A Comparative Study of a Novel Postural Garment Versus Exercise for Women with Nonspecific Cervical Pain: A Randomized Cross-over Trial

STUDY DESIGN

Randomized cross-over study.

OBJECTIVE

The aim of this study was to compare exercise, the criterion standard, to the postural garment PosturePlusForce in the management of nonspecific cervical pain in women. We also analyzed both interventions with regards to baseline posture, use of pharmacological pain relievers, compliance, and comfort.

SUMMARY OF BACKGROUND DATA

The prevalence of neck pain has increased during the last decade, preferentially affecting women. Those suffering from this condition may manifest a decrease in quality of life and inability to work. Consistent recommendations highlight the importance of exercise and posture for neck pain improvement.

METHODS

A total of 32 female health care professionals with cervical pain (≥3 on the visual analogue scale) entered the trial. Participants were allocated to either performing exercises or wearing the postural garment. The cross-over between interventions was separated by a 3-month washout period. Primary outcomes included pain intensity and posture. Secondary outcomes comprised cervical pain-related disability, psychological factors, physical activity, global perceived effect of treatment, and garment comfort. Treatment compliance, medication use, and adverse events were also recorded.

RESULTS

Both interventions showed a significant improvement in pain in subjects with an adherence >60%. However, in participants with dorsal hyperkyphosis (>45°), the garment demonstrated a greater reduction in pain than exercise (P = 0.019). Additionally, those wearing the garment needed fewer pain relievers than those performing exercises (P = 0.007). Compliance was >50% for both interventions and comfort was contingent on season.

CONCLUSION

In our study, PosturePlusForce showed, at least, a similar effect on pain to exercise, although those with dorsal hyperkyphosis exhibited a greater reduction in pain and related variables with the garment. Pain relievers were less required by those wearing PosturePlusForce than by those performing the exercises.Level of Evidence: 1.

Correlation between MR imaging - prognosis factors and molecular classification of breast cancers

The molecular classification of breast cancers defines subgroups of cancer with different prognoses and treatments. Each molecular type representing the intrinsic signature of the cancer corresponds to a histological profile incorporating hormone receptors, HER2 status and the proliferation index. This article describes the correlations between this molecular classification obtained in routine clinical practice using histological parameters and MRI. It shows that there is a specific MRI profile for triple-negative cancers: distinct demarcation, regular edges, hyperintensity on T2 weighted signals and, particularly, a crown enhancement. It is important for the radiologist to understand this molecular classification, firstly because of the relatively suggestive appearance of triple-negative basal-like cancers in the molecular classification, secondly, and particularly, as cancers in patients with the BRCA1 mutation are often triple-negative meaning that the criteria for reading the MRI needs to be tailored to this feature of the cancers, and finally because the efficacy of MRI in assessing response to neoadjuvant chemotherapy depends on the molecular class of cancer treated.

Pearls and pitfalls in breast MRI

At our academic institution, we have noticed repeated examples of both false-positive and false-negative MR diagnoses in breast cancer. The most common diagnostic errors in interpreting MRI of the breast are discussed in this review and experience-based advice is provided to avoid similar mistakes. The most common reasons for false-positive diagnoses are misinterpretation of artefacts, confusion between normal enhancing structures and tumours and, above all, insufficient use of the American College of Radiology breast imaging reporting and data system lexicon, whereas false-negative diagnoses are made as a result of missed tiny enhancement, a background-enhancing breast, or enhancement interpreted as benign rather than malignant.

Up to 21-day banked red blood cells collected by apheresis and stored for 14 days after automated wash at different times of storage

BACKGROUND AND OBJECTIVES

A closed-system technology (ACP-215, Haemonetics, Braintree, MA) enables automated washing and extended storage of frozen red blood cells (RBC). This technology was applied to wash banked RBC for removal of undesirable protein and metabolites before transfusion. We studied protein and metabolite depletion as well as RBC metabolism and viability up to 14 days postwash with regard to various pre-storage times.

