is required for memory consolidation of pavlovian fear conditioning.

Although much has been learned about the neurobiological mechanisms underlying Pavlovian fear conditioning at the systems and cellular levels, relatively little is known about the molecular mechanisms underlying fear memory consolidation. The present experiments evaluated the role of the extracellular signal-regulated kinase/mitogen-activated protein kinase (ERK/MAPK) signaling cascade in the amygdala during Pavlovian fear conditioning. We first show that ERK/MAPK is transiently activated-phosphorylated in the amygdala, specifically the lateral nucleus (LA), at 60 min, but not 15, 30, or 180 min, after conditioning, and that this activation is attributable to paired presentations of tone and shock rather than to nonassociative auditory stimulation, foot shock sensitization, or unpaired tone-shock presentations. We next show that infusions of U0126, an inhibitor of ERK/MAPK activation, aimed at the LA, dose-dependently impair long-term memory of Pavlovian fear conditioning but leaves short-term memory intact. Finally, we show that bath application of U0126 impairs long-term potentiation in the LA in vitro. Collectively, these results demonstrate that ERK/MAPK activation is necessary for both memory consolidation of Pavlovian fear conditioning and synaptic plasticity in the amygdala.

Pharmacological antagonism of tyrosine kinases and MAP kinase in brainstem blocks taste aversion learning in mice.

Although c-Fos induction in the brainstem is a reliable correlate of taste aversion learning and appears necessary for the encoding of the unconditioned stimulus, little is known about the intracellular signaling pathways in the brainstem that regulate c-Fos expression during taste aversion learning. Infusion of the tyrosine kinase inhibitor genistein and the MAP kinase kinase (MEK) inhibitor PD98059 into the fourth ventricle of mice potently blocks acquisition of a learned taste aversion. The unconditioned stimulus LiCl produces a rapid and robust phosphorylation of MAP kinase, as revealed by immunohistochemistry with an antibody specific to the dually phosphorylated active form of MAP kinase. This immunoreactivity is localized to the same region of the intermediate nucleus tractus solitarius in which we have shown large increases in c-Fos immunoreactive cells, suggesting that in at least a subset of these cells, MAP kinase activation may lead to c-fos induction.

Phosphorylation of MAP kinase and CREB in mouse cortex and amygdala during taste aversion learning.

Mice were subjected to a taste aversion conditioning procedure in which they drank water, familiar saccharin, or novel saccharin, followed by injection of either NaCl or the emetic agent LiCl. Immunohistochemistry was used to localize phosphorylated MAP kinase (ppERK) and phosphoCREB (pCREB) in the brain shortly after conditioning. An examination of insular cortex and amygdala revealed specific phosphorylation of MAP kinase by novel saccharin and LiCl, and CREB by LiCl. Pairing of novel saccharin with LiCl was the only stimulus sufficient to increase ppERK and pCREB immunoreactivity in the lateral amygdala, suggesting this as a site of CS-US convergence. ppERK immunoreactivity was localized to both nuclear and non-nuclear compartments, suggesting multiple functional roles of MAP kinase during learning.

Conditioned c-Fos in mouse NTS during expression of a learned taste aversion depends on contextual cues.

c-Fos expression in the nucleus tractus solitarius (NTS) of the rat has been found to follow administration of a variety of pharmacologically diverse unconditioned stimuli (US), and it has been proposed that NTS is a critical structure in transduction of the US during taste aversion learning. Before conditioning, the conditioned stimulus (CS) taste does not induce c-Fos in NTS, but following pairing of the CS and US, subsequent CS presentation induces c-Fos in NTS. Although it has been suggested that the shift in the c-Fos response following conditioning represents a molecular correlate of taste aversion learning, i.e. the formerly neutral CS now predicts the toxicity associated with the US, the data presented here suggest a more cautious interpretation of c-Fos expression in NTS. In mice, post-conditioning c-Fos expression to the CS depends on contextual cues: when conditioning and testing occur in a novel environment, CS saccharin causes an increase in c-Fos expression, and when conditioning and testing occur in the home cage, CS saccharin produces a decrease in c-Fos expression relative to controls. Furthermore, we show that merely placing an animal into a novel environment is sufficient to drive c-Fos expression in NTS. These data suggest that c-Fos expression in NTS can be driven by a number of different stimuli and conditions, and that these responses may depend on context-dependent activation of forebrain structures shown to drive conditioned c-Fos expression in NTS.

