Volume 106, Issue 3

Muscle energy technique is an established osteopathic manipulative intervention often used to treat somatic dysfunctions of the spine. There are little objective data to demonstrate its efficacy, however. To determine the efficacy of this osteopathic manipulative technique, the authors compared active cervical range of motion among asymptomatic young and middle-aged adults (n=18) before and after this treatment protocol, comparing those results against matched control subjects (n=14) who received sham manipulative treatment. Range of motion was measured in three planes (flexion/extension, lateral bending, rotation) on all subjects (N=32) using a motion-analysis system. Multiplanar gross cervical motion restrictions were diagnosed in this asymptomatic population. In the treatment group, cervical long restrictor muscles were treated with the muscle energy technique in the sagittal, frontal, and horizontal planes. The control group had relative restrictions addressed by means of a sham manipulative treatment protocol in which the barriers to motion were not challenged therapeutically. The muscle energy technique produced a significant increase in overall regional cervical range of motion in the treatment group (approximately 4 degrees) when compared with control subjects ( P <.001). Significant differences were also observed in the magnitude of change in the three planes of movement (rotation, P <.002; lateral bending, P <.01), with flexion/extension being the least affected ( P =.2). These data demonstrate that the application of the muscle energy technique can produce acute increases in the active cervical range of motion in asymptomatic subjects.

Celiac disease is a gastrointestinal disorder characterized by inflammation, leading to injury to the mucosal lining of the small intestine. The inflammation occurs when gliadin, a protein found in such gluten-containing foods as wheat, rye, and barley, is ingested by genetically susceptible individuals. The mucosal damage and subsequent malabsorption of nutrients leads to various complications. Researchers estimate that more than 2 million people in the United States have celiac disease—a prevalence that is greater than was previously believed. Approximately 60,000 Americans are diagnosed annually with celiac disease. Until recently, diagnosis has been complicated by the fact that the indicators of celiac disease are nonspecific. However, because of the development of new, easy-to-administer serology tests, diagnosis has become much less complicated. After conducting a review of the literature, the authors recommend a serologic testing sequence for diagnosis of celiac disease and urge that adults and children with an assortment of symptoms be tested for this disease. Common signs and symptoms of celiac disease include anemia, arthralgia, fatigue, infertility, neuropathy, and weight loss, in addition to such gastrointestinal symptomatology as abdominal pain, anorexia, bloating, constipation, and diarrhea. The only treatment for patients with celiac disease remains a gluten-free diet.

Context: There has been an increase in research evaluating factors associated with disciplinary action of physicians by state medical boards. However, factors related to the severity of disciplinary action are lacking. By investigating these factors while controlling for the type of violation, the authors sought to determine whether physician characteristics influenced the process of disciplinary action by state medical boards. Methods: Physicians disciplined by the Texas Medical Board between January 1, 1989, and December 31, 1998, were included in this case-controlled study (N=1129). Multivariate logistic regression analysis was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with license revocation, the most severe disciplinary action, compared with all other forms of disciplinary action combined. Results: Anesthesiologists (OR, 2.45; 95% CI, 1.05–5.74), general practitioners (OR, 1.80; 95% CI, 1.01–3.19), and psychiatrists (OR, 2.68; 95% CI, 1.41–5.13), as well as those with multiple disciplinary actions (OR, 1.91; 95% CI, 1.29–2.83) were most susceptible to license revocation. The more years a disciplined physician was in practice, the greater risk he or she had of license revocation (OR, 1.05; 95% CI, 1.04–1.07). Conclusions: Factors associated with a greater likelihood of license revocation for physicians are: primary medical specialty, number of years in practice, and a history of multiple disciplinary actions.

Context: Normal physiologic movement, pathologic conditions, and osteopathic manipulative treatment (OMT) are believed to produce effects on the shape and proliferation of human fibroblasts. Studies of biophysically strained fibroblasts would be useful in producing a model of the cellular mechanisms underlying OMT. Objective: To investigate the effects of acyclic in vitro biophysical strain on normal human dermal fibroblasts and observe potential changes in cellular shape and proliferation, as well as potential changes in cellular production of nitric oxide, interleukin (IL) 1β, and IL-6. Design and Methods: Randomized controlled trial. Human fibroblasts were subjected in vitro to control conditions (no strain) or biophysical strain of various magnitudes (10%–30% beyond resting length) and durations (12–72 hours). After control or strain stimuli, fibroblasts were analyzed for potential changes in cell shape, proliferative capacity, nitric oxide secretion, and cytokine (IL-1β, IL-6) secretion. Results: Low strain magnitudes (<20%) induced mild cellular rounding and pseudopodia truncation. High strain magnitudes (>20%) decreased overall cell viability and the mitogenic response, and induced cell membrane decomposition and pseudopodia loss. No basal or strain-induced secretion of IL-1β was observed. Interleukin 6 concentrations increased two-fold, while nitric oxide levels increased three-fold, in cells strained at 10% magnitude for 72 hours ( P <.05). Conclusion: Human fibroblasts respond to in vitro strain by secreting inflammatory cytokines, undergoing hyperplasia, and altering cell shape and alignment. The in vitro biophysical strain model developed by the authors is useful for simulating a variety of injuries, determining in vivo mediators of somatic dysfunction, and investigating the underlying mechanisms of OMT.