Faculty Bibliography

OBJECTIVES: To examine older persons' willingness to participate in exercise and relaxation programs for managing chronic pain, to identify characteristics associated with willingness to participate, and to ascertain their barriers to participation. DESIGN: Cross-sectional survey. SETTING: A geriatric ambulatory care practice located in New York, New York, and the General Clinical Research Center of Weill Cornell Medical College. PARTICIPANTS: Sixty-eight English-speaking patients aged 70 and older with chronic pain. MEASUREMENTS: Participants' level of willingness to participate in the programs was assessed using 5-point Likert scales, and information regarding their demographic, clinical, psychological, and pain status was obtained. Qualitative methods were used to ascertain participants' perceived barriers to participation. RESULTS: Participants had a mean age+/-standard deviation of 81.9+/-7.0 and were mostly white (85%) and female (68%). Although only 16% of participants reported current use of exercise as a pain-management strategy, 73% reported a willingness to try the exercise program. Four percent reported current use of relaxation methods; 70% reported an interest in learning these techniques. Moderate correlations were found between increasing days of restricted activity due to pain and greater willingness to participate. Seventeen unique barriers were identified; the mean number of barriers reported per person was 2.9+/-1.8 for exercise and 2.2+/-1.4 for relaxation. Commonly reported barriers to participating in either program included time conflicts, transportation, treatment efficacy concerns, and fear of pain or injury. CONCLUSION: Older primary care patients with chronic pain are willing to try exercise and relaxation therapies to help manage pain but report a substantial number of barriers to participating in these programs. Addressing patient-level barriers could improve engagement in and adherence to exercise and relaxation therapies for managing pain in older persons.

The etiology of aneurysmal bone cysts is uncertain, but they may originate as a localized arteriovenous malformation. These benign lesions can be primary or occur secondary to an underlying lesion. The majority of patients who present with aneurysmal bone cysts are younger than age 20 years. One half of lesions occur within the long bones and one third involve the spine. Most flat bone lesions, approximately 10%, occur in the pelvis. Fluid-fluid levels are common on CT and MRI but are not pathognomonic. Although aneurysmal bone cyst is benign, there may be aggressive clinical and imaging features. Treatment for aneurysmal bone cyst is surgical curettage, intraoperative adjuvant therapy, and bone grafting of the lesion. The prognosis following treatment is very good, although 10% to 20% of cases are reported to recur

The initial host response to Mycobacterium tuberculosis is driven by innate immunity. For this study, we examined the ability of 18 recent clinical isolates and 5 reference strains to survive and replicate in the context of host innate immunity by using whole blood culture. Six healthy tuberculin-negative volunteers served as subjects. H(37)Ra showed the least capacity to replicate of any of the strains tested, decreasing in viability 1.3 log CFU during 72 h of whole blood culture, whereas H(37)Rv increased 0.32 log. Clinical isolates varied greatly in their ability to replicate in blood cells, ranging from -0.4 to +0.8 log (P < 0.001). Four showed significantly more growth than H(37)Rv, and one showed significantly reduced growth. Host mechanisms for restricting intracellular mycobacterial growth were more effective during the first 24 h of whole blood culture than during the 24- to 72-h period. Certain mycobacterial isolates appeared preferentially able to withstand host defenses during each of these intervals. Although there was relatively more homogeneity among subjects than among strains, one of the six subjects showed a reduced capacity to restrict intracellular mycobacterial growth due to a defect expressed during the first 24 h of culture. Our findings indicate substantial variability in the capacity of clinical tuberculosis isolates to replicate in host cells in the face of innate host immunity

Anabolic steroids were developed in the late 1930s, primarily to treat hypogonadism. Scientists discovered these steroids caused muscle growth in animals, which led to use of the compounds by bodybuilders. In Germany in the 1930s, experiments were conducted on dogs; steroids were subsequently given to German soldiers and prisoners during World War II. In the 1950s, Russians began to dominate the sport of power lifting, and it was shown that most of these athletes were using steroids containing testosterone. An American physician, Dr. John Ziegler, then created a selective form of anabolic steroids that was available on the open market. Not all bulking up comes from anabolic steroids. Human growth hormone, which is made by the pituitary gland in the brain and does not contain sex hormones or steroids, can cause increased muscle mass and weight gain. [Gary Wadler] says that one of the main motivations for abusing synthetic human growth hormone is that no urine tests exist, so a user may elude detection. There is a blood test for growth hormone but it's rarely used and is not mandated in professional sports. The only true medical indication for growth hormone is a deficiency in either childhood or adulthood. Studies have shown that the unregulated use of the drug as an anti-aging agent carries an increased risk of developing diabetes

No cases of influenza from the strain known as A(H2N2), which caused the Asian flu pandemic in 1957, have been detected anywhere in the world, said the official, Dr. Julie L. Gerberding, who directs the Centers for Disease Control and Prevention in Atlanta. Meridian Bioscience Inc., in Cincinnati, shipped the samples beginning last fall under contract with the College of American Pathologists as part of the group's proficiency testing program. Dr. Jared N. Schwartz, an official of the college, has said that when Meridian checked a United States government manual, its team found that the A(H2N2) strain could be sent to laboratories as a biosafety level 2 microbe, the second-lowest in a four-class danger rating system