Citations

Patients with connective tissue diseases are thought to be at a higher risk for a number of cerebrovascular diseases such as intracranial aneurysms, dissections, and acute ischemic strokes. In this report, we aim to understand the prevalence and occurrences of such neurovascular manifestations in four heritable connective tissue disorders: Marfan syndrome, Ehlers-Danlos syndrome, Neurofibromatosis Type 1, and Loeys-Dietz syndrome. We discuss the fact that although there are various case studies reporting neurovascular findings in these connective tissue diseases, there is a general lack of case-control and prospective studies investigating the true prevalence of these findings in these patient populations. Furthermore, the differences observed in the manifestations and histology of such disease pathologies encourages future multi-center registries and studies in better characterizing the pathophysiology, prevalence, and ideal treatment options of neurovascular lesions in patents with connective tissue diseases.

Many factors are involved in weight gain and metabolic disturbances associated with obesity. The gut microbiota has been of particular interest in recent years, since both human and animal studies have increased our understanding of the delicate symbiosis between the trillions of microbes that reside in the GI tract and the host. It has been suggested that disruption of this mutual tolerance may play a significant role in modulating host physiology during obesity. Environmental influences such as diet, exercise, and early life exposures can significantly impact the composition of the microbiota, and this dysbiosis can in turn lead to increased host adiposity via a number of different mechanisms. The ability of the microbiota to regulate host fat deposition, metabolism, and immune function makes it an attractive target for achieving sustained weight loss.

Multiple myeloma (MM) patient frailty has been delineated primarily by age and ECOG performance score (PS) and recently by the IMWG frailty score based on functional status [Activity of Daily Living (ADL) and Instrumental‐ADL scores], comorbidities [Charlson‐comorbidity‐index (CCI)] and age. It was hypothesized that N‐terminal natriuretic peptide type B (NT‐proBNP) might be both a more convenient measure of frailty and a predictor of overall survival (OS). Three‐hundred and fifty‐one consecutive symptomatic MM patients who were seen at Mayo Clinic within 30 days of diagnosis and who had blood stored were eligible. Data from the first visit was abstracted and used to calculate an ADL, CCI, and measure the NT‐proBNP level. The best cutoff of NT‐proBNP predicting OS was 300 ng/L. Variables predictive for OS were ECOG‐PS, age, CCI, ADL, ISS, revised‐ISS, and NT‐proBNP. On multivariate analysis age ≥70, PS ≥2, and NT‐proBNP ≥300 were independent predictors of survival. Patients were assigned a score of 1 for each of these variables, creating stages I–IV with scores of 0–3 points, respectively. The median OS from diagnosis was not reached, 58, 28, and 18 months (P < 0.0001), respectively. This frailty risk schema was independent of initial therapy and the revised‐ISS. NT‐proBNP is a useful predictor of survival independent of age and PS. It is a widely available biomarker that could be added to the panel of laboratory tests of newly diagnosed MM patients and serve as a simple and objective tool of determining frailty in clinical practice. Am. J. Hematol. 91:1129–1134, 2016. © 2016 Wiley Periodicals, Inc.

Plantar fasciitis is a common foot disorder that affects more than two million Americans each year. Conservative management of plantar fasciitis is the first line of treatment by the medical specialist who frequently encounters this common foot complaint. In this study, 50 patients with plantar fasciitis of 4 weeks duration but less than 12 weeks were randomized into two groups. One group of 25 patients used the AirHeel (Aircast, Inc.) and the second group of 25 used the 1st Step prefabricated foot insert (Wrymark, Inc). Standardized weight-bearing radiographs were obtained in order to categorize the foot type: normal arch, pes planus, or pes cavus. Patients were initially evaluated and at 12 weeks they returned for a subsequent visit. The contact area of the foot with the AirHeel and 1st Step insert were similar, an increase of 27% and 26%, respectively, over the contact area barefoot. There was a noted difference in force reduction with the two devices. The AirHeel reduced the midstance force by 20.19%, as compared to the 1st Step insert which showed a 1.03% increase in midstance force. Patients with a higher initial pain score seemed to respond better initially to the AirHeel (p= 0.015) than the 1st Step insert (p= 0.035). This study demonstrates the benefits of offloading the foot at midstance with two devices to relieve the discomfort associated with plantar fasciitis. The Aircast AirHeel is a new modality for dynamic, functional treatment of proximal plantar fasciitis.

This current special issue of the Journal of Clinical Sport Psychology was conceived and developed to provide a resource for clinicians who have contact with athletes who are at risk for or have sustained a concussion during sport participation. The special issue is part of an exciting two-issue series. This first installment contains papers from leaders in the field of sport concussion who review the frequency and mechanisms of concussion, models for managing concussion, the emotional aspects of concussion in sport, practical examples from a model sport concussion clinic, and the importance of sport concussion education and prevention. As Guest Editors, we hope that this timely and unique special series will be used by clinicians who help care for athletes and their families who have experienced concussion in their sport life.