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Goal-directed therapy

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https://www.readbyqxmd.com/read/29149855/increasing-upper-limb-training-intensity-in-chronic-stroke-using-embodied-virtual-reality-a-pilot-study
#1
Daniel Perez-Marcos, Odile Chevalley, Thomas Schmidlin, Gangadhar Garipelli, Andrea Serino, Philippe Vuadens, Tej Tadi, Olaf Blanke, José D R Millán
BACKGROUND: Technology-mediated neurorehabilitation is suggested to enhance training intensity and therefore functional gains. Here, we used a novel virtual reality (VR) system for task-specific upper extremity training after stroke. The system offers interactive exercises integrating motor priming techniques and embodied visuomotor feedback. In this pilot study, we examined (i) rehabilitation dose and training intensity, (ii) functional improvements, and (iii) safety and tolerance when exposed to intensive VR rehabilitation...
November 17, 2017: Journal of Neuroengineering and Rehabilitation
https://www.readbyqxmd.com/read/29148575/effects-of-spot-parameters-in-pencil-beam-scanning-treatment-planning
#2
Aafke Christine Kraan, Nicolas Depauw, Ben Clasie, Marina Giunta, Tom Madden, Hanne M Kooy
BACKGROUND: Spot size σ (in-air at isocenter), inter-spot spacing d, and spot charge q influence dose delivery efficiency and plan quality in Intensity Modulated Proton Therapy (IMPT) treatment planning. The choice and range of parameters varies among different manufacturers. The goal of this work is to demonstrate the influence of the spot parameters on dose quality and delivery in IMPT treatment plans, to show their interdependence, and to make practitioners aware of the spot parameter values for a certain facility...
November 17, 2017: Medical Physics
https://www.readbyqxmd.com/read/29146953/achievements-and-obstacles-of-remyelinating-therapies-in-multiple-sclerosis
#3
REVIEW
Martin Stangel, Tanja Kuhlmann, Paul M Matthews, Trevor J Kilpatrick
Remyelination in the CNS is the natural process of damage repair in demyelinating diseases such as multiple sclerosis (MS). However, remyelination becomes inadequate in many people with MS, which results in axonal degeneration and clinical disability. Enhancement of remyelination is a logical therapeutic goal; nevertheless, all currently licensed therapies for MS are immunomodulatory and do not support remyelination directly. Several molecular pathways have been identified as potential therapeutic targets to induce remyelination, and some of these have now been assessed in proof-of-concept clinical trials...
November 17, 2017: Nature Reviews. Neurology
https://www.readbyqxmd.com/read/29143339/cell-death-pathways-associated-with-photodynamic-therapy-an-update
#4
David Kessel, Nancy L Oleinick
Photodynamic therapy (PDT) has the potential to make a significant impact on cancer treatment. PDT can sensitize malignant tissues to light, leading to a highly selective effect if an appropriate light dose can be delivered. Variations in light distribution and drug delivery, along with impaired efficacy in hypoxic regions, can reduce the overall tumor response. There is also evidence that malignant cells surviving PDT may become more aggressive than the initial tumor population. Promotion of more effective direct tumor eradication is therefore an important goal...
November 16, 2017: Photochemistry and Photobiology
https://www.readbyqxmd.com/read/29139337/do-people-with-severe-traumatic-brain-injury-benefit-from-making-errors-a-randomized-controlled-trial-of-error-based-and-errorless-learning
#5
Tamara Ownsworth, Jennifer Fleming, Robyn Tate, Elizabeth Beadle, Janelle Griffin, Melissa Kendall, Julia Schmidt, Amanda Lane-Brown, Mathilde Chevignard, David H K Shum
BACKGROUND: Errorless learning (ELL) and error-based learning (EBL) are commonly used approaches to rehabilitation for people with traumatic brain injury (TBI). However, it is unknown whether making errors is beneficial in the learning process to promote skills generalization after severe TBI. OBJECTIVE: To compare the efficacy of ELL and EBL for improving skills generalization, self-awareness, behavioral competency, and psychosocial functioning after severe TBI...
