Managing pain by visually distorting the size of painful body parts: is there any therapeutic value?

Painful conditions such as complex regional pain syndrome, phantom limb pain and low back pain may change the sense of body image, so that body parts are perceived as large, swollen, heavy or stuck in one position [1]. In 1995, Ramachandran et al. [2] reported that phantom limb pain could be relieved by creating a visual illusion whereby the amputated limb appeared to be wholly intact by reflecting a nonpainful intact limb in a mirror (i.e., using mirror visual feedback). Randomized, sham-controlled clinical trials of mirror visual feedback have confirmed the potential utility of the technique. For example, Chan et al. [3] assigned 22 patients with phantom limb pain to a 4-week course of one of the following interventions: viewing a reflected image of their intact foot in a mirror; viewing a covered mirror; or mental visualization. All patients receiving mirror visual feedback reported a decrease in pain (n = 6) compared with only one patient in the covered mirror group and two in the mental visualization group. Three patients reported worsening pain in the covered mirror group and four patients reported worsening pain in the mental visualization group. Nowadays, mirror visual feedback, often termed mirror box therapy, has been incorporated within therapeutic programs to treat painful conditions associated with alterations of body image resulting from neuropathy [4], complex regional pain syndrome [5], fibromyalgia [6] and nonspecific mechanical back pain [7]

Progressive photon mapping for daylight redirecting components

AbstractDaylight redirecting components (DRCs) are characterised by complex transmissive and reflective behaviour that is difficult to predict accurately largely due to their highly directional scattering, and the caustics this produces. This paper examines the application of progressive photon mapping as a state of the art forward raytracing technique to efficiently simulate the behaviour of such DRCs, and how this approach can support architects in assessing their performance.Progressive photon mapping is an iterative variant of static photon mapping that effects noise reduction through accumulation of results, as well as a reduction in bias inherent to all density estimation methods by reducing the associated bandwidth at a predetermined rate. This not only results in simplified parametrisation for the user, but also provides a preview of the progressively refined simulation, thus making the tool accessible to non-experts as well.We demonstrate the effectiveness of this technique with an implementation based on the Radiancephoton mapping extension and a case study involving retroreflecting prismatic blinds as a representative DRC

Diagnostik bei Autismus-Spektrum-Störungen

Die Autismus-Spektrum-Störung ist eine tiefgreifende Entwicklungsstörung mit einer weltweiten Prävalenz von ca. 1 %. Sie ist charakterisiert durch Defizite in der sozialen Interaktion und Kommunikation sowie durch restriktive, repetitive oder stereotype Verhaltensweisen und Interessen. Deutliche Symptomüberlappungen zu anderen psychischen Störungen und ein hohes Maß an komorbiden Störungen führen zu einem herausfordernden diagnostischen Prozesse. Damit dieser Prozess verbessert werden kann und akkurate Diagnosen vergeben werden können, ist eine Untersuchung der Genauigkeit der Autismus-spezifischen Diagnostikinstrumente essenziell. Der vorliegende Kumulus stellt zwei Studien zu Aspekten der Diagnostik und Differentialdiagnostik der Autismus-Spektrum-Störung vor. Die erste Studie untersuchte die zugrundeliegende Struktur der Autismus-Spektrum-Störung anhand verschiedener Analysen. Die Ergebnisse weisen darauf hin, dass eine rein kategoriale Einteilung das heterogene Störungsbild nicht adäquat darstellen kann. Ein hybrides Modell der Autismus-Spektrum-Störung, welches sowohl Kategorien als auch Dimensionen berücksichtigt, scheint besser zur Beschreibung und Interpretation geeignet zu sein als ein rein dimensionales Modell, welches Autismus als ein Spektrum definiert. Die Ergebnisse der Studie zeigen insgesamt eine Evidenz für drei Klassen mit quantitativen und qualitativen Unterschieden in der Symptomausprägung. Diese latente Struktur scheint dafür geeignet zu sein, früh Fälle mit einer Autismus-Spektrum-Störung in Differenzierung zu anderen psychischen Störungen zu identifizieren. Die zweite Studie untersuchte die Abgrenzung zwischen Autismus-Spektrum-Störung und emotionalen sowie Angststörungen als relevante Differentialdiagnosen. Dazu wurden Daten einer Verhaltensbeobachtungsskala von Kindern, Jugendlichen und Erwachsenen analysiert, um Merkmale zu identifizieren, die eine Abgrenzung zwischen diesen beiden Störungsgruppen vereinfachen. Die Ergebnisse zeigen, dass eine Kombination an sozial-kommunikativen Merkmalen zur Klassifikation zwischen Autismus-Spektrum-Störung und emotionalen sowie Angststörungen geeignet ist. Gleichzeitig wird eine breite Symptomüberlappung deutlich, sodass die Gefahr einer Fehlinterpretation der Ergebnisse besteht, was sich langfristig auf die Behandlung und den Störungsverlauf auswirken würde. Die Diagnosestellung sollte daher alle verfügbaren Informationen berücksichtigen, damit eine adäquate Behandlungsform ausgewählt wird, bei welcher affektive und ängstliche Symptome berücksichtigt werden. Zusammengefasst liefern die Studien auf Basis von Verhaltensbeobachtungsdaten wichtige neue Informationen in Ergänzung zu Studien mit Fremdurteilen. Weitere Untersuchungen zur Diagnostik der Autismus-Spektrum-Störung sind notwendig, um diagnostische Verfahren zu entwickeln, die sensibel für die Heterogenität des Störungsbildes sind und adäquate Behandlungen zu initiieren. Die Verbesserung des Verständnisses ist essenziell für die Einleitung geeigneter Behandlungsformen

