Serum free thiols predict cardiovascular events and all-cause mortality in the general population:a prospective cohort study

BACKGROUND: Serum free thiols (R-SH, sulfhydryl groups) reliably reflect systemic oxidative stress. Since serum free thiols are rapidly oxidized by reactive species, systemic oxidative stress is generally associated with reduced serum free thiol levels. Free thiols associate with favorable disease outcomes in many patient cohorts, and the current hypothesis is that oxidative stress might also play an important role in cardiovascular disease. In this study, we aimed to establish the role of serum free thiols in the general population by investigating their relationship with the risk of cardiovascular (CV) events and all-cause mortality. METHODS: Participants (n = 5955) of the Prevention of REnal and Vascular ENd-stage Disease (PREVEND) cohort study from the general population were included. At baseline, serum levels of free thiols were quantified and adjusted to total protein levels. Protein-adjusted serum free thiol levels were studied for their associations with clinical and biochemical parameters, as well as with the risk of CV events and all-cause mortality. RESULTS: The mean protein-adjusted serum free thiol level was 5.05 ± 1.02 μmol/g of protein. Protein-adjusted serum free thiols significantly predicted the risk of CV events, even after adjustment for potential confounding factors (hazard ratio [HR] per doubling 0.68 [95% confidence interval [CI] 0.47-1.00], P = 0.048). Similarly, protein-adjusted serum free thiols were significantly predictive of the risk of all-cause mortality (HR per doubling 0.66 [95% CI 0.44-1.00], P = 0.050). Stratified analyses revealed lower HRs for subjects with a lower body mass index (BMI), without hypertension, and without diabetes. Conversely, HRs were lower in subjects with albuminuria. CONCLUSIONS: In this large population-based cohort study, serum free thiols significantly predicted the risk of CV events and all-cause mortality. Our results highlight the potential significance and clinical applicability of serum free thiols since they are amendable to therapeutic intervention

Thyroid function and risk of all-cause and cardiovascular mortality:a prospective population-based cohort study

PURPOSE Although thyroid hormones are irrefutably implicated in cardiovascular physiology, the impact of within-reference range variations of thyroid function on cardiovascular disease (CVD) remains unclear. Elucidating this is important, since it could foster preventive treatment and reduce global CVD burden. We therefore investigated the impact of within-reference range variations of thyroid function on all-cause and cardiovascular mortality. METHODS We included community-dwelling individuals aged 28-75 years from a prospective cohort study, without known use of thyroid-affecting therapy and with thyrotropin within reference range. Associations of thyroid function with mortality were quantified using Cox models and adjusted for sociodemographic and cardiovascular risk factors. RESULTS Mean (SD) age of the 6,054 participants (52.0% male) was 53.3 (12.0) years. During 47,594 person-years of follow-up, we observed 380 deaths from all causes and 103 from CVDs. Although higher thyrotropin was not associated with all-cause mortality (adjusted HR 1.02, 95% CI 0.92-1.14), point estimates for cardiovascular mortality diverged toward increased risk in younger (<72 years) participants (1.31, 1.00-1.72) and decreased risk in elderly (≥72 years) (0.77, 0.56-1.06). Higher free thyroxine (FT4) was associated with all-cause mortality (1.18, 1.07-1.30) and with cardiovascular mortality only in elderly (1.61, 1.19-2.18), but not in younger participants (1.03, 0.78-1.34). Higher free triiodothyronine (FT3) was associated with all-cause mortality in females only (1.18, 1.02-1.35). FT3 was not associated with cardiovascular mortality (0.91, 0.70-1.18). CONCLUSIONS Community-dwelling elderly individuals with high-normal thyroid function are at increased risk of all-cause and cardiovascular mortality, reinforcing the need of redefining the current reference ranges of thyroid function

Effectiveness of individualized physiotherapy on pain and functioning compared to a standard exercise protocol in patients presenting with clinical signs of subacromial impingement syndrome. A randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Shoulder impingement syndrome is a common musculoskeletal complaint leading to significant reduction of health and disability. Physiotherapy is often the first choice of treatment although its effectiveness is still under debate. Systematic reviews in this field highlight the need for more high quality trials to investigate the effectiveness of physiotherapy interventions in patients with subacromial impingement syndrome.