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Different Modalities (different + modality)

Distribution by Scientific Domains

Medical Sciences	72%
Life Sciences	16%
3 Other Domains	12%

Selected Abstracts

Striae Distensae (Stretch Marks) and Different Modalities of Therapy: An Update

DERMATOLOGIC SURGERY, Issue 4 2009
MOHAMED L. ELSAIE MD
BACKGROUND Striae distensea (SD; stretch marks) are a well-recognized, common skin condition that rarely causes any significant medical problems but are often a significant source of distress to those affected. The origins of SD are poorly understood, and a number of treatment modalities are available for their treatment, yet none of them is consistently effective, and no single therapy is considered to be pivotal for this problem. With a high incidence and unsatisfactory treatments, stretch marks remain an important target of research for an optimum consensus of treatment. OBJECTIVE To identify the current treatment modalities and their effectiveness in the treatment of stretch marks. MATERIALS AND METHODS Review of the recent literature regarding clinical treatment of stretch marks with emphasis on the safety and efficacy of the newer optical devices and laser applications. RESULTS No current therapeutic option offers complete treatment, although there are a number of emerging new modalities that are encouraging. CONCLUSION The therapeutic strategies are numerous, and no single modality has been far more consistent than the rest. The long-term future of treatment strategies is encouraging with the advance in laser technologies. [source]

Effect of Seven Different Modalities of Antihypertensive Therapy on Pulse Pressure in Patients with Newly Diagnosed Stage I Hypertension

CARDIOVASCULAR THERAPEUTICS, Issue 1 2009
Gokhan Alici
In this study, we investigated the effect of different antihypertensive agents on pulse pressure (PP). The study was designed in a prospective manner and patients were sequentially allocated to one of the seven different therapy groups, according to the order of enrollment (every first patient to group I, every second patient to group II, and etc). Patients in group I received 10 mg of lisinopril, in group II 10/6.25 mg of lisinopril/hydrochlorothiazide, in group III 80 mg of valsartan, in group IV 80/6.25 mg of valsartan/hydrochlorothiazide, in group V 5 mg of amlodipine, in group VI 1.25 mg of indapamide, and finally those in group VII received 50 mg of atenolol. The reduction in PP was more significant in patients receiving lisinopril, lisinopril hydrochlorothiazide, valsartan, and valsartan hydrochlorothiazide, when compared with patients receiving indapamide, atenolol, and amlodipine (P < 0.05 for each group). Factors such as age, gender, and body mass index were not found to significantly influence the effectiveness of antihypertensive agents on PP. The reduction in PP was more apparent with lisinopril, lisinopril hydrochlorothiazide, valsartan, and valsartan hydrochlorothiazide in diabetic patients, when compared with those without diabetes (P < 0.001, P < 0.05). And also patients on therapy with 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors had a greater reduction in PP with lisinopril, lisinopril hydrochlorothiazide, valsartan, and valsartan hydrochlorothiazide (P < 0.001, P < 0.05). [source]

Ketamine reduce left ventricular systolic and diastolic function in patients with ischaemic heart disease

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2010
C.-J. JAKOBSEN
Objective: Ketamine may be followed by a general increase in haemodynamics and oxygen consumption, which may be of concern in patients with ischaemic heart disease. The purpose of this study was to evaluate the effect of ketamine on left ventricular (LV) systolic and diastolic function by different modalities of echocardiography and tissue Doppler imaging in patients with ischaemic heart disease. Methods and Results: Prospective observational study of 11 patients acting as own control based on echocardiographic imaging before and after bolus ketamine 0.5 mg/kg. Simpson's 2 D-volumetric method was used to quantify left ventricular volume and ejection fraction. General global LV deformation was assessed by Speckle tracking ultrasound, systolic LV longitudinal displacement was assessed by Tissue Tracking score index and the diastolic function was evaluated from changes in early-(E') and atrial (A') peak velocities during diastole. Average heart rate (34%) and blood pressure (35%) increased significantly after ketamine (P<0.0001). Mean tissue tracking score index decreased from 11.2±2.3 to 8.3±2.6 (P=0.005) and Global Speckle tracking 2D strain from 17.7±2.7 to 13.7±3.6 (P=0.0014) indicating a decrease in LV global systolic function. The E'/A' ratio decreased from 1.11±0.43 to 0.81±0.46 (P=0.044) indicating impaired relaxation. Conclusion: Different modalities of echocardiography in combination with tissue Doppler indicate both diminished systolic and diastolic function after ketamine administration in patients with ischaemic heart disease. [source]

