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At least 1,225 records · Page 68Linked to original sources

PubMed2001

Evaluation of grip strength with a sustained maximal isometric contraction for 6 and 10 seconds.

The grip strength in which subjects sustained a maximal isometric contraction for 6 seconds (the 6-second test) was compared with that for 10 seconds (the 10-second test) to clarify a reliable sustained grip strength test procedure. Fifty healthy students (22+/-4 years, 25 men and 25 women) participated in this study. Strength was measured continuously by the Dexter (Cedaron Medical Inc.). The maximal grip strength, the peak time, and the momentary strength every second during a trial were evaluated. For both tests, the reliable maximal strength and a typical strength-time curve consisting of an early peak time and a decrease in the strength after the peak gradually over time were obtained. In the 6-second test, the momentary strength after 5 seconds that was 82+/-10 approximately 87+/-7% of the peak strength showed good reliability. This variable may be effective in assessing the ability to sustain maximal grip strength.

Adolescent↗

PubMed1997

Unimanual and bimanual simultaneous fingertapping in schoolchildren: developmental aspects and hand preference-related asymmetries.

Computerised analysis of finger tapping was performed in 233 normal 5- to 12-year-old children whose hand preference was assessed with six demonstration actions. Performance with both hands became more rapid with age when tapping unimanually or simultaneously in phase with two hands as quickly as possible. There were no differences between the sexes. Performance with both hands also acquired more tapping regularity with age during unimanual tapping, whereas only the left hand did so during bimanual tapping. There was no age effect on the dexterity (speed) difference between unimanually tapping hands, nor on the relative time lag and the degree of synchrony between the hands in bimanual tapping. The degree of synchrony, however, becomes more stable in older children. The more righthanded children are, the faster the right hand is in unimanual tapping, and the more the right hand is ahead of the left hand during bimanual tapping. However, there is a right shift for both of these variables which makes them poor predictors of hand preference. These results suggest that there is a strong bias towards the right hand in complete righthanders as well as--to a lesser extent--in all others, which might be connected to the leading role of the left hemisphere for the performance aspects of hand motor function under study.

Journal Article↗

PubMed2000

Hand skill and hand preference in blind and sighted children.

Congenitally blind and sighted blindfold children between the ages of 6 and 15 years were compared with each other for hand preferences and hand ability. All the children performed a 20-item hand preference test and every child performed three hand ability tasks: a sorting task, a finger dexterity task, and the Minnesota rate of manipulation task, each separately with the left and the right hand. Results indicated no differences between the hand preferences of the two groups. The sighted children were faster than the blind children on some of the hand ability tasks. There were no differences between the left and right hands for any of the tasks for either group. Results indicate an equipotentiality between the hands and suggest the possibility of training both hands during development on tasks that require tactile ability.

Journal Article↗

PubMed2000

Circadian rhythms in healthy aging--effects downstream from the pacemaker.

Using both previously published findings and entirely new data, we present evidence in support of the argument that the circadian dysfunction of advancing age in the healthy human is primarily one of failing to transduce the circadian signal from the circadian timing system (CTS) to rhythms "downstream" from the pacemaker rather than one of failing to generate the circadian signal itself. Two downstream rhythms are considered: subjective alertness and objective performance. For subjective alertness, we show that in both normal nychthemeral (24 h routine, sleeping at night) and unmasking (36 h of constant wakeful bed rest) conditions, advancing age, especially in men, leads to flattening of subjective alertness rhythms, even when circadian temperature rhythms are relatively robust. For objective performance, an unmasking experiment involving manual dexterity, visual search, and visual vigilance tasks was used to demonstrate that the relationship between temperature and performance is strong in the young, but not in older subjects (and especially not in older men).

Adult↗

PubMed1990

Monoclonal antibodies to Pgp-1/CD44 block lympho-hemopoiesis in long-term bone marrow cultures.

