Assessment Of Function In Patients Research Articles

One-Stage Integra Coverage for Fingertip Injuries

We hypothesize that one-stage Integra skin coverage is an effective treatment modality for the treatment of fingertip defects. Nine patients who sustained fingertip injuries were treated with one-stage Integra coverage. In all cases, Integra was placed directly on bone. Static two-point discrimination and the Semmes-Weinstein Monofilament Test (SWMFT) were used to determine the sensations of the affected and opposite unaffected digit. The QuickDASH, Cold Intolerance Symptom Severity (CISS), visual analog scale (VAS), and a 0-10-point pain scale were administered to assess patient function, satisfaction, and pain levels. The mean age was 53.1years (39-61). There were 8 males and 1 female. The average area covered was 2.3cm(2) (1.0-3.2). The mean follow-up duration was 16months (8-46). The median QuickDASH, CISS score, VAS patient satisfaction, and 0-10 pain score were 9.1 (2.3-40.9), 18 (4-30), 10 (most satisfied) (7-10), and 0 (0-3), respectively. Five patients were evaluated for their digital sensory perception. The mean static two-point discrimination was 9.6mm for the affected digit and 4.6mm for the opposite unaffected digit. The median SWMFT was 4.31 for the affected digit and 3.61 for the opposite unaffected digit. For small soft tissue and bone defects involving the fingertip, the use of Integra without further skin grafting appears to be effective, avoids the morbidity of the donor site, and avoids a second surgery. Despite mild sensory deficits, patients were satisfied with the results and fully functional during short-term follow-up.

Pfeiffer Syndrome

Among the craniosynostosis syndromes, Pfeiffer syndrome is notable because of high mortality and the need for multiple surgical interventions. However, it is variable in severity. We propose a new classification of Pfeiffer Syndrome to define pathology and function. A retrospective review was conducted of 42 patients with Pfeiffer syndrome treated from 1975 to 2010, the largest series reported to date. The classification was based on a functional assessment of patients in terms of respiratory, ocular, otological, and neurological status. This classification was tested by scoring and stratifying patients as follows: type A (mild problems), B (moderate problems), or C (severe problems). Patients were scored both at the time of presentation and after all surgical interventions to assess change in functional outcome. The functional classification system was compared to another previously reported. Type A patients did not have any change in postoperative functional outcomes (mean preoperative score 1.6, mean postoperative score 1.6); type B patients showed functional improvement (mean preoperative score 4.1, mean postoperative score 3.4) but type C patients (mean preoperative score 7.7, mean postoperative score 4.8) demonstrated the greatest improvement in functional scores after surgical intervention. Suture pathology did not indicate the clinical severity of phenotype, a variance from a previously published classification. The proposed classification is useful to assess severity of phenotype: respiratory, ocular, otologic, and neurologic problems are key indicators of the need for treatment. The classification can provide a helpful guide in multidisciplinary treatment planning, in reporting outcomes, and in the sharing of data among craniofacial anomalies centers.

Functional evaluation using the modified Japanese Orthopedic Association score (mJOA) for cervical spondylotic myelopathy disease by age, gender, and type of disease

Background and Objective: Cervical spondylotic myelopathy (CSM) is a common cause of significant clinical morbidity. The modified Japanese Orthopedic Association score (mJOA) is a very short instrument for functional evaluation in these patients. This study aimed to evaluate functionality in patients diagnosed with CSM diseases using the mJOA and to compare the scores based on age, sex, and type of disease. Methods: A sample of patients with CSM who were candidate for decompressive surgery entered into this cross sectional study. The mJOA scores were obtained for the functional assessment of patients. Score on the mJOA range from 0 to 18 with higher scores indicating a better condition. In addition to descriptive statistics, the data were compared among study subgroups as categorized by age, gender and type of disease. Results: A total of 63 patients were studied. The mean age of the patients was 54 ± 8.3 (SD)(range 21-79 years) All patients diagnosed as having cervical herniated disc (n = 36) or cervical spinal stenosis (n = 27). Overall, the mean mJOA score for all patients was 9.82 (SD = 1.0). The mJOA score for men were significantly higher than women (P < 0.0001). The mJOA score in younger patients was significantly higher than older patients (P < 0.0001). No significant difference was observed for type of disease (P = 0.47). Conclusions: The findings of the study suggest that functionality score as measured by the mJOA can be a useful parameter for clinicians help them to manage patients with cervical spondylotic myelopathy prior to surgery.

Neurophysiological and functional assessment of patients with difficult-to-control asthma

IntroductionDue to the inadequate response to inhaled corticosteroids, patients with difficult-to-control asthma (DCA) are submitted to oral corticosteroids or use of omalizumab. Although it is necessary to treat these patients, a significant relationship between steroid usage and both peripheral and respiratory weakness muscle, results in implications, such as loss of quality of life and compromised lung function. Nonetheless, it is not known whether these patients suffer neurophysiological changes due to drug effect. ObjectiveTo investigate the neurophysiological and functional characteristics of patients with DCA in order to gain a better understanding of the condition. MethodA cross-sectional study was carried out involving three groups of patients: DCA-C (use of oral corticosteroids), DCA-O (use of omalizumab) and CG (healthy controls matched for age). The assessment involved the six-minute walk test, sit-to-stand test, static balance on a pressure platform, patellar and Achilles reflexes and quadriceps strength in the dominant leg. ResultsThe results revealed no statistically significant differences between the control group and DCA groups in relation to neurophysiological aspects. However, the DCA groups exhibited a significant reduction in functional capacity [decreased muscle strength (p<0.05), shorter distance covered on walk test (p<0.05) and lesser number of repetitions on sit-to-stand test (p<0.05)] in comparison to the control group. ConclusionIndividuals with DCA exhibited a reduction in functional capacity. The DCA-C group also demonstrated a reduction in muscle strength when compared with control group, likely caused by the continual use of corticosteroids. However, no neurophysiological alterations were found in the studied population.

Arthroscopic Wrist Debridement and Radial Styloidectomy for Late-stage Scapholunate Advanced Collapse Wrist (SS-49)

For patients with symptomatic stage II or III scapholunate advanced collapse (SLAC) wrist, we hypothesize that arthroscopic wrist debridement and radial styloidectomy is a safe and effective procedure to obtain significant pain relief and improved wrist function, and thereby delay or avoid salvage procedures, such as proximal row carpectomy (PRC) or partial/total wrist arthrodesis. The purpose of this study is to assess the outcomes and clarify the indications for this procedure. Over 7 years, the senior author performed this procedure for 8 SLAC wrists in 7 patients. The procedure consists of wrist arthroscopy, synovectomy, and arthroscopic radial styloidectomy; three of the 8 wrists underwent additional neurectomies of the anterior and posterior interosseous nerves. Data collected at final follow-up included outcome scores (DASH, SF-36, and visual analog pain scale), mobility measurements, and patient's functional assessment and satisfaction. Seven wrists in 6 patients were available for questionnaires; one patient was unavailable for examination. At arthroscopy, 3 were staged as SLAC II and 4 as SLAC III. The mean time to final follow-up was 28 months (range 4 – 88 months). One patient was revised to a wrist arthrodesis at 79 months after the arthroscopic procedure and had a DASH score of 65 and VAS pain of 96 post-arthrodesis. For the other 6 cases, the mean DASH score at follow-up was 21 (range 0 – 35, SD 12) and the mean VAS pain score with activity was 35 (range 0 – 88, SD 37). Divided into SLAC II and III, the mean DASH scores were 17 and 25, respectively. Their mean wrist flexion was 56 degrees and extension was 50 degrees. In this small series, patients were satisfied with the results of 5 of the 7 procedures. Arthroscopic debridement and radial styloidectomy can be an effective procedure to delay or prevent PRC or intercarpal arthrodesis. The procedure is indicated for SLAC II or SLAC III wrists as an intermediate step to relieve pain and preserve functional motion. Arthroscopic removal of radial styloid-scaphoid impingement in conjunction with wrist denervation may be reasonable first alternative to more complex wrist salvage procedures in patients with advanced SLAC.

Functional Capacity Scale as a new tool for early functional assessment in patients after surgical treatment of intracranial aneurysms: A prospective study involving 128 patients

SummaryBackgroundFunctional assessment of a patient focuses on the assessment of independence in activities of daily living. The aim of the study was to verify the usefulness of a new tool (Functional Capacity Scale – FCS) for early functional assessment of patients after surgical treatment of an intracranial aneurysm.Material/MethodsThe study was conducted in the Neurosurgical Department and Clinic, CM in Bydgoszcz, NCU, within a group of 128 patients after surgical treatment of an intracranial aneurysm. Direct observation and measurement were used in the study. In clinical assessment, the Hunt and Hess Scale was applied. For the final functional assessment, the Functional Capacity Scale (FCS), the Glasgow Outcome Scale, the Functional Index “Repty”, the Barthel Index, and the Rankin Scale were used.ResultsThe study shows that on the day of discharge almost 60% of patients are independent or slightly dependent on others for functional capability, and 15% are significantly or totally dependent. FCS significantly correlates with FIR (0.93, p<0.001), GOS (0.89, p<0.01), RS (−0.88, p<0.01) and BI (0.82, p<0.001).Conclusions1. Fifty percent of patients with intracranial aneurysm assessed at the early postoperative stage leave the ward as functionally capable of performing everyday activities. 2. There are significant correlations between FCS and the other scales used for functional assessment. 3. There is a significant relationship between functional capacity of the patient on the day of discharge and clinical condition before the surgical treatment.

Assessment of functional outcomes in patients with vestibular disorders after rehabilitation

Vestibular disorders cause functional limitations or decreased ability to perform activities of daily living independently. These problems are not necessarily predicted by vertigo scales or physiologic measures. Therefore, the clinician should evaluate functional ability using self-rated scales or direct observation of specific skills of interest. This paper will review the literature and important issues related to assessment of functional performance and participation in activities of daily living in the vestibular disorders population. Self-rated scales have the benefit of being relatively quick but may be inaccurate. Direct observation may be time consuming and a thorough evaluation of all skills may not be possible in the context of out-patient or home-based care. This paper reviews the available scales and discusses the major problems in functional assessment of patients with vestibular disorders.

Functional assessment of patients with cervical myelopathy by using target-reaching movements

In order to test the working hypothesis that motor deficits after low pyramidotomy may be due to transection of the cortico-cuneate pathway, a low pyramidotomy was made 2–4 months after a C2 dorsal column (DC) transection and tested on forelimb target-reaching and food-taking. Since food-taking recovered faster than after pyramidotomy alone, it is inferred that the loss of food-taking after pyramidotomy without previous DC transection is due mainly to transection of the cortico-cuneate pathway which controls transmission from forelimb Ia afferents to the motor cortex. The dysmetria and dyscoordination of target-reaching, on the other hand, was similar whether or not the low pyramidotomy was made after a previous C2 DC transection. It is tentatively suggested that dysmetria and dyscoordination of target-reaching after pyramidotomy may be due to transection of the pathway from the motor cortex which controls spinocerebellar transmission by its effect on the lateral reticular nucleus.

Nonsteroidal Antiinflammatory Drug Withdrawal in Patients with Stable Rheumatoid Arthritis

To evaluate the effect of nonsteroidal antiinflammatory drug (NSAID) withdrawal on blood pressure (BP), 44-joint Disease Activity Score (DAS44), and functional assessments in patients with stable rheumatoid arthritis (RA). NSAID was withdrawn from 30 patients with stable RA (DAS44 ≤ 2.8). Other prescribed medication continued. Clinical and laboratory measures were taken at baseline, 6 weeks, and 12 weeks. No participants required NSAID reintroduction during the study period. Significant improvement in systolic BP was noted: maximal median reduction was 7 mm Hg (baseline to 12 weeks). There was no significant deterioration in DAS44 or function. Eleven participants required additional intervention. NSAID withdrawal resulted in improvement in BP without loss of disease control.

Functioning/satisfaction with fentanyl buccal tablet compared to traditional short-acting opioids for the management of breakthrough pain in opioid-tolerant patients with chronic pain

There are limited data directly comparing different treatments for breakthrough pain (BTP). After obtaining IRB approval and informed written consent, opioid-tolerant adults with BTP who completed a randomized, double-blind, crossover study were re-randomized to fentanyl buccal tablet (FBT) or any traditional short-acting opioid (SAO) for 12 weeks of open-label treatment. Patients/clinicians completed the following functionality/satisfaction assessments: Patient Assessment of Function (PAF), Clinician Assessment of Patient Function (CAPF), Patient Global Impression of Change (PGIC), and Clinical Global Impression of Change (CGIC). All assessments were rated on a 7-point scale, from very much worsened to very much improved. 130 patients received treatment (65, FBT; 65, SAO). For the PAF, more patients receiving FBT than SAO reported improvement in 11 of 12 areas of functioning (P<0.05 for 7 areas of functioning), including improvement in enjoyment of life (72% vs 43%; P=0.001 for the distribution of responses). For the CAPF, clinicians reported that more patients improved in all 12 areas of functioning (P<0.05 for 6 areas of functioning) with FBT than SAO, including improvement in enjoyment of life (68% vs 38%; P<0.001). Responses to the PGIC and CGIC also favored FBT vs SAO (PGIC: mean [SD] 1.5 [1.02] vs 0.9 [1.09]; CGIC: 1.4 [1.01] vs 0.7 [1.05]; both P<0.001). Adverse events were generally similar between treatments and typical of opioids. In conclusion, following 12 weeks of open-label treatment, patients and clinicians reported consistently better efficacy, including functional improvement, with FBT than with traditional SAOs in opioid-tolerant patients with BTP. Supported by Cephalon, Inc. There are limited data directly comparing different treatments for breakthrough pain (BTP). After obtaining IRB approval and informed written consent, opioid-tolerant adults with BTP who completed a randomized, double-blind, crossover study were re-randomized to fentanyl buccal tablet (FBT) or any traditional short-acting opioid (SAO) for 12 weeks of open-label treatment. Patients/clinicians completed the following functionality/satisfaction assessments: Patient Assessment of Function (PAF), Clinician Assessment of Patient Function (CAPF), Patient Global Impression of Change (PGIC), and Clinical Global Impression of Change (CGIC). All assessments were rated on a 7-point scale, from very much worsened to very much improved. 130 patients received treatment (65, FBT; 65, SAO). For the PAF, more patients receiving FBT than SAO reported improvement in 11 of 12 areas of functioning (P<0.05 for 7 areas of functioning), including improvement in enjoyment of life (72% vs 43%; P=0.001 for the distribution of responses). For the CAPF, clinicians reported that more patients improved in all 12 areas of functioning (P<0.05 for 6 areas of functioning) with FBT than SAO, including improvement in enjoyment of life (68% vs 38%; P<0.001). Responses to the PGIC and CGIC also favored FBT vs SAO (PGIC: mean [SD] 1.5 [1.02] vs 0.9 [1.09]; CGIC: 1.4 [1.01] vs 0.7 [1.05]; both P<0.001). Adverse events were generally similar between treatments and typical of opioids. In conclusion, following 12 weeks of open-label treatment, patients and clinicians reported consistently better efficacy, including functional improvement, with FBT than with traditional SAOs in opioid-tolerant patients with BTP. Supported by Cephalon, Inc.

Validation analyses of the patient assessment of function and clinician assessment of patient function in patients with breakthrough pain

This study evaluated the reliability, validity, and responsiveness of the Patient Assessment of Function (PAF; a 7-item questionnaire) and the Clinician Assessment of Patient Function (CAPF; a 5-item questionnaire) in assessing the effect of breakthrough pain (BTP) on patient functioning. For this analysis, data were utilized from148 opioid-tolerant patientswho participated in a 12-week openlabel study of fentanyl buccal tablet, comprising 3 within-patient, doubleblind, placebo-controlled periods. The psychometric analyses performed included establishing the factor structure of the measures; internal consistency and test-retest reliability; construct validity; and responsiveness. The underlying factor structure (a single factor for each measure) was supported by the exploratory and confirmatory factor analyses (comparative fit index >0.9, standardized root mean residual 0.40) and the reliability analyses. Both measures showed acceptable internal consistency (Cronbach’s alpha$0.83) and test-retest reliability (most correlationsweremoderate to large). Construct validity was mixed, with generally no correlations with the Modified Oswestry, but more consistent correlations with the Profile of Mood States (POMS) Vigor subscale and Short-FormHealth Survey (SF-36).When comparing mean PAF and CAPF between patients who did and did not report $33% improvement in pain intensity during the double-blind periods (responsiveness), both measures were responsive to change (P<0.05 for most questions). The results of the confirmatory factor analyses showed high correlations (0.72–0.82) between the patient-reported PAF and the clinician-reported CAPF. In conclusion, PAF and CAPF were unidimensional, had good internal consistency and test-retest reliability, and were responsive to improvements as indicated on the pain intensity scale. These brief assessments show promise for measuring changes in functioning in patients with BTP. Supported by Cephalon, Inc.

Assessment of Pulmonary Hypertension: What CT and MRI Can Provide

<h3>Rationales and Objectives</h3> Pulmonary hypertension (PH) is a life-threatening condition, characterized by elevated pulmonary arterial pressure, which is confirmed based on invasive right heart catheterization (RHC). Noninvasive examinations may support diagnosis of PH before proceeding to RHC and play an important role in management and treatment of the disease. Although echocardiography is considered a standard tool in diagnosis, recent advances have made computed tomography (CT) and magnetic resonance (MR) imaging promising tools, which may provide morphologic and functional information. In this article, we review image-based assessment of PH with a focus on CT and MR imaging. <h3>Conclusions</h3> CT may provide useful morphologic information for depicting PH and seeking for underlying diseases. With the accumulated technological advancement, CT and MRI may provide practical tools for not only morphologic but also functional assessment of patients with PH.

Physician Assessment of Pretreatment Functional Status: A Process-Outcomes Link

Since all interventions for localized prostate cancer have a significant impact on health related quality of life, pretherapy assessment of functional status remains an essential quality of care indicator. We determined whether accurate pretherapy assessment has a significant role in forecasting health related quality of life after definitive treatment for prostate cancer. We examined data from CaPSURE™ to identify men who underwent treatment for localized prostate cancer between 1995 and 2006. We restricted our analysis to those who completed the UCLA-PCI survey before and after therapy. We performed multiple logistic regression for the outcome measure (decrease in each of the 6 UCLA-PCI domains) on the predictor (whether the physician performed an assessment that was in agreement with patient reported pretherapy status) while adjusting for clinical and sociodemographic characteristics. Of the 2,195 men included in the analysis 1,411 (64%) did not have pretherapy function documented. Of the remaining 784 men only 354 (45%) had pretherapy physician assessments that were concordant with patient reported status. On multiple logistic regression analysis men who were not assessed were more likely to experience decreased sexual function (OR 1.66, 95% CI 1.23-2.23), sexual bother (OR 1.46, 95% CI 1.09-1.97) and bowel function (OR 1.43, 95% CI 1.02-2.00) according to post-therapy UCLA-PCI scores than those who were assessed and concordant. Pretherapy functional assessment of patients with localized prostate cancer is associated with less decrease in health related quality of life. This simple yet mutable process of care measure serves as a potential target to improve quality of care for patients with prostate cancer.

Cardiopulmonary exercise testing in small abdominal aortic aneurysm: profile, safety, and mortality estimates

Few data are available regarding exercise testing in patients with abdominal aortic aneurysm (AAA) disease. The purpose of this study was to evaluate safety and to characterize the hemodynamic and cardiopulmonary (CPX) response to exercise in a large group of patients with AAA. Three hundred and six patients with AAA ≥3.0 to ≤5.0 cm (mean 72 ± 8 years) underwent CPX as part of a randomized trial of exercise training. CPX and hemodynamic responses, ischemic events, rhythm disturbances, and risk estimates based on treadmill scores were quantified and compared to an age-matched group of 2155 veterans referred for exercise testing for clinical reasons. Peak VO(2) was similar between patients with AAA and the referral group (20.0 ± 6 ml/kg/min; 77 percent of age-predicted and 20.3 ± 7 ml/kg/min; 80 percent of age-predicted, respectively). The incidence of exercise-induced hypotension and hypertension was higher in AAA patients versus the referral group (2.9 and 3.6 percent vs <1.0 percent, p < 0.001), but there were no occurrences of ventricular tachycardia (≥3 beats) or other serious events in the AAA subjects. The Duke Treadmill Score and VA Treadmill Scores, which estimate annual cardiovascular events and all-cause mortality, respectively, were similar between groups. Patients with AAA have a slightly higher incidence of hyper- and hypotensive responses to exercise than age-matched referrals, but no serious events related to CPX occurred. AAA patients can undergo maximal CPX safely and have risk scores based on treadmill test results that are similar to age-matched referral subjects. These findings extend recent studies using sub-maximal evaluations to stratify risk in patients considered for surgery, and support the routine use of exercise testing for risk evaluation and the functional assessment of patients with AAA.

M2006 Clinical, Laboratorial, Imaginological and Functional Assessment of Patients Submitted to Subtotal Splenectomy With Preservation of the Upper Splenic Pole

M2006 Clinical, Laboratorial, Imaginological and Functional Assessment of Patients Submitted to Subtotal Splenectomy With Preservation of the Upper Splenic Pole

Differential Renal Function Estimation Using Computerized Tomography Based Renal Parenchymal Volume Measurement

Nuclear renal scan is currently the gold standard imaging study to determine differential renal function. We propose helical computerized tomography as a more efficient way to gain renal function information. Renal parenchymal volume is measured and percent total renal volume is used as a surrogate marker for differential renal function. Computerized tomography and diuretic enhanced nuclear renal scan were performed in 33 patients with chronic obstruction. Computerized tomography was contrast enhanced in 23 cases and nonenhanced in 10. Diagnoses included ureteropelvic junction obstruction, ureteral stricture and extrinsic compression. Using semiautomated boundary delineation with manual editing method the parenchymal volume of each kidney was measured and percent renal volume was calculated. Percent renal volume was compared with percent renal function, as determined by nuclear renal scan. Correlations between the 2 measures were evaluated using the Spearman or Pearson coefficient. Strong correlations were observed between percent renal function and percent renal volume in all cases (r = 0.90, p <0.001), including the enhanced (r = 0.87, p <0.001) and nonenhanced (r = 0.95, p <0.001) groups. Moderately strong correlations were noted in the less than 40% (r = 0.76, p <0.001) and less than 30% (r = 0.64, p = 0.015) renal function subgroups. Differential renal volume measured from computerized tomography strongly correlates with differential renal function on nuclear renal scan for normal and chronically obstructed kidneys. Computerized tomography may serve as a single radiological diagnostic study for anatomical and functional assessment in patients in whom a poorly functioning kidney is suspected.

The validity and reliability of a 6-Metre Timed Walk for the functional assessment of patients with stroke

ABSTRACTThe 10-Metre Timed Walk (10MTW) is well established for use in assessment of patients with stroke. However, space limitations and the exhaustive nature of the test for many patients have resulted in many physiotherapists using a walk test of shorter distance. The aim of this study was to investigate the validity and reliability of a 6-Metre Timed Walk (6MTW) in patients with stroke. Forty-five patients with stroke (27 men and 18 women) participated in the study. Subjects performed two 6MTWs by using their usual walking aids. On the following day, subjects repeated the walk administered by a different tester. On a different day, subjects similarly performed two 10MTWs. Gait speed and cadence were calculated from the timed data. Isometric knee extensor strength of the paretic side was tested. Significant correlations were found between 6MTW and cadence, walking aids used, 10MTW, and isometric knee extensor strength (rho = 0.924, –0.868, 0.992, and 0.553 respectively, p < 0.0125). The ICC coefficients of test-retest and intertester reliability were 0.993 (p = 0.000) and 0.986 (p = 0.000), respectively. The 6MTW was shown to be valid and reliable for the assessment of the walking ability of patients with stroke and can be recommended especially in clinics with limited space.

W1167 Patient's Functional Assessment (PFA) Provides Insight Into the Patient's Perception for Onset of Action Using Delayed-Release Mesalamine for Ulcerative Colitis (UC)

W1167 Patient's Functional Assessment (PFA) Provides Insight Into the Patient's Perception for Onset of Action Using Delayed-Release Mesalamine for Ulcerative Colitis (UC)

Atherosclerotic Peripheral Vascular Disease Symposium II

The Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group was commissioned by the American Heart Association (AHA) to provide a forum to address important and emerging issues in this multidisciplinary area of clinical science. The working group was a primary outgrowth of the AHA Atherosclerotic Vascular Disease Conference held in Boston, Mass, in July 2002. It was created in recognition of the fact that atherosclerosis is a systemic disease with important sequelae in many regional circulations in addition to the heart, including the brain, kidneys, mesentery, and limbs. Its mission is to provide a forum for the multiple disciplines engaged in research, evaluation, and management of patients with noncoronary atherosclerosis. The goals of the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group are to develop a strategy to increase awareness of atherosclerotic vascular disease, identify important gap areas in knowledge that require further clinical investigation, and develop programs that will facilitate prevention and treatment of peripheral atherosclerotic diseases. Developments in research and technology that are relevant to atherosclerotic vascular disease are emerging rapidly. As a result, greater opportunities to translate science to clinical practice are available. The American College of Cardiology/AHA practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic) provide many evidenced-based recommendations for diagnosing and treating patients with atherosclerotic vascular diseases.1 Nevertheless, in some areas, the evidence has not matured sufficiently for definitive guidelines. Some of these areas have engendered considerable controversy among practitioners. Among these are the efficacy and outcome of screening programs for vascular disease and the appropriate and timely use of endovascular interventions. Accordingly, the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group convened the second AHA conference on Atherosclerotic Vascular Disease, which took place in Boston, Mass, in July 2006. The conference was also sponsored by the …

A randomized, double‐blind, multicenter, controlled clinical trial of chicken type II collagen in patients with rheumatoid arthritis

To assess the efficacy and safety of chicken type II collagen (CCII) in rheumatoid arthritis (RA) compared with methotrexate (MTX). We conducted a prospective, 24-week, followup, multicenter, double-blind, controlled study of CCII (0.1 mg/day) versus MTX (10 mg/week) in patients with active RA. Clinical assessments were performed at screening and at 12, 18, and 24 weeks of treatment. A total of 236 RA patients were included; 211 patients (89.4%) completed the 24-week followup. In both groups there was a decrease in pain, morning stiffness, tender joint count, swollen joint count, Health Assessment Questionnaire score, and investigator and patient assessment of function; all differences were statistically significant. In the MTX group, erythrocyte sedimentation rate and C-reactive protein level decreased. Rheumatoid factor did not change in either group. At 24 weeks, 68.57% of patients in the CCII group and 83.02% in the MTX group met the American College of Rheumatology 20% improvement criteria (ACR20), and 40.95% and 57.54%, respectively, met the ACR50 criteria. The ACR20 and ACR50 response rates in the CCII group were lower than those in the MTX group, and this difference was statistically significant (P < 0.05). Gastrointestinal symptoms were common in both groups. There were fewer and milder side effects in the CCII group than the MTX group. The difference in incidence of adverse events between the 2 groups was statistically significant (P < 0.05). CCII is effective in the treatment of RA. CCII is well tolerated, and the incidence of adverse events of CCII is lower than that of MTX.