Nitric oxide activation facilitated by cooperative multimetallic electron transfer within an iron-functionalized polyoxovanadate-alkoxide cluster.

A series of NO-bound, iron-functionalized polyoxovanadate-alkoxide (FePOV-alkoxide) clusters have been synthesized, providing insight into the role of multimetallic constructs in the coordination and activation of a substrate. Upon exposure of the heterometallic cluster to NO, the vanadium-oxide metalloligand is oxidized by a single electron, shuttling the reducing equivalent to the {FeNO} subunit to form a {FeNO}7 species. Four NO-bound clusters with electronic distributions ranging from [VV3VIV2]{FeNO}7 to [VIV5]{FeNO}7 have been synthesized, and characterized via 1H NMR, infrared, and electronic absorption spectroscopies. The ability of the FePOV-alkoxide cluster to store reducing equivalents in the metalloligand for substrate coordination and activation highlights the ultility of the metal-oxide scaffold as a redox reservoir.

Sports medicine clinical trial research publications in academic medical journals between 1996 and 2005: an audit of the PubMed MEDLINE database.

OBJECTIVE: To identify sports medicine-related clinical trial research articles in the PubMed MEDLINE database published between 1996 and 2005 and conduct a review and analysis of topics of research, experimental designs, journals of publication and the internationality of authorships. HYPOTHESIS: Sports medicine research is international in scope with improving study methodology and an evolution of topics. DESIGN: Structured review of articles identified in a search of a large electronic medical database. SETTING: PubMed MEDLINE database. PARTICIPANTS: Sports medicine-related clinical research trials published between 1996 and 2005. INTERVENTIONS: Review and analysis of articles that meet inclusion criteria. MAIN OUTCOME MEASUREMENTS: Articles were examined for study topics, research methods, experimental subject characteristics, journal of publication, lead authors and journal countries of origin and language of publication. RESULTS: The search retrieved 414 articles, of which 379 (345 English language and 34 non-English language) met the inclusion criteria. The number of publications increased steadily during the study period. Randomised clinical trials were the most common study type and the "diagnosis, management and treatment of sports-related injuries and conditions" was the most popular study topic. The knee, ankle/foot and shoulder were the most frequent anatomical sites of study. Soccer players and runners were the favourite study subjects. The American Journal of Sports Medicine had the highest number of publications and shared the greatest international diversity of authorships with the British Journal of Sports Medicine. The USA, Australia, Germany and the UK produced a good number of the lead authorships. In all, 91% of articles and 88% of journals were published in English. CONCLUSIONS: Sports medicine-related research is internationally diverse, clinical trial publications are increasing and the sophistication of research design may be improving.

Nonorthopaedic problems in the aquatic athlete.

This article discusses a number of medical conditions that are common to aquatic athletes. Exercise-induced asthma is particularly prevalent in swimmers because swimming is among the activities tolerated best by asthmatics. The healthcare professional frequently must evaluate and manage respiratory infections and infectious mononucleosis in swimmers, particularly in regard to the safe timing of return to training and competition. Dilutional sports pseudoanemia must be differentiated from the true anemias that are due mostly to iron-deficiency and intravascular hemolysis. Finally, the evaluation, management, and prevention of otitis externa, external auditory canal exostoses, and dermatologic disorders in swimmers are reviewed.

The thoracic outlet syndrome in athletes.

