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Sample records for biomechanics clinical aspects

  1. Structural and biomechanical aspects of equine sacroiliac joint function and their relationship to clinical disease.

    PubMed

    Goff, L M; Jeffcott, L B; Jasiewicz, J; McGowan, C M

    2008-06-01

    Pain originating from the sacroiliac joint (SIJ) in horses has long been associated with poor performance, yet specific diagnosis of sacroiliac dysfunction (SID) has been difficult to achieve. Clinical presentation of SID appears to fall into two categories. The first, presenting as pain and poor performance, is responsive to local analgesia of periarticular structures with poorly defined pathology. The second presents primarily as poor performance with bony pathological changes as a result of chronic instability. Diagnostic tests based on biomechanics as well as manual provocation for SIJ pain have formed the basis of tests currently used to diagnose SIJ dysfunction in humans. This review summarises the anatomy and biomechanics of the equine SIJ and current biomechanical, innervation and motor control concepts in human SID. The relationship between abnormal SIJ motion and altered neuromotor control with clinical disease of the equine SIJ are discussed. Future utilisation of these principles to develop new diagnostic and management tools for the equine SID is promising.

  2. [The sterno-clavicular joint: anatomy, biomechanic, clinical features and aspects of manual therapy].

    PubMed

    Frosi, G; Sulli, A; Testa, M; Cutolo, M

    2004-01-01

    The sterno-clavicular joint covers one remarkable importance in the complex of the shoulder girdle. This review investigates the anatomy, biomechanics, main affections and involvement of this joint in the pathological processes of the shoulder girdle in its complex. Moreover, it focuses on the opportunities offered from the conservative treatment, using in particular the manual therapy. Active and passive, as well as against isometric resistance movements, are discussed. In particular, the passive mobilization is demonstrated effective in the restoration of joint mobility. The sterno-clavicular joint is not structured in order to complete great work loads and has the tendency to become hypermotile or unstable, if subordinate to overload works, becoming painful. In this case, the techniques of passive mobilization and of modulation of the pain turn out effective.

  3. Clinical applications of biomechanics cinematography.

    PubMed

    Woodle, A S

    1986-10-01

    Biomechanics cinematography is the analysis of movement of living organisms through the use of cameras, image projection systems, electronic digitizers, and computers. This article is a comparison of cinematographic systems and details practical uses of the modality in research and education. PMID:2946390

  4. Musculoskeletal demands on flamenco dancers: a clinical and biomechanical study.

    PubMed

    Bejjani, F J; Halpern, N; Pio, A; Dominguez, R; Voloshin, A; Frankel, V H

    1988-04-01

    The flamenco dancer acts on the floor like a drummer. The percussive footwork and vibration patterns created during dancing impose unusual demands on the musculoskeletal system. This study investigated the clinical and biomechanical aspects of this task. Using the electrodynogram and skin-mounted accelerometers, foot pressures as well as hip and knee vibrations were recorded in 10 female dancers after a thorough clinical evaluation. A health questionnaire was also distributed to 29 dancers. Foot pressures and acceleration data reveal the percussive nature of the dance. Some clinical findings, like calluses, are related to pressure distribution. Urogenital disorders, as well as back and neck pain, may be related to the vibrations generated by the flamenco dance form. The hip joint seems to absorb most of the impacts. "Vibration-pressure" diagrams are suggested as a useful tool for evaluating a dancer's biomechanical behavior, as well as the effect of floors and footwear on this behavior. PMID:3366430

  5. Using Clinical Gait Case Studies to Enhance Learning in Biomechanics

    ERIC Educational Resources Information Center

    Chester, Victoria

    2011-01-01

    Clinical case studies facilitate the development of clinical reasoning strategies through knowledge and integration of the basic sciences. Case studies have been shown to be more effective in developing problem-solving abilities than the traditional lecture format. To enhance the learning experiences of students in biomechanics, clinical case…

  6. The Chêneau concept of bracing--biomechanical aspects.

    PubMed

    Rigo, Manuel; Weiss, Hans-Rudolf

    2008-01-01

    Current concept of bracing must take in consideration both the three-dimensional (3D) nature of Adolescent Idiopathic Scoliosis (AIS) and its pathomechanism of progression. A modern brace should be able to correct in 3D in order to break the so called 'vicious cycle' model. Generally speaking, it is necessary to create detorsional forces to derotate in the transversal plane, to correct the lateral deviation in the frontal plane and to normalize the sagittal profile of the spine. Breathing mechanics can be used to fight against the thoracic structural flat back. The original Chêneau brace was introduced at the end of the 70's and its principles were based more in anatomical observations rather than in biomechanics. A further evolution , enunciating new principles, has allowed a higher standard, improving in brace corrections and trunk modelling. This biomechanical principles have been developed under the name of Rigo-Chêneau-System (RSC) and used later in latest brace models like the Chêneau light with reduced material, and similar in brace corrections. Experience is also important to improve the end results. The blueprints to built the brace according to the anatomorradiological pattern are very helpful.

  7. Biomechanical Aspects of the Muscle-Bone Interaction

    PubMed Central

    Avin, Keith G.; Bloomfield, Susan A.; Gross, Ted S.; Warden, Stuart J.

    2014-01-01

    There is growing interest in the interaction between skeletal muscle and bone, particularly at the genetic and molecular levels. However, the genetic and molecular linkages between muscle and bone are achieved only within the context of the essential mechanical coupling of the tissues. This biomechanical and physiological linkage is readily evident as muscles attach to bone and induce exposure to varied mechanical stimuli via functional activity. The responsiveness of bone cells to mechanical stimuli, or their absence, is well established. However, questions remain regarding how muscle forces applied to bone serve to modulate bone homeostasis and adaptation. Similarly, the contributions of varied, but unique, stimuli generated by muscle to bone (such as low-magnitude, high-frequency stimuli) remains to be established. The current article focuses upon the mechanical relationship between muscle and bone. In doing so, we explore the stimuli that muscle imparts upon bone, models that enable investigation of this relationship, and recent data generated by these models. PMID:25515697

  8. [Electronic glottography (clinical aspects)].

    PubMed

    Chernobel'skiĭ, S I

    1991-01-01

    In order to study the application of electronic glottography in clinical laryngology, 200 patients with different diseases were examined, using a glottographic unit, computer, oscilloscope, and a recorder. It was found that glottography is an objective method which can be applied to evaluate and detect disorders of vocal folds in different states. This method fails to determine the vibration capacity of an individual fold or diagnose laryngeal lesions without an additional examination.

  9. Applications of artificial neural nets in clinical biomechanics.

    PubMed

    Schöllhorn, W I

    2004-11-01

    The purpose of this article is to provide an overview of current applications of artificial neural networks in the area of clinical biomechanics. The body of literature on artificial neural networks grew intractably vast during the last 15 years. Conventional statistical models may present certain limitations that can be overcome by neural networks. Artificial neural networks in general are introduced, some limitations, and some proven benefits are discussed.

  10. Clinical aspects of melatonin.

    PubMed

    Reiter, Russel J; Korkmaz, Ahmet

    2008-11-01

    Melatonin is produced in the human pineal gland, particularly at night, with the circadian rhythm of blood melatonin levels closely paralleling its production within the pineal gland. Light exposure at night, or rapid transmeridian travel severely compromises the circadian production of melatonin. The disturbed melatonin rhythm contributes to jet lag and sleep inefficiency, both of which are improved by melatonin administration. Melatonin is also a highly effective direct free radical scavenger and antioxidant. In this capacity, melatonin reduces experimental cataractogenesis, traumatic injury to the spinal cord and brain, and protects against oxidative damage to neurons and glia in models of stroke, Parkinsonism, and Alzheimer's disease. Additionally, melatonin and its metabolites are highly effective in protecting against ionizing radiation. Finally, melatonin may be a treatment for hypertension. Melatonin's high efficacy, its high safety profile, and its virtual lack of toxicity make it of interest in clinical medicine. PMID:18997997

  11. Clinical aspects of neurocysticercosis.

    PubMed

    Takayanagui, Osvaldo M; Odashima, Newton Satoru

    2006-01-01

    The clinical features of neurocysticercosis (NCC) largely depend on the number, type, size, localization and stage of development of cysticerci, as well as on the host immune response against the parasite. Seizures are widely reported to be the most common symptom, occurring in 70-90% of patients, while NCC is considered to be the main cause of late-onset epilepsy in endemic areas. When cysticerci lodge within the ventricular system, life-threatening acute intracranial hypertension secondary to hydrocephalus may develop. Cysts in the subarachnoid space may invade the Sylvian fissure and grow to large sizes (giant cysts) causing intracranial hypertension with hemiparesis, partial seizures or other focal neurological signs. Racemose cysts in the basal cisterns can cause an intense inflammatory reaction, fibrosis and progressive thickening of the leptomeninges at the base of the brain. In approximately 60% of the cases, there is an obstruction of the cerebrospinal fluid (CSF) circulation, resulting in hydrocephalus and intracranial hypertension. When hydrocephalus secondary to cysticercotic meningitis is present, the mortality rate is high (50%) and most patients die within 2 years after CSF shunting. Therefore, ventricular and basal cisternal locations are considered to be malignant forms of NCC. The diagnosis of NCC is based upon neuroimaging studies, laboratory analysis of the CSF and antibody detection in the serum. Nowadays, albendazole is considered the medication of choice for the therapy of NCC. Its main use is for symptomatic patients showing multiple viable brain parenchymal cysticerci.

  12. Clinical aspects of telemedicine

    NASA Technical Reports Server (NTRS)

    Merrell, Ronald C.

    1991-01-01

    Communication among physicians is an essential in order to combine our experiences for the elucidation and application of new knowledge and for the accurate and uniform application of established medical practice. This communication requires an adequate understanding of the culture of the patient and the social context of disease and indeed the culture of the physician. Malnutrition in Bangladesh means caloric insufficiency, and a program to lower cholesterol would be impertinent, while a program to enhance the nutrition of patients in Texas by an international effort to import more grain would be ludicrous. In the same vein a public health effort to combat alcoholic cirrhosis in Mecca would be as silly as a program to increase fiber in the diet of the Bantu. Clinical communication must acknowledge the culture of the issue at hand and the differences in the experiential base of the physicians. Not only do geography and culture affect the potential differences in the experiential bases, but the world utilizes very different traditions of education and science in training physicians. We are influenced by the diseases we treat, and learn to look for the expected at least as much as we are attentive to the unexpected. A physician in Siberia would be much more likely to recognize frostbite than one from Buenos Aires, and the Argentine doctor would much more likely consider Chaga's Disease to explain abdominal pain than a colleague in Zurich. Beyond these obvious issues in communication among physicians we must deal with the many languages and idioms used in the world. An overview of using Telemedicine SpaceBridge after the earthquake in the Republic of Armenia in 1988 is presented.

  13. Biomechanical aspects of two different implant-prosthetic concepts for edentulous maxillae.

    PubMed

    Benzing, U R; Gall, H; Weber, H

    1995-01-01

    Two essentially different implant-prosthetic concepts are known for the treatment of edentulous maxillae. One concept propagates a "concentrated" arrangement of four to six implants in the premolar and anterior regions with a fixed cantilever superstructure. An alternative is a "spread-out" implant arrangement of six implants placed in the tuberosity, premolar, and anterior regions. The prosthetic rehabilitation consists of a fixed horseshoe-shaped bar and a removable prosthesis. A cantilever situation is avoided. The biomechanical aspects of these implant-prosthetic concepts were studied with clinical strain-gauge measurements and theoretical three-dimensional analysis using the finite element method. Results revealed that the distribution of bone stresses is more favorable with a spread-out implant arrangement than with a concentrated implant arrangement and cantilever restoration. The resistance to bending of a superstructure has an influence on bone stress concentration that should not be ignored. Stresses are controlled not only by the number or distribution of implants, but also by the material and design of the superstructure. PMID:7744438

  14. Clinical, biomechanical and histological study on oophorectomy induced menopause

    PubMed Central

    Bordinhon, Maristela; Müller, Sérgio Swain; Silva, Maeli Dal Pai

    2014-01-01

    Objective: To investigate the clinical implications as well as biomechanical and histological changes and in bone tissue induced by ovariectomy in 64 rats. Methods: The rats were divided into two groups: bilateral oophorectomy or placebo, and subdivided into four subgroups, according to time postoperatively: three, six, nine and 12 months. The weight of the animals at the time of sacrifice was taken into consideration. The biomechanical study was performed on the right tibia, to the maximum load and stiffness coefficient. For the histological study we calculated the trabecular bone of the left tibia. Statistical analysis of body weight and mechanical properties was performed by variance analysis, complemented with Tukey's multiple comparison tests; and trabecular area, the non-parametric variance analysis. Results: Ovariectomy-induced menopause caused an increase in body weight, reduction of diaphyseal bone resistance at six months of hormone deprivation, but this effect is equalized over time by aging; bone stiffness was smaller in the ovariectomized group and reduction of bone mass occurred. Conclusion: The removal of the ovaries produced systemic alterations, characterized by metabolic changes that caused weight gain and changes in bone tissue, associated with alteration of the mechanical profile and reduced bone mass. Level of Evidence I, Clinical Study. PMID:25328434

  15. Weightbath hydrotraction treatment: application, biomechanics, and clinical effects

    PubMed Central

    Kurutz, Márta; Bender, Tamás

    2010-01-01

    Background and purpose: Weightbath hydrotraction treatment (WHT) is a simple noninvasive effective method of hydro- or balneotherapy to stretch the spine or lower limbs, applied successfully in hospitals and health resort sanitaria in Hungary for more than fifty years. This study aims to introduce WHT with its biomechanical and clinical effects. History, development, equipment, modes of application, biomechanics, spinal traction forces and elongations, indications and contraindications of WHT are precented. Subjects and methods: The calculation of traction forces acting along the spinal column during the treatment is described together with the mode of suspension and the position of extra weight loads applied. The biomechanics of the treatment are completed by in vivo measured elongations of lumbar segments using a special underwater ultrasound measuring method. The clinical effects, indications, and contraindications of the treatment are also presented. Results: In the underwater cervical suspension of a human body, approximately 25 N stretching load occurs in the cervical spine, and about 11 N occurs in the lumbar spine. By applying extra weights, the above tensile forces along the spinal column can be increased. Thus, the traction effect can be controlled by applying such loads during the treatment. Elongations of segments L3–L4, L4–L5, and L5–S1 were measured during the usual WHT of patients suspended cervically in water for 20 minutes, loaded by 20–20 N lead weights on the ankles. The mean initial elastic elongations of spinal segments were about 0.8 mm for patients aged under 40 years, 0.5 mm between 40–60 years, and 0.2 mm for patients over 60 years. The mean final viscoelastic elongations were 1.5 mm, 1.2 mm, and 0.6 mm for the same age classes, respectively. No significant difference was found between the sexes regarding age-dependence in tension. WHT for discopathy showed significant improvement of clinical parameters, which was still evident

  16. Tularaemia: clinical aspects in Europe.

    PubMed

    Maurin, Max; Gyuranecz, Miklós

    2016-01-01

    Tularaemia is a zoonotic disease caused by Francisella tularensis, a Gram-negative, facultative intracellular bacterium. Typically, human and animal infections are caused by F tularensis subspecies tularensis (type A) strains mainly in Canada and USA, and F tularensis subspecies holarctica (type B) strains throughout the northern hemisphere, including Europe. In the past, the epidemiological, clinical, therapeutic, and prognostic aspects of tularaemia reported in the English medical literature were mainly those that had been reported in the USA, where the disease was first described. Tularaemia has markedly changed in the past decade, and a large number of studies have provided novel data for the disease characteristics in Europe. In this Review we aim to emphasise the specific and variable aspects of tularaemia in different European countries. In particular, two natural lifecycles of F tularensis have been described in this continent, although not fully characterised, which are associated with different modes of transmission, clinical features, and public health burdens of tularaemia.

  17. [Clinical aspects of witchcraft delusions].

    PubMed

    Pashkovskiĭ, V E

    2005-01-01

    To distinguish clinical variants and to specify nosologic entity of witchcraft delusions, 69 patients (10 males, aged 15-72 years) have been examined. It was found that witchcraft delusions exist in passive and active forms. In a passive form, the patient is sure that unknown (mystic) power damaged him/her; in an active form the patient, possessing a gift for unusual abilities, can influence the others (bewitches, heals, etc). Five clinical syndromes, in the structure of which the above delusions were found, namely, paranoiac-hypochondriac, hallucination-paranoid, depressive-paranoid, paraphrenic and delirious, were identified. Psychoses of schizophrenia spectrum were diagnosed in 52 patients, organic--in 8, alcoholic--in 7 and recurrent depressive disorder--in 2. Clinical significance of witchcraft delusions is closely related to its social aspect. Being combined with ideas of persecution, poisoning and damage, it results in the brutal forms of delusions defense and may be considered as an unfavorable prognostic trait.

  18. Biomechanical aspects of the optimal number of implants to carry a cross-arch full restoration.

    PubMed

    Brunski, John B

    2014-01-01

    A proper definition of the 'optimal' number of implants to support a full arch prosthesis should go beyond solely a listing of the number of implants used in a treatment plan; it should be based upon a biomechanical analysis that takes into account several factors: the locations of the implants in the jaw; the quality and quantity of bone into which they are placed; the loads (forces and moments) that develop on the implants; the magnitudes of stress and strain that develop in the interfacial bone as well as in the implants and prosthesis; and the relationship of the stresses and strains to limits for the materials involved. Overall, determining an 'optimal' number of implants to use in a patient is a biomechanical design problem. This paper discusses some of the approaches that are already available to aid biomechanically focused clinical treatment planning. A number of examples are presented to illustrate how relatively simple biomechanical analyses - e.g. the Skalak model - as well as more complex analyses (e.g. finite element modelling) can be used to assess the pros and cons of various arrangements of implants to support fullarch prostheses. Some of the examples considered include the use of 4 rather than 6 implants to span the same arc-length in a jaw, and the pros and cons of using tilted implants as in the 'all-on-4' approach. In evaluating the accuracy of the various biomechanical analyses, it is clear that our current prediction methods are not always perfectly accurate in vivo, although they can provide a reasonably approximate analysis of a treatment plan in many situations. In the current era of cone beam computerised tomography (CT) scans of patients in the dental office, there is significant promise for finite element analyses (FEA) based on anatomically-accurate input data. However, at the same time it has to be recognised that effective use of FEA software requires a reasonable engineering background, especially insofar as interpretations of the

  19. Biomechanical aspects of bone microstructure in vertebrates: potential approach to palaeontological investigations.

    PubMed

    Mishra, S

    2009-11-01

    Biomechanical or biophysical principles can be applied to study biological structures in their modern or fossil form. Bone is an important tissue in paleontological studies as it is a commonly preserved element in most fossil vertebrates, and can often allow its microstructures such as lacuna and canaliculi to be studied in detail. In this context, the principles of Fluid Mechanics and Scaling Laws have been previously applied to enhance the understanding of bone microarchitecture and their implications for the evolution of hydraulic structures to transport fluid. It has been shown that the microstructure of bone has evolved to maintain efficient transport between the nutrient supply and cells, the living components of the tissue. Application of the principle of minimal expenditure of energy to this analysis shows that the path distance comprising five or six lamellar regions represents an effective limit for fluid and solute transport between the nutrient supply and cells; beyond this threshold, hydraulic resistance in the network increases and additional energy expenditure is necessary for further transportation. This suggests an optimization of the size of the bone's building blocks (such as osteon or trabecular thickness) to meet the metabolic demand concomitant to minimal expenditure of energy. This biomechanical aspect of bone microstructure is corroborated from the ratio of osteon to Haversian canal diameters and scaling constants of several mammals considered in this study. This aspect of vertebrate bone microstructure and physiology may provide a basis of understanding of the form and function relationship in both extinct and extant taxa. PMID:20009272

  20. Biomechanics of oral mucosa

    PubMed Central

    Chen, Junning; Ahmad, Rohana; Li, Wei; Swain, Michael; Li, Qing

    2015-01-01

    The prevalence of prosthodontic treatment has been well recognized, and the need is continuously increasing with the ageing population. While the oral mucosa plays a critical role in the treatment outcome, the associated biomechanics is not yet fully understood. Using the literature available, this paper provides a critical review on four aspects of mucosal biomechanics, including static, dynamic, volumetric and interactive responses, which are interpreted by its elasticity, viscosity/permeability, apparent Poisson's ratio and friction coefficient, respectively. Both empirical studies and numerical models are analysed and compared to gain anatomical and physiological insights. Furthermore, the clinical applications of such biomechanical knowledge on the mucosa are explored to address some critical concerns, including stimuli for tissue remodelling (interstitial hydrostatic pressure), pressure–pain thresholds, tissue displaceability and residual bone resorption. Through this review, the state of the art in mucosal biomechanics and their clinical implications are discussed for future research interests, including clinical applications, computational modelling, design optimization and prosthetic fabrication. PMID:26224566

  1. Regulatory aspects of clinical xenotransplantation.

    PubMed

    Schuurman, Henk-Jan

    2015-11-01

    Xenotransplantation attracted interest from regulatory authorities, particularly after the demonstration of pig-to-human transmission of porcine endogenous retrovirus (1996). This added to the risk of a product, resulting in a Guidance of the US Food and Drug Administration (2003). This addresses the full flow chart in product manufacturing, starting with the designated pathogen-free status of the source animal; and special aspects regarding the recipient like informed consent and monitoring for infectious pathogens. Also archiving of records from the donor and recipient, as well as storage of samples is described. The European Medicines Agency issued a Guideline on xenogeneic cell therapy products (2009). Cell-based medicinal products are subject to specific regulations and directives, which apply also to xenogeneic products: the xenotransplant guidances/guidelines are an addition to these regulations. Noteworthy, acellular products like heart valves and decellularized cornea are not considered a cell therapy product, but rather a medical device with its own regulation. WHO issued relevant documents, especially about safety, and the International Xenotransplantation Association published consensus documents, a.o., addressing preclinical efficacy requirements before entering clinical trials. This manuscript presents an overview of the regulatory framework, with special focus on cell therapy products necause these are expected to reach the market first (i.e., pancreatic islets, hepatocytes and cellularized cornea); major illustrations are from the European situation. Albeit being complex, the regulation of xenotransplant products does not form a block in product development, but rather supports the introduction of efficacious and safe products to meet the medical need.

  2. Systemic lupus erythematosus: Clinical and experimental aspects

    SciTech Connect

    Smolen, J.S.

    1987-01-01

    This text covers questions related to the history, etiology, pathogenesis, clinical aspects and therapy of systematic lupus erythematosus (SLE). Both animal models and human SLE are considered. With regard to basic science, concise information on cellular immunology, autoantibodies, viral aspects and molecular biology in SLE is provided. Clinical topics then deal with medical, dermatologic, neurologic, radiologic, pathologic, and therapeutic aspects. The book not only presents the most recent information on clinical and experimental insights, but also looks at future aspects related to the diagnosis and therapy of SLE.

  3. Clinical aspects of radiation nephropathy.

    PubMed

    Breitz, Hazel

    2004-06-01

    Small radiolabeled molecules are finding increasing clinical use for targeted radionuclide therapy. With the administration of radiolabeled small molecules, the bone marrow is not necessarily the first organ to show radiation toxicity. Rapid excretion of radioactivity through the urinary tract and the retention of radiolabeled small-protein molecules in the kidneys may expose the kidneys to radiation sufficient enough to cause toxicity--and in clinical trials, radiation toxicity of the urinary tract has become clinically relevant. The cells of the kidneys are slowly repairing cells; thus, the radiation toxicity may not be manifest for several months. The clinical and pathological features associated with radiation nephropathy, and issues particular to radiation nephropathy following targeted radionuclide therapy, are described here.

  4. Translating Ocular Biomechanics into Clinical Practice: Current State and Future Prospects

    PubMed Central

    Girard, Michaël J.A.; Dupps, William J.; Baskaran, Mani; Scarcelli, Giuliano; Yun, Seok H.; Quigley, Harry A.; Sigal, Ian A.; Strouthidis, Nicholas G.

    2014-01-01

    Biomechanics – the study of the relationship between forces and function in living organisms – is thought to play a critical role in a significant number of ophthalmic disorders. This is not surprising, as the eye is a pressure vessel that requires a delicate balance of forces to maintain its homeostasis. Over the past few decades, basic science research in ophthalmology mostly confirmed that ocular biomechanics could explain in part the mechanisms involved in almost all major ophthalmic disorders such as optic nerve head neuropathies, angle closure, ametropia, presbyopia, cataract, corneal pathologies, retinal detachment, and macular degeneration. Translational biomechanics in ophthalmology, however, is still in its infancy. It is believed that its use could make significant advances in diagnosis and treatment. Several translational biomechanics strategies are already emerging, such as corneal stiffening for the treatment of keratoconus, and more are likely to follow. This review aims to cultivate the idea that biomechanics plays a major role in ophthalmology and that its clinical translation, lead by collaborative teams of clinicians and biomedical engineers, will benefit our patients. Specifically, recent advances and future prospects in corneal, iris, trabecular meshwork, crystalline lens, scleral and lamina cribrosa biomechanics are discussed. PMID:24832392

  5. Clinical aspects of cervical insufficiency.

    PubMed

    Lotgering, Frederik K

    2007-06-01

    Fetal loss is a painful experience. A history of second or early third trimester fetal loss, after painless dilatation of the cervix, prolapse or rupture of the membranes, and expulsion of a live fetus despite minimal uterine activity, is characteristic for cervical insufficiency. In such cases the risk of recurrence is high, and a policy of prophylactic cerclage may be safer than one of serial cervical length measurements followed by cerclage, tocolysis and bed rest in case of cervical shortening or dilatation. In low risk cases, however, prophylactic cerclage is not useful. There is a need for more basic knowledge of cervical ripening, objective assessment of cervical visco-elastic properties, and randomized controlled trials of technical aspects of cervical cerclage (e.g. suturing technique).

  6. Multiple sclerosis: Experimental and clinical aspects

    SciTech Connect

    Scheinberg, L.; Raine, C.S.

    1984-01-01

    This book discusses the experimental and clinical aspects of multiple sclerosis. Specifically discussed are - Association of Epstein Barr Virus with pathology of central nervous system; immunology of viruses; and immunosuppression.

  7. [Clinical aspects of Marfan syndrome].

    PubMed

    Belsing, Tina Zimmermann; Lund, Allan Meldgaard; Søndergaard, Lars; Friis-Hansen, Lennart; Abildstrøm, Steen Zabell

    2011-01-31

    Marfan syndrome (MFS) and MFS-related diseases are inherited connective tissue disorders involving several organ systems. The diagnosis of MFS is difficult as the many symptoms overlap with those of other systemic connective tissue diseases. The phenotype is progressive. Effective surgical therapy and standardized follow-up programs have led to an improved lifespan for the affected individuals. Selective angiotensin II, type 1 (AT1) blockers may improve several manifestations of MFS, but the outcome of clinical trials is presently unknown. This review describes the importance of a coordinated strategy for diagnosis, treatment and follow-up. PMID:21276396

  8. [Haemostatic aspects in clinical oncology].

    PubMed

    Langer, F; Holstein, K; Eifrig, B; Bokemeyer, C

    2008-12-01

    The clinical link between cancer and thrombosis has been recognized by Armand Trousseau in 1865. It has now become clear that clotting activation in malignancy not only plays an important role in the evolution of venous thromboembolism (VTE) or systemic coagulation disorders such as disseminated intravascular coagulation, but that multiple components of the haemostatic and fibrinolytic systems are directly involved in tumour progression. In particular, tissue factor (TF) appears to be involved in several pathways relevant to cancer growth and metastasis. Increasing evidence emerges that haemostatic perturbances in cancer patients are, at least in part, controlled by defined genetic events in molecular tumourigenesis including activating and inactivating mutations of oncogenes and tumour suppressor genes, respectively. Long-term therapy with low-molecular-weight heparin (LMWH) is considered as standard treatment for cancer-associated VTE. However, several experimental studies and clinical trials suggest that LMWH may also be beneficial as an adjunct in the treatment of patients with malignant disease. This article provides an overview on the significance, pathogenesis and treatment of cancer-related clotting disorders as well as on the cellular and molecular mechanisms, by which haemostatic components such as TF, platelets and fibrin(ogen) drive tumour progression. PMID:19132177

  9. Biomechanical properties of the spinal cord: implications for tissue engineering and clinical translation.

    PubMed

    Bartlett, Richard D; Choi, David; Phillips, James B

    2016-10-01

    Spinal cord injury is a severely debilitating condition which can leave individuals paralyzed and suffering from autonomic dysfunction. Regenerative medicine may offer a promising solution to this problem. Previous research has focused primarily on exploring the cellular and biological aspects of the spinal cord, yet relatively little remains known about the biomechanical properties of spinal cord tissue. Given that a number of regenerative strategies aim to deliver cells and materials in the form of tissue-engineered therapies, understanding the biomechanical properties of host spinal cord tissue is important. We review the relevant biomechanical properties of spinal cord tissue and provide the baseline knowledge required to apply these important physical concepts to spinal cord tissue engineering. PMID:27592549

  10. Biomechanical properties of the spinal cord: implications for tissue engineering and clinical translation.

    PubMed

    Bartlett, Richard D; Choi, David; Phillips, James B

    2016-10-01

    Spinal cord injury is a severely debilitating condition which can leave individuals paralyzed and suffering from autonomic dysfunction. Regenerative medicine may offer a promising solution to this problem. Previous research has focused primarily on exploring the cellular and biological aspects of the spinal cord, yet relatively little remains known about the biomechanical properties of spinal cord tissue. Given that a number of regenerative strategies aim to deliver cells and materials in the form of tissue-engineered therapies, understanding the biomechanical properties of host spinal cord tissue is important. We review the relevant biomechanical properties of spinal cord tissue and provide the baseline knowledge required to apply these important physical concepts to spinal cord tissue engineering.

  11. Clinical aspects of venous thrombophilia.

    PubMed

    Girolami, Antonio; Fabris, Fabrizio; Girolami, Bruno

    2002-01-01

    Venous thrombophilia is the result of clotting changes namely of a hypercoagulable state together with blood flow and vessel wall changes. There is no need for all these components to be present in order for thrombosis to occur. As the matter of fact, thrombosis may occur even if only one of these conditions is present. In clinical practice a combination of factors is usualy seen. In comparison with arterial thrombophilia, clotting changes and blood flow seen to play a major role in venous thrombosis. Venous thrombophilia may remain asynptomatic or may result in a series of clinical syndromes. The commonest of these are: 1. Superficial vein thrombosis, 2. Deep vein thrombosis of legs, 3. Deep vein thrombosis of arms, 4. Caval veins thrombosis, 5. Portal vein thrombosis, 6. Hepatic veins thrombosis, 7. Renal vein thrombosis, 8. Cerebral sinuses thrombosis, 9. Right heart thrombosis, 10. Miscellaneous (ovarian, adrenal veins thrombosis, etc.). Since the first two are widely and easily recognized, these is no need for an extensive discussion. Deep vein thromboses of upper limbs are not as frequent as those of lower limbs or of superficial phlebitis but they can still be recognized on clinical grounds and non invasive techniques. The remaining 7 syndromes are less common and therefore less frequently suspected and recognized. Of particular interest, among these less common manifestations of venous thrombophilia are hepatic vein and renal vein thrombosis. Hepatic veins thrombosis, sometimes part of inferior vena cava thrombosis is most frequently due to an isolated occlusion of hepatic veins thereby causing a form of venocclusive disease. Occasionally diagnosis may be difficult because of slow onset of symptoms (hepatomegaly, right flank pain, fever, ascites etc.). The same is true for renal vein thrombosis which may also be of difficult diagnosis since it causes proteinuria and flank pain. The proteinuria is often interpreted as due to a nephrotic syndrome which

  12. Clinical aspects of urea transporters.

    PubMed

    Ran, Jianhua; Wang, Hongkai; Hu, Tinghai

    2014-01-01

    Jk antigens, which were identified as urea transporter B (UT-B) in the plasma membrane of erythrocytes, and which determine the Kidd blood type in humans, are involved in transfusion medicine, and even in organ transplantation. The Jk(a-b-) blood type is a consequence of a silent Slc14A1 gene caused by various mutations related to lineage. In addition, the specific mutations related to hypertension and metabolic syndrome cannot be ignored. Genome-wide association studies established Slc14A1 as a related gene of bladder cancer and some genotypes are associated with higher morbidity. This chapter aims to introduce the clinical significance of urea transporters. PMID:25298346

  13. Biomechanical modeling of the three-dimensional aspects of human vocal fold dynamics

    PubMed Central

    Yang, Anxiong; Lohscheller, Jörg; Berry, David A.; Becker, Stefan; Eysholdt, Ulrich; Voigt, Daniel; Döllinger, Michael

    2010-01-01

    Human voice originates from the three-dimensional (3D) oscillations of the vocal folds. In previous studies, biomechanical properties of vocal fold tissues have been predicted by optimizing the parameters of simple two-mass-models to fit its dynamics to the high-speed imaging data from the clinic. However, only lateral and longitudinal displacements of the vocal folds were considered. To extend previous studies, a 3D mass-spring, cover-model is developed, which predicts the 3D vibrations of the entire medial surface of the vocal fold. The model consists of five mass planes arranged in vertical direction. Each plane contains five longitudinal, mass-spring, coupled oscillators. Feasibility of the model is assessed using a large body of dynamical data previously obtained from excised human larynx experiments, in vivo canine larynx experiments, physical models, and numerical models. Typical model output was found to be similar to existing findings. The resulting model enables visualization of the 3D dynamics of the human vocal folds during phonation for both symmetric and asymmetric vibrations. PMID:20136223

  14. [Somnambulism: clinical and eletrophysiological aspects].

    PubMed

    Szúcs, Anna; Halász, Péter

    2005-06-01

    The authors review the literature on the epidemiology, the clinical and electrophysiological symptoms of somnambulism. The disorder specified as "nREM parasomnia with awakening disorder" belongs to the nREM sleep (awakening) parasomnias. In most of the cases its occurence is familial with the highest prevalence at age 12 year. Above age 12 year most cases recover whereas 6% of prevalence is reported in adults. It is probable that most patients seek medical help only in severe cases associated with injuries, accidents or violence. Its etiology is unknown; in essence it is a sleep regulation disorder characterised by a dissociated state of partial awakening from nREM sleep: the motor system becomes awake while consciousness remains clouded. There are several medicines inducing somnambulism in patients otherwise free from this disorder. In somnambule patients the most important provoking factors are sleep deprivation as well as pathological states and circumstances evoking sleep loss. Somnambulism should be differentiated from complex partial epileptic seizures and REM behaviour disorder. As there is no specific treatment at the moment it is important to assure safe sleeping circumstances - ground flour, closed windows, and no fragile furniture. Clonazepam and selective serotonin reuptake inhibitors prove sometimes effective, but the most effective methods in decreasing the frequency of somnambule episodes are the regular sleep-wakefulness schedule and the avoidance of sleep deprivation. PMID:15988917

  15. [Somnambulism: clinical and eletrophysiological aspects].

    PubMed

    Szúcs, Anna; Halász, Péter

    2005-06-01

    The authors review the literature on the epidemiology, the clinical and electrophysiological symptoms of somnambulism. The disorder specified as "nREM parasomnia with awakening disorder" belongs to the nREM sleep (awakening) parasomnias. In most of the cases its occurence is familial with the highest prevalence at age 12 year. Above age 12 year most cases recover whereas 6% of prevalence is reported in adults. It is probable that most patients seek medical help only in severe cases associated with injuries, accidents or violence. Its etiology is unknown; in essence it is a sleep regulation disorder characterised by a dissociated state of partial awakening from nREM sleep: the motor system becomes awake while consciousness remains clouded. There are several medicines inducing somnambulism in patients otherwise free from this disorder. In somnambule patients the most important provoking factors are sleep deprivation as well as pathological states and circumstances evoking sleep loss. Somnambulism should be differentiated from complex partial epileptic seizures and REM behaviour disorder. As there is no specific treatment at the moment it is important to assure safe sleeping circumstances - ground flour, closed windows, and no fragile furniture. Clonazepam and selective serotonin reuptake inhibitors prove sometimes effective, but the most effective methods in decreasing the frequency of somnambule episodes are the regular sleep-wakefulness schedule and the avoidance of sleep deprivation.

  16. Vasectomy: clinical aspects and reversibility.

    PubMed

    Muangman, V

    1979-12-01

    Sterilization, which was originated in Thailand 35 years ago, was initially performed in Bangkok and in the large up-country towns only. Sterilization acceptors were the minority group of well educated families. Population in Thailand increased rapidly following World War 2, and the demand in sterilization has risen respectively. In 1950 the government decentralized the National Health Program, and both vasectomy and tubal ligation were accepted by the Thai. After the government announced their population policy in 1971, vasectomy was included in the plan and has become popular. During 1967-72 there were only 2588 vasectomy acceptors. After the government launched an intensive program, the numbers were augmented. In 1977 there were 15,000 vasectomy acceptors, and 107,000 tubal ligation acceptors--a ratio of 1:7. At Ramathibodi Hospital in Bangkok there were 536 vasectomy acceptors. In 1967-69 the National Family Planning Division was established and activities were motivated through health centers, i.e., hospitals, provincial health centers, hygiene centers, mother and child care centers, and so forth. The government set up a Mobile Vasectomy Unit in 1975 with the goal of performing vasectomy in the remote areas of the country. The National Family Planning Division, established in 1977, has encouraged private clinics throughout Thailand to perform sterilizations. The aim of vasectomy surgery is to block the passage of spermatozoa through the vas deferens. The standard technic of vasectomy consists of division of the vas at the level of upper scrotum and removal of 1 cm portion of the vas. Both ends of vas are tied with No. 3-0 black silk thread. Currently, there are more than 20 methods of vasectomy. The result of vasectomy can be divided into 4 categories: complication, changes from the obstruction of sperm passage, autoantibody, and result in physical and mental condition. The effects of vasectomy on postvasectomized Thai men were studied in 1976 and 1978. The

  17. Clinical anatomy and biomechanics of the ankle in dance.

    PubMed

    Russell, Jeffrey A; McEwan, Islay M; Koutedakis, Yiannis; Wyon, Matthew A

    2008-01-01

    The ankle is an important joint to understand in the context of dance because it is the connection between the leg and the foot that establishes lower extremity stability. Its function coordinates with the leg and foot and, thus, it is crucial to the dancer's ability to perform. Furthermore, the ankle is one of the most commonly injured body regions in dance. An understanding of ankle anatomy and biomechanics is not only important for healthcare providers working with dancers, but for dance scientists, dance instructors, and dancers themselves. The bony architecture, the soft tissue restraints, and the locomotive structures all integrate to allow the athletic artistry of dance. Yet, there is still much research to be carried out in order to more completely understand the ankle of the dancer.

  18. [Biomechanical aspects of the claw-floor interaction in dairy cattle: implications for locomotion and claw disorders].

    PubMed

    van der Tol, P P J

    2004-07-01

    The prevalence of claw disorders is still high among cows housed on concrete floors. Concrete floors affect the locomotion of cattle, their natural behavior. Although many factors affect the development of claw disorders and locomotor problems, biomechanical aspects have hardly been analysed. In this thesis, mechanical (over)loading of the claw and its significance for claw disorders and lameness are discussed. The mechanical characteristics a floor needs to provide in order to enable unrestrained locomotory behavior. This biomechanical approach, which is a relatively new approach in cattle locomotion, has provided new insights. Despite preventive trimming, the weakest parts of the claw capsule are loaded relatively the most. Concrete floors provide too little friction to enable unrestricted cattle locomotion.

  19. Clinical and biomechanical perspectives on pressure injury prevention research: The case of prophylactic dressings.

    PubMed

    Gefen, A; Kottner, J; Santamaria, N

    2016-10-01

    In this perspective paper, we discuss clinical and biomechanical viewpoints on pressure injury (or pressure ulcer) prevention research. We have selected to focus on the case of prophylactic dressings for pressure injury prevention, and the background of the historical context of pressure injury research, as an exemplar to illuminate some of the good and not so good in current biomechanical and clinical research in the wound prevention and care arena. Investigators who are conducting medical or clinical research in academia, in medical settings or in industry to determine the efficacy of wound prevention and care products could benefit from applying some basic principles that are detailed in this paper, and that should leverage the research outcomes, thereby contributing to setting higher standards in the field.

  20. [The clinical relevance of biomechanical analysis of the hip area].

    PubMed

    Kummer, B

    1991-01-01

    Some diseases of the hip are due to mechanical causes or are influenced in a positive or negative sense by mechanical factors. In every case, the balance between stressing and biological reaction of the tissues of the locomotor system plays a decisive role. A careful biomechanical analysis should therefore be made at the beginning of any prognostical or therapeutical consideration. This means respective to the hip joint analyses of magnitude and distribution of the articular pressure and of the stressing of the femoral neck. The normal hip joint is characterised by a nearly evenly distributed articular pressure, and this is expressed in a bone condensation of equal thickness in the acetabular roof (sourcil). The consequence of an uneven stress distribution is a triangular shape of the sourcil, increasing either to the lateral or to the medial border of the acetabular roof. The lateral triangle is in general steeper and therefore more dangerous than the medial one. The stress concentration alters first the articular cartilage and then the subchondral bone. The aim of a causal surgical therapy is the decrease and the equal distribution of the articular pressure. It can be attained by increasing the weight-bearing surface of the joint and by centralisation of the stressing force (joint resultant) within this surface. The neck of the normally shaped femur is stressed in the sense of bending, and the magnitude of this stress depends on the neck/shaft angle. In consequence of this result shearing forces at the level of neck fractures, thus preventing the bony reunion. The therapeutical intervention tries either to strengthen the resistance against the shearing force (by nailing) or to eliminate it--as for example in the case of non-union of a neck fracture--(valgisation osteotomy). The reduction of the shearing stress by a valgisation osteotomy (Y-osteotomy, Pauwels) is the decisive factor in the treatment of the congenital coxa vara, a disease, due to a reduced

  1. [Clinical aspects of viral respiratory infections].

    PubMed

    Pescetti, G; Gozzelino, F

    1980-12-01

    The Authors deal with some clinical aspect of the commonest types of respiratory tract viral infections. After a description of the characteristics of the most important diseases (common cold, ARD, influenza, viral pneumonia) they deal with some particular problem difficult in resolution, both from a pathogenetic and clinical viewpoint and quite constant bacterial over infection, the cardiac complications, th possible evolution to fibrosis and the relationship between viral infections and asthma. The nowadays problem of immunological and chemotherapeutic prevention of viral infections, particularly of type A influenza, is also discussed.

  2. Fixation systems of greater trochanteric osteotomies: biomechanical and clinical outcomes.

    PubMed

    Jarit, Gregg J; Sathappan, Sathappan S; Panchal, Anand; Strauss, Eric; Di Cesare, Paul E

    2007-10-01

    The development of cerclage systems for fixation of greater trochanteric osteotomies has progressed from monofilament wires to multifilament cables to cable grip and cable plate systems. Cerclage wires and cables have various clinical indications, including fixation for fractures and for trochanteric osteotomy in hip arthroplasty. To achieve stable fixation and eventual union of the trochanteric osteotomy, the implant must counteract the destabilizing forces associated with pull of the peritrochanteric musculature. The material properties of cables and cable grip systems are superior to those of monofilament wires; however, potential complications with the use of cables include debris generation and third-body polyethylene wear. Nevertheless, the cable grip system provides the strongest fixation and results in lower rates of nonunion and trochanteric migration. Cable plate constructs show promise but require further clinical studies to validate their efficacy and safety.

  3. Clinical Biomechanics of Wear in Total Hip Arthroplasty

    PubMed Central

    Callaghan, John J; Pedersen, Douglas R; Johnston, Richard C; Brown, Thomas D

    2003-01-01

    Complementary clinical and laboratory studies were performed to identify variables associated with polyethylene wear following total hip replacement, and to elucidate the mechanisms responsible for accelerated wear in the total hip arthroplasty construct. Observational cohort studies were performed using a prospective clinical database of more than 4000 consecutive primary total hip arthroplasties performed by a single surgeon, to identify wear-related variables. These variables included head size, acetabular/femoral component impingement, and third body debris. Novel digital edge detection techniques were developed and employed to accurately measure wear, and to determine the relationships of head size and third body debris to acceleration of wear. A novel slidingdistance-coupled finite element model was formulated and employed to examine the mechanisms responsible for wear. The long-term cohort studies demonstrated smaller head sizes to be associated with less wear. Third body debris generated from cable fretting was associated with an increase in wear, osteolysis, and acetabular loosening, especially with larger head sizes. The sliding-distance-coupled finite element model replicated the wear rates occurring in vitro and in vivo, demonstrating the importance of sliding distance on polyethylene wear following total hip arthroplasty. It also demonstrated substantial increases in wear associated with femoral head scratching from third body debris. Further extension of the finite element formulation demonstrated the potential for acetabular component rim damage from impingement wear, and the enhanced potential for third body ingress to the bearing surface with larger head sizes. Edge detection wear measurement techniques demonstrated that early wear rates were predictive of long-term wear rates. These complementary clinical and laboratory investigations have provided insight into 1) the significance of sliding distance and physiologic loci of motion as contributing

  4. Clinical aspects of neurocysticercosis in children.

    PubMed

    Morales, N M; Agapejev, S; Morales, R R; Padula, N A; Lima, M M

    2000-04-01

    The purpose of this report was to evaluate the clinical aspects of neurocysticercosis in children from a Brazilian region. A retrospective study of 25 children with this neuroparasitosis was performed. The diagnosis was based on clinical, cerebrospinal fluid, and neuroimaging findings. The patients were predominantly male (72%), were 1 to 11 years of age (average = 8 years, 6 months), and most resided in urban areas (68%). The more frequent manifestations were epileptic seizures (72%), headache (60%), learning disability (24%), behavioral changes (12%), psychomotor involution (8%), and intracranial hypertension (4%). The neurologic examination was normal in 80% of the patients. Twenty-two children received only symptomatic drugs. Three patients underwent treatment with cysticidal drugs, one with praziquantel and two with albendazole, with complete remission of the signs in one patient (33%) and improvement in two others (67%). Of the 25 patients, 43.4% had remission and 47.8% had improvement. We emphasize the need to consider neurocysticercosis as a differential diagnosis in children coming from endemic areas and presenting with learning disabilities, behavioral changes, and psychomotor involution. The clinical aspects in most of the children from the Botucatu region suggest a spontaneous resolution of neurocysticercosis without the need for cysticidal treatment.

  5. Clinical, Biomechanical, and Physiological Translational Interpretations of Human Resting Myofascial Tone or Tension

    PubMed Central

    Masi, Alfonse T.; Nair, Kalyani; Evans, Tyler; Ghandour, Yousef

    2010-01-01

    Background Myofascial tissues generate integrated webs and networks of passive and active tensional forces that provide stabilizing support and that control movement in the body. Passive [central nervous system (CNS)–independent] resting myofascial tension is present in the body and provides a low-level stabilizing component to help maintain balanced postures. This property was recently called “human resting myofascial tone” (HRMT). The HRMT model evolved from electromyography (EMG) research in the 1950s that showed lumbar muscles usually to be EMG-silent in relaxed gravity-neutral upright postures. Methods Biomechanical, clinical, and physiological studies were reviewed to interpret the passive stiffness properties of HRMT that help to stabilize various relaxed functions such as quiet balanced standing. Biomechanical analyses and experimental studies of the lumbar multifidus were reviewed to interpret its passive stiffness properties. The lumbar multifidus was illustrated as the major core stabilizing muscle of the spine, serving an important passive biomechanical role in the body. Results Research into muscle physiology suggests that passive resting tension (CNS-independent) is generated in sarcomeres by the molecular elasticity of low-level cycling cross-bridges between the actomyosin filaments. In turn, tension is complexly transmitted to intimately enveloping fascial matrix fibrils and other molecular elements in connective tissue, which, collectively, constitute the myofascial unit. Postural myofascial tonus varies with age and sex. Also, individuals in the population are proposed to vary in a polymorphism of postural HRMT. A few people are expected to have outlier degrees of innate postural hypotonicity or hypertonicity. Such biomechanical variations likely predispose to greater risk of related musculoskeletal disorders, a situation that deserves greater attention in clinical practice and research. Axial myofascial hypertonicity was hypothesized to

  6. Biomechanical and biological aspects of defect treatment in fractures using helical plates.

    PubMed

    Perren, S M; Regazzoni, P; Fernandez, A A D

    2014-01-01

    The clinical case of figure 1 through figure 11 shows a series of impressive failures of plate fixation. The plates were repeatedly applied bridging a comminuted bone segment in a heavy patient. The biomechanical analysis elaborates why this happened and proposes an unconventional procedure to prevent this failure with a minimally invasive procedure. A plate bridging an open gap or a defect in a long bone diaphysis is exposed to full functional load. According to clinical observations such plate application often fails even without external load such as weight bearing. The plate risks to break through fatigue when exposed during a long time to cyclic loading. This type of failure has been observed even with broad plates as well in femoral as in tibiae. The first option to avoid such failure consists in protecting the plate by installing load sharing between plate and either bone or an additional implant. This reduces the load carried by the plate to a safe level. Load sharing with bone may be installed at surgery by establishing solid mechanical bridge between the two main fragments of the fractured bone. The optimal load sharing relies on a solid compressed contact between the main fragments. It can be established because the bone is able to take a large load which results in optimal protection of the plate. In the case of an extended comminuted bone segment it may be very difficult, traumatizing and inefficient to reconstruct the bone. In the present case it was impossible to establish load sharing through the bone. The second option protecting the plate is provided by callus bridging of the gap or defect. The formation of a solid callus bridge takes time but the fatigue failure of the plate also takes time. Therefore, the callus bridge may prevent a late fatigue failure. The surgeon may select one of several options: - Replacing the lack of bone support using a second plate which immediately alleviates plate loading. The drawback of application of a second

  7. Selenium. Nutritional, toxicologic, and clinical aspects

    SciTech Connect

    Fan, A.M.; Kizer, K.W. )

    1990-08-01

    Despite the recent findings of environmental contamination, selenium toxicosis in humans is exceedingly rare in the United States, with the few known cases resulting from industrial accidents and an episode involving the ingestion of superpotent selenium supplements. Chronic selenosis is essentially unheard of in this country because of the typical diversity of the American diet. Nonetheless, because of the growing public interest in selenium as a dietary supplement and the occurrence of environmental selenium contamination, medical practitioners should be familiar with the nutritional, toxicologic, and clinical aspects of this trace element. 53 references.

  8. Selenium. Nutritional, toxicologic, and clinical aspects.

    PubMed Central

    Fan, A. M.; Kizer, K. W.

    1990-01-01

    Despite the recent findings of environmental contamination, selenium toxicosis in humans is exceedingly rare in the United States, with the few known cases resulting from industrial accidents and an episode involving the ingestion of superpotent selenium supplements. Chronic selenosis is essentially unheard of in this country because of the typical diversity of the American diet. Nonetheless, because of the growing public interest in selenium as a dietary supplement and the occurrence of environmental selenium contamination, medical practitioners should be familiar with the nutritional, toxicologic, and clinical aspects of this trace element. PMID:2219873

  9. [Clinical aspects of congenital maxillofacial deformities].

    PubMed

    Sólya, Kitti; Dézsi, Csilla; Vanya, Melinda; Szabó, János; Sikovanyecz, János; Kozinszky, Zoltán; Szili, Károly

    2015-09-13

    The cleft lip and palate deformity is one of the most common type of congenital abnormalities. The aim of this paper is to summarise the literature knowledge about cleft lip and/or palate. The authors review and discuss international literature data on the prevention, genetic and environmental predisposing factors, anatomical and embryological features, as well as pre- and post-natal diagnosis and treatment of these deformities. The aetiology is multifactorial, driven by both genetic and environmental factors which lead to multifaceted phenotypes and clinical features of these malformations. The lack of the multidisciplinary knowledge about prenatal diagnosis, prevention, genetic aspects and treatment strategy could result in serious diagnostic errors, hence clinical teamwork is critically important to solve the problems of this pathology. Only the professional teamwork and multidisciplinary cooperation can guarantee the optimal level of health care and better quality of life for these patients and their families.

  10. [Some clinical aspects of sodium homeostasis disorders].

    PubMed

    Sulyok, Endre

    2013-09-22

    In this review three major issues of sodium homeostasis are addressed. Specifically, volume-dependent (salt-sensitive) hypertension, sodium chloride content of maintenance fluid and clinical evaluation of hyponatremia are discussed. Regarding volume-dependent hypertension the endocrine/paracrine systems mediating renal sodium retention, the relationship between salt intake, plasma sodium levels and blood pressure, as well as data on the dissociation of sodium and volume regulation are presented. The concept of perinatal programming of salt-preference is also mentioned. Some theoretical and practical aspects of fluid therapy are summarized with particular reference to using hypotonic sodium chloride solution for maintenance fluid as opposed to the currently proposed isotonic sodium chloride solution. Furthermore, the incidence, the aetiological classification and central nervous system complications of hyponatremia are presented, too. In addition, clinical and pathophysical features of hyponatremic encephalophathy and osmotic demyelinisation are given. The adaptive reactions of the brain to hypotonic stress are also described with particular emphasis on the role of brain-specific water channel proteins (aquaporin-4) and the benzamil-inhibitable sodium channels. In view of the outmost clinical significance of hyponatremia, the principles of efficient and safe therapeutic approaches are outlined. PMID:24036017

  11. [Some clinical aspects of sodium homeostasis disorders].

    PubMed

    Sulyok, Endre

    2013-09-22

    In this review three major issues of sodium homeostasis are addressed. Specifically, volume-dependent (salt-sensitive) hypertension, sodium chloride content of maintenance fluid and clinical evaluation of hyponatremia are discussed. Regarding volume-dependent hypertension the endocrine/paracrine systems mediating renal sodium retention, the relationship between salt intake, plasma sodium levels and blood pressure, as well as data on the dissociation of sodium and volume regulation are presented. The concept of perinatal programming of salt-preference is also mentioned. Some theoretical and practical aspects of fluid therapy are summarized with particular reference to using hypotonic sodium chloride solution for maintenance fluid as opposed to the currently proposed isotonic sodium chloride solution. Furthermore, the incidence, the aetiological classification and central nervous system complications of hyponatremia are presented, too. In addition, clinical and pathophysical features of hyponatremic encephalophathy and osmotic demyelinisation are given. The adaptive reactions of the brain to hypotonic stress are also described with particular emphasis on the role of brain-specific water channel proteins (aquaporin-4) and the benzamil-inhibitable sodium channels. In view of the outmost clinical significance of hyponatremia, the principles of efficient and safe therapeutic approaches are outlined.

  12. Progressive multifocal leukoencephalopathy: Clinical and molecular aspects

    PubMed Central

    Tavazzi, Eleonora; White, Martyn K.; Khalili, Kamel

    2011-01-01

    The fatal CNS demyelinating disease, progressive multifocal leukoencephalopathy (PML), is rare and appears to occur almost always as a consequence of immune dysfunction. Thus it is associated with HIV/AIDS and also as a side-effect of certain immunomodulatory monoclonal antibody therapies. In contrast to the rarity of PML, the etiological agent of the disease, the polyomavirus JC (JCV) is widespread in populations worldwide. In the forty years since JCV was first isolated, much has been learned about the virus and the disease from laboratory and clinical observations. However, there are many aspects of the viral life cycle and the pathogenesis of the disease that still remain unclear and our understanding is constantly evolving. In this review, we will discuss our current understanding of the clinical features of PML and molecular characteristics of JCV and how they relate to each other. Clinical observations can inform molecular studies of the virus and likewise molecular findings concerning the life cycle of the virus can guide the development of novel therapeutic strategies. PMID:21936015

  13. The effects of the arm swing on biomechanical and physiological aspects of roller ski skating.

    PubMed

    Hegge, Ann Magdalen; Ettema, Gertjan; de Koning, Jos J; Rognstad, Asgeir Bakken; Hoset, Martin; Sandbakk, Øyvind

    2014-08-01

    This study analyzed the biomechanical and physiological effects of the arm swing in roller ski skating, and compared leg-skating (i.e. ski skating without poles) using a pronounced arm swing (SWING) with leg-skating using locked arms (LOCKED). Sixteen elite male cross-country skiers performed submaximal stages at 10, 15 and 20kmh(-1) on a 2% inclined treadmill in the two techniques. SWING demonstrated higher peak push-off forces and a higher force impulse at all speeds, but a longer cycle length only at the highest speed (all P<.05), indicating a lower force effectiveness with SWING at the two lowest speeds. Additionally, the flexion-extension movement in the lower limbs was more pronounced for SWING. Oxygen uptake was higher for SWING at the two lowest speeds (both P<.05) without any differences in blood lactate. At the highest speed, oxygen uptake did not differ between SWING and LOCKED, but the RER, blood lactate and ventilation were lower with SWING (all P<.05). Taken together, these results demonstrate that utilizing the arm swing in roller ski skating increases the ski forces and aerobic energy cost at low and moderate speeds, whereas the greater forces at high speed lead to a longer cycle length and smaller anaerobic contribution.

  14. Ricin Toxicity: Clinical and Molecular Aspects

    PubMed Central

    Moshiri, Mohammad; Hamid, Fatemeh; Etemad, Leila

    2016-01-01

    Seeds of the castor bean plant Ricinuscommunis L (CB) contain ricin toxin (RT), one of the most poisonous naturally-occurring substances known. Ricin toxin, a water-soluble glycoprotein that does not partition into the oil extract, is a ribosome-inactivating toxin composed of two chains, labeled A and B. Severity of the toxicity varies depending on the route of exposure to the toxin. Inhalational is the most toxic route, followed by oral ingestion. Orally-ingested RT accumulates in the liver and spleen but other cells are also affected. The main clinical manifestations are also related to the administration route. Oral ingestion of CB or RT results in abdominal pain, vomiting, diarrhea, and various types of gastrointestinal bleeding that leading to volume depletion, hypovolemic shock, and renal failure. Inhalation of the toxin presents with non-cardiogenic pulmonary edema, diffuse necrotizing pneumonia, interstitial and alveolar inflammation, and edema. Local injection of RT induces indurations at the injection site, swelling of regional lymph nodes, hypotension, and death. An enzyme-linked immunosorbent assay (ELISA) has been developed to detect RT in animal tissues and fluids. Ricinine, an alkaloid of CB, can be detected in rat urine within 48 h of RT exposure. Supportive care is the basic treatment and standard biowarfare decontamination protocols are used for RT intoxication. Dexamethasone and difluoromethylornithine might be effective treatments. This review examines the clinical and molecular aspects of ricin toxicity. PMID:27536698

  15. Ricin Toxicity: Clinical and Molecular Aspects.

    PubMed

    Moshiri, Mohammad; Hamid, Fatemeh; Etemad, Leila

    2016-04-01

    Seeds of the castor bean plant Ricinuscommunis L (CB) contain ricin toxin (RT), one of the most poisonous naturally-occurring substances known. Ricin toxin, a water-soluble glycoprotein that does not partition into the oil extract, is a ribosome-inactivating toxin composed of two chains, labeled A and B. Severity of the toxicity varies depending on the route of exposure to the toxin. Inhalational is the most toxic route, followed by oral ingestion. Orally-ingested RT accumulates in the liver and spleen but other cells are also affected. The main clinical manifestations are also related to the administration route. Oral ingestion of CB or RT results in abdominal pain, vomiting, diarrhea, and various types of gastrointestinal bleeding that leading to volume depletion, hypovolemic shock, and renal failure. Inhalation of the toxin presents with non-cardiogenic pulmonary edema, diffuse necrotizing pneumonia, interstitial and alveolar inflammation, and edema. Local injection of RT induces indurations at the injection site, swelling of regional lymph nodes, hypotension, and death. An enzyme-linked immunosorbent assay (ELISA) has been developed to detect RT in animal tissues and fluids. Ricinine, an alkaloid of CB, can be detected in rat urine within 48 h of RT exposure. Supportive care is the basic treatment and standard biowarfare decontamination protocols are used for RT intoxication. Dexamethasone and difluoromethylornithine might be effective treatments. This review examines the clinical and molecular aspects of ricin toxicity. PMID:27536698

  16. Current computational modelling trends in craniomandibular biomechanics and their clinical implications.

    PubMed

    Hannam, A G

    2011-03-01

    Computational models of interactions in the craniomandibular apparatus are used with increasing frequency to study biomechanics in normal and abnormal masticatory systems. Methods and assumptions in these models can be difficult to assess by those unfamiliar with current practices in this field; health professionals are often faced with evaluating the appropriateness, validity and significance of models which are perhaps more familiar to the engineering community. This selective review offers a foundation for assessing the strength and implications of a craniomandibular modelling study. It explores different models used in general science and engineering and focuses on current best practices in biomechanics. The problem of validation is considered at some length, because this is not always fully realisable in living subjects. Rigid-body, finite element and combined approaches are discussed, with examples of their application to basic and clinically relevant problems. Some advanced software platforms currently available for modelling craniomandibular systems are mentioned. Recent studies of the face, masticatory muscles, tongue, craniomandibular skeleton, temporomandibular joint, dentition and dental implants are reviewed, and the significance of non-linear and non-isotropic material properties is emphasised. The unique challenges in clinical application are discussed, and the review concludes by posing some questions which one might reasonably expect to find answered in plausible modelling studies of the masticatory apparatus.

  17. Clinical aspects of malignant mesothelioma in Australia.

    PubMed

    Driscoll, T R; Baker, G J; Daniels, S; Lee, J; Thompson, R; Ferguson, D A; Leigh, J

    1993-02-01

    Australia is currently experiencing an epidemic of malignant mesothelioma. The clinical aspects of malignant mesothelioma were investigated in 295 Australian patients as part of a national study of the disease. Most patients were male (91%), with the mean age at diagnosis being 64 years. The predominant cell type was epithelial (38%) and the majority of primary tumours arose from the pleura (94%). Mean survival was poor (17.6 months from first symptom; 11.8 months from diagnosis). Patients with a pleural primary tumour were more likely to present with dyspnoea, chest pain and cough; to have a pleural effusion diagnosed radiologically; and to have metastatic spread. Patients with a peritoneal primary tumour were more likely to present with weight loss, loss of appetite, abdominal pain and ascites; to have radiologic evidence of asbestos exposure; and to have spread along a needle track created during a diagnostic tap. A minority of patients had past thoracic conditions, or radiologic findings, specifically related to previous asbestos exposure. About one fifth of patients had no known asbestos exposure. Forty-one per cent of subjects received some form of chemotherapy, radiotherapy and/or surgery, but no formal disease staging had been documented for any patient. Proper controlled trials of secondary and tertiary treatments in malignant mesothelioma are now needed.

  18. Clinical and Neurobiological Aspects of Narcolepsy

    PubMed Central

    Nishino, Seiji

    2007-01-01

    Narcolepsy is characterized by excessive daytime sleepiness (EDS), cataplexy and/or other dissociated manifestations of rapid eye movement (REM) sleep (hypnagogic hallucinations and sleep paralysis). Narcolepsy is currently treated with amphetamine-like central nervous system (CNS) stimulants (for EDS) and antidepressants (for cataplexy). Some other classes of compounds such as modafinil (a non-amphetamine wake-promoting compound for EDS) and gamma-hydroxybutyrate (GHB, a short-acting sedative for EDS/fragmented nighttime sleep and cataplexy) given at night are also employed. The major pathophysiology of human narcolepsy has been recently elucidated based on the discovery of narcolepsy genes in animals. Using forward (i.e., positional cloning in canine narcolepsy) and reverse (i.e., mouse gene knockout) genetics, the genes involved in the pathogenesis of narcolepsy (hypocretin/orexin ligand and its receptor) in animals have been identified. Hypocretins/orexins are novel hypothalamic neuropeptides also involved in various hypothalamic functions such as energy homeostasis and neuroendocrine functions. Mutations in hypocretin-related genes are rare in humans, but hypocretin-ligand deficiency is found in many narcolepsy-cataplexy cases. In this review, the clinical, pathophysiological and pharmacological aspects of narcolepsy are discussed. PMID:17470414

  19. Traumatic Extensor Tendon Injuries to the Hand: Clinical Anatomy, Biomechanics, and Surgical Procedure Review.

    PubMed

    Colzani, Giulia; Tos, Pierluigi; Battiston, Bruno; Merolla, Giovanni; Porcellini, Giuseppe; Artiaco, Stefano

    2016-04-01

    The extensor apparatus is a complex muscle-tendon system that requires integrity or optimal reconstruction to preserve hand function. Anatomical knowledge and the understanding of physiopathology of extensor tendons are essential for an accurate diagnosis of extensor tendon injuries (ETIs) of the hand and wrist, because these lesions are complex and commonly observed in clinical practice. A careful clinical history and assessment still remain the first step for the diagnosis, followed by US and MR to confirm the suspect of ETI or to investigate some doubtful conditions and rule out associate lesions. During last decades the evolution of surgical techniques and rehabilitative treatment protocol led to gradual improvement in clinical results of ETI treatment and surgical repair. Injury classification into anatomical zones and the evaluation of the characteristics of the lesions are considered key points to select the appropriate treatment for ETI. Both conservative and surgical management can be indicated in ETI, depending on the anatomical zone and on the characteristics of the injuries. As a general rule, an attempt of conservative treatment should be performed when the lesion is expected to have favorable result with nonoperative procedure. Many surgical techniques have been proposed over the time and with favorable results if the tendon injury is not underestimated and adequately treated. Despite recent research findings, a lack of evidence-based knowledge is still observed in surgical treatment and postoperative management of ETI. Further clinical and biomechanical investigations would be advisable to clarify this complex issue. PMID:27616821

  20. Vesicle-Like Biomechanics Governs Important Aspects of Nuclear Geometry in Fission Yeast

    PubMed Central

    Lim H. W., Gerald; Huber, Greg; Torii, Yoshihiro; Hirata, Aiko; Miller, Jonathan; Sazer, Shelley

    2007-01-01

    It has long been known that during the closed mitosis of many unicellular eukaryotes, including the fission yeast (Schizosaccharomyces pombe), the nuclear envelope remains intact while the nucleus undergoes a remarkable sequence of shape transformations driven by elongation of an intranuclear mitotic spindle whose ends are capped by spindle pole bodies embedded in the nuclear envelope. However, the mechanical basis of these normal cell cycle transformations, and abnormal nuclear shapes caused by intranuclear elongation of microtubules lacking spindle pole bodies, remain unknown. Although there are models describing the shapes of lipid vesicles deformed by elongation of microtubule bundles, there are no models describing normal or abnormal shape changes in the nucleus. We describe here a novel biophysical model of interphase nuclear geometry in fission yeast that accounts for critical aspects of the mechanics of the fission yeast nucleus, including the biophysical properties of lipid bilayers, forces exerted on the nuclear envelope by elongating microtubules, and access to a lipid reservoir, essential for the large increase in nuclear surface area during the cell cycle. We present experimental confirmation of the novel and non-trivial geometries predicted by our model, which has no free parameters. We also use the model to provide insight into the mechanical basis of previously described defects in nuclear division, including abnormal nuclear shapes and loss of nuclear envelope integrity. The model predicts that (i) despite differences in structure and composition, fission yeast nuclei and vesicles with fluid lipid bilayers have common mechanical properties; (ii) the S. pombe nucleus is not lined with any structure with shear resistance, comparable to the nuclear lamina of higher eukaryotes. We validate the model and its predictions by analyzing wild type cells in which ned1 gene overexpression causes elongation of an intranuclear microtubule bundle that deforms the

  1. Load carriage using packs: a review of physiological, biomechanical and medical aspects.

    PubMed

    Knapik, J; Harman, E; Reynolds, K

    1996-06-01

    This paper reviews the biomedical aspects of transporting loads in packs and offers suggestions for improving load-carriage capability. Locating the load mass as close as possible to the body center of gravity appears to result in the lowest energy cost when carrying a pack. Thus, the double pack (half the load on the front of the body and half the load on the back) has a lower energy cost than the backpack. However, backpacks provide greater versatility in most situations. The energy cost of walking with backpack loads increases progressively with increases in load mass, body mass, walking speed or grade; type of terrain also influences energy cost. Predictive equations have been developed for estimating the energy cost of carrying loads during locomotion but these may not be accurate for prolonged (>2 h) or downhill carriage. Training with loads can result in greater energy efficiency since walking with backpack loads over several weeks decreases energy cost. Load-carriage speed can be increased with physical training that involves regular running and resistance training. Erector spinae electrical activity (EMG) is lower during load carriage than in unloaded walking until loads exceed 30-40 kg, at which point erector spinae EMG activity is higher than during unloaded walking. EMGs of the quadriceps and gastrocnemius, but not the tibialis anterior or hamstrings, increase with load. Framed packs with hip belts reduce the electrical activity of the trapezius muscles, presumably by shifting forces from the shoulders to the hips. Increases in the backpack load mass result in increases in forces exerted on the grounds, amount of knee flexion and the forward inclination of the trunk. Compared to backpacks, double packs produce fewer deviations from normal walking. Common injuries associated with prolonged load carriage include foot blisters, stress fractures, back strains, metatarsalgia (foot pain), rucksack palsy (shoulder traction injury) and knee pain. Closed

  2. [Social aspect of clinical research in Poland].

    PubMed

    Masełbas, Wojciech; Czarkowski, Marek

    2007-12-01

    Each year more than 400 new clinical studies are registered in Poland. They gather above 50.000 of study participants. Social opinion on clinical trials is an important factor. The paper presents the review of actual opinions on clinical research in Poland. It provides the description of standards of protection of study participants, benefits and risks related to the participation in clinical research and the role of media in creating and influencing of the social perception of clinical trials. Results of conducted questionnaire studies imply that Poles correctly identify and assess the risk of participation in clinical experiments. The primary reason for the participation seams to be the possibility to help other patients, contribution to the progress of science and standards of medical care and potential benefits for other sufferers. The need of testing the safety and efficacy of the new medication in man is generally well recognized. At the same time a substantial part of the society is concerned with the possible corruption of investigators and unethical behaviour of sponsors. The social perception of clinical research in Poland is in majority of analyzed parameters not substantially different from opinions in other member states of EU. However, the medical society should be more active in influencing and changing some negative impressions.

  3. Cerebral blood flow: Physiologic and clinical aspects

    SciTech Connect

    Wood, J.H.

    1987-01-01

    This book contains 46 chapters divided among nine sections. The section titles are: Historical Perspectives; Cerebrovascular Anatomy; Cerebrovascular Physiology; Methods of Clinical Measurement; Experimental Methods; Imaging of Cerebral Circulation; Cerebrovascular Pathophysiology; Cerebrovascular Pharmacology; and Surgical and Interventional Augmentation.

  4. Myocardial Na,K-ATPase: Clinical aspects

    PubMed Central

    Kjeldsen, Keld

    2003-01-01

    The specific binding of digitalis glycosides to Na,K-ATPase is used as a tool for Na,K-ATPase quantification with high accuracy and precision. In myocardial biopsies from patients with heart failure, total Na,K-ATPase concentration is decreased by around 40%; a correlation exists between a decrease in heart function and a decrease in Na,K-ATPase concentration. During digitalization, around 30% of remaining pumps are occupied by digoxin. Myocardial Na,K-ATPase is also influenced by other drugs used for the treatment of heart failure. Thus, potassium loss during diuretic therapy has been found to reduce myocardial Na,K-ATPase, whereas angiotensin-converting enzyme inhibitors may stimulate Na,K pump activity. Furthermore, hyperaldosteronism induced by heart failure has been found to decrease Na,K-ATPase activity. Accordingly, treatment with the aldosterone antagonist, spironolactone, may also influence Na,K-ATPase activity. The importance of Na,K pump modulation with heart disease, inhibition in digitalization and other effects of medication should be considered in the context of sodium, potassium and calcium regulation. It is recommended that digoxin be administered to heart failure patients who, after institution of mortality-reducing therapy, still have heart failure symptoms, and that the therapy be continued if symptoms are revealed or reduced. Digitalis glycosides are the only safe inotropic drugs for oral use that improve hemodynamics in heart failure. An important aspect of myocardial Na,K pump affection in heart disease is its influence on extracellular potassium (Ke) homeostasis. Two important aspects should be considered: potassium handling among myocytes, and effects of potassium entering the extracellular space of the heart via the bloodstream. It should be noted that both of these aspects of Ke homeostasis are affected by regulatory aspects, eg, regulation of the Na,K pump by physiological and pathophysiological conditions, as well as by medical

  5. Open Knee: Open Source Modeling & Simulation to Enable Scientific Discovery and Clinical Care in Knee Biomechanics

    PubMed Central

    Erdemir, Ahmet

    2016-01-01

    Virtual representations of the knee joint can provide clinicians, scientists, and engineers the tools to explore mechanical function of the knee and its tissue structures in health and disease. Modeling and simulation approaches such as finite element analysis also provide the possibility to understand the influence of surgical procedures and implants on joint stresses and tissue deformations. A large number of knee joint models are described in the biomechanics literature. However, freely accessible, customizable, and easy-to-use models are scarce. Availability of such models can accelerate clinical translation of simulations, where labor intensive reproduction of model development steps can be avoided. The interested parties can immediately utilize readily available models for scientific discovery and for clinical care. Motivated by this gap, this study aims to describe an open source and freely available finite element representation of the tibiofemoral joint, namely Open Knee, which includes detailed anatomical representation of the joint's major tissue structures, their nonlinear mechanical properties and interactions. Three use cases illustrate customization potential of the model, its predictive capacity, and its scientific and clinical utility: prediction of joint movements during passive flexion, examining the role of meniscectomy on contact mechanics and joint movements, and understanding anterior cruciate ligament mechanics. A summary of scientific and clinically directed studies conducted by other investigators are also provided. The utilization of this open source model by groups other than its developers emphasizes the premise of model sharing as an accelerator of simulation-based medicine. Finally, the imminent need to develop next generation knee models are noted. These are anticipated to incorporate individualized anatomy and tissue properties supported by specimen-specific joint mechanics data for evaluation, all acquired in vitro from varying age

  6. [Microbiological and clinical aspects of tularaemia].

    PubMed

    Pavliš, Oto; Pohanka, Miroslav

    2011-10-01

    Francisella tularensis belongs to the most important biological agents potentially applicable in biological warfare and bioterrorism. High virulence, easy and rapid spread among individual vectors, stability of the cells in aerosol and good penetration into the lungs make F. tularensis one of the most important biological warfare agents in both human and veterinary medicine. The text provides comprehensive data about tularaemia and outlines the fate of the pathogen in the host. Special attention is paid to immunological aspects of the disease, therapy, and diagnostic methods.

  7. Acting Out; Theoretical and Clinical Aspects.

    ERIC Educational Resources Information Center

    Abt, Lawrence Edwin, Ed.; Weissman, Stuart L.

