The influence of self-esteem and social support on the relationship between stigma and depressive symptomology in parents caring for children with intellectual disabilities.

BACKGROUND: This study explored the synergistic relationship between stigma, self-esteem and social support, as predictors of depressive symptomology in parents of children with disabilities (e.g. Autism and Down syndrome). METHOD: One hundred and seventy-three parents (115 parents of children with disabilities and 58 control parents) completed measures of perceived stigma, self-esteem, social support and depressive symptoms. RESULTS: Parents of children with disabilities reported more depressive symptomology; additionally, stigma, self-esteem and social support were associated with depressive symptomology. Moreover, the association between stigma and depressive symptomology was mediated by self-esteem, i.e. parents who reported higher stigma were lower on self-esteem and more depressed. Further, this path varied as a function of emotional support. CONCLUSION: Results highlight the need for tailored interventions that offer parents effective strategies in dealing with stigma through social support and self-esteem.

Simultaneous Bilateral Vertebral Artery 3D Rotational Angiography. Technical Report of Two Cases.

SUMMARY: We describe the first reported use of simultaneous bilateral vertebral artery rotational angiography to visualize an aneurysm. Images acquired from 3D rotational angiography with a single vertebral injection provided insufficient anatomic detail in two cases with vertebrobasilar junction aneurysms associated with fenestration. Therefore, simultaneous bilateral vertebral artery 3D rotational runs were performed. Anatomic detail was superior with the simultaneous injection and this allowed for the appropriate plan of care to be instituted. In the rare cases of vertebrobasilar junction aneurysm associated with fenestration, simultaneous bilateral vertebral artery 3D rotational angiography may provide the most useful anatomic detail when evaluating a patient for possible endovascular intervention.

A brachial plexopathy due to myositis ossificans. Case report and review of the literature.

Myositis ossificans (MO) is a disorder characterized by the intramuscular proliferation of fibroblasts and osteoblasts, with subsequent deposition of bone and cartilage. A typical clinical presentation involves traumatic injury to a young adult, usually localized to the thigh, buttock, or upper arm, with resultant MO and mildly restricted range of motion in adjacent joints. Rarely, MO is associated with peripheral neuropathies involving the radial, median, sciatic, and sural nerves. The authors present an unusual case of MO causing a brachial plexopathy. To their knowledge, this is the first description of such a presentation.

Mutagenesis of two acidic active site residues in human muscle creatine kinase: implications for the catalytic mechanism.

Creatine kinase (CK) catalyzes the reversible phosphorylation of the guanidine substrate, creatine, by MgATP. Although several X-ray crystal structures of various isoforms of creatine kinase have been published, the detailed catalytic mechanism remains unresolved. A crystal structure of the CK homologue, arginine kinase (AK), complexed with the transition-state analogue (arginine-nitrate-ADP), has revealed two carboxylate amino acid residues (Glu225 and Glu314) within 2.8 A of the proposed transphosphorylation site. These two residues are the putative catalytic groups that may promote nucleophilic attack by the guanidine amino group on the gamma-phosphate of ATP. From primary sequence alignments of arginine kinases and creatine kinases, we have identified two homologous creatine kinase acidic amino acid residues (Glu232 and Asp326), and these were targeted for examination of their potential roles in the CK mechanism. Using site-directed mutagenesis, we have made several substitutions at these two positions. The results indicate that of these two residues the Glu232 is the likely catalytic residue while Asp326 likely performs a role in properly aligning substrates for catalysis.

The prognostic value of tumor markers in patients with glioblastoma multiforme: analysis of 32 patients and review of the literature.

Although several studies have examined brain tumor markers for prognostic value, few investigations have stratified analysis based on specific histologic grade. The objective of this study was to evaluate a single histologic grade of glioma, the grade IV glioma or glioblastoma (World Health Organization Classification), with a comprehensive panel of tumor markers in an attempt to identify those with prognostic significance. Tumor samples from a cohort of patients with glioblastoma multiforme (n = 32) were examined for tumor markers, DNA analysis, and clinical variables in an attempt to determine a 'profile' for this tumor. We used univariate and multivariate statistical analysis to determine the prognostic value of tumor cell ploidy, percent S-phase, DNA index, p53, and Ki-67 labeling index, as well as the variables of gender, race, age, location of tumor, history of chemotherapy, and primary versus recurrent tumor. Two additional tumor markers, multidrug resistance gene 1 and glutathione-S-transferase subtype pi, were included in the sample testing, but were not analyzed statistically. Univariate analysis indicated that increasing age had a strong association with decreased survival. Female gender, increasing Ki-67, no chemotherapy before sample collection, and primary glioblastoma showed some association with decreased survival in the univariate model. The univariate results indicated that race, side of tumor, ploidy, S-phase, DNA index, and p53 had no prognostic value. Multivariate modeling demonstrated that age, gender, and Ki-67 were the strongest factors associated with survival. The relevant literature is reviewed.

