title stringlengths 0 1.13k | abstract stringlengths 1 15.7k | PMID int64 22 36.5M |
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Errors and analysis of errors. | Methods of analyzing errors and proactively preventing errors are discussed. A framework for using these concepts is presented. | 18,981,790 |
Negotiating, mediating, and arbitrating physician-patient conflicts. | Medical errors, unanticipated outcomes, and physician-patient conflicts are going to occur. The traditional tort-based system of adjudicating these as "medical malpractice" in court is inefficient and expensive. Litigation as a kind of faultfinding judicial autopsy actually victimizes both the patient and the physician. Disproportionate transaction costs in litigation reduce motivation and available resources that could otherwise be used for problem solving. Instead, physicians and patients can use negotiation and mediation to resolve conflicts, and employ arbitration to adjudicate their disputes if they are unsuccessful. | 18,981,796 |
Prevention, diagnosis, and treatment of cerebral palsy in near-term and term infants. | The incidence, risk factors, and etiology of cerebral palsy (CP) are reviewed based on evidence-based data. Current methods for diagnosing risk for brain injury, including neuroimaging data on CP in this group of infants are presented. Prevention of CP in term and near-term infants currently seems to be promising with neuroprotection with hypothermia for neonatal encephalopathy secondary to presumed acute hypoxic-ischemia at birth. Treatment of CP based on evidenced-based data will be reviewed. | 18,981,806 |
A new technique for single-person fascia lata harvest. | Reconstitution of a watertight dural closure at the conclusion of most neurosurgical operations is a very important step to prevent cerebrospinal fluid leak, encephalocele formation, or infection. If sufficient native dura is not available to accomplish this goal, a dural substitute is required. We have developed a system of single-person fascia lata harvest that is fast, safe, and easily mastered. Through a standard incision along the iliotibial band, the fascia lata is dissected from the underlying muscle, and with the use of a simple system of stainless steel plates, a tray, and 2 nonperforating towel clips, a large volume of fascia is harvested. We have used this technique on 23 patients in the past 12 months, with good results. We have had fewer postoperative pain complaints and less seroma formation compared with the standard technique. This technique requires only simple instrumentation and, because the harvesting is done by 1 person, it can proceed independently of the main operation, thus eliminating any added operative time and inconvenience. It reliably produces a large volume of high-quality fascia that can be used in a variety of neurosurgical procedures. | 18,981,843 |
Conversion to symptomatic Chiari I malformation after minor head or neck trauma. | The Chiari I malformation is a rare disorder characterized by downward herniation of the brainstem and cerebellar tonsils through the foramen magnum. Many individuals with the Chiari I malformation do not become symptomatic until adulthood, and the factors that contribute to the onset of symptoms have not been well characterized. The purpose of this systematic chart review was to determine the incidence and validity of minor head or neck trauma as precipitating factors for the onset of symptomatic Chiari I malformation. The charts of all patients seen by the senior author (CHT) between January 1985 and July 2006 were reviewed to identify patients who had presented with symptomatic Chiari I malformation after minor head or neck trauma. Specific inclusion criteria were used to determine whether the onset of symptoms could be reliably attributed to the minor trauma. Of the 85 patients with symptomatic Chiari I malformation seen by the senior author during this time, 11 (12.9%) had a history of minor head or neck trauma preceding the onset of symptoms. Of these, there were 3 patients (3.5%) in whom the onset of symptoms could be attributed to the trauma based on strict inclusion criteria. Minor head or neck trauma can precipitate the onset of symptoms in a small number of previously asymptomatic patients with Chiari I malformation. Health care professionals must be aware that neurological symptoms that persist or worsen after minor head or neck trauma could indicate an underlying Chiari I malformation. | 18,981,886 |
