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Objective: The objectives of this study were to investigate prevalence of urinary incontinence at 6 months postpartum and to study how continence status during pregnancy and mode of delivery influence urinary incontinence at 6 months postpartum in primiparous women., Design: Cohort study., Setting: Pregnant women attending routine ultrasound examination were recruited to the Norwegian Mother and Child Cohort Study (MoBa)., Population: A total of 12,679 primigravidas who were continent before pregnancy., Methods: Data are from MoBa, conducted by the Norwegian Institute of Public Health. Data are based on questionnaires answered at week 15 and 30 of pregnancy and 6 months postpartum., Main Outcome Measures: Urinary incontinence 6 months postpartum is presented as proportions, odds ratios and relative risks (RRs)., Results: Urinary incontinence was reported by 31% of the women 6 months after delivery. Compared with women who were continent during pregnancy, incontinence was more prevalent 6 months after delivery among women who experienced incontinence during pregnancy (adjusted RR 2.3, 95% CI 2.2-2.4). Adjusted RR for incontinence after spontaneous vaginal delivery compared with elective caesarean section was 3.2 (95% CI 2.2-4.7) among women who were continent and 2.9 (95% CI 2.3-3.4) among women who were incontinent in pregnancy., Conclusion: Urinary incontinence was prevalent 6 months postpartum. The association between incontinence postpartum and mode of delivery was not substantially influenced by incontinence status in pregnancy. Prediction of a group with high risk of incontinence according to mode of delivery cannot be based on continence status in pregnancy.

Learning Objectives: After studying this article, the participant should be able to: 1. Identify clinical situations in which hand sonography can result in the detection of partial extensor tendon tears. 2. Identify the limitations of magnetic resonance imaging in diagnosing extensor tendon tears. 3. Understand the various postoperative therapeutic protocols for extensor tendon repair. 4. Choose the appropriate surgical repair and postoperative therapeutic protocol for a specific extensor tendon injury. 5. Identify the social and economic variables that may influence the availability and efficacy of the various postoperative therapeutic protocols., Background: This article describes how the application of radiographic imaging facilitates the earlier detection and differentiation of extensor tendon injuries. Furthermore, it defines the best surgical procedure and postoperative therapy for a specific injury., Methods: A literature review was performed of extensor tendon injury articles published since 1989., Results: High-resolution sonography was more accurate than physical examination and magnetic resonance imaging in detecting extensor tendon injuries. Traditional postoperative static splinting was equivalent to early motion protocols for all uncomplicated thumb injuries and zone 1 to 3 injuries of the second through fifth digits. The only definable benefit of early motion therapy compared with static splinting was a quicker return to final function for proximal zones of injury in the second through fifth digits. The results of early active and passive motion, measured at 6 months, were comparable to those from static splinting. A higher rupture rate for early active motion and greater cost for early active and passive motion were noted compared with static splinting., Conclusions: High-resolution sonography allows identification of difficult to diagnose partial and complete extensor tendon injuries. Static splinting should remain the postoperative standard of care for extensor tendon injuries to the thumb and distal zones of injury for digits 2 through 5. The best therapy protocol for proximal zones of injury should be individualized based on social and economic variables.

Learning Objectives: After studying this article, the participant should be able to: 1. Identify clinical situations in which hand sonography can result in the detection of partial extensor tendon tears. 2. Identify the limitations of magnetic resonance imaging in diagnosing extensor tendon tears. 3. Understand the various postoperative therapeutic protocols for extensor tendon repair. 4. Choose the appropriate surgical repair and postoperative therapeutic protocol for a specific extensor tendon injury. 5. Identify the social and economic variables that may influence the availability and efficacy of the various postoperative therapeutic protocols., Background: This article describes how the application of radiographic imaging facilitates the earlier detection and differentiation of extensor tendon injuries. Furthermore, it defines the best surgical procedure and postoperative therapy for a specific injury., Methods: A literature review was performed of extensor tendon injury articles published since 1989., Results: High-resolution sonography was more accurate than physical examination and magnetic resonance imaging in detecting extensor tendon injuries. Traditional postoperative static splinting was equivalent to early motion protocols for all uncomplicated thumb injuries and zone 1 to 3 injuries of the second through fifth digits. The only definable benefit of early motion therapy compared with static splinting was a quicker return to final function for proximal zones of injury in the second through fifth digits. The results of early active and passive motion, measured at 6 months, were comparable to those from static splinting. A higher rupture rate for early active motion and greater cost for early active and passive motion were noted compared with static splinting., Conclusions: High-resolution sonography allows identification of difficult to diagnose partial and complete extensor tendon injuries. Static splinting should remain the postoperative standard of care for extensor tendon injuries to the thumb and distal zones of injury for digits 2 through 5. The best therapy protocol for proximal zones of injury should be individualized based on social and economic variables.