A new panel of mAbs was prepared to a stromal cell line known to support lymphocytes in Whitlock-Witte type long-term bone marrow cultures. These antibodies were then screened with a cell adhesion assay and four were selected that inhibited the binding of B lineage cells to stromal cell monolayers. Immunofluorescent and biochemical analyses revealed that these new antibodies detected epitopes of the previously described Pgp-1/CD44 antigen complex. Addition of Pgp-1/CD44 antibodies to Dexter-type long-term bone marrow cultures completely prevented emergence of myeloid cells and they also blocked lymphocyte growth in Whitlock-Witte type cultures. mAbs MEL-14, LFA-1, and CD45R did not inhibit under the same conditions and there was no apparent relationship to Ig isotype. Adherent layers in treated cultures were not unusual in terms of morphology and the antibodies did not affect factor-dependent replication of lymphoid or myeloid progenitor cells. Therefore, the mechanism of inhibition may not involve direct toxicity to precursors or microenvironmental elements. Previous studies in humans and mice have implicated Pgp-1/CD44-related glycoproteins in the migration of peripheral lymphoid cells, as well as interactions of cells with the extracellular matrix. These findings suggest that they may also be critical for formation of lymphoid and myeloid cells within bone marrow.

Animals↗

PubMed1987

Ultraviolet radiometry of clinical sources with a miniature multijunction thermopile.

Three versions of the Dexter 2M miniature multijunction thermopile were evaluated for the radiometry of clinical ultraviolet radiation (UVR) sources. The acceptance angle had been increased in two of these devices, and one also contained an additional ceramic heat sink under its receiver element. Measurements were made of their absolute sensitivity and linearity, and their response to various UVR sources was compared to that of Hilger Schwarz FT17 and FT32 vacuum compensated thermopiles. Both of the acceptance angle modifications yielded an angular response less than that of the wide-angle FT32 thermopile. The additional ceramic heat sink diminished, but did not eliminate, the initial surge in the 2M thermopile output voltage following exposure. Under constant irradiance, the 2M output voltage was stable after the initial surge had decayed, even without the additional heat sink. It was concluded that irradiance measurements should be made after the output voltage had stabilised. Any version of the 2M thermopile could be used for relative day-to-day monitoring of all UVR sources, and the version with the widest acceptance angle could be used for the absolute radiometry of certain extended sources.

Evaluation Studies as Topic↗

PubMed2003

Simple model for training in the laparoscopic vesicourethral running anastomosis.

PURPOSE: To create a simple model for training in the complex technique of laparoscopic vesicourethral anastomosis after radical prostatectomy. MATERIALS AND METHODS: A model simulating the performance of a laparoscopic running urethrovesical anastomosis was fashioned using skin of a supermarket chicken set in a laparoscopic training box. A circular continuous anastomosis was performed, following exactly the technique we use in vivo for performing a vesicourethral anastomosis after laparoscopic radical prostatectomy. Details regarding the use of the right or the left needle holder, needle positioning, precise stitch position, and use of forehand or backhand stitch were strictly respected in order to reproduce the continuous stitch currently done in vivo in our department. The learning curve was analyzed in terms of the time necessary to perform the task and the quality of the anastomosis. RESULTS: The model was created and used by the junior authors during their year of fellowship in advanced laparoscopic urology. The authors had no previous experience with hands-on laparoscopic suturing but have assisted in a great number of laparoscopic radical prostatectomies. The time required for performing the anastomosis on the model declined from 75 minutes initially to 20 minutes after the trainees had performed 20 anastomoses each. After this training, it was possible to create a watertight running laparoscopic vesicourethral anastomosis in patients in a mean time of 40 minutes (range 30-55 minutes). CONCLUSION: This simple model allows the trainee in laparoscopic urology to acquire the skills necessary to perform a laparoscopic vesicourethral anastomosis, one of the most complex steps in laparoscopic radical prostatectomy, as well as to develop dexterity and facility in laparoscopic manipulation of needles, sutures, and fragile tissues.

Anastomosis, Surgical↗

PubMed2002

Behavioral recovery in a primate model of Parkinson's disease by triple transduction of striatal cells with adeno-associated viral vectors expressing dopamine-synthesizing enzymes.

