Now Is the Time: A Primer on How to Be a Disability Education Champion in Your Medical School.

One in four noninstitutionalized adults in the United States lives with a disability. People with disabilities have frequent interactions with the medical community and the healthcare system yet experience disparities in access and outcomes. The Association of American Medical Colleges has included disability in its definition of diversity as one of the aspects of patient care that may affect health equity.

Can a single dose of 300 mg of pregabalin reach acute antihyperalgesic levels in the central nervous system?

Background And Objectives: Central spinal cord sensitization can occur during surgery and may lead to persistent pain after surgery. Pregabalin has been shown to decrease central sensitization in experimental pain paradigms, and so the same antihyperalgesic effect of pregabalin may occur during and immediately after surgery. Our study investigated whether a single 300-mg dose of pregabalin in patients has sufficient central nervous system bioavailability to be useful under acute conditions where brain or spinal cord excitability may lead to long-term disease, such as chronic pain.

Improving outcomes in hypertensive patients: focus on adherence and persistence with antihypertensive therapy.

Although effective control of blood pressure (BP) reduces the risk of cardiovascular events in patients with hypertension, BP control rates among treated patients in actual clinical practice are less than optimal. Although the costs of medicines and medical care (which are difficult to estimate both in clinical trials and general clinical practice) are important, medication-taking behavior--adherence and persistence with antihypertensive regimens--influences BP control rates. Many factors affect adherence and persistence with medications, including efficacy and tolerability of drugs prescribed, such that rates vary greatly among antihypertensive classes.

Age-related changes in the extracellular matrix of nucleus pulposus and anulus fibrosus of human intervertebral disc.

Study Design: To characterize age-related changes in the matrix of human intervertebral disc (IVD) specimens, human specimens from the third to the eighth decade of life were collected and analyzed for collagen and proteoglycan (PG) composition.

Objective: To identify age-related changes in the concentration of matrix macromolecules (collagen and PGs, including the small leucine-rich PGs biglycan, decorin, fibromodulin, and lumican) in human anulus fibrosus (AF) and nucleus pulposus (NP).

Summary Of Background Data: IVD degeneration is associated with changes in the concentration and fragmentation of matrix molecules.

Peripheral nerve stimulator for the treatment of supraorbital neuralgia: a retrospective case series.

Peripheral nerve blocks of the supraorbital, supratrochlear or occipital nerve have been utilized for the relief of headaches, although relief may be short-lasting. The purpose of this study was to evaluate the efficacy of supraorbital nerve stimulation for treatment of intractable supraorbital neuralgia. Patients presenting to the pain clinic with refractory frontal headaches who responded to a diagnostic supraorbital nerve block were selected for this case series.

Aggrecanases and aggrecanase-generated fragments in the human intervertebral disc at early and advanced stages of disc degeneration.

Study Design: A comparative study of aggrecanases and aggrecan fragmentation profile in the human intervertebral disc at early and advanced stages of disc degeneration.

Objective: To determine differences in the content of the aggrecanases and the profile of aggrecan fragmentation in early and advanced stages of disc degeneration using cadaveric human intervertebral discs.

Summary Of Background Data: Aggrecanases and aggrecanase-generated aggrecan fragments have been found in human degenerated discs.

Response of chronic pain patients to terrorism: the role of underlying depression.

Objectives: This study seeks to identify characteristics of the chronic pain patient population that may increase vulnerability to vicariously experienced psychological trauma.

Design: Characteristics, including demographics and psychological measures, were evaluated by modeling change in visit rates to a university pain center immediately after the terrorist attacks of September 11, 2001.

Setting: University pain center.

Matrix replenishment by intervertebral disc cells after chemonucleolysis in vitro with chondroitinase ABC and chymopapain.

Background Context: One of the advantages of chemonucleolysis for the treatment of a herniated intervertebral disc is the potential for the disc to self-repair. It has been suggested that the enzymes used for chemonucleolysis differentially affect the potential of the disc cells to promote repair.

Purpose: To test the ability of nucleus pulposus and anulus fibrosus cells to repair the extracellular matrix degraded in vitro by either chondroitinase ABC or chymopapain.

Recombinant human osteogenic protein-1 upregulates proteoglycan metabolism of human anulus fibrosus and nucleus pulposus cells.