Purpose: Many older individuals have persistent quadriceps strength impairments after a total knee arthroplasty (TKA). A combination of muscle atrophy and neuromuscular activation deficits apparently contributes to residual strength impairments. The purpose of this short report is to describe the contribution of quadriceps muscle activation and muscle volume to impaired muscle strength in older individuals an average of 21 months following a TKA., Methods: Seventeen individuals (males: 3, females: 14; mean age: 68 yrs +/- 8.7; BMI: 33 +/- 4.8 kg/m2; number of TKA: 24; average postoperative months: 21 +/- 11.3) recruited from an orthopaedic surgeon's practice provided their written consent and participated in this study. Quadriceps strength (MVIC) and voluntary quadriceps muscle activation (QA) were measured with use of a burst-superimposition technique in which a supramaximal burst of electrical stimulation is superimposed on an MVIC. Quadriceps volume (QV) was assessed from magnetic resonance images of the quadriceps., Results: The mean quadriceps strength was 107.3 Nm +/- 36.4 (range: 43.22 - 205.2). The mean QA (as described with a central activation ratio) was 0.97 +/- 0.04 (range: 0.83 - 1.00). The mean QV was 1093 cm3 +/- 311.80 (range: 653.66 - 1706.56). QA and QV explain 85% of the variance in quadriceps strength (R2 = .85, p < 0.001), with QV having the greatest contribution to strength (R2 = .77, p < 0.001)., Conclusions: QV is a much stronger predictor of quadriceps strength than QA in individuals more than 1 year following TKA. Activation levels contributed little to strength one year following TKA, compared to its profound contribution in the first few postoperative months. Physical therapy interventions focused on improving muscle size in this population should be considered more relevant than countermeasures addressing neuromuscular activation.

Background and Purpose: Parkinson disease (PD) results in an increased frequency of falls relative to the frequency in neurologically healthy people. The purpose of this study was to compare the accuracy of PD fall risk diagnosis based on one test with that based on the collective interpretation of multiple tests., Participants: Seventy people with PD (mean age=73.91 years) participated in this study., Method: Clinical balance tests were conducted during the initial examinations of people with PD. Validity indices were calculated for individual tests and compared with validity indices calculated for a combination of multiple tests., Results: Thirty-six participants reported a fall history. Analysis of individual tests revealed broad variations in validity indices, whereas the collective interpretation of multiple tests improved sensitivity and negative likelihood ratios., Discussion and Conclusion: Collective interpretation of clinical balance tests resulted in fewer false-negative results and more substantial adjustments to the posttest probability of being a "faller" than the interpretation of one test alone. These results should be confirmed in a prospective examination of fall risk in PD.

Background: Newborn macrosomia is associated with both short- and long-term health risks for the infant, and increases the prevalence of birth complications. Parity, maternal age and gender of the child are known variables that influence fetal growth. The purpose of the present investigation was to evaluate prospectively the contributions of modifiable maternal predictors of fetal macrosomia (> or =4,200 g), which included lifestyle-related factors, such as nutritional intake, physical activity, and plasma glucose values, in addition to overweight and pregnancy weight gain., Methods: Some 553 women were followed through pregnancy. Predictive variables were subjected to univariate and multiple logistic regression analysis. Among these were: body mass index (BMI), weight gain, maternal subcutaneous fat (mm), fasting and 2-h plasma glucose, self-reported physical activity before and during pregnancy, and nutritional intake of macronutrients. Gestational age, parity and gender were also included in the model. All continuous variables were dichotomized using the upper quartile as the cut-off point in most cases., Results: If physical activity was left out of the analyses, BMI, weight gain, plasma glucose and gestational age were independent determinants of macrosomia. After including low level pre-gestational physical activity in the model, we found that this was now a significant determinant of delivering a macrosomic infant with an OR=2.9 (95% CI: 1.9, 7.3)., Conclusion: The present study indicates that a low level of pre-gestational physical activity adds to the modifiable determinants of newborn macrosomia.

