text:
Integrated system for planning peripheral bronchoscopic procedures
NASA Astrophysics Data System (ADS)
Gibbs, Jason D.; Graham, Michael W.; Yu, Kun-Chang; Higgins, William E.
Bronchoscopy is often performed for diagnosing lung cancer. The recent development of multidetector CT (MDCT) scanners and ultrathin bronchoscopes now enable the bronchoscopic biopsy and treatment of peripheral regions of interest (ROIs). Because the peripheral ROIs are often located several generations within the airway tree, careful planning is required prior to a procedure. The current practice for planning peripheral bronchoscopic procedures, however, is difficult, error-prone, and time-consuming. We propose a system for planning peripheral bronchoscopic procedures using patient-specific MDCT chest scans. The planning process begins with a semi-automatic segmentation of ROIs. The remaining system components are completely automatic, beginning with a new strategy for tracheobronchial airway-tree segmentation. The system then uses a new locally-adaptive approach for finding the interior airway-wall surfaces. From the polygonal airway-tree surfaces, a centerline-analysis method extracts the central axes of the airway tree. The system's route-planning component then analyzes the data generated in the previous stages to determine an appropriate path through the airway tree to the ROI. Finally, an automated report generator gives quantitative data about the route and both static and dynamic previews of the procedure. These previews consist of virtual bronchoscopic endoluminal renderings at bifurcations encountered along the route and renderings of the airway tree and ROI at the suggested biopsy location. The system is currently in use for a human lung-cancer patient pilot study involving the planning and subsequent live image-based guidance of suspect peripheral cancer nodules.
3D MDCT-Based System for Planning Peripheral Bronchoscopic Procedures
Gibbs, Jason D.; Graham, Michael W.; Higgins, William E.
The diagnosis and staging of lung cancer often begins with the assessment of a suspect peripheral chest site. Such suspicious peripheral sites may be solitary pulmonary nodules or other abnormally appearing regions of interest (ROIs). The state-of-the-art process for assessing such peripheral ROIs involves off-line procedure planning using a three-dimensional (3D) multidetector computed tomography (MDCT) chest scan followed by bronchoscopy with an ultrathin bronchoscope. We present an integrated computer-based system for planning peripheral bronchoscopic procedures. The system takes a 3D MDCT chest image as input and performs nearly all operations automatically. The only interaction required by the physician is the selection of ROI locations. The system is computationally efficient and fits smoothly within the clinical work flow. Integrated into the system and described in detail in the paper is a new surface-definition method, which is vital for effective analysis and planning to peripheral sites. Results demonstrate the efficacy of the system and its usage for the live guidance of ultrathin bronchoscopy to the periphery. PMID:19217089
Planning and visualization methods for effective bronchoscopic target localization
NASA Astrophysics Data System (ADS)
Gibbs, Jason D.; Taeprasarsit, Pinyo; Higgins, William E.
Bronchoscopic biopsy of lymph nodes is an important step in staging lung cancer. Lymph nodes, however, lie behind the airway walls and are near large vascular structures - all of these structures are hidden from the bronchoscope's field of view. Previously, we had presented a computer-based virtual bronchoscopic navigation system that provides reliable guidance for bronchoscopic sampling. While this system offers a major improvement over standard practice, bronchoscopists told us that target localization- lining up the bronchoscope before deploying a needle into the target - can still be challenging. We therefore address target localization in two distinct ways: (1) automatic computation of an optimal diagnostic sampling pose for safe, effective biopsies, and (2) a novel visualization of the target and surrounding major vasculature. The planning determines the final pose for the bronchoscope such that the needle, when extended from the tip, maximizes the tissue extracted. This automatically calculated local pose orientation is conveyed in endoluminal renderings by a 3D arrow. Additional visual cues convey obstacle locations and target depths-of-sample from arbitrary instantaneous viewing orientations. With the system, a physician can freely navigate in the virtual bronchoscopic world perceiving the depth-of-sample and possible obstacle locations at any endoluminal pose, not just one pre-determined optimal pose. We validated the system using mediastinal lymph nodes in eleven patients. The system successfully planned for 20 separate targets in human MDCT scans. In particular, given the patient and bronchoscope constraints, our method found that safe, effective biopsies were feasible in 16 of the 20 targets; the four remaining targets required more aggressive safety margins than a "typical" target. In all cases, planning computation took only a few seconds, while the visualizations updated in real time during bronchoscopic navigation.
The Effects of Bronchoscope Diameter on the Diagnostic Yield of Transbronchial Lung Biopsy of Peripheral Pulmonary Nodules
Lee, Nakwon; Kim, Sang-Ha; Kwon, Woocheol; Lee, Myoung Kyu; Yong, Suk Joong; Shin, Kye Chul; Jung, Ye-Ryung; Choi, Yeun Seoung; Choi, Jiwon; Choi, Ji Sun
Background Transbronchial lung biopsy (TBLB) is a valuable diagnostic tool for peripheral pulmonary lesions. The diagnostic yield of TBLB reportedly ranges from 41%-60%. Many studies demonstrated the various factors that influence the yield of TBLB, including size, location, and distance from the carina or pleura. However, no study has evaluated the effects of the bronchoscope diameter. We evaluated whether the bronchoscope diameter affected the diagnostic yield of TBLB. Methods We reviewed records from 178 patients who underwent TBLB using bronchoscopes of two different diameters (5.7 mm, thick outer diameter, Olympus BF-200; 4.9 mm, thin, BF-260). The fluoroscopic guidance rates, yield of TBLB and flexible bronchoscopy (FB) were compared between the two groups. Additionally, we compared the results of the procedures with respect to diagnosis, distance from the pleura, and size of the lesion. Results The results of fluoroscopic guidance, TBLB, and FB yield using thin diameter bronchoscope were significantly better than those obtained with a thick diameter bronchoscope (p=0.021, p=0.036, and p=0.010, respectively). Particularly, when the distance from the pleura was ≤ 10 mm, success rates for fluoroscopic guidance and FB with thin bronchoscope were higher (p=0.013 and p=0.033, respectively), as compared to with thick bronchoscope. Conclusion A thinner diameter bronchoscope increased the yield of bronchoscopy, and bronchial washing in conjunction with TBLB was useful in the diagnosis of peripheral pulmonary nodules. PMID:25580141
Comparison of diagnostic performances among bronchoscopic sampling techniques in the diagnosis of peripheral pulmonary lesions
Kanoksil, Wasana; Laungdamerongchai, Sarangrat
Background There are many sampling techniques dedicated to radial endobronchial ultrasound (R-EBUS) guided flexible bronchoscopy (FB). However, data regarding the diagnostic performances among bronchoscopic sampling techniques is limited. This study was conducted to compare the diagnostic yields among bronchoscopic sampling techniques in the diagnosis of peripheral pulmonary lesions (PPLs). Methods A prospective study was conducted on 112 patients who were diagnosed with PPLs and underwent R-EBUS-guided FB between Oct 2012 and Sep 2014. Sampling techniques—including transbronchial biopsy (TBB), brushing cell block, brushing smear, rinsed fluid of brushing, and bronchoalveolar lavage (BAL)—were evaluated for the diagnosis. Results The mean diameter of the PPLs was 23.5±9.5 mm. The final diagnoses included 76 malignancies and 36 benign lesions. The overall diagnostic yield of R-EBUS-guided bronchoscopy was 80.4%; TBB gave the highest yield among the 112 specimens: 70.5%, 34.8%, 62.5%, 50.0% and 42.0% for TBB, brushing cell block, brushing smear, rinsed brushing fluid, and BAL fluid (BALF), respectively (P<0.001). TBB provided high diagnostic yield irrespective of the size and etiology of the PPLs. The combination of TBB and brushing smear achieved the maximum diagnostic yield. Of 31 infectious PPLs, BALF culture gave additional microbiological information in 20 cases. Conclusions TBB provided the highest diagnostic yield; however, to achieve the highest diagnostic performance, TBB, brushing smear and BAL techniques should be performed together. PMID:25973236
Multimodal 3D PET/CT system for bronchoscopic procedure planning
NASA Astrophysics Data System (ADS)
Cheirsilp, Ronnarit; Higgins, William E.
Integrated positron emission tomography (PET) / computed-tomography (CT) scanners give 3D multimodal data sets of the chest. Such data sets offer the potential for more complete and specific identification of suspect lesions and lymph nodes for lung-cancer assessment. This in turn enables better planning of staging bronchoscopies. The richness of the data, however, makes the visualization and planning process difficult. We present an integrated multimodal 3D PET/CT system that enables efficient region identification and bronchoscopic procedure planning. The system first invokes a series of automated 3D image-processing methods that construct a 3D chest model. Next, the user interacts with a set of interactive multimodal graphical tools that facilitate procedure planning for specific regions of interest (ROIs): 1) an interactive region candidate list that enables efficient ROI viewing in all tools; 2) a virtual PET-CT bronchoscopy rendering with SUV quantitative visualization to give a "fly through" endoluminal view of prospective ROIs; 3) transverse, sagittal, coronal multi-planar reformatted (MPR) views of the raw CT, PET, and fused CT-PET data; and 4) interactive multimodal volume/surface rendering to give a 3D perspective of the anatomy and candidate ROIs. In addition the ROI selection process is driven by a semi-automatic multimodal method for region identification. In this way, the system provides both global and local information to facilitate more specific ROI identification and procedure planning. We present results to illustrate the system's function and performance.
Novel bronchoscopic strategies for the diagnosis of peripheral lung lesions: present techniques and future directions.
Gilbert, Christopher; Akulian, Jason; Ortiz, Ricardo; Lee, Hans; Yarmus, Lonny
The diagnosis of the peripheral lung lesion has been a long-standing clinical challenge--balancing accuracy with patient safety. With recent data revealing mortality benefits with lung cancer screening via low-dose computed tomography, now more than ever, clinicians will be challenged with the task of providing the means to provide a safe and minimally invasive method of obtaining accurate tissue diagnostics for the pulmonary nodule. In this review, we present available technologies to aid clinicians in attempts at minimally invasive techniques and the data supporting their use. In addition, we review novel tools under investigation that may further increase yield and provide additional benefit in obtaining an early diagnosis of lung cancer. PMID:24797257
... a laboratory exam to check a piece of tissue or fluid from the lungs for infection-causing germs. ... Culture - bronchoscopic ... used to get a sample ( biopsy ) of lung tissue or fluid. The sample ... a special dish (culture). It is then watched to see if bacteria ...
[Bronchoscopic treatments for COPD].
Mineshita, Masamichi; Inoue, Takeo; Miyazawa, Teruomi
Several non-surgical and minimally invasive bronchoscopic interventions, such as bronchoscopic lung volume reduction (BLVR) techniques, have been developed to treat patients with severe chronic obstructive pulmonary disease (COPD). BLVR has been studied for treatment in severe COPD patients with emphysema. BLVR with one-way endobronchial valves is reported to be effective for patients with a heterogeneous emphysema distribution and without inter-lobar collateral ventilation. For the patients with collateral ventilation, and for the patients with homogeneous emphysema, BLVR with lung volume reduction coil has shown promising results. Targeted lung denervation(TLD) is a novel bronchoscopic intervention based on ablation of parasympathetic nerves surrounding the main bronchi. TLD seems to be effective for COPD with chronic bronchitis phenotype. This review gives a general overview of BLVR with one-way valve and lung volume reduction coil, and TLD. PMID:27254951
Assessing idiopathic pulmonary fibrosis (IPF) with bronchoscopic OCT (Conference Presentation)
NASA Astrophysics Data System (ADS)
Hariri, Lida P.; Adams, David C.; Colby, Thomas V.; Tager, Andrew M.; Suter, Melissa J.
Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal form of fibrotic lung disease, with a 3 year survival rate of 50%. Diagnostic certainty of IPF is essential to determine the most effective therapy for patients, but often requires surgery to resect lung tissue and look for microscopic honeycombing not seen on chest computed tomography (CT). Unfortunately, surgical lung resection has high risks of associated morbidity and mortality in this patient population. We aim to determine whether bronchoscopic optical coherence tomography (OCT) can serve as a novel, low-risk paradigm for in vivo IPF diagnosis without surgery or tissue removal. OCT provides rapid 3D visualization of large tissue volumes with microscopic resolutions well beyond the capabilities of CT. We have designed bronchoscopic OCT catheters to effectively and safely access the peripheral lung, and conducted in vivo peripheral lung imaging in patients, including those with pulmonary fibrosis. We utilized these OCT catheters to perform bronchoscopic imaging in lung tissue from patients with pulmonary fibrosis to determine if bronchoscopic OCT could successfully visualize features of IPF through the peripheral airways. OCT was able to visualize characteristic features of IPF through the airway, including microscopic honeycombing (< 1 mm diameter) not visible by CT, dense peripheral fibrosis, and spatial disease heterogeneity. These findings support the potential of bronchoscopic OCT as a minimally-invasive method for in vivo IPF diagnosis. However, future clinical studies are needed to validate these findings.
[Bronchoscopic treatment of emphysema].
Fruchter, Oren; Kramer, Mordechai R
Bronchoscopic techniques for the management of emphysema have evolved from the success of surgical treatment. Lung volume reduction surgery (LVRS) involves the removal of 20% to 30% of each lung and targets the most emphysematous segments. Patients with heterogeneous upper lobe emphysema and a low baseline exercise capacity have been identified as a subgroup within COPD in whom mortality benefits can even be achieved, along with improvements in exercise capacity and quality of life. Increased short-term mortality of approximately 5% and postoperative morbidity are the main limitations of LVRS. The extremely restrictive selection criteria for LVRS coupled with the relatively high mortality/morbidity have been the impetus for developing less invasive endoscopic modalities. Bronchoscopic lung volume reduction (BLVR) researchers have pursued various approaches using a range of modalities, such as blockers, stents, valves, sealants, and implants. BLVR appears to be safer than LVRS in terms of mortality and morbidity. This safety profile presents an attractive alternative for patients with COPD who are fragile physiologically because of the severity of their lung disease and the presence of co-morbid illnesses. The current report aims to describe the various minimally invasive modalities available for the treatment of emphysema. PMID:22616152
Endobronchial Ultrasound Bronchoscope Damage.
Patil, Monali; Harris, Kassem; Krishnan, Amita; Alraiyes, Abdul H; Dhillon, Samjot S
Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration is an effective, safe, and cost-effective diagnostic bronchoscopy technique for the work-up of mediastinal lymphadenopathy. Concern has been raised, however, about the high cost of convex-probe EBUS bronchoscope repairs. The damage is usually due to breakage of the insertion tube (the flexible part that is advanced into the airways), moisture invasion and damages to the working channel, image guide bundle, or umbilical cord. Understanding the root cause of EBUS scope damage is important for its prevention. We describe 2 unusual cases of EBUS scope damage. In the first case, the distal black rubber covering of the EBUS scope insertion tube was damaged due to friction with the edge of an endotracheal tube and in the second case, the EBUS scope insertion tube was angulating laterally instead of vertically during the flexion maneuver, probably due to scope manipulation while wedged tightly in a segmental bronchus. PMID:27077640
Assessing idiopathic pulmonary fibrosis (IPF) with bronchoscopic OCT (Conference Presentation)
NASA Astrophysics Data System (ADS)
Hariri, Lida P.; Adams, David C.; Colby, Thomas V.; Tager, Andrew M.; Suter, Melissa J.
Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal form of fibrotic lung disease, with a significantly worse prognosis than other forms of pulmonary fibrosis (3-year survival rate of 50%). Distinguishing IPF from other fibrotic diseases is essential to patient care because it stratifies prognosis and therapeutic decision-making. However, making the diagnosis often requires invasive, high-risk surgical procedures to look for microscopic features not seen on chest CT, such as characteristic cystic honeycombing in the peripheral lung. Optical coherence tomography (OCT) provides rapid 3D visualization of large tissue volumes with microscopic resolutions well beyond the capabilities of CT. We aim to determine whether bronchoscopic OCT can provide a low-risk, non-surgical method for IPF diagnosis. We have developed bronchoscopic OCT catheters that access the peripheral lung and conducted in vivo peripheral lung imaging in patients, including those with pulmonary fibrosis. We also conducted bronchoscopic OCT in ex vivo lung from pulmonary fibrosis patients, including IPF, to determine if OCT could successfully visualize features of IPF through the peripheral airways. Our results demonstrate that OCT is able to visualize characteristic features of IPF through the airway, including microscopic honeycombing (< 1 mm diameter) not visible by CT, dense peripheral fibrosis, and spatial disease heterogeneity. We also found that OCT has potential to distinguish mimickers of IPF honeycombing, such as traction bronchiectasis and emphysema, from true honeycombing. These findings support the potential of bronchoscopic OCT as a minimally-invasive method for in vivo IPF diagnosis. However, future clinical studies are needed to validate these findings.
Bronchoscopy guidance system based on bronchoscope-motion measurements
NASA Astrophysics Data System (ADS)
Cornish, Duane C.; Higgins, William E.
Bronchoscopy-guidance systems assist physicians during bronchoscope navigation. However, these systems require an attending technician and fail to continuously track the bronchoscope. We propose a real-time technicianfree bronchoscopy-guidance system that employs continuous tracking. For guidance, our system presents directions on virtual views that are generated from the bronchoscope's tracked location. The system achieves bronchoscope tracking using a strategy that is based on a recently proposed method for sensor-based bronchoscope-motion tracking.1 Furthermore, a graphical indicator notifies the physician when he/she has maneuvered the bronchoscope to an incorrect branch. Our proposed system uses the sensor data to generate virtual views through multiple candidate routes and employs image matching in a Bayesian framework to determine the most probable bronchoscope pose. Tests based on laboratory phantoms validate the potential of the system.
Therapeutic bronchoscopic interventions for malignant airway obstruction
Dalar, Levent; Özdemir, Cengiz; Abul, Yasin; Karasulu, Levent; Sökücü, Sinem Nedime; Akbaş, Ayşegül; Altın, Sedat
Abstract There is no definitive consensus about the factors affecting the choice of interventional bronchoscopy in the management of malignant airway obstruction. The present study defines the choice of the interventional bronchoscopic modality and analyzes the factors influencing survival in patients with malignant central airway obstruction. Totally, over 7 years, 802 interventional rigid bronchoscopic procedures were applied in 547 patients having malignant airway obstruction. There was a significant association between the type of stent and the site of the lesion in the present study. Patients with tracheal involvement and/or involvement of the main bronchi had the worst prognosis. The sites of the lesion and endobronchial treatment modality were independent predictors of survival in the present study. The selection of different types of airway stents can be considered on the base of site of the lesion. Survival can be estimated based on the site of the lesion and endobronchial brochoscopic modality used. PMID:27281104
Bronchoscopic lung volume reduction in severe emphysema.
Ingenito, Edward P; Wood, Douglas E; Utz, James P
Lung volume reduction surgery (LVRS) produces physiological, symptomatic, and survival benefits in selected patients with advanced emphysema. Because it is associated with significant morbidity, mortality, and cost, nonsurgical alternatives for achieving volume reduction have been developed. Three bronchoscopic lung volume reduction (BLVR) approaches have shown promise and reached later-stage clinical trials. These include the following: (1) placement of endobronchial one-way valves designed to promote atelectasis by blocking inspiratory flow; (2) formation of airway bypass tracts using a radiofrequency catheter designed to facilitate emptying of damaged lung regions with long expiratory times; and (3) instillation of biological adhesives designed to collapse and remodel hyperinflated lung. The limited clinical data currently available suggest that all three techniques are reasonably safe. However, efficacy signals have been substantially smaller and less durable than those observed after LVRS. Studies to optimize patient selection, refine treatment strategies, characterize procedural safety, elucidate mechanisms of action, and characterize short- and longer-term effectiveness of these approaches are ongoing. Results will be available over the next few years and will determine whether BLVR represents a safe and effective alternative to LVRS. PMID:18453355
A bronchoscopic navigation system using bronchoscope center calibration for accurate registration of electromagnetic tracker and CT volume without markers
Luo, Xiongbiao
Purpose: Various bronchoscopic navigation systems are developed for diagnosis, staging, and treatment of lung and bronchus cancers. To construct electromagnetically navigated bronchoscopy systems, registration of preoperative images and an electromagnetic tracker must be performed. This paper proposes a new marker-free registration method, which uses the centerlines of the bronchial tree and the center of a bronchoscope tip where an electromagnetic sensor is attached, to align preoperative images and electromagnetic tracker systems. Methods: The chest computed tomography (CT) volume (preoperative images) was segmented to extract the bronchial centerlines. An electromagnetic sensor was fixed at the bronchoscope tip surface. A model was designed and printed using a 3D printer to calibrate the relationship between the fixed sensor and the bronchoscope tip center. For each sensor measurement that includes sensor position and orientation information, its corresponding bronchoscope tip center position was calculated. By minimizing the distance between each bronchoscope tip center position and the bronchial centerlines, the spatial alignment of the electromagnetic tracker system and the CT volume was determined. After obtaining the spatial alignment, an electromagnetic navigation bronchoscopy system was established to real-timely track or locate a bronchoscope inside the bronchial tree during bronchoscopic examinations. Results: The electromagnetic navigation bronchoscopy system was validated on a dynamic bronchial phantom that can simulate respiratory motion with a breath rate range of 0–10 min{sup −1}. The fiducial and target registration errors of this navigation system were evaluated. The average fiducial registration error was reduced from 8.7 to 6.6 mm. The average target registration error, which indicates all tracked or navigated bronchoscope position accuracy, was much reduced from 6.8 to 4.5 mm compared to previous registration methods. Conclusions: An
Advanced bronchoscopy for the diagnosis of peripheral pulmonary lesions.
Asano, Fumihiro
Bronchoscopy to examine peripheral pulmonary lesions is performed using a bronchoscope with an outer diameter of 5-6mm under fluoroscopy, but the diagnostic yield can be insufficient. Problems with transbronchial biopsy include a limited range of bronchoscope insertion, difficulty in guiding a bronchoscope and biopsy instruments to lesions, and insufficient confirmation of the arrival of biopsy instruments at the target lesion; as such, new techniques have been used to overcome these individual problems. Radial-endobronchial ultrasound is used to identify peripheral pulmonary lesions and sampling sites. In a meta-analysis, the diagnostic yield, that of lesions smaller than 2cm, and complication rate were 73, 56.3, and 1.0%, respectively. Virtual bronchoscopic navigation is a method to guide a bronchoscope to peripheral lesions under direct vision using virtual bronchoscopic images of the bronchial route, and the diagnostic yield, that of 2-cm or smaller lesions, and complication rate were 73.8, 67.4, and 1.0%, respectively. Electromagnetic navigation utilizes electromagnetism; the diagnostic yield was 64.9-71%, and the pneumothorax complication rate was 4% for this modality. Ultrathin bronchoscopes can be advanced to the peripheral bronchus under direct vision in contrast to normal-size bronchoscopes, and the diagnostic yield and pneumothorax complication rates were reported to be 63 and 1.5%, respectively. The overall diagnostic yield of these new techniques on meta-analysis was 70%, a higher yield than that obtained with conventional transbronchial biopsy. Each technique has advantages and disadvantages, and the investigation of appropriate combinations corresponding to individual cases is necessary. PMID:27424820
[Removal of bronchial foreign bodies by suction with a bronchoscope].
Mita, Y; Dobashi, K; Saitoh, R; Tsuchiya, S; Nakano, H; Watanabe, S; Makimoto, T; Ishihara, S; Mori, M
We report two cases in which intrabronchial foreign bodies were removed with a fiberoptic bronchoscope. In both cases the foreign body was a seed of a small Japanese apricot. Atelectasis or obstructive pneumonia was seen on chest roentgenograms. The foreign bodies were associated with slight inflammation and polyps on the bronchial epithelium. The foreign bodies were removed by applying suction with a fiberoptic bronchoscope. This method may also be useful for removing other large, hard, uneven, and ball-like foreign bodies. PMID:9212671
Can Bronchoscopic Airway Anatomy Be an Indicator of Autism?
ERIC Educational Resources Information Center
Stewart, Barbara A.; Klar, Amar J. S.
Bronchoscopic evaluations revealed that some children have double branching of bronchi (designated "doublets") in the lower lungs airways, rather than normal, single branching. Retrospective analyses revealed only one commonality in them: all subjects with doublets also had autism or autism spectrum disorder (ASD). That is, 49 subjects exhibited…
Impact of spot size on plan quality of spot scanning proton radiosurgery for peripheral brain lesions
Wang, Dongxu Dirksen, Blake; Hyer, Daniel E.; Buatti, John M.; Sheybani, Arshin; Dinges, Eric; Felderman, Nicole; TenNapel, Mindi; Bayouth, John E.; Flynn, Ryan T.
Purpose: To determine the plan quality of proton spot scanning (SS) radiosurgery as a function of spot size (in-air sigma) in comparison to x-ray radiosurgery for treating peripheral brain lesions. Methods: Single-field optimized (SFO) proton SS plans with sigma ranging from 1 to 8 mm, cone-based x-ray radiosurgery (Cone), and x-ray volumetric modulated arc therapy (VMAT) plans were generated for 11 patients. Plans were evaluated using secondary cancer risk and brain necrosis normal tissue complication probability (NTCP). Results: For all patients, secondary cancer is a negligible risk compared to brain necrosis NTCP. Secondary cancer risk was lower in proton SS plans than in photon plans regardless of spot size (p = 0.001). Brain necrosis NTCP increased monotonically from an average of 2.34/100 (range 0.42/100–4.49/100) to 6.05/100 (range 1.38/100–11.6/100) as sigma increased from 1 to 8 mm, compared to the average of 6.01/100 (range 0.82/100–11.5/100) for Cone and 5.22/100 (range 1.37/100–8.00/100) for VMAT. An in-air sigma less than 4.3 mm was required for proton SS plans to reduce NTCP over photon techniques for the cohort of patients studied with statistical significance (p = 0.0186). Proton SS plans with in-air sigma larger than 7.1 mm had significantly greater brain necrosis NTCP than photon techniques (p = 0.0322). Conclusions: For treating peripheral brain lesions—where proton therapy would be expected to have the greatest depth-dose advantage over photon therapy—the lateral penumbra strongly impacts the SS plan quality relative to photon techniques: proton beamlet sigma at patient surface must be small (<7.1 mm for three-beam single-field optimized SS plans) in order to achieve comparable or smaller brain necrosis NTCP relative to photon radiosurgery techniques. Achieving such small in-air sigma values at low energy (<70 MeV) is a major technological challenge in commercially available proton therapy systems.
Exogenous lipoid pneumonia successfully treated with bronchoscopic segmental lavage therapy.
Nakashima, Shota; Ishimatsu, Yuji; Hara, Shintaro; Kitaichi, Masanori; Kohno, Shigeru
A 65-y-old Japanese man was referred to the respiratory medicine department because of abnormal radiologic findings. High-resolution chest computed tomography scans revealed a geographic distribution of ground-glass opacities and associated thickening of the interlobular septa (crazy-paving patterns) in both lower lobes. He had a habit of drinking 400-500 mL of milk and 400-800 mL of canned coffee with milk every day. A swallowing function test revealed liquid dysphagia. Bronchoalveolar lavage fluid cytology findings showed multiple lipid-laden macrophages. Taken together, these findings revealed exogenous lipoid pneumonia. We performed bronchoscopic segmental lavage therapy 3 times in the left lung. After the treatment, the radiologic findings improved in both lungs. The patient has not experienced a recurrence of lipoid pneumonia in 2 y to date. In conclusion, a case of exogenous lipoid pneumonia was successfully treated with bronchoscopic segmental lavage therapy. PMID:25161297
Bronchoscopic location of bronchopleural fistula with xenon-133
Lillington, G.A.; Stevens, R.P.; DeNardo, G.L.
Successful application of the technique of transbronchoscopic endobronchial occlusion of a persistent bronchopleural fistula requires an accurate determination of the segmental location of the air leak. This was achieved by injections of small boluses of Xe-133 into a number of segmental bronchi through a fiber-optic bronchoscope. Following the instillation of Xe-133 into the segmental bronchus leading to the fistula, there was a marked increase in radioactivity in the intercostal drainage tube.
Sealing of tracheoesophageal fistula using a Y stent through fiberoptic bronchoscope during general anesthesia under laryngeal mask airway
Ye, Ling; Yang, Pingliang; Zuo, Yunxia
A 64-yr-old man was admitted because of repeated pneumonia. Both fiberoptic bronchoscopy and esophagoscopy revealed a large tracheoesophageal fistula (15 mm) in the right posterior trachea 1 cm beyond the carina. Coated nickel-titanium shape memory alloy Y shaped stent was planned to seal this fistula under general anesthesia. We took advantage of laryngeal mask airway to insert the fiberoptic bronchoscope to guide the stent placement. Our method of sealing a large tracheoesophageal fistula with LMA under total intravenous anesthesia was successful. PMID:25664132
Comparison of the glidescope®, flexible fibreoptic intubating bronchoscope, iPhone modified bronchoscope, and the Macintosh laryngoscope in normal and difficult airways: a manikin study
Background Smart phone technology is becoming increasingly integrated into medical care. Our study compared an iPhone modified flexible fibreoptic bronchoscope as an intubation aid and clinical teaching tool with an unmodified bronchoscope, Glidescope® and Macintosh laryngoscope in a simulated normal and difficult airway scenario. Methods Sixty three anaesthesia providers, 21 consultant anaesthetists, 21 registrars and 21 anaesthetic nurses attempted to intubate a MegaCode Kelly™ manikin, comparing a normal and difficult airway scenario for each device. Primary endpoints were time to view the vocal cords (TVC), time to successful intubation (TSI) and number of failed intubations with each device. Secondary outcomes included participant rated device usability and preference for each scenario. Advantages and disadvantages of the iPhone modified bronchoscope were also discussed. Results There was no significant difference in TVC with the iPhone modified bronchoscope compared with the Macintosh blade (P = 1.0) or unmodified bronchoscope (P = 0.155). TVC was significantly shorter with the Glidescope compared with the Macintosh blade (P < 0.001), iPhone (P < 0.001) and unmodified bronchoscope (P = 0.011). The iPhone bronchoscope TSI was significantly longer than all other devices (P < 0.001). There was no difference between anaesthetic consultant or registrar TVC (P = 1.0) or TSI (P = 0.252), with both being less than the nurses (P < 0.001). Consultant anaesthetists and nurses had a higher intubation failure rate with the iPhone modified bronchoscope compared with the registrars. Although more difficult to use, similar proportions of consultants (14/21), registrars (15/21) and nurses (15/21) indicated that they would be prepared to use the iPhone modified bronchoscope in their clinical practice. The Glidescope was rated easiest to use (P < 0.001) and was the preferred device by all participants for the difficult airway scenario
Endoscopic bronchial occlusion with silicone spigots under virtual bronchoscopic navigation
Sato, Shingo; Shiroyama, Takayuki; Nishida, Takuji; Nishihara, Takashi; Okamoto, Norio
Abstract A 68‐year‐old woman with interstitial lung disease related to dermatomyositis and systemic scleroderma was admitted to our hospital with fever and dyspnoea. Although the fever was reduced after antibiotic therapy, a left pneumothorax suddenly occurred on day 27 after admission. A continuous air leak persisted despite chest drainage with three tubes and repeated pleurodesis. Chest computed tomography (CT) images showed a cavitary lesion with a pinhole in the left upper division, which was suspected to be the affected lesion with the air leak. Virtual bronchoscopic navigation images were constructed from CT data. Bronchial occlusion with Endobronchial Watanabe Spigots (EWSs) was performed on day 52. Two medium‐sized EWSs were inserted into the left B1 + 2a and B1 + 2b, and the air leak stopped immediately. No procedure‐related adverse events occurred. All three chest tubes were successfully removed by day 60. This case demonstrates that virtual bronchoscopic navigation can improve bronchial occlusion procedures using EWSs. PMID:27512560
Lung volume reduction for advanced emphysema: surgical and bronchoscopic approaches.
Tidwell, Sherry L; Westfall, Elizabeth; Dransfield, Mark T
Chronic obstructive pulmonary disease is the third leading cause of death in the United States, affecting more than 24 million people. Inhaled bronchodilators are the mainstay of therapy; they improve symptoms and quality of life and reduce exacerbations. These and smoking cessation and long-term oxygen therapy for hypoxemic patients are the only medical treatments definitively demonstrated to reduce mortality. Surgical approaches include lung transplantation and lung volume reduction and the latter has been shown to improve exercise tolerance, quality of life, and survival in highly selected patients with advanced emphysema. Lung volume reduction surgery results in clinical benefits. The procedure is associated with a short-term risk of mortality and a more significant risk of cardiac and pulmonary perioperative complications. Interest has been growing in the use of noninvasive, bronchoscopic methods to address the pathological hyperinflation that drives the dyspnea and exercise intolerance that is characteristic of emphysema. In this review, the mechanism by which lung volume reduction improves pulmonary function is outlined, along with the risks and benefits of the traditional surgical approach. In addition, the emerging bronchoscopic techniques for lung volume reduction are introduced and recent clinical trials examining their efficacy are summarized. PMID:22189668
A novel external bronchoscope tracking model beyond electromagnetic localizers: dynamic phantom validation
NASA Astrophysics Data System (ADS)
Luo, Xiongbiao; Kitasaka, Takayuki; Mori, Kensaku
Localization of a bronchoscope and estimation of its motion is a core component for constructing a bronchoscopic navigation system that can guide physicians to perform any bronchoscopic interventions such as the transbronchial lung biopsy (TBLB) and the transbronchial needle aspiration (TBNA). To overcome the limitations of current methods, e.g., image registration (IR) and electromagnetic (EM) localizers, this study develops a new external tracking technique on the basis of an optical mouse (OM) sensor and IR augmented by sequential Monte Carlo (SMC) sampling (here called IR-SMC). We first construct an external tracking model by an OM sensor that is uded to directly measure the bronchoscope movement information including the insertion depth and the rotation of the viewing direction of the bronchoscope. To utilize OM sensor measurements, we employed IR with SMC sampling to determine the bronchoscopic camera motion parameters. The proposed method was validated on a dynamic phantom. Experimental results demonstrate that our constructed external tracking prototype is a perspective means to estimate the bronchoscope motion, compared to the start-of-the-art, especially for image-based methods, improving the tracking performance by 17.7% successfully processed video images.
Amplification of residual DNA sequences in sterile bronchoscopes leading to false-positive PCR results.
Kaul, K; Luke, S; McGurn, C; Snowden, N; Monti, C; Fry, W A
PCR has been used successfully for the direct detection of Mycobacterium tuberculosis in uncultured patient samples. Its potential is hindered by the risk of false-positive results as a result of either amplicon carryover of cross-contamination between patient samples. In the present study, we investigated whether residual amplifiable human or M. tuberculosis DNA could remain in sterile bronchoscopes and potentially be a cause of false-positive PCR results in subsequent patient samples. Sterilized bronchoscopes were flushed with sterile saline, and the collected eluate was submitted for PCR amplification of IS6110 sequences and exon 8 of the human p53 gene. Of a total of 55 washes of sterile bronchoscopes from two institutions, 2 (3.6%) contained amplifiable M. tuberculosis DNA and 11 (20%) contained residual human DNA. These findings indicate that residual DNA can remain in sterilized bronchoscopes and can be a source of false-positive PCR results. PMID:8818888
On scale invariant features and sequential Monte Carlo sampling for bronchoscope tracking
NASA Astrophysics Data System (ADS)
Luó, Xióngbiao; Feuerstein, Marco; Kitasaka, Takayuki; Natori, Hiroshi; Takabatake, Hirotsugu; Hasegawa, Yoshinori; Mori, Kensaku
This paper presents an improved bronchoscope tracking method for bronchoscopic navigation using scale invariant features and sequential Monte Carlo sampling. Although image-based methods are widely discussed in the community of bronchoscope tracking, they are still limited to characteristic information such as bronchial bifurcations or folds and cannot automatically resume the tracking procedure after failures, which result usually from problematic bronchoscopic video frames or airway deformation. To overcome these problems, we propose a new approach that integrates scale invariant feature-based camera motion estimation into sequential Monte Carlo sampling to achieve an accurate and robust tracking. In our approach, sequential Monte Carlo sampling is employed to recursively estimate the posterior probability densities of the bronchoscope camera motion parameters according to the observation model based on scale invariant feature-based camera motion recovery. We evaluate our proposed method on patient datasets. Experimental results illustrate that our proposed method can track a bronchoscope more accurate and robust than current state-of-the-art method, particularly increasing the tracking performance by 38.7% without using an additional position sensor.
SU-E-T-40: Analysis of Composite MVCT Planning Dosimetry with SBRT of Upper Peripheral Lung Cancer
Yang, C; Doxsee, K; Chen, Y
Purpose: Quantitatively evaluate and compare the final adaptive planning doses of upper peripherally located lung SBRT treated with Tomotherapy using 3rd party software tool. Methods: With tumor located in the upper quadrant of lung, a 3rd party software tool was implemented to evaluate the Tomotherapy composite dosimetry created by adaptive fan beam MVCT images described by RTOG 0915 dose criteria (48 Gy / 4 fractions). The composite doses was then summarized with deformable registration in this package with corresponding target and critical structures. The final dosimetry variation, both for target and critical structures, were evaluated in a tabular format and isodose distribution comparisons. Results: Composite SBRT treatment doses were evaluated with adaptive planning. The PTV and several critical structures were mapped/deformed into the package via DICOM from Tomotherapy after the final composite doses were created. Initial plan versus the final composite plan calculated from verification images were compared. The ITV defined by 4D CT and contoured on MVCT images were correlated in patient repositioning. Final composite dose calculated for PTV coverage has shown 0.1–0.17 cGy coverage (0.2–0.4% of prescription dose) variation. Total lung and cord were both less than 0.17 Gy which represented <0.4% difference. All other critical structure were within statistical significance. The adaptive plans justified/included the breathing and motion during the treatment process. Final 95% isotope line coverage from prescription has been met without issues. Conclusions: With lung tumor location in the upper peripheral area, breathing control was not necessary required during SBRT treatment using Tomotherapy technique. Slow fan beam CT provides definitive ITV information and the adaptive composite plan for all fractions were suitable for final dose delivery. The final composite dose calculated with Tomotherapy adaptive tool indicated that the composite dosimetry
Bronchoscopic procedures and lung biopsies in pediatric lung transplant recipients.
Wong, Jackson Y; Westall, Glen P; Snell, Gregory I
Bronchoscopy remains a pivotal diagnostic and therapeutic intervention in pediatric patients undergoing lung transplantation (LTx). Whether performed as part of a surveillance protocol or if clinically indicated, fibre-optic bronchoscopy allows direct visualization of the transplanted allograft, and in particular, an assessment of the patency of the bronchial anastomosis (or tracheal anastomosis following heart-lung transplantation). Additionally, bronchoscopy facilitates differentiation of infective processes from rejection episodes through collection and subsequent assessment of bronchoalveolar lavage (BAL) and transbronchial biopsy (TBBx) samples. Indeed, the diagnostic criteria for the grading of acute cellular rejection is dependent upon the histopathological assessment of biopsy samples collected at the time of bronchoscopy. Typically, performed in an out-patient setting, bronchoscopy is generally a safe procedure, although complications related to hemorrhage and pneumothorax are occasionally seen. Airway complications, including stenosis, malacia, and dehiscence are diagnosed at bronchoscopy, and subsequent management including balloon dilatation, laser therapy and stent insertion can also be performed bronchoscopically. Finally, bronchoscopy has been and continues to be an important research tool allowing a better understanding of the immuno-biology of the lung allograft through the collection and analysis of collected BAL and TBBx samples. Whilst new investigational tools continue to evolve, the simple visualization and collection of samples within the lung allograft by bronchoscopy remains the gold standard in the evaluation of the lung allograft. This review describes the use and experience of bronchoscopy following lung transplantation in the pediatric setting. PMID:25940429
Bronchoscopic debulking for endobronchial malignancy: Predictors of recanalization and recurrence
Kuo, Scott Chih-Hsi; Lo, Yu-Lun; Chou, Chun-Liang; Chung, Fu-Tsai; Lin, Shu-Min; Liu, Chien-Ying; Kuo, Han-Pin
Background Central airway obstruction related to endobronchial malignancy is one of the most difficult oncological complications and requires efficient palliative intervention. Methods Fifty-three consecutive patients with unresectable endobronchial malignancy receiving bronchoscopic cryotherapy as palliative treatment were retrospectively reviewed. Efficiency was evaluated by the improvement of performance status (PS), and the best achievement of tumor removal was assessed as complete or partial removal. Result Patients' PS after cryotherapeutic tumor removal improved from the baseline PS (P = 0.006). In multivariate logistic regression analysis, the compression part of the tumor (odds ratio [OR] 0.42; 95% confidence interval [CI] 0.23∼0.75, P = 0.004) and the thin tumor stalk (OR 87.86; 95% CI 2.31∼3337.37, P = 0.016) were independent predictors of complete tumor removal. Tumors larger than 9.3 cm, including compression and invasion parts, had the highest odds of being only partially removed (positive predictive value [PPV]: 88.2%, likelihood ratio [LR]+: 10.49); tumors smaller than 9.3 cm were likely to be completely removed (negative predictive value [NPV]: 80.6%, LR−: 0.34). After cryotherapy, re-obstruction was significantly associated with non-squamous cell carcinoma (65.7 vs. 16.7%, P = 0.001) and patients who had longer overall survival (11.7 vs. 1.5 months, P < 0.001). Odds of tumor re-obstruction increased 2.28-fold (PPV: 81.6%, LR+: 2.28) beyond two months; the odds decreased by 81% (NPV: 73.3%, LR−: 0.19) within two months. Conclusion Debulking of a tumor using cryotherapy is a useful palliative treatment for endobronchial obstruction secondary to a variety of malignancies. PMID:26557910
Poster — Thur Eve — 65: A dosimetric comparison of isocentric and non-isocentric coplanar SBRT VMAT plans for peripheral lung tumours
Conroy, L; Liu, HW; Lau, H; Smith, WL
Volumetric modulated arc therapy (VMAT) delivers lung sterotactic body radiotherapy (SBRT) in shorter treatment time and less monitor units with comparable coverage and organ at risk sparing compared to conventional SBRT treatments. Isocentric VMAT treatment of peripheral lung tumours occasionally requires couch shifts that can inhibit 360° gantry rotation, resulting in additional imaging shifts for each treatment session, and increased potential for involuntary in-fraction motion. Here, we investigate whether non-isocentric VMAT plans can achieve comparable plan quality to isocentric plans for peripheral lung tumours. Three patient plans were selected with targets displaced > 8.5 cm (range: 8.8 – 9.9 cm) laterally from patient midline. For each patient, a plan with isocentre placed within the target volume (isocentric plan) was created and optimized. The same optimization parameters were then used to create a plan with the isocentre at patient midline (non-isocentric plan). Plan quality was evaluated and compared based on planning target volume (PTV) coverage, high dose spillage, dose homogeneity, intermediate dose spillage, dose fall-off gradient, and organ at risk contraints. Non-isocentric plans of equivalent plan quality to isocentric plans were achieved for all patients by optimizing collimator rotations. Field isocentres can be placed at patient midline, as opposed to inside the target volume, with no significant degradation in VMAT plan quality for lateral tumour displacements up to 10 cm. Non-isocentric treatment of peripheral lung tumours could result in decreased overall treatment session time and eliminate the need for imaging shifts prior to VMAT treatment.
Poster — Thur Eve — 32: Stereotactic Body Radiation Therapy for Peripheral Lung Lesion: Treatment Planning and Quality Assurance
Wan, Shuying; Oliver, Michael; Wang, Xiaofang
Stereotactic body radiation therapy (SBRT), due to its high precision for target localizing, has become widely used to treat tumours at various locations, including the lungs. Lung SBRT program was started at our institution a year ago. Eighteen patients with peripheral lesions up to 3 cm diameter have been treated with 48 Gy in 4 fractions. Based on four-dimensional computed tomography (4DCT) simulation, internal target volume (ITV) was delineated to encompass the respiratory motion of the lesion. A margin of 5 mm was then added to create the planning target volume (PTV) for setup uncertainties. There was no expansion from gross tumour volume (GTV) to clinical target volume (CTV). Pinnacle 9.6 was used as the primary treatment planning system. Volumetric modulated arc therapy (VMAT) technique, with one or two coplanar arcs, generally worked well. For quality assurance (QA), each plan was exported to Eclipse 10 and dose calculation was repeated. Dose volume histograms (DVHs) of the targets and organs at risk (OARs) were then compared between the two treatment planning systems. Winston-Lutz tests were carried out as routine machine QA. Patient-specific QA included ArcCheck measurement with an insert, where an ionization chamber was placed at the centre to measure dose at the isocenter. For the first several patients, and subsequently for the plans with extremely strong modulation, Gafchromic film dosimetry was also employed. For each patient, a mock setup was scheduled prior to treatments. Daily pre- and post-CBCT were acquired for setup and assessment of intra-fractional motion, respectively.
... Enhancing Diversity Find People About NINDS NINDS Peripheral Neuropathy Information Page Condensed from Peripheral Neuropathy Fact Sheet ... Español Additional resources from MedlinePlus What is Peripheral Neuropathy? Peripheral neuropathy describes damage to the peripheral nervous ...
21 CFR 874.4680 - Bronchoscope (flexible or rigid) and accessories.
Code of Federal Regulations, 2010 CFR
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Bronchoscope (flexible or rigid) and accessories. 874.4680 Section 874.4680 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Surgical Devices § 874.4680...
21 CFR 874.4680 - Bronchoscope (flexible or rigid) and accessories.
Code of Federal Regulations, 2013 CFR
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Bronchoscope (flexible or rigid) and accessories. 874.4680 Section 874.4680 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Surgical Devices § 874.4680...
21 CFR 874.4680 - Bronchoscope (flexible or rigid) and accessories.
Code of Federal Regulations, 2012 CFR
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Bronchoscope (flexible or rigid) and accessories. 874.4680 Section 874.4680 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Surgical Devices § 874.4680...
21 CFR 874.4680 - Bronchoscope (flexible or rigid) and accessories.
Code of Federal Regulations, 2014 CFR
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Bronchoscope (flexible or rigid) and accessories. 874.4680 Section 874.4680 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Surgical Devices § 874.4680...
21 CFR 874.4680 - Bronchoscope (flexible or rigid) and accessories.
Code of Federal Regulations, 2011 CFR
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Bronchoscope (flexible or rigid) and accessories. 874.4680 Section 874.4680 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Surgical Devices § 874.4680...
Serial bronchoscopic lung lavage in pulmonary alveolar proteinosis under local anesthesia.
Davis, K Rennis; Vadakkan, D Thomas; Krishnakumar, E V; Anas, A Muhammed
Pulmonary alveolar proteinosis (PAP) is a rare disease, characterized by alveolar accumulation of surfactant composed of proteins and lipids due to defective surfactant clearance by alveolar macrophages. Mainstay of treatment is whole lung lavage, which requires general anesthesia. Herein, we report a case of primary PAP, successfully treated with serial bronchoscopic lung lavages under local anesthesia. PMID:25814803
Bronchoscopic NdYAG laser treatment in lung cancer, 30 years on: an institutional review.
Moghissi, K; Dixon, Kate
We review our 21-year experience in bronchoscopic NdYAG laser for lung cancer and the relevant literature. Patients totaling 1,159 received 2,235 bronchoscopic treatments. The pre-requisite for laser therapy was the presence of >50% obstruction of the bronchial lumen. We use the rigid bronchoscope, with the patient under general anaesthetic and application of laser in its non-contact mode. Two patients (0.17%) died following the procedure, and 4.8% had non-fatal complications. Four to 6 weeks after treatment there was a 48% increase in bronchial calibre and an increase of 27% (mean) in forced vital capacity and 15% (mean) in forced expiratory volume in one second, respectively. These paralleled symptomatic relief and chest X-ray improvement. Literature review indicated results similar to ours in those centres with high volume activity. Thirty years on, bronchoscopic YAG laser therapy of lung cancer still has an important role in palliation of patients with inoperable lung cancer, particularly those requiring immediate relief of bronchial obstruction. PMID:17003957
Bronchoscopic and histological changes over time following acute ferrous sulphate tablet aspiration.
Maw, Matthew; Chiu, Robert; Lim, Albert Yick Hou
An 84-year-old woman accidentally aspirated an iron tablet. She was successfully treated with early endobronchial removal of the iron tablet remnants, oral corticosteroids and antibiotics. We describe the bronchoscopic and histological changes over time following acute iron tablet aspiration and highlight the importance of early intervention to avoid complications. PMID:23257641
Observation-driven adaptive differential evolution and its application to accurate and smooth bronchoscope three-dimensional motion tracking.
Luo, Xiongbiao; Wan, Ying; He, Xiangjian; Mori, Kensaku
This paper proposes an observation-driven adaptive differential evolution algorithm that fuses bronchoscopic video sequences, electromagnetic sensor measurements, and computed tomography images for accurate and smooth bronchoscope three-dimensional motion tracking. Currently an electromagnetic tracker with a position sensor fixed at the bronchoscope tip is commonly used to estimate bronchoscope movements. The large tracking error from directly using sensor measurements, which may be deteriorated heavily by patient respiratory motion and the magnetic field distortion of the tracker, limits clinical applications. How to effectively use sensor measurements for precise and stable bronchoscope electromagnetic tracking remains challenging. We here exploit an observation-driven adaptive differential evolution framework to address such a challenge and boost the tracking accuracy and smoothness. In our framework, two advantageous points are distinguished from other adaptive differential evolution methods: (1) the current observation including sensor measurements and bronchoscopic video images is used in the mutation equation and the fitness computation, respectively and (2) the mutation factor and the crossover rate are determined adaptively on the basis of the current image observation. The experimental results demonstrate that our framework provides much more accurate and smooth bronchoscope tracking than the state-of-the-art methods. Our approach reduces the tracking error from 3.96 to 2.89 mm, improves the tracking smoothness from 4.08 to 1.62 mm, and increases the visual quality from 0.707 to 0.741. PMID:25660001
Peripheral neuritis; Neuropathy - peripheral; Neuritis - peripheral; Nerve disease; Polyneuropathy ... Neuropathy is very common. There are many types and causes. Often, no cause can be found. Some ...
Anastomotic Airway Complications After Lung Transplant: Clinical, Bronchoscopic and CT Correlation.
Luecke, Kyle; Trujillo, Camilo; Ford, Jonathan; Decker, Summer; Pelaez, Andres; Hazelton, Todd R; Rojas, Carlos A
The purpose of this article is to review the normal appearance and common complications of the airway anastomosis in lung transplant patients with emphasis on computed tomography images with bronchoscopic correlation. The spectrum of complications will be presented as early (<1 mo after transplant) or late (>1 mo). Variations in surgical technique as well as presentation and management options for airway complications will also be discussed. PMID:27428022
Bronchoscopic Implantation of a Novel Wireless Electromagnetic Transponder in the Canine Lung: A Feasibility Study
Mayse, Martin L.; Parikh, Parag J. Lechleiter, Kristen M.; Dimmer, Steven; Park, Mia; Chaudhari, Amir; Talcott, Michael; Low, Daniel A.; Bradley, Jeffrey D.
Purpose: The success of targeted radiation therapy for lung cancer treatment is limited by tumor motion during breathing. A real-time, objective, nonionizing, electromagnetic localization system using implanted electromagnetic transponders has been developed (Beacon electromagnetic transponder, Calypso Medical Technologies, Inc., Seattle, WA). We evaluated the feasibility and fixation of electromagnetic transponders bronchoscopically implanted in small airways of canine lungs and compared to results using gold markers. Methods and Materials: After approval of the Animal Studies Committee, five mongrel dogs were anesthetized, intubated, and ventilated. Three transponders were inserted into the tip of a plastic catheter, passed through the working channel of a flexible bronchoscope, and implanted into small airways of a single lobe using fluoroscopic guidance. This procedure was repeated for three spherical gold markers in the opposite lung. One, 7, 14, 28, and 60 days postimplantation imaging was used to assess implant fixation. Results: Successful bronchoscopic implantation was possible for 15 of 15 transponders and 12 of 15 gold markers; 3 markers were deposited in the pleural space. Fixation at 1 day was 15 of 15 for transponders and 12 of 12 for gold markers. Fixation at 60 days was 6 of 15 for transponders and 7 of 12 for gold markers, p value = 0.45. Conclusions: Bronchoscopic implantation of both transponders and gold markers into the canine lung is feasible, but fixation rates are low. If fixation rates can be improved, implantable electromagnetic transponders may allow improved radiation therapy for lung cancer by providing real-time continuous target tracking. Developmental work is under way to improve the fixation rates and to reduce sensitivity to implantation technique.
[Application of Interventional Bronchoscopy in Pulmonary Peripheral Lesions].
Wang, Hui; Huang, Linian
Lung cancer is the leading cause of cancer-related mortality worldwide. A low cure rate of lung cancer is not only attributed to intrinsic aggressive biological behavior, but also little attention to lung cancer screening. With lung screening methods continuous progress, peripheral pulmonary lesions detection rate gradually increased. Currently, a transbronchial approach using a bronchoscope or computed tompgraphy (CT) guided transthoracic needle aspiration/biopsy have been the most generally accepted methods for diagnosing peripheral pulmonary lesions. However, conventional bronchoscopy has a poor diagnostic yield and CT-guided approach has high rates of pneumothorax for such peripheral pulmonary lesions. Therefore, clinicians will be challenged with the task of providing the means to provide a safe and minimally invasive method of obtaining accurate tissue diagnostics for the pulmonary peripheral lesions. New bronchoscopic interventional diagnosis technologies have recommended in clinical gradually. They can effectively improve the peripheral pulmonary lesions diagnosis rate, shorten the time of diagnosis, and make the patients get timely and effective treatment. In this paper, we reviewed briefly available technologies to aid clinicians in attempts at minimally invasive techniques. PMID:27561808
Comparison of pencil beam–based homogeneous vs inhomogeneous target dose planning for stereotactic body radiotherapy of peripheral lung tumors through Monte Carlo–based recalculation
Ohtakara, Kazuhiro; Hoshi, Hiroaki
This study was conducted to ascertain whether homogeneous target dose planning is suitable for stereotactic body radiotherapy (SBRT) of peripheral lung cancer under appropriate breath-holding. For 20 peripheral lung tumors, paired dynamic conformal arc plans were generated by only adjusting the leaf margin to the planning target volume (PTV) edge for fulfilling the conditions such that the prescription isodose surface (IDS) encompassing exactly 95% of the PTV (PTV D{sub 95}) corresponds to 95% and 80% IDS, normalized to 100% at the PTV isocenter under a pencil beam (PB) algorithm with radiologic path length correction. These plans were recalculated using the x-ray voxel Monte Carlo (XVMC) algorithm under otherwise identical conditions, and then compared. Lesions abutting the parietal pleura or not were defined as edge or island tumors, respectively, and the influences of the target volume and its location relative to the chest wall on the target dose were examined. The median (range) leaf margin required for the 95% and 80% plans was 3.9 mm (1.3 to 5.0) and −1.2 mm (−1.8 to 0.1), respectively. Notably, the latter was significantly correlated negatively with PTV. In the 80% plans, the PTV D{sub 95} was slightly higher under XVMC, whereas the PTV D{sub 98} was significantly lower, irrespective of the dose calculation algorithm used. Other PTV and all gross tumor volume doses were significantly higher, while the lung doses outside the PTV were slightly lower. The target doses increased as a function of PTV and were significantly lower for island tumors than for edge tumors. In conclusion, inhomogeneous target dose planning using smaller leaf margin for a larger tumor volume was deemed suitable in ensuring more sufficient target dose while slightly reducing lung dose. In addition, more inhomogeneous target dose planning using <80% IDS (e.g., 70%) for PTV covering would be preferable for island tumors.
Outbreak of pulmonary Pseudomonas aeruginosa and Stenotrophomonas maltophilia infections related to contaminated bronchoscope suction valves, Lyon, France, 2014.
Guy, Marine; Vanhems, Philippe; Dananché, Cédric; Perraud, Michel; Regard, Anne; Hulin, Monique; Dauwalder, Olivier; Bertrand, Xavier; Crozon-Clauzel, Jullien; Floccard, Bernard; Argaud, Laurent; Cassier, Pierre; Bénet, Thomas
In April 2014, pulmonary Pseudomonas aeruginosa and Stenotrophomonas maltophilia co-infections potentially related to bronchoscopic procedures were identified in the intensive care units of a university hospital in Lyon, France. A retrospective cohort of 157 patients exposed to bronchoscopes from 1 December 2013 to 17 June 2014 was analysed. Environmental samples of suspected endoscopes were cultured. Bronchoscope disinfection was reviewed. Ten cases of pulmonary P. aeruginosa/S. maltophilia co-infections were identified, including two patients with secondary pneumonia. Eight cases were linked to bronchoscope A1 and two to bronchoscope A2. Cultures deriving from suction valves were positive for P. aeruginosa/S. maltophilia. Exposure to bronchoscopes A1 and A2 was independently coupled with increased risk of co-infection (adjusted odds ratio (aOR) = 84.6; 95% confidence interval (CI): 9.3-771.6 and aOR = 11.8, 95% CI: 1.2-121.3). Isolates from suction valves and clinical samples presented identical pulsotypes. The audit detected deficiencies in endoscope disinfection. No further cases occurred after discontinuation of the implicated bronchoscopes and change in cleaning procedures. This outbreak of pulmonary P. aeruginosa/S. maltophilia co-infections was caused by suction valve contamination of two bronchoscopes of the same manufacturer. Our findings underscore the need to test suction valves, in addition to bronchoscope channels, for routine detection of bacteria. PMID:27458712
Impacted Sharp Oesophageal Foreign Bodies--A Novel Technique of Removal with the Paediatric Bronchoscope.
Mitra, Aparajita; Bajpai, Minu
Sharp foreign bodies in the oesophagus may present as an entirely asymptomatic child with only radiological evidence but require emergent surgical management. Safety pins, razor blades and needles are a few of the commonly ingested sharp objects in developing countries. The open safety pin is a particularly interesting clinical problem, as the management depends on its location and orientation. Many methods and instruments have been used over the years to remove them from the upper digestive tract. We present a novel method using the rigid paediatric bronchoscope and alligator forceps for the extraction of this unusual foreign body from the oesophagus of a 6 year old girl. PMID:26851436
Extracts from the test plan for in-flight evaluation of the NT-33A peripheral vision display
NASA Technical Reports Server (NTRS)
Knotts, L.
The Peripheral Vision Display (PVD) which presents the pilot with a gyro stabilized artificial horizon projected onto his instrument panel by a laser light source is outlined. During instrument flight conditions, such a display allows the pilot to gain attitude awareness by sensing the horizon line through his peripheral vision. The pilot can detect changes to aircraft attitude without continuously referring back to his flight instruments. A second generation PVD unit was installed in the USAF/Calspan NT-33A during late 1982. An NT-33A flight evaluation of the display provides a unique opportunity to utilize a Workload Assessment Device (WAD) to obtain quantitative data regarding the utility of the PVD in reducing pilot workload. The experimental design and procedures for a two phase NT-33 PVD flight evaluation program is described.
Real-time motion compensation for EM bronchoscope tracking with smooth output - ex-vivo validation
NASA Astrophysics Data System (ADS)
Reichl, Tobias; Gergel, Ingmar; Menzel, Manuela; Hautmann, Hubert; Wegner, Ingmar; Meinzer, Hans-Peter; Navab, Nassir
Navigated bronchoscopy provides benefits for endoscopists and patients, but accurate tracking information is needed. We present a novel real-time approach for bronchoscope tracking combining electromagnetic (EM) tracking, airway segmentation, and a continuous model of output. We augment a previously published approach by including segmentation information in the tracking optimization instead of image similarity. Thus, the new approach is feasible in real-time. Since the true bronchoscope trajectory is continuous, the output is modeled using splines and the control points are optimized with respect to displacement from EM tracking measurements and spatial relation to segmented airways. Accuracy of the proposed method and its components is evaluated on a ventilated porcine ex-vivo lung with respect to ground truth data acquired from a human expert. We demonstrate the robustness of the output of the proposed method against added artificial noise in the input data. Smoothness in terms of inter-frame distance is shown to remain below 2 mm, even when up to 5 mm of Gaussian noise are added to the input. The approach is shown to be easily extensible to include other measures like image similarity.
Surgical and Bronchoscopic Lung Volume Reduction in Chronic Obstructive Pulmonary Disease
Meena, Manoj; Dixit, Ramakant; Singh, Mrityunjaya; Samaria, Jai Kumar; Kumar, Surendra
Chronic obstructive pulmonary disease (COPD) is the most extensively studied and researched disease in pulmonology and a cause of significant morbidity, mortality, and financial burden on patient's family and country's economy. Its management continues to be a challenge to both the physician and the patient's family. So far, it is preventable and treatable but not curable. Emphysema, a phenotype of COPD, is the most debilitating condition associated with progressive exercise intolerance and severe dyspnea. Despite decades of research, medical treatments available so far have helped improve quality of life and slowed down the decline in respiratory function but did not significantly improve the survival benefits. Though surgical lung volume reduction (LVR) procedures have shown some promise in context to functional gains and survival but, only in a carefully selected group of patients, bronchoscopic LVR procedures are yet to explore their full potential and limitations. This paper retrospectively studied the developments so far, medical and surgical, with special emphasis on the bronchoscopic procedures of lung volume reduction, and tried to comparatively analyze the risks and benefits of each one of them through various trials and studies done to date. PMID:25614834
Surgical and bronchoscopic lung volume reduction in chronic obstructive pulmonary disease.
Meena, Manoj; Dixit, Ramakant; Singh, Mrityunjaya; Samaria, Jai Kumar; Kumar, Surendra
Chronic obstructive pulmonary disease (COPD) is the most extensively studied and researched disease in pulmonology and a cause of significant morbidity, mortality, and financial burden on patient's family and country's economy. Its management continues to be a challenge to both the physician and the patient's family. So far, it is preventable and treatable but not curable. Emphysema, a phenotype of COPD, is the most debilitating condition associated with progressive exercise intolerance and severe dyspnea. Despite decades of research, medical treatments available so far have helped improve quality of life and slowed down the decline in respiratory function but did not significantly improve the survival benefits. Though surgical lung volume reduction (LVR) procedures have shown some promise in context to functional gains and survival but, only in a carefully selected group of patients, bronchoscopic LVR procedures are yet to explore their full potential and limitations. This paper retrospectively studied the developments so far, medical and surgical, with special emphasis on the bronchoscopic procedures of lung volume reduction, and tried to comparatively analyze the risks and benefits of each one of them through various trials and studies done to date. PMID:25614834
Bronchoscopic removal of foreign bodies in adults: experience with 62 patients from 1974-1998.
