Science.gov

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. Clinical biomechanics of the elbow.

    PubMed

    Lockard, Margary

    2006-01-01

    This paper describes the biomechanics of the articulations of the elbow joint that is relevant to therapists who design rehabilitation programs for patients following injuries or surgeries to the elbow. Individual and combined joint movements required for function such as activities of daily living are discussed, including normal arthrokinematics and the components that contribute to joint stability. The strain behavior of the nerves that cross the elbow is also reviewed. Therapists will understand the complexities of the biomechanics of the elbow that is necessary to design safe and effective rehabilitation programs.

  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.

  4. Physiological and biomechanical aspects of orienteering.

    PubMed

    Creagh, U; Reilly, T

    1997-12-01

    Orienteering is an endurance running event which differs from other running sports both in its cognitive element and in the type of terrain encountered. The demands of overcoming this terrain are not manifest in significant differences between orienteers and road runners in somatotype, though elite female orienteers have consistently been shown to have higher levels of adiposity (> 19%) than elite road runners. High aerobic power in orienteers (up to 63 and 76 ml/kg/min in women and men, respectively) is coupled with lower anaerobic performance. While leg strength is generally not high when compared with other athletic specialties, female orienteers have relatively good leg flexion strength. The energy cost of running is greatly increased in rough terrain. Oxygen cost was 26% higher while running in a forest when compared with road running. Biomechanical differences in stride pattern contribute towards this increased demand. Despite the high energy demands during competition, orienteers pace themselves such that their mean heart rate remains within the range of 167 to 172 beats/min, despite large fluctuations. The rough terrain encountered in orienteering results not only in a high energy cost but also in a higher incidence of sport-specific injuries, particularly to the ankle. Minor injuries such as cuts and bruises are common during competition.

  5. Regularity Aspects in Inverse Musculoskeletal Biomechanics

    NASA Astrophysics Data System (ADS)

    Lund, Marie; Stâhl, Fredrik; Gulliksson, Mârten

    2008-09-01

    Inverse simulations of musculoskeletal models computes the internal forces such as muscle and joint reaction forces, which are hard to measure, using the more easily measured motion and external forces as input data. Because of the difficulties of measuring muscle forces and joint reactions, simulations are hard to validate. One way of reducing errors for the simulations is to ensure that the mathematical problem is well-posed. This paper presents a study of regularity aspects for an inverse simulation method, often called forward dynamics or dynamical optimization, that takes into account both measurement errors and muscle dynamics. Regularity is examined for a test problem around the optimum using the approximated quadratic problem. The results shows improved rank by including a regularization term in the objective that handles the mechanical over-determinancy. Using the 3-element Hill muscle model the chosen regularization term is the norm of the activation. To make the problem full-rank only the excitation bounds should be included in the constraints. However, this results in small negative values of the activation which indicates that muscles are pushing and not pulling, which is unrealistic but the error maybe small enough to be accepted for specific applications. These results are a start to ensure better results of inverse musculoskeletal simulations from a numerical point of view.

  6. Biomechanical aspects of sports-related head injuries.

    PubMed

    Park, Min S; Levy, Michael L

    2008-02-01

    With the increased conditioning, size, and speed of professional athletes and the increase in individuals engaging in sports and recreational activities, there is potential for rising numbers of traumatic brain injuries in sports. Fortunately, parallel strides in basic research technology and improvements in computer and video technology have created a new era of discovery in the study of the biomechanical aspects of sports-related head injuries. Although prevention will always be the most important factor in reducing the incidence of sports-related traumatic brain injuries, ongoing studies will lead to the development of newer protective equipment, improved recognition and management of concussions on the field of play, and modification of rules and guidelines to make these activities safer and more enjoyable.

  7. 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…

  8. Biomechanics of the thorax - research evidence and clinical expertise.

    PubMed

    Lee, Diane Gail

    2015-07-01

    Understanding the biomechanics of the thorax is critical for understanding its role in multiple conditions since the thorax is part of many integrated systems including the musculoskeletal, respiratory, cardiac, digestive and urogynecological. The thorax is also an integrated system within itself and an element of the whole body/person. Therefore, understanding the biomechanics of the thorax is fundamental to all forms of treatment for multiple conditions. The interpretation of movement examination findings depends on one's view of optimal biomechanics and the influential factors. This article will provide a synopsis of the current state of research evidence as well as observations from clinical experience pertaining to the biomechanics of the thorax in order to help clinicians organise this knowledge and facilitate evidence-based and informed management of the, often complex, patient with or without thoracic pain and impairment. The integrated systems model (ISM) will be introduced as a way to determine when the noted biomechanical findings are relevant to a patient's clinical presentation.

  9. Biomechanical assessment and treatment in lower extremity prosthetics and orthotics: a clinical perspective.

    PubMed

    Bedotto, Robert A

    2006-02-01

    article will see the need to combine their efforts to provide truly biomechanical treatment. By working together, they can expand their present knowledge and skills. In this way, treatment and outcomes can improve and serve as the guiding force for a new generation of rehabilitation specialists. This process can be expedited through the educational system by offering advanced clinical degrees specializing in biomechanical treatment specifically designed for clinical practice rather than research, administrative, or academic positions. For this idea to become reality, educational institutions representing the physical and mechanical aspects of biomechanical treatment also must work together; this would expedite the learning curve so that it would not take so long to put the pieces of the puzzle together.

  10. 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

  11. 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.

  12. Contribution of biomechanics to clinical practice in orthopaedics.

    PubMed

    Woo, Savio L-Y

    2004-01-01

    Biomechanics is a field that has a very long history. It was described in ancient Chinese and Greek literature as early as 400-500 BC. The foundation of biomechanics, however, was laid during a period between the 1500's to 1700's by renowned personalities, da Vinci, Galileo, Borelli, Hooke, Newton, and so (Fung, Y.C., Biomechanics: Mechanical Properties of Living Tissues, 2nd Ed. Springer Verlag, Chapter 1, 1993). Beginning in the 1950's, Muybridge, Steindler, Inman, Lissner, and Hirsch performed the pioneering work on musculoskeletal biomechanics and the foundation of orthopaedic biomechanics was formed. For the following two decades, the field has blossomed and significant contributions in the biomechanics of bone, articular cartilage, soft tissues, upper and lower extremities, spine and so on has been made. More sophisticated equipment, coupled with mathematical modeling and better engineering design, has enabled us to make great strides. Bioengineers, in collaboration with orthopaedic surgeons, have translated many laboratory discoveries into clinical practice, leading to improved patient treatment and outcome. In the past 30 years, my colleagues and I have focused our research on the biomechanics of musculoskeletal soft tissues, ligaments and tendons, in particular. Therefore, in this lecture, the function of knee ligaments, the associated homeostatic responses secondary to immobilization and exercise, and healing of the ligaments will be reviewed. Examples of scientific findings that help to guide the surgical management of injury to ligaments will be given. New ideas on functional tissue engineering to improve the healing of knee ligaments and tendons will be presented. We have learned that tendons and ligaments are indeed complex biological tissues. To fully understand their behavior, healing and remodelling processes, this author advocates major efforts be made to bring molecular biologists, morphologists, biochemists, bioengineers, physical therapists and

  13. 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.

  14. Poor relation between biomechanical and clinical studies for the proximal femoral locking compression plate.

    PubMed

    Viberg, Bjarke; Rasmussen, Katrine M V; Overgaard, Søren; Rogmark, Cecilia

    2017-03-13

    Background and purpose - The proximal femur locking compression plate (PF-LCP) is a new concept in the treatment of hip fractures. When releasing new implants onto the market, biomechanical studies are conducted to evaluate performance of the implant. We investigated the relation between biomechanical and clinical studies on PF-LCP. Methods - A systematic literature search of relevant biomechanical and clinical studies was conducted in PubMed on December 1, 2015. 7 biomechanical studies and 15 clinical studies were included. Results - Even though the biomechanical studies showed equivalent or higher failure loads for femoral neck fracture, the clinical results were far worse, with a 37% complication rate. There were no biomechanical studies on pertrochanteric fractures. Biomechanical studies on subtrochanteric fractures showed that PF-LCP had a lower failure load than with proximal femoral nail, but higher than with angled blade plate. 4 clinical studies had complication rates less than 8% and 9 studies had complication rates between 15% and 53%. Interpretation - There was no clear relation between biomechanical and clinical studies. Biomechanical studies are generally inherently different from clinical studies, as they examine the best possible theoretical use of the implant without considering the long-term outcome in a clinical setting. Properly designed clinical studies are mandatory when introducing new implants, and they cannot be replaced by biomechanical studies.

  15. Biomechanics of human movement and its clinical applications.

    PubMed

    Lu, Tung-Wu; Chang, Chu-Fen

    2012-02-01

    All life forms on earth, including humans, are constantly subjected to the universal force of gravitation, and thus to forces from within and surrounding the body. Through the study of the interaction of these forces and their effects, the form, function and motion of our bodies can be examined and the resulting knowledge applied to promote quality of life. Under gravity and other loads, and controlled by the nervous system, human movement is achieved through a complex and highly coordinated mechanical interaction between bones, muscles, ligaments and joints within the musculoskeletal system. Any injury to, or lesion in, any of the individual elements of the musculoskeletal system will change the mechanical interaction and cause degradation, instability or disability of movement. On the other hand, proper modification, manipulation and control of the mechanical environment can help prevent injury, correct abnormality, and speed healing and rehabilitation. Therefore, understanding the biomechanics and loading of each element during movement using motion analysis is helpful for studying disease etiology, making decisions about treatment, and evaluating treatment effects. In this article, the history and methodology of human movement biomechanics, and the theoretical and experimental methods developed for the study of human movement, are reviewed. Examples of motion analysis of various patient groups, prostheses and orthoses, and sports and exercises, are used to demonstrate the use of biomechanical and stereophotogrammetry-based human motion analysis studies to address clinical issues. It is suggested that further study of the biomechanics of human movement and its clinical applications will benefit from the integration of existing engineering techniques and the continuing development of new technology.

  16. [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.

  17. 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

  18. A biomechanical sorting of clinical risk factors affecting osteoporotic hip fracture.

    PubMed

    Luo, Y

    2016-02-01

    Osteoporotic fracture has been found associated with many clinical risk factors, and the associations have been explored dominantly by evidence-based and case-control approaches. The major challenges emerging from the studies are the large number of the risk factors, the difficulty in quantification, the incomplete list, and the interdependence of the risk factors. A biomechanical sorting of the risk factors may shed lights on resolving the above issues. Based on the definition of load-strength ratio (LSR), we first identified the four biomechanical variables determining fracture risk, i.e., the risk of fall, impact force, bone quality, and bone geometry. Then, we explored the links between the FRAX clinical risk factors and the biomechanical variables by looking for evidences in the literature. To accurately assess fracture risk, none of the four biomechanical variables can be ignored and their values must be subject-specific. A clinical risk factor contributes to osteoporotic fracture by affecting one or more of the biomechanical variables. A biomechanical variable represents the integral effect from all the clinical risk factors linked to the variable. The clinical risk factors in FRAX mostly stand for bone quality. The other three biomechanical variables are not adequately represented by the clinical risk factors. From the biomechanical viewpoint, most clinical risk factors are interdependent to each other as they affect the same biomechanical variable(s). As biomechanical variables must be expressed in numbers before their use in calculating LSR, the numerical value of a biomechanical variable can be used as a gauge of the linked clinical risk factors to measure their integral effect on fracture risk, which may be more efficient than to study each individual risk factor.

  19. 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

  20. Fibromyalgia: clinical and occupational aspects.

    PubMed

    Helfenstein Jr, Milton; Goldenfum, Marco Aurélio; Siena, César Augusto Fávaro

    2012-01-01

    Fibromyalgia (FM) is a clinical syndrome commonly observed in daily medical practice and its etiopathogenesis is still unclear. As it is characterized by chronic musculoskeletal pain associated with several symptoms, FM may be confused with several other rheumatic and nonrheumatic diseases when they course with pictures of diffuse pain and chronic fatigue. FM treatment should be multidisciplinary, individualized, count on active participation of the patient, and based on combined pharmacological and nonpharmacological modalities. It is found both in work and non-work settings, and there is no scientific evidence in the literature showing that FM might be caused by occupation. FM seldom leads to incapacity to work. In cases where pain or fatigue do not respond to appropriate treatment, reaching significant levels, a short period away from work can be considered. As FM is a relevant subject, this review article was based on exploratory, qualitative, and bibliographic investigation, aiming to study the main clinical and occupational aspects of FM, emphasizing the theoretical-conceptual background and the experience of specialists.

  1. Clinical aspects of phage therapy.

    PubMed

    Międzybrodzki, Ryszard; Borysowski, Jan; Weber-Dąbrowska, Beata; Fortuna, Wojciech; Letkiewicz, Sławomir; Szufnarowski, Krzysztof; Pawełczyk, Zdzisław; Rogóż, Paweł; Kłak, Marlena; Wojtasik, Elżbieta; Górski, Andrzej

    2012-01-01

    Phage therapy (PT) is a unique method of treatment of bacterial infections using bacteriophages (phages)-viruses that specifically kill bacteria, including their antibiotic-resistant strains. Over the last decade a marked increase in interest in the therapeutic use of phages has been observed, which has resulted from a substantial rise in the prevalence of antibiotic resistance of bacteria, coupled with an inadequate number of new antibiotics. The first, and so far the only, center of PT in the European Union is the Phage Therapy Unit (PTU) established at the Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Wrocław, Poland in 2005. This center continues the rich tradition of PT in Poland, which dates from the early 1920s. The main objective of this chapter is to present a detailed retrospective analysis of the results of PT of 153 patients with a wide range of infections resistant to antibiotic therapy admitted for treatment at the PTU between January 2008 and December 2010. Analysis includes the evaluation of both the efficacy and the safety of PT. In general, data suggest that PT can provide good clinical results in a significant cohort of patients with otherwise untreatable chronic bacterial infections and is essentially well tolerated. In addition, the whole complex procedure employed to obtain and characterize therapeutic phage preparations, as well as ethical aspects of PT, is discussed.

  2. 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

  3. Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale.

    PubMed

    Kim, Yongsik; Oh, Tae-Ju; Misch, Carl E; Wang, Hom-Lay

    2005-02-01

    Due to lack of the periodontal ligament, osseointegrated implants, unlike natural teeth, react biomechanically in a different fashion to occlusal force. It is therefore believed that dental implants may be more prone to occlusal overloading, which is often regarded as one of the potential causes for peri-implant bone loss and failure of the implant/implant prosthesis. Overloading factors that may negatively influence on implant longevity include large cantilevers, parafunctions, improper occlusal designs, and premature contacts. Hence, it is important to control implant occlusion within physiologic limit and thus provide optimal implant load to ensure a long-term implant success. The purposes of this paper are to discuss the importance of implant occlusion for implant longevity and to provide clinical guidelines of optimal implant occlusion and possible solutions managing complications related to implant occlusion. It must be emphasized that currently there is no evidence-based, implant-specific concept of occlusion. Future studies in this area are needed to clarify the relationship between occlusion and implant success.

  4. Biomechanics of the ankle joint and clinical outcomes of total ankle replacement.

    PubMed

    Michael, Junitha M; Golshani, Ashkahn; Gargac, Shawn; Goswami, Tarun

    2008-10-01

    Until the 1970s ankle arthrodesis was considered to be the "gold-standard" to treat arthritis. But the low fusion rate of ankle arthrodeses along with the inability to achieve normal range of motion led to the growing interest in the development of total ankle replacements. Though the short-term outcomes were good, their long-term outcomes were not as promising. To date, most models do not exactly mimic the anatomical functionality of a natural ankle joint. Therefore, research is being conducted worldwide to either enhance the existing models or develop new models while understanding the intricacies of the joint more precisely. This paper reviews the anatomical and biomechanical aspects of the ankle joint. Also, the evolution and comparison of clinical outcomes of various total ankle replacements are presented.

  5. 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.

  6. Clinical Aspects of Huntington's Disease.

    PubMed

    Ghosh, Rhia; Tabrizi, Sarah J

    2015-01-01

    Huntington's disease (HD) is a devastating inherited neurodegenerative condition characterized by progressive motor, cognitive, and psychiatric symptoms. Symptoms progress over 15-20 years, and there are currently no disease-modifying therapies. The causative genetic mutation is an expanded CAG repeat in the HTT gene encoding the Huntingtin protein, and is inherited in an autosomal dominant manner. In this chapter we discuss the genetics, clinical presentation, and management of this condition, as well as new data from large-scale clinical research studies on the natural history of HD.

  7. Biomechanical Modeling to Improve Coronary Artery Bifurcation Stenting: Expert Review Document on Techniques and Clinical Implementation.

    PubMed

    Antoniadis, Antonios P; Mortier, Peter; Kassab, Ghassan; Dubini, Gabriele; Foin, Nicolas; Murasato, Yoshinobu; Giannopoulos, Andreas A; Tu, Shengxian; Iwasaki, Kiyotaka; Hikichi, Yutaka; Migliavacca, Francesco; Chiastra, Claudio; Wentzel, Jolanda J; Gijsen, Frank; Reiber, Johan H C; Barlis, Peter; Serruys, Patrick W; Bhatt, Deepak L; Stankovic, Goran; Edelman, Elazer R; Giannoglou, George D; Louvard, Yves; Chatzizisis, Yiannis S

    2015-08-24

    Treatment of coronary bifurcation lesions remains an ongoing challenge for interventional cardiologists. Stenting of coronary bifurcations carries higher risk for in-stent restenosis, stent thrombosis, and recurrent clinical events. This review summarizes the current evidence regarding application and use of biomechanical modeling in the study of stent properties, local flow dynamics, and outcomes after percutaneous coronary interventions in bifurcation lesions. Biomechanical modeling of bifurcation stenting involves computational simulations and in vitro bench testing using subject-specific arterial geometries obtained from in vivo imaging. Biomechanical modeling has the potential to optimize stenting strategies and stent design, thereby reducing adverse outcomes. Large-scale clinical studies are needed to establish the translation of pre-clinical findings to the clinical arena.

  8. Painful diabetic neuropathy: clinical aspects.

    PubMed

    Didangelos, Triantafyllos; Doupis, John; Veves, Aristidis

    2014-01-01

    Painful diabetic neuropathy (PDN) is one of several clinical syndromes in patients with diabetic peripheral neuropathy (DPN) and presents a major challenge for optimal management. The epidemiology of PDN has not been extensively studied. On the basis of available data, the prevalence of pain ranges from 10% to 20% in patients with diabetes and from 40% to 50% in those with diabetic neuropathy. Neuropathic pain can be disabling and devastating, with a significant impact on the patient's quality of life and associated healthcare cost. Pathophysiologic mechanisms underlying PDN are similar to other neuropathic pain disorders and broadly invoke peripheral and central sensitization. The natural course of PDN is variable, with the majority of patients experiencing spontaneous improvement and resolution of pain. Quantifying neuropathic pain is difficult, especially in clinical practice, but has improved recently in clinical trials with the development of neuropathic pain-specific tools, such as the Neuropathic Pain Questionnaire and the Neuropathic Pain Symptom Inventory. Hyperglycemia-induced pathways result in nerve dysfunction and damage, which lead to hyperexcitable peripheral and central pathways of pain. Glycemic control may prevent or partially reverse DPN and modulate PDN.

  9. 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.

  10. [Current clinical aspects of AIDS].

    PubMed

    Clumeck, N

    1993-01-01

    Our knowledge of the natural history of VIH infection has considerably increased during the last years. We know now that clinical evolution will depend of host factors as well as of viral characteristics. Among the host factors, the early specific cytotoxic response to VIH components plays a major role. Phenotypic variation of the virus (syncytium inducer mutants) and viral load in the lymph node and in the circulating CD4 cells play also an important role. As far as antiviral therapeutic is concerned, at the moment we know that monotherapy with nucleosides analogues is probably of limited efficacy because of emergence of resistance. Future perspectives include combination of antivirals aimed to prevent emergence of resistance and to reduce toxicity.

  11. 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

  12. Thrombophilia: clinical-practical aspects.

    PubMed

    Moll, Stephan

    2015-04-01

    No consensus exists as to who should be tested for thrombophilia, mainly due to the lack of good quality clinical outcome data in relationship to presence or absence of a given thrombophilia. Testing may be considered if (a) finding a thrombophilia predicts recurrent thrombosis and, thus, influences length of anticoagulation treatment decisions; (b) identifying a thrombophilia has implications on management of asymptomatic family members who are carriers of the detected thrombophilia; (c) a patient wishes to better understand why a thrombotic event occurred. Testing may be helpful in patients with venous thromboembolism at intermediate risk of recurrence in whom the finding of a strong thrombophilia can be one of the arguments for long-term anticoagulation--the "risk-of-recurrence-triangle" may be a useful aid in this decision process. Patients whose venous thromboembolism was provoked by a major transient risk factor should not be tested for thrombophilia. Thrombophilia tests should only be ordered by health care professionals who can provide the "4P": (a) appropriately select which patient to test, (b) provide pre-test counseling, (c) properly interpret the test results, and (d) provide education and advice to the patient. If testing is embarked on in patients with venous thromboembolism, it is advisable to be done at the time of decision making whether to stop or continue anticoagulation, i.e. typically after 3 months of anticoagulant therapy. Thrombophilia testing is best not done at the time of an acute thrombotic event and while a patient is on an anticoagulant.

  13. [Somnambulism: clinical and eletrophysiological aspects].

    PubMed

    Szúcs, Anna; Halász, Péter

    2005-06-05

    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.

  14. Clinical aspects of symptomatic hyponatremia

    PubMed Central

    Schneider, Andreas; Höybye, Charlotte

    2016-01-01

    Hyponatremia (HN) is a common condition, with a large number of etiologies and a complicated treatment. Although chronic HN has been shown to be a predictor of poor outcome, sodium-increasing treatments in chronic stable and asymptomatic HN have not proven to increase life expectancy. For symptomatic HN, in contrast, the necessity for urgent treatment has broadly been accepted to avoid the development of fatal cerebral edema. On the other hand, a too rapid increase of serum sodium in chronic HN may result in cerebral damage due to osmotic demyelinisation. Recently, administration of hypertonic saline bolus has been recommended as first-line treatment in patients with moderate-to-severe symptomatic HN. This approach is easy to memorize and holds the potential to greatly facilitate the initial treatment of symptomatic HN. First-line treatment of chronic HN is fluid restriction and if ineffective treatment with tolvaptan or in some patients other agents should be considered. A number of recommendations and guidelines have been published on HN. In the present review, the management of patients with HN in relation to everyday clinical practice is summarized with focus on the acute management. PMID:27609587

  15. Translating ocular biomechanics into clinical practice: current state and future prospects.

    PubMed

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

    2015-01-01

    Biomechanics is the study of the relationship between forces and function in living organisms and 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 the 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.

  16. 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

  17. Biomechanical testing and clinical experience with the OMEGA-21 spinal fixation system.

    PubMed

    Cook, S D; Salkeld, S L; Whitecloud, T S; Barberá, J

    2001-05-01

    The role of spinal instrumentation is to provide mechanical stability, obtain and maintain anatomic alignment, and promote fusion. The American Society for Testing and Materials (ASTM) introduced guidelines and procedures so that biomechanical properties of different implant designs could be compared in a consistent manner. Combined with biomechanical analyses, clinical evaluation allows the safety and efficacy of a spinal implant system to be determined before construction. The objective of our study was to determine the biomechanical properties and clinical performance of the OMEGA-21 Spinal Fixation System. Static and dynamic (fatigue) biomechanical testing was performed per ASTM guidelines and recommendations on individual components and on the system assembled in a corpectomy model. Clinical and radiographic evaluation of 57 consecutive patients with indications for instrumented spinal arthrodesis of the lower dorsal lumbar and sacral segments of the spine was performed at a mean follow-up of 31.9 months. Static and fatigue testing revealed superior biomechanical properties of the individual components and of the assembled system. The mechanical-strength values of the system were comparable with maximum reported values for existing implant designs. At final clinical follow-up, 86% of patients obtained relief of their symptoms; 84% considered their clinical results to be excellent or good. Ninety-one percent of patients satisfied radiographic criteria for bony fusion. There were 5 implant-related complications: 2 misplaced screws (2 patients), local pain above the implant (2 patients), and 2 broken expansive screws (1 patient). Biomechanical and clinical results indicate that the OMEGA-21 system is feasible and performs well as a spinal instrumentation system for the lower dorsal, lumbar, and sacral spine.

  18. 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.

  19. [Pharmacology and clinical aspects of benzodiazepines].

    PubMed

    Mendlewicz, J; Sevy, S

    1985-01-01

    The widespread use of benzodiazepines has led the authors to review the pharmacological and clinical aspects of these substances. On a molecular level, the benzodiazepines have an effect on receptors in relation with the GABA system. Presently, endogenous ligand(s) to these receptors have not yet been fully demonstrated. The main benzodiazepines are also compared for their kinetics which is function of absorption, metabolisation and various factors such as binding to the receptor, age, hepatic and renal disorders. These pharmacological studies have clinical implications. The authors finally make a brief review of the clinical indications of the benzodiazepines.

  20. Frontiers in Head and Neck Trauma: Clinical and Biomechanical.

    DTIC Science & Technology

    2007-11-02

    the frontal, parietal and occipital bones that form the bulk of the convexity on top . The lateral aspect of the sphenoid bone meets the temporal bone...Bones The facial bones consist of fourteen bones: two nasal, two superior maxillary , two lachrymal, two malar, two palate, two inferior turbinate...vomer and inferior maxillary bones. These bones form the housing for most of the sensory structures of the human, including sight, smell and taste

  1. 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

  2. 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

  3. [Primary ciliary dyskinesia: clinical and genetic aspects].

    PubMed

    D'Auria, E; Palazzo, S; Argirò, S; El, Oksha S; Riva, E

    2012-01-01

    Primary ciliary dyskinesia (PCD) is a rare, genetically heterogeneous disease, characterized by ciliary disfunction and impaired mucociliary clearance, resulting in a range of clinical manifestations such as chronic bronchitis, bronchiectasis, chronic rhino-sinusitis, chronic otitis media, situs viscerum inversus in almost 40-50% of cases and male infertility. The triad situs viscerum inversus, bronchiectasis and sinusitis is known as Kartagener syndrome. Up to now little is known about genetic, diagnostic and therapeutic aspects of primary motile ciliary diseases in children: for this reason, diagnosis is generally delayed and almost all treatments for PCD are not based on randomized studies but extrapolated from cystic fibrosis guidelines. The aim of this review is to propose to pediatricians a summary of current clinical and diagnostic evidence to obtain better knoledwge of this condition. The earlier diagnosis and the right treatment are both crucial to improve the prognosis of PCD.

  4. [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.

  5. Postmenopausal osteoporosis - clinical, biological and histopathological aspects.

    PubMed

    Pavel, Oana Roxana; Popescu, Mihaela; Novac, Liliana; Mogoantă, LaurenŢiu; Pavel, LaurenŢiu Petrişor; Vicaş, Răzvan Marius; Trăistaru, Magdalena Rodica

    2016-01-01

    Osteoporosis is one of the most common disorders in postmenopausal women, affecting the quality of life and increasing the risk for fractures in minor traumas. Changes in the bone microarchitecture causes static changes in the body and affects motility. In this study, we analyzed two groups of women, one with physiological menopause and one with surgically induced menopause. The diagnosis of osteoporosis was suspected based on the clinical symptoms and confirmed by assessing bone mineral density by the dual-energy X-ray absorptiometry (DEXA). Comparing some clinical and biological aspects there was noted that a much higher percentage of women with surgically induced menopause exhibited increases in body mass index, changes in serum lipids, cholesterol, triglycerides, blood glucose, serum calcium, magnesemia and osteocalcin. In contrast, no significant differences were observed in the histopathological aspects of bone tissue examined from these two groups. In all patients, there was identified a significant reduction in the number of osteocytes and osteoblasts, the expansion of haversian channels, reducing the number of trabecular bone in the cancellous bone with wide areola cavities often full of adipose tissue, non-homogenous demineralization of both the compact bone and the cancellous bone, atrophy and even absence of the endosteal, and the presence of multiple microfractures. Our study showed that early surgically induced menopause more intensely alters the lipid, carbohydrate and mineral metabolism, thus favoring the onset of osteoporosis.

  6. 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

  7. 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.

  8. Clinical aspects of Marburg hemorrhagic fever

    PubMed Central

    Mehedi, Masfique; Groseth, Allison; Feldmann, Heinz; Ebihara, Hideki

    2011-01-01

    Marburg virus belongs to the genus Marburgvirus in the family Filoviridae and causes a severe hemorrhagic fever, known as Marburg hemorrhagic fever (MHF), in both humans and nonhuman primates. Similar to the more widely known Ebola hemorrhagic fever, MHF is characterized by systemic viral replication, immunosuppression and abnormal inflammatory responses. These pathological features of the disease contribute to a number of systemic dysfunctions including hemorrhages, edema, coagulation abnormalities and, ultimately, multiorgan failure and shock, often resulting in death. A detailed understanding of the pathological processes that lead to this devastating disease remains elusive, a fact that contributes to the lack of licensed vaccines or effective therapeutics. This article will review the clinical aspects of MHF and discuss the pathogenesis and possible options for diagnosis, treatment and prevention. PMID:22046196

  9. Uromodulin storage diseases: clinical aspects and mechanisms.

    PubMed

    Scolari, Francesco; Caridi, Gianluca; Rampoldi, Luca; Tardanico, Regina; Izzi, Claudia; Pirulli, Doroti; Amoroso, Antonio; Casari, Giorgio; Ghiggeri, Gian Marco

    2004-12-01

    The recent discovery of mutations in the uromodulin gene ( UMOD ) in patients with medullary cystic kidney disease type 2 (MCKD2), familial juvenile hyperuricemic nephropathy (FJHN), and glomerulocystic kidney disease (GCKD) provides the opportunity for a revision of pathogenic aspects and puts forth the basis for a renewed classification. This review focuses on clinical, pathological, and cell biology advances in UMOD -related pathological states, including a review of the associated clinical conditions described to date in the literature. Overall, 31 UMOD mutations associated with MCKD2 and FJHN (205 patients) and 1 mutation associated with GCKD (3 patients) have been described, with a cluster at exons 4 and 5. Most are missense mutations causing a cysteine change in uromodulin sequence. No differences in clinical symptoms between carriers of cysteine versus polar residue changes have been observed; clinical phenotypes invariably are linked to classic MCKD2/FJHN. A common motif among all reports is that many overlapping symptoms between MCKD2 and FJHN are present, and a separation between these 2 entities seems unwarranted or redundant. Cell experiments with mutant variants indicated a delay in intracellular maturation and export dynamics, with consequent uromodulin storage within the endoplasmic reticulum (ER). Patchy uromodulin deposits in tubule cells were found by means of immunohistochemistry, and electron microscopy showed dense fibrillar material in the ER. Mass spectrometry showed only unmodified uromodulin in urine of patients with UMOD mutations. Lack of uromodulin function(s) is associated with impairments in tubular function, particularly the urine-concentrating process, determining water depletion and hyperuricemia. Intracellular uromodulin trapping within the ER probably has a major role in determining tubulointerstitial fibrosis and renal failure. We propose the definition of uromodulin storage diseases for conditions with proven UMOD mutations.

  10. 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

  11. Blau syndrome, clinical and genetic aspects.

    PubMed

    Sfriso, Paolo; Caso, Francesco; Tognon, Sofia; Galozzi, Paola; Gava, Alessandra; Punzi, Leonardo

    2012-11-01

    Blau syndrome (BS) is a rare autosomal dominant, autoinflammatory syndrome characterized by the clinical triad of granulomatous recurrent uveitis, dermatitis and symmetric arthritis. The gene responsible for BS has been identified in the caspase recruitment domain gene CARD15/NOD2. In the majority of patients, the disease is characterized by early onset, usually before 3-4years of age. The manifestations at disease onset are usually represented by articular and cutaneous involvement signs, generally followed later by ocular manifestations which are often the most relevant morbidity of BS. In some cases the presence of fever is also observed; atypical cases of BS have been reported with cardiovascular, neurological, renal, intestinal and other organ involvement. The rarity and the variations in the severity and evolution of its expressions do not permit sufficient data about optimal treatment for patients with BS. The first step of therapy is represented by the use of corticosteroids and successively, in case of unsatisfactory response, by additional treatment with immunosuppressive agents. The results with biologic anti-cytokine agents, such as anti-TNFα and anti-IL1β, are different, particularly with regard to ocular morbidity. Clinical and genetic aspects of the familial and the sporadic form of BS will be discussed and focused on. A description of a case study of an Italian family is also included.

  12. Clinical and molecular aspects of severe malaria.

    PubMed

    Kirchgatter, Karin; Del Portillo, Hernando A

    2005-09-01

    The erythrocytic cycle of Plasmodium falciparum presents a particularity in relation to other Plasmodium species that infect man. Mature trophozoites and schizonts are sequestered from the peripheral circulation due to adhesion of infected erythrocytes to host endothelial cells. Modifications in the surface of infected erythrocytes, termed knobs, seem to facilitate adhesion to endothelium and other erythrocytes. Adhesion provides better maturation in the microaerophilic venous atmosphere and allows the parasite to escape clearance by the spleen which recognizes the erythrocytes loss of deformability. Adhesion to the endothelium, or cytoadherence, has an important role in the pathogenicity of the disease, causing occlusion of small vessels and contributing to failure of many organs. Cytoadherence can also describe adhesion of infected erythrocytes to uninfected erythrocytes, a phenomenon widely known as rosetting. Clinical aspects of severe malaria, as well as the host receptors and parasite ligands involved in cytoadherence and rosetting, are reviewed here. The erythrocyte membrane protein 1 of P. falciparum (PfEMP1) appears to be the principal adhesive ligand of infected erythrocytes and will be discussed in more detail. Understanding the role of host receptors and parasite ligands in the development of different clinical syndromes is urgently needed to identify vaccination targets in order to decrease the mortality rates of this disease.

  13. [Cystinuria update: clinical, biochemical and genetic aspects].

    PubMed

    Orts Costa, J A; Zúñiga Cabrera, A; Martínez de la Cára y Salmerón, J

    2003-06-01

    Cystinuria is an autosomal recessive disorder with an estimated incidence of 1 case in 7000 live births, that results in elevated urinary excretion of cystine and dibasic aminoacids: ornithine, lysine and arginine. Discussed by Sir Archibald Edward Garrod, in 1908, as one of the four first known inborn errors of metabolism, it is characterized by a defect in transport of cystine and dibasic aminoacids, that affects their reabsortion in both renal tubule and gastrointestinal tract. To date, according to the recent molecular findings, two genes have been identified as responsible for this disease: SLC3A1 and SLC7A9. A more accurate pheno/genotyping identification of cystinuric patients will allow to improve prophilaxis and therapy for this illness. Cystinuria only causes recurrent urolithiasis (about 1-2 / of renal calculi in adults) and its associated complications as clinical feature because of poor cystine solubility at low pH. An accurate control over prohylaxis (based on high water intake and potassium citrate treatment, on first line, and tiol-derivatives treatment, on second line) must be taken in patients -like homozygous type I- with high lithiasis risk. However, approximately one half of patients under prophylaxis control will develop recurrent lithiasis; in this case, only urology or surgical approaches would be possible. 474 Updated knowledge about biochemical, genetic, clinical, diagnosis, prevention, treatment and prognosis aspects of this, relatively unusual, disease has been reviewed in this article.

  14. Multidirectional instability of the shoulder: biomechanics, clinical presentation, and treatment strategies.

    PubMed

    Merolla, Giovanni; Cerciello, Simone; Chillemi, Claudio; Paladini, Paolo; De Santis, Elisa; Porcellini, Giuseppe

    2015-08-01

    Multidirectional instability (MDI) of the shoulder is a condition where the dislocation occurs in more than one direction with minimal or no causative trauma. Its pathoanatomy is complex and characterized by a redundant capsule, resulting in increased glenohumeral joint volume. The fact that several further factors may contribute to symptom onset complicates the diagnosis and hampers the identification of a therapeutic approach suitable for all cases. There is general agreement that the initial treatment should be conservative and that surgery should be reserved for patients who have not responded to an ad hoc rehabilitation program. We review the biomechanics, clinical presentation, and treatment strategies of shoulder MDI.

  15. LDL-Apheresis: Technical and Clinical Aspects

    PubMed Central

    Bambauer, Rolf; Bambauer, Carolin; Lehmann, Boris; Latza, Reinhard; Schiel, Ralf

    2012-01-01

    The prognosis of patients suffering from severe hyperlipidemia, sometimes combined with elevated lipoprotein (a) levels, and coronary heart disease refractory to diet and lipid-lowering drugs is poor. For such patients, regular treatment with low-density lipoprotein (LDL) apheresis is the therapeutic option. Today, there are five different LDL-apheresis systems available: cascade filtration or lipid filtration, immunoadsorption, heparin-induced LDL precipitation, dextran sulfate LDL adsorption, and the LDL hemoperfusion. There is a strong correlation between hyperlipidemia and atherosclerosis. Besides the elimination of other risk factors, in severe hyperlipidemia therapeutic strategies should focus on a drastic reduction of serum lipoproteins. Despite maximum conventional therapy with a combination of different kinds of lipid-lowering drugs, sometimes the goal of therapy cannot be reached. Hence, in such patients, treatment with LDL-apheresis is indicated. Technical and clinical aspects of these five different LDL-apheresis methods are shown here. There were no significant differences with respect to or concerning all cholesterols, or triglycerides observed. With respect to elevated lipoprotein (a) levels, however, the immunoadsorption method seems to be most effective. The different published data clearly demonstrate that treatment with LDL-apheresis in patients suffering from severe hyperlipidemia refractory to maximum conservative therapy is effective and safe in long-term application. PMID:22654591

  16. Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice

    PubMed Central

    Malone, Terry R.

    2004-01-01

    Objective: Plantar fasciitis is a prevalent problem, with limited consensus among clinicians regarding the most effective treatment. The purpose of this literature review is to provide a systematic approach to the treatment of plantar fasciitis based on the windlass mechanism model. Data Sources: We searched MEDLINE, SPORT Discus, and CINAHL from 1966 to 2003 using the key words plantar fasciitis, windlass mechanism, pronation, heel pain, and heel spur. Data Synthesis: We offer a biomechanical application for the evaluation and treatment of plantar fasciitis based on a review of the literature for the windlass mechanism model. This model provides a means for describing plantar fasciitis conditions such that clinicians can formulate a potential causal relationship between the conditions and their treatments. Conclusions/Recommendations: Clinicians' understanding of the biomechanical causes of plantar fasciitis should guide the decision-making process concerning the evaluation and treatment of heel pain. Use of this approach may improve clinical outcomes because intervention does not merely treat physical symptoms but actively addresses the influences that resulted in the condition. Principles from this approach might also provide a basis for future research investigating the efficacy of plantar fascia treatment. PMID:16558682

  17. Vesicle-like biomechanics governs important aspects of nuclear geometry in fission yeast.

    PubMed

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

    2007-09-26

    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

  18. The prevention of diabetic foot ulceration: how biomechanical research informs clinical practice

    PubMed Central

    DiLiberto, Frank E.; Baumhauer, Judith F.; Nawoczenski, Deborah A.

    2016-01-01

    ABSTRACT Background Implementation of interprofessional clinical guidelines for the prevention of neuropathic diabetic foot ulceration has demonstrated positive effects regarding ulceration and amputation rates. Current foot care recommendations are primarily based on research regarding the prevention of ulcer recurrence and focused on reducing the magnitude of plantar stress (pressure overload). Yet, foot ulceration remains to be a prevalent and debilitating consequence of Diabetes Mellitus. There is limited evidence targeting the prevention of first-time ulceration, and there is a need to consider additional factors of plantar stress to supplement current guidelines. Objectives The first purpose of this article is to discuss the biomechanical theory underpinning diabetic foot ulcerations and illustrate how plantar tissue underloading may precede overloading and breakdown. The second purpose of this commentary is to discuss how advances in biomechanical foot modeling can inform clinical practice in the prevention of first-time ulceration. Discussion Research demonstrates that progressive weight-bearing activity programs to address the frequency of plantar stress and avoid underloading do not increase ulceration risk. Multi-segment foot modeling studies indicate that dynamic foot function of the midfoot and forefoot is compromised in people with diabetes. Emerging research demonstrates that implementation of foot-specific exercises may positively influence dynamic foot function and improve plantar stress in people with diabetes. Conclusion Continued work is needed to determine how to best design and integrate activity recommendations and foot-specific exercise programs into the current interprofessional paradigm for the prevention of first-time ulceration in people with Diabetes Mellitus. PMID:27849290

  19. Foot orthoses in the treatment of symptomatic midfoot osteoarthritis using clinical and biomechanical outcomes: a randomised feasibility study.

    PubMed

    Halstead, Jill; Chapman, Graham J; Gray, Janine C; Grainger, Andrew J; Brown, Sarah; Wilkins, Richard A; Roddy, Edward; Helliwell, Philip S; Keenan, Anne-Maree; Redmond, Anthony C

    2016-04-01

    This randomised feasibility study aimed to examine the clinical and biomechanical effects of functional foot orthoses (FFOs) in the treatment of midfoot osteoarthritis (OA) and the feasibility of conducting a full randomised controlled trial. Participants with painful, radiographically confirmed midfoot OA were recruited and randomised to receive either FFOs or a sham control orthosis. Feasibility measures included recruitment and attrition rates, practicality of blinding and adherence rates. Clinical outcome measures were: change from baseline to 12 weeks for severity of pain (numerical rating scale), foot function (Manchester Foot Pain and Disability Index) and patient global impression of change scale. To investigate the biomechanical effect of foot orthoses, in-shoe foot kinematics and plantar pressures were evaluated at 12 weeks. Of the 119 participants screened, 37 were randomised and 33 completed the study (FFO = 18, sham = 15). Compliance with foot orthoses and blinding of the intervention was achieved in three quarters of the group. Both groups reported improvements in pain, function and global impression of change; the FFO group reporting greater improvements compared to the sham group. The biomechanical outcomes indicated the FFO group inverted the hindfoot and increased midfoot maximum plantar force compared to the sham group. The present findings suggest FFOs worn over 12 weeks may provide detectable clinical and biomechanical benefits compared to sham orthoses. This feasibility study provides useful clinical, biomechanical and statistical information for the design and implementation of a definitive randomised controlled trial to evaluate the effectiveness of FFOs in treating painful midfoot OA.

  20. 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.

  1. ["Ledderhose" disease. Plantar fibromatosis--clinical aspects].

    PubMed

    Parnitzke, B; Decker, O; Neumann, U

    1991-01-01

    The Ledderhose's diseases is a relatively rare and not well known clinical picture. Even there are tight pathomorphological and clinical relations to the Dupuytren's contracture, the genesis is also here quite unknown. Because of inefficiency of conventional therapy the surgical treatment is the only alternative. On the sample of 12 operations in 7 patients from 1979 to 1989 surgical procedure and long-term results are discussed.

  2. Clinical and molecular aspects of malaria fever.

    PubMed

    Oakley, Miranda S; Gerald, Noel; McCutchan, Thomas F; Aravind, L; Kumar, Sanjai

    2011-10-01

    Although clinically benign, malaria fever is thought to have significant relevance in terms of parasite growth and survival and its virulence which in turn may alter the clinical course of illness. In this article, the historical literature is reviewed, providing some evolutionary perspective on the genesis and biological relevance of malaria fever, and the available molecular data on the febrile-temperature-inducible parasite factors that may contribute towards the regulation of parasite density and alteration of virulence in the host is also discussed. The potential molecular mechanisms that could be responsible for the induction and regulation of cyclical malaria fevers caused by different species of Plasmodium are also discussed.

  3. 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

  4. [Focal epithelial hyperplasia. An unusual clinical aspect].

    PubMed

    Bodokh, I; Lacour, J P; Rainero, C; Orth, G; Perrin, C; Hoffman, P; Santini, J; Ortonne, J P

    1993-01-01

    We report a case of focal epithelial hyperplasia in a child born in France of Algerian parents. The clinical appearance was unusual in that certain lesions were verrucous and pediculate. A virological study revealed the presence of papillomavirus 32, one of the two types of HPV specifically associated with this entity.

