Publications by authors named "P Quesada"

142 Publications

Ergogenic and Physiological Outcomes Derived From a Novel Skin Cooling Device.

J Strength Cond Res 2021 Feb;35(2):391-403

Departments of Health and Sport Sciences.

Abstract: Gray, WD, Jett, DM, Cocco, AR, Vanhoover, AC, Colborn, CE, Pantalos, GM, Stumbo, J, Quesada, PM, and Caruso, JF. Ergogenic and physiological outcomes derived from a novel skin cooling device. J Strength Cond Res 35(2): 391-403, 2021-Our study's purpose assessed a cooling headband's ergogenic and physiological impacts. Subjects (15 women and 13 men) completed six visits; the final 3 entailed rowing workouts with the following treatment conditions: no head cooling (NoHC), intermittent head cooling during exercise (HCex), and intermittent head cooling during exercise and post-exercise recovery (HCex&post). Data collection occurred at the following times (a) pre-exercise and post-warm-up, (b) between stages of up to eight 2-minute bouts, and (c) at 5, 10, 15, and 20 minutes post-exercise. In addition to distance rowed, thermal, cardiovascular, perceptual, and metabolic measurements were obtained. Results included a small yet significant intertreatment difference (HCex, HCex&post > NoHC) for distance rowed. Our cardiovascular and metabolic indices exhibited sex and time differences but likely did not contribute to the ergogenic effect. Yet, left hand temperatures (LHT) exhibited significant 2-way and 3-way interactions that were the likely source of the ergogenic effect. Auditory canal temperature (AUDT) results suggest the head is sensitive to heat increases, yet LHT data show headband use evoked significantly greater temperature increases at the hand's palmar surface, indicative of heat transfer. We conclude, and our practical applications suggest, the headband's ergogenic effect was manifested by cold-induced vasodilation at the hand's palmar surface, rather than heat losses through the head.
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http://dx.doi.org/10.1519/JSC.0000000000003864DOI Listing
February 2021

Pathways and Barriers to Careers in Academic Clinical Cancer Prevention: a Qualitative Study.

J Cancer Educ 2020 Nov 12. Epub 2020 Nov 12.

Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

National surveys document steady declines over time in interest in academic medicine and cancer prevention careers (Am J Prev Med 54(3):444-8, 2018). Through interviews with 16 academic cancer prevention physicians at one comprehensive cancer center, this study identifies motivations and barriers to physician careers in academic cancer prevention and proposes recommendations to increase recruitment. Participants reported that cancer prevention was vague to them early in training, impairing career exploration. Further, without role models and opportunities to learn about cancer prevention, many were ignorant of career options. Many had incorrect views about cancer prevention practice being mainly within the scope of primary care physicians, and some reported colleagues viewing the rigor of cancer prevention skeptically. However, all described notable experiences-in classes, with mentors, on research projects, or from encounters with patients, motivating them to pursue academic clinical cancer prevention regardless of challenges. Clearly, a lack of both information and guidance towards careers in clinical cancer prevention has been critical barriers to robust recruitment of physicians to the field and must be addressed urgently. Helping physicians earlier during training to both understand the value of prevention and cultivate their interests in it, particularly for clinical cancer prevention, would have widespread benefits.
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http://dx.doi.org/10.1007/s13187-020-01921-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7660128PMC
November 2020

CD163 deficiency increases foam cell formation and plaque progression in atherosclerotic mice.

FASEB J 2020 Nov 14;34(11):14960-14976. Epub 2020 Sep 14.

Vascular Research Laboratory, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.

Atherosclerosis is an inflammatory disease characterized by the accumulation of macrophages in the vessel wall. Macrophages depend on their polarization to exert either pro-inflammatory or anti-inflammatory effects. Macrophages of the anti-inflammatory phenotype express high levels of CD163, a scavenger receptor for the hemoglobin-haptoglobin complex. CD163 can also bind to the pro-inflammatory cytokine TWEAK. Using ApoE-deficient or ApoE/CD163 double-deficient mice we aim to investigate the involvement of CD163 in atherosclerosis development and its capacity to neutralize the TWEAK actions. ApoE/CD163 double-deficient mice displayed a more unstable plaque phenotype characterized by an increased lipid and macrophage content, plaque size, and pro-inflammatory cytokine expression. In vitro experiments demonstrated that the absence of CD163 in M2-type macrophages-induced foam cell formation through upregulation of CD36 expression. Moreover, exogenous TWEAK administration increased atherosclerotic lesion size, lipids, and macrophages content in ApoE /CD163 compared with ApoE /CD163 mice. Treatment with recombinant CD163 was able to neutralize the proatherogenic effects of TWEAK in ApoE/CD163 double-deficient mice. Recombinant CD163 abolished the pro-inflammatory actions of TWEAK on vascular smooth muscle cells, decreasing NF-kB activation, cytokines and metalloproteinases expression, and macrophages migration. In conclusion, CD163-expressing macrophages serve as a protective mechanism to prevent the deleterious effects of TWEAK on atherosclerotic plaque development and progression.
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http://dx.doi.org/10.1096/fj.202000177RDOI Listing
November 2020

Interleukin-17-induced neutrophil extracellular traps mediate resistance to checkpoint blockade in pancreatic cancer.

J Exp Med 2020 12;217(12)

Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX.

Pancreatic ductal adenocarcinoma (PDAC) remains a lethal malignancy with an immunosuppressive microenvironment that is resistant to most therapies. IL17 is involved in pancreatic tumorigenesis, but its role in invasive PDAC is undetermined. We hypothesized that IL17 triggers and sustains PDAC immunosuppression. We inhibited IL17/IL17RA signaling using pharmacological and genetic strategies alongside mass cytometry and multiplex immunofluorescence techniques. We uncovered that IL17 recruits neutrophils, triggers neutrophil extracellular traps (NETs), and excludes cytotoxic CD8 T cells from tumors. Additionally, IL17 blockade increases immune checkpoint blockade (PD-1, CTLA4) sensitivity. Inhibition of neutrophils or Padi4-dependent NETosis phenocopies IL17 neutralization. NMR spectroscopy revealed changes in tumor lactate as a potential early biomarker for IL17/PD-1 combination efficacy. Higher expression of IL17 and PADI4 in human PDAC corresponds with poorer prognosis, and the serum of patients with PDAC has higher potential for NETosis. Clinical studies with IL17 and checkpoint blockade represent a novel combinatorial therapy with potential efficacy for this lethal disease.
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http://dx.doi.org/10.1084/jem.20190354DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7953739PMC
December 2020

Applicant-to-Residency Program Communication: Does It Matter?

