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3-D Analysis of a Functional Reach Test in Subjects With Functional Ankle Instabilityde la Motte, Sarah J. 25 November 2008 (has links)
CONTEXT: 3-D kinematics and kinetics of the lower extremity during the Star Excursion Balance Test (SEBT) have not been examined in FAI subjects. Additionally, the effects of Kinesio® tape use in subjects with functional ankle instability (FAI) during functional tasks is uninvestigated. OBJECTIVE: To determine if lower extremity kinematics and kinetics differed in FAI subjects using Kinesio® tape during maximal SEBT reach. SUBJECTS: Twenty subjects with FAI (Age=24.2±3.8yrs; Ht=169±11.6cm; Wt=69±12.4kg) and twenty uninjured subjects (Age=25.7±5.6yrs; Ht=170.1.4±8.8cm; Wt=69.9±10.5kg) with no history of ankle sprain. FAI was operationally defined as repeated episodes of ankle “giving way” and/or ankle “rolling over”, regardless of neuromuscular deficits or pathologic laxity. All FAI subjects scored < 26 on the Cumberland Ankle Instability Tool. METHODS: SEBT reaches included the anteromedial, medial, and posteromedial directions. FAI subjects used their unstable side as the stance leg, while control subjects were side-matched to the FAI group. The stance leg ankle was taped using 1) Kinesio® tape and the Kinesio taping method (Kinesio method); 2) white linen tape with the Kinesio method; 3) Kinesio® tape along the distal peroneals tendons (lateral method); 4) white tape with the lateral method. Three-dimensional lower extremity kinematics, kinetics, and force plate data were collected during SEBT performance. A repeated measures ANOVA analyzed the effects of group, tape, tape method, and reach direction on all variables (α=0.05). Tukey HSD post-hoc analyses were performed for significant interactions. RESULTS: Normalized reach distance was not significantly different between groups in any direction (F2,76=1.16, P=.32). A significant four-way interaction for tape, method, direction, and group (F2,72=3.874, P=.03) was found. Post-hoc testing showed FAI subjects exhibited hip abduction while control subjects used hip adduction (Condition 1: .65±8.23° vs. -2.14±8.51°; Condition 2: 1.29±7.71° vs. -1.75±8.29°; Condition 3: 1.08±8.39° vs. -1.88±18.33°; Condition 4: 2.13±7.62° vs. -1.54±6.61°). Additionally, a significant difference in FAI subjects’ hip abduction angles between the white tape/Kinesio method (.65±8.23°) and Kinesio tape/Kinesio method (1.08±8.39°) was found. Conclusions: These results indicate that FAI subjects’ movement strategies differ from those of uninjured subjects. Furthermore, the use of Kinesio® tape at a distal joint can alter proximal joint movement in subjects with FAI.
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A randomised trial of different approaches to the surveillance of patients with primary open angle glaucoma : follow-up by community-based optometrists compared to the hospital eye serviceGray, Selena F. January 2000 (has links)
No description available.
