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Selected AbstractsA Randomized, Double-Blind Comparison of Two Topical Anesthesic Formulations Prior to Electrodesiccation of Dermatosis Papulosa NigraDERMATOLOGIC SURGERY, Issue 1 2006ERIC L. CARTER MD BACKGROUND Liposomal lidocaine 4% (L.M.X.4 cream, Ferndale Laboratories Inc., Ferndale, MI, USA) has been proposed as a more rapidly acting topical anesthetic than the eutectic mixture of lidocaine 2.5% and prilocaine 2.5% (EMLA cream, AstraZeneca LP, Wilmington, DE, USA) for venipuncture and laser procedures. However, their anesthetic efficacy has not been previously compared for electrosurgical destruction of superficial skin lesions. OBJECTIVE To test the hypothesis that L.M.X.4 and EMLA differ in anesthetic efficacy when applied under occlusion for 30 minutes prior to electrodesiccation of papules of dermatosis papulosa nigra. METHODS Forty adults were randomly assigned to treatment with either agent for 30 minutes under Tegaderm. The study drug was administered for an additional 30 minutes if the electrodesiccation of the first few papules was too painful. RESULTS One subject treated with EMLA versus none treated with L.M.X.4 experienced complete anesthesia after a single 30-minute application. Nineteen of 20 (95%) subjects treated with EMLA versus 18 of 20 (90%) subjects treated with L.M.X.4 required only a single application (p=.49). Pain scores after the initial 30-minute application (scale: 0=none to 10=very severe) were EMLA 3.3±2.2 (mean±SD) versus L.M.X. 4 2.9±2.0 (p=.46). CONCLUSION EMLA and L.M.X.4 provide comparable levels of anesthesia after a single 30-minute application under occlusion prior to electrodesiccation of superficial skin lesions. [source] Nutritional factors affecting serum phenylalanine concentration during pregnancy for identical twin mothers with phenylketonuriaACTA PAEDIATRICA, Issue 8 2000C Fox The effect of energy, protein, fat, and phenylalanine on serum phenylalanine concentrations during pregnancy for a set of identical twins with phenylketonuria (PKU) was examined. Blood samples were collected one to two times per week. The subjects completed a 3-d food record prior to each blood collection. The effect of the factors on serum phenylalanine levels was evaluated statistically using time-series analysis. Dietary intakes of the nutrients evaluated were similar for the subjects. For one subject, there were highly significant effects of energy, protein, and fat on serum phenylalanine levels. In contrast, these nutrients had no significant effect on serum phenylalanine for the other subject. Dietary phenylalanine had no significant effect on serum phenylalanine for either twin. Conclusions: There was no effect of phenylalanine intake and no consistent effect of energy, protein, or fat on serum phenylalanine. Other dietary or environmental factors or a combination of factors may impact serum phenylalanine levels of pregnant women with PKU. [source] Biting Behavior, Aggression, and SeizuresEPILEPSIA, Issue 5 2005Carlo Alberto Tassinari Summary:,Purpose: To describe the semiologic features of aggressive behaviors observed in human epileptic seizures with particular reference to the act of biting a conspecific. Methods: We analyzed the biting behavior (BB) and other aggressive gestures occurring in a group of 11 patients retrospectively selected from >1,000 patients subjected to video-EEG/SEEG monitoring for presurgical evaluation of drug-resistant seizures. Results: Patients displaying BB showed (a) a male sex predominance, (b) heterogeneous etiologies and lesion locations, and (c) seizures involving the frontotemporal regions of both hemispheres. The act of biting was a rapid motor action, lasting ,600 ms, occurring in the context of strong emotional arousal, fear, and anger, with various bodily gestures with aggressive connotation. BB was mainly a "reflexive" behavior, in that biting acts were evoked (both during and after seizures) by actions of people in close contact with the patient. The sole intrusion of the examiner's hand in the space near the patient's face was effective in triggering BB. Rarely, self-directed or object-directed biting acts were not triggered by external stimuli. Intracranial data (SEEG) obtained in one subject showed that the amygdala/hippocampal region plus the orbitomedial prefrontal cortex had to be involved by ictal activity to observe BB. Conclusions: Anatomic and electrophysiologic data in our patients suggest that a model of dual,temporal and frontal,dysfunction could account for the occurrence of ictal/postictal BB. Behavioral data suggest also that BB and related aggressive gestures can be considered as the emergence of instinctive behaviors with an adaptative significance of defense of the peripersonal space. [source] Molecular spectrum of SLC22A5 (OCTN2) gene mutations detected in 143 subjects evaluated for systemic carnitine deficiency,HUMAN MUTATION, Issue 8 2010Fang-Yuan Li Abstract Systemic primary carnitine deficiency (CDSP) is caused by recessive mutations in the SLC22A5 (OCTN2) gene encoding the plasmalemmal carnitine transporter and characterized by hypoketotic hypoglycemia, and skeletal and cardiac myopathy. The entire coding regions of the OCTN2 gene were sequenced in 143 unrelated subjects suspected of having CDSP. In 70 unrelated infants evaluated