    The beneficial and harmful effects of acting out are studied in a series of short essays by numerous authors. Included are four articles on the theoretical and dynamic considerations of acting out, along with five clinical manifestations of acting out involving suicide and criminality in adolescents and adults. Special forms of harmful acting out…

  8. Clinical Aspects of Feline Retroviruses: A Review

    PubMed Central

    Hartmann, Katrin

    2012-01-01

    Feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) are retroviruses with global impact on the health of domestic cats. The two viruses differ in their potential to cause disease. FeLV is more pathogenic, and was long considered to be responsible for more clinical syndromes than any other agent in cats. FeLV can cause tumors (mainly lymphoma), bone marrow suppression syndromes (mainly anemia), and lead to secondary infectious diseases caused by suppressive effects of the virus on bone marrow and the immune system. Today, FeLV is less commonly diagnosed than in the previous 20 years; prevalence has been decreasing in most countries. However, FeLV importance may be underestimated as it has been shown that regressively infected cats (that are negative in routinely used FeLV tests) also can develop clinical signs. FIV can cause an acquired immunodeficiency syndrome that increases the risk of opportunistic infections, neurological diseases, and tumors. In most naturally infected cats, however, FIV itself does not cause severe clinical signs, and FIV-infected cats may live many years without any health problems. This article provides a review of clinical syndromes in progressively and regressively FeLV-infected cats as well as in FIV-infected cats. PMID:23202500

  9. Biomechanical Rupture Risk Assessment

    PubMed Central

    2016-01-01

    Abdominal aortic aneurysm (AAA) rupture is a local event in the aneurysm wall that naturally demands tools to assess the risk for local wall rupture. Consequently, global parameters like the maximum diameter and its expansion over time can only give very rough risk indications; therefore, they frequently fail to predict individual risk for AAA rupture. In contrast, the Biomechanical Rupture Risk Assessment (BRRA) method investigates the wall’s risk for local rupture by quantitatively integrating many known AAA rupture risk factors like female sex, large relative expansion, intraluminal thrombus-related wall weakening, and high blood pressure. The BRRA method is almost 20 years old and has progressed considerably in recent years, it can now potentially enrich the diameter indication for AAA repair. The present paper reviews the current state of the BRRA method by summarizing its key underlying concepts (i.e., geometry modeling, biomechanical simulation, and result interpretation). Specifically, the validity of the underlying model assumptions is critically disused in relation to the intended simulation objective (i.e., a clinical AAA rupture risk assessment). Next, reported clinical BRRA validation studies are summarized, and their clinical relevance is reviewed. The BRRA method is a generic, biomechanics-based approach that provides several interfaces to incorporate information from different research disciplines. As an example, the final section of this review suggests integrating growth aspects to (potentially) further improve BRRA sensitivity and specificity. Despite the fact that no prospective validation studies are reported, a significant and still growing body of validation evidence suggests integrating the BRRA method into the clinical decision-making process (i.e., enriching diameter-based decision-making in AAA patient treatment).

  10. [Glucotransporters: clinical, molecular and genetic aspects].

    PubMed

    Sandoval-Muñiz, Roberto de Jesús; Vargas-Guerrero, Belinda; Flores-Alvarado, Luis Javier; Gurrola-Díaz, Carmen Magdalena

    2016-01-01

    Oxidation of glucose is the major source of obtaining cell energy, this process requires glucose transport into the cell. However, cell membranes are not permeable to polar molecules such as glucose; therefore its internalization is accomplished by transporter proteins coupled to the cell membrane. In eukaryotic cells, there are two types of carriers coupled to the membrane: 1) cotransporter Na+-glucose (SGLT) where Na+ ion provides motive power for the glucose´s internalization, and 2) the glucotransporters (GLUT) act by facilitated diffusion. This review will focus on the 14 GLUT so far described. Despite the structural homology of GLUT, different genetic alterations of each GLUT cause specific clinical entities. Therefore, the aim of this review is to gather the molecular and biochemical available information of each GLUT as well as the particular syndromes and pathologies related with GLUT´s alterations and their clinical approaches. PMID:27595260

  11. Placebo effects: clinical aspects and neurobiology

    PubMed Central

    2008-01-01

    Placebo effects are beneficial health outcomes not related to the relatively direct biological effects of an intervention and can be elicited by an agent that, by itself, is inert. Understanding these placebo effects will help to improve clinical trial design, especially for interventions such as surgery, CNS-active drugs and behavioural interventions which are often non-blinded. A literature review was performed to retrieve articles discussing placebo implications of clinical trials, the neurobiology of placebo effects and the implications of placebo effect for several disorders of neurological relevance. Recent research in placebo analgesia and other conditions has demonstrated that several neurotransmitter systems, such as opiate and dopamine, are involved with the placebo effect. Brain regions including anterior cingulate cortex, dorsolateral prefrontal cortex and basal ganglia have been activated following administration of placebo. A patient's expectancy of improvement may influence outcomes as much as some active interventions and this effect may be greater for novel interventions and for procedures. Maximizing this expectancy effect is important for clinicians to optimize the health of their patient. There have been many relatively acute placebo studies that are now being extended into clinically relevant models of placebo effect. PMID:18567924

  12. Clinical Aspects of Uncomplicated and Severe Malaria

    PubMed Central

    Bartoloni, Alessandro; Zammarchi, Lorenzo

    2012-01-01

    The first symptoms of malaria, common to all the different malaria species, are nonspecific and mimic a flu-like syndrome. Although fever represents the cardinal feature, clinical findings in malaria are extremely diverse and may range in severity from mild headache to serious complications leading to death, particularly in falciparum malaria. As the progression to these complications can be rapid, any malaria patient must be assessed and treated rapidly, and frequent observations are needed to look for early signs of systemic complications. In fact, severe malaria is a life threatening but treatable disease. The protean and nonspecific clinical findings occurring in malaria (fever, malaise, headache, myalgias, jaundice and sometimes gastrointestinal symptoms of nausea, vomiting and diarrhoea) may lead physicians who see malaria infrequently to a wrong diagnosis, such as influenza (particularly during the seasonal epidemic flu), dengue, gastroenteritis, typhoid fever, viral hepatitis, encephalitis. Physicians should be aware that malaria is not a clinical diagnosis but must be diagnosed, or excluded, by performing microscopic examination of blood films. Prompt diagnosis and appropriate treatment are then crucial to prevent morbidity and fatal outcomes. Although Plasmodium falciparum malaria is the major cause of severe malaria and death, increasing evidence has recently emerged that Plasmodium vivax and Plasmodium knowlesi can also be severe and even fatal. PMID:22708041

  13. Molecular and Clinical Aspects of Angelman Syndrome

    PubMed Central

    Dagli, A.; Buiting, K.; Williams, C.A.

    2012-01-01

    The Angelman syndrome is caused by disruption of the UBE3A gene and is clinically delineated by the combination of severe mental disability, seizures, absent speech, hypermotoric and ataxic movements, and certain remarkable behaviors. Those with the syndrome have a predisposition toward apparent happiness and paroxysms of laughter, and this finding helps distinguish Angelman syndrome from other conditions involving severe developmental handicap. Accurate diagnosis rests on a combination of clinical criteria and molecular and/or cytogenetic testing. Analysis of parent-specific DNA methylation imprints in the critical 15q11.2–q13 genomic region identifies 75–80% of all individuals with the syndrome, including those with cytogenetic deletions, imprinting center defects and paternal uniparental disomy. In the remaining group, UBE3A sequence analysis identifies an additional percentage of patients, but 5–10% will remain who appear to have the major clinical phenotypic features but do not have any identifiable genetic abnormalities. Genetic counseling for recurrence risk is complicated because multiple genetic mechanisms can disrupt the UBE3A gene, and there is also a unique inheritance pattern associated with UBE3A imprinting. Angelman syndrome is a prototypical developmental syndrome due to its remarkable behavioral phenotype and because UBE3A is so crucial to normal synaptic function and neural plasticity. PMID:22670133

  14. Pedicle screw-based posterior dynamic stabilizers for degenerative spine: in vitro biomechanical testing and clinical outcomes.

    PubMed

    Chamoli, Uphar; Diwan, Ashish D; Tsafnat, Naomi

    2014-09-01

    Dynamic stabilization in a degenerate symptomatic spine may be advantageous compared with conventional fusion procedures, as it helps preserve motion and minimizes redistribution of loads at instrumented and adjacent segments. This article presents a systematic review of biomechanical and clinical evidence available on some of the pedicle screw based posterior dynamic stabilization (PDS) devices. Using Medline, Embase, and Scopus online databases, we identified four pedicle-screw-PDS devices for which both, biomechanical testing and clinical follow-up data are available: Graf artificial ligaments, Isobar TTL, Polyetheretherketone rods, and Dynesys. The current state-of-the-art of pedicle-screw-PDS devices is far from achieving its desired biomechanical efficacy, which has resulted in a weak support for the posited clinical benefits. Although pedicle-screw-PDS devices are useful in salvaging a moderately degenerate functionally suboptimal disc, for severe disc degeneration cases fusion is still the preferred choice. We conclude that a pedicle-screw-PDS device should aim at restoring load sharing amongst spinal elements while preserving the qualitative and quantitative nature of spinal motion, especially minimize posterior shift of the helical axis of motion. More precise and objective assessment techniques need to be standardized for in vivo evaluation of intervertebral motion and load sharing amongst spinal elements across different pedicle-screw-PDS devices.

  15. [Clinical aspects and diagnosis of viral hepatitis].

    PubMed

    Vince, Adriana

    2003-01-01

    Viral hepatitides are common diseases of modern man in both industrialized and developing countries, with a varying prevalence of particular types and mode of transmission. In current medicine, viral hepatitides are classified in the A-E nomenclature, differentiating viruses that can be etiologically defined with certainty on the basis of serum markers and hepatitides exhibiting all clinical and laboratory characteristics of viral hepatitis but of as yet nondemonstrable causative agents, classified in the non-A, non-E hepatitis group. Two issues are of high relevance in the pathogenesis of viral hepatitides: route of transmission (fecal-oral or parenteral) and basic mechanism of hepatocyte lesion. Although all hepatitis viruses replicate within the hepatocyte, the exact mechanism of hepatocyte necrosis has not yet been fully elucidated, i.e. direct cytotoxicity or hepatoprogressive immune response mediated primarily by the specific cytotoxic CD8 lymphocytes. Depending on the site of entry, the virus replicates in the adjacent lymphatic tissue for some time, followed by primary viremia, virus replication in the lymphoreticular organs (lymph nodes, liver, spleen), and eventual entry in the target cells--hepatocytes, accompanied by a varying grade of necrosis and inflammatory reaction. The clinical and laboratory signs of the disease correspond to the degree of liver necrosis and are not specific for particular types of viral hepatitis. The most frequent symptoms common to all types of viral hepatitis of moderate severity include elevated body temperature persisting for days, fatigue, gradual loss of appetite, nausea, dull pain and discomfort on DRL, vomiting, multiple loose stools, dark urine, jaundice of the skin and mucosa, and light stools. Generally, the ultimate outcome of the disease is elimination of the virus and complete recovery, however, a fulminant course with lethal outcome or transition to chronic disease may also occur, making viral hepatitides a major

  16. Achalasia in siblings. Clinical and genetic aspects.

    PubMed

    Bosher, L P; Shaw, A

    1981-08-01

    Achalasia is rare in children; less than 2% of all patients with achalasia are less than 6 years old. Familial achalasia is extraordinarily rare, for an exhaustive search of the world literature yielded only 31 cases. Two additional cases are reported here. Based on an analysis of the reported cases in the literature coupled with our two cases, we have observed that familial achalasia is likely transmitted as an autosomal recessive trait. We recommend that all siblings of children with confirmed achalasia should either be studied by contrast roentgenography or be monitored closely for clinical signs of achalasia, especially if they are products of consanguineous parents.

  17. Inherited epidermolysis bullosa: clinical and therapeutic aspects*

    PubMed Central

    Boeira, Vanessa Lys Simas Yamakawa; Souza, Erica Sales; Rocha, Bruno de Oliveira; Oliveira, Pedro Dantas; de Oliveira, Maria de Fátima Santos Paim; Rêgo, Vitória Regina Pedreira de Almeida; Follador, Ivonise

    2013-01-01

    Inherited epidermolysis bullosa (EB) is a heterogeneous group of genetic disorders that present with skin and, in some cases, mucosal fragility, predisposing patients to the development of blisters and/or erosions after minimal trauma or friction. Children with a recurrent history of these kinds of lesions or neonates that present them in the absence of another reasonable explanation should be investigated. Diagnosis must be based on clinical and histopathological findings. To date, management of inherited EB basically consists in avoiding traumas that trigger lesions, as well as preventing infection and facilitating healing of the wounds with the systematic use of bandages. PMID:23739692

  18. Clinical aspects of rodent dental anatomy.

    PubMed

    Crossley, D A

    1995-12-01

    The order Rodentia is vast, encompassing a large number of species with significant anatomical variations developed during natural adaptation to differing habitats. Many veterinarians have little knowledge of the anatomy of species other than the commoner domestic large herbivores and small carnivores. Clinicians require a basic knowledge of the relevant anatomy of species they are likely to be asked to treat. This article provides sufficient working knowledge of the oral and dental anatomy of those rodents commonly kept as pets to enable veterinarians to interpret clinical and radiographic findings when investigating suspected dental disease.

  19. [Melatonin in dermatology. Experimental and clinical aspects].

    PubMed

    Fischer, T; Wigger-Alberti, W; Elsner, P

    1999-01-01

    Melatonin (N-acetyl-5-methoxytryptamine) is a hormone with multiple functions in humans, produced by the pineal gland and stimulated by beta-adrenergic receptors. Serum melatonin levels exhibit a circadian rhythm with low levels during the day, rise in the evening and maximum levels at night between 2 and 4 a.m. Melatonin participates in the regulation of several physiological processes such as seasonal biological rhythm, daily sleep induction, aging and modulation of immunobiological defence reactions. Furthermore, melatonin has a highly lipophilic molecular structure facilitating penetration of cell membranes and serving as an extra- and intracellular free radical scavenger. Melatonin seems to quench mainly hydroxyl radicals, the most damaging of all free radicals. Melatonin may play a role in the etiology and treatment of several dermatoses e.g. atopic eczema, psoriasis and malignant melanoma. The influence of melatonin on hair growth is another aspect. Topical application of melatonin inhibits the development of UV-erythema. Penetration through skin after topical application and oral bioavailability auxit further investigations on the pharmacokinetic and pharmacodynamic actions of melatonin. PMID:10068925

  20. Nutritional aspects of detoxification in clinical practice.

    PubMed

    Cline, John C

    2015-01-01

    Detoxification is a vital cellular task that, if lacking, can lead to early morbidity and mortality. The process of detoxification involves the mobilization, biotransformation, and elimination of toxicants of exogenous and endogenous origin. This article discusses the phase I and phase II detoxification and biotransformation pathways and promotes using food to support these highly complex processes. The author identifies the comprehensive elimination diet as a useful therapeutic tool for clinicians and patients to use to achieve detoxification. Using this diet, the patient removes the most common allergenic foods and beverages from the diet and replaces them with nonallergenic choices for a period of 4 wk, gradually adding back the eliminated foods and observing their effects. Another effective clinical tool that the author discusses is the detox-focused core food plan, which identifies the variety of foods required to supply key nutrients that can maximize the effectiveness of detoxification. Finally, the author provides a case study in which these tools were used to help a patient suffering from major, debilitating illnesses that resulted from exposure to malathion, including severe vomiting and diarrhea, headaches, night sweats, severe arthralgias and myalgias, episcleritis, and shortness of breath. The article details the interventions used and the clinical results (ie, successful resolution of most issues after 3 mo). PMID:26026145

  1. Vitamin D and cancer: Clinical aspects

    PubMed Central

    Woloszynska-Read, Anna; Johnson, Candace S.; Trump, Donald L.

    2015-01-01

    There are substantial preclinical and epidemiologic data that suggest that vitamin D plays a role in the prevention and treatment of cancer. Numerous observational studies have shown that low blood levels of 25(OH) vitamin D (cholecalciferol), estimated by geographical location, diet and activity assessment or measured serum levels are associated with a higher risk of cancer and worse cancer-specific survival as well as numerous morbidities to e.g. cardiovascular disease, stroke, infection, autoimmune disease, and neuromuscular dysfunction among large populations. A considerable number of in vitro and in vivo studies indicate that the most active metabolite of vitamin D – 1,25-dihydroxycholecalciferol or calcitriol – has anti-proliferative, pro-apoptotic, pro-differentiating, and anti-angiogenic properties. Combined treatment of calcitriol and many types of cytotoxic agents has synergistic or at least additive effects. However, clinical trials testing these hypotheses have been less encouraging, though a number of methodological, pharmacological, and pharmaceutical issues confound all trials ever conducted. In order to properly assess the clinical value of vitamin D, its metabolites and analogs in cancer prevention and treatment, more studies are needed. PMID:21872802

  2. [Salivary gland tumors. Clinical aspects and therapy].

    PubMed

    Swoboda, H; Franz, P

    1994-05-01

    Salivary gland tumors are rare. One-fifth are malignant. The parotid is the gland most often affected, particularly in adenomas. Adenomas and carcinomas are tumors that occur in adulthood; angiomas are the tumors that occur most frequently in childhood. Other than their localization, salivary gland tumors have few specific signs. In the clinical examination the locoregional and functional presentation is evaluated. Imaging studies refine or correct the clinical diagnosis, primarily by visualizing the deeper planes. Morphological diagnosis in benign lesions depends on resection results; in malignant lesions additional intraoperative frozen section is needed, and in questionable cases incisional biopsy. Fine-needle aspiration cytology may provide valuable knowledge when planning therapy. Limited parotid tumors are resected by lateral or subtotal parotidectomy. Carcinomas are resected as needed, with neck dissection added in case of lymph-node involvement. Small adenoid cystic carcinomas can be treated curatively by very wide resection. Aggressive and extensive tumors are irradiated postoperatively. Malignancies not operated upon are irradiated primarily. Facial nerve paralysis can be rehabilitated by different nerve repair or static surgical techniques.

  3. [Adrenoleukodystrophy--clinical, biochemical and therapeutic aspects].

    PubMed

    Skjeldal, O H; Strømme, P; Christensen, E

    1994-11-20

    X-linked adrenoleukodystrophy is a metabolic disorder with broad clinical variations. The disease may be considered as a differential diagnosis in the case of encephalopathy, polyneuropathy, multiple sclerosis-like syndromes and adrenal insufficiency with unknown etiology. The most common form of adrenoleukodystrophy is lethal and starts with dementia in boys under ten years of age. The genetic defect is located to the Xq28 region and codes for a protein which regulates the transport of beta-oxidation enzymes in the peroxisomes. A defect of this protein seems to cause the accumulation of very long-chain fatty acids. This defect can be measured easily in the serum from patients and female carriers. Therapeutic attempts, for instance with Lorenzo's oil, in order to reduce serum level of very long-chain fatty acids, have not proven to be effective in already neurologically symptomatic patients. At present, the treatment of choice seems to be bone marrow transplantation in presymptomatic boys.

  4. Prader-Willi Syndrome: Clinical Aspects

    PubMed Central

    Elena, Grechi; Bruna, Cammarata; Benedetta, Mariani; Stefania, Di Candia; Giuseppe, Chiumello

    2012-01-01

    Prader-Willi Syndrome (PWS) is a complex multisystem genetic disorder that shows great variability, with changing clinical features during a patient's life. The syndrome is due to the loss of expression of several genes encoded on the proximal long arm of chromosome 15 (15q11.2–q13). The complex phenotype is most probably caused by a hypothalamic dysfunction that is responsible for hormonal dysfunctions and for absence of the sense of satiety. For this reason a Prader-Willi (PW) child develops hyperphagia during the initial stage of infancy that can lead to obesity and its complications. During infancy many PW child display a range of behavioural problems that become more noticeable in adolescence and adulthood and interfere mostly with quality of life. Early diagnosis of PWS is important for effective long-term management, and a precocious multidisciplinary approach is fundamental to improve quality of life, prevent complications, and prolong life expectancy. PMID:23133744

  5. [Parkinsonian rigidity: clinical and physiopathologic aspects].

    PubMed

    Delwaide, P J; Pepin, J L; Maertens de Noordhout, A

    1990-01-01

    Neurophysiologic mechanisms responsible for parkinsonian rigidity are poorly understood. In any case, they have to fit all the clinical data which are first reviewed before discussing 2 theories which are proposed to interpret rigidity. The first theory postulates that increased resistance to mobilization is due to hyperactivity in a long loop reflex pathway which originates at the neuromuscular spindles and relays in the motor cortex. This theory is based on the largely accepted finding that, in parkinsonian patients, M2 response is increased when a voluntary movement is abruptly stopped. Although popular this hypothesis is far from explaining all the clinical facts, namely that rigidity is equal in extensor and flexor, proximal and distal muscles. Based on a reflex set by primary afferent discharges, it is incompatible with the lack of rigidity reinforcement after faster passive mobilization. The second theory rests on data obtained from electrophysiological studies of some spinal interneurones. Both IA and IB inhibitory interneurones are functionally modified but not in the same direction. While the IA inhibitory interneurone is facilitated, the IB inhibitory interneurone is less active. Disappearance of autogenic inhibition can explain rigidity at rest and the tonic stretch reflex. In addition, interneurones intervening in the flexor reflex disclose a modified excitability. It is possible to interpret these facts by postulating an abnormal influence transmitted through descending reticulospinal pathways. This abnormal influence would result from modified activation of reticular nuclei by afferents projecting from the basal ganglia. Such a hypothesis is open to experimental testing through the startle reaction. The latter facilitates the H reflex by the reticulospinal pathways, the influence of cortex--if any--being negligible.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Clinical and Biomechanical Evaluations of Staged Bilateral Total Knee Arthroplasty Patients with Two Different Implant Designs

    PubMed Central

    Renaud, Alexandre; Fuentes, Alexandre; Hagemeister, Nicola; Lavigne, Martin; Vendittoli, Pascal-André

    2016-01-01

    Background: Various implants of total knee arthroplasty (TKA) are used in clinical practice and each presents specific design characteristics. No implant managed this day to reproduce perfectly the biomechanics of the natural knee during gait. Objectives: We therefore asked whether (1) differences in tridimensional (3D) kinematic data during gait could be observed in two different designs of TKA on the same patients, (2) if those gait kinematic data are comparable with those of asymptomatic knees and (3) if difference in clinical subjective scores can be observed between the two TKA designs on the same patient. Methods: We performed knee kinematic analysis on 15 patients (30 TKAs) with two different TKA implant designs (Nexgen, Zimmer and Triathlon, Stryker) on each knee and on 25 asymptomatic subjects (35 knees). Clinical evaluation included range of motion, weight bearing radiographs, questionnaire of joint perception, KOOS, WOMAC and SF-12. Results: Comparison between TKAs and asymptomatic knees revealed that asymptomatic knees had significantly less knee flexion at initial contact (p < 0.04) and more flexion for most of the swing phase (p between 0.004 and 0.04). Asymptomatic knees also had less varus at loading response, during stance phase and during most of the swing phase (p between 0.001 - 0.05). Transverse plane analysis showed a tendency for asymptomatic knees to be more in internal rotation during stance phase (p 0.02 - 0.04). Comparing both TKA designs, NexgenTM implant had significantly more flexion at the end of swing phase (p = 0.04) compared to knees with the TriathlonTM implant. In frontal plane, from initial contact to maximum mid stance angle and between the mean mid stance angle and initial contact NexgenTM TKA had significantly more adduction (varus, p =0.02 – 0.03). Clinical scores of both TKAs did not have significant difference. Conclusions: TKA with the tested implants did not reproduce natural knee kinematics during gait. In our cohort

  7. Olmsted syndrome: clinical, molecular and therapeutic aspects.

    PubMed

    Duchatelet, Sabine; Hovnanian, Alain

    2015-03-17

    Olmsted syndrome (OS) is a rare genodermatosis classically characterized by the combination of bilateral mutilating transgredient palmoplantar keratoderma (PPK) and periorificial keratotic plaques, but which shows considerable clinical heterogeneity. The disease starts usually at birth or in early childhood. About 73 cases have been reported worldwide. OS is observed in both sexes, although male cases are more frequent. The most suggestive symptoms associate PPK with pseudoainhum and periorificial keratotic plaques. Frequently associated features include hair and nail abnormalities, leukokeratosis, corneal default and recurrent infections. Pain and itching are variable but can be severe. Most of reported OS cases are sporadic, although familial cases with different mode of inheritance were also described. Mutations in TRPV3 (Transient receptor potential vanilloid-3) gene have recently been identified as a cause of autosomal dominant (gain-of-function mutations) or recessive OS. Mutations in MBTPS2 (membrane-bound transcription factor protease, site 2) gene were identified in a recessive X-linked form. The diagnosis relies mainly on clinical features associating severe PPK and periorificial keratotic plaques, but can be challenging in patients with incomplete phenotype or atypical features. OS has to be differentiated from other severe forms of PPK including Vohwinkel, Clouston, Papillon-Lefèvre or Haim-Munk syndromes, Mal de Meleda, pachyonychia congenita, Tyrosinemia type II and acrodermatitis enteropathica. When differential diagnoses are difficult to exclude, genetic studies are essential to search for a TRPV3 or MBTPS2 mutation. However, additional genes remain to be identified. No specific and satisfactory therapy is currently available for OS. Current treatments of hyperkeratosis (mainly emollients, keratolytics, retinoids or corticosteroids), either topical or systemic, are symptomatic and offer only temporary partial relief. Specific management of pain and

  8. [Clinical and biological aspects of chronic brucellosis].

    PubMed

    Buşilă, V T; Vasilescu, I; Popian, R; Fitărău, A; Teodorescu, R; Sarlău, A; Alexandrescu, R; Stamboliu, W

    1975-01-01

    The present study refers to 53 cases of chronic brucellosis admitted to the clinic or followed up in an out-patient unit for ten years (1962-1971). There was a total of 946 days in hospital and 1688 days of occupational disability, about 40% of the patients necessitating repeated hospitalization because of the relapsing course of the disease. This group of cases presented the classical dominant features of an occupational anthropozoonoses (90.5%). Elements of visceral and tissular pathology, obviously conditioned in their structure by the stage of the disease, were found in cardiovascular, hepatic, nervous, osteoarticular, orchitic, ocular, cutaneous localizations, etc. Their associated character particularize the polyvisceral forms. The immunopathology of chronic brucellosis is marked by its dynamics and frequently dissociated character of the sero-allergic diagnostic reactions. Blood proteins behave unequally (hypoalbuminemia, hyperalpha1-, hyperalpha2- and hypergammaglobulinemia). There is still debate about the terapeutic attempts, although sigmamycin associated with cortisone derivatives reduce or temporize the relapsing evolution, opening up new therapeutical perspectives. PMID:128800

  9. Primal repression: clinical and theoretical aspects.

    PubMed

    Kinston, W; Cohen, J

    1986-01-01

    Primal repression, long an obscure and unusable concept, has been given a precise place in a recent re-working of the theory of repression (Cohen & Kinston, 1984); and this paper specifically examines its properties and presentation. Primal repression refers to an absence of psychic structure which can be made good in the process of emotional growth. It is a part of the mind where trauma persists; and it has a close connexion to the unrepressed unconscious. Direct emergence of primal repression is a threat to life and its activation is therefore risky. During psychoanalysis, primal repression is normally avoided by object-narcissism buttressed by neurotic defences, but it may be reached and worked with in the presence of a non-internalizable valuing and nurturing relationship which we label 'primary relatedness'. This relation is therefore the interactional context for emotional growth. Numerous clinical examples are provided to demonstrate characteristic features of this region of the mind as seen in psychoanalyses. Vignettes illustrate the experiences of patient and analyst as primary relatedness is established; the consequent re-emergence of traumatic states and unmet needs, often initially in the form of severe physical and psychological deterioration; primitive forms of symbolization in the course of repairing primal repression; and the role of action in emotional growth. PMID:2427464

  10. Influence of clinically relevant factors on the immediate biomechanical surrounding for a series of dental implant designs.

    PubMed

    Shunmugasamy, Vasanth Chakravarthy; Gupta, Nikhil; Pessoa, Roberto Sales; Janal, Malvin N; Coelho, Paulo G

    2011-03-01

    The objective of the present study was to assess the influence of various clinically relevant scenarios on the strain distribution in the biomechanical surrounding of five different dental implant macrogeometries. The biomechanical environment surrounding an implant, i.e., the cortical and trabecular bone, was modeled along with the implant. These models included two different values of the study parameters including loading conditions, trabecular bone elastic modulus, cortical/trabecular bone thickness ratio, and bone loss for five implant designs. Finite element analysis was conducted on the models and strain in the bones surrounding the implant was calculated. Bone volumes having strains in four different windows of 0-200 με, 200-1000 με, 1000-3000 με, and > 3000 με were measured and the effect of each biomechanical variable and their two-way interactions were statistically analyzed using the analysis of variance method. This study showed that all the parameters included in this study had an effect on the volume of bones in all strain windows, except the implant design, which affected only the 0-200 με and >3000 με windows. The two-way interaction results showed that interactions existed between implant design and bone loss, and loading condition, bone loss in the 200-1000 με window, and between implant design and loading condition in the 0-200 με window. Within the limitations of the present methodology, it can be concluded that although some unfavorable clinical scenarios demonstrated a higher volume of bone in deleterious strain levels, a tendency toward the biomechanical equilibrium was evidenced regardless of the implant design.

  11. Fibrodysplasia ossificans progressiva: clinical and genetic aspects.

    PubMed

    Pignolo, Robert J; Shore, Eileen M; Kaplan, Frederick S

    2011-12-01

    Fibrodysplasia ossificans progressiva (FOP) is a severely disabling heritable disorder of connective tissue characterized by congenital malformations of the great toes and progressive heterotopic ossification that forms qualitatively normal bone in characteristic extraskeletal sites. The worldwide prevalence is approximately 1/2,000,000. There is no ethnic, racial, gender, or geographic predilection to FOP. Children who have FOP appear normal at birth except for congenital malformations of the great toes. During the first decade of life, sporadic episodes of painful soft tissue swellings (flare-ups) occur which are often precipitated by soft tissue injury, intramuscular injections, viral infection, muscular stretching, falls or fatigue. These flare-ups transform skeletal muscles, tendons, ligaments, fascia, and aponeuroses into heterotopic bone, rendering movement impossible. Patients with atypical forms of FOP have been described. They either present with the classic features of FOP plus one or more atypical features [FOP plus], or present with major variations in one or both of the two classic defining features of FOP [FOP variants]. Classic FOP is caused by a recurrent activating mutation (617G>A; R206H) in the gene ACVR1/ALK2 encoding Activin A receptor type I/Activin-like kinase 2, a bone morphogenetic protein (BMP) type I receptor. Atypical FOP patients also have heterozygous ACVR1 missense mutations in conserved amino acids. The diagnosis of FOP is made by clinical evaluation. Confirmatory genetic testing is available. Differential diagnosis includes progressive osseous heteroplasia, osteosarcoma, lymphedema, soft tissue sarcoma, desmoid tumors, aggressive juvenile fibromatosis, and non-hereditary (acquired) heterotopic ossification. Although most cases of FOP are sporadic (noninherited mutations), a small number of inherited FOP cases show germline transmission in an autosomal dominant pattern. At present, there is no definitive treatment, but a brief 4-day

  12. Pain following hysterectomy: epidemiological and clinical aspects.

    PubMed

    Brandsborg, Birgitte

    2012-01-01

    It is well known that different surgical procedures like amputation, thoracotomy, inguinal herniotomy, and mastectomy are associated with a risk of developing chronic postsurgical pain. Hysterectomy is the most frequent gynecological procedure with an annual frequency of 5000 hysterectomies for a benign indication in Denmark, but is has not previously been documented in detail to what extent this procedure leads to chronic pain. The aim of this PhD thesis was therefore to describe the epidemiology, type of pain, risk factors, and predictive factors associated with chronic pain after hysterectomy for a benign indication. The thesis includes four papers, of which one is based on a questionnaire study, two are based on a prospective clinical study, and one is a review of chronic pain after hysterectomy. The questionnaire paper included 1135 women one year after hysterectomy. A postal questionnaire about pain before and after hysterectomy was combined with data from the Danish Hysterectomy Database. Chronic postoperative pain was described by 32%, and the identified risk factors were preoperative pelvic pain, previous cesarean section, other pain problems and pain as an indication for hysterectomy. Spinal anesthesia was associated with a decreased risk of having pain after one year. The type of surgery (i.e. abdominal or vaginal hysterectomy) did not influence chronic pain. The prospective paper included 90 women referred for a hysterectomy on benign indication. The tests were performed before, on day 1, and 4 months after surgery and included questionnaires about pain, coping, and quality of life together with quantitative sensory testing of pain thresholds. Seventeen percent had pain after 4 months, and the risk factors were preoperative pain problems elsewhere and a high intensity of acute postoperative pain. Type of surgery was not a risk factor. Preoperative brush-evoked allodynia, pinprick hyperalgesia, and vaginal pain threshold were associated with a high

  13. THE CLINICAL, FUNCTIONAL AND BIOMECHANICAL PRESENTATION OF PATIENTS WITH SYMPTOMATIC HIP ABDUCTOR TENDON TEARS

    PubMed Central

    Retheesh, Theertha; Mutreja, Rinky; Janes, Gregory C.

    2016-01-01

    Background Hip abductor tendon (HAT) tearing is commonly implicated in greater trochanteric pain syndrome (GTPS), though limited information exists on the disability associated with this condition and specific presentation of these patients. Purpose To describe the clinical, functional and biomechanical presentation of patients with symptomatic HAT tears. Secondary purposes were to investigate the association between these clinical and functional measures, and to compare the pain and disability reported by HAT tear patients to those with end-stage hip osteoarthritis (OA). Study Design Prospective case series. Methods One hundred forty-nine consecutive patients with symptomatic HAT tears were evaluated using the Harris (HHS) and Oxford (OHS) Hip Scores, SF-12, an additional series of 10 questions more pertinent to those with lateral hip pain, active hip range of motion (ROM), maximal isometric hip abduction strength, six-minute walk capacity and 30-second single limb stance (SLS) test. The presence of a Trendelenburg sign and pelvis-on-femur (POF) angle were determined via 2D video analysis. An age matched comparative sample of patients with end-stage hip OA was recruited for comparison of all patient-reported outcome scores. Independent t-tests investigated group and limb differences, while analysis of variance evaluated pain changes during the functional tests. Pearson's correlation coefficients investigated the correlation between clinical measures in the HAT tear group. Results No differences existed in patient demographics and patient-reported outcome scores between HAT tear and hip OA cohorts, apart from significantly worse SF-12 mental subscale scores (p = 0.032) in the HAT tear group. Patients with HAT tears demonstrated significantly lower (p < 0.05) hip abduction strength and active ROM in all planes of motion on their affected limb. Pain significantly increased throughout the 30-second SLS test for the HAT tear group, with 57% of HAT tear patients

  14. Functional and biomechanic aspects of the scapular girdle and forelimbs of Unaysaurus tolentinoiLeal et al., 2004 (Saurischia: Sauropodomorpha)

    NASA Astrophysics Data System (ADS)

    Vargas-Peixoto, Dilson; Da-Rosa, Átila Augusto Stock; Gallo de França, Marco Aurélio

    2015-08-01

    This study presents evidence about the biomechanics and forelimbs functionality of the basal sauropodomorph Unaysaurus tolentinoi (upper portion of the SM2 sequence, Santa Maria Supersequence, Upper Triassic from southern Brazil). Maximum and minimum motion angles were inferred in the joints, disregarding the presence and/or thickness of cartilage. Furthermore, processes and external structures of the bones were analyzed in attributing the functionality of forelimbs. Unaysaurus tolentinoi had well-developed grapple ability. However, the preserved elements and their osteological features are not conclusive about strictly bipedalism or quadrupedalism in U. tolentinoi.

  15. Biomechanics and tennis

    PubMed Central

    Elliott, B

    2006-01-01

    Success in tennis requires a mix of player talent, good coaching, appropriate equipment, and an understanding of those aspects of sport science pertinent to the game. This paper outlines the role that biomechanics plays in player development from sport science and sport medicine perspectives. Biomechanics is a key area in player development because all strokes have a fundamental mechanical structure and sports injuries primarily have a mechanical cause. PMID:16632567

  16. Towards clinical management of traumatic brain injury: a review of models and mechanisms from a biomechanical perspective

    PubMed Central

    Namjoshi, Dhananjay R.; Good, Craig; Cheng, Wai Hang; Panenka, William; Richards, Darrin; Cripton, Peter A.; Wellington, Cheryl L.

    2013-01-01

    Traumatic brain injury (TBI) is a major worldwide healthcare problem. Despite promising outcomes from many preclinical studies, the failure of several clinical studies to identify effective therapeutic and pharmacological approaches for TBI suggests that methods to improve the translational potential of preclinical studies are highly desirable. Rodent models of TBI are increasingly in demand for preclinical research, particularly for closed head injury (CHI), which mimics the most common type of TBI observed clinically. Although seemingly simple to establish, CHI models are particularly prone to experimental variability. Promisingly, bioengineering-oriented research has advanced our understanding of the nature of the mechanical forces and resulting head and brain motion during TBI. However, many neuroscience-oriented laboratories lack guidance with respect to fundamental biomechanical principles of TBI. Here, we review key historical and current literature that is relevant to the investigation of TBI from clinical, physiological and biomechanical perspectives, and comment on how the current challenges associated with rodent TBI models, particularly those involving CHI, could be improved. PMID:24046354

  17. Pedicle-Screw-Based Dynamic Systems and Degenerative Lumbar Diseases: Biomechanical and Clinical Experiences of Dynamic Fusion with Isobar TTL

    PubMed Central

    Barrey, Cédric; Perrin, Gilles; Champain, Sabina

    2013-01-01

    Dynamic systems in the lumbar spine are believed to reduce main fusion drawbacks such as pseudarthrosis, bone rarefaction, and mechanical failure. Compared to fusion achieved with rigid constructs, biomechanical studies underlined some advantages of dynamic instrumentation including increased load sharing between the instrumentation and interbody bone graft and stresses reduction at bone-to-screw interface. These advantages may result in increased fusion rates, limitation of bone rarefaction, and reduction of mechanical complications with the ultimate objective to reduce reoperations rates. However published clinical evidence for dynamic systems remains limited. In addition to providing biomechanical evaluation of a pedicle-screw-based dynamic system, the present study offers a long-term (average 10.2 years) insight view of the clinical outcomes of 18 patients treated by fusion with dynamic systems for degenerative lumbar spine diseases. The findings outline significant and stable symptoms relief, absence of implant-related complications, no revision surgery, and few adjacent segment degenerative changes. In spite of sample limitations, this is the first long-term report of outcomes of dynamic fusion that opens an interesting perspective for clinical outcomes of dynamic systems that need to be explored at larger scale. PMID:25031874

  18. Epilepsy in Down Syndrome: Clinical Aspects and Possible Mechanisms.

    ERIC Educational Resources Information Center

    Stafstrom, Carl E.

    1993-01-01

    This review examines clinical aspects of seizures among individuals with Down's syndrome and explores possible mechanisms by which the trisomy 21 brain may generate seizures. Evidence suggests an interplay between pathologically hyperexcitable membrane properties, altered neuronal structure, and abnormal inhibitory neurotransmission. (Author/JDD)

  19. Clinical aspects of coal workers' pneumoconiosis and silicosis

    SciTech Connect

    Balaan, M.R.; Weber, S.L.; Banks, D.E. )

    1993-01-01

    Coal workers' pneumoconiosis and silicosis are two important respiratory disorders that result from the inhalation of respirable particles in mining. This chapter focuses on the clinical aspects of these disorders, including their pathogenesis and pathology, and approaches to their evaluation and management. 57 refs.

  20. Congenital myotonic dystrophy in Britain. I. Clinical aspects.

    PubMed Central

    Harper, P S

    1975-01-01

    A clinical and genetic study of congenital myotonic dystrophy in Britain has been carried out in 70 patients from 54 sibships. The clinical aspects are analysed here, and the existence of a syndrome clinically distinct from myotonic dystrophy of later onset is confirmed. Characteristic features included neonatal hypotonia, motor and mental retardation, and facial diplegia. A high incidence of talipes occurs at birth together with hydramnios and reduced fetal movements during pregnancy, factors suggesting prenatal onset of the disorder in many cases. Prolonged survival is the rule after infancy, but the occurrence of numerous neonatal deaths in the sibships suggests the existence of unrecognized cases dying in the neonatal period. PMID:1101835

  1. Effect of eldecalcitol, an active vitamin D analog, on hip structure and biomechanical properties: 3D assessment by clinical CT.

    PubMed

    Ito, Masako; Nakamura, Toshitaka; Fukunaga, Masao; Shiraki, Masataka; Matsumoto, Toshio

    2011-09-01

    The effects of an active vitamin D analog, eldecalcitol (ELD), on bone mineral density (BMD), bone geometry, and biomechanical properties of the proximal femur were investigated by using clinical CT. The subjects--a subgroup of a recent randomized, double-blind study comparing anti-fracture efficacy of ELD with alfacalcidol (ALF) - constituted 193 ambulatory patients with osteoporosis (189 postmenopausal women and 4 men aged 52-85 years, average ± SD: 70.9 ± 6.92 years) enrolled at 11 institutions. Multidetector-row CT data was acquired at baseline and at completion of 144 weeks' treatment. Cross-sectional densitometric and geometric parameters of the femoral neck were derived from three-dimensional CT data. Biomechanical properties including cross-sectional moment of inertia (CSMI), section modulus (SM) and buckling ratio (BR) of the femoral neck, and CSMI of the femoral shaft were also calculated. We found that, (1) with respect to the femoral neck cross-sectional parameters (total bone), in the ALF group, volumetric BMD (vBMD) decreased but bone mass was maintained and cross-sectional area (CSA) increased. In contrast, ELD maintained vBMD with a significant increase in bone mass and a trend toward increased CSA. (2) With respect to the femoral neck cross-sectional parameters (cortex), cortical thickness decreased in the ALF group, but was maintained in the ELD group. In the ALF group, vBMD and bone mass increased, and CSA was maintained. In the ELD group, vBMD, CSA, and bone mass increased. (3) With respect to the biomechanical properties of the femoral neck, ELD improved CSMI and SM to a greater extent than did ALF. BR increased in both the ALF and ELD groups. (4) With respect to the femoral shaft parameters, overall the results of bone geometry and CSMI of the femoral shaft were very consistent with the results for the femoral neck; however, cortical vBMD of the femoral shaft decreased significantly in both the ELD and ALF groups. In conclusion, our

  2. Fungal infections of the immunocompromised host: clinical and laboratory aspects.

    PubMed Central

    Musial, C E; Cockerill, F R; Roberts, G D

    1988-01-01

    Fungal infections of the immunocompromised host are being seen with greater frequency than ever before. In addition, a growing list of unusual and unexpected etiologic agents presents a unique and difficult challenge to the clinician and microbiologist. The clinical manifestations of opportunistic fungal infections are often not characteristic and, in many instances, may prevent a rapid diagnosis from being made. Clinical microbiology laboratories should consider any organism as a potential etiologic agent. This requires that all fungi recovered from immunocompromised patients be thoroughly identified and reported so that their clinical significance may be assessed. This review presents a brief discussion of the clinical and laboratory aspects of some fungal infections seen in this important group of patients. PMID:3069198

  3. Arthrogryposis: an update on clinical aspects, etiology, and treatment strategies

    PubMed Central

    Feluś, Jarosław

    2016-01-01

    Arthrogryposes – multiple joint contractures – are a clinically and etiologically heterogeneous class of diseases, where accurate diagnosis, recognition of the underlying pathology and classification are of key importance for the prognosis as well as for selection of appropriate management. This treatment remains challenging and optimally in arthrogrypotic patients should be carried out by a team of specialists familiar with all aspects of arthrogryposis pathology and treatment modalities: rehabilitation, orthotics and surgery. In this comprehensive review article, based on literature and clinical experience, the authors present an update on current knowledge on etiology, classifications and treatment options for skeletal deformations possible in arthrogryposis. PMID:26925114

  4. Using anxiolytics in epilepsy: neurobiological, neuropharmacological and clinical aspects.

    PubMed

    Mula, Marco

    2016-09-01

    Anxiety disorders represent a common psychiatric comorbidity in patients with epilepsy, affecting prognosis and quality of life. However, they are still underdiagnosed and undertreated. In clinical practice, a number of compounds are currently used as anxiolytics, with benzodiazepines being the most popular. Other drug classes, especially antiepileptic drugs, are increasingly prescribed for the treatment of anxiety. This article discusses the neurobiological targets and basic neuropharmacological aspects of anxiolytics in order to give the reader clear insight into their activity and mechanism of action. Clinical data regarding the treatment of anxiety in both adults and children with epilepsy are also summarised, emphasising the need for further studies. PMID:27435111

  5. Chronic Mountain Sickness: Clinical Aspects, Etiology, Management, and Treatment.

    PubMed

    Villafuerte, Francisco C; Corante, Noemí

    2016-06-01

    Villafuerte, Francisco C., and Noemí Corante. Chronic mountain sickness: clinical aspects, etiology, management, and treatment. High Alt Med Biol. 17:61-69, 2016.-Millions of people worldwide live at a high altitude, and a significant number are at risk of developing Chronic Mountain Sickness (CMS), a progressive incapacitating syndrome caused by lifelong exposure to hypoxia. CMS is characterized by severe symptomatic excessive erythrocytosis (EE; Hb ≥19 g/dL for women and Hb ≥21 g/dL for men) and accentuated hypoxemia, which are frequently associated with pulmonary hypertension. In advanced cases, the condition may evolve to cor pulmonale and congestive heart failure. Current knowledge indicates a genetic predisposition to develop CMS. However, there are important risk factors and comorbidities that may trigger and aggravate the condition. Thus, appropriate medical information on CMS is necessary to provide adequate diagnosis and healthcare to high-altitude inhabitants. After reviewing basic clinical aspects of CMS, including its definition, diagnosis, and common clinical findings, we discuss aspects of its etiology, and address its epidemiology, risk factors, and treatment.

  6. Chronic Mountain Sickness: Clinical Aspects, Etiology, Management, and Treatment

    PubMed Central

    Corante, Noemí

    2016-01-01

    Abstract Villafuerte, Francisco C., and Noemí Corante. Chronic mountain sickness: clinical aspects, etiology, management, and treatment. High Alt Med Biol. 17:61–69, 2016.—Millions of people worldwide live at a high altitude, and a significant number are at risk of developing Chronic Mountain Sickness (CMS), a progressive incapacitating syndrome caused by lifelong exposure to hypoxia. CMS is characterized by severe symptomatic excessive erythrocytosis (EE; Hb ≥19 g/dL for women and Hb ≥21 g/dL for men) and accentuated hypoxemia, which are frequently associated with pulmonary hypertension. In advanced cases, the condition may evolve to cor pulmonale and congestive heart failure. Current knowledge indicates a genetic predisposition to develop CMS. However, there are important risk factors and comorbidities that may trigger and aggravate the condition. Thus, appropriate medical information on CMS is necessary to provide adequate diagnosis and healthcare to high-altitude inhabitants. After reviewing basic clinical aspects of CMS, including its definition, diagnosis, and common clinical findings, we discuss aspects of its etiology, and address its epidemiology, risk factors, and treatment. PMID:27218284

  7. Inertial Measures of Motion for Clinical Biomechanics: Comparative Assessment of Accuracy under Controlled Conditions – Changes in Accuracy over Time

    PubMed Central

    Lebel, Karina; Boissy, Patrick; Hamel, Mathieu; Duval, Christian

    2015-01-01

    Background Interest in 3D inertial motion tracking devices (AHRS) has been growing rapidly among the biomechanical community. Although the convenience of such tracking devices seems to open a whole new world of possibilities for evaluation in clinical biomechanics, its limitations haven’t been extensively documented. The objectives of this study are: 1) to assess the change in absolute and relative accuracy of multiple units of 3 commercially available AHRS over time; and 2) to identify different sources of errors affecting AHRS accuracy and to document how they may affect the measurements over time. Methods This study used an instrumented Gimbal table on which AHRS modules were carefully attached and put through a series of velocity-controlled sustained motions including 2 minutes motion trials (2MT) and 12 minutes multiple dynamic phases motion trials (12MDP). Absolute accuracy was assessed by comparison of the AHRS orientation measurements to those of an optical gold standard. Relative accuracy was evaluated using the variation in relative orientation between modules during the trials. Findings Both absolute and relative accuracy decreased over time during 2MT. 12MDP trials showed a significant decrease in accuracy over multiple phases, but accuracy could be enhanced significantly by resetting the reference point and/or compensating for initial Inertial frame estimation reference for each phase. Interpretation The variation in AHRS accuracy observed between the different systems and with time can be attributed in part to the dynamic estimation error, but also and foremost, to the ability of AHRS units to locate the same Inertial frame. Conclusions Mean accuracies obtained under the Gimbal table sustained conditions of motion suggest that AHRS are promising tools for clinical mobility assessment under constrained conditions of use. However, improvement in magnetic compensation and alignment between AHRS modules are desirable in order for AHRS to reach their

  8. Interstitial Lung Disease in Childhood: Clinical and Genetic Aspects

    PubMed Central

    Kitazawa, Hiroshi; Kure, Shigeo

    2015-01-01

    Interstitial lung disease (ILD) in childhood is a heterogeneous group of rare pulmonary conditions presenting chronic respiratory disorders. Many clinical features of ILD still remain unclear, making the treatment strategies mainly investigative. Guidelines may provide physicians with an overview on the diagnosis and therapeutic directions. However, the criteria used in different clinical studies for the classification and diagnosis of ILDs are not always the same, making the development of guidelines difficult. Advances in genetic testing have thrown light on some etiologies of ILD, which were formerly classified as ILDs of unknown origins. The need of genetic testing for unexplained ILD is growing, and new classification criteria based on the etiology should be adopted to better understand the disease. The purpose of this review is to give an overview of the clinical and genetic aspects of ILD in children. PMID:26512209

  9. Clinical and Sociodemographic Aspects of Inflammatory Bowel Disease Patients

    PubMed Central

    Delmondes, Leda Maria; Nunes, Marcelo Oliveira; Azevedo, Arthur Rangel; Oliveira, Murilo Matos de Santana; Coelho, Lorena Eugenia Rosa; Torres-Neto, Juvenal da Rocha

    2015-01-01

    Background In Brazil, there are few epidemiological studies available about the demographic and clinical aspects of inflammatory bowel disease (IBD). The aim of this study was to identify epidemiological and clinical characteristics of patients with IBD treated at the University Hospital (HU) of the Sergipe Federal University (UFS). Methods A cross-sectional descriptive study was conducted in HU/UFS from October 2011 to January 2014. The sample consisted of 87 patients with IBD, who registered in the coloproctology clinic. We applied a questionnaire with sociodemographic and clinical variables. Results Of the 87 patients, 40 (46%) had Crohn’s disease (CD) and 47 (54%) had ulcerative colitis (UC). Women had a higher prevalence of IBD. Data obtained were significant (P < 0.05) in the variables: age, origin and level of education. CD patients were younger (< 25 years old), had higher prevalence of smoking habits and were associated with urban origin, conjunctivitis, palpable mass, appendectomy and intestinal complications. UC was more prevalent in older individuals (> 25 years old), with rural origin, bloody diarrhea and rectal bleeding. Location and initial behavior of CD were ileum-colic (L3), inflammatory behavior and penetrating form of the disease. There is higher prevalence of proctitis and mild and severe forms of the UC among women. Osteoarticular and systemic manifestations predominated in both diseases. Conclusions IBD affected more women than men. The age, origin and level of education can interfere with early diagnosis. Demographic and clinical aspects were similar to the literature. Data differ in the time interval between the onset of symptoms and diagnosis, smoking habit, appendectomy and severity of UC for age and gender.

  10. [Key aspects in interpreting clinical trials in radiology].

    PubMed

    Díaz Gómez, L; García Villar, C; Seguro Fernández, Á

    2015-01-01

    A clinical trial is an experimental study to evaluate the efficacy and safety of a treatment or diagnostic technique in human beings. To ensure the methodological quality of a clinical trial and the validity of its results, various checklists have been elaborated to identify biases that could invalidate its conclusions. This article focuses on the points we need to consider in the critical evaluation of a clinical trial. We can usually find this information in the "materials and methods" and "results" sections of articles. Randomization, follow-up (or analysis of losses), blinding, and equivalence between groups (apart from the intervention itself) are some key aspects related to design. In the "results" section, we need to consider what measures of clinical efficacy were used (relative risk, odds ratio, or number needed to treat, among others) and the precision of the results (confidence intervals). Once we have confirmed that the clinical trial fulfills these criteria, we need to determine whether the results can be applied in our environment and whether the benefits obtained justify the risks and costs involved.

  11. [Post-traumatic stress disorder: Clinical aspects and pharmacological approach].

    PubMed

    Auxéméry, Y

    2012-12-01

    All medical specialities are interested in the clinical aspects of psychological trauma. Due to psychopathological determinants which structure the trauma, although pathognomonic of posttraumatic stress disorder, flashbacks are rarely highlighted by the psychotraumatised patient in their contact with the health care system. Contact with the medical profession is expressed by somatic symptoms or psychiatric comorbidities. Addictive and suicidal problems, as well as somatisations and physical pain, are more traditional methods of contact with the health care system. In relation to the evolution of investigative techniques, modern wars have highlighted other dissociative and psychotic dimensions of the psycho- and craniatraumatic repercussions. These different clinical forms of posttraumatic stress disorder can receive a specific pharmacological treatment according to the predominant impairment of the incriminated monoaminergic neuromodulatory system. PMID:23036781

  12. Blepharospasm: Update on Epidemiology, Clinical Aspects, and Pathophysiology

    PubMed Central

    Valls-Sole, Josep; Defazio, Giovanni

    2016-01-01

    Blepharospasm (BSP) is a rather distressing form of focal dystonia. Although many aspects of its pathophysiological mechanisms are already known, we lack fundamental evidence on etiology, prevention, and treatment. To advance in our knowledge, we need to review what is already known in various aspects of the disorder and use these bases to find future lines of interest. Some of the signs observed in BSP are cause, while others are consequence of the disorder. Non-motor symptoms and signs may be a cue for understanding better the disease. Various cerebral sites have been shown to be functionally abnormal in BSP, including the basal ganglia, the cortex, and the cerebellum. However, we still do not know if the dysfunction or structural change affecting these brain regions is cause or consequence of BSP. Further advances in neurophysiology and neuroimaging may eventually clarify the pathophysiological mechanisms implicated. In this manuscript, we aim to update what is known regarding epidemiology, clinical aspects, and pathophysiology of the disorder and speculate on the directions of research worth pursuing in the near future. PMID:27064462

  13. Biomechanics and muscle coordination of human walking: part II: lessons from dynamical simulations and clinical implications.

    PubMed

    Zajac, Felix E; Neptune, Richard R; Kautz, Steven A

    2003-02-01

    Principles of muscle coordination in gait have been based largely on analyses of body motion, ground reaction force and EMG measurements. However, data from dynamical simulations provide a cause-effect framework for analyzing these measurements; for example, Part I (Gait Posture, in press) of this two-part review described how force generation in a muscle affects the acceleration and energy flow among the segments. This Part II reviews the mechanical and coordination concepts arising from analyses of simulations of walking. Simple models have elucidated the basic multisegmented ballistic and passive mechanics of walking. Dynamical models driven by net joint moments have provided clues about coordination in healthy and pathological gait. Simulations driven by muscle excitations have highlighted the partial stability afforded by muscles with their viscoelastic-like properties and the predictability of walking performance when minimization of metabolic energy per unit distance is assumed. When combined with neural control models for exciting motoneuronal pools, simulations have shown how the integrative properties of the neuro-musculo-skeletal systems maintain a stable gait. Other analyses of walking simulations have revealed how individual muscles contribute to trunk support and progression. Finally, we discuss how biomechanical models and simulations may enhance our understanding of the mechanics and muscle function of walking in individuals with gait impairments.

  14. Cutaneous field cancerization: clinical, histopathological and therapeutic aspects*

    PubMed Central

    Torezan, Luís Antônio Ribeiro; Festa-Neto, Cyro

    2013-01-01

    The concept of "field cancerization" was first introduced by Slaughter in 1953 when studying the presence of histologically abnormal tissue surrounding oral squamous cell carcinoma. It was proposed to explain the development of multiple primary tumors and locally recurrent cancer. Organ systems in which field cancerization has been described since then are: head and neck (oral cavity, oropharynx, and larynx), lung, vulva, esophagus, cervix, breast, skin, colon, and bladder. Recent molecular studies support the carcinogenesis model in which the development of a field with genetically altered cells plays a central role. An important clinical implication is that fields often remain after the surgery for the primary tumor and may lead to new cancers, designated presently as "a second primary tumor" or "local recurrence," depending on the exact site and time interval. In conclusion, the development of an expanding pre-neoplastic field appears to be a critical step in epithelial carcinogenesis with important clinical consequences. Diagnosis and treatment of epithelial cancers should not only be focused on the tumor but also on the field from which it developed. The most important etiopathogenetic, clinical, histopathological and therapeutic aspects of field cancerization are reviewed in this article. PMID:24173184

  15. CA 19-9: Biochemical and Clinical Aspects.

    PubMed

    Scarà, Salvatore; Bottoni, Patrizia; Scatena, Roberto

    2015-01-01

    CA19-9 (carbohydrate antigen 19-9, also called cancer antigen 19-9 or sialylated Lewis a antigen) is the most commonly used and best validated serum tumor marker for pancreatic cancer diagnosis in symptomatic patients and for monitoring therapy in patients with pancreatic adenocarcinoma. Normally synthesized by normal human pancreatic and biliary ductal cells and by gastric, colon, endometrial and salivary epithelia, CA 19-9 is present in small amounts in serum, and can be over expressed in several benign gastrointestinal disorders. Importantly, it exhibits a dramatic increase in its plasmatic levels during neoplastic disease. However, several critical aspects for its clinical use, such as false negative results in subjects with Lewis (a-b-) genotype and false positive elevation, occasional and transient, in patients with benign diseases, together with its poor positive predictive value (72.3 %), do not make it a good cancer-specific marker and renders it impotent as a screening tool. In the last years a large number of putative biomarkers for pancreatic cancer have been proposed, most of which is lacking of large scale validation. In addition, none of these has showed to possess the requisite sensitivity/specificity to be introduced in clinical use. Therefore, although with important limitations we well-know, CA 19-9 continues being the only pancreatic cancer marker actually in clinical use.

  16. Corneal biomechanics: a review.

    PubMed

    Piñero, David P; Alcón, Natividad

    2015-03-01

    Biomechanics is often defined as 'mechanics applied to biology'. Due to the variety and complexity of the behaviour of biological structures and materials, biomechanics is better defined as the development, extension and application of mechanics for a better understanding of physiology and physiopathology and consequently for a better diagnosis and treatment of disease and injury. Different methods for the characterisation of corneal biomechanics are reviewed in detail, including those that are currently commercially available (Ocular Response Analyzer and CorVis ST). The clinical applicability of the parameters provided by these devices are discussed, especially in the fields of glaucoma, detection of ectatic disorders and orthokeratology. Likewise, other methods are also reviewed, such as Brillouin microscopy or dynamic optical coherence tomography and others with potential application to clinical practice but not validated for in vivo measurements, such as ultrasonic elastography. Advantages and disadvantages of all these techniques are described. Finally, the concept of biomechanical modelling is revised as well as the requirements for developing biomechanical models, with special emphasis on finite element modelling. PMID:25470213

  17. [Clinical aspects of puerperal psychoses. Review with 3 case examples].

    PubMed

    Fallgatter, A J; Schnizlein, M; Pfuhlmann, B; Heidrich, A

    2002-07-01

    Psychic disturbances in the post-partum period are divided into the postpartum blues, postpartum depression, and postpartum psychoses. The latter are severe endogenous psychoses which mostly fulfill the diagnostic criteria for cycloid psychoses according to Leonhard. Based on three case reports, characteristic symptoms, the phasic clinical course with remissions, and distinct etiological, therapeutic, and forensic aspects of cycloid psychoses in the post-partum period are discussed. The high relapse rate of approximately 50% in patients at risk requires intensive psychiatric care in the peripartal period. In particular, the possibility of a prophylactic treatment of patients at risk with lithium immediately after delivery is emphasized. However, this sophisticated therapeutic strategy requires close cooperation between gynecologists and psychiatrists.

  18. [Basilar ectasia and stroke: clinical aspects of 21 cases].

    PubMed

    de Oliveira, R de M; Cardeal, J O; Lima, J G

    1997-09-01

    Ectasia of the basilar artery (EB) occurs when its diameter is greater than normal along all or part of its course, and/or when it is abnormally tortuous. EB may cause cranial nerve dysfunction, ischemic stroke or subarachnoid hemorrhage, pseudotumor or hydrocephalus. We tried to describe cases of stroke associated with EB, analyze its frequency, clinical aspects, and the mechanisms involved in different forms of its presentation. We found 21 patients with stroke and EB. The association between EB and stroke was more prevalent in males over the age of fifty. Main symptoms were hemiparesia, cranial nerves dysfunction, and cerebellar ataxia. Cerebral infarcts associated with EB were due to different mechanisms: arterial thrombosis, artery-to-artery embolism, mass effect with angulation and obstruction of the vertebral and basilar branches. PMID:9629405

  19. Anterior Cruciate Ligament Biomechanics During Robotic and Mechanical Simulations of Physiologic and Clinical Motion Tasks: A Systematic Review and Meta-Analysis

    PubMed Central

    Bates, Nathaniel A.; Myer, Gregory D.; Shearn, Jason T.; Hewett, Timothy E.

    2014-01-01

    Investigators use in vitro joint simulations to invasively study the biomechanical behaviors of the anterior cruciate ligament. The aims of these simulations are to replicate physiologic conditions, but multiple mechanisms can be used to drive in vitro motions, which may influence biomechanical outcomes. The objective of this review was to examine, summarize, and compare biomechanical evidence related to anterior cruciate ligament function from in vitro simulations of knee motion. A systematic review was conducted (2004 to 2013) in Scopus, PubMed/Medline, and SPORTDiscus to identify peer-reviewed studies that reported kinematic and kinetic outcomes from in vitro simulations of physiologic or clinical tasks at the knee. Inclusion criteria for relevant studies were articles published in English that reported on whole-ligament anterior cruciate ligament mechanics during the in vitro simulation of physiologic or clinical motions on cadaveric knees that were unaltered outside of the anterior-cruciate-ligament-intact, -deficient, and -reconstructed conditions. A meta-analysis was performed to synthesize biomechanical differences between the anterior-cruciate-ligament-intact and reconstructed conditions. 77 studies met our inclusion/exclusion criteria and were reviewed. Combined joint rotations have the greatest impact on anterior cruciate ligament loads, but the magnitude by which individual kinematic degrees of freedom contribute to ligament loading during in vitro simulations is technique-dependent. Biomechanical data collected in prospective, longitudinal studies corresponds better with robotic-manipulator simulations than mechanical-impact simulations. Robotic simulation indicated that the ability to restore intact anterior cruciate ligament mechanics with anterior cruciate ligament reconstructions was dependent on loading condition and degree of freedom examined. PMID:25547070

  20. Anterior cruciate ligament biomechanics during robotic and mechanical simulations of physiologic and clinical motion tasks: a systematic review and meta-analysis.

    PubMed

    Bates, Nathaniel A; Myer, Gregory D; Shearn, Jason T; Hewett, Timothy E

    2015-01-01

    Investigators use in vitro joint simulations to invasively study the biomechanical behaviors of the anterior cruciate ligament. The aims of these simulations are to replicate physiologic conditions, but multiple mechanisms can be used to drive in vitro motions, which may influence biomechanical outcomes. The objective of this review was to examine, summarize, and compare biomechanical evidence related to anterior cruciate ligament function from in vitro simulations of knee motion. A systematic review was conducted (2004 to 2013) in Scopus, PubMed/Medline, and SPORTDiscus to identify peer-reviewed studies that reported kinematic and kinetic outcomes from in vitro simulations of physiologic or clinical tasks at the knee. Inclusion criteria for relevant studies were articles published in English that reported on whole-ligament anterior cruciate ligament mechanics during the in vitro simulation of physiologic or clinical motions on cadaveric knees that were unaltered outside of the anterior-cruciate-ligament-intact, -deficient, and -reconstructed conditions. A meta-analysis was performed to synthesize biomechanical differences between the anterior-cruciate-ligament-intact and reconstructed conditions. 77 studies met our inclusion/exclusion criteria and were reviewed. Combined joint rotations have the greatest impact on anterior cruciate ligament loads, but the magnitude by which individual kinematic degrees of freedom contribute to ligament loading during in vitro simulations is technique-dependent. Biomechanical data collected in prospective, longitudinal studies corresponds better with robotic-manipulator simulations than mechanical-impact simulations. Robotic simulation indicated that the ability to restore intact anterior cruciate ligament mechanics with anterior cruciate ligament reconstructions was dependent on loading condition and degree of freedom examined.

  1. Uses of coercion in addiction treatment: clinical aspects.

    PubMed

    Sullivan, Maria A; Birkmayer, Florian; Boyarsky, Beth K; Frances, Richard J; Fromson, John A; Galanter, Marc; Levin, Frances R; Lewis, Collins; Nace, Edgar P; Suchinsky, Richard T; Tamerin, John S; Tolliver, Bryan; Westermeyer, Joseph

    2008-01-01

    Coerced or involuntary treatment comprises an integral, often positive component of treatment for addictive disorders. By the same token, coercion in health care raises numerous ethical, clinical, legal, political, cultural, and philosophical issues. In order to apply coerced care effectively, health care professionals should appreciate the indications, methods, advantages, and liabilities associated with this important clinical modality. An expert panel, consisting of the Addiction Committee of the Group for the Advancement of Psychiatry, listed the issues to be considered by clinicians in considering coerced treatment. In undertaking this task, they searched the literature using Pubmed from 1985 to 2005 using the following search terms: addiction, alcohol, coercion, compulsory, involuntary, substance, and treatment. In addition, they utilized relevant literature from published reports. In the treatment of addictions, coercive techniques can be effective and may be warranted in some circumstances. Various dimensions of coercive treatment are reviewed, including interventions to initiate treatment; contingency contracting and urine testing in the context of psychotherapy; and pharmacological methods of coercion such as disulfiram, naltrexone, and the use of a cocaine vaccine. The philosophical, historical, and societal aspects of coerced treatment are considered.

  2. Clinical and cytopathological aspects in phyllodes tumors of the breast.

    PubMed

    Pătraşcu, Anca; Popescu, Carmen Florina; Pleşea, I E; Bădulescu, Adriana; Tănase, Florentina; Mateescu, Garofiţa

    2009-01-01

    The frequency of mesenchymal breast tumors is very low, being represented mostly by tumors with biphasic proliferation (phyllodes tumors) and less by other types of non-epithelial tumors. From clinical point of view, phyllodes tumors (PT) can mimic a breast carcinoma. Therefore, the preoperative diagnosis by cytological examination on material obtained by fine needle aspiration (FNA) is very important for adequate treatment of these tumors. In current study, we assessed clinical aspects of 79 phyllodes tumors regarding patient's age and localization of the tumors. In 17 out of 79 cases, it has been performed FNA within the tumors with further cytological examination on the smears obtained. The median age of the patients was 46.07-year-old, being progressively higher with grade of the tumors with significant values between benign and borderline tumors (p=0.04954) and between benign and malignant ones (p=0.02890). The distinguish on the smears of stromal fragments and naked stromal nuclei with variable grade of atypia regarding the tumoral type, in detriment of epithelial elements have been conclusive for fibroepithelial lesion as cytopathological diagnosis. The preoperative differentiation between a breast phyllodes tumor and a breast carcinoma is extremely important for avoiding of a useless radical surgery for the patient. If the fine needle aspiration was correctly performed, the accuracy of the cytodiagnosis has been 82% in current study. PMID:19942954

  3. [Autism in females: clinical, neurobiological and genetic aspects].

    PubMed

    Ruggieri, V L; Arberas, C L

    2016-01-01

    Autism spectrum disorders are more prevalent in males than in females, and the proportion can range from 1.4 to 1, depending on the samples that are analysed. The smaller difference has been related to those who also manifest an associated intellectual disability, and it is accepted that in those cases females are far more seriously affected. There is likely to be a subregister of females with autism spectrum disorder, especially in those who have high cognitive performance, that is possibly related with the assessment techniques that are used and even with the lack of suitable levels of arousal in girls. In general, females with autism have better early language development, better social skills and their playing can even develop in the expected way. Their interests can be similar to those of their peer group, although they usually vary in intensity and quality. It is accepted as a fact that the difference in the social skills becomes more apparent in adolescence. The extreme male brain theory, the female-specific protective factor, variants in brain plasticity (lower threshold in males with greater susceptibility) and genetic and epigenetic factors, among others, are put forward as possible hypotheses to justify this lower prevalence and the clinical variants in females. This work aims to analyse the clinical and developmental aspects, the variability of expression in females with respect to males, and some of the possible neurobiological and genetic bases that account for the higher prevalence and the differences in expression.

  4. Analytical Aspects of the Implementation of Biomarkers in Clinical Transplantation.

    PubMed

    Shipkova, Maria; López, Olga Millán; Picard, Nicolas; Noceti, Ofelia; Sommerer, Claudia; Christians, Uwe; Wieland, Eberhard

    2016-04-01

    In response to the urgent need for new reliable biomarkers to complement the guidance of the immunosuppressive therapy, a huge number of biomarker candidates to be implemented in clinical practice have been introduced to the transplant community. This includes a diverse range of molecules with very different molecular weights, chemical and physical properties, ex vivo stabilities, in vivo kinetic behaviors, and levels of similarity to other molecules, etc. In addition, a large body of different analytical techniques and assay protocols can be used to measure biomarkers. Sometimes, a complex software-based data evaluation is a prerequisite for appropriate interpretation of the results and for their reporting. Although some analytical procedures are of great value for research purposes, they may be too complex for implementation in a clinical setting. Whereas the proof of "fitness for purpose" is appropriate for validation of biomarker assays used in exploratory drug development studies, a higher level of analytical validation must be achieved and eventually advanced analytical performance might be necessary before diagnostic application in transplantation medicine. A high level of consistency of results between laboratories and between methods (if applicable) should be obtained and maintained to make biomarkers effective instruments in support of therapeutic decisions. This overview focuses on preanalytical and analytical aspects to be considered for the implementation of new biomarkers for adjusting immunosuppression in a clinical setting and highlights critical points to be addressed on the way to make them suitable as diagnostic tools. These include but are not limited to appropriate method validation, standardization, education, automation, and commercialization.

  5. Evidence-based protocol for structural rehabilitation of the spine and posture: review of clinical biomechanics of posture (CBP®) publications

    PubMed Central

    Oakley, Paul A.; Harrison, Donald D.; Harrison, Deed E.; Haas, Jason W.

    2005-01-01

    BACKGROUND Although practice protocols exist for SMT and functional rehabilitation, no practice protocols exist for structural rehabilitation. Traditional chiropractic practice guidelines have been limited to acute and chronic pain treatment, with limited inclusion of functional and exclusion of structural rehabilitation procedures. OBJECTIVE (1) To derive an evidence-based practice protocol for structural rehabilitation from publications on Clinical Biomechanics of Posture (CBP®) methods, and (2) to compare the evidence for Diversified, SMT, and CBP®. METHODS Clinical control trials utilizing CBP® methods and spinal manipulative therapy (SMT) were obtained from searches in Mantis, CINAHL, and Index Medicus. Using data from SMT review articles, evidence for Diversified Technique (as taught in chiropractic colleges), SMT, and CBP® were rated and compared. RESULTS From the evidence from Clinical Control Trials on SMT and CBP®, there is very little evidence support for Diversified (our rating = 18), as taught in chiropractic colleges, for the treatment of pain subjects, while CBP® (our rating = 46) and SMT for neck pain (rating = 58) and low back pain (our rating = 202) have evidence-based support. CONCLUSIONS While CBP® Technique has approximately as much evidence-based support as SMT for neck pain, CBP® has more evidence to support its methods than the Diversified technique taught in chiropractic colleges, but not as much as SMT for low back pain. The evolution of chiropractic specialization has occurred, and doctors providing structural-based chiropractic care require protocol guidelines for patient quality assurance and standardization. A structural rehabilitation protocol was developed based on evidence from CBP® publications. PMID:17549209

  6. OPTICAL PRINCIPLES, BIOMECHANICS, AND INITIAL CLINICAL PERFORMANCE OF A DUAL-OPTIC ACCOMMODATING INTRAOCULAR LENS (AN AMERICAN OPHTHALMOLOGICAL SOCIETY THESIS)

    PubMed Central

    McLeod, Stephen D.

    2006-01-01

    Purpose To design and develop an accommodating intraocular lens (IOL) for endocapsular fixation with extended accommodative range that can be adapted to current standard extracapsular phacoemulsification technique. Methods Ray tracing analysis and lens design; finite element modeling of biomechanical properties; cadaver eye implantation; initial clinical evaluation. Results Ray tracing analysis indicated that a dual-optic design with a high plus-power front optic coupled to an optically compensatory minus posterior optic produced greater change in conjugation power of the eye compared to that produced by axial movement of a single-optic IOL, and that magnification effects were unlikely to account for improved near vision. Finite element modeling indicated that the two optics can be linked by spring-loaded haptics that allow anterior and posterior axial displacement of the front optic in response to changes in ciliary body tone and capsular tension. A dual-optic single-piece foldable silicone lens was constructed based on these principles. Subsequent initial clinical evaluation in 24 human eyes after phacoemulsification for cataract indicated mean 3.22 diopters of accommodation (range, 1 to 5 D) based on defocus curve measurement. Accommodative amplitude evaluation at 1- and 6-month follow-up in all eyes indicated that the accommodative range was maintained and that the lens was well tolerated. Conclusions A dual-optic design increases the accommodative effect of axial optic displacement, with minimal magnification effect. Initial clinical trials suggest that IOLs designed on this principle might provide true pseudophakic accommodation following cataract extraction and lens implantation. PMID:17471355

  7. Biological and Clinical Aspects of Lanthanide Coordination Compounds

    PubMed Central

    Misra, Sudhindra N.; M., Indira Devi; Shukla, Ram S.

    2004-01-01

    The coordinating chemistry of lanthanides, relevant to the biological, biochemical and medical aspects, makes a significant contribution to understanding the basis of application of lanthanides, particularly in biological and medical systems. The importance of the applications of lanthanides, as an excellent diagnostic and prognostic probe in clinical diagnostics, and an anticancer material, is remarkably increasing. Lanthanide complexes based X-ray contrast imaging and lanthanide chelates based contrast enhancing agents for magnetic resonance imaging (MRI) are being excessively used in radiological analysis in our body systems. The most important property of the chelating agents, in lanthanide chelate complex, is its ability to alter the behaviour of lanthanide ion with which it binds in biological systems, and the chelation markedly modifies the biodistribution and excretion profile of the lanthanide ions. The chelating agents, especially aminopoly carboxylic acids, being hydrophilic, increase the proportion of their complex excreted from complexed lanthanide ion form biological systems. Lanthanide polyamino carboxylate-chelate complexes are used as contrast enhancing agents for Magnetic Resonance Imaging. Conjugation of antibodies and other tissue specific molecules to lanthanide chelates has led to a new type of specific MRI contrast agents and their conjugated MRI contrast agents with improved relaxivity, functioning in the body similar to drugs. Many specific features of contrast agent assisted MRI make it particularly effective for musculoskeletal and cerebrospinal imaging. Lanthanide-chelate contrast agents are effectively used in clinical diagnostic investigations involving cerebrospinal diseases and in evaluation of central nervous system. Chelated lanthanide complexes shift reagent aided 23Na NMR spectroscopic analysis is used in cellular, tissue and whole organ systems. PMID:18365075

  8. Chronic urticaria and coagulation: pathophysiological and clinical aspects.

    PubMed

    Tedeschi, A; Kolkhir, P; Asero, R; Pogorelov, D; Olisova, O; Kochergin, N; Cugno, M

    2014-06-01

    Chronic urticaria (CU) is a widespread skin disease, characterized by the recurrence of transient wheals and itch for more than 6 weeks. Besides autoimmune mechanisms, coagulation factors, in particular tissue factor and thrombin, might also participate in the disease pathophysiology. Tissue factor expressed by eosinophils can induce activation of blood coagulation generating thrombin which in turn can increase vascular permeability both directly, acting on endothelial cells, and indirectly, inducing degranulation of mast cells with release of histamine, as demonstrated in experimental models. D-dimer, a fibrin degradation product, generated following activation of the coagulation cascade and fibrinolysis, has been found to be increased during urticaria exacerbations; moreover, it has been proposed as a biomarker of severity and resistance to H1-antihistamines in CU patients. The possible role of coagulation in CU is also supported by case reports, case series and a small controlled study showing the efficacy of anticoagulant therapy in this disease. The purpose of this review was to summarize the available data on the possible contribution of coagulation to the pathophysiology of CU focusing on clinical aspects and possible future therapeutic developments. PMID:24673528

  9. Clinical and technical aspects of bipolar transurethral prostate resection.

    PubMed

    Faul, Peter; Schlenker, Boris; Gratzke, Christian; Stief, Christian G; Reich, Oliver; Hahn, Robert Gustaw

    2008-01-01

    This review aims to provide an overview and critical assessment of the developments in transurethral electroresection in non-conductive and conductive irrigants. In the 1970s, measurements of the electric pathway in saline were performed for different locations of the neutral electrode. It was then concluded that the current pathway and the possible hazards of burn injuries to the patient should be investigated separately for each arrangement of the neutral electrode. The position and shape of the neutral electrode have decisive effects on the current flow in the patient. Thus, different electrode arrangements of the various bipolar resection systems need to be analysed separately. Furthermore, not only electrical power, but also conductivity and quality of the lubricant gel have to be considered as critical factors with regard to electrothermal injuries of the urethra. The supposedly better cutting quality seems to be based more on subjective observations than on scientific valid data. When performing "bipolar" TUR it is necessary to consider all electrotechnical and clinical aspects, particularly with regard to the potential risk of thermoelectrical urethral damage. PMID:18622807

  10. Central Nervous System Tuberculosis: Pathogenesis and Clinical Aspects

    PubMed Central

    Rock, R. Bryan; Olin, Michael; Baker, Cristina A.; Molitor, Thomas W.; Peterson, Phillip K.