Herds of pigs in the Mid-Eastern region of China have experienced recent outbreaks of a severe form of porcine reproductive and respiratory syndrome (PRRS) characterised by high fever and morbidity and mortality in animals of different ages. Eighty-one herds were diagnosed with PRRS virus (PRRSV) infection from June to December 2006 on the basis of clinical signs, pathological findings and reverse transcriptase polymerase chain reaction (RT-PCR). Twenty strains of PRRSV were isolated from 20 herds in six provinces. Following experimental inoculation, one isolate, designated SY0608, caused 100% morbidity and 25-50% mortality in 30-, 65- and 105-day-old pigs and the birth of stillborn and weak piglets from affected sows. The ORF5 gene had 99.5-99.8% nucleotide and 99-100% derived amino acid sequence identities among SY0608 and five other field isolates, but only 89.4% and 88.6% identities, respectively, with VR-2332, the prototypic North American isolate. The 2850bp Nsp2 gene of SY0608 had 79.4% nucleotide and 74.9% derived amino acid sequence identities with VR-2332; deletions of 1 and 29 amino acids corresponded to positions 480 and 531-559 of strain VR-2332, respectively. These findings demonstrated that a new highly pathogenic Northern American type PRRSV has spread widely in the Mid-Eastern region of China.

Background: Arterial grafts are superior to venous grafts when used for microvascular grafting procedures. Advantages of arterial grafts include anatomical taper, improved size match, improved handling characteristics, and superior patency rates. The deep inferior epigastric artery may be used as a source of microvascular graft to replace damaged or diseased arterial segments. By studying cadaver dissections, it is possible to estimate the clinically usable length and caliber of the deep inferior epigastric artery., Methods: Thirty-four preserved cadavers were dissected and 63 deep inferior epigastric arterial systems were removed and measured. The deep inferior epigastric artery was used as an arterial conduit to bypass across nine wrists in eight patients., Results: The mean length from the external iliac artery to the point at which the vessel displayed an external diameter of 1 mm was 14.06 +/- 2.54 cm. The deep inferior epigastric artery has been used in nine clinical cases as an arterial conduit to bypass distal to the wrist. All nine bypasses were patent 1 year postoperatively, without donor-site complication., Conclusion: The deep inferior epigastric artery is a morphologically reliable and clinically useful source of arterial grafts.

The methods for authoring and distributing course content are undergoing substantial changes due to advancement in computer technology. Paper has been the traditional method to author and distribute course content. Paper enables students to personalize content through highlighting and note taking but does not enable the incorporation of multimedia elements. Computers enable multimedia content but lack the capability of the user to personalize the content. Therefore, we investigated TK3 eBooks as a potential solution to incorporate the benefits of both paper and computer technology. The objective of our study was to assess the utility of TK3 eBooks in the context of authoring and distributing dermatology course content for use by second-year medical students at the University of Utah School of Medicine during the spring of 2004. We incorporated all dermatology course content into TK3 eBook format. TK3 eBooks enable students to personalize information through tools such as "notebook," "hiliter," "stickies," mark pages, and keyword search. Students were given the course content in both paper and eBook formats. At the conclusion of the dermatology course, students completed a questionnaire designed to evaluate the effectiveness of the eBooks compared with paper. Students perceived eBooks as an effective way to distribute course content and as a study tool. However, students preferred paper over eBooks to take notes during lecture. In conclusion, the present study demonstrated that eBooks provide a convenient method for authoring, distributing, and using course content but that students preferred paper to take notes during lecture.

The cadaver continues to be the primary tool to teach human gross anatomy. However, cadavers are not available to students outside of the teaching laboratory. A solution is to make course content available through computer-assisted instruction (CAI). While CAI is commonly used as an ancillary teaching tool for anatomy, use of screen space, annotations that obscure the image, and restricted interactivity have limited the utility of such teaching tools. To address these limitations, we designed a Web-based CAI tool that optimizes use of screen space, uses annotations that do not decrease the clarity of the images, and incorporates interactivity across different operating systems and browsers. To assess the design and utility of our CAI tool, we conducted a prospective evaluation of 43 graduate students enrolled in neuroanatomy taught by the Divisions of Physical and Occupational Therapy at the University of Utah, College of Health. A questionnaire addressed navigation, clarity of the images, benefit of the CAI tool, and rating of the CAI tool compared to traditional learning tools. Results showed that 88% of the respondents strongly agreed that the CAI tool was easy to navigate and overall beneficial. Eighty-four percent strongly agreed that the CAI tool was educational in structure identification and had clear images. Furthermore, 95% of the respondents thought that the CAI tool was much to somewhat better than traditional learning tools. We conclude that the design of a CAI tool, with minimal limitations, provides a useful ancillary tool for human neuroanatomy instruction., (Copyright 2005 Wiley-Liss, Inc.)

