Analysis of the efficacy of EPIONE therapies to treat phantom limb pain

Indiana University-Purdue University Indianapolis (IUPUI)The primary objectives of this thesis are (1) to discuss the current understanding of phenomena associated with, proposed mechanisms of, and suggested treatments for amputation related pain, (2) to describe the software developed for analyzing results of a clinical study for the treatment of phantom limb pain (PLP), (3) to discuss the methods for a multi-center trial by the EPIONE consortium along with presenting preliminary results, and (4) to discuss the methods and results of a case study involving a new therapy modality for alleviating PLP. Each objective has been expanded into a chapter as described below. Chapter 1 serves as a literature review introducing the topic of amputation, associ- ated phenomena, and proposed mechanisms. The chapter also discusses the currently available treatments and the instruments used to measure PLP. Key topics include the definition of PLP, the prevalence of PLP, current treatment options for PLP, and experimental measurement of PLP. The final objective of this chapter is to introduce topics related to the investigation paradigm utilized for the studies following in Chapter 4 and Chapter 5. Therefore, a minor emphasis has been put on surface electrical stimulation (SES) and operant conditioning. As with any multi-center clinical study, coordination is key. Chapter 2 introduces the common clinical protocol (CCP) and methods of analysis for the clinical trials conducted by the EPIONE consortium. In order to analyze results in an automated fashion, a software tool was developed. This tool, the EPIONE Extraction Program (EEP) along with its extension the Group Analysis Module (GAM), is the focus of Chapter 3. A high-level overview of the requirements, process flow, and software testing are described. This chapter also discusses the methods of analysis for several self-report instruments used to determine effect size in Chapter 4 and Chapter 5. The outputs of the software tools make up the results presented and described in these chapters. In addition to the details included in Chapter 3, supplemental information is available in Appendix A and Appendix B, which are the detailed User Guides for the EEP and GAM. Chapter 4 reviews the pilot study data conducted by the EPIONE consortium. The primary and two secondary instruments used for analysis are discussed. This chapter provides a brief overview of results from the group. Each clinical site used slightly different variations of a common clinical protocol to better understand what effectively drives alleviation of PLP and to allow comparison of results. The work done at Indiana University - Purdue University Indianapolis (IUPUI) represents a small part of several other universities involved in the EPIONE consortium. Chapter 5 focuses on a case study at IUPUI with a more in-depth review of data collected throughout the study period. Using SES, we seek to reverse cortical reorganization by giving meaningful stimuli through existing circuitry. In this chapter the present work is discussed by introducing a case study in detail with an analysis of psychophysical data

Autologous Fat Graft: Not Only an Aesthetic Solution

Subcutaneous adipose tissue was defined as the “perfect filler†as is soft and malleable and is usually enough present in the body for correcting volume defects and small remodelling purposes. The first attempts to implant autologous adipose tissue dates back to the end of the twentieth century, and with the refinement of harvesting, processing and replanting techniques today a uniform and predictable amount of survival rate were achieved. Those improvements have led to wider use of autologous fat grafts in many medical specialities not only in aesthetic or reconstructive treatments

Genetics of the Multiple Endocrine Neoplasia Type 2B Syndrome

Multiple endocrine neoplasia type 2B (MEN 2B) is similar to MEN 2A in that both autosomal dominant syndromes include medullary thyroid cancers and pheochromocytomas. It is distinct in that MEN 2B patients have much earlier age of onset with more aggressive tumors and mucosa/neuromas of the lips and tongue. The neuromas allow ascertainment generally before age 5. Studies of two and three generations of 14 MEN 2B families disclosed close linkage of the MEN 2B gene to DNA markers to which MEN2A had been linked. Multipoint analysis utilizing additional results in three generations of a 15th family have disclosed a peak total lod score of 8.89 at the midpoint between the centromere markers D10ZJ and RBP3 on the long arm (band q11). One recombinant was observed between D10ZJ and MEN28, but this individual was not recombinant with D10S94. These studies suggest physical proximity of MEN2A and MEN28 but do not establish allelism for the gene(s)

The influence of exercise environment and gender on mood and exertion

This study examined the influence of exercise environment and gender on post-exercise mood and exertion. College student participants (55 females, 49 males) were instructed to pedal a stationary bike at a moderate pace for 20 minutes. Participants were randomly assigned to one of three laboratory conditions: (1) exercising in front of a mirror and posters showing ideal fit body types (i.e., celebrity male and female personal trainers), (2) exercising in front of a mirror only, or (3) a control condition in which participants exercised without a mirror or posters. The Activation- Deactivation Adjective Check List (AD-ACL), measuring exercise-induced mood states, was administered both before and after exercise. Average bike speed throughout the exercise session measured exertion. Mirrors and posters of ideally fit celebrities did interact with gender on postexercise tension in that women felt most tense after exercising in front of the mirror and posters while men were most tense after exercising in front of the mirror only. Exercise exertion was also impacted by experimental condition such that participants rode significantly faster in the mirror and posters condition. There was no significant interaction of gender and condition on exercise exertion, but women pedaled fastest in the mirror and poster condition relative to the other conditions. Results suggest that exercise exertion and tension reduction are partially a by-product of gender and exercise environment