Transcutaneous electrostimulation for osteoarthritis of the knee

BACKGROUND: Osteoarthritis is the most common form of joint disease and the leading cause of pain and physical disability in the elderly. Transcutaneous electrical nerve stimulation (TENS), interferential current stimulation and pulsed electrostimulation are used widely to control both acute and chronic pain arising from several conditions, but some policy makers regard efficacy evidence as insufficient. OBJECTIVES: To compare transcutaneous electrostimulation with sham or no specific intervention in terms of effects on pain and withdrawals due to adverse events in patients with knee osteoarthritis. SEARCH STRATEGY: We updated the search in CENTRAL, MEDLINE, EMBASE, CINAHL and PEDro up to 5 August 2008, checked conference proceedings and reference lists, and contacted authors. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials that compared transcutaneously applied electrostimulation with a sham intervention or no intervention in patients with osteoarthritis of the knee. DATA COLLECTION AND ANALYSIS: We extracted data using standardised forms and contacted investigators to obtain missing outcome information. Main outcomes were pain and withdrawals or dropouts due to adverse events. We calculated standardised mean differences (SMDs) for pain and relative risks for safety outcomes and used inverse-variance random-effects meta-analysis. The analysis of pain was based on predicted estimates from meta-regression using the standard error as explanatory variable. MAIN RESULTS: In this update we identified 14 additional trials resulting in the inclusion of 18 small trials in 813 patients. Eleven trials used TENS, four interferential current stimulation, one both TENS and interferential current stimulation, and two pulsed electrostimulation. The methodological quality and the quality of reporting was poor and a high degree of heterogeneity among the trials (I(2) = 80%) was revealed. The funnel plot for pain was asymmetrical (P < 0.001). The predicted SMD of pain intensity in trials as large as the largest trial was -0.07 (95% CI -0.46 to 0.32), corresponding to a difference in pain scores between electrostimulation and control of 0.2 cm on a 10 cm visual analogue scale. There was little evidence that SMDs differed on the type of electrostimulation (P = 0.94). The relative risk of being withdrawn or dropping out due to adverse events was 0.97 (95% CI 0.2 to 6.0). AUTHORS' CONCLUSIONS: In this update, we could not confirm that transcutaneous electrostimulation is effective for pain relief. The current systematic review is inconclusive, hampered by the inclusion of only small trials of questionable quality. Appropriately designed trials of adequate power are warranted.

Glutamate receptors expressed in {\it Xenopus\/} oocytes: Studies in function and regulation

The amino acid glutamate is the primary excitatory neurotransmitter for the CNS and is responsible for the majority of fast synaptic transmission. Glutamate receptors have been shown to be involved in multiple forms of synaptic plasticity such as LTP, LTD, and the formation of specific synaptic connections during development. In addition to contributing to the plasticity of the CNS, glutamate receptors also are involved in, at least in part, various pathological conditions such as epilepsy, ischemic damage due to stroke, and Huntington's chorea. The regulation of glutamate receptors, particularly the ionotropic NMDA and AMPA/KA receptors is therefore of great interest. In this body of work, glutamate receptor function and regulation by kinase activity was examined using the Xenopus oocyte which is a convenient and faithful expression system for exogenous proteins. Glutamate receptor responses were measured using the two-electrode voltage clamp technique in oocytes injected with rat total forebrain RNA. NMDA elicited currents that were glycine-dependent, subject to block by Mg$\sp{2+}$ in a voltage-dependent manner and sensitive to the specific NMDA antagonist APV in a manner consistent with those types of responses found in neural tissue. Similarly, KA-evoked currents were sensitive to the specific AMPA/KA antagonist CNQX and exhibited current voltage relationships consistent with the calcium permeable type II KA receptors found in the hippocampus. There is evidence to indicate that NMDA and AMPA/KA receptors are regulated by protein kinase A (PKA). We explored this by examining the effects of activators of PKA (forskolin, 1-isobutyl-3-methylxanthine (IBMX) and 8-Br-cAMP) on NMDA and KA currents in the oocyte. In buffer where Ca$\sp{2+}$ was replaced by 2 mM Ba$\sp{2+},$ forskolin plus IBMX and 8-Br-cAMP augmented currents due to NMDA application but not KA. This augmentation was abolished by pretreating the oocytes in the kinase inhibitor K252A. The use of chloride channel blockers resulted in attenuation of this effect indicating that Ba$\sp{2+}$ influx through the NMDA channel was activating the endogenous calcium-activated chloride current and that the cAMP mediated augmentation was at the level of the chloride channel and not the NMDA channel. This was confirmed by (1) the finding that 8-Br-cAMP increased chloride currents elicited via calcium channel activation while having no effect on the calcium channels themselves and (2) the fact that lowering the Ba$\sp{2+}$ concentration to 200 $\mu$M abolished the augmentation NMDA currents by 8-Br-cAMP. Thus PKA does not appear to modulate ionotropic glutamate receptors in our preparation. Another kinase also implicated in the regulation of NMDA receptors, calcium/phospholipid-dependent protein kinase (PKC), was examined for its effects on the NMDA receptor under low Ba$\sp{2+}$ (200 $\mu$M) conditions. Phorbol esters, activators of PKC, induced a robust potentiation of NMDA currents that was blockable by the kinase inhibitor K252A. Furthermore activation of metabotropic receptors by the selective agonist trans-ACPD, also potentiated NMDA albeit more modestly. These results indicate that neither NMDA nor KA-activated glutamate receptors are modulated by PKA in Xenopus oocytes whereas NMDA receptors appear to be augmented by PKC. Furthermore, the endogenous chloride current of the oocyte was found to be responsive to Ba$\sp{2+}$ and in addition is enhanced by PKA. Both of these latter findings are novel. In conclusion, the Xenopus oocyte is a useful expression system for the analysis of ligand-gated channel activity and the regulation of those channels by phosphorylation. ^

