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Objective To evaluate the benefit of niacin in addition to statin therapy on plaque regression among older individuals with established atherosclerosis. Design Randomized, controlled, double-blind clinical trial. Setting University outpatient center. Patients 145 patients older than 65 years, half of them older than 75 years of age, with established atherosclerosis were enrolled. Interventions Participants received either extended release niacin (1500 mg daily) or placebo in addition to statin therapy to reach their National Cholesterol Education Program-defined low density lipoprotein (LDL) cholesterol target. Main Outcome Measures The primary endpoint was reduction in the wall volume of the internal carotid artery (ICA) measured by MRI. Results After 18 months, high density lipoprotein cholesterol was higher with statins plus niacin compared with statins alone (1.6±0.4 vs 1.4±0.4 mmol/L p<0.001). Both groups had significant decreases in the main outcome measure of ICA wall volume, which regressed at 0.5%/month (SEM 0.2, p=0.004) in the statins plus placebo group and at 0.7%/month in the statins plus niacin group (SEM 0.2, p<0.001). There was no difference in the rate of regression between groups (p=0.49). Conclusions Treatment with statin therapy to presently recommended LDL levels, with or without niacin, resulted in significant atherosclerosis reduction.

Background: Metacarpophalangeal (MCP) joint dislocations are the result of a hyperextension injury. Complex MCP joint dislocations-those that are irreducible to closed maneuvers and require surgical intervention-are considered uncommon, even in the pediatric population. Although several structures have been identified that contribute to irreducible dislocations, the volar plate is the most significant barrier to reduction through interposition into the MCP joint. Key differences that require consideration for MCP joint dislocations in pediatric patients include ligamentous laxity, the absence of sesamoid bones, the possibility for cartilage fractures, and the possibility of growth arrest. Open surgical intervention for a complex MCP joint dislocation is performed through either the volar or dorsal approach. Controversy exists about which approach is superior. Case Report: We present the case of a 7-year-old female who sustained a complex MCP joint dislocation of the index finger. After numerous unsuccessful attempts at closed reduction, the patient underwent open reduction through the dorsal approach. The phalangeal head had buttonholed through the volar plate and was reduced by using a Freer elevator as a lever and applying gentle traction and flexion. At 4-week follow-up, the patient was pain-free and had regained nearly full range of motion of the index finger MCP joint. Conclusion: In addition to the classic volar and dorsal approaches, different techniques have been used to reduce complex dislocations in pediatric patients, including arthroscopic surgery, a percutaneous technique with manipulation of a skin hook, and a percutaneous technique with a dorsal incision. As demonstrated in this case, open reduction through the dorsal approach remains a viable treatment option for complex MCP joint dislocations in the pediatric population.

Up-regulation and activation of epidermal growth factor receptor and/or urokinase-type plasminogen activator receptor in a variety of cancers have been shown to be associated with poor prognosis. High molecular weight kininogen can be hydrolyzed by plasma kallikrein to bradykinin and HKa. HKa and its domain 5 (D5) both have been demonstrated to have potent anti-angiogenic activity. We now show that HKa blocks human prostate cancer cell (DU145) migration by 76.0±2.4% at 300nM and invasion by 78.0±12.9% at 11.1nM. D5 inhibits tumor migration and invasion in a concentration-dependent manner. Stimulation by bFGF or VEGF results in clustering of uPAR and EGFR on the surface of DU145 cells. The co-localization of uPAR and EGFR is prevented by HKa. Immunoprecipitation suggests that uPAR, EGFR and α5β1 integrin formed a ternary complex. Immunoblotting demonstrates that HKa significantly decreases the bFGF-transactivated phosphorylation of EGFR at Tyr 1173 between 30min and 4hr. The phosphorylation of ERK and AKT, which are downstream effectors of EGFR, is also inhibited by HKa. These novel data indicate that HKa and D5 inhibit migration and invasion of human prostate cancer cells via a EGFR/uPAR pathway, suggesting the therapeutic potential of HKa and D5 to decrease metastasis of human prostate cancer.