Oligomenorrhea in active adolescent females of normal weight is presumed to be related to hypoestrogenism secondary to physical activity and decreased fat mass. We hypothesized that active adolescents with oligomenorrhea would have lower estrogen levels than normal controls with similar levels of cardiovascular fitness.

DESIGN/PARTICIPANTS:
Twenty healthy participants between the ages of 16 and 20 years were recruited at least 2 years postmenarche. Adolescents reporting fewer than 9 cycles a year (n = 6) were compared to 14 controls with monthly menstrual cycles. Histories of eating disorder, hirsutism, severe acne, depression, or amenorrhea were cause for exclusion.

MAIN OUTCOME MEASURES:
Body composition and bone density were measured by total body dual x-ray absorpitometry. Cardiovascular fitness was evaluated by measuring oxygen consumption during exercise. Control subjects were matched by age, body mass index (BMI), and fitness level. Serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, progesterone, and estradiol were obtained. Statistical analysis was performed using SAS 9.1.

RESULTS:
Cardiovascular fitness in both groups was within normal limits for age. No significant differences in BMI, estradiol concentrations, or bone density were found, but trunk fat mass was lower in adolescents with oligomenorrhea who also reported more frequent exercise. Testosterone concentrations and LH/FSH ratios were significantly higher in participants with irregular menstrual cycles (P = 0.0018 and



"Elevated Testosterone and Hypergonadotropism in Active Adolescents of Normal Weight with Oligomenorrhea"
J Pediatr Adolesc Gynecol. 2009 Oct; 22(5): 323-7Singer K, Rosenthal A, Kasa-Vubu JZ

Although numerous animal models for low back pain associated with intervertebral disk (IVD) degeneration have been proposed, insufficient data have been provided to make any conclusions regarding pain. Our aim in this study was to determine the reliability of complete Freund's adjuvant (CFA) injection into the rat spine as an animal model representing human discogenic pain.

METHODS:
We studied IVD degenerative changes with pain development after a 10-microL CFA injection into the L5-6 IVD of adult rats using behavioral, histologic, and biochemical studies. Serial histologic changes were analyzed to detect degenerative changes. Expression of calcitonin gene-related peptide (CGRP), prostaglandin E (PGE), and inducible nitric oxide synthase (iNOS) were determined using immunohistochemistry or real-time polymerase chain reaction as support data for pain development. In addition, CGRP immunoreactivity (ir) at the IVD was considered indirect evidence of neural ingrowth into the IVD.

RESULTS:
There was a significant increase of the hindpaw withdrawal response in the CFA group until 7 wk postoperatively (P < 0.05). Histologic analyses revealed progressive degenerative changes of the disks without any damage in adjacent structures, including nerve roots. In the CGRP-ir staining study, the bilateral dorsal horns and IVD had positive ir after intradiscal CFA injection. CGRP mRNA expression was increased in the dorsal root ganglion (DRG) at 2 and 4 wk, whereas PGE and iNOS mRNAs were markedly increased at 2 wk. The increment of CGRP expression was higher in allodynic rats compared with nonallodynic rats.

CONCLUSION:
Intradiscal CFA injection led to chronic disk degeneration with allodynia, which was suggested by pain behavior and expression of pain-related mediators. The increment of CGRP, PGE, and iNOS also suggest pain-related signal processing between the IVD and the neural pathway in this animal model. This animal model may be useful for future research related to the pathophysiology and development of novel treatment for spine-related pain.




"Complete Freund's adjuvant-induced intervertebral discitis as an animal model for discogenic low back pain"
Anesth Analg. 2009 Oct; 109(4): 1287-96
Lee M, Kim BJ, Lim EJ, Back SK, Lee JH, Yu SW, Hong SH, Kim JH, Lee SH, Jung WW, Sul D, Na HS

The purpose of this study was to investigate whether the effect of treatment with hyaluronic acid (HA) on cartilage in osteoarthritis (OA) can be determined by measuring the magnetic resonance (MR) T2 value of cartilage in an anterior cruciate ligament transection (ACLX) animal model.