Health-related quality of life using the SF-36 in patients with bipolar disorder compared with patients with chronic back pain and the general population.

BACKGROUND: The purpose of this study was to assess and compare the health-related quality of life of patients with bipolar disorder and chronic back pain and, in turn, to compare these results with those previously generated for the general population. METHODS: Subjects were patients with bipolar disorder (n=44), a comparison group of chronic back pain patients (n=30), and a population-based control sample (n=2,474). Health-related quality of life was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), a self-administered questionnaire in which lower scores are indicative of greater impairment. RESULTS: Patients with bipolar disorder had lower mean scores than the general population on all scales except Physical Functioning. Bipolar patients had significantly higher scores than chronic back pain patients in the categories of Physical Functioning, Role Limitations--Physical, Bodily Pain, and Social Function. There were no significant differences between bipolar disorder and chronic back pain groups in the Mental Health and Role Limitations - Emotional categories. LIMITATIONS: The results of the study are limited by the relatively small sample sizes of the bipolar and back pain patient groups. CONCLUSIONS: Patients with bipolar disorder had substantial impairment in health-related quality of life in comparison with the general population. Bipolar patients were less compromised in areas of physical and social functioning than chronic back pain patients but had similar impairment in mental health.

Long-term outcomes of stereotactic breast biopsies.

Stereotactic core needle biopsies (SCNBs) are accurate and relatively convenient for the patient; however, the long-term follow-up of benign results has not been reported. All patients between 1993 and 1998 undergoing SCNB at a community-based hospital were entered into a registry. Follow-up was obtained by a retrospective analysis of the charts. Biopsies were performed on 865 lesions. One hundred thirty-one (15%) were malignant, 42 (5%) were suspicious for malignancy, 687 (79%) were benign, and five (1%) were lobular carcinoma in situ. Of the 42 patients with suspicious findings 38 underwent biopsy. Ten were malignant and 28 benign. Of the 687 patients with benign pathology, 377 had follow-up available with a mean length of 1.7 years. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SCNB for benign lesions in our study are all 100 per cent. Eight lesions were worrisome and await final analysis. Of 687 patients with benign lesions 310 were lost to follow-up. This study suggests that patients with a benign diagnosis should be returned to routine mammography. These data also extend the reported follow-up to 1.7 years and establish an acceptable level of accuracy for SCNB. The lost patients remind us that follow-up is essential despite a benign diagnosis.

Coordinate regulation of Fos and Jun proteins in mouse brain by LiCl.

Expression of the bZIP transcription factor c-Fos in the nucleus tractus solitarius (NTS) of the brain stem may allow for genomic encoding of an unconditioned stimulus (US) during taste aversion learning. Dimerization of c-Fos with other bZIP proteins of the Jun family is necessary to enable transcriptional efficacy at the AP-1 sequence of putative target gene promoter regions. The present study examined the regulation of Fos and Jun proteins by LiCl. Double immunofluorescence labelling revealed that LiCl causes a coordinate upregulation of c-Fos, FosB and JunB, and these proteins are colocalized in a majority of cells examined in NTS, parabrachial nucleus (PBN), and central nucleus of the amygdala (CeA). This study demonstrates that a coordinate signalling response occurs in relevant brain regions in response to LiCl.

Rigid internal fixation with lateral mass plates in multilevel anterior and posterior reconstruction of the cervical spine.