Debeljak, A; Sorli, J; Music, E; Kecelj, P
The authors reviewed their experience with therapeutic bronchoscopy for removal of tracheobronchial foreign bodies in the adult. Bronchoscopy records and collection of foreign bodies in the endoscopic department were retrospectively examined. Among 37,466 bronchoscopies performed between 1974-1998, 62 (0.2%) were performed for the removal of tracheobronchial foreign bodies. Medical history was suggestive of foreign body aspiration in 33 patients and the chest radiograph was suggestive in 10 patients. The procedure was performed with the flexible bronchoscope in 42 patients (68%), rigid bronchoscope in 4 (6%), and with both in 16 (26%) patients. Foreign bodies were found in the right bronchial tree on 42 occasions, in the left on 20 and in the trachea once. In 39 patients, inflammatory granulations were found around the foreign body. The origins of the foreign bodies included: bone fragments (n=31), vegetable (n=10), broncholith (n=8), a part of dental prosthesis (n=7), endodontic needle (n=2), a metallic (n=2), or plastic (n=1) particle, a tracheostomy tube (n=1) and a match (n=1). In one patient, 2 foreign bodies were found. The foreign bodies were successfully removed in all but 2 patients (3%). The most useful instruments for removal were alligator forceps and the wire basket. Foreign bodies in the tracheobronchial system are rare in adults. They can be successfully removed in the majority of patients under either flexible or rigid bronchoscopy. PMID:10573222
Anesthesia for Advanced Bronchoscopic Procedures: State-of-the-Art Review.
Goudra, Basavana G; Singh, Preet Mohinder; Borle, Anuradha; Farid, Nahla; Harris, Kassem
The bronchoscopic procedures have seen a remarkable increase in both numbers and complexity. Although many anesthesia providers have kept pace with the challenge, the practice is varied and frequently suboptimal. Shared airway during bronchoscopy poses unique challenges. The available reviews have tried to address this lacuna; however, these have frequently dealt with the technical aspects of bronchoscopy than anesthetic challenges. The present review provides evidence-based management insights into anesthesia for bronchoscopy-both flexible and rigid. A systematic approach toward pre-procedural evaluation and risk stratification is presented. The possible anatomical and physiological factors that can influence the outcomes are discussed. Pharmacological principles guiding sedation levels and appropriate selection of sedatives form the crux of safe anesthetic management. The newer and safer drugs that can have potential role in anesthesia for bronchoscopy in the near future are discussed. Ventilatory strategies during bronchoscopy for prevention of hypoxia and hypercarbia are emphasized. PMID:25921014
Bronchoscopic intubation during continuous nasal positive pressure ventilation in the treatment of hypoxemic respiratory failure.
Barjaktarevic, Igor; Berlin, David
Endotracheal intubation is difficult in patients with hypoxemic respiratory failure who deteriorate despite treatment with noninvasive positive pressure ventilation (NIPPV). Maintaining NIPPV during intubation may prevent alveolar derecruitment and deterioration in gas exchange. We report a case series of 10 nonconsecutive patients with NIPPV failure who were intubated via a flexible bronchoscope during nasal mask positive pressure ventilation. All 10 patients were intubated in the first attempt. Hypotension was the most frequent complication (33%). Mean decrease in oxyhemoglobin saturation during the procedure was 4.7 ± 3.1. This method of intubation may extend the benefits of preoxygenation throughout the whole process of endotracheal intubation. It requires an experienced operator and partially cooperative patients. A prospective trial is necessary to determine the best intubation method for NIPPV failure. PMID:24243561
Automated segmentation of lung airway wall area measurements from bronchoscopic optical coherence tomography imaging
NASA Astrophysics Data System (ADS)
Heydarian, Mohammadreza; Choy, Stephen; Wheatley, Andrew; McCormack, David; Coxson, Harvey O.; Lam, Stephen; Parraga, Grace
Chronic Obstructive Pulmonary Disease (COPD) affects almost 600 million people and is currently the fourth leading cause of death worldwide. COPD is an umbrella term for respiratory symptoms that accompany destruction of the lung parenchyma and/or remodeling of the airway wall, the sum of which result in decreased expiratory flow, dyspnea and gas trapping. Currently, x-ray computed tomography (CT) is the main clinical method used for COPD imaging, providing excellent spatial resolution for quantitative tissue measurements although dose limitations and the fundamental spatial resolution of CT limit the measurement of airway dimensions beyond the 5th generation. To address this limitation, we are piloting the use of bronchoscopic Optical Coherence Tomography (OCT), by exploiting its superior spatial resolution of 5-15 micrometers for in vivo airway imaging. Currently, only manual segmentation of OCT airway lumen and wall have been reported but manual methods are time consuming and prone to observer variability. To expand the utility of bronchoscopic OCT, automatic and robust measurement methods are required. Therefore, our objective was to develop a fully automated method for segmenting OCT airway wall dimensions and here we explore several different methods of image-regeneration, voxel clustering and post-processing. Our resultant automated method used K-means or Fuzzy c-means to cluster pixel intensity and then a series of algorithms (i.e. cluster selection, artifact removal, de-noising) was applied to process the clustering results and segment airway wall dimensions. This approach provides a way to automatically and rapidly segment and reproducibly measure airway lumen and wall area.
Flexible bronchoscopic management of benign tracheal stenosis: long term follow-up of 115 patients
Background Management of benign tracheal stenosis (BTS) varies with the type and extent of the disease and influenced by the patient's age and general health status, hence we sought to investigate the long-term outcome of patients with BTS that underwent minimally invasive bronchoscopic treatment. Methods Patients with symptomatic BTS were treated with flexible bronchoscopy therapeutic modalities that included the following: balloon dilatation, laser photo-resection, self-expanding metal stent placement, and High-dose rate endobronchial brachytherapy used in cases of refractory stent-related granulation tissue formation. Results A total of 115 patients with BTS and various cardiac and respiratory co-morbidities with a mean age of 61 (range 40-88) were treated between January 2001 and January 2009. The underlining etiologies for BTS were post - endotracheal intubation (N = 76) post-tracheostomy (N = 30), Wegener's granulomatosis (N = 2), sarcoidosis (N = 2), amyloidosis (N = 2) and idiopathic BTS (N = 3). The modalities used were: balloon dilatation and laser treatment (N = 98). Stent was placed in 33 patients of whom 28 also underwent brachytherapy. Complications were minor and mostly included granulation tissue formation. The overall success rate was 87%. Over a median follow-up of 51 months (range 10-100 months), 30 patients (26%) died, mostly due to exacerbation of their underlying conditions. Conclusions BTS in elderly patients with co-morbidities can be safely and effectively treated by flexible bronchoscopic treatment modalities. The use of HDR brachytherapy to treat granulation tissue formation following successful airway restoration is promising. PMID:20078894
Real-time bronchoscope three-dimensional motion estimation using multiple sensor-driven alignment of CT images and electromagnetic measurements.
Luo, Xiongbiao; Mori, Kensaku
Bronchoscope three-dimensional motion estimation plays a key role in developing bronchoscopic navigation systems. Currently external tracking devices, particularly electromagnetic trackers with electromagnetic sensors, are increasingly introduced to navigate surgical tools in pre-clinical images. An unavoidable problem, which is to align the electromagnetic tracker to pre-clinical images, must be solved before navigation. This paper proposes a multiple sensor-driven registration method to establish this alignment without using any anatomical fiducials. Although current fiducially free registration methods work well, they limit to the initialization of optimization and manipulating the bronchoscope along the bronchial centerlines, which could be failed easily during clinical interventions. To address these limitations, we utilize measurements of multiple electromagnetic sensors to calculate bronchoscope geometric center positions that are usually closer to the bronchial centerlines than the sensor itself measured positions. We validated our method on a bronchial phantom. The experimental results demonstrate that our idea of using multiple sensors to determine bronchoscope geometric center positions for fiducial-free registration was very effective. Compared to currently available methods in bronchoscope three-dimensional motion estimation, our method reduced fiducial alignment error from at least 6.79 to 4.68-5.26 mm and significantly improved motion estimation or tracking accuracy from at least 5.42 to 3.78-4.53 mm. PMID:25002104
Successful Treatment of Tracheal Invasion Caused by Thyroid Cancer Using Endotracheal Tube Balloon Inflation under Flexible Bronchoscopic Guidance.
Han, Yang-Hee; Jung, Bock-Hyun; Kwon, Jun Sung; Lim, Jaemin
Tracheal invasion is an uncommon complication of thyroid cancer, but it can cause respiratory failure. A rigid bronchoscope may be used to help relieve airway obstruction, but general anesthesia is usually required. Tracheal balloon dilatation and stent insertion can be performed without general anesthesia, but complete airway obstruction during balloon inflation may be dangerous in some patients. Additionally, placement of the stent adjacent to the vocal cords can be technically challenging. An 86-year-old female patient with tracheal invasion resulting from thyroid cancer was admitted to our hospital because of worsening dyspnea. Due to the patient's refusal of general anesthesia and the interventional radiologist's difficulty in completing endotracheal stenting, we performed endotracheal tube balloon dilatation and argon plasma coagulation. We have successfully treated tracheal obstruction in the patient with thyroid cancer by using endotracheal tube balloon inflation and a flexible bronchoscope without general anesthesia or airway obstruction during balloon inflation. PMID:25473409
... can be associated with peripheral neuropathy. Metabolic and endocrine disorders impair the body's ability to transform nutrients into ... to neuropathies as a result of chemical imbalances. Endocrine disorders that lead to hormonal imbalances can disturb normal ...
Exploration under the dome: Esophageal ultrasound with the ultrasound bronchoscope is indispensible
Meena, Nikhil; Hulett, Cidney; Patolia, Setu; Bartter, Thaddeus
Background: Effective use of the convex curvilinear ultrasound bronchoscope in the esophagus (EUS-B) for fine needle aspiration biopsy of mediastinal structures is now well described. In contrast, there is little to no reporting, depending on the site of EUS-B for access to sub-diaphragmatic structures. Our practice has been accessing sub-diaphragmatic sites for years. This review documents our experience with EUS-B to biopsy liver, left adrenal glands, and coeliac lymph nodes. Methods: After Institutional Review Board's approval, all endosonographic procedures performed by interventional pulmonary between July 2013 and June 2015 were reviewed. Those including biopsy of sub-diaphragmatic sites were then selected for analysis. Results: Over the study interval, 45 sub-diaphragmatic biopsy procedures (25 left adrenal glands, 7 liver, and 13 celiac node) were performed with EUS-B. In all cases, cellular adequacy was present, and samples were large enough for immunohistochemistry and any relevant ancillary studies. Metastatic malignancy was documented in 58% of cases, 16% of cases contained benign diagnostic findings, and in 27% of cases, normal organ tissue was documented. There were no complications. Conclusions: Operators comfortable with the endobronchial ultrasound scope in both the airway and the esophagus can actively seek and successfully perform biopsy of sub-diaphragmatic abnormalities when present and can thereby add to the diagnostic value of the procedure. PMID:27503158
The Molecular Bronchoscope: A Tool for Measurement of Spatially Dependent CO2 Concentrations in the Lungs.
Ciaffoni, Luca; Couper, John H; Richmond, Graham; Hancock, Gus; Ritchie, Grant A D
Respiratory physicians use bronchoscopy for visual assessment of the lungs' topography and collecting tissue samples for external analysis. We propose a novel bronchoscope tool that would enable spatially dependent measurements of the functioning of the lungs by determining local concentrations of carbon dioxide, which will be produced by healthy parts of the lung at rates that are higher than from portions where gas exchange is impaired. The gas analyzer is based on a compact laser absorption spectrometer making use of fiber optics for delivery and return of low intensity diode laser radiation to and from the measurement chamber at the distal end of a flexible conduit. The appropriate optical wavelength was chosen such that light is selectively absorbed only by gaseous CO2. The optical absorption takes place over a short path (8.8 mm) within a rigid, 12 mm long, perforated probe tip. Wavelength modulation spectroscopy was adopted as the analytical technique to reduce the noise on the optical signal and yield measurements of relative CO2 concentration every 180 ms with a precision as low as 600 part-per-million by volume. The primary objective of such a device is to see if additional spatial information about the lungs functionality can be gathered, which will complement visual observation. PMID:27487178
Towards hybrid bronchoscope tracking under respiratory motion: evaluation on a dynamic motion phantom
NASA Astrophysics Data System (ADS)
Luo, Xiongbiao; Feuerstein, Marco; Sugiura, Takamasa; Kitasaka, Takayuki; Imaizumi, Kazuyoshi; Hasegawa, Yoshinori; Mori, Kensaku
This paper presents a hybrid camera tracking method that uses electromagnetic (EM) tracking and intensitybased image registration and its evaluation on a dynamic motion phantom. As respiratory motion can significantly affect rigid registration of the EM tracking and CT coordinate systems, a standard tracking approach that initializes intensity-based image registration with absolute pose data acquired by EM tracking will fail when the initial camera pose is too far from the actual pose. We here propose two new schemes to address this problem. Both of these schemes intelligently combine absolute pose data from EM tracking with relative motion data combined from EM tracking and intensity-based image registration. These schemes significantly improve the overall camera tracking performance. We constructed a dynamic phantom simulating the respiratory motion of the airways to evaluate these schemes. Our experimental results demonstrate that these schemes can track a bronchoscope more accurately and robustly than our previously proposed method even when maximum simulated respiratory motion reaches 24 mm.
Bronchoscopic diathermy resection and stent insertion: a cost effective treatment for tracheobronchial obstruction.
Petrou, M.; Kaplan, D.; Goldstraw, P.
BACKGROUND--Major airways obstruction is a distressing cause of morbidity and mortality. For disease that is extensive and recurrent, there is a need for a safe and cost effective technique for palliation. METHODS--The results of 29 patients with tracheobronchial obstruction (24 malignant and five benign) treated by diathermy resection alone or in combination with endobronchial stenting have been reviewed. RESULTS--The major site of obstruction was the trachea in 14, main carina in seven, right main bronchus in six, and left main bronchus in two patients. Fifteen had received other forms of treatment beforehand including external radiotherapy, endoscopic dilatation, and laser resection (Nd:YAG). Five patients required two or more treatment sessions for symptom recurrence. Ten patients also received additional treatment with a stent (nine) or insertion of gold grains (one). There were no intraoperative deaths or complications and the average length of stay was five days (range 2-14). Twenty eight patients reported immediate symptomatic relief, and objective improvement in the results of lung function tests was seen in eight patients whose condition was less acute and where preoperative lung function tests could be undertaken (average improvement in FEV1 of 53.1% and in FVC of 20.6%). CONCLUSIONS--Bronchoscopic diathermy resection is an effective and safe method for relieving the symptoms of tracheobronchial obstruction at appreciably less cost than laser resection. Images PMID:8296261
... Physician Resources Professions Site Index A-Z Peripheral Artery Disease (PAD) Peripheral artery disease (PAD) refers to ... is peripheral artery disease treated? What is peripheral artery disease (PAD)? Peripheral artery disease, or PAD, refers ...
A model of respiratory airway motion for real-time tracking of an ultrathin bronchoscope
NASA Astrophysics Data System (ADS)
Soper, Timothy D.; Haynor, David R.; Glenny, Robb W.; Seibel, Eric J.
Deformable registration of chest CT scans taken of a subject at various phases of respiration provide a direct measure of the spatially varying displacements that occur in the lung due to breathing. This respiratory motion was studied as part of the development of a CT-based guidance system for a new electromagnetically tracked ultrathin bronchoscope. Fifteen scans of an anesthesized pig were acquired at five distinct lung pressures between full expiration to full inspiration. Deformation fields were computed by non-rigid registration using symmetric "demons" forces followed by Gaussian regularization in a multi-resolution framework. Variants of the registration scheme were tested including: initial histogram matching of input images, degree of field smoothing during regularization, and applying an adaptive smoothing method that weights elements of the smoothing kernel by the magnitude of the image gradient. Registration quality was quantified and compared using inverse and transitive consistency metrics. After optimizing the algorithm parameters, deformation fields were computed by registering each image in the set to a baseline image. Registration of the baseline image at full inspiration to an image at full expiration produced the maximum deformation. Two hypotheses were made: first, that each deformation could be modeled as a mathematical sub-multiple of the maximum deformation, and second, that the deformation scales linearly with respiratory pressure. The discrepancy between the deformation measured by image registration and that predicted by the linear model was 1.25 mm on average. At maximum deformation, this motion compensation constitutes an 87% reduction in respiration-induced localization error.
Evaluation of Endotracheal Intubation with a Flexible Fiberoptic Bronchoscope in Lateral Patient Positioning: A Prospective Randomized Controlled Trial
Li, Hui; Wang, Wu; Lu, Ya-Ping; Wang, Yan; Chen, Li-Hua; Lei, Li-Pei; Fang, Xiang-Ming
Background: There is an unmet need for a reliable method of airway management for patients in the lateral position. This prospective randomized controlled two-center study was designed to evaluate the feasibility of intubation using a flexible fiberoptic bronchoscope in the lateral position during surgery. Methods: Seventy-two patients scheduled for elective nonobstetric surgery in the lateral decubitus position requiring tracheal intubation under general anesthesia at Lishui Central Hospital of Zhejiang Province and Jiaxing First Hospital of Zhejiang Province from April 1, 2015, to September 30, 2015, were enrolled in this study. Patients were randomly assigned to the supine position group (Group S, n = 38) and the lateral position group (Group L, n = 34). Experienced anesthetists performed tracheal intubation with a fiberoptic bronchoscope after general anesthesia. The time required for intubation, intubation success rates, and hemodynamic changes was recorded. Between-group differences were assessed using the Student's t-test, Mann–Whitney U-test, or Chi-square test. Results: The median total time to tracheal intubation was significantly longer in Group S (140.0 [135.8, 150.0] s) compared to Group L (33.0 [24.0, 38.8] s) (P < 0.01). The first-attempt intubation success rate was significantly higher in Group L (97%) compared to Group S (16%). Hemodynamic changes immediately after intubation were more exaggerated in Group S compared to Group L (P = 0.02). Conclusion: Endotracheal intubation with a flexible fiberoptic bronchoscope may be an effective and timesaving technique for patients in the lateral position. Trial Registration: Chinese Clinical Trial Register, ChiCTR-IIR-16007814; http://www.chictr.org.cn/showproj.aspx?proj=13183. PMID:27569229
Pulmonary infiltrates in non-HIV immunocompromised patients: a diagnostic approach using non-invasive and bronchoscopic procedures
Rano, A; Agusti, C; Jimenez, P; Angrill, J; Benito, N; Danes, C; Gonzalez, J; Rovira, M; Pumarola, T; Moreno, A; Torres, A
BACKGROUND—The development of pulmonary infiltrates is a frequent life threatening complication in immunocompromised patients, requiring early diagnosis and specific treatment. In the present study non-invasive and bronchoscopic diagnostic techniques were applied in patients with different non-HIV immunocompromised conditions to determine the aetiology of the pulmonary infiltrates and to evaluate the impact of these methods on therapeutic decisions and outcome in this population. METHODS—The non-invasive diagnostic methods included serological tests, blood antigen detection, and blood, nasopharyngeal wash (NPW), sputum and tracheobronchial aspirate (TBAS) cultures. Bronchoscopic techniques included fibrobronchial aspirate (FBAS), protected specimen brush (PSB), and bronchoalveolar lavage (BAL). Two hundred consecutive episodes of pulmonary infiltrates were prospectively evaluated during a 30 month period in 52 solid organ transplant recipients, 53 haematopoietic stem cell transplant (HSCT) recipients, 68 patients with haematological malignancies, and 27 patients requiring chronic treatment with corticosteroids and/or immunosuppressive drugs. RESULTS—An aetiological diagnosis was obtained in 162 (81%) of the 200 patients. The aetiology of the pulmonary infiltrates was infectious in 125 (77%) and non-infectious in 37 (23%); 38 (19%) remained undiagnosed. The main infectious aetiologies were bacterial (48/125, 24%), fungal (33/125, 17%), and viral (20/125, 10%), and the most frequent pathogens were Aspergillus fumigatus (n=29), Staphylococcus aureus (n=17), and Pseudomonas aeruginosa (n=12). Among the non-infectious aetiologies, pulmonary oedema (16/37, 43%) and diffuse alveolar haemorrhage (10/37, 27%) were the most common causes. Non-invasive techniques led to the diagnosis of pulmonary infiltrates in 41% of the cases in which they were used; specifically, the diagnostic yield of blood cultures was 30/191 (16%); sputum cultures 27/88 (31%); NPW 9/50 (18
Effect of Acute Hypercapnia on Outcomes and Predictive Risk Factors for Complications among Patients Receiving Bronchoscopic Interventions under General Anesthesia
Wang, Hongwu; Zhang, Rujin; Yue, Yun; Li, Lei
Background The aim of this study is to investigate the effect of acute hypercapnia on surgery outcomes among patients receiving bronchoscopic interventions under general anesthesia. Furthermore, independent predictive factors for surgery complications were analyzed. Method A total of 323 patients with airway stenosis were enrolled in this retrospective study. Each patient underwent interventional rigid bronchoscopy under general anesthesia. Arterial blood gas (ABG) was measured intraoperatively. In light of PaCO2 levels in ABG, patients were divided into three groups: Group C (control) (PaCO2:≤ 60 mmHg), Group M (moderate) (PaCO2:61–100 mmHg), and Group S (severe) (PaCO2: >100 mmHg). Parameters, including PaO2 levels and recovery delays, were compared across three groups. Complications among patients receiving bronchoscopic interventions were evaluated as well. Independent predictive factors for surgery related complications were analyzed by multivariable regression method. Results Significant differences in weight (p=0.04), ASA IV (p=0.008), dyspnea index (p=0.003),COPD (p=0.02), dynamic airway collapse (p=0.002), severe stenosis severity (p=0.02), and stenosis locations among three groups were observed. Mild (PaCO2:~60 mmHg) to moderate (PaCO2:60–100 mmHg) hypercapnia was not associated with delayed recovery, whereas severe hypercapnia (PaCO2:>100 mmHg) was associated with delayed recovery, as well as declined PaO2 (p=0.00) and elevated blood glucose levels (p=0.00). The complications of bronchoscopic interventions included postoperative congestive heart failure (14 cases, 4.3%), tracheorrhagia (8 cases, 2.5%), delayed recovery (19 cases, 5.9%), and transfers to ICU after surgery (10 cases, 3.1%). The multivariable regression analysis showed that procedure duration (p=0.003), lobectomy (p=0.007), dynamic airway collapse (p=0.01), severe bronchial stenosis (p=0.01) and hypercapnia (p=0.02) were independent predictive factors for surgery related complications
[Diagnosis and surgical treatment for small-sized peripheral lung cancer].
Iyoda, A; Fujisawa, T; Moriya, Y
Small-sized peripheral lung cancers have been detected more frequently as a result of recent developments in diagnostic imaging including high-resolution computed tomography (HRCT). Although the diagnosis of small-sized peripheral lung cancers is difficult, it makes an adequate diagnosis possible using transbronchial fine needle aspiration cytology or a new thin-type bronchoscope. Surgical treatment using mini-thoracotomy or video-assisted thoracic surgery is effective for early stage small-sized peripheral lung cancers. Lesser resection of lung cancer may provide many benefits to patients, such as preserving vital lung tissue and providing the chance for further resection if a second primary lung cancer develops, however, lobectomy with systematic hilar and mediastinal lymph node dissection should remain the standard surgical treatment, and an intentional limited resection should be adopted for very limited patients with a definitive early stage because of recurrence rates. PMID:14733091
[Treatment of spontaneous pneumothorax by electrocoagulation via a fiberoptic bronchoscope with a hysteroscope irrigation outer sheath as a thoracoscope].
Tsukamoto, T; Nakamura, H
Since 1981 in Yamagata Prefectural Central Hospital, the authors performed electro-coagulation therapy for air leakage from bullae (blebs) via a rigid thoracoscope in 31 patients with spontaneous pneumothorax. Among these patients, this treatment was unsuccessful in 14 patients (45.2%) because of 5 multiple or giant bullae and 9 cases in which it was impossible to visualize the bullae in the mediastinum or because of pleural adhesion. In order to widen the visual field and increase the mobility of the thoracoscope, we employed a fiberoptic bronchoscope with a hysteroscope outer sheath used for irrigation as a flexible thoracoscope. This method makes it possible to examine both mediastinal pleura and adhesive pleural space, and to electrocoagulate bullae which cannot be visualized by a rigid thoracoscope. It was possible to visualize the blebs in all 13 cases with spontaneous pneumothorax in which this examination was attempted. This therapeutic procedure causes the patients less pain and the hospitals more economical because no new thoracoscope is necessary. This method of thoracoscopic therapy of spontaneous pneumothorax using a fiberoptic bronchoscope is more successful, effective, economical and painless than by rigid thoracoscope and should be attempted before thoracotomy. PMID:2214384
Automated fiducial marker planning for thoracic stereotactic body radiation therapy
NASA Astrophysics Data System (ADS)
Gibbs, Jason D.; Rai, Lav; Wibowo, Henky; Tsalyuk, Serge; Anderson, Eric D.
Stereotactic body-radiation therapy (SBRT) has gained acceptance in treating lung cancer. Localization of a thoracic lesion is challenging as tumors can move significantly with breathing. Some SBRT systems compensate for tumor motion with the intrafraction tracking of targets by two stereo fluoroscopy cameras. However, many lung tumors lack a fluoroscopic signature and cannot be directly tracked. Small radiopaque fiducial markers, acting as fluoroscopically visible surrogates, are instead implanted nearby. The spacing and configuration of the fiducial markers is important to the success of the therapy as SBRT systems impose constraints on the geometry of a fiducial-marker constellation. It is difficult even for experienced physicians mentally assess the validity of a constellation a priori. To address this challenge, we present the first automated planning system for bronchoscopic fiducial-marker placement. Fiducial-marker planning is posed as a constrained combinatoric optimization problem. Constraints include requiring access from a navigable airway, having sufficient separation in the fluoroscopic imaging planes to resolve each individual marker, and avoidance of major blood vessels. Automated fiducial-marker planning takes approximately fifteen seconds, fitting within the clinical workflow. The resulting locations are integrated into a virtual bronchoscopic planning system, which provides guidance to each location during the implantation procedure. To date, we have retrospectively planned over 50 targets for treatment, and have implanted markers according to the automated plan in one patient who then underwent SBRT treatment. To our knowledge, this approach is the first to address automated bronchoscopic fiducialmarker planning for SBRT.
Efficacy of bronchoscopic biopsy for the detection of epidermal growth factor receptor mutations and anaplastic lymphoma kinase gene rearrangement in lung adenocarcinoma
Zhu, Pei; Pan, Qingqing; Wang, Mengzhao; Zhong, Wei; Zhao, Jing
Background To explore the efficacy of bronchoscopic biopsy for the detection of epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) gene rearrangement in lung adenocarcinoma. Methods All patients with bronchoscopic biopsy-proven lung adenocarcinoma at the Peking Union Medical College Hospital from January 2009 to November 2011 were enrolled. Scorpion amplification refractory mutation system (ARMS) was used to detect EGFR gene mutations and fluorescence in situ hybridization (FISH) to detect ALK rearrangement. The correlation of immunohistochemistry (IHC) results with standard methods for EGFR mutation status and ALK rearrangement were checked. Results Bronchoscopic specimens were successfully used to detect EGFR mutation and ALK rearrangement with success rates of 85.2% and 71.3%, respectively, in non-small cell lung cancer patients. EGFR analysis by ARMS yielded a positive result in 35.8% (33/92) and positive ALK rearrangement was detected by FISH in 7.8% (6/77) of cases. It was more likely to be unsuccessful in patients with tumor cells less than 100/high power field and the ratio tumor numbers in 0–10%. In EGFR-IHC, the sensitivity and specificity of E746-A750 deletions were 73.3% (11/15) and 93.3% (70/75), respectively, and those of L858R were 93.3% (14/15) and 93.2% (69/74), respectively. In ALK-IHC, the sensitivity and specificity were 50% (3/6) and 100% (71/71), respectively. Conclusions Small bronchoscopic specimens could achieve higher successful detection rates via EGFR mutation and ALK gene rearrangement. PMID:26557908
Real time ultrasound-guided percutaneous tracheostomy: Is it a better option than bronchoscopic guided percutaneous tracheostomy?
Ravi, Parli Raghavan; Vijay, M.N.
Background The purpose of this study was to evaluate the efficacy of ultrasound guided percutaneous tracheostomy (USPCT) and bronchoscopic guided percutaneous tracheostomy (BPCT) and the incidence of complications in critically ill, obese patients. Methods Seventy four consecutive patients were included in a prospective study and randomly divided into USPCT and BPCT. Incidence of complications, ease and efficacy were compared in obese USPCT (n = 38)and BPCT (n = 36). Results are expressed as the median (25th–75th percentile) or number (percentage). Results The median times for tracheostomy were 12 min (9–14) in USPCT patients and 18 min (12–21.5) in BPCT (p = 0.05). The overall complication rate was higher in BPCT than USPCT patient group (75% vs. 321%, p < 0.05). Most complications were minor (hypotension, desaturation, tracheal cuff puncture and minor bleeding) and of higher number in the BPCT. Ultrasound-guided PCT was possible in all enrolled patients and there were no surgical conversions or deaths. Conclusions This study demonstrated that real US-guided PCT is a favourable alternative to BPCT with a low complication rate and ease, thus proving more efficacious. A US examination provides information on cervical anatomy, vasculature etc. and hence modifies and guides choice of the PCT puncture site. PMID:25859079
... spinal cord. Like static on a telephone line, peripheral nerve disorders distort or interrupt the messages between the brain ... body. There are more than 100 kinds of peripheral nerve disorders. They can affect one nerve or many nerves. ...
Propylthiouracil and peripheral neuropathy.
Van Boekel, V; Godoy, J M; Lamy, L A; Assuf, S; Meyer Neto, J G; Balassiano, S L; Prata, L E
Peripheral neuropathy is a rare manifestation in hyperthyroidism. We describe the neurological manifestations of a 38 year old female with Graves' disease who developed peripheral neuropathy in the course of her treatment with propylthiouracil. After the drug was tapered off, the neurological signs disappeared. Therefore, we call attention for a possible toxic effect on peripheral nervous system caused by this drug. PMID:1339201
Pretreatment imaging of peripheral vascular malformations
Johnson, Joshua B; Cogswell, Petrice M; McKusick, Michael A; Binkovitz, Larry A; Riederer, Stephen J; Young, Phillip M
Peripheral vascular malformations (VMs) are complex and diverse vascular lesions which require individualized pretreatment planning. Pretreatment imaging using various modalities, especially magnetic resonance imaging and time-resolved magnetic resonance angiography, is a valuable tool for classifying peripheral VMs to allow proper diagnosis, demonstrate complete extent, identify the nidus, and distinguish between low-flow and high-flow dynamics that determines the treatment approach. We discuss pretreatment imaging findings in four patients with peripheral VMs and how diagnostic imaging helped guide management. PMID:25625123
Evaluating Peripheral Displays
NASA Astrophysics Data System (ADS)
Matthews, Tara; Hsieh, Gary; Mankoff, Jennifer
Although peripheral displays have been a domain of inquiry for over a decade now, evaluation criteria and techniques for this area are still being created. Peripheral display evaluation is an acknowledged challenge in a field setting. This chapter first describes models and methods that have been tailored specifically to evaluating peripheral displays (measuring how well they achieve their goals). Then, we present evaluation criteria used in past evaluations of peripheral displays, ranging from issues such as learnability to distraction. After explaining how these criteria have been assessed in the past, we present a case study evaluation of two e-mail peripheral displays that demonstrates the pros and cons of various evaluation techniques.
Tissue requirements in lung cancer diagnosis for tumor heterogeneity, mutational analysis and targeted therapies: initial experience with intra-operative Frozen Section Evaluation (FROSE) in bronchoscopic biopsies
Iding, Jeffrey S.
Background Recent advances in lung cancer treatment have changed the requirement for the amount and quality of biopsy specimens needed to characterize the tumor and select the best treatment. One adjunct to guide the bronchoscopist on the quality and quantity of specimens during bronchoscopic biopsies for the diagnosis of lung cancer is rapid on-site evaluation (ROSE) of cytological specimens. This technique has been shown to add to the diagnostic yield of bronchoscopy when obtaining adequate specimens for molecular profiling in lung cancer. ROSE is not available at all medical centers. We describe our initial experience using intra-procedural Frozen Section Evaluation (FROSE) of bronchoscopic biopsy specimens as an alternative to ROSE. Methods A retrospective analysis of all interventional pulmonology cases using FROSE between February and July 2015 was performed. Results analyzed to evaluate the success in obtaining adequate specimens for molecular profiling. Results A total of 88 interventional pulmonology cases employing a frozen section in at least one site were identified. In 94.3% of cases, a definitive diagnosis of benign or malignant was made. The concordance of frozen section diagnoses of benign or malignant was 100% with final diagnoses. Thirteen of the eighty-eight cases were ultimately sent for molecular analysis. Of these, twelve of thirteen (92.3%) cases were adequate to perform all ordered molecular testing. In all cases there was sufficient tissue to perform EGFR and ALK testing. Conclusions In medical centers where ROSE may not be available, the use of FROSE by the local pathologist can be an effective technique to obtain adequate tissue and cytological samples for the diagnosis and molecular profiling of lung cancers. Further prospective study in bronchoscopic tissue sampling techniques to obtain the optimum quantity and quality of samples for molecular profiling of lung cancers for targeted treatments is needed. PMID:27606077
Bronchoscopic lung volume reduction with endobronchial valves for patients with heterogeneous emphysema and intact interlobar fissures (the BeLieVeR-HIFi trial): study design and rationale.
Davey, C; Zoumot, Z; Jordan, S; Carr, D H; Polkey, M I; Shah, P L; Hopkinson, N S
Although lung volume reduction surgery improves survival in selected patients with emphysema, there has been ongoing interest in developing and evaluating bronchoscopic approaches to try to reduce lung volumes with less morbidity and mortality. The placement of endobronchial valves is one such technique, and although some patients have had a significant improvement, responses have been inconsistent because collateral ventilation prevents lobar atelectasis. We describe the protocol of a trial (ISRCTN04761234) aimed to show that a responder phenotype, patients with heterogeneous emphysema and intact interlobar fissures on CT scanning, can be identified prospectively, leading to a consistent benefit in clinical practice. PMID:24664535
Peripheral giant cell granuloma.
Adlakha, V K; Chandna, P; Rehani, U; Rana, V; Malik, P
Peripheral giant cell granuloma is a benign reactive lesion of gingiva. It manifests as a firm, soft, bright nodule or as a sessile or pedunculate mass. This article reports the management of peripheral giant cell granuloma in a 12-year-old boy by surgical excision. PMID:21273719
A set of structured demonstrations of the vividness of peripheral color vision is provided by arrays of multicolored disks scaled with eccentricity. These demonstrations are designed to correct the widespread misconception that peripheral color vision is weak or nonexistent. PMID:27551354
Bronchoscopic diagnosis of pneumonia.
Baselski, V S; Wunderink, R G
Lower respiratory tract infections are characterized by significant morbidity and mortality but also by a relative inability to establish a specific etiologic agent on clinical grounds alone. With the recognized shortcomings of expectorated or aspirated secretions toward establishing an etiologic diagnosis, clinicians have increasingly used bronchoscopy to obtain diagnostic samples. A variety of specimen types may be obtained, including bronchial washes or brushes, protected specimen brushings, bronchoalveolar lavage, and transbronchial biopsies. Bronchoscopy has been applied in three primary clinical settings, including the immunocompromised host, especially human immunodeficiency virus-infected and organ transplant patients; ventilator-associated pneumonia; and severe, nonresolving community- or hospital-acquired pneumonia in nonventilated patients. In each clinical setting, and for each specimen type, specific laboratory protocols are required to provide maximal information. These protocols should provide for the use of a variety of rapid microscopic and quantitative culture techniques and the use of a variety of specific stains and selective culture to detect unusual organism groups. PMID:7834604
Bronchoscopic treatments for emphysema.
Delage, A; Marquette, C-H
In late stage chronic obstructive pulmonary disease, emphysema can worsen respiratory symptoms, not only via the loss of surface for gas exchange, but also via alterations in mechanical properties of the respiratory system (dynamic and static hyperinflation). Emphysematous lung volume reduction aims at improving respiratory mechanics and symptomatology in patients with advanced emphysema. Lung volume reduction surgery (LVRS) has been shown to be effective in selected patient populations, but its morbidity and costs are quite elevated. Alternatives to LVRS do not remove emphysematous lung tissue per se, but rather consist of devices aiming to: 1) reduce the volume that affected lung parenchyma occupies (unidirectional endobronchial valves or plugs, parenchymal injection of bioactive scarring agents); 2) redistribute ventilatory flow (airway bypass systems). Preliminary studies of these devices have shown that they are relatively safe. These also show modest benefits in exercise capacity, although individual subjects can experience spectacular improvement. Current objective is to identify predictors of response to therapy with such devices. PMID:22099415
Peripheral Neuropathy: Symptoms and Signs
... Research News Make a Difference Symptoms of Peripheral Neuropathy Print This Page Peripheral Neuropathy symptoms usually start ... slowly over many years. The symptoms of peripheral neuropathy often include: A sensation of wearing an invisible " ...
Occlusive Peripheral Arterial Disease
... artery. Such people should seek medical care immediately. Did You Know... When people suddenly develop a painful, ... In This Article Animation 1 Peripheral Arterial Disease Did You Know 1 Did You Know... Figure 1 ...
... Information Center Back to previous page En español Aneurysms and Dissections Angina Arrhythmia Bundle Branch Block Cardiomyopathy ... blockage including peripheral artery disease or PAD Aortic aneurysms Buerger's Disease Raynaud's Phenomenon Disease of the veins ...
Peripheral arterial disease (PAD) happens when there is a narrowing of the blood vessels outside of your heart. The cause of ... smoking. Other risk factors include older age and diseases like diabetes, high blood cholesterol, high blood pressure, ...
Peripheral artery bypass - leg
... P. Peripheral arterial diseases. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's ... noncoronary obstructive vascular disease.In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's ...
Peripheral Artery Disease (PAD)
... changes and medication . View an animation of atherosclerosis Atherosclerosis and PAD Atherosclerosis is a disease in which plaque builds up ... of an artery. PAD is usually caused by atherosclerosis in the peripheral arteries (or outer regions away ...
Permanent Peripheral Neuropathy
Higgins, Elizabeth
The health risks and side effects of fluoroquinolone use include the risk of tendon rupture and myasthenia gravis exacerbation, and on August 15, 2013, the Food and Drug Administration updated its warning to include the risk of permanent peripheral neuropathy. We present a case of fluoroquinolone-induced peripheral neuropathy in a patient treated for clinically diagnosed urinary tract infection with ciprofloxacin antibiotic. PMID:26425618
Endotracheal tube intubation with the aid of a laryngeal mask airway, a fiberoptic bronchoscope, and a tube exchanger in a difficult airway patient: a case report.
Sung, Joon Kyung; Kim, Hyung Gon; Kim, Jung Eun; Jang, Myung-Soo; Kang, Jong-Man
A 28-year-old male patient with occipito-atlanto-axial instability underwent a cervical fusion with posterior technique. Post-operatively, the endotracheal tube (ETT) was removed, and the patient was transferred to the intensive care unit. After transfer, an upper airway obstruction developed and reintubations with a laryngoscope were attempted but failed. We inserted a #4 proseal laryngeal mask airway (LMA) and passed a 5.0 mm ETT through the LMA with the aid of a fiberoptic bronchoscope. We passed a tube exchanger through the 5.0 mm ETT and exchanged it with a 7.5 mm ETT. This method may be a useful alternative for difficult tracheal intubations. PMID:24729847
A randomized trial to assess the utility of preintubation adult fiberoptic bronchoscope assessment in patients for thoracic surgery requiring one-lung ventilation
Amin, Nayana; Tarwade, Pritee; Shetmahajan, Madhavi; Pramesh, C. S.; Jiwnani, Sabita; Mahajan, Abhishek; Purandare, Nilendu
Background: Confirmation of placement of Double lumen endobronchial tubes (DLETT) and bronchial blockers (BBs) with the pediatric fiberoptic bronchoscope (FOB) is the most preferred practice worldwide. Most centers possess standard adult FOBs, some, particularly in developing countries might not have access to the pediatric-sized devices. We have evaluated the role of preintubation airway assessment using the former, measuring the distance from the incisors to the carina and from carina to the left and right upper lobe bronchus in deciding the depth of insertion of the lung isolation device. Methods: The study was a randomized, controlled, double-blind trial consisting of 84 patients (all >18 years) undergoing thoracic surgery over a 12-month period. In the study group (n = 38), measurements obtained during FOB with the adult bronchoscope decided the depth of insertion of the lung isolation device. In the control group (n = 46), DLETTs and BBs were placed blindly followed by clinical confirmation by auscultation. Selection of the type and size of the lung isolation device was at the discretion of the anesthesiologist conducting the case. In all cases, pediatric FOB was used to confirm accurate placement of devices. Results: Of 84 patients (DLETT used in 76 patients; BB used in 8 patients), preintubation airway measurements significantly improved the success rate of optimal placement of lung isolation device from 25% (11/44) to 50% (18/36) (P = 0.04). Our incidence of failed device placement at initial insertion was 4.7% (4/84). Incidence of malposition was 10% (8/80) with 4 cases in each group. The incidence of suboptimal placement was lower in the study group at 38.9% (14/36) versus 65.9% (29/44). Conclusions: Preintubation airway measurements with the adult FOB reduces airway manipulations and improves the success rate of optimal placement of DLETT and BB. PMID:27052065
Peripheral doses from pediatric IMRT
Klein, Eric E.; Maserang, Beth; Wood, Roy; Mansur, David
Peripheral dose (PD) data exist for conventional fields ({>=}10 cm) and intensity-modulated radiotherapy (IMRT) delivery to standard adult-sized phantoms. Pediatric peripheral dose reports are limited to conventional therapy and are model based. Our goal was to ascertain whether data acquired from full phantom studies and/or pediatric models, with IMRT treatment times, could predict Organ at Risk (OAR) dose for pediatric IMRT. As monitor units (MUs) are greater for IMRT, it is expected IMRT PD will be higher; potentially compounded by decreased patient size (absorption). Baseline slab phantom peripheral dose measurements were conducted for very small field sizes (from 2 to 10 cm). Data were collected at distances ranging from 5 to 72 cm away from the field edges. Collimation was either with the collimating jaws or the multileaf collimator (MLC) oriented either perpendicular or along the peripheral dose measurement plane. For the clinical tests, five patients with intracranial or base of skull lesions were chosen. IMRT and conventional three-dimensional (3D) plans for the same patient/target/dose (180 cGy), were optimized without limitation to the number of fields or wedge use. Six MV, 120-leaf MLC Varian axial beams were used. A phantom mimicking a 3-year-old was configured per Center for Disease Control data. Micro (0.125 cc) and cylindrical (0.6 cc) ionization chambers were appropriated for the thyroid, breast, ovaries, and testes. The PD was recorded by electrometers set to the 10{sup -10} scale. Each system set was uniquely calibrated. For the slab phantom studies, close peripheral points were found to have a higher dose for low energy and larger field size and when MLC was not deployed. For points more distant from the field edge, the PD was higher for high-energy beams. MLC orientation was found to be inconsequential for the small fields tested. The thyroid dose was lower for IMRT delivery than that predicted for conventional (ratio of IMRT/cnventional ranged
Mizbah, K; Soehardi, A; Maal, T J J; Weijs, W L J; Merkx, M A W; Barkhuysen, R
A 43-year-old man appeared with a painless, asymptomatic swelling on the left side of his neck, which had existed for years and had slowly been progressing. After surgical removal, it became clear that it had to do with a peripheral osteoma. This is a benign lesion with a low incidence. Generally, complete surgical removal leads to cure, although recurrence is possible. A peripheral osteoma is mostly located in the mandible, although peripheral osteomata in the frontal or maxillary sinus have been described. The aetiology is unknown. Trauma in the patient's history has been described on occasion. The presence of multiple osteomata in the jawbones is characteristic of Gardner's syndrome. PMID:22428273
Painful Peripheral Neuropathies
Marchettini, P; Lacerenza, M; Mauri, E; Marangoni, C
Peripheral neuropathies are a heterogeneous group of diseases affecting peripheral nerves. The causes are multiple: hereditary, metabolic, infectious, inflammatory, toxic, traumatic. The temporal profile includes acute, subacute and chronic conditions. The majority of peripheral neuropathies cause mainly muscle weakness and sensory loss, positive sensory symptoms and sometimes pain. When pain is present, however, it is usually extremely intense and among the most disabling symptoms for the patients. In addition, the neurological origin of the pain is often missed and patients receive inadequate or delayed specific treatment. Independently of the disease causing the peripheral nerve injury, pain originating from axonal pathology or ganglionopathy privileges neuropathies affecting smaller fibres, a clinical observation that points towards abnormal activity within nociceptive afferents as a main generator of pain. Natural activation of blood vessels or perineurial nociceptive network by pathology also causes intense pain. Pain of this kind, i.e. nerve trunk pain, is among the heralding symptoms of inflammatory or ischemic mononeuropathy and for its intensity represents itself a medical emergency. Neuropathic pain quality rekindles the psychophysical experience of peripheral nerves intraneural microstimulation i.e. a combination of large and small fibres sensation temporally distorted compared to physiological perception evoked by natural stimuli. Pins and needles, burning, cramping mixed with numbness, and tingling are the wording most used by patients. Nociceptive pain instead is most often described as aching, deep and dull. Good command of peripheral nerve anatomy and pathophysiology allows timely recognition of the different pain components and targeted treatment, selected according to intensity, type and temporal profile of the pain. PMID:18615140
Inherited Peripheral Neuropathies
Saporta, Mario A.; Shy, Michael E.
SYNOPSIS Charcot Marie Tooth disease (CMT) is a heterogeneous group of inherited peripheral neuropathies in which the neuropathy is the sole or primary component of the disorder, as opposed to diseases in which the neuropathy is part of a more generalized neurological or multisystem syndrome. Due to the great genetic heterogeneity of this condition, it can be challenging for the general neurologist to diagnose patients with specific types of CMT. Here, we review the biology of the inherited peripheral neuropathies, delineate major phenotypic features of the CMT subtypes and suggest strategies for focusing genetic testing. PMID:23642725
Prolonged increased responsiveness of canine peripheral airways after exposure to O/sub 3/
Beckett, W.S.; Freed, A.N.; Turner, C.; Menkes, H.A.
Because it is relatively insoluble, the oxidant gas O3 may penetrate to small peripheral airways when it is inhaled. Increased responsiveness in large airways after O3 breathing has been associated with the presence of inflammatory cells. To determine whether O3 produces prolonged hyperresponsiveness of small airways associated with the presence of inflammatory cells, we exposed the peripheral lungs of anesthetized dogs to 1.0 ppm O3 for 2 h using a wedged bronchoscope technique. A contralateral sublobar segment was simultaneously exposed to air as a control. In the O3-exposed segments, collateral resistance (Rcs) was increased within 15 min and remained elevated approximately 150% throughout the 2-h exposure period. Fifteen hours later, the base-line Rcs of the O3-exposed sublobar segments was significantly elevated, and these segments demonstrated increased responsiveness to aerosolized acetylcholine (100 and 500 micrograms/ml). There were no differences in neutrophils, mononuclear cells, or mast cells (numbers or degree of mast cell degranulation) between O3 and air-exposed airways at 15 h. The small airways of the lung periphery thus are capable of remaining hyperresponsive hours after cessation of localized exposure to O3, but this does not appear to be dependent on the presence of inflammatory cells in the small airway wall.
Barriers of the peripheral nerve
Peltonen, Sirkku; Alanne, Maria; Peltonen, Juha
This review introduces the traditionally defined anatomic compartments of the peripheral nerves based on light and electron microscopic topography and then explores the cellular and the most recent molecular basis of the different barrier functions operative in peripheral nerves. We also elucidate where, and how, the homeostasis of the normal human peripheral nerve is controlled in situ and how claudin-containing tight junctions contribute to the barriers of peripheral nerve. Also, the human timeline of the development of the barriers of the peripheral nerve is depicted. Finally, potential future therapeutic modalities interfering with the barriers of the peripheral nerve are discussed. PMID:24665400
Treatment of peripheral neuropathies.
Hallett, M; Tandon, D; Berardelli, A
There are three general approaches to treatment of peripheral neuropathy. First, an attempt should be made to reverse the pathophysiological process if its nature can be elucidated. Second, nerve metabolism can be stimulated and regeneration encouraged. Third, even if the neuropathy itself cannot be improved, symptomatic therapy can be employed. This review outlines the options available for each approach. PMID:3003254
Assal, J.P.; Liniger, C.
The authors present results and experience in sixteen specific disciplines related to the study of nerve physiopathology, diagnosis and treatment. Twenty-two different peripheral neuropathies are presented, and different models related to health care strategies are discussed. The authors report on Inflammatory and autoimmune neuropathies and Genetic neuropathies.
Efficacy and safety of electromagnetic navigation bronchoscopy with or without radial endobronchial ultrasound for peripheral lung lesions
Ozgul, Guler; Cetinkaya, Erdogan; Ozgul, Mehmet Akif; Abul, Yasin; Gencoglu, Atayla; Kamiloglu, Emine; Gul, Sule; Dincer, H. Erhan
Background and Objectives: Electromagnetic navigation bronchoscopy (ENB) is a promising new technology to increase the diagnostic yield of peripheral lung and mediastinal lesions. Conventional flexible bronchoscopy has a limited yield in peripheral pulmonary lesions, even in experienced hands. Radial endobronchial ultrasound (r-EBUS) with its real-time imaging capability can help to diagnose peripheral pulmonary lesions. In the present study, we aimed to investigate the diagnostic yield and safety of ENB with or without r-EBUS for peripheral lung lesions. Materials and Methods: This study was conducted in a tertiary medical center, and 56 consecutive patients who were thought to be the best candidates for bronchoscopic biopsies at a multidisciplinary meeting were enrolled. ENB was performed under conscious sedation by using an electromagnetic tracking system with multiplanar reconstruction of previously acquired computed tomography (CT) data. Sampling was performed by biopsy forceps, endobronchial brush, and bronchoalveolar lavage. Results: Fifty-six patients (50 men and 6 women; mean age, 60 ± 9 years) were studied. While an electromagnetic navigation system was used in all patients, r-EBUS was used in 26 of 56 patients. The median diameter of the lesions was 30 mm (interquartile range: 23-44 mm). Mean distance of the lesions from the pleura was 14.9 ± 14.6 mm. Mean procedure time was 20 ± 11.5 min. Mean registration error was 5.8 ± 1.5 mm. Mean navigation error was 1.2 ± 0.5 mm. The diagnostic yield of the procedure was 71.4% for peripheral lesions (non-small cell lung cancer = 23, small cell lung cancer = 3, benign diseases = 14). Pneumothorax occurred in only 1 patient (1.7%). Conclusion: ENB with or without r-EBUS is a safe, efficient, and easily applied method for sampling of peripheral lung lesions, with high diagnostic yield independent of lesion size and location. PMID:27386477
Peripheral Artery Disease and Diabetes
... High Blood Pressure Tools & Resources Stroke More Peripheral Artery Disease & Diabetes Updated:Jan 26,2016 People with ... developing atherosclerosis, the most common cause of peripheral artery disease (PAD) . And individuals with PAD have a ...
Angioplasty and stent placement -- peripheral arteries
Percutaneous transluminal angioplasty - peripheral artery; PTA - peripheral artery; Angioplasty - peripheral arteries; Iliac artery -angioplasty; Femoral artery - angioplasty; Popliteal artery - angioplasty; Tibial artery - angioplasty; Peroneal artery - ...
SU-C-BRA-07: Virtual Bronchoscopy-Guided IMRT Planning for Mapping and Avoiding Radiation Injury to the Airway Tree in Lung SAbR
Sawant, A; Modiri, A; Bland, R; Yan, Y; Ahn, C; Timmerman, R
Purpose: Post-treatment radiation injury to central and peripheral airways is a potentially important, yet under-investigated determinant of toxicity in lung stereotactic ablative radiotherapy (SAbR). We integrate virtual bronchoscopy technology into the radiotherapy planning process to spatially map and quantify the radiosensitivity of bronchial segments, and propose novel IMRT planning that limits airway dose through non-isotropic intermediate- and low-dose spillage. Methods: Pre- and ∼8.5 months post-SAbR diagnostic-quality CT scans were retrospectively collected from six NSCLC patients (50–60Gy in 3–5 fractions). From each scan, ∼5 branching levels of the bronchial tree were segmented using LungPoint, a virtual bronchoscopic navigation system. The pre-SAbR CT and the segmented bronchial tree were imported into the Eclipse treatment planning system and deformably registered to the planning CT. The five-fraction equivalent dose from the clinically-delivered plan was calculated for each segment using the Universal Survival Curve model. The pre- and post-SAbR CTs were used to evaluate radiation-induced segmental collapse. Two of six patients exhibited significant segmental collapse with associated atelectasis and fibrosis, and were re-planned using IMRT. Results: Multivariate stepwise logistic regression over six patients (81 segments) showed that D0.01cc (minimum point dose within the 0.01cc receiving highest dose) was a significant independent factor associated with collapse (odds-ratio=1.17, p=0.010). The D0.01cc threshold for collapse was 57Gy, above which, collapse rate was 45%. In the two patients exhibiting segmental collapse, 22 out of 32 segments showed D0.01cc >57Gy. IMRT re-planning reduced D0.01cc below 57Gy in 15 of the 22 segments (68%) while simultaneously achieving the original clinical plan objectives for PTV coverage and OAR-sparing. Conclusion: Our results indicate that the administration of lung SAbR can Result in significant injury to
Ultrasound of Peripheral Nerves
Suk, Jung Im; Walker, Francis O.; Cartwright, Michael S.
Over the last decade, neuromuscular ultrasound has emerged as a useful tool for the diagnosis of peripheral nerve disorders. This article reviews sonographic findings of normal nerves including key quantitative ultrasound measurements that are helpful in the evaluation of focal and possibly generalized peripheral neuropathies. It also discusses several recent papers outlining the evidence base for the use of this technology, as well as new findings in compressive, traumatic, and generalized neuropathies. Ultrasound is well suited for use in electrodiagnostic laboratories where physicians, experienced in both the clinical evaluation of patients and the application of hands-on technology, can integrate findings from the patient's history, physical examination, electrophysiological studies, and imaging for diagnosis and management. PMID:23314937
Immunotherapy in Peripheral Neuropathies.
Léger, Jean-Marc; Guimarães-Costa, Raquel; Muntean, Cristina
Immunotherapy has been investigated in a small subset of peripheral neuropathies, including an acute one, Guillain-Barré syndrome, and 3 chronic forms: chronic inflammatory demyelinating polyradiculoneuropathy, multifocal motor neuropathy, and neuropathy associated with IgM anti-myelin-associated glycoprotein. Several experimental studies and clinical data are strongly suggestive of an immune-mediated pathogenesis. Either cell-mediated mechanisms or antibody responses to Schwann cell, compact myelin, or nodal antigens are considered to act together in an aberrant immune response to cause damage to peripheral nerves. Immunomodulatory treatments used in these neuropathies aim to act at various steps of this pathogenic process. However, there are many phenotypic variants and, consequently, there is a significant difference in the response to immunotherapy between these neuropathies, as well as a need to improve our knowledge and long-term management of chronic forms. PMID:26602549
[Ganglia of peripheral nerves].
Tatagiba, M; Penkert, G; Samii, M
The authors present two different types of ganglion affecting the peripheral nerves: extraneural and intraneural ganglion. Compression of peripheral nerves by articular ganglions is well known. The surgical management involves the complete removal of the lesion with preservation of most nerve fascicles. Intraneural ganglion is an uncommon lesion which affects the nerve diffusely. The nerve fascicles are usually intimately involved between the cysts, making complete removal of all cysts impossible. There is no agreement about the best surgical management to be applied in these cases. Two possibilities are available: opening of the epineural sheath lengthwise and pressing out the lesion; or resection of the affected part of the nerve and performing a nerve reconstruction. While in case of extraneural ganglion the postoperative clinical evolution is very favourable, only long follow up studies will reveal in case of intraneural ganglion the best surgical approach. PMID:8128785
Introduction Up to 20% of adults aged over 55 years have detectable peripheral arterial disease of the legs, but this may cause symptoms of intermittent claudication in only a small proportion of affected people. The main risk factors are smoking and diabetes mellitus, but other risk factors for cardiovascular disease are also associated with peripheral arterial disease. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for people with chronic peripheral arterial disease? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2009. (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 59 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: antiplatelet agents; bypass surgery; cilostazol; exercise; pentoxifylline; percutaneous transluminal angioplasty (PTA); prostaglandins; smoking cessation; and statins. PMID:19454099
Introduction Up to 20% of adults aged over 55 years have detectable peripheral arterial disease of the legs, but this may cause symptoms of intermittent claudication in only a small proportion of affected people. The main risk factors are smoking and diabetes mellitus, but other risk factors for cardiovascular disease are also associated with peripheral arterial disease. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for people with chronic peripheral arterial disease? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2010. Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review. We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 70 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: antiplatelet agents, bypass surgery, cilostazol, exercise, pentoxifylline, percutaneous transluminal angioplasty (PTA), prostaglandins, smoking cessation, and statins. PMID:21477401
Randomised controlled trial comparing the Ambu® aScope™2 with a conventional fibreoptic bronchoscope in orotracheal intubation of anaesthetised adult patients.
Chan, J K; Ng, I; Ang, J P; Koh, S M; Lee, K; Mezzavia, P; Morris, J; Loh, F; Segal, R
Fibreoptic intubation remains an essential skill for anaesthetists to master. In addition to the reusable fibrescope, an alternative disposable videoscope is available (aScope(™)2, Ambu®, Ballerup, Denmark). A total of 60 anaesthetised adult patients were randomised to either having orotracheal intubation using the aScope 2 or a Karl Storz fibrescope. Intubations were performed by experienced operators who were familiar with both devices. The primary outcome was the Global Rating Scale score. Secondary outcomes included intubation success, number of intubation attempts and intubation time. Other subjective outcomes including practicality, useability and image quality were also recorded. There was no significant difference in the Global Rating Scale score, intubation success orintubation time between the aScope 2 or Karl Storz fibrescope. Global Rating Scale scores were three and two in the aScope 2 and Karl Storz groups respectively (P=0.14). All of the other subjective outcomes were similar between the two groups, except that operators found it easier to use the aScope 2 compared to the fibrescope. There was no significant difference in clinical performance between the aScope 2 and the Karl Storz fibreoptic bronchoscope. The aScope's practicality, disposability and recently improved version (aScope(™)3) potentially make it an acceptable alternative to the reusable fibrescope. PMID:26099760
Non-fermentative gram-negative bacteria in hospital tap water and water used for haemodialysis and bronchoscope flushing: prevalence and distribution of antibiotic resistant strains.
Vincenti, Sara; Quaranta, Gianluigi; De Meo, Concetta; Bruno, Stefania; Ficarra, Maria Giovanna; Carovillano, Serena; Ricciardi, Walter; Laurenti, Patrizia
This study provides a detailed description of the distribution of non-fermentative gram-negative bacteria (NFGNB) collected in water sources (tap water and water used for haemodialysis and bronchoscope flushing) from different wards of a tertiary care hospital. The aim is to identify risk practices for patients or to alert clinicians to the possible contamination of environment and medical devices. The resistance profile of NFGNB environmental isolates has shown that more than half (55.56%) of the strains isolated were resistant to one or more antibiotics tested in different antimicrobial categories. In particular, 38.89% of these strains were multidrug resistant (MDR) and 16.67% were extensively drug resistant (XDR). The most prevalent bacterial species recovered in water samples were Pseudomonas aeruginosa, Pseudomonas fluorescens, Ralstonia pickettii and Stenotrophomonas maltophilia. Analysis of antibiotic resistance rates has shown remarkable differences between Pseudomonadaceae (P. aeruginosa and P. fluorescens) and emerging pathogens, such as S. maltophilia and R. pickettii. Multidrug resistance can be relatively common among nosocomial isolates of P. aeruginosa, which represent the large majority of clinical isolates; moreover, our findings highlight that the emergent antibiotic resistant opportunistic pathogens, such as R. pickettii and S. maltophilia, isolated from hospital environments could be potentially more dangerous than other more known waterborne pathogens, if not subjected to surveillance to direct the decontamination procedures. PMID:25173861
[Chemotherapy induced peripheral neuropathy].
Kolak, Agnieszka; Starosławska, Elzbieta; Kubiatowski, Tomasz; Kieszko, Dariusz; Cisek, Paweł; Patyra, Krzysztof Ireneusz; Surdyka, Dariusz; Mocarska, Agnieszka; Burdan, Franciszek
Modern cancer therapy prolongs patients life but commonly increases incidence of treatment-related complications. One of such adverse effect is a neurotoxicity, which usually manifestates as peripheral neuropathies (CIPN), characterised by various sensory (tingling, numbness, pain), motor (foot and hands drop, fastening buttons difficulties) and autonomic (constipation, arythmia) abnormalities as well as pain. Despite of intensive epidemiological and clinical studies, standardized diagnostic criteria and methods of the neuropathy prevention and treatment have not been fully established. The most commonly used form of treatment is symptomatic therapy, including anticonvulsant and antidepressant drugs. Proper education of patients and their families of symptoms and neuropathy consequences is desirable to reduce anxiety and stress. PMID:24575651
Peripheral Doses from Noncoplanar IMRT for Pediatric Radiation Therapy
Kan, Monica W.K.; Leung, Lucullus H.T.; Kwong, Dora L.W.; Wong, Wicger; Lam, Nelson
The use of noncoplanar intensity-modulated radiation therapy (IMRT) might result in better sparing of some critical organs because of a higher degree of freedom in beam angle optimization. However, this can lead to a potential increase in peripheral dose compared with coplanar IMRT. The peripheral dose from noncoplanar IMRT has not been previously quantified. This study examines the peripheral dose from noncoplanar IMRT compared with coplanar IMRT for pediatric radiation therapy. Five cases with different pediatric malignancies in head and neck were planned with both coplanar and noncoplanar IMRT techniques. The plans were performed such that the tumor coverage, conformality, and dose uniformity were comparable for both techniques. To measure the peripheral doses of the 2 techniques, thermoluminescent dosimeters (TLD) were placed in 10 different organs of a 5-year-old pediatric anthropomorphic phantom. With the use of noncoplanar beams, the peripheral doses to the spinal cord, bone marrow, lung, and breast were found to be 1.8-2.5 times of those using the coplanar technique. This is mainly because of the additional internal scatter dose from the noncoplanar beams. Although the use of noncoplanar technique can result in better sparing of certain organs such as the optic nerves, lens, or inner ears depending on how the beam angles were optimized on each patient, oncologists should be alert of the possibility of significantly increasing the peripheral doses to certain radiation-sensitive organs such as bone marrow and breast. This might increase the secondary cancer risk to patients at young age.