Relation of apical dendritic spikes to output decision in CA1 pyramidal cells during synchronous activation: a computational study

EUROPEAN JOURNAL OF NEUROSCIENCE, Issue 5 2006
José M. Ibarz
Abstract Recent studies on the initiation and propagation of dendritic spikes have modified the classical view of postsynaptic integration. Earlier we reported that subthreshold currents and spikes recruited by synaptic currents play a critical role in defining outputs following synchronous activation. Experimental factors strongly condition these currents due to their nonlinear behaviour. Hence, we have performed a detailed parametric study in a CA1 pyramidal cell model to explore how different variables interact and initiate dendritic spiking, and how they influence cell output. The input pattern, the relative excitability of axon and dendrites, the presence/modulation of voltage-dependent channels, and inhibition were cross analysed. Subthreshold currents and spikes on synaptically excited branches fired spikes in other branches to jointly produce different modalities of apical shaft spiking with a variable impact on cell output. Synchronous activation initiated a varying number and temporal scatter of firing branches that produced in the apical shaft-soma axis nonpropagating spikes, pseudosaltatory or continuous forward conduction, or backpropagation. As few as 6,10 local spikes within a time window of 2 ms ensure cell output. However, the activation mode varied extremely when two or more variables were cross-analysed, becoming rather unpredictable when all the variables were considered. Spatially clustered inputs and upper modulation of dendritic Na+ or Ca2+ electrogenesis favour apical decision. In contrast, inhibition biased the output decision toward the axon and switched between dendritic firing modes. We propose that dendrites can discriminate input patterns and decide immediate cell output depending on the particular state of a variety of endogenous parameters. [source]

Ketamine reduce left ventricular systolic and diastolic function in patients with ischaemic heart disease

Healing and Salvation in Late Modernity: the Use and Implication of Such Terms in the Ecumenical Movement

INTERNATIONAL REVIEW OF MISSION, Issue 380-381 2007
Vebjørn Horsfjord
This article explores developments over the last decades in the way ecumenical texts, primarily originating from world conferences organized by the Commission on World Mission and Evangelism, speak about soteriology. Under the headlines, "Salvation Today" (1973) and "Your Kingdom Come" (1980), terminology inspired by liberation theology took centre stage, and a predominantly immanent understanding of salvation was promoted. In recent years a different terminology has taken over, and it is one that focuses on "healing" and "the fullness of life". At its best, the holistic healing approach manages to take up the important concerns from earlier times, such as economic justice, racism and environmental issues, while at the same time giving more room for existential issues and the experiences of the individual The new healing discourse appears to reflect two different modalities of the church's healing ministry, viz. that which is concerned with the causes of suffering, and that which addresses the experience of suffering. The latter was often ignored in the recent past. The healing discourse gives room for new explorations of practices that have been central in the church throughout its history, such as anointing the sick, and praying for and with them, and hearing individual confessions. Openness towards subjective experience also has implications for the contextualization of the Christian faith. There is a new awareness that not only do the causes of suffering vary from situation to situation but so does the understanding of (what constitutes) suffering itself. Changing or varying understandings of suffering give rise to different approaches to its alleviation, and can inspire a rethinking of how we understand salvation in different contexts. The new healing discourse can also be studied in its relationship to cultural trends known as post-modernity or late modernity. The texts under study display very ambivalent approaches to these developments. There might be a tendency for texts that have concrete experience as their starting point to take a more positive view of these cultural developments than do texts that begin with more general theological observations. [source]

Chronic, painful lower extremity wounds: postoperative pain management through the use of continuous infusion of regional anaesthesia supplied by a portable pump device

INTERNATIONAL WOUND JOURNAL, Issue 3 2010
Christy L Scimeca
Reducing and preventing postoperative pain are currently a topic of great interest. There are different modalities for providing analgesia that can provide an alternative or adjunct to opioid therapy. One mode of therapy involves the use of portable pain pump devices that can deliver continuous local anaesthesia directly to the site of interest. A considerable amount of attention in literature has been dedicated to using regional anaesthesia postoperatively for various surgical applications. However, to our knowledge, little or no work has been published concerning the use of infusion of regional anaesthesia in the treatment of painful lower extremity wounds. We present a case report of a 55-year-old gentleman with a complex past medical history, 2-year history of opioid dependency and a 2-week history of intractable pain associated with the combination of debilitating painful diabetic neuropathy and painful lower extremity wounds. After surgical debridement of the lower extremity wounds, substantial analgesia was achieved postoperatively through the implantation of a portable direct infusion pump device. The device supplied 2 ml/hour of 0·25% bupivacaine and resulted in a reduction in pain within the first hour of implantation. Although the device achieved maximal analgesia at 6 hours, we found that this could have been likely reduced through the use of a 5-ml bolus dose of 0·25% bupivacaine at the time of implantation. The device provided sufficient analgesia to the patient without any observed adverse effects, and showed significant potential in avoiding an increase in his requirement for other systemic analgesia including opioids. [source]

