Useful Alternative (useful + alternative)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Treatment of Parthenium dermatitis with methotrexate

Vinod K. Sharma
Patients with parthenium dermatitis are often unresponsive to topical steroids, and immunosuppressive agents may be necessary to reduce their need for systemic corticosteroids. We evaluated the efficacy of methotrexate in parthenium dermatitis. Sixteen patients unresponsive to topical treatment were included after baseline investigations, and treated with oral methotrexate (15 mg/week). Clinical response was monitored using a dermatitis area and severity index (DASI). Seven patients completed ,6 months' follow-up, and their mean DASI fell to 5, 2.7 and 2.1 at the end of 1, 3 and 6 months respectively, from a baseline score of 10. Only 3/7 patients required oral prednisolone in the initial 2,4 weeks. Side effects were minor, being mainly folliculitis and furuncles. Methotrexate may hence be a useful alternative for patients with severe parthenium dermatitis. [source]

Periorbital Reconstruction with Adjacent-Tissue Skin Grafts

Andrew J. Kaufman MD
Background. Reconstruction in the periorbital area is challenging owing to the complex function of the eye, relative lack of adjacent loose tissue, free anatomic margin, central facial location, and the need to maintain symmetry with the contralateral eye. Reconstructive options risk crossing anatomic margins, deviation of the lid margin (ectropion), persistent lymphedema, and repair with skin of dissimilar color, texture, and thickness. Objective. The purpose was to describe a reconstructive option that would avoid crossing cosmetic units or subunits, minimize the risk of ectropion, repair with tissue of similar surface characteristics, and maintain function and symmetry with the contralateral side. Methods. The adjacent-tissue skin graft provides closure in cosmetic units and subunits, avoids tension on the lid margin, and provides similar skin for repair. The procedure is demonstrated by graphic and photographic examples. Results. The procedure provides for esthetic repair of the periorbital area and minimizes the risk of ectropion, lymphedema, asymmetry, and dysfunction of the lids and lacrimal system. Conclusion. Adjacent-tissue skin grafts are a useful alternative for reconstruction of partial-thickness defects on the eyelid and periorbital area. ANDREW J. KAUFMAN, MD, HAS INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source]

Can behavioral evolution be measured on a staircase? a commentary

Celia L. Moore
Abstract The serious, comparative study of behavioral complexity that Greenberg et al. advocate is a progressive direction for the field, but their proposal to separate comparative psychology from its roots in evolutionary biology seems regressive. Modern evolutionary theory has been broadened within biology to include development and paleontology alongside natural selection, making closer integration with that discipline particularly timely. Such an integrated evolutionary approach in psychology would offer a useful alternative to the adaptationism popularized by evolutionary psychology. Although the differences between comparative psychologists and biologists may be blurred in the process, the behavioral sciences will be better served by a rich biological approach to evolution than by a uniquely psychological approach. © 2003 Wiley Periodicals, Inc. Dev Psychobiol 44: 16,20, 2004. [source]

Systematic review of methods to diagnose infection in foot ulcers in diabetes

S. O'Meara
Abstract Aim, To undertake a systematic review of the diagnostic performance of clinical examination, sample acquisition and sample analysis in infected foot ulcers in diabetes. Methods, Nineteen electronic databases plus other sources were searched. To be included, studies had to fulfil the following criteria: (i) compare a method of clinical assessment, sample collection or sample analysis with a reference standard; (ii) recruit diabetic individuals with foot ulcers; (ii) present 2 × 2 diagnostic data. Studies were critically appraised using a 12-item checklist. Results Three eligible studies were identified, one each on clinical examination, sample collection and sample analysis. For all three, study groups were heterogeneous with respect to wound type and a small proportion of participants had foot ulcers due to diabetes. No studies identified an optimum reference standard. Other methodological problems included non-blind interpretation of tests and the time lag between index and reference tests. Individual signs or symptoms of infection did not prove to be useful tests when assessed against punch biopsy as the reference standard. The wound swab did not perform well when assessed against tissue biopsy. Semiquantitative analysis of wound swab might be a useful alternative to quantitative analysis. The limitations of these findings and their impact on recommendations from relevant clinical guidelines are discussed. Conclusion, Given the importance of this topic, it is surprising that only three eligible studies were identified. It was not possible to describe the optimal methods of diagnosing infection in diabetic patients with foot ulceration from the evidence identified in this systematic review. Diabet. Med. 23, 341,347 (2006) [source]

The effects of applied felted foam on wound healing and healing times in the therapy of neuropathic diabetic foot ulcers

