Torsion deformity and joint loading for medial knee osteoarthritis.

Purpose: The consequences of lower limb torsion deformity on knee loading in knee osteoarthritis are poorly understood. The purpose of this study was to quantify the associations between the mechanical axis, tibial torsion and knee loading in subjects with medial knee OA and in controls.

Methods: Twenty-four subjects: end-staged medial knee osteoarthritis (OA) with apparent torsion deformity (TKO, n=6) and without torsion deformity (KOA, n=8) and controls (CON, n=10) were imaged using long standing lower extremity (LSLE) radiographs and computed tomography (CT).

Overexpression of MMP-9 contributes to invasiveness of prostate cancer cell line LNCaP.

Matrix metallaprotinase-9 (MMP-9) is zinc-containing proteinase whose expression and trafficking are frequently altered in cancer. MMP-9 in the plasma membrane and the secreted forms are thought to contribute to the invasive and metastatic properties of malignant tumors. We have manipulated the expression of MMP-9 in prostate tumor cell line LNCaP and measured their capacity to invade through a basement membrane matrix.

A prospective protocol-based trial of darbepoetin alfa therapy to correct the early anemia following renal transplantation.

Anemia is a common complication accompanying renal transplantation. The evaluation and therapy for posttransplant anemia (PTA) are not standardized and remain controversial. This was a prospective, protocol-driven attempt at early PTA evaluation and management by transplant nurse coordinators.

Strategies in stable ischemic heart disease: lessons from the COURAGE and BARI-2D trials.

There is a continuing debate regarding the most effective strategy for treating stable ischemic heart disease (SIHD). Conflicting data have emerged from several small, randomized controlled trials and meta-analyses regarding the benefits of early revascularization in SIHD. Two recent multicenter, randomized trials, the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial and the Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes (BARI-2D) trial, compared two management strategies in SIHD-an initial conservative approach with optimal medical therapy (OMT) versus a strategy of early revascularization in combination with OMT.

Incidental finding of placental choriocarcinoma after an uncomplicated term pregnancy: a case report with review of the literature.

Choriocarcinoma is frequently preceded by a complete mole, ectopic pregnancy, nonmolar intrauterine abortion, and uncommonly by a partial mole. Choriocarcinoma coexisting with or after an otherwise "normal" pregnancy is extremely rare, with an estimated occurrence of 1 per 160,000 pregnancies. We here report a case of a placental choriocarcinoma with no metastases in a full-term intrauterine pregnancy.

Predicting conversion to MS--the role of a history suggestive of demyelination.

Background: The ability to predict conversion to multiple sclerosis (MS) accurately when assessing a patient with a clinically isolated syndrome (CIS) is of paramount importance. Magnetic resonance imaging (MRI) is the best paraclinical tool currently available; however the significance of a history of an event suggestive of demyelination prior to CIS presentation has not been evaluated.

Methods: A retrospective chart review of all optic neuritis cases presenting as CIS to a single neuro-ophthalmologist in London, Ontario between 1990 to 1998 was performed.

Role of dual antiplatelet therapy in symptomatic patients with established vascular disease: putting the CHARISMA trial into therapeutic perspective.

Introduction: The CHARISMA (Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance) trial has spurred debate over subgroup analysis interpretation and prompted renewed consideration of the long-term role of dual aspirin and clopidogrel therapy (DAPT) in patients with established vascular disease.

Discussion: Previous DAPT studies consistently demonstrated greater efficacy but an increased risk of bleeding compared with aspirin alone in patients with acute coronary syndromes or undergoing percutaneous coronary intervention. However, CHARISMA data were inconclusive and difficult to interpret.

The rs2030324 SNP of brain-derived neurotrophic factor (BDNF) is associated with visual cognitive processing in multiple sclerosis.

Purpose: To investigate the associations between the rs2030324 SNP of brain-derived neurotrophic factor (BDNF) and neuropsychological (NP) test measures in multiple sclerosis (MS) patients.

Background: BDNF regulates the survival of neuronal and non-neuronal cells and plays a critical role in neurochemical processes underlying learning and memory.