Advanced magnetic resonance imaging of cerebral cavernous malformations: part I. High-field imaging of excised human lesions. | We hypothesized that structural details that have not been described previously would be revealed in cerebral cavernous malformations (CCM) through the use of high-field magnetic resonance and confocal microscopy. The structural details of CCMs excised from patients were sought by examination with high-field magnetic resonance imaging (MRI) and correlated with confocal microscopy of the same specimens. Novel features of CCM structure are outlined, including methodological limitations, venues for future research, and possible clinical implications. CCM lesions excised from 4 patients were fixed in 2% paraformaldehyde and subjected to high-resolution MRI at 9.4 or 14.1-T by spin echo and gradient recalled echo methods. Histological validation of angioarchitecture was conducted on thick sections of CCM lesions using fluorescent probes to endothelium under confocal microscopy. Images of excised human CCM lesions were acquired with proton density-weighted, T1-weighted, T2-weighted spin echo, and T2*-weighted gradient recalled echo MRI. These images revealed large "bland" regions with thin-walled caverns and "honeycombed" regions with notable capillary proliferation and smaller caverns surrounding larger caverns. Proliferating capillaries and caverns of various sizes were also associated with the walls of apparent larger blood vessels in the lesions. Similar features were confirmed within thick sections of CCMs by confocal microscopy. MRI relaxation times in different regions of interest suggested the presence of different states of blood breakdown products in areas with apparent angiogenic proliferative activity. High-field MRI techniques demonstrate novel features of CCM angioarchitecture, visible at near histological resolution, including regions with apparently different biological activity. These preliminary observations will motivate future research, correlating lesion biological and clinical activity with features of MRI at higher field strength. | 18,981,890 |
Influence of the epicanthal fold on the perceived direction of gaze. | Judged direction of gaze from straight and turned heads is known to be biased from its true direction. We have tested the additional influence of epicanthal folds on the perceived direction of gaze. Western observers (U.S. residents of Western appearance) and Eastern observers (native Japanese) judged the direction of gaze from cathode ray tube-imaged heads with and without epicanthal folds (Japanese vs. Western models) when the heads, both straight and turned, gazed in different lateral directions. When the gazers' heads were straight and gave eye contact, both Western and Eastern observers judged the gaze to be giving eye contact. However, with straight heads and gaze to the side, epicanthal folds produced significant differences in the judged direction of gaze. Observers judged the right and left eyes to be gazing in nearly the same direction when the gazer had the eye appearance that the observers were used to viewing within their own country, but in very different directions when the gazer had eyes typical of the other country. When the gazers' heads were turned, the Western and Eastern observers judged the direction of gaze of the Western gazer's right and left eyes similarly, but both judged large differences in direction of gaze between right and left eyes for the Eastern gazer. Direction of gaze from eyes that have epicanthal folds is judged very differently than gaze from eyes that do not have epicanthal folds. This difference is sensitive to the cultural experience of the observers. | 18,981,921 |
Desktop publishing and validation of custom near visual acuity charts. | Customized visual acuity (VA) assessment is an important part of basic and clinical vision research. Desktop computer based distance VA measurements have been utilized, and shown to be accurate and reliable, but computer based near VA measurements have not been attempted, mainly due to the limited spatial resolution of computer monitors. In this paper, we demonstrate how to use desktop publishing to create printed custom near VA charts. We created a set of six near VA charts in a logarithmic progression, 20/20 through 20/63, with multiple lines of the same acuity level, different letter arrangements in each line and a random noise background. This design allowed repeated measures of subjective accommodative amplitude without the potential artifact of familiarity of the optotypes. The background maintained a constant and spatial frequency rich peripheral stimulus for accommodation across the six different acuity levels. The paper describes in detail how pixel-wise accurate black and white bitmaps of Sloan optotypes were used to create the printed custom VA charts. At all acuity levels, the physical sizes of the printed custom optotypes deviated no more than 0.034 log units from that of the standard, satisfying the 0.05 log unit ISO criterion we used to demonstrate physical equivalence. Also, at all acuity levels, log unit differences in the mean target distance for which reliable recognition of letters first occurred for the printed custom optotypes compared to the standard were found to be below 0.05, satisfying the 0.05 log unit ISO criterion we used to demonstrate functional equivalence. It is possible to use desktop publishing to create custom near VA charts that are physically and functionally equivalent to standard VA charts produced by a commercial printing process. | 18,981,923 |