Tracing the origin of Arctic driftwood

Arctic environments, where surface temperatures increase and sea ice cover and permafrost depth decrease, are very sensitive to even slight climatic variations. Placing recent environmental change of the high-northern latitudes in a long-term context is, however, complicated by too short meteorological observations and too few proxy records. Driftwood may represent a unique cross-disciplinary archive at the interface of marine and terrestrial processes. Here, we introduce 1445 driftwood remains from coastal East Greenland and Svalbard. Macroscopy and microscopy were applied for wood anatomical classification; a multi-species subset was used for detecting fungi; and information on boreal vegetation patterns, circumpolar river systems, and ocean current dynamics was reviewed and evaluated. Four conifer (Pinus, Larix, Picea, and Abies) and three deciduous (Populus, Salix, and Betula) genera were differentiated. Species-specific identification also separated Pinus sylvestris and Pinus sibirica, which account for ~40% of all driftwood and predominantly originate from western and central Siberia. Larch and spruce from Siberia or North America represents ~26% and ~18% of all materials, respectively. Fungal colonization caused different levels of driftwood staining and/or decay. Our results demonstrate the importance of combining wood anatomical knowledge with insight on boreal forest composition for successfully tracing the origin of Arctic driftwood. To ultimately reconstruct spatiotemporal variations in ocean currents, and to better quantify postglacial uplift rates, we recommend consideration of dendrochronologically dated material from many more circumpolar sites.

Multiple Sclerosis: Current Knowledge and Future Outlook

Background: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by demyelination and axonal loss. The etiology of MS is unknown; however, environmental and genetic factors play a key role in the development of MS. Diagnostic criteria have been adapted to facilitate earlier diagnosis with increased sensitivity and specificity. Our understanding of the pathophysiology of MS has deepened considerably in recent years, resulting in different therapies to modify the disease course. Furthermore, several drugs have lately shown efficacy in phase III studies and their approval is expected in the near future. As treatment options expand, a future challenge will be to find the optimal treatment for the individual patient. Summary: This mini-review gives an overview of the current knowledge of MS with emphasis on the latest diagnostic criteria and both current and upcoming treatment options. Key Messages: Treatment of MS changes rapidly as the knowledge and therapeutic options in MS expand. Clinical Impact: Diagnosis of MS is based on McDonald criteria. MS therapy can be divided into relapse, disease-modifying and symptomatic treatment. Relapses are commonly treated with intravenous methylprednisolone. First-line therapy consists of either interferon-β, glatiramer acetate or teriflunomide. In general, agents used as escalation therapies (natalizumab, fingolimod and mitoxantrone) are more potent than the agents used for first-line therapy; however, these have potentially serious side effects and should be used with care.

Field-Applicable Recombinase Polymerase Amplification Assay for Rapid Detection of Mycoplasma capricolum subsp. capripneumoniae.

