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Clinical Tool (clinical + tool)
Kinds of Clinical Tool Selected AbstractsThe Focused Abdominal Sonography for Trauma (FAST) Examination: Considerations and Recommendations for Training Physicians in the Use of a New Clinical ToolACADEMIC EMERGENCY MEDICINE, Issue 2 2000Philip N. Salen MD Abstract. Focused abdominal sonography for trauma (FAST) is being used by growing numbers of emergency physicians and surgeons because it has proven to be an accurate, rapid, and repeatable bedside test for evaluating abdominal trauma victims. Controversy exists about the optimal means of FAST education and the number of examinations necessary to demonstrate competency. Most FAST educators agree that FAST education should consist of three phases: didactic, practical, and experiential. This article summarizes options and preliminary recommendations suitable for developing a FAST curriculum. [source] The Assessment of Basic Learning Abilities Test for Persons with Intellectual Disability: A Valuable Clinical ToolJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 5 2007Tricia Vause The Assessment of Basic Learning Abilities (ABLA) test requires a tester to attempt to teach to a person, using standard prompting and reinforcement procedures, six tasks that are hierarchically ordered in difficulty. Performance on the test provides valuable information for teachers and rehabilitation workers to match the difficulty of training tasks with the learning ability of persons with profound, severe and moderate intellectual disabilities. This paper summarizes the characteristics of the test, outlines the testing procedures, and reviews supporting data and practical guidelines for clinicians. [source] Selective Control Assessment of the Lower Extremity (SCALE): development, validation, and interrater reliability of a clinical tool for patients with cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 8 2009EILEEN G FOWLER PhD PT Normal selective voluntary motor control (SVMC) can be defined as the ability to perform isolated joint movement without using mass flexor/extensor patterns or undesired movement at other joints, such as mirroring. SVMC is an important determinant of function, yet a valid, reliable assessment tool is lacking. The Selective Control Assessment of the Lower Extremity (SCALE) is a clinical tool developed to quantify SVMC in patients with cerebral palsy (CP). This paper describes the development, utility, validation, and interrater reliability of SCALE. Content validity was based on review by 14 experienced clinicians. Mean agreement was 91.9% (range 71.4,100%) for statements about content, administration, and grading. SCALE scores were compared with Gross Motor Function Classification System Expanded and Revised (GMFCS-ER) levels for 51 participants with spastic diplegic, hemiplegic, and quadriplegic CP (GMFCS levels I , IV, 21 males, 30 females; mean age 11y 11mo [SD 4y 9mo]; range 5,23y). Construct validity was supported by significant inverse correlation (Spearman's r=-0.83, p<0.001) between SCALE scores and GMFCS levels. Six clinicians rated 20 participants with spastic CP (seven males, 13 females, mean age 12y 3mo [SD 5y 5mo], range 7,23y) using SCALE. A high level of interrater reliability was demonstrated by intraclass correlation coefficients ranging from 0.88 to 0.91 (p<0.001). [source] Botulinum toxin in the management of cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 7 2004Rosalind J Jefferson MB BS BSc PhD DIC MRCP MRCPCH Botulinum toxin has rapidly gained wide acceptance as a treatment for focal spasticity, and is becoming more readily available. Early studies established its effectiveness, but many issues are still open for discussion. After a brief re view of the historical and scientific development of botulinum toxin as a clinical tool and an outline of previous work in the field, some important questions are discussed in the light of more recent trials. [source] The metabolic syndrome in type 2 diabetes: When does it matter?DIABETES OBESITY & METABOLISM, Issue 6 2006J. Wong Aims:, Young adults with type 2 diabetes (T2Dm) present the clinician with the problem of when to start therapies for the primary prevention of vascular disease and how to identify those at most vascular risk. We examine whether the metabolic syndrome (MetS) can be a useful clinical tool to stratify vascular risk in this context. Methods:, Data were collected from 5928 subjects with T2Dm, and subjects were categorized as having MetS by World Health Organization criteria (body mass index criteria modified for Asians using >23 kg/m2). The prevalence of macrovascular disease was examined by MetS status and age. Results:, The overall MetS prevalence was 72.3%. MetS was associated with an increased prevalence of ischaemic heart disease (IHD) (17.2% MetS vs. 11.6% no MetS, p < 0.0001), coronary artery bypass graft (7.6 vs. 4.7%, p < 0.0003), peripheral vascular disease (PVD) (4.7 vs. 3.7%, p = 0.08) and stroke (6 vs. 3.9%, p = 0.002) across all age groups. MetS subjects had an IHD prevalence equivalent to that seen in subjects who were one decade older without MetS. The most significant impact of MetS was for the age group of 40,49 years with much lesser impact seen with progressively increasing age [odds ratio (OR) = 2.1 for IHD in MetS compared with no MetS at age 40,50 years, p < 0.05; falling progressively to OR = 1.5 at age >70 years, p > 0.05]. Similar trends were seen for coronary artery by-pass graft (CABG) and PVD. There was a strong relationship between the number of MetS risk factors and IHD prevalence (r = 0.99, p = 0.0001). Conclusions:, These data suggest that MetS is particularly useful in stratifying vascular risk in younger T2Dm patients and in those with a high number of MetS components. For patients with MetS, especially those with a full house of MetS risk factors, commencing risk-lowering interventions 10 years earlier than their MetS-free counterparts could be considered. [source] Confabulation, but not executive dysfunction discriminate AD from frontotemporal dementiaEUROPEAN JOURNAL OF NEUROLOGY, Issue 11 2004Z. Nedjam We examined confabulation and performance on frontal/executive tasks in Alzheimer's disease (AD) patients and patients with a diagnosis of probable frontotemporal dementia (FTD). Twenty-two patients with probable AD, 10 patients with probable FTD and 32 normal control subjects entered the study. Executive functions were assessed with the Modified Card Sorting test; a verbal fluency test; the Cognitive Estimation test; and the Stroop test. Confabulations were assessed with a modified version of the Confabulation Battery. The Confabulation Battery included 10 questions tapping each of the following domains: Episodic Memory (memories of personal past episodes), Semantic Memory (knowledge of famous facts and famous people), and Personal Future (personal plans). The results revealed that both AD patients and FTD patients were clearly and equally impaired on tests of executive functions. Both patients' groups confabulated across the three tasks of the Confabulation Battery, but FTD patients confabulated significantly more than AD patients on Episodic Memory and Personal Future. The results failed to provide any evidence of a correlation between the performance on frontal/executive tasks and the tendency to produce confabulatory reports. According to our results, confabulation, more than a deficit of frontal/executive functions, discriminate between AD and FTD. Therefore, screening for confabulation and, possibly, for other types of memory distortions may constitute a useful additional clinical tool in order to discriminate AD from FTD. [source] The future of magnetic resonance-based techniques in neurologyEUROPEAN JOURNAL OF NEUROLOGY, Issue 1 2001European Federation of Neurological Societies Task Force Magnetic resonance techniques have become increasingly important in neurology for defining: 1,brain, spinal cord and peripheral nerve or muscle structure; 2,pathological changes in tissue structures and properties; and 3,dynamic patterns of functional activation of the brain. New applications have been driven in part by advances in hardware, particularly improvements in magnet and gradient coil design. New imaging strategies allow novel approaches to contrast with, for example, diffusion imaging, magnetization transfer imaging, perfusion imaging and functional magnetic resonance imaging. In parallel with developments in hardware and image acquisition have been new approaches to image analysis. These have allowed quantitative descriptions of the image changes to be used for a precise, non-invasive definition of pathology. With the increasing capabilities and specificity of magnetic resonance techniques it is becoming more important that the neurologist is intimately involved in both the selection of magnetic resonance studies for patients and their interpretation. There is a need for considerably improved access to magnetic resonance technology, particularly in the acute or intensive care ward and in the neurosurgical theatre. This report illustrates several key developments. The task force concludes that magnetic resonance imaging is a major clinical tool of growing significance and offers recommendations for maximizing the potential future for magnetic resonance techniques in neurology. [source] Clinical use of the adult attachment interview in parent,infant psychotherapyINFANT MENTAL HEALTH JOURNAL, Issue 4 2004Miriam Steele This article provides an illustration of how the use of the Adult Attachment Interview (AAI; George, Kaplan, & Main, 1985) can be extended beyond the research arena to its use as a clinical instrument in parent,infant psychotherapy. The article is based on the ongoing work of the Parent,Infant Project team at the Anna Freud Centre, London, where psychoanalytically trained therapists routinely administer the AAI early in the therapeutic process. In the first part of the article, we introduce the thinking behind the use of the AAI as a clinical tool and its particular relevance to the field of parent,infant psychotherapy. In the second part, we track the accruing clinical picture built up from a case example of the initial clinical sessions with a father who attended the Parent,Infant Project with his partner and two young children, and from the father's AAI. The discussion of the AAI material illustrates the distinct, yet related, interpretations of the parent,infant psychotherapist and the independent AAI coder as each made sense of the father's interview transcript. The resulting dialogue, between the psychodynamic-clinical and the attachment-research based approaches to the AAI, aims to highlight the added value the interview provides to the clinical understanding and process in parent,infant psychotherapy, which may ultimately help bridge the gap