Although many proteasome inhibitors have been either synthesized or identified from natural sources, the development of more sophisticated, selective proteasome inhibitors is important for a detailed understanding of proteasome function. We have found that antitumor natural product epoxomicin and eponemycin, both of which are linear peptides containing a alpha,beta-epoxyketone pharmacophore, target proteasome for their antitumor activity. Structural studies of the proteasome-epoxomicin complex revealed that the unique specificity of the natural product toward proteasome is due to the alpha,beta-epoxyketone pharmacophore, which forms an unusual six-membered morpholino ring with the amino terminal catalytic Thr-1 of the 20S proteasome. Thus, we believe that a facile synthetic approach for alpha,beta-epoxyketone linear peptides provides a unique opportunity to develop proteasome inhibitors with novel activities. In this chapter, we discuss the detailed synthetic procedure of the alpha',beta'-epoxyketone natural product epoxomicin and its derivatives.

The study was carried out to examine whether acupuncture treatment can reduce chronic pain in the neck and shoulders and related headache, and also to examine whether possible effects are long-lasting. Therefore, 24 female office workers (47+/-9 years old, mean+/-SD) who had had neck and shoulder pain for 12+/-9 years were randomly assigned to a test group (TG) or a control group (CG). Acupuncture was applied 10 times during 3-4 weeks either at presumed anti-pain acupoints (TG) or at placebo-points (CG). A physician measured the pain threshold (PPT) in the neck and shoulder regions with algometry before the first treatment, and after the last one and six months after the treatments. Questionnaires on muscle pain and headache were answered at the same occasions and again 3 years after the last treatment. The intensity and frequency of pain fell more for TG than for CG (Pb < or = 0.04) during the treatment period. Three years after the treatments TG still reported less pain than before the treatments (Pw < 0.001) contrary to what CG did (Pb < 0.04) The degree of headache fell during the treatment period for both groups, but more for TG than for CG (Pb=0.02) Three years after the treatments the effect still lasted for TG (Pw < 0.01) while the degree of headache for CG was back to the pre-treatment level (Pb < 0.001) PPT of some muscles rose during the treatments for TG and remained higher 6 months after the treatments (Pw < 0.05) which contrasts the situation for CG. Adequate acupuncture treatment may reduce chronic pain in the neck and shoulders and related headache. The effect lasted for 3 years.

We present two patients with spinal epidural arteriovenous fistulas involving the vertebral body recruiting dural and osseous branches as feeders. The fistulas, forming a round venous sac into which the multiple arterial feeders converge, were located near the round bony defect of the vertebral body, suggesting the osseous component of this vascular lesion. Transvenous coil embolization of the round venous sac results in near-total obliteration of the lesion, leading to symptomatic improvement.

Objective: To assess the efficacy of physical therapies for first-line use in the treatment and prevention of stress urinary incontinence (SUI) in women, using a systematic review of randomized clinical trials (RCTs)., Materials and Methods: A computer-aided and manual search for published RCTs investigating treatment and prevention of SUI using physical therapies, e.g. pelvic floor muscle (PFM) exercises, with or without other treatment modalities, were carried out. The methodological quality of the included trials was assessed using criteria based on generally accepted principles of interventional research., Results: Twenty-four RCTs (22 treatment and two prevention) were identified; the methodological quality of the studies included was moderate and 11 RCTs were of sufficient quality to be included in further analysis. Based on levels-of-evidence criteria, there is strong evidence to suggest that PFM exercises are effective in reducing the symptoms of SUI. There is limited evidence for the efficacy of high-intensity vs a low-intensity regimen of PFM exercises. Despite significant effects of biofeedback after testing as an adjunct to PFM exercises, there is no evidence that PFM exercises with biofeedback are more effective than PFM exercises alone. There is little consistency (of stimulation types and parameters) in the studies of electrical stimulation, but when the results are combined there is strong evidence to suggest that electrostimulation is superior to sham electrostimulation, and limited evidence that there is no difference between electrostimulation and other physical therapies. In the prevention of SUI the efficacy of PFM exercises, with or without other adjuncts, is uncertain.