Contagious caprine pleuropneumonia (CCPP) is a highly contagious disease caused by Mycoplasma capricolum subsp. capripneumoniae that affects goats in Africa and Asia. Current available methods for the diagnosis of Mycoplasma infection, including cultivation, serological assays, and PCR, are time-consuming and require fully equipped stationary laboratories, which make them incompatible with testing in the resource-poor settings that are most relevant to this disease. We report a rapid, specific, and sensitive assay employing isothermal DNA amplification using recombinase polymerase amplification (RPA) for the detection of M. capricolum subsp. capripneumoniae. We developed the assay using a specific target sequence in M. capricolum subsp. capripneumoniae, as found in the genome sequence of the field strain ILRI181 and the type strain F38 and that was further evidenced in 10 field strains from different geographical regions. Detection limits corresponding to 5 × 10(3) and 5 × 10(4) cells/ml were obtained using genomic DNA and bacterial culture from M. capricolum subsp. capripneumoniae strain ILRI181, while no amplification was obtained from 71 related Mycoplasma isolates or from the Acholeplasma or the Pasteurella isolates, demonstrating a high degree of specificity. The assay produces a fluorescent signal within 15 to 20 min and worked well using pleural fluid obtained directly from CCPP-positive animals without prior DNA extraction. We demonstrate that the diagnosis of CCPP can be achieved, with a short sample preparation time and a simple read-out device that can be powered by a car battery, in <45 min in a simulated field setting.

How Plankton Swim: An Interdisciplinary Approach for Using Mathematics & Physics to Understand the Biology of the Natural World

The authors have developed and field-tested high school-level curricular materials that guide students to use biology, mathematics, and physics to understand plankton and how these tiny organisms move in a world where their intuition does not apply. The authors chose plankton as the focus of their materials primarily because the challenges faced by plankton are novel problems to most students, forcing adoption of new perspectives and making the study of plankton exciting. Additional reasons that they chose plankton to focus on include their ecological importance, their availability to most teachers and students, the ease with which they can be collected and observed, and the current focus of some scientific researchers on their movement and behavior. These curricular materials include a series of inquiry-based, hands-on exercises designed to be accessible to students with a range of backgrounds. Many of these materials could be adapted for use by middle-school, and/or college-level students. In this article, the authors describe sample lessons, summarize what worked well, and flag obstacles they encountered while integrating mathematics and physics into the biology classroom.

Should Texas use public funding for bariatric surgery?

Background. Obesity in America has increased exponentially since the 1970s with no sign of slowing down. It is a major public health problem, and is currently the second leading cause of preventable deaths in America (Flegal et al., 2010). Bariatric surgery is currently the only approved therapy that has shown to have a lasting impact on obese patients. While the initial cost of the surgery remains high, numerous cost-benefit analyses have demonstrated an overall cost saving within two to five years (McEwen et al., 2010). Only three states, including Texas, do not currently fund bariatric surgery through Medicare and Medicaid. ^ Objectives. To determine whether the current data on the cost-benefit analysis of bariatric surgery supports Texas' decision to not publicly fund bariatric surgery through its Medicare and Medicaid programs. ^ Methods. We conducted literature reviews to determine the current cost of obesity in Texas as well as the methods being employed to treat obesity currently. We then analyzed the history of bariatric surgery and its current implementation, looking at safety and the future benefits of bariatric surgery. We then looked at key cost-benefit analyses and meta-analyses to determine the cost effectiveness of bariatric surgery. We then analyzed both direct medical expenditures and indirect benefits of bariatric surgery. ^ Conclusions. If the obesity epidemic continues unabated, it will become one of the leading health expenditures in Texas within decades. Given that surgery is currently the only approved therapy for obesity that has been shown to be effective in the majority of patients, Texas' decision not to publicly fund bariatric surgery is short sighted.^