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Vulvar vestibulitis syndrome : an ultrastructural and epidemiological investigationSargeant, Penelope January 1996 (has links)
Vulvar Vestibulitis Syndrome (VVS) is a chronic inflammatory condition affecting the vestibular epithelium of the vulva, which has been estimated to affect 15% of the female population (Goetsch, 1991). Many studies have attempted unsuccessfully, to elucidate the cause of this condition, and few advancesh ave beenm adet owards the understandingo f the associatedin flammatory responseT. he initial, and principal aim of this investigation was to characterise normal vestibular epithelium using electron microscopy. The ultrastructural characteristics of normal vestibular epithelium were compared with closely related epithelia, and with vestibular epithelia from VVS patients. Other aims included an investigation of the epidemiological characteristics of VVS; an assessmenot f vulvar sensitivity over several months, and an evaluation of ketoconazole as a non-invasive treatment for VVS. Transmission electron microscopy, confirmed that vestibular epithelium was non-keratinised, and closely resembled oral and vaginal mucosae. Intermediate cells were predominant, characterised by pale staining cytokeratin filaments and glycogen deposits. Leukocytes were present in small numbers. Using SEM, superficial cells were characterised by an interlacing network of rounded microridges. By comparison, vestibular epithelium from VVS patients demonstrated the presence of numerous, intensely staining, apoptotic-like cells. These cells were associated with membrane bound cytoplasmic lobules and leukocytes of varying types. A similar ultrastructural appearance was observed in post-treatment biopsies. However, apoptotic-like cells appeared heavily vacuolated, and the number of cytoplasmic bodies present was increased. Mature plasma cells, NK-like cells and macrophages were common in the dermis. Leukocyte counts, demonstrated a significantly greater number of leukocytes in the VVS biopsies compared with the controls, however, there was no statistical difference in the number of leukocytes in pre and post-treatment samples. The presence of apoptotic-like cells accompanied by a significant inflammatory cell infiltrate, may suggest a cell signalling defect, resulting in the pain associatedw ith VVS. Treatment with ketoconazolec ream was found to have very little effect on either the number of leukocytes or the frequency of apoptotic-like cells as quantified using image analysis. The epidemiological characteristics of VVS patients were investigated using a structured questionnaire interview. All of the VVS patients interviewed fulfilled the diagnostic criteria established by Friedrich (1987), and epidemiological findings were generally consistent with previous epidemiological reports. Unique to this study, HPV infections were rare, however recurrent Candida infections and cystitis were commonly reported. The 'Vulvar Algesiometer', was designed and developed in Plymouth, to assist diagnosis and assessmenot f VVS patients. Using this equipment, VVS patients demonstrate heightened vestibular sensitivity when compared with control patients. The utilisation of a pain measuring device the 'Vulvar Algesiometer', in accordance with the questionnaire and ultrastructural investigation has formed a novel and balanced approach to the study of VVS. This study has demonstrated several distinct features of VVS which have not previously been described, features which may be important in elucidating the cause of this condition. These features centre around the presence of apoptotic-like cells and associated cytoplasmic bodies which have not previously been described in association with VVS.
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The profile of chronic pain patients attending the Helen Joseph Hospital Pain Management UnitMayat, Yasmin Mohamed Saleem January 2014 (has links)
A
research
report
submitted
to
the
Faculty
of
Health
Sciences,
University
of
the
Witwatersrand,
in
partial
fulfillment
of
the
requirements
for
the
degree
of
Master
of
Science
in
Medicine
in
the
branch
of
Anaesthesiology
Johannesburg,
2014 / BACKGROUND:
Chronic
pain
is
a
biopsychosocial
phenomenon
that
can
have
a
profound
impact
on
people’s
lives.
Internationally,
chronic
pain
is
being
recognised
as
a
health
priority.
South
Africa
is
a
developing
country
with
limited
resources
that
are
directed
at
catering
for
a
growing
population
where
life
threatening
conditions
like
Human
Immunodeficiency
Virus
(HIV)/Acquired
Immunodeficiency
Syndrome
(AIDS),
violent
crimes,
and
poverty
predominate.
Auditing
the
Helen
Joseph
Hospital
Pain
Management
Unit
(HJHPMU)
is
a
step
towards
addressing
the
paucity
of
epidemiological
data
on
chronic
pain
in
South
Africa.
Clinical
records
are
a
basic
clinical
tool
that
also
serves
as
a
medicolegal
document.
It
is
essential
that
these
records
are
legible
and
complete.
AIM:
The
aim
of
this
study
was
to
describe
the
profile
of
chronic
pain
patients
at
the
HJHPMU
for
2011
and
to
determine
the
adequacy
of
record
keeping.
METHODOLOGY:
A
retrospective,
contextual,
descriptive
study
design
was
utilised.
A
consecutive
sampling
method
was
used
and
the
study
sample
included
the
HJHPMU
database
and
all
files
of
adult
patients
that
attended
the
HJHPMU
during
the
period
January
2011
to
December
2011.
Patient
files
were
excluded
from
the
audit
if
insufficient
data
were
found.
Descriptive
statistics
were
used
to
analyse
the
data
obtained
during
the
study.
Frequencies
and
percentages
have
been
reported.
A
Chi-‐squared
test
was
utilised
to
analyse
any
association
between
gender
and
type
of
pain.