Does childhood motor skill proficiency predict adolescent fitness? | To determine whether childhood fundamental motor skill proficiency predicts subsequent adolescent cardiorespiratory fitness. In 2000, children's proficiency in a battery of skills was assessed as part of an elementary school-based intervention. Participants were followed up during 2006/2007 as part of the Physical Activity and Skills Study, and cardiorespiratory fitness was measured using the Multistage Fitness Test. Linear regression was used to examine the relationship between childhood fundamental motor skill proficiency and adolescent cardiorespiratory fitness controlling for gender. Composite object control (kick, catch, throw) and locomotor skill (hop, side gallop, vertical jump) were constructed for analysis. A separate linear regression examined the ability of the sprint run to predict cardiorespiratory fitness. Of the 928 original intervention participants, 481 were in 28 schools, 276 (57%) of whom were assessed. Two hundred and forty-four students (88.4%) completed the fitness test. One hundred and twenty-seven were females (52.1%), 60.1% of whom were in grade 10 and 39.0% were in grade 11. As children, almost all 244 completed each motor assessments, except for the sprint run (n = 154, 55.8%). The mean composite skill score in 2000 was 17.7 (SD 5.1). In 2006/2007, the mean number of laps on the Multistage Fitness Test was 50.5 (SD 24.4). Object control proficiency in childhood, adjusting for gender (P = 0.000), was associated with adolescent cardiorespiratory fitness (P = 0.012), accounting for 26% of fitness variation. Children with good object control skills are more likely to become fit adolescents. Fundamental motor skill development in childhood may be an important component of interventions aiming to promote long-term fitness. | 18,981,934 |
Substrate metabolism and exercise performance with caffeine and carbohydrate intake. | 1) To investigate the effect of caffeine on exogenous carbohydrate (CHO) oxidation and glucose kinetics during exercise; and 2) to determine whether combined ingestion of caffeine and CHO enhanced cycling performance compared with CHO alone. Ten endurance-trained cyclists performed three experimental trials consisting of 105 min steady-state (SS) cycling at 62% VO2max followed by a time trial (TT) lasting approximately 45 min. During exercise, subjects ingested either of the following: a 6.4% glucose solution (GLU), a 6.4% glucose plus caffeine solution providing 5.3 mg kg(-1) of caffeine (GLU + CAF), or a placebo (PLA). Glucose solutions contained a trace amount of [U-C]glucose, and eight subjects received a primed continuous [6,6-H2]glucose infusion. Peak exogenous CHO oxidation rates were not significantly different between GLU and GLU + CAF trials (52.6 +/- 2.7 and 49.1 +/- 2.1 micromol kg.min(-1), respectively). Rates of appearance (Ra) and disappearance (Rd) of glucose were significantly higher with CHO ingestion than PLA (P < 0.01) but were not significantly different between GLU and GLU + CAF trials. Performance times were 43.45 +/- 0.86, 45.45 +/- 1.07, and 47.40 +/- 1.30 min for GLU + CAF, GLU, and PLA, respectively. Therefore, GLU + CAF ingestion enhanced TT performance by 4.6% (P < 0.05) compared with GLU and 9% (P < 0.05) compared with PLA. The coingestion of caffeine (5.3 mg kg(-1)) with CHO during exercise enhanced TT performance by 4.6% compared with CHO and 9.0% compared with water placebo. However, caffeine did not influence exogenous CHO oxidation or glucose kinetics during SS exercise. | 18,981,939 |
Where are youth active? Roles of proximity, active transport, and built environment. | This study examined factors related to two sources of physical activity for youth: active use of recreation sites and active transport to recreation sites. Parents of children (n = 87) and matched pairs of parents and adolescents (n = 124 pairs) in three US cities reported on youths' active use of, proximity to, and walking/biking to 12 recreation sites and on neighborhood walkability and safety. Multivariate regression models evaluated factors associated with youths' frequent site use and active transport to sites. Proximity to the site was associated with frequent use of large parks and public open space. Walking/biking to the site was associated with frequent use of most sites (indoor recreation sites, small and large parks, basketball courts, walking/running tracks, school recreation sites, playgrounds, and public open space). After controlling for proximity and demographic factors, active transport to sites remained significantly associated (P < 0.05) with frequent use of four sites for children (indoor recreation, walking/running tracks, school recreation facilities, and public