Short-term Effects of Mulligan's Mobilization With Movement on Pain, Function, and Emotional Aspects in Individuals With Knee Osteoarthritis: A Prospective Case Series.

OBJECTIVE: To evaluate the short-term effects of Mulligan's mobilization with movement (MWM) on pain, physical function, emotional aspects, and proprioceptive acuity after a 2-week treatment period and throughout a 3-week follow-up period. METHODS: A single group of 30 participants (60.96 ± 5.16 years) with symptomatic knee osteoarthritis (KOA) was evaluated. The protocol involved 5 evaluations moments, before (baseline) and after 2 weeks of intervention (24 hours after the last session), and at 3-week follow-up. The intervention included 3 Mulligan's MWM techniques. The variables evaluated were pain (pressure pain threshold and Visual Numeric Scale), physical function (range of motion, proprioceptive acuity, and the Western Ontario and McMaster Universities Osteoarthritis Index) and emotional aspects (Beck Depression Inventory). Analysis of variance for repeated measures was used considering a significance level of 5%. RESULTS: At the second evaluation (after intervention), the pressure pain threshold presented higher values for rectus femoris, tibialis anterior, and patellar tendon sites and reduced values for the Visual Numeric Scale, Beck Depression Inventory, and Western Ontario and McMaster Universities Osteoarthritis Index compared with baseline. Also, during the follow-up period, all variables returned close to baseline levels. Proprioceptive acuity and range of motion did not present significant changes. CONCLUSION: Scores for pain relief, physical function, and emotional aspects improved after a course of MWM in this single group of individuals with KOA. Mobilization with movement had limited outcome during follow-up. It suggests that future clinical trials on the use of MWM for KOA should be considered.

Huxley-type cross-bridge models in largeish-scale musculoskeletal models; an evaluation of computational cost.

A Huxley-type cross-bridge model is attractive because it is inspired by our current understanding of the processes underlying muscle contraction, and because it provides a unified description of muscle's mechanical behavior and metabolic energy expenditure. In this study, we determined the computational cost for task optimization of a largeish-scale musculoskeletal model in which muscles are represented by a 2-state Huxley-type cross-bridge model. Parameter values defining the rate functions of the Huxley-type cross-bridge model could be chosen such that the steady-state force-velocity relation resembled that of a Hill-type model. Using these parameter values, maximum-height squat jumping was used as the example task to evaluate the computational cost of task optimization for a skeletal model driven by a Huxley-type cross-bridge model. The optimal solutions for the Huxley- and Hill-type muscle models were similar for all mechanical variables considered. Computational cost of the Huxley-type cross-bridge model was much higher than that of the Hill-type model. Compared to the Hill-type model, the number of state variables per muscle was large (2 vs about 18,000), the integration step size had to be about 100 times smaller, and the computational cost per integration step was about 100 times higher.

Multidisciplinary decision-making regarding chemotherapy for lung cancer patients-An age-based comparison.

Optimising decision-making in elderly patients is becoming increasingly urgent. We analysed treatment decisions and course of therapy for patients with lung cancer in different age categories: <65, 65-75, and 75 years and older. About 349 patients with lung cancer (median age 67.8 years), discussed at the multidisciplinary team meeting in the Diakonessenhuis Utrecht, the Netherlands, were reviewed. Multidisciplinary decision-making and subsequent clinical course were extracted from medical files. We found that 39% of eligible patients older than 75 years of age started treatment with chemotherapy compared to 80% of the younger patients (<65 and 65-75). When patients did receive chemotherapy, primary and secondary treatment adaptations were effectuated in 58%: for patients aged <65 in 49%, for patients aged 65-75 and >75 years in 66%. For 44% of all patients treated with chemotherapy, unplanned hospital admissions were required: in 42% for the patients <65, in 52% for those aged 65-75 and in 27% for >75 years. The decision-making process and course of treatment for lung cancer vary per age category. In particular, patients between 65 and 75 years of age might be more frail than initially thought. Age and frailty are important characteristics that need more attention.

Chemotherapy and healthcare utilisation near the end of life in patients with cancer.