RESULTS:
There
were
475
patients
in
the
HJHPMU
database
for
the
year
2011
and
190
of
these
patients
were
excluded
from
the
study
due
to
illegible
handwriting,
duplication
in
the
HJHPMU
database,
missing
data
such
as
no
hospital
number
recorded,
no
initials
to
a
surname,
or
the
file
not
found.
This
resulted
in
a
study
sample
of
285
patients.
The
HJHPMU
had
215
(75,44%)
pre-‐existing
patients
and
70
(24,56%)
new
patients
during
the
year
2011.
The
preponderance
of
patients
were
in
the
41-‐60
year
age
group,
with
146
(51,23%)
patients
presenting
in
this
age
group.
Of
the
285
patients
in
the
study,
91
(31,93%)
patients
were
male
and
194
(68,07%)
were
female.
The
most
common
complaint
was
of
lower
back
pain
(LBP).
There
were
97
(34,04%)
patients
with
a
diagnosis
of
spinal
pain
and
59
(20,70%)
with
Failed
Back
Surgery
Syndrome
(FBSS).
There
were
164
patients
with
a
relevant
surgical
history.
This
included
46
(28,05%)
patients
that
had
been
involved
in
a
traumatic
event,
47
(16,49%)
patients
that
had
surgery
other
than
spinal
surgery
that
was
relevant
to
their
pain
diagnosis,
and
71
patients
(43,29%)
that
4
had
spinal
surgery
that
was
relevant
to
their
diagnosis.
A
Chi-‐squared
test
was
performed
on
the
relationship
between
gender
and
the
type
of
pain,
and
a
p
value
of
0.001
was
found.
When
relating
the
type
of
pain
with
age,
mixed
pain
and
nociceptive
pain
was
found
to
be
most
common
in
those
aged
>60
years
(n=26),
whereas
neuropathic
pain
was
found
to
be
most
common
in
the
41-‐60
year
age
group
(n=43).
CONCLUSION:
With
the
limited
data
from
this
study,
the
profile
of
patients
with
chronic
pain
in
South
Africa
seems
to
not
differ
grossly
from
data
collected
internationally.
The
most
pertinent
finding
of
this
study
is
the
inadequacy
of
record
keeping.
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315 |
Telomere dynamics in chronic myeloid leukaemiaGil, Marcel Eduardo 06 March 2014 (has links)
Telomeres are regions of tandem repeats at the ends of chromosomes ensuring chromosome stability or inducing replicative senescence when critically short. Telomerase extends telomeres and its catalytic subunit, telomerase reverse transcriptase is tightly regulated at multiple levels. Cancerous cells prevent telomere-mediated senescence to attain unlimited proliferation, in most cases by enhancing telomerase activity. Chronic myeloid leukaemia is characterised by the translocation, t(9;22), in haematopoietic stem cells. The resulting fusion protein exhibits constitutive tyrosine kinase activity in the cytoplasm, promoting cellular proliferation, inhibiting apoptosis and impeding cell adhesion. Changes in telomere biology have been observed in chronic myeloid leukaemic cells. The current study aimed to investigate telomere biology in 18 chronic myeloid leukaemia patients at various time intervals from date of diagnosis. Although telomeres were significantly shorter in patients compared to controls, results point to complex telomere dynamics in the malignancy. Increased telomerase activity did not necessarily accompany telomere lengthening and increased transcription of the telomerase catalytic subunit was not necessarily indicative of telomerase activity. Ultimately the current study could not detect any trends between telomere length, telomerase activity and telomerase catalytic subunit expression in chronic myeloid leukaemia patients. Together with inherent patient-to-patient variation and the high cost per assay, measurement of telomere biology does not appear to hold prognostic value in chronic myeloid leukaemia and does not warrant inclusion into a routine test repertoire.
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316 |
Frail older adults' experience of participating in clinical trialsGriffith, Catherine A. January 2015 (has links)
Thesis advisor: Callista L. Roy / Purpose: The purpose of this research was to address the gap in the literature related to frail older adults' experience of participating in clinical trials.
Background: Frail older adults are generally underrepresented in the population of research volunteers from which evidence-based guidelines are derived. To improve care for frail older adults, research must be expanded to specifically target this population. Most of the users of healthcare today are greater than 65 years old, use more health care services than any other age cohort and suffer from coexisting illnesses for which they take several prescribed medications. Since the number of elders is increasing within the general population, it is important to reach a more thorough understanding of frail older adults' experience. Acquiring a better understanding of their experience will give the investigator more insight into barriers of recruitment, retention, and factors affecting elders' decision to participate in research.