One potential strategy for gene therapy of Parkinson's disease (PD) is the local production of dopamine (DA) in the striatum induced by restoring DA-synthesizing enzymes. In addition to tyrosine hydroxylase (TH) and aromatic-L-amino-acid decarboxylase (AADC), GTP cyclohydrolase I (GCH) is necessary for efficient DA production. Using adeno-associated virus (AAV) vectors, we previously demonstrated that expression of these three enzymes in the striatum resulted in long-term behavioral recovery in rat models of PD. We here extend the preclinical exploration to primate models of PD. Mixtures of three separate AAV vectors expressing TH, AADC, and GCH, respectively, were stereotaxically injected into the unilateral putamen of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-treated monkeys. Coexpression of the enzymes in the unilateral putamen resulted in remarkable improvement in manual dexterity on the contralateral to the AAV-TH/-AADC/-GCH-injected side. Behavioral recovery persisted during the observation period (four monkeys: 48 days, 65 days, 50 days, and >10 months, each). TH-immunoreactive (TH-IR), AADC-IR, and GCH-IR cells were present in a large region of the putamen. Microdialysis demonstrated that concentrations of DA in the AAV-TH/-AADC/-GCH-injected putamen were increased compared with the control side. Our results show that AAV vectors efficiently introduce DA-synthesizing enzyme genes into the striatum of primates with restoration of motor functions. This triple transduction method may offer a potential therapeutic strategy for PD.

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine↗

PubMed2002

Virtual reality and haptics as an assessment device in the postacute phase after stroke.

Virtual reality (VR) technology is altering the health care environment and is changing the options that are available to therapists. This study describes how a haptic device was used as a cinematic assessment utility. Three chronic stroke inpatients at Sahlgrenska University Hospital with left hemisphere damage were assessed. The patients were administered by the box and block manual dexterity test. For comparisons, a reference group was added to the study. Several parameters, including time, speed, and movement of the right upper extremity, were extracted and evaluated. The results indicate that the system shows potential as an assessment device. The feasibility study setup is working well, as is the assessment method. Further research, testing, refinement of the exercises, and use of VR and haptics within neurological rehabilitation are suggested.

Adult↗

PubMed2001

Severe hematopoietic alterations in vitro, in bone marrow transplant recipients who develop graft-versus-host disease.

Graft-versus-host disease (GVHD) is currently one of the major obstacles for successful allogeneic bone marrow transplantation (BMT). GVHD results from a complex set of interactions between donor T cells and a variety of target tissues from the host. To gain a better understanding of the biology of the human hematopoietic system in GVHD patients, in the present study we have determined the progenitor cell content in bone marrow (BM) samples from BMT recipients, with and without GVHD, and followed their growth kinetics in Dexter-type long-term marrow cultures (LTMC). We have also assessed some aspects regarding the composition of the hematopoietic microenvironment developed in vitro. As compared to normal subjects, BMT recipients showed decreased numbers of myeloid, erythroid, and multipotent progenitor cells. Interestingly, progenitor levels were significantly lower in GVHD patients (7% of the levels in normal marrow) than in those without GVHD (44% of the levels in normal marrow). When marrow cells from BMT recipients were cultured in LTMC, hematopoiesis was sustained at lower levels and for shorter periods of time, as compared to cultures from normal subjects. The hematopoietic deficiencies observed in this in vitro system were also more pronounced in GVHD patients. In terms of the microenvironment elements, reduced numbers of fibroblastic progenitors and adherent stromal cells were observed in BMT recipients, as compared to normal subjects, who showed 7 colony-forming unit fibroblast (CFU-F)/10(5) marrow cells and 320,000 adherent cells in LTMC. Again, GVHD patients showed more severe deficiencies (0.16 CFU-F/10(5) marrow cells and 34,000 adherent cells in LTMC) than patients without GVHD (2 CFU-F/10(5) marrow cells and 122,000 adherent cells in LTMC). Our results demonstrate that the hematopoietic system of BMT recipients is impaired, both in terms of its in vitro composition and function, and that these deficiencies are clearly more pronounced in patients with GVHD than in those without GVHD. Finally, although the evidence is still preliminary, our results also indicate that the severity of the hematopoietic alterations may be greater in acute GVHD than in chronic GVHD.