</p> <p>Methods/Design</p> <p>This randomized controlled trial will investigate the effectiveness of individualized physiotherapy in patients presenting with clinical signs and symptoms of subacromial impingement, involving 90 participants aged 18-75. Participants are recruited from outpatient physiotherapy clinics, general practitioners, and orthopaedic surgeons in Germany. Eligible participants will be randomly allocated to either individualized physiotherapy or to a standard exercise protocol using central randomization.</p> <p>The control group will perform the standard exercise protocol aiming to restore muscular deficits in strength, mobility, and coordination of the rotator cuff and the shoulder girdle muscles to unload the subacromial space during active movements. Participants of the intervention group will perform the standard exercise protocol as a home program, and will additionally be treated with individualized physiotherapy based on clinical examination results, and guided by a decision tree. After the intervention phase both groups will continue their home program for another 7 weeks.</p> <p>Outcome will be measured at 5 weeks and at 3 and 12 months after inclusion using the shoulder pain and disability index and patients' global impression of change, the generic patient-specific scale, the average weekly pain score, and patient satisfaction with treatment. Additionally, the fear avoidance beliefs questionnaire, the pain catastrophizing scale, and patients' expectancies of treatment effect are assessed. Participants' adherence to the protocol, use of additional treatments for the shoulder, direct and indirect costs, and sick leave due to shoulder complaints will be recorded in a shoulder log-book.</p> <p>Discussion</p> <p>To our knowledge this is the first trial comparing individualized physiotherapy based on a defined decision making process to a standardized exercise protocol. Using high-quality methodologies, this trial will add evidence to the limited body of knowledge about the effect of physiotherapy in patients with SIS.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN86900354</p

Absorption and distribution of etoricoxib in plasma, CSF, and wound tissue in patients following hip surgery—a pilot study

The perioperative administration of selective cyclooxygenase-2 (COX-2)-inhibitors to avoid postoperative pain is an attractive option: they show favorable gastro-intestinal tolerability, lack inhibition of blood coagulation, and carry a low risk of asthmatic attacks. The purpose of this study was to determine the cerebrospinal fluid (CSF), plasma, and tissue pharmacokinetics of orally administered etoricoxib and to compare it with effect data, i.e., COX-2-inhibition in patients after hip surgery. The study was performed in a blinded, randomized, parallel group design. A total of 12 adult patients were included who received 120 mg etoricoxib (n = 8) or placebo (n = 4) on day 1 post-surgery. Samples from plasma, CSF, and tissue exudates were collected over a period of 24 h post-dosing and analyzed for etoricoxib and prostaglandin E2 (PGE2) using liquid chromatography-tandem mass spectrometry and immuno-assay techniques. CSF area under the curve (AUC) [AUCs(O–24h)] for etoricoxib amounted to about 5% of the total AUC in plasma (range: 2–7%). Individual CSF lag times with respect to (50%) peak plasma concentration were ≤2 h in all but one case (median: 1 h). PGE2 production in tissue was significantly blocked by the COX-2 inhibitor starting with the appearance of etoricoxib in tissue and lasting for the whole observation period of 24 h (P < 0.01). In conclusion, etoricoxib reaches the CSF and site of surgery at effective concentrations and reduces PGE2 production at the presumed site of action

A Probabilistic Model of Glenohumeral External Rotation Strength for Healthy Normals and Rotator Cuff Tear Cases

The reigning paradigm of musculoskeletal modeling is to construct deterministic models from parameters of an “average” subject and make predictions for muscle forces and joint torques with this model. This approach is limited because it does not perform well for outliers, and it does not model the effects of population parameter variability. The purpose of this study was to simulate variability in musculoskeletal parameters on glenohumeral external rotation strength in healthy normals, and in rotator cuff tear case using a Monte Carlo model. The goal was to determine if variability in musculoskeletal parameters could quantifiably explain variability in glenohumeral external rotation strength. Multivariate Gamma distributions for musculoskeletal architecture and moment arm were constructed from empirical data. Gamma distributions of measured joint strength were constructed. Parameters were sampled from the distributions and input to the model to predict muscle forces and joint torques. The model predicted measured joint torques for healthy normals, subjects with supraspinatus tears, and subjects with infraspinatus–supraspinatus tears with small error. Muscle forces for the three conditions were predicted and compared. Variability in measured torques can be explained by differences in parameter variability.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44005/1/10439_2005_Article_9045.pd

Athlete's Shoulder (2nd Edition).

