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Family Practitioner, Sports Medicine Specialist, Surgical Specialist, Orthopaedic Surgeon, Neurologist (brain, nervous system)
16 years of experience
Accepting new patients

Credentials

Education ?

Medical School Score Rankings
Harvard University (1995)
  •  
Top 25%

Awards & Distinctions ?

Associations
American Board of Orthopaedic Surgery
American Orthopaedic Society for Sports Medicine

Affiliations ?

Dr. Miller is affiliated with 3 hospitals.

Hospital Affiliations

Score

Rankings

  • University of Michigan Hospitals & Health Centers *
    Orthopaedic Surgery
    1500 E Medical Center Dr, Ann Arbor, MI 48109
    •  
  • C.S. Mott Children's Hospital
    1500 E Medical Center Dr, Ann Arbor, MI 48109
  • University of Michigan Health System
  • * This information was reported to Vitals by the doctor or doctor's office.

    Publications & Research

    Dr. Miller has contributed to 98 publications.
    Title When Do Rotator Cuff Repairs Fail? Serial Ultrasound Examination After Arthroscopic Repair of Large and Massive Rotator Cuff Tears.
    Date February 2012
    Journal The American Journal of Sports Medicine
    Excerpt

    Despite advances in arthroscopic repair of rotator cuff tears, recurrent tears after repair of large and massive tears remain a significant clinical problem. The primary objective of this study was to define the timing of structural failure of surgically repaired large and massive rotator cuff tears by serial imaging with ultrasound. The secondary objective of this study was to investigate the association between recurrent tears and clinical outcome after rotator cuff repair.

    Title Fibroblasts Expressing the Thyrotropin Receptor Overarch Thyroid and Orbit in Graves' Disease.
    Date February 2012
    Journal The Journal of Clinical Endocrinology and Metabolism
    Excerpt

    Graves' disease (GD) is a systemic autoimmune syndrome comprising manifestations in thyroid and orbital connective tissue. The link between these two tissues in GD eludes our understanding. Patients with GD have increased frequency of circulating monocyte lineage cells known as fibrocytes. These fibrocytes infiltrate orbital connective tissues in thyroid-associated ophthalmopathy and express functional TSH receptor (TSHR).

    Title Bone Density of the Greater Tuberosity is Decreased in Rotator Cuff Disease with and Without Full-thickness Tears.
    Date December 2011
    Journal Journal of Shoulder and Elbow Surgery / American Shoulder and Elbow Surgeons ... [et Al.]
    Excerpt

    Despite the high prevalence of rotator cuff disease in the aging adult population, the basic mechanisms initiating the disease are not known. It is known that changes occur at both the bone and tendon after rotator cuff tears. However, no study has focused on early or "pretear" rotator cuff disease states. The purpose of this study was to compare the bone mineral density of the greater tuberosity in normal subjects with that in subjects with impingement syndrome and full-thickness rotator cuff tears.

    Title Long Head of Biceps Brachii Tendon Evaluation: Accuracy of Preoperative Ultrasound.
    Date December 2011
    Journal Ajr. American Journal of Roentgenology
    Excerpt

    The purpose of this study was to investigate the ability of ultrasound to accurately identify long head of biceps brachii (LHB) tendon abnormalities.

    Title Pubertal Development in Alg6 Deficiency (congenital Disorder of Glycosylation Type Ic).
    Date August 2011
    Journal Molecular Genetics and Metabolism
    Excerpt

    Information on the hypothalamic pituitary ovarian axis in congenital disorders of glycosylation (CDG) females is scarce. Varying hormonal profiles and degrees of virilization in CDG females suggest a spectrum of yet unidentified mechanisms affected by impaired N-glycosylation. We describe an ALG6D woman who completed puberty with normal gonadotropins and testosterone levels, no virilization, and regular menses. Hormonal follow-up of CDG females is necessary to improve our understanding of the role of glycosylation in pubertal development.

    Title Optimizing the Management of Rotator Cuff Problems.
    Date July 2011
    Journal The Journal of the American Academy of Orthopaedic Surgeons
    Excerpt

    Of the 31 recommendations made by the work group, 19 were determined to be inconclusive because of the absence of definitive evidence. Of the remaining recommendations, four were classified as moderate grade, six as weak, and two as consensus statements of expert opinion. The four moderate-grade recommendations include suggestions that exercise and nonsteroidal anti-inflammatory drugs be used to manage rotator cuff symptoms in the absence of a full-thickness tear, that routine acromioplasty is not required at the time of rotator cuff repair, that non-cross-linked, porcine small intestine submucosal xenograft patches not be used to manage rotator cuff tears, and that surgeons can advise patients that workers' compensation status correlates with less favorable outcomes after rotator cuff surgery.

    Title Proposal for Modification of the Ensat Staging System for Adrenocortical Carcinoma Using Tumor Grade.
    Date February 2011
    Journal Langenbeck's Archives of Surgery / Deutsche Gesellschaft Für Chirurgie
    Excerpt

    Various staging systems for adrenocortical carcinoma (ACC) have been proposed. We hypothesized that incorporating tumor grade into the current European Network for the Study of Adrenal Tumors (ENSAT) staging system would improve the ability to more accurately predict time to recurrence and death.

    Title Influence of Prophylactic Central Lymph Node Dissection on Postoperative Thyroglobulin Levels and Radioiodine Treatment in Papillary Thyroid Cancer.
    Date January 2011
    Journal Surgery
    Excerpt

    Prophylactic central lymph node dissection with total thyroidectomy (TT) for the treatment of papillary thyroid cancer (PTC) is controversial because of the possibility of increased morbidity with uncertain benefit. The purpose of this study is to determine whether prophylactic central neck dissection provides any advantages over TT alone.

    Title An International Perspective on Ultrasound Training and Use for Thyroid and Parathyroid Disease.
    Date September 2010
    Journal World Journal of Surgery
    Excerpt

    Use of ultrasound (USN) by endocrine surgeons has dramatically increased. Presently, optimal training and certification requirements have not been standardized at any level (resident/fellow/attending). We sought to define the types of USN training endocrine surgeons receive and how USN is employed in practice. We hypothesized that in more recent years fellowship-trained endocrine surgeons were more likely to receive formal training in the use of USN during their endocrine surgery fellowship.

    Title Laparoscopic Resection is Inappropriate in Patients with Known or Suspected Adrenocortical Carcinoma.
    Date September 2010
    Journal World Journal of Surgery
    Excerpt

    Complete surgical resection is the mainstay of treatment for patients with adrenocortical cancer (ACC). Use of laparoscopy has been questioned in patients with ACC. This study compares the outcomes of patients undergoing laparoscopic versus open resection (OR) for ACC.

    Title Activation of the Shoulder Musculature During Pendulum Exercises and Light Activities.
    Date May 2010
    Journal The Journal of Orthopaedic and Sports Physical Therapy
    Excerpt

    Prospective, single-group, repeated-measures design.

    Title An Analysis of the Orthopaedic In-training Examination Sports Section: the Importance of Reviewing the Current Orthopaedic Subspecialty Literature.
    Date April 2010
    Journal The Journal of Bone and Joint Surgery. American Volume
    Title Defining Safe Rehabilitation for Ulnar Collateral Ligament Reconstruction of the Elbow: a Biomechanical Study.
    Date March 2010
    Journal The American Journal of Sports Medicine
    Excerpt

    Ulnar collateral ligament reconstruction of the elbow using a variety of techniques has been successful in enabling overhead athletes with ulnar collateral ligament insufficiency to return to competition. Most current postoperative rehabilitation programs begin with a period of motion restriction, including limiting elbow extension, that is followed by a transition from elbow strengthening to an interval throwing program, to competition. Motion restrictions early in the postoperative period may increase the risk for contractures. There is limited information to support current motion restrictions.

    Title Anaplastic Thyroid Cancer Manifesting As New-onset Horner Syndrome.
    Date January 2010
    Journal Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
    Excerpt

    To report a case of Horner syndrome as the initial sign of locally advanced anaplastic thyroid cancer.

    Title Short-term Growth Hormone Treatment in Children with Hurler Syndrome After Hematopoietic Cell Transplantation.
    Date December 2009
    Journal Bone Marrow Transplantation
    Excerpt

    Children with Hurler syndrome experience progressive growth failure after hematopoietic cell transplantation (HCT). The goal of this study was to review the safety and efficacy of growth hormone (GH) in eight children with Hurler syndrome who were treated at our institution with GH for short stature or GH deficiency between 2005 and 2008. The age at initiation of treatment with GH was 9.6+/-2.3 years and time since HCT was 7.5+/-1.5 years. Mean GH dose was 0.32 mg/kg/week. Baseline growth velocity was 3.5+/-1.5 cm/year (-2.6+/-1.9 s.d.), and it increased to 5.2+/-3.0 cm/year (-0.1+/-3.6 s.d.) after 1 year of treatment. Of the six patients with radiographic data, there was one progression of scoliosis, one progression of kyphosis and one progression of genu valgum. No patient discontinued treatment due to progression of skeletal disease. One patient discontinued GH due to slipped capital femoral epiphysis. Preliminary data suggest that 1-year GH treatment may modestly improve growth velocity in children with Hurler syndrome.

    Title Completion Pancreatectomy and Duodenectomy for Recurrent Men-1 Pancreaticoduodenal Endocrine Neoplasms.
    Date October 2009
    Journal Surgery
    Excerpt

    The purpose of this study is to describe outcomes of MEN-1 patients with recurrence requiring completion pancreatectomy and duodenectomy after initial treatment of pancreatic endocrine neoplasms (PENs) and hypergastrinemia with distal pancreatectomy, enucleation of pancreatic head PENs, and duodenotomy.