The quality of medical care delivered to patients with cancer near the end of life is a significant issue. Previous studies have defined several areas suggestive of aggressive cancer treatment as potentially representing poor quality care. The primary objective of current analysis was to examine chemotherapy and healthcare utilisation in the last 3 months of life among patients with cancer that received palliative chemotherapy. Patients were selected from the hospital administration database of the Diakonessenhuis Utrecht, the Netherlands. Data were extracted from the medical files. A total of 604 patients were included for analysis (median age: 64 years). For 300 patients (50%) chemotherapy was given in the last 3 months (CT+). For 76% (n = 229) of CT+ patients unplanned hospital admissions were made in these last 3 months, compared to 44% (n = 133) of CT- patients (p < .001). Visits to the emergency room in last 3 months were made by 67% (n = 202) of CT+ patients compared to 43% (n = 132) of CT- patients (p < .001). Healthcare consumption was significantly higher in patients who received chemotherapy in the last 3 months of life. Being able to inform our patients about these aspects of treatment can help to optimise both the quality of life and the quality of dying in patients with cancer.

Fatty acids, vitamins and cholesterol content, and sensory properties of cheese made with milk from sheep fed rapeseed oilcake.

The aim of the present study was to evaluate the influence of rapeseed oilcake used for feeding sheep on the content of fatty acids (FA), tocopherols, retinoids, and cholesterol of milk and cheese, and on the sensory properties of cheese. Indoor animal feeding (in winter) is the highest cost of production for cheesemakers, and the inclusion of locally produced rapeseed oilcake in the concentrate feed formulation can reduce the cost of cheese production, as long as the quality of the cheese is not altered. The experiment was carried out in March (mid lactation) with 72 Latxa sheep from an experimental farm located in the Basque Country (northern Spain). Two homogeneous groups of animals (n = 36) were set to receive each a different diet based on commercial or rapeseed concentrate, respectively, and forage (Festuca hay). Animal production parameters were individually recorded for each feeding group, whereas bulk milk from each group was used for cheesemaking trials. The rapeseed concentrate had higher amounts of unsaturated FA (mainly C18:1 cis isomers, C18:2 cis-9,cis-12 and C18:3 cis-9,cis-12,cis-15) and tocopherols than the commercial concentrate. The inclusion of rapeseed oilcake in the diet of dairy sheep did not compromise animal production parameters or milk gross composition. Bulk milk and cheese from sheep fed rapeseed concentrate showed higher content of unsaturated FA and tocopherols than those from sheep fed commercial concentrate. No differences were observed in the content of retinoid in milk and cheese between feeding groups, whereas the cholesterol content was slightly lower in cheese made with milk from sheep fed rapeseed concentrate. Thus, milk and cheese from sheep fed rapeseed concentrate had a healthier lipid profile. In addition, the inclusion of rapeseed oilcake in the diet of sheep did not change the typical sensory attributes of Protected Denomination of Origin Idiazabal cheese. Therefore, rapeseed concentrate could be a good local resource for feeding sheep to improve the nutritional quality of dairy products and to provide higher returns to farms.

[Lateral semicircular canal cupulolithiasis in children: a case report].

We report a case of lateral semicircular canal cupulolithiasis in a 12 years old child. He presented to ENT clinic due to vertigo and nausea for 4 hours. Roll test showed strong apogeotropic nystagmus for about 70 seconds when roll to the left recumbent position. The right lateral semicircular canal cupulolithiasis was diagnosed. The child was treated with the Li's quick repositioning maneuver and the vertigo was disappeared. His symptoms did not occurred after 6 months follow-up.

Case study of a commercial sheep flock under extensive mountain grazing: Pasture derived lipid compounds in milk and cheese.

Terpenoid, fat-soluble antioxidant and fatty acid (FA) composition of pasture as well as those of milk and cheese from a commercial sheep flock managed under extensive mountain grazing in the east region of the Cantabrian mountain (Northern Spain) was investigated. The grazing period lasted for 2 months and ewes were at late lactation stage. Plants, feces, bulk milk and cheese samples were collected on two sampling dates. The abundance of the dominating botanical families in the mountain pasture prevailed in the sheep diet of the commercial flock. Major terpenoids and tocols in the pasture appeared as major ones in milk and cheese, whereas C18 unsaturated FAs in milk and cheese were derived from the intake of C18 polyunsaturated FAs which were prevalent in the pasture. No carotene was detected in the dairy samples but retinol (free or esterified), derived from the intake of ß-carotene present in pasture plants, was found in milk and cheese.