    2008-01-01

    Summary: Tuberculosis of the central nervous system (CNS) is a highly devastating form of tuberculosis, which, even in the setting of appropriate antitubercular therapy, leads to unacceptable levels of morbidity and mortality. Despite the development of promising molecular diagnostic techniques, diagnosis of CNS tuberculosis relies largely on microbiological methods that are insensitive, and as such, CNS tuberculosis remains a formidable diagnostic challenge. Insights into the basic neuropathogenesis of Mycobacterium tuberculosis and the development of an appropriate animal model are desperately needed. The optimal regimen and length of treatment are largely unknown, and with the rising incidence of multidrug-resistant strains of M. tuberculosis, the development of well-tolerated and effective antibiotics remains a continued need. While the most widely used vaccine in the world largely targets this manifestation of tuberculosis, the BCG vaccine has not fulfilled the promise of eliminating CNS tuberculosis. We put forth this review to highlight the current understanding of the neuropathogenesis of M. tuberculosis, to discuss certain epidemiological, clinical, diagnostic, and therapeutic aspects of CNS tuberculosis, and also to underscore the many unmet needs in this important field. PMID:18400795

  11. [Clinical and evolutive aspects of hydrocephalus in neurocysticercosis].

    PubMed

    Agapejev, Svetlana; Pouza, Ana Flávia P; Bazan, Rodrigo; Faleiros, Antonio Tadeu S

    2007-09-01

    With the purpose to verify clinical aspects of hydrocephalus (HC) in patients with neurocysticercosis (NCC), a retrospective study of 47 patients was performed. The majority of patients (70.2%) were men aging 21-50 years. Intracranial hypertension (ICH) occurred in all patients, headache (HA) in 42 (89.4%), meningoencephalitis (ME) in 38 (80.8%) and psychiatric disorders (PD) in 34 (72.3%). The cerebrospinal fluid syndrome of NCC was detected in 31 patients (65.9%). In addition to HC, computed tomography (CT) scans showed cystic lesions in 28 (59.6%) patients, diffuse brain edema also in 28 (59.6%), and calcifications in 26 (55.3%). Shunts were inserted in 41 (87.2%) patients and 22 (53.7%) of them were submitted to 1-7 surgical revision/patient (mean=3) that were higher (mean=4) in those who died than in survivors (mean=2). Evolution was satisfactory in 24 (51.1%) patients and fatal in 15 (31.9%). It is possible to conclude that, in patients with NCC, HC occurs predominantly in men in productive life with ICH, HA, ME and PD as common manifestations, and the need for shunt revision makes patient's prognosis worse.

  12. Cataplexy--clinical aspects, pathophysiology and management strategy.

    PubMed

    Dauvilliers, Yves; Siegel, Jerry M; Lopez, Regis; Torontali, Zoltan A; Peever, John H

    2014-07-01

    Cataplexy is the pathognomonic symptom of narcolepsy, and is the sudden uncontrollable onset of skeletal muscle paralysis or weakness during wakefulness. Cataplexy is incapacitating because it leaves the individual awake but temporarily either fully or partially paralyzed. Occurring spontaneously, cataplexy is typically triggered by strong positive emotions such as laughter and is often underdiagnosed owing to a variable disease course in terms of age of onset, presenting symptoms, triggers, frequency and intensity of attacks. This disorder occurs almost exclusively in patients with depletion of hypothalamic orexin neurons. One pathogenetic mechanism that has been hypothesized for cataplexy is the activation, during wakefulness, of brainstem circuitry that normally induces muscle tone suppression in rapid eye movement sleep. Muscle weakness during cataplexy is caused by decreased excitation of noradrenergic neurons and increased inhibition of skeletal motor neurons by γ-aminobutyric acid-releasing or glycinergic neurons. The amygdala and medial prefrontal cortex contain neural pathways through which positive emotions probably trigger cataplectic attacks. Despite major advances in understanding disease mechanisms in cataplexy, therapeutic management is largely symptomatic, with antidepressants and γ-hydroxybutyrate being the most effective treatments. This Review describes the clinical and pathophysiological aspects of cataplexy, and outlines optimal therapeutic management strategies. PMID:24890646

  13. Conformal piezoelectric systems for clinical and experimental characterization of soft tissue biomechanics

    NASA Astrophysics Data System (ADS)

    Dagdeviren, Canan; Shi, Yan; Joe, Pauline; Ghaffari, Roozbeh; Balooch, Guive; Usgaonkar, Karan; Gur, Onur; Tran, Phat L.; Crosby, Jessi R.; Meyer, Marcin; Su, Yewang; Chad Webb, R.; Tedesco, Andrew S.; Slepian, Marvin J.; Huang, Yonggang; Rogers, John A.

    2015-07-01

    Mechanical assessment of soft biological tissues and organs has broad relevance in clinical diagnosis and treatment of disease. Existing characterization methods are invasive, lack microscale spatial resolution, and are tailored only for specific regions of the body under quasi-static conditions. Here, we develop conformal and piezoelectric devices that enable in vivo measurements of soft tissue viscoelasticity in the near-surface regions of the epidermis. These systems achieve conformal contact with the underlying complex topography and texture of the targeted skin, as well as other organ surfaces, under both quasi-static and dynamic conditions. Experimental and theoretical characterization of the responses of piezoelectric actuator-sensor pairs laminated on a variety of soft biological tissues and organ systems in animal models provide information on the operation of the devices. Studies on human subjects establish the clinical significance of these devices for rapid and non-invasive characterization of skin mechanical properties.

  14. Conformal piezoelectric systems for clinical and experimental characterization of soft tissue biomechanics.

    PubMed

    Dagdeviren, Canan; Shi, Yan; Joe, Pauline; Ghaffari, Roozbeh; Balooch, Guive; Usgaonkar, Karan; Gur, Onur; Tran, Phat L; Crosby, Jessi R; Meyer, Marcin; Su, Yewang; Chad Webb, R; Tedesco, Andrew S; Slepian, Marvin J; Huang, Yonggang; Rogers, John A

    2015-07-01

    Mechanical assessment of soft biological tissues and organs has broad relevance in clinical diagnosis and treatment of disease. Existing characterization methods are invasive, lack microscale spatial resolution, and are tailored only for specific regions of the body under quasi-static conditions. Here, we develop conformal and piezoelectric devices that enable in vivo measurements of soft tissue viscoelasticity in the near-surface regions of the epidermis. These systems achieve conformal contact with the underlying complex topography and texture of the targeted skin, as well as other organ surfaces, under both quasi-static and dynamic conditions. Experimental and theoretical characterization of the responses of piezoelectric actuator-sensor pairs laminated on a variety of soft biological tissues and organ systems in animal models provide information on the operation of the devices. Studies on human subjects establish the clinical significance of these devices for rapid and non-invasive characterization of skin mechanical properties. PMID:25985458

  15. Biomechanical analysis and clinical effects of bridge combined fixation system for femoral fractures.

    PubMed

    Wang, Da-xing; Xiong, Ying; Deng, Hong; Jia, Fu; Gu, Shao; Liu, Bai-lian; Li, Qun-hui; Pu, Qi; Zhang, Zhong-Zi

    2014-09-01

    This work aimed to compare the stress distribution and mechanical properties of our bridge combined fixation system and commonly used metal locking plate screw system by finite element analysis and by using the Zwick/Z100 testing machine. In addition, we also investigated the clinical outcome of our bridge combined fixation system for femoral fractures in 59 patients from June 2005 to January 2013. As a result, the stress distribution in the bone plate and screws of metal locking plate screw system during walking and climbing stairs was significantly lower than that of metal locking plate screw system. No significant difference in the displacement was observed between two systems. The equivalent bending stiffness of bridge combined fixation system was significantly lower than that of metal locking plate screw system. There were no significant differences in the bending strength, yield load, and maximum force between two systems. All the cases were followed up for 12-24 months (average 18 months). The X-ray showed bone callus was formed in most patients after 3 months, and the fracture line was faint and disappeared at 6-9 months postoperatively. No serious complications, such as implant breakage and wound infection, occurred postoperatively. According to self-developed standard for bone healing, clinical outcomes were rated as excellent or good in 55 out of 59 patients (success rate: 93.2%). Therefore, our findings suggest that our bridge combined fixation system may be a promising approach for treatment of long-bone fractures.

  16. Biomechanical gait features associated with hip osteoarthritis: Towards a better definition of clinical hallmarks.

    PubMed

    Meyer, Christophe A G; Corten, Kristoff; Fieuws, Steffen; Deschamps, Kevin; Monari, Davide; Wesseling, Mariska; Simon, Jean-Pierre; Desloovere, Kaat

    2015-10-01

    Critical appraisal of the literature highlights that the discriminative power of gait-related features in patients with hip osteoarthritis (OA) has not been fully explored. We aimed to reduce the number of gait-related features and define the most discriminative ones comparing the three-dimensional gait analysis of 20 patients with hip osteoarthritis (OA) with those of 17 healthy peers. First, principal component analysis was used to reduce the high-dimensional gait data into a reduced set of interpretable variables for further analysis, including tests for group differences. These differences were indicative for the selection of the top 10 variables to be included into linear discriminant analysis models (LDA). Our findings demonstrated the successful data reduction of hip osteoarthritic-related gait features with a high discriminatory power. The combination of the top variables into LDA models clearly separated groups, with a maximum misclassification error rate of 19%, estimated by cross-validation. Decreased hip/knee extension, hip flexion and internal rotation moment were gait features with the highest discriminatory power. This study listed the most clinically relevant gait features characteristics of hip OA. Moreover, it will help clinicians and physiotherapists understand the movement pathomechanics related to hip OA useful in the management and design of rehabilitation intervention.

  17. [The unilateral axial dynamic fixator study of its biomechanical property and clinical application].

    PubMed

    Chen, Z B

    1990-06-01

    The home made UADF after Bastiani's pattern was mechanically tested in our lab on fracture of cadaveric femurs. For comparison, the same test was also carried out with conventional semicircular external fixator. The results showed that the rigidity and stability of fixation closely related with the diameter of the bone-pin used. The diameter of the treated pins used in UADF was one time larger than that of the round pin used in conventional semicircular external fixator. The compression rigidity of the former frame was 3.5 times stronger than that of the latter one; the extent of displacement of the fragments happened in the former frame was much less than that occurred in the latter one. Clinical Application of UADF. on fracture of tibia and fibula in 31, of femur in 8, knee arthrodesis and osteotomy of tibia and fibula one in each, brought bony healing on successfully. It is apparent that the UADF is multifunctional, universal and adaptable in use, leading to success. PMID:2096059

  18. [Regulatory aspects and medicolegal considerations regarding clinical drug trials].

    PubMed

    Cammarano, Andrea; De Dominicis, Enrico; Marella, Gian Luca; Maurici, Massimo; Arcudi, Giovanni

    2016-01-01

    This article aims to explore the regulatory and medicolegal aspects of experimental drug trials. Firstly, the authors provide definitions of drug according to WHO, the European Community and our official Pharmacopoeia, and that of experimental studies. They then explain the distinction between pure or basic research and drug trials and explain the various phases of the latter. Besides providing definitions, and exploring doctrinal, theoretical but also practical aspects of drug trials, the authors also discuss and analyze legislative aspects, with particular reference to the Italian legislative framework, and medicolegal issues, including informed consent, effects on humans, and professional responsibility.

  19. Mathematical foundations of biomechanics.

    PubMed

    Niederer, Peter F

    2010-01-01

    The aim of biomechanics is the analysis of the structure and function of humans, animals, and plants by means of the methods of mechanics. Its foundations are in particular embedded in mathematics, physics, and informatics. Due to the inherent multidisciplinary character deriving from its aim, biomechanics has numerous connections and overlapping areas with biology, biochemistry, physiology, and pathophysiology, along with clinical medicine, so its range is enormously wide. This treatise is mainly meant to serve as an introduction and overview for readers and students who intend to acquire a basic understanding of the mathematical principles and mechanics that constitute the foundation of biomechanics; accordingly, its contents are limited to basic theoretical principles of general validity and long-range significance. Selected examples are included that are representative for the problems treated in biomechanics. Although ultimate mathematical generality is not in the foreground, an attempt is made to derive the theory from basic principles. A concise and systematic formulation is thereby intended with the aim that the reader is provided with a working knowledge. It is assumed that he or she is familiar with the principles of calculus, vector analysis, and linear algebra. PMID:21303323

  20. Functional, Clinical and Biomechanical Comparison of Anterior Cruciate Ligament Reconstruction with Anatomical Placement of Transtibial Tunnel Placement

    PubMed Central

    Kılınç, Eray; Kara, Adnan; Öç, Yunus; Çelik, Haluk; Çamur, Savaş; Eren, Osman Tuğrul

    2014-01-01

    Objectives: Functional, clinical and biomechanical comparison of Anterior Cruciate Ligament reconstruction with anatomical placement of transtibial tunnel placement. Methods: 55 patients who can be adequately followed-up being divided into transtibial and anatomic groups. Lachman and Pivot-shift tests were performed to all patients. Laxity was measured by performing KT-1000 arthrometer test with 15,20 and 30 pounds power. Muscle strength were evaluated with Cybex II at 60 ° / sec, 240 ° / sec frequencies with flexion and extension peak torque. The maximum force values of untouched knee and the knee with surgery have been compared. Groups were evaluated by using IKDC knee ligament healing standard form, IKDC activity scale, modified Lysholm and Cincinnati evaluation forms. Return to work and return to fitness times of patients were compared. NCSS 2007 & PASS 2008 Statistical Software was used for statistical analysis. Results: Statistically, there was not any observed significant difference between Lachman and Pivot-shift levels. Positive value of Pivot-shift test and incidence of anterior translation in Lachman test were higher in the cases which were subjected to transtibial technique . There was not any statistically significant difference between Lysholm activity levels of cases. Lysholm activity levels of patients who underwent anatomic techniques significantly higher than transtibial technique. There was not any statistically significant difference between Modified Cincinnati activity levels. Modified Cincinnati activity levels of patients who were subjected anatomical techniques, are significantly higher than transtibial technique. There was not any statistically significant difference between post treatment IKDC activity levels. Intense activity after treatment rate of patient who were subjected to anatomic techniques was significantly higher than transtibial technique. There was a statistically significant differences between Cybex extension-flexion 60

  1. Physical modelling in biomechanics.

    PubMed Central

    Koehl, M A R

    2003-01-01

    Physical models, like mathematical models, are useful tools in biomechanical research. Physical models enable investigators to explore parameter space in a way that is not possible using a comparative approach with living organisms: parameters can be varied one at a time to measure the performance consequences of each, while values and combinations not found in nature can be tested. Experiments using physical models in the laboratory or field can circumvent problems posed by uncooperative or endangered organisms. Physical models also permit some aspects of the biomechanical performance of extinct organisms to be measured. Use of properly scaled physical models allows detailed physical measurements to be made for organisms that are too small or fast to be easily studied directly. The process of physical modelling and the advantages and limitations of this approach are illustrated using examples from our research on hydrodynamic forces on sessile organisms, mechanics of hydraulic skeletons, food capture by zooplankton and odour interception by olfactory antennules. PMID:14561350

  2. Porcelain veneering of titanium--clinical and technical aspects.

    PubMed

    Haag, Per

    2011-01-01

    Gold and other alloys have long been used for the production of crowns and bridges as replacements for damaged or lost teeth. However, doubts have arisen on the suitability of using these materials for dental restorations, as gold has also shown a capacity to cause side-effects such as allergic reactions. This is especially valid for alloys, which during the last decades have been used as porcelain-fused-to metal restorations. This fact has led to an interest in using titanium instead of these alloys. Trials to use titanium for this purpose were initiated in Japan in the early 1980s. Titanium as an unalloyed metal differs in two aspects from the above named alloys: it has a phase transformation at 882 degrees C, which changes its outer and inner properties, and it has an expansion that lies between that of the porcelain types available on the market at the time. In Japan a technique for casting titanium was developed, where the after-treatment of the casting was elaborate, to re-establish the original properties of titanium. The porcelain developed for veneering had shortcomings as the rendering produced a rough surface and non satisfactory esthetics. In Sweden a new concept was introduced in 1989. Here the processing of titanium was performed by industrial methods such as milling, spark erosion and laser welding. The idea behind this was to avoid phase transformation. During the 1990s a number of porcelain products were launched and a vast number of both laboratory and clinical studies were performed and published, with varying results. In the first study of this thesis a prospective clinical trial was performed at a public dental health clinic in Sweden. Twenty-five patients were provided with 40 copings of pure titanium, which were veneered with porcelain. After 2 years 36 of these crowns were evaluated and the patients were also interviewed regarding problems such as shooting pains or difficulties in cleaning around the teeth that were crowned. This evaluation

  3. Porcelain veneering of titanium--clinical and technical aspects.

    PubMed

    Haag, Per

    2011-01-01

    Gold and other alloys have long been used for the production of crowns and bridges as replacements for damaged or lost teeth. However, doubts have arisen on the suitability of using these materials for dental restorations, as gold has also shown a capacity to cause side-effects such as allergic reactions. This is especially valid for alloys, which during the last decades have been used as porcelain-fused-to metal restorations. This fact has led to an interest in using titanium instead of these alloys. Trials to use titanium for this purpose were initiated in Japan in the early 1980s. Titanium as an unalloyed metal differs in two aspects from the above named alloys: it has a phase transformation at 882 degrees C, which changes its outer and inner properties, and it has an expansion that lies between that of the porcelain types available on the market at the time. In Japan a technique for casting titanium was developed, where the after-treatment of the casting was elaborate, to re-establish the original properties of titanium. The porcelain developed for veneering had shortcomings as the rendering produced a rough surface and non satisfactory esthetics. In Sweden a new concept was introduced in 1989. Here the processing of titanium was performed by industrial methods such as milling, spark erosion and laser welding. The idea behind this was to avoid phase transformation. During the 1990s a number of porcelain products were launched and a vast number of both laboratory and clinical studies were performed and published, with varying results. In the first study of this thesis a prospective clinical trial was performed at a public dental health clinic in Sweden. Twenty-five patients were provided with 40 copings of pure titanium, which were veneered with porcelain. After 2 years 36 of these crowns were evaluated and the patients were also interviewed regarding problems such as shooting pains or difficulties in cleaning around the teeth that were crowned. This evaluation

  4. Legal aspects of clinical supervision 1: Employer vs employee.

    PubMed

    Dimond, B

    In order to implement clinical supervision some major issues need to be clarified. This article looks at clinical supervision in terms of the relationship between the employer and the employee. It discusses clinical supervision as a contractual requirement and a voluntary system and examines some of the related problems. The implementation of clinical supervision may be limited by the significant cost of training. Possible frameworks for setting up a system for supervision are suggested. Employers need to be adequately informed about the clinical supervision process so that it can become both effective and flexible. The second article in this series will consider legal issues relating to professional accountability, patients' rights, and records and record keeping. These two articles refer to information generated from a workshop held at Prince Philip Hospital, Llanelli, in which practitioners looked at some of the legal issues relating to clinical supervision.

  5. [Urticaria pigmentosa: clinical and therapeutic aspects for the paediatrician].

    PubMed

    Moll-Manzur, Catherina; Araos-Baeriswyl, Esteban; Downey, Camila; Dossi, María T

    2016-08-01

    Urticaria pigmentosa, also known as maculopapular mastocytosis, is the most common type of paediatric mastocytosis. It presents with yellow to brown macules or papules, usually located on trunk and extremities. Regarding its diagnostic and therapeutic implications, the objective of this article is to serve as an update for the paediatrician on the most relevant aspects of this pathology.

  6. PSYCHOLOGY IN COMMUNITY SETTINGS--CLINICAL, EDUCATIONAL, VOCATIONAL, SOCIAL ASPECTS.

    ERIC Educational Resources Information Center

    SARASON, SEYMOUR B.; AND OTHERS

    IN THIS DESCRIPTION OF THE PSYCHOEDUCATIONAL CLINIC IN THE DEPARTMENT OF PSYCHOLOGY AT YALE UNIVERSITY, THE CLINIC'S HISTORICAL AND PROFESSIONAL ORIGINS ARE REVIEWED, AND ITS RELATIONSHIP TO THE SCHOOLS THAT IT SERVES DISCUSSED. SPECIFIC TOPICS CONSIDERED ARE (1) THE APPROACH TO THE SCHOOLS, (2) TEACHING IS A LONELY PROFESSION, (3) HELPING TO…

  7. Regulatory aspects for translating gene therapy research into the clinic.

    PubMed

    Laurencot, Carolyn M; Ruppel, Sheryl

    2009-01-01

    Gene therapy products are highly regulated, therefore moving a promising candidate from the laboratory into the clinic can present unique challenges. Success can only be achieved by proper planning and communication within the clinical development team, as well as consultation with the regulatory scientists who will eventually review the clinical plan. Regulators should not be considered as obstacles but rather as collaborators whose advice can significantly expedite the product development. Sound scientific data is required and reviewed by the regulatory agencies to determine whether the potential benefit to the patient population outweighs the risk. Therefore, compliance with Good Manufacturing Practice (GMP) and Good Laboratory Practice (GLP) principles to ensure quality, safety, purity, and potency of the product, and to establish "proof of concept" for efficacy, and for safety information, respectively, is essential. The design and conduct of the clinical trial must adhere to Good Clinical Practice (GCP) principals. The clinical protocol should contain adequate rationale, supported by nonclinical data, to justify the starting dose and regimen, and adequate safety monitoring based on the patient population and the anticipated toxicities. Proper review and approval of gene therapy clinical studies by numerous committees, and regulatory agencies before and throughout the study allows for ongoing risk assessment of these novel and innovative products. The ethical conduct of clinical trials must be a priority for all clinical investigators and sponsors. As history has shown us, only a few fatal mistakes can dramatically alter the regulation of investigational products for all individuals involved in gene therapy clinical research, and further delay the advancement of gene therapy to licensed medicinal products.

  8. Nutritional aspect of pediatric inflammatory bowel disease: its clinical importance.

    PubMed

    Kim, Seung; Koh, Hong

    2015-10-01

    Inflammatory bowel disease (IBD) is a chronic inflammatory disease mainly affecting the gastrointestinal tract. The incidence of the disease is rapidly increasing worldwide, and a number of patients are diagnosed during their childhood or adolescence. Aside from controlling the gastrointestinal symptoms, nutritional aspects such as growth, bone mineral density, anemia, micronutrient deficiency, hair loss, and diet should also be closely monitored and managed by the pediatric IBD team especially since the patients are in the development phase.

  9. Nutritional aspect of pediatric inflammatory bowel disease: its clinical importance

    PubMed Central

    Kim, Seung

    2015-01-01

    Inflammatory bowel disease (IBD) is a chronic inflammatory disease mainly affecting the gastrointestinal tract. The incidence of the disease is rapidly increasing worldwide, and a number of patients are diagnosed during their childhood or adolescence. Aside from controlling the gastrointestinal symptoms, nutritional aspects such as growth, bone mineral density, anemia, micronutrient deficiency, hair loss, and diet should also be closely monitored and managed by the pediatric IBD team especially since the patients are in the development phase. PMID:26576179

  10. [The oral aspects of osteogenesis imperfecta. A clinical case report].

    PubMed

    Moniaci, D; Migliario, M; Flecchia, G; Re, G

    1989-10-01

    The oral symptoms observable in patients with imperfect osteogenesis are described and a clinical case that makes a contribution to our knowledge of a rarely encountered pathology is reported. PMID:2615733

  11. [Biodegradable synthetic implant materials : clinical applications and immunological aspects].

    PubMed

    Witte, F; Calliess, T; Windhagen, H

    2008-02-01

    In the last decade biodegradable synthetic implant materials have been established for various clinical applications. Ceramic materials such as calcium phosphate, bioglass and polymers are now routinely used as degradable implants in the clinical practice. Additionally these materials are now also used as coating materials or as microspheres for controlled drug release and belong to a series of examples for applications as scaffolds for tissue engineering. Because immense local concentrations of degradation products are produced during biodegradation, this review deals with the question whether allergic immune reactions, which have been reported for classical metallic and organic implant materials, also play a role in the clinical routine for synthetic biodegradable materials. Furthermore, possible explanatory theories will be developed to clarify the lack of clinical reports on allergy or sensitization to biodegradable synthetic materials.

  12. Renal findings in rheumatoid arthritis: clinical aspects of 132 necropsies.

    PubMed

    Boers, M; Croonen, A M; Dijkmans, B A; Breedveld, F C; Eulderink, F; Cats, A; Weening, J J

    1987-09-01

    Renal abnormalities in 132 necropsied patients with rheumatoid arthritis were studied. Clinical findings before death included extra-articular manifestations of the disease (86% of patients), systemic vasculitis (6%), and uraemia (23%). Necropsy findings included nephrosclerosis (90%), systemic vasculitis (14%) with kidney involvement in 8%, amyloidosis (11%), membranous glomerulopathy (8%), and focal glomerular disease (8%). Association with clinical data suggests that both rheumatoid and non-rheumatoid disease may play a part in the cause of these abnormalities. PMID:3675007

  13. Biomechanics of Disc Degeneration

    PubMed Central

    Palepu, V.; Kodigudla, M.; Goel, V. K.

    2012-01-01

    Disc degeneration and associated disorders are among the most debated topics in the orthopedic literature over the past few decades. These may be attributed to interrelated mechanical, biochemical, and environmental factors. The treatment options vary from conservative approaches to surgery, depending on the severity of degeneration and response to conservative therapies. Spinal fusion is considered to be the “gold standard” in surgical methods till date. However, the association of adjacent level degeneration has led to the evolution of motion preservation technologies like spinal arthroplasty and posterior dynamic stabilization systems. These new technologies are aimed to address pain and preserve motion while maintaining a proper load sharing among various spinal elements. This paper provides an elaborative biomechanical review of the technologies aimed to address the disc degeneration and reiterates the point that biomechanical efficacy followed by long-term clinical success will allow these nonfusion technologies as alternatives to fusion, at least in certain patient population. PMID:22745914

  14. Immunoregulation by Mesenchymal Stem Cells: Biological Aspects and Clinical Applications

    PubMed Central

    Castro-Manrreza, Marta E.; Montesinos, Juan J.

    2015-01-01

    Mesenchymal stem cells (MSCs) are multipotent cells capable of differentiation into mesenchymal lineages and that can be isolated from various tissues and easily cultivated in vitro. Currently, MSCs are of considerable interest because of the biological characteristics that confer high potential applicability in the clinical treatment of many diseases. Specifically, because of their high immunoregulatory capacity, MSCs are used as tools in cellular therapies for clinical protocols involving immune system alterations. In this review, we discuss the current knowledge about the capacity of MSCs for the immunoregulation of immunocompetent cells and emphasize the effects of MSCs on T cells, principal effectors of the immune response, and the immunosuppressive effects mediated by the secretion of soluble factors and membrane molecules. We also describe the mechanisms of MSC immunoregulatory modulation and the participation of MSCs as immune response regulators in several autoimmune diseases, and we emphasize the clinical application in graft versus host disease (GVHD). PMID:25961059

  15. [Geriatric particularities of Parkinson's disease: Clinical and therapeutic aspects].

    PubMed

    Belin, J; Houéto, J L; Constans, T; Hommet, C; de Toffol, B; Mondon, K

    2015-12-01

    Parkinson's disease (PD) is a frequent and complex progressive neurological disorder that increases in incidence with age. Although historically PD has been characterized by the presence of progressive dopaminergic neuronal loss of the substantia nigra, the disease process also involves neurotransmitters other that dopamine and regions of the nervous system outside the basal ganglia. Its clinical presentation in elderly subjects differs from that in younger subjects, with more rapid progression, less frequent tremor, more pronounced axial signs, more frequent non-motor signs linked to concomitant degeneration of non-dopaminergic systems, and more frequent associated lesions. Despite the high prevalence of PD in elderly subjects, few therapeutic trials have been conducted in geriatric patients. Nevertheless, to improve functional disability while ensuring drug tolerance, the principles of optimized and multidisciplinary clinical management have to be known. The aim of this review is to provide an update on clinical and therapeutic features of PD specifically observed in elderly subjects. PMID:26573332

  16. The Pathophysiology and Clinical Aspects of Hypercalcemic Disorders

    PubMed Central

    Lee, David B. N.; Zawada, Edward T.; Kleeman, Charles R.

    1978-01-01

    For the purposes of this review, the vast and increasingly complex subject of hypercalcemic disorders can be broken down into the following categories: (1) Physiochemical state of calcium in circulation. (2) Pathophysiological basis of hypercalcemia. (3) Causes of hypercalcemia encountered in clinical practice: causes indicated by experience at the University of California, Los Angeles; neoplasia; hyperparathyroidism; nonparathyroid endocrinopathies; pharmacological agents; possible increased sensitivity to vitamin D; miscellaneous causes. (4) Clinical manifestations and diagnostic considerations of hypercalcemic disorders. (5) The management of hypercalcemic disorders: general measures; measures for lowering serum calcium concentration; measures for correcting primary causes—the management of asymptomatic hyperparathyroidism. PMID:362722

  17. Clinical aspects of lagomorph dental anatomy: the rabbit (oryctolagus cuniculus).

    PubMed

    Crossley, D A

    1995-12-01

    The lagomorphs most commonly encountered as pets are rabbits. There are many breeds of domestic rabbit, varying from dwarf varieties with an adult weight of under one kilogram to giants weighing 10 kg. This article provides a working knowledge of the dental anatomy and physiology of rabbits so that veterinarians can interpret clinical and radiographic findings when investigating rabbits with suspected dental disease.

  18. Research and clinical aspects of the late effects of poliomyelitis

    SciTech Connect

    Halstead, L.S.; Wiechers, D.O.

    1986-01-01

    This book contains 32 selections. Some of the titles are: Late effects of Polio: Historical Perspectives; Sleep-Disordered Breathing as a Late Effect of Poliomyelitis; Clinical Subtypes, DNA Repair Efficiency, and Therapeutic Trials in the Post-Polio Syndromes; and Post-Polio Muscle Function.

  19. Companion diagnostics for targeted cancer drugs - clinical and regulatory aspects.

    PubMed

    Olsen, Dana; Jørgensen, Jan Trøst

    2014-01-01

    Companion diagnostics (CDx) holds the promise of improving the predictability of the oncology drug development process and become an important tool for the oncologist in relation to the choice of treatment for the individual patient. A number of drug-diagnostic co-development programs have already been completed successfully, and in the clinic, the use of several targeted cancer drugs is now guided by a CDx. This central role of the CDx assays has attracted the attention of the regulators, and especially the US Food and Drug Administration has been at the forefront in relation to developing regulatory strategies for CDx and the drug-diagnostic co-development project. For an increasing number of cancer patients the treatment selection will depend on the result generated by a CDx assay, and consequently this type of assay has become critical for the care and safety of the patients. In order to secure that the CDx assays have a high degree of analytical and clinical validity, they must undergo an extensive non-clinical and clinical testing before release for routine patient management. This review will give a brief introduction to some of the scientific and medical challenges related to the CDx development with specific emphasis on the regulatory requirements in different regions of the world. PMID:24904822

  20. Qualitative biomechanical principles for application in coaching.

    PubMed

    Knudson, Duane

    2007-01-01

    Many aspects of human movements in sport can be readily understood by Newtonian rigid-body mechanics. Many of these laws and biomechanical principles, however, are counterintuitive to a lot of people. There are also several problems in the application of biomechanics to sports, so the application of biomechanics in the qualitative analysis of sport skills by many coaches has been limited. Biomechanics scholars have long been interested in developing principles that facilitate the qualitative application of biomechanics to improve movement performance and reduce the risk of injury. This paper summarizes the major North American efforts to establish a set of general biomechanical principles of movement, and illustrates how principles can be used to improve the application of biomechanics in the qualitative analysis of sport technique. A coach helping a player with a tennis serve is presented as an example. The standardization of terminology for biomechanical principles is proposed as an important first step in improving the application ofbiomechanics in sport. There is also a need for international cooperation and research on the effectiveness of applying biomechanical principles in the coaching of sport techniques. PMID:17542182

  1. [Sudeck disease--pathology, clinical aspects and therapy].

    PubMed

    Schulz, R H; Buch, K

    1998-06-01

    In our opinion the etiology of Sudeck's disease (acute reflex bone atrophy) plays a decisive role in therapeutic planning. The therapy is based on clinical and radiological findings. Physiotherapy addresses the symptom complex of pain, hyperemia, edema formation, and limitations of movement which act in a vicious circle and its intensity is modified according to the prevailing clinical and possibly also radiological findings. A strict coupling of the therapy to a classification according to stage is not recommended. Pharmacological therapy is merely a supporting element and focuses on the sympathetic overexcitability. The best therapy for Sudeck's disease is prophylaxis. Interventions collected under the general term early functional mobilization are, especially after surgical measures, a major factor in the avoidance of neurovegetative dysregulation in the sense of sympathetic reflex dystrophy. PMID:9738286

  2. Coryneform bacteria in infectious diseases: clinical and laboratory aspects.

    PubMed Central

    Coyle, M B; Lipsky, B A

    1990-01-01

    Coryneform isolates from clinical specimens frequently cannot be identified by either reference laboratories or research laboratories. Many of these organisms are skin flora that belong to a large number of taxonomic groups, only 40% of which are in the genus Corynebacterium. This review provides an update on clinical presentations, microbiological features, and pathogenic mechanisms of infections with nondiphtheria Corynebacterium species and other pleomorphic gram-positive rods. The early literature is also reviewed for a few coryneforms, especially those whose roles as pathogens are controversial. Recognition of newly emerging opportunistic coryneforms is dependent on sound identification schemes which cannot be developed until cell wall analyses and nucleic acid studies have defined the taxonomic groups and all of the reference strains within each taxon have been shown by molecular methods to be authentic members. Only then can reliable batteries of biochemical tests be selected for distinguishing each taxon. PMID:2116939

  3. Pericoronitis: a reappraisal of its clinical and microbiologic aspects.

    PubMed

    Nitzan, D W; Tal, O; Sela, M N; Shteyer, A

    1985-07-01

    Pericoronitis is an infectious disease of the operculum overlying an erupting or semi-impacted tooth. It manifests itself mainly in late adolescence and young adulthood and nearly always occurs around the lower third molar. The distinctive location, age, clinical picture, and link with predisposing factors warranted a reappraisal of pericoronitis and its etiology. Spirochetes and fusobacteria proved prevalent at all stages of the disease. The presence of these microbacteria may provide a clue as to the late appearance, particular location, and singular clinical picture of pericoronitis. The fact that spirochetes and fusobacteria are also found in acute necrotizing ulcerative gingivitis, and have been associated with alveolar osteitis, indicates a possible relationship between these disorders and pericoronitis.

  4. [Skin manifestations in lupus erythematosus: clinical aspects and therapy].

    PubMed

    Kuhn, A; Ruland, V; Bonsmann, G

    2011-04-01

    Lupus erythematosus (LE) is an inflammatory autoimmune disorder, which is characterized by clinically heterogeneous manifestations of different organs. In systemic LE (SLE) the skin, the musculoskeletal system, the kidneys, the cardiovascular and central nervous systems can be involved. The skin lesions can be divided into LE-specific and LE-non-specific manifestations, the former represent the subtypes of cutaneous LE (CLE). The diagnosis is confirmed by clinical, histopathological, immunoserological and genetic features. The treatment is similar for the different subtypes of CLE; however, the therapeutic regimen should be individually defined in each patient. Antimalarials are still the first-line systemic therapy and in addition to sunscreens, glucocorticosteroids and calcineurin inhibitors have an important impact as topical agents in this disease.

  5. Epidemiological, clinical and immunological aspects of neuromyelitis optica (NMO).

    PubMed

    Asgari, Nasrin

    2013-10-01

    Neuromyelitis optica (NMO) is an inflammatory demyelinating disease (IDD) of the central nervous system (CNS) and probably the most common non-multiple sclerosis (MS) CNS IDD. Serum immunoglobulin G autoantibodies have been identified in the majority of NMO patients with the water channel aquaporin-4 (AQP4) as their main target autoantigen. Previous studies have suggested ethnicity-based prevalence differences of NMO. The genetic background for these putative differences is not known. An HLA-association with NMO has been identified, but the association is not very pronounced. Human and experimental studies support that anti-AQP4 antibodies/NMO-IgG are involved in the pathogenesis of NMO. Previous experimental animal models have reported induction of NMO-like histopathology in animals by transfer of human anti-AQP4 antibodies/NMO-IgG. A main goal of this PhD thesis was to perform a population-based study in a predominantly Caucasian population (in the Region of Southern Denmark) to estimate the incidence and prevalence of NMO and describe the clinical phenotypes in this population. Furthermore the aims were to investigate whether autoimmunity underlies or contributes to the pathogenesis of NMO with specific clinical, immunogenetic and experimental perspectives. The yearly incidence rate of NMO in the population was estimated to be 0.4 per 105 person-years (95% CI 0.30-0.54) and the prevalence was 4.4 per 105 (95% CI 3.1-5.7). The results indicated that NMO is more common in a Caucasian population than earlier believed. Clinical, radiologic and serological data were reviewed in order to establish the diagnostic accuracy of anti-AQP4 antibodies/NMO-IgG for specific syndromes in NMO. We observed assay characteristics with a sensitivity of 62% and a specificity of 100%. The diagnosis of NMO based on either the Wingerchuk 2006 criteria or the United States National Multiple Sclerosis Society 2008 criteria could be made purely on clinical grounds in a high proportion (64

  6. [Compatibility of science and clinical aspects. Between realism and utopia].

    PubMed

    Stange, R; Perl, M; Münzberg, M; Histing, T

    2013-01-01

    The working environment for young residents in orthopedic surgery has changed tremendously over the past 10 years. Due to cumulative clinical requirements and increasing demands on work-life balance research activity has become less attractive. Successful incorporation of research into the career of residents is a challenging project for the future. The young forum of the German Association for Orthopedics and Traumatology (DGOU) provides different approaches to enhance the quality of research and to help young orthopedists and trauma surgeons. PMID:23325157

  7. [Compatibility of science and clinical aspects. Between realism and utopia].

    PubMed

    Stange, R; Perl, M; Münzberg, M; Histing, T

    2013-01-01

    The working environment for young residents in orthopedic surgery has changed tremendously over the past 10 years. Due to cumulative clinical requirements and increasing demands on work-life balance research activity has become less attractive. Successful incorporation of research into the career of residents is a challenging project for the future. The young forum of the German Association for Orthopedics and Traumatology (DGOU) provides different approaches to enhance the quality of research and to help young orthopedists and trauma surgeons.

  8. Biosimilar monoclonal antibodies: preclinical and clinical development aspects.

    PubMed

    Gonçalves, João; Araújo, Filipe; Cutolo, Maurizio; Fonseca, João Eurico

    2016-01-01

    Biological drugs and their originated biosimilars are large, highly complex molecules derived from living cells or organisms. Traditional medicines, by contrast, are usually simple molecules of low molecular weight, synthesised by chemical means. The distinct complexities and methods of manufacture create an important difference between biosimilars and conventional generic drugs: while chemical generics can be fully characterised as identical to the originator product, biosimilars cannot. In addition, biological therapies are inherently variable, creating unavoidable differences between even subsequent batches of the same product. An expiring patent does not necessarily mean that the manufacturing process of the originator product becomes available to the biosimilar developers (for instance, the relevant cell line clone and growth medium). Therefore, it cannot be guaranteed that biosimilar products are identical to their reference product on a molecular level. This difference has important implications for the regulation and licensing of biosimilars. While conventional generic drugs require only a limited comparison and demonstration of identical chemical structure to the reference product, biosimilars require far more rigorous testing. In general, there must be a thorough comparison of structural and functional characteristics between biosimilar and originator drug. Stepwise nonclinical in vitro and in vivo approaches are recommended to evaluate the similarity of both drugs and any identified micro-heterogeneities must then be assessed for their impact on safety and clinical performance. Subsequently, clinical pharmacokinetic (PK) studies need to be performed in order to demonstrate a similar PK profile, prior to conducting clinical efficacy trials. PMID:27383278

  9. Delayed union and nonunions: epidemiology, clinical issues, and financial aspects.

    PubMed

    Hak, David J; Fitzpatrick, Daniel; Bishop, Julius A; Marsh, J Lawrence; Tilp, Susanne; Schnettler, Reinhard; Simpson, Hamish; Alt, Volker

    2014-06-01

    Fracture healing is a critically important clinical event for fracture patients and for clinicians who take care of them. The clinical evaluation of fracture healing is based on both radiographic findings and clinical findings. Risk factors for delayed union and nonunion include patient dependent factors such as advanced age, medical comorbidities, smoking, non-steroidal anti-inflammatory use, various genetic disorders, metabolic disease and nutritional deficiency. Patient independent factors include fracture pattern, location, and displacement, severity of soft tissue injury, degree of bone loss, quality of surgical treatment and presence of infection. Established nonunions can be characterised in terms of biologic capacity, deformity, presence or absence of infection, and host status. Hypertrophic, oligotrophic and atrophic radiographic appearances allow the clinician to make inferences about the degree of fracture stability and the biologic viability of the fracture fragments while developing a treatment plan. Non-unions are difficult to treat and have a high financial impact. Indirect costs, such as productivity losses, are the key driver for the overall costs in fracture and non-union patients. Therefore, all strategies that help to reduce healing time with faster resumption of work and activities not only improve medical outcome for the patient, they also help reduce the financial burden in fracture and non-union patients.

  10. [Current clinical aspects of ambulatory blood pressure monitoring].

    PubMed

    Sauza-Sosa, Julio César; Cuéllar-Álvarez, José; Villegas-Herrera, Karla Montserrat; Sierra-Galán, Lilia Mercedes

    2016-01-01

    Systemic arterial hypertension is the prevalentest disease worldwide that significantly increases cardiovascular risk. An early diagnosis together to achieve goals decreases the risk of complications significatly. Recently have been updated the diagnostic criteria for hypertension and the introduction of ambulatory blood pressure monitoring. The introduction into clinical practice of ambulatory blood pressure monitoring was to assist the diagnosis of «white coat hypertension» and «masked hypertension». Today has also shown that ambulatory blood pressure monitoring is better than the traditional method of recording blood pressure in the office, to the diagnosis and to adequate control and adjustment of drug treatment. Also there have been introduced important new concepts such as isloted nocturnal hypertension, morning blood pressure elevation altered and altered patterns of nocturnal dip in blood pressure; which have been associated with increased cardiovascular risk. Several studies have shown significant prognostic value in some stocks. There are still other concepts on which further study is needed to properly establish their introduction to clinical practice as hypertensive load variability, pulse pressure and arterial stiffness. In addition to setting values according to further clinical studies in populations such as elderly and children. PMID:26794338

  11. [Radiologic and clinical aspects of osteoarticular amyloidosis caused by dialysis].

    PubMed

    Baldrati, L; Rocchi, A; Balbi, B; Bonsanto, R; Mughetti, M; Pasini, A; Feletti, C; Capponcini, C; Docci, D

    1991-06-01

    Many long-term (greater than 60 months) hemodialysis patients develop a severe osteoarticular disease, called "dialysis arthropathy", which is characterized by the deposition in bone and synovia of a new type of amyloid made mainly of beta 2-microglobulin. In the present study, 31 patients (17 males, 14 females; age 54.1 +/- 13 years), undergoing chronic hemodialysis for 60-125 months, were examined for dialysis arthropathy by means of clinics and of radiological investigations (conventional radiography and computed tomography). Sixteen patients (51.6%) had radiographic evidence of dialysis arthropathy: geodes (shoulders, 12 cases; wrists, 11; hips, 2; knees, 2) and/or destructive arthropathies (cervical spine, 13 cases, dorsolumbar spine, 2; hands, 2; hips, 1). Within 24 months, these lesions were found to progress slowly in the majority of cases. In the diagnostic process, CT should be employed in the study of spine, shoulders and hips when the lesions have not been sufficiently demonstrated by conventional radiography in the presence of evident clinical signs. Patients with dialysis arthropathy had undergone dialysis for longer periods than those without it (p less than 0.005) and showed a significantly higher incidence of both carpal tunnel syndrome (p less than 0.0005) and shoulder pain (p less than 0.005). Our findings confirm the high incidence and clinical importance of dialysis arthropathy in long-term hemodialysis patients and the value of diagnostic imaging in screening such patients for those lesions.

  12. [Current clinical aspects of ambulatory blood pressure monitoring].

    PubMed

    Sauza-Sosa, Julio César; Cuéllar-Álvarez, José; Villegas-Herrera, Karla Montserrat; Sierra-Galán, Lilia Mercedes

    2016-01-01

    Systemic arterial hypertension is the prevalentest disease worldwide that significantly increases cardiovascular risk. An early diagnosis together to achieve goals decreases the risk of complications significatly. Recently have been updated the diagnostic criteria for hypertension and the introduction of ambulatory blood pressure monitoring. The introduction into clinical practice of ambulatory blood pressure monitoring was to assist the diagnosis of «white coat hypertension» and «masked hypertension». Today has also shown that ambulatory blood pressure monitoring is better than the traditional method of recording blood pressure in the office, to the diagnosis and to adequate control and adjustment of drug treatment. Also there have been introduced important new concepts such as isloted nocturnal hypertension, morning blood pressure elevation altered and altered patterns of nocturnal dip in blood pressure; which have been associated with increased cardiovascular risk. Several studies have shown significant prognostic value in some stocks. There are still other concepts on which further study is needed to properly establish their introduction to clinical practice as hypertensive load variability, pulse pressure and arterial stiffness. In addition to setting values according to further clinical studies in populations such as elderly and children.

  13. Serrated polyposis syndrome: molecular, pathological and clinical aspects.

    PubMed

    Guarinos, Carla; Sánchez-Fortún, Cristina; Rodríguez-Soler, María; Alenda, Cristina; Payá, Artemio; Jover, Rodrigo

    2012-05-28

    Hyperplastic polyps have traditionally been considered not to have malignant potential. New pathological classification of serrated polyps and recent discoveries about the serrated pathway of carcinogenesis have revolutionized the concepts and revitalized the research in this area. Until recently, it has been thought that most colorectal cancers arise from conventional adenomas via the traditional tumor suppressor pathway initiated by a mutation of the APC gene, but it has been found that this pathway accounts for only approximately 70%-80% of colorectal cancer (CRC) cases. The majority of the remaining colorectal cancer cases follow an alternative pathway leading to CpG island methylator phenotype carcinoma with BRAF mutation and with or without microsatellite instability. The mechanism of carcinomas arising from this alternative pathway seems to begin with an activating mutation of the BRAF oncogene. Serrated polyposis syndrome is a relatively rare condition characterized by multiple and/or large serrated polyps of the colon. Clinical characteristics, etiology and relationship of serrated polyposis syndrome to CRC have not been clarified yet. Patients with this syndrome show a high risk of CRC and both sporadic and hereditary cases have been described. Clinical criteria have been used for diagnosis and frequent colonoscopy surveillance should be performed in order to prevent colorectal cancer. In this review, we try to gather new insights into the molecular pathogenesis of serrated polyps in order to understand their possible clinical implications and to make an approach to the management of this syndrome.

  14. Lupus erythematosus: considerations about clinical, cutaneous and therapeutic aspects*

    PubMed Central

    Moura Filho, Jucélio Pereira; Peixoto, Raiza Luna; Martins, Lívia Gomes; de Melo, Sillas Duarte; de Carvalho, Ligiana Leite; Pereira, Ana Karine F. da Trindade C.; Freire, Eutilia Andrade Medeiros

    2014-01-01

    Systemic Lupus Erythematosus is a chronic inflammatory disease with multifactorial etiology. Although clinical manifestations are varied, the skin is an important target-organ, which contributes to the inclusion of skin lesions in 4 out of the 17 new criteria for the diagnosis of the disease, according to the Systemic Lupus International Collaborating Clinics. The cutaneous manifestations of lupus are pleomorphic. Depending on their clinical characteristics, they can be classified into Acute Cutaneous Lupus Erythematosus, Subacute Cutaneous Lupus Erythematosus, Chronic Cutaneous Lupus Erythematosus and Intermittent Cutaneous Lupus Erythematosus. Treatment is based on preventive measures, reversal of inflammation, prevention of damage to target organs and relief of adverse events due to pharmacological therapy. The most commonly used treatment options are topical, systemic and surgical treatment, as well as phototherapy. The correct handling of the cases depends on a careful evaluation of the morphology of the lesions and the patient's general status, always taking into consideration not only the benefits but also the side effects of each therapeutic proposal. PMID:24626656

  15. Clinical aspects of accidents resulting in acute total body irradiation

    SciTech Connect

    Cronkite, E.P.

    1988-01-01

    That the management of whole body radiation injury involves: (1) watchful waiting, (2) observation of the hematologic parameters, (3) use of antibiotics, platelet red cell and possibly granulocyte transfusions, (4) administration of hemopoietic molecular regulators of granulopoiesis, and (5) bone marrow transplantation as the last line of defense. The clinical indication for the preceding will not be discussed, since this will be a subject of later speakers in this conference. Certainly, if a radiation casualty is fortunate enough to have an identical twin, a marrow transplant may be lifesaving and certainly can do no harm to the patient, and there is little risk to the donor.

  16. Renal failure in obstructive jaundice—clinical aspects

    PubMed Central

    Dawson, J. L.

    1975-01-01

    The patient with obstructive jaundice has an increased risk of developing renal failure. The commonest clinical situations in which this is seen is after surgical operation, as a result of percutaneous cholangiography or in association with severe ascending cholangitis. The risk of acute renal failure is decreased by ensuring adequate hydration and maintaining a high urine flow, if necessary using mannitol or some other osmotic diuretic. In patients undergoing percutaneous cholangiography, prophylactic antibiotics are probably indicated. Early surgery to control severe ascending cholangitis may be life saving and also prevent the development of renal failure. PMID:1234332

  17. Nonmotor Symptoms in Parkinson's Disease in 2012: Relevant Clinical Aspects

    PubMed Central

    Bonnet, Anne Marie; Jutras, Marie France; Czernecki, Virginie; Corvol, Jean Christophe; Vidailhet, Marie

    2012-01-01

    Nonmotor symptoms (NMSs) of Parkinson's disease (PD) are common, but they are often underrecognized in clinical practice, because of the lack of spontaneous complaints by the patients, and partly because of the absence of systematic questioning by the consulting physician. However, valid specific instruments for identification and assessment of these symptoms are available in 2012. The administration of the self-completed screening tool, NMSQuest, associated with questioning during the consultation, improves the diagnosis of NMSs. NMSs play a large role in degradation of quality of life. More relevant NMSs are described in this review, mood disorders, impulse control disorders, cognitive deficits, hallucinations, pain, sleep disorders, and dysautonomia. PMID:22888466

  18. Clinical aspects of IMRT for head-and-neck cancer.

    PubMed

    Eisbruch, Avraham

    2002-01-01

    The tightly conformal doses produced by intensity-modulated radiotherapy (IMRT), the existence of many critical structures in close proximity to the target, and the lack of internal organ motion in the head and neck, provide the potential for organ sparing and improved tumor irradiation. Many studies of treatment planning for head-and-neck cancer have demonstrated the dosimetric superiority of IMRT over conventional techniques in these respects. The initial results of clinical studies demonstrate reduced xerostomia. They suggest an improvement in tumor control, which needs to be verified in larger studies and longer follow-up. PMID:12074474

  19. Molecular and Clinical Aspects of Drug-induced Gingival Overgrowth

    PubMed Central

    Kantarci, A.

    2015-01-01

    Drug-induced gingival overgrowth is a tissue-specific condition and is estimated to affect approximately one million North Americans. Lesions occur principally as side-effects from phenytoin, nifedipine, or ciclosporin therapy in approximately half of the people who take these agents. Due to new indications for these drugs, their use continues to grow. Here, we review the molecular and cellular characteristics of human gingival overgrowth lesions and highlight how they differ considerably as a function of the causative drug. Analyses of molecular signaling pathways in cultured human gingival fibroblasts have provided evidence for their unique aspects compared with fibroblasts from the lung and kidney. These findings provide insights into both the basis for tissue specificity and into possible therapeutic opportunities which are reviewed here. Although ciclosporin-induced gingival overgrowth lesions exhibit principally the presence of inflammation and little fibrosis, nifedipine- and especially phenytoin-induced lesions are highly fibrotic. The increased expression of markers of gingival fibrosis, particularly CCN2 [also known as connective tissue growth factor (CTGF)], markers of epithelial to mesenchymal transition, and more recently periostin and members of the lysyl oxidase family of enzymes have been documented in phenytoin or nifedipine lesions. Some oral fibrotic conditions such as leukoplakia and oral submucous fibrosis, after subsequent additional genetic damage, can develop into oral cancer. Since many pathways are shared, the study of gingival fibrosis and comparisons with characteristics and molecular drivers of oral cancer would likely enhance understandings and functional roles of molecular drivers of these oral pathologies. PMID:25680368

  20. PATHOLOGIC AND IMPENDING FRACTURES: BIOLOGICAL AND CLINICAL ASPECTS.

    PubMed

    Spinelli, M S; Campi, S; Sacchetti, F M; Rossi, B; Di Martino, A; Giannini, S; Piccioli, A

    2015-01-01

    Bone metastases from carcinomas are epidemiologically rising because of the increased survival rate of oncologic patients, related to several factors such as improvement of primary and secondary screening, advancement of medical research and technology and the better understanding of mechanisms underlying bone metastases origination from primary tumor. Skeletal Related Events (SREs) can seriously affect quality of life in patients with metastatic disease. These events include the necessity of radiotherapy or bone surgery, malignant hypercalcemia, pathologic fractures and spinal cord compression. Among the SREs, pathologic fractures are the most disabling events and represent an emergency in these delicate patients. A pathologic fracture is defined as a fracture that occurs at the level of a pre-existing bone lesion (that is often a tumor), spontaneously or as the result of low-energy trauma (1). The pre-existence of the metastatic lesion in the bone, its evaluation and the assessment of progression can make these complications predictable and preventable. Pathologic fractures imply several severe consequences, including patient immobilization (in the case of fractures involving the lower limbs), loss of autonomy, anaemia, need of blood transfusion, discontinuation of medical therapies or radiotherapy and protracted hospitalization. Secondary effects of prolonged immobilization and loss of autonomy further lengthen this list of complications in patients who are already significantly limited in their activities. In the present paper, the authors present a review on the main aspects involved in bone metastastic disease: biology, quality of life, economic impact and survival. PMID:26652492

  1. Clinical and pathologic aspects of recurrent placental villitis.

    PubMed

    Redline, R W; Abramowsky, C R

    1985-07-01

    In a retrospective survey, recurrent villitis was identified in ten of 59 patients in whom placental villitis had been diagnosed. The ten patients had a total of 41 pregnancies, with a reproductive loss of 60 per cent. In addition to enhanced fetal losses in all trimesters of gestation and postnatally, the incidences of fetal growth retardation and premature delivery were increased. There was no evidence of recent TORCH (toxoplasma, rubella, cytomegalovirus, herpes) infection, but all patients tested had rubella immunity. In six patients genital cultures were positive for gonorrhea and assorted microorganisms. Uterine abnormalities, including two septate uteri, one incompetent cervix, one submucosal leiomyoma, and one retroflexion, were common, and vaginal bleeding had occurred in five patients. Other factors included obesity (five patients) and clinical and laboratory evidence of autoimmunity (four of the five patients tested). In a control group of 20 patients with nonrecurrent villitis, the perinatal loss rate (37 per cent) was lower, and the incidences of positive cultures, uterine structural anomalies, obesity, and autoimmunity were also lower. Placental histologic findings included decidual plasma cell and intervillous fibrin and histiocytic infiltration, in addition to villous inflammation. These lesions, although consistent for a given patient, defined two clinically relevant groups of patients. The results of this study suggest that recurrent villitis is more frequent than previously reported, that it is associated with high perinatal mortality, and that immunologic and structural abnormalities in the host may play a role in its pathogenesis.

  2. Gaucher disease in Iraqi children (Clinical, diagnostic & therapeutic aspects)

    PubMed Central

    Thejeal, Rabab Farhan; Kadhum, Ausama Jamal

    2016-01-01

    Background and Objective: Gaucher disease is the most common inherited lysosomal storage disorder. It is a multi organ disease affecting bone marrow, liver, spleen, lungs, and other organs contributes to pancytopenia and massive hepatosplenomegaly. This study aimed to spotlight on clinical and laboratory characteristics of children with Gaucher disease to raise awareness among physicians about the disease and to evaluate the outcome of enzyme replacement therapy (ERT). Methods: Clinical courses were reviewed in 30 patients with age (2-22 years) with Gaucher disease. After starting (ERT), assessment of response included serial measurements of hematological parameters, spleen and liver sizes, symptoms and signs of bone disease, growth and severity scores were also evaluated. Results: The most presenting age group was (1 – 5) years (60%). Abdominal distension was the most common presenting symptom, Splenomegaly presented in all of the patients. A significant response to ERT was observed, weight and height increased, both liver and spleen sizes decreased. Hemoglobin level normalizedin (67%) of the anemic patients, platelet count normalized in (53.8%)after 6 months from (ERT), the mean of severity scoring index decreased with ERT from (10.2±5.8) to (7.8±5.7) after one year of treatment. Conclusion: Using ERT was safe and effective in the reversal of hematological complications and organomegaly in most of the patients. PMID:27182231

  3. Psychological aspects of prostate cancer: a clinical review.

    PubMed

    De Sousa, A; Sonavane, S; Mehta, J

    2012-06-01

    Prostate cancer is the most common non-skin cancer in men. It is fraught with both physical and psychological symptomatology. Depression, anxiety, stress, fatigue, pain and psychosocial factors all affect the patient with prostate cancer. Impotence, erectile dysfunction, sexual issues and incontinence in these patients complicate matters further. Anxiety may exist both before testing and while awaiting test results. Confusion over choosing from various interventions often adds to anxiety and depression in these patients. Various demographic factors and the developmental stage of the couple affect these psychological symptoms. The caregiver may undergo significant psychological turmoil while caring for a patient diagnosed with prostate cancer, which is addressed. The role of nurses in the management of prostate cancer is discussed. The present review looks at psychological issues in patients with prostate cancer from a clinical perspective, with the aim of highlighting these issues for the clinical urologist dealing with these patients. It also explores the consultation-liaison relationship between psychiatrists, psychologists and urologists as a team for the multimodal management of prostate cancer. PMID:22212706

  4. Achalasia in central Israel, 1973-83: clinical aspects.

    PubMed

    Arber, N; Grossman, A; Tiomny, E; Rattan, J; Kadish, U; Novis, B; Neuman, G; Lilos, P; Rozen, P; Gilat, T

    1994-12-01

    In the framework of an epidemiologic study we collected data on all the 162 patients with achalasia in central Israel. The mean (+/- SD) follow-up was 9.9 +/- 8.7 years (range 1-52). At the last, as compared to the initial examination, the clinical condition of the patients had improved: 38% were without dysphagia as compared to 0% initially, 67% did not vomit and 92% did not complain of aspiration as compared to 17% and 68% initially, and 67% did not complain of chest pain as against 36% initially. In contrast, X-ray examinations, endoscopy as well as manometry did not show major changes. Esophageal retention of a semisolid radiolabeled meal 10 min after ingestion was 46 +/- 25% initially and 34 +/- 26% at last examination (NS). Medical therapy was given to 99 patients and a beneficial response was initially noted in 65% of them. About 88.7% had a beneficial response to surgery and 82.7% to pneumatic dilatations which were associated with a 7.3% perforation rate. Overall the clinical course of this unselected, regional group of patients was better than expected.

  5. Review: Clinical aspects of hereditary DNA Mismatch repair gene mutations.

    PubMed

    Sijmons, Rolf H; Hofstra, Robert M W

    2016-02-01

    Inherited mutations of the DNA Mismatch repair genes MLH1, MSH2, MSH6 and PMS2 can result in two hereditary tumor syndromes: the adult-onset autosomal dominant Lynch syndrome, previously referred to as Hereditary Non-Polyposis Colorectal Cancer (HNPCC) and the childhood-onset autosomal recessive Constitutional Mismatch Repair Deficiency syndrome. Both conditions are important to recognize clinically as their identification has direct consequences for clinical management and allows targeted preventive actions in mutation carriers. Lynch syndrome is one of the more common adult-onset hereditary tumor syndromes, with thousands of patients reported to date. Its tumor spectrum is well established and includes colorectal cancer, endometrial cancer and a range of other cancer types. However, surveillance for cancers other than colorectal cancer is still of uncertain value. Prophylactic surgery, especially for the uterus and its adnexa is an option in female mutation carriers. Chemoprevention of colorectal cancer with aspirin is actively being investigated in this syndrome and shows promising results. In contrast, the Constitutional Mismatch Repair Deficiency syndrome is rare, features a wide spectrum of childhood onset cancers, many of which are brain tumors with high mortality rates. Future studies are very much needed to improve the care for patients with this severe disorder. PMID:26746812

  6. Clinical and Genetic Aspects of Primary Ciliary Dyskinesia / Kartagener Syndrome

    PubMed Central

    Leigh, Margaret W.; Pittman, Jessica E.; Carson, Johnny L.; Ferkol, Thomas W.; Dell, Sharon D.; Davis, Stephanie D.; Knowles, Michael R.; Zariwala, Maimoona A.

    2013-01-01

    Primary ciliary dyskinesia (PCD) is a genetically heterogeneous disorder of motile cilia. Most of the disease-causing mutations identified to date involve the heavy (DNAH5) or intermediate (DNAI1) chain dynein genes in ciliary outer dynein arms, although a few mutations have been noted in other genes. Clinical molecular genetic testing for PCD is available for the most common mutations. The respiratory manifestations of PCD (chronic bronchitis leading to bronchiectasis, chronic rhino-sinusitis and chronic otitis media) reflect impaired mucociliary clearance owing to defective axonemal structure. Ciliary ultrastructural analysis in most patients (>80%) reveals defective dynein arms, although defects in other axonemal components have also been observed. Approximately 50% of PCD patients have laterality defects (including situs inversus totalis and, less commonly, heterotaxy and congenital heart disease), reflecting dysfunction of embryological nodal cilia. Male infertility is common and reflects defects in sperm tail axonemes. Most PCD patients have a history of neonatal respiratory distress, suggesting that motile cilia play a role in fluid clearance during the transition from a fetal to neonatal lung. Ciliopathies involving sensory cilia, including autosomal dominant or recessive polycystic kidney disease, Bardet-Biedl syndrome, and Alstrom syndrome, may have chronic respiratory symptoms and even bronchiectasis suggesting clinical overlap with PCD. PMID:19606528

  7. The spectrum of celiac disease: epidemiology, clinical aspects and treatment.

    PubMed

    Tack, Greetje J; Verbeek, Wieke H M; Schreurs, Marco W J; Mulder, Chris J J

    2010-04-01

    Celiac disease is a gluten-sensitive enteropathy that affects people of all ages worldwide. This disease has emerged as a major health-care problem, as advances in diagnostic and screening methods have revealed its global prevalence. Environmental factors such as gluten introduction at childhood, infectious agents and socioeconomic features, as well as the presence of HLA-DQ2 and/or HLA-DQ8 haplotypes or genetic variations in several non-HLA genes contribute to the development of celiac disease. Growing insight into the variable clinical and histopathological presentation features of this disease has opened new perspectives for future research. A strict life-long gluten-free diet is the only safe and efficient available treatment, yet it results in a social burden. Alternative treatment modalities focus on modification of dietary components, enzymatic degradation of gluten, inhibition of intestinal permeability and modulation of the immune response. A small group of patients with celiac disease (2-5%), however, fail to improve clinically and histologically upon elimination of dietary gluten. This complication is referred to as refractory celiac disease, and imposes a serious risk of developing a virtually lethal enteropathy-associated T-cell lymphoma.

  8. Taxonomy, biology, and clinical aspects of Fusarium species.

    PubMed Central

    Nelson, P E; Dignani, M C; Anaissie, E J

    1994-01-01

    There are several taxonomic systems available for identifying Fusarium species. The philosophy used in each taxonomic system is discussed as well as problems encountered in working with Fusarium species in culture. Fusarium species are toxigenic, and the mycotoxins produced by these organisms are often associated with animal and human diseases. The implications for the association of the carcinogens, fumonisins, produced by Fusarium moniliforme and other Fusarium species with human diseases are discussed. Foreign-body-associated fusarial infection such as keratitis in contact lens wearers, onychomycosis, skin infections, and disseminated multiorgan infections are discussed. Disseminated fusarial hyalohyphomycosis has emerged as a significant, usually fatal infection in the immunocompromised host. Successful outcome is determined by the degree of immunosuppression, the extent of the infection, and the presence of a removable focus such as an indwelling central venous catheter. These infections may be clinically suspected on the basis of a constellation of clinical and laboratory findings, which should lead to prompt therapy, probably with one of the newer antifungal agents. Perhaps the use of such agents or the use of colony-stimulating factors may improve the outcome of this devastating infection. However, until new approaches for treatment develop, effective preventive measures are urgently needed. Images PMID:7834602

  9. [Clinical aspects of chromosomal aberrations - problems of semiotics and nosography].

    PubMed

    Leiber, B

    1975-01-01

    Despite intense clinical and cytogenetic research for more than 15 years we are far from knowing any definite relations between karyotype and phenotype. Both cytogeneticists and clinicians are working on the methodological improvements which are still necessary. In the methods of clinical recording there is still very great weakness of exact documentation of findings. Above all there is a lack of reproducible qualitative, and especially quantitative standards which constitute the basis of any practicable nosography. Some procedures for quantifying dysplastic facial features which have hardly been described so far (graphic statistics) are reported briefly. Also the summation of symptoms, a method currently used in the field of chromosomopathy syndromes, is subject to critical consideration. In this group of diseases a total list of symptoms of about 250 items can be obtained which includes multilocular minor stigmata, dysplasias, errors of differentiation and gross malformations of organs. An extraordinarily high degree of overlapping of symptoms is characteristic of these syndromes and makes accurate diagnosis difficult. However, for the trisomy-syndromes we succeeded in working out a diagnostic guideline by differentiating between an unspecified basic symptomatology concerning all trisomias and a pattern-forming additional symptomatology of each single syndrome. Thereby the diverse total symptomatology is reduced to the crucial and the recognition of patterns in daily practice is facilitated considerably. The comparatively specific additional symptomatologies of trisomy 13 -- 14 (Patau), trisomy 17 -- 18 (EDWARDS), and trisomy 21 (DOWN) are demonstrated in graphic views.

  10. Food hypersensitivity among adult patients: epidemiological and clinical aspects.

    PubMed

    Castillo, R; Delgado, J; Quiralte, J; Blanco, C; Carrillo, T

    1996-01-01

    Food hypersensitivity (FH) is lesser frequent among adult patients than in childhood. Foods implicated in hypersensitivity reactions vary with sociocultural and diet habits from a geographic place to other. We studied 142 adult patients sensitized to foods, among 7698 patients visited at our Outpatient Clinic. Hundred and twenty patients referred clinical symptoms after consumption of one or more foods consistently. From the latest, 107 patients (89.2%) were atopics (92 of them sensitizes to dust mites) and 54 (45%) referred atopic familiar background. Most frequent recorded symptoms were: urticaria/angioedema 84 cases (70%), oral syndrome 65 (54%), asthma 48 (37%) and anaphylaxis 33 patients (27.5%). Shellfish sensitization occurred in 50 patients, fresh fruits in 33 and nuts in 29 cases. Shrimp (48 patients), squid (33), kiwi (14), papaya (14), avocado (13) and banana (12 cases) were the most frequent causes of FH. Significant statistical association between foods and inhalants was observed for fresh fruits and latex (p < 0.001), fresh fruits and pollens (p < 0.01), and shellfish and Blatta germanica (p < 0.001). Prevalence of FH among patients at our Area is around 1.6%. Tropical fruits, as other kind of fruits, seem to share common IgE-epitopes to pollens. High prevalence of shellfish and cockroach hypersensitivity could be more easily developed by previous domestic mites sensitization.

  11. Future aspects of cellular and molecular research in clinical voice treatment aspects of optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Pedersen, Mette; Mahmood, Sanila

    2015-02-01

    Focus is upon our clinical experience in a prospective cohort study on cure of dystonia where the mode of treatment was fexofenadine tablets and local budesonide inhaler in the larynx, and in a randomized controlled trial of lifestyle change related to acid provocation of food and habits in laryngopharyngeal reflux (LPR). The advanced high-speed films is one new tool, another being optical coherence tomography (OCT), which should be used in the future in randomized controlled trials. We are focusing on OCT of the swallowing process in the oesophagaus and larynx as well as the vocal fold function. It can be shown on OCT how the layer of the vocal folds develop, possibly corresponding to hormonal and paediatric development. The arytenoid area in the larynx should also be focused upon with OCT in pathology. The thyroid function is related to voice and the swallowing function, both hormonally and pathoanatomically. We know too little about voice and thyroid hormones in an updated way as well as the outer anatomic supporting muscular structure of the larynx, related to thyroid immune degeneration and cysts. Also, here OCT analyses might be of value.

  12. Clinical care of adult Turner syndrome--new aspects.

    PubMed

    Trolle, Christian; Mortensen, Kristian Havmand; Hjerrild, Britta E; Cleemann, Line; Gravholt, Claus H

    2012-05-01

    Turner syndrome (TS) is characterized by numerous medical challenges during adolescence and adulthood. Puberty has to be induced in most cases, and female sex hormone replacement therapy (HRT) should continue during adult years. These issues are normally dealt with by the paediatrician, but once a TS female enters adulthood it is less clear who should be the primary care giver. Morbidity and mortality is increased, especially due to the risk of dissection of the aorta and other cardiovascular diseases, as well as the risk of type 2 diabetes, hypertension, osteoporosis, thyroid disease and other diseases. The proper dose of HRT with female sex steroids has not been established, and, likewise, benefits and/or drawbacks from HRT have not been thoroughly evaluated. The transition period from paediatric to adult care seems to be especially vulnerable and the proper framework for transition has not yet been established. Likewise, no framework is in place for continuous follow-up during adult years in many countries. Today, most treatment recommendations are based on expert opinion and are unfortunately not evidence based, although more areas, such as growth hormone and oxandrolone treatment for increasing height, are becoming well founded. Osteoporosis, diabetes, both type 1 and 2, hypothyroidism, obesity and a host of other endocrine diseases and conditions are seen more frequently in TS. Prevention, intervention and proper treatment is only just being recognized. Hypertension is frequent and can be a forerunner of cardiovascular disease. The description of adult life with TS has been broadened and medical, social and psychological aspects are being added at a compelling pace. Proper care during adulthood should be studied and a framework for care should be in place, since most morbidity potentially is amenable to intervention. In summary, TS is a condition associated with a number of diseases and conditions which need the attention of a multi-disciplinary team during

  13. [Clinical aspects of immunoneuroendocrine alterations in HIV infection].

    PubMed

    Rondanelli, M; Minoli, L

    1995-06-01

    A number of studies confirm that any human tissue can be targeted by HIV, and also the endocrine system is involved during HIV infection. No endocrine adenus is saved by the assault of the opportunistic pathogens that overrun the organism unprotected due to the severe and progressive immune deficits induced by the HIV. As a consequence clinical, but often subclinical alterations can be detected that underline the close relationship among the systems of body adaptation to the environment (immune, endocrine, and nervous). Indeed these alterations can be viewed as an immunoneuroendocrine pathology. AIDS is a paradigmatic syndrome for the variety of immune dysfunctions, and also presents endocrine and neurological dysfunctions, which allow to better understand the connections among these systems, and the interactions of HIV with the immunoneuroendocrine dynamics. PMID:8531893

  14. [Familial Mediterranean fever--from gene test to clinical aspects].

    PubMed

    Sudeck, H

    2000-10-26

    Familial Mediterranean Fever (FMF) is a genetically defined disease affecting mostly families of jewish, turkish or armenian origin whose ancestors originate from the mediterranean basin. The first officially acknowledged description was given by SIEGAL in 1945 but previous cases were reported since 1908. The main clinical signs which are very varying in intensity and appearance are periodic attacks of fever with peritonitis, pleurisy and arthritis. The classical but not always found complication is amyloidosis with renal failure which is preventable by lifelong colchicine therapy. By using a novel genetest it is now possible to definitely diagnose FMF instead of relying on a diagnosis made merely by exclusion. This will emphasize the use of colchicine and should bring us nearer to the pathophysiology of this interesting disease. PMID:11103618

  15. Biological and clinical aspects of ABO blood group system.

    PubMed

    Hosoi, Eiji

    2008-08-01

    The ABO blood group was discovered in 1900 by Austrian scientist, Karl Landsteiner. At present, the International Society of Blood Transfusion (ISBT) approves as 29 human blood group systems. The ABO blood group system consists of four antigens (A, B, O and AB). These antigens are known as oligosaccharide antigens, and widely expressed on the membranes of red cell and tissue cells as well as, in the saliva and body fluid. The ABO blood group antigens are one of the most important issues in transfusion medicine to evaluate the adaptability of donor blood cells with bone marrow transplantations, and lifespan of the hemocytes.This article reviews the serology, biochemistry and genetic characteristics, and clinical application of ABO antigens.

  16. [Clinical-epidemiological aspects of gastric and duodenum ulcer].

    PubMed

    Larichev, A B; Maĭorov, M I; Favstov, S V; Shalop'ev, A G

    2014-01-01

    An analysis of reporting and statistical data showed the considerable changes in clinical-epidemiological indices of gastric and duodenum ulcer at the period from 1998 to 2012. The prevalence of the disease and the number of primary patients decreased in 2-3 times. The reduction of the rate of perforations and ulcerous bleeding had been observed. However, the authors noted, that a tendency of frequency of occurrence increased and efficacy indices reduced in the last years. The rate of postoperative lethality raised in the cases of perforated ulcer. On this basis, the authors recommend to reconsider the existing opinion about further extension of out-patient treatment of patients with given pathology.

  17. Clinical Effects and Lethal and Forensic Aspects of Propofol*

    PubMed Central

    Levy, Richard J.

    2010-01-01

    Propofol is a potent intravenous anesthetic agent that rapidly induces sedation and unconsciousness. The potential for propofol dependency, recreational use and abuse has only recently been recognized and several cases of accidental overdose and suicide have emerged. In addition, the first documented case of murder using propofol was reported a few months ago and a high profile case of suspected homicide with propofol is currently under investigation. A number of analytical methods have been employed to detect and quantify propofol concentrations in biological specimens. The reported propofol related deaths and post-mortem blood and tissue levels are reviewed. Importantly, limitations of propofol detection are discussed and future considerations are presented. Because propofol has the potential for diversion with lethal consequences, the forensic scientist must have a basic understanding of its clinical indications and uses, pharmacologic properties, and detection methods. In addition, medical institutions should develop systems to prevent and detect diversion of this potential drug of abuse. PMID:20950316

  18. [Paraquat poisoning: clinical and anatomopathologic aspects in 3 cases].