  5. Palmoplantar keratodermas: clinical and genetic aspects.

    PubMed

    Has, Cristina; Technau-Hafsi, Kristin

    2016-02-01

    Palmoplantar keratodermas comprise a diverse group of acquired and hereditary disorders marked by excessive thickening of the epidermis of palms and soles. Early onset and positive family history suggest a genetic cause. While hereditary forms of palmoplantar keratoderma (PPK) may represent the sole or dominant clinical feature, they may also be associated with other ectodermal defects or extracutaneous manifestations. In recent years, much progress has been made in deciphering the genetic basis of PPK, which has led to the emergence of new disorders and syndromes. The elucidation of disease mechanisms has opened new avenues for specific therapies, increasingly sparking interest in this field. Given the high heterogeneity with respect to clinical features, genetic defects, and disease mechanisms, the classification of PPK is based on various criteria. These include extent of disease manifestations, morphology of palmoplantar skin involvement, inheritance patterns, and molecular pathogenesis. Though not always feasible, the clinical distinction of various PPK entities is based on fine-tuned criteria or clues. Remarkably, apparently distinct disorders have been shown to be allelic, as they are caused by mutations in the same gene. By contrast, similar clinical pictures may result from mutations in different genes. Because of this complexity, mutation analysis is required to determine the precise type of PPK. The best-defined entities are described in this review.

  6. 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…

  7. Clinical and biomechanical outcome of minimal invasive and open repair of the Achilles tendon

    PubMed Central

    2011-01-01

    Introduction With evolutions in surgical techniques, minimally invasive surgical (MIS) repair with Achillon applicator has been introduced. However, there is still a lack of literature to investigate into the clinical merits of MIS over open surgery. This study aims to investigate the correlation between clinical outcome, gait analysis and biomechanical properties comparing both surgical methods. Materials and methods A single centre retrospective review on all the consecutive operated patients between January 2004 and December 2008 was performed. Twenty-six patients (19 male and 7 female; age 40.4 ± 9.2 years) had experienced a complete Achilles tendon rupture with operative repair. Nineteen of the patients, 10 MIS versus 9 open repairs (13 men with a mean age of 40.54 ± 10.43 (range 23-62 yrs) and 6 women with a mean age of 45.33 ± 7.71 (range 35-57 yrs) were further invited to attend a thorough clinical assessment using Holz's scale and biomechanical evaluation at a mean of 25.3 months after operation. This study utilized the Cybex II isokinetic dynamometer to assess the isokinetic peak force of plantar-flexion and dorsiflexion of both ankles. The patients were also invited to return to our Gait Laboratory for analysis. The eight-infrared camera motion capture system (VICON, UK) was utilized for the acquisition of kinematic variables. Their anthropometric data was measured according to the Davis and coworkers' standard. Results The mean operative time and length of hospital stay were shorter in the MIS group. The operative time was 54.55 ± 15.15 minutes versus 68.80 ± 18.23 minutes of the MIS group and Open group respectively (p = 0.045), whereas length of stay was 3.36 ± 1.21 days versus 6.40 ± 3.70 days respectively (p = 0.039). There is statistically significant decrease (p = 0.005) in incision length in MIS group than the open surgery group, 3.23 ± 1.10 cm versus 9.64 ± 2.55 cm respectively. Both groups attained similar Holz's scores, 11.70 ± 0

  8. [Surgical site infection: clinical and microbiological aspects].

    PubMed

    Sikora, Agnieszka; Kozioł-Montewska, Maria

    2010-01-01

    Surgical site infection (SSI) is one of the most common and serious postoperative complication of modern surgery. It contributes to an increase of morbidity, mortality, prolonged hospitalization and costs of treatment. The optimal strategy in order to reduce wound infections in surgery is SSI knowledge of risk factors associated with a patient, surgery and postoperative care as well as the caution of fundamental recommendations concerning prevention, which include: preparation of patient for surgery, preparation of antiseptic principles for hand skin of the operation team, the proceedings in the case of allegation of infection or colonization within the operation team members, preoperative antibiotic prophylaxis, procedures and aspects of aseptic surgical technique, postoperative care and the rules for monitoring infections in the surgical ward.

  9. Invasive Aspergillosis: Epidemiology, Clinical Aspects, and Treatment.

    PubMed

    Gregg, Kevin S; Kauffman, Carol A

    2015-10-01

    Invasive aspergillosis remains an often fatal, difficult-to treat infection in immunocompromised patients. Patients not classically defined as immunocompromised, especially those in an intensive care unit setting, also develop invasive aspergillosis. Clinical clues suggesting angioinvasion and radiographic modalities, especially computed tomographic scans, combined with newer non-culture-based diagnostic techniques, have allowed earlier recognition of invasive aspergillosis. Although mortality remains high, it has greatly decreased over the past 15 years. Voriconazole has supplanted amphotericin B, with its various toxicities, as primary treatment for invasive aspergillosis. Combination therapy with voriconazole and an echinocandin for initial therapy, based on results from a recent controlled clinical trial, could become the standard of care in high-risk patients.

  10. Clinical aspects of hereditary hearing loss.

    PubMed

    Kochhar, Amit; Hildebrand, Michael S; Smith, Richard J H

    2007-07-01

    Hearing loss is an etiologically diverse condition with many disease-related complications and major clinical, social, and quality of life implications. As the rate of acquired hearing loss secondary to environmental causes decreases and improvements in the diagnosis of abnormalities occur, the significance of genetic factors that lead to deafness increases. Advancements in molecular biology have led to improved detection and earlier intervention in patients with hearing loss. Subsequently, earlier implementation of educational services and cochlear implant technology in patients with profound hearing loss now results in superior communication skills and enhanced language development. The aim of this review is to provide a comprehensive framework underlying the causes of hearing impairment and to detail the clinical management for patients with hereditary hearing loss.

  11. Liposomal anticancer therapy: pharmacokinetic and clinical aspects.

    PubMed

    Di Paolo, A

    2004-11-01

    Liposomes, which are vesicles composed of a phospholipid bilayer surrounding an aqueous milieu, represent a new strategy for anticancer drug delivery. Extravasation and accumulation of liposomal drugs within neoplastic tissues are possible because of the leaky vasculature and scarce lymphatic vessels of tumours (the enhanced permeability and retention effect). Furthermore, liposomal chemotherapeutic agents display distinctive pharmacokinetic characteristics, because they possess longer elimination half-lives, reduced clearance and smaller volume of distribution with respect to corresponding free drugs. Taken together, these features lead to highest levels of cytotoxic agents in tumours, as demonstrated in preclinical models and clinical trials, whereas healthy tissues are spared from toxicity. In fact, liposomal drugs (i.e., doxorubicin), alone or in combination with other cytotoxic agents, lead to improved clinical effectiveness and ameliorated toxicity profile with respect to corresponding free drugs when they are used for the treatment of metastatic breast and ovarian cancers, and Kaposi's sarcoma.

  12. Rosmarinic Acid--Pharmaceutical and Clinical Aspects.

    PubMed

    Amoah, Solomon K S; Sandjo, Louis P; Kratz, Jadel M; Biavatti, Maique W

    2016-03-01

    The biosynthesis and biotechnological production of Rosmarinic acid, a phenolic ester that is widespread in the plant kingdom, has been widely investigated. This compound has shown many remarkable biological and pharmacological activities, which have led to its pharmaceutical and analytical development, as well as clinical studies, which are summarized and analyzed here for the first time. This review compiles data from the Pubmed, Scopus, Scifinder, Web Of Science, and Science Direct databases published between 1990 and 2015, restricting the search to works with the keywords "Rosmarinic acid" in the title. The initial search identified more than 800 articles; after an initial screening and removal of duplicate works, the search was further refined, resulting in approximately 300 articles that were scrutinized and comprise this review. The articles were organized to describe extraction and isolation, analytical methods, pharmaceutical development, and biological and pharmacological activities [divided into nonclinical (in vitro, in vivo) and clinical studies], pharmacokinetic studies, and stability studies.

  13. Fluids and electrolytes--clinical aspects.

    PubMed

    Jospe, N; Forbes, G

    1996-11-01

    Medical practice rests on the foundation of science. Clinicians are constantly making practical decisions and dealing with immediate situations that demand solutions. Time should be taken to focus on those scientific principles that underlie our diagnostic and therapuetic maneuvers. This section of Pediatrics in Review presents selected topics that are relevant to practice from the areas of physiology, pharmacology, biochemistry, and other disciplines; clarification of these will augment the pediatrician's understanding of clinical procedures.

  14. [Spigelian hernia: clinical, diagnostic and therapeutical aspects].

    PubMed

    Versaci, A; Rossitto, M; Centorrino, T; Barbera, A; Fonti, M T; Broccio, M; Ciccolo, A

    1998-01-01

    The Authors describing a case of Spigelian hernia observed point out clinical, diagnostic and therapeutic considerations about this rare pathology of abdominal wall. They specify the anatomic characteristics of the region and underline as any diagnostic difficulties are by passed by use of USG and TC imaging for formulation of correct preoperative diagnosis. They confirm as surgical treatment by a correct access isn't different by a normal hernioplasty and guarantee the long term surgical outcome.

  15. Clinical aspects of infection with Trichinella spp.

    PubMed Central

    Capó, V; Despommier, D D

    1996-01-01

    Isolated cases and outbreaks of infection with Trichinella spp. occur frequently throughout the world, sometimes resulting in fatalities. The clinical presentations of signs and symptoms are remarkably constant for most of the species of Trichinella, but in infections with Trichinella nativa and Trichinella britovi, classical symptoms of trichinellosis may be absent. It is important to be able to correlate the clinical presentation of trichinellosis with the life cycle of these helminths in order to make an accurate diagnosis. Knowledge of the epidemiology of the disease enables the physician to identify other potential cases, since most epidemics can be traced back to a common source of raw or undercooked meat. A comprehensive summary relating the most important clinical variables is presented graphically for easy reference to the text. Symptoms and signs are considered in relation to severity of infection. Laboratory findings and diagnostic techniques, including new modalities (e.g., DNA and antigen detection), are discussed. A discussion of treatment and preventive measures concludes our review. PMID:8665476

  16. Placebo effects: clinical aspects and neurobiology.

    PubMed

    Oken, Barry S

    2008-11-01

    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.

  17. [Fundamental and clinical aspects of cystatin C].

    PubMed

    Itoh, Yoshihisa; Kawabata, Isao; Akasaka, Kazumi; Kino, Shuichi

    2012-08-01

    Recent progress of fundamental and clinical studies on cystatin C was reviewed. Most of key studies are indebted to prof. Grubb A and his groups. International contributions from Japanese research work are included here. The protein is a basic low molecular weight protein of 13,300 with 120 amino acid residues and pI 9.3, functioning as a cysteine protease inhibitor. With an introduction of ERM-DA471, international reference material for serum cystatin C, global standardization for immunoassay systems has been much facilitated. No serious problems are present in the pre-analytical stage. Serum reference intervals are properly set in all Asian populations including Japanese with age and gender-related differences. The protein is a powerful serum intrinsic marker for glomerular filtration rate. Estimated glomerular filtration rate (eGFRcysC) in coupled with eGFRCr will definitely be a clinical routine for early detection and prevention of altered kidney function and cardiovascular events in general population. Genetic tests clinically indicated include hereditary cystatin C amyloid angiopathy (L68Q) and adult macular degeneration (A25T) although their frequency is extremely low.

  18. Erythrocyte aggregation: basic aspects and clinical importance.

    PubMed

    Baskurt, Oguz K; Meiselman, Herbert J

    2013-01-01

    Red blood cell (RBC) aggregate to form two- and three-dimensional structures when suspended in aqueous solutions containing large plasma proteins or polymers; this aggregation is reversible and shear dependent (i.e., dispersed at high shear and reformed at low or stasis). The extent of aggregation is the main determinant of low shear blood viscosity, thus predicting an inverse relationship between aggregation and in vivo blood flow. However, the effects of aggregation on hemodynamic mechanisms (e.g., plasma skimming, Fåhraeus Effect, microvascular hematocrit) may promote rather than impede vascular blood flow. The impact of enhanced RBC aggregation on endothelial function and hemostatic mechanisms adds further complexity, thereby requiring specific attention to the nature, extent and time course of aggregation when considering its overall influence on tissue perfusion. A detailed understanding of aggregation effects is important from a clinical point of view since it may be enhanced during a variety of pathophysiological processes, including infections, circulatory and metabolic disorders, hematological pathologies and several other disease states. Altered RBC aggregation may be an indicator of disease as well as a factor affecting the course of the clinical condition; the prognostic value of RBC aggregation indices has been demonstrated in various diseases. Currently, RBC aggregation is an easily and accurately measurable parameter, and therefore may be expected to have broader clinical usage in the future.

  19. 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

  20. Patellofemoral anatomy and biomechanics.

    PubMed

    Sherman, Seth L; Plackis, Andreas C; Nuelle, Clayton W

    2014-07-01

    Patellofemoral disorders are common. There is a broad spectrum of disease, ranging from patellofemoral pain and instability to focal cartilage disease and arthritis. Regardless of the specific condition, abnormal anatomy and biomechanics are often the root cause of patellofemoral dysfunction. A thorough understanding of normal patellofemoral anatomy and biomechanics is critical for the treating physician. Recognizing and addressing abnormal anatomy will optimize patellofemoral biomechanics and may ultimately translate into clinical success.

  1. Biomechanical Role of Bone Anisotropy Estimated on Clinical CT Scans by Image Registration.

    PubMed

    Taghizadeh, Elham; Reyes, Mauricio; Zysset, Philippe; Latypova, Adeliya; Terrier, Alexandre; Büchler, Philippe

    2016-08-01

    Image-based modeling is a popular approach to perform patient-specific biomechanical simulations. Accurate modeling is critical for orthopedic application to evaluate implant design and surgical planning. It has been shown that bone strength can be estimated from the bone mineral density (BMD) and trabecular bone architecture. However, these findings cannot be directly and fully transferred to patient-specific modeling since only BMD can be derived from clinical CT. Therefore, the objective of this study was to propose a method to predict the trabecular bone structure using a µCT atlas and an image registration technique. The approach has been evaluated on femurs and patellae under physiological loading. The displacement and ultimate force for femurs loaded in stance position were predicted with an error of 2.5% and 3.7%, respectively, while predictions obtained with an isotropic material resulted in errors of 7.3% and 6.9%. Similar results were obtained for the patella, where the strain predicted using the registration approach resulted in an improved mean squared error compared to the isotropic model. We conclude that the registration of anisotropic information from of a single template bone enables more accurate patient-specific simulations from clinical image datasets than isotropic model.

  2. 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). PMID:27757402

  3. Clinical and genetic aspects of KBG syndrome.

    PubMed

    Low, Karen; Ashraf, Tazeen; Canham, Natalie; Clayton-Smith, Jill; Deshpande, Charu; Donaldson, Alan; Fisher, Richard; Flinter, Frances; Foulds, Nicola; Fryer, Alan; Gibson, Kate; Hayes, Ian; Hills, Alison; Holder, Susan; Irving, Melita; Joss, Shelagh; Kivuva, Emma; Lachlan, Kathryn; Magee, Alex; McConnell, Vivienne; McEntagart, Meriel; Metcalfe, Kay; Montgomery, Tara; Newbury-Ecob, Ruth; Stewart, Fiona; Turnpenny, Peter; Vogt, Julie; Fitzpatrick, David; Williams, Maggie; Smithson, Sarah

    2016-11-01

    KBG syndrome is characterized by short stature, distinctive facial features, and developmental/cognitive delay and is caused by mutations in ANKRD11, one of the ankyrin repeat-containing cofactors. We describe 32 KBG patients aged 2-47 years from 27 families ascertained via two pathways: targeted ANKRD11 sequencing (TS) in a group who had a clinical diagnosis of KBG and whole exome sequencing (ES) in a second group in whom the diagnosis was unknown. Speech delay and learning difficulties were almost universal and variable behavioral problems frequent. Macrodontia of permanent upper central incisors was seen in 85%. Other clinical features included short stature, conductive hearing loss, recurrent middle ear infection, palatal abnormalities, and feeding difficulties. We recognized a new feature of a wide anterior fontanelle with delayed closure in 22%. The subtle facial features of KBG syndrome were recognizable in half the patients. We identified 20 ANKRD11 mutations (18 novel: all truncating) confirmed by Sanger sequencing in 32 patients. Comparison of the two ascertainment groups demonstrated that facial/other typical features were more subtle in the ES group. There were no conclusive phenotype-genotype correlations. Our findings suggest that mutation of ANKRD11 is a common Mendelian cause of developmental delay. Affected patients may not show the characteristic KBG phenotype and the diagnosis is therefore easily missed. We propose updated diagnostic criteria/clinical recommendations for KBG syndrome and suggest that inclusion of ANKRD11 will increase the utility of gene panels designed to investigate developmental delay. © 2016 The Authors. American Journal of Medical Genetics Part A Published by Wiley Periodicals, Inc.

  4. Enterovirus Infections: Etiologic, Epidemiologic and Clinical Aspects

    PubMed Central

    Horstmann, Dorothy M.

    1965-01-01

    The term enteroviruses was introduced in 1957 to bring together in one large family the polioviruses, Coxsackie A and B and echoviruses, all agents for which the human alimentary tract is the natural habitat. At present more than 60 distinct members are recognized: three polioviruses, 24 Coxsackie A, six Coxsackie B and 30 echoviruses. The list of new members, particularly in the echo-group, grows regularly. The viruses are frequently widely disseminated in the summer and fall of the year, circulating chiefly among young children, causing both apparent and inapparent infection. The enteroviruses are responsible for a wide spectrum of clinical manifestations, including non-specific febrile illness, sometimes with rash, aseptic meningitis, paralytic disease, respiratory infections, pericarditis and myocarditis. There is considerable overlap in biologic behavior, and the same syndrome can be induced by many different agents. In a few instances the clinical pattern is distinct enough to suggest the group of agents involved. Thus, herpangina is associated with the Coxsackie A viruses and epidemic myalgia (devil's grip) with the Coxsackie B group. Paralytic disease is caused primarily by the polioviruses, but recently it has been found that other members, particularly the Coxsackie B viruses and Coxsackie A7 can also cause “paralytic poliomyelitis.” The ultimate potential of enteroviruses in terms of central nervous system disease and other manifestations is unpredictable. Great variety in terms of clinical and epidemiologic behavior of known and “new” viruses has been the pattern in the past, and is likely to continue. PMID:14336786

  5. Bovine neosporosis: clinical and practical aspects.

    PubMed

    Almería, S; López-Gatius, F

    2013-10-01

    Neospora caninum is a protozoan parasite with a wide host range but with a preference for cattle and dogs. Since the description of N. caninum as a new genus and species in 1988, bovine neosporosis has become a disease of international concern as it is among the main causes of abortion in cattle. At present there is no effective treatment or vaccine. This review focuses on the epidemiology of the disease and on prospects for its control in cattle. Finally, based on the implications of clinical findings reported to date, a set of recommendations is provided for veterinarians and cattle farmers.

  6. 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

  7. [Lichen sclerosus--clinical and therapeutic aspects].

    PubMed

    Manolova, G; Pehlivanov, G; Bakardzhiev, I; Saleva, M; Yungareva, I; Lozanova, P; Prisadashka, K; Karagiozova, Zh

    2014-01-01

    Lichen sclerosus (LS) is a lymphocyte-mediated inflammatory dermatosis with a characteristic location (85-98%) in the anogenital region. The authors point out the main features in the epidemiology and clinical presentation of the disease and the possible approach to neoplastic development. Expanded differential diagnosis of LS sparked not only dermatologists but also gynecologists, urologists and GPs. Points are the chronic course of the disease and resistance to therapy. Discuss the results of the treatment of LS with less potent topical corticosteroids, calcineurin inhibitors, phototherapy and photodynamic therapy, surgery.

  8. 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).

  9. 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

  10. Alcohol and suicide: neurobiological and clinical aspects.

    PubMed

    Sher, Leo

    2006-06-21

    Alcohol, primarily in the form of ethyl alcohol (ethanol), has occupied an important place in the history of humankind for at least 8,000 years. In most Western societies, at least 90% of people consume alcohol at some time during their lives, and 30% or more of drinkers develop alcohol-related problems. Severe alcohol-related life impairment, alcohol dependence (alcoholism), is observed at some time during their lives in about 10% of men and 3-5% of women. An additional 5-10% of each sex develops persistent, but less intense, problems that are diagnosed as alcohol abuse. It this review, neurobiological aspects of suicidal behavior in alcoholism is discussed. In individuals with comorbid depression and alcoholism, greater serotonergic impairment may be associated with higher risk of completed suicide. Dopaminergic dysfunction may play an important role in the pathophysiology of suicidal behavior in alcoholism. Brain damage and neurobehavioral deficits are associated with alcohol use disorders and may contribute to suicidal behavior in persons with alcohol dependence or abuse. Aggression/impulsivity and alcoholism severity affect risk for suicide among individuals with alcoholism. Major depressive episodes and stressful life events particularly, partner-relationship disruptions, may precipitate suicidal behavior in individuals with alcohol use disorders. Alcohol misuse and psychosocial adversity can combine to increase stress on the person, and, thereby, potentially, increase the risk for suicidal behavior. The management of suicidal patients with alcohol use disorders is also discussed. It is to be hoped that the efforts of clinicians will reduce morbidity and mortality associated with alcohol misuse.

  11. 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

  12. Prader-willi syndrome: clinical aspects.

    PubMed

    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.

  13. 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

  14. Legal aspects of clinical ethics committees.

    PubMed

    Hendrick, J

    2001-04-01

    In an increasingly litigious society where ritual demands for accountability and "taking responsibility" are now commonplace, it is not surprising that members of clinical ethics committees (CECs) are becoming more aware of their potential legal liability. Yet the vulnerability of committee members to legal action is difficult to assess with any certainty. This is because the CECs which have been set up in the UK are--if the American experience is followed--likely to vary significantly in terms of their functions, procedures, composition, structures and authority. As a consequence it is difficult to generalize about the legal implications. Nevertheless, despite these difficulties this article will outline the broad legal principles governing the potential liability of committee members. It will also consider the relationship between CECs and the courts. It begins, however, with a brief analysis of the relationship between ethics and law in committee deliberations, and in particular of the role of law and legal expertise on CECs.

  15. [Clinical aspects of the Niigata Minamata disease].

    PubMed

    Shimohata, Takayoshi; Hirota, Koichi; Takahashi, Hitoshi; Nishizawa, Masatoyo

    2015-01-01

    The Minamata disease was discovered in the Minamata region, Kumamoto Prefecture, Japan, in 1956. Symptoms of this disease included cerebellar ataxia, sensory disturbance, narrowing of the visual field, and hearing and speech disturbances. In 1965, similar conditions were identified in persons living around the Agano River area, Niigata Prefecture, Japan and accordingly termed as the Niigata Minamata disease or the second Minamata disease. Both the diseases have been attributed to poisoning with methyl mercury that was generated during the production of acetaldehyde using mercury as a catalyst. The discharged methyl mercury accumulated in fishes and shellfishes and caused poisoning on consumption. This review discusses the history, clinical presentation including atypical forms, and autopsy findings of the Niigata Minamata disease. In addition, it highlights the problems about criteria for official recognition and the therapeutic trial for this disease.

  16. Hyperprolactinemia and schizophrenia: mechanisms and clinical aspects.

    PubMed

    Halbreich, Uriel; Kahn, Linda S

    2003-09-01

    The association between elevated prolactin levels and conventional antipsychotics is well-established. The novel antipsychotic, risperidone, has also been shown to elevate prolactin levels. Patients undergoing treatment with these medications are at high risk for developing hyperprolactinemia, which is associated with decreased bone mineral density, osteoporosis, menstrual disruptions and infertility, galactorrhea, breast cancer, cardiovascular disorders, and sexual impairment. Patients treated with conventional antipsychotics and risperidone should be routinely screened for hyperprolactinemia, and monitored for known sequelae. Optimally, patients with hyperprolactinemia secondary to antipsychotic drug treatment should be switched to a prolactin-sparing antipsychotic. This review will briefly highlight the regulation and function of prolactin secretion, discuss clinical effects of antipsychotic-induced hyperprolactinemia, and suggest a course of treatment.

  17. Clinical and genetic aspects of phaeochromocytoma.

    PubMed

    Opocher, Giuseppe; Schiavi, Francesca; Conton, Pierantonio; Scaroni, Carla; Mantero, Franco

    2003-01-01

    Phaeochromocytoma is a tumour of the adrenal medulla, which, although rare, is a major cause of correctable hypertension with a prevalence of 0.1-0.5% in the hypertensive population. Clinical symptoms include attacks of paroxysmal headache, sweating, palpitations, stress and a sense of imminent death. Often associated with the above is an increase in blood pressure. Despite the fact that the underlying genetic mechanisms of phaeochromocytoma have been well investigated, they are still incompletely understood. In approximately 80% of cases the tumour occurs sporadically, but it may occur in association with type 2 multiple endocrine neoplasia, type 1 neurofibromatosis or von Hippel-Lindau disease. Molecular evidence suggests that other genes such as SDHD or SDHB may control its development; the possibility of other putative phaeochromocytoma genes is currently being investigated.

  18. The ART approach: clinical aspects reviewed.

    PubMed

    Molina, Gustavo Fabián; Cabral, Ricardo Juan; Frencken, Jo E

    2009-01-01

    The success of ART as a caries management approach is supported by more than 20 years of scientific evidence. ART follows the contemporary concepts of modern cariology and restorative dentistry. It challenges treatment concepts such as step-wise excavation and the need for complete removal of affected dentine. The ART approach so far has mainly used high-viscosity glass-ionomer as the sealant and restorative material. Cariostatic and remineralization properties have been ascribed to this material which requires further research to establish its clinical relevance. The adhesion of high-viscosity glass-ionomer to enamel in pits and fissures is apparently strong, as its remnants, blocking the pits and fissures, have been considered a possible reason for the low prevalence of carious lesion development after the glass-ionomer has clinically disappeared from it. Encapsulated high-viscosity glass-ionomers may lead to higher restoration survival results than those of the hand-mixed version and should, therefore, not be neglected when using ART. Similarly, the use of resin-modified glass-ionomer with ART should be researched. The effectiveness of ART when compared to conventional caries management approaches has been shown in numerous studies. Proper case selection is an important factor for long-lasting ART restoration survival. This is based on the caries risk situation of the individual, the size of the cavity opening, the strategic position of the cavitated tooth and the presence of adequate caries control measures. As the operator is one of the main causes for failure of ART restorations, attending a well-conducted ART training course is mandatory for successful implementation of ART.

  19. Feline sporotrichosis: epidemiological and clinical aspects.

    PubMed

    Gremião, Isabella D F; Menezes, Rodrigo C; Schubach, Tânia M P; Figueiredo, Anna B F; Cavalcanti, Maíra C H; Pereira, Sandro A

    2015-01-01

    Feline sporotrichosis, which is caused by species of the Sporothrix schenckii complex, is endemic to Rio de Janeiro, Brazil. More than 4000 cases of the disease were diagnosed at Fundação Oswaldo Cruz, Brazil, between 1998 and 2012. Sporotrichosis in cats has been reported in several countries, but nowhere has an outbreak of animal sporotrichosis been as large as that seen in Brazil. The clinical manifestations of the disease range from an isolated skin lesion that can progress to multiple skin lesions and even fatal systemic involvement. Nodules and ulcers are the most common types of lesions, and respiratory signs and mucosa involvement are frequent. The definitive diagnosis depends on isolation of the etiologic agent in culture. Cytology, histopathology, and serology are useful tools for preliminary diagnosis. Severe pyogranulomatous inflammatory infiltrate, high fungal load, and extension of lesions to mucosa, cartilage, and bone in the nose of cats are indicative of an agent of high virulence in this endemic region. Itraconazole is the drug of choice, while, in refractory cases, amphotericin B or potassium iodide might be alternative treatments; however, recurrence after discharge may occur. Sporotrichosis persists as a neglected disease in Rio de Janeiro, and the treatment of cats remains a challenging and long-term endeavor.

  20. Noonan Syndrome: Clinical Aspects and Molecular Pathogenesis

    PubMed Central

    Tartaglia, M.; Zampino, G.; Gelb, B.D.

    2010-01-01

    Noonan syndrome (NS) is a relatively common, clinically variable and genetically heterogeneous developmental disorder characterized by postnatally reduced growth, distinctive facial dysmorphism, cardiac defects and variable cognitive deficits. Other associated features include ectodermal and skeletal defects, cryptorchidism, lymphatic dysplasias, bleeding tendency, and, rarely, predisposition to hematologic malignancies during childhood. NS is caused by mutations in the PTPN11, SOS1, KRAS, RAF1, BRAF and MEK1 (MAP2K1) genes, accounting for approximately 70% of affected individuals. SHP2 (encoded by PTPN11), SOS1, BRAF, RAF1 and MEK1 positively contribute to RAS-MAPK signaling, and possess complex autoinhibitory mechanisms that are impaired by mutations. Similarly, reduced GTPase activity or increased guanine nucleotide release underlie the aberrant signal flow through the MAPK cascade promoted by most KRAS mutations. More recently, a single missense mutation in SHOC2, which encodes a cytoplasmic scaffold positively controlling RAF1 activation, has been discovered to cause a closely related phenotype previously termed Noonan-like syndrome with loose anagen hair. This mutation promotes aberrantly acquired N-myristoylation of the protein, resulting in its constitutive targeting to the plasma membrane and dysregulated function. PTPN11, BRAF and RAF1 mutations also account for approximately 95% of LEOPARD syndrome, a condition which resembles NS phenotypically but is characterized by multiple lentigines dispersed throughout the body, café-au-lait spots, and a higher prevalence of electrocardiographic conduction abnormalities, obstructive cardiomyopathy and sensorineural hearing deficits. These recent discoveries demonstrate that the substantial phenotypic variation characterizing NS and related conditions can be ascribed, in part, to the gene mutated and even the specific molecular lesion involved. PMID:20648242

  1. Kinect One-based biomechanical assessment of upper-limb performance compared to clinical scales in post-stroke patients.

    PubMed

    Scano, Alessandro; Caimmi, Marco; Chiavenna, Andrea; Malosio, Matteo; Tosatti, Lorenzo Molinari

    2015-08-01

    This paper presents a Kinect One sensor-based protocol for the evaluation of the motor-performances of the upper limb of neurological patients during rehabilitative sessions. The assessment provides evaluations of kinematic, dynamic, motor and postural control variables. A pilot study was conducted on three post-stroke neurological patients, comparing Kinect-One biomechanical assessment with the outcomes of some of the most common clinical scales for the evaluation of the upper-limb functionality. Preliminary results indicate coherency between the clinical and instrumental evaluation. Moreover, the Kinect-One assessment seems to provide some complementary quantitative information, consistently integrating the clinical assessment.

  2. Clinical aspects of the visually evoked potential.

    PubMed Central

    Weinstein, G W

    1977-01-01

    The visually evoked potential (VEP) was studied in normal and abnormal human subjects, and in Rhesus monkeys with central, paracentral, and peripheral photocoagulation lesions. A relatively simple protocol for clinical VEP testing is described. The monkeys showed similar VEP responses but these were smaller in amplitude than those obtained from human subjects. Central, but not paracentral or peripheral retinal lesions were associated with VEP abnormalities. For both monkey and human subjects, some variability of responses between normal and subjects was noted. Generally, there are differences in VEP responses obtained from the affected eye of abnormal subjects who had one eye which could serve as a control, as compared to responses from the normal eye. In these subjects as well as in subjects with two abnormal eyes, computer analysis of digitized VEP data from 10 Hz stimulus responses was performed. Fourier transformation analyses showed abnormalities which could be detected easily by evaluating the pattern of the amplitudes of the fundamental and first three harmonics. With this technique, it was possible to group correctly normal VEP's with eyes with normal visual acuity (greater than or equal to 20/30 or 0.67), and abnormal VEP's with eyes with poor visual acuity (less than 20/30 or 0.67) in 72% of cases. Analysis of the data obtained with 1 Hz and 10 Hz stimulation suggests that the components of the VEP related to visual acuity occur within the first 60-100 msec of the response, corresponding to the primary evoked response of Chiganek. The second, smaller wave of the response complex to 10 Hz flash stimuli corresponds to the primary evoked response, and is closely related to visual acuity. This was further supported in another series in which the digitized data was filtered around the stimulating frequency. It was possible to recognize visually this VEP waveform and subjectively interpret the record correctly in 85% of eyes with regard to visual acuity

  3. 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

  4. 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.

  5. Basilar Invagination, Basilar Impression, and Platybasia: Clinical and Imaging Aspects.

    PubMed

    Pinter, Nandor K; McVige, Jennifer; Mechtler, Laszlo

    2016-08-01

    The congenital and acquired deformities of the craniovertebral junction (CVJ), such as basilar invagination, basilar impression, or platybasia, can present in the form of slowly progressive or acute neurologic deterioration. In many cases, an insidious headache is the only symptom and can be a diagnostic challenge for the neurologist. Proper imaging studies as well as recognizing often associated neurologic or systemic conditions are required for early diagnosis and effective therapy. In the current report, the primary focus will be on clinical aspects of these CVJ abnormalities; the pathologic and radiologic aspects, such as developmental and pathophysiologic background or radiographic analysis, will be discussed briefly, confined to clinically relevant data.

  6. 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

  7. 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

  8. 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)

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

    PubMed

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

    2013-11-01

    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.

  10. 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

  11. Sexually transmitted diseases: epidemiological and clinical aspects in adults.

    PubMed

    Siracusano, Salvatore; Silvestri, Tommaso; Casotto, Daniela

    2014-01-01

    Sexually transmitted diseases (STDs) are the first 10 causes of unpleased diseases in young adult women in the world. The concept of STDs includes a series of syndromes caused by pathogens that can be acquired by sexual intercourse or sexual activity.Adolescents and young adults are responsible for only 25% of the sexually active population and they represent almost 50% of all newly acquired STDs.In this way, we evaluated the epidemiological and clinical aspects of most relevant pathogens as Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, Haemophilus Ducreyi, Trichomonas vaginalis, herpes simplex virus, human papilloma virus (HPV) with the exception of hepatitis, and HIV infections for which we suggest specific guidelines.To attain this objective, we analyzed the results of epidemiological and clinical aspects of STDs through a review of the literature using MEDLINE and PubMed database for original articles published using the terms "sexual transmitted disease, epidemiology, diagnosis and therapy" from 2005 to 2014.

  12. Trachyonychia: Review and Update on Clinical Aspects, Histology, and Therapy

    PubMed Central

    Haber, Jessica S.; Chairatchaneeboon, Manasmon; Rubin, Adam I.

    2017-01-01

    Trachyonychia is a disorder of the nail unit that most commonly presents with rough, longitudinally ridged nails (opaque trachyonychia) or less frequently, uniform, opalescent nails with pits (shiny trachyonychia). The term trachyonychia refers to ‘rough nails.’ This article comprehensively reviews the clinical, histologic, and therapeutic aspects of trachyonychia. The authors' preferred evaluation and management strategies of trachyonychia are included. PMID:28232917

  13. 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

  14. 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

  15. 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

  16. Good clinical practice: historical background and key aspects.

    PubMed

    Otte, Andreas; Maier-Lenz, Herbert; Dierckx, Rudi A

    2005-07-01

    Clinical research trials (both academic and industry sponsored) are increasingly playing a role in various medical disciplines, including younger fields of clinical trial interest, such as nuclear medicine research. Knowledge for and compliance with good clinical practice (GCP) is essential for anyone involved. In this review article, key aspects of GCP and the responsibilities of investigators, monitors and sponsors are described. In addition, a comprehensive overview of the historical background on the development of GCP from the US Pure Food and Drugs Act of 1906 over the Nuremberg Code, the Kefauver-Harris Amendments and the Declaration of Helsinki until now is given. Knowledge of the historical background may help understand the developments in GCP.

  17. 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

  18. [Chronic cholesteatomatous otitis media: the histopathological and clinical aspects].

    PubMed

    Marcato, P; Giuritti, P; Pozzo, T; Vitiello, R; Valente, G; Giordano, C; Sartoris, A

    1991-01-01

    In recent years the immunologic aspects of the normal and pathological ear have been studied by several authors, with particular attention given to the histopathologic aspects of the epidermis of the tympanic membranes of the outer ear canal and of the middle ear mucosa in normal physiologic as well as in inflammatory conditions. Such studies may help in giving a more precise definition to the pathogenesis and clinical behavior of middle ear cholesteatoma. In this paper we report the results of an immunohistopathologic study carried out using the immunohistochemical technique of monoclonal antibodies on cholesteatoma matrix samples taken during radical mastoidectomy or tympanoplasty. In particular, the presence of T-lymphocytes and Langerhans cells was evaluated using selective monoclonal antibodies and a relationship between the data collected and the clinical expression of the disease in each case was sought. In this study it was not possible to establish a close relationship between clinical behavior and immunohistopathological findings, which appeared rather similar in all the cases. The presence of Langerhans' cells may confirm the hypothesized role they play in phlogistic reactions and bone reabsorption due to the presence of the cholesteatoma in the middle ear. Yet, in order to evaluate their true role correctly, more detailed studies should be carried out on the spatial distribution of T-lymphocytes and Langerhans' cells in the cholesteatoma matrix as well as on their ultrastructural characteristics.

  19. Biomechanics of occlusion--implications for oral rehabilitation.

    PubMed

    Peck, C C

    2016-03-01

    The dental occlusion is an important aspect of clinical dentistry; there are diverse functional demands ranging from highly precise tooth contacts to large crushing forces. Further, there are dogmatic, passionate and often diverging views on the relationship between the dental occlusion and various diseases and disorders including temporomandibular disorders, non-carious cervical lesions and tooth movement. This study provides an overview of the biomechanics of the masticatory system in the context of the dental occlusion's role in function. It explores the adaptation and precision of dental occlusion, its role in bite force, jaw movement, masticatory performance and its influence on the oro-facial musculoskeletal system. Biomechanics helps us better understand the structure and function of biological systems and consequently an understanding of the forces on, and displacements of, the dental occlusion. Biomechanics provides insight into the relationships between the dentition, jaws, temporomandibular joints, and muscles. Direct measurements of tooth contacts and forces are difficult, and biomechanical models have been developed to better understand the relationship between the occlusion and function. Importantly, biomechanical research will provide knowledge to help correct clinical misperceptions and inform better patient care. The masticatory system demonstrates a remarkable ability to adapt to a changing biomechanical environment and changes to the dental occlusion or other components of the musculoskeletal system tend to be well tolerated.

  20. 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

  1. [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.

  2. Diabetes in Cushing syndrome: basic and clinical aspects.

    PubMed

    Mazziotti, Gherardo; Gazzaruso, Carmine; Giustina, Andrea

    2011-12-01

    Diabetes mellitus is a frequent complication of Cushing syndrome (CS) which is caused by chronic exposure to glucocorticoid excess, either endogenous or exogenous, and that is characterized by several clinical symptoms such as central obesity, purple striae, proximal muscle weakness, acne, hirsutism and neuropsychological disturbances. Diabetes occurs as a consequence of an insulin-resistant state together with impaired insulin secretion which are induced by glucocorticoid excess. The management of patients with CS and diabetes mellitus includes the treatment of hyperglycemia and, when possible, the correction of glucocorticoid excess. This review focuses on the disorders of glucose metabolism in patients exposed to glucocorticoid excess, addressing both the pathophysiological aspects and the clinical and therapeutic implications.

  3. Early application of deep brain stimulation: clinical and ethical aspects.

    PubMed

    Woopen, Christiane; Pauls, K Amande M; Koy, Anne; Moro, Elena; Timmermann, Lars

    2013-11-01

    Deep brain stimulation (DBS) has proven to be a successful therapeutic approach in several patients with movement disorders such as Parkinson's disease and dystonia. Hitherto its application was mainly restricted to advanced disease patients resistant to medication or with severe treatment side effects. However, there is now growing interest in earlier application of DBS, aimed at improving clinical outcomes, quality of life, and avoiding psychosocial consequences of chronic disease-related impairments. We address the clinical and ethical aspects of two "early" uses of DBS, (1) DBS early in the course of the disease, and (2) DBS early in life (i.e. in children). Possible benefits, risks and burdens are discussed and thoroughly considered. Further research is needed to obtain a careful balance between exposing vulnerable patients to potential severe surgical risks and excluding them from a potentially good outcome.

  4. 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

  5. Inertial Measures of Motion for Clinical Biomechanics: Comparative Assessment of Accuracy under Controlled Conditions - Effect of Velocity

    PubMed Central

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

    2013-01-01

    Background Inertial measurement of motion with Attitude and Heading Reference Systems (AHRS) is emerging as an alternative to 3D motion capture systems in biomechanics. The objectives of this study are: 1) to describe the absolute and relative accuracy of multiple units of commercially available AHRS under various types of motion; and 2) to evaluate the effect of motion velocity on the accuracy of these measurements. Methods The criterion validity of accuracy was established under controlled conditions using an instrumented Gimbal table. AHRS modules were carefully attached to the center plate of the Gimbal table and put through experimental static and dynamic conditions. Static and absolute accuracy was assessed by comparing the AHRS orientation measurement to those obtained using an optical gold standard. Relative accuracy was assessed by measuring the variation in relative orientation between modules during trials. Findings Evaluated AHRS systems demonstrated good absolute static accuracy (mean error < 0.5o) and clinically acceptable absolute accuracy under condition of slow motions (mean error between 0.5o and 3.1o). In slow motions, relative accuracy varied from 2o to 7o depending on the type of AHRS and the type of rotation. Absolute and relative accuracy were significantly affected (p<0.05) by velocity during sustained motions. The extent of that effect varied across AHRS. Interpretation Absolute and relative accuracy of AHRS are affected by environmental magnetic perturbations and conditions of motions. Relative accuracy of AHRS is mostly affected by the ability of all modules to locate the same global reference coordinate system at all time. Conclusions Existing AHRS systems can be considered for use in clinical biomechanics under constrained conditions of use. While their individual capacity to track absolute motion is relatively consistent, the use of multiple AHRS modules to compute relative motion between rigid bodies needs to be optimized according to

  6. Plaque hemorrhage in carotid artery disease: Pathogenesis, clinical and biomechanical considerations

    PubMed Central

    Teng, Zhongzhao; Sadat, Umar; Brown, Adam J.; Gillard, Jonathan H.

    2014-01-01

    Stroke remains the most prevalent disabling illness today, with internal carotid artery luminal stenosis due to atheroma formation responsible for the majority of ischemic cerebrovascular events. Severity of luminal stenosis continues to dictate both patient risk stratification and the likelihood of surgical intervention. But there is growing evidence to suggest that plaque morphology may help improve pre-existing risk stratification criteria. Plaque components such a fibrous tissue, lipid rich necrotic core and calcium have been well investigated but plaque hemorrhage (PH) has been somewhat overlooked. In this review we discuss the pathogenesis of PH, its role in dictating plaque vulnerability, PH imaging techniques, marterial properties of atherosclerotic tissues, in particular, those obtained based on in vivo measurements and effect of PH in modulating local biomechanics. PMID:24485514

  7. Psoas Major: a case report and review of its anatomy, biomechanics, and clinical implications

    PubMed Central

    Sajko, Sandy; Stuber, Kent

    2009-01-01

    A 25-year-old male professional hockey player with right sided hip pain was diagnosed with myofascopathy of the right psoas major and rectus femoris. The patient maintained a conservative treatment regimen and was prescribed a four week active strengthening program. The program progressed from resisted concentric exercise to eccentric abduction/adduction exercises along with balance training, core stabilizing and endurance exercises in the first two weeks. In the final two weeks the program progressed to include sport specific exercises. At three weeks the patient was able to participate in non-contact practice and was clear for full contact at five weeks. The anatomy, biomechanics, and function of the psoas major muscle are discussed as is its influence on lumbar spine stability. Evidence-based evaluation and management strategies for psoas dysfunction are presented. PMID:20037696

  8. [Ethical aspects of clinical trials in rare diseases].