Identifizierung und Charakterisierung essentieller Aminosäuren im humanen ADP-Rezeptor P2Y12

Kardiovaskuläre Ereignisse bilden die Haupttodesursache in den westlichen Ländern. Mit der Einführung von Clopidogrel, welches am ADP-Rezeptor P2Y12 wirkt, konnte die Mortalität und Morbidität von kardiovaskulären Ereignissen signifikant gesenkt werden. Der P2Y12 gehört als G-Protein-gekoppelter Rezeptor (GPCR) zur größten Gruppe membranständiger Rezeptoren, welche durch ihr ubiquitäres Vorkommen einen idealen Angriffspunkt in der Pharmakotherapie bilden. Zur intelligenten und gezielten Entwicklung von neuen Arzneimitteln bedarf es umfassender Kenntnisse der Struktur- und Wirkungsbeziehung von GPCR. Um den Modellrezeptor P2Y12 strukturell und funktionell zu charakterisieren, wurde eine sättigende Mutagenese in einem funktionell essentiellen Bereich des Rezeptors (Transmembranhelices 6 und 7 sowie 3. extrazellulärer Loop) durchgeführt. Hiermit sollten die Auswirkungen von Punktmutationen auf die Funktionsweise des Rezeptors untersucht werden. Hierfür wurden sättigende Mutantenbibliotheken für 66 Positionen erstellt, wobei jede Aminosäure (AS) durch jede nicht natürlicherweise im humanen P2Y12 vorkommende AS ersetzt wurde (1254 Mutanten). Diese wurden funktionell im Expressionssystem der Hefe Saccharomyces cerevisiae mit steigenden Agonistenkonzentrationen charakterisiert und anhand ihrer Funktionalität klassifiziert. Dabei wiesen 90,8 ± 1,9 % der Rezeptormutanten keine Wildtypeigenschaften auf. Die Auswertung von 77 Wirbeltierorthologen zeigte ebenso eine hohe Konservierung von 90,7 ± 1,5 % pro Position. Im direkten positionalen Vergleich zwischen evolutionären und in vitro Daten konnte eine Übereinstimmung der in vitro und in vivo Daten von 90,2 % gefunden werden. Die funktionellen Daten wurden in eine Online-Mutantendatenbank eingearbeitet und wurden in einem 3D-Rezeptor-Homologiemodell visualisiert. Damit ist der Beweis geführt worden, dass es mit guter Vorhersagewahrscheinlichkeit möglich ist, von evolutionären Daten Rückschlüsse auf die Relevanz von Mutationen zu ziehen

Lighting features in indian-style traditional architecture

Due to the effect of impinging solar radiation, high thermal loads can be predicted in buildings ¡n many climates of South-East Asia. The logical need to protect and ventílate the fagades has been known for centuries. Features such as the jalis or lattice work combined with deep overhangs and elements conceived to reflect excessive sunlight such as water tanks or ritual ponds have adorned Indian-style palaces and temples since ancient times. Those features have subsequently inspired modern architects like Le Corbusier, Antonin Raymond, Benjamín Polk and Geoffrey Bawa to cite just a few. Climatic control elements were well suited to the craftsmanship of traditional architecture but their use as industrial producís that could be prefabrlcated ¡s more controversial. Not only has the climate changed since the origin of Indian-style architecture, but also the use of glazing has increased in an alarming way and thus the need to protect the fagades is now even more demanding. If this is not properly done the performance of air-conditioning Systems would be compromised and the lifespan of the Windows would result severely affected. Nonetheless, depending on the type and reflective nature of the shading system selected, undesirable effects for ventilaron, comfort and especially for day-lighting tend to occur in the space that, paradoxically, we are trying to protect. In this paper, within the context of Indian civilization we will present the simulation of the radiative field generated by different types of solar protection and reflective surfaces, especially ponds and Systems of louvres or brise-soleil. In the process we intend to extrapólate the procedures for ancient fabrics to some modern counterparts found in internationally acclaimed buildings and to obtain useful design insights for future projects

