eHealth literacy in prostate cancer: A systematic review

OBJECTIVE

This systematic review (PROSPERO ID: CRD42022226375) aimed to identify the eHealth literacy of men with prostate cancer, and their caregivers.

METHODS

8 databases (MEDLINE, SCOPUS, EMBASE, Web Of Science, PsycINFO, ERIC, CINAHL, Cochrane CENTRAL) and grey literature sources (e.g. Google Scholar) were searched from inception to December 2023. Articles were included if assessing eHealth/digital literacy of men with prostate cancer, or their carers', and health outcome associations. Formats such as case reports, and review papers were excluded. Records and full texts underwent independent screening and data extraction. Author disagreements were resolved by discussion. The Mixed Methods Appraisal Tool (MMAT) was used to appraise included literature, with narrative synthesis of results.

RESULTS

21,581 records were retrieved, with 7 articles satisfying inclusion criteria. A heterogenous field was characterised with lack of modern eHealth literacy measurement tools identified. Results suggest novice eHealth literacy using web 1.0 technologies. Non-validated measures of literacy demonstrate mixed results, while health outcome effects limited in scope and reliability.

CONCLUSION

Prostate cancer survivors' eHealth literacy levels is likely novice, and requires further investigation.

PRACTICE IMPLICATIONS

Digital technologies/resources implemented as part of patient communication practices should be vetted for quality, and tailored to patients' eHealth literacy abilities and/or needs.

Prostate cancer, online health information and communication technology - Bibliometric analysis of field with research frontiers

OBJECTIVES

The purpose of this study is to conduct the first bibliometric analysis which examines eHealth communication technologies in prostate cancer care, and the utilization of internet-based health information and communication technology by men with prostate cancer.

METHODS

Original articles were extracted from the Science Citation Index Expanded (SCI-E) on Web of Science (WOS) and analyzed concerning their distributions. Quantitative guidance directed investigation of findings from previous studies and trending issues within the field. The WOS, VOSViewer and CiteSpace IV were used for information analysis.

RESULTS

302 articles were included in the final analysis. There has been a 165 % increase in productivity over the past decade. The leading country by publication was the USA (145 articles = 48.02 %). Journals which published the highest number of original articles were the Journal of Medical Internet Research (6.95 %), and Patient Education and Counseling (4.64 %).

DISCUSSION AND PRACTICE IMPLICATIONS

The field of research which examines utilization and impacts of internet-based health information on men with prostate cancer is growing and diverse. Research frontiers are 'Information quality and diversity', 'eHealth literacy', 'decision making', and 'survivorship and advanced disease'. Clinicians should be aware of several significant limitations which exist within the current field of research.

Robotic Surgery Research in Urology: A Bibliometric Analysis of Field and Top 100 Articles

Introduction: There has been a surge in robotic surgery research publications over the past 20 years. However, to date, there has been no characterization of urology's contribution to the robotic field, and there is a lack of bibliometric literature to guide future investigation. We conducted this bibliometric analysis to characterize the distributions and characteristics of robotic surgery research in the urologic field, with subanalysis of the top 100 articles. Materials and Methods: The Web of Science Core Collection of the ISI Web of Science was searched and analyzed to determine distributions and characteristics of robotic urologic surgery research. The top 100 articles were categorized by urologic subfield and organ of pathology, with a level of evidence rating system applied (adapted from the Centre of Evidence-Based Medicine). Results: The total number of articles retrieved was 1294 from 1999 to 2018. The number of articles published in the last decade has increased by 845.75%, with 153 articles published in the preceding decade. The United States leads countries in publication with 699 (54.02%) articles across the field, and 71 within the top 100 articles. The Journal of Endourology published most articles (n = 292, 22.57%) within the field, while European Urology published most (n = 36) within the top 100 articles. Top 100 articles where generally associated with cancer (n = 76), with prostate cancer dominating literature (n = 38). The most common level of evidence for top 100 articles was that of a level 3 study (n = 31). Conclusions: This analysis of research activity has the potential to guide future robotic surgery research trends in the field of urology. There has been an explosion in robotic surgery urologic research activity over the last decade, with level 3 evidence dominating the top 100 articles of the field.

R-spondin 2 mediates neutrophil egress into the alveolar space through increased lung permeability

Objective

R-spondin 2 (RSPO2) is required for lung morphogenesis, activates Wnt signaling, and is upregulated in idiopathic lung fibrosis. Our objective was to investigate whether RSPO2 is similarly important in homeostasis of the adult lung. While investigating the characteristics of bronchoalveolar lavage in RSPO2-deficient (RSPO2^−/−) mice, we observed unexpected changes in neutrophil homeostasis and vascular permeability when compared to control (RSPO2^+/+) mice at baseline. Here we quantify these observations to explore how tonic RSPO2 expression impacts lung homeostasis.

Results

Quantitative PCR (qPCR) analysis demonstrated significantly elevated myeloperoxidase (MPO) expression in bronchoalveolar lavage fluid (BALF) cells from RSPO2^−/− mice. Likewise, immunocytochemical (ICC) analysis demonstrated significantly more MPO+ cells in BALF from RSPO2^−/− mice compared to controls, confirming the increase of infiltrated neutrophils. We then assessed lung permeability/barrier disruption via Fluorescein Isothiocyanate (FITC)-dextran instillation and found a significantly higher dextran concentration in the plasma of RSPO2^−/− mice compared to identically treated RSPO2^+/+ mice. These data demonstrate that RSPO2 may be crucial for blood-gas barrier integrity and can limit neutrophil migration from circulation into alveolar spaces associated with increased lung permeability and/or barrier disruption. This study indicates that additional research is needed to evaluate RSPO2 in scenarios characterized by pulmonary edema or neutrophilia.

