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PubMed1997

[Stretching].

Static stretching exercises have become very popular over the past fifteen years both in professional and amateur sports. In the fields of physical therapy and in manual therapy, in particular, static stretching has become part of a standard and successful treatment modality. Together with an appropriate strengthening program, static stretching techniques have become the therapy of choice for treatment of muscle imbalances associated with functional disturbances of the musculoskeletal system. Specific muscle length testing procedures have been developed to determine muscle shortening in clinical practice. In this article, the fundamental principles of the different types of muscle stretching techniques are described, including the dynamic stretching and static stretching techniques. The exercises are organized along the concepts of passive static or neuromuscular stretching principles. The pertaining neurophysiologic fundamentals are discussed, as are the benefits of the individual methods of a functional exercise program. Examples are provided for the most important muscle groups.

Exercise↗
PubMed2004

Renal transplantation in prune-belly syndrome.

We assess the effect of the prune-belly syndrome (PBS) on renal transplantation outcome. Six renal transplantations were performed in five boys affected by PBS (median age 5.8+/-2.1 years, median weight 13.6+/-2.4kg). Renal graft survival, graft function, lower urinary tract dysfunction, urinary tract infections (UTIs), associated complications and patients' survival after 1 and 5 years of follow-up were analysed. The rate for 1-5-year graft survival was 66.7% (mean serum creatinine 98-103 micromol/l). The surgical treatment of the documented bladder obstruction (two patients) and the severe abdominal wall deficit (one patient) led to a reduction of UTI: the patients maintained their native urinary tract and none received prophylactic antibiotics. The lack of abdominal wall musculature led to severe mechanical complication in one patient, but Monfort's abdominal wall reconstruction was able to restore the graft's function. The outcome of patients with PBS who undergo renal transplantation is good. Before the transplant, an accurate assessment of urinary tract anomalies and deficiency of the abdominal wall musculature is mandatory, to program the appropriate treatment and obtain a good long-term prognosis for the renal graft.

Abdominal Wall↗
PubMed1998

The role of the pedunculopontine tegmental nucleus in relation to conditioned motor performance in the cat. II. Effects of reversible inactivation by intracerebral microinjections.

The effects of reversible pharmacological manipulation of the neuronal activity in the pedunculopontine tegmental nucleus (PPTg) on the performance of a conditioned movement was studied in two freely moving cats. The microinjections were given in regions where, in the same subjects, we had previously identified neurons with context-dependent early activity after a trigger stimulus and with reinforcement-related activity. The subjects were conditioned to perform a forelimb-flexion movement controlled by a simple reaction-time task. In addition, one subject was trained to execute the same flexion movement, but delayed after the trigger stimulus. Food pellets were used as the reinforcer. Lidocaine injections (1 microl of 2% solution, injected over a 6-min period) induced a transient arrest of performance within minutes. The cessation of performance could be preceded by behavioral signs such as meowing, attempt to escape from the experimental booth, licking, or stereotyped posture. No rotational behavior could be observed. The effects of lidocaine could be mimicked in one subject by an extinction procedure. Muscimol injections (two injections of 0.2 microg in 1 microl, tested in one subject) also induced arrest of performance, but the return to pre-injection level of performance could not be obtained within the time of the test session. The quantitative analysis of reaction times and of inter-trial intervals showed that altering PPTg activity affected inter-trial intervals, but only slightly affected the reaction times. It is speculated that the PPTg is involved in the reinforcement process related to selecting the appropriate motor program.

Animals↗
PubMed2006

Development and evaluation of a training module for the clinical introduction of the da Vinci robotic system in visceral and vascular surgery.

BACKGROUND: With the increasing use of the surgical robotic system in the clinical arena, appropriate training programs and assessment systems need to be established for mastery of this new technology. The authors aimed to design and evaluate a clinic-like training program for the clinical introduction of the da Vinci robotic system in visceral and vascular surgery. METHODS: Four trainees with different surgical levels of experience participated in this study using the da Vinci telemanipulator. Each participant started with an initial evaluation stage composed of standardized visceral and vascular operations (cholecystectomy, gastrotomy, anastomosis of the small intestine, and anastomosis of the aorta) in a porcine model. Then the participants went on to the training stage with the rat model, performing standardized visceral and vascular operations (gastrotomy, anastomosis of the large and small intestines, and anastomosis of the aorta) four times in four rats. The final evaluation stage was again identical to the initial stage. The operative times, the number of complications, and the performance quality of the participants were compared between the two evaluation stages to assess the impact of the training stage on the results. RESULTS: The operative times in the final evaluation stage were considerably shorter than in the initial evaluation stage and, except for cholecystectomies, all the differences reached statistical significance. Also, significantly fewer complications and improved quality for each operation in the final evaluation stage were documented, as compared with their counterparts in the initial evaluation stage. These improvements were recorded at each level of experience. CONCLUSIONS: The presented experimental small and large animal model is a standardized and reproducible training method for robotic surgery that allows evaluation of the surgical performance while shortening and optimizing the learning-curve.