STUDY DESIGN: A retrospective clinical and radiographic analysis was performed on 17 patients with multilevel cervical disease who were treated with anterior and posterior reconstruction with a new rigid, segmental, internal fixation system applied to the lateral masses. OBJECTIVES: To determine the applicability, safety, and clinical efficacy of an instrumentation system used as a cervical lateral mass plate in the management of complex spinal disorders. SUMMARY OF BACKGROUND DATA: Cervical disorders involving three or more levels present a difficult reconstruction problem, especially if the posterior elements are deficient. Segmental fixation with lateral mass plating provides an alternative method to situations that would otherwise require a halo. METHODS: Seventeen patients treated by a single surgeon underwent cervical reconstruction surgery involving three or more levels. All patients had anterior decompression and reconstruction and a posterior fusion with rigid internal fixation with a device applied to the lateral masses of the cervical vertebrae. Patients were reviewed clinically and radiographically to determine the efficacy and safety of this method of fixation. RESULTS: Of the 15 patients with adequate follow-up data that were studied, the condition of 13 patients, (87%) was improved, that of one patient (6.7%) was the same, and that of another (6.7%) was worse after surgical intervention. Sagittal alignment was restored to within 5 degrees of the preoperative lordosis in active extension by the modified Cobb method and the Gore method. No patient had radiographic nonunion. One patient had a sensory radiculopathy associated with an overpenetrated lateral mass screw that partially resolved after hardware removal. One patient had asymptomatic loosening of a C7 lateral mass screw. CONCLUSIONS: Segmental posterior fixation with lateral mass plating provides more rigid immobilization than traditional techniques, allows restoration and maintenance of spinal alignment, obviates the need for halo immobilization, and is associated with a low incidence of neurovascular injury.

Anterior cervical allograft arthrodesis and instrumentation: multilevel interbody grafting or strut graft reconstruction.

This retrospective study evaluated a single surgeon's series of patients treated by multilevel cervical disc excision (two or three levels), allograft tricortical iliac crest arthrodesis, and anterior instrumentation. The objective of this retrospective study was to compare fusion success and clinical outcome between multilevel Smith-Robinson interbody grafting and tricortical iliac strut graft reconstruction, both supplemented with anterior instrumentation in the cervical spine. The incidence of nonunion for cervical discectomy and fusion varies widely depending on the number of disc levels involved, type of bone graft used, and whether the anterior grafting is supplemented with instrumentation. An alternative to multilevel interbody fusion is corpectomy and strut grafting, in which the incidence of nonunion has been reported to be 27% with autograft and 41% with allograft. Sixty-four consecutive patients who underwent allograft tricortical iliac crest reconstruction and anterior cervical plating were studied. The average follow-up was 39 months. There were 38 patients in the discectomy and interbody grafting group and 26 patients in the corpectomy and strut graft reconstruction group. Pseudoarthrosis occurred in 42% of the anterior cervical interbody fusion patients and 31% of the corpectomy patients. Nonunion in two-level interbody fusions occurred in 36% of the patients as compared to 10% for patients with one-level corpectomies; while 54% of patients with three-level interbody fusions and 44% of patients with two-level corpectomies were noted to have pseudoarthrosis. Higher percentages of nonunion were noted in multilevel interbody grafting than in corpectomy with strut grafting and when more vertebral levels were involved. These radiographic and clinical findings underscore the shortcomings of multilevel anterior cervical allograft reconstruction with plating. Corpectomy may be the preferred method when multiple disc levels are fused. In addition, anterior corpectomy affords decompression of significant osteophytes in a safer and quicker manner. In retrospective studies, there is a need for long-term follow-up before accurate statements can be made about the study population.

c-Fos antisense blocks acquisition and extinction of conditioned taste aversion in mice.

Conditioned taste aversion is an unusual form of associative learning in which long delays between conditional stimulus taste (CS) and unconditioned stimulus illness (US) suggest stimulus encoding by novel mechanisms. Recent data suggest that stimulus inputs are encoded by inducible bZIP proteins, the kinetics of which match the temporal features of the CS and US in taste aversion learning. Blockade of US-induced c-Fos translation in the brain stem by antisense oligonucleotides specifically blocks both acquisition and extinction of a learned taste aversion, but does not impair sensory processing of either CS or US, suggesting that c-Fos antisense blocks associative events within NTS necessary to support taste aversion learning.

Posterior cervical arthrodesis and stabilization with a lateral mass plate. Clinical and computed tomographic evaluation of lateral mass screw placement and associated complications.