    PubMed

    Hasford, Joerg; Koch, Armin

    2017-03-08

    It is estimated that there are about four million people suffering from rare diseases in Germany. For roughly the last 20 years, there has been an increasing interest in therapeutic research for rare diseases. Drug research is highly regulated via numerous laws, regulations and ethical conventions that do not offer any waivers for clinical trials in rare diseases. Thus the ethical assessment of the clinical trial application for a rare disease is basically the same as for a common disease. As the ethical standards of clinical research, for example regarding informed consent, are derived from constitutional rights and have been codified in the German drug law, it is no surprise that they cannot depend on the frequency of a disease. A very important aspect of the ethical assessment is the biometric quality with regard to study design, sample size estimation and statistical analysis, as methodologically poor research with humans is per se unethical. Problems with sample size estimations and pilot studies will be addressed in more detail. Pilot studies should be avoided and sample size estimations should not assume overoptimistic effect sizes and should not increase the error probability beyond 5% two-sided.

  9. 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

  10. Immigration and hepatitis B virus: epidemiological, clinical and therapeutic aspects.

    PubMed

    Palumbo, E; Scotto, G; Cibelli, D C; Faleo, G; Saracin, A; Angarano, G

    2008-01-01

    This study in Italy aimed to evaluate the epidemiological, clinical and therapeutic aspects of hepatitis B virus (HBV) infection in a population of recent (< 6 months) immigrants. Between February 2003 and December 2004, 83 (9.3%) out of 890 immigrants tested positive for hepatitis B surface antigen. All were men and 62.6% came-from Africa, 21.6% from Asia and 16.8% from Eastern Europe. About half (54.3%) of the patients had elevated alanine aminotransferase levels and detectable serum HBV DNA. Genotype distribution was as follows: E (20 cases), D (14 cases) and A (11 cases). Our study underscores the potential of migratory flow to introduce genotype non-D hepatitis B virus into our country.

  11. [Clinical and neuropathological aspects of Wernicke-Korsakoff syndrome].

    PubMed

    Zubaran, C; Fernandes, J; Martins, F; Souza, J; Machado, R; Cadore, M

    1996-12-01

    Alcohol abuse is one of most serious problems in public health and the Wernicke-Korsakoff syndrome one of the gravest consequences of alcoholism. The pathology is often undiagnosed in its less evident presentations, therefore an accurate diagnostic approach is a critical step in planning treatment. Besides new pharmacological proposals, treatment is based on the restoration of thiamine, although this is insufficient to prevent the psychological decline of a great number of patients. The cognitive impact of the pathology is derived from the interaction of alcoholic neurotoxicity, thiamine deficiency and personal susceptibility. In this article the history, epidemiology, clinical and neuropathological features of the Wernicke-Korsakoff syndrome, as well as some aspects of its treatment and prognosis, are described.

  12. X-linked creatine transporter deficiency: clinical aspects and pathophysiology.

    PubMed

    van de Kamp, Jiddeke M; Mancini, Grazia M; Salomons, Gajja S

    2014-09-01

    Creatine transporter deficiency was discovered in 2001 as an X-linked cause of intellectual disability characterized by cerebral creatine deficiency. This review describes the current knowledge regarding creatine metabolism, the creatine transporter and the clinical aspects of creatine transporter deficiency. The condition mainly affects the brain while other creatine requiring organs, such as the muscles, are relatively spared. Recent studies have provided strong evidence that creatine synthesis also occurs in the brain, leading to the intriguing question of why cerebral creatine is deficient in creatine transporter deficiency. The possible mechanisms explaining the cerebral creatine deficiency are discussed. The creatine transporter knockout mouse provides a good model to study the disease. Over the past years several treatment options have been explored but no treatment has been proven effective. Understanding the pathogenesis of creatine transporter deficiency is of paramount importance in the development of an effective treatment.

  13. [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.

  14. [Clinical, laboratory and therapeutics aspects of Sheehan's syndrome].

    PubMed

    Soares, Débora Vieira; Conceição, Flávia Lúcia; Vaisman, Mário

    2008-07-01

    Sheehan's syndrome is characterized by hypopituitarism that occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. Nowadays it is not usually seen in developed countries because of the improvements in obstetric care. However, in developing countries it is still frequent and probably one of the most common causes of hypopituitarism. Most patients usually present it months to years later, with a history of failure of postpartum lactation, failure to resume menses and other signs of panhypopituitarism. In mild forms of the disease, patients may remain undetected and do not receive treatment for many years. Early diagnosis and appropriate treatment are important to reduce the morbimortality of the patients with Sheehan's syndrome. The aim of this review is to describe clinical, laboratory and therapeutic aspects of Sheehan's syndrome, including our experience in the replacement of recombinant GH in these patients.

  15. 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.

  16. Tourette syndrome: clinical and psychological aspects of 250 cases.

    PubMed

    Comings, D E; Comings, B G

    1985-05-01

    Tourette syndrome is a common hereditary neuropsychiatric disorder consisting of multiple tics and vocal noises. We summarize here clinical aspects of 250 consecutive cases seen over a period of 3 years. The sex ratio was four males to one female, and the mean age of onset was 6.9 years. Only 10% were Jewish, indicating that it is not more prevalent in Ashkenazi Jews. Only 33% had compulsive swearing (coprolalia), indicating that this is not necessary for the diagnosis. The most frequent initial symptoms were rapid eye-blinking, facial grimacing, and throat-clearing. In this series, it was clear that Tourette syndrome is a psychiatric as well as a neurological disorder. Significant discipline problems and/or problems with anger and violence occurred in 61%, and 54% had attention-deficit disorder with hyperactivity. Some degree of exhibitionism was present in 15.9% of males and 6.1% of females. Obsessive-compulsive behavior was seen in 32%. Other than tics and vocal noises, the most common parental complaints were of short temper and everything being a confrontation. There were no significant clinical differences between familial and sporadic cases. Whenever a child presents with a learning disorder, attention-deficit disorder, or significant discipline or emotional problems, the parents should be questioned about the presence of tics or vocal noises in the patient and other family members.

  17. [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.

  18. 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.

  19. Tourette syndrome: clinical and psychological aspects of 250 cases.

    PubMed Central

    Comings, D E; Comings, B G

    1985-01-01

    Tourette syndrome is a common hereditary neuropsychiatric disorder consisting of multiple tics and vocal noises. We summarize here clinical aspects of 250 consecutive cases seen over a period of 3 years. The sex ratio was four males to one female, and the mean age of onset was 6.9 years. Only 10% were Jewish, indicating that it is not more prevalent in Ashkenazi Jews. Only 33% had compulsive swearing (coprolalia), indicating that this is not necessary for the diagnosis. The most frequent initial symptoms were rapid eye-blinking, facial grimacing, and throat-clearing. In this series, it was clear that Tourette syndrome is a psychiatric as well as a neurological disorder. Significant discipline problems and/or problems with anger and violence occurred in 61%, and 54% had attention-deficit disorder with hyperactivity. Some degree of exhibitionism was present in 15.9% of males and 6.1% of females. Obsessive-compulsive behavior was seen in 32%. Other than tics and vocal noises, the most common parental complaints were of short temper and everything being a confrontation. There were no significant clinical differences between familial and sporadic cases. Whenever a child presents with a learning disorder, attention-deficit disorder, or significant discipline or emotional problems, the parents should be questioned about the presence of tics or vocal noises in the patient and other family members. PMID:3859204

  20. Primordial dwarfism: overview of clinical and genetic aspects.

    PubMed

    Khetarpal, Preeti; Das, Satrupa; Panigrahi, Inusha; Munshi, Anjana

    2016-02-01

    Primordial dwarfism is a group of genetic disorders which include Seckel Syndrome, Silver-Russell Syndrome, Microcephalic Osteodysplastic Primordial Dwarfism types I/III, II and Meier-Gorlin Syndrome. This genetic disorder group is characterized by intra-uterine growth retardation and post-natal growth abnormalities which occur as a result of disorganized molecular and genomic changes in embryonic stage and, thus, it represents a unique area to study growth and developmental abnormalities. Lot of research has been carried out on different aspects; however, a consolidated review that discusses an overall spectrum of this disorder is not accessible. Recent research in this area points toward important molecular and cellular mechanisms in human body that regulate the complexity of growth process. Studies have emerged that have clearly associated with a number of abnormal chromosomal, genetic and epigenetic alterations that can predispose an embryo to develop PD-associated developmental defects. Finding and associating such fundamental changes to its subtypes will help in re-examination of alleged functions at both cellular and developmental levels and thus reveal the intrinsic mechanism that leads to a balanced growth. Although such findings have unraveled a subtle understanding of growth process, we further require active research in terms of identification of reliable biomarkers for different subtypes as an immediate requirement for clinical utilization. It is hoped that further study will advance the understanding of basic mechanisms regulating growth relevant to human health. Therefore, this review has been written with an aim to present an overview of chromosomal, molecular and epigenetic modifications reported to be associated with different subtypes of this heterogenous disorder. Further, latest findings with respect to clinical and molecular genetics research have been summarized to aid the medical fraternity in their clinical utility, for diagnosing disorders

  1. 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

  2. Brugada Syndrome: Clinical, Genetic, Molecular, Cellular, and Ionic Aspects.

    PubMed

    Antzelevitch, Charles; Patocskai, Bence

    2016-01-01

    Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome first described as a new clinical entity in 1992. Electrocardiographically characterized by distinct coved type ST segment elevation in the right-precordial leads, the syndrome is associated with a high risk for sudden cardiac death in young adults, and less frequently in infants and children. The electrocardiographic manifestations of BrS are often concealed and may be unmasked or aggravated by sodium channel blockers, a febrile state, vagotonic agents, as well as by tricyclic and tetracyclic antidepressants. An implantable cardioverter defibrillator is the most widely accepted approach to therapy. Pharmacologic therapy is designed to produce an inward shift in the balance of currents active during the early phases of the right ventricular action potential (AP) and can be used to abort electrical storms or as an adjunct or alternative to device therapy when use of an implantable cardioverter defibrillator is not possible. Isoproterenol, cilostazol, and milrinone boost calcium channel current and drugs like quinidine, bepridil, and the Chinese herb extract Wenxin Keli inhibit the transient outward current, acting to diminish the AP notch and thus to suppress the substrate and trigger for ventricular tachycardia or fibrillation. Radiofrequency ablation of the right ventricular outflow tract epicardium of patients with BrS has recently been shown to reduce arrhythmia vulnerability and the electrocardiographic manifestation of the disease, presumably by destroying the cells with more prominent AP notch. This review provides an overview of the clinical, genetic, molecular, and cellular aspects of BrS as well as the approach to therapy.

  3. Brugada Syndrome. Clinical, Genetic, Molecular, Cellular and Ionic Aspects

    PubMed Central

    Antzelevitch, Charles; Patocskai, Bence

    2015-01-01

    The Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome first described as a new clinical entity in 1992. Electrocardiographically characterized by distinct coved type ST segment elevation in the right precordial leads, the syndrome is associated with a high risk for sudden cardiac death in young adults, and less frequently in infants and children. The ECG manifestations of the BrS are often concealed and may be unmasked or aggravated by sodium channel blockers, a febrile state, vagotonic agents, as well as by tricyclic and tetracyclic antidepressants. An implantable cardioverter defibrillator (ICD) is the most widely accepted approach to therapy. Pharmacological therapy is designed to produce an inward shift in the balance of currents active during the early phases of the right ventricular action potential and can be used to abort electrical storms or as an adjunct or alternative to device therapy when use of an ICD is not possible. Isoproterenol, cilostazol and milrinone boost calcium channel current and drugs like quinidine, bepridil and the Chinese herb extract Wenxin Keli inhibit the transient outward current, acting to diminish the action potential (AP) notch and thus to suppress the substrate and trigger for VT/VF. Radiofrequency ablation of the right ventricular outflow tract epicardium of BrS patients has recently been shown to reduce arrhythmia-vulnerability and the ECG-manifestation of the disease, presumably by destroying the cells with more prominent AP notch. This review provides an overview of the clinical, genetic, molecular and cellular aspects of the BrS as well as the approach to therapy. PMID:26671757

  4. 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.

  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. Compliant flooring to prevent fall-related injuries in older adults: A scoping review of biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety

    PubMed Central

    Jurkowski, Michal P.; Dymarz, Ania C.; Robinovitch, Stephen N.; Feldman, Fabio; Laing, Andrew C.; Mackey, Dawn C.

    2017-01-01

    Background Compliant flooring, broadly defined as flooring systems or floor coverings with some level of shock absorbency, may reduce the incidence and severity of fall-related injuries in older adults; however, a lack of synthesized evidence may be limiting widespread uptake. Methods Informed by the Arksey and O’Malley framework and guided by a Research Advisory Panel of knowledge users, we conducted a scoping review to answer: what is presented about the biomechanical efficacy, clinical effectiveness, cost-effectiveness, and workplace safety associated with compliant flooring systems that aim to prevent fall-related injuries in healthcare settings? We searched academic and grey literature databases. Any record that discussed a compliant flooring system and at least one of biomechanical efficacy, clinical effectiveness, cost-effectiveness, or workplace safety was eligible for inclusion. Two independent reviewers screened and abstracted records, charted data, and summarized results. Results After screening 3611 titles and abstracts and 166 full-text articles, we included 84 records plus 56 companion (supplementary) reports. Biomechanical efficacy records (n = 50) demonstrate compliant flooring can reduce fall-related impact forces with minimal effects on standing and walking balance. Clinical effectiveness records (n = 20) suggest that compliant flooring may reduce injuries, but may increase risk for falls. Preliminary evidence suggests that compliant flooring may be a cost-effective strategy (n = 12), but may also result in increased physical demands for healthcare workers (n = 17). Conclusions In summary, compliant flooring is a promising strategy for preventing fall-related injuries from a biomechanical perspective. Additional research is warranted to confirm whether compliant flooring (i) prevents fall-related injuries in real-world settings, (ii) is a cost-effective intervention strategy, and (iii) can be installed without negatively impacting workplace

  8. Biomechanics of foetal movement.

    PubMed

    Nowlan, N C

    2015-01-02

    Foetal movements commence at seven weeks of gestation, with the foetal movement repertoire including twitches, whole body movements, stretches, isolated limb movements, breathing movements, head and neck movements, jaw movements (including yawning, sucking and swallowing) and hiccups by ten weeks of gestational age. There are two key biomechanical aspects to gross foetal movements; the first being that the foetus moves in a dynamically changing constrained physical environment in which the freedom to move becomes increasingly restricted with increasing foetal size and decreasing amniotic fluid. Therefore, the mechanical environment experienced by the foetus affects its ability to move freely. Secondly, the mechanical forces induced by foetal movements are crucial for normal skeletal development, as evidenced by a number of conditions and syndromes for which reduced or abnormal foetal movements are implicated, such as developmental dysplasia of the hip, arthrogryposis and foetal akinesia deformation sequence. This review examines both the biomechanical effects of the physical environment on foetal movements through discussion of intrauterine factors, such as space, foetal positioning and volume of amniotic fluid, and the biomechanical role of gross foetal movements in human skeletal development through investigation of the effects of abnormal movement on the bones and joints. This review also highlights computational simulations of foetal movements that attempt to determine the mechanical forces acting on the foetus as it moves. Finally, avenues for future research into foetal movement biomechanics are highlighted, which have potential impact for a diverse range of fields including foetal medicine, musculoskeletal disorders and tissue engineering.

  9. ASPECT

    EPA Pesticide Factsheets

    Able to deploy within one hour of notification, EPA's Airborne Spectral Photometric Environmental Collection Technology (ASPECT) is the nation’s only airborne real-time chemical and radiological detection, infrared and photographic imagery platform.

  10. [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.

  11. 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.

  12. 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.

  13. Chirality and drugs in clinical practice and its ethical aspect.

    PubMed

    Banerjee, Molly; Biswas, Indranil; Halder, Swaraj

    2009-01-01

    Recently specific enantiomer of different chiral molecules are being launched in the market as drugs. Here the rationality of scopes and uses of these drugs in therapeutic medicine is discussed including the ethical aspect.

  14. [Biomechanical-clinical interpretation of firearm wounds. General problems. IX. Propedeutic ABC of terminal ballistics].

    PubMed

    Marini, F; Radin, S; Dagradi, V; Carolo, F; Mangiante, G; Tenci, A; Dalla Giacoma, C; Giarolli, M; Massari, S; Prati, G

    1993-01-01

    In this chapter, the leading role is played by the mechanical-thermal-ballistic device, issued as a long-barrelled regulation firearm to modern armies. The most accurate description of this type of firearm and its present and possible future development seeks to be in line with the objective comparison between the biological matter and the mechanical material, which constitutes the essential basis for any optimal nosological, aetiological, or pathogenetic classification of bullet wounds. We should not forget that the advent of the M 16 A 1 has aroused great technical interest, particularly--though not only--as regards the hydroshock aspect, and that the technological developments in future can hardly fail to increasingly confirm the singular nature of bullet wounds, which refuse to be encompassed merely within the somewhat limited sphere of their strictly local effects, but carry a broader significance in a critical context open to further verification in the future. There can be no denying that this unique nature of modern bullet wounds makes them ideal candidates bearing witness to a new interpretation of traumatism, which at present is only in its infancy.

  15. [Scientific, practical and educational aspects of clinical epidemiology].

    PubMed

    Briko, N I

    2012-01-01

    This article defines clinical epidemiology and describes its goal and objectives. The author claims that clinical epidemiology is a section of epidemiology which underlies the development of evidence-based standards for diagnostics, treatment and prevention and helps to select the appropriate algorithm for each clinical case. The study provides a comprehensive overview of the relationship between clinical epidemiology and evidence-based medicine. Epidemiological research is shown to be methodological basis of clinical epidemiology and evidence-based medicine with randomized controlled trials being the "gold standard" for obtaining reliable data. The key stages in the history of clinical epidemiology are discussed and further development of clinical epidemiology and the integration of courses on clinical epidemiology in education is outlined for progress in medical research and health care practice.

  16. A Static Biomechanical Load Carriage Model

    DTIC Science & Technology

    2001-05-01

    three categories: physiological studies, biomechanical studies, and subjective appraisal studies. Most of the biomechanical studies concentrate on gait ... analysis (e.g. DeVita et al., 1991). As there are several comprehensive survey articles on various aspects of load carriage (e.g. Rorke, 1990; Haisman

  17. 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

  18. 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

  19. 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.

  20. 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…

  1. 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.

  2. [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.

  3. Laboratory, clinical, and epidemiological aspects of coagulase-negative staphylococci.

    PubMed Central

    Pfaller, M A; Herwaldt, L A

    1988-01-01

    Coagulase-negative staphylococci, particularly Staphylococcus epidermidis, are increasingly important causes of nosocomial infection. Microbiologists and clinicians no longer can afford to disregard clinical isolates of coagulase-negative staphylococci as contaminants. Accurate species identification and antimicrobial susceptibility testing, in a clinically relevant time frame, are important aids in the diagnosis and management of serious coagulase-negative staphylococcal infections. Emphasis in the clinical laboratory should be placed on the routine identification of S. epidermidis and Staphylococcus saprophyticus, with identification of other species of coagulase-negative staphylococci as clinically indicated. The application of newer techniques, such as plasmid analysis and tests for slime production and adherence, contribute to our understanding of the epidemiology and pathogenesis of coagulase-negative staphylococci and may also be helpful in establishing the diagnosis of infection. PMID:3058297

  4. Cutaneous tuberculosis: epidemiologic, etiopathogenic and clinical aspects - Part I*

    PubMed Central

    dos Santos, Josemir Belo; Figueiredo, Ana Roberta; Ferraz, Cláudia Elise; de Oliveira, Márcia Helena; da Silva, Perla Gomes; de Medeiros, Vanessa Lucília Silveira

    2014-01-01

    Cutaneous tuberculosis (CTB) is the result of a chronic infection by Mycobacterium tuberculosis, M. ovis and occasionally by the Calmette-Guerin bacillus. The clinical manifestations are variable and depend on the interaction of several factors including the site of infection and the host's immunity. This article revises the current knowledge about this disease's physiopathology and immunology as well as detailing the possible clinical presentations. PMID:24770496

  5. Palmar hyperhidrosis: clinical, pathophysiological, diagnostic and therapeutic aspects*

    PubMed Central

    Romero, Flávio Ramalho; Haddad, Gabriela Roncada; Miot, Hélio Amante; Cataneo, Daniele Cristina

    2016-01-01

    Abstract Palmar hyperhidrosis affects up to 3% of the population and inflict significant impact on quality of life. It is characterized by chronic excessive sweating, not related to the necessity of heat loss. It evolves from a localized hyperactivity of the sympathetic autonomic system and can be triggered by stressful events. In this study, the authors discuss clinical findings, pathophysiological, diagnostic and therapeutic issues (clinical and surgical) related to palmar hyperhidrosis. PMID:28099590

  6. Aspects of vulnerable patients and informed consent in clinical trials

    PubMed Central

    Kuthning, Maria; Hundt, Ferdinand

    2013-01-01

    Scope: To discuss the rationale behind informed consent in clinical trials focusing on vulnerable patients from a European and German viewpoint. Methods: Scientific literature search via PubMed, Medline, Google. Results: Voluntary informed consent is the cornerstone of policies regulating clinical trials. To enroll a patient into a clinical trial without having obtained written and signed consent is to be considered as a serious issue in the conduct of a clinical trial. Development of ethical guidance for physicians started before Christ Era with the Hippocratic Oath. Main function of consent, as articulated in all guidelines developed for clinical research, is to facilitate an individual’s freedom of choice, respect autonomy, and thus to ensure welfare of the participants in clinical trials. Minors are unable to provide legally binding informed consent, this issue is addressed through a combination of parental permission and minor’s assent. Illiteracy is a critical problem that affects all corners of our earth; it has no boundaries and exists among every race and ethnicity, age group, and economic class. New strategies to improve communication with patients including the use of videotapes or animated cartoon illustrations could be taught. Finally the time with the potential participant seems to be the best way to improve understanding. Conclusion: Discovery of life saving and life enhancing new treatments requires partnership that is based on good communication and trust between patients and researchers, sponsors, ethics committees, authorities, lawyers and politicians so that vulnerable patients can benefit from the results of well controlled clinical trials. PMID:23346043

  7. Multiple sclerosis in children: clinical, diagnostic, and therapeutic aspects.

    PubMed

    Rostásy, Kevin

    2007-01-01

    Multiple sclerosis (MS) is the most common inflammatory disease of human central nervous system (CNS), which is characterized by inflammatory demyelination and neuroaxonal injury/loss. The majority of MS patients are diagnosed in early- to mid-adulthood; however, the onset of MS in childhood is being increasingly recognized. Although adults and children share important aspects of the disease, several features including course of the disease and a broader differential diagnosis are unique to children. This chapter summarizes recent insights and emphasizes that children with MS should be started on immunomodulatory therapies early in order to prevent future disability.

  8. New developments in clinical aspects of lymphatic disease

    PubMed Central

    Mortimer, Peter S.; Rockson, Stanley G.

    2014-01-01

    The lymphatic system is fundamentally important to cardiovascular disease, infection and immunity, cancer, and probably obesity — the four major challenges in healthcare in the 21st century. This Review will consider the manner in which new knowledge of lymphatic genes and molecular mechanisms has demonstrated that lymphatic dysfunction should no longer be considered a passive bystander in disease but rather an active player in many pathological processes and, therefore, a genuine target for future therapeutic developments. The specific roles of the lymphatic system in edema, genetic aspects of primary lymphedema, infection (cellulitis/erysipelas), Crohn’s disease, obesity, cancer, and cancer-related lymphedema are highlighted. PMID:24590276

  9. Familial renal cell carcinoma: clinical and molecular genetic aspects

    PubMed Central

    Maher, E.R.; Yates, J.R.W.

    1991-01-01

    Renal cell carcinoma (RCC) accounts for 2% of all human cancer, but familial cases are infrequent. Riches (1963) and Griffin et al. (1984) in a population-based case-control study found a family history of renal cell carcinoma in 2.4% of affected patients compared to 1.4% of controls. Nevertheless the importance of inherited tumours in clinical practice and medical research is disproportionate to their frequency. In clinical practice recognition of familial RCC can provide opportunities to prevent morbidity and mortality by appropriate screening. In medical research recent advances in molecular genetics offer the prospect of isolating the genes involved in the pathogenesis of familial RCC and of the more common sporadic cases. In this article we review the clinical and molecular genetics of inherited renal cell carcinoma (adenocarcinoma or hypernephroma). PMID:1997093

  10. Oncolytic Virus: Regulatory Aspects from Quality Control to Clinical Studies.

    PubMed

    Yamaguchi, Teruhide; Uchida, Eriko

    2017-02-22

    Oncolytic viruses, which include both naturally occurring wild-type viruses/attenuated viruses and genetically modified viruses, have recently been developed for use in innovative cancer therapies. Genetically modified oncolytic viruses possess the unique ability to replicate conditionally as a unique gene therapy product. Since oncolytic viruses exhibit prolonged persistence in patients, viral shedding and transmission to third parties should be major concerns for clinical trials, along with the clinical safety and efficacy. Accordingly, studies are now underway to establish the safety and efficacy of oncolytic viruses.

  11. Clinical aspects of neurointestinal disease: Pathophysiology, diagnosis, and treatment.

    PubMed

    Goldstein, Allan M; Thapar, Nikhil; Karunaratne, Tennekoon Buddhika; De Giorgio, Roberto

    2016-09-15

    The enteric nervous system (ENS) is involved in the regulation of virtually all gut functions. Conditions referred to as enteric neuropathies are the result of various mechanisms including abnormal development, degeneration or loss of enteric neurons that affect the structure and functional integrity of the ENS. In the past decade, clinical and molecular research has led to important conceptual advances in our knowledge of the pathogenetic mechanisms of these disorders. In this review we consider ENS disorders from a clinical perspective and highlight the advancing knowledge regarding their pathophysiology. We also review current therapies for these diseases and present potential novel reparative approaches for their treatment.

  12. 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

  13. Clinical and microbiological aspects of the Sargon immediate load implant.

    PubMed

    Nowzari, H; Chee, W; Tuan, A; Abou-Rass, M; Landesman, H M

    1998-07-01

    A maxillary lateral incisor with severe periodontal destruction was extracted after forced eruption and was replaced with a Sargon Immediate Load Implant. The clinical and microbiological results of the case are reported. The Sargon Immediate Load Implant is an apically expandable, quintapodal, root-form dental implant, designed to be loaded immediately with a provisional fixed restoration in normal occlusion.

  14. 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.

  15. Statistical aspect of translational and correlative studies in clinical trials

    PubMed Central

    Pang, Herbert; Wang, Xiaofei

    2015-01-01

    In this article, we describe statistical issues related to the conduct of translational and correlative studies in cancer clinical trials. In the era of personalized medicine, proper biomarker discovery and validation is crucial for producing groundbreaking research. In order to carry out the framework outlined in this article, a team effort between oncologists and statisticians is the key for success. PMID:26932435

  16. THE CLINICAL ASPECTS, DIAGNOSIS AND EPIDEMIOLOGY OF HISTOPLASMOSIS

    DTIC Science & Technology

    Histoplasmosis in adults can have an acute, subacute, or chronic course. In children, particularly in the early ages, the disease has an acute...this its clinical manifestations are extremely varied. Generalized histoplasmosis is accompanied by an irregular type fever, splenohepatomegaly, anemia, lymphadenopathy, and sharp emaciation.

  17. 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

  18. Clinical, pathological, and etiologic aspects of acquired dermal melanocytosis.

    PubMed

    Mizoguchi, M; Murakami, F; Ito, M; Asano, M; Baba, T; Kawa, Y; Kubota, Y

    1997-06-01

    To study the pathogenesis of acquired dermal melanocytosis (ADM), we reviewed the clinical, immunohistochemical, and ultrastructural features of 34 cases (female, 33, and male, 1) of ADM. The patients' ages at onset ranged from 8 to 51 years and averaged 26.8 +/- 12.7 years. There was a positive family history. Gray-brown macules were mostly recognized on the face. Not only active dermal melanocytes but also non-pigmented c-KIT- and TRP-2-positive immature melanocytes were detected in the dermis. Taken together those clinical and histological findings, activation of pre-existing immature melanocytes by sunlight, estrogen, and/or progesterone, and some other factors, may be the most likely mode of the development of ADM. Moreover, using cultured murine neural crest cells as a model of c-KIT-positive immature melanocytes, we confirmed that endothelin-1, which is produced and secreted by keratinocytes after UV-irradiation, affects melanocytes and accelerated melanogenesis.

  19. 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

  20. Clinical aspects of feline immunodeficiency and feline leukemia virus infection.

    PubMed

    Hartmann, Katrin

    2011-10-15

    Feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) are retroviruses with a global impact on the health of domestic cats. The two viruses differ in their potential to cause disease. FIV can cause an acquired immunodeficiency syndrome that increases the risk of developing 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. 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 important as a deadly infectious agent as in the last 20 years prevalence has been decreasing in most countries.

  1. Molecular approaches to epidemiology and clinical aspects of malaria.

    PubMed

    Brown, G V; Beck, H P; Molyneux, M; Marsh, K

    2000-10-01

    Malaria is a problem of global importance, responsible for 1-2 million deaths per year, mainly in African children, as well as considerable morbidity manifested as severe anaemia and encephalopathy in young children. Fundamental to the development of new tools for malaria control in humans is an increased understanding of key features of malaria infection, such as the diversity of outcome in different individuals, the understanding of different manifestations of the disease and of the mechanisms of immunity that allow clinical protection in the face of ongoing low-grade infection (concomitant immunity or premunition). Here, Graham Brown and colleagues review some of the ways in which molecular approaches might be used to increase our understanding of the epidemiology and clinical manifestations of malaria, as discussed at the Molecular Approaches to Malaria conference (MAM2000), Lorne, Australia, 2-5 February 2000.

  2. BK Polyomavirus: Clinical Aspects, Immune Regulation, and Emerging Therapies.

    PubMed

    Ambalathingal, George R; Francis, Ross S; Smyth, Mark J; Smith, Corey; Khanna, Rajiv

    2017-04-01

    BK polyomavirus (BKV) causes frequent infections during childhood and establishes persistent infections within renal tubular cells and the uroepithelium, with minimal clinical implications. However, reactivation of BKV in immunocompromised individuals following renal or hematopoietic stem cell transplantation may cause serious complications, including BKV-associated nephropathy (BKVAN), ureteric stenosis, or hemorrhagic cystitis. Implementation of more potent immunosuppression and increased posttransplant surveillance has resulted in a higher incidence of BKVAN. Antiviral immunity plays a crucial role in controlling BKV replication, and our increasing knowledge about host-virus interactions has led to the development of improved diagnostic tools and clinical management strategies. Currently, there are no effective antiviral agents for BKV infection, and the mainstay of managing reactivation is reduction of immunosuppression. Development of immune-based therapies to combat BKV may provide new and exciting opportunities for the successful treatment of BKV-associated complications.

  3. Pediatric Flexible Flatfoot; Clinical Aspects and Algorithmic Approach

    PubMed Central

    Halabchi, Farzin; Mazaheri, Reza; Mirshahi, Maryam; Abbasian, Ladan

    2013-01-01

    Flatfoot constitutes the major cause of clinic visits for pediatric foot problems. The reported prevalence of flatfoot varies widely due to numerous factors. It can be divided into flexible and rigid flatfoot. Diagnosis and management of pediatric flatfoot has long been the matter of controversy. Common assessment tools include visual inspection, anthropometric values, footprint parameters and radiographic evaluation. Most flexible flatfeet are physiologic, asymptomatic, and require no treatment. Otherwise, the physician should treat symptomatic flexible flatfeet. Initial treatment options include activity modification, proper shoe and orthoses, exercises and medication. Furthermore, comorbidities such as obesity and ligamenous laxity should be identified and managed, if applicable. When all nonsurgical treatment options faile, surgery can be considered. Our purpose in this article is to present a clinical algorithmic approach to pediatric flatfoot. PMID:23795246

  4. Shoulder biomechanics.

    PubMed

    Lugo, Roberto; Kung, Peter; Ma, C Benjamin

    2008-10-01

    The biomechanics of the glenohumeral joint depend on the interaction of both static and dynamic-stabilizing structures. Static stabilizers include the bony anatomy, negative intra-articular pressure, the glenoid labrum, and the glenohumeral ligaments along with the joint capsule. The dynamic-stabilizing structures include the rotator cuff muscles and the other muscular structures surrounding the shoulder joint. The combined effect of these stabilizers is to support the multiple degrees of motion within the glenohumeral joint. The goal of this article is to review how these structures interact to provide optimal stability and how failure of some of these mechanisms can lead to shoulder joint pathology.

  5. [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.

  6. [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.

  7. Clinical Aspects of Cerebral Venous Thrombosis: Experiences in Two Institutions

    PubMed Central

    Rim, Hyun Taek; Jun, Hyo Sub; Ahn, Jun Hyong; Kim, Ji Hee; Oh, Jae Keun; Song, Joon Ho; Cho, Byung Moon

    2016-01-01

    Objective Cerebral venous thrombosis (CVT) is a rare condition for which few clinical reviews have been conducted in Korea. Our aim was to investigate, risk factors, clinical presentations/courses, and outcomes of 22 patients treated for CVT at two centers. Materials and Methods A retrospective analysis was conducted, selecting 22 patients diagnosed with and treated for CVT at two patient care centers over a 10-year period (January 1, 2004 to August 31, 2015). Patient data, pathogenetic concerns (laboratory findings), risk factors, locations, symptoms, treatments, and clinical outcomes were reviewed. Results Mean patient age at diagnosis was 54.41 ± 16.19. Patients most often presented with headache (40%), followed by seizure (27%) and altered mental status (18%). Focal motor deficits (5%), visual symptoms (5%), and dysarthria (5%) were less common. Important predisposing factors in CVT included prothrombotic conditions (35%), infections (14%), hyperthyroidism (18%), trauma (14%), and malignancy (4%). By location, 9 patients (40%) experienced thrombosis of superior sagittal sinus predominantly, with involvement of transverse sinus in 20 (90%), sigmoid sinus in 12 (40%), and the deep venous system in 5 (23%). Treatment generally consisted of anticoagulants (63%) or antiplatelet (23%) drugs, but surgical decompression was considered if warranted (14%). Medical therapy in CVT yields good functional outcomes. Conclusion Mean age of patients with CVT in our study exceeded that reported in Europe or in America and had difference in risk factors. Functional outcomes are good with use of antithrombotic medication, whether or not hemorrhagic infarction is evident. PMID:27847760

  8. 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

  9. 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.

  10. Pubourethral ligaments in women: anatomical and clinical aspects.

    PubMed

    Vazzoler, N; Soulié, M; Escourrou, G; Seguin, P; Pontonnier, F; Bécue, J; Plante, P

    2002-02-01

    The anatomy and histological structure of the proximal (PPUL), distal (DPUL) and intermediate (IPUL) pubourethral ligaments in women was examined to improve the understanding of their roles in female urethral physiology. An anatomical study of the pelvis was carried out in 10 adult female cadavers (60-102 years), the pelvis being removed and frozen prior to dissection. The pubourethral ligaments (PUL) were dissected in sagittal sections in seven specimens and in a frontal section in one specimen; the remaining two pelves were dissected using a hypogastric approach. The location, insertion, direction and histological structure of the ligamentous structures were studied. The PUL were identified in all 10 dissections, being paired, symmetrical, pearly-white, fibrous and resistant to stretching. The bony (parietal) insertion was variable on the posterior surface of the pubis, while the visceral insertion was located on the dorsal aspect of the proximal third of the urethra and neck of the bladder for the PPUL and on the distal third of the urethra for the DPUL. Histologically, the ligaments were composed of dense collagen fibres and bundles of axially orientated smooth muscle fibres. The PPUL was closely associated with the sphincter urogenitalis muscle, whereas the DPUL appeared to reinforce the role of the compressor urethra. It is suggested that the PUL plays an effective role in passive and active suspension of the urethra. The pubourethral ligaments are a constant anatomical entity which should be spared in urethral surgery in women in order to ensure an intact urogenital sphincter.

  11. [FeLV infection in the cat: clinically relevant aspects].

    PubMed

    Boretti, F S; Lutz, H; Hofmann-Lehmann, R

    2011-11-01

    The feline leukemia virus (FeLV) is a retrovirus of the domestic cat that was described almost 50 years ago. The FeLV-infection may lead to fatal diseases in domestic and small wild cats. The use of efficacious diagnostics assays and vaccines led to a reduction of the FeLV prevalence; however, FeLV still poses a problem for the cat presented with the infection. This article aims to describe recent developments in diagnostics and findings in the infection pathogenesis that are clinically relevant.

  12. 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

  13. Elastoma: clinical and histopathological aspects of a rare disease*

    PubMed Central

    Maciel, Marina Gagheggi; Enokihara, Milvia Maria Simões e Silva; Seize, Maria Bandeira de Melo Paiva; Marcassi, Aline Pantano; Piazza, Christiane Affonso De Donato; Cestari, Silmara da Costa Pereira

    2016-01-01

    Elastoma is a connective tissue nevus characterized by changes in elastic fibers. It can be congenital or acquired, and is usually diagnosed before puberty. Associated with osteopoikilosis, it is known as Buschke-Ollendorff syndrome. Histopathology with specific staining for elastic fibers is critical for a diagnostic conclusion. This report describes the case of a 7-year-old male patient with lesions diagnosed as elastoma, with absence of bone changes in the radiological imaging. This study aims to report the clinical presentation and histological examination of such unusual disease.

  14. 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.

  15. Alcoholic liver disease: pathologic, pathogenetic and clinical aspects.

    PubMed

    Ishak, K G; Zimmerman, H J; Ray, M B

    1991-02-01

    Alcoholic liver disease includes steatosis, alcoholic hepatitis and cirrhosis. Other liver diseases of genetic origin, but with a curious association with alcohol intake, are hemochromatosis and porphyria cutanea tarda. The attribution of chronic hepatitis to alcohol intake remains speculative, and the association may reflect hepatitis C infection. Hepatic injury attributed to alcohol includes the changes reported in the fetal alcohol syndrome. Steatosis, the characteristic consequence of excess alcohol intake, is usually macrovesicular and rarely microvesicular. Acute intrahepatic cholestasis, which in rare instances accompanies steatosis, must be distinguished from other causes of intrahepatic cholestasis (e.g., drug-induced) and from mechanical obstruction of the intrahepatic bile ducts (e.g., pancreatitis, choledocholithiasis) before being accepted. Alcoholic hepatitis (steatonecrosis) is characterized by a constellation of lesions: steatosis, Mallory bodies (with or without a neutrophilic inflammatory response), megamitochondria, occlusive lesions of terminal hepatic venules, and a lattice-like pattern of pericellular fibrosis. All these lesions mainly affect zone 3 of the hepatic acinus. Other changes, observed at the ultrastructural level, are of importance in progression of the disease. They include widespread cytoplasmic shedding, and capillarization and defenestration of sinusoids. Progressive fibrosis complicating alcoholic hepatitis eventually leads to cirrhosis that is typically micronodular but can evolve to a mixed or macronodular pattern. Hepatocellular carcinoma occurs in 5 to 15% of patients with alcoholic liver disease. The clinical syndrome of alcoholic liver disease is the result of three factors--parenchymal insufficiency, portal hypertension and the clinical consequences of extrahepatic damage produced by alcohol. At the several phases of the life history of alcoholic liver disease, the individual factors play a different role. The clinical

  16. 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.

  17. 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

  18. Impact of alcohol consumption on clinical aspects of gambling disorder.

    PubMed

    Del Pino-Gutiérrez, Amparo; Fernández-Aranda, Fernando; Granero, Roser; Tárrega, Salomé; Valdepérez, Ana; Agüera, Zaida; Håkansson, Anders; Sauvaget, Anne; Aymamí, Neus; Gómez-Peña, Mónica; Moragas, Laura; Baño, Marta; Honrubia, María; Menchón, José M; Jiménez-Murcia, Susana

    2017-04-01

    Similarities between gambling disorder and substance use disorders have been extensively described. To date, however, few studies using large clinical samples have been carried out that reliably assess the relationship between different levels of alcohol consumption and gambling disorders. The present study aimed to assess the impact of baseline alcohol consumption levels on the clinical profile in a large sample of treatment-seeking individuals. Nine hundred and fifty-one consecutive outpatients diagnosed with gambling disorder according to DSM-IV criteria were compared after being included in three alcohol consumption groups (low risk, abuse and risk of dependence) based on their total raw scores on the AUDIT questionnaire. Results showed a high prevalence of risk of alcohol dependence in GD patients who were immigrants, unemployed, and had a low level of education. A positive linear trend was also found between alcohol consumption level and the prevalence of other current and life-time comorbid mental disorders, and for the presence of drug abuse. Statistically significant differences were found between the three alcohol consumption groups in terms of the evolution and severity of the gambling disorder, self-directedness personality trait, and levels of general psychopathology, hostility and paranoid ideation. In conclusion, the results showed an association between increased alcohol consumption and greater dysfunction.

  19. Periodontal disease in diabetic patients - clinical and histopathological aspects.

    PubMed

    Corlan Puşcu, Dorina; Ciuluvică, Radu Constantin; Anghel, Andreea; Mălăescu, Gheorghe Dan; Ciursaş, Adina Nicoleta; Popa, Gabriel Valeriu; Agop Forna, Doriana; Busuioc, Cristina Jana; Siloşi, Izabela

    2016-01-01

    Periodontal disease is one of the most frequent diseases affecting people all over the world. The relation between periodontal disease and diabetes mellitus raised the interest both of dentists and doctors treating metabolic diseases, as the two conditions influence one another. In our study, we analyzed a number of 75 patients with diabetes mellitus and periodontal disease that presented to the medical consultory for conditions of the dental maxillary system. The clinical study showed that periodontal disease and diabetes may affect young adults as well, still this pathological association more frequently appears after the age of 50. The disease was identified especially in the women living in urban area. The clinical examination of the dental maxillary system identified the presence of gingival ulcerations, dental calculus, gingival bleeding, radicular leftovers with anfractuous margins, fixed prostheses with an inappropriate cervical adjustment. Of the systemic diseases associated to periodontal disease and diabetes mellitus, there was observed that 66.66% of the patients also suffered from cardiovascular diseases (high blood pressure, ischemic cardiopathy, heart failure), and 37.33% suffered from obesity. The histopathological and immunohistochemical tests highlighted the presence of an inflammatory chronic, intense reaction, mainly formed of lymphocytes, plasmocytes, macrophages and granulocytes, heterogeneously disseminated and alteration of the structure of marginal and superficial periodontium. The inflammatory reaction in the patients with periodontal disease and diabetes was more intense than in the patients with periodontal disease without diabetes.

  20. [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.

  1. 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.

  2. Urinary proteins of tubular origin: basic immunochemical and clinical aspects.

    PubMed

    Scherberich, J E

    1990-01-01

    A variety of tubular marker proteins, as compared to healthy controls, are excreted at an increased rate in the urine of patients with renal damage. Beside cytoplasmic glutathione-S-transferase and lysosomal beta-N-acetyl-glucosaminidase (beta-NAG) the majority of kidney-related urine proteins derives from membrane surface components of the most vulnerable proximal tubule epithelia, among them ala-(leu-gly)-aminopeptidase, gamma-glutamyl transpeptidase (GGT), the tubular portion of angiotensinase A, the major brush border glycoprotein 'SGP-240' and adenosine-deaminase-binding protein. Urinary tissue proteins, e.g. brush border (BB) microvilli, are immunologically identical with those antigens prepared from cell membranes of the human kidney itself. BB antigens are shed into the urine of patients with glomerulonephritis, interstitial nephritis, systemic diseases, e.g. systemic lupus erythematosus (SLE), diabetes mellitus and multiple myeloma, arterial hypertension, infectious diseases (malaria, AIDS) and after operations, renal grafting and administration of X-ray contrast media, aminoglycosides or certain cytostatics (cis-platinum). Tissue proteinuria of tubular proteins is determined by enzyme-kinetic or quantitative immunological assays applying either poly- or monoclonal antikidney antibodies. Clinical, ultrastructural and histochemical studies support the idea that both 'soluble' and high-molecular-weight membrane particles (vacuolar blebs, greater than 10(6) dalton) as well as microfilamental components of the epithelial cytoskeleton contribute to tubular 'histuria' which appears as a sensitive parameter in monitoring tubular damage under clinical conditions at a very early phase.

  3. 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.