November 1, 2017: Neurorehabilitation and Neural Repair
https://www.readbyqxmd.com/read/29132342/a-low-cost-uterine-balloon-tamponade-for-management-of-postpartum-hemorrhage-modeling-the-potential-impact-on-maternal-mortality-and-morbidity-in-sub-saharan-africa
#6
Tara Herrick, Mercy Mvundura, Thomas F Burke, Elizabeth Abu-Haydar
BACKGROUND: Postpartum hemorrhage (PPH) is the leading cause of maternal deaths worldwide. This study sought to quantify the potential health impact (morbidity and mortality reductions) that a low-cost uterine balloon tamponade (UBT) could have on women suffering from uncontrolled PPH due to uterine atony in sub-Saharan Africa. METHODS: The Maternal and Neonatal Directed Assessment of Technology (MANDATE) model was used to estimate maternal deaths, surgeries averted, and cases of severe anemia prevented through UBT use among women with PPH who receive a uterotonic drug but fail this therapy in a health facility...
November 13, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29128608/a-retrospective-comparison-of-survivors-and-non-survivors-of-massive-pulmonary-embolism-receiving-veno-arterial-extracorporeal-membrane-oxygenation-support
#7
Bennet George, Marc Parazino, Hesham R Omar, George Davis, Maya Guglin, John Gurley, Susan Smyth
INTRODUCTION: While the optimal care of patients with massive pulmonary embolism (PE) is unclear, the general goal of therapy is to rapidly correct the physiologic derangements propagated by obstructive clot. Extracorporeal membrane oxygenation (ECMO) in this setting is promising, however the paucity of data limits its routine use. Our institution expanded the role of ECMO as an advanced therapy option in the initial management of massive PE. The purpose of this project was to evaluate ECMO-treated patients with massive PE at an academic medical center and report shortterm mortality outcomes...
November 8, 2017: Resuscitation
https://www.readbyqxmd.com/read/29126689/the-feasibility-and-impact-of-routine-combined-limited-transthoracic-echocardiography-and-lung-ultrasound-on-diagnosis-and-management-of-patients-admitted-to-icu-a-prospective-observational-study
#8
Kavi Haji, Darsim Haji, David J Canty, Alistair G Royse, Dhaksha Tharmaraj, Meor Azraee, Lynda Hopkins, Collin F Royse
OBJECTIVES: Limited transthoracic echocardiography (TTE) and lung ultrasound increasingly is performed in the intensive care unit (ICU), though used in a goal-directed rather than routine manner. DESIGN: Prospective observational study. SETTINGS: Tertiary ICU. PARTICIPANTS: Ninety-three critically ill participants within 24 hours of admission to ICU. METHODS: A treating intensivist documented a clinical diagnosis and management plan before and after combined limited TTE and lung ultrasound...
August 18, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29120938/fibrinogen-on-admission-in-trauma-score-early-prediction-of-low-plasma-fibrinogen-concentrations-in-trauma-patients
#9
Tobias Gauss, Sébastien Campion, Sébastien Kerever, Mathilde Eurin, Mathieu Raux, Anatole Harrois, Catherine Paugam-Burtz, Sophie Hamada
BACKGROUND: Early recognition of low fibrinogen concentrations in trauma patients is crucial for timely haemostatic treatment and laboratory testing is too slow to inform decision-making. OBJECTIVE: To develop a simple clinical tool to predict low fibrinogen concentrations in trauma patients on arrival. DESIGN: Retrospective cohort study. SETTING: Three designated level 1 trauma centres in the Paris Region, from January 2011 to December 2013...
November 8, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29101938/practical-considerations-for-the-diagnosis-and-management-of-asthma-in-older-adults
#10
REVIEW
Barbara P Yawn, MeiLan K Han
Although often considered a disease of childhood, the prevalence of asthma in US adults aged 65 years or older is similar to that in children, with the number of older patients needing care for asthma likely to continue to increase. As with most chronic diseases, there are challenges associated with the diagnosis and management of asthma in an older population. This review discusses these challenges, suggesting practical management strategies for primary care physicians and their teams. Asthma comprises a spectrum of phenotypes, some associated with adult onset...