Method: Using a qualitative descriptive approach involving semi-structured interviews, a cohort of participants age 65 and older was asked about their experience of participating in research studies. Data analysis used an interpretive paradigm involving the methods of Miles, Huberman, and Saldana (2014).
Results: Participants identified the main factors influencing their decision to participate as the opinions and encouragement of family members with the strongest influence being a recommendation from their doctor. Participants were varied in the emotions evoked by their participation in the study procedures. The majority of participants stressed how important it was to them to receive feedback in the form of results of studies in which they had participated. The majority of participants stated that receiving feedback or research results was the exception.
Conclusions: Data generated from this study related to the experience of frail elder participation in clinical trials will be useful in designing future clinical trials to be more inclusive of this patient population. Keywords: frail elders, research participation, clinical trials, chronic illness, qualitative, multmorbidity / Thesis (PhD) — Boston College, 2015. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.
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Genetic insights on the role of telomere dynamics in Chronic Kidney Disease (CKD) regardless of HIV statusMalindisa, Sibusiso Tebogo January 2016 (has links)
A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfilment of requirements for the degree of Master of Science in the School of Molecular and Cell Biology. Johannesburg, 2016. / Telomeres play significant roles in maintaining genome stability, regulating cell proliferation and apoptosis. The role of telomere biology and telomerase reactivation has been studied extensively in cancers. Telomerase has been previously associated with driving chronic kidney disease (CKD) advancement and most frequently due to HIV infection. However, the mechanism by which telomerase activation contributes towards disease progression beyond its canonical function of telomere maintenance is poorly understood. Telomerase is a ribonucleoprotein whose main function is telomere maintenance. Telomerase activity is dependent on expression of the rate-limiting human telomerase reverse transcriptase (hTERT) component. In addition to telomere maintenance, hTERT is implicated in other non-telomere related functions that promote cellular proliferation. Expression of hTERT is predominantly regulated at the transcription level where variation in promoter and minisatellite (MNS16A) sequences alter its expression. This variation has been implicated to confer susceptibility to diseases such as cancer and ageing disorders in non-African populations. Data on variation and pathogenicity of telomere-associated genes in African populations is limited and warrants further research. Thus bioinformatics analysis was performed to elucidate variation within the human TERT gene and promoter in different populations. The promoter, MNS16A and relative telomere length (RTL) were also evaluated in 159 African study participants with and without CKD. TERT common variants are equally distributed across populations with limited data on connection to the effects of the variants in African populations. Further bioinformatics analyses revealed significant difference (p<0.0001) in distribution of promoter variant rs2853669 between African and non-African populations. No common promoter mutations were identified in our study population. Interestingly, the long MNS16A variant suggested to increase TERT expression was significantly overrepresented in individuals with CKD regardless of HIV status. For the first time, a strong association of the long MNS16A variant with CKD regardless of HIV status is reported, implicating MNS16A as a potential risk factor in CKD.
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Targeting the Process of c-MYC Stabilization in Chronic Myelogenous LeukemiaSunohara, Maxwell January 2017 (has links)
Currently there is no curative therapy for Chronic Myelogenous Leukemia (CML), and patients must remain on the current prescribed treatment, tyrosine kinase inhibitors (TKI), indefinitely. Although many patients can survive in the chronic phase of the disease under TKI treatment, some patients do progress to the terminal blast crisis phase of the disease. Patients in this terminal phase do not respond to TKI treatment. We evaluated the therapeutic benefit of targeting the oncogene c-MYC in CML, using the CML cell line K562. This was achieved by inhibiting the enzyme O-linked β-N-acetylglucosamine Transferase (OGT), using two indirect inhibitors 2-deoxyglucose and Azaserine, and the direct inhibitor ST078925. Treatment with these inhibitors resulted in decreased half-life of c-MYC protein in K562, reduced c-MYC protein in K562 cells, and reduced K562 cell growth. Together these results suggest that targeting c-MYC through OGT may be a potential therapeutic option for patients with CML.
