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PubMed1998

The "Femassist": a new device for the treatment of female urinary incontinence.

Objective: This study was undertaken in order to determine if the "Femassist" device is a safe and effective treatment for women with the diagnosis of urinary incontinence.Methods: The Femassist is a medical-grade silicon dome-shaped device, worn over the urethra and held securely via suction and a commercially available adhesive lotion. Women with a chief complaint of urinary incontinence responding to local newspaper advertisements were screened for inclusion. Potential candidates underwent medical history, physical (including gynecologic) examination, Papanicolaou test, urine culture and cytology, and multichannel urodynamic testing (including abdominal leak-point pressure measurements). A total of 38 women with documented genuine stress urinary incontinence (GSUI) or mixed incontinence were ultimately recruited into the study and fitted with either the standard or petite-sized Femassist device, according to their individual anatomy. Subjects were assessed before and after 1 month's use. Subjective assessment included quality of life questionnaires, daily voiding and activity diaries, as well as ongoing patient comments retrieved through daily telephone contact with the study nurse. Objective assessment included blinded evaluation of bacteriuria and urinary infection rates and vulvar irritation and ulceration rates.Results: To date, of the 38 women who have completed the study, over 50% reported an improvement in their quality of life including comfort, convenience, and overall satisfaction. In total for all patients studied, the device was worn for a total of 886 days; 82% of these were dry days. Similar results were obtained for women with GSUI and mixed incontinence. Factors associated with successful experience with the device included degree of tissue estrogenization (either naturally or via a topical estrogen preparation), manual dexterity, and degree of motivation. One in five women reported vulvar irritation or urethral discomfort at some point; this was not correlated with percentage of dry days. There have been no reported significant increases in bacteriuria or urinary tract infection rates over patients' baseline experiences.Conclusion: Our preliminary study suggests that the Femassist device is a safe and effective method for the management of female urinary incontinence.

Journal Article↗

PubMed1998

Use of an intuitive telemanipulator system for remote trauma surgery: an experimental study.

BACKGROUND: Death from battlefield trauma occurs rapidly. Potentially salvageable casualties generally exsanguinate from truncal hemorrhage before operative intervention is possible. An intuitive telemanipulator system that would allow distant surgeons to remotely treat injured patients could improve the outcome from severe injuries. STUDY DESIGN: We evaluated a prototype, four-degree-of-freedom, telesurgery system that provides a surgeon with a stereoscopic video display of a remote operative field. Using dexterous robotic manipulators, surgical instruments at the remote site can be precisely controlled, enabling operative procedures to be performed remotely. Surgeons (n = 3) used the telesurgery system to perform organ excision, hemorrhage control, suturing, and knot tying on anesthetized swine. The ability to complete tasks, times required, technical quality, and subjective impressions were recorded. RESULTS: Surgeons using the telesurgery system were able to close gastrotomies remotely, although times required were 2.7 times as long as those performed by conventional techniques (451 +/- 83 versus 1,235 +/- 165 seconds, p < 0.002). Cholecystectomies, hemorrhage control from liver lacerations, and enterotomy closures were successfully completed in all attempts. Force feedback and stereoscopic video display were important for achieving intuitive performance with the telesurgery system, although tasks were completed adequately in the absence of these sensory cues. CONCLUSIONS: We demonstrated the feasibility of performing standard surgical procedures remotely, with the operating surgeon linked to the distant field only by electronic cabling. Complex manipulations were possible, although the times required were much longer. The capabilities of the system used would not support resuscitative surgery. Telesurgery is unlikely to play a role in early trauma management, but may be a unique research tool for acquiring basic knowledge of operative surgery.

Abdominal Injuries↗

PubMedDate not supplied

Multilineage gene expression in human bone marrow stromal cells as evidenced by single-cell microarray analysis.

