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PubMedDate not supplied

Effect of 3M Coban Self-Adherent Wraps on edema and function of the burned hand: a case study.

Edema and limited function are common acute problems associated with hand burns. This case study examined the effects of 3M Coban Self-Adherent Wraps on edema and function in a 59-year-old male (46% TBSA flame injury) with newly skin grafted dorsally burned hands. At the time of each dressing change, circumferential measurements were taken of both hands and weekly active range of motion and grip strength measurements were recorded. The nine-hole peg test was used to appraise dexterity. During the 4-week study period, there was less edema, greater active range of motion and grip strength, and greater dexterity in the hand with 3M Coban Self-Adherent Wraps as compared with the control hand. This case study suggests that 3M Coban Self-Adherent Wraps were effective in reducing edema in the skin-grafted hand after skin grafting. It further appeared that the reduced edema may have contributed to improved hand function and that 3M Coban Self-Adherent Wraps as a compressive dressing do not impede hand function

Burns↗

PubMed2005

Functional outcome for children with thumb aplasia undergoing pollicization.

BACKGROUND: Hand function is difficult to evaluate in young patients. It is helpful to assess young children after surgery for trauma or congenital anomaly to see how they cope as they progress through their developmental milestones. METHODS: Functional outcome in 10 children (12 upper extremities) who had previous pollicization for a congenitally absent or severely hypoplastic thumb were evaluated by standard radiographs, thumb total active range of motion, grip and pinch strength, parent questionnaire, modified Jebsen functional testing, and a pegboard Functional Dexterity Test. RESULTS: Grip strength was significantly less (p = 0.008) in the hands that had been operated on (mean, 2 kg) compared with the hands that had not been operated on (mean, 5.6 kg). Pinch strength was also significantly less (p = 0.008) in the hands that had been operated on (mean, 1.0 kg) compared with those that had not been operated on (mean, 2.1 kg). In most, hands that had been operated on and those that had not been operated on tested outside the 2-SD range of age-matched normals for pinch and grip strength and also for the Functional Dexterity Test. In contrast, total Jebsen Hand Function Test time was not significantly different from hands that had not been operated on, except that some subtests were significantly different, such as checker stacking (p = 0.016; mean difference, 7.2 seconds) and page turning (p = 0.031; mean difference, -10 seconds). The total active range of motion in hands that had been operated on and those that had not been operated on was also not significantly different. All children used their reconstructed thumbs in a normal pattern. Parent questionnaires revealed satisfaction with appearance and good social interactions. Functional activities showed greatest difficulty handling small objects, especially when simultaneous pinch strength was required, such as fastening buttons and small snaps. CONCLUSIONS: This study demonstrates the importance of evaluating multiple aspects of functional outcome for congenital hand problems and of using comparative age-appropriate validated norms. Pollicization is a rewarding procedure for children with thumb aplasia.

Child↗

PubMedDate not supplied

Peripheral arterial disease and cognitive function.

OBJECTIVE: Peripheral arterial disease (PAD) is associated with comorbid atherosclerosis of the coronary and carotid arteries and is a significant risk factor for stroke. However, cognitive function in PAD patients before clinically evident stroke remains poorly characterized. Here we hypothesized that, on neuropsychological testing, PAD patients would perform more poorly than healthy control subjects, and persons with mild cardiovascular disease (essential hypertension), but better than stroke patients, thus reflecting a continuum of cognitive impairment associated with increased severity of vascular disease. METHOD: The cognitive performance of 38 PAD patients (mean ankle-brachial index=0.67, Fontaine Class II) was contrasted with that of 23 healthy normotensive controls, 20 essential hypertensives, and 26 anterior ischemic stroke patients on twelve neuropsychological tests. RESULTS: PAD patients performed significantly more poorly than hypertensives and normotensives, but better than stroke patients, on seven tests of nonverbal memory, concentration, executive function, perceptuo-motor speed, and manual dexterity. Hypertensives displayed poorer performance than normotensives on tests of nonverbal memory and manual dexterity. These findings were independent of age, education, and depression scores. Higher diastolic blood pressure and plasma glucose levels predicted poorer performance of select cognitive tests by PAD patients. Eight to 67% of PAD patients displayed impaired performance (< 5(th) percentile of normotensive controls) on the seven aforementioned cognitive tests. CONCLUSIONS: PAD patients exhibit diminished performance across a variety of domains of cognitive function. Findings also suggest a continuum of cognitive impairment associated with increasingly severe manifestations of cardiovascular disease, thus emphasizing the need for enhanced preventative measures to avert functional declines.