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The role of B cells in a mouse model of renal transplantationTse, George Hondag January 2016 (has links)
Renal transplantation is the optimum treatment for end-stage renal failure. B cells have been identified in chronic allograft damage (CAD) and are associated with the development of tertiary lymphoid tissue within the human renal allograft. To investigate this pathology we utilized a mouse model of renal transplantation. A mouse model of kidney transplantation was first described in 1973. Although the mouse model is technically difficult it is attractive for several reasons: the mouse genome has been characterized and in many aspects is similar to man and there is a greater diversity of experimental reagents and techniques available for mouse studies than other experimental models. We reviewed the literature on all studies of mouse kidney transplantation to report the donor and recipient strain combinations that have been investigated and the resultant survival and histological outcomes. Some models of kidney transplantation have used the transplanted kidney as a life-supporting organ, however in many studies the recipient mouse’s native kidney has been left in situ. Several different combinations of inbred mouse strains have been reported, with varying degrees of injury, survival, or tolerance due to haplotype differences. Both cellular and humoral rejection processes have been observed. This model has been exceptionally useful as an investigational tool to understand multiple aspects of transplantation including acute rejection, cellular and humoral rejection mechanisms and their treatment. Furthermore this model has been used to investigate disease mechanisms beyond transplant rejection including intrinsic renal disease and infection-associated pathology. We performed renal transplantation in mice to model CAD and identified B cells forming tertiary lymphoid tissue with germinal centres. Intra-allograft B220+ B cells comprised of IgMhigh CD23- marginal zone, IgMlo CD23+ follicular zone and IgMlo CD23- transitional-type B cells similar to spleen, and these compartments had elevated expression of CD86. Depletion of B cells with anti-CD20 was associated with an improvement in CAD but only when administered after transplantation and not before. Isolated intra-allograft B cells were cultured and shown to synthesise multiple cytokines, the most abundant of these being GRO-α (CXCL1), RANTES (CCL5), IL-6 and MCP-1 (CCL2). Tubular loss was associated with T cell mediated injury and interstitial fibrosis, whilst type III collagen deposition driven by F4/80+ macrophages and PDGFR-β+ and transgelin+ fibroblasts, all of which were reduced by B cell depletion. In this report we show that intra-allograft B cells are key mediators of chronic damage to the transplant allograft kidney by cytokine orchestration of T cell, macrophage infiltration and fibroblast activation.
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Understanding the reasons for non-participation in self-management interventions amongst patients with chronic conditions : addressing and increasing opportunities for patients with advanced chronic obstructive pulmonary disease to access self-managementSohanpal, Ratna January 2015 (has links)
Background: In chronic obstructive pulmonary disease (COPD), understanding the problem of poor patient participation in evidence-based self-management (SM) and pulmonary rehabilitation (PR) programmes (together referred to as SM support programmes) is critical. This thesis aimed to improve understanding of poor patient participation and retention in these programmes; how participation might be improved; and how might patients be better supported with their SM. Methods: Using the Medical Research Council guidance on complex interventions this thesis (1) quantified the 'actual' patient participation and completion rates; (2) explained, using theory, the factors that influenced participation in studies of SM support including the programmes among chronic disease and COPD patients; and (3) explored patient and expert stakeholders' perspectives on the reasons for non-participation in SM support programmes, how participation might be improved, how might patients be supported with their SM. Results: (1) Among 56 studies, high study participation rates and completion rates were seen however, the incomplete reporting of participant flow confused the problem of participation. (2) Among 31 studies, participation among patients with chronic disease including COPD was shown to be influenced by their 'attitude' and 'perceived social influence/subjective norms'; 'illness' and 'intervention perceptions'. (3) From 38 interviewees, besides patients' beliefs, non-participation was also influenced by resignation and denial of the illness; health systems; and programme organisational factors. Professionals building relationships and supporting patients with their SM alongside programme organisational improvements might encourage patient participation in SM and the programmes. Conclusions Patient participation is a complex behaviour, besides socio-behavioural factors, participation behaviour can by influenced by a mix of several health system and programme organisational factors. Changing the behaviour of health professionals and indeed the wider health system, towards normalising a patient partnership approach, with implementation of SM support in routine care might help more patients to consider participation in their care and improve patient participation in COPD SM support programmes.
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