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Tuck N, Pollard C, Good C, Williams C, Lewis G, Hames M, Aamir T, Bean D. Active Virtual Reality for Chronic Primary Pain: Mixed Methods Randomized Pilot Study. JMIR Form Res 2022; 6:e38366. [PMID: 35830224 PMCID: PMC9330488 DOI: 10.2196/38366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/23/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background The modern management of chronic pain is largely focused on improving functional capacity (often despite ongoing pain) by using graded activation and exposure paradigms. However, many people with chronic pain find functional activation programs aversive, and dropout rates are high. Modern technologies such as virtual reality (VR) could provide a more enjoyable and less threatening way for people with chronic pain to engage in physical activity. Although VR has been successfully used for pain relief in acute and chronic pain settings, as well as to facilitate rehabilitation in conditions such as stroke and cerebral palsy, it is not known whether VR can also be used to improve functional outcomes in people with chronic pain. Objective This study aimed to assess the feasibility of conducting an adequately powered randomized controlled trial (RCT) to test the efficacy of VR in a chronic pain treatment center and assess the acceptability of an active VR treatment program for patients in this setting. Methods For this mixed methods pilot study, which was designed to test the feasibility and acceptability of the proposed study methods, 29 people seeking treatment for chronic pain were randomized to an active VR intervention or physiotherapy treatment as usual (TAU). The TAU group completed a 6-week waitlist before receiving standard treatment to act as a no-treatment control group. The VR intervention comprised twice-weekly immersive and embodied VR sessions using commercially available gaming software, which was selected to encourage movement. A total of 7 VR participants completed semistructured interviews to assess their perception of the intervention. Results Of the 99 patients referred to physiotherapy, 53 (54%) were eligible, 29 (29%) enrolled, and 17 (17%) completed the trial, indicating that running an adequately powered RCT in this setting would not be feasible. Despite this, those in the VR group showed greater improvements in activity levels, pain intensity, and pain interference and reported greater treatment satisfaction and perceived improvement than both the waitlist and TAU groups. Relative effect sizes were larger when VR was compared with the waitlist (range small to very large) and smaller when VR was compared with TAU (range none to medium). The qualitative analysis produced the following three themes: VR is an enjoyable alternative to traditional physiotherapy, VR has functional and psychological benefits despite continued pain, and a well-designed VR setup is important. Conclusions The active VR intervention in this study was highly acceptable to participants, produced favorable effects when compared with the waitlist, and showed similar outcomes as those of TAU. These findings suggest that a confirmatory RCT is warranted; however, substantial barriers to recruitment indicate that incentivizing participation and using a different treatment setting or running a multicenter trial are needed.
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Affiliation(s)
- Natalie Tuck
- The Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- The Pain Management Unit, Department of Anaesthesiology and Perioperative Medicine, Waitematā District Health Board, Auckland, New Zealand
| | - Catherine Pollard
- The Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- The Auckland Regional Pain Service, Auckland District Health Board, Auckland, New Zealand
| | - Clinton Good
- The Auckland Regional Pain Service, Auckland District Health Board, Auckland, New Zealand
| | - Caitlin Williams
- The Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Gwyn Lewis
- The Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Murray Hames
- The Auckland Regional Pain Service, Auckland District Health Board, Auckland, New Zealand
| | - Tipu Aamir
- The Auckland Regional Pain Service, Auckland District Health Board, Auckland, New Zealand
| | - Debbie Bean
- The Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- The Pain Management Unit, Department of Anaesthesiology and Perioperative Medicine, Waitematā District Health Board, Auckland, New Zealand
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Canham S, Davidson S, Custodio K, Mauboules C, Good C, Wister AV, Bosma H. HEALTH NEEDS OF OLDER HOMELESS PERSONS WHO ARE TRANSITIONING FROM HOSPITAL TO SHELTER/HOUSING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Canham
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - S Davidson
- Gerontology Research Centre, Simon Fraser University, Vancouver, BC, Canada
| | - K Custodio
- Providence Health Care, Vancouver, BC, Canada
| | - C Mauboules
- Homelessness Services Association of BC, Vancouver, BC, Canada
| | - C Good
- Homelessness Services Association of BC, Vancouver, BC, Canada
| | - A V Wister
- Gerontology Research Centre, Simon Fraser University, Vancouver, BC, Canada
| | - H Bosma
- Providence Health Care, Vancouver, BC, Canada
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Good C, May T, Crouse C, Summerfelt S, Welch TJ. Assessing the impact of swimming exercise and the relative susceptibility of rainbow trout Oncorhynchus mykiss (Walbaum) and Atlantic salmon Salmo salar L. following injection challenge with Weissella ceti. J Fish Dis 2016; 39:1387-1391. [PMID: 27087506 DOI: 10.1111/jfd.12468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 06/05/2023]
Affiliation(s)
- C Good
- The Conservation Fund's Freshwater Institute, Shepherdstown, WV, USA.
