title stringlengths 0 1.13k | abstract stringlengths 1 15.7k | PMID int64 22 36.5M |
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Subcoronary implantation of a stentless valve in patients with aortic aneurysms. | Experience with a new operation for patients with aortic valve disease and aneurysm or dissection of the ascending aorta is described. Twenty-four patients aged 66-87 years were operated on using a subcoronary implantation technique with a stentless aortic valve bioprosthesis and an extension using a vascular tube prosthesis. No major adverse cardiac events were observed in the postoperative period. This operation offers a safe alternative to the technically more demanding procedures of composite bioprosthetic ascending aortic replacement or full root replacement. | 18,812,341 |
Factors influencing survival in patients after bidirectional Glenn shunt. | Clinical characteristics, echocardiographic values, and catheterization data of 45 patients with a functional univentricular heart who had a bidirectional Glenn shunt instituted between November 1994 and October 2006 were retrospectively reviewed. Median age at operation was 20 months (range, 9 months to 19 years). Median follow-up time after the bidirectional Glenn operation was 4 years (range, 1 day to 11 years). The early mortality rate was 4/45 (8.9%); overall mortality was 24.4%. Actuarial survival after a bidirectional Glenn shunt was 73% +/- 8% at 5 years and 55% +/- 17% at 10 years. In multivariate Cox proportional hazards analysis, heterotaxy syndrome and systemic right ventricle were independent predictors of mortality after the bidirectional Glenn shunt. Age at operation, oxygen saturation, previous surgery, a pulsatile Glenn shunt, cardiopulmonary bypass, postoperative pulmonary artery pressure, bilateral superior venae cavae, and Nakata index were not predictive of mortality. The presence of heterotaxy syndrome and systemic right ventricle in patients with a functional univentricular heart should lead to aggressive investigation and management strategies. | 18,812,346 |
Verapamil and nitroglycerin improves the patency rate of radial artery grafts. | The best way to prevent spasm of the radial artery is still under investigation. We retrospectively compared the effectiveness of topical verapamil-nitroglycerin with papaverine in preventing graft spasm in 215 patients who underwent isolated conventional coronary artery bypass using a radial artery. Postoperative angiographic data were successfully collected in 116 patients. Perioperative radial artery graft spasm was observed in 2 patients in the papaverine group and 1 in the verapamil-nitroglycerin group; this difference was not considered significant. Complete or functional occlusion was detected by postoperative angiography in 13 grafts (10 in the papaverine group and 3 in the verapamil-nitroglycerin group). Multivariate regression analysis revealed that topical papaverine and grafting to the right coronary artery significantly increased the rate of occlusion of radial artery grafts. Although further studies are needed, our data support the view that topical verapamil-nitroglycerin reduces the incidence of radial artery graft occlusion. | 18,812,349 |
Expression of heat shock protein 27 and alpha-crystallins in human retinoblastoma after chemoreduction. | Small heat shock proteins (sHSP) play an important role in the resistance to anticancer drugs. We examined the expression of the sHSP family, HSP27 and alpha-crystallins, in human retinoblastoma with and without preoperative chemotherapy. Eighteen enucleated eyes from patients with retinoblastoma were used. Six patients had undergone chemotherapy before enucleation. Formalin-fixed, paraffin-embedded tissue sections were processed for H&E staining and examined by immunohistochemistry using anti-HSP27 and alpha-crystallins antibodies. Eleven of 12 cases with no history of preoperative chemotherapy showed weakly positive or negative staining for HSP27, whereas six and five cases were strongly positive for alphaA and alphaB-crystallin, respectively. In the six cases with a history of chemotherapy, several viable retinoblastoma cells remained. Immunoreactivity for HSP27 and alphaB-crystallin was strongly detected in the cytoplasm of viable retinoblastoma cells, while alphaA-crystallin immunoreactivity was less marked. Immunoreactivity for HSP27 was significantly higher in retinoblastoma cases with preoperative chemotherapy than in those without chemotherapy (p<0.0001). In contrast, immunoreactivity for alphaA-crystallin was significantly lower in cases with chemotherapy than in cases without chemotherapy (p<0.01). HSP27 and alphaB-crystallin, but not alphaA-crystallin, were highly expressed in viable tumour cells after chemotherapy, suggesting that HSP27 and alphaB-crystallin may protect tumour cells from apoptotic signals produced by anticancer drugs in retinoblastoma. | 18,812,387 |
Serial analysis of mutation spectra (SAMS): a new approach for the determination of mutation spectra of site-specific DNA damage and their sequence dependence. | Many mutations occur as a result of DNA synthesis past the site of DNA damage by DNA damage bypass polymerases. The frequency and types of mutations not only depend on the nature of the damage, but also on the sequence context, as revealed from analysis of mutation spectra of DNA exposed to mutagens. Herein we report a new method for the rapid determination of the effect of sequence context on mutagenesis called SAMS for serial analysis of mutation spectra. This technique makes use of the methodology that underlies serial analysis of gene expression (SAGE) to analyze mutations that result from DNA synthesis past a DNA lesion site-specifically embedded in a library of DNA sequences. To illustrate our technique we determined the effect of sequence context on mutations generated by DNA synthesis past a tetrahydrofuran abasic site model by the DNA damage bypass polymerase yeast polymerase eta. | 18,812,400 |
Self-efficacy moderates the relation between declines in physical activity and perceived social support in high school girls. | To test whether self-efficacy for overcoming barriers to physical activity has direct, indirect (i.e., mediated), or moderating relations with naturally occurring change in perceived social support and declines in physical activity during high school. Latent growth modeling was used with measures completed in the 8th, 9th, and 12th grades by a cohort of 195 Black and White girls. Self-efficacy was stable and moderated the relation between changes in physical activity and perceived social support. Girls who maintained a perception of strong social support had less of a decline in physical activity if they also had high self-efficacy. However, girls having high self-efficacy had a greater decline in physical activity if they perceived declines in social support. Randomized controlled trials of physical activity interventions based on social cognitive theory should consider that the influence of girls' perceptions of social support on their physical activity may differ according to their efficacy beliefs about barriers to physical activity. | 18,812,410 |
The treatment of lupus pernio: results of 116 treatment courses in 54 patients. | Lupus pernio is a disfiguring sarcoidosis skin lesion that is difficult to treat and often causes a major psychosocial impact that may adversely affect the patient's quality of life. We reviewed the treatment outcome of 54 patients with lupus pernio who received 116 individual courses of treatment in our sarcoidosis clinic. Lupus pernio patients were identified from an institution-approved database. All patients were assessed at each clinic visit with facial photographs. By examining the photographs, the percentage of face involved (< 10%, 10 to 25%, > 25 to 50%, > 50%) was determined as was the effect of therapy (resolution, near resolution, improvement, no change, worsening). Medications included infliximab-containing regimens; systemic corticosteroids; noninfliximab, noncorticosteroid agents; and corticosteroids plus noncorticosteroid agents. In terms of achieving resolution or near resolution, infliximab regimens were superior to all others (infliximab, 77%; corticosteroids plus noncorticosteroids, 29%; corticosteroids, 20%; noncorticosteroids, 11%; infliximab vs other therapies: corticosteroids plus noncorticosteroids, p = 0.0015; corticosteroids, p = 0.0005; noncorticosteroids, p = 0.0002). The percentage of facial involvement also improved most with infliximab. Evaluating a secondary analysis of achieving resolution, near resolution, or improvement, infliximab (92%) was superior to noncorticosteroids (20%; p < 0.0001) and corticosteroids plus noncorticosteroids (56%; p = 0.0098), but not corticosteroids (72%; p = 0.2456); and noncorticosteroid agents were inferior to all other regimens. Infliximab appears superior to systemic corticosteroids with or without additional agents for the treatment of lupus pernio. Noninfliximab, noncorticosteroid-containing regimens are of limited use for this condition. | 18,812,454 |
Chronic lymphocytic leukemia antibodies with a common stereotypic rearrangement recognize nonmuscle myosin heavy chain IIA. | Leukemic B lymphocytes of a large group of unrelated chronic lymphocytic leukemia (CLL) patients express an unmutated heavy chain immunoglobulin variable (V) region encoded by IGHV1-69, IGHD3-16, and IGHJ3 with nearly identical heavy and light chain complementarity-determining region 3 sequences. The likelihood that these patients developed CLL clones with identical antibody V regions randomly is highly improbable and suggests selection by a common antigen. Monoclonal antibodies (mAbs) from this stereotypic subset strongly bind cytoplasmic structures in HEp-2 cells. Therefore, HEp-2 cell extracts were immunoprecipitated with recombinant stereotypic subset-specific CLL mAbs, revealing a major protein band at approximately 225 kDa that was identified by mass spectrometry as nonmuscle myosin heavy chain IIA (MYHIIA). Reactivity of the stereotypic mAbs with MYHIIA was confirmed by Western blot and immunofluorescence colocalization with anti-MYHIIA antibody. Treatments that alter MYHIIA amounts and cytoplasmic localization resulted in a corresponding change in binding to these mAbs. The appearance of MYHIIA on the surface of cells undergoing stress or apoptosis suggests that CLL mAb may generally bind molecules exposed as a consequence of these events. Binding of CLL mAb to MYHIIA could promote the development, survival, and expansion of these leukemic cells. | 18,812,466 |
Directed evolution of a G protein-coupled receptor for expression, stability, and binding selectivity. | We outline a powerful method for the directed evolution of integral membrane proteins in the inner membrane of Escherichia coli. For a mammalian G protein-coupled receptor, we arrived at a sequence with an order-of-magnitude increase in functional expression that still retains the biochemical properties of wild type. This mutant also shows enhanced heterologous expression in eukaryotes (12-fold in Pichia pastoris and 3-fold in HEK293T cells) and greater stability when solubilized and purified, indicating that the biophysical properties of the protein had been under the pressure of selection. These improvements arise from multiple small contributions, which would be difficult to assemble by rational design. In a second screen, we rapidly pinpointed a single amino acid substitution in wild type that abolishes antagonist binding while retaining agonist-binding affinity. These approaches may alleviate existing bottlenecks in structural studies of these targets by providing sufficient quantities of stable variants in defined conformational states. | 18,812,512 |
A channel connecting the mother cell and forespore during bacterial endospore formation. | At an early stage during Bacillus subtilis endospore development the bacterium divides asymmetrically to produce two daughter cells. The smaller cell (forespore) differentiates into the endospore, while the larger cell (mother cell) becomes a terminally differentiated cell that nurtures the developing forespore. During development the mother cell engulfs the forespore to produce a protoplast, surrounded by two bilayer membranes, which separate it from the cytoplasm of the mother cell. The activation of sigma(G), which drives late gene expression in the forespore, follows forespore engulfment and requires expression of the spoIIIA locus in the mother cell. One of the spoIIIA-encoded proteins SpoIIIAH is targeted specifically to the membrane surrounding the forespore, through an interaction of its C-terminal extracellular domain with the C-terminal extracellular domain of the forespore membrane protein SpoIIQ. We identified a homologous relationship between the C-terminal domain of SpoIIIAH and the YscJ/FliF protein family, members of which form multimeric rings involved in type III secretion systems and flagella. If SpoIIIAH forms a similar ring structure, it may also form a channel between the mother cell and forespore membranes. To test this hypothesis we developed a compartmentalized biotinylation assay, which we used to show that the C-terminal extracellular domain of SpoIIIAH is accessible to enzymatic modification from the forespore cytoplasm. These and other results lead us to suggest that SpoIIIAH forms part of a channel between the forespore and mother cell that is required for the activation of sigma(G). | 18,812,514 |
Prehospital termination of resuscitation in cases of refractory out-of-hospital cardiac arrest. | Identifying patients in the out-of-hospital setting who have no realistic hope of surviving an out-of-hospital cardiac arrest could enhance utilization of scarce health care resources. To validate 2 out-of-hospital termination-of-resuscitation rules developed by the Ontario Prehospital Life Support (OPALS) study group, one for use by responders providing basic life support (BLS) and the other for those providing advanced life support (ALS). Retrospective cohort study using surveillance data prospectively submitted by emergency medical systems and hospitals in 8 US cities to the Cardiac Arrest Registry to Enhance Survival (CARES) between October 1, 2005, and April 30, 2008. Case patients were 7235 adults with out-of-hospital cardiac arrest; of these, 5505 met inclusion criteria. Specificity and positive predictive value of each termination-of-resuscitation rule for identifying patients who likely will not survive to hospital discharge. The overall rate of survival to hospital discharge was 7.1% (n = 392). Of 2592 patients (47.1%) who met BLS criteria for termination of resuscitation efforts, only 5 (0.2%) patients survived to hospital discharge. Of 1192 patients (21.7%) who met ALS criteria, none survived to hospital discharge. The BLS rule had a specificity of 0.987 (95% confidence interval [CI], 0.970-0.996) and a positive predictive value of 0.998 (95% CI, 0.996-0.999) for predicting lack of survival. The ALS rule had a specificity of 1.000 (95% CI, 0.991-1.000) and positive predictive value of 1.000 (95% CI, 0.997-1.000) for predicting lack of survival. In this validation study, the BLS and ALS termination-of-resuscitation rules performed well in identifying patients with out-of-hospital cardiac arrest who have little or no chance of survival. | 18,812,534 |
Volumetric evaluation of liver metastases after thermal ablation: long-term results following MR-guided laser-induced thermotherapy. | To volumetrically analyze liver metastases and posttherapeutic findings of the thermally ablated area after thermal ablation with magnetic resonance (MR)-guided laser-induced thermotherapy in a long-term evaluation using contrast-enhanced MR imaging. The study was approved by the institutional review board, and informed consent was obtained from all patients. In 40 patients (27 women, 13 men; age range, 33-94 years; mean age, 62.5 years) in whom colorectal cancer (n = 20) and breast cancer (n = 20) had metastasized to the liver, initial tumor volume and thermal-induced necrosis after MR-guided laser-induced thermotherapy were retrospectively analyzed. All patients presented with oligonodular liver metastases and underwent follow-up with contrast-enhanced MR imaging for at least 3 years. No concomitant oncologic therapies were performed. Volumetric MR imaging evaluation depicted 40 metastases with an initial tumor volume less than 5 mL (x = 1.75), nine metastases with initial volume of 5-20 mL (x = 12.35), and eight metastases with initial volume more than 20 mL (x = 50.57). The mean volume of the thermally damaged area was 498% of the initial volume for colorectal cancer metastases and 604% of the initial volume for breast cancer metastases. The ischemic and necrotic volume for colorectal cancer metastases had decreased by a mean of 48.6% after 3 months, by 63% after 6 months, by 70.2% after 12 months, and by 92.2% after 36 months. For breast cancer metastases at 36 months, the necrotic volume had decreased by 80.61%; the reduction in the volume of the thermally damaged region was statistically significantly lower than that of colorectal cancer metastases. MR-guided laser-induced thermotherapy induced a high volume of thermal ablation; the greatest reduction in the necrotic volume occurred in the first year, and lower values were seen in the next period. The reduction was statistically significantly higher in colorectal cancer metastases. | 18,812,558 |