Aged↗

PubMed1983

Effects on psychological performance of the benzodiazepine, loprazolam, alone and with alcohol.

The effects of a new 1,4 benzodiazepine hypnotic, loprazolam (1.0 mg) and alcohol (0.7 g/kg body weight) were investigated over a 15 h period in eight healthy male medical students, in a placebo controlled balanced design. Loprazolam when given alone impaired performance on a manual dexterity task, on a test of mental arithmetic, on a tracking task and it impaired memory as judged by the name and address memory test. Given alone, alcohol impaired performance on the simple reaction time task and on the tracking task. Performance on the memory test and choice reaction time test actually improved. No evidence was found suggesting a potentiation of effect when loprazolam and alcohol were given together. However, (a) on the manual dexterity task the alcohol, having no effect on its own, alleviated the loprazolam-induced impairment. (b) In the tracking task both alcohol and loprazolam impaired performance when given alone but not when given together. (c) The memory test was impaired by loprazolam, improved by alcohol and the effect of the combination is the expected sum of the two effects. Similarly for the arithmetic task the effect of the combination of the alcohol and loprazolam effects is the expected sum of the independent effects. The bulk of the evidence on the interaction suggests that alcohol mitigates the effects of loprazolam. In no sense could the drug be said to be having a sobering influence.

Anti-Anxiety Agents↗

PubMed2004

Teaching subfascial perforator veins surgery: survey on a 2-day hands-on course.

BACKGROUND: The present paper describes a training method with objective evaluation to enhance video-assisted surgical skills in subfascial endoscopic perforator veins surgery (SEPS). Training was scheduled during a 2-day intensive course. METHODS: Hands-on exercises were performed (i) on a simulator to assess whether specific training exercises were helpful in attainment of skills; (ii) on a known animal model that uses the swine abdominal wall and which allows practice in endoscopic dissection and perforator veins (PV) using appropriate instrumentation in an environment that is a reasonable surrogate for the human calf; and (iii) assisting a senior surgeon performing SEPS. Thirty surgeons without experience in SEPS were trained to perform a sequence of standardized drills connected with the SEPS technique. The SEPS simulator consisted of an artificially constructed subfascial space of the leg in which false perforator veins had to be localized, and cut. The participants performed a sequence of drills three times in order to improve their dexterity. The same exercises were then performed on a swine model. The model consisted of the arteries and veins penetrating the rectus fascia and passing into the overlying cutaneous trunci muscle and hypodermis on either side of the midline between the arch of the ribs cranially and the umbilicus caudally. Trainees were required to achieve operative space in the animal subcutaneous fat, to reach and identify the "perforating" subcutaneous vessels, and to interrupt some of them with a 5-mm clamp coagulator ultrasonic scalpel. The time required to perform each dexterity drill was recorded in seconds. Finally, the day after, trainees were asked to drive the senior operator during clinical SEPS performed on eight patients, suggesting the following manoeuvres in order to: (i) enter the subfascial space of the leg; (ii) make operative space; (iii) identify the incompetent perforator vein(s); and (iv) coagulate and divide them with the ultrasonic scalpel. Each of these four steps scored 1 point. RESULTS: All the trainees showed a steady improvement in skill acquisition on the SEPS simulator (P < 0.001), and on the animal model with the single-port technique (P < 0.001). These results reflect positively on the animal model using the dual-port technique, and on the scores achieved in the operating theatre during clinical SEPS. CONCLUSIONS: The validity of the 2-day course was demonstrated by significant improvement in performance with increasing skill on the training models, and in clinical practice.

