Cranial osteopathic treatment and stress-related effects on autonomic nervous system measured by salivary markers: A pilot study.

BACKGROUND: Variations in the concentration of salivary alpha amylase (sAA) may indicate a change in the autonomic nervous system functionality. In osteopathic medicine it has long been stated that the osteopathic manipulative treatment (OMT) can modulate the autonomic nervous system. Studies carried out on the compression of the fourth ventricle (CV4) have shown a positive effect in reducing the sympathetic tone. The goal of this pilot study is measuring the physiological response of the sAA levels after CV4 technique. METHODS: 90 subjects were randomly assigned to a sham, a control or a CV4 group. Randomization accounted for sex and score in the STAI-2 (form Y) questionnaire. Each subject completed the STAI-1 (form Y) questionnaire to evaluate the anxiety of the moment. sAA activity and saliva flow rate were measured. Saliva was collected before, immediately after and 30 min after treatment. RESULTS: Within group analysis revealed that sAA activity increased significantly immediately after the technique application only in the CV4 group (p = 0,05). Between groups analysis show a significant difference of the sAA activity in the CV4 group respect the control group (p < 0,05), but no significant difference between CV4 and sham group (p > 0,05). The effect in the CV4 group after the intervention is highly variable and appeared to be related to the level of stress measured with the STAI-Y1 questionnaire (p = 0,002). CONCLUSIONS: This study shows a positive effect of the CV4 procedure on sAA activity even if not significantly different from the sham procedure, probably due to the confounding effect of stress variability between groups.

Calcium: the common theme in vesicular cycling.

Synaptic vesicle release is known to depend on calcium. A new technique for separating endocytosis from exocytosis now shows that calcium regulates both processes.

Failure of total condylar knee replacement. Correlation of radiographic, clinical, and surgical findings.

The authors reviewed 55 failed total condylar knee replacements, correlating the radiographic and surgical findings at removal or revision. Failure was due to infection in 20 cases, mechanical loosening in 18, instability without loosening in 10, malalignment without loosening in 4, a supracondylar fracture in 2, and unknown causes in 1. In infection with loosening or chronic infection, radiographs usually showed a wide, extensive radiolucent region at the cement-bone interface around one or more components without shifting, while in acute infection without loosening the radiographs were normal. In mechanical loosening, in addition to a similar lucent region, the prosthesis became tilted in 16 out of 18 cases. Most loosening involved tilting of the tibial component into the varus position with subsidence into the medial tibial plateau, collapse of the cancellous bone, and plastic deformation. Radiographs can be helpful in determining the reason for failure of a total knee replacement, which is important in planning surgery.