Volume 107, Issue 12

Context : Clinical studies have supported the efficacy of a variety of osteopathic manipulative techniques. However, an evidence base for the cellular mechanisms underlying these clinical findings is lacking. Objective : To investigate human fibroblast proliferation and interleukin secretory profiles in response to modeled repetitive motion strain (RMS) and modeled indirect osteopathic manipulative techniques (IOMT). The authors hypothesized that the RMS model would increase fibroblast proliferation and proinflammatory interleukin secretion, while the IOMT model would reverse these effects. Methods : Human fibroblasts were exposed in vitro to one of three conditions: (1) an 8-hour RMS; (2) a 60-second IOMT; or (3) an 8-hour RMS followed by a 60-second IOMT. Data on fibroblast proliferation and interleukins present in conditioned media were obtained immediately after RMS, at 24 hours after RMS (24RMS), at 24 hours after IOMT (24IOMT), and at 24 hours after RMS and IOMT (24RMS+IOMT). Cytokine protein array and enzyme-linked immunosorbent assay were used in data analysis. Fibroblast proliferation was also measured colorimetrically with a cell proliferation assay. Results : Fibroblasts that underwent RMS secreted several proinflammatory interleukins 24 hours after strain cessation, with substantially increased secretion of IL-1α, IL-1β, IL-2, IL-3, IL-6, and IL-16. At 24 hours after strain cessation, fibroblasts subjected to RMS also secreted increased amounts of the anti-inflammatory IL-1ra, and they displayed 15% less proliferation, compared with baseline cells ( P <.05). Fibroblasts that underwent IOMT, when analyzed at 24 hours after IOMT, did not display increased interleukin secretion or proliferation. However, they did display a 44% reduction in proinflammatory IL-3 secretion when compared with baseline cells ( P <.05). The use of 24RMS+IOMT did not induce interleukin secretion in fibroblasts that were analyzed 24 hours after the combined exposure. However, cells in the 24RMS+IOMT group did display a 46% reduction in proinflammatory IL-6 secretion compared with RMS alone (24RMS; P <.05), as well as a 51% increase in proliferation compared with the 24RMS group ( P <.05). Conclusion : An in vitro strain model that simulates RMS has different effects on fibroblast proliferation and interleukin secretion than does an in vitro model that simulates IOMT. Modeled RMS appears to cause a reduction in fibroblast proliferation and a delayed inflammatory response. Modeled IOMT not only fails to induce this response, it also reverses inflammatory effects in cells that have been strained repetitively. Data from the present study suggest that fibroblast proliferation and expression/secretion of proinflammatory and anti-inflammatory interleukins may contribute to the clinical efficacy of indirect osteopathic manipulative techniques.

The degree to which osteopathic physicians (DOs) take care of their own health is of interest not only to the osteopathic medical community, but also to physicians' patients. The American Osteopathic Association (AOA) Committee on Physician Health asked attendees at the July 2001 AOA House of Delegates Annual Business Meeting in Chicago, Ill, to complete a one-page survey on their personal health practices. This survey comprised 22 questions on such items as vacation and personal time, exercise habits, weight control, tobacco and alcohol use, and regular physical examinations and medical screening. Two hundred ninety-nine attendees completed the survey during the 15 minutes immediately after the report of the Committee on Physician Health (response rate: ∼75%). The results indicate that DOs are similar to the proverbial patient in terms of personal health practices. Although DOs follow some physicians' orders, they do not follow others. Most DOs take regular vacations and daily personal time, and they get some of their recommended physical examinations and medical screenings. The authors suggest that DOs pay greater attention to their exercise habits, weight control, and signs of substance abuse.

Context: President George W. Bush announced a national smallpox vaccination program (SVP) on December 13, 2002, for military personnel, civilian healthcare workers, and “first responders.” The program was intended to protect these individuals against exposure to weaponized smallpox. The US Air Force (USAF) began implementation of the SVP on January 7, 2003. Objectives: To determine if the SVP affected USAF personnel readiness, and, based on these results, to determine the overall safety of a large-scale SVP. Methods: A retrospective cohort study of duty-restriction rates measured by duties not to include flying (DNIFs) of C-17 aircrews in the USAF Air Mobility Command (AMC). Data from January 2002 to May 2002 (prevaccination) and January 2003 to May 2003 (vaccination) were compiled by month from three of the 11 AMC bases. Total DNIFs associated with or attributed to the smallpox vaccine were recorded. In addition, total 2003 DNIFs in 1662 study subjects (678 [40.8%] of whom received smallpox vaccination) were recorded and compared with total 2002 DNIFs in 1602 control subjects before SVP implementation. Differences in monthly DNIF rates were calculated using the one-tailed paired t test. Results: In the 678 subjects who received smallpox vaccination, 13 vaccine-related DNIFs (1.9%) occurred. Differences in DNIF rates were statistically significant ( P <.05) during 2 months at one AMC base. However, the SVP did not increase overall DNIF rates in the SVP study period. Conclusions: With DNIF status as a health marker, the SVP did not impose operational constraints or adversely affect aircrew preparedness in the USAF AMC. The authors suggest that a similar SVP with comparable screening measures would indicate the overall safety of the vaccine.

Chronic gout and rheumatoid arthritis are common medical manifestations with debilitating effects on patients. However, these conditions are not typically identified concomitantly and can be hard to distinguish from one another. We report a rare case of a 50-year-old white woman with a history of chronic gout and rheumatoid arthritis who presented with intradermal tophaceous gout. Physical examination and laboratory results are described.

Context: A 2001 survey of 19 colleges of osteopathic medicine (COMs) revealed that standardized patient programs (SPPs) are increasingly used in osteopathic medical education. However, no new data have been published since. Objectives: To evaluate current SPP and mechanical simulator use at COMs compared with previous survey results. Methods: In 2005, an electronic survey regarding the use of SPPs (eg, staffing, facilities) and mechanical simulators in the teaching and assessment of students' clinical skills was sent to the deans of the 23 fully accredited COMs and branch campuses. Results: Responses were received from all 23 COMs for a 100% response rate. According to survey results, 19 COMs (87%) had active SPPs, 2 COMs (9%) reported that SPPs were in development, and the remaining 2 COMs (9%) used students as patients. In comparison, only 12 COMs (63%) in 2001 had active SPPs. Results indicated an increased use of standardized patients for assessment, particularly in physician-patient communication, osteopathic manipulative medicine, and osteopathic manipulative treatment. In addition, 12 COMs (52%) reported using mechanical simulators in the teaching or assessment of clinical skills. Conclusion: From 2001 to 2005, the use of SPPs and mechanical simulators at COMs increased substantially.