Colorectal tumor vascularity: quantitative assessment with multidetector CT--do tumor perfusion measurements reflect angiogenesis? | To establish the relationships between quantitative perfusion computed tomography (CT) parameters-specifically, primary tumor blood flow, blood volume, transit time, and permeability surface-area product-and immunohistologic markers of angiogenesis in colorectal cancer. After institutional review board approval and informed patient consent were obtained for this prospective study, 23 patients (11 men, 12 women; mean age, 68.4 years; age range, 34.8-87.1 years) with colorectal adenocarcinoma underwent a 65-second perfusion CT examination, and tumor blood flow, blood volume, mean transit time, and permeability surface-area product were determined. After surgery, resected specimens were sectioned and stained immunohistochemically to identify CD34 for quantification of microvessel density (MVD), to identify smooth muscle actin for assessment of pericyte coverage index, to identify vascular endothelial growth factor (VEGF), and to identify glucose transporter protein (GLUT-1). Perfusion CT measurements were correlated with MVD, pericyte coverage index, VEGF expression, and GLUT-1 expression by using Pearson or Spearman rank correlation analysis, with significance assigned at the 5% level. Mean blood flow, blood volume, transit time, and permeability surface-area product values were 72.1 mL/min/100 g of tissue +/- 28.4 (standard deviation), 6.2 mL/100 g of tissue +/- 1.4, 9.3 seconds +/- 3.9, and 13.9 mL/min/100 g of tissue +/- 3.2, respectively. Blood volume (r = 0.59, P = .002) and permeability surface-area product (r = 0.46, P = .03) correlated positively with MVD, but blood flow (r = 0.27, P = .22) and transit time (r = -0.18, P = .44) did not. There were no significant associations between any perfusion CT parameter and pericyte coverage index (r <or= 0.36, P > .05), VEGF score (rho <or= 0.30, P >or= .15), or GLUT-1 score (rho < 0.21, P >or= .33). Tumor permeability surface-area product and blood volume correlate positively with MVD and may reflect the microvascularity of colorectal tumors. | 18,812,560 |
High-throughput analysis of HGF-stimulated cell scattering. | Historically, only relatively low-throughput or expensive methods have been available to measure cell migration. Hepatocyte growth factor (HGF) is a ligand for the tyrosine kinase receptor Met that, in addition to mediating proliferation and survival, increases cell motility and metastasis. The authors have developed a high-throughput imaging assay for measuring inhibition of HGF-induced scattering in human HPAF-II pancreatic adenocarcinoma cells. Following treatment with test compounds and HGF for 24 h, cells are labeled with a nuclear stain and imaged at 10x magnification. The proximity of neighboring nuclei is measured, and the distribution of internuclear distances across each field of view is used to calculate the fraction of scattered cells. This method of analysis can be extended to other cell types and signaling pathways and, compared with other membrane-based migration assays currently available, the assay is significantly lower in cost, is less labor intensive, and provides higher throughput. | 18,812,567 |
High-throughput microsomal stability assay for screening new chemical entities in drug discovery. | In this work, the authors present a novel, robotic, automated protocol for assessing a metabolic stability protocol assembled on a Hamilton platform and a new strategy for pooling samples (cassette analysis). To increase the high throughput of the liquid chromatography (LC) step, fast chromatography and automated liquid chromatography tandem mass spectrometry (LC/MS/MS) analytical methods were also developed, and a rapid data analysis system was generated that converts peak areas obtained by LC/MS/MS in intrinsic clearance values. All of the steps of the microsomal stability assay were carefully studied and optimized. Standard errors and confidence intervals of the measured clearances were also automatically generated in the process to allow an immediate evaluation of the significance of observed values. Methods based on pooling analysis of 2 and 4 different analytes were compared with a standard method without pooling. A simple statistical treatment was used to show their equivalence. The different protocols developed were analyzed in terms of the best compromise between accuracy and high-throughput capabilities. | 18,812,573 |
A novel high-throughput screening assay for putative antidiabetic agents through PPARalpha interactions. | As natural peroxisome proliferator-activated receptor-alpha (PPARalpha) ligands, high levels of fatty acids and glucose could lead to hyperactivation of PPARalpha, like that seen in diabetes. Important diabetes research goals are to uncover new metabolic or signaling pathways involved in hyperglycemic cellular injury and to develop therapeutics for preventing or reversing this injury. Consequently, 1040 putative antidiabetic agents were screened for their ability to 1) affect PPARalpha lipid binding, 2) directly bind PPARalpha, and 3) alter PPARalpha transactivation in the presence of high glucose. A high-throughput fluorescent binding assay was developed to examine each compound's ability to restore fatty acyl-CoA binding to PPARalpha in the presence of high glucose concentrations. Approximately 1% of the compounds restored acyl-CoA binding by 60% or more. These compounds directly interacted with PPARalpha with high affinity (nM K(d)s), validating the primary screen. Furthermore, these compounds altered PPARalpha transactivation, and 1 strongly reversed the hyperactivation of PPARalpha found in the presence of clofibrate and high glucose levels. | 18,812,576 |
A multiattribute model for evaluating the benefit-risk profiles of treatment alternatives. | The assessment of the benefits and risks associated with a medicine's use requires careful consideration of a wealth of information of varying format and quality, ranging from efficacy and safety data derived from randomized clinical trials to statistical results from health outcomes studies to spontaneously reported adverse events. Contrary to the expectations of patients, physicians, and regulators, the literature offers little guidance as to how to strike an appropriate balance between benefit and risk. Although a qualitative listing of a medicine's benefits and risks is useful, much could be gained from a systematic and transparent process to evaluate a medicine's pre- and postmarketing performance. The authors propose a representational model based on multicriteria decision analysis that can incorporate both evaluative judgments from different perspectives (e.g., physician, patient) and quantitative data to inform tradeoffs between multiple benefit and multiple risk elements in a logically consistent and transparent manner. The model is designed to highlight the relative merits and deficits of treatment alternatives in well-defined and specific contexts. It is intended to serve as a common platform to facilitate focused benefit-risk tradeoff discussions between scientists, physicians, regulatory authorities, and pharmaceutical companies, and to assist in the communication of clear and consistent messages regarding those tradeoffs. | 18,812,582 |
Drug-binding cavities in long-lived biologics: cause for concern but also potential benefit. | Universally present but overlooked cavities or pockets in long-lived biopharmaceuticals, such as monoclonal antibodies (mAbs), are capable of binding small drugs. Such direct interactions can alter the pharmacokinetics of drugs and potentially affect clinical outcome. The extreme differences in the pharmacokinetic properties of these 2 classes of drugs largely account for such effects. This overlooked mechanism of biologic-chemical drug interaction should be considered before approval of new long-lived entities. | 18,812,610 |
Comorbidities in a cancer patient: problems in pain management and palliation. | Pain management and palliation face a great challenge with inclusion of the palliation teams from the earliest phases of diagnosis. The presented case report highlights that early inclusion of pain and palliative physicians in patient care demands comprehensive evaluation of the symptoms by the palliative physicians with possibly curable comorbid conditions requiring active and aggressive curative management. In summary, it is crucial for the treating palliative physician to be more proactive in the management of comorbid treatable conditions in a patient who may be an established case of advanced stage cancer. | 18,812,616 |
Management of patients with ICDs at the end of life (EOL): a qualitative study. | Implantable cardioverter defibrillator shocks at the end of life are distressing and warrant consideration of implantable cardioverter defibrillator deactivation discussions. A nationwide survey collected physicians' comments regarding such discussions. Vignettes ascertained respondents' practices regarding implantable cardioverter defibrillator deactivation discussions. Respondents' comments were analyzed to identify themes. About 177 respondents (32%) provided 310 comments. One third reported that initiating the discussion would depend on specific circumstances, such as do not resuscitate status (35%); 21% advocated life-prolonging therapies; 17% said the patient/family or another physician should initiate the discussion; and 9% expressed inadequate education/awareness about implantable cardioverter defibrillator functions. Geriatricians and general internists expressed inadequate knowledge most frequently (12 writers, 75% in this theme), while electrophysiologists most frequently suggested further treatments/procedures (22 writers, 58%), and another doctor (13 writers, 76%) or the patient (8 writers, 62%) should begin the discussion. Improving the end of life care for patients with implantable cardioverter defibrillators will require additional physician education and increased commitment by subspecialists to deactivation discussions. | 18,812,618 |
Thirty four years since the discovery of gastrointestinal melatonin. | After the discovery of melatonin in the pineal gland by Lerner and co-workers in 1958, melatonin was also detected in the retina and the human appendix. Later, melatonin was confirmed immunohistologically in all segments of the gastrointestinal tract (GIT), in the guts of bovine embryos and in the GIT of low vertebrates. Melatonin was also confirmed in the pancreas and the hepatobiliary system. Melatonin is produced in the enteroendocrine cells of the GIT mucosa. The concentrations of melatonin in the GIT are 10-100x higher than in the plasma and the total amount of melatonin in the GIT is around 400x higher than the amount of melatonin in the pineal gland. Similar to pineal melatonin, GIT melatonin is a multifunctional compound which exhibits some general as well as some specific effects, depending on the organ and the location of GIT tissue. In the GIT, melatonin exhibits endocrine, paracrine, autocrine and luminal actions. Generally, the episodic secretion of melatonin from the GIT is related to the intake and digestion of food and to the prevention of tissue damage caused by hydrochloric acid and digestive enzymes. Some actions, such as the scavenging of hydroxyl free radicals, immunoenhancement and antioxidant effects are of general nature, whereas others, such as an increase of mucosal blood flow, the reduction of peristalsis and the regulation of fecal water content, are specific to the tubular GIT. Generally, melatonin actions oppose those of serotonin. Laboratory and clinical studies indicate that the utilization of melatonin can prevent or treat pathological conditions such as esophageal and gastric ulcers, pancreatitis, colitis, irritable bowel disease, and colon cancer. | 18,812,627 |
Physiological mediators in nonsteroidal anti-inflammatory drugs (NSAIDs)-induced impairment of gastric mucosal defense and adaptation. Focus on nitric oxide and lipoxins. | Prostaglandins mediate various physiological aspects of mucosal defense and the suppression of prostaglandin synthesis in the stomach is a critical event in terms of the development of mucosal injury after NSAID administration. However, it has become clear that other mediators besides prostaglandins can similarly act to protect the stomach from injury. For instance, nitric oxide (NO) released from vascular epithelium, epithelial cells of gastrointestinal tract and sensory nerves can influence many of the same components of mucosal defense as do prostaglandins. Thus, administration of NO in a form of NO-donors exert protective influence on the stomach from the injury that usually occurs when mucosal prostaglandin levels are suppressed. The new class of NO releasing NSAIDs, including NO-aspirin, represent a very promising approach to reducing the toxicity of anti-inflammatory drugs. Lipoxins are another group of lipid mediators that can protect the stomach. Aspirin-triggered lipoxin synthesis, via COX-2, acts to reduce the severity of damage induced by this drug. Lipoxin analogues may prove to be useful for preventing mucosal injury and for modulating mucosal inflammation. Aspirin-triggered lipoxin also seems to play in important role in gastric adaptation during chronic aspirin administration. Suppression of COX-2 activity by selective COX-2 inhibitors abolishes the production of this endogenous gastroprotective substance and diminishes the gastric tolerability of NSAIDS and gastric adaptation to these drugs. This review was designed to give an updated overview on the physiological factors and experimental and clinical attempts that were used or may be used in the future as the therapeutic approach to counteract adverse effects in the stomach associated with NSAID ingestion. | 18,812,631 |
Roles of short-chain fatty acids receptors, GPR41 and GPR43 on colonic functions. | Short chain fatty acids (SCFAs) are the major anions in the large intestine. They are produced by a bacterial fermentation of dietary fiber. SCFAs are known to have a variety of physiological and pathphysiological effects on intestine. However, the mechanisms by which intraluminal SCFAs are sensed are not known. In 2003, two orphan G protein coupled receptors (GPRs), GPR41 and GPR43, have been cloned and demonstrated to be receptors for SCFAs. Thus, we had attempted to make antibodies raised against GPR43 and GPR41 to elucidate the roles of SCFAs on colonic functions. We have also evaluated the effects of SCFAs on colonic motility to define the physiological roles on luminal SCFAs. In rat and human colon, GPR43 protein was detected by Western blot analysis in extracts of whole wall and separated mucosa, but not in muscle plus submucosa extract. By immunohistochemistry, GPR43 immunoreactivity was localized with enteroendocrine cells expressing peptide YY, whereas 5-HT immunoreactive enteroendocrine cells were not immunoreactive for GPR43. GPR41 immunoreactivity was also found in human colon. In functional studies, propionate and butyrate concentration-dependently (10 microM - 10 mM) induced phasic and tonic contractions in rat colonic circular muscle. The propionate-induced phasic contraction was attenuated by atropine, tetrodotoxin and the 5-HT(4) receptor antagonists SB204070. However, acetate did not induce phasic or tonic contractions. Propionate-induced responses were not observed in mucosal free preparations. The present results suggest that the SCFA-induced physiological effects on colonic functions might be attributable to the activation of SCFA receptors on epithelial cells in the colon. | 18,812,643 |
A surgical device for radiofrequency ablation of large liver tumors. | Radiofrequency ablation has become an accepted treatment option of patients with primary and metastatic liver tumors. We propose an ablation electrode array consisting of 4-8 blade shaped electrodes arranged in a circular geometry for the treatment of large liver tumors. We developed a 3D code based on the finite difference method for evaluating the effect of different numbers of electrodes (4, 6 and 8) and electrode distance on lesion size. The configuration with six electrodes can ablate a volume of 70 x 70 x 40 mm(3) in approximately 5 min, with tissue temperature above 50 degrees C throughout the treatment volume. We then performed an experimental study in polyacrylamide gel in order to validate the theoretical results. The average temperature error between the simulation and the experiment was 3.8% at the center of the electrode array. This study shows that the proposed device potentially allows more rapid treatment of large tumors than current radiofrequency ablation devices. | 18,812,644 |
[Histopathologic and ultrastructural study of extraocular muscles in thyroid associated ophthalmopathy]. | To investigate histopathologic and ultrastructural changes of extraocular muscles (EOM) in thyroid associated ophthalmopathy (TAO). Twelve EOM specimens from 11 patients with TAO were observed. Each of the specimen was stained with HE and observed by light microscope,and then was sectioned with ultrathin method and observed by transmission electronic microscope. Under the light microscope, sarcoplasm coagulation,granular degeneration, vacuolization and necrosis were found in the extraocular muscular cells.Under the electronic microscope, there were disturbance and disappearance of the Z line in part of muscular fibers and various degrees of sarcoplasmic reticulum dilatation, myofilament lysis and destruction with formation of vacuoles.In severe cases,the muscular cells could be completely destroyed and phagocytosed by macrophages,fibrosis occurred and myofibroblasts were found in some cases. The extraocular muscles in TAO are destroyed at various degrees,and the muscular cells may be the target cells in TAO. | 18,812,663 |