METHOD:
Eighteen male Sprague Dawley rats were separated randomly into three groups (n=6 for each group). Group 1 was given anterior cruciate ligament transectionand intra-articular (IA) normal saline (NS) injection (ACLX+NS), group 2 was given ACLX and IA HA injection (ACLX+HA), and group 3 was the sham control. The ACLX+NS and ACLX+HA groups received ACLX on the right knee at 8 weeks of age and were then treated with IA NS or HA injection once a week, respectively, for 4 weeks starting at 13 weeks of age. In the sham-control group, the right knee joint was opened surgically but anterior cruciate ligament transectionwas not performed at 8 weeks of age. MR T2 measurements were obtained on all rats at 8, 12, and 21 weeks of age, and histological Mankin scoring was performed at 21 weeks of age.

RESULTS:
Five weeks after the 4-week treatment, the MR T2 value of the ACLX right knee cartilage was significantly lower in ACLX+HA (29.58+/-1.12ms) than in ACLX+NS (32.04+/-1.39ms) (P<0.05). Five weeks after the 4-week treatment, the Mankin score of the ACLX right knee was significantly lower in ACLX+HA (3.3+/-0.81) than in ACLX+NS (7.3+/-1.03) (P<0.001). The T2 value was significantly and positively correlated with the Mankin score in the ACLX+NS (rho=0.77, P<0.05) and ACLX+HA (rho=0.69, P<0.05) groups.

CONCLUSION:
This study demonstrates the feasibility of quantitative MR T2 measurement in the early assessment of HA treatment efficiency in a cartilage degeneration model.


"Quantitative MR T2 measurement of articular cartilage to assess the treatment effect of intra-articular hyaluronic acid injection on experimental osteoarthritis induced by ACLX"
Osteoarthritis Cartilage. 2009 Sep 6;
Huang GS, Lee HS, Chou MC, Shih YY, Tsai PH, Lin MH, Lin CY, Lee CH, Chung HW

The aim of the present study was to scrutinize the evidence on the use of acupoint stimulation for managing therapy-related adverse events in breast cancer. A comprehensive search was conducted on eight English and Chinese databases to identify clinical trials designed to examine the efficacy of acupressure, acupuncture, or acupoint stimulation (APS) for the management of adverse events due to treatments of breast cancer. Methodological quality of the trials was assessed using a modified Jadad scale.

Using pre-determined keywords, 843 possibly relevant titles were identified. Eventually 26 papers, 18 in English and eight in Chinese, satisfied the inclusion criteria and entered the quality assessment stage. The 26 articles were published between 1999 and 2008.

They assessed the application of acupoint stimulation on six disparate conditions related to anticancer therapies including vasomotor syndrome, chemotherapy-induced nausea and vomiting, lymphedema, post-operation pain, aromatase inhibitors-related joint pain and leukopenia. Modalities of acupoint stimulation used included traditional acupuncture, acupressure, electroacupuncture, and the use of magnetic device on acupuncture points.

Overall, 23 trials (88%) reported positive outcomes on at least one of the conditions examined. However, only nine trials (35%) were of high quality; they had a modified Jadad score of 3 or above. Three high quality trials revealed that acupoint stimulation on P6 (NeiGuang) was beneficial to chemotherapy-induced nausea and vomiting. For other adverse events, the quality of many of the trials identified was poor; no conclusive remarks can be made.

Very few minor adverse events were observed, and only in five trials. APS, in particular acupressure on the P6 acupoint, appears beneficial in the management of chemotherapy-induced nausea and vomiting, especially in the acute phase. More well-designed trials using rigorous methodology are required to evaluate the effectiveness of acupoint stimulation interventions on managing other distress symptoms.