S. Zimny
Abstract Aims The application of felted foam is a promising method for plantar pressure reduction in the ulcer region of diabetic foot ulcers, but knowledge of its effects on wound healing is sparse. The objective of this study was to evaluate the effects of felted foam on wound healing in diabetic foot ulcers compared with a standard method of plantar pressure relief. Materials and methods A total of 54 Type 1 or Type 2 diabetic patients with neuropathic diabetic foot ulcers were evaluated in this prospective randomized controlled study. Ulcer healing was assessed by planimetric measurement of the wound area at beginning of the study and after 10 weeks and at least until wound healing. The patients were consecutively enrolled in the study; 24 patients were randomized to the felted foam therapy, and 30 patients were randomized to conventional therapy. Results In the felted foam group, the initial average wound area was 102.3 ± 45.3 mm2 (mean ± sd), and 5.4 ± 3.1 mm2 after 10 weeks with an average healing time of 75 days [95% confidence interval (CI) 67,84]. In the conventional therapy group, the initial average wound area was 112.5 ± 50.8 mm2, and 10.6 ± 4.2 mm2 after 10 weeks with an average healing time of 85 days (95% CI 79,92) (P = 0.03). The mean wound radius decreased by 0.48 mm (95% CI 0.42,0.56) per week in the felted foam group and by 0.39 mm (95% CI 0.35,0.42) per week in the conventional group (P = 0.005). Conclusions The felted foam technique appears to be at least as effective as conventional plantar ulcer treatment. It may be a useful alternative in treating neuropathic foot ulceration, especially in patients who are not able to avoid weight-bearing reliably. [source]

Clinical issues in using buprenorphine in the treatment of opiate dependence

Dr A. Chadderton MB
Abstract This paper looks at the current role of buprenorphine in the treatment of opiate dependence. It suggests that buprenorphine is a useful alternative to methadone and that in at least some cases it may be the preferred option. Buprenorphineis a partial agonist and a partial antagonist with a ceiling of opiate activity probably approximately equal to 30mg methadone. It achieves this at a dose of 10-12mg, although there is considerable individual variation. Because of its ceiling effect it has a good safety profile compared to full agonists such as methadone although some overdose deaths, particularly in conjunction with benzodiazepine abuse, have been reported in France. Induction of buprenorphine may take slightly longer than for methadone and there is a higher dropout rate compared to methadone in the first 2 weeks. This is probably due to the antagonist action of buprenorphine causing more withdrawal symptoms in comparison to methadone. Also, the ceiling effect for buprenorphine means that some clients do not experience sufficient opiate activity to satisfy them. Buprenorphine has a long half-life and dissociates slowly from opiate receptors. Most clients can be dosed second-daily but some find this unacceptable due to mood swings and/or withdrawal symptomson the second day. For these clients daily dosing is required. Transferring from buprenorphine to methadone is straightforward and well tolerated by clients. Transferring from methadone to buprenorphine, however, is more difficult because of the partial antagonist action of buprenorphine. Clients experience withdrawal symptoms that can take up to 2 weeks to settle. Most clients find these symptoms unacceptable when transferring from doses of over 30mg of methadone. The optimum method for transferring from methadone to buprenorphine is still to be determined. Withdrawal from buprenorphine appears to be relatively easier than from methadone. This is presumably due to buprenorphine's partial agonist effect at mureceptors. It is expected that during 2000 buprenorphine will be approved for use in Australia for the treatment of opiate dependence. It may well becomea first-line choice for opiate replacement in heroin dependence. It is also likely to be useful in assisting detoxification fromboth methadone and heroin. [source]

A simple and rapid CZE method for the analysis of mycophenolic acid and its phenol glucuronide metabolite in human serum,

Kaname Ohyama
Abstract A simple and rapid capillary electrophoretic method was developed for simultaneous determination of mycophenolic acid and its metabolite, phenol glucuronide, in human serum. The sample preparation in the proposed method required only the precipitation by acetonitrile. Separation was performed by capillary zone electrophoresis using 75,mM phosphate buffer (pH 7.5) as running buffer, an applied voltage of 10,kV, and UV detection at 217,nm. Each serum sample analysis was completed within 15,min. The optimized method demonstrated good performance concerning specificity, linearity (r>0.9955), accuracy (95.9,113%), precision (<6.4%) and enough sensitivity for therapeutic drug monitoring. This method was successfully applied to measurements of mycophenolic acid and mycophenolic acid glucuronide in renal transplant patient samples and was a useful alternative to high-performance liquid chromatography-based methods. [source]

Rectal Absorption of Lamotrigine Compressed Tablets

EPILEPSIA, Issue 7 2000
Angela K. Birnbaum
Summary: Purpose: Interruption of oral drug administration poses a significant clinical problem for antiepileptic drugs that have no parenteral formulation. If a drug is absorbed rectally, rectal administration can be a useful alternative when the oral route of administration is not possible. The purpose of this study was to compare the single-dose pharmacokinetics of la-motrigine (LTG) compressed tablets after rectal and oral administration in healthy volunteers. Methods: A single LTG compressed tablet (100 mg) was administered orally and rectally to 12 volunteers in this single-dose, two-period, crossover study with a 2-week washout between doses. For rectal administration, tablets were crushed and suspended in 10 mL of water. Plasma samples were collected from 0 to 120 hr after each dose and analyzed for LTG by an HPLC method developed for this investigation. Results: LTG plasma concentrations were lower after rectal administration versus oral administration. The average area under the curve was 28.90 ± 9.5 ,g/mL/hr after rectal administration and 51.71 ± 19.2 ,g/mL/hr after oral administration. The average maximum LTG concentration was 0.53 ± 0.14 ,g/mL after rectal administration and 1.45 ± 0.35 ,g/mL after oral administration. The relative bioavailability for LTG compressed tablets was 0.63 ± 0.33 for rectal administration. There were no drug-related rashes or serious side effects. Conclusions: LTG suspension prepared from LTG compressed tablets is absorbed rectally, although not to the same extent or rate as when given orally. [source]