[Effect of enalapil on renal interstitial fibrosis in rats with unilateral ureteral obstruction]. | To investigate the effect of enalapril on renal interstitial fibrosis in rats with unilateral ureteral obstruction(UUO). UUO model was induced by ligating the left ureter in rats. Male Sprague-Dawley(SD) rats were randomly divided into a sham-operated group(n=16), a UUO model group(n=24), and an enalapril treated group(n=24). The rats were treated with 10 mg/kg.d by gastric gavage in the enalapril treated group from 24 h before the operation, and the rats were treated with the identical dose of normal saline in the other 2 groups. The rats were sacrificed at 3,7,14, and 21 days after UUO. Pathological changes of the renal tissue were observed by HE and Masson staining, the mRNA expression of collagen I (Col I) was detected by real-time PCR, and the protein expression of connective tissue growth factor (CTGF) was detected by Western blot. The renal interstitial damage index, relative collagen area and the expression of Col I mRNA and CTGF in the renal tissues in the model group increased with the prolongation of obstruction. Enalapril significantly reduced the renal interstitial damage index and relative collagen area, and inhibted the expression of Col I mRNA and CTGF. There was significant difference on day 3,7,and 14 (P<0.05), but not on day 21 (P>0.05). Enalapril significantly attenuates renal interstitial fibrosis by supressing the expression of Col I mRNA and CTGF. | 18,812,665 |
[Design and manufacture of the static 3 dimensional screw-plate system and its matching tools]. | To design and manufacture a new type instrument and its matching tools for the proximal femur. A new type instrument of subtrochanterical fracture-static 3-dimensional screw-plate system(STDSP)was designed and manufactured. The different types of accessory instruments which adapted to STDSP,the aiming guide, and the accessory tools were also designed and manufactured, and they were tested on bones. STDSP included 3 special lag screws and 1 anatomic plate. The lag screws distributed in femoral neck like "or"shape. There was 135 degree between the lag screws and femoral shaft. The shape of the plate was similar to the anatomic structure of the proximal thighbone. The posterior screw was stably connected to the plate. The plate was affixed crosswise to the lateral and anterior side by bicortical screws. The aiming guides and all kinds of accessory tools could help to install STDSP exactly and conveniently,which was verified on cadavers and X-ray photographs. STDSP has the function of dynamic compressing in 3-dimensional space, and can match with the structure of the proximal femur preferably. STDSP may be a suitable instrument to the subtrochanteric fractures. The accessory apparatus of STDSP has simple configuration,and can let the STDSP be installed accurately, conveniently and rapidly. | 18,812,666 |
Gradual deterioration of brainstem cavernous angioma associated with hemophilia--case report. | A 49-year-old man presented with a brainstem cavernous angioma associated with hemophilia manifesting as gradual progression of neurological deficits over a period of 2 weeks. Computed tomography revealed a hematoma and perifocal edema on the left side of the pons, and T(2)-weighted magnetic resonance imaging revealed a hemosiderin rim around the lesion with venous malformation. The neurological deficits deteriorated despite conservative treatment, so surgery was performed 2 weeks after admission, after supplementary therapy of factor IX. The hematoma and anomalous vascular component were entirely removed without intractable bleeding. The postoperative course was uneventful and his neurological symptoms improved. The histological diagnosis was cavernous angioma. Six months after onset, he was doing well. Surgery can be effective for the treatment of hemorrhagic cavernous angioma associated with hemophilia after initiation of supplementary therapy with coagulation factor. | 18,812,681 |
Decline of serum HBV DNA and no change apportioned by the same hepatic parenchyma cell volume from hepatic fibrosis stage 1 to stage 4 during the natural history of chronic hepatitis B. | During the initial phase of chronic hepatitis B virus (HBV) infection, serum HBV DNA levels are high. Contrarily, fibrosis, cirrhosis and hepatocellular carcinoma have been found in patients with lower serum HBV DNA levels. The aim of this study is to clarify HBV DNA level dynamics of serum apportioned by the same hepatic parenchyma cell volume (HPCV) in hepatic fibrosis stages 1-4 during the natural history of chronic hepatitis B. Serum HBV DNA levels were evaluated by real-time polymerase chain reaction. Further, serum HBV DNA levels were apportioned by and compared with the same HPCV in hepatic fibrosis stages 1-4, respectively. Serum HBV DNA levels were 8.91 x 10(6) +/- 4.37 x 10(1), 8.13 x 10(6) +/- 7.41 x 10(1), 9.55 x 10(5) +/- 1.02 x 10(2), and 4.07 x 10(5) +/- 7.24 x 10(1) copies/ml, respectively; there were differences among hepatic fibrosis stages 1-4 (p < 0.021-0.000). However, serum HBV DNA levels apportioned by the same volume of hepatic parenchyma cells in hepatic fibrosis stages 1-4 were 3.47 x 10(10) +/- 8.71 x 10(2), 1.02 x 10(11) +/- 9.55 x 10(2), 1.41 x 10(10) +/- 2.57 x 10(3), and 3.72 x 10(10) +/- 3.02 x 10(3) with HPCV proportions 65.9, 62.7, 58.9, and 53.3%, respectively; there were no differences among hepatic fibrosis stages 1-4 (p > 0.203-0.967).Following the progression of hepatic fibrosis from stage 1 to 4, ongoing decline of HPCV is responsible for a declining trend of serum HBV DNA levels. | 18,812,696 |
Breast-feeding, self-exam, and exercise practices before and after reduction mammoplasty. | The current indications for reduction mammoplasty include the relief of painful physical symptoms of macromastia. Numerous studies have demonstrated not only improvement in physical symptoms following reduction mammoplasty, but postoperative psychological benefits as well, including increased ability to participate in physical activity as a result of pain relief and decreased breast mass. Reduction mammoplasty may have additional effects on the patient's ability to breast-feed and perform breast self-exam. The present study is a retrospective study of the effects of reduction mammoplasty on breast-feeding, breast self-exam, physical symptoms, and physical activity. One-hundred and forty-one patients who underwent reduction mammoplasty at our institution between the years 1996-2005 agreed to participate in the study. Each was asked a series of questions in order to assess changes in symptoms and behaviors including breast-feeding and breast self-exam practices before and after the surgery. Patients were also asked questions regarding their pain symptoms and physical activity profiles. Ninety-seven percent of the participants claimed to have back, neck, and/or shoulder pain that was either significantly improved or completely resolved. Moreover, 100% of patients report that physical activity such as exercise was easier following reduction mammoplasty. Ninety-three percent of participants reported that performing breast self-exam following surgery was either the same (68%) or easier (25%) as a result of having less breast tissue. Eighty-nine percent of participants had no children following surgery, therefore effects on breast-feeding practices following reduction mammoplasty were not statistically significant. However, we suggest that when patients are seen in consultation or in the perioperative period, there is an opportunity to teach patients about the benefits of breast-feeding, and to assure patients that a pedicle flap reduction will likely allow breastfeeding. This is also a chance for physicians to teach patients how to perform breast self-examination and explain the importance of early breast mass detection. | 18,812,705 |
Which venous system to choose for anastomosis in head and neck reconstructions? | It has been postulated that venous thrombosis in free flap surgery necessitates the use of 2 venous anastomoses into different venous systems. We retrospectively analyzed a single surgeon's 10-year experience (August 1993 to August 2003) in primary free flap reconstruction for malignant tumors of the head and neck. Of 492 primary reconstructions that did not need a vein graft, vein loop, or cephalic turnover procedure, 251 used the internal jugular venous system as venous outflow, 140 used the subclavian system as outflow, and 101 used both. Two hundred thirty-eight of 251 (95%) of flaps utilizing the internal jugular venous system for outflow were successful compared with 129 of 140 (92%) of flaps utilizing the subclavian system. Where both venous systems were used the success rate was 101 of 101 (100%) (P < 0.05). Where possible, a second venous anastomosis should be performed utilizing both venous drainage systems. | 18,812,709 |
Quantification of the osmotic expansion in implants filled with polyethylene glycol. | High reoperation rates continue to agonize the field of breast augmentation surgery. Patient dissatisfaction is a contributing factor for reoperations. This is often attributable to patients' desire to be larger after the augmentation. Polyethylene glycol (PEG) is a potential alternative breast implant filler under investigation. It has been shown to swell secondary to osmotic expansion when it is placed in vivo. We hypothesize that there is a finite expansion in this process. An experimental study was designed utilizing an in vitro model to quantify the rate and volume of the osmotic expansion of PEG-filled implants. Seventeen silicone elastomer shells were filled with various percent concentration and molecular weight PEG/saline solutions. These implants were kept in saline baths at varying temperatures to assess the effect of temperature on osmotic expansion. Daily weights were recorded to quantify the expansion and determine if a plateau was reached. Implant expansion was observed to plateau in all groups tested. Implants filled with 85% concentration PEG solutions demonstrated a uniform expansion at a rate of 0.032 to 0.037 g/d. Implants filled with 85% concentration PEG stored at human core temperature (37 degrees C) gained on average 6.2% to 7.6% of their original weight. Implants stored at 4 degrees C expanded to a higher volume than implants stored at 37 degrees C (P < 0.01). Implants filled with 50% concentration PEG solution gained only 2.7% of their original weight (P < 0.01). PEG-filled implants undergo controlled osmotic expansion to a final predictable weight in vitro. Higher concentration PEG induces greater volume expansion. A colder environment also induces greater volume expansion. PEG is biologically inert and may be an alternative filler for breast implants. The predictable expansion process may be beneficial in breast augmentation that may alleviate patient dissatisfaction about breast size once postoperative edema resolves. | 18,812,723 |
Preliminary single center North American experience with the Berlin Heart pediatric EXCOR device. | For children requiring mechanical circulatory support as a bridge to cardiac transplantation in North America, options previously were limited to extracorporeal membrane oxygenation (ECMO) or centrifugal pump ventricular assist, both of which were suitable for only very short term application and were associated with significant complications and limitations. The Berlin Heart EXCOR ventricular assist device (VAD) was recently introduced into practice in North America to address this deficiency. We report a preliminary single center experience with the EXCOR in 17 children, 13 who received only a left-sided pump and four who required biventricular support. Before EXCOR placement, six patients were on ECMO, and one was on a centrifugal VAD. Eleven children were bridged to transplantation, one was bridged to recovery, and one remains on support. Three children died during support and one died after explantation. There was one late death nearly 2 years after transplant. Complications included stroke in seven patients, two of which were ultimately fatal. Five patients required re-operations for bleeding or evacuation of hematoma. Despite a disappointing rate of neurologic morbidity, our preliminary experience with the EXCOR has been very encouraging. | 18,812,737 |
Use of a pulsatile ventricular assist device (Berlin Heart EXCOR) and an interventional lung assist device (Novalung) in an animal model. | Pulsatile ventricular assist devices (VADs) are used in pediatric patients mainly as a bridge to heart transplantation. If severe respiratory failure occurs, extracorporeal membrane oxygenation (ECMO) is currently the treatment of choice. ECMO has the potential for severe complications. Interventional lung assist (iLA) devices, e.g., the Novalung, are used in patients with isolated lung failure. This study aimed to show the feasibility of the combined use of the EXCOR VAD (10 ml and 30 ml blood pumps) and the Novalung. There were two separate experiments within this study. First, a bench test was carried out to analyze pressure and flow through both devices. Second, 10 kg and 30 kg pigs received support with the VAD and iLA in series. Pressures and flow were measured systemically before and after the iLA. Flow was unaffected by the iLA. The mean arterial pressure was reduced (mean of 13 mm Hg) by the iLA. There were no obvious difficulties observed within the interaction of VAD and iLA. The combined use of both devices is feasible and able to provide sufficient perfusion pressures. Oxygenation and CO2 clearance was effectively supported by the iLA. Patients with myocardial and respiratory failure may benefit from this setup. | 18,812,741 |
Development of a miniaturized heart-lung machine for neonates with congenital heart defect. | Predominantly, standard adult heart lung machines are used for pediatric cardiac surgery, only with individually downsized components. Downsizing is limited, e.g., by the required gas exchange surface. To diminish complications, we developed a new miniaturized heart lung machine (MiniHLM) for neonates, with significantly reduced priming volume and blood contact surface by integration of all major system components in one single device. In particular, a rotary blood pump is centrically integrated into the oxygenator and the cardiotomy reservoir with integrated heat exchanger is directly connected. Thus, tubing is only necessary between patient and MiniHLM. A total priming volume of 102 ml could be achieved for the entire extracorporeal circuit (including arterial/venous line), in contrast to the currently smallest device on the market with 213 ml. In first animal experiments with female New Zealand rabbits, the MiniHLM guaranteed both a sufficient gas exchange and an adequate blood flow; 12 rabbits could successfully be weaned off after 1 hour of aortic clamp time. The first in vitro and in vivo tests confirm the concept of the MiniHLM. Its low priming volume and blood contact surface may significantly reduce complications during heart surgery in neonates. | 18,812,743 |
Ocular complications in 2 cases with porphyria. | We aimed to report our observation regarding the long-term follow-up results of 2 cases with similar ophthalmic manifestations of 2 different porphyrias, congenital erythropoietic porphyria (CEP), and porphyria cutanea tarda (PCT). Both patients presented with ocular pain and photophobia in both eyes. The patient with CEP had a scleral necrosis of 3 mm in diameter at the lateral limbus of the right eye and medial limbus of the left eye, accompanied with cicatricial ectropion and lid swelling OU. The patient with PCT had scleral necrosis in the interpalpebral area nasally, OU. Both patients were followed-up for 4 years. The patients received intensive topical lubrication and topical and oral immune-suppressive medication. They underwent amniotic membrane grafting, when required, and were advised to wear UV glasses. The case with PCT followed a more salient course and remained symptom free until the end of the follow-up period. In contrast, the patient with CEP developed further scleral necrosis, despite the treatment and evisceration surgery were inevitable owing to endophthalmitis unresponsive to the treatment. Ocular complications are rarely reported in porphyrias, and the studies on the long-term follow-up results are fewer. Despite careful follow-up and intensive treatment, scleral necrosis can be progressive and results in the loss of vision or even the loss of eye. Further studies regarding the care of patients with porphyrias are required to more effectively treat these rare ophthalmic conditions. | 18,812,782 |
