| 196441. |
- Patel, Mayurkumar, et al.
(författare)
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Quantification of dermal and transdermal delivery of meloxicam gels in rabbits
- 2011
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Ingår i: Drug Development and Industrial Pharmacy. - : Informa UK Limited. - 0363-9045 .- 1520-5762. ; 37:5, s. 613-617
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Tidskriftsartikel (refereegranskat)abstract
- Background: This study was designed to quantify the effects of penetration enhancers on systemic bioavailability of 0.3% meloxicam (MLX) hydroxypropylcellulose gels. Cutaneous microdialysis was also performed to assess dermis availability and to better understand the penetration process. The gels tested were a 1% oleic acid gel, a 5% menthol gel, and a control gel without penetration enhancers. Methods: To assess systemic bioavailability, three female rabbits received according to a crossover design 0.135 g/cm(2) of gel applied to a 7.5 x 7.5 cm area of their shaved back and a short (5 min) infusion of 1 mg. In each experiment, blood samples were collected serially for 36 h and analyzed by a validated HPLC method. For skin bioavailability studies, 0.135 g/cm(2) of the same gels were applied to a 1 x 2 cm area on top of a microdialysis probe previously inserted in the dermis. Dialysate samples were collected for 6 h every 30 min. Results: Systemically, the 5% menthol gel delivered 3.93 +/- 0.85 mg of MLX versus the 1.41 +/- 0.24 mg of the oleic acid gel. Only traces of MLX were detectable from the control gel. In dermis, substantial concentrations of MLX were detected only after the application of the menthol gel, whereas skin concentration from the control gel and the 1% oleic acid gel were always below the lowest limit of quantification (LLOQ). Conclusions: The 5% menthol gel can possibly deliver therapeutically relevant amount of MLX in vivo. Dermis concentrations can be predictive of systemic plasma levels.
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| 196442. |
- Patel, Mitesh, et al.
(författare)
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Spectral Analysis of Body Movement during Deep Brain Stimulation in Parkinson's Disease
- 2021
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Ingår i: Gait and Posture. - : Elsevier BV. - 0966-6362. ; 86, s. 217-225
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Tidskriftsartikel (refereegranskat)abstract
- Background: The characteristics of Parkinson's disease (PD) include postural instability and resting tremor. However, reductions of tremor amplitude do not always improve postural stability. Research question: What is the effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on spectral analysis of body movement in patients with PD when tested without anti-PD medication? The effect of visual cues was also studied. Methods: Ten patients with PD (mean age 64.3 years, range 59−69 years) and 17 control participants (mean age 71.2 years, range 65–79 years) were recruited. Spectral power following a period of quiet stance (35 s) was analysed in three different spectral power bands (0−4 Hz, 4−7 Hz and 7−25 Hz). Motion markers were secured to the head, shoulder, hip, and knee, which recorded movements in two directions, the anteroposterior and lateral. Results: DBS STN significantly changed the spectral distribution pattern across the body in the anteroposterior (p = 0.029) and lateral directions (p ≤ 0.003). DBS predominantly reduced spectral power at the head (p ≤ 0.037) and shoulder (p ≤ 0.031) in the lateral direction. The spectral power of the lower and upper body in patients with PD, with DBS ON, were more similar to the control group, than to DBS OFF. Visual cues mainly reduced spectral power in the anteroposterior direction at the shoulder (p ≤ 0.041) in controls and in patients with PD with DBS ON. Significance: There is an altered postural strategy in patients with PD with DBS ON as shown by an altered spectral power distribution pattern across body segments and a reduction of spectral power in the lateral direction at the head and shoulder. A reduction of spectral power in controls and in patients with PD with DBS ON suggests that visual cues are able to reduce spectral power to some extent, but not with DBS OFF where postural sway and power are larger.
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| 196443. |
- Patel, Mitesh, et al.
(författare)
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Strategic Alterations of Posture are Delayed in Parkinson's Disease Patients during Deep Brain Stimulation
- 2021
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Parkinson's disease (PD) is characterized by rigidity, akinesia, postural instability and tremor. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) reduces tremor but the effects on postural instability are inconsistent. Another component of postural control is the postural strategy, traditionally referred to as the ankle or hip strategy, which is determined by the coupling between the joint motions of the body. We aimed to determine whether DBS STN and vision (eyes open vs. eyes closed) affect the postural strategy in PD in quiet stance or during balance perturbations. Linear motion was recorded from the knee, hip, shoulder and head in 10 patients with idiopathic PD with DBS STN (after withdrawal of other anti-PD medication), 25 younger adult controls and 17 older adult controls. Correlation analyses were performed on anterior-posterior linear motion data to determine the coupling between the four positions measured. All participants were asked to stand for a 30 s period of quiet stance and a 200 s period of calf vibration. The 200 s vibration period was subdivided into four 50 s periods to study adaptation between the first vibration period (30-80 s) and the last vibration period (180-230 s). Movement was recorded in patients with PD with DBS ON and DBS OFF, and all participants were investigated with eyes closed and eyes open. DBS settings were randomized and double-blindly programmed. Patients with PD had greater coupling of the body compared to old and young controls during balance perturbations (p ≤ 0.046). Controls adopted a strategy with greater flexibility, particularly using the knee as a point of pivot, whereas patients with PD adopted an ankle strategy, i.e., they used the ankle as the point of pivot. There was higher flexibility in patients with PD with DBS ON and eyes open compared to DBS OFF and eyes closed (p ≤ 0.011). During balance perturbations, controls quickly adopted a new strategy that they retained throughout the test, but patients with PD were slower to adapt. Patients with PD further increased the coupling between segmental movement during balance perturbations with DBS ON but retained a high level of coupling with DBS OFF throughout balance perturbations. The ankle strategy during balance perturbations in patients with PD was most evident with DBS OFF and eyes closed. The increased coupling with balance perturbations implies a mechanism to reduce complexity at a cost of exerting more energy. Strategic alterations of posture were altered by DBS in patients with PD and were delayed. Our findings therefore show that DBS does not fully compensate for disease-related effects on posture.