November 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/29096867/the-efficacy-of-anti-pcsk9-antibodies-results-from-recent-trials
#11
Ioanna Gouni-Berthold
The serine protease proprotein convertase subtilisin/kexin type 9 (PCSK9) binds to the low-density lipoprotein (LDL) receptor (LDLR) and directs it to the lysosome for degradation. This results in decreased numbers of LDLR available on the cell surface to bind LDL particles and remove them from the circulation and a subsequent increase in circulating LDL-cholesterol (LDL-C) concentrations. Since the role PCSK9 plays in LDL-C metabolism has been discovered in 2003, there have been major efforts in finding efficient and safe methods to inhibit it...
November 2017: Atherosclerosis. Supplements
https://www.readbyqxmd.com/read/29095543/background-current-role-and-potential-applications-of-radiogenomics
#12
Katja Pinker, Fuki Shitano, Evis Sala, Richard K Do, Robert J Young, Andreas G Wibmer, Hedvig Hricak, Elizabeth J Sutton, Elizabeth A Morris
With the genomic revolution in the early 1990s, medical research has been driven to study the basis of human disease on a genomic level and to devise precise cancer therapies tailored to the specific genetic makeup of a tumor. To match novel therapeutic concepts conceived in the era of precision medicine, diagnostic tests must be equally sufficient, multilayered, and complex to identify the relevant genetic alterations that render cancers susceptible to treatment. With significant advances in training and medical imaging techniques, image analysis and the development of high-throughput methods to extract and correlate multiple imaging parameters with genomic data, a new direction in medical research has emerged...
November 2, 2017: Journal of Magnetic Resonance Imaging: JMRI
https://www.readbyqxmd.com/read/29095069/effects-of-tryptophan-depletion-on-selective-serotonin-reuptake-inhibitor-remitted-patients-with-obsessive-compulsive-disorder
#13
Sean D Hood, Annabel Broyd, Hayley Robinson, Jessica Lee, Abdul-Rahman Hudaib, Dana A Hince
BACKGROUND: Serotonergic antidepressants are first-line medication therapies for obsessive-compulsive disorder, however it is not known if synaptic serotonin availability is important for selective serotonin reuptake inhibitor efficacy. The present study tested the hypothesis that temporary reduction in central serotonin transmission, through acute tryptophan depletion, would result in an increase in anxiety in selective serotonin reuptake inhibitor-remitted obsessive-compulsive disorder patients...
October 1, 2017: Journal of Psychopharmacology
https://www.readbyqxmd.com/read/29094792/dietary-therapies-for-functional-bowel-symptoms-recent-advances-challenges-and-future-directions
#14
REVIEW
C J Tuck, S J Vanner
BACKGROUND: Functional gastrointestinal symptoms in irritable bowel syndrome (IBS) and quiescent inflammatory bowel disease (IBD) cause significant morbidity and a reduction in quality of life. Multiple dietary therapies are now available to treat these symptoms, but supporting evidence for many is limited. In addition to a further need for studies demonstrating efficacy and mechanism of action of dietary therapies, the risk of nutritional inadequacy, alterations to the microbiome and changes in quality of life are key concerns requiring elucidation...
November 2, 2017: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
https://www.readbyqxmd.com/read/29093794/minimally-invasive-versus-conventional-repair-of-spondylolysis-in-athletes-a-review-of-outcomes-and-return-to-play
#15
REVIEW
John Paul G Kolcun, Lee Onn Chieng, Karthik Madhavan, Michael Y Wang
Spondylolysis from pars fracture is a common injury among young athletes, which can limit activity and cause chronic back pain. While current literature has examined the relative benefits of surgical and conservative management of these injuries, no study has yet compared outcomes between conventional direct repair of pars defects and modern minimally invasive procedures. The goals of surgery are pain resolution, return to play at previous levels of activity, and a shorter course of recovery. In this review, the authors have attempted to quantify any differences in outcome between patients treated with conventional or minimally invasive techniques...