open space) and all but three sites for adolescents (indoor recreation, playfields/courts, and beach/lake/rivers). Adolescents' active transport to more sites was most positively related to higher perceived traffic safety and to better pedestrian infrastructure and was negatively related to crime threat. Adolescents with driver's licenses walked/biked to recreation sites less often. Active transport was strongly associated with the use of multiple recreation sites by children and adolescents, even when accounting for proximity and demographic factors. Adolescents living in neighborhoods with better traffic safety walked/biked to more recreation sites for physical activity. Findings support the need for built environments and transportation policies that facilitate safe, active transport to recreation sites for youth physical activity. | 18,981,942 |
Autonomic control of cerebral circulation: exercise. | On the basis of measurement techniques that require steady-state hemodynamic conditions when the measurement of cerebral blood flow (CBF) is being obtained, cerebral autoregulation (CA) maintains CBF stable over a wide range of cerebral perfusion pressures. When an acute (or dynamic) change in cerebral perfusion pressure (seconds) is imposed, CBF is not maintained. For example, after thigh cuff occlusion, its release induces an acute drop in arterial blood pressure (ABP). The sharp decrease in CBF indicates that CA was unable to respond to the dynamic (or rapid) changes in cerebral perfusion pressure. Therefore, control mechanisms of arterial pressure with short time constants must contribute importantly to CBF regulation. In order for CA to be effective, the cerebral perfusion pressure must lie within an autoregulatory range of perfusion pressures. The traditional thinking is that changes in sympathetic tone have a limited effect on CBF at rest. However, moderate- to heavy-intensity exercise causes only moderate increases in CBF despite large increases in sympathetic activity and ABP. Animal studies demonstrate that increases in sympathetic nerve activity cause cerebral vasoconstriction and protection against disruption of the blood-brain barrier. These findings suggest that the regulation of CBF during exercise is modulated not only by CA but also by autonomic nervous system and the arterial baroreflex-mediated control of the systemic circulation. | 18,981,945 |
Baroreflex and muscle metaboreflex: control of muscle sympathetic nerve activity. | During heavy exercise, the arterial baroreflex and the reflexes evoked by the activation of those afferent nerve endings in the working skeletal muscles that are sensitive to metabolic changes (the so-called muscle metaboreflex) are hypothesized to be activated and, moreover, to interact in ways that lead to the modulation of the primary cardiovascular reflex responses. For the past few years, our group has been investigating the interaction between the arterial baroreflex and the muscle metaboreflex. We have focused our efforts in identifying the effects of muscle metaboreflex activation on the arterial baroreflex regulation of the cardiovascular hemodynamics and muscle sympathetic nerve activity (MSNA) in humans. In a series of studies, we have found that during muscle metaboreflex activation, dynamic carotid baroreflex responses are modulated, as exemplified by the augmentation of the MSNA, leg vascular conductance and blood pressure responses to carotid baroreflex unloading and the shorter suppression period of MSNA, diminished vasodilation, and reduced blood pressure response to carotid baroreflex stimulation. Furthermore, we have found that the modification of the arterial baroreflex-mediated beat-to-beat control of MSNA, which is seen during activation of the muscle metaboreflex (i.e., resetting and an increase in sensitivity), could be a consequence of the alteration in the arterial baroreflex control of both the occurrence and strength of the MSNA burst. In addition, we have demonstrated that the arterial baroreflex beat-to-beat control of MSNA is time-dependently modulated during isometric exercise. We suggest that the modulation of arterial baroreflex function during the activation of muscle metaboreflex is one of the mechanisms for increasing, or maintaining, blood pressure at the required pressure and thereby contributes to the regulation of the cardiovascular system during exercise. | 18,981,946 |