Distraction osteogenesis in the management of severe maxillary hypoplasia in cleft lip and palate patients. | The aim of this study was to systematically review literature reporting on the use of external distraction osteogenesis (DO) and internal DO in the treatment of severe maxillary hypoplasia in cleft and palate patients. Literature research has been performed using the PubMed database of the National Library of Medicine and National Institutes of Health from 1966 to August 2007. We used cleft lip and palate and distraction osteogenesis as key words. Of the 104 articles found, we only considered the Anglo-Saxon literature, which reported on the correction of the maxillary hypoplasia with DO techniques. A total of 32 studies reported on anteroposterior external DO (27 studies on rigid external device and 5 on face mask), 17 studies reported on anteroposterior internal DO, and 3 studies reported on transverse internal DO have been retained for this review. Despite the heterogeneity and methodological limitations of most of the studies, results showed that external DO with rigid external device and internal DO resulted to be a more reliable and accurate technique than the face mask in the management of severe maxillary hypoplasia in patients with cleft lip and palate. The current review demonstrated that external and internal DO in the treatment of severe maxillary hypoplasia in cleft and palate patients (1) is a reproducible and valuable alternative to standard orthognathic surgery procedures, (2) allows for a global improvement in facial aesthetic, (3) allows a maxillary correction in patients during the period of mixed dentition, and (4) allows either for an unchanged or better velopharyngeal function. | 18,812,842 |
Maxillary growth impairment in cleft lip and palate patients: a simplified approach in the search for a cause. | No true consensus exists regarding the causes of maxillary growth restriction in cleft lip and palate patients. The aim of this study was to evaluate a simplified method to identify the causes of this growth impairment. We analyzed a sample of 82 consecutively treated 5-year-old patients with unilateral complete cleft lip and palate, operated on by the same surgeon (R.B.). Multiple cephalometric measurements of the sample revealed a wide distribution of maxillary growth values. We selected Sella-Nasion A point angle (SNA) as a value describing maxillary position, and we arbitrarily isolated 2 "extreme" groups of patients: the 20 patients with the highest SNA were called "good growers" (group A), and the 20 patients with the lowest SNA were called "poor growers" (group B). Parameters investigated to search for different influencing factors within the groups were initial cast measurements, timing of lip and of gingivoalveoloplasty/palatal surgery, presence of lateral incisors, and family history of maxillary hypoplasia. Statistical differences were investigated with an independent-samples t-test. The 2 extreme groups had a significant difference (P < 0.01) in SNA and in lip protrusion relative to true vertical line. Cranial base angle was larger in group A. Timing of lip surgery in group B was earlier than in group A, but only close to significance. Timing of gingivoalveoloplasty did not differ. In group A, the permanent lateral incisor was missing in 20% of the patients; whereas in group B, it was missing in 82% of the patients (P < 0.01). Selecting cleft lip and palate population with different growth pattern might help in isolating the factors responsible for maxillary growth impairment. Congenitally missing laterals that could indicate inherent tissue hypoplasia seems to be the most important factor. | 18,812,855 |
A simple method of fabricating nasal packing armed with ventilation tube. | Various packing materials have been used for closed reduction of nasal bone fractures or for septorhinoplasty. Most patients experience significant discomfort after the surgery owing to the lack of nasal breathing, and there are many reports concerning the complications related to nasal packing. Although nasal packing material with nasal airway maintenance is commercially available, the authors have developed an easy method to fabricate nasal packing materials with airway maintenance by using Merocel (Medtronic Xomed, Minneapolis, Minnesota) and a silastic suction catheter (16F, Qingdao Sewon Medical Co Ltd, Qingdae, China). The authors believe this idea, and innovation will be very useful for surgeons and patients of young age. | 18,812,868 |
An isolated bilateral pure macrostomia in a 2-year-old girl. | Congenital macrostomia is a lateral orofacial cleft between the maxillary and mandibular components of the first branchial arch. Bilateral macrostomia is a rare entity. To date, 17 cases have been reported in the literature, with more than 50% isolated. We present a case of bilateral transverse facial cleft (macrostomia) in a 2-year-old girl. It was not associated with any other anomaly. The cleft involved only the soft tissues of the face. Hence, it was a pure macrostomia. She was the third female child of the family, with 2 elder sisters normal. Nutritional deficiency during intrauterine life and/or advanced maternal age can be causative factors. Transverse facial cleft was closed by Z-plasty incision, with good functional and aesthetic result. | 18,812,873 |
Nasal hair matrix cyst mimicking dermoid cyst. | Dermoid cysts are primarily observed in the head and neck region. Nasal dermoids are uncommon. The terms nasal dermoid, nasal epidermoid, and nasal sebaceous cysts are used interchangeably by clinicians. Hair matrix cyst is a variant of epidermal cyst resembling the pattern of pilomatrixoma. Formerly, nasal hair matrix cyst has not been reported at all. Here, an additional pathologic proof is presented as well. | 18,812,877 |
Patient-controlled epidural analgesia (PCEA) for postoperative pain control after lumbar spine surgery. | Spine surgery remains one of the most common procedures for patients with a wide variety of spine disorders. Postoperative pain after major spine surgery is moderate to severe. We retrospectively reviewed 245 medical records of adult patients undergoing major spine surgery who received either patient-controlled epidural analgesia based on local anesthetics and opioids or patient-controlled intravenous analgesia as postoperative pain management. Several outcomes were analyzed including pain intensity, opioid consumption, time to endotracheal extubation, the incidence of deep venous thrombosis, and length of stay in the hospital. We found that the use of patient-controlled epidural analgesia provided better postoperative analgesia [median (quartiles) verbal analog scale score of 4 (3, 5) vs. 5 (3, 6)] and decreased the amount of opioid consumption postoperatively [median of 0 mg (0, 3) vs. 35 mg (0, 150)] compared with patient-controlled intravenous analgesia. Also, a substantially higher number of patients in the patient-controlled intravenous group required opioids as rescue analgesia. Incidences of deep venous thrombosis, operating room extubation, and length of stay in the hospital were not associated with the analgesic technique. The results of this study suggest that the use of neuroaxial analgesia for the management of postoperative pain associated with major spine surgery may have some beneficial properties over intravenous analgesia. The use of a reduced amount of opioids by patients with epidural analgesia may be relevant because of potential fewer side effects mainly in elderly patients. Several limitations related to the retrospective nature of the study are described. Prospective randomized-controlled trials are needed to understand and elucidate the optimum regimen of postoperative pain management after major spine surgery. | 18,812,889 |
Pedicle subtraction osteotomy. | Pedicle subtraction osteotomy (PSO) is an effective tool for the correction of fixed sagittal plane deformity. However, there is potentially significant perioperative morbidity associated with this technique. We report our perioperative morbidity rate in recently performed PSO cases treated with our present surgical, anesthetic, and monitoring techniques and discuss complication-avoidance strategies. We conducted a retrospective study of 10 patients (mean age, 56 yr; range, 7-77 yr) undergoing thoracolumbar PSO at a single institution in the past 3 years. Two patients underwent PSO at T12, seven patients underwent PSO at L3, and one patient underwent PSO at L2. Eight of the patients had undergone at least one previous spine surgery in the region of the PSO, and nine of the patients had comorbidities that increased their surgical risk stratification. We identified all causes of perioperative morbidity. We classified perioperative complications into two categories: intraoperative and early postoperative. Intraoperative complications included dural tears in two patients, cardiovascular instability in one patient, and coagulopathy in two patients. Early postoperative complications included neurological deficit (one patient), wound infection (two patients), urinary tract infection (one patient), and delirium (two patients). All patients recovered fully from these complications. There was no mortality in this series. In this series, most patients undergoing PSO had multiple previous spine surgeries and comorbidities. The risk of perioperative morbidity for revision cases undergoing PSO was in excess of 50%. We discuss complication-avoidance strategies. | 18,812,921 |
Vertebral column resection for rigid spinal deformity. | Vertebral column resection (VCR) is a surgical technique that may be applied for correction of moderate to severe spinal deformities, including those with large rigid curves, fixed trunk translation, or asymmetry between the length of the convex and concave column of the deformity. This article reviews the VCR technique as it relates to correction of rigid spinal deformity, including case examples to illustrate its application. The literature was reviewed in reference to the use of VCR for correction of rigid spinal deformity. VCR involves complete resection of one or more vertebral segments using either combined anterior and posterior approaches or a posterior-only approach and enables significant deformity correction in all three dimensions. Herein, we provide description of the indications, preoperative planning, surgical techniques, complication avoidance, postoperative management, and case examples for VCR. VCR enables significant correction of rigid spinal deformities in cases in which less aggressive approaches are not adequate. | 18,812,922 |
Principles of growth modulation in the treatment of scoliotic deformities. | Intraoperative manipulation to correct scoliotic deformities relies upon spinal instrumentation for stabilization and fusion. However, novel strategies and innovative implant biotechnologies have emerged, applying natural growth and elongation of the immature spine for the treatment of scoliosis in young patients. In this work, we review the principles of growth modulation and the Hueter-Volkmann law as it applies to experimental models of scoliosis formation and correction. Current implant technologies, including shape memory alloy vertebral staples, growing rods, and vertical expandable titanium prosthetic ribs, are explored, with regards to implant design, surgical techniques, and clinical investigations. An exciting area of spinal implant technology is now becoming available to expand the surgical armamentarium for treating severe scoliotic deformity in young patients. | 18,812,928 |
Decision making in pediatric spinal deformity. | To review the concepts involved in the decision-making process for management of pediatric patients with spinal deformity. The literature was reviewed in reference to pediatric deformity evaluation and management. Pediatric spinal deformity includes a broad range of disorders with differing causes, natural histories, and treatments. Appropriate categorization of pediatric deformities is an important first step in the clinical decision-making process. An understanding of both nonoperative and operative treatment modalities and their indications is requisite to providing treatment for pediatric patients with spinal deformity. The primary nonoperative treatment modalities include bracing and casting, and the primary operative treatments include nonfusion instrumentation and fusion with or without instrumentation. In this article, we provide a review of pediatric spinal deformity classification and an overview of general treatment principles. The decision-making process in pediatric deformity begins with appropriate diagnosis and classification of the deformity. Treatment decisions, both nonoperative and operative, are often predicated on the basis of the age of the patient and the natural history of the disorder. | 18,812,934 |
The development of ring-shaped contrast enhancement in a case of cerebellar dysembryoplastic neuroepithelial tumor: case report. | Dysembryoplastic neuroepithelial tumor (DNT) occurs rarely in the cerebellum. We describe a rare case of cerebellar DNT that developed contrast enhancement after long-term observation and discuss the underlying mechanism and clinical relevance of this unusual phenomenon. A 34-year-old woman with known cystic cerebellar lesions presented with increased frequency of vertigo and new onset of truncal ataxia. Magnetic resonance imaging revealed new contrast enhancement in the dominant cystic lesion of the cerebellar vermis without any change in size and shape or evidence of edema. The lesions were resected under magnetic resonance imaging guidance. Histological assessment revealed populations of small, round cells in a microcystic background containing "floating" neurons, diagnostic of DNT. Microvascular proliferation and pigmented neurons were also present. This is the first report of the development of contrast enhancement in a previously nonenhancing case of cerebellar DNT. The acquisition of ring-shaped contrast enhancement may be associated with microvascular proliferation, but otherwise no evidence of malignant progression. In addition, this case presents the novel pathological finding of pigmented neurons in DNT. | 18,812,941 |
The role of stereotactic radiosurgery for intracranial hemangioblastomas. | To evaluate the role of stereotactic radiosurgery (SRS) in the management of recurrent or residual intracranial hemangioblastomas, we assessed tumor control, survival, and complications in 32 consecutive patients. We retrospectively reviewed records of 32 consecutive hemangioblastoma patients (74 intracranial tumors) who underwent gamma knife SRS. The median patient age was 43.8 years (range, 21.3-79.4 yr). Thirty-one patients had undergone previous surgical resections. Nineteen patients had sporadic lesions (22 tumors), and 13 patients had von Hippel-Lindau disease-associated hemangioblastomas (52 tumors). The median SRS target volume was 0.72 mL (range, 0.08-16.6 mL), and the median marginal dose was 16.0 Gy (range, 11-20 Gy). At a median of 50.1 months (range, 6.0-165.4 mo), seven patients had died from disease progression, and one patient had died secondary to heart failure. The overall survival after radiosurgery was 100%, 94.4%, and 68.7% at 1, 3, and 7 years, respectively. Follow-up imaging studies demonstrated tumor control in 68 tumors (91.9%). The progression-free survival after SRS at 1, 3, and 5 years was 96.9%, 95.0%, and 89.9%, respectively. Factors associated with an improved progression-free survival included von Hippel-Lindau disease-associated hemangioblastoma, solid tumor, lower tumor volume, and greater marginal dose. SRS is an important tool in the management of hemangioblastomas and is associated with a high tumor control rate and a low risk of adverse radiation effects. | 18,812,955 |
Delayed visual deficits and monocular blindness after endovascular treatment of large and giant paraophthalmic aneurysms. | Paraophthalmic aneurysms may exert mass effect on the optic apparatus. Although surgical clipping and endovascular coiling of these aneurysms can be complicated by immediate postoperative visual deterioration, endovascular coil embolization has the unique risk of visual complications later (>24 h) in the perioperative period. Six patients with a delayed onset of vision loss after technically successful coil embolization of paraophthalmic region aneurysms were identified. All available clinical, angiographic, and cross sectional imaging for these patients, in addition to histopathological data, were reviewed. Six patients who underwent endovascular treatment of paraclinoid aneurysms at our institutions developed delayed postoperative visual decline. Four were treated with combination hydrogel-coated and bare platinum coils, one with hydrogel-coated coils, and one with bare platinum coils. Three patients presented with some degree of visual impairment caused by their aneurysms. Catheter angiography performed after the visual decline revealed no etiology in any of the cases. Magnetic resonance imaging was performed in all patients and was unremarkable in two. At follow-up, two had improved, three remained unchanged, and one patient died before any follow-up assessment of her vision. Both acute and delayed visual disturbances can present after the endovascular treatment of carotid artery paraophthalmic aneurysms. Delayed visual deterioration can be observed up to 35 days after embolization. Although the cause is still undefined, it is likely that the more delayed visual deterioration can be attributed to progression of mass effect and/or perianeurysmal inflammatory change. Our case series raises the possibility that this phenomenon may be more likely with HydroCoil (HydroCoil Embolic System; MicroVention, Aliso Viejo, CA). This possibility should be taken into account by neurointerventionists when selecting a coil type to treat large paraophthalmic aneurysms. | 18,812,958 |