between the research and clinical domains. [source] Stratification of foot ulcer risk in patients with diabetes: a population-based studyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2006G. P. Leese Summary This trial assessed whether a simple clinical tool can be used to stratify patients with diabetes, according to risk of developing foot ulceration. This was a prospective, observational follow-up study of 3526 patients with diabetes (91% type 2 diabetes) attending for routine diabetes care. Mean age was 64.7 (range 15,101) years and duration of diabetes was 8.8 (±1.5 SD) years. Patients were categorised into ,low' (64%), ,moderate' (23%) or ,high' (13%) risk of developing foot ulcers by trained staff using five clinical criteria during routine patient care. During follow-up (1.7 years), 166 (4.7%) patients developed an ulcer. Foot ulceration was 83 times more common in high risk and six times more in moderate risk, compared with low-risk patients. The negative predictive value of a ,low-risk score' was 99.6% (99.5,99.7%; 95% confidence interval). This clinical tool accurately predicted foot ulceration in routine practice and could be used direct scarce podiatry resources towards those at greatest need. [source] Examination of normal intestine using confocal endomicroscopyJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 5 2007Isao Odagi Abstract Background and Aim:, Endoscopy is an important clinical tool for the diagnosis and treatment of gastrointestinal disorders. However, biopsy tissue is still required in many cases to obtain a definitive histopathological diagnosis. The aim of this study was to evaluate confocal endomicroscopy (CEM) as a tool for conducting virtual biopsies of the colon by comparing CEM images with biopsy samples from normal colon. Methods:, The study cohort comprised 45 patients who underwent investigative colonoscopy between April 2004 and January 2006, 25 of whom also had biopsy due to suspected diseases such as inflammation and neoplasm. The small and large intestine were examined with CEM using an intravenous injection of fluorescein, and CEM images were compared with conventional histopathological results from biopsied samples. In addition, the injected fluorescein was localized immunohistochemically to further analyze the CEM images taken in vivo. Results:, A total of 46 biopsies were taken, of which 24 demonstrated no histopathological abnormality and were regarded as normal. All of the CEM images observed from the surface to the deeper layers were concordant histopathologically with the biopsy results. Furthermore, CEM allowed observation of physiological functions such as blood flow in the capillaries of the surrounding crypts and mucus release from crypts. The immunohistochemical localization of fluorescein was consistent with the CEM images. Conclusions:, CEM provides endoscopists with a valuable new diagnostic tool, not only for observing tissue in situ at the histopathological level, but also for the coincident evaluation of physiological function during endoscopic examination. [source] Changes in explicit memory associated with early dementia in adults with Down's syndromeJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 3 2002S. J. Krinsky-McHale Abstract Background A modified version of the Selective Reminding Test (SRT) (Buschke 1973) was used to examine the changes in memory that occur with early-stage dementia of the Alzheimer's type (DAT) in adults with intellectual disability (ID) and Down's syndrome (DS), and to compare these changes to those occurring with ,normal' ageing. Method Hierarchical linear modelling analyses showed steep declines in the performance of participants who had met the criteria for the onset of DAT. Non-demented participants also showed declines in performance which were related to their age. However, the absolute magnitude of these declines was consistent with a ,normal' ageing pattern and not with undetected dementia. Results In analysing the specific memory components that are compromised, the present authors found that participants with early-stage DAT showed severely diminished long-term storage and retrieval processing abilities compared to their non-demented peers. Notably, these declines preceded other symptoms of dementia, in most cases by more than a full year and sometimes by as much as 3 years. Conclusions Thus, the present results clearly confirm that memory processes are affected during early dementia in adults with DS, and that the SRT has promise as a clinical tool. [source] Therapeutic benefits of intrathecal protein therapy in a mouse model of amyotrophic lateral sclerosisJOURNAL OF NEUROSCIENCE RESEARCH, Issue 13 2008Yasuyuki Ohta Abstract When fused with the protein transduction domain (PTD) derived from the human immunodeficiency virus TAT protein, proteins can cross the blood,brain barrier and cell membrane and transfer into several tissues, including the brain, making protein therapy feasible for various neurological disorders. We have constructed a powerful antiapoptotic modified Bcl-XL protein (originally constructed from Bcl-XL) fused with PTD derived from TAT (TAT-modified Bcl-XL), and, to examine its clinical effectiveness in a mouse model of familial amyotrophic lateral sclerosis (ALS), transgenic mice expressing human Cu/Zn superoxide dismutase (SOD1) bearing a G93A mutation were treated by intrathecal infusion of TAT-modified Bcl-XL. We demonstrate that