Does the rectus femoris nerve block improve knee recurvatum in adult stroke patients? A kinematic and electromyographic study.

Knee recurvatum (KR) during gait is common in hemiplegic patients. Quadriceps spasticity has been postulated as a cause of KR in this population. The aim of this study was to assess the role of rectus femoris spasticity in KR by using selective motor nerve blocks of the rectus femoris nerve in hemiparetic stroke patients. The data from six adult, post-stroke hemiplegic patients who underwent a rectus femoris nerve block for a stiff-knee gait were retrospectively analyzed. An extensive clinical and functional evaluation was performed and gait was assessed by motion analysis (kinematic, kinetic and electromyographic parameters) before and during the block realized using 2% lidocaine injected under a neurostimulation and ultrasonographic targeting procedure. The main outcome measures were the peak knee extension in stance and peak knee extensor moment obtained during gait analysis. No serious adverse effect of the nerve block was observed. The block allowed a reduction of rectus femoris overactivity in all patients. Peak knee extension and extensor moment in stance did not improve in any patient, but peak knee flexion during the swing phase was significantly higher after block (mean: 31.2° post, 26.4 pre, p < 0.05). Our results provide arguments against the hypothesis that the spasticity of the rectus femoris contributes to KR.

Behaviour and performance of juvenile shortnose sturgeon Acipenser brevirostrum at different water velocities.

Critical swimming speeds (mean +/-s.e.) for juvenile shortnose sturgeon Acipenser brevirostrum were 34.4 cm s(-1)+/- 1.7 (2.18 +/- 0.09 body lengths, BL s(-1)). Swimming challenges at 10, 20 and 30 cm s(-1) revealed that juvenile A. brevirostrum are relatively poor swimmers, and that the fish did not significantly modify their swimming behaviour, although they spent more time substratum skimming (i.e. contact with flume floor) at 30 cm s(-1) relative to 10 cm s(-1). When present, these behavioural responses are probably related to morphological features, such as flattened rostrum, large pectoral fins, flattened body shape and heterocercal tail, and may be important to reduce the costs of swimming.

Multivitamin use and B vitamin status in a homebound elderly population.

OBJECTIVE: Homebound elderly are at increased risk for micronutrient deficiencies and nutritional status in this population has not been adequately described. There is evidence for beneficial effects of multivitamin use and a greater understanding of their nutritional contribution could identify behaviors that may help alleviate excess chronic disease. The purpose of this analysis is to investigate, in a racially diverse group of homebound elders, the association of multivitamin use with measures of plasma B vitamin concentrations. DESIGN: We examined the cross-sectional association between multivitamin use and plasma concentrations of B vitamins and homocysteine in 236 white and 182 black homebound elders (65-99y). Dietary intake was assessed and demographic and health information was ascertained. RESULTS: White and black elders had a high prevalence of dietary intakes below the Estimated Average Requirement for folate (38.1 and 40.7%), vitamin B6 (16.9 and 19.2%.), and vitamin B12 (3 and 3.9%) respectively. Multivitamin use was associated with higher mean plasma B vitamin concentrations in each group. In whites, multivitamin users had higher concentrations of vitamin B6 (64.6 vs. 32.4 nmol/L; p < 0.001), vitamin B12 (398 vs. 324 pmol/L;p < 0.001) and folate (39.4 vs. 30.4 nmol/L;p < 0.001). Black multivitamin users had higher concentrations of vitamin B6 (53.7 vs. 29.5 nmol/L; p < 0.001), B12 (427 vs. 372 pmol/L; p < 0.05) and folate (35.7 vs. 25.4 nmol/L; < 0.001) than non-users. CONCLUSIONS: Multivitamin supplementation was associated with higher mean plasma concentrations of vitamins B6, B12, and folate and lower prevalence of low plasma B vitamin status in a biracial homebound elderly.

Evaluation of the Confusion Assessment Method (CAM) as a screening tool for delirium in the emergency room.

The objective of this study was to compare the results of the Confusion Assessment Method (CAM) obtained by a trained non-physician interviewer to those obtained by a geriatrician, among a sample of elderly patients seen in an emergency room. A group of 110 elderly patients (> or =66 years) were evaluated in the emergency room by a lay interviewer. The geriatrician conducted an interview in the presence of the lay interviewer. Subsequently, the geriatrician and the lay interviewer completed a CAM checklist independently. Kappa statistics, sensitivity, specificity, positivity predictive value (PPV), and negative predictive value (NPV) for the geriatrician's and lay interviewer's results with the CAM diagnostic algorithm were compared. The kappa coefficient was 0.91, the sensitivity 0.86, the specificity 1.00, the PPV 1.00, and the NPV 0.97. In conclusion, the CAM used by a trained lay interviewer in the emergency room is sensitive, specific, reliable and easy to use for the identification of patients with delirium. The under-recognition and under-treatment of delirium is a major health issue and has important clinical and financial implications. The implementation of systematic screening in populations at risk could increase the rate of early detection and lead to the appropriate management of delirious patients.