    Title Raman Spectroscopy of Synovial Fluid As a Tool for Diagnosing Osteoarthritis.
    Date September 2009
    Journal Journal of Biomedical Optics
    Excerpt

    For many years, viscosity has been the primary method used by researchers in rheumatology to assess the physiochemical properties of synovial fluid in both normal and osteoarthritic patients. However, progress has been limited by the lack of methods that provide multiple layers of information, use small sample volumes, and are rapid. Raman spectroscopy was used to assess the biochemical composition of synovial fluid collected from 40 patients with clinical evidence of knee osteoarthritis (OA) at the time of elective surgical treatment. Severity of knee osteoarthritis was assessed by a radiologist using Kellgren/Lawrence (K/L) scores from knee joint x rays, while light microscopy and Raman spectroscopy were used to examine synovial fluid (SF) aspirates (2 to 10 microL), deposited on fused silica slides. We show that Raman bands used to describe protein secondary structure and content can be used to detect changes in synovial fluid from osteoarthritic patients. Several Raman band intensity ratios increased significantly in spectra collected from synovial fluid in patients with radiological evidence of moderate-to-severe osteoarthritis damage. These ratios can be used to provide a "yes/no" damage assessment. These studies provide evidence that Raman spectroscopy would be a suitable candidate in the evaluation of joint damage in knee osteoarthritis patients.

    Title Complications After Medial Opening Wedge High Tibial Osteotomy.
    Date September 2009
    Journal Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association
    Excerpt

    The purpose of this study was to investigate complications of the medial opening wedge high tibial osteotomy (HTO) procedure at our institution.

    Title Igf System in Children with Congenital Disorders of Glycosylation.
    Date September 2009
    Journal Clinical Endocrinology
    Excerpt

    The function of IGF system components is affected by their glycosylation status in vitro. However, little is known about the role of glycosylation status of these components in vivo. In this study we determined the impact of glycosylation on the endocrine IGF system in children with the rare syndrome of congenital disorders of glycosylation (CDG).

    Title Auxological Evaluation and Determinants of Growth Failure at the Time of Adoption in Eastern European Adoptees.
    Date June 2009
    Journal Journal of Pediatric Endocrinology & Metabolism : Jpem
    Excerpt

    To identify factors contributing to growth failure in international adoptees (IAs) from Eastern Europe.

    Title Age- and Sex-related Incidence of Surgically Treated Primary Hyperparathyroidism.
    Date October 2008
    Journal World Journal of Surgery
    Excerpt

    BACKGROUND: Primary hyperparathyroidism (1 degrees HPT) is reported most often in women over the age of 50. Beyond that, little is known about the epidemiology of this condition, and no studies have specifically examined the age and gender distribution of patients with 1 degrees HPT. METHODS: We analyzed patients from the Nationwide Inpatient Sample (NIS), a 20% random sample of all hospital stays from 2000-2004, and also from the University of Michigan endocrine surgery database from 1999-2005. Surgically treated 1 degrees HPT was used as a surrogate marker for 1 degrees HPT. An age- and sex-based frequency distribution was computed for each dataset. RESULTS: A total of 7,513 females and 2,677 males who underwent surgery for 1 degrees HPT in the 5-year period 2000 through 2004 were reported in the NIS. At the University of Michigan from 1999 through 2005, 790 females and 276 males underwent parathyroidectomy for 1 degrees HPT. In both datasets, the frequency of 1 degrees HPT began to rise slowly in both sexes at age 11 and increased more rapidly among females than males beginning at age 21-25 (NIS) and 26-30 (UM). Incidence curves for both women and men in both databases were similar in shape and unipolar in configuration. Peak incidence was at age 56-60 (NIS) and 61-65 (UM) in females and age 56-60 in males (both datasets). The female:male ratio was noted to rise steadily among the NIS patients until perimenopausal age, after which it became stable for the next 20 years before decreasing again. No change in the female:male ratio over time was seen among the UM patients. CONCLUSIONS: Primary HPT occurs more frequently in females than in males at all ages. The incidence increases steadily after age 25 in both sexes. The female:male ratio does not change during the peri- and postmenopausal years. This information should stimulate new hypotheses to explain the difference in the incidence of 1 degrees HPT between men and women.

    Title Iron Deficiency in International Adoptees from Eastern Europe.
    Date August 2008
    Journal The Journal of Pediatrics
    Excerpt

    OBJECTIVE: To assess iron deficiency (ID) in international adoptees after adoption. STUDY DESIGN: Participants (n = 37) were adopted into the United States from Eastern Europe before they were 24 months of age. Baseline (within 1 month post-adoption) and follow-up (6 months post-adoption) assessments included routine post-adoption clinical evaluations, anthropometrics, dietary intakes, and iron measures (hemogram and serum analysis). RESULTS: At adoption and follow-up, mean percent transferrin saturation and mean corpucuscular volume were low compared with the US population. Mean serum ferritin concentration became lower than the US population at follow-up, although the mean daily iron intake was more than the Recommended Dietary Allowance. Participants with Giardia lamblia at baseline had more compromised iron status at baseline and follow-up. Growth rate (change in z-score/months between assessments) was negatively correlated with change in serum ferritin concentrations between baseline and follow-up (r = -0.34; P < .05). CONCLUSIONS: International adoptees had compromised iron status, with ID more prevalent in participants with G lamblia, a parasite that may interfere with iron absorption. The persistent ID at follow-up was likely caused by the erythropoietic demands of catch-up growth.

    Title Damage Control in Complex Penetrating Tracheal Injury and Silicone T-tube.
    Date March 2008
    Journal The Journal of Trauma
    Title The Santa Barbara County Care Data Exchange: What Happened?
    Date November 2007
    Journal Health Affairs (project Hope)
    Excerpt

    The Santa Barbara County Care Data Exchange was once one of the most ambitious and publicized U.S. health information exchange (HIE) efforts. Eight years after its inception, and several months after providing some data, the Santa Barbara Project shut down operations. Despite its developed HIE infrastructure, participants found no compelling value proposition in initial HIE services. Even with fewer technology delays and more community leadership, other regional health information organizations (RHIOs) may also stumble over HIE service-value propositions without some combination of grants, incentives, and mandates that develop initial RHIO infrastructure and services and ensure provision of unprofitable yet socially valuable services.

    Title Patient Satisfaction After Medial Opening High Tibial Osteotomy and Microfracture.
    Date June 2007
    Journal The Journal of Knee Surgery
    Excerpt

    High tibial osteotomy has become an accepted treatment for patients with varus degenerative arthritis of the knee. We sought to determine factors associated with patient satisfaction and functional outcome following medial opening wedge high tibial osteotomy for the degenerative varus knee. Sixty-one patients (14 women and 47 men) undergoing medial opening wedge osteotomy and chondral resurfacing procedure (microfracture) for medial knee pain, with minimum 2-year follow-up, were identified through our clinical database. Mean patient age was 52.2 years (range: 35-65 years). Thirty patients were treated with plate fixation, and 31 with distraction osteogenesis and external fixation. Nineteen patients had Outerbridge grade III or IV patellofemoral lesions at initial surgery. The mean preoperative Lysholm score of 49.9 improved postoperatively to 75.4 (P < .001). Mean satisfaction score was 7.6 (1 = not satisfied, 10 = very satisfied). Women showed a significantly higher improvement in Lysholm and satisfaction scores than men (P = .029, P = .034). A positive correlation was observed between satisfaction and postoperative Lysholm score (P < .001). The independent multivariate predictor of patient satisfaction was the postoperative Lysholm score. Medial opening wedge high tibial osteotomy is an efficacious surgical option for the treatment of the degenerative varus knee, as demonstrated by both patient satisfaction and functional outcome scores.

    Title Pregnancy Associated Plasma Protein-a is Necessary for Expeditious Fracture Healing in Mice.
    Date April 2007
    Journal The Journal of Endocrinology
    Excerpt

    Pregnancy-associated plasma protein A (PAPP-A), a metalloproteinase that regulates IGF bioavailability in vitro through cleavage of inhibitory IGF-binding protein-4 (IGFBP-4), has been implicated in skeletal development and injury repair responses. However, direct in vivo data are lacking. In this study, we used PAPP-A knock-out (KO) mice to determine the role of PAPP-A in fracture repair. Stabilized mid-shaft fractures were produced in femurs of 3-month-old mice. At 14 days post-fracture, complete bony bridging of the fracture callus was seen radiographically in wild-type but not in PAPP-A KO mice. Histological examination 5 to 28 days post-fracture showed reductions in the amount of intramembranous bone formation, cartilage production, endochondral ossification and remodeling in PAPP-A KO compared with wild-type mice. However, fracture healing appeared similar in both groups at 42 days post-fracture when analyzed by histology. A similar degree of healing strength in wild-type and PAPP-A KO femurs was demonstrated by mechanical testing at 28 and 42 days post-fracture. Untreated cultures of day 5 fracture calluses from wild-type mice showed robust IGFBP-4 protease activity and IGF receptor phosphorylation, whereas fracture calluses from PAPP-A KO mice had no IGFBP-4 protease activity and reduced IGF receptor phosphorylation. These data demonstrate a marked delay in fracture healing in PAPP-A KO compared with wild-type mice, and suggest that PAPP-A is necessary in the early phases of the process for expeditious fracture repair. The ability of PAPP-A to enhance local IGF action may be an important mechanism for optimizing the fracture repair response.

    Title An Evaluation of Shoulder External Rotation Braces.
    Date February 2007
    Journal Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association
    Excerpt

    PURPOSE: The purpose of the present study was to evaluate 4 commercially available shoulder external rotation braces to determine their ability to achieve and maintain shoulder external rotation. In addition, for each brace, we collected patient-derived data on comfort level, ease of application, and ease of performing activities of daily living during brace wear. METHODS: Four commercially available shoulder external rotation braces were evaluated for their ability to achieve and maintain external rotation in 12 healthy subjects. RESULTS: Significant differences were noted between braces in their ability to achieve and maintain shoulder external rotation, as well as in their comfort ratings. CONCLUSIONS: We have shown that the commercially available shoulder external rotation braces evaluated in this study vary in (1) ability to achieve and maintain a desired position of external rotation of the shoulder, and (2) comfort ratings. CLINICAL RELEVANCE: Selection of an external rotation brace should involve consideration of the device's performance and comfort profile.

