Predictors and outcomes of crossover to surgery from physical therapy for meniscal tear and osteoarthritis a randomized trial comparing physical therapy and surgery

BACKGROUND: Arthroscopic partial meniscectomy (APM) combined with physical therapy (PT) have yielded pain relief similar to that provided by PT alone in randomized trials of subjects with a degenerative meniscal tear. However, many patients randomized to PT received APM before assessment of the primary outcome. We sought to identify factors associated with crossing over to APM and to compare pain relief between patients who had crossed over to APM and those who had been randomized to APM. METHODS: We used data from the MeTeOR (Meniscal Tear in Osteoarthritis Research) Trial of APM with PT versus PT alone in subjects ≥45 years old who had mild-to-moderate osteoarthritis and a degenerative meniscal tear. We assessed independent predictors of crossover to APM among those randomized to PT. We also compared pain relief at 6 months among those randomized to PT who crossed over to APM, those who did not cross over, and those originally randomized to APM. RESULTS: One hundred and sixty-four subjects were randomized to and received APM and 177 were randomized to PT, of whom 48 (27%) crossed over to receive APM in the first 140 days after randomization. In multivariate analyses, factors associated with a higher likelihood of crossing over to APM among those who had originally been randomized to PT included a baseline Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Score of ≥40 (risk ratio [RR] = 1.99; 95% confidence interval [CI] = 1.00, 3.93) and symptom duration of <1 year (RR = 1.74; 95% CI = 0.98, 3.08). Eighty-one percent of subjects who crossed over to APM and 82% of those randomized to APM had an improvement of ≥10 points in their pain score at 6 months, as did 73% of those who were randomized to and received only PT. CONCLUSIONS: Subjects who crossed over to APM had presented with a shorter symptom duration and greater baseline pain than those who did not cross over from PT. Subjects who crossed over had rates of surgical success similar to those of the patients who had been randomized to surgery. Our findings also suggest that an initial course of rigorous PT prior to APM may not compromise surgical outcome. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence

Role of toll-like receptor 2 (TLR2) in neutrophil activation: GM-CSF enhances TLR2 expression and TLR2-mediated interleukin 8 responses in neutrophils

In vitro studies as well as clinical trials indicate that the cytokines granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) enhance the ability of neutrophils (polymorphonuclear leukocytes) to eliminate microbial organisms. Toll-like receptor (TLR) proteins, homologs of the Drosophila protein Toll, have been found on the surface of mammalian cells and are important in the responses of macrophages to bacterial, viral, and fungal antigens. TLR4 is critical for the response to lipopolysaccharide (LPS) of gram-negative bacteria, while TLR2 is important for response to gram-positive bacteria, bacterial peptides, and yeast zymosan. We demonstrate that TLR2, but very little TLR4, is present on the surface of human neutrophils. In addition we demonstrate that GM-CSF and G-CSF dramatically up-regulate TLR2 and CD14 surface expression. GM-CSF treatment also up-regulates TLR2 and CD14 mRNA levels in neutrophils. In addition to increasing receptor expression, GM-CSF treatment enhanced the interleukin 8 (IL-8) secretion and superoxide priming responses of neutrophils to stimulation with TLR2 ligands, including zymosan, peptidoglycan, and lipoarabinomannan. The human monocyte response to crude bacterial LPS is composed of a TLR4-specific response to the pure LPS component and a TLR2-dependent response to associated lipopeptides. The removal of TLR2 lipopeptide components from LPS by phenol re-extraction substantially reduced both the IL-8 and superoxide response of the stimulated neutrophils, indicating that, unlike monocytes, the neutrophil response is preferentially directed to TLR2 ligands. Thus, our studies demonstrate that GM-CSF dramatically enhances the functional response of neutrophils to TLR2 ligands, including LPS-associated lipopeptides

Micro RNAs from DNA Viruses are Found Widely in Plasma in a Large Observational Human Population

Viral infections associate with disease risk and select families of viruses encode miRNAs that control an efficient viral cycle. The association of viral miRNA expression with disease in a large human population has not been previously explored. We sequenced plasma RNA from 40 participants of the Framingham Heart Study (FHS, Offspring Cohort, Visit 8) and identified 3 viral miRNAs from 3 different human Herpesviridae. These miRNAs were mostly related to viral latency and have not been previously detected in human plasma. Viral miRNA expression was then screened in the plasma of 2763 participants of the remaining cohort utilizing high-throughput RT-qPCR. All 3 viral miRNAs associated with combinations of inflammatory or prothrombotic circulating biomarkers (sTNFRII, IL-6, sICAM1, OPG, P-selectin) but did not associate with hypertension, coronary heart disease or cancer. Using a large observational population, we demonstrate that the presence of select viral miRNAs in the human circulation associate with inflammatory biomarkers and possibly immune response, but fail to associate with overt disease. This study greatly extends smaller singular observations of viral miRNAs in the human circulation and suggests that select viral miRNAs, such as those for latency, may not impact disease manifestation