Peripheral neuropathies during biologic therapies.
Yagita, Masato; Hamano, Toshiaki; Hatachi, Saori; Fujita, Masaaki
Peripheral neuropathies should be recognized as the adverse effects of biological agents, especially anti-TNF agents. However, no solid clinical databases for biological agent-associated peripheral neuropathies (BAPN) have been established in Japan. Here we report two cases of peripheral neuropathy associated with anti-TNF agents. One was peroneal motor neuropathy. The other case was chronic inflammatory demyelinating polyradiculoneuropathy. In addition, we summarize the previous reports on BAPN and discuss their prevalence rate, pathogenesis and management. PMID:24313920
Aerosol delivery and safety of recombinant human deoxyribonuclease in young children with cystic fibrosis: a bronchoscopic study. Pulmozyme Pediatric Broncoscopy Study Group.
Wagener, J S; Rock, M J; McCubbin, M M; Hamilton, S D; Johnson, C A; Ahrens, R C
The purpose of this study was to assess the delivery to the lungs and the short-term safety of recombinant human deoxyribonuclease (rhDNase, Pulmozyme) in children with cystic fibrosis younger than 5 years of age compared with older children. Patients between the ages of 3 months and 10 years had bronchoscopic examination with bronchoalveolar lavage (BAL) after administration of an aerosol dose of 2.5 mg of rhDNase. After recovery from the procedure, patients were discharged home for an additional 13 days of rhDNase therapy. During this time adverse events were recorded to assess short-term safety. A total of 98 patients were enrolled, 65 (66%) aged 3 months to 5 years and 33 (34%) aged 5 years to 10 years. Deoxyribonuclease concentrations in BAL fluid were variable (interquartile range, 752 to 3943 micrograms/mL epithelial lining fluid [ELF]) and did not depend on patient age, weight, or height or differ when delivered through a mouthpiece or mask. The median value for the BAL DNA concentration in the younger group was 432 micrograms/mL ELF compared with 703 micrograms/mL ELF in the older patients. This study demonstrates the value of bronchoscopy and BAL for assessing nebulized medication delivery in young children and shows that aerosolized medications can be delivered to and are present in comparable amounts in the lower airways of younger and older children. Exposure to rhDNase appears to be safe over 2 weeks in infants and young children with cystic fibrosis. PMID:9787685
Comparison of hemodynamic responses to intubation: Flexible fiberoptic bronchoscope versus McCoy laryngoscope in presence of rigid cervical collar simulating cervical immobilization for traumatic cervical spine
Gill, Nitesh; Purohit, Shobha; Kalra, Poonam; Lall, Tarun; Khare, Avneesh
Background: Intubation is known to cause an exaggerated hemodynamic response in the form of tachycardia, hypertension, and dysrhythmias. In cervical spine instability, intubation has to be performed using cervical immobilization to prevent exacerbation of spinal cord injuries. Application of rigid cervical collar may reduce cervical spine movements, but it hinders tracheal intubation with a standard laryngoscope. The aim of this study was to compare the hemodynamic responses to fiberoptic bronchoscope (FOB) and McCoy laryngoscope in patients undergoing elective surgery under general anesthesia with rigid cervical collar simulating cervical spine immobilization in the situation of cervical trauma. Methods: Thirty-two patients in the age range 20–50 years, of American Society of Anaesthesiologist I-II, and of either sex undergoing elective surgery under general anesthesia were randomly allocated into each group. There were two groups according to the technique used for intubation: Group A (flexible FOB) and Group B (McCoy laryngoscope). Systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and heart rate (HR) were recorded at baseline, intraoperatively, immediately before and after induction, and immediately after intubation. Thereafter, every min for next 5 min. Statistical Analysis: Intergroup comparison of categorical data was done by Chi-square test. P < 0.05 was considered statistically significant. Intergroup comparison of quantitative data was done by the parametric test (unpaired t-test), and probability was considered to be significant if <0.05. Results: Due to intubation response, HR and blood pressure increased significantly (P < 0.05) above preoperative values in McCoy group as compared to the fiberoptic group. Conclusion: We suggest that the flexible FOB is an effective and better method of intubation in a situation like traumatic cervical spine injury and provides stable hemodynamics. PMID:26712970
Peripherally Silylated Porphyrins.
Kato, Kenichi; Fujimoto, Keisuke; Yorimitsu, Hideki; Osuka, Atsuhiro
Silylation of peripherally lithiated porphyrins with silyl electrophiles has realized the first synthesis of a series of directly silyl-substituted porphyrins. The meso-silyl group underwent facile protodesilylation, whereas the β-silyl group was entirely compatible with standard work-up and purification on silica gel. The meso-silyl group caused larger substituent effects to the porphyrin compared with the β-silyl group. Silylation of β-lithiated porphyrins with 1,2-dichlorodisilane furnished β-to-β disilane-bridged porphyrin dimers. A doubly β-to-β disilane-bridged Ni(II)-porphyrin dimer was also synthesized from a β,β-dilithiated Ni(II)-porphyrin and characterized by X-ray crystallographic analysis to take a steplike structure favorable for interporphyrinic interaction. Denickelation of β-silylporphyrins was achieved upon treatment with a 4-tolylmagnesium bromide to yield the corresponding freebase porphyrins. PMID:26356498
Autoimmune peripheral neuropathies.
Bourque, Pierre R; Chardon, Jodi Warman; Massie, Rami
Peripheral nervous system axons and myelin have unique potential protein, proteolipid, and ganglioside antigenic determinants. Despite the existence of a blood-nerve barrier, both humoral and cellular immunity can be directed against peripheral axons and myelin. Molecular mimicry may be triggered at the systemic level, as was best demonstrated in the case of bacterial oligosaccharides. The classification of immune neuropathy has been expanded to take into account specific syndromes that share unique clinical, electrophysiological, prognostic and serological features. Guillain-Barré syndrome encompasses a classical syndrome of acute demyelinating polyradiculoneuropathy and many variants: axonal motor and sensory, axonal motor, Miller-Fisher, autonomic, and sensory. Similarly, chronic immune neuropathy is composed of classic chronic inflammatory demyelinating polyradiculoneuropathy and variants characterized as multifocal (motor or sensorimotor), sensory, distal symmetric, and syndromes associated with monoclonal gammopathy. Among putative biomarkers, myelin associated glycoprotein and several anti-ganglioside autoantibodies have shown statistically significant associations with specific neuropathic syndromes. Currently, the strongest biomarker associations are those linking Miller-Fisher syndrome with anti-GQ1b, multifocal motor neuropathy with anti-GM1, and distal acquired symmetric neuropathy with anti-MAG antibodies. Many other autoantibody associations have been proposed, but presently lack sufficient specificity and sensitivity to qualify as biomarkers. This field of research has contributed to the antigenic characterization of motor and sensory functional systems, as well as helping to define immune neuropathic syndromes with widely different clinical presentation, prognosis and response to therapy. Serologic biomarkers are likely to become even more relevant with the advent of new targeted forms of immunotherapy, such as monoclonal antibodies. PMID:25748038
Tendon Transfers for Combined Peripheral Nerve Injuries.
Makarewich, Christopher A; Hutchinson, Douglas T
Combined peripheral nerve injuries present a unique set of challenges to the hand surgeon when considering tendon transfers. They are often associated with severe soft tissue trauma, including lacerations to remaining innervated muscles and tendons, significant scar formation, and substantial sensory loss. In the case of combined nerve injuries, there are typically fewer options for tendon transfers due to fewer tendons of shared function that are expendable as well as associated injuries to tendon or muscle bellies. As such, careful preoperative planning must be performed to make the most of remaining muscle tendon units. PMID:27387081
Factors Affecting the Diagnostic Yield of Transbronchial Biopsy Using Endobronchial Ultrasonography with a Guide Sheath in Peripheral Lung Cancer.
Okachi, Shotaro; Imai, Naoyuki; Imaizumi, Kazuyoshi; Iwano, Shingo; Ando, Masahiko; Hase, Tetsunari; Aso, Hiromichi; Morise, Masahiro; Wakahara, Keiko; Ito, Satoru; Hashimoto, Naozumi; Sato, Mitsuo; Kondo, Masashi; Hasegawa, Yoshinori
Objective Endobronchial ultrasonography with a guide sheath (EBUS-GS) and virtual bronchoscopic navigation (VBN) improves the diagnostic yield in patients with peripheral pulmonary lesions (PPLs). Most previous reports on EBUS-GS-guided transbronchial biopsy (TBB) have included patients with benign and malignant diseases. We aimed to determine the factors that predicted a successful diagnosis by EBUS-GS-guided TBB diagnostic in patients with small peripheral lung cancer, with a focus on the high-resolution computed tomography (HRCT) findings before bronchoscopy. Methods We retrospectively reviewed the medical records of 173 consecutive patients with 175 small (≤30 mm) PPLs who were diagnosed with primary lung cancer between June 2010 and October 2013 at Nagoya University Hospital. All patients underwent EBUS-GS-guided TBB with VBN using a ZioStation computer workstation (Ziosoft, Osaka, Japan). We analyzed the patient characteristics, HRCT findings, diagnostic yield, and the diagnostic factors in small peripheral lung carcinoma. Results The EBUS probe position was within the PPL in 83 of the 175 lesions (47%) and 112 (64.0%) cases were successfully diagnosed by EBUS-GS-guided TBB. A univariate analysis revealed that the following factors were associated with a significantly higher diagnostic yield: CT bronchus sign positivity, a lesion of >20 mm in diameter, a solid nodule, and a probe position that was within the lesion. The following factors were not significant: the lesion location, the number of biopsies, and the lung cancer histology. A multivariate analysis revealed that the following factors significantly affected the diagnostic yield: CT bronchus sign positivity [odds ratio (OR) =2.479]; a probe position that was within the lesion (OR=2.542); and a solid nodule (OR=2.304). Conclusion The significant factors that were significantly associated with a successful diagnosis using EBUS-GS-guided TBB in small peripheral lung carcinoma were as follows: CT
Gabbai, Alberto Alain; Castelo, Adauto; Oliveira, Acary Souza Bulle
Peripheral neuropathies are the most common neurological manifestations occurring in HIV-infected individuals. Distal symmetrical sensory neuropathy is the most common form encountered today and is one of the few that are specific to HIV infection or its treatment. The wide variety of other neuropathies is akin to the neuropathies seen in the general population and should be managed accordingly. In the pre-ART era, neuropathies were categorized according to the CD4 count and HIV viral load. In the early stages of HIV infection when CD4 count is high, the inflammatory demyelinating neuropathies predominate and in the late stages with the decline of CD4 count opportunistic infection-related neuropathies prevail. That scenario has changed with the present almost universal use of ART (antiretroviral therapy). Hence, HIV-associated peripheral neuropathies are better classified according to their clinical presentations: distal symmetrical polyneuropathy, acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), mononeuropathies, mononeuropathies multiplex and cranial neuropathies, autonomic neuropathy, lumbosacral polyradiculomyelopathy, and amyotrophic lateral sclerosis (ALS)-like motor neuropathy. Treated with ART, HIV-infected individuals are living longer and are at a higher risk of metabolic and age-related complications; moreover they are also prone to the potentially neurotoxic effects of ART. There are no epidemiological data regarding the incidence and prevalence of the peripheral neuropathies. In the pre-ART era, most data were from case reports, series of patients, and pooled autopsy data. At that time the histopathological evidence of neuropathies in autopsy series was almost 100%. In large prospective cohorts presently being evaluated, it has been found that 57% of HIV-infected individuals have distal symmetrical sensory neuropathy and 38% have neuropathic pain. It is now clear that
Peripheral Mechanisms of Itch.
Azimi, Ehsan; Xia, Jimmy; Lerner, Ethan A
A multitude of exogenous environmental stimuli and endogenous molecular and cellular components interface directly or indirectly with the free nerve endings of sensory nerves in the skin. Environmental stimuli include substances derived from the microbiome and materials, such as allergens, that otherwise come in contact with the skin. Endogenous stimuli include components of or mediators derived from the epidermal barrier, keratinocytes, mast cells, and additional resident and skin-homing immune cells. The sensation of itch is ultimately provoked by mediators that interact with and activate pruriceptors on the sensory nerve fibers. These peripheral fibers convey signals from the skin to the dorsal root and trigeminal ganglia and on to the spinal cord and brain where central processing of the itch sensation occurs. A discussion of the nature and sources of itch stimuli and receptors in the periphery form the basis of this chapter. The development of drugs that target these processes is in the process of revolutionizing therapeutic approaches to itch. PMID:27578066
Epigenetics and Peripheral Artery Disease.
Golledge, Jonathan; Biros, Erik; Bingley, John; Iyer, Vikram; Krishna, Smriti M
The term epigenetics is usually used to describe inheritable changes in gene function which do not involve changes in the DNA sequence. These typically include non-coding RNAs, DNA methylation and histone modifications. Smoking and older age are recognised risk factors for peripheral artery diseases, such as occlusive lower limb artery disease and abdominal aortic aneurysm, and have been implicated in promoting epigenetic changes. This brief review describes studies that have associated epigenetic factors with peripheral artery diseases and investigations which have examined the effect of epigenetic modifications on the outcome of peripheral artery diseases in mouse models. Investigations have largely focused on microRNAs and have identified a number of circulating microRNAs associated with human peripheral artery diseases. Upregulating or antagonising a number of microRNAs has also been reported to limit aortic aneurysm development and hind limb ischemia in mouse models. The importance of DNA methylation and histone modifications in peripheral artery disease has been relatively little studied. Whether circulating microRNAs can be used to assist identification of patients with peripheral artery diseases and be modified in order to improve the outcome of peripheral artery disease will require further investigation. PMID:26888065
Managing a peripheral ossifying fibroma.
Kendrick, F; Waggoner, W F
The Peripheral Ossifying Fibroma is an inflammatory lesion which most often appears in twenty-five to thirty-four-year-old females. It averages 1.0 cm at its greatest dimension. This case reports a seven-year-eight-month-old female who presented with a peripheral ossifying fibroma lesion which measured 2.7 cm by 1.5 cm by 1.0 cm. A review of peripheral ossifying fibroma, and the management and postsurgical sequelae of this child are discussed. PMID:8708123
Malignant Peripheral Nerve Sheath Tumor.
James, Aaron W; Shurell, Elizabeth; Singh, Arun; Dry, Sarah M; Eilber, Fritz C
Malignant peripheral nerve sheath tumor (MPNST) is the sixth most common type of soft tissue sarcoma. Most MPNSTs arise in association with a peripheral nerve or preexisting neurofibroma. Neurofibromatosis type is the most important risk factor for MPNST. Tumor size and fludeoxyglucose F 18 avidity are among the most helpful parameters to distinguish MPNST from a benign peripheral nerve sheath tumor. The histopathologic diagnosis is predominantly a diagnosis of light microscopy. Immunohistochemical stains are most helpful to distinguish high-grade MPNST from its histologic mimics. Current surgical management of high-grade MPNST is similar to that of other high-grade soft tissue sarcomas. PMID:27591499
Peripheral artery bypass - leg - discharge
... P. Peripheral arterial diseases. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's ... noncoronary obstructive vascular disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's ...
About Peripheral Artery Disease (PAD)
... changes and medication . View an animation of atherosclerosis Atherosclerosis and PAD Atherosclerosis is a disease in which plaque builds up ... of an artery. PAD is usually caused by atherosclerosis in the peripheral arteries (or outer regions away ...
Peripheral Neuropathy and Agent Orange
... registry health exam . Research on peripheral neuropathy and herbicides The Health and Medicine Division (HMD) (formally known ... acute or subacute onset may be associated with herbicide exposure. Based on this evidence, VA presumed an ...
Management of peripheral arterial disease.
Gey, Daniela C; Lesho, Emil P; Manngold, Johannes
Peripheral arterial disease is common, but the diagnosis frequently is overlooked because of subtle physical findings and lack of classic symptoms. Screening based on the ankle brachial index using Doppler ultrasonography may be more useful than physical examination alone. Noninvasive modalities to locate lesions include magnetic resonance angiography, duplex scanning, and hemodynamic localization. Major risk factors for peripheral arterial disease are cigarette smoking, diabetes mellitus, older age (older than 40 years), hypertension, hyperlipidemia, and hyperhomocystinemia. Nonsurgical therapy for intermittent claudication involves risk-factor modification, exercise, and pharmacologic therapy. Based on available evidence, a supervised exercise program is the most effective treatment. All patients with peripheral arterial disease should undergo aggressive control of blood pressure, sugar intake, and lipid levels. All available strategies to help patients quit smoking, such as counseling and nicotine replacement, should be used. Effective drug therapies for peripheral arterial disease include aspirin (with or without dipyridamole), clopidogrel, cilostazol, and pentoxifylline. PMID:14971833
Bronchoscopic interventions for severe COPD
Browning, Robert F.; Parrish, Scott; Sarkar, Saiyad; Krimsky, William; Turner, J. Francis; Zarogoulidis, Konstantinos; Kougioumtzi, Ioanna; Dryllis, Georgios; Kioumis, Ioannis; Pitsiou, Georgia; Machairiotis, Nikolaos; Katsikogiannis, Nikolaos; Courcoutsakis, Nikolaos; Madesis, Athanasios; Diplaris, Konstantinos; Karaiskos, Theodoros
Chronic obstructive pulmonary disease (COPD) causes severe handicap among smokers. Most patients have to remain under continuous oxygen therapy at home. Moreover, respiratory infections are very common among these patients and vaccination is obligatory against influenza. Emphysema and bronchiectasis are observed with computed tomography (CT) and in several situations these parenchymal damages are responsible for pneumothorax in one case and pseudomonas aeroginosa infection. Novel mini-invasive techniques are used currently for emphysema treatments which are described extensively throughout our current work. PMID:25337396
Adaptive optics for peripheral vision
NASA Astrophysics Data System (ADS)
Rosén, R.; Lundström, L.; Unsbo, P.
Understanding peripheral optical errors and their impact on vision is important for various applications, e.g. research on myopia development and optical correction of patients with central visual field loss. In this study, we investigated whether correction of higher order aberrations with adaptive optics (AO) improve resolution beyond what is achieved with best peripheral refractive correction. A laboratory AO system was constructed for correcting peripheral aberrations. The peripheral low contrast grating resolution acuity in the 20° nasal visual field of the right eye was evaluated for 12 subjects using three types of correction: refractive correction of sphere and cylinder, static closed loop AO correction and continuous closed loop AO correction. Running AO in continuous closed loop improved acuity compared to refractive correction for most subjects (maximum benefit 0.15 logMAR). The visual improvement from aberration correction was highly correlated with the subject's initial amount of higher order aberrations (p = 0.001, R 2 = 0.72). There was, however, no acuity improvement from static AO correction. In conclusion, correction of peripheral higher order aberrations can improve low contrast resolution, provided refractive errors are corrected and the system runs in continuous closed loop.
Camilleri, Michael
Peripheral mechanisms in appetite regulation include the motor functions of the stomach, such as the rate of emptying and accommodation, which convey symptoms of satiation to the brain. The rich repertoire of peripherally released peptides and hormones provides feedback from the arrival of nutrients in different regions of the gut from where they are released to exert effects on satiation, or regulate metabolism through their incretin effects. Ultimately, these peripheral factors provide input to the highly organized hypothalamic circuitry and vagal complex of nuclei to determine cessation of energy intake during meal ingestion, and the return of appetite and hunger after fasting. Understanding these mechanisms is key to the physiological control of feeding and the derangements that occur in obesity and their restoration with treatment (as demonstrated by the effects of bariatric surgery). PMID:25241326
Peripheral nerve conduits: technology update
Arslantunali, D; Dursun, T; Yucel, D; Hasirci, N; Hasirci, V
Peripheral nerve injury is a worldwide clinical problem which could lead to loss of neuronal communication along sensory and motor nerves between the central nervous system (CNS) and the peripheral organs and impairs the quality of life of a patient. The primary requirement for the treatment of complete lesions is a tension-free, end-to-end repair. When end-to-end repair is not possible, peripheral nerve grafts or nerve conduits are used. The limited availability of autografts, and drawbacks of the allografts and xenografts like immunological reactions, forced the researchers to investigate and develop alternative approaches, mainly nerve conduits. In this review, recent information on the various types of conduit materials (made of biological and synthetic polymers) and designs (tubular, fibrous, and matrix type) are being presented. PMID:25489251
Peripheral signals modifying food reward.
Menzies, John R W; Skibicka, Karolina P; Egecioglu, Emil; Leng, Gareth; Dickson, Suzanne L
The pleasure derived from eating may feel like a simple emotion, but the decision to eat, and perhaps more importantly what to eat, involves central pathways linking energy homeostasis and reward and their regulation by metabolic and endocrine factors. Evidence is mounting that modulation of the hedonic aspects of energy balance is under the control of peripheral neuropeptides conventionally associated with homeostatic appetite control. Here, we describe the significance of reward in feeding, the neural substrates underlying the reward pathway and their modification by peptides released into the circulation from peripheral tissues. PMID:22249813
How to Pick Computer Peripherals.
ERIC Educational Resources Information Center
Fisher, Glenn
A guide to computer peripherals--additional hardware that can expand the educational uses of computers--is given. Tips are furnished on selection and possible use of computer printers; modulator/demodulators (modems); graphics tablets; plotters, speech synthesizers, and robots. (PP)
[Peripheral Nerve Injuries in Sports].
Tettenborn, B; Mehnert, S; Reuter, I
Peripheral nerve injuries due to sports are relatively rare but the exact incidence is not known due to a lack of epidemiological studies. Particular sports activities tend to cause certain peripheral nerve injuries including direct acute compression or stretching, repetitive compression and stretching over time, or another mechanism such as ischemia or laceration. These nerve lesions may be severe and delay or preclude the athlete's return to sports, especially in cases with delayed diagnosis. Repetitive and vigorous use or overuse makes the athlete vulnerable to disorders of the peripheral nerves, and sports equipment may cause compression of the nerves. Depending on etiology, the treatment is primarily conservative and includes physiotherapy, modification of movements and sports equipment, shoe inserts, splinting, antiphlogistic drugs, sometimes local administration of glucocorticoids or, lately, the use of extracorporeal shock waves. Most often, cessation of the offending physical activity is necessary. Surgery is only indicated in the rare cases of direct traumatic nerve injury or when symptoms are refractory to conservative therapy. Prognosis mainly depends on the etiology and the available options of modifying measures.This article is based on the publications "Reuter I, Mehnert S. Engpasssyndrome peripherer Nerven bei Sportlern". Akt Neurol 2012;39:292-308 and Sportverl Sportschad 2013;27:130-146. PMID:27607069
Peripheral arterial disease: implications beyond the peripheral circulation.
Paraskevas, Kosmas I; Mukherjee, Debabrata; Whayne, Thomas F
Peripheral arterial disease (PAD) affects a considerable percentage of the population. The manifestations of this disease are not always clinically overt. As a result, PAD remains underdiagnosed and undertreated. PAD is not just a disease of the peripheral arteries, but also an indication of generalized vascular atherosclerosis. PAD patients also have a high prevalence of other arterial diseases, such as coronary/carotid artery disease and abdominal aortic aneurysms. PAD is also a predictor of increased risk of lung and other cancers. The most often used examination for the establishment of the diagnosis of PAD, the ankle-brachial pressure index (ABPI), is also a predictor of generalized atherosclerosis, future cardiovascular events and cardiovascular mortality. Several markers that have been linked with PAD (e.g. C-reactive protein, serum bilirubin levels) may also have predictive value for other conditions besides PAD (e.g. kidney dysfunction). The management of PAD should therefore not be restricted to the peripheral circulation but should include measurements to manage and decrease the systemic atherosclerotic burden of the patient. PMID:23221278
Peripheral Giant Cell Granuloma in a Dog.
Hiscox, Lorraine A; Dumais, Yvan
Peripheral giant cell granuloma is considered rare in the dog with little known about the clinicopathologic features. There are few reports in the veterinary literature concerning this benign, reactive lesion, formerly known as giant cell epulis. In humans, the four most commonly described reactive epulides are focal fibrous hyperplasia (fibrous epulis), pyogenic granuloma, peripheral ossifying fibroma, and peripheral giant cell granuloma. This case report describes the diagnosis and surgical management of a peripheral giant cell granuloma in a dog. PMID:26415387
Theory underlying the peripheral vision horizon device
NASA Technical Reports Server (NTRS)
Money, K. E.
Peripheral Vision Horizon Device (PVHD) theory states that the likelihood of pilot disorientation in flight is reduced by providing an artificial horizon that provides orientation information to peripheral vision. In considering the validity of the theory, three areas are explored: the use of an artificial horizon device over some other flight instrument; the use of peripheral vision over foveal vision; and the evidence that peripheral vision is well suited to the processing of orientation information.
Men and Family Planning. Worldwatch Paper 41.
ERIC Educational Resources Information Center
Stokes, Bruce
This monograph focuses on men's potentially positive role in family planning. In addition, it identifies reasons why so few organized family planning programs have targeted men as clients and why men have so often played a peripheral or negative role in family planning. The document is presented in seven chapters. Chapter I introduces the topic…
Peripheral Neuropathy – Clinical and Electrophysiological Considerations
Chung, Tae; Prasad, Kalpana; Lloyd, Thomas E.
This article is a primer on the pathophysiology and clinical evaluation of peripheral neuropathy for the radiologist. Magnetic resonance neurography (MRN) has utility in the diagnosis of many focal peripheral nerve lesions. When combined with history, examination, electrophysiology, and laboratory data, future advancements in high-field MRN may play an increasingly important role in the evaluation of patients with peripheral neuropathy. PMID:24210312
Coaching Peripheral Vision Training for Soccer Athletes
ERIC Educational Resources Information Center
Marques, Nelson Kautzner, Jr.
Brazilian Soccer began developing its current emphasis on peripheral vision in the late 1950s, by initiative of coach of the Canto do Rio Football Club, in Niteroi, Rio de Janeiro, a pioneer in the development of peripheral vision training in soccer players. Peripheral vision training gained world relevance when a young talent from Canto do Rio,…
Peripheral neuromodulation in chronic migraine.
Perini, F; De Boni, A
Patients with chronic migraines are often refractory to medical treatment. Therefore, they might need other strategies to modulate their pain, according to their level of disability. Neuromodulation can be achieved with several tools: meditation, biofeedback, physical therapy, drugs and electric neurostimulation (ENS). ENS can be applied to the central nervous system (brain and spinal cord), either invasively (cortical or deep brain) or non-invasively [cranial electrotherapy stimulation, transcranial direct current stimulation and transcranial magnetic stimulation]. Among chronic primary headaches, cluster headaches are most often treated either through deep brain stimulation or occipital nerve stimulation because there is a high level of disability related to this condition. ENS, employed through several modalities such as transcutaneous electrical nerve stimulation, interferential currents and pulsed radiofrequency, has been applied to the peripheral nervous system at several sites. We briefly review the indications for the use of peripheral ENS at the site of the occipital nerves for the treatment of chronic migraine. PMID:22644166
Adewoyin, AS; Nwogoh, B.
The peripheral blood film (PBF) is a laboratory work-up that involves cytology of peripheral blood cells smeared on a slide. As basic as it is, PBF is invaluable in the characterization of various clinical diseases. This article highlights the basic science and art behind the PBF. It expounds its laboratory applications, clinical indications and interpretations in the light of various clinical diseases. Despite advances in haematology automation and application of molecular techniques, the PBF has remained a very important diagnostic test to the haematologist. A good quality smear, thorough examination and proper interpretation in line with patient's clinical state should be ensured by the haemato-pathologist. Clinicians should be abreast with its clinical utility and proper application of the reports in the management of patients. PMID:25960697
Peripheral neuritis due to isoniazid*
Devadatta, S.; Gangadharam, P. R. J.; Andrews, R. H.; Fox, Wallace; Ramakrishnan, C. V.; Selkon, J. B.; Velu, S.
It is well known that in the treatment of tuberculosis with isoniazid the complication of peripheral neuritis may arise. This complication is normally rare when small dosages of the drug are used, but a high incidence of the neuropathy has recently been observed in East Africa in a group of malnourished tuberculous patients receiving isoniazid in comparatively low dosage (4-6 mg/kg body-weight daily). The present paper reports on 20 cases of peripheral neuritis encountered in Madras, India, among 338 poorly nourished tuberculous patients during a trial of four isoniazid regimens, two of low and two of high dosage (3.9-5.5 and 7.8-9.6 mg/kg body-weight daily, respectively). Nineteen of the 20 cases occurred in the two groups of patients receiving the high dosage and these 19 patients were found to have a higher mean serum level of free isoniazid than the patients in the same groups who did not develop the complication. The authors consider that dosages of 7.8-9.6 mg/kg body-weight daily should not be used for the mass therapy of poorly nourished patients unless steps are taken to prevent the development of peripheral neuritis. Pyridoxine has been reported to be an effective preventive, but is too expensive for use on a large scale. This study indicates, however, that administration of the cheaper vitamin B complex might give satisfactory results and warrants further investigation. PMID:13722334
Detection of peripheral nerve pathology
Seelig, Michael J.; Baker, Jonathan C.; Mackinnon, Susan E.; Pestronk, Alan
Objective: To compare accuracy of ultrasound and MRI for detecting focal peripheral nerve pathology, excluding idiopathic carpal or cubital tunnel syndromes. Methods: We performed a retrospective review of patients referred for neuromuscular ultrasound to identify patients who had ultrasound and MRI of the same limb for suspected brachial plexopathy or mononeuropathies, excluding carpal/cubital tunnel syndromes. Ultrasound and MRI results were compared to diagnoses determined by surgical or, if not performed, clinical/electrodiagnostic evaluation. Results: We identified 53 patients who had both ultrasound and MRI of whom 46 (87%) had nerve pathology diagnosed by surgical (n = 39) or clinical/electrodiagnostic (n = 14) evaluation. Ultrasound detected the diagnosed nerve pathology (true positive) more often than MRI (43/46 vs 31/46, p < 0.001). Nerve pathology was correctly excluded (true negative) with equal frequency by MRI and ultrasound (both 6/7). In 25% (13/53), ultrasound was accurate (true positive or true negative) when MRI was not. These pathologies were typically (10/13) long (>2 cm) and only occasionally (2/13) outside the MRI field of view. MRI missed multifocal pathology identified with ultrasound in 6 of 7 patients, often (5/7) because pathology was outside the MRI field of view. Conclusions: Imaging frequently detects peripheral nerve pathology and contributes to the differential diagnosis in patients with mononeuropathies and brachial plexopathies. Ultrasound is more sensitive than MRI (93% vs 67%), has equivalent specificity (86%), and better identifies multifocal lesions than MRI. In sonographically accessible regions ultrasound is the preferred initial imaging modality for anatomic evaluation of suspected peripheral nervous system lesions. PMID:23553474
Peripheral vision horizon display testing in RF-4C aircraft
NASA Technical Reports Server (NTRS)
Hammond, L. B., Jr.
A test program to assess the capability of the peripheral vision horizon display (PVHD) to provide peripheral attitude cues to the pilot is described. The system was installed in the rear cockpit of a RF-4C aircraft, selected because its poor instrument crosscheck conditions. The PVHD test plan was designed to assess three primary areas: (1) ability of the system to reduce spatial disorientation; (2) ability of the system to aid the pilot in recovering from unusual attitudes; and (3) improvement in pilot performance during instrument landing system (ILS) approaches. Results of preliminary test flights are summarized. The major problem areas concern the distinction of the display itself and the capability of the display to provide pitch motion cues.
Scleritis and Peripheral Ulcerative Keratitis
Galor, Anat; Thorne, Jennifer E.
Scleritis and peripheral ulcerative keratitis (PUK) can present as isolated conditions or as part of a systemic inflammatory or infectious disorder. Both are serious ocular conditions that can result in vision loss and therefore require early diagnosis and treatment. Nearly two-thirds of patients with non-infectious scleritis require systemic glucocorticoid therapy, and one fourth need a glucocorticoid-sparing agent, as well. Essentially all patients with non-infectious PUK require systemic glucocorticoids. Detailed clinical history, thorough physical examination, and thoughtful laboratory evaluations are all important in the exclusion of underlying disorders and extraocular involvement. PMID:18037120
Peripheral ossifying fibroma: case report.
Pradeep, A R; Guruprasad, C N; Agarwal, Esha
We present a case of peripheral ossifying fibroma (POF) in a 17-year-old boy. Clinical, radiographic and histologic characteristics are discussed and recommendations regarding differential diagnosis, treatment and follow-up are provided. Lesions histologically similar to POF have been given various names in the existing literature; therefore, the controversial varied nomenclature and possible etiopathogenesis of POF are discussed. A slowly growing soft tissue mass with speckled calcifications in the anterior oral cavity of children or young adults should raise the suspicion of a reactive gingival lesion such as POF. PMID:23252197
Peripheral nerve disease in pregnancy.
Klein, Autumn
Neuropathies during pregnancy and the postpartum period are common and are usually due to compression around pregnancy and childbirth. The most common peripheral neuropathies are Bell's palsy, carpal tunnel syndrome (CTS), and lower extremity neuropathies. Although most neuropathies are usually reversible, associated disabilities or morbidities can limit functioning and require therapy. Nerve conduction study tests and imaging should only be considered if symptoms are unusual or prolonged. Some neuropathies may be associated with preeclampsia or an inherent underlying neuropathy that increases the risk of nerve injury. All neuropathies in pregnancy should be followed as some may be persistent and require follow-up. PMID:23563878
Sci—Thur AM: YIS - 05: 10X-FFF VMAT for Lung SABR: an Investigation of Peripheral Dose
Mader, J; Mestrovic, A
Flattening Filter Free (FFF) beams exhibit high dose rates, reduced head scatter, leaf transmission and leakage radiation. For VMAT lung SABR, treatment time can be significantly reduced using high dose rate FFF beams while maintaining plan quality and accuracy. Another possible advantage offered by FFF beams for VMAT lung SABR is the reduction in peripheral dose. The focus of this study was to investigate and quantify the reduction of peripheral dose offered by FFF beams for VMAT lung SABR. The peripheral doses delivered by VMAT Lung SABR treatments using FFF and flattened beams were investigated for the Varian Truebeam linac. This study was conducted in three stages, (1): ion chamber measurement of peripheral dose for various plans, (2): validation of AAA, Acuros XB and Monte Carlo for peripheral dose using measured data, and (3): using the validated Monte Carlo model to evaluate peripheral doses for 6 VMAT lung SABR treatments. Three energies, 6X, 10X, and 10X-FFF were used for all stages. Measured data indicates that 10X-FFF delivers the lowest peripheral dose of the three energies studied. AAA and Acuros XB dose calculation algorithms were identified as inadequate, and Monte Carlo was validated for accurate peripheral dose prediction. The Monte Carlo-calculated VMAT lung SABR plans show a significant reduction in peripheral dose for 10X-FFF plans compared to the standard 6X plans, while no significant reduction was showed when compared to 10X. This reduction combined with shorter treatment time makes 10X-FFF beams the optimal choice for superior VMAT lung SABR treatments.
Optoacoustic angiography of peripheral vasculature
NASA Astrophysics Data System (ADS)
Ermilov, Sergey; Su, Richard; Zamora, Mario; Hernandez, Travis; Nadvoretsky, Vyacheslav; Oraevsky, Alexander
We developed a new optoacoustic microangiography system (OmAS) intended for in-vivo vascular imaging of a human finger. The system employs an arc-shaped acoustic array that is rotated 360 degrees around the finger providing optoacoustic data necessary for tomographic reconstruction of the three-dimensional images of a finger. A near-infrared Q-switched laser is used to generate optoacoustic signals with increased contrast of blood vessels. The laser is coupled through two randomized fiberoptic bundles oriented in orthogonal optoacoustic mode. To demonstrate OmAS capabilities, we present a time-series of optoacoustic images of a human finger taken after the hypothermia stress test. The images show a detailed vascular anatomy of a finger down to the capillary level. A series of quick 30s scans allowed us to visualize the thermoregulatory response within the studied finger as it was manifested via vasomotor activity during the hypothermia recovery. We propose that the developed system can be used for diagnostics of various medical conditions that are manifested in change of the peripheral (finger) blood flow. Examples of the medical conditions that could be diagnosed and staged using the OmAS include the peripheral arterial disease (PAD), thrombosis, frostbite, and traumas.
Diagnostic approach to peripheral neuropathy
Misra, Usha Kant; Kalita, Jayantee; Nair, Pradeep P.
Peripheral neuropathy refers to disorders of the peripheral nervous system. They have numerous causes and diverse presentations; hence, a systematic and logical approach is needed for cost-effective diagnosis, especially of treatable neuropathies. A detailed history of symptoms, family and occupational history should be obtained. General and systemic examinations provide valuable clues. Neurological examinations investigating sensory, motor and autonomic signs help to define the topography and nature of neuropathy. Large fiber neuropathy manifests with the loss of joint position and vibration sense and sensory ataxia, whereas small fiber neuropathy manifests with the impairment of pain, temperature and autonomic functions. Electrodiagnostic (EDx) tests include sensory, motor nerve conduction, F response, H reflex and needle electromyography (EMG). EDx helps in documenting the extent of sensory motor deficits, categorizing demyelinating (prolonged terminal latency, slowing of nerve conduction velocity, dispersion and conduction block) and axonal (marginal slowing of nerve conduction and small compound muscle or sensory action potential and dennervation on EMG). Uniform demyelinating features are suggestive of hereditary demyelination, whereas difference between nerves and segments of the same nerve favor acquired demyelination. Finally, neuropathy is classified into mononeuropathy commonly due to entrapment or trauma; mononeuropathy multiplex commonly due to leprosy and vasculitis; and polyneuropathy due to systemic, metabolic or toxic etiology. Laboratory investigations are carried out as indicated and specialized tests such as biochemical, immunological, genetic studies, cerebrospinal fluid (CSF) examination and nerve biopsy are carried out in selected patients. Approximately 20% patients with neuropathy remain undiagnosed but the prognosis is not bad in them. PMID:19893645
Endovascular Intervention for Peripheral Artery Disease
Thukkani, Arun K.; Kinlay, Scott
Advances in endovascular therapies during the past decade have broadened the options for treating peripheral vascular disease percutaneously. Endovascular treatment offers a lower risk alternative to open surgery in many patients with multiple comorbidities. Noninvasive physiological tests and arterial imaging precede an endovascular intervention and help localize the disease and plan the procedure. The timing and need for revascularization are broadly related to the 3 main clinical presentations of claudication, critical limb ischemia, and acute limb ischemia. Many patients with claudication can be treated by exercise and medical therapy. Endovascular procedures are considered when these fail to improve quality of life and function. In contrast, critical limb ischemia and acute limb ischemia threaten the limb and require more urgent revascularization. In general, endovascular treatments have greater long-term durability for aortoiliac disease than femoral popliteal disease. Infrapopliteal revascularization is generally reserved for critical and acute limb ischemia. Balloon angioplasty and stenting are the mainstays of endovascular therapy. New well-tested innovations include drug-eluting stents and drug-coated balloons. Adjunctive devices for crossing chronic total occlusions or debulking plaque with atherectomy are less rigorously studied and have niche roles. Patients receiving endovascular procedures need a structured surveillance plan for follow-up care. This includes intensive treatment of cardiovascular risk factors to prevent myocardial infarction and stroke, which are the main causes of death. Limb surveillance aims to identify restenosis and new disease beyond the intervened segments, both of which may jeopardize patency and lead to recurrent symptoms, functional impairment, or a threatened limb. PMID:25908731
Peripheral Neuropathy Associated withHypereosinophilic Syndrome
Lee, Kyung Ho; Kim, Jung Eun
The idiopathic hypereosinophilic syndrome (HES) represents a leukoproliferative disorder, characterized by unexplained prolonged eosinophilia (>6 months) and evidence of specific organ damage. So far, the peripheral neuropathy associated with skin manifestations of HES has not been reported in the dermatologic literature although the incidence of peripheral neuropathy after HES ranges from 6~52%. Herein, we report the peripheral neuropathy associated with HES, documented by clinical, histopathological, and electrodiagnostic criteria. PMID:27303181
Solitary peripheral osteomas of the jaws
de França, Talita Ribeiro Tenório; Gueiros, Luiz Alcino Monteiro; de Castro, Jurema Freire Lisboa; Catunda, Ivson; Leão, Jair Carneiro
Osteoma is a benign osteogenic tumor composed of cancellous or compact bone, classified as peripheral, central, or extraskeletal. Peripheral osteomas are uncommon. Excluding the maxillary sinuses, the maxilla is a rare site for osteomas. The purpose of this report was to describe clinicopathological and radiological features of two peripheral osteomas occurring in the jaws, one located in the mandible and another in the edentulous maxillary alveolar ridge. The tumors were asymptomatic and were fully excised without any complications or recurrence. The lesions were submitted to histopathological analysis and diagnosed as peripheral osteoma, compact type. PMID:22783479
Updates in diabetic peripheral neuropathy
Juster-Switlyk, Kelsey; Smith, A. Gordon
Diabetes has become one of the largest global health-care problems of the 21 st century. According to the Centers for Disease Control and Prevention, the population prevalence of diabetes in the US is approaching 10% and is increasing by 5% each year. Diabetic neuropathy is the most common complication associated with diabetes mellitus. Diabetes causes a broad spectrum of neuropathic complications, including acute and chronic forms affecting each level of the peripheral nerve, from the root to the distal axon. This review will focus on the most common form, distal symmetric diabetic polyneuropathy. There has been an evolution in our understanding of the pathophysiology and the management of diabetic polyneuropathy over the past decade. We highlight these new perspectives and provide updates from the past decade of research. PMID:27158461
Peripheral arterial injuries: a reassessment.
Burnett, H F; Parnell, C L; Williams, G D; Campbell, G S
Ninety-four patients with peripheral arterial injuries were subjected to acute repair, negative exploration, or late repair of the complications of the arterial injury (false aneurysm, A-V fistula, and/or limb ischemia). The causes of failure after acute injury include extensive local soft tissue and bony damage, severe concomitant head, chest or abdominal wounding, stubborn reliance on negative arteriograms in patients with probable arterial injury, failure to repair simultaneous venous injuries, or harvesting of a vein graft from a severely damaged extremity. There is a positive correlation between non-operative expectant treatment and the incidence of late vascular complications requiring late arterial repair. Delayed complications of arterial injuries occurred most frequently in wounds below the elbow and knee. PMID:973757
Peripheral Leptin Regulates Bone Formation
Turner, Russell T.; Kalra, Satya P.; Wong, Carmen P.; Philbrick, Kenneth A.; Lindenmaier, Laurence B.; Boghossian, Stephane; Iwaniec, Urszula T.
Substantial evidence does not support the prevailing view that leptin, acting through a hypothalamic relay, decreases bone accrual by inhibiting bone formation. To clarify the mechanisms underlying regulation of bone architecture by leptin, we evaluated bone growth and turnover in wild type (WT) mice, leptin receptor-deficient db/db mice, leptin-deficient ob/ob mice and ob/ob mice treated with leptin. We also performed hypothalamic leptin gene therapy to determine the effect of elevated hypothalamic leptin levels on osteoblasts. Finally, to determine the effects of loss of peripheral leptin signaling on bone formation and energy metabolism, we used bone marrow (BM) from WT or db/db donor mice to reconstitute the hematopoietic and mesenchymal stem cell compartments in lethally irradiated WT recipient mice. Decreases in bone growth, osteoblast-lined bone perimeter and bone formation rate were observed in ob/ob mice and greatly increased in ob/ob mice following subcutaneous administration of leptin. Similarly, hypothalamic leptin gene therapy increased osteoblast-lined bone perimeter in ob/ob mice. In spite of normal osteoclast-lined bone perimeter, db/db mice exhibited a mild but generalized osteopetrotic-like (calcified cartilage encased by bone) skeletal phenotype and greatly reduced serum markers of bone turnover. Tracking studies and histology revealed quantitative replacement of BM cells following BM transplantation. WT mice engrafted with db/db BM did not differ in energy homeostasis from untreated WT mice or WT mice engrafted with WT BM. Bone formation in WT mice engrafted with WT BM did not differ from WT mice, whereas bone formation in WT mice engrafted with db/db cells did not differ from the low rates observed in untreated db/db mice. In summary, our results indicate that leptin, acting primarily through peripheral pathways, increases osteoblast number and activity. PMID:22887758
Malignant Peripheral Nerve Sheath Tumour: CT and MRI Findings.
Sperandio, Massimiliano; Di Poce, Isabelle; Ricci, Aurora; Di Trapano, Roberta; Costanzo, Elisa; Di Cello, Pierfrancesco; Pelle, Fabio; Izzo, Luciano; Simonetti, Giovanni
Malignant peripheral nerve sheath tumour (MPNST) is extremely rare malignancy in the general population, occurring more frequently in patients with Neurofibromatosis type 1 (NF1). In the literature five cases of MPNST arising from the parapharyngeal space (PPS) in patients without neurofibromatosis have been reported. We report imaging techniques in a patient with MPNST in the PPS, who had neither a family history nor sign of NF1. Computed tomography (CT) scan and magnetic resonance imaging (MRI) were performed for a correct therapeutic planning. CT and MRI findings were correlated with hystopathological diagnosis. PMID:23970990
Peripheral Developing Odontoma or Peripheral Ameloblastic Fibroodontoma: A Rare Challenging Case
Atarbashi Moghadam, Saede
Peripheral odontogenic lesions are considered to be rare within the classification of odontogenic tumors. They share the same microscopic characteristics of their central counterparts. Here, we report an ulcerated mass of the maxillary gingiva that on histopathological examination was diagnosed as peripheral developing odontoma or peripheral ameloblastic fibroodontoma. The diagnosis of this tumor is challenging and may lead to unnecessary treatment. PMID:26981293
Peripheral Developing Odontoma or Peripheral Ameloblastic Fibroodontoma: A Rare Challenging Case.
Atarbashi Moghadam, Saede; Mokhtari, Sepideh
Peripheral odontogenic lesions are considered to be rare within the classification of odontogenic tumors. They share the same microscopic characteristics of their central counterparts. Here, we report an ulcerated mass of the maxillary gingiva that on histopathological examination was diagnosed as peripheral developing odontoma or peripheral ameloblastic fibroodontoma. The diagnosis of this tumor is challenging and may lead to unnecessary treatment. PMID:26981293
Raman microspectroscopy for visualization of peripheral nerves
NASA Astrophysics Data System (ADS)
Minamikawa, Takeo; Harada, Yoshinori; Koizumi, Noriaki; Takamatsu, Tetsuro
The peripheral nervous system plays an important role in motility, sensory, and autonomic functions of the human body. Preservation of peripheral nerves in surgery is essential for improving quality of life of patients. To preserve peripheral nerves, detection of ne peripheral nerves that cannot be identi ed by human eye or under white light imaging is necessary. In this study, we sought to provide a proof-of-principle demonstration of a label-free detection technique of peripheral nerve tissues against adjacent tissues that employs spontaneous Raman microspectroscopy. A line-illumination confocal Raman microscope was used for the experiment. A laser operating at the wavelength of 532 nm was used as an excitation laser light. We obtained Raman spectra of peripheral nerve, brous connective tissue, skeletal muscle, blood vessel, and adipose tissue of Wistar rats, and extracted speci c spectral features of peripheral nerves and adjacent tissues. By applying multivariate image analysis, peripheral nerves were clearly detected against adjacent tissues without any preprocessing neither xation nor staining. These results suggest the potential of the Raman spectroscopic observation for noninvasive and label-free nerve detection, and we expect this method could be a key technique for nerve-sparing surgery.
Beauty and cuteness in peripheral vision
Kuraguchi, Kana; Ashida, Hiroshi
Guo et al. (2011) showed that attractiveness was detectable in peripheral vision. Since there are different types of attractiveness (Rhodes, 2006), we investigated how beauty and cuteness are detected in peripheral vision with a brief presentation. Participants (n = 45) observed two Japanese female faces for 100 ms, then were asked to respond which face was more beautiful (or cuter). The results indicated that both beauty and cuteness were detectable in peripheral vision, but not in the same manner. Discrimination rates for judging beauty were invariant in peripheral and central vision, while discrimination rates for judging cuteness declined in peripheral vision as compared with central vision. This was not explained by lower resolution in peripheral vision. In addition, for male participants, it was more difficult to judge cuteness than beauty in peripheral vision, thus suggesting that gender differences can have a certain effect when judging cuteness. Therefore, central vision might be suitable for judging cuteness while judging beauty might not be affected by either central or peripheral vision. This might be related with the functional difference between beauty and cuteness. PMID:25999883
Color vision in the peripheral retina.
Johnson, M A
Until recently, color vision in the peripheral field has been thought to be substantially less developed than color vision in the central field. Although the exact dimensions vary from study to study, most estimates of peripheral chromatic perception place the limit of trichromatic vision at no more than 30 degrees from fixation; the visual field is thought to be completely color blind at about 50 degrees of eccentricity. Within the last 10 years, an increased understanding of the changing spatial scale in the peripheral field has led researchers to reevaluate what is believed about peripheral function. We now know that virtually every measure of peripheral color perception can be improved by using a suitably large stimulus in the peripheral field. This paper examines current and past perspectives on peripheral color function, and describes two studies which demonstrate that peripheral and central chromatic processing are the same to the first order if the changes in spatial scale and photopic sensitivity with eccentricity are considered. PMID:3953765
Peripheral Arterial Disease (P.A.D.)
... turn Javascript on. Peripheral Artery Disease (P.A.D.) What is P.A.D.? Arteries Clogged With Plaque Peripheral arterial disease (P. ... button on your keyboard.) Why Is P.A.D. Dangerous? Click for more information Blocked blood flow ...
Symmetrical peripheral gangrene caused by septic shock
Shimbo, Keisuke; Yokota, Kazunori; Miyamoto, Junpei; Okuhara, Yukako; Ochi, Mitsuo
We report three cases of symmetrical peripheral gangrene (SPG) caused by septic shock. Most of sepsis survivors with SPG require amputation of the affected extremities. To preserve the length of the thumb and fingers, we performed surgical amputation and used flaps to cover the amputated peripheral extremities.
Continuous peripheral nerve blocks in children.
Dadure, C; Capdevila, X
In recent years, regional anaesthesia in children has generated increasing interest. Continuous peripheral nerve blocks have an important role in the anaesthetic arsenal, allowing effective, safe and prolonged postoperative pain management. Indications for continuous peripheral nerve blocks depend on benefits/risks analysis of each technique for each patient. The indications include surgery associated with intense postoperative pain, surgery requiring painful physical therapy, and complex regional pain syndrome. Continuous peripheral nerve blocks are usually performed under general anaesthesia or sedation, and require appropriate equipment in order to decrease the risk of nerve injury. New techniques, such as transcutaneous stimulation or ultrasound guidance, appear to facilitate nerve and plexus identification in paediatric patients. Nevertheless, continuous peripheral nerve block may mask compartment syndrome in certain surgical procedure or trauma. Finally, ropivacaine appears to be the best local anaesthetic for continuous peripheral nerve blocks in children, requiring low flow rate with low concentration of the local anaesthetic. PMID:15966500
Peripheral Ulcerative Keratitis with Pyoderma Gangrenosum
Imbernón-Moya, Adrián; Vargas-Laguna, Elena; Aguilar, Antonio; Gallego, Miguel Ángel; Vergara, Claudia; Nistal, María Fernanda
Pyoderma gangrenosum is an unusual necrotizing noninfective and ulcerative skin disease whose cause is unknown. Ophthalmic involvement in pyoderma gangrenosum is an unusual event. Only a few cases have been reported, from which we can highlight scleral, corneal, and orbital cases. Peripheral ulcerative keratitis is a process which destroys the peripheral cornea. Its cause is still unknown although it is often associated with autoimmune conditions. Pyoderma gangrenosum should be included in the differential diagnosis of peripheral ulcerative keratitis. Early recognition of these manifestations can vary the prognosis by applying the appropriate treatment. We introduce a 70-year-old woman who suffered pyoderma gangrenosum associated with peripheral ulcerative keratitis in her left eye. The patient's skin lesions and peripheral keratitis responded successfully to systemic steroids and cyclosporine A. PMID:26527531
Talarico, Jennifer M.; Berntsen, Dorthe; Rubin, David C.
Emotional arousal and negative affect enhance recall of central aspects of an event. However, the role of discrete emotions in selective memory processing is understudied. Undergraduates were asked to recall and rate autobiographical memories of eight emotional events. Details of each memory were rated as central or peripheral to the event. Significance of the event, vividness, reliving and other aspects of remembering were also rated for each event. Positive affect enhanced recall of peripheral details. Furthermore, the impairment of peripheral recall was greatest in memories of anger, not of fear. Reliving the experience at retrieval was negatively correlated with recall of peripheral details for some emotions (e.g., anger) but not others (e.g., fear), irrespective of similarities in affect and intensity. Within individuals, recall of peripheral details was correlated with less belief in the memory's accuracy and more likelihood to recall the memory from one's own eyes (i.e., a field perspective). PMID:21359127
Peripheral olfactory signaling in insects
Suh, Eunho; Bohbot, Jonathan; Zwiebel, Laurence J.
Olfactory signaling is a crucial component in the life history of insects. The development of precise and parallel mechanisms to analyze the tremendous amount of chemical information from the environment and other sources has been essential to their evolutionary success. Considerable progress has been made in the study of insect olfaction fueled by bioinformatics- based utilization of genomics along with rapid advances in functional analyses. Here we review recent progress in our rapidly emerging understanding of insect peripheral sensory reception and signal transduction. These studies reveal that the nearly unlimited chemical space insects encounter is covered by distinct chemosensory receptor repertoires that are generally derived by species-specific, rapid gene gain and loss, reflecting the evolutionary consequences of adaptation to meet their specific biological needs. While diverse molecular mechanisms have been put forth, often in the context of controversial models, the characterization of the ubiquitous, highly conserved and insect-specific Orco odorant receptor co-receptor has opened the door to the design and development of novel insect control methods to target agricultural pests, disease vectors and even nuisance insects. PMID:25584200
Malignant Peripheral Nerve Sheath Tumors.
Durbin, Adam D; Ki, Dong Hyuk; He, Shuning; Look, A Thomas
Malignant peripheral nerve sheath tumors (MPNST) are tumors derived from Schwann cells or Schwann cell precursors. Although rare overall, the incidence of MPNST has increased with improved clinical management of patients with the neurofibromatosis type 1 (NF1) tumor predisposition syndrome. Unfortunately, current treatment modalities for MPNST are limited, with no targeted therapies available and poor efficacy of conventional radiation and chemotherapeutic regimens. Many murine and zebrafish models of MPNST have been developed, which have helped to elucidate the genes and pathways that are dysregulated in MPNST tumorigenesis, including the p53, and the RB1, PI3K-Akt-mTOR, RAS-ERK and Wnt signaling pathways. Preclinical results have suggested that new therapies, including mTOR and ERK inhibitors, may synergize with conventional chemotherapy in human tumors. The discovery of new genome editing technologies, like CRISPR-cas9, and their successful application to the zebrafish model will enable rapid progress in the faithful modeling of MPNST molecular pathogenesis. The zebrafish model is especially suited for high throughput screening of new targeted therapeutics as well as drugs approved for other purposes, which may help to bring enhanced treatment modalities into human clinical trials for this devastating disease. PMID:27165368
Chemotherapy-induced peripheral neuropathy.
Fehrenbacher, Jill C
Chemotherapy-induced peripheral neuropathy (CIPN) is common in patients receiving anticancer treatment and can affect survivability and long-term quality of life of the patient following treatment. The symptoms of CIPN primarily include abnormal sensory discrimination of touch, vibration, thermal information, and pain. There is currently a paucity of pharmacological agents to prevent or treat CIPN. The lack of efficacious therapeutics is due, at least in part, to an incomplete understanding of the mechanisms by which chemotherapies alter the sensitivity of sensory neurons. Although the clinical presentation of CIPN can be similar with the various classes of chemotherapeutic agents, there are subtle differences, suggesting that each class of drugs might induce neuropathy via different mechanisms. Multiple mechanisms have been proposed to underlie the development and maintenance of neuropathy; however, most pharmacological agents generated from preclinical experiments have failed to alleviate the symptoms of CIPN in the clinic. Further research is necessary to identify the specific mechanisms by which each class of chemotherapeutics induces neuropathy. PMID:25744683
Peripheral dose measurement for CyberKnife radiosurgery with upgraded linac shielding.
Chuang, Cynthia F; Larson, David A; Zytkovicz, Andrea; Smith, Vernon; Petti, Paula L
The authors investigated the peripheral dose reduction for CyberKnife radiosurgery treatments after the installation of a linac shielding upgrade. As in a previous investigation, the authors considered two treatment plans, one for a hypothetical target in the brain and another for a target in the thorax, delivered to an anthropomorphic phantom. The results of the prior investigation showed that the CyberKnife delivered significantly higher peripheral doses than comparable model C Gamma Knife or IMRT treatments. Current measurements, after the linac shielding upgrade, demonstrate that the additional shielding decreased the peripheral dose, expressed as a percentage of the delivered monitor units (MU), by a maximum of 59%. The dose reduction was greatest for cranial-caudal distances from the field edge less than 30 cm, and at these distances, the CyberKnife peripheral dose, expressed as a percentage of the delivered MU, is now comparable to that measured for the other treatment modalities in our previous investigation. For distances between 30 and 70 cm from the field edge, the additional shielding reduced the peripheral dose by between 20% and 55%. At these distances, the CyberKnife peripheral dose remains higher than doses measured in our previous study for the model C Gamma Knife and IMRT. PMID:18491544
Double-mirror peripheral vitrectomy lens.
Ohji, M; Tano, Y
Many surgeons use prism lenses to see the periphery of the fundus during vitrectomy; however, chromatic aberrations in higher-power prismatic lenses cause blurring of the peripheral image. For better visualization of the periphery of the fundus, we developed a new contact lens, the double-mirror peripheral vitrectomy lens. The new lens is a quartz cylinder with two mirrors, and it provides a crisp, clear, upright image of much more of the peripheral fundus than is visible through conventional prism lenses. The new lens also provides a wider area of view than conventional prism lenses. PMID:7487611
Peripheral osteoma of maxilla: A case report
Batra, Namish; Batra, Renu; Singh, Gaurav; Gaur, Amit
Osteoma is a benign osteogenic lesion with a very slow growth, characterized by proliferation of either compact or cancellous bone. Most cases of peripheral osteomas are asymptomatic and produce swelling and asymmetry. Its pathogenesis is unclear but commonly accepted theories propose embryologic, traumatic, or infectious causes. The osteoma may appear in the form of a limited peripheral lesion involving the alveoli or cheek or as a tumoral growth developing inward toward the sinus. Recurrences of osteomas have not been reported in the literature. We report a rare case of maxillary peripheral osteoma with impacted right canine in a 32-year-old female patient. PMID:25937746
Systems and methods to control multiple peripherals with a single-peripheral application code
Ransom, Ray M.
Methods and apparatus are provided for enhancing the BIOS of a hardware peripheral device to manage multiple peripheral devices simultaneously without modifying the application software of the peripheral device. The apparatus comprises a logic control unit and a memory in communication with the logic control unit. The memory is partitioned into a plurality of ranges, each range comprising one or more blocks of memory, one range being associated with each instance of the peripheral application and one range being reserved for storage of a data pointer related to each peripheral application of the plurality. The logic control unit is configured to operate multiple instances of the control application by duplicating one instance of the peripheral application for each peripheral device of the plurality and partitioning a memory device into partitions comprising one or more blocks of memory, one partition being associated with each instance of the peripheral application. The method then reserves a range of memory addresses for storage of a data pointer related to each peripheral device of the plurality, and initializes each of the plurality of peripheral devices.
Magnetic resonance imaging of the peripheral nervous system.
Fritz, R C; Boutin, R D; Boutin, R A
An accurate diagnosis is the essential first step toward a successful treatment plan in patients who present with pain and suspected nerve entrapment. Pain and dysfunction are often related to an acute traumatic event or a classic presentation that leads to a straightforward clinical diagnosis. The diagnostic approach to abnormalities of the peripheral nervous system always begins with a thorough history and physical examination. Imaging may play an important role in confirming the initial clinical [figure: see text] diagnosis so that a rational plan of treatment may be selected. Diagnostic imaging is especially important when there is significant uncertainty regarding the cause of pain and the outcome may be improved by timely implementation of various treatment options. Diagnostic accuracy is important when various conditions in the differential diagnosis would be treated differently from the beginning. Indeed, certain conditions that result in pain and dysfunction related to peripheral nerve entrapment are best treated with initial rest, protection, and rehabilitation whereas other conditions are best treated with prompt surgery. Promptly arriving at an accurate diagnosis is an essential step in designing a rational course of therapy, in achieving a good outcome, and in treating medical conditions in a timely fashion. Indeed, because pain is mediated through peripheral nerves, establishing an accurate diagnosis is especially important in disorders of the peripheral nervous system in which there may be considerable pain and suffering with an incorrect or delayed diagnosis. Moreover, an early diagnosis is desirable [figure: see text] to preserve motor power and sensory function in cases of clinically occult nerve entrapment. Although entrapment syndromes are well described and widely documented in the literature, they may be easily missed in clinical practice in certain instances. Although MR imaging is useful to confirm and characterize a known or suspected case
Acupuncture for peripheral joint osteoarthritis
Manheimer, Eric; Cheng, Ke; Linde, Klaus; Lao, Lixing; Yoo, Junghee; Wieland, Susan; van der Windt, Daniëlle AWM; Berman, Brian M; Bouter, Lex M
Background Peripheral joint osteoarthritis is a major cause of pain and functional limitation. Few treatments are safe and effective. Objectives To assess the effects of acupuncture for treating peripheral joint osteoarthritis. Search strategy We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 1), MEDLINE, and EMBASE (both through December 2007), and scanned reference lists of articles. Selection criteria Randomized controlled trials (RCTs) comparing needle acupuncture with a sham, another active treatment, or a waiting list control group in people with osteoarthritis of the knee, hip, or hand. Data collection and analysis Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We calculated standardized mean differences using the differences in improvements between groups. Main results Sixteen trials involving 3498 people were included. Twelve of the RCTs included only people with OA of the knee, 3 only OA of the hip, and 1 a mix of people with OA of the hip and/or knee. In comparison with a sham control, acupuncture showed statistically significant, short-term improvements in osteoarthritis pain (standardized mean difference -0.28, 95% confidence interval -0.45 to -0.11; 0.9 point greater improvement than sham on 20 point scale; absolute percent change 4.59%; relative percent change 10.32%; 9 trials; 1835 participants) and function (-0.28, -0.46 to -0.09; 2.7 point greater improvement on 68 point scale; absolute percent change 3.97%; relative percent change 8.63%); however, these pooled short-term benefits did not meet our predefined thresholds for clinical relevance (i.e. 1.3 points for pain; 3.57 points for function) and there was substantial statistical heterogeneity. Additionally, restriction to sham-controlled trials using shams judged most likely to adequately blind participants to treatment assignment (which were also the same shams judged most
Angioplasty and stent placement -- peripheral arteries
... P. Peripheral arterial diseases. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's ... noncoronary obstructive vascular disease.In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's ...