Guideline adherence for empirical treatment of pneumonia and patient outcome. Treating pneumonia in the Netherlands.

INTRODUCTION: According to the Dutch guidelines, severity of community acquired pneumonia (CAP) (mild, moderate-severe, severe) should be based on either PSI, CURB65 or a 'pragmatic' classification. In the last mentioned, the type of ward of admission, as decided by the treating physician, is used as classifier: no hospital admission is mild, admission to a general ward is moderate-severe and admission to an intensive care unit (ICU) is severe CAP. Empiric antibiotic recommendations for each severity class are uniform. We investigated, in 23 hospitals, which of the three classification systems empirical treatment of CAP best adhered to, and whether a too narrow spectrum coverage (according to each of the systems) was associated with a poor patient outcome (in-hospital mortality or need for ICU admission). PATIENTS AND METHODS: Prospective observational study in 23 hospitals. RESULTS: 271 (26%) of 1047 patients with CAP confirmed by X-ray were categorised in the same severity class with all three classification methods. Proportions of patients receiving guideline-adherent antibiotics were 62.9% (95% CI 60.0-65.8%) for the pragmatic, 43.1% (95% CI 40.1-46.1%) for PSI and 30.5% (95% CI 27.8-33.3%) for CURB65 classification. 'Under-treatment' based on the pragmatic classification was associated with a trend towards poor clinical outcome, but no such trend was apparent for the other two scoring systems. CONCLUSIONS: Concordance between three CAP severity classification systems was low, implying large heterogeneity in antibiotic treatment for CAP patients. Empirical treatment appeared most adherent to the pragmatic classification. Non-adherence to treatment recommendations based on the PSI and CURB65 was not associated with a poor clinical outcome.

Are fast interceptive actions continuously guided by vision? Revisiting Bootsma and van Wieringen (1990).

In an influential study, R. J. Bootsma and P. C. W. van Wieringen (1990) argued that 2 of their 5 participants used visual information continuously during the attacking forehand drive in table tennis, its brief duration vis-à-vis the visuomotor delay notwithstanding. The authors repeated Bootsma and van Wieringen's experiment and included a condition in which vision was obscured after drive initiation. The authors replicated most of Bootsma and van Wieringen's findings but found no significant differences between the full-vision and no-vision conditions, which goes against the interpretation of these findings as evidence for continuous visual guidance. A subsequent simulation study found that a single preprogrammed muscle stimulation pattern resulted in spatiotemporal convergence similar to that observed experimentally but not in other important behavioral characteristics. The results contain no indications that visual information that becomes available after drive initiation affects arm motion and suggest that a form of model-based predictive control is operative rather than continuous visual guidance.

Effects of seasonal changes in feeding management under part-time grazing on the evolution of the composition and coagulation properties of raw milk from ewes.

Ewe raw milk composition, rennet coagulation parameters, and curd texture were monitored throughout the milk production season in 11 commercial flocks reared under a part-time grazing system. Milking season lasted from February to July. During that period, the diet of the animals shifted from indoor feeding, consisting of concentrate and forage, to an outdoor grazing diet. Lean dry matter, fat, protein, calcium, and magnesium contents increased throughout the milking season, as did rennet coagulation time, curd firmness, and curd resistance to compression. However, lean dry matter, protein content, and curd resistance to compression stabilized when sheep started to graze. Principal component analysis correlated curd resistance to compression and proteins, whereas curd firmness was highly correlated with fat content and minerals. Discriminant analysis distributed milk samples according to the feeding management. Curd firmness, fat, and magnesium turned out to be discriminant variables. Those variables reflected the evolution of the composition and coagulation parameters when fresh pasture prevailed over other feeds in the diet of the flocks. The present study shows that seasonal changes associated with feeding management influence milk technological quality and that milk of good processing quality can be obtained under part-time grazing.

Online survey of current autopsy practice.