    PubMed

    Pazos, M R; Reig, R; Sanz, P; Nogue, S; Boix, D; Palomar, M; Tenorio, L; Corbella, J

    1989-03-01

    3 cases of suicide due to ingestion of 150, 200 and 4 gr. of paraquat, respectively, are presented. Two of them were brothers and agricultural industrialists, the other one was a farmer. The first two cases died 16 and 10 hours after intake. The farmer died 21 days after ingestion. All of them had progressive hypoxemia and renal failure the two brothers had heart conduction system glycemia (23 mg/dl) a few hours after ingestion. The postmortem study showed edema, hemorrhage and congestion of the lungs, alveolitis, fibrosis and lobar atelectasia; renal tubular necrosis adrenal necrosis; colestasia; hepatic steatosis focal miocarditis. The clinical evolution, particularly short in the first two patients, is commented on, as well as the post-mortem findings, comparing them with those described in the literature. Finally, due to the high toxicity of this herbicide, we insist in prompt transport to herbicide, we insist in prompt transport to the hospital in order to apply early treatment. PMID:2491192

  19. New aspects in the clinical spectrum of neonatal lupus.

    PubMed

    Laurinaviciene, Rasa; Christesen, Henrik Thybo; Bygum, Anette

    2012-05-01

    Neonatal lupus erythematosus (NLE) is a rare, passively acquired autoimmune disease, caused by maternal autoantibodies. Characteristic clinical features of NLE are transient rash and congenital heart block (CHB), but also hematological abnormalities and hepatobiliary dysfunction may occur. Complications to the transient dermatitis are rarely described. We describe two patients with NLE and cutaneous manifestations. Both patients had involvement of the sun-protected genital skin and soles. New manifestations of NLE were gastrointestinal bleeding in one patient despite normal coagulation parameters, but with mucosal telangiectatic lesions found on sigmoidoscopy. In addition, one patient developed painful atrophy after plantar dermatitis on follow-up with need of orthopedic footwear. CHB was not found. In conclusion, NLE may be complicated with sigmoidal telangiectasia with rectal bleeding and painful plantar atrophy.

  20. Lyme borreliosis: reviewing potential vaccines, clinical aspects and health economics.

    PubMed

    Šmit, Renata; Postma, Maarten J

    2015-01-01

    Lyme borreliosis (LB) is a multisystem infectious disease with a growing burden in many parts of North America, Asia and Europe. Persistent infection of LB can usually be treated effectively with antibiotic therapy, but it may be followed by post-treatment Lyme disease syndrome. Therefore, it is important to begin with treatment in the early phase of the disease. Vaccination shows potential as the most effective way of preventing LB and reducing its burden in these continents. It is concluded that there is a need for continuous effort in research from all perspectives on LB, especially regarding prevention with novel vaccines, their development, clinical efficacy and cost-effectiveness. This review may help to further develop (cost-) effective strategies for prevention and control of the disease to reduce its burden and achieve population-wide health benefits. PMID:26414102

  1. Methyltin intoxication in six men; toxicologic and clinical aspects

    SciTech Connect

    Rey, C.; Reinecke, H.J.; Besser, R.

    1984-04-01

    Neurologic and psychiatric symptoms such as headache, tinnitus, defective hearing, changing desorientation and aggressiveness are initial symptoms of methyltin chloride intoxication. Some patients also developed epileptic equivalents, such as dreamy attacks and central ventilation transaminases. Laboratory findings included low levels of serum potassium, leucocytosis and elevated transaminases. The excretion rate of tin in the urine correlated with the severity of the intoxication. There was no measurable effect of plasma separation or d-penicillamine therapy on tin excretion in the urine or on the clinical picture. The long-term prognosis of severely intoxicated persons is poor. To prevent such events workers need to be warned of the risk and dangers of working with organo-metallic compounds. The effectiveness of protective clothes and gas masks should be checked. In exposed workers regular testing is advised of tin concentrations in the urine.

  2. Lyme borreliosis: reviewing potential vaccines, clinical aspects and health economics.

    PubMed

    Šmit, Renata; Postma, Maarten J

    2015-01-01

    Lyme borreliosis (LB) is a multisystem infectious disease with a growing burden in many parts of North America, Asia and Europe. Persistent infection of LB can usually be treated effectively with antibiotic therapy, but it may be followed by post-treatment Lyme disease syndrome. Therefore, it is important to begin with treatment in the early phase of the disease. Vaccination shows potential as the most effective way of preventing LB and reducing its burden in these continents. It is concluded that there is a need for continuous effort in research from all perspectives on LB, especially regarding prevention with novel vaccines, their development, clinical efficacy and cost-effectiveness. This review may help to further develop (cost-) effective strategies for prevention and control of the disease to reduce its burden and achieve population-wide health benefits.

  3. [The lumbar disc herniation - management, clinical aspects and current recommendations].

    PubMed

    Stienen, M N; Cadosch, D; Hildebrandt, G; Gautschi, O P

    2011-11-30

    Lumbar disc herniation has a high prevalence and strong social-medical impact. Patients suffer from lower back pain that radiates from the spine. Loss of sensation or paresis adds to the clinical picture. The diagnosis should be confirmed by imaging in patients considered for surgery. High remission rates initially warrant conservative treatment (adequate analgesia and physiotherapy) in many patients. If this treatment does not lead to significant alleviation within 5-8 weeks, surgery should be performed to reduce the risk of chronic nerve affection. Posterior interlaminar fenestration is the intervention primarily conducted for this diagnosis. A relapse in the same region occurs in up to 10% of patients after months through years, which sometimes necessitates a reoperation if symptoms are pertinent. PMID:22124958

  4. [Coronary microvascular dysfunction : Clinical aspects, diagnosis and therapy].

    PubMed

    Ong, P; Sechtem, U

    2016-06-01

    Just as in epicardial coronary stenosis, coronary microvascular dysfunction (CMD) also leads to an imbalance of myocardial oxygen supply and demand. The dysfunction is located at the level of the coronary microcirculation with vessel diameters < 500 µm and structural as well as functional alterations have been described. The underlying mechanisms are diverse, frequently overlap and are still incompletely understood. Among others, conditions such as chronic inflammation, estrogen deficiency and a genetic familial predisposition have been reported. A common and often underdiagnosed clinical manifestation of CMD is found in patients who have symptoms of angina pectoris but no obstructive epicardial coronary artery disease or myocardial disease. The CMD can be diagnosed using non-invasive procedures, such as the combination of coronary computed tomography (CT) angiography and cardiac stress magnetic resonance imaging (MRI) or coronary CT and positron emission tomography (PET). In addition, invasive coronary vasomotor assessment is also suitable. Very little evidence is available regarding the effectiveness of pharmacological treatment of CMD. The current European Society of Cardiology (ESC) guidelines on the management of stable coronary artery disease from 2013 recommend using acetylsalicylic acid (ASS) and a statin as well as beta blockers and/or calcium channel blockers. Patients with CMD have an elevated risk for coronary events and death of approximately 1.7 % per year. Moreover, there is an increased morbidity with frequent presentations in practices and emergency admissions. Clinical research efforts should aim at a better characterization of the underlying mechanisms of CMD in order to develop targeted treatment approaches. PMID:27255117

  5. Newer endovascular tools: a review of experimental and clinical aspects.

    PubMed

    Sorenson, Thomas; Brinjikji, Waleed; Lanzino, Giuseppe

    2016-03-01

    The history of treatment of intracranial aneurysms dates back to the late 18th century. These early physicians largely based their crude techniques around "wire insertion alone, galvanopuncture (electrothrombosis), and fili-galvanopuncture (wire insertion together with electrothrombosis)," albeit with overwhelmingly unfavorable outcomes. By the end of the 20th century, treatment options progressed to include two highly effective, and safe, procedures: surgical clipping and endovascular coiling. These methods have been found to be effective treatments for a large portion of aneurysms, but there still exists a subset of patients that do not respond well to these therapies. While much progress has been made in stent-assisted coiling including the development of newer stents aimed at keep the coil ball from protruding into the parent vessel, the introduction of flow diverters has characterized a new phase in the endovascular treatment of intracranial aneurysms. This treatment paradigm is rapidly becoming the treatment of choice for large and complex aneurysms internal carotid artery. Intrasaccular flow diverters such as the Woven EndoBridge device (WEB) and Luna device are showing promise in the treatment of wide neck bifurcation aneurysms. Other newer devices including the pCONus Bifurcating Aneurysm Implant and Endovascular Clip Systems (eCLIPs) are showing promise in small clinical and preclinical studies. As technology improves, newer devices with ingenious designs are constantly being introduced into the clinical arena. Most of these devices try to address the limitations of traditional endovascular methods in regard to providing a safe and effective treatment of wide-necked bifurcation aneurysms. Several large prospective studies are underway and once completed, the role of these newer devices will be better defined. It is easy to anticipate that with advances in 3D techniques and printing, a future in which customized devices are designed based on the individual

  6. Clinical aspects of obesity in childhood and adolescence.

    PubMed

    Kiess, W; Galler, A; Reich, A; Müller, G; Kapellen, T; Deutscher, J; Raile, K; Kratzsch, J

    2001-02-01

    The level of fatness of a child at which morbidity acutely and/or later in life increases is determined on an acturial basis. Direct measurements of body fat content, e.g. hydrodensitometry, bioimpedance, or DEXA, are useful tools in scientific studies. However, body mass index (BMI) is easy to calculate and is generally accepted now to be used to define obesity in children and adolescents clinically. An increased risk of death from cardiovascular disease in adults has been found in subjects whose BMI had been greater than the 75th percentile as adolescents. Childhood obesity seems to substantially increase the risk of subsequent morbidity whether or not obesity persists into adulthood. The genetic basis of childhood obesity has been elucidated to some extent through the discovery of leptin, the ob gene product, and the increasing knowledge on the role of neuropeptides such as POMC, neuropeptide Y (NPY) and the melanocyte concentrating hormone receptors (for example, MC4R). Environmental/exogenous factors largely contribute to the development of a high degree of body fatness early in life. Twin studies suggest that approximately 50% of the tendency toward obesity is inherited. There are numerous disorders including a number of endocrine disorders (Cushing's syndrome, hypothyroidism, etc.) and genetic syndromes (Prader-Labhard-Willi syndrome, Bardet Biedl syndrome, etc.) that can present with obesity. A simple diagnostic algorithm allows for the differentiation between primary or secondary obesity. Among the most common sequelae of primary childhood obesity are hypertension, dyslipidemia, back pain and psychosocial problems. Therapeutic strategies include psychological and family therapy, lifestyle/behaviour modification and nutrition education. The role of regular exercise and exercise programmes is emphasized. Surgical procedures and drugs used in adult obesity are still not generally recommended in children and adolescents with obesity. As obesity is the most

  7. Novel clinical and diagnostic aspects of antineutrophil cytoplasmic antibodies.

    PubMed

    Schulte-Pelkum, Johannes; Radice, Antonella; Norman, Gary L; Lόpez Hoyos, Marcos; Lakos, Gabriella; Buchner, Carol; Musset, Lucile; Miyara, Makoto; Stinton, Laura; Mahler, Michael

    2014-01-01

    Antineutrophil cytoplasmic antibodies (ANCA) are the serological hallmark of some idiopathic systemic vasculitides. Besides the investigation of ANCA-associated vasculitis (AAV) and constant effort for a standardized nomenclature and classification of the AAV, a main focus of research during the last few years has been to constantly improve the performance of enzyme immunoassays. With the latest so called third generation ELISA, this goal seemed to be fulfilled. The International Consensus Statement on Testing and Reporting of ANCA gave recommendations for standardized strategies for the serological diagnosis of ANCA. New developments now target the system immanent drawbacks of the respective diagnostic methods, be it the need for batching and the long time to result for ELISA, or the high likelihood of error and subjectivity of indirect immunofluorescence (IIF). Random access technology and multiplexing for solid phase assays as well as digital imaging for IIF are tools which may help to expedite and simplify routine diagnostics in the lab and in emergency settings. Recent findings indicate that PR3-ANCA have clinical utility beyond the diagnosis of AAV. PR3-ANCA can also serve as an aid for the differentiation between ulcerative colitis (UC) and Crohn's disease (CrD) and the stratification of UC patients. This review provides a detailed review of what is known about ANCA and highlights the latest research and state-of-the-art developments in this area. PMID:24995343

  8. [Confronting bioterrorism: Epidemiologic, clinical, and preventive aspects of smallpox].

    PubMed

    Franco-Paredes, Carlos; del Río, Carlos; Nava-Frías, Margarita; Rangel-Frausto, Sigfrido; Téllez, Ildefonso; Santos-Preciado, José Ignacio

    2003-01-01

    The worldwide eradication of smallpox, a major achievement in public health, is currently threatened by the risk of bioterrorism. The debate on the destruction of the Variola virus in the two reference laboratories of the World Health Organization has dramatically switched to the preservation of the remaining virus after the September 2001 terrorist events in the U.S. along with the intentional release of Bacillus anthracis in the U.S. The risk of intentional release of Variola virus constitutes a minimal, yet possible risk. A smallpox epidemic could have a devastating impact due to its elevated morbidity and mortality that would inflict in non-immune human population, in addition to the ensuing panic and social unrest. Therefore, the development of national preparedness and response plans along with the availability of smallpox vaccine to be used in the post-exposure phase represent a fundamental part of the preventive efforts to cope with bioterrorism. Reestablishing a preventive vaccination program was recently recommended by the Advisory Committee on Immunization Practices (ACIP). However, the vaccine currently available has historically been associated with serious adverse reactions, even death. Thus, this recommendation has not been universally accepted. To counter an epidemic of smallpox, medical personnel in the frontline need to be prepared with updated smallpox information to identify, diagnose, isolate, and treat cases if a bioterrorist attack should occur. Herein we present an indepth review for health care personnel with relevant epidemiologic, clinical, and preventive information on smallpox.

  9. Clinical and molecular aspects of varicella zoster virus infection

    PubMed Central

    Gilden, Don; Nagel, Maria A.; Mahalingam, Ravi; Mueller, Niklaus H.; Brazeau, Elizabeth A.; Pugazhenthi, Subbiah; Cohrs, Randall J.

    2009-01-01

    Summary A declining cell-mediated immunity to varicella zoster virus (VZV) with advancing age or immunosuppression results in virus reactivation from latently infected human ganglia anywhere along the neuraxis. Virus reactivation produces zoster, often followed by chronic pain (postherpetic neuralgia or PHN) as well as vasculopathy, myelopathy, retinal necrosis and cerebellitis. VZV reactivation also produces pain without rash (zoster sine herpete). Vaccination after age 60 reduces the incidence of shingles by 51%, PHN by 66% and the burden of illness by 61%. However, even if every healthy adult over age 60 years is vaccinated, there would still be about 500,000 zoster cases annually in the United States alone, about 200,000 of whom will experience PHN. Analyses of viral nucleic acid and gene expression in latently infected human ganglia and in an animal model of varicella latency in primates are serving to determine the mechanism(s) of VZV reactivation with the aim of preventing reactivation and the clinical sequelae. PMID:19946620

  10. [Syphilis. Part 1: Introduction, pathology and clinical aspects].

    PubMed

    Gross, G; Flaig, B; Rode, S

    2013-10-01

    In Germany more than 3,500 people become infected with syphilis annually. As elsewhere in Western Europe there is a low level endemicity with a concentration among population subgroups with high rates of partner exchange, such as men who have sex with other men. In Germany after initially reduced numbers of cases, the incidence rate has increased after the turn of the millennium. In 2011 the incidence reached 4.5 cases per 100,000 inhabitants, which is the highest incidence since the introduction of the Infection Protection Act of 2001. Syphilis, like other sexually transmitted infections and diseases with its manifold clinical manifestations and complex diagnostics, is a large global problem for public health systems. The recent resurgence of syphilis presents a challenge for all physicians but particularly for dermatologists and venereologists because the skin and adjacent mucous membranes are initially affected. Rapid diagnosis, differential diagnosis, consequent treatment and monitoring can cure the disease. Prevention of misdiagnosis is essential otherwise severe, sometimes fatal cardiovascular complications, neurosyphilis and transfer to unborn and newborn children can occur. The synergy of syphilis and sexually transmitted human immunodeficiency virus (HIV) is of special importance. Syphilis together with genital herpes and other sexually transmitted genital and oral ulcers is an important pacemaker for HIV. PMID:24150827

  11. Clinical aspects of Chagas disease and implications for novel therapies.

    PubMed

    Menezes, Cristiane; Costa, Germano Carneiro; Gollob, Kenneth J; Dutra, Walderez O

    2011-09-01

    The interaction between the protozoan parasite Trypanosoma cruzi and the human host dates back 9000 years, as demonstrated by molecular analysis of material obtained from Andean mummies indicating the presence of the parasite's kinetoplast DNA in populations from Chile and Peru. This long-established interaction, which persists today, demonstrates that T. cruzi has established a very well adapted relationship with the human host. From a host-parasite relationship point-of-view this is desirable, however, such a high degree of adaptation is perhaps the foundation for many of the unknowns that surround this disease. Unveiling of the immunological mechanisms that underlie the establishment of pathology, identification of parasite-associated factors that determine strain-differential tissue tropism, discovery of host genetic elements that influence the development of different clinical forms of the disease, and understanding environmental factors that may influence the host-parasite interactions, are some of the key questions remaining to be answered. The response to these questions will aid in addressing some of the current challenges in Chagas disease: fulfilling the need for efficient diagnosis, developing effective prophylactic measures, discovering effective therapeutics, and finding methods to control disease progression.

  12. [Beta-thalassemias: molecular, epidemiological, diagnostical and clinical aspects].

    PubMed

    Joly, Philippe; Pondarre, Corinne; Badens, Catherine

    2014-01-01

    Beta-thalassemia is one of most common autosomal recessive disorders worldwide. In France, 5 to 10 new major or intermedia forms are diagnosed annually and the global prevalence is about 500 cases. Since 20 years and thanks to the generalization of iron chelator treatments, the life expectancy has dramatically increased. Nearly 90% of the β-thalassemic alleles are point mutations easily identified by Sanger sequencing or dedicated methods. The remaining 10% are deletions detectable by MLPA or CGH Array. The alpha-globin genotype is also essential in the exploration of beta-thalassemia because an alpha-thalassemia improves the clinical state whereas an alpha triplication worsens it. The additional genotyping of a few HbF inducer polymorphisms allows to predict the age of the first transfusion, thanks to a recent dedicated algorithm, making beta-thalassemia one of the first potential application of predictive medicine. Gene therapy, pre-implantatory diagnosis and new drugs (Sotatercept®, hepcidin-like molecules) have also recently contributed to make beta-thalassemia a main scientific topic again. PMID:25486662

  13. [Clinical and toxicologic aspects of the use of Ecstasy].

    PubMed

    Pennings, E J; Konijn, K Z; de Wolff, F A

    1998-08-29

    Methylenedioxymethamphetamine (MDMA, the active compound of ecstacy (XTC) tablets) is a psychoactive amphetamine congener which in humans has a stimulatory effect and enhances feelings of openness and solidarity. MDMA is neurotoxic in animals. It depletes axonal serotonin stores, it inhibits serotonin synthesis by inhibiting tryptophan hydroxylase, and it inhibits the reuptake of serotonin into the neuron. These events lead to destruction of serotonergic axon terminals in animal brain. Selective serotonin reuptake inhibitors protect against the neurotoxic effects of MDMA. Binding of (+)[11C]McN-5652, a selective neuroligand for the serotonin transporter, is decreased in the brains of XTC-users. This indicates that XTC damages serotonergic axon terminals in human brain, also. We strongly advise against the use of XTC as the long-term clinical consequences are not known. In man, somatic life-threatening complications after XTC use include hyperthermia, hyponatraemia and liver failure. Psychiatric complications include psychosis, depression, panic disorder, and impulsive behaviour. The chronic psychosis responds poorly to therapy.

  14. [Mucocutaneous leishmaniasis in Panama. Etiologic agent, epidemiologic and clinical aspects].

    PubMed

    Sáenz, R E; Paz, H M; de Rodriguez, G C; de Vásquez, A M; Mata, R E; Johnson, C M

    1989-01-01

    From November 1985 to December 1988, 33 patients were enrolled at Santo Tomas Hospital and Gorgas Memorial Laboratory to study the etiology, epidemiology and clinical characteristics of mucocutaneous leishmaniasis. Seventeen were males and 16 females, 14 to 80 years old from the endemic rural areas of the provinces of Panama, Colón, Coclé, Darién, Veraguas, Bocas del Toro and San Blas. In 8 patients the respiratory mucosa involvement occurred at the time of the primary infection and 25 had the involvement after an incubation period of 2 to 30 years. Twenty one of these 25 patients had a clear history of cutaneous leishmaniasis and the characteristic depressed and hyperpigmented scar of a previous leishmanial infection. The Montenegro skin test was positive in all the patients, serology in 84%, direct smear in 47%, histopathology in 37% and culture in 26%. The strains were characterized as L. braziliensis panamensis by electrophoresis of isoenzymes. Possible risk factors in development of MCL were found to be female sex and the lack of past treatment of CL. The mucosal involvement was mild in the majority of the patients, the infection was localized in the nasal mucosal (nasal septum and inferior turbinate) in 91% of the patients, and the most common symptoms were epistaxis, nasal obstruction and rhinorrhea.

  15. Endodontic retreatment. Aspects of decision making and clinical outcome.

    PubMed

    Kvist, T

    2001-01-01

    regardless of assessment method. Compared with Standard gamble Visual Analogue Scale systematically produced lower ratings. U-values were found to change considerably in both the short and long-term. Any significant correlation between endodontists' U-values and retreatment prescriptions could not be demonstrated. Surgical and nonsurgical retreatment were randomly assigned to 95 "failed" root filled teeth in 92 patients. Cases were followed clinically and radiographically for four years postoperatively. At the 12-month recall a statistically significant higher healing rate was observed for teeth retreated surgically. At the final 48-month recall no systematic difference was detected. Patients were found to be more subject to postoperative discomfort when teeth were retreated surgically compared with nonsurgically. Consequently, surgical retreatment tended to be associated with higher indirect costs than a nonsurgically approach. In the final part of the thesis it is argued that retreatment decision making in everyday clinical practice normally should be based on simple principles. It is suggested that in order to achieve the best overall consequence a periapical lesion in a root filled tooth that is not expected to heal should be retreated. Arguments to withhold retreatment should be based on (i) respect for patient autonomy, (ii) retreatment risks or (iii) retreatment costs. PMID:11288682

  16. Sexual maturation of the hypothalamus: pathophysiological aspects and clinical implications.

    PubMed

    Forest, M G

    1985-01-01

    Sexual maturation in humans begins early in fetal life and culminates in adulthood when the gonads have acquired a full capacity for reproduction. It is remarkable that during this long process, the pituitary gonadal function, hence its hypothalamic control presents an alternative of activation and inhibition periods, during which the interrelations of the 3 components of the hypothalamic-pituitary-gonadal axis change gradually and inversely. The ontogeny of the hypothalamic-pituitary system, the varying activity of the reproductive endocrine system throughout sexual maturation and the developmental changes in the interrelations of the hypothalamic-pituitary-gonadal axis are reviewed: the most striking feature of human sexual development is the long inhibition of hypothalamo-pituitary function during childhood. Much indirect evidence points to the determining role of the CNS in the maturation of hypothalamic function: the occurrence of rhythms of secretion, the amplitude of secretions and peripubertal specific sleep-related nycthemeral rhythm of secretion at the onset of puberty. Despite the reality of a negative feedback control, these changes do occur independently of gonadal secretions since they are observed (qualitatively if not strictly quantitatively) in agonadal children. It is likely that neurotransmitters (dopamine, serotonine) and opiates have an inhibitory effect on Gn-RH release. But we still don't know their evolution during sexual maturation. It does not appear that melatonine plays any determinant role in the onset of human puberty. The clinical implications of our present understanding of the physiological events occurring during sexual maturation are several. Considering the major problems related to abnormal sexual maturation we will discuss successively: (1) diagnosis of hypogonadotrophic hypogonadism in early infancy; (2) differential diagnosis between premature thelarche and true sexual precocity; (3) the usefulness of endocrine investigations

  17. Microbiological and Clinical Aspects of Infection Associated with Stenotrophomonas maltophilia

    PubMed Central

    Denton, Miles; Kerr, Kevin G.

    1998-01-01

    The gram-negative bacterium Stenotrophomonas maltophilia is increasingly recognized as an important cause of nosocomial infection. Infection occurs principally, but not exclusively, in debilitated and immunosuppressed individuals. Management of S. maltophilia-associated infection is problematic because many strains of the bacterium manifest resistance to multiple antibiotics. These difficulties are compounded by methodological problems in in vitro susceptibility testing for which there are, as yet, no formal guidelines. Despite its acknowledged importance as a nosocomial pathogen, little is known of the epidemiology of S. maltophilia, and although it is considered an environmental bacterium, its sources and reservoirs are often not readily apparent. Molecular typing systems may contribute to our knowledge of the epidemiology of S. maltophilia infection, thus allowing the development of strategies to interrupt the transmission of the bacterium in the hospital setting. Even less is known of pathogenic mechanisms and putative virulence factors involved in the natural history of S. maltophilia infection and this, coupled with difficulties in distinguishing colonization from true infection, has fostered the view that the bacterium is essentially nonpathogenic. This article aims to review the current taxonomic status of S. maltophilia, and it discusses the laboratory identification of the bacterium. The epidemiology of the organism is considered with particular reference to nosocomial outbreaks, several of which have been investigated by molecular typing techniques. Risk factors for acquisition of the bacterium are also reviewed, and the ever-expanding spectrum of clinical syndromes associated with S. maltophilia is surveyed. Antimicrobial resistance mechanisms, pitfalls in in vitro susceptibility testing, and therapy of S. maltophilia infections are also discussed. PMID:9457429

  18. Aspirin-induced asthma: clinical aspects, pathogenesis and management.

    PubMed

    Hamad, Ahmed M; Sutcliffe, Amy M; Knox, Alan J

    2004-01-01

    Aspirin (acetylsalicylic acid)-induced asthma (AIA) consists of the clinical triad of asthma, chronic rhinosinusitis with nasal polyps, and precipitation of asthma and rhinitis attacks in response to aspirin and other NSAIDs. The prevalence of the syndrome in the adult asthmatic populations is approximately 4-10%. Respiratory disease in these patients may be aggressive and refractory to treatment. The aetiology of AIA is complex and not fully understood, but most evidence points towards an abnormality of arachidonic acid (AA) metabolism. Cyclo-oxygenase (COX), the rate-limiting enzyme in AA metabolism, exists as two main isoforms. COX-1 is the constitutive enzyme responsible for synthesis of protective prostanoids, whereas COX-2 is induced under inflammatory conditions. A number of theories regarding its pathogenesis have been proposed. The shunting hypothesis proposes that inhibition of COX-1 shunts AA metabolism away from production of protective prostanoids and towards cysteinyl leukotriene (cys-LT) biosynthesis, resulting in bronchoconstriction and increased mucus production. The COX-2 hypothesis proposes that aspirin causes a structural change in COX-2 that results in the generation of products of the lipoxygenase pathway. It is speculated that this may result in the formation of mediators that cause respiratory reactions in AIA. Related studies provide evidence for abnormal regulation of the lipoxygenase pathway, demonstrating elevated levels of cys-LTs in urine, sputum and peripheral blood, before and following aspirin challenge in AIA patients. These studies suggest that cys-LTs are continually and aggressively synthesised before exposure to aspirin and, during aspirin-induced reactions, acceleration of synthesis occurs. A genetic polymorphism of the LTC4S gene has been identified consisting of an A to C transversion 444 nucleotides upstream of the first codon, conferring a relative risk of AIA of 3.89. Furthermore, carriers of the C444 allele demonstrate a

  19. Fruit biomechanics based on anatomy: a review

    NASA Astrophysics Data System (ADS)

    Li, Zhiguo; Yang, Hongling; Li, Pingping; Liu, Jizhan; Wang, Jizhang; Xu, Yunfeng

    2013-01-01

    Fruit biomechanics is needed for quality determination, multiscale modelling and engineering design of fruit processes and equipments. However, these determined fruit biomechanics data often have obvious differences for the same fruit or tissue. In order to investigate it, the fruit biomechanics based on anatomy was reviewed in this paper. First, the anatomical characteristics of fruit biomaterials were described at the macroscopic `tissue' level and microscopic `cellular' level. Subsequently, the factors affecting fruit biomechanics based on anatomy and the relationships between fruit biomechanics, texture and mechanical damage were summarised according to the published literature. Fruit biomechanics is mainly affected by size, number and arrangement of cells, quantity and volume of intracellular spaces, structure, thickness, chemical composition and permeability of cell walls, and pectin degradation level and turgor pressure within cells based on microanatomy. Four test methods and partial determined results of fruit biomechanics were listed and reviewed. The determined mechanical properties data of fruit are only approximate values by using the existing four test methods, owing to the fruit biomaterials being non-homogeneous and living. Lastly, further aspects for research on fruit biomechanics were proposed for the future.

  20. Dinosaur biomechanics

    PubMed Central

    Alexander, R. McNeill

    2006-01-01

    Biomechanics has made large contributions to dinosaur biology. It has enabled us to estimate both the speeds at which dinosaurs generally moved and the maximum speeds of which they may have been capable. It has told us about the range of postures they could have adopted, for locomotion and for feeding, and about the problems of blood circulation in sauropods with very long necks. It has made it possible to calculate the bite forces of predators such as Tyrannosaurus, and the stresses they imposed on its skull; and to work out the remarkable chewing mechanism of hadrosaurs. It has shown us how some dinosaurs may have produced sounds. It has enabled us to estimate the effectiveness of weapons such as the tail spines of Stegosaurus. In recent years, techniques such as computational tomography and finite element analysis, and advances in computer modelling, have brought new opportunities. Biomechanists should, however, be especially cautious in their work on animals known only as fossils. The lack of living specimens and even soft tissues oblige us to make many assumptions. It is important to be aware of the often wide ranges of uncertainty that result. PMID:16822743

  1. Dinosaur biomechanics.

    PubMed

    Alexander, R McNeill

    2006-08-01

    Biomechanics has made large contributions to dinosaur biology. It has enabled us to estimate both the speeds at which dinosaurs generally moved and the maximum speeds of which they may have been capable. It has told us about the range of postures they could have adopted, for locomotion and for feeding, and about the problems of blood circulation in sauropods with very long necks. It has made it possible to calculate the bite forces of predators such as Tyrannosaurus, and the stresses they imposed on its skull; and to work out the remarkable chewing mechanism of hadrosaurs. It has shown us how some dinosaurs may have produced sounds. It has enabled us to estimate the effectiveness of weapons such as the tail spines of Stegosaurus. In recent years, techniques such as computational tomography and finite element analysis, and advances in computer modelling, have brought new opportunities. Biomechanists should, however, be especially cautious in their work on animals known only as fossils. The lack of living specimens and even soft tissues oblige us to make many assumptions. It is important to be aware of the often wide ranges of uncertainty that result.

  2. Biomechanics in Schools.

    ERIC Educational Resources Information Center

    Vincent, J. F. V.

    1980-01-01

    Examines current usage of the term "biomechanics" and emphasizes the importance of differentiating between structure and material. Describes current prolects in biomechanics and lists four points about the educational significance of the field. (GS)

  3. Biomechanics or Necromechanics? Or How to Interpret Biomechanical Studies

    PubMed Central

    Brand, Richard A

    2002-01-01

    The field of biomechanics is inextricably linked with orthopaedic surgery: loads and load distribution play a major role in the problems we treat and in the success and failure of many of our treatments. Nonetheless, despite powerful investigational tools, I would argue biomechanics has made a relatively minor impact in clinical practice primarily because most studies fail to account for the major distinction between living and nonliving systems: adaptability. While any study requires a clear question or hypothesis or goal, without accounting for adaptability and tissue tolerance, these studies might well be termed "necromechanical." These studies will always have limited clinical relevance unless they contain several key features: 1.) A choice of a mechanical parameter which is arguably a surrogate for relevant biological behavior; 2.) A set of loading regimens which arguably represent the entire range of loadings experienced in vivo; 3.) An explicit discussion of tissue tolerance to the mechanical perturbations of the study; 4.) When appropriate (i.e., the question relates to longer-term effects), an explicit exploration of tissue adaptation over time. Without meeting these requirements, any biomechanical study is suspect and requires interpretation with great caution. When meeting these requirements, biomechanics can provide powerful tools to explain the function of the body and to predict the success or failure of treatments prior to using them on patients. PMID:12180603

  4. Biomechanical Stability of Dental Implants in Augmented Maxillary Sites: Results of a Randomized Clinical Study with Four Different Biomaterials and PRF and a Biological View on Guided Bone Regeneration

    PubMed Central

    Angelo, Troedhan; Marcel, Wainwright; Andreas, Kurrek; Izabela, Schlichting

    2015-01-01

    Introduction. Bone regenerates mainly by periosteal and endosteal humoral and cellular activity, which is given only little concern in surgical techniques and choice of bone grafts for guided bone regeneration. This study investigates on a clinical level the biomechanical stability of augmented sites in maxillary bone when a new class of moldable, self-hardening calcium-phosphate biomaterials (SHB) is used with and without the addition of Platelet Rich Fibrin (aPRF) in the Piezotome-enhanced subperiosteal tunnel-technique (PeSPTT). Material and Methods. 82 patients with horizontal atrophy of anterior maxillary crest were treated with PeSPTT and randomly assigned biphasic (60% HA/40% bTCP) or monophasic (100% bTCP) SHB without or with addition of aPRF. 109 implants were inserted into the augmented sites after 8.3 months and the insertion-torque-value (ITV) measured as clinical expression of the (bio)mechanical stability of the augmented bone and compared to ITVs of a prior study in sinus lifting. Results. Significant better results of (bio)mechanical stability almost by two-fold, expressed by higher ITVs compared to native bone, were achieved with the used biomaterials and more constant results with the addition of aPRF. Conclusion. The use of SHB alone or combined with aPRF seems to be favourable to achieve a superior (bio)mechanical stable restored alveolar bone. PMID:25954758

  5. Research Techniques in Biomechanics.

    ERIC Educational Resources Information Center

    Ward, Terry

    Biomechanics involves the biological human beings interacting with his/her mechanical environment. Biomechanics research is being done in connection with sport, physical education, and general motor behavior, and concerns mechanics independent of implements. Biomechanics research falls in the following two general categories: (1) that specific…

  6. Some biomechanical aspects of crutch and cane walking: the relationship between forward rate of progression, symmetry, and efficiency--a case report.

    PubMed

    McDonough, A L; Razza-Doherty, M

    1988-07-01

    The purpose of this case report is to review the progression of crutch ambulation typically used in the management of lower extremity injuries, and to describe some biomechanical parameters of gait using assistive devices. A comparison is made between weight bearing status and the use of different devices (that is, axial crutches, cane). Unilateral versus bilateral and nonreciprocal versus reciprocal crutch gait patterns are evaluated. Review of the data showed bilateral use of crutches helped to maintain the symmetry of gait as was demonstrated when right and left cycle times and right and left stride lengths were compared. Symmetry was maintained for most bilateral crutch gaits with the exception of the NWB (three-point) pattern. This trial represents, by definition, an asymmetrical condition. The comparison of nonreciprocal versus reciprocal FWB crutch gaits revealed little objective difference in the parameters studied. However, it is the authors' view that a two-point reciprocal crutch gait more closely approximates normal gait, and therefore should be encouraged. It is possible that consideration of different parameters (for example, electrogoniometric analysis of joint angles) might demonstrate an objective difference between nonreciprocal and reciprocal gait patterns. When a single assistive device was used (crutch or cane) asymmetries were demonstrated. When single crutch and single cane trials were compared obvious asymmetries in cycle time and stride length were noted in the former. A single axial crutch splints the upper trunk, thereby decreasing pelvic/trunk rotation and reducing reciprocal arm swing. Using a cane substantially improves symmetry and forward rate of progression by increasing rotation and reciprocal arm swing. The authors believe this finding is significant and should be considered when selecting a unilateral device. Indeed, these findings suggest it may, under certain circumstances, be more appropriate to forego the use of a unilateral

  7. Some biomechanical aspects of crutch and cane walking: the relationship between forward rate of progression, symmetry, and efficiency--a case report.

    PubMed

    McDonough, A L; Razza-Doherty, M

    1988-07-01

    The purpose of this case report is to review the progression of crutch ambulation typically used in the management of lower extremity injuries, and to describe some biomechanical parameters of gait using assistive devices. A comparison is made between weight bearing status and the use of different devices (that is, axial crutches, cane). Unilateral versus bilateral and nonreciprocal versus reciprocal crutch gait patterns are evaluated. Review of the data showed bilateral use of crutches helped to maintain the symmetry of gait as was demonstrated when right and left cycle times and right and left stride lengths were compared. Symmetry was maintained for most bilateral crutch gaits with the exception of the NWB (three-point) pattern. This trial represents, by definition, an asymmetrical condition. The comparison of nonreciprocal versus reciprocal FWB crutch gaits revealed little objective difference in the parameters studied. However, it is the authors' view that a two-point reciprocal crutch gait more closely approximates normal gait, and therefore should be encouraged. It is possible that consideration of different parameters (for example, electrogoniometric analysis of joint angles) might demonstrate an objective difference between nonreciprocal and reciprocal gait patterns. When a single assistive device was used (crutch or cane) asymmetries were demonstrated. When single crutch and single cane trials were compared obvious asymmetries in cycle time and stride length were noted in the former. A single axial crutch splints the upper trunk, thereby decreasing pelvic/trunk rotation and reducing reciprocal arm swing. Using a cane substantially improves symmetry and forward rate of progression by increasing rotation and reciprocal arm swing. The authors believe this finding is significant and should be considered when selecting a unilateral device. Indeed, these findings suggest it may, under certain circumstances, be more appropriate to forego the use of a unilateral

  8. The Clinical Aspects of Mirror Therapy in Rehabilitation: A Systematic Review of the Literature

    ERIC Educational Resources Information Center

    Rothgangel, Andreas Stefan; Braun, Susy M.; Beurskens, Anna J.; Seitz, Rudiger J.; Wade, Derick T.

    2011-01-01

    The objective of this study was to evaluate the clinical aspects of mirror therapy (MT) interventions after stroke, phantom limb pain and complex regional pain syndrome. A systematic literature search of the Cochrane Database of controlled trials, PubMed/MEDLINE, CINAHL, EMBASE, PsycINFO, PEDro, RehabTrials and Rehadat, was made by two…

  9. Clinical and biomechanical evaluation of three bioscaffold augmentation devices used for superficial digital flexor tenorrhaphy in donkeys (Equus asinus): An experimental study

    PubMed Central

    El-Shafaey, El-Sayed A.; Karrouf, Gamal I.; Zaghloul, Adel E.

    2012-01-01

    The present study was designed to carry out an in vivo and in vitro comparative evaluation of three bio-scaffold augmentation devices used for superficial digital flexor tenorrhaphy in donkeys. Twenty-four clinically healthy donkeys were assigned for three treatment trials (n = 8) using one of three bioscaffold materials (glycerolized bovine pericardium xenograft, tendon allograft and allograft with glycerolized by bovine pericardium). In addition, eight clinically healthy donkeys were selected to serve as control. Clinical signs of each animal were scored and the sum of all clinical indexes was calculated at each time point of the experiment. Four donkeys from each group were euthanized at 45 and 90 days postoperatively, respectively, for biomechanical and histopathological evaluation of treated superficial digital flexor tendon (SDFT). The failure stress in allograft shielding group significantly increased compared to the corresponding values of the other groups at 45 (62.7 ± 6.5 N mm−2) and 90 (88.8 ± 3.5 N mm−2) days postoperatively. The fetlock angle in the allograft shielding group at both 45 (112.8° ± 4.4) and 90 (123.8° ± 1.1) days postoperatively showed a significant increase (p < 0.05) relative to the values of the other groups and a significant decrease (p < 0.05) when compared to normal angle (125° ± 0). However, the histomorphological findings revealed no remarkable changes between the treatment groups. In conclusion, the failure stress, fetlock angle and histomorphological findings may provide useful information about the healing characteristics of SDFT tenorrhaphy. The bio-scaffold augmentation devices, either xenogenic or allogenic, provide good alternative techniques accelerating SDFT healing with minimal adhesions in donkeys. PMID:25685407

  10. Fracture biology, biomechanics, and internal fixation.

    PubMed

    Trostle, S S; Markel, M D

    1996-03-01

    The success of orthopedic surgery in ruminants is directly related to the surgeon's knowledge and understanding of bone physiology and mechanics. The relationship of the macro and micro structure and function of bone as it relates to fracture physiology and repair is discussed. A basic review of the biomechanical principles of bone, bone fracture, and fracture repair are presented. The clinical and biomechanical principles of internal fixation are described for fracture repair in ruminants.

  11. Current Topics on Bicuspid Aortic Valve: Clinical Aspects and Surgical Management

    PubMed Central

    Tanemoto, Kazuo

    2015-01-01

    Bicuspid aortic valve (BAV) has been identified as the most common heart valve anomaly and is considered to be a heritable disorder that affects various cardiovascular disorders, including aortopathy. Current topics regarding the clinical management of BAV including surgical strategies with or without concomitant aortic repair or replacement are attracting interest, in addition to the pathological and morphological aspects of BAV as well as aortopathy. However, surgical indications are still being debated and are dependent on current clinical guidelines and surgeons’ preferences. Although clinical guidelines have already been established for the management of BAV with or without aortopathy, many studies on clinical management and surgical techniques involving various kinds of subjects have previously been published. Although a large number of studies concerning the clinical aspects of BAV have been reviewed in detail, controversy still surrounds the clinical and surgical management of BAV. Therefore, surgeons should carefully consider valve pathology when deciding whether to replace the ascending aorta. In this review, we summarized current topics on BAV and the surgical management of diseased BAV with or without aortopathy based on previous findings, including catheter-based interventional management. PMID:26095042

  12. Methodological aspects of clinical trials in tinnitus: A proposal for an international standard

    PubMed Central

    Landgrebe, Michael; Azevedo, Andréia; Baguley, David; Bauer, Carol; Cacace, Anthony; Coelho, Claudia; Dornhoffer, John; Figueiredo, Ricardo; Flor, Herta; Hajak, Goeran; van de Heyning, Paul; Hiller, Wolfgang; Khedr, Eman; Kleinjung, Tobias; Koller, Michael; Lainez, Jose Miguel; Londero, Alain; Martin, William H.; Mennemeier, Mark; Piccirillo, Jay; De Ridder, Dirk; Rupprecht, Rainer; Searchfield, Grant; Vanneste, Sven; Zeman, Florian; Langguth, Berthold

    2013-01-01

    Chronic tinnitus is a common condition with a high burden of disease. While many different treatments are used in clinical practice, the evidence for the efficacy of these treatments is low and the variance of treatment response between individuals is high. This is most likely due to the great heterogeneity of tinnitus with respect to clinical features as well as underlying pathophysiological mechanisms. There is a clear need to find effective treatment options in tinnitus, however, clinical trials differ substantially with respect to methodological quality and design. Consequently, the conclusions that can be derived from these studies are limited and jeopardize comparison between studies. Here, we discuss our view of the most important aspects of trial design in clinical studies in tinnitus and make suggestions for an international methodological standard in tinnitus trials. We hope that the proposed methodological standard will stimulate scientific discussion and will help to improve the quality of trials in tinnitus. PMID:22789414

  13. Comparative genomic hybridization: technical development and cytogenetic aspects for routine use in clinical laboratories.

    PubMed

    Lapierre, J M; Cacheux, V; Da Silva, F; Collot, N; Hervy, N; Wiss, J; Tachdjian, G

    1998-01-01

    Comparative genomic hybridization (CGH) offers a new global approach for detection of chromosomal material imbalances of the entire genome in a single experiment without cell culture. In this paper, we discuss the technical development and the cytogenetic aspects of CGH in a clinical laboratory. Based only on the visual inspection of CGH metaphase spreads, the correct identification of numerical and structural anomalies are reported. No commercial image analysis software was required in these experiments. We have demonstrated that this new technology can be set up easily for routine use in a clinical cytogenetics laboratory.

  14. Diseases in the cranio-cervical junction: Anatomical and pathological aspects and detailed clinical accounts

    SciTech Connect

    Voth, D.; Glees, P.

    1987-01-01

    This book contains over 40 selections. Some of the titles are: Radionuclide imaging of the cranio-cervical region; Magnetic resonance imaging in the cranio-cervical region: Experiences in 194 cases; NMR-finding in a case of Morquio's syndrome with syncope; The dynamic evaluation of the cervical spinal canal and spinal cord by magnetic resonance imaging during movement; and A review of clinical and radiological aspects of rheumatoid arthritis of head joints.

  15. Mitochondrial Disease: Clinical Aspects, Molecular Mechanisms, Translational Science, and Clinical Frontiers

    PubMed Central

    Thornton, Ben; Cohen, Bruce; Copeland, William; Maria, Bernard L.

    2015-01-01

    Mitochondrial medicine provides a metabolic perspective on the pathology of conditions linked with inadequate oxidative phosphorylation. Dysfunction in the mitochondrial machinery can result in improper energy production, leading to cellular injury or even apoptosis. Clinical presentations are often subtle, so clinicians must have a high index of suspicion to make early diagnoses. Symptoms could include muscle weakness and pain, seizures, loss of motor control, decreased visual and auditory functions, metabolic acidosis, acute developmental regression, and immune system dysfunction. The 2013 Neurobiology of Disease in Children Symposium, held in conjunction with the 42nd Annual Meeting of the Child Neurology Society, aimed to (1) describe accepted clinical phenotypes of mitochondrial disease produced from various mitochondrial mutations, (2) discuss contemporary understanding of molecular mechanisms that contribute to disease pathology, (3) highlight the systemic effects produced by dysfunction within the mitochondrial machinery, and (4) introduce current strategies that are being translated from bench to bedside as potential therapeutics. PMID:24916430

  16. Clinical aspects and potential clinical applications of laser accelerated proton beams

    NASA Astrophysics Data System (ADS)

    Spatola, C.; Privitera, G.

    2013-07-01

    Proton beam radiation therapy (PBRT), as well as the other forms of hadrontherapy, is in use in the treatment of neoplastic diseases, to realize a high selective irradiation with maximum sparing of surrounding organs. The main characteristic of such a particles is to have an increased radiobiological effectiveness compared to conventional photons (about 10% more) and the advantage to deposit the energy in a defined space through the tissues (Bragg peak phenomenon). The goal of ELIMED Project is the realization of a laser accelerated proton beam line to prove its potential use for clinical application in the field of hadrontherapy. To date, there are several potential clinical applications of PBRT, some of which have become the treatment of choice for a specific tumour, for others it is under investigation as a therapeutic alternative to conventional X-ray radiotherapy, to increase the dose to the tumour and reduce the side effects. For almost half of cancers, an increased local tumour control is the mainstay for increased cancer curability.

  17. [Trichophyton species of Arthroderma benhamiae : Clinical therapeutic aspects of a new pathogen in dermatology].

    PubMed

    Hiernickel, C; Wiegand, C; Schliemann, S; Seyfarth, F; Jung, K; Elsner, P; Hipler, U-C

    2016-09-01

    Cutaneous infections with Trichophyton species of Arthroderma (A.) benhamiae are increasingly being detected in Germany. This dermatophyte typically causes tinea corporis, tinea faciei or tinea capitis with in part heavy clinical manifestation like kerion celsi. In special cases diagnosis and therapy can be difficult. In this article, four clinical cases are presented, whereby attention is given to special clinical situations and therapeutic aspects with regard to Trichophyton species of A. benhamiae: Case 1: Kerion celsi by in a 6-year-old boy; Case 2: Deep trichophytia at the mons pubis in a 32-year-old man working in a pet shop and his 27-year-old female partner; Case 3: Tinea manuum in a 7-year-old girl; Case 4: Tinea corporis in an 8‑year-old girl. PMID:27380384

  18. Recent microfluidic devices for studying gamete and embryo biomechanics.

    PubMed

    Lai, David; Takayama, Shuichi; Smith, Gary D

    2015-06-25

    The technical challenges of biomechanic research such as single cell analysis at a high monetary cost, labor, and time for just a small number of measurements is a good match to the strengths of microfluidic devices. New scientific discoveries in the fertilization and embryo development process, of which biomechanics is a major subset of interest, is crucial to fuel the continual improvement of clinical practice in assisted reproduction. The following review will highlight some recent microfluidic devices tailored for gamete and embryo biomechanics where biomimicry arises as a major theme of microfluidic device design and function, and the application of fundamental biomechanic principles are used to improve outcomes of cryopreservation.

  19. Recent microfluidic devices for studying gamete and embryo biomechanics.

    PubMed

    Lai, David; Takayama, Shuichi; Smith, Gary D

    2015-06-25

    The technical challenges of biomechanic research such as single cell analysis at a high monetary cost, labor, and time for just a small number of measurements is a good match to the strengths of microfluidic devices. New scientific discoveries in the fertilization and embryo development process, of which biomechanics is a major subset of interest, is crucial to fuel the continual improvement of clinical practice in assisted reproduction. The following review will highlight some recent microfluidic devices tailored for gamete and embryo biomechanics where biomimicry arises as a major theme of microfluidic device design and function, and the application of fundamental biomechanic principles are used to improve outcomes of cryopreservation. PMID:25801423

  20. Carpal height and postoperative strength after proximal row carpectomy or four-corner arthrodesis: Clinical, anatomical and biomechanical study.

    PubMed

    Laronde, Pascale; Christiaens, Nicolas; Aumar, Aurélien; Chantelot, Christophe; Fontaine, Christian

    2016-04-01

    Proximal row carpectomy (PRC) and four-corner arthrodesis (4CA) are the two most commonly performed surgical procedures to treat wrist arthritis. Postoperative strength is one of the criteria for choosing between the two techniques. Some authors believe that strength is correlated with residual carpal height. The goal of this study was to determine if postoperative carpal height was predictive of postoperative strength. This study consisted of two parts: a clinical evaluation of grip strength after 4CA or PRC; anatomical and radiological measurements of carpal height before and after 4CA or PRC. Grip strength was better preserved after PRC (87.5%) than after 4CA (76.1%), when expressed relative to the opposite hand (P=0.053). There was a significant decrease in carpal height for the PRC group with a Youm's index of 0.37 versus 0.50 for the 4CA group (P<0.0001). Our clinical results and analysis of the literature indicate that 4CA is not superior to PRC when it comes to grip strength, whereas carpal height is significantly decreased after PRC. The decreased tendon excursion after PRC is balanced by an increase in joint stresses after 4CA. PMID:27117123

  1. Carpal height and postoperative strength after proximal row carpectomy or four-corner arthrodesis: Clinical, anatomical and biomechanical study.

    PubMed

    Laronde, Pascale; Christiaens, Nicolas; Aumar, Aurélien; Chantelot, Christophe; Fontaine, Christian

    2016-04-01

    Proximal row carpectomy (PRC) and four-corner arthrodesis (4CA) are the two most commonly performed surgical procedures to treat wrist arthritis. Postoperative strength is one of the criteria for choosing between the two techniques. Some authors believe that strength is correlated with residual carpal height. The goal of this study was to determine if postoperative carpal height was predictive of postoperative strength. This study consisted of two parts: a clinical evaluation of grip strength after 4CA or PRC; anatomical and radiological measurements of carpal height before and after 4CA or PRC. Grip strength was better preserved after PRC (87.5%) than after 4CA (76.1%), when expressed relative to the opposite hand (P=0.053). There was a significant decrease in carpal height for the PRC group with a Youm's index of 0.37 versus 0.50 for the 4CA group (P<0.0001). Our clinical results and analysis of the literature indicate that 4CA is not superior to PRC when it comes to grip strength, whereas carpal height is significantly decreased after PRC. The decreased tendon excursion after PRC is balanced by an increase in joint stresses after 4CA.

  2. The adaptation problems of patients undergoing hemodialysis: socio-economic and clinical aspects1

    PubMed Central

    Frazão, Cecília Maria Farias de Queiroz; de Sá, Jéssica Dantas; Medeiros, Ana Beatriz de Almeida; Fernandes, Maria Isabel da Conceição Dias; Lira, Ana Luisa Brandão de Carvalho; Lopes, Marcos Venícios de Oliveira

    2014-01-01

    OBJECTIVES: to identify adaptation problems under Roy's Model in patients undergoing hemodialysis and to correlate them with the socioeconomic and clinical aspects. METHOD: a transversal study, undertaken using a questionnaire. The sample was made up of 178 individuals. The Chi-squared and Mann-Whitney U tests were undertaken. RESULTS: the adaptation problems and the socioeconomic and clinical aspects which presented statistical associations were: Hyperkalemia and age; Edema and income; Impairment of a primary sense: touch and income; Role failure and age; Sexual dysfunction and marital status and sex; Impairment of a primary sense: vision and years of education; Intolerance to activity and years of education; Chronic pain and sex and years of education; Impaired skin integrity and age: Hypocalcemia and access; Potential for injury and age and years of education; Nutrition below the organism's requirements and age; Impairment of a primary sense: hearing and sex and kinetic evaluation of urea; Mobility in gait and/or coordination restricted, and months of hemodialysis; and, Loss of ability for self-care, and months of hemodialysis and months of illness. CONCLUSION: adaptation problems in the clientele undergoing hemodialysis can be influenced by socioeconomic/clinical data. These findings contribute to the development of the profession, fostering the nurse's reflection regarding the care. PMID:25591091

  3. Stüve-Wiedemann Syndrome: Update on Clinical and Genetic Aspects

    PubMed Central

    Romeo Bertola, Débora; Honjo, Rachel S.; Baratela, Wagner A.R.

    2016-01-01

    Stüve-Wiedemann syndrome is a rare autosomal recessive disorder characterized by bowed long bones, joint restrictions, dysautonomia, and respiratory and feeding difficulties, leading to death in the neonatal period and infancy in several occasions. Since the first cases in 1971, much has been learned about this condition, including its molecular basis - mutations in the leukemia inhibitory factor receptor gene (LIFR) -, natural history and management possibilities. This review aims to highlight the clinical aspects, radiological features, molecular findings, and management strategies in Stüve-Wiedemann syndrome. PMID:27194968

  4. [The clinical history in surgical processes. Bioethical aspects and basic professional ethics].

    PubMed

    Collazo Chao, Eliseo

    2008-11-01

    Surgeons are increasingly facing multiple civil liability claims from their patients. Against this background and taking any eventual liability claims into account, surgeons must be increasingly aware of the importance of maintaining patient medical histories, which raises numerous questions on the length of time and form of keeping them. Ethical and legal obligations need to be taken into account in order to identify the controversial aspects related to patients and their environment, as well as shedding light on the most appropriate behaviour in each case. We must never forget the case history is a clinical document, subjected to the medical art and medical ethics which regulate it. PMID:19080907

  5. Stüve-Wiedemann Syndrome: Update on Clinical and Genetic Aspects.

    PubMed

    Romeo Bertola, Débora; Honjo, Rachel S; Baratela, Wagner A R

    2016-04-01

    Stüve-Wiedemann syndrome is a rare autosomal recessive disorder characterized by bowed long bones, joint restrictions, dysautonomia, and respiratory and feeding difficulties, leading to death in the neonatal period and infancy in several occasions. Since the first cases in 1971, much has been learned about this condition, including its molecular basis - mutations in the leukemia inhibitory factor receptor gene (LIFR) -, natural history and management possibilities. This review aims to highlight the clinical aspects, radiological features, molecular findings, and management strategies in Stüve-Wiedemann syndrome. PMID:27194968

  6. [The clinical history in surgical processes. Bioethical aspects and basic professional ethics].

    PubMed

    Collazo Chao, Eliseo

    2008-11-01

    Surgeons are increasingly facing multiple civil liability claims from their patients. Against this background and taking any eventual liability claims into account, surgeons must be increasingly aware of the importance of maintaining patient medical histories, which raises numerous questions on the length of time and form of keeping them. Ethical and legal obligations need to be taken into account in order to identify the controversial aspects related to patients and their environment, as well as shedding light on the most appropriate behaviour in each case. We must never forget the case history is a clinical document, subjected to the medical art and medical ethics which regulate it.

  7. Biomechanics of Corneal Ring Implants

    PubMed Central

    2015-01-01

    Purpose: To evaluate the biomechanics of corneal ring implants by providing a related mathematical theory and biomechanical model for the treatment of myopia and keratoconus. Methods: The spherical dome model considers the inhomogeneity of the tunica of the eye, dimensions of the cornea, lamellar structure of the corneal stroma, and asphericity of the cornea. It is used in this study for calculating a strengthening factor sf for the characterization of different ring-shaped corneal implant designs. The strengthening factor is a measure of the amount of strengthening of the cornea induced by the implant. Results: For ring segments and incomplete rings, sf = 1.0, which indicates that these implants are not able to strengthen the cornea. The intracorneal continuous complete ring (MyoRing) has a strengthening factor of up to sf = 3.2. The MyoRing is, therefore, able to strengthen the cornea significantly. Conclusions: The result of the presented biomechanical analysis of different ring-shaped corneal implant designs can explain the different postoperative clinical results of different implant types in myopia and keratoconus. PMID:26312619

  8. Biomechanical determinants of the stability of dental implants: influence of the bone-implant interface properties.

    PubMed

    Mathieu, Vincent; Vayron, Romain; Richard, Gilles; Lambert, Grégory; Naili, Salah; Meningaud, Jean-Paul; Haiat, Guillaume

    2014-01-01

    Dental implants are now widely used for the replacement of missing teeth in fully or partially edentulous patients and for cranial reconstructions. However, risks of failure, which may have dramatic consequences, are still experienced and remain difficult to anticipate. The stability of biomaterials inserted in bone tissue depends on multiscale phenomena of biomechanical (bone-implant interlocking) and of biological (mechanotransduction) natures. The objective of this review is to provide an overview of the biomechanical behavior of the bone-dental implant interface as a function of its environment by considering in silico, ex vivo and in vivo studies including animal models as well as clinical studies. The biomechanical determinants of osseointegration phenomena are related to bone remodeling in the vicinity of the implants (adaptation of the bone structure to accommodate the presence of a biomaterial). Aspects related to the description of the interface and to its space-time multiscale nature will first be reviewed. Then, the various approaches used in the literature to measure implant stability and the bone-implant interface properties in vitro and in vivo will be described. Quantitative ultrasound methods are promising because they are cheap, non invasive and because of their lower spatial resolution around the implant compared to other biomechanical approaches.

  9. Leprosy: review of the epidemiological, clinical, and etiopathogenic aspects - Part 1*

    PubMed Central

    Lastória, Joel Carlos; de Abreu, Marilda Aparecida Milanez Morgado

    2014-01-01

    Leprosy is caused by Mycobacterium leprae and has been known since biblical times. It is still endemic in many regions of the world and a public health problem in Brazil. The prevalence rate in 2011 reached 1.54 cases per 10,000 inhabitants in Brazil. The mechanism of transmission of leprosy consists of prolonged close contact between susceptible and genetically predisposed individuals and untreated multibacillary patients. Transmission occurs through inhalation of bacilli present in upper airway secretion. The nasal mucosa is the main entry or exit route of M. leprae. The deeper understanding of the structural and biological characteristics of M. leprae, the sequencing of its genome, along with the advances in understanding the mechanisms of host immune response against the bacilli, dependent on genetic susceptibility, have contributed to the understanding of the pathogenesis, variations in the clinical characteristics, and progression of the disease. This article aims to update dermatologist on epidemiological, clinical, and etiopathogenic leprosy aspects. PMID:24770495

  10. Biomechanics of interspinous devices.

    PubMed

    Parchi, Paolo D; Evangelisti, Gisberto; Vertuccio, Antonella; Piolanti, Nicola; Andreani, Lorenzo; Cervi, Valentina; Giannetti, Christian; Calvosa, Giuseppe; Lisanti, Michele

    2014-01-01

    A number of interspinous devices (ISD) have been introduced in the lumbar spine implant market. Unfortunately, the use of these devices often is not associated with real comprehension of their biomechanical role. The aim of this paper is to review the biomechanical studies about interspinous devices available in the literature to allow the reader a better comprehension of the effects of these devices on the treated segment and on the adjacent segments of the spine. For this reason, our analysis will be limited to the interspinous devices that have biomechanical studies published in the literature. PMID:25114923

  11. Biomechanics of Interspinous Devices

    PubMed Central

    Parchi, Paolo D.; Evangelisti, Gisberto; Vertuccio, Antonella; Piolanti, Nicola; Andreani, Lorenzo; Cervi, Valentina; Giannetti, Christian; Calvosa, Giuseppe; Lisanti, Michele

    2014-01-01

    A number of interspinous devices (ISD) have been introduced in the lumbar spine implant market. Unfortunately, the use of these devices often is not associated with real comprehension of their biomechanical role. The aim of this paper is to review the biomechanical studies about interspinous devices available in the literature to allow the reader a better comprehension of the effects of these devices on the treated segment and on the adjacent segments of the spine. For this reason, our analysis will be limited to the interspinous devices that have biomechanical studies published in the literature. PMID:25114923

  12. Biomechanics and mechanobiology in functional tissue engineering.

    PubMed

    Guilak, Farshid; Butler, David L; Goldstein, Steven A; Baaijens, Frank P T

    2014-06-27

    The field of tissue engineering continues to expand and mature, and several products are now in clinical use, with numerous other preclinical and clinical studies underway. However, specific challenges still remain in the repair or regeneration of tissues that serve a predominantly biomechanical function. Furthermore, it is now clear that mechanobiological interactions between cells and scaffolds can critically influence cell behavior, even in tissues and organs that do not serve an overt biomechanical role. Over the past decade, the field of "functional tissue engineering" has grown as a subfield of tissue engineering to address the challenges and questions on the role of biomechanics and mechanobiology in tissue engineering. Originally posed as a set of principles and guidelines for engineering of load-bearing tissues, functional tissue engineering has grown to encompass several related areas that have proven to have important implications for tissue repair and regeneration. These topics include measurement and modeling of the in vivo biomechanical environment; quantitative analysis of the mechanical properties of native tissues, scaffolds, and repair tissues; development of rationale criteria for the design and assessment of engineered tissues; investigation of the effects biomechanical factors on native and repair tissues, in vivo and in vitro; and development and application of computational models of tissue growth and remodeling. Here we further expand this paradigm and provide examples of the numerous advances in the field over the past decade. Consideration of these principles in the design process will hopefully improve the safety, efficacy, and overall success of engineered tissue replacements.

  13. Optic Nerve Head Biomechanics in Aging and Disease

    PubMed Central

    Downs, J. Crawford

    2015-01-01

    This nontechnical review is focused upon educating the reader on optic nerve head biomechanics in both aging and disease along two main themes: what is known about how mechanical forces and the resulting deformations are distributed in the posterior pole and ONH (biomechanics) and what is known about how the living system responds to those deformations (mechanobiology). We focus on how ONH responds to IOP elevations as a structural system, insofar as the acute mechanical response of the lamina cribrosa is confounded with the responses of the peripapillary sclera, prelaminar neural tissues, and retrolaminar optic nerve. We discuss the biomechanical basis for IOP-driven changes in connective tissues, blood flow, and cellular responses. We use glaucoma as the primary framework to present the important aspects of ONH biomechanics in aging and disease, as ONH biomechanics, aging, and the posterior pole extracellular matrix (ECM) are thought to be centrally involved in glaucoma susceptibility, onset and progression. PMID:25819451

  14. Training for Women's Basketball: A Biomechanical Emphasis for Preventing Anterior Cruciate Ligament Injury.

    ERIC Educational Resources Information Center

    Pettitt, Robert W.; Bryson, Erin R.

    2002-01-01

    Summarizes proposed variables linked with higher incidences of anterior cruciate ligament tears in females and the biomechanical aspects of the lower extremity during the performance of common basketball skills, focusing on gender differences in knee joint stability and neuromuscular control, biomechanical aspects of lower extremity skills in…

  15. Biomechanically Engineered Athletes.

    ERIC Educational Resources Information Center

    Perry, Tekla S.

    1991-01-01

    The real-world meeting of electronics, computer monitoring, control systems, and mathematics, introduced in the context of sports, is described. Recent advances in the field of biomechanics and its use in improving athletic performance are discussed. (KR)

  16. Identity and individuality in the nouveau-religious patient: theoretical and clinical aspects.

    PubMed

    Spero, M H

    1987-02-01

    Revitalized interest in the clinical complexities of psychotherapy with religious patients (for example, Bradford 1984; Lovinger 1984; Spero 1985a; Stern 1985) has drawn attention to the need for perspectives on religious personality development that account for healthy and adaptational aspects as well as psychopathological aspects of particular forms and levels of religious beliefs, enabling more creative, enriching psychotherapy. This search represents movement beyond the significance of infantile wish-fulfillment aspects of religiosity toward the broader domain of ego functioning and quality of object relations. Rizzuto (1976, 1979) and McDargh (1983) emphasize qualitative similarities between interpersonal object representations and God representations. Elkind (1971), using a Piagetian model, views religious beliefs and rituals as forms of constructive adaptation to normal cognitive needs for conservation, representation, symbols of relation, and comprehension. Meissner (1984) highlights the role of God concepts as transitional phenomena. In earlier papers, I have demonstrated the relationship between patients' use of religious themes and legends, quality of psychosexual and object relational achievements, and the consolidation of religious identity (Spero 1982a,b, 1986a,b). Throughout the preceding there is unequivocal recognition that religious development recapitulates many important aspects of healthy psychological development, and that in the case of pathological or dysfunctional religiosity something has gone wrong in an otherwise normal process. There is need to understand and if necessary distinguish between the development of religious belief in individuals whose ideological commitment is relatively constant from earliest childhood and its development in those who adopt or modify religious belief in later life, in conjunction with the many technical implications for psychotherapy. Clinical experience has taught that the process of religious change in

  17. Biomechanical analysis of a new carbon fiber/flax/epoxy bone fracture plate shows less stress shielding compared to a standard clinical metal plate.

    PubMed

    Bagheri, Zahra S; Tavakkoli Avval, Pouria; Bougherara, Habiba; Aziz, Mina S R; Schemitsch, Emil H; Zdero, Radovan

    2014-09-01

    Femur fracture at the tip of a total hip replacement (THR), commonly known as Vancouver B1 fracture, is mainly treated using rigid metallic bone plates which may result in "stress shielding" leading to bone resorption and implant loosening. To minimize stress shielding, a new carbon fiber (CF)/Flax/Epoxy composite plate has been developed and biomechanically compared to a standard clinical metal plate. For fatigue tests, experiments were done using six artificial femurs cyclically loaded through the femoral head in axial compression for four stages: Stage 1 (intact), stage 2 (after THR insertion), stage 3 (after plate fixation of a simulated Vancouver B1 femoral midshaft fracture gap), and stage 4 (after fracture gap healing). For fracture fixation, one group was fitted with the new CF/Flax/Epoxy plate (n = 3), whereas another group was repaired with a standard clinical metal plate (Zimmer, Warsaw, IN) (n = 3). In addition to axial stiffness measurements, infrared thermography technique was used to capture the femur and plate surface stresses during the testing. Moreover, finite element analysis (FEA) was performed to evaluate the composite plate's axial stiffness and surface stress field. Experimental results showed that the CF/Flax/Epoxy plated femur had comparable axial stiffness (fractured = 645 ± 67 N/mm; healed = 1731 ± 109 N/mm) to the metal-plated femur (fractured = 658 ± 69 N/mm; healed = 1751 ± 39 N/mm) (p = 1.00). However, the bone beneath the CF/Flax/Epoxy plate was the only area that had a significantly higher average surface stress (fractured = 2.10 ± 0.66 MPa; healed = 1.89 ± 0.39 MPa) compared to bone beneath the metal plate (fractured = 1.18 ± 0.93 MPa; healed = 0.71 ± 0.24 MPa) (p < 0.05). FEA bone surface stresses yielded peak of 13 MPa at distal epiphysis (stage 1), 16 MPa at distal epiphysis (stage 2), 85 MPa for composite and 129

  18. Biomechanical analysis of a new carbon fiber/flax/epoxy bone fracture plate shows less stress shielding compared to a standard clinical metal plate.

    PubMed

    Bagheri, Zahra S; Tavakkoli Avval, Pouria; Bougherara, Habiba; Aziz, Mina S R; Schemitsch, Emil H; Zdero, Radovan

    2014-09-01

    Femur fracture at the tip of a total hip replacement (THR), commonly known as Vancouver B1 fracture, is mainly treated using rigid metallic bone plates which may result in "stress shielding" leading to bone resorption and implant loosening. To minimize stress shielding, a new carbon fiber (CF)/Flax/Epoxy composite plate has been developed and biomechanically compared to a standard clinical metal plate. For fatigue tests, experiments were done using six artificial femurs cyclically loaded through the femoral head in axial compression for four stages: Stage 1 (intact), stage 2 (after THR insertion), stage 3 (after plate fixation of a simulated Vancouver B1 femoral midshaft fracture gap), and stage 4 (after fracture gap healing). For fracture fixation, one group was fitted with the new CF/Flax/Epoxy plate (n = 3), whereas another group was repaired with a standard clinical metal plate (Zimmer, Warsaw, IN) (n = 3). In addition to axial stiffness measurements, infrared thermography technique was used to capture the femur and plate surface stresses during the testing. Moreover, finite element analysis (FEA) was performed to evaluate the composite plate's axial stiffness and surface stress field. Experimental results showed that the CF/Flax/Epoxy plated femur had comparable axial stiffness (fractured = 645 ± 67 N/mm; healed = 1731 ± 109 N/mm) to the metal-plated femur (fractured = 658 ± 69 N/mm; healed = 1751 ± 39 N/mm) (p = 1.00). However, the bone beneath the CF/Flax/Epoxy plate was the only area that had a significantly higher average surface stress (fractured = 2.10 ± 0.66 MPa; healed = 1.89 ± 0.39 MPa) compared to bone beneath the metal plate (fractured = 1.18 ± 0.93 MPa; healed = 0.71 ± 0.24 MPa) (p < 0.05). FEA bone surface stresses yielded peak of 13 MPa at distal epiphysis (stage 1), 16 MPa at distal epiphysis (stage 2), 85 MPa for composite and 129

  19. Understanding the biomechanical nature of musculoskeletal tissue.

    PubMed

    Karduna, Andrew R

    2012-01-01

    This article provides a general overview of the biomechanical principles associated with hand therapy. Specifically, it reviews the basic topics of material properties (including both theoretical principles and practical concepts), static analysis (including forces, moments, muscle forces, and Newton's laws), and ends with a clinical example involving analysis of the risk of damage to the A3 pulley.

  20. Biomechanics of bird flight.

    PubMed

    Tobalske, Bret W

    2007-09-01

    Power output is a unifying theme for bird flight and considerable progress has been accomplished recently in measuring muscular, metabolic and aerodynamic power in birds. The primary flight muscles of birds, the pectoralis and supracoracoideus, are designed for work and power output, with large stress (force per unit cross-sectional area) and strain (relative length change) per contraction. U-shaped curves describe how mechanical power output varies with flight speed, but the specific shapes and characteristic speeds of these curves differ according to morphology and flight style. New measures of induced, profile and parasite power should help to update existing mathematical models of flight. In turn, these improved models may serve to test behavioral and ecological processes. Unlike terrestrial locomotion that is generally characterized by discrete gaits, changes in wing kinematics and aerodynamics across flight speeds are gradual. Take-off flight performance scales with body size, but fully revealing the mechanisms responsible for this pattern awaits new study. Intermittent flight appears to reduce the power cost for flight, as some species flap-glide at slow speeds and flap-bound at fast speeds. It is vital to test the metabolic costs of intermittent flight to understand why some birds use intermittent bounds during slow flight. Maneuvering and stability are critical for flying birds, and design for maneuvering may impinge upon other aspects of flight performance. The tail contributes to lift and drag; it is also integral to maneuvering and stability. Recent studies have revealed that maneuvers are typically initiated during downstroke and involve bilateral asymmetry of force production in the pectoralis. Future study of maneuvering and stability should measure inertial and aerodynamic forces. It is critical for continued progress into the biomechanics of bird flight that experimental designs are developed in an ecological and evolutionary context.

  1. Clinical and roentgenographic aspects of pseudogout: a study of 50 cases and a review.

    PubMed Central

    Fam, A G; Topp, J R; Stein, H B; Little, A H

    1981-01-01

    Pseudogout, defined as recurrent acute arthritis due to intrasynovial deposition of calcium pyrophosphate dihydrate crystals, is a relatively common arthritic disorder of the elderly. The clinical and roentgenographic aspects of 50 cases of pseudogout in hospitalized patients are reviewed in this paper. Oligoarticular and polyarticular episodes were observed in half of these patients. Antecedent problems included infection, trauma, surgery and vascular events. Consistent with previous reports, most patients had roentgenographic evidence of chondrocalcinosis. A third had asymptomatic capsular or periarticular calcific deposits or both, and a third had pyrophosphate arthropathy, a progressive, destructive, accelerated form of osteoarthritis. An attack of pseudogout may offer a clue to the presence of an unsuspected metabolic disease, such as primary hyperparathyroidism or idiopathic hemochromatosis. Images FIG. 3 FIG. 4 FIG. 5 FIG. 6 FIG. 7 FIG. 8 PMID:7008926

  2. EAST syndrome: Clinical, pathophysiological, and genetic aspects of mutations in KCNJ10

    PubMed Central

    Iancu, Daniela; Stanescu, Horia

    2016-01-01

    ABSTRACT EAST syndrome is a recently described autosomal recessive disorder secondary to mutations in KCNJ10 (Kir4.1), a gene encoding a potassium channel expressed in the brain, eye, ear and kidney. This condition is characterized by 4 cardinal features; Epilepsy, Ataxia, Sensorineural deafness, and (a renal salt-wasting) Tubulopathy, hence the acronym EAST syndrome. Here we review reported clinical manifestations, in particular the neurological signs and symptoms which typically have the most impact on the quality of life of patients. In addition we review the pathophysiology and genetic aspects of the disease. So far 14 different KCNJ10 mutations have been published which either directly affect channel function or may lead to mislocalisation. Investigations of the pathophysiology may provide clues to potential treatments. PMID:27500072

  3. Hereditary nonpolyposis colorectal cancer: Review of clinical, molecular genetics, and counseling aspects

    SciTech Connect

    Bellacosa, A.; Genuardi, M.; Anti, M.; Viel, A.; Ponz de Leon, M.

    1996-04-24

    Lynch syndrome, or hereditary nonpolyposis colon cancer (HNPCC), is an autosomal dominant disease accounting for approximately 1-5% of all colorectal cancer cases. Due to the lack of pathognomonic morphological or biomolecular markers, HNPCC has traditionally posed unique problems to clinicians and geneticists alike, both in terms of diagnosis and clinical management. Recently, novel insight into the pathogenesis of this syndrome has been provided by the identification of its molecular basis. In HNPCC families, germline mutations in any of four genes encoding proteins of a specialized DNA repair system, the mismatch repair, predispose to cancer development. Mutations in mismatch repair genes lead to an overall increase of the mutation rate and are associated with a phenotype of length instability of microsatellite loci. The present report summarizes the clinicopathological aspects of HNPCC and reviews the most recent molecular and biochemical findings. 115 refs., 2 figs., 3 tabs.

  4. An Update on Hidradenitis Suppurativa (Part I): Epidemiology, Clinical Aspects, and Definition of Disease Severity.

    PubMed

    Martorell, A; García-Martínez, F J; Jiménez-Gallo, D; Pascual, J C; Pereyra-Rodriguez, J; Salgado, L; Vilarrasa, E

    2015-11-01

    Hidradenitis suppurativa is a chronic inflammatory disorder that has attracted increasing attention in recent years due to underestimations of prevalence and the considerable impact of the condition on interpersonal relationships, physical appearance, self-esteem, and body image. Although hidradenitis suppurative has a significant psychological impact on patients and can even cause physical limitations when thick scarring results in limb mobility limitation, until very recently little evidence was available relating to its epidemiology, etiology, or pathogenesis. In this review, we highlight the latest advances in our understanding of the epidemiological and clinical aspects of hidradenitis suppurativa. We will also look at the different classification systems for hidradenitis suppurativa and discuss the emergence of skin ultrasound as a promising technique for monitoring the course of this chronic inflammatory disease.