  4. Andersen-Tawil syndrome: clinical and molecular aspects.

    PubMed

    Nguyen, Hoai-Linh; Pieper, Gerard H; Wilders, Ronald

    2013-12-05

    Andersen–Tawil syndrome (ATS) is a rare hereditary multisystem disorder. Ventricular arrhythmias, periodic paralysis and dysmorphic features constitute the classic triad of ATS symptoms. The expressivity of these symptoms is, however, extremely variable, even within single ATS affected families, and not all ATS patients present with the full triad of symptoms. ATS patients may show a prolongation of the QT interval,which explains the classification as long QT syndrome type 7 (LQT7), and specific neurological or neurocognitive defects. In ATS type 1 (ATS1), the syndrome is associated with a loss-of-function mutation in the KCNJ2 gene,which encodes the Kir2.1 inward rectifier potassium channel. In ATS type 2 (ATS2), which does not differ from ATS1 in its clinical symptoms, the genetic defect is unknown. Consequently, ATS2 comprises all cases of ATS in which genetic testing did not reveal a mutation in KCNJ2. The loss-of-function mutations in KCNJ2 in ATS1 affect the excitability of both skeletal and cardiac muscle, which underlies the cardiac arrhythmias and periodic paralysis associated with ATS. Thus far, the molecular mechanism of the dysmorphic features is only poorly understood. In this review, we summarize the clinical symptoms, the underlying genetic and molecular defects, and the management and treatment of ATS.

  5. Prostate cancer in dogs: comparative and clinical aspects.

    PubMed

    Leroy, Bruce E; Northrup, Nicole

    2009-05-01

    The canine prostate gland shares many morphological and functional similarities with the human prostate and dogs are the only other large mammals that commonly develop spontaneous prostate cancer. However, the incidence of prostate cancer is much lower in dogs and the precise cell of origin is not known. Dogs with prostate cancer usually present with advanced disease that does not respond to androgen deprivation therapy. Similar to humans, affected dogs often develop osteoblastic bone metastases in the pelvis and/or lumbar spine with associated pain and neurological deficits. Other clinical signs include weight loss, lethargy, and abnormal urination and/or defecation. Surgery, chemotherapy, and radiation have been used to treat dogs with prostate cancer, but success has been limited by the location and aggressive nature of the disease. It is evident that better methods of early detection and more effective therapies are needed for prostate cancer in dogs and advanced prostate carcinoma in men. Dogs with naturally-occurring prostate cancer are relevant models for the disease in humans and pre-clinical studies of new diagnostics and therapies in dogs may benefit both humans and dogs with prostate cancer.

  6. [Heterotopic gray matter: MR findings and clinical aspects].

    PubMed

    Schuierer, G; Stefan, H; Wenzel, D; Kurlemann, G

    1995-01-01

    Heterotopias are conglomerates of neurons and glial cells in an abnormal location and belong to a group of malformations, which are the result of a disturbed migration of neurons during the embryonic development of the brain. The MRI-appearance and clinical symptoms of 14 patients with nodular or lamellar heterotopias are presented. Seizures were the leading symptom (12 of 14 patients), in children also a developmental deficit (4/10) with or without seizures. Most of the children (9/10) had further brain malformations especially of the corpus callosum or the cerebellar vermis. Nodular heterotopias without further malformations were found in 4 patients, two of them developing grand-mal seizures after childhood. On MRI heterotopias are characterized by a signal isointense to gray matter in all sequences. MRI-scans in at least 2 orientations are necessary to detect these anomalies reliably. MRI is the optimum method for the demonstration of these anomalies and should always be performed if seizures develop during childhood. At least in nodular heterotopias there is no definite correlation between the extent of the anomalies, the EEG-findings and the clinical symptoms. However there is a frequent combination of heterotopias with further cerebral malformations.

  7. Quantitation of Cytomegalovirus: Methodologic Aspects and Clinical Applications

    PubMed Central

    Boeckh, Michael; Boivin, Guy

    1998-01-01

    Cytomegalovirus (CMV) is an important pathogen in transplant recipients and human immunodeficiency virus (HIV)-infected individuals. Major progress has been made in developing quantitative detection methods for CMV in recent years. Due to their high sensitivity, these assays can detect CMV early, and quantitation may be useful in predicting the patient’s risk for disease and in monitoring the effect of antiviral therapy. This review discusses methodological aspects of currently used quantitative assays for CMV (i.e., viral culture techniques, antigen detection assays, DNA detection assays including PCR, branched-DNA assay, and the DNA hybrid capture assay) and addresses the correlation of systemic and site-specific CMV load and CMV disease in different populations of immunosuppressed patients as well as the response to antiviral treatment. To date, direct antigen detection and molecular techniques have largely replaced traditional culture-based techniques for CMV quantitation. In general, a high systemic CMV load is correlated with CMV disease. This correlation is strong in the HIV-infected population and in solid-organ transplant recipients but less clear in allogeneic marrow transplant recipients. Measuring the viral load at specific anatomic sites may be an alternative way to assess disease activity in situations where the systemic viral load correlates poorly with disease activity. A reduction of the systemic CMV load also correlates with a response to antiviral treatment, but more research is needed to evaluate the role of viral load as a surrogate marker for drug resistance. Due to the widespread use of quantitative CMV detection techniques to direct and monitor antiviral treatment, there is a great need for an assessment of the reproducibility of test results and better standardization of the assays. PMID:9665982

  8. 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.

  9. 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.

  10. 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

  11. Herpes genitalis without frontiers: from clinical aspects to viral identification.

    PubMed

    Papini, M

    2012-10-01

    Genital herpes simplex virus infection is a recurrent, lifelong disease with no cure. The strongest predictor for infection is a person's number of lifetime sex partners. HSV-2 is the commonest responsible, although infections caused by HSV-1 are rapidly increasing, particularly in adolescents, women and men who have sex with men. The natural history includes first-episode of mucocutaneous infection, establishment of latency in the dorsal root ganglion, and subsequent reactivation. Most infections are transmitted via asymptomatic viral shedding. Atypical manifestations are common. Genital HSV-2 recurs six times more frequently than type 1. Laboratory confirmation of the clinical diagnosis is recommended in all patients in order to guide a correct counselling and management. Real-time PCR and viral culture represent the gold standard for diagnosis. Serologic testing can be useful in persons with a questionable history. Counselling patients about the risk of transmission is crucial and helps prevent the spread of disease and neonatal complications.

  12. Helicobacter pylori infection: New pathogenetic and clinical aspects

    PubMed Central

    Hagymási, Krisztina; Tulassay, Zsolt

    2014-01-01

    Helicobacter pylori (H. pylori) infects more than half of the world’s human population, but only 1% to 3% of infected people consequently develop gastric adenocarcinomas. The clinical outcome of the infection is determined by host genetic predisposition, bacterial virulence factors, and environmental factors. The association between H. pylori infection and chronic active gastritis, peptic ulcer disease, gastric cell carcinoma, and B cell mucosa-associated lymphoid tissue lymphoma has been well established. With the exception of unexplained iron deficiency anemia and idiopathic thrombocytopenic purpura, H. pylori infection has no proven role in extraintestinal diseases. On the other hand, there is data showing that H. pylori infection could be beneficial for some human diseases. The unpredictability of the long-term consequences of H. pylori infection and the economic challenge in eradicating it is why identification of high-risk individuals is crucial. PMID:24914360

  13. [Clinical and pharmacological aspects of pancreatic enzyme substitution therapy].

    PubMed

    Löser, C; Fölsch, U R

    1991-03-01

    The adequate therapy of pancreatic enzyme replacement in patients with exocrine pancreatic insufficiency is still a difficult clinical problem especially in patients following pancreatectomys, with chronic alcoholic pancreatitis or cystic fibrosis. The substitution of lipase to eliminate steatorrhoea is the most important aim but due to its acid lability even the most serious problem in pancreatic enzyme replacement therapy. Various different medications are meanwhile available: conventional preparations from porcine pancreatin or fungal enzymes as rizolipase, enteric-coated tablets or even enteric-coated microspheres or adjunctive therapy with H2-receptor antagonists. While dosage requirements vary widely and therefore have to be tried out individually, the choice of the adequate preparation should be influenced by the realization of the physiological and pathophysiological characteristics of the individual patient and the pharmaceutical characteristics of the different supplements. The advantages and disadvantages of the various medications for enzyme replacement therapy in patients with exocrine pancreatic insufficiency are reviewed in this article.

  14. [Clinical and preclinical aspects of adrenal Cushing syndrome].

    PubMed

    Ambrosi, B; Re, T; Passini, E; Peverelli, S; Sartorio, A; Colombo, P

    1995-03-01

    Cushing's syndrome of adrenal origin encompasses different entities: besides the occurrence of adenoma and carcinoma, a not homogeneous group includes the ACTH-independent macro- or micronodular bilateral hyperplasia and the familial pigmented nodular hyperplasia (Carney's syndrome). Moreover, isolated cases of immunological origin and food-dependence have recently described. On clinical grounds no major characteristics may help to identify the adrenal origin of Cushing's syndrome, except for few situations as carcinoma or nodular dysplasia. Laboratory investigations of patients with adrenocortical tumor are based on ACTH and cortisol determinations in basal conditions and in response to high dose dexamethasone and CRH tests. However, isolated diagnostic problems may occur, as the presence of a black adrenocortical adenoma or the uncommon persistence of a circadian rhythmicity of glucocorticoid secretion. The evaluation of new markers of bone turnover (BGP, ICTP) and of collagen turnover (PIIINP) confirms the existence of corticosteroid-induced bone and collagen damages and may also be a useful prognostic index after treatment. Although up to now food-dependent Cushing's syndrome appears to be very rare, the adrenocortical sensitivity to GIP has been investigated in patients with either pituitary Cushing's disease, or clinically silent adrenal masses. No evidence of GIP-dependent cortisol secretion during the peptide infusion or after endogenous stimulation by OGTT was observed in any case. Since the wide availability of sensitive and noninvasive imaging techniques (CT and NMR), in recent years the finding of incidentalomas has become fairly common. In patients with incidentaloma abnormalities of the endocrine function are frequently encountered, and the "preclinical" Cushing's syndrome is increasingly recognized.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. [Researches in forensic biomechanics].

    PubMed

    Xu, Yan; Fan, Yubo; Yu, Xiaojun

    2004-02-01

    Forensic biomechanics is the science of proof, which applies the biomechanical theory and technology to resolve problems related to mechanics in the process of expert witness. It belongs to the realm of a new subject combining biomechanics and forensics. Forensic biomechanics is a new branch of modern biomechanics and at the same time a new important branch of forensics, and it is one of the most potential research areas in forensics of injury. In this paper, the task of forensic biomechanics expert witness, the procedure of expert witness, and the forensic biomechanics research methods and cases are reviewed.

  16. Clinical aspects of Alzheimer's disease in black and white patients.

    PubMed Central

    Hargrave, R.; Stoeklin, M.; Haan, M.; Reed, B.

    1998-01-01

    This article examines the association between ethnicity and psychiatric symptoms in patients with Alzheimer's disease. Data from a cross-sectional study of patients evaluated at nine California Department of Health Alzheimer's Disease Diagnostic and Treatment Centers (ADDTCs) were used. Using the ADDTC patient database, sociodemographic and clinical variables in 207 black patients and 1818 white patients with probable and possible Alzheimer's disease were compared. Logistic and linear regression analysis indicated the following results: 1) black patients had fewer years of education and more often had hypertension, 2) black patients reported shorter duration of illness at the time of initial diagnosis of dementia, 3) black patients had lower Mini-Mental State Examination scores and higher Blessed Roth Dementia Rating Scale scores at the time of initial diagnosis, and 4) black patients more frequently reported insomnia and less frequently reported anxiety. Additional studies are needed to validate these findings and to generate hypotheses about the role of cardiovascular disease and pathophysiology of psychiatric symptoms in ethnic populations with Alzheimer's disease. PMID:9510621

  17. Angelman syndrome: a review of the clinical and genetic aspects.

    PubMed

    Clayton-Smith, J; Laan, L

    2003-02-01

    Angelman syndrome (AS) is a neurodevelopmental disorder characterised by severe learning difficulties, ataxia, a seizure disorder with a characteristic EEG, subtle dysmorphic facial features, and a happy, sociable disposition. Most children present with delay in developmental milestones and slowing of head growth during the first year of life. In the majority of cases speech does not develop. Patients with AS have a characteristic behavioural phenotype with jerky movements, frequent and sometimes inappropriate laughter, a love of water, and sleep disorder. The facial features are subtle and include a wide, smiling mouth, prominent chin, and deep set eyes. It is caused by a variety of genetic abnormalities involving the chromosome 15q11-13 region, which is subject to genomic imprinting. These include maternal deletion, paternal uniparental disomy, imprinting defects, and point mutations or small deletions within the UBE3A gene, which lies within this region. UBE3A shows tissue specific imprinting, being expressed exclusively from the maternal allele in brain. The genetic mechanisms identified so far in AS are found in 85-90% of those with the clinical phenotype and all interfere with UBE3A expression.

  18. Pathophysiological and clinical aspects of gastric hyperplastic polyps.

    PubMed

    Markowski, Adam Roman; Markowska, Agnieszka; Guzinska-Ustymowicz, Katarzyna

    2016-10-28

    Gastric polyps become a major clinical problem because of high prevalence and tendency to malignant transformation of some of them. The development of gastric hyperplastic polyps results from excessive proliferation of foveolar cells accompanied by their increased exfoliation, and they are macroscopically indistinguishable from other polyps with lower or higher malignant potential. Panendoscopy allows detection and differentiation of gastric polyps, usually after obtaining histopathological biopsy specimens. Unremoved gastric hyperplastic polyps may enlarge and sometimes spontaneously undergo a sequential progression to cancer. For this reason, gastric hyperplastic polyps larger than 5 mm in size should be removed in one piece. After excision of polyps with atypical focal lesion, endoscopic surveillance is suggested depending on histopathological diagnosis and possibility of confirming the completeness of endoscopic resection. Because of the risk of cancer development also in gastric mucosa outside the polyp, neighboring fragments of gastric mucosa should undergo microscopic investigations. This procedure allows for identification of patients who can benefit most from oncological endoscopic surveillance. If Helicobacter pylori (H. pylori) infection of the gastric mucosa is confirmed, treatment strategies should include eradication of bacteria, which may prevent progression of intestinal metaplasia. The efficacy of H. pylori eradication should be checked 3-6 mo later.

  19. Insecticide resistance in head lice: clinical, parasitological and genetic aspects.

    PubMed

    Durand, R; Bouvresse, S; Berdjane, Z; Izri, A; Chosidow, O; Clark, J M

    2012-04-01

    Insecticide treatment resistance is considered to be a major factor in the increasing number of infestations by head lice. The large insecticide selection pressure induced by conventional topical pediculicides has led to the emergence and spread of resistance in many parts of the world. Possible mechanisms of resistance include accelerated detoxification of insecticides by enzyme-mediated reduction, esterification, oxidation that may be overcome by synergistic agents such as piperonyl butoxide, alteration of the binding site, e.g. altered acetylcholinesterase or altered nerve voltage-gated sodium channel, and knockdown resistance (kdr). Clinical, parasitological and molecular data on resistance to conventional topical pediculicides show that treatments with neurotoxic insecticides have suffered considerable loss of activity worldwide. In particular, resistance to synthetic pyrethroids has become prominent, probably because of their extensive use. As other treatment options, including non-insecticidal pediculicides such as dimeticone, are now available, the use of older insecticides, such as lindane and carbaryl, should be minimized, owing to their loss of efficacy and safety concerns. The organophosphorus insecticide malathion remains effective, except in the UK, mostly in formulations that include terpineol.

  20. Pathogenesis and clinical aspects of pain in patients with osteoporosis

    PubMed Central

    Mediati, Rocco Domenico; Vellucci, Renato; Dodaro, Lucia

    2014-01-01

    Summary Bone pain is one of the most frequent kinds of chronic pain, mainly in elderly patients. It causes a significant worsening of functional capacity and deterioration in the quality of life in people affected. Mechanisms of pain in osteoporosis are poorly known and often extrapolated by other pathologies or other experimental model. One of principal causes would be a “hyper-remodeling” of bone, that involves osteoclasts activity and pathological modifications of bone innervation. Several studies show that osteoclasts play a significant role in bone pain etiology. Pain in osteoporosis is mainly nociceptive, if it become persistent a sensitization of peripheral and central nervous system can occur, so underlining the transition to a chronic pain syndrome. Central sensitization mechanisms are complex and involve several neuromediators and receptors (Substance P, NMDA, etc.). Most common manifestations of osteoporosis are vertebral compression fractures that cause persistent pain, though to differentiate from pain originating in structures as joint or muscle. First manifestation can be an acute pain due to pathological fracture, those of hip often causes disability. Pain in osteoporosis is an important clinical challenge. Often its complications and consequences on patient quality of life are underestimated with not negligible social implications. A balanced and early multimodal pain therapy including opioids as necessary, even in cases of acute pain, improve the functional capacity of patients and helps to prevent neurological alterations that seems to contribute in significant way in causing irreversible pain chronic syndromes. PMID:25568647

  1. Pathophysiological and clinical aspects of gastric hyperplastic polyps

    PubMed Central

    Markowski, Adam Roman; Markowska, Agnieszka; Guzinska-Ustymowicz, Katarzyna

    2016-01-01

    Gastric polyps become a major clinical problem because of high prevalence and tendency to malignant transformation of some of them. The development of gastric hyperplastic polyps results from excessive proliferation of foveolar cells accompanied by their increased exfoliation, and they are macroscopically indistinguishable from other polyps with lower or higher malignant potential. Panendoscopy allows detection and differentiation of gastric polyps, usually after obtaining histopathological biopsy specimens. Unremoved gastric hyperplastic polyps may enlarge and sometimes spontaneously undergo a sequential progression to cancer. For this reason, gastric hyperplastic polyps larger than 5 mm in size should be removed in one piece. After excision of polyps with atypical focal lesion, endoscopic surveillance is suggested depending on histopathological diagnosis and possibility of confirming the completeness of endoscopic resection. Because of the risk of cancer development also in gastric mucosa outside the polyp, neighboring fragments of gastric mucosa should undergo microscopic investigations. This procedure allows for identification of patients who can benefit most from oncological endoscopic surveillance. If Helicobacter pylori (H. pylori) infection of the gastric mucosa is confirmed, treatment strategies should include eradication of bacteria, which may prevent progression of intestinal metaplasia. The efficacy of H. pylori eradication should be checked 3-6 mo later. PMID:27833379

  2. Novel biological and clinical aspects of thyroid hormone metabolism.

    PubMed

    Dumitrescu, Alexandra M; Refetoff, Samuel

    2007-01-01

    Intracellular metabolism of thyroid hormone (TH) and availability of the active hormone T3 is regulated by three selenoprotein iodothyronine deiodinases (Ds). D1 and D2 convert the precursor T4 into the active hormone, T3. D3 is the principal inactivator of T4 and T3 to their respective metabolites, rT3 and T2. While acquired changes in D activities are common, inherited defects in humans were not known. Recently, two families with abnormal thyroid function tests, high serum T4, high rT3, low T3 and slightly increased TSH, were identified. Linkage analysis and sequencing excluded abnormalities in all 3 DIO genes, yet clinical studies showed reduced responsiveness to T4 but not to T3. Extensive search for putative defects in genes involved in D2 metabolism led to the identification of mutations in the Sec insertion sequence binding protein (SBP)2 gene, involved in the synthesis of selenoproteins, including Ds. Affected children were either homozygous or compound heterozygous for these mutations. Other selenoproteins, including glutathione peroxidase, were also reduced in affected subjects, confirming a generalized effect of the SBP2 defect. Opposite thyroid test abnormalities are found in mutations of the TH transporter MCT8, and appear to be caused by the resulting increases in D2 and D1 activities.

  3. 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

  4. Clinical and therapeutic aspects of Klinefelter's syndrome: sexual function.

    PubMed

    Vignozzi, L; Corona, G; Forti, G; Jannini, E A; Maggi, M

    2010-06-01

    Klinefelter's syndrome (KS) is the most common sex chromosomal aberration among men, with estimated prevalence of about 1 in 500 newborn males. The classical phenotype of KS is widely recognized, but many affected subjects present only very mild signs. While the association between KS and infertility has been well documented, few studies have investigated sexual function in the KS patients. In the present paper we reviewed studies addressed to emotional processing and sexual function in KS. We searched the following databases Medline, Pubmed, Embase, for Klinefelter's syndrome, sexuality. We focus on the peculiar contribution of genetic and hormonal background, which characterizes sexual dysfunction in KS. Abnormal structure and function of the emotional brain circuits have been described in KS. These alterations were less pronounced when the patients underwent to testosterone replacement therapy suggesting that they were mediated by testosterone deficiency. Accordingly, clinical studies indicate that sexual dysfunctions, eventually present in KS, are not specifically associated with the syndrome but are related to the underlying hypogonadism. In conclusion, androgen deficiency more than chromosomal abnormality is the major pathogenic factor of sexual dysfunction in KS.

  5. Clinical aspects of coenzyme Q10: an update.

    PubMed

    Littarru, Gian Paolo; Tiano, Luca

    2010-03-01

    The fundamental role of coenzyme Q(10) (CoQ(10)) in mitochondrial bioenergetics and its well-acknowledged antioxidant properties constitute the basis for its clinical applications, although some of its effects may be related to a gene induction mechanism. Cardiovascular disease is still the main field of study and the latest findings confirm a role of CoQ(10) in improving endothelial function. The possible relation between CoQ(10) deficiency and statin side effects is highly debated, particularly the key issue of whether CoQ(10) supplementation counteracts statin myalgias. Furthermore, in cardiac patients, plasma CoQ(10) was found to be an independent predictor of mortality. Studies on CoQ(10) and physical exercise have confirmed its effect in improving subjective fatigue sensation and physical performance and in opposing exercise-related damage. In the field of mitochondrial myopathies, primary CoQ(10) deficiencies have been identified, involving different genes of the CoQ(10) biosynthetic pathway; some of these conditions were found to be highly responsive to CoQ(10) administration. The initial observations of CoQ(10) effects in Parkinson's and Huntington's diseases have been extended to Friedreich's ataxia, where CoQ(10) and other quinones have been tested. CoQ(10) is presently being used in a large phase III trial in Parkinson's disease. CoQ(10) has been found to improve sperm count and motility on asthenozoospermia. Moreover, for the first time CoQ(10) was found to decrease the incidence of preeclampsia in pregnancy. The ability of CoQ(10) to mitigate headache symptoms in adults was also verified in pediatric and adolescent populations.

  6. 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

  7. 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.

  8. Effects of short-term fatigue on biomechanical and physiological aspects of double poling in high-level cross-country skiers.

    PubMed

    Zoppirolli, Chiara; Pellegrini, Barbara; Bortolan, Lorenzo; Schena, Federico

    2016-06-01

    The study aim was to evaluate biomechanical and physiological alterations in double poling technique (DP) after a short-term fatiguing exercise. Eight high-level skiers performed a sub-maximal DP trial (20kmh(-1), 1°) before (PRE) and after (POST) a DP test to exhaustion while roller skiing on a treadmill. An integrated analysis of DP technique during PRE and POST included measurement of pole, joint, and centre of mass (COM) kinematics, poling forces, cycle timing, and metabolic parameters. Muscle fatigue in three upper-body muscles was assessed by calculating the Dimitrov' fatigue index (FInms5) of specific electromyographic segments. FInms5 tended to increase in the latissimus dorsi and teres major muscles (P=0.023 and P=0.030, respectively) across consecutive DP cycles, as did blood lactate concentration (P=0.001) and rating of perceived exertion (P=0.005). The changes indicated a state of fatigue during POST and coincided with the reduction in poling force exertion capacity (P=0.020). Pole, joint and COM kinematics did not differ between PRE and POST (P>0.050), whereas recovery phase and cycle times were shorter at POST (P<0.001 and P=0.001, respectively). Short-term fatigue led to a reduction in poling force exertion capacity and cycle time in high-level skiers, without altering body and pole kinematics.

  9. Effects of sodium-hyaluronate and glucosamine-chondroitin sulfate on remodeling stage of tenotomized superficial digital flexor tendon in rabbits: a clinical, histopathological, ultrastructural, and biomechanical study.

    PubMed

    Oryan, Ahmad; Moshiri, Ali; Meimandiparizi, Abdul-Hamid

    2011-01-01

    This study was designed to evaluate the effects of sodium-hyaluronate (NaH) combined with glucosamine HCl-chondroitin sulfate (GlcN-CS) on the post-surgical repair of tendon rupture on day 84 post injury. Twenty white New Zealand female rabbits were divided randomly into two equal groups of injured treated and injured untreated. After tenotomy and surgical repair, using the modified Kessler technique and running pattern, the injured legs were casted for 14 days. NaH was injected subcutaneously over the lesion on days 3, 7, and 10 and was followed by daily oral administration of GlcN-CS on days 3 to 23 post injury. The control animals received normal saline injection and oral placebo similarly. The weight of the animals, tendon diameter, clinical manifestations, and radiographic and ultrasonographic evaluations were conducted for 12 weeks. The rabbits were euthanized 84 days post injury and the tendons were evaluated at macroscopic, histopathologic, and ultrastructural level and were assessed for biomechanical and percentage dry-weight parameters. Treatment significantly reduced the tendon diameter and ultimate and yield strain, and increased the echogenicity, dry-weight content, ultimate and yield strength, and stress and stiffness of the injured tendons compared to those of the untreated ones. Treatment also significantly enhanced the maturation rate of the tenoblasts, fibrillogenesis, the diameters of the collagen fibrils, and fibrillar density. These findings suggest that a combined treatment of NaH and GlcN-CS could be effective in restoring the morphological and biomechanical properties of injured superficial digital flexor tendon of rabbits and might be helpful for future clinical trial studies in tendon ruptures.

  10. 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

  11. Dinosaur biomechanics.

    PubMed

    Alexander, R McNeill

    2006-08-07

    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.

  12. 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)

  13. Biomechanics in dermatology: Recent advances and future directions.

    PubMed

    Lewinson, Ryan T; Haber, Richard M

    2017-02-01

    Biomechanics is increasingly being recognized as an important research area in dermatology. To highlight only a few examples, biomechanics has contributed to the development of novel topical therapies for aesthetic and medical purposes, enhanced our understanding of the pathogenesis of plantar melanoma, and provided insight into the epidemiology of psoriatic disease. This article summarizes the findings from recent studies to demonstrate the important role that biomechanics may have in dermatologic disease and therapy and places these biomechanical findings in a clinical context for the practicing physician. In addition, areas for future biomechanics research and development in dermatology are discussed.

  14. 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

  15. 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…

  16. 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…

  17. 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

  18. 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.

  19. C-arm cone-beam computed tomography in interventional oncology: technical aspects and clinical applications

    PubMed Central

    Floridi, Chiara; Radaelli, Alessandro; Abi-Jaoudeh, Nadine; Grass, Micheal; Lin, Ming De; Chiaradia, Melanie; Geschwind, Jean-Francois; Kobeiter, Hishman; Squillaci, Ettore; Maleux, Geert; Giovagnoni, Andrea; Brunese, Luca; Wood, Bradford; Carrafiello, Gianpaolo; Rotondo, Antonio

    2014-01-01

    C-arm cone-beam computed tomography (CBCT) is a new imaging technology integrated in modern angiographic systems. Due to its ability to obtain cross-sectional imaging and the possibility to use dedicated planning and navigation software, it provides an informed platform for interventional oncology procedures. In this paper, we highlight the technical aspects and clinical applications of CBCT imaging and navigation in the most common loco-regional oncological treatments. PMID:25012472

  20. 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

  1. Minimal residual disease detection in mantle cell lymphoma: technical aspects and clinical relevance.

    PubMed

    Pott, Christiane

    2011-07-01

    The prognostic impact of minimal residual disease (MRD) has been demonstrated for several hematologic malignancies. While in acute lymphoblastic leukemias MRD assessment by polymerase chain reaction (PCR)-based methods has been established as an important tool for clinical risk assessment and is part of clinical management, data demonstrating a prognostic value of MRD in mantle cell lymphoma (MCL) were sparse and results from randomized trials have been published only recently. In the present review technical aspects of different MRD detection methods are discussed, as well as the prognostic relevance of MRD in the context of clinical trials in patients with MCL. Furthermore, recommendations are given for workflow and useful implication of MRD in future clinical trials design.

  2. The clinical and biomechanical effects of fascial-muscular lengthening therapy on tight hip flexor patients with and without low back pain

    PubMed Central

    Avrahami, Daniel; Potvin, Jim R.

    2014-01-01

    Background: Many patients have tight hip flexors with or without low back pain. Manual fascial-muscular lengthening therapy (FMLT) is one commonly used treatment for this population. Objective: Investigate the clinical and biomechanical effects of manual FMLT on tight hip flexor patients with and without low back pain. Methods: A nonrandomized trial, before-and-after experiment with multiple baselines conducted on two different patient populations: 1) Mechanical low back pain patients with tight hip flexors (n = 10) and 2) Asymptomatic group with tight hip flexors (n = 8). Four treatments of manual FMLT were performed on the hip flexor of the two groups of patients over a two-week period. Primary outcome measures over the two-week period were 1) Maximum voluntary trunk flexor and extensor moments, 2) Disability (Roland Morris Disability Questionnaire) and pain (10-cm Visual Analogue Scale), 3) Passive hip extension mobility. Results: Primary outcome analysis involved within-groups comparisons. Maximum voluntary trunk extension demonstrated increases for the low back pain patients. The low back pain patients demonstrated a small, but significant, reduction in disability and pain. Both groups demonstrated an increase in passive hip extension measurements. Conclusion: This preliminary study demonstrated interesting results from manual FMLT on two tight hip flexor patient populations with and without low back pain. However, there were several significant limitations from this study, which restrict the ability to generalize the results. PMID:25550670

  3. Mitochondrial disease: clinical aspects, molecular mechanisms, translational science, and clinical frontiers.

    PubMed

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

    2014-09-01

    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.

  4. 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

  5. [The German Clinical Trials Register: reasons, general and technical aspects, international integration].

    PubMed

    Dreier, G; Hasselblatt, H; Antes, G; Schumacher, M

    2009-04-01

    In order to provide a central portal for information on clinical research in Germany and thus to facilitate the search of planned, ongoing and completed clinical trials, the German Clinical Trials Register (GermanCTR) was implemented in cooperation with the WHO's registries network. It is an open access online register of clinical trials conducted in Germany, which allows all users to search for, register and share information on clinical trials. The project is funded by the Federal Ministry of Education and Research and is implemented at the Institute for Medical Biometry and Medical Informatics of the University Medical Center Freiburg as a joint project of the Clinical Trials Center Freiburg and the German Cochrane Center. Since October 2008 the GermanCTR is an approved WHO Primary Registry and allows clinical trial registration in Germany according to the requirements of the International Committee of Medical Journal Editors (ICMJE). Reasons for a national trials register, general and technical aspects of implementing the GermanCTR as well as the national and international integration are described here.

  6. Release of palladium from biomechanical prostheses in body fluids can induce or support PD-specific IFNgamma T cell responses and the clinical setting of a palladium hypersensitivity.

    PubMed

    Cristaudo, A; Bordignon, V; Petrucci, F; Caimi, S; De Rocco, M; Picardo, M; Cordiali Fei, P; Ensoli, F

    2009-01-01

    The increased use of Palladium (Pd) for biomedical applications, which has more than doubled in the last ten years, appears to be associated with an increased frequency of adverse reactions to Pd. The aim of this study is to investigate the relationship between the implant of a biomechanical apparatus containing Pd and the setting of a hypersensitivity to Pd by determining the levels of the metal released in biological fluids, assessing the effects of Pd on peripheral blood mononuclear cell (PBMC) cytokine production and exploring the clinical setting of skin sensitization. Of a total of 3,093 subjects examined in 2006, sensitization to Pd alone or in association with nickel (Ni) was observed in 1.6% and 13.03% of the individuals, respectively. Of these, a group of six subjects positive to Pd and negative to Ni at patch testing were selected on the basis of the oral clinical symptoms in order to measure both the levels of Pd in biological fluids and the degradation of the dental prostheses. Specific Pd measurements were carried out on salivary fluid, urine and serum samples by High Resolution Inductively Coupled Plasma-Mass Spectrometry. In addition, the degradation of the dental prostheses was assessed by both a leaching test and an analysis of the micro morphology of orthodontic prostheses. The induction of IFN-gamma production by Pd was assessed in PBMC by the ELISpot assay. Skin sensitization to Pd was evaluated by patch testing and clinical examination. Ten healthy subjects were comparatively tested as controls. We found a specific induction of an IFN-gamma response by Pd in PBMC collected from all the subjects positive to Pd at patch testing. On the contrary, control subjects did not show any response to Pd as assessed by IFN-gamma ELISpot assay or by skin testing. Remarkably, the levels of Pd in all biological samples (saliva, sera, urine) were significantly higher in Pd-sensitized patients than in those collected from controls, reaching the highest

  7. 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.

  8. Granuloma faciale: clinical, morphological and immunohistochemical aspects in a series of 10 patients*

    PubMed Central

    Oliveira, Cristiano Claudino; Ianhez, Pedro Eugênio de Carvalho; Marques, Silvio Alencar; Marques, Mariângela Esther Alencar

    2016-01-01

    Granuloma faciale is a chronic, benign, cutaneous vasculitis with well-established clinical and morphological patterns, but with an unknown etiology. This study describes clinical and pathologic aspects of patients diagnosed with granuloma faciale. The authors analyzed demographic, clinical, morphological and immunohistochemical data from patients with a final diagnosis of granuloma faciale, confirmed between 1998 and 2012. There was a proportional and mixed inflammatory infiltrate, Grenz zones were present in almost all the samples. Immunophenotyping confirmed a higher intensity of T lymphocytes than B lymphocytes in thirteen samples, with a predominance of T CD8 lymphocytes in 64% of cases, in contrast to the literature, which indicates that the major component is T CD4 lymphocytes. All cases were positive for IgG4 but the majority (12/14) had less than 25% of stained cells. The pathogenesis of granuloma faciale remains poorly understood, making studies of morphological and immunohistochemical characterization important to better understand it. PMID:28099604

  9. Regulatory transparency: social, technical, and ethical aspects of clinical trial data access.

    PubMed

    Sousa, Varley Dias; Silveira, Dâmaris

    2015-06-01

    In the field of health regulation, enabling public access to data from clinical trials is a process currently undergoing consolidation by the principal regulators worldwide. This paper discusses recent developments in public policy regarding regulatory transparency, and the risks and benefits of a regulatory impact-analysis on clinical trial reports, from the perspective of the key stakeholders (i.e., patients, prescribers, government, society, industry, and regulators). Additionally, the social, technical, and ethical aspects of the datasharing process are highlighted, including access limits, commercially-confidential data and patent rights, privacy of research subjects, arrangements and publicity tools, and clinical trials registration. Furthermore, perspectives on improvement and expansion of regulatory transparency policies are presented, contextualizing North American, Latin American, and European experiences, and highlighting in-teragency cooperation and collaboration initiatives that aim to harmonize health programs and regulatory convergence.

  10. [Etiopathogenetic aspects and clinical implications of insulin resistance in polycystic ovary syndrome].

    PubMed

    Scarpitta, A M; Sinagra, D

    1997-06-01

    Polycystic ovary syndrome (PCOS) is a heterogeneous pathological condition characterized by a number of clinical, endocrine and pathological anatomic aspects. The heterogeneity of these factors and the variability of their presence makes it difficult to classify the syndrome and define it precisely as a separate nosographic entity. It is also difficult to position it with precision among the insulin-resistant syndromes in view of the multiple pathogenetic hypotheses that have been proposed over the years which are still the subject of numerous studies and deserve further confirmation. Data regarding beta-cell secretion in PCOS are also discordant; numerous experimental findings are therefore required to define this aspect correctly. On the basis of the most recent data reported in the international literature, the authors affirm the importance of considering this syndrome both from a purely endocrine point of view and in metabolic terms, for the therapeutic purpose of restoring hormone status and preventing, where possible, the onset of metabolic changes.

  11. Clinical and Non-Clinical Aspects of Distal Radioulnar Joint Instability

    PubMed Central

    Wijffels, MME; Brink, PRG; Schipper, IB

    2012-01-01

    Untreated distal radioulnar joint (DRUJ) injuries can give rise to long lasting complaints. Although common, diagnosis and treatment of DRUJ injuries remains a challenge. The articulating anatomy of the distal radius and ulna, among others, enables an extensive range of forearm pronosupination movements. Stabilization of this joint is provided by both intrinsic and extrinsic stabilizers and the joint capsule. These structures transmit the load and prevent the DRUJ from luxation during movement. Several clinical tests have been suggested to determine static or dynamic DRUJ stability, but their predictive value is unclear. Radiologic evaluation of DRUJ instability begins with conventional radiographs in anterioposterior and true lateral view. If not conclusive, CT-scan seems to be the best additional modality to evaluate the osseous structures. MRI has proven to be more sensitive and specific for TFCC tears, potentially causing DRUJ instability. DRUJ instability may remain asymptomatic. Symptomatic DRUJ injuries treatment can be conservative or operative. Operative treatment should consist of restoration of osseous and ligamenteous anatomy. If not successful, salvage procedures can be performed to regain stability. PMID:22675411

  12. 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

  13. [Biomechanics and aging].

    PubMed

    Struck, H J

    1991-01-01

    Starting from the physical basics of the biomechanics of connective tissues, organ structures and the corresponding age-related changes of skin, tendons, ligaments, cartilage, bones, blood vessels, and lungs are described. Finally, exogenous factors such as nutrition, hormones, immobilization, activity and adaptive mechanisms and their influence on the biomechanical properties of connective tissue are represented.

  14. 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.

  15. [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.

  16. [The role of Czech physicians in the etiology, clinical aspects and epidemiology of exanthematous typhus].

    PubMed

    Pospisil, R

    1999-11-01

    Typhus fever was a lethal disease of mankind. Elucidation of its origin and spread was due to more or less unscientific approaches at the time. Only in the second half of the 19th and at the beginning of the 20th century the period of a scientific approach to knowledge of its etiology, clinical aspects and epidemiology started. A great contribution was made in this respect by Czech doctors. The latter included Professor Hlava who made a series of experiments which were among the first which investigated the etiology of this disease. He may be therefore quite rightly included among one of the discoverers of the origin of typhus fever.

  17. 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

  18. Technical and clinical aspects of spectrometric analysis of trace elements in clinical samples.

    PubMed

    Chan, S; Gerson, B; Reitz, R E; Sadjadi, S A

    1998-12-01

    Jarvisalo as well as by Chan and Gerson. Lutz et al observed the ranges in blood shown in Table 4. We have adopted the ranges listed in Table 5 in urines of healthy, ambulatory, and community-dwelling individuals through a limited in-house study and review of literature. In conclusion, differentiation of trace element abnormalities (primary intoxication or disease versus secondary underlying disease) can be made only by utilizing results from trace element analyses in clinical specimens, medical history, and careful observation of symptoms. Repeat analysis on a second specimen collection is recommended when contamination is suspected.

  19. Biomechanics of concussion.

    PubMed

    Stemper, Brian D; Pintar, Frank A

    2014-01-01

    This report provides an overview of the biomechanics associated with mild traumatic brain injury (TBI), also known as concussion. Specifically, the role of angular acceleration in modulating concussion onset and severity is highlighted. Studies conducted and published from the 1960s to the 1980s provided initial estimates for TBI tolerance due to high rate head rotation. However, injury levels in those studies were more severe than what is considered to be concussion in the contemporary environment. Therefore, this issue deserves additional attention to provide quantitative estimates for concussive tolerance due to head rotational acceleration focusing on the types of clinical outcomes described today. Likewise, concussion in military personnel has notably increased in current conflicts due to the incorporation of improvised explosive devices and roadside bombs. Clinical evidence indicates that outcomes from concussion due to blast may be quite different from those due to head rotational acceleration. This report also provides an overview of blast concussion mechanisms and highlights some of the recent preclinical work in this area. As with head rotational acceleration, blast tolerance is necessary to understand the scope of this problem, better protect these personnel, and provide more informed return-to-duty guidelines for service members.

  20. A multiscale model for the study of cardiac biomechanics in single-ventricle surgeries: a clinical case.

    PubMed

    Meoli, Alessio; Cutrì, Elena; Krishnamurthy, Adarsh; Dubini, Gabriele; Migliavacca, Francesco; Hsia, Tain-Yen; Pennati, Giancarlo; Taylor, Andrew; Giardini, Alessandro; Khambadkone, Sachin; Schievano, Silvia; de Leval, Marc; Hsia, T-Y; Bove, Edward; Dorfman, Adam; Baker, G Hamilton; Hlavacek, Anthony; Migliavacca, Francesco; Pennati, Giancarlo; Dubini, Gabriele; Marsden, Alison; Feinstein, Jeffrey; Vignon-Clementel, Irene; Figliola, Richard; McGregor, John

    2015-04-06

    Complex congenital heart disease characterized by the underdevelopment of one ventricular chamber (single ventricle (SV) circulation) is normally treated with a three-stage surgical repair. This study aims at developing a multiscale computational framework able to couple a patient-specific three-dimensional finite-element model of the SV to a patient-specific lumped parameter (LP) model of the whole circulation, in a closed-loop fashion. A sequential approach was carried out: (i) cardiocirculatory parameters were estimated by using a fully LP model; (ii) ventricular material parameters and unloaded geometry were identified by means of the stand-alone, three-dimensional model of the SV; and (iii) the three-dimensional model of SV was coupled to the LP model of the circulation, thus closing the loop and creating a multiscale model. Once the patient-specific multiscale model was set using pre-operative clinical data, the virtual surgery was performed, and the post-operative conditions were simulated. This approach allows the analysis of local information on ventricular function as well as global parameters of the cardiovascular system. This methodology is generally applicable to patients suffering from SV disease for surgical planning at different stages of treatment. As an example, a clinical case from stage 1 to stage 2 is considered here.

  1. [Anorexia nervosa in adolescents. Clinical aspects of the diagnosis and a follow-up].

    PubMed

    Saccomani, L; Savoini, M; Naselli, A; Cirrincione, M; Matricardi, A

    1989-01-01

    In a brief review of the literature, the diagnostic, prognostic and therapeutic criteria of anorexia nervosa in adolescence are considered. An interdisciplinary approach (child neuropsychiatrists, clinical psychologists, auxological pediatricians) was adopted in 52 cases with a diagnosis of anorexia nervosa (46 females, 6 males; mean age 14). The results of the analysis of somatic disturbances (weight loss, anomalous sexual maturation), psychological aspects (cognitive level, organization of the personality), environmental implications (familial, social and school adjustment; mother-child relationship; pedagogic modalities; social and economic factors) are reported. The data from a follow-up of 29 patients (26 females, 3 males; mean age 19) are reported, and the degree of recovery assessed as follows: 1) clinical recovery at somatic-adjustment level (79% complete, 17% with atypical characteristics); 2) achievement of a harmonic organization of the personality (48%). The paper concludes with some remarks on the treatment, prognosis and prospects for prevention of the condition.

  2. 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

  3. L-carnitine in cardiogenic shock therapy: pharmacodynamic aspects and clinical data.

    PubMed

    Corbucci, G G; Loche, F

    1993-01-01

    Following our previous work on biochemical and clinical aspects of cardiogenic shock, we carried out an open study on 27 patients hospitalized in shock condition and investigated for the entire period of permanence in intensive care units (ICU). The subjects were treated with high doses of L-carnitine following previous results on the use of this molecule in conditions of oxidative damage due to acute cellular hypoxia. When compared with the data reported in the literature, the results obtained in this study show a surprisingly positive trend for the carnitine-treated patients in terms of survival rate to the cardiogenic shock. This finding and statistical analysis of the clinical parameters confirm the suggestion that L-carnitine could be credited with a new and interesting role in the therapy of cardiogenic shock.

  4. 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

    2014-01-03

    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.

  5. 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

  6. Optic nerve head biomechanics in aging and disease.

    PubMed

    Downs, J Crawford

    2015-04-01

    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.

  7. 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

  8. 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…

  9. Biomechanics and mechanobiology in functional tissue engineering

    PubMed Central

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

    2014-01-01

    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. PMID:24818797

  10. 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.

