Abstract Purpose This study aimed to investigate the effect of elastic taping on kinematics, muscle activity and strength of the scapular region in baseball players with shoulder impingement. Scope ...Seventeen baseball players with shoulder impingement were recruited from three amateur baseball teams. All subjects received both the elastic taping (Kinesio TexTM ) and the placebo taping (3 M Micropore tape) over the lower trapezius muscle. We measured the 3-dimensional scapular motion, electromyographic (EMG) activities of the upper and lower trapezius, and the serratus anterior muscles during arm elevation. Strength of the lower trapezius was tested prior to and after each taping application. The results of the analyses of variance (ANOVA) with repeated measures showed that the elastic taping significantly increased the scapular posterior tilt at 30° and 60° during arm raising and increased the lower trapezius muscle activity in the 60–30° arm lowering phase ( p < 0.05) in comparison to the placebo taping. Conclusions The elastic taping resulted in positive changes in scapular motion and muscle performance. The results supported its use as a treatment aid in managing shoulder impingement problems.
CD4(+) T-helper cells that selectively produce interleukin (IL)-17 (T(H)17), are critical for host defence and autoimmunity. Although crucial for T(H)17 cells in vivo, IL-23 has been thought to be ...incapable of driving initial differentiation. Rather, IL-6 and transforming growth factor (TGF)-β1 have been proposed to be the factors responsible for initiating specification. Here we show that T(H)17 differentiation can occur in the absence of TGF-β signalling. Neither IL-6 nor IL-23 alone efficiently generated T(H)17 cells; however, these cytokines in combination with IL-1β effectively induced IL-17 production in naive precursors, independently of TGF-β. Epigenetic modification of the Il17a, Il17f and Rorc promoters proceeded without TGF-β1, allowing the generation of cells that co-expressed RORγt (encoded by Rorc) and T-bet. T-bet(+)RORγt(+) T(H)17 cells are generated in vivo during experimental allergic encephalomyelitis, and adoptively transferred T(H)17 cells generated with IL-23 without TGF-β1 were pathogenic in this disease model. These data indicate an alternative mode for T(H)17 differentiation. Consistent with genetic data linking IL23R with autoimmunity, our findings re-emphasize the importance of IL-23 and therefore may have therapeutic implications.
Objective This meta-analysis of randomized, controlled trials evaluated effects of statins on postoperative atrial fibrillation risk after cardiac surgery. Methods Randomized, controlled trials ...evaluating statins in cardiac surgery were selected from MEDLINE (1996–August 2009), Cochrane CENTRAL Register, and manual review of references without any language restrictions. End points examined included postoperative atrial fibrillation, intensive care unit stay, and total hospital stay. Meta-regression analyses were conducted to determine whether statins' effects were duration or dose dependent. A random-effects model was used in all instances. Results Eight trials (n = 774) were identified and subjected to meta-analysis. Statins reduced postoperative atrial fibrillation risk (relative risk 0.57, 95% confidence interval 0.45–0.72, P < .0001, risk difference −0.14, 95% confidence interval −0.20 to −0.08, P < .0001, number needed to treat 8) and total hospital stay (weighted mean difference −0.66 days, 95% confidence interval −1.01 to −0.30 days, P = .0004) relative to placebo. Intensive care unit stay was also reduced (weighted mean difference −0.17 days, 95% confidence interval −0.37 to 0.03 days, P = .09) but did not meet prespecified criteria for statistical significance. Metaregression analysis revealed association between duration of preoperative statin prophylaxis and postoperative atrial fibrillation risk reduction (3% reduction per day, P = .008). No association was found between statin dose used and risk reduction ( P = .47). Conclusions Evidence suggests that statins are associated with reduced risk of postoperative atrial fibrillation and shorter hospital stay after cardiac surgery and that earlier therapy results in more profound benefit.
The objective of this study is to determine the role and underlying mechanisms of RGC-32 (response gene to complement 32 protein) in atherogenesis.
RGC-32 was mainly expressed in endothelial cells of ...atherosclerotic lesions in both ApoE
(apolipoprotein E deficient) mice and human patients.
-32 deficiency (
) attenuated the high-fat diet-induced and spontaneously developed atherosclerotic lesions in ApoE
mice without affecting serum cholesterol concentration.
seemed to decrease the macrophage content without altering collagen and smooth muscle contents or lesional macrophage proliferation in the lesions. Transplantation of WT (wild type) mouse bone marrow to lethally irradiated
mice did not alter
-caused reduction of lesion formation and macrophage accumulation, suggesting that RGC-32 in resident vascular cells, but not the macrophages, plays a critical role in the atherogenesis. Of importance,
decreased the expression of ICAM-1 (intercellular adhesion molecule-1) and VCAM-1 (vascular cell adhesion molecule-1) in endothelial cells both in vivo and in vitro, resulting in a decrease in TNF-α (tumor necrosis factor-α)-induced monocyte-endothelial cell interaction. Mechanistically, RGC-32 mediated the ICAM-1 and VCAM-1 expression, at least partially, through NF (nuclear factor)-κB signaling pathway. RGC-32 directly interacted with NF-κB and facilitated its nuclear translocation and enhanced TNF-α-induced NF-κB binding to ICAM-1 and VCAM-1 promoters.