  5. EAST syndrome: Clinical, pathophysiological, and genetic aspects of mutations in KCNJ10.

    PubMed

    Abdelhadi, Ola; Iancu, Daniela; Stanescu, Horia; Kleta, Robert; Bockenhauer, Detlef

    2016-01-01

    EAST syndrome is a recently described autosomal recessive disorder secondary to mutations in KCNJ10 (Kir4.1), a gene encoding a potassium channel expressed in the brain, eye, ear and kidney. This condition is characterized by 4 cardinal features; Epilepsy, Ataxia, Sensorineural deafness, and (a renal salt-wasting) Tubulopathy, hence the acronym EAST syndrome. Here we review reported clinical manifestations, in particular the neurological signs and symptoms which typically have the most impact on the quality of life of patients. In addition we review the pathophysiology and genetic aspects of the disease. So far 14 different KCNJ10 mutations have been published which either directly affect channel function or may lead to mislocalisation. Investigations of the pathophysiology may provide clues to potential treatments. PMID:27500072

  6. Basics of particle therapy II biologic and dosimetric aspects of clinical hadron therapy.

    PubMed

    Rong, Yi; Welsh, James

    2010-12-01

    Besides photons and electrons, high-energy particles like protons, neutrons, ⁴He ions or heavier ions (C, Ne, etc) have been finding increasing applications in the treatment of radioresistant tumors and tumors located near critical structures. The main difference between photons and hadrons is their different biologic effect and depth-dose distribution. Generally speaking, protons are superior in dosimetric aspects whereas neutrons have advantages in biologic effectiveness because of the high linear energy transfer. In 1946 Robert Wilson first published the physical advantages in dose distribution of ion particles for cancer therapy. Since that time hadronic radiotherapy has been intensively studied in physics laboratories worldwide and clinical application have gradually come to fruition. Hadron therapy was made possible by the advances in accelerator technology, which increases the particles' energy high enough to place them at any depth within the patient's body. As a follow-up to the previous article Introduction to Hadrons, this review discusses certain biologic and dosimetric aspects of using protons, neutrons, and heavy charged particles for radiation therapy. PMID:20395789

  7. Clinical and epidemiological aspects of cardiomyopathies: a critical review of current knowledge.

    PubMed

    Sangiorgi, Mario

    2003-02-01

    Five years after the second report of the WHO/ISFC Task Force on the definition and classification of cardiomyopathies (CM), a critical review of the matter appears well-timed. The need for a correct definition of myocardial diseases is emphasized by considering them the result of a 'direct' injury due to different known and unknown causes and not a consequence of ischemic disease or of pressure and/or volume overload. This is in order to eliminate terms like ischemic CM, valvular CM, and hypertensive CM, which are a source of confusion. The concept of myocardial injury is also reviewed. This should not only include the structural/organic macroscopic injury, but also the subcellular, ultrastructural, and molecular damage (mostly of genetic origin) of the contracting element proteins, of citosol, sarcolemma and cell membrane ion channels. As the myocardium is a complex structure, made of common fibers and of specific conduction tissue, injury may be clinically identified either by ventricular function impairment or by bioelectric function defects, i.e. tachyarrhythmias and/or bradyarrhythmias, which sometimes are the unique manifestation of the disease (arrhythmogenic CM, in the strict sense). On the basis of the morpho-functional alterations, CMs may be classified as dilated CM (which could be better identified as hypokinetic CM, referring to the functional aspect, because the morphologic aspect is not always present), hypertrophic CM, restrictive CM, and arrhythmogenic CM (including not only arrhythmogenic right ventricular CM, but also other forms, like the so-called arrhythmias of the 'apparently' healthy heart, due to 'occult' myocardial injury). Moreover, these forms may present in association, like mixed CM (dilated-arrhythmogenic, dilated-hypertrophic, etc.). From an etiologic point of view, it is advisable to maintain the distinction between specific CM, due to a known cause, and primary or idiopathic CM, including, together with sporadic forms of an

  8. Biomechanical regulation of mesenchymal cell function

    PubMed Central

    Tschumperlin, Daniel J.; Liu, Fei; Tager, Andrew M.

    2016-01-01

    Purpose of review Cells of mesenchymal origin are strongly influenced by their biomechanical environment. They also help to shape tissue architecture and reciprocally influence tissue mechanical environments through their capacity to deposit, remodel, and resorb extracellular matrix and to promote tissue vascularization. Although mechanical regulation of cell function and tissue remodeling has long been appreciated in other contexts, the purpose of this review is to highlight the increasing appreciation of its importance in fibrosis and hypertrophic scarring. Recent findings Experiments in both animal and cellular model systems have demonstrated pivotal roles for the biomechanical environment in regulating myofibroblast differentiation and contraction, endothelial barrier function and angiogenesis, and mesenchymal stem cell fate decisions. Through these studies, a better understanding of the molecular mechanisms transducing the biomechanical environment is emerging, with prominent and interacting roles recently identified for key network components including transforming growth factor-β/SMAD, focal adhesion kinase, MRTFs, Wnt/β-catenin and YAP/TAZ signaling pathways. Summary Progress in understanding biomechanical regulation of mesenchymal cell function is leading to novel approaches for improving clinical outcomes in fibrotic diseases and wound healing. These approaches include interventions aimed at modifying the tissue biomechanical environment, and efforts to target mesenchymal cell activation by, and reciprocal interactions with, the mechanical environment. PMID:23114589

  9. Clinical and molecular aspects of the live attenuated Oka varicella vaccine.

    PubMed

    Quinlivan, Mark; Breuer, Judy

    2014-07-01

    VZV is a ubiquitous member of the Herpesviridae family that causes varicella (chicken pox) and herpes zoster (shingles). Both manifestations can cause great morbidity and mortality and are therefore of significant economic burden. The introduction of varicella vaccination as part of childhood immunization programs has resulted in a remarkable decline in varicella incidence, and associated hospitalizations and deaths, particularly in the USA. The vaccine preparation, vOka, is a live attenuated virus produced by serial passage of a wild-type clinical isolate termed pOka in human and guinea pig cell lines. Although vOka is clinically attenuated, it can cause mild varicella, establish latency, and reactivate to cause herpes zoster. Sequence analysis has shown that vOka differs from pOka by at least 42 loci; however, not all genomes possess the novel vOka change at all positions, creating a heterogeneous population of genetically distinct haplotypes. This, together with the extreme cell-associated nature of VZV replication in cell culture and the lack of an animal model, in which the complete VZV life cycle can be replicated, has limited studies into the molecular basis for vOka attenuation. Comparative studies of vOka with pOka replication in T cells, dorsal root ganglia, and skin indicate that attenuation likely involves multiple mutations within ORF 62 and several other genes. This article presents an overview of the clinical aspects of the vaccine and current progress on understanding the molecular mechanisms that account for the clinical phenotype of reduced virulence.

  10. [Neurologic aspects of clinical manifestations, pathophysiology and therapy of reflex sympathetic dystrophy (causalgia, Sudeck's disease)].

    PubMed

    Blumberg, H; Griesser, H J; Hornyak, M

    1991-04-01

    The symptomatology of reflex sympathetic dystrophy (RSD), a diagnostic term which today includes causalgia and M. Sudeck, is characterized clinically by a triad of autonomic (sympathetic), motor and sensory disturbances. They develop following a noxious event--though independent of its nature and location--in a generalized distribution pattern at the distal site of the affected extremity. Pathophysiologically, a complex disturbance of the sympathetic vasoconstrictor system is involved, which mediates the dominant symptoms of RSD, namely the spontaneous pain and the swelling. This disturbance is thought to be initiated by nociceptive impulses, occurring in conjunction with the preceding noxious event, and to be maintained reflexly, in a form of a vicious circle, by means of the typical pain sensation accompanying the RSD-syndrome. From these ideas, an important part of the RSD therapy is deduced; i.e. the early interruption of the neuronal sympathetic activity by means of a sympathetic blockade. Such a blockade can interrupt the pain and at the same time also the vicious circle of RSD. Altogether, for the RSD syndrome there are relevant neurological aspects with respect to its clinical symptomatology, its pathophysiology and its therapy. PMID:1713305

  11. Cladophialophora bantiana: a rare cause of fungal brain abscess. Clinical aspects and new therapeutic options.

    PubMed

    Garzoni, Christian; Markham, Lydia; Bijlenga, Philippe; Garbino, Jorge

    2008-08-01

    Black molds or dematiaceous fungi are rare etiologic agents of intracerebral abscesses and such infections carry a high mortality of up to 70% despite combined surgical and antifungal therapy. While the growing use of immunosuppressive therapies and organ transplantation have caused an increase in the incidence of rare fungal cerebral infections, occurrence in immunocompetent hosts is also possible. We describe a 60-year-old female patient with a cerebral abscess caused by Cladophialophora bantiana. The case illustrates the clinical and radiological similarities between glioblastomas and brain abscesses and emphasizes the need to perform histological and microbiological studies prior to the initiation of any form of therapy. Long-term survival from cerebral black mold abscesses has been reported only when complete surgical resection was possible. The recommended antifungal treatment involves the use of amphotericin B combined with a triazole and, if possible, flucytosine. Highly-active new generation triazole antifungal compounds (voriconazole or posaconazole) are likely to offer improved survival rates for patients with rare mold infections. In particular, posaconazole could be a new therapeutic option given its better tolerance, lower toxicity and fewer drug-drug interactions. We discuss clinical, microbiological and practical pharmacological aspects and review current and evolving treatment options.

  12. [Clinical and epidemiological aspects of neurocysticercosis in Brazil: a critical approach].

    PubMed

    Agapejev, Svetlana

    2003-09-01

    With the objective to show the characteristics of neurocysticercosis (NCC) in Brazil, was performed a critical analysis of national literature which showed a frequency of 1.5% in autopsies and 3.0% in clinical studies, corresponding to 0.3% of all admissions in general hospitals. In seroepidemiological studies the positivity of specific reactions was 2.3%. Brazilian patient with NCC presents a general clinical-epidemilogical profile (31-50 years old man, rural origin, complex partial epileptic crisis, increased protein levels or normal CSF, CT showing calcifications, constituting the inactive form of NCC), and a profile of severity (21-40 years old woman, urban origin, vascular headache and intracranial hypertension, typical CSF syndrome of NCC or alteration of two or more CSF parameters, CT showing vesicles and/or calcifications, constituting the active form of NCC). Although two localities from the state of S o Paulo have 72:100000 and 96:100000/habitants as prevalence coefficients, regional and national prevalences are very underestimated. Some aspects related to underestimation of NCC prevalence in Brazil are discussed.

  13. Laparoscopic Navigated Liver Resection: Technical Aspects and Clinical Practice in Benign Liver Tumors

    PubMed Central

    Kleemann, Markus; Deichmann, Steffen; Esnaashari, Hamed; Besirevic, Armin; Shahin, Osama; Bruch, Hans-Peter; Laubert, Tilman

    2012-01-01

    Laparoscopic liver resection has been performed mostly in centers with an extended expertise in both hepatobiliary and laparoscopic surgery and only in highly selected patients. In order to overcome the obstacles of this technique through improved intraoperative visualization we developed a laparoscopic navigation system (LapAssistent) to register pre-operatively reconstructed three-dimensional CT or MRI scans within the intra-operative field. After experimental development of the navigation system, we commenced with the clinical use of navigation-assisted laparoscopic liver surgery in January 2010. In this paper we report the technical aspects of the navigation system and the clinical use in one patient with a large benign adenoma. Preoperative planning data were calculated by Fraunhofer MeVis Bremen, Germany. After calibration of the system including camera, laparoscopic instruments, and the intraoperative ultrasound scanner we registered the surface of the liver. Applying the navigated ultrasound the preoperatively planned resection plane was then overlain with the patient's liver. The laparoscopic navigation system could be used under sterile conditions and it was possible to register and visualize the preoperatively planned resection plane. These first results now have to be validated and certified in a larger patient collective. A nationwide prospective multicenter study (ProNavic I) has been conducted and launched. PMID:23133783

  14. Neuropharmacological Aspects of Crocus sativus L.: A Review of Preclinical Studies and Ongoing Clinical Research.

    PubMed

    Singh, Damanpreet

    2015-01-01

    Crocus sativus L. (Iridaceae) is an important member of the genus Crocus having high medicinal value. Its dried stigmas, known as "saffron" are being widely used form past many centuries as a food additive, coloring agent, flavoring agent and a potential source of traditional medicine. The stigmas along with other botanical parts of Crocus sativus are being extensively used in ethnomedical treatment of varied central nervous system diseases. In line with its ethnomedical importance, several preclinical studies have been carried out to validate its traditional uses, identify active principle(s), understand pharmacological basis of therapeutic action and explore novel medicinal uses. The bioactive components of Crocus sativus have been found to modulate several synaptic processes via direct/indirect interplay with neurotransmitter receptor functions, interaction with neuronal death/survival pathways and alteration in neuronal proteins expression. Many clinical studies proving beneficial effect of Crocus sativus in depressive disorders, Alzheimer's disease and some other neurological abnormalities have also been carried out. Based on the vast literature reports available, an attempt has been made to comprehend the fragmented information on neuropharmacological aspects, chemistry and safety of Crocus sativus. Although the plant has been well explored, but still a large scope of future preclinical and clinical research exist to explore its potential in neurological diseases, that has been discussed in depth in the present review.

  15. An elective course on the basic and clinical sciences aspects of vitamins and minerals.

    PubMed

    Islam, Mohammed A

    2013-02-12

    Objective. To develop and implement an elective course on vitamins and minerals and their usefulness as dietary supplements. Design. A 2-credit-hour elective course designed to provide students with the most up-to-date basic and clinical science information on vitamins and minerals was developed and implemented in the doctor of pharmacy (PharmD) curriculum. In addition to classroom lectures, an active-learning component was incorporated in the course in the form of group discussion. Assessment. Student learning was demonstrated by examination scores. Performance on pre- and post-course surveys administered in 2011 demonstrated a significant increase in students' knowledge of the basic and clinical science aspects of vitamins and minerals, with average scores increasing from 61% to 86%. At the end of the semester, students completed a standard course evaluation. Conclusion. An elective course on vitamin and mineral supplements was well received by pharmacy students and helped them to acquire knowledge and competence in patient counseling regarding safe, appropriate, effective, and economical use of these products.

  16. Challenge of biomechanics.

    PubMed

    Volokh, K Y

    2013-06-01

    The application of mechanics to biology--biomechanics--bears great challenges due to the intricacy of living things. Their dynamism, along with the complexity of their mechanical response (which in itself involves complex chemical, electrical, and thermal phenomena) makes it very difficult to correlate empirical data with theoretical models. This difficulty elevates the importance of useful biomechanical theories compared to other fields of engineering. Despite inherent imperfections of all theories, a well formulated theory is crucial in any field of science because it is the basis for interpreting observations. This is all-the-more vital, for instance, when diagnosing symptoms, or planning treatment to a disease. The notion of interpreting empirical data without theory is unscientific and unsound. This paper attempts to fortify the importance of biomechanics and invigorate research efforts for those engineers and mechanicians who are not yet involved in the field. It is not aimed here, however, to give an overview of biomechanics. Instead, three unsolved problems are formulated to challenge the readers. At the micro-scale, the problem of the structural organization and integrity of the living cell is presented. At the meso-scale, the enigma of fingerprint formation is discussed. At the macro-scale, the problem of predicting aneurysm ruptures is reviewed. It is aimed here to attract the attention of engineers and mechanicians to problems in biomechanics which, in the author's opinion, will dominate the development of engineering and mechanics in forthcoming years. PMID:24015479

  17. Challenge of biomechanics.

    PubMed

    Volokh, K Y

    2013-06-01

    The application of mechanics to biology--biomechanics--bears great challenges due to the intricacy of living things. Their dynamism, along with the complexity of their mechanical response (which in itself involves complex chemical, electrical, and thermal phenomena) makes it very difficult to correlate empirical data with theoretical models. This difficulty elevates the importance of useful biomechanical theories compared to other fields of engineering. Despite inherent imperfections of all theories, a well formulated theory is crucial in any field of science because it is the basis for interpreting observations. This is all-the-more vital, for instance, when diagnosing symptoms, or planning treatment to a disease. The notion of interpreting empirical data without theory is unscientific and unsound. This paper attempts to fortify the importance of biomechanics and invigorate research efforts for those engineers and mechanicians who are not yet involved in the field. It is not aimed here, however, to give an overview of biomechanics. Instead, three unsolved problems are formulated to challenge the readers. At the micro-scale, the problem of the structural organization and integrity of the living cell is presented. At the meso-scale, the enigma of fingerprint formation is discussed. At the macro-scale, the problem of predicting aneurysm ruptures is reviewed. It is aimed here to attract the attention of engineers and mechanicians to problems in biomechanics which, in the author's opinion, will dominate the development of engineering and mechanics in forthcoming years.

  18. Early Specialization in Youth Sport: A Biomechanical Perspective

    ERIC Educational Resources Information Center

    Mattson, Jeffrey M.; Richards, Jim

    2010-01-01

    This article examines, from a biomechanical perspective, three issues related to early specialization: overuse injuries, the developmental aspects, and the performance aspects. It concludes that "there is no evidence that early specialization causes overuse injuries or hinders growth and maturation." At the same time, early specialization has…

  19. Biomechanics and Wound Healing in the Cornea

    PubMed Central

    Dupps, William J.; Wilson, Steven E.

    2009-01-01

    The biomechanical and wound healing properties of the cornea undermine the predictability and stability of refractive surgery and contribute to discrepancies between attempted and achieved visual outcomes after LASIK, surface ablation and other keratorefractive procedures. Furthermore, patients predisposed to biomechanical failure or abnormal wound healing can experience serious complications such as keratectasia or clinically significant corneal haze, and more effective means for the identification of such patients prior to surgery are needed. In this review, we describe the cornea as a complex structural composite material with pronounced anisotropy and heterogeneity, summarize current understanding of major biomechanical and reparative pathways that contribute to the corneal response to laser vision correction, and review the role of these processes in ectasia, intraocular pressure measurement artifact, diffuse lamellar keratitis (DLK) and corneal haze. The current understanding of differences in the corneal response after photorefractive keratectomy (PRK), LASIK and femtosecond-assisted LASIK are reviewed. Surgical and disease models that integrate corneal geometric data, substructural anatomy, elastic and viscoelastic material properties and wound healing behavior have the potential to improve clinical outcomes and minimize complications but depend on the identification of preoperative predictors of biomechanical and wound healing responses in individual patients. PMID:16720023

  20. To Use or Not? Evaluating ASPECTS of Smartphone Apps and Mobile Technology for Clinical Care in Psychiatry.

    PubMed

    Torous, John B; Chan, Steven R; Yellowlees, Peter M; Boland, Robert

    2016-06-01

    In this commentary, we discuss smartphone apps for psychiatry and the lack of resources to assist clinicians in evaluating the utility, safety, and efficacy of apps. Evaluating an app requires new considerations that are beyond those employed in evaluating a medication or typical clinical intervention. Based on our software engineering, informatics, and clinical knowledge and experiences, we propose an evaluation framework, "ASPECTS," to spark discussion about apps and aid clinicians in determining whether an app is Actionable, Secure, Professional, Evidence-based, Customizable, and TranSparent. Clinicians who use the ASPECTS guide will be more informed and able to make more thorough evaluations of apps. PMID:27136691

  1. Frequency of neonatal hyperglycaemia at Gaafar Ibnauf Children's Hospital: Clinical aspects and short term outcome.

    PubMed

    Mohammed, Monera Mm; Abdel Rahman, Sirageldin Mk

    2016-01-01

    Hyperglycaemia has become a significant risk factor for morbidity and mortality of the smaller fragile infants surviving the neonatal period. Its risk is inversely related to gestational age, birth weight and baby's clinical condition. The aim of this study was to determine the frequency, some clinical aspects and immediate outcome of hyperglycaemia in neonates admitted to the neonatal intensive care unit (NICU) at Gaafar Ibnauf Children's Hospital, Khartoum. The study was a prospective, descriptive and hospital-based, conducted during the period of 1st January to 31st December 2014. Eighty-five neonates out of 345 had neonatal hyperglycaemia with a frequency rate of (24.6%). Fifty-two (61.2%) were males (male: female ratio=1.6:1), 61.2% of the babies were in the age group (0-7) days, and 25.9% in age group (8-14) days. Forty-two (49.4%) were preterm, while 43 (50.6%) were term babies. Four (4.7%) of the mothers had diabetes, and 6(7.1%) had hypertension. Neonatal sepsis was a predominant risk factor of hyperglycaemia occurring in 67 babies (78.8%), followed by respiratory distress syndrome in 28 (32.9%) babies. Ten babies (11.8%) were diagnosed as acute kidney injury, four babies (4.7%) had hypernatraemic dehydration and seven babies (8.3%) were having hypoxic ischemic encephalopathy. Out of 85 hyperglycaemic neonates death was reported in 10 babies (11.8%), 75 (88.2%) survived. All cases had transient hyperglycaemia; therefore insulin intervention was not necessary. Currently, at Gaafar Ibnauf Children's Hospital, specific protocol for management of hyperglycaemia is lacking. Further studies are recommended to assess long term sequels of hyperglycaemia in neonates.

  2. Frequency of neonatal hyperglycaemia at Gaafar Ibnauf Children's Hospital: Clinical aspects and short term outcome.

    PubMed

    Mohammed, Monera Mm; Abdel Rahman, Sirageldin Mk

    2016-01-01

    Hyperglycaemia has become a significant risk factor for morbidity and mortality of the smaller fragile infants surviving the neonatal period. Its risk is inversely related to gestational age, birth weight and baby's clinical condition. The aim of this study was to determine the frequency, some clinical aspects and immediate outcome of hyperglycaemia in neonates admitted to the neonatal intensive care unit (NICU) at Gaafar Ibnauf Children's Hospital, Khartoum. The study was a prospective, descriptive and hospital-based, conducted during the period of 1st January to 31st December 2014. Eighty-five neonates out of 345 had neonatal hyperglycaemia with a frequency rate of (24.6%). Fifty-two (61.2%) were males (male: female ratio=1.6:1), 61.2% of the babies were in the age group (0-7) days, and 25.9% in age group (8-14) days. Forty-two (49.4%) were preterm, while 43 (50.6%) were term babies. Four (4.7%) of the mothers had diabetes, and 6(7.1%) had hypertension. Neonatal sepsis was a predominant risk factor of hyperglycaemia occurring in 67 babies (78.8%), followed by respiratory distress syndrome in 28 (32.9%) babies. Ten babies (11.8%) were diagnosed as acute kidney injury, four babies (4.7%) had hypernatraemic dehydration and seven babies (8.3%) were having hypoxic ischemic encephalopathy. Out of 85 hyperglycaemic neonates death was reported in 10 babies (11.8%), 75 (88.2%) survived. All cases had transient hyperglycaemia; therefore insulin intervention was not necessary. Currently, at Gaafar Ibnauf Children's Hospital, specific protocol for management of hyperglycaemia is lacking. Further studies are recommended to assess long term sequels of hyperglycaemia in neonates. PMID:27651553

  3. Neurobehavior inventory: correlation with clinical aspects and quality of life in patients with epilepsy.

    PubMed

    Tedrus, Glória Maria Almeida Souza; Fonseca, Lineu Corrêa; Carvalho, Rachel Marin

    2013-08-01

    Fifty-five adult patients with epilepsy were evaluated, and the Neurobehavior Inventory (NBI) was administered. The relationship between the NBI data and clinical aspects and quality of life (QoL) was studied. The total NBI score was 58 ± 18.2. The domains with the highest scores were "religious conviction", "orderliness", and "sense of personal destiny". There was a significant difference in "hatred and revenge" and "religious conviction" according to the epileptic syndrome. The "physical well-being" score was higher for patients with mesial temporal lobe epilepsy with right hippocampal sclerosis than for left sclerosis (2.77 ± 1.6 × 1.57 ± 0.5, respectively, p = 0.002). The total NBI score was higher in patients with psychiatric comorbidities and with depression according to the Hamilton Depression Scale and was negatively correlated with the "emotional well-being" QOLIE score (-0.398, p = 0.005). The NBI findings showed that behavioral changes can be present in various epilepsies and that there is a complex bidirectional neurobiological relationship between epilepsy and psychiatric comorbidity, sustained by common physiopathological mechanisms. PMID:23770631

  4. The Iceberg Nature of Fibromyalgia Burden: The Clinical and Economic Aspects

    PubMed Central

    Ghavidel-Parsa, Banafsheh; Bidari, Ali; Ghalebaghi, Babak

    2015-01-01

    This review has focused on important but less visible aspects of fibromyalgia (FM) with respect to the high impact of this disorder on patients and societies. FM is a common but challengeable illness. It is characterized by chronic widespread pain, which can be accompanied by other symptoms including fatigue, sleep disturbances, cognitive dysfunction, anxiety and depressive episodes. While our understanding of this debilitating disorder is limited, diagnosis and treatment of this condition is very difficult, even in the hands of experts. Due to the nature of disease, where patients experience invalidation by medical services, their families and societies regarding the recognition and management of disease, direct, indirect and immeasurable costs are considerable. These clinical and economic costs are comparable with other common diseases, such as diabetes, hypertension and osteoarthritis, but the latter usually receives much more attention from healthcare and non-healthcare resources. Present alarming data shows the grave and "iceberg-like" burden of FM despite the benign appearance of this disorder and highlights the urgent need both for greater awareness of the disease among medical services and societies, as well as for more research focused on easily used diagnostic methods and target specific treatment. PMID:26175876

  5. Clinical, hematological, biochemical, and ultrasonographic aspects of Platynosomum sp. (Trematoda: Dicrocoeliidae) infection of captive Callithrix penicillata.

    PubMed

    Mattioli, Mariana Portugal; Batista, Juliana dos Santos; Ferrari, Marlon; Paludo, Giane Regina; Dias, Cecília Azevedo; Hoppe, Estevam G L; da Rocha, Gino Chaves; Monteiro, Rafael Veríssimo

    2016-04-01

    Trematodes from the genus Platynosomum have been found to infect Neotropical primates in captivity, but little is known about their pathogeny in such hosts. This study evaluated the physiological effects of natural infection by the liver-dwelling trematode Platynosomum sp. in ten males and ten females of Callithrix penicillata kept in captivity at the Primate Center of the University of Brasília. The marmosets were examined twice, 6 months apart. The following parameters were analyzed: complete blood count, bleeding time, serum total protein, albumin, and the liver enzymes AST and ALT, and both a stool analysis and a liver ultrasonic evaluation were performed. We were able to characterize a group of abnormalities associated with this trematode infection which were mainly derived from the hepatitis caused by it: coagulation disorders, abnormal red blood cells, hypoalbuminemia, and abnormal levels of liver-linked serum enzymes. Eosinophilia and thrombocytopenia were also commonly seen. All of the aforementioned abnormalities were in good accord with typical effects of trematodes on liver parenchyma. We suggest that this set of abnormalities is characteristic of the infection of C. penicillata with Platynosomum sp., and should be among the most prominent aspects that the veterinary surgeon considers when suspecting such an infection. We also suggest that these clinical signs and abnormalities will be similar in other liver-dwelling trematode-infected primate species. PMID:26922567

  6. Meteorological and agricultural effects on airborne Alternaria and Cladosporium spores and clinical aspects in Valladolid (Spain).

    PubMed

    Reyes, Estefanía Sánchez; de la Cruz, David Rodríguez; Merino, Ma Eugenia Sanchís; Sánchez, José Sánchez

    2009-01-01

    The aeropalynological monitoring was carried out from 1 February 2005-31 January 2007. The total number of spores collected during the main spore season (MSS) in 2005 was 4,500 for Alternaria and 93,744 in the case of Cladosporium, whereas in 2006 values were increased (8,385 for Alternaria and 150,144 for Cladosporium), reaching the maximum concentrations on 18 July and 17 June 2006 with 344 and 5,503 spores, respectively. The influence of the main meteorological parameters on spore concentrations was studied, resulting in a positive correlation with temperature. Rainfall, relative humidity and frequency of calms obtained negative correlations in the case of Alternaria, and positive for Cladosporium, the total daily hours of sunshine having an inverse influence on them. The intra-diurnal pattern was very similar for both genera, with a greater representation towards the central hours of the day and at night. Finally, some clinical aspects for the Alternaria spore type were analyzed, with a low percentage of sensitized patients though (9.5%). Only one patient showed positive skin test reaction to Cladosporium.

  7. The wolf in sheep’s clothing: Microtomographic aspects of clinically incipient radiation-related caries

    PubMed Central

    Morais-Faria, Karina; Neves-Silva, Rodrigo; Lopes, Marcio-Ajudarte; Ribeiro, Ana-Carolina-Prado; de Castro Jr, Gilberto; da Conceição-Vasconcelos, Karina-Gondim-Moutinho; Brandão, Thais-Bianca; Santos-Silva, Alan-Roger

    2016-01-01

    Background Radiation-related caries (RRC) can cause rapid progression, with a high potential for dental destruction affecting mainly cervical and incisal areas. Unlike the injuries that occur in the conventional caries, incipient RRC present in unusual surfaces have difficult diagnosis and classification stages of cavitation. Material and Methods Evaluate the radiographic patterns of demineralization of RRC by using micro-CT. Ten teeth with incipient RRC and 10 teeth with incipient conventional caries (control group) matched by anatomic teeth group and caries affected surfaces were evaluated by X-ray microtomography (micro-CT) Skyscan 1174V2 (50Kv, 1.3 megapixel, Kontich, Belgium). Teeth were placed in a standard position for micro-CT (coronal, transaxial and sagittal sections) during images acquisition. Lesions were classified according to the depth of invasion and relationship with enamel, dentin and pulp. Results RRC samples presented deeper lesions with higher involvement of enamel and dentin. Control group presented focal and superficial lesions with lower involvement of enamel and dentin. Conclusions Incipient RRC present aggressive microtomographic patterns of demineralization when compared to conventional caries, as indicated by deep lesions, regardless of its clinically incipient aspects. Key words:Head and neck cancer, radiotherapy, microtomography, radiation caries. PMID:26946198

  8. Biomechanics: an integral part of sport science and sport medicine.

    PubMed

    Elliott, B

    1999-12-01

    Biomechanics is one of the disciplines in the field of Human Movement and Exercise Science and it can be divided into three broad categories from a research perspective. Clinical biomechanics involves research in the areas of gait, neuromuscular control, tissue mechanics, and movement evaluation during rehabilitation from either injury or disease. Occupational biomechanics typically involves research in the areas of ergonomics and human growth or morphology as they influence movement. While these two categories will briefly be discussed, the primary aim of this paper is to show the role of biomechanics in sports science and sports medicine. Research in sports biomechanics may take the form of describing movement from a performance enhancement (such as matching of impulse curves in rowing) or injury reduction perspective (such as diving in swimming or the assessment of knee joint loading during downhill walking). However, the strength of sports biomechanics research is the ability to establish an understanding of causal mechanisms for selected movements (such as the role of internal rotation of the upper arm in hitting or striking, and the influence of elastic energy and muscle pre-stretch in stretch-shorten-cycle actions). The growth of modelling and computer simulation has further enhanced the potential use of sports biomechanics research (such as quantification of knee joint ligament forces from a dynamic model and optimising gymnastics performance through simulation of in-flight movements). Biomechanics research may also play an integral role in reducing the incidence and severity of sporting injuries (such as identification of the causes of back injuries in cricket, and the causes of knee joint injuries in sport). In the following discussion no attempt will be made to reference all papers published in each of these areas because of the enormity of the task. Published and current work from the biomechanics laboratory at the Department of Human Movement and

  9. ON THE BIOMECHANICS OF HEART VALVE FUNCTION

    PubMed Central

    Sacks, Michael S.; Merryman, W. David; Schmidt, David E.

    2009-01-01

    Heart valves (HVs) are fluidic control components of the heart that ensure unidirectional blood flow during the cardiac cycle. However, this description does not adequately describe the biomechanical ramifications of their function in that their mechanics are multi-modal. Moreover, they must replicate their cyclic function over an entire lifetime, with an estimated total functional demand of least 3×109 cycles. The focus of the present review is on the functional biomechanics of heart valves. Thus, the focus of the present review is on functional biomechanics, referring primarily to biosolid as well as several key biofluid mechanical aspects underlying heart valve physiological function. Specifically, we refer to the mechanical behaviors of the extra-cellular matrix structural proteins, underlying cellular function, and their integrated relation to the major aspects of valvular hemodynamic function. While we focus on the work from the author’s laboratories, relevant works of other investigators have been included whenever appropriate. We conclude with a summary of important future trends. PMID:19540499

  10. Genotypes and clinical aspects associated with bone mineral density in Argentine postmenopausal women.

    PubMed

    Pérez, Adriana; Ulla, María; García, Beatriz; Lavezzo, María; Elías, Eliana; Binci, Miriam; Rivoira, María; Centeno, Viviana; Alisio, Arturo; Tolosa de Talamoni, Nori

    2008-01-01

    The aim of this study was to determine genotypes and clinical aspects associated with bone mineral density (BMD) in postmenopausal women from Córdoba, Argentina. Polymorphisms were assessed by RFLP-PCR technique using BsmI and FokI for vitamin D receptor gene (VDR) and XbaI and PvuII for estrogen receptor-alpha gene (ERalpha) as restrictases. Sixty-eight healthy, 54 osteopenic, and 64 osteoporotic postmenopausal women were recruited. Femoral neck and lumbar spine BMD were inversely correlated with age in the entire analyzed population. Height was lower in osteopenic and osteoporotic women as compared to healthy women (P < 0.05). Weight and body mass index (BMI) were the lowest in osteoporotic women (P < 0.01 versus healthy group). Serum procollagen type I Nterminal propeptide (PINP) was higher in osteoporotic women as compared to the other groups. Distribution of VDR and ERalpha genotypes was similar in the three groups. Genotype bb (VDR) was associated with low values of lumbar BMD in the healthy group (P < 0.05 versus genotype Bb), and with low values of femoral BMD (P < 0.05 versus genotype BB) in osteoporotic women. BB*Pp interaction was associated with the highest femoral neck BMD (P < 0.05), whereas the bb*xx interaction was associated with the lowest femoral neck BMD in the total population analyzed (P < 0.05). In conclusion, parameters such as age, height, weight, BMI, serum PINP, VDR genotypes, and interactions between VDR and ERalpha genotypes could be useful to predict a decrease in BMD in Argentine postmenopausal women. PMID:18600402

  11. Cutaneous approach towards clinical and pathophysiological aspects of hyperglycemia by ATR FTIR spectroscopy

    NASA Astrophysics Data System (ADS)

    Eikje, Natalja Skrebova; Sota, Takayuki; Aizawa, Katsuo

    2007-07-01

    Attempts were made to non-invasively detect glucose-specific spectral signals in the skin by ATR-FTIR spectroscopy. In vivo spectra were collected from the inner wrists of healthy, prediabetes and diabetes subjects in the 750-4000 cm -1 region, with a closer assessment of the glucose-related region between 1000 and 1180 cm -1. Spectra in vivo showed glucose-specific peaks at 1030, 1080, 1118 and 1151 cm -1, as a variety of glucose solutions are found in vitro. Based on the differences of intensities at 1030 and 1118 cm -1 two spectral patterns were seen: I 1118 > I 1030 for a diabetes and I 1030> I 1118 for non-diabetes subjects. The peak at 1030 cm -1 was used to assess glucose concentrations in the skin due to its good correlation with glucose concentrations in vitro. Calculated mean values of the peak at 1030 cm -1 showed evidence of correlation with blood glucose levels when grouped as <= 140, 140-200 and >= 200 mg/dL, though there was no constant correlation between them when compared before/after OGTT or at the fasting/postprandial states. Absorbances at 1030 cm -1 were not only increased in a dose-dependent manner in a diabetes patient, but were also generally higher than in non-diabetes subjects at 30 min OGTT assessment. Also we could monitor absorbances at 1030 cm -1 and determine their changes in the skin tissue at different times of OGTT. We assume that our approach to in vivo measurement and monitoring of glucose concentrations at 1030 cm -1 may be one of the indicators to assess glucose activity level and its changes in the skin tissue, and has further implications in the study of clinical and pathophysiological aspects of hyperglycemia in diabetes and non-diabetes subjects by ATR-FTIR spectroscopy.

  12. [Present-day approach to pharmacological and clinical aspects of novel antidepressants].

    PubMed

    Danileviciūte, Vita; Sveikata, Audrius

    2002-01-01

    Depression is the most common illness that affects a large number of individuals in all countries. Recent evidence suggest that depressive episodes if left untreated may heighten severity of subsequent episodes and may increase need for more health care resources. The first antidepressants, tricyclics and monoamine oxidase inhibitors, became available in the late 1950s. A progressive tightening of requirements by drug licensing authorities has ensured that efficacy evidence is good for most antidepressants that are in use. Contemporary antidepressant classification system is based on the mechanism of action, which is presumed to be responsible for their antidepressant effects. A pharmacodynamic system of classification has advantages because it incorporates the current theories of disease pathophysiology. Understanding the basic aspects of mechanism of action of antidepressants is important for treatment of depressive episode, for development of augmenting strategies and combining antidepressants with other antidepressants or antipsychotics. Antidepressants as a class of psychotropic medication have the broad range of indications. The choice of initial antidepressant legitimately varies considerably among clinicians and countries. Referring to some differences of recommendations for the first line treatment of depressive episode we suppose that the choice of antidepressant medication must be individualized for a particular patient. Novel antidepressants (SSRI, SNRI, NaSSA, NARI, NDRI and other) are safe and better tolerated. Metabolism of novel antidepressants is much improved compared with MAOIs and TCAs. The combination of antidepressants is an important clinical issue. There are the following principles of combining antidepressants: 1. to combine mechanisms of action not just drugs, 2. to combine antidepressants and to promote pharmacological synergy and tolerability, 3. to use important synergies within the serotonin, noradrenaline and even dopamine

  13. [Arterial hypertension in menopausal women: Clinical, functional, and pharmaco-economical aspects].

    PubMed

    Gel'tser, B I; Kotel'nikov, V N; Khludeeva, T A

    2003-01-01

    The study was undertaken to define the specific features of daily variations of blood pressure (BP) and autonomic cardiac regulation (ACR), as well as the functional status of the myocardium and vascular endothelium in females with menopausal arterial hypertension (MPAH) and to assess the pharmacotherapeutic and economical aspects of the combined use of arifon retard and clinonorm. The study enrolled 30 reproductive females with mild and moderate arterial hypertension (AH) and 65 females with MPAH who were randomly divided into 2 groups according to the therapeutic model. MPAH was characterized by more unfavorable hemodynamic changes that AH in the presence of preserved fertile function: greater load on target organs, elevated BP, its inadequate nocturnal lowering, greater BP variations, the magnitude and rate of its morning elevation. In AH, the vasomotor function of the endothelium varies with the clinical form of the disease and with the functional status of the female reproductive system. By and large, in the group of patients with MPAH, the latter was characterized by a more significant decrease in endothelium-dependent vasodilation (EDVD). Arifon retard monotherapy has an adequate antihypertensive effect in female patients with MPAH, by ensuring 24-hour control of BP and affecting its chronostructure. A combination of arifon retard and climonorm has no cumulative effect on the level of BP and on the parameters of pressure-induced load; however, this is a pathogenetically grounded combination that potentiates the positive effects of a diuretic in significantly improving EDVD and ACR. The use of arifon retard in combination with climonorm in MPAH is the most cost-effective for public health care facilities and effective for patients. The course of MPAH is of certain peculiarity, which should be taken into account in choosing a therapeutic model for this category of patients.

  14. Somatosensory-evoked spikes on electroencephalography (EEG): longitudinal clinical and EEG aspects in 313 children.

    PubMed

    Fonseca, Lineu Corrêa; Tedrus, Gloria M A S

    2012-01-01

    Somatosensory-evoked spikes (ESp) are high-voltage potentials registered on the EEG, which accompany each of the percussions on the feet or hands. The objective of this research was to study the longitudinal clinical and EEG aspects of children with ESp. A total of 313 children, 53.7% male, showing ESp on the EEG and with an average initial age of 6.82 (range from 2 to 14 years) were followed for a mean period of 35.7 months. In the initial evaluation, 118 (37.7%) had a history of nonfebrile epileptic seizures (ES). Epileptiform activity (EA) was observed on the EEG in 61% and showed a significantly greater occurrence in children with ES than in those without (P = .000). Of the 118 showing seizures from the start, 53 (44.9%) continued to have seizures; of the 195 without seizures at the start, only 13 (6.67%) developed them. Thus, only 66 (21.1%) children showed ES during the follow-up. ESp disappeared in 237 (75.7%) cases and EA in 221 (70.6%). In the children with ES, it was found that the presence of EA on the first EEG did not indicate continuation of the ES throughout the remaining period, while the 13 children who presented their first ES in a later period showed a greater occurrence of EA on the initial EEG than those who did not develop ES (P = .001). Evidence of brain injury was observed in 43 (13.7%) children and was associated with a greater continuity of the ES during the study (P = .018). ESp, EA, and ES tend to disappear, suggesting an age-dependent phenomenon. The finding of ESp, particularly in the absence of any evidence of brain injury, indicates a low association with ES and benign outcome.

  15. [The acute visual hallucinosis in infancy. Clinical, neurophysiological and psychodevelopmental aspects and differential typology (author's transl)].

    PubMed

    Eggers, C

    1975-09-01

    By introducing the definition "hallucinosis" (Wernicke) it has become possible to confine the psychoses of organic origin more closely. Therefore, this term should also be used in pediatry and pedopsychiatry in order to designate cases with corresponding clinical aspects. Thus, accordance to the phenomenological characteristics of such syndromes as described in this paper, it is justified to emphasize that the acute hallucinosis in children is a special type of disease as compared to other psychoses caused by exogenic influences in this age group. The 10 case reports deal with visual hallucinoses which turned out to be characteristically different compared to those in adults. Hallucinating children at the age of 3 to 9 years predominantly visualized animals and legendary beings. Contrary to findings in adults, scenic and systematized visions were scarcely noticed, which psychodevelopmentally may be attributed to the fact that creative power in children is still little pronounced. Etiologically intoxications and infectious diseases were the cause for the visual hallucinations of the 10 children described. In the development of visual hallucinations somatic and psychic factors are significant. They have been discussed on the basis of today's knowledge. As today, however, there exists no satisfactory theory concerning the conditions favoring the development of hallucinations. To explain the somatogenesis of visual hallucinations three theories have been outlined, based on the present neurophysiological findings. It has been worked out that especially in children emotion plays an essential role in the origin of hallucinations. In infancy and early school age, while rational control of reality is still suppressed to a great extent, domination of emotional life goes along with lack of differentiation. At the same time the difference between imagination and perception is still little precise; therefore, phenomena, impressing as hallucinations in the adult, occur with

  16. [The acute visual hallucinosis in infancy. Clinical, neurophysiological and psychodevelopmental aspects and differential typology (author's transl)].

    PubMed

    Eggers, C

    1975-09-01

    By introducing the definition "hallucinosis" (Wernicke) it has become possible to confine the psychoses of organic origin more closely. Therefore, this term should also be used in pediatry and pedopsychiatry in order to designate cases with corresponding clinical aspects. Thus, accordance to the phenomenological characteristics of such syndromes as described in this paper, it is justified to emphasize that the acute hallucinosis in children is a special type of disease as compared to other psychoses caused by exogenic influences in this age group. The 10 case reports deal with visual hallucinoses which turned out to be characteristically different compared to those in adults. Hallucinating children at the age of 3 to 9 years predominantly visualized animals and legendary beings. Contrary to findings in adults, scenic and systematized visions were scarcely noticed, which psychodevelopmentally may be attributed to the fact that creative power in children is still little pronounced. Etiologically intoxications and infectious diseases were the cause for the visual hallucinations of the 10 children described. In the development of visual hallucinations somatic and psychic factors are significant. They have been discussed on the basis of today's knowledge. As today, however, there exists no satisfactory theory concerning the conditions favoring the development of hallucinations. To explain the somatogenesis of visual hallucinations three theories have been outlined, based on the present neurophysiological findings. It has been worked out that especially in children emotion plays an essential role in the origin of hallucinations. In infancy and early school age, while rational control of reality is still suppressed to a great extent, domination of emotional life goes along with lack of differentiation. At the same time the difference between imagination and perception is still little precise; therefore, phenomena, impressing as hallucinations in the adult, occur with

  17. Anterior Deep Bite Malocclusion Treated with Connecticut Intrusion Arch: Biomechanical Consideration

    PubMed Central

    Bansal, Abhishek; Sami, Laique; Tapashetti, Roopali; Gaikwad, Shashank

    2014-01-01

    Most Class II division 2 malocclusion manifest a severe deep bite, the orthodontic correction of deep overbite can be achieved with several mechanisms one such mechanics is true intrusion of anterior teeth. Deep overbite correction by intrusion of anterior teeth affords a number of advantages which includes simplifying control of the vertical dimension and allowing forward rotation of mandible to aid in Class II correction. It also aid in correction of a high gingival smile line. This case report presents the patient of a 14-year-old boy with Class II division 2 subdivision malocclusion treated with connecticut intrusion arch and also highlights the biomechanical aspect of this appliance. Intrusion of anterior teeth is difficult. An appropriate, effective and clinically manageable biomechanical system is required. The treatment approach shown in this case can treat the deep overbite precisely with incisor intrusion. The article shows the versatility of Connecticut Intrusion Arch and by applying the sound biomechanical principles we can execute the planned mechanics with minimal side effects. PMID:24995261

  18. Suspension biomechanics of swimming microbes

    PubMed Central

    Ishikawa, Takuji

    2009-01-01

    Micro-organisms play a vital role in many biological, medical and engineering phenomena. Some recent research efforts have demonstrated the importance of biomechanics in understanding certain aspects of micro-organism behaviours such as locomotion and collective motions of cells. In particular, spatio-temporal coherent structures found in a bacterial suspension have been the focus of many research studies over the last few years. Recent studies have shown that macroscopic properties of a suspension, such as rheology and diffusion, are strongly affected by meso-scale flow structures generated by swimming microbes. Since the meso-scale flow structures are strongly affected by the interactions between microbes, a bottom-up strategy, i.e. from a cellular level to a continuum suspension level, represents the natural approach to the study of a suspension of swimming microbes. In this paper, we first provide a summary of existing biomechanical research on interactions between a pair of swimming micro-organisms, as a two-body interaction is the simplest many-body interaction. We show that interactions between two nearby swimming micro-organisms are described well by existing mathematical models. Then, collective motions formed by a group of swimming micro-organisms are discussed. We show that some collective motions of micro-organisms, such as coherent structures of bacterial suspensions, are satisfactorily explained by fluid dynamics. Lastly, we discuss how macroscopic suspension properties are changed by the microscopic characteristics of the cell suspension. The fundamental knowledge we present will be useful in obtaining a better understanding of the behaviour of micro-organisms. PMID:19674997

  19. ASPECT-R—A Tool to Rate the Pragmatic and Explanatory Characteristics of a Clinical Trial Design

    PubMed Central

    Bossie, Cynthia A.

    2016-01-01

    Objective: Clinical and observational trials can be broadly categorized into having explanatory or pragmatic approaches with specific trial designs located somewhere along this spectrum. Two 10-domain instruments, the PRECIS and Pragmascope, have been developed to facilitate clinical trial design within a framework that is either more explanatory or pragmatic. Design: We have adapted the PRECIS and Pragmascope instruments to permit both design support and post-hoc evaluation of clinical trials and to improve consistency of use and interpretation across raters. This adapted instrument, A Study Pragmatic-Explanatory Characterization Tool-Rating—or ASPECT-R—is described. Results: Adaption of the PRECIS and Pragmascope instruments included reducing the 10 original domains to six. Each of the six ASPECT-R domains has a definition of domain terminology and detailed descriptive anchors. The domains are rated from 0 to 6, where 0 is considered extremely explanatory and 6 extremely pragmatic. Using an Excel®-based file with cover page cells for entry of the study objective(s) and study population of interest, the ASPECT-R instrument has individual domain-related worksheets where the user rates each of the six domains. Each of the six domain worksheets has a section provided for the user to summarize and record the rationale for their domain scoring. Each domain worksheet page also contains a radar graph that auto-populates each of the domain ratings as the user completes these ratings. Conclusion: This new tool, ASPECT-R, should provide a reliable, objective way to rate studies along the explanatory-pragmatic spectrum that will better support trial design and facilitate interpretation of completed trials. The complete ASPECT-R tool and guide materials can be accessed online by clicking or visiting this link: http://innovationscns.com/aspect-r-tool-and-training-materials/. PMID:27413583

  20. Different aspects of dysexecutive syndrome in patients with moyamoya disease and its clinical subtypes.

    PubMed

    Fang, Lingling; Huang, Jia; Zhang, Qian; Chan, Raymond C K; Wang, Rong; Wan, Weiqing

    2016-08-01

    OBJECTIVE Dysexecutive syndrome is common in patients with moyamoya disease (MMD), a chronic cerebrovascular disease that is characterized by stenosis of the bilateral internal carotid arteries and progressive collateral revascularization, and MMD can be classified as ischemic or hemorrhagic according to the disease presentation and history. In this study, the authors aimed to determine which aspects of executive function are impaired in patients with MMD, in addition to the specific dysexecutive functions present among its clinical subtypes and the mechanisms underlying dysexecutive function in these patients. METHODS The authors administered 5 typical executive function tests (the Stroop test, the Hayling Sentence Completion Test [HSCT], the verbal fluency [VF] test, the N-back test, and the Sustained Attention to Response Task [SART]) to 49 patients with MMD and 47 IQ-, age-, education-, and social status-matched healthy controls. The dysexecutive questionnaire (DEX) was also used to assess participants' subjective feelings about their executive function. A total of 39 of the patients were evaluated by CT perfusion (CTP) before the assessments were performed, and the correlations among the performances of the patients on the above tests with the parameters of cerebral blood volume, cerebral blood flow (CBF), mean transit time (MTT), and time-to-peak (TTP) in the frontal lobes of these patients were also analyzed. RESULTS Many aspects of executive function in the patients with MMD were significantly poorer than those in the healthy controls, and the patients performed particularly poorer on the VF test, HSCT, N-back test, and SART. The patients with hemorrhagic MMD exhibited worse executive inhibition, executive processing, and semantic inhibition compared with those with ischemic MMD, but the latter group presented a worse working memory and poorer sustained attention. There were no significant differences in the DEX scores between the patients with MMD and

  1. Different aspects of dysexecutive syndrome in patients with moyamoya disease and its clinical subtypes.

    PubMed

    Fang, Lingling; Huang, Jia; Zhang, Qian; Chan, Raymond C K; Wang, Rong; Wan, Weiqing

    2016-08-01

    OBJECTIVE Dysexecutive syndrome is common in patients with moyamoya disease (MMD), a chronic cerebrovascular disease that is characterized by stenosis of the bilateral internal carotid arteries and progressive collateral revascularization, and MMD can be classified as ischemic or hemorrhagic according to the disease presentation and history. In this study, the authors aimed to determine which aspects of executive function are impaired in patients with MMD, in addition to the specific dysexecutive functions present among its clinical subtypes and the mechanisms underlying dysexecutive function in these patients. METHODS The authors administered 5 typical executive function tests (the Stroop test, the Hayling Sentence Completion Test [HSCT], the verbal fluency [VF] test, the N-back test, and the Sustained Attention to Response Task [SART]) to 49 patients with MMD and 47 IQ-, age-, education-, and social status-matched healthy controls. The dysexecutive questionnaire (DEX) was also used to assess participants' subjective feelings about their executive function. A total of 39 of the patients were evaluated by CT perfusion (CTP) before the assessments were performed, and the correlations among the performances of the patients on the above tests with the parameters of cerebral blood volume, cerebral blood flow (CBF), mean transit time (MTT), and time-to-peak (TTP) in the frontal lobes of these patients were also analyzed. RESULTS Many aspects of executive function in the patients with MMD were significantly poorer than those in the healthy controls, and the patients performed particularly poorer on the VF test, HSCT, N-back test, and SART. The patients with hemorrhagic MMD exhibited worse executive inhibition, executive processing, and semantic inhibition compared with those with ischemic MMD, but the latter group presented a worse working memory and poorer sustained attention. There were no significant differences in the DEX scores between the patients with MMD and

  2. Biomechanics of Rowing

    NASA Astrophysics Data System (ADS)

    Hase, Kazunori; Kaya, Motoshi; Yamazaki, Nobutoshi; Andrews, Brian J.; Zavatsky, Amy B.; Halliday, Suzanne E.

    Compared with the other exercise, such as walking and cycling, rowing was expected to have some fitness advantage, while there were some misgivings about the risk of injury. The objectives of this study were to quantify biomechanical characteristics of rowing for fitness and rehabilitation and to offer normative data for the prevention of injury and for determining effective exercise. An experiment was performed to collect the kinematic and kinetic data during rowing by experienced and non-experienced subjects. A three-dimensional whole-body musculo-skeletal model was used to calculate the biomechanical loads, such as the joint moments, the muscular tensions, the joint contact forces and the energy consumption. The results of this study indicate that rowing is an effective exercise for rehabilitation and fitness. However, the non-experienced rower should acquire considerable skill to obtain sufficient exercise. The rowing cadence should be decided according to the purpose of the exercise.

  3. Biomechanics of Tendon Transfers.

    PubMed

    Livermore, Andrew; Tueting, Jonathan L

    2016-08-01

    The transfer of tendons in the upper extremity is a powerful technique to restore function to a partially paralyzed hand. The biomechanical principles of muscle tension and tendon excursion dictate motor function both in the native as well as transferred states. Appropriately tensioning transferred tendons to maximize the function of the associated muscle remains an area of focused research. Newer methods of tendon coaptation have proven similar in strength to the standard Pulvertaft weave, affording more options to the surgeon. PMID:27387073

  4. Biological, Epidemiological, and Clinical Aspects of Echinococcosis, a Zoonosis of Increasing Concern

    PubMed Central

    Eckert, Johannes; Deplazes, Peter

    2004-01-01

    Echinococcosis in humans is a zoonotic infection caused by larval stages (metacestodes) of cestode species of the genus Echinococcus. Cystic echinococcosis (CE) is caused by Echinococcus granulosus, alveolar echinococcosis (AE) is caused by E. multilocularis, and polycystic forms are caused by either E. vogeli or E. oligarthrus. In untreated cases, AE has a high mortality rate. Although control is essentially feasible, CE remains a considerable health problem in many regions of the northern and southern hemispheres. AE is restricted to the northern hemisphere regions of North America and Eurasia. Recent studies have shown that E. multilocularis, the causative agent of AE, is more widely distributed than previously thought. There are also some hints of an increasing significance of polycystic forms of the disease, which are restricted to Central and South America. Various aspects of human echinococcosis are discussed in this review, including data on the infectivity of genetic variants of E. granulosus to humans, the increasing invasion of cities in Europe and Japan by red foxes, the main definitive hosts of E. multilocularis, and the first demonstration of urban cycles of the parasite. Examples of emergence or reemergence of CE are presented, and the question of potential spreading of E. multilocularis is critically assessed. Furthermore, information is presented on new and improved tools for diagnosing the infection in final hosts (dogs, foxes, and cats) by coproantigen or DNA detection and the application of molecular techniques to epidemiological studies. In the clinical field, the available methods for diagnosing human CE and AE are described and the treatment options are summarized. The development of new chemotherapeutic options for all forms of human echinococcosis remains an urgent requirement. A new option for the control of E. granulosus in the intermediate host population (mainly sheep and cattle) is vaccination. Attempts are made to reduce the

  5. Biomechanics of Cardiac Function

    PubMed Central

    Voorhees, Andrew P.; Han, Hai-Chao

    2015-01-01

    The heart pumps blood to maintain circulation and ensure the delivery of oxygenated blood to all the organs of the body. Mechanics play a critical role in governing and regulating heart function under both normal and pathological conditions. Biological processes and mechanical stress are coupled together in regulating myocyte function and extracellular matrix structure thus controlling heart function. Here we offer a brief introduction to the biomechanics of left ventricular function and then summarize recent progress in the study of the effects of mechanical stress on ventricular wall remodeling and cardiac function as well as the effects of wall mechanical properties on cardiac function in normal and dysfunctional hearts. Various mechanical models to determine wall stress and cardiac function in normal and diseased hearts with both systolic and diastolic dysfunction are discussed. The results of these studies have enhanced our understanding of the biomechanical mechanism in the development and remodeling of normal and dysfunctional hearts. Biomechanics provide a tool to understand the mechanism of left ventricular remodeling in diastolic and systolic dysfunction and guidance in designing and developing new treatments. PMID:26426462

  6. Anthropometry and Biomechanics Facility

    NASA Technical Reports Server (NTRS)

    Bernal, Yaritza

    2016-01-01

    The Anthropometry and Biomechanics Facility (ABF) is equipped with anthropometric and biomechanical instrumentation and regularly performs population analysis based on analytical and modeling capabilities to test and verify if all eligible crew/passengers can be accommodated, and fitted with a protective suit that enables performance of reach and access tasks. The ABF's unique expertise can aid in identifying potential ergonomic and occupational biomechanical problems with recommended solutions to improve a suited passenger's safety, comfort, and injury protection. My involvement was in the following projects: The ABF is currently trying to define human performance capabilities in the Extravehicular Mobility Unit (EMU) space suit. Subjects are tested in an effort to further understand shoulder and elbow strength performance deficits when suited compared to unsuited. Another ongoing project is to develop a protocol to reliably characterize human health and performance metrics for individuals working inside various extravehicular activity (EVA) suits under realistic spaceflight conditions. This project will provide benchmarking data and protocols to be used in the making of future EVA suit configurations.

  7. Forcing Form and Function: Biomechanical Regulation of Tumor Evolution

    PubMed Central

    Yu, Hongmei; Mouw, Janna Kay; Weaver, Valerie M.

    2010-01-01

    Cancer cells exist in a constantly evolving tissue microenvironment of diverse cell types within a proteinaceous extracellular matrix. As tumors evolve, the physical forces within this complex microenvironment change, with pleiotropic effects on both cell- and tissue-level behaviors. Recent work suggests that these biomechanical factors direct tissue development and modulate tissue homeostasis, and, when altered, critically influence tumor evolution. In this review, we discuss the biomechanical regulation of cell and tissue homeostasis from the molecular, cellular and tissue levels, including how modifications of this physical dialogue could contribute to cancer etiology. Because of the broad impact of biomechanical factors on cell and tissue functions, an understanding of tumor evolution from the biomechanical perspective should improve risk assessment, clinical diagnosis and the efficacy of cancer treatment. PMID:20870407

  8. Biomechanical Issues in Endovascular Device Design

    PubMed Central

    Moore, James E.

    2009-01-01

    The biomechanical nature of the arterial system and its major disease states provides a series of challenges to treatment strategies. Endovascular device design objectives have mostly centered on short-term challenges, such as deployability and immediate restoration of reliable flow channels. The resulting design features may be at odds with long-term clinical success. In-stent restenosis, endoleaks, and loss of device structural integrity (e.g., strut fractures) are all manifestations of a lack of compatibility between the host vessel biomechanical environment and the implant design. Initial attempts to adapt device designs for increased compatibility, including drug-eluting and bioabsorbable stents, barely begin to explore the ways in which implant design can be modulated in time to minimize risk of failure. Biomechanical modeling has the potential to provide a virtual vascular environment in which new designs can be tested for their implications on long-term tissue reaction. These models will be based on high quality, highly resolved imaging information, as well as mechanobiology experiments from the cellular to the whole tissue level. These models can then be extended to incorporate biodegradation mechanics, facilitating the next generations of devices whose designs (including drug delivery profiles) change with time to enhance healing. The possibility of initiating changes in device design or drug release according to information on vascular healing (through clinical intervention or automated methods) provides the opportunity for truly individualized dynamic device design optimization. PMID:19317580

  9. Clinical aspects of patients with traumatic lesions of the brachial plexus following surgical treatment☆

    PubMed Central

    de Moraes, Frederico Barra; Kwae, Mário Yoshihide; da Silva, Ricardo Pereira; Porto, Celmo Celeno; Magalhães, Daniel de Paiva; Paulino, Matheus Veloso

    2015-01-01

    Objective To evaluate sociodemographic and clinical aspects of patients undergoing operations due to traumatic lesions of the brachial plexus. Method This was a retrospective study in which the medical files of a convenience sample of 48 patients operated between 2000 and 2010 were reviewed. The following were evaluated: (1) range of motion (ROM) of the shoulder, elbow and wrist/hand, in degrees; (2) grade of strength of the shoulder, elbow and wrist/hand; (3) sensitivity; and (4) visual analogue scale (VAS) (from 0 to 10). The Student's t, chi-square, Friedman, Wilcoxon and Kruskal–Wallis tests were used (p < 0.05). Results The patients’ mean age was 30.6 years; 60.4% of them had suffered motorcycle accidents and 52.1%, multiple trauma. The mean length of time until surgery was 8.7 months (range: 2–48). Thirty-one patients (64.6%) presented complete rupture of the plexus. The frequent operation was neurosurgery in 39 cases (81.3%). The ROM achieved was ≥30° in 20 patients (41.6%), with a range from 30° to 90° and mean of 73° (p = 0.001). Thirteen (27.1%) already had shoulder strength ≥M3 (p = 0.001). Twenty-seven patients (56.2%) had elbow flexion ≥80°, with a range from 30° to 160° and mean of 80.6° (p < 0.001). Twenty-two had strength ≥M3 (p < 0.001). Twenty-two patients (45.8%) had wrist extension ≥30° starting from flexion of 45°, with a range from 30° to 90° and mean of 70° (p = 0.003). Twenty-seven (56.3%) presented wrist/hand extension strength ≥M3 (p = 0.002). Forty-five (93.8%) had hypoesthesia and three (6.2%) had anesthesia (p = 0.006). The initial VAS was 4.5 (range: 1.0–9.0) and the final VAS was 3.0 (range: 1.0–7.0) (p < 0.001). Conclusion Traumatic lesions of the brachial plexus were more prevalent among young adults (21–40 years), men, people living in urban areas, manual workers and motorcycle accidents, with multiple trauma and total rupture of the plexus. Neurosurgery, with a second

  10. CHEMICAL LEUKODERMA: WHAT’S NEW ON ETIOPATHOLOGICAL AND CLINICAL ASPECTS?

    PubMed Central

    Ghosh, Sanjay

    2010-01-01

    Chemical leukoderma denotes an acquired hypopigmentation caused by repeated exposure to specific chemical compounds simulating clinically idiopathic vitiligo. The ailment has been increasing in developing countries like India in recent years. Etiologically, a lot of chemicals, especially phenolic group, have been identified in various countries including India. The term, “chemical leukoderma syndrome” has been described to encompass all the various manifestations of chemical leukoderma. Clinical diagnostic criteria have been proposed to diagnose chemical leukoderma clinically more confidently. PMID:21063518

  11. Yoga and Mindfulness: Clinical Aspects of an Ancient Mind/Body Practice

    ERIC Educational Resources Information Center

    Salmon, Paul; Lush, Elizabeth; Jablonski, Megan; Sephton, Sandra E.

    2009-01-01

    The use of Yoga and other complementary healthcare interventions for both clinical and non-clinical populations has increased substantially in recent years. In this context, we describe the implementation of Hatha Yoga in the Mindfulness-Based Stress Reduction (MBSR) program of Kabat-Zinn and colleagues. This is embedded in a more general…

  12. Anatomy, pathophysiology, and biomechanics of shoulder instability.

    PubMed

    Doukas, W C; Speer, K P

    2001-07-01

    Instability in the athlete presents a unique challenge to the orthopaedic surgeon. A spectrum of both static and dynamic pathophysiology, as well as gross and microscopic histopathology, contribute to this complex clinical continuum. Biomechanical studies of the shoulder and ligament cutting studies in recent years have generated a more precise understanding of the individual contributions of the various ligaments and capsular regions to shoulder instability. An understanding of the underlying pathology and accurate assessment of degree and direction of the instability by clinical examination and history are essential to developing appropriate treatment algorithms.

  13. Speciation through the lens of biomechanics: locomotion, prey capture and reproductive isolation

    PubMed Central

    Rogers, Sean M.; Langerhans, R. Brian; Jamniczky, Heather A.; Lauder, George V.; Stewart, William J.; Martin, Christopher H.; Reznick, David N.

    2016-01-01

    Speciation is a multifaceted process that involves numerous aspects of the biological sciences and occurs for multiple reasons. Ecology plays a major role, including both abiotic and biotic factors. Whether populations experience similar or divergent ecological environments, they often adapt to local conditions through divergence in biomechanical traits. We investigate the role of biomechanics in speciation using fish predator–prey interactions, a primary driver of fitness for both predators and prey. We highlight specific groups of fishes, or specific species, that have been particularly valuable for understanding these dynamic interactions and offer the best opportunities for future studies that link genetic architecture to biomechanics and reproductive isolation (RI). In addition to emphasizing the key biomechanical techniques that will be instrumental, we also propose that the movement towards linking biomechanics and speciation will include (i) establishing the genetic basis of biomechanical traits, (ii) testing whether similar and divergent selection lead to biomechanical divergence, and (iii) testing whether/how biomechanical traits affect RI. Future investigations that examine speciation through the lens of biomechanics will propel our understanding of this key process. PMID:27629033

  14. Speciation through the lens of biomechanics: locomotion, prey capture and reproductive isolation.

    PubMed

    Higham, Timothy E; Rogers, Sean M; Langerhans, R Brian; Jamniczky, Heather A; Lauder, George V; Stewart, William J; Martin, Christopher H; Reznick, David N

    2016-09-14

    Speciation is a multifaceted process that involves numerous aspects of the biological sciences and occurs for multiple reasons. Ecology plays a major role, including both abiotic and biotic factors. Whether populations experience similar or divergent ecological environments, they often adapt to local conditions through divergence in biomechanical traits. We investigate the role of biomechanics in speciation using fish predator-prey interactions, a primary driver of fitness for both predators and prey. We highlight specific groups of fishes, or specific species, that have been particularly valuable for understanding these dynamic interactions and offer the best opportunities for future studies that link genetic architecture to biomechanics and reproductive isolation (RI). In addition to emphasizing the key biomechanical techniques that will be instrumental, we also propose that the movement towards linking biomechanics and speciation will include (i) establishing the genetic basis of biomechanical traits, (ii) testing whether similar and divergent selection lead to biomechanical divergence, and (iii) testing whether/how biomechanical traits affect RI. Future investigations that examine speciation through the lens of biomechanics will propel our understanding of this key process. PMID:27629033

  15. [Ameloblastic fibro-odontoma. Clinical aspects and review of the literature].

    PubMed

    Villareal, P M; Junquera, L M; Albertos, J M; Molina, R; Gonzalez, S; Villarreal, P M

    1998-02-01

    Ameloblastic fibro-odontoma is a rare odontogenic tumor. It is formed by proliferation of epithelial odontogenic elements combined with ectomesechimal tissue. The presence of dentine, enamel and osteoid like tissue can be identified. Cases of sarcomatous degeneration have been described. In this work, we present two new cases of ameloblastic fibro-odontoma, analyzing the most important aspects of their differential diagnosis, with a review of literature.

  16. [Clinical aspects and treatment of tuberculosis of respiratory organs in adolescents under present epidemiological conditions].

    PubMed

    Stoiunin, M B; Chebotareva, T V; Repina, E S; Kosina, A M; Tochilova, T P; Kolotilova, O N

    1999-01-01

    The paper summarizes the results of clinical observations of 55 teenagers suffering from active respiratory tuberculosis. It defines risk factors for this disease in adolescents. Emphasis is laid on the current pathomorphology and a great variety of clinical types of tuberculosis. Treatment of tuberculosis is ascertained to be preferred by using the short-term intensive chemotherapy regimen recommended by the World Health Organization, which is intended to cure most patients in the shortest period as compared with existing routine regimens.

  17. [The clinical aspects of occupational sensorineural impairment of hearing of the acoustic origin].

    PubMed

    Zinkin, V N; Sheshegov, P M; Chistov, S D

    2015-01-01

    The objective of the present study was to elucidate the specific clinical features of occupational sensorineural impairment of hearing (OSNHI) depending on the origin of this pathology, viz. noise, infrasound and/or their combination. The review of research concerning this problem made it possible to systematize variants of ODNHI based on the clinical signs taking into consideration the influence of these physical factors. Pathophysiological features of the exposure of the organs of hearing to infrasound are described. PMID:27006983

  18. Biomechanics of the normal and arthritic ankle joint.

    PubMed

    Snedeker, Jess G; Wirth, Stephan H; Espinosa, Norman

    2012-12-01

    Understanding biomechanics of the normal and arthritic ankle joint can aid in analysis of an underlying clinical problem and provide a strategic basis for a more optimal management. The challenge to the clinician and the biomechanist is that the mechanical complexity of the ankle joint still clouds current understanding. This article provides an overview of current understanding of functional ankle anatomy, how this function can be altered in the degenerated ankle, and how surgical intervention further affects foot and ankle biomechanics. The focus is on how altered loading of neighboring joints in the midfoot and hindfoot may induce postoperative joint remodeling and can manifest in secondary clinical problems.

  19. Behavioral aspects of clinical trials. An integrated framework from behavior theory.

    PubMed

    Morrow, G R; Hickok, J T; Burish, T G

    1994-11-01

    A less-than-optimal proportion of patients with cancer are entered into National Cancer Institute-sponsored clinical trials. This article reviews the literature on accrual in oncology clinical trials to characterize the extent of the problem, identify reasons for low accrual, and suggest ways to promote accrual. Four well known theories of health behavior (the Health Belief Model, Subjective Expected Utility Theory, Protection Motivation Theory, and the Theory of Reasoned Action) point to central concepts involved in understanding patient health-related behavior: (1) the probability that an unwelcomed health event will happen to a patient, (2) the severity of that event if it does occur, (3) the effectiveness of a particular behavior (such as taking part in a clinical trial) to modify the severity, and (4) the cost of adopting that behavior. These concepts form a framework for integrating the available information about accrual to clinical oncology trials. Patient and physician factors previously related to clinical trials suggest specific recommendations for increasing accrual to clinical oncology trials. PMID:7954285

  20. Cognitive Features of Essential Tremor: A Review of the Clinical Aspects and Possible Mechanistic Underpinnings

    PubMed Central

    Bermejo-Pareja, Félix; Puertas-Martín, Verónica

    2012-01-01

    The classical concept of essential tremor (ET) as a monosymptomatic tremorogenic disorder has been questioned in the last decade as new evidence has been described. Clinical, neuroimaging, and pathological studies have described a probable structural basis (mainly in cerebellum) and evidence that ET is associated with subtle clinical cerebellar deficits and several non-motor clinical manifestations, such as cognitive and mood disorders. We performed literature searches in Medline, ISI Web of Knowledge, and PsycInfo databases. The aim of this review is to describe cognitive deficits associated with ET. First, we present a brief history of ET cognitive disorders presented. Second, we describe several clinical cross-sectional series demonstrating that ET is associated with mild cognitive deficits of attention, executive functions, several types of memory (working memory, immediate, short term, delayed, and possibly others) and, mood disorders (depression). Recent neuroimaging studies favor a cerebellar basis for these cognitive deficits. Population-based surveys confirm that mild cognitive dysfunction is not limited to severe ET cases, the entire ET group, including mild and undiagnosed cases, can be affected. Cohort studies indicated that ET cognitive deficits could be progressive and that ET patients had an increased risk of dementia. The mood and cognitive deficits in ET are in agreement with cognitive affective cerebellar syndrome described in patients with cerebellar disorders. New evidence, mainly from functional (neuroimaging) and prospective clinical studies would further bolster recent descriptions of ET clinical manifestations. PMID:23440004

  1. Biomechanical strain of goldsmiths.

    PubMed

    Cândido, Paula Emanuela Fernandes; Teixeira, Juliana Vieira Schmidt; Moro, Antônio Renato Pereira; Gontijo, Leila Amaral

    2012-01-01

    The work of the goldsmiths consists in the manufacture of jewelry. The piece, be it an earring, bracelet or necklace, is hand-assembled. This task requires precision, skill, kindness and patience. In this work, we make use of tools such as cuticle clippers and rounded tip, beads or precious stones and also pieces of metal. This type of activity requires a biomechanical stress of hands and wrists. In order to quantify the biomechanical stress, we performed a case study to measure the movements performed by an assembly of pieces of jewelry. As method for research, filming was done during assembly of parts to a paste, using a Nikon digital camera, for 1 (one) hour. The film was edited by Kinovea software, and the task was divided into cycles, each cycle corresponds to a complete object. In one cycle, there are four two movements of supination and pronation movements of the forearm. The cycle lasts approximately sixteen seconds, totaling 1800 cycles in eight hours. Despite the effort required of the wrists, the activity shows no complaints from the employees, but this fact does not mischaracterizes the ability of employees to acquire repetitive strain injuries and work-related musculoskeletal disorders. PMID:22317096

  2. [Biomechanics of the shoulder].

    PubMed

    Gohlke, F

    2000-10-01

    The shoulder joint takes a special position among all the other joints of the human body because of its special requirements of stability and mobility. Knowledge of the biomechanics of the shoulder joint forms the basis for the development of modern concepts of reconstructive surgery and arthroplasty. Most of the biomechanical findings are the result of research performed on cadaver shoulders using increasingly sophisticated methods of measurement. These studies elucidate the interaction of the static and dynamic factors which contribute to the delicate balance of the glenohumeral joint. Recently performed research is increasingly being focussed on more detailed analyses of muscle forces and stress distribution in the subchondral bone and periarticular soft tissues. The efficiency of the computer systems now available has enabled the development of complex, virtual shoulder models and three-dimensional finite element analyses. In the future a pure mechanical understanding has to be modified to extend to a concept which includes more data obtained from living subjects, especially with regard to muscle activity under varying loads and neuromuscular feedback systems which currently are difficult to assess.

  3. Biomechanical strain of goldsmiths.

    PubMed

    Cândido, Paula Emanuela Fernandes; Teixeira, Juliana Vieira Schmidt; Moro, Antônio Renato Pereira; Gontijo, Leila Amaral

    2012-01-01

    The work of the goldsmiths consists in the manufacture of jewelry. The piece, be it an earring, bracelet or necklace, is hand-assembled. This task requires precision, skill, kindness and patience. In this work, we make use of tools such as cuticle clippers and rounded tip, beads or precious stones and also pieces of metal. This type of activity requires a biomechanical stress of hands and wrists. In order to quantify the biomechanical stress, we performed a case study to measure the movements performed by an assembly of pieces of jewelry. As method for research, filming was done during assembly of parts to a paste, using a Nikon digital camera, for 1 (one) hour. The film was edited by Kinovea software, and the task was divided into cycles, each cycle corresponds to a complete object. In one cycle, there are four two movements of supination and pronation movements of the forearm. The cycle lasts approximately sixteen seconds, totaling 1800 cycles in eight hours. Despite the effort required of the wrists, the activity shows no complaints from the employees, but this fact does not mischaracterizes the ability of employees to acquire repetitive strain injuries and work-related musculoskeletal disorders.

  4. Clinical and Ethical Aspects of Financial Capacity in Dementia: A Commentary

    PubMed Central

    Marson, Daniel C.