    Title Interpretation of Intraoperative Parathyroid Hormone Monitoring in Patients with Baseline Parathyroid Hormone Levels of <100 Pg/ml.
    Date January 2007
    Journal Surgery
    Excerpt

    BACKGROUND: Common guidelines for intraoperative parathyroid hormone (IOPTH) interpretation are based on clearly elevated baseline parathyroid hormone (PTH) values. We hypothesize that patients with low-baseline levels (<100 pg/mL) have a higher incidence of multigland disease (MGD) and display differences in PTH kinetics compared with patients with high-baseline levels. METHODS: We retrospectively reviewed the cases of 1151 patients with primary hyperparathyroidism who underwent parathyroidectomy with IOPTH monitoring. Of these, 141 patients had low-baseline values. Multiple comparisons were made between the low-baseline and high-baseline groups. RESULTS: Twenty-six percent of the low-baseline patients had MGD versus 15% of the high-baseline patients (P = .002). The PTH kinetics differed between groups after gland excision at both 5 and 10 minutes. Adherence solely to the "50% rule" during minimally invasive parathyroidectomy potentially would have missed 25% of patients with MGD in the low-baseline group versus 10% in the high-baseline group; 5.7% of the low-baseline patients had persistent or recurrent hypercalcemia versus 2.9% of the high-baseline patients. CONCLUSION: MGD is significantly more prevalent among low-baseline patients, and PTH kinetics are somewhat different between groups. The current guidelines that are used for IOPTH monitoring may not be ideal for use in this low-baseline group and will likely need to be revised after further study of this group of patients.

    Title Thyroid Lymphoma Arising from Hashimoto's Thyroiditis.
    Date November 2006
    Journal The Journal of Clinical Endocrinology and Metabolism
    Title Does Changing the Configuration of a Motor Racing Circuit Make It Safer?
    Date July 2006
    Journal British Journal of Sports Medicine
    Title The Stability of Three Commercially Available Implants Used in Medial Opening Wedge High Tibial Osteotomy.
    Date June 2006
    Journal The Journal of Knee Surgery
    Excerpt

    This biomechanical study tested three commercially available fixation devices for medial opening wedge high tibial osteotomy (HTO). A medial opening wedge HTO model was created on replicate tibias. Fixation was achieved with one of three fixation devices: VS Osteotomy plate (EBI, Parsippany, NJ), Arthrex Osteotomy plate (Arthrex, Naples, Fla), and OsteoTrac plate (DJ Orthopedics Inc, Vista, Calif). For each fixation system, seven specimens were cyclically loaded in compression and torsion under physiologic loads on a servohydraulic machine. Mean axial stiffness was 2425 N/mm, 2358 N/mm and 2258 N/mm, respectively, for the EBI, Arthrex, and Alaron surgical plates. Mean torsional stiffness was 4.5 Nm/degree, 4.1 Nm/degree and 4.0 Nm/degree, respectively, for the EBI, Arthrex, and DJ Orthopedics surgical plates. Though the differences are not statistically significant between the three fixation devices (P=.74 for mean axial stiffness and P=.10 for mean torsional stiffness), there is insufficient statistical power to rule out a true difference. Using this replicate tibia model, all three fixation devices tested appear to successfully stabilize the osteotomy site with regards to physiologic axial and torsional loads.

    Title Primary Hyperaldosteronism: Effect of Adrenal Vein Sampling on Surgical Outcome.
    Date May 2006
    Journal Archives of Surgery (chicago, Ill. : 1960)
    Excerpt

    HYPOTHESIS: Adrenal vein sampling is superior to computed tomography for subtype differentiation of primary hyperaldosteronism. DESIGN: Retrospective review. SETTING: University medical center. PATIENTS: Forty-eight patients (32 men and 16 women) with biochemically confirmed primary hyperaldosteronism. MAIN OUTCOME MEASURES: We compared demographic factors, results of biochemical and imaging studies (computed tomography and adrenal vein sampling), therapy, and patient outcomes. RESULTS: Mean +/- SEM adrenal nodule size was 1.54 +/- 0.2 cm. Adrenal vein sampling was performed in 41 (85%) of 48 patients, and it was successful in 39 (95%) of those 41 patients. Concordance between computed tomography and adrenal vein sampling was observed in 22 (54%) of the 41 patients. Thirty-two patients underwent successful laparoscopic adrenalectomy. There was 1 complication and no deaths. All 32 patients were cured of hypokalemia. CONCLUSION: Adrenal vein sampling is superior to image-based techniques for subtype differentiation of primary hyperaldosteronism.

    Title Facioscapulohumeral Muscular Dystrophy Presenting As Shoulder Pain in a Baseball Player.
    Date March 2006
    Journal Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association
    Excerpt

    Facioscapulohumeral muscular dystrophy is a commonly occurring myopathy that affects the facial and periscapular musculature. We describe a case in a high school throwing athlete that presented as shoulder pain with throwing a baseball. The patient has begun an intensive physical therapy training program that targets his weak scapular stabilizers as well as altering his throwing mechanics. His symptoms have improved, and he is able to continue competing in throwing sports at a high level.

    Title Rupture of the Subscapularis Tendon After Shoulder Arthroplasty: Diagnosis, Treatment, and Outcome.
    Date February 2006
    Journal Journal of Shoulder and Elbow Surgery / American Shoulder and Elbow Surgeons ... [et Al.]
    Excerpt

    The purpose of this study was to document the diagnosis, surgical treatment, and functional outcome in patients with subscapularis ruptures after shoulder arthroplasty. Prospective objective and subjective data were collected on 7 patients with symptomatic rupture of the subscapularis tendon after shoulder arthroplasty. Presenting signs and symptoms included pain, weakness in internal rotation, increased external rotation, and anterior instability. All patients were treated with surgical repair of the ruptured tendon. Four required repair augmentation with a transfer of the pectoralis major tendon. After subscapularis repair and pectoralis transfer, 2 patients continued to have anterior instability and required an additional operation to address the instability. At a mean follow-up of 2.3 years (range, 18-55 months), the mean American Shoulder and Elbow Surgeons shoulder score in this study group was 63.2. The mean patient satisfaction rating, on a 10-point scale, was 6.2. Factors associated with post-arthroplasty subscapularis ruptures included subscapularis lengthening techniques used to address internal rotation contracture and previous surgery that violated the subscapularis tendon. Symptomatic subscapularis rupture after shoulder arthroplasty introduces the need for additional surgery and a period of protected or delayed rehabilitation after arthroplasty. Although symptoms were adequately addressed with appropriate surgical treatment, decreased functional outcomes were observed.

    Title Golf and Racquet Sports Injuries.
    Date February 2006
    Journal Seminars in Musculoskeletal Radiology
    Excerpt

    There are specific injuries that are common in golf and racquet sports. These abnormalities have a predilection for specific structures as well and can be divided into two categories on the basis of etiology as either chronic repetitive injury or acute trauma. With golf injuries, upper extremity abnormalities prevail and include rotator cuff disease, epicondylitis, wrist tenosynovitis, and hamate hook fracture. Thoracolumbar spine pain can also occur. The order of frequency of these ailments is different for professional and recreational athletes. With racquet injuries, as in tennis, lower extremity injuries are more common and include medial gastrocnemius and Achilles tendon abnormalities, although shoulder, elbow, and wrist abnormalities may also occur. Knowledge of the biomechanics behind each sport is also helpful in understanding the pathophysiology of injury and in part explains the findings seen at imaging.

    Title Type I Insulin-like Growth Factor Receptor As a Therapeutic Target in Cancer.
    Date January 2006
    Journal Cancer Research
    Excerpt

    Data from experimental model systems and population studies have implicated type I insulin-like growth factor receptor (IGF1R) signaling in many different human cancers. Drugs to disrupt IGF1R function have been developed and are now entering clinical trial. This brief review will identify key areas to consider as these clinical trials move forward.

    Title The Effect of Lateral Cortex Disruption and Repair on the Stability of the Medial Opening Wedge High Tibial Osteotomy.
    Date December 2005
    Journal The American Journal of Sports Medicine
    Excerpt

    BACKGROUND: Medial opening wedge high tibial osteotomy is gaining popularity as a treatment option for medial compartment degenerative disease in the young, active patient. One of the potential technical pitfalls of this procedure is inadvertent disruption of the lateral tibial cortex during distraction at the osteotomy site. PURPOSE: (1) To investigate the effect of lateral cortex disruption on stability during medial opening wedge high tibial osteotomy and (2) to evaluate 3 different methods of repair of the disrupted lateral cortex. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 50 validated replicate tibias were evaluated in a medial opening wedge high tibial osteotomy model. Specimens were divided into 5 groups: (1) control, or intact lateral cortex (n = 10); (2) disrupted lateral cortex (n = 10); (3) lateral cortex repaired with 1 staple (n = 10); (4) lateral cortex repaired with 2 staples (n = 10); and (5) lateral cortex repaired with a periarticular plate and screws (n = 10). Specimens were placed in compression and torsion under physiologic loads, and stiffness and micromotion were calculated. RESULTS: Disruption of the lateral cortex resulted in a 58% reduction in axial stiffness and a 68% reduction in torsional stiffness compared to control specimens (P < .05). Disruption of the lateral cortex also resulted in increased micromotion at the osteotomy site. All 3 methods of repair of the lateral cortex restored stiffness and micromotion values to those of the control group (P < .05). CONCLUSIONS: Instability at the osteotomy site may contribute to the high rate of delayed union or nonunion associated with medial opening wedge high tibial osteotomy. Repair of the lateral tibial cortex by each of these techniques restored stability to the osteotomy site in this replicate tibia model and might be effective in clinical use. However, more studies are needed to further explore the relationship between lateral cortex disruption and patient outcomes in the clinical setting before definitive conclusions can be drawn.