RGC-32 mediates atherogenesis by facilitating monocyte-endothelial cell interaction via the induction of endothelial ICAM-1 and VCAM-1 expression, at least partially, through NF-κB signaling pathway.
OBJECTIVE To determine the strength of evidence supporting an accentuated bleeding risk when patients with CHADS2 risk factors (chronic heart failure, hypertension, advanced age, diabetes, and prior ...stroke/transient ischemic attack) receive warfarin. METHODS A systematic literature search of MEDLINE (January 1, 1950, through December 22, 2009) and Cochrane CENTRAL (through December 22, 2009) was conducted to identify studies that reported multivariate results on the association between CHADS2 covariates and risk of bleeding in patients receiving warfarin. Each covariate was evaluated for its association with a specific type of bleeding. Individual evaluations were rated as good, fair, or poor using methods consistent with those recommended by the Agency for Healthcare Research and Quality. The strength of the associations between each CHADS2 covariate and a specific type of bleeding was determined using Grading of Recommendations Assessment, Development and Evaluation criteria as insufficient, very low, low, moderate, or high for the entire body of evidence. RESULTS Forty-one studies were identified, reporting 127 multivariate evaluations of the association between a CHADS2 covariate and bleeding risk. No CHADS2 covariate had a high strength of evidence for association with any bleeding type. For the vast majority of evaluations, the strength of evidence between covariates and bleeding was low. Advanced age was the only covariate that had a moderate strength of evidence for association; this was the strongest independent positive predictor for major bleeding. Similar findings were observed regardless of whether all included studies, or only those evaluating patients with atrial fibrillation, were assessed. CONCLUSION The associations between CHADS2 covariates and increased bleeding risk were weak, with the exception of age. Given the known association of the CHADS2 score and stroke risk, the decision to prescribe warfarin should be driven more by patients' risk of stroke than by the risk of bleeding.
The effect of ascorbic acid on inflammatory markers after cardiothoracic surgery (CTS) was studied.
In this randomized, double-blind, placebo-controlled trial, patients undergoing cardiopulmonary ...bypass graft surgery or valve replacement surgery from April 2009 through March 2010 at Hartford Hospital were randomized to receive ascorbic acid (2-g loading dose followed by 500 mg every 12 hours) or matching placebo the evening before surgery and for four days postoperatively. Inflammatory mediators were measured preoperatively and on postoperative days 1-4. Intergroup comparisons were performed using two-tailed t tests and Fisher's exact test. Multiple comparisons were conducted using repeated analyses of variance with Bonferroni tests.
Of the 62 patients screened, 24 met the study inclusion criteria. Of these, 13 were assigned to receive ascorbic acid and 11 received placebo. Ascorbic acid did not affect the natural course of inflammatory marker rise for C-reactive protein (CRP) concentration, white blood cell (WBC) count, or fibrinogen concentration versus placebo at any evaluated time point (p > 0.05 for all intergroup comparisons). Intragroup analyses demonstrated significant differences among baseline and postoperative measures of all inflammatory mediators (p < 0.05). No significant differences were noted in inflammatory markers between patients undergoing cardiothoracic surgery with or without cardiopulmonary bypass, regardless of treatment group.
Ascorbic acid did not attenuate the rise in inflammatory markers after CTS when compared with placebo. The use of off-pump surgery did not significantly change the levels of CRP and fibrinogen or the WBC count postoperatively when compared with on-pump surgery with a biocompatible polymer coating.
Recombinant human growth hormone (rhGH) improves growth in patients with growth hormone deficiency or idiopathic short stature. Its role in patients with cystic fibrosis (CF) is unclear.
To review ...the effectiveness of rhGH in the treatment of patients with CF.
Medline and the Cochrane Central Register of Controlled Trials were searched from the earliest date through April 2010. Randomized controlled trials, observational studies, systematic reviews/meta-analyses, or case reports were included if rhGH therapy was administered to patients with CF and data on prespecified harms, intermediate outcomes, or final health outcomes were reported. When applicable, end points were pooled by using a random-effects model. The overall body of evidence was graded for each outcome as insufficient, low, moderate, or high.