ERP Correlates of a Receptive Language-Switching Task

Previous research has shown large response time costs (in excess of 50 ms) when bilingual speakers switch predictably back and forth between naming items (a productive switching task) in their first (L1) and second languages (L2). A recent study using event-related potentials (ERPs) has shown that switching between languages is associated with activity over frontal (N2) and parietal (late positive complex) areas of cortex (Jackson, Swainson, Cunnington, & Jackson, 2001). Switching between naming in different languages requires a switch in both language representations and language-specific motor responses. The current study investigated a receptive (input) language-switching task with a common manual response. Number words were presented in L1 and L2, and participants were required to judge whether the words were odd or even (a parity judgement). Response costs were considerably reduced, and the frontal and parietal switch related activity reported in the productive switching task was absent. Receptive switching was associated with early switch-related activity over central sensors that were not language specific. These results are discussed in relation to the idea that there is no language-specific lexical selection mechanism. Instead the costs of receptive language switching may arise from outside the bilingual lexicon.

Applications of Hairpin DNA-Functionalized Gold Nanoparticles for Imaging mRNA in Living Cells

Molecular imaging agents are useful for imaging molecular processes in living systems in order to elucidate the function of molecular mediators in health and disease. Here, we demonstrate a technique for the synthesis, characterization, and application of hairpin DNA-functionalized gold nanoparticles (hAuNPs) as fluorescent hybridization probes for imaging mRNA expression and spatiotemporal dynamics in living cells. These imaging probes feature gold colloids linked to fluorophores via engineered oligonucleotides to resemble a molecular beacon in which the gold colloid serves as the fluorescence quencher in a fluorescence resonance energy transfer system. Target-specific hybridization of the hairpin oligonucleotide enables fluorescence de-quenching and subsequent emission with high signal to noise ratios. hAuNPs exhibit high specificity without adverse toxicity or the need for transfection reagents. Furthermore, tunability of hAuNP emission profiles by selection of spectrally distinct fluorophores enables multiplexed mRNA imaging applications. Therefore, hAuNPs are promising tools for imaging gene expression in living cells. As a representative application of this technology, we discuss the design and applications of hAuNP targeted against distinct matrix metalloproteinase enzymes for the multiplexed detection of mRNA expression in live breast cancer cells using flow cytometry and fluorescence microscopy.

Heterotopic pregnancy

Heterotopic pregnancy is a life-threatening condition. A recent case at our institution prompted a systematic review of the literature from 2005 to 2010. In the majority (71%) of cases reviewed, risk factors for a heterotopic pregnancy were present. However, in several instances (33%), previous sonographic reports of a normal intrauterine pregnancy gave false reassurance. These results highlight the complexity of diagnosis. In addition, our findings were compared with two previous reviews covering cases from 1971 to 2004. This comparison highlighted two important trends: first, the increasing role of ultrasound in the definitive diagnosis of a heterotopic pregnancy, and second, the development of conservative approaches to management. Medical knowledge and technology may be improving, but ultimately, even in the presence of a known intrauterine pregnancy, the simple dictum 'think ectopic' must not be forgotten.

Nutrient sensor O-GlcNAc transferase regulates breast cancer tumorigenesis through targeting of the oncogenic transcription factor FoxM1

Cancer cells upregulate glycolysis, increasing glucose uptake to meet energy needs. A small fraction of a cell's glucose enters the hexosamine biosynthetic pathway (HBP), which regulates levels of O-linked beta-N-acetylglucosamine (O-GlcNAc), a carbohydrate posttranslational modification of diverse nuclear and cytosolic proteins. We discovered that breast cancer cells upregulate the HBP, including increased O-GlcNAcation and elevated expression of O-GlcNAc transferase (OGT), which is the enzyme catalyzing the addition of O-GlcNAc to proteins. Reduction of O-GlcNAcation through RNA interference of OGT in breast cancer cells leads to inhibition of tumor growth both in vitro and in vivo and is associated with decreased cell-cycle progression and increased expression of the cell-cycle inhibitor p27(Kip1). Elevation of p27(Kip1) was associated with decreased expression and activity of the oncogenic transcription factor FoxM1, a known regulator of p27(Kip1) stability through transcriptional control of Skp2. Reducing O-GlcNAc levels in breast cancer cells decreased levels of FoxM1 protein and caused a decrease in multiple FoxM1-specific targets, including Skp2. Moreover, reducing O-GlcNAcation decreased cancer cell invasion and was associated with the downregulation of matrix metalloproteinase-2, a known FoxM1 target. Finally, pharmacological inhibition of OGT in breast cancer cells had similar anti-growth and anti-invasion effects. These findings identify O-GlcNAc as a novel mechanism through which alterations in glucose metabolism regulate cancer growth and invasion and suggest that OGT may represent novel therapeutic targets for breast cancer.

Laparoscopic hysteropexy: the initial results of a uterine suspension procedure for uterovaginal prolapse

OBJECTIVE

The aim of this study was to evaluate the outcome of laparoscopic hysteropexy, a surgical technique for the management of uterine prolapse, involving suspension of the uterus from the sacral promontory using bifurcated polypropylene mesh.

DESIGN

The investigation was designed as a prospective observational study (clinical audit).

SETTING

The study was undertaken at a tertiary referral urogynaecology unit in the UK.

POPULATION

The participants comprised 51 consecutive women with uterovaginal prolapse, who chose laparoscopic hysteropexy as one of the available surgical options.

METHODS

The hysteropexy was conducted laparoscopically in all cases. A bifurcated polypropylene mesh was used to suspend the uterus from the sacral promontory. The two arms of the mesh were introduced through bilateral windows created in the broad ligaments, and were sutured to the anterior cervix; the mesh was then fixed to the anterior longitudinal ligament over the sacral promontory, to elevate the uterus.

MAIN OUTCOME MEASURES

Cure of the uterine prolapse was evaluated subjectively using the International Consultation on Incontinence Questionnaire for vaginal symptoms (ICIQ-VS), and objectively by vaginal examination using the Baden-Walker halfway system and the pelvic organ prolapse quantification (POP-Q) scale. Operative and postoperative complications were also assessed.

RESULTS

The mean age of the 51 women was 52.5 years (range 19-71 years). All were sexually active, and at least three of them expressed a strong desire to have children in the future. All were available for follow-up in clinic at 10 weeks, and 38 have completed the questionnaires. In 50 out of 51 women the procedure was successful, with no objective evidence of uterine prolapse on examination at follow-up; there was one failure. Significant subjective improvements in prolapse symptoms, sexual wellbeing and related quality of life were observed, as detected by substantial reductions in the respective questionnaire scores.