  11. Review of renal carcinoid tumor with focus on clinical and pathobiological aspects.

    PubMed

    Kuroda, N; Tanaka, A; Ohe, C; Mikami, S; Nagashima, Y; Inoue, K; Shuin, T; Taguchi, T; Tominaga, A; Alvarado-Cabrero, I; Petersson, F; Brunelli, M; Martignoni, G; Michal, M; Hes, O

    2013-01-01

    Renal carcinoid tumor is a rare neoplasm. In this article, we review this neoplasm with a focus on clinical and pathobiological aspects. The majority of patients present in the fourth to seventh decades, but there is no gender predilection. Clinically, patients with renal carcinoid tumor frequently present with abdominal, back or flank pain. This tumor is occassionally associated with horseshoe kidney and/or mature cystic teratoma located in the kidney. Macroscopically, these tumors are well demarcated with a lobulated appearance and yellow or tan-brown color cut surface. Microscopically, these tumors are composed of monomorphic round to polygonal cells with granular amphophilic to eosinophilic cytoplasm. Tumor cells are arranged in trabecular, ribbon-like, gyriform, insular, glandular and solid patterns. The nuclei are round to oval and with evenly distributed nuclear chromatin, frequently with a "salt and pepper"-pattern. Immunohistochemically, tumor cells demonstrate immuno-labeling for chromogranin A and synaptophysin. Ultrastructurally, the neoplastic cells contain abundant dense core neurosecretory granules. In previous genetic studies, abnormalities of chromosomes 3 or 13 have been reported. The clinical behavior of renal carcinoid tumors is variable, but is more indolent than most renal cell carcinomas. Further investigations are warranted in order to elucidate the critical genetic abnormalities responsible for the pathogenesis of this rare entity in renal neoplastic pathology.

  12. Bovine laminitis: clinical aspects, pathology and pathogenesis with reference to acute equine laminitis.

    PubMed

    Boosman, R; Németh, F; Gruys, E

    1991-07-01

    This review deals with the features of clinical and subclinical laminitis in cattle. Prominent clinical signs of acute laminitis are a tender gait and arched back. The sole horn reveals red and yellowish discolourations within five days. In subacute and chronic cases clinical signs are less severe. In chronic laminitis the shape of the claws is altered. Laminitis is frequently followed by sole ulceration and white zone lesions. Blood tests showed no significant changes for laminitic animals. Arteriographic studies of claws affected by laminitis indicated that blood vessels had narrowed lumens. Gross pathology revealed congestion of the corium and rotation of the distal phalanx. Histopathologic studies indicate that laminitis is associated with changes of the vasculature. Peripartum management and nutrition are important factors in its aetiology. It is hypothesised that laminitis is evoked by disturbed digital circulation. In the pathogenesis of acute laminitis three factors are considered important: the occurrence of thrombosis, haemodynamic aspects of the corium, and endotoxins which trigger these pathologic events.

  13. [Respiratory changes in obesity. Functional and clinical aspects. Study of 26 cases].

    PubMed

    Martínez Guerra, M L; Fernández Bonetti, P; Lupi Herrera, E; Rotberg, T; Elizalde, A

    1975-01-01

    A study was made, at the altitude of Mexico City, of the clinic aspects and of the pulmonary function of 26 obese subjects more than 45% overweight. This excess weight habitually produces severe disturbances in pulmonary and/or heart function. In 50% of the patients, clinic, radiologic and electrocardiographic manifestations were found which suggested the existence of pulmonary arterial hypertension. This provoked right heart failure in 19% of the cases. The most constant alterations in the pulmonary volumes was the decrease in the VER, which occurred in 96% of the cases. Most of the patients had hypoxemia (92.5), which was produced mainly by the increase in venoarterial shunts. Although the clinic manifestations were similar to those described in Pickwick's syndrome, alveolar hypoventilation was presented in only a minority of the cases. No relationship was found between the degree of obesity and alveolar hypoventilation. Altitudes of 2,200 meters or more apparently favor hypoxemia in obese patients, and "protects" them from the hypercapnea. The altitude of Mexico City may be one of the reasons why alveolar hypoventilation is observed in only 15% of the cases.

  14. 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)

  15. Periodontal disease in HIV-infected adults in the HAART era: Clinical, immunological, and microbiological aspects.

    PubMed

    Gonçalves, Lucio Souza; Gonçalves, Barbara Mulatinho Lopo; Fontes, Tatiana Vasconcellos

    2013-10-01

    The introduction of highly active antiretroviral therapy (HAART) has decreased the incidence and prevalence of several oral manifestations such as oral candidiasis, hairy leukoplakia, and Kaposi's sarcoma in HIV-infected patients. Regarding periodontal disease the findings are not clear. This disease represents a group of chronic oral diseases characterized by infection and inflammation of the periodontal tissues. These tissues surround the teeth and provide periodontal protection (the gingival tissue) and periodontal support (periodontal ligament, root cementum, alveolar bone). Clinical, immunological, and microbiological aspects of these diseases, such as linear gingival erythema (LGE), necrotizing periodontal diseases (NPD) (necrotizing ulcerative gingivitis [NUG], necrotizing ulcerative periodontitis [NUP] and necrotizing stomatitis), and chronic periodontitis, have been widely studied in HIV-infected individuals, but without providing conclusive results. The purpose of this review was to contribute to a better overall understanding of the probable impact of HIV-infection on the characteristics of periodontal infections.

  16. 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

  17. 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.

  18. 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.

  19. Clinical and economic aspects of sevelamer therapy in end-stage renal disease patients.

    PubMed

    Ossareh, Shahrzad

    2014-01-01

    Phosphate control is still a great challenge in chronic kidney disease (CKD), and in spite of the great improvements in dialysis techniques, achievement of the goals for mineral metabolism control is still far from ideal. Aluminum hydroxide has been largely abandoned due to the high risk of aluminum toxicity, while the use of calcium-based phosphate binders may cause hypercalcemia, overzealous parathyroid suppression, and extraskeletal calcification. Sevelamer hydrochloride has been introduced as an efficient medication for phosphate control, with a lower risk of hypercalcemia and parathyroid suppression. Various clinical trials have compared the risk of vascular calcification between sevelamer and calcium salts with inconsistent results. In spite of these inconsistencies, the Kidney Disease Outcomes Quality Initiative (KDOQI) suggests non-calcium phosphate binders as the preferred phosphate binder in dialysis patients with severe vascular and/or other soft-tissue calcifications and in those with hypercalcemia or parathyroid hormone (PTH) <150 mg/dL. The Kidney Disease Improving Global Outcome (KDIGO) limits the use of non-calcium phosphate binders to patients with hypercalcemia. Regarding the effect on mortality, the results of clinical trials are again inconsistent. The other important aspect of using sevelamer is the issue of price, which is substantially higher than calcium-based phosphate binders. Reviewing the studies on economic aspects shows that sevelamer increases quality-adjusted life-years (QALY) and possibly life years, with a higher cost compared to calcium-based phosphate binders. In conclusion, sevelamer is a very useful drug for phosphate control, reduction of hypercalcemia, and lessening the risk of adynamic bone disease, with probable reduction in vascular calcification and possible reduction in mortality rate. It has a higher economic burden on health care systems compared to calcium-based phosphate binders. This may affect its extensive use

  20. Comparative Analysis between Total Disc Replacement and Posterior Foraminotomy for Posterolateral Soft Disc Herniation with Unilateral Radiculopathy : Clinical and Biomechanical Results of a Minimum 5 Years Follow-up

    PubMed Central

    Kim, Kyoung-Tae; Cho, Dae-Chul; Sung, Joo-Kyung; Kim, Young-Baeg; Kim, Du Hwan

    2017-01-01

    Objective To compare the clinical outcomes and biomechanical effects of total disc replacement (TDR) and posterior cervical foraminotomy (PCF) and to propose relative inclusion criteria. Methods Thirty-five patients who underwent surgery between 2006 and 2008 were included. All patients had single-level disease and only radiculopathy. The overall sagittal balance and angle and height of a functional segmental unit (FSU; upper and lower vertebral body of the operative lesion) were assessed by preoperative and follow-up radiographs. C2–7 range of motion (ROM), FSU, and the adjacent segment were also checked. Results The clinical outcome of TDR (group A) was tended to be superior to that of PCF (group B) without statistical significance. In the group A, preoperative and postoperative upper adjacent segment level motion values were 8.6±2.3 and 8.4±2.0, and lower level motion values were 8.4±2.2 and 8.3±1.9. Preoperative and postoperative FSU heights were 37.0±2.1 and 37.1±1.8. In the group B, upper level adjacent segment motion values were 8.1±2.6 and 8.2±2.8, and lower level motion values were 6.5±3.3 and 6.3±3.1. FSU heights were 37.1±2.0 and 36.2±1.8. The postoperative FSU motion and height changes were significant (p<0.05). The patient’s satisfaction rates for surgery were 88.2% in group A and 88.8% in group B. Conclusion TDR and PCF have favorable outcomes in patients with unilateral soft disc herniation. However, patients have different biomechanical backgrounds, so the patient’s biomechanical characteristics and economic status should be understood and treated using the optimal procedure. PMID:28061490

  1. Clinical, Microbial, and Biochemical Aspects of the Exfoliative Toxins Causing Staphylococcal Scalded-Skin Syndrome

    PubMed Central

    Ladhani, Shamez; Joannou, Christopher L.; Lochrie, Denise P.; Evans, Robert W.; Poston, Susan M.

    1999-01-01

    The exfoliative (epidermolytic) toxins of Staphylococcus aureus are the causative agents of the staphylococcal scalded-skin syndrome (SSSS), a blistering skin disorder that predominantly affects children. Clinical features of SSSS vary along a spectrum, ranging from a few localized blisters to generalized exfoliation covering almost the entire body. The toxins act specifically at the zona granulosa of the epidermis to produce the characteristic exfoliation, although the mechanism by which this is achieved is still poorly understood. Despite the availability of antibiotics, SSSS carries a significant mortality rate, particularly among neonates with secondary complications of epidermal loss and among adults with underlying diseases. The aim of this article is to provide a comprehensive review of the literature spanning more than a century and to cover all aspects of the disease. The epidemiology, clinical features, potential complications, risk factors, susceptibility, diagnosis, differential diagnoses, investigations currently available, treatment options, and preventive measures are all discussed in detail. Recent crystallographic data on the toxins has provided us with a clearer and more defined approach to studying the disease. Understanding their mode of action has important implications in future treatment and prevention of SSSS and other diseases, and knowledge of their specific site of action may provide a useful tool for physiologists, dermatologists, and pharmacologists. PMID:10194458

  2. 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.

  3. Correlation between classification in risk categories and clinical aspects and outcomes 1

    PubMed Central

    Oliveira, Gabriella Novelli; Vancini-Campanharo, Cássia Regina; Lopes, Maria Carolina Barbosa Teixeira; Barbosa, Dulce Aparecida; Okuno, Meiry Fernanda Pinto; Batista, Ruth Ester Assayag

    2016-01-01

    ABSTRACT Objective: to correlate classification in risk categories with the clinical profiles, outcomes and origins of patients. Method: analytical cross-sectional study conducted with 697 medical forms of adult patients. The variables included: age, sex, origin, signs and symptoms, exams, personal antecedents, classification in risk categories, medical specialties, and outcome. The Chi-square and likelihood ratio tests were used to associate classifications in risk categories with origin, signs and symptoms, exams, personal antecedents, medical specialty, and outcome. Results: most patients were women with an average age of 44.5 years. Pain and dyspnea were the symptoms most frequently reported while hypertension and diabetes mellitus were the most common comorbidities. Classifications in the green and yellow categories were the most frequent and hospital discharge the most common outcome. Patients classified in the red category presented the highest percentage of ambulance origin due to surgical reasons. Those classified in the orange and red categories also presented the highest percentage of hospitalization and death. Conclusion: correlation between clinical aspects and outcomes indicate there is a relationship between the complexity of components in the categories with greater severity, evidenced by the highest percentage of hospitalization and death. PMID:27982310

  4. Retinal blinding disorders and gene therapy--molecular and clinical aspects.

    PubMed

    Lorenz, Birgit; Preising, Markus; Stieger, Knut

    2010-10-01

    Retinal blinding disorders together have a prevalence of 1 in 2000 humans world wide and represent a significant impact on the quality of life as well as the possibility to attain personal achievements. Mutations in genes that are expressed either in RPE cells, photoreceptors or bipolar cells can cause varying forms of degenerative or stationary retinal disorders, as the presence of the encoded proteins is crucial for normal function, maintenance and synaptic interaction. The degree of damage caused by different mutations depends upon the type of mutation within the gene, resulting in either total absence or the presence of a non-functional or potentially toxic protein. Potential treatment strategies require the identification of the cell type, in which the mutated gene is expressed for later targeting by viral vector mediated gene transfer. In the first part of this review, the authors present different cellular pathways that take place either in the RPE, photoreceptors, or bipolar cells. Furthermore, the authors demonstrate why genetic and molecular testing methods, which clearly identify the disease causing mutations, are crucial for attaining the correct diagnosis in order to identify patients suitable to be treated by upcoming new therapeutic methods. In the second part, a short clinical classification of the most important forms of retinal blinding disorders is given, together with clinical aspects concerning the problems that arise when facing low residual visual perception and the enormous heterogeneity of symptoms within these disorders.

  5. 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.

  6. miRNA assays in the clinical laboratory: workflow, detection technologies and automation aspects.

    PubMed

    Kappel, Andreas; Keller, Andreas

    2017-05-01

    microRNAs (miRNAs) are short non-coding RNA molecules that regulate gene expression in eukaryotes. Their differential abundance is indicative or even causative for a variety of pathological processes including cancer or cardiovascular disorders. Due to their important biological function, miRNAs represent a promising class of novel biomarkers that may be used to diagnose life-threatening diseases, and to monitor disease progression. Further, they may guide treatment selection or dosage of drugs. miRNAs from blood or derived fractions are particularly interesting candidates for routine laboratory applications, as they can be measured in most clinical laboratories already today. This assures a good accessibility of respective tests. Albeit their great potential, miRNA-based diagnostic tests have not made their way yet into the clinical routine, and hence no standardized workflows have been established to measure miRNAs for patients' benefit. In this review we summarize the detection technologies and workflow options that exist to measure miRNAs, and we describe the advantages and disadvantages of each of these options. Moreover, we also provide a perspective on data analysis aspects that are vital for translation of raw data into actionable diagnostic test results.

  7. Generalized Glucocorticoid Resistance: Clinical Aspects, Molecular Mechanisms, and Implications of a Rare Genetic Disorder

    PubMed Central

    Charmandari, Evangelia; Kino, Tomoshige; Ichijo, Takamasa; Chrousos, George P.

    2008-01-01

    Context: Primary generalized glucocorticoid resistance is a rare genetic condition characterized by generalized, partial, target-tissue insensitivity to glucocorticoids. We review the clinical aspects, molecular mechanisms, and implications of this disorder. Evidence Acquisition: We conducted a systematic review of the published, peer-reviewed medical literature using MEDLINE (1975 through February 2008) to identify original articles and reviews on this topic. Evidence Synthesis: We have relied on the experience of a number of experts in the field, including our extensive personal experience. Conclusions: The clinical spectrum of primary generalized glucocorticoid resistance is broad, ranging from asymptomatic to severe cases of hyperandrogenism, fatigue, and/or mineralocorticoid excess. The molecular basis of the condition has been ascribed to mutations in the human glucocorticoid receptor (hGR) gene, which impair glucocorticoid signal transduction and reduce tissue sensitivity to glucocorticoids. A consequent increase in the activity of the hypothalamic-pituitary-adrenal axis compensates for the reduced sensitivity of peripheral tissues to glucocorticoids at the expense of ACTH hypersecretion-related pathology. The study of functional defects of natural hGR mutants enhances our understanding of the molecular mechanisms of hGR action and highlights the importance of integrated cellular and molecular signaling mechanisms for maintaining homeostasis and preserving normal physiology. PMID:18319312

  8. [The current aspects of the computed tomographic and clinical diagnosis of degenerative changes in the spine of flight personnel].

    PubMed

    Vasil'ev, A Iu; Martynenko, M V; Martynenko, A V; Aleksakhina, T Iu

    1995-01-01

    The paper deals with the modern aspects of the computed tomographic and clinical diagnostics of the degenerative changes in the vertebral column of the pilots. There has been elaborated the classification of degenerative changes with consideration of the present-day requirements of clinical diagnostics and medical examination. The more frequently seen damages of intervertebral disks in the pilots in the form of protrusions and prolapses are indicated, the computed tomographic and clinical characteristics are compared.

  9. 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

  10. Biomechanics of slips.

    PubMed

    Redfern, M S; Cham, R; Gielo-Perczak, K; Grönqvist, R; Hirvonen, M; Lanshammar, H; Marpet, M; Pai, C Y; Powers, C

    2001-10-20

    The biomechanics of slips are an important component in the prevention of fall-related injuries. The purpose of this paper is to review the available literature on the biomechanics of gait relevant to slips. This knowledge can be used to develop slip resistance testing methodologies and to determine critical differences in human behaviour between slips leading to recovery and those resulting in falls. Ground reaction forces at the shoe-floor interface have been extensively studied and are probably the most critical biomechanical factor in slips. The ratio of the shear to normal foot forces generated during gait, known as the required coefficient of friction (RCOF) during normal locomotion on dry surfaces or 'friction used/achievable' during slips, has been one biomechanical variable most closely associated with the measured frictional properties of the shoe/floor interface (usually the coefficient of friction or COF). Other biomechanical factors that also play an important role are the kinematics of the foot at heel contact and human responses to slipping perturbations, often evident in the moments generated at the lower extremity joints and postural adaptations. In addition, it must be realized that the biomechanics are dependent upon the capabilities of the postural control system, the mental set of the individual, and the perception of the environment, particularly, the danger of slipping. The focus of this paper is to review what is known regarding the kinematics and kinetics of walking on surfaces under a variety of environmental conditions. Finally, we discuss future biomechanical research needs to help to improve walkway-friction measurements and safety.

  11. 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…

  12. 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.

  13. [Methodological aspects of clinical and economic impact of vaccine interventions and HTA. Focus on HPV vaccination].

    PubMed

    Ricciardi, W; Dirodi, B; Bonanni, P; Capri, S; Castiglia, P; Gabutti, G; Gasparini, R; Giorgi Rossi, P; Grilli, G; La Torre, G

    2011-01-01

    The aim of the present study is to analyze the methodological and technical aspects of Health Technology Assessment (HTA) as a tool for the clinical and economic impact of vaccine interventions, describe and comment the main studies at the national level, with a particular focus on HPV vaccination. The work was conducted in 3 phases: a) revision of the scientific literature, strictly linked to methodologies adopted in different studies on economic evaluations on HPV vaccines and analysis of Guidelines for building models for the economic assessment; b) analysis of the peculiarities and critical elements of economic evaluations in the field of vaccinology, from the clinical and epidemiological point of view, as well as the recognition of lack of knowledge on HPV infection dynamics; c) a comparative analysis of the two italian studies and of the results coming from them. Many differences between studies were found. Nevertheless, there is a general agreement on the economic profile of HPV vaccination for adolescent girls, if compared with the actual practice on the prevention of cervical carcinoma (pap-test screening). All the models showed a significant impact in terms of reduction of the incidence of cervical carcinoma and related mortality, in the long run, as well as a reduction of pre-cancer lesions and abnormal Pap tests. HTA approach has been recently recognized as a tool for decision making in vaccinology, and its methodologies and procedures are currently debated by public health experts. There is a strong need to continue the work in improving the model techniques of economic evaluations concerning HPV vaccination, as well as the adoption of homogeneous methods and standards, with the aim of helping the decision process in the field of Public Health.

  14. Endemic Lassa fever in Liberia. I. Clinical and epidemiological aspects at Curran Lutheran Hospital, Zorzor, Liberia.

    PubMed

    Monson, M H; Frame, J D; Jahrling, P B; Alexander, K

    1984-01-01

    In a study to assess the epidemiological and clinical aspects of endemic Lassa fever (LF) in Liberia at Curran Lutheran Hospital (CLH), 44 cases were diagnosed by virological and serological techniques over a 22-month period. During one calendar month, testing of febrile patients admitted to the medical-surgical ward revealed six cases of LF, 13% of all febrile cases and 17% of those who were tested. As the study progressed the diagnostic skills of the hospital staff improved. The most common mistake was the diagnosis of a case of LF as pneumonia; the most potentially serious diagnostic problem was differentiating LF from typhoid fever, a readily treatable infection. LF may also mimic other diseases such as aseptic meningitis, pelvic inflammatory disease, gastroenteritis or arbovirus infection. We found a previously unreported symptom of LF, rib tenderness typical of costochondritis. The mortality rate in the medical-surgical ward was 5.4%; the over-all case-fatality rate was 13.6%. Women outnumbered men by nearly three to one, and had a higher mortality particularly noted in the pregnant. LF is common at CLH, and as many as 100 cases may occur annually at this hospital.

  15. Cardiac Alpha1-Adrenergic Receptors: Novel Aspects of Expression, Signaling Mechanisms, Physiologic Function, and Clinical Importance

    PubMed Central

    O’Connell, Timothy D.; Jensen, Brian C.; Baker, Anthony J.

    2014-01-01

    Adrenergic receptors (AR) are G-protein-coupled receptors (GPCRs) that have a crucial role in cardiac physiology in health and disease. Alpha1-ARs signal through Gαq, and signaling through Gq, for example, by endothelin and angiotensin receptors, is thought to be detrimental to the heart. In contrast, cardiac alpha1-ARs mediate important protective and adaptive functions in the heart, although alpha1-ARs are only a minor fraction of total cardiac ARs. Cardiac alpha1-ARs activate pleiotropic downstream signaling to prevent pathologic remodeling in heart failure. Mechanisms defined in animal and cell models include activation of adaptive hypertrophy, prevention of cardiac myocyte death, augmentation of contractility, and induction of ischemic preconditioning. Surprisingly, at the molecular level, alpha1-ARs localize to and signal at the nucleus in cardiac myocytes, and, unlike most GPCRs, activate “inside-out” signaling to cause cardioprotection. Contrary to past opinion, human cardiac alpha1-AR expression is similar to that in the mouse, where alpha1-AR effects are seen most convincingly in knockout models. Human clinical studies show that alpha1-blockade worsens heart failure in hypertension and does not improve outcomes in heart failure, implying a cardioprotective role for human alpha1-ARs. In summary, these findings identify novel functional and mechanistic aspects of cardiac alpha1-AR function and suggest that activation of cardiac alpha1-AR might be a viable therapeutic strategy in heart failure. PMID:24368739

  16. 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.

  17. 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

  18. Rare hereditary red blood cell enzymopathies associated with hemolytic anemia - pathophysiology, clinical aspects, and laboratory diagnosis.

    PubMed

    Koralkova, P; van Solinge, W W; van Wijk, R

    2014-06-01

    Hereditary red blood cell enzymopathies are genetic disorders affecting genes encoding red blood cell enzymes. They cause a specific type of anemia designated hereditary nonspherocytic hemolytic anemia (HNSHA). Enzymopathies affect cellular metabolism, which, in the red cell, mainly consists of anaerobic glycolysis, the hexose monophosphate shunt, glutathione metabolism, and nucleotide metabolism. Enzymopathies are commonly associated with normocytic normochromic hemolytic anemia. In contrast to other hereditary red cell disorders such as membrane disorders or hemoglobinopathies, the morphology of the red blood cell shows no specific abnormalities. Diagnosis is based on detection of reduced specific enzyme activity and molecular characterization of the defect on the DNA level. The most common enzyme disorders are deficiencies of glucose-6-phosphate dehydrogenase (G6PD) and pyruvate kinase (PK). However, there are a number of other enzyme disorders, often much less known, causing HNSHA. These disorders are rare and often underdiagnosed, and the purpose of this review. In this brief review, we provide an overview of clinically relevant enzymes, their function in red cell metabolism, and key aspects of laboratory diagnosis.

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

    PubMed

    Ghavidel-Parsa, Banafsheh; Bidari, Ali; Amir Maafi, Alireza; Ghalebaghi, Babak

    2015-07-01

    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.

  20. 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

  1. Nannizziopsis guarroi infection in 2 Inland Bearded Dragons (Pogona vitticeps): clinical, cytologic, histologic, and ultrastructural aspects.

    PubMed

    Le Donne, Viviana; Crossland, Nicholas; Brandão, João; Sokolova, Yuliya; Fowlkes, Natalie; Nevarez, Javier G; Langohr, Ingeborg M; Gaunt, Stephen D

    2016-06-01

    Chrysosporium-related infections have been increasingly reported in reptiles over the last 2 decades. In this report, we describe clinical, cytologic, histopathologic, and ultrastructural aspects of Chrysosporium-related infection in 2 Inland Bearded Dragons (Pogona vitticeps). Case 1 was presented for an enlarging raised lesion over the left eye and multiple additional masses over the dorsum. Case 2 was submitted to necropsy by the referring veterinarian for suspected yellow fungus disease. Impression smears of the nodules in case 1 revealed granulomatous to pyogranulomatous inflammation and many septate, variably long, 4-10 μm wide, often undulated hyphae, and very rare conidia. Postmortem impression smears of the superficial lesions of case 2 contained large numbers of solitary conidia and arthroconidia and low numbers of hyphae with similar morphology to case 1. Histopathology of the 2 cases revealed severe, multifocal, chronic, ulcerative, nodular pyogranulomatous dermatitis, with myriad intralesional septate hyphae, and arthroconidia. Fungal culture and molecular sequencing in both cases indicated infection with Nannizziopsis guarroi.

  2. The Influence of Acetyl Salicylic Acid (Aspirin) and Acetaminophen on Clinical and Histologic Aspects of Orthodontic Tooth Movement

    DTIC Science & Technology

    1988-05-01

    of this lipid family. :., t z, , understood but has neverthele’s Iej t,.. ,I nI,-al ramifications. 6f particular !ntor; ,’Jrr.ly I orthodontic ...inhibitors, on clinical and histologic aspects of orthodontic tooth movement. Clinical and histologic results revealed no statistical differences among...against the use of prostaglandin inhibitors for the relief of orthodontic discomfort. However, this study did not produce evidence to contraindicate

  3. 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

  4. Mothering: An Unacknowledged Aspect of Undergraduate Clinical Teachers' Work in Nursing

    ERIC Educational Resources Information Center

    McKenna, Lisa; Wellard, Sally

    2009-01-01

    Clinical education is an important component of undergraduate nurse education, in which clinical teachers facilitate students' application of theoretical classroom knowledge into the clinical practice setting. Mothering as part of clinical teachers' work was a major finding from a larger study exploring clinical teaching work to identify what…

  5. 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.

  6. 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.

  7. 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

  8. A biomechanical perspective on bone quality

    PubMed Central

    Hernandez, C.J.; Keaveny, T.M

    2007-01-01

    Observations that dual-energy x-ray absorptiometry (DXA) measures of areal bone mineral density cannot completely explain fracture incidence after anti-resorptive treatment have led to renewed interest in bone quality. Bone quality is a vague term, but generally refers to the effects of skeletal factors that contribute to bone strength but are not accounted for by measures of bone mass. Since a clinical fracture is ultimately a mechanical event, it follows then that any clinically relevant modification of bone quality must change bone biomechanical performance relative to bone mass. In this perspective, we discuss a framework for assessing the clinically relevant effects of bone quality based on two general concepts: 1) the biomechanical effects of bone quality can be quantified from analysis of the relationship between bone mechanical performance and bone density; and 2) because of its hierarchical nature, biomechanical testing of bone at different physical scales (<1mm, 1mm, 1 cm, etc.) can be used to isolate the scale at which the most clinically relevant changes in bone quality occur. As an example, we review data regarding the relationship between the strength and density in excised specimens of trabecular bone and highlight the fact that it is not yet clear how this relationship changes during aging, osteoporosis development, and anti-resorptive treatment. Further study of new and existing data using this framework should provide insight into the role of bone quality in osteoporotic fracture risk. PMID:16876493

  9. 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

  10. 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

  11. 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

  12. Biomechanics of Rowing

    NASA Astrophysics Data System (ADS)

    Hase, Kazunori; Andrews, Brian J.; Zavatsky, Amy B.; Halliday, Suzanne E.

    A new control model for the study of biomechanical simulation of human movement was investigated using rowing as an example. The objectives were to explore biological and mechanical alternatives to optimal control methods. The simulation methods included simple control mechanisms based on proportional and derivative (PD) control, consideration of a simple neural model, introduction of an inverse dynamics system for feedback, and computational adjustment of control parameters by using an evaluative criterion and optimization method. By using simulation, appropriate rowing motions were synthesized. The generated rowing motion was periodic, continuous, and adaptable so that the pattern was stable against the mechanical force and independent of the initial condition. We believe that the simulation model is not only practical as a computational research tool from a biomechanical-engineering viewpoint but also significant from the point of view of fundamental biological theories of movement.

  13. 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.

  14. 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

  15. The Impact of Biomechanics in Tissue Engineering and Regenerative Medicine

    PubMed Central

    Butler, David L.; Goldstein, Steven A.; Guo, X. Edward; Kamm, Roger; Laurencin, Cato T.; McIntire, Larry V.; Mow, Van C.; Nerem, Robert M.; Sah, Robert L.; Soslowsky, Louis J.; Spilker, Robert L.; Tranquillo, Robert T.

    2009-01-01

    Biomechanical factors profoundly influence the processes of tissue growth, development, maintenance, degeneration, and repair. Regenerative strategies to restore damaged or diseased tissues in vivo and create living tissue replacements in vitro have recently begun to harness advances in understanding of how cells and tissues sense and adapt to their mechanical environment. It is clear that biomechanical considerations will be fundamental to the successful development of clinical therapies based on principles of tissue engineering and regenerative medicine for a broad range of musculoskeletal, cardiovascular, craniofacial, skin, urinary, and neural tissues. Biomechanical stimuli may in fact hold the key to producing regenerated tissues with high strength and endurance. However, many challenges remain, particularly for tissues that function within complex and demanding mechanical environments in vivo. This paper reviews the present role and potential impact of experimental and computational biomechanics in engineering functional tissues using several illustrative examples of past successes and future grand challenges. PMID:19583462

  16. Gait biomechanics in the era of data science.

    PubMed

    Ferber, Reed; Osis, Sean T; Hicks, Jennifer L; Delp, Scott L

    2016-12-08

    Data science has transformed fields such as computer vision and economics. The ability of modern data science methods to extract insights from large, complex, heterogeneous, and noisy datasets is beginning to provide a powerful complement to the traditional approaches of experimental motion capture and biomechanical modeling. The purpose of this article is to provide a perspective on how data science methods can be incorporated into our field to advance our understanding of gait biomechanics and improve treatment planning procedures. We provide examples of how data science approaches have been applied to biomechanical data. We then discuss the challenges that remain for effectively using data science approaches in clinical gait analysis and gait biomechanics research, including the need for new tools, better infrastructure and incentives for sharing data, and education across the disciplines of biomechanics and data science. By addressing these challenges, we can revolutionize treatment planning and biomechanics research by capitalizing on the wealth of knowledge gained by gait researchers over the past decades and the vast, but often siloed, data that are collected in clinical and research laboratories around the world.

  17. 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…

  18. Developmental dysplasia of the hip: A computational biomechanical model of the path of least energy for closed reduction.

    PubMed

    Zwawi, Mohammed A; Moslehy, Faissal A; Rose, Christopher; Huayamave, Victor; Kassab, Alain J; Divo, Eduardo; Jones, Brendan J; Price, Charles T

    2016-10-20

    This study utilized a computational biomechanical model and applied the least energy path principle to investigate two pathways for closed reduction of high grade infantile hip dislocation. The principle of least energy when applied to moving the femoral head from an initial to a final position considers all possible paths that connect them and identifies the path of least resistance. Clinical reports of severe hip dysplasia have concluded that reduction of the femoral head into the acetabulum may occur by a direct pathway over the posterior rim of the acetabulum when using the Pavlik harness, or by an indirect pathway with reduction through the acetabular notch when using the modified Hoffman-Daimler method. This computational study also compared the energy requirements for both pathways. The anatomical and muscular aspects of the model were derived using a combination of MRI and OpenSim data. Results of this study indicate that the path of least energy closely approximates the indirect pathway of the modified Hoffman-Daimler method. The direct pathway over the posterior rim of the acetabulum required more energy for reduction. This biomechanical analysis confirms the clinical observations of the two pathways for closed reduction of severe hip dysplasia. The path of least energy closely approximated the modified Hoffman-Daimler method. Further study of the modified Hoffman-Daimler method for reduction of severe hip dysplasia may be warranted based on this computational biomechanical analysis. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

  19. Cytotoxicity, histopathological, microbiological and clinical aspects of an endodontic iodoform-based paste used in pediatric dentistry: a review.

    PubMed

    Cerqueira, Daniella Ferraz; Mello-Moura, Anna Carolina Volpi; Santos, Elaine Marcílio; Guedes-Pinto, Antonio Carlos

    2008-01-01

    This review aims at describing and comparing materials commonly used in root canal therapy, the cytotoxicity, histopathological, microbiological and clinical aspects ofa iodoform-based paste (Guedes-Pinto Paste-GPP) used in endodontic treatment of primary teeth. GPP has shown excellent biocompatibility to pulp fibroblasts and mild inflammatory reactions, having been well-tolerated by the periapical and connective tissues. Moreover, GPP bactericidal and bacteriostatic effects against many oral microorganisms were also demonstrated. Regarding clinical trials, the GPP technique has achieved success rates when considering clinical and radiographic examinations. In the face of all the above mentioned results, this paper would like to propose the use of this endodontic material as a root canal filling for primary teeth.

  20. 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.

  1. 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

  2. Correlates of Faculty and Student Attitudes toward Evaluation in Behavioral Aspects of Clinical Practice.

    ERIC Educational Resources Information Center

    Cohen, Leonard; And Others

    1983-01-01

    Current attitudes of students and faculty toward incorporation of behavioral skills such as patient management, patient motivation, control of patient and dentist stress, and communication skills into clinical practice education are reported. (MSE)

  3. Longitudinal PBL in Undergraduate Medical Education Develops Lifelong-Learning Habits and Clinical Competencies in Social Aspects.

    PubMed

    Okubo, Yumiko; Matsushita, Susumu; Takakuwa, Yuichi; Yoshioka, Toshimasa; Nitta, Kosaku

    2016-01-01

    Problem-based learning (PBL) is popular in medical education in Japan. We wished to understand the influence of PBL on the clinical competence of medical residents, using self-assessment and observer assessment. Tokyo Women's Medical University (TWMU) implemented PBL longitudinally (long-time) for four years, and on this basis we analyzed whether long-time PBL education is useful for clinical work. A self-assessment questionnaire was sent to junior and senior residents who were alumni of several schools, and an observation-based assessment questionnaire to senior doctors instructing them. Respondents were asked if they had used the PBL process in daily clinical tasks, and if so in what processes. Senior doctors were asked whether TWMU graduates perform differently from graduates of other schools. TWMU graduates answered "used a lot" and "used a little" with regard to PBL at significantly higher rates than other graduates. As useful points of PBL, they mentioned extracting clinical problems, solving clinical problems, self-directed leaning, positive attitude, collaboration with others, presentation, doctor-patient relations, self-assessment, and share the knowledge with doctors at lower levels and students. Observer assessments of TWMU graduates by senior doctors represented them as adaptive, good at presenting, good at listening to others' opinions, practical, selfish, and eager in their instructional practice. Longitudinal PBL can be a good educational method to develop lifelong-learning habits and clinical competencies especially in terms of the social aspect.

  4. Biomechanical constraints and optimal posture of a human operator

    SciTech Connect

    Riffard, V.; Chedmail, P.

    1995-12-31

    In complex mechanical systems, an important feature of concurrent engineering is to take into account the operators accessibility for assembly operations and maintenance checking in the earliest phases of assembly design. Accessibility can be viewed from geometric and biomechanical points of view. The first one was described in a previous paper. The object of this paper is to integrate the biomechanical aspects of finding optimal postures of a human operator in an encumbered environment. Research on mechanical modeling of human operators deals with (1) geometric and kinematics models; (2) inertial characterizations; (3) static and muscular efforts; and (4) human-gesture characterization.

  5. 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

  6. 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.

  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. Range of indications for translucent zirconia modifications: clinical and technical aspects.

    PubMed

    Rinke, Sven; Fischer, Carsten

    2013-01-01

    Translucent zirconia modifications offer esthetic improvement for manually veneered zirconia structures, as they do not lead to a shining through of the substructure material, even in cases with a pronounced anatomic core design for maximum support of the veneering ceramics. Moreover, these zirconia modifications allow the production of fully anatomic zirconia crowns and fixed dental prostheses in the posterior region. The clinical advantage of these restorations is defined by a significantly reduced material thickness in comparison with veneered restorations or other monolithic materials. As the restoration can be colored individually prior to sintering, followed by characterization by staining, good esthetic results in the posterior region are achieved, even in cases with substantially reduced space. The results of laboratory studies performed so far seem to justify the clinical application of fully anatomic restorations. However, additional clinical studies are required to support these new material modifications.

  9. The Epidemiological, Morphological, and Clinical Aspects of the Cervical Ribs in Humans

    PubMed Central

    Spadliński, Łukasz; Cecot, Tomasz; Majos, Agata; Stefańczyk, Ludomir; Pietruszewska, Wioletta; Wysiadecki, Grzegorz; Topol, Mirosław

    2016-01-01

    A familiarity with the anatomy of some types of bone anomalies is necessary for clinicians involved in many medical areas. The aim of this paper is to review the newest literature concerning the morphology, embryology, clinical image, and therapeutic methods of the cervical ribs in the humans. The incidence of cervical ribs has been found to vary from 0.58% in Malaysian population to 6.2% in Turkish population. Cervical ribs have clinical implications that are generally divided into neurological or vascular. This study is of particular importance for clinicians, as early identification of cervical ribs may prevent life-threatening complications. PMID:27975060

  10. CLINICAL AND PARACLINICAL ASPECTS OF EBSTEIN'S ANOMALY--SEVERE FORM IN NEWBORNS.

    PubMed

    Iordache, C; Holoc, Andreea-Simona; Luca, Alina Costina

    2015-01-01

    Ebstein's anomaly is a rare heart malformation, with a broad spectrum of anatomic abnormalities, leading to different clinical, electrocardiographic, echocardiographic changes and a reserved prognosis. We have described a case of an infant diagnosed with Ebstein's anomaly--a severe form.

  11. [Swiss scrapie surveillance. I. Clinical aspects of neurological diseases in sheep and goats].

    PubMed

    Maurer, E; Botteron, C; Ehrensperger, F; Fatzer, R; Jaggy, A; Kolly, C; Meylan, M; Zurbriggen, A; Doherr, M G

    2005-10-01

    Small ruminants infected with scrapie show a large range of often unspecific clinical symptoms. The most-often described signs, locomotion, sensibility and behavioural disorders and emaciation, rarely occur together, and cases have been described in which only one of those signs was detectable.Thus, formulating a well-circumscribed definition of a clinical suspect case is difficult. Most animals with CNS-effecting diseases such as listeriosis, polioencephalomacia, cerebrospinal nematidiasis and enterotoxemia will, in a thorough neurological examination, show at least some scrapie-like symptoms. Among the 22 neurological field cases examined in this study, a goat with cerebral gliomatosis and hair lice showed the closest similarity to clinical scrapie. The unilateral deficiency of the cerebral nerves has potential as an clinical exclusion criterion for scrapie. However, the laboratory confirmation--or exclusion--of scrapie remains important. It thus needs to be realized that a consistent and thorough examination of neurologically diseased small ruminants (including fallen stock) is the backbone of a good surveillance system for these diseases. This should be a motivation for submitting adult sheep and goats for neuropathological examination.

  12. Cyberdermatoethics I: ethical, legal, technologic, and clinical aspects of patient-physician e-mail.

    PubMed

    Luo, John; Logan, Christopher; Long, Thomas P; Bercovitch, Lionel

    2009-01-01

    As Internet access has become ubiquitous, electronic mail (e-mail) is becoming more widely used as a means of communication between patient and dermatologist. Dealing with the ethical, legal, and clinical consequences has lagged behind the technology. Privacy of e-mail cannot exist without security, and as a foundation for understanding e-mail security, the elements of e-mail technology are reviewed. One of the greatest risks of e-mail is compromise of privacy. Although self-documenting and convenient, e-mail lacks the emotional cues of face-to-face encounters, is asynchronous and not always read in timely fashion, and is not suitable for certain clinical concerns such as urgent matters and cancer diagnoses. Legal issues relating to federal privacy regulations, ethical issues such as autonomy and justice, and guidelines for the use of e-mail in clinical practice are reviewed. Case scenarios are used to present the pitfalls in clinical e-mail encounters, including establishment of the doctor-patient relationship, diagnosis and treatment over the Internet, and curbside consultations.

  13. Clinical and Neurophysiological Aspects of Epilepsy in Subjects with Autism and Mental Retardation.

    ERIC Educational Resources Information Center

    Elia, M.; And Others

    1995-01-01

    Clinical and neurophysiological findings for 28 patients (mean age 15 years) with mental retardation, autism, and epilepsy were described, including classification of seizure type and epileptic syndrome, etiology, severity of autism and epilepsy, electroencephalography findings, and neuroimaging findings. No particular epileptic syndrome…

  14. [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.

  15. Clinical variants of Guillain-Barre syndrome: some aspects of differential diagnosis.

    PubMed

    Dididze, M N

    2009-01-01

    Acute Inflammatory Demyelinating Polyneuropathy--Guillain-Barre syndrome (GBS) affects spinal roots, peripheral and cranial nerves. Various clinical variants of GBS have been described. Isolated cranial nerve involvement without prominent signs of GBS is considered as rare variant of this disease. The aim of the study was to identify clinical characteristics of various forms of GBS particularly in rare variants of the disease. 57 patients with GBS were evaluated based on clinical and electrophysiological data. The following forms of GBS were revealed: 27 had acute inflammatory demyelinating polyradiculoneuropathy, 9--acute motor axonal neuropathy, 12--acute motor and sensory axonal neuropathy, 5--Fisher syndrome and 3--facial diplegia (rare clinical variant). 50 patients were graded 3 or more according to Hughes functional grading scale. Seasonal preponderance was found in spring (March-May) and autumn (September-November). 23 patients received IVIG and 34 were treated by plasma exchange within two weeks after onset. Follow up study revealed: 46 recovered satisfactory, 8 were persistently disabled, 3 died during admission to hospital. Guillain-Barre syndrome showed seasonal distribution and high frequency of axonal forms. Intravenous immunoglobulin therapy was more effective than plasma exchange. Poor outcomes were likely due to severe condition (required mechanical ventilation) and axonal forms. It is crucial to timely identify rare variants of GBS which recover with appropriate treatment.

  16. Financial capacity in persons with schizophrenia and serious mental illness: clinical and research ethics aspects.

    PubMed

    Marson, Daniel C; Savage, Robert; Phillips, Jacqueline

    2006-01-01

    In contrast with issues of consent capacity, financial capacity has received surprisingly little clinical or ethical attention in the psychiatric literature. Issues of financial capacity emerge frequently regarding clients with serious mental illness (SMI), and their resolution has practical and ethical significance for clients, their families, and mental health professionals. These issues include whether a client has sufficient financial skills and judgment to live independently, whether a client requires a representative payee, and what goals for community reintegration should be established with a client. Similar to informed consent, issues of financial capacity raise ethical challenges for clinicians, caseworkers, and agencies. The present article addresses clinical and research ethics questions related to financial capacity in clients with schizophrenia and SMI. Clinical questions concern evaluation of financial capacity in clients with SMI, whether to seek assignment of a mandatory representative payee, whether to leverage treatment compliance through a representative payee arrangement, and whether a mental health professional should also serve as a client's representative payee. The research ethics question addresses implications of providing financial compensation for research participation to individuals with SMI and limited financial capacity and means. The ultimate goal of this article is to focus clinical and ethical attention on a neglected decisional capacity in SMI that is of fundamental importance for clients, families, clinicians, and researchers.

  17. [Inflammatory linear verrucous epidermal nevus. Clinical and histopathological aspects of 7 cases].