Animals↗
PubMed2005

A scoring system for the strength of a family history of colorectal cancer.

BACKGROUND: Family history of colorectal cancer is associated with an increased risk for the disease, although there are many combinations of family history that are hard to correlate with risk status. A scoring system for family history of colorectal cancer was designed to make risk more readily quantifiable. METHODS: A colonoscopy database was used to test the following points system: each first-degree relative with colorectal cancer = 3 points; each second-degree relative with colorectal cancer = 1 point. Families with one or more first-degree relative affected under 50 years of age = an extra 3 points. Families with one or more second-degree relative affected under 50 years of age = an extra 1 point. Families with multiple relatives on the same side of the family = an extra 3 points (first-degree relatives), 1 point (second-degree relatives), or 2 points (first-degree and second-degree relatives). Points were added and categories defined as follows: low risk, 1 to 4 points; medium risk, 5 to 7 points; high risk, 8 to 10 points; very high risk, >10 points. A control group of average-risk patients having screening colonoscopy was used. Categories were compared in number of adenomas, hyperplastic polyps, and cancers. RESULTS: The records of 992 patients were used to test the system. Mean adenomas per patient per group were 0.4 for controls, 1.0 for low risk, 1.0 for medium risk, 1.7 for high risk, and 1.7 for very high risk. Cancers per group were 2 of 196 for controls, 8 of 513 for low risk, 3 of 171 for medium risk, 3 of 84 for high risk, and 1 of 28 for very high risk. The score categories were combined to produce revised risk levels of low (score 1 to 7) and high (>7). Average adenomas per patient in the revised categories were 0.4 (control), 1.0 (low risk), and 1.7 (high risk). The odds ratio of having one to two adenomas was 1.73 (1.19-2.50, 95% confidence limits) in the low-risk group and 2.39 (1.41-4.01) in the high-risk group. Odds ratios for having three or more adenomas were 5.70 (2.44-13.32) in the low-risk group and 10.35 (3.97-26.97) in the high-risk group. CONCLUSION: In the two-category system proposed here of quantifying familial risk of colorectal cancer, patients having less than 8 points were at low risk and those with 8 or more were at high risk. Surveillance and chemoprevention protocols can be designed through use of these risk categories. A scoring system for family history of colorectal cancer can make risk assessment easier and facilitate both collaborative studies and patient triage into appropriate screening programs.

Adenoma↗
PubMed2005

[Health campaign for atherosclerosis prevention].

The goal of the campaign "plus leben", a project designed to run for at least 5 years, is to heighten the awareness of patients at risk of heart disease and to provide them with an appropriate prevention program. During the first two years of the campaign 20,000 visitors were registered on the homepage, 400,000 tests for risk of heart disease were distributed, and more than 3,000 health information brochures were requested. Thus, a survey of patients was designed to provide information on the extent to which preventive measures are effective. The survey, which was carried out by mail, had a response rate of 28%, or 230 participants. In the random sample, consisting of about 60% men and 40% women, only 16% are younger than 50 years of age. Thus the survey provides a representative picture of the affected target group. The test for risk of cardiac disease provided by "plus leben" led to an increase in awareness of preventive measures in more than two thirds of the respondents, and 60% also completed the test. Although only a fourth of the patients are regularly informed by their physician about preventive measures, the campaign has led about 90% of the respondents to make fundamental or at least partial changes in their lifestyle. In connection with the study it was shown that the media play an important role in providing information on preventive measures. Communication in the doctor's office as an important building block in raising consciousness about atherosclerosis prevention could be further improved.

Adult↗
PubMed2007

Human immunodeficiency virus (HIV) and substance use risk behaviors among tri-ethnic adolescents of Florida.

Previous research documents the co-occurrence of substance use and HIV risk behaviors, but most studies examined these behaviors among adults and White adolescents. The diversity of Florida's adolescents presents a unique setting for examining the variations in these risk behaviors. An in-depth analysis of HIV and substance use behaviors among White, African American, and Hispanic adolescents in Florida was conducted. Results suggest that significant ethnic variations exist in lifetime alcohol and illicit drug use and HIV risk. Compared with Hispanics, African Americans were less likely and Whites were more likely to be frequent alcohol and illicit drug users. White and African American adolescents were 1.3 and 1.5 times, respectively, at higher risk of at least one HIV risk behavior compared with their Hispanic counterparts. Future research should seek to identify sources and consequences of such variations in risk behavior and design culturally appropriate prevention programs for adolescents.