CONCLUSIONS

Laparoscopic hysteropexy is both a feasible and an effective procedure for correcting uterine prolapse without recourse to hysterectomy. It allows restoration of the length of the vagina without compromising its calibre, and is therefore likely to have a favourable functional outcome.

Clinical audit of the use of tension-free vaginal tape as a surgical treatment for urinary stress incontinence, set against NICE guidelines

Urinary incontinence affects a large proportion of adult women and is associated with considerable distress and social disability. In February 2003 the UK National Institute for Clinical Excellence (NICE) published new clinical guidelines on the use of tension free vaginal tape (TVT) for surgical treatment of stress urinary incontinence. Against these guidelines we have conducted a retrospective audit of patient care by the Oxford Radcliffe NHS Trust over 3 years, using the BFLUTS questionnaire in conjunction with patient records. This is believed to be the first such audit. Our results show overall performance to be satisfactory with no major problems. For all women the type of incontinence was confirmed by urodynamic investigation and in 92% of cases conservative management was tried and had failed before surgery was considered. For the TVT operation patients reported a high subjective cure rate, with 95% either fully cured or showing substantial improvement in their condition. Incidences of the main complications of TVT were found within statistical limits to be low (bladder/urethral perforation 4%; haemorrhage 1%; long-term voiding dysfunction 2%; tape rejection 0%; defective healing 0%; de novo urine retention 12%). These levels are similar to those reported elsewhere in the literature. However, a quarter of patients either did not receive full information about the TVT procedure in order to make an informed choice, or this was not documented. To improve care we recommend that local agreement should be reached between clinicians on information that will be provided to the patient as part of the consent process.

Development and psychometric evaluation of the ICIQ Vaginal Symptoms Questionnaire: the ICIQ-VS

OBJECTIVES

To develop and validate a self-completion questionnaire for comprehensive assessment of the severity and impact of vaginal symptoms and related sexual matters, particularly those attributed to pelvic organ prolapse. To provide an instrument that can characterise the severity of these symptoms, measure their impact and evaluate treatment outcome.

DESIGN

Prospective development of the content of the questionnaire and testing of its psychometric properties including validity.

SETTING

Two hospital-based urogynaecology clinics and one community general practice in the South of England.

POPULATION

One hundred and forty-one urogynaecology clinic attendees with varying degrees of pelvic organ prolapse and 77 randomly selected women registered with a general practice.

METHODS

The questionnaire was developed through a literature review, consultation with clinicians and health scientists and structured interviews with patients. Content validity, construct validity, stability, internal consistency and sensitivity to change were examined by comparing the responses from the urogynaecology clinic with responses from the general community. Sensitivity to change was assessed using responses from women undergoing surgical treatment for pelvic organ prolapse before and 3 months after surgery. A final version of the questionnaire was obtained after factor analysis to assist item reduction and refinement of the scoring system.

MAIN OUTCOME MEASURES

Content validity, construct validity, stability (test-retest reliability), internal consistency and sensitivity to change.

RESULTS

The questionnaire exhibited good validity, reliability and sensitivity to change. Excellent internal consistency was demonstrated for vaginal (Cronbach's alpha 0.79) and sexual (Cronbach's alpha 0.84) symptoms. Reliability was good. The questionnaire was able to identify changes in symptoms following surgical treatment. The final ICIQ-VS questionnaire had 14 items and a simple scoring system. CONCLUSION; The ICIQ-VS self-completion questionnaire meets the need for a robust instrument for assessing a range of vaginal and sexual symptoms, in particular those of pelvic organ prolapse. It will be of use in both routine clinical practice and epidemiological research, particularly when there is a need to assess the severity of these symptoms or the efficacy of treatment.

Posterior parietal cortex and the dissociable components of prism adaptation

Recent evidence has implicated posterior parietal cortex (PPC) in adaptation to optical displacing prisms. It has been suggested that PPC contributes to the strategic component of prism adaptation necessary for perceptual realignment (true adaptation). It has also been suggested, however, that the part of PPC responsible for corrections to ongoing movements (a putative strategic component) may not be necessary for successful adaptation. A patient presenting with bilateral posterior parietal damage (patient JJ) was tested with both hands on two versions of a prism adaptation task--one using prism goggles and one using a virtual prism arrangement. JJ displayed independent deficits: his right hand failed to show strategic control, yet adapted fully to the prisms whereas his left hand showed evidence of strategic control without subsequent adaptation. The data indicates that the ability to implement control strategies may not be necessary for successful adaptation to prisms. A proposed model for the role of posterior parietal cortex in prism adaptation is also presented.

Extending pedicle length in free jejunal loop grafts

By mobilisation of the jejunal marginal artery with reverse flow, the authors present a novel way of increasing artery length available for anastomosis in free jejunal loop transfer for reconstruction in head and neck cancer surgery.

Cognitive Control Mechanisms Revealed by ERP and fMRI: Evidence from Repeated Task-Switching

We investigated the extent to which a common neural mechanism is involved in task set-switching and response withholding, factors that are frequently confounded in taskswitching and go/no-go paradigms. Subjects' brain activity was measured using event-related electrical potentials (ERPs) and event-related functional MRI (fMRI) neuroimaging in separate studies using the same cognitive paradigm. Subjects made compatible left/right keypress responses to left/right arrow stimuli of 1000 msec duration; they switched every two trials between responding at stimulus onset (GO task—green arrows) and stimulus offset (WAIT task—red arrows). Withholding an immediate response (WAIT vs. GO) elicited an enhancement of the frontal N2 ERP and lateral PFC activation of the right hemisphere, both previously associated with the “nogo” response, but only on switch trials. Task-switching (switch vs. nonswitch) was associated with frontal N2 amplification and right hemisphere ventrolateral PFC activation, but only for the WAIT task. The anterior cingulate cortex (ACC) was the only brain region to be activated for both types of task switch, but this activation was located more rostrally for the WAIT than for the GO switch trials. We conclude that the frontal N2 ERP and lateral PFC activation are not markers for withholding an immediate response or switching tasks per se, but are associated with switching into a response-suppression mode. Different regions within the ACC may be involved in two processes integral to task-switching: processing response conflict (rostral ACC) and overcoming prior response suppression (caudal ACC).