intrathecally infused TAT-fused protein was effectively transferred into spinal cord neurons, including motor neurons, and that intrathecal infusion of TAT-modified Bcl-XL delayed disease onset, prolonged survival, and improved motor performance. Histological studies show an attenuation of motor neuron loss and a decrease in the number of cleaved caspase 9-, cleaved caspase 3-, and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL)-positive cells in the lumbar cords of TAT-modified Bcl-XL -treated G93A mice. Our results indicate that intrathecal protein therapy using a TAT-fused protein is an effective clinical tool for the treatment of ALS. © 2008 Wiley-Liss, Inc. [source] Diode-pumped fiber lasers: A new clinical tool?LASERS IN SURGERY AND MEDICINE, Issue 3 2002Stuart D. Jackson PhD Abstract Background and Objective Diode-pumped fiber lasers are a compact and an efficient source of high power laser radiation. These laser systems have found wide recognition in the area of lasers as a result of these very practical characteristics and are now becoming important tools for a large number of applications. In this review, we outline the basic physics of fiber lasers and illustrate how a number of clinical procedures would benefit from their employment. Study Design/Materials and Methods The pump mechanisms, the relevant pump and laser transitions between the energy levels, and the main properties of the output from fiber lasers will be briefly reviewed. The main types of high power fiber lasers that have been demonstrated will be examined along with some recent medical applications that have used these lasers. We will also provide a general review of some important medical specialties, highlighting why these fields would gain from the introduction of the fiber laser. Results/Conclusion It is established that while the fiber laser is still a new form of laser device and hence not commercially available in a wide sense, a number of important medical procedures will benefit from its general introduction into medicine. With the number of medical and surgical applications requiring high power laser radiation steadily increasing, the demand for more efficient and compact laser systems providing this capacity will grow commensurately. The high power fiber laser is one system that looks like a promising modality to meet this need. Lasers Surg. Med. 30:184-190, 2002. © 2002 Wiley-Liss, Inc. [source] Rapid 3D-T1, mapping of the knee joint at 3.0T with parallel imagingMAGNETIC RESONANCE IN MEDICINE, Issue 3 2006S. Kubilay Pakin Abstract Three-dimensional spin-lattice relaxation time in the rotating frame (3D-T1,) with parallel imaging at 3.0T was implemented on a whole-body clinical scanner. A 3D gradient-echo sequence with a self-compensating spin-lock pulse cluster was combined with generalized autocalibrating partially parallel acquisitions (GRAPPA) to acquire T1, -weighted images. 3D-T1, maps of an agarose phantom and three healthy subjects were constructed using an eight-channel phased-array coil without parallel imaging and with parallel imaging acceleration factors of 2 and 3, in order to assess the reproducibility of the method. The coefficient of variation (CV) of the median T1, of the agarose phantom was 0.44%, which shows excellent reproducibility. The reproducibility of in vivo 3D-T1, maps was also investigated in three healthy subjects. The CV of the median T1, of the patellar cartilage varied between ,1.1% and 4.3%. Similarly, the CV varied between ,2.1,5.8%, ,1.4,8.7%, and ,1.5,4.1% for the biceps femoris and lateral and medial gastrocnemius muscles, respectively. The preliminary results demonstrate that 3D-T1, maps can be constructed with good reproducibility using parallel imaging. 3D-T1, with parallel imaging capability is an important clinical tool for reducing both the total acquisition time and RF energy deposition at 3T. Magn Reson Med, 2006. © 2006 Wiley-Liss, Inc. [source] fMRI of the lumbar spinal cord during a lower limb motor taskMAGNETIC RESONANCE IN MEDICINE, Issue 2 2004J. Kornelsen Abstract This study applied spinal fMRI to the lumbar spinal cord during lower limb motor activity. During active ankle movement, activity was detected in the lumbar spinal cord motor areas and sensory areas bilaterally. During passive ankle movement, activity was detected in the motor and sensory areas in lower lumbar spinal cord segments and motor activity in higher lumbar spinal cord segments. Spinal fMRI detects patterns of activity consistent with known physiology and can be used to reliably assess activity in the lumbar spinal cord during lower limb motor stimulation. This study affirms spinal fMRI as an effective tool for assessing spinal cord function and increases its potential as a clinical tool. Magn Reson Med 52:411,414, 2004. © 2004 Wiley-Liss, Inc. [source] The H-reflex as a tool in neurophysiology: Its limitations and uses in understanding nervous system functionMUSCLE AND NERVE, Issue 2 2003John E. Misiaszek PhD Abstract The Hoffmann reflex (H-reflex) is extensively used as both a research and clinical tool. The ease with which this reflex can be elicited in several muscles throughout the body makes it an attractive tool. This review discusses some of the important limitations in using the H-reflex. In particular, the inaccurate but widely held assumptions that the H-reflex (1) represents the monosynaptic reflex of the Ia afferent onto homonymous motoneurons, and (2) can be used to measure motoneuronal excitability are addressed. The second part of this review explores the utility of the H-reflex as a neural probe in neurophysiology and motor control research. Applications ranging from the investigation of the functional organization of neural circuitry to the study of adaptive plasticity in spinal structures in health and disease suggest that the H-reflex will continue to be an extensively used tool in motor control neurophysiology. Muscle Nerve 28: 144,160, 2003 [source] Metabolite quantification and high-field MRS in breast cancerNMR IN BIOMEDICINE, Issue 1 2009Ihab S. Haddadin Abstract In vivo1H MRS is rapidly developing as a clinical tool for diagnosing and characterizing breast cancers. Many in vivo and in vitro experiments have demonstrated that alterations in concentrations of choline-containing metabolites are associated with malignant transformation. In recent years, considerable efforts have been made to evaluate the role of 1H MRS measurements of total choline-containing compounds in the management of patients with breast cancer. Current technological developments, including the use of high-field MR scanners and quantitative spectroscopic analysis methods, promise to increase the sensitivity and accuracy of breast MRS. This article reviews the literature describing in vivo MRS in breast cancer, with an emphasis on the development of high-field MR scanning and quantitative methods. Potential applications of these technologies for diagnosing suspicious lesions and monitoring response to chemotherapy are discussed. Copyright © 2008 John Wiley & Sons, Ltd. [source] The Ablation of Atrial Fibrillation with the Loop Catheter Design: What We Have Learned From the Animal ModelPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2001BOAZ AVITALL AVITALL, B., et al.: The Ablation of Atrial Fibrillation with the Loop Catheter Design: What We Have Learned From the Animal Model. Ablation of chronic atrial fibrillation (AF) with the use of transcutaneous catheter ablation is yet to become a clinical tool. This article summarizes the development of the technology and the technique for the ablation of AF that was tested on the rapidly paced AF dog model. The current ablation technology using the standard ablation technique used in humans is not suitable for the creation of transmural contiguous linear lesions, and such technology is subjecting the patient to the prolonged procedures with considerable risk of complication. The use of the loop catheter design or other designs of ablation technology, which is specifically targeted for the creation of linear lesions, should be developed if the catheter approach for the ablation of AF is to succeed. This article describes the data available for the loop catheter design that is currently undergoing human feasibility studies. [source] Ambulatory blood pressure monitoring in pediatric renal transplantationPEDIATRIC TRANSPLANTATION, Issue 2 2003Mark M. Mitsnefes Abstract: Over last two decades ABPM has evolved from a research device to an established and valuable clinical tool for BP evaluation. More than 10 yrs ago ABPM was introduced to pediatrics and since that time, its importance has been increasing in the management of hypertension in children and adolescents. This review summarizes the information gathered from the studies of ABPM in adult and pediatric patients with renal transplants. We will review the importance of hypertension in this patient subset, discuss the advantage of ABPM over CBP and focus on specific abnormalities and clinical significance of ABPM in renal transplant recipients. [source] Serum protein profiling by miniaturized solid-phase extraction and matrix-assisted laser desorption/ionization mass spectrometryRAPID COMMUNICATIONS IN MASS SPECTROMETRY, Issue 12 2005Anne K. Callesen Serum profiling by matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS) holds promise as a clinical tool for early diagnosis of cancer and other human diseases. Sample preparation is key to achieving reproducible and well-resolved signals in MALDI-MS; a prerequisite for translation of MALDI-MS based diagnostic methods to clinical applications. We have investigated a number of MALDI matrices and several miniaturized solid-phase extraction (SPE) methods for serum protein concentration and desalting with the aim of generating reproducible, high-quality protein profiles by MALDI-MS. We developed a simple protocol for serum profiling that combines a matrix mixture of 2,5-dihydroxybenzoic acid and , -cyano-4-hydroxycinnamic acid with miniaturized SPE and MALDI-MS. Functionalized membrane discs with hydrophobic, ion-exchange or chelating properties allowed reproducible MALDI mass spectra (m/z 1000,12,000) to be obtained from serum. In a proof-of-principle application, SPE with chelating material and MALDI-MS identified protein peaks in serum that had been previously reported for distinguishing a person diagnosed with breast cancer from a control. These preliminary results indicate that this simple SPE/MALDI-MS method for serum profiling provides a versatile and scalable platform for clinical proteomics. Copyright © 2005 John Wiley & Sons, Ltd. [source] Array-based proteomics: mapping of protein circuitries for diagnostics, prognostics, and therapy guidance in cancerTHE JOURNAL OF PATHOLOGY, Issue 5 2006C Gulmann Abstract The human proteome, due to the enormity of post-translational permutations