    2013-01-01

    In contrast to issues like treatment and research consent capacity, financial capacity has received relatively little clinical and ethical attention in the dementia literature. Yet issues of financial capacity emerge frequently in patients with Alzheimer's disease (AD), Parkinson's disease (PD) and related dementias, and commonly present ethical and clinical challenges for clinicians treating these patients. These issues include whether a patient with possible dementia has sufficient capacity independently to manage their financial affairs, needs referral for financial capacity assessment, and/or is being financially exploited or abused by others. The accurate identification, assessment and successful handling of such financial capacity issues can have a substantial impact on the financial and psychological well-being of patients and their family members. The present commentary presents an overview of financial capacity and associated clinical and ethical issues in dementia, and describes a set of possible clinician roles regarding these issues as they arise in clinical practice. The commentary concludes with a section describing educational resources available to clinicians and bioethicists seeking additional guidance in handling financial capacity issues. The ultimate goal of the paper is to focus clinical and ethical attention on a neglected capacity that is of fundamental importance for patients, families, and health care and legal professionals. PMID:24078779

  5. Are biomechanical changes necessary for tumor progression?

    NASA Astrophysics Data System (ADS)

    Kas, Josef A.

    2014-03-01

    Already the Roman Celsus recognized rigid tissue as characteristic for solid tumors. Conversely, changes towards a weaker cytoskeleton have been described as a feature of cancer cells since the early days of tumor biology. It remains unclear if a carcinoma's rigid signature stems from more inflexible cells or is caused by the stroma. Despite that the importance of cell biomechanics for tumor progression becomes more and more evident the chicken-and-egg problem to what extent cancer cells already change their mechanical properties within the solid tumor in order to transgress its boundary or mechanical changes are induced by the microenvironment when the cell has left the tumor has been discussed highly controversial. Comprehensive clinical biomechanical measurements only exist from tumor tissue without the possibility to identify individual cells or from individual cancer cells from pleural effusions. Since the biomechanical properties of cells in carcinomas remain unknown measurements on individual cells that directly stem out of primary tumor samples are required, which we have conducted. We found in cervix and mammary carcinomas a distinctive increase of softer cells as well as contractile cells. A soft and contractile cell is like a strong elastic rope. The cell can generate a strong tensile tension to pull its self along and is soft against compression to avoid jamming.

  6. Restriction in Hip Internal Rotation is Associated with an Increased Risk of ACL Injury in NFL Combine Athletes: A Clinical and Biomechanical Study

    PubMed Central

    Bedi, Asheesh; Warren, Russell F.; Oh, Youkeun K.; Wojtys, Edward M.; Oltean, Hanna N.; Ashton-Miller, James A.; Kelly, Bryan T.

    2013-01-01

    Objectives: A deficiency in hip internal rotation secondary to femoroacetabular impingement (FAI) may result in compensatory increases in rotational stresses applied to the ACL with cutting and pivoting activities, thereby increasing the risk of ACL failure in athletes. The purpose of this study was to correlate ACL injury with hip range of motion in a consecutive series of elite, contact athletes and to test the hypothesis that a restriction in the available hip axial rotation in a dynamic in silico model of a simulated pivot landing would increase ACL strain and the risk of ACL rupture. Methods: We examined 324 football athletes attending the 2012 NFL National Invitational Camp. Hip range of internal rotation was measured by three orthopaedic surgeons and correlated with a history of ACL injury and surgical repair using generalized estimating equation logistic regression analysis. An in silico biomechanical model was used to study the effect of FAI on the peak relative ACL strain developed during a simulated pivot landing. Results: The in vivo results demonstrated that a reduction in internal rotation of the left hip was associated with a statistically significant increased odds of ACL injury in the ipsilateral or contralateral knee (OR = 0.95, P =.0001 and P < .0001, respectively). A post-estimation calculation of odds ratio for ACL injury based on deficiency in hip internal rotation demonstrated that a 30-degree reduction in left hip internal rotation was associated with 4.06 and 5.29 times greater odds of ACL injury in the ipsilateral and contralateral limbs, respectively (Figure 1A). The in silico model demonstrated that FAI systematically increased the peak ACL strain predicted during the pivot landing (Figure 1B). The peak AM-ACL strain for 5-degrees of internal rotation was 22.5% greater than the corresponding value for 10-degrees of internal rotation (i.e., a peak AM-ACL strain of 5.77% vs. 4.71%, respectively). Conclusion: FAI may significantly increase

  7. Batten Disease: Clinical Aspects, Molecular Mechanisms, Translational Science, and Future Directions

    PubMed Central

    Dolisca, Sarah-Bianca; Mehta, Mitali; Pearce, David A.; Mink, Jonathan W.; Maria, Bernard L.

    2014-01-01

    The neuronal ceroid lipofuscinoses, collectively the most common neurodegenerative disorders of childhood, are primarily caused by an autosomal recessive genetic mutation leading to a lysosomal storage disease. Clinically these diseases manifest at varying ages of onset, and associated symptoms include cognitive decline, movement disorders, seizures, and retinopathy. The underlying cell biology and biochemistry that cause the clinical phenotypes of neuronal ceroid lipofuscinoses are still being elaborated. The 2012 Neurobiology of Disease in Children Symposium, held in conjunction with the 41st Annual Meeting of the Child Neurology Society, aimed to (1) provide a survey of the currently accepted forms of neuronal ceroid lipofuscinoses and their associated genetic mutations and clinical phenotypes; (2) highlight the specific pathology of Batten disease; (3) discuss the contemporary understanding of the molecular mechanisms that lead to pathology; and (4) introduce strategies that are being translated from bench to bedside as potential therapeutics. PMID:23838031

  8. Ethical and Legal Aspects of Conducting Clinical Trials in Alcohol Withdrawal Syndrome

    PubMed Central

    R, Harsha

    2014-01-01

    Alcohol Withdrawal Syndrome (AWS) is a condition where the patients will be mentally unstable initially and where later, with therapy, they gradually return to normalcy. As AWS comprises two stages; a mentally unstable state and a normal state of mind, the ethical and legal issues behind recruitment of these subjects become a little ambiguous in a clinical trial. This study was taken up to clarify the uncertainty regarding the biphasic states of minds (i.e. unstable mind and sound mind) of the subjects who were involved in a clinical trial done on AWS. Law and ethics regarding the clinical trials which involve psychiatric subjects need to be strengthened and amended from time to time, in order to protect the interests of both patients and physicians. PMID:24995195

  9. [Clinical aspects of use of preparations from seaweeds for caries and gingivitis prevention].

    PubMed

    Vilova, T V; Zenovskiĭ, V P; Deviatkova, M A

    2005-01-01

    Clinical application of seaweed's preparations has shown the appreciable preventive effect, which is connected, first of all, with structure of a water solution of a laminaria's mineral concentrate. This perspective direction contains the following ways of perfection of primary prevention of dental caries: improvement of salivary glands function, optimization of saturation of oral liquid by mineral components, amplification of autopurification of oral cavity, increase of dental tissue's resistance. Application of a fususe's water solution extract improves clinical condition of paradontium, reduces quantity of pathogenic microorganisms that testifies to high anti-inflammatory efficiency of an extract.

  10. Humeral fractures by arm wrestling in adult: a biomechanical study.

    PubMed

    Pedrazzini, Alessio; Pedrazzoni, Mario; De Filippo, Massimo; Nicoletto, Gianni; Govoni, Riccardo; Ceccarelli, Francesco

    2012-08-01

    Humeral shaft fractures may occur as a result of arm wrestling. We discuss the biomechanics of this rare injury mechanism. Using Strength of materials concepts, Computerized Tomography and Bone Density Scans we studied the biomechanical and anatomical conditions that predispose to this particular fracture. An unfavorable ratio between inner-outer diameter and a low bone mineral concentration in the distal third of humerus compared to other sections of bone were seen as critical aspects. The biomechanical study observed the primary importance of these factors to explain the typical shape and location of this fracture. These results indicate that each arm wrestler should be conscious of the risks of practicing this activity. (www.actabiomedica.it).

  11. Glycoprotein Biochemistry--Some Clinical Aspects of Interest to Biochemistry Students.

    ERIC Educational Resources Information Center

    Smith, Christopher A.; And Others

    1991-01-01

    Authors describe some clinical features of glycoprotein biochemistry, including recognition, selected blood glycoproteins, glycated proteins, histochemistry, and cancer. The material presented has largely been taught to medical laboratory students; however, it can be used to teach premedical students and pure biochemistry students. Includes two…

  12. [Clinical and hygienic aspects of occupational neurosensory deafness in civil aviation flight personnel].

    PubMed

    Kruglikova, N V; Romeiko, V L; Bekeneva, T I; Kharitonova, O I

    2015-01-01

    The article covers implementation of regulatory and legal concepts in prevention of risk caused by hazardous effects of noise in civil aviation flight personnel. The authors analyzed case histories of civil aviation flight personnel patients examined in occupational diseases clinic, with first diagnosed occupational neurosensory deafness.

  13. Gaucher disease--Norrbottnian type (III). Neuropaediatric and neurobiological aspects of clinical patterns and treatment.

    PubMed

    Erikson, A

    1986-01-01

    This investigation was undertaken to study the clinical manifestations, development and course of the Norrbottnian type of Gaucher disease--a type III variant--with emphasis on central nervous system symptomatology and function, to correlate clinical signs with laboratory, neuropathological and biochemical findings, to evaluate effects of splenectomy on the course and severity of the disease and to investigate the effect of bone marrow transplantation. Clinical methods applied were neuropaediatric follow-up examinations, psychometric tests and motor age tests. Conventional neurophysiological, haematological and clinico-chemical methods were used. The investigation comprised 22 patients, 10 girls and 12 boys, in all of whom the clinical diagnosis was confirmed by enzymatic tests. The median age at diagnosis was 1.9 years. The clinical pattern at diagnosis was usually that of an alert child with normal intelligence, short stature, splenomegaly, a tendency to bleeding and ocular manifestations. The course was slowly progressive but varied considerably between patients. The median age at death in a representative group of patients was 11.8 years. Early motor development was delayed in the lower limbs but normal in the upper. Eight patients later developed ataxia and six patients signs of mild spastic paraparesis which usually appeared many years after splenectomy. IQ tended to decrease with age. Early splenectomy resulted in lower IQ scores than late splenectomy. With progression of the disease, EEG abnormalities became increasingly frequent, more markedly among splenectomized patients. Thirteen patients had abducens nerve weakness and ten had age dependent abnormalities of horizontal gaze. Retinal infiltrates were characteristic, mainly among splenectomized patients. At, autopsy, Gaucher cell accumulations were found in the adventitia of brain venules, most frequently in cerebral and cerebellar subcortical white matter. Intraneuronal storage of glucosylceramide was

  14. Generalized odontodysplasia in a 5-year-old patient with Hallermann-Streiff syndrome: clinical aspects, cone beam computed tomography findings, and conservative clinical approach.

    PubMed

    Damasceno, Juliana Ximenes; Couto, José Luciano Pimenta; Alves, Karla Shangela da Silva; Chaves, Cauby Maia; Costa, Fábio Wildson Gurgel; Pimenta, Alynne de Menezes Vieira; Fonteles, Cristiane Sá Roriz

    2014-08-01

    This article aims to report the main clinical aspects, cone beam computed tomography (CBCT) findings, and conservative oral rehabilitation in a child born from a consanguineous marriage who presented with Hallermann-Streiff syndrome (HSS) and generalized odontodysplasia. A 5-year-old girl presented with a diagnosis of HSS for oral evaluation. Radiographically, all teeth showed wide pulp chambers and roots with thin dentinal walls and open apices, resembling ghost teeth and indicating a diagnosis of odontodysplasia. Oral rehabilitation consisted of partial dentures that were regularly adjusted to conform the device with the pattern of growth and development of the child. CBCT scan provided great insight into HSS, allowing a detailed view of the morphologic aspects and associated trabecular bone pattern. Treatment of these 2 rare conditions in young children must consider the stage of growth and development. Although extremely rare in HSS, odontodysplasia should be investigated and conservatively managed in young children.

  15. Zika Virus Outbreak in Rio de Janeiro, Brazil: Clinical Characterization, Epidemiological and Virological Aspects

    PubMed Central

    Calvet, Guilherme Amaral; Siqueira, André Machado; Wakimoto, Mayumi; de Sequeira, Patrícia Carvalho; Nobre, Aline; Quintana, Marcel de Souza Borges; de Mendonça, Marco Cesar Lima; Lupi, Otilia; de Souza, Rogerio Valls; Romero, Carolina; Zogbi, Heruza; Bressan, Clarisse da Silveira; Alves, Simone Sampaio; Lourenço-de-Oliveira, Ricardo; Nogueira, Rita Maria Ribeiro; Carvalho, Marilia Sá

    2016-01-01

    Background In 2015, Brazil was faced with the cocirculation of three arboviruses of major public health importance. The emergence of Zika virus (ZIKV) presents new challenges to both clinicians and public health authorities. Overlapping clinical features between diseases caused by ZIKV, Dengue (DENV) and Chikungunya (CHIKV) and the lack of validated serological assays for ZIKV make accurate diagnosis difficult. Methodology / Principal Findings The outpatient service for acute febrile illnesses in Fiocruz initiated a syndromic clinical observational study in 2007 to capture unusual presentations of DENV infections. In January 2015, an increase of cases with exanthematic disease was observed. Trained physicians evaluated the patients using a detailed case report form that included clinical assessment and laboratory investigations. The laboratory diagnostic algorithm included assays for detection of ZIKV, CHIKV and DENV. 364 suspected cases of Zika virus disease were identified based on clinical criteria between January and July 2015. Of these, 262 (71.9%) were tested and 119 (45.4%) were confirmed by the detection of ZIKV RNA. All of the samples with sequence information available clustered within the Asian genotype. Conclusions / Significance This is the first report of a ZIKV outbreak in the state of Rio de Janeiro, based on a large number of suspected (n = 364) and laboratory confirmed cases (n = 119). We were able to demonstrate that ZIKV was circulating in Rio de Janeiro as early as January 2015. The peak of the outbreak was documented in May/June 2015. More than half of the patients reported headache, arthralgia, myalgia, non-purulent conjunctivitis, and lower back pain, consistent with the case definition of suspected ZIKV disease issued by the Pan American Health Organization (PAHO). However, fever, when present, was low-intensity and short-termed. In our opinion, pruritus, the second most common clinical sign presented by the confirmed cases, should be added

  16. Collagen: Biochemistry, biomechanics, biotechnology

    SciTech Connect

    Nimni, M.E.

    1988-01-01

    This book is an up-to-date reference for new ideas, information, and concepts in collagen research. The first volume emphasizes the relationship between the molecular structure and function of collagen, including descriptions of collagen types which exist in tissues as well as how these molecules organize into fibrils and the nature of the chemical crosslinks which stabilize them. In Volume II the biomechanical behavior of various specialized tissues, abnormal accumulation of collagen in the form of scars of fibrous infiltration are examined/and wound healing, tissue regulation and repair are covered in detail. Volume III explores the increasing application of collagen technology to the field of bioprosthesis, including the production of heart valve bioprosthesis, blood vessels, ligament substitutes, and bone substitutes.

  17. Analysis of protein biomarkers in human clinical tumor samples: critical aspects to success from tissue acquisition to analysis.

    PubMed

    Warren, Madhuri V; Chan, W Y Iris; Ridley, John M

    2011-04-01

    There has been increased interest in the analysis of protein biomarkers in clinical tumor tissues in recent years. Tissue-based biomarker assays can add value and aid decision-making at all stages of drug development, as well as being developed for use as predictive biomarkers and for patient stratification and prognostication in the clinic. However, there must be an awareness of the legal and ethical issues related to the sourcing of human tissue samples. This article also discusses the limits of scope and critical aspects on the successful use of the following tissue-based methods: immunohistochemistry, tissue microarrays and automated image analysis. Future advances in standardization of tissue biobanking methods, immunohistochemistry and quantitative image analysis techniques are also discussed. PMID:21473728

  18. International Clinical Guidelines for the Adoption of Digital Pathology: A Review of Technical Aspects.

    PubMed

    García-Rojo, Marcial

    2016-01-01

    Digital slides, also called whole-slide images, are being evaluated to replace conventional microscopy, and several guidelines have been published. This paper reviews technical specifications of digital pathology systems that have been included in the guidelines and position papers from the Canadian Association of Pathologists, the College of American Pathologists, the American Telemedicine Association, the Digital Pathology Association, the Food and Drug Administration, the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, the Society of Toxicologic Pathology, the European Commission, the Spanish Society of Anatomic Pathology, The Royal College of Pathologists and The Royal College of Pathologists of Australasia. In conclusion, most technical aspects are well covered by these guidelines, although they offer limited information regarding image quality and compression, and file formats.

  19. A review of feline infectious peritonitis virus: molecular biology, immunopathogenesis, clinical aspects, and vaccination.

    PubMed

    Olsen, C W

    1993-07-01

    Feline infectious peritonitis (FIP) has been an elusive and frustrating problem for veterinary practitioners and cat breeders for many years. Over the last several years, reports have begun to elucidate aspects of the molecular biology of the causal virus (FIPV). These papers complement a rapidly growing base of knowledge concerning the molecular organization and replication of coronaviruses in general. The fascinating immunopathogenesis of FIPV infection and the virus' interaction with macrophages has also been the subject of several recent papers. It is now clear that FIPV may be of interest to scientists other than veterinary virologists since its pathogenesis may provide a useful model system for other viruses whose infectivity is enhanced in the presence of virus-specific antibody. With these advances and the recent release of the first commercially-available FIPV vaccine, it is appropriate to review what is known about the organization and replication of coronaviruses and the pathogenesis of FIPV infection.

  20. One-year clinical experience with a fully digitized nuclear medicine department: organizational and economical aspects

    NASA Astrophysics Data System (ADS)

    Anema, P. C.; de Graaf, C. N.; Wilmink, J. B.; Hall, David R.; Hoekstra, A. G.; van Rijk, P. P.; Van Isselt, J. W.; Viergever, Max A.

    1991-07-01

    At the department of nuclear medicine of the University Hospital Utrecht a single-modality PACS has been operational since mid-1990. After one year of operation the functionality, the organizational and economical consequences, and the acceptability of the PACS were evaluated. The functional aspects reviewed were: viewing facilities, patient data management, connectivity, reporting facilities, archiving, privacy, and security. It was concluded that the improved quality of diagnostic viewing and the potential integration with diagnosis, reporting, and archiving are highly appreciated. The many problems that have occurred during the transition period, however, greatly influence the appreciation and acceptability of the PACS. Overall, it is felt that in the long term there will be a positive effect on the quality and efficiency of the work.

  1. Indian perspective on clinical aspects, usage, and guidelines of folic Acid.

    PubMed

    Paayal, Chobe; Ganesh, Uchit; Shaantanu, Donde

    2014-10-01

    Folic acid (pteroylmonoglutamic acid) is the stable, fully oxidized form of folate which is used in food fortification and supplements. Keen interest has been generated in folic acid due to its suggested role in prevention of various disorders. Strong evidence from clinical trials indicates preventive effect of folic acid on both occurrence and recurrence of neural tube defects. It also plays a significant role in mitigating the risk of cardiovascular disorders through homocysteine regulation. In addition, the beneficial effect of folic acid in various types of cancers, neurological disorders, conditions affecting pregnancy, and other clinical conditions has been reported in literature. Various guidelines reinforce the need for women to obtain adequate amount of folic acid either through food fortification or supplements. In India, national guidelines on the proper dose of folic acid to pregnant women are not available. Given its significant beneficial effects on health, awareness should be spread among communities on the usage and benefits of folic acid.

  2. Burkitt's lymphoma: a child's case presenting in the maxilla. Clinical and radiological aspects.

    PubMed

    Valenzuela-Salas, Borja; Dean-Ferrer, Alicia; Alamillos-Granados, Francisco-Jesús

    2010-05-01

    Burkitt's lymphoma (BL) is a neoplasm which, despite its very aggressive behaviour is potentially curable. It typically affects the paediatric population. BL belongs to the non-Hodgkin lymphomas group, and is the first human tumour undoubtedly related to a viral origin (Epstein-Barr virus). Two main clinical subtypes are recognized: endemic or African type, and sporadic type; HIV associated BL constitutes a third type. Although common in endemic BL, maxillary involvement is rare in sporadic cases. This, together with the clinical lack of specificity associated to this location, makes diagnosis difficult. New chemotherapeutic protocols achieve a high survival rate. Most important prognostic factors are location and tumour stage. We report a paediatric case of BL presenting in the maxilla, with a review and a description of the characteristics of the disease.

  3. Prognostic stratification of acute pulmonary embolism: Focus on clinical aspects, imaging, and biomarkers

    PubMed Central

    Masotti, Luca; Righini, Marc; Vuilleumier, Nicolas; Antonelli, Fabio; Landini, Giancarlo; Cappelli, Roberto; Ray, Patrick

    2009-01-01

    Pulmonary embolism (PE) represents a common disease in emergency medicine and guidelines for diagnosis and treatment have had wide diffusion. However, PE morbidity and mortality remain high, especially when associated to hemodynamic instability or right ventricular dysfunction. Prognostic stratification to identify high risk patients needing to receive more aggressive pharmacological and closer monitoring is of utmost importance. Modern guidelines for management of acute PE are based on risk stratification using either clinical, radiological, or laboratory findings. This article reviews the modern treatment of acute PE, which is customized upon patient prognosis. Accordingly the current risk stratification tools described in the literature such as clinical scores, echocardiography, helical computer tomography, and biomarkers will be reviewed. PMID:19649307

  4. Old World hantaviruses: aspects of pathogenesis and clinical course of acute renal failure.

    PubMed

    Krautkrämer, Ellen; Zeier, Martin

    2014-07-17

    Hantavirus-associated diseases represent emerging infections that are ranked in the highest priority group of communicable diseases for surveillance and epidemiological research. In the last years, several novel hantavirus species were described and the number of host reservoir species harboring hantaviruses is also increasing. Reports of cases with severe or atypical clinical courses become also more frequent. These facts raise more and more questions concerning host reservoir specificity, pathogenicity and molecular mechanism of pathogenesis. Hantavirus disease is characterized by vascular leakage due to increased capillary permeability. The infection manifests often in the lung (hantaviral cardiopulmonary syndrome; HCPS) or in the kidney (hemorrhagic fever with renal syndrome, HFRS). The underlying mechanisms of both syndromes are probably similar despite the difference in organ tropism. Characterization of hantaviral replication cycle and of patient-specific determinants will help to identify factors responsible for the clinical symptoms and course.

  5. Psychological aspects of orthodontics in clinical practice. Part two: general psychosocial wellbeing.

    PubMed

    Ukra, Ali; Bennani, Florence; Farella, Mauro

    2012-05-01

    Orthodontists tend to treat/see their patients on a systematic, recurrent basis, often during crucial stages of psychological development. Therefore, they have a pivotal role in identifying a number of psychological as well as of psychiatric disorders. Effective communication is crucial and unfortunately, it is often underestimated in a busy clinical practice. Aim of part two of this article it to review the role clinical orthodontics and the orthodontist-patient relationship have on the patients' psychosocial wellbeing, including effects on self-esteem, bullying and harassment by peers, and even several psychiatric disorders, such as anorexia/bulimia nervosa, and attention deficit hyperactivity disorders. Due to the complexity and importance of these issues, the orthodontist may play a dynamic role, not only in the management of dental malocclusions, but at times, as "psychologist" and a counselor to the patient. PMID:22583589

  6. The biology, pathogenesis and clinical aspects of acute lymphoblastic leukemia in children with Down syndrome.

    PubMed

    Lee, P; Bhansali, R; Izraeli, S; Hijiya, N; Crispino, J D

    2016-09-01

    Children with Down syndrome (DS) are at a 20-fold increased risk for acute lymphoblastic leukemia (DS-ALL). Although the etiology of this higher risk of developing leukemia remains largely unclear, the recent identification of CRLF2 (cytokine receptor like factor 2) and JAK2 mutations and study of the effect of trisomy of Hmgn1 and Dyrk1a (dual-specificity tyrosine phosphorylation-regulated kinase 1A) on B-cell development have shed significant new light on the disease process. Here we focus on the clinical features, biology and genetics of ALL in children with DS. We review the unique characteristics of DS-ALL on both the clinical and molecular levels and discuss the differences in treatments and outcomes in ALL in children with DS compared with those without DS. The identification of new biological insights is expected to pave the way for novel targeted therapies. PMID:27285583

  7. Biodegradable device applied in flatfoot surgery: comparative studies between clinical and technological aspects of removed screws.

    PubMed

    Ruozi, Barbara; Belletti, Daniela; Manfredini, Giuseppe; Tonelli, Massimo; Sena, Paola; Vandelli, Maria Angela; Forni, Flavio; Tosi, Giovanni

    2013-04-01

    Poly-L-lactide (PLLA) is one of the most used polymers for biomedical application; its use in sutures and other implants has been widely investigated. Although the knowledge of PLLA biodegradation and biocompatibility features is deep, PLLA screws used to correct the flat foot deformity have deserved attention since they are not degraded in most of cases after a long period of years (3-7) from the implantation. In this article, a clinical and radiological evaluation (NMR, histological and clinical outcomes) on patients was correlated with physico-chemical characterization (by SEM, DSC, GPC and XRD analysis at different temperatures) on both native and patient-recovered screws together with the theoretical degradation processes of PLLA-based implants. The data demonstrated the need for crossing the biodegradation and bioabsorption of the polymer with the characteristics of both the device (geometry, structure and fabrication process) and the implantation site.

  8. Clinical aspects of eosinophilic meningitis and meningoencephalitis caused by Angiostrongylus cantonensis, the rat lungworm.

    PubMed

    Murphy, Gerald S; Johnson, Stuart

    2013-06-01

    Angiostrongylus Eosinophilic Meningitis is caused by human infection with larvae of the rat lungworm, Angiostrongylus cantonensis. The clinical presentation includes a spectrum of disease, from meningitis through radiculitis, cranial nerve abnormalities, ataxia, encephalitis, coma, and rarely death. The condition is diagnosed by recognizing the triad of: the clinical syndrome, eosinophils in the cerebrospinal fluid or blood, and exposure history. A history of eating raw or poorly cooked snails is classic, but ingestion of other intermediate hosts or unwashed produce (such as lettuce) harboring hosts is not uncommon. Several serologic tests exist but none has yet been fully validated. There is good evidence that a 2 week course of high dose corticosteroids shortens the duration and severity of symptoms. There is somewhat weaker evidence that albendazole reduces symptoms. The combination of prednisolone and albendazole is being used more commonly for treatment. Some suggestions for future research are given. PMID:23901382

  9. [A case of 9p partial monosomy caused by paternal translocation. Clinical and cytogenetic aspects].

    PubMed

    Calzolari, C; Seracini, D; Burgio, G; Gaeta, G; Pacini, M; Giovannucci-Uzielli, M L; Mainardi, A

    1988-01-01

    The authors describe a case of partial monosomy 9p in a newborn infant, with breakpoint in the region p221, due to a father's balanced translocation with karyotype 46 XY t(9;16)(p221;q224). The phenotypical features of our patient reproduce those reported in other 35 cases described up to now in the literature: trigonocephaly, upward slanting palpebral fistures, little and horizontal mouth, disproportionally long fingers and toes. Some peculiar clinical and cytogenetical features of the case are discussed, particularly the early closure of the sternal body ossification centers (already detected during the prenatal life), the partial agenesia of the splenium corporis callosi and the partial anomalous pulmonary venous return. The Authors point out the importance of an early diagnosis, based on the awareness to the clinical abnormalities and dysmorphisms, in order to provide for an adequate and opportune genetic counseling. PMID:3241758

  10. Serological aspects of Dengue fever and its correlation with clinical features in a recent febrile outbreak.

    PubMed

    Chatterjee, T K; Nayak, K; Som, S; Chatterjee, S; Chaudhuris, N; Mukherjee, B

    2007-01-01

    The study was done to assess correlation between serology and clinical features of Dengue fever at Burdwan Medical College, where after clinical examination, blood samples were processed by E.I.A. Of 139 cases, mostly between 1 to 20 years, Male-Female ratio was 80:59. Bleeding manifestation was observed only in 3 cases, and Lymphadenopathy, Myocarditis were uncommon features. Few patients have biphasic temperature. Fever and severity of symptoms did not have correlation. Patients' blood was examined for Dengue viruses, with only 44.6% positivity. Correlation exists between illness duration and antibody titer. [r = 0.41; (P < 0.01)]. Fever other, than Dengue also exhibited similar symptoms, but optical density in EIA test was less. As high fever with similar symptoms may be due to causes other than Dengue, thorough search for other viral infection namely Chikungunya should be done in endemic areas also.

  11. Clinical aspects of eosinophilic meningitis and meningoencephalitis caused by Angiostrongylus cantonensis, the rat lungworm.

    PubMed

    Murphy, Gerald S; Johnson, Stuart

    2013-06-01

    Angiostrongylus Eosinophilic Meningitis is caused by human infection with larvae of the rat lungworm, Angiostrongylus cantonensis. The clinical presentation includes a spectrum of disease, from meningitis through radiculitis, cranial nerve abnormalities, ataxia, encephalitis, coma, and rarely death. The condition is diagnosed by recognizing the triad of: the clinical syndrome, eosinophils in the cerebrospinal fluid or blood, and exposure history. A history of eating raw or poorly cooked snails is classic, but ingestion of other intermediate hosts or unwashed produce (such as lettuce) harboring hosts is not uncommon. Several serologic tests exist but none has yet been fully validated. There is good evidence that a 2 week course of high dose corticosteroids shortens the duration and severity of symptoms. There is somewhat weaker evidence that albendazole reduces symptoms. The combination of prednisolone and albendazole is being used more commonly for treatment. Some suggestions for future research are given.

  12. Clinical aspects of porcelain laminate veneers: considerations in treatment planning and preparation design.

    PubMed

    Jordan, Andrea

    2015-04-01

    Making the transition from conventional methods to more modern, perhaps more sophisticated, methods in dentistry can be intimidating. Introduction of new techniques and materials into private practice requires understanding of the current scientific literature. Here, a review of the traditional clinical approach to porcelain laminate veneer case planning and intraoral preparation is reviewed. Current research in each of these subjects is also discussed, summarizing some of the literature as well as newer products and technologies.

  13. Human platelets frozen with glycerol in liquid nitrogen: biological and clinical aspects.

    PubMed

    Herve, P; Potron, G; Droule, C; Beduchaud, M P; Masse, M; Coffe, C; Bosset, J F; Peters, A

    1981-01-01

    Platelets were frozen using glycerol (3% in plasma) as a cryoprotective agent, a rapid cooling rate, and liquid nitrogen for storage. The cryopreserved platelets were thawed at 42 C and infused without washing. The results indicate that the quality of the thawed platelets is equivalent to platelets stored for 24 to 48 hours at room temperature. The availability of HLA phenotyped leukocyte poor platelets can reduce the frequency of sensitization to strong antigens and provide clinically effective platelets for alloimmunized patients. PMID:7268863

  14. Circulatory support devices: fundamental aspects and clinical management of bleeding and thrombosis.

    PubMed

    Susen, S; Rauch, A; Van Belle, E; Vincentelli, A; Lenting, P J

    2015-10-01

    Circulatory support devices are increasingly being used to overcome cardiac or respiratory failure. Long-term devices are used either as a 'bridge to transplant' to support patients who are unable to wait any longer for a heart transplant, or, more recently, as 'destination therapy' for older patients suffering from end-stage heart failure and who have contraindications to heart transplantation. Short-term support devices for high-risk percutaneous coronary intervention, or as a 'bridge for decision' for patients suffering from refractory cardiogenic shock, have also been developed. The clinical benefit of such assist devices has been demonstrated in several important studies, but, unfortunately, thrombotic and bleeding complications are two major clinical issues in patients requiring these devices. Overcoming these issues is of major importance to allow the safe and broad use of these devices, and to consider them as true alternatives to heart transplantation. The present review focuses on thrombotic and bleeding complications, and describes how the risk of thrombosis and bleeding may vary according to the clinical indication, but also according to the type of device. We describe the current knowledge of the mechanisms underlying the occurrence of these complications, provide some guidance for choosing the most appropriate anticoagulation regimen to prevent their occurrence for each type of device and indication, and provide some recommendations for the management of patients when the complication occurs.

  15. Cytomegalovirus infection in renal transplantation: clinical aspects, management and the perspectives

    PubMed Central

    Requião-Moura, Lúcio Roberto; de Matos, Ana Cristina Carvalho; Pacheco-Silva, Alvaro

    2015-01-01

    Cytomegalovirus infection is one of most frequent infectious complications after renal transplantation, and can be classified as primo-infection, when the transmission occurs through the graft, or reactivation, when the recipient is cytomegalovirus seropositive. After transplantation, cytomegalovirus can appear as an infection, when the patient presents with evidence of viral replication without symptoms or disease, which has two clinical spectra: typical viral syndrome or invasive disease, which is a less common form. Their effects can be classified as direct, while the disease is developed, or indirect, with an increase of acute rejection and chronic allograft dysfunction risks. Diagnosis must be made based on viremia by one of the standardized methods: antigenemia or PCR, which is more sensitive. The risk factors related to infection after transplantation are the serologic matching (positive donor and negative recipient) and anti-lymphocyte antibody drugs. One of the strategies to reduce risk of disease should be chosen for patients at high risk: preemptive treatment or universal prophylaxis. Recent clinical research has described ganciclovir resistance as an emergent problem in management of cytomegalovirus infection. Two types of mutation that cause resistance were described: UL97 (most frequent) and UL54. Today, sophisticated methods of immunologic monitoring to detect specific T-cell clones against cytomegalovirus are used in clinical practice to improve the management of high-risk patients after renal transplantation. PMID:25993081

  16. [Natural history of viral hepatitis A in Chilean adults: clinical and laboratory aspects].

    PubMed

    Ibarra, H; Riedemann, S; Froesner, G; Reinhardt, G; Gómez, J C; Cornejo, A; Toledo, C; Soto, N; Ruiz, M

    1993-01-01

    In many countries, Hepatitis is mainly due to virus. A. When improving life condition in a given population, initially there is a tendency to increase the number of cases in adults. We report clinical and laboratory findings in 87 adults with acute viral Hepatitis A in Chile. The rate man/woman was 1.55/1. Mean age: 23.8 years. Clinical forms: icteric classical (77.01%), cholestatic (10.34%), anicteric (8.05%), biphasic (2.30%) and fulminant (2.30%). From 87 patients in consult 1, 64 were controlled at day 15 (consult 2) and 35 one year later (consult 3). Laboratory (means): ALT (UI/L): 856.8, 111.6 and 20.8 in consult 1, 2 and 3 respectively. Correlation between values of ALT and AST (p < 0.0001). Mean total bilirubin (mg%): 6.6, 2.5 and 0.8 respectively. The evolution of Hepatitis A was favorable with a rapid decrease of clinical signs and normalization of laboratory values within the 3 first weeks of disease.

  17. [Clinical-electroneuromyographic and immunologic aspects of myasthenia gravis with anti-musk antibodies].

    PubMed

    2014-01-01

    Myasthenia gravis (MG) is a neuromuscular autoimmune disorder caused by autoaggression directed to different antigenic goals of peripherial neuromotor apparatus. Approximately 80% of patients have detectable serum antibodies against acetylcholine receptors (ACHR). About 10-15% of the MG patients do not have ACHR - antibodies. This form is called seronegative (SN) MG. IN 35% of SN patients antibodies against muscle - specific fyrozine kinase (MUSK) is clearly observed. According to modern data, SN MG patients are resistant against traditional pathogenetic therapy of MG. In order to develop the strategy of timely and adequate treatment of SN MUSK positive MG, we decided to build up differential diagnostic criteriums for this form of MG. For this purpose we analyzed clinical - electroneuromyographic (ENMG), immunologic and pharmacological data of 9 SN MUSK positive MG patients. The specific clinical patterns for SN positive MG was not revealed. The analogical clinic - ENMG and pharmacological signs were observed in seropositive MG. Accordingly, antibodies do not determine the peculiarity of this desease. Therefore, the revelation of the antibodies has not only diagnostic value; it also defines the expediency of pathogenetic therapy of MG. PMID:25214270

  18. Berberine: New Insights from Pharmacological Aspects to Clinical Evidences in the Management of Metabolic Disorders.

    PubMed

    Caliceti, Cristiana; Franco, Placido; Spinozzi, Silvia; Roda, Aldo; Cicero, Arrigo F G

    2016-01-01

    Berberine is a quaternary ammonium salt from the protoberberine group of isoquinoline alkaloids found in such plants as gender Berberis. Berberine is recognised to improve glucose and lipid metabolism disorders and preliminary clinical evidences suggest the ability of berberine to reduce endothelial inflammation improving vascular health, even in patients already affected by cardiovascular diseases, suggesting a possible interesting role of berberine and its metabolites in clinical practice. However, its physicochemical properties, pharmacokinetic, and metabolism are not fully elucidated and contradictory data have been reported. This review provides a summary regarding the pharmacological and biological features of berberine, with a focus on berberine as well as their pharmacologically active metabolites and the different mechanisms underlying their activities in order to clarify the correct use of berberine supplementation, alone or in association with other nutraceuticals, for the management of metabolic disorders associated to increased cardiovascular disease risk. A particular attention has also been given to the available clinical trials assessing its short- and middle- term use tolerability, safety and efficacy in various conditions, such as dyslipidaemia, impaired fasting glucose, metabolic syndrome and type 2 diabetes. PMID:27063256

  19. Clinical Aspects of Melatonin Intervention in Alzheimer’s Disease Progression

    PubMed Central

    Cardinali, Daniel P; Furio, Analía M; Brusco, Luis I

    2010-01-01

    Melatonin secretion decreases in Alzheimer´s disease (AD) and this decrease has been postulated as responsible for the circadian disorganization, decrease in sleep efficiency and impaired cognitive function seen in those patients. Half of severely ill AD patients develop chronobiological day-night rhythm disturbances like an agitated behavior during the evening hours (so-called “sundowning”). Melatonin replacement has been shown effective to treat sundowning and other sleep wake disorders in AD patients. The antioxidant, mitochondrial and antiamyloidogenic effects of melatonin indicate its potentiality to interfere with the onset of the disease. This is of particularly importance in mild cognitive impairment (MCI), an etiologically heterogeneous syndrome that precedes dementia. The aim of this manuscript was to assess published evidence of the efficacy of melatonin to treat AD and MCI patients. PubMed was searched using Entrez for articles including clinical trials and published up to 15 January 2010. Search terms were “Alzheimer” and “melatonin”. Full publications were obtained and references were checked for additional material where appropriate. Only clinical studies with empirical treatment data were reviewed. The analysis of published evidence made it possible to postulate melatonin as a useful ad-on therapeutic tool in MCI. In the case of AD, larger randomized controlled trials are necessary to yield evidence of effectiveness (i.e. clinical and subjective relevance) before melatonin´s use can be advocated. PMID:21358972

  20. Circulatory support devices: fundamental aspects and clinical management of bleeding and thrombosis.

    PubMed

    Susen, S; Rauch, A; Van Belle, E; Vincentelli, A; Lenting, P J

    2015-10-01

    Circulatory support devices are increasingly being used to overcome cardiac or respiratory failure. Long-term devices are used either as a 'bridge to transplant' to support patients who are unable to wait any longer for a heart transplant, or, more recently, as 'destination therapy' for older patients suffering from end-stage heart failure and who have contraindications to heart transplantation. Short-term support devices for high-risk percutaneous coronary intervention, or as a 'bridge for decision' for patients suffering from refractory cardiogenic shock, have also been developed. The clinical benefit of such assist devices has been demonstrated in several important studies, but, unfortunately, thrombotic and bleeding complications are two major clinical issues in patients requiring these devices. Overcoming these issues is of major importance to allow the safe and broad use of these devices, and to consider them as true alternatives to heart transplantation. The present review focuses on thrombotic and bleeding complications, and describes how the risk of thrombosis and bleeding may vary according to the clinical indication, but also according to the type of device. We describe the current knowledge of the mechanisms underlying the occurrence of these complications, provide some guidance for choosing the most appropriate anticoagulation regimen to prevent their occurrence for each type of device and indication, and provide some recommendations for the management of patients when the complication occurs. PMID:26302994

  1. [Nintedanib (BIBF 1120) in the treatment of solid cancers: an overview of biological and clinical aspects].

    PubMed

    Török, Szilvia; Cserepes T, Mihály; Rényi-Vámos, Ferenc; Döme, Balázs

    2012-09-01

    Angiogenesis is essential for tumor growth and metastasis. The main regulators of the process are the signaling cascades of VEGF-, PDGF- and FGF receptors. Inhibition of these pathways holds potential therapeutic benefit not only for cancer patients, but also for the treatment of other diseases. This paper summarizes the experimental and clinical results of studies available so far on the multi-target tyrosine kinase inhibitor nintedanib (BIBF 1120). According to these studies, nintedanib effectively inhibits VEGFR-, PDGFR- and FGFR signalization and thus the proliferation and survival of cell types which highly express these receptors (i.e. endothelial and smooth muscle cells and pericytes). In vitro studies and in vivo xenograft experiments have provided promising results. In the clinical setting, BIBF 1120 seems to be effective and well tolerated in various tumor types, such as lung, prostate, colorectal and hepatocellular carcinoma, as well as in gynecological tumors. The main adverse events are gastrointestinal toxicities and the reversible elevation of liver enzyme levels. Nintedanib might also be combined with paclitaxel, carboplatin, pemetrexed and docetaxel. There are several ongoing clinical trials testing the efficacy of BIBF 1120. PMID:23008829

  2. Clinical aspects of 2541 patients with second stage human African trypanosomiasis.

    PubMed

    Blum, Johannes; Schmid, Caecilia; Burri, Christian

    2006-01-01

    The clinical symptoms and signs of patients with second stage HAT are described for a large cohort of patients treated in a prospective multicentre, multinational study. Special emphasis is given to the influence of disease stage (duration, number of WBC in CSF) and patient age to the clinical picture. Even though the frequencies of symptoms and signs are highly variable between centres, the clinical picture of the disease is similar for all countries. Headache (78.7%), sleeping disorder (74.4%) and lymphadenopathy (56.1%) are the most frequent symptoms and signs and they are similar for all stages of the disease. Lymphadenopathy tends to be highest in the advanced second stage (59.0%). The neurological and psychiatric symptoms increase significantly with the number of WBC in the CSF indicating the stage of progression of the disease. Pruritus is observed in all stages and increases with the number of WBC in CSF from 30 to 55%. In children younger than 7 years, lymphadenopathy is less frequently reported (11.8-37.3%) than in older children or adults (56.4-61.2%). Fever is most frequently reported in children between 2 and 14 years of age (26.1-28.7%) and malnutrition is significantly more frequently observed in children of all ages (43-56%) than in adults (23.5%).

  3. Practical aspects of genetic identification of hallucinogenic and other poisonous mushrooms for clinical and forensic purposes

    PubMed Central

    Kowalczyk, Marek; Sekuła, Andrzej; Mleczko, Piotr; Olszowy, Zofia; Kujawa, Anna; Zubek, Szymon; Kupiec, Tomasz

    2015-01-01

    Aim To assess the usefulness of a DNA-based method for identifying mushroom species for application in forensic laboratory practice. Methods Two hundred twenty-one samples of clinical forensic material (dried mushrooms, food remains, stomach contents, feces, etc) were analyzed. ITS2 region of nuclear ribosomal DNA (nrDNA) was sequenced and the sequences were compared with reference sequences collected from the National Center for Biotechnology Information gene bank (GenBank). Sporological identification of mushrooms was also performed for 57 samples of clinical material. Results Of 221 samples, positive sequencing results were obtained for 152 (69%). The highest percentage of positive results was obtained for samples of dried mushrooms (96%) and food remains (91%). Comparison with GenBank sequences enabled identification of all samples at least at the genus level. Most samples (90%) were identified at the level of species or a group of closely related species. Sporological and molecular identification were consistent at the level of species or genus for 30% of analyzed samples. Conclusion Molecular analysis identified a larger number of species than sporological method. It proved to be suitable for analysis of evidential material (dried hallucinogenic mushrooms) in forensic genetic laboratories as well as to complement classical methods in the analysis of clinical material. PMID:25727040

  4. Update on immunoglobulin a nephropathy. Part II: Clinical, diagnostic and therapeutical aspects

    PubMed Central

    Salvadori, Maurizio; Rosso, Giuseppina

    2016-01-01

    Immunoglobulin A nephropathy (IgAN) is characterized by different clinical manifestations and by long-term different outcomes. Major problem for the physicians is to understanding which patients are at risk of a disease evolution and to prescribe the right therapy to the right patients. Indeed, in addition to patients with a stable disease with no trend to evolution or even with a spontaneous recovery, patients with an active disease and patients with a rapidly evolving glomerulonephritis are described. Several histopathological, biological and clinical markers have been described and are currently used to a better understanding of patients at risk, to suggest the right therapy and to monitor the therapy effect and the IgAN evolution over time. The clinical markers are the most reliable and allow to divide the IgAN patients into three categories: The low risk patients, the intermediate risk patients and the high risk patients. Accordingly, the therapeutic measures range from no therapy with the only need of repeated controls, to supportive therapy eventually associated with low dose immunosuppression, to immunosuppressive treatment in the attempt to avoid the evolution to end stage renal disease. However the current evidence about the different therapies is still matter of discussion. New drugs are in the pipeline and are described. They are object of randomized controlled trials, but studies with a number of patients adequately powered and with a long follow up are needed to evaluate efficacy and safety of these new drugs. PMID:26788460

  5. Clinical and genetic aspects of Ehlers-Danlos syndrome, classic type.

    PubMed

    Malfait, Fransiska; Wenstrup, Richard J; De Paepe, Anne

    2010-10-01

    Classic Ehlers-Danlos syndrome is a heritable connective tissue disorder characterized by skin hyperextensibility, fragile and soft skin, delayed wound healing with formation of atrophic scars, easy bruising, and generalized joint hypermobility. It comprises Ehlers-Danlos syndrome type I and Ehlers-Danlos syndrome type II, but it is now apparent that these form a continuum of clinical findings and differ only in phenotypic severity. It is currently estimated that approximately 50% of patients with a clinical diagnosis of classic Ehlers-Danlos syndrome harbor mutations in the COL5A1 and the COL5A2 gene, encoding the α1 and the α2-chain of type V collagen, respectively. However, because no prospective molecular studies of COL5A1 and COL5A2 have been performed in a clinically well-defined patient group, this number may underestimate the real proportion of patients with classic Ehlers-Danlos syndrome harboring a mutation in one of these genes. In the majority of patients with molecularly characterized classic Ehlers-Danlos syndrome, the disease is caused by a mutation leading to a nonfunctional COL5A1 allele and resulting in haploinsufficiency of type V collagen. A smaller proportion of patients harbor a structural mutation in COL5A1 or COL5A2, causing the production of a functionally defective type V collagen protein. Most mutations identified so far result in a reduced amount of type V collagen in the connective tissues available for collagen fibrillogenesis. Inter- and intrafamilial phenotypic variability is observed, but no genotype-phenotype correlations have been observed. No treatment for the underlying defect is presently available for Ehlers-Danlos syndrome. However, a series of preventive guidelines are applicable.

  6. Demographic variables, clinical aspects, and medicolegal implications in a population of patients with adjustment disorder

    PubMed Central

    Anastasia, Annalisa; Colletti, Chiara; Cuoco, Valentina; Quartini, Adele; Urso, Stefania; Rinaldi, Raffaella; Bersani, Giuseppe

    2016-01-01

    Introduction Although adjustment disorder (AD) is considered as residual diagnosis and receives little attention in research, it plays an important role in clinical practice and also assumes an increasingly important role in the field of legal medicine, where the majority of diagnostic frameworks (eg, mobbing) often refer to AD. Our study aimed to look for specific stressor differences among demographic and clinical variables in a naturalistic setting of patients with AD. Methods A restrospective statistical analysis of the data of patients diagnosed with AD from November 2009 to September 2012, identified via manual search from the archive of the outpatient setting at the University Unit of Psychiatry “A. Fiorini” Hospital, Terracina (Latina, Italy), was performed. Results The sample consisted of 93 patients (46 males and 47 females), aged between 26 and 85, with medium–high educational level who were mainly employed. In most cases (54.80%), a diagnosis of AD with mixed anxiety and depressed mood was made. In all, 72% of the sample reported a negative family history for psychiatric disorders. In 22.60%, a previous history of psychopathology, especially mood disorders (76.19%), was reported. The main stressors linked to the development of AD were represented by working problems (32.30%), family problems (23.70%), and/or somatic disease (22.60%) with significant differences with respect to age and sex. Half of the patients were subjected to a single first examination; 24.47% requested a copy of medical records. Conclusion Confirming previous data from previous reports, our results suggest that AD may have a distinct profile in demographic and clinical terms. Increased scientific attention is hoped, particularly focused on addressing a better definition of diagnostic criteria, whose correctness and accuracy are critical, especially in situations with medicolegal implications. PMID:27099504

  7. Oral contraceptive-induced menstrual migraine. Clinical aspects and response to frovatriptan.

    PubMed

    Allais, Gianni; Bussone, Gennaro; Airola, Gisella; Borgogno, Paola; Gabellari, Ilaria Castagnoli; De Lorenzo, Cristina; Pavia, Elena; Benedetto, Chiara

    2008-05-01

    Oral contraceptive-induced menstrual migraine (OCMM) is a poorly defined migraine subtype mainly triggered by the cyclic pill suspension. In this pilot, open-label trial we describe its clinical features and evaluate the efficacy of frovatriptan in the treatment of its acute attack. During the first 3 months of the study 20 women (mean age 32.2+/-7.0, range 22-46) with a 6-month history of pure OCMM recorded, in monthly diary cards, clinical information about their migraine. During the 4th menstrual cycle they treated an OCMM attack with frovatriptan 2.5 mg. The majority of attacks were moderate/severe and lasted 25-72 h or more, in the presence of usual treatment. Generally an OCMM attack appeared within the first 5 days after the pill suspension, but in 15% of cases it started later. After frovatriptan administration, headache intensity progressively decreased (2.4 at onset, 1.6 after 2 h, 1.1 after 4 h and 0.8 after 24 h; p=0.0001). In 55% of patients pain relief was reported after 2 h. Ten percent of subjects were pain-free subjects after 2 h, 35% after 4 h and 60% after 24 h (p=0.003 for trend); 36% relapsed within 24 h. Rescue medication was needed by 35% of patients; 50% of frovatriptan-treated required a second dose. Concomitant nausea and/or vomiting, photophobia and phonophobia decreased significantly after drug intake. OCMM is a severe form of migraine; actually its clinical features are not always exactly identified by the ICHD-II classification. However, treatment with frovatriptan 2.5 mg might be effective in its management.

  8. Teaching the psychosocial aspects of care in the clinical setting: practical recommendations.

    PubMed

    Kern, David E; Branch, William T; Jackson, Jeffrey L; Brady, Donald W; Feldman, Mitchell D; Levinson, Wendy; Lipkin, Mack

    2005-01-01

    Communication skills and the psychosocial dimensions of patient care are increasingly taught in medical schools and generalist residency programs. Evidence suggests they are not reinforced or optimally implemented in clinical training. The authors present the product of an iterative process that was part of a national faculty development program and involved both experts and generalist teachers concerning teaching psychosocial medicine while precepting medical students and residents in clinical settings. Using scientific evidence, educational theory, and experience, the authors developed recommendations, presented them in workshops, and revised them based on input from other experts and teachers, who gave feedback and added suggestions. The results are practical, expert consensus recommendations for clinical preceptors on how to teach and reinforce learning in this area. General skills to use in preparing the trainee for improved psychosocial care are organized into the mnemonic "CAARE MORE": Connect personally with the trainee; Ask psychosocial questions and Assess the trainee's knowledge/attitudes/skills/behaviors; Role model desired attitudes/skills/behaviors; create a safe, supportive, enjoyable learning Environment; formulate specific Management strategies regarding psychosocial issues; Observe the trainee's affect and behavior; Reflect and provide feedback on doctor-patient and preceptor-trainee interactions; and provide Educational resources and best Evidence. The preceptor-trainee teaching skills that are recommended parallel good doctor-patient interaction skills. They can be used during both preceptor-trainee and preceptor-trainee-patient encounters. Important common psychosocial situations that need to be managed in patients include substance abuse, depression, anxiety, somatoform disorder, physical and sexual abuse, and posttraumatic stress disorder. For these problems, where high-level evidence exists, specific psychosocial questions for screening and

  9. PSYCHIATRIC ASPECTS OF CLINICAL PRACTICE IN GENERAL HOSPITALS: A SURVEY OF NON-PSYCHIATRIC CLINICIANS

    PubMed Central

    Chadda, R.K.; Shome, S.

    1996-01-01

    The present work was carried out to study the awareness of non-psychiatric clinicians working in a teaching general hospital about the frequency of psychiatric morbidity in their clinical practice, their utilization of psychiatric consultation services, and opinion about utility of liaison psychiatry in general hospitals. A substantial proportion of doctors underestimated the psychiatric morbidity especially about unexplained physical symptoms and specific depressive symptoms in their patients. Psychiatric consultation services were not sufficiently utilised by a large number of clinicians. Most ofthemfelt the need to improve upon undergraduate medical education in psychiatry in India as well as a desire to have consultation - liaison psychiatric units in India. PMID:21584151

  10. [Clinical aspects of the evolution of dental caries and periodontal disease in patients treated with corticosteroids].

    PubMed

    Lăcătuşu, St; Ghiorghe, Angela

    2004-01-01

    Patients treated with adrenal glucocorticoids may run a higher risk of dental caries, both as a result of their medical condition and of the physical and physiological effects of their pharmacotherapy. Our clinical study reports about patients treated with glucocorticoids who were also having an odonto-periodontal condition. They were examined and we found rampant caries and periodontal diseases. The slow evolution of asymptomatic periodontal disease encouraged destruction of teeth in root caries. The rampant caries were correlated with immunodeficiency and treatment of these caries must take into account the general treatment.

  11. [Carcinoma with low malignant potential (borderline tumor) of the ovary: immunomorphology and clinical aspects].

    PubMed

    Neunteufel, W; Gitsch, G; Schieder, K; Kölbl, H; Breitenecker, G

    1989-01-01

    Four of 28 patients with borderline tumors of the ovary died of intercurrent disease. Twenty-four are alive without clinical evidence of disease, despite the fact that six of them were stage III; joined with the invasive carcinomas they would distort the survival rates. The development of monoclonal antibodies specific to borderline tumors could improve the value of immunohistochemistry in the diagnosis of borderline tumors. Our results show that the rates of expression of CA 125, CA 19-9, and CEA indicate that borderline tumors are an independent group between benign and malignant ovarian tumors.

  12. [Vertical condylar hyperplasia, clinical and histologic aspects. Apropos of 2 cases].

    PubMed

    Pantoja, R; Martinez, B; Encina, S; Cortes, J; Argandoña, J

    1994-01-01

    Condylar hyperplasia is a pathologic condition associated with an overgrowing of the condylar cartilage. It is possible to distinguish two clinical forms; vertical and horizontal when the lesion is unilateral. We have reported two cases of vertical condylar hyperplasia, both of them treated by simple condylectomy, in our opinion the selected treatment. Histopathological images show an increase of the growth and maturation layers of the condylar cartilage and inclusions of cartilaginous tissue, with appearance of glove fingers into the underlying cancellous bone. PMID:7939358

  13. [Sexual addiction in alcohol abuse and dependence. Clinical, nosologic and psychoanalytic aspects].

    PubMed

    Roth, K

    1992-03-01

    DSM-III-R names sexual addiction for the first time as a sexual disorder. In this study a group of alcoholics was examined who described their own sexual behavior as being addictive and self-destructive. In this nearly all male patient group sexual addiction manifested itself mostly in excessive masturbation and obsessional sexual fantasies often in combination with use of pornography. Promiscuity, prostitute contacts and excessive sexual demands on a steady partner and sexually deviant behavior, were less often reported in this population. The addictive sexual behavior was said to be usually provoked by emotional distress and unresolved conflicts. More than 80% of these patients were dependent upon at least one other substance beside alcohol. Two-thirds considered their sexual addictive behavior to be their primary and earliest dependency. The nosology of this disorder seems to be unspecific, since a number of forms of neurosis and personality disorder are diagnosed. A psychodynamic interpretation of sexual addiction points to defence mechanisms against inner psychic conflicts, as seen both in addiction and sexual perversion. Aspects of differential diagnosis and classification are also discussed. PMID:1579173

  14. Review of renal anastomosing hemangioma with focus on clinical and pathological aspects.

    PubMed

    Kuroda, N; Ohe, C; Deepika, S; Yorita, K; Mikami, S; Furuya, M; Nagashima, Y; Hes, O; Agaimy, A; Michal, M; Amin, M B

    2016-06-01

    Renal anastomosing hemangiomas (RAH) has been recently proposed as a new entity. In this article, we summarize the clinicopathologic features of this tumor. RAH usually develops on a background of end-stage renal disease. Macroscopically, tumors are well-defined and their cut surface shows mahogany brown spongy tissue with epicenter in the renal medulla. Tumors are usually small, but larger lesions are reported. On microscopic examination, the tumor consists of sinusoid-like vascular channels lined by cuboidal endothelial cells with occasional hobnail-like appearance of endothelial cells closely mimicking splenic sinusoids. Eosinophilic hyaline globules may be present in the cytoplasm of neoplastic endothelial cells. Extramedullary hematopoiesis containing erythroid precursor and megakaryocytes may be present in the vascular lumens. Immunohistochemically, endothelial cells are positive for CD31 and CD34, but negative for D2-40, GLUT-1 and HHV8. The surrounding stroma around endothelial cells demonstrates positivity for  smooth muscle action. To date, there are no studies on molecular genetic aspects of RAH. This tumor is indolent based on site and size of the lesion, partial or nephrectomy is sufficient as a therapeutic modality. PMID:27543862

  15. [Diagnostic and therapy of salivary gland diseases: relevant aspects for the pathologist from the clinical perspective].

    PubMed

    Wittekindt, C; Burmeister, H P; Guntinas-Lichius, O

    2009-11-01

    Significant progress in the diagnosis and therapy of salivary gland diseases has been made in recent years. The new technique of diagnostic and interventional sialendoscopy has made an important contribution and is indicated in every case of obstructive sialadenitis. The number of open resections of salivary glands due to stones will clearly decrease in the future in favor of endoscopic removal. Due to recent publications on the appropriate extent of salivary gland resection in benign tumors, more and more specimens with reduced cuffs of healthy salivary gland tissue will be sent to the pathologists. Ultrasound will stay the procedure of first choice for imaging of salivary gland diseases in Germany. In combination with fine-needle aspiration cytology high sensitivity and specificity for the assessment of salivary gland tumors can be achieved. Diffusion-weighted magnetic resonance imaging (MRI) is a new imaging tool and the power of distinction of pleomorphic adenoma from malignant tumors is promising. The use of botulinum toxin for salivary glands diseases is increasing. Intraglandular injections have been shown to induce salivary gland atrophy in animal experiments. The availability of biologicals is currently yielding new aspects for the treatment of Sjögren's disease.

  16. Myocardial ischemic conditioning: Physiological aspects and clinical applications in cardiac surgery.

    PubMed

    Bousselmi, Radhouane; Lebbi, Mohamed Anis; Ferjani, Mustapha

    2014-04-01

    Ischemia-reperfusion is a major determinant of myocardial impairment in patients undergoing cardiac surgery. The main goal of research in cardioprotection is to develop effective techniques to avoid ischemia-reperfusion lesions. Myocardial ischemic conditioning is a powerful endogenous cardioprotective phenomenon. First described in animals in 1986, myocardial ischemic conditioning consists of applying increased tolerance of the myocardium to sustained ischemia by exposing it to brief episodes of ischemia-reperfusion. Several studies have sought to demonstrate its effective cardioprotective action in humans and to understand its underlying mechanisms. Myocardial ischemic conditioning has two forms: ischemic preconditioning (IPC) when the conditioning stimulus is applied before the index ischemia and ischemic postconditioning when the conditioning stimulus is applied after it. The cardioprotective action of ischemic conditioning was reproduced by applying the ischemia-reperfusion stimulus to organs remote from the heart. This non-invasive manner of applying ischemic conditioning has led to its application in clinical settings. Clinical trials for the different forms of ischemic conditioning were mainly developed in cardiac surgery. Many studies suggest that this phenomenon can represent an interesting adjuvant to classical cardioprotection during on-pump cardiac surgery. Ischemic conditioning was also tested in interventional cardiology with interesting results. Finally, advances made in the understanding of mechanisms that underlie the cardioprotective action of ischemic conditioning have paved the way to a new form of myocardial conditioning which is pharmacological conditioning.

  17. [The clinical aspects of HPV-positive cancer of the oral cavity and oropharynx].

    PubMed

    Dvoryaninova, O Yu; Chainzonov, E L; Litvyakov, N V

    2016-01-01

    This review was designed to focus on the prevalence and the magnitude of infection with human papilloma virus (HPV) among healthy subjects and patients presenting with cancer of the oral cavity and oropharynx. We compare the data on the relative frequency of HPV-positive and HPV-negative cancer of the oral cavity and oropharynx in different populations, peculiarities of the clinical course of this pathology, and methods of its treatment. Much emphasis is placed on the specific clinical and morphological features of HPV-positive cancer of the oral cavity and oropharynx. The general and relapse-free survival rates are considered with special reference to the outcome and prognosis of this disease. The currently accepted approaches to the treatment of HPV-positive cancer of the oral cavity and oropharynx are discussed. It is concluded that HPV-positive cancer of the oral cavity and oropharynx should be regarded as an autonomous pathological condition requiring specific approaches to its management, such as the application of adequate treatment schemes and algorithms.

  18. Leishmania (Viannia) braziliensis in dogs in Brazil: epidemiology, co-infection, and clinical aspects.

    PubMed

    Carvalho, F S; Wenceslau, A A; Albuquerque, G R; Munhoz, A D; Gross, E; Carneiro, P L S; Oliveira, H C; Rocha, J M; Santos, I A; Rezende, R P

    2015-01-01

    Leishmaniasis is an endemic disease present in 98 countries. In Brazil, the northeast region accounts for approximately half of the cases in humans, and has experienced an increased number of positive cases in dogs. In this study, we investigated the epidemiology of canine leishmaniasis in the city of Ilhéus, Bahia, using serological and molecular techniques and evaluated the possible environmental risk factors and associated clinical signs. Blood samples were collected from 560 dogs in urban and peri-urban areas in Ilhéus, northeastern Brazil. Genomic DNA was extracted from the selected animals and subjected to molecular analysis using Leishmania species-specific primers and diagnosis of Trypanosoma cruzi. A total of 54.72% of dogs were positive for Leishmania braziliensis, and animals positive for both Leishmania infantum and T. cruzi were not identified. Hematologic variables were not statistically associated with cases of L. braziliensis. However, the positive animal group showed lower red blood cell and platelet counts and higher levels of urea and serum creatinine. Few dogs presented clinical signs compatible with the presence of Leishmania. Age of more than 2 years and specific hair colors were associated with positive results for L. braziliensis. The geoclimatic characteristics of the region may improve parasite survival, reproduction, and vectors. This may explain the higher rate of dogs identified as positive in this study.

  19. I Brazilian Registry of Heart Failure - Clinical Aspects, Care Quality and Hospitalization Outcomes

    PubMed Central

    de Albuquerque, Denilson Campos; de Souza, João David; Bacal, Fernando; Rohde, Luiz Eduardo Paim; Bernardez-Pereira, Sabrina; Berwanger, Otavio; Almeida, Dirceu Rodrigues

    2015-01-01

    Background Heart failure (HF) is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. Objective Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. Methods Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. Results A total of 1,263 patients (64±16 years, 60% women) were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%), dyslipidemia (36.7%) and diabetes (34%). Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. Conclusion The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence. PMID:26131698

  20. Clinical and epidemiological aspects of scorpion stings in the northeast region of Brazil.

    PubMed

    Barros, Rafaella Moreno; Pasquino, Jackeline Araujo; Peixoto, Laisla Rangel; Targino, Isabely Tamarys Gomes; de Sousa, Jorge Alves; Leite, Renner de Souza

    2014-04-01

    Scorpion stings are a serious public health issue in tropical and subtropical countries. This is a descriptive and retrospective study of the clinical-epidemiological characteristics of scorpion sting cases registered in the Health System in the city of Campina Grande, Paraíba state, from 2007 to 2012. Data was collected from the Injury Notification Information System data banks of the Ministry of Health. A total of 2,283 records, provided by the Third Health Sector of Campina Grande, were analyzed. Data revealed that the majority of the victims are female aged between 20 and 29 years, and the highest incidence of stings was in the urban area. Victims were mostly stung on the feet and hand. Serotherapy was not administered in most cases. The majority of the victims received medical assistance within 1 to 3 hours after the sting. The most prevalent clinical manifestations were pain, edema and paresthesias. Most cases were classified as mild, though seven deaths were reported. The high incidence rate suggests that this town may be an endemic area of scorpion stings, supporting the need to develop strategies to control and prevent scorpion stings. PMID:24820610

  1. Therapeutic and clinical aspects of portal vein thrombosis in patients with cirrhosis

    PubMed Central

    Primignani, Massimo; Tosetti, Giulia; La Mura, Vincenzo

    2015-01-01

    Portal vein thrombosis (PVT) is a frequent complication in cirrhosis, particularly in advanced stages of the disease. As for general venous thromboembolism, risk factors for PVT are slow blood flow, vessel wall damage and hypercoagulability, all features of advanced cirrhosis. Actually, the old dogma of a hemorrhagic tendency in cirrhosis has been challenged by new laboratory tools and the clinical evidence that venous thrombosis also occurs in cirrhosis. The impaired hepatic synthesis of both pro- and anticoagulants leads to a rebalanced hemostasis, more liable to be tipped towards thrombosis or even bleeding. Conventional anticoagulant drugs (low molecular weight heparin or vitamin K antagonists) may be used in cirrhosis patients with PVT, particularly in those eligible for liver transplantation, to prevent thrombosis progression thus permitting/facilitating liver transplant. However, several doubts exist on the level of anticoagulation achieved as estimated by coagulation tests, on the efficacy of treatment monitoring and on the correct timing for discontinuation in non-transplant candidates, while in transplant candidates there is expert consensus on continuing anticoagulation until transplantation. The recent introduction of direct acting oral anticoagulant drugs (DOACs) in other clinical settings generates much interest on their possible application in patients with cirrhosis and PVT. However, DOACs were not evaluated yet in patients with liver disease and cannot be recommended for the present time. PMID:26689354

  2. Leishmania (Viannia) braziliensis in dogs in Brazil: epidemiology, co-infection, and clinical aspects.

    PubMed

    Carvalho, F S; Wenceslau, A A; Albuquerque, G R; Munhoz, A D; Gross, E; Carneiro, P L S; Oliveira, H C; Rocha, J M; Santos, I A; Rezende, R P

    2015-01-01

    Leishmaniasis is an endemic disease present in 98 countries. In Brazil, the northeast region accounts for approximately half of the cases in humans, and has experienced an increased number of positive cases in dogs. In this study, we investigated the epidemiology of canine leishmaniasis in the city of Ilhéus, Bahia, using serological and molecular techniques and evaluated the possible environmental risk factors and associated clinical signs. Blood samples were collected from 560 dogs in urban and peri-urban areas in Ilhéus, northeastern Brazil. Genomic DNA was extracted from the selected animals and subjected to molecular analysis using Leishmania species-specific primers and diagnosis of Trypanosoma cruzi. A total of 54.72% of dogs were positive for Leishmania braziliensis, and animals positive for both Leishmania infantum and T. cruzi were not identified. Hematologic variables were not statistically associated with cases of L. braziliensis. However, the positive animal group showed lower red blood cell and platelet counts and higher levels of urea and serum creatinine. Few dogs presented clinical signs compatible with the presence of Leishmania. Age of more than 2 years and specific hair colors were associated with positive results for L. braziliensis. The geoclimatic characteristics of the region may improve parasite survival, reproduction, and vectors. This may explain the higher rate of dogs identified as positive in this study. PMID:26505353

  3. [Clinical and patho-anatomic aspects of metastases of breast cancer].

    PubMed

    Heberling, D; Höffken, H; Kühn, W; Leppien, G; Rieth, J; Rummel, H H; Tshahagane, C

    1984-02-01

    The importance of carcinoma of the breast in female malignancies demands a critical examination of the condition of metastases by means of certain clinical and pathological data. The clinical data and the results of autopsies of 384 patients with breast carcinoma were examined. The frequency and the chronology of occurrence of metastases put out metastases of lymphnodes , skeleton, lung, liver and local recurrences. The importance of the mediastinal lymph node metastases in the distribution of metastases in thoracical organs was established and is discussed. The relation of frequency of the metastases to primary tumour staging (TNM) shows a 63% rate of metastases in patients with No and 86% in patients with N+. A comparison of two decades (I = 1960-1969; II = 1970-1979) shows certain trends 1. In decade II more patients with primary stage T1-T2 NoMo were found in autopsies having less metastases. 2. More local recurrences and metastases of genital organs were diagnosed. 3. In decade II more "late-metastases" (2-10 years after primary diagnosis) were found. These developments are explained by better primary diagnostic methods, more frequent follow-up examinations after primary therapy, and more frequent application of secondary therapies (chemotherapy, radiotherapy). PMID:6329894

  4. Targeting stem cells by radiation: From the biological angle to clinical aspects

    PubMed Central

    Vallard, Alexis; Espenel, Sophie; Guy, Jean-Baptiste; Diao, Peng; Xia, Yaoxiong; El Meddeb Hamrouni, Anis; Ben Mrad, Majed; Falk, Alexander Tuan; Rodriguez-Lafrasse, Claire; Rancoule, Chloé; Magné, Nicolas

    2016-01-01

    Radiotherapy is a cornerstone of anticancer treatment. However in spite of technical evolutions, important rates of failure and of toxicity are still reported. Although numerous pre-clinical data have been published, we address the subject of radiotherapy-stem cells interaction from the clinical efficacy and toxicity perspective. On one side, cancer stem cells (CSCs) have been recently evidenced in most of solid tumor primary locations and are thought to drive radio-resistance phenomena. It is particularly suggested in glioblastoma, where CSCs were showed to be housed in the subventricular zone (SVZ). In recent retrospective studies, the radiation dose to SVZ was identified as an independent factor significantly influencing overall survival. On the other side, healthy tissue stem cells radio-destruction has been recently suggested to cause two of the most quality of life-impacting side effects of radiotherapy, namely memory disorders after brain radiotherapy, and xerostomia after head and neck radiotherapy. Recent publications studying the impact of a radiation dose decrease on healthy brain and salivary stem cells niches suggested significantly reduced long term toxicities. Stem cells comprehension should be a high priority for radiation oncologists, as this particular cell population seems able to widely modulate the efficacy/toxicity ratio of radiotherapy in real life patients.

  5. Influence of cytochrome P450 polymorphisms on drug therapies: pharmacogenetic, pharmacoepigenetic and clinical aspects.

    PubMed

    Ingelman-Sundberg, Magnus; Sim, Sarah C; Gomez, Alvin; Rodriguez-Antona, Cristina

    2007-12-01

    The polymorphic nature of the cytochrome P450 (CYP) genes affects individual drug response and adverse reactions to a great extent. This variation includes copy number variants (CNV), missense mutations, insertions and deletions, and mutations affecting gene expression and activity of mainly CYP2A6, CYP2B6, CYP2C9, CYP2C19 and CYP2D6, which have been extensively studied and well characterized. CYP1A2 and CYP3A4 expression varies significantly, and the cause has been suggested to be mainly of genetic origin but the exact molecular basis remains unknown. We present a review of the major polymorphic CYP alleles and conclude that this variability is of greatest importance for treatment with several antidepressants, antipsychotics, antiulcer drugs, anti-HIV drugs, anticoagulants, antidiabetics and the anticancer drug tamoxifen. We also present tables illustrating the relative importance of specific common CYP alleles for the extent of enzyme functionality. The field of pharmacoepigenetics has just opened, and we present recent examples wherein gene methylation influences the expression of CYP. In addition microRNA (miRNA) regulation of P450 has been described. Furthermore, this review updates the field with respect to regulatory initiatives and experience of predictive pharmacogenetic investigations in the clinics. It is concluded that the pharmacogenetic knowledge regarding CYP polymorphism now developed to a stage where it can be implemented in drug development and in clinical routine for specific drug treatments, thereby improving the drug response and reducing costs for drug treatment.

  6. Targeting stem cells by radiation: From the biological angle to clinical aspects

    PubMed Central

    Vallard, Alexis; Espenel, Sophie; Guy, Jean-Baptiste; Diao, Peng; Xia, Yaoxiong; El Meddeb Hamrouni, Anis; Ben Mrad, Majed; Falk, Alexander Tuan; Rodriguez-Lafrasse, Claire; Rancoule, Chloé; Magné, Nicolas

    2016-01-01

    Radiotherapy is a cornerstone of anticancer treatment. However in spite of technical evolutions, important rates of failure and of toxicity are still reported. Although numerous pre-clinical data have been published, we address the subject of radiotherapy-stem cells interaction from the clinical efficacy and toxicity perspective. On one side, cancer stem cells (CSCs) have been recently evidenced in most of solid tumor primary locations and are thought to drive radio-resistance phenomena. It is particularly suggested in glioblastoma, where CSCs were showed to be housed in the subventricular zone (SVZ). In recent retrospective studies, the radiation dose to SVZ was identified as an independent factor significantly influencing overall survival. On the other side, healthy tissue stem cells radio-destruction has been recently suggested to cause two of the most quality of life-impacting side effects of radiotherapy, namely memory disorders after brain radiotherapy, and xerostomia after head and neck radiotherapy. Recent publications studying the impact of a radiation dose decrease on healthy brain and salivary stem cells niches suggested significantly reduced long term toxicities. Stem cells comprehension should be a high priority for radiation oncologists, as this particular cell population seems able to widely modulate the efficacy/toxicity ratio of radiotherapy in real life patients. PMID:27621758

  7. [Directed therapeutic approach to Staphylococcus aureus infections. Clinical aspects of prescription].