Krit1 modulates beta 1-integrin-mediated endothelial cell proliferation. | Using ribonucleic acid interference on cultured cell lines, we examined the role of Krev interaction trapped 1 (krit1) and integrin cytoplasmic domain-associated protein-1 alpha (icap1alpha) in beta1-integrin-mediated cell proliferation. Upon depletion of either krit1 or icap1alpha in the HeLa cells, umbilical vein endothelial cells, and microvascular endothelial cells, we examined the cell number and proliferation changes in the cells, followed by the evaluation of beta1-integrin-mediated mitogen-activated protein kinase signal pathway and microscopic study. Depletion of krit1 reduces cell number and decreases endothelial cell proliferation. Examination of beta1-integrin signaling downstream of focal adhesion kinase reveals decreased phosphorylation along the extracellular signal-regulated kinase/mitogen-activated protein kinase pathway. Depletion of icap1alpha, a protein known to interact with krit1, has similar effects, suggesting synergistic function. We also show that krit1 colocalizes with icap1alpha in both the nucleus and the cytoplasm; however, most of icap1alpha is found in the nucleus and most of krit1 is found in the cytoplasm at steady state. On depletion of krit1, icap1alpha decreases in the cytoplasm and is no longer detected in the nucleus. Both krit1 and icap1alpha act concordantly to play a critical role in beta1-integrin-mediated cell proliferation. Our data further suggest that krit1 both stabilizes and shuttles icap1alpha and thus modulates its regulation of beta1-integrin-mediated signal transduction. | 18,812,969 |
Excess gestational weight gain amplifies risks among obese mothers. | In this issue of Epidemiology, Chen et al report that obese mothers who gained the most weight during pregnancy had elevated risk for infant mortality. Other outcomes related to excess maternal weight or weight gain not only cause complications around the time of birth but also confer elevated chronic disease risk for both mother and child. There is good reason to believe that constraining gestational weight gain within an optimal range will minimize adverse outcomes. Revised gestational weight gain guidelines are needed, especially for obese women. | 18,813,018 |
Recent heterosexual partnerships and patterns of condom use: a weighted analysis. | In epidemiologic studies of sexual partnerships, characteristics are often collected in part through detailed questions concerning recent partnerships. These data present challenges for analysis. First, although research interest generally lies in all partnerships in a certain time period, participants may be asked to provide detailed information only concerning their most recent, up to a fixed number. As more recent partnerships may differ from others, a simple analysis of these data may lead to bias. Second, the total number of partnerships for a study participant may be informative, so the analyst must choose between inference for the population of partnerships or for a typical partnership from the population of individuals. Third, data may be more fully recorded for study participants than their partners, and not all partners may be eligible to participate. We propose weighting to deal with these challenges. Weighting provides a sensitivity analysis for the possible selection bias due to incomplete reporting. We analyze heterosexual condom use in Britain, using data from the National Survey of Sexual Attitudes and Lifestyles 2000. The sensitivity of estimates to possible selection bias is low. We find that the choice of population for inference is important for prevalence estimates, but has relatively little impact on measures of association. By defining within-participant partnership predictors we demonstrate how participants vary their condom use. We establish that, at least for male participants, shorter partnership duration is linked to a higher probability of condom use at last sex but lower probability at first sex. We recommend a weighted analysis approach to recent partnership data, which can be simply implemented in standard survey analysis software. In other surveys the sensitivity of estimates to possible selection bias may be substantial and this will need to be assessed in each case. | 18,813,022 |
Ambient air pollution and daily mortality among survivors of myocardial infarction. | Certain subgroups in the general population, such as persons with existing cardiovascular or respiratory disease, may be more likely to experience adverse health effects from air pollution. In this European multicenter study, 25,006 myocardial infarction (MI) survivors in 5 cities were recruited from 1992 to 2002 via registers, and daily mortality was followed for 6 to 12 years in relation to ambient particulate and gaseous air pollution exposure. Daily air pollution levels were obtained from central monitor sites, and particle number concentrations were measured in 2001 and estimated retrospectively based on measured pollutants and meteorology. City-specific effect estimates from time-series analyses with Poisson regression were pooled over all 5 cities. Particle number concentrations and PM10 averaged over 2 days (lag 0-1) were associated with increased total nontrauma mortality for patients of age 35 to 74 (5.6% [95% confidence interval, 2.8%-8.5%] per 10,000/cm and 5.1% [1.6%-9.3%] per 10 microg/m, respectively). For longer averaging times (5 and 15 days), carbon monoxide and nitrogen dioxide were also associated with mortality. There were no clear associations with ozone or sulfur dioxide. Exposure to traffic-related air pollution was associated with daily mortality in MI survivors. Point estimates suggest a stronger effect of air pollution in MI survivors than among the general population. | 18,813,023 |
Brief periods of nitric oxide inhalation protect against myocardial ischemia-reperfusion injury. | Prolonged breathing of nitric oxide reduces myocardial ischemia-reperfusion injury, but the precise mechanisms responsible for the cardioprotective effects of inhaled nitric oxide are incompletely understood. The authors investigated the fate of inhaled nitric oxide (80 parts per million) in mice and quantified the formation of nitric oxide metabolites in blood and tissues. The authors tested whether the accumulation of nitric oxide metabolites correlated with the ability of inhaled nitric oxide to protect against cardiac ischemia-reperfusion injury. Mice absorbed nitric oxide in a nearly linear fashion (0.19 +/- 0.02 micromol/g x h). Breathing nitric oxide rapidly increased a broad spectrum of nitric oxide metabolites. Levels of erythrocytic S-nitrosothiols, N-nitrosamines, and nitrosyl-hemes increased dramatically within 30 s of commencing nitric oxide inhalation. Marked increases of lung S-nitrosothiol and liver N-nitrosamine levels were measured, as well as elevated cardiac and brain nitric oxide metabolite levels. Breathing low oxygen concentrations potentiated the ability of inhaled nitric oxide to increase cardiac nitric oxide metabolite levels. Concentrations of each nitric oxide metabolite, except nitrate, rapidly reached a plateau and were similar after 5 and 60 min. In a murine cardiac ischemia-reperfusion injury model, breathing nitric oxide for either 5 or 60 min before reperfusion decreased myocardial infarction size as a fraction of myocardial area at risk by 31% or 32%, respectively. Breathing nitric oxide leads to the rapid accumulation of a variety of nitric oxide metabolites in blood and tissues, contributing to the ability of brief periods of nitric oxide inhalation to provide cardioprotection against ischemia-reperfusion injury. The nitric oxide metabolite concentrations achieved in a target tissue may be more important than the absolute amounts of nitric oxide absorbed. | 18,813,047 |
A rational approach to perioperative fluid management. | Replacement of assumed preoperative deficits, in addition to generous substitution of an unsubstantiated increased insensible perspiration and third space loss, plays an important role in current perioperative fluid regimens. The consequence is a positive fluid balance and weight gain of up to 10 kg, which may be related to severe complications. Because the intravascular blood volume remains unchanged and insensible perspiration is negligible, the fluid must accumulate inside the body. This concept brings into question common liberal infusion regimens. Blood volume after fasting is normal, and a fluid-consuming third space has never been reliably shown. Crystalloids physiologically load the interstitial space, whereas colloidal volume loading deteriorates a vital part of the vascular barrier. The endothelial glycocalyx plays a key role and is destroyed not only by ischemia and surgery, but also by acute hypervolemia. Therefore, undifferentiated fluid handling may increase the shift toward the interstitial space. Using the right kind of fluid in appropriate amounts at the right time might improve patient outcome. | 18,813,052 |
Recent advances in cultivated epithelial transplantation. | Currently, cultivated epithelial transplantation usually uses ex vivo-expanded epithelial cells, with or without biological carriers. Our group has carried out approximately 100 such procedures and has conducted research in this area. The results of a retrospective study indicate that cultivated limbal epithelial transplantation with amniotic membrane (AM) and airlifting may be beneficial at avoiding sight-threatening complications in patients with severe chronic cicatricial keratoconjunctivitis. Our experience in cultivated oral mucosal epithelial transplantation indicates that this technique is useful in achieving a stable ocular surface. However, the treatment for severe ocular surface diseases such as Stevens-Johnson syndrome remains unsatisfactory. In addition to using epithelial sheets with AM, we have developed a technique for generating carrier-free sheets using fibrin sealants. These sheets seem to contain more differentiated epithelium than those obtained with AM while retaining similar levels of colony-forming progenitor cells. A clinical trial of this technique is currently underway. We have also generated epithelial sheets using as biological carrier silk fibroin film, which offers a more transparent medium than conventional sheets. In terms of isolation and cultivation of corneal epithelial stem/progenitor cells, we found that single murine limbal cells exhibited clonal growth and generated stratified epithelial sheets. We also reported that hypoxic culture (2%) enhanced proliferation in human limbal epithelial cells while inhibiting differentiation. This technique may help maintain progenitor cells during ex vivo expansion of epithelial cells. Although these advances are expected to improve clinical outcomes in patients with ocular surface disorders, further improvements, such as the development of cultivation methods that do not require 3T3 feeder cells or real-time assessment of cultivated sheets, are required in the near future. | 18,813,074 |
Effects of the medication nursing assistant role on nurse job satisfaction and stress in long-term care. | Long-term care nurses continue to struggle with increasing workloads, fulfilling regulatory requirements and limited staffing resources. One method of impacting the workload is the introduction of the new medication nursing assistant (MNA) role to alleviate the nurse from prolonged time intervals spent administering medications. An early step in MNA role implementation is to evaluate its impact by comparing agencies using the MNA and those not using the role. This article presents findings from a mixed method study examining the efficacy of the MNA role in relationship to job satisfaction and the degree of perceived stress experienced by long-term care nurses. Ninety-one nurses employed at 2 large New Hampshire facilities responded. Findings offer empirical evidence supporting the use of the MNA to reduce job stress and increase satisfaction for licensed nurses. The MNA role is accepted by nurse leaders and viewed as a benefit. Findings also support a correlation between empowerment and decision making in the nursing environment with levels of nurse satisfaction. | 18,813,086 |
Image-guided transsylvian, transinsular approach for insular cavernous angiomas. | Surgical treatment of cavernomas arising in the insula is especially challenging because of the proximity to the internal capsule and lenticulostriate arteries. We present our technique of image guidance for operations on insular cavernomas and assess its clinical usefulness. Between 1997 and 2003, with the guidance of a frameless stereotactic system (BrainLab AG, Munich, Germany), we operated on eight patients who harbored an insular cavernoma. Neuronavigation was used for 1) accurate planning of the craniotomy, 2) identification of the distal sylvian fissure, and, finally, 3) finding the exact site for insular corticotomy. Postoperative clinical and neuroradiological evaluations were performed in each patient. The navigation system worked properly in all eight neurosurgical patients. Exact planning of the approach and determination of the ideal trajectory of dissection toward the cavernoma was possible in every patient. All cavernomas were readily identified and completely removed by use of microsurgical techniques. No surgical complications occurred, and the postoperative course was uneventful in all patients. Image guidance during surgery for insular cavernomas provides high accuracy for lesion targeting and permits excellent anatomic orientation. Accordingly, safe exposure can be obtained because of a tailored dissection of the sylvian fissure and minimal insular corticotomy. | 18,813,148 |
Surgical risks associated with the management of Grade I and II brain arteriovenous malformations. | Grade I and II arteriovenous malformations (AVMs) have been considered safe to resect. However, unoperated low-grade AVMs have not been considered in previously reported series. The aim of this study was to examine all cases, both operated and unoperated, to identify any characteristics of low-grade AVMs that comprise a subgroup that might pose a relatively higher risk. A prospectively enrolled AVM database included 237 patients in Spetzler-Martin Grade I or II. These patients were analyzed on the basis of demographic characteristics, angiographic and magnetic resonance imaging features, clinical presentation, method of treatment, and outcome. Surgery was performed in 220 patients in Spetzler-Martin Grade I or II. Seventeen patients did not undergo treatment because of poor neurological condition (six patients), patient refusal (nine patients), and perceived surgical difficulty (AVM size approaching 3 cm adjacent to Broca's area) (two patients). The overall surgical morbidity rate was 0.9%, and the mortality rate was 0.5%. Adverse outcomes occurred in 1 (0.6%) of 180 patients with AVMs located away from eloquent cortex and in 2 (5%) of 40 patients with AVMs adjacent to eloquent cortex. None of 28 surgical patients with deep venous drainage had an adverse outcome. All 219 patients who survived surgery underwent postoperative angiography that confirmed cure. No postoperative hemorrhage has occurred in 1143 patient-years of follow-up (mean follow-up, 5.3 yr). When considering adverse outcome in the surgical series of Grade I and II AVMs alone, no statistical difference between non-eloquently located AVMs (0.6%) and eloquently located AVMs (5% adverse outcome) can be detected. However, consideration of all Grade I and II AVMs, both surgical and nonsurgical, may prove that a difference in outcome exists between these two groups masked by case selection. Generalization of the chances of adverse outcomes to all Grade I and II AVMs (both operated and unoperated) suggests that the risk of performing surgery on noneloquent brain in our series was 0.6% and that in eloquent brain could have been as high as 9.5%, had all such patients undergone surgery. | 18,813,149 |
Operation of arteriovenous malformations assisted by stereoscopic navigation-controlled display of preoperative magnetic resonance angiography and intraoperative ultrasound angiography. | To study the application of navigated stereoscopic display of preoperative three-dimensional (3-D) magnetic resonance angiography and intraoperative 3-D ultrasound angiography in a clinical setting. Preoperative magnetic resonance angiography and intraoperative ultrasound angiography are presented as stereoscopic images on the monitor during the operation by a simple red/blue technique. Two projections are generated, one for each eye, according to a simple ray casting method. Because of integration with a navigation system, it is possible to identify vessels with a pointer. The system has been applied during operations on nine patients with arteriovenous malformations (AVMs). Seven of the patients had AVMs in an eloquent area. The technology makes it easier to understand the vascular architecture during the operation, and it offers a possibility to identify and clip AVM feeders both on the surface and deep in the tissue at the beginning of the operation. All 28 feeders identified on the preoperative angiograms were identified by intraoperative navigated stereoscopy. Twenty-five were clipped at the beginning of the operation. The other three were clipped at a later phase of the operation. 3-D ultrasound angiography was useful to map the size of the nidus, to detect the degree of brain shift, and to identify residual AVM. Stereoscopic visualization enhances the surgeon's perception of the vascular architecture, and integrated with navigation technology, this offers a reliable system for identification and clipping of AVM feeders in the initial phase of the operation. | 18,813,150 |