because of abnormal newborn screening (NBS) results, 48 were found to have at least 1 mutation/unclassified missense variant. Twenty-eight of 33 mothers whose infants had abnormal NBS results were found to carry at least 1 mutation/unclassified missense variant, including 11 asymptomatic mothers who had 2 mutations. Therefore, sequencing of the OCTN2 gene is recommended for infants with abnormal NBS results and for their mothers. Conversely, 52 unrelated subjects were tested due to clinical indications other than abnormal NBS and only 14 of them were found to have at least one mutation/unclassified variant. Custom designed oligonucleotide array CGH analysis revealed a heterozygous ,1.6 Mb deletion encompassing the entire OCTN2 gene in one subject who was apparently homozygous for the c.680G>A (p.R227H) mutation. Thus, copy number abnormalities at the OCTN2 locus should be considered if by sequencing, an apparently homozygous mutation or only one mutant allele is identified. ©2010 Wiley-Liss, Inc. [source] SCN5A Mutation Associated with Cardiac Conduction Defect and Atrial ArrhythmiasJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2006PÄIVI J. LAITINEN-FORSBLOM Ph.D. Introduction: We aimed at identifying the molecular defect underlying the clinical phenotype of a Finnish family with a cardiac conduction defect and atrial arrhythmias. Methods and Results: A large Finnish family was clinically evaluated (ECG, 24-hour ambulatory ECG, echocardiography). We performed linkage analysis with markers flanking the SCN5A gene and subsequently sequenced the SCN5A gene. Five family members had atrial arrhythmias and intracardiac conduction defects, and due to bradycardia needed a pacemaker when adolescents. No heart failure or sudden cardiac death was observed. Left ventricle dilatation was seen in one individual and three individuals had a slightly enlarged right ventricle. Premature death due to stroke occurred in one subject during the study, and two other members had suffered from stroke at young age. Linkage analysis favored the role of the SCN5A gene in disease pathogenesis, and direct sequencing disclosed D1275N mutation. This alteration was present not only in all six affected individuals, but also in two young individuals lacking clinical symptoms. Conclusions: Cardiac conduction defect and atrial arrhythmias in a large Finnish family appear to result from the SCN5A D1275N mutation. Although no sudden cardiac death was recorded in the family, at least three affected members had encountered brain infarction at the age of 30 or younger. [source] Using a Motion-Capture System to Record Dynamic Articulation for Application in CAD/CAM SoftwareJOURNAL OF PROSTHODONTICS, Issue 8 2009Oliver Röhrle PhD Abstract Purpose: One of the current limitations of computer software programs for the virtual articulation of the opposing teeth is the static nature of the intercuspal position. Currently, software programs cannot identify eccentric occlusal contacts during masticatory cyclic movements of the mandible. Materials and Methods: Chewing trajectories with six degrees of freedom (DOF) were recorded and imposed on a computer model of one subject's maxillary and mandibular teeth. The computer model was generated from a set of high-resolution ,-CT images. To obtain natural chewing trajectories with six DOF, an optoelectronic motion-capturing system (VICON MX) was used. For this purpose, a special mandibular motion-tracking appliance was developed for this subject. Results: Mandibular movements while chewing elastic and plastic food samples were recorded and reproduced with the computer model. Examples of mandibular movements at intraoral points are presented for elastic and plastic food samples. The potential of such a kinematic computer model to analyze the dynamic nature of an occlusion was demonstrated by investigating the interaction of the second molars and the direction of the biting force during a chewing cycle. Conclusions: The article described a methodology that measured mandibular movements during mastication for one subject. This produced kinematic input to 3D computer modeling for the production of a virtual dynamic articulation that is suitable for incorporation into dental CAD/CAM software. [source] SAFETY OF DEXTROAMPHETAMINE AND COCAINE COMBINATIONS IN COCAINE USERSALCOHOLISM, Issue 2008William Murff Two studies evaluated the safety and abuse liability of d-amphetamine in combination with cocaine in twenty cocaine-using research volunteers maintained in a controlled research laboratory. The first study tested low doses of d-amphetamine (15 mg) administered orally as a 1.5-hr pretreatment before low intranasal doses (48 mg) of cocaine. The study was double-blind, double-dummy, and placebo-controlled. A dose run-up procedure was employed to maximize safety. All drug effects were modest and the main finding of the study was diminished subjective effects of cocaine on a replicate determination of the original cocaine dose. The second study examined higher doses of d-amphetamine (30 mg, p.o.) and cocaine (96 mg, i.n.), alone and in combination, without a gradual dose run-up. Cocaine alone increased subjective mood, cocaine craving, and ratings indicating cocaine abuse potential. Again, replicate administration of cocaine produced lesser subjective effects than the first dose. D-amphetamine