Ann Otol Rhinol Laryngol 2020 Nov 2;129(11):1056-1062. Epub 2020 Jun 2.

Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA, USA.

Objectives: To elucidate the frequency and types of pre- and post-interview communication that applicants engage with programs, to garner the perceptions of both applicants and program directors (PDs), and determine if communication influences outcomes.

Subjects And Methods: Electronic surveys were distributed to otolaryngology residency applicants, and to PDs of ACGME-accredited otolaryngology programs after the 2018 to 2019 application cycle.

Results: 93 of 324 applicants (28.7%) and 33 of 106 PDs (31.3%) responded. In the pre-interview period, 58.1% of applicants sent emails of interest, and 41.9% had a mentor initiate communication. In the post-interview period, the majority of applicants (82.8%) sent notes of intent to their number one choice, and 32.3% had a faculty mentor communicate this on their behalf. The majority of PDs (84.8%) were undecided or did not believe that emails of interest influence decisions to offer an interview, whereas 81.8% believed that communication initiated by an applicant's mentor has an impact on interview offers. No PD agreed that declarations of intent from applicants have an impact on their rank lists, while only 33.3% of PDs believed that a mentor communicating this for an applicant has some impact. Our statistical findings are in agreement with these perceptions as neither applicant-initiated pre-interview ( = .54), mentor-initiated pre-interview ( = .62), applicant-initiated post-interview ( = .11) nor mentor-initiated post-interview ( = .78) communications influenced the number of interviews received or ultimate match outcome.

Conclusion: Pre- and post-interview communication practices vary widely among otolaryngology applicants. Applicant-initiated communication has no impact on outcomes, while mentor-initiated communication is perceived to have more benefit, despite not impacting interview or match outcomes in this study.
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http://dx.doi.org/10.1177/0003489420928381DOI Listing
November 2020

Otolaryngology Residency Application during the SARS-CoV-2 (COVID-19) Pandemic.

Otolaryngol Head Neck Surg 2020 07 5;163(1):89-90. Epub 2020 May 5.

Department of Otolaryngology-Head and Neck Surgery, School of Medicine, The University of Kansas, Kansas City, Kansas, USA.

The escalation of the COVID-19 pandemic has affected health care at every level, including medical education. As some fourth-year medical students graduate early to join the front lines, we must now turn our attention to those trainees in their penultimate year. In this commentary, we address the unique dilemmas facing otolaryngology residency candidates for the 2020-2021 cycle, with a focus on those applicants with no institutional otolaryngology department.
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http://dx.doi.org/10.1177/0194599820925037DOI Listing
July 2020

Student Medical Interpreters: A Double-Edged Sword.

Otolaryngol Head Neck Surg 2020 Apr 10;162(4):476-478. Epub 2020 Mar 10.

Boston University School of Medicine, Boston, Massachusetts, USA.

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http://dx.doi.org/10.1177/0194599820909083DOI Listing
April 2020

Tumor Microbiome Diversity and Composition Influence Pancreatic Cancer Outcomes.

Cell 2019 08;178(4):795-806.e12

Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Clinical Cancer Genetics Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address:

Most patients diagnosed with resected pancreatic adenocarcinoma (PDAC) survive less than 5 years, but a minor subset survives longer. Here, we dissect the role of the tumor microbiota and the immune system in influencing long-term survival. Using 16S rRNA gene sequencing, we analyzed the tumor microbiome composition in PDAC patients with short-term survival (STS) and long-term survival (LTS). We found higher alpha-diversity in the tumor microbiome of LTS patients and identified an intra-tumoral microbiome signature (Pseudoxanthomonas-Streptomyces-Saccharopolyspora-Bacillus clausii) highly predictive of long-term survivorship in both discovery and validation cohorts. Through human-into-mice fecal microbiota transplantation (FMT) experiments from STS, LTS, or control donors, we were able to differentially modulate the tumor microbiome and affect tumor growth as well as tumor immune infiltration. Our study demonstrates that PDAC microbiome composition, which cross-talks to the gut microbiome, influences the host immune response and natural history of the disease.
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http://dx.doi.org/10.1016/j.cell.2019.07.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7288240PMC
August 2019

Pancreatic Cancer Early Detection and Interception in an Atypical Case of Peutz-Jeghers Syndrome.

Pancreas 2019 04;48(4):e29-e30

Clinical Cancer Genetics Program The University of Texas MD Anderson Cancer Center Houston, TX Department of Clinical Cancer Prevention The University of Texas MD Anderson Cancer Center Houston, TX Clinical Cancer Genetics Program The University of Texas MD Anderson Cancer Center Houston, TX Department of Clinical Cancer Prevention The University of Texas MD Anderson Cancer Center Houston, TX Department of Surgical Oncology The University of Texas MD Anderson Cancer Center Houston, TX Department of Gastroenterology The University of Texas MD Anderson Cancer Center Houston, TX Clinical Cancer Genetics Program Departments of Clinical Cancer Prevention and GI Medical Oncology The University of Texas MD Anderson Cancer Center Houston, TX

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http://dx.doi.org/10.1097/MPA.0000000000001293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6461374PMC
April 2019

Eleven Years of Clozapine Experience in Autism Spectrum Disorder: Efficacy and Tolerance.

J Clin Psychopharmacol 2018 Dec;38(6):577-581

Centre Ressource Autisme Haute Normandie, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen.

Background: Autism spectrum disorders (ASDs) are neurodevelopmental disorders that comprise wide graduated clinical expressions but similar core symptoms (repetitive, stereotyped behavior, and social communication disabilities). Many patients with ASD have disruptive behaviors like aggressiveness, temper tantrums, or self-injury that interfere with their socializations, their learning abilities, and their quality of life. These behaviors represent a common target for pharmacology. Beherec et al (J Clin Psychopharmacol. 2011;31:341-344) (first cohort), showed the efficacy of clozapine on disruptive behaviors in 6 patients with autism who were older than 16 years. The aim of this study was to assess the efficacy and tolerance of clozapine in a new cohort and the long-term effect in our first cohort.

