To compare the effect of ultrasound (US)-guided dry needling (DN) with traditional DN in the treatment of pain and dysfunction for patients with knee osteoarthritis (KOA). A double-blind, randomized ...controlled trial. Eighty-four participants (61.26±5.57 years) completed the study. G1 achieved significant improvement in VAS at 8 weeks compared to G2 and G3 (G1 vs. G2: MD = -15.61, 95% CI -25.49, -5.51, p = 0.001; G1 vs. G3: MD = -19.90, 95% CI -29.71, -10.08, p< 0.001). G1 achieved significant improvement in KOOS-pain at 8 weeks compared to G2 and G3 (G1 vs. G2: MD = 9.76, 95% CI 2.38, 17.14, p = 0.006; G1 vs. G3: MD = 9.48, 95% CI 2.31, 16.66, p = 0.010). KOOS-symptoms and KOOS-QoL were not statistically significant between groups. G2 had no significant difference of the perceptions as G1 with p = 0.128. G2 were successfully blinded to placebo US-guided DN. US-guided DN with exercise therapy may be more effective than traditional DN with exercise therapy or exercise therapy alone in reduce pain of KOA.
Initiation of warfarin therapy using trial‐and‐error dosing is problematic. Our goal was to develop and validate a pharmacogenetic algorithm. In the derivation cohort of 1,015 participants, the ...independent predictors of therapeutic dose were: VKORC1 polymorphism −1639/3673 G>A (−28% per allele), body surface area (BSA) (+11% per 0.25 m2), CYP2C9*3 (−33% per allele), CYP2C9*2 (−19% per allele), age (−7% per decade), target international normalized ratio (INR) (+11% per 0.5 unit increase), amiodarone use (−22%), smoker status (+10%), race (−9%), and current thrombosis (+7%). This pharmacogenetic equation explained 53–54% of the variability in the warfarin dose in the derivation and validation (N= 292) cohorts. For comparison, a clinical equation explained only 17–22% of the dose variability (P < 0.001). In the validation cohort, we prospectively used the pharmacogenetic‐dosing algorithm in patients initiating warfarin therapy, two of whom had a major hemorrhage. To facilitate use of these pharmacogenetic and clinical algorithms, we developed a nonprofit website, http://www.WarfarinDosing.org.
Clinical Pharmacology & Therapeutics (2008); 84, 3, 326–331 doi:10.1038/clpt.2008.10
We review the results of an extensive campaign to determine the physical, geological, and dynamical properties of asteroid (101955) Bennu. This investigation provides information on the orbit, shape, ...mass, rotation state, radar response, photometric, spectroscopic, thermal, regolith, and environmental properties of Bennu. We combine these data with cosmochemical and dynamical models to develop a hypothetical timeline for Bennu's formation and evolution. We infer that Bennu is an ancient object that has witnessed over 4.5 Gyr of solar system history. Its chemistry and mineralogy were established within the first 10 Myr of the solar system. It likely originated as a discrete asteroid in the inner Main Belt approximately 0.7–2 Gyr ago as a fragment from the catastrophic disruption of a large (approximately 100‐km), carbonaceous asteroid. It was delivered to near‐Earth space via a combination of Yarkovsky‐induced drift and interaction with giant‐planet resonances. During its journey, YORP processes and planetary close encounters modified Bennu's spin state, potentially reshaping and resurfacing the asteroid. We also review work on Bennu's future dynamical evolution and constrain its ultimate fate. It is one of the most Potentially Hazardous Asteroids with an approximately 1‐in‐2700 chance of impacting the Earth in the late 22nd century. It will most likely end its dynamical life by falling into the Sun. The highest probability for a planetary impact is with Venus, followed by the Earth. There is a chance that Bennu will be ejected from the inner solar system after a close encounter with Jupiter. OSIRIS‐REx will return samples from the surface of this intriguing asteroid in September 2023.
The promise of “personalized medicine” guided by an understanding of each individual's genome has been fostered by increasingly powerful and economical methods to acquire clinically relevant ...information. We describe the operational implementation of prospective genotyping linked to an advanced clinical decision‐support system to guide individualized health care in a large academic health center. This approach to personalized medicine entails engagement between patient and health‐care provider, identification of relevant genetic variations for implementation, assay reliability, point‐of‐care decision support, and necessary institutional investments. In one year, approximately 3,000 patients, most of whom were scheduled for cardiac catheterization, were genotyped on a multiplexed platform that included genotyping for CYP2C19 variants that modulate response to the widely used antiplatelet drug clopidogrel. These data are deposited into the electronic medical record (EMR), and point‐of‐care decision support is deployed when clopidogrel is prescribed for those with variant genotypes. The establishment of programs such as this is a first step toward implementing and evaluating strategies for personalized medicine.