Low dose 2-CdA schedule activity in splenic marginal zone lymphomas

R. Riccioni
Abstract Splenic Marginal Zone Lymphoma (SMZL) is a rare clinicopathological entity among marginal zone lymphomas. SMZL is an indolent lymphoma usually treated by splenectomy. A subset of patients is characterized by a more aggressive clinical course and poor prognosis. Treatment of these cases and second-line therapy for relapsed patients have not been yet identified. We report 10 cases treated with cladribrine (5,mg/m2/week) for six courses. Six patients (60%) achieved partial response, two patients (20%) achieved a complete response and the two remaining patients did not respond and died as a result of progression of the disease. The treatment was well tolerated. A total of 60% of the patients had an overall survival rate of 48 months and 24 months progression-free-survival was achieved by 37% with a median time of progression-free-survival of 17 months. Interestingly, in addition to a relevant percentage of hematological remission, some patients also experienced a molecular remission. We conclude that this treatment is safe and well tolerated and is able to induce a substantial number of responses. Our results suggest that this schedule is well tolerated and could be an useful alternative to splenectomy. Copyright © 2003 John Wiley & Sons, Ltd. [source]

Dynamics of black spot sea bream (Pagellus bogaraveo) mean length: evaluating the influence of life history parameters, recruitment, size selectivity and exploitation rates

K. Erzini
Summary Stochastic simulations were used to evaluate the influence of recruitment pattern (log-normal, decreasing), size selectivity (normal, logistic model) and fishing mortality pattern (abrupt, continuous increase in fishing mortality) on the evolution of mean length and the dispersion of mean length for a relatively long-lived deep-water species, the black spot sea bream (Pagellus bogaraveo). An abrupt increase in fishing mortality resulted in mean size decreasing and stabilizing at a lower level while a steady increase in fishing mortality caused the continuous decrease in mean size that has been reported for many long-lived species. Decrease in mean size was greatest for logistic model simulations and for cases where fish were susceptible to capture at a small size. Logistic selectivity, with decreasing recruitment and increasing fishing mortality over time, resulted in mean length and variability in mean length trends similar to that observed for the Strait of Gibraltar fishery. Furthermore, it was found with the declining recruitment that moderate increases in fishing mortality can result in significant decreases in mean length. Given the importance of mean size as an indicator of the state of a resource, these simulations are a useful alternative or complement to standard fisheries assessment methods, helping to provide information on exploitation patterns and rates that can be used for conservation and management. [source]

Awake tracheal intubation using the Airtraq® laryngoscope: a case series

The Airtraq® laryngoscope (AL) is a new single use indirect laryngoscope designed to facilitate tracheal intubation in anaesthetised patients either with normal or difficult airway anatomy. It is designed to provide a view of the glottis without alignment of the oral, pharyngeal and tracheal axes. We report four cases of successful awake tracheal intubation using the AL. The first case is a patient with severe ankylosing spondylitis and the other three cases with anticipated difficult airway. An awake intubation under sedation and topical airway anaesthesia was chosen. We consider that the AL can be used effectively to accomplish an awake intubation in patients with a suspected or known difficult airway and may be a useful alternative where other methods for awake intubation have failed or are not available. [source]

Relaxing music as pre-medication before surgery: a randomised controlled trial

Introduction: Patients who await surgery often suffer from fear and anxiety, which can be prevented by anxiolytic drugs. Relaxing music may be an alternative treatment with fewer adverse effects. This randomised clinical trial compared pre-operative midazolam with relaxing music. Method: Three hundred and seventy-two patients scheduled for elective surgery were randomised to receive pre-operative prevention of anxiety by 0.05,0.1 mg/kg of midazolam orally or by relaxing music. The main outcome measure was the State Trait Anxiety Inventory (STAI X-1), which was completed by the patients just before and after the intervention. Results: Of the 177 patients who completed the music protocol, the mean and (standard deviation) STAI-state anxiety scores were 34 (8) before and 30 (7) after the intervention. The corresponding scores for the 150 patients in the midazolam group were 36 (8) before and 34 (7) after the intervention. The decline in the STAI-state anxiety score was significantly greater in the music group compared with the midazolam group (P<0.001, 95% confidence interval range ,3.8 to ,1.8). Conclusion: Relaxing music decreases the level of anxiety in a pre-operative setting to a greater extent than orally administrated midazolam. Higher effectiveness and absence of apparent adverse effects makes pre-operative relaxing music a useful alternative to midazolam for pre-medication. [source]