BACKGROUND: The array of symptoms that characterize thoracic outlet syndrome (TOS) often lead to a failure or delay in diagnosing this condition in persons who are physically active. METHODS: Using the key words and phrases "thoracic outlet syndrome," "sport," "exercise," and "athlete," the MEDLINE files from 1991 to April 1996 were searched. Articles dating before 1991 were accessed by cross-referencing the more recent articles. RESULTS AND CONCLUSIONS: TOS results from compression of the neural or vascular structures of the upper extremity at the thoracic outlet. Clinical manifestations can include upper extremity pain, paresthesias, numbness, weakness, fatigability, swelling, discoloration, and Raynaud phenomenon. Four symptom patterns have been described: upper plexus, lower plexus, vascular, and mixed. The lower brachial plexus pattern is the most common. Specific causes of outlet compression include injury to the scalene or scapular suspensory muscles, anomalous fibromuscular bands, cervical ribs, clavicular deformity, and pectoralis minor tendon hypertrophy. The diagnosis of TOS is established on the results of the history and physical examination. Ancillary studies are most helpful to rule out other conditions rather than confirm the diagnosis of TOS. In most cases the initial treatment is nonoperative with an emphasis on rehabilitative exercises for the neck and shoulder girdle. Surgery is indicated for acute vascular insufficiency, progressive neurologic dysfunction, and refractory pain that fails conservative treatment. The surgical technique involves the release or removal of the structures that cause compression and can involve scalene muscle release, first rib resection, cervical rib excision, and resection of fibromuscular bands.

Sports medicine and the Americans with Disabilities Act.

OBJECTIVE: To explore the potential impact of the Americans with Disabilities Act of 1990 on the practice of clinical sports medicine. DATA SYNTHESIS: The Federal Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 (ADA) have given physically impaired athletes the legal means by which to challenge medical sports participation decisions. The Federal Rehabilitation Act prohibits the exclusion of otherwise qualified individuals from participation in federally funded programs, and the ADA extends the rights of disabled persons to include the private sector. These legal statutes contest the team physician's traditionally unchallenged authority in determining sports participation eligibility for medically impaired individuals. CONCLUSIONS: The team physician is advised to use his or her best judgment and the opinions of consultants and to consider special circumstances to formulate a recommendation about sports participation. Consequently, the prospective athlete, after becoming fully informed about the risks of participation, assumes greater responsibility in the decision-making process. Sports medicine professionals must be cognizant of this potential conflict between medical safety recommendations and the expanded legal rights of disabled individuals.

Pre-participation examination: a new form for Hawaii.

A recent study examining the adequacy of the existing pre-participation physical examination (PPE) form in the State of Hawaii suggested that the form be modified and expanded. The standards for a comprehensive PPE indicate that the screening should include an extensive medical history, assessment of height, weight, blood pressure, pulses, vision, cardiopulmonary (heart, and lungs), maturation, skin, abdominal, genitalia, and musculoskeletal function. Pursuant to the recommendation of this recent study and the accepted standards of the American Academy of Family Physicians, American Academy of Pediatrics, American Medical Society for Sports Medicine, American Orthopedic Society for Sports Medicine, and the American Osteopathic Academy of Sports Medicine, the PPE form utilized by the Hawaii High School Athletic Association has been drastically modified. The new form includes an expanded medical history, a maturational assessment (Tanner Stage), a complete musculoskeletal examination, and a participation clearance and recommendation.

Adequacy of a pre-participation examination form: a study of Hawaii physicians.

Many states currently require a medical screening prior to participation in organized sports. The purpose of this study was to examine the adequacy of the existing pre-participation examination form in Hawaii. One hundred forty-eight physicians who perform school health/pre-participation physical examinations were surveyed. The results indirectly suggest that these physicians agreed that the form should be modified and improved (p, .001).

[The utilization of Arizona medical services by residents of Mexico]. / Utilización de servicios médicos de Arizona por residentes de México.

Arizona physicians practicing in the four counties bordering Mexico were surveyed regarding the use of their services by residents of Mexico. One hundred eighty-eight (79%) of the 239 respondents to the mail survey reported seeing at least one Mexican resident per week during 1988. Ninety-nine of these physicians (53%) practiced in Tucson; 89 (47%) practiced elsewhere in the four border counties. The mean number of Mexican resident patients seen per week was nine (9% of total) for border physicians and 5 (6% of total) for Tucson physicians. The most frequent responses from border physicians asked to list the most common health conditions of their Mexican resident patients were injury and poisoning (21%) and circulatory diseases (11%), while the most frequent responses of Tucson physicians were circulatory diseases (10%) and digestive diseases (9%). Problems and solutions in the border care health system are mainly related to quality of care and health care financing.