Ten unique controlled trials (n = 312) and 8 observational studies (n = 58) were included. On quantitative synthesis of controlled trials, several markers of pulmonary function, anthropometrics, and bone mineralization were significantly improved versus control. Results of single-arm observational studies for the aforementioned outcomes were generally supportive of findings in clinical trials. There is insufficient evidence to determine the effect of rhGH on intravenous antibiotic use during therapy, pulmonary exacerbations, health-related quality-of-life, bone consequences, or total mortality, but moderate evidence suggests that rhGH therapy reduces the rate of hospitalization versus control.
rhGH improved almost all intermediate measures of pulmonary function, height, and weight in patients with CF. Improvements in bone mineral content are also promising. However, with the exception of hospitalizations, the benefits on final health outcomes cannot be directly determined at this time.
During percutaneous coronary intervention (PCI), dislodgement of atherothrombotic material from coronary lesions can result in distal embolization, and may lead to increased major adverse ...cardiovascular events (MACE) and mortality. We sought to systematically review the comparative effectiveness of adjunctive devices to remove thrombi or protect against distal embolization in patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI of native vessels.
We conducted a systematic literature search of Medline, the Cochrane Database, and Web of Science (January 1996-March 2011), http://www.clinicaltrials.gov, abstracts from major cardiology meetings, TCTMD, and CardioSource Plus. Two investigators independently screened citations and extracted data from randomized controlled trials (RCTs) that compared the use of adjunctive devices plus PCI to PCI alone, evaluated patients with STEMI, enrolled a population with 95% of target lesion(s) in native vessels, and reported data on at least one pre-specified outcome. Quality was graded as good, fair or poor and the strength of evidence was rated as high, moderate, low or insufficient. Disagreement was resolved through consensus.
37 trials met inclusion criteria. At the maximal duration of follow-up, catheter aspiration devices plus PCI significantly decreased the risk of MACE by 27% compared to PCI alone. Catheter aspiration devices also significantly increased the achievement of ST-segment resolution by 49%, myocardial blush grade of 3 (MBG-3) by 39%, and thrombolysis in myocardial infarction (TIMI) 3 flow by 8%, while reducing the risk of distal embolization by 44%, no reflow by 48% and coronary dissection by 70% versus standard PCI alone. In a majority of trials, the use of catheter aspiration devices increased procedural time upon qualitative assessment.Distal filter embolic protection devices significantly increased the risk of target revascularization by 39% although the use of mechanical thrombectomy or embolic protection devices did not significantly impact other final health outcomes. Distal balloon or any embolic protection device increased the achievement of MBG-3 by 61% and 20% and TIMI3 flow by 11% and 6% but did not significantly impact other intermediate outcomes versus control. Upon qualitative analysis, all device categories, with exception of catheter aspiration devices, appear to significantly prolong procedure time compared to PCI alone while none appear to significantly impact ejection fraction. Many of the final health outcome and adverse event evaluations were underpowered and the safety of devices overall is unclear due to insufficient amounts of data.
In patients with STEMI, for most devices, few RCTs evaluated final health outcomes over a long period of follow-up. Due to insufficient data, the safety of these devices is unclear.
Despite warfarin's marked efficacy, not all eligible patients receive it for stroke prevention in AF. The aim of this meta-analysis was to evaluate the association between prescriber and/or patient ...characteristics and subsequent prescription of warfarin for stroke prevention in patients with atrial fibrillation (AF).
Observational studies conducted in the US using multivariate analysis to determine the relationship between characteristics and the odds of receiving warfarin for stroke prevention were identified in MEDLINE, EMBASE and a manual review of references. Effect estimates of prescriber and/or patient characteristics from individual studies were pooled to calculate odds ratios (ORs) with 95% confidence intervals.
Twenty-eight studies reporting results of 33 unique multivariate analyses were identified. Warfarin use across studies ranged from 9.1%-79.8% (median=49.1%). There was a moderately-strong correlation between warfarin use and year of study (r=0.60, p=0.002). Upon meta-analysis, characteristics associated with a statistically significant increase in the odds of warfarin use included history of cerebrovascular accident (OR=1.59), heart failure (OR=1.36), and male gender (OR=1.12). Those associated with a significant reduction in the odds of warfarin use included alcohol/drug abuse (OR=0.62), perceived barriers to compliance (OR=0.87), contraindication(s) to warfarin (OR=0.81), dementia (OR=0.32), falls (OR=0.60), gastrointestinal hemorrhage (OR=0.47), intracranial hemorrhage (OR=0.39), hepatic (OR=0.59), and renal impairment (OR=0.69). While age per 10-year increase (OR=0.78) and advancing age as a dichotomized variable (cut-off varied by study) (OR=0.57) were associated with significant reductions in warfarin use; qualitative review of results of studies evaluating age as a categorical variable did not confirm this relationship.
Warfarin use has increased somewhat over time. The decision to prescribe warfarin for stroke prevention in atrial fibrillation is based upon multiple prescriber and patient characteristics. These findings can be used by family practice prescribers and other healthcare decision-makers to target interventions or methods to improve utilization of warfarin when it is indicated for stroke prevention.
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