    Title Cast Immobilization Versus Percutaneous Pin Fixation of Displaced Distal Radius Fractures in Children: a Prospective, Randomized Study.
    Date October 2005
    Journal Journal of Pediatric Orthopedics
    Excerpt

    Thirty-four patients were enrolled in a prospective randomized study comparing cast immobilization alone versus percutaneous pin fixation following closed reduction of distal radial metaphyseal fractures. Patients older than 10 years of age with greater than 30 degrees of dorsal angulation or with complete fracture displacement were eligible for enrollment. Average follow-up was 10.5 weeks. All fractures healed uneventfully without deformity, growth arrest, or functional limitations. Overall complication rates were similar between groups. Thirty-nine percent of patients treated with casting had subsequent loss of reduction requiring remanipulation; there were no cases of loss of reduction in patients treated with pin fixation. Thirty-eight percent of patients treated with pin fixation had pin-related complications; all resolved following pin removal without long-term sequelae. Cost analysis showed no significant difference in treatment charges between groups. Treating surgeons should be aware of the potential short-term complications of each treatment method and adjust their postoperative care appropriately.

    Title Should Acute Anterior Dislocations of the Shoulder Be Immobilized in External Rotation? A Cadaveric Study.
    Date March 2005
    Journal Journal of Shoulder and Elbow Surgery / American Shoulder and Elbow Surgeons ... [et Al.]
    Excerpt

    The high recurrence rate associated with anterior shoulder dislocations may reflect inadequate healing of a Bankart lesion when the arm is immobilized in internal rotation. The effect of external rotation (ER) of the humerus on the glenoid-labrum contact of Bankart lesions was examined in 10 human cadaveric shoulders. The contact force between the glenoid labrum and the glenoid was measured in 60 degrees of internal rotation, neutral rotation, and 45 degrees of ER in 10 human cadaveric shoulders. No detectable contact force was found with the arm in internal rotation. The contact force increased as the arm passed through neutral rotation and reached a maximum at 45 degrees of ER. The contact force returned to 0 g when the arm was returned to neutral rotation. The mean contact force at 45 degrees of ER was 83.5 g. External rotation significantly increases the labrum-glenoid contact force and may influence the healing of a Bankart lesion.

    Title Chronic Exertional Compartment Syndrome.
    Date October 2004
    Journal American Journal of Orthopedics (belle Mead, N.j.)
    Excerpt

    Chronic exertional compartment syndrome is an overuse condition affecting primarily active, athletic people. Its etiology is unclear, but several theories have been proposed. The syndrome is characterized by recurrent, often severe muscle compartment pain that occurs with vigorous exercise and subsides with rest. Physical examination usually provides little helpful information. Compartment pressure measurement before and after exercise is the mainstay of objective diagnosis. Conservative management has been highly unsuccessful. Overall, considerable success can be expected from fasciotomy of the involved compartments followed by a rigorous rehabilitation program, though recurrence of symptoms is a reported complication. Recent research efforts have focused on the development of less invasive and more accurate diagnostic modalities and safer and more effective surgical procedures.

    Title Impact of Prefractionation Using Gradiflow on Two-dimensional Gel Electrophoresis and Protein Identification by Matrix Assisted Laser Desorption/ionization-time of Flight-mass Spectrometry.
    Date July 2004
    Journal Electrophoresis
    Excerpt

    Prefractionation of protein samples prior to two-dimensional electrophoresis (2-DE) has the potential to increase the dynamic detection range for proteomic analysis. We evaluated a membrane-based electrophoretic separation technique (Gradiflow) for its ability to fractionate an exoproteome sample from the filamentous fungus Trichoderma reesei. The sample was separated on the basis of size and charge. Buffer optimization was found to be necessary for successful size fractionation. Fractionation by charge was used to resolve the sample into four fractions that were subjected to analysis by two-dimensional electrophoresis (2-DE). Enhanced detection of low-abundance proteins with selective removal of high-abundance species was achieved. Fractionated and unfractionated samples were examined for differences in the ability to identify proteins following 2-DE using trypsin in-gel digestion followed by peptide mass fingerprinting using matrix assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOF-MS). Fractionated samples showed marked improvement in protein identification ability and sequence coverage. This study demonstrates the utility of the Gradiflow for fractionation, resulting in an enhancement of resolution and characterization of a moderately complex proteome.

    Title Idiopathic Short Stature in Children.
    Date June 2004
    Journal Pediatric Annals
    Excerpt

    Idiopathic short stature represents a group of conditions that are not definable by current biochemical criteria but usually respond to GH therapy. Natural-history studies confirm adult height will be short in untreated ISS individuals. Children and adults with short stature have disadvantages compared with their peers. The evidence for benefit from treatment of children with idiopathic short stature is strong. Numerous studies, now including a placebo-controlled study, have demonstrated the positive effect of GH treatment on final height. The effect of GH treatment is quantitatively similar to results seen in other non-GH-deficient conditions. Although currently very expensive, rhGH treatment is relatively safe. GH treatment of children with idiopathic short stature should not be withheld because of our inability to explain the etiology or because of the inadequacy of our current diagnostic tests. Continued efforts to delineate specific causes of poor growth in ISS individuals may result in our being able to predict subsets of individuals who will respond well to GH and subgroups who may be considered for other treatments, such as IGF-1 or a combination of IGF-1 and IGFBP-3.

    Title Biomechanical Analysis of Five Fixation Techniques Used in Glenohumeral Arthrodesis.
    Date June 2004
    Journal Anz Journal of Surgery
    Excerpt

    BACKGROUND: The purpose of the present study is to compare five fixation techniques in shoulder fusion. The most common complications resulting from shoulder fusion, non-union and unacceptable arm position, might reflect a failure to achieve rigid fixation during the surgical procedure. METHODS: Twenty-five shoulder fusions were carried out on human cadaveric specimens using the following techniques: screw fixation, external fixation, external fixation supplemented with screw fixation, single plate fixation and double plate fixation. Each specimen was tested on a servohydraulic machine to determine stiffness. RESULTS: There was a statistically significant difference in bending and torsional stiffness between all five fixation techniques. Normalized bending (B) and torsional stiffness (T), in descending order, were: double plate (B = 1.00, T = 1.00), single plate (B = 0.77, T = 0.89), external fixation with screws (B = 0.68, T = 0.74), external fixation alone (B = 0.40, T = 0.53), and screws alone (B = 0.13, T = 0.26). CONCLUSION: The risk of the most common complications resulting from shoulder fusion might be minimized if these biomechanical findings are applied to surgical decision making.

    Title Regional Antibiotic Prophylaxis in Elbow Surgery.
    Date May 2004
    Journal Journal of Shoulder and Elbow Surgery / American Shoulder and Elbow Surgeons ... [et Al.]
    Excerpt

    In this study we describe a technique for the delivery of regional antibiotic prophylaxis in patients undergoing elbow surgery and compare tissue antibiotic concentrations achieved by this technique with those achieved by standard systemic intravenous prophylaxis. We collected bone and fat samples from patients undergoing elective elbow surgery who had received regional antibiotic prophylaxis and measured the tissue antibiotic concentration. For comparison, we measured the antibiotic concentration in bone and fat samples taken from patients undergoing elective shoulder surgery who had received systemic prophylaxis. Mean tissue antibiotic concentrations were significantly higher in the regional antibiotic group (bone, 1484 microg/g vs 35.8 microg/g; fat, 1422.7 microg/g vs 10.7 microg/g; P <.05). No adverse effects were encountered with regional antibiotic delivery. The delivery of regional antibiotic prophylaxis in elbow surgery achieves higher tissue antibiotic concentrations than those achieved with standard systemic delivery. This technique may help reduce the risk of perioperative infection in elbow surgery.

    Title Patient Satisfaction and Outcome After Microfracture of the Degenerative Knee.
    Date May 2004
    Journal The Journal of Knee Surgery
    Excerpt

    Satisfaction and functional outcome was measured in 81 patients who were treated arthroscopically with microfracture for isolated degenerative lesions of the knee. Average patient age was 49 years (range: 40-70 years) and average degenerative lesion measured 229.5 mm2 (range: 25-2000 mm2). Patients were evaluated at average 2.6-year follow-up (range: 2-5 years). All subjective parameters measured (pain, swelling, limping, walking, stairs, sport level, and activities of daily living) demonstrated significant improvement over preoperative status (P<.003). Lysholm score improved from 53.8 to 83.1 (P<.001), and mean Tegner Activity Scale score improved from 2.9 to 4.5 (P<.05). No significant association was noted between Lysholm improvement and gender or age. Significant improvement in mean Lysholm score was noted for lesions in all three knee compartments. Thirteen patients required repeat arthroscopy within 5 years of initial microfracture for lysis of adhesions. Five patients required revision microfracture to a previously treated lesion or total knee arthroplasty at an average of 23 months (range: 5-36 months) from the initial microfracture. Microfracture is an efficacious surgical option for the treatment of degenerative chondral lesions of the knee. The modest rate of failure and need for arthroscopic lysis of adhesions reflects the challenge of joint-sparing arthroscopic surgery in the degenerative knee.