"The efficacy of acupoint stimulation for the management of therapy-related adverse events in patients with breast cancer: a systematic review"
Breast Cancer Res Treat. 2009 Sep 17;
Chao LF, Zhang AL, Liu HE, Cheng MH, Lam HB, Lo SK

In our previous study, we bred a stable cytoplasmic male sterility(CMS) line of tuber mustard by using distant hybridization and subsequent backcrosses. In this CMS plants, all floral organs are normal except the anthers, which are transformed into petals or tubular structures. Recently, 2 mitochondrial genes-atpA and orf220-that are distinctively present in the cytoplasmic male sterility line of tuber mustard were cloned and partially characterized.

In our study of genetic diversity analysis of cytoplasmic male sterility , 7 species of Brassica and Raphanus crops, which included 5 CMS lines and their respective maintainer lines, were used to compare the constitution of protein-coding genes in the mitochondrial genomes.

In 4 of the 43 mitochondrial genes, namely, atpA, orf220, orf256, and orf305/orf324, polymorphisms were detected among the tuber mustard cytoplasmic male sterility line and its maintainer line. The results of a cluster analysis indicate that petaloid cytoplasmic male sterility phenotype of tuber mustard is a novel cytoplasmic male sterility type and is nearer to the nap cytoplasmic male sterility in Brassica napus at the phylogenetic level.

The results of individual amplifications of these genes indicate the presence of 4 sequence-characterized amplified region (SCAR) markers, which enable rapid and reliable identification of this CMS. Expressions of the orf220 and orf256 genes were detected only in the CMS line, while expression of the orf305 gene was detected in the maintainer line.

The different expression patterns of different mitochondrial-specific marker genes indicate that the quantity of mitochondrial proteins is differentially regulated during organ/tissue development in tuber mustard. The results of this study suggest that the above mentioned 4 mitochondrial genes are associated with the petaloid CMS phenotype in tuber mustard.



"Analysis of genetic diversity in cytoplasmic male sterility, and association of mitochondrial genes with petaloid-type cytoplasmic male sterility in tuber mustard (Brassica juncea var. tumida Tsen et"
Mol Biol Rep. 2009 Sep 17;
Yu X, Lu H, Lu G, Chen Z, Cao J, Hirata Y

We present two cases of crystalline keratopathy managed this way. A 36-year-old female contact lens wearer presented with crystalline keratopathy following recent treatment with topical steroids and antibiotics for a corneal abscess.

In this case crystalline keratopathy developed despite the intensive topical antibiotic treatment. A 55-year-old man with a history of acne rosacea, chronic myelomonocytic leukaemia, asthma and Crohn's disease presented with crystalline keratopathy following an episode of infectious keratitis.

Treatment with the Nd:YAG laser to the area of involvement was instituted in both cases. Noticeable resolution occurred within days, with subsequent full recovery. No side-effects from the use of the Nd:YAG laser were noted. There have been only two cases previously reported using this treatment modality.



"Laser corneal biofilm disruption for infectious crystalline keratopathy"
Clin Experiment Ophthalmol. 2009 Mar; 37(2): 177-80Masselos K, Tsang HH, Ooi JL, Sharma NS, Coroneo MTCrystalline keratopathy can be successfully treated by the Nd:YAG laser.

Introduction. Sexual pain disorders refer to conditions of genital pain that interfere with intercourse. They often have a musculoskeletal component related to the pelvic floor and are included in the DSM-IV as sexual dysfunctions. Musculoskeletal pain (MP) that is not essentially genitally based often interferes with sex as well yet is not considered a distinct sexual dysfunction.

Musculoskeletal pain is generally addressed by physiatrists, orthopedists, and rheumatologists who are not traditionally trained in sexual medicine, and therefore, the sexual concerns of women with MP often go unaddressed.

Aim. 
The purposes of this review article were to describe how Musculoskeletal pain is perceived in the literature as affecting sexual function, illustrate how specific MP conditions prevalent in women may affect sexual function, and offer recommendations for clinical practice.

Methods. 
PubMed and Medline searches were performed using the keywords "musculoskeletal pain and sex,""lower back pain and sex,""arthritis and sex," and "fibromyalgia and sex".

