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Genomic approaches hold great promise for resolving unanswered questions about transmission patterns and responses to control efforts for schistosomiasis and other neglected tropical diseases. However, the cost of generating genomic data and the challenges associated with obtaining sufficient DNA from individual schistosome larvae (miracidia) from mammalian hosts have limited the application of genomic data for studying schistosomes and other complex macroparasites. Here, we demonstrate the feasibility of utilizing whole genome amplification and sequencing (WGS) to analyze individual archival miracidia. As an example, we sequenced whole genomes of 22 miracidia from 11 human hosts representing two villages in rural Sichuan, China, and used these data to evaluate patterns of relatedness and genetic diversity. We also down-sampled our dataset to test how lower coverage sequencing could increase the cost effectiveness of WGS while maintaining power to accurately infer relatedness. Collectively, our results illustrate that population-level WGS datasets are attainable for individual miracidia and represent a powerful tool for ultimately providing insight into overall genetic diversity, parasite relatedness, and transmission patterns for better design and evaluation of disease control efforts., Author summary Schistosomiasis is a neglected tropical disease caused by helminths within the genus Schistosoma, which affects over 200 million people globally. Here, we demonstrate the ability to obtain whole genome sequences from single S. japonicum miracidia that have been archived for years, and the promise of how these data may be used to answer major questions to understand and eventually help control schistosomiasis. To demonstrate the approach, we generated a moderate-sized dataset of 22 individual S. japonicum genomes and use these data to infer fine-scale patterns of relatedness among parasites from human hosts from two villages in Sichuan, China. We highlight how this type of genomic information may be useful for understanding the genetic variation among individual parasites with high precision, which could ultimately provide high resolution for understanding transmission pathways and inform control efforts with larger sample sizes. We also show that it is possible to use less data per individual than we obtained here, and still maintain high levels of accuracy; this would enable greater sample sizes by lowering individual sample cost. Collectively our results demonstrate that sampling genomes of individual schistosome parasites is now feasible on a population-level scale, opening new avenues for studying relatedness, tracing parasite spread, and studying parasite biology.

Patellofemoral pain (PFP) and abnormal patellofemoral congruence (PFC) are common athletic problems whose treatment remains controversial. This study examined the effects of a high volume of submaximal knee muscle exercise on objective measures of PFP and PFC under a test-retest design.A sample of 100 subjects was randomly divided into two groups: control and treatment. All subjects of both groups were tested for PFC, using a Merchant x-ray view, function, via Kujala patellofemoral score (KPS), and pain, through a visual analog scale (VAS), initially and then 4 wk later. The treatment group exercised during activities of daily living (ADL) by wearing a Protonics device; the control group did not receive treatment.One-way analysis of variance tests found no difference between pre- and posttest results for the control group but found significant changes in PFC, KPS, and VAS (all P0.001). PFC and joint function improved, and PFP decreased in all subjects of the treatment group.It was concluded that the treatment reduced PFP and PFC as compared with the control. A high volume of submaximal knee exercise seems useful for clinical patients with PFP and abnormal PFC.

The professional literature contains relatively few randomized-control studies that have assessed the efficacy of physical therapy approaches to the management of patients with chronic low back pain (CLBP). The purposes of this study were: 1) to investigate the effects of physical agents, joint manipulation, low-tech exercise, and high-tech exercise on objective measures of CLBP; 2) to track the length of CLBP relief; and 3) to determine treatment cost-effectiveness. Two-hundred-fifty subjects (68 females, 182 males; ages 34-51 years) with CLBP following an L5 laminectomy were randomly assigned into five separate groups for a treatment period of 8 weeks. Chronic low back pain status was measured by modified-modified Schober, Cybex Liftask, and Oswestry procedures. Results revealed that: 1) only low-tech and high-tech exercise produced significant improvements (p < .05) in CLBP, 2) the mean period of CLBP relief ranged from 1.6 weeks (control) to 91.4 weeks (low-tech exercise), and 3) low-tech exercise was most cost-effective. It was concluded that: 1) low-tech and high-tech exercise were the only effective treatments for CLBP, 2) low-tech exercise produced the longest period of CLBP relief, and 3) low-tech exercise was the most cost-effective form of treatment. Clinically, low-tech exercise may be the treatment method of choice for the effective management of chronic low back pain.