Co-ordination of bimanual movements in a centrally deafferented patient executing open loop reach-to-grasp movements

Many everyday tasks require that we use our hands co-operatively. For tasks where both hands are required to perform the same action, a common motor program can be used. But, where each hand must perform a different action, some degree of independent control of each hand is required. In this paper we examine the co-ordination of bimanual movement kinematics in a female patient recovering from brain injury involving anterior regions of the parietal lobe of the right hemisphere, which has resulted in a dense hemianaesthesia of her left arm. A particular focus of this paper is the co-ordination of bimanual movements for reaches executed without visual feedback. Specifically we present new data, which quantify the synchronisation of patient D.B.'s hands by comparing their relative time lag at the start and the end of her bimanual reaches. The results are discussed with particular reference to the role played by limb proprioception in the planning and control of prehension movements.

Is grasping impaired in hemispatial neglect?

Patients with right unilateral cerebral stroke, four of which showed acute hemispatial neglect, and healthy aged-matched controls were tested for their ability to grasp objects located in either right or left space at near or far distances. Reaches were performed either in free vision or without visual feedback from the hand or target object. It was found that the patient group showed normal grasp kinematics with respect to maximum grip aperture, grip orientation, and the time taken to reach the maximum grip aperture. Analysis of hand path curvature showed that control subjects produced straighter right hand reaches when vision was available compared to when it was not. The right hemisphere lesioned patients, however, showed similar levels of curvature in each of these conditions. No behavioural differences, though, could be found between right hemisphere lesioned patients with or without hemispatial neglect on either grasp parameters, path deviation or temporal kinematics.

Vision: Visual space is not what it appears to be

The location of visual objects in the world around us is reconstructed in a complex way from the image falling on the retina. Recent studies have begun to reveal the different ways in which the brain dynamically re-maps retinal information across eye movements to compute object locations for perception and directing actions.

Vision: getting to grips with the Ebbinghaus illusion

It is well known that visual illusions can have a dramatic effect upon our visual perception of such properties as an object's size. It remains the subject of much debate, however, whether visual illusions have a similar influence on visually guided actions. Recent studies have thrown new light on this debate.

Links between vision and somatosensation. Vision can improve the felt position of the unseen hand

During reaching movements, sensory signals must be transformed into appropriate motor commands. Anatomical, electrophysiological, and neuropsychological evidence suggest that there is no single, supramodal map of space that is used to guide reaching. Instead, movements appear to be planned and controlled within multiple coordinate systems, each one attached to a different body part. Recent neuropsychological investigations demonstrating that somatosensory impairments can be ameliorated by visual cues, and visual impairments by proprioceptive cues, have been interpreted as evidence that arm-centered representations may exist in humans. A critical difference between the findings obtained in the monkey and in humans, however, is that in the latter case, vision of the limb appears be critical for visual somatosensory binding. Here, we report a case study of a patient (C.T.) recovering from unilateral somatosensory impairment, including tactile extinction, who executed reaches toward visually defined or proprioceptively defined locations. We demonstrate that when the target location of a reach was defined proprioceptively, by passively positioning our patient's impaired hand beneath the table surface, vision of the workspace immediately adjacent to the unseen hand dramatically increased the endpoint accuracy of her reaching movements, even though such cues could not possibly signal the position of the target directly.

Prism adaptation produces neglect-like patterns of hand path curvature in healthy adults

Visuospatial neglect is a common consequence of brain injury in which patients fail to respond appropriately to stimuli or events occurring within their contralesional hemispace and may restrict eye and hand movements to objects or events occurring within ipsilesional space. Emerging evidence suggests, however, that neglect is a syndrome consisting of several components, including the impaired representation of corporeal and extrapersonal space. To better understand the neglect syndrome it is important to develop experimental models of each of these components. Here we develop an experimental model of the spatial impairment associated with visuospatial neglect based upon adaptation to laterally displacing optical prisms. We demonstrate that after a short period spent adapting to rightward displacing prisms, healthy subjects exhibit increases in hand-path curvature during reaches executed under visual guidance, but, not during reaches executed to proprioceptively-defined targets without vision.

Globus pharyngeus: a postal questionnaire survey of UK ENT consultants

Globus pharyngeus is a common complaint often referred to the ENT outpatient department. The precise nature of globus pharyngeus and its aetiology remains something of a mystery. There is no uniform policy of management of this condition. A postal questionnaire was sent to all UK-based ENT consultants registered with the British Association of Otorhinolaryngolgists-Head and Neck Surgeons (BAO-HNS). The aim of this study was to ascertain if there was a favoured management policy by the majority of consultants. Our results indicate that there is a lack of consensus in the investigation and management of globus pharyngeus. Fourteen per cent do not perform any investigations, but would prescribe antacid medication if clinically indicated. The remainder would investigate in a variety of ways. The most common investigation is rigid endoscopy which is performed by 61% of respondents, followed by barium swallow (56%). The combination of endoscopy and barium swallow is routinely performed by 17.5% of respondents.

Pleomorphic adenoma causing acute airway obstruction

A case is reported of a pleomorphic adenoma of the minor salivary glands of the oral cavity presenting with acute airway obstruction. This is the first reported case to our knowledge of a mixed salivary tumour of the upper respiratory tract causing upper airway obstruction and acute respiratory failure. The patient had to be intubated and transferred to the intensive care unit. After an elective tracheostomy was performed, the adenoma was excised from its fibrous capsule. It was found to originate from the soft palate and occupied the parapharyngeal space. A high index of suspicion should be kept in order to diagnose tumours of the parapharyngeal space with unusual presentation. These tumours which are usually benign should be considered in the differential diagnosis from more common infectious or traumatic conditions and surgical morbidity should be minimal.