Front Cover -- The Athlete's Shoulder -- Copyright Page -- Contributors -- Preface -- Acknowledgments -- Contents -- SECTION I: BASIC SCIENCE -- CHAPTER 1. Functional Anatomy of the Shoulder Complex -- COMPONENTS -- SUMMARY -- CHAPTER 2. Clinical Biomechanics of the Shoulder Complex -- RESTING POSITION -- PLANES OF MOTION -- OSTEOKINEMATICS AND ARTHROKINEMATICS -- STABILITY -- MUSCLE ACTIVITY -- SUMMARY -- SECTION II: EXAMINATION -- CHAPTER 3. Standardized Shoulder Examination-Clinical and Functional Approaches -- EXAMINATION SCHEMA -- MUSCLE ACTIONS -- FUNCTIONAL ASSESSMENT -- CONCLUSIONS -- STRENGTH ASSESSMENT -- FUNCTIONAL ASSESSMENT -- CHAPTER 4. Clinical Examination of the Shoulder Complex -- INITIAL EVALUATION -- IMPINGEMENT AND ROTATOR CUFF PATHOLOGY -- BICEPS AND SLAP CONDITIONS -- GLENOHUMERAL STABILITY ASSESSMENT -- NEUROLOGIC EXAMINATION -- VASCULAR EXAMINATION -- SUMMARY -- CHAPTER 5. Diagnostic Imaging of the Shoulder Complex -- IMAGING TECHNIQUES -- IMAGING OF SPECIFIC PATHOLOGIC CONDITIONS -- SECTION III: ARTHROSCOPY -- CHAPTER 6. Normal Arthroscopic Anatomy of the Shoulder -- STRUCTURAL ANATOMIC CONSIDERATIONS -- SUMMARY -- CHAPTER 7. Operative Arthroscopy of the Shoulder -- COMPRESSIVE CUFF DISEASE -- INTERNAL IMPINGEMENT -- TENSILE LESIONS -- ROTATOR CUFF TEARS -- GLENOHUMERAL LAXITY -- GLENOID LABRAL TEARS -- THROWER'S EXOSTOSIS -- ACROMIOCLAVICULAR JOINT INJURIES -- CONCLUSIONS AND SUMMARY -- CHAPTER 8. Arthroscopic Techniques of the Shoulder -- OPERATIVE TECHNIQUE -- EXTERNAL ANATOMY -- PORTALS AND ANATOMY -- SUMMARY -- SECTION IV: PATHOLOGY AND SURGERY -- CHAPTER 9. Tensile Failure of the Rotator Cuff -- FORCES AND MUSCLE ACTIVITY -- PATHOGENESIS OF TENSILE FAILURE -- DIAGNOSIS -- TREATMENT OPTIONS -- SUMMARY -- CHAPTER 10. Subacromial Impingement -- CAUSES AND PATHOLOGY -- ANATOMY.IMPINGEMENT IN THE ATHLETIC SHOULDER: PATHOPHYSIOLOGY AND CLINICAL CORRELATION -- EVALUATION -- TREATMENT -- SUMMARY -- CHAPTER 11. Internal Impingement -- PATHOLOGY -- EXAMINATION -- RADIOGRAPHIC DIAGNOSIS -- TREATMENT -- POSTOPERATIVE REHABILITATION -- SUMMARY -- CHAPTER 12. Partial Articular Supraspinatus Tendon Avulsion (PASTA) Lesions of the Rotator Cuff -- PATHOGENESIS -- CLINICAL DIAGNOSIS -- IMAGING STUDIES -- CLASSIFICATION -- TREATMENT -- CHAPTER 13. Calcific Tendinitis -- HISTORICAL PERSPECTIVE -- PATHOGENESIS -- EVALUATION -- TREATMENT -- SUMMARY -- CHAPTER 14. Open Repair of the Rotator Cuff -- OPERATIVE PROCEDURE -- REHABILITATION -- SUMMARY -- CHAPTER 15. Mini-Open Rotator Cuff Repair -- COMPARISON OF MINI-OPEN, ALL-ARTHROSCOPIC, AND OPEN ARTHROSCOPIC PROCEDURES -- MINI-OPEN SURGICAL TECHNIQUE -- POSTOPERATIVE REHABILITATION -- SUMMARY -- CHAPTER 16. Arthroscopic Rotator Cuff Repair -- CLASSIFICATION -- BIOMECHANICS -- SURGICAL INDICATIONS AND CONTRAINDICATIONS -- PREOPERATIVE CONSIDERATIONS -- SURGICAL TECHNIQUES -- POSTOPERATIVE REHABILITATION -- RESULTS AND OUTCOMES -- CHAPTER 17. Anterior Instability of the Shoulder -- ANATOMY OF THE STABLE AND UNSTABLE SHOULDER -- PATHOLOGIC LESIONS AND ANTERIOR INSTABILITY -- SURGICAL TECHNIQUES TO CORRECT ANTERIOR INSTABILITY -- REHABILITATION FOLLOWING ANTERIOR STABILIZATION -- CHAPTER 18. Posterior Shoulder Instability -- ANATOMY, BIOMECHANICS, AND PATHOMECHANICS OF POSTERIOR INSTABILITY -- ATHLETE AND PATIENT PRESENTATION -- PHYSICAL EXAMINATION -- IMAGING STUDIES -- TREATMENT OF POSTERIOR INSTABILITY -- POSTOPERATIVE REHABILITATION -- OUTCOMES -- SUMMARY -- CHAPTER 19. Multidirectional Instability of the Shoulder -- ANATOMY AND BIOMECHANICS -- CLINICAL PRESENTATION -- TREATMENT -- SUMMARY -- CHAPTER 20. Management of the First-Time Shoulder Dislocation in the Athlete -- CLASSIFICATION.PATHOANATOMY -- CAUSES AND EPIDEMIOLOGY -- DIAGNOSIS -- TREATMENT -- POSTOPERATIVE CARE -- TECHNICAL ERRORS -- OUTCOMES -- CHAPTER 21. Bankart Lesions: Diagnosis and Treatment with Arthroscopic and Open Approaches -- PATHOANATOMY -- LITERATURE REVIEW -- DIAGNOSIS AND ASSESSMENT OF BANKART LESIONS -- OPERATIVE INDICATIONS -- ARTHROSCOPIC TECHNIQUES -- OPEN TECHNIQUES -- REHABILITATION PRINCIPLES -- COMPLICATIONS -- CONCLUSION -- CHAPTER 22. Superior Labral Anterior-Posterior Lesions of the Shoulder -- BACKGROUND -- ANATOMY -- CLASSIFICATION -- DIAGNOSIS -- TREATMENT -- POSTOPERATIVE CARE -- SUMMARY -- CHAPTER 23. Soft Tissue Injuries of the Shoulder -- TENDINITIS, BURSITIS, AND THE INFLAMMATORY RESPONSE -- BICEPS TENDON -- PECTORALIS MAJOR RUPTURES -- SNAPPING SCAPULA SYNDROME -- QUADRILATERAL SPACE SYNDROME -- SUMMARY -- CHAPTER 24. Adhesive Capsulitis of the Shoulder -- CAUSATIVE FACTORS AND PATHOGENESIS -- DIAGNOSIS -- TREATMENT -- SUMMARY -- CHAPTER 25. Acromioclavicular Joint Injuries -- ANATOMY -- MECHANISMS OF INJURY -- CLASSIFICATION AND