    Title Effects of Braiding on Tensile Properties of Four-strand Human Hamstring Tendon Grafts.
    Date March 2004
    Journal The American Journal of Sports Medicine
    Excerpt

    BACKGROUND: Anterior cruciate ligament reconstruction is commonly performed with autogenous hamstring tendon grafts. PURPOSE: To ascertain the effects of braiding on ultimate tensile strength and stiffness of hamstring tendon graft. STUDY DESIGN: Controlled laboratory study. METHODS: Sixteen fresh-frozen semitendinosus and gracilis tendons were harvested from eight matched (right and left) human cadaveric specimens. Both sets of hamstring tendons from each matched pair were doubled, creating a four-strand graft. Grafts were then randomized so that one graft from each matched pair was braided and the other remained unbraided. The diameter of each graft construct was recorded. Grafts were tested to failure on a materials testing machine. RESULTS: There were no significant differences in cross-sectional area before or after braiding. Fifteen of 16 tendons failed midsubstance; 1 failed at the lower clamp. Braiding reduced the initial tensile strength and stiffness of human hamstring tendon grafts in this study by 35.0% and 45.8%, respectively. CONCLUSIONS: Braiding may place the collagen fibers in a suboptimal orientation for loading that results in a weaker graft. We do not recommend the use of braiding if the strongest, stiffest initial graft is desired.

    Title Differential Proteomic Analysis of Bacillus Subtilis Nitrate Respiration and Fermentation in Defined Medium.
    Date September 2003
    Journal Proteomics
    Excerpt

    A comparative investigation of protein expression by two-dimensional gel electrophoresis was conducted between Bacillus subtilis cultures grown in defined medium under aerobic, anaerobic nitrate respiration, or fermentation conditions. Defined medium specific for either nitrate respiration or fermentation allowed distinction between proteins induced by each individual growth process. Our differential protein profiling analysis between aerobic and anaerobic conditions showed that anaerobic fermentation induced at least 44 proteins and nitrate respiration induced at least 19 proteins compared to aerobic controls. Certain proteins were specifically induced during nitrate respiration or fermentation, while others were induced by both anaerobic processes. Eleven proteins induced by nitrate respiration and/or fermentation were identified by peptide mass matching using matrix-assisted laser desorption/ionization-time of flight mass spectrometry. Proteins encoded by feuA, hmp, and ytkD were induced by nitrate respiration. Proteins encoded by pyrR, sucD, trpC, and ywjH were induced by fermentation. Proteins encoded by acuB, pdhC, ydjL, and yvyD were induced by nitrate respiration and fermentation. This proteomic analysis has provided a more complete characterization of B. subtilis anaerobic growth and increased our understanding of its metabolic pathways of nitrate respiration and fermentation.

    Title The Microfracture Technique in the Treatment of Full-thickness Chondral Lesions of the Knee in National Football League Players.
    Date August 2003
    Journal The Journal of Knee Surgery
    Excerpt

    Between 1986 and 1997, 25 active National Football League (NFL) players underwent microfracture to treat full-thickness chondral lesions. Average follow-up was 4.5 years (range: 2-13 years). Preoperative and postoperative data were rated according to symptoms (4 = severe, 1 = none), function (5 = unable to perform, 1 = no limitations), and activity level (10 = full activity, 1 = unable to perform). Nineteen (76%) players returned to football the season following microfracture. Six players retired for various reasons. At follow-up, pain, swelling, running, cutting, and squatting improved. Activities of daily living, strenuous work, and strenuous sport levels also improved. Those who returned to play averaged 4.6 seasons of participation (range: 1-13 seasons) and 56 games (range: 2-183 games) after microfracture. Nine (36%) players continue active participation in the NFL. Results of microfracture to resurface full-thickness chondral lesions in high-demand NFL players are encouraging. Microfracture is safe, effective, and appears to improve symptoms, function, and activity levels in NFL players.

    Title Impact of Deglycosylation Methods on Two-dimensional Gel Electrophoresis and Matrix Assisted Laser Desorption/ionization-time of Flight-mass Spectrometry for Proteomic Analysis.
    Date July 2003
    Journal Electrophoresis
    Excerpt

    Glycosylation is a common post-translational modification that can add complexity to the proteome of many cell types. We used enzymatic and chemical methods of deglycosylation to treat a heavily glycosylated exoproteome sample from the filamentous fungus Trichoderma reesei. Deglycosylated samples were resolved on one-dimensional (1-D) and two-dimensional (2-D) gels in order to determine the effect of deglycosylation on the electrophoresis patterns and on the ability to identify proteins by peptide mass matching using matrix assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOF-MS) analysis of in-gel tryptic digests. We found that deglycosylation of the protein sample resulted in different protein patterns on 1-D and 2-D gels, reduced the complexity of gel patterns, and enhanced the protein identification of some proteins via MALDI-TOF-MS. Deglycosylation with trifluoromethanesulfonic acid (TFMS) was found to be more effective than enzymatic treatments. These deglycosylation techniques may be employed in whole proteome analysis to locate glycosylated proteins and assist in their identification by MS.

    Title New Disorders in Carbohydrate Metabolism: Congenital Disorders of Glycosylation and Their Impact on the Endocrine System.
    Date July 2003
    Journal Reviews in Endocrine & Metabolic Disorders
    Title Comparative Growth Analysis of the Facultative Anaerobes Bacillus Subtilis, Bacillus Licheniformis, and Escherichia Coli.
    Date March 2003
    Journal Systematic and Applied Microbiology
    Excerpt

    Bacillus subtilis anaerobic respiration and fermentative growth capabilities were compared to two other facultative anaerobes, Bacillus licheniformis and Escherichia coli. In glycerol defined medium, B. subtilis grew with nitrate, but not nitrite or fumarate, while B. licheniformis grew with nitrate or fumarate, but not nitrite. Growth of E. coli occurred in glycerol defined medium with either nitrate, nitrite, or fumarate. In order to grow by fermentation, B. subtilis required both glucose and pyruvate, while B. licheniformis and E. coli were capable of using either glucose or pyruvate.

    Title Serous Flexor Tenosynovitis As an Associated Finding in Meningococcal Septic Polyarthritis.
    Date September 2002
    Journal American Journal of Orthopedics (belle Mead, N.j.)
    Excerpt

    Flexor tenosynovitis complicating meningococcal septic polyarthritis may be sterile and could be misdiagnosed as disseminated gonococcal infection. Awareness of clinical findings associated with meningococcal polyarthritis is recommended to prevent onset of fulminant meningococcemia (Waterhouse-Friderichsen syndrome).

    Title Complete Reconstitution of Human Ikappab Kinase (ikk) Complex in Yeast. Assessment of Its Stoichiometry and the Role of Ikkgamma on the Complex Activity in the Absence of Stimulation.
    Date October 2001
    Journal The Journal of Biological Chemistry
    Excerpt

    The IkappaB kinase (IKK) complex, composed of two catalytic subunits (IKKalpha and IKKbeta) and a regulatory subunit (IKKgamma), is the key enzyme in activation of nuclear factor kappaB (NF-kappaB). To study the mechanism and structure of the complex, we wanted to recombinantly express IKK in a model organism that lacks IKK. For this purpose, we have recombinantly reconstituted all three subunits together in yeast and have found that it is biochemically similar to IKK isolated from human cells. We show that there is one regulatory subunit per kinase subunit. Thus, the core subunit composition of IKKalpha.beta.gamma complex is alpha(1)beta(1)gamma(2), and the core subunit composition of IKKbeta.gamma is beta(2)gamma(2). The activity of the IKK complex (alpha+beta+gamma or beta+gamma) expressed in yeast (which lack NF-kappaB and IKK) is 4-5-fold higher than an equivalent amount of IKK from nonstimulated HeLa cells. In the absence of IKKgamma, IKKbeta shows a level of activity similar to that of IKK from nonstimulated HeLa cells. Thus, IKKgamma activates IKK complex in the absence of upstream stimuli. Deleting the gamma binding domain of IKKbeta or IKKalpha prevented IKKgamma induced activation of IKK complex in yeast, but it did not prevent the incorporation of IKKgamma into IKK and large complex formation. The possibility of IKK complex being under negative control in mammalian cells is discussed.

    Title Alfalfa Rapidly Remediates Excess Inorganic Nitrogen at a Fertilizer Spill Site.
    Date April 2001
    Journal Journal of Environmental Quality
    Excerpt

    By 19%, standard remediation techniques had significantly reduced the concentration of nitrate nitrogen (NO3- -N) in local ground water at the site of a 1989 anhydrous ammonia spill, but NO3- -N concentrations in portions of the site still exceeded the public drinking water standard. Our objective was to determine whether local soil and ground water quality could be improved with alfalfa (Medicago sativa L.). A 3-yr study was conducted in replicated plots (24 by 30 m) located hydrologically upgradient of the ground water under the spill site. Three alfalfa entries ['Agate', Ineffective Agate (a non-N2-fixing elite germplasm similar to Agate), and MWNC-4 (an experimental germplasm)] were seeded in the spring of 1996. Corn (Zea mays L.) or wheat (Triticum aestivum L.) was seeded adjacent to the alfalfa each year. Crops were irrigated with N-containing ground water to meet water demand. During the 3-yr period, about 540 kg of inorganic N was removed from the aquifer through irrigation of 4.9 million L water. Cumulative N removal from the site over 3 yr was 972 kg N ha(-1) in Ineffective Agate alfalfa hay, compared with 287 kg N ha(-1) for the annual cereal grain. Soil solution NO3- concentrations were reduced to low and stable levels by alfalfa, but were more variable under the annual crops. Ground water quality improved, as evidenced by irrigation water N concentration. We do not know how much N was removed by the N2-fixing alfalfas, but it appears that either fixing or non-N2-fixing alfalfa will effectively remove inorganic N from N-affected sites.