Evolution of brain tissue injury after evacuation of acute traumatic subdural hematomas. | Acute traumatic subdural hematoma complicated by brain parenchymal injury is associated with a 60 to 90% mortality rate. Early surgical evacuation of the mass lesion is essential for a favorable outcome, but the severity of the underlying brain injury determines the outcome, even when surgery has been prompt. The purpose of this study was to analyze tissue biochemical patterns in the brain underlying an evacuated acute subdural hematoma to identify a characteristic pattern of changes that might indicate evolving brain injury. Prospectively collected data from 33 patients after surgical evacuation of acute subdural hematoma were analyzed. Both a brain tissue oxygen tension probe and an intracerebral microdialysis probe were placed in brain tissue exposed at surgery. On the basis of the postoperative clinical course, the patients were divided into three groups: patients with early intractable intracranial hypertension, patients with evolution of delayed traumatic injury (DTI), and patients with an uncomplicated course (the no-DTI group). The overall mortality rate was 46%, with 100% mortality in the intracranial hypertension group (five patients). Mortality in the DTI group was 53% compared with only 9% in the no-DTI group (P = 0.002). There were no significant differences in the initial computed tomographic scan characteristics, such as thickness of the subdural hematoma or amount of midline shift, among the three groups. Physiological variables, as well as the microdialysate measures of brain biochemistry, were markedly different in the intracranial hypertension group compared with the other groups. Differences between the other two groups were more subtle but were significant. Significantly lower values of brain tissue oxygen tension (14 +/- 8 mm Hg versus 27 +/- 14 mm Hg) and higher dialysate values of lactate and pyruvate were documented in patients who developed a delayed injury compared with patients with uncomplicated courses (4.1 +/- 2.3 mmol/L versus 1.7 +/- 0.7 mmol/L for lactate, and 104 +/- 47 micromol/L versus 73 +/- 54 micromol/L for pyruvate at 24 h after injury). Evolution of DTI in the area of brain underlying an evacuated subdural hematoma is associated with a significant increase in mortality. Postoperatively decreasing brain tissue oxygen tension and increasing dialysate concentrations of lactate and pyruvate in this area may warn of evolving brain injury and evoke further diagnostic and therapeutic activity. | 18,813,164 |
Surgery of cerebral trauma and associated critical care. | The last 30 years have been both exciting and frustrating for those in the field of traumatic brain injury (TBI). Much has been learned, but no new treatment has been shown to improve patient outcomes despite the execution of many clinical trials. The overall incidence of TBI has decreased, probably because of intensive efforts toward prevention and education. Rigorous assessment of available research has produced several evidence-based guidelines for the management of neurotrauma patients. The creation of organized emergency medical services systems in many regions has improved prehospital care. Computed tomographic scans have become the gold standard for obtaining immediate images of patients with TBI, and ongoing advances in visualizing cerebral metabolism continue to be remarkable. The major current question regarding surgical treatment for TBI involves the role of decompressive craniectomy, an operation that first fell out of favor and has since (in the last three decades) enjoyed a resurgence of interest. Growing interest in the intensive care management of TBI patients helped to establish the new field of neurocritical care. Prophylactic hyperventilation is no longer recommended, and earlier recommendations for aggressive elevation of blood pressure have been softened to endorsement of a cerebral perfusion pressure of 60 mmHg. Recombinant factor VIIa is increasingly used for minimizing complications related to coagulopathy. Intracranial pressure monitoring is now recommended for the majority of TBI patients. At present, available technologies allow measurement of other aspects of cerebral metabolism including cerebral blood flow, brain oxygen tension, biochemistry, and electrical activity. Therapeutic interventions that are growing in popularity or are presently under investigation include administration of hypertonic saline, hyperoxygenation, decompressive craniectomy, and hypothermia. Rehabilitation has become accepted as an important part of the TBI recovery process, and additional work is needed to identify optimal interventions in this area. Socioeconomic factors will play a growing role in our treatment of TBI patients. Although much progress has been made in the last 30 years, the challenge now is to find ways to translate that progress into improved care and outcomes for TBI patients. | 18,813,168 |
The combined effect of calcium channel blocker Lercanidipine and antioxidants on low-grade systemic inflammation parameters in essential hypertension patients. | The influence of oxidative stress (OS) and inflammation on up-regulation of blood pressure (BP) has been well established. Peripheral polymorphonuclear leukocytes (PMNLs) are primed in essential hypertension (EH) patients, releasing uncontrolled superoxide anion contributing to OS in these patients. PMNL priming correlates with PMNL intracellular calcium [Ca2+]i. Previous studies have shown that treatment by calcium channel blockers lowers BP, OS and inflammation. In the same time, there are some trials showing down regulation influence of ''anti-oxidative'' drugs as Vitamin E and C to inflammation and OS. The data of clinical significance of anti-oxidative drugs to BP is controversial. The aim of this paper was to evaluate the benefit of combined treatment by calcium channel blockers (Lercanidipine) and antioxidative drugs (Vitamins C and E) on BP and on parameters of inflammation and OS. Sixteen new diagnosed patients with mild to moderate BP were sampled to 2 groups after randomization by age, sex, and mean arterial pressure (MAP), cholesterol and glucose level. The first group was treated by Lercanidip-ine only, the second group by combination of Lercanidipine and antioxidative drugs both for 6 months. PMNL priming was assessed by the rate of superoxide release from separated, phorbol ester-stimulated PMNLs and by PMNL-CD11b level. Inflammation was reflected by plasma C-reactive protein (CRP) and albumin levels, white blood cells (WBC) and PMNL counts and by PMNL apoptosis. In both groups, BP decreased after 6 months of treatment, and in a more pronounced manner following the combined treatment. In both groups PMNL priming parameters remained unchanged after 6 months of treatment, with transient differences between the two groups during the experimental period. In both groups inflammation parameters remained unchanged after 6 months of treatment, without difference between the two groups, except a pronounced decrease in the percentage of apoptotic PMNLs in the combined treatment group. Our trial shows a clinical benefit combining calcium channel blockers treatment with antioxidants in BP treatment, although it did not reveal significant influence of complementation of antioxidants to calcium channel blockers on OS and inflammation parameters. Additional clinical and laboratory investigations are needed to clear this issue. Conflicting data are reported on the influence of vitamins E and C on OS and inflammation together with controversy regarding anti-oxidative drugs and their effect on BP. | 18,813,182 |
Optical coherence tomography: clinical applications and the evaluation of DES. | Optical coherencet tomography (OCT) is a light-based imaging modality that can provide in vivo high-resolution images of the coronary artery. In the last years there has been a continuous technical development that has improved the image quality and has simplified the acquisition procedure in order to spread the clinical applicability of this technique. Due to its high resolution OCT, can be a very valuable tool for the evaluation of the coronary vessel wall, the acute and long-term impact of catheter-based intervention on plaque structure and vessel architecture and the assessment of stents. During stenting, OCT offers the possibility to evaluate stent apposition in great detail and can identify the presence of vessel injury due to stent implantation. At follow-up, the tissue coverage of individual struts can be imaged with OCT. This is of increasing interest in drug-eluting stents in which the neointimal proliferation is inhibited to such extent that it might not be visualized with conventional intracoronary imaging techniques such as IVUS. Regarding the analysis of the coronary vessel wall, OCT holds promise for the identification of thin cap fibroatheroma due to its ability to provide information about plaque composition, presence of macrophages and thickness of the fibrous cap. | 18,813,186 |
Management of nerve sheath tumors arising in the sympathetic chain. | Extradural schwannomas arising from the sympathetic chain are uncommon benign nerve sheath tumors. We present our experience with three patients having such tumors located in the cervical, thoracic and lumbar regions and we describe clinical presentation, surgical treatment, and outcomes. Between 2002 and 2006, the medical records of three patients with pathologically proven sympathetic schwannomas at the Moffitt Cancer Center were reviewed retrospectively. The three patients were female, with a mean age of 44 years. Presentation and symptomatology varied between patients, and radiographic findings were not diagnostic. Complete excision of tumors was performed in all three patients without added morbidity or mortality. Surgical observation, histopathology, and immunohistochemistry confirmed the tumors to be schwannomas arising from the sympathetic chain. The schwannomas had a mean diameter of 3.2 cm and were all benign. At a mean follow-up of 21 months following resection, all patients remained free of disease recurrence. Sympathetic schwannomas are rare tumors that are difficult to diagnose preoperatively. Diagnosis relies on clinical suspicion, and confirmation is often obtained by means of surgical pathology. Long-term surveillance is not recommended and surgical excision should be considered for this tumor, even though the tumor is considered benign and recurrence is rare. | 18,813,203 |
Treatment strategies to optimize clinical benefit in the patient with myelodysplastic syndromes. | In recent years we have witnessed a transformation in care for patients with myelodysplastic syndromes (MDS) following approval by the US Food and Drug Administration of the first agents for treatment of the disease. Emerging evidence indicates that active treatment strategies modify the natural history of the underlying disease and hence lower the potential for leukemic transformation while prolonging survival. The methyltransferase inhibitor (MTI) azacitidine, in particular, has shown the capacity to extend survival in higher-risk disease in a post-approval phase III trial while demonstrating an improved risk/benefit profile in a new dosing schedule. By utilizing an MTI as a bridge to transplantation, allogeneic stem cell transplantation can now be postponed for appropriate candidates until a suitable donor is identified. Results of iron chelation studies indicate that the improved compliance of an oral iron chelator yields greater iron storage reduction with sustained suppression of the labile plasma form. The current active treatment paradigm for MDS incorporates the most recent strategies yielding improved disease outcomes and patient survival. | 18,813,207 |
Analysis of 10 independent samples provides evidence for association between schizophrenia and a SNP flanking fibroblast growth factor receptor 2. | We and others have previously reported linkage to schizophrenia on chromosome 10q25-q26 but, to date, a susceptibility gene in the region has not been identified. We examined data from 3606 single-nucleotide polymorphisms (SNPs) mapping to 10q25-q26 that had been typed in a genome-wide association study (GWAS) of schizophrenia (479 UK cases/2937 controls). SNPs with P<0.01 (n=40) were genotyped in an additional 163 UK cases and those markers that remained nominally significant at P<0.01 (n=22) were genotyped in replication samples from Ireland, Germany and Bulgaria consisting of a total of 1664 cases with schizophrenia and 3541 controls. Only one SNP, rs17101921, was nominally significant after meta-analyses across the replication samples and this was genotyped in an additional six samples from the United States/Australia, Germany, China, Japan, Israel and Sweden (n=5142 cases/6561 controls). Across all replication samples, the allele at rs17101921 that was associated in the GWAS showed evidence for association independent of the original data (OR 1.17 (95% CI 1.06-1.29), P=0.0009). The SNP maps 85 kb from the nearest gene encoding fibroblast growth factor receptor 2 (FGFR2) making this a potential susceptibility gene for schizophrenia. | 18,813,210 |
Racial differences in chronic kidney disease incidence and progression among individuals with HIV. | This Practice Point commentary discusses the findings of Lucas et al.'s longitudinal cohort study of chronic kidney disease (CKD) in African American and white individuals with HIV. The study found that--compared with whites--African Americans had a slightly increased risk of incident CKD, but markedly increased rates of estimated glomerular filtration rate decline and progression to end-stage renal disease. This commentary details the clinical implications and limitations of these findings in the context of known racial differences in CKD prevalence and progression to end-stage renal disease in the general population and highlights the importance of screening high-risk HIV patients for kidney disease. CKD is common among HIV patients, and-as in the general population-has a more-aggressive course among African Americans than whites. | 18,813,233 |
Status of chronic kidney disease prevention programs: International Federation of Kidney Foundation Members 2005/2007. | The International Federation of Kidney Foundations surveyed its members on chronic kidney disease 'prevention' programs in their regions and countries in 2005 and 2007. A profile was developed, representing 28 countries (56% response). Some form of screening activity was reported in 24 of the 28 countries (85.7%). Two countries (7%) had, or anticipated development of, legislated national screening. Programs were conducted by kidney foundations or research groups, and were variously population based, focused on high risk groups or opportunistic. Tests in 63% of responding programs included weight, height, blood pressure, blood glucose, dipstick urinalysis and serum creatinine. Several programs used the USA's Kidney Early Evaluation Program's and International Society of Nephrology's templates. World Kidney Day activities contributed significantly. Stated needs were for more government recognition, firm policies and approaches, and critically, resources. Repeat responders reported progress in 2007, particularly in government interest and education delivery. Despite difficulties, programs are developing in many regions. Most need more resources and some members need substantial and sustained assistance. | 18,813,288 |
Phagosome maturation: going through the acid test. | Phagosome maturation is the process by which internalized particles (such as bacteria and apoptotic cells) are trafficked into a series of increasingly acidified membrane-bound structures, leading to particle degradation. The characterization of the phagosomal proteome and studies in model organisms and mammals have led to the identification of numerous candidate proteins that cooperate to control the maturation of phagosomes containing different particles. A subset of these candidate proteins makes up the first pathway to be identified for the maturation of apoptotic cell-containing phagosomes. This suggests that a machinery that is distinct from receptor-mediated endocytosis is used in phagosome maturation. | 18,813,294 |
Breast cancer awareness among older women. | The aim of this study was to elicit the level of breast cancer awareness in older women. A cross-sectional study-specific questionnaire survey of 712 British women aged 67-73 years (response rate 83.8%), assessing knowledge of symptoms and risk and confidence to detect a change, was conducted. Over 85% of respondents were aware that a lump was a symptom of breast cancer but knowledge of non-lump symptoms was limited. Knowledge of risk was poor; 50% believed that the lifetime risk of developing breast cancer was less than 1 in 100 women and 75% were not aware that age is a risk factor. Thirty-one percent of women reported low levels of confidence to detect a breast change and 19% rarely or never checked their breasts. Those with fewer educational qualifications had poorer knowledge of symptoms, less awareness of lifetime and age-related risks, but were more likely to check their breasts than more highly educated women. This national survey demonstrates a significant lack of the prerequisite knowledge and confidence to detect a breast change. Raising breast cancer awareness and promoting early presentation among older women is important, as they are more at risk of breast cancer and more likely to delay seeking help with breast cancer symptoms than younger women. | 18,813,307 |