Usefulness of multidetector computed tomography for detecting protruding lesions in intraductal papillary mucinous neoplasm of the pancreas in comparison with single-detector computed tomography and endoscopic ultrasonography. | To retrospectively evaluate the usefulness of multidetector computed tomography (MDCT) with multiplanar reformations (MPRs) and curved planar reformations (CPRs) for detecting protruding lesions in intraductal papillary mucinous neoplasms of the pancreas (IPMNs) as compared with single-detector CT (SDCT) and endoscopic ultrasonography (EUS). Eighty-six patients with IPMNs were imaged either with SDCT (n = 52) or MDCT with MPRs/CPRs and EUS (n = 34). The diagnostic accuracy of each imaging modality for identifying protruding lesions was compared with histological samples. Among the patients in whom protruding lesions were histopathologically identified, the lesions were detected in 9 of the 33 patients subjected to SDCT (51.9% accuracy), in 17 of the 25 patients subjected to MDCT with MPRs and CPRs (76.5% accuracy), and in 21 of the 25 patients subjected to EUS (70.6% accuracy). Thus, significant difference was observed between MDCT and SDCT regarding accuracy (P < 0.05); however, no significant difference was seen between MDCT and EUS. Protruding lesions of less than 10 mm in height were better visualized with MDCT (53.3%) than with SDCT (13.0%; P < 0.05). Multidetector computed tomography proved more useful than SDCT and equivalent to EUS in detecting protruding lesions in IPMNs. | 18,981,954 |
Why do district nurse prescribers alter their prescribing patterns? | This paper describes how district nurses decide what products to start prescribing and explores the reasons why prescribing patterns change. It is based on semi-structured interviews with fourteen nurses from one primary care trust. The first products prescribed immediately following qualification depended on the route taken to becoming a prescriber. These were either the same products they had been using before qualifying as a prescriber or if prescribing was included with their district nurse training then it was the same products that their mentor prescribed. The two drivers for changes in prescribing patterns were patients, whose current therapy was ineffective, and products, where patients were selected to try new products on. Representatives from the pharmaceutical industry and fellow nurses had the greatest influence on product selection for those prescribers that changed their prescribing. The nurse's own experience had the greatest impact on the decision to continue prescribing a new product. | 18,981,966 |
District nursing workforce planning: a review of the methods. | District nursing services in Northern Ireland face increasing demands and challenges which may be responded to by effective and efficient workforce planning and development. The aim of this paper is to critically analyse district nursing workforce planning and development methods, in an attempt to find a suitable method for Northern Ireland. A systematic analysis of the literature reveals four methods: professional judgement; population-based health needs; caseload analysis and dependency-acuity. Each method has strengths and weaknesses. Professional judgement offers a 'belt and braces' approach but lacks sensitivity to fluctuating patient numbers. Population-based health needs methods develop staffing algorithms that reflect deprivation and geographical spread, but are poorly understood by district nurses. Caseload analysis promotes equitable workloads but poorly performing district nursing localities may continue if benchmarking processes only consider local data. Dependency-acuity methods provide a means of equalizing and prioritizing workload but are prone to district nurses overstating factors in patient dependency or understating carers' capability. In summary a mixed method approach is advocated to evaluate and adjust the size and mix of district nursing teams using empirically determined patient dependency and activity-based variables based on the population's health needs. | 18,981,969 |
[Comparative study among autologous and synthetic slings in the treatment of stress urinary incontinence]. | Procedures to correct stress urinary incontinence (SUI) are designed to restore support of the urethrovescical junction and, in cases of intrinsic sphinteric dysfunction, improve the coaptation of the urethra. Voiding dysfunction and urinary retention are frequent complications of both urethropexy and urethral sling. Guatelli et al. reported a 8.5% obstruction rate following autologous sling procedure, while the obstruction rate after polypropylene sling meshes procedures was 3.7%. The aim of this study was to compare the success and bladder outlet obstruction (BOO) rates following sling procedure for SUI with two different mesh materials, synthetic versus autologous. A prospective study was carried out between July 1995 and December 1995 at the Department of Urology, University of Campinas Medical Center. The median time between the anti-incontinence procedure and the diagnosis of BOO was nine months (3-96 months). All obstructed patients suffered from refractory urgency/frequency syndrome with varying postvoid residual volume. Our experience showed that autologous pubovaginal slings were statistically more obstructive than synthetic ones. Autologous and synthetic slings presented comparable success rates in treating SUI. However, BOO was more frequent among patients who underwent autologous sling procedure. | 18,981,974 |