that result in large numbers of isoforms, is much more complex than the genome and alterations in cancer can occur in ways that are not predictable by translational analysis alone. Proteomic analysis therefore represents a more direct way of investigating disease at the individual patient level. Furthermore, since most novel therapeutic targets are proteins, proteomic analysis potentially has a central role in patient care. At the same time, it is becoming clear that mapping entire networks rather than individual markers may be necessary for robust diagnostics as well as tailoring of therapy. Consequently, there is a need for high-throughput multiplexed proteomic techniques, with the capability of scanning multiple cases and analysing large numbers of endpoints. New types of protein arrays combined with advanced bioinformatics are currently being used to identify molecular signatures of individual tumours based on protein pathways and signalling cascades. It is envisaged that analysing the cellular ,circuitry' of ongoing molecular networks will become a powerful clinical tool in patient management. Copyright © 2006 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [source] In vitro stage-specific chondrogenesis of mesenchymal stem cells committed to chondrocytesARTHRITIS & RHEUMATISM, Issue 2 2009Wei-Hong Chen Objective Osteoarthritis is characterized by an imbalance in cartilage homeostasis, which could potentially be corrected by mesenchymal stem cell (MSC),based therapies. However, in vivo implantation of undifferentiated MSCs has led to unexpected results. This study was undertaken to establish a model for preconditioning of MSCs toward chondrogenesis as a more effective clinical tool for cartilage regeneration. Methods A coculture preconditioning system was used to improve the chondrogenic potential of human MSCs and to study the detailed stages of chondrogenesis of MSCs, using a human MSC line, Kp-hMSC, in commitment cocultures with a human chondrocyte line, hPi (labeled with green fluorescent protein [GFP]). In addition, committed MSCs were seeded into a collagen scaffold and analyzed for their neocartilage-forming ability. Results Coculture of hPi-GFP chondrocytes with Kp-hMSCs induced chondrogenesis, as indicated by the increased expression of chondrogenic genes and accumulation of chondrogenic matrix, but with no effect on osteogenic markers. The chondrogenic process of committed MSCs was initiated with highly activated chondrogenic adhesion molecules and stimulated cartilage developmental growth factors, including members of the transforming growth factor , superfamily and their downstream regulators, the Smads, as well as endothelial growth factor, fibroblast growth factor, insulin-like growth factor, and vascular endothelial growth factor. Furthermore, committed Kp-hMSCs acquired neocartilage-forming potential within the collagen scaffold. Conclusion These findings help define the molecular markers of chondrogenesis and more accurately delineate the stages of chondrogenesis during chondrocytic differentiation of human MSCs. The results indicate that human MSCs committed to the chondroprogenitor stage of chondrocytic differentiation undergo detailed chondrogenic changes. This model of in vitro chondrogenesis of human MSCs represents an advance in cell-based transplantation for future clinical use. [source] Indentation testing of human cartilage: Sensitivity to articular surface degenerationARTHRITIS & RHEUMATISM, Issue 12 2003Won C. Bae Objective To determine, for clinical indentation testing of human articular cartilage, the effects of aging and degeneration on indentation stiffness and traditional indices of cartilage degeneration; the relationship between indentation stiffness and indices of degeneration; and the sensitivity and specificity of indentation stiffness to cartilage degeneration. Methods Osteochondral cores from femoral condyles of cadaveric human donors were harvested. Samples were distributed into experimental groups based on donor age (young [20,39 years], middle [40,59 years], and old [,60 years]), and a macroscopic articular surface appearance that was either normal or mildly degenerate, without deep erosion. Samples were analyzed for indentation stiffness, cartilage thickness, India ink staining (quantitated as the reflected light score), and Mankin-Shapiro histopathology score. Results Indentation stiffness, India ink staining, and the histopathology score each varied markedly between normal-sample and degenerate-sample groups but varied relatively little between normal samples obtained from different age groups. A decrease in indentation stiffness (softening) correlated with a decrease in the reflectance score and an increase in the overall histopathology score, especially the surface irregularity component of the histopathology score. Receiver operating characteristic analysis suggested that the indentation testing could accurately detect cartilage degeneration as indicated by macroscopic appearance, India ink staining, and histopathology score. Conclusion The indentation stiffness of the normal to mildly degenerate samples tested in this study was sensitive to mild degeneration at the articular surface and was insensitive to changes associated with normal aging or to slight variations in cartilage thickness. This suggests that indentation testing may be a useful clinical tool for the evaluation of early-stage degenerative changes in