| | - T May
- The Conservation Fund's Freshwater Institute, Shepherdstown, WV, USA
| | - C Crouse
- The Conservation Fund's Freshwater Institute, Shepherdstown, WV, USA
| | - S Summerfelt
- The Conservation Fund's Freshwater Institute, Shepherdstown, WV, USA
| | - T J Welch
- National Center for Cool and Cold Water Aquaculture, USDA-ARS, Kearneysville, WV, USA.
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Good C, Davidson J, Wiens GD, Welch TJ, Summerfelt S. Flavobacterium branchiophilum and F. succinicans associated with bacterial gill disease in rainbow trout Oncorhynchus mykiss (Walbaum) in water recirculation aquaculture systems. J Fish Dis 2015; 38:409-13. [PMID: 24720801 PMCID: PMC4406145 DOI: 10.1111/jfd.12249] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/18/2014] [Accepted: 02/21/2014] [Indexed: 05/24/2023]
Affiliation(s)
- C Good
- The Conservation Fund's Freshwater InstituteShepherdstown, WV, USA
| | - J Davidson
- The Conservation Fund's Freshwater InstituteShepherdstown, WV, USA
| | - G D Wiens
- National Center for Cool and Cold Water AquacultureKearneysville, WV, USA
| | - T J Welch
- National Center for Cool and Cold Water AquacultureKearneysville, WV, USA
| | - S Summerfelt
- The Conservation Fund's Freshwater InstituteShepherdstown, WV, USA
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McDonald S, Pullenayegum E, Taylor V, Lutsiv O, Bracken K, Good C, Hutton E, Chen A, Hutchison R, Malott A, McDonald H, Sword W. Three-quarters of overweight and obese women are planning on exceeding the gestational weight gain recommendations. Can J Diabetes 2011. [DOI: 10.1016/s1499-2671(11)52180-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Porto L, Preibisch C, Hattingen E, Bartels M, Lehrnbecher T, Dewitz R, Zanella F, Good C, Lanfermann H, DuMesnil R, Kieslich M. Voxel-based morphometry and diffusion-tensor MR imaging of the brain in long-term survivors of childhood leukemia. Eur Radiol 2008; 18:2691-700. [PMID: 18491104 DOI: 10.1007/s00330-008-1038-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 03/06/2008] [Accepted: 04/06/2008] [Indexed: 11/25/2022]
Abstract
The aims of this study were to detect morphological changes in neuroanatomical components in adult survivors of acute lymphoblastic leukemia (ALL). Voxel-based morphometry (VBM) can be used to detect subtle structural changes in brain morphology and via analysis of fractional anisotropy (FA), diffusion-tensor imaging (DTI) can non-invasively probe white matter (WM) integrity. We used VBM and DTI to examine 20 long-term survivors of ALL and 21 healthy matched controls. Ten ALL survivors received chemotherapy and irradiation; ten survivors received chemotherapy alone during childhood. Imaging was performed on a 3.0-T MRI. For VBM, group comparisons of segmented T1-weighted grey matter (GM) and WM images from controls and ALL survivors were performed separately for patients who received chemotherapy alone and who received chemotherapy and irradiation. For DTI, FA in WM was compared for the same groups. Survivors of childhood ALL who underwent cranial irradiation during childhood had smaller WM volumes and reduced GM concentration within the caudate nucleus and thalamus. The FA in WM was reduced in adult survivors of ALL but the effect was more severe after combined treatment with irradiation and chemotherapy. Our results indicate that DTI and VBM can reveal persistent long-term WM and caudate changes in children after ALL treatment, even without T2 changes in conventional imaging.
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Affiliation(s)
- L Porto
- Department of Neuroradiology, Klinikum Goethe Universität, Frankfurt, Germany.
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Rajani HR, Good C. 66. Innovation in the academic half-day CanMEDS medical expert competency for residency educations. CLIN INVEST MED 2007. [DOI: 10.25011/cim.v30i4.2827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Over the past decade we have attempted various iterations of the academic half-day, but recurring trainee complaints of only didactic sessions, a parallel resident-directed “Nelsons” rounds, and low attendance necessitated a reconsideration of the approach.
