Consumer Participation in Identifying Research and Development Priorities for Power Wheelchair Input Devices and Controllers

A focus group comprised of persons who use power wheelchairs and professionals working in the field were asked to participate in a brainstorming session to determine priorities for the development and application of power mobility input devices and control concepts. The group consensus was that durability and reliability are the most important criteria. Essentially, the expectation is that a power wheelchair must work everyday in the way a person needs it and wants it. At the same time, there is a desire to enhance and advance the features of input devices and control systems. Many would say these changes constitute designing “smarter” power wheelchairs, such as systems that can independently detect obstacles and can provide users with more feedback. This paper presents the rationale behind forming this focus group and details of the results of a brainstorming session where ideas were generated and prioritized. The five most important issues as determined by the group are discussed in depth.     

An Algorithm for the Treatment of Pain in Advanced Cancer

An algorithm is presented that has been developed over the past three years to provide pain relief in advanced cancer. The hospital records of 92 patients were reviewed to evaluate the validity of the algorithm. The algorithm is as follows: the 24 hour oral consumption of opioids was converted to sustained release morphine. If ineffective usually over 360?mg daily the total 24 hour oral dose was divided by 6 to convert to I.V. If this was ineffective, usually over 10?mg/hr of morphine, the intravenous dose was divided by 10 and infused epidurally. Local anesthetic was added for plexus involvement. After four days, the patient was weaned from local anesthetic solution. If sharp pain or pain to movement persisted, 6% phenol in 1 to 2?ml aliquots was injected every 8-12 hours to a total of 5-8?ml. While the conversion from intravenous to epidural morphine was 10:1 that from epidural to intravenous was only 1:3. Intravenous dose converts directly to the subcutaneous. The conversion from intravenous to oral is 1:3. There view showed that the dosages at which the conversions were made varied considerably. The reasons for the wide variation are presented. In summary the algorithm is a good practical guide for treatment of cancer pain.     

β-thromboglobulin and fibrinopeptide a in diabetes mellitus as markers of vascular damage

Summary β-thromboglobulin (BTG) and fibrinopeptide A (FpA) were studied in 68 non-insulin dependent diabetic patients (NIDD) aged 32–81 with a mean duration of diabetes of 9±0.8 SEM years and 44 healthy controls, comparable for age and sex. Diabetic patients were subdivided into subsets according to the presence of microvascular disease, macrovascular disease or the absence of these lesions. Patients with microangiopathy (micro- and/or macrovascular disease) had higher HbA (p<0.01), higher blood pressure (p<0.05) than both healthy controls and uncomplicated diabetics. Plasma BTG was higher in diabetic patients than in healthy controls (p<0.02), and was higher in complicated than in non-complicated diabetic subjects. Fpa was higher in complicated than in non-complicated diabetes (p<0.05). No differences were observed between the two subsets of complicated patients. In conclusion, we have shown that increased plasma- and platelet-BTG levels are present in non-insulin dependent diabetic subjects, with normal renal function and that plasma BTG is higher in patients with than in those without vascular disease. Fibrinopeptide A, a sensitive marker ofin vivo fibrin formation, was significantly increased in NIDD with vascular complications. This study was supported by the Juvenile Diabetes Foundation Grant N. 184066 and by the National Research Council of Italy,Progetto Finalizzato di Medicina Preventiva e Riabilitativa, Sottoprogetto 4.     

American Society of Neuroradiology research survey 2001

RATIONALE AND OBJECTIVES: Research is a critical component of the mission of academic radiology, and success in research is necessary for the future of neuroradiology. Thus, the authors set out to establish a baseline of research activities of American Society of Neuroradiology (ASNR) members. MATERIALS AND METHODS: The authors surveyed 100 fellowship program directors. The survey was Web based, with recruitment from the ASNR Fellowship Database survey site and with e-mail and fax solicitations to the Web site. Questions focused on neuroradiologist and neuroradiology fellow involvement in research. RESULTS: Forty-eight of the 100 program directors (48%) responded. Several key findings emerged: (a) About one-third of fellowship programs require all fellows to do some research, with most fellows receiving less than 1 day per week of academic time; (b) just over half of the programs expect fellows to publish a paper; (c) about two-thirds of academic neuroradiologists get at least 1 academic day per week; (d) most academic neuroradiologists perform research, but most of this research is unfunded; and (e) about nine of 10 academic sections have at least one neuroradiologist with some extramural funding. CONCLUSION: The relative lack of extramural funding among academic neuroradiologists is a reality that is probably multifactorial; however, there may be a direct relationship between amount of academic time free from clinical duties and successful competition for funding. The time (and, thus, financial) support of research-oriented fellows and faculty should be increased.     