Perioperative lower extremity peripheral nerve traction injuries.
Plastaras, Christopher T; Chhatre, Akhil; Kotcharian, Ashot S
Peripheral nerve traction injuries may occur after surgical care and can involve any of the lower extremity large peripheral nerves. In this review, the authors discuss injuries after knee or hip surgical intervention. The diagnosis, including electrodiagnostic studies, is time sensitive and also relies on a detailed history and physical examination. Successful prevention and treatment involve familiarity with risk and predisposing factors as well as prophylactic measures. PMID:24267207
Peripheral Neuropathy in Rats Exposed to Dichloroacetate
Calcutt, Nigel A.; Lopez, Veronica L.; Bautista, Arjel D.; Mizisin, Leah M.; Torres, Brenda R.; Shroads, Albert L.; Mizisin, Andrew P.; Stacpoole, Peter W.
The use of dichloroacetate (DCA) for treating patients with mitochondrial diseases is limited by the induction of peripheral neuropathy. The mechanisms of DCA-induced neuropathy are not known. Oral DCA treatment (50–500 mg/kg/day for up to 16 weeks) induced tactile allodynia in both juvenile and adult rats; concurrent thermal hypoalgesia developed at higher doses. Both juvenile and adult rats treated with DCA developed nerve conduction slowing that was more pronounced in adult rats. No overt axonal or glial cell abnormalities were identified in peripheral nerves or spinal cord of any DCA-treated rats but morphometric analysis identified a reduction of mean axonal caliber of peripheral nerve myelinated fibers. DCA treatment also caused accumulation of oxidative stress markers in the nerves. These data indicate that behavioral, functional and structural indices of peripheral neuropathy may be induced in both juvenile and adult rats treated with DCA at doses similar to those in clinical use. DCA-induced peripheral neuropathy primarily afflicts axons and involves both metabolic and structural disorders. The DCA-treated rat may provide insight into the pathogenesis of peripheral neuropathy and facilitate development of adjuvant therapeutics to prevent this disorder that currently restricts the clinical use of DCA. PMID:19680144
Multimodal system for the planning and guidance of bronchoscopy
NASA Astrophysics Data System (ADS)
Higgins, William E.; Cheirsilp, Ronnarit; Zang, Xiaonan; Byrnes, Patrick
Many technical innovations in multimodal radiologic imaging and bronchoscopy have emerged recently in the effort against lung cancer. Modern X-ray computed-tomography (CT) scanners provide three-dimensional (3D) high-resolution chest images, positron emission tomography (PET) scanners give complementary molecular imaging data, and new integrated PET/CT scanners combine the strengths of both modalities. State-of-the-art bronchoscopes permit minimally invasive tissue sampling, with vivid endobronchial video enabling navigation deep into the airway-tree periphery, while complementary endobronchial ultrasound (EBUS) reveals local views of anatomical structures outside the airways. In addition, image-guided intervention (IGI) systems have proven their utility for CT-based planning and guidance of bronchoscopy. Unfortunately, no IGI system exists that integrates all sources effectively through the complete lung-cancer staging work flow. This paper presents a prototype of a computer-based multimodal IGI system that strives to fill this need. The system combines a wide range of automatic and semi-automatic image-processing tools for multimodal data fusion and procedure planning. It also provides a flexible graphical user interface for follow-on guidance of bronchoscopy/EBUS. Human-study results demonstrate the system's potential.
Peripheral Biomarkers Revisited: Integrative Profiling of Peripheral Samples for Psychiatric Research
Hayashi-Takagi, Akiko; Vawter, Marquis P.; Iwamoto, Kazuya
Peripheral samples, such as blood and skin, have been used for decades in psychiatric research as surrogates for central nervous system samples. Although the validity of the data obtained from peripheral samples has been questioned and other state-of-the-art techniques, such as human brain imaging, genomics, and induced pluripotent stem cells, seem to reduce the value of peripheral cells, accumulating evidence has suggested that revisiting peripheral samples is worthwhile. Here, we re-evaluate the utility of peripheral samples and argue that establishing an understanding of the common signaling and biological processes in the brain and peripheral samples is required for the validity of such models. First, we present an overview of the available types of peripheral cells and describe their advantages and disadvantages. We then briefly summarize the main achievements of omics studies, including epigenome, transcriptome, proteome, and metabolome analyses, as well as the main findings of functional cellular assays, the results of which imply that alterations in neurotransmission, metabolism, the cell cycle, and the immune system may be partially responsible for the pathophysiology of major psychiatric disorders such as schizophrenia. Finally, we discuss the future utility of peripheral samples for the development of biomarkers and tailor-made therapies, such as multimodal assays that are used as a battery of disease and trait pathways and that might be potent and complimentary tools for use in psychiatric research. PMID:24286759
Surgical Technique for Repair of Peripheral Pulmonary Artery Stenosis and Other Complex Peripheral Reconstructions.
Mainwaring, Richard D; Ibrahimiye, Ali N; Hanley, Frank L
Surgical reconstruction of peripheral pulmonary artery stenosis is a technically challenging procedure due to the need to access all lobar and segmental branches. This paper describes our surgical approach that entails division of the main pulmonary and separation of the branch pulmonary arteries. This surgical approach can also be utilized for other complex peripheral pulmonary artery reconstructions. PMID:27449462
Tissue engineered constructs for peripheral nerve surgery
Johnson, P. J.; Wood, M. D.; Moore, A. M.; Mackinnon, S. E.
Summary Background Tissue engineering has been defined as "an interdisciplinary field that applies the principles of engineering and life sciences toward the development of biological substitutes that restore, maintain, or improve tissue function or a whole organ". Traumatic peripheral nerve injury resulting in significant tissue loss at the zone of injury necessitates the need for a bridge or scaffold for regenerating axons from the proximal stump to reach the distal stump. Methods A review of the literature was used to provide information on the components necessary for the development of a tissue engineered peripheral nerve substitute. Then, a comprehensive review of the literature is presented composed of the studies devoted to this goal. Results Extensive research has been directed toward the development of a tissue engineered peripheral nerve substitute to act as a bridge for regenerating axons from the proximal nerve stump seeking the distal nerve. Ideally this nerve substitute would consist of a scaffold component that mimics the extracellular matrix of the peripheral nerve and a cellular component that serves to stimulate and support regenerating peripheral nerve axons. Conclusions The field of tissue engineering should consider its challenge to not only meet the autograft "gold standard" but also to understand what drives and inhibits nerve regeneration in order to surpass the results of an autograft. PMID:24385980
Animal models of HIV peripheral neuropathy
Burdo, Tricia H; Miller, Andrew D
The use of animal models in the study of HIV and AIDS has advanced our understanding of the underlying pathophysiologic mechanisms of infection. Of the multitude of HIV disease manifestations, peripheral neuropathy remains one of the most common long-term side effects. Several of the most important causes of peripheral neuropathy in AIDS patients include direct association with HIV infection with or without antiretroviral medication and infection with opportunistic agents. Because the pathogeneses of these diseases are difficult to study in human patients, animal models have allowed for significant advancement in the understanding of the role of viral infection and the immune system in disease genesis. This review focuses on rodent, rabbit, feline and rhesus models used to study HIV-associated peripheral neuropathies, focusing specifically on sensory neuropathy and antiretroviral-associated neuropathies. PMID:25214880
Vitamin B supplementation for diabetic peripheral neuropathy
Jayabalan, Bhavani; Low, Lian Leng
Vitamin B12 deficiency has been associated with significant neurological pathology, especially peripheral neuropathy. This review aims to examine the existing evidence on the effectiveness of vitamin B12 supplementation for the treatment of diabetic peripheral neuropathy. A search of PubMed and the Cochrane Central Register of Controlled Trials for all relevant randomised controlled trials was conducted in December 2014. Any type of therapy using vitamin B12 or its coenzyme forms was assessed for efficacy and safety in diabetics with peripheral neuropathy. Changes in vibration perception thresholds, neuropathic symptoms and nerve conduction velocities, as well as the adverse effects of vitamin B12 therapy, were assessed. Four studies comprising 363 patients met the inclusion criteria. This review found no evidence that the use of oral vitamin B12 supplements is associated with improvement in the clinical symptoms of diabetic neuropathy. Furthermore, the majority of studies reported no improvement in the electrophysiological markers of nerve conduction. PMID:26892473
The Escherichia coli Peripheral Inner Membrane Proteome*
Papanastasiou, Malvina; Orfanoudaki, Georgia; Koukaki, Marina; Kountourakis, Nikos; Sardis, Marios Frantzeskos; Aivaliotis, Michalis; Karamanou, Spyridoula; Economou, Anastassios
Biological membranes are essential for cell viability. Their functional characteristics strongly depend on their protein content, which consists of transmembrane (integral) and peripherally associated membrane proteins. Both integral and peripheral inner membrane proteins mediate a plethora of biological processes. Whereas transmembrane proteins have characteristic hydrophobic stretches and can be predicted using bioinformatics approaches, peripheral inner membrane proteins are hydrophilic, exist in equilibria with soluble pools, and carry no discernible membrane targeting signals. We experimentally determined the cytoplasmic peripheral inner membrane proteome of the model organism Escherichia coli using a multidisciplinary approach. Initially, we extensively re-annotated the theoretical proteome regarding subcellular localization using literature searches, manual curation, and multi-combinatorial bioinformatics searches of the available databases. Next we used sequential biochemical fractionations coupled to direct identification of individual proteins and protein complexes using high resolution mass spectrometry. We determined that the proposed cytoplasmic peripheral inner membrane proteome occupies a previously unsuspected ∼19% of the basic E. coli BL21(DE3) proteome, and the detected peripheral inner membrane proteome occupies ∼25% of the estimated expressed proteome of this cell grown in LB medium to mid-log phase. This value might increase when fleeting interactions, not studied here, are taken into account. Several proteins previously regarded as exclusively cytoplasmic bind membranes avidly. Many of these proteins are organized in functional or/and structural oligomeric complexes that bind to the membrane with multiple interactions. Identified proteins cover the full spectrum of biological activities, and more than half of them are essential. Our data suggest that the cytoplasmic proteome displays remarkably dynamic and extensive communication with
Epineurium-mimicking chitosan conduits for peripheral nervous tissue engineering.
Nawrotek, Katarzyna; Tylman, Michał; Rudnicka, Karolina; Gatkowska, Justyna; Wieczorek, Marek
In this investigation, we report on a fabrication method of epineurium-mimicking tubular conduits based on electrodeposition from chitosan solution. The pre-enrichment of electrodeposition solution with hyaluronic acid and/or collagen components results in structures which structural, morphological, and physicochemical properties can be controlled. In order to determine the optimal composition of the initial chitosan solution resulting in conduits meeting the requirements imposed on peripheral nerve implants, we perform chemical, physical, and biological studies. Both the molecular weight of hyaluronic acid and the concentration of additives are found to be crucial for the final mechanical as well as biological performance of conduits. Because, the obtained structures show biocompatibility when contacting with a mouse hippocampal cell line (mHippoE-18), we further plan to test their application potential on an animal model. PMID:27516256
[Sleep quality in aged patients with peripheral vascular diseases].
Corrêa, Karina; Ceolim, Maria Filomena
Peripheral vascular diseases (PVD) are prevalent among the elderly, and, due to their chronic character, result in poor quality of life and poor sleep quality. This study aimed at evaluating sleep quality of elderly people diagnosed with PVD who undergo clinical ambulatory treatment in a university hospital in Campinas, in the State of São Paulo. Subjects (n=50, aged 74 +/- 8 years old) answered the Pittsburgh Sleep Quality Index (PSQI) and provided basic demographic data and PVD history (35 subjects had arterial blockage in lower limbs). Results showed that 34 subjects presented bad sleep quality; sleep length was 5.8 (+/- 2.3) hours, and, according to 23 subjects, night sleep was frequently disturbed by pain (thrice a week or more). Eighteen subjects took analgesics; four took sleep medicines. Findings may have important implications for nurses working with PVD patients, stressing the need to take into account consequences of PVD on sleep disturbances when planning their interventions. PMID:18450142
[Continuous peripheral regional analgesia in children].
Lacroix, F
Continuous peripheral nerve blocks (CPNB) have important role in the therapeutic arsenal, anaesthetic or analgesic in children. Indications for CPNB depend on benefits/risks analysis for each patient. The indications include surgery associated with intense postoperative pain, surgery requiring painful physical therapy, and complex regional pain syndrome. CPNB are usually performed under sedation or general anaesthesia, and require appropriate equipment in order to decrease the risk of nerve injury. Nevertheless, CPNB may mask compartment syndrome in trauma or certain surgical procedure. Finally, ropivacaine, and perhaps levobupivacaine, appears to be the best local anaesthetic for continuous peripheral nerve blocks in children, requiring low flow rate with low concentration. PMID:17543494
Peripheral phlebitis: a point-prevalence study.
Washington, Georgita T; Barrett, Robin
The purpose of this research study was to determine the factors influencing peripheral phlebitis in the adult medical-surgical population. The authors would then be able to use those data to determine whether a change in practice was warranted. Data collection and analysis of 188 intravenous sites revealed that females with higher doses of medications in intravenous sites of longer dwell times and suboptimal nutrition were at greater risk of developing peripheral phlebitis. The point prevalence was greater than the recommended 5%, which led the authors to review their facility's patient care and documentation practices. PMID:22759829
Familial multiple symmetric lipomatosis with peripheral neuropathy.
Chalk, C H; Mills, K R; Jacobs, J M; Donaghy, M
We describe coexisting peripheral neuropathy and multiple symmetric lipomatosis in 4 of 7 siblings. The absence of either condition in 3 other generations of this family suggests autosomal recessive inheritance. None of the affected siblings were alcoholic, a factor some have proposed to explain the frequent occurrence of peripheral neuropathy in sporadic multiple symmetric lipomatosis. Serum lipid studies, including apoprotein A levels, were normal. Sural nerve biopsy from 1 patient showed nerve fiber loss, predominantly affecting large myelinated fibers. The relationship between myelin sheath thickness and axon diameter was normal, arguing that this neuropathy is not due to primary axonal atrophy. PMID:2166247
Ultrasound-Guided Peripheral Nerve Procedures.
Strakowski, Jeffrey A
Ultrasound guidance allows real-time visualization of the needle in peripheral nerve procedures, improving accuracy and safety. Sonographic visualization of the peripheral nerve and surrounding anatomy can provide valuable information for diagnostic purposes and procedure enhancement. Common procedures discussed are the suprascapular nerve at the suprascapular notch, deep branch of the radial nerve at the supinator, median nerve at the pronator teres and carpal tunnel, lateral cutaneous nerve of the thigh, superficial fibular nerve at the leg, tibial nerve at the ankle, and interdigital neuroma. For each procedure, the indications, relevant anatomy, preprocedural scanning technique, and injection procedure itself are detailed. PMID:27468673
Bronchoscopes of the twenty-first century.
Yarmus, Lonny; Feller-Kopman, David
Over the past century, bronchoscopy has become an essential tool for pulmonologists and thoracic surgeons, who for many years have employed bronchoscopy with such therapeutic modalities as laser therapy, electrocautery, cryotherapy, and stent placement. Over the past decade, advanced imaging techniques, such as autofluoresence bronchoscopy, electromagnetic navigation, narrow-band imaging, confocal fluorescence microendoscopy, and endobronchial ultrasound, have greatly expanded the diagnostic utility of bronchoscopy. This article reviews the technological advances in the field of diagnostic bronchoscopy. PMID:20172429
Radiation-induced malignant and atypical peripheral nerve sheath tumors
Foley, K.M.; Woodruff, J.M.; Ellis, F.T.; Posner, J.B.
The reported peripheral nerve complications of therapeutic irradiation in humans include brachial and lumbar plexus fibrosis and cranial and peripheral nerve atrophy. We have encountered 9 patients with malignant (7) and atypical (2) peripheral nerve tumors occurring in an irradiated site suggesting that such tumors represent another delayed effect of radiation treatment on peripheral nerve. In all instances the radio-theray was within an acceptable radiation dosage, yet 3 patients developed local radiation-induced skin and bony abnormalities. The malignant peripheral nerve sheath tumors developed only in the radiation port. Animal studies support the clinical observation that malignant peripheral nerve sheath tumors can occur as a delayed effect of irradiation.
Drugs for the treatment of peripheral neuropathies.
Marmiroli, Paola; Cavaletti, Guido
Peripheral neuropathies are frequent in association with systemic diseases as well as isolated disorders. Recent advances in the therapy of specific neuropathies led to the approval of new drugs/treatments. This review selected those peripheral neuropathies where the most recent approvals were provided and revised the potential future developments in diabetic and toxic-induced neuropathies, although they do not have a currently available causal therapy in view of their epidemiological and social relevance. Data have been extracted from the most important published trials and from clinical experience. In addition, data from the Food and Drug Administration and European Medicine Agency indications on the treatment of the selected peripheral neuropathies and from recently updated international guidelines have also been included. The website of the U.S. National Institutes of Health www.clinicaltrials.gov registry has been used as the reference database for phase III clinical trials not yet published or ongoing. This review gives a general overview of the most recent advances in the treatment of amyloid, inflammatory, and paraproteinemic peripheral neuropathies. Moreover, it briefly describes the unmet medical need in disabling and frequent conditions, such as diabetic and chemotherapy-induced neuropathy, highlighting the most promising therapeutic approaches to their treatment. PMID:26567516
Massive exophytic malignant peripheral nerve sheath tumor.
Khorsand, Derek; Porrino, Jack; Flaherty, Erin; Bandhlish, Anshu; Davidson, Darin
We present a case of a solitary neurofibroma involving the right posterior shoulder of a 69-year-old man with degeneration into a massive, malignant peripheral nerve sheath tumor measuring more than 3 times the average reported size. The radiographic, magnetic resonance imaging, and computed tomographic features are compared with the gross appearance and pathology. PMID:27257459
Peripheral Mechanisms of Pain and Analgesia
Stein, Christoph; Clark, J. David; Oh, Uhtaek; Vasko, Michael R.; Wilcox, George L.; Overland, Aaron C.; Vanderah, Todd W.; Spencer, Robert H.
This review summarizes recent findings on peripheral mechanisms underlying the generation and inhibition of pain. The focus is on events occurring in peripheral injured tissues that lead to the sensitization and excitation of primary afferent neurons, and on the modulation of such mechanisms. Primary afferent neurons are of particular interest from a therapeutic perspective because they are the initial generator of noxious impulses traveling towards relay stations in the spinal cord and the brain. Thus, if one finds ways to inhibit the sensitization and/or excitation of peripheral sensory neurons, subsequent central events such as wind-up, sensitization and plasticity may be prevented. Most importantly, if agents are found that selectively modulate primary afferent function and do not cross the blood-brain-barrier, centrally mediated untoward side effects of conventional analgesics (e.g. opioids, anticonvulsants) may be avoided. This article begins with the peripheral actions of opioids, turns to a discussion of the effects of adrenergic co-adjuvants, and then moves on to a discussion of pro-inflammatory mechanisms focusing on TRP channels and nerve growth factor, their signaling pathways and arising therapeutic perspectives. PMID:19150465
[Colonic Crohn's disease complicated with peripheral neuropathy].
Chaoui, F; Hellal, H; Balamane, M; Boudhane, M; Mikol, J; Masmoudi, A
The association of Crohn's disease and peripheral neuropathy is a rare event and the pathogenic factors often implicated are vitamin B12 deficiency or metronidazole treatment. We report a case of severe axonal polyneuropathy associated with Crohn's disease and unrelated to vitamin deficiency or metronidazole treatment. This represents a very rare extra-digestive manifestation of Crohn's disease. PMID:2125951
Peripheral nerve regeneration and neurotrophic factors
The role of neurotrophic factors in the maintenance and survival of peripheral neuronal cells has been the subject of numerous studies. Administration of exogenous neurotrophic factors after nerve injury has been shown to mimic the effect of target organ-derived trophic factors on neuronal cells. After axotomy and during peripheral nerve regeneration, the neurotrophins NGF, NT-3 and BDNF show a well defined and selective beneficial effect on the survival and phenotypic expression of primary sensory neurons in dorsal root ganglia and of motoneurons in spinal cord. Other neurotrophic factors such as CNTF, GDNF and LIF also exert a variety of actions on neuronal cells, which appear to overlap and complement those of the neurotrophins. In addition, there is an indirect contribution of GGF to nerve regeneration. GGF is produced by neurons and stimulates proliferation of Schwann cells, underlining the close interaction between neuronal and glial cells during peripheral nerve regeneration. Different possibilities have been investigated for the delivery of growth factors to the injured neurons, in search of a suitable system for clinical applications. The studies reviewed in this article show the therapeutic potential of neurotrophic factors for the treatment of peripheral nerve injury and for neuropathies. PMID:10227662
Legitimate Peripheral Participation and Home Education
ERIC Educational Resources Information Center
Safran, L.
After a description of home education, Lave and Wenger's (1991) theory of legitimate peripheral participation (LPP) is applied to the situation of home educators who join a neighbourhood home education group, a community of practice. Then, it is argued that the theory of LPP, with suitable modification, can also apply to and illuminate the…
Chapter 11: Tissue engineering of peripheral nerves.
Battiston, Bruno; Raimondo, Stefania; Tos, Pierluigi; Gaidano, Valentina; Audisio, Chiara; Scevola, Anna; Perroteau, Isabelle; Geuna, Stefano
Tissue engineering of peripheral nerves has seen an increasing interest over the last years and, similarly to many other fields of regenerative medicine, great expectations have risen within the general public to its potential clinical application in the treatment of damaged nerves. However, in spite of the scientific advancements, applications to the patients is still very limited and it appears that to optimize the strategy for the tissue engineering of the peripheral nerves in the clinical view, researchers have to strive for a new level of innovation which will bring together (in a multitranslational approach) the main pillars of tissue engineering: namely (1) microsurgery, (2) cell and tissue transplantation, (3) material science, and (4) gene transfer. This review paper provides an overview of these four key approaches to peripheral nerve tissue engineering. While some of these issues will also be specifically addressed in other papers in this special issue on peripheral nerve regeneration of the International Review of Neurobiology, in this paper we will focus on an example of successful translational research in tissue engineering, namely nerve reconstruction by muscle-vein-combined nerve scaffolds. PMID:19682640
Peripheral genetic structure of Helicoverpa zea indicates asymmetrical panmixia
Technology Transfer Automated Retrieval System (TEKTRAN)
Seasonal climatic shifts create peripheral habitats that alternate between habitable and uninhabitable for migratory species. Such dynamic peripheral habitats are potential sites where migratory species could evolve high genetic diversity resulting from convergence of immigrants from multiple region...
Peripheral artery disease of the legs - self-care
... 000577.htm Peripheral artery disease of the legs - self-care To use the sharing features on this ... do not heal Alternate Names Peripheral vascular disease - self-care; Intermittent claudication - self-care References Creager MA, ...
21 CFR 868.2775 - Electrical peripheral nerve stimulator.
Code of Federal Regulations, 2012 CFR
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Electrical peripheral nerve stimulator. 868.2775... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2775 Electrical peripheral nerve stimulator. (a) Identification. An electrical peripheral nerve stimulator (neuromuscular blockade monitor)...
21 CFR 868.2775 - Electrical peripheral nerve stimulator.
Code of Federal Regulations, 2010 CFR
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Electrical peripheral nerve stimulator. 868.2775... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2775 Electrical peripheral nerve stimulator. (a) Identification. An electrical peripheral nerve stimulator (neuromuscular blockade monitor)...
16 CFR 1203.14 - Peripheral vision test.
Code of Federal Regulations, 2011 CFR
... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Peripheral vision test. 1203.14 Section 1203... SAFETY STANDARD FOR BICYCLE HELMETS The Standard § 1203.14 Peripheral vision test. Position the helmet on... the helmet to set the comfort or fit padding. (Note: Peripheral vision clearance may be...
16 CFR 1203.14 - Peripheral vision test.
Code of Federal Regulations, 2013 CFR
... 16 Commercial Practices 2 2013-01-01 2013-01-01 false Peripheral vision test. 1203.14 Section 1203... SAFETY STANDARD FOR BICYCLE HELMETS The Standard § 1203.14 Peripheral vision test. Position the helmet on... the helmet to set the comfort or fit padding. (Note: Peripheral vision clearance may be...
16 CFR 1203.14 - Peripheral vision test.
Code of Federal Regulations, 2012 CFR
... 16 Commercial Practices 2 2012-01-01 2012-01-01 false Peripheral vision test. 1203.14 Section 1203... SAFETY STANDARD FOR BICYCLE HELMETS The Standard § 1203.14 Peripheral vision test. Position the helmet on... the helmet to set the comfort or fit padding. (Note: Peripheral vision clearance may be...
16 CFR 1203.14 - Peripheral vision test.
Code of Federal Regulations, 2014 CFR
... 16 Commercial Practices 2 2014-01-01 2014-01-01 false Peripheral vision test. 1203.14 Section 1203... SAFETY STANDARD FOR BICYCLE HELMETS The Standard § 1203.14 Peripheral vision test. Position the helmet on... the helmet to set the comfort or fit padding. (Note: Peripheral vision clearance may be...
16 CFR 1203.14 - Peripheral vision test.
Code of Federal Regulations, 2010 CFR
... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Peripheral vision test. 1203.14 Section 1203... SAFETY STANDARD FOR BICYCLE HELMETS The Standard § 1203.14 Peripheral vision test. Position the helmet on... the helmet to set the comfort or fit padding. (Note: Peripheral vision clearance may be...
Dry needling — peripheral and central considerations
Dommerholt, Jan
Dry needling is a common treatment technique in orthopedic manual physical therapy. Although various dry needling approaches exist, the more common and best supported approach targets myofascial trigger points. This article aims to place trigger point dry needling within the context of pain sciences. From a pain science perspective, trigger points are constant sources of peripheral nociceptive input leading to peripheral and central sensitization. Dry needling cannot only reverse some aspects of central sensitization, it reduces local and referred pain, improves range of motion and muscle activation pattern, and alters the chemical environment of trigger points. Trigger point dry needling should be based on a thorough understanding of the scientific background of trigger points, the differences and similarities between active and latent trigger points, motor adaptation, and central sensitize application. Several outcome studies are included, as well as comments on dry needling and acupuncture. PMID:23115475
Glutamate in peripheral organs: Biology and pharmacology.
Du, Jie; Li, Xiao-Hui; Li, Yuan-Jian
Glutamate is a versatile molecule existing in both the central nervous system and peripheral organs. Previous studies have mainly focussed on the biological effect of glutamate in the brain. Recently, abundant evidence has demonstrated that glutamate also participates in the regulation of physiopathological functions in peripheral tissues, including the lung, kidney, liver, heart, stomach and immune system, where the glutamate/glutamate receptor/glutamate transporter system plays an important role in the pathogenesis of certain diseases, such as myocardial ischaemia/reperfusion injury and acute gastric mucosa injury. All these findings provide new insight into the biology and pharmacology of glutamate and suggest a potential therapeutic role of glutamate in non-neurological diseases. PMID:27164423
Light emitting device having peripheral emissive region
Forrest, Stephen R
Light emitting devices are provided that include one or more OLEDs disposed only on a peripheral region of the substrate. An OLED may be disposed only on a peripheral region of a substantially transparent substrate and configured to emit light into the substrate. Another surface of the substrate may be roughened or include other features to outcouple light from the substrate. The edges of the substrate may be beveled and/or reflective. The area of the OLED(s) may be relatively small compared to the substrate surface area through which light is emitted from the device. One or more OLEDs also or alternatively may be disposed on an edge of the substrate about perpendicular to the surface of the substrate through which light is emitted, such that they emit light into the substrate. A mode expanding region may be included between each such OLED and the substrate.
Peripheral Modulation of Smell: Fact or Fiction?
Lucero, Mary T.
Despite studies dating back 30 or more years showing modulation of odorant responses at the level of the olfactory epithelium, most descriptions of the olfactory system infer that odorant signals make their way from detection by cilia on olfactory sensory neurons to the olfactory bulb unaltered. Recent identification of multiple subtypes of microvillar cells and identification of neuropeptide and neurotransmitter expression in the olfactory mucosa add to the growing body of literature for peripheral modulation in the sense of smell. Complex mechanisms including perireceptor events, modulation of sniff rates, and changes in the properties of sensory neurons match the sensitivity of olfactory sensory neurons to the external odorant environment, internal nutritional status, reproductive status, and levels of arousal or stress. By furthering our understanding of the players mediating peripheral olfaction, we may open the door to novel approaches for modulating the sense of smell in both health and disease. PMID:22986099
Binocular summation and peripheral visual response time
NASA Technical Reports Server (NTRS)
Gilliland, K.; Haines, R. F.
Six males were administered a peripheral visual response time test to the onset of brief small stimuli imaged in 10-deg arc separation intervals across the dark adapted horizontal retinal meridian under both binocular and monocular viewing conditions. This was done in an attempt to verify the existence of peripheral binocular summation using a response time measure. The results indicated that from 50-deg arc right to 50-deg arc left of the line of sight binocular summation is a reasonable explanation for the significantly faster binocular data. The stimulus position by viewing eye interaction was also significant. A discussion of these and other analyses is presented along with a review of related literature.
Social suggestibility to central and peripheral misinformation.
Dalton, Andrea L; Daneman, Meredyth
This study used a laboratory-based paradigm to investigate social influences on participants' susceptibility to misleading suggestions. Participants viewed a video clip of an action sequence with one or more peers, and then were required to discuss the event with the co-witness or with the group of co-witnesses. During the discussion a confederate, posing as a peer, presented misinformation about central and peripheral features of the co-witnessed event. Results indicated that participants were more susceptible to misleading suggestions during one-on-one discussions than during group discussions. In addition, participants were susceptible to misleading suggestions about central features of the witnessed event, although to a lesser extent than they were susceptible to misleading suggestions about peripheral features. PMID:16766450
[Blast cells in peripheral blood smear].
Lüthi, U; Huber, A R
Despite modern technologies such as immunophenotyping and molecular probing cytomorphological examination of stained peripheral blood smears by microscopy remains the mainstay of diagnosis in a large variety of diseases. Although technically simple morphological analysis requires considerable skill. Early diagnosis in several hematological diseases is important (for example acute promyelocytic leukaemia associated frequently with disseminated intravascular coagulation), in order to initiate adjusted therapy. Further, referral of the patient to tertiary care centers is only justified after a solid diagnosis is obtained. Many disorders can be diagnosed by pathognomonic blood smears. The present article is a short overview of important hematological disorders, which are associated with blast cells in the peripheral blood. Important morphological cell characteristics are illustrated by microscopic pictures. PMID:15018395
Expenditures in the elderly with peripheral neuropathy
Callaghan, Brian C.; Burke, James F.; Rodgers, Ann; McCammon, Ryan; Langa, Kenneth M.; Feldman, Eva L.; Kerber, Kevin A.
Summary To optimize care in the evaluation of peripheral neuropathy, we sought to define which tests drive expenditures and the role of the provider type. We investigated test utilization and expenditures by provider type in those with incident neuropathy in a nationally representative elderly, Medicare population. Multivariable logistic regression was used to determine predictors of MRI and electrodiagnostic utilization. MRIs of the neuroaxis and electrodiagnostic tests accounted for 88% of total expenditures. Mean and aggregate diagnostic expenditures were higher in those who saw a neurologist. Patients who saw a neurologist were more likely to receive an MRI and an electrodiagnostic test. MRIs and electrodiagnostic tests are the main contributors to expenditures in the evaluation of peripheral neuropathy, and should be the focus of future efficiency efforts. PMID:24175158
Peripheral Neuropathy in Mouse Models of Diabetes.
Jolivalt, Corinne G; Frizzi, Katie E; Guernsey, Lucie; Marquez, Alex; Ochoa, Joseline; Rodriguez, Maria; Calcutt, Nigel A
Peripheral neuropathy is a frequent complication of chronic diabetes that most commonly presents as a distal degenerative polyneuropathy with sensory loss. Around 20% to 30% of such patients may also experience neuropathic pain. The underlying pathogenic mechanisms are uncertain, and therapeutic options are limited. Rodent models of diabetes have been used for more than 40 years to study neuropathy and evaluate potential therapies. For much of this period, streptozotocin-diabetic rats were the model of choice. The emergence of new technologies that allow relatively cheap and routine manipulations of the mouse genome has prompted increased use of mouse models of diabetes to study neuropathy. In this article, we describe the commonly used mouse models of type 1 and type 2 diabetes, and provide protocols to phenotype the structural, functional, and behavioral indices of peripheral neuropathy, with a particular emphasis on assays pertinent to the human condition. © 2016 by John Wiley & Sons, Inc. PMID:27584552
Effects of Laser Irradiation on Peripheral Nerve
NASA Astrophysics Data System (ADS)
Baxter, G. D.; Chow, R.; Armati, P.; Bjordal, J. M.; Laakso, L.
A literature review was undertaken to determine the electrophysiological effects of Laser Irradiation (LI) on peripheral mammalian nerves, as a means of elucidating the potential mechanisms underlying pain relief associated with laser therapy. Relevant computerized databases and reference lists were searched, and experts consulted for further articles. A total of 38 studies, comprising 82 separate experiments were identified. In human studies, all types of LI (red and infrared, pulsed and cw) slowed nerve conduction velocity, and reduced compound action potential of irradiated nerves. In animal studies, infrared LI suppressed conduction velocity, as well as noxious stimulation evoked potential. This review thus indicates the potential of laser irradiation to inhibit activity in peripheral nerves, and highlights one potential mechanism of action for laser-mediated pain relief.
Chiral dynamics and peripheral transverse densities
Granados, Carlos G.; Weiss, Christian
In the partonic (or light-front) description of relativistic systems the electromagnetic form factors are expressed in terms of frame-independent charge and magnetization densities in transverse space. This formulation allows one to identify the chiral components of nucleon structure as the peripheral densities at transverse distances b = O(M{sub {pi}}{sup -1}) and compute them in a parametrically controlled manner. A dispersion relation connects the large-distance behavior of the transverse charge and magnetization densities to the spectral functions of the Dirac and Pauli form factors near the two--pion threshold at timelike t = 4 M{ sub {pi}}{sup 2}, which can be computed in relativistic chiral effective field theory. Using the leading-order approximation we (a) derive the asymptotic behavior (Yukawa tail) of the isovector transverse densities in the "chiral" region b = O(M{sub {pi}}{sup -1}) and the "molecular" region b = O(M{sub N}{sup 2}/M{sub {pi}}{sup 3}); (b) perform the heavy-baryon expansion of the transverse densities; (c) explain the relative magnitude of the peripheral charge and magnetization densities in a simple mechanical picture; (d) include Delta isobar intermediate states and study the peripheral transverse densities in the large-N{ sub c} limit of QCD; (e) quantify the region of transverse distances where the chiral components of the densities are numerically dominant; (f) calculate the chiral divergences of the b{sup 2}-weighted moments of the isovector transverse densities (charge and anomalous magnetic radii) in the limit M{sub {pi}} -> 0 and determine their spatial support. Our approach provides a concise formulation of the spatial structure of the nucleon's chiral component and offers new insights into basic properties of the chiral expansion. It relates the information extracted from low-t elastic form factors to the generalized parton distributions probed in peripheral high-energy scattering processes.
Peripheral Nervous System Manifestations of Infectious Diseases
Brizzi, Kate T.
Infectious causes of peripheral nervous system (PNS) disease are underrecognized but potentially treatable. Heightened awareness educed by advanced understanding of the presentations and management of these infections can aid diagnosis and facilitate treatment. In this review, we discuss the clinical manifestations, diagnosis, and treatment of common bacterial, viral, and parasitic infections that affect the PNS. We additionally detail PNS side effects of some frequently used antimicrobial agents. PMID:25360209
Cell Therapy of Peripheral Arterial Disease
Raval, Zankhana; Losordo, Douglas W.
The age-adjusted prevalence of peripheral arterial disease in the US population was estimated to approach 12% in 1985, and as the population ages, the overall population having peripheral arterial disease is predicted to rise. The clinical consequences of occlusive peripheral arterial disease include intermittent claudication, that is, pain with walking, and critical limb ischemia (CLI), which includes pain at rest and loss of tissue integrity in the distal limbs, which may ultimately lead to amputation of a portion of the lower extremity. The risk factors for CLI are similar to those linked to coronary artery disease and include advanced age, smoking, diabetes mellitus, hyperlipidemia, and hypertension. The worldwide incidence of CLI was estimated to be 500 to 1000 cases per million people per year in 1991. The prognosis is poor for CLI subjects with advanced limb disease. One study of >400 such subjects in the United Kingdom found that 25% required amputation and 20% (including some subjects who had required amputation) died within 1 year. In the United States, ≈280 lower-limb amputations for ischemic disease are performed per million people each year. The first objective in treating CLI is to increase blood circulation to the affected limb. Theoretically, increased blood flow could be achieved by increasing the number of vessels that supply the ischemic tissue with blood. The use of pharmacological agents to induce new blood vessel growth for the treatment or prevention of pathological clinical conditions has been called therapeutic angiogenesis. Since the identification of the endothelial progenitor cell in 1997 by Asahara and Isner, the field of cell-based therapies for peripheral arterial disease has been in a state of continuous evolution. Here, we review the current state of that field. PMID:23620237
Peripheral contrast sensitivity and attention in myopia.
Kerber, Kristen L; Thorn, Frank; Bex, Peter J; Vera-Diaz, Fuensanta A
Disruption of normal visual experience or changes in the normal interaction between central and peripheral retinal input may lead to the development of myopia. In order to examine the relationship between peripheral contrast sensitivity and myopia, we manipulated attentional load for foveal vision in emmetropes and myopes while observers detected targets with peripheral vision. Peripheral contrast detection thresholds were measured binocularly using vertical Gabor stimuli presented at three eccentricities (±8°, 17°, 30°) in a spatial 2 alternative forced choice task. Contrast thresholds were measured in young adult (mean age 24.5±2.6years) emmetropes (n=17; group SE: +0.19±0.32D) and myopes (n=25; group SE: -3.74±1.99D). Attention at central fixation was manipulated with: (1) a low attention task, requiring simple fixation; or (2) a high attention task, which required subjects to perform a mathematical task. We found that at 30° all subjects exhibited lower contrast sensitivity (higher thresholds). In addition, myopes (Wilcoxon, p<0.01), but not emmetropes (Wilcoxon, p=0.1), had a significant decrease in sensitivity at 30° during the high attention task. However, the attention dependent threshold increase for myopes was not significantly greater than for emmetropes (Wilcoxon, p=0.27). Attentional load did not increase thresholds at 8° or 17° for either refractive group. These data indicate that myopes experience a greater decrease in contrast sensitivity in the far periphery than emmetropes when attention is deployed in central vision. PMID:27264028
Circulating dihydrotestosterone may not reflect peripheral formation.
Toscano, V; Horton, R
We compared the blood (PBDHT) and urine (PUDHT) production rate of dihydrotestosterone (DHT) in normal men and women to determine whether peripheral formation was totally reflected in blood. PBDHT was similar when measured at both sites in men (674 +/- 79 vs. 788 +/- 207 SE micrograms/d); however, PUDHT was greater than PBDHT in women (174 +/- 55 vs. 55 +/- 8 micrograms/d, P less than 0.02). Excretion rates of DHT and 3 alpha-androstanediol (3 alpha diol) were similar in both sexes despite major differences in blood levels. However, between sexes large differences were present in 3 alpha diol glucuronide (3 alpha diolG) in both plasma and urine. These observations indicate that peripheral (renal) formation of DHT and probably 3 alpha diol were not accurately determined by measurement of these steroids in blood. The large difference between blood and urine production rates in women suggests an important role of non-testosterone precursors of 5 alpha-reduced steroids. Measurements of 3 alpha diolG may provide more insight into these peripheral events. PMID:3584464
Computer aided diagnosis of diabetic peripheral neuropathy
NASA Astrophysics Data System (ADS)
Chekh, Viktor; Soliz, Peter; McGrew, Elizabeth; Barriga, Simon; Burge, Mark; Luan, Shuang
Diabetic peripheral neuropathy (DPN) refers to the nerve damage that can occur in diabetes patients. It most often affects the extremities, such as the feet, and can lead to peripheral vascular disease, deformity, infection, ulceration, and even amputation. The key to managing diabetic foot is prevention and early detection. Unfortunately, current existing diagnostic techniques are mostly based on patient sensations and exhibit significant inter- and intra-observer differences. We have developed a computer aided diagnostic (CAD) system for diabetic peripheral neuropathy. The thermal response of the feet of diabetic patients following cold stimulus is captured using an infrared camera. The plantar foot in the images from a thermal video are segmented and registered for tracking points or specific regions. The temperature recovery of each point on the plantar foot is extracted using our bio-thermal model and analyzed. The regions that exhibit abnormal ability to recover are automatically identified to aid the physicians to recognize problematic areas. The key to our CAD system is the segmentation of infrared video. The main challenges for segmenting infrared video compared to normal digital video are (1) as the foot warms up, it also warms up the surrounding, creating an ever changing contrast; and (2) there may be significant motion during imaging. To overcome this, a hybrid segmentation algorithm was developed based on a number of techniques such as continuous max-flow, model based segmentation, shape preservation, convex hull, and temperature normalization. Verifications of the automatic segmentation and registration using manual segmentation and markers show good agreement.
Small field tritanopia in the peripheral retina.
Volbrecht, Vicki J
If stimuli are made sufficiently small, color-normal individuals report a loss in hue perception, in particular a decrease in the perception of green, in both the fovea and peripheral retina. This effect is referred to as small field tritanopia. It is not clear, however, how rod input may alter the dynamics of small field tritanopia in the peripheral retina. This paper looks at peripheral hue-naming data obtained for small stimuli at mesopic and photopic retinal illuminances under conditions that minimize (bleach) and maximize (no bleach) rod contribution. The data show that attenuation in the perception of green occurs with larger stimuli in the no-bleach condition than in the bleach condition. As retinal illuminance increases, the stimulus size that elicits small field tritanopia decreases, but the stimulus size is still larger under the no-bleach condition. Small field tritanopia in both the bleach and no-bleach conditions may be related to short-wavelength-sensitive (S) cone activity and its potential role in the mediation of the perception of green. The differences in stimulus size for small field tritanopia may be explained by rod input into the magnocellular and koniocellular pathways, which compromises the strength of the chromatic signals and creates a differential loss in the perception of green as compared to the other elemental hues. PMID:27409678
Peripheral Lymphadenopathy: Approach and Diagnostic Tools
Mohseni, Shahrzad; Shojaiefard, Abolfazl; Khorgami, Zhamak; Alinejad, Shahriar; Ghorbani, Ali; Ghafouri, Ali
Peripheral lymph nodes, located deep in the subcutaneous tissue, clean antigens from the extracellular fluid. Generally, a normal sized lymph node is less than one cm in diameter. Peripheral lymphadenopathy (LAP) is frequently due to a local or systemic, benign, self-limited, infectious disease. However, it could be a manifestation of underlying malignancy. Seventy-five percent of all LAPs are localized, with more than 50% being seen in the head and neck area. LAP may be localized or generalized. Cervical lymph nodes are involved more often than the other lymphatic regions. Generally, it is due to infections, but most of the supraclavicular lymphadenopathies are associated with malignancy. Based on different geographical areas, the etiology is various. For example, in tropical areas, tuberculosis (TB) is a main benign cause of LAP in adults and children. Complete history taking and physical examination are mandatory for diagnosis; however, laboratory tests, imaging diagnostic methods, and tissue samplings are the next steps. Tissue diagnosis by fine needle aspiration biopsy or excisional biopsy is the gold standard evaluation for LAP. We concluded that in patients with peripheral LAP, the patient's age and environmental exposures along with a careful history taking and physical examination can help the physician to request step by step further work-up when required, including laboratory tests, imaging modalities, and tissue diagnosis, to reach an appropriate diagnosis. PMID:24753638
Abnormal calcium homeostasis in peripheral neuropathies
Fernyhough, Paul; Calcutt, Nigel A.
Abnormal neuronal calcium (Ca2+) homeostasis has been implicated in numerous diseases of the nervous system. The pathogenesis of two increasingly common disorders of the peripheral nervous system, namely neuropathic pain and diabetic polyneuropathy, has been associated with aberrant Ca2+ channel expression and function. Here we review the current state of knowledge regarding the role of Ca2+ dyshomeostasis and associated mitochondrial dysfunction in painful and diabetic neuropathies. The central impact of both alterations of Ca2+ signalling at the plasma membrane and also intracellular Ca2+ handling on sensory neuron function is discussed and related to abnormal endoplasmic reticulum performance. We also present new data highlighting sub-optimal axonal Ca 2+ signalling in diabetic neuropathy and discuss the putative role for this abnormality in the induction of axonal degeneration in peripheral neuropathies. The accumulating evidence implicating Ca2+ dysregulation with both painful and degenerative neuropathies, along with recent advances in understanding of regional variations in Ca2+ channel and pump structures, makes modulation of neuronal Ca2+ handling an increasingly viable approach for therapeutic interventions against the painful and degenerative aspects of many peripheral neuropathies. PMID:20034667
Sensory Coding in Oscillatory Peripheral Receptors
NASA Astrophysics Data System (ADS)
Neiman, Alexander
Rhythmical activity have been observed in several types of peripheral sensory receptors, e.g. in senses of hearing, balance and electroreception. We use two examples of spontaneously oscillating peripheral sensory receptors: bullfrog saccular hair cells and electroreceptors of paddlefish, to discuss how oscillations emerge, how these sensors may utilize oscillations to optimize their sensitivity and information processing. In the hair cell system oscillations occur on two very different levels: first, the mechano-sensory hair bundle itself can undergo spontaneous mechanical oscillations and second, self-sustained voltage oscillations across the membrane of the hair cell have been documented. Modelling show that interaction of these two compartment results in enhanced sensitivity to periodic mechanical stimuli. The second example, a single peripheral electroreceptor, is a complex system comprised of several thousands of sensory epithelial cells innervated by a few primary sensory neurons. It embeds two distinct oscillators: one residing in a population of epithelial cells, synaptically coupled to another oscillator residing in a branched myelinated afferent axon. We show how neuronal oscillations emerge in a complex network of excitable nodes. We further demonstrate that epithelial oscillations results in extended serial correlations of neruonal discharges enhancing coding of external stimuli.
Experimental study on photon-beam peripheral doses, their components and some possibilities for their reduction
NASA Astrophysics Data System (ADS)
Chofor, Ndimofor; Harder, Dietrich; Rühmann, Antje; Willborn, Kay C.; Wiezorek, Tilo; Poppe, Björn
The component analysis of the peripheral doses produced at typical accelerators such as the Siemens Primus 6/15 is regarded as an approach enabling technical strategies towards the reduction of second malignancies associated with photon beam radiotherapy. Suitable phantom and detector arrangements have been applied to show that the unavoidable peripheral dose contribution due to photon scattering from the directly irradiated part of the body or phantom does not constitute the entirety of the peripheral doses. Rather, there are peripheral dose contributions due to beam head leakage and to extrafocal radiation which can be regarded as partly avoidable. Simple methods of reducing beam head leakage from the Siemens Primus 6/15 linac are, for the crossplane direction, to install a pair of adjustable shielding blocks in the accessory holder and, for the inplane direction, to close all out-of-field leaf pairs of the multileaf collimator via the treatment planning system software. The relative efficiency of these shielding measures is largest in the case of small unavoidable dose contributions, i.e. for small fields and small depths. Methods of avoiding doses coming from extrafocal radiation are also envisaged for future research.
Peripheral changes in endometriosis-associated pain
Morotti, Matteo; Vincent, Katy; Brawn, Jennifer; Zondervan, Krina T.; Becker, Christian M.
BACKGROUND Pain remains the cardinal symptom of endometriosis. However, to date, the underlying mechanisms are still only poorly understood. Increasing evidence points towards a close interaction between peripheral nerves, the peritoneal environment and the central nervous system in pain generation and processing. Recently, studies demonstrating nerve fibres and neurotrophic and angiogenic factors in endometriotic lesions and their vicinity have led to increased interest in peripheral changes in endometriosis-associated pain. This review focuses on the origin and function of these nerves and factors as well as possible peripheral mechanisms that may contribute to the generation and modulation of pain in women with endometriosis. METHODS We conducted a systematic search using several databases (PubMed, MEDLINE, EMBASE and CINAHL) of publications from January 1977 to October 2013 to evaluate the possible roles of the peripheral nervous system in endometriosis pathophysiology and how it can contribute to endometriosis-associated pain. RESULTS Endometriotic lesions and peritoneal fluid from women with endometriosis had pronounced neuroangiogenic properties with increased expression of new nerve fibres, a shift in the distribution of sensory and autonomic fibres in some locations, and up-regulation of several neurotrophins. In women suffering from deep infiltrating endometriosis and bowel endometriosis, in which the anatomical distribution of lesions is generally more closely related to pelvic pain symptoms, endometriotic lesions and surrounding tissues present higher nerve fibre densities compared to peritoneal lesions and endometriomas. More data are needed to fully confirm a direct correlation between fibre density in these locations and the amount of perceived pain. A better correlation between the presence of nerve fibres and pain symptoms seems to exist for eutopic endometrium. However, this appears not to be exclusive to endometriosis. No correlation between
Peripheral nerve injuries in the athlete.
Feinberg, J H; Nadler, S F; Krivickas, L S
Peripheral nerves are susceptible to injury in the athlete because of the excessive physiological demands that are made on both the neurological structures and the soft tissues that protect them. The common mechanisms of injury are compression, traction, ischaemia and laceration. Seddon's original classification system for nerve injuries based on neurophysiological changes is the most widely used. Grade 1 nerve injury is a neuropraxic condition, grade 2 is axonal degeneration and grade 3 is nerve transection. Peripheral nerve injuries are more common in the upper extremities than the lower extremities, tend to be sport specific, and often have a biomechanical component. While the more acute and catastrophic neurological injuries are usually obvious, many remain subclinical and are not recognised before neurological damage is permanent. Early detection allows initiation of a proper rehabilitation programme and modification of biomechanics before the nerve injury becomes irreversible. Recognition of nerve injuries requires an understanding of peripheral neuroanatomy, knowledge of common sites of nerve injury and an awareness of the types of peripheral nerve injuries that are common and unique to each sport. The electrodiagnostic exam, usually referred to as the 'EMG', consists of nerve conduction studies and the needle electrode examination. It is used to determine the site and degree of neurological injury and to predict outcome. It should be performed by a neurologist or physiatrist (physician specialising in physical medicine and rehabilitation), trained and skilled in this procedure. Timing is essential if the study is to provide maximal information. Findings such as decreased recruitment after injury and conduction block at the site of injury may be apparent immediately after injury but other findings such as abnormal spontaneous activity may take several weeks to develop. The electrodiagnostic test assists with both diagnosis of the injury and in predicting
[Peripheral arterial disease--an underappreciated clinical problem].
Masanauskiene, Edita; Naudziūnas, Albinas
Peripheral artery disease is a common vascular disorder. In contrast to coronary and cerebral artery disease, peripheral arterial disease remains an underappreciated condition that despite being serious and extremely prevalent is rarely diagnosed and even less frequently treated. Early diagnosis of peripheral artery disease and individual assessment of risk factors are important in preventing further cardiovascular complications. The ankle-brachial index is a simple, reliable tool for diagnosing peripheral artery disease. Many studies underscore the importance of using the ankle-brachial index to identify persons with peripheral artery disease, since peripheral artery disease is frequently undiagnosed or asymptomatic. Measurement of the ankle-brachial index is simple enough to be performed in any doctor's office, and it is one of the most reliable indices of peripheral artery disease. PMID:18469511
ERIC Educational Resources Information Center
DeJong, William S.
A synopsis of a Planning Assistance Kit designed by the Council of Educational Facility Planners (CEFP) and Educational Facilities Laboratories (EFL) to assist local communities in participatory planning. (MLF)
ERIC Educational Resources Information Center
Gabel, Medard
To solve societal problems, both local and global, a global approach is needed. Serious diseases that are crippling present-day problem solving and planning are discussed, and the characteristics of a healthy, effective planning approach are described. (RM)
ERIC Educational Resources Information Center
Pavlenko, Victor V.
Comprehensive planning, defined as the work of those who engage in efforts, within a delimited geographic area, to identify and order the physical, social, and economic relationships of that area, is discussed in the four sections of this paper. Section I, Introduction, describes what "planning" and "comprehensive planning" are. In Section II, Why…
ERIC Educational Resources Information Center
Power, June
Many libraries have disaster recovery plans, but not all have prevention and action plans to prepare for an emergency in advance. This article presents the author's review of the prevention and action plans of several libraries: (1) Evergreen State College; (2) Interlochen Public Library; (3) University of Maryland, Baltimore-Marshall Law Library;…
Peripheral Stent Placement in Hemodialysis Grafts
Kariya, Shuji Tanigawa, Noboru; Kojima, Hiroyuki; Komemushi, Atsushi; Shomura, Yuzo; Shiraishi, Tomokuni; Kawanaka, Toshiaki; Sawada, Satoshi
The purpose of the present study was to evaluate the clinical outcome of peripheral stent placement after failed balloon angioplasty in patients with grafts who are on hemodialysis. We examined 30 Wallstents that were placed in 26 patients because balloon angioplasty failed or early restenosis (<3 months) occurred within 3 months. We retrospectively reviewed 267 consecutive balloon angioplasties performed in 71 patients with graft access between August 2000 and March 2007. Stent placements accounted for 30 (11.2%) of the 267 balloon angioplasties. The clinical success rate of stent placement was 93.3% (28 of 30 stent placements). The 3-, 6-, and 12-month primary patency rates were 73.3%, 39.3%, and 17.7%, respectively. The 1-, 2-, and 3-year secondary patency rates were 90.2%, 83.8%, and 83.8%, respectively. Primary patency was significantly prolonged by stent placement after early restenosis compared with previous balloon angioplasty alone (P = 0.0059). Primary patency after stent placement was significantly lower than after successful balloon angioplasty without indications for stent placement (P = 0.0279). Secondary patency rates did not significantly differ between stent placement and balloon angioplasty alone. The mean number of reinterventions required to maintain secondary patency after stent placement was significantly larger than that after balloon angioplasty alone (Mann-Whitney U test, P = 0.0419). We concluded that peripheral stent placement for graft access is effective for salvaging vascular access after failed balloon angioplasty and for prolonging patency in early restenosis after balloon angioplasty. However, reinterventions are required to maintain secondary patency after stent placement. Furthermore, peripheral stent placement for graft access cannot achieve the same primary patency as balloon angioplasty alone.
Peripheral refraction in normal infant rhesus monkeys
Hung, Li-Fang; Ramamirtham, Ramkumar; Huang, Juan; Qiao-Grider, Ying; Smith, Earl L.
Purpose To characterize peripheral refractions in infant monkeys. Methods Cross-sectional data for horizontal refractions were obtained from 58 normal rhesus monkeys at 3 weeks of age. Longitudinal data were obtained for both the vertical and horizontal meridians from 17 monkeys. Refractive errors were measured by retinoscopy along the pupillary axis and at eccentricities of 15, 30, and 45 degrees. Axial dimensions and corneal power were measured by ultrasonography and keratometry, respectively. Results In infant monkeys, the degree of radial astigmatism increased symmetrically with eccentricity in all meridians. There were, however, initial nasal-temporal and superior-inferior asymmetries in the spherical-equivalent refractive errors. Specifically, the refractions in the temporal and superior fields were similar to the central ametropia, but the refractions in the nasal and inferior fields were more myopic than the central ametropia and the relative nasal field myopia increased with the degree of central hyperopia. With age, the degree of radial astigmatism decreased in all meridians and the refractions became more symmetrical along both the horizontal and vertical meridians; small degrees of relative myopia were evident in all fields. Conclusions As in adult humans, refractive error varied as a function of eccentricity in infant monkeys and the pattern of peripheral refraction varied with the central refractive error. With age, emmetropization occurred for both central and peripheral refractive errors resulting in similar refractions across the central 45 degrees of the visual field, which may reflect the actions of vision-dependent, growth-control mechanisms operating over a wide area of the posterior globe. PMID:18487366
In vitro models for peripheral nerve regeneration.
Geuna, S; Raimondo, S; Fregnan, F; Haastert-Talini, K; Grothe, C
The study of peripheral nerve repair and regeneration is particularly relevant in the light of the high clinical incidence of nerve lesions. However, the clinical outcome after nerve lesions is often far from satisfactory and the functional recovery is almost never complete. Therefore, a number of therapeutic approaches are being investigated, ranging from local delivery of trophic factors and other molecules to bioactive biomaterials and complex nerve prostheses. Translation of the new therapeutic approaches to the patient always requires a final pre-clinical step using in vivo animal models. The need to limit as much as possible animal use in biomedical research, however, makes the preliminary use of in vitro models mandatory from an ethical point of view. In this article, the different types of in vitro models available today for the study of peripheral nerve regeneration have been ranked by adopting a three-step stair model based on their increasing ethical impact: (i) cell line-based models, which raise no ethical concern; (ii) primary cell-based models, which have low ethical impact as animal use, although necessary, is limited; and (iii) organotypic ex vivo-based models, which raise moderate ethical concerns as the use of laboratory animals is required although with much lower impact on animal wellbeing in comparison to in vivo models of peripheral nerve regeneration. This article aims to help researchers in selecting the best experimental approach for their scientific goals driven by the 'Three Rs' (3Rs) rules (Replacement, Reduction or Refinement of animal use in research) for scientific research. PMID:26309051
Optical and neural anisotropy in peripheral vision
Zheleznyak, Len; Barbot, Antoine; Ghosh, Atanu; Yoon, Geunyoung
Optical blur in the peripheral retina is known to be highly anisotropic due to nonrotationally symmetric wavefront aberrations such as astigmatism and coma. At the neural level, the visual system exhibits anisotropies in orientation sensitivity across the visual field. In the fovea, the visual system shows higher sensitivity for cardinal over diagonal orientations, which is referred to as the oblique effect. However, in the peripheral retina, the neural visual system becomes more sensitive to radially-oriented signals, a phenomenon known as the meridional effect. Here, we examined the relative contributions of optics and neural processing to the meridional effect in 10 participants at 0°, 10°, and 20° in the temporal retina. Optical anisotropy was quantified by measuring the eye's habitual wavefront aberrations. Alternatively, neural anisotropy was evaluated by measuring contrast sensitivity (at 2 and 4 cyc/deg) while correcting the eye's aberrations with an adaptive optics vision simulator, thus bypassing any optical factors. As eccentricity increased, optical and neural anisotropy increased in magnitude. The average ratio of horizontal to vertical optical MTF (at 2 and 4 cyc/deg) at 0°, 10°, and 20° was 0.96 ± 0.14, 1.41 ± 0.54 and 2.15 ± 1.38, respectively. Similarly, the average ratio of horizontal to vertical contrast sensitivity with full optical correction at 0°, 10°, and 20° was 0.99 ± 0.15, 1.28 ± 0.28 and 1.75 ± 0.80, respectively. These results indicate that the neural system's orientation sensitivity coincides with habitual blur orientation. These findings support the neural origin of the meridional effect and raise important questions regarding the role of peripheral anisotropic optical quality in developing the meridional effect and emmetropization. PMID:26928220
Optical and neural anisotropy in peripheral vision.
Zheleznyak, Len; Barbot, Antoine; Ghosh, Atanu; Yoon, Geunyoung
Optical blur in the peripheral retina is known to be highly anisotropic due to nonrotationally symmetric wavefront aberrations such as astigmatism and coma. At the neural level, the visual system exhibits anisotropies in orientation sensitivity across the visual field. In the fovea, the visual system shows higher sensitivity for cardinal over diagonal orientations, which is referred to as the oblique effect. However, in the peripheral retina, the neural visual system becomes more sensitive to radially-oriented signals, a phenomenon known as the meridional effect. Here, we examined the relative contributions of optics and neural processing to the meridional effect in 10 participants at 0°, 10°, and 20° in the temporal retina. Optical anisotropy was quantified by measuring the eye's habitual wavefront aberrations. Alternatively, neural anisotropy was evaluated by measuring contrast sensitivity (at 2 and 4 cyc/deg) while correcting the eye's aberrations with an adaptive optics vision simulator, thus bypassing any optical factors. As eccentricity increased, optical and neural anisotropy increased in magnitude. The average ratio of horizontal to vertical optical MTF (at 2 and 4 cyc/deg) at 0°, 10°, and 20° was 0.96 ± 0.14, 1.41 ± 0.54 and 2.15 ± 1.38, respectively. Similarly, the average ratio of horizontal to vertical contrast sensitivity with full optical correction at 0°, 10°, and 20° was 0.99 ± 0.15, 1.28 ± 0.28 and 1.75 ± 0.80, respectively. These results indicate that the neural system's orientation sensitivity coincides with habitual blur orientation. These findings support the neural origin of the meridional effect and raise important questions regarding the role of peripheral anisotropic optical quality in developing the meridional effect and emmetropization. PMID:26928220
Recurrent Annular Peripheral Choroidal Detachment after Trabeculectomy
Liu, Shaohui; Sun, Lisa L.; Kavanaugh, A. Scott; Langford, Marlyn P.; Liang, Chanping
We report a challenging case of recurrent flat anterior chamber without hypotony after trabeculectomy in a 54-year-old Black male with a remote history of steroid-treated polymyositis, cataract surgery, and uncontrolled open angle glaucoma. The patient presented with a flat chamber on postoperative day 11, but had a normal fundus exam and intraocular pressure (IOP). Flat chamber persisted despite treatment with cycloplegics, steroids, and a Healon injection into the anterior chamber. A transverse B-scan of the peripheral fundus revealed a shallow annular peripheral choroidal detachment. The suprachoroidal fluid was drained. The patient presented 3 days later with a recurrent flat chamber and an annular peripheral choroidal effusion. The fluid was removed and reinforcement of the scleral flap was performed with the resolution of the flat anterior chamber. A large corneal epithelial defect developed after the second drainage. The oral prednisone was tapered quickly and the topical steroid was decreased. One week later, his vision decreased to count fingers with severe corneal stromal edema and Descemet's membrane folds that improved to 20/50 within 24 h of resumption of the oral steroid and frequent topical steroid. The patient's visual acuity improved to 20/20 following a slow withdrawal of the oral and topical steroid. Eight months after surgery, the IOP was 15 mm Hg without glaucoma medication. The detection of a shallow anterior choroidal detachment by transverse B-scan is critical to making the correct diagnosis. Severe cornea edema can occur if the steroid is withdrawn too quickly. Thus, steroids should be tapered cautiously in steroid-dependent patients. PMID:24348402
Peripheral circadian clocks--a conserved phenotype?