The nonhematopoietic stromal cells of the bone marrow are critical for the development of hematopoietic stem cells into functionally competent blood cells. This study addresses the question of whether bone marrow stromal cell cultures in the Dexter system propagate multiple different mesenchymal stromal cell types or one stromal cell type that expresses multiple phenotypes. Results show that isolated single stromal cells simultaneously express transcripts associated with osteoblast, fibroblast, muscle, and adipocyte differentiation. Furthermore, isolated single stromal cells simultaneously express transcripts characteristic of epithelial cells, endothelial cells, and neural/glial cells. Isolated single stromal cells also express transcripts for CD45, CD19, CD10, CD79a, and representative proto-oncogenes and transcription factors, which are typically associated with normal and neoplastic hematopoietic cells. These findings suggest that the nonhematopoietic mesenchymal cells and the hematopoietic B-lymphocytes have a common progenitor. This is consistent with the idea that progenitor cells express genes that are characteristic of the multiple lineage paths that such cells may be capable of adopting. This study demonstrates the technical feasibility of transcriptome analysis of individual primary cell-culture grown stromal cells and supports the concept that bone marrow stromal cells are relatively homogeneous and show a phenotypic signature of potential multilineage differentiation capacity.

Adult↗

PubMed2001

Effects of whole body cooling on sensory perception and manual performance in subjects with Raynaud's phenomenon.

Patients with Raynaud's phenomenon (RP) have abnormal digital vasoconstriction in response to cold. The aim of the study was to investigate the effects of cooling on sensory perception and manual performance in healthy male subjects and subjects with RP. There were two groups of subjects with primary RP: 12 subjects fulfilled the criteria of Lewis (L) and the other 12 the more critical criteria of Maricq (M). Control group (C) consisted of 19 healthy men. Subjects were exposed to 5 degrees C for 60 min. Skin temperatures were measured. Finger dexterity, pinch strength, abduction/adduction of fingers, pressure perception threshold and vibration perception threshold were tested during the exposure every 15 min. At the beginning of the exposure the mean (S.E.) finger temperature was 2.5 (1.2) degrees C (P<0.05) lower in M than in C. Manual performance and sensory perception were impaired due to the cooling, the impairment being significantly greater in M than in C. Responses of L were between those of M and C. In a given finger temperature vibration and pressure sensibility and manual performance were lower in M and L than in C. In conclusion, cold exposure decreased sensory perception and manual performance in the subjects with RP to a lower level than in the healthy subjects. Non-thermal factors may also decrease performance in RP.

Adult↗

PubMed1992

[Communication between stem cells and the hematopoietic microenvironment. Experimental data and models of interaction].

The aim of this review is to analyze the different ways by which stem cells and microenvironmental cells may interact. Stem cells are defined as immature cells that ensure the continuous renewal of blood cells. This small set of marrow cells comprises different kinds of cells, differing by their degree of maturity, their commitment, self-renewal ability and repopulating capacity. Microenvironmental cells are fixed marrow cells involved in stem cell survival, proliferation and differentiation. In vivo studies on the distribution within spleen or marrow, of stem cells injected to lethally irradiated mice, have suggested that cells of the microenvironment play a significant role in stem cell proliferation and differentiation. This role has been demonstrated using an in vitro model, i.e. the long-term marrow cultures as described in 1976 by M. Dexter. Analysis of stem cell maintenance in this culture system has made it possible to define the different means by which stromal cells and macrophages (the microenvironmental cells) may control stem cell behavior. Different molecules play a critical role: cytokines (growth factors and inhibitors), adhesion molecules (cell adhesion molecules and molecules belonging to the extracellular matrix) and eventually small peptides. It appears nowadays possible to materially represent the hemopoietic niche, whose existence was postulated by R. Schofield 10 years ago for theoretical reasons related to the the physiology of stem cells.

Amino Acid Sequence↗

PubMed2000

Subjective and objective outcomes after total wrist arthrodesis in patients with radiocarpal arthrosis or Kienböck's disease.

Sixty patients underwent total wrist arthrodesis for post-traumatic arthrosis, or Kienböck's disease. All of them could be included in the study with complete data. The average follow-up time was 37 months. Forty-nine patients were males, 11 were females; the average age was 48 years. Outcomes were assessed by several methods. Grip strength was measured using the DEXTER-Computer-System and was reduced by 50% compared to the contralateral side. Pain was evaluated pre- and postoperatively with a visual analogue scale from 0 to 100 and was reduced to 55% of the preoperative values. Patient's activities of daily living (ADLs) and general postoperative quality of life were estimated with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. For functional evaluation additionally the Mayo and Krimmer wrist scores were used. The overall DASH score was 51.4, the wrist scores reached 46.4 and 50.5, respectively. Both scores correlated significantly with the DASH. It can be concluded from our data that pain relief was sufficient in the most patients, although complete pain relief was rare. Although 80% of the patients complained about reduction of postoperative quality of life with impaired personal hygiene and functional deficits, the majority (80%) would undergo the procedure again. Seventy percent of the patients returned to their original occupation. Compared to other measures commonly used to assess outcomes after wrist arthrodesis, the DASH questionnaire proved to be a very useful tool for the evaluation of subjective outcomes in upper extremity disorders as well.