Clinical predictors of upgrading to Gleason grade 4 or 5 disease at radical prostatectomy: potential implications for patient selection for radiation and androgen suppression therapy.

PURPOSE: A survival benefit has been suggested by the Radiation Therapy Oncology Group (RTOG) for the addition of androgen suppression to external beam radiation therapy for patients with locally advanced and high-grade disease. This study was performed to identify clinical factors that predicted high-grade disease at prostatectomy (i.e., Gleason grade 4 or 5) in patients with clinically localized and low-grade disease (i.e., Gleason grades 1-3) at biopsy. These pretreatment factors may allow for the identification of patients likely to derive a survival benefit from the addition of androgen suppression to external beam radiation therapy while awaiting the results of the prospective randomized trials. METHODS AND MATERIALS: Concordance testing of both the primary and secondary biopsy and prostatectomy Gleason grades was performed in 693 patients with clinical Stage T1c, 2 prostate cancer managed with a radical prostatectomy (RP). For the subset of 420 patients with low-grade disease (i.e., Gleason grade < or =3) a logistic regression multivariable analysis was performed to evaluate the ability of the preoperative prostate-specific antigen (PSA), clinical stage, and ultrasound determined prostate gland volume to predict for upgrading to high-grade disease (i.e., Gleason grade 4 or 5). RESULTS: Forty percent of men with low-grade disease at biopsy were found to have high-grade disease at RP. Men who have at least a 50% chance of being upgraded from biopsy Gleason grade < or =3 to prostatectomy Gleason grade > or =4 disease included those with prostate gland volumes < or =75 cm3 and a PSA > 20 ng/ml or a PSA >10 and < or =20 and clinical Stage T2b,2c. For men with prostate gland volumes >75 cm3, only those with both PSA > 20 ng/ml and clinical Stage T2b,2c were at a significant risk of upgrading. CONCLUSION: Until the randomized data become available, clinical factors may be useful in identifying patients with clinically localized prostate cancer who are likely to benefit from combined androgen suppression and external beam radiation therapy.

A longitudinal evaluation of the Mississippi Scale for Combat-Related PTSD in detecting war-related stress symptomatology.

The long-term psychological effects of war-related stress were assessed 3 years after the Persian Gulf War with the Mississippi Scale for Desert Storm War Zone Personnel (M-PTSD-DS), developed from the Mississippi Scale for Combat-Related PTSD (M-PTSD: Keane, Caddell, Taylor, 1988). The M-PTSD-DS scores of 30 Marine reservists were compared with the number of DSM-III-R PTSD criteria each met at two points in time, initially at 3 months after the Gulf War and again 3 years later. Findings support the construct validity (sensitivity) of this scale in the immediate and longitudinal measurement of relatively nonpathological degrees of war-related stress in reservists not involved in direct fighting. Initial level of PTSD symptomatology upon returning from a war zone was predictive of M-PTSD-DS scores 3 years later. This scale was effective in detecting varying degrees of war-related stress in this self-selected group of reservists and warrants further study.

Use of the hand test in the assessment of combat-related stress.

This study investigated the effectiveness of the Hand Test in discriminating the differential symptomatology of posttraumatic stress (PTS) in Vietnam combat veterans (VCVs). Participants were 108 VCV outpatients, 85 of whom met the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) criteria for posttraumatic stress disorder (PTSD), and 23 patients that were found to meet some, but not the minimum criteria, required for a diagnosis of PTSD by the DSM-IV. The latter group of patients was classified into a subclinical PTSD, posttraumatic stress symptoms (PTSS) group. Results showed higher levels of overall psychopathology, a vulnerable capacity for coping, and a tendency for feelings of inadequacy and inferiority in the PTSD group. The PTSD group also exhibited more limited interaction with the world around them than the PTSS group, which may be indicative of withdrawal, apathy, or a lack of concern with environmental activities and goals. These findings are discussed in relation to the assessment, understanding, and treatment of PTS symptomatology and PTSD.

Immunity to cartilage link protein in patients with juvenile rheumatoid arthritis.