The control of bimanual reach-to-grasp movements in hemiparkinsonian patients

The basal ganglia are thought to participate in the control and programming of a variety of motor behaviours. However, the precise nature of this participation still remains to be clarified. This paper examines the proposal that the basal ganglia may serve to scale the amplitude of limb movements, with basal-ganglia dysfunction leading to the inappropriate scaling of intended motor activity. Several authors have suggested that examining the loss of function in Parkinson's-disease (PD) patients offers perhaps the best way of learning about the role played by the basal ganglia in human motor function. While it has previously been reported that PD patients underscale the transport phase of their reach-to grasp movements, it has generally been assumed that the grasp component is normal. In this paper we demonstrate, using a group of hemiparkinson patients, that the scaling of the grasp component is also underscaled in PD patients.

Reaching movements may reveal the distorted topography of spatial representations after neglect

It has been proposed that patients with spatial neglect fail to respond appropriately toward stimuli opposite their brain lesion because they have an impairment of directing attention. However, a disorder of 'intention' - or movement initiation - has also been demonstrated in this condition. Recently, the paths of neglect patients' reaches have been shown to be abnormally curved, but it is unclear whether this impairment is visual or motor. Here, we show for the first time that reaches to and from identical positions executed by three patients recovering from neglect are significantly more curved to visually defined targets compared to when the same targets are defined proprioceptively. These findings indicate that abnormal hand paths in neglect result from an impairment in the visual representation of space used to guide reaches but without any general failure of spatial representation of target position. Furthermore, the curved hand paths reveal how the topography of that representation is distorted in spatial neglect.

The Ponzo illusion affects grip-force but not grip-aperture scaling during prehension movements

Contextual cues such as linear perspective and relative size can exert a powerful effect on the perception of objects. This fact is demonstrated by the illusory effects that can be induced by such cues (e.g., the Ponzo railway track and Titchener circles illusions). Several recent studies have reported, however, that visual illusions based on such cues have little or no influence on the visuomotor mechanisms used to guide hand action. Furthermore, evidence of this sort has been cited in support of a distinction between visual perception and the visual control of action. In the current study, the authors investigated the effect of the Ponzo visual illusion on the control of hand action, specifically, the scaling of grip force and grip aperture during prehension movements. The results demonstrate that grip force scaling is significantly influenced by the Ponzo visual illusion, whereas the scaling of grip aperture is unaffected by the illusion.

The coordination of bimanual prehension movements in a centrally deafferented patient

Many everyday tasks require that we use our hands co-operatively, for example, when unscrewing a jar. For tasks where both hands are required to perform the same action, a common motor programme can be used. However, where each hand needs to perform a different action, some degree of independent control of each hand is required. We examined the coordination of bimanual movement kinematics in a female patient recovering from a cerebrovascular accident involving anterior regions of the parietal lobe of the right hemisphere, which resulted in a dense hemianaesthesia of her left arm. Our results indicate that unimanual movements executed by our patient using her non-sensate hand are relatively unimpaired. In contrast, during bimanual movements, reaches executed by our patient using her non-sensate hand show gross directional errors and spatiotemporal irregularities, including the inappropriate coupling of movement velocities. These data are discussed with reference to the role played by limb proprioception in the planning and control of prehension movements.

The Ponzo illusion affects grip-force but not grip-aperture scaling during prehension movements

Contextual cues such as linear perspective and relative size can exert a powerful effect on the perception of objects. This fact is demonstrated by the illusory effects that can be induced by such cues (e.g., the Ponzo railway track and Titchener circles illusions). Several recent studies have reported, however, that visual illusions based on such cues have little or no influence on the visuomotor mechanisms used to guide hand action. Furthermore, evidence of this sort has been cited in support of a distinction between visual perception and the visual control of action. In the current study, the authors investigated the effect of the Ponzo visual illusion on the control of hand action, specifically, the scaling of grip force and grip aperture during prehension movements. The results demonstrate that grip force scaling is significantly influenced by the Ponzo visual illusion, whereas the scaling of grip aperture is unaffected by the illusion.

Pathological perceptual completion in hemianopia extends to the control of reach-to-grasp movements

The neuropsychological phenomenon of blindsight is observed when patients who are cortically blind exhibit residual visual processing capabilities for stimuli presented within their scotoma to which they are otherwise unaware. Cortically blind patients may also exhibit the phenomenon of pathological visual completion in which, paradoxically, they can become aware of a complete visual stimulus even when a significant portion of that stimulus falls within their blind hemifield. In this study, the ability of a blindsight patient (G.Y.) to use visual information to control reach-to-grasp movements to static objects presented within his blind hemifield was investigated. The results indicate that while G.Y. was insensitive to variations in object size when reaching for objects presented entirely within his blind hemifield, his ability to accurately grasp objects located within his blind field was vastly improved if part of the object to be grasped extended into his seeing hemifield. This finding demonstrates that visual awareness can facilitate the visuomotor processing of object form within G.Y.'s apparently blind field, and suggests that the primary deficit in blindsight may be an impairment of visual consciousness rather than an absolute loss of visual function.

Attention for action: coordinating bimanual reach-to-grasp movements

Theories of attention have frequently pointed to the finding that there is a significant performance decrement ('cost') to responding to two different objects concurrently. However, much of the research aimed at investigating how attention is 'divided' in such circumstances has adopted response time (RT) as the measure of interest. In this paper we investigate how attention is 'divided' during the execution of concurrent motor responses, by studying bimanual reach-to-grasp movements directed towards two separate target objects. Furthermore, a key aspect of our study is that each hand is required to perform either the same action (congruent reaches) or a different action (incongruent reaches). Thus in Expt 1 we manipulated the movement amplitude of each hand, while in Expt 2 we manipulated object size. The results of this study suggest that while there is an overall cost associated with carrying out two movements simultaneously, kinematic measures are unaffected by whether the actions required of each hand are the same (congruent) or different (incongruent). The problem of executing incongruent bimanual movements appears to be solved by synchronizing each limb to a common movement duration, while movement velocity and grip aperture are independently scaled. These findings are discussed in relation to theories developed to explain the coordination of the reach-and-grasp phases of unimanual prehension, and in the context of recent theories of attention for action.

