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PURPOSE: We aimed to evaluate whether tears of the posterior horn of the medial meniscus root ligament (PHMM RL) are associated with osteoarthritis of the far posterior femoral condyles (FPFC). METHODS: Retrospective review of 1158 patients who underwent arthroscopy identified 49 patients with confirmed tears of the medial meniscus posterior root ligament attachment. Preoperative magnetic resonance imaging (MRI) studies were reviewed to identify advanced osteoarthritis involving the medial and lateral FPFC. Control patients (n=48) had no meniscal tears confirmed by arthroscopy. Cases and controls were age- and sex-matched exactly 1:1. One case patient was excluded since there was no age- and sex-matched control available. The International Cartilage Research Society (ICRS) MRI cartilage grade was recorded for the medial and lateral FPFC. Associations were evaluated using univariate and multivariable conditional logistic regression analyses. RESULTS: There were 48 case and 48 control patients (10 men in each group, 20.8%) with median age 53 years (range, 21–67). Medial FPFC ICRS Grade 2 or higher lesions were present in 34 (70.8%) of case patients and 16 (33.3%) of control patients. Lateral FPFC ICRS Grade 2 or higher lesions were present in 24 (50%) of case patients and 14 (28.2%) of control patients. Increased body mass index (BMI) was associated with PHMM RL tears (OR=1.11, 95% CI [1.01, 1.22], P = 0.020). MRI was 81.2% (39/48) sensitive and 91.2% (44/48) specific for detection of PHMM RL tears. PHMM RL tears were associated with Grade 2 or higher medial FPFC osteoarthritis (OR=10.00, 95% CI (2.34, 42.78), P < 0.001). This association remained after adjusting for BMI (OR=11.79, 95% CI [2.46, 56.53], P = 0.002). There was also an association between PHMM RL tears and lateral FPFC osteoarthritis, which persisted after adjusting for BMI (OR =3.00, 95% CI [1.07, 8.37], P = 0.036). CONCLUSION: PHMM RL tears are associated with advanced osteoarthritis of the FPFC. Radiologists identifying FPFC osteoarthritis should look carefully for PHMM RL tears.

Remote Ischemic Preconditioning and Cardiac Arrhythmias. Introduction: The effect of remote ischemic preconditioning (RIPC) on arrhythmias in in vivo models is unknown. Our purpose was to determine effects of both acute and delayed RIPC on arrhythmias. Methods and Results: In the acute protocol anesthetized open chest rats were exposed to 5 minutes of proximal left coronary artery occlusion (CAO) and 10 minutes of reperfusion. Rats were either untreated (ischemia/reperfusion, IR group, n = 17) or received RIPC (n = 14) with 5 minutes bilateral femoral occlusions followed by 5 minutes of reperfusion times 3, started 30 minutes before CAO. At reperfusion, onset of ventricular tachycardia (VT) was delayed in RIPC group (25.7 seconds) versus IR (8.8 seconds; P = 0.04). Number of episodes of VT was 17.0 in IR versus 3.0 in the RIPC group (P = 0.01) and duration of VT was 54.1 seconds in IR versus 4.9 seconds in RIPC (P = 0.019). Number of ventricular premature complexes (VPC) was 26.0 in IR and 10.0 in RIPC rats (P = 0.04). Levels of reperfusion injury salvage kinases (RISK), that is, phospho-Akt and phospho-p70S6 in the risk area of IR and RIPC hearts were similarly higher compared to the nonischemic areas both at 1 and 10 minutes into reperfusion. Delayed RIPC was induced on day 1 and on day 2, myocardial IR was induced. Delayed RIPC did not affect VT or VPC. Conclusion: Acute RIPC of the lower limbs induced a powerful delay in/and reduction in IR induced ventricular arrhythmias, but without evoking the RISK pathway; a late protective phase of RIPC on arrhythmias did not occur. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1374-1383, December 2012)

Objective(s): (1) To compare the effectiveness of customized exercises with that of standard exercises for the treatment of patients with shoulder disorders. (2) To determine whether four weeks or eight weeks would be needed to see improvement in outcome measures. Design: A single-blinded randomized clinical trial. Setting: An outpatient physical therapy clinic affiliated with an academic institution. Subjects: Thirty patients with shoulder disorders were tested and treated between February 2003 and December 2004. Interventions: Patients were randomized to a customized or standard exercise group. Each patient first underwent a standardized physical therapy assessment. Based on the results of the assessment, a classification was determined and a classification-specific exercise programme was instructed to the patients in the customized exercise group. The standard exercise group, regardless of classification, received preselected standard exercises. Both groups were followed for eight weeks. Main measures: Shoulder range of motion, strength, pain intensity and function were assessed three times (weeks 0, 4 and 8). Results: There were no significant differences between the customized and standard exercise groups in measures of shoulder range of motion, strength, pain intensity and function after four or eight weeks of exercise. Patients in both groups had significant improvements in shoulder strength, pain intensity and function. Significant improvements occurred at week 8, but not at week 4. Conclusion: The customized shoulder exercises did not provide additional benefit to our shoulder patients than the standard exercises.

The purposes of this study were to determine inter-tester reliability, one-week test-retest reliability and smallest detectable difference (SDD) of serratus anterior muscle strength and endurance tests. Asymptomatic subjects were tested on an apparatus designed by the investigators. During strength testing, subjects performed isometric contractions recorded by a hand-held dynamometer. For endurance testing, subjects held a dumbbell of 15% of their body weight and performed repetitions until they became fatigued. Intraclass correlation coefficients (ICC) for the strength test revealed good inter-tester reliability (ICC2,3 = .90-.93) and good one-week test-retest reliability (ICC2,3 = .83-.89). For the endurance test, ICCs showed good inter-tester reliability (ICC2,1 = .71-.76) but moderate one-week test-retest reliability (ICC2,1 = .59-.62). The SDDs at 68% confidence level ranged from 22.7 to 39.2 newtons for the strength test, and 11 to 20 repetitions for the endurance test. In summary, the technique used in the study is reliable for quantifying the SA muscle strength.