Abnormalities of the executive control network in multiple sclerosis phenotypes: An fMRI effective connectivity study

The Stroop interference task is a cognitively demanding task of executive control, a cognitive ability that is often impaired in patients with multiple sclerosis (MS). The aim of this study was to compare effective connectivity patterns within a network of brain regions involved in the Stroop task performance between MS patients with three disease clinical phenotypes [relapsing‐remitting (RRMS), benign (BMS), and secondary progressive (SPMS)] and healthy subjects. Effective connectivity analysis was performed on Stroop task data using a novel method based on causal Bayes networks. Compared with controls, MS phenotypes were slower at performing the task and had reduced performance accuracy during incongruent trials that required increased cognitive control. MS phenotypes also exhibited connectivity abnormalities reflected as weaker shared connections, presence of extra connections (i.e., connections absent in the HC connectivity pattern), connection reversal, and loss. In SPMS and the BMS groups but not in the RRMS group, extra connections were associated with deficits in the Stroop task performance. In the BMS group, the response time associated with correct responses during the congruent condition showed a positive correlation with the left posterior parietal → dorsal anterior cingulate connection. In the SPMS group, performance accuracy during the congruent condition showed a negative correlation with the right insula → left insula connection. No associations between extra connections and behavioral performance measures were observed in the RRMS group. These results suggest that, depending on the phenotype, patients with MS use different strategies when cognitive control demands are high and rely on different network connections. Hum Brain Mapp, 37:2293–2304, 2016. © 2016 Wiley Periodicals, Inc.     

Primary Nasal Tip Surgery: A Conservative Approach

Background

Rhinoplasty and rhinoseptoplasty are very important and complex surgical procedures because the nose plays a pivotal aesthetic role in the face and an important functional role in breathing. Mild bulbous, plunging, undefined tips are very common, and tip refining and repositioning often are required surgical procedures.

Methods

For 97 selected patients, the authors performed their personal technique consisting of a transcartilaginous approach, incomplete vertical interruption, and retrograde undermining of the lower lateral cartilages to improve tip projection and definition. The five aspects analyzed were nasal tip symmetry, nostril symmetry, tip projection, tip definition, and appearance of the nasal tip only. Each parameter was assessed using pre- and postoperative quantification according to a visual analog scale. Postoperative evaluation was performed during a mean follow-up period of 1?year.

Results

The results at 1?year showed high rates of improvement in tip definition (mean, 7.9?±?2.4) and nasal tip only evaluation (mean, 6.5?±?3.1). The patients reported an improvement in nasal tip symmetry (mean, 4.2?±?3.2), nostril symmetry (mean, 4.5?±?4.1), and tip projection (mean, 5.8?±?2.9).

Conclusions

This simple, safe, and effective technique is proposed for mild bulbous, plunging, undefined, and hypoprojected tips.     

Complete Pathologic Response after Combined Modality Treatment for Rectal Cancer and Long-Term Survival: A Meta-Analysis

Background

Complete pathologic response (CPR) after neoadjuvant chemoradiotherapy (combined modality treatment, CMT) for rectal cancer seems associated with improved survival compared to partial or no response (NPR). However, previous reports have been limited by small sample size and single-institution design.

Methods

A systematic literature review was conducted to detect studies comparing long-term results of patients with CPR and NPR after CMT for rectal cancer. Variables were pooled only if evaluated by 3 or more studies. Study end points included rates of CPR, local recurrence (LR), distant recurrence (DR), 5-year overall survival (OS), and disease-free survival (DFS).

