scholarly journals Levodopa Responsiveness Subtypes of Freezing of Gait: Results Using a Levodopa Challenge

2019 ◽  
Author(s):  
J. Lucas McKay ◽  
Felicia C. Goldstein ◽  
Barbara Sommerfeld ◽  
Douglas Bernhard ◽  
Sahyli Perez Parra ◽  
...  
Keyword(s):  
Interaction Effect ◽  
Mixed Models ◽  
Outcome Measure ◽  
Freezing Of Gait ◽  
Timed Up And Go ◽  
Significant Group ◽  
Main Outcome Measure ◽  
Clinical Exam ◽  
Threshold Levels ◽  
Distinct Subtype

AbstractObjectiveTo demonstrate that levodopa-unresponsive freezing of gait (ONOFF-FOG), which is a disabling untreatable feature of Parkinson’s disease (PD), is distinct from responsive/OFF only FOG (OFF-FOG) and potentially has a distinct pathophysiology.MethodsFifty-five PD patients completed levodopa challenges after >12 hours OFF with supratherapeutic doses to classify them as NOFOG, OFF-FOG or ONOFF-FOG. Serum levodopa levels ensured threshold levels were met. An “ON” response was defined as ≥20% improvement in MDS-UPDRS-III score. Main outcome measure was MDS-UPDRS-III based on clinical exam, timed-up-and-go tests and 360° turns.Results45 patients exhibited an “ON” response to the challenge. Levodopa-equivalent-dose was 142±56% of patients’ typical morning doses. Patients could be classified as: 19 ONOFF-FOG, 11 OFF-FOG, 15 NOFOG. The ONOFF-FOG group exhibited significantly higher NFOG-Q, MDS-UPDRS-II/III scores compared to the OFF-FOG group. MDS-UPDRS-III total varied significantly across medication response states (P<0.01) and groups (P=0.03). Among MDS-UPDRS-III subdomains, significant effects of group (highest in ONOFF-FOG group) were identified for measures of lower extremities and gait. Linear mixed models revealed a highly significant association between serum levodopa level and MDS-UPDRS-III score that did not vary across the groups. There was a highly significant group interaction effect on the association between serum levodopa level with MDS-UPDRS-III item 11 “Freezing of Gait” (P<0.001).ConclusionsONOFF-FOG is a distinct subtype of FOG in PD, as opposed to OFF-FOG. This is an important step in demonstrating that FOG is not a single entity and, in turn, could lead to better understanding of pathophysiology and development of effective therapies.

scholarly journals Hormonal Profiles of Menstrual Bleeding Patterns During the Luteal-Follicular Transition

2020 ◽  
Vol 105 (5) ◽  
pp. e2024-e2031
Author(s):  
Melanie H Jacobson ◽  
Penelope P Howards ◽  
James S Kesner ◽  
Juliana W Meadows ◽  
Celia E Dominguez ◽  
...  
Keyword(s):  
Mixed Models ◽  
Luteal Phase ◽  
Outcome Measure ◽  
Premenopausal Women ◽  
Menstrual Bleeding ◽  
Main Outcome Measure ◽  
Hormonal Profiles ◽  
Late Luteal Phase ◽  
Insight Into ◽  
Endocrine Axis

Abstract Context Menstrual cycle function is determined by a complex endocrine axis that controls the ovaries and endometrium. While the late luteal phase is characterized by declining progesterone and estrogen, how these hormonal profiles relate to menstrual bleeding patterns is not well understood. Objective Characterize associations between luteal phase hormonal profiles and subsequent menstrual bleeding patterns, specifically spotting before bleeding. Design, Setting, and Participants We examined creatinine-adjusted urinary estrone 3-glucuronide (E13G) and pregnanediol 3-glucuronide (Pd3G) levels in relation to spotting in 116 premenopausal women (ages 20–47) who kept daily menstrual diaries and collected first morning urine samples for ≥ 2 consecutive cycles or 1 luteal-follicular transition (n = 283 transitions). We used linear mixed models to estimate associations between luteal phase hormone levels and spotting before bleeding. Main Outcome Measure(s) and Results Transitions with ≥ 1 days of spotting before menstrual bleeding (n = 118) had greater luteal phase Pd3G levels vs nonspotting transitions (n = 165). Differences in Pd3G between spotting and nonspotting transitions were largest at menses onset (34.8%, 95% confidence interval, 18.9%, 52.7%). Pd3G levels for spotting transitions dropped to similar levels as nonspotting transitions an average of 1 day later, which aligned with the first day of bleeding for transitions with contiguous spotting. Spotting transitions were preceded by slower rates of Pd3G decline than nonspotting transitions, whereas E13G declines were similar. Conclusions Self-reported bleeding patterns may provide insight into luteal phase Pd3G levels. First bleed appears to be the best choice for defining the end of the luteal phase and achieving hormonal consistency across transitions.