Passing galvanic current across the skin (known as "tap water iontophoresis" or TWI) inhibits sweating; however, its mechanism of action is unclear. Using improved methods, we confirmed that anodal current has more of an inhibitory effect than cathodal current, water is superior to saline, and the inhibitory effect is a function of the amperage used. To address the importance of current flowing through the pores, a layer of silicone grease was placed on the skin to reduce the shunt pathway across the epidermis. With silicone, total skin conductance decreased 60% without the sweat pores being occluded, swelling of the stratum corneum and collapse of the poral lumen was prevented, and current-induced inhibition of sweating was enhanced, most likely because of an increase in current density in the pores. The pH of anodal water, but not of saline, dropped to 3, whereas that of cathodal water increased to 10 during passage of current through the skin. Acidified anodal water was superior to alkaline water. Sweat glands isolated from TWI-induced anhidrotic palmar skin responded to methacholine in vitro, but the sweat rate and pharmacological sensitivity were slightly lowered. Thus the strong acidity generated by hydrolysis of water in the anodal bath and the further accumulation of H+ in the sweat duct by anodal current may be responsible for TWI-induced inhibition of sweating due to an unknown lesion(s) in the duct or sweat pore. The secretory coil function may also be altered because of exposure to intense acidity during TWI. The importance of H+ movement into the sweat pore for inhibition of sweating could be further exploited to develop new strategies for the control of sweating.

Study Design Cross-sectional, descriptive study. Objectives To examine the occurrence of sacroiliac joint dysfunction (SIJD) in a group of elite rowers. Background Sacroiliac joint dysfunction is a common problem for elite athletes, but is largely unstudied in the medical literature. Methods and Measures The United States Senior National Rowing Teams at the Pan American Games and the World Rowing Championships in 1995 were tested for SIJD through the standing flexion test followed by palpatory examination of anatomic landmarks. Results Sacroiliac joint dysfunction occurred in 54.1% of team members. Sacroiliac joint dysfunction was prevalent in both sweep rowers (66%) and scullers (34%). Prevalence of SIJD did not differ among the specific types of SIJD, the side of involvement, or for the handedness of sweep rowing. Conclusion Sacroiliac joint dysfunction is an important orthopaedic problem in rowers. This information may be useful for clinicians who treat rowers and elite athletes. J Orthop Sports Phys T...

Patient rehabilitation following anterior cruciate ligament reconstruction is a continuing challenge for physical therapists. This study compared the effectiveness of an established protocol to a new program which included Protonics exercise. Sixty patient (42 males and 18 females; mean age = 24.7 +/- 3.9 years; age range = 19-30 years) were randomly assigned into two groups: Group 1 received the established protocol and Group 2 received a Protonics exercise regimen. Both groups were measured for the time needed for return to unrestricted activity on the basis of objective, functional, and clinical exams; all tests were repeated at a 1-year follow-up exam. Group 2 completed treatment an average of 3.3 weeks sooner than Group 1 (mean = 19.8 vs. 23.1 weeks) at an average lower cost of $990.00 per subject. All subjects had good functional outcomes at the 1-year follow-up exam. It was concluded that the Protonics exercise program was more clinically and cost-effective than the other program, although both methods were successful for postsurgical anterior cruciate ligament rehabilitation.

As part of a broader community program to evaluate approaches to hypertension control, a Community Hypertension Clinic, staffed by two nurse practitioners, was set up in a rural community. Hypertensive persons were identified either by an initial central blood pressure screening or by a subsequent home screening. Slightly more than half of the hypertensive patients at initial screening, or 256 persons, elected to go to the Community Hypertension Clinic for second-stage screening, whereas the remainder elected to see their physicians or to do neither. After secondary screening at the Clinic, 120 patients eventually came under care and were managed by the nurse practitioners. After 2 years of follow-up, 57% of the Clinic patients had office-recorded diastolic blood pressures of less than 90 mm Hg. The Community Hypertension Clinic dropout rate was only 5% after 30 months of operation, for participants whose duration of follow-up ranged from 12 to 27 months (median 16 months), when a repeat home blood pressure screening examination was performed. Comparison of outcomes was thus possible between persons who attended the Community Hypertension Clinic and those who were referred to their physicians' offices. Persons with more severe hypertension most often elected to go to the Clinic, whereas patients with milder degrees of hypertension tended to go to their private physicians for follow-up or failed to make the recommended second-stage screening contact altogether. Greater declines in blood pressure were observed in the Clinic group.

This study was an investigation into the influences of rehabilitation procedures on the long-term success of postsurgical knee patients. In a blind retrospective par adigm, the cases of 5,381 patients (2,417 females, 2,964 males; mean age, 32.7 years; age range, 13 to 61 years) were reviewed to correlate rehabilitation methods with postsurgical success. Postsurgical suc cess was defined as patient resumption of required activities without symptom recurrence, over a period of 5 years after surgery. The four rehabilitation methods studied were programs of no exercise, home exercise, isotonic exercise, and isokinetic exercise. Statistical analysis revealed significant differences at the P = 0.05 level for comparison of the isokinetic exercise to the other methods on the basis of rehabilitation interval (isokinetic, 8.9 ± 3.7 weeks; isotonic, 12.3 ± 6.1 weeks; home, 10.0 ± 4.5 weeks) and correlation to success (isokinetic, r = 0.92, isotonic, r = 0.48, home, r = 0.09, no exercise, r = 0.00). It was concluded that rehabilitation methods that incorporate isokinetic exer cise are more efficient and effective than nonisokinetic programs in the long-term successful management of postsurgical knee patients.