Weigl, Yuval; Harbour, Valerie L; Robinson, Barry; Dufresne, Line; Amir, Shimon
The circadian system of mammals regulates the timing of occurrence of behavioral and physiological events, thereby optimizing adaptation to their surroundings. This system is composed of a single master pacemaker located in the suprachiasmatic nucleus (SCN) and a population of peripheral clocks. The SCN integrates time information from exogenous sources and, in turn, synchronizes the downstream peripheral clocks. It is assumed that under normal conditions, the circadian phenotype of different peripheral clocks would be conserved with respect to its period and robustness. To study this idea, we measured the daily wheel-running activity (WRA; a marker of the SCN output) in 84 male inbred LEW/Crl rats housed under a 12 h:12 h light-dark cycle. In addition, we assessed the mRNA expression of two clock genes, rPer2 and rBmal1, and one clock-controlled gene, rDbp, in four tissues that have the access to time cues other than those emanating from the SCN: olfactory bulbs (OBs), liver, tail skin, and white blood cells (WBCs). In contrast with the assumption stated above, we found that circadian clocks in peripheral tissues differ in the temporal pattern of the expression of circadian clock genes, in the robustness of the rhythms, and possibly in the number of functional ~24-h-clock cells. Based on the tissue diversity in the robustness of the clock output, the hepatic clock is likely to house the highest number of functional ~24-h-clock cells, and the OBs, the fewest number. Thus, the phenotype of the circadian clock in the periphery is tissue specific and may depend not only on the SCN but also on the sensitivity of the tissue to non-SCN-derived time cues. In the OBs and liver, the circadian clock phenotypes seem to be dominantly shaped by the SCN output. However, in the tail skin and WBC, other time cues participate in the phenotype design. Finally, our study suggests that the basic phenotype of the circadian clock is constructed at the transcript level of the core clock
Peripheral Vision Horizon Display (PVHD). Corrected Copy
NASA Technical Reports Server (NTRS)
A Canadian invention, the peripheral vision horizon display (PVHD), shows promise in alleviating vertigo or disorientation in pilots flying under instrument conditions and easing the piloting task when flying in weather or other conditions requiring close attention to aircraft attitude instruments. A diversity of research and applied work was being done to investigate and validate the benefits of the PVHD during the years immediately preceding this conference. Organizers of the conference were able to assemble a group of outstanding presenters representing academic, industrial, and military. The theoretical foundation and applied use of the PVHD are discussed, and results from operational tests are presented.
Axonal transport disruption in peripheral nerve disease
Lloyd, Thomas E.
Many neurodegenerative diseases and neuropathies have been proposed to be caused by a disruption of axonal transport. However, the mechanisms whereby impaired transport causes disease remain unclear. Proposed mechanisms include impairment in delivery of organelles such as mitochondria, defective retrograde neurotrophic signaling, and disruption of the synaptic vesicle cycle within the synaptic terminal. Simple model organisms such as the fruitfly, Drosophila melanogaster, allow live imaging of axonal transport to be combined with high-throughput genetic screens and are providing insights into the pathophysiology of peripheral nerve diseases. PMID:23279432
Peripheral and central mechanisms of stress resilience
Pfau, Madeline L.; Russo, Scott J.
Viable new treatments for depression and anxiety have been slow to emerge, likely owing to the complex and incompletely understood etiology of these disorders. A budding area of research with great therapeutic promise involves the study of resilience, the adaptive maintenance of normal physiology and behavior despite exposure to marked psychological stress. This phenomenon, documented in both humans and animal models, involves coordinated biological mechanisms in numerous bodily systems, both peripheral and central. In this review, we provide an overview of resilience mechanisms throughout the body, discussing current research in animal models investigating the roles of the neuroendocrine, immune, and central nervous systems in behavioral resilience to stress. PMID:25506605
Platelet peripheral benzodiazepine receptors in repeated stress
Dar, D.E.; Bidder, M.; Gavish, M. ); Weizman, A.; Karp, L.; Tyano, S. ); Grinshpoon, A.; Bleich, A.
({sup 3}H)PK 11195 binding to platelet membranes and plasma stress hormones were studied in soldiers at the beginning of a parachute training course, following 6 days of preparatory exercises, and after the fourth actual parachute jump. A slight reduction (15%; NS) in the number of peripheral benzodiazepine receptors (PBR) was detected at the end of the exercise period, prior to the first jump. Reduced density of PBR was observed immediately after the repeated actual jumps. Equilibrium dissociation constants were not affected by the stressful situation. Plasma cortisol and prolactin levels remained unaltered during the entire study period.
Visualization of nerve fibers and their relationship to peripheral nerve tumors by diffusion tensor imaging.
Cage, Tene A; Yuh, Esther L; Hou, Stephanie W; Birk, Harjus; Simon, Neil G; Noss, Roger; Rao, Anuradha; Chin, Cynthia T; Kliot, Michel
OBJECT The majority of growing and/or symptomatic peripheral nerve tumors are schwannomas and neurofibromas. They are almost always benign and can usually be resected while minimizing motor and sensory deficits if approached with the proper expertise and techniques. Intraoperative electrophysiological stimulation and recording techniques allow the surgeon to map the surface of the tumor in an effort to identify and thus avoid damaging functioning nerve fibers. Recently, MR diffusion tensor imaging (DTI) techniques have permitted the visualization of axons, because of their anisotropic properties, in peripheral nerves. The object of this study was to compare the distribution of nerve fibers as revealed by direct electrical stimulation with that seen on preoperative MR DTI. METHODS The authors conducted a retrospective chart review of patients with a peripheral nerve or nerve root tumor between March 2012 and January 2014. Diffusion tensor imaging and intraoperative data had been prospectively collected for patients with peripheral nerve tumors that were resected. Preoperative identification of the nerve fiber location in relation to the nerve tumor surface as seen on DTI studies was compared with the nerve fiber's intraoperative localization using electrophysiological stimulation and recordings. RESULTS In 23 patients eligible for study there was good correlation between nerve fiber location on DTI and its anatomical location seen intraoperatively. Diffusion tensor imaging demonstrated the relationship of nerve fibers relative to the tumor with 95.7% sensitivity, 66.7% specificity, 75% positive predictive value, and 93.8% negative predictive value. CONCLUSIONS Preoperative DTI techniques are useful in helping the peripheral nerve surgeon to both determine the risks involved in resecting a nerve tumor and plan the safest surgical approach. PMID:26323818
A summary-statistic representation in peripheral vision explains visual crowding
Balas, Benjamin; Nakano, Lisa; Rosenholtz, Ruth
Peripheral vision provides a less faithful representation of the visual input than foveal vision. Nonetheless, we can gain a lot of information about the world from our peripheral vision, for example in order to plan eye movements. The phenomenon of crowding shows that the reduction of information available in the periphery is not merely the result of reduced resolution. Crowding refers to visual phenomena in which identification of a target stimulus is significantly impaired by the presence of nearby stimuli, or flankers. What information is available in the periphery? We propose that the visual system locally represents peripheral stimuli by the joint statistics of responses of cells sensitive to different position, phase, orientation, and scale. This "textural" representation by summary statistics predicts the subjective "jumble" of features often associated with crowding. We show that the difficulty of performing an identification task within a single pooling region using this representation of the stimuli is correlated with peripheral identification performance under conditions of crowding. Furthermore, for a simple stimulus with no flankers, this representation can be adequate to specify the stimulus with some position invariance. This provides evidence that a unified neuronal mechanism may underlie peripheral vision, ordinary pattern recognition in central vision, and texture perception. A key component of our methodology involves creating visualizations of the information available in the summary statistics of a stimulus. We call these visualizations "mongrels" and show that they are highly useful in examining how the early visual system represents the visual input. Mongrels enable one to study the "equivalence classes" of our model, i.e., the sets of stimuli that map to the same representation according to the model. PMID:20053104
Peripheral doses in patients undergoing Cyberknife treatment for intracranial lesions. A single centre experience
Background Stereotactic radiosurgery/radiotherapy procedures are known to deliver a very high dose per fraction, and thus, the corresponding peripheral dose could be a limiting factor for the long term surviving patients. The aim of this clinical study was to measure the peripheral dose delivered to patients undergoing intracranial Cyberknife treatment, using the MOSFET dosimeters. The influence of the supplemental shielding, the number of monitor units and the collimator size to the peripheral dose were investigated. Methods MOSFET dosimeters were placed in preselected anatomical regions of the patient undergoing Cyberknife treatment, namely the thyroid gland, the nipple, the umbilicus and the pubic symphysis. Results The mean peripheral doses before the supplemental shielding was added to the Cyberknife unit were 51.79 cGy, 13.31 cGy and 10.07 cGy while after the shielding upgrade they were 38.40 cGy, 10.94 cGy, and 8.69 cGy, in the thyroid gland, the umbilicus and the pubic symphysis, respectively. The increase of the collimator size corresponds to an increase of the PD and becomes less significant at larger distances, indicating that at these distances the PD is predominate due to the head leakage and collimator scatter. Conclusion Weighting the effect of the number of monitor units and the collimator size can be effectively used during the optimization procedure in order to choose the most suitable treatment plan that will deliver the maximum dose to the tumor, while being compatible with the dose constraints for the surrounding organs at risk. Attention is required in defining the thyroid gland as a structure of avoidance in the treatment plan especially in patients with benign diseases. PMID:22082279
[Peripheral neuropathies due to mitochondrial disorders].
Funalot, B
Involvement of peripheral nerves is frequent in mitochondrial disorders but with variable severity. Mitochondrial diseases causing peripheral neuropathies (PN) may be due to mutations of mitochondrial DNA (mtDNA), as is the case in MERRF and MELAS syndromes, or to mutations of nuclear genes. Secondary abnormalities of mtDNA (such as multiple deletions of muscle mtDNA) may result from mitochondrial disorders due to mutations in nuclear genes involved in mtDNA maintenance. This is the case in several syndromes caused by impaired mtDNA maintenance, such as Sensory Ataxic Neuropathy, Dysarthria and Ophthalmoplegia (SANDO) due to recessive mutations in the POLG gene, which encodes the catalytic subunit of mtDNA polymerase (DNA polymerase gamma), or Mitochondrial Neuro-Gastro-Intestinal Encephalomyopathy (MNGIE), due to recessive mutations in the TYMP gene, which encodes thymidine phosphorylase. Genetically-determined PN due to mutations of mitofusin 2, a GTPase involved in the fusion of external mitochondrial membranes, were identified during the last few years. Characteristic ultrastructural lesions (abnormalities of axonal mitochondria) are observed on longitudinal sections of nerve biopsies in patients with PN due to mitofusin 2 mutations. PMID:19942242
Treating Painful Diabetic Peripheral Neuropathy: An Update.
Snyder, Matthew J; Gibbs, Lawrence M; Lindsay, Tammy J
Painful diabetic peripheral neuropathy occurs in approximately 25% of patients with diabetes mellitus who are treated in the office setting and significantly affects quality of life. It typically causes burning pain, paresthesias, and numbness in a stocking-glove pattern that progresses proximally from the feet and hands. Clinicians should carefully consider the patient's goals and functional status and potential adverse effects of medication when choosing a treatment for painful diabetic peripheral neuropathy. Pregabalin and duloxetine are the only medications approved by the U.S. Food and Drug Administration for treating this disorder. Based on current practice guidelines, these medications, with gabapentin and amitriptyline, should be considered for the initial treatment. Second-line therapy includes opioid-like medications (tramadol and tapentadol), venlafaxine, desvenlafaxine, and topical agents (lidocaine patches and capsaicin cream). Isosorbide dinitrate spray and transcutaneous electrical nerve stimulation may provide relief in some patients and can be considered at any point during therapy. Opioids and selective serotonin reuptake inhibitors are optional third-line medications. Acupuncture, traditional Chinese medicine, alpha lipoic acid, acetyl-l-carnitine, primrose oil, and electromagnetic field application lack high-quality evidence to support their use. PMID:27479625
Antithrombotic Therapy After Peripheral Vascular Intervention.
Hu, Peter; Jones, Schuyler
Cardioprotective medications and risk-factor modification are the hallmarks of treatment for all patients with peripheral artery disease (PAD). If symptoms are life-limiting and/or do not respond to conservative treatment, endovascular or surgical revascularization can be considered especially for patients with critical limb ischemia or acute limb ischemia. The rates of peripheral vascular intervention (PVI) have risen dramatically over the past few decades and much of this care have shifted from inpatient hospital settings to outpatient settings and office-based clinics. While PVI rates have surged and technology advancements have dramatically changed the face of PVI, the data behind optimal antithrombotic therapy following PVI is scant. Currently in the USA, most patients are treated with indefinite aspirin therapy and a variable duration of clopidogrel (or other P2Y12 inhibitor)-typically 1 month, 3 months, or indefinite therapy. More observational analyses and randomized clinical trials evaluating clinically relevant outcomes such as cardiovascular morbidity/mortality and the risk of bleeding are needed to guide the optimal role and duration of antithrombotic therapy post-PVI. PMID:26841788
Peripheral arterial endothelial dysfunction of neurodegenerative diseases.
Fukui, Yusuke; Hishikawa, Nozomi; Shang, Jingwei; Sato, Kota; Nakano, Yumiko; Morihara, Ryuta; Ohta, Yasuyuki; Yamashita, Toru; Abe, Koji
This study evaluates endothelial functions of neurodegenerative diseases such as amyotrophic lateral sclerosis (ALS), Parkinson's disease (PD), progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and spinocerebellar ataxia (SCA). The reactive hyperemia index (RHI) of peripheral arterial tonometry and serological data were compared between age- and gender-matched normal controls (n=302) and five disease groups (ALS; n=75, PD; n=180, PSP; n=30, MSA; n=35, SCA; n=53). Correlation analyses were performed in ALS with functional rating scale-revised (FRS-R), and in PD with the Hehn-Yahr scale (H-Y) and a heart to mediastinum ratio using (123)I-MIBG scintigraphy (MIBG). The RHI of ALS and PD, but not of PSP, MSA or SCA, were significantly lower than normal controls (p<0.01). ALS showed a negative correlation of RHI with serum triglycerides (TG) and immunoreactive insulin (IRI) levels, but not with disease severity (FRS-R) or rates of disease progression (∆FRS-R). On the other hand, PD showed a negative correlation of RHI with a progressive disease severity (H-Y) and a positive correlation of RHI with early/delayed MIBG scintigraphy, but not with serological data. The present study demonstrated significant declines of peripheral arterial endothelial functions in ALS and PD. The RHI of ALS was more correlated with disease duration and serum parameters while the RHI of PD was more correlated with disease severity and MIBG, suggesting different mechanisms of endothelial dysfunction. PMID:27288784
Regulation of Peripheral Nerve Stimulation Technology.
Birk, Daniel M; Yin, Dali; Slavin, Konstantin V
The number of peripheral nerve stimulation (PNS) indications, targets, and devices is expanding, yet the development of the technology has been slow because many devices used for PNS do not have formal regulatory approval. Manufacturers have not sought Food and Drug Administration (FDA) approval for PNS devices because of a perceived lack of interest amongst practitioners and patients. Without FDA approval, companies cannot invest in marketing to educate the implanters and the patients about the benefits of PNS in the treatment of chronic pain. Violation of this has resulted in governmental investigation and prosecution. Most of the PNS devices currently used to treat chronic pain are FDA approved for epidural spinal cord stimulation. Many of the complications seen in PNS surgery can be attributed to the lack of purpose-built hardware with FDA approval. Despite the lack of regulatory approval, there are insurance companies that approve PNS procedures when deemed medically necessary. As the targets and indications for PNS continue to expand, there will be an even greater need for customized technological solutions. It is up to the medical device industry to invest in the design and marketing of PNS technology and seek out FDA approval. Market forces will continue to push PNS into the mainstream and physicians will increasingly have the choice to implant devices specifically designed and approved to treat chronic peripheral nerve pain. PMID:26394389
[The problem of osteosynthesis in peripheral replantation].
Winter, I; Zilch, H; Gaudin, B P
In this report, 16 cases of peripheral replantation are described, in which osteosynthesis was carried out by means of AO-mini or small-fragment plates with the obvious advantage of allowing early mobilisation. A disadvantage of this method is that it is necessary to dissect the soft tissue to a greater extent and to elevate the periosteum more than in using Kirschner wires, this dissection to permit sufficient fixation of the plate and screws. As a result, primary technical difficulties in the venous anastomosis may occur and there is a risk of adhesions developing between the extensor apparatus and the bone (two cases). Difficulties occur when using plates and screws for comminuted and juxtaarticular fractures. In these cases Kirschner wire osteosynthesis is preferred. For injuries in zones 1 and 2 in the majority of the cases an osteosynthesis with wire is indicated. Only in cases of replantation in zone 2, where the DIP joint is destroyed, can an arthrodesis be performed by means of a screw. When using the above mentioned osteosynthesis for peripheral replantations, we have achieved good to very good end results in the majority of the cases. PMID:7343424
In vivo peripheral nervous system insulin signaling
Grote, Caleb W.; Ryals, Janelle M.; Wright, Douglas E.
Alterations in peripheral nervous system (PNS) insulin support may contribute to diabetic neuropathy (DN); yet, PNS insulin signaling is not fully defined. Here, we investigated in vivo insulin signaling in the PNS and compared the insulin-responsiveness to that of muscle, liver, and adipose. Nondiabetic mice were administered increasing doses of insulin to define a dose response relationship between insulin and Akt activation in the DRG and sciatic nerve. Resulting EC50 doses were used to characterize the PNS insulin signaling time course and make comparisons between insulin signaling in the PNS and other peripheral tissues (i.e., muscle, liver, adipose). The results demonstrate that the PNS is responsive to insulin and that differences in insulin signaling pathway activation exist between PNS compartments. At a therapeutically relevant dose, Akt was activated in the muscle, liver, and adipose at 30 minutes, correlating with the changes in blood glucose levels. Interestingly, the sciatic nerve showed a similar signaling profile as insulin-sensitive tissues, however there was not a comparable activation in the DRG or spinal cord. These results present new evidence regarding PNS insulin signaling pathways in vivo and provide a baseline for studies investigating the contribution of disrupted PNS insulin signaling to DN pathogenesis. PMID:24028189
Perspectives in regeneration and tissue engineering of peripheral nerves.
Raimondo, Stefania; Fornaro, Michele; Tos, Pierluigi; Battiston, Bruno; Giacobini-Robecchi, Maria G; Geuna, Stefano
Peripheral nerve injury is a common casualty and although peripheral nerve fibers retain a considerable regeneration potential also in the adult, recovery is usually rather poor, especially in case of large nerve defects. The aim of this paper is to address the perspectives in regeneration and tissue engineering after peripheral nerve injury by reviewing the relevant experimental studies in animal models. After a brief overview of the morphological changes related to peripheral nerve injury and regeneration, the paper will address the evolution of peripheral nerve tissue engineering with special focus on transplantation strategies, from organs and tissues to cells and genes, that can be carried out, particularly in case of severe nerve lesions with substance loss. Finally, the need for integrated research which goes beyond therapeutic strategies based on single approaches is emphasized, and the importance of bringing together the various complimentary disciplines which can contribute to the definition of effective new strategies for regenerating the injured peripheral nerve is outlined. PMID:21474294
Camera motion tracking of real bronchoscope using epipolar geometry analysis and CT-derived bronchoscopic images
NASA Astrophysics Data System (ADS)
Deguchi, Daisuke; Mori, Kensaku; Hasegawa, Jun-ichi; Toriwaki, Jun-ichiro; Takabatake, Hirotsugu; Natori, Hiroshi
This paper describes a method to track camera motion of a real endoscope by using epipolar geometry analysis and CT derived virtual endoscopic images. A navigation system for a flexible endoscope guides medical doctors by providing navigation information during endoscope examinations. This paper tries to estimate the motion from an endoscopic video image based on epipolar geometry analysis and image registration between virtual endoscopic (VE) and real endoscopic (RE) images. The method consists of three parts: (a) direct estimation of camera motion by using epipolar geometry analysis, (b) precise estimation by using image registration, and (c) detection of bubble frames for avoiding miss-registration. First we calculate optical flow patterns from two consecutive frames. The camera motion is computed by substituting the obtained flows into the epipolar equations. Then we find the observation parameter of a virtual endoscopy system that generates the most similar endoscopic view to the current RE frame. We execute these processes for all frames of RE videos except for frames where bubbles appear. We applied the proposed method to RE videos of three patients who have CT images. The experimental results show the method can track camera motion for over 500 frames continuously in the best case.
Locating the cortical bottleneck for slow reading in peripheral vision
Yu, Deyue; Jiang, Yi; Legge, Gordon E.; He, Sheng
Yu, Legge, Park, Gage, and Chung (2010) suggested that the neural bottleneck for slow peripheral reading is located in nonretinotopic areas. We investigated the potential rate-limiting neural site for peripheral reading using fMRI, and contrasted peripheral reading with recognition of peripherally presented line drawings of common objects. We measured the BOLD responses to both text (three-letter words/nonwords) and line-drawing objects presented either in foveal or peripheral vision (10° lower right visual field) at three presentation rates (2, 4, and 8/second). The statistically significant interaction effect of visual field × presentation rate on the BOLD response for text but not for line drawings provides evidence for distinctive processing of peripheral text. This pattern of results was obtained in all five regions of interest (ROIs). At the early retinotopic cortical areas, the BOLD signal slightly increased with increasing presentation rate for foveal text, and remained fairly constant for peripheral text. In the Occipital Word-Responsive Area (OWRA), Visual Word Form Area (VWFA), and object sensitive areas (LO and PHA), the BOLD responses to text decreased with increasing presentation rate for peripheral but not foveal presentation. In contrast, there was no rate-dependent reduction in BOLD response for line-drawing objects in all the ROIs for either foveal or peripheral presentation. Only peripherally presented text showed a distinctive rate-dependence pattern. Although it is possible that the differentiation starts to emerge at the early retinotopic cortical representation, the neural bottleneck for slower reading of peripherally presented text may be a special property of peripheral text processing in object category selective cortex. PMID:26237299
Role of ultrasound in evaluation of peripheral nerves
Lawande, Ashwin D; Warrier, Sudhir S; Joshi, Mukund S
Ultrasonography (USG) is an excellent cost-effective modality in imaging of peripheral nerves. With the newer high-frequency probes with different footprints which allow high-resolution imaging at relatively superficial location, USG can detect and evaluate traumatic, inflammatory, infective, neoplastic, and compressive pathologies of the peripheral nerves. This article describes the technique for evaluation of nerves by USG as well as the USG appearances of normal and diseased peripheral nerves. PMID:25114388
Clinical observation of the application of autologous peripheral blood stem cell transplantation for the treatment of diabetic foot gangrene
The aim of the present study was to investigate the optimal mobilization plan in autologous peripheral blood stem cell transplantation for the treatment of diabetic foot and to observe its clinical curative effect. A total of 127 patients with diabetic foot were treated with different doses of granulocyte colony stimulating factor (G-CSF) to mobilize their hematopoietic stem cells. Subsequently, the extracted stem cell suspension was injected into the ischemic lower extremities along the blood vessels in the areas presenting with pathological changes. Following the treatment, the intermittent claudication distance, skin temperature, ankle brachial index and pain scores of the patients were evaluated. In addition, the associations among the mobilization time, doses and peripheral blood CD34+ level were analyzed. The collection efficiency of the stem cells was associated with the dose of G-CSF and the mobilization time. Following the injection of the autologous peripheral blood stem cell suspension, the ischemic area of the patients was improved significantly. In conclusion, autologous peripheral blood stem cell transplantation can promote the establishment of collateral circulation in patients with diabetic foot, and the optimal time for gathering stem cells is closely correlated with the peripheral blood CD34+ level. PMID:26889255
Neuroactive steroids and the peripheral nervous system: An update.
Giatti, Silvia; Romano, Simone; Pesaresi, Marzia; Cermenati, Gaia; Mitro, Nico; Caruso, Donatella; Tetel, Marc J; Garcia-Segura, Luis Miguel; Melcangi, Roberto C
In the present review we summarize observations to date supporting the concept that neuroactive steroids are synthesized in the peripheral nervous system, regulate the physiology of peripheral nerves and exert notable neuroprotective actions. Indeed, neuroactive steroids have been recently proposed as therapies for different types of peripheral neuropathy, like for instance those occurring during aging, chemotherapy, physical injury and diabetes. Moreover, pharmacological tools able to increase the synthesis of neuroactive steroids might represent new interesting therapeutic strategy to be applied in case of peripheral neuropathy. PMID:25824325
Magnetic resonance neurography of peripheral nerve tumors and tumorlike conditions.
Ahlawat, Shivani; Chhabra, Avneesh; Blakely, Jaishri
Peripheral nerve enlargement may be seen in multiple conditions including hereditary or inflammatory neuropathies, sporadic or syndromic peripheral nerve sheath tumors, perineurioma, posttraumatic neuroma, and intraneural ganglion. Malignancies such as neurolymphoma, intraneural metastases, or sarcomas may also affect the peripheral nervous system and result in nerve enlargement. The imaging appearance and differentiating factors become especially relevant in the setting of tumor syndromes such as neurofibromatosis type 1, neurofibromatosis type 2, and schwannomatosis. This article reviews the typical magnetic resonance neurography imaging appearances of neurogenic as well as nonneurogenic neoplasms and tumorlike lesions of peripheral nerves, with emphasis on distinguishing factors. PMID:24210319
Discoid lateral meniscus: prevalence of peripheral rim instability.
Klingele, Kevin E; Kocher, Mininder S; Hresko, M Timothy; Gerbino, Peter; Micheli, Lyle J
The purpose of this study was to determine the prevalence of peripheral rim instability in discoid lateral meniscus. A consecutive series of 112 patients (128 knees) (mean age 10.0 years [range 1 month to 22 years]) who underwent arthroscopic evaluation and treatment of a discoid lateral meniscus between 1993 and 2001 was reviewed. Of those discoid menisci classified intraoperatively (n = 87), 62.1% (n = 54) were complete discoid lateral menisci and 37.9% (n = 33) were incomplete discoid lateral menisci. An associated meniscal tear was present in 69.5% (n = 89) of all knees studied. Overall, 28.1% (n = 36) of discoid lateral menisci had peripheral rim instability: 47.2% (n = 17) were unstable at the anterior-third peripheral attachment, 11.1% (n = 4) at the middle-third peripheral attachment, and 38.9% (n = 14) at the posterior-third peripheral attachment. Thirty-one of the 36 unstable discoid menisci underwent repair of the peripheral meniscal rim attachment. One patient underwent a complete, open meniscectomy. Peripheral rim instability was significantly more common in complete discoid lateral menisci (38.9% vs. 18.2%; P = 0.043) and in younger patients (8.2 vs. 10.7 years; P = 0.002). The frequency of peripheral instability mandates a thorough assessment of meniscal stability at all peripheral attachments during the arthroscopic evaluation and treatment of discoid lateral meniscus, particularly in complete variants and in younger children. PMID:14676539
Role of Neuroactive Steroids in the Peripheral Nervous System
Melcangi, Roberto Cosimo; Giatti, Silvia; Pesaresi, Marzia; Calabrese, Donato; Mitro, Nico; Caruso, Donatella; Garcia-Segura, Luis Miguel
Several reviews have so far pointed out on the relevant physiological and pharmacological role exerted by neuroactive steroids in the central nervous system. In the present review we summarize observations indicating that synthesis and metabolism of neuroactive steroids also occur in the peripheral nerves. Interestingly, peripheral nervous system is also a target of their action. Indeed, as here reported neuroactive steroids are physiological regulators of peripheral nerve functions and they may also represent interesting therapeutic tools for different types of peripheral neuropathy. PMID:22654839
Animal Models of Peripheral Neuropathy Due to Environmental Toxicants
Rao, Deepa B.; Jortner, Bernard S.; Sills, Robert C.
Despite the progress in our understanding of pathogeneses and the identification of etiologies of peripheral neuropathy, idiopathic neuropathy remains common. Typically, attention to peripheral neuropathies resulting from exposure to environmental agents is limited relative to more commonly diagnosed causes of peripheral neuropathy (diabetes and chemotherapeutic agents). Given that there are more than 80,000 chemicals in commerce registered with the Environmental Protection Agency and that at least 1000 chemicals are known to have neurotoxic potential, very few chemicals have been established to affect the peripheral nervous system (mainly after occupational exposures). A wide spectrum of exposures, including pesticides, metals, solvents, nutritional sources, and pharmaceutical agents, has been related, both historically and recently, to environmental toxicant-induced peripheral neuropathy. A review of the literature shows that the toxicity and pathogeneses of chemicals adversely affecting the peripheral nervous system have been studied using animal models. This article includes an overview of five prototypical environmental agents known to cause peripheral neuropathy—namely, organophosphates, carbon disulfide, pyridoxine (Vitamin B6), acrylamide, and hexacarbons (mainly n-hexane, 2,5-hexanedione, methyl n-butyl ketone). Also included is a brief introduction to the structural components of the peripheral nervous system and pointers on common methodologies for histopathologic evaluation of the peripheral nerves. PMID:24615445
Animal models of peripheral neuropathy due to environmental toxicants.
Rao, Deepa B; Jortner, Bernard S; Sills, Robert C
Despite the progress in our understanding of pathogeneses and the identification of etiologies of peripheral neuropathy, idiopathic neuropathy remains common. Typically, attention to peripheral neuropathies resulting from exposure to environmental agents is limited relative to more commonly diagnosed causes of peripheral neuropathy (diabetes and chemotherapeutic agents). Given that there are more than 80,000 chemicals in commerce registered with the Environmental Protection Agency and that at least 1000 chemicals are known to have neurotoxic potential, very few chemicals have been established to affect the peripheral nervous system (mainly after occupational exposures). A wide spectrum of exposures, including pesticides, metals, solvents, nutritional sources, and pharmaceutical agents, has been related, both historically and recently, to environmental toxicant-induced peripheral neuropathy. A review of the literature shows that the toxicity and pathogeneses of chemicals adversely affecting the peripheral nervous system have been studied using animal models. This article includes an overview of five prototypical environmental agents known to cause peripheral neuropathy--namely, organophosphates, carbon disulfide, pyridoxine (Vitamin B6), acrylamide, and hexacarbons (mainly n-hexane, 2,5-hexanedione, methyl n-butyl ketone). Also included is a brief introduction to the structural components of the peripheral nervous system and pointers on common methodologies for histopathologic evaluation of the peripheral nerves. PMID:24615445
Sonography of Common Peripheral Nerve Disorders With Clinical Correlation.
Jacobson, Jon A; Wilson, Thomas J; Yang, Lynda J-S
Sonography is now considered an effective method to evaluate peripheral nerves. Low cost, high resolution, the ability to image an entire limb in a short time, and dynamic assessment are several of the positive attributes of sonography. This article will review the normal appearance of peripheral nerves as shown with sonography. In addition, the most common applications for sonography of the peripheral nerves will be reviewed, which include entrapment neuropathies, intraneural ganglion cyst, nerve trauma, and peripheral nerve sheath tumors. Clinical information related to nerve disorders is also included, as it provides valuable information that can be obtained during sonographic examinations, increasing diagnostic accuracy. PMID:26931790
Evaluation of MatriXX for IMRT and VMAT dose verifications in peripheral dose regions
Han Zhaohui; Ng, Sook Kien; Bhagwat, Mandar S.; Lyatskaya, Yulia; Zygmanski, Piotr
Purpose: MatriXX is a two-dimensional ion chamber array designed for IMRT/VMAT (RapidArc, IMAT, etc.) dose verifications. Its dosimetric properties have been characterized for megavoltage beams in a number of studies; however, to the best of the authors' knowledge, there is still a lack of an investigation into its performance in the peripheral or low dose regions. In this work, the authors have carried out a systematic study on this issue. Methods: The authors compare the performance of MatriXX with a cylindrical ion chamber in solid water phantoms in the peripheral dose regions. The comparisons are performed for a number of typical irradiation conditions that involve different gantry and/or MLC motions, field sizes, and distances to the target including static gantry/open fields, static gantry/sweeping MLC gap (mimicking an IMRT delivery), dynamic gantry/oscillating sweeping MLC gap (mimicking a VMAT delivery), as well as clinical IMRT and VMAT plans. Results: MatriXX, when used according to the manufacturer's recommendations, is found to disagree with an ion chamber in peripheral dose regions. This disagreement has been attributed to four types of MatriXX errors, namely, positive bias, over-response to scattered doses, round-off error, and angular dependence, all of which contribute to dose inaccuracies in the peripheral regions. The positive bias, which is independent of the dose level, is cumulative when MatriXX operates in the movie mode. The accumulation is proportional to the number of movie frames (snaps) when the sampling time is greater than 500 ms and is proportional to the overall movie time for a sampling time shorter than 500 ms. This behavior suggests multiple sources of the bias. MatriXX is also found to over-respond to peripheral doses by about 2.0% for the regions investigated in this work (3-15 cm from the field edge), where phantom scatter and collimator scatter dominate. Round-off error is determined to be due to insufficient precision in
Pathology of the peripheral nervous system.
Fernandez; Marchese; Palma; Lauretti; Procaccini; Pallini
In this review, the first four papers deal with an important chapter in peripheral nerve surgery: cranial nerve reconstruction after injury occurring during skull base surgery. The last paper discusses the problem of peripheral nerves affected by a ganglion cyst. Damage to a cranial nerve is no longer considered to be an absolutely irreparable event. The first two studies are related to facial nerve management during the surgical treatment of vestibular schwannomas. The most common mechanisms responsible for facial nerve injury during tumor removal and the technical means to avoid them are cited. The importance of intraoperative neurophysiologic monitoring to save the facial nerve is stressed. A comparison between microsurgery and radiosurgery results in the conclusion that for vestibular schwannomas, the first choice of treatment is microsurgery. These two large and exceptional series show that by using a refined technique it is possible to obtain both total tumor removal and preservation of the facial nerve in most of the vestibular schwannomas. In the minority of patients in whom the facial nerve is severed, there are several therapeutic options to re-establish facial nerve function. After facial nerve reconstruction, performed immediately during the same tumor operation, a satisfactory reinnervation was obtained in 74% of the cases. After facial nerve reanimation, using as donor nerve the hypoglossus and performed 1 week after the tumor operation, a satisfactory reinnervation was obtained in 96% of the cases. The other two papers deal with the intraoperative transection of the trochlear and abducens nerve during surgery for skull base tumors. These two cranial nerves, owing to their simply organized motor nerve system (they are purely motor nerves and supply one muscle each), show quite a good expectation of functional recovery. The behavior of ganglion cysts involving peripheral nerves is the topic of the last paper reviewed. These cysts are benign lesions
ERIC Educational Resources Information Center
Statfeld, Jenna L.
Post-school transition is the movement of a child with disabilities from school to activities that occur after the completion of school. This paper provides information about: (1) post-school transition; (2) transition plan; (3) transition services; (4) transition planning; (5) vocational rehabilitation services; (6) services that are available…
Landau, R
Medical technology, which today makes it possible to bear a child after death, enables planned orphanhood. The first part of this paper will discuss the medical innovations in human conception, the psycho-social aspects of the wish for children from the genes of someone who is no longer alive, and the ensuing orphanhood and its implications. The second part will discuss the ethical issues relating to planned orphanhood: Who are involved in the matter of planned orphanhood? Is the decision to produce a planned orphan a private or public matter? Whose responsibility is the birth and bringing up of the planned orphan? To whom does society have more responsibility - the children who already exist or future children? And can planned orphanhood be regarded as a justification for wrongful conception? The last part of the paper will examine the judicial aspects of planned orphanhood in Israel and elsewhere and discuss the application of the principles of human dignity, human welfare, and justice. The paper argues for discouraging planned orphanhood so as to avoid violating the principles of human dignity and liberty, human welfare, and human justice, from the perspectives of both those who are involved in the process in general and the orphan who is the target of the medical intervention in particular. Its aim is to encourage deep and comprehensive public discussion of this issue in all its aspects. PMID:10414828
ERIC Educational Resources Information Center
Ewert, Alan
Planning an expedition, particularly an expedition to climb Mount McKinley, can appear monumental. Not only must the obvious items like food, equipment and personnel be carefully planned, but attention must also focus on "insignificant" items like applications and reservations which, if forgotten, could mean the difference between a successful or…
[Cytomegalovirus mononucleosis complicated with peripheral facial palsy].
Hirano, Taichi; Tsuji, Takahiro; Yamasaki, Hiroshi; Tsuda, Hiroyuki
A 36-year-old woman was admitted to our hospital for further examination of an acute febrile illness with liver dysfunction. A peripheral blood smear displayed atypical lymphocytes. Cytomegalovirus (CMV) mononucleosis was diagnosed based on the detection of CMV-specific IgM and conventional CMV pp65 antigen. The physical examination on admission revealed signs of lower motor neuron right facial palsy. There were no significant cerebrospinal fluid findings, nor were there other neurological abnormalities. After receiving a short-course of oral corticosteroids, the patient gradually recovered from the facial paralysis. A one-month follow-up examination indicated that she had fully recovered neurologically, showing disappearance of CMV-DNA and a significant increase in the anti-CMV IgG titer. To our knowledge, there has been only one previous report describing CMV as the cause of an isolated facial palsy combined with CMV mononucleosis. PMID:24681941
Neurophysiological approach to disorders of peripheral nerve.
Crone, Clarissa; Krarup, Christian
Disorders of the peripheral nerve system (PNS) are heterogeneous and may involve motor fibers, sensory fibers, small myelinated and unmyelinated fibers and autonomic nerve fibers, with variable anatomical distribution (single nerves, several different nerves, symmetrical affection of all nerves, plexus, or root lesions). Furthermore pathological processes may result in either demyelination, axonal degeneration or both. In order to reach an exact diagnosis of any neuropathy electrophysiological studies are crucial to obtain information about these variables. Conventional electrophysiological methods including nerve conduction studies and electromyography used in the study of patients suspected of having a neuropathy and the significance of the findings are discussed in detail and more novel and experimental methods are mentioned. Diagnostic considerations are based on a flow chart classifying neuropathies into eight categories based on mode of onset, distribution, and electrophysiological findings, and the electrophysiological characteristics in each type of neuropathy are discussed. PMID:23931776
Peripheral nerve morphogenesis induced by scaffold micropatterning
Memon, Danish; Boneschi, Filippo Martinelli; Madaghiele, Marta; Brambilla, Paola; Del Carro, Ubaldo; Taveggia, Carla; Riva, Nilo; Trimarco, Amelia; Lopez, Ignazio D.; Comi, Giancarlo; Pluchino, Stefano; Martino, Gianvito; Sannino, Alessandro; Quattrini, Angelo
Several bioengineering approaches have been proposed for peripheral nervous system repair, with limited results and still open questions about the underlying molecular mechanisms. We assessed the biological processes that occur after the implantation of collagen scaffold with a peculiar porous microstructure of the wall in a rat sciatic nerve transection model compared to commercial collagen conduits and nerve crush injury using functional, histological and genome wide analyses. We demonstrated that within 60 days, our conduit had been completely substituted by a normal nerve. Gene expression analysis documented a precise sequential regulation of known genes involved in angiogenesis, Schwann cells/axons interactions and myelination, together with a selective modulation of key biological pathways for nerve morphogenesis induced by porous matrices. These data suggest that the scaffold's microstructure profoundly influences cell behaviors and creates an instructive micro-environment to enhance nerve morphogenesis that can be exploited to improve recovery and understand the molecular differences between repair and regeneration. PMID:24559639
Physics of Ultra-Peripheral Nuclear Collisions
Bertulani, Carlos A.; Klein, Spencer R.; Nystrand, Joakim
Moving highly-charged ions carry strong electromagnetic fields which act as a field of photons. In collisions at large impact parameters, hadronic interactions are not possible, and the ions interact through photon-ion and photon-photon collisions known as ultra-peripheral collisions (UPC). Hadron colliders like the Relativistic Heavy Ion Collider (RHIC), the Tevatron and the Large Hadron Collider (LHC) produce photonuclear and two-photon interactions at luminosities and energies beyond that accessible elsewhere; the LHC will reach a {gamma}p energy ten times that of the Hadron-Electron Ring Accelerator (HERA). Reactions as diverse as the production of anti-hydrogen, photoproduction of the {rho}{sup 0}, transmutation of lead into bismuth and excitation of collective nuclear resonances have already been studied. At the LHC, UPCs can study many types of ''new physics''.
Evaluation of Peripheral Arterial Disease in Prediabetes
Faghihimani, Elham; Darakhshandeh, Ali; Feizi, Awat; Amini, Masoud
Background: The prevalence of prediabetes in the world continues to increase. These patients have elevated the risk of atherosclerosis. The current study was designed to assess the prevalence of peripheral arterial disease (PAD) and its related risk factors in prediabetes patients. Methods: This was the case-control study in which 135 adults in three groups: Diabetes, prediabetes, and normal were studied. We evaluated the prevalence of PAD through the measurement of ankle-brachial index (ABI). All the patients were interviewed about demographic and medical data, including age, sex, disease duration, body mass index, hypertension (HTN), fasting blood glucose, hemoglobin A1C (HbA1C), lipid profile, and medication use. Results: The prevalence of PAD in diabetes patients was higher than the normal group (8.5%vs. 0.0%) (P < 0.05), but the differences between prediabetes compared with diabetes and normal group were not significant. The mean level of ABI in normal, prediabetes, and diabetes group was (1.11 ± 0.11), (1.09 ± 0.12), and (1.05 ± 0.03) respectively (P < 0.1). There were marginally significant differences of ABI observed between the normal group and the diabetes group. The observed differences between groups in the ABI were significant after adjusting the effects of age and sex (P < 0.05). There was an association observed between ABI and HbA1C in diabetes patients (r = 0.249, P < 0.01) and a significant association seen between PAD and HTN in the prediabetes group (P < 0.01). Conclusions: Peripheral arterial disease is common in asymptomatic diabetes and prediabetes patients. Management of hypertensive prediabetes patients and early detection of PAD in this group as well as in asymptomatic patients is important. PMID:25317291
Primary Uterine Peripheral T-cell Lymphoma
Gong, Jing; Dong, Aisheng; Wang, Yang; Zhang, Xuefeng; Yang, Panpan; Wang, Li; Jing, Wei
Abstract Primary uterine non-Hodgkin's lymphoma is extremely rare accounting for <1% of all extranodal non-Hodgkin's lymphomas. Imaging findings of primary uterine lymphoma have rarely been reported before. We present magnetic resonance imaging (MRI) and fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT findings in a patient with primary uterine peripheral T-cell lymphoma. A 27-year-old female presented with intermittent fever with neutropenia for 7 months. MRI showed an ill-defined mass involved both the uterine corpus and cervix, resulting in diffuse enlargement of the uterus. This mass showed inhomogeneous hypointensity on unenhanced T1-weighted images, hyperintensity on diffusion-weighted imaging, relative hypointensity compared to the surrounding myometrium on T2-weighted images and lower enhancement than the surrounding myometrium on enhanced T1-weighted images. FDG PET/CT showed intense FDG uptake in the thickened wall of the uterine corpus and cervix with SUVmax of 26.9. There were multiple hypermetabolic lymph nodes in the pelvis and retroperitoneum. Uterine curettage and CT-guided biopsy of the uterine mass revealed peripheral T-cell lymphoma. Bone marrow biopsy revealed no evidence of lymphomatous involvement. The imaging and pathologic findings were consistent with primary uterine lymphoma. After 3 circles of chemotherapy, follow-up enhanced MRI showed decreased thickness of the uterine wall. Despite its rarity, primary uterine non-Hodgkin's lymphoma should be taken into consideration when a uterine tumor shows large size, relative hypointesity on both T2-weighted images and enhanced T1-weighted images compared to the surrounding myometrium, and intense FDG uptake on PET/CT. MRI may be helpful for describing the relationship between the tumor and adjacent structures. FDG PET/CT may be useful for tumor detection and staging. PMID:27124063
Animal models for inherited peripheral neuropathies
Recent progress in human genetics and neurobiology has led to the identification of various mutations in particular myelin genes as the cause for many of the known inherited demyelinating peripheral neuropathies. Mutations in 3 distinct myelin genes, PMP22, P0, and connexin 32 cause the 3 major demyelinating subtypes of Charcot-Marie-Tooth (CMT) disease, CMT1A, CMT1B and CMTX, respectively. In addition, a reduction in the gene dosage of PMP22 causes hereditary neuropathy with liability to pressure palsies (HNPP), while particular point mutations in PMP22 and P0 cause the severe Dejerine-Sottas (DS) neuropathy. A series of spontaneous and genetically engineered rodent mutants for genes for the above-mentioned myelin constituents are now available and their suitability to serve as models for these still untreatable diseases is an issue of particular interest. The spontaneous mutants Trembler-J and Trembler, with point mutations in PMP22, reflect some of the pathological alterations seen in CMT1A and DS patients, respectively. Furthermore, engineered mutants that either over or underexpress particular myelin genes are suitable models for patients who are similarly compromised in the gene dosage of the corresponding genes. In addition, engineered mutants heterozygously or homozygously deficient in the myelin component P0 show the pathology of distinct CMT1B and DS patients, respectively, while Cx32 deficient mice develop pathological abnormalities similar to those of CMTX patients. Mutants that mimic human peripheral neuropathies might allow the development of strategies to alleviate the symptoms of the diseases, and help to define environmental risk factors for aggravation of the disease. In addition, such mutants might be instrumental in the development of strategies to cure the diseases by gene therapy. PMID:9418989
Probing the Peripheral Site of Human Butyrylcholinesterase
Acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) catalyze the hydrolysis of the neurotransmitter acetylcholine and, thereby, function as coregulators of cholinergic neurotransmission. For both enzymes, hydrolysis takes place near the bottom of a 20 Å deep active site gorge. A number of amino acid residues within the gorge have been identified as important in facilitating efficient catalysis and inhibitor binding. Of particular interest is the catalytic triad, consisting of serine, histidine, and glutamate residues, that mediates hydrolysis. Another site influencing the catalytic process is located above the catalytic triad toward the periphery of the active site gorge. This peripheral site (P-site) contains a number of aromatic amino acid residues as well as an aspartate residue that is able to interact with cationic substrates and guide them down the gorge to the catalytic triad. In human AChE, certain aryl residues in the vicinity of the anionic aspartate residue (D74), such as W286, have been implicated in ligand binding and have therefore been considered part of the P-site of the enzyme. The present study was undertaken to explore the P-site of human BuChE and determine whether, like AChE, aromatic side chains near the peripheral aspartate (D70) of this enzyme contribute to ligand binding. Results obtained, utilizing inhibitor competition studies and BuChE mutant species, indicate the participation of aryl residues (F329 and Y332) in the E-helix component of the BuChE active site gorge, along with the anionic aspartate residue (D70), in binding ligands to the P-site of the enzyme. PMID:22901043
Animal models for inherited peripheral neuropathies.
Martini, R
Recent progress in human genetics and neurobiology has led to the identification of various mutations in particular myelin genes as the cause for many of the known inherited demyelinating peripheral neuropathies. Mutations in 3 distinct myelin genes, PMP22, P0, and connexin 32 cause the 3 major demyelinating subtypes of Charcot-Marie-Tooth (CMT) disease, CMT1A, CMT1B and CMTX, respectively. In addition, a reduction in the gene dosage of PMP22 causes hereditary neuropathy with liability to pressure palsies (HNPP), while particular point mutations in PMP22 and P0 cause the severe Dejerine-Sottas (DS) neuropathy. A series of spontaneous and genetically engineered rodent mutants for genes for the above-mentioned myelin constituents are now available and their suitability to serve as models for these still untreatable diseases is an issue of particular interest. The spontaneous mutants Trembler-J and Trembler, with point mutations in PMP22, reflect some of the pathological alterations seen in CMT1A and DS patients, respectively. Furthermore, engineered mutants that either over or underexpress particular myelin genes are suitable models for patients who are similarly compromised in the gene dosage of the corresponding genes. In addition, engineered mutants heterozygously or homozygously deficient in the myelin component P0 show the pathology of distinct CMT1B and DS patients, respectively, while Cx32 deficient mice develop pathological abnormalities similar to those of CMTX patients. Mutants that mimic human peripheral neuropathies might allow the development of strategies to alleviate the symptoms of the diseases, and help to define environmental risk factors for aggravation of the disease. In addition, such mutants might be instrumental in the development of strategies to cure the diseases by gene therapy. PMID:9418989
SU-E-J-56: Dosimetric Impact of Patient Roll Variability in Peripheral-Lung SBRT
Casto, B; Ying, J; Ku, L
Purpose: Positional variation about the patient longitudinal axis may introduce deleterious effects to clinical treatment plans, the effects of which are exacerbated by hypo-fractionated treatment regimens. Our goal is to evaluate the dosimetric impact of rotational setup error in stereotactic body radiation therapy (SBRT) for peripherally-located lung lesions. Methods: Six patients who had been treated for peripheral lung lesions using varying SBRT techniques were analyzed. Each patient's planning CT was processed using custom in-house software to simulate 1, 3, and 5 degree roll in both directions about their longitudinal axis. The original plan was fused and re-calculated. Agreement between planned and error-simulated dose distributions was quantified using 3%, 3mm criteria for the 3-dimensional gamma metric, and changes in target coverage and adjacent normal anatomy were also quantified. Results: Increased rotational setup error resulted in reduced target coverage, with changes in equivalent uniform dose ranging from −1.24% to −6.11% for simulated roll greater than or equal to 3 degrees, increasing with magnitude of error and skewed for roll directed toward the involved side. Changes to normal tissue metrics are linearly related to simulated roll, with rib D(1cc) changes ranging from −4.23% to 3.27% relative to the original treatment plan. Error-simulated dose distributions demonstrate agreement by the gamma metric in the planned target of 72.56%, 81.02%, and 99.52% for 5, 3, and 1 degree simulated roll scenarios, respectively. Corresponding agreement for the regional dose in excess of 50% of the maximum were 65.71%,70.77%, and 97.88%. Conclusion: This study suggests that the ability to detect and compensate for rotational positioning variations beyond a threshold level may improve care for patients with peripherally-located lesions beyond that which may be accomplished using only translational axes. Positional error of one degree of roll had little
38 CFR 4.123 - Neuritis, cranial or peripheral.
Code of Federal Regulations, 2013 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Neuritis, cranial or....123 Neuritis, cranial or peripheral. Neuritis, cranial or peripheral, characterized by loss of... the scale provided for injury of the nerve involved, with a maximum equal to severe,...
38 CFR 4.123 - Neuritis, cranial or peripheral.
Code of Federal Regulations, 2014 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Neuritis, cranial or....123 Neuritis, cranial or peripheral. Neuritis, cranial or peripheral, characterized by loss of... the scale provided for injury of the nerve involved, with a maximum equal to severe,...
38 CFR 4.123 - Neuritis, cranial or peripheral.
Code of Federal Regulations, 2012 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Neuritis, cranial or....123 Neuritis, cranial or peripheral. Neuritis, cranial or peripheral, characterized by loss of... the scale provided for injury of the nerve involved, with a maximum equal to severe,...
38 CFR 4.124 - Neuralgia, cranial or peripheral.
Code of Federal Regulations, 2010 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Neuralgia, cranial or....124 Neuralgia, cranial or peripheral. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on...
38 CFR 4.124 - Neuralgia, cranial or peripheral.
Code of Federal Regulations, 2012 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Neuralgia, cranial or....124 Neuralgia, cranial or peripheral. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on...
38 CFR 4.124 - Neuralgia, cranial or peripheral.
Code of Federal Regulations, 2013 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Neuralgia, cranial or....124 Neuralgia, cranial or peripheral. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on...
38 CFR 4.124 - Neuralgia, cranial or peripheral.
Code of Federal Regulations, 2014 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Neuralgia, cranial or....124 Neuralgia, cranial or peripheral. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on...
38 CFR 4.123 - Neuritis, cranial or peripheral.
Code of Federal Regulations, 2011 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Neuritis, cranial or....123 Neuritis, cranial or peripheral. Neuritis, cranial or peripheral, characterized by loss of... the scale provided for injury of the nerve involved, with a maximum equal to severe,...
38 CFR 4.123 - Neuritis, cranial or peripheral.
Code of Federal Regulations, 2010 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Neuritis, cranial or....123 Neuritis, cranial or peripheral. Neuritis, cranial or peripheral, characterized by loss of... the scale provided for injury of the nerve involved, with a maximum equal to severe,...
38 CFR 4.124 - Neuralgia, cranial or peripheral.
Code of Federal Regulations, 2011 CFR
... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Neuralgia, cranial or....124 Neuralgia, cranial or peripheral. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on...
The Interaction between Central and Peripheral Processes in Handwriting Production
ERIC Educational Resources Information Center
Roux, Sebastien; McKeeff, Thomas J.; Grosjacques, Geraldine; Afonso, Olivia; Kandel, Sonia
Written production studies investigating central processing have ignored research on the peripheral components of movement execution, and vice versa. This study attempts to integrate both approaches and provide evidence that central and peripheral processes interact during word production. French participants wrote regular words (e.g. FORME),…
21 CFR 868.2775 - Electrical peripheral nerve stimulator.
Code of Federal Regulations, 2013 CFR
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Electrical peripheral nerve stimulator. 868.2775 Section 868.2775 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2775 Electrical peripheral...
Continuous peripheral nerve block for battlefield anesthesia and evacuation.
Buckenmaier, Chester C; McKnight, Geselle M; Winkley, James V; Bleckner, Lisa L; Shannon, Clarence; Klein, Stephen M; Lyons, Robert C; Chiles, John H
Peripheral nerve and continuous peripheral nerve block (CPNB) have the potential to be valuable techniques in combat anesthesia. We describe the first successful application of CPNB in the pain management and surgical management of a combat casualty as he was evacuated from the Iraqi battlefield to the United States. PMID:15765463
Relationships among metabolic homeostasis, diet, and peripheral afferent neuron biology
Technology Transfer Automated Retrieval System (TEKTRAN)
It is well-established that food intake behavior and energy balance are regulated by cross-talk between peripheral organ systems and the central nervous system (CNS), for instance through the actions of peripherally-derived leptin on hindbrain and hypothalamic loci. Diet- or obesity-associated dist...
21 CFR 868.2775 - Electrical peripheral nerve stimulator.
Code of Federal Regulations, 2011 CFR
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Electrical peripheral nerve stimulator. 868.2775 Section 868.2775 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2775 Electrical peripheral nerve stimulator. (a) Identification....
21 CFR 868.2775 - Electrical peripheral nerve stimulator.
Code of Federal Regulations, 2014 CFR
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Electrical peripheral nerve stimulator. 868.2775 Section 868.2775 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2775 Electrical peripheral nerve stimulator. (a) Identification....
21 CFR 876.5310 - Nonimplanted, peripheral electrical continence device.
Code of Federal Regulations, 2014 CFR
....5310 Nonimplanted, peripheral electrical continence device. (a) Identification. A nonimplanted, peripheral electrical continence device is a device that consists of an electrode that is connected by an electrical cable to a battery-powered pulse source. The electrode is placed onto or inserted into the body...
21 CFR 876.5310 - Nonimplanted, peripheral electrical continence device.
Code of Federal Regulations, 2013 CFR
....5310 Nonimplanted, peripheral electrical continence device. (a) Identification. A nonimplanted, peripheral electrical continence device is a device that consists of an electrode that is connected by an electrical cable to a battery-powered pulse source. The electrode is placed onto or inserted into the body...
Solitary Peripheral Osteoma of the Angle of the Mandible
Kshirsagar, Kapil; Bhate, Kalyani; Pawar, Vivek; SanthoshKumar, S. N.; Kheur, Supriya; Dusane, Shrikant
Solitary peripheral osteoma is a benign, slow-growing osteogenic tumor arising from craniofacial bones such as the sinus, temporal, or jaw bones but rarely originating from the mandible. Osteoma consists of compact or cancellous bone that may be of peripheral, central, or extraskeletal type. Peripheral osteoma arises from the periosteum and is commonly a unilateral, pedunculated mushroom-like mass. Solitary peripheral osteomas are characterized by well-defined, rounded, or oval radiopaque mass in the computed tomography. Although multiple osteomas of the jaws are a hallmark of Gardner's syndrome (familial adenomatous polyposis), nonsyndromic cases are typically solitary. Herein, we report a rare case of solitary peripheral osteoma of the angle of the mandible in a 27-year-old female with clinical, radiologic, and histopathologic findings. PMID:26421198
Peripheral Neuropathy Due to Vitamin Deficiency, Toxins, and Medications
Staff, Nathan P.; Windebank, Anthony J.
Purpose of Review: Peripheral neuropathies secondary to vitamin deficiencies, medications, or toxins are frequently considered but can be difficult to definitively diagnose. Accurate diagnosis is important since these conditions are often treatable and preventable. This article reviews the key features of different types of neuropathies caused by these etiologies and provides a comprehensive list of specific agents that must be kept in mind. Recent Findings: While most agents that cause peripheral neuropathy have been known for years, newly developed medications that cause peripheral neuropathy are discussed. Summary: Peripheral nerves are susceptible to damage by a wide array of toxins, medications, and vitamin deficiencies. It is important to consider these etiologies when approaching patients with a variety of neuropathic presentations; additionally, etiologic clues may be provided by other systemic symptoms. While length-dependent sensorimotor axonal peripheral neuropathy is the most common presentation, several examples present in a subacute severe fashion, mimicking Guillain-Barré syndrome. PMID:25299283
Effect of firefighter masks on monocular and binocular peripheral vision.
Samo, Daniel G; Bahk, Jane K; Gerkin, Richard D
Peripheral vision can impact essential job functions of firefighters and other workers who use Self-Contained Breathing Apparatus and other full face masks. It is important for physicians to know how these masks alter peripheral vision. Also, one must understand the effect of monocular vision on peripheral vision. Using the Goldman Perimeter Machine we measured peripheral vision in the monocular and binocular state, with and without two different types of masks. The results show that monocularity causes an average loss of 23 degrees in the nasal meridian. The use of the masks did not affect this difference. Also, the masks caused an average loss of 28 degrees of peripheral vision in the inferior meridian. How these losses affect the ability of the users of the masks to perform their essential job functions still needs to be researched. PMID:12708146
Third Floor Plan, Second Floor Plan, First Floor Plan, Ground ...
Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey
Third Floor Plan, Second Floor Plan, First Floor Plan, Ground Floor Plan, West Bunkhouse - Kennecott Copper Corporation, On Copper River & Northwestern Railroad, Kennicott, Valdez-Cordova Census Area, AK
Southwest elevation, roof plan, site plan & main floor plan, ...
Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey
Southwest elevation, roof plan, site plan & main floor plan, loft plan, section looking east, north window head detail - Richard Buckminster Fuller & Anne Hewlett Fuller Dome Home, 407 South Forest Avenue, Carbondale, Jackson County, IL
Clopidogrel Responsiveness in Patients Undergoing Peripheral Angioplasty
Pastromas, Georgios Spiliopoulos, Stavros Katsanos, Konstantinos Diamantopoulos, Athanasios Kitrou, Panagiotis Karnabatidis, Dimitrios Siablis, Dimitrios
Purpose: To investigate the incidence and clinical significance of platelet responsiveness in patients receiving clopidogrel after peripheral angioplasty procedures. Materials and Methods: This prospective study included patients receiving antiplatelet therapy with clopidogrel 75 mg after infrainguinal angioplasty or stenting and who presented to our department during routine follow-up. Clopidogrel responsiveness was tested using the VerifyNow P2Y12 Assay. Patients with residual platelet reactivity units (PRU) {>=} 235 were considered as nonresponders (NR group NR), whereas patients with PRU < 235 were considered as normal (responders [group R]). Primary end points were incidence of resistance to clopidogrel and target limb reintervention (TLR)-free survival, whereas secondary end points included limb salvage rates and the identification of any independent predictors influencing clinical outcomes. Results: In total, 113 consecutive patients (mean age 69 {+-} 8 years) with 139 limbs were enrolled. After clopidogrel responsiveness analysis, 61 patients (53.9 %) with 73 limbs (52.5 %) were assigned to group R and 52 patients (46.1 %) with 66 limbs (47.5 %) to group NR. Mean follow-up interval was 27.7 {+-} 22.9 months (range 3-95). Diabetes mellitus, critical limb ischemia, and renal disease were associated with clopidogrel resistance (Fisher's exact test; p < 0.05). According to Kaplan-Meier analysis, TLR-free survival was significantly superior in group R compared with group NR (20.7 vs. 1.9 %, respectively, at 7-year follow-up; p = 0.001), whereas resistance to clopidogrel was identified as the only independent predictor of decreased TLR-free survival (hazard rate 0.536, 95 % confidence interval 0.31-0.90; p = 0.01). Cumulative TLR rate was significantly increased in group NR compared with group R (71.2 % [52 of 73] vs. 31.8 % [21 of 66], respectively; p < 0.001). Limb salvage was similar in both groups. Conclusion: Clopidogrel resistance was related with
77 FR 20047 - Certain Computer and Computer Peripheral Devices and Components Thereof and Products Containing...
Federal Register 2010, 2011, 2012, 2013, 2014
... COMMISSION Certain Computer and Computer Peripheral Devices and Components Thereof and Products Containing.... International Trade Commission has received a complaint entitled Certain Computer and Computer Peripheral... States after importation of certain computer and computer peripheral devices and components thereof...