October 2017: Asian Spine Journal
https://www.readbyqxmd.com/read/29090347/hepatic-intra-arterial-delivery-of-a-trojan-horses-gene-therapy-a-pilot-study-on-rabbit-vx2-hepatic-tumor-model
#16
Olivier Pellerin, Ikram Amara, Marc Sapoval, Tchao Méachi, Carole Déan, Philippe Beaune, Isabelle de Waziers
PURPOSE: Gene-directed enzyme prodrug therapy (GDEPT) is a "Trojan-horses" suicide gene therapy that consists of tumor-targeted gene delivery (vectorized by mesenchymal stem cells MSCs) encoding an enzyme that converts a harmless prodrug into cytotoxic metabolites in situ. Then, cytotoxic metabolites passively diffuse in the neighboring tumor cells and kill them (bystander effect). The goal of our study was to assess the feasibility and efficacy of intra-arterial administration of MSCs transduced with an optimized gene (MSC-CYP2B6TM-RED) followed by intravenous administration of cyclophosphamide (CPA) into the VX2 rabbit liver tumor...
October 31, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/29078912/mortality-rates-of-severe-traumatic-brain-injury-patients-impact-of-direct-versus-nondirect-transfers
#17
Kartik Prabhakaran, Patrizio Petrone, Gary Lombardo, Christy Stoller, Anthony Policastro, Corrado P Marini
BACKGROUND: Direct transport of patients with severe traumatic brain injury (sTBI) to trauma centers (TCs) that can provide definitive care results in lower mortality rates. This study investigated the impact of direct versus nondirect transfers on the mortality rates of patients with sTBI. METHODS: Data on patients with TBI admitted between January 1, 2012, and December 31, 2013, to our Level I TC were obtained from the trauma registry. Data included patient age, sex, mechanism, and type of injury, comorbidities, Glasgow Coma Scale, Injury Severity scores, prehospital time, time to request and to transfer, time to initiation of multimodality monitoring and goal-directed therapy protocol, dwell time in the emergency department (EDT), and mortality...
November 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/29077720/goal-directed-therapy-for-suspected-acute-bacterial-meningitis-in-adults-and-adolescents-in-sub-saharan-africa
#18
Emma C Wall, Mavuto Mukaka, Brigitte Denis, Veronica S Mlozowa, Malango Msukwa, Khumbo Kasambala, Mulinda Nyrienda, Theresa J Allain, Brian Faragher, Robert S Heyderman, David G Lalloo
BACKGROUND: Mortality from acute bacterial meningitis (ABM) in sub-Saharan African adults and adolescents exceeds 50%. We tested if Goal Directed Therapy (GDT) was feasible for adults and adolescents with clinically suspected ABM in Malawi. MATERIALS AND METHODS: Sequential patient cohorts of adults and adolescents with clinically suspected ABM were recruited in the emergency department of a teaching hospital in Malawi using a before/after design. Routine care was monitored in year one (P1)...
2017: PloS One
https://www.readbyqxmd.com/read/29076131/minimal-residual-disease-in-non-hodgkin-lymphoma-current-applications-and-future-directions
#19
REVIEW
Matthew L Chase, Philippe Armand
Non-Hodgkin Lymphomas (NHLs) are a heterogeneous group of tumours with distinct treatment paradigms, but in all cases the goal of treatment is to maximize quality and duration of remission while minimizing therapy-related toxicity. Identification of persistent disease or relapse is most often the trigger to intensify or re-initiate anti-neoplastic therapy, respectively. In the current era of NHL treatment, this determination is mostly based on imaging and clinical evaluations, tools with imperfect sensitivity and specificity...
October 26, 2017: British Journal of Haematology
https://www.readbyqxmd.com/read/29068831/crystalloid-versus-colloid-for-intraoperative-goal-directed-fluid-therapy-using-a-closed-loop-system-a-randomized-double-blinded-controlled-trial-in-major-abdominal-surgery
#20
Alexandre Joosten, Amelie Delaporte, Brigitte Ickx, Karim Touihri, Ida Stany, Luc Barvais, Luc Van Obbergh, Patricia Loi, Joseph Rinehart, Maxime Cannesson, Philippe Van der Linden
BACKGROUND: The type of fluid and volume regimen given intraoperatively both can impact patient outcome after major surgery. This two-arm, parallel, randomized controlled, double-blind, bi-center superiority study tested the hypothesis that when using closed-loop assisted goal-directed fluid therapy, balanced colloids are associated with fewer postoperative complications compared to balanced crystalloids in patients having major elective abdominal surgery. METHODS: One hundred and sixty patients were enrolled in the protocol...
October 25, 2017: Anesthesiology
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