alone increased systolic and mean arterial pressures, but produced minimal effects on subjective mood. The combination of d-amphetamine and cocaine never produced effects greater than cocaine alone except for one subject who had an asymptomatic hypertensive episode. The data are interpreted in light of the possible use of stimulants for the treatment of cocaine dependence. [source] Assessing the trade-offs between crossover and parallel group designs in sleep researchJOURNAL OF SLEEP RESEARCH, Issue 4 2006CHARLES C. BERRY Summary Sleep researchers invariably struggle with decisions regarding the optimal design for their studies. Whether such studies involve treatment for insomnia, obstructive sleep apnea, or any other sleep disorder, questions arise regarding the respective trade-offs between a parallel group and a crossover design. This study analyzed the variance structure of commonly measured polysomnographic variables in an effort to describe the statistical impact of these alternate designs. The study examined the effects of opioids on sleep and employed multiple crossovers between placebo, MS-contin, and methadone using a double-blind, randomized crossover design. Thirty-seven healthy subjects were studied. Four of the subjects were unable to complete the protocol for a variety of reasons, and polysomnogram data was unavailable for one subject. Data from 37 subjects provide the basis for this analysis. Despite dropouts, the crossover study was approximately four times as efficient as the parallel group design in terms of being able to recognize differences in deep sleep across these conditions. Other polysomnographic variables also favored the crossover design to varying extents. Despite the operational complexity of a crossover design, the statistical efficiency of this approach makes it a preferable approach for designing intervention studies in sleep research. [source] The clinical safety of long-term lansoprazole for the maintenance of healed erosive oesophagitisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 12 2009J. W. FRESTON Summary Background, The clinical safety of long-term lansoprazole therapy for the maintenance of healed erosive oesophagitis has not been extensively studied in clinical trials. Aim, To assess the long-term clinical safety of dose-titrated lansoprazole as maintenance therapy for up to 82 months in subjects with healed erosive oesophagitis. Methods, Clinical safety was assessed by monitoring adverse events (AEs), laboratory data including serum gastrin levels, and endoscopy. Results, Mean duration (± s.d.) of lansoprazole treatment during the titrated open-label period was 56 ± 24 months (range <1,82 months). Overall, 189 of 195 (97%) subjects experienced a total of 2825 treatment-emergent AEs. Most AEs occurred during the first year of treatment, were mild-to-moderate in severity and resolved while on treatment. Of 155 serious AEs (in 74 subjects), only two (colitis and rectal haemorrhage in one subject) were considered treatment-related. Sixty-nine of 195 subjects (35%) experienced 187 treatment-related AEs, with diarrhoea (10%), headache (8%) and abdominal pain (6%) being the most common. Gastrin levels ,400 pg/mL were seen in 9% of subjects; hypergastrinemia was not associated with gastro-intestinal AEs or nodules/polyps. Conclusions, Lansoprazole maintenance therapy for up to 6 years is safe and well tolerated in subjects with healed erosive oesophagitis. [source] Normal cerebral perfusion measurements using arterial spin labeling: Reproducibility, stability, and age and gender effectsMAGNETIC RESONANCE IN MEDICINE, Issue 4 2004Laura M. Parkes Abstract Before meaningful conclusions can be drawn from clinical measures of cerebral blood perfusion, the precision of the measurement must be determined and set in the context of inter- and intrasubject sources of variability. This work establishes the reproducibility of perfusion measurements using the noninvasive MRI technique of continuous arterial spin labeling (CASL). Perfusion was measured in 34 healthy normal subjects. Intersubject variability was assessed, and age and gender contributions were estimated. Intersubject variation was found to be large, with up to 100% perfusion difference for subjects of the same age and gender. Repeated measurements in one subject showed that perfusion remains remarkably stable in the short term when compared with intersubject variation and the large capacity for perfusion change in the brain. A significant decrease in the ratio of gray-matter to white-matter perfusion was found with increasing age (0.79% per year (P < 0.0005)). This appears to be due mainly to a reduction in gray-matter perfusion, which was found to decrease by 0.45% per year (P = 0.04). Regional analysis suggested that the gray-matter age-related changes were predominantly localized in the frontal cortex. Whole-brain perfusion was 13% higher (P = 0.02) in females compared to males. Magn Reson Med 51:736,743, 2004. © 2004 Wiley-Liss, Inc. [source] The predominant cultivable Veillonella spp. of the tongue of healthy adults identified using rpoB sequencingMOLECULAR ORAL MICROBIOLOGY, Issue 4 2008D. Beighton The predominant Veillonella spp. were isolated from the dorsum surface of the tongues of 11 healthy adults and identified to species level using rpoB sequencing because 16S ribosomal