Adolescent↗
PubMed1987

Quality of life and its impact on hypertensive patients.

Noncompliance of hypertensive patients with their therapy is a frequent problem. Although the basis of this noncompliance is multifactorial, it is largely related to deterioration in a patient's quality of life produced by the commonly prescribed antihypertensive agents. Quality of life is a collective term that encompasses multiple components of a person's social and mental status. Simply stated, it is the ability of a person to function normally in society, as perceived by the person. There is increasing evidence that social and behavioral science techniques can be used to quantify the effects of antihypertensive agents on a patient's quality of life. Thus, in determining the most appropriate antihypertensive program for an individual patient, physicians will now be able to add impact of the agent on quality of life as a dimension in addition to the more common triad of efficacy, cost, and serious side effects.

Antihypertensive Agents↗
PubMed1986

Free flap monitoring using a microcomputer linked to a laser Doppler flowmeter.

The problems of free flap monitoring using the Periflux PF108D laser Doppler flowmeter (PLDF) are discussed, as are the indices of flap perfusion that the laser Doppler flowmeter can provide. The use of a microcomputer linked to a laser Doppler flowmeter by a suitable interface and using an appropriate monitoring program is described together with details of the system and program. It is suggested that linkage with a microcomputer offers a relatively simple, low cost method of improving the ease and reliability of free flap monitoring with the laser Doppler flowmeter.

Forearm↗
PubMed1992

Development of a knowledge base for diagnostic reasoning in cardiology.

This paper reports on a formative evaluation of the diagnostic capabilities of the Heart Failure Program, which uses a probability network and a heuristic hypothesis generator. Using 242 cardiac cases collected from discharge summaries at a tertiary care hospital, we compared the diagnoses of the program to diagnoses collected from cardiologists using the same information as was available to the program. With some adjustments to the knowledge base, the Heart Failure Program produces appropriate diagnoses about 90% of the time on this training set. The main reasons for the inappropriate diagnoses of the remaining 10% include inadequate reasoning with temporal relations between cause and effect, severity relations, and independence of acute and chronic diseases.

Artificial Intelligence↗
PubMed1985

The therapeutic applications of computerised games.

Microcomputers have great potential in therapeutic environments, but, if they are to achieve this potential, they need appropriate software (programs). This paper examines the ideas behind games software and the relevance of commercially available software to therapy. It recommends that specially designed programs are needed and lays down some guidelines for the design and development of such software.

Computers↗
PubMed1989

A needs assessment study of traditional birth attendants in rural Kenya.

For several reasons traditional birth attendants (TBAs) still deliver the majority of women in many developing areas of the world. A needs assessment study of TBAs serving one area of Kenya was conducted for the purpose of designing an appropriate intervention program. Thirty-six TBAs were interviewed. Together, they had attended to a total of 116 deliveries within 1 month. The local hospital was conducting an average of 37 deliveries per month. Although most TBAs were good at abdominal palpation, they did not conduct routine prenatal checks and rarely referred their clients to hospital. Several risky practices were identified from which a training program has been designed. The findings and their implications are discussed within the context of improved MCH/FP services.

Delivery, Obstetric↗
PubMed1983

Outpatient regulation of the insulin-requiring person with diabetes (an alternative to hospitalization).

One hundred and six insulin-requiring diabetic patients were randomly recruited to a pilot out-patient diabetes regulation and self-care program. The program was designed to offer an alternative to hospitalization. 89 patients completed the 5-day program. Fasting plasma glucose values at 5 days were significantly lower than initial levels (263 +/- 73 mg/dl vs 156 +/- 60 mg/dl; p-value less than 0.001). Long-term diabetic control was similarly improved at 6 months after entry when total glycosylated hemoglobin levels were significantly lower than initial values (13.8 +/- 2.8% vs 11.1 +/- 2.4%; p-value less than 0.0005). 17 patients failed to complete the program. Only four patients of the 89 were subsequently hospitalized with diabetes-related conditions. 445 hospital days were saved during the study period with calculated total dollar savings over $90,000. It is suggested that a structured out-patient program for diabetes regulation and self-care can be successfully developed and carried out at a significantly lower cost than hospitalization. Third party payors should take cognizance of these programs and appropriately include them in their health care coverage.

Adult↗
PubMed1983

Lymphokine-stimulated macrophage phagocytosis of fluorescent microspheres: a rapid new assay.