Animals↗

PubMed2006

Role of stromal-derived factor-1 in the hematopoietic-supporting activity of human mesenchymal stem cells.

Mesenchymal stem cells (MSC) have the ability to support and maintain hematopoiesis in vitro. However, mechanisms implicated in this support are not fully characterized. In the present study, the role of stromal-derived factor-1 (SDF-1)/CXCR4 axis in the interactions between MSC and hematopoietic stem/progenitor cells (HSPC) was studied. Human bone marrow MSC were plated as feeder layers in Dexter-type long-term cultures (LTC) with human cord blood CD34(+) HSPC. Cultures were supplemented weekly with neutralizing antibodies against CXCR4 or SDF-1 for 5 wk. LTC-initiating cell (IC) activity was strongly dependent on the SDF-1/CXCR4 axis, as both antibodies significantly decreased secondary colony-forming cell production. To assess the effect of SDF-1/CXCR4 axis on progenitor cell proliferation, LTC-IC killing assays were carried out: in LTC of CD34(+) cells in contact with MSC, treatment with anti-CXCR4 antibody significantly reduced the number of cycling progenitors. These results indicate that the SDF-1/CXCR4 axis promotes HSPC proliferation in contact with MSC. Interestingly, when HSPC were separated from MSC by a semipermeable membrane, LTC-IC activity became CXCR4 independent. Multiplex analysis of MSC-conditioned medium revealed that in addition to SDF-1, MSC produced stimulatory and inhibitory factors, such as interleukin (IL)-6, IL-11, granulocyte macrophage-colony stimulating factor as well as monocyte-chemoattractant protein-1. Altogether, human MSC support hematopoiesis in Dexter-type cultures through the activation of the SDF-1/CXCR4 axis. Our data further suggest that SDF-1 stimulates retention of HSPC in MSC niches which expose them to stimulatory and inhibitory factors in a paracrine manner.

Antibodies↗

PubMed2006

Self-reported oral hygiene habits among institutionalised elderly and their relationship to the condition of oral tissues in Taubaté, Brazil.

OBJECTIVES: To record self-reported hygiene habits, examine the oral conditions of a sample group of institutionalised elderly, and examine possible relationships between these habits and conditions. DESIGN: Cross-sectional. SETTING: All the institutions for the elderly in Taubaté, Brazil. SUBJECTS: The entire population of these institutionalised elderly people (n = 553). INTERVENTION: The subjects were interviewed and underwent an oral examination. MAIN OUTCOME MEASURES: Oral hygiene habits, oral conditions and statistical relationships between habits and oral conditions were recorded. RESULTS: The average age of the subjects who knew their age (n = 364) was 74.9 years (+/-12.9), and 64.7% of the sample group were females. Denture-related stomatitis was found in 19.5%, impaired manual dexterity in 40%, dry mouth sensation in 36.3%, difficulty in performing oral hygiene in 20%, no oral hygiene-related orientation in 54.1%, no periodic oral examinations in 59.5%, and no tongue cleaning in 68.3% was declared. Among dentate subjects, 73.3% had periodontal disease, 54.7% had caries, 26% reported no toothbrushing, and 7.3% reported flossing. Of the denture wearers, 7% did not brush their dentures. Denture-related stomatitis showed a statistical relationship with impaired manual dexterity (p = 0.012) and an inverse statistical relationship with denture brushing frequency (p = 0.006). Periodontal disease showed an inverse relationship to flossing (p < 0.001) and tongue cleaning (p = 0.0026). Caries showed an inverse relationship with tooth-brushing (p = 0.043), flossing (0.022), proper oral hygiene orientation (p = 0.041) and periodical check-ups (p = 0.007). CONCLUSION: Oral hygiene practices in this sample group were found to be inadequate, and statistically significant relationships were verified between the lack of good oral hygiene practices and the deleterious oral conditions.

Age Factors↗

PubMed1989

Effects of flossing on plaque and gingivitis in third grade schoolchildren.