RNA sequence analysis does not reliably differentiate between all members of this genus. In all, 253 isolates were identified and the mean proportion (± SE) of Veillonella spp. per sample was 16.2 (± 3.6) with a range of 3.0% to 36.3% of the total anaerobic colony count. The predominant species were Veillonella atypica (10/11), Veillonella dispar (9/11) and Veillonella rogosae (8/11) because they were isolated from the majority of subjects. Veillonella parvula was isolated from only one subject while Veillonella dentocariosi and Veillonella montpelleriensis were not isolated from any subject. [source] The effects of traditional and computer-aided instruction on promoting independent skin care in adults with paraplegiaOCCUPATIONAL THERAPY INTERNATIONAL, Issue 1 2003Associate Professor, Joseph M. Pellerito Jr MS, OTR Interim Chairperson Abstract This study aimed to explore the viability of using computer-aided instruction (CAI) as an educational tool for promoting independent skin care in adults with paraplegia. There is a need to identify effective intervention strategies that provide health education for skin care management and the prevention of pressure ulcers for individuals with spinal cord injuries (SCI). There continues to be tremendous financial and personal costs associated with the treatment of pressure ulcers and the prevalence of skin breakdown among the SCI population, despite traditional educational methods. The methodology used in this study evaluated to what degree CAI assisted individuals with paraplegia to acquire knowledge and demonstrate skills necessary for optimal skin care. Results were obtained using a multiple baseline across subjects approach including an ABC (for two subjects) and an AC (for one subject) single case experimental design. Results indicated that CAI was more effective than traditional educational methods in increasing the initiation and performance of pressure-relieving techniques. Limitations in this study include the possibility of carryover effects, relatively short time periods for baseline and treatment conditions, and extraneous variables that were difficult to control such as the participants' level of motivation and cooperation. Further study using a larger group design with a control group is recommended to explore the effects CAI has on promoting optimal skin care among adults with paraplegia. Copyright © 2003 Whurr Publishers Ltd. [source] Macular pigment optical density at four retinal loci during 120 days of lutein supplementationOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 4 2007Adam J. Wenzel Abstract Background:, Increased consumption of lutein and zeaxanthin has been shown to increase macular pigment optical density (MPOD) in some individuals. Most interventions either obtained infrequent measures of MPOD or measured MPOD at a single retinal locus. Purpose:, The aim of this study was to measure acute changes in MPOD at four retinal loci during lutein intervention. Methods:, For 120 days, three subjects consumed 30 mg of lutein and 2.7 mg of zeaxanthin supplement per day. MPOD was measured with heterochromatic flicker photometry at 20,, 30,, 60, and 120, eccentricity three or four times per week. High-performance liquid chromatography was used to measure serum carotenoid concentrations in blood samples collected at baseline and at 30-day intervals. Results:, At the two most central loci, MPOD significantly increased in all three subjects with a mean change of approximately 0.09 log units at 20, eccentricity and 0.08 log units at 30, eccentricity. MPOD significantly increased in two subjects at 60, eccentricity, and in one subject at 120, eccentricity. The increases in MPOD appeared to be linear and continued after treatment was ended. In all three subjects, log sensitivity at the reference locus decreased linearly. Serum lutein and serum zeaxanthin increased from baseline, reaching peak concentrations after 30 days of supplementation. Conclusion:, The changes in MPOD suggest that carotenoid deposition occurs linearly and may be biased towards the central retina. Further, carotenoid deposition may occur outside the central fovea in interventions with pharmacological doses of carotenoid, resulting in underestimations of psychophysical measures of MPOD. [source] Compensation for light loss due to filtering by macular pigment: relation to hue cancellationOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 3 2007James M. Stringham Abstract Background:, A long-standing question in colour vision research is how the visual system is able to correct for the significant absorbance of short wave light by the crystalline lens and macular pigment (MP). Such compensation must be required in order to maintain colour constancy across the retina where MP levels are changing quickly and dramatically. Objective:, We studied this compensation mechanism by measuring MP spatial density profiles and hue cancellation functions across the central retina in a sample of six young healthy subjects. Method:, Yellow (Y, 575 nm)/blue (B, 440 nm) and red (R, 600 nm)/green (G, 501 nm) cancellation functions were obtained at 0, 1, 1.75, 3 and 7° eccentricity. The MP optical density at 460 nm was measured at these same eccentricities using heterochromatic flicker photometry. One subject was assessed repeatedly over a 4-month period during daily