Measurement of plantarflexor spasticity in traumatic brain injury: correlational study of resistance torque compared with the modified Ashworth scale.

Objectives: To examine the usefulness of a biomechanical measure, resistance torque (RT), in quantifying spasticity by comparing its use with a clinical scale, the modified Ashworth scale (MAS), and quantitative electrophysiological measures.

Design: This is a correlational study of spasticity measurements in 34 adults with traumatic brain injury and plantarflexor spasticity. Plantarflexor spasticity was measured in the seated position before and after cryotherapy using the MAS and also by strapping each subject's foot and ankle to an apparatus that provided a ramp and hold stretch.

Using the single-compartment ratio model to calculate half-life, NT-proBNP as an example.

Background: The single-compartment model offers a simple way to calculate the half-life of a compound if it is secreted or injected at the known rate compared with another compound whose half-life is known. This model may be easier to use than the exponential decay model. Investigators disagree on the value of the half-life of NT-proBNP, with published values ranging from 70 to 120 min.

Male osteoporosis: deadly, but ignored.

Male osteoporosis is a relatively unknown condition for many physicians. Yet about 500,000 fractures happen in men every year. For comparison, prostate cancer is diagnosed in 200,000 men annually.

Acid has antiproliferative effects in nonneoplastic Barrett's epithelial cells.

Objectives: For patients with Barrett's esophagus, physicians commonly prescribe antisecretory medications in dosages above those required to heal reflux esophagitis because acid has been shown to have proproliferative and antiapoptotic effects on Barrett's cancer cells and on Barrett's mucosal explants. For a number of reasons, these model systems may not be ideal for determining the effects of acid on benign Barrett's epithelial cells, however. We studied the effects of acid on proliferation and apoptosis in a nonneoplastic, telomerase-immortalized Barrett's epithelial cell line.

Radiological findings in Birt-Hogg-Dubé syndrome: a rare differential for pulmonary cysts and renal tumors.

Birt-Hogg-Dubé syndrome is a rare disorder characterized by cutaneous hair follicle tumors, pulmonary cysts, and renal tumors. We report a case of a 63-year-old male patient with this syndrome. The radiological findings seen with this syndrome are described.

Predictors of recurrence in veteran patients with umbilical hernia: single center experience.

Background: Different medical and social conditions have been associated with primary and recurrent hernias. Possible predictors of recurrence after elective umbilical hernia repair have not been defined clearly. The aim of this study was to determine factors that predict recurrence in patients after elective repair of umbilical hernias.

Physician assistants and nurse practitioners: the United States experience.

Physician assistants (PAs) and nurse practitioners (NPs) were introduced in the United States in 1967. As of 2006, there are 110 000 clinically active PAs and NPs (comprising approximately one sixth of the US medical workforce). Approximately 11 200 new PAs and NPs graduate each year.

Oxidative modification of protein tyrosine phosphatases.

Our understanding of the biological effects of reactive oxidants has deepened considerably over the past decade. Less the indiscriminate loose cannons we previously imagined, both superoxide and hydrogen peroxide appear to target relatively specific molecular structures. Perhaps the most consequential of such targets within proteins is the reduced sulfhydryl of cysteine residues.

Concepts in the prevention of adenocarcinoma of the distal esophagus and proximal stomach.

For decades, the incidence rates for squamous cell carcinoma of the esophagus and adenocarcinoma of the distal stomach have been declining while the rates for adenocarcinomas of the esophagus and gastric cardia have increased profoundly. Recent studies have shown that the gastroesophageal junction (GEJ) is regularly exposed to concentrated gastric acid and to a variety of nitrosating species, noxious agents that may contribute to carcinogenesis in this region. For adenocarcinomas that straddle the GEJ, it can be difficult to determine whether the tumor originated in the esophagus or in the gastric cardia.

A comparison of complications associated with colostomy reversal versus ileostomy reversal.

Background: The incidence of complications after reversal of Hartmann's procedure is unknown. This study compares the morbidity of Hartmann's reversal versus loop ileostomy reversal.

Methods: Two groups of 20 patients were studied retrospectively over a 5-year period.

Therapy of infections caused by dematiaceous fungi.

Dematiaceous fungi are responsible for a wide variety of clinical syndromes, from local infections due to trauma, to disseminated infection in immunocompromised patients. These fungi are unique owing to the presence of melanin in their cell walls, which imparts the characteristic dark color to their spores and hyphae. Melanin may also be a virulence factor in these fungi.

Dematiaceous fungi.

Dematiaceous fungi are the etiologic agents of phaeohyphomycosis and are increasingly recognized as causing disease in humans. A wide variety of infectious syndromes are seen, from local infections due to trauma to widely disseminated infection in immunocompromised patients. Pulmonary disease may be divided into allergic bronchopulmonary and nonallergic syndromes, depending on the species.

Molecular targets for treatment of Barrett's esophagus.

SUMMARY. Esophageal cancer is one of the most deadly forms of gastrointestinal cancer with a mortality rate exceeding 90%. The major risk factors for esophageal adenocarcinoma are gastroesophageal reflux disease (GERD) and its sequela, Barrett's esophagus.

Barrett's esophagus: a molecular perspective.