Adult presentation of a tracheoesophageal fistula with co-existing laryngeal cleft

Congenital posterior laryngeal clefts are rare anomalies, being first described by Richter in 1792, and first operated upon successfully by Pettersson in 1955. Most clefts present within the first few months of life, with only a few cases being documented as presenting in adulthood. We present the case of a 50-year-old lady presenting with a previously undiagnosed posterior laryngeal cleft with an associated tracheoesophageal fistula. The defect was graded as 2 on the Benjamin and Inglis classification system of posterior laryngeal clefts. Following a literature review, we believe that our patient is the oldest to present with this congenital defect.

The selection and suppression of action: ERP correlates of executive control in humans

A key aspect of higher cortical function is the ability to selectively withhold or suppress action where appropriate. To examine the time course of executive control we used dense-sensor EEG recording techniques to study event-related electrical potentials (ERPs) during a visual 'go/no-go' task. We show that during both go and no-go trials there is a positive deflection in the ERP, which develops over posterior parietal sensors approximately 350 ms (P300) after the onset of a conditional visual stimulus, but is selectively suppressed during no-go trials. We also show that this modulation of the parietal P300 is preceded by a negative deflection in the ERP recorded over frontal cortex (N2), which is apparent only for no-go trials. We suggest that this signal provides an electrophysiological marker in man for the decision to withhold the execution of a motor response.

In situ calibration of miniature sensors implanted into the anterior cruciate ligament part I: strain measurements

The goals of this study were to (a) evaluate the differential variable reluctance transducer as an instrument for measuring tissue strain in the anteromedial band of the anterior cruciate ligament, (b) develop a series of calibration curves (for simple states of knee loading) from which resultant force in the ligament could be estimated from measured strain levels in the anteromedial band of the ligament, and (c) study the effects of knee flexion angle and mode of applied loading on output from the transducer. Thirteen fresh-frozen cadaveric knee specimens underwent mechanical isolation of a bone cap containing the tibial insertion of the anterior cruciate ligament and attachment of a load cell to measure resultant force in the ligament. The transducer (with barbed prongs) was inserted into the anteromedial band of the anterior cruciate ligament to record local elongation of the instrumented fibers as resultant force was generated in the ligament. A series of calibration curves (anteromedial bundle strain versus resultant force in the anterior cruciate ligament) were determined at selected knee flexion angles as external loads were applied to the knee. During passive knee extension, strain readings did not always follow the pattern of resultant force in the ligament; erratic strain readings were often measured beyond 20 degrees of flexion, where the anteromedial band was slack. For anterior tibial loading, the anteromedial band was a more active contributor to resultant ligament force beyond 45 degrees of flexion and was less active near full extension; mean resultant forces in the range of 150-200 N produced strain levels on the order of 3-4%. The anteromedial band was also active during application of internal tibial torque; mean resultant forces on the order of 180-220 N produced strains on the order of 2%. Resultant forces generated by varus moment were relatively low, and the anteromedial band was not always strained. Mean coefficients of variation for resultant force in the ligament (five repeated measurements) ranged between 0.038 and 0.111. Mean coefficients of variation for five repeated placements of the strain transducer in the same site ranged from 0.209 to 0.342. Insertion and removal of this transducer at the anteromedial band produced observable damage to the ligament. In our study, repeatable measurements were possible only if both prongs of the transducer were sutured to the ligament fibers.

In situ calibration of miniature sensors implanted into the anterior cruciate ligament part II: force probe measurements

The arthroscopically implantable force probe transducer, which measures the effects of local ligament fiber tension, was inserted into the anteromedial band of the anterior cruciate ligament after measurements with the differential variable reluctance transducer were completed in Part I of this study. The overall goals in Part II remained the same, with additional experiments included to determine the sensitivity of output voltage from the transducer to medial-lateral placement of the device within the anteromedial band and to depth of placement within a given insertion hole. Calibration curves of output voltage from the arthroscopically implantable force probe transducer versus resultant force in the ligament were generated during a separate series of knee-loading experiments identical to those performed in Part I. The output voltage for a given probe placement was highly sensitive to the depth of implantation into the anteromedial band. When the probe was completely buried within the ligament, voltage outputs were often sporadic or absent even though surface fibers had clearly developed tension. When the probe was only partially inserted into the hole, such that the end of the probe was slightly proud to the surface, voltage output was significantly higher as the device measured tension in the superficial fibers. Voltage outputs for proud placement were always significantly higher than corresponding voltages for deep placements for all test conditions. With proud placements, voltage outputs were not sensitive to small deviations in medial-lateral position within the anteromedial band. Mean coefficients of variation for output voltage (four repeated placements of the probe into the same central hole) ranged from 0.156 to 0.359 (deep and proud insertions). Output voltage from the probe generally followed the pattern of resultant force in the ligament during passive knee extension. For anterior tibial loading, the contribution of deep fibers to resultant force did not depend on the knee flexion angle at which the test was conducted; the contribution of superficial fibers was greatest beyond 45 degrees of flexion and least at full extension. The contributions of the anteromedial band to resultant force in the ligament were not significantly different between the three modes of loading (anterior tibial force, internal tibia torque, and varus moment) at either 0 or 10 degrees of flexion; this was true for both superficial and deep fibers. We found it necessary to secure the probe within the insertion site using a suture (for both deep and proud placements) to obtain repeatable readings. Puncturing the anteromedial band clearly produced tissue damage; the insertion hole often produced a permanent plane of cleavage in the anteromedial band. However, this tissue damage did not alter the overall ability of the ligament to generate resultant force.