Procedures: Concerning the replication study, we conducted a retrospective study of the changes of aggressive behaviors for all patients with ASD who were treated with clozapine from 2011 to 2017. Disruptive behaviors were monitored from 1 to 6 months before and after the initiation of the clozapine.

Results: All the patients of the first cohort were still on clozapine after an average of 11 + 2.6 years, with the same efficacy and no serious adverse effect was noted. For the replication study, 13 patients were included. Clozapine resulted in a significant decrease in the number of the days with aggression (65.2% + 32.6%). Once again, no serious adverse effect was notified. All the patients had a better quality of life.

Conclusions: Our study confirms that clozapine could be an efficacious and well-tolerated treatment for ASD patients with disruptive behaviors who do not respond to other antipsychotics on the long term.
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http://dx.doi.org/10.1097/JCP.0000000000000955DOI Listing
December 2018

A shortened study design for embryo-fetal development studies in the minipig.

Reprod Toxicol 2018 09 22;80:35-43. Epub 2018 Jun 22.

Ellegaard Göttingen Minipigs, Dalmose, Denmark.

The minipig is accepted from scientific and regulatory perspectives for the safety evaluation of drug candidates on embryo-fetal development. The relative size and the duration of gestation (112-115 days) in the minipig is, however, considered a drawback compared with routine smaller species. We evaluated if study duration and cost could be optimized without impacting scientific validity by performing all terminal procedures around mid-gestation (60 days). At this stage, minipig fetal size is not too dissimilar to full term rabbit and therefore better suited to fetal processing/examination compared with at the end of gestation. Despite encountering higher than anticipated embryo-fetal death, morphological defects clearly associated with a known teratogen, pyrimethamine, were detected. Although the gonads are poorly differentiated macroscopically at mid-term, a histological examination confirmed that external sexing of the fetuses was accurate. Double staining of the bone and cartilage of the mid-term fetal skeleton allowed a more refined examination.
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http://dx.doi.org/10.1016/j.reprotox.2018.06.009DOI Listing
September 2018

[Validation of the French version of the self-evaluation of negative symptoms (SNS)].

Encephale 2018 Dec 29;44(6):512-516. Epub 2017 Nov 29.

Service hospitalo-universitaire, centre hospitalier du Rouvray, 4, rue Paul-Éluard, 76300 Sotteville-lès-Rouen, France; CHU de Rouen, 1, rue de Germont, 76000 Rouen, France; Inserm U1079, faculté de médecine pharmacie, 76000 Rouen, France. Electronic address:

Introduction: Schizophrenia is a disorder affecting 1% of the population and is associated with severe functional impairment. Negative symptoms are responsible for the majority of this impairment, and many patients with schizophrenia have negative symptoms. However, their evaluation is still a challenge. Thus, standardized assessments are needed to facilitate identification of these symptoms. Many tools have been developed, but most are based on observer ratings. Self-evaluation can provide an additional outcome measure and allow patients to be more engaged in their treatment. The Self-evaluation of Negative Symptoms (SNS) has been developed recently. This is a remarkably understandable instrument for patients with schizophrenia as it allows them to readily complete it without assistance, providing information with respect to their own perception of negative symptoms. The SNS is a self-assessment that permits patients to evaluate themselves in 5 dimensions of negative symptoms. This validation study for the SNS revealed good psychometric properties alongside satisfactory acceptance by patients.

Aim: This study was to confirm the validation of the French version of the self-evaluation of negative symptoms (SNS).

Methods: Patients with schizophrenia or schizoaffective disorder according to the DSM-IV-R, with a stable regimen of anti-psychotic drugs for the last two months, aged more than 18 years old were eligible for the study. Symptoms were rated using the SNS, the Scale for the Assessment of Negative Symptoms (SANS), the Calgary Depression Scale for Schizophrenics (CDSS), the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impression and Parkinsonism. Patients were asked to fulfill the SNS twice, 6 weeks apart.

Results: Sixty patients were evaluated. Cronbach's coefficient (α=0.8) showed good internal consistency. The SNS significantly correlated with the SANS (r=0.6), the negative sub-score of the BPRS (r=0.6) and the Clinician Global Impression on the severity of negative symptoms (r=0.7). SNS scores did not correlate with level of insight (r=0.08) or Brief Psychiatric Rating Scale positive sub-scores (r=0.2). SNS scores correlated with CDSS scores. However, we did not find correlation between the first item of the CDSS which evaluates depression and the "diminished emotional range" sub-score of SNS. The test-retest of SNS revealed no changes of scores at two evaluations 6 weeks apart.

Conclusion: The acceptance by patients of the SNS was excellent. The French version of the SNS demonstrated a good internal consistency, good convergent validity and good discriminant validity. The study demonstrates the ability of patients with schizophrenia to accurately report their own experiences. Self-assessments of negative symptoms should be more widely employed in clinical practice because they may allow patients with schizophrenia to develop appropriate coping strategies.
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http://dx.doi.org/10.1016/j.encep.2017.10.002DOI Listing
December 2018

Cerebrospinal fluid leak during stapes surgery: Gushing leaks and oozing leaks, two different phenomena.

Ear Nose Throat J 2017 Aug;96(8):302-310

Department of Otorhinolaryngology, Vall d'Hebron University Hospital, Barcelona, Spain.

Cerebrospinal fluid (CSF) leak is an uncommon event that can occur during stapes surgery. Such leaks can be classified as gushing leaks (stapes gushers) and oozing leaks. A stapes gusher is a massive flow of CSF through the perforated footplate that fills the middle ear suddenly, while an oozing leak is a slower and less profuse flow. We conducted a retrospective, observational, multicenter study of 38 patients-23 men and 15 women, aged 23 to 71 years (mean: 47)-who had experienced a CSF leak during stapes surgery. Patients were divided into various groups according to the type of surgical procedure performed and the type of postoperative complications they experienced. Audiometric and clinical evaluations were carried out pre- and postoperatively. Correlations among surgical variations (total or partial stapedectomy, placement of a prosthesis), hearing outcomes, and the incidence of postoperative complications (postoperative CSF leak and vertigo) were studied. Our statistical analysis revealed that gushing leaks and oozing leaks result in different degrees of hearing impairment and different rates of complications. We recommend that an individual approach be used to manage these complications.
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http://dx.doi.org/10.1177/014556131709600817DOI Listing
August 2017

Biomechanics of Lower Limbs during Walking among Candidates for Total Knee Arthroplasty with and without Low Back Pain.