Acute Disease↗

PubMed2002

CD44-mediated hematopoietic progenitor cell adhesion and its complex role in myelopoiesis.

During hematopoiesis in the bone marrow (BM), hematopoietic progenitor cells (HPC) proliferate and differentiate in intimate contact with BM stromal cells in a highly regulated interplay among cytokines, chemokines, and adhesion molecules. Using the mouse BM stromal cell line MS-5 as immunogen, we raised monoclonal antibodies (mAb) against surface proteins that could participate in interactions between HPC and stroma. Flow cytometry and immunodepletion analysis indicated that two antibodies, MA-8 and MA-2, recognized CD44. Although MA-8 and another anti-CD44 antibody, IM7.8.1, blocked adhesion of hematopoietic cells to hyaluronate, adhesion to BM stroma was notably increased by these mAb, suggesting minor roles for CD44/hyaluronate interaction and the triggering of additional adhesion pathways upon CD44 engagement. The presence of MA-8 in Dexter-type long-term BM cultures (LTBMC) only slightly inhibited production of myeloid cells, and the number of myeloid progenitors (measured as CFU-GM) in the supernatants of LTBMC performed with MA-8 was similar to those carried out with control antibodies. Instead, IM7.8.1 completely blocked myelopoiesis, whereas an anti-alpha 4 integrin mAb increased CFU-GM amounts. In summary, two anti-CD44 antibodies with similar effects in cell adhesion showed notable differences in myelopoietic cultures, indicating the structural and functional complexity of the CD44 molecule.

Animals↗

PubMed2002

Quantitative and qualitative analysis of the human primitive progenitor cell compartment after autologous stem cell transplantation.

The aim of this study was to examine whether the severe prolonged deficiency in marrow clonogenic progenitor cells reported after autologous stem cell transplantation (ASCT) is associated with impairment of the primitive progenitor cell compartment. We performed Dexter-type marrow cultures and limiting dilution assays with CD34(+) cells from patients 1 year and/or later after autografting with peripheral blood stem cells for non-Hodgkin's lymphoma (NHL). Flow cytometric analysis was used to assess the CD38 antigen expression and apoptotic state (7-ADD(-)/annexin-V(+) cells) of the CD34(+) cell population. We found a dramatic decrease in both clonogenic progenitor cell production and frequency of long term culture-initiating cells (LTC-IC) in all the patients tested at 1 year, even in those displaying normal progenitor cell frequency. Surprisingly, the clonogenic capacity of each LTC-IC was not increased. Flow cytometric analysis of the CD34(+) cell population confirmed this quantitative defect, with a reduction in the CD38(dim/neg) cell population but no increase in apoptosis. This defect did not improve over time up to 4 years after transplantation. In addition, qualitative abnormalities were revealed, demonstrated by decreased CD34 antigen expression, together with impaired differentiating properties of LTC-IC toward erythroid lineage at 1 year. This study indicates that both quantitative and qualitative abnormalities of the primitive progenitor cell compartment are a constant feature up to 4 years after autologous stem cell transplantation.

Adult↗

PubMed2004

Candida albicans can stimulate stromal cells resulting in enhanced granulopoiesis.

Previously, we have reported that although unperturbed granulocyte colony-stimulating factor (GCSF)-deficient (G-CSF-/-) mice are neutropenic, when challenged with Candida albicans, they develop a profound neutrophilia. In an attempt to understand the basis of Candida-induced neutrophilia in G-CSF-deficient mice, we have modified the Dexter bone marrow culture system to produce an in vitro model that mimics emergency granulopoiesis in vivo. In this model, stromal cultures are overlaid with bone marrow cells in the presence or absence of heat-inactivated (HI) Candida. Irrespective of the genotype of mice used as a source of bone marrow-derived stromal cells, stimulation of these cultures with HI Candida led to a significantly greater recovery of cells compared to unstimulated stromal cultures. In addition, there was a marked increase in the number of colony-forming units granulocyte-macrophage (CFU-GM), as well as in the percentage of granulocytes in the population of nonadherent cells recovered from HI Candida-stimulated cultures. The conditioned medium generated from stromal cultures derived from either wild-type or G-CSF-/- mice exposed to HI Candida, when applied to bone marrow cells in a soft agar clonogenic assay stimulated M-, GM-, and G- type colonies. Interleukin-3 (IL-3) and GM-CSF could not be detected in the conditioned medium from either HI Candida stimulated or unstimulated stromal cultures. However, IL-6 was detected in the conditioned media from both wild-type and G-CSF-/- stromal cultures. Addition of anti-IL-6 antibody significantly impaired granulopoiesis in unstimulated and HI Candida-stimulated, wild type, and G-CSF-/- stromal cultures. Conditioned medium generated from G-CSF/IL-6-deficient stromal cells had the capacity to stimulate bone marrow cells to form colonies comprised of granulocytes and macrophages in soft agar clonogenic assay. This study demonstrates that stromal cells can be stimulated with HI Candida and gives an insight into Candida mediated granulopoiesis.

