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George M.S.,Medical University of South Carolina | George M.S.,Ralph hnson Medical Center
Expert Review of Neurotherapeutics | Year: 2010

Repeated daily left prefrontal transcranial magnetic stimulation (TMS) was first proposed as a potential treatment for depression in 1993. Multiple studies from researchers around the world since then have repeatedly demonstrated that TMS has antidepressant effects greater than sham treatment, and that these effects are clinically meaningful. A large industry-sponsored trial, published in 2007, resulted in US FDA approval in October 2008. Most recently, a large NIH-sponsored trial, with a more rigorous sham technique, found that a course of treatment (3-5 weeks) was statistically and clinically significant in reducing depression. However, consistently showing statistically and clinically significant antidepressant effects, and gaining regulatory approval, is merely the beginning for this new treatment. As with any new treatment involving a radically different approach, there are many unanswered questions about TMS, and the field is still rapidly evolving. These unanswered questions include the appropriate scalp location, understanding the mechanisms of action, refining the 'dose (frequency, train, number of stimuli/day and pattern of delivery), understanding whether and how TMS can be combined with medications or talking/exposure therapy, or both, and how to deliver maintenance TMS. This article summarizes the available clinical information, and discusses key areas where more research is needed. TMS reflects a paradigm shift in treating depression. It is a safe, relatively noninvasive, focal brain stimulation treatment that does not involve seizures or implanted wires, and does not have drug-drug interactions or systemic side effects. © 2010 Expert Reviews Ltd. Source


Vistamehr A.,University of Texas at Austin | Kautz S.A.,Medical University of South Carolina | Kautz S.A.,Ralph hnson Medical Center | Neptune R.R.,University of Texas at Austin
Clinical Biomechanics | Year: 2014

Background In post-stroke hemiparetic subjects, solid polypropylene ankle-foot-orthoses are commonly prescribed to assist in foot clearance during swing while bracing the ankle during stance. Mobility demands, such as changing walking speed and direction, are accomplished by accelerating or decelerating the body and maintaining dynamic balance. Previous studies have shown that the ankle plantarflexors are primary contributors to these essential biomechanical functions. Thus, with ankle-foot-orthoses limiting ankle motion and plantarflexor output during stance, execution of these walking subtasks may be compromised. This study examined the influence of a solid polypropylene ankle-foot-orthosis on forward propulsion and dynamic balance in healthy adults. Methods Kinematic and kinetic data were recorded from 10 healthy adults walking with and without a unilateral ankle-foot-orthosis at steady-state slow (0.6 m/s) and moderate (1.2 m/s) speeds, and during accelerated (0-1.8 m/s at 0.06 m/s2) and decelerated (1.8-0 m/s at - 0.06 m/s2) walking. Propulsion was quantified by propulsive and braking impulses (i.e., time integral of the anterior-posterior ground reaction force) while dynamic balance was quantified by the peak-to-peak range of whole-body angular momentum. Findings The propulsive impulses decreased in the leg with ankle-foot-orthosis compared to the contralateral leg and no ankle-foot-orthosis condition. Further, the ankle-foot-orthosis resulted in a greater range of angular momentum in both the frontal and sagittal planes, which were correlated with the reduced peak hip abduction and reduced ankle plantarflexor moments, respectively. Interpretation Solid ankle-foot-orthoses limit the successful execution of important mobility subtasks in healthy adults and that the prescription of ankle-foot-orthosis should be carefully considered. © 2014 Elsevier Ltd. All rights reserved. Source


Alge J.L.,Medical University of South Carolina | Karakala N.,Medical University of South Carolina | Neely B.A.,Medical University of South Carolina | Janech M.G.,Medical University of South Carolina | And 3 more authors.
Critical Care | Year: 2013