Biomed Res Int 2015 11;2015:142562. Epub 2015 Jun 11.

Department of Mechanical Engineering, University of Louisville, Louisville, KY 40292, USA.

The effect of joint pathologies, such as unilateral knee osteoarthritis (UKOA) or low back pain (LBP), on bilateral gait symmetry has gained increased attention during the past decade. This study is the first to compare gait patterns between patients with UKOA and LBP in combination and with UKOA only. Temporal, kinematic, and kinetic variables were measured bilaterally during gait stance phase in 31 subjects with UKOA and LBP (Group I) and 11 subjects with only UKOA (Group II). Group I patients exhibited less hip rotation in the affected limb (A) than in the nonaffected (NA) limb during walking in contrast to Group II patients. Group I patients had minimal bilateral differences in hip abduction and flexion, but Group II patients displayed significantly larger values in the NA limb compared to the A limb for both parameters. Hip flexion patterns were significantly different between Groups I and II. Subjects in both groups adapted gait patterns that minimized vertical ground reaction force, knee flexion motion, and stance time on the UKOA affected limb. The distinct kinematic gait patterns that were revealed in this study may provide clinical value for assessment of patients with UKOA in conjunction with LBP.
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http://dx.doi.org/10.1155/2015/142562DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480238PMC
April 2016

Outcomes of Estrogen Receptor Negative and Progesterone Receptor Positive Breast Cancer.

PLoS One 2015 10;10(7):e0132449. Epub 2015 Jul 10.

Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.

Purpose: To describe the clinical features and outcomes of estrogen receptor negative (ER-) and progesterone receptor positive (PgR+) breast cancer.

Methods: We retrospectively reviewed a well-characterized database of sequential patients diagnosed with early stage invasive breast carcinoma. Outcomes of interest were time to relapse (TTR) and overall survival (OS). Multivariable Cox proportional hazards analysis was conducted to assess the association of ER-/PgR+ with TTR and OS in comparison to ER+ and to ER- and PgR negative (ER-/PgR-) tumors irrespective of HER2 status. ER and PgR expression was conservatively defined as 10% or greater staining of cancer cells.

Results: 815 patients were followed for a median of 40.5 months; 56 patients (7%) had ER-/PgR+, 624 (77%) had ER+ and 136 (17%) had ER-/PgR- phenotypes. Compared with ER+ tumors, ER-/PgR+ tumors were associated with younger age (50 versus 59 years, p=0.03), high grade (50% versus 24%, p<0.001) and more frequent HER2 overexpression/amplification (43% versus 14%, p<0.001). TTR for ER-/PgR+ was intermediate between ER+ and ER-/PgR- tumors, but was not significantly different from ER+ tumors. Recurrences in the ER-/PgR+ and ER-/PgR- groups occurred early in follow-up while in ER+ tumors recurrences continued to occur over the duration of follow-up. OS of ER-/PgR+ was similar to ER+ tumors and better than that of ER-/PgR- tumors.

Conclusions: The ER-/PgR+ phenotype is associated with higher grade with HER2 overexpression/amplification and occurs more commonly in younger women. Risk of relapse and death more closely resembles ER+ than ER-/PgR- tumors suggesting this phenotype represents a group of more aggressive hormone receptor positive tumors.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0132449PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4498889PMC
April 2016

Hormonal contraception and postmenopausal hormone therapy in Spain: time trends and patterns of use.

Menopause 2015 Oct;22(10):1138-46

1Unit of Infections and Cancer, Cancer Epidemiology Research Program, IDIBELL, Catalan Institute of Oncology, Barcelona, Spain 2Department of Medicine, University of Barcelona, Barcelona, Spain 3Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiologia y Salud Pública), Madrid, Spain 4Preventive Medicine and Epidemiology Service, Hospital Clínic of Barcelona, Barcelona, Spain 5Public Health Division of Gipuzkoa, San Sebastian, Spain 6Biodonostia Research Institute, San Sebastian, Spain 7Environmental and Cancer Epidemiology Area, National Center of Epidemiology, Carlos III Institute of Health, Madrid, Spain 8Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro, Madrid, Spain 9Grupo de Investigación en Interacciones Gen-Ambiente y Salud, Universidad de León, León, Spain 10Universidad de Cantabria-IDIVAL, Santander, Spain 11Public Health Institute of Navarra, Pamplona, Spain 12Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Madrid, Spain 13Institute of Oncology, IUOPA, University of Oviedo, Oviedo, Spain 14Cancer Prevention Program, Catalan Institute of Oncology, IDIBELL, Barcelona, Spain 15Servicio de Medicina Interna, Complejo Hospitalario de Huelva-Hospital Infanta Elena, CYSMA, Huelva, Spain 16Fundación para el Fomento de la Investigación Sanitaria y Biomédica, FISABIO, Breast Cancer Screening Program, Valencian Public Health Directorate, Valencia, Spain 17Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain 18Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario de Granada, Servicio Andaluz de Salud/Universidad de Granada, Granada, Spain 19Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia and Descriptive Epidemiology, Genetics and Cancer Prevention Group (Girona Biomedical Research Institute), Catalan Institute of Oncology, G

Objective: This study aims to describe time trends in and patterns of use of hormonal contraception and postmenopausal hormone therapy and to identify factors associated with their use among Spanish women.

Methods: We performed a cross-sectional analysis using data from 1,954 population controls (aged 24-85 y) in 12 provinces of Spain who were enrolled in the Multi Case-Control Spain study (2007-2013). Data were collected from a questionnaire conducted face-to-face by trained personnel. We collected information on sociodemographic factors, lifestyle, sleep patterns, reproductive history, and occupational history.

Results: Overall, 48.5% of Spanish women reported ever use of hormonal contraception, and 9.8% of women in the postmenopausal group reported use of postmenopausal hormone therapy. Younger cohorts used hormonal contraception for a longer period, whereas postmenopausal hormone therapy use dramatically dropped in the 2000s. Women with higher education levels (including education of partners) and smoking history were the most probable users of hormonal contraception, whereas inverse associations were observed among housewives, obese women, and nulliparous women. Postmenopausal hormone therapy use was associated with a surgical or therapeutic cause of menopause and with occupational history of rotating shifts.

Conclusions: In this Spanish population, several demographic, lifestyle, occupational, and reproductive factors are associated with use of hormonal compounds. Characterizing hormonal users and monitoring trends in the use of these hormonal compounds are essential from a public health perspective.
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http://dx.doi.org/10.1097/GME.0000000000000487DOI Listing
October 2015

Hepatitis C virus seroprevalence in the general female population from 8 countries.