After discussion with the postgraduate trainees we divided the academic year into two blocks. An initial 8 week “summer program” with 24 student contact hours, focuses on the introduction to and review of common, critical care and emergency pediatric issues. The following 40 weeks has 120 student contact hours. Two thirds of the time is directed at the CanMEDS Medical Expert Core Competency. The postgraduate trainees have developed a three year core knowledge curriculum. The 200 “core” topics are mapped onto four international curricula; the RCPSC’s Objectives of Training and Specialty Training Requirements in Pediatrics using the Systems-Based Educational Objectives in the Core Program in Pediatrics, the American Board of Pediatrics – General Pediatrics Outline, and the Royal College of Pediatrics & Child Health (RCPCH) Framework of Competencies for Basic Specialist Training, and Core Higher Specialist Training in Paediatrics.
The two hour Medical Expert session is divided equally into a postgraduate trainee didactic presentation, and a collaborator case-based learning session. Six weeks prior to the scheduled session the trainee and the assigned faculty collaborator receive the core Medical Expert topic mapped to the four international curricula. The pediatric trainee develops a didactic presentation along with a two page summary. The collaborator, a resource for the trainee’s didactic presentation, develops three clinical cases that emphasize core knowledge, and attends as a Medical Expert resource person.
We are currently surveying the postgraduate trainees and faculty about this international-based core medical expert program of study.
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Abstract
BACKGROUND True treatment rates and the impact of comorbidities on treatment rates for hepatitis C virus in the HCV-HIV-coinfected subjects are unknown. AIM To quantify the rates of treatment prescription and the effect of comorbidities on hepatitis C virus treatment rates in HCV-HIV-coinfected veterans. METHODS The Veterans Affairs National Patient Care Database was used to identify all hepatitis C virus-infected subjects between 1999 and 2003 using ICD-9 codes. Demographics, comorbidities and pharmacy data were retrieved. We used logistic regression to compare the predictors of hepatitis C virus treatment in hepatitis C virus-monoinfected and HCV-HIV-coinfected subjects. FINDINGS We identified 120 507 hepatitis C virus-infected subjects, of which 6502 were HIV coinfected. 12% of the hepatitis C virus-monoinfected and 7% of the -coinfected subjects were prescribed hepatitis C virus treatment (P < 0.0001). Those not prescribed treatment were older (48.6 years vs. 47.7 years, P = 0.007) and more likely to be black (52% vs. 32%, P < 0.0001). HIV coinfected was less likely to be prescribed hepatitis C virus treatment (OR 0.74, 95% CI: 0.67-0.82). Among the coinfected subjects, the following were associated with non-treatment (OR, 95% CI): black race (0.45, 0.35-0.57); Hispanic race (0.56, 0.38-0.82); drug use (0.68, 0.53-0.88); anaemia (0.17, 0.11-0.26); bipolar disorder (0.63, 0.40-0.99); major depression (0.72, 0.53-0.99); mild depression (0.47, 0.35-0.62). CONCLUSIONS A small number of HCV-HIV-coinfected veterans are prescribed treatment for hepatitis C virus. Non-treatment is associated with increasing age, minority race, drug use and psychiatric illness. Further studies are needed to determine the eligibility for treatment and reasons for non-treatment for hepatitis C virus.
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Affiliation(s)
- A A Butt
- University of Pittsburgh School of Medicine, PA 15213, USA.
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Abstract
The developmental decrease in rapid-eye-movement (REM) sleep in man occurs between birth and after puberty. We hypothesize that if this decrease in REM sleep does not occur, lifelong increases in REM sleep drive may ensue. Such disorders are characterized by hypervigilance and sensory-gating deficits, such as are present in postpubertal onset disorders like schizophrenia, panic attacks (a form of anxiety disorder), and depression. The decrease in REM sleep in the rat occurs between 10 and 30 days of age. We studied changes in size and physiological properties of pedunculopontine nucleus (PPN) cells involved in the control of arousal, i.e., waking and REM sleep. During the largest decrease in REM sleep (12-21 days), cholinergic PPN neurons doubled in cell area, the hypertrophy peaking at 15-16 days, then decreasing in area by 20-21 days. Noncholinergic PPN cells did not change in area during this period. We confirmed the presence of two populations of PPN neurons based on action potential (AP) duration, with the proportion of short-AP-duration cells increasing and long AP duration decreasing between 12 and 21 days. Most cholinergic and noncholinergic cells had short AP durations. Afterhyperpolarization (AHP) duration became segregated into long and short AHP duration after 15 days. Cells with short AP duration also had short AHP duration. The proportion of PPN cells with Ih current increased gradually, peaking at 15 days, then decreased by 21 days. These changes in morphological and physiological properties are discussed in relation to the developmental decrease in REM sleep.