Bronchopulmonary dysplasia and postnatal growth following extremely preterm birth

2020 ◽  
pp. fetalneonatal-2020-320816
Author(s):  
Theodore Dassios ◽  
Emma E Williams ◽  
Ann Hickey ◽  
Catey Bunce ◽  
Anne Greenough
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Head Circumference ◽  
Outcome Measure ◽  
Postnatal Growth ◽  
Z Score ◽  
Main Outcome Measure ◽  
Extremely Preterm ◽  
Postmenstrual Age ◽  
Extremely Preterm Birth ◽  
Current Incidence

ObjectivesTo report the current incidence of bronchopulmonary dysplasia (BPD) and to compare changes in weight and head circumference between infants who developed BPD and infants who did not.DesignRetrospective, whole-population study.SettingAll neonatal units in England between 2014 and 2018.PatientsAll liveborn infants born <28 completed weeks of gestation.InterventionsThe change in weight z-score (ΔWz) was calculated by subtracting the birthweight z-score from the weight z-score at 36 weeks postmenstrual age (PMA) and at discharge. The change in head circumference z-score (ΔHz) was calculated by subtracting the birth head circumference z-score from the head circumference z-score at discharge.Main outcome measureBPD was defined as the need for any respiratory support at 36 weeks PMA.Results11 806 infants were included in the analysis. The incidence of BPD was 57.5%, and 18.9% of the infants died before 36 weeks PMA. The median (IQR) ΔWz from birth to 36 weeks PMA was significantly smaller in infants who developed BPD (−0.69 (−1.28 to −0.14), n=6105) than in those who did not develop BPD (−0.89 (−1.40 to −0.33), n=2390; adjusted p<0.001). The median (IQR) ΔHz from birth to discharge was significantly smaller in infants who developed BPD (−0.33 (−1.69 to 0.71)) than in those who did not develop BPD (−0.61 (−1.85 to 0.35); adjusted p<0.001).ConclusionsPostnatal growth was better in infants diagnosed with BPD compared with infants without BPD possibly due to more aggressive nutrition strategies.

S153 – Radiological Balloon Dilatation of Neo-Pharyngeal Strictures

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P127-P128
Author(s):  
Robert L Harris ◽  
Grundy Alan ◽  
Tunde A Odutoye
Keyword(s):  
Total Laryngectomy ◽  
Balloon Dilatation ◽  
Malignant Disease ◽  
Outcome Measure ◽  
Tertiary Care ◽  
Case Series ◽  
Stent Insertion ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Main Outcome Measure

Objectives Radiological balloon dilatation of lower oesophageal strictures is common practice. Other than some early reports from our own centre, there is little published regarding radiological dilatation of pharyngeal and upper oesophageal strictures and less still on radiological balloon dilatation of post-total laryngectomy and pharyngolaryngectomy neo-pharyngeal strictures. Standard practise is bouginage under general anaesthaesia. The objective of this study is to assess the efficacy of radiological balloon dilatation for the treatment of dysphagia secondary to neopharyngeal strictures in patients who have undergone laryngectomy. Methods A tertiary care centre case series of 20 consecutive patients (17 males and 3 females aged 40 to 84) with pharyngeal stricture and dysphagia post-total laryngectomy or pharyngolaryngectomy who underwent balloon dilatation of the stricture under radiological guidance. Maintenance of swallowing was the main outcome measure. Results 5 patients gained relief of their dysphagia with 1 balloon dilatation only. 9 patients required more than 1 dilatation to maintain swallowing. 2 patients had balloon dilatation procedures and stent insertion for palliative relief of dysphagia from known recurrent malignant disease. 3 patients failed to maintain swallowing with repeat dilatations. No patients suffered any significant complications such as perforation. Conclusions Balloon dilatation is minimally invasive and less traumatic than rigid pharyngoscopy with bouginage dilatation. It is well tolerated. It may be repeated frequently and can successfully relieve strictures of the pharynx in patients who have undergone total laryngectomy or pharyngolaryngectomy.

