Comparison of tissue-interface pressure in healthy subjects lying on two trauma splinting devices: The vacuum mattress splint and long spine board.

BACKGROUND: Most emergency transport protocols in the United States currently call for the use of a spine board (SB) to help immobilize the trauma patient. However, there are concerns that their use is associated with a risk of pressure ulcer development. An alternative device, the vacuum mattress splint (VMS) has been shown by previous investigations to be a viable alternative to the SB, but no single study has explicated the tissue-interface pressure in depth. METHODS: To determine if the VMS will exert less pressure on areas of the body susceptible to pressure ulcers than a SB we enrolled healthy subjects to lie on the devices in random order while pressure measurements were recorded. Sensors were placed underneath the occiput, scapulae, sacrum, and heels of each subject lying on each device. Three parameters were used to analyze differences between the two devices: 1) mean pressure of all active cells, 2) number of cells exceeding 9.3kPa, and 3) maximal pressure (Pmax). RESULTS: In all regions, there was significant reduction in the mean pressure of all active cells in the VMS. In the number of cells exceeding 9.3kPa, we saw a significant reduction in the sacrum and scapulae in the VMS, no difference in the occiput, and significantly more cells above this value in the heels of subjects on the VMS. Pmax was significantly reduced in all regions, and was less than half when examining the sacrum (104.3 vs. 41.8kPa, p<0.001). CONCLUSION: This study does not exclude the possibility of pressure ulcer development in the VMS although there was a significant reduction in pressure in the parameters we measured in most areas. These results indicate that the VMS may reduce the incidence and severity of pressure ulcer development compared to the SB. Further prospective trials are needed to determine if these results will translate into better clinical outcomes.

Young Females Exhibit Decreased Coronal Plane Postural Stability Compared to Young Males.

BACKGROUND: Female athletes are at significantly higher risk of noncontact ACL injury than males, particularly in pivoting sports such as soccer and basketball. Sex-based differences in proprioception and core stability may contribute to this elevated risk. QUESTIONS/PURPOSE: This study evaluates a novel method of assessing dynamic stability to test the hypothesis that healthy adolescent controls have sex-based differences in postural stability. METHODS: Seventy-nine male and 72 female subjects completed three rounds of dynamic postural stability testing. During the assessment, subjects attempted to stabilize their torso and upper body in response to random movements of the platform. The total time a subject lasted on the platform and dynamic motion analysis (DMA) score, a summation of motion in five planes throughout testing, was calculated for each subject. The average score for each subject was included in the analysis. RESULTS: Males lasted longer on the platform (98 ± 14 s) than females (94 ± 13 s) (p = 0.04). Coronal plane and rotation stability differed significantly between genders (323 ± 126 vs. 365 ± 128, p = 0.04) and (318 ± 82 vs. 403 ± 153, p = 0.0002), respectively. No statistically significant difference was seen in the other planes of motion. CONCLUSIONS: Females have less dynamic postural stability than their male counterparts in the coronal plane based on a novel assessment tool. This finding may contribute to better understanding of sex-based differences in rates of injury such as noncontact ACL tears.

Minimally invasive methods for bulbar urethral strictures: a survey of members of the American Urological Association.

OBJECTIVE: To determine current practice patterns, we mailed a questionnaire regarding urethral stricture evaluation, treatment, and follow-up to members of the American Urological Association (AUA). The minimally invasive methods used for treating and evaluating anterior urethral strictures vary widely among clinicians. METHODS: A nationwide survey of practicing members of the AUA was performed by mailed questionnaires. Surveys were mailed to 1262 Urologists, randomly selected from all 50 states. Four-hundred thirty-one urologists (34%) completed the questionnaire and formed the basis for our analysis. RESULTS: Most urologists (63%) treat 6-20 urethral strictures per year. The most common minimally invasive procedures used for managing anterior urethral strictures were dilation (92.8%), cold-knife optical internal urethrotomy (85.6%), endourethral stent (23.4%), laser urethrotomy (19%), and periurethral steroid injection after urethrotomy (7.9%). Most urologists will perform urethrotomy on bulbar strictures up to 2 cm (68.7%) and leave a Foley catheter in place for 1 week or less (86.5%). Technical method of urethrotomy is commonly 1 cut at 12 o'clock (86.3%) or radial cuts (12.1%). Recommended follow-up diagnostic tests after urethrotomy included flow rate (62.9%) and, to a lesser degree (with roughly one-third each), cystoscopy, urethral calibration, and the International Prostate Symptom Score (IPSS). Other tests, such as ultrasonography or urethrography were rarely used. CONCLUSION: Our survey provides information regarding current minimally invasive management and follow-up practice strategies recommended by members of the AUA for anterior urethral strictures. Many common practices in the treatment of anterior urethral stricture disease are not supported in the literature.

Specific posttranslational modification regulates early events in mammary carcinoma formation.

The expression of an enzyme, GnT-V, that catalyzes a specific posttranslational modification of a family of glycoproteins, namely a branched N-glycan, is transcriptionally up-regulated during breast carcinoma oncogenesis. To determine the molecular basis of how early events in breast carcinoma formation are regulated by GnT-V, we studied both the early stages of mammary tumor formation by using 3D cell culture and a her-2 transgenic mouse mammary tumor model. Overexpression of GnT-V in MCF-10A mammary epithelial cells in 3D culture disrupted acinar morphogenesis with impaired hollow lumen formation, an early characteristic of mammary neoplastic transformation. The disrupted acinar morphogenesis of mammary tumor cells in 3D culture caused by her-2 expression was reversed in tumors that lacked GnT-V expression. Moreover, her-2-induced mammary tumor onset was significantly delayed in the GnT-V null tumors, evidence that the lack of the posttranslational modification catalyzed by GnT-V attenuated tumor formation. Inhibited activation of both PKB and ERK signaling pathways was observed in GnT-V null tumor cells. The proportion of tumor-initiating cells (TICs) in the mammary tumors from GnT-V null mice was significantly reduced compared with controls, and GnT-V null TICs displayed a reduced ability to form secondary tumors in NOD/SCID mice. These results demonstrate that GnT-V expression and its branched glycan products effectively modulate her-2-mediated signaling pathways that, in turn, regulate the relative proportion of tumor initiating cells and the latency of her-2-driven tumor onset.