AIMS: The Royal College of Pathologists (RCPath) has for several years published guidance on good autopsy practice. However, pressures such as time, cost and the introduction of the Human Tissue Act have generated suggestions that there is a discrepancy between the published guidelines and what can realistically be achieved in daily practice. The aims of this study were to determine the extent to which practising pathologists agree with this complaint, and what suggestions they might have for its resolution. METHODS: All histopathologists in the UK on the RCPath database (n = 1213) were sent an email invitation to participate in an online questionnaire. RESULTS: 406 pathologists completed the survey, providing numerical data and free-text responses. Results concerning pressures of time, resources and limitations on examination and sampling were in keeping with those expected from recent issues raised. The view that RCPath guidelines are higher than can be achieved in routine coronial autopsy practice was widely supported, but only 45% stated that the RCPath should publish separate guidelines to differentiate between hospital ("consent") autopsies and medico-legal cases. CONCLUSION: The circumstances under which coronial autopsies are conducted in many parts of the UK make it difficult or impossible to comply with current RCPath guidance. Pathologists disagree on whether this situation demands a reduction of RCPath standards, an improvement in autopsy practice in medico-legal cases to current RCPath standards, or the implementation of "double standards". Resolution of this dilemma requires clarification of exactly what a coronial autopsy is trying to achieve.

Drug-delivery study and estimation of polymer-solvent interaction parameter for bisacrylate ester-modified Pluronic hydrogels.

In this study, Pluronic F127 hydrogels were characterised as an injectable system for the controlled release of drugs with variable molecular weights (FITC-Dextran at 70 and 40 kDa). In addition, the polymer-solvent interaction parameter (chi) was successfully estimated. Pluronic hydrogels (10-25 wt.%) were redox cured and their swelling behaviour investigated in PBS (pH 7.45) at 37 degrees C. After swelling to equilibrium, the hydrogels were compressed and the rubber-elasticity theory was applied to evaluate chi. Tensile tests proved the hydrogels were elastic and their chi values ranged between 0.50 and 0.53. The full drug load could be delivered over a period of approximately 15 h suggesting that redox cured Pluronic F127 hydrogels can function as injectable systems for controlled and sustained release of macromolecules.

Can cause of death be predicted from the pre-necropsy information provided in coroners' cases?

AIM: To determine whether the cause of death can be accurately predicted from the pre-necropsy information available in coroners' cases, before carrying out a postmortem examination. METHODS: In this prospective study pathologists read the clinical summary provided by the Coroner's Office and formulated a predicted cause of death. An external examination was then conducted and any relevant information recorded, together with any changes to the original predicted cause of death. They then carried out a complete necropsy before recording a final cause of death, which was subsequently compared with their prediction. RESULTS: A total of 95 necropsies were included in the study. The cause of death was deemed to have been correctly predicted from the history in 62 cases (65.3%). In 33 cases (34.7%) an unexpected cause of death was found. Findings from the external examination were noteworthy in only 8 cases (8.4%), and did not alter the cause of death in any case. CONCLUSIONS: In certain circumstances an accurate cause of death may be given with confidence without the apparent need for necropsy. However, many common causes of death can present with similar or misleading scenarios. This study indicates that performing necropsies, despite seemingly predictable circumstances, is advisable if an accurate cause of death is to be recorded.

Quantitative gas chromatographic method for the analysis of cis-9, trans-11 and trans-10, cis-12 isomers of the conjugated linoleic acid in liver.

A quantitative GC method for conjugated linoleic acid (CLA) isomers of physiological significance (cis-9, trans-11 CLA and trans-10, cis-12 CLA) as non-esterified fatty acids (NEFA) or triacylglycerols (TAG) was developed. Furthermore, the effect of the internal standard addition point (sample or fat extract) was studied. Response linearity, recovery and precision assays, detection and quantification limits were determined. Linearity was demonstrated over a range from 0.1 to 10 microg/mL. When CLA isomers were present as NEFA, the recovery significantly decreased (P< or =0.05) from 76% to 27.1% (cis-9, trans-11 CLA) and 28.5% (trans-10, cis-12 CLA) when the standards were added to the fat extract or to the initial tissue, respectively. As an application, liver samples from hamsters fed a diet supplemented with both CLA isomers were analyzed. The CLA isomers in liver samples were detected with reasonable reproducibility.

Effects of high pressure treatment on volatile profile during ripening of ewe milk cheese.