The purpose of this investigation was to determine whether flossing, as an adjunct to toothbrushing, performed in a school-based program can contribute significantly to a reduction in gingivitis. Four volunteer third grade classrooms (n = 112) were randomly assigned to finger-floss, looped-floss, flossholder, and brushing-only control group. Measures taken at baseline and in four weeks included gingival (GI), plaque (PI), and flossing dexterity indices (FDI). Results using ANOVA showed no differences in PI among groups. However, both brushing-only and finger-floss groups showed GI scores significantly lower than the looped-floss group. A repeated measures ANOVA revealed that the finger-floss group improved gingivitis scores most over time, while the flossholder group improved scores the least. The ANCOVA results with FDI showed that at the final measurement, looped-floss manual dexterity was rated significantly better than finger-floss and that both groups were rated better than flossholder. Final indications are that toothbrushing alone can produce clinical results similar to use of a combination of toothbrushing and flossing.

Child↗

PubMed1990

Aptitude testing and the selection of dental students.

This paper discusses the problems involved in the selection of dental students and the need for some form of aptitude testing. It describes the situation in the United Kingdom both in the past and the present, and then describes in detail the situation in North America (both in the United States and Canada). The Dental Admission Test, its history and the research into its development are described with particular emphasis on the dexterity, perceptual and aptitude components of the test. More recent research into dexterity and aptitude testing of dental students is also covered. However, it is apparent that many questions remain unanswered.

Aptitude Tests↗

PubMed2006

Mechanism-based inactivation and reversibility: is there a new trend in the inactivation of cytochrome p450 enzymes?

Recent studies with cytochrome P450 (P450) enzymes from the 2E and 2B subfamilies have shed light on what may be a new trend in the mechanism-based inactivation of P450s: reversibility. The reversible inactivation of P450-type enzymes was first reported in the mid-1990s by Dexter and Hager [Dexter AF and Hager LP (1995) J Am Chem Soc 117:817-818], who studied the transient heme N-alkylation of chloroperoxidase by allylbenzene and 1-hexyne. While characterizing small tert-butyl acetylenes as mechanism-based inactivators of P450s 2E1 and 2B4, Hollenberg and coworkers observed the reversible inactivation of an acetylene-inactivated T303A mutant of P450 2E1. The mechanism of reversibility was a combined product of the structure of the inactivator and the positioning of conserved amino acid residues, threonine 303 (alanine in the mutant) and glutamate 302, in the enzyme active site. Reversibility was also observed with both wild-type P450 2B4 and the T302A mutant of 2B4, although this inactivation and reversibility did not seem to depend on the T302 residue. Subsequent studies have attempted to elucidate the chemical/structural requirements of the inactivator in determining reversibility and have shown that both the size and the chemical nature of functional groups play an important role. At this time, reversibility has only been observed with P450 2E and 2B enzymes during their mechanism-based inactivation by terminal alkynes. Future studies with P450s from other subfamilies and structurally distinct inactivators will greatly aid our understanding of the molecular and chemical determinants of reversibility.

Acetylene↗

PubMed1994

Central neural mechanisms of prehension.

The digital dexterity seen in man and macaque monkeys but not present in other primates, such as the squirrel monkey, occurs without anatomical specialization of the hand. The central nervous system apparatus essential to such dexterity resides in the motor cortex and its outflow to lower centres. Areas other than the motor cortex are involved in the initiation and execution of complex sequential movements, including those of the fingers and hand. These include the supplementary motor and premotor areas of the cerebral cortex and the lateral parts of the cortex and the deep nuclei of the cerebellum.

Animals↗

PubMed1999

Robotics for surgery.

Robotic technology is enhancing surgery through improved precision, stability, and dexterity. In image-guided procedures, robots use magnetic resonance and computed tomography image data to guide instruments to the treatment site. This requires new algorithms and user interfaces for planning procedures; it also requires sensors for registering the patient's anatomy with the preoperative image data. Minimally invasive procedures use remotely controlled robots that allow the surgeon to work inside the patient's body without making large incisions. Specialized mechanical designs and sensing technologies are needed to maximize dexterity under these access constraints. Robots have applications in many surgical specialties. In neurosurgery, image-guided robots can biopsy brain lesions with minimal damage to adjacent tissue. In orthopedic surgery, robots are routinely used to shape the femur to precisely fit prosthetic hip joint replacements. Robotic systems are also under development for closed-chest heart bypass, for microsurgical procedures in ophthalmology, and for surgical training and simulation. Although results from initial clinical experience is positive, issues of clinician acceptance, high capital costs, performance validation, and safety remain to be addressed.