A Clinical Review of Infected Wound Treatment with Vacuum Assisted Closure® (V.A.C.®) Therapy: Experience and Case Series

INTERNATIONAL WOUND JOURNAL, Issue 2009
Allen Gabriel
ABSTRACT Over the last decade Vacuum Assisted Closure® (KCI Licensing, Inc., San Antonio, TX) has been established as an effective wound care modality for managing complex acute and chronic wounds. The therapy has been widely adopted by many institutions to treat a variety of wound types. Increasingly, the therapy is being used to manage infected and critically colonized, difficult-to-treat wounds. This growing interest coupled with practitioner uncertainty in using the therapy in the presence of infection prompted the convening of an interprofessional expert advisory panel to determine appropriate use of the different modalities of negative pressure wound therapy (NPWT) as delivered by V.A.C.® Therapy and V.A.C. Instill® with either GranuFoamÔ or GranuFoam SilverÔ Dressings. The panel reviewed infected wound treatment methods within the context of evidence-based medicine coupled with experiential insight using V.A.C.® Therapy Systems to manage a variety of infected wounds. The primary objectives of the panel were 1) to exchange state-of-practice evidence, 2) to review and evaluate the strength of existing data, and 3) to develop practice recommendations based on published evidence and clinical experience regarding use of the V.A.C.® Therapy Systems in infected wounds. These recommendations are meant to identify which infected wounds will benefit from the most appropriate V.A.C.® Therapy System modality and provide an infected wound treatment algorithm that may lead to a better understanding of optimal treatment strategies. [source]

The role of letter knowledge and phonological awareness in young Braille readers

JOURNAL OF RESEARCH IN READING, Issue 3 2002
Brown, Fiona Barlow
Research into sighted children's reading shows that letter recognition skill predicts phonological awareness skill. Congenitally,blind children do not receive exposure to environmental print and do not generally learn to recognise written letters of the alphabet prior to schooling in Braille. A cross,sectional analysis revealed that blind children with no knowledge of written letters or written words showed no ability at measures of phonological awareness. Blind children with knowledge of written letters and no written words showed much increased phonological awareness scores and blind children with knowledge of written letters and written words scored higher still on phonological awareness measures. It was concluded that letter learning is a major contributor to the development of phonological awareness in blind children. It suggests key similarities in the underlying processes of reading development across two different populations using different modalities to learn to read. [source]

Motor evoked potentials from the pelvic floor

NEUROUROLOGY AND URODYNAMICS, Issue 7 2003
Søren Brostrøm
Proper function of the lower urinary tract depends on the integrity of the central and peripheral nervous pathways on multiple levels, and the complexity of this system leaves it susceptible to even minor lesions. While dysfunction of the lower urinary tract is prevalent amongst patients with nervous system disease, e.g., multiple sclerosis (MS), most women with lower urinary tract dysfunction (LUTD) have no overt neurological cause. Refined neuro-diagnostic approaches are needed to reveal neurogenicity in these patients. A potential method is transcranial magnetic stimulation (TMS), which is used routinely to test the motor innervation of limb muscles, but also can be applied to test pelvic floor efferents. To resolve the lack of methodological clarity and the need for normative values for the use of pelvic floor motor evoked potentials (MEPs), 30 healthy women and 16 women with MS were studied. Methods The healthy women underwent MEP studies with various stimulus and recording modalities, and, to test reproducibility, 18 of them were retested at a separate session. The women with MS underwent MEP testing as well as urodynamic studies. Results From the methodological studies of healthy women, the use of invasive concentric needle electrodes was found to be superior to surface electrodes. When applying magnetic stimuli over the sacral region, various methodological problems were encountered. In the healthy women, a large variability of responses was noted, the long-term reproducibility of pelvic floor MEP latencies was poor, and in some cases responses could not be obtained. In the study of women with MS, prolonged central conduction times were found, along with many cases of unevokable responses, and a poor correlation of MEPs to urodynamic findings. The problems of obtaining selective recordings from the inaccessible pelvic floor musculature are discussed, and possible sources of variability in MEPs from the pelvic floor are considered. By relating the findings in the present studies to those of others using different modalities, some reflections are presented on the nature of the neural pathways to the pelvic floor activated by magnetic stimulation. As unevokable responses from the pelvic floor were an occasional finding among the healthy women, it is argued that a pelvic floor non-response in a patient with suspected corticospinal lesion should be interpreted with care, and should not carry the same clinical significance as an absent limb response. Conclusions The inherent limitations of pelvic floor MEPs are discussed, and it is concluded that while there seems to be only limited clinical value of pelvic floor MEP testing, there might be some interesting scientific perspectives in studies that aim to control and explain the variability of responses. Neurourol. Urodynam. 22:620,637, 2003. © 2003 Wiley-Liss, Inc. [source]