    Title Osteochondromas of the Distal Aspect of the Tibia or Fibula. Natural History and Treatment.
    Date October 2000
    Journal The Journal of Bone and Joint Surgery. American Volume
    Excerpt

    BACKGROUND: There is little information on the natural history or treatment of osteochondromas arising from the distal aspect of either the tibia or the fibula. It is believed that there is a risk of deformation of the ankle if these exostoses are left untreated or if the physis or neurovascular structures are injured during operative intervention. METHODS: We reviewed the records of twenty-three patients who had been treated for osteochondroma of the distal aspect of the tibia or fibula between 1980 and 1996. Four of the patients had hereditary multiple cartilaginous exostoses. There were seventeen male and six female patients, and the average age at the time of presentation was sixteen years (range, eight to forty-eight years). RESULTS: Preoperative radiographs showed evidence of plastic deformation of the fibula in eleven patients who had a large osteochondroma. Four patients elected not to have an operation. The tumor was excised in nineteen patients. Postoperatively, all nineteen patients had a Musculoskeletal Tumor Society score of 100 percent for function of the lower extremity with pain-free symmetrical and unrestricted motion of the ankle at the latest follow-up examination. Partial remodeling of the tibia and fibula gradually diminished the asymmetry of the ankles in all nineteen operatively managed patients; however, the remodeling was most complete in the younger patients. Pronation deformities of the ankle did not change after excision of the tumor. Complications of operative treatment included four recurrences (only three of which were symptomatic), one sural neuroma, one superficial wound infection, and one instance of growth arrest of the distal aspects of the tibia and fibula. CONCLUSIONS: Osteochondromas of the distal and lateral aspects of the tibia were more often symptomatic than those of the distal aspect of the fibula; they most commonly occurred in the second decade of life with ankle pain, a palpable mass, and unrestricted ankle motion. Untreated or partially excised lesions in skeletally immature patients may become larger and cause plastic deformation of the tibia and fibula and a pronation deformity of the ankle. Ideally, operative intervention should be delayed until skeletal maturity, but, in symptomatic patients, partial excision preserving the physis may be necessary for the relief of symptoms and the prevention of progressive ankle deformity. However, partial excision is associated with a high rate of recurrence, so a close follow-up is required. Skeletally mature patients who are symptomatic may require excision of the tumor.

    Title Proteome Analysis of Biofilms: Growth of Bacillus Subtilis on Solid Medium As Model.
    Date December 1999
    Journal Methods in Enzymology
    Title A New Mechanism of Action of Fluoride on Streptococci.
    Date September 1999
    Journal Biochimica Et Biophysica Acta
    Excerpt

    Addition of fluoride to the growth medium of Streptococcus sobrinus resulted in a loss of glucan-binding lectin activity. Upon removal of fluoride, the bacteria regained their ability to bind glucan in about one generation. Chloramphenicol prevented recovery of ability to produce the lectin, showing the requirement for protein synthesis. Fluoride also caused a significant reduction in the tendency of the streptococci to form chains of cells, although the spent medium from fluoride-containing growth media did not dechain control cells. The fluoride thus does not activate autolytic enzymes. Importantly, 2-D electrophoresis and SDS-PAGE revealed several proteins were synthesized in the presence of fluoride that were not synthesized in its absence. It seems possible that fluoride places a stress on the bacteria, causing the synthesis of proteins that may play a role in protecting the cells against the stress. Numerous stress proteins are known for bacteria, including those resulting from heat, enzymes and osmotic shocks. The ability of fluoride to cause loss of glucan-binding may be related to its reported beneficial effects on oral health.

    Title Bradykinin Induces Tubulin Phosphorylation and Nuclear Translocation of Map Kinase in Mesangial Cells.
    Date February 1998
    Journal The American Journal of Physiology
    Excerpt

    Glomerular hypertension and glomerular hypertrophy act early and synergistically to promote glomerular injury in diabetes. We have previously shown that increased renal kinin production contributes to the glomerular hemodynamic abnormalities associated with diabetes. Glomerulosclerosis, characterized by mesangial cell proliferation and matrix expansion, is the final pathway leading to renal failure. The signal(s) initiating mesangial cell proliferation is ill defined. In the present study, we utilized immunofluorescence, immunoprecipitation, and immunoblotting techniques to identify substrates that are tyrosine phosphorylated in response to bradykinin action in mesangial cells. Immunofluorescence microscopy of mesangial cells stained with anti-phosphotyrosine (anti-PY) antibodies following bradykinin treatment (10(-9)-10(-6) M) revealed a dose-dependent increase in the labeling of cytoplasmic and nuclear proteins. Immunoprecipitation with anti-PY, followed by immunoblot revealed bradykinin-induced tyrosyl phosphorylation of tubulin and mitogen-activated protein kinase (MAPK). Confocal microscopy of mesangial cells stained for MAPK indicated that bradykinin stimulation resulted in translocation of MAPK from the cytoplasm to the nucleus by 2 h. These data demonstrate that bradykinin action results in the tyrosine phosphorylation of cellular proteins in mesangial cells and suggest a role for tubulin and MAPK in the signaling cascade of bradykinin leading to altered mesangial function.

    Title Solid Medium Labeling Applied to Two-dimensional Gel Electrophoresis.
    Date May 1997
    Journal Analytical Biochemistry
    Title Activation of C-jun N-terminal Kinase/stress-activated Protein Kinase in Primary Glial Cultures.
    Date May 1997
    Journal Journal of Neuroscience Research
    Excerpt

    Glial cells in the mammalian CNS are subject to environmental stress resulting from a variety of neuro-pathological conditions. In this study, we have examined the activation of a stress signal responsive kinase, i.e., stress-activated protein kinase (SAPK) or c-Jun N-terminal kinase (JNK), in primary cultures of rat brain glial cells (i.e., astrocytes and oligodendrocytes) and an oligodendrocyte progenitor cell line, CG4, in response to cytokines and other stress inducers. JNK/SAPK activity was measured by an immune complex kinase assay using polyclonal anti-JNK antibodies along with GST c-Jun (1-79) as the substrate. Among the cytokines tested, TNF-alpha had the strongest effect on JNK activation followed by TNF-beta in both the glial cell types while a substantial level of kinase activation was observed in response to IL-1 in astrocytes. JNK activation by TNF-alpha in astrocytes, but not in oligodendrocytes, showed a biphasic response. An in-gel kinase assay of cell extracts and immunoprecipitated JNK confirmed the activation of JNK1 in cells treated with TNF-alpha. JNK was also activated by several other stress-inducing factors including. UV light, heat shock, inhibitors of protein synthesis, and mechanical injury. Incubation of cells with bacterial sphingomyelinase and a cell-permeable ceramide stimulated JNK activity, suggesting that the ceramide pathway may play a role in JNK activation, although the time course of activation did not correspond to that of TNF-alpha. The results are discussed in terms of possible roles of JNK activation in signaling for gliosis in astrocytes and as a protective/toxic response in oligodendrocytes.

    Title Anxiety Disorders of Childhood, Implications for Adult Psychopathology.
    Date September 1996
    Journal The Psychiatric Clinics of North America
    Excerpt

    Although the exact path of acquisition remains incompletely understood, research supports the association between anxiety disorders in children and psychopathologic conditions in adults. This article addresses this relationship; reviews findings on the temperamental profile and behavioral inhibition, which may be an early identifiable childhood predictor of later anxiety disorders; and discusses the importance of early intervention.

    Title Activation of Cjun Nh2-terminal Kinase/stress-activated Protein Kinase by Insulin.
    Date August 1996
    Journal Biochemistry
    Excerpt

    One of insulin's many biological effects is the increased transcription of AP-1-regulated genes. cJun is the principal component of the AP-1 transcription complex, which is regulated by the newly discovered members of the MAPK superfamily referred to as cJun NH2-terminal kinases (JNKs) or stress-activated protein kinases (SAPKs). We show that insulin stimulates a dose- and time-dependent increase in JNK activity in Rat 1 fibroblasts overexpressing human insulin receptors (Rat 1 HIR cells). Using two different polyclonal anti-JNK antibodies, JNK activity was measured after immunoprecipitation from whole cell extracts by phosphorylation of GSTcJun(1-79). Peak activation occurred 15 min after insulin addition, resulting in a 2.5-fold increase in GSTcJun(1-79) phosphorylation over unstimulated controls. Maximal JNK activation correlated with the onset of AP-1 DNA binding activity. Both insulin-stimulated JNK activity and insulin-induced AP-1 transcriptional activity were found to be Ras-dependent. These data suggest that in Rat 1 cells, JNK activation may play a role in insulin-regulated AP-1 transcriptional activity leading to a mitogenic response.

    Title Insulin Like Growth Factor 1 Receptor Signal Transduction to the Nucleus.
    Date June 1994
    Journal Advances in Experimental Medicine and Biology
    Excerpt

    The mechanism by which IGF-1Rs regulate the growth and maintenance of cells in normal and disease states provides an important setting for studies addressing signal transduction events at the nuclear level. With the identification of c-Jun/AP-1 as a nuclear target of IGF-1 action we are provided with a model system for pursuing the molecular mechanisms triggered by IGF-1 action.

    Title Bacteriophage Phi 105clz Induces the Groel-homologue Protein in Bacillus Subtilis.
    Date September 1992
    Journal Antonie Van Leeuwenhoek
    Excerpt

    Using two-dimensional polyacrylamide gel electrophoresis, the GroEL homologue of Bacillus subtilis was shown to be induced upon infection with phi 105clz, a clear plaque mutant of the temperate bacteriophage phi 105. Western blotting of one dimensional polyacrylamide gels also showed the induction of the GroEL homologue when cells were infected with phi 105clz.

    Title [x-ray Diagnosis of Aseptic Necrosis of the Femur Head in Adults at the Preclinical Stage]
    Date March 1990
    Journal Vestnik Rentgenologii I Radiologii
    Excerpt

    The time course of an x-ray picture from the normal bone structure up to the appearance of positive x-ray signs of aseptic necrosis of the head of the femur (ANHF) was followed-up. The former, appearing long before the development of clinical signs of disease, were foci of the rarefaction of a round or oval shape in the upper, central parts of the head of the femur, and along its periphery in somewhat dense or normal structure of the head of the femur.