articular cartilage. [source] Development and validation of a model predictive of occult nipple involvement in women undergoing mastectomy,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 11 2008J. E. Rusby Background: This prospective study aimed to build a predictive model using preoperative information to aid selection for nipple-sparing mastectomy. Methods: Two hundred consecutive skin-sparing mastectomy specimens without overt nipple involvement were evaluated. Demographic, preoperative pathology and imaging information was collected. Nipple specimens (2 × 2 × 2 cm) were sectioned at 3-mm intervals. Haematoxylin and eosin-stained slides were examined by a breast pathologist for involvement by tumour. Logistic regression analyses of 65 therapeutic procedures identified factors associated with occult involvement and created a predictive model. This was tested on specimens from a further 65 therapeutic procedures. Results: Occult nipple involvement was noted in 32 (24·6 per cent) of 130 mastectomy specimens. In the training set, imaging diameter of the lesion and its distance from the nipple predicted nipple involvement on univariable analysis (P = 0·011 and P = 0·014 respectively). The multivariable logistic regression model was validated in the test set. The areas under the receiver,operating characteristic curve were 0·824 and 0·709 for the training and test sets respectively. Conclusion: Three-quarters of women undergoing mastectomy did not have occult nipple involvement. A clinical tool including tumour size and distance from the nipple has been developed to improve patient selection for nipple-sparing mastectomy. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Post-stroke depression: can we predict its development from the acute stroke phase?ACTA NEUROLOGICA SCANDINAVICA, Issue 3 2009B. Fuentes Objectives,,, To identify possible predictive factors for post-stroke depression (PSD) in the acute phase of stroke. Methods,,, The study design was prospective, observational cohort study of patients with acute cerebral infarction (CI). Neurological and neuropsychological evaluations were conducted within the first 10 days from the onset of stroke and repeated at the 3-month follow-up. DSM-IV criteria were used to define PSD. Results,,, From a total of 85 patients with CI, 59 patients completed the 3-month follow-up and 17 of them (28.8 %) fulfilled PSD criteria at the 3-month follow-up. Melancholy index of the Hamilton Depression Rankin Scale (HDRS) was associated with a risk three times greater than that of PSD at the 3-month follow-up in the univariate analysis (OR 3.07; 95% CI 1.53,6.16; P = 0.002) with no significant influence of stroke severity or the location of brain infarction (right or left side). The receiver operating characteristic curves pointed to a melancholy index ,1.5 as the optimal cut-off level associated with the development of PSD at the 3-month follow-up. Conclusions,,, Melancholy index of the HDRS ,1.5 could be a useful clinical tool to detect patients with acute stroke at high risk of developing PSD. [source] Serum creatinine ratio: A novel predictor of mortality after percutaneous coronary intervention in patients with normal and abnormal renal function,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 1 2009Annapoorna S. Kini MD Abstract The occurrence of contrast induced nephropathy (CIN) is associated with increased mortality after percutaneous revascularization procedures. However, the exact correlation between various levels of creatinine elevation relative to the baseline and subsequent mortality in patients with chronic renal insufficiency (CRI) is not well established. In addition, the relationship between elevated postprocedural creatinine and ensuing mortality in patients with normal baseline renal function needs to be investigated. Methods: All percutaneous coronary intervention (PCI) patients (n = 12,997) were analyzed for any rise in serum creatinine (SCr): CRI group (BSC , 1.5 mg/dl) (n = 1,853) and normal baseline renal function (NBR BSC < 1.5 mg/dl) group (n = 11,144). Patients in each group were analyzed for any elevation in SCr postprocedure and subdivided based on the SCr ratio [peak SCr/Baseline creatinine (BSC)] of <1.25, 1.25,1.5, and >1.5. The overall incidence of CIN (defined as an increment of 25% over baseline creatinine) was 5.9%: 11.3% in the CRI group versus 5.1% in normal BSC group (P < 0.01). Recursive partitioning and Cox hazard modeling were used to assess significant variables associated with mortality within 1 year. Only serum creatinine ratio (SCrR) > 1.5 correlated with increased mortality in both CRI group as well as normal BSC group. Conclusions: SCrR > 1.5 predicts mortality at 1 year after PCI. The association between SCrR > 1.5 and increased mortality at follow-up is observed in patients with CRI as well as normal baseline renal function. SCrR may thus serve as a useful clinical tool for risk stratification and prognostication of patients after PCI. © 2009 Wiley-Liss, Inc. [source] NIKE: a new clinical tool for establishing levels of indications for cataract surgeryACTA OPHTHALMOLOGICA, Issue 4 2006Mats Lundström Abstract. Purpose:, The purpose of this study was to construct a new clinical tool for establishing levels of indications for cataract surgery, and to validate this tool. Methods:, Teams from nine eye clinics reached an agreement about the need to develop a clinical tool for setting levels