A Psychophysical Investigation of the Facial Action Coding System as an Index of Pain Variability among Older Adults with and without Alzheimer's Disease

PAIN MEDICINE, Issue 8 2007
Amanda C. Lints-Martindale MA
ABSTRACT Objective., Reflexive responses to pain such as facial reactions become increasingly important for pain assessment among patients with Alzheimer's disease (AD) because self-report capabilities diminish as cognitive abilities decline. Our goal was to study facial expressions of pain in patients with and without AD. Design., We employed a quasi-experimental design and used the Facial Action Coding System (FACS) to assess reflexive facial responses to noxious stimuli of varied intensity. Two different modalities of stimulation (mechanical and electrical) were employed. Results., The FACS identified differences in facial expression as a function of level of discomforting stimulation. As expected, there were no significant differences based on disease status (AD vs control group). Conclusions., This is the first study to discriminate among FACS measures collected during innocuous and graded levels of precisely measured painful stimuli in seniors with (mild) dementia and in healthy control group participants. We conclude that, as hypothesized, FACS can be used for the assessment of evoked pain, regardless of the presence of AD. [source]

Complementary medicine use by Australian women with gynaecological cancer

PSYCHO-ONCOLOGY, Issue 3 2006
Milica Markovic
Abstract Aims and objectives: Social and cultural factors are identified that impact on complementary therapy use among Australia-born and immigrant women diagnosed with gynaecological cancer. Methods: A qualitative study design including in-depth interviews with women diagnosed with gynaecological cancer (N=53) and participant observation was conducted. Results: Approximately one-third of women utilized complementary and alternative medicine, with this being determined by current health concerns and health beliefs related to the efficacy of different modalities. Four types of complementary therapy users emerged: consequential, therapeutic, informed and exploratory. Conclusion: There was a relatively low uptake of complementary treatments. Choice was influenced by women's socio-demographic background, clinical and personal history, lack of personal experiences of gynaecological cancer among study participants' kin and friends, and lack of popular alternative literature on such cancer. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Cytokine response of electrolytic ablation in an ex vivo perfused liver model

ANZ JOURNAL OF SURGERY, Issue 7-8 2010
Gianpiero Gravante
Abstract Background:, The inflammatory response following hepatic ablation depends on different factors including the method used, the duration and intensity of the treatment and the presence or absence of ischemia. Debate continues about the use of different modalities and whether some aspects of the response may be advantageous by releasing immunological active substances. Little data have been published concerning the cytokine response elicited by hepatic electrolytic ablation (EA). Study of an ex vivo liver model could allow for the evaluation of this response without the influence of confounding systemic factors. Methods:, Livers explanted from 11 pigs were perfused extracorporeally with normothermic autologous blood. Four of them underwent EA after 1 h of reperfusion. Serum samples were obtained up to 6 h after the reperfusion and assayed for IL-1,, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IFN-,, TNF-,. Results:, Significant changes in the control group were observed for IL-6 after the second hour and IL-8 after the first hour compared with baseline levels (P < 0.001). In the EA group, IL-6 and IL-12 were raised after the second hour and IL-8 and IL-10 after the first hour (P < 0.001). The comparison between groups showed significant differences for IL-2, IL-4 (decreased in the EA group compared with controls), IL-10 and TNF-, (EA group increased compared with controls; P < 0.001). Conclusions:, The ex vivo perfused liver model demonstrated changes in levels of IL-2, IL-4, IL-10 and TNF-, following hepatic EA. [source]