J Clin Virol 2015 Jul 12;68:89-93. Epub 2015 May 12.

Unit of Infections and Cancer (UNIC), IDIBELL, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. Electronic address:

Background: Hepatitis C virus (HCV) infection is a significant global health issue because it is widespread and persistent and can cause serious liver diseases.

Objectives: The aim of this study is to estimate HCV prevalence in women from the general population in different geographical areas worldwide and to assess the potential role of sexual behaviour in the virus transmission.

Study Design: Each participating centre recruited a random sample of women from the general population aged from less than 20 to more than 75 years. The study included 8130 women from 8 countries with information on sociodemographic factors, reproductive and sexual behaviour, smoking habit and HPV DNA through individual interviews. A blood sample was also collected to perform serological tests. We estimated the prevalence ratios associated to HCV to evaluate the effect of sexual behaviour in viral transmission.

Results: Women were reactive to a minimum of two HCV antigens, including at least one non structural protein were considered as positive (33% of the samples were classified as positive, 40% as negative, and 27% as indeterminate (N=402), that were considered as not positive). The age-adjusted HCV seroprevalence varied significantly by regions (0.3% in Argentina to 21.1% in Nigeria). We found no association between HCV prevalence and age, educational level, smoking habit and any of the available variables for sexual behaviour and reproductive history.

Conclusions: This large study showed heterogeneous distribution of HCV seroprevalence in female and provides evidence of the null impact of sexual behaviour in HCV transmission.
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http://dx.doi.org/10.1016/j.jcv.2015.05.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4466105PMC
July 2015

Incidence and risk factors for tenofovir-associated renal toxicity in HIV-infected patients.

Int J Clin Pharm 2015 Oct 26;37(5):865-72. Epub 2015 May 26.

Pharmacy Department, University Hospital of Getafe, Getafe, Madrid, Spain.

Background: Since the beginning of highly active antiretroviral therapy utilization, the association of renal impairment with treatment toxicity is more prevalent. Tenofovir disoproxil fumarate (TDF) side effects include renal toxicity.

Objective: To assess the incidence of renal damage in human immunodeficiency virus (HIV)-positive patients treated with TDF and to identify associated potential risk factors.

Setting: A public university tertiary 450-beds hospital in Spain.

Method: Retrospective, longitudinal observational study that included adult HIV-1-infected patients treated with TDF. Patient´s treated with TDF from January 2010 to December 2012 were included. Patient follow-up started when initiating treatment with TDF up until either end of treatment or end of study (July 31, 2013). The estimated glomerular filtration rate was calculated using the four-variable modification of diet in renal disease. Renal toxicity was classified as moderate [estimated glomerular filtration rate (eGFR) < 60 ml/min] or severe (eGFR < 30 ml/min). The incidence rate for moderate and severe renal insufficiency was calculated as number of cases per 1000 patient-year. A univariate analysis and binary logistic regression was carried out in order to identify risk factors associated with renal toxicity by using the forward stepwise method (likelihood ratio)

Main Outcome Measure: Incidence rate for moderate and severe renal insufficiency (RI) RESULTS: 451 patients were included in the study. The incidence rate of moderate RI was 29.2 cases per 1000 person-year (95% CI 22.1-36.3), whereas the incidence of severe RI was 2.2 cases per 1000 person-year (95% CI 0.3-4.1). Multivariate analysis confirmed an independent association with the risk of kidney damage for age (OR 1.08 95% CI 1.05-1.12), time on treatment with TDF (OR 1.16 95% CI 1.04-1.30), baseline creatinine (OR 49.80 95% CI 7.90-311.92) and treatment with NNRTIs (OR 0.45 95% CI 0.24-0.83).

Conclusion: Mild to moderate renal failure is a frequent complication during treatment with TDF although severe renal impairment is scarce. Risk factors include age, duration of treatment with TDF, elevated baseline creatinine levels, and treatment with protease inhibitor boosted with ritonavir combinations.
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http://dx.doi.org/10.1007/s11096-015-0132-1DOI Listing
October 2015

Effect of poly(ADP-ribose)polymerase and DNA topoisomerase I inhibitors on the p53/p63-dependent survival of carcinoma cells.

Biochem Pharmacol 2015 Apr 7;94(3):212-9. Epub 2015 Feb 7.

Department of Biology, University of Naples "Federico II", Naples, Italy. Electronic address:

Depending on their genetic background (p53(wt) versus p53(null)), carcinoma cells are more or less sensitive to drug-induced cell cycle arrest and/or apoptosis. Among the members of the p53 family, p63 is characterized by two N-terminal isoforms, TAp63 and ΔNp63. TAp63 isoform has p53-like functions, while ΔNp63 acts as a dominant negative inhibitor of p53. We have previously published that TAp63 is involved in poly(ADP-ribose)polymerase-1 (PARP-1) signaling of DNA damage deriving from DNA topoisomerase I (TOP I) inhibition in carcinoma cells. In the present study, we treated MCF7 breast carcinoma cells (p53(+)/ΔNp63(-)) or SCC022 (p53(-)/ΔNp63(+)) squamous carcinoma cells with the TOP I inhibitor topotecan (TPT) and the PJ34 PARP inhibitor, to compare their effects in the two different cell contexts. In MCF7 cells, we found that PJ34 addition reverts TPT-dependent PARP-1 auto-modification and triggers caspase-dependent PARP-1 proteolysis. Moreover, TPT as single agent stimulates p53(ser15) phosphorylation, p53 PARylation and occupancy of the p21WAF promoter by p53 resulting in an increase of p21WAF expression. Interestingly, PJ34 in combination with TPT enhances p53 occupancy at the BAX promoter and is associated with increased BAX protein level. In SCC022 cells, instead, TPT+PJ34 combined treatment reduces the level of the anti-apoptotic ΔNp63α protein without inducing apoptosis. Remarkably, in such cells, either exogenous p53 or TAp63 can rescue the apoptotic program in response to the treatment. All together our results suggest that in cancer cells PARP inhibitor(s) can operate in the choice between growth arrest and apoptosis by modulating p53 family-dependent signal.
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http://dx.doi.org/10.1016/j.bcp.2015.01.012DOI Listing
April 2015

p63 involvement in poly(ADP-ribose) polymerase 1 signaling of topoisomerase I-dependent DNA damage in carcinoma cells.