STUDY DESIGN: A prospective study evaluating screw position and associated complications in 21 consecutive patients treated with a plate and screw fixation system applied to the lateral masses of the cervical spine. OBJECTIVES: To determine the clinical safety of lateral mass screws by determining their anatomic location and clinical complications in a consecutive patient series. SUMMARY OF BACKGROUND DATA: Lateral mass plating has been advocated for procedures in which wiring techniques cannot be used, especially in instances in which the posterior elements are deficient. METHODS: The first 21 consecutive patients who underwent posterior cervical arthrodesis and lateral mass plating with a single fixation system were reviewed prospectively. Computed tomography scans taken after surgery were reviewed independently by an orthopedic spinal surgeon and by a radiologist to evaluate screw tip position. Clinical and radiographic outcome was assessed at each visit after surgery. RESULTS: Ten of 164 (6.1%) lateral mass screws were malpositioned in six patients. Three symptomatic patients underwent four additional operative procedures to remove or replace the malpositioned screws. All patients had radiographic union, and no patient developed mechanical implant failure requiring removal of instrumentation. Radiographic evaluation noted that 17% of the screws were in the central axial zone of the lateral mass on computed tomography. CONCLUSIONS: Lateral mass plating was associated with no vertebral artery or spinal cord injury. There was a 1.8%-per-screw risk of radiculopathy, which corresponds with published cadaveric studies. Radicular symptoms improved with screw removal in each case. The advantages of segmental fixation achieved with lateral mass plates and screws must be weighed against the risk of radiculopathy.

Evidence for glucocorticoid regulation of the rat vasopressin V1a receptor gene.

WRK-1 cells express vasopressin V1a receptors. Twenty-four-hour treatment of these cells with dexamethasone (DEX) resulted in an increase in [3H]AVP binding that was maximal at 12 h, and could be blocked by addition of RU 38486. The increases in [3H]AVP binding were paralleled by increases in V1a receptor mRNA. The in vivo effects of glucocorticoids (GCs) on V1a receptor binding in hepatic tissue were also investigated in adrenalectomized and hormone-replaced rats given either DEX or aldosterone (ALDO). DEX effectively increased V1a receptor binding site density whereas ALDO had no effect. The DEX effects on V1a receptor mRNA and binding strongly implicate glucocorticoids in the regulation of V1a receptor gene expression.

Surgical revision for failed anterior cervical fusions. Articular pillar plating or anterior revision?

STUDY DESIGN: This retrospective study reviewed one surgeon's experience in treating symptomatic anterior cervical pseudarthrosis by three methods: anterior revisions, posterior revisions, and circumferential procedures. OBJECTIVES: To determine whether anterior revision and plating achieves a higher probability of radiographic fusion and better clinical outcomes compared with posterior fusion and articular pillar plating. The role of circumferential procedures was evaluated. SUMMARY OF BACKGROUND DATA: Management of cervical pseudarthrosis by a repeat anterior procedure requires a difficult dissection in a previously operated area, resection of a nonunion site, and regrafting. Because the incidence of failure is reported to be high, posterior cervical fusion has been proposed as a treatment for anterior pseudarthrosis. METHODS: The second author has performed 44 surgical revisions for symptomatic anterior cervical pseudarthrosis. Before this surgical revision, all patients had pain and a radiographic nonunion that was confirmed during surgery. The average follow-up period after the secondary procedure was 28 months with a range of 12-60 months. All patients (100%) were available for follow-up evaluation. Twenty patients had anterior pseudarthrosis repair and anterior plating. Seventeen patients underwent posterior cervical fusion and articular pillar plating. Seven patients had a circumferential repair with anterior revision and posterior articular pillar plating. RESULTS: All seven patients (100%) who had circumferential procedures achieved a solid radiographic fusion. Clinically, five patients felt better than before surgery, and two patients felt the same. Sixteen of 17 patients (94%) with posterior repairs achieved a solid fusion. Fourteen patients felt better; two patients felt the same, and one patient with a nonunion felt worse than before surgery. A solid fusion was obtained in only 45% of the patients after anterior repair alone. CONCLUSIONS: Posterior cervical articular pillar plating and fusion result in a higher probability of fusion than repeat anterior procedures, even with the addition of anterior plate stabilization. Posterior fusion and articular pillar plating, whether alone or part of a circumferential procedure, provides the added fixation required to successfully repair failed anterior cervical fusions.