Information Tradeoff Relations for Finite-Strength Quantum Measurements

In this paper we give a new way to quantify the folklore notion that quantum measurements bring a disturbance to the system being measured. We consider two observers who initially assign identical mixed-state density operators to a two-state quantum system. The question we address is to what extent one observer can, by measurement, increase the purity of his density operator without affecting the purity of the other observer's. If there were no restrictions on the first observer's measurements, then he could carry this out trivially by measuring the initial density operator's eigenbasis. If, however, the allowed measurements are those of finite strength---i.e., those measurements strictly within the interior of the convex set of all measurements---then the issue becomes significantly more complex. We find that for a large class of such measurements the first observer's purity increases the most precisely when there is some loss of purity for the second observer. More generally the tradeoff between the two purities, when it exists, forms a monotonic relation. This tradeoff has potential application to quantum state control and feedback.Comment: 15 pages, revtex3, 3 eps figure

Assessment of Strike of Adult Killer Whales by an OpenHydro Tidal Turbine Blade

Report to DOE on an analysis to determine the effects of a potential impact to an endangered whale from tidal turbines proposed for deployment in Puget Sound

Systematic Errors in the Hubble Constant Based on Measurement of the Sunyaev-Zeldovich Effect

Values of the Hubble constant reported to date which are based on measurement of the Sunyaev-Zeldovich (SZ) effect in clusters of galaxies are systematically lower than those derived by other methods (e.g., Cepheid variable stars, or the Tully-Fisher relation). We investigate the possibility that systematic errors may be introduced into the analysis by the generally adopted assumptions that observed clusters are in hydrostatic equilibrium, are spherically symmetric, and are isothermal. We construct self-consistent theoretical models of merging clusters of galaxies using hydrodynamical/N-body simulations. We then compute the magnitude of Ho derived from the SZ effect at different times and at different projection angles both from first principles, and by applying each of the standard assumptions used in the interpretation of observations. Our results indicate that the assumption of isothermality in the evolving clusters can result in Ho being underestimated by 10-30% depending on both epoch and projection angle. Moreover, use of the projected, emission-weighted temperature profile under the assumption of spherical symmetry does not significantly improve the situation except in the case of more extreme mergers (i.e., those involving relatively gas-rich subclusters).Comment: 31 pages, Latex, 2 tables, 10 postscript figures, Accepted for publication in ApJ, scheduled for June 20, 199

Tropospheric O 3 moderates responses of temperate hardwood forests to elevated CO 2 : a synthesis of molecular to ecosystem results from the Aspen FACE project

1.   The impacts of elevated atmospheric CO 2 and/or O 3 have been examined over 4 years using an open-air exposure system in an aggrading northern temperate forest containing two different functional groups (the indeterminate, pioneer, O 3 -sensitive species Trembling Aspen, Populus tremuloides and Paper Birch, Betula papyrifera , and the determinate, late successional, O 3 -tolerant species Sugar Maple, Acer saccharum ). 2.   The responses to these interacting greenhouse gases have been remarkably consistent in pure Aspen stands and in mixed Aspen/Birch and Aspen/Maple stands, from leaf to ecosystem level, for O 3 -tolerant as well as O 3 -sensitive genotypes and across various trophic levels. These two gases act in opposing ways, and even at low concentrations (1·5 × ambient, with ambient averaging 34–36 nL L −1 during the summer daylight hours), O 3 offsets or moderates the responses induced by elevated CO 2 . 3.   After 3 years of exposure to 560 µmol mol −1 CO 2 , the above-ground volume of Aspen stands was 40% above those grown at ambient CO 2 , and there was no indication of a diminishing growth trend. In contrast, O 3 at 1·5 × ambient completely offset the growth enhancement by CO 2 , both for O 3 -sensitive and O 3 -tolerant clones. Implications of this finding for carbon sequestration, plantations to reduce excess CO 2 , and global models of forest productivity and climate change are presented.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72125/1/j.1365-2435.2003.00733.x.pd

Geometric phases and Bloch sphere constructions for SU(N), with a complete description of SU(4)

A two-sphere ("Bloch" or "Poincare") is familiar for describing the dynamics of a spin-1/2 particle or light polarization. Analogous objects are derived for unitary groups larger than SU(2) through an iterative procedure that constructs evolution operators for higher-dimensional SU in terms of lower-dimensional ones. We focus, in particular, on the SU(4) of two qubits which describes all possible logic gates in quantum computation. For a general Hamiltonian of SU(4) with 15 parameters, and for Hamiltonians of its various sub-groups so that fewer parameters suffice, we derive Bloch-like rotation of unit vectors analogous to the one familiar for a single spin in a magnetic field. The unitary evolution of a quantal spin pair is thereby expressed as rotations of real vectors. Correspondingly, the manifolds involved are Bloch two-spheres along with higher dimensional manifolds such as a four-sphere for the SO(5) sub-group and an eight-dimensional Grassmannian manifold for the general SU(4). This latter may also be viewed as two, mutually orthogonal, real six-dimensional unit vectors moving on a five-sphere with an additional phase constraint.Comment: 9 page

A Search for Dark Higgs Bosons

Recent astrophysical and terrestrial experiments have motivated the proposal of a dark sector with GeV-scale gauge boson force carriers and new Higgs bosons. We present a search for a dark Higgs boson using 516 fb-1 of data collected with the BABAR detector. We do not observe a significant signal and we set 90% confidence level upper limits on the product of the Standard Model-dark sector mixing angle and the dark sector coupling constant.Comment: 7 pages, 5 postscript figures, published version with improved plots for b/w printin