Kinetic Chain Rehabilitation in a Juvenile Idiopathic Arthritis Patient

CASE HISTORY: The patient’s chief complaint was decreasing ROM and pain noticed after conservative orthopedic treatment in the dominant (left) elbow. After extensive evaluation, the patient was diagnosed with juvenile idiopathic arthritis (JIA) at 9 years old. PHYSICAL EXAM: Upon physical therapist examination, it was determined that she had deficits throughout the entire left upper extremity and quadrant. Findings include signs and symptoms of Upper Cross Syndrome including pectoralis muscle group tightness, weakness of deep neck flexors with overuse of sternocleidomastoid and scalenes group, weakness of posterior shoulder and upper back including lower trap, middle trap, and all scapular stabilizing musculature including significant overuse of the upper trapezius and levator scapula complex. This presented as poor scapulothoracic rhythm and scapular dyskinesis with significant scapular winging, forward head and rounded shoulders causing inefficient mechanical function during functional movement patterns. Other specific objective findings included pectoralis minor length difference of right to left of one inch, MMT grade of teres minor and latissimus 3+/5, serratus anterior 3+/5, other rotator cuff reveals 4/5, with subscapularis 4/5. The initial AROM of the elbow revealed a 40° extension lag, excessive supination of 105° with limited pronation of 70°. DIFFERENTIAL DIAGNOSES: Medial epicondylitis, avulsion fracture, rheumatoid arthritis, ankylosing spondylitis. TESTS & RESULTS: X-rays and MRIs were obtained in order to make the JIA diagnosis. Imaging obtained by the patient’s rheumatologist nine months ago showed a slowing of the disease processes, confirmation of the cessation was confirmed on MRI obtained 3 months ago. After failing occupational therapy for ROM and joint sparing techniques, she was referred to physical therapy (PT) to address kinetic chain dysfunction to avoid other joint involvement. FINAL DIAGNOSIS: The final diagnosis was JIA with multiple joint involvement. For the purpose of this case study, Upper Cross Syndrome with associated scapular dyskinesis was addressed in rehabilitation. DISCUSSION: Treatment of JIA is often targeted at the involved joints. It is important for the medical professional to evaluate and address joints that are not currently involved in the disease process. In this case, the patient’s parents advocated for physical therapy. Many cases will go untreated which could affect the long-term functioning of the kinetic chain. Additionally, early intervention can improve functioning of other joints and increase strength of muscles that, when functioning at full capacity, could affect the involved joint. OUTCOME OF THE CASE: After 2 months of PT, objective findings revealed great improvements in pectoralis minor flexibility as demonstrated through measurement of just ½ inch which is symmetrical to the right side; increased postural awareness of downward scapular retraction; appropriate chin tuck posture due to increased deep neck flexor strength; decreased compensation of scalenes and upper trap and levator complex; improved rotator cuff strength and AROM pronation 82°. Most important, she is demonstrating improved awareness of correct downward retracted scapular position with little winging and good head alignment utilizing a chin tuck position. All AROM of the elbow remained the same. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: The patient is navigating all activities of daily living for her age group with a lack in ROM of her elbow. She competes on a shotgun team and plays sports at recess. She will continue with PT once per week for the next 3 months. After revaluation, she may be released with a maintenance program

Clinical utility of rosuvastatin and other statins for cardiovascular risk reduction among the elderly

Age is one of the strongest predictors of cardiovascular disease (CVD) risk. Treatment with statins can significantly reduce CVD events and mortality in both primary and secondary prevention. Yet despite the high CVD risk among the elderly, there is underutilization of statins in this population (ie, the treatment-risk paradox). Few studies have investigated the use of statins in the elderly, particularly for primary prevention and, as a result, guidelines for treating the elderly are limited. This is likely due to: uncertainties of risk assessment in older individuals where the predictive value of individual risk factors is decreased; the need to balance the benefits of primary prevention with the risks of polypharmacy, health care costs, and adverse medication effects in a population with decreased life expectancy; the complexity of treating patients with many other comorbidities; and increasingly difficult social and economic concerns. As life expectancy increases and the total elderly population grows, these issues become increasingly important. JUPITER (Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) is the largest primary prevention statin trial to date and enrolled a substantial number of elderly adults. Among the 5695 JUPITER participants ≥70 years of age, the absolute CVD risk reduction associated with rosuvastatin was actually greater than for younger participants. The implications of this JUPITER subanalysis and the broader role of statins among older adults is the subject of this review