Muscle tightness is often considered to be a predisposing factor in muscle injuries. The purpose of this study was to assess the muscle flexibility of the hamstrings, rectus femoris, iliopsoas, gastrocnemius, and soleus muscles in long distance runners. Range of motion measurements of five movements, including hip flexion with knee extended, hip extension with knee flexed, hip extension with knee extended, ankle dorsiflexion with knee extended, and ankle dorsiflexion with knee flexed, were evaluated to determine muscle tightness. Twenty runners and 20 nonrunners volunteered for the study. Each group consisted of 10 males and 10 females. The observed means were compared between runners and nonrunners, males and females, plus the dominant and nondominant leg using a three-way analysis of variance. The runners were found to have tighter hamstrings (p < .05), and soleus (p < .05) muscles than nonrunners. There was no significant difference in rectus femoris and iliopsoas muscle tightness in runners compared with nonrunners. In addition, the males had tighter hamstring muscles than the females in both runners and nonrunners (p < .05). The hamstring muscles of the dominant leg were tighter than the hamstrings of the nondominant leg in all subjects (p < .05). In conclusion, long distance runners appear to have posterior muscle tightness in the lower extremity.

Bowen's disease (BD), or cutaneous squamous cell carcinoma (SCC) in situ, is rare in children. BD usually occurs in Caucasian adults on sun-exposed areas and may progress to invasive cutaneous SCC. Most cases of periungual BD have been linked to human papillomavirus infection. We report an immunocompetent child with periungual BD.

Survivors of a stroke are forever in a battle for complete recovery. Signs and symptoms of the initial stroke may remain. Patients who has had a stroke may retain some of their initial manifestations, e.g., hemiparesis. Limbs that were initially paralyzed will usually retain signs of upper motor neuron damage. This patient demonstrated such a situation, and we felt that the proper treatment in this case of severe hammer digit syndrome was modified Lambrinudi fusions.

This study deals with murine marrow stromal cells (MSC) during hematopoietic regeneration. Regenerative marrow was induced in infant mice by two consecutive i. p. injections of hydroxyurea (HU) (2 X 1,000 mg/kg) which kill most cells in DNA synthesis. Two days later the marrow becomes enriched in pluripotent stem cells (CFU-S) and committed progenitors. It was found that fibroblastoid colony-forming-units (CFU-F) become concentrated approximately four fold above controls and give rise to significantly larger fibroblastoid colonies than CFU-F in control marrow. In split-phase semisolid agar cultures, i. e. adherent cells of HU-treated marrow (in under layers) and normal bone marrow cells (in upper layers), inhibition of G/M colonies in the upper layer in observed. In control split-phase cultures of both under layers and upper layers of normal bone marrow, CFU-C inhibition is by far less pronounced. In liquid cultures, pre-established adherent layers of HU-treated marrow have a stimulatory effect on normal marrow CFU-C. It is concluded that during increased demand for pluripotent stem cells and progenitors, such as after HU administration, marrow stromal cells and possibly other adherent cells produce inhibitory factor(s) of CFU-C differentiation. The inhibitory activity possibly is an effective mechanism for stem cell pool preservation. The differing effect of adherent cells of HU-treated marrow on CFU-C in liquid and in semi-solid medium suggests production of two different factors with opposing influences on CFU-C, depending upon the culture conditions.

Long-term antihypertensive treatment by once-weekly application of transdermal clonidine patches, in doses equivalent to 0.1, 0.2, 0.3 mg of clonidine daily, was evaluated in an open trial of 41 patients with baseline seated diastolic blood pressures of 90 to 103 mmHg. In all the patients, seated diastolic blood pressure was reduced to less than 90 mmHg with transdermal clonidine alone at the end of a dose titration phase of two to six weeks. Thirty-two patients successfully completed at least 22 months of therapy; three patients withdrew because of lack of efficacy and six because of adverse events. In the second treatment year 14 patients required a concomitant diuretic. Mean reductions in seated diastolic blood pressure from baseline values were statistically significant (P less than 0.0001) at all study intervals. The incidence of patient withdrawals resulting from the development of contact dermatitis at the patch application site was 5%; skin irritation not requiring withdrawal occurred in 13 patients during the first year of treatment and in two during the second. The incidence of dry mouth (in 7%) and drowsiness (in 10%) was lower than has been reported during oral clonidine therapy (40% and 35%). The results suggest that transdermal clonidine may be beneficial for the maintenance therapy of many patients with mild hypertension.

The excretion levels of urinary amino acids obtained from acid hydrolysates were studied by gas chromatographic analysis in 29 normal individuals and 118 patients with bladder carcinoma. Leucine and isoleucine excretion were elevated in patients with bladder carcinoma as compared with normal subjects under the same experimental condition. Mathematical computer-assisted programs developed to aid in determining clusters of amino acid variables suggested that excretion of glycine, leucine, proline, and glutamic acid in men and concentrations of valine, serine, aspartic acid, phenylalanine, and lysine in women vary according to the invasiveness of the disease. These findings suggest that measurements of urinary amino acids may provide a useful parameter for the detection and aid in the staging of bladder carcinoma.