A one-session circumferential reconstruction in thoracic and lumbar spine fractures using a small expandable cage. | Circumferential reconstruction of thoracic and lumbar vertebrae is most frequently performed in two sessions. The authors assessed feasibility, safety and results of a surgical technique in which the use of a small cage allows a less invasive strategy. In addition, since the authors perform urgent decompression in specific cases of spinal cord injury, feasibility of this technique in emergency was verified. In two Neurosurgical Departments, between May 2001 and May 2006, 62 patients with thoracic or lumbar fractures were operated on using this technique. X-rays were performed postoperatively and around 45 days from surgery. Three-dimension-computed tomography (3D-CT) scans were performed at 3, 6 and 12 months. Neurological evaluations were repeated at every outpatient visit. After screw insertion at the adjacent levels and traditional transpedicular circumferential decompression, further bone is removed to excavate a niche in the vertebral body and the contiguous discs are removed. The expandable cage, filled with bone fragments, is inserted horizontal or oblique laterally to the sac and applied vertical inside that niche and then expanded. The circumferential stabilization is completed with bone grafting and posterior instrumentation. 3D-CT scans showed sound fusion and no manifest correction loss. Nineteen patients improved at least one grade in the ASIA scale and 11 gained neuromeric levels. This technique, fairly undemanding and feasible also in emergency, proved to be safe and resistant. Two-year follow-up demonstrated thriving fusion and steady alignment. It is a valuable surgical therapy to selected cases of burst fracture. | 18,981,984 |
NRP/B mutations impair Nrf2-dependent NQO1 induction in human primary brain tumors. | Brain tumors are associated with genetic alterations of oncogenes and tumor suppressor genes. Accumulation of reactive oxygen species (ROS) in cells leads to oxidative stress-induced damage, resulting in tumorigenesis. Here, we showed that the nuclear matrix protein nuclear restricted protein in brain (NRP/B) was colocalized and interacted with NF-E2-related factor 2 (Nrf2). During oxidative stress response, NRP/B expression and its interaction with Nrf2 were upregulated in SH-SY5Y cells. Association of NRP/B with Nrf2 was crucial for NAD(P)H:quinone oxidoreductase 1 (NQO1) expression. NRP/B was localized predominantly in the nucleus of normal brain cells, whereas in primary brain tumors NRP/B was almost exclusively contained in the cytoplasm. In addition, unlike wild-type NRP/B, the expression of NRP/B mutants isolated from primary brain tumors was found in the cytoplasm, and these mutants failed to induce Nrf2-dependent NQO1 transcription. Thus, NRP/B mutations and their altered localization resulted in changes in NRP/B function and deregulation of Nrf2-dependent NQO1 activation in brain tumors. This study provides insights into the mechanism by which the NRP/B modulates Nrf2-dependent NQO1 induction in cellular protection against ROS in brain tumors. | 18,981,988 |
Genetic influences on growth and body composition in mice: multilocus interactions. | The genetic architecture of body weight and body composition is complex because these traits are normally influenced by multiple genes and their interactions, even after controlling for the environment. Bayesian methodology provides an efficient way of estimating these interactions. We used Bayesian model selection techniques to simultaneously estimate the main effects, epistasis and gene-sex interactions on age-related body weight (at 3, 6 and 10 weeks, denoted as WT3wk, WT6wk and WT10wk) and body composition (organ weights and fat-related traits) in an F(2) sample obtained from a cross between high-growth (M16i) mice and low-growth (L6) mice. We observed epistatic and main-effect quantitative trait loci (QTL) that controlled both body weight and body composition. Epistatic effects were generally more significant for WT6wk than WT10wk. Chromosomes 5 and 13 interacted strongly to control body weight at 3 weeks. A pleiotropic QTL on chromosome 2 was associated with body weight and some body composition phenotypes. Testis weight was regulated by a QTL on chromosome 13 with a significantly large main effect (2log(e)BF approximately 15). By analyzing epistatic interactions, we detected QTL not found in a previous analysis of this mouse population. Hence, the detection of gene-gene interactions may provide new information about the genetic architecture of complex obesity-related traits and may lead to the detection of additional obesity genes. | 18,982,013 |