Biochem Pharmacol 2013 Apr 29;85(7):999-1006. Epub 2013 Jan 29.

Department of Biology, University of Naples Federico II, Italy.

Poly(ADP-ribose)polymerase 1 (PARP-1) inhibitors are thought as breakthrough for cancer treatment in solid tumors such as breast cancer through their effects on PARP's enzymatic activity. Our previous findings showed that the hydrophilic PARP inhibitor PJ34 enhances the sensitivity of p53 proficient MCF7 breast carcinoma cells to topotecan, a DNA Topoisomerase I (TOP 1) inhibitor. In the present study, we combine the classical TOP 1 poison camptothecin or its water-soluble derivative topotecan with PJ34 to investigate the potentiation of chemotherapeutic efficiency in MCF7 (p53(WT)), MDA-MB231 (p53(mut)) breast carcinoma cells and SCC022 (p53(null)) squamous carcinoma cells. We show that, following TPT-PJ34 combined treatment, MCF7 cells exhibit apoptotic death while MDA-MB231 and SCC022 cells are more resistant to these agents. Specifically, in MCF7, (i) PJ34 in combination with TPT causes a G2/M cell cycle arrest followed by massive apoptosis; (ii) PJ34 addition reverts TPT-dependent PARP-1 automodification and triggers caspase-dependent PARP-1 proteolysis; (iii) TPT, used as a single agent, stimulates p53 expression while in combination with PJ34 increases p53, TAp63α and TAp63γ protein levels with a concomitant reduction of MDM2 protein. The identification of p63 proteins as new players involved in the cancer cell response to TPT-PJ34 is relevant for a better understanding of the PARP1-dependent signaling of DNA damage. Furthermore, our data indicate that, in response to TPT-PJ34 combined chemotherapy, a functional cooperation between p53 and TAp63 proteins may occur and be essential to trigger apoptotic cell death.
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http://dx.doi.org/10.1016/j.bcp.2013.01.019DOI Listing
April 2013

A retrospective study of the relationship between back pain and unilateral knee osteoarthritis in candidates for total knee arthroplasty.

Orthop Nurs 2012 Nov-Dec;31(6):336-43

Department of Industrial Engineering, University of Louisville, Louisville, KY, USA.

The purpose of this study was to determine the presence and temporal relationship between back pain and knee osteoarthritis (OA). All subjects were candidates for unilateral total knee arthroplasty (TKA) to relieve knee pain related to OA, and information regarding the prevalence of back pain was collected via questionnaires. A total of 42 subjects with unilateral knee OA responded to the questionnaires, and 74% of subjects reported chronic back pain, which first occurred approximately 10 years before their becoming candidates for TKA. All but 1 subject reported the onset of back pain prior to TKA candidacy, and less than 15% of subjects felt that their worst back pain occurred after the onset of knee OA. The results of this study are a first step toward quantifying the temporal relationship between back pain and unilateral knee OA, and future studies will look to assess potential risk factors for knee OA such as strength, biomechanical, and anatomical asymmetry.
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http://dx.doi.org/10.1097/NOR.0b013e31827425f4DOI Listing
November 2013

A musculoskeletal modeling approach for estimating anterior cruciate ligament strains and knee anterior-posterior shear forces in stop-jumps performed by young recreational female athletes.

Ann Biomed Eng 2013 Feb 27;41(2):338-48. Epub 2012 Sep 27.

Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA.

The central goal of this study was to contribute to the advancements being made in determining the underlying causes of anterior cruciate ligament (ACL) injuries. ACL injuries are frequently incurred by recreational and professional young female athletes during non-contact impact activities in sports like volleyball and basketball. This musculoskeletal-neuromuscular study investigated stop-jumps and factors related to ACL injury like knee valgus and internal-external moment loads, knee anterior-posterior (AP) shear forces, ACL strains and internal forces. Motion capture data was obtained from the landing phase of stop-jumps performed by eleven young recreational female athletes and electromyography (EMG) data collected from quadriceps, hamstring and gastrocnimius muscles which were then compared to numerically estimated activations. Numerical simulation tools used were Inverse Kinematics, Computed Muscle Control and Forward Dynamics and the knee modeled as a six degree of freedom joint. Results showed averaged peak strains of 12.2 ± 4.1% in the right and 11.9 ± 3.0% in the left ACL. Averaged peak knee AP shear forces were 482.3 ± 65.7 N for the right and 430.0 ± 52.4 N for the left knees, approximately equal to 0.7-0.8 times body weight across both knees. A lack of symmetry was observed between the knees for valgus angles (p < 0.04), valgus moments (p < 0.001) and muscle activations (p < 0.001), all of which can be detrimental to ACL stability during impact activities. Comparisons between recorded EMG data and estimated muscle activations show the relation between electrical signal and muscle depolarization. In summary, this study outlines a musculoskeletal simulation approach that provides numerical estimations for a number of variables associated with ACL injuries in female athletes performing stop-jumps.
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http://dx.doi.org/10.1007/s10439-012-0644-yDOI Listing
February 2013

A numerical simulation approach to studying anterior cruciate ligament strains and internal forces among young recreational women performing valgus inducing stop-jump activities.

Ann Biomed Eng 2012 Aug 21;40(8):1679-91. Epub 2012 Apr 21.

Thayer School of Engineering, Dartmouth College, 8000 Cummings Hall, Hanover, NH 03755, USA.

Anterior cruciate ligament (ACL) injuries are commonly incurred by recreational and professional women athletes during non-contact jumping maneuvers in sports like basketball and volleyball, where incidences of ACL injury is more frequent to females compared to males. What remains a numerical challenge is in vivo calculation of ACL strain and internal force. This study investigated effects of increasing stop-jump height on neuromuscular and bio-mechanical properties of knee and ACL, when performed by young female recreational athletes. The underlying hypothesis is increasing stop-jump (platform) height increases knee valgus angles and external moments which also increases ACL strain and internal force. Using numerical analysis tools comprised of Inverse Kinematics, Computed Muscle Control and Forward Dynamics, a novel approach is presented for computing ACL strain and internal force based on (1) knee joint kinematics and (2) optimization of muscle activation, with ACL insertion into musculoskeletal model. Results showed increases in knee valgus external moments and angles with increasing stop-jump height. Increase in stop-jump height from 30 to 50 cm lead to increase in average peak valgus external moment from 40.5 ± 3.2 to 43.2 ± 3.7 Nm which was co-incidental with increase in average peak ACL strain, from 9.3 ± 3.1 to 13.7 ± 1.1%, and average peak ACL internal force, from 1056.1 ± 71.4 to 1165.4 ± 123.8 N for the right side with comparable increases in the left. In effect this study demonstrates a technique for estimating dynamic changes to knee and ACL variables by conducting musculoskeletal simulation on motion analysis data, collected from actual stop-jump tasks performed by young recreational women athletes.
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http://dx.doi.org/10.1007/s10439-012-0572-xDOI Listing
August 2012

Symmetry of ground reaction forces and muscle activity in asymptomatic subjects during walking, sit-to-stand, and stand-to-sit tasks.