    PubMed

    Kuri, R; Ruíz Maldonado, R; Tamayo, L

    1978-01-01

    The inflammatory linear verrucous nevus is a recently described variety of epidermal nevus clinically and histologically characterized by an inflammatory component. The lesion stars at birth or at early age, pruritus is constant. Histologically the picture is psoriasiform. The therapeutic response is poor. Seven cases are presented. Associated extracutaneous alterations were presented in four of them.

  18. 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…

  19. Biomechanics of Esophageal Function in Eosinophilic Esophagitis

    PubMed Central

    Pandolfino, John E

    2012-01-01

    Eosinophilic Esophagitis (EoE) is a chronic inflammatory disease of the esophagus triggered by an immune response that leads to symptoms of dysphagia, chest pain, and food impaction. EoE is a clinicopathologic syndrome that requires clinical symptoms and pathologic findings for a diagnosis. The inflammatory process and eosinophilic infiltration of the esophagus in EoE lead to fibrosis and structural changes within the esophagus that cause esophageal dysfunction. The biomechanics of the esophageal function in EoE have been explored using manometry, impedance planimetry, barium esophagograms, and endoscopic ultrasound. These studies have identified several biomechanical changes to the esophagus in EoE including pan-esophageal pressurization on manometry, changes in esophageal compliance with decreased distentisbility by impedance planimetry, decreased esophageal luminal diameter by esophagograms, and dysfunction in the esophageal longitudinal muscles by endoscopic ultrasound. Treatments for the disease involve dietary changes, immunosuppressive drugs, and dilation techniques. However, the data regarding the effect of these therapies on altering mechanical properties of the esophagus is limited. As the pathogenesis of esophageal dysfunction in EoE appears multifactorial, further study of the biomechanics of EoE is critical to better diagnose, monitor and treat the disease. PMID:23105995

  20. 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.

  1. Biomechanics of esophageal function in eosinophilic esophagitis.

    PubMed

    Read, Andrew J; Pandolfino, John E

    2012-10-01

    Eosinophilic Esophagitis (EoE) is a chronic inflammatory disease of the esophagus triggered by an immune response that leads to symptoms of dysphagia, chest pain, and food impaction. EoE is a clinicopathologic syndrome that requires clinical symptoms and pathologic findings for a diagnosis. The inflammatory process and eosinophilic infiltration of the esophagus in EoE lead to fibrosis and structural changes within the esophagus that cause esophageal dysfunction. The biomechanics of the esophageal function in EoE have been explored using manometry, impedance planimetry, barium esophagograms, and endoscopic ultrasound. These studies have identified several biomechanical changes to the esophagus in EoE including pan-esophageal pressurization on manometry, changes in esophageal compliance with decreased distentisbility by impedance planimetry, decreased esophageal luminal diameter by esophagograms, and dysfunction in the esophageal longitudinal muscles by endoscopic ultrasound. Treatments for the disease involve dietary changes, immunosuppressive drugs, and dilation techniques. However, the data regarding the effect of these therapies on altering mechanical properties of the esophagus is limited. As the pathogenesis of esophageal dysfunction in EoE appears multifactorial, further study of the biomechanics of EoE is critical to better diagnose, monitor and treat the disease.

  2. [Susceptibility weighted magnetic resonance sequences "SWAN, SWI and VenoBOLD": technical aspects and clinical applications].

    PubMed

    Hodel, J; Rodallec, M; Gerber, S; Blanc, R; Maraval, A; Caron, S; Tyvaert, L; Zuber, M; Zins, M

    2012-05-01

    Susceptibility-weighted MR sequences, T2 star weighted angiography (SWAN, General Electric), Susceptibility weighted imaging (SWI, Siemens) and venous blood oxygen level dependant (VenoBOLD, Philips) are 3D spoiled gradient-echo sequence that provide a high sensitivity for the detection of blood degradation products, calcifications, and iron deposits. For all these sequences, an appropriate echo time allows for the visualization of susceptibility differences between adjacent tissues. However, each of these sequences presents a specific technical background. The purpose of this review was to describe 1/the technical aspects of SWAN, VenoBOLD and SWI sequences, 2/the differences observed in term of contrast within the images, 3/the key imaging findings in neuroimaging using susceptibility-weighted MR sequences.

  3. Minicomputer For Biomechanical Research

    NASA Astrophysics Data System (ADS)

    Shierman, Gail; Rhymes, Tom

    1982-02-01

    The increased capabilities of minicomputers today allows a biomechanics laboratory to establish a self-contained computer system for a reasonable price. The system includes a microprocessor, a printer and a CRT. Analog to digital conversion is an important feature to consider as well as the ability to interface with a mainframe computer. A minicomputer adapted for film analysis should be a consideration for data analysis when developing a cinematography laboratory. For the past 10-15 years the area of biomechanics has enjoyed the advances in technology. Equipment and instrumentation once used exclusively by engineers and physicists have become readily available to those involved with snorts analyses. Among the various pieces of equipment accessible to biomechanists today, probably the most important one is the computer. At this time several biomechanics laboratories are using the computer to analyze kinematic and kinetic data obtained from film. The computer in use at each school is generally the main University or College computer with a remote terminal set-up in the biomechanics laboratory. This system functions well if there is adequate response from the time-sharing system of the main computer, and if there is at least one knowledgeable technician available. With the trend toward minicomputers today, their increased capabilities, and their ease of use, a self-contained minicomputer system in the biomechanics laboratory appears to be a viable alternative. The computer system in use in the ,Biomechanics Laboratory at the University of Oklahoma is based around the Cromemco Z2D computer connected to a PCD motion analyzer (Figure 1). The data acquisition system consists of the eight-bit microprocessor-based minicomputer connected to an analog to digital converter (ADC). As a terminal for the computer, we have either a video display unit or a Model 43 Teletype. The Model 43 provides a hard copy out-put while the video terminal provides much faster I/O, useful for

  4. Macroscopic and microscopic aspects of the temporomandibular joint related to its clinical implication.

    PubMed

    Siéssere, Selma; Vitti, Mathias; Semprini, Marisa; Regalo, Simone Cecílio Hallak; Iyomasa, Mamie Mizusaki; Dias, Fernando José; Issa, João Paulo Mardegan; de Sousa, Luiz Gustavo

    2008-10-01

    In order to obtain a precise diagnosis and treatment for temporomandibular dysfunctions, it is necessary to have morphological and functional knowledge of the temporomandibular joint. Anatomic components are important to the understanding of the complexity of temporomandibular joint. Nonetheless, just as important are the anatomic relationships that this joint has with the neighboring structures. Thus, the aim of this study was to present the anatomic relationships of the temporomandibular joint in its various surfaces: external or lateral, anterior, posterior, medial, superior, and posterosuperior, considering the morphological and histological aspects. Nine human heads, fixed in formalin (10%) underwent sagittal medial section and were subsequently dissected, evidencing the anatomic components of all surfaces to be analyzed. Components of the external surface were: skin, subcutaneous tissue, lymphatic ganglia, parotid gland, superficial temporal artery, transverse facial artery, zygomatic-orbital artery, superficial temporal vein, facial and auriculotemporal nerves, masseter muscle, and pre-auricular lymphonodus. The anterior surface comprised the masseter and lateral pterygoid muscles (upper and inferior heads), pterygoid venous plexus, mandibular notch, posterior deep temporal artery, masseteric nerve, and deep posterior temporal branches. Medial surface components were: internal maxillary artery, of which middle meningeal artery was one of the closest branches to the TMJ, anterior tympanic artery, inferior alveolar, lingual, auriculotemporal, and chorda tympani nerves, which belonged to the surface posterior to the anterior wall of the auditory duct; auricolotemporal nerve, parotid gland; and petrotympanic fissure. The cerebral fossa (meninges and encephalon) belonged to the superior surface and the ear belonged to the posterosuperior surface. Histologically, the temporomandibular joint is composed by different tissues that compound the mandibular head

  5. CURRENT CONCEPTS IN BIOMECHANICAL INTERVENTIONS FOR PATELLOFEMORAL PAIN

    PubMed Central

    Meira, Erik P.

    2016-01-01

    Patellofemoral pain (PFP) has historically been a complex and enigmatic issue. Many of the factors thought to relate to PFP remain after patients' symptoms have resolved making their clinical importance difficult to determine. The tissue homeostasis model proposed by Dye in 2005 can assist with understanding and implementing biomechanical interventions for PFP. Under this model, the goal of interventions for PFP should be to re-establish patellofemoral joint (PFJ) homeostasis through a temporary alteration of load to the offended tissue, followed by incrementally restoring the envelope of function to the baseline level or higher. High levels of PFJ loads, particularly in the presence of an altered PFJ environment, are thought to be a factor in the development of PFP. Clinical interventions often aim to alter the biomechanical patterns that are thought to result in elevated PFJ loads while concurrently increasing the load tolerance capabilities of the tissue through therapeutic exercise. Biomechanics may play a role in PFJ load modification not only when addressing proximal and distal components, but also when considering the involvement of more local factors such as the quadriceps musculature. Biomechanical considerations should consider the entire kinetic chain including the hip and the foot/ankle complex, however the beneficial effects of these interventions may not be the result of long-term biomechanical changes. Biomechanical alterations may be achieved through movement retraining, but the interventions likely need to be task-specific to alter movement patterns. The purpose of this commentary is to describe biomechanical interventions for the athlete with PFP to encourage a safe and complete return to sport. Level of Evidence 5 PMID:27904791

  6. CURRENT CONCEPTS IN BIOMECHANICAL INTERVENTIONS FOR PATELLOFEMORAL PAIN.

    PubMed

    Willy, Richard W; Meira, Erik P

    2016-12-01

    Patellofemoral pain (PFP) has historically been a complex and enigmatic issue. Many of the factors thought to relate to PFP remain after patients' symptoms have resolved making their clinical importance difficult to determine. The tissue homeostasis model proposed by Dye in 2005 can assist with understanding and implementing biomechanical interventions for PFP. Under this model, the goal of interventions for PFP should be to re-establish patellofemoral joint (PFJ) homeostasis through a temporary alteration of load to the offended tissue, followed by incrementally restoring the envelope of function to the baseline level or higher. High levels of PFJ loads, particularly in the presence of an altered PFJ environment, are thought to be a factor in the development of PFP. Clinical interventions often aim to alter the biomechanical patterns that are thought to result in elevated PFJ loads while concurrently increasing the load tolerance capabilities of the tissue through therapeutic exercise. Biomechanics may play a role in PFJ load modification not only when addressing proximal and distal components, but also when considering the involvement of more local factors such as the quadriceps musculature. Biomechanical considerations should consider the entire kinetic chain including the hip and the foot/ankle complex, however the beneficial effects of these interventions may not be the result of long-term biomechanical changes. Biomechanical alterations may be achieved through movement retraining, but the interventions likely need to be task-specific to alter movement patterns. The purpose of this commentary is to describe biomechanical interventions for the athlete with PFP to encourage a safe and complete return to sport.

  7. 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

  8. Atypical feline sporotrichosis resembling vaccine-induced sarcoma: clinical and histopathological aspects.

    PubMed

    dos Santos, Isabele Barbieri; Quintella, Leonardo Pereira; de Miranda, Luisa Helena Monteiro; de Sousa Trotte, Marcele Nogueira; Schubach, Tânia Maria Pacheco; Tortelly, Rogerio

    2013-06-01

    A 7-year-old Siamese cat presenting with three ulcerated cutaneous nodules in the lumbosacral region was seen at the Laboratory for Clinical Research on Dermatozoonoses in Domestic Animals in Rio de Janeiro, Brazil. Histopathological analysis showed that the lesions consisted of polyhedral and spindle-shaped voluminous mononuclear cells with loose chromatin and clearly visible nucleoli, few giant cells, and foci of coagulative and caseous necrosis -- findings suggestive of a vaccine-induced sarcoma. No significant mitotic rate, cytological atypias or asteroid bodies were observed. Special histopathological staining with periodic acid-Schiff and Grocott's silver stain demonstrated the presence of small yeast cells characterized by simple and narrow-base budding compatible with Sporothrix schenckii. Mycological culture grew S schenckii. Cytopathology was negative for yeast cells. These atypical clinical and histopathological signs support the importance of histopathological analysis with special staining techniques, in addition to mycological culture in the diagnosis of feline sporotrichosis.

  9. Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management

    PubMed Central

    Poddighe, Dimitri; Gelardi, Matteo; Licari, Amelia; del Giudice, Michele Miraglia; Marseglia, Gian Luigi

    2016-01-01

    Chronic rhinitis is a very common disease, as the prevalence in the general population resulted to be 40%. Allergic rhinitis has been considered to be the most frequent form of chronic rhinitis, as non-allergic rhinitis has been estimated to account for 25%. However, several evidences suggested that non-allergic rhinitis have been underrated, especially in children. In pediatrics, the diagnostic definition of non-allergic rhinitis has been often limited to the exclusion of an allergic sensitization. Actually, local allergic rhinitis has been often misdiagnosed as well as mixed rhinitis has not been recognized in most cases. Nasal cytology is a diagnostic procedure being suitable for routine clinical practice with children and could be a very useful tool to characterize and diagnose non-allergic rhinitis, providing important clues for epidemiological analysis and clinical management. PMID:28074172

  10. Molecular and clinical aspects of iron homeostasis: From anemia to hemochromatosis.

    PubMed

    Nairz, Manfred; Weiss, Günter

    2006-08-01

    The discovery in recent years of a plethora of new genes whose products are implicated in iron homeostasis has led to rapid expansion of our knowledge in the field of iron metabolism and its underlying complex regulation in both health and disease. Abnormalities of iron metabolism are among the most common disorders encountered in practical medicine and may have significant negative impact on physical condition and life expectancy. Basic insights into the principles of iron homeostasis and the pathophysiological and clinical consequences of iron overload, iron deficiency and misdistribution are thus of crucial importance in modern medicine. This review summarizes our current understanding of human iron metabolism and focuses on the clinically relevant features of hereditary and secondary hemochromatosis, iron deficiency anemia, anemia of chronic disease and anemia of critical illness. The interconnections between iron metabolism and immunity are also addressed, in as much as they may affect the risk and course of infections and malignancies.

  11. Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management.

    PubMed

    Poddighe, Dimitri; Gelardi, Matteo; Licari, Amelia; Del Giudice, Michele Miraglia; Marseglia, Gian Luigi

    2016-12-26

    Chronic rhinitis is a very common disease, as the prevalence in the general population resulted to be 40%. Allergic rhinitis has been considered to be the most frequent form of chronic rhinitis, as non-allergic rhinitis has been estimated to account for 25%. However, several evidences suggested that non-allergic rhinitis have been underrated, especially in children. In pediatrics, the diagnostic definition of non-allergic rhinitis has been often limited to the exclusion of an allergic sensitization. Actually, local allergic rhinitis has been often misdiagnosed as well as mixed rhinitis has not been recognized in most cases. Nasal cytology is a diagnostic procedure being suitable for routine clinical practice with children and could be a very useful tool to characterize and diagnose non-allergic rhinitis, providing important clues for epidemiological analysis and clinical management.

  12. Restoration of the striatal circuitry: from developmental aspects toward clinical applications

    PubMed Central

    Pauly, Marie-Christin; Piroth, Tobias; Döbrössy, Máté; Nikkhah, Guido

    2012-01-01

    In the basal ganglia circuitry, the striatum is a highly complex structure coordinating motor and cognitive functions and it is severely affected in Huntington's disease (HD) patients. Transplantation of fetal ganglionic eminence (GE) derived precursor cells aims to restore neural circuitry in the degenerated striatum of HD patients. Pre-clinical transplantation in genetic and lesion HD animal models has increased our knowledge of graft vs. host interactions, and clinical studies have been shown to successfully reduce motor and cognitive effects caused by the disease. Investigating the molecular mechanisms of striatal neurogenesis is a key research target, since novel strategies aim on generating striatal neurons by differentiating embryonic stem cells or by reprogramming somatic cells as alternative cell source for neural transplantation. PMID:22529778

  13. 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.

  14. 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.

  15. 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.

  16. [Hereditary palmoplantar keratoderma - a focus on clinical and molecular genetic aspects].

    PubMed

    Kamaleswaran, Shailajah; Ousager, Lilian Bomme; Bach, Rasmus Overgaard; Bygum, Anette

    2014-02-10

    Hereditary palmoplantar keratoderma comprises a heterogenous group of genodermatoses. The clinical spectrum of palmoplantar keratoderma can range from pure skin thickening, restricted to palmoplantar skin to complex conditions with dental anomalies, eye symptoms, deafness, cardiac disease and cancer. The classification of hereditary palmoplantar keratoderma has been complicated. In recent years the molecular genetic background has been clarified for an increasing number of palmoplantar keratodermas, which makes it possible to make a more accurate diagnosis.

  17. Clinical aspects of the acquired immune deficiency syndrome in the United Kingdom.

    PubMed Central

    Weber, J N; Carmichael, D J; Sawyer, N; Pinching, A J; Harris, J R

    1984-01-01

    Between August and November 1983, seven new patients with AIDS were seen at this hospital; two with disseminated Kaposi's sarcoma, and five with opportunist infections, of whom three have died. We present the case histories of the five patients with opportunist infections, which show the wide clinical range of AIDS and suggest that the pattern of infection in the UK may differ from that reported in the USA. PMID:6744012

  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.

  19. 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

  20. 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

  1. Aspects of matrix effects in applications of liquid chromatography-mass spectrometry to forensic and clinical toxicology--a review.

    PubMed

    Peters, Frank T; Remane, Daniela

    2012-06-01

    In the last decade, liquid chromatography coupled to (tandem) mass spectrometry (LC-MS(-MS)) has become a versatile technique with many routine applications in clinical and forensic toxicology. However, it is well-known that ionization in LC-MS(-MS) is prone to so-called matrix effects, i.e., alteration in response due to the presence of co-eluting compounds that may increase (ion enhancement) or reduce (ion suppression) ionization of the analyte. Since the first reports on such matrix effects, numerous papers have been published on this matter and the subject has been reviewed several times. However, none of the existing reviews has specifically addressed aspects of matrix effects of particular interest and relevance to clinical and forensic toxicology, for example matrix effects in methods for multi-analyte or systematic toxicological analysis or matrix effects in (alternative) matrices almost exclusively analyzed in clinical and forensic toxicology, for example meconium, hair, oral fluid, or decomposed samples in postmortem toxicology. This review article will therefore focus on these issues, critically discussing experiments and results of matrix effects in LC-MS(-MS) applications in clinical and forensic toxicology. Moreover, it provides guidance on performance of studies on matrix effects in LC-MS(-MS) procedures in systematic toxicological analysis and postmortem toxicology.

  2. The Differences in Clinical Aspect Between Specific Language Impairment and Global Developmental Delay

    PubMed Central

    Kim, Seong Woo; Jeon, Ha Ra; Chung, Hee Jung; Song, Jung Eun

    2014-01-01

    Objective To compare and analyze the clinical characteristics of children with delayed language acquisition due to two different diagnoses, which were specific language impairment (SLI, a primarily delayed language development) and global developmental delay (GDD, a language delay related to cognitive impairment). Methods Among 1,598 children who had visited the developmental delay clinic from March 2005 to February 2011, 467 children who were diagnosed with GDD and 183 children who were diagnosed with SLI were included in this study. All children were questioned about past, family, and developmental history, and their language competences and cognitive function were assessed. Some children got electroencephalography (EEG), in case of need. Results The presence of the perinatal risk factors showed no difference in two groups. In the children with GDD, they had more delayed acquisition of independent walking and more frequent EEG abnormalities compared with the children with SLI (p<0.01). The positive family history of delayed language development was more prevalent in children with SLI (p<0.01). In areas of language ability, the quotient of receptive language and expressive language did not show any meaningful statistical differences between the two groups. Analyzing in each group, the receptive language quotient was higher than expressive language quotient in both group (p<0.01). In the GDD group, the Bayley Scales of Infant Development II (BSID-II) showed a marked low mental and motor quotient while the Wechsler Intelligence Scale showed low verbal and nonverbal IQ. In the SLI group, the BSID-II and Wechsler Intelligence Scale showed low scores in mental area and verbal IQ but sparing motor area and nonverbal IQ. Conclusion The linguistic profiles of children with language delay could not differentiate between SLI and GDD. The clinicians needed to be aware of these developmental issues, and history taking and clinical evaluation, including cognitive assessment

  3. 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

  4. Clinical and Morphological Aspects of Gray Matter Heterotopia Type Developmental Malformations

    PubMed Central

    Zając-Mnich, Monika; Kostkiewicz, Agnieszka; Guz, Wiesław; Dziurzyńska-Białek, Ewa; Solińska, Anna; Stopa, Joanna; Kucharska-Miąsik, Iwona

    2014-01-01

    Summary Background Gray matter heterotopia (GMH) is a malformation of the central nervous system characterized by interruption of normal neuroblasts migration between the 7th and 16th week of fetal development. The aim of the study was the analysis of clinical symptoms, prevalence rate and the most common concurrent central nervous system (CNS) developmental disorders as well as assessment of characteristic morphological changes of gray matter heterotopia in children hospitalized in our institution between the year 2001 and 2012. Material/Methods We performed a retrospective analysis of patients’ data who were hospitalized in our institution between the year 2001 and 2012. We assessed clinical data and imaging exams in children diagnosed with gray matter heterotopia confirmed in MRI (magnetic resonance imaging). Results GMH occurred in 26 children hospitalized in our institution between the year 2001 and 2012. Among children with gray matter heterotopia most common clinical symptoms were: epilepsy, intellectual disability and hemiparesis. The commonest location of heterotopic gray matter were fronto-parietal areas of brain parenchyma, mostly subependymal region. Gray matter heterotopia occurred with other developmental disorders of the central nervous system rather than solely and in most cases it was bilateral. Schizencephaly and abnormalities of the corpus callosum were the most often developmental disorders accompanying GMH. Conclusions 1. Subependymal gray matter heterotopia was more common than subcortical GMH. Subependymal GMH showed tendency to localize in the region of the bodies of the lateral ventricles. The least common was laminar GMH. 2. Gray matter heterotopia occurred more often with other developmental disorders of the central nervous system rather than solely. The most frequent concurrent disorders of the central nervous system were: schizencephaly, developmental abnormalities of the corpus callosum, arachnoid cyst, abnormalities of the septum

  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. Bicuspid aortic valve: theoretical and clinical aspects of concomitant ascending aorta replacement.

    PubMed

    De Sá, Mauro Paes Leme; Bastos, Eduardo Sergio; Murad, Henrique

    2009-01-01

    Bicuspid aortic valve (BAV) is associated with annuloaortic ectasia, dissection and ascending aortic aneurysm. The high incidence of this congenital malformation and aortic disease suggests a close correlation between the two phenomena. Abnormalities in different phases of cell migration of the neural crest might be responsible for the occurrence of abnormalities in the aortic valve, media layer of the ascending aorta and vessels of the aortic arch. Previous studies have shown that patients with normal BAV or slight dysfunction may present with dilation of the aortic root. The hemodynamic changes caused by BAV without stenosis or insufficiency seem to be an insufficient explanation for these findings. Several mechanisms have been proposed to explain the molecular and hystological aspects of this disease. We found a reduced fibrillin-1 content in both ascending aorta and pulmonary trunk as a possible cause. Histologically, the ascending aorta can present cystic medial necrosis and elastic fragmentation, similar to Marfan's disease. Some authors concluded that many patients, mainly those with aortic regurgitation, should have the aortic valve and the ascending aorta replaced at the same procedure, even if a mild dilatation (45 mm) is present in patients with BAV if life expectancy is anticipated to be greater than 10 years to prevent further aneurysms or ruptures.

  7. Clinical Update in Aspects of the Management of Autoimmune Thyroid Diseases

    PubMed Central

    2016-01-01

    Aspects of autoimmune thyroid disease updated in this review include: immunoglobulin G4 (IgG4)-related thyroid disease (Riedel's thyroiditis, fibrosing variant of Hashimoto's thyroiditis, IgG4-related Hashimoto's thyroiditis, and Graves' disease with elevated IgG4 levels); recent epidemiological studies from China and Denmark indicating that excess iodine increases the incidence of Hashimoto's thyroiditis and hypothyroidism; immunomodulatory agents (ipilimumab, pembrolizumab, nivolumab) activate immune response by inhibiting T-cell surface receptors which down-regulate immune response, i.e., cytotoxic T-lymphocyte antigen 4 and programmed cell death protein 1 pathways; alemtuzumab is a humanised monoclonal antibody to CD52 which causes immune depletion and thyroid autoimmune disease especially Graves' hyperthyroidism; small molecule ligand (SML) agonists which activate receptors, SML neutral antagonists, which inhibit receptor activation by agonists, and SML inverse agonists which inhibit receptor activation by agonists and inhibit constitutive agonist independent signaling have been identified. SML antagonism of thyroid-stimulating hormone-receptor stimulatory antibody could treat Graves' hyperthyroidism and Graves' ophthalmopathy; and thyroxine treatment of subclinical hypothyroidism can produce iatrogenic subclinical hyperthyroidism with the risk of atrial fibrillation and osteoporosis. The increased risk of harm from subclinical hyperthyroidism may be stronger than the potential benefit from treatment of subclinical hypothyroidism. PMID:28029020

  8. Sunitinib Improves Some Clinical Aspects and Reverts DMBA-Induced Hyperplasic Lesions in Hamster Buccal Pouch

    PubMed Central

    de Souza, Fernanda Lopes; Oliveira, Mariana; Nunes, Marianne Brochado; Serafim, Lucas Horstmann; Azambuja, Alan Arrieira; Braga, Luisa Maria G. de M.; Saur, Lisiani; de Souza, Maria Antonieta Lopes; Xavier, Léder Leal

    2014-01-01

    Oral squamous cell carcinoma (OSCC) is a public health problem. The hamster buccal pouch model is ideal for analyzing the development of OSCC. This research analysed the effects of sunitinib (tyrosine kinase inhibitor) in precancerous lesions induced by 7,12-dimethylbenz(a)anthracene (DMBA) in this model. Thirty-four male hamsters, divided into six groups: control—C (n = 7), acetone—A (n = 12), carbamide peroxide—CP (n = 5 ), acetone and CP—A+CP (n = 8), 1% DMBA in acetone and CP—DA+CP (n = 6), and 1% DMBA in acetone and CP and 4-week treatment with sunitinib—DA+CP+S (n = 7). The aspects evaluated were anatomopathological features (peribuccal area, paws, nose, and fur), histological sections of the hamster buccal pouches (qualitatively analyzed), epithelium thickness, and the rete ridge density (estimated). Sunitinib was unable to attenuate the decrease in weight gain induced by DMBA; no increase in volume was detected in the pouch and/or ulceration, observed in 43% of the animals in the DA+CP group. DA+CP groups presented a significant increase in rete ridge density compared to the control groups (P < 0.01) which was reverted by sunitinib in the DA+CP+S group. Sunitinib seems to have important benefits in early stage carcinogenesis and may be useful in chemoprevention. PMID:24693453

  9. Syringoma of vulva: an unusual presentation. Clinical, morphological and immunohistochemical aspects.

    PubMed

    Núñez-Troconis, José; Viloria de Alvarado, María Elena

    2015-03-01

    The case of a 34-year-old woman, who consulted because she observed the appearance of numerous yellow-white asymptomatic papules on the vulva, is presented. Clinical diagnosis of syringoma of vulva was established. The pathological and immunohistochemical studies confirmed the diagnosis. Vulvar syringoma usually occurs as a multiple flesh-colored or brownish papules on both sides of labia majora of women in their third decade. Its diagnosis should be considered when the patient complaints of vulvar pruritus and/or sweating.

  10. Clinical and hormonal aspects in breast cancer with special reference to malignant evolutive push.

    PubMed

    Kiricuta, I; Frenkel, Z; Munteanu, S

    1975-01-01

    It is tried to differentiate between various stages of malignant evolutive push and normal mammary tumors to establish an individual therapeutic procedure. Besides mammography and thermometry, investigations of urinary excretions of estrogenic and androgenic steriods are qualified for this purpose. Patients with malignant evolutive push showed an increased excretion of estrogens which reached its highest levels in patients suffering from inflammatory mammary carcinomas. The excretion of 17-ketosteroids shows a behaviour vice versa. Altogether mammary tumors with malignant evolutive push are characterized by a state of absolute and relative hyperestrogenity respectively. This phenomenon preferably depends on the clinical stage of the disease than on the age of the patients.

  11. [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.

  12. Clinical and biologic aspects of human cytomegalovirus resistance to antiviral drugs.

    PubMed

    Baldanti, Fausto; Lurain, Nell; Gerna, Giuseppe

    2004-05-01

    The emergence of human cytomegalovirus (HCMV) drug resistant strains is a life-threatening condition in immunocompromised individuals with active HCMV infection. HCMV drug resistance represented a major problem in patients with acquired immunodeficiency syndrome until the recent introduction of highly active antiretroviral combination therapy, which dramatically decreased the incidence in this clinical setting. However, HCMV resistance to antiviral drugs is now an emerging problem in the transplantation setting. The molecular mechanisms of HCMV drug resistance have been elucidated and rely on the selection during treatment of HCMV strains harboring mutations in two key viral genes: UL97 coding for a viral phosphotransferase and UL54 coding for the viral DNA polymerase.

  13. [Clinical aspects and the course of psychopathologic conditions simulating vertebrogenic pathology].

    PubMed

    Ostroglazov, V G; Lisina, M A

    1989-01-01

    The study of clinical picture and the course of unclear pathological states simulating the vertebral pathology suggested that the major signs were centered around the primary general and muscular sensory disorders. These served as a basis for development of more complicated psychosensory and psychomotor disorders and creation of an interpretative hypochondriac++ delirium system. Domination of psychomotor disorders led to a high incidence of social and labor dysadaptation of the patients. Thus, the study of this unclear mental pathology has a major theoretic, clinico-psychopathological and also practical medico-social importance.

  14. 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

  15. [Clinical aspects of injury to the eye inflicted with gas pistols for self-defense].

    PubMed

    Gundorova, R A; Bykov, V P; Petriashvili, G G; Lekishvili, G R

    1996-01-01

    The clinical picture of an injury inflicted with gas pistols represents polymorphous changes and severe injury to the organ of vision, involving not only the anterior segment, but the deep structures as well. Analysis of the status of the damaged eyes and the mechanism of injury permitted us to distinguish 3 clinical groups in terms of the intensity of exposure to this or that factor: 1) chemical burn of the cornea and conjunctiva (65 patients); 2) chemical burn with elements of thermal involvement and impregnation of tissues with particles of gunpowder that failed to burn and slight or medium-severe contusion of the eyeball (31 patients): and 3) severe thermochemical burn with grave contusion of the eyeball, sometimes with rupture of membranes (6 patients). Hence, we may conclude that the consequences of using gas weapons differ from those described in the Status of Gas Weapons Application and in advertising materials by a much greater severity, and in 11.7% cases such injuries led to complete irreversible loss of vision. Obviously the shortest distance from which it may be allowed to shoot from gas pistols should be increased to 1 meter.

  16. [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.

  17. Mustard gas: clinical, toxicological, and mutagenic aspects based on modern experience.

    PubMed

    Aasted, A; Darre, E; Wulf, H C

    1987-10-01

    Based on a study of the literature and our own experience treating fisherman poisoned by mustard gas, this article outlines the clinical effects, and toxicological and mutagenic properties of the agent. Mustards are very persistent chemical agents that easily penetrate clothing. Mustard gas usually causes clinical symptoms after the liquid penetrates the skin or the vapor is inhaled. Skin lesions are similar to first- or second-degree burns and usually heal spontaneously in 4 to 6 weeks. Eye symptoms are photophobia and reduced vision. Following inhalation of the agent, pulmonary edema and long-term dyspnea may be seen. As mustard gas is an alkylating substance, it is conceivable that the risk of developing cancer may be increased, as observed in people who were involved with the production of mustard gas and in animals exposed to the gas. Also, transient significantly increased sister chromatid exchange rates have been found in fishermen exposed to mustard gas. Patients exposed to mustard gas must be treated immediately after exposure. Treatment should consist of cleaning of the exposed skin and clothes with an antigas powder and water and soap. The skin lesions should be treated as burns. Eye lesions and respiratory problems should be treated symptomatically.

  18. [Microneurography--from basic aspects to clinical applications and application in space medicine].

    PubMed

    Mano, Tadaaki

    2009-03-01

    Microneurography is an electrophysiological method that directly records impulse traffic from human peripheral nerves by using metal microelectrodes. This method enables the recording of identified postganglionic sympathetic efferent neural traffic leading to the skeletal muscles (muscle sympathetic nerve activity) and skin (skin sympathetic nerve activity), as well as myelinated and unmyelinated afferent nerve impulses from the sensory receptors in skeletal muscles (muscle spindles, Golgi tendon organs, and nociceptors) and skin (skin mechanoreceptors and noci-thermoceptors). The clinical applications of sympathetic microneurography are useful for the elucidation of the neural mechanisms of abnormal blood pressure control and thermoregulation. Sympathetic microneurography is also used in space medicine to elucidate changes in sympathetic neural traffic during and after exposure to simulated microgravity and spaceflight. The clinical applications of sensory microneurography are useful to clarify the neural mechanisms underlying abnormalities in muscle and skin sensation and those in sensory motor control. Microstimulation by using the microneurography technique can also be used to determine the peripheral sensory, sympathetic, and motor nerve functions.

  19. 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

  20. Clinical and genetic aspects of primary ciliary dyskinesia/Kartagener syndrome.

    PubMed

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

    2009-07-01

    Primary ciliary dyskinesia is a genetically heterogeneous disorder of motile cilia. Most of the disease-causing mutations identified to date involve the heavy (dynein axonemal heavy chain 5) or intermediate(dynein axonemal intermediate chain 1) chain dynein genes in ciliary outer dynein arms, although a few mutations have been noted in other genes. Clinical molecular genetic testing for primary ciliary dyskinesia is available for the most common mutations. The respiratory manifestations of primary ciliary dyskinesia (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 patients with primary ciliary dyskinesia 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 patients with primary ciliary dyskinesia 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 primary ciliary dyskinesia.

  1. 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

  2. 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

  3. Damage of collagen and elastic fibres by borrelia burgdorferi - known and new clinical and histopathological aspects.

    PubMed

    Müller, Kurt E

    2012-01-01

    Lyme Borreliosis, or Lyme's disease, manifests itself in numerous skin conditions. Therapeutic intervention should be initiated as soon as a clinical diagnosis of erythema migrans is made. The histopathology of some of the skin conditions associated with Lyme Borreliosis is characterised by structural changes to collagen, and sometimes also elastic fibres. These conditions include morphea, lichen sclerosus et atrophicus and acrodermatitis chronica atrophicans. More recently, further skin conditions have been identified by the new microscopic investigation technique of focus floating microscopy: granuloma annulare, necrobiosis lipoidica, necrobiotic xanthogranuloma, erythema annulare centrifugum, interstitial granulomatous dermatitis, cutaneous sarcoidosis and lymphocytic infiltration; these conditions also sometimes cause changes in the connective tissue. In the case of ligaments and tendons, collagen and elastic fibres predominate structurally. They are also the structures that are targeted by Borrelia. The resultant functional disorders have previously only rarely been associated with Borreliosis in clinical practice. Ligamentopathies and tendinopathies, spontaneous ruptures of tendons after slight strain, dislocation of vertebrae and an accumulation of prolapsed intervertebral discs as well as ossification of tendon insertions can be viewed in this light.

  4. Myotonic Dystrophy Type 2: An Update on Clinical Aspects, Genetic and Pathomolecular Mechanism

    PubMed Central

    Meola, Giovanni; Cardani, Rosanna

    2015-01-01

    Abstract Myotonic dystrophy (DM) is the most common adult muscular dystrophy, characterized by autosomal dominant progressive myopathy, myotonia and multiorgan involvement. To date two distinct forms caused by similar mutations have been identified. Myotonic dystrophy type 1 (DM1, Steinert’s disease) is caused by a (CTG)n expansion in DMPK, while myotonic dystrophy type 2 (DM2) is caused by a (CCTG)n expansion in CNBP. Despite clinical and genetic similarities, DM1 and DM2 are distinct disorders. The pathogenesis of DM is explained by a common RNA gain-of-function mechanism in which the CUG and CCUG repeats alter cellular function, including alternative splicing of various genes. However additional pathogenic mechanism like changes in gene expression, modifier genes, protein translation and micro-RNA metabolism may also contribute to disease pathology and to clarify the phenotypic differences between these two types of myotonic dystrophies. This review is an update on the latest findings specific to DM2, including explanations for the differences in clinical manifestations and pathophysiology between the two forms of myotonic dystrophies. PMID:27858759

  5. Vitamin B12 in neurology and ageing; clinical and genetic aspects.

    PubMed

    McCaddon, Andrew

    2013-05-01

    The classic neurological and psychiatric features associated with vitamin B12 deficiency have been well described and are the subject of many excellent review articles. The advent of sensitive diagnostic tests, including homocysteine and methylmalonic acid assays, has revealed a surprisingly high prevalence of a more subtle 'subclinical' form of B12 deficiency, particularly within the elderly. This is often associated with cognitive impairment and dementia, including Alzheimer's disease. Metabolic evidence of B12 deficiency is also reported in association with other neurodegenerative disorders including vascular dementia, Parkinson's disease and multiple sclerosis. These conditions are all associated with chronic neuro-inflammation and oxidative stress. It is possible that these clinical associations reflect compromised vitamin B12 metabolism due to such stress. Physicians are also increasingly aware of considerable inter-individual variation in the clinical response to B12 replacement therapy. Further research is needed to determine to what extent this is attributable to genetic determinants of vitamin B12 absorption, distribution and cellular uptake.

  6. [Pharmacological and clinical aspects of fluvoxamine (Depromel), the first selective serotonin reuptake inhibitor approved for clinical use employed in Japan].

    PubMed

    Hachisu, M; Ichimaru, Y

    2000-05-01

    Fluvoxamine (Depromel), a selective serotonin reuptake inhibitor (SSRI), was launched in May 1999 in Japan with more than 10 years' delay from the marketing in Europe and the United States. Fluvoxamine has been approved in about 80 countries as the indication to "depression" since 1983. As the indication to obsessive-compulsive disorder (OCD), fluvoxamine was first approved in the United States in 1994 and then in about 30 countries. Efficacy of the drug on "depression and depressed state" was found to be comparable to traditional tricyclic antidepressants (TCAs) by the clinical studies in Japan. Indication to OCD was first approved for fluvoxamine in Japan. The antidepressant and the anti-OCD action are considered the result of the serotonin reuptake inhibition at the serotonergic neurons. Fluvoxamine has little affinity for muscarinic, adrenergic alpha 1- and histamine H1-receptors, which TCAs have. Therefore, fluvoxamine possesses less side effects such as dry mouse, disuria, dizziness, orthostatic hypotension and drowsiness, etc.; and it is useful for elderly patients and long-term treatments for depression and OCD.

  7. Clinical and audiologic characteristics of patients with sensorineural tinnitus and its association with psychological aspects: an analytic retrospective study.

    PubMed

    Al-Swiahb, Jamil Nasser; Hwang, Eul Seung; Kong, Ji Sun; Kim, Woo Jin; Yeo, Sang Won; Park, Shi Nae

    2016-12-01

    This study was performed to analyze clinical and audiologic characteristics of sensorineural tinnitus and to investigate the associating factors reflecting psychological aspects of stress and depression of the patients. This is a retrospective analytical study conducted in a tinnitus clinic of a tertiary referral center of a university hospital. The medical records of 216 patients suffering from sensorineural tinnitus were thoroughly evaluated to determine correlations between clinical and audiological characteristics, including age, sex, predisposing or etiologic factors, hearing levels up to extended high frequencies, and tinnitus severity. Psychological aspects of stress and depression were also evaluated and analyzed to seek the associations with tinnitus severity. All data were stored in our database bank and were statistically analyzed. Our study subjects showed a slight male predominance. The highest percentage of tinnitus was found in patients of 60-80 years old. Only 32.5 % of tinnitus patients were subjectively aware of their hearing loss, whereas 73 % of subjects had hearing deficits in some frequencies in their audiogram. Hearing impairments were of the low-frequency sensorineural type in 18.2 % of patients and were limited to the high frequencies in 77.9 % of patients. Tinnitus was unilateral in 51 % of patients and had a tonal nature in 45 % of patients. In total, 45.8 % of patients with high-frequency sensorineural hearing loss had high-pitched tinnitus. There were significant correlations between tinnitus severity, loudness and annoyance. Correlations with THI (Tinnitus Handicap Inventory) and Beck depression index scores were also found. Sensorineural tinnitus was related with hearing loss in some frequencies nevertheless of patients' own awareness of hearing loss. Loudness and annoyance of tinnitus seems to be two important factors reflecting psychological problems of patients' stress and depression.

  8. 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

  9. Multiparametric magnetic resonance imaging of the prostate: technical aspects and role in clinical management.

    PubMed

    Costa, Daniel N; Pedrosa, Ivan; Roehrborn, Claus; Rofsky, Neil M

    2014-08-01

    The heterogeneity and largely indolent nature of prostate cancer require better tools to avoid overdetection of low-risk disease and improve diagnostic accuracy in high-risk patients. During the last 3 decades, magnetic resonance imaging (MRI) has evolved to become the most accurate imaging technique for prostate cancer detection and staging, with a promising role in risk stratification. Because each MRI technique has advantages and limitations, state of the art of the so-called multiparametric MRI of the prostate is achieved combining anatomical T2-weighted imaging integrated with other techniques in which image contrast is related to the pathophysiology of the disease, such as diffusion-weighted imaging, dynamic contrast-enhanced imaging, and MR spectroscopy. After reviewing this article, readers will understand the clinical challenges in the management of patients with confirmed or suspected prostate cancer, when and how multiparametric MRI of the prostate can provide meaningful information, and how to perform and interpret it.

  10. Clinical and therapeutic aspects of vulvodynia: the importance of physical therapy.

    PubMed

    Polpeta, N C; Giraldo, P C; Teatin Juliato, C R; Gomes Do Amaral, R L; Moreno Linhares, I; Romero Leal Passos, M

    2012-10-01

    Vulvodynia affects a large number of women worldwide. It is estimated that the prevalence rate of vulvodynia is 16% in women aged 18 to 64 years, resulting in constant demand for specialized medical care, although little therapeutic success is achieved. Furthermore, the cause of this disorder remains unknown and involves different symptoms that are implicated in important chronic vulvar pain with disastrous consequences for the afflicted women. In view of these data, the authors have proposed a bibliographic review of the pathophysiology and treatment of vulvodynia. The aim of this review was to assist in clinical diagnosis and elucidate the multidisciplinary treatment that appears to be associated with a higher success rate in these women. Physical therapy using diverse techniques has an important role in multidisciplinary care, obtaining satisfactory results in the treatment of pelvic floor muscle dysfunction and thus improving the symptoms and quality of life in women with vulvodynia.

  11. [Clinical aspects of arteriosclerotic stenosis of the left coronary artery main stem].

    PubMed

    Volth, L; Csapó, K; Mihóczy, L

    1991-06-23

    Authors have found 37 significant (greater than 50%) or severe (greater than 75%) cases of left main stem stenosis (LMS) (3.4%, 35 male and 2 female) during 1097 consecutive selective coronarography. Retrospective analysis of the clinical data of the 35 male pts. showed severe effort or resting anginal complaints in the 2/3 of the pts., however this was not in tight connection with the degree of the LMS stenosis or the number of associated peripheral coronary stenoses respectively, similar to the ischaemic disorders of the resting ECG. In the bycicle ergometry ECG data lone the double index showed statistically significant difference between the groups of less than or equal to 2 and 3 vessel diseases connected to the severe LMS. Myocardium scintigraphy was performed out in 6 pts., all of them has given positive result. They emphasise the necessarity of urgent revascularisation against the higher risk of the intervention because of the pour results of the medical treatment.

  12. Cryptococcus gattii infections: contemporary aspects of epidemiology, clinical manifestations and management of infection.