Overview: End-Stage Renal Disease in the Developing World

ARTIFICIAL ORGANS, Issue 9 2002
Rashad S. Barsoum
Abstract: Although the vast majority of patients with end-stage renal disease (ESRD) worldwide live in what is called the developing world, little is known about its epidemiology and management. With the current paucity of credible and adequately representative registries, it is justified to resort to innovative means of obtaining information. In this attempt, world-renowned leading nephrologists in 10 developing countries collaborated in filling a 103-item questionnaire addressing epidemiology, etiology, and management of ESRD in their respective countries on the basis of integrating available data from different sources. Through this joint effort, it was possible to identify a number of important trends. These include the expected high prevalence of ESRD, despite the limited access to renal replacement therapy, and the dependence of prevalence on wealth. Glomerulonephritis, rather than diabetes, remains as the main cause of ESRD with significant geographical variations in the prevailing histopathological types. The implementation of different modalities of renal replacement therapy (RRT) is inhibited by the lack of funding, although governments, insurance companies, and donations usually constitute the major sponsors. Hemodialysis is the preferred modality in most countries with the exception of Mexico where chronic ambulatory peritoneal dialysis (CAPD) takes the lead. In several other countries, dialysis is available only for those on the transplant waiting list. Dialysis is associated with a high frequency of complications particularly HBV and HCV infections. Data on HIV are lacking. Aluminum intoxication remains as a major problem in a number of countries. Treatment withdrawal is common for socioeconomic reasons. Transplantation is offered to an average of 4 per million population (pmp). Recipient exclusion criteria are minimal. Donor selection criteria are generally loose regarding tissue typing, remote viral infection, and, in some countries, blood-relation to the recipient in live-donor transplants. Cadaver donors are accepted in many countries participating in this survey. Treatment outcomes with different RRT modalities are, on the average, inferior to the internationally acknowledged standards largely due to infective and cardiovascular complications. [source]

The management of paediatric urolithiasis

BJU INTERNATIONAL, Issue 7 2000
S. Choong
Objective To evaluate the efficacy and safety of the management of paediatric urolithiasis by extracorporeal shock wave lithotripsy (ESWL), endoscopic ureterolithotomy, percutaneous nephrolithotomy (PCNL) and open nephrolithotomy. Patients and methods In a 3-year period (1997,1999), 59 children were treated for urolithiasis and underwent a total of 79 procedures. Thirty-two ESWL sessions were performed in 23 children (mean age 7.4 years, median 6.0). PCNL was undertaken in 30 renal units in 25 children (mean age 6.4 years, median 4.0). Eight patients (mean age 7.8 years, median 5) underwent 17 ureteroscopic procedures, six of which involved the use of a holmium laser. Three children with staghorn calculi underwent open nephrolithotomy under conditions of renal ischaemia and hypothermia. Results Of the 23 children treated using ESWL, 21 (91%) became stone-free; 17 underwent one ESWL session (74%), three had two sessions and three (13%) had three sessions. All eight patients who underwent ureteroscopy became stone-free. Four patients in whom the stone could not be reached by ureteroscopy initially had a JJ stent inserted, and the stone and stent subsequently removed. Stones were cleared using PCNL in 27 of 30 renal units (90%); three patients who had residual stone fragments were rendered stone-free by ESWL. Two of three children undergoing open nephrolithotomy were stone-free after surgery and the remaining one rendered stone-free with ESWL. Metabolic evaluation showed that 25 of 45 children (55%) had a urinary infection, eight (18%) had hyperoxaluria, three (7%) had hypercalciuria, two (4%) had cystinuria, and no identifiable cause was found in seven (16%). Treatment by a single modality rendered 52 of the 59 children (88%) stone-free; when the different modalities were combined, 57 of 59 patients (97%) were cleared of their stones. Conclusions Technological advances in ESWL, ureteroscopy and PCNL have had a significant effect on the management of urolithiasis in children, allowing a safe and successful outcome. The comprehensive care of children with urolithiasis should include a full metabolic evaluation. Anatomical anomalies contribute to the complexity of many cases, necessitating a close liaison between adult and paediatric urologists, nephrologists and radiologists to optimize stone management in children. [source]

Phase I/II study of topical imiquimod and intralesional interleukin-2 in the treatment of accessible metastases in malignant melanoma