Main Outcome Measure. 
Review of the peer-reviewed literature. Results. Most studies cite fatigue, medication, and relationship adjustment as affecting sexuality much as chronic illness does. While musculoskeletal contributors to genital sexual response and pain are considered relevant to sexual function, little is understood about how Musculoskeletal pain syndromes specifically affect sexual activity.

Conclusion.
Lack of mobility and Musculoskeletal pain can restrict intercourse and limit sexual activity, and gender differences are noted in response to pain. Sexual and relationship counseling should be offered as a component of rehabilitative treatment. Physical therapists are uniquely qualified to provide treatment to address functional activities of daily living, including sexual intercourse, and offer advice for modifications in positioning. Rosenbaum TY. Musculoskeletal pain and sexual function in women.


"Musculoskeletal Pain and Sexual Function in Women"
J Sex Med. 2009 Sep 14; Rosenbaum TY

Skin care regimens have been recommended in conjunction with topical medications for the treatment of rosacea. Specifically, a mild cleanser and a moisturizer can help relieve symptoms and maintain skin barrier integrity.

The Assessment of Skin Characteristics Study, a multicenter open-label study (N=102), compared the use of a specified skin care regimen with or without the moisturizer component. Participants used a facial cleanser immediately before application of azelaic acid (AzA) gel 15% twice daily to both sides of the face and then applied the provided moisturizer to the right side of the face only.

Scores for severity and duration of stinging, burning, tingling, and itching were recorded in the morning and evening for 7 days. Cumulative symptom scores (CSSs) decreased on the right side of the face with facial moisturizer applied.



"The use of moisturizers as an integral component of topical therapy for rosacea: clinical results based on the Assessment of Skin Characteristics Study"
Cutis. 2009 Aug; 84(2): 72-6
Del Rosso JQ

Consecutive cohort study.

OBJECTIVE:
To reconsider effects of the Second National Acute Spinal Cord Injury Study.

SUMMARY OF BACKGROUND DATA:
High dose methylprednisolone sodium succinate (MPSS) for the patients with acute spinal cord injury has been considered standard treatment in the several countries. However, many authors have criticized the effect of MPSS because of lack of evidence about neurologic improvement and the high incidence of complications. METHODS: During 2-year, all patients with cervical cord injury were treated with MPSS within 8 hours of their injuries based on the Second National Acute Spinal Cord Injury Study protocol (MPSS group). During the next 2-year, all patients were treated without MPSS (non-MPSS group). There were 38 patients in the MPSS group and 41 in the non-MPSS. Early spinal decompression and stabilization was performed as soon after injury in both the groups.

RESULTS:
According to The American Spinal Injury Association (ASIA) motor score, there was an average improvement by 3 months postinjury of 12.4 points in the MPSS group and 13.8 points in the non-MPSS group. In patients with complete motor loss, average ASIA motor score improved 9.0 points in the MPSS group and 12.6 points in the non-MPSS group. For patients with incomplete motor loss, average ASIA motor score improvement was 14.1 and 15.5 points in the MPSS and non-MPSS groups, respectively.In the MPSS group, 19 patients developed pneumonia, 13 developed urinary tract infections, and 5 developed wound infections. Incidence of pneumonia was significantly increased with the use of MPSS medication.

CONCLUSION:
We found no evidence supporting the opinion that high-dose MPSS administration facilitates neurologic improvement in patients with spinal cord injury. We believe MPSS should be used under limited circumstances because of the high incidence of pulmonary complication.