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| 196444. |
- Patel, Mitesh, et al.
(författare)
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The contribution of mechanoreceptive sensation on stability and adaptation in the young and elderly.
- 2009
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Ingår i: European Journal of Applied Physiology. - : Springer Science and Business Media LLC. - 1439-6327 .- 1439-6319. ; 105, s. 167-173
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to determine the contributions of foot mechanoreceptive sensation, vision and their interaction on postural stability during quiet stance, balance perturbations and adaptive adjustments. Postural stability was measured as anteroposterior torque variance in Young (n = 25, average age = 25.1 years) and Elderly subjects (n = 16, average age = 71.5 years) during repeated calf vibrations while standing with eyes open and closed. Sensation, recorded using vibration perception and tactile sensitivity, was poorer in elderly than young subjects. Sensation was of low importance for stability during quiet stance and the first 50 s of repeated vibrations, but was associated with stability during the last three 50 s periods of balance perturbations, suggesting that the mechanoreceptive sensation affected how well postural control could adapt to repeated balance perturbations. The findings suggest that clinicians should investigate whether patients with balance problems and poor adaptation have mechanoreceptive sensation deficits.
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| 196445. |
- Patel, Mitesh, et al.
(författare)
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The effect of foam surface properties on postural stability assessment while standing.
- 2008
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Ingår i: Gait & Posture. - : Elsevier BV. - 1879-2219 .- 0966-6362. ; 28, s. 649-656
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Tidskriftsartikel (refereegranskat)abstract
- A common assessment of postural control often involves subjects standing on a compliant surface, such as a foam block, to make balance tests more challenging. However, the physical properties of the foam block used by different researchers can vary considerably. The objective of this study was to provide an initial approach for investigating whether two of the foam properties, i.e. density and elastic modulus, influenced recorded anteroposterior and lateral torque variance with eyes open and eyes closed. Thirty healthy adults (mean age 22.5 years) were assessed with posturography using three different types of foam block placed on a force platform. These blocks were categorised: firm foam, medium foam and soft foam by their elastic modulus. To investigate the spectral characteristics of recorded body movements, variance values were calculated for total movements, movements <0.1Hz and movements >0.1Hz. Results showed that anteroposterior and lateral torque variances >0.1Hz were larger when standing on the firm foam compared with medium and soft foam and in turn were larger on the medium foam compared with the soft foam with eyes closed. Moreover, GLM and correlation analysis demonstrated that the properties of the foam blocks affected anteroposterior torque variance >0.1Hz and lateral torque variance in all frequency ranges. In addition, the stabilising effect of vision in the anteroposterior direction had a greater influence when the subjects' stability was increasingly challenged by the support surface, as illustrated by the higher torque variance values. In conclusion, caution should be taken when analysing balance deficits with foam test setups, because the foam properties may influence the recorded body movements.
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| 196446. |
- Patel, Mitesh, et al.
(författare)
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The effects of foam surface properties on standing body movement.
- 2008
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 1651-2251 .- 0001-6489. ; 128:9, s. 952-960
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Tidskriftsartikel (refereegranskat)abstract
- CONCLUSION: The properties of a foam surface significantly affect body movement variance. Therefore, studies where different kinds of foam have been used may not provide congruent results. OBJECTIVES: To investigate whether different properties of foam affect body movement variance (32 subjects, mean age 22.5 years) in terms of linear head, shoulder, hip and knee movements. Subjects repeated tests with eyes open and closed, to also determine the effect of vision on the different surfaces. SUBJECTS AND METHODS: Body movement was captured on three different foam surfaces and on a control solid surface over 2 min using a Zebris ultrasound measuring system. The foam surfaces were categorized by their firmness as firm foam, medium foam and soft foam. RESULTS: Body movement variance increased significantly when standing on all foam surfaces compared with the solid surface. However, movement variance was larger when standing on the firm foam compared with the softer foams, except in the anteroposterior total and low frequency ranges. We also found that the body movement pattern differed when standing on foam and firm surfaces, with greater reliance on movements at the knee to give postural stability on foam than on the solid surface. Vision clearly reduced all body movement variances, but particularly within the high frequency range.