Activities of Daily Living↗

PubMed2000

Adaptive Morse code communication system for severely disabled individuals.

Morse code with an easy-to-operate, single switch input system has been shown to be an excellent communication adaptive device. Because maintaining a stable typing rate is not easy for the disabled, the automatic recognition of Morse code is difficult. Therefore, a suitable adaptive automatic recognition method is needed. This paper presents the application of a Least-Mean-Square algorithm to adaptive Morse code recognition for persons with impaired hand coordination and dexterity. Four processes are involved in this adaptive Morse code recognition method: space recognition, tone recognition, adaptive processing, and character recognition. Statistical analyses demonstrated that the proposed method results in a better recognition rate for the participants tested in comparison to other methods from the literature.

Acoustics↗

PubMed2004

Therapeutic Eurythmy-movement therapy for children with attention deficit hyperactivity disorder (ADHD): a pilot study.

This paper considers Therapeutic Eurythmy (TE) as a possible therapy for children with attention deficit hyperactivity disorder (ADHD).ADHD manifests as a complex psychological disturbance in which deficit of attention such as forgetfulness or distraction is the main symptom. It would seem that a growing number of children seem to be affected by this syndrome and an increasing number of alternative approaches to treatment are being sought. Therapeutic Eurythmy is a movement Therapy in the context of anthroposophical medicine. As a holistic therapy TE affects both physical and spiritual aspects of illness. TE entails the practice of movement exercises learned from a trained therapist. In this exploratory study, the effects of TE on behavioural functioning were examined.This paper addresses five single cases where the therapy induced positive changes to client's attention span, concentration, tempo of work and motor skills such as coordination, dexterity and social behaviour. Standard psychological tests parameters for movement, and for attention were used to assess aspects of performance.A positive shift was observed with reference to concentration and development of movement skills. Results were less pronounced but showed positive improvements on working speed and social behaviour problems. Hyperactivity also diminished to some extent. Generally, children were considered to be more mature in their development after therapy. The results of these case studies suggest that TE may be helpful for children with ADHD. However, more systematic research is warranted.

Attention↗

PubMed1998

Guiding systems for computer-assisted surgery: introducing synergistic devices and discussing the different approaches.

Computer-assisted surgery (CAS) or computer-assisted therapy (CAT) attempt primarily to optimize the performance of medical tasks. CAS systems include a guiding system to connect the information world of data and plans to the physical world of surgeons, patients and instruments, and to supplement the surgeon's perception and dexterity. Passive, semi-active and active systems have been proposed and implemented in various clinical applications. In this paper we introduce synergistic devices which are an extension of semi-active systems. We also discuss the advantages of the different categories of guiding systems on the basis of a list of task-oriented and user-oriented qualitative factors.

Humans↗

PubMed2001

2D or not 2D. Two-dimensional gel electrophoresis.

2D gel electrophoresis is the technology that everyone loves to hate-it requires manual dexterity and precision to reproduce precisely and is thus not well-suited as a high-throughput technology. Although almost everyone would like to replace it, the resolution and sensitivity it offers are exquisite and unsurpassed if one wants a global view of cellular activity. There have been several recent developments, for example, the detection of low abundance proteins, and the resolution possible with narrow-range IPG gels.

Animals↗

PubMed1998

A rapid method for the isolation of metabolically active mitochondria from rat neurons and astrocytes in primary culture.