MATERIALS AND METHODS

Thirty RBC units were collected by means of apheresis and subdivided into three arms based on prewash storage time period (6 days/group 1, 14 days/group 2, 21 days/group 3). Wash efficacy (protein depletion, IgA), RBC metabolism (pH, lactate, potassium, haemolysis) and cell viability (ATP) were analysed immediately and 14 days after washing.

RESULTS

Total protein and IgA postwash were lowered by automated wash in all groups and uniformly met EC guidelines. Potassium (mmol/l) was below 1.2 mmol/l postwash and significantly below prewash values in all groups, even after 14 days of storage (prewash vs. postwash; P < 0.05). RBCs washed after 14 and 21 days, respectively, showed significantly lower pH values and lower ATP content than RBCs washed after only 6 days of storage. Haemolysis rate remained significantly below 0.8%, the maximum level recommended by the EC guidelines, immediately and 14 days after washing in all units.

CONCLUSION

Our data confirm that RBC units banked up to 21 days can be effectively protein- and potassium-depleted with the ACP-215 independent from prewash storage time. With respect to high ATP levels and pH, postwash storage of 2 weeks should be limited to units not older than 7 days before wash. This new washing technology ensures better standardization in washed RBC and provides blood centres with a logistical alternative to 24-h washed RBC products.

The phosphodiesterase inhibitory selectivity and the in vitro and in vivo potency of the new PDE5 inhibitor vardenafil

We investigated the potency and the selectivity profile of vardenafil on phosphodiesterase (PDEs) enzymes, its ability to modify cGMP metabolism and cause relaxation of penile smooth muscle and its effect on erections in vivo under conditions of exogenous nitric oxide (NO) stimulation. PDE isozymes were extracted and purified from human platelets (PDE5) or bovine sources (PDEs 1, 2, 3, 4 and 6). The inhibition of these PDEs and of human recombinant PDEs by vardenafil was determined. The ability to potentiate NO-mediated relaxation and influence cGMP levels in human corpus cavernosum strips was measured in vitro, and erection-inducing activity was demonstrated in conscious rabbits after oral administration together with intravenous doses of sodium nitroprusside (SNP). The effects of vardenafil were compared with those of the well-recognized PDE5 inhibitor, sildenafil (values for sildenafil in brackets). Vardenafil specifically inhibited the hydrolysis of cGMP by PDE5 with an IC50 of 0.7 nM (6.6 nM). In contrast, the IC50 of vardenafil for PDE1 was 180 nM; for PDE6, 11 nM; for PDE2, PDE3 and PDE4, more than 1000 nM. Relative to PDE5, the ratios of the IC50 for PDE1 were 257 (60), for PDE6 16 (7.4). Vardenafil significantly enhanced the SNP-induced relaxation of human trabecular smooth muscle at 3 nM (10 nM). Vardenafil also significantly potentiated both ACh-induced and transmural electrical stimulation-induced relaxation of trabecular smooth muscle. The minimum concentration of vardenafil that significantly potentiated SNP-induced cGMP accumulation was 3 nM (30 nM). In vivo studies in rabbits showed that orally administered vardenafil dose-dependently potentiated erectile responses to intravenously administered SNP. The minimal effective dose that significantly potentiated erection was 0.1 mg/kg (1 mg/kg). The selectivity for PDE5, the potentiation of NO-induced relaxation and cGMP accumulation in human trabecular smooth muscle and the ability to enhance NO-induced erection in vivo indicate that vardenafil has the appropriate properties to be a potential compound for the treatment of erectile dysfunction. Vardenafil was more potent and selective than sildenafil on its inhibitory activity on PDE5.

Thoracic disc herniation, cord compression, and paraplegia caused by electrical injury: case report and review of the literature

The case of a patient with thoracic intervertebral disc prolapse, cord compression, and delayed paraplegia with recovery secondary to high-tension electrical current is presented. The unusual entry wound in the neck, makes this a rare event that to our knowledge has not been previously described in the literature. Magnetic resonance imaging allowed noninvasive and early diagnosis, and in the future probably will reveal the true incidence of cord compression in electrical injury victims.