(Table T1) Radiolaria abundance of ODP Hole 175-1082A

A primary objective of Leg 175 was to investigate the upwelling history of the Benguela Current. Upwelling along the coast is found over the shelf in several well-established cells, as well as along the shelf-slope break, and extends over the 1000-m isobath. Streaming filaments along the coast also carry upwelled water off shore (Shannon, 1985). The upwelled nutrient-rich waters are sourced from the South Atlantic central water mass, which is a mixture of subtropical and subantarctic water masses. Below the central water mass lies Antarctic intermediate water (Shannon and Hunter, 1988, doi:10.2989/025776188784480735; Stramma and Peterson, 1989, doi:10.1175/1520-0485(1989)019<1440:GTITBC>2.0.CO;2). The upwelling system supports a robust marine community (Shannon and Pillar, 1986) where radiolarians are abundant (Bishop et al., 1978, doi:10.1016/0146-6291(78)90010-3). The endemic nature of radiolarians makes them useful in reconstructing the paleocirculation patterns. The biogeographic distribution of many species is limited by water-mass distribution. In a given geographic region, species may also have discrete depth habitats. However, their depth of occurrence can change worldwide because the depths of water masses vary with latitude (Boltovskoy, 1999). Consequently, species found at shallow depths at high latitudes (cold-water fauna) are observed deeper in the water column at lower latitudes. The low-latitude submergence of cold-water species broadens their distribution, resulting in species distributions that can cover multiple geographic regions (Kling, 1976, doi:10.1016/0011-7471(76)90880-9; Casey, doi:10.1016/0031-0182(89)90017-5; 1971; Boltovskoy, 1987, doi:10.1016/0377-8398(87)90014-4). Since radiolarian distribution is closely related to water-mass distribution and controlled by climatic conditions rather than geographic regions, similar assemblages characterize the equatorial, subtropical, transition, subpolar, and polar regions of ocean basins (Petrushevskaya, 1971a; Casey, 1989, doi:10.1016/0031-0182(89)90017-5; Boltovskoy, 1999). Numerous radiolarian species found in water masses in the Angola and Benguela Current systems have also been observed in plankton net samples, sediment traps, and surface-sediment studies in the Atlantic sector of the Southern Ocean, where they exhibited particular water-mass affinities (Abelmann, 1992a, doi:10.1007/BF00243107; Abelmann 1992b, doi:10.1007/BF00243108; Abelmann and Gowing, 1997, doi:10.1016/S0377-8398(96)00021-7). This report presents data on the radiolarian fauna recovered from Site 1082 sediments in the form of a survey of species reflecting the latitudinal migration of the Angola-Benguela Front and upwelling. The data constitute a time series of relative radiolarian abundances at very high resolution (every 20 cm) of the upper 12 m of Hole 1082A.

Age data of ODP Site 181-1124

ODP Site 1124, located 600 km east of the North Island of New Zealand, records post-middle Oligocene variations in the Pacific Deep Western Boundary Current (DWBC) and New Zealand's climatic and tectonic evolution. Sediment parameters, such as terrigenous grain size, flux, magnetic fabric, and non-depositional episodes, are used to interpret DWBC intensity and Antarctic climate. Interpretations of DWBC velocities indicate that the Antarctic Circumpolar Current reached modern intensities at ~23 Ma, as the tectonic seaways expanded, completing the thermal isolation of Antarctica. Periods of more intense bottom water formation are suggested by the presence of hiatuses formed under the DWBC at 22.5-17.6, 16.5-15, and 14-11 Ma. The oldest interval of high current intensity occurs within a climatically warm period during which the intensity of thermohaline circulation around Antarctica increased as a result of recent opening of circum-Antarctic gateways. The younger hiatuses represent glacial periods on Antarctica and major fluctuations in the East Antarctic Ice Sheet, whereas intervals around the hiatuses represent times of relative warmth, but with continued current activity. The period between 11 to 9 Ma is characterized by conditions surrounding a high velocity DWBC around the time of the formation and stabilization of the West Antarctic Ice Sheet. The increased terrigenous input may result from either changing Antarctic conditions or more direct sediment transport from New Zealand. The Pacific DWBC did not exert a major influence on sedimentation at Site 1124 from 9 Ma to the present; the late Miocene to Pleistocene sequence is more influenced by the climatic and tectonic history of New Zealand. Despite the apparent potential for increased sediment supply to this site from changes in sediment channeling, increasing rates of mountain uplift, and volcanic activity, terrigenous fluxes remain low and constant throughout this younger period.

Age determination of sediment core MD99-2201

A marine sediment core from the leeward margin of Great Bahama Bank (GBB) was subjected to a multiproxy study. The aragonite dominated core MD992201 comprises the past 7230 years in a decadal time resolution and shows sedimentation rates of up to 13.8 m/kyr. Aragonite mass accumulation rates, age differences between planktonic foraminifera and aragonite sediments, and temperature distribution are used to deduce changes in aragonite production rates and paleocurrent strengths. Aragonite precipitation rates on GBB are controlled by exchange of carbonate ions and CO2 loss due to temperature-salinity conditions and biological activity, and these are dependent on the current strength. Paleocurrent strengths on GBB show high current velocities during the periods 6000-5100 years BP, 3500-2700 years BP, and 1600-700 years BP; lower current speeds existed during the time intervals 5100-3500 years BP, 2700-1600 years BP, and 700-100 years BP. Bahamian surface currents are directly linked to the North Atlantic atmospheric circulation, and thus periods with high (low) current speeds are proposed to be phases of strong (weak) atmospheric circulation.