A rapid method (about 1.5 h) for the isolation of intact functional mitochondria from neurons and astrocytes in primary culture is described. Mitochondria isolated by this method are metabolically active and tightly coupled as shown by respiratory control ratio values, which were about 4 with glutamate-malate as substrate. The activities of marker enzymes revealed the occurrence of a low degree of cytosolic (5%) or synaptosomal (5.5%) contamination in the mitochondrial fractions. In addition, the activity of citrate synthase was increased by 4 fold in both neuronal and astrocytic mitochondria with respect to values found in cell homogenates. These results confirm that the method affords mitochondrial preparations from cultured brain cells at suitable levels of purity and enrichment for the study of their mitochondrial function. Since mitochondrial damage has been associated with the pathogenesis of certain neurodegenerative diseases, such as Alzheimer's and Parkinson's diseases (P. Chagnon, C. Betard, Y. Robitaille, A. Cholette, D. Gauvreau, Distribution of brain cytochrome oxidase activity in various neurodegenerative disease, Neuroreport 6 (1995) 711-715 [6]; S.J. Kish, C. Bergeron, A. Rajput, S. Dozic, F. Mastrogiacomo, L. Chang, J.M. Wilson, L.M. DiStefano, J.N. Nobrega, Brain cytochrome oxidase in Alzheimer's disease, J. Neurochem. 59 (1992) 776-779 [10]; A.H.V. Schapira, J.M. Cooper, D. Dexter, J.B. Clark, P. Jenner, C.D. Marsden, Mitochondrial complex I deficiency in Parkinson's disease, J. Neurochem. 54 (1990) 823-827 [15]), the method described here shed light on the possible susceptibility of neuronal or astrocytic mitochondria to deleterious effects of these diseases.

Animals↗

PubMed2003

Primary total hip replacement.

Primary hip replacement requires careful patient selection, a knowledge of available prostheses, thorough pre-operative planning, familiarity with surgical exposures and sufficient manual dexterity to carry out the procedure. The aim of hip replacement is to restore the biomechanics of the diseased joint as closely as is practical. Failure to observe these principals results in premature failure of the joint replacement.

Acetabulum↗

PubMed2003

Double gloving: a risk reduction strategy.

BACKGROUND: The use of sterile surgical gloves has become the international standard of care in the perioperative environment. Yet the potential for barrier failure exists, with the subsequent potential for the transfer of pathogens to both the patient and the surgical team. The practice of double gloving (wearing two pairs of sterile surgical gloves) is often considered a mechanism for managing the potential risk of exposure during surgery. LITERATURE ON DOUBLE GLOVING: In the 2002 Cochrane review of double gloving, findings were summarized from 18 studies. The review, which covers a variety of surgical environments and addresses several double gloving options, indicates that double gloving significantly reduced perforations to the innermost glove. Other studies report a risk reduction of 70%-78% attributed to double gloving. OVERCOMING PRACTITIONER OBJECTIONS: Practitioners, in voicing objections to double gloving, cite poor fit, loss of tactile sensitivity, and increased costs. An important issue is how the two gloves work together, especially when they are powder free. Several studies have reported good acceptance of double gloving without loss of tactile sensitivity, two-point discrimination, or loss of dexterity. Although double gloving increases the glove cost per practitioner, the reduction of bloodborne pathogen exposure and possible seroconversion of practitioners represents a significant savings. Strategies that may help to facilitate the process include sharing the data on double gloving to build justification for the implementation, enlisting the support of the champions of the change at hand, and providing a glove-fitting station. SUMMARY: The stresses placed on a surgical glove today--the length of cases, heavy and/or sharp instrumentation, and chemicals used in the surgical field--make it imperative that barrier protection be ensured.

Blood-Borne Pathogens↗

PubMed1998

Neurodevelopmental dysfunction and specific learning disabilities in school-aged twins.

The frequency of the developmental dysfunction and specific learning disabilities were assessed in the retrospective study in the group of 56 school-aged twins. The relationships between genetic, perinatal and social factors and learning disability were also determined. It was found that 12.5% of twins had learning disabilities. The most common neurodevelopmental dysfunction were language disorders, poor graphomotor fluency and poor fine motor dexterity. It was also found that educational difficulty were associated with prematurity, low Apgar scores, neonatal complications and familial predisposition.

Adolescent↗

PubMed2000

Impaired force coordination during object release in children with hemiplegic cerebral palsy.