INCIDENCE -- DIAGNOSIS -- RADIOGRAPHIC EVALUATION -- TREATMENT -- REHABILITATION -- SUMMARY -- CHAPTER 26. Shoulder Arthroplasty in the Athletic Shoulder -- DEGENERATIVE GLENOHUMERAL OSTEOARTHRITIS -- CONCEPT OF OBLIGATE TRANSLATION -- INDICATIONS -- REHABILITATION -- OUTCOMES -- SUMMARY -- CHAPTER 27. Neurovascular Compression Syndromes of the Shoulder -- HISTORY -- NEUROVASCULAR COMPRESSION SYNDROMES -- SUMMARY -- CHAPTER 28. Brachial Plexus Injuries -- CLASSIFICATION OF NERVE INJURIES -- ANATOMY -- TYPES OF INJURIES -- SUMMARY -- CHAPTER 29. Suprascapular Nerve Entrapment -- ANATOMY -- PATHOPHYSIOLOGY -- CLINICAL EVALUATION -- TREATMENT -- SUMMARY -- CHAPTER 30. Cervicogenic Shoulder Pain -- FUNCTIONAL ANATOMY -- DIFFERENTIAL DIAGNOSIS -- SPECIFIC CERVICOGENIC INJURIES -- TREATMENT.REHABILITATION PROGRESSION -- SUMMARY -- SECTION V: SPORT SPECIFIC INJURIES -- CHAPTER 31. Biomechanics of the Shoulder During Sports -- BASEBALL PITCHING -- FOOTBALL THROWING -- WINDMILL THROWING -- JAVELIN THROWING -- CRICKET THROWING AND BOWLING -- HANDBALL -- TENNIS SERVE -- BASEBALL SWING -- GOLF SWING -- SWIMMING -- SUMMARY -- CHAPTER 32. Electromyographic Activity During Upper Extremity Sports -- OVERHEAD BASEBALL PITCH -- OVERHEAD FOOTBALL THROW: -- WINDMILL SOFTBALL PITCHING -- VOLLEYBALL SERVE AND SPIKE -- TENNIS SERVE AND VOLLEY -- BASEBALL BATTING -- GOLF SWING -- CHAPTER 33. Shoulder Injuries in Baseball -- SHOULDER JOINT INJURIES IN THE OVERHEAD ATHLETE -- ROTATOR CUFF INJURIES -- SHOULDER INSTABILITY -- GLENOID LABRUM TEARS -- THROWER'S EXOSTOSIS: BENNETT'S LESION -- BICEPS BRACHII TENDON PATHOLOGY -- OSTEOCHONDRITIS DISSECANS OF THE GLENOID -- ACROMIOCLAVICULAR JOINT DISORDERS -- NEUROVASCULAR SYNDROMES -- SUPRASCAPULAR NERVE ENTRAPMENT -- SCAPULA DISORDERS -- REHABILITATION -- SUMMARY -- CHAPTER 34. Shoulder Injuries in Football -- BRACHIAL PLEXUS INJURIES -- ACROMIOCLAVICULAR JOINT INJURIES -- GLENOHUMERAL JOINT INJURIES -- BICEPS TENDON DISORDERS -- ROTATOR CUFF INJURIES AND IMPINGEMENT -- FRACTURES -- SUMMARY -- CHAPTER 35. Shoulder Injuries in Tennis -- EPIDEMIOLOGY AND CAUSE -- ANALYSIS OF THE SHOULDER JOINT IN TENNIS-SPECIFIC MOVEMENTS -- ANATOMIC ADAPTATIONS OF THE DOMINANT SHOULDER -- TREATMENT -- SUMMARY -- CHAPTER 36. The Shoulder in Swimming -- EPIDEMIOLOGY OF SWIMMER'S SHOULDER -- DEFINITION -- CAUSES -- SIGNS AND SYMPTOMS -- EXAMINATION, EVALUATION, AND