Managing Challenges in Thumb Carpometacarpal Arthritis.

Thumb carpometacarpal osteoarthritis is commonly encountered and multifactorial in etiology, and its management is based on the radiographic stage and surgeon preference. A variety of management strategies exist including ligament reconstruction, arthroscopic débridement, extension osteotomy, open versus arthroscopic total and partial trapeziectomy with or without interposition and/or suspensionplasty, arthrodesis, and total or hemi implant arthroplasty. A review of the literature shows each of these management strategies to be effective in pain relief, but no one procedure has been shown to be superior despite theoretic benefits to preserving trapezial height. The one common denominator is removal of the arthritic contact between the thumb metacarpal and trapezial surfaces.

Selective Deletion of Renin-b in the Brain Alters Drinking and Metabolism.

The brain-specific isoform of renin (Ren-b) has been proposed as a negative regulator of the brain renin-angiotensin system (RAS). We analyzed mice with a selective deletion of Ren-b which preserved expression of the classical renin (Ren-a) isoform. We reported that Ren-bNull mice exhibited central RAS activation and hypertension through increased expression of Ren-a, but the dipsogenic and metabolic effects in Ren-bNull mice are unknown. Fluid intake was similar in control and Ren-bNull mice at baseline and both exhibited an equivalent dipsogenic response to deoxycorticosterone acetate-salt. Dehydration promoted increased water intake in Ren-bNull mice, particularly after deoxycorticosterone acetate-salt. Ren-bNull and control mice exhibited similar body weight when fed a chow diet. However, when fed a high-fat diet, male Ren-bNull mice gained significantly less weight than control mice, an effect blunted in females. This difference was not because of changes in food intake, energy absorption, or physical activity. Ren-bNull mice exhibited increased resting metabolic rate concomitant with increased uncoupled protein 1 expression and sympathetic nerve activity to the interscapular brown adipose tissue, suggesting increased thermogenesis. Ren-bNull mice were modestly intolerant to glucose and had normal insulin sensitivity. Another mouse model with markedly enhanced brain RAS activity (sRA mice) exhibited pronounced insulin sensitivity concomitant with increased brown adipose tissue glucose uptake. Altogether, these data support the hypothesis that the brain RAS regulates energy homeostasis by controlling resting metabolic rate, and that Ren-b deficiency increases brain RAS activity. Thus, the relative level of expression of Ren-b and Ren-a may control activity of the brain RAS.

Hand Hygiene Among Health Care Workers: Is Educating Patients and Families a Feasible Way to Increase Rates?

BACKGROUND: The Centers for Disease Control and Prevention has recommended teaching patients to remind health care workers to disinfect their hands. However, cognitive impairment among patients may hamper such efforts. METHODS: The St. Louis University Mental Status (SLUMS) Examination was administered to randomly selected inpatients at the Omaha VA Medical Center in Omaha, Nebraska. We asked patients and their families about attitudes toward reminding health care workers to disinfect their hands: willingness, feeling comfortable, and feeling responsible. RESULTS: Of 143 patients, 94 completed SLUMS; 9 had normal mental status and appropriate attitudes. Overall, 16 encounters involved patients or family who were well-suited for giving reminders. CONCLUSION: Programs to encourage hospitalized adults to remind staff to perform hand hygiene may encounter barriers related to cognitive impairment and attitudes.