A highly sensitive and rapid in vitro macrophage phagocytosis assay is described for screening of lymphokine preparations with macrophage activating properties. Non-induced mouse peritoneal macrophages were incubated on glass slides for 60 min in the presence of fluorescent 2 micron latex beads and partially purified lymphokine fractions or media control. Lymphokine samples were prepared from culture supernatants of the B lymphoblastoid cell line RPMI 1788 by high performance liquid chromatography of a soluble trichloroacetic acid extract of concentrated culture supernatant. Phagocytosis was measured by direct counts of the percent phagocytic cells and the number of intracellular beads per 100 cells as seen by fluorescence microscopy. Phagocytic uptake in the presence of as little as 0.1 ng of active lymphokine could readily be determined qualitatively by correlation plots and quantitatively by appropriate statistical programs for data processing by computer. This technique provides a rapid, reproducible, screening assay for biological activity of macrophage activating lymphokines and other compounds affecting macrophage phagocytosis.

Animals↗
PubMed1989

Force matching by patients with unilateral focal cerebral lesions.

The performance of patients with unilateral frontal-, temporal- or fronto-temporal excisions was examined on an isometric force-matching task involving the coordination of forces generated by flexing the fingers. Patients with excisions from the right fronto-temporal cortex were significantly slower with both hands when performing this task using either two or three fingers, whereas the other patient groups tested were not impaired. This deficit in force coordination may result from an impairment in monitoring proprioceptive feedback or an inefficiency in programming the appropriate amount of force output.

Adolescent↗
PubMed1982

Three-dimensional reconstruction of biological sections.

To observe internal detail in biological structures using light or electron microscopy, specimens need to be prepared from thin sections. Quantitative analysis of these section requires the transfer of complete section images, or selected features from them, into a computer. Where a complete structure is represented by a series of consecutive sections, images may be combined to represent the three dimensional structure. An interactive computer system is described which enables selected features of serial section images to be entered into the computer, edited, reconstructed in three-dimensions and displayed in any orientation. Sections can be analysed individually using appropriate, compatible programs, and an assessment of the complete structure obtained by interpolating between them. Categorisation of the different substructures within the sections allows them to be analysed and displayed separately.

Animals↗
PubMed1994

Implantable controlled delivery systems for proteins based on collagen--pHEMA hydrogels.

Co-polymeric hydrogels of collagen and poly(hydroxyethyl methacrylate) (pHEMA) were prepared using an ammonium persulphate-sodium metabisulphite redox initiation technique. Fluorescein isothiocyanate (FITC)-labelled bovine serum albumin (BSA) was entrapped into these hydrogels. These gels were modified differently by external cross-linking and made highly porous by incorporation of ethylene glycol. The morphological characteristics of the gels containing FITC-BSA before and after release were studied. The in vitro release of FITC-labelled BSA was studied in phosphate buffer, pH 7.4, at 37 degrees C. The results clearly indicated that collagen-pHEMA hydrogels release FITC-BSA in a zero-order fashion. In the case of uncross-linked hydrogels, the release of FITC-BSA was about 81% within 8 d, compared to 49% for the same period in the case of cross-linked hydrogels. It was also observed that in the case of porous hydrogels the release was very fast (19% in the first hour) and lasted for about 12 h, releasing 76% of FITC-BSA. These results clearly indicated that collagen-pHEMA hydrogels released BSA in a zero-order fashion and that the release rate can be programmed by appropriate modification of the hydrogel matrices.

Animals↗
PubMed1995

Characteristics of childhood sexual abuse in a predominantly Mexican-American population.

Little has been written about the characteristics of childhood sexual abuse among Mexican Americans. In addition, certain aspects of the epidemiology of reported sexual abuse in the United States have changed significantly over the past 12 years. To better understand how characteristics of sexual abuse vary with ethnicity, race, gender, and age, we reviewed the records of 2,130 children under age 18 who were evaluated at our university-based facilities for possible sexual abuse from 1987 to 1989. The demographic, historical, and physical findings of the cases from our predominantly Mexican-American population were analyzed. T-test, analysis of variance, and chi-square analyses were used to test for differences related to ethnicity, race, gender, and age. Significant differences in these factors were found with respect to the relationship of the perpetrator to the child, the number of perpetrators, the interval from the abuse to the evaluation, the types of abuse, and the findings of the physical examination. This study demonstrates the important influences of ethnicity, race, gender, and age on characteristics of childhood sexual abuse. Awareness of these influences can be helpful in understanding factors that contribute to childhood sexual abuse, preparing for legal proceedings, and designing appropriate prevention programs.

Adolescent↗