Is Polidocanol Foam Sclerotherapy Effective in Treating Varicose Veins as Compared to Conventional Treatments?

OBJECTIVE: The objective of this selective EBM review is to determine whether or not Polidocanol foam sclerotherapy is effective in treating varicose veins as compared to conventional treatments. STUDY DESIGN: Review of three randomized controlled trials. All three studies are published in English between 2008 – 2012. DATA SOURCES: Three randomized control trials were found using PubMED and Medline. The sources were selected based on the outcomes measured and how the studies and outcomes mattered to patients (POEMS). OUTCOMES MEASURED: The patients’ assessment for quality of life analyzed by logistic regression model, Chronic Venous Insufficiency Questionnaire (CVIQ), EQ-5D model, Visual analog scale and Venous clinical severity score (VCSS) and ordinal scale. RESULTS: Three randomized controlled trials were included in the review. The first study, Rabe et al study showed statistically significant evidence in patient satisfaction (p= 0.008) in reduction of symptoms of varicose veins among the polidocanol foam sclerotherapy group as compared to liquid treatment. The second study Shadid et al showed that patient satisfaction of venous symptoms was higher in surgical intervention group (66.1%) as compared to the polidocanol foam sclerotherapy group (59.6%). However, when other factors like cost and cosmetic evidence of scars were considered; polidocanol foam sclerotherapy reflected as a better option. The third study, Ukritmanoroat demonstrates that polidocanol foam sclerotherapy has greater efficacy for venous sclerosis and venous symptoms as compared to polidocanol liquid therapy (p=0.002). CONCLUSION: The systemic review concludes that polidocanol foam sclerotherapy is an effective treatment in treating varicose veins. When compared to different conventional treatments; there are different factors like cost, quality of life post treatment, cosmetic effects of individual treatments that should also be considered when considering the efficacy of the Polidocanol foam sclerotherapy

Tongue Operated Smart Environment for Paralytic People

ABSTRACT: The "tongue drive" system is a tongue operated assistive technology developed for people with severe disability to control their environment. The tongue is considered an excellent appendage in severely disabled people for operating an assistive device. Tongue drive consists of an magnet reed relays outside of the teeth to measure the magnetic field generated by a small permanent magnet secured on the tongue. The sensor signals are transmitted to an encoder which wirelessly transmit signal and processed to display the needs of paralytic person. The tongue is considered an excellent attachment in severely disabled people for operating an assistive device. This paper presents our recent progress to the development of tongue operated smart environment for paralytic people

Meeting the JCHE Team: A Reconstructed Interview

This “reconstructed interview-conversation” involves the entire editorial team of the Journal of Contemplative and Holistic Education (JCHE). Together, the team dialogues around the shared visions, aspirations, motivations, and aims we have in creating this new journal platform. With this sharing, the team sends out a welcoming invitation to colleagues from around the world to get to know our new journal and to join our work to support and promote contemplative and holistic education. We at JCHE are committed to the ideal of education as transformative integration of mind-body-heart-spirit, which we ultimately understand as a decolonizing project. Through this interview, various research and life themes have emerged: the centrality of education for wisdom, the life-sustaining importance of contemplative practice, the role of contemplative and holistic education as decolonial project; how JCHE exemplifies and aims at cultivating the wide diversity that exists in intellectual work; the place of contemplative and holistic education within peace education and environmental education; the important contributions that Indigenous knowledge practices make to education, science, medicine, and health care, and to the broader task of cultivating ecological and human flourishing; as well as concerns about contemplative/holistic practices being co-opted by neoliberal and instrumental forces in education

Role of somatostatin and muscarinic - acetylcholine system in 3NP-induced neurotoxicity in mutant Htt knock-in cultured striatal neuronal cells

Huntington’s disease (HD), is an inherited neurological disease with severe neuronal loss in the striatum. Previous studies have shown the selective sparing of somatostatin (SST) positive medium-sized aspiny interneurons and large cholinergic interneurons expressing choline acetyltransferase (ChAT) in the striatum. This suggests a crucial role of somatostatinergic and cholinergic neurotransmission in the pathophysiology of HD. The biological effects of SST in the central and peripheral systems are mediated by five different somatostatin receptors (SSTR1 - 5); whereas five metabotropic muscarinic receptors (M1R - M5R) mediate acetylcholine (ACh) functions. Whether SSTR and MR subtypes work in concert in HD is not known. In the present study, using STHdhQ7/7 (wt) cells and STHdhQ111/111 (mutant) cells and 3-Nitro propionic acid (3NP)-induced model of toxicity, first the expression levels of SSTR and MR subtypes were determined using the immunocytochemistry and Western blot analysis, second cell viability study and apoptosis were performed using MTT assay and Hoechst 33258 dye, third we determined the status of downstream signaling pathways including ERK1/2 and Akt upon treatment with SST and Carbachol (Carb) alone and in combination. STHdhQ7/7 and STHdhQ111/111 cells display moderate to strong expression and colocalization between M1R/M4R and SSTR2/4. Both STHdhQ7/7 and STHdhQ111/111 cells display significant changes in internalization and cell surface-expression of M1R/M4R and SSTR2/4 in a receptor- and treatment-specific manner. STHdhQ111/111 cells exhibit a slow proliferation rate than STHdhQ7/7 cells, and exhibit concentration- and time-dependent effect on the cell viability in the presence of 3NP. STHdhQ111/111 cells are more susceptible to 3NP-induced toxicity and apoptosis when compared to STHdhQ7/7 cells. In cell viability assay, agonist-treatment before and after 3NP-toxicity affords better protection than co-treatment. Consistent with receptor expression, cell proliferation and cell viability, time- and concentration-dependent regulation of signal transduction pathways- ERK1/2 and Akt attest the neuroprotective role of Carb and SST against 3NP-induced neurotoxicity. In conclusion, the results presented here shed a new light on the neuroprotective role of Carb and SST, and further enhance our understanding of functional interaction between MRs - SSTRs in an in vitro model of HD.Pharmaceutical Sciences, Faculty ofGraduat

Politics and religion in eighteenth-century North India

Despite the prolific authorship within the Gauá¸Ä«ya Vaiá¹£á¹ava tradition, it had not produced a single text that addresses the theological basis for engagement with public or social systems, nor any that offer guidance or insight into how a practitioner might behave or integrate into such environments. Nor have they in any substantial way referred to politically orientated texts such as the Dharma-ÅÄstras. The traditionâs most prominent texts relate instead to philosophical expositions on themes such as bhakti rasa or devotional aesthetic sentiments. However, in the early-eighteenth century, we notice an intriguing phenomenon, suddenly a series of works are fashioned to rationalize and promote a system of integration with the socio-political circumstances of their time. This fascinating period within Gauá¸Ä«ya Vaiá¹£á¹ava history witnesses the production of specialized treatises that provide theological foundations to endorse and encourage responsible public conduct grounded on notions such as karma and varnÌ£aÌsÌrama. This thesis adopts a two-fold approach, the close reading and examination of this new genre of Sanskrit based works, alongside reviewing the contemporary context these works emerge in. The political maneuverings of this historical era became a critical factor in invoking the production of these texts, and consequently these works reflect the interests and concerns of Jaisingh II, the ruler of a precolonial North Indian polity, the KachvÄhÄ dynasty. The texts were specific tools employed by the tradition to address the apparently contradictory mandate to reconcile responsible public engagement with the esoteric transcendent nature of bhakti practices, formulating a public theology which placed at its center bhakti practice. Through examining this innovation, I extract the perspectives from four critical figures in this period, king Jaisingh II, and Gauá¸Ä«ya Vaiá¹£á¹ava scholars ViÅvanÄtha, KrÌ£sÌ£nÌ£adeva and Baladeva, enabling me to gain a comprehensive understanding of the exact nature of public theology for this tradition in this compelling era.</p

Is it melanoma-associated retinopathy or drug toxicity? Bilateral cystoid macular edema posing a diagnostic and therapeutic dilemma

Purpose: To report the clinical presentation, multimodal imaging, and management of a patient with metastatic melanoma who presented with cystoid macular edema (CME). Observations: We report a case of a 71-year-old Caucasian male with metastatic melanoma who presented with bilateral cystoid macular edema after being on treatment with a programmed T cell death ligand 1 inhibitor, MPDL3280, for 1 year. Multimodal imaging techniques, including color fundus photographs, autofluorescence, spectral domain optical coherence tomography (OCT), fluorescein angiography (Spectralis, Heidelberg, Germany), and spectral-domain OCT angiography (Zeiss; California, USA) were performed to evaluate the etiology of his CME and to monitor his response to treatment. Clinical examination and multimodal imaging revealed 1 + chronic vitreous cells, an epiretinal membrane, and mild macular edema in both eyes. Fundus autofluorescence showed paravenous hypoautofluorescence in the right eye and scattered hypoautofluorescent spots in the left eye. Optical coherence tomography angiography (OCTA) revealed mild drop out of superficial vessels in the peri-foveal region bilaterally. These findings were concerning for melanoma-associated retinopathy, drug-related uveitis, or activation of a previous chronic autoimmune process. The patient was started on prednisone 30 mg oral daily and ketorolac tromethamine 0.5% 1 drop four times daily. He was then treated with bilateral sustained-release dexamethasone intravitreal implants (Ozurdex). He had complete resolution of CME, and was tapered off of oral steroids within 6 weeks. Conclusions and Importance: Melanoma-associated retinopathy can be accompanied by CME, which presents a diagnostic and therapeutic dilemma in cases where a new drug has been recently initiated. By treating the condition locally, the ophthalmologist may be able to taper systemic immunosuppression more quickly. Keywords: Cystoid macular edema, Melanoma, Melanoma-associated retinopathy, PD-L1 inhibitor, Optical coherence tomography angiography (OCTA), Multimodal imagin

Prospective comparison of rectal dose reduction during intracavitary brachytherapy for cervical cancer using three rectal retraction techniques.

PURPOSE: To compare three rectal retraction methods on dose to organs at risk, focusing on rectal dose, in cervix cancer patients treated with high-dose-rate intracavitary brachytherapy. METHODS AND MATERIALS: A prospective study was conducted on patients with cervical carcinoma treated with chemoradiotherapy, including external beam radiation and four fractions of high-dose-rate intracavitary brachytherapy prescribed to Point A using a ring and tandem applicator under conscious sedation. Rectal retraction methods included: a rectal retractor blade (RR), vaginal gauze packing (VP), and a tandem Foley balloon (FB). All three methods were used in all patients. The RR was used first, and the following applications were randomly assigned to VP or FB. CT planning was used to calculate D2cc for rectum, sigmoid, small bowel, and bladder. The Wilcoxon signed rank test was used to determine if the median dose differences between methods were statistically significant. RESULTS: In these 11 patients, median dose (min, max) in cGy to the rectum using RR, FB, and VP was 131 (102, 165), 199 (124, 243), and 218 (149, 299), respectively. The RR demonstrated lower median intrapatient doses to rectum compared with FB and VP (-55 cGy; p = 0.014 and -76 cGy; p = 0.004, respectively). The RR also resulted in lower sigmoid doses. No differences in dose were observed between the VP and FB methods. CONCLUSION: The rectal retractor significantly reduced the dose to rectum and sigmoid compared with FP and VP. In patients treated under conscious sedation, the RR method provides the best rectal sparing. There were no significant differences in dose observed between the FB and VP techniques

Preference for secondary findings in prenatal and pediatric exome sequencing

ObjectiveWe aimed to determine the frequency of accepting secondary findings in families undergoing exome sequencing in prenatal and pediatric settings.MethodsThis was a secondary analysis of prospectively enrolled patients undergoing trio exome sequencing for congenital anomalies or developmental disorders in prenatal and pediatric settings, in which families were offered receiving secondary findings (initially assessed in the proband and, if identified, then in the parents). The primary outcome was frequency of accepting secondary findings. Secondary outcomes included frequency of acceptance in prenatal versus pediatric settings, and sociodemographic differences between those who accepted versus declined secondary findings.ResultsThere were 682 families included in the cohort (289 prenatal and 393 pediatric). Overall, 84% (576/682) of families accepted secondary findings: 86.2% (249/289) of families undergoing prenatal versus 83.2% (327/393) pediatric (p&nbsp;=&nbsp;0.30) testing. Secondary findings were identified in 2.6% (15/576) of cases, with no difference between prenatal and pediatric settings. There were no differences in sociodemographics between families that accepted versus declined secondary findings.ConclusionThe majority of families undergoing exome sequencing accepted secondary findings; this did not differ in prenatal versus pediatric settings. This highlights the need for guidance surrounding the offer of secondary findings in the prenatal setting