"Does high dose methylprednisolone sodium succinate really improve neurological status in patient with acute cervical cord injury?: a prospective study about neurological recovery and early complicatio"
Spine (Phila Pa 1976). 2009 Sep 15; 34(20): 2121-4 Ito Y, Sugimoto Y, Tomioka M, Kai N, Tanaka M

Paraplegia of late onset in adolescents with caries of dorsal spine is considered to be due to the reactivation of infection. Internal salient at the level of acute kyphotic deformity of the dorsal spine is formed by posterior cartilaginous remains of grossly destroyed vertebral bodies. The author presents a study of eight adolescent patients with paraplegia of late onset associated with severe kyphotic deformity of dorsal spine with observations on the cause of paraplegia, the final neurological outcome following anterior decompression and its prevention.

MATERIALS AND METHODS:
Eight adolescent patients mean age 14.4 yrs 6 males and 2 females with healed childhood caries of dorsal spine, having a mean kyphotic angle of 80 degrees (range 60 degrees -140 degrees ) presented with paraplegia of late onset.

Of these patients, two had medical research council grade 0 muscle power; four had grade 2 muscle power, and two others had grade 3 muscle power in the lower limbs and were unable to walk unaided. One patient with 140 degrees kyphoscoliotic deformity with grade 3 muscle power had post-polio residual paralysis (PPRP) in addition. All patients were subjected to thorough anterior spinal decompression through transthoracic, transpleural thoracotomy from the left side.

RESULTS:
In six of the eight patients, the spine at the site of deformity being very rigid, the deformity could not be corrected and the intervertebral gap was bridged with appropriate autogenous tricortical cortico cancelluous bone graft. In one patient (case 4), the kyphotic deformity could be corrected by 50%.

In one patient with 140 degrees kyphosis and PPRP, the gap after the decompression of cord, could not be bridged with bone graft and was given a custom made, well molded plastic black shell to wear while walking and, in particular, while traveling in a vehicle. In all seven patients, bone grafts took six months for bridging the intervertebral gaps. All patients recovered to grade 4 muscle power 6-12 months after surgery.

CONCLUSION:
In adolescents with healed caries of dorsal spine with acute kyphosis and paraplegia, the treatment of choice is anterior surgical decompression of the cord and bridging the gap thus created with bone graft.



"Paraplegia of late onset in adolescents with healed childhood caries of dorsal spine: A cause of pressure on the cord and treatment".
Indian J Orthop. 2008 Oct; 42(4): 454-9Paravastu R

Zone II flexor tendon repairs may create a bulging effect with increased bulk and resistance to tendon gliding. A biomechanical time 0 study was performed to assess 2 methods of tendon antibulking for work of flexion and strength characteristics.

METHODS:
We placed 24 fresh-frozen porcine forelimb tendons in a custom jig. Deep flexor tendon was sectioned just distal to the intact A1 and A2 pulleys. Specimens were divided into 3 groups before repair: group 1, nonmodified tendon; group 2, 30 degrees bilateral notch excised from both tendon ends; and group 3, triangular longitudinal central wedge excised from both tendon ends. All repairs used a 4-strand modified Kessler core suture and running circumferential epitendinous suture. Work of flexion, 2-mm gap formation, and ultimate load to failure were tested.

Prospective, match-cohort study of disc degeneration progression over 10 years with and without baseline discography.

OBJECTIVES.:
To compare progression of common degenerative findings between lumbar discs injected 10 years earlier with those same disc levels in matched subjects not exposed to discography.

SUMMARY OF BACKGROUND DATA.:
Experimental disc puncture in animal and in vivo studies have demonstrated accelerated disc degeneration. Whether intradiscal diagnostic or treatment procedures used in clinical practice causes any damage to the punctured discs over time is currently unknown. METHODS.: Seventy-five subjects without serious low back pain illness underwent a protocol MRI and an L3/4, L4/5, and L5/S1 discography examination in 1997. A matched group was enrolled at the same time and underwent the same protocol MRI examination. Subjects were followed for 10 years. At 7 to 10 years after baseline assessment, eligible discography and controlled subjects underwent another protocol MRI examination. MRI graders, blind to group designation, scored both groups for qualitative findings (Pfirrmann grade, herniations, endplate changes, and high intensity zone). Loss of disc height and loss of disc signal were measured by quantitative methods.