James Webb Space Telescope Optical Simulation Testbed I: Overview and First Results

The James Webb Space Telescope (JWST) Optical Simulation Testbed (JOST) is a tabletop workbench to study aspects of wavefront sensing and control for a segmented space telescope, including both commissioning and maintenance activities. JOST is complementary to existing optomechanical testbeds for JWST (e.g. the Ball Aerospace Testbed Telescope, TBT) given its compact scale and flexibility, ease of use, and colocation at the JWST Science & Operations Center. We have developed an optical design that reproduces the physics of JWST's three-mirror anastigmat using three aspheric lenses; it provides similar image quality as JWST (80% Strehl ratio) over a field equivalent to a NIRCam module, but at HeNe wavelength. A segmented deformable mirror stands in for the segmented primary mirror and allows control of the 18 segments in piston, tip, and tilt, while the secondary can be controlled in tip, tilt and x, y, z position. This will be sufficient to model many commissioning activities, to investigate field dependence and multiple field point sensing & control, to evaluate alternate sensing algorithms, and develop contingency plans. Testbed data will also be usable for cross-checking of the WFS&C Software Subsystem, and for staff training and development during JWST's five- to ten-year mission.Comment: Proceedings of the SPIE, 9143-150. 13 pages, 8 figure

DHODH modulates transcriptional elongation in the neural crest and melanoma

Melanoma is a tumour of transformed melanocytes, which are originally derived from the embryonic neural crest. It is unknown to what extent the programs that regulate neural crest development interact with mutations in the BRAF oncogene, which is the most commonly mutated gene in human melanoma1. We have used zebrafish embryos to identify the initiating transcriptional events that occur on activation of human BRAF(V600E) (which encodes an amino acid substitution mutant of BRAF) in the neural crest lineage. Zebrafish embryos that are transgenic for mitfa:BRAF(V600E) and lack p53 (also known as tp53) have a gene signature that is enriched for markers of multipotent neural crest cells, and neural crest progenitors from these embryos fail to terminally differentiate. To determine whether these early transcriptional events are important for melanoma pathogenesis, we performed a chemical genetic screen to identify small-molecule suppressors of the neural crest lineage, which were then tested for their effects on melanoma. One class of compound, inhibitors of dihydroorotate dehydrogenase (DHODH), for example leflunomide, led to an almost complete abrogation of neural crest development in zebrafish and to a reduction in the self-renewal of mammalian neural crest stem cells. Leflunomide exerts these effects by inhibiting the transcriptional elongation of genes that are required for neural crest development and melanoma growth. When used alone or in combination with a specific inhibitor of the BRAF(V600E) oncogene, DHODH inhibition led to a marked decrease in melanoma growth both in vitro and in mouse xenograft studies. Taken together, these studies highlight developmental pathways in neural crest cells that have a direct bearing on melanoma formation

The Fifth Data Release of the Sloan Digital Sky Survey

This paper describes the Fifth Data Release (DR5) of the Sloan Digital Sky Survey (SDSS). DR5 includes all survey quality data taken through June 2005 and represents the completion of the SDSS-I project (whose successor, SDSS-II will continue through mid-2008). It includes five-band photometric data for 217 million objects selected over 8000 square degrees, and 1,048,960 spectra of galaxies, quasars, and stars selected from 5713 square degrees of that imaging data. These numbers represent a roughly 20% increment over those of the Fourth Data Release; all the data from previous data releases are included in the present release. In addition to "standard" SDSS observations, DR5 includes repeat scans of the southern equatorial stripe, imaging scans across M31 and the core of the Perseus cluster of galaxies, and the first spectroscopic data from SEGUE, a survey to explore the kinematics and chemical evolution of the Galaxy. The catalog database incorporates several new features, including photometric redshifts of galaxies, tables of matched objects in overlap regions of the imaging survey, and tools that allow precise computations of survey geometry for statistical investigations.Comment: ApJ Supp, in press, October 2007. This paper describes DR5. The SDSS Sixth Data Release (DR6) is now public, available from http://www.sdss.or