    PubMed

    Carmona-Torre, F; Rua, M; Del Pozo, J L

    2016-09-01

    Infections caused by Staphylococcus aureus have had classically an important impact in morbidity and mortality in the nosocomial and community scene. The description of methicillin resistance among nosocomial isolates of S. aureus and his widespread diffusion has become methicillin-resistant S. aureus (MRSA) in one of the most common causes of bacterial nosocomial infections. In the last years MRSA strains have also emergence in the community. This together with a progressive increase in resistance to antibiotics used classically has become vancomycin in the treatment of choice in most cases according to clinical guidelines. As a result, a progressive rise in the minimum inhibitory concentration (MIC) to vancomycin has been reported. In this context strains with intermediate susceptibility to vancomycin (MIC 8-4 mg/L) and heteroresistance have been noted. These strains are associated with a higher risk of treatment failure when using vancomycin. Among isolates of S. aureus susceptible to vancomycin there has been described stains with elevated MICs (≥1.5 mg/L). It is controversial if the presence of these strains has an impact on clinical outcome if treatment with vancomycin or β-lactams is prescribed. The development of new antibiotics with activity against MRSA and exploring synergies offer a promising alternative to treatment with vancomycin. PMID:27608307

  8. Targeting stem cells by radiation: From the biological angle to clinical aspects.

    PubMed

    Vallard, Alexis; Espenel, Sophie; Guy, Jean-Baptiste; Diao, Peng; Xia, Yaoxiong; El Meddeb Hamrouni, Anis; Ben Mrad, Majed; Falk, Alexander Tuan; Rodriguez-Lafrasse, Claire; Rancoule, Chloé; Magné, Nicolas

    2016-08-26

    Radiotherapy is a cornerstone of anticancer treatment. However in spite of technical evolutions, important rates of failure and of toxicity are still reported. Although numerous pre-clinical data have been published, we address the subject of radiotherapy-stem cells interaction from the clinical efficacy and toxicity perspective. On one side, cancer stem cells (CSCs) have been recently evidenced in most of solid tumor primary locations and are thought to drive radio-resistance phenomena. It is particularly suggested in glioblastoma, where CSCs were showed to be housed in the subventricular zone (SVZ). In recent retrospective studies, the radiation dose to SVZ was identified as an independent factor significantly influencing overall survival. On the other side, healthy tissue stem cells radio-destruction has been recently suggested to cause two of the most quality of life-impacting side effects of radiotherapy, namely memory disorders after brain radiotherapy, and xerostomia after head and neck radiotherapy. Recent publications studying the impact of a radiation dose decrease on healthy brain and salivary stem cells niches suggested significantly reduced long term toxicities. Stem cells comprehension should be a high priority for radiation oncologists, as this particular cell population seems able to widely modulate the efficacy/toxicity ratio of radiotherapy in real life patients. PMID:27621758

  9. VAV3 Oncogene Expression in Colorectal Cancer: Clinical Aspects and Functional Characterization

    PubMed Central

    Uen, Yih-Huei; Fang, Chia-Lang; Hseu, You-Cheng; Shen, Pei-Chun; Yang, Hsin-Ling; Wen, Kuo-Shan; Hung, Shih-Ting; Wang, Lu-Hai; Lin, Kai-Yuan

    2015-01-01

    Although colorectal cancer (CRC) is one of the most common malignancies worldwide, the current therapeutic approaches for advanced CRC are ineffective. In this study, we investigated the involvement of the VAV3 oncogene in tumor progression and in the prognosis of human CRC. The two patient cohorts in this study comprised 354 CRC cases from 1998 to 2005 with documented pathologic and clinical factors and clinical outcomes. VAV3 protein levels were significantly correlated with the depth of invasion (P = 0.0259), the nodal status (P < 0.0001), distant metastasis (P = 0.0354), the stage (P < 0.0001), and poor disease-free survival (P = 0.003). Multivariate Cox regression analysis showed that VAV3 overexpression is an independent prognostic marker for CRC (P = 0.041). In vitro experiments indicated that VAV3 knockdown inhibited CRC cell growth, spread, and xenograft proliferation. Mechanistic studies further revealed that VAV3 overexpression could dysregulate the expression of cell cycle control- and metastasis-related molecules by activating the PI3K-AKT signaling pathway in both CRC cells and xenografts. This study suggests that VAV3 overexpression could be a useful marker for predicting the outcomes of CRC patients and that VAV3 targeting represents a potential modality for treating CRC. PMID:25791293

  10. A Review on the Wettability of Dental Implant Surfaces II: Biological and Clinical Aspects

    PubMed Central

    Gittens, Rolando A.; Scheideler, Lutz; Rupp, Frank; Hyzy, Sharon L.; Geis-Gerstorfer, Jürgen; Schwartz, Zvi; Boyan, Barbara D.

    2014-01-01

    Dental and orthopaedic implants have been under continuous advancement to improve their interactions with bone and ensure a successful outcome for patients. Surface characteristics such as surface topography and surface chemistry can serve as design tools to enhance the biological response around the implant, with in vitro, in vivo and clinical studies confirming their effects. However, the comprehensive design of implants to promote early and long-term osseointegration requires a better understanding of the role of surface wettability and the mechanisms by which it affects the surrounding biological environment. This review provides a general overview of the available information about the contact angle values of experimental and of marketed implant surfaces, some of the techniques used to modify surface wettability of implants, and results from in vitro and clinical studies. We aim to expand the current understanding on the role of wettability of metallic implants at their interface with blood and the biological milieu, as well as with bacteria, and hard and soft tissues. PMID:24709541

  11. [Body dysmorphic disorder: clinical aspects, nosological dimensions and controversies with anorexia nervosa].

    PubMed

    Behar, Rosa; Arancibia, Marcelo; Heitzer, Cristóbal; Meza, Nicolás

    2016-05-01

    There is strong evidence about the co-existence of body dysmorphic disorder (BDD) and eating disorders (ED), particularly with anorexia nervosa (AN). An exhaustive review of the specialised literature regarding these disorders was carried out. The results show that their co-occurrence implies a more complex diagnosis and treatment, a more severe clinical symptomatology and a worse prognosis and outcome. Both disorders display common similarities, differences and comorbidities, which allow authors to classify them in different nosological spectra (somatomorphic, anxious, obsessive-compulsive, affective and psychotic). Their crossover involves higher levels of body dissatisfaction and body image distortion, depression, suicidal tendency, personality disorders, substance use/abuse, obsessive-compulsive disorder, social phobia, alexithymia and childhood abuse or neglect background. Treatment including cognitive-behavioral psychotherapy and selective reuptake serotonin inhibitors are effective for both, BDD and ED; nevertheless, plastic surgery could exacerbate BDD. Clinical traits of BDD must be systematically detected in patients suffering from ED and vice versa. PMID:27552014

  12. Current understanding of androgenetic alopecia. Part II: clinical aspects and treatment.

    PubMed

    Hoffmann, R; Happle, R

    2000-01-01

    The first signs of androgenetic alopecia (AGA) may start to develop with the onset of puberty. The prevalence of progressive AGA approaches 50% of Caucasian men and women beyond the age of 40; whereas in Asian, native American and African-American men the prevalence is lower and AGA is less severe. Only exceptionally laboratory tests or scalp biopsies are needed to confirm the diagnosis. Therefore the clinical assessment of AGA is largely a matter of common sense and practice. The loss of hair is often trivialised, but hair loss may have profound effects on a patient's well-being and quality of life. The treatment of AGA is obscured by myths. Many products or procedures are advertized for the treatment of AGA such as vitamins, trace elements, exotic herbs, amino acids, "soft laser", scalp massage, etc. Most of these techniques or substances have never been verified in sound clinical trials. Because of the psychosocial impact of hair loss, however, it is important to explain to patients what they may expect in terms of continuing hair loss, and that response to any therapy may be slow and may include hair regrowth or only retardation of further thinning. The aim of AGA treatment is to reverse or to stabilize the process of HF miniaturization and with this overview we summarize the present treatment modalities for both men and women. PMID:10882953

  13. Clinical and microbiological aspects of biofilm-associated surgical site infections.

    PubMed

    Edmiston, Charles E; McBain, Andrew J; Roberts, Christopher; Leaper, David

    2015-01-01

    While microbial biofilms have been recognized as being ubiquitous in nature for the past 40 years, it has only been within the past 20 years that clinical practitioners have realized that biofilm play a significant role in both device-related and tissue-based infections. The global impact of surgical site infections (SSIs) is monumental and as many as 80 % of these infections may involve a microbial biofilm. Recent studies suggest that biofilm- producing organisms play a significant role in persistent skin and soft tissue wound infections in the postoperative surgical patient population. Biofilm, on an organizational level, allows bacteria to survive intrinsic and extrinsic defenses that would inactivate the dispersed (planktonic) bacteria. SSIs associated with biomedical implants are notoriously difficult to eradicate using antibiotic regimens that would typically be effective against the same bacteria growing under planktonic conditions. This biofilm-mediated phenomenon is characterized as antimicrobial recalcitrance, which is associated with the survival of a subset of cells including "persister" cells. The ideal method to manage a biofilm-mediated surgical site wound infection is to prevent it from occurring through rational use of antibiotic prophylaxis, adequate skin antisepsis prior to surgery and use of innovative in-situ irrigation procedures; together with antimicrobial suture technology in an effort to promote wound hygiene at the time of closure; once established, biofilm removal remains a significant clinical problem.

  14. Mesenchymal stromal cells derived from various tissues: Biological, clinical and cryopreservation aspects.

    PubMed

    Marquez-Curtis, Leah A; Janowska-Wieczorek, Anna; McGann, Locksley E; Elliott, Janet A W

    2015-10-01

    Originally isolated from bone marrow, mesenchymal stromal cells (MSCs) have since been obtained from various fetal and post-natal tissues and are the focus of an increasing number of clinical trials. Because of their tremendous potential for cellular therapy, regenerative medicine and tissue engineering, it is desirable to cryopreserve and bank MSCs to increase their access and availability. A remarkable amount of research and resources have been expended towards optimizing the protocols, freezing media composition, cooling devices and storage containers, as well as developing good manufacturing practices in order to ensure that MSCs retain their therapeutic characteristics following cryopreservation and that they are safe for clinical use. Here, we first present an overview of the identification of MSCs, their tissue sources and the properties that render them suitable as a cellular therapeutic. Next, we discuss the responses of cells during freezing and focus on the traditional and novel approaches used to cryopreserve MSCs. We conclude that viable MSCs from diverse tissues can be recovered after cryopreservation using a variety of freezing protocols, cryoprotectants, storage periods and temperatures. However, alterations in certain functions of MSCs following cryopreservation warrant future investigations on the recovery of cells post-thaw followed by expansion of functional cells in order to achieve their full therapeutic potential. PMID:26186998

  15. Co-infection by Cryptococcus neoformans and Mycobacterium avium intracellulare in AIDS. Clinical and epidemiological aspects.

    PubMed

    Arastéh, K; Cordes, C; Futh, U; Grosse, G; Dietz, E; Staib, F

    In the observation of various opportunistic pathogens in HIV-positive persons, co-infection by Cryptococcus neoformans together with Mycobacterium avium intracellulare was found if there was a CD4 lymphocyte count as low as 3-20/microliters. In 1540 HIV-positive patients under treatment at a Berlin hospital (Auguste-Viktoria-Krankenhaus) during 1985-1994, all AIDS-relevant diseases were examined in a multivariate analysis as variables of influence on the manifestation of a systemic Mycobacterium avium complex (MAC) infection. The analysis involved data on 36 cases of cryptococcosis and 202 cases with a typical clinical course in whom MAC had been detected at sterile body sites. As significant and independent factors of influence, the following were identified: C. neoformans infection, wasting syndrome, lower age, low CD4 lymphocyte count and preceding Pneumocystis carinii pneumonia (PcP) prophylaxis. Cryptococcosis ranged first with an ods ratio of 2.75. The concomitant manifestation of cryptococcosis and systemic MAC infection in six patients is shown. Because both opportunists, C. neoformans and avian mycobacteria, may have their common habitat in droppings of defined species of pet birds, a common source of infection deserves further clinical and epidemiological attention.

  16. [Triple therapy in cirrhotic patients and those with advanced fibrosis: relevant aspects in clinical practice].

    PubMed

    Albillos, Agustín; Luis Calleja, José; Molina, Esther; Planas, Ramon; Romero-Gómez, Manuel; Turnes, Juan; Hernández-Guerra, Manuel

    2014-07-01

    The first-line option in the treatment of patients with advanced fibrosis and cirrhosis due to genotype 1 hepatitis C virus is currently triple therapy with boceprevir/telaprevir and pegylated interferon-ribavirin. However, certain limitations could constitute a barrier to starting treatment or achieving sustained viral response in these patients. These limitations include the patient's or physician's perception of treatment effectiveness in routine clinical practice-which can weight against the decision to start treatment-, the advanced stage of the disease with portal hypertension and comorbidity, treatment interruption due to poor adherence, and adverse effects, mainly anemia. In addition, it is now possible to identify patients who could benefit from a shorter therapeutic regimen with a similar cure rate. This review discusses these issues and their possible effect on the use of triple therapy. PMID:25907434

  17. Deficiencies of the Natural Anticoagulants – Novel Clinical Laboratory Aspects of Thrombophilia Testing

    PubMed Central

    Gindele, Réka; Speker, Marianna; Kállai, Judit

    2016-01-01

    Venous thrombosis is a typical common complex disease as acquired and genetic causes play a role in its development. The different „loss of function“ mutations of the natural anticoagulant system lead to antithrombin (AT), protein C (PC) and protein S (PS) deficiencies. Since thrombophilia testing has high cost and it has several methodological issues (analytical, pre-analytical), which makes the interpretation of results difficult, considerations should be made on the indications of testing, on the parameters that are measured and on the best available method to use. The latest guideline on clinical and laboratory management of thrombophilia kept the relatively old laboratory recommendations unchanged. This is partly because of the existence of unresolved problems with the laboratory tests used for diagnosis. Based on the literature and our previous research here we discuss the unresolved problems, the recently raised questions and issues concerning AT, PC and PS laboratory diagnosis and summarize the recent findings in molecular genetic investigations. PMID:27683526

  18. [New aspects of etiopathogenesis and clinical characteristics of diabetes mellitus type 1 in children].

    PubMed

    Sajić, Silvija; Necić, Svetislav; Jesić, Maja; Bojić, Vladislav

    2004-10-01

    Apparent increase of the incidence of childhood diabetes mellitus has been observed in many countries over the last decades. Data of seasonality are not consistent, especially in younger group. The triggering of the autoimmune process in genetically susceptible individuals may be the result of a variety of environmental factors including viral infections, specific nutrients, early introduction of cow's milk proteins and ingestion of nitrosamines, stress-inducing events, early perinatal lesions. Clinical studies of the last decade have confirmed that diabetes mellitus in young children is specific type of type 1 diabetes. At presentation, children in preschool age group, who have type 1 diabetes, have higher incidence of ketoacidosis with coma because of immaturity of the central nervous system. Delays in diagnosis in small children often lead to more severe dehydration and ketoacidosis. Chi dren in the young age group who have type 1 diabetes represent unique set of problems for their families and health care team.

  19. Molecular, Cellular and Clinical Aspects of Intracerebral Hemorrhage: Are the Enemies Within?

    PubMed Central

    Righy, Cássia; Bozza, Marcelo T.; Oliveira, Marcus F.; Bozza, Fernando A.

    2016-01-01

    Hemorrhagic stroke is a disease with high incidence and mortality rates. In addition to the mass lesions that result from hemorrhagic stroke, substances such as the blood-derived products (BDP) (hemoglobin (Hb), heme and iron) induce a potent inflammatory response and exert direct toxic effects on neurons, astrocytes, and microglia. In the present review, we discuss the mechanisms of brain injury secondary to hemorrhagic stroke, focusing on the involvement of BDP as major players of cellular redox imbalance, inflammation, and glutamate excitotoxicity. Potential natural mechanisms of protection against free Hb and heme such as haptoglobin and hemopexin, respectively, are highlighted. We finally discuss the experimental and clinical trials targeting free iron and heme scavenging as well as inflammation, as potential new therapies to minimize the devastating effects of hemorrhagic stroke on brain structure and function. PMID:26714583

  20. [Rare malignant tumors of the ovaries in adolescents--clinical aspects in deciding therapeutic aggressiveness].

    PubMed

    Schröder, W; Bau, O

    1990-01-01

    4 patients below the age of 20 years have been treated for a malignant tumor of the ovary during the period November 1, 1984 until April 30, 1988. Dysgerminoma was the diagnosis in two cases, as the third patient suffered from a bilateral malignant teratoma. Burkitt's Lymphoma involved both ovaries primarily in an 17-year-old girl. Retrospectively we analyzed diagnosis, therapy and clinical course of these young patients. Regarding the different histological types of the tumors that have been found we discuss critically current recommendations in therapeutic managements referring chemotherapy and/or radiotherapy. Defined conditions provided surgical treatment, that preserves fertility in early stages of malignant germ cell tumors of adolescent women, may be justified, especially for dysgerminomas. A real benefit relate to survival and quality of life by using chemotherapeutic agents can only be expected, if all prognostic factors are regarded.

  1. [Osteo-articular amyloidosis caused by dialysis. Clinical and radiologic aspects].

    PubMed

    Baldrati, L; Brunetti, L; Rocchi, A; Bonsanto, R; Docci, D; Turci, F

    1990-10-01

    Twenty-nine patients who had received chronic hemodialysis for more than 5 years provided the material for the present study. In 12 of them (41%) there were radiological findings of dialysis related amyloidosis, mainly destructive spondyloarthropathy of the cervical spine (n = 11) and geodes of the shoulder (n = 5). When compared with negative patients, these patients were significantly older (p less than 0.001 and had been dialyzed for longer periods of time (p less than 0.01). Moreover, in such patients there was an higher incidence of carpal tunnel syndrome (p less than 0.025) and shoulder pain (p less than 0.001). Our results confirm that osteoarticular amyloidosis is a frequent long-term complication of chronic hemodialysis and underline the correlation between clinical and radiological findings.

  2. Potential pathogenesis and clinical aspects of pulmonary fibrosis associated with rheumatoid arthritis.

    PubMed

    Gochuico, B R

    2001-01-01

    Pulmonary fibrosis is an extra-articular disorder that can occur in association with rheumatoid arthritis. The differential diagnosis of this disorder is similar to that of idiopathic pulmonary fibrosis, but specific entities such as atypical pulmonary infections and drug-induced interstitial lung disease must be considered as causes of pulmonary fibrosis in patients with rheumatoid arthritis. Although the cause of lung fibrosis in persons with rheumatoid arthritis is unknown, factors that can potentially contribute to the pathogenesis of this pulmonary disease include genetic susceptibility, development of an altered immunologic response, and/or aberrant host repair processes. The clinical course of patients with pulmonary fibrosis and rheumatoid arthritis is heterogeneous but is generally insidious, chronic, and progressive. These patients respond unpredictably to available empiric therapeutic agents and, overall, their prognosis is poor; limited data suggests that the median survival time can be less than 4 years.

  3. Microbiological and clinical aspects of respiratory infections associated with Bordetella bronchiseptica.

    PubMed

    García-de-la-Fuente, Celia; Guzmán, Laura; Cano, María Eliecer; Agüero, Jesús; Sanjuán, Carmen; Rodríguez, Cristina; Aguirre, Amaia; Martínez-Martínez, Luis

    2015-05-01

    Bordetella bronchiseptica is a well-known veterinary pathogen, but its implication in human disease is probably not fully recognized. The purpose of this study was to determine the clinical significance of 36 B. bronchiseptica isolates from respiratory samples of 22 patients. Therefore, we describe microbiological characteristics, including phenotypic and genotypic identification as well as antimicrobial susceptibilities of the isolates. Clonal relatedness was evaluated using pulsed-field gel electrophoresis (PFGE). Most of the patients had some underlying immunosuppressive condition. Eighteen out of 22 (82%) patients had respiratory symptoms, and the death of 2 patients was associated with respiratory infection.All strains were correctly identified at species level by the simultaneous use of phenotypic methods and were confirmed by specific amplification of the upstream region of the fla gene. Tigecycline, minocycline, doxycycline, colistin, and meropenem were the most active agents tested. PFGE analysis revealed that repeated infections involving each patient had been caused by the same strain. PMID:25703895

  4. A clinical report of Type III dens invaginatus: relevant aspects of a combined therapeutic approach.

    PubMed

    Silva E Souza, Patricia de Almeida Rodrigues; de Almeida, Bruno Vila Nova; Tartari, Talita; Alves, Ana Claudia Braga Amoras; Tuji, Farbicio Mesquita; Silva E Souza, Mario Honorato

    2013-01-01

    Dens invaginatus is a developmental abnormality that alters dental morphology; as a result, treating this condition is a challenge for endodontic practices. This article describes how a combination of nonsurgical and surgical therapies was utilized to treat a maxillary central incisor with Type III dens invaginatus and vital pulp. The treatment plan included using computed tomography (CT) for a detailed analysis of the dental anatomy and periapical area, endodontic and surgical procedures, and a 4-year follow-up period that included periodic clinical and radiographic examinations. The follow-up examinations revealed a regression of the apical lesion and no other signs or symptoms. Based on the present case report, the authors concluded that this combination of surgical and nonsurgical approaches was effective and that CT is a valuable auxiliary tool for the study of dental anatomy.

  5. [Acute heart failure and cardiogenic shock: pathophysiology, clinical aspects and management strategies].

    PubMed

    Störk, S; Angermann, C E; Ertl, G

    2005-03-01

    Irrespective of improved medical and interventional therapeutic options, mortality among patients with acute heart failure and cardiogenic shock has remained disappointingly high. Early diagnosis and rapid initiation of basic treatment measures to improve hemodynamics and metabolism are of vital importance until causal therapy, e. g. revascularization, is initiated. Due to the principal difficulty to set up larger clinical trials, in patients with cardiogenic shock empirical rather than firm evidence supports the various treatment and management strategies currently in use. Continuous hemodynamic monitoring to tailor fluid therapy, new drugs, and prognostic markers have been developed for the treatment and monitoring of cardiogenic shock, all of which await testing in larger-scale studies. Ongoing challenges remain the right ventricular pump failure or hemodynamically compromising arrhythmia which may be either cause or consequence of cardiogenic shock. PMID:15702302

  6. [Clinical and epidemiological aspects of the dengue epidemic in Recife, PE, 2002].

    PubMed

    Montenegro, Demetrius; Lacerda, Heloisa Ramos; Lira, Tereza Maciel; Oliveira, Denise Santos Correia de; Lima, Ana Antunes Fonseca de; Guimarães, Maria José Bezerra; Vasconcelos, Petrônio Gusmão de

    2006-01-01

    This paper shows data regarding dengue and hemorrhagic fever of the dengue epidemic in Recife in 2002 and the clinical, laboratorial and necropsy results from the 14 patients who died that year. The serotype Den-3 was detected in 76.3% of cases. The majority of deaths occurred among men, over 20 years old, on the 11th day of disease, attended in the private hospitals. The average values of the hematocrit and platelets were 40.7% and 56,313 p/mm3, respectively. Hepatitis, with high levels of transaminases, occurred in the majority of patients, who generally were anicteric. Of the fourteen deaths, 13 received laboratorial confirmation of the infection. In eight cases death occurred due to hemorrhagic phenomena, however, in the other 6 cases significant bleeding was not identified. Vascular collapse (shock) was present in 12 (85.7%) cases, with or without the association of major bleeding, and was the most important cause of death.

  7. A clinical report of Type III dens invaginatus: relevant aspects of a combined therapeutic approach.

    PubMed

    Silva E Souza, Patricia de Almeida Rodrigues; de Almeida, Bruno Vila Nova; Tartari, Talita; Alves, Ana Claudia Braga Amoras; Tuji, Farbicio Mesquita; Silva E Souza, Mario Honorato

    2013-01-01

    Dens invaginatus is a developmental abnormality that alters dental morphology; as a result, treating this condition is a challenge for endodontic practices. This article describes how a combination of nonsurgical and surgical therapies was utilized to treat a maxillary central incisor with Type III dens invaginatus and vital pulp. The treatment plan included using computed tomography (CT) for a detailed analysis of the dental anatomy and periapical area, endodontic and surgical procedures, and a 4-year follow-up period that included periodic clinical and radiographic examinations. The follow-up examinations revealed a regression of the apical lesion and no other signs or symptoms. Based on the present case report, the authors concluded that this combination of surgical and nonsurgical approaches was effective and that CT is a valuable auxiliary tool for the study of dental anatomy. PMID:23302365

  8. [Regional electro-hyperthermia--technical principles, clinical results and health insurance aspects].

    PubMed

    Heyll, Uwe

    2012-06-01

    The method of electro-hyperthermia is based on the production of alternating currents from capacitive coupled electrodes. Because of the associated heating of body tissues, the electro-hyperthermia is promoted as an alternative to the more sophisticated methods of scientific hyperthermia, which find use in oncologic diseases. The analysis of technical data, however, reveals that the electro-hyperthermia is not qualified for a focused, effective and therapeutically useful heating of circumscribed target areas. Data from clinical studies demonstrating efficacy for defined indications are not available. The application of electro-hyperthermia is excluded form the German system of public health insurance. As proof of medical necessity cannot be provided, there is also no claim for reimbursement from private health insurance. According to legal regulations in Germany, an invoice as hyperthermia treatment is usually not possible. Rather, an item from the electrotherapy section of the official provision of medical fees (GOA) has to be chosen. PMID:22808643

  9. Clinical and Molecular Aspects of MBD5-Associated Neurodevelopmental Disorder (MAND).

    PubMed

    Mullegama, Sureni V; Elsea, Sarah H

    2016-08-01

    MBD5-associated neurodevelopmental disorder (MAND) is an umbrella term that describes a group of disorders, 2q23.1 deletion syndrome, 2q23.1 duplication syndrome, and MBD5 variants, that affect the function of methyl-binding domain 5 (MBD5) and share a common set of neurodevelopmental, cognitive, and behavioral impairments. This review provides a comprehensive clinical and molecular synopsis of 2q23.1 deletion syndrome. Approaches to diagnosis, genetic counseling, and up-to-date management are summarized, followed by a discussion of the molecular and functional role of MBD5. Finally, we also include a brief summary of MBD5 variants that affect function of MBD5 and 2q23.1 duplication syndrome.

  10. Microbiological and clinical aspects of respiratory infections associated with Bordetella bronchiseptica.

    PubMed

    García-de-la-Fuente, Celia; Guzmán, Laura; Cano, María Eliecer; Agüero, Jesús; Sanjuán, Carmen; Rodríguez, Cristina; Aguirre, Amaia; Martínez-Martínez, Luis

    2015-05-01

    Bordetella bronchiseptica is a well-known veterinary pathogen, but its implication in human disease is probably not fully recognized. The purpose of this study was to determine the clinical significance of 36 B. bronchiseptica isolates from respiratory samples of 22 patients. Therefore, we describe microbiological characteristics, including phenotypic and genotypic identification as well as antimicrobial susceptibilities of the isolates. Clonal relatedness was evaluated using pulsed-field gel electrophoresis (PFGE). Most of the patients had some underlying immunosuppressive condition. Eighteen out of 22 (82%) patients had respiratory symptoms, and the death of 2 patients was associated with respiratory infection.All strains were correctly identified at species level by the simultaneous use of phenotypic methods and were confirmed by specific amplification of the upstream region of the fla gene. Tigecycline, minocycline, doxycycline, colistin, and meropenem were the most active agents tested. PFGE analysis revealed that repeated infections involving each patient had been caused by the same strain.

  11. Epidemiological, clinical and pharmacological aspects of headache in a university undergraduate population in Palestine.

    PubMed

    Sweileh, W M; Sawalha, A F; Zyoud, S H; Al-Jabi, S W; Shamseh, F F B; Khalaf, H S

    2010-04-01

    Headache is one of the most common complaints in clinical practice. Few studies regarding headache in university students have been conducted in the Middle East. The objective of this study was to explore the prevalence, clinical characteristics, triggering factors and treatment options of headaches in university undergraduate students in Palestine/Middle East. Data were collected by interviewing a sample of 1900 students. The Headache Assessment Quiz was used to measure quality and severity of headache and to collect data on triggering factors and symptom management. A total of 1808 (95.2%) reported having at least one headache episode in the previous year. A positive family history of headache was found in 40% of students. The prevalence rate of frequent headache (tow or more episodes/month) was found in 1096 (60.9%) students; 613 women (55.9%). Of those having frequent headaches, 228 (20.8%) experienced moderate to severe episodes, 341 (31.2%) had pulsating, throbbing and pounding pain, and 274 (25%) had unilateral pain. The most common triggering factors among students with frequent headaches were: tension/stress (78.2%) and sleep deprivation (75.4%). Less than 5% of students sought medical assistance during headache episodes. Most students (79.1%) reported self-therapy with a single analgesic (53.4%), herbs (10.2%) or combination (15.5%), while 20.9% reported using no medication of any type to decrease pain. Paracetamol (48.5%) followed by ibuprofen (4.9%) were the most commonly used non-prescription analgesic drugs. Headache is a prevalent symptom in the college age population. Further research is needed to determine the prevalence of specific types of headaches. Healthcare providers are required to educate this population as well as to assist students in properly diagnosing and treating headache types. PMID:19673913

  12. Pandemic (H1N1) 2009: epidemiological, clinical and prevention aspects.

    PubMed

    Narain, Jai P; Kumar, Rajesh; Bhatia, Rajesh

    2009-01-01

    The influenza pandemic caused by the new H1N1 virus has by now affected all the continents of the world. However, the extent and likely impact are still uncertain. Like seasonal flu, the illness is mild and self-limiting in a great majority of cases, with only 1%-2% of patients requiring hospitalization. In a few cases, the clinical course can deteriorate in a matter of hours, leading to severe complications and eventually death. The risk of complications is higher among those who have preexisting diseases, such as asthma, heart disease and kidney disease, and among pregnant women. In such cases, antiviral treatment should not be delayed pending laboratory confirmation. The preferred antiviral drug is oseltamivir, and zanamivir is an alternative. Antiviral treatment is not necessary for those who are otherwise healthy, and have mild or uncomplicated illness. It is beneficial for patients with progressive lower respiratory tract disease or pneumonia, and those with underlying medical conditions and pregnant patients. As the supply of antivirals is limited, they should be used judiciously and where appropriate. There is a limited supply of pandemic influenza vaccine available in a few countries and efforts to produce it in India are presently underway. Effective personal preventive measures include shielding one's mouth and nose while coughing and sneezing, frequent washing of hands with soap, avoiding mass gatherings and voluntary isolation by symptomatic individuals. While at present the virus is causing a mild disease, the next wave may be more severe. Hence, enhanced surge capacity of health services is required for the clinical management of an increased patient load. PMID:20334046

  13. Rectal forceps biopsy procedure in cystic fibrosis: technical aspects and patients perspective for clinical trials feasibility

    PubMed Central

    2013-01-01

    Background Measurements of CFTR function in rectal biopsies ex vivo have been used for diagnosis and prognosis of Cystic Fibrosis (CF) disease. Here, we aimed to evaluate this procedure regarding: i) viability of the rectal specimens obtained by biopsy forceps for ex vivo bioelectrical and biochemical laboratory analyses; and ii) overall assessment (comfort, invasiveness, pain, sedation requirement, etc.) of the rectal forceps biopsy procedure from the patients perspective to assess its feasibility as an outcome measure in clinical trials. Methods We compared three bowel preparation solutions (NaCl 0.9%, glycerol 12%, mannitol), and two biopsy forceps (standard and jumbo) in 580 rectal specimens from 132 individuals (CF and non-CF). Assessment of the overall rectal biopsy procedure (obtained by biopsy forceps) by patients was carried out by telephone surveys to 75 individuals who underwent the sigmoidoscopy procedure. Results Integrity and friability of the tissue specimens correlate with their transepithelial resistance (r = −0.438 and −0.305, respectively) and are influenced by the bowel preparation solution and biopsy forceps used, being NaCl and jumbo forceps the most compatible methods with the electrophysiological analysis. The great majority of the individuals (76%) did not report major discomfort due to the short procedure time (max 15 min) and considered it relatively painless (79%). Importantly, most (88%) accept repeating it at least for one more time and 53% for more than 4 times. Conclusions Obtaining rectal biopsies with a flexible endoscope and jumbo forceps after bowel preparation with NaCl solution is a safe procedure that can be adopted for both adults and children of any age, yielding viable specimens for CFTR bioelectrical/biochemical analyses. The procedure is well tolerated by patients, demonstrating its feasibility as an outcome measure in clinical trials. PMID:23688510

  14. The biomechanics of Kansal Separator: A ‘2 in 1’ self-secured orthodontic spring separator

    PubMed Central

    Kumar, Arun; Kansal, Sudhanshu; Thareja, Vimal; Singh, Gurkeerat; Kumar, Piush

    2014-01-01

    Background: An important stage at the very beginning of orthodontic therapy is the separation of teeth where space is created for banding of the molars. A dislodged separator may create problems if ingested or it may get wedged between the adjacent teeth causing acute localized periodontitis. In order to overcome these shortcomings of conventional separators, the Kansal Separator was conceptualized. This separator has been designed as a single device that acts simultaneously on both mesial and distal aspects of tooth, causing adequate separation. In addition to separator's independent 2 in 1 action, the self-locking connecting bar prevents the premature dislodgement of the separator. Aim: To determine the force vectors produced by Kansal separator. Materials and Methods: A prototype model was created to study the forces produced. Results: The separator's unique design is based on sound biomechanical principles that explicate the proof of concept and allows the separator to be distinctly effective and efficient in variable clinical situations, thus amplifying its uniqueness. Discussion: The Kansal Separator, a 2 in 1 orthodontic tooth separator, has a unique design enabling the device to simultaneously separate the teeth on the mesial and distal aspect of the tooth to be banded. Conclusion: Kansal Separator's unique design is based on sound biomechanical principles that explicate the proof of concept and allows the separator to be distinctly effective and efficient in variable clinical situations, thus amplifying its uniqueness. PMID:24987658

  15. Scorpion envenoming in the north of Mali (West Africa): epidemiological, clinical and therapeutic aspects.

    PubMed

    Dabo, A; Golou, G; Traoré, M S; Diarra, N; Goyffon, M; Doumbo, O

    2011-08-01

    Scorpion envenomation remains a poorly known problem in sub-Saharan Africa, particularly in Mali, where the incidence is high in Northern area of the country (Sahara desert). We conducted a prospective study in two district health centers, Kidal and Tessalit (North-east of Mali), to describe the epidemiological, clinical and therapeutic features of scorpion stings. This study consisted of an exhaustive follow-up from admission to discharge of all patients stung by scorpions. Of a total of 282 cases recorded during one year, 207 (73.4%) occurred in Kidal, and the remaining 75 (26.6%) took place in Tessalit. The annual incidence was significantly higher in Tessalit (437 cases/100,000 population/year) than in Kidal (243 cases/100,000 population/year) (p < 10⁻⁶). Two hundred two (71.6%) stings occurred inside human dwellings, 142 (50.4%) during sleeping/resting, especially in August. One hundred ninety-one (67.7%) were on the lower extremities. Nocturnal stings, 168 (59.6%), occurred more often than diurnal stings, 114 (40.4%). Most patients, 163 (57.8%), were admitted less than 1 h after being stung. Local pain at the sting site was the common primary complaint. However, moderate and severe clinical signs were significantly higher in children than in adults (p < 0.05). The death rate (3.9%) was higher in children (3.5%) than in adults (0.3%) (p = 8.10⁻⁶; RR = 0.90 [IC: 0.84-0.06]). Of the 22 scorpion species identified, 13 (59.1%) were Leiurus quinquestriiatus, 8 (36.4%) were Androctonus amoreuxi, and 1 (4.5%) specimen was Buthiscus bicalcaratus. From these species, L. quinquestriiatus and A. amoreuxi were responsible of stings. The medical treatment was only symptomatic, and one hundred twenty-eight (45.3%) patients received traditional remedies before seeking medical attention. Our findings suggest that scorpion stings are common in the north of Mali and are a significant threat to human health.

  16. Strangles in Arabian horses in Egypt: Clinical, epidemiological, hematological, and biochemical aspects

    PubMed Central

    Neamat-Allah, Ahmed N. F.; Damaty, Hend M. El

    2016-01-01

    Aim: Respiratory tract infections are considered the major problem of equine worldwide. Strangles is an infectious and highly contagious respiratory bacterial disease of equine caused by Streptococcus equi. This study is aimed to evaluate some clinical and epidemiological investigation associated with strangles and to study the hematological and biochemical changes in 20 Arabian horse naturally infected with S. equi during the disease and after 10 days from treatment by procaine penicillin with benzathine penicillin. Materials and Methods: A total of 490 Arabian horses have been examined, 120 (24.5%) have been clinically diagnosed as strangles. Under complete aseptic conditions, nasal swabs and pus samples from those were collected for bacterial culture. 20 horses from the positive infected with S. equi have been treated by 6 mg/kg b.wt procaine penicillin with 4.5 mg/kg b.wt benzathine penicillin deep intramuscular injection/twice dose/4 days interval. Results: 102 horses (20.8%) were found positive for S. equi. Horses with age group under 1 year were the most prone to strangles (32.25%) followed by horses of the age group from 1 to 2 years (20%) and finally of the age group over 2-4 years (11.89%). Hematological parameters revealed anemia in the infected horses, while leucogram revealed a significant increase in the total leucocytic, granulocytic and monocytic counts without a significant change in the lymphocytic count. Biochemical parameters revealed a significant increase in serum aspartate aminotransferase, total proteins, globulins, cardiac troponin I (cTnI), and potassium. In other side, hypoalbuminemia and hyponatremia have been reported, whereas alanine aminotransferase activity and creatinine level showed non-significant changes. Respiratory acidosis has been exhibited in the infected horses. Treatment of horses by procaine penicillin with benzathine penicillin revealed improvement of these parameters toward the healthy horses. Conclusion: S. equi easily

  17. Sustainable clinical research, health economic aspects and medical marketing: drivers of product innovation.

    PubMed

    Haschke, Ferdinand; Klassen-Wigger, Petra

    2010-01-01

    Marketing-driven innovation in the field of pediatric nutrition, in particular in the infant formula segment is not sustainable. New benefits of products must be scientifically proven and safety and efficacy of new formulae established in clinical trials. The scientific innovation process of three infant formulae is described. Improvement in protein quality allowed to reduce the protein concentration in whey-based infant formula. Weight gain and BMI of infants fed those formulae corresponds to breastfed infants and is lower than in infants fed traditional formulae with higher protein concentration. A meta-analysis indicates associations between rapid weight gain in infancy and obesity later in life. If infants cannot be exclusively breastfed until 4-6 months of age, feeding low-protein formulae may contribute to positive long-term health outcome with potentially important health economic effects. A partially hydrolyzed whey based formula for prevention of allergic symptoms in children with hereditary risk for allergic diseases was developed more than 25 years ago. The most recent meta-analysis which included 15 randomized clinical trials indicates that the risk of all allergic diseases and atopic dermatitis/eczema is significantly reduced in infants at risk when the partially hydrolyzed formula is fed. The partially hydrolyzed formula had the same protective effect as casein-based high-degree extensively hydrolyzed formula. Because of substantial price differences between the two formulae, feeding the partially hydrolyzed whey formula is cost saving. Hypoallergenic claims can be made in many countries, and international nutrition committees have positively commented the preventive effect of those formulae. Acidified formulae have been widely used during the last decade in replacement feeding programs for infants whose mothers are HIV positive. The formula was innovated by improving whey protein quality and lowering protein concentration. The bacteriostatic

  18. Scorpion envenoming in the north of Mali (West Africa): epidemiological, clinical and therapeutic aspects.

    PubMed

    Dabo, A; Golou, G; Traoré, M S; Diarra, N; Goyffon, M; Doumbo, O

    2011-08-01

    Scorpion envenomation remains a poorly known problem in sub-Saharan Africa, particularly in Mali, where the incidence is high in Northern area of the country (Sahara desert). We conducted a prospective study in two district health centers, Kidal and Tessalit (North-east of Mali), to describe the epidemiological, clinical and therapeutic features of scorpion stings. This study consisted of an exhaustive follow-up from admission to discharge of all patients stung by scorpions. Of a total of 282 cases recorded during one year, 207 (73.4%) occurred in Kidal, and the remaining 75 (26.6%) took place in Tessalit. The annual incidence was significantly higher in Tessalit (437 cases/100,000 population/year) than in Kidal (243 cases/100,000 population/year) (p < 10⁻⁶). Two hundred two (71.6%) stings occurred inside human dwellings, 142 (50.4%) during sleeping/resting, especially in August. One hundred ninety-one (67.7%) were on the lower extremities. Nocturnal stings, 168 (59.6%), occurred more often than diurnal stings, 114 (40.4%). Most patients, 163 (57.8%), were admitted less than 1 h after being stung. Local pain at the sting site was the common primary complaint. However, moderate and severe clinical signs were significantly higher in children than in adults (p < 0.05). The death rate (3.9%) was higher in children (3.5%) than in adults (0.3%) (p = 8.10⁻⁶; RR = 0.90 [IC: 0.84-0.06]). Of the 22 scorpion species identified, 13 (59.1%) were Leiurus quinquestriiatus, 8 (36.4%) were Androctonus amoreuxi, and 1 (4.5%) specimen was Buthiscus bicalcaratus. From these species, L. quinquestriiatus and A. amoreuxi were responsible of stings. The medical treatment was only symptomatic, and one hundred twenty-eight (45.3%) patients received traditional remedies before seeking medical attention. Our findings suggest that scorpion stings are common in the north of Mali and are a significant threat to human health. PMID:21605586

  19. Strangles in Arabian horses in Egypt: Clinical, epidemiological, hematological, and biochemical aspects

    PubMed Central

    Neamat-Allah, Ahmed N. F.; Damaty, Hend M. El

    2016-01-01

    Aim: Respiratory tract infections are considered the major problem of equine worldwide. Strangles is an infectious and highly contagious respiratory bacterial disease of equine caused by Streptococcus equi. This study is aimed to evaluate some clinical and epidemiological investigation associated with strangles and to study the hematological and biochemical changes in 20 Arabian horse naturally infected with S. equi during the disease and after 10 days from treatment by procaine penicillin with benzathine penicillin. Materials and Methods: A total of 490 Arabian horses have been examined, 120 (24.5%) have been clinically diagnosed as strangles. Under complete aseptic conditions, nasal swabs and pus samples from those were collected for bacterial culture. 20 horses from the positive infected with S. equi have been treated by 6 mg/kg b.wt procaine penicillin with 4.5 mg/kg b.wt benzathine penicillin deep intramuscular injection/twice dose/4 days interval. Results: 102 horses (20.8%) were found positive for S. equi. Horses with age group under 1 year were the most prone to strangles (32.25%) followed by horses of the age group from 1 to 2 years (20%) and finally of the age group over 2-4 years (11.89%). Hematological parameters revealed anemia in the infected horses, while leucogram revealed a significant increase in the total leucocytic, granulocytic and monocytic counts without a significant change in the lymphocytic count. Biochemical parameters revealed a significant increase in serum aspartate aminotransferase, total proteins, globulins, cardiac troponin I (cTnI), and potassium. In other side, hypoalbuminemia and hyponatremia have been reported, whereas alanine aminotransferase activity and creatinine level showed non-significant changes. Respiratory acidosis has been exhibited in the infected horses. Treatment of horses by procaine penicillin with benzathine penicillin revealed improvement of these parameters toward the healthy horses. Conclusion: S. equi easily

  20. Clinical aspects of obesity in childhood and adolescence--diagnosis, treatment and prevention.

    PubMed

    Kiess, W; Reich, A; Müller, G; Meyer, K; Galler, A; Bennek, J; Kratzsch, J

    2001-05-01

    The level of fatness at which morbidity increases is determined on an acturial basis. Direct measurements of body fat content, eg hydrodensitometry, bioimpedance or DEXA, are useful tools in scientific studies. However, body mass index (BMI) is easy to calculate and is frequently used to define obesity clinically. An increased risk of death from cardiovascular disease in adults has been found in subjects whose BMI had been greater than the 75th percentile as adolescents. Childhood obesity seems to increase the risk of subsequent morbidity whether or not obesity persists into adulthood. The genetic basis of childhood obesity has been elucidated to some extent through the discovery of leptin, the ob gene product, and the increasing knowledge on the role of neuropeptides such as POMC, neuropeptide Y (NPY) and the melanocyte concentrating hormone receptors (MC4R). Environmental/exogenous factors contribute to the development of a high degree of body fatness early in life. Twin studies suggest that approximately 50% of the tendency toward obesity is inherited. There are numerous disorders including a number of endocrine disorders (Cushing's syndrome, hypothyroidism, etc) and genetic syndromes (Prader-Labhard-Willi syndrome, Bardet-Biedl syndrome etc) that can present with obesity. A simple diagnostic algorithm allows for the differentiation between primary or secondary obesity. Among the most common sequelae of primary childhood obesity are hypertension, dyslipidemia and psychosocial problems. Therapeutic strategies include psychological and family therapy, lifestyle/behavior modification and nutrition education. The role of regular exercise and exercise programs is emphasized. Surgical procedures and drugs used as treatments for adult obesity are still not recommended for children and adolescents with obesity. As obesity is the most common chronic disorder in the industrialized societies, its impact on individual lives as well as on health economics has to be

  1. The Role of Human Chorionic Gonadotropin as Tumor Marker: Biochemical and Clinical Aspects.

    PubMed

    Sisinni, Lorenza; Landriscina, Matteo

    2015-01-01

    Tumor markers are biological substances that are produced/released mainly by malignant tumor cells, enter the circulation in detectable amounts and are potential indicators of the presence of a tumor. The most useful biochemical markers are the tumor-specific molecules, i.e., receptors, enzymes, hormones, growth factors or biological response modifiers that are specifically produced by tumor cells and not, or minimally, by the normal counterpart (Richard et al. Principles and practice of gynecologic oncology. Wolters Kluwer Health, Philadelphia, 2009). Based on their specificity and sensitivity in each malignancy, biomarkers are used for screening, diagnosis, disease monitoring and therapeutic response assessment in clinical management of cancer patients.This chapter is focused on human chorionic gonadotropin (hCG), a hormone with a variety of functions and widely used as a tumor biomarker in selected tumors. Indeed, hCG is expressed by both trophoblastic and non-trophoblastic human malignancies and plays a role in cell transformation, angiogenesis, metastatization, and immune escape, all process central to cancer progression. Of note, hCG testing is crucial for the clinical management of placental trophoblastic malignancies and germ cell tumors of the testis and the ovary. Furthermore, the production of hCG by tumor cells is accompanied by varying degrees of release of the free subunits into the circulation, and this is relevant for the management of cancer patients (Triozzi PL, Stevens VC, Oncol Rep 6(1):7-17, 1999).The name chorionic gonadotropin was conceived: chorion derives from the latin chordate meaning afterbirth, gonadotropin indicates that the hormone is a gonadotropic molecule, acting on the ovaries and promoting steroid production (Cole LA, Int J Endocrinol Metab 9(2):335-352, 2011). The function, the mechanism of action and the interaction between hCG and its receptor continue to be the subject of intensive investigation, even though many issues about

  2. [Clinical aspects, epidemiology and economic impact of foot epidermomycosis in an industrial milieu].

    PubMed

    Grosshans, E; Schwaab, E; Samsoen, M; Grange, D; Koenig, H; Kremer, M

    1986-01-01

    Fungal infections of the feet are very common in some professions. This has been particularly studied in coal mine workers up to 50 p. 100 of whom were found to have dermatophytosis of the feet. The purpose of this study was to determine the clinical, epidemiological and evolutive characteristics of interdigital and plantar intertrigo of the feet among people working in a coking plant, a potash mine and a motorcar factory. We have also evaluated the cost of treatments in relation to their immediate effectiveness and their preventive effects on relapses. Initially, 208 workers entered the study: 84 (40.7 p. 100) had a mycotic infection (M) and 124 (59.3 p. 100) presented with a non-mycotic (NM) inflammation between the toes and on the soles, characterized by maceration of the skin, hyperhidrosis and bromhidrosis. Change in the lesions under treatment were subjected to statistical analysis. In both M and NM groups the workers were allocated by randomization to a double-blind treatment consisting of: group M: either 2 p. 100 miconazole powder or talcum powder with 2 p. 100 salicylic acid and boric acid; group NM: either 2 p. 100 miconazole powder or ordinary talcum powder. Each subject was seen on at least two occasions after 3 and 12 months of daily foot care and topical treatment. Mycological examinations in group M subjects showed that fungal infections of the feet were primarily due to Trichophyton mentagrophytes or to Trichophyton rubrum. A logistic regression analysis (BMDPLR program) of anamnestic and clinical data (table IV) led to a "mathematical model of the mycotic foot", characterized by 6 main parameters of statistically significant occurrence: a history of interdigital-plantar intertrigo, recurrent in 90 p. 100 of subjects in group M (significant association at 0.1 p. 100); a functional symptom, pruritus, present in 71 p. 100 of subjects with mycosis; the stronger, more disturbing the pruritus, the greater the probability of it being of fungal origin

  3. Emerging from obscurity: biological, clinical, and diagnostic aspects of Dientamoeba fragilis.

    PubMed

    Johnson, Eugene H; Windsor, Jeffrey J; Clark, C Graham

    2004-07-01

    Ever since its first description in 1918, Dientamoeba fragilis has struggled to gain recognition as a significant pathogen. There is little justification for this neglect, however, since there exists a growing body of case reports from numerous countries around the world that have linked this protozoal parasite to clinical manifestations such as diarrhea, abdominal pain, flatulence, and anorexia. A number of studies have even incriminated D. fragilis as a cause of irritable bowel syndrome, allergic colitis, and diarrhea in human immunodeficiency virus patients. Although D. fragilis is most commonly identified using permanently stained fecal smears, recent advances in culturing techniques are simplifying as well as improving the ability of investigators to detect this organism. However, there are limitations in the use of cultures since they cannot be performed on fecal samples that have been fixed. Significant progress has been made in the biological classification of this organism, which originally was described as an ameba. Analyses of small-subunit rRNA gene sequences have clearly demonstrated its close relationship to Histomonas, and it is now known to be a trichomonad. How the organism is transmitted remains a mystery, although there is some evidence that D. fragilis might be transmitted via the ova of the pinworm, Enterobius vermicularis. Also, it remains to be answered whether the two distinct genotypes of D. fragilis recently identified represent organisms with differing virulence. PMID:15258093

  4. [Pathophysiological and clinical aspects of using L-arginine in cardiology and angiology].

    PubMed

    Valeev, V V; Trashkov, A P; Kovalenko, A L; Vasil'ev, A G

    2016-01-01

    Presented herein is a review of scientific publications dedicated to studying the pharmacodynamics of L-arginine and possibilities of its clinical application. Interest to L-arginine is associated, first of all, with its role as a precursor in endogenous synthesis of nitric oxide (NO), playing an important role in regulation of the functional state of the vascular wall. According to numerous studies, oral and parenteral administration of L-arginine restores endothelial production of NO in such diseases as atherosclerosis, hypertension, type 2 diabetes mellitus, obliterating diseases of arteries of lower extremities. The NO-mediated effect of L-arginine manifests itself in increasing the capability of vessels to dilatation, decreasing blood platelet aggregation, and inhibiting proliferation of smooth muscle cells of vessels. The effect is most pronounced in patients presenting with hypercholesterolaemia and initially decreased reactivity of the blood channel. The mostly pronounced NO-mediated effect of L-arginine is observed in parenteral route of its administration. Prolonged administration of L-arginine slows down progression of atherosclerosis. PMID:27626244

  5. Serology of Lupus Erythematosus: Correlation between Immunopathological Features and Clinical Aspects

    PubMed Central

    Cozzani, Emanuele; Drosera, Massimo; Parodi, Aurora

    2014-01-01

    Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the aberrant production of a broad and heterogenous group of autoantibodies. Even though the presence of autoantibodies in SLE has been known, for more than 60 years, still nowadays a great effort is being made to understand the pathogenetic, diagnostic, and prognostic meaning of such autoantibodies. Antibodies to ds-DNA are useful for the diagnosis of SLE, to monitor the disease activity, and correlate with renal and central nervous involvements. Anti-Sm antibodies are highly specific for SLE. Anti-nucleosome antibodies are an excellent marker for SLE and good predictors of flares in quiescent lupus. Anti-histone antibodies characterize drug-induced lupus, while anti-SSA/Ro and anti-SSB/La antibodies are associated with neonatal lupus erythematosus and photosensitivity. Anti-ribosomal P antibodies play a role in neuropsychiatric lupus, but their association with clinical manifestations is still unclear. Anti-phospholipid antibodies are associated with the anti-phospholipid syndrome, cerebral vascular disease, and neuropsychiatric lupus. Anti-C1q antibodies amplify glomerular injury, and the elevation of their titers may predict renal flares. Anti-RNP antibodies are a marker of Sharp's syndrome but can be found in SLE as well. Anti-PCNA antibodies are present in 5–10% of SLE patients especially those with arthritis and hypocomplementemia. PMID:24649358

  6. Solitary fibrous tumor of the kidney with focus on clinical and pathobiological aspects.

    PubMed

    Kuroda, Naoto; Ohe, Chisato; Sakaida, Noriko; Uemura, Yoshiko; Inoue, Keiji; Nagashima, Yoji; Hes, Ondrej; Michal, Michal

    2014-01-01

    Renal solitary fibrous tumor (SFT) is a rare, and a large scale study on this topic is lacking to date. In this article, we summarize the previously reported cases. The symptoms and signs resemble those of renal cell carcinoma, including hematuria, flank/abdominal/lumbar pain and palpable abdominal mass. Grossly, the tumor demonstrates a well-circumscribed solid mass. Microscopically, the tumor consists of fusiform or ovoid spindle cells and a various amounts of collagen bundles with patternless, storiform, or fascicular arrangements with an occasional hemangiopericytomatous pattern. Immunohistochemically, CD34, CD99 and bcl-2 are often detected. Ultrastructurally, tumor cells contain irregular nuclei, prominent Golgi apparatus, branching rough endoplasmic reticulum, variable numbers of mitochondria. Surgical resection is considered to be the gold standard therapy. Most of renal SFT are benign, but cases of approximately 10 to 15% behave in an aggressive fashion. All patients need to be on long-term follow-up because clinical behavior is rather unpredictable. As the molecular genetic study of renal SFTs is lacking, a large scale study will be desirable in the future.

  7. A Critical Overview on the Pharmacological and Clinical Aspects of Popular Satureja Species.

    PubMed

    Jafari, Fereshteh; Ghavidel, Fatemeh; Zarshenas, Mohammad M

    2016-06-01

    Throughout the world, various parts of most Satureja species are traditionally used to treat patients with various diseases and complications. As for the presence of different classes of metabolites in Satureja and their numerous ethnomedical and ethnopharmacological applications, many species have been pharmacologically evaluated. The current work aimed to compile information from pharmacological studies on this savory for further investigations. The keyword Satureja was searched through Scopus and PubMed up to January 1, 2016. We found nearly 55 papers that dealt with the pharmacology of Satureja. We found that 13 species had been evaluated pharmacologically and that Satureja khuzestanica, Satureja bachtiarica, Satureja montana and Satureja hortensis appeared to be the most active, both clinically and phytopharmacologically. Regarding the content of rich essential oil, most evaluations were concerned with the antimicrobial properties. However, the antioxidant, antidiabetic and anticholesterolemic properties of the studied species were found to be good. In addition to the pharmacological activities that have been indentified for some species, opportunities still exist to assess the effectiveness of other well-known species. If different Satureja species are to have extensive ethnopharmacological applications, comprehensive assessments of the acute and chronic toxicities, as well as the teratogenicity, of those plants are needed. PMID:27342885

  8. [Autoimmune diseases of the peripheral cornea. Immunopathology, clinical aspects and therapy].

    PubMed

    Pleyer, U; Bergmann, L; Krause, A; Hartmann, C

    1996-02-01

    Noninfectious ulceration of the peripheral cornea remains a major diagnostic and therapeutic challenge. The pathogenesis in most of these disorders is unclear, however, on the basis of systemic connective tissue diseases, autoimmune mechanisms are most likely involved. The peripheral cornea has distinct morphological and immunological characteristics that predispose for inflammatory reactions. Major differences exist regarding humoral and cellular components of the immune system. In the peripheral cornea there is more high-molecular IgM and initial complement component C1 than in the central cornea and may predispose for immune complex formation. The close contact to the conjunctival vasculature provides the basis necessary to generate an immune response. Langerhans cells and macrophages as important antigen presenting and processing cells are present in higher number in the peripheral cornea. Autoimmune diseases that affect the peripheral cornea include collagen vascular diseases and Mooren's ulcer. Although this association is obvious in advanced rheumatoid arthritis more subtle forms of polyarteritis nodosa or systemic lupus erythematosus require careful medical evaluation and workup. Ocular manifestations may present as the initial clinical signs and require careful workup in these potentially lethal disorders.

  9. Soluble Epidermal Growth Factor Receptors (sEGFRs) in Cancer: Biological Aspects and Clinical Relevance

    PubMed Central

    Maramotti, Sally; Paci, Massimiliano; Manzotti, Gloria; Rapicetta, Cristian; Gugnoni, Mila; Galeone, Carla; Cesario, Alfredo; Lococo, Filippo

    2016-01-01

    The identification of molecules that can reliably detect the presence of a tumor or predict its behavior is one of the biggest challenges of research in cancer biology. Biological fluids are intriguing mediums, containing many molecules that express the individual health status and, accordingly, may be useful in establishing the potential risk of cancer, defining differential diagnosis and prognosis, predicting the response to treatment, and monitoring the disease progression. The existence of circulating soluble growth factor receptors (sGFRs) deriving from their membrane counterparts has stimulated the interest of researchers to investigate the use of such molecules as potential cancer biomarkers. But what are the origins of circulating sGFRs? Are they naturally occurring molecules or tumor-derived products? Among these, the epidermal growth factor receptor (EGFR) is a cell-surface molecule significantly involved in cancer development and progression; it can be processed into biological active soluble isoforms (sEGFR). We have carried out an extensive review of the currently available literature on the sEGFRs and their mechanisms of regulation and biological function, with the intent to clarify the role of these molecules in cancer (and other pathological conditions) and, on the basis of the retrieved evidences, speculate about their potential use in the clinical setting. PMID:27104520

  10. Pathogenesis, Epidemiology, Diagnosis and Clinical Aspects of Smith-Lemli-Opitz Syndrome

    PubMed Central

    Bianconi, Simona E.; Cross, Joanna L.; Wassif, Christopher A.; Porter, Forbes D.

    2015-01-01

    Introduction Smith-Lemli-Opitz Syndrome (SLOS) is a malformation syndrome inherited in an autosomal recessive fashion. It is due to a metabolic defect in the conversion of 7-dehydrocholesterol to cholesterol, which leads to an accumulation of 7-dehydrocholesterol and frequently a deficiency of cholesterol. The syndrome is characterized by typical dysmorphic facial features, multiple malformations, and intellectual disability. Areas covered In this paper we provide an overview of the clinical phenotype and discuss how the manifestations of the syndrome vary depending on the age of the patients. We then explore the underlying biochemical defect and pathophysiological alterations that may contribute to the many disease manifestations. Subsequently we explore the epidemiology and succinctly discuss population genetics as they relate to SLOS. The next section presents the diagnostic possibilities. Thereafter, the treatment and management as is standard of care are presented. Expert opinion Even though the knowledge of the underlying molecular mutations and the biochemical alterations is being rapidly accumulated, there is currently no efficacious therapy addressing neurological dysfunction. We discuss the difficulty of treating this disorder, which manifests as a combination of a malformation syndrome and an inborn error of metabolism. A very important factor in developing new therapies is the need to rigorously establish efficacy in controlled trials. PMID:25734025

  11. Clinical aspects and adrenal functions in eleven Japanese children with X-linked adrenoleukodystrophy.

    PubMed

    Miyoshi, Yoko; Sakai, Norio; Hamada, Yusuke; Tachibana, Makiko; Hasegawa, Yasuhiro; Kiyohara, Yuki; Yamada, Hiroyuki; Murakami, Mari; Kondou, Hiroki; Kimura-Ohba, Shihoko; Mine, Junji; Sato, Tatsuharu; Kamio, Noriko; Ueda, Hitoshi; Suzuki, Yasuhiro; Shiomi, Masashi; Ohta, Hideaki; Shimozawa, Nobuyuki; Ozono, Keiichi

    2010-01-01

    X-linked adrenoleukodystrophy (X-ALD) is a genetic disease associated with demyelination of the central nervous system, adrenocortical insufficiency and accumulation of very long chain fatty acids. It is a clinically heterogeneous disorder ranging from a severe childhood cerebral form to an asymptomatic form. The incidence in Japan is estimated to be between 1:30,000 and 1:50,000 boys as determined by a nationwide retrospective survey between 1990 and 1999, which found no cases with Addison's form. We reviewed the medical records of eleven Japanese boys with X-ALD from 1990 to 2010 in our institute. Eight patients were detected by neuropsychological abnormalities, whereas a higher prevalence of unrecognized adrenocortical insufficiency (5/11: 45%) was observed than previously recognized. While no neurological abnormalities were demonstrated in two brothers, the elder brother had moderate Addison's disease at diagnosis and the presymptomatic younger brother progressed to Addison's disease six months after the diagnosis of X-ALD. Early detection of impaired adrenal function as well as early identification of neurologically presymptomatic patients by genetic analysis is essential for better prognosis. Addison's form might be overlooked in Japan; therefore, X-ALD should be suspected in patients with adrenocortical insufficiency.

  12. Emerging from Obscurity: Biological, Clinical, and Diagnostic Aspects of Dientamoeba fragilis

    PubMed Central

    Johnson, Eugene H.; Windsor, Jeffrey J.; Clark, C. Graham

    2004-01-01

    Ever since its first description in 1918, Dientamoeba fragilis has struggled to gain recognition as a significant pathogen. There is little justification for this neglect, however, since there exists a growing body of case reports from numerous countries around the world that have linked this protozoal parasite to clinical manifestations such as diarrhea, abdominal pain, flatulence, and anorexia. A number of studies have even incriminated D. fragilis as a cause of irritable bowel syndrome, allergic colitis, and diarrhea in human immunodeficiency virus patients. Although D. fragilis is most commonly identified using permanently stained fecal smears, recent advances in culturing techniques are simplifying as well as improving the ability of investigators to detect this organism. However, there are limitations in the use of cultures since they cannot be performed on fecal samples that have been fixed. Significant progress has been made in the biological classification of this organism, which originally was described as an ameba. Analyses of small-subunit rRNA gene sequences have clearly demonstrated its close relationship to Histomonas, and it is now known to be a trichomonad. How the organism is transmitted remains a mystery, although there is some evidence that D. fragilis might be transmitted via the ova of the pinworm, Enterobius vermicularis. Also, it remains to be answered whether the two distinct genotypes of D. fragilis recently identified represent organisms with differing virulence. PMID:15258093

  13. Clinical Aspects associated with Syndromic forms of Orofacial Clefts in a Colombian population

    PubMed Central

    Briceño Balcazar, Ignacio; Martinez Lozano, Julio; Collins, Andrew; Uricoechea Patiño, Daniel Alfredo

    2015-01-01

    Objectives: To present descriptive epidemiology of Orofacial Clefts and to determine the association of syndromic forms with antenatal high-risk conditions, preterm birth, and comorbidities among nested-series of cases. Methods: A study of nested-series of cases was conducted. Frequencies of cleft type, associated congenital anomalies, syndromic, non-syndromic and multiple malformation forms, and distribution of Orofacial Clefts according to sex and affected-side were determined. Odds ratios were calculated as measures of association between syndromic forms and antenatal high-risk conditions, preterm birth and comorbidities. A total of three hundred and eleven patients with Orofacial Clefts were assessed in a 12-month period. Results: The most frequent type of Orofacial Clefts was cleft lip and palate, this type of cleft was more frequent in males, whereas cleft palate occurred more often in females. The most common cases occurred as non-syndromic forms. Aarskog-Scott syndrome showed the highest frequency amongst syndromic forms. Hypertensive disorders in pregnancy, developmental dysplasia of the hip, central nervous diseases and respiratory failure showed significant statistical associations (p <0.05) with syndromic forms. Conclusions: These data provide an epidemiological reference of Orofacial Clefts in Colombia. Novel associations between syndromic forms and clinical variables are determined. In order to investigate causality relationships between these variables further studies must be carried out. PMID:26848196

  14. Physiopathological, Epidemiological, Clinical and Therapeutic Aspects of Exercise-Associated Hyponatremia

    PubMed Central

    Urso, Caterina; Brucculeri, Salvatore; Caimi, Gregorio

    2014-01-01

    Exercise-associated hyponatremia (EAH) is dilutional hyponatremia, a variant of inappropriate antidiuretic hormone secretion (SIADH), characterized by a plasma concentration of sodium lower than 135 mEq/L. The prevalence of EAH is common in endurance (<6 hours) and ultra-endurance events (>6 hours in duration), in which both athletes and medical providers need to be aware of risk factors, symptom presentation, and management. The development of EAH is a combination of excessive water intake, inadequate suppression of the secretion of the antidiuretic hormone (ADH) (due to non osmotic stimuli), long race duration, and very high or very low ambient temperatures. Additional risk factors include female gender, slower race times, and use of nonsteroidal anti-inflammatory drugs. Signs and symptoms of EAH include nausea, vomiting, confusion, headache and seizures; it may result in severe clinical conditions associated with pulmonary and cerebral edema, respiratory failure and death. A rapid diagnosis and appropriate treatment with a hypertonic saline solution is essential in the severe form to ensure a positive outcome. PMID:26237602

  15. [Clinical and neurobiological aspects of long-term administration of psychotropic drugs].

    PubMed

    Bourin, M; Bradwejn, J

    1991-05-01

    In neuroleptic therapy for psychotic illnesses, clinical improvement occurs much later than central dopamine blockade, and its time course varies widely among patients. A hypothesis explaining neuroleptic-responsive illness cannot be explained by dopamine blockade alone. Nevertheless, experimental data suggest that this mechanism may be a step in the therapeutic process for schizophrenia. Explanations are suggested for the time lag in therapeutic response for neuroleptics, including the hypothesis of delayed inactivation of mid-brain dopamine neurones. Chronic benzodiazepine treatment elicits adaptive responses in the CNS that are manifested as functional tolerance and physical dependence. Possible mechanisms involved in such a profound alteration of neuronal functioning are suggested. Down regulation of benzodiazepine receptors has been shown to be related to functional tolerance under certain conditions. The effect of repeated treatment with antidepressants is compatible with the hypothesis that changes in central monoamine transmission are involved in the activity of these drugs. Beta-adrenergic receptors are desensitized and their density is decreased; alpha-2 adrenoreceptors sensitivity is reduced, and post-synaptic serotoninergic receptors sensitivity is increased. It remains to be clarified whether some of the changes have larger role than others or whether they all contribute to the psychotropic drug activity in the therapeutic process.

  16. Beta Thalassemia Major in a Developing Country: Epidemiological, Clinical and Evolutionary Aspects

    PubMed Central

    Bejaoui, Mohamed; Guirat, Naouel

    2013-01-01

    Beta-thalassemia major (TM) remains to be one of the major health problems particularly in developing countries. Tunisia is a part of the Mediterranean countries mostly affected by this disease which is highly concentrated in small towns in families with low-income earners. The main objectives of this study are to provide a description of the demographic, clinical features and transfusion-related complications in patients with TM living in Tunisia. A standardized questionnaire was sent to clinicians throughout 33 different medical institutions caring for thalassemic patients. 391 transfusion dependant thalassemic patients with a median age of 10.7 years (range 3 months- 31 years) were included in the study. The majority originated from the north west of the country. A moderate iron overload between 1501 and 2500 ng/ml was found in 61patients, while 81 patients (26.9%) had a ferritin level more than 2500 ng/ml and greater than 5000ng/ml in 21 patients (6.9%). 51 patients died from complications related to their disease. Heart failure was the main cause of death. The incidence of cardiac, endocrine, and infectious complications will be reviewed. Preventive measures such as health education, carrier screening and premarital screening remain the best ways for lowering the incidence of these diseases, which might be reflected in financial saving, social s and health benefits. PMID:23350015

  17. [Noma in children in a hospital environment in Bobo-Dioulasso: epidemiologic, clinical and management aspects].

    PubMed

    Tall, F; Ki-Zerbo, G; Ouedraogo, I; Guigma, Y

    2001-12-01

    A retrospective study covering ten years (1987-1996) was conducted to assess the epidemiology, clinical features and management of cancrum oris (noma) in children from Burkina Faso. Fifty nine (59) children were admitted with cancrum oris at the paediatrics and maxillo-facial surgery units of Bobo-Dioulasso, the second town of Burkina Faso. The hospital prevalence of noma is 1.5/1000. 81% of the cases were in the 1 to 5 years age group and 58% were females. Predisposing factors include poverty, lack of immunization, malnutrition, bad oral hygiene, measles and parasitic diseases. The cheek was involved in 31% of the cases. Cure was obtained in 80% of patients after medical and surgical treatment. However, many sequels were observed. Post operative outcome is complicated by the children's growth and often results in retractions, recurrence of ulcers or constriction. Psychological and social problems are associated. Management is difficult in our setting because of the lack of information, cost of the treatment and the absence of well-equipped plastic surgery units.

  18. Nerve cell death in degenerative diseases of the central nervous system: clinical aspects.

    PubMed

    Agid, Y; Blin, J

    1987-01-01

    The origin of degenerative diseases of the central nervous system lies in genetic and acquired disorders. Analysis of the clinical characteristics of diseases affecting specific neuronal systems may help us to understand their pathogenesis. The stereotyped symptomatology characteristic of most degenerative diseases results from neuronal death in specific pathways: pyramidal tract and motor neurons in amyotrophic lateral sclerosis, nigrostriatal dopamine system in Parkinson's disease, posterior and lateral columns of the spinal cord in Friedreich's ataxia, etc. This suggests that these neurons are sensitive to pathological processes that are still unknown. Progression of the disease, whether linear or not, is slow, but it is more rapid than similar effects due to ageing. This indicates either that the environmental cause of degeneration (if it exists) is continuously present or that a vital process has been once and for all disrupted, perhaps at the level of the genome, causing insufficient production of essential proteins, or accumulation of eventually toxic metabolites. Symptoms generally appear during adulthood, i.e. after normal differentiation has taken place, and after a considerable number of neurons have already been damaged. The initiation of neuronal death precedes the appearance of the first symptoms. PMID:3556087

  19. Sjögren's syndrome: clinical, cytological, histological and colposcopic aspects in women.

    PubMed

    Capriello, P; Barale, E; Cappelli, N; Lupo, S; Teti, G

    1988-01-01

    Sjögren's syndrome, characterized by a progressive alteration of the exocrine glands which ultimately results in their atrophy, has the highest incidence among females. The main etiopathogenetic mechanism is autoimmunological. The symptomatology is made up of symptoms depending on an altered glandular secretion and mucosal dryness. Dyspareunia and pruritus, due to vaginal and vulvar dryness, are quite common symptoms. Few studies have considered the clinical and histological consequences of Sjögren's syndrome in the external female genitalia. In the present study 26 women (mean age 46 years) affected by Sjögren's syndrome were examined by means of a series of tests including gynecological examination exam, colposcopic inspection and cervical biopsy. All the patients showed a particular dryness a series of tests including gynecological examination failed to evidence malign cells and, in 15% of the subjects, showed an estrogenic insufficiency in various degrees. The colposcopic inspection revealed dystrophic processes resulting in the atrophy of the cervico-vaginal mucosa in 50% of the cases. The histological findings of the cervical biopsies evidenced the presence of a chronic cervicitis in 10% of the cases. PMID:3359647

  20. Hyporeninemic hypoaldosteronism and diabetes mellitus: Pathophysiology assumptions, clinical aspects and implications for management.

    PubMed

    Sousa, André Gustavo P; Cabral, João Victor de Sousa; El-Feghaly, William Batah; de Sousa, Luísa Silva; Nunes, Adriana Bezerra

    2016-03-10

    Patients with diabetes mellitus (DM) frequently develop electrolyte disorders, including hyperkalemia. The most important causal factor of chronic hyperkalemia in patients with diabetes is the syndrome of hyporeninemic hypoaldosteronism (HH), but other conditions may also contribute. Moreover, as hyperkalemia is related to the blockage of the renin-angiotensin-aldosterone system (RAAS) and HH is most common among patients with mild to moderate renal insufficiency due to diabetic nephropathy (DN), the proper evaluation and management of these patients is quite complex. Despite its obvious relationship with diabetic nephropathy, HH is also related to other microvascular complications, such as DN, particularly the autonomic type. To confirm the diagnosis, plasma aldosterone concentration and the levels of renin and cortisol are measured when the RAAS is activated. In addition, synthetic mineralocorticoid and/or diuretics are used for the treatment of this syndrome. However, few studies on the implications of HH in the treatment of patients with DM have been conducted in recent years, and therefore little, if any, progress has been made. This comprehensive review highlights the findings regarding the epidemiology, diagnosis, and management recommendations for HH in patients with DM to clarify the diagnosis of this clinical condition, which is often neglected, and to assist in the improvement of patient care.

  1. Hyporeninemic hypoaldosteronism and diabetes mellitus: Pathophysiology assumptions, clinical aspects and implications for management

    PubMed Central

    Sousa, André Gustavo P; Cabral, João Victor de Sousa; El-Feghaly, William Batah; de Sousa, Luísa Silva; Nunes, Adriana Bezerra

    2016-01-01

    Patients with diabetes mellitus (DM) frequently develop electrolyte disorders, including hyperkalemia. The most important causal factor of chronic hyperkalemia in patients with diabetes is the syndrome of hyporeninemic hypoaldosteronism (HH), but other conditions may also contribute. Moreover, as hyperkalemia is related to the blockage of the renin-angiotensin-aldosterone system (RAAS) and HH is most common among patients with mild to moderate renal insufficiency due to diabetic nephropathy (DN), the proper evaluation and management of these patients is quite complex. Despite its obvious relationship with diabetic nephropathy, HH is also related to other microvascular complications, such as DN, particularly the autonomic type. To confirm the diagnosis, plasma aldosterone concentration and the levels of renin and cortisol are measured when the RAAS is activated. In addition, synthetic mineralocorticoid and/or diuretics are used for the treatment of this syndrome. However, few studies on the implications of HH in the treatment of patients with DM have been conducted in recent years, and therefore little, if any, progress has been made. This comprehensive review highlights the findings regarding the epidemiology, diagnosis, and management recommendations for HH in patients with DM to clarify the diagnosis of this clinical condition, which is often neglected, and to assist in the improvement of patient care. PMID:26981183

  2. Interleukin 10 and Tumor Necrosis Factor-Alpha in Pregnancy: Aspects of Interest in Clinical Obstetrics

    PubMed Central

    Brogin Moreli, Jusciele; Cirino Ruocco, Ana Maria; Vernini, Joice Monaliza; Rudge, Marilza Vieira Cunha; Calderon, Iracema Mattos Paranhos

    2012-01-01

    The purpose of this study was to review the literature regarding the action of the cytokines interleukin 10 (IL-10) and tumor necrosis factor-alpha (TNF-α) in pregnancy and to emphasize the factors that are of interest to clinical obstetrics. The literature highlights several actions of IL-10 and TNF-α during pregnancy. The actions of these cytokines seem to be antagonistic and dependent on the balance between them, which is orchestrated by the specific immunosuppressive action of IL-10. TNF-α has a characteristic inflammatory action, and it is an additional diabetogenic factor in pregnancy. The loss of the control of the production of these cytokines, with increase of TNF-α, is related to the risk for developing obstetric complications, particularly recurrent fetal loss, gestational diabetes mellitus, hypertensive syndromes, and fetal growth restriction. However, study results are controversial and are not clearly defined. These issues are attributed to the heterogeneity of the studies, particularly regarding their sample sizes and sources, the evaluation methods, and the multiplicity of factors and conditions that influence cytokine production. These questions are fundamental and should be addressed in future investigations to obtain more consistent results that can be applied to obstetric practice. PMID:22462002

  3. Biomechanics of the mandible.

    PubMed

    van Eijden, T M

    2000-01-01

    In this review the biomechanical behavior of the mandibular bone tissue, and of the mandibular bone as a whole, in response to external loading is discussed. A survey is given of the determinants of mandibular stiffness and strength, including the mechanical properties and distribution of bone tissue and the size and shape of the mandible. Mandibular deformations, stresses, and strains that occur during static biting and chewing are reviewed. During biting and the powerstroke of mastication, a combination of sagittal bending, corpus rotation, and transverse bending occurs. The result is a complex pattern of stresses and strains (compressive, tensile, shear, torsional) in the mandible. To be able to resist forces and bending and torsional moments, not only the material properties of the mandible but also its geometrical design is of importance. This is reflected by variables like polar and maximum and minimum moments of inertia and the relative amount and distribution of bone tissue. In the longitudinal direction, the mandible is stiffer than in transverse directions, and the vertical cross-sectional dimension of the mandible is larger than its transverse dimension. These features enhance the resistance of the mandible to the relatively large vertical shear forces and bending moments that come into play in the sagittal plane.