Animals↗

PubMed1999

A controlled investigation of bodywork in multiple sclerosis.

OBJECTIVE: To determine whether a course of Feldenkrais bodywork would result in significant improvement in physical, mood symptoms and functioning in multiple sclerosis (MS) patients beyond the effects observed using a sham condition (nontherapeutic bodywork). DESIGN: The bodywork method used was the Feldenkrais method. Subjects were randomly assigned to 1 of 2 groups in a crossover design to control for order effects of treatment. Half of the subjects received 8 weeks of sham sessions followed by 8 weeks of Feldenkrais sessions. The other half of the subjects received Feldenkrais sessions first and then sham. All subjects completed the outcome measures prior to the first course of treatment, in between Feldenkrais and sham, and at study completion. SETTING: Participants were recruited from a regional MS clinic and were administered bodywork treatment and outcome measures in a bodywork practitioner's office. SUBJECTS: Twenty individuals with clinically definite MS and disability status scores between 2.0 and 6.0 participated. OUTCOME MEASURES: Nine-hole pegboard test of hand dexterity, Hospital Anxiety and Depression Scale, MS self-efficacy scale, MS Symptom Inventory, MS Performance Scales, and the Perceived Stress Scale. RESULTS: The only significant differences were observed for perceived stress and lowered anxiety after Feldenkrais sessions. There were nonsignificant trends toward higher self-efficacy after both Feldenkrais and sham sessions. MS symptoms, levels of functional ability, and upper extremity performance were not affected by Feldenkrais or sham sessions.

Adult↗

PubMed1991

Technical considerations and factors that influence the outcome of laser-assisted angioplasty.

In the last several years many studies have been conducted to evaluate the feasibility of laser-assisted angioplasty procedures as a therapeutic option for the treatment of patients with peripheral vascular disease. Assessing patient outcomes from studies done at various centers is complicated by the number of variables in patient selection, technical aspects of the procedures, laser parameters, and followup procedures. An ongoing process of defining and refining important parameters and aspects of these procedures is evolving. Important components in achieving good long-term results are technical dexterity with catheter systems, knowledge of angiography techniques, in-depth knowledge in the evaluation and treatment of patients with peripheral vascular disease, and a thorough understanding of laser biophysics and tissue interactions. The importance of technical details as a determinant of successful outcome in the treatment of these patients is discussed. Percutaneous vascular access is the method of choice for angioplasty procedures, but about 36% of patients will require surgical exposure of the femoral artery and possibly endarterectomy of patchplasty. In 11% of patients, the intraluminal channel is inadequate, revascularization is incomplete, or for other technical reasons surgical bypass is necessary. Peripheral laser-assisted angioplasty is a viable treatment alternative in selected patients. As the technique matures the value of its role in the therapeutic armamentarium will emerge.

Angioplasty, Laser↗

PubMed2005

Assessment of dose selection attributes with audible notification in insulin pen devices.