OBJECTIVE: To determine whether children with juvenile rheumatoid arthritis (JRA) express cellular immunity to cartilage link protein. METHODS: Link protein was purified from human fetal epiphyseal and bovine adult nasal cartilage. It was used in proliferation assays with the peripheral blood lymphocytes isolated from 54 children with JRA and 22 nonarthritic controls. RESULTS: Patients with JRA expressed a significantly higher prevalence of cellular proliferation to human link protein compared with the control group, independent of whether they had pauciarticular, polyarticular, or systemic disease. In the case of bovine link protein, significant differences were only noted for the polyarticular group. There was significant correlation between the immunity to bovine and to human link proteins. Furthermore, immune responses to both molecules correlated with measures of joint disease activity. CONCLUSION: These results suggest that immunity to link protein may play a role in the pathogenesis of JRA.

The Juvenile Arthritis Quality of Life Questionnaire--development of a new responsive index for juvenile rheumatoid arthritis and juvenile spondyloarthritides.

OBJECTIVE: To develop a disease specific measure of quality of life for application in children with juvenile rheumatoid arthritis and juvenile spondyloarthritides-the Juvenile Arthritis Quality of Life Questionnaire (JAQQ). METHODS: Patients and their parents were interviewed by a trained interviewer using a questionnaire focusing on physical function, psychosocial function, and general symptoms to determine the most appropriate items to include in the JAQQ. Respondents volunteered items and scored them for frequency of occurrence and importance. Items so generated were scored by a panel of experts for potential responsiveness and categorized into dimensions. Item number was reduced using this scoring system. The product was then pretested to confirm its construct validity and responsiveness. Thereafter, it was distributed to clinical experts to establish face and content validity. RESULTS: 91 patients, mean age 10.35 years (range 1.25-18.0), mean disease duration 3.99 years, and their parents were included in the interview process. 220 items generated were ultimately reduced to 85. Pretesting this version of the instrument in a further 30 patients showed it to have construct validity and responsiveness and led to a further reduction in items to 74, distributed in 4 dimensions: gross motor function (17 items), fine motor function (16 items), psychosocial function (22 items), and general symptoms (19 items). Face and content validity were established in 20 clinicians. Scaling was by 7 point Likert scale to enhance responsiveness. English and French versions were developed. CONCLUSION: The JAQQ measures physical and psychosocial function and an array of general symptoms. Preliminary data suggest it is valid and responsive and thus might have potential in clinical trials.

A polymer-based drug delivery system for the antineoplastic agent bis(maltolato)oxovanadium in mice.

Using vanadyl sulphate, sodium orthovanadate or bis(maltolato)oxovanadium (BMOV), Cruz TF, Morgan A, Min W (1995, Mol Cell Biochem 153: 161-166) have recently demonstrated the antineoplastic effects of vanadium in mice. In this study, the antineoplastic effects of BMOV against human tumour cell lines was confirmed, and this effect was shown to depend on the prolonged exposure of the cells to the drug. We have investigated a polymeric drug delivery system for the sustained delivery of BMOV as an antineoplastic agent in mice. The objective was to design and evaluate an injectable polymer-BMOV paste that would act as a drug implant for the slow but sustained release of BMOV in the mice. In vitro studies showed that the biodegradable polymer poly (Ghlr epsilon epsilon-caprolactone) (PCL) released BMOV in a sustained manner with rates of drug release increasing with increased loading of the drug in the polymer. In vivo studies showed that PCL-BMOV paste implants produced a concentration-dependent inhibition of MDAY-D2 tumour growth via systemic drug delivery. Further in vivo studies showed that 5% BMOV-loaded PCL (containing 20% methoxypolyethylene glycol) was effective in preventing tumour regrowth of resected RIF tumour masses in mice when the PCL-BMOV paste was applied to the resected site for localized drug delivery. The results confirm the potential of vanadium as an antineoplastic agent and show that the injectable PCL-BMOV formulation releases a chemotherapeutic dose of vanadium for the systemic treatment of whole tumours as well as the localized treatment of resected RIF tumours.

Dentate granule cell layer collagen explant cultures: spontaneous axonal growth and induction by brain-derived neurotrophic factor or basic fibroblast growth factor.