Clinical Pharmacology & Therapeutics (2012); 92 1, 87–95. doi:10.1038/clpt.2011.371
Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. ...Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodontium in either a non‐periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be restored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored.
Two broad categories of gingival diseases include non‐dental plaque biofilm–induced gingival diseases and dental plaque‐induced gingivitis. Non‐dental plaque biofilm‐induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque‐induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque‐induced gingivitis may arise on an intact periodontium or on a reduced periodontium in either a non‐periodontitis patient or in a currently stable “periodontitis patient” i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehensive risk assessment and management are imperative to ensure early prevention and/or treatment of recurrent/progressive periodontitis.
Precision dental medicine defines a patient‐centered approach to care, and therefore, creates differences in the way in which a “case” of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations.
The survey description and the near-, mid-, and far-infrared flux properties are presented for the 258 galaxies in the Local Volume Legacy (LVL). LVL is a Spitzer Space Telescope legacy program that ...surveys the local universe out to 11 Mpc, built upon a foundation of ultraviolet, H Delta *a, and Hubble Space Telescope imaging from 11HUGS (11 Mpc H Delta *a and Ultraviolet Galaxy Survey) and ANGST (ACS Nearby Galaxy Survey Treasury). LVL covers an unbiased, representative, and statistically robust sample of nearby star-forming galaxies, exploiting the highest extragalactic spatial resolution achievable with Spitzer. As a result of its approximately volume-limited nature, LVL augments previous Spitzer observations of present-day galaxies with improved sampling of the low-luminosity galaxy population. The collection of LVL galaxies shows a large spread in mid-infrared colors, likely due to the conspicuous deficiency of 8 Delta *mm polycyclic aromatic hydrocarbon emission from low-metallicity, low-luminosity galaxies. Conversely, the far-infrared emission tightly tracks the total infrared emission, with a dispersion in their flux ratio of only 0.1 dex. In terms of the relation between the infrared-to-ultraviolet ratio and the ultraviolet spectral slope, the LVL sample shows redder colors and/or lower infrared-to-ultraviolet ratios than starburst galaxies, suggesting that reprocessing by dust is less important in the lower mass systems that dominate the LVL sample. Comparisons with theoretical models suggest that the amplitude of deviations from the relation found for starburst galaxies correlates with the age of the stellar populations that dominate the ultraviolet/optical luminosities.
High-latitude terrestrial ecosystems are key components in the global carbon cycle. The Northern Circumpolar Soil Carbon Database (NCSCD) was developed to quantify stocks of soil organic carbon (SOC) ...in the northern circumpolar permafrost region (a total area of 18.7 10 super(6) km super(2)). The NCSCD is a geographical information system (GIS) data set that has been constructed using harmonized regional soil classification maps together with pedon data from the northern permafrost region. Previously, the NCSCD has been used to calculate SOC storage to the reference depths 0-30 cm and 0-100 cm (based on 1778 pedons). It has been shown that soils of the northern circumpolar permafrost region also contain significant quantities of SOC in the 100-300 cm depth range, but there has been no circumpolar compilation of pedon data to quantify this deeper SOC pool and there are no spatially distributed estimates of SOC storage below 100 cm depth in this region. Here we describe the synthesis of an updated pedon data set for SOC storage (kg C m super(-2)) in deep soils of the northern circumpolar permafrost regions, with separate data sets for the 100-200 cm (524 pedons) and 200-300 cm (356 pedons) depth ranges. These pedons have been grouped into the North American and Eurasian sectors and the mean SOC storage for different soil taxa (subdivided into Gelisols including the sub-orders Histels, Turbels, Orthels, permafrost-free Histosols, and permafrost-free mineral soil orders) has been added to the updated NCSCDv2. The updated version of the data set is freely available online in different file formats and spatial resolutions that enable spatially explicit applications in GIS mapping and terrestrial ecosystem models. While this newly compiled data set adds to our knowledge of SOC in the 100-300 cm depth range, it also reveals that large uncertainties remain. Identified data gaps include spatial coverage of deep (> 100 cm) pedons in many regions as well as the spatial extent of areas with thin soils overlying bedrock and the quantity and distribution of massive ground ice. An open access data-portal for the pedon data set and the GIS-data sets is available online at http://bolin.su.se/data/ncscd/. The NCSCDv2 data set has a digital object identifier (doi:10.5879/ECDS/00000002).
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