77 FR 26041 - Certain Computers and Computer Peripheral Devices and Components Thereof and Products Containing...
Federal Register 2010, 2011, 2012, 2013, 2014
... COMMISSION Certain Computers and Computer Peripheral Devices and Components Thereof and Products Containing... ] sale within the United States after importation of certain computers and computer peripheral devices... importation of certain computers and computer peripheral devices and components thereof and...
77 FR 47795 - Disease Associated With Exposure to Certain Herbicide Agents: Peripheral Neuropathy
Federal Register 2010, 2011, 2012, 2013, 2014
... herbicide exposure and the occurrence of ``acute and subacute transient peripheral neuropathy.'' In... established a regulatory presumption of service connection for ``acute and subacute peripheral neuropathy...'s current regulation presumes service connection for ``acute and subacute peripheral...
Therapeutic options in peripheral T cell lymphoma.
Zhang, Yaping; Xu, Wei; Liu, Hong; Li, Jianyong
Peripheral T cell lymphoma (PTCL) is a rare and heterogeneous group of non-Hodgkin lymphomas with a very poor prognosis. The standard first-line treatments have resulted in unsatisfactory patient outcomes. With the exception of low-risk anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma (ALCL), the majority of patients relapse rapidly; the current 5-year overall survival rates are only 10-30%. Novel targeted therapies and combination chemotherapies are required for the treatment of patients with PTCL. In recent years, some retrospective and prospective studies have been performed concerning PTCL. Consequently, a number of novel agents and their relevant combination therapies have been identified, including histone deacetylase inhibitors, immunoconjugates, antifolates, monoclonal antibodies, immunomodulatory agents, nucleoside analogs, proteasome inhibitors, kinase inhibitors, bendamustine, L-asparaginase, and other targeted agents. It is hoped that these innovative approaches will finally improve outcomes in patients with PTCL. This review summarizes the currently available approaches for the treatment of PTCL with an emphasis on potential new agents, including the role of stem cell transplantation. PMID:27071634
Inherited peripheral neuropathies due to mitochondrial disorders.
Cassereau, J; Codron, P; Funalot, B
Mitochondrial disorders (MIDs) are frequently responsible for neuropathies with variable severity. Mitochondrial diseases causing peripheral neuropathies (PNP) may be due to mutations of mitochondrial DNA (mtDNA), as is the case in MERRF and MELAS syndromes, or to mutations of nuclear genes. Secondary abnormalities of mtDNA (such as multiple deletions of muscle mtDNA) may result from mitochondrial disorders due to mutations in nuclear genes involved in mtDNA maintenance. This is the case in several syndromes caused by impaired mtDNA maintenance, such as Sensory Ataxic Neuropathy, Dysarthria and Ophthalmoplegia (SANDO) due to recessive mutations in the POLG gene, which encodes the catalytic subunit of mtDNA polymerase (DNA polymerase gamma), or Mitochondrial Neuro-Gastro-Intestinal Encephalomyopathy (MNGIE), due to recessive mutations in the TYMP gene, which encodes thymidine phosphorylase. The last years have seen a growing list of evidence demonstrating that mitochondrial bioenergetics and dynamics might be dysfunctional in axonal Charcot-Marie-Tooth disease (CMT2), and these mechanisms might present a common link between dissimilar CMT2-causing genes. PMID:24768438
The peripheral clock regulates human pigmentation.
Hardman, Jonathan A; Tobin, Desmond J; Haslam, Iain S; Farjo, Nilofer; Farjo, Bessam; Al-Nuaimi, Yusur; Grimaldi, Benedetto; Paus, Ralf
Although the regulation of pigmentation is well characterized, it remains unclear whether cell-autonomous controls regulate the cyclic on-off switching of pigmentation in the hair follicle (HF). As human HFs and epidermal melanocytes express clock genes and proteins, and given that core clock genes (PER1, BMAL1) modulate human HF cycling, we investigated whether peripheral clock activity influences human HF pigmentation. We found that silencing BMAL1 or PER1 in human HFs increased HF melanin content. Furthermore, tyrosinase expression and activity, as well as TYRP1 and TYRP2 mRNA levels, gp100 protein expression, melanocyte dendricity, and the number gp100+ HF melanocytes, were all significantly increased in BMAL1 and/or PER1-silenced HFs. BMAL1 or PER1 silencing also increased epidermal melanin content, gp100 protein expression, and tyrosinase activity in human skin. These effects reflect direct modulation of melanocytes, as BMAL1 and/or PER1 silencing in isolated melanocytes increased tyrosinase activity and TYRP1/2 expression. Mechanistically, BMAL1 knockdown reduces PER1 transcription, and PER1 silencing induces phosphorylation of the master regulator of melanogenesis, microphthalmia-associated transcription factor, thus stimulating human melanogenesis and melanocyte activity in situ and in vitro. Therefore, the molecular clock operates as a cell-autonomous modulator of human pigmentation and may be targeted for future therapeutic strategies. PMID:25310406
Peripheral biomarkers of endometriosis: a systematic review
May, K.E.; Conduit-Hulbert, S.A.; Villar, J.; Kirtley, S.; Kennedy, S.H.; Becker, C.M.
BACKGROUND Endometriosis is estimated to affect 1 in 10 women during the reproductive years. There is often delay in making the diagnosis, mainly due to the non-specific nature of the associated symptoms and the need to verify the disease surgically. A biomarker that is simple to measure could help clinicians to diagnose (or at least exclude) endometriosis; it might also allow the effects of treatment to be monitored. If effective, such a marker or panel of markers could prevent unnecessary diagnostic procedures and/or recognize treatment failure at an early stage. METHODS We used QUADAS (Quality Assessment of Diagnostic Accuracy Studies) criteria to perform a systematic review of the literature over the last 25 years to assess critically the clinical value of all proposed biomarkers for endometriosis in serum, plasma and urine. RESULTS We identified over 100 putative biomarkers in publications that met the selection criteria. We were unable to identify a single biomarker or panel of biomarkers that have unequivocally been shown to be clinically useful. CONCLUSIONS Peripheral biomarkers show promise as diagnostic aids, but further research is necessary before they can be recommended in routine clinical care. Panels of markers may allow increased sensitivity and specificity of any diagnostic test. PMID:20462942
Fingolimod-Associated Peripheral Vascular Adverse Effects.
Russo, Margherita; Guarneri, Claudio; Mazzon, Emanuela; Sessa, Edoardo; Bramanti, Placido; Calabrò, Rocco Salvatore
Fingolimod is the first oral disease-modifying drug approved for the treatment of multiple sclerosis. The drug is usually well tolerated, and common adverse effects include bradycardia, headache, influenza, diarrhea, back pain, increased liver enzyme levels, and cough. Fingolimod is thought to provide therapeutic benefit by preventing normal lymphocyte egress from lymphoid tissues, thus reducing the infiltration of autoaggressive lymphocytes into the central nervous system. However, because the drug acts on different sphingosine-1-phosphate receptors, it may induce several biological effects by influencing endothelial cell-cell adhesion, angiogenesis, vascular development, and cardiovascular function. We describe a patient with multiple sclerosis who, after 3 weeks of fingolimod administration, developed purplish blotches over the dorsal surface of the distal phalanges of the second and fifth digits and the middle phalanx of the fourth ray, itching, and edema on his left hand, without other evident clinical manifestations. When fingolimod therapy was discontinued, the clinical picture regressed within a few days but reappeared after a rechallenge test. Physicians should be aware of unexpected peripheral vascular adverse effects due to fingolimod use, and patients with vascular-based acropathies should be carefully screened and monitored when taking this drug. PMID:26349949
Mitotoxicity in distal symmetrical sensory peripheral neuropathies
Bennett, Gary J.; Doyle, Timothy; Salvemini, Daniela
Chronic distal symmetrical sensory peripheral neuropathy is a common neurological complication of cancer chemotherapy, HIV treatment and diabetes. Although aetiology-specific differences in presentation are evident, the clinical signs and symptoms of these neuropathies are clearly similar. Data from animal models of neuropathic pain suggest that the similarities have a common cause: mitochondrial dysfunction in primary afferent sensory neurons. Mitochondrial dysfunction is caused by mitotoxic effects of cancer chemotherapeutic drugs of several chemical classes, HIV-associated viral proteins, and nucleoside reverse transcriptase inhibitor treatment, as well as the (possibly both direct and indirect) effects of excess glucose. The mitochondrial injury results in a chronic neuronal energy deficit, which gives rise to spontaneous nerve impulses and a compartmental neuronal degeneration that is first apparent in the terminal receptor arbor—that is, intraepidermal nerve fibres—of cutaneous afferent neurons. Preliminary data suggest that drugs that prevent mitochondrial injury or improve mitochondrial function could be useful in the treatment of these conditions. PMID:24840972
Peripheral nerve morphogenesis induced by scaffold micropatterning.
Cerri, Federica; Salvatore, Luca; Memon, Danish; Martinelli Boneschi, Filippo; Madaghiele, Marta; Brambilla, Paola; Del Carro, Ubaldo; Taveggia, Carla; Riva, Nilo; Trimarco, Amelia; Lopez, Ignazio D; Comi, Giancarlo; Pluchino, Stefano; Martino, Gianvito; Sannino, Alessandro; Quattrini, Angelo
Several bioengineering approaches have been proposed for peripheral nervous system repair, with limited results and still open questions about the underlying molecular mechanisms. We assessed the biological processes that occur after the implantation of collagen scaffold with a peculiar porous micro-structure of the wall in a rat sciatic nerve transection model compared to commercial collagen conduits and nerve crush injury using functional, histological and genome wide analyses. We demonstrated that within 60 days, our conduit had been completely substituted by a normal nerve. Gene expression analysis documented a precise sequential regulation of known genes involved in angiogenesis, Schwann cells/axons interactions and myelination, together with a selective modulation of key biological pathways for nerve morphogenesis induced by porous matrices. These data suggest that the scaffold's micro-structure profoundly influences cell behaviors and creates an instructive micro-environment to enhance nerve morphogenesis that can be exploited to improve recovery and understand the molecular differences between repair and regeneration. PMID:24559639
Schwann cell spectrins modulate peripheral nerve myelination
Susuki, Keiichiro; Raphael, Alya R.; Ogawa, Yasuhiro; Stankewich, Michael C.; Peles, Elior; Talbot, William S.; Rasband, Matthew N.
During peripheral nerve development, Schwann cells ensheathe axons and form myelin to enable rapid and efficient action potential propagation. Although myelination requires profound changes in Schwann cell shape, how neuron–glia interactions converge on the Schwann cell cytoskeleton to induce these changes is unknown. Here, we demonstrate that the submembranous cytoskeletal proteins αII and βII spectrin are polarized in Schwann cells and colocalize with signaling molecules known to modulate myelination in vitro. Silencing expression of these spectrins inhibited myelination in vitro, and remyelination in vivo. Furthermore, myelination was disrupted in motor nerves of zebrafish lacking αII spectrin. Finally, we demonstrate that loss of spectrin significantly reduces both F-actin in the Schwann cell cytoskeleton and the Nectin-like protein, Necl4, at the contact site between Schwann cells and axons. Therefore, we propose αII and βII spectrin in Schwann cells integrate the neuron–glia interactions mediated by membrane proteins into the actin-dependent cytoskeletal rearrangements necessary for myelination. PMID:21518878
Stem cell salvage of injured peripheral nerve.
Grimoldi, Nadia; Colleoni, Federica; Tiberio, Francesca; Vetrano, Ignazio G; Cappellari, Alberto; Costa, Antonella; Belicchi, Marzia; Razini, Paola; Giordano, Rosaria; Spagnoli, Diego; Pluderi, Mauro; Gatti, Stefano; Morbin, Michela; Gaini, Sergio M; Rebulla, Paolo; Bresolin, Nereo; Torrente, Yvan
We previously developed a collagen tube filled with autologous skin-derived stem cells (SDSCs) for bridging long rat sciatic nerve gaps. Here we present a case report describing a compassionate use of this graft for repairing the polyinjured motor and sensory nerves of the upper arms of a patient. Preclinical assessment was performed with collagen/SDSC implantation in rats after sectioning the sciatic nerve. For the patient, during the 3-year follow-up period, functional recovery of injured median and ulnar nerves was assessed by pinch gauge test and static two-point discrimination and touch test with monofilaments, along with electrophysiological and MRI examinations. Preclinical experiments in rats revealed rescue of sciatic nerve and no side effects of patient-derived SDSC transplantation (30 and 180 days of treatment). In the patient treatment, motor and sensory functions of the median nerve demonstrated ongoing recovery postimplantation during the follow-up period. The results indicate that the collagen/SDSC artificial nerve graft could be used for surgical repair of larger defects in major lesions of peripheral nerves, increasing patient quality of life by saving the upper arms from amputation. PMID:24268028
Exenatide and feeding: possible peripheral neuronal pathways.
Hunt, Jizette V; Washington, Martha C; Sayegh, Ayman I
Intraperitoneal (i.p.) administration of the synthetic agonist of the glucagon like peptide-1 (GLP-1) receptor exenatide reduces food intake. Here, we evaluated possible peripheral pathways for this reduction. Exenatide (0.5 μg/kg, i.p.) was given to three, overnight food-deprived, groups of rats: total subdiaphragmatic vagotomy (VGX, severs the vagus nerve), celiaco-mesenteric ganglionectomy (CMGX, severs the splanchnic nerve) and combined VGX/CMGX. Following the injection, meal sizes (MSs) and intermeal intervals (IMIs) were determined for a total of 120 min. We found that exenatide reduced the sizes of the first two meals but failed to prolong the IMI between them, that VGX attenuated the reduction of the first MS, and that VGX, CMGX and combined VGX/CMGX attenuated the reduction of the second MS by exenatide. Therefore, the vagus nerve appears necessary for the reduction of the first MS by exenatide, whereas both nerves appear necessary for the reduction of the second MS by this peptide. PMID:22222610
Human peripheral blood eosinophils induce angiogenesis.
Puxeddu, Ilaria; Alian, Akram; Piliponsky, Adrian Martin; Ribatti, Domenico; Panet, Amos; Levi-Schaffer, Francesca
Eosinophils play a crucial role in allergic reactions and asthma. They are also involved in responses against parasites, in autoimmune and neoplastic diseases, and in fibroses. There is increasing evidence that angiogenesis plays an important role in these processes. Since eosinophils are known to produce angiogenic mediators, we have hypothesized a direct contribution of these cells to angiogenesis. The effect of human peripheral blood eosinophil sonicates on rat aortic endothelial cell proliferation (in vitro), rat aorta sprouting (ex vivo) and angiogenesis in the chick embryo chorioallantoic membrane (in vivo) have been investigated. To determine whether eosinophil-derived vascular endothelial growth factor influences the eosinophil pro-angiogenic activity, eosinophil sonicates were incubated with anti-vascular endothelial growth factor antibodies and then added to the chorioallantoic membrane. Vascular endothelial growth factor mRNA expression and vascular endothelial growth factor receptor density on the endothelial cells were also evaluated. Eosinophils were found to enhance endothelial cell proliferation and to induce a strong angiogenic response both in the aorta rings and in the chorioallantoic membrane assays. Pre-incubation of eosinophil sonicates with anti-vascular endothelial growth factor antibodies partially reduced the angiogenic response of these cells in the chorioallantoic membrane. Eosinophils also increased vascular endothelial growth factor mRNA production on endothelial cells. Eosinophils are able to induce angiogenesis and this effect is partially mediated by their pre-formed vascular endothelial growth factor. This strongly suggests an important role of eosinophils in angiogenesis-associated diseases such as asthma. PMID:15618019
Spatiotemporal Changes Posttreatment in Peripheral Arterial Disease
Myers, Sara A.; Huben, Neil B.; Yentes, Jennifer M.; McCamley, John D.; Lyden, Elizabeth R.; Pipinos, Iraklis I.; Johanning, Jason M.
Accumulating evidence suggests revascularization of peripheral arterial disease (PAD) limbs results in limited improvement in functional gait parameters, suggesting underlying locomotor system pathology. Spatial and temporal (ST) gait parameters are well studied in patients with PAD at baseline and are abnormal when compared to controls. The purpose of this study was to systematically review and critically analyze the available data on ST gait parameters before and after interventions. A full review of literature was conducted and articles were included which examined ST gait parameters before and after intervention (revascularization and exercise). Thirty-three intervention articles were identified based on 154 articles that evaluated ST gait parameters in PAD. Four articles fully assessed ST gait parameters before and after intervention and were included in our analysis. The systematic review of the literature revealed a limited number of studies assessing ST gait parameters. Of those found, results demonstrated the absence of improvement in gait parameters due to either exercise or surgical intervention. Our study demonstrates significant lack of research examining the effectiveness of treatments on ST gait parameters in patients with PAD. Based on the four published articles, ST gait parameters failed to significantly improve in patients with PAD following intervention. PMID:26770826
Episodic neurological dysfunction in hereditary peripheral neuropathy
Kulkarni, Girish Baburao; Mailankody, Pooja; Isnwara, Pawanraj Palu; Prasad, Chandrajit; Mustare, Veerendrakumar
Episodic transient neurological symptoms are an important set of problems presenting to a neurologist in his routine practice. Occasionally, detailed clinical history including past and family history supplemented with focused examination can bring out a rare cause for such symptoms. We describe in this report in a young male presenting with episodic focal neurological dysfunction, with family history of similar episodes in mother and brother. Examination showed features of pes cavus and peripheral neuropathy for which patient was asymptomatic. Mother and brother were established cases of hereditary neuropathy. Imaging on multiple occasions showed reversible white matter abnormalities. Clinical suspicion of X-linked Charcot-Marie-Tooth disease type 1 (CMT1X) was confirmed with detection of mutation in Gap Junction B1 (GJB1) gene, which codes for connexin 32 protein (c.425G>A; p.R142Q hemizygous mutation). Though this mutation has been already reported in CMTX patients, it has not been associated with transient neurological dysfunctions. This is probably the first reported case of CMTX patient with transient neurological dysfunction from India, whose family members had similar episodes. PMID:25745327
Optical stimulation of peripheral nerves in vivo
NASA Astrophysics Data System (ADS)
Wells, Jonathon D.
This dissertation documents the emergence and validation of a new clinical tool that bridges the fields of biomedical optics and neuroscience. The research herein describes an innovative method for direct neurostimulation with pulsed infrared laser light. Safety and effectiveness of this technique are first demonstrated through functional stimulation of the rat sciatic nerve in vivo. The Holmium:YAG laser (lambda = 2.12 mum) is shown to operate at an optimal wavelength for peripheral nerve stimulation with advantages over standard electrical neural stimulation; including contact-free stimulation, high spatial selectivity, and lack of a stimulation artifact. The underlying biophysical mechanism responsible for transient optical nerve stimulation appears to be a small, absorption driven thermal gradient sustained at the axonal layer of nerve. Results explicitly prove that low frequency optical stimulation can reliably stimulate without resulting in tissue thermal damage. Based on the positive results from animal studies, these optimal laser parameters were utilized to move this research into the clinic with a combined safety and efficacy study in human subjects undergoing selective dorsal rhizotomy. The clinical Holmium:YAG laser was used to effectively stimulate human dorsal spinal roots and elicit functional muscle responses recorded during surgery without evidence of nerve damage. Overall these results predict that this technology can be a valuable clinical tool in various neurosurgical applications.
Management of oxaliplatin-induced peripheral neuropathy
Saif, M Wasif; Reardon, John
Neurotoxicity is the most frequent dose-limiting toxicity of oxaliplatin. Acute sensory neurotoxicity manifests as rapid onset of cold-induced distal dysesthesia and/or paresthesia, sometimes accompanied by cold-dependent muscular contractions of the extremities or the jaw. The symptoms, often occurring during or shortly after infusion, are usually transient and mild. A cumulative sensory peripheral neuropathy may also develop with prolonged treatment with oxaliplatin, eventually causing superficial and deep sensory loss, sensory ataxia, and functional impairment. Studies have shown patients with acute sensory symptoms to display little or no axonal degeneration. The similarity of acute symptoms induced by oxaliplatin to those caused by several drugs or toxins acting on neuronal or muscular ion channels suggests that these symptoms may result from a specific interaction of oxaliplatin with voltage-gated sodium (Na+) channels. The current recommendations for the management of the acute and cumulative neurotoxicity from oxaliplatin include education about exposure to cold, dose modification, "stop and go", and use of neuromodulatory agents, in particular, intravenous calcium and magnesium infusion. Upon the approval of oxaliplatin-based regimens both for adjuvant and metastatic treatment of colon cancer, it is crucial to compile knowledge about the recognition and management of neurotoxicity from oxaliplatin. PMID:18360567
Specifying peripheral heterochromatin during nuclear lamina reassembly
Poleshko, Andrey; Katz, Richard A
A conserved organizational feature of eukaryotic nuclei is the peripheral heterochromatin compartment, which provides a protected area for epigenetically silent genes and gene-poor DNA. In metazoan cells this compartment is associated with the nuclear lamina, the protein meshwork at the inner edge of the nucleus. Heterochromatin-nuclear lamina interactions promote epigenetic gene silencing, which may drive many normal and diseased biological processes. We recently obtained evidence that a previously unstudied human protein, PRR14, participates in the tethering of heterochromatin to the inner nuclear periphery. PRR14 associates with the nuclear lamina and attaches to heterochromatin through its binding partner, heterochromatin protein 1 (HP1). After disassembly early in mitosis, PRR14 reassembles in two steps, first binding to anaphase chromosomes through HP1, followed by association with the nuclear lamina in telophase. PRR14 may thereby play a role in specifying HP1-bound heterochromatin for reattachment to the nuclear lamina at mitotic exit. Here we review the relevant literature, summarize our initial work, and provide additional comments and findings. PMID:24637393
Slowed response to peripheral visual stimuli during strenuous exercise.
Ando, Soichi; Komiyama, Takaaki; Kokubu, Masahiro; Sudo, Mizuki; Kiyonaga, Akira; Tanaka, Hiroaki; Higaki, Yasuki
Recently, we proposed that strenuous exercise impairs peripheral visual perception because visual responses to peripheral visual stimuli were slowed during strenuous exercise. However, this proposal was challenged because strenuous exercise is also likely to affect the brain network underlying motor responses. The purpose of the current study was to resolve this issue. Fourteen participants performed a visual reaction-time (RT) task at rest and while exercising at 50% (moderate) and 75% (strenuous) peak oxygen uptake. Visual stimuli were randomly presented at different distances from fixation in two task conditions: the Central condition (2° or 5° from fixation) and the Peripheral condition (30° or 50° from fixation). We defined premotor time as the time between stimulus onset and the motor response, as determined using electromyographic recordings. In the Central condition, premotor time did not change during moderate (167±19ms) and strenuous (168±24ms) exercise from that at rest (164±17ms). In the Peripheral condition, premotor time significantly increased during moderate (181±18ms, P<0.05) and strenuous exercise (189±23ms, P<0.001) from that at rest (173±17ms). These results suggest that increases in Premotor Time to the peripheral visual stimuli did not result from an impaired motor-response network, but rather from impaired peripheral visual perception. We conclude that slowed response to peripheral visual stimuli during strenuous exercise primarily results from impaired visual perception of the periphery. PMID:27080081
Disruption of Foveal Space Impairs Discrimination of Peripheral Objects
Weldon, Kimberly B.; Rich, Anina N.; Woolgar, Alexandra; Williams, Mark A.
Visual space is retinotopically mapped such that peripheral objects are processed in a cortical region outside the region that represents central vision. Despite this well-known fact, neuroimaging studies have found information about peripheral objects in the foveal confluence, the cortical region representing the fovea. Further, this information is behaviorally relevant: disrupting the foveal confluence using transcranial magnetic stimulation impairs discrimination of peripheral objects at time-points consistent with a disruption of feedback. If the foveal confluence receives feedback of information about peripheral objects to boost vision, there should be behavioral consequences of this phenomenon. Here, we tested the effect of foveal distractors at different stimulus onset asynchronies (SOAs) on discrimination of peripheral targets. Participants performed a discrimination task on target objects presented in the periphery while fixating centrally. A visual distractor presented at the fovea ~100 ms after presentation of the targets disrupted performance more than a central distractor presented at other SOAs. This was specific to a central distractor; a peripheral distractor at the same time point did not have the same effect. These results are consistent with the claim that foveal retinotopic cortex is recruited for extra-foveal perception. This study describes a new paradigm for investigating the nature of the foveal feedback phenomenon and demonstrates the importance of this feedback in peripheral vision. PMID:27242612
Physiological and pharmacologic aspects of peripheral nerve blocks
Vadhanan, Prasanna; Tripaty, Debendra Kumar; Adinarayanan, S.
A successful peripheral nerve block not only involves a proper technique, but also a thorough knowledge and understanding of the physiology of nerve conduction and pharmacology of local anesthetics (LAs). This article focuses on what happens after the block. Pharmacodynamics of LAs, underlying mechanisms of clinically observable phenomena such as differential blockade, tachyphylaxis, C fiber resistance, tonic and phasic blockade and effect of volume and concentration of LAs. Judicious use of additives along with LAs in peripheral nerve blocks can prolong analgesia. An entirely new group of drugs-neurotoxins has shown potential as local anesthetics. Various methods are available now to prolong the duration of peripheral nerve blocks. PMID:26330722
Exercise Training and Peripheral Arterial Disease
Haas, Tara L.; Lloyd, Pamela G.; Yang, Hsiao-Tung; Terjung, Ronald L.
Peripheral arterial disease (PAD) is a common vascular disease that reduces blood flow capacity to the legs of patients. PAD leads to exercise intolerance that can progress in severity to greatly limit mobility, and in advanced cases leads to frank ischemia with pain at rest. It is estimated that 12–15 million people in the United States are diagnosed with PAD, with a much larger population that is undiagnosed. The presence of PAD predicts a 50–1500% increase in morbidity and mortality, depending on severity. Treatment of patients with PAD is limited to modification of cardiovascular disease risk factors, pharmacological intervention, surgery, and exercise therapy. Extended exercise programs that involve walking ~5 times/wk, at a significant intensity that requires frequent rest periods, are most significant. Pre-clinical studies and virtually all clinical trials demonstrate the benefits of exercise therapy, including: improved walking tolerance, modified inflammatory/hemostatic markers, enhanced vasoresponsiveness, adaptations within the limb (angiogenesis, arteriogenesis, mitochondrial synthesis) that enhance oxygen delivery and metabolic responses, potentially delayed progression of the disease, enhanced quality of life indices, and extended longevity. A synthesis is provided as to how these adaptations can develop in the context of our current state of knowledge and events known to be orchestrated by exercise. The benefits are so compelling that exercise prescription should be an essential option presented to patients with PAD in the absence of contraindications. Obviously, selecting for a life style pattern, that includes enhanced physical activity prior to the advance of PAD limitations, is the most desirable and beneficial. PMID:23720270
Biomarkers of peripheral muscle fatigue during exercise
Background Biomarkers of peripheral muscle fatigue (BPMFs) are used to offer insights into mechanisms of exhaustion during exercise in order to detect abnormal fatigue or to detect defective metabolic pathways. This review aims at describing recent advances and future perspectives concerning the most important biomarkers of muscle fatigue during exercise. Results BPMFs are classified according to the mechanism of fatigue related to adenosine-triphosphate-metabolism, acidosis, or oxidative-metabolism. Muscle fatigue is also related to an immunological response. impaired calcium handling, disturbances in bioenergetic pathways, and genetic responses. The immunological and genetic response may make the muscle susceptible to fatigue but may not directly cause muscle fatigue. Production of BPMFs is predominantly dependent on the type of exercise. BPMFs need to change as a function of the process being monitored, be stable without appreciable diurnal variations, correlate well with exercise intensity, and be present in detectable amounts in easily accessible biological fluids. The most well-known BPMFs are serum lactate and interleukin-6. The most widely applied clinical application is screening for defective oxidative metabolism in mitochondrial disorders by means of the lactate stress test. The clinical relevance of most other BPMFs, however, is under debate, since they often depend on age, gender, physical fitness, the energy supply during exercise, the type of exercise needed to produce the BPMF, and whether healthy or diseased subjects are investigated. Conclusions Though the role of BPMFs during fatigue is poorly understood, measuring BPMFs under specific, standardised conditions appears to be helpful for assessing biological states or processes during exercise and fatigue. PMID:23136874
Repair of peripheral nerve with vein wrapping*
Objective The post–traumatic neuro-anastomosis must be protected from the surrounding environment. This barrier must be biologically inert, biodegradable, not compressing but protecting the nerve. Formation of painful neuroma is one of the major issues with neuro-anastomosis; currently there is no consensus on post-repair neuroma prevention. Aim of this study is to evaluate the efficacy of neuroanastomosis performed with venous sheath to reduce painful neuromas formation, improve the electrical conductivity of the repaired nerve, and reduce the discrepancies of the sectioned nerve stumps. Patients and methods From a trauma population of 320 patients treated in a single centre between January 2008 and December 2011, twenty-six patients were identified as having an injury to at least one of the peripheral nerves of the arm and enrolled in the study. Patients were divided into two groups. In the group A (16 patients) the end-to-end nerve suture was wrapped in a vein sheath and compared with the group B (10 patients) in which a simple end-to-end neurorrhaphy was performed. The venous segment used to cover the nerve micro-suture was harvested from the superficial veins of the forearm. The parameters analyzed were: functional recovery of motor nerves, sensitivity and pain. Results Average follow-up was 14 months (range: 12–24 months). The group A showed a more rapid motor and sensory recovery and a reduction of the painful symptoms compared to the control group (B). Conclusions The Authors demonstrated that, in their experience, the venous sheath provides a valid solution to avoid the dispersion of the nerve fibres, to prevent adherent scars and painful neuromas formation. Moreover it can compensate the different size of two nerve stumps, allowing, thereby, a more rapid functional and sensitive recovery without expensive devices. PMID:24841688
Renalase regulates peripheral and central dopaminergic activities
Serrão, Maria Paula; Soares-Silva, Isabel; Fernandes-Cerqueira, Cátia; Simões-Silva, Liliana; Pinho, Maria João; Remião, Fernando; Sampaio-Maia, Benedita; Desir, Gary V.; Pestana, Manuel
Renalase is a recently identified FAD/NADH-dependent amine oxidase mainly expressed in kidney that is secreted into blood and urine where it was suggested to metabolize catecholamines. The present study evaluated central and peripheral dopaminergic activities in the renalase knockout (KO) mouse model and examined the changes induced by recombinant renalase (RR) administration on plasma and urine catecholamine levels. Compared with wild-type (WT) mice, KO mice presented increased plasma levels of epinephrine (Epi), norepinephrine (NE), and dopamine (DA) that were accompanied by increases in the urinary excretion of Epi, NE, DA. In addition, the KO mice presented an increase in urinary DA-to-l-3,4-dihydroxyphenylalanine (l-DOPA) ratios without changes in renal tubular aromatic-l-amino acid decarboxylase (AADC) activity. By contrast, the in vivo administration of RR (1.5 mg/kg sc) to KO mice was accompanied by significant decreases in plasma levels of Epi, DA, and l-DOPA as well as in urinary excretion of Epi, DA, and DA-to-l-DOPA ratios notwithstanding the accompanied increase in renal AADC activity. In addition, the increase in renal DA output observed in renalase KO mice was accompanied by an increase in the expression of the L-type amino acid transporter like (LAT) 1 that is reversed by the administration of RR in these animals. These results suggest that the overexpression of LAT1 in the renal cortex of the renalase KO mice might contribute to the enhanced l-DOPA availability/uptake and consequently to the activation of the renal dopaminergic system in the presence of renalase deficiency. PMID:25411385
Peripheral neutrophils after allergic asthmatic reactions.
Asman, B; Strand, V; Bylin, G; Bergström, K
The response of peripheral neutrophils was studied in 16 patients with allergic asthma after challenge with birch/grass pollen allergen, in order to identify inflammatory markers associated with only the early asthmatic reaction and those associated with both early and late asthmatic reactions. The allergen challenge proceeded until the patients had an early asthmatic reaction with 100% increase in specific airway resistance. Bronchoconstriction after allergen challenge was monitored hourly over 9 h and finally after 18 h, by measurement of the forced expiratory volume in 1 s. Seven patients had a late reaction, defined as a decrease in forced expiratory volume in 1 s of more than 15%. Blood samples were taken before and 18 h after challenge. After allergen challenge (18 h) the blood concentration of neutrophils in patients with a late asthmatic reaction was 1.4 times higher than before challenge and there was a tendency for increased Fc gamma receptor-mediated chemiluminescence. Lewis X-antigen (CD 15), which is associated with endothelial adhesion and extravasation, significantly decreased at the same time. Neutrophils were incubated with the tetrapeptide arginine-glycine-aspartate-serine before and 18 h after allergen challenge. Both patient groups showed an increased Fc gamma receptor-mediated chemiluminescence and a decreased Fc gamma receptor membrane expression following allergen challenge, suggesting a preactivation. In conclusion, patients with a dual asthmatic reaction show a sustained primed inflammatory response and primed neutrophils compared with patients with only an early reaction when measured after the decline of clinical symptoms provoked by allergen challenge. PMID:9352381
Leptospirosis and Peripheral Artery Occlusive Disease
Chiu, Chun-Hsiang; Lin, Cheng-Li; Lee, Feng-You; Wang, Ying-Chuan; Kao, Chia-Hung
Abstract Data on the association between peripheral artery occlusive disease (PAOD) and leptospirosis are limited. We conducted a retrospective cohort study for determining whether leptospirosis is one of the possible risk factors for PAOD. Patients diagnosed with leptospirosis by using 2000 to 2010 data from the Taiwan National Health Insurance Research Database. Patients with leptospirosis without a history of PAOD were selected. For each leptospirosis patient, 4 controls without a history of leptospirosis and PAOD were randomly selected and frequency-matched for sex, age, the year of the index date, and comorbidity diseases. The follow-up period was from the time of the initial diagnosis of leptospirosis to the diagnosis date of PAOD, or December 31, 2011. The Cox proportional hazard regression models were used for analyzing the risk of PAOD. During the follow-up period, the cumulative incidence of PAOD was higher among the patients from the leptospirosis cohort than among the nonleptospirosis cohort (log-rank test, P < 0.001). In total, 29 patients with PAOD from the leptospirosis cohort and 81 from the nonleptospirosis cohort were observed with the incidence rates of 2.1 and 1.3 per 1000 person-years, respectively, yielding a crude hazards ratio (HR) of 1.62 (95% confidence interval [CI] = 1.44–1.81) and adjusted HR (aHR) of 1.75 (95% CI = 1.58–1.95). The risk of PAOD was 1.75-fold higher in the patients with leptospirosis than in the general population. PMID:26986166
Myelin synthesis in the peripheral nervous system.
Garbay, B; Heape, A M; Sargueil, F; Cassagne, C
By imposing saltatory conduction on the nervous impulse, the principal role of the myelin sheath is to allow the faster propagation of action potentials along the axons which it surrounds. Peripheral nervous system (PNS) myelin is formed by the differentiation of the plasma membrane of Schwann cells. One of the biochemical characteristics that distinguishes myelin from other biological membranes is its high lipid-to-protein ratio. All the major lipid classes are represented in the myelin membrane, while several myelin-specific proteins have been identified. During development, the presence of axons is required for the initiation of myelination, but the nature of the axonal signal is still unknown. The only certainties are that this signal is synthesized by axons whose diameter is greater than 0.7 microm, and that the signal(s) include(s) a diffusible molecule. Morphological studies have provided us with information concerning the timing of myelination, the mechanism by which immature Schwann cells differentiate into a myelinating phenotype and lay down the myelin sheath around the axon, and the accumulation and the structure of the myelin membrane. The last 20 years have seen the identification and the cDNA and gene cloning of the major PNS myelin proteins, which signalled the beginning of the knock-out decade: transgenic null-mutant mice have been created for almost every protein gene. The study of these animals shows that the formation of myelin is considerably less sensitive to molecular alterations than the maintenance of myelin. During the same period, important data has been gathered concerning the synthesis and function of lipids in PNS myelin, although this field has received relatively little attention compared with that of their protein counterparts. PMID:10727776
Motion Planning for a Three-Stage Multilumen Transoral Lung Access System
Kuntz, Alan; Torres, Luis G.; Feins, Richard H.; Webster, Robert J.; Alterovitz, Ron
Lung cancer is the leading cause of cancer-related death, and early-stage diagnosis is critical to survival. Biopsy is typically required for a definitive diagnosis, but current low-risk clinical options for lung biopsy cannot access all biopsy sites. We introduce a motion planner for a multilumen transoral lung access system, a new system that has the potential to perform safe biopsies anywhere in the lung, which could enable more effective early-stage diagnosis of lung cancer. The system consists of three stages in which a bronchoscope is deployed transorally to the lung, a concentric tube robot pierces through the bronchial tubes into the lung parenchyma, and a steerable needle deploys through a properly oriented concentric tube and steers through the lung parenchyma to the target site while avoiding anatomical obstacles such as significant blood vessels. A sampling-based motion planner computes actions for each stage of the system and considers the coupling of the stages in an efficient manner. We demonstrate the motion planner's fast performance and ability to compute plans with high clearance from obstacles in simulated anatomical scenarios. PMID:26942041
Toxicity After Central versus Peripheral Lung Stereotactic Body Radiation Therapy: A Propensity Score Matched-Pair Analysis
Mangona, Victor S.; Aneese, Andrew M.; Marina, Ovidiu; Hymas, Richard V.; Ionascu, Dan; Robertson, John M.; Gallardo, Lori J.; Grills, Inga Siiner
Purpose: To compare toxicity after stereotactic body radiation therapy (SBRT) for "central" tumors—within 2 cm of the proximal bronchial tree or with planning tumor volume (PTV) touching mediastinum—versus noncentral ("peripheral") lung tumors. Methods and Materials: From November 2005 to January 2011, 229 tumors (110 central, 119 peripheral; T1-3N0M0 non–small-cell lung cancer and limited lung metastases) in 196 consecutive patients followed prospectively at a single institution received moderate-dose SBRT (48-60 Gy in 4-5 fractions [biologic effective dose=100-132 Gy, α/β=10]) using 4-dimensional planning, online image-guided radiation therapy, and institutional dose constraints. Clinical adverse events (AEs) were graded prospectively at clinical and radiographic follow-up using Common Terminology Criteria for Adverse Events version 3.0. Pulmonary function test (PFT) decline was graded as 2 (25%-49.9% decline), 3 (50.0%-74.9% decline), or 4 (≥75.0% decline). Central/peripheral location was assessed retrospectively on planning CT scans. Groups were compared after propensity score matching. Characteristics were compared with χ{sup 2} and 2-tailed t tests, adverse events with χ{sup 2} test-for-trend, and cumulative incidence using competing risks analysis (Gray's test). Results: With 79 central and 79 peripheral tumors matched, no differences in AEs were observed after 17 months median follow-up. Two-year cumulative incidences of grade ≥2 pain, musculoskeletal, pulmonary, and skin AEs were 14%, 5%, 6%, and 10% (central) versus 19%, 10%, 10%, and 3% (peripheral), respectively (P=.31, .38, .70, and .09). Grade ≥2 cardiovascular, gastrointestinal, and central nervous system AEs were rare (<1%). Two-year incidences of grade ≥2 clinical AEs (28% vs 25%, P=.79), grade ≥2 PFT decline (36% vs 34%, P=.94), grade ≥3 clinical AEs (3% vs 7%, P=.48), and grade ≥3 PFT decline (0 vs 10%, P=.11) were similar for central versus peripheral tumors
Edaravone promotes functional recovery after mechanical peripheral nerve injury
Zhang, Teng; Li, Zhengwei; Dong, Jianli; Nan, Feng; Li, Tao; Yu, Qing
Edaravone has been shown to reduce ischemia/reperfusion-induced peripheral nerve injury. However, the therapeutic effect of edaravone on peripheral nerve injury caused by mechanical factors is unknown. In the present study, we established a peripheral nerve injury model by crushing the sciatic nerve using hemostatic forceps, and then administered edaravone 3 mg/kg intraperitoneally. The sciatic functional index and superoxide dismutase activity of the sciatic nerve were increased, and the malondialdehyde level was decreased in animals in the edaravone group compared with those in the model group. Bcl-2 expression was increased, but Bax expression was decreased in anterior horn cells of the L4-6 spinal cord segments. These results indicated that edaravone has a neuroprotective effect following peripheral nerve injury caused by mechanical factors through alleviating free radical damage to cells and inhibiting lipid peroxidation, as well as regulating apoptosis-related protein expression. PMID:25374594
[The peripheral sexual response ... from urogynecology to sexology].
Meyer, Sylvain; Salchli, François; Bettaieb, Hela; Vial, Yvan; Baud, David; Fornage, Sandra; Bianchi-Demicheli, Francesco
The peripheral sexual response is achieved by the the Clitoro-Urethro-Vaginal Complex who is responsible of the transmission of the sensitive stimulation to the CNS where this information is modulated by the different cerebral areas. These latter will send this message to the peripheral sexual organs using efferent somatic and autonomic pathways able to induce vaso congestive response of clitoridal area with contractions of pelvic floor muscles. Muscles stretch injuries after obstetrical or surgical trauma can decrease the quality of the sexual peripheral response. These modifications of peripheral sexual response have to be evaluated with a specific questionnaire and pelvic floor clinical examination and recently, with a new microsystem device able to record continuously intra-vaginal pressure modifications. PMID:26790237
The study on computer aided peripheral visual field diagnosis.
Shuyi, Wang; Xingsan, Qian
Background Despite the widespread adoption of automated perimetry, there is still a role for peripheral perimetry. So far there was no accurate quantitative analysis on the change of visual field, most analysis were qualitative and depend on doctor's experience. Method Computer aided diagnose system was designed to judge the accurate change in visual field. Tabu Seach technology was used to identify visual field from the result of Peripheral perimeter test, and accurate visual filed defect dimension can be concluded by compared with point to point. At the same time liable eye diseases were predicted by computer. Conclusion Computer aided peripheral visual field diagnose system can identify defect in visual field, and provide reliable clinical diagnosis. Key words peripheral visual field, Computer aided diagnose, tabu search. PMID:17282924
Perceived speed in peripheral vision can go up or down.
Hassan, Omar; Thompson, Peter; Hammett, Stephen T
We measured the perceived speed and contrast of patterns in peripheral vision relative to foveal patterns for a range of eccentricities at both mesopic and photopic levels. The results indicate that perceived speed varies with eccentricity, speed, and luminance. At high (photopic) luminance, patterns appear slower when viewed peripherally rather than foveally, but at low (mesopic) luminance fast-moving patterns can appear faster when viewed peripherally. When perceived contrast is equated, perceived speed reduces as a function of eccentricity in a speed-independent manner. Peripheral stimuli appear faster or slower than foveal stimuli depending upon luminance-an image parameter known to influence the gain of magno and parvocellular cells. We conclude that speed encoding in the periphery is consistent with a ratio-type speed code that is weighted by ganglion cell density. PMID:27128323
Label-free photoacoustic microscopy of peripheral nerves
NASA Astrophysics Data System (ADS)
Matthews, Thomas Paul; Zhang, Chi; Yao, Da-Kang; Maslov, Konstantin; Wang, Lihong V.
Peripheral neuropathy is a common neurological problem that affects millions of people worldwide. Diagnosis and treatment of this condition are often hindered by the difficulties in making objective, noninvasive measurements of nerve fibers. Photoacoustic microscopy (PAM) has the ability to obtain high resolution, specific images of peripheral nerves without exogenous contrast. We demonstrated the first proof-of-concept imaging of peripheral nerves using PAM. As validated by both standard histology and photoacoustic spectroscopy, the origin of photoacoustic signals is myelin, the primary source of lipids in the nerves. An extracted sciatic nerve sandwiched between two layers of chicken tissue was imaged by PAM to mimic the in vivo case. Ordered fibrous structures inside the nerve, caused by the bundles of myelin-coated axons, could be observed clearly. With further technical improvements, PAM can potentially be applied to monitor and diagnose peripheral neuropathies.
An Uncommon Case of Solitary Peripheral Osteoma in the Mandible
Agrawal, Rohit; Agrawal, Shipra; Bhargava, Shitij; Motlani, Mahesh; Agrawal, Rahul
Osteoma is a benign osteogenic lesion which is composed of well differentiated mature compact and/or cancellous bone that proliferates continuously. Its prevalence is 4%. Its pathogenesis is still controversial. Solitary peripheral osteoma of craniofacial region is a rare finding. We report a case of 30-year-old female having solitary peripheral osteoma present on the lingual cortex of the left posterior mandible which was initially asymptomatic but now is causing discomfort while chewing and not associated with Gardner's syndrome. We also laid emphasis on its clinical, differential diagnosis, radiological, surgical, and histopathological features. The aim of this paper is to present an uncommon case of solitary peripheral osteoma in the mandible along with analysis of literature for peripheral osteomas of jaws and to contribute to the knowledge concerning the pathogenesis, differential diagnosis, and management of these lesions. PMID:26788378
An Uncommon Case of Solitary Peripheral Osteoma in the Mandible.
Agrawal, Rohit; Agrawal, Shipra; Bhargava, Shitij; Motlani, Mahesh; Agrawal, Rahul
Osteoma is a benign osteogenic lesion which is composed of well differentiated mature compact and/or cancellous bone that proliferates continuously. Its prevalence is 4%. Its pathogenesis is still controversial. Solitary peripheral osteoma of craniofacial region is a rare finding. We report a case of 30-year-old female having solitary peripheral osteoma present on the lingual cortex of the left posterior mandible which was initially asymptomatic but now is causing discomfort while chewing and not associated with Gardner's syndrome. We also laid emphasis on its clinical, differential diagnosis, radiological, surgical, and histopathological features. The aim of this paper is to present an uncommon case of solitary peripheral osteoma in the mandible along with analysis of literature for peripheral osteomas of jaws and to contribute to the knowledge concerning the pathogenesis, differential diagnosis, and management of these lesions. PMID:26788378
What Are the Signs and Symptoms of Peripheral Arterial Disease?
... from the NHLBI on Twitter. What Are the Signs and Symptoms of Peripheral Artery Disease? Many people ... flow, so the symptoms will go away. Other Signs and Symptoms Other signs and symptoms of P. ...
Advances and Future Applications of Augmented Peripheral Nerve Regeneration.
Jones, Salazar; Eisenberg, Howard M; Jia, Xiaofeng
Peripheral nerve injuries remain a significant source of long lasting morbidity, disability, and economic costs. Much research continues to be performed in areas related to improving the surgical outcomes of peripheral nerve repair. In this review, the physiology of peripheral nerve regeneration and the multitude of efforts to improve surgical outcomes are discussed. Improvements in tissue engineering that have allowed for the use of synthetic conduits seeded with neurotrophic factors are highlighted. Selected pre-clinical and available clinical data using cell based methods such as Schwann cell, undifferentiated, and differentiated stem cell transplantation to guide and enhance peripheral nerve regeneration are presented. The limitations that still exist in the utility of neurotrophic factors and cell-based therapies are outlined. Strategies that are most promising for translation into the clinical arena are suggested. PMID:27618010
Heat transfer analysis for peripheral blood flow measurement system
NASA Astrophysics Data System (ADS)
Nagata, Koji; Hattori, Hideharu; Sato, Nobuhiko; Ichige, Yukiko; Kiguchi, Masashi
Some disorders such as circulatory disease and metabolic abnormality cause many problems to peripheral blood flow condition. Therefore, frequent measurement of the blood flow condition is bound to contribute to precaution against those disorders and to control of conditions of the diseases. We propose a convenient means of blood flow volume measurement at peripheral part, such as fingertips. Principle of this measurement is based on heat transfer characteristics of peripheral part containing the blood flow. Transition response analysis of skin surface temperature has provided measurement model of the peripheral blood flow volume. We developed the blood flow measurement system based on that model and evaluated it by using artificial finger under various temperature conditions of ambience and internal fluid. The evaluation results indicated that proposed method could estimate the volume of the fluid regardless of temperature condition of them. Finally we applied our system to real finger testing and have obtained results correlated well with laser Doppler blood flow meter values.
Reflections on osteopathic fascia treatment in the peripheral nervous system
Bordoni, Bruno; Bordoni, Giovanni
The peripheral nerve is composed of several layers of fascia tissue, which can become a source of pain if the way they slide is impeded. It is only recently that fascial osteopathy research has been aimed at understanding what happens to the fascia following treatment, and as a result of previous studies, we are able to highlight some of the benefits, including a reduction in local pain and inflammation. The osteopathic approach to the fascial system of the peripheral nerve does not have a grounding in scientific research, being based instead on the clinical experience of individual operators, despite peripheral nerve palpation being used as a method to evaluate and test its function. The authors wish to encourage the initiation of new research in the fields of academic and clinical osteopathy that is aimed at quantifying the possible benefits a patient may derive from osteopathic treatment of the peripheral nerve. PMID:26586962
Label-free photoacoustic microscopy of peripheral nerves
Matthews, Thomas Paul; Zhang, Chi; Yao, Da-Kang; Maslov, Konstantin; Wang, Lihong V.
Abstract. Peripheral neuropathy is a common neurological problem that affects millions of people worldwide. Diagnosis and treatment of this condition are often hindered by the difficulties in making objective, noninvasive measurements of nerve fibers. Photoacoustic microscopy (PAM) has the ability to obtain high resolution, specific images of peripheral nerves without exogenous contrast. We demonstrated the first proof-of-concept imaging of peripheral nerves using PAM. As validated by both standard histology and photoacoustic spectroscopy, the origin of photoacoustic signals is myelin, the primary source of lipids in the nerves. An extracted sciatic nerve sandwiched between two layers of chicken tissue was imaged by PAM to mimic the in vivo case. Ordered fibrous structures inside the nerve, caused by the bundles of myelin-coated axons, could be observed clearly. With further technical improvements, PAM can potentially be applied to monitor and diagnose peripheral neuropathies. PMID:24395587
ERIC Educational Resources Information Center
Vivelo, Frank Robert
Describes the future environment facing community colleges, addressing the service population, demands for accountability and quality, and the need for currency. Identifies seven areas a strategic plan should address (e.g., mission, student success, instructional quality, resource development, diversity, operational efficiency, and community…
Wong, Aaron L; Haith, Adrian M; Krakauer, John W
Motor planning colloquially refers to any process related to the preparation of a movement that occurs during the reaction time prior to movement onset. However, this broad definition encompasses processes that are not strictly motor-related, such as decision-making about the identity of task-relevant stimuli in the environment. Furthermore, the assumption that all motor-planning processes require processing time, and can therefore be studied behaviorally by measuring changes in the reaction time, needs to be reexamined. In this review, we take a critical look at the processes leading from perception to action and suggest a definition of motor planning that encompasses only those processes necessary for a movement to be executed-that is, processes that are strictly movement related. These processes resolve the ambiguity inherent in an abstract goal by defining a specific movement to achieve it. We propose that the majority of processes that meet this definition can be completed nearly instantaneously, which means that motor planning itself in fact consumes only a small fraction of the reaction time. PMID:24981338
ERIC Educational Resources Information Center
Flynn, Richard B., Ed.; And Others
Nine articles give information to help make professionals in health, physical education, recreation, dance, and athletics more knowledgeable about planning facilities. Design of natatoriums, physical fitness laboratories, fitness trails, gymnasium lighting, homemade play equipment, indoor soccer arenas, and dance floors is considered. A…
ERIC Educational Resources Information Center
Groff, Warren H.
Reviews the strategic elements of an institutional plan: assessment of the external environment, auditing of institutional strengths and weaknesses, and matching of institutional strengths with external opportunities through the process of strategic goal setting. Urges community colleges to take action-oriented, dynamic, purposeful steps to shape…
Imaging of a glioma using peripheral benzodiazepine receptor ligands
Starosta-Rubinstein, S.; Ciliax, B.J.; Penney, J.B.; McKeever, P.; Young, A.B.
Two types of benzodiazepine receptors have been demonstrated in mammalian tissues, one which is localized on neuronal elements in brain and the other, on glial cells and in peripheral tissues such as kidney. In vivo administration of /sup 3/H-labeled PK 11195 (1-(2-chlorophenyl-N-methyl-N-(1-methylpropyl)-3-isoquinoline carboxamide) or (/sup 3/H)flunitrazepam with 5 mg of clonazepam per kg to rats with intracranial C6 gliomas resulted in high levels of tritiated-drug binding to the tumor as shown by quantitative autoradiography. Pharmacological studies indicated that the bound drugs labeled the peripheral benzodiazepine binding site. Binding to the peripheral benzodiazepine site was confirmed primarily to malignant cells with little binding to adjacent normal brain tissue or to necrotic tissue. Tumor cell binding was completely inhibited by preadministration of the peripheral benzodiazepine blocking agent PK 11195 at 5 mg/kg. The centrally selective benzodiazepine ligand clonazepam had no effect on PK 11195 binding to the tumor cells. When binding to other tumor cell lines grown in nude mice and nude athymic rats was evaluated, little or no peripheral benzodiazepine binding was detected on human pheochromocytoma (RN1) and neuroblastoma (SK-N-MC, SK-N-SH) tumor cells, respectively. However, high densities of peripheral benzodiazepine binding sites were observed on tumors derived from a human glioma cell line (ATCC HTB 14, U-87 MG). The presence of high concentrations of specific peripheral benzodiazepine receptors on glial tumors suggests that human primary central nervous system tumors could be imaged and diagnosed using peripheral benzodiazepine ligands labeled with positron- or gamma-emitting isotopes.
Hot topics in ultra-peripheral ion collisions
Baur, G.; Bertulani, C.A.; Chiu, M.; Ginzburg, I.F.; Hencken, K.; Klein, S.R.; Nystrand, J.; Piotrzkowski, K.; Roldao, C.G.; Silvermyr, D.; Thomas, J.H.; White, S.N.; Yepes, P.
Ultra-peripheral collisions of relativistic heavy ions involve long-ranged electromagnetic interactions at impact parameters too large for hadronic interactions to occur. The nuclear charges are large; with the coherent enhancement, the cross sections are also large. Many types of photonuclear and purely electromagnetic interactions are possible. We present here an introduction to ultra-peripheral collisions, and present four of the most compelling physics topics.
Design principle of the peripheral vision display system
NASA Astrophysics Data System (ADS)
Guo, Xiaowei; Wang, Yuefeng; Niu, Yanxiong; Yu, Lishen; Liu, Shen H.
The peripheral vision display system (PVDS) presents the pilot with a gyro stabilized artificial horizon projected onto the instrument panel by means of a red laser light source. The pilot can detect changes to aircraft attitude without continuously referring back to his flight instruments. The PVDS effectively applies the peripheral vision of the pilot to overcome disorientation. This paper gives the principles of the PVDS, according to which, we have designed the PVDS and used it for aviation medicine.
Impediments to rapid insertion of innovative displays and peripherals
NASA Astrophysics Data System (ADS)
Nicholson, Gail
In order to optimize system performance and minimize cost for a system to fill capability gaps, an improvement to rapid insertion of innovative display and peripheral technology is required to take advantage of human-machine intersections. Current approaches to testing and integration impedes successful rapid insertion of innovative technology for new systems and incremental upgrades. Considerations to innovative displays and peripherals must occur further to the left of the lifecycle to be successful and key integration areas must be address for success.
Associations between peripheral vertigo and gastroesophageal reflux disease.
Viliušytė, Edita; Macaitytė, Raminta; Vaitkus, Antanas; Rastenytė, Daiva
We hypothesize that peripheral vertigo is associated with gastroesophageal reflux disease (GERD). Two mechanisms could be considered – gastric acids may directly irritate the respiratory mucosa and cause inflammation, or Helicobacter pylori (H. pylori) could be present and cause local infection. Reflux material (Hydrochloric acid (HCl) and pepsin) could get into the middle ear via Eustachian tube and affect osseous structures directly. Disturbance of ossicles could cause tinnitus, which is more common for peripheral vertigo. H. pylori could also get in the esophagus and in the upper respiratory tract via gastroesophageal reflux, and could cause tympanosclerosis and fixation of ossicles. In our study group, 120 of 153 (78.4%) patients had gastroesophageal reflux disease (GERD). Diagnostic tests of H. pylori (rapid urease test or blood antibody test) were performed for 96 of 120 (80%) patients with GERD and were found positive for 32 of 96 (33.3%) patients. Peripheral vertigo was present in 93 of 120 (77.6%) patients with GERD compared to 33 of 126 (26%) patients without GERD (χ(2)=9.016, p=0.003). H. pylori and peripheral vertigo coexisted in 26 of 126 patients (20.6%) (OR 1.36; 95% CI 0.49-3.74, p=0.55). Our study demonstrated statistically significant association between peripheral vertigo and GERD but not between peripheral vertigo and H. pylori. Further more extensive investigations are needed in order to explore our hypothesis. PMID:26115947
[Research Progress in Seeding Cells of Peripheral Nerve].
Shi, Gengqiang; Hu, Yi
Seeding cells play an important role in the peripheral nerve damage repair. Seeding cells studied conse- quently in peripheral nerve are Schwann cells, bone marrow mesenchymal stem cells and neural stem cells. Schwann cells, the first seeding cells, are various unique glial cells in the peripheral nervous system, which can form the myelin sheath for insulation and package of the neuron projecting axons in the peripheral nervous system so that the conduction velocity of the nerve signal was accelerated. It can be proved that Schwann cells played an important role in the maintenance of peripheral nerve function and in the regeneration process after peripheral nerve injury. The second, bone marrow mesenchymal stem cells are the various mesenchymal stem cells mainly exist in the systemic connective tissues and organs. These functional stem cells are often studied at present, and it has been found that they have exuberant proliferation and differentiation potentials. Neural stem cells, mentioned the third in sequence, are the kind of pluripotent cells with multi-directional differentiation, which could conduct the self-renewal function, and generate and differentiate neurons, astrocytes and oligodendrocytes through asymmetric cell division. These three types of seed cells are discussed in this paper. PMID:26211274
Impact of Millimeter-Level Margins on Peripheral Normal Brain Sparing for Gamma Knife Radiosurgery
Ma, Lijun; Sahgal, Arjun; Larson, David A.; Pinnaduwage, Dilini; Fogh, Shannon; Barani, Igor; Nakamura, Jean; McDermott, Michael; Sneed, Penny
Purpose: To investigate how millimeter-level margins beyond the gross tumor volume (GTV) impact peripheral normal brain tissue sparing for Gamma Knife radiosurgery. Methods and Materials: A mathematical formula was derived to predict the peripheral isodose volume, such as the 12-Gy isodose volume, with increasing margins by millimeters. The empirical parameters of the formula were derived from a cohort of brain tumor and surgical tumor resection cavity cases (n=15) treated with the Gamma Knife Perfexion. This was done by first adding margins from 0.5 to 3.0 mm to each individual target and then creating for each expanded target a series of treatment plans of nearly identical quality as the original plan. Finally, the formula was integrated with a published logistic regression model to estimate the treatment-induced complication rate for stereotactic radiosurgery when millimeter-level margins are added. Results: Confirmatory correlation between the nominal target radius (ie, R{sub T}) and commonly used maximum target size was found for the studied cases, except for a few outliers. The peripheral isodose volume such as the 12-Gy volume was found to increase exponentially with increasing Δ/R{sub T}, where Δ is the margin size. Such a curve fitted the data (logarithmic regression, R{sup 2} >0.99), and the 12-Gy isodose volume was shown to increase steeply with a 0.5- to 3.0-mm margin applied to a target. For example, a 2-mm margin on average resulted in an increase of 55% ± 16% in the 12-Gy volume; this corresponded to an increase in the symptomatic necrosis rate of 6% to 25%, depending on the Δ/R{sub T} values for the target. Conclusions: Millimeter-level margins beyond the GTV significantly impact peripheral normal brain sparing and should be applied with caution. Our model provides a rapid estimate of such an effect, particularly for large and/or irregularly shaped targets.
Probing peripheral and central cholinergic system responses.
Naranjo, C A; Fourie, J; Herrmann, N; Lanctôt, K L; Birt, C; Yau, K K
OBJECTIVE: The pharmacological response to drugs that act on the cholinergic system of the iris has been used to predict deficits in central cholinergic functioning due to diseases such as Alzheimer's disease, yet correlations between central and peripheral responses have not been properly studied. This study assessed the effect of normal aging on (1) the tropicamide-induced increase in pupil diameter, and (2) the reversal of this effect with pilocarpine. Scopolamine was used as a positive control to detect age-dependent changes in central cholinergic functioning in the elderly. DESIGN: Randomized double-blind controlled trial. PARTICIPANTS: Ten healthy elderly (mean age 70) and 9 young (mean age 33) volunteers. INTERVENTIONS: Pupil diameter was monitored using a computerized infrared pupillometer over 4 hours. The study involved 4 sessions. In 1 session, tropicamide (20 microL, 0.01%) was administered to one eye and placebo to the other. In another session, tropicamide (20 microL, 0.01%) was administered to both eyes, followed 23 minutes later by the application of pilocarpine (20 microL, 0.1%) to one eye and placebo to the other. All eye drops were given in a randomized order. In 2 separate sessions, a single dose of scopolamine (0.5 mg, intravenously) or placebo was administered, and the effects on word recall were measured using the Buschke Selective Reminding Test over 2 hours. OUTCOME MEASURES: Pupil size at time points after administration of tropicamide and pilocarpine; scopolamine-induced impairment in word recall. RESULTS: There was no significant difference between elderly and young volunteers in pupillary response to tropicamide at any time point (p > 0.05). The elderly group had a significantly greater pilocarpine-induced net decrease in pupil size 85, 125, 165 and 215 minutes after administration, compared with the young group (p < 0.05). Compared with the young group, the elderly group had greater scopolamine-induced impairment in word recall 60, 90
Reflected Deck Plan, Reflected Roof Plan, Deck Plan Bridgeport ...
Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey
Reflected Deck Plan, Reflected Roof Plan, Deck Plan - Bridgeport Covered Bridge, Spanning South Fork of Yuba River at bypassed section of Pleasant Valley Road (originally Virginia Turnpike) in South Yuba River State Park , Bridgeport, Nevada County, CA
Energy planning and management plan
This paper contains printed copies of 60FR 53181, October 12, 1995 and 60 FR 54151. This is a record of decision concerning the Western Area Power Administration`s final draft and environmental impact statement, and Energy Planning and Management Program.