Botulinum toxin for periocular lines: the single-injection technique

Giovanni Salti
Summary Background, Botulinum is a well established treatment for facial wrinkles and hyperfunctional lines, including those at the periocular area. Objective, To illustrate a simple periocular injection technique. It differs from the usual one since it is a single injection, instead of several. Methods, Thirty consecutive patients were treated with this technique on one side, and the standard multipuncture technique on the contralateral side. Each patient, being their own control, received 10,12 Botox units to each side. The orbicularis oculi muscle was injected using two different types of needles: a standard 30 g 13 mm needle for the multipunctured side and a 30 g 25 mm needle for the single puncture side. Follow up assessments were made on days 7, 15 and 120. Results, Good results were achieved in all patients. No relevant cosmetic difference was noticeable between the two sides. The pharmacological effect lasted about 5 months, with no difference between the two techniques. Both techniques were safe and caused the same amount of bruising. The single injection was preferred by patients. The single-injection technique, on the other hand, requires more skill and experience by the operator. Conclusions, The single-injection technique for periocular lines is a useful alternative to the standard multipuncture technique. It reduces patients' discomfort. [source]

Size-independent growth in fishes: patterns, models and metrics

D. B. Sigourney
A combination of a dynamic energy budget (DEB) model, field data on Atlantic salmon Salmo salar and brown trout Salmo trutta and laboratory data on Atlantic salmon was used to assess the underlying assumptions of three different metrics of growth including specific growth rate (G), standardized mass-specific growth rate (GS) and absolute growth rate in length (GL) in salmonids. Close agreement was found between predictions of the DEB model and the assumptions of linear growth in length and parabolic growth in mass. Field data comparing spring growth rates of age 1+ year and 2+ year Atlantic salmon demonstrated that in all years the larger age 2+ year fish exhibited a significantly lower G, but differences in growth in terms of GS and GL depended on the year examined. For brown trout, larger age 2+ year fish also consistently exhibited slower growth rates in terms of G but grew at similar rates as age 1+ year fish in terms of GS and GL. Laboratory results revealed that during the age 0+ year (autumn) the divergence in growth between future Atlantic salmon smolts and non-smolts was similar in terms of all three metrics with smolts displaying higher growth than non-smolts, however, both GS and GL indicated that smolts maintain relatively fast growth into the late autumn where G suggested that both smolts and non-smolts exhibit a sharp decrease in growth from October to November. During the spring, patterns of growth in length were significantly decoupled from patterns in growth in mass. Smolts maintained relatively fast growth though April in length but not in mass. These results suggest GS can be a useful alternative to G as a size-independent measure of growth rate in immature salmonids. In addition, during certain growth stanzas, GS may be highly correlated with GL. The decoupling of growth in mass from growth in length over ontogeny, however, may necessitate a combination of metrics to adequately describe variation in growth depending on ontogenetic stage particularly if life histories differ. [source]


ABSTRACT The nutritional and health properties of some citrus peel components such as pectin, flavonoids, carotenoids or limonene make interesting developing processing methods to obtain peel stable products, maintaining its quality attributes, increasing its sweetness and improving its sensory acceptability. In this sense, osmotic dehydration represents a useful alternative by using sugar solutions at mild temperature. Kinetics of osmotic treatments of orange and mandarin peels carried out at atmospheric pressure and by applying a vacuum pulse at the beginning of the process were analysed at 30, 40 and 50C, in 65 °Brix sucrose, 55 °Brix glucose and 60 °Brix rectified grape must. Vacuum pulse greatly affected mass transfer behavior of peels due to the greatly porous structure of albedo. So, PVOD treatments greatly accelerate the changes in the product composition in line with an increase in the peel sample thickness. In osmotic processes at atmospheric pressure, sample impregnation occurs coupled with osmotic process, but much longer treatments are required to achieve a reasonable concentration degree which assures sample stability. Low viscosity osmotic solutions seems recommendable in order to promote both diffusional and hydrodynamic transport, in vacuum pulsed pretreatments at mild temperatures. [source]

Field performance and seasonal changes in the efficacy against Helicoverpa armigera (Hübner) of transgenic cotton expressing the insecticidal protein vip3A

Danny J. Llewellyn
Abstract 1,Three years of field experiments in Eastern Australia were carried out on transgenic cotton (Gossypium hirsutum L.) event Cot102 expressing the insecticidal protein gene vip3A from Bacillus thuringiensis to evaluate performance against Helicoverpa armigera Hübner. Efficacy, defined as the capacity of plant tissues to induce larval mortality, was determined with a well-validated leaf bioassay fortnightly through the growth cycle of the cotton in each season. 2,Cot102 plants proved highly efficacious against H. armigera, particularly early in the season, although their efficacy declined as the season progressed, in a manner similar to, but not as dramatic as, that observed with commercial Cry1Ac expressing cotton (Bollgard or Ingard cotton). 3,Field surveys indicated that very few larvae survived beyond first instar on intact growing plants. 4,In one season efficacy declined for a period of approximately 20 days after a cool wet period, suggesting that this may have had a detrimental effect on the expression or efficacy of the gene, but this will need to be verified in further replicated trials. 5,Quantitative enzyme-linked immunosorbent assays indicated that there was no dramatic reduction in production of the vip3A protein during growth and maturation of the crop, suggesting that other host plant factors were affecting the efficacy of the insecticidal protein in the insect gut. 6,These data indicate that Cot102 cotton would provide a useful alternative to Bollgard cotton but, given the similar lytic mode of action of vip3A proteins in the insect midgut, there may be similar inherent vulnerabilities to resistance evolution for these proteins if used alone. Pyramiding of the vip3A trait with a second insecticidal gene would appear to be a high priority for achieving sustainable deployment against H. armigera or similar susceptible species. [source]

