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1.  GLUT-1 GLUCOSE TRANSPORTERS IN THE BLOOD-BRAIN BARRIER: DIFFERENTIAL PHOSPHORYLATION 
Journal of neuroscience research  2011;89(12):10.1002/jnr.22738.
Glucose is the primary metabolic fuel for the mammalian brain and a continuous supply is required to maintain normal CNS function. The transport of glucose across the blood-brain barrier (BBB) into the brain is mediated by the facilitative glucose transporter GLUT-1. Prior studies (Simpson et al. 2001) had revealed that the conformations of the GLUT-1 transporter were different in luminal (blood facing) and abluminal (brain facing) membranes of bovine cerebral endothelial cells, based on differential antibody recognition. In this study we have extended these observations and using a combination of 2D-PAGE/Western blotting and immunogold electron microscopy we determined that these different conformations are exhibited in vivo and arise from differential phosphorylation of GLUT-1 and not from alternative splicing or altered O- or N-linked glycosylation.
doi:10.1002/jnr.22738
PMCID: PMC3835747  PMID: 21910135
2.  Twice recurrent gallstone ileus: a case report 
Introduction
Gallstone ileus is a rare cause of bowel obstruction and results from the passage of gallstones into the bowel.
Case presentation
We present the case of an 83-year-old Caucasian woman who had three episodes of gallstone ileus, each of which was managed with simple enterotomy. This sequence is one of the first reported in the medical literature and may be seen to challenge the traditional surgical approach of enterotomy alone.
Conclusions
The available evidence comparing enterotomy alone with combined enterotomy, cholecystectomy, and fistula closure in the management of gallstone ileus is reviewed. Neither approach is clearly identified as superior, but available series suggest that simple enterotomy may be safer than a combined approach and does not result in a higher rate of recurrent biliary disease.
doi:10.1186/1752-1947-6-362
PMCID: PMC3492071  PMID: 23095215
Recurrent gallstone ileus; enterotomy; fistulectomy
3.  Future doctors 
doi:10.1258/jrsm.2009.09k032
PMCID: PMC2697049  PMID: 19531612
4.  An investigation of the relationship between measures of pain intensity, pain affect, and disability, in patients with shoulder dysfunction 
Objectives
Numerous outcomes measures can be used to capture and differentiate change in different constructs comprising recovery. Consequently, patients are often burdened by completing a number of measures which involves considerable time and effort. The purpose of this longitudinal, observational study was to identify the number of dimensions in a battery of self-report findings in a patient population who received shoulder injections to investigate the association of the instruments.
Methods
Ninety-nine subjects, with diagnoses of adhesive capsulitis, labral injuries, rotator cuff injuries, and osteoarthritis completed outcomes measures including five different forms of pain intensity measures, the McGill Short Form Questionnaire, and the Disabilities of the Arm, Shoulder, and Hand Questionnaire. Change scores were calculated at 4 weeks and an exploratory factor analysis (EFA) with varimax rotation was used to analyze dimensionality. The relationship between the raw scores of the seven measures was investigated using a correlation matrix.
Results
The EFA yielded only one factor and the raw score correlations demonstrated very strong, significant associations. The finding of a single factor suggests that in this sample of patients, only one dimension of change, most likely a change in pain, is represented by the seven individual outcomes measures.
Discussion
In this isolated example, one outcomes measure would have been sufficient in determining outcome and could have reduced the administrative burden to the caregivers and the patients.
doi:10.1179/2042618610Y.0000000006
PMCID: PMC3172941  PMID: 22547916
Shoulder; Outcomes measures; Factor analysis
5.  Glutamate permeability at the blood-brain barrier in insulinopenic and insulin-resistant rats 
The influence of diabetes on brain glutamate (GLU) uptake was studied in insulinopenic (streptozotocin (STZ)) and insulin-resistant (diet-induced obesity (DIO)) rat models of diabetes. In the STZ study, adult male Sprague-Dawley rats were treated with STZ (65 mg/kg iv) or vehicle and studied 3 weeks later. STZ rats had elevated plasma levels of glucose, ketone bodies and branched-chain amino acids; brain uptake of GLU was very low in both STZ and control rats, examined under conditions of normal and greatly elevated (by iv infusion) plasma GLU concentrations. In the DIO study, rats ingested a palatable, high-energy diet for 2 weeks, and were then divided into weight tertiles: rats in the heaviest tertile were designated DIO, rats in lightest tertile diet-resistant (DR), and rats in the intermediate tertile controls. DIO and DR rats continued to consume the high-energy diet for 4 more weeks, while control rats were switched to standard rat chow. All rats were studied at 6 weeks (subgroups were examined under conditions of normal or elevated plasma GLU concentrations). DIO rats ate more food and were heavier than DR or control rats, and had higher plasma leptin levels and insulin:glucose ratios. In all diet groups, the BBB showed very low GLU penetration, and was unaffected by plasma GLU concentration. Brain GLU uptake also did not differ among the diet groups. Together, the results indicate that the BBB remains intact to the penetration of GLU in two models of diabetes under the conditions examined.
doi:10.1016/j.metabol.2009.07.022
PMCID: PMC2813370  PMID: 19793593
insulin; brain capillaries; endothelial cells; dicarboxylic amino acids; leptin; diabetes; streptozotocin; diet-induced obesity
6.  Diagnostic Accuracy and Association to Disability of Clinical Test Findings Associated with Patellofemoral Pain Syndrome 
Physiotherapy Canada  2010;62(1):17-24.
ABSTRACT
Purpose: To investigate the diagnostic accuracy and association to disability of selected functional findings or physical examination tests for patellofemoral pain syndrome (PFPS) in patients with anterior knee pain.
Methods: A sample of 76 consecutive patients with anterior knee pain was further subdivided into PFPS and other diagnoses. Routine physical examination tests were examined in a prospective, consecutive-subjects design for a cohort of patients with anterior knee pain. Diagnostic accuracy findings, including sensitivity, specificity, positive (PPV) and negative (NPV) predictive value, and positive (LR+) and negative (LR−) likelihood ratios, were calculated for each test. PPV and NPV reflect the percentage of time of positive or a negative test (respectively) accurately captures the diagnosis of the condition. LR+ and LR− reflect alterations in post-test probability when the test is positive or negative (respectively). Lastly, associations to disability (International Knee Documentation Committee (IKDC) subjective form) were calculated for each clinical finding.
Results: Diagnostic accuracy analyses of individual functional assessment and situational phenomena suggest that the strongest diagnostic test is pain encountered during resisted muscle contraction of the knee (PPV=82%; LR+=2.2; 95% CI: 0.99–5.2). Clusters of test findings were substantially more diagnostic, with any two of three positive findings of muscle contraction, pain during squatting, and pain during palpation yielding the following values: PPV=89%; LR+=4.0 (95% CI: 1.8–10.3). No individual or clustered test findings were significantly associated with the IKDC score.
Conclusion: Combinations of functional assessment tests and situational phenomena are diagnostic for PFPS and may serve to rule in and rule out the presence of PFPS. Single findings are not related to disability scores (IKDC).
doi:10.3138/physio.62.1.17
PMCID: PMC2841549  PMID: 21197175
diagnostic accuracy; International Knee Documentation Committee; patellofemoral pain syndrome; sensitivity; specificity; International Knee Documentation Committee; précision des diagnostics; syndrome fémoro-rotulien; syndrome fémoro-patellaire; spécificité
7.  Glenohumeral Internal Rotation Deficit in the Asymptomatic Professional Pitcher and its Relationship to Humeral Retroversion 
The purpose of this study was to determine if glenohumeral internal rotation deficits (GIRD) exist in an asymptomatic population of professional pitchers, and to assess whether these changes are primarily a bony or soft tissue adaptation. Twenty three, active, asymptomatic professional (Major League Baseball) pitchers volunteered for the study. Clinical measures of glenohumeral ranges of motion, laxity, GIRD, as well as radiographic measures of humeral retroversion were taken by two independent orthopaedic surgeons. Data comparing side to side differences in range of motion, laxity, and humeral retroversion were analyzed for statistical significance using a paired t-test for continuous data and a Chi-squared test for ordinal data, with a significance set at 0.05. Evaluations of statistical correlations between different measurement parameters were accomplished using a Pearson product moment correlation. We hypothesized GIRD will be positively correlated with humeral retroversion (HR) in the pitching arm. All clinical and radiographic measures were made in the field, at spring training, by physicians of both private and institutional based sports medicine practices. For the entire group, significant differences were exhibited for HR, external rotation at 90° and internal rotation at 90°, for dominant vs. non-dominant arms. GIRD of greater than 25° was noted in 10/23 of pitchers. In this group, HR was significantly increased and correlated to GIRD. No such increase or correlation was noted for the non-GIRD group. GIRD is a common finding in asymptomatic professional pitchers, and is related to humeral retroversion. Thus internal rotation deficits should not be used as the sole screening tool to diagnose the disabled throwing shoulder.
Key pointsGIRD is relatively common in asymptomatic baseball pitchers (35-43%).Large ranges (-45 to 5°) and a large standard deviation (±16°) were noted suggesting that GIRD is quite variable in this population.GIRD is a variable measure in the asymptomatic population, and therefore should not be used as sole proof for the disabled throwing shoulder.
PMCID: PMC3763355  PMID: 24150137
Glenohumeral internal rotation; humeral retroversion; pitcher ROM
8.  Developing a health surveillance strategy for professional footballers in compliance with UK health and safety legislation 
The need for health surveillance for professional footballers has been assessed against criteria specified in UK health and safety legislation. As footballers suffer from chronic injuries under normal playing conditions, professional football clubs have a requirement to implement health surveillance programmes to protect their players. A health surveillance programme, based on benchmarking a player's fitness and addressing the issues of pre-recruitment, pre-season, during-season, post-season, and rehabilitation assessment, is proposed.
PMCID: PMC1332616  PMID: 9192131
football; health surveillance; legislation

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