J Electromyogr Kinesiol 2011 Aug 13;21(4):610-5. Epub 2011 Apr 13.

University of Louisville, Department of Industrial Engineering, Louisville, KY, USA.

In addition to walking, essential activities of daily living include the ability to rise from a seated position and sit from a standing position. Although many high-quality studies have been performed on these common functional tasks, the objective of the current research is to quantify symmetry indices (SI) of ground reaction force (GRF) and electromyographical (EMG) variables between the non-dominant (ND) and dominant (D) sides of the body in asymptomatic subjects during walking, sit-to-stand, and stand-to-sit tasks. Thirty-five healthy subjects consented to participate in the study that included collection of bilateral GRF and muscle activity of the back, trunk, and legs during the stance phase of walking and sit-stand tasks. No significant differences in SI values between the ND and D sides of the body were found, indicating that asymptomatic subjects walk, stand up, and sit down in a rather symmetric manner. Gait stance time, peak vertical GRF at heel strike, and peak vertical GRF during the entire sit-stand cycle were found to be "perfectly symmetrical" with SI values equal to 1. Future studies will involve similar analyses to determine the level of asymmetry among symptomatic subjects.
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http://dx.doi.org/10.1016/j.jelekin.2011.03.006DOI Listing
August 2011

Prehabilitation before total knee arthroplasty increases strength and function in older adults with severe osteoarthritis.

J Strength Cond Res 2011 Feb;25(2):318-25

Exercise Physiology Laboratory, University of Louisville, Louisville, Kentucky, USA.

Preparing for the stress of total knee arthroplasty (TKA) surgery by exercise training (prehabilitation) may improve strength and function before surgery and, if effective, has the potential to contribute to postoperative recovery. Subjects with severe osteoarthritis (OA), pain intractable to medicine and scheduled for TKA were randomized into a usual care (UC) group (n = 36) or usual care and exercise (UC + EX) group (n = 35). The UC group maintained normal daily activities before their TKA. The UC + EX group performed a comprehensive prehabilitation program that included resistance training using bands, flexibility, and step training at least 3 times per week for 4-8 weeks before their TKA in addition to UC. Leg strength (isokinetic peak torque for knee extension and flexion) and ability to perform functional tasks (6-minute walk, 30 second sit-to-stand repetitions, and the time to ascend and descend 2 flights of stairs) were assessed before randomization at baseline (T1) and 1 week before the subject's TKA (T2). Repeated-measures analysis of variance indicated a significant group by time interaction (p < 0.05) for the 30-second sit-to-stand repetitions, time to ascend the first flight of stairs, and peak torque for knee extension in the surgical knee. Prehabilitation increased leg strength and the ability to perform functional tasks for UC + EX when compared to UC before TKA. Short term (4-8 weeks) of prehabilitation was effective for increasing strength and function for individuals with severe OA. The program studied is easily transferred to a home environment, and clinicians working with this population should consider prehabilitation before TKA.
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http://dx.doi.org/10.1519/JSC.0b013e318202e431DOI Listing
February 2011

Poly(ADP-ribose) polymerase signaling of topoisomerase 1-dependent DNA damage in carcinoma cells.

Biochem Pharmacol 2011 Jan 25;81(2):194-202. Epub 2010 Sep 25.

Department of Structural and Functional Biology, University Federico II of Naples, Italy.

A molecular approach to enhance the antitumour activity of topoisomerase 1 (TOP1) inhibitors relies on the use of chemical inhibitors of poly(ADP-ribose)polymerases (PARP). Poly(ADP-ribosyl)ation is involved in the regulation of many cellular processes such as DNA repair, cell cycle progression and cell death. Recent findings showed that poly(ADP-ribosyl)ated PARP-1 and PARP-2 counteract camptothecin action facilitating resealing of DNA strand breaks. Moreover, repair of DNA strand breaks induced by poisoned TOP1 is slower in the presence of PARP inhibitors, leading to increased toxicity. In the present study we compared the effects of the camptothecin derivative topotecan (TPT), and the PARP inhibitor PJ34, in breast (MCF7) and cervix (HeLa) carcinoma cells either PARP-1 proficient or silenced, both BRCA1/2(+/+) and p53(+/+). HeLa and MCF7 cell lines gave similar results: (i) TPT-dependent cell growth inhibition and cell cycle perturbation were incremented by the presence of PJ34 and a 2 fold increase in toxicity was observed in PARP-1 stably silenced HeLa cells; (ii) higher levels of DNA strand breaks were found in cells subjected to TPT+PJ34 combined treatment; (iii) PARP-1 and -2 modification was evident in TPT-treated cells and was reduced by TPT+PJ34 combined treatment; (iv) concomitantly, a reduction of soluble/active TOP1 was observed. Furthermore, TPT-dependent induction of p53, p21 and apoptosis were found 24-72h after treatment and were increased by PJ34 both in PARP-1 proficient and silenced cells. The characterization of such signaling network can be relevant to a strategy aimed at overcoming acquired chemoresistance to TOP1 inhibitors.
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http://dx.doi.org/10.1016/j.bcp.2010.09.019DOI Listing
January 2011

Prehabilitation versus usual care before total knee arthroplasty: A case report comparing outcomes within the same individual.

Physiother Theory Pract 2010 Aug;26(6):399-407

Exercise Physiology Laboratory, Department of Health and Sport Sciences, University of Louisville, Louisville, Kentucky 40292, USA.