DIAGNOSIS -- ISOKINETIC SHOULDER STRENGTH IN SWIMMERS -- ANALYSIS OF NORMAL FRONT CRAWL STROKE BIOMECHANICS -- PATHOMECHANICS OF THE FRONT CRAWL -- MUSCLE ACTIVITY OF THE FRONT CRAWL -- REHABILITATION -- EXERCISE PROGRESSION CONTINUUM -- FUNCTIONAL SPECIFICITY TRAINING.PROGNOSIS -- SPECIFICITY -- RETURN TO SWIMMING WITH INTERVAL TRAINING PROGRAMS -- PREVENTION -- CHAPTER 37. Conditioning, Training, and Rehabilitation for the Golfer's Shoulder -- ELECTROMYOGRAPHIC AND KINEMATIC ANALYSIS OF THE GOLF SWING -- PATHOMECHANICAL ANALYSIS -- REHABILITATION, CONDITIONING, AND TRAINING -- SUMMARY AND APPLICATIONS -- MODIFICATIONS TO THE GOLF SWING -- SUMMARY -- CHAPTER 38. The Artistic Gymnast's Shoulder -- OVERVIEW -- CAUSES OF INJURY -- MECHANICS OF THE SHOULDER IN GYMNASTICS -- REHABILITATION TECHNIQUES FOR THE INJURED GYMNAST'S SHOULDER -- TEMPLATE FOR RETURN TO GYMNASTICS AFTER A SHOULDER INJURY -- SUMMARY -- CHAPTER 39. Pediatric Shoulder Injuries -- BIOMECHANICS -- THE THROWING ATHLETE -- LITTLE LEAGUER'S SHOULDER -- ROTATOR CUFF INJURY -- GLENOHUMERAL INSTABILITY -- FRACTURES -- SUMMARY -- CHAPTER 40. Female Shoulder Injuries -- EPIDEMIOLOGY -- MULTIDIRECTIONAL INSTABILITY -- FLEXIBILITY AND JOINT LAXITY -- TREATMENT -- SUMMARY -- SECTION VI: REHABILITATION PRINCIPLES -- CHAPTER 41. Nonoperative Treatment of Shoulder Impingement -- DEFINITION -- CAUSES OF IMPINGEMENT -- IMPORTANCE OF SUBACROMIAL SPACE VASCULARITY -- NONOPERATIVE MANAGEMENT -- SUMMARY -- CHAPTER 42. Nonoperative Rehabilitation for Traumatic and Congenital Glenohumeral Instability -- REHABILITATION FACTORS -- REHABILITATION GUIDELINES -- SUMMARY -- CHAPTER 43. Strength and Conditioning for the Preadolescent and Adolescent Athlete -- EFFICACY OF STRENGTH TRAINING IN ADOLESCENTS -- BENEFITS OF STRENGTH TRAINING -- GENERAL GUIDELINES -- AGE-SPECIFIC GUIDELINES -- SUMMARY -- CHAPTER 44. Injuries and Rehabilitation of the Overhead Female Athlete's Shoulder -- SHOULDER INJURIES IN THE FEMALE ATHLETE -- REHABILITATION OF THE FEMALE ATHLETE'S SHOULDER -- SUMMARY -- CHAPTER 45. Biomechanical Considerations in Shoulder Rehabilitation Exercises.BIOMECHANICAL IMPLICATIONS OF SHOULDER REHABILITATION.Description based on publisher supplied metadata and other sources.Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, 2017. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries