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The resolution of chronic inversion and plantarflexion of the foot: a pediatric case study. Ellis W.B., Ebrall, P.S. Chiropractic Technique Vol. 3, No. 2 May 1991. Receptor based manipulative lesions in children who toe walk. Press H. Proceedings of the National Conference on Chiropractic and Pediatrics. Oct, 1993 Palm Springs, CA. Pub. International Chiropractors Assoc., Arlington, VA. Eight children, four normal and four toe walkers were studied. The four toe walkers were diagnosed with childhood schizophrenia. All eight children vocalized, verbalized, and appeared more alert and responsive after manipulation of the cervical spine. The four abnormal toe walkers demonstrated restoration of joint position sense, increased mobility of the cervical spine. Parents of all four children reported no observable dysplagia during family meals since the children's second chiropractic ; visit. In addition, the parents reported undisturbed and less disrupted sleeping patterns since the initial adjustment. After 180 days, the children did not exhibit any toe walking. Their family physicians reported normal urinalysis and restoration of the normal cervical lordosis in all four abnormal children. ADD, Enuresis, Toe Walking. International Chiropractic Pediatric Association Newsletter May June 1997. From the records of Rejeana Crystal, D.C., Hendersonville, TN. A six year old boy with nightly nocturnal enuresis bedwetting ; , attention deficit disorder and toe walking. He walked with his heels 4 inches above the ground. The medical specialist recommended that both Achilles' tendons be cut and both ankles be broken to achieve normal posture and gait. Chiropractic findings included subluxation of atlas, occiput, sacrum and pelvis.after 4 weeks of care both heels dropped 2 inches and the bedwetting frequency decreased to 2-3 times per week. His doctor could not believe how chiropractic care made such a change. The side-effects of the chiropractic adjustment. Arno Burnier, D.C. Chiropractic Pediatrics Vol. 1 No. 4 May 1995. J.C., 1-year-old male was diagnosed with post-viral enteritis, c.difficile enteritis, colitis secondary to antibiotic usage, allergic colitis, gastroesophageal reflux with esophagitis, gastric and or duodenal ulcer disease, duodenitis secondary to congenital or autoimmune phenomenon, Club feet requiring surgery. Medication: Amoxicillin, Zantac, Reglan, Tylenol, and Ambesol. Chiropractic results: Off all medication after first visit. Immediate improvement within 24 hours. Complete resolution within 3 weeks of care. Six months later the child is in radiant health, has had no need for medical care and has been free of medication and over-thecounter drugs. Club feet straightened out without surgery within 1 2 months of care. Presenting Subluxation Findings: Occiput C1 with an Atlas ASRP, Sacrum base posterior. Original Adjustments: Left occiput ridge meningeal contact for 30 seconds, double notch sacral meningeal contact for 1 minute; structural manual adjustment of Atlas ASRP, left Temporoparietal suture adjustment.

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Table 2 Respondent GPs and patient referral to the WSH Pain Clinic n 46 ; The GPs were asked if they thought that the pain clinic input had any effect on both the number of patients' subsequent contact with GP or in requests for home visits. More GPs thought that patients requested less home visits 47% vs. % ; , but there was little difference in number of subsequent contact visits, with 4% saying they felt that the patients had fewer appointments and 48% feeling they had about the same. The next section asked what services the GPs wished the pain clinic to provide, whether they had or had not referred patient in the past. The services the pain clinic currently offers are marked with an asterix see Table ; . The results of our survey of GPs show that the GPs who refer patients to the service are very satisfied with the treatment, follow-up and aftercare that their patients receive - albeit less than satisfied with the waiting times for first appointment. They are Had referred a patient Nerve Blocks * Medication Review * Opioid initiation * TENs * Acupuncture * Cancer Fast-track * Counseling * Psychology OT Rehabilitation Nurse Outreach GP Education 41 24 20 also happy with the advice that they can get from the pain clinic. They also believe that the patients require fewer home visits and about half feel that contact visits with the GP have decreased. All the GPs surveyed felt that the pain clinic was a valuable resource, whether they personally had referred patients or not, and most felt that a wide range of treatment should be available. The GPs indicated a high preference for the services currently offered: 70% wanted to have a nerve block interventional pain service, 58% wanted a TENS service, and 56% wanted acupuncture. Interestingly, psychology which is not currently offered ; scored highly 55% ; and counseling which is offered ; scored lower 7% ; . This probably reflects the large evidence base for the success of CBT in the treatment of chronic pain vs. the more Had NOT referred a patient 98 62 44 Total open-ended transpersonal approach. The majority of respondents did not believe there should be a set limit on follow-up appointments see Fig 2, next page and naprelan.