The Application of Miniplex Primer Sets in the Analysis of Degraded DNA from Human Skeletal Remains§

Kerry L. Opel M.A.
ABSTRACT: A new set of multiplexed PCR primers has been applied to the analysis of human skeletal remains to determine their efficacy in analyzing degraded DNA. These primer sets, known as Miniplexes, produce shorter amplicons (50,280 base pairs (bp)) than standard short tandem repeat (STR) kits, but still utilize the 13 CODIS STR loci, providing results that are searchable on national DNA databases. In this study, a set of 31 different human remains were exposed to a variety of environmental conditions, extracted, and amplified with commercial and Miniplex DNA typing kits. The amplification efficiency of the Miniplex sets was then compared with the Promega PowerPlex® 16 system. Sixty-four percent of the samples generated full profiles when amplified with the Miniplexes, while only 16% of the samples generated full profiles with the Powerplex® 16 kit. Complete profiles were obtained for 11 of the 12 Miniplex loci with amplicon sizes less than 200 bp. These data suggest smaller PCR amplicons may provide a useful alternative to mitochondrial DNA for anthropological and forensic analysis of degraded DNA from human skeletal remains. [source]

Self-Compassion Versus Global Self-Esteem: Two Different Ways of Relating to Oneself

Kristin D. Neff
ABSTRACT This research examined self-compassion and self-esteem as they relate to various aspects of psychological functioning. Self-compassion entails treating oneself with kindness, recognizing one's shared humanity, and being mindful when considering negative aspects of oneself. Study 1 (N=2,187) compared self-compassion and global self-esteem as they relate to ego-focused reactivity. It was found that self-compassion predicted more stable feelings of self-worth than self-esteem and was less contingent on particular outcomes. Self-compassion also had a stronger negative association with social comparison, public self-consciousness, self-rumination, anger, and need for cognitive closure. Self-esteem (but not self-compassion) was positively associated with narcissism. Study 2 (N=165) compared global self-esteem and self-compassion with regard to positive mood states. It was found that the two constructs were statistically equivalent predictors of happiness, optimism, and positive affect. Results from these two studies suggest that self-compassion may be a useful alternative to global self-esteem when considering what constitutes a healthy self-stance. [source]

The Use of Radial Extracorporeal Shockwave Therapy in the Treatment of Urethral Urolithiasis in the Horse: A Preliminary Study

D. Verwilghen
Background: Radial extracorporeal shockwave therapy (ESWT) is widely used in equine practice for the treatment of orthopedic problems. However, its original use as a lithotripsy device in human and canine urology led us to postulate that it could be used as an alternative to the surgical treatment of urethral calculi in horses. Hypothesis: Radial ESWT can easily and safely fragment calculi in the distal urethra of the horse. Animals: Two postmortem cases and 1 live case of obstructive urinary disease admitted at the Veterinary Teaching Hospital of Liege. Methods: A radial shockwave device was directly applied to the urethra in an attempt to fragment calculi. An ex vivo trial was performed on the same retrieved calculi to investigate pressure settings in order to obtain complete fragmentation of the calculus. Results: In all cases, radial ESWT was able to fragment the calculus partially, enabling retrieval of the remaining fragments via the urethra. Much higher pressure settings than those used for in vivo partial fragmentation were necessary to obtain complete destruction of the calculi ex vivo. Conclusions and Clinical Importance: This brief report suggests the use of radial ESWT as a safe and useful alternative to more invasive surgical management of urethral calculi in horses. [source]

The effect of mosapride citrate on proximal and distal colonic motor function in the guinea-pig in vitro

H. S. Kim
Abstract, Mosapride citrate (mosapride), a substituted benzamide, is a selective 5-HT4 receptor agonist, and is known to have prokinetic properties on the stomach. However, it is unclear whether mosapride also has a prokinetic effect on the colon. We previously found that mosapride significantly shortened colonic transit time in the guinea-pig, an animal with a distribution of colonic 5-HT4 receptors similar to that of a human. So, we aimed to separately evaluate the effect of mosapride on proximal and distal colonic motor function in the guinea-pig. Proximal (approximately 8 cm from the ileocolic junction) and distal colon (approximately 8 cm from the anus) were removed. Both ends of the colon were connected to a chamber containing a Krebs-Henseleit solution. To measure colonic transit time, artificial faeces were inserted into the oral side of the lumen and moved towards the anal side by intraluminal perfusion via a peristaltic pump. A total of 6 cm of transit was observed and time was measured in 2 cm increments. A tissue bath study, using electrical stimulation, was performed to estimate the contractile activity of the circular musculature of the colon. Immunohistochemical staining for 5-HT4 receptors was performed in the myenteric plexus and circular muscle in both proximal and distal colon, and the stained area was measured using a microscope and computer software. Mosapride enhanced contraction at 10,9 to 10,7 mol L,1, coinciding with rapid transit both in proximal and distal colon. This pattern was more prominent in proximal colon. At the high dose (10,6 mol L,1) mosapride had little or no effect on colonic contraction. This stimulatory effect was attenuated by GR113808, atropine and tetrodotoxin. In the myenteric plexus, the density of 5-HT4 receptors was significantly greater in the proximal colon than in the distal colon, but in circular muscle the density was greater in the distal colon. Thus, mosapride accelerates transit through increased contraction in the proximal colon more than distal colon. The different distribution of neuronal and muscular 5-HT4 receptors may support these findings. Therefore, mosapride may be a useful alternative to tegaserod and cisapride for constipation. [source]