The effect of interactive virtual reality on pain perception: a systematic review of clinical studies

Purpose: The aim of this systematic review was to evaluate the effect of immersive and non-immersive interactive virtual reality on pain perception in patients with a clinical pain condition. Methods: The following databases were searched from inception: Medline (Ovid), PsychInfo, CINAHL, Cochrane library and Web of Science. Two reviewers screened reports and extracted the data. A third reviewer acted as an arbiter. Studies were eligible if they were randomized controlled trials, quasirandomized trials, and uncontrolled trials. Crossover and parallel-group designs were included. Risk of bias was assessed for all included studies. Results: Thirteen clinical studies were included. The majority of studies investigated a sample o participants with chronic pain. Six were controlled trials and seven uncontrolled studies. Findings from controlled research suggest that interactive virtual reality may reduce pain associated with ankylosing spondylitis and post-mastectomy, but results are inconsistent for patients with neck pain. Findings from uncontrolled studies suggest that interactive virtual reality may reduce neuropathic limb pain, and phantom limb pain, but had no effect on nonspecific chronic back pain. Conclusions: There is a need for more rigorous randomized control trials in order to conclude on the effectiveness of the use of virtual reality for the management of pain

Daylighting in historical centres: the case of an architect's office in Seville

Historical towns ¡n Europe usually have as their main feature an extremely dense urban tissue. This, in turn, generates a wide variety of situations which make it difficult to provide adequate light to the ¡nside of buildings. On the other hand, the trend for revitalization of cities often demands a change in the utilization of spaces adding even more difficulties to the case because the previous constraints and standards are heavily modified. Architecture today must face this challenge as a new aim for creativity based on the idea of “design with the environment”. Basically, the achievement of the said urban renewal of oíd towns should not entail the creation of a kind of enclosure where sustainability is absent as the conservationists would have it. With this concept in mind, the complex process of building an architect's office was been launched, and though the starting situation was that of “a windowless fagade", a number of strategies have been devised to provide for sun and light in the working and living spaces. Simulations of the project taking into account the principies of radiant energy transfer have been duly conducted and after some corrections the office was completed and monitored. The procedure yields both the thermal gains and the luminous distribution of the building in order to assess the performance and comfort level on a seasonal basis. Therefore, we consider that the project is a valid example of sustainability in historical cities not merely because of the former but also due to its integration with professional practice and its attempt to address severe urban and political constraints

Prenatal diagnosis and treatment planning of congenital heart defects—possibilities and limits

Background: Newborns with hypoplastic left heart syndrome (HLHS) or right heart syndrome or other malformations with a single ventricle physiology and associated hypoplasia of the great arteries continue to be a challenge in terms of survival. The vast majority of these forms of congenital heart defects relate to abnormal morphogenesis during early intrauterine development and can be diagnosed accurately by fetal echocardiography. Early knowledge of these conditions not only permits a better understanding of the progression of these malformations but encourages some researchers to explore new minimally invasive therapeutic options with a view to early pre- and postnatal cardiac palliation. Data sources: PubMed database was searched with terms of "congenital heart defects”, "fetal echocardiography” and "neonatal cardiac surgery”. Results: At present, early prenatal detection has been applied for monitoring pregnancy to avoid intrauterine cardiac decompensation. In principle, the majority of congenital heart defects can be diagnosed by prenatal echocardiography and the detection rate is 85%-95% at tertiary perinatal centers. The majority, particularly of complex congenital lesions, show a steadily progressive course including subsequent secondary phenomena such as arrhythmias or myocardial insufficiency. So prenatal treatment of an abnormal fetus is an area of perinatal medicine that is undergoing a very dynamic development. Early postnatal treatment is established for some time, and prenatal intervention or palliation is at its best experimental stage in individual cases. Conclusion: The upcoming expansion of fetal cardiac intervention to ameliorate critically progressive fetal lesions intensifies the need to address issues about the adequacy of technological assessment and patient selection as well as the morbidity of those who undergo these procedure