Admission of bone marrow transplant recipients to the intensive care unit: outcome, survival and prognostic factors

The role of ICU support in BMT patients is controversial. In an era of constrained resources, the use of prognostic factors predicting outcome may be helpful in identifying patients who are most likely (or unlikely) to benefit from this intervention. We attempted to define the survival of patients admitted to ICU following autologous or allogeneic BMT and to identify those factors important in determining patient outcome. A retrospective study of all adult BMT recipients admitted to intensive care over a 6 year study period was performed to determine overall and prognostic indicators of poor outcome. Pre-treatment, pre-ICU admission and ICU admission data were analyzed to identify factors predicting long-term survival. 116 patients were admitted to ICU on 135 separate occasions with the primary reasons for admission being respiratory failure (66%), sepsis associated with hypotension (10%), and cardiorespiratory failure (8%). No pre-ICU characteristics were predictive of survival. Univariate analysis identified the number of support measures required, the need for ventilation or hemodynamic support, the APACHE II score, the year of ICU admission and the serum bilirubin as significant predictors of post-discharge survival. On multivariate analysis the year of ICU admission, the need for hemodynamic support and the serum bilirubin remained significant. The APACHE II score significantly underestimated survival in the 46% of patients with scores less than 35, and could only be used to predict 100% mortality when it exceeded 45. Twenty-three percent of all BMT patients admitted to the ICU and 17% of ventilated patients survived to hospital discharge. Of the 27 patients surviving to leave hospital, 16 remain alive with a median follow-up of 4.2 years and a mean Karnofsky performance status of 90. Although mortality in BMT recipients admitted to ICU is high our results indicate that intensive care support can be lifesaving and that the outcome in patients requiring ventilation and ICU support may not be as poor as has been previously reported. No single variable was identified which could be used to predict futility but patients requiring both hemodynamic support and mechanical ventilation, and those with an APACHE II score greater than 45 have a very poor prognosis and are unlikely to benefit from lengthy ICU support.

The influence of initial hand posture on the expression of prehension parameters

This paper describes the transport and grasp kinematic parameters associated with four initial hand postures (palm flat and thumb against the hand, palm flat and thumb extended laterally, index and thumb in opposition, and index and thumb in opposition and elbow flexed 90 degrees). A group of healthy adult subjects reached for and picked up a wooden dowel placed midsagittally, at one of three distances (20 cm, 25 cm and 30 cm). The initial posture of the hand and arm altered transport (peak velocity and peak negative acceleration) as well as grasp (peak angle and time to peak angle) parameters, particularly when the elbow was flexed 90 degrees. The pattern of results was reproduced in a pointing paradigm. The findings are discussed in the context of joint space models of reaching.

Grip force scaling after hemispatial neglect

Spatial neglect has been explained as an impairment in the representation of extrapersonal space. One account suggests that representations of extrapersonal space are spatially compressed following neglect. In support of this view it has been demonstrated that neglect patients systematically underestimate the size of stimuli presented in their left hemifield. In the current study we investigated this phenomena by obtaining an indirect measure of perceived object size - the scaling of grip force during prehension. We demonstrate for the first time that neglect patients show increased levels of grip force for objects presented in their left hemifield. This finding is discussed with reference to a proposed distinction between visual processing used for object recognition, and visual processing used to guide action.

A prospective, randomized trial comparing continuous bladder drainage with catheterization at abdominal hysterectomy

OBJECTIVE

To compare the infection rate and post-operative morbidity between in-dwelling urinary catheterization and 'in-out' catheterization at the time of routine total abdominal hysterectomy.

PATIENTS AND METHODS

The study comprised 100 patients who were blindly randomized to have either an indwelling Foley catheter or an 'in-out' catheterization at the time of surgery. Follow-up data on the retention of urine, urinary symptoms and infection were obtained.

RESULTS

Of the 95 patients with complete data, 36% of those undergoing in-out catheterization had urinary retention after operation, requiring bladder emptying, compared with 4% of those receiving an indwelling catheter (P < 0.001). In addition, 29% of the catheterized group had urinary tract bacteriuria compared with 13% of the uncatheterized group (P < 0.025).

CONCLUSION

This randomized controlled trial showed that in-out urinary catheterization at the time of routine abdominal hysterectomy was associated with a significantly higher incidence of post-operative urinary retention compared with in-dwelling catheterization, and may have implications for long-term bladder function.

Detection of glove puncture and skin contamination during caesarean section

Measures that can be taken to reduce exposure to potentially infected body fluids are of particular relevance in obstetric and gynaecological surgery due to high rates of glove puncture and relatively higher prevalence of human immunodeficiency virus seropositivity in the obstetric age group. We describe the use of a simple electronic device that alarms following puncture of surgical gloves or the creation of a fluid bridge between surgeon and patient. Further exposure to potentially infected body fluids is thus prevented. This present study was performed in the context of caesarean section, but the application of the technique to gynaecological procedures is appropriate.

Visuomotor functions of the lateral pre-motor cortex

Recent studies have provided new insights into the visuomotor functions of the dorsal and ventral regions of the lateral pre-motor cortex. Anatomical and physiological investigations in non-human primates have demonstrated that these regions have differing patterns of cortical connectivity and distinctive neuronal responses. Brain-imaging techniques and lesion studies have begun to probe the functions of homologous regions in humans.

Changes in metabolism of collagen in genitourinary prolapse

BACKGROUND

Genitourinary prolapse is a common problem, the pathophysiology of which is unknown.

METHODS

We analysed vaginal-epithelial tissue from premenopausal women with genitourinary prolapse and compared them with controls.

FINDINGS

We found that genitourinary prolapse is associated with a reduction in total collagen content and a decrease in collagen solubility. Both intermediate intermolecular cross-links and advanced glycation cross-links were increased in prolapse tissue. Collagen turnover, as indicated by matrix metalloproteinase activity, was up to four times higher in prolapse tissue. Collagen-type ratios, mature cross-link pyridinoline and total elastin content were similar in both prolapse and control tissues. Increased collagenolytic activity causes loss of collagen from prolapse tissue.

INTERPRETATION

Based on these findings, we have identified a probable mechanism for genitourinary prolapse. Development of agents to inhibit collagenolytic activity may help in the treatment of this condition.

The continence control pad--a new external urethral occlusion device in the management of stress incontinence

OBJECTIVE

To assess the use of an external urethral occlusion pad (the continence control pad, CCP) in the management of stress incontinence.

PATIENTS AND METHODS

Nineteen women (median age 47 years, range 36-72) complaining of stress incontinence were taught to use the CCP. The patients were assessed during the week before, and again after using the CCPs for 2 weeks, by urinary diaries, pad-tests and a review of their symptoms.