supplementation with 30 mg of lutein (L). Results:, Hue cancellation values for the Y/B system did not change across the retina (r = 0.09). In contrast, R/G sensitivity changed as a direct function of MP absorbance (r = 0.99). The Y/B values did not change in the one subject supplemented with 30 mg L daily, despite increases in MP of about 50% over 4 months. Conclusions:, Despite large variations in MP across the retina, hue cancellation values for the Y-B system across the central retina were constant. For example, one subject's MP density declined from a central peak of 0.99 to near zero at 7° (near 90% transmission difference) yet thresholds for the Y/B system were unaffected. In contrast, the G lobe of the R/G system was directly correlated with MP density. Taken together, these results confirm that the Y/B system compensates for MP density, but the R/G system does not. [source] Cling film as a barrier against CJD in corneal contact A-scan ultrasonographyOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 1 2003Asha Rani Abstract Purpose: To determine the validity of covering a corneal contact transducer probe with cling film as protection against the transmission of Creutzfeldt,Jakob disease (CJD). Methods: The anterior chamber depth, lens thickness and vitreous chamber depth of the right eyes of 10 subjects was recorded, under cycloplegia, with and without cling film covering over the transducer probe of a Storz Omega Compu-scan Biometric Ruler. Measurements were repeated on two occasions. Results: Cling film covering did not influence bias or repeatability. Although the 95% limits of agreement between measurements made with and without cling film covering tended to exceed the intrasessional repeatability, they did not exceed the intersessional repeatability of measurements taken without cling film. Conclusions: The results support the use of cling film as a disposable covering for corneal contact A-scan ultrasonography to avoid the risk of spreading CJD from one subject to another. [source] A cognitive aid for neonatal resuscitation: a randomized controlled trialPEDIATRIC ANESTHESIA, Issue 7 2009M.D. Bould Introduction:, Anaesthetists are among several health care practitioners responsible for neonatal resuscitation in Canada. The Neonatal resuscitation program (NRP) courses are the North American educational standard. NRP has been shown to be an effective way of learning skills and knowledge but retention has been found to be problematic [1]. The use of cognitive aids is mandatory in industries such as aviation, to avoid dependence on memory when decision making in critical situations. Visual cognitive aids have been studied retrospectively in resuscitation and performance was found to correlate to the frequency of use of the aid [2]. Cognitive aids have been found to be of benefit in an unblinded prospective study [3]. We aimed to conduct the first blinded study on the effect of a cognitive aid on the performance of simulated resuscitation. Methods:, We conducted a single-blind randomized controlled trial to investigate whether the presence of a cognitive aid improved performance in a simulated neonatal resuscitation. After ethics board approval we recruited 32 anaesthesia residents who had previously passed the NRP. Subjects were randomized to an intervention group that had a poster detailing the NRP algorithm and a control group without the poster. The cognitive aid was positioned so that it could not be seen on the video recordings of the simulation that was used to assess performance. The scenario was piloted to confirm adequate blinding. Both groups had their performance in a simulated neonatal resuscitation recorded and subsequently analyzed by a peer, an expert anaesthetist and an expert neonatologist, using a previously validated checklist. A further rater observed the scenario in real time to examine frequency of use of the cognitive aid. Results:, The inter-rater reliability of the checklist was excellent with an intraclass correlation coefficient of 0.88. Consequently the mean of the scores assigned by all three raters was used for analysis. The median checklist score in the control group 18.2 [15.0,20.5 (10.7,25.3)] was not significantly different from that in the intervention group 20.3 [18.3,21.3 (15.0,24.3)] (P = 0.08). Retention of NRP skills and knowledge of was poor: when evaluated by the neonatologist none of the subjects correctly performed all life-saving interventions necessary to pass the checklist. Although only one subject in the intervention group did not use the aid at all, only 26.7% used the aid frequently and none used it extensively. Discussion:, Retention of skills after NRP training was poor. Our study confirms previous findings of poor retention of skills after NRP training: Kaczorowski et al. investigated family medicine trainees and found that none of 44 residents that were retested 6,8 months after an NRP course would have passed the course due to errors in life-saving interventions [1]. Previous research has shown that the presence of a cognitive aid can improve performance in the simulated management of a rare, high stakes scenario: malignant hyperthermia [3]. Our negative findings contrast with this and another previous study [2]. A potential reason for this discrepancy is that the raters in the previous studies were not blinded