Methods: A total of 209 MS patients (161 females; 48 males) underwent brain MRI and genotyping for BDNF rs2030324.

Refinements of surgical technique in soft tissue sarcomas.

The primary modality of treatment for a localized soft tissue sarcoma is surgical resection. Adjuvant or neoadjuvant radiation helps reduce the rate of local recurrence. The rate of limb preserving resection is 94% in our series.

Ulcerative colitis and cancer.

Patients with ulcerative colitis (UC) are at an increased risk for the development of colorectal cancer (CRC). Unlike sporadic CRC, the cancer in UC patients arises from a focal or multifocal dysplastic mucosa in areas of inflammation. The clinical features of UC-associated cancer are similar to those found in patients with hereditary non-polyposis colorectal cancer.

Thermoablation of colorectal liver metastasis.

Thermoablation is a local therapy that is effective in in situ destruction of colorectal liver metastasis while preserving surrounding normal liver tissue. It is less invasive compared to surgery, easy to use, and can be repeated. The therapy provides local control of unresectable disease and is an alternative therapy for small resectable lesions in patients with insufficient hepatic reserve after resection or coexistent comorbid conditions.

Regional treatment of colorectal liver metastasis.

Compared to systemic chemotherapy, intraarterial administration of tumoricidal agents with or without systemic chemotherapy in the treatment of nonresectable metastatic colorectal cancer is associated with superior response rate. The time-to-hepatic progression is also increased but the effect on overall survival is variable. When combined with other treatment modalities the number of patients who benefit from the treatment increases.

Successful reduction of surgeries secondary to arterial access site complications: a retrospective review at a single center with an extravascular closure device.

Background: Access site complications requiring emergent surgery following femoral catheterization expose patients to additional morbidities and mortality. We observed a significant decrease in such surgeries after the Mynx device was introduced.

Methods: A retrospective review of surgeries performed as a complication of 6F & 7F femoral cardiac and peripheral catheterization was done.

Enhancing the delivery of anti retroviral drug "Saquinavir" across the blood brain barrier using nanoparticles.

Antiretroviral drugs are ineffective at treating viral infection in the brain because they cannot freely diffuse across the blood-brain barrier (BBB). Therefore, HIV-1 viral replication persists in the central nervous system (CNS) and continues to augment the neuropathogenesis process. Nanotechnology can play a pivotal role in HIV-1 therapeutics as it can increase drug solubility, enhance systemic bioavailability, and at the same time offer multifunctionality.

The role of revascularization versus medical therapy in patients with type 2 diabetes mellitus and coronary artery disease.

Patients with type 2 diabetes mellitus (T2DM) are at increased risk for cardiovascular clinical events, adverse nonfatal outcomes, and death. There has been considerable improvement in the medical management of patients with T2DM in an attempt to alter the metabolic cascade that is triggered by insulin resistance. Recent trials have demonstrated that medical management of patients with diabetes mellitus and stable coronary artery disease (CAD) is equivalent to revascularization in terms of morality benefit and rates of major adverse cardiovascular events, particularly in patients who do not have extensive CAD.

Role of chemokine and cytokine polymorphisms in the progression of HIV-1 disease.

Allelic variants of the genes for chemokine receptors and their natural ligands, the chemokines, and cytokines can affect HIV-1 disease progression. This study investigates the level of expression of the CCR5-Delta32, CCR2b-641, RANTES In1.1C, SDF-1 3'A, IL-10-5'-592A and IL-4-589T alleles in two unique HIV-1 infected patient cohorts that represent the two distinct stages of disease progression, namely rapid progressors (RPs) and long term non-progressors (LTNPs) (n=12/group) were recruited.

Cerebellar mutism in pediatric acute disseminated encephalomyelitis.

Acute disseminated encephalomyelitis is a demyelinating process affecting multiple areas of the central nervous system, frequently including the cerebellum. Cerebellar insult may lead to absence of speech or cerebellar mutism. Cerebellar mutism often occurs in young children after posterior fossa tumor resection, and generally appears as part of a larger subset of neurobehavioral signs and personality changes known as posterior fossa syndrome.

