Citations

Abstract Background: The locations of most of the 361 classical acupuncture points are determined in clinical practice by measuring their traditionally described positions using the cun system. Some data suggest the routinely taught methods of cun measurement may lead to inaccurate acupoint localizations. Objectives: To determine the accuracy of the traditional cun measuring techniques in localizing acupoints LU 4 and TE 8 compared with tape measure determination of their optimal locations, and to assess if the ability to accurately localize these points correlates with the length of acupuncture experience. Design, Setting, and Participants: Nonrandomized, experimental study conducted with 20 physician-acupuncturists on 2 adult volunteers at a medical acupuncture conference in Fall 2009. Eleven acupuncturists independently marked the location of LU 4, and 9 acupuncturists marked the location of TE 8 by traditional cun measuring techniques on the 2 volunteers, utilizing a novel point-marking method that blinded each acupuncturist from the others' point location findings. The optimal locations for the 2 acupoints were determined by direct measurement using a tape measure. Main Outcome Measures: Distances in millimeters of the clinicians' acupuncture point localizations from the optimal point positions. Results: For LU 4, the mean inaccuracy in locating this point using traditional measurement methods was 22.3 mm (range, 5-44 mm; SD = 10.9 mm). For TE 8, the mean inaccuracy was 8.4 mm (range, 1-21 mm; SD = 5.4 mm). Years of acupuncture experience (≤10 vs >10) did not affect the accuracy of clinicians' point localizations. Conclusions: Traditional cun methods routinely used to locate acupuncture points can produce enough inaccuracy in point localization that incorrect nearby acupoints could be needled inadvertently, irrespective of the amount of clinical experience of the acupuncturist. False-negative acupuncture intervention results (i.e., no beneficial clinical effect) in clinical trials could result.

Introduction: To determine the relationship between fibrin D-dimer levels, symptom duration, and thrombus volume, consecutive patients with incident deep venous thrombosis (DVT) were evaluated. Methods: In a cross-sectional study design, patient symptom onset was determined by careful patient questioning. Venous thrombosis was confirmed by compression duplex ultrasonography. Thrombus volume was estimated based on patient’s femur length using a forensic anthropology method. Fibrin D-dimer was measured by latex immunoassay. Results: 72 consecutive patients with confirmed leg DVT agreed to participate. The median symptom duration at the time of diagnosis was 10 days. The median D-dimer concentration was 1050 ng/dL. The median thrombus volume was 12.92 cm 3 . D-Dimer levels correlated with estimated thrombus volume (P < .0006 CI 0.12-0.41; R 2 adjusted = .15) but not symptom duration, patient’s age, or gender. Conclusions: Despite varying symptom duration prior to diagnosis, fibrin D-dimer remains a sensitive measure of venous thrombosis and correlates with thrombus volume.

Abstract The Division of Lung Diseases of the National Heart, Lung, and Blood Institute, with the Office of Rare Diseases Research, held a workshop to identify priority areas and strategic goals to enhance and accelerate research that will result in improved understanding of the lung vasculature, translational research needs, and ultimately the care of patients with pulmonary vascular diseases. Multidisciplinary experts with diverse experience in laboratory, translational, and clinical studies identified seven priority areas and discussed limitations in our current knowledge, technologies, and approaches. The focus for future research efforts include the following: (1) better characterizing vascular genotype–phenotype relationships and incorporating systems biology approaches when appropriate; (2) advancing our understanding of pulmonary vascular metabolic regulatory signaling in health and disease; (3) expanding our knowledge of the biologic relationships between the lung circulation and circulating elements, systemic vascular function, and right heart function and disease; (4) improving translational research for identifying disease-modifying therapies for the pulmonary hypertensive diseases; (5) establishing an appropriate and effective platform for advancing translational findings into clinical studies testing; and (6) developing the specific technologies and tools that will be enabling for these goals, such as question-guided imaging techniques and lung vascular investigator training programs. Recommendations from this workshop will be used within the Lung Vascular Biology and Disease Extramural Research Program for planning and strategic implementation purposes.

A three-dimensional (3D) geometric model for predicting muscle forces in the shoulder complex is proposed. The model was applied throughout the range of arm elevation in the scapular plan. In vitro testing has been performed on 13 cadaveric shoulders. The objectives were to determine homogeneous values of physiological parameters of shoulder muscles and to locate sites of muscular attachment to any bone of the shoulder complex. Muscular fiber lengths, lengths of contractile element (CE), and muscle volumes were measured, corresponding physiological cross-sectional area (PCSA) were calculated, and force/length muscle relations were found. An in vivo biplanar radiography was performed on five volunteers. The photogrammetric reconstruction of bone axes and landmarks were coupled with a geometric modeling of bones and muscle sites of attachment. Muscular paths were drawn and changes in lengths during movement have been estimated. Directions of muscle forces are the same as that of muscular path at the point of attachment to bone. Magnitudes of muscular forces were found from muscle lengths coupled with force/length relations. Passive forces were directly determined contrary to active muscle forces. A resulting active muscle force is calculated from balancing weight and passive forces at each articular center. Active muscle forces were calculated by distributing the resulting force among active muscles based on the muscular PCSA values.

Background— Studies report a protective effect of higher attained educational level (AEL) on cardiovascular outcomes. However, most of these studies have been conducted in high-income countries (HICs) and lack representation from low- and middle-income countries (LMICs), which bear >80% of the global burden of cardiovascular disease. Methods and Results— The Reduction of Atherothrombosis for Continued Health (REACH) Registry is a prospective study of 67 888 subjects with either established atherothrombotic (coronary, cerebrovascular, and/or peripheral arterial) disease or multiple atherothrombotic risk factors enrolled from 5587 physician practices in 44 countries. At baseline, AEL (0 to 8 years, 9 to 12 years, trade or technical school, and university) was self-reported for 61 332 subjects. Outcomes included the baseline prevalence of atherothrombotic risk factors and the rate of incident cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) through 23 months across AEL groups, stratified by sex and world region (LMICs or HICs). Educational attainment was inversely associated with age and diabetes mellitus and directly associated with hypercholesterolemia in all subjects. However, for other risk factors such as obesity, smoking, hypertension, and baseline burden of vascular disease, AEL was protective (inversely associated) in HICs but not protective in LMICs. The protective effect of greater AEL on incident cardiovascular events was strongest in men from HICs ( P <0.0001), more modest in women from HICs ( P =0.0026) and in men from LMICs ( P =0.082), and essentially absent in women from LMICs ( P =0.32). Conclusion— In contrast to HICs, higher AEL may not be protective against cardiovascular events in LMICs, particularly in women.