of indications for cataract surgery and about the items that should be included in the tool. The tool was to be called ,NIKE' (Nationell Indikationsmodell för Kataraktextraktion). The Canadian Cataract Priority Criteria Tool served as a model for the NIKE tool, which was modified for Swedish conditions. Items included in the tool were visual acuity of both eyes, patients' perceived difficulties in day-to-day life, cataract symptoms, the ability to live independently, and medical/ophthalmic reasons for surgery. The tool was validated and tested in 343 cataract surgery patients. Validity, stability and reliability were tested and the outcome of surgery was studied in relation to the indication setting. Results:, Four indication groups (IGs) were suggested. The group with the greatest indications for surgery was named group 1 and that with the lowest, group 4. Validity was proved to be good. Surgery had the greatest impact on the group with the highest indications for surgery. Test-retest reliability test and interexaminer tests of indication settings showed statistically significant intraclass correlations (intraclass correlation coefficients [ICCs] 0.526 and 0.923, respectively). Conclusions:, A new clinical tool for indication setting in cataract surgery is presented. This tool, the NIKE, takes into account both visual acuity and the patient's perceived problems in day-to-day life because of cataract. The tool seems to be stable and reliable and neutral towards different examiners. [source] Ligand binding strategies of human serum albumin: How can the cargo be utilized?CHIRALITY, Issue 1 2010Ankita Varshney Abstract Human serum albumin (HSA), being the most abundant carrier protein in blood and a modern day clinical tool for drug delivery, attracts high attention among biologists. Hence, its unfolding/refolding strategies and exogenous/endogenous ligand binding preference are of immense use in therapeutics and clinical biochemistry. Among its fellow proteins albumin is known to carry almost every small molecule. Thus, it is a potential contender for being a molecular cargo/or nanovehicle for clinical, biophysical and industrial purposes. Nonetheless, its structure and function are largely regulated by various chemical and physical factors to accommodate HSA to its functional purpose. This multifunctional protein also possesses enzymatic properties which may be used to convert prodrugs to active therapeutics. This review aims to highlight current overview on the binding strategies of protein to various ligands that may be expected to lead to significant clinical applications. Chirality, 2010. © 2009 Wiley-Liss, Inc. [source] Platelet releasate increases the proliferation and migration of bone marrow-derived cells cultured under osteogenic conditionsCLINICAL ORAL IMPLANTS RESEARCH, Issue 3 2006Lianne R. Kark Abstract: Concentrated platelets and their products are currently being used as a clinical tool to accelerate endosseous wound healing. However, there is little understanding regarding the actions of platelets and platelet-released products on osteogenic cells. We show, herein, that releasate from thrombin-activated platelets increases the migration and proliferation of osteogenic cultures of bone marrow cells. Using a scratch wound assay, we demonstrated that platelet releasate (PR) stimulated up to a 2.4±0.5-fold increase in wound closure in serum-free medium, relative to a control containing thrombin. In the presence of serum, the addition of PR resulted in a 1.45±0.13-fold increase in scratch closure. To isolate cell migration from the effects of cell proliferation, cell monolayers were pre-incubated with 5, 10 and 20 ,g/ml of Mitomycin C (MMC), which is a potent inhibitor of cell proliferation. This resulted in a large decrease in the leading front of scratch closure, which indicates that PR stimulated cell mitogenesis. However, irrespective of MMC pre-treatment, PR stimulated a motogenic response. These results provide evidence of possible mechanisms by which platelets could influence bone regeneration. [source] The development of a General Nasal Patient InventoryCLINICAL OTOLARYNGOLOGY, Issue 5 2001S.A. Douglas Most available clinical outcome measures for rhinology patients relate to specific nasal disease or general quality of life. Fairley's validated 12-item questionnaire measures general nasal symptoms, but is a ,physician-derived' clinical tool and may not reflect all the problems that rhinology patients experience. Our aims were to develop a patient-orientated questionnaire, representing the concerns of a large number of rhinology patients, called the General Nasal Patient Inventory (GNPI) and compare this with the Fairley nasal questionnaire (FNQ). The GNPI was developed from the open-ended problem lists of 211 rhinology patients, from the 45 most frequent complaints. Both questionnaires were then administered to 153 general rhinology patients and the results compared. The highest-ranking items for each questionnaire were different, but the total scores were highly correlated (r = 0.79, P < 0.0001). Factor analysis showed six factors to account for 75% of FNQ variance and 18 factors for 78% of GNPI variance. The 45-item GNPI, the first patient-derived, comprehensive nasal questionnaire could be a time-saving tool in rhinology clinics and more sensitive to change after intervention than other available measures. [source] | ||||||||||||||||||||||||||||||||||