to group allocation, nor were the rating scales used validated. The infrequent use of the cognitive aid may be the reason that it did not improve performance in. Further research is required to investigate whether cognitive aids can be useful if their use is incorporated into NRP training. Conclusion:, A randomized single-blinded trial found that a cognitive aid did not improve performance at simulated resuscitation, in contrast to previous retrospective and unblended studies. Retention of skills and knowledge after resuscitation training remains an ongoing challenge for medical educators. [source] Fluctuations in isometric muscle force can be described by one linear projection of low-frequency components of motor unit discharge ratesTHE JOURNAL OF PHYSIOLOGY, Issue 24 2009Francesco Negro The aim of the study was to investigate the relation between linear transformations of motor unit discharge rates and muscle force. Intramuscular (wire electrodes) and high-density surface EMG (13 × 5 electrode grid) were recorded from the abductor digiti minimi muscle of eight healthy men during 60 s contractions at 5%, 7.5% and 10% of the maximal force. Spike trains of a total of 222 motor units were identified from the EMG recordings with decomposition algorithms. Principal component analysis of the smoothed motor unit discharge rates indicated that one component (first common component, FCC) described 44.2 ± 7.5% of the total variability of the smoothed discharge rates when computed over the entire contraction interval and 64.3 ± 10.2% of the variability when computed over 5 s intervals. When the FCC was computed from four or more motor units per contraction, it correlated with the force produced by the muscle (62.7 ± 10.1%) by a greater degree (P < 0.001) than the smoothed discharge rates of individual motor units (41.4 ± 7.8%). The correlation between FCC and the force signal increased up to 71.8 ± 13.1% when the duration and the shape of the smoothing window for discharge rates were similar to the average motor unit twitch force. Moreover, the coefficients of variation (CoV) for the force and for the FCC signal were correlated in all subjects (R2 range = 0.14,0.56; P < 0.05) whereas the CoV for force was correlated to the interspike interval variability in only one subject (R2= 0.12; P < 0.05). Similar results were further obtained from measures on the tibialis anterior muscle of an additional eight subjects during contractions at forces up to 20% of the maximal force (e.g. FCC explained 59.8 ± 11.0% of variability of the smoothed discharge rates). In conclusion, one signal captures most of the underlying variability of the low-frequency components of motor unit discharge rates and explains large part of the fluctuations in the motor output during isometric contractions. [source] Ligasure versus Cold Knife TonsillectomyTHE LARYNGOSCOPE, Issue 9 2005Vassilios A. Lachanas MD Abstract Objective: To assess parameters related to ligasure tonsillectomy (LT) versus cold knife tonsillectomy (CKT) procedure. Study Design: Prospective randomized study. Methods: A prospective study was conducted on 200 consecutive adult patients undergoing tonsillectomy. Indications included chronic tonsillitis and obstructive sleep apnea syndrome. Patients undergoing adenoidectomy, or any procedure together with tonsillectomy, and patients with peritonsillar abscess history or bleeding disorders were excluded. Patients were randomly assigned to either the LT or CKT group. Intraoperative bleeding, operative time, postoperative pain using a visual analogue scale, and complication rates were evaluated. Results: The LT and CDT groups consisted of 108 and 92 individuals, respectively. In the LT group, there was no measurable intraoperative bleeding, whereas mean bleeding for CKT group was 125 mL. The mean operative time was 15 ± 1.43 minutes for the LT group and 21 ± 1.09 minutes for the CKT group (P < .001). The overall mean pain score for the LT group was 3.63, whereas for the CKT group it was 5.09 (P < .001). Primary hemorrhage occurred in one subject of the CKT group. Secondary postoperative hemorrhage was noticed two subjects of the LT group and two subjects of the CKT group. In 21 subjects of the LT group, limited peritonsillar edema was noticed. No other complication occurred in both groups. Conclusion: LT procedure provides sufficient hemostasis, lower postoperative pain, and reduced operative time, as well as safety against Creutzfeld Jakob disease transmission. [source] Tracheal intubation and alternative airway management devices used by healthcare professionals with different level of pre-existing skills: a manikin study,ANAESTHESIA, Issue 5 2009B. M. Wahlen Summary The classic Laryngeal Mask Airway (cLMAÔ), ProSeal Laryngeal Mask Airway (PLMAÔ), Intubating Laryngeal Mask AirwayÔ (ILMAÔ), Combitube (CTÔ), Laryngeal Tube (LTÔ) and tracheal intubation (TI) were compared in a manikin study. Nurses, anaesthetic nurses, paramedics, physicians and anaesthetists inserted the devices three times in a randomised sequence. Time taken for successful insertion, success rates and ease of insertion were evaluated. Anaesthetists performed tracheal intubation significantly faster than other healthcare professionals (p < 0.05). Insertion times for the cLMA, PLMA, LT and CT were not significantly different between the