Study Design: In vitro assessment of the effects of recombinant human osteogenic protein-1 (rhOP-1) on the proteoglycan metabolism of human intervertebral disc cells.

Objectives: To determine whether rhOP-1 is effective in stimulating the cell proliferation and proteoglycan metabolism of human intervertebral disc cells cultured in alginate beads.

Summary Of The Background Data: OP-1 has been shown to stimulate the proteoglycan and collagen synthesis of rabbit intervertebral disc cells in vitro.

Restoration of disc height loss by recombinant human osteogenic protein-1 injection into intervertebral discs undergoing degeneration induced by an intradiscal injection of chondroitinase ABC.

Study Design: In vivo study of the effect of an injection of recombinant human osteogenic protein-1 into degenerated discs induced by chondroitinase ABC.

Objective: To investigate the efficacy of an injection of recombinant human osteogenic protein-1 to induce the recovery of disc height, and biochemical and histologic repair, in discs degenerated through enzymatic digestion by chondroitinase ABC.

Summary Of The Background Data: Chondroitinase ABC is currently proposed as a chemonucleolysis agent; however, postchemonucleolysis degeneration is currently unavoidable.

Axonal growth potential of lumbar dorsal root ganglion neurons in an organ culture system: response of nerve growth factor-sensitive neurons to neuronal injury and an inflammatory cytokine.

Study Design: The axonal growth potential of dorsal root ganglion (DRG) neurons in an organ culture system was investigated.

Objective: To examine the effects of neuronal injury and tumor necrosis factor-alpha (TNF-alpha) on the axonal growth potential of 2 types of nociceptive DRG neurons: nerve growth factor (NGF)-sensitive and glial cell line-derived neurotrophic factor (GDNF)-sensitive neurons.

Summary Of Background Data: Nerve ingrowth into the disc is recognized to be one of the causes of discogenic pain.

Proinflammatory cytokines stimulate the expression of nerve growth factor by human intervertebral disc cells.

Study Design: In vitro studies of the effects of proinflammatory cytokines on the production of nerve growth factor (NGF) by human intervertebral disc (IVD) cells.

Objective: To determine the constitutive expression and production of NGF and the effect of cytokines on the expression of NGF by human IVD cells.

Summary Of The Background Data: NGF may play a role in the collateral sprouting of sensory axons, neural survival, and regulation of nociceptive sensory neurons.

The expression of NG2 proteoglycan in the human intervertebral disc.

Study Design: Immunohistochemical and biochemical analyses of NG2 proteoglycan in the human intervertebral disc.

Objective: To determine if the human intervertebral disc expresses NG2 proteoglycan.

Summary Of Background Data: In the nervous system, NG2 has been reported to play an important role as an interactive extracellular matrix component and membrane receptor for growth factors.

Persistence, adherence, and risk of discontinuation associated with commonly prescribed antihypertensive drug monotherapies.

Objective: To assess 1-year persistence and adherence with monotherapy using the most commonly dispensed individual agent in 4 antihypertensive drug classes: hydrochlorothiazide (HCTZ), amlodipine, lisinopril, or valsartan.

Design: Retrospective, longitudinal analysis of initial prescriptions during 2001 to 2002 from a nationwide administrative claims database representing 11 million covered lives in the United States.

Measurements: Drug utilization following initiation.

Use of lighted stylets to facilitate insertion of double-lumen endobronchial tubes in patients with difficult airway anatomy.

Placement of double-lumen endobronchial tubes (DLTs) into the trachea can be difficult because of their size and configuration. For patients with abnormal airway anatomy and anticipated difficult tracheal intubation, DLT placement can be extremely challenging. We present our experience using lighted stylets to facilitate insertion of DLTs in a series of patients with difficult airway anatomy.

Effects of growth differentiation factor-5 on the intervertebral disc--in vitro bovine study and in vivo rabbit disc degeneration model study.

Study Design: In vitro studies on the effects of recombinant human growth and differentiation factor-5 (rhGDF-5) on matrix metabolism of bovine intervertebral disc cells and an in vivo study on the effect of rhGDF-5 in the rabbit anular puncture model.

Objective: To determine the reparative capacity of rhGDF-5 on the intervertebral disc.