BACKGROUND: Patients with type 2 diabetes often suffer from impairments in vision as well as manual dexterity. The purpose of this study was to assess the reliability of dose selection and setting of five insulin devices by patients using auditory and sensory confirmation. METHODS: A total of 48 patients (30 men, 18 women; mean +/- SD age 60.5 +/- 14.0 years; hemoglobin A(1c) 8.7 +/- 1.9%) were randomized to test the following devices: NovoPen 3 (Novo Nordisk A/S, Bagsvaerd, Denmark), HumaPen Ergo (Eli Lilly, Indianapolis, IN), Humalog Pen (Eli Lilly), InnoLet (Novo Nordisk), and FlexPen(Novo Nordisk). RESULTS: Significantly more patients detected an auditory confirmation of dose setting when using the NovoPen 3 compared with the Humalog Pen (P < 0.001), HumaPen Ergo (P < 0.001), and InnoLet (P < 0.01). The audible click for the FlexPen was also heard by more patients than for the Humalog Pen (P < 0.001) and HumaPen Ergo (P < 0.01). All patients found that the Flex- Pen provided physical sensory confirmation; the percentage was higher than for those using the Humalog Pen (P < 0.001), HumaPen Ergo (P < 0.001), and InnoLet (P < 0.01). The NovoPen 3 was also associated with a higher percentage of patients who felt the click sensation than with the Humalog Pen (P < 0.001) and HumaPen Ergo (P < 0.01). Patients reported more confidence in setting the correct dose with the NovoPen 3 and FlexPen, and found these the most reliable for dose setting. Sound recordings showed that the NovoPen 3 produced the loudest clicks when setting a dose (P < 0.001 for all comparisons). CONCLUSIONS: The clarity of the click when setting a dose on an insulin delivery device can affect the patient's confidence in selecting the correct dose.

Automation↗

PubMed1993

A program of instruction in operative laparoscopy in a residency in obstetrics and gynecology.

Operative laparoscopy has found an increasingly innovative role in contemporary gynecologic practice. Residency programs must now formulate protocols for training in laparoscopic surgery on which subsequent credentialling may be safely recommended. This report describes a program of instruction in operative laparoscopy and the number of procedures required to develop technical skills at each year level of a 4-year residency. The objective of the program was to develop clinical judgment and technical skills in operative laparoscopy during the first 3 resident years. The main outcome measurement was the safe performance of complicated operative laparoscopy during the fourth resident year. This program emphasized progressive, graded responsibility in operative laparoscopy to develop skills in both the principles and practice of laparoscopic surgery. Principles were taught through didactic sessions in laparoscopic instruments and techniques, assignment of reading lists for each year level, and a review of videotapes to assist in decision making for each procedure. Skills in technique and development of manual dexterity were taught over 4 years as follows. Postgraduate year (PGY) 1: restricted to diagnostic procedures emphasizing the development of basic eye-hand coordination using a video monitor system; PGY2: incorporation of principles of laparoscopic hemostasis and laparoscopic tubal ligation; PGY3: operative laparoscopy using multiple puncture sites, sharp dissection, and suture techniques; PGY4: progressively more complicated procedures to include salpingectomy, salpingostomy, and segmental resection for ectopic pregnancies; oophorectomy for benign disease, appendectomy, and adhesiolysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Competence↗

PubMed2005

Novel uses of surgical robotics in head and neck surgery.

PURPOSE: To demonstrate the utility of robotically assisted approaches in head and neck surgery. MATERIALS AND METHODS: Two teenage patients, one with a solitary thyroid nodule who was scheduled for a right thyroid lobectomy and the other with intractable seizures who was scheduled for placement of a vagal nerve stimulator were offered the option of a robotically assisted technique using a transaxillary endoscopic approach. RESULTS: Both procedures were completed successfully using the da Vinci surgical system (Intuitive Surgical, Sunnyvale, California). A 12 mm telescope and 5 mm instruments were used. There was sufficient mobility of the robotic arms despite the small working space. There were no complications, minimal pain in the axillary incisions, and patient satisfaction was high. Operative times were 4.5 and 4.2 hours, respectively. CONCLUSION: Transaxillary, endoscopic, robotically assisted approaches to the head and neck are feasible. The addition of robotics improves surgical dexterity in a difficult-to-reach anatomic region. Patient satisfaction appears high because of the avoidance of a cervical incision.

Adolescent↗