Recent studies on hand motor control in children with cerebral palsy (CP) have focused on the coordination of fingertip forces during the grasping and lifting of objects. However, little is known about the ability to replace and release an object from grasp, a function that is just as important for fine dexterity. The present study examines the coordination of fingertip forces during the replacement and release of an object (either 200 g or 400 g) from grasp in 14 children (aged between 7 and 13 years) with hemiplegic CP and in 14 age-matched typically developing children. The results indicate that children with hemiplegic CP abruptly replaced the object but had a prolonged and uncoordinated release of the grasp. Unlike what was seen in the control children, the grip and load forces decreased sequentially in the children with CP. However, all the children could appropriately scale the rate of force decrease based on somatosensory weight-related information from the ongoing lift. The results provide further information about the impaired hand skills in children with hemiplegic CP.

Adolescent↗

PubMed2000

Quantitative assessment of mirror movements in children and adolescents with hemiplegic cerebral palsy.

Mirror movements in individuals with hemiplegic cerebral palsy (CP) may result from a reorganization of the central sensorimotor system. Motor performances of both hands were measured to characterize mirror activity (or mirroring) and hand functions in 22 participants (6 to 18 years) with hemiplegic CP and in 17 control participants. During a unimanual repetitive squeezing task, contractions of the active hand and fingertip forces of the opposite hand were recorded simultaneously. In the control group, slight mirror activity (or mirroring) was found that decreased with age. In participants with CP, mirror activity was 15 times stronger than in the control group, and was found at all age levels. Mirroring was more prominent in the unaffected hand of the CP group. The amount of mirror activity was not related to the degree of hemiplegia, which was assessed with measures of spasticity, strength, and dexterity. Mirror movements disturbed functional bimanual skills, although to some extent they could be suppressed by voluntary effort.

Adolescent↗

PubMed2002

Health status of school-aged children with cerebral palsy: information from a population-based sample.

In this study parents' systematic accounts of the health status of 408 school-aged children with cerebral palsy (CP) are reported (221 males, 187 females; mean age 8 years 5 months, SD 1 year 11 months; range 5 to 13 years), as are relations between severity of functional motor impairment and eight functional health status domains. Data were collected as part of a longitudinal study of the motor development of a population-based, stratified, random sample of children with CP from across Ontario, Canada. The Gross Motor Function Classification System (GMFCS) was used to classify severity of CP and functional health status was described with the eight-level Health Utilities Index-Mark 3. Rates of functional limitations in Mobility, Dexterity, Speech, and Vision were statistically significantly associated with GMFCS levels (all p<0.01), with correlation values (tau-b) of 0.82, 0.58, 0.46, and 0.36, respectively. Functional limitations in hearing (tau-b=0.16; p=0.04) and cognition (tau-b=0.27; p<0.01) were both statistically significantly associated with GMFCS levels, though correlations were low. Neither emotion (tau-b=0.03; p=0.24) nor pain (tau-b=0.07; p=0.37) was associated with degree of functional limitation as described by the GMFCS. Clinical and epidemiological implications of findings are discussed.

Activities of Daily Living↗

PubMed2005

Refractive errors in infancy predict reduced performance on the movement assessment battery for children at 3 1/2 and 5 1/2 years.

We have previously reported that significant hyperopia at 9 months predicts mild deficits on visuocognitive and visuomotor measures between 2 years and 5 years 6 months. Here we compare the motor skills of children who had been hyperopic in infancy (hyperopic group) with those who had been emmetropic (control group), using the Movement Assessment Battery for Children (Movement ABC). Children were tested at 3 years 6 months (hyperopic group: 47 males, 63 females, mean age 3 y 7 mo, SD 1.6 mo; control group: 61 males, 70 females, mean age 3 y 7 mo, SD 1.2 mo) and at 5 years 6 months (hyperopic group: 43 males, 56 females, mean age 5 y 4 mo, SD 1.7 mo; control group: 51 males, 62 females, mean age 5 y 3 mo, SD 1.6 mo). The hyperopic group performed significantly worse at both ages, overall and on at least one test from each category of motor skill (manual dexterity, balance, and ball skills). Distributions of scores showed that these differences were not due to poor performance by a minority but to a widespread mild deficit in the hyperopic group. This study also provides the first normative data on the Movement ABC for children below 4 years of age, and shows that it provides a useful measure of motor development at this young age.

Age Factors↗