The Ninth Data Release of the Sloan Digital Sky Survey: First Spectroscopic Data from the SDSS-III Baryon Oscillation Spectroscopic Survey

The Sloan Digital Sky Survey III (SDSS-III) presents the first spectroscopic data from the Baryon Oscillation Spectroscopic Survey (BOSS). This ninth data release (DR9) of the SDSS project includes 535,995 new galaxy spectra (median z=0.52), 102,100 new quasar spectra (median z=2.32), and 90,897 new stellar spectra, along with the data presented in previous data releases. These spectra were obtained with the new BOSS spectrograph and were taken between 2009 December and 2011 July. In addition, the stellar parameters pipeline, which determines radial velocities, surface temperatures, surface gravities, and metallicities of stars, has been updated and refined with improvements in temperature estimates for stars with T_eff<5000 K and in metallicity estimates for stars with [Fe/H]>-0.5. DR9 includes new stellar parameters for all stars presented in DR8, including stars from SDSS-I and II, as well as those observed as part of the SDSS-III Sloan Extension for Galactic Understanding and Exploration-2 (SEGUE-2). The astrometry error introduced in the DR8 imaging catalogs has been corrected in the DR9 data products. The next data release for SDSS-III will be in Summer 2013, which will present the first data from the Apache Point Observatory Galactic Evolution Experiment (APOGEE) along with another year of data from BOSS, followed by the final SDSS-III data release in December 2014.Comment: 9 figures; 2 tables. Submitted to ApJS. DR9 is available at http://www.sdss3.org/dr

The Eighth Data Release of the Sloan Digital Sky Survey: First Data from SDSS-III

The Sloan Digital Sky Survey (SDSS) started a new phase in August 2008, with new instrumentation and new surveys focused on Galactic structure and chemical evolution, measurements of the baryon oscillation feature in the clustering of galaxies and the quasar Ly alpha forest, and a radial velocity search for planets around ~8000 stars. This paper describes the first data release of SDSS-III (and the eighth counting from the beginning of the SDSS). The release includes five-band imaging of roughly 5200 deg^2 in the Southern Galactic Cap, bringing the total footprint of the SDSS imaging to 14,555 deg^2, or over a third of the Celestial Sphere. All the imaging data have been reprocessed with an improved sky-subtraction algorithm and a final, self-consistent photometric recalibration and flat-field determination. This release also includes all data from the second phase of the Sloan Extension for Galactic Understanding and Evolution (SEGUE-2), consisting of spectroscopy of approximately 118,000 stars at both high and low Galactic latitudes. All the more than half a million stellar spectra obtained with the SDSS spectrograph have been reprocessed through an improved stellar parameters pipeline, which has better determination of metallicity for high metallicity stars.Comment: Astrophysical Journal Supplements, in press (minor updates from submitted version

The Baryon Oscillation Spectroscopic Survey of SDSS-III

The Baryon Oscillation Spectroscopic Survey (BOSS) is designed to measure the scale of baryon acoustic oscillations (BAO) in the clustering of matter over a larger volume than the combined efforts of all previous spectroscopic surveys of large scale structure. BOSS uses 1.5 million luminous galaxies as faint as i=19.9 over 10,000 square degrees to measure BAO to redshifts z<0.7. Observations of neutral hydrogen in the Lyman alpha forest in more than 150,000 quasar spectra (g<22) will constrain BAO over the redshift range 2.15<z<3.5. Early results from BOSS include the first detection of the large-scale three-dimensional clustering of the Lyman alpha forest and a strong detection from the Data Release 9 data set of the BAO in the clustering of massive galaxies at an effective redshift z = 0.57. We project that BOSS will yield measurements of the angular diameter distance D_A to an accuracy of 1.0% at redshifts z=0.3 and z=0.57 and measurements of H(z) to 1.8% and 1.7% at the same redshifts. Forecasts for Lyman alpha forest constraints predict a measurement of an overall dilation factor that scales the highly degenerate D_A(z) and H^{-1}(z) parameters to an accuracy of 1.9% at z~2.5 when the survey is complete. Here, we provide an overview of the selection of spectroscopic targets, planning of observations, and analysis of data and data quality of BOSS.Comment: 49 pages, 16 figures, accepted by A