Synaptotagmin III/VII isoforms mediate Ca2+-induced insulin secretion in pancreatic islet beta -cells.

Synaptotagmins (Syt) play important roles in Ca(2+)-induced neuroexocytosis. Insulin secretion of the pancreatic beta-cell is dependent on an increase in intracellular Ca(2+); however, Syt involvement in insulin exocytosis is poorly understood. Reverse transcriptase-polymerase chain reaction studies showed the presence of Syt isoforms III, IV, V, and VII in rat pancreatic islets, whereas Syt isoforms I, II, III, IV, V, VII, and VIII were present in insulin-secreting betaTC3 cell. Syt III and VII proteins were identified in rat islets and betaTC3 and RINm5F beta-cells by immunoblotting. Confocal microscopy showed that Syt III and VII co-localized with insulin-containing secretory granules. Two-fold overexpression of Syt III in RINm5F beta-cell (Syt III cell) was achieved by stable transfection, which conferred greater Ca(2+) sensitivity for exocytosis, and resulted in increased insulin secretion. Glyceraldehyde + carbachol-induced insulin secretion in Syt III cells was 2.5-fold higher than control empty vector cells, whereas potassium-induced secretion was 6-fold higher. In permeabilized Syt III cells, Ca(2+)-induced and mastoparan-induced insulin secretion was also increased. In Syt VII-overexpressing RINm5F beta-cells, there was amplification of carbachol-induced insulin secretion in intact cells and of Ca(2+)-induced and mastoparan-induced insulin secretion in permeabilized cells. In conclusion, Syt III/VII are located in insulin-containing secretory granules, and we suggest that Syt III/VII may be the Ca(2+) sensor or one of the Ca(2+) sensors for insulin exocytosis of the beta-cell.

Use of the blue MACS: acceptance by clinical instructors and self-reports of adherence.

BACKGROUND AND PURPOSE: The purpose of this study was to evaluate clinical instructors' (CIs') acceptance of and self-reported adherence to instructions for use of The Blue MACS (5th edition) for evaluating the clinical performance of physical therapist students. SUBJECTS AND METHODS: One hundred twenty-four usable survey instruments were returned by CIs. RESULTS: Twenty-two items from The Blue MACS were collapsed into a score representing acceptance, and 10 items were collapsed into a score representing reported adherence to instructions. Ninety-six percent of the CIs surveyed expressed a positive opinion of the instrument. Ninety-eight percent of the CIs reported at least moderately consistent adherence to instructions. CONCLUSION AND DISCUSSION: The instrument was regarded as a useful tool, and most CIs reported using the instrument according to the instructions. A positive opinion of the clinical performance assessment instrument is desirable to facilitate its use by CIs. Consistent use by different CIs is desirable to promote accurate communication among students, CIs, and the educational institution.

A 'sensitive heart' in a tennis player.

A 49-year-old man was evaluated because of exertional chest pain of 1 month's duration that began during vigorous tennis. Initially, the pain was substernal and lasted 1 to 2 minutes. Recurrent episodes were always exercise related, though the activity might be mild, and episodes were relieved by several minutes of rest. At times, the pain radiated to the left side of the neck.

Leila Denmark, MD: practicing medicine at age 100.

Leila Denmark, MD, continues to practice medicine at age 100. Her lifestyle and work ethic are an inspiration in the current era of managed care mania.

Case study: accidental clonidine patch overdose in attention-deficit/hyperactivity disorder patients.