Improved Cancer Pain Treatment Using Combined Fentanyl-TTS and Tramadol

PAIN PRACTICE, Issue 4 2007
Franco Marinangeli MD
,,Abstract: The aim of the study was to facilitate dose escalation of strong opioids. In this randomized open-label study the influence of tramadol on dose adjustment of transdermal fentanyl in advanced cancer pain control was prospectively evaluated. Seventy patients affected by intractable cancer disease with visual analog scale (VAS) score >3 were enrolled. Thirty-five patients were treated conventionally with increasing transdermal fentanyl dosage as required (group F) and 35 patients received oral tramadol added to their transdermal fentanyl before each increment of the transdermal opioid dosage (group T). Pain control was equally satisfactory in the two groups. VAS scores at baseline (T: 4.36 ± 1.53; F: 4.51 ± 1.36; n.s.) and at the end of the study (T: 1.8 ± 1.6; F: 1.6 ± 1.5; n.s.) did not differ. However, in the tramadol group this level of pain control was achieved with much slower dose escalation of fentanyl. The mean application time of the fentanyl-Transdermal Therapeutic System patch for each dosage (25, 50, 75 ,g/hour) was significantly greater in patients receiving tramadol. No patient in group T escalated to the 100 ,g/hour patch, while in 12 patients of group F the 100 ,g/hour patch was applied after a 75 ,g/hour patch mean application period of 18.6 ± 4.7 days. The number of fentanyl-TTS dosage changes was significantly lower in group T (1.2 ± 0.4 vs. 2.3 ± 0.5; P < 0.05). The mean total duration of treatment in group T, was 37.1 ± 11.6 days. The amount of fentanyl used at study end was 56.6 ± 11.2 ,g/hour plus 141.1 ± 151.9 mg tramadol per day (median: 200 mg/day) in group T patients compared with 84.1 ± 12.2 ,g/hour in group F patients (P < 0.05). The combination of a strong opioid with a weak opioid to treat severe cancer pain allowed a more gradual increase of analgesic delivery than was possible using fentanyl-TTS alone, minimizing periods of under- and overdosing. In addition, it considerably slowed the pace of fentanyl dose escalation. In conclusion, this TTS fentanyl-tramadol analgesic protocol provides a useful alternative to the usual treatment of cancer pain with fentanyl-TTS alone, especially in case of quick progression of disease and pain.,, [source]

ProSealTM laryngeal mask airway in 120 pediatric surgical patients: a prospective evaluation of characteristics and performance

Summary Background:, The ProSealTM LMA (PLMATM) has recently been introduced in pediatric sizes (1.5, 2, 2.5, 3). Limited pediatric data have been published. Methods:, After Institutional Review Board (IRB) approval, the PLMATM was placed in 120 children aged 4 months to 13 years (5,50 kg). The following data were collected prospectively: induction agent, number of placement attempts (limited to three), placement success or failure, PLMATM size, leak pressure, ventilatory pattern [spontaneous (SV) or controlled positive pressure ventilation (PPV)], success or failure of gastric suction tube placement, hypoxemia, dislodgement, laryngospasm, bronchospasm, aspiration, and traumatic placement. Results:, The PLMATM was easily placed in children with a higher first attempt success rate (94%) than reported for adults. Overall PLMATM and gastric tube placement were both 100% successful. Leak pressures were similar to those reported for the PLMATM in adults and higher than reported for the ClassicTM LMATM in children. No bronchospasm, laryngospasm, hypoxemia, dislodgement, or aspiration occurred. Conclusions:, Although the PLMATM can be used with SV or PPV, the higher leak pressure achieved with the PLMATM, and the ability to evacuate fluid and air from the stomach suggest that it may be a useful alternative to tracheal intubation for procedures in which PPV is desired in children aged 4 months to 13 years. [source]

Dobutamine Stress Cardiac Magnetic Resonance Imaging to Detect Myocardial Ischemia in Women

Subha V. Raman MD
This study sought to evaluate dobutamine stress cardiac magnetic resonance imaging (DCMRI) in women with abnormal stress nuclear testing results. Women with findings on stress nuclear exams, including electrocardiography and/or perfusion, thought to require further evaluation with invasive coronary angiography were prospectively enrolled. Multiplane cine imaging was obtained at rest and at each stage of inotropic stress with atropine as needed to achieve target heart rate. DCMRI results were compared with stress nuclear and invasive cardiac catheterization results. Of 23 patients enrolled successfully, 22 completed DCMRI examination without complications. In all cases, DCMRI imaging demonstrated appropriate stress response with no ischemia despite abnormalities on stress nuclear testing. In the 18 patients who also underwent invasive coronary angiography, no significant obstructive disease was identified. DCMRI may be a useful alternative to stress nuclear examination in women; larger studies are warranted to determine its potential to more accurately predict obstructive coronary artery disease. [source]