The effect of high-pressure treatment on the volatile profile of ewe milk cheeses was investigated. Cheeses were submitted to 200, 300, 400 and 500 MPa at 2 stages of ripening (after 1 and 15 d of manufacturing) and volatile compounds were assayed at 15 and 60 d of ripening. High-pressure treatment altered the balance of volatile profile of cheeses, limiting the formation of acids, alcohols, ketones, aldehydes, and sulfur compounds and enhancing the formation of 2,3-butanedione. In general, cheeses pressurized at 15 d of ripening were more similar to untreated cheeses than those treated at 1 d. Cheeses treated at 300 MPa after 1 d of manufacturing were characterized by higher levels of free amino acids, ethanol, ethyl esters, and branched-chain aldehydes, whereas cheeses treated at 500 MPa after 1 d of manufacturing had lower microbial populations, showed the highest abundance of 2,3-butanedione, pyruvaldehyde, and methyl ketones, and the lowest abundance of alcohols.

In vitro and in vivo tissue repair with laser-activated chitosan adhesive.

BACKGROUND AND OBJECTIVES: Sutures are currently the gold standard for wound closure but they are still unable to seal tissue and may induce scarring or inflammation. Biocompatible glues, based on polysaccharides such as chitosan, are a possible alternative to conventional wound closure. In this study, the adhesion of laser-activated chitosan films is investigated in vitro and in vivo. In particular we examine the effect of varying the laser power, as well as adding a natural cross-linker (genipin) to the adhesive composition. STUDY DESIGN/MATERIALS AND METHODS: Flexible and insoluble strips of chitosan films (surface area approximately 34 mm(2), thickness approximately 20 microm) were bonded to sheep intestine using several laser powers (0, 80, 120, and 160 mW) at 808-nm wavelength. The strength of repaired tissue was tested by a calibrated tensiometer to select the best power. A natural cross-linker (genipin) was also added to the film and the tissue repair strength compared with the strength of plain films. The adhesive was also bonded in vivo to the sciatic nerve of rats and the thermal damage induced by the laser assessed 4 days post-operatively. RESULTS: Chitosan adhesives successfully repaired intestine tissue, attaining a maximum repair strength of 14.7+/-4.3 kPa (n = 30) at the laser power of 120 mW. The chitosan-genipin films achieved lower repair strength (9.1+/-2.9 kPa). The laser caused partial demyelination of axons at the site of operation, but the myelinated axons retained a normal morphology proximally and distally. CONCLUSIONS: The chitosan adhesive effectively bonded to tissue causing only localized thermal damage in vivo, when the appropriate laser parameters were selected.

Kimura disease of the eyelid: a clinicopathologic study with electron microscopic observations.

A 70-year-old white man presented with a solitary eyelid nodule of 6 months' duration. Because lymphoma could not be excluded on the initial biopsy, the mass was completely excised. Histologic examination confirmed the diagnosis of Kimura disease, an uncommon chronic inflammatory condition. Peripheral eosinophilia was present. The patient did not have any other lesions of Kimura disease on follow-up examination. The clinical, radiologic, histologic, and electron microscopic findings of Kimura disease are discussed. To our knowledge, solitary involvement of the eyelid has not been reported previously. Kimura disease should be included in the differential diagnosis of an eyelid mass lesion.

Dermatomyositis as a paraneoplastic syndrome in carcinosarcoma of uterine origin.

Paraneoplastic syndromes are a collection of disorders affecting an organ or tissue caused by cancer but occurring at a site distant from the primary or metastases. Dermatomyositis can occur in association with malignancy as a paraneoplastic phenomenon. We present a case of a patient presenting simultaneously with an advanced carcinosarcoma of the uterus and dermatomyositis. The diagnoses, pathophysiology and treatment of these two conditions are discussed and current published studies reviewed.

Gas-liquid chromatographic method for analysing complex mixtures of fatty acids including conjugated linoleic acids (cis9trans11 and trans10cis12 isomers) and long-chain (n-3 or n-6) polyunsaturated fatty acids. Application to the intramuscular fat of beef meat.

The optimisation and validation of a gas-liquid chromatographic (GLC) method using direct saponification with KOH/methanol followed by a derivatization with (trimethylsilyl)diazomethane was carried out trying to overcome all the difficulties posed by the analysis of complex mixtures of fatty acids (FAs) in animal fat tissues. The presented method allowed sensitive, selective and simultaneous determination of a wide range of different FAs, including short-chain FAs, branched-chain FAs and conjugated linoleic acid isomers in the same GLC run along with other well known saturated, monounsaturated and polyunsaturated FAs. To demonstrate the feasibility of the procedure, the total FA profile of beef meat was characterised.