DISPRO datasets for validation of coastal hydrodynamic models

Appropriate field data are required to check the reliability of hydrodynamic models simulating the dispersion of soluble substances in the marine environment. This study deals with the collection of physical measurements and soluble tracer data intended specifically for this kind of validation. The intensity of currents as well as the complexity of topography and tides around the Cap de La Hague in the center of the English Channel makes it one of the most difficult areas to represent in terms of hydrodynamics and dispersion. Controlled releases of tritium - in the form of HTO - are carried out in this area by the AREVA-NC plant, providing an excellent soluble tracer. A total of 14 493 measurements were acquired to track dispersion in the hours and days following a release. These data, supplementing previously gathered data and physical measurements (bathymetry, water-surface levels, Eulerian and Lagrangian current studies) allow us to test dispersion models from the hour following release to periods of several years which are not accessible with dye experiments. The dispersion characteristics are described and methods are proposed for comparing models against measurements. An application is proposed for a 2 dimensions high-resolution numerical model. It shows how an extensive dataset can be used to build, calibrate and validate several aspects of the model in a highly dynamic and macrotidal area: tidal cycle timing, tidal amplitude, fixed-point current data, hodographs. This study presents results concerning the model's ability to reproduce residual Lagrangian currents, along with a comparison between simulation and high-frequency measurements of tracer dispersion. Physical and tracer data are available from the SISMER database of IFREMER (www.ifremer.fr/sismer/catal). This tool for validation of models in macro-tidal seas is intended to be an open and evolving resource, which could provide a benchmark for dispersion model validation.

(Table 1) Light minerals in sand at DSDP Leg 84 holes

The Middle America active continental margin is the best-sampled active plate margin to date, having been drilled during Legs 84, 67, and 66. With nine sites drilled on the continental slope of Guatemala and an additional site drilled on the Costa Rican slope, a summary of slope sediments and sedimentary processes can be made. Sediments are easily subdivided into a thick apron of Neogene and Quaternary volcanically derived hemipelagic and turbidite mud and mudstone and a thinner, more varied assemblage of mostly Paleogene mudstone, radiolarian mudstone, and limestone. This latter assemblage may contain hiatuses or be completely lacking between slope deposits and basement. Cores from the foot of the continental slope (Core 567A-19) consist of Campanian micrite. The pre-Neogene section is much thicker and of more terrigenous provenance beneath the forearc basin landward of the forearc structural high than on the continental slope. Sedimentary processes of the Neogene and Quaternary slope sediments include reworking of hemipelagic and turbidite deposits. Redeposition by slumping, plastic flow, and turbidity current-documentable through benthic foraminiferal analysis-occurs in intracanyon and canyon settings. Erosion by slumping and by turbidity current and deposition of mud or sand in canyons and in local depressions on the continental slope and different rates of sediment accumulation result in dramatic thickness variations of lithologic units over small distances in localized pockets of sand in small filled canyons on the slope or in sediment ponds, and in high-relief basement topography. The age of sediment overlying igneous basement ranges from Cretaceous to Quaternary. Gas hydrate was visible or inferred present at every site drilled during Leg 84. Nevertheless, except for a small amount in the last core, it was not recovered in sufficient quantities to be visible at Site 568, a site specifically chosen for the study of hydrate and located near Site 496, which was abandoned during Leg 67 because of the dangerous abundance of hydrates. The association of hydrate with porous, coarser sediment results in a distribution as localized and unpredictable as the slope sands off Guatemala, which do not occur in beds coherent enough to produce acoustic reflection. Although the normal lithologic section at Sites 567 and 496 limits the volume of sediment that could be part of an accretionary prism offshore Guatemala and the volume of sediment in the Trench axis is not sufficient to argue for significant accumulation of Cocos Plate sediments, the varied lithology and attenuated thickness of pre-Neogene sediment seaward of the forearc structural high do not exclude earlier accretion from the history of the Guatemalan continental margin.