Stature estimation formulae for indigenous North American populations

Benjamin M. Auerbach
Abstract Stature estimation methods for adult indigenous humans from the Americas have generally relied on a limited number of regression equations. The available equations, however, are not broadly applicable to the diversity of the populations that lived in the New World prior to European colonization. Furthermore, some equations that have been used were originally derived from inappropriate reference samples, such as the "Mongoloid" group measured by Trotter and Gleser (Am J Phys Anthropol 16 [1958] 79-123). This study develops new stature estimation equations for long bones of the lower limb from a geographically diverse sample of North American archaeological sites. Statures were reconstructed from 967 skeletons from 75 archaeological sites using the revised Fully anatomical technique (Raxter et al., Am J Phys Anthropol 130 [2006] 374-384). Archaeological samples were grouped according to general body proportions, using relative tibia and femur length to stature as guides. On the basis of differences in these proportions, three broad groupings were identified: a high latitude "arctic" group, a general "temperate" group, and a Great Plains group. Sex-specific ordinary least squares regression formulae were developed based on femoral and tibial lengths for each of these groups. Comparisons of the new stature estimation equations with previously available equations were conducted using several archaeological test samples. In most cases, the new stature estimation equations are more precise than those previously available, and we recommend their use throughout most of North America. The equations developed by Genovés for Mesoamerican and US Southwest samples are a useful alternative for these regions. Applicability of the new equations to South American samples awaits further testing. Am J Phys Anthropol, 2010. © 2009 Wiley-Liss, Inc. [source]

Partial confounding and projective properties of Plackett,Burman designs

Murat Kulahci
Abstract Screening experiments are typically used when attempting to identify a few active factors in a larger pool of potentially significant factors. In general, two-level regular factorial designs are used, but Plackett,Burman (PB) designs provide a useful alternative. Although PB designs are run-efficient, they confound the main effects with fractions of strings of two-factor interactions, making the analysis difficult. However, recent discoveries regarding the projective properties of PB designs suggest that if only a few factors are active, the original design can be reduced to a full factorial, with additional trials frequently forming attractive patterns. In this paper, we show that there is a close relationship between the partial confounding in certain PB designs and their projective properties. With the aid of examples, we demonstrate how this relationship may help experimenters better appreciate the use of PB designs. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Towards automatic computer-aided knee surgery by innovative methods for processing the femur surface model

Pietro Cerveri
Abstract Background The femoral shaft (FDA) and transepicondylar (TA), anterior,posterior (WL) and posterior condylar (PCL) axes are fundamental quantities in planning knee arthroplasty surgery. As an alternative to the TA, we introduce the anatomical flexion axis (AFA). Obtaining such axes from image data without any manual supervision remains a practical objective. We propose a novel method that automatically computes the axes of the distal femur by processing the femur mesh surface. Methods Surface data were processed by exploiting specific geometric, anatomical and functional properties. Robust ellipse fitting of the two-dimensional (2D) condylar profiles was utilized to determine the AFA alternative to the TA. The repeatability of the method was tested upon 20 femur surfaces reconstructed from CT scans taken on cadavers. Results At the highest surface resolutions, the relative median error in the direction of the FDA, AFA, PCL, WL and TA was < 0.50°, 1.20°, 1.0°, 1.30° and 1.50°, respectively. As expected, at the lowest surface resolution, the repeatability decreased to 1.20°, 2.70°, 3.30°, 3.0° and 4.70°, respectively. The computed directions of the FDA, PCL, WL and TA were in agreement (0.60°, 1.55°, 1.90°, 2.40°) with the corresponding reference parameters manually identified in the original CT images by medical experts and with the literature. Conclusions The proposed method proved that: (a) the AFA can be robustly computed by a geometrical analysis of the posterior profiles of the two condyles and can be considered a useful alternative to the TA; (b) higher surface resolutions leads to higher repeatability of all computed quantities; (c) the TA is less repeatable than the other axes. Copyright © 2010 John Wiley & Sons, Ltd. [source]

Implantation of the Ossified Cochlea: Management with the Split Electrode Array

D A. Millar BS
Abstract Objectives/Hypothesis: To describe indications for, the surgical technique required, and the expected functional results of split electrode array cochlear implants. Study Design: Retrospective chart review. Methods: Data collected included etiology of deafness, radiographic findings, pre- and postoperative aided pure tone thresholds, and speech perception testing. Adult speech perception outcomes were measured using the Consonant Nucleus Consonant (CNC) monosyllable words and Hearing in Noise Test (HINT) in quiet/noise (+10dB). The children were assessed using the Infants and Toddlers Meaningful Auditory Integration Scale. Results: Five patients were implanted with a split electrode array. This included two adults and three children. Both adults had preoperative binaural aided pure tone averages worse than 50d B and scores of 0% on both HINT quiet and CNC words. The children had undetectable preoperative aided thresholds and scored an average 4/40 on the IT-MAIS. Postimplant, the average threshold gain was 38.5 dB in the adults and 81.5 dB in the children. One adult improved to score 51%/22% on HINT quiet/noise at 6 months and 72%/30% at 12 months. The other adult continued to score 0% on HINT at 12 months but claimed substantial subjective auditory improvement after the first year of device use. The children averaged 28/40 on the IT MAIS at 6 months after implantation. Forty-two of 48 implanted electrodes were functional. Conclusions: The split electrode array is a useful alternative to traditional cochlear implants in treating deafened patients with cochlear ossification. Patients implanted with the split array show marked improvement in sound and speech perception. [source]