The molecular mechanisms that underlie dentate granule cell axon (i.e., mossy fiber) growth during development and following seizure-induced hippocampal injury remain unknown. Part of this process may involve specific factors that support dentate granule cells during differentiation, and molecular cues that allow the appropriate growth of mossy fiber axons toward their targets. To study this process, we developed an in vitro assay system to measure the activity of putative trophic, chemoattractant and chemorepulsive factors. Two-hundred-micrometer-thick transverse hippocampal sections were prepared from neonatal rats and microdissected to isolate the middle one-third of the superior blade of the dentate granule cell layer. These were embedded in a three-dimensional collagen matrix either alone or with microdissected regions of the CA2 pyramidal cell layer. Cultures were maintained in a defined medium and grown for two to three days in a standard culture environment. Results showed that numerous processes grew primarily from the hilar side of explants into the collagen matrix, often in excess of 500 microns in length. These were determined to be axons based on: (i) morphological criteria including size and presence of growth cones, (ii) synaptophysin and growth-associated protein-43 immunoreactivity, (iii) lack of glial fibrillary acidic protein immunoreactivity and (iv) contiguity of biocytin-filled processes with neuronal soma within the explant. Treatment of cultures with brain-derived neurotrophic factor caused a significant increase in axon number and length, and this effect was partially reversed by the addition of a trkB-immunoglobulin fusion protein that blocks the activity of brain-derived neurotrophic factor and neurotrophin-4/5. Basic fibroblast growth factor also caused a marked increase in axon number and length, and caused a migration of neuron-like cells out of the explant into the collagen. These results show that cultured dentate granule cell layer explants are capable of growing mossy fibers into a neutral collagen matrix, and the growth of axons can be modified by the addition of exogenous growth factors. Furthermore, since target tissue and point sources of purified factors can easily be co-cultured with the explants, this new system provides a direct means for testing the molecular cues that influence mossy fiber growth.

The effects of growth factors on the survival and differentiation of cultured dentate gyrus neurons.

Dentate granule cells (DGCs) are the principal cell population of the hippocampal dentate gyrus, and granule cells provide the main excitation to the hippocampus proper via their mossy fibers axons. Although it is well established that granule cells express various growth factors and growth factor receptors, the functional effects of growth factors on the normal development and response to injury of granule cells are relatively unknown. To address this question, primary cultures enriched in DGCs were prepared by microdissecting hippocampal slices from neonatal rats and growing dissociated cells in defined media with added nerve growth factor, brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), neurotrophin-4/5 (NT4/5), ciliary neurotrophic factor, basic fibroblast growth factor (bFGF), or vehicle. The effects on cell survival and morphology were quantified by studying neuron-specific enolase-immunostained cells at various time points, plating densities, host ages, and growth factor concentrations. BDNF or bFGF significantly increased both neuronal survival and differentiation by 30-80% compared with control cultures. Maximal effects were observed at relatively longer time points (5-12 d), with younger cells (postnatal day 3-5) and at lowest plating densities. Addition of a trkB-IgG fusion protein that blocks the activity of BDNF or NT4/5 inhibited the effects of BDNF and attenuated the differentiation of cells cultured at high plating densities. Furthermore, treatment of cultures with the kinase inhibitor K252b specifically blocked the effects of BDNF, suggesting involvement of trkB (the high-affinity BDNF receptor) in BDNF-induced differentiation. These results show that growth properties of cultured neonatal DGCs are influenced by exogenously applied BDNF or bFGF in a time-, age-, and density-dependent manner. The effect of plating density suggests an endogenous expression of growth factors in these culture conditions, and this is mediated in part by endogenous BDNF acting via a tyrosine kinase receptor. Combined with previous work showing that various growth factors and their receptors are expressed by DGCs, these findings provide strong support for the hypothesis that BDNF and bFGF influence both the growth and development of DGCs in vivo.

Rorschach measures of posttraumatic stress in Persian Gulf War veterans: a three-year follow-up study.

The long-term psychological effects of war-related stress were assessed with the Rorschach 3 years after the Persian Gulf War. Rorschach data are presented for 30 U.S. Marine reservists at a 3-year follow-up who reported experiencing symptoms of posttraumatic stress (PTS) initially after Operation Desert Storm (ODS), and for 25 Marine reservist controls who did not participate in ODS. Results showed significant differences over time between the initial evaluation data and follow-up, and between initial evaluation and the control group on selected Rorschach variables associated with coping ability and PTS. Scores associated with acute distress, capacity for coping and control, and feeling overwhelmed all were found to significantly decrease over time. These findings are discussed in relation to the assessment and understanding of PTS symptomatology over time.

Use of the Mississippi scale for combat-related PTSD in detecting war-related, non-combat stress symptomatology.

This study investigated the effectiveness of the Mississippi Scale for Desert Storm War Zone Personnel (M-PTSD-DS), developed from the Mississippi Scale for Combat Related PTSD (M-PTSD; Keane, Caddell, & Taylor, 1988), in the measurement of varying degrees of war-related post-traumatic stress (PTS) symptomatology of non-combat Persian Gulf War veterans. Thirty Marines were administered the M-PTSD-DS after 3 months of active duty in Operation Desert Storm. The M-PTSD-DS scores of the Marines were related significantly to the number of PTS symptoms reported by the Marines. This scale appears to be quite effective in detecting varying degrees of war-related stress in non-combatants.