Biomedical Engineering↗

PubMedDate not supplied

Physical fitness related to disability in older persons.

BACKGROUND: In today's aging society, preventing or reducing disability is important. Physical activity may serve this goal. Generally, physical activity aims to enhance physical fitness, which in turn may prevent disability. The relationship between physical fitness and disability has been much less explored than the relationship between physical activity and physical fitness. OBJECTIVE: To investigate the relationship between separate components of physical fitness and disability. METHODS: The subjects were a community-based sample of 176 men and 233 women aged 65 years or older. Physical fitness was assessed with performance-based tests. Disability and potential confounders were assessed during face-to-face interviews. RESULTS: Independently of other fitness components, walking endurance, grip strength, manual dexterity and balance contributed significantly to the prediction of disability for both men and women. Flexibility of the hip and spine, flexibility of the shoulder and reaction time were not independent predictors of disability for men or women. Physical fitness explained a greater percentage of variance in disability for women (31-48%) than for men (14-34%). Although depressive symptoms, cognitive functioning (men), number of chronic conditions (women) and age (women) explained additional variance in disability, these variables did not confound the relationship between physical fitness and disability. CONCLUSION: Walking endurance, grip strength and manual dexterity are important unique predictors of disability. Physical activity programs should be directed at these fitness components.

Activities of Daily Living↗

PubMed2002

Tissue plasminogen activator administration does not result in clinically relevant neuropsychological dysfunction in patients with myocardial ischemia.

BACKGROUND: Recent evidence from animal models has demonstrated that tPA can be neurotoxic to the hippocampus and cerebellum. Since tPA is used in patients with myocardial infarction and has been approved for the treatment of acute ischemic stroke, we carried out a pilot study to investigate whether its administration could result in any clinically relevant neuropsychological dysfunction, with particular attention to those structures most involved in the animal model. PATIENT AND METHODS: Patients with acute myocardial infarction (AMI) who were subjected to thrombolysis with r-tPA and without evidence of prior or concomitant neurological-neuropsychological damage, were eligible. Controls consisted of patients with AMI not candidate for thrombolysis or patients with severe angina admitted to the intensive care unit. A detailed neurological and neuropsychological evaluation was performed, which included mood, visual and verbal memory, psychomotor speed processing and motor dexterity and visuomotor sequence learning. RESULTS: Ten patients and 13 controls were included. No significant differences between both groups were found, although all the subjects performed in the lower limits of the normal range on the Purdue pegboard test (motor dexterity) and digit-symbol test (psychomotor speed). There was no evidence of depression, as assessed by the Hamilton scale, that could have interfered with performance. Declarative memory (Rey auditory-verbal learning test) as well as visual memory (Rey-Osterrieth figure copy) and visuomotor sequence learning (serial reaction time task) were normal, without between-group differences. CONCLUSIONS: tPA administration at the usual doses did not result in detectable neuropsychological abnormalities in patients with myocardial ischemia.

Adult↗

PubMed2006

Pulmonary function, cognitive impairment and brain atrophy in a middle-aged community sample.