BRITISH JOURNAL OF DERMATOLOGY, Issue 2 2007
D.S. Green
Summary Background, Patients with metastatic skin disease in malignant melanoma can be difficult to treat effectively, often requiring repeated treatments with different modalities in an attempt to control their disease. Treatment of nonsurgically resectable melanoma deposits is unsatisfactory, as they are often multiple and recurring. Anecdotal evidence from individual use of imiquimod in superficial metastases and intralesional interleukin (IL)-2 in subcutaneous deposits suggests that the combination may be more effective in bulky subcutaneous disease. Objectives, To investigate the combination of topical imiquimod and, for selected lesions, intralesional IL-2, to treat a small cohort of patients with accessible melanoma metastases resistant to other treatments. Methods, Thirteen patients were recruited: all had evidence of multiple cutaneous and/or subcutaneous metastases. Imiquimod was applied to the metastases on a daily basis for 4 weeks, before the introduction of intralesional IL-2. This was injected up to three times a week, into selected lesions, with 0·1 mL injected per lesion at a concentration of 3·6 MIU mL,1, a total of 1 mL being given at each session. The treated lesions were assessed individually at intervals of 3 months. Results, Thirteen patients were treated, with 10 being eligible for assessment. In total, 182 lesions were treated: 137 purely cutaneous lesions and 41 subcutaneous lesions. Overall, a clinical response was seen in 92 lesions (50·5%) with 74 (40·7%) of these being a complete response (CR) with 91% of the CRs being in the cutaneous lesions. New lesions did appear during the treatment course; however, patients with cutaneous disease experienced a marked slowing of the appearance of new cutaneous lesions. No cutaneous lesions that responded reappeared on cessation of treatment. Conclusions, The combination of imiquimod and IL-2 is effective in controlling this mixed cutaneous and subcutaneous disease, and is well tolerated. Imiquimod alone is often enough to elicit a response in purely cutaneous lesions. The addition of intralesional IL-2 increases the response rates in subcutaneous lesions, and in otherwise refractory cutaneous lesions. [source]

Survey of U.K. current practice in the treatment of lentigo maligna

BRITISH JOURNAL OF DERMATOLOGY, Issue 1 2001
R. Mahendran
Background ,Lentigo maligna (LM) is the in situ phase of LM melanoma (LMM). There is a paucity of data on the natural history of LM, the risk factors for progression to LMM and on treatment outcomes of the various modalities used. Objectives ,To investigate our impression that this, combined with the difficulties of treatment for large lesions particularly in the elderly and infirm, has led to considerable variation between dermatologists in the management of LM within the U.K. Methods ,A postal questionnaire survey was performed to establish current practice. Results ,One hundred and seventy clinicians representing one-third of U.K. consultant dermatologists responded. Fifty-seven per cent of the dermatologists reported treating only one to four LMs per year, 30% treated five to 10 LMs per year and only 13% treated more than 10 LMs per year. Ninety-four per cent of the respondents routinely took an initial biopsy to confirm the diagnosis and plan treatment. The preferred treatment option was dependent on the age of the patient. Dermatologists were far more likely to use surgery for patients under the age of 60 years and more likely to use cryotherapy/radiotherapy or merely to observe with increasing age. Where surgery was used, the excision margins chosen ranged from 0 to 10 mm. Conclusions ,This survey highlights that a significant proportion of U.K. dermatologists is managing small numbers of LMs each year. On the basis of this current practice and the data in the literature on the recurrence rates for the different modalities, we propose an algorithm for treatment options. The survey, however, showed no consensus between dermatologists regarding surgical margins for excision, which is reflected in the literature; further studies to establish this are required. [source]

REVIEW: Nonpharmacological Therapies for Atrial Fibrillation

CARDIOVASCULAR THERAPEUTICS, Issue 5 2010
Mark Alber Meshil
SUMMARY In recent years, nonpharmacological therapies for atrial fibrillation (AF) have emerged given the limitations of medical therapy. Advancements in particular have been made in the areas of radiofrequency catheter ablation and AF surgery, and have been accompanied by substantial technological improvements. This article will discuss several different modalities of nonpharmacological AF management including catheter ablation, AF surgery and device-based therapy. [source]