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Affiliation(s)
- T Kobayashi
- Center for Translational Neuroscience, Department of Anatomy and Neurobiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
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Abstract
Rapid eye movement (REM) sleep in the human declines from approximately 50% of total sleep time ( approximately 8 h) in the newborn to approximately 15% of total sleep time (approximately 1 h) in the adult, and this decrease takes place mainly between birth and the end of puberty. We hypothesize that without this developmental decrease in REM sleep drive, lifelong increases in REM sleep drive may ensue. In the rat, the developmental decrease in REM sleep occurs 10-30 days after birth, declining from >70% of total sleep time in the newborn to the adult level of approximately 15% of sleep time during this period. Rats at 12-21 days of age were anesthetized with ketamine and decapitated, and brain stem slices were cut for intracellular recordings. We found that excitatory responses of pedunculopontine nucleus (PPN) neurons to N-methyl-D-aspartic acid decrease, while responses to kainic acid increase, over this critical period. During this developmental period, inhibitory responses to serotonergic type 1 agonists increase but responses to serotonergic type 2 agonists do not change. The results suggest that as PPN neurons develop, they are increasingly activated by kainic acid and increasingly inhibited by serotonergic type 1 receptors. These processes may be related to the developmental decrease in REM sleep. Developmental disturbances in each of these systems could induce differential increases in REM sleep drive, accounting for the postpubertal onset of a number of different disorders manifesting increases in REM sleep drive. Examination of modulation by PPN projections to ascending and descending targets revealed the presence of common signals modulating ascending arousal-related functions and descending postural/locomotor-related functions.
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Affiliation(s)
- T Kobayashi
- Center for Translational Neuroscience, Department of Anatomy and Neurobiology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
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Hattingen E, Pilatus U, Good C, Franz K, Lanfermann H, Zanella FE. An unusual intraventricular haemangiopericytoma: MRI and spectroscopy. Neuroradiology 2003; 45:386-9. [PMID: 12707742 DOI: 10.1007/s00234-003-0992-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2003] [Accepted: 03/03/2003] [Indexed: 11/26/2022]
Abstract
We present a 43-year-old woman with a tumour within the left lateral ventricle with the typical appearances of meningioma on MRI. (1)H MR spectroscopy demonstrated an increased choline peak, suggesting a malignant form of meningioma. Histologically a haemangiopericytoma was found, an exceptionally rare tumour at this site.
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Affiliation(s)
- E Hattingen
- Institute of Neuroradiology, University of Frankfurt, Schleusenweg 2-16, 60528 Frankfurt, Germany.
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Abstract
Oral fluid is becoming increasingly useful for the detection of drugs, since it is a non-invasive specimen to collect and, because collection is directly observed, it is difficult to adulterate. A point-of-collection (POCT) oral fluid drug analysis kit has been developed for use in many drug testing situations. This paper summarizes the results of field evaluations of the ORALscreen System for screening of drugs in oral fluid. The ORALscreen System consists of an oral fluid collection device and a test device containing a lateral flow membrane immunoassay system. Paired samples (oral fluid and urine) were collected from drug users and the results from the ORALscreen POCT system were compared to urine screening results conducted in a licensed laboratory. The results demonstrate that the ORALscreen System has excellent percent agreement with the laboratory-based urine screening test results for the detection of cocaine and opiates through 2.5-3 days following drug use, respectively. Tetrahydrocannabinol (THC) was detected by ORALscreen on the day of use and 1 day after use. Good correlation between urine and oral fluid screening results was observed for the methamphetamine positive samples; however, the number of days following drug use was not determined.
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Affiliation(s)
- C Barrett
- Avitar Research and Development, Avitar, 65 Dan Road, Canton, MA 02021, USA.