A method for prolonged imaging of motile lymphocytes. | With new imaging technologies and fluorescent probes, live imaging of cells in vitro has revolutionized many aspects of cell biology. A key goal now is to develop systems to optimize in vitro imaging, which do not compromise the physiological relevance of the study. We have developed a methodology that contains non-adherent cells within the field of view. 'Cell paddocks' are created by generating an array of microgrids using polydimethylsiloxane. Each microgrid is up to 250 x 250 microm(2) with a height of 60 microm. Overlayed cells settle into the grids and the walls restrict their lateral movement, but a contiguous supply of medium between neighboring microgrids facilitates the exchange of cytokines and growth factors. This allows culture over at least 6 days with no impact upon viability and proliferation. Adaptations of the microgrids have enabled imaging and tracking of lymphocyte division through multiple generations of long-term interactions between T lymphocytes and dendritic cells, and of thymocyte-stromal cell interactions. | 18,982,018 |
Burnout, psychological distress, and overwork: the case of Quebec's ophthalmologists. | Studies have shown that physicians are subject to high stress levels that can lead to mental health problems. Ophthalmologists are facing particularly high pressures because of shortages in their number and lack of resources. This study describes the state of mental health of Quebec's ophthalmologists and identifies certain elements of their work environment and personal lives that may contribute to problems. This cross-sectional study uses self-report questionnaires, including validated instruments, as well as instruments created for the study. A total of 133 out of 266 Quebec's ophthalmologists participated in the study. More than 35% of ophthalmologists reported high levels of burnout and psychological distress. The 5 main occupational stressors were growth in demand for services (49.2%), shortage of ophthalmologists (48.1%), amount of work to be done (45.4%), budgetary pressures (44.6%), and repeated training of new work teams (41.9%). Self-acceleration is the defensive strategy used most often to deal with work overload. Nearly half (47.4%) reported having problems reconciling work and personal life. The mean scores indicate that ophthalmologists received little recognition from administration. Work overload and systemic organizational deficiencies are burdening ophthalmologists in Quebec. They constantly work harder to preserve their professional ideals, but they receive little recognition from the administration. The levels of distress observed in this context point to the need for the authorities to take action to improve practice conditions. The situation is urgent because population aging has already begun to cause a sharp increase in demand, and younger physicians appear to be suffering most from work overload and burnout. | 18,982,028 |
Intrinsic capability of budding yeast cofilin to promote turnover of tropomyosin-bound actin filaments. | The ability of actin filaments to function in cell morphogenesis and motility is closely coupled to their dynamic properties. Yeast cells contain two prominent actin structures, cables and patches, both of which are rapidly assembled and disassembled. Although genetic studies have shown that rapid actin turnover in patches and cables depends on cofilin, how cofilin might control cable disassembly remains unclear, because tropomyosin, a component of actin cables, is thought to protect actin filaments against the depolymerizing activity of ADF/cofilin. We have identified cofilin as a yeast tropomyosin (Tpm1) binding protein through Tpm1 affinity column and mass spectrometry. Using a variety of assays, we show that yeast cofilin can efficiently depolymerize and sever yeast actin filaments decorated with either Tpm1 or mouse tropomyosins TM1 and TM4. Our results suggest that yeast cofilin has the intrinsic ability to promote actin cable turnover, and that the severing activity may rely on its ability to bind Tpm1. | 18,982,060 |
Functional diffusion tensor imaging: measuring task-related fractional anisotropy changes in the human brain along white matter tracts. | Functional neural networks in the human brain can be studied from correlations between activated gray matter regions measured with fMRI. However, while providing important information on gray matter activation, no information is gathered on the co-activity along white matter tracts in neural networks. We report on a functional diffusion tensor imaging (fDTI) method that measures task-related changes in fractional anisotropy (FA) along white matter tracts. We hypothesize that these fractional anisotropy changes relate to morphological changes of glial cells induced by axonal activity although the exact physiological underpinnings of the measured FA changes remain to be elucidated. As expected, these changes are very small as compared to the physiological noise and a reliable detection of the signal change would require a large number of measurements. