EMG Map for Designing the Electrode Shape for Functional Electrical Therapy of Upper Extremities

Achieving the functional grasp by electrical stimulation using surface electrodes is a demanding task. The innervations of muscles come via ulnar, radial and median nerves. The anatomy of nerve branches connecting various muscles in the forearm differs significantly between individuals. We hypothesize that the anatomical differences between the paretic and nonparetic arms are minimal. Based on this assumption we developed a method where the differences of muscle activities (EMG) between the healthy and paretic arms recorded by the 24-contact electrode within an array define the target zones to be stimulated on the affected forearm. We used special electrode where magnetic contacts allow simple change of the stimulation pads. The examiner positions the magnetic contact on the pads where the EMG differences are maximal. The stimulator delivers asynchronous stimulation to the selected pads. We proved that the method is working in stroke patients by measuring joint angles and the grasping force. © 2019, Springer Nature Switzerland AG.Biosystems and Biorobotics, Vol. 21This is the peer-reviewed version of the following article: Popović-Maneski, L., Topalović, I., 2019. EMG Map for Designing the Electrode Shape for Functional Electrical Therapy of Upper Extremities, in: Masia, L., Micera, S., Akay, M., Pons, J.L. (Eds.), Converging Clinical and Engineering Research on Neurorehabilitation III, Biosystems & Biorobotics. Springer International Publishing, pp. 1003–1007, http://dx.doi.org/10.1007/978-3-030-01845-0_20

Fear and loathing in the Caribbean: three studies of fear and cancer screening in Brooklyn's immigrant Caribbean subpopulations

Background: Anxiety, worry, and fear are among the most common emotional responses to the threat of disease and several studies have linked various fears to cancer preventive and detection behaviors. Cancer-related worry and fears about screening or its consequences are also characteristics that vary across ethnic groups and may be differentially linked to screening outcomes 1. Limiting the utility of this growing literature are at least two key considerations. First, little attention has been paid to documenting variation in cancer-related fears among subpopulations of persons of African descent, despite evidence that (a) rates of screening may vary among both male 2 and female 3 immigrants from islands in the Caribbean living in the United States and (b) incidence rates for cancers such as those of the prostate may be very high in men from Jamaica 4, Guadaloupe 5 and Trinidad and Tobago 6, as well as in immigrant groups in both the United Kingdom 7 and United States 8. Second, findings regarding the relations anxiety, cancer worry, and screening fear hold with screening behavior seen thus far have been inconsistent, in our view because anxieties stemming from different sources have different relations with behavior. In the emotions theory view, understanding the role of fear in health behavior in diverse groups is predicated on understanding the object or source of the fear 91011 for the simple reason that anxiety motivates avoidance of particular elicitors 1012. Research conducted within the U54 Comprehensive Cancer Partnership between Long Island University and Columbia University has produced several studies documenting differences in breast and prostate cancer screening frequencies among Caribbean subpopulations living in Brooklyn, New York 11213. A major concentration in this program of behavioral research has investigated whether trait anxiety, cancer worry, and screening-related fears vary across Caribbean subpopulations and whether these highly differentiated emotional responses independently predict screening behavior in multivariate models 12121314. Consistent with theory, we expected that fears pertaining to the screening context (e.g., fear of pain or the psychological implications of certain screens), would predict avoidance of the fear-inducing situation and thus be associated with less frequent screening. Conversely, where fears relate to the disease itself, greater fear should predict more frequent screening. Methods: Because of our overarching interest in the links between cancer and cancer-screening-related fears and cancer screening behaviors among the diverse groups of men and women living in Brooklyn, New York, we combined data from three community-based studies. Although measures and samples varied somewhat across studies, each study investigated the link between emotions and screening outcome in ethnic groups that included immigrants from islands in the Caribbean. Because of our interest in examining differences within traditional racial categories, we used a combination of (a) self-categorization based on a the traditional racial categories offered in the US Census together with (b) information regarding country of origin. Allowing a combination of self-reported racial categorization (tapping aspects of identity and minority status) in concert with shared birthplace to influence groupings increases the likelihood that participants share cultural and developmental characteristics thought to form part of ethnicity 15. We distinguished between Black men born in the United States (hereafter, U.S.-born African Americans), and those originating from countries in the English-speaking Caribbean (e.g., Trinidad & Tobago, Jamaica, Barbados). Immigrant and non-immigrant minority groups were contrasted with men self-identifying as "European or White/Non-Hispanic" who were born in the United States (hereafter, U.S.-born European American). In Study 1, stratified cluster-sampling was used to recruit 1364 women (aged between 50–70 years) from six ethnic groups: US-born African American, US-born European American, immigrants from islands in the English-speaking Caribbean (Jamaica, Barbados, Trinidad and Tobago), the Dominican Republic, Haiti, and Eastern Europe 1. In Study 2, 180 US-born African American, US-born European American and immigrant Jamaican men (aged between 40–70 years) were recruited using convenience sampling 13. In Study 3, 533 men (aged between 45–70 years) from four groups – US-born African American, US-born European American, and immigrant men from Jamaica and from Trinidad and Tobago – were recruited 12. In each study, participants provided background data, reported on screening history for either breast or prostate cancer, and completed a measure of trait anxiety, cancer worry, and/or screening fears. Results: As expected, we found differences among groups of African descent from the United States and the Caribbean. Although women from all groups screened at rates below those recommended, data from Study 1 showed that English-speaking Caribbean, Haitian and Dominican women screened less frequently than US-born African Americans and European Americans and that immigrant Eastern European women were also infrequent screeners (see Figure 1). Conversely, however, there were no differences in rates of self-reported prostate screening among men from the English-speaking Caribbean, US-born African Americans, or US-born European Americans in either Study 2 or Study 3. As expected, cancer-related emotional characteristics also varied across subpopulations (see Figure 2). Cancer worry was generally lower among women from the various Caribbean immigrant groups (Study 1) than it was among US-born African Americans or US-born European Americans. Fears regarding screening, however, varied somewhat differently. Fear of screening was higher among US-born African Americans and immigrant men from the English-speaking Caribbean (Studies 2 and 3) than among US-born European Americans. Consistent with the need to carefully measure fear-related constructs in the context of cancer behavior, however, our data also demonstrated that a specific fear related to concerns regarding threats to masculinity in the context of male screening strongly characterized the attitudes of men from the English-speaking Caribbean compared to the views of US-born European and US-born African Americans (Study 2). Finally, a combination of multiple regression and ANOVAs in each study showed that emotional characteristics independently predicted screening, in most cases even when background characteristics were controlled. Across studies, greater cancer worry predicted more frequent screening while fear of screening predicted less frequent screening. Figure 1 Number of cancer screens in prior 10 years Number of cancer screens in prior 10 years. DRE = digital rectal examination, PSA = prostate specific antigen test, Mamm = mammogram, CBE = clinical breast exam. Figure 2 Emotion characteristics related to screening Emotion characteristics related to screening. Trait = trait anxiety, Worry = cancer worry, Scr. Fr. = screening fear, and Em. Con. = emasculation concern. Conclusion: Data from three large-scale studies in Brooklyn, New York suggest that members of immigrant Caribbean subpopulations screen for breast and prostate cancer at very low rates; in most cases lower than those of either US-born African or US-born European Americans. Groups of Caribbean men and women also vary in the emotions they report regarding cancer and the screening process, generally revealing a pattern that is predictive of poorer screening. Coupled with the fact that emotion characteristics predicted screening outcomes even when controlling for other factors, data from these three studies suggest that the emotional responses Caribbean groups place them at risk for poor screening. Interventions that address these responses may offer the prospect of improving screening frequency in these disadvantaged groups. Competing interests: The authors declare that they have no competing interests. Authors' contributions: NSC and CM was involved in study design, analysis, interpretation/write up and critical revision of the manuscript. BA and DH in the analysis, interpretation and write up. AKJ, TU and LNB were involved in the interpretation and write up. PMR was part of the study design, analysis and interpretation/write up. JMM and AIN had part in the study design, analysis and critical revision whilst JSJ took part in critical revision

Surgical Management of Inguinal Hernias at Bugando Medical Centre in Northwestern Tanzania: Our Experiences in a Resource-Limited Setting.

Inguinal hernia repair remains the commonest operation performed by general surgeons all over the world. There is paucity of published data on surgical management of inguinal hernias in our environment. This study is intended to describe our own experiences in the surgical management of inguinal hernias and compare our results with that reported in literature. A descriptive prospective study was conducted at Bugando Medical Centre in northwestern Tanzania. Ethical approval to conduct the study was obtained from relevant authorities before the commencement of the study. Statistical data analysis was done using SPSS software version 17.0. A total of 452 patients with inguinal hernias were enrolled in the study. The median age of patients was 36 years (range 3 months to 78 years). Males outnumbered females by a ratio of 36.7:1. This gender deference was statistically significant (P=0.003). Most patients (44.7%) presented late (more than five years of onset of hernia). Inguinoscrotal hernia (66.8%) was the commonest presentation. At presentation, 208 (46.0%) patients had reducible hernia, 110 (24.3%) had irreducible hernia, 84 (18.6%) and 50(11.1%) patients had obstructed and strangulated hernias respectively. The majority of patients (53.1%) had right sided inguinal hernia with a right-to-left ratio of 2.1: 1. Ninety-two (20.4%) patients had bilateral inguinal hernias. 296 (65.5%) patients had indirect hernia, 102 (22.6%) had direct hernia and 54 (11.9%) had both indirect and direct types (pantaloon hernia). All patients in this study underwent open herniorrhaphy. The majority of patients (61.5%) underwent elective herniorrhaphy under spinal anaesthesia (69.2%). Local anaesthesia was used in only 1.1% of cases. Bowel resection was required in 15.9% of patients. Modified Bassini's repair (79.9%) was the most common technique of posterior wall repair of the inguinal canal. Lichtenstein mesh repair was used in only one (0.2%) patient. Complication rate was 12.4% and it was significantly higher in emergency herniorrhaphy than in elective herniorrhaphy (P=0.002). The median length of hospital stay was 8 days and it was significantly longer in patients with advanced age, delayed admission, concomitant medical illness, high ASA class, the need for bowel resection and in those with surgical repair performed under general anesthesia (P<0.001). Mortality rate was 9.7%. Longer duration of symptoms, late hospitalization, coexisting disease, high ASA class, delayed operation, the need for bowel resection and presence of complications were found to be predictors of mortality (P<0.001). Inguinal hernias continue to be a source of morbidity and mortality in our centre. Early presentation and elective repair of inguinal hernias is pivotal in order to eliminate the morbidity and mortality associated with this very common problem

PRISM protocol: A randomised phase II trial of nivolumab in combination with alternatively scheduled ipilimumab in first-line treatment of patients with advanced or metastatic renal cell carcinoma

Background The combination of nivolumab, a programmed death-1 (PD-1) targeted monoclonal antibody, with the cytotoxic T-lymphocyte antigen-4 (CTLA-4) targeted antibody, ipilimumab, represents a new standard of care in the first-line setting for patients with intermediate- and poor-risk metastatic renal cell carcinoma (mRCC) based on recent phase III data. Combining ipilimumab with nivolumab increases rates of grade 3 and 4 toxicity compared with nivolumab alone, and the optimal scheduling of these agents when used together remains unknown. The aim of the PRISM study is to assess whether less frequent dosing of ipilimumab (12-weekly versus 3-weekly), in combination with nivolumab, is associated with a favourable toxicity profile without adversely impacting efficacy. Methods The PRISM trial is a UK-based, open label, multi-centre, phase II, randomised controlled trial. The trial population consists of patients with untreated locally advanced or metastatic clear cell RCC, and aims to recruit 189 participants. Participants will be randomised on a 2:1 basis in favour of a modified schedule of 4 doses of 12-weekly ipilimumab versus a standard schedule of 4 doses of 3-weekly ipilimumab, both in combination with standard nivolumab. The proportion of participants experiencing a grade 3 or 4 adverse reaction within 12 months forms the primary endpoint of the study, but with 12-month progression free survival a key secondary endpoint. The incidence of all adverse events, discontinuation rates, overall response rate, duration of response, overall survival rates and health related quality of life will also be analysed as secondary endpoints. In addition, the potential of circulating and tissue-based biomarkers as predictors of therapy response will be explored. Discussion The combination of nivolumab with ipilimumab is active in patients with mRCC. Modifying the frequency of ipilimumab dosing may mitigate toxicity rates and positively impact quality of life without compromising efficacy, a hypothesis being explored in other tumour types such as non-small cell lung cancer. The best way to give this combination to patients with mRCC must be similarly established

Basic Biomedical Sciences and the Future of Medical Education: Implications for Internal Medicine

The academic model of medical education in the United States is facing substantial challenges. Apprenticeship experiences with clinical faculty are increasingly important in most medical schools and residency programs. This trend threatens to separate clinical education from the scientific foundations of medical practice. Paradoxically, this devaluation of biomedical science is occurring as the ability to use new discoveries to rationalize clinical decision making is rapidly expanding. Understanding the scientific foundations of medical practice and the ability to apply them in the care of patients separates the physician from other health care professionals. The de-emphasis of biomedical science in medical education poses particular dangers for the future of internal medicine as the satisfaction derived from the application of science to the solving of a clinical problem has been a central attraction of the specialty. Internists should be engaged in the ongoing discussions of medical education reform and provide a strong voice in support of rigorous scientific training for the profession

Urinary nitrate might be an early biomarker for pediatric acute kidney injury in the emergency department

NO is involved in normal kidney function and perturbed in acute kidney injury (AKI). We hypothesized that urinary concentration of NO metabolites, nitrite, and nitrate would be lower in children with early AKI presenting to the emergency department (ED), when serum creatinine (SCr) was uninformative. Patients up to 19 y were recruited if they had a urinalysis and SCr obtained for routine care. Primary outcome, AKI, was defined by pediatric Risk, Injury, Failure, Loss of function, End-stage renal disease (pRIFLE) criteria. Urinary nitrite and nitrate were determined by HPLC. A total of 252 patients were enrolled, the majority (93%) of whom were without AKI. Although 18 (7%) had AKI by pRIFLE, 50% may not have had it identified by the SCr value alone at the time of visit. Median urinary nitrate was lower for injury versus risk (p = 0.03); this difference remained significant when the injury group was compared against the combined risk and no AKI groups (p = 0.01). Urinary nitrite was not significantly different between groups. Thus, low urinary nitrate is associated with AKI in the pediatric ED even when SCr is normal. Predictive potential of this putative urinary biomarker for AKI needs further evaluation in sicker patients

Antibacterial activity of some selected medicinal plants of Pakistan

<p>Abstract</p> <p>Background</p> <p>Screening of the ethnobotenical plants is a pre-requisite to evaluate their therapeutic potential and it can lead to the isolation of new bioactive compounds.</p> <p>Methods</p> <p>The crude extracts and fractions of six medicinal important plants (<it>Arisaema flavum</it>, <it>Debregeasia salicifolia</it>, <it>Carissa opaca</it>, <it>Pistacia integerrima</it>, <it>Aesculus indica</it>, and <it>Toona ciliata</it>) were tested against three Gram positive and two Gram negative ATCC bacterial species using the agar well diffusion method.</p> <p>Results</p> <p>The crude extract of <it>P. integerrima </it>and <it>A. indica </it>were active against all tested bacterial strains (12-23 mm zone of inhibition). Other four plant's crude extracts (<it>Arisaema flavum</it>, <it>Debregeasia salicifolia</it>, <it>Carissa opaca</it>, and <it>Toona ciliata</it>) were active against different bacterial strains. The crude extracts showed varying level of bactericidal activity. The aqueous fractions of <it>A. indica </it>and <it>P. integerrima </it>crude extract showed maximum activity (19.66 and 16 mm, respectively) against <it>B. subtilis</it>, while the chloroform fractions of <it>T. ciliata </it>and <it>D. salicifolia </it>presented good antibacterial activities (13-17 mm zone of inhibition) against all the bacterial cultures tested.</p> <p>Conclusion</p> <p>The methanol fraction of <it>Pistacia integerrima</it>, chloroform fractions of <it>Debregeasia salicifolia </it>&<it>Toona ciliata </it>and aqueous fraction of <it>Aesculus indica </it>are suitable candidates for the development of novel antibacterial compounds.</p