groups. Insertion of the CT, ILMA and TI was associated with a significant learning effect in all groups. This was not observed with the cLMA, PLMA or LT. All non-anaesthetists were able to insert the cLMA, PLMA and LT within two attempts with a > 90% success rate on the first attempt. The ILMA and TI were the only devices where more than one subject experienced some difficulty in insertion. The cLMA, PLMA and LT should be evaluated for use in situations where only limited airway training is possible. [source] Spatial Properties of QT and the T-Wave MorphologyANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 3 2000Kaspar Lund M.S.S.E. Objective: To describe the relation between the QT interval and the T-wave morphology. Material and methods: Frank orthogonal leads X, Y, Z of one subject and resting 12-lead ECG of 40 subjects. QT was measured by the tangent method. The QT values are organized according to the anatomic orientation of the leads: I, -aVR, II, aVF, III, -aVL, -I, aVR, -II, -aVF, -III, aVL. and: V1, V2, V3, V4, V5, V6, -V1 -V2, -V3, -V4, -V5, -V6. The T-wave amplitudes and QT were categorized according to QT into four groups with increasing mean QT. Results: Kruskal-Wallis nonparametric test showed that the shortest and longest QT values are measured on the T wave with the smallest amplitudes (P < 0.001). Inspection of plots of QT and T waves reveals that the shortest and longest QT values are usually measured in leads with a small difference in orientation (neighbor leads). The mechanism behind these characteristics is mainly that the shortest and longest QT values are measured on T waves that are close to a lead orientation, whereas the T waves are flat or biphasic. We also observed an almost significant (P = 0.057) decrease in the T-wave amplitude with increasing dispersion. Conclusion: The relation between T-wave morphology and QT in the same cardiac plane is highly organized. The shortest and longest QT values are measured on the T wave with the smallest amplitudes (P < 0.001). [source] Peritoneal T Cell Responses Can Be Polarized Toward Th1 or Th2 in Children on Chronic Peritoneal DialysisARTIFICIAL ORGANS, Issue 8 2004Sabrina Chiesa Abstract:, Peritoneal T cell responses can be polarized toward Th1 or Th2 in children on chronic peritoneal dialysis. Previous studies on the peritoneal immune system described the presence of activated T lymphocytes in peritoneal effluents from subjects on chronic peritoneal dialysis (CPD). Since Th1/Th2 polarized response can influence the outcome of specific infectious diseases, we investigated if activated Th1/Th2 cells can be detected in peritoneal effluents during peritoneal dialysis, in order to better understand the role of T cells in the mechanisms of peritoneal defense. We have studied 8 children (4 males, 4 females, mean age 5.8 ± 5.7 years, range 0.3,13.4) on CPD. Peritoneal cells have been isolated from peritoneal effluents by centrifugation. Immunofluorescent staining of intracellular cytokines for flow cytometric analysis was used to detect the percentage of T cells producing either IFN-, (Th1) or IL-4 (Th2). In the initial study 3 months after CPD initiation, high percentages of IFN-, positive peritoneal T cells (38% and 63%) were detected in two subjects; this finding is consistent with a Th1 polarization of peritoneal T cells. In another subject, high percentages of IL-4 positive T cells (31%) were detected, suggesting a Th2 polarization of peritoneal T cell response. Small amounts of either Th1 or Th2 T cells (2,4%) were also detected in the other subjects. At the 1 year follow-up, Th1 polarization persisted in one subject (18% IFN-, positive peritoneal T cells), in another a shift from Th1 to Th2 was observed, and in the other subject a down regulation of both T cell subsets occurred. The finding that a predominance of T cells producing either IFN-, or IL-4 was found in 3 out of 8 children strongly suggests that peritoneal T cell responses can be polarized toward Th1 or Th2. The decrease of Th1 and/or Th2 polarized T cells in the peritoneum of 4 out of 6 subjects (after 1 year) suggests that CPD can play an immunosuppressive role on T cell peritoneal responses. Further studies are needed in order to define whether different T helper activation patterns are associated with a higher risk of peritoneal infection or of peritoneal damage. [source] Original Article: Complications of laparoscopic myomectomy: A single surgeon's series of 1001 casesAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2010G. P. Paul Objective:, The objective of this retrospective study was to evaluate the safety, intra-operative and post-operative morbidity of laparoscopic approach for myomectomy. Methods:, The total 1001 subjects who underwent endoscopic surgery over a 16-year period were studied retrospectively. All the data were collected regarding clinical presentation, intra-operative findings, intra-operative and post-operative complications, and hospital stay, and statistically analysed. Results:, The average age of subjects was 32.62 years and the most common indication for surgery was infertility (48.5%). A total of 2167 myomas were removed; 43.98% of subjects required removal of multiple myomas. The average blood loss was 248 mL, and the average hospital stay was 1.5 days. The overall major and minor complication rate is very low