Skeletal and Dental Correction and Stability Following LeFort I Advancement in Patients With Cleft Lip and Palate With Mild, Moderate, and Severe Maxillary Hypoplasia

2021 ◽  
pp. 105566562199610
Author(s):  
Buddhathida Wangsrimongkol ◽  
Roberto L. Flores ◽  
David A. Staffenberg ◽  
Eduardo D. Rodriguez ◽  
Pradip. R. Shetye
Keyword(s):  
Retrospective Study ◽  
Outcome Measures ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Inclusion Criteria ◽  
Maxillary Hypoplasia ◽  
Main Outcome Measure ◽  
Lateral Cephalograms

Objective: This study evaluates skeletal and dental outcomes of LeFort I advancement surgery in patients with cleft lip and palate (CLP) with varying degrees of maxillary skeletal hypoplasia. Design: Retrospective study. Method: Lateral cephalograms were digitized at preoperative (T1), immediately postoperative (T2), and 1-year follow-up (T3) and compared to untreated unaffected controls. Based on the severity of cleft maxillary hypoplasia, the sample was divided into 3 groups using Wits analysis: mild: ≤0 to ≥−5 mm; moderate: <−5 to >−10 mm; and severe: ≤−10 mm. Participants: Fifty-one patients with nonsyndromic CLP with hypoplastic maxilla who met inclusion criteria. Intervention: LeFort I advancement. Main Outcome Measure: Skeletal and dental stability post-LeFort I surgery at a 1-year follow-up. Results: At T2, LeFort I surgery produced an average correction of maxillary hypoplasia by 6.4 ± 0.6, 8.1 ± 0.4, and 10.7 ± 0.8 mm in the mild, moderate, and severe groups, respectively. There was a mean relapse of 1 to 1.5 mm observed in all groups. At T3, no statistically significant differences were observed between the surgical groups and controls at angle Sella, Nasion, A point (SNA), A point, Nasion, B point (ANB), and overjet outcome measures. Conclusions: LeFort I advancement produces a stable correction in mild, moderate, and severe skeletal maxillary hypoplasia. Overcorrection is recommended in all patients with CLP to compensate for the expected postsurgical skeletal relapse.

scholarly journals Ultrasound Screening for Thyroid Carcinoma in Childhood Cancer Survivors: A Case Series

2008 ◽  
Vol 93 (12) ◽  
pp. 4840-4843 ◽  
Author(s):  
Enrico Brignardello ◽  
Andrea Corrias ◽  
Giuseppe Isolato ◽  
Nicola Palestini ◽  
Luca Cordero di Montezemolo ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Outcome Measure ◽  
Childhood Cancer Survivors ◽  
Ultrasound Screening ◽  
Thyroid Ultrasound ◽  
Main Outcome Measure ◽  
Head Neck

Context: Childhood cancer survivors need regular monitoring into young adulthood and beyond, because they are at risk for developing late-onset complications of cancer therapy, including second malignancies. Objective: This study focuses on the use of thyroid ultrasound to screen for thyroid carcinoma in a population of childhood cancer survivors. Patients: A total of 129 subjects who had received radiotherapy to the head, neck, or upper thorax for a pediatric cancer were studied in the setting of a long-term follow-up unit. Design: Thyroid ultrasound usually began 5 yr after radiotherapy and was repeated every third year, if negative. Median follow-up time since childhood cancer diagnosis was 15.8 yr (range 6.1–34.8 yr). Solid thyroid nodules were found in 35 patients. Fine-needle aspiration was performed in 19 patients, of which 14 had nodules above 1 cm. Main Outcome Measure: The main outcome measure was the finding of not palpable thyroid cancers. Results: Cytological examination of specimens diagnosed papillary carcinoma in five patients who underwent surgery. The cytological diagnosis of papillary thyroid carcinoma was confirmed in all cases by histological examination. Notably, only two of these patients had palpable nodules; the other three were smaller than 1 cm and were detected only by ultrasound. However, histological examination showed nodal metastases in two of these. Conclusions: Although ultrasound screening for thyroid cancer in the general population is not cost effective and could lead to unnecessary surgery, due to false positives, we believe that in childhood cancer survivors who received radiotherapy involving the head, neck, or upper thorax, it would be worthwhile.

scholarly journals The value of domiciliary medication reviews: a thematic analysis of patient views