Facile cyanamide-ammonia coupling mediated by cis- and trans-[PtIIL2] centers and giving metal-bound guanidines. | Diffusion of ammonia into CH(2)Cl(2) solutions of the dialkylcyanamide complexes cis- or trans-[PtCl(2)(RCN)(2)] (R = NMe(2), NEt(2), NC(5)H(10)) at 20-25 degrees C leads to metal-mediated cyanamide-ammonia coupling to furnish, depending on reaction time, one or another type of novel bisguanidine compound, i.e. the molecular cis- or trans-[PtCl(2){NH=C(NH(2))R}(2)] (cis- and trans-) and the cationic cis- or trans-[Pt(NH(3))(2){NH=C(NH(2))R}(2)](Cl)(2) (cis- and trans-) complexes. Compounds cis- or trans- were converted to cis- or trans-, accordingly, upon prolonged treatment with NH(3) in CH(2)Cl(2). The ammination of the relevant nitrile complexes cis- or trans-[PtCl(2)(RCN)(2)] (R = Et, CH(2)Ph, Ph) in CH(2)Cl(2) solutions affords only the cationic compounds cis- or trans-[Pt(NH(3))(2){NH=C(NH(2))R}(2)](Cl)(2) (cis- and trans-). The formulation of was supported by satisfactory C, H and N elemental analyses, agreeable ESI(+)-MS (or FAB(+)-MS), IR, (1)H and (13)C NMR spectroscopies. The structures of trans-, trans-, cis-, trans-, cis-, and cis- were determined by single-crystal X-ray diffraction disclosing structural features and showing that the ammination gives ligated guanidines and amidines in the E- and Z-forms, respectively, where both correspond to the trans-addition of NH(3) to the nitrile species. | 18,813,372 |
An integrated QCM-based narcotics sensing microsystem. | We present the design, fabrication and successful testing of a 14x14x4 mm3 integrated electronic narcotics sensing system which consists of only four parts. The microsystem absorbs airborne narcotics molecules and performs a liquid assay using an integrated quartz crystal microbalance (QCM). A vertically conductive double-sided adhesive foil (VCAF) was used and studied as a novel material for LOC and MEMS applications and provides easy assembly, electrical contacting and liquid containment. The system was tested for measuring cocaine and ecstasy, with successful detection of amounts as small as 100 ng and 200 ng, respectively. These levels are of interest in security activities in customs, prisons and by the police. | 18,813,386 |
[Social inequalities, healthcare and well-being: opportunities and obstacles on the horizon of transversal public policies]. | The development of a distributive justice model that is responsive to new claims and demands in the social policy field requires in-depth examinations and critiques of the ways in which public policies are drawn up and implemented. Reconstituting and analyzing different institutional dynamics, decision contexts and program performances emerge as tasks that are crucial to the quest for alternatives ways of strengthening integration and empowerment experiences. The purpose of this article is to present these issues and help affirm commitments to transversal and convergent public actions combating poverty, social exclusion and unequal healthcare. | 18,813,477 |
[Unconditional to conditional rights: counterparts in Brazil's Family Allowance Program]. | This paper analyzes the concepts and challenges of the counterpart contributions demanded by Brazil's Family Allowance Program, which requires mandatory school attendance for children and adolescents, and healthcare for children, pregnant women and breast-feeding mothers. These issues are prompting much discussion in Brazil and elsewhere in the world. This study charts theoretical aspects that underpin arguments for and against conditional cash transfer programs, through a review and systematization of the literature and a study of the related legislation. This analysis demonstrates that the opponents of counterpart obligations claim they breach unconditional rights to citizenship. Some supporters of these conditional transfers believe that a return is required for these benefits, while others see such requirements as a strategy for ensuring easier access to social welfare services, thereby breaking away from the cycle of poverty. Although latter view is present in Brazil's original Family Allowance Program, the manner in which supplementary legislation defines the application of the conditions is coercive and remote from the concept of social insertion. | 18,813,483 |
[Healthcare rights and conditional cash transfers in Latin America]. | Conditional cash transfer programs in Latin America impose specific requirements and responsibilities on beneficiary households, in order to upgrade education levels, improve drop-out rates and eliminate child labor, while enhancing health and nutrition indicators. Although counterpart healthcare conditions are common to all these programs, government strategies differ in terms of reaching their goals, at times even undermining improvements in the living conditions of more vulnerable segments of the population. Instead of upholding rights to healthcare, such initiatives may well trigger a new cycle of tightly-focused basic care through provisional programs. | 18,813,487 |
[Private home healthcare and its strategies (apparent and hidden)]. | This paper analyses the findings of an investigation into private home healthcare. Considered the most visible model of Managed Healthcare, it is being developed through the supply of multiple services. This concept is based on a set of principles - out-of-hospital care, lower infection risks, family-based benefits for patients - all linked to a cost-cutting strategy. Some labor relations aspects are also discussed that underpin the development of this type of care. | 18,813,501 |
[Sanitary and socio-environmental conditions in the Iauaretê indigenous area, São Gabriel da Cachoeira, Amazonas State, Brazil]. | To describe sanitary, social and environmental conditions that are significant for health of residents in the Iauaretê Indigenous Area in Brazilian Amazonia, notable for its population concentration. Qualitative and quantitative methodologies were used, with the action research method deployed mainly for qualitative approaches, through community meetings with tribespeople and researchers in the villages constituting the hub of the Area. Talking maps were prepared and interviews were conducted, together with studies of solid wastes disposal techniques, in addition to locating, sampling and analyzing the quality of water used for human consumption, in parallel to the use of geo-referencing techniques. Of the 65 water samples analyzed, 89.2% presented fecal coliforms, with no adequate sanitary solutions found for the disposal of solid wastes. From the public health standpoint, the sanitary practices of these indigenous peoples caused concern, clashing with their own relative knowledge. The specific set of problems associated with the way of life imposed by mainstream society requires the implementation of joint activities in the infra-structure and health education fields in order to solve collective health issues, stressing local community participation. | 18,813,507 |
[Evaluation of oral health actions in the Family Health Program in the Mosqueiro district, Pará State, Brazil]. | The extension of Brazil's Family Health Program Teams through the introduction of Oral Health Teams (OHT) as required by Decree N degrees 1,444 dated December 28, 2000, was an important step in the restructuring of the Oral Healthcare System, ensuring easier access to good quality dental care and treatment for less privileged segments of the population. In the Mosqueiro district of Pará State, an Oral Health Team was added to the Family Health Program in 2002, working closely with the local community through home calls and school visits, as well as at the Family Health Unit. In order to assess these Oral Health activities, 103 users of the Family Health Program Unit responded to a questionnaire with closed and semi-open questions in July 2004. The resulting data were tabulated, showing that most of these users were young adult women with high school diplomas but lacking access to higher education. This public felt that Oral Health quality had improved considerably, being satisfied with the performance of the current team. | 18,813,518 |
[Satisfaction with dental care: qualitative study of the mothers of children treated at the Santa Catarina Federal University, Brazil]. | This survey examines perceptions among mothers of the treatment provided through pediatric dentistry clinic at the Santa Catarina Federal University and their concept of the 'ideal' dentist, using the qualitative (case study) method. Collected through semi-structured interviews with seven mothers of children treated at this pediatric dentistry clinic, the data showed that these mothers felt the 'ideal' dentist should blend affective, psychomotor and cognitive abilities: enjoying his work; being attentive and friendly; providing clear information about oral health; resolving oral problems presented by patients; and keeping up-to-date. Interpersonal aspects were crucial factors for satisfaction with the treatment provided at the University, in addition to the technical skills of the students and easy appointments at the pediatric dentistry clinic. A better understanding of the relationship between dentist and patient is suggested, associating affective factors with cognitive and psychomotor aspects in dental practice routines. | 18,813,519 |
[Punishment, penalty or providence? Morbidity due to external causes in basic healthcare, Porto Alegre, Brazil]. | This research project is based on the work of the External Causes Observer Group for Municipal Health Services under the Partenon and Lomba do Pinheiro District Administration in Porto Alegre, Brazil. It reflects on the actions and roles of Health Services in response to injuries due to External Causes, from the standpoint of strategies promoting health and quality of life. The high rate for these events prompted dissatisfaction among local healthcare parishioners, keenly aware that they constitute a serious Public Health problem. Coping strategies were initially intended to keep records of injuries due to external causes in this region, involving the entire team. Subsequently, the assistance rendered to victim of accidents and violence was examined. The findings of this group were presented at special events and community meetings, in addition to activities specifically addressing healthcare workers. Awareness-heightening and better qualifications are expected to underpin commitments to networking and the implementation of initiatives providing protection, particularly for more vulnerable segments. | 18,813,526 |
[Ways of inserting physicians into the healthcare production process: case of study of basic healthcare units in Belo Horizonte, Brazil]. | The main purpose of this paper is to describe and analyze the ways of inserting physicians into the health production process. This subject is justified by a belief that that this way of working may be a problem but at the same time may well be the key to implementing healthcare models that are ethically and politically committed to the lives of public health system users. Initially, the problem is presented through the construction of an archetype physician and his historical and social and cultural conditioning factors, taking the work processes of physicians at Basic Healthcare Units in Belo Horizonte as an example that is built up through interviews and participative observations. Some possibilities for intervention are indicated through the introduction of new concepts and technologies that could transform the work of these practitioners in ways that would build up links with more responsibility for the care and lives of users of public healthcare services. | 18,813,530 |
[Self-assessment in graduate public health programs: characteristics and constraints]. | The purpose of this paper is to discuss the characteristics and constraints of internal appraisals or self-assessments in Graduate Public Health Programs, conducted through a study of the report on 25 programs participating in the three-year CAPES evaluation (2001-2003). Three main aspects were considered: (a) tools and/or procedures employed; (b) self-assessment procedures; (c) products for upgrading program quality. The findings indicate that different tools are employed and used improperly. For most of the programs, it is not clear how ongoing processes take place, as the products presented are not directly related to the process as performed and the program quality assurance procedures. The importance of self-assessment is discussed as a tool for exploring the possibilities and boundaries of a process or an institution, as well as for taking decisions. A suggestion is presented: setting up a basic structure with working groups and a self-assessment coordination team; real participation and commitment among staff members and decision-makers; reliable data with effective use of the findings. | 18,813,536 |
Research and the (free and) informed consent. | The aim of this article was to reflect about the Free and Informed Consent (IC) in qualitative researches in the health field. Coming from the experience of being part of a CER (Committee for Ethic in Research) in the health area the authoresses place in debate some important questions, exploring them and conducting suggestions. One of these questions and topic of analysis is the meaning of IC, as for the participant as for the researcher. | 18,813,550 |
[Is the principlist model still satisfactory for the analysis of the morality of the scientific research involving human beings?]. | This paper discusses the application of principlism to research involving human subjects, starting from the question of its pertinence in the current situation of the paradigmatic pluralization on science and the multiplication of models of ethical evaluation in the complex societies. Highlights that the development of modern scientific medicine depended strongly on human experimentation and that up to the mid 20th century the good intention of the researcher was, theoretically, enough to justify a research morally, but that with the twofold paradigmatic transition in Science and in Ethics, occurred in the course of the 20th century, a pluralization and complexification took form in both the scientific know-how and the field of ethics applied to scientific research, which on normative level was in the uncomfortable situation of having to deal with a permanent contestation of scientific and ethic paradigms. In the field of ethics, other principles also pass to guide decisions such as the principles of protection, applicable to situations of need as they arise mainly in the case of the populations of the Third World. Finally, principlism is pertinent in its general philosophic posture and methodological value, but insufficient when applied to the moral problems of public health and in particular to research ethics in dependent countries. | 18,813,552 |
[Research ethics in social sciences--new challenges]. | This paper aims to discuss how already established principles of research ethics can be incorporated to the ethical review of research projects in Social Sciences, particularly ethnographic studies or studies using the techniques of participant observation and open interviews. The discussion is guided by an analysis of the methodological and ethical procedures used in the production of the ethnographic documentary "Severina's Story". The analysis of the film shows the urgent need to expand the horizons of the debate around research ethics beyond the biomedical fundaments of this field. | 18,813,558 |
[The Family Health Program (FHP) and human resources: perceptions of students from two different dentistry schools]. | The purpose of this study was to evaluate the perceptions and opinions of dental students from two different Dentistry Schools in Brazil, both known here as Dentistry Schools 1 and 2 about the Family Health Program--FHP. The study analyzed if the Dentistry Schools had any influence on the students, graduating professionals with humanitarian and social sensibility, which are considered very important prerequisites for those who wish to work on this governmental health program, as well as searching for professional expectation of the students. Individual questionnaires were applied by only one researcher among the students who took part in the study. Answers were analysed by the Epi-Info program and results showed that difficulties related to the job market may be influencing students to join the FHP. Results also reveal that students consider technician an important prerequisite for dentists who wish to work on this governmental program. Significant statistical differences between the students were found: those who were graduating in Dentistry School 1 seemed more adequate to FHP and the reason for this difference may be the Supervised Training Program, a unit available on this Dentistry School that enables the students face the reality of FHP, as well the social and economical reality of the families assisted by this program. | 18,813,569 |