OBJECTIVE: To determine the relationship of lung function to brain anatomical parameters and cognitive function and to examine the mediating factors for any relationships. METHODS: A random sub-sample of 469 persons (men = 252) aged 60-64 years from a larger community sample underwent brain magnetic resonance imaging scans and pulmonary function tests (forced vital capacity, FVC, forced expiratory volume in the first second, FEV(1)). Subjects were assessed for global cognitive function, episodic memory, working memory, information processing speed, fine motor dexterity and grip strength. The magnetic resonance imaging scans were analysed for overall brain atrophy, subcortical atrophy (ventricle-to-brain ratio, VBR), hippocampal volume, and white matter hyperintensity (WMH) volume. RESULTS: FEV(1) had a significant negative correlation with overall brain atrophy and VBR in men. The FEV(1)/FVC ratio had a significant correlation with WMHs in both men and women. In regression models that controlled for sex, age, height, level of activity, smoking, chronic respiratory disease and education, FEV(1) and FVC were significant predictors of VBR but no other structural brain measure. Pulmonary function was also significantly related to information processing speed and fine motor dexterity. Male subjects with chronic respiratory disease had more deep WMHs. Path analyses to examine if structural measures mediated between lung function and cognition, and whether markers of inflammation and oxidative stress or cortisol mediated between lung function and brain measures were negative. CONCLUSIONS: Decreased lung function is related to poorer cognitive function and increased subcortical atrophy in mid-adult life. Presence of chronic respiratory disease may be related to deep WMHs in men.

Atrophy↗

PubMed1995

Thalamotomy for essential and cerebellar tremor.

Thalamotomy significantly suppressed essential tremor in 86% of patients and restored the ability to hold a glass to drink in 81% in the long term, but tremor recurred in 5/21 patients up to 5 years postoperatively, unlike parkinsonian patients whose tremor seldom recurs after 3 months. In multiple sclerosis (MS), 67% of those followed showed sustained significant suppression of tremor, 67% sustained improvement in dexterity, 50% in drinking; tremor recurred up to 5 years postoperatively. In other cerebellar tremors, 52% of those followed enjoyed lasting significant relief of tremor, 55% in dexterity, 45% in drinking, tremor relief being best in poststroke cases. Chronic thalamic stimulation may be the preferred therapy in MS and other cerebellar tremors.

Adult↗

PubMed1985

Effect of hydrocortisone and BCNU on long-term murine bone marrow cultures.

Hydrocortisone (HC) has been observed to influence an in vitro Dexter culture system with maintenance of pluripotent hematopoietic stem cells (CFU-s) and progenitor cells (CFU-gm, BFU-e). In the present study, a two-phase murine Dexter culture system was established to study the mechanism of HC-mediated suppression of stem cells or progenitor cells. Furthermore, the effect of exposing 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) to an adherent cell layer for 1 h was investigated for maintenance of progenitor cells. Cultures supplemented with selenium and transferrin showed relatively good growth. The BFU-e number was significantly enhanced at 2 and 3 weeks of culture in the BCNU-treated group. This system is a good model for monitoring the influence of agents to a hematopoietic-inductive microenvironment.

Animals↗

PubMed2004

Motor cortex excitability after cerebellar infarction.

BACKGROUND AND PURPOSE: The cerebellum has an influence on motor excitability. We investigated if the location of a cerebellar infarction was crucial for changes of motor cortex excitability and if the electrophysiological findings were correlated with motor performance. METHODS: Transcranial magnetic stimulation was applied to study intracortical inhibition (ICI), intracortical facilitation (ICF), motor thresholds, and corticospinal excitability. Dexterity as a measure of motor performance was tested with the Nine-Hole-Peg Test (9HPT). Ratios (affected/unaffected) were also calculated. RESULTS: ICI and ICF ratios were negatively correlated with 9HPT ratios in all patients (n=9). Compared with an age-matched control group, patients with lesions in the territory of the superior cerebellar artery (SCA) (n=3) or a lesion rostral of the dentate nucleus (n=1) had abnormally enhanced ICI and a loss of ICF (3 patients). Dexterity was impaired in all 4 patients. Motor excitability and motor performance normalized over the subsequent weeks. Patients with an infarct either in the territory of the anterior inferior cerebellar artery (n=2) or in the territory of the posterior inferior cerebellar artery (n=3) displayed motor excitability and motor performance within the normal range. CONCLUSIONS: The superior part of the cerebellum has a strong influence on motor cortex excitability. We suggest that the enhancement of motor inhibition and reduction of motor facilitation is mediated by an impairment of the deep cerebellar nuclei.

Adult↗