Carcinogenesis in Barrett's esophagus involves the accumulation of DNA abnormalities that enable cells to 1) provide their own growth signals; 2) ignore growth-inhibitory signals; 3) avoid apoptosis; 4) replicate without limit; 5) sustain angiogenesis; and 6) invade and proliferate in unnatural locations. This report reviews recent publications describing molecular abnormalities in Barrett's esophagus that could lead to the acquisition of these key physiologic hallmarks of malignancy. Some recent reports suggest that the gastroesophageal reflux of acid and bile can activate molecular pathways that promote proliferation and interfere with apoptosis in Barrett's metaplastic cells.

Biventricular pacing reduces the induction of monomorphic ventricular tachycardia: a potential mechanism for arrhythmia suppression.

Objectives: The aim of the present study was to evaluate in a prospective randomized fashion the electrophysiologic effects of acute biventricular (BV) pacing. We hypothesized that (1) the local coupling interval in the left ventricle in response to right-sided ventricular premature beats is prolonged when BV pacing is applied during the drive train compared with right ventricular (RV) pacing, and (2) BV programmed electrical stimulation (PES) decreases the induction of ventricular arrhythmias compared with standard RV-PES, regardless of the presence of intraventricular conduction delay.

Background: Previous studies have suggested that BV pacing might decrease the frequency of ventricular arrhythmias; however, the mechanism of arrhythmia suppression remains unclear.

Differences in ERK activation in squamous mucosa in patients who have gastroesophageal reflux disease with and without Barrett's esophagus.

Objectives: In some patients with gastroesophageal reflux disease (GERD), the reflux-damaged esophageal squamous epithelium heals through the process of intestinal metaplasia (resulting in Barrett's esophagus) rather than through the regeneration of more squamous cells. We hypothesized that squamous epithelium in Barrett's esophagus might have abnormalities in activation of the extracellular-regulated kinases 1 and 2 (ERK1/2) signaling pathway that may facilitate esophageal repair through metaplasia in response to acid-induced injury.

Methods: Endoscopic biopsies were taken from distal esophageal squamous mucosa in patients who had GERD with and without Barrett's esophagus and in controls, before and after esophageal perfusion with 0.

Management of NSAID-associated upper gastrointestinal problems.

Objective: To describe risk factors and review appropriate management strategies for patients who experience nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) adverse events.

Summary: NSAIDs are the most heavily prescribed class of drugs. Their association with gastrointestinal events has been known for many years.

Review article: what I do now to manage adenocarcinoma risk, and what I may be doing in 10 years' time.

This article summarizes the present recommendations for the screening, surveillance and treatment of Barrett's oesophagus, and identifies those areas in which change seems likely within the next decade. As a result of economic constraints and emerging data on ethnic variations in the frequency of Barrett's oesophagus, future screening programmes will probably focus on those individuals most likely to develop Barrett's adenocarcinomas: older white men whose gastro-oesophageal reflux symptoms are of long duration. The present surveillance strategy for patients with Barrett's oesophagus relies heavily on random biopsy sampling of the oesophagus to find dysplasia.

Calibration verification performance relates to proficiency testing performance.

Context: Since 1988, the College of American Pathologists has been offering materials for calibration verification coupled with the surveys for linearity, called the linearity (LN) surveys.

Objective: To determine whether successful completion of the College of American Pathologists LN surveys provides a benefit in terms of improved proficiency testing (PT) performance.

Design: In this study, we used information from LN surveys LN1/2, LN3, and LN5 and from the PT surveys C, Z, and K administered and analyzed in the year 2000.

Barrett's esophagus: chemoprevention.

The clinical applicability of the experimental data discussed previously remains questionable, and results of clinical studies on chemoprevention in Barrett's esophagus are needed. The utility of selectively targeting acid exposure, ODC, and COX-2 is not clear, and elucidation of that role will be facilitated by a better understanding of the contribution of these factors in the development of Barrett's cancers. The insights already gained into the basic mechanisms of acid exposure, ODC, and COX-2 in the pathogenesis of Barrett's esophagus and esophageal adenocarcinoma hold promise for the development of future therapies aimed at these molecular targets and their signaling pathways.

The role of cyclooxygenase selective inhibitors in the gastrointestinal tract.

This article reviews the gastrointestinal manifestations of traditional nonsteroidal anti-inflammatory drugs (NSAIDs) and the improved gastrointestinal safety profile of cyclooxygenase selective (COX)-2 inhibitors. By inhibiting the COX enzyme, NSAIDs provide effective analgesia and suppress inflammation in a variety of conditions. Most NSAIDs (nonselective or traditional) not only inhibit prostaglandins at sites of inflammation but also inhibit prostaglandins that have important normal functions in other parts of the body.

The natural history of dysplasia and cancer in esophagitis and Barrett esophagus.

The natural history of metaplasia and dysplasia in Barrett esophagus is not well defined. Publication bias, the selective reporting of studies that have positive or extreme results, has exaggerated the risk of esophageal adenocarcinoma in this condition. Recent data suggest that patients with Barrett esophagus develop these tumors at the rate of 0.

Gastrointestinal safety of low-dose aspirin.

The cardioprotective benefits of aspirin support the use of low-dose regimens for primary and secondary prevention of cardiovascular disease. However, these cardioprotective benefits must often be balanced against the well-documented gastrointestinal (GI) effects of aspirin. Recent research suggests that the GI effects of aspirin may be dose-dependent; however, even low-dose aspirin can cause significant GI sequelae.