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| 196447. |
- Patel, Onisha, et al.
(författare)
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Recognition of CD1d-sulfatide mediated by a type II natural killer T cell antigen receptor.
- 2012
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Ingår i: Nature immunology. - : Springer Science and Business Media LLC. - 1529-2916 .- 1529-2908. ; 13:9, s. 857-63
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Tidskriftsartikel (refereegranskat)abstract
- Natural killer T cells (NKT cells) are divided into type I and type II subsets on the basis of differences in their T cell antigen receptor (TCR) repertoire and CD1d-antigen specificity. Although the mode by which type I NKT cell TCRs recognize CD1d-antigen has been established, how type II NKT cell TCRs engage CD1d-antigen is unknown. Here we provide a basis for how a type II NKT cell TCR, XV19, recognized CD1d-sulfatide. The XV19 TCR bound orthogonally above the A' pocket of CD1d, in contrast to the parallel docking of type I NKT cell TCRs over the F' pocket of CD1d. At the XV19 TCR-CD1d-sulfatide interface, the TCRα and TCRβ chains sat centrally on CD1d, where the malleable CDR3 loops dominated interactions with CD1d-sulfatide. Accordingly, we highlight the diverse mechanisms by which NKT cell TCRs can bind CD1d and account for the distinct antigen specificity of type II NKT cells.
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| 196448. |
- Patel, Pratik B., et al.
(författare)
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An opportunity for diagonal development in global surgery: cleft lip and palate care in resource-limited settings
- 2012
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Ingår i: Plastic Surgery International. - : Hindawi Limited. - 2090-1461 .- 2090-147X. ; 2012, s. 892437-892437
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Tidskriftsartikel (refereegranskat)abstract
- Global cleft surgery missions have provided much-needed care to millions of poor patients worldwide. Still, surgical capacity in low- and middle-income countries is generally inadequate. Through surgical missions, global cleft care has largely ascribed to a vertical model of healthcare delivery, which is disease specific, and tends to deliver services parallel to, but not necessarily within, the local healthcare system. The vertical model has been used to address infectious diseases as well as humanitarian emergencies. By contrast, a horizontal model for healthcare delivery tends to focus on long-term investments in public health infrastructure and human capital and has less often been implemented by humanitarian groups for a variety of reasons. As surgical care is an integral component of basic healthcare, the plastic surgery community must challenge itself to address the burden of specific disease entities, such as cleft lip and palate, in a way that sustainably expands and enriches global surgical care as a whole. In this paper, we describe a diagonal care delivery model, whereby cleft missions can enrich surgical capacity through integration into sustainable, local care delivery systems. Furthermore, we examine the applications of diagonal development to cleft care specifically and global surgical care more broadly.
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| 196449. |
- Patel, Pankaj C., et al.
(författare)
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Perceived risk and the need for trust as drivers of improved surgical skills in 3D surgical video technology
- 2022
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Ingår i: Journal of Innovation and Knowledge. - : Elsevier. - 2530-7614 .- 2444-569X. ; 7:4
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Tidskriftsartikel (refereegranskat)abstract
- Based on the technology adoption model, the implementation of medical technology presents a double-edged sword. On the one hand, it may improve health outcomes and facilitate improved skills; on the other hand, it could elicit risk and trust concerns. In this exploratory study, which combines adoption of the medical technology with an associated skills improvement framework, we use responses from eighty-five staff members directly involved in the peri- and intra-operative care of the patient at a large hospital in Sweden during the gestating stages of 3D surgical video implementation. We find that a perceived lower risk for patients from 3D surgical videos is positively associated with improved surgical skills through a lower perceived need for trust in 3D surgical videos. The findings show that lower perceived losses lead to lower need for trust, which, in turn, improves perceptions of improved surgical skills. The findings carry implications for considering non-technological and non-medical factors in driving appreciation of the benefits (perceived improvements in surgical skills).
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| 196450. |
- Patel, Priya, et al.
(författare)
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Clinical practice guideline for the prevention of oral and oropharyngeal mucositis in pediatric cancer and hematopoietic stem cell transplant patients : 2021 update
- 2021
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Ingår i: European Journal of Cancer. - : Elsevier. - 0959-8049 .- 1879-0852. ; 154, s. 92-101
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Forskningsöversikt (refereegranskat)abstract
- Purpose: To update the 2015 clinical practice guideline for the prevention of oral mucositis in pediatric cancer or hematopoietic stem cell transplant (HSCT) patients. Methods: We performed seven systematic reviews of mucositis prevention. Three reviews included randomized controlled trials (RCTs) conducted in pediatric and adult patients evaluating cryotherapy, keratinocyte growth factor (KGF) or photobiomodulation therapy with a focus on efficacy. Three reviews included studies of any design conducted in pediatric patients evaluating these same interventions with a focus on adverse events and feasibility. One review included all RCTs of any intervention for mucositis prevention in pediatric patients. Primary outcome was severe oral mucositis.
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