Introduction: Acute kidney injury (AKI) is commonly observed in the intensive care unit (ICU), where it can be caused by a variety of factors. The objective of this study was to evaluate the prognostic value of urinary angiotensinogen, a candidate prognostic AKI biomarker identified in post-cardiac surgery patients, in this heterogeneous population.Methods: Urinary angiotensinogen was measured by ELISA and corrected for urine creatinine in 45 patients who developed AKI in the ICU. Patients were grouped by AKI etiology, and the angiotensinogen-to-creatinine ratio (uAnCR) was compared among the groups using the Kruskal-Wallis test. The ability of uAnCR to predict the following endpoints was tested using the area under the ROC curve (AUC): the need for renal replacement therapy (RRT) or death, increased length of stay (defined as hospital discharge > 7 days or death ≤ 7 days from sample collection), and worsening AKI (defined as an increase in serum creatinine > 0.3 mg/dL after sample collection or RRT).Results: uAnCR was significantly elevated in patients who met the composite outcome RRT or death (89.4 vs 25.4 ng/mg; P = 0.01), and it was a strong predictor of this outcome (AUC = 0.73). Patients with uAnCR values above the median for the cohort (55.21 ng/mg) had increased length of stay compared to patients with uAnCR ≤ 55.21 ng/mg (22 days vs 7 days after sample collection; P = 0.01). uAnCR was predictive of the outcome increased length of stay (AUC = 0.77). uAnCR was also a strong predictor of worsening of AKI (AUC = 0.77). The uAnCR of patients with pre-renal AKI was lower compared to patients with AKI of other causes (median uAnCR 11.3 vs 80.2 ng/mg; P = 0.02).Conclusions: Elevated urinary angiotensinogen is associated with adverse events in AKI patients in the ICU. It could be used to identify high risk patients who would benefit from timely intervention that could improve their outcomes. © 2013 Alge et al.; licensee BioMed Central Ltd. Source


Schacht J.P.,Medical University of South Carolina | Anton R.F.,Medical University of South Carolina | Voronin K.E.,Medical University of South Carolina | Randall P.K.,Medical University of South Carolina | And 4 more authors.
Neuropsychopharmacology | Year: 2013

Variation at a single nucleotide polymorphism in the μ-opioid receptor gene (OPRM1), A118G (Asn40Asp), may moderate naltrexone (NTX) effects in alcohol dependence. Both NTX and A118G variation have also been reported to affect alcohol cue-elicited brain activation. This study investigated whether sub-acute NTX treatment and A118G genotype interacted in their effects on cue-elicited activation of the ventral striatum (VS), medial prefrontal cortex (mPFC), and orbitofrontal cortex (OFC). Secondarily, variation at a variable number tandem repeat polymorphism in the dopamine transporter gene (DAT1/SLC6A3), which has been associated with increased reward-related activation in VS, was analyzed as a moderator of medication and A118G effects. Seventy-four non-treatment-seeking alcohol-dependent individuals, half preselected to carry at least one copy of the A118G G (Asp) allele, were randomized to NTX (50 mg) or placebo for 7 days, and performed an fMRI alcohol cue reactivity task on day 6. Region-of-interest analyses indicated no main effects of medication or A118G genotype. However, these factors interacted in their effects on OFC activation, such that, among NTX-treated individuals, G-allele carriers had less activation than A-allele homozygotes. DAT1 variation also moderated medication/A118G effects. There was a three-way interaction between medication and A118G and DAT1 genotypes on VS activation, such that, among G-allele carriers who received NTX, DAT1 10-repeat-allele (10R) homozygotes had less activation than 9-repeat-allele (9R) carriers. Further, 10R homozygotes who received NTX had less mPFC activation than 9R carriers. Polymorphic variation in OPRM1 and DAT1 should be considered in future studies of NTX, particularly regarding its effects on reward processing. © 2013 American College of Neuropsychopharmacology. All rights reserved. Source


Price M.,Medical University of South Carolina | Davidson T.M.,Medical University of South Carolina | Andrews J.O.,Medical University of South Carolina | Ruggiero K.J.,Ralph hnson Medical Center
Journal of Telemedicine and Telecare | Year: 2013

African-Americans and Hispanics are disproportionally affected by disasters. We evaluated differences in the use and completion of a web-based mental health intervention, Disaster Recovery Web (DRW), by White, African-American and Hispanic adults in the aftermath of Hurricane Ike. Approximately one year after the hurricane, a telephone survey was carried out with adults from Galveston and Chambers counties. A total of 1249 adults participated in the survey (80% White, 14% African-American and 6% Hispanic). Mental health and mental health service utilization were assessed. Whites were more likely to have previously used the Internet to obtain general health information than African-Americans or Hispanics (P, 0.001). A logistic regression was used to identify differences in the use of the Internet intervention after controlling for covariates. There were no differences in rates of non-use and dropout attrition between Whites, African-Americans and Hispanics. Thus the findings suggest that web-based mental health interventions can be used to reach African-American, Hispanic and White adults at similar rates after a disaster. Source

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