  4. Modelling approaches in biomechanics.

    PubMed Central

    Alexander, R McN

    2003-01-01

    Conceptual, physical and mathematical models have all proved useful in biomechanics. Conceptual models, which have been used only occasionally, clarify a point without having to be constructed physically or analysed mathematically. Some physical models are designed to demonstrate a proposed mechanism, for example the folding mechanisms of insect wings. Others have been used to check the conclusions of mathematical modelling. However, others facilitate observations that would be difficult to make on real organisms, for example on the flow of air around the wings of small insects. Mathematical models have been used more often than physical ones. Some of them are predictive, designed for example to calculate the effects of anatomical changes on jumping performance, or the pattern of flow in a 3D assembly of semicircular canals. Others seek an optimum, for example the best possible technique for a high jump. A few have been used in inverse optimization studies, which search for variables that are optimized by observed patterns of behaviour. Mathematical models range from the extreme simplicity of some models of walking and running, to the complexity of models that represent numerous body segments and muscles, or elaborate bone shapes. The simpler the model, the clearer it is which of its features is essential to the calculated effect. PMID:14561333

  5. Bioactive Peptides in Cereals and Legumes: Agronomical, Biochemical and Clinical Aspects

    PubMed Central

    Malaguti, Marco; Dinelli, Giovanni; Leoncini, Emanuela; Bregola, Valeria; Bosi, Sara; Cicero, Arrigo F. G.; Hrelia, Silvana

    2014-01-01

    Cereals and legumes are key components of a healthy and balanced diet. Accordingly, many national nutritional guidelines emphasize their health promoting properties by placing them at the base of nutritional food pyramids. This concept is further validated by the observed correlation between a lower risk and occurrence of chronic diseases and the adherence to dietary patterns, like the Mediterranean diet, in which cereal grains, legumes and derived products represent a staple food. In the search for a dietary approach to control/prevent chronic degenerative diseases, protein derived bioactive peptides may represent one such source of health-enhancing components. These peptides may already be present in foods as natural components or may derive from hydrolysis by chemical or enzymatic treatments (digestion, hydrolysis or fermentation). Many reports are present in the literature regarding the bioactivity of peptides in vitro and a wide range of activities has been described, including antimicrobial properties, blood pressure-lowering (ACE inhibitory) effects, cholesterol-lowering ability, antithrombotic and antioxidant activities, enhancement of mineral absorption/bioavailability, cyto- or immunomodulatory effects, and opioid-like activities. However it is difficult to translate these observed effects to human. In fact, the active peptide may be degraded during digestion, or may not be absorbed or reach the target tissues at a concentration necessary to exert its function. This review will focus on bioactive peptides identified in cereals and legumes, from an agronomical and biochemical point of view, including considerations about requirements for the design of appropriate clinical trials necessary for the assessment of their nutraceutical effect in vivo. PMID:25405741

  6. [An outbreak of Pontiac fever due to Legionella pneumophila serogroup 7. I. Clinical aspects].

    PubMed

    Mori, M; Hoshino, K; Sonoda, H; Yoshida, H; Yabuuchi, E; Yamashiro, Y; Koide, M; Saito, A; Kishimoto, T; Furuhata, K

    1995-06-01

    In August 1994, an epidemic of acute febrile illness occurred at the Education Center Building of a company in Shibuya-ku, Tokyo. All 43 trainees attended in two groups and 2 staff members of the Center fell ill. The 45 patients came to one of our hospitals in two groups, and 35 patients were treated. The patients were 4 males and 31 females, and the average age was 29.0 years. The duration until falling ill was 36 to 90 hours after entering the Center. Symptoms were fever, lumbago arthralgia, headache, dyspnea, general fatigue, etc. Physical examination revealed slightly injected mucosa of the pharynx in a patient who complained of a sore throat. On laboratory examination, leukocytosis with a left shift of the nucleus and elevation of serum CRP levels were found. Erythromycin (600 mg, daily) and nonsteroidal antiinflammatory drugs (NSAIDs) were given by mouth to almost every patient. Two patients were hospitalized. The illness was self-limited, generally lasting from two to five days. Strains of legionellae isolated from the water of the cooling tower located at the top of the Center, were identified as L. pneumophila serogroup 7. Since seroconversion in a patient against the cooling tower strain from 1:16 to 1:256 was determined and the clinical courses agreed with the definition of Pontiac fever by Glick et al, we concluded that the epidemic was an outbreak of Pontiac fever due to L. pneumophila serogroup 7. Pontiac fever is considered to be one of the community-acquired diseases. Thus, we have to note that Pontiac fever may be misdiagnosed as we examine patients who complain of the symptoms noted above.

  7. Clinical aspects of the control of plasma volume at microgravity and during return to one gravity

    NASA Technical Reports Server (NTRS)

    Convertino, V. A.

    1996-01-01

    Plasma volume is reduced by 10-20% within 24-48 h of exposure to simulated or actual microgravity. The clinical importance of microgravity induced hypovolemia is manifested by its relationship with orthostatic intolerance and reduced maximal oxygen uptake (VO2max) after return to one gravity (1G). Since there is no evidence to suggest that plasma volume reduction during microgravity is associated with thirst or renal dysfunctions, a diuresis induced by an immediate blood volume shift to the central circulation appears responsible for microgravity-induced hypovolemia. Since most astronauts choose to restrict their fluid intake before a space mission, absence of increased urine output during actual space flight may be explained by low central venous pressure (CVP) which accompanies dehydration. Compelling evidence suggests that prolonged reduction in CVP during exposure to microgravity reflects a "resetting" to a lower operating point, which acts to limit plasma volume expansion during attempts to increase fluid intake. In ground based and space flight experiments, successful restoration and maintenance of plasma volume prior to returning to an upright posture may depend upon development of treatments that can return CVP to its baseline IG operating point. Fluid-loading and lower body negative pressure (LBNP) have not proved completely effective in restoring plasma volume, suggesting that they may not provide the stimulus to elevate the CVP operating point. On the other hand, exercise, which can chronically increase CVP, has been effective in expanding plasma volume when combined with adequate dietary intake of fluid and electrolytes. The success of designing experiments to understand the physiological mechanisms of and development of effective counter measures for the control of plasma volume in microgravity and during return to IG will depend upon testing that can be conducted under standardized controlled baseline conditions during both ground-based and space

  8. Clinical, morphological, and molecular aspects of sialic acid storage disease manifesting in utero

    PubMed Central

    Froissart, R; Cheillan, D; Bouvier, R; Tourret, S; Bonnet, V; Piraud, M; Maire, I

    2005-01-01

    Background: Sialic acid storage diseases (SASDs) are caused by the defective transport of free sialic acid outside the lysosome. Apart from the Salla presentation in Finland, SASD is a very rare form of lysosomal storage disease (LSD) with approximately 35 cases, all diagnosed after birth, having been reported worldwide. We report a series of 12 French patients with very early manifestations, including eight fetuses diagnosed in utero. Results: Ultrasound examination, fetal autopsy, or clinical examination showed prominent ascites, rarely progressing to complete hydrops, and highlighted the early severity of bone disease. Dramatic increase of free sialic acid in various biological samples confirmed the diagnosis in all cases. Storage staining affinities and storage distribution in placenta and fetal organs allowed differential diagnosis from other LSDs but cannot differentiate between SASD, sialidosis, and galactosialidosis. Fourteen different mutations were identified, showing the molecular heterogeneity of SASD in the French population. We found that the previously described p.Y306X mutation generated two different transcripts, and we identified seven novel mutations: three deletions (del exon 7, del exons10+11 and c.1296delT), one splice site mutation (c.1350+1G→T) one nonsense mutation (p.W339X), and two missense mutations (p.R57C and p.G127E). Conclusions: The severity of our patients' genotypes is in agreement with their phenotypes but not with the importance and early appearance of the very frequent in utero manifestations. Minimal fetal disease in some patients and a reported case of heterogeneity of fetal involvement within a family suggest that factors other than the genotype influence fetal manifestations. PMID:15805149

  9. [Gender medicine. Sex- and gender-specific aspects of clinical medicine].

    PubMed

    Kautzky-Willer, A

    2014-09-01

    Gender medicine studies sex- and gender-based differences in the development and prevention of diseases, the awareness and presentation of symptoms, and the effectiveness of therapy. Gender medicine is part of personalized medicine, considering differences in biological and psychosocial factors individually. There are differences in genes, chromosomes, hormones, and metabolism as well as differences in culture, environment, and society. Lifelong interactions between physical and psychosocial factors will influence the health and ill-health of men and women in different ways. Epigenetic modifications provide evidence of the impact of environment and lifestyle during vulnerable phases on biological processes, effecting future generations. Maternal lifestyle and environmental factors during pregnancy can impact the health of offspring in later life already in utero in a sex-specific way. Pain, stress, and coping styles differ between men and women. Women experience more dramatic physical changes during their lifetime, which are associated with specific burdens and psychosocial alterations. Women with multiple roles and responsibilities suffering from stress develop depression more frequently. However, men are often not diagnosed and treated appropriately in cases of depression or osteoporosis, diseases that are typically considered "female." There are prominent differences between men and women in medicine regarding the immune system, inflammation, and noncommunicable diseases such as obesity, type 2 diabetes, hypertension, and cardiovascular disease. Women experience more often autoimmune diseases and suffer more frequently from (chronic) pain, neurodegenerative changes, and functional disabilities. Men have shorter life expectancy but relatively more healthy years of life, which is in greater part ascribed to psychosocial determinants. State-of-the-art clinical medicine comprises individual risk factors based on sex- and gender-sensitive health programs in order to

  10. Maternal near miss in the intensive care unit: clinical and epidemiological aspects

    PubMed Central

    Oliveira, Leonam Costa; da Costa, Aurélio Antônio Ribeiro

    2015-01-01

    Objective To analyze the epidemiological clinical profile of women with maternal near miss according to the new World Health Organization criteria. Methods A descriptive crosssectional study was conducted, in which the records of patients admitted to the obstetric intensive care unit of a tertiary hospital in Recife (Brazil) over a period of four years were analyzed. Women who presented at least one near miss criterion were included. The variables studied were age, race/color, civil status, education, place of origin, number of pregnancies and prenatal consultations, complications and procedures performed, mode of delivery, gestational age at delivery, and maternal near miss criteria. The descriptive analysis was performed using the program Epi-Info 3.5.1. Results Two hundred fifty-five cases of maternal near miss were identified, with an overall ratio of maternal near miss of 12.8/1,000 live births. Among these cases, 43.2% of the women had incomplete primary education, 44.7% were primiparous, and 20.5% had undergone a previous cesarean section. Regarding specific diagnoses, there was a predominance of hypertensive disorders (62.7%), many of which were complicated by HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome (41.2%). The laboratory near miss criteria were the most often observed (59.6%), due mainly to the high frequency of acute thrombocytopenia (32.5%). Conclusions A high frequency of women who had a low level of education and who were primiparous was observed. According to the new criteria proposed by the World Health Organization, hypertensive pregnancy disorders are still the most common among maternal near miss cases. The high frequency of HELLP syndrome was also striking, which contributed to acute thrombocytopenia being the most frequent near miss criterion. PMID:26270856

  11. [Immune-mediated neuromyotonia (Isaacs' syndrome)--clinical aspects and pathomechanism].

    PubMed

    Arimura, Kimiyoshi; Watanabe, Osamu

    2010-04-01

    Neuromyotonia occurs due to several causes such as hereditary, immune-mediated and degenerative neurological disorders. Isaacs' syndrome (immune-mediated neuromyotonia) is an antibody-mediated potassium channel disorder (channelopathy). Clinical symptoms of Isaacs' syndrome are characterized by muscle cramp, slow relaxation following muscle contraction (pseudomyotonia), and hyperhidrosis; these symptoms are due to hyperexcitability of the peripheral nerve, including autonomic nerve. These symptoms are relieved by the administration of Na channel blocker and immunotherapy. Recent studies show that this disease is not infrequently associated with neoplasm, especially thymoma. The target channel proteins of the antigens are voltage-gated potassium channels (VGKCs), specifically dendrotoxin-sensitive fast potassium channels. The suppression of voltage-gated outward K+ current by antibodies induces the hyper- excitability of the peripheral nerve. The findings of patch clamp studies show that antibodies may not directly block the kinetics of VGKCs, but may decrease channel density. From the electrophysiologic, pharmacologic and immunologic view points, the site of origin of spontaneous discharges is located principally in the distal portion of the motor nerve and/or within the terminal arborization. Anti-VGKC antibodies were also found to be positive in patients with Morvan's syndrome, limbic encephalitis and temporal epilepsy. Thus, an increasing number of immune-mediated neurological disorders with anti-VGKC antibodies are being identified. However, except in Morvan's syndrome, it is rare to find symptoms pertaining to involvement of both the peripheral and central nervous system in the same patient with anti-VGKC antibodies. The differences in the pathomechanism of Isaacs' syndrome and limbic encephalitis are still unclear. PMID:20420181

  12. Clinical Aspects of the Control of Plasma Volume at Microgravity and During Return to One Gravity

    NASA Technical Reports Server (NTRS)

    Convertino, Victor A.

    1995-01-01

    Plasma volume is reduced by 10%-20% within 24 to 48 h of exposure to simulated or actual microgravity. The clinical importance of microgravity-induced hypovolemia is manifested by its relationship with orthostatic intolerance and reduced VO2max after return to one gravity (1G). Since there is no evidence to suggest plasma volume reduction during microgravity is associated with thirst or renal dysfunctions, a diuresis induced by an immediate blood volume shift to the central circulation appears responsible for microgravity-induced hypovolemia. Since most astronauts choose to restrict their fluid intake before a space mission, absence of increased urine output during actual spaceflight may be explained by low central venous pressure (CVP) which accompanies dehydration. Compelling evidence suggests that prolonged reduction in CVP during exposure to microgravity reflects a 'resetting' to a lower operating point which acts to limit plasma volume expansion during attempts to increase fluid intake. In groudbase and spaceflight experiments, successful restoration and maintenance of plasma volume prior to returning to an upright posture may depend upon development of treatments that can return CVP to its baseline 10 operating point. Fluid-loading and LBNP have not proved completely effective in restoring plasma volume, suggesting that they may not provide the stimulus to elevate the CVP operating point. On the other, exercise, which can chronically increase CVP, has been effective in expanding plasma volume when combined with adequate dietary intake of fluid and electrolytes. The success of designing experiments to understand the physiological mechanisms of and development of effective countermeasures for the control of plasma volume in microgravity and during return to one gravity will depend upon testing that can be conducted under standardized controlled baseline condi

  13. Biomechanics: cell research and applications for the next decade

    PubMed Central

    Fredberg, Jeffrey J.; Discher, Dennis; Dong, Cheng; Guilak, Farshid; Ingber, Donald; Janmey, Paul; Kamm, Roger D.; Schmid-Schönbein, Geert W.; Weinbaum, Sheldon

    2010-01-01

    With the recent revolution in Molecular Biology and the deciphering of the Human Genome, our understanding of the building blocks that comprise living systems has advanced rapidly. We have yet to understand, however, how the physical forces that animate life affect the synthesis, folding, assembly, and function of these molecular building blocks. We are equally uncertain as to how these building blocks interact dynamically to create coupled regulatory networks from which integrative biological behaviors emerge. Here we review several recent advances in the field of biomechanics at the cellular and molecular levels, and we set forth some of the challenges confronting the field. Living systems work and move as multi-molecular collectives, and in order to understand key aspects of health and disease we must first be able to explain how physical forces and mechanical structures contribute to the ‘active’ material properties of living cells and tissues, as well as how these forces impact information processing and cellular decision making. Such insights will no doubt inform basic biology and rational engineering of effective new approaches to clinical therapy. PMID:19259817

  14. [Biomechanics of whiplash injuries of the cervical spine].

    PubMed

    Schmidt, G

    1989-07-01

    1. The whiplash injury of the cervical spine is a typical, but not very often observed injury of occupants of automotive vehicles involved in moderate collisions. 2. There still exist great uncertainties in the elaboration of expertises concerning the minor whiplash injury, so that the great part of the disturbances cannot be objectivated under a clinical point of view. And on the other hand, serious whiplash injuries often are superposed or veiled by secondary injuries. 3. Thus, the aim of the present paper was to point out injury mechanisms, to give a rough scaling of the whiplash severity under biomechanical aspects and finally to set these injury mechanisms in correlation to the following criteria of accident: a) vehicle velocity change (energy equivalent speed--EES); b) deformation of vehicles on the impact-exposed structure; c) loading of occupants by acceleration or deceleration. 4. The tolerance limit of the cervical spine generally decreases to a lower limit, if the cervical spine is changed in a pathological way, e.g. by preexisting diseases. 5. It is evident and important, that the difficult work of giving an expert's opinion on this field must be performed in an interdisciplinary collaboration of engineers for collision-analysis and physicians experienced in accident-traumatology. PMID:2669311

  15. Psychological and behavioural aspects of patients with Turner syndrome from childhood to adulthood: a review of the clinical literature.

    PubMed

    Christopoulos, P; Deligeoroglou, E; Laggari, V; Christogiorgos, S; Creatsas, G

    2008-03-01

    Turner syndrome (TS) is a chromosomal abnormality, which occurs in approximately one of every 2500 female births. Short stature, infertility, additional physical abnormalities, skeletal and medical problems may be present. Genetic, hormonal, and medical problems associated with TS are likely to affect psychosexual development of female adolescent patients, and thus influence their psychological functioning, behavior patterns, social interactions and learning ability. Although TS constitutes a chronic medical condition, with possible physical, social and psychological complications in a woman's life, hormonal and estrogen replacement therapy and assisted reproduction, are treatments that can be helpful for TS patients and improve their quality of life. Authors report on a review of the research literature clinical aspects of the syndrome as well as the beneficial effect of hormonal therapy in such patients.

  16. [Clinical, epidemiologic and therapeutic aspects of idiopathic epilepsy in 25 golden retrievers: results of a long term study].

    PubMed

    Lengweiler, C; Jaggy, A

    1999-01-01

    The records of 25 Golden Retrievers with idiopathic epilepsy were reviewed. One goal was to identify objective aspects enabling a realistic prognosis prior to treatment. In half the dogs seizures occurred for the first time at the age of one to three years and were mostly generalised. The character, feeding habits and confinement of the dogs played a minor role in the clinical manifestation of the fits, but they were seen mostly during sleep in two thirds of the dogs. Because of the long follow-up period some important findings were made. At the beginning of the standardized long-term therapy with phenobarbital a success was observed in two thirds of the dogs, while after four years the symptoms worsened significantly in about half the dogs. We found no better success rate in castrated dogs. Dogs responded well to therapy if treated as early as possible.

  17. Clinical-pharmacokinetic aspects of prolonged effect duration as illustrated by beta2-agonists.

    PubMed

    Rosenburg, Johan

    2002-07-01

    Regularity is a key element of maintenance drug treatment; compliance is crucial for treatment success. Once- or twice-daily intake of a drug is always easier to comply with than regimens requiring more frequent dosing. Bronchodilating treatment was used as an example to illustrate how sustained duration of effect can be achieved by two different approaches: oral administration of the terbutaline prodrug bambuterol and inhalation of formoterol. Bioanalytical methods were employed to monitor the kinetic fate of bambuterol and formoterol in plasma, urine, or faeces. Generated terbutaline in plasma was used as a marker of effect for bambuterol. Established clinical laboratory tests were used to assess local and systemic effects of inhaled formoterol compared with salbutamol. Recommended doses of bambuterol, 10-20 mg once daily in adults, normally produced plasma concentrations of the active moiety terbutaline within therapeutically relevant limits. Dose proportionality for terbutaline makes dosing with bambuterol predictable. Compared with adults, children should be given higher doses than indicated by their lower body weight. Pharmacokinetic analysis indicated that absorption of bambuterol was slow and multi-phasic and that slow biotransformation to terbutaline occurred both presystemically and systemically. Systemically circulating formoterol was rapidly eliminated, the inactive (S;S)-formoterol more rapidly than the active (R;R)-formoterol. An inactive phenol glucuronide was the main metabolite, and a previously unknown sulphate metabolite was discovered. Duration of systemically mediated cardiovascular or metabolic side-effects of inhaled formoterol seemed not to differ from those of an inhaled systemically equieffective dose of salbutamol. There was a trend suggesting that the magnitude of systemic side-effects may be less pronounced after inhalation of formoterol compared with a locally equieffective dose of inhaled salbutamol. Both approaches to sustaining

  18. [Percutaneous electric and magnetic stimulation of the motor cortex in man. Physiological aspects and clinical applications].

    PubMed

    Maertens de Noordhout, A; Rothwell, J C; Day, B L; Thompson, P D; Delwaide, P J; Marsden, C D

    1989-01-01

    well correlated with clinical weakness, but the correlations seems to be better with hyperreflexia and the presence of brisk finger flexor jerks. The same abnormalities are observed in cervical spondylosis, although to a lesser extent. In motor neurone disease, the responses have a moderately increased latency and their size and duration are markedly reduced. Patients with acute hemispheric stroke usually show absent responses on the contralateral side. Finally, electric cortical stimulation can be very useful in monitoring the functional integrity of descending motor tracts during surgical operations performed on the spinal cord. PMID:2646678

  19. CT-guided Bipolar and Multipolar Radiofrequency Ablation (RF Ablation) of Renal Cell Carcinoma: Specific Technical Aspects and Clinical Results

    SciTech Connect

    Sommer, C. M.; Lemm, G.; Hohenstein, E.; Bellemann, N.; Stampfl, U.; Goezen, A. S.; Rassweiler, J.; Kauczor, H. U.; Radeleff, B. A.; Pereira, P. L.

    2013-06-15

    Purpose. This study was designed to evaluate the clinical efficacy of CT-guided bipolar and multipolar radiofrequency ablation (RF ablation) of renal cell carcinoma (RCC) and to analyze specific technical aspects between both technologies. Methods. We included 22 consecutive patients (3 women; age 74.2 {+-} 8.6 years) after 28 CT-guided bipolar or multipolar RF ablations of 28 RCCs (diameter 2.5 {+-} 0.8 cm). Procedures were performed with a commercially available RF system (Celon AG Olympus, Berlin, Germany). Technical aspects of RF ablation procedures (ablation mode [bipolar or multipolar], number of applicators and ablation cycles, overall ablation time and deployed energy, and technical success rate) were analyzed. Clinical results (local recurrence-free survival and local tumor control rate, renal function [glomerular filtration rate (GFR)]) and complication rates were evaluated. Results. Bipolar RF ablation was performed in 12 procedures and multipolar RF ablation in 16 procedures (2 applicators in 14 procedures and 3 applicators in 2 procedures). One ablation cycle was performed in 15 procedures and two ablation cycles in 13 procedures. Overall ablation time and deployed energy were 35.0 {+-} 13.6 min and 43.7 {+-} 17.9 kJ. Technical success rate was 100 %. Major and minor complication rates were 4 and 14 %. At an imaging follow-up of 15.2 {+-} 8.8 months, local recurrence-free survival was 14.4 {+-} 8.8 months and local tumor control rate was 93 %. GFR did not deteriorate after RF ablation (50.8 {+-} 16.6 ml/min/1.73 m{sup 2} before RF ablation vs. 47.2 {+-} 11.9 ml/min/1.73 m{sup 2} after RF ablation; not significant). Conclusions. CT-guided bipolar and multipolar RF ablation of RCC has a high rate of clinical success and low complication rates. At short-term follow-up, clinical efficacy is high without deterioration of the renal function.

  20. Inelastic mechanics: A unifying principle in biomechanics.

    PubMed

    Gralka, Matti; Kroy, Klaus

    2015-11-01

    Many soft materials are classified as viscoelastic. They behave mechanically neither quite fluid-like nor quite solid-like - rather a bit of both. Biomaterials are often said to fall into this class. Here, we argue that this misses a crucial aspect, and that biomechanics is essentially damage mechanics, at heart. When deforming an animal cell or tissue, one can hardly avoid inducing the unfolding of protein domains, the unbinding of cytoskeletal crosslinkers, the breaking of weak sacrificial bonds, and the disruption of transient adhesions. We classify these activated structural changes as inelastic. They are often to a large degree reversible and are therefore not plastic in the proper sense, but they dissipate substantial amounts of elastic energy by structural damping. We review recent experiments involving biological materials on all scales, from single biopolymers over cells to model tissues, to illustrate the unifying power of this paradigm. A deliberately minimalistic yet phenomenologically very rich mathematical modeling framework for inelastic biomechanics is proposed. It transcends the conventional viscoelastic paradigm and suggests itself as a promising candidate for a unified description and interpretation of a wide range of experimental data. This article is part of a Special Issue entitled: Mechanobiology.

  1. Mechanistic and clinical aspects of fatigue of ultrahigh molecular weight polyethylene

    NASA Astrophysics Data System (ADS)

    Furmanski, Jevan

    Ultrahigh molecular weight polyethylene (UHMWPE) is a tough semi-crystalline polymer employed widely as a bearing material in total joint replacements. While UHMWPE has been tremendously successful in this application, debris generated due to frictional contact may lead ultimately to an adverse biological reaction and failure of the implant. Radiation cross-linking of the polymer has been undertaken in order to improve its wear resistance, but this also reduces its strength, toughness, and ductility. The majority of implants using highly cross-linked UHMWPE seem to be functioning as designed, but a number of recent reports detail unexpected apparently brittle surface cracking and fracture of such devices. The work presented in this dissertation first documents and analyzes two series of clinical failures of total hip replacements employing highly cross-linked UHMWPE. In the first failure study, an implant was removed shortly after implantation due to infection, and the surface of the implant had sustained extensive surface cracking. An analysis showed that the femoral head contained an asphericity in the main weight bearing region, and a finite element analysis concluded that such a defect doubles the peak contact pressure in the bearing. The increased pressure and decreased toughness were then inferred to have cooperatively resulted in the observed surface cracking. A series of four catastrophically fractured UHMWPE total hip replacement bearings was also analyzed. In all cases, cracks initiated at a sharp notch in the periphery of the implant and propagated into the bulk. Finite element analysis predicted that these locations experienced maximal values of principal stress, and that the stress was of a magnitude and orientation appropriate to agree with the observed crack initiation. The brittle nature of fatigue crack propagation (FCP) in UHMWPE was then explored from a fundamental perspective, with special attention paid to the static mode nature of the process

  2. Kinesiology/Biomechanics: Perspectives and Trends.

    ERIC Educational Resources Information Center

    Atwater, Anne E.

    1980-01-01

    Past and recent developments and future directions in kinesiology and biomechanics are reviewed. Similarities and differences between these two areas are clarified. The areas of kinesiology and biomechanics have distinct unique qualities and should be treated as separate disciplines. (CJ)

  3. Biomechanics of Degenerative Spinal Disorders

    PubMed Central

    Iorio, Justin A.; Jakoi, Andre M.

    2016-01-01

    The spine has several important functions including load transmission, permission of limited motion, and protection of the spinal cord. The vertebrae form functional spinal units, which represent the smallest segment that has characteristics of the entire spinal column. Discs and paired facet joints within each functional unit form a three-joint complex between which loads are transmitted. Surrounding the spinal motion segment are ligaments, composed of elastin and collagen, and joint capsules which restrict motion to within normal limits. Ligaments have variable strengths and act via different lever arm lengths to contribute to spinal stability. As a consequence of the longer moment arm from the spinous process to the instantaneous axis of rotation, inherently weaker ligaments (interspinous and supraspinous) are able to provide resistance to excessive flexion. Degenerative processes of the spine are a normal result of aging and occur on a spectrum. During the second decade of life, the intervertebral disc demonstrates histologic evidence of nucleus pulposus degradation caused by reduced end plate blood supply. As disc height decreases, the functional unit is capable of an increased range of axial rotation which subjects the posterior facet capsules to greater mechanical loads. A concurrent change in load transmission across the end plates and translation of the instantaneous axis of rotation further increase the degenerative processes at adjacent structures. The behavior of the functional unit is impacted by these processes and is reflected by changes in the stress-strain relationship. Back pain and other clinical symptoms may occur as a result of the biomechanical alterations of degeneration. PMID:27114783

  4. Biomechanics and the wheelchair.

    PubMed

    McLaurin, C A; Brubaker, C E

    1991-04-01

    Wheelchair biomechanics involves the study of how a wheelchair user imparts power to the wheels to achieve mobility. Because a wheelchair can coast, power input need not be continuous, but each power strike can be followed by a period of recovery, with the stroking frequency depending on user preferences and the coasting characteristics of the wheelchair. The latter is described in terms of rolling resistance, wind resistance and the slope of the surface. From these three factors the power required to propel the wheelchair is determined, and must be matched by the power output of the user. The efficiency of propulsion is the ratio of this power output to the metabolic cost and is typically in the order of 5% in normal use. The features required in a wheelchair depend upon user characteristics and intended activities. The ideal wheelchair for an individual will have the features that closely match these characteristics and activities. Thus prescription is not just choosing a wheelchair, but choosing the components of the wheelchair that best serve the intended purpose. In this paper, each component is examined for available options and how these options effect the performance of the wheelchair for the individual. The components include wheels, tyres, castors, frames, bearings, materials, construction details, seats, backrests, armrests, foot and legrests, headrests, wheel locks, running brakes, handrims, levers, accessories, adjustments and detachable parts. Each component is considered in relation to performance characteristics including rolling resistance, versatility, weight, comfort, stability, maneouvrability, transfer, stowage, durability and maintenance. Where they exist, wheelchair standards are referred to as a source of information regarding these characteristics.

  5. [Clinical-pharmacological aspects to accelerate the development process from the preclinical to the clinical phase/1st communication: The contribution of clinical pharmacology].

    PubMed

    Kuhlmann, Jochen

    2004-01-01

    To improve the transition from research to development a critical evaluation of the individual project by research and disease area teams is required to include input from pharmacology, toxicology, pharmacokinetics, galenics, clinical pharmacology, clinical as well as regulatory experts and marketing. Decisions on the individual development strategy should be made prior to the start of development and all projects should be reviewed at predefined stages throughout the product development life cycle. This ensures consistency of decision-making not only during the development of individual products but throughout the entire development pipeline. Studies in the exploratory stage of drug development should be designed for decision making in contrast to later clinical trials in the confirmatory stage that require power for proof-of-safety and proof-of-efficacy. The more thorough and profound studies have been carried out during this exploratory stage of drug development, the earlier a decision can be made on the continuation or discontinuation of further development, thus saving development time and money and assessing and considerably reducing the risk for the patients and increasing the success rate of the project in the later confirmatory effectiveness trial with an adequate number of subjects receiving the new therapy under typical conditions of use. Strategies which may be helpful to improve the quality of decisions in drug discovery and drug development are: discovery experiments should be done to critically evaluate the compound, the "killer" experiments should be done as early as possible, continuous effort on preclinical disease models is necessary to improve predictability of efficacy in patients ("humanized" research): genomic technology should be used to identify novel, disease-related targets and to characterise preclinical test systems, improvement of knowledge and experience concerning the relevance of new technologies for the clinical picture; genotyping

  6. [Clinical-pharmacological aspects to accelerate the development process from the preclinical to the clinical phase/1st communication: The contribution of clinical pharmacology].

    PubMed

    Kuhlmann, Jochen

    2004-01-01

    To improve the transition from research to development a critical evaluation of the individual project by research and disease area teams is required to include input from pharmacology, toxicology, pharmacokinetics, galenics, clinical pharmacology, clinical as well as regulatory experts and marketing. Decisions on the individual development strategy should be made prior to the start of development and all projects should be reviewed at predefined stages throughout the product development life cycle. This ensures consistency of decision-making not only during the development of individual products but throughout the entire development pipeline. Studies in the exploratory stage of drug development should be designed for decision making in contrast to later clinical trials in the confirmatory stage that require power for proof-of-safety and proof-of-efficacy. The more thorough and profound studies have been carried out during this exploratory stage of drug development, the earlier a decision can be made on the continuation or discontinuation of further development, thus saving development time and money and assessing and considerably reducing the risk for the patients and increasing the success rate of the project in the later confirmatory effectiveness trial with an adequate number of subjects receiving the new therapy under typical conditions of use. Strategies which may be helpful to improve the quality of decisions in drug discovery and drug development are: discovery experiments should be done to critically evaluate the compound, the "killer" experiments should be done as early as possible, continuous effort on preclinical disease models is necessary to improve predictability of efficacy in patients ("humanized" research): genomic technology should be used to identify novel, disease-related targets and to characterise preclinical test systems, improvement of knowledge and experience concerning the relevance of new technologies for the clinical picture; genotyping

  7. The innovative viscoelastic CP ESP cervical disk prosthesis with six degrees of freedom: biomechanical concepts, development program and preliminary clinical experience.

    PubMed

    Lazennec, Jean-Yves; Aaron, Alain; Ricart, Olivier; Rakover, Jean Patrick

    2016-01-01

    The viscoelastic cervical disk prosthesis ESP is an innovative one-piece deformable but cohesive interbody spacer. It is an evolution of the LP ESP lumbar disk implanted since 2006. CP ESP provides six full degrees of freedom about the three axes including shock absorbtion. The prosthesis geometry allows limited rotation and translation with resistance to motion (elastic return property) aimed at avoiding overload of the posterior facets. The rotation center can vary freely during motion. The concept of the ESP prosthesis is fundamentally different from that of the devices currently used in the cervical spine. The originality of the concept of the ESP® prosthesis led to innovative and intense testing to validate the adhesion of the viscoelastic component of the disk on the titanium endplates and to assess the mechanical properties of the PCU cushion. The preliminary clinical and radiological results with 2-year follow-up are encouraging for pain, function and kinematic behavior (range of motion and evolution of the mean centers of rotation). In this series, we did not observe device-related specific complications, misalignment, instability or ossifications. Additional studies and longer patient follow-up are needed to assess long-term reliability of this innovative implant.

  8. Disrupting P-glycoprotein function in clinical settings: what can we learn from the fundamental aspects of this transporter?

    PubMed Central

    Chung, Francisco S; Santiago, Jayson S; Jesus, Miguel Francisco M De; Trinidad, Camille V; See, Melvin Floyd E

    2016-01-01

    P-glycoprotein is one of the most well-studied drug transporters, significant for its role in cancer multiple drug resistance. However, using P-gp inhibitors with the aim of enhancing the therapeutic efficacy of anti-cancer drugs has led to disappointing outcomes. Furthermore, several lead compounds suggested by in vitro and pre-clinical studies have shown variable pharmacokinetics and therapeutic efficacies when applied in the clinical setting. This review will highlight the need to revisit a sound approach to better design and apply P-gp inhibitors in light of safety and efficacy. Challenges confronting the issue hinge upon myriad studies that do not necessarily represent the heterogeneous target population of this therapeutic approach. The application of P-gp modulators has also been complicated by the promiscuous substrate-binding behaviour of P-gp, as well as toxicities related to its intrinsic presence in healthy tissue. This review capitalizes on information spanning genetics, energetics, and pharmacology, bringing to light some fundamental aspects that ought to be reconsidered in order to improve upon and design the next generation of P-gp inhibitors. PMID:27648351

  9. Spiritual/religious coping in patients with epilepsy: relationship with sociodemographic and clinical aspects and quality of life.

    PubMed

    Tedrus, Glória Maria Almeida Souza; Fonseca, Lineu Corrêa; De Pietro Magri, Fabiane; Mendes, Pedro Henrique Magalhães

    2013-09-01

    One hundred and ten patients with epilepsy with a mean age of 45.9 were assessed by a clinical-neurological evaluation, Quality of Life in Epilepsy Inventory-31 (QOLIE-31), and the Spiritual/Religious Coping (SRCOPE) Scale. The objective of this study was to evaluate if patients with epilepsy used positive and/or negative spiritual/religious coping and the relationships between this type of coping and the sociodemographic and clinical aspects of epilepsy and the QOLIE-31. A greater use of positive coping (3.0±0.7) than negative coping (2.3±0.7) was found. The use of the positive factor was greater in mesial temporal lobe epilepsy (MTLE) than in other types of epilepsy. The ratio of negative/positive coping was associated with lower scores in the QOLIE-31 (-0.222; p=0.036). Patients with epilepsy appear to use spiritual/religious coping, especially those with MTLE, and a predominance of negative coping was associated with a reduced quality of life. Future studies should evaluate interventions considering the knowledge of spiritual/religious strategies by the patients.

  10. Disrupting P-glycoprotein function in clinical settings: what can we learn from the fundamental aspects of this transporter?

    PubMed Central

    Chung, Francisco S; Santiago, Jayson S; Jesus, Miguel Francisco M De; Trinidad, Camille V; See, Melvin Floyd E

    2016-01-01

    P-glycoprotein is one of the most well-studied drug transporters, significant for its role in cancer multiple drug resistance. However, using P-gp inhibitors with the aim of enhancing the therapeutic efficacy of anti-cancer drugs has led to disappointing outcomes. Furthermore, several lead compounds suggested by in vitro and pre-clinical studies have shown variable pharmacokinetics and therapeutic efficacies when applied in the clinical setting. This review will highlight the need to revisit a sound approach to better design and apply P-gp inhibitors in light of safety and efficacy. Challenges confronting the issue hinge upon myriad studies that do not necessarily represent the heterogeneous target population of this therapeutic approach. The application of P-gp modulators has also been complicated by the promiscuous substrate-binding behaviour of P-gp, as well as toxicities related to its intrinsic presence in healthy tissue. This review capitalizes on information spanning genetics, energetics, and pharmacology, bringing to light some fundamental aspects that ought to be reconsidered in order to improve upon and design the next generation of P-gp inhibitors.

  11. A Canonical Biomechanical Vocal Fold Model

    PubMed Central

    Bhattacharya, Pinaki; Siegmund, Thomas H.

    2012-01-01

    Summary The present article aimed at constructing a canonical geometry of the human vocal fold (VF) from subject-specific image slice data. A computer-aided design approach automated the model construction. A subject-specific geometry available in literature, three abstractions (which successively diminished in geometric detail) derived from it, and a widely used quasi two-dimensional VF model geometry were used to create computational models. The first three natural frequencies of the models were used to characterize their mechanical response. These frequencies were determined for a representative range of tissue biomechanical properties, accounting for underlying VF histology. Compared with the subject-specific geometry model (baseline), a higher degree of abstraction was found to always correspond to a larger deviation in model frequency (up to 50% in the relevant range of tissue biomechanical properties). The model we deemed canonical was optimally abstracted, in that it significantly simplified the VF geometry compared with the baseline geometry but can be recalibrated in a consistent manner to match the baseline response. Models providing only a marginally higher degree of abstraction were found to have significant deviation in predicted frequency response. The quasi two-dimensional model presented an extreme situation: it could not be recalibrated for its frequency response to match the subject-specific model. This deficiency was attributed to complex support conditions at anterior-posterior extremities of the VFs, accentuated by further issues introduced through the tissue biomechanical properties. In creating canonical models by leveraging advances in clinical imaging techniques, the automated design procedure makes VF modeling based on subject-specific geometry more realizable. PMID:22209063

  12. Biomechanics of Posterior Dynamic Stabilization Systems

    PubMed Central

    Erbulut, D. U.; Zafarparandeh, I.; Ozer, A. F.; Goel, V. K.

    2013-01-01

    Spinal rigid instrumentations have been used to fuse and stabilize spinal segments as a surgical treatment for various spinal disorders to date. This technology provides immediate stability after surgery until the natural fusion mass develops. At present, rigid fixation is the current gold standard in surgical treatment of chronic back pain spinal disorders. However, such systems have several drawbacks such as higher mechanical stress on the adjacent segment, leading to long-term degenerative changes and hypermobility that often necessitate additional fusion surgery. Dynamic stabilization systems have been suggested to address adjacent segment degeneration, which is considered to be a fusion-associated phenomenon. Dynamic stabilization systems are designed to preserve segmental stability, to keep the treated segment mobile, and to reduce or eliminate degenerative effects on adjacent segments. This paper aimed to describe the biomechanical aspect of dynamic stabilization systems as an alternative treatment to fusion for certain patients. PMID:23606975

  13. Biomechanical Perspective on the Remineralization of Dentin

    PubMed Central

    Bertassoni, L.E.; Habelitz, S.; Kinney, J.H.; Marshall, S.J.; Marshall, G.W.

    2009-01-01

    The objective of this article is to critically evaluate the methods that are used to assess outcomes of remineralization of dentin. Currently, the most used assessment methods fall either into quantitative analysis of the mineral content of the remineralized structures or dry measurements of their mechanical properties. Properties obtained from the dehydrated organic dentin matrix may not reflect the true mechanical behavior of the remineralized tissue under physiological and hydrated conditions. Here we seek to clarify the biomechanical aspects of remineralization of dentin, pointing out the effects of hydration and dehydration on the mechanical properties of treated tissues. We also emphasize that a more appropriate endpoint to evaluate the effectiveness of remineralization in dentin should be associated with the recovery of the mechanical properties of the hydrated tissue, which is presumed to correlate well with its overall functionality. PMID:19208991

  14. Physiology, biomechanics, and biomimetics of hagfish slime.

    PubMed

    Fudge, Douglas S; Schorno, Sarah; Ferraro, Shannon

    2015-01-01

    Hagfishes thwart attacks by fish predators by producing liters of defensive slime. The slime is produced when slime gland exudate is released into the predator's mouth, where it deploys in a fraction of a second and clogs the gills. Slime exudate is composed mainly of secretory products from two cell types, gland mucous cells and gland thread cells, which produce the mucous and fibrous components of the slime, respectively. Here, we review what is known about the composition of the slime, morphology of the slime gland, and physiology of the cells that produce the slime. We also discuss several of the mechanisms involved in the deployment of both mucous and thread cells during the transition from thick glandular exudate to ultradilute material. We review biomechanical aspects of the slime, along with recent efforts to produce biomimetic slime thread analogs, and end with a discussion of how hagfish slime may have evolved.

  15. Combination treatment of biomechanical support and targeted intra-arterial infusion of peripheral blood stem cells mobilized by granulocyte-colony stimulating factor for the osteonecrosis of the femoral head: a randomized controlled clinical trial.

    PubMed

    Mao, Qiang; Wang, Weidong; Xu, Taotao; Zhang, Shanxing; Xiao, Luwei; Chen, Di; Jin, Hongting; Tong, Peijian

    2015-04-01

    The objective of this study was to determine the benefits of combination treatment with mechanical support and targeted intra-arterial infusion of peripheral blood stem cells (PBSCs) mobilized by granulocyte-colony stimulating factor (G-CSF) via the medial circumflex femoral artery on the progression of osteonecrosis of the femoral head (ONFH). Fifty-five patients (89 hips) with early and intermediate stage ONFH were recruited and randomly assigned to combination treatment or mechanical support treatment (control group). All hips received mechanical support treatment (porous tantalum rod implantation). Then, hips in the combination treatment group were performed targeted intra-arterial infusion of PBSCs. At each follow-up, Harris hip score (HHS) and Association Research Circulation Osseous (ARCO) classification were used to evaluate the symptoms and progression of osteonecrosis. Total hip arthroplasty (THA) was assessed as an endpoint at each follow-up. At 36 months, 9 of the 41 hips (21.95%) in the control group progressed to clinical failure and underwent THA whereas only 3 of the 48 hips (6.25%) in the combination treatment group required THA (p = 0.031). Kaplan-Meier survival analysis showed a significant difference in the survival time between the two groups (log-rank test; p = 0.025). Compared to the control group, combination treatment significantly improved the HHS at 36 months (p = 0.003). At the final follow-up examination, radiological progression was noted in 13 of 41 hips (31.71%) for the control group, but in only 4 of 48 hips (8.33%) for the combination treatment group (p = 0.005). The overall collapse rates were 15.15% (5/33 hips) and 8.11% (3/37 hips) in the control and combination treatment groups, respectively. Targeted intra-arterial infusion of PBSCs is capable of enhancing the efficacy of biomechanical support in the treatment of ONFH. This clinical trial confirmed that the combination treatment might be a safe and feasible

  16. Biomechanical design considerations for transradial prosthetic interface: A review.

    PubMed

    Sang, Yuanjun; Li, Xiang; Luo, Yun

    2016-03-01

    Traditional function and comfort assessment of transradial prostheses pay scant attention to prosthetic interface. With better understanding of the biomechanics of prosthetic interface comes better efficiency and safety for interface design; in this way, amputees are more likely to accept prosthetic usage. This review attempts to provide design and selection criteria of transradial interface for prosthetists and clinicians. Various transradial socket types in the literature were chronologically reviewed. Biomechanical discussion of transradial prosthetic interface design from an engineering point of view was also done. Suspension control, range of motion, stability, as well as comfort and safety of socket designs have been considered in varying degrees in the literature. The human-machine interface design should change from traditional "socket design" to new "interface design." From anatomy and physiology to biomechanics of the transradial residual limb, the force and motion transfer, together with comfort and safety, are the two main aspects in prosthetic interface design. Load distribution and transmission should mainly rely on achieving additional skeletal control through targeted soft tissue relief. Biomechanics of the residual limb soft tissues should be studied to find the relationship between mechanical properties and the comfort and safety of soft tissues.

  17. Biomechanics of Early Cardiac Development

    PubMed Central

    Goenezen, Sevan; Rennie, Monique Y.

    2012-01-01

    Biomechanics affect early cardiac development, from looping to the development of chambers and valves. Hemodynamic forces are essential for proper cardiac development, and their disruption leads to congenital heart defects. A wealth of information already exists on early cardiac adaptations to hemodynamic loading, and new technologies, including high resolution imaging modalities and computational modeling, are enabling a more thorough understanding of relationships between hemodynamics and cardiac development. Imaging and modeling approaches, used in combination with biological data on cell behavior and adaptation, are paving the road for new discoveries on links between biomechanics and biology and their effect on cardiac development and fetal programming. PMID:22760547

  18. Unified Approach to the Biomechanics of Dental Implantology

    NASA Technical Reports Server (NTRS)

    Grenoble, D. E.; Knoell, A. C.

    1973-01-01

    The human need for safe and effective dental implants is well-recognized. Although many implant designs have been tested and are in use today, a large number have resulted in clinical failure. These failures appear to be due to biomechanical effects, as well as biocompatibility and surgical factors. A unified approach is proposed using multidisciplinary systems technology, for the study of the biomechanical interactions between dental implants and host tissues. The approach progresses from biomechanical modeling and analysis, supported by experimental investigations, through implant design development, clinical verification, and education of the dental practitioner. The result of the biomechanical modeling, analysis, and experimental phases would be the development of scientific design criteria for implants. Implant designs meeting these criteria would be generated, fabricated, and tested in animals. After design acceptance, these implants would be tested in humans, using efficient and safe surgical and restorative procedures. Finally, educational media and instructional courses would be developed for training dental practitioners in the use of the resulting implants.

  19. Anaphylaxis: clinical aspects.

    PubMed

    Sheffer, Albert L

    2004-01-01

    Anaphylaxis is a rarely anticipated, potentially life-threatening systemic allergic reaction with symptoms ranging from mild flushing to upper respiratory obstruction with or without vascular collapse. Early recognition of symptoms with prompt institution of therapy is central to a successful outcome. Anaphylaxis is IgE mediated, whereas non-IgE mediated anaphylatic reactions are termed anaphylactoid. Food-induced anaphylactic reactions, particularly peanut, are being recognized with increasing frequency. Central to appropriate therapy of the acute reaction is adminstration of intramuscular adrenalin. However, with the advent of humanized anti-IgE monoclonal antibody, such reactions may be reduced in frequency and severity.

  20. Modeling the biomechanics of fetal movements.

    PubMed

    Verbruggen, Stefaan W; Loo, Jessica H W; Hayat, Tayyib T A; Hajnal, Joseph V; Rutherford, Mary A; Phillips, Andrew T M; Nowlan, Niamh C

    2016-08-01

    Fetal movements in the uterus are a natural part of development and are known to play an important role in normal musculoskeletal development. However, very little is known about the biomechanical stimuli that arise during movements in utero, despite these stimuli being crucial to normal bone and joint formation. Therefore, the objective of this study was to create a series of computational steps by which the forces generated during a kick in utero could be predicted from clinically observed fetal movements using novel cine-MRI data of three fetuses, aged 20-22 weeks. A custom tracking software was designed to characterize the movements of joints in utero, and average uterus deflection of [Formula: see text] mm due to kicking was calculated. These observed displacements provided boundary conditions for a finite element model of the uterine environment, predicting an average reaction force of [Formula: see text] N generated by a kick against the uterine wall. Finally, these data were applied as inputs for a musculoskeletal model of a fetal kick, resulting in predicted maximum forces in the muscles surrounding the hip joint of approximately 8 N, while higher maximum forces of approximately 21 N were predicted for the muscles surrounding the knee joint. This study provides a novel insight into the closed mechanical environment of the uterus, with an innovative method allowing elucidation of the biomechanical interaction of the developing fetus with its surroundings. PMID:26534772

  1. Integrative Structural Biomechanical Concepts of Ankylosing Spondylitis

    PubMed Central

    Masi, Alfonse T.; Nair, Kalyani; Andonian, Brian J.; Prus, Kristina M.; Kelly, Joseph; Sanchez, Jose R.; Henderson, Jacqueline

    2011-01-01

    Ankylosing spondylitis (AS) is not fully explained by inflammatory processes. Clinical, epidemiological, genetic, and course of disease features indicate additional host-related risk processes and predispositions. Collectively, the pattern of predisposition to onset in adolescent and young adult ages, male preponderance, and widely varied severity of AS is unique among rheumatic diseases. However, this pattern could reflect biomechanical and structural differences between the sexes, naturally occurring musculoskeletal changes over life cycles, and a population polymorphism. During juvenile development, the body is more flexible and weaker than during adolescent maturation and young adulthood, when strengthening and stiffening considerably increase. During middle and later ages, the musculoskeletal system again weakens. The novel concept of an innate axial myofascial hypertonicity reflects basic mechanobiological principles in human function, tissue reactivity, and pathology. However, these processes have been little studied and require critical testing. The proposed physical mechanisms likely interact with recognized immunobiological pathways. The structural biomechanical processes and tissue reactions might possibly precede initiation of other AS-related pathways. Research in the combined structural mechanobiology and immunobiology processes promises to improve understanding of the initiation and perpetuation of AS than prevailing concepts. The combined processes might better explain characteristic enthesopathic and inflammatory processes in AS. PMID:22216409

  2. Frequency of neonatal hyperglycaemia at Gaafar Ibnauf Children’s Hospital: Clinical aspects and short term outcome

    PubMed Central

    Mohammed, Monera MM

    2016-01-01

    Hyperglycaemia has become a significant risk factor for morbidity and mortality of the smaller fragile infants surviving the neonatal period. Its risk is inversely related to gestational age, birth weight and baby’s clinical condition. The aim of this study was to determine the frequency, some clinical aspects and immediate outcome of hyperglycaemia in neonates admitted to the neonatal intensive care unit (NICU) at Gaafar Ibnauf Children’s Hospital, Khartoum. The study was a prospective, descriptive and hospital-based, conducted during the period of 1st January to 31st December 2014. Eighty-five neonates out of 345 had neonatal hyperglycaemia with a frequency rate of (24.6%). Fifty-two (61.2%) were males (male: female ratio=1.6:1), 61.2% of the babies were in the age group (0—7) days, and 25.9% in age group (8—14) days. Forty-two (49.4%) were preterm, while 43 (50.6%) were term babies. Four (4.7%) of the mothers had diabetes, and 6(7.1%) had hypertension. Neonatal sepsis was a predominant risk factor of hyperglycaemia occurring in 67 babies (78.8%), followed by respiratory distress syndrome in 28 (32.9%) babies. Ten babies (11.8%) were diagnosed as acute kidney injury, four babies (4.7%) had hypernatraemic dehydration and seven babies (8.3%) were having hypoxic ischemic encephalopathy. Out of 85 hyperglycaemic neonates death was reported in 10 babies (11.8%), 75 (88.2%) survived. All cases had transient hyperglycaemia; therefore insulin intervention was not necessary. Currently, at Gaafar Ibnauf Children’s Hospital, specific protocol for management of hyperglycaemia is lacking. Further studies are recommended to assess long term sequels of hyperglycaemia in neonates. PMID:27651553

  3. Leprosy Reactions in Patients Coinfected with HIV: Clinical Aspects and Outcomes in Two Comparative Cohorts in the Amazon Region, Brazil

    PubMed Central

    Pires, Carla Andréa Avelar; Jucá Neto, Fernando Octávio Machado; de Albuquerque, Nahima Castelo; Macedo, Geraldo Mariano Moraes; Batista, Keila de Nazaré Madureira; Xavier, Marília Brasil

    2015-01-01

    Background Leprosy, caused by Mycobacterium leprae, can lead to scarring and deformities. Human immunodeficiency virus (HIV), a lymphotropic virus with high rates of replication, leads to cell death in various stages of infection. These diseases have major social and quality of life costs, and although the relevance of their comorbidity is recognized, several aspects are still not fully understood. Methodology/Principal Findings Two cohorts of patients with leprosy in an endemic region of the Amazon were observed. We compared 40 patients with leprosy and HIV (Group 1) and 107 leprosy patients with no comorbidity (Group 2) for a minimum of 2 years. Group 1 predominantly experienced the paucibacillary classification, accounting for 70% of cases, whereas Group 2 primarily experienced the multibacillary classification (80.4% of cases). There was no significant difference in the prevalence of leprosy reactions among the two groups (37.5% for Group 1 vs. 56.1% for Group 2), and the most frequent reaction was Type 1. The appearance of Group 1 patients’ reversal reaction skin lesions was consistent with each clinical form: typically erythematous and infiltrated, with similar progression as those patients without HIV, which responded to prednisone. Patients in both groups primarily experienced a single episode (73.3% in Group 1 and 75% in Group 2), and Group 1 had shorter reaction periods (≤3 months; 93.3%), moderate severity (80%), with 93.3% of the patients in the state of acquired immune deficiency syndrome, and 46.7% presenting the reaction at the time of the immune reconstitution inflammatory syndrome. Conclusions/Significance This study used a large sample and makes a significant contribution to the clinical outcomes of patients in the reactive state with comorbid HIV and leprosy. The data indicate that these diseases, although concurrent, have independent courses. PMID:26029928

  4. Frequency of neonatal hyperglycaemia at Gaafar Ibnauf Children’s Hospital: Clinical aspects and short term outcome

    PubMed Central

    Mohammed, Monera MM

    2016-01-01

    Hyperglycaemia has become a significant risk factor for morbidity and mortality of the smaller fragile infants surviving the neonatal period. Its risk is inversely related to gestational age, birth weight and baby’s clinical condition. The aim of this study was to determine the frequency, some clinical aspects and immediate outcome of hyperglycaemia in neonates admitted to the neonatal intensive care unit (NICU) at Gaafar Ibnauf Children’s Hospital, Khartoum. The study was a prospective, descriptive and hospital-based, conducted during the period of 1st January to 31st December 2014. Eighty-five neonates out of 345 had neonatal hyperglycaemia with a frequency rate of (24.6%). Fifty-two (61.2%) were males (male: female ratio=1.6:1), 61.2% of the babies were in the age group (0—7) days, and 25.9% in age group (8—14) days. Forty-two (49.4%) were preterm, while 43 (50.6%) were term babies. Four (4.7%) of the mothers had diabetes, and 6(7.1%) had hypertension. Neonatal sepsis was a predominant risk factor of hyperglycaemia occurring in 67 babies (78.8%), followed by respiratory distress syndrome in 28 (32.9%) babies. Ten babies (11.8%) were diagnosed as acute kidney injury, four babies (4.7%) had hypernatraemic dehydration and seven babies (8.3%) were having hypoxic ischemic encephalopathy. Out of 85 hyperglycaemic neonates death was reported in 10 babies (11.8%), 75 (88.2%) survived. All cases had transient hyperglycaemia; therefore insulin intervention was not necessary. Currently, at Gaafar Ibnauf Children’s Hospital, specific protocol for management of hyperglycaemia is lacking. Further studies are recommended to assess long term sequels of hyperglycaemia in neonates.

  5. An integrated procedure for spine and full skeleton multi-sensor biomechanical analysis & averaging in posture gait and cyclic movement tasks.

    PubMed

    D'Amico, Moreno; D'Amico, Gabriele; Paniccia, Michele; Roncoletta, Piero; Vallasciani, Massimo

    2010-01-01

    Spine and posture disorders cover large interest in rehabilitation. Quantitative functional evaluation represents the main goal in Movement/Gait analysis. However very few studies outline the behaviour of spine during Posture and Movement/Gait analysis. To overcome such limits, several years ago our group started, a project to transfer into a complete fully 3D reliable and detailed representation, different segmental biomechanical models presented in literature. As result a complete 3D parametric biomechanical skeleton model has been developed to be used in quantitative analysis. Posture and Movement/Gait analysis are performed by 3D Opto-electronic stereophotogrammetric measurements of body landmarks labelled by passive markers. Depending on different analysis purposes, the model can work at different stages of complexity. Examples on the application of such model into biomechanical and clinical fields have been presented in literature. Our group is continuously working to add new features to such model, which is now able to fully integrate data deriving from force platforms, SEMG, foot pressure maps. By means of data fusion and optimisation procedures all these inputs are used in the model to assess lower limbs internal joint forces, torques and muscular efforts. The possibility to compute the average of cyclic or repetitive tasks has been included as well. Recently we added the possibility to assess internal joint forces and torques at each spine vertebral level and to correlate these latter with all the other model's features. The aim of this study is to present the methodological aspects of such new features and their potential applicability in clinical and biomechanical fields.

  6. Molecular and Clinical Aspects of the Target Therapy with the Calcimimetic Cinacalcet in the Treatment of Parathyroid Tumors.

    PubMed

    Mingione, Alessandra; Verdelli, Chiara; Terranegra, Annalisa; Soldati, Laura; Corbetta, Sabrina

    2015-01-01

    Parathyroid tumors are almost invariably associated with parathormone (PTH) hypersecretion resulting in primary (PHPT) or secondary (SHPT) hyperparathyroidism. PHPT is the third most common endocrine disorder with a prevalence of 1-2% in post-menopausal women; SHPT is a major complication of chronic kidney failure, the prevalence of which is increasing. The calciumsensing receptor (CASR) is the key molecule regulating PTH synthesis and release from the parathyroid cells in response to changes in extracellular calcium concentrations. A potent calcimimetic, cinacalcet, has been developed in the last ten years and made available for medical treatment of both PHPT and SHPT. Cinacalcet has been demonstrated to be effective in inhibiting PTH secretion, though the drug fails to normalize PTH release, both in PHPT and SHPT patients with different degrees of disease severity, including patients with parathyroid carcinomas and with MEN1-related parathyroid tumors. Here we reviewed the molecular aspects of CASR target therapy and the effect of the CASR gene single nucleotide polymorphisms. Clinical data concerning the efficacy and safety of cinacalcet in controlling hyperparathyroidism are reported, focusing on the treatment of the different types of parathyroid tumors. Finally, limits of this target therapy are analyzed, pointing out the lack of efficacy in improving kidney and bone morbidities in PHPT and cardiovascular diseases in SHPT. Though cinacalcet is a target therapeutic option for parathyroid tumors, further approaches are warranted to fully control these metabolic disorders and the underlying tumors. PMID:26033088

  7. Waldenström Macroglobulinemia: Clinical and Immunological Aspects, Natural History, Cell of Origin, and Emerging Mouse Models

    PubMed Central

    2013-01-01

    Waldenström macroglobulinemia (WM) is a rare and currently incurable neoplasm of IgM-expressing B-lymphocytes that is characterized by the occurrence of a monoclonal IgM (mIgM) paraprotein in blood serum and the infiltration of the hematopoietic bone marrow with malignant lymphoplasmacytic cells. The symptoms of patients with WM can be attributed to the extent and tissue sites of tumor cell infiltration and the magnitude and immunological specificity of the paraprotein. WM presents fascinating clues on neoplastic B-cell development, including the recent discovery of a specific gain-of-function mutation in the MYD88 adapter protein. This not only provides an intriguing link to new findings that natural effector IgM+IgD+ memory B-cells are dependent on MYD88 signaling, but also supports the hypothesis that WM derives from primitive, innate-like B-cells, such as marginal zone and B1 B-cells. Following a brief review of the clinical aspects and natural history of WM, this review discusses the thorny issue of WM's cell of origin in greater depth. Also included are emerging, genetically engineered mouse models of human WM that may enhance our understanding of the biologic and genetic underpinnings of the disease and facilitate the design and testing of new approaches to treat and prevent WM more effectively. PMID:24106612

  8. Sport-specific biomechanics of spinal injuries in aesthetic athletes (dancers, gymnasts, and figure skaters).

    PubMed

    d'Hemecourt, Pierre A; Luke, Anthony

    2012-07-01

    Young aesthetic athletes require special understanding of the athletic biomechanical demands peculiar to each sport. The performance of these activities may impart specific biomechanical stresses and subsequent injury patterns. The clinician must understand these aspects as well as the spinal changes that occur with growth when many of these injuries often occur. Further, athletes, parents, coaches, and healthcare providers must be sensitive to the overall aspects of the athlete, including nutrition, overtraining, adequate recovery, proper technique, and limiting repetition of difficult maneuvers to minimize injuries.

  9. Surface-based prostate registration with biomechanical regularization

    NASA Astrophysics Data System (ADS)

    van de Ven, Wendy J. M.; Hu, Yipeng; Barentsz, Jelle O.; Karssemeijer, Nico; Barratt, Dean; Huisman, Henkjan J.

    2013-03-01

    Adding MR-derived information to standard transrectal ultrasound (TRUS) images for guiding prostate biopsy is of substantial clinical interest. A tumor visible on MR images can be projected on ultrasound by using MRUS registration. A common approach is to use surface-based registration. We hypothesize that biomechanical modeling will better control deformation inside the prostate than a regular surface-based registration method. We developed a novel method by extending a surface-based registration with finite element (FE) simulation to better predict internal deformation of the prostate. For each of six patients, a tetrahedral mesh was constructed from the manual prostate segmentation. Next, the internal prostate deformation was simulated using the derived radial surface displacement as boundary condition. The deformation field within the gland was calculated using the predicted FE node displacements and thin-plate spline interpolation. We tested our method on MR guided MR biopsy imaging data, as landmarks can easily be identified on MR images. For evaluation of the registration accuracy we used 45 anatomical landmarks located in all regions of the prostate. Our results show that the median target registration error of a surface-based registration with biomechanical regularization is 1.88 mm, which is significantly different from 2.61 mm without biomechanical regularization. We can conclude that biomechanical FE modeling has the potential to improve the accuracy of multimodal prostate registration when comparing it to regular surface-based registration.

  10. Assessment and characterization of in situ rotator cuff biomechanics

    NASA Astrophysics Data System (ADS)

    Trent, Erika A.; Bailey, Lane; Mefleh, Fuad N.; Raikar, Vipul P.; Shanley, Ellen; Thigpen, Charles A.; Dean, Delphine; Kwartowitz, David M.

    2013-03-01

    Rotator cuff disease is a degenerative disorder that is a common, costly, and often debilitating, ranging in severity from partial thickness tear, which may cause pain, to total rupture, leading to loss in function. Currently, clinical diagnosis and determination of disease extent relies primarily on subjective assessment of pain, range of motion, and possibly X-ray or ultrasound images. The final treatment plan however is at the discretion of the clinician, who often bases their decision on personal experiences, and not quantitative standards. The use of ultrasound for the assessment of tissue biomechanics is established, such as in ultrasound elastography, where soft tissue biomechanics are measured. Few studies have investigated the use of ultrasound elastography in the characterization of musculoskeletal biomechanics. To assess tissue biomechanics we have developed a device, which measures the force applied to the underlying musculotendentious tissue while simultaneously obtaining the related ultrasound images. In this work, the musculotendinous region of the infraspinatus of twenty asymptomatic male organized baseball players was examined to access the variability in tissue properties within a single patient and across a normal population. Elastic moduli at percent strains less than 15 were significantly different than those above 15 percent strain within the normal population. No significant difference in tissue properties was demonstrated within a single patient. This analysis demonstrated elastic moduli are variable across individuals and incidence. Therefore threshold elastic moduli will likely be a function of variation in local-tissue moduli as opposed to a specific global value.

  11. Biomechanical evaluation of the Nice knot

    PubMed Central

    Hill, Shannon W.; Chapman, Christopher R.; Adeeb, Samer; Duke, Kajsa; Beaupre, Lauren; Bouliane, Martin J.

    2016-01-01

    Background: The Nice knot is a bulky double-stranded knot. Biomechanical data supporting its use as well as the number of half hitches required to ensure knot security is lacking. Materials and Methods: Nice knots with, one, two, or three half-hitches were compared with the surgeon's and Tennessee slider knots with three half hitches. Each knot was tied 10 times around a fixed diameter using four different sutures: FiberWire (Arthrex, Naples, FL), Ultrabraid (Smith and Nephew, Andover, MA), Hi-Fi (ConMed Linvatec, Largo, FL) and Force Fiber (Teleflex Medical OEM, Gurnee, IL). Cyclic testing was performed for 10 min between 10N and 45N, resulting in approximately 1000 cycles. Displacement from an initial 10N load was recorded. Knots surviving cyclic testing were subjected to a load to failure test at a rate of 60 mm/min. Load at clinical failure: 3 mm slippage or opening of the suture loop was recorded. Bulk, mode of ultimate failure, opening of the loop past clinical failure, was also recorded. Results: During cyclic testing, the Nice knots with one or more half-hitches performed the best, slipping significantly less than the surgeon's and Tennessee Slider (P < 0.002). After one half-hitch, the addition of half-hitches did not significantly improve Nice knot performance during cyclic testing (P > 0.06). The addition of half-hitches improved the strength of the Nice knot during the force to failure test, however after two half-hitches, increase of strength was not significant (P = 0.59). While FiberWire was the most bulky of the sutures tested, it also performed the best, slipping the least. Conclusion: The Nice knot, especially using FiberWire, is biomechanically superior to the surgeon's and Tennessee slider knots. Two half hitches are recommended to ensure adequate knot security. PMID:26980985

  12. Clinical and laboratory aspects of the diagnosis and management of cutaneous and subcutaneous infections caused by rapidly growing mycobacteria.

    PubMed

    Kothavade, R J; Dhurat, R S; Mishra, S N; Kothavade, U R

    2013-02-01

    Rapidly growing mycobacteria (RGM) are known to cause pulmonary, extra-pulmonary, systemic/disseminated, and cutaneous and subcutaneous infections. The erroneous detection of RGM that is based solely on microscopy, solid and liquid cultures, Bactec systems, and species-specific polymerase chain reaction (PCR) may produce misleading results. Thus, inappropriate therapeutic measures may be used in dermatologic settings, leading to increased numbers of skin deformity cases or recurrent infections. Molecular tools such as the sequence analyses of 16S rRNA, rpoB and hsp65 or PCR restriction enzyme analyses, and the alternate gene sequencing of the superoxide dismutase (SOD) gene, dnaJ, the 16S-23S rRNA internal transcribed spacers (ITS), secA, recA1, dnaK, and the 32-kDa protein gene have shown promising results in the detection of RGM species. PCR restriction enzyme analyses (PRA) work better than conventional methods at identifying species that are closely related. Recently introduced molecular tools such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), pyrosequencing, DNA chip technology, and Beacon probes-combined PCR probes have shown comparable results in the detection of various species of RGM. Closely related RGM species (e.g., Mycobacterium fortuitum, M. chelonae, and M. abscessus) must be clearly differentiated using accurate molecular techniques because their therapeutic responses are species-specific. Hence, this paper reviews the following aspects of RGM: (i) its sources, predisposing factors, clinical manifestations, and concomitant fungal infections; (ii) the risks of misdiagnoses in the management of RGM infections in dermatological settings; (iii) the diagnoses and outcomes of treatment responses in common and uncommon infections in immunocompromised and immunocompetent patients; (iv) conventional versus current molecular methods for the detection of RGM; (v) the basic principles of a promising MALDI-TOF MS

  13. Endoscopic ultrasonography guided-fine needle aspiration for the diagnosis of solid pancreaticobiliary lesions: Clinical aspects to improve the diagnosis

    PubMed Central

    Matsubayashi, Hiroyuki; Matsui, Toru; Yabuuchi, Yohei; Imai, Kenichiro; Tanaka, Masaki; Kakushima, Naomi; Sasaki, Keiko; Ono, Hiroyuki

    2016-01-01

    Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been applied to pancreaticobiliary lesions since the 1990s and is in widespread use throughout the world today. We used this method to confirm the pathological evidence of the pancreaticobiliary lesions and to perform suitable therapies. Complications of EUS-FNA are quite rare, but some of them are severe. Operators should master conventional EUS observation and experience a minimum of 20-30 cases of supervised EUS-FNA on non-pancreatic and pancreatic lesions before attempting solo EUS-FNA. Studies conducted on pancreaticobiliary EUS-FNA have focused on selection of suitable instruments (e.g., needle selection) and sampling techniques (e.g., fanning method, suction level, with or without a stylet, optimum number of passes). Today, the diagnostic ability of EUS-FNA is still improving; the detection of pancreatic cancer (PC) currently has a sensitivity of 90%-95% and specificity of 95%-100%. In addition to PC, a variety of rare pancreatic tumors can be discriminated by conducting immunohistochemistry on the FNA materials. A flexible, large caliber needle has been used to obtain a large piece of tissue, which can provide sufficient histological information to be helpful in classifying benign pancreatic lesions. EUS-FNA can supply high diagnostic yields even for biliary lesions or peri-pancreaticobiliary lymph nodes. This review focuses on the clinical aspects of EUS-FNA in the pancreaticobiliary field, with the aim of providing information that can enable more accurate and efficient diagnosis. PMID:26811612

  14. The Biomechanics of Cervical Spondylosis

    PubMed Central

    Ferrara, Lisa A.

    2012-01-01

    Aging is the major risk factor that contributes to the onset of cervical spondylosis. Several acute and chronic symptoms can occur that start with neck pain and may progress into cervical radiculopathy. Eventually, the degenerative cascade causes desiccation of the intervertebral disc resulting in height loss along the ventral margin of the cervical spine. This causes ventral angulation and eventual loss of lordosis, with compression of the neural and vascular structures. The altered posture of the cervical spine will progress into kyphosis and continue if the load balance and lordosis is not restored. The content of this paper will address the physiological and biomechanical pathways leading to cervical spondylosis and the biomechanical principles related to the surgical correction and treatment of kyphotic progression. PMID:22400120

  15. The biomechanics of cervical spondylosis.

    PubMed

    Ferrara, Lisa A

    2012-01-01

    Aging is the major risk factor that contributes to the onset of cervical spondylosis. Several acute and chronic symptoms can occur that start with neck pain and may progress into cervical radiculopathy. Eventually, the degenerative cascade causes desiccation of the intervertebral disc resulting in height loss along the ventral margin of the cervical spine. This causes ventral angulation and eventual loss of lordosis, with compression of the neural and vascular structures. The altered posture of the cervical spine will progress into kyphosis and continue if the load balance and lordosis is not restored. The content of this paper will address the physiological and biomechanical pathways leading to cervical spondylosis and the biomechanical principles related to the surgical correction and treatment of kyphotic progression. PMID:22400120

  16. Link between immunoexpression of hMLH1 and hMSH2 proteins and clinical-epidemiological aspects of actinic cheilitis*

    PubMed Central

    Sarmento, Dmitry José de Santana; Godoy, Gustavo Pina; Miguel, Márcia Cristina da Costa; da Silveira, Éricka Janine Dantas

    2016-01-01

    Background The studies found in the literature associate the immunoexpression of hMLH1 and hMSH2 proteins with histologic aspects, but do not correlate it with clinical and epidemiological data. Objective To evaluate the immunoexpression of hMLH1 and hMSH2 in actinic cheilitis, correlating it with clinical characteristics. Methods We analyzed 40 cases. Histological and immunohistochemical analyses were performed. The following clinical variables were evaluated: gender, age range, ethnicity, clinical aspect and occupational sunlight exposure. Statistical evaluation included the Student t-test, while the significance level was set at 5%. Results Greater immunoexpression of hMLH1 and hMSH2 was observed in females, individuals aged over 40, and mixed-race/black patients. Furthermore, the immunoexpression of these proteins was greater in actinic cheilitis with a white-colored appearance and in patients without occupational sunlight exposure. No statistical differences were observed for the variables studied. Conclusion This study uncovered variations of hMLH1 and hMSH2 protein expression upon evaluation of clinical aspects in actinic cheilitis. PMID:27579741

  17. Anatomy and Selected Biomechanical Aspects of the Shoulder.

    ERIC Educational Resources Information Center

    Keene, James S.

    This paper focuses on the anatomy and functions of the shoulder that are relevant to the evaluation and treatment of athletic injuries. A discussion is presented on the four basic components of the shoulder mechanism: (1) super structure--bony components; (2) moving parts--joints involved; (3) motor power--musculature; and (4) communications…

  18. [Stability versus mobility of the shoulder. Biomechanical aspects in athletes].

    PubMed

    Pastor, M F; Smith, T; Struck, M; Wellmann, M

    2014-03-01

    The demand profile of athletes shoulders is high. On the one hand the shoulder has to provide a maximum active range of motion that allows rapid movements of the arm and on the other hand it has to be sufficiently stabilized to decelerate rapid movements and to neutralize the resulting translational forces. Two general types of instability can be differentiated in athletes shoulders: the macroinstability typically occurring in athletes involved in contact sports and the microinstability occurring in athletes involved in overhead sports.Repetitive abduction and external rotation movements of athletes involved in overhead sports lead to adaptation of the glenohumeral joint capsule and ligaments. The anterior capsule becomes stretched while the posterior capsule develops tightness. These adaptations can result in an anterior microinstability as well as posterosuperior impingement (PSI) which implicates a pathological contact of the posterosuperior rotator cuff with the posterior glenoid and which is also associated with SLAP lesions. In contrast the shoulders of swimmers are prone to anterosuperior impingement because the arm stroke involves a forceful combined anteflexion, adduction and internal rotation of the arm.The macroinstability of contact athletes is caused by sufficient trauma and characterized by a structural lesion of capsulolabral or bony lesion. While the empirical recurrence risk of young contact athletes is already high, it can be further impaired by bony defects of the glenoid. In suspected cases, critical glenoid defects should be quantified by computed tomography (CT) scans and treated by bony augmentation of the glenoid.

  19. Brillouin Optical Microscopy for Corneal Biomechanics

    PubMed Central

    Scarcelli, Giuliano; Pineda, Roberto

    2012-01-01

    Purpose. The mechanical properties of corneal tissue are linked to prevalent ocular diseases and therapeutic procedures. Brillouin microscopy is a novel optical technology that enables three-dimensional mechanical imaging. In this study, the feasibility of this noncontact technique was tested for in situ quantitative assessment of the biomechanical properties of the cornea. Methods. Brillouin light-scattering involves a spectral shift proportional to the longitudinal modulus of elasticity of the tissue. A 532-nm single-frequency laser and a custom-developed ultrahigh-resolution spectrometer were used to measure the Brillouin frequency. Confocal scanning was used to perform Brillouin elasticity imaging of the corneas of whole bovine eyes. The longitudinal modulus of the bovine corneas was compared before and after riboflavin corneal collagen photo-cross-linking. The Brillouin measurements were then compared with conventional stress–strain mechanical test results. Results. High-resolution Brillouin images of the cornea were obtained, revealing a striking depth-dependent variation of the elastic modulus across the cornea. Along the central axis, the Brillouin frequency shift varied gradually from 8.2 GHz in the epithelium to 7.5 GHz near the endothelium. The coefficients of the down slope were measured to be approximately 1.09, 0.32, and 2.94 GHz/mm in the anterior, posterior, and innermost stroma, respectively. On riboflavin collagen cross-linking, marked changes in the axial Brillouin profiles (P < 0.001) were noted before and after cross-linking. Conclusions. Brillouin imaging can assess the biomechanical properties of cornea in situ with high spatial resolution. This novel technique has the potential for use in clinical diagnostics and treatment monitoring. PMID:22159012

  20. Effects of psychological and biomechanical trauma on brain and behavior

    PubMed Central

    McAllister, Thomas W.; Stein, Murray B.

    2011-01-01

    The current conflicts in Iraq and Afghanistan have resulted in a large cohort of military personnel exposed to combat-related psychological trauma as well as biomechanical trauma, including proximity to blast events. Historically, the long-term effects of both types of trauma have been viewed as having different neural substrates, with some controversy over the proper attribution of such symptoms evident after each of the major conflicts of the last century. Recently, great effort has been directed toward distinguishing which neuropsychiatric sequelae are due to which type of trauma. Of interest, however, is that the chronic effects of exposure to either process are associated with a significant overlap in clinical symptoms. Furthermore, similar brain regions are vulnerable to the effects of either psychological or biomechanical trauma, raising the possibility that shared mechanisms may underlie the clinically observed overlap in symptom profile. This paper reviews the literature on the neural substrate of biomechanical and psychological injury and discusses the implications for evaluation and treatment of the neuropsychiatric sequelae of these processes. PMID:20955325