Exercise-induced anaphylaxis and urticaria.

Physical exercise is a stimulus capable of provoking urticaria and anaphylaxis in certain individuals. The cutaneous manifestations of EIA include erythema, pruritus, and urticarial whealing. Symptoms may also progress to angioedema, laryngeal edema, bronchospasm, and hypotension. Attacks are consistently associated with increases in serum histamine levels, and atopic individuals are more commonly affected. At least two distinct diseases cause EIA, including CU and classic EIA. A variant form of EIA may also exist. CU episodes are induced by increases in body temperature occurring secondary to physical exercise or passive body warming. Classic EIA episodes are induced only by exercise. Further differences between these two disorders include the size of skin lesions and the high frequency of progression to upper airway distress and shock in classic EIA. The manifestations of EIA occur as a result of mast cell degranulation that releases histamine and other mediators into the circulation. An exaggerated cholinergic response to body warming seems to provoke mast cell degranulation in individuals with CU. In classic EIA, exercise acts as a physical stimulus, which through an unknown mechanism provokes mast cell degranulation. The treatment of acute episodes of EIA includes administration of epinephrine and antihistamines, airway maintenance, and cardiovascular support. Prophylactic treatment includes exercise avoidance, abstention from coprecipitating foods and medications, pretreatment with antihistamines and cromolyn, and the induction of tolerance through regular exercise.

Community financed and operated health services: the case of the Ajo-Lukeville Health Service District.

The concept of a health service district, as a variation of the special tax district, is described and discussed. Tax districts have traditionally been used to support both capital construction (revenue bonds) and operational expenses of single-purpose governmental entities. The health service district, where authorized by state laws, may be used by local areas to subsidize the delivery of ambulatory health care. A particular case, the Ajo-Lukeville Health Service District in Arizona, illustrates what can be accomplished by this mechanism with the cooperation of local residents and outside agencies. Both the process of establishing such a district and the outcome of the Ajo-Lukeville experience is described. Reasons why health service districts may prove potentially attractive at this time are reviewed. Impediments to the development of more health service districts are also explored, including the lack of technical assistance, an inadequate awareness of the potential of health service districts, and the absence of a widespread orientation toward community financed and controlled health care. Movement in this direction should facilitate the development of additional health service districts.

Achilles tendinitis in running athletes.

Achilles tendinitis is an injury that commonly affects athletes in the running and jumping sports. It results from repetitive eccentric load-induced microtrauma that stresses the peritendinous structures causing inflammation. Achilles tendinitis may be classified histologically as peritendinitis, tendinosis, or partial tendon rupture. Training errors are frequently responsible for the onset of Achilles tendinitis. These include excessive running mileage and training intensity, hill running, running on hard or uneven surfaces, and wearing poorly designed running shoes. Biomechanical abnormalities that predispose to Achilles tendinitis include gastrocnemius-soleus muscle weakness or inflexibility and hindfoot malalignment with foot hyperpronation. The initial treatment should be conservative with relative rest, gastrocnemius-soleus rehabilitation, cryotherapy, heel lifts, nonsteroidal anti-inflammatory drugs, and correction of biomechanical abnormalities. Surgery is recommended only for persons with chronic symptoms who wish to continue running and have not benefited from conservative therapy.

Management of elevated serum cholesterol in a university-based family practice.