    PubMed

    McMullan, Brendan Joseph; Sorrell, Tania Christine; Chen, Sharon Chih-Ann

    2013-12-01

    Cryptococcus gattii is an important primary and opportunistic pathogen, predominantly causing meningoencephalitis and pulmonary disease with substantial mortality. Initially considered geographically restricted to immune-competent, highly exposed individuals in the tropics, an apparent epidemic in North America has led to new perspectives on its ecology, epidemiology and clinical associations, which are distinct from its sibling species Cryptococcus neoformans. The role of C. gattii molecular genotypes/subtypes in different settings is under investigation. Diagnostic and treatment strategies are similar to those for C. neoformans in immunocompetent hosts, although data indicate that more prolonged induction, as well as total duration of therapy, is required. Exclusion of CNS involvement is mandatory. Brain cryptococcomas are characteristic of C. gattii infection, and raised intracranial pressure is common, for which surgery is often required. Immune reconstitution syndrome may occur. Ongoing C. gattii research and greater awareness and availability of specific diagnostic tests are required to improve patient outcomes.

  13. 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.

  14. Insulin resistance and clinical aspects of non-alcoholic steatohepatitis (NASH).

    PubMed

    Agarwal, Naresh; Sharma, Barjesh Chander

    2005-10-01

    Non-alcoholic steatohepatitis (NASH) is one of the most common liver disorders. This is highly prevalent in obese and diabetic subjects. Persons with central obesity are at particular risk. Other clinical predictors are age more than 40-50 years and hyperlipidemias, but none of these factors is invariable for causation of NASH. Other reported associations are, celiac disease, Wilson's Disease and few other metabolic diseases. Drugs, particularly amiodarone, tamoxifen, nucleoside analogues and methotrxate have also been linked to NASH. The disease is evenly distributed in both sexes but advanced disease is more common in women. Ethnic variation exists and African Americans are less affected than Hispanic Americans. Specific clinical features of NASH are infrequent. Patients usually come to clinical attention by elevated liver enzymes found on routine evaluation but on history, about two third of patients will admit to have mild fatigue and about half will report right upper quadrant pain. Rarely, patient may present with a complication of cirrhosis. Physical examination may reveal hepatomegaly and splenomegaly. Research in last few years has stressed that development of steatosis, stetohepatitis, fibrosis with subsequent cirrhosis are most probably the result of insulin resistance. Therefore, clinical features may reflect existence of insulin resistance. Obesity, particularly central obesity is most important of these. Patients may have sleep apnea syndrome. Hypertension and manifestations of diabetes mellitus like polyuria, polydypsia, and neurological deficits may occur. Patients may have varying combination of obesity, diabetes, hyperlipidemia, hypertension and impaired fibrinolysis (syndrome X). Children with insulin resistance may show acanthosis nigricance. Patients with polycystic ovary syndrome, which consists of insulin resistance, diabetes, obesity, hirsutism, oligo or polymenorrha and hyperlipidemia may have NASH. Other rare manifestations of insulin

  15. [Clinical aspects, outcome and prognosis of Horton's disease. Retrospective study of 47 cases].

    PubMed

    Godeau, P; Aubert, L; Guillevin, L; Tard, P; Maaouni, A; Wechsler, B; Bletry, O; Herreman, G

    1982-01-01

    The authors report their experience of Horton's disease in 47 histologically confirmed cases treated between 1966 and 1979. The symptomatology is recalled with the incidence of the various clinical and biochemical signs. The actuarial survival curve shows a 71.2 p. cent three year and a 61 p. cent five year survival rate. There was no statistically significant difference at three years with a control population. The duration of maintenance therapy was, on average, of 24.8 months, never less than 15 months and sometimes reaching 60 months. The average maintenance dose was 12 mg. Specific and non-specific complications are discussed. The incidence of refractory and cortico-dependent forms shows that the optimal treatment for this disease has yet to be found; the often brilliant initial results of corticotherapy do not reflect its long-term efficacy.

  16. Skin reactions to inhaled corticosteroids. Clinical aspects, incidence, avoidance, and management.

    PubMed

    Guillot, B

    2000-01-01

    Inhaled corticosteroids are considered by many to be the therapy of choice in the treatment of asthma and allergic rhinitis. Systemic adverse effects are well known and are mainly dose dependent. Adverse cutaneous effects have also been characterized. Some of them are frequent and dose dependent, for example thinning of the skin and easy bruising. These adverse effects are probably present in about half of the patients treated with inhaled corticosteroids. The risk of these adverse effects is more important among elderly people and increases with the duration of the treatment and the daily dosage. Thinning of the skin and easy bruising are probably dependent on collagen synthesis modifications. Among rare or underestimated reactions, several adverse effects have been described such as angina bullosa hemorrhagica, acne and allergy. In this latter case, the attention should be paid to relevant clinical signs such as eczematous lesions of the face and aggravation of the nasal symptoms. Mucocutaneous infections related to inhaled corticosteroid use have also been reported, the most frequent being candidiasis. However, the frequency of symptomatic clinical infection is very rare. The risk of viral infection, especially with a herpes virus, has never been described. As cutaneous complications of corticosteroids are mainly dose dependent, these adverse effects could be prevented by attention to the daily dosage. Infection could be prevented by rising the mouth after inhalation and the use of a spacer device. If cutaneous adverse effects occur despite proper use of the inhaled corticosteroids and became unpleasant for the patient, discussion with a pneumologist or otorhinolaryngologist may be required but temporary halting therapy is rarely useful.

  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. 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

  19. 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

  20. Clinical aspects of coeliac disease in children with insulin-dependent diabetes mellitus.

    PubMed

    Lorini, R; Scaramuzza, A; Vitali, L; d'Annunzio, G; Avanzini, M A; De Giacomo, C; Severi, F

    1996-03-01

    Coeliac disease (CD) is heterogeneous in its clinical presentation and pathological expression. Silent, latent and potential forms represent the submerged part of the so-called "coeliac iceberg". The association of insulin-dependent diabetes mellitus (IDDM) and CD has been widely reported. For the screening of CD in diabetic patients, anti-reticulin R1 (ARA-R1) and anti-endomysium (AEA) antibodies are more reliable markers than anti-gliadin (AGA) antibodies. Recent studies have reported an increased prevalence of CD in children with IDDM. In our experience intestinal biopsy confirmed a diagnosis of CD in 6 out of 172 diabetic patients, with a prevalence of 3.5%. Only occasionally does CD precede the onset of IDDM; more often CD is diagnosed shortly or sometimes years after the onset of diabetes. Typical gastrointestinal complaints of CD (such as diarrhoea, abdominal distension) are rare in IDDM patients, while atypical isolated signs or symptoms of CD are more common, in particular sideropenic anemia, short stature, delayed puberty, epilepsy, hypertransaminasemia, dyspeptic symptoms, herpetiform dermatitis, and recurrent aphthous stomatitis. It is recommended that all diabetic children, even those asymptomatic, should be screened yearly for CD, using a combination of AGA plus ARA-R1 and AEA.

  1. Clinical aspects and pathogenesis of congenital dyserythropoietic anemias: from morphology to molecular approach.

    PubMed

    Iolascon, Achille; Esposito, Maria Rosaria; Russo, Roberta

    2012-12-01

    Congenital dyserythropoietic anemias belong to a group of inherited conditions characterized by a maturation arrest during erythropoiesis with a reduced reticulocyte production in contrast with erythroid hyperplasia in bone marrow. The latter shows specific morphological abnormalities that allowed for a morphological classification of these conditions mainly represented by congenital dyserythropoietic anemias types I and II. The identification of their causative genes provided evidence that these conditions have different molecular mechanisms that induce abnormal cell maturation and division. Some altered proteins seem to be involved in the chromatin assembly, such as codanin-1 in congenital dyserythropoietic anemia I. The gene involved in congenital dyserythropoietic anemia II, the most frequent form, is SEC23B. This condition seems to belong to a group of diseases attributable to defects in the transport of newly synthesized proteins from endoplasmic reticulum to the Golgi. This review will analyze recent insights in congenital dyserythropoietic anemias types I and II. It will also attempt to clarify the relationship between mutations in causative genes and the clinical phenotype of these conditions.

  2. Hypopigmenting agents: an updated review on biological, chemical and clinical aspects.

    PubMed

    Solano, Francisco; Briganti, Stefania; Picardo, Mauro; Ghanem, Ghanem

    2006-12-01

    An overview of agents causing hypopigmentation in human skin is presented. The review is organized to put forward groups of biological and chemical agents. Their mechanisms of action cover (i) tyrosinase inhibition, maturation and enhancement of its degradation; (ii) Mitf inhibition; (iii) downregulation of MC1R activity; (iv) interference with melanosome maturation and transfer; (v) melanocyte loss, desquamation and chemical peeling. Tyrosinase inhibition is the most common approach to achieve skin hypopigmentation as this enzyme catalyses the rate-limiting step of pigmentation. Despite the large number of tyrosinase inhibitors in vitro, only a few are able to induce effects in clinical trials. The gap between in-vitro and in-vivo studies suggests that innovative strategies are needed for validating their efficacy and safety. Successful treatments need the combination of two or more agents acting on different mechanisms to achieve a synergistic effect. In addition to tyrosinase inhibition, other parameters related to cytotoxicity, solubility, cutaneous absorption, penetration and stability of the agents should be considered. The screening test system is also very important as keratinocytes play an active role in modulating melanogenesis within melanocytes. Mammalian skin or at least keratinocytes/melanocytes co-cultures should be preferred rather than pure melanocyte cultures or soluble tyrosinase.

  3. [3-hydroxy-3-methylglutaraturia. Clinical aspects, follow-up and therapy in a young child].

    PubMed

    Plöchl, E; Bachmann, C; Colombo, J P; Gibson, K M

    1990-01-01

    This is a report of an infant with 3-hydroxy-3-methylglutaryl-CoA-lyase deficiency. During infancy vomiting and feeding difficulties had been found repeatedly. Nutrition consisted in a mixture of one third of milk diluted with two thirds of water. Shortly before admission a change to whole milk had taken place. The one year old girl was admitted to the hospital because of vomiting and diarrhoea. Liver was enlarged and consciousness reduced. There was acidosis, hypoglycemia and an elevation of the transaminases. The typical pattern of organic acids in urine and dicarboxylic aciduria was pathognomonic. The diagnosis was proved by a deficiency of 3-hydroxy-3-methylglutaryl-CoA-lyase in fibroblasts. A protein and fat restricted diet, but also carnitine supplement was introduced. With the exception of severe hypoglycemia seizures on one morning the more than 2 1/2 year old girl is developed normally. It is of importance for future to avoid hypoglycemia after fasting, infections diseases or stress. The possible impairment of pancreatic function even in a normal clinical condition with normal values of transaminases is especially pointed out.

  4. 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

  5. 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

  6. 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

  7. [Role and future aspects of hospital clinical laboratories in medical team approaches].

    PubMed

    Suwabe, Akira

    2011-09-01

    The recent progress in medicine increases the routine works of the physicians or nurses and decreases the chances to obtain the new information on the laboratory medicine. Although the patients desire to know their test results in detail, it is likely to be difficult to obtain them from the physician in charge. Thereby, the quality of the medical services may be deteriorated. In these situations, needs of the medical team approaches in which the medical technologists (MTs) in the hospital laboratories participate are increasing. In Japan, there are a variety of medical team approaches in which MTs are involved. In our university hospital, MTs play important roles in the infection control team (ICT), in the nutrition support team (NST), in the educational class for the patients with diabetes mellitus, in the clinical research center, in the order-made medicine realizing project, in the infertility center and in the laboratory information room. In April 2010, the new payment system for the team approaches such as ICT or NST was established. In the future, the team approaches other than ICT or NST could be chosen for the subjects for the payment if they are recognized as important. The goal of the team approaches is to realize a patient-oriented medicine. MTs can reconfirm that they are working as one of the medical staffs through these team approaches. It is important to always find out a possibility of new team approaches.

  8. Diagnosis and management of congenital adrenal hyperplasia: clinical, molecular and prenatal aspects.

    PubMed

    Mathur, R; Kabra, M; Menon, P S

    2001-01-01

    Congenital adrenal hyperplasia (CAH) is the most common cause of female pseudohermaphroditism in Indian children. It is caused by enzymatic defects in the steroidogenic pathway of the adrenal glands and is characterized by impaired cortisol and aldosterone synthesis and overproduction of androgens. The disease usually presents with life-threatening problems and virilization, with long term physical and psychological effects. The clinical and laboratory diagnoses play an important role in deciding the course of treatment, which continues lifelong. To ensure proper growth and development of the patient, optimized disease management and treatment with steroids is required. Often the patient also requires surgical correction. Recent developments in molecular genetics have greatly helped in understanding the pathogenesis of the disease. The gene encoding for steroid 21-hydroxylase, CYP21, is located on the short arm of chromosome 6 in the HLA region and is amplified for genetic diagnosis. Rapid characterization of point mutations is possible using the allele-specific polymerase chain reaction technique in affected children. Counselling, prenatal diagnosis and treatment are recommended in all pregnant women with a positive family history to reduce or eliminate the effects in affected foetuses. This spares the female newborn the consequences of genital ambiguity and problems of gender identity.

  9. [Clinical and genetic aspects of congenital insensitivity to pain with anhidrosis].

    PubMed

    Schwarzkopf, Ran; Pinsk, Vered; Weisel, Yaron; Atar, Dan; Gorzak, Yair

    2005-06-01

    Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive genetic disease, which is characterized by recurrent episodes of fever, anhidrosis, self mutilation, absence of reaction to noxious stimuli, prolonged healing times and mental retardation. The absence of pain sensation combined with mental retardation predisposes the children to recurrent wound infections and deep ulcers that heal at a slower pace than seen in healthy people. The anomalous pain is due to the absence of dorsal root ganglia that are responsible for pain sensation and absence of afferent neurons activated by tissue damaging stimuli. Nerve Growth Factor (NGF) is a growth factor that supports the survival of nociceptive sensory and autonomic sympathetic neurons. Neurotrophin Tyrosine Receptor (NTRK1) encodes a receptor tyrosine kinase that is activated in response to NGF. NTRK1 mutations have been found in mice that presented with clinical signs similar to CIPA, subsequently CIPA patients have been examined for these mutations as well. Currently, 37 different mutations at the NTRK1 are known which cause CIPA. The above syndrome is so rare that until the year 2000 only 84 cases have been reported, not including 28 known cases of CIPA patients from Israeli Bedouins. Since no cure is available, prenatal screening, as conducted in our institution, is the only available preventive option to avoid the birth of an affected child.

  10. Establishing a Biologic Specimens Repository for Reproductive Clinical Trials: Technical Aspects

    PubMed Central

    Krawetz, Stephen A.; Casson, Peter R.; Diamond, Michael P.; Zhang, Heping; Legro, Richard S.; Schlaff, William D.; Coutifaris, Christos; Brzyski, Robert G.; Christman, Gregory M.; Santoro, Nanette; Eisenberg, Esther

    2011-01-01

    The individual research group or independent investigator often requires access to samples from a unique well characterized subject population. Cohorts of such samples from a well-defined comparative population are rare and limited access can impede progress. This bottleneck can be removed by accessing the samples provided by biorepositories such as the NIH/NICHD Cooperative Reproductive Medicine Network (RMN) Biorepository (detailed in the accompanying manuscript in this issue. In those cases where the individual research group or independent investigator already has access to a unique population, comparisons between well-defined groups are often sought to contextualize the data. In both cases seamless integration of data resources associated with the samples is required to ensure optimal comparisons. At the most basic level this requires standardization of sample collection and storage, as well as a de-identified data base containing demographic, clinical, and laboratory values. To facilitate such interoperability, the reagents and protocols that have been adopted by the RMN Biorepository for the collection and storage of serum, blood, saliva and sperm are described. PMID:21899384

  11. Clinical radiological aspects of primary endodontic lesions with secondary periodontal involvement

    PubMed Central

    Jivoinovici, R; Suciu, Ileana; Gheorghiu, I; Suciu, Ioana

    2017-01-01

    Damage of pulp tissue usually begins in the coronal pulp. Its mistreatment or its lack of on time detection determines the progressive inclusion of the whole endodontic space in its evolution, opening the way of its expansion in the surrounding tissues of the tooth, and on the marginal apical tissue. Aim. The goal of this study was to highlight that the primary endodontic lesions with secondary periodontal implication healed and bone repair was obtained due to a proper disinfection and an adequate sealing of the endodontic system. In primary endodontic lesion with secondary periodontal involvement, endodontic treatment is required in the first stage followed by specific periodontal treatment. The prognosis is good if an appropriate endodontic approach is chosen, depending on the stage of the periodontal disease and the treatment response. The identification of the etiological factors is the most important to establish the appropriate treatment. In all clinical cases selected in this article, the healing tendency was noticed after an adequate disinfection and sealing of the endodontic system. PMID:28255382

  12. 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

  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. Respiratory viruses in the pediatric intensive care unit: prevalence and clinical aspects.

    PubMed

    Straliotto, Selir M; Siqueira, Marilda M; Machado, Vera; Maia, Tânia M R

    2004-12-01

    A survey was conducted in two pediatric intensive care units in hospitals in Porto Alegre, Brazil, in order to monitor the main respiratory viruses present in bronchiolitis and/or pneumonia and their involvement in the severity of viral respiratory infections. Viral respiratory infection prevalence was 38.7%. In bronchiolitis, respiratory syncytial virus (RSV) was detected in 36% of the cases. In pneumonia, the prevalence rates were similar for adenovirus (10.3%) and RSV (7.7%). There was a difference among the viruses detected in terms of frequency of clinical findings indicating greater severity. Frequency of crackles in patients with RSV (47.3%) showed a borderline significance (p = 0.055, Fisher's exact test) as compared to those with adenovirus (87.5%). The overall case fatality rate in this study was 2.7%, and adenovirus showed a significantly higher case fatality rate (25%) than RSV (2.8%) (p = 0.005). Injected antibiotics were used in 49% of the children with RSV and 60% of those with adenovirus. Adenovirus was not detected in any of the 33 children submitted to oxygen therapy.

  15. [Pulmonary and cardiovascular syndrome due to hantavirus: clinical aspects of an emerging disease in southeastern Brazil].

    PubMed

    Campos, Gelse Mazzoni; Borges, Alessandra Abel; Badra, Soraya Jabur; Figueiredo, Glauciane Garcia; Souza, Ricardo Luiz Moro de; Moreli, Marcos Lázaro; Figueiredo, Luiz Tadeu Moraes

    2009-01-01

    Pulmonary and cardiovascular syndrome due to hantavirus is a disease caused by inhalation of aerosols from the excreta of wild rodents contaminated by viruses of the Bunyaviridae family. We studied the clinical and laboratory manifestations of 70 cases that occurred in the region of Ribeirão Preto, SP, Brazil, between 1998 and 2007. The frequency of symptoms was as follows: dyspnea (87%), fever (81%), coughing (44%), headache (34%), tachycardia (81%), low arterial blood pressure (56%), metabolic acidosis (57%), lymphocytopenia (51%), hematocrit > 45% (70%), leukocytosis with left deviation (67%), creatinine (51%) and urea (42%). Mortality (54.3%) occurred mainly on the fourth day. Respiratory insufficiency, low arterial blood pressure and shock occurred after 24 to 48 hours. High hematocrit and decreased platelet levels were signs strongly suggestive of the disease. The diagnostic hypothesis of atypical pneumonia was associated with a good prognosis (p = 0.0136). Fluid infusion greater than 2,000 ml and arterial hypotension were associated with a poor prognosis (p = 0.0286 and p = 0.0453).

  16. [Cutaneous histiocytosarcoma: clinical, immunohistochemical and ultrastructural aspects; difficulties of study and problems of nosology (author's transl)].

    PubMed

    Forestier, J Y; Schmitt, D; Thivolet, J

    1980-01-01

    Reporting a case of cutaneous tumor of the back of recent occurrence and rapid increase in a 79-years-old woman, according to Crosti's "reticulosis", the authors discuss the following points:--the histiocytic nature of the tumor cells particularly based on immunohistochemical studies (peroxidase activity, anti-HTLA serum) and on electron microscopy with special reference to the multivesicular bodies found in their cytoplasm;--the tests for correct identification of the histiocyte (including electron microscopy, tests for HTLA and HBLA antigens, peroxidatic reaction, acid phosphatase activity, and in vivo or in vitro phagocytosis);--the out of date character of the concept of malignant "reticulosis" in the hematologica and dermatologic classifications, the recent advances in the knowledge of the nature of the so-called "reticulum" (or "reticular") cell which seems to be a distinct entity derived from the mesenchymal cell (as the fibroblast);--the clinical and evolutive characteristics of histiocytic tumors (no hematologic involvement, slow evolution, high radiosensitivity), the difficulties in defining their malignancy and, above all, in finding comparable references in the literature with complete cellular study;--the nosologic place of this affection among the group of haematodermas and in the pathology of the mononuclear phagocyte system. The generic term of cutaneous histiocytosarcoma (stage I or II) is suggested, including the whole malignant and isolated tumoral proliferations developing from the dermic histiocyte.

  17. Adhesive systems: important aspects related to their composition and clinical use

    PubMed Central

    SILVA E SOUZA JUNIOR, Mario Honorato; CARNEIRO, Karina Gama Kato; LOBATO, Marcelo Figueiredo; SILVA E SOUZA, Patrícia de Almeida Rodrigues; de GÓES, Mário Fernando

    2010-01-01

    This literature review article addresses the types and the main components of different etch-and-rinse and self-etch adhesive systems available in the market, and relates them to their function, possible chemical interactions and influence of handling characteristics. Scanning electron microscopy (SEM) images are presented to characterize the interface between adhesives and dentin. Adhesive systems have been recently classified according to their adhesion approaches in etch-and-rinse, self-etch and glass ionomer. The etch-andrinse systems require a specific acid-etch procedure and may be performed in two or three steps. Self-etch systems employ acidic monomers that demineralize and impregnate dental substrates almost at the same time. These systems are separated in one or two steps. Some advantages and deficiencies were noted for etch-and-rinse and self-etch approaches, mainly for the simplified ones due to some chemical associations and interactions. The SeM micrographs illustrate different relationships between adhesive systems and dental structures, particularly dentin. The knowledge of composition, characteristics and mechanisms of adhesion of each adhesive system is of fundamental importance to permit the adoption of ideal bonding strategies under clinical conditions. PMID:20856995

  18. ENDOCRINOLOGY OF PREGNANCY: Gestational diabetes mellitus: definition, aetiological and clinical aspects.

    PubMed

    Baz, Baz; Riveline, Jean-Pierre; Gautier, Jean-François

    2016-02-01

    Gestational diabetes (GDM) is defined as a glucose intolerance resulting in hyperglycaemia of variable severity with onset during pregnancy. This review aims to revisit the pathogenesis and aetiology of GDM in order to better understand its clinical presentation and outcomes. During normal pregnancy, insulin sensitivity declines with advancing gestation. These modifications are due to placental factors, progesterone and estrogen. In a physiological situation, a compensatory increase in insulin secretion maintains a normal glucose homeostasis. GDM occurs if pancreatic β-cells are unable to face the increased insulin demand during pregnancy. GDM is most commonly a forerunner of type 2 diabetes (T2D) - the most prevalent form of diabetes. These women share similar characteristics with predisposed subjects to T2D: insulin resistance before and after pregnancy, and carry more T2D risk alleles. Auto-immune and monogenic diabetes are more rare aetiologies of GDM. Adverse pregnancy outcomes of GDM are mainly related to macrosomia caused by fetal hyperinsulinism in response to high glucose levels coming from maternal hyperglycaemia. Screening recommendations and diagnosis criteria of GDM have been recently updated. High risk patients should be screened as early as possible using fasting plasma glucose, and if normal, at 24-28 weeks of gestation using 75 g oral glucose tolerance test. The treatment of GDM is based on education with trained nurses and dieticians, and if necessary insulin therapy.

  19. 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.

  20. 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

  1. 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

  2. Current clinical aspects of drug-facilitated sexual assaults in sexually abused victims examined in a forensic emergency unit.

    PubMed

    Marc, Bernard

    2008-04-01

    Sexual assault is defined as any undesired physical contact of a sexual nature perpetrated against another person and is a prevalent problem presenting at emergency departments, emergency forensic medicine units, and rape crisis centres worldwide. Drug-facilitated sexual assault (DFSA) is a complex problem that is encountered with increasing frequency. But this problem is often underrepresented because most DFSAs are not reported by the frightened victims or are diagnosed as an acute drug or alcohol intoxication, thereby bypassing sexual abuse diagnosis and appropriate care. Proper care must be taken to ensure the chain of custody. Emergency physicians need to be aware of the phenomenon and work together with reference emergency forensic medicine units and rape crisis centres, which are capable of taking care of the male and female victims of sexual abuse. If no attention is given to the risk of DFSA, then toxicological samples (urine, blood, hair) and other biologic evidence may remain unidentified and semen, vaginal secretions, and vaginal epithelial cells cannot be genetically typed by a crime laboratory. This article reports the main clinical aspects of DFSA encountered in emergency departments at the beginning of the 21st century and the experience of an emergency forensic medicine unit based at a hospital (Compiègne, France). Guidelines are proposed for clinical examination of DFSA victims, clinical forensic medical examination, and accurate samplings for further toxicological and biological evidence.

  3. Biomechanics of sport concussion: quest for the elusive injury threshold.

    PubMed

    Guskiewicz, Kevin M; Mihalik, Jason P

    2011-01-01

    Previous concussion biomechanics research has relied heavily on the animal model or laboratory reconstruction of concussive injuries captured on video footage. Real-time data collection involves a novel approach to better understanding the medical issues related to sport concussion. Recent studies suggest that a concussive injury threshold is elusive and may, in fact, be irrelevant when predicting the clinical outcome.

  4. Biomechanics of metastatic disease in the vertebral column.

    PubMed

    Whyne, Cari M

    2014-06-01

    Metastatic disease in the vertebral column compromises the structural stability of the spine leading to increased risk of fracture. The complex patterns of osteolytic and osteoblastic disease within the bony spine have motivated a multimodal approach to better characterize the biomechanics of tumor-involved bone. This review presents our current understanding of the biomechanical behavior of metastatically involved vertebrae, and experimental and computational image-based approaches that have been employed to quantify structural integrity in preclinical models with translation to clinical data sets.

  5. Cranial cruciate ligament disease in dogs: biology versus biomechanics.

    PubMed

    Cook, James L

    2010-04-01

    The stifle joint of dogs is an organ comprised of multiple tissue types that must work in concert to maintain joint health and function. Cruciate disease in dogs is caused by a spectrum of causal and risk factors that result in a final common pathway of abnormal biomechanics and abnormal biology causing osteoarthritis, or organ failure, of the stifle and the clinical signs of lameness, pain, and limb dysfunction. It is vital to understand the components of the biologic and biomechanical pathologies to improve our understanding of cruciate disease in dogs so that we can improve preventative, diagnostic, and therapeutic strategies for our canine patients.

  6. Tropical spastic paraparesis and HTLV-1 associated myelopathy: clinical, epidemiological, virological and therapeutic aspects.

    PubMed

    Gessain, A; Mahieux, R

    2012-03-01

    In 1980, Human T cell leukemia/lymphoma virus type 1 (HTLV-1) was the first oncogenic human retrovirus to be discovered. HTLV-1 belongs to the Retroviridae family, the Orthoretrovirinae subfamily and to the deltaretrovirus genus. HTLV-1 preferentially infects CD4(+) lymphoid cells in vivo. Three molecules have been identified for binding and/or entry of HTLV-1: heparan sulfate proteoglycans, neuropilin-1, and glucose transporter 1. An efficient transfer of the virus from an infected cell to a target cell can occur through the formation of a viral synapse and/or by virofilm structure. As for all retroviruses, HTLV-1 genome possesses three major ORFs (gag, pol and env) encoding the structural and enzymatic proteins. HTLV-1 encodes also some regulatory and auxillary proteins including the tax protein with transforming activities and the HBZ protein which plays a role in the proliferation and maintenance of the leukemic cells. HTLV-1 is present throughout the world with clusters of high endemicity including mainly Southern Japan, the Caribbean region, areas in South America and in intertropical Africa. The worldwide HTLV-1 infected population is estimated to be around 10-20 million. HTLV-1 has three modes of transmission: (1): mother to child, mainly linked to prolonged breast-feeding; (2): sexual, mainly occurring from male to female and (3): contaminated blood products. HTLV-1 possesses a remarkable genetic stability. HTLV-1 is the etiological agent of mainly two severe diseases: a malignant T CD4(+) cell lymphoproliferation, of very poor prognosis, named Adult T cell Leukemia/Lymphoma (ATLL), and a chronic neuro-myelopathy named Tropical spastic paraparesis/HTLV-1 Associated Myelopathy (TSP/HAM). The lifetime risk among HTLV-1 carriers is estimated to be around 0.25 to 3%. TSP/HAM mainly occurs in adults, with a mean age at onset of 40-50 years and it is more common in women than in men. Blood transfusion is a major risk factor for TSP/HAM development. Clinically

  7. Mastocytosis: the puzzling clinical spectrum and challenging diagnostic aspects of an enigmatic disease.

    PubMed

    Gülen, T; Hägglund, H; Dahlén, B; Nilsson, G

    2016-03-01

    Mastocytosis is a complex disorder characterized by the accumulation of abnormal mast cells (MC) in the skin, bone marrow and/or other visceral organs. The clinical manifestations result from MC-derived mediators and, less frequently, from destructive infiltration of MCs. Patients suffer from a variety of symptoms including pruritus, flushing and life-threatening anaphylaxis. Whilst mastocytosis is likely to be suspected in a patient with typical skin lesions [i.e. urticaria pigmentosa (UP)], the absence of cutaneous signs does not rule out the diagnosis of this disease. Mastocytosis should be suspected in cases of recurrent, unexplained or severe insect-induced anaphylaxis or symptoms of MC degranulation without true allergy. In rare cases, unexplained osteoporosis or unexplained haematological abnormalities can be underlying feature of mastocytosis, particularly when these conditions are associated with elevated baseline serum tryptase levels. The diagnosis is based on the World Health Organization criteria, in which the tryptase level, histopathological and immunophenotypic evaluation of MCs and molecular analysis are crucial. A somatic KIT mutation, the most common of which is D816V, is usually detectable in MCs and their progenitors. Once a diagnosis of systemic mastocytosis (SM) is made, it is mandatory to assess the burden of the disease, its activity, subtype and prognosis, and the appropriate therapy. Mastocytosis comprises seven different categories that range from indolent forms, such as cutaneous and indolent SM, to progressive forms, such as aggressive SM and MC leukaemia. Although prognosis is good in patients with indolent forms of the disease, patients with advanced categories have a poor prognosis.

  8. [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

  9. 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

  10. Influenza A pandemics: clinical and organizational aspects: the experience in Chile.

    PubMed

    Ugarte, Sebastián; Arancibia, Francisco; Soto, Rodrigo

    2010-04-01

    Recently, the World Health Organization declared a pandemic mediated by the novel A H1N1 influenza virus. Soon after the first report from Mexico, the disease arrived in Chile, where it spread quickly from south to north, mimicking cold weather progression through the country. Between May and September 2009, 366,624 cases of H1N1 were reported; 12,248 were confirmed by real-time reverse-transcription polymerase chain reaction and 1562 were hospitalized. One hundred thirty-two deaths were attributable to the infection, creating a death rate of 0.78 per 100,000 inhabitants. Common comorbidities were present in 59%, including obesity, chronic obstructive pulmonary disease, hypertension, type II diabetes, and congestive heart failure. Nine percent were pregnant. Severe disease developed early; the median time to admittance was 5 days, and the most common clinical manifestations were cough, fever, dyspnea, and myalgia. Mean acute physiology and chronic health evaluation II and sequential organ failure assessment scores were 14 and 5, respectively. Highlighted laboratory data were lactate dehydrogenase and creatine kinase elevation, leukocytosis in 50%, elevated creatinine in a 25%, and thrombocytopenia in 20%. Severe respiratory failure requiring high-frequency oscillatory ventilation and extracorporeal membrane oxygenation as sophisticated modes of respiratory support was seen in 17%. Acute renal failure occurred in 25% of the intensive care unit patients, with death rates near 50%. Health systems reinforced outpatient guards with extra staff and extension of the duty schedules. Antivirals were supplied free for medically diagnosed cases. Admissions for severe cases were prioritized, reconverting hospital beds into advanced care ones; a central coordination station rationed their assignment. Recommendations for small hospitals include adding ventilators, using videoconferences, providing tutorial activity from experts, developing guidelines for disease management, and

  11. Ion transport its regulation in the endolymphatic sac: suggestions for clinical aspects of Meniere's disease.

    PubMed

    Mori, Nozomu; Miyashita, Takenori; Inamoto, Ryuhei; Matsubara, Ai; Mori, Terushige; Akiyama, Kosuke; Hoshikawa, Hiroshi

    2017-04-01

    Ion transport and its regulation in the endolymphatic sac (ES) are reviewed on the basis of recent lines of evidence. The morphological and physiological findings demonstrate that epithelial cells in the intermediate portion of the ES are more functional in ion transport than those in the other portions. Several ion channels, ion transporters, ion exchangers, and so on have been reported to be present in epithelial cells of ES intermediate portion. An imaging study has shown that mitochondria-rich cells in the ES intermediate portion have a higher activity of Na(+), K(+)-ATPase and a higher Na(+) permeability than other type of cells, implying that molecules related to Na(+) transport, such as epithelial sodium channel (ENaC), Na(+)-K(+)-2Cl(-) cotransporter 2 (NKCC2) and thiazide-sensitive Na(+)-Cl(-) cotransporter (NCC), may be present in mitochondria-rich cells. Accumulated lines of evidence suggests that Na(+) transport is most important in the ES, and that mitochondria-rich cells play crucial roles in Na(+) transport in the ES. Several lines of evidence support the hypothesis that aldosterone may regulate Na(+) transport in ES, resulting in endolymph volume regulation. The presence of molecules related to acid/base transport, such as H(+)-ATPase, Na(+)-H(+) exchanger (NHE), pendrin (SLC26A4), Cl(-)-HCO3(-) exchanger (SLC4A2), and carbonic anhydrase in ES epithelial cells, suggests that acid/base transport is another important one in the ES. Recent basic and clinical studies suggest that aldosterone may be involved in the effect of salt-reduced diet treatment in Meniere's disease.

  12. 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

  13. Bioactive peptides in cereals and legumes: agronomical, biochemical and clinical aspects.

    PubMed

    Malaguti, Marco; Dinelli, Giovanni; Leoncini, Emanuela; Bregola, Valeria; Bosi, Sara; Cicero, Arrigo F G; Hrelia, Silvana

    2014-11-14

    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.

  14. Some clinical aspects of reconstruction for chronic anterior cruciate ligament deficiency.

    PubMed Central

    Dandy, D. J.

    1995-01-01

    A total of 250 patients was reviewed 71.8 months (range 49-105 months) after anterior cruciate ligament (ACL) reconstruction for disabling instability that had not responded to conservative treatment or correction of internal derangements. Knees that had undergone previous operation or had damage to other ligaments were excluded. Four techniques were used; MacIntosh extra-articular lateral substitution alone (n = 18), extra-articular reconstruction plus intra-articular carbon fibre (n = 29), extra-articular reconstruction plus a free graft from the medial third of the patellar tendon (n = 74), or extra-articular reconstruction plus a Leeds-Keio prosthesis (n = 129). The knees were assessed 1, 3 and 6 years after reconstruction using the Lysholm score and clinical examination for the anterior drawer, Lachman and pivot shift signs. The mean Lysholm score after 6 years was 77.4 (range 31-100) in the extra-articular group; 74.4 (range 34-100) in the carbon fibre group; 95.4 (range 43-100) in the patellar tendon group; and 91.2 (range 45-100) in the Leeds-Keio group. The patellar tendon group had the highest scores (P < 0.003). The pivot shift sign returned in 39% of the extra-articular group; 48% of the carbon fibre group; 1% of the patellar tendon group, and 36% of the Leeds-Keio group. The pivot shift returned least often in the patellar tendon group (P < 0.001). There were 44% satisfactory results (pivot shift negative and Lysholm score 77 or more) in the extra-articular group; 55% in the carbon fibre group; 92% in the patellar tendon group; and 60% in the Leeds-Keio group.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7574323

  15. 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

  16. 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

  17. Clinical/pharmacological aspect of adenosine A2A receptor antagonist for dyskinesia.

    PubMed

    Kanda, Tomoyuki; Uchida, Shin-ichi

    2014-01-01

    Dopamine replacement therapy using the dopamine precursor, l-3,4-dihydroxyphenylalanine (l-DOPA), with a peripheral dopa decarboxylase inhibitor is the most effective treatment currently available for the symptoms of Parkinson's disease (PD). However, the long-term use of dopaminergic therapies for PD is often limited by the development of motor response complications, such as dyskinesia. Adenosine A2A receptors are a promising nondopaminergic target for the treatment of PD. The treatment of motor response complications involves combinations of regular and controlled release L-DOPA, perhaps with the addition of a COMT inhibitor or the use of a longer-acting dopamine agonist. However, when dyskinesia is already established, the increase in dopaminergic load produced by the addition of a dopamine agonist can result in an increase in the severity and duration of dyskinesia. Currently, there are no well-tolerated antidyskinesia agents available. Amantadine, which may exert its effects through the inhibition of N-methyl-D-aspartate (NMDA) receptors, shows some effects on established dyskinesia. Dyskinesia has a negative impact on the quality of life of patients, sometimes being more disabling than PD itself. Although some patients prefer experiencing dyskinesia than being in the OFF state and unable to move, alternative, more effective therapies are still required for severe disabling dyskinesia to afford patients an improved quality of life while in the ON state. The mechanisms causing and maintaining the dyskinesia have not been clarified. The application of a nondopaminergic approach to modify the basal ganglial activity would be helpful to better understand and treat dyskinesia. The use of an adenosine A2A receptor may provide one such approach. In this literature review, we will summarize the current knowledge from both clinical and nonclinical studies on the effects of adenosine A2A receptor blockade on dyskinesia.

  18. Biomechanics of whiplash injury.

    PubMed

    Chen, Hai-bin; Yang, King H; Wang, Zheng-guo

    2009-10-01

    Despite a large number of rear-end collisions on the road and a high frequency of whiplash injuries reported, the mechanism of whiplash injuries is not completely understood. One of the reasons is that the injury is not necessarily accompanied by obvious tissue damage detectable by X-ray or MRI. An extensive series of biomechanics studies, including injury epidemiology, neck kinematics, facet capsule ligament mechanics, injury mechanisms and injury criteria, were undertaken to help elucidate these whiplash injury mechanisms and gain a better understanding of cervical facet pain. These studies provide the following evidences to help explain the mechanisms of the whiplash injury: (1) Whiplash injuries are generally considered to be a soft tissue injury of the neck with symptoms such as neck pain and stiffness, shoulder weakness, dizziness, headache and memory loss, etc. (2) Based on kinematical studies on the cadaver and volunteers, there are three distinct periods that have the potential to cause injury to the neck. In the first stage, flexural deformation of the neck is observed along with a loss of cervical lordosis; in the second stage, the cervical spine assumes an S-shaped curve as the lower vertebrae begin to extend and gradually cause the upper vertebrae to extend; during the final stage, the entire neck is extended due to the extension moments at both ends. (3) The in vivo environment afforded by rodent models of injury offers particular utility for linking mechanics, nociception and behavioral outcomes. Experimental findings have examined strains across the facet joint as a mechanism of whiplash injury, and suggested a capsular strain threshold or a vertebral distraction threshold for whiplash-related injury, potentially producing neck pain. (4) Injuries to the facet capsule region of the neck are a major source of post-crash pain. There are several hypotheses on how whiplash-associated injury may occur and three of these injuries are related to strains

  19. Benefits of Repetitive Transcranial Magnetic Stimulation (rTMS) for Spastic Subjects: Clinical, Functional, and Biomechanical Parameters for Lower Limb and Walking in Five Hemiparetic Patients

    PubMed Central

    Gross, Raphael; Leboeuf, Fabien; Desal, Hubert; Hamel, Olivier; Nguyen, Jean Paul; Pérot, Chantal; Buffenoir, Kévin

    2014-01-01

    Introduction. Spasticity is a disabling symptom resulting from reorganization of spinal reflexes no longer inhibited by supraspinal control. Several studies have demonstrated interest in repetitive transcranial magnetic stimulation in spastic patients. We conducted a prospective, randomized, double-blind crossover study on five spastic hemiparetic patients to determine whether this type of stimulation of the premotor cortex can provide a clinical benefit. Material and Methods. Two stimulation frequencies (1 Hz and 10 Hz) were tested versus placebo. Patients were assessed clinically, by quantitative analysis of walking and measurement of neuromechanical parameters (H and T reflexes, musculoarticular stiffness of the ankle). Results. No change was observed after placebo and 10 Hz protocols. Clinical parameters were not significantly modified after 1 Hz stimulation, apart from a tendency towards improved recruitment of antagonist muscles on the Fügl-Meyer scale. Only cadence and recurvatum were significantly modified on quantitative analysis of walking. Neuromechanical parameters were modified with significant decreases in Hmax⁡ /Mmax⁡ and T/Mmax⁡ ratios and stiffness indices 9 days or 31 days after initiation of TMS. Conclusion. This preliminary study supports the efficacy of low-frequency TMS to reduce reflex excitability and stiffness of ankle plantar flexors, while clinical signs of spasticity were not significantly modified. PMID:24883390

  20. Biomechanics and functionality of hepatocytes in liver cirrhosis.

    PubMed

    Sun, Shan; Song, Zhenyuan; Cotler, Scott J; Cho, Michael

    2014-06-27

    Cirrhosis is a life-threatening condition that is generally attributed to overproduction of collagen fibers in the extracellular matrix that mechanically stiffens the liver. Chronic liver injury due to causes including viral hepatitis, inherited and metabolic liver diseases and external factors such as alcohol abuse can result in the development of cirrhosis. Progression of cirrhosis leads to hepatocellular dysfunction. While extensive studies to understand the complexity underlying liver fibrosis have led to potential application of anti-fibrotic drugs, no such FDA-approved drugs are currently available. Additional studies of hepatic fibrogenesis and cirrhosis primarily have focused on the extracellular matrix, while hepatocyte biomechanics has received limited attention. The role of hepatocyte biomechanics in liver cirrhosis remains elusive, and how the cell stiffness is correlated with biological functions of hepatocytes is also unknown. In this study, we demonstrate that the biomechanical properties of hepatocytes are correlated with their functions (e.g., glucose metabolism), and that hepatic dysfunction can be restored through modulation of the cellular biomechanics. Furthermore, our results indicate the hepatocyte functionality appears to be regulated through a crosstalk between the Rho and Akt signaling. These novel findings may lead to biomechanical intervention of hepatocytes and the development of innovative tissue engineering for clinical treatment to target liver cells rather than exclusively focusing on the extracellular matrix alone in liver cirrhosis.

  1. Biomechanical Assessment in Models of Glaucomatous Optic Neuropathy

    PubMed Central

    Nguyen, Thao D.; Ethier, C. Ross

    2015-01-01

    The biomechanical environment within the eye is of interest in both the regulation of intraocular pressure and the loss of retinal ganglion cell axons in glaucomatous optic neuropathy. Unfortunately, this environment is complex and difficult to determine. Here we provide a brief introduction to basic concepts of mechanics (stress, strain, constitutive relationships) as applied to the eye, and then describe a variety of experimental and computational approaches used to study ocular biomechanics. These include finite element modeling, direct experimental measurements of tissue displacements using optical and other techniques, direct experimental measurement of tissue microstructure, and combinations thereof. Thanks to notable technical and conceptual advances in all of these areas, we are slowly gaining a better understanding of how tissue biomechanical properties in both the anterior and posterior segments may influence the development of, and risk for, glaucomatous optic neuropathy. Although many challenging research questions remain unanswered, the potential of this body of work is exciting; projects underway include the coupling of clinical imaging with biomechanical modeling to create new diagnostic tools, development of IOP control strategies based on improved understanding the mechanobiology of the outflow tract, and attempts to develop novel biomechanically-based therapeutic strategies for preservation of vision in glaucoma. PMID:26115620

  2. 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.

  3. 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

  4. Peritonsillar abscess: clinical aspects of microbiology, risk factors, and the association with parapharyngeal abscess.