Increased tissue damage and lesion volumes in African Americans with multiple sclerosis.

Background: African American (AA) patients with multiple sclerosis (MS) have more rapid disease progression and poorer responses to disease-modifying therapies than white American (WA) patients with MS.

Objectives: To investigate brain MRI characteristics in AA compared to WA in a cohort of consecutive patients with MS.

Methods: We studied 567 patients with MS (age: 45.

Low levels of high-density lipoprotein cholesterol: an independent risk factor for late adverse cardiovascular events in renal transplant recipients.

Long-term kidney transplant graft and patient survival is often limited by cardiovascular (CV) disease. Risk factors for CV disease such as diabetes, hypertension and elevated low-density lipoprotein levels are well documented; however, the impact of low levels of high-density lipoprotein (HDL) has not been defined. We performed a retrospective chart review of 324 consecutive renal transplant recipients from 2001 to 2007 to correlate baseline HDL levels with major adverse cardiovascular events (MACEs) defined as a composite of new onset CV illness, cerebral vascular events and peripheral vascular disease.

Acute coronary syndromes: selective vs early invasive strategies.

Recommendations in the 2007 update of the American College of Cardiology/American Heart Association guidelines for patients with non-ST-elevation myocardial infarction (NSTEMI) provide considerable latitude regarding treatment choices and care pathways. Nevertheless, as accumulating evidence leads to increased recommendations for early invasive strategies, more patients are likely to receive care that falls short of recommendations. While tailoring pharmacotherapy to optimize the risk/benefit ratio for individual patients remains essential, it becomes increasingly important that care paradigms be prospectively defined.

Therapeutic targeting of "DARPP-32": a key signaling molecule in the dopiminergic pathway for the treatment of opiate addiction.

The 32-kDa dopamine- and adenosine 3',5'-monophosphate-regulated phosphoprotein (DARPP-32) is recognized to be critical to the pathogenesis of drug addiction. Opiates via the mu-receptor act on the dopaminergic system in the brain and modulates the expression of DARPP-32 phosphoprotein which is an important mediator of the activity of the extracellular signal-regulated kinase (ERK) signaling cascades, the activation of which represents an exciting nexus for drug-induced changes in neural long-term synaptic plasticity. Silencing of DARPP-32 using an siRNA against DARPP-32 may provide a novel gene therapy strategy to overcome drug addiction.

Proteomic analyses of the effects of drugs of abuse on monocyte-derived mature dendritic cells.

Drug abuse has become a global health concern. Understanding how drug abuse modulates the immune system and how the immune system responds to pathogens associated with drug abuse, such hepatitis C virus (HCV) and human immunodeficiency virus (HIV-1), can be assessed by an integrated approach comparing proteomic analyses and quantitation of gene expression. Two-dimensional (2D) difference gel electrophoresis was used to determine the molecular mechanisms underlying the proteomic changes that alter normal biological processes when monocyte-derived mature dendritic cells were treated with cocaine or methamphetamine.

Cutdowns for totally implantable access ports to central veins.

For insertion of totally implantable access ports, with the catheter end in the superior vena cava, the percutaneous (Seldinger) technique is commonly used. Of cutdowns, the cephalic vein cutdown is the most popular one (success rate about 80%), followed by the external jugular vein cutdown. Our preliminary experience suggests that internal jugular vein and basilic vein cutdowns have the anatomic features to prove both of them superior to the cephalic vein cutdown.

Evolving concepts in selecting optimal strategies for the management of patients with stable coronary disease: pharmacologic or revascularization therapy.

Purpose Of Review: Initial management of patients with stable ischemic heart disease (SIHD) continues to be vigorously debated amongst cardiologists. Despite the lack of robust data to support percutaneous coronary intervention (PCI) as the initial management of SIHD patients, it remains one of the most commonly performed procedures. Results of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial reignited the controversy of the benefit of routine initial PCI over optimal medical therapy (OMT).