21 CFR 882.5870 - Implanted peripheral nerve stimulator for pain relief.
Code of Federal Regulations, 2012 CFR
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Implanted peripheral nerve stimulator for pain....5870 Implanted peripheral nerve stimulator for pain relief. (a) Identification. An implanted peripheral nerve stimulator for pain relief is a device that is used to stimulate electrically a peripheral...
21 CFR 882.5870 - Implanted peripheral nerve stimulator for pain relief.
Code of Federal Regulations, 2014 CFR
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Implanted peripheral nerve stimulator for pain....5870 Implanted peripheral nerve stimulator for pain relief. (a) Identification. An implanted peripheral nerve stimulator for pain relief is a device that is used to stimulate electrically a peripheral...
21 CFR 882.5870 - Implanted peripheral nerve stimulator for pain relief.
Code of Federal Regulations, 2011 CFR
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Implanted peripheral nerve stimulator for pain....5870 Implanted peripheral nerve stimulator for pain relief. (a) Identification. An implanted peripheral nerve stimulator for pain relief is a device that is used to stimulate electrically a peripheral...
21 CFR 882.5870 - Implanted peripheral nerve stimulator for pain relief.
Code of Federal Regulations, 2013 CFR
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Implanted peripheral nerve stimulator for pain....5870 Implanted peripheral nerve stimulator for pain relief. (a) Identification. An implanted peripheral nerve stimulator for pain relief is a device that is used to stimulate electrically a peripheral...
21 CFR 882.5870 - Implanted peripheral nerve stimulator for pain relief.
Code of Federal Regulations, 2010 CFR
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Implanted peripheral nerve stimulator for pain....5870 Implanted peripheral nerve stimulator for pain relief. (a) Identification. An implanted peripheral nerve stimulator for pain relief is a device that is used to stimulate electrically a peripheral...
Gene expression profiling of peripheral blood mononuclear cells in the setting of peripheral arterial disease
Background Peripheral arterial disease (PAD) is a relatively common manifestation of systemic atherosclerosis that leads to progressive narrowing of the lumen of leg arteries. Circulating monocytes are in contact with the arterial wall and can serve as reporters of vascular pathology in the setting of PAD. We performed gene expression analysis of peripheral blood mononuclear cells (PBMC) in patients with PAD and controls without PAD to identify differentially regulated genes. Methods PAD was defined as an ankle brachial index (ABI) ≤0.9 (n = 19) while age and gender matched controls had an ABI > 1.0 (n = 18). Microarray analysis was performed using Affymetrix HG-U133 plus 2.0 gene chips and analyzed using GeneSpring GX 11.0. Gene expression data was normalized using Robust Multichip Analysis (RMA) normalization method, differential expression was defined as a fold change ≥1.5, followed by unpaired Mann-Whitney test (P < 0.05) and correction for multiple testing by Benjamini and Hochberg False Discovery Rate. Meta-analysis of differentially expressed genes was performed using an integrated bioinformatics pipeline with tools for enrichment analysis using Gene Ontology (GO) terms, pathway analysis using Kyoto Encyclopedia of Genes and Genomes (KEGG), molecular event enrichment using Reactome annotations and network analysis using Ingenuity Pathway Analysis suite. Extensive biocuration was also performed to understand the functional context of genes. Results We identified 87 genes differentially expressed in the setting of PAD; 40 genes were upregulated and 47 genes were downregulated. We employed an integrated bioinformatics pipeline coupled with literature curation to characterize the functional coherence of differentially regulated genes. Conclusion Notably, upregulated genes mediate immune response, inflammation, apoptosis, stress response, phosphorylation, hemostasis, platelet activation and platelet aggregation. Downregulated genes included several genes from
Systemic sclerosis induces pronounced peripheral vascular dysfunction characterized by blunted peripheral vasoreactivity and endothelial dysfunction.
Frech, Tracy; Walker, Ashley E; Barrett-O'Keefe, Zachary; Hopkins, Paul N; Richardson, Russell S; Wray, D Walter; Donato, Anthony J
Systemic sclerosis (SSc) vasculopathy can result in a digital ulcer (DU) and/or pulmonary arterial hypertension (PAH). We hypothesized that bedside brachial artery flow-mediated dilation (FMD) testing with duplex ultrasound could be used in SSc patients to identify features of patients at risk for DU or PAH. Thirty-eight SSc patients were compared to 52 age-matched healthy controls from the VAMC Utah Vascular Research Laboratory. Peripheral hemodynamics, arterial structure, and endothelial function were assessed by duplex ultrasound. A blood pressure cuff was applied to the forearm and 5-min ischemia was induced. Post-occlusion, brachial artery vascular reactivity (peak hyperemia/area under the curve [AUC]), shear rate, and endothelial function (FMD) were measured. SSc patients had smaller brachial artery diameters (p < 0.001) and less reactive hyperemia (p < 0.001), peak shear rate (p = 0.03), and brachial artery FMD (p < 0.001) compared with healthy controls. Brachial artery FMD was lower (p < 0.05) in SSc patients with DU. Tertile analysis suggested the 2 lower FMD tertiles (<5.40 %) had a 40-50 % chance of presenting with DU while the SSc patients with highest FMD tertile (>5.40 %) had less than 15 % chance of DU. All brachial artery FMD measurements were similar between SSc patients with and without PAH (all p > 0.05). Compared to healthy controls, SSc patients had significantly smaller brachial artery diameter and blunted peripheral vascular reactivity and endothelial function. SSc patients with DU have even greater impairments in endothelial function compared to those without DU. FMD testing has clinical utility to identify SSc patients at risk for DU. PMID:25511849
Resident Exposure to Peripheral Nerve Surgical Procedures During Residency Training.
Gil, Joseph A; Daniels, Alan H; Akelman, Edward
Background Variability in case exposures has been identified for orthopaedic surgery residents. It is not known if this variability exists for peripheral nerve procedures. Objective The objective of this study was to assess ACGME case log data for graduating orthopaedic surgery, plastic surgery, general surgery, and neurological surgery residents for peripheral nerve surgical procedures and to evaluate intraspecialty and interspecialty variability in case volume. Methods Surgical case logs from 2009 to 2014 for the 4 specialties were compared for peripheral nerve surgery experience. Peripheral nerve case volume between specialties was performed utilizing a paired t test, 95% confidence intervals were calculated, and linear regression was calculated to assess the trends. Results The average number of peripheral nerve procedures performed per graduating resident was 54.2 for orthopaedic surgery residents, 62.8 for independent plastic surgery residents, 84.6 for integrated plastic surgery residents, 22.4 for neurological surgery residents, and 0.4 for surgery residents. Intraspecialty comparison of the 10th and 90th percentile peripheral nerve case volume in 2012 revealed remarkable variability in training. There was a 3.9-fold difference within orthopaedic surgery, a 5.0-fold difference within independent plastic surgery residents, an 8.8-fold difference for residents from integrated plastic surgery programs, and a 7.0-fold difference within the neurological surgery group. Conclusions There is interspecialty and intraspecialty variability in peripheral nerve surgery volume for orthopaedic, plastic, neurological, and general surgery residents. Caseload is not the sole determinant of training quality as mentorship, didactics, case breadth, and complexity play an important role in training. PMID:27168883
Evaluation of the peripheral dose in stereotactic radiotherapy and radiosurgery treatments
Di Betta, Erika; Fariselli, Laura; Bergantin, Achille; Locatelli, Federica; Del Vecchio, Antonella; Broggi, Sara; Fumagalli, Maria Luisa
Purpose: The main purpose of this work was to compare peripheral doses absorbed during stereotactic treatment of a brain lesion delivered using different devices. These data were used to estimate the risk of stochastic effects. Methods: Treatment plans were created for an anthropomorphic phantom and delivered using a LINAC with stereotactic cones and a multileaf collimator, a CyberKnife system (before and after a supplemental shielding was applied), a TomoTherapy system, and a Gamma Knife unit. For each treatment, 5 Gy were prescribed to the target. Measurements were performed with thermoluminescent dosimeters inserted roughly in the position of the thyroid, sternum, upper lung, lower lung, and gonads. Results: Mean doses ranged from of 4.1 (Gamma Knife) to 62.8 mGy (LINAC with cones) in the thyroid, from 2.3 (TomoTherapy) to 30 mGy (preshielding CyberKnife) in the sternum, from 1.7 (TomoTherapy) to 20 mGy (preshielding CyberKnife) in the upper part of the lungs, from 0.98 (Gamma Knife) to 15 mGy (preshielding CyberKnife) in the lower part of the lungs, and between 0.3 (Gamma Knife) and 10 mGy (preshielding CyberKnife) in the gonads. Conclusions: The peripheral dose absorbed in the sites of interest with a 5 Gy fraction is low. Although the risk of adverse side effects calculated for 20 Gy delivered in 5 Gy fractions is negligible, in the interest of optimum patient radioprotection, further studies are needed to determine the weight of each contributor to the peripheral dose.
Evaluation of the peripheral dose in stereotactic radiotherapy and radiosurgery treatments1
Di Betta, Erika; Fariselli, Laura; Bergantin, Achille; Locatelli, Federica; Del Vecchio, Antonella; Broggi, Sara; Fumagalli, Maria Luisa
Purpose: The main purpose of this work was to compare peripheral doses absorbed during stereotactic treatment of a brain lesion delivered using different devices. These data were used to estimate the risk of stochastic effects. Methods: Treatment plans were created for an anthropomorphic phantom and delivered using a LINAC with stereotactic cones and a multileaf collimator, a CyberKnife® system (before and after a supplemental shielding was applied), a TomoTherapy® system, and a Gamma Knife® unit. For each treatment, 5 Gy were prescribed to the target. Measurements were performed with thermoluminescent dosimeters inserted roughly in the position of the thyroid, sternum, upper lung, lower lung, and gonads. Results: Mean doses ranged from of 4.1 (Gamma Knife) to 62.8 mGy (LINAC with cones) in the thyroid, from 2.3 (TomoTherapy) to 30 mGy (preshielding CyberKnife) in the sternum, from 1.7 (TomoTherapy) to 20 mGy (preshielding CyberKnife) in the upper part of the lungs, from 0.98 (Gamma Knife) to 15 mGy (preshielding CyberKnife) in the lower part of the lungs, and between 0.3 (Gamma Knife) and 10 mGy (preshielding CyberKnife) in the gonads. Conclusions: The peripheral dose absorbed in the sites of interest with a 5 Gy fraction is low. Although the risk of adverse side effects calculated for 20 Gy delivered in 5 Gy fractions is negligible, in the interest of optimum patient radioprotection, further studies are needed to determine the weight of each contributor to the peripheral dose. PMID:20831066
Usability and Acceptability of a Web-Based Program for Chemotherapy-Induced Peripheral Neuropathy.
Tofthagen, Cindy; Kip, Kevin E; Passmore, Denise; Loy, Ian; Berry, Donna L
Chemotherapy-induced neuropathy is a painful and debilitating adverse effect of certain chemotherapy drugs. There have not been any patient-centered, easily accessible Web-based interventions to assist with self-management of chemotherapy-induced neuropathy. The aims of this study were to evaluate usability and acceptability and to estimate an effect size of a Web-based intervention for assessing and managing chemotherapy-induced neuropathy. Participants (N = 14) were instructed to complete the Creativity, Optimism, Planning, and Expert Information for Chemotherapy-Induced Peripheral Neuropathy program and provide verbal responses to the program. Participants completed the Chemotherapy Induced Peripheral Neuropathy Assessment Tool and Post-Study System Usability Questionnaire. Iterative changes were made to the COPE-CIPN. Participants were asked to provide feedback on the revised COPE-CIPN, repeat the Chemotherapy Induced Peripheral Neuropathy Assessment Tool, and evaluate acceptability using the Acceptability e-Scale. The COPE-CIPN demonstrated high usability (mean, 1.98 [SD, 1.12]) and acceptability (mean, 4.40 [SD, 0.52]). Comments indicated that the interface was easy to use, and the information was helpful. While neuropathy symptoms continued to increase in this group of patients receiving neurotoxic chemotherapy, there was a decrease in mean level of interference with activities from 53.71 to 39.29 over 3 to 4 months, which indicated a moderate effect (d = 0.39) size. The COPE-CIPN may be a useful intervention to support self-management of chemotherapy-induced neuropathy. PMID:27116414
[Perioperative analgesia with continuous peripheral nerve blocks in children].
Dadure, C; Capdevila, X
Recently, regional anaesthesia in children has generated increasing interest. But single injection techniques have a limited duration of postoperative analgesia. Then, continuous peripheral nerve blocks have taken an important position in the anaesthetic arsenal, allowing an effective, safe and prolonged postoperative pain management. As adults, indications for continuous peripheral nerve blocks depend on the analysis of individual benefits/risks ratio. Main indications are intense postoperative pain surgical procedures, with or without postoperative rehabilitation, and complex regional pain syndrome. Contraindications to these procedures are rather similar to those in adults, plus parental and/or children refusal. Continuous peripheral nerve blocks are usually performed under general anaesthesia or sedation in children, and require appropriate equipment in order to decrease the risk of nerve injury. New techniques, such as transcutaneous nerve stimulation or ultrasound guidance, appeared to facilitate nerve and plexus approach identification in paediatric patients. Nevertheless, continuous peripheral nerve block may theoretically mask a compartment syndrome after trauma surgical procedures. Finally, ropivacaine appears to be the most appropriate drug for continuous peripheral nerve blocks in children, requiring low flow rates and concentrations of local anaesthetic. These techniques may facilitate early ambulation by an improved pain management or even postoperative analgesia at home with disposable pumps. One might infer from the current review that excellent pain relief coupled with a reduction of side effects would contribute to improve the quality of life and to decrease the frequency of disabling behavioural modifications in children, sometimes psychologically injured by hospital stay and postoperative pain. PMID:17174518
Sebben, Alessandra Deise; Lichtenfels, Martina; da Silva, Jefferson Luis Braga
Peripheral nerve trauma results in functional loss in the innervated organ, and recovery without surgical intervention is rare. Many surgical techniques can be used for nerve repair. Among these, the tubulization technique can be highlighted: this allows regenerative factors to be introduced into the chamber. Cell therapy and tissue engineering have arisen as an alternative for stimulating and aiding peripheral nerve regeneration. Therefore, the aim of this review was to provide a survey and analysis on the results from experimental and clinical studies that used cell therapy and tissue engineering as tools for optimizing the regeneration process. The articles used came from the LILACS, Medline and SciELO scientific databases. Articles on the use of stem cells, Schwann cells, growth factors, collagen, laminin and platelet-rich plasma for peripheral nerve repair were summarized over the course of the review. Based on these studies, it could be concluded that the use of stem cells derived from different sources presents promising results relating to nerve regeneration, because these cells have a capacity for neuronal differentiation, thus demonstrating effective functional results. The use of tubes containing bioactive elements with controlled release also optimizes the nerve repair, thus promoting greater myelination and axonal growth of peripheral nerves. Another promising treatment is the use of platelet-rich plasma, which not only releases growth factors that are important in nerve repair, but also serves as a carrier for exogenous factors, thereby stimulating the proliferation of specific cells for peripheral nerve repair. PMID:27027067
Opioid overdose with gluteal compartment syndrome and acute peripheral neuropathy
Adrish, Muhammad; Duncalf, Richard; Diaz-Fuentes, Gilda; Venkatram, Sindhaghatta
Patient: Male, 42 Final Diagnosis: Gluteal compartment syndrome • acute peripheral nauropathy Symptoms: — Medication: — Clinical Procedure: — Specialty: Critical Care Medicine Objective: Management of emergency care Background: Heroin addiction is common, with an estimated 3.7 million Americans reporting to have used it at some point in their lives. Complications of opiate overdose include infection, rhabdomyolysis, respiratory depression and central or peripheral nervous system neurological complications. Conclusions: We present a 42-year-old male admitted after heroin use with heroin-related peripheral nervous system complication preceded by an acute gluteal compartment syndrome and severe rhabdomyolysis. Case Report: Early diagnosis and surgical intervention of the compartment syndrome can lead to full recovery while any delay in management can be devastating and can lead to permanent disability. The presence of peripheral nervous system injuries may portend a poor prognosis and can also lead to long term disability. Careful neurological evaluation for signs and symptoms of peripheral nervous system injuries is of paramount importance, as these may be absent at presentation in patients with opioid overdose. There is a potential risk of delaying a necessary treatment like fasciotomy in these patients by falsely attributing clinical symptoms to a preexisting neuropathy. Early EMG and nerve conduction studies should be considered when the etiology of underlying neurological weakness is unclear. PMID:24459539
κ-Opioid receptor participates of NSAIDs peripheral antinociception.
Silva, Lívia Caroline Resende; Castor, Marina Gomes Miranda E; Navarro, Larissa Caldeira; Romero, Thiago Roberto Lima; Duarte, Igor Dimitri Gama
NSAIDs represent some of the most widely prescribed drugs for relief of short-term fever, pain and inflammation. The participation of the opioid system in the peripheral is poorly understood. The aim of this study was evaluate the role of opioid system in the peripheral antinociception by diclofenac and dipyrone. To test this hypothesis, opioid receptor antagonists were evaluated using the rat paw pressure test, in which pain sensitivity is increased by intraplantar injection of prostaglandin E2 (PGE2, 2μg). Diclofenac (20μg/paw) and Dipyrone (40μg/paw) administered locally into the right paw elicited an antinociceptive effect. It was used naloxone (50μg/paw), a non-selective opioid receptor antagonist, which antagonized peripheral antinociception induced by diclofenac and dipyrone. Selectively, it was evaluated the μ-, δ- and κ-opioid receptor antagonists, respectively, clocinnamox (40μg/paw), naltrindole (50μg/paw) and nor-binaltorphimine (20, 40 and 80μg/paw). Our data indicated that only the κ-opioid antagonist was capable to reverse the peripheral antinociception by NSAIDs. The present results provide evidence that the opioid system participated in the diclofenac and dipyrone-induced peripheral antinociception by indirect activation of κ-opioid receptor probable by release of endogenous opioids such as dynorphins. PMID:27091501
Synchronous Multiple Lung Adenocarcinomas: Estrogen Concentration in Peripheral Lung
Shinchi, Yusuke; Sanada, Mune; Motooka, Yamato; Fujino, Kosuke; Mori, Takeshi; Suzuki, Makoto
Background The detection rate of synchronous multiple lung adenocarcinomas (SMLA), which display multiple ground glass opacity nodules in the peripheral lung, is increasing due to advances in high resolution computed tomography. The backgrounds of multicentric development of adenocarcinoma are unknown. In this study, we quantitated estrogen concentration in the peripheral lungs of postmenopausal female patients with SMLA. Methods The tissue concentration of estrogens (estrone [E1] and estdadiol [E2]) in the noncancerous peripheral lung were measured with liquid chromatography/electrospray tandem mass spectrometry in postmenopausal female patients with lung adenocarcinoma. The expression levels of CYP19A1 in the normal lung were also quantitated with real-time PCR. Thirty patients with SMLA and 79 cases of control patients with single lung adenocarcinoma were analyzed. Results The concentrations of E1 and E2 in the noncancerous tissue were significantly higher in SMLA cases than control cases (P = 0.004 and P = 0.02, respectively). The minor allele (A) of single nucleotide polymorphism rs3764221 were significantly associated with higher concentration of E1 and E2 (P = 0.002 and P = 0.01, respectively) and higher CYP19A1 mRNA expression (P = 0.03). Conclusion The tissue estrogen concentration of peripheral lung was significantly higher in SMLA than control cases. The high concentration of estrogen may be one of the causes of multicentric development of peripheral lung adenocarcinomas. PMID:27526096
Gnathic and peripheral ameloblastomas lack human papillomavirus DNA.
Verduin, Lindsey; Bishop, Justin; Mills, Stacey E
Human papillomavirus (HPV) has been associated with a variety of head and neck neoplasms, including squamous cell carcinomas and Schneiderian papillomas. Ameloblastomas can arise from either the gnathic bones or peripheral soft tissues. Peripheral sinonasal ameloblastomas share clinical features with Schneiderian papillomas. A small number of reports have described detection of HPV DNA within ameloblastomas. However, Most of these cases was reported in the 1990s, used the polymerase chain reaction technique, and only examined gnathic tumors. The current study was designed to determine whether low- or high-risk HPV DNA could be detected in gnathic or peripheral ameloblastomas using in situ hybridization. Twenty-nine examples of gnathic osseous and peripheral head and neck ameloblastomas were obtained from the authors' archives (University of Virginia and the Johns Hopkins Hospital). High-risk HPV DNA was not detected in any of the 29 tumors analyzed. Low-risk HPV DNA was identified in only 1 tumor, which was peripheral in origin, and from an immunocompromised patient. We believe that the HPV in this case represents a background "passenger" infection. This study demonstrates that HPV of either high- or low-risk subtypes is unlikely to play a role in the pathogenesis of sinonasal ameloblastomas. PMID:26190154
Crosstalk between the heart and peripheral organs in heart failure
Jahng, James Won Suk; Song, Erfei; Sweeney, Gary
Mediators from peripheral tissues can influence the development and progression of heart failure (HF). For example, in obesity, an altered profile of adipokines secreted from adipose tissue increases the incidence of myocardial infarction (MI). Less appreciated is that heart remodeling releases cardiokines, which can strongly impact various peripheral tissues. Inflammation, and, in particular, activation of the nucleotide-binding oligomerization domain-like receptors with pyrin domain (NLRP3) inflammasome are likely to have a central role in cardiac remodeling and mediating crosstalk with other organs. Activation of the NLRP3 inflammasome in response to cardiac injury induces the production and secretion of the inflammatory cytokines interleukin (IL)-1β and IL-18. In addition to having local effects in the myocardium, these pro-inflammatory cytokines are released into circulation and cause remodeling in the spleen, kidney, skeletal muscle and adipose tissue. The collective effects of various cardiokines on peripheral organs depend on the degree and duration of myocardial injury, with systematic inflammation and peripheral tissue damage observed as HF progresses. In this article, we review mechanisms regulating myocardial inflammation in HF and the role of factors secreted by the heart in communication with peripheral tissues. PMID:26964833
Acceptance and confidence of central and peripheral misinformation.
Luna, Karlos; Migueles, Malen
We examined the memory for central and peripheral information concerning a crime and the acceptance of false information. We also studied eyewitnesses' confidence in their memory. Participants were shown a video depicting a bank robbery and a questionnaire was used to introduce false central and peripheral information. The next day the participants completed a recognition task in which they rated the confidence of their responses. Performance was better for central information and participants registered more false alarms for peripheral contents. The cognitive system's limited attentional capacity and the greater information capacity of central elements may facilitate processing the more important information. The presentation of misinformation seriously impaired eyewitness memory by prompting a more lenient response criterion. Participants were more confident with central than with peripheral information. Eyewitness memory is easily distorted in peripheral aspects but it is more difficult to make mistakes with central information. However, when false information is introduced, errors in central information can be accompanied by high confidence, thus rendering them credible and legally serious. PMID:19899643
The regulation of central and peripheral circadian clocks in humans.
Cermakian, N; Boivin, D B
Many circadian rhythms are controlled by the central clock of the suprachiasmatic nucleus of the hypothalamus, as well as clocks located in other brain regions and most peripheral tissues. These central and peripheral clocks are based on clock genes and their protein products. In recent years, the expression of clock genes has started to be investigated in human samples, primarily white blood cells, but also skin, oral mucosa, colon cells, adipose tissue as well as post-mortem brain tissue. The expression of clock genes in those peripheral tissues offers a way to monitor human peripheral clocks and to compare their function and regulation with those of the central clock, which is followed by markers such as melatonin, cortisol and core body temperature. We have recently used such an approach to compare central and peripheral rhythms in subjects under different lighting conditions. In particular, we have monitored the entrainment of the clock of blood cells in subjects undergoing a simulated night shift protocol with bright light treatment, known to efficiently reset the central clock. This line of research will be helpful for learning more about the human circadian system and to find ways to alleviate health problems of shift workers, and other populations experiencing altered circadian rhythms. PMID:19849799
Peripheral dose measurements in cervical cancer radiotherapy: a comparison of volumetric modulated arc therapy and step-and-shoot IMRT techniques
Purpose The aim of this study was to investigate the peripheral doses resulting from volumetric modulated arc therapy (VMAT) and intensity modulated radiotherapy (IMRT) techniques in cervical cancer radiotherapy. Methods Nine patients with cervical cancer had treatment planned with both VMAT and IMRT. A specially designed phantom was used for this study, with ion chambers placed at interest points approximating the position of the breast, thyroid, and lens. The peripheral doses at the phantom interest points were measured and compared between the VMAT and IMRT techniques. Results VMAT provides a potential dosimetric advantage compared with IMRT. The mean (± standard deviation) peripheral dose to the breast point for 1 fraction (2 Gy) during VMAT measured 5.13 ± 0.96 mGy, compared with 9.04 ± 1.50 mGy for IMRT. At the thyroid and lens interest points, the mean (± standard deviation) peripheral dose during VMAT was 2.19 ± 0.33 and 2.16 ± 0.28 mGy, compared with 7.07 ± 0.76 and 6.97 ± 0.91 mGy for IMRT, respectively. VMAT reduced the monitor units used by 28% and shortened the treatment delivery time by 54% compared with IMRT. Conclusion While the dosimetric results are similar for both techniques, VMAT results in a lower peripheral dose to the patient and reduces the monitor-unit usage and treatment delivery time compared with IMRT. PMID:24555547
Modelling Framework and Assistive Device for Peripheral Intravenous Injections
NASA Astrophysics Data System (ADS)
Kam, Kin F.; Robinson, Martin P.; Gilbert, Mathew A.; Pelah, Adar
Intravenous access for blood sampling or drug administration that requires peripheral venepuncture is perhaps the most common invasive procedure practiced in hospitals, clinics and general practice surgeries.We describe an idealised mathematical framework for modelling the dynamics of the peripheral venepuncture process. Basic assumptions of the model are confirmed through motion analysis of needle trajectories during venepuncture, taken from video recordings of a skilled practitioner injecting into a practice kit. The framework is also applied to the design and construction of a proposed device for accurate needle guidance during venepuncture administration, assessed as consistent and repeatable in application and does not lead to over puncture. The study provides insights into the ubiquitous peripheral venepuncture process and may contribute to applications in training and in the design of new devices, including for use in robotic automation.
[Introduction and prospect of peripheral blood stem cell transplantation].
Nakanishi, Y
The number of hematopoietic stem cells circulating in peripheral blood increases remarkably during the recovery of marrow function after myelosuppressive chemotherapy. In peripheral blood stem cell transplantation, these stem cells are collected and cryopreserved, and then used to restore marrow function after myelodisruptive (high-dose) anticancer therapy, Marrow recovery is faster with this procedure than with autologous bone marrow transplantation. Recently, this procedure has been used after high-dose chemotherapy for chemosensitive solid tumors such as breast cancer. We used high-dose chemotherapy with etoposide and carboplatin, followed by peripheral blood stem cell transplantation, to treat 5 patients with intrathoracic malignant tumors, including small cell lung cancer Neutrophils recovered (> 500 microliters) with 9 to 11 days and platelets recovered (> 5,000 microliters) within 8 to 13 days after the transplantation. No other serious complication was seen. Current topics regarding this procedure, problems to be solved, and prospects for further development are discussed. PMID:8752478
Sister chromatid exchanges in peripheral lymphocytes after preoperative mammography
Husum, B.; Wulf, H.C.; Niebuhr, E.
Examination of sister chromatid exchanges (SCE) in peripheral lymphocytes may be useful for evaluating in vivo exposure to chemical mutagens. In vitro exposure of human lymphocytes to low levels of ionizing radiation has failed to produce increased SCE rates. Scarcity of information about the SCE test system and in vivo exposure to radiation prompted the present study of SCE rates in peripheral lymphocytes in women investigated with mammography prior to operation because of a tumor of the breast. In 64 of a total of 131 women a mammography was performed before the operation. The two groups of patients were identical with respect to age, smoking habits, and incidence of malignancy of the mammary tumors. SCE rates were examined in 30 metaphases from each patient following cultivation of peripheral blood lymphocytes using the BrdU/Giemsa technique.
The Possible Role of Peripheral Refraction in Development of Myopia.
Atchison, David A; Rosén, Robert
Recent longitudinal studies do not support the current theory of relative peripheral hyperopia causing myopia. The theory is based on misunderstanding of the Hoogerheide et al. article of 1971, which actually found relative peripheral hyperopia to be present after, rather than before, myopia development. The authors present two alternative theories of the role of peripheral refraction in the development and progression of myopia. The one for which most detail is given is based on cessation of ocular growth when the periphery is at an emmetropic stage as determined by equivalent blur of the two line foci caused by oblique astigmatism. This paper is based on an invited commentary on the role of lens treatments in myopia from the 15th International Myopia Conference in Wenzhou, China in September 2015. PMID:27560691
Controversies related to electromagnetic field exposure on peripheral nerves.
Say, Ferhat; Altunkaynak, Berrin Zuhal; Coşkun, Sina; Deniz, Ömür Gülsüm; Yıldız, Çağrı; Altun, Gamze; Kaplan, Arife Ahsen; Kaya, Sefa Ersan; Pişkin, Ahmet
Electromagnetic field (EMF) is a pervasive environmental presence in modern society. In recent years, mobile phone usage has increased rapidly throughout the world. As mobile phones are generally held close to the head while talking, studies have mostly focused on the central and peripheral nervous system. There is a need for further research to ascertain the real effect of EMF exposure on the nervous system. Several studies have clearly demonstrated that EMF emitted by cell phones could affect the systems of the body as well as functions. However, the adverse effects of EMF emitted by mobile phones on the peripheral nerves are still controversial. Therefore, this review summarizes current knowledge on the possible positive or negative effects of electromagnetic field on peripheral nerves. PMID:26718608
Drug-Coated Balloons for Infrainguinal Peripheral Artery Disease.
Sethi, Sanjum S; Lee, Michael S
Revascularization of infrainguinal peripheral artery disease has traditionally been accomplished via percutaneous transluminal angioplasty. However, long-term results have been hampered by high rates of restenosis. Along with the advent of stents, paclitaxel-coated balloons are an emerging therapeutic option for the invasive management of infrainguinal peripheral artery disease. Paclitaxel has been successful in inhibiting neointimal hyperplasia, the main mechanism for in-stent restenosis. Technological advances have facilitated the development of paclitaxel-coated balloons, which show promise in early trials for femoropopliteal stenosis relative to uncoated balloons. For infrapopliteal stenoses, the data remain scant and conflicted. Therefore, large-scale randomized clinical trials with long-term follow-up evaluating safety and effectiveness between various strategies need to be performed to determine the optimal invasive management strategy for infrainguinal peripheral artery disease. PMID:27342205
The interactions of peripheral membrane proteins with biological membranes
Johs, Alexander; Whited, A. M.
The interactions of peripheral proteins with membrane surfaces are critical to many biological processes, including signaling, recognition, membrane trafficking, cell division and cell structure. On a molecular level, peripheral membrane proteins can modulate lipid composition, membrane dynamics and protein-protein interactions. Biochemical and biophysical studies have shown that these interactions are in fact highly complex, dominated by several different types of interactions, and have an interdependent effect on both the protein and membrane. Here we examine three major mechanisms underlying the interactions between peripheral membrane proteins and membranes: electrostatic interactions, hydrophobic interactions, and fatty acid modification of proteins. While experimental approaches continue to provide critical insights into specific interaction mechanisms, emerging bioinformatics resources and tools contribute to a systems-level picture of protein-lipid interactions. Through these recent advances, we begin to understand the pivotal role of protein-lipid interactions underlying complex biological functions at membrane interfaces.
Peripheral gangrene in a case of severe dengue.
Nair, B T; Sanjeev, R K; Tarikjot, S B
We report the case of a 10-year-old male who developed gangrene of his fingers and toes following severe dengue fever complicated by disseminated intravascular coagulation (DIC). Child developed bilateral dry gangrene of fingers and toes. All the peripheral pulses of the affected limbs were palpable. The child had no history of taking B-blockers, ergot alkaloids or other related medications. Color Doppler of peripheral arterial and venous systems of all limbs indicated normal flow. Blood was positive for D-dimers and fibrin degradation products. The patient was managed with broad spectrum antibiotics, fluid resuscitation, low molecular weight heparin, blood transfusions, fresh frozen plasma and other supportive measures. Peripheral gangrene seen in DIC associated with dengue is very rare and carries a higher mortality. PMID:26755235
Symmetrical peripheral gangrene due to Plasmodium falciparum malaria
Abdali, Nasar; Malik, Azharuddin Mohammed; Kamal, Athar; Ahmad, Mehtab
A 45-year-old man presented with a 4-day history of high-grade fever with rigours and a 2-day history of painful bluish black discolouration of extremities (acrocyanosis). He was haemodynamically stable and all peripheral pulses palpable, but the extremities were cold with gangrene involving bilateral fingers and toes. Mild splenomegaly was present on abdominal examination but rest of the physical examinations were normal. On investigating he was found to have anaemia, thrombocytopaenia with gametocytes of Plasmodium falciparum on peripheral blood smear. His blood was uncoagulable during performance of prothrombin time with a raised D-dimer. Oxygen saturation was normal and the arterial Doppler test showed reduced blood flow to the extremities. A diagnosis of complicated P. falciparum malaria with disseminated intravascular coagulation (DIC) leading to symmetrical peripheral gangrene was performed. Artemisinin combination therapy was started and heparin was given for DIC. A final line of demarcation of gangrene started forming by 12th day. PMID:24862424
A Lipid Gate for the Peripheral Control of Pain
Hohmann, Andrea G.; Seybold, Virginia; Hammock, Bruce D.
Cells in injured and inflamed tissues produce a number of proalgesic lipid-derived mediators, which excite nociceptive neurons by activating selective G-protein-coupled receptors or ligand-gated ion channels. Recent work has shown that these proalgesic factors are counteracted by a distinct group of lipid molecules that lower nociceptor excitability and attenuate nociception in peripheral tissues. Analgesic lipid mediators include endogenous agonists of cannabinoid receptors (endocannabinoids), lipid-amide agonists of peroxisome proliferator-activated receptor-α, and products of oxidative metabolism of polyunsaturated fatty acids via cytochrome P450 and other enzyme pathways. Evidence indicates that these lipid messengers are produced and act at different stages of inflammation and the response to tissue injury, and may be part of a peripheral gating mechanism that regulates the access of nociceptive information to the spinal cord and the brain. Growing knowledge about this peripheral control system may be used to discover safer medicines for pain. PMID:25392487
Evidence for a Peripheral Olfactory Memory in Imprinted Salmon
NASA Astrophysics Data System (ADS)
Nevitt, Gabrielle A.; Dittman, Andrew H.; Quinn, Thomas P.; Moody, William J., Jr.
The remarkable homing ability of salmon relies on olfactory cues, but its cellular basis is unknown. To test the role of peripheral olfactory receptors in odorant memory retention, we imprinted coho salmon (Oncorhynchus kisutch) to micromolar concentrations of phenyl ethyl alcohol during parr-smolt transformation. The following year, we measured phenyl ethyl alcohol responses in the peripheral receptor cells using patch clamp. Cells from imprinted fish showed increased sensitivity to phenyl ethyl alcohol compared either to cells from naive fish or to sensitivity to another behaviorally important odorant (L-serine). Field experiments verified an increased behavioral preference for phenyl ethyl alcohol by imprinted salmon as adults. Thus, some component of the imprinted olfactory homestream memory appears to be retained peripherally.
Surgical decompression in lower-extremity diabetic peripheral neuropathy.
Rader, Andrew J
Peripheral neuropathy can be a devastating complication of diabetes mellitus. This article describes surgical decompression as a means of restoring sensation and relieving painful neuropathy symptoms. A prospective study was performed involving patients diagnosed as having type 1 or type 2 diabetes with lower-extremity peripheral neuropathy. The neuropathy diagnosis was confirmed using quantitative sensory testing. Visual analog scales were used for subjective assessment before and after surgery. Treatment consisted of external and as-needed internal neurolysis of the common peroneal, deep peroneal, tibial, medial plantar, lateral plantar, and calcaneal nerves. Subjective pain perception and objective sensibility were significantly improved in most patients who underwent the described decompression. Surgical decompression of multiple peripheral nerves in the lower extremities is a valid and effective method of providing symptomatic relief of neuropathy pain and restoring sensation. PMID:16166461
Peripheral tachykinin receptors as targets for new drugs.
Patacchini, R; Maggi, C A
Tachykinins are widely distributed in the peripheral nervous system of the respiratory, urinary and gastrointestinal tract, stored in enteric neurons and in peripheral nerve endings of capsaicin-sensitive primary afferent neurons from which are released by stimuli having both pathological and physiological relevance. The most studied effects produced by tachykinins in these systems are smooth muscle contraction, plasma protein extravasation, mucus secretion and recruitment/activation of immune cells. The use of tachykinin receptor-selective antagonists and knockout animals has enabled to identify the involvement of tachykinin NK(1), NK(2) and NK(3) receptors as mediators of peripheral effects of tachykinins in different systems/species. The bulk of data obtained in experimental animal models suggests that tachykinins could contribute to the genesis of symptoms accompanying various human diseases including asthma/bronchial hyperreactivity, cystitis of various aetiology, inflammatory bowel diseases and irritable bowel syndrome. Tachykinin receptor antagonists are expected to afford therapeutically relevant effects. PMID:11698023
The interactions of peripheral membrane proteins with biological membranes
Johs, Alexander; Whited, A. M.
The interactions of peripheral proteins with membrane surfaces are critical to many biological processes, including signaling, recognition, membrane trafficking, cell division and cell structure. On a molecular level, peripheral membrane proteins can modulate lipid composition, membrane dynamics and protein-protein interactions. Biochemical and biophysical studies have shown that these interactions are in fact highly complex, dominated by several different types of interactions, and have an interdependent effect on both the protein and membrane. Here we examine three major mechanisms underlying the interactions between peripheral membrane proteins and membranes: electrostatic interactions, hydrophobic interactions, and fatty acid modification of proteins. While experimental approachesmore » continue to provide critical insights into specific interaction mechanisms, emerging bioinformatics resources and tools contribute to a systems-level picture of protein-lipid interactions. Through these recent advances, we begin to understand the pivotal role of protein-lipid interactions underlying complex biological functions at membrane interfaces.« less
Central changes in primary afferent fibers following peripheral nerve lesions.
Coggeshall, R E; Lekan, H A; Doubell, T P; Allchorne, A; Woolf, C J
Cutting or crushing rat sciatic nerve does not significantly reduce the number of central myelinated sensory axons in the dorsal roots entering the fourth and fifth lumbar segments even over very extended periods of time. Unmyelinated axons were reduced by approximately 50%, but only long after sciatic nerve lesions (four to eight months), and reinnervation of the peripheral target did not rescue these axons. This indicates that a peripheral nerve lesion sets up a slowly developing but major shift towards large afferent fiber domination of primary afferent input into the spinal cord. In addition, since myelinated axons are never lost, this is good evidence that the cells that give rise to these fibers are also not lost. If this is the case, this would indicate that adult primary sensory neurons with myelinated axons do not depend on peripheral target innervation for survival. PMID:9130791
Schwann cells as a therapeutic target for peripheral neuropathies
Lehmann, Helmar C.; Höke, Ahmet
Schwann cells, the myelin forming cells in the peripheral nervous system, play a key role in the pathology of various inflammatory, metabolic and hereditary polyneuropathies. Advances in identifying growth factors and signaling molecules that are expressed by Schwann cells have paved the way to development of new treatment strategies that are aimed to improve the protective and regenerative properties of Schwann cells in peripheral nerve disorders. These include the exogenous application of growth factors and neurohormones, which have been advanced into clinical trials in humans and transplantation paradigms that have been moved into late stage preclinical models. In this review we will discuss the latest developments in these therapeutic approaches with special regard to peripheral nerve disorders, in which the progress in basic research have already been translated into clinical trials including HIV-associated distal sensory polyneuropathy and diabetic neuropathy. PMID:20874704
Peripheral Surgical Wounding and Age-Dependent Neuroinflammation in Mice
Wang, Hui; Culley, Deborah J.; Marcantonio, Edward R.; Crosby, Gregory; Tanzi, Rudolph E.; Zhang, Yiying; Xie, Zhongcong
Post-operative cognitive dysfunction is associated with morbidity and mortality. However, its neuropathogenesis remains largely to be determined. Neuroinflammation and accumulation of β-amyloid (Aβ) have been reported to contribute to cognitive dysfunction in humans and cognitive impairment in animals. Our recent studies have established a pre-clinical model in mice, and have found that the peripheral surgical wounding without the influence of general anesthesia induces an age-dependent Aβ accumulation and cognitive impairment in mice. We therefore set out to assess the effects of peripheral surgical wounding, in the absence of general anesthesia, on neuroinflammation in mice with different ages. Abdominal surgery under local anesthesia was established in 9 and 18 month-old mice. The levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), Iba1 positive cells (the marker of microglia activation), CD33, and cognitive function in mice were determined. The peripheral surgical wounding increased the levels of TNF-α, IL-6, and Iba1 positive cells in the hippocampus of both 9 and 18 month-old mice, and age potentiated these effects. The peripheral surgical wounding increased the levels of CD33 in the hippocampus of 18, but not 9, month-old mice. Finally, anti-inflammatory drug ibuprofen ameliorated the peripheral surgical wounding-induced cognitive impairment in 18 month-old mice. These data suggested that the peripheral surgical wounding could induce an age-dependent neuroinflammation and elevation of CD33 levels in the hippocampus of mice, which could lead to cognitive impairment in aged mice. Pending further studies, anti-inflammatory therapies may reduce the risk of postoperative cognitive dysfunction in elderly patients. PMID:24796537
Choice of Grating Orientation for Evaluation of Peripheral Vision
Venkataraman, Abinaya Priya; Winter, Simon; Rosén, Robert; Lundström, Linda
ABSTRACT Purpose Peripheral resolution acuity depends on the orientation of the stimuli. However, it is uncertain if such a meridional effect also exists for peripheral detection tasks because they are affected by optical errors. Knowledge of the quantitative differences in acuity for different grating orientations is crucial for choosing the appropriate stimuli for evaluations of peripheral resolution and detection tasks. We assessed resolution and detection thresholds for different grating orientations in the peripheral visual field. Methods Resolution and detection thresholds were evaluated for gratings of four different orientations in eight different visual field meridians in the 20-deg visual field in white light. Detection measurements in monochromatic light (543 nm; bandwidth, 10 nm) were also performed to evaluate the effects of chromatic aberration on the meridional effect. A combination of trial lenses and adaptive optics system was used to correct the monochromatic lower- and higher-order aberrations. Results For both resolution and detection tasks, gratings parallel to the visual field meridian had better threshold compared with the perpendicular gratings, whereas the two oblique gratings had similar thresholds. The parallel and perpendicular grating acuity differences for resolution and detection tasks were 0.16 logMAR and 0.11 logMAD, respectively. Elimination of chromatic errors did not affect the meridional preference in detection acuity. Conclusions Similar to peripheral resolution, detection also shows a meridional effect that appears to have a neural origin. The threshold difference seen for parallel and perpendicular gratings suggests the use of two oblique gratings as stimuli in alternative forced-choice procedures for peripheral vision evaluation to reduce measurement variation. PMID:26889822
Connexin32 expression in central and peripheral nervous systems
Deschenes, S.M.; Scherer, S.S.; Fischbeck, K.H.
Mutations have been identified in the gap junction gene, connexin32 (Cx32), in patients affected with the X-linked form of the demyelinating neuropathy, Charcot-Marie-Tooth disease (CMTX). Gap junctions composed of Cx32 are present and developmentally regulated in a wide variety of tissues. In peripheral nerve, our immunohistochemical analysis localized Cx32 to the noncompacted myelin of the paranodal regions and the Schmidt-Lantermann incisures, where previous studies describe gap junctions. In contrast to the location of Cx32 in peripheral nerve and the usual restriction of clinical manifestations to the peripheral nervous system (PNS) (abstract by Paulson describes an exception), preliminary studies show that Cx32 is present in the compacted myelin of the central nervous system (CNS), as demonstrated by radial staining through the myelin sheath of oligodendrocytes in rat spinal cord. Analysis of Cx32 expression in various regions of rat CNS during development shows that the amount of Cx32 mRNA and protein increases as myelination increases, a pattern observed for other myelin genes. Studies in the PNS provide additional evidence that Cx32 and myelin genes are coordinately regulated at the transcriptional level; Cx32 and peripheral myelin gene PMP-22 mRNAs are expressed in parallel following transient or permanent nerve injury. Differences in post-translational regulation of Cx32 in the CNS and PNS may be indicated by the presence of a faster migrating form of Cs32 in cerebrum versus peripheral nerve. Studies are currently underway to determine the unique role of Cx32 in peripheral nerve.
Indications for peripheral, midline and central catheters: summary of the MAGIC recommendations.
Moureau, Nancy; Chopra, Vineet
Patients admitted to acute care frequently require intravenous access to effectively deliver medications and prescribed treatment. For patients with difficult intravenous access, those requiring multiple attempts, those who are obese, or have diabetes or other chronic conditions, determining the vascular access device (VAD) with the lowest risk that best meets the needs of the treatment plan can be confusing. Selection of a VAD should be based on specific indications for that device. In the clinical setting, requests for central venous access devices are frequently precipitated simply by failure to establish peripheral access. Selection of the most appropriate VAD is necessary to avoid the potentially serious complications of infection and/or thrombosis. An international panel of experts convened to establish a guide for indications and appropriate usage for VADs. This publication summarises the work and recommendations of the panel for the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC). PMID:27126759
Melatonin and its therapeutic actions on peripheral nerve regeneration.
Behram Kandemir, Y; Sarikcioglu, L
Melatonin has many different roles in the human body, including its importance in circadian rhythms, sleep physiology, mental status, reproduction, tumour development, ageing, and many other physiologic processes. Although there are more than hundreds of studies on effects of melatonin in several tissues, its effects on peripheral nerve has been documented in a limited number of studies. This paper focused to review the available literature in terms of several actions and effects of melatonin (beneficial or toxic effects) on well-known peripheral nerve injury models. PMID:26339807
Telltale signs of peripheral neurogenic tumors on magnetic resonance imaging
Kakkar, Chandan; Shetty, Chandrakant M; Koteshwara, Prakashini; Bajpai, Surabhi
Peripheral nerve sheath tumors are categorized into benign and malignant forms, comprising of neurofibroma and schwannoma in the benign category and malignant peripheral nerve sheath tumors in the malignant category. Magnetic resonance imaging plays an important role in the diagnosis of these lesions. The various imaging features and signs that help to identify and characterize a nerve sheath tumor are, distribution of the tumor along a major nerve, an entering or exiting nerve sign, target sign, a fascicular sign and a split-fat sign. PMID:26752825
Telltale signs of peripheral neurogenic tumors on magnetic resonance imaging.
Kakkar, Chandan; Shetty, Chandrakant M; Koteshwara, Prakashini; Bajpai, Surabhi
Peripheral nerve sheath tumors are categorized into benign and malignant forms, comprising of neurofibroma and schwannoma in the benign category and malignant peripheral nerve sheath tumors in the malignant category. Magnetic resonance imaging plays an important role in the diagnosis of these lesions. The various imaging features and signs that help to identify and characterize a nerve sheath tumor are, distribution of the tumor along a major nerve, an entering or exiting nerve sign, target sign, a fascicular sign and a split-fat sign. PMID:26752825
CNS GLP-1 Regulation of Peripheral Glucose Homeostasis
Sandoval, Darleen
Current models hold that peripheral and CNS GLP-1 signaling operate as distinct systems whereby CNS GLP-1 regulates food intake and circulating GLP-1 regulates glucose homeostasis. There is accumulating evidence that the arcuate nucleus, an area of the CNS that regulates energy homeostasis, responds to hormones and nutrients to regulate glucose homeostasis as well. Recent data suggest that GLP-1 may be another signal acting on the arcuate to regulate glucose homeostasis challenging the conventional model of GLP-1 physiology. This review discusses the peripheral and central GLP-1 systems and presents a model whereby these systems are integrated in regulation of glucose homeostasis. PMID:18508100
GP IIb/IIIa Blockade During Peripheral Artery Interventions
Tepe, Gunnar Wiskirchen, Jakub; Pereira, Philippe; Claussen, Claus D.; Miller, Stephen; Duda, Stephan H.
The activation of the platelet GP IIb/IIIa receptor is the final and common pathway in platelet aggregation. By blocking this receptor, platelet aggregation can be inhibited independently of the stimulus prompted the targeting of this receptor. Several years ago, three drugs have been approved for coronary artery indications. Since that time, there is increasing evidence that GP IIb/IIIa receptor blockade might have also an important role in peripheral arterial intervention. This article summarizes the action and differences of GP Ilb/IIIa receptor inhibitors and its possible indication in peripheral arteries.
[Thinking and Problems of Peripheral Vascular Disease Research].
Shang De-jun
It is necessary to study further syndrome differentiation based treatment of peripheral vascular disease. In order to improve the clinical effect and reduce the rate of amputation, early diagnosis and early intervention are important. Meanwhile, treatment of Chinese medicine should be combined with necessary surgical intervention. It should be important to supplement some details about blood stasis syndrome and activating blood and dissolving stasis therapy of peripheral vascular disease. The application of various Chinese medicine external therapies should not be ignored, especially promoting granulation and wound healing therapy. PMID:26955670
The BHVI-EyeMapper: Peripheral Refraction and Aberration Profiles
Fedtke, Cathleen; Ehrmann, Klaus; Falk, Darrin; Bakaraju, Ravi C.; Holden, Brien A.
ABSTRACT Purpose The aim of this article was to present the optical design of a new instrument (BHVI-EyeMapper, EM), which is dedicated to rapid peripheral wavefront measurements across the visual field for distance and near, and to compare the peripheral refraction and higher-order aberration profiles obtained in myopic eyes with and without accommodation. Methods Central and peripheral refractive errors (M, J180, and J45) and higher-order aberrations (C[3, 1], C[3, 3], and C[4, 0]) were measured in 26 myopic participants (mean [±SD] age, 20.9 [±2.0] years; mean [±SD] spherical equivalent, −3.00 [±0.90] diopters [D]) corrected for distance. Measurements were performed along the horizontal visual field with (−2.00 to −5.00 D) and without (+1.00 D fogging) accommodation. Changes as a function of accommodation were compared using tilt and curvature coefficients of peripheral refraction and aberration profiles. Results As accommodation increased, the relative peripheral refraction profiles of M and J180 became significantly (p < 0.05) more negative and the profile of M became significantly (p < 0.05) more asymmetric. No significant differences were found for the J45 profiles (p > 0.05). The peripheral aberration profiles of C[3, 1], C[3, 3], and C[4, 0] became significantly (p < 0.05) less asymmetric as accommodation increased, but no differences were found in the curvature. Conclusions The current study showed that significant changes in peripheral refraction and higher-order aberration profiles occurred during accommodation in myopic eyes. With its extended measurement capabilities, that is, permitting rapid peripheral refraction and higher-order aberration measurements up to visual field angles of ±50 degrees for distance and near (up to −5.00 D), the EM is a new advanced instrument that may provide additional insights in the ongoing quest to understand and monitor myopia development. PMID:25105690
Intraoperative peripheral nerve injury in colorectal surgery. An update.
Colsa Gutiérrez, Pablo; Viadero Cervera, Raquel; Morales-García, Dieter; Ingelmo Setién, Alfredo
Intraoperative peripheral nerve injury during colorectal surgery procedures is a potentially serious complication that is often underestimated. The Trendelenburg position, use of inappropriately padded armboards and excessive shoulder abduction may encourage the development of brachial plexopathy during laparoscopic procedures. In open colorectal surgery, nerve injuries are less common. It usually involves the femoral plexus associated with lithotomy position and self-retaining retractor systems. Although in most cases the recovery is mostly complete, treatment consists of physical therapy to prevent muscular atrophy, protection of hypoesthesic skin areas and analgesics for neuropathic pain. The aim of the present study is to review the incidence, prevention and management of intraoperative peripheral nerve injury. PMID:26008880
Clinical outcomes for Conduits and Scaffolds in peripheral nerve repair
Gerth, David J; Tashiro, Jun; Thaller, Seth R
The gold standard of peripheral nerve repair is nerve autograft when tensionless repair is not possible. Use of nerve autograft has several shortcomings, however. These include limited availability of donor tissue, sacrifice of a functional nerve, and possible neuroma formation. In order to address these deficiencies, researchers have developed a variety of biomaterials available for repair of peripheral nerve gaps. We review the clinical studies published in the English literature detailing outcomes and reconstructive options. Regardless of the material used or the type of nerve repaired, outcomes are generally similar to nerve autograft in gaps less than 3 cm. New biomaterials currently under preclinical evaluation may provide improvements in outcomes. PMID:25685760
The utility of digital subtraction arteriography in peripheral vascular disease.
Kubal, W S; Crummy, A B; Turnipseed, W D
Digital subtraction angiography (DSA), whether used in conjunction with intravenous or intraarterial injection techniques, has an established role in evaluation of peripheral vascular disease. Use of DSA can reduce the time, cost, and patient discomfort of the standard arteriographic study. While it is limited by field size and patient cooperation in some instances, the utility of noninvasive imaging using intravenous DSA and the added anatomic detail of intraarterial DSA for roadmapping and delineation of small distal vessels provide the basis for future integration of standard arteriographic and DSA methods in assessment of peripheral vascular disease. PMID:6228296
[Deviation index of eye and mouth on peripheral facial paralysis].
Li, Xue; Liao, Pin-Dong; Luo, Min; Zhu, Bin-Ye
Differences of some points, levels and angles of the healthy and affected sides of patients with peripheral facial paralysis were picked out according to photographs. Through analysis of the index between the healthy and affected side of the patients and the difference between healthy people and patients, it is approved that those special points, levels and angles, which are called as deviation index of eye and mouth, can evaluate peripheral facial paralysis objectively and judge the degree of deviation. Therefore, it provides references for the diagnosis of facial paralysis and its degree judgement. PMID:21972641
Peripheral Calcifying Cystic Odontogenic Tumour - A Rare Case Report
Shenoi, Ramakrishna; Gadve, Vandana; Rajderkar, Anand; Dive, Alka
Odontogenic lesions are derived from remnants of the components of the developing tooth germ. The calcifying cystic odontogenic tumour (CCOT) is a benign cystic neoplasm of odontogenic origin that is characterized by ameloblastoma-like epithelial cells and ghost cells. Most peripheral CCOTs are located in the anterior gingiva of the mandible or maxilla. This is a rare case report of CCOT. The rare feature in our case was its peripheral nature of existence and its location in the left buccal vestibule and retromolar region. Based on the radiological, cytological and histopathological findings the lesion was surgically excised. PMID:26393218
Malignant peripheral nerve sheath tumor of the parotid gland.
Chis, Octavian; Albu, Silviu
Malignant peripheral nerve sheath tumor (MPNST) refers to spindle cell sarcomas arising from or separating in the direction of cells of the peripheral nerve sheath. The MPNST of the parotid gland is an extremely rare tumor, usually having a poor prognosis, and only a few cases been described in the literature. In this article, we report the diagnostic and therapeutic challenges related to a new case of MPNST of the parotid. Diagnosis was made based on clinical, imaging (computed tomography scan), histologic, and immunohistochemistry findings. Despite comprehensive treatment--complete surgical resection and radiotherapy--the tumor displayed a highly aggressive course. PMID:25153067
Anatomic evidence for peripheral neural processing in mammalian graviceptors
NASA Technical Reports Server (NTRS)
Ross, M. D.
Ultrastructural study of utricular and saccular maculas demonstrates that their innervation patterns are complex. There is a clustering of type I and type II hair cells based upon a sharing of afferents, a system of efferent-type beaded fibers that is of intramacular (mostly calyceal) origin, and a plexus-like arrangement of afferents and efferents at many sites in the neuroepithelium. Results suggest that information concerning linear acceleration is processed peripherally, beginning at the hair cell level, before being sent to the central nervous system. The findings may supply a structural basis for peripheral adaptation to a constant stimulus, and for lateral inhibition to improve signal relative to noise.
Peripheral nerve/field stimulation for neuropathic pain.
Deogaonkar, Milind; Slavin, Konstantin V
Peripheral nerve stimulation and peripheral nerve field stimulation are emerging as a viable neuromodulatory therapy in the treatment of refractory pain. Although the technology of percutaneous stimulation has been available for decades, recent advancements have broadened the number of indications. Success of treatment revolves around identifying the correct patient population, and the selection and placement of the appropriate electrodes and implantable pulse generators. Most results to date have come from case reports and retrospective studies. However, given the promising outcomes in reducing otherwise medically refractory pain, future randomized controlled studies are needed to assess this emerging technology. PMID:24262894
The peripheral dose outside the applicator in electron beams of Oncor linear accelerator.
Iktueren, Basak; Bilge, Hatice; Karacam, Songul; Atkovar, Gulyuz
In this study, the peripheral dose outside the applicator was measured using electron beams produced by an Oncor linear accelerator and compared with the data of the treatment planning system (TPS). The dose profiles have been measured, by using a water-equivalent slab phantom and a parallel plate ionisation chamber, at 6, 9 and 15 MeV energy levels in 5×5, 10×10, 15×15, 20×20 and 25×25 cm(2) applicators and at 0, 10 and 20° gantry angles; and at the surface, 0.2, 0.5, 1 cm and d(max) depth for each electron energy level. The peripheral dose has been determined with these profiles by normalisation at the field central beam axis (CAX). It has been noticed that, using a 10×10 cm(2) applicator, there is a 1.4 % dose peak on the surface 6 cm away from the field edge where the field CAX is at 100 %, at a gantry angle of 0° with 6 and 9 MeV electron beams; also for the 15 MeV electron beam there is a 2.3 % dose peak. It has been discovered that the peak dose approaches a minimum depending on the increase in depth and reaches 2.5-4 % depending on the growth of the field dimension. At gantry angles of 10 and 20°, 6 and 9 MeV electron beams created small peaks and a maximum dose could be reached at 0.2 and 1 cm depth. Electron beam of 15 MeV did not peak at depths of 0.2 and 1 cm at gantry angles of 10 and 20°. The measured peripheral dose outside the applicators has been compared with the data from a TPS's computer using the Pencil Beam algorithm; it has been stated that dose calculations can be made as far as 3 cm outside the field. In conclusion, the TPS is not sufficient to measure the peripheral dose outside the applicators, and this dose can only be determined by direct measurement. PMID:22025738
Preoperative evaluation of peripheral nerve injuries: What is the place for ultrasound?
Toia, Francesca; Gagliardo, Andrea; D'Arpa, Salvatore; Gagliardo, Cesare; Gagliardo, Giuseppe; Cordova, Adriana
OBJECTIVE The purpose of this study was to evaluate the usefulness of ultrasound in the preoperative workup of peripheral nerve lesions and illustrate how nerve ultrasonography can be integrated in routine clinical and neurophysiological evaluation and in the management of focal peripheral nerve injuries. The diagnostic role and therapeutic implications of ultrasonography for different neuropathies are described. METHODS The authors analyzed the use of ultrasound in 119 entrapment, tumoral, posttraumatic, or postsurgical nerve injuries of limbs evaluated in 108 patients during 2013 and 2014. All patients were candidates for surgery, and in all cases the evaluation included clinical examination, electrodiagnostic studies (nerve conduction study and electromyography), and ultrasound nerve study. Ultrasound was used to explore the nerve fascicular echotexture, continuity, and surrounding tissues. The maximum cross-sectional area (CSA) and the presence of epineurial hyperechogenicity or intraneural hyper- or hypoechogenicity, of anatomical anomalies, dynamic nerve dislocations, or compressions were recorded. The concordance rate of neurophysiological and ultrasonographic data was analyzed, classifying ultrasound findings as confirming, contributive, or nonconfirming with respect to electrodiagnostic data. The correlation between maximum nerve CSA and neurophysiological severity degree in entrapment syndromes was statistically analyzed. RESULTS Ultrasonography confirmed electrodiagnostic findings in 36.1% of cases and showed a contributive role in the diagnosis and surgical planning in 53.8% of all cases; the findings were negative ("nonconfirming") in only 10.1% of the patients. In 16% of cases, ultrasound was not only contributive, but had a key diagnostic role in the presence of doubtful electrodiagnostic findings. The contributive role differed according to etiology, being higher for tumors (100%) and for posttraumatic or postsurgical neuropathies (72.2%) than for
Catanzaro, Thomas E
This article provides the reader with an appreciation of the diverse elements that go into a buy-sell, affiliation, or merger situation for veterinary practices. In the changing market place of American veterinary medicine, old paradigms no longer hold comfort. The generational differences are briefly explored herein as well as the new economic realities. A few examples are offered to illustrate just how much variability exists in the current business of veterinary medicine and the subsequent practice transitions needed to enhance value. Functioning models are explored, as well as affiliation and merger options. Practice valuation is discussed in general terms, referencing the cutting-edge factors. The six-point summary provides almost all practices a solid operational base for daily operations and succession planning. PMID:16442447
Prevalence of peripheral neuropathy and painful peripheral neuropathy in Turkish diabetic patients.
Erbas, Tomris; Ertas, Mustafa; Yucel, Aysen; Keskinaslan, Abdulkadir; Senocak, Mustafa
The aim of this study was to determine the prevalence of diabetic peripheral neuropathy (DPN) and neuropathic pain in diabetic patients attending university outpatient clinics in Turkey. In this multicenter cross-sectional study, neurologic examinations and nerve conduction studies along with clinical diabetic neuropathy score, and Leeds Assessment of Neuropathic Symptoms and Signs pain scale were performed on 1,113 patients (46.2% male) from 14 centers. Prevalence of DPN determined only by clinical examination was 40.4% and increased to 62.2%, by combining nerve conduction studies with clinical examination. According to Leeds Assessment of Neuropathic Symptoms and Signs scores, neuropathic pain prevalence was 16.0% in those who reported pain. Poor glycemic control, retinopathy, microalbuminuria, hyperlipidemia, diabetic foot, and foot amputation were more commonly observed in patients with DPN. Clinical DPN affected 40.4% of diabetic patients, and neuropathic pain prevalence in diabetic patient population was 14.0%. Clinical examinations and nerve conduction studies are important components for early detection and accurate diagnosis of DPN and painful DPN. PMID:21221008
ERIC Educational Resources Information Center
RP Group of California Community Colleges, Santa Ana.