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Prostate tumor cells preferentially adhere to bone marrow endothelial cells BMECs ; compared with endothelial linings from other tissue microvessels, implicating the importance of BMEC adhesion in the predilection of prostate tumor metastasis to bone. E endothelial ; -selectin, which functions as an initiator of leukocyte adhesion to target tissue endothelium, is constitutively expressed on BMECs, suggesting that prostate tumor cells could use this adhesive mechanism to initiate their migration into bone. In this report, we demonstrate for the first time that human bone-metastatic prostate tumor cells roll on human BMECs under physiological flow conditions. We show that these dynamic adhesive interactions are dependent on the expression of BMEC E-selectin and sialylated glycoconjugates on bone-metastatic prostate tumor cells. We also establish the importance of both glycoprotein s ; and glycosphingolipid structures displaying sialyl Lewis X epitopes as potential E-selectin ligands on bonemetastatic prostate tumor cells. Coexpression of sialylated glycoproteins and glycolipids on bone-metastatic prostate tumor cells triggers robust E-selectin binding activity, which is identical to that observed on human hematopoietic progenitor cells. By Western blot analysis, we identify candidate E-selectin glycoprotein ligand s distinct sialyl Lewis X or HECA-452 antigen ; -bearing membrane proteins were resolved at Mr 130, 000 and Mr 220, 000 as well as others ranging from Mr 100, 000 to Mr 220, 000. Immunohistochemical analysis of HECA-452 antigen expression on normal prostate tissue and on low- and high-grade prostate adenocarcinoma shows that HECA-452 antigen expression is directly associated with prostate tumor progression and may indicate acquisition of E-selectin ligand expression. These findings provide novel insight into potential adhesive mechanisms promoting hematogenous dissemination of prostate tumor cells into bone. Median CD4 + count at the time of immunological failure, for those who failed was 230 cells l IQR 120 340 cells l ; . In multivariate Cox regression model four factors were found to be significantly associated with an increased risk of immunological failure: pre-HAART CD4 + count per 50 % higher RH 2.11, 95 % CI 1.87 - 2.37, p 0.0001 ; , time-updated pVL per 1 log1 0 higher RH 1.74, 95 % CI 1.61 - 1.89, p 0.0001 ; , 5 drugs in HAART regimen compared to 3 drugs RH 1.83, 95 % CI 1.14 - 2.93, p 0.012 ; , and risk group being intravenous drug use compared to male homosexuality RH 1.55, 95 % CI 1.19 - 2.02, p 0.0011 and viramune and reglan, for example, dhe reglan.

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Purpose: Rickets is a preventable cause of permanent and severe physical disability in children. Reports of vitamin D deficiency rickets have increased over the last few years, including in children living in climates with abundant sunshine. The purpose of our study was to describe vitamin D recommendation practices and the criteria health care providers use in recommending vitamin D supplementation in Las Vegas. Methods: This study was a cross-sectional survey of pediatricians, family physicians and nurse practitioners practicing in an outpatient setting in Las Vegas more than 10% of their time. We faxed the survey to subjects, following an initial phone call to invite their participation. We analyzed data using frequency statistics on demographic variables. Chi-square, t-tests and multivariate analyses were used to develop a predictive model of vitamin D supplementation. Results: Preliminary data from 60 health care providers was collected. 55% of providers did not recommend vitamin D supplementation for solely breastfed babies. Personal spousal breastfeeding experience, experience with cases of rickets, taking a history of infants' sun exposure, and training in less sunny climates were the strongest predictors of vitamin D recommendation. A discrepancy existed between providers' knowledge of nutritional rickets and their practice of recommending supplementation. Conclusion: Current data suggests vitamin D supplementation for all infants who are solely breastfed. Approximately 42% of pediatricians in Las Vegas do not recommend vitamin D supplementation for solely breastfed babies. Fifteen years ago, in a similar survey conducted by Hayward et al, 29% of pediatricians in San Diego did not recommend supplementation. Data collected from 90 additional providers in the next 3 months will give us the desired sample size for our study. This information could serve in needs assessment for planning educational activities for health care providers, for instance, reflan nursing.
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