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Abstract
OBJECTIVE To examine bone mineral density (BMD) and fat distribution in lean women with polycystic ovary syndrome (PCOS) compared with matched control women. DESIGN Controlled clinical study. SETTING An academic clinical research center. PATIENT(S) Twelve non-Hispanic white women with PCOS and a body mass index of <26 and 10 healthy control women matched for age, ethnicity, and weight. INTERVENTION(S) Biometric measures, blood sample collection, and total body/regional bone density and fat analysis were performed. MAIN OUTCOME MEASURE(S) Serum levels of androgens, glucose, and insulin were measured. Bone density and fat distribution were measured by total body dual-energy x-ray absorptiometry. RESULT(S) Androgen levels were elevated significantly in the lean women with PCOS compared with the controls. There was no statistically significant difference in total body BMD between the two groups. A significant increase in BMD was noted in the left arm, right arm, and left ribs of the lean PCOS group. Evaluation of upper body BMD showed a significant correlation between testosterone levels and BMD. No statistically significant differences were noted in body fat distribution, although the lean PCOS group tended to have lower mean percentages of body fat. CONCLUSION(S) Lean women with PCOS have regional differences in BMD, with significantly increased BMD in the upper skeleton compared with control women.
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Affiliation(s)
- C Good
- Pennsylvania State University College of Medicine, Hershey 17033, USA
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Rudich S, Riegler J, Sturges M, Goren M, Good C, Zakerski S, Perez R, McVicar J. Predictors of early discharge after orthotopic liver transplantation. Transplant Proc 1999; 31:388-90. [PMID: 10083155 DOI: 10.1016/s0041-1345(98)01674-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Rudich
- Department of Surgery, University of California, Davis, Medical Center, Sacramento 95817, USA
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Bird RP, Salo D, Lasko C, Good C. A novel methodological approach to study the level of specific protein and gene expression in aberrant crypt foci putative preneoplastic colonic lesions by Western blotting and RT-PCR. Cancer Lett 1997; 116:15-9. [PMID: 9177452 DOI: 10.1016/s0304-3835(97)04736-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aberrant crypt foci (ACF) represent microscopic preneoplastic lesions, present in the carcinogen-treated rodent colons. The cellular and molecular changes occurring within these lesions may provide important clues to the sequence of events leading to advanced preneoplastic or neoplastic lesions. The main objective of this investigation was to determine whether intact mRNA and protein can be isolated from fixed tissue and studied. A pure population of ACF was harvested from colonic tissue that had been preserved in 70% ethanol or 10% buffered formalin, by using a dissecting microscope and plucking the ACF out using fine forceps. The standard procedure of isolating RNA was performed successfully on ACF and normal tissue preserved in 70% ethanol. The expression of a housekeeping gene, beta-actin was demonstrated. Analysis of ethanol-preserved ACF for phosphorylated proteins was carried out by immunoblotting. The present study demonstrated that ACF are easily harvested from fixed tissues and that intact RNA and protein can be isolated from ACF or normal epithelium which can be used in techniques such as immunoblotting and RT-PCR.
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Affiliation(s)
- R P Bird
- Department of Foods and Nutrition, University of Manitoba, Winnipeg, Canada.
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Robieux IC, Kellner JD, Coppes MJ, Shaw D, Brown E, Good C, O'Brodovich H, Manson D, Olivieri NF, Zipursky A. Analgesia in children with sickle cell crisis: comparison of intermittent opioids vs. continuous intravenous infusion of morphine and placebo-controlled study of oxygen inhalation. Pediatr Hematol Oncol 1992; 9:317-26. [PMID: 1467165 DOI: 10.3109/08880019209016603] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The objectives of the study were to compare the efficacy and safety of a continuous infusion (CIV) of morphine and intermittent parenteral opioids (IPO) in children with sickle cell vaso-occlusive crises (VOCs); to determine whether 50% oxygen administration through a face mask can reduce the duration of severe pain in patients receiving CIV morphine; and to measure morphine concentration at steady state for pharmacokinetic and pharmacodynamic analysis in patients receiving CIV morphine. The study was designed as a prospective, controlled, "before-and-after" evaluation of two different analgesic regimens. For patients receiving CIV morphine, there was a randomized, double-blind, placebo-controlled study of O2 vs. air. The patients were 66 children with sickle cell disease, 3-18 years old, requiring opioid therapy for severe VOC (32 patients in phase A, 34 in phase B). The analgesic regimens were as follows: phase A: meperidine, morphine, or codeine IM or IV bolus every 3 or 4 hours; phase B: morphine sulfate, loading dose 0.15 mg followed by CIV 0.04 mg/kg/hr. The infusion rate was adjusted every 8 hours according to pain and/or symptoms of opioid toxicity. Pain assessment was by behavioral observation (BPS). In terms of results, the mean opioid dose (morphine equivalent) was similar in both groups (0.032 +/- 0.020 mg/kg/hr in phase A and 0.035 +/- 0.011 in phase B). However, the duration of severe pain was significantly shorter in phase B (0.9 +/- 1.0 days) than in phase A (2.0 +/- 1.8 days). No severe opioid toxicity was observed in either group. Oxygen did not shorten the duration of severe pain compared to the placebo group (0.94 +/- 1.08 and 0.95 +/- 1.19 days, respectively) nor did it prevent the appearance of new pain sites. Pharmacokinetic analysis was performed in 24 patients of phase B. Total body clearance (TBC) of morphine was greater in children before puberty than after (40.4 +/- 10 vs. 28 +/- 11 mL/kg/min; p < 0.05). In conclusion, in children with severe VOCs, continuous infusion of morphine provides better analgesia than intermittent opioid therapy. Fifty percent oxygen inhalation had no effect on the duration of pain.