The safety and efficacy of the clonidine patch are contingent on the integrity of the transdermal system and the condition of the dermal surface to which it is applied. This article presents the first 2 case reports in the literature of unintentional overdose in pediatric patients with attention-deficit/hyperactivity disorder treated with transdermal clonidine. Appropriate precautions and patient education can help limit toxicity from the clonidine patch in children and adolescents.

ECG Variations in College Athletes.

At Georgia Institute of Technology, the sports preparticipation evaluation includes a cardiovascular questionnaire and careful examination of the heart, listening especially for systolic murmurs that intensify with Valsalva's maneuver and/or standing, which could indicate hypertrophic cardiomyopathy (1,2).

Preparticipation physical evaluation: getting to the heart of the matter.

The cardiovascular evaluation is an important component of the preparticipation physical examination of the athlete. The history should be standardized to include questions ranging from those about chest pain and palpitations to ones about syncope. The physical examination should not be a perfunctory one, but rather a careful search for findings that might include a low grade heart murmur that accentuates with Valsalva'a maneuver (suggestive of hypertrophic cardiomyopathy, the leading cause of sudden death in a competitive athlete). The cardiovascular risks to the athlete are known. Fortunately, only a small percentage of athletes who are screened have such abnormalities. The validity of such screening remains to be proven. Recommendations are provided to make the present approach more time efficient and perhaps more cost effective.

Medical care delivery at the 1996 Olympic Games. Centers for Disease Control and Prevention Olympics Surveillance Unit.

CONTEXT: Mass gatherings like the 1996 Olympic Games require medical services for large populations assembled under unusual circumstances. OBJECTIVE: To examine delivery of medical services and to provide data for planning future events. DESIGN: Observational cohort study, with review of medical records at Olympics medical facilities. SETTING: One large multipurpose clinic and 128 medical aid stations operating at Olympics-sponsored sites in the vicinity of Atlanta, Ga. PARTICIPANTS: A total of 10715 patients, including 1804 athletes, 890 officials, 480 Olympic dignitaries, 3280 volunteers, 3482 spectators, and 779 others who received medical care from a physician at an Olympic medical station. MAIN OUTCOME MEASURES: Number of injuries and cases of heat-related illness among participant categories, medical use rates among participants with official Games credentials, and use rates per 10000 persons attending athletic competitions. RESULTS: Injuries, accounting for 35% of all medical visits, were more common among athletes (51.9% of their visits, P < .001) than among other groups. Injuries accounted for 31.4% of all other groups combined. Spectators and volunteers accounted for most (88.9%, P < .001) of the 1059 visits for heat-related illness. The rates for number of medical encounters treated by a physician were highest for athletes (16.2 per 100 persons, P < .001) and lowest for volunteers (2.0 per 100). Overall physician treatment rate was 4.2 per 10000 in attendance (range, 1.6-30.1 per 10000). A total of 432 patients were transferred to hospitals. CONCLUSIONS: Organizers used these data during the Games to monitor the health of participants and to redirect medical and other resources to areas of increased need. These data should be useful for planning medical services for future mass gatherings.

Management of casualties from the bombing at the centennial olympics.

BACKGROUND: The explosion of a bomb 75 to 100 yards away from attendees at a concert who were in the process of being evacuated from Centennial Olympic Park at approximately 1:25 AM on July 27, 1996, resulted in a multiple-casualty event involving primarily four hospitals in proximity to the blast. The purpose of this study was to review triage and care of the victims, emphasizing those with significant injuries. METHODS: Retrospective review of triage and care of injured patients. RESULTS: Ninety-six of the 111 victims of the blast were triaged in the first half hour to four hospitals within 3 miles of the bombing. Only four minor operations were performed in 61 patients evaluated at community hospitals. Ten of 35 patients evaluated at the regional trauma center underwent emergency or urgent operations, and all who were seriously injured did well. CONCLUSIONS: Although overtriage to the regional trauma center occurred, outcome was excellent in all seriously injured victims treated there.

ECG Quiz: Flushing, Paresthesias, and Difficulty Swallowing After a Run.

A 45-year-old veteran runner, while on a summer vacation in Martha's Vineyard, went for his usual 5-mile jog in 80 degrees F weather. Two minutes after completing the run, his vision blurred and he became lightheaded. He had difficulty swallowing and noted tingling in his hands and arms and generalized flushing. He felt no chest pain, but his facial and arm muscles felt "distorted."