This case report compared pre- and postoperative functional ability, knee strength, and pain of a female who underwent two separate total knee arthroplasty (TKA) procedures. The female patient was part of a larger research study. The first surgery on the right knee was preceded with usual care and the second surgery on the left knee was preceded by prehabilitation. Functional ability was assessed by a 6-minute walk, chair raises, and the time required to ascend and descend stairs. Knee extension and flexion isokinetic strength was assessed using the KinCom Isokinetic Dynamometer. Pain was assessed using the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC). Functional abilities, knee strength, and pain were assessed at baseline measurements 4 weeks before surgery, 1 week before surgery, and at 1 and 3 months post surgery during each TKA procedure. Results indicate that the prehabilitation intervention had a favorable impact on improving functional ability up to 30%, increasing knee strength by 50% and decreasing pain prior to the left knee TKA. For this patient, prehabilitation increased functional ability and strength prior to surgery. Gains in strength were maintained in the nonsurgical knee after surgery. These findings indicate that prehabilitation may be effective at facilitating the rehabilitation following a TKA.
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http://dx.doi.org/10.3109/09593980903334909DOI Listing
August 2010

Kinematic evaluation of the finger's interphalangeal joints coupling mechanism--variability, flexion-extension differences, triggers, locking swanneck deformities, anthropometric correlations.

J Biomech 2010 Aug 18;43(12):2381-93. Epub 2010 May 18.

Biomechanics Research Laboratory, Department of Mechanical Engineering, Speed School of Engineering, University of Louisville, Louisville, KY, USA.

The human finger contains tendon/ligament mechanisms essential for proper control. One mechanism couples the movements of the interphalangeal joints when the (unloaded) finger is flexed with active deep flexor. This study's aim was to accurately determine in a large finger sample the kinematics and variability of the coupled interphalangeal joint motions, for potential clinical and finger model validation applications. The data could also be applied to humanoid robotic hands. Sixty-eight fingers were measured in seventeen hands in nine subjects. Fingers exhibited great joint mobility variability, with passive proximal interphalangeal hyperextension ranging from zero to almost fifty degrees. Increased measurement accuracy was obtained by using marker frames to amplify finger segment motions. Gravitational forces on the marker frames were not found to invalidate measurements. The recorded interphalangeal joint trajectories were highly consistent, demonstrating the underlying coupling mechanism. The increased accuracy and large sample size allowed for evaluation of detailed trajectory variability, systematic differences between flexion and extension trajectories, and three trigger types, distinct from flexor tendon triggers, involving initial flexion deficits in either proximal or distal interphalangeal joint. The experimental methods, data and analysis should advance insight into normal and pathological finger biomechanics (e.g., swanneck deformities), and could help improve clinical differential diagnostics of trigger finger causes. The marker frame measuring method may be useful to quantify interphalangeal joints trajectories in surgical/rehabilitative outcome studies. The data as a whole provide the most comprehensive collection of interphalangeal joint trajectories for clinical reference and model validation known to us to date.
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http://dx.doi.org/10.1016/j.jbiomech.2010.04.021DOI Listing
August 2010

[Gated single photon emission computer tomography for the detection of silent myocardial ischemia].

Rev Med Chil 2009 Aug 4;137(8):1023-30. Epub 2009 Nov 4.

Centro de Investigaciones Clínicas, Ciudad de La Habana, Cuba.

Background: Asymptomatic patients with severe coronary atherosclerosis may have a normal resting electrocardiogram and stress test.

Aim: To assess the yield of Gated Single Photon Emission Computer Tomography (SPECT) for the screening of silent myocardial ischemia in type 2 diabetic patients.

Material And Methods: Electrocardiogram, stress test and gated-SPECT were performed on 102 type 2 diabetic patients aged 60+/-8 years without cardiovascular symptoms. AH subjects were also subjected to a coronary angiography whose results were used as gold standard.

Results: Gated-SPECT showed myocardial ischemia on 26.5% of studied patients. The sensibility, specificity accuracy, positive predictive value and negative predictive value were 92.3%, 96%, 95%, 88.8%, 97.3%, respectively. In four and six patients ischemia was detected on resting electrocardiogram and stress test, respectively. Eighty percent of patients with doubtful resting electrocardiogram results and 70% with a doubtful stress test had a silent myocardial ischemia detected by gated-SPECT There was a good agreement between the results of gated-SPECT and coronary angiography (k=0.873).

Conclusions: Gated-SPECT was an useful tool for the screening of silent myocardial ischemia.
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http://dx.doi.org//S0034-98872009000800004DOI Listing
August 2009

The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty.

PM R 2009 Aug;1(8):729-35

School of Nursing, University of Louisville, 555 S. Floyd Street, Louisville, KY 40205, USA.

Objective: The purpose of this study was to examine the effect of a preoperative exercise intervention on knee pain, functional ability, and quadriceps strength among patients with knee osteoarthritis before and after total knee arthroplasty (TKA) surgery.

Design: A repeated-measures design was used to compare 2 groups over 4 data collection points.

Setting And Patients: Community-dwelling subjects with osteoarthritis of the knee who were scheduled for a unilateral TKA were recruited from a single orthopedic surgeon's office and were randomized into control (n = 28) or prehab groups (n = 26).

Interventions: The control patients maintained usual care before their TKA. The exercisers performed prehabilitation exercises, which included resistance training, flexibility, and step training, 3 times per week before their TKA.

Outcome Measures: Knee pain, functional ability, quadriceps strength, and strength asymmetry were assessed at baseline (T1), at 1 week before the patients' TKA (T2), and again at 1 (T3) and 3 (T4) months after TKA.

Results: The exercisers improved their sit-to-stand performance at T2, whereas the control group did not change their performance of functional tasks and had increased pain at T2. At T3 the exercisers demonstrated improved sit-to-stand performance. The control patients at T3 exhibited decreases in pain, their 6-minute walk, surgical leg strength and an increase in their nonsurgical leg strength and leg strength asymmetry. At T4 the exercisers improved in their performance of 3 of the 4 functional tasks, decreased all of their pain measures, and increased their surgical and nonsurgical quadriceps strength. At T4 the control group improved their performance on 2 of the 4 functional tasks, decreased all of their pain measures, increased their nonsurgical leg strength, and exhibited greater leg strength asymmetry.

Conclusion: These findings appear to indicate the efficacy of prehabilitation among TKA patients and support the theory of prehabilitation.
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http://dx.doi.org/10.1016/j.pmrj.2009.06.003DOI Listing
August 2009