Hypercholesterolemia is a well-known risk factor of coronary heart disease. This study was designed to determine whether a group of family physicians in an academic medical center followed recent recommendations in the recognition and treatment of young patients with elevated cholesterol levels. Patient charts were reviewed retrospectively in 94.1 percent of the 1,129 patients aged between 30 and 39 years seen in the University of California at Los Angeles (UCLA) Family Health Center over a one-year period. Only 346, or 32.6 percent, of the charts reviewed contained the patient's cholesterol values. Ninety-nine patients had serum cholesterol levels greater than the recommended treatment level of 5.70 mmol/L (220 mg/dL). Of patients with elevated cholesterol levels, only 34.1 percent were treated. There was no difference in the treatment rates of faculty members' patients as compared with residents' patients. The incidence of treatment increased linearly with respect to rising cholesterol values. This study identified the relative infrequency with which cholesterol levels appear in the charts of patients aged 30 to 39 years. It also illustrated that significantly more physician effort is required to meet suggested treatment guidelines for patients with elevated cholesterol levels. The cholesterol "normal ranges" that are reported on laboratory result sheets, which are not age-specific, may be misleading, and consequently affect patient care.

Wrist Pain in a Gymnast.

A group of experts met to discuss a case from the University of California, Los Angeles, School of Medicine.

Financing medical care for the underserved in an era of Federal retrenchment: the health service district.

Federal funding programs have, since the 1960s, been available in a variety of forms to deal with problems of access to medical care for the medically underserved. Certain programs, such as the National Health Service Corps, have recently pulled back from their points of maximal impact in terms of numbers of obligated physicians in the field. This change leaves a need for greater contributions by State and local entities in the face of Federal retrenchment. The health service district (HSD) is one such mechanism for filling the gap. It has been available under this name in Arizona law since 1977, but the first such district in the State in only now under development in a small copper mining community. Similar to school districts in concept, the HSDs allow residents in their catchment areas to tax themselves for the purpose of delivering primary health care. Two successful HSDs--or similar entities--in other States are described. One program is in Stickney, IL, and other in Condon, OR. The political success and financial viability of the Condon program are documented.

The effect of malpractice liability on the delivery of rural obstetrical care.

A telephone survey of all non-governmental obstetricians, family physicians, general practitioners, and osteopathic physicians in rural Arizona was undertaken to determine the effects of medical liability issues on the availability of rural obstetrical services. One hundred ninety-one (88.8%) responded, and after exclusion of those who had never provided obstetrical care, 126 physicians remained for evaluation. These included 32 obstetricians, 55 family physicians, 25 general practitioners, and 14 osteopaths. During the past three years, 26 (20.6%) had discontinued providing obstetrical service, citing liability issues as the reason. An additional 12 physicians (9.5%) planned to discontinue obstetrics upon expiration of their 1986 malpractice insurance policy. By the end of 1986, the number of obstetrical providers in rural Arizona will have decreased by 30.1 percent. Women in many rural areas already have pregnancy outcomes that are inferior to their urban counterparts. A further decrease in the availability of obstetrical providers may have additional adverse effect on pregnancy outcomes.

Frequency, associated factors, and treatment of breaststroker's knee in competitive swimmers.

Thirty-six competitive breaststroke swimmers were interviewed and examined for knee pain specifically related to the breaststroke kick. Eighty-six percent of the subjects had a history of at least one episode of breaststroke knee pain, while 47.2% had breaststroke knee pain that occurred at least once a week. There was a significant relationship between more frequent knee pain and increasing swimmer's age, increasing years of competitive swimming, increasing breaststroke training distance, and decreasing warm-up distance. The subjects with frequent knee pain were found to have less internal rotation at the hip joint. The most common site of breaststroke knee pain was the medial portion of the knee, with specific sites differing among the individuals. The medial synovial plica syndrome may be a cause of breaststroke knee pain, since 47% of subjects with weekly knee pain had tender, thickened medial plicae. Palpation of those plicae produced pain similar to that experienced with the breaststroke kick. The findings in this study suggest that reducing or eliminating breaststroke training distance should be an initial measure in treatment. Applications of ice, changes in kick technique, stretching exercises to increase hip rotation, and administration of aspirin may also be effective. The breaststroke training distance should be increased very gradually in the early season, and warm-up distance should be adequate to help prevent the symptoms of breaststroker's knee.