2021 ◽  
Author(s):  
Patricia McCormick ◽  
Bridget Coleman ◽  
Ian Bates
Keyword(s):  
Thematic Analysis ◽  
Outcome Measure ◽  
Service Users ◽  
Structured Interviews ◽  
Main Outcome Measure ◽  
Healthcare Settings ◽  
Medication Reviews ◽  
Informal Carers ◽  
The Individual ◽  
Patient Centric

AbstractBackground Medication reviews are recognised as essential to tackling problematic polypharmacy. Domiciliary medication reviews (DMRs) have become more prevalent in recent years. They are proclaimed as being patient-centric but published literature mainly focuses on clinical outcomes. However, it is not known where the value of DMRs lies for patients who participate in them. Objective To determine the value of domiciliary medication reviews to service users. Setting Interviews took place with recipients of domiciliary medication reviews residing in the London boroughs of Islington and Haringey. Method Semi-structured interviews analysed using thematic analysis. Main outcome measure Themes and sub-themes identified from interview transcripts. Results Five themes were identified: advantages over traditional settings, attributes of the professional, adherence, levels of engagement and knowledge. Conclusion For many patients, the domiciliary setting is preferred to traditional healthcare settings. Patients appreciated the time spent with them during a DMR and felt listened to. Informal carers felt reassured that the individual medication needs of their relative had been reviewed by an expert.

scholarly journals Association of Cryptorchidism with a Specific Haplotype of the Estrogen Receptor α Gene: Implication for the Susceptibility to Estrogenic Environmental Endocrine Disruptors

2005 ◽  
Vol 90 (8) ◽  
pp. 4716-4721 ◽  
Author(s):  
Rie Yoshida ◽  
Maki Fukami ◽  
Isoji Sasagawa ◽  
Tomonobu Hasegawa ◽  
Naoyuki Kamatani ◽  
...  
Keyword(s):  
Estrogen Receptor ◽  
Endocrine Disruptors ◽  
Outcome Measure ◽  
Estrogen Receptor Α ◽  
Nucleotide Polymorphisms ◽  
Single Nucleotide ◽  
Main Outcome Measure ◽  
Environmental Endocrine Disruptors ◽  
Estrogenic Effects ◽  
Specific Haplotype

Context: The prevalence of cryptorchidism (CO) has increased during the past few decades in several countries, and this event has primarily been ascribed to the estrogenic effects of environmental endocrine disruptors (EEDs). Little is known, however, about the role of genetic susceptibility to EEDs in this phenomenon. Objective: The objective of this study was to determine whether CO is associated with a specific haplotype of the gene for estrogen receptor α (ESR1) that mediates the estrogenic effects of EEDs. Design: This was a case-control study. Setting: The study was performed at the National Research Institute and University Hospitals. Subjects: Sixty-three cryptorchid males, aged 1–13 yr, and 47 control males, aged 4–12 yr, were studied. Intervention: After genotyping 15 single nucleotide polymorphisms widely distributed in the greater than 300-kb genomic sequences of ESR1, haplotype analysis was performed. Main Outcome Measure: Identification of a specific ESR1 haplotype associated with CO was the main outcome measure. Results: A haplotype block was identified for an approximately 50-kb region encompassing single nucleotide polymorphisms 10–14 in the 3′ region of ESR1 in both groups. The frequency of the estimated AGATA haplotype within the block was higher in the patients than in the control males (34.0% vs. 21.3%; P = 0.037), and the association of this haplotype with CO phenotype was significant in a recessive mode (P = 0.0060). The homozygosity for this haplotype was identified only in the patients, and the frequency of the homozygotes was significantly different between the two groups (10 of 63 vs. zero of 47; P = 0.0042). Conclusions: The association of CO with homozygosity for the specific ESR1 haplotype suggests the relevance of genetic susceptibility to EEDs in the development of CO.

The Effects of Superficial Heating before 1-MHz Ultrasound on Tissue Temperature

2003 ◽  
Vol 12 (2) ◽  
pp. 95-103 ◽  
Author(s):  
William R. Holcomb ◽  
Chris Blank
Keyword(s):  
Athletic Training ◽  
Repeated Measures ◽  
Outcome Measure ◽  
Tissue Temperature ◽  
Temperature Elevation ◽  
Main Outcome Measure ◽  
Cooling Period ◽  
Dependent Variables ◽  
Within Subjects ◽  
Independent Variable