except one subject who required laparotomy for post-operative bleeding, and there was one unexplained post-operative death. Conclusions:, Laparoscopic myomectomy is comparable to laparotomy myomectomy in terms of duration of surgery, blood loss and complication rates. This large single surgeon series on laparoscopic myomectomy also shows a low complication rate suggesting that laparoscopic myomectomy is a safe and reliable procedure, even in the presence of multiple or large myomas. [source] Can sensitization to aeroallergens disappear over time in children with allergic disease?ACTA PAEDIATRICA, Issue 9 2010KD Jacobs Abstract Background:, Remittance of aeroallergen sensitization has been shown in population-based studies, but there is a common perception that sensitization to aeroallergens rarely if ever disappears in children with allergic disease. Methods:, We retrospectively reviewed all specific IgE tests carried out in children aged 0,18 years at our hospital laboratory over a 14-year period. Of 3115 children sensitized to one or more aeroallergens, 244 (7.8%) were retested after a mean (SD) period of 45 (28) months at their physician's discretion. Results:, Disappearance of sensitization to individual aeroallergens did occur, with remittance rates ranging from 3.1% for house dust mite to 17.5% for cat. However, complete remittance of aeroallergen sensitization was found in only one subject. In up to 35% of cases, remittance of sensitization was offset by the appearance of one or more new aeroallergen sensitizations. Remittance was only observed in children sensitized to multiple allergens (with a median of 3 aeroallergen sensitizations), and their median degree of sensitization was low (median 2.1 kU/L). Conclusion: Aeroallergen sensitization can disappear in children with allergic disease, but only in polysensitized individuals. Complete remittance of sensitization to aeroallergens is rare in symptomatic children. [source] Impaired GH secretion to provocative stimuli in two families with hypocalciuric hypercalcaemiaCLINICAL ENDOCRINOLOGY, Issue 5 2003Elisabetta Cecconi Summary objective, To determine whether hypercalcemia per se might be responsible for an impairment in GH secretion. design, Prospective study. patients, Six subjects of two unrelated families with familial hypocalciuric hypercalcaemia (FHH), an autosomal dominant disorder due to inactivating mutations in the calcium receptor gene, leading to an increase in serum calcium levels and inappropriately normal serum PTH concentrations. Forty normal subjects, matched for sex and age served as controls. measurements, Serum GH concentrations were measured after GHRH-Arginine (GHRH-Arg) stimulation test; serum IGF-I, ACTH, cortisol, FT4, FT3, TSH, PRL, LH, FSH levels were measured under basal conditions. results, All subjects (two male, four female, age range 24,74 years) had increased serum ionized calcium levels (range 1·36,1·56 mmol/l) and five of six patients had normal PTH levels (range for all patients was 14,68 ng/l). Basal serum GH concentrations ranged from 0·1 to 7·0 µg/l. Mean serum GH secretory peak after GHRH-Arg stimulation test was reduced in five subjects (mean 9·3 ± 3·6 µg/l, P < 0·006 vs. Controls, mean 67·0 ± 44·0 µg/l, cut-off, 16·0 µg/l) and normal in one subject (38·7 µg/l). However, serum IGF-I levels were reduced only in two patients (29 and 57 µg/l) and normal in four subjects (range 127,208 µg/l). The basal secretion of the other anterior pituitary hormones was within their normal ranges. conclusions, The results of the present study support the concept that elevated serum calcium levels impair GH secretion. However, the clinical relevance of GH deficiency in FHH remains to be elucidated. [source] ADH Genotype Does Not Modify the Effects of Alcohol on High-Density LipoproteinALCOHOLISM, Issue 3 2003John B. Whitfield Background: Alcohol consumption has beneficial effects on mortality which are mainly due to reduction in cardiovascular disease. These are believed to be due, at least in part, to the increase in plasma high-density lipoprotein (HDL) which is associated with alcohol consumption. It has been proposed that ADH3 genotype modifies the relationships between alcohol intake and cardiovascular disease by altering the HDL response to alcohol. The aim of this paper was to test for effects of ADH2 and ADH3 genotypes on the response of HDL components to habitual alcohol consumption. Methods: Adult male and female subjects were genotyped for ADH2 and ADH3; and plasma HDL cholesterol, apolipoprotein A-I, and apolipoprotein A-II were measured. Nine hundred one subjects had both ADH2 and ADH3 genotypes and HDL cholesterol results, while 753 had both genotypes and all three lipid results. The effect of alcohol intake on the three measured HDL components, and a factor score derived from them, was estimated for each of the ADH2 and ADH3 genotype groups. Results: All the measured components of HDL increased with increasing alcohol consumption over the range of intakes studied, 0,4 drinks per day. There were no significant interactions between alcohol consumption and ADH2 or ADH3 genotypes. Conclusions: The concept that alcohol dehydrogenase genotype and alcohol metabolic rate modify the effects of alcohol on plasma HDL concentration is not supported by our results. [source] | |||||||||||||||||||||||||