Results

Twelve studies (1,913 patients) with rectal cancer treated with CMT were included. CPR was observed in 300 patients (15.6%). CPR and NPR patient groups were similar with respect to age, sex, tumor size, distance of tumor from the anus, and stage of disease before treatment. Median follow-up ranged from 23 to 46?months. CPR patients had lower rates of LR [0.7% vs. 2.6%; odds ratio (OR) 0.45, 95% confidence interval (CI) 0.22?C0.90, P?=?0.03], DR (5.3% vs. 24.1%; OR 0.15, 95% CI 0.07?C0.31, P?=?0.0001), and simultaneous LR?+?DR (0.7% vs. 4.8%; OR 0.32, 95% CI 0.13?C0.79, P?=?0.01). OS was 92.9% for CPR versus 73.4% for NPR (OR 3.6, 95% CI 1.84?C7.22, P?=?0.002), and DFS was 86.9% versus 63.9% (OR 3.53, 95% CI 1.62?C7.72, P?=?0.002).

Conclusions

CPR after CMT for rectal cancer is associated with improved local and distal control as well as better OS and DFS.     

Surgery after intracranial investigation with subdural electrodes in patients with drug-resistant focal epilepsy: outcome and complications

Video-EEG monitoring with intracranial subdural electrodes is a useful assessment tool for the localization of the epileptogenic zone in patients with drug-resistant focal epilepsy. We aimed at assessing the morbidity related to electrode implantation and the surgical outcome in patients who underwent epilepsy surgery after intracranial EEG monitoring. All patients (N?=?58) admitted to our Epilepsy Surgery Centre for drug-resistant focal epilepsy who underwent resective surgery after intracranial monitoring with subdural electrodes and were followed up for at least 2?years were included in the study. Their mean age was 30.4?years (range 8-60?years), 25 (43?%) were female, and 44 (76?%) had a preoperatively detected structural lesion. The mean duration of invasive recording was 2.3?days (range 1-14?days). Extraoperative ECoG allowed the identification of the epileptogenic focus in all cases. The temporal lobe was involved in 21 (36?%) patients, whereas extratemporal foci were identified in 24 (41?%) patients. Thirteen patients (23?%) had multilobar involvement. Functional brain mapping was performed in 15 (26?%) patients. Transient complications related to electrode implantation occurred in three patients. Among patients with evidence of lesion on preoperative MRI, lesionectomy alone was performed in 12 cases (27?%), while it was combined with tailored cortical resection in the remaining cases. Tailored cortical resection was also performed in patients without evidence of lesion on MRI. After resective surgery, transient neurological deficits occurred in five cases, while another patient experienced permanent lateral homonymous hemianopia. At the last follow-up observation, 34 (57?%) patients were seizure-free (Engel class I). This study suggests that invasive EEG recording with subdural electrodes may be useful and fairly safe for many candidates for epilepsy surgery.     

p16 Is upregulated in proliferative inflammatory atrophy of the prostate

BACKGROUND: Proliferative inflammatory atrophy (PIA) of the prostate is a common histological finding that has been postulated to be associated with prostate cancer. We examine PIA lesions for the expression of p16/CDKN2, a cyclin-dependent kinase inhibitor frequently altered in prostate cancer. METHODS: Within tissues from two independent patient populations ("Test Set" and "Validation Set") undergoing radical prostatectomy, PIA lesions were identified and subjected to immunohistochemical staining for p16. Atrophic epithelial cells and regional normal epithelium were scored for the extent of p16 staining. In the Test Set, staining was also performed for the proliferation marker Ki-67. Double label immunofluorescence was employed to co-localize staining for p16 and Ki-67. RESULTS: p16 expression was elevated in PIA in both data sets compared to normal epithelium (mean percent of cells staining positive in PIA = 11.1%-16.2%; mean percent of cells staining positive in normal = 0.6%-1.3%) (P = 0.0001). As expected from prior studies, the mean Ki-67 index was higher in PIA lesions (mean 8.2% staining positive) versus normal epithelium (mean 1.9% staining positive) (P = 0.0001), and the extent of staining for p16 correlated with Ki-67 (r = 0.7, P < 0.0001). However, co-localization immunofluorescent studies did not demonstrate staining for nuclear p16 and Ki-67 in the same cells. CONCLUSIONS: Increased p16 expression accompanies increased cell proliferation in PIA lesions of the prostate. Yet, on the individual cell level, the upregulation of p16 in PIA lesions appears to represent a non-proliferative stress response, possibly to oxidative damage.