Rorschach measures of posttraumatic stress in Persian Gulf War veterans.

The effectiveness of the Rorschach in detecting acute posttraumatic stress (PTS) in Persian Gulf War veterans was investigated. Subjects were 30 U.S. Marine Reservists who reported experiencing symptoms of PTS after 3 months of active duty in Operation Desert Storm. Subjects were administered the Rorschach and MMPI-2 soon after their return from the Persian Gulf War. Results showed acute distress, a vulnerable capacity for coping and control, and a tendency to be overwhelmed by internal and external stimulation. Selected Rorschach variables were significantly related in a conceptually valid manner to MMPI-2 scales associated with defensiveness, coping ability, and PTS. These findings are discussed in relation to the assessment, understanding, and treatment of PTS symptomatology and posttraumatic stress disorder.

The relationship between vigilance deficits and traffic injuries involving children.

OBJECTIVE: This study was designed to determine whether there is an increased frequency of deficits in impulse control, vigilance, or both, among child bicyclists or pedestrians who have been injured in traffic accidents, as assessed using objective measures and parent and teacher reports. RESEARCH DESIGN: This was a case-control study, in which cases were children injured as pedestrians or bicyclists (excluding those with severe head injuries) and controls were those injured as passengers or in some other manner in which the child's behavior was unlikely to be a factor. SETTING: Children ages 5 to 15 years presenting to the emergency room of the Montreal Children's Hospital. PARTICIPANTS: For each of 286 cases, two controls were selected, making a total of 848 subjects. Among the cases, 172 were injured as pedestrians and 114 as bicyclists. MEASURES: Children were assessed using the Continuous Performance Task and the Delayed Response Test, both parts of a computerized test battery. Parents and teachers completed the Conners Abbreviated Symptom Questionnaire to assess hyperactivity. RESULTS: Cases and controls were similar on most sociodemographic and clinical measures but showed statistically significant differences in mean scores on the Continuous Performance Task measures of omissions and commissions, pointing to differences in vigilance, and on the Delayed Response Test measures of impulsivity. Mean Conners scale scores of both parent and teacher were significantly higher for cases than controls, and those of parents were higher than those of teachers. CONCLUSIONS: Among children whose behavior may have been a factor in the occurrence of an injury, there is subjective evidence of increased hyperactivity and objective evidence of deficits in vigilance and attention when compared with closely matched controls. These findings have important implications for prevention.

Taxol encapsulation in poly(epsilon-caprolactone) microspheres.

Poly(epsilon-caprolactone) (PCL) microspheres containing taxol were prepared by the solvent evaporation method and tested for angiogenesis inhibition using the chick chorioallantoic membrane (CAM) model. Very high encapsulation efficiencies (95%) for taxol in PCL microspheres were obtained. In vitro release studies showed about 25% of the loaded drug was released in 6 weeks from microspheres containing 5% taxol. Studies with the CAM showed that taxol released from the microspheres induced vascular regression and inhibited angiogenesis.

Endemic disease and development: the leishmaniases.

Health and sustainable development are intricately interwoven. Communities under pressure from a barrage of endemic diseases face tremendous obstacles in achieving an improved quality of life. The leishmaniases are examples of hitherto underestimated parasitic zoonoses which place those communities affected at significant risk of morbidity, debility and mortality. This article summarizes the experience of community-based applied research projects on leishmaniasis supported by the Canadian International Development Research Centre, in Lebanon, Jordan, Ethiopia, Kenya, Tunisia, Mexico, Costa Rica, Colombia, Peru, and Brazil. The article examines the role of leishmaniasis-associated morbidity versus mortality, and the impact of these diseases on a community's capacity to develop. It further analyzes the various determinants of leishmaniasis infection, disease and outcomes, and their interactions at the individual as well as the community level. Adverse health implications as a result of external and intervening factors are examined. Such factors include ecological/environmental changes such as those arising from developmental projects, unplanned urbanization, and continuous movements of populations. The paper views strategies for prevention and control of leishmaniases in the context of socio-political and economic constraints of the affected countries. Particularly emphasized is the need to take into account the knowledge base, beliefs, perceptions and practices of the population by incorporating active community participation in preventive and intervention practices. Leishmaniasis poses a particular challenge to classical health systems that tend to resist innovative change needed to address socio-political and economic realities of the present and future decades.