[Profile of clinical research subjects in an independent outpatient center]. | This paper assesses the quality of assistance in a clinical trial outpatient center as well as the patients understanding of the informed consent (IC); determine the reasons why they participate and detail socio-economic levels. A cross-sectional study was adopted in a clinical trial outpatient center using a self-explanatory questionnaire. All 100 respondents considered the assistance at the center excellent (86%) or good (9%). Almost all of them were well informed about the content of the IC. Their knowledge about the right to "confidentiality", present in all ICs, was 6 times higher than their knowledge about their right to "access the results", generally not included in the IC. The main reasons for participating were "to know more about ones health" (59%) and to "to benefit other people in the future" (47%). The participants income varied from 3 to 5 minimum wages (48%) and most (66%) concluded at least the 4th grade of basic education in Brazil. The subjects showed the economical characteristics of the average population of Rio de Janeiro. Their level of education allowed them to sign and to understand what they were signing. They were aware of the existence of the IC and its content. The main reason for participating was for one s own benefit and for the benefit of others. | 18,813,596 |
[Representations of aging for community health agents and nursing professionals: psychological aspects of the health-disease process]. | This paper addresses the aging process in the context of public health, with emphasis to human resources and to how aging is perceived by the public health professionals. The aim of this study was to identify the representations of the aging process for public health professionals and how these representations are expressed in health care, well-being and elderly care. The sample included 27 public health professionals, 10 community health agents and 17 nursing professionals. Two instruments were used, a sociocultural questionnaire and a questionnaire about aging representations. Data analysis included qualitative and quantitative procedures (Chi-square test). Among the main findings, the most representative words used in relation to aging were retirement and rest. For this sample, good family support and care were considered the most important factors contributing to the well-being of the elderly. When it comes to defining care, the most frequent concept referred to biological aspects. Moreover, this sample in general showed some knowledge about Alzheimer Disease. These findings can contribute to the capacitation of human resources. Health agents and nursing professionals should be guided towards construction of a deeper comprehension of the biopsychosocial context of the aging process. | 18,813,627 |
[Procedures and perceptions of professionals and groups acting in the Brazilian health plan market]. | This study analyzes the mechanisms used in Brazil by health plan and insurance operators, hospitals and physicians for organizing the access to health care services and their strategies towards cost reduction and decision-making. The study is based on the literature about regulation of the health services, with special focus on micro-management and managed care. From an intentional sample of health care organizations selected according to the number of beneficiaries, organizational modality and geographic criteria we selected probabilistic samples of doctors and hospital services. Data were collected through questionnaires applied to key informants from health care operators and affiliated doctors and hospitals. Results suggest that the relationships between health care organizations, physicians and hospitals follow basically patterns inherited from the former social security system, mainly with fixed pricing and open account payments. More complex financing mechanisms, risk sharing and efficiency strategies are of minor interest. Mechanisms for risk reduction and encouragement of adequate use of technologies are weak. Cost control is mainly based on co-payment and barriers to access to the services. We conclude that in Brazil managed care is still in its beginning. | 18,813,650 |
[Compared supplementary healthcare policies in the context of public health systems: European Union and Brazil]. | This paper analyzes the supplementary healthcare policies adopted in recent years in Brazil and in European countries. The proposed approach is a comparative analysis of the private health plan and insurance policies in the context of the European Union and Brazilian public health systems. This comparison allowed establishing parameters and categories capable of showing the differences and similarities between these experiences. These variables served as a basis for analyzing the Brazilian case using recent results of studies on private health insurance in the context of the Unified Health System (SUS), the Brazilian Public Health System. The main topics investigated were: the contracts and agreements between the public and the private sector, the attributions of the private health care services in the public system, the production, available capacity and financing of the public and private health systems and finally, the regulations regarding reimbursement of the SUS in those cases, where users covered by the private sector made use of the public services. We conclude retaking the discussion of the theoretical and conceptual perspective in the comparative analysis of health system policies based on the insights originated by this work. | 18,813,647 |
[Control of carotenoid loss in vegetables prepared in a hospital foodservice]. | The aim of this study was to assess the handling procedures of kale and tomatoes in a hospital foodservice (HFS) in order to control loss of beta-carotene and licopene. The adopted measures, up to then not used by the HFS, were: 24-h storage under refrigeration (10 degrees C), hygienizing for 15 min and distribution immediately after preparation. Vegetable samples were collected after reception and after each stage of manipulation in the HFS. The samples were analyzed using high performance liquid chromatography (HPLC) with a mobile phase of methanol, ethyl acetate and acetonitrile (50:40:10). ANOVA (alpha = 0.05) was used to detect significant differences. No significant differences in the content of the components were found between the different stages of manipulation but there was an important decrease in the retention rates. In kale a retention rate of 68.2% for beta-carotene was verified 60 minutes after preparation whereas in tomatoes 91.96% of this compound were preserved for 120 minutes after preparation. No important decrease was observed in the retention of licopene. The high retention rates showed that the evaluated procedures contributed to control the loss of carentoids in vegetables and therefore these measures should be adopted in other HFS. | 18,813,663 |
[Evaluation of emergency hospital services in the state of Rio de Janeiro]. | This study aimed at the evaluation of urgency/emergency hospital units and recorded the relations of emergency units with users, other hospital services and the healthcare network and approached the size of the teams, the relations among the professionals, their qualification and income. It further describes the infrastructure of these services including basic organizational aspects. The aspect care was one component in this broader object. It is a descriptive study applying a questionnaire to the heads of the emergency services of a sample of 30 hospitals.The statements suggest the overcrowding of emergency services (in 80% of hospitals) deteriorating the work and care conditions to be due to the inefficiency of primary care and the healthcare network. The deficit of human resources was found larger than the lack of technology. The precarious employment relations were considered a factor hampering the qualification and retention of professionals. The most favorably evaluated items were: relationship with service heads, trust and expectations with regard to the service. The worst items were: wages, team size and labor medicine. The nvestment in human resources is indispensable. There is a need for public policies that articulate more efficient interventions given that those in force are defining the configuration of territories with their hierarchized and solidary networks. | 18,813,664 |
[Definition of priority medicines for monitoring laboratory quality in Brazil: the interface between health surveillance and the National Drug Policy]. | A key objective of the Brazilian National Drug Policy is the quality of medicines supplied to the population. This study aimed to set priorities for the analysis of the National Program for Quality Control of Medicines. The main criterion was the drug's presence in at least three Pharmaceutical Care Programs under the Ministry of Health. Additional criteria were presence on the National List of Essential Drugs (RENAME) in 2002 and its indication for the 20 main causes of disability-adjusted life years (DALY). The sources were data from the Ministry of Health and related legislation. The drugs were classified according to the Anatomical Therapeutic Chemical Classification System (ATC) of the WHO. The 13 pharmaceutical care programs included 893 products classified in 449 different ATC codes. Twenty-eight drugs were considered priorities, 26 of which were listed on the RENAME and 12 indicated as causes of DALY. It is recommended that the National Health Surveillance Agency and Secretariat of Science, Technology, and Strategic Inputs establish an integrated strategy to guarantee comprehensive quality of these drugs, including laboratory quality, registration, good manufacturing practices, and information for health professionals and the general population. | 18,813,684 |
Professor Octávio de Silveira: the pioneer of neurology in the State of Paraná. | The author gives a brief overview of the career of Professor Octávio da Silveira, the first neurologist and professor of neurology in the State of Paraná, as well as the first full professor of clinical neurology in the Federal University of Paraná. | 18,813,730 |
Population dynamics of Aceria guerreronis Keifer (Acari: Eriophyidae) and associated predators on coconut fruits in Northeastern Brazil. | Aceria guerreronis Keifer can cause severe damage to coconuts in several countries around the world. Rare studies have been conducted to determine the predatory mites associated with A. guerreronis in Brazil. The study evaluated the prevalence of A. guerreronis and associated predators on the bracts and on the surface of the fruits underneath the bracts, for 12 months, on coconut palms grown along the coast of the States of Alagoas, Paraíba and Pernambuco, Northeastern Brazil. Mites of 10 families were found, but by far the most abundant species was A. guerreronis, corresponding to 99.5% of the mites collected. The prevailing species amongst the predators were the Phytoseiidae mites Neoseiulus baraki (Athias-Henriot) and Neoseiulus paspalivorus (De Leon). These are flat mites that have short limbs, characteristics that allow them to invade the main habitat occupied by A. guerreronis. Other predators were found, but in low numbers, due mainly to their difficulty in reaching the fruit areas most inhabited by A. guerreronis. However, these mites could prey on that pest when it leaves its preferred habitat to disperse. No significant correlations were observed between the levels of abiotic factors and the population levels of A. guerreronis or of the phytoseiids associated with it. This probably occurred due to the simultaneous and conflicting effects of those factors on the mites in the field, or to significant differences between the climatic factors measured in the environment and those prevailing in the habitat occupied by A. guerreronis. | 18,813,749 |
Is alcohol really good for health? | Several observational follow-up studies about cardiovascular health have found an overlap between moderate drinking and lower mortality from coronary heart disease and other causes. However, such studies have serious methodological limitations. Most non-drinkers were in fact ex-drinkers, that is, people who had had to stop drinking for health reasons. Other variables that may play a decisive role in cardiovascular risk, such as tobacco smoking, exercise and body mass index, were not evaluated, and changes in drinking habits were not assessed periodically. Due to the methodological limitations of these studies, the findings suggest a statistical association but not a causality relationship between moderate alcohol consumption and lower risk of mortality. Furthermore, numerous studies have shown that excessive drinking can cause not only cardiovascular diseases--such as hypertension, arrhythmias, dilated cardiomyopathy and stroke--but also other medical and psychiatric disorders. Alcohol clearly has addictive properties that can contribute to the development of heavy drinking in some people, leading to alcohol-related physical and mental disorders. The public health message should emphasize the potential risk of heavy drinking rather than promote the possible benefits of moderate consumption. A simplistic message that alcohol is good for cardiovascular health may be prejudicial when stated outside the context of the possible adverse consequences of heavy drinking. | 18,813,769 |
[Efficacy of oxcarbazepine treatment in patients diagnosed with cocaine abuse/dependence]. | To assess the efficacy of oxcarbazepine in the treatment of cocaine addiction and its influence on impulsivity and craving in cocaine addicts. A prospective, observational and clinical study was conducted in patients diagnosed with cocaine abuse/dependence (DSM IV criteria), monitoring supervised treatment with oxcarbazepine for 12 weeks. 30 patients (aged 18 or over) voluntarily undergoing treatment at an Addictive Behaviors Unit (UCA). Patients were selected randomly after providing explicit authorization and informed consent. Abstinence rate increased, reaching 100% of participants that remained in compliance throughout the 12-week period (60% of those who started the treatment). Negative results in the urine test for cocaine detection also increased, reaching 90.9% of those in treatment at week 8. Treatment with oxcarbazepine was seen to produce a statistically significant reduction in craving and impulsivity after 4, 8 and 12 weeks, with respect to baseline measures at the start of treatment. The craving index correlates with reduction in cocaine use. Oxcarbazepine is effective in reducing impulsivity and craving in relation to cocaine. Thus, we recommend high initial doses of oxcarbazepine in patients with high impulsivity prior to treatment. | 18,813,772 |
Regulation of p63 expression in primary and immortalized nasopharyngeal epithelial cells. | Mutation of the p53 gene is a common event in human cancer. Interestingly, p53 mutation is uncommon in nasopharyngeal carcinoma (NPC). The DeltaNp63 has been postulated to have a dominant-negative effect on the function of the p53 gene and may play a role in the pathogenesis of nasopharyngeal carcinoma. Immortalization is a common property of cancer cells and is believed to be an early event in carcinogenesis. At present, the relationship between DeltaNp63 and immortalization is poorly understood. In this study, we defined the expression profile of p63 and its various isoforms in primary and immortalized nasopharyngeal epithelial cells. Also, we elucidated some events regulating the expression of p63. Elevated expression of p63 was generally detected in both primary and immortalized nasopharyngeal epithelial cells at their proliferation stage and the predominant isoform of p63 expressed was DeltaNp63alpha. p63 expression was suppressed upon cellular senescence of primary nasopharyngeal epithelial cells and induction of terminal differentiation in immortalized nasopharyngeal epithelial cells. Expression of DeltaNp63 alone was able to drive clonal proliferation in primary nasopharyngeal cells in culture while downregulation of DeltaNp63 induced cellular apoptosis. All these results support a role of DeltaNp63 in proliferation and immortalization which facilitates pathogenesis of nasopharyngeal carcinoma. TGFbeta and retinoic acid downregulated the expression of p63 in immortalized nasopharyngeal epithelial cells and may play a role in regulating differentiation in squamous epithelial cells with potential applications in prevention and treatment of nasopharyngeal carcinoma. | 18,813,784 |
HIV-1 Tat enhances replicative potential of human oral keratinocytes harboring HPV-16 genome. | Introducing highly active antiretroviral therapy (HAART) has significantly decreased the morbidity and mortality in human immunodeficiency virus-positive (HIV+) individuals by decreasing the viral loads and increasing the CD4+ T-cell counts. Subsequently, the occurrence of many HIV-associated diseases has been dramatically declined except human papillomavirus (HPV)-associated lesions. Such notion suggests that immune response is not a major determinant, and that the direct interaction between HIV and HPV may be involved in the HPV-associated pathogenesis. In the current study, we investigated whether HIV plays a direct role in HPV-associated oral carcinogenesis by using HIV-1 transactivator protein (Tat), which is known to have oncogenic properties. We found that HIV-1 Tat not only increased the expression of HPV-16 E6 and E7 oncogenes in human oral keratinocytes harboring the HPV type-16 genome (HOK-16B), but also notably enhanced the proliferative capacity of the cells in vitro. Moreover, HOK-16B cells expressing HIV-1 Tat was capable of inducing cystic nodules in nude mice, while the control HOK-16B cells failed to produce nodules in the mice. Our results indicate that HIV could play a role in the HPV-associated pathogenesis by exerting oncogenic stimulus via Tat protein. | 18,813,791 |
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