Internal limiting membrane staining

ACTA OPHTHALMOLOGICA, Issue 2009
J KATSIMPRIS
Purpose To describe the different modalities of internal limiting membrane (ILM) staining for the treatment of idiopathic macular hole (IMH). Methods Search of the MEDLINE database by using Medical Subject Heading search terms and key words related to ILM staining, macular hole surgery. Results ILM removal has been closely related with increased closure rates. However, because of poor ILM visibility the surgical removal of ILM is very difficult and poses serious complications. To obtain better visibility of ILM some special techniques have been developed using specific dyes such as, trypan blue (TB), indocyanine green (ICG), infracyanine green or triamsinolone acetonide(TA). Anatomic success rates with one surgery have increased (>90%) however, concern for toxicity has emerged. Patients with ICG-assisted ILM peeling appear to have a depressed recovery of visual acuity compared to those not using ICG. Concentrations of ICG that are <0.5 mg/mL have been shown to be non-toxic in cultures of RPE cells. Infracyanine green is a similar molecule that does not contain iodine and is less likely to induce osmolarity related toxic effects on the PRE cells when compared to ICG. It has been used also for ILM staining in combination with trypan(TB). TB is a second generation vital dye that stains epiretinal membranes (ERMs) directly and ILM to a lesser extent. Thus TB is useful for both macular hole and macular pucker surgery. TA may be also used to help highlight the ILM, although it is not a dye. It does adhere to the posterior hyaloid, making the detection of ILM easier. Conclusion This review largely reflects the great advent of different techniques for ILM staining. The use of ICG is more toxic when compared with TB. For TA long-term effects have not been well studied. [source]

Verbal,Behavioral Dissociations in Development

CHILD DEVELOPMENT, Issue 6 2006
Jacqueline D. Woolley
Verbal and behavioral measures of children's knowledge are frequently dissociated. These situations represent a largely untapped but important resource for furthering an understanding of human cognition. In this paper, verbal,behavioral dissociations in children are discussed and analyzed, drawing from a wide range of domains. The article explores what might lead to different responses in different modalities, and it is proposed that children's goals may be an important factor. It is concluded that a variety of factors are involved in producing these dissociations, and that a richer picture of development will result from attention to these factors. [source]

1-Hz repetitive TMS over ipsilateral motor cortex influences the performance of sequential finger movements of different complexity

EUROPEAN JOURNAL OF NEUROSCIENCE, Issue 5 2008
Laura Avanzino
Abstract To elucidate the role of ipsilateral motor cortex (M1) in the control of unilateral finger movements (UFMs) in humans we used a conditioning protocol of 1-Hz repetitive transcranial magnetic stimulation (1-Hz rTMS) over M1 in 11 right-handed healthy subjects. We analysed the effects of conditioning rTMS on UFMs of different complexity (simple vs sequential finger movements), and performed with a different modality (internally vs externally paced movements). UFMs were monitored with a sensor-engineered glove, and a quantitative evaluation of the following parameters was performed: touch duration (TD); inter-tapping interval (ITI); timing error (TE); and number of errors (NE). 1-Hz rTMS over ipsilateral M1 was able to affect the performance of a sequence of finger opposition movements in a metronome-paced condition, significantly increasing TD and reducing ITI without TE changes. The effects on motor behaviour had a different magnitude as a function of the sequence complexity. Further, we found a different effect of the ipsilateral 1-Hz rTMS on externally paced movements with respect to an internally paced condition. All these findings indicate that ipsilateral M1 plays an important role in the execution of sequential UFMs. Interestingly, NE did not change in any experimental condition, suggesting that ipsilateral M1 influences only the temporal and not the spatial accuracy of UFMs. Finally, the duration (up to 30 min) of 1-Hz rTMS effects on ipsilateral M1 can indicate its direct action on the mechanisms of cortical plasticity, suggesting that rTMS can be used to modulate the communication between the two hemispheres in rehabilitative protocols. [source]

Crossmodal influences in somatosensory cortex: Interaction of vision and touch

HUMAN BRAIN MAPPING, Issue 1 2010
Jennifer K. Dionne
Abstract Previous research has shown that information from one sensory modality has the potential to influence activity in a different modality, and these crossmodal interactions can occur early in the cortical sensory processing stream within sensory-specific cortex. In addition, it has been shown that when sensory information is relevant to the performance of a task, there is an upregulation of sensory cortex. This study sought to investigate the effects of simultaneous bimodal (visual and vibrotactile) stimulation on the modulation of primary somatosensory cortex (SI), in the context of a delayed sensory-to-motor task when both stimuli are task-relevant. It was hypothesized that the requirement to combine visual and vibrotactile stimuli would be associated with an increase in SI activity compared to vibrotactile stimuli alone. Functional magnetic resonance imaging (fMRI) was performed on healthy subjects using a 3T scanner. During the scanning session, subjects performed a sensory-guided motor task while receiving visual, vibrotactile, or both types of stimuli. An event-related design was used to examine cortical activity related to the stimulus onset and the motor response. A region of interest (ROI) analysis was performed on right SI and revealed an increase in percent blood oxygenation level dependent signal change in the bimodal (visual + tactile) task compared to the unimodal tasks. Results of the whole-brain analysis revealed a common fronto-parietal network that was active across both the bimodal and unimodal task conditions, suggesting that these regions are sensitive to the attentional and motor-planning aspects of the task rather than the unimodal or bimodal nature of the stimuli. Hum Brain Mapp, 2010. © 2009 Wiley-Liss, Inc. [source]

Is focal task-specific dystonia limited to the hand and face?