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Affiliation(s)
- I C Robieux
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
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Humphrey FJ, Mayes SD, Bixler EO, Good C. Variables associated with frequency of rumination in a boy with profound mental retardation. J Autism Dev Disord 1989; 19:435-47. [PMID: 2793788 DOI: 10.1007/bf02212941] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The relationships between frequency of rumination in a boy with profound mental retardation and a variety of environmental, interpersonal, and temporal variables were investigated by collecting and analyzing data during all waking hours over a 4-week period. Low levels of rumination were associated with periods of special education programming (versus nonschool hours), individual attention (versus group activities and independent play), and time spent with caretakers who like the child (versus those who like him less). The findings also revealed a mealtime effect (decreasing rumination as time elapsed following meals) and a time of day effect (increasing rumination as the day progressed). Directions for future research and possible implications for the environmental management of rumination are discussed.
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Affiliation(s)
- F J Humphrey
- Department of Psychiatry, Pennsylvania State University College of Medicine
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Abstract
In a prospective study, 25 patients who had acute complete rupture of the medial collateral ligament of the knee with associated anterior cruciate ligament injury were treated by cast bracing and physiotherapy. Their average age was 27.6 years (range 15-53 years) with average follow-up of 24.2 months (range 12-48 months). All 25 patients had good or excellent results, with return to the pre-injury level of sporting activities by 1 year and with restoration of medial stability. This study shows that conservation treatment of this injury can restore stability to the medial side of the knee, even in the presence of anterior cruciate ligament damage.
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Affiliation(s)
- D W Mok
- Department of Orthopaedic Surgery, St George's Hospital, London, UK
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Abstract
The relationship between extracellular proteinase and the virulence for mice in Candida albicans was studied by using a set of three isolates. The set included a proteinase-producing parent (C9), a proteinase-deficient mutant derived from C9 by nitrous acid treatment (C9M1), and a spontaneous revertant (C9M1M) obtained by mouse passage of C9M1. The morphological markers and the carbon assimilation pattern were identical in these isolates. Isolate C9 produced a high level of proteinase in vitro and caused fatal infection (100%) within 21 days. The mutant produced no detectable enzymes in vitro, and all mice survived until day 22. Only 30% of the mice infected with C9M1 died between day 23 and 30. The isolates recovered from the dead mice were found to be proteinase sufficient, indicating that the mice died after the organism in tissue had reverted. The C9M1M isolate produced proteinase in vitro at 44% the level of C9 and induced fatal infection in 90% of the mice within 30 days. The number of CFU recovered from the kidneys correlated with the level of proteinase produced in vitro and, in turn, the rate of fatal infection produced by the isolates. These results support a previous observation indicating that proteinase activity is one of the virulence factors associated with C. albicans.
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Abstract
The moulded baby syndrome comprises: head moulding (plagiocephaly); pelvic obliquity with unilateral loss of hip abduction in flexion; and occasionally scoliosis, torticollis and bat ears. The hips, however, are radiologically normal and do not require the treatment used in the management of congenital dislocation or dysplasia. A review of 67 hips confirms this finding.
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Abstract
Fifteen cases of non-union of a long bone were treated by pulsed electromagnetic fields in combination with a Denham external fixator. Thirteen united within a few months and a controlled trial has been established to determine the contribution made by PEMF.
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Good C. Tolamolol in Treatment of Angina Pectoris. West J Med 1975. [DOI: 10.1136/bmj.3.5976.156-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Good C. Letter: Tolamolol in treatment of angina pectoris. Br Med J 1975; 2:560. [PMID: 1173789 PMCID: PMC1673363 DOI: 10.1136/bmj.2.5970.560-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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