    Title [early Diagnosis of Aseptic Necrosis of the Femur Head in Adults]
    Date March 1990
    Journal Ortopediia Travmatologiia I Protezirovanie
    Excerpt

    Having analysed the case histories of 121 patients with unilateral aseptic necrosis of the femoral head the authors revealed early roentgenologic symptoms of aseptic necrosis in the other hip which was normal on admission in 19 patients with absence of the clinical signs of the disease. In other 13 patients at different terms after the exposure of the roentgenologic changes (up to 9 years) a clinical picture of aseptic necrosis of this previously normal joint developed. A picture that is characteristic both of the preclinical stage and of other stages of aseptic necrosis of the femoral head may be revealed in the roentgenograms during the initial examination of the patient, which is connected with some peculiarities of the course of the disease.

    Title Erectile Dysfunction Posttransplant.
    Date February 1990
    Journal Transplantation Proceedings
    Title Young Children's Ability to Infer Spatial Relationships: Evidence from a Large, Familiar Environment.
    Date December 1985
    Journal Child Development
    Excerpt

    Young (mean age = 3-9) and old (mean age = 5-0) nursery school children were tested on their ability to infer spatial relationships in a large, familiar environment. Each child in the younger group was matched to a child of the same sex in the older group who had been attending the nursery school for the same number of months. Subjects were taken to 3 different locations in their nursery school and were asked to point to 5 targets on the school grounds. Older children were more accurate than younger children on nursery school targets, but children's spatial representations were relatively nonintegrated at both age levels. Consistent sex differences in favor of males were discussed in the context of a new framework that could potentially explain the appearance of sex differences on spatial tasks conducted in large-scale environments. It was concluded that very young children have difficulty inferring spatial relationships, even in a large, familiar environment. This difficulty seems to be due to a relative lack of symbolic capacity.

    Title Comment on Ibuprofen's Effect on Digoxin Concentrations.
    Date April 1984
    Journal Drug Intelligence & Clinical Pharmacy
    Title Benzo(a)pyrene-induced Morphologic and Developmental Abnormalities in Rainbow Trout.
    Date April 1983
    Journal Archives of Environmental Contamination and Toxicology
    Title [modification of Kriuk's Operation in Treating Varus Deformity of the Femur Neck in Adults]
    Date October 1982
    Journal Ortopediia Travmatologiia I Protezirovanie
    Title Effects of Benzo(a)pyrene on Early Development of Flatfish.
    Date August 1982
    Journal Archives of Environmental Contamination and Toxicology
    Excerpt

    The ontogenetic effects of the environmental carcinogen benzo(a)pyrene (BAP) on three species of larval flatfish were investigated using concentrations (from 0.10 to 4.2 ppb) which were comparable to levels found in polluted harbors. BAP-treated sand sole (Psettichthys melanostichus) eggs displayed a significant decline in hatching success and a significantly higher incidence of developmental anomalies than did control eggs. Flathead sole (Hippoglossoides elassodon) eggs exposed to a single dose of a water-soluble BAP-bovine serum albumin complex demonstrated evidence of toxic injury with pycnotic nuclei present in the integument and, more commonly, in ocular and neural tissues. An increased incidence of morphological anomalies in English sole (Parophyrs vetulus) eggs and larvae exposed to BAP was not detected.

    Title [underwater Traction in the Treatment of Patients with Coxarthrosis]
    Date May 1982
    Journal Voprosy Kurortologii, Fizioterapii, I Lechebnoĭ Fizicheskoĭ Kultury
    Title Uptake of Benzo[a]pyrene by Gonadal Tissue of Flatfish (family Pleuronectidae) and Its Effects on Subsequent Egg Development.
    Date October 1981
    Journal Journal of Toxicology and Environmental Health
    Excerpt

    Accumulation of benzo[a]pyrene (BaP) by sexually mature flatfish gonad, its transfer to developing gametes, and its subsequent effects on developing embryos were studied. Thin-layer chromatography revealed both unmetabolized BaP and polar metabolites in the ovary, wolffian ducts, oocytes, and semen of English sole 24 h after ip injection with 200 microCi [3H]BaP. Concentrations of BaP and its metabolites were 3-11 times higher in oocytes and semen than in gonadal tissue. Fertilized eggs from flathead sole that had been fed 4.0 mg BaP 5 h before spawning demonstrated a significantly lower (p less than 0.001) hatching success (11.9%) than eggs from control fish (56.6%). Morphological abnormalities were found in only 1.6% of control embryos but in 5.6% of embryos from treated females.

    Title [functional State of the Hip Joint in Coxarthrosis After Underwater Traction]
    Date July 1981
    Journal Ortopediia Travmatologiia I Protezirovanie
    Title [method of Introduction of the Fixator in Osteotomy of the Femur]
    Date August 1979
    Journal Ortopediia Travmatologiia I Protezirovanie
    Title [biomechanical Disorders During Walking in Patients with Bilateral Coxarthrosis]
    Date December 1977
    Journal Ortopediia Travmatologiia I Protezirovanie
    Title Hepatomas in Marine Fish from an Urban Estuary.
    Date September 1977
    Journal Bulletin of Environmental Contamination and Toxicology
    Title Epidermal Papillomas in Pleuronectidae of Puget Sound, Washington. Review of the Current Status of the Problem.
    Date December 1976
    Journal Progress in Experimental Tumor Research. Fortschritte Der Experimentellen Tumorforschung. Progrès De La Recherche Expérimentale Des Tumeurs
    Title [case of Podagra Requiring Surgical Treatment]
    Date October 1975
    Journal Klinicheskaia Meditsina
    Title [pathologic Reconstruction of Autografts Following Radius Resection in Paget's Disease]
    Date January 1975
    Journal Ortopediia Travmatologiia I Protezirovanie
    Title [indications for Surgical Treatment of Bilateral Coxarthrosis]
    Date October 1974
    Journal Ortopediia Travmatologiia I Protezirovanie
    Title [arthrodesis of the Hip Joint in Congenital Dislocation of the Hip in Adults]
    Date January 1974
    Journal Ortopediia Travmatologiia I Protezirovanie
    Title [treatment of Pathologic Fractures of the Femur in Paget's Disease]
    Date January 1972
    Journal Khirurgiia
    Title [functionally Advantageous Position of the Hip in Unilateral Ankylosis of the Hip Joint]
    Date March 1970
    Journal Ortopediia Travmatologiia I Protezirovanie
    Title [arthrodesis of the Hip Joint in the Light of Remote Results]
    Date February 1969
    Journal Ortopediia Travmatologiia I Protezirovanie
    Title Pathology of Skin Tumors Found on English Sole and Starry Flounder from Puget Sound, Washington.
    Date September 1968
    Journal Journal of the National Cancer Institute
    Title Current Research in Prevention and Treatment of Cerebral Palsy and Related Cerebral Dysfunction.
    Date December 1966
    Journal Journal of Rehabilitation
    Title Growth and Endocrine Function in Patients with Hurler Syndrome After Hematopoietic Stem Cell Transplantation.
    Date
    Journal Bone Marrow Transplantation
    Excerpt

    Short stature is characteristic of Hurler syndrome, or mucopolysaccharidosis type IH (MPS IH). Hematopoietic stem cell transplantation (HSCT) is used to treat children with MPS IH. While HSCT corrects some of the metabolic features of MPS IH, its effects on growth are not well delineated. We investigated growth in patients with MPS IH after HSCT and described accompanying endocrine abnormalities. A cohort of 48 patients with MPS IH who had received HSCT between 1983 and 2005 were included. The prevalence of short stature (height <-2 s.d. score, SDS) before HSCT was 9%, and increased to 71% at last follow-up (6.9+/-5.1 years after HSCT). Short stature was positively associated with increased age at HSCT (P=0.002) and TBI (P=0.009). In total, 23% had growth hormone deficiency and/or low insulin-like growth factor-1, one female patient had premature adrenarche, one precocious puberty and 27% had clinical or subclinical hypothyroidism. Growth failure is highly prevalent in children with MPS IH after HSCT. Children who had no TBI exposure and were younger at the time of HSCT had a better height outcome.

    Title Antibacterial Properties of Synovial Fluid in the Knee.
    Date
    Journal The Journal of Knee Surgery
    Excerpt

    This study evaluated antimicrobial properties of synovial fluid against 3 gram-positive organisms: Staphylococcus aureus, Streptococcus pyogenes, and Staphylococcus epidermidis. Synovial fluid was collected from the knees of 52 patients. Three gram-positive bacteria culture lines were incubated in wells containing either synovial fluid and broth, or broth alone. Fluid was plated and incubated, and colonies were counted after 1, 4, and 24 hours to determine bacterial growth. Statistically significant differences in bacterial counts were found between control and experimental groups at 0, 4, and 24 hours for all 3 bacterial species. Bacterial counts in the control specimens demonstrated exponential growth over 24 hours as would be expected in the absence of growth inhibition. In contrast, bacterial counts in all of the synovial fluid specimens decreased steadily over 24 hours. These results demonstrate synovial fluid possesses potent bactericidal activity against the most common gram-positive pathogens responsible for septic arthritis. Delineating these antimicrobial properties further may offer avenues to augment the body's protection against bacterial infections.