Context:Ultrasound significantly raises tissue temperature, but the time of temperature elevation is short.Objective:To assess the effectiveness of superficial preheating on temperature elevation and decline when using ultrasound.Design:Within-subjects design to test the independent variable, treatment condition; repeated-measures ANOVAs to analyze the dependent variables, temperature elevation and decline.Setting:Athletic training laboratory.Intervention:Temperature at a depth of 3.75 cm was measured during ultrasound after superficial heating and with ultrasound alone.Subjects:10 healthy men.Main Outcome Measure:Temperature was recorded every 30 s during 15 min of ultrasound and for 15 min afterward.Results:Temperature elevation with ultrasound was significantly greater with preheating (4.0 ± 0.21 °C) than with ultrasound alone (3.0 ± 0.22 °C). Temperature decline was not significantly different between preheating and ultrasound alone.Conclusions:Superficial preheating significantly increases temperature elevation but has no effect on temperature decline during a 15-min cooling period.

Strength Training Using Elastic Bands: Improvement of Muscle Power and Throwing Performance in Young Female Handball Players

2017 ◽  
Vol 26 (3) ◽  
pp. 245-252 ◽  
Author(s):  
Naryana Cristina Mascarin ◽  
Claudio Andre Barbosa de Lira ◽  
Rodrigo Luiz Vancini ◽  
Alberto de Castro Pochini ◽  
Antonio Carlos da Silva ◽  
...  
Keyword(s):  
Strength Training ◽  
Outcome Measures ◽  
Interaction Effect ◽  
Muscle Power ◽  
Young Female ◽  
Muscle Performance ◽  
Significant Group ◽  
Ball Speed ◽  
Time Interaction ◽  
Elastic Bands

Context:Imbalance in shoulder-rotator muscles has been considered a risk factor for injuries in handball. Strength training programs (STPs) may play an important preventive role.Objective:To verify the effects of an STP using elastic bands on shoulder muscles and ball-throwing speed.Design:Randomized and prospective controlled trial.Setting:Exercise physiology laboratory.Participants:Thirty-nine female handball players were randomly assigned to an experimental (EG, n = 21, 15.3 ± 1.1 y) or a control (CG, n = 18, 15.0 ± 0.8 y) group.Intervention:The EG performed the STP with elastic-band progressive exercises for 6 wk before regular handball training, and the CG underwent only their regular training.Main Outcome Measures:Before and after the STP, both groups underwent a ball-throwing-speed test and isokinetic test to assess shoulder internal- (IR) and external-rotator muscle performance.Results:Average power values for IR muscles presented a significant group-vs-time interaction effect (F = 3.9, P = .05); EG presented significantly higher values after the STP (P = .03). Ball speed presented higher values in EG after the STP in standing (P = .04) and jumping (P = .03) throws. IR peak-torque values and balance in shoulder-rotator muscles presented no group-vs-time interaction effect.Conclusions:STP using elastic bands performed for 6 wk was effective to improve muscle power and ball speed for young female handball players.

scholarly journals Self-Monitoring Symptoms in Glaucoma: A Feasibility Study of a Web-Based Diary Tool

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Leanne McDonald ◽  
Fiona C. Glen ◽  
Deanna J. Taylor ◽  
David P. Crabb
Keyword(s):  
Outcome Measure ◽  
Visual Field Loss ◽  
Qualitative Synthesis ◽  
Self Monitoring ◽  
Web Based ◽  
Main Outcome Measure ◽  
Negative Feelings ◽  
Behavioural Aspects ◽  
Study Questionnaire ◽  
Eye Clinic

Purpose. Glaucoma patients annually spend only a few hours in an eye clinic but spend more than 5000 waking hours engaged in everything else. We propose that patients could self-monitor changes in visual symptoms providing valuable between clinic information; we test the hypothesis that this is feasible using a web-based diary tool. Methods. Ten glaucoma patients with a range of visual field loss took part in an eight-week pilot study. After completing a series of baseline tests, volunteers were prompted to monitor symptoms every three days and complete a diary about their vision during daily life using a bespoke web-based diary tool. Response to an end of a study questionnaire about the usefulness of the exercise was a main outcome measure. Results. Eight of the 10 patients rated the monitoring scheme to be “valuable” or “very valuable.” Completion rate to items was excellent (96%). Themes from a qualitative synthesis of the diary entries related to behavioural aspects of glaucoma. One patient concluded that a constant focus on monitoring symptoms led to negative feelings. Conclusions. A web-based diary tool for monitoring self-reported glaucoma symptoms is practically feasible. The tool must be carefully designed to ensure participants are benefitting, and it is not increasing anxiety.

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