The Planning Resource Guide by the RP Group of California Community Colleges was created to provide practical planning assistance. It contains four sections, including: (1) a basic conceptual framework for planning; (2) common planning definitions for colleges; (3) planning steps and samples of planning structures; and (4) suggestions for linking…
Heterogeneity of the Peripheral Circadian Systems in Drosophila melanogaster: A Review
Ito, Chihiro; Tomioka, Kenji
Circadian rhythms in organisms are involved in many aspects of metabolism, physiology, and behavior. In many animals, these rhythms are produced by the circadian system consisting of a central clock located in the brain and peripheral clocks in various peripheral tissues. The oscillatory machinery and entrainment mechanism of peripheral clocks vary between different tissues and organs. The relationship between the central and peripheral clocks is also tissue-dependent. Here we review the heterogeneous nature of peripheral circadian clocks in the fruit fly Drosophila melanogaster and their dependence on the central clock, and discuss their significance in the temporal organization of physiology in peripheral tissues/organs. PMID:26858652
Heterogeneity of the Peripheral Circadian Systems in Drosophila melanogaster: A Review.
Ito, Chihiro; Tomioka, Kenji
Circadian rhythms in organisms are involved in many aspects of metabolism, physiology, and behavior. In many animals, these rhythms are produced by the circadian system consisting of a central clock located in the brain and peripheral clocks in various peripheral tissues. The oscillatory machinery and entrainment mechanism of peripheral clocks vary between different tissues and organs. The relationship between the central and peripheral clocks is also tissue-dependent. Here we review the heterogeneous nature of peripheral circadian clocks in the fruit fly Drosophila melanogaster and their dependence on the central clock, and discuss their significance in the temporal organization of physiology in peripheral tissues/organs. PMID:26858652
A prospective surveillance model for physical rehabilitation of women with breast cancer: chemotherapy-induced peripheral neuropathy.
Stubblefield, Michael D; McNeely, Margaret L; Alfano, Catherine M; Mayer, Deborah K
Chemotherapy-induced peripheral neuropathy (CIPN) results from damage to or dysfunction of the peripheral nerves. The development of CIPN is anticipated for the majority of breast cancer patients who receive neurotoxic chemotherapy, depending on the agent used, dose, and schedule. Sensory symptoms often predominate and include numbness, tingling, and distal extremity pain. Weakness, gait impairment, loss of functional abilities, and other deficits may develop with more severe CIPN. This article outlines a prospective surveillance model for physical rehabilitation of women with breast cancer who develop CIPN. Rehabilitative efforts for CIPN start at the time of breast cancer diagnosis and treatment planning. The prechemotherapy evaluation identifies patients with preexisting peripheral nervous system disorders that may place them at higher risk for the development of CIPN. This clinical evaluation should include a history focusing on symptoms and functional activities as well as a physical examination that objectively assesses the patient's strength, sensation, reflexes, and gait. Ongoing surveillance following the initiation of a neurotoxic agent is important to monitor for the development and progression of symptoms associated with CIPN, and to ensure its resolution over the long term. CIPN is managed best by a multidisciplinary team approach. Early identification of symptoms will ensure appropriate referral and timely symptom management. The prospective surveillance model promotes a patient-centered approach to care, from pretreatment through survivorship and palliative care. In this way, the model offers promise in addressing and minimizing both the acute and long-term morbidity associated with CIPN. PMID:22488699
Peripheral artery disease in patients with coronary artery disease.
Atmer, B; Jogestrand, T; Laska, J; Lund, F
The prevalence of peripheral vascular disease in patients with coronary artery disease has been investigated in many different ways and depends on the diagnostic methods and the definition of the atherosclerotic manifestations in the different vascular beds. In this study we used the non-invasive methods digital volume pulse plethysmography and ankle and toe blood pressure measurements to identify arterial abnormalities in the lower limbs in 58 patients (49 males and 9 females; age 37-72 years) examined with coronary angiography. The prevalence of peripheral artery disease was 22%, in agreement with the results of most previous investigations. There was a tendency towards increasing prevalence of peripheral artery disease with more advanced coronary artery disease: 14% of the patients with no or minimal coronary atheromotous lesions, 18% of the patients with moderate coronary atheromotous lesions and 32% of the patients with marked coronary atheromotous disease. For this reason a non-invasive investigation of the peripheral arterial circulation should be included early in the clinical consideration of patients with chest pain or similar symptoms suggesting coronary heart disease. Toe pressure measurement appears to be the most appropriate technique being rather simple in management and also in evaluation of results. PMID:7658111
Assessment of Normal Variability in Peripheral Blood Gene Expression
Campbell, Catherine; Vernon, Suzanne D.; Karem, Kevin L.; Nisenbaum, Rosane; Unger, Elizabeth R.
Peripheral blood is representative of many systemic processes and is an ideal sample for expression profiling of diseases that have no known or accessible lesion. Peripheral blood is a complex mixture of cell types and some differences in peripheral blood gene expression may reflect the timing of sample collection rather than an underlying disease process. For this reason, it is important to assess study design factors that may cause variability in gene expression not related to what is being analyzed. Variation in the gene expression of circulating peripheral blood mononuclear cells (PBMCs) from three healthy volunteers sampled three times onemore » day each week for one month was examined for 1,176 genes printed on filter arrays. Less than 1% of the genes showed any variation in expression that was related to the time of collection, and none of the changes were noted in more than one individual. These results suggest that observed variation was due to experimental variability.« less
[Management of peripheral facial nerve palsy in children].
Tabarki, B
Peripheral facial nerve palsy may (secondary) or may not have a detectable cause (idiopathic facial palsy or Bell's palsy). Idiopathic facial palsy is the common form of facial palsy. It remains diagnosis by exclusion. The prognosis is more favourable in children than in adults. We present current diagnostic procedures and recommendations regarding treatment in children. PMID:25048647
Peripheral formalin injection induces unique spinal cord microglial phenotypic changes.
Fu, Kai-Yuan; Tan, Yong-Hui; Sung, Backil; Mao, Jianren
Microglia are resident immune cells of brain and activated by peripheral tissue injury. In the present study, we investigated the possible induction of several microglial surface immunomolecules in the spinal cord, including leukocyte common antigen (LCA/CD45), MHC class I antigen, MHC class II antigen, Fc receptor, and CD11c following formalin injection into the rat's hind paw. CD45 and MHC class I were upregulated in the activated microglia, which was evident on day 3 with the peak expression on day 7 following peripheral formalin injection. There was a very low basal expression of MHC class II, CD11c, and the Fc receptor, which did not change after the formalin injection. These results, for the first time, indicate that peripheral formalin injection can induce phenotypic changes of microglia with distinct upregulation of CD45 and MHC class I antigen. The data suggest that phenotypic changes of the activated microglia may be a unique pattern of central changes following peripheral tissue injury. PMID:19015000
Intrathecal gene therapy rescues a model of demyelinating peripheral neuropathy.
Kagiava, Alexia; Sargiannidou, Irene; Theophilidis, George; Karaiskos, Christos; Richter, Jan; Bashiardes, Stavros; Schiza, Natasa; Nearchou, Marianna; Christodoulou, Christina; Scherer, Steven S; Kleopa, Kleopas A
Inherited demyelinating peripheral neuropathies are progressive incurable diseases without effective treatment. To develop a gene therapy approach targeting myelinating Schwann cells that can be translatable, we delivered a lentiviral vector using a single lumbar intrathecal injection and a myelin-specific promoter. The human gene of interest, GJB1, which is mutated in X-linked Charcot-Marie-Tooth Disease (CMT1X), was delivered intrathecally into adult Gjb1-null mice, a genetically authentic model of CMT1X that develops a demyelinating peripheral neuropathy. We obtained widespread, stable, and cell-specific expression of connexin32 in up to 50% of Schwann cells in multiple lumbar spinal roots and peripheral nerves. Behavioral and electrophysiological analysis revealed significantly improved motor performance, quadriceps muscle contractility, and sciatic nerve conduction velocities. Furthermore, treated mice exhibited reduced numbers of demyelinated and remyelinated fibers and fewer inflammatory cells in lumbar motor roots, as well as in the femoral motor and sciatic nerves. This study demonstrates that a single intrathecal lentiviral gene delivery can lead to Schwann cell-specific expression in spinal roots extending to multiple peripheral nerves. This clinically relevant approach improves the phenotype of an inherited neuropathy mouse model and provides proof of principle for treating inherited demyelinating neuropathies. PMID:27035961
"Roda Boa", "Roda Boa": Legitimate Peripheral Participation in Diasporic "Capoeira"
ERIC Educational Resources Information Center
Stephens, Neil; Delamont, Sara
"Capoeira", the Brazilian dance and martial art, is taught across the world. Learners acquire vital knowledge and are socialised as "capoeiristas" through legitimate peripheral participation, in particular when watching games in the "roda". The "roda", the circle within which the "capoeira" game is played, is a classic place for learning by…
Modular peripheral functionalization of thiophene dendrons and dendrimers.
Deng, Suxiang; Sriwichai, Saengrawee; Taranekar, Prasad; Krueger, Greg; Mays, Jimmy W; Advincula, Rigoberto C
A series of thiophene dendrons and dendrimers with peripheral functional groups were designed and synthesized. Two methodologies using thiophene dendrons and dendrons as synthetic building blocks, namely, (1) periphery functionalization; (2) a combination of focal and periphery functionalization have been demonstrated. PMID:21735024
Effect of induced transverse chromatic aberration on peripheral vision.
Winter, Simon; Fathi, Mohammad Taghi; Venkataraman, Abinaya Priya; Rosén, Robert; Seidemann, Anne; Esser, Gregor; Lundström, Linda; Unsbo, Peter
Transverse chromatic aberration (TCA) is one of the largest optical errors affecting the peripheral image quality in the human eye. However, the effect of chromatic aberrations on our peripheral vision is largely unknown. This study investigates the effect of prism-induced horizontal TCA on vision, in the central as well as in the 20° nasal visual field, for four subjects. Additionally, the magnitude of induced TCA (in minutes of arc) was measured subjectively in the fovea with a Vernier alignment method. During all measurements, the monochromatic optical errors of the eye were compensated for by adaptive optics. The average reduction in foveal grating resolution was about 0.032 ± 0.005 logMAR/arcmin of TCA (mean ± std). For peripheral grating detection, the reduction was 0.057 ± 0.012 logMAR/arcmin. This means that the prismatic effect of highly dispersive spectacles may reduce the ability to detect objects in the peripheral visual field. PMID:26479929
Dcc Mediates Functional Assembly of Peripheral Auditory Circuits
Kim, Young J.; Wang, Sheng-zhi; Tymanskyj, Stephen; Ma, Le; Tao, Huizhong W.; Zhang, Li I.
Proper structural organization of spiral ganglion (SG) innervation is crucial for normal hearing function. However, molecular mechanisms underlying the developmental formation of this precise organization remain not well understood. Here, we report in the developing mouse cochlea that deleted in colorectal cancer (Dcc) contributes to the proper organization of spiral ganglion neurons (SGNs) within the Rosenthal's canal and of SGN projections toward both the peripheral and central auditory targets. In Dcc mutant embryos, mispositioning of SGNs occurred along the peripheral auditory pathway with misrouted afferent fibers and reduced synaptic contacts with hair cells. The central auditory pathway simultaneously exhibited similar defective phenotypes as in the periphery with abnormal exit of SGNs from the Rosenthal's canal towards central nuclei. Furthermore, the axons of SGNs ascending into the cochlear nucleus had disrupted bifurcation patterns. Thus, Dcc is necessary for establishing the proper spatial organization of SGNs and their fibers in both peripheral and central auditory pathways, through controlling axon targeting and cell migration. Our results suggest that Dcc plays an important role in the developmental formation of peripheral and central auditory circuits, and its mutation may contribute to sensorineural hearing loss. PMID:27040640
Correlation of peripheral innervation density and dorsal horn map scale.
Wang, L; Millecchia, R; Brown, P B
Dorsal horn map scale and peripheral innervation density were compared to test a hypothesized linear relationship. In anesthetized cats, low-threshold mechanoreceptive peripheral nerve innervation fields (IFs) were measured by outlining areas of skin from which action potentials could be elicited in cutaneous nerves. The same nerves were processed histologically and used to count myelinated axons. Innervation density for each nerve was calculated as number of axons divided by IF area. Single units were recorded throughout the hindlimb representation, in laminae III and IV. These data, combined with single-unit data from other animals and with cell counts in laminae III and IV, permitted estimation of numbers of cells whose receptive field centers fell in contiguous 1-cm bands from tips of toes to proximal thigh. A similar estimate was performed with the use of the nerve innervation data, so that peripheral innervation densities and map scales for the different 1-cm bands of skin could be compared. Correlation between the two was quite high (r = 0.8), and highly significant (P = 2.5 x 10(-7)). These results are consistent with a proposed developmental model in which map scale, peripheral innervation density, and reciprocal of dorsal horn cell receptive field size are mutually proportional, as a result of developmental mechanisms that produce constant divergence and convergence between primary afferent axons and dorsal horn cells. PMID:9307105
Biomaterials for the Development of Peripheral Nerve Guidance Conduits
Nectow, Alexander R.; Marra, Kacey G.
Currently, surgical treatments for peripheral nerve injury are less than satisfactory. The gold standard of treatment for peripheral nerve gaps >5 mm is the autologous nerve graft; however, this treatment is associated with a variety of clinical complications, such as donor site morbidity, limited availability, nerve site mismatch, and the formation of neuromas. Despite many recent advances in the field, clinical studies implementing the use of artificial nerve guides have yielded results that are yet to surpass those of autografts. Thus, the development of a nerve guidance conduit, which could match the effectiveness of the autologous nerve graft, would be beneficial to the field of peripheral nerve surgery. Design strategies to improve surgical outcomes have included the development of biopolymers and synthetic polymers as primary scaffolds with tailored mechanical and physical properties, luminal "fillers" such as laminin and fibronectin as secondary internal scaffolds, surface micropatterning, stem cell inclusion, and controlled release of neurotrophic factors. The current article highlights approaches to peripheral nerve repair through a channel or conduit, implementing chemical and physical growth and guidance cues to direct that repair process. PMID:21812591
Central and Peripheral Components of Working Memory Storage
Cowan, Nelson; Saults, J. Scott; Blume, Christopher L.
This study re-examines the issue of how much of working memory storage is central, or shared across sensory modalities and verbal and nonverbal codes, and how much is peripheral, or specific to a modality or code. In addition to the exploration of many parameters in 9 new dual-task experiments and re-analysis of some prior evidence, the innovations of the present work compared to previous studies of memory for two stimulus sets include (1) use of a principled set of formulas to estimate the number of items in working memory, and (2) a model to dissociate central components, which are allocated to very different stimulus sets depending on the instructions, from peripheral components, which are used for only one kind of material. We consistently find that the central contribution is smaller than was suggested by Saults and Cowan (2007), and that the peripheral contribution is often much larger when the task does not require the binding of features within an object. Previous capacity estimates are consistent with the sum of central plus peripheral components observed here. We consider the implications of the data as constraints on theories of working memory storage and maintenance. PMID:24867488
21 CFR 876.5310 - Nonimplanted, peripheral electrical continence device.
Code of Federal Regulations, 2010 CFR
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonimplanted, peripheral electrical continence device. 876.5310 Section 876.5310 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices §...
Deaf and Hearing Children: A Comparison of Peripheral Vision Development
ERIC Educational Resources Information Center
Codina, Charlotte; Buckley, David; Port, Michael; Pascalis, Olivier
This study investigated peripheral vision (at least 30[degrees] eccentric to fixation) development in profoundly deaf children without cochlear implantation, and compared this to age-matched hearing controls as well as to deaf and hearing adult data. Deaf and hearing children between the ages of 5 and 15 years were assessed using a new,…
Peripheral neuropathies of rheumatologic disease and gluten-related disorders.
Reda, Haatem; Chin, Russell L
Peripheral nervous system disease is a common and often debilitating feature of many systemic rheumatologic disorders. Such involvement takes many forms, reflecting the variety of underlying pathophysiology, though most patients present with painful multifocal neuropathy (usually vasculitic) or a distal sensory more than motor peripheral neuropathy (sometimes vasculitic and nearly always axonal). The presence of peripheral nervous system involvement is often an early signal of the generalization of inflammatory disease in blood vessels or extravascular tissues, though peripheral neuropathy is not itself an independent predictor of mortality. Nonetheless, progressive multifocal neuropathy, motor neuropathy, small fiber neuropathy, and sensory neuronopathy should be treated early and aggressively with immunosuppression (or the gluten-free diet in appropriate situations) to limit morbidity. Given the rapidly evolving therapeutic landscape, partnership with a rheumatologist is essential. Treatment is usually sustained for 1 to 2 years, and remission is possible in many cases within 6 to 12 months, with variable rates of relapse and treatment resistance. Patients should be meticulously monitored for relapse with serial laboratory testing, electrodiagnostic studies, and clinical examination. Functional rating scores, such as the neuropathy impairment scale and the total neuropathy score are useful for longitudinal assessment. PMID:25369437
Dynamic characteristics of peripheral jet ACV. II - Pitching motion
NASA Astrophysics Data System (ADS)
Mori, T.; Maeda, H.
The dynamic pitching characteristics of peripheral jet ACV (Air Cushion Vehicle) which have a stability curtain are investigated analytically and experimentally. The measured values of moment, lift and cushion pressure are compared with numerical results noting applicability to the pitching motion. The response of ACV to the sinusoidal pitching oscillation of the ground is also studied.
Simultaneous hybrid peripheral re-vascularization: early results.
Yurekli, Ismail; Gokalp, Orhan; Gunes, Tevfik; Yilik, Levent; Gurbuz, Ali
Endovascular and open surgical interventions may be combined in treatment of peripheral arterial disease. In this study, we presented our simultaneous hybrid peripheral interventions under the light of current literature data. Eleven patients who were operated for occlusive peripheral arterial disease without aneurysms between June 2008 and November 2010 at our hybrid operating room were investigated retrospectively. Generally, endovascular intervention was performed initially, and then followed by surgery. After hybrid interventions, control angiograms were held during the same session. None of the patients experienced either stent or graft occlusion during early postoperative period. Primary patency rate was found to be 100% for the postoperative first six months. Ankle-brachial indices (ABI) increased significantly during postoperative period and clinical symptoms were relieved in all patients (mean preoperative ABI: 0.43 ± 0.08, mean postoperative sixth month ABI: 0.87 ± 0.08). Peripheral hybrid interventions may be performed both in separate sessions and also simultaneously by experienced teams if an angiography device is available within the operating room. PMID:23518846
Low monoamine oxidase B in peripheral organs in smokers
Fowler, Joanna S.; Logan, Jean; Wang, Gene-Jack; Volkow, Nora D.; Telang, Frank; Zhu, Wei; Franceschi, Dinko; Pappas, Naomi; Ferrieri, Richard; Shea, Colleen; Garza, Victor; Xu, Youwen; Schlyer, David; Gatley, S. John; Ding, Yu-Shin; Alexoff, David; Warner, Donald; Netusil, Noelwah; Carter, Pauline; Jayne, Millard; King, Payton; Vaska, Paul
One of the major mechanisms for terminating the actions of catecholamines and vasoactive dietary amines is oxidation by monoamine oxidase (MAO). Smokers have been shown to have reduced levels of brain MAO, leading to speculation that MAO inhibition by tobacco smoke may underlie some of the behavioral and epidemiological features of smoking. Because smoking exposes peripheral organs as well as the brain to MAO-inhibitory compounds, we questioned whether smokers would also have reduced MAO levels in peripheral organs. Here we compared MAO B in peripheral organs in nonsmokers and smokers by using positron emission tomography and serial scans with the MAO B-specific radiotracers,l-[11C]deprenyl and deuterium-substituted l-[11C]deprenyl (l-[11C]deprenyl-D2). Binding specificity was assessed by using the deuterium isotope effect. We found that smokers have significantly reduced MAO B in peripheral organs, particularly in the heart, lungs, and kidneys, when compared with nonsmokers. Reductions ranged from 33% to 46%. Because MAO B breaks down catecholamines and other physiologically active amines, including those released by nicotine, its inhibition may alter sympathetic tone as well as central neurotransmitter activity, which could contribute to the medical consequences of smoking. In addition, although most of the emphases on the carcinogenic properties of smoke have been placed on the lungs and the upper airways, this finding highlights the fact that multiple organs in the body are also exposed to pharmacologically significant quantities of chemical compounds in tobacco smoke. PMID:12972641
Peripheral Insulin Doesn't Alter Appetite of Broiler Chicks
Liu, Lei; Xu, Shaohua; Wang, Xiaojuan; Jiao, Hongchao; Lin, Hai
An experiment was conducted to investigate the effect of peripheral insulin treatment on appetite in chicks. Six-d-age chicks with ad libitum feeding or fasting for 3 h before injection received a subcutaneous injection of 0, 1, 3, 5, 10, or 20 IU of insulin or vehicle (saline). The results showed peripheral insulin treatment (1 to 20 IU) did not alter significantly the feed intake in chicks under either ad libitum feeding or fasting conditions within 4 h (p>0.05). Compared with the control, plasma glucose concentration was significantly decreased after insulin treatment of 3, 5, 10, and 20 IU for 4 h in chicks with ad libitum feeding (p<0.05). In fasted chicks, 10 and 20 IU insulin treatments significantly decreased the plasma glucose level for 4 h (p<0.05). Peripheral insulin treatment of 10 IU for 2 or 4 h did not significantly affect the hypothalamic genes expression of neuropeptide Y, proopiomelanocortin, corticotropin-releasing factor and insulin receptors (p>0.05). All results suggest peripheral administration of insulin has no effect on appetite in chicks. PMID:26954230
Peripheral Fat Loss and Decline in Adipogenesis in Older Humans
CASO, Giuseppe; MCNURLAN, Margaret A; MILEVA, Izolda; ZEMLYAK, Alla; MYNARCIK, Dennis C; GELATO, Marie C
Objective Aging is associated with a redistribution of body fat including a relative loss of subcutaneous peripheral fat. These changes in body fat can have important clinical consequences since they are linked to increased risk of metabolic complications. The causes and mechanisms of loss of peripheral fat associated with aging are not clear. The aim of this study was to assess whether defects in adipogenesis contribute to fat loss in aging humans, as suggested from animal studies, and to evaluate the role of inflammation on pathogenesis of fat loss. Materials/Methods Preadipocytes isolated from subcutaneous peripheral fat of healthy young and elderly subjects were compared in their ability to replicate and differentiate. Results The results show that both the rate of replication and differentiation of preadipocytes are reduced in older subjects. The reduction in adipogenesis is accompanied by a higher plasma level of the inflammatory marker, soluble tumor necrosis factor receptor 2, and greater release of tumor necrosis factor α from fat tissue. Conclusions Thus, the gradual relative loss of peripheral fat in aging humans may in part result from a defect in adipogenesis, which may be linked to inflammation and increased release of proinflammatory cytokines from fat tissue. PMID:22999012
Foveal Processing Under Concurrent Peripheral Load in Profoundly Deaf Adults.
Dye, Matthew W G
Development of the visual system typically proceeds in concert with the development of audition. One result is that the visual system of profoundly deaf individuals differs from that of those with typical auditory systems. While past research has suggested deaf people have enhanced attention in the visual periphery, it is still unclear whether or not this enhancement entails deficits in central vision. Profoundly deaf and typically hearing adults were administered a variant of the useful field of view task that independently assessed performance on concurrent central and peripheral tasks. Identification of a foveated target was impaired by a concurrent selective peripheral attention task, more so in profoundly deaf adults than in the typically hearing. Previous findings of enhanced performance on the peripheral task were not replicated. These data are discussed in terms of flexible allocation of spatial attention targeted towards perceived task demands, and support a modified "division of labor" hypothesis whereby attentional resources co-opted to process peripheral space result in reduced resources in the central visual field. PMID:26657078
21 CFR 876.5310 - Nonimplanted, peripheral electrical continence device.
Code of Federal Regulations, 2011 CFR
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nonimplanted, peripheral electrical continence device. 876.5310 Section 876.5310 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices §...
Continuous cardiac output monitoring by peripheral blood pressure waveform analysis.
Mukkamala, Ramakrishna; Reisner, Andrew T; Hojman, Horacio M; Mark, Roger G; Cohen, Richard J
A clinical method for monitoring cardiac output (CO) should be continuous, minimally invasive, and accurate. However, none of the conventional CO measurement methods possess all of these characteristics. On the other hand, peripheral arterial blood pressure (ABP) may be measured reliably and continuously with little or no invasiveness. We have developed a novel technique for continuously monitoring changes in CO by mathematical analysis of a peripheral ABP waveform. In contrast to the previous techniques, our technique analyzes the ABP waveform over time scales greater than a cardiac cycle in which the confounding effects of complex wave reflections are attenuated. The technique specifically analyzes 6-min intervals of ABP to estimate the pure exponential pressure decay that would eventually result if pulsatile activity abruptly ceased (i.e., after the high frequency wave reflections vanish). The technique then determines the time constant of this exponential decay, which equals the product of the total peripheral resistance and the nearly constant arterial compliance, and computes proportional CO via Ohm's law. To validate the technique, we performed six acute swine experiments in which peripheral ABP waveforms and aortic flow probe CO were simultaneously measured over a wide physiologic range. We report an overall CO error of 14.6%. PMID:16532772
Platelet peripheral benzodiazepine receptors are decreased in Parkinson's disease
Bonuccelli, U.; Nuti, A.; Del Dotto, P.; Piccini, P.; Martini, C.; Giannacccini, G.; Lucacchini, A.; Muratorio, A. )
Peripheral benzodiazepine (BDZ) receptors are located in a variety of tissues, including platelets, in the nuclear and/or mitochondrial membranes. The authors studied the density of peripheral BDZ receptors in platelets of 10 de novo Parkinson's disease (PD) patients, 18 PD patients treated with a levodopa/carbidopa combination, and in 15 healthy subjects matched for sex and age. The binding assay was conducted using ({sup 3}H)PK 11195, a specific ligand for peripheral BDZ receptors. A significant decrease in the density of ({sup 3}H)PK 11195 binding sites has been observed in PD patients with respect to controls but not between de novo and treated PD patients. No correlation has been found between the decrease in density of ({sup 3}H)PK 11195 binding sites in platelets and either the duration or severity of PD. Peripheral BDZ receptors are implicated in the regulation of mitochondrial respiratory function. Thus, their decrease in PD might parallel the abnormalities in mitochondrial function recently found in this neurologic disease.
Peripheral Insulin Doesn't Alter Appetite of Broiler Chicks.
Liu, Lei; Xu, Shaohua; Wang, Xiaojuan; Jiao, Hongchao; Lin, Hai
An experiment was conducted to investigate the effect of peripheral insulin treatment on appetite in chicks. Six-d-age chicks with ad libitum feeding or fasting for 3 h before injection received a subcutaneous injection of 0, 1, 3, 5, 10, or 20 IU of insulin or vehicle (saline). The results showed peripheral insulin treatment (1 to 20 IU) did not alter significantly the feed intake in chicks under either ad libitum feeding or fasting conditions within 4 h (p>0.05). Compared with the control, plasma glucose concentration was significantly decreased after insulin treatment of 3, 5, 10, and 20 IU for 4 h in chicks with ad libitum feeding (p<0.05). In fasted chicks, 10 and 20 IU insulin treatments significantly decreased the plasma glucose level for 4 h (p<0.05). Peripheral insulin treatment of 10 IU for 2 or 4 h did not significantly affect the hypothalamic genes expression of neuropeptide Y, proopiomelanocortin, corticotropin-releasing factor and insulin receptors (p>0.05). All results suggest peripheral administration of insulin has no effect on appetite in chicks. PMID:26954230
NASA Technical Reports Server (NTRS)
Morring, Frank, Jr.
Industry proposals for the Crew Exploration Vehicle that NASA plans as a replacement for the space shuttle are due next week, but the agency's new chief says it might be necessary to slow the CEV procurement at first to speed it up later. After a quick trip to Kennedy Space Center for briefings on getting the space shuttle back in operation, Michael D. Griffin sat down with his growing staff last week to begin work on modifying the CEV procurement. "We are going to rethink our entire program in that area," he said during an inaugural press conference Apr. 18. The proposals due May 2 are being prepared in response to NASA's call for a "risk-reduction flight effort" in 2008 that would lead to delivery of a human-rated CEV in 2014. But Griffin was co-leader on an independent study in 2004 that recommended a way to get the CEV flying astronauts in 2010, the year President Bush has set as a deadline for retiring the space shuttle fleet. In that study, produced for The Planetary Society, Griffin and his team called for development of a 13-15-ton "Block 1" CEV limited to low Earth orbit (LEO) that would be launched atop a single space shuttle solid rocket motor (SRM), with a new cryogenic upper stage based on existing rocket engine technology, Under this approach, NASA would develop a "Block 2" CEV later for human exploration beyond LEO.
Peripheral Refraction with and without Contact Lens Correction
Shen, Jie; Clark, Christopher A.; Soni, P. Sarita; Thibos, Larry N.
Purpose Peripheral refractive error degrades the quality of retinal images and has been hypothesized to be a stimulus for the development of refractive error. The purpose of this study was to investigate the changes in refractive error across the horizontal visual field produced by contact lenses (CLs) and to quantify the effect of CLs on peripheral image blur. Methods A commercial Shack-Hartmann aberrometer measured ocular wavefront aberrations in 5° steps across the central 60° of visual field along the horizontal meridian before and after CLs correction. Wavefront refractions for peripheral lines-of-sight were based on the full elliptical pupil encountered in peripheral measurements. Curvature of field is the change in peripheral spherical equivalent relative to the eye's optical axis. Results Hyperopic curvature of field in the naked eye increases with increasing amounts central myopic refractive error as predicted by Atchison (2006). For an eccentricity of E degrees, field curvature is approximately E percent of foveal refractive error. Rigid gas permeable (RGP) lenses changed field curvature in the myopic direction twice as much as soft contact lenses (SCLs). Both of these effects varied with CLs power. For all lens powers, SCL cut the degree of hyperopic field curvature in half whereas RGP lenses nearly eliminated field curvature. The benefit of reduced field curvature was partially offset by increased oblique astigmatism. The net reduction of retinal blur due to CLs is approximately constant across the visual field. Conclusions Both SCL and RGP lenses reduced the degree of hyperopic field curvature present in myopic eyes, with RGP lenses having greater effect. The tradeoff between field curvature and off-axis astigmatism with RGP lenses may limit their effectiveness for control of myopia progression. These results suggest that axial growth mechanisms that depend on retinal image quality will be affected more by RGP than by SCL lenses. PMID:20601913
Neural tissue engineering options for peripheral nerve regeneration.
Gu, Xiaosong; Ding, Fei; Williams, David F
Tissue engineered nerve grafts (TENGs) have emerged as a potential alternative to autologous nerve grafts, the gold standard for peripheral nerve repair. Typically, TENGs are composed of a biomaterial-based template that incorporates biochemical cues. A number of TENGs have been used experimentally to bridge long peripheral nerve gaps in various animal models, where the desired outcome is nerve tissue regeneration and functional recovery. So far, the translation of TENGs to the clinic for use in humans has met with a certain degree of success. In order to optimize the TENG design and further approach the matching of TENGs with autologous nerve grafts, many new cues, beyond the traditional ones, will have to be integrated into TENGs. Furthermore, there is a strong requirement for monitoring the real-time dynamic information related to the construction of TENGs. The aim of this opinion paper is to specifically and critically describe the latest advances in the field of neural tissue engineering for peripheral nerve regeneration. Here we delineate new attempts in the design of template (or scaffold) materials, especially in the context of biocompatibility, the choice and handling of support cells, and growth factor release systems. We further discuss the significance of RNAi for peripheral nerve regeneration, anticipate the potential application of RNAi reagents for TENGs, and speculate on the possible contributions of additional elements, including angiogenesis, electrical stimulation, molecular inflammatory mediators, bioactive peptides, antioxidant reagents, and cultured biological constructs, to TENGs. Finally, we consider that a diverse array of physicochemical and biological cues must be orchestrated within a TENG to create a self-consistent coordinated system with a close proximity to the regenerative microenvironment of the peripheral nervous system. PMID:24818883
Associations between peripheral androgens and cortisol in infertile women.
Gleicher, Norbert; Seier, Kenneth; Kushnir, Vitaly A; Weghofer, Andrea; Wu, Yan-Guang; Wang, Qi; Albertini, David F; Barad, David H
Testosterone has in recent years been proven essential for normal growth and maturation of small growing follicles. Concomitantly, low functional ovarian reserve (LFOR), characterized by a small growing follicle pool, has been associated with low testosterone levels, which can be of ovarian and/or adrenal origin. In this study we, therefore, investigated whether peripheral sex steroid precursors and testosterone levels potentially reflect on adrenal function. In a retrospective cohort study of 355 consecutive infertile women, who presented to an academically affiliated fertility center in New York City, we investigated in a series of statistical models whether low peripheral sex steroid precursors and testosterone are associated with peripheral cortisol (C) levels, reflecting adrenal function. To determine potential correlations, we investigated the dehydroepiandrosterone (DHEA), DHEA sulfate (DHEAS), androstenedione (AD), total testosterone (TT), free testosterone (FT); sex hormone binding globulin (SHBG), anti-Müllerian hormone (AMH), thyroid stimulating hormone (TSH) and C in a series of multivariate and logistic regression analyses, utilizing C either as a continuous variable or with cut off <5.0μg/dL, and TT only as a continuous variable. Practically all models demonstrated significant predictability of peripheral sex hormone precursors for C levels, with DHEA demonstrating the strongest and most consistent predictability as an individual parameter and as part of the DHEAS/DHEA ratio. We conclude that in infertile women peripheral sex hormone precursors, especially DHEA, reflect C levels and, therefore, adrenal function. In infertile women, at all ages low levels of sex hormone precursors, therefore, should be considered indications for further adrenal assessments. PMID:26804970
Roof Plans: Section "CC", Roof Plan; Roof Framing Plans: Section ...
Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey
Roof Plans: Section "C-C", Roof Plan; Roof Framing Plans: Section "C-C", Section "D-D"; Roof Framing Sections: Cross Section "G-G", Cross Section "H-H" - Fort Washington, Fort Washington Light, Northeast side of Potomac River at Fort Washington Park, Fort Washington, Prince George's County, MD
Lectin histochemistry of normal and neoplastic peripheral nerve sheath. 1. Lectin binding pattern of normal peripheral nerve in man.
Matsumura, K; Nakasu, S; Nioka, H; Handa, J
The binding patterns of lectins to normal peripheral nerves were examined. Twelve biotinylated lectins were used in this study; Canavalia ensiformis (Con A), Pisum sativum (PSA), Lens culinaris (LCA), Ricinus communis 1 (RCA-1), Arachis hypogaea (PNA), Glycine max (SBA), Sophora japonica (SJA), Bandeiraea simplicifolia 1 (BSL-1), Triticum vulgaris (WGA), succinylated WGA (s-WGA), Ulex europaeus 1 (UEA-1) and Helix pomatia (HPA). Cytoplasm of Schwann cells and perineurial cells was stained by Con A, PSA, LCA, s-WGA and WGA. PNA showed specific binding to perineurial cells, while after neuraminidase treatment stain with this lectin was demonstrated also in Schwann cells. Myelin sheaths were stained with fewer lectins. SBA and HPA with sialic acid removal rarely showed reactivity to the peripheral nerve structure in surgical specimens, in contrast to clear staining of Schwann cells, perineurial cells and myelin sheaths in autopsy specimens. The present study shows distinct lectin stainings of specific structures of the normal human peripheral nerves, and provides important basic information on the alterations of lectin binding patterns during pathological processes in the peripheral nerves. PMID:8310810
Interocular Difference of Peripheral Refraction in Anisomyopic Eyes of Schoolchildren
Chen, Junhong; He, Ji C.; Chen, Yunyun; Xu, Jingjing; Wu, Haoran; Wang, Feifu; Lu, Fan; Jiang, Jun
Purpose Refraction in the peripheral visual field is believed to play an important role in the development of myopia. The purpose of this study was to investigate the differences in peripheral refraction among anisomyopia, isomyopia, and isoemmetropia for schoolchildren. Methods Thirty-eight anisomyopic children were recruited and divided into two groups: (1) both eyes were myopic (anisomyopic group, AM group) and (2) one eye was myopic and the contralateral eye was emmetropic (emmetropic anisomyopic group, EAM group). As controls, 45 isomyopic and isoemmetropic children were also recruited with age and central spherical equivalent (SE) matched to those of the AM and EAM groups. The controls were divided into three groups: (1) intermediate myopia group (SE matched to the more myopic eye of AM group), (2) low myopia group (SE matched to the less myopic eye of AM group and the more myopic eye of EAM group), and (3) emmetropia group (SE matched to the less myopic eye of EAM group). Peripheral refraction at 7 points across the central ±30° on the horizontal visual field with a 10° interval was measured with an autorefractor. Axial length (AL), corneal curvature (CC), and anterior chamber depth (ACD) were also determined by using the Zeiss IOL-Master. Results The relative peripheral spherical equivalent [RPR(M)] and relative peripheral spherical value [RPR(S)] of the more myopic eye was shifted more hyperopically than the contralateral eye in both the AM and the EAM groups (both p<0.0001). The RPR(M, S) of the less myopic eyes in the AM and EAM groups showed a relatively flat trend across the visual field and were not significantly different from the emmetropia group. The RPR(M, S) of less myopic eyes in the AM group were shifted less hyperopically than in the isomyopic low myopia group and the more myopic eye of the EAM group [RPR(M), p = 0.007; RPR(S), p = 0.001], although the central SEs of the three groups were not significantly different from each other. However
Rinne, C.A.; Curry, R.H.; Hagan, J.W.; Seiler, S.W.; Sommer, D.J. ); Yancey, E.F. )
The Hanford Site Development Plan (Site Development Plan) is intended to guide the short- and long-range development and use of the Hanford Site. All acquisition, development, and permanent facility use at the Hanford Site will conform to the approved plan. The Site Development Plan also serves as the base document for all subsequent studies that involve use of facilities at the Site. This revision is an update of a previous plan. The executive summary presents the highlights of the five major topics covered in the Site Development Plan: general site information, existing conditions, planning analysis, Master Plan, and Five-Year Plan. 56 refs., 67 figs., 31 tabs.
Treatment parameters for beta and gamma devices in peripheral endovascular brachytherapy
Kirisits, Christian . E-mail: firstname.lastname@example.com; Pokrajac, Boris; Berger, Daniel; Minar, Erich; Poetter, Richard; Georg, Dietmar
Purpose: To determine dosimetric parameters, such as radial and longitudinal dose profiles, for {beta} and {gamma} devices in peripheral endovascular brachytherapy. Methods and materials: An {sup 192}Ir high-dose rate stepping source, a {sup 90}Sr source train, and a {sup 32}P-coated radiation balloon were investigated. The treatment-planning software PLATO, Monte Carlo code EGSnrc, and GafChromic film dosimetry were used to analyze the dose distribution of these devices. Results: For a 5-mm-diameter vessel, the ratio between the dose at 2 mm depth and the dose at the lumen surface was 1.8, 3.4, and 16.2 for the {sup 192}Ir, {sup 90}Sr, and {sup 32}P devices, respectively. The dose variation at the reference depth of 2 mm into the vessel wall was 7-18 Gy, for different analyzed dose prescriptions. The reference lumen dose was different by a factor >8. For all three devices, the reference isodose length was not <5 mm on the proximal and distal edge of the active source length. Conclusions: A complete set of dose parameters for {beta} and {gamma} sources has to be considered for appropriate treatment planning and performance, including reporting of reference depth dose, reference lumen dose, and reference isodose length.
Peripheral Tumor with Osteodentin and Cementum-like Material in an Infant: Odontogenic Hamartoma or Odontoma?
Sfakianou, Aikaterini; Emmanouil, Dimitris E; Tosios, Konstantinos I; Sklavounou, Alexandra
The purpose of this report is to describe a peripheral tumor on the mandibular alveolar ridge of a seven-month-old Caucasian boy, consisting of ectomesencymal odontogenic tissues, in particular osteodentin and cementum-like material, in a cellular or loose vascular connective tissue stroma. This case may be considered either a peripheral odontogenic hamartoma or a peripheral odontoma. PMID:27098720
Image analysis software for following progression of peripheral neuropathy
NASA Astrophysics Data System (ADS)
Epplin-Zapf, Thomas; Miller, Clayton; Larkin, Sean; Hermesmeyer, Eduardo; Macy, Jenny; Pellegrini, Marco; Luccarelli, Saverio; Staurenghi, Giovanni; Holmes, Timothy
A relationship has been reported by several research groups [1 - 4] between the density and shapes of nerve fibers in the cornea and the existence and severity of peripheral neuropathy. Peripheral neuropathy is a complication of several prevalent diseases or conditions, which include diabetes, HIV, prolonged alcohol overconsumption and aging. A common clinical technique for confirming the condition is intramuscular electromyography (EMG), which is invasive, so a noninvasive technique like the one proposed here carries important potential advantages for the physician and patient. A software program that automatically detects the nerve fibers, counts them and measures their shapes is being developed and tested. Tests were carried out with a database of subjects with levels of severity of diabetic neuropathy as determined by EMG testing. Results from this testing, that include a linear regression analysis are shown.
Peripheral activities of growth hormone-releasing hormone.
Granata, R
Growth hormone (GH)-releasing hormone (GHRH) is produced by the hypothalamus and stimulates GH synthesis and release in the anterior pituitary gland. In addition to its endocrine role, GHRH exerts a wide range of extrapituitary effects which include stimulation of cell proliferation, survival and differentiation, and inhibition of apoptosis. Accordingly, expression of GHRH, as well as the receptor GHRH-R and its splice variants, has been demonstrated in different peripheral tissues and cell types. Among the direct peripheral activities, GHRH regulates pancreatic islet and β-cell survival and function and endometrial cell proliferation, promotes cardioprotection and wound healing, influences the immune and reproductive systems, reduces inflammation, indirectly increases lifespan and adiposity and acts on skeletal muscle cells to inhibit cell death and atrophy. Therefore, it is becoming increasingly clear that GHRH exerts important extrapituitary functions, suggesting potential therapeutic use of the peptide and its analogs in a wide range of medical settings. PMID:26891937
Photoacoustic tomography of small-animal and human peripheral joints
NASA Astrophysics Data System (ADS)
Wang, Xueding; Chamberland, David L.; Fowlkes, J. Brian; Carson, Paul L.; Jamadar, David A.
As an emerging imaging technology that combines the merits of both light and ultrasound, photoacoustic tomography (PAT) holds promise for screening and diagnosis of inflammatory joint diseases such as rheumatoid arthritis. In this study, the feasibility of PAT in imaging small-animal joints and human peripheral joints in a noninvasive manner was explored. Ex vivo rat tail and fresh cadaveric human finger joints were imaged. Based on the intrinsic optical contrast, intra- and extra-articular tissue structures in the joints were visualized successfully. Using light in the near-infrared region, the imaging depth of PAT is sufficient for cross-sectional imaging of a human peripheral joint as a whole organ. PAT, as a novel imaging modality with unique advantages, may contribute significantly to the early diagnosis of inflammatory joint disorders and accurate monitoring of disease progression and response to therapy.
Design of peripheral airways for efficient gas exchange.
Weibel, Ewald R; Sapoval, Bernard; Filoche, Marcel
Peripheral airways combine branched tubes for ventilation with the gas exchanging alveoli in the pulmonary acini, defined as the complex of airways supplied by one first order respiratory or transitional bronchiole. In this part, the replenishment of oxygen at the alveolar surface occurs by a combination of convective air flow with diffusion of oxygen in the air. The transition between convection and diffusion depends on the morphometric properties of the airways. The design of the peripheral airways in the acinus of the human lung is described quantitatively on the basis of measurements obtained on casts of the acinar airways. Comparable data for rat and rabbit are also discussed. On the basis of this morphometric information, a typical path model for human acinar airways is derived. These studies also form the basis for advanced modeling studies of gas exchange and ventilation. In particular the problems occurring because of diffusional screening and the design conditions for minimizing this effect are discussed. PMID:15921964
Effects of lymphoma on the peripheral nervous system.
Hughes, R A; Britton, T; Richards, M
Peripheral nervous system abnormalities occur in 5% of patients with lymphoma and have a wide differential diagnosis. Herpes zoster is the commonest cause. Vinca alkaloids are the only drugs used in lymphoma which commonly cause neuropathy. Compression or infiltration of nerve roots by lymphoma is a rare presenting feature but becomes more common with advanced disease. Radiation plexopathy does not usually develop until at least 6 months after irradiation and can be difficult to distinguish from neoplastic infiltration. Either multifocal infiltration of nerves or lymphoma-associated vasculitis may present as a peripheral neuropathy. The incidence of Guillain-Barré (GBS) syndrome, and possibly chronic idiopathic demyelinating polyradiculoneuropathy, appears to be increased in association with lymphoma, especially Hodgkin's disease. Subacute sensory neuronopathy and subacute lower motor neuronopathy have both been reported as paraneoplastic syndromes associated with Hodgkin's disease. Treatment of the underlying lymphoma is only rarely followed by recovery of the associated neuropathy. PMID:7932460
Post-traumatic stimulus suppressible myoclonus of peripheral origin.
Assal, F; Magistris, M R; Vingerhoets, F J
A patient is described who presented with myoclonus of the first dorsal interosseus muscle of the right foot. This myoclonus occurred 18 months after trauma of the cutaneous branch of the deep peroneal nerve on the dorsal aspect of the foot. Tactile stimulation in the dermatome of this nerve, or an anaesthetic block of the deep peroneal nerve stopped the myoclonus. The different innervation between the efferent motor activity responsible for the movements and the sensory afference suppressing it points firmly towards involvement of central connections. However, abolition of the movement by anaesthesia suggests the presence of a peripheral ectopic generator. This finding confirms that focal myoclonus can have its origin in the peripheral nervous system and may be modulated by sensory inputs. PMID:9598689
Tissue engineering and peripheral nerve reconstruction: an overview.
Geuna, Stefano; Gnavi, Sara; Perroteau, Isabelle; Tos, Pierluigi; Battiston, Bruno
Nerve repair is no more regarded as merely a matter of microsurgical reconstruction. To define this evolving reconstructive/regenerative approach, the term tissue engineering is being increasingly used since it reflects the search for interdisciplinary and integrated treatment strategies. However, the drawback of this new approach is its intrinsic complexity, which is the result of the variety of scientific disciplines involved. This chapter presents a synthetic overview of the state of the art in peripheral nerve tissue engineering with a look forward at the most promising innovations emerging from basic science investigation. This review is intended to set the stage for the collection of papers in the thematic issue of the International Review of Neurobiology that is focused on the various interdisciplinary approaches in peripheral nerve tissue engineering. PMID:24083430
Qigong Effects on Heart Rate Variability and Peripheral Vasomotor Responses.
Chang, Mei-Ying
Population aging is occurring worldwide, and preventing cardiovascular event in older people is a unique challenge. The aim of this study was to examine the effects of a 12-week qigong (eight-form moving meditation) training program on the heart rate variability and peripheral vasomotor response of middle-aged and elderly people in the community. This was a quasi-experimental study that included the pre-test, post-test, and nonequivalent control group designs. Seventy-seven participants (experimental group = 47; control group = 30) were recruited. The experimental group performed 30 min of eight-form moving meditation 3 times per week for 12 weeks, and the control group continued their normal daily activities. After 12 weeks, the interaction effects indicated that compared with the control group, the experimental group exhibited significantly improved heart rate variability and peripheral vasomotor responses. PMID:24869492
Spontaneous malignant glaucoma in a patient with patent peripheral iridotomy
Background To report a case of spontaneous malignant glaucoma in an Asian female. To propose the term "positive vitreous pressure glaucoma" to reflect the pathophysiology, treatment and prognosis of the condition. Case presentation A 56-year old Chinese female was diagnosed of primary angle closure glaucoma and had bilateral laser peripheral iridotomy one year ago. She presented with spontaneous onset of malignant glaucoma involving the left eye. The condition was treated successfully; the final best corrected visual acuity was 0.67 (decimal notation). Conclusion This case highlights that acute angle closure attack can occur in an eye with patent peripheral iridotomy. Early recognition and treatment is essential for good visual prognosis. PMID:23241197
Journey to the skin: Somatosensory peripheral axon guidance and morphogenesis.
Wang, Fang; Julien, Donald P; Sagasti, Alvaro
The peripheral axons of vertebrate tactile somatosensory neurons travel long distances from ganglia just outside the central nervous system to the skin. Once in the skin these axons form elaborate terminals whose organization must be regionally patterned to detect and accurately localize different kinds of touch stimuli. This review describes key studies that identified choice points for somatosensory axon growth cones and the extrinsic molecular cues that function at each of those steps. While much has been learned in the past 20 years about the guidance of these axons, there is still much to be learned about how the peripheral axons of different kinds of somatosensory neurons adopt different trajectories and form specific terminal structures. PMID:23670092
Uveal Melanoma in the Peripheral Choroid Masquerading as Chronic Uveitis
Feng, Lei; Zhu, Jiang; Gao, Tao; Li, Baizhou; Yang, Yabo
ABSTRACT Purpose To describe a case of uveal melanoma in the peripheral choroid masquerading as chronic uveitis and to raise awareness about malignant masquerade syndromes. Case Report A 36-year-old Chinese woman presented from an outside ophthalmologist with a 6-month history of unilateral chronic uveitis unresponsive to medical therapy in the left eye. She was found to have a uveal melanoma in the retinal periphery and underwent successful enucleation of her left eye. The histopathological diagnosis confirmed the clinical diagnosis. Conclusions When uveal melanoma presents in an atypical way, the diagnosis is more difficult. This case highlights the uncommon presentations of malignant melanoma of the choroid. It provides valuable information on how peripheral uveal melanoma can present with clinical signs consistent with an anterior uveitis. PMID:25036546
[Cardiac tamponade after withdrawal of a peripheral access central catheter].
García-Galiana, E; Sanchis-Gil, V; Martínez-Navarrete, M Á
Central venous catheterization is a very common technique, although its complications can be multiple and sometimes fatal. A case is presented of cardiac tamponade by parenteral nutrition a few hours after moving a central venous catheter peripherally inserted a few days before. The diagnosis was made by echocardiography, and an emergency pericardiocentesis was performed, achieving complete recovery of the patient. Peripherally inserted central venous catheters are more likely to change their position secondary to the movements of the patient's arm, thus it is important to use soft catheters, make sure the tip lies above the carina to avoid perforation of the pericardial reflexion, and fix it well to the skin. Diagnosis must be made as soon as possible, given the high mortality rate of this complication, and the essential diagnostic tool is echocardiography. Elective treatment consists of early catheter withdrawal and emergency pericardiocentesis. PMID:24929256
Potential Peripheral Biomarkers for the Diagnosis of Alzheimer's Disease
Patel, Seema; Shah, Raj J.; Coleman, Paul; Sabbagh, Marwan
Advances in the discovery of a peripheral biomarker for the diagnosis of Alzheimer's would provide a way to better detect the onset of this debilitating disease in a manner that is both noninvasive and universally available. This paper examines the current approaches that are being used to discover potential biomarker candidates available in the periphery. The search for a peripheral biomarker that could be utilized diagnostically has resulted in an extensive amount of studies that employ several biological approaches, including the assessment of tissues, genomics, proteomics, epigenetics, and metabolomics. Although a definitive biomarker has yet to be confirmed, advances in the understanding of the mechanisms of the disease and major susceptibility factors have been uncovered and reveal promising possibilities for the future discovery of a useful biomarker. PMID:22114744
Peripheral glucose metabolism and insulin sensitivity in Alzheimer's disease.
Kilander, L; Boberg, M; Lithell, H
Twenty-four patients with Alzheimer's disease and matched controls were examined with reference to metabolic parameters such as peripheral insulin and glucose metabolism, serum lipid concentrations and blood pressure levels. Blood glucose levels and insulin response were measured during an intravenous glucose tolerance test and peripheral insulin sensitivity was estimated with the hyperinsulinemic euglycemic clamp technique. There were no differences recorded between the two groups in glucose metabolism, triglyceride, cholesterol or HDL-cholesterol levels. The patients with Alzheimer's disease had significantly lower blood pressure levels, which partly could be explained by ongoing treatment with neuroleptics and antidepressives. Previous findings of higher insulin levels in Alzheimer's disease could not be verified. PMID:8503259
Spatial and nonspatial peripheral auditory processing in congenitally blind people.
Chen, Qi; Zhang, Ming; Zhou, Xiaolin
Congenitally blind adults' performance in spatial and nonspatial peripheral auditory attention tasks was compared with that of sighted adults in a paradigm manipulating location-based and frequency-based inhibition of return concurrently. Blind study participants responded faster in spatial attention tasks (detection/localization) and slower in the nonspatial frequency discrimination task than sighted participants. Both groups, however, showed the same patterns of interaction between location-based and frequency-based inhibition of return. These results suggest that early vision deprivation enhances the function of the posterior-dorsal auditory 'where' pathway but impairs the function of the anterior-ventral 'what' pathway during peripheral auditory attention. The altered processing speed in the blind, however, is not accompanied by alteration in attentional orienting mechanisms that may be localized to higher cortices. PMID:16932156
Methodological Considerations to Strengthen Studies of Peripheral Vision.
Odegaard, Brian; Lau, Hakwan
In a recent issue of Trends in Cognitive Sciences, Cohen et al.[1] argue that the study of visual summary statistics represents an elegant method to account for the richness of visual experience in the periphery. We resoundingly agree that employing ensemble statistics is a strong step towards resolving questions of how conscious we are of our visual surroundings. However, we think the explanatory power of this approach can be augmented by focusing on two specific areas: (i) psychophysical quantification of metacognitive capacities and decision biases associated with peripheral vision; (ii) distinction between perceptual decisions that involve different levels of detail. Consideration of these issues will facilitate the development of precise hypotheses about peripheral phenomenology and yield useful data from experiments investigating summary statistics; we explain how below. PMID:27388876
Peripheral arterial disease in general and diabetic population.
Rabia, K; Khoo, E M
Peripheral arterial disease (PAD) is stenosis or occlusion of peripheral arterial vessels by atherosclerotic plaque. It may present as intermittent claudication, rest pain and impotence. PAD of the lower limbs is the third most important site of atherosclerotic disease after coronary heart disease and cerebrovascular disease. Increasing age, family history, smoking, hypertension, dyslipidemia and more decisively diabetes are significant risk factors. PAD is a clinical condition that has often been neglected, underdiagnosed, undertreated and has a serious outcome. It may lead to nonhealing wounds, gangrene and amputation of the lower limbs. Hence, early identification of patients at risk of PAD and timely referral to the vascular surgeon in severe cases is crucial. PMID:18705464
Peripheral Serotonin: a New Player in Systemic Energy Homeostasis
Namkung, Jun; Kim, Hail; Park, Sangkyu
Whole body energy balance is achieved through the coordinated regulation of energy intake and energy expenditure in various tissues including liver, muscle and adipose tissues. A positive energy imbalance by excessive energy intake or insufficient energy expenditure results in obesity and related metabolic diseases. Although there have been many obesity treatment trials aimed at the reduction of energy intake, these strategies have achieved only limited success because of their associated adverse effects. An ancient neurotransmitter, serotonin is among those traditional pharmacological targets for anti-obesity treatment because it exhibits strong anorectic effect in the brain. However, recent studies suggest the new functions of peripheral serotonin in energy homeostasis ranging from the endocrine regulation by gut-derived serotonin to the autocrine/paracrine regulation by adipocyte-derived serotonin. Here, we discuss the role of serotonin in the regulation of energy homeostasis and introduce peripheral serotonin as a possible target for anti-obesity treatment. PMID:26628041
Chemotherapy-induced peripheral neuropathy - diagnosis, evolution and treatment.
Iżycki, Dariusz; Niezgoda, Adam Andrzej; Kaźmierczak, Maciej; Piorunek, Tomasz; Iżycka, Natalia; Karaszewska, Bogusława; Nowak-Markwitz, Ewa
Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most frequent neurologic complications experienced by patients receiving antineoplastic drugs. Involvement of the peripheral nerves may have an important impact on daily activi-ties and lead to severe impairment of the patient's quality of life (QoL). It seems to be of crucial importance to make a correct and early diagnosis of polyneuropathy and, if possible, spare the patient unnecessary suffering or loss of function. In the preceding article we have presented epidemiology, grading and pathogenesis of the toxic CIPN. The purpose of this article is to review current knowledge of diagnostic techniques, prevention and management strategies in the context of CIPN. PMID:27504945
Selective recovery of fascicular activity in peripheral nerves
NASA Astrophysics Data System (ADS)
Wodlinger, B.; Durand, D. M.
The peripheral nerves of an amputee's residual limb still carry the information required to provide the robust, natural control signals needed to command a dexterous prosthetic limb. However, these signals are mixed in the volume conductor of the body and extracting them is an unmet challenge. A beamforming algorithm was used to leverage the spatial separation of the fascicular sources, recovering mixed pseudo-spontaneous signals with normalized mean squared error of 0.14 ± 0.10 (n = 12) in an animal model. The method was also applied to a human femoral nerve model using computer simulations and recovered all five fascicular-group signals simultaneously with R2 = 0.7 ± 0.2 at a signal-to-noise ratio of 0 dB. This technique accurately separated peripheral neural signals, potentially providing the voluntary, natural and robust command signals needed for advanced prosthetic limbs.
The Clinical Spectrum of Isolated Peripheral Motor Dysfunction
Sanderson, Alan B.; Arnold, W. David; Elsheikh, Bakri; Kissel, John T.
Introduction Isolated peripheral motor dysfunction due to lower motor neuron or peripheral nerve disorders presents an interesting challenge to clinicians because of the diverse differential diagnosis with a broad range of prognoses. Methods We retrospectively reviewed clinical data of adults who presented over 12 years with muscle weakness, atrophy, or fasciculations, but without hyperreflexia or sensory involvement. Results In 119 patients, 52% had a motor neuron disease (MND), 13% had immune neuropathies, 11% had genetic neuronopathies, 10% had residual or post-polio syndrome, 5% had benign fasciculation, 1% had an infectious etiology, and 8% were not given a final diagnosis. Only MND patients had cognitive dysfunction or frontal release signs. Bulbar and respiratory symptoms virtually excluded consideration of immune neuropathy. Conclusions Only half of the patients were diagnosed with MND. A significant minority have treatable conditions. Cognitive involvement, frontal release signs, and bulbar or respiratory symptoms are strongly suggestive of MND. PMID:25042002
Overview of Classification Systems in Peripheral Artery Disease
Hardman, Rulon L.; Jazaeri, Omid; Yi, J.; Smith, M.; Gupta, Rajan
Peripheral artery disease (PAD), secondary to atherosclerotic disease, is currently the leading cause of morbidity and mortality in the western world. While PAD is common, it is estimated that the majority of patients with PAD are undiagnosed and undertreated. The challenge to the treatment of PAD is to accurately diagnose the symptoms and determine treatment for each patient. The varied presentations of peripheral vascular disease have led to numerous classification schemes throughout the literature. Consistent grading of patients leads to both objective criteria for treating patients and a baseline for clinical follow-up. Reproducible classification systems are also important in clinical trials and when comparing medical, surgical, and endovascular treatment paradigms. This article reviews the various classification systems for PAD and advantages to each system. PMID:25435665
Peripheral Arterial Disease in Patients with Type 2 Diabetes Mellitus
Rhee, Sang Youl
Peripheral arterial disease (PAD) in patients with type 2 diabetes mellitus (T2DM) exhibits broad clinical characteristics and various consequences and is known as one of the major macrovascular complications of T2DM. Atherosclerosis is recognized as the most direct and important cause of PAD, but acute or chronic limb ischemia may be the result of various risk factors. In light of the increasing number of patients who undergo peripheral vascular procedures, the number of subjects who are exposed to the risks for PAD and related complications is increasing. In this review, we will discuss the clinical and epidemiological characteristics of PAD, as well as the clinical significance of PAD in T2DM subjects. PMID:26301189
RU 486 inhibits peripheral effects of glucocorticoids in humans.
Gaillard, R C; Poffet, D; Riondel, A M; Saurat, J H
RU 486 [17 beta-hydroxy-11 beta-(4-dimethylaminophenyl)17 alpha-(prop-1-ynyl)estra-4,9-dien-3-one] is a synthetic steroid receptor antagonist. To evaluate the peripheral antiglucocorticoid action of this compound, we investigated its ability to antagonize cutaneous steroid-induced vasoconstriction. This phenomenon, produced by three different topical steroids in six normal men, was consistently and significantly attenuated or abolished by oral administration of 6 mg/kg RU 486. This demonstration of a peripheral action of RU 486 is important in relation to the potential therapeutic use of this well tolerated drug in states of hypercortisolism. It also indicates that the cutaneous vasoconstrictor effects of topical steroids are mediated by occupancy of glucocorticoid receptors. PMID:4055982
Molecular mechanisms regulating myelination in the peripheral nervous system.
Pereira, Jorge A; Lebrun-Julien, Frédéric; Suter, Ueli
Glial cells and neurons are engaged in a continuous and highly regulated bidirectional dialog. A remarkable example is the control of myelination. Oligodendrocytes in the central nervous system (CNS) and Schwann cells (SCs) in the peripheral nervous system (PNS) wrap their plasma membranes around axons to organize myelinated nerve fibers that allow rapid saltatory conduction. The functionality of this system is critical, as revealed by numerous neurological diseases that result from deregulation of the system, including multiple sclerosis and peripheral neuropathies. In this review we focus on PNS myelination and present a conceptual framework that integrates crucial signaling mechanisms with basic SC biology. We will highlight signaling hubs and overarching molecular mechanisms, including genetic, epigenetic, and post-translational controls, which together regulate the interplay between SCs and axons, extracellular signals, and the transcriptional network. PMID:22192173
The role of exosomes in peripheral nerve regeneration
Ching, Rosanna C.; Kingham, Paul J.
Peripheral nerve injuries remain problematic to treat, with poor functional recovery commonly observed. Injuries resulting in a nerve gap create specific difficulties for axonal regeneration. Approaches to address these difficulties include autologous nerve grafts (which are currently the gold standard treatment) and synthetic conduits, with the latter option being able to be impregnated with Schwann cells or stem cells which provide an appropriate micro-environment for neuronal regeneration to occur. Transplanting stem cells, however, infers additional risk of malignant transformation as well as manufacturing difficulties and ethical concerns, and the use of autologous nerve grafts and Schwann cells requires the sacrifice of a functioning nerve. A new approach utilizing exosomes, secreted extracellular vesicles, could avoid these complications. In this review, we summarize the current literature on exosomes, and suggest how they could help to improve axonal regeneration following peripheral nerve injury. PMID:26109947