RESULTS

Use of the CCP was associated with a cure or improvement in 17 women, as assessed by the number of incontinent episodes per week. There was a significant decrease in both the number of incontinent episodes (P < 0.001) and pad-test leakage (P = 0.002) when using the CCP. Minor difficulties in placement and removal were described in a minority of women.

CONCLUSION

The CCP offers a simple, non-invasive treatment for women complaining of stress incontinence. The short-term success rate was better than that with other conservative methods of treatment, is independent of the general practitioner and safe. It is a promising home-based method of managing stress incontinence.

Detection of urinary incontinence during ambulatory monitoring of bladder function by a temperature-sensitive device

OBJECTIVES

To determine whether the difference between urinary and perineal temperatures is sufficient to allow registration of incontinent episodes by detection of temperature change alone. To design and assess the use of a diode-based temperature-sensitive device in the detection of episodes of urinary incontinence in long-term ambulatory monitoring (LTAM) studies.

SUBJECTS AND METHODS

Perineal temperature recordings were made in 46 women during various activities. A temperature-sensitive device consisting of six IN4148 diodes, spanning 5 cm, and a nearby reference negative diode, was placed in a light perineal pad and attached to a portable amplifier/digitizer and recorder. The performance of the device was determined by comparison with increases in pad weight in 51 incontinent and 23 continent control subjects.

RESULTS

A sufficient temperature differential existed between perineal and urinary temperature during all activities except being seated with crossed legs. Incontinence was reliably detected by the temperature-sensitive device. The device had a sensitivity of 95.2% and a specificity of 90.6% compared to a pad test.

CONCLUSIONS

This temperature-sensitive device offers a new method for detecting urinary incontinence during LTAM studies. It can be fitted in an unobtrusive perineal pad and has a higher sensitivity and specificity for the detection of incontinence when compared to a pad test. It may also be used as a marker of voiding in ambulatory studies not employing an integrated voiding channel.

Glandular lesions of the cervix-cytological and histological correlation

In this retrospective review we assessed the frequency with which atypical glandular cells in cervical smears predict cervical glandular lesions. Asymptomatic patients (n=34) with one or more smears showing atypical glandular cells aand subsequent histopathological assessment were studied. Independent cytological and histological review was undertaken. Cytological review confirmed atypical glandular cells in 29 cases, 17 of which had coexisting squamous dyskaryosis. Histological review of these 29 cases revealed glandular neoplasia in 13 (45%) and microglandular hyperplasia (MEH) in an additional four (14%). Initial reporting had underestimated the prevalence of glandular neoplasia.

An open, in-patient incremental safety and efficacy study of desmopressin in women with multiple sclerosis and nocturia

OBJECTIVES

To examine the safety and efficacy of desmopressin in three doses given to women with multiple sclerosis to treat nocturia with or without enuresis.

PATIENTS AND METHODS

Eight women with clinically confirmed multiple sclerosis and nocturia with or without enuresis were entered as in-patients into an open, nonrandomized, placebo-controlled study of incremental doses of 20, 40 and 60 micrograms desmopressin. Urinary and serum sodium, plasma arginine vasopressin and urine osmolality were monitored every 4 h for 24 h. A single dose of placebo or desmopressin was given during each of four 24-h periods.

RESULTS

There was a significant decrease in nocturnal urinary volumes and a significant increase in nocturnal urinary osmolalities in patients taking desmopressin when compared with those taking a placebo, but there was no difference among the desmopressin doses. There was no significant difference in serum sodium level between the desmopressin doses. However, at the end of the 24-h period with the 60 micrograms dose, serum sodium was decreased significantly.

CONCLUSIONS

Neither a significant decrease in nocturnal urinary volumes nor an increase in urinary osmolality was achieved by doses of desmopressin > 20 micrograms. A dose of 60 g was associated with a decreased serum sodium level at the end of the 24-h period but there was no biochemical hyponatraemia. Because there were no benefits and a possibility of clinical hyponatraemia with higher doses, doses of > 20 micrograms desmopressin cannot be recommended.

Hydration monitoring in the prevention of recurrent idiopathic urinary tract infections in pre-menopausal women

OBJECTIVE

To assess whether the use of simple hydration monitoring can encourage adequate hydration and reduce urinary osmolality and the incidence of urinary tract infections (UTIs) in a population of susceptible pre-menopausal women with recurrent idiopathic urinary infections.

SUBJECTS AND METHODS

The study included 28 pre-menopausal women who had at least two idiopathic UTIs in the previous 6 months. Urinary osmolality was assessed by the patients at each void by a simple hand-held probe, and the readings over 4 months compared. Monthly urine culture was compared between successive 4-month periods in which the probe was or was not used.

RESULTS

The study was completed by 17 women. There was a significant shift towards urine of lower osmolality over the 4-month period using the probe (Pearson's chi 2 < 0.001). Significantly fewer urinary tract infections developed during the 4 months using the probe (McNemar's chi 2 = 0.046).

CONCLUSIONS

The use of the osmolality probe encouraged the subject to maintain adequate hydration. The resulting augmentation of the natural urethral 'washout' mechanism led to lower osmolality urine and a reduction in the incidence of UTIs.

The internal control of action and Parkinson's disease: a kinematic analysis of visually-guided and memory-guided prehension movements

This paper reports two experiments which examined the effects of Parkinson's disease (PD) upon the sensorimotor mechanisms used to control prehension movements. Transport and grasp kinematics for visually-guided and memory-guided prehension movements were examined in healthy control subjects and compared against those of patients with idiopathic PD. Two research questions were addressed: (1) Are patients with PD particularly susceptible to distraction by non-relevant objects? (2) Are patients with PD especially reliant on external feedback when executing goal-directed actions? The results indicated that the patient group were no more susceptible to distraction by non-relevant objects than the control group. In contrast, the patients with PD were shown to be significantly impaired when executing memory-guided reaches. Furthermore, the deficits exhibited by the PD group on memory-guided reaches were confined solely to those markers associated with the transport component of the prehension movement. That is, while both controls and patients with PD widened their grip aperture on memory-guided trials, the magnitude of this adjustment was comparable across the two groups. The implications of these findings for theories of visuomotor processing in sufferers of PD and the control of prehension movements more generally are discussed.