MOVEMENT DISORDERS, Issue 7 2007
Steven E. Lo MD
Abstract Focal task-specific dystonia (FTSD) of the hand and face have been well described; however, FTSD of the leg is exceedingly rare. We describe and demonstrate by videotape 2 patients with FTSD affecting the leg, in both cases triggered specifically by walking down steps. Walking on a level surface, up steps, and down steps backward, and sideways were normal. An interoceptive sensory trick (imagining walking in a different modality) led to temporary improvement. Our patients appear to demonstrate that task-specificity in focal dystonia may not be limited to skilled, rehearsed actions and that FTSD may occur in an activity that is relatively automatic. © 2007 Movement Disorder Society [source]

Role of the somatosensory system in primary dystonia

MOVEMENT DISORDERS, Issue 6 2003
Michele Tinazzi MD
Abstract The pathophysiology of dystonia is still not fully understood, but it is widely held that a dysfunction of the corticostriatal,thalamocortical motor circuits plays a major role in the pathophysiology of this syndrome. Although the most dramatic symptoms in dystonia seem to be motor in nature, marked somatosensory perceptual deficits are also present in this disease. In addition, several lines of evidence, including neurophysiological, neuroimaging and experimental findings, suggest that both motor and somatosensory functions may be defective in dystonia. Consequently, abnormal processing of the somatosensory input in the central nervous system may lead to inefficient sensorimotor integration, thus contributing substantially to the generation of dystonic movements. Whether somatosensory abnormalities are capable of triggering dystonia is an issue warranting further study. Although it seems unlikely that abnormal somatosensory input is the only drive to dystonia, it might be more correlated to the development of focal hand than generalized dystonia because local somesthetic factors are more selectively involved in the former than in the latter where, instead it seems to be a widespread deficit in processing sensory stimuli of different modality. Because basal ganglia and motor areas are heavily connected not only with somatosensory areas, but also with visual and acoustic areas, it is possible that abnormalities of other sensory modalities, such as visual and acoustic, may also be implicated in the pathophysiology of more severe forms of primary dystonia. Further studies have to be addressed to the assessment of the role of sensory modalities and their interaction on the pathophysiology of different forms of primary dystonia. © 2003 Movement Disorder Society [source]

Large scale demonstration of a process analytical technology application in bioprocessing: Use of on-line high performance liquid chromatography for making real time pooling decisions for process chromatography

BIOTECHNOLOGY PROGRESS, Issue 2 2010
Anurag S. Rathore
Abstract Process Analytical Technology (PAT) has been gaining a lot of momentum in the biopharmaceutical community because of the potential for continuous real time quality assurance resulting in improved operational control and compliance. In previous publications, we have demonstrated feasibility of applications involving use of high performance liquid chromatography (HPLC) and ultra performance liquid chromatography (UPLC) for real-time pooling of process chromatography column. In this article we follow a similar approach to perform lab studies and create a model for a chromatography step of a different modality (hydrophobic interaction chromatography). It is seen that the predictions of the model compare well to actual experimental data, demonstrating the usefulness of the approach across the different modes of chromatography. Also, use of online HPLC when the step is scaled up to pilot scale (a 2294 fold scale-up from a 3.4 mL column in the lab to a 7.8 L column in the pilot plant) and eventually to manufacturing scale (a 45930 fold scale-up from a 3.4 mL column in the lab to a 158 L column in the manufacturing plant) is examined. Overall, the results confirm that for the application under consideration, online-HPLC offers a feasible approach for analysis that can facilitate real-time decisions for column pooling based on product quality attributes. The observations demonstrate that the proposed analytical scheme allows us to meet two of the key goals that have been outlined for PAT, i.e., "variability is managed by the process" and "product quality attributes can be accurately and reliably predicted over the design space established for materials used, process parameters, manufacturing, environmental, and other conditions". The application presented here can be extended to other modes of process chromatography and/or HPLC analysis. © 2009 American Institute of Chemical Engineers Biotechnol. Prog., 2010 [source]