    Title Application of Ultrasound for Bone Age Estimation in Clinical Practice.
    Date
    Journal The Journal of Pediatrics
    Excerpt

    OBJECTIVE: To assess the validity of bone age assessment by ultrasonography (US). STUDY DESIGN: Wrist US was performed on children (n = 100) undergoing radiographic bone age and compared with bone age estimation by a radiologist in the clinic and by endocrinologists under blinded conditions with Greulich and Pyle (GP) and Tanner and Whitehouse (TW3) methods. RESULTS: The strongest correlation (r(2)) was seen in the radiographic bone age assessment between the 2 endocrinologists using the GP method (96.7%). The poorest correlation was seen when comparing radiographic methods to US of either wrist (74.6% to 82.6%). When bone age correlations were divided into normal, delayed or advanced, the highest correlation between the radiographic and US methods was found in the normal bone age group (80.9% to 86.1%) with weaker correlations for the delayed bone age group (77.1% to 86.9%) and the advanced bone age group (62.2% to 81.1%). US tended to overread delayed bone age and underread advanced bone age. US had poor positive and negative predictive value for identification of a normal or delayed bone age. The negative predictive value of US was 91% for an advanced bone age. CONCLUSIONS: On the basis of our data, US assessment should not yet be considered a valid replacement for radiographic bone age determination.

    Title Surgical Approach and Perioperative Complications Determine Short-term Outcomes in Patients with Insulinoma: Results of a Bi-institutional Study.
    Date
    Journal Annals of Surgical Oncology
    Excerpt

    BACKGROUND: Despite advancements in radiologic imaging and minimally invasive surgery, the evaluation and management of insulinomas is institution and surgeon dependent. Therefore, the reported surgical outcomes are highly variable. We compared the surgical management and outcomes of insulinomas between two international tertiary-care surgical units to better identify the best management as determined by short-term outcomes. METHODS: We performed a retrospective review of patients who underwent surgery for insulinomas over a 117-month period at UT Southwestern Medical Center in Dallas (UTSW) and Queen Mary Hospital in Hong Kong (QMHK). Data collected included imaging studies, operative procedure, complications, and outcomes. RESULTS: Thirty-seven patients were identified. Preoperative localization by computed tomography (CT) scan was successful in 21 patients (63.9%). In Hong Kong, 16 patients underwent selective arterial cannulation and calcium stimulation (SACST) with a success rate of 87.5%. Surgical management consisted of enucleation in 24 patients and distal pancreatectomy in 13 patients. Thirty patients underwent a concurrent intraoperative ultrasound, with localization in 96.7%. Laparoscopic procedures were accomplished in 20 patients. Nine postoperative complications were identified, four occurring in the laparoscopic group. Patients undergoing laparoscopic procedures had a decreased length-of-stay (LOS) compared with patients undergoing an open procedure and patients who had uncomplicated surgery had a trend toward decreased LOS. CONCLUSION: Though the accuracy of CT scans for localizing insulinomas is only 64%, the addition of SACST or intraoperative ultrasound and pancreatic palpation increases accuracy to 97.1%. Compared with open procedures, laparoscopic resection is associated with comparable complication rates and shorter hospital length of stay.

    Title Synchronous Thymoma and Thymic Carcinoid in a Woman with Multiple Endocrine Neoplasia Type 1: Case Report and Review.
    Date
    Journal Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
    Excerpt

    OBJECTIVE: To report a rare case of multiple endocrine neoplasia type 1 (MEN 1) in conjunction with concomitant thymoma and thymic carcinoid. METHODS: We describe a never before reported case involving a 63-year-old female patient with MEN 1 who had synchronous thymoma and thymic carcinoid tumors. A review of the pertinent literature is also undertaken. RESULTS: Although prognosis is stage dependent for patients with thymoma, patients with thymic carcinoids and MEN 1 have been reported to have an extremely poor prognosis, with many patients dying of complications from thymic carcinoid rather than dying of other manifestations of MEN 1. Our patient underwent successful surgical treatment and remains under surveillance for all aspects of the MEN 1 syndrome. CONCLUSION: Thymic tumors are rare, and thymic carcinoids, while very rare in occurrence overall, have a definite association with MEN 1. Thus, it is important for practitioners to screen for thymic tumors routinely in patients with MEN 1 and to treat such tumors aggressively when found because they can be a major cause of mortality. Many thymic carcinoids are far advanced before diagnosis, and optimal screening for and treatment of thymic carcinoid are still being developed.

    Title The Role of Radiologic Studies in the Evaluation and Management of Primary Hyperaldosteronism.
    Date
    Journal Surgery
    Excerpt

    BACKGROUND: Surgical treatment of primary hyperaldosteronism (PHA) requires demonstration of unilateral adrenal hypersecretion. Optimal methods for interpretation of imaging and invasive testing are still in development. METHODS: A retrospective review from 1996-2007 of 106 patients with PHA was undertaken. Patient demographics, biochemical studies, radiologic imaging, operative reports, and pathology were reviewed and comparisons made. Optimal ratios for adrenal vein sampling were tested with regard to sensitivity and specificity. Preoperative and postoperative medication requirements and blood pressures were compared among different treatment groups. RESULTS: Seventy-eight patients (62 surgically treated) met criteria for inclusion. Median arterial blood pressure at diagnosis was 150/86 mm Hg while taking 3 antihypertensive medications. 69.2% required potassium supplementation. Median aldosterone:renin ratio was 107.0. Forty-two AVS procedures changed the management of 15 patients (35.7%) when compared to CT results. AVS accuracy was 96.6 vs 88.9% for NP-59 scintigraphy. Operative patients remained on fewer antihypertensive medications (1 vs 3), and mean systolic pressure was lower (130 vs 146 mm Hg) compared with medically managed patients. CONCLUSION: When used together, pre-ACTH aldosterone ratios, normalized A/C:A/C ratios, ratios to define contralateral suppression, and post-ACTH stimulated values allowed for capture of episodically secreting tumors and subtle unilateral or bilateral hyperaldosteronism.

    Title Growth Patterns and the Use of Growth Hormone in the Mucopolysaccharidoses.
    Date
    Journal Journal of Pediatric Rehabilitation Medicine
    Excerpt

    Short stature is characteristic of patients with mucopolysaccharidosis (MPS) diseases. For children with skeletal dysplasias, such as MPS, it is important to know the natural history of growth. An understanding of the natural growth pattern in each MPS disease provides a measurement to which treatments can be compared, as well as data which can help families and providers make individualized decisions about growth promoting treatments. Multiple advancements have been made in the treatment of MPS with both hematopoietic cell transplantation (HCT) and enzyme replacement therapy (ERT). The long term benefit of these treatments on growth is unknown. This article will review the published data on growth in children with MPS, and describe preliminary data on the use of human growth hormone (hGH) in children with MPS.

    Title Consensus and Discordance in the Management of Growth Hormone-treated Patients: Results of a Knowledge, Attitudes, Beliefs, and Practices Survey.
    Date
    Journal International Journal of Pediatric Endocrinology
    Excerpt

    Our purpose was to determine pediatric endocrinologists' knowledge, attitudes, beliefs, and practices (KABPs) regarding recombinant human growth hormone (rhGH) treatment, examine care-related attitude consensus or discordance, and identify evidence-based practice gaps. We developed a survey for National Cooperative Growth Study (NCGS) investigators (N = 711) to elicit their KABPs regarding GH stimulation testing as a diagnostic tool, IGF-1 monitoring for safety and dosing guidance, and pubertal dosing. Responses were compared with NCGS data from the last 20 years. Comparison between survey responses and NCGS data revealed potential discrepancies between expressed opinions and actual practice. In conclusion, this KABP survey, combined with NCGS data, suggests changes over time in diagnostic and rhGH-related therapeutic practices. Variability and inconsistency exist between the survey responses and practice trends over time as reflected in the NCGS database. Further study is necessary to provide evidence to guide rhGH treatment decisions.

    Title Preliminary Clinical Findings on Neumune As a Potential Treatment for Acute Radiation Syndrome.
    Date
    Journal Journal of Radiological Protection : Official Journal of the Society for Radiological Protection
    Excerpt

    5-androstenediol (5-AED) has been advanced as a possible countermeasure for treating the haematological component of acute radiation syndrome (ARS). It has been used in animal models to stimulate both innate and adaptive immunity and treat infection and radiation-induced immune suppression. We here report on the safety, tolerability and haematologic activity of 5-AED in four double-blinded, randomized, placebo-controlled studies on healthy adults including elderly subjects. A 5-AED injectable suspension formulation (NEUMUNE) or placebo was administered intramuscularly as either a single injection, or once daily for five consecutive days at doses of 50, 100, 200 or 400 mg. Subjects (n = 129) were randomized to receive NEUMUNE (n = 95) or the placebo (n = 34). NEUMUNE was generally well-tolerated; the most frequent adverse events were local injection site reactions (n = 104, 81%) that were transient, dose-volume dependent, mild to moderate in severity, and that resolved over the course of the study. Blood chemistries revealed a transient increase (up to 28%) in creatine phosphokinase and C-reactive protein levels consistent with intramuscular injection and injection site irritation. The blood concentration profile of 5-AED is consistent with a depot formulation that increases in disproportionate increments following each dose. NEUMUNE significantly increased circulating neutrophils (p < 0.001) and platelets (p < 0.001) in the peripheral blood of adult and elderly subjects. A dose-response relationship was identified. Findings suggest that parenteral administration of 5-AED in aqueous suspension may be a safe and effective means to stimulate innate immunity and alleviate neutropenia and thrombocytopenia associated with ARS.

    Title Intraoperative Parathyroid Hormone Monitoring in Patients with Recognized Multiglandular Primary Hyperparathyroidism.
    Date
    Journal World Journal of Surgery
    Excerpt

    Intraoperative parathyroid hormone (IOPTH) monitoring reliably predicts cure of primary hyperparathyroidism (PHPT) due to single-gland disease. However, its utility in PHPT caused by multiple-gland disease (MGD) is still debated, for both detection and prediction of adequate resection. Our hypothesis is that once MGD is encountered during an operation, more stringent criteria for determining adequate resection can improve cure rates.

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