Ventilation Time of the Middle Ear in Otitis Media With Effusion (OME) After CO2 Laser Myringotomy

Benedikt Sedlmaier MD
Abstract Objective The aim of this study was to investigate the transtympanic ventilation time, the healing course of the tympanic membrane, the early and late complications, and the recurrence rate of otitis media with effusion (OME) within 6 months after CO2 laser myringotomy with the CO2 laser otoscope Otoscan. Study Design Prospective clinical study. Materials and Methods In this study, laser myringotomy was performed with the CO2 laser otoscope Otoscan in a patient population comprising 81 children (159 ears) with a history of otitis media with effusion (OME) associated with adenoidal and sometimes tonsillar hyperplasia. The procedure on the tympanic membrane was accordingly combined with an adenoidectomy, a CO2 laser tonsillotomy, or a tonsillectomy and therefore performed under insufflation anesthesia. In all ears, approximately 2 mm circular perforations were created in the lower anterior quadrants with a power of 12 to 15 W, a pulse duration of 180 msec, and a scanned area of 2.2 mm in diameter. Results None of the children showed postoperative impairment of cochleovestibular function such as sensorineural hearing loss or nystagmus. Otomicroscopic and videoendoscopic monitoring documented the closure time and healing pattern of tympanic membrane perforations. The mean closure time was found to be 16.35 days (minimum, 8 days; maximum, 34 days). As a rule, an onion-skin-like membrane of keratinized material was seen in the former myringotomy perforations at the time of closure. At the follow-up 6 months later, the condition of the tympanic membrane of 129 ears (81.1%) could be checked by otomicroscopy and videoendoscopy and the hearing ability by audiometry and tympanometry. The CO2 laser myringotomy sites appeared normal and irritation-free. Two of the tympanic membranes examined (1.6%) showed atrophic scar formation, and 1 (0.8%) had a perforation with a diameter of 0.3 mm. The perforation was seen closed in a control otoscopy 15 months postoperatively. OME recurred in 26.3% of the ears seen intraoperatively with mucous secretion (n = 38) and in 13.5% of the ears with serous secretion (n = 37;P <.05). Conclusion The most important principle in treating OME is ventilation of the tympanic cavity. CO2 laser myringotomy achieves this through a self-healing perforation in which its diameter roughly determines the duration of transtympanic ventilation. Laser myringotomy competes with ventilation tube insertion in the treatment of OME. It may be a useful alternative in the surgical management of secretory otitis media. [source]

Appraisal of the electrical octet method for estimating earthworm populations in arable land

Summary Quantitative methods are needed for the assessment of the size and composition of earthworm communities. A poorly documented electrical sampling method, Thielemann's octet method, was compared with two long-established methods, formalin extraction and soil hand sorting, in conventional and direct-drilled wheat cropping systems at two sites with medium to heavy textured soils in Ireland. Under all agronomic conditions tested, the electrical method extracted significantly higher earthworm numbers than formalin, but earthworm biomasses were not significantly different. When used routinely over two years during periods of high earthworm activity, the electrical method yielded community estimates that were comparable in both size and species composition to those obtained by soil hand sorting (25 cm depth), except in recently ploughed land. However, Murchieona minuscule, a minute endogeic species, was underestimated by electrical extraction. It is concluded that the electrical octet method can be a reliable and useful alternative to other dynamic methods for estimating earthworm populations, especially in situations where minimum soil disturbance is desirable. [source]

How self-relevant imagination affects memory for behaviour

Ayanna K. Thomas
Research has demonstrated that imagination can be used to affect behaviour and also to distort memory, yet few studies have examined whether the effects of imagination on behavioural estimates and memory are related. In two experiments, the effects of imagination on self-reported behaviour and subsequent memory for that behaviour were investigated. A comparison of behavioural estimates collected before and after imagination demonstrated that reported estimates of behaviour changed after imagination. In addition, memory for the original estimates of behaviour was also affected, suggesting that imagination may impair one's ability to remember originally reported behaviour. Experiment 2 demonstrated that the observed changes in reported behaviour were accompanied by the largest errors in memory for originally reported behaviour when participants generate images based on self-relevant scenarios. On the other hand, memory distortion was minimized when participants read but did not imagine self-relevant scenarios. These results have direct application to clinicians and researchers who employ imagination techniques as behavioural modifiers, and suggest that techniques that are self-relevant but do not include imagery may be a useful alternative to imagination. Copyright © 2006 John Wiley & Sons, Ltd. [source]