Summary Of Background Data: The in vitro and in vivo effects of rhGDF-5, a crucial protein in the developing musculoskeletal system, on repair of the degenerated intervertebral disc remain unidentified.

Nerve fiber ingrowth into scar tissue formed following nucleus pulposus extrusion in the rabbit anular-puncture disc degeneration model: effects of depth of puncture.

Study Design: In vivo histologic study of nerve ingrowth in the rabbit anular-puncture disc degeneration model.

Objective: To examine innervation of intervertebral discs and surrounding tissues in the rabbit anular-puncture model with various magnitudes of injury.

Summary Of Background Data: A rabbit anular-puncture model of disc degeneration was recently established.

Prevention of disc degeneration with growth factors.

Clinically, a large number of patients have persistent low back pain attributable to intervertebral disc (IVD) degeneration. After the concept of biologically regenerating the degenerated IVD using growth factor injection was first proposed in early 1990, the advancement of molecular technology to produce recombinant proteins, including growth factors, on an industrial scale accelerated research in this field. The purpose of this review is to summarize the most recent findings of the in vitro and in vivo effects of growth factors on the IVD and, further, to discuss the limitations of growth factor therapy and its clinical implications.

Platelet-rich plasma stimulates porcine articular chondrocyte proliferation and matrix biosynthesis.

Objective: Platelet-rich plasma (PRP) is a fraction of plasma that contains high levels of multiple growth factors. The purpose of this study was to examine the effects of PRP on cell proliferation and matrix synthesis by porcine chondrocytes cultured in alginate beads, conditions that promote the retention of the chondrocytic phenotype, in order to determine the plausibility of using this plasma-derived material for engineering cartilage.

Design: PRP and platelet-poor plasma (PPP) were prepared from adult porcine blood.

Comparison of cellular response in bovine intervertebral disc cells and articular chondrocytes: effects .of lipopolysaccharide on proteoglycan metabolism.

Lipopolysaccharide (LPS) induces matrix degradation and markedly stimulates the production of several cytokines, i.e., interleukin-1beta, -6, and -10, by disc cells and chondrocytes.

Platelet-rich plasma (PRP) stimulates the extracellular matrix metabolism of porcine nucleus pulposus and anulus fibrosus cells cultured in alginate beads.

Study Design: In vitro assessment of the effects of platelet-rich plasma on the extracellular matrix metabolism of porcine intervertebral disc cells.

Objectives: To determine whether platelet-rich plasma is effective in stimulating cell proliferation and extracellular matrix metabolism by porcine disc cells cultured in alginate beads.

Summary Of Background Data: Platelet-rich plasma is used to accelerate wound healing and tissue regeneration.

Osteogenic protein-1 injection into a degenerated disc induces the restoration of disc height and structural changes in the rabbit anular puncture model.

Study Design: In vivo study of the effect of injection of osteogenic protein-1 (OP-1) on a rabbit anular needle puncture model of intervertebral disc (IVD) degeneration.

Objective: To study radiographic, magnetic resonance imaging (MRI), biochemical, and histologic changes in the rabbit IVD after injection of OP-1 into the nucleus pulposus in a needle puncture disc degeneration model.

Summary Of The Background Data: Growth factors, such as OP-1, have the ability to stimulate synthesis of proteoglycans and collagen in vitro.

Anti-adhesion properties of a thrombin-based hemostatic gelatin in a canine laminectomy model: a biomechanical, biochemical, and histologic study.

Study Design: An in vivo study on the effects of an agent for scar prevention in a dog laminectomy model.

Objective: To examine the anti-adhesion properties of a thrombin-based hemostatic gelatin (FLOSEAL; Baxter International Inc., Deerfield, IL).

Collagen and proteoglycan turnover in focally damaged human ankle cartilage: evidence for a generalized response and active matrix remodeling across the entire joint surface.

Objective: Although cartilage lesions occur in the ankles, osteoarthritis rarely develops in the ankles, suggesting that ankle cartilage can up-regulate mechanisms to repair the damaged matrix. To define these processes, we compared cartilage samples obtained from normal tali and from lesional sites of damaged tali.

Methods: Cartilage samples were obtained from the tali of normal ankles and from 3 sites on tali with lesions (the lesion, adjacent to the lesion, and far removed from the lesion).