    PubMed

    Klug, Tejs Ehlers

    2017-03-01

    pathogen in PTA, we recommend clindamycin instead of a macrolide in penicillin-allergic patients with PTA. Furthermore, cultures made from PTA aspirates should include a selective FN-agar plate in order to identify growth of this bacterium. Recent studies of sore throat patients document an association between recovery of FN and acute tonsillitis. Studying the bacterial flora of both tonsils in study II, we found almost perfect concordance between the bacterial findings of the tonsillar core at the side of the abscess and contralaterally. This finding suggests that FN is not a subsequent overgrowth phenomenon after abscess development, but that FN can act as pathogen in severe acute tonsillitis. Future studies of patients with FN-positive acute tonsillitis focusing on the optimal methods (clinical characteristics, culture, polymerase chain reaction, or other) for diagnosis and whether antibiotics (and which) can reduce symptoms and avoid complications are warranted. Until further studies are undertaken, we recommend clinicians to have increased focus on acute tonsillitis patients aged 15-24 years with regards to symptoms and findings suggestive of incipient peritonsillar involvement. We have conducted a number of studies with novel findings: 1. FN is a significant and prevalent pathogen in PTA. 2. Bacteremia during abscess tonsillectomy is no more prevalent than during elective tonsillectomy. 3. The development of anti-FN antibodies in FN-positive PTA patients. We have used novel approaches as principles to suggest pathogenic significance of candidate microorganisms: 1. Comparative microbiology between PTA patients and "normal tonsils". 2. Measurements indicating larger inflammatory response compared to clinically equivalent infection.

  5. 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.

  6. Clinical aspects of left ventricular diastolic function assessed by Doppler echocardiography following acute myocardial infarction.

    PubMed

    Poulsen, S H

    2001-11-01

    LV systolic function and dilation after Ml have been extensively studied and have been related to heart failure and cardiac mortality. In recent years, it has been increasingly apparent that LV diastolic dysfunction contributes to signs and symptoms of heart failure and LV diastolic dysfunction is associated with increased mortality rates in patients chronic heart failure independent of systolic function. LV diastolic dysfunction is difficult to assess on basis of clinical examination including chest radiography and electrocardiography. LV diastolic filling has traditionally been evaluated by cardiac catherization with direct measurement of filling pressures and relaxation. However, the invasive approach describing LV compliance and relaxation as the major determinants of LV diastolic function, is not feasible and suitable for routine investigations of diastolic function. Two-dimensional and Doppler echocardiography has become a well accented practical and safe non-invasive method for diagnosis of LV diastolic dysfunction. Combined invasive and echocardiographic studies have shown that analysis of mitral and pulmonary venous flow velocities relate to invasively measured filling pressures and relaxation rate in cardiac diseases. Based on Doppler analysis of mitral and pulmonary venous flow three abnormal LV filling patterns are identified: impaired relaxation, "pseudonormalization" and restrictive. These LV filling patterns have been related to symptoms, relaxation rate, filling pressure and prognosis in patients with restrictive and dilated cardiomyopathy. The Doppler flow profiles are influenced by several factors including age, heart rate, load conditions and valve heart diseases which must be taken into consideration during evaluation. During the last decade information about LV diastolic function assessed non-invasively by Doppler echocardiography has gained in patients with CAD. Myocardial ischemia induced by brief coronary artery occlusion or pacing leads to

  7. Coronary artery bifurcation biomechanics and implications for interventional strategies.

    PubMed

    Moore, James E; Timmins, Lucas H; Ladisa, John F

    2010-11-15

    The treatment of atherosclerotic plaques near and involving coronary bifurcations is especially challenging for interventional procedures. Optimization of these treatment strategies should begin with an understanding of how disease came to be localized to these regions, followed by careful design of the interventional tools and implanted devices. This manuscript reviews the basic biomechanics of coronary bifurcations, stented arteries, and the complex biomechanical challenges associated with bifurcation stenting. Flow patterns in bifurcations are inherently complex, including vortex formation and creation of zones of low and oscillating wall shear stress that coincide with early intimal thickening. Bifurcation geometry (in particular, the angle between the side branches), is of paramount importance in creating these proatherogenic conditions. This predilection for disease formation leads to a large number of bifurcation lesions presenting for clinical intervention. Therefore, several strategies have developed for treating these challenging lesions, including both dedicated devices and creative adaptation of single vessel lesion technologies. The biomechanical implications of these strategies are likely important in short and long term clinical outcomes. While the biomechanical environment in a stented coronary bifurcation is extremely challenging to model, computational methods have been deployed recently to better understand these implications. Enhancement of clinical success will be best achieved through the collaborative efforts of clinicians, biomechanicians, and device manufacturers.

  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. Review of renal tumors associated with Birt-Hogg-Dubé syndrome with focus on clinical and pathobiological aspects.

    PubMed

    Kuroda, N; Furuya, M; Nagashima, Y; Gotohda, H; Kawakami, F; Moritani, S; Ota, S; Hora, M; Michal, M; Hes, O; Nakatani, Y

    2014-06-01

    Birt-Hogg-Dubé syndrome (BHDS) is an autosomal dominant inherited disorder characterized by clinical features of skin lesions, pulmonary lesions and renal tumor. The gene responsible for this syndrome is located on chromosome 17p11.2 and designated as FLCN. In this article, we review renal tumors associated with BHDS with a focus on clinical and pathobiological aspects. Renal tumors often occur multifocally or bilaterally in the imaging analyses or gross examination. Histological examination of renal tumors includes a variety of subtypes such as hybrid oncocytic tumor, chromophobe renal cell carcinoma (RCC), oncocytoma, clear cell RCC and papillary RCC. The histologic discordance in multiple tumors seems to be characteristic of this syndrome. Oncocytosis is observed histologically in about half of the cases. Several investigations have elucidated that folliculin may be involved in the mammalian target of rapamycin (mTOR) pathway recently. Renal tumors composed of clear cells may behave in an aggressive fashion. However, renal tumors including hybrid oncocytic tumor, chromophobe RCC and oncocytoma behave mostly in an indolent fashion.

  10. The biomechanics of seed germination.

    PubMed

    Steinbrecher, Tina; Leubner-Metzger, Gerhard

    2016-12-07

    From a biomechanical perspective, the completion of seed (and fruit) germination depends on the balance of two opposing forces: the growth potential of the embryonic axis (radicle-hypocotyl growth zone) and the restraint of the seed-covering layers (endosperm, testa, and pericarp). The diverse seed tissues are composite materials which differ in their dynamic properties based on their distinct cell wall composition and water uptake capacities. The biomechanics of embryo cell growth during seed germination depend on irreversible cell wall loosening followed by water uptake due to the decreasing turgor, and this leads to embryo elongation and eventually radicle emergence. Endosperm weakening as a prerequisite for radicle emergence is a widespread phenomenon among angiosperms. Research into the biochemistry and biomechanics of endosperm weakening has demonstrated that the reduction in puncture force of a seed's micropylar endosperm is environmentally and hormonally regulated and involves tissue-specific expression of cell wall remodelling proteins such as expansins, diverse hydrolases, and the production of directly acting apoplastic reactive oxygen. The endosperm-weakening biomechanics and its underlying cell wall biochemistry differ between the micropylar (ME) and chalazal (CE) endosperm domains. In the ME, they involve cell wall loosening, cell separation, and programmed cell death to provide decreased and localized ME tissue resistance, autolysis, and finally the formation of an ME hole required for radicle emergence. Future work will further unravel the molecular mechanisms, environmental regulation, and evolution of the diverse biomechanical cell wall changes underpinning the control of germination by endosperm weakening.

  11. Navigating the site for embryo implantation: biomechanical and molecular regulation of intrauterine embryo distribution.

    PubMed

    Chen, Qi; Zhang, Ying; Elad, David; Jaffa, Ariel J; Cao, Yujing; Ye, Xiaoqin; Duan, Enkui

    2013-10-01

    The distribution of intrauterine embryo implantation site(s) in most mammalian species shows remarkably constant patterns: in monotocous species such as humans, an embryo tends to implant in the uterine fundus; in polytocous species such as rodents, embryos implant evenly along the uterine horns. These long-time evolved patterns bear great biological significance because disruption of these patterns can have adverse effects on pregnancies. However, lack of suitable models and in vivo monitoring techniques has impeded the progress in understanding the mechanisms of intrauterine embryo distribution. These obstacles are being overcome by genetically engineered mouse models and newly developed high-resolution ultrasound. It has been revealed that intrauterine embryo distribution involves multiple events including uterine sensing of an embryo, fine-tuned uterine peristaltic movements, time-controlled uterine fluid reabsorption and uterine luminal closure, as well as embryo orientation. Diverse molecular factors, such as steroid hormone signaling, lipid signaling, adrenergic signaling, developmental genes, ion/water channels, and potentially embryonic signaling are actively involved in intrauterine embryo distribution. This review covers the biomechanical and molecular aspects of intrauterine embryo distribution (embryo spacing at the longitudinal axis and embryo orientation at the vertical axis), as well as its pathophysiological roles in human reproductive medicine. Future progress requires multi-disciplinary research efforts that will integrate in vivo animal models, clinical cases, physiologically relevant in vitro models, and biomechanical/computational modeling. Understanding the mechanisms for intrauterine embryo distribution could potentially lead to development of therapeutics for treating related conditions in reproductive medicine.

  12. Smoothing spline analysis of variance models: A new tool for the analysis of cyclic biomechanical data.

    PubMed

    Helwig, Nathaniel E; Shorter, K Alex; Ma, Ping; Hsiao-Wecksler, Elizabeth T

    2016-10-03

    Cyclic biomechanical data are commonplace in orthopedic, rehabilitation, and sports research, where the goal is to understand and compare biomechanical differences between experimental conditions and/or subject populations. A common approach to analyzing cyclic biomechanical data involves averaging the biomechanical signals across cycle replications, and then comparing mean differences at specific points of the cycle. This pointwise analysis approach ignores the functional nature of the data, which can hinder one׳s ability to find subtle differences between experimental conditions and/or subject populations. To overcome this limitation, we propose using mixed-effects smoothing spline analysis of variance (SSANOVA) to analyze differences in cyclic biomechanical data. The SSANOVA framework makes it possible to decompose the estimated function into the portion that is common across groups (i.e., the average cycle, AC) and the portion that differs across groups (i.e., the contrast cycle, CC). By partitioning the signal in such a manner, we can obtain estimates of the CC differences (CCDs), which are the functions directly describing group differences in the cyclic biomechanical data. Using both simulated and experimental data, we illustrate the benefits of using SSANOVA models to analyze differences in noisy biomechanical (gait) signals collected from multiple locations (joints) of subjects participating in different experimental conditions. Using Bayesian confidence intervals, the SSANOVA results can be used in clinical and research settings to reliably quantify biomechanical differences between experimental conditions and/or subject populations.

  13. 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)

  14. 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

  15. Biomechanics of soft tissues.

    PubMed

    Miller, K

    2000-01-01

    Recent developments in Computer-Integrated and Robot-Aided Surgery (in particular, the emergence of automatic surgical tools and robots (as well as advances in Virtual Reality techniques, call for closer examination of the mechanical properties of very soft tissues (such as brain, liver, kidney, etc.). Moreover, internal organs are very susceptible to trauma. In order to protect them properly against car crash and other impact consequences we need to be able to predict the organ deformation. Such prediction can be achieved by proper mathematical modelling followed by a computer simulation. The ultimate goal of our research into the biomechanics of these tissues is development of corresponding, realistic mathematical models. This paper contains experimental results of in vitro, uniaxial, unconfined compression of swine brain tissue obtained by the author in Mechanical Engineering Laboratory, Japan, and discusses liver and kidney in vivo compression experiments conducted in Highway Safety Research Institute and the Medical Centre of The University of Michigan. The stress-strain curves for investigated tissues are concave upward for all compression rates containing no linear portion from which a meaningful elastic modulus might be determined. The tissue response stiffened as the loading speed increased, indicating a strong stress (strain rate dependence. As the step in the direction towards realistic computer simulation of injuries and surgical procedures, this paper presents two mathematical representations of brain, liver and kidney tissue stiffness. Biphasic and single-phase models are discussed. The biphasic model is shown to be inappropriate due to its inability to account for strong stress-strain relationship. Agreement between the proposed single-phase models and experiment is good for compression levels reaching 30% and for loading velocities varying over five orders of magnitude. Presented mathematical models can find applications in computer and robot

  16. [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

  17. 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

  18. Clinical aspects of blastomycosis

    PubMed Central

    O'Neill, Richard P.; Penman, Robert W.

    1970-01-01

    Blastomycosis is a specific granulomatous disease which tends to be chronic and indolent. It frequently presents in extrapulmonary form by means of haematogenous dissemination from the lungs. It has been shown that tuberculosis, histoplasmosis and coccidioidomycosis are, in the majority of cases, mild and subclinical in effect and often heal without therapy. It is probable that blastomycosis behaves in a like manner. The exact mortality is not known but is probably in the range of 13% in hospitalized cases with disseminated disease (Blastomycosis Cooperative Study of the Veterans Administration, 1964). The most effective form of therapy in active disease is amphotericin B; 2-hydroxy-stilbamidine is also used. Blastomycosis has largely been considered to be a disease of the American continent. However, cases have been reported from Africa and Europe and therefore a wider appreciation of this disease is considered pertinent. The relevant literature has been reviewed and four illustrative cases are presented. Images PMID:5537055

  19. [Nosocomial infection: clinical aspects].

    PubMed

    Frottier, J

    1993-05-01

    Nosocomial infections develop within a hospital or are produced by microorganisms acquired during hospitalization. They may involve not only patients (2 to 10 percent) but also hospital personnel. They arise from complex interactions of multiple causal factors. Patients risk factors are these that reduce the patient's capacity for resisting the injurious effects of the microorganisms and impair natural host defense mechanisms: patients with malignant disorders or immunosuppressive therapy, poor nutritional status, extensive burn wounds ... The young and the elderly are generally more susceptible to infection. Other infections are preventable. Disease causation is often multifactorial. Nosocomial urinary tract infections had the highest rate, followed by lower respiratory tract infections, surgical infections and bacteremias. The emergence of other nosocomial infections, caused by bacteria (tuberculosis), virus (HIV, hepatitis B and C virus, cytomegalovirus...), Aspergillus species or Pneumocystis carinii appears to be recent in origin and is of importance to immunocompromised hosts, other patients and hospital personnel. Nosocomial infections and their social and economic impacts require for their prevention vigorous organized hospital-wide surveillance and control programs.

  20. 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.

  1. 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.

  2. 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.

  3. Biomechanical properties of the keratoconic cornea: a review.

    PubMed

    Vellara, Hans R; Patel, Dipika V

    2015-01-01

    There has been a recent surge of interest in assessing corneal biomechanical properties due to potential clinical applications, particularly in the early detection of keratoconus (KC). This review discusses the effects of keratoconus on the biomechanical properties of the cornea and the current techniques used to detect these changes both in the laboratory and clinical setting. Specific structural changes occurring in the corneal stroma as part of the disease process can be linked to alterations in the viscous and elastic properties of the cornea in keratoconus. Although there are extensive ex vivo studies using techniques such as extensometry and inflation testing to analyse the biomechanical properties of the normal cornea, few have investigated the keratoconic cornea using the same methods. There are a number of ex vivo studies that confirm the effectiveness of collagen cross-linking in increasing Young's modulus in healthy corneas. Recently, research has focussed on measuring corneal biomechanical parameters in vivo using two commercially available instruments: the Ocular Response Analyser (ORA) and the CorVis ST (CST). Both instruments analyse the dynamic behaviour of the cornea, when temporarily deformed by an air puff; however, the outputs of these instruments are not directly comparable due to differences in the characteristics of the air puff and output parameters. Studies using these instruments have reported significant differences between keratoconic and healthy corneas; however, neither instrument can currently be used in isolation to reliably diagnose keratoconus. Further research analysing the outputs of these instruments may enhance their diagnostic capabilities.

  4. 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

  5. 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.

  6. Clinical and translational aspects of hypothermia in major trauma patients: from pathophysiology to prevention, prognosis and potential preservation.

    PubMed

    Søreide, Kjetil

    2014-04-01

    The human body strives at maintaining homeostasis within fairly tight regulated mechanisms that control vital regulators such as core body temperature, mechanisms of metabolism and endocrine function. While a wide range of medical conditions can influence thermoregulation the most common source of temperature loss in trauma patients includes: exposure (environmental, as well as cavitary), the administration of i.v. fluids, and anaesthesia/loss of shivering mechanisms, and blood loss per se. Loss of temperature can be classified either according to the aetiology (i.e. accidental/spontaneous versus trauma/haemorrhage-induced temperature loss), or according to an unintended, accidental induction in contrast to a medically intended therapeutic hypothermia. Hypothermia occurs infrequently (prevalence<10% of all injured), but more often (30-50%) in the severely injured. Hypothermia usually come together with and may aggravate acidosis and coagulopathy (the "lethal triad of trauma"), which again may be associated with a high mortality. However, recent studies disagree in the independent predictive role of hypothermia and mortality. Prevention of hypothermia is imperative through all phases of trauma care and must be an interest among all team members. Hypothermia in the trauma setting has attracted focus in the past from a pathophysiological, preventive and prognostic perspective; yet recent focus has shifted towards the potential for using hypothermia for pre-emptive and cellular protective purposes. This paper gives a brief update on some of the clinically relevant aspects of hypothermia in the injured patient.

  7. Parent and teacher report of pragmatic aspects of communication: use of the children's communication checklist in a clinical setting.

    PubMed

    Bishop, D V; Baird, G

    2001-12-01

    The Children's Communication Checklist (CCC) was developed to provide an objective assessment of pragmatic aspects of children's communication difficulties. We aimed to (1) see whether the checklist provided valid and reliable information when completed by parents, and (2) consider its usefulness in a clinical context. Checklists were completed by parents and a professional who knew the child well for all 5 to 17-year-old referrals to a tertiary developmental paediatrics centre over a 31-month period. Children who were not yet speaking in sentences were excluded. From a sample of 151 children (81% male; mean age 8.7 years) with pervasive or specific developmental disorders, valid checklists were completed by 119 parents and 93 professionals. Reliability, as measured by internal consistency, was 0.7 or higher for most scales. Correlations between ratings for parents and professionals were in the range of 0.30 to 0.58 for individual pragmatic scales, with a correlation of 0.46 (n=82) for the pragmatic composite. For both parents and professionals, the pragmatic composite was lowest for children with a diagnosis of autism; intermediate for those with a diagnosis of Asperger syndrome, pervasive developmental disorder not otherwise specified or attention-deficit-hyperactivity disorder (ADHD); and highest for those with a diagnosis of specific learning disability. The strongest relation between the pragmatic composite and diagnosis was seen when ratings from parents and professionals were combined. Differences between diagnostic groups were not explicable in terms of age or verbal IQ.

  8. 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

  9. 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.

  10. Biomechanical Evaluation of Ascending Aortic Aneurysms

    PubMed Central

    Avanzini, Andrea; Battini, Davide

    2014-01-01

    The biomechanical properties of ascending aortic aneurysms were investigated only in the last decade in a limited number of studies. Indeed, in recent years, there has been a growing interest in this field in order to identify new predictive parameters of risk of dissection, which may have clinical relevance. The researches performed so far have been conducted according to the methods used in the study of abdominal aortic aneurysms. In most cases, uniaxial or biaxial tensile tests were used, while in a smaller number of studies other methods, such as opening angle, bulge inflation, and inflation-extension tests, were used. However, parameters and protocols of these tests are at present very heterogeneous in the studies reported in the literature, and, therefore, the results are not comparable and are sometimes conflicting. The purpose of this review then thence to provide a comprehensive analysis of the experimental methodology for determination of biomechanical properties in the specific field of aneurysms of the ascending aorta to allow for better comparison and understanding of the results. PMID:24991568

  11. Cerebral Blood Volume ASPECTS Is the Best Predictor of Clinical Outcome in Acute Ischemic Stroke: A Retrospective, Combined Semi-Quantitative and Quantitative Assessment

    PubMed Central

    Padroni, Marina; Bernardoni, Andrea; Tamborino, Carmine; Roversi, Gloria; Borrelli, Massimo; Saletti, Andrea; De Vito, Alessandro; Azzini, Cristiano; Borgatti, Luca; Marcello, Onofrio; d’Esterre, Christopher; Ceruti, Stefano; Casetta, Ilaria; Lee, Ting-Yim; Fainardi, Enrico

    2016-01-01

    Introduction The capability of CT perfusion (CTP) Alberta Stroke Program Early CT Score (ASPECTS) to predict outcome and identify ischemia severity in acute ischemic stroke (AIS) patients is still questioned. Methods 62 patients with AIS were imaged within 8 hours of symptom onset by non-contrast CT, CT angiography and CTP scans at admission and 24 hours. CTP ASPECTS was calculated on the affected hemisphere using cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) maps by subtracting 1 point for any abnormalities visually detected or measured within multiple cortical circular regions of interest according to previously established thresholds. MTT-CBV ASPECTS was considered as CTP ASPECTS mismatch. Hemorrhagic transformation (HT), recanalization status and reperfusion grade at 24 hours, final infarct volume at 7 days and modified Rankin scale (mRS) at 3 months after onset were recorded. Results Semi-quantitative and quantitative CTP ASPECTS were highly correlated (p<0.00001). CBF, CBV and MTT ASPECTS were higher in patients with no HT and mRS≤2 and inversely associated with final infarct volume and mRS (p values: from p<0.05 to p<0.00001). CTP ASPECTS mismatch was slightly associated with radiological and clinical outcomes (p values: from p<0.05 to p<0.02) only if evaluated quantitatively. A CBV ASPECTS of 9 was the optimal semi-quantitative value for predicting outcome. Conclusions Our findings suggest that visual inspection of CTP ASPECTS recognizes infarct and ischemic absolute values. Semi-quantitative CBV ASPECTS, but not CTP ASPECTS mismatch, represents a strong prognostic indicator, implying that core extent is the main determinant of outcome, irrespective of penumbra size. PMID:26824672

  12. Biomechanical analysis of pediatric injuries and child restraint system.

    PubMed

    Kumar, Sri; Harcourt, John; Herbst, Brian; Strickland, Daniel

    2012-01-01

    Airbag related injuries to infants in rear facing child seats are common in frontal crashes. Several vehicular modifications such as deactivated passenger airbags, manual cut-off switches, depowered airbags and smart airbags have been advanced to mitigate the effect of airbag deployment on child seats. However, there is limited research effort to address the biomechanics of airbag injuries due to modification in child restraint systems. The purpose of this research is to evaluate the biomechanical effects of a protective barrier between the rear facing child restraint and the frontal passenger airbag of the vehicle. An experimental study was conducted using an Anthropometric Test Dummy (ATD) in a vehicular partial structure (buck). The rear facing child seat was placed in the right front passenger seat of the vehicle. The child seat was restrained using the three-point restraint in the vehicle. The six-month-old instrumented ATD was restrained in the child seat. The ATD was instrumented with the head tri-axial and two uni-axial linear accelerometers. The uni-axial linear acceleration was used to calculate the angular acceleration. Two different rear facing child seats, the standard rear facing infant seat and the rear facing infant seat inside the protective barrier structure were tested. In each test, the Head Injury Criteria (HIC) and angular head acceleration were measured. Results show that the HIC was reduced by 95% and the angular head acceleration was reduced by 85% by the protective barrier. The head injury values were well below the tolerance limit for the child with the barrier. The protective barrier deflected the airbag away from the ATD’s head and also acted as a shield to minimize airbag force on the child seat. In the typical infant seat, the airbag contacted the ATD’s head and exerted significant force on the child seat which rotated the seat rearward. These kinematic responses may explain the clinical observation of severe head injuries by

  13. Biomechanics and pathomechanisms of osteoarthritis.

    PubMed

    Egloff, Christian; Hügle, Thomas; Valderrabano, Victor

    2012-07-19

    Today, the most frequent chronic musculoskeletal disorder and the leading cause of disability in the elderly is osteoarthritis (OA). Approximately 43 million people in the United States and 15% of the world population are affected. Due to demographic changes, the incidence of OA is rapidly increasing, leading to an ascending socioeconomical and personal burden. Despite the exact cause of OA remains unknown, the pathogenic role of biomechanical dysfunction in OA is well established. For weight-bearing joints altered loading mechanisms, increased mechanical forces and changed biomechanics are significant contributing factors for initiation and progression of OA. Thus, OA is a disease of the whole joint, including muscles, tendons, ligaments, synovium and bone. This review focuses on the influence of biomechanics on the pathogenesis and progression of OA. We notably illustrate the pathological bioreactivity of soft tissues, subchondral bone and joint inflammation. Procedures, conservative or surgical, which actively alter the biomechanics of the lower limb, are promising strategies to treat symptoms as well as to influence disease progression in OA.

  14. Biomechanics of complex shoulder instability.

    PubMed

    Degen, Ryan M; Giles, Joshua W; Thompson, Stephen R; Litchfield, Robert B; Athwal, George S

    2013-10-01

    Identification and treatment of the osseous lesions associated with complex shoulder instability remains challenging. Further biomechanical testing is required to delineate critical defect values and determine which treatments provide improved glenohumeral joint stability for the various defect sizes, while minimizing the associated complications.

  15. 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.

  16. Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) as a model of small vessel disease: update on clinical, diagnostic, and management aspects.

    PubMed

    Di Donato, Ilaria; Bianchi, Silvia; De Stefano, Nicola; Dichgans, Martin; Dotti, Maria Teresa; Duering, Marco; Jouvent, Eric; Korczyn, Amos D; Lesnik-Oberstein, Saskia A J; Malandrini, Alessandro; Markus, Hugh S; Pantoni, Leonardo; Penco, Silvana; Rufa, Alessandra; Sinanović, Osman; Stojanov, Dragan; Federico, Antonio

    2017-02-24

    Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common and best known monogenic small vessel disease. Here, we review the clinical, neuroimaging, neuropathological, genetic, and therapeutic aspects based on the most relevant articles published between 1994 and 2016 and on the personal experience of the authors, all directly involved in CADASIL research and care. We conclude with some suggestions that may help in the clinical practice and management of these patients.

  17. 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.

  18. Reconstruction of the biomechanical transfer path of femoral head necrosis: a subject-specific finite element investigation.

    PubMed

    Zhou, Guang-Quan; Pang, Zhi-Hui; Chen, Qin-Qun; He, Wei; Chen, Zhen-Qiu; Chen, Lei-Lei; Li, Zi-Qi

    2014-09-01

    According to Wolff׳s law, the structure and function of bone are interdependent. The disruption of trabeculae in the necrotic femoral head destroys the biomechanical transfer path, increasing the risk of a collapse in the cortical bone. Hence, biomaterials are needed to promote osteogenesis to aid in the reconstruction of a similar biomechanical transfer path that can provide structural and biomechanical support to prevent and delay bone deterioration. Fibular allograft combined with impaction bone grafting (FAIBG) is a hip preservation method that provides both biological repair materials and biomechanical support. This method has been used successfully in the clinical setting, but it still lacks biomechanical insight. In this paper, we aim to provide a biomechanical basis for treatment using FAIBG, we used subject-specific finite element (FE) methods to analyse the biomechanical transfer characteristics of hip models: physiological, pathological and postoperative. The physiological model provided insight into the biomechanical transfer characteristics of the proximal femur. The pathological model showed an abnormal stress distribution that destroyed stress transfer capability. The postoperative model showed that FAIBG can reconstruct the biomechanical transfer path of the femoral head and reduce the risk of a collapse in the cortical bone. In conclusion, FAIBG seems to treat necrosis of the femoral head.

  19. 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.

  20. The medical simulation markup language - simplifying the biomechanical modeling workflow.

    PubMed

    Suwelack, Stefan; Stoll, Markus; Schalck, Sebastian; Schoch, Nicolai; Dillmann, Rüdiger; Bendl, Rolf; Heuveline, Vincent; Speidel, Stefanie

    2014-01-01

    Modeling and simulation of the human body by means of continuum mechanics has become an important tool in diagnostics, computer-assisted interventions and training. This modeling approach seeks to construct patient-specific biomechanical models from tomographic data. Usually many different tools such as segmentation and meshing algorithms are involved in this workflow. In this paper we present a generalized and flexible description for biomechanical models. The unique feature of the new modeling language is that it not only describes the final biomechanical simulation, but also the workflow how the biomechanical model is constructed from tomographic data. In this way, the MSML can act as a middleware between all tools used in the modeling pipeline. The MSML thus greatly facilitates the prototyping of medical simulation workflows for clinical and research purposes. In this paper, we not only detail the XML-based modeling scheme, but also present a concrete implementation. Different examples highlight the flexibility, robustness and ease-of-use of the approach.

  1. 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

  2. Loads Carried by Soldiers: Historical, Physiological, Biomechanical and Medical Aspects

    DTIC Science & Technology

    1989-06-01

    most affected. " Winged scapula " was common in many cases. Symptoms were probably due to compression of the upper trunk of the brachial plexus. In...Environmental .,;edicine Protocol No. PH-l-88, Natick, MA, 1988. 49. Hauser, CU and Martin WF. Two additional cases of traumatic winged scapula occurring in...Holder, HG. Winged scapula : case occwrring in soldiers from knapsacks. JAMA 120:448-449, 1942. 55. Jones, BH et al. Exercise induced stress fractures

  3. 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…

  4. Adaptive sports technology and biomechanics: prosthetics.

    PubMed

    De Luigi, Arthur Jason; Cooper, Rory A

    2014-08-01

    With the technologic advances in medicine and an emphasis on maintaining physical fitness, the population of athletes with impairments is growing. It is incumbent upon health care practitioners to make every effort to inform these individuals of growing and diverse opportunities and to encourage safe exercise and athletic participation through counseling and education. Given the opportunities for participation in sports for persons with a limb deficiency, the demand for new, innovative prosthetic designs is challenging the clinical and technical expertise of the physician and prosthetist. When generating a prosthetic prescription, physicians and prosthetists should consider the needs and preferences of the athlete with limb deficiency, as well as the functional demands of the chosen sporting activity. The intent of this article is to provide information regarding the current advancements in the adaptive sports technology and biomechanics in the field of prosthetics, and to assist clinicians and their patients in facilitating participation in sporting activities.

  5. 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

  6. 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

  7. Biomechanics of Gait during Pregnancy

    PubMed Central

    Vieira, Filomena

    2014-01-01

    Introduction. During pregnancy women experience several changes in the body's physiology, morphology, and hormonal system. These changes may affect the balance and body stability and can cause discomfort and pain. The adaptations of the musculoskeletal system due to morphological changes during pregnancy are not fully understood. Few studies clarify the biomechanical changes of gait that occur during pregnancy and in postpartum period. Purposes. The purpose of this review was to analyze the available evidence on the biomechanical adaptations of gait that occur throughout pregnancy and in postpartum period, specifically with regard to the temporal, spatial, kinematic, and kinetic parameters of gait. Methods. Three databases were searched and 9 studies with a follow-up design were retrieved for analysis. Results. Most studies performed temporal, spatial, and kinematic analysis. Only three studies performed kinetic analysis. Conclusion. The adaptation strategies to the anatomical and physiological changes throughout pregnancy are still unclear, particularly in a longitudinal perspective and regarding kinetic parameters. PMID:25587566

  8. Investigation of Crew Restraint System Biomechanics.

    DTIC Science & Technology

    1982-05-01

    46FAMRL-TR-81 -103 SINVESTIGATION OF CREW RESTRAINT SYSTEM BIOMECHANICS NORMWAN S. PHILLIPS ROBERT A. THOMSON IRA B. FISCUS UNIVERSITY OF DA YTON RESEARCH...Escape System Biomechanics 20. ABSTRACT (Continue on reverse side If necessary and identify by block number) .Experimental data were collected and...properties and harness characteristics were included in the model. The analytical model was also used with biomechanical data for the rhesus monkey

  9. Grammont reverse prosthesis: design, rationale, and biomechanics.

    PubMed

    Boileau, Pascal; Watkinson, Duncan J; Hatzidakis, Armodios M; Balg, Frederic

    2005-01-01

    Combined destruction of the rotator cuff and the glenohumeral joint may lead to a painful and pseudo-paralyzed shoulder. In this situation a nonconstrained shoulder prosthesis yields a limited functional result or may even be contraindicated. Previous constrained prostheses (ball-and-socket or reverse ball-and-socket designs) have failed because their center of rotation remained lateral to the scapula, which limited motion and produced excessive torque on the glenoid component, leading to early loosening. The reverse prosthesis designed by Paul Grammont, unlike any previous reverse ball-and-socket design, has introduced 2 major innovations that have led to its success: (1) a large glenoid hemisphere with no neck and (2) a small humeral cup almost horizontally oriented with a nonanatomic inclination of 155 degrees, covering less than half of the glenosphere. This design medializes and stabilizes the center of rotation, minimizes torque on the glenoid component, and helps in recruiting more fibers of the anterior and posterior deltoid to act as abductors. Furthermore, the humerus is lowered relative to the acromion, restoring and even increasing deltoid tension. The Grammont reverse prosthesis imposes a new biomechanical environment for the deltoid muscle to act, thus allowing it to compensate for the deficient rotator cuff muscles. The clinical experience does live up to the biomechanical concept: the reverse prosthesis restores active elevation above 90 degrees in patients with a cuff-deficient shoulder. However, external rotation often remains limited, particularly in patients with an absent or fat-infiltrated teres minor. Internal rotation is also rarely restored after a reverse prosthesis. Failure to restore sufficient tension in the deltoid may result in prosthetic instability. The design does appear to protect against early loosening of the glenoid component, but impingement of the humeral cup on the scapular neck can lead to scapular notching and polyethylene

  10. Complementary Keratoconus Indices Based on Topographical Interpretation of Biomechanical Waveform Parameters: A Supplement to Established Keratoconus Indices

    PubMed Central

    Wagenpfeil, Stefan; Cayless, Alan; Seitz, Berthold

    2017-01-01

    Purpose. To build new models with the Ocular Response Analyzer (ORA) waveform parameters to create new indices analogous to established topographic keratoconus indices. Method. Biomechanical, tomographic, and topographic measurements of 505 eyes from the Homburger Keratoconus Centre were included. Thirty-seven waveform parameters (WF) were derived from the biomechanical measurement with the ORA. Area under curve (ROC, receiver operating characteristic) was used to quantify the screening performance. A logistic regression analysis was used to create two new keratoconus prediction models based on these waveform parameters to resample the clinically established keratoconus indices from Pentacam and TMS-5. Results. ROC curves show the best results for the waveform parameters p1area, p2area, h1, h2, dive1, mslew1, aspect1, aplhf, and dslope1. The new keratoconus prediction model to resample the Pentacam topographic keratoconus index (TKC) was WFTKC = −4.068 + 0.002 × p2area − 0.005 × dive1 − 0.01 × h1 − 2.501 × aplhf, which achieves a sensitivity of 90.3% and specificity of 89.4%; to resample the TMS-5 keratoconus classification index (KCI) it was WFKCI = −3.606 + 0.002 × p2area, which achieves a sensitivity of 75.4% and a specificity of 81.8%. Conclusion. In addition to the biomechanically provided Keratoconus Index two new indices which were based on the topographic gold standards (either Pentacam or TMS-5) were created. Of course, these do not replace the original topographic measurement. PMID:28270858

  11. Complementary Keratoconus Indices Based on Topographical Interpretation of Biomechanical Waveform Parameters: A Supplement to Established Keratoconus Indices.

    PubMed

    Goebels, Susanne; Eppig, Timo; Wagenpfeil, Stefan; Cayless, Alan; Seitz, Berthold; Langenbucher, Achim

    2017-01-01

    Purpose. To build new models with the Ocular Response Analyzer (ORA) waveform parameters to create new indices analogous to established topographic keratoconus indices. Method. Biomechanical, tomographic, and topographic measurements of 505 eyes from the Homburger Keratoconus Centre were included. Thirty-seven waveform parameters (WF) were derived from the biomechanical measurement with the ORA. Area under curve (ROC, receiver operating characteristic) was used to quantify the screening performance. A logistic regression analysis was used to create two new keratoconus prediction models based on these waveform parameters to resample the clinically established keratoconus indices from Pentacam and TMS-5. Results. ROC curves show the best results for the waveform parameters p1area, p2area, h1, h2, dive1, mslew1, aspect1, aplhf, and dslope1. The new keratoconus prediction model to resample the Pentacam topographic keratoconus index (TKC) was WFTKC = -4.068 + 0.002 × p2area - 0.005 × dive1 - 0.01 × h1 - 2.501 × aplhf, which achieves a sensitivity of 90.3% and specificity of 89.4%; to resample the TMS-5 keratoconus classification index (KCI) it was WFKCI = -3.606 + 0.002 × p2area, which achieves a sensitivity of 75.4% and a specificity of 81.8%. Conclusion. In addition to the biomechanically provided Keratoconus Index two new indices which were based on the topographic gold standards (either Pentacam or TMS-5) were created. Of course, these do not replace the original topographic measurement.

  12. 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

  13. Animal Galloping and Human Hopping: An Energetics and Biomechanics Laboratory Exercise

    ERIC Educational Resources Information Center

    Lindstedt, Stan L.; Mineo, Patrick M.; Schaeffer, Paul J.

    2013-01-01

    This laboratory exercise demonstrates fundamental principles of mammalian locomotion. It provides opportunities to interrogate aspects of locomotion from biomechanics to energetics to body size scaling. It has the added benefit of having results with robust signal to noise so that students will have success even if not "meticulous" in…

  14. [Advances on biomechanics and kinematics of sprain of ankle joint].

    PubMed

    Zhao, Yong; Wang, Gang

    2015-04-01

    Ankle sprains are orthopedic clinical common disease, accounting for joint ligament sprain of the first place. If treatment is not timely or appropriate, the joint pain and instability maybe develop, and even bone arthritis maybe develop. The mechanism of injury of ankle joint, anatomical basis has been fully study at present, and the diagnostic problem is very clear. Along with the development of science and technology, biological modeling and three-dimensional finite element, three-dimensional motion capture system,digital technology study, electromyographic signal study were used for the basic research of sprain of ankle. Biomechanical and kinematic study of ankle sprain has received adequate attention, combined with the mechanism research of ankle sprain,and to explore the the biomechanics and kinematics research progress of the sprain of ankle joint.

  15. Dance biomechanics: a tool for controlling health, fitness, and training.

    PubMed

    Koutedakis, Yiannis; Owolabi, Emmanuel O; Apostolos, Margo

    2008-01-01

    The need for superior performance in dance has impelled teachers and choreographers to use increasingly effective and sophisticated methods of preparation. To that end, such modalities ofbiomechanics as advanced motion-capture, muscle-function and muscle-strength techniques are being used to provide useful information about which of the dancers' needs require special attention. This often involves improving aspects of dance technique, which, in turn, may help dancers to prevent disabling injuries, the most frequent cause of notoriously short dance careers. Biomechanics may also help dancers to assess fitness levels, to control overtraining or "burnout," and assist them and their teachers in the effective scheduling of practice and exercise sessions.

  16. Exploring the biomechanics of taurodontism.

    PubMed

    Benazzi, Stefano; Nguyen, Huynh N; Kullmer, Ottmar; Hublin, Jean-Jacques

    2015-02-01

    Taurodontism (i.e. enlarged pulp chamber with concomitant apical displacement of the root bi/trifurcation) is considered a dental anomaly with relatively low incidence in contemporary societies, but it represents a typical trait frequently found in Neandertal teeth. Four hypotheses can be envisioned to explain the high frequency in Neandertals: adaptation to a specific occlusal loading regime (biomechanical advantage), adaptation to a high attrition diet, pleiotropic or genetic drift effects. In this contribution we used finite element analysis (FEA) and advanced loading concepts based on macrowear information to evaluate whether taurodontism supplies some dental biomechanical advantages. Loads were applied to the digital model of the lower right first molar (RM1 ) of the Neandertal specimen Le Moustier 1, as well as to the digital models of both a shortened and a hyper-taurodontic version of Le Moustier RM1 . Moreover, we simulated a scenario where an object is held between teeth and pulled in different directions to investigate whether taurodontism might be useful for para-masticatory activities. Our results do not show any meaningful difference among all the simulations, pointing out that taurodontism does not improve the functional biomechanics of the tooth and does not favour para-masticatory pulling activities. Therefore, taurodontism should be considered either an adaptation to a high attrition diet or most likely the result of pleiotropic or genetic drift effects. Finally, our results have important implications for modern dentistry during endodontic treatments, as we observed that filling the pulp chamber with dentine-like material increases tooth stiffness, and ultimately tensile stresses in the crown, thus favouring tooth failure.

  17. Exploring the biomechanics of taurodontism

    PubMed Central

    Benazzi, Stefano; Nguyen, Huynh N; Kullmer, Ottmar; Hublin, Jean-Jacques

    2015-01-01

    Taurodontism (i.e. enlarged pulp chamber with concomitant apical displacement of the root bi/trifurcation) is considered a dental anomaly with relatively low incidence in contemporary societies, but it represents a typical trait frequently found in Neandertal teeth. Four hypotheses can be envisioned to explain the high frequency in Neandertals: adaptation to a specific occlusal loading regime (biomechanical advantage), adaptation to a high attrition diet, pleiotropic or genetic drift effects. In this contribution we used finite element analysis (FEA) and advanced loading concepts based on macrowear information to evaluate whether taurodontism supplies some dental biomechanical advantages. Loads were applied to the digital model of the lower right first molar (RM1) of the Neandertal specimen Le Moustier 1, as well as to the digital models of both a shortened and a hyper-taurodontic version of Le Moustier RM1. Moreover, we simulated a scenario where an object is held between teeth and pulled in different directions to investigate whether taurodontism might be useful for para-masticatory activities. Our results do not show any meaningful difference among all the simulations, pointing out that taurodontism does not improve the functional biomechanics of the tooth and does not favour para-masticatory pulling activities. Therefore, taurodontism should be considered either an adaptation to a high attrition diet or most likely the result of pleiotropic or genetic drift effects. Finally, our results have important implications for modern dentistry during endodontic treatments, as we observed that filling the pulp chamber with dentine-like material increases tooth stiffness, and ultimately tensile stresses in the crown, thus favouring tooth failure. PMID:25407030

  18. Multiscale modeling methods in biomechanics.

    PubMed

    Bhattacharya, Pinaki; Viceconti, Marco

    2017-01-19

    More and more frequently, computational biomechanics deals with problems where the portion of physical reality to be modeled spans over such a large range of spatial and temporal dimensions, that it is impossible to represent it as a single space-time continuum. We are forced to consider multiple space-time continua, each representing the phenomenon of interest at a characteristic space-time scale. Multiscale models describe a complex process across multiple scales, and account for how quantities transform as we move from one scale to another. This review offers a set of definitions for this emerging field, and provides a brief summary of the most recent developments on multiscale modeling in biomechanics. Of all possible perspectives, we chose that of the modeling intent, which vastly affect the nature and the structure of each research activity. To the purpose we organized all papers reviewed in three categories: 'causal confirmation,' where multiscale models are used as materializations of the causation theories; 'predictive accuracy,' where multiscale modeling is aimed to improve the predictive accuracy; and 'determination of effect,' where multiscale modeling is used to model how a change at one scale manifests in an effect at another radically different space-time scale. Consistent with how the volume of computational biomechanics research is distributed across application targets, we extensively reviewed papers targeting the musculoskeletal and the cardiovascular systems, and covered only a few exemplary papers targeting other organ systems. The review shows a research subdomain still in its infancy, where causal confirmation papers remain the most common. For further resources related to this article, please visit the WIREs website.

  19. Biomechanics finds practical applications in aerospace research

    NASA Astrophysics Data System (ADS)

    Yanghe, X.

    1984-10-01

    Biomechanics is a branch of science which studies the mechanical properties of biological parts using the basic principles of mechanics and engineering. Formulas and quantitative calculations are used to analyze and understand physiological phenomena. Problems caused by weightlessness, coronary heart disease, blood circulation, use of medication, and application of biomechanics in aviation rescue are discussed.

  20. Applied Biomechanics in an Instructional Setting

    ERIC Educational Resources Information Center

    Hudson, Jackie L.

    2006-01-01

    Biomechanics is the science of how people move better, meaning more skillfully and more safely. This article places more emphasis on skill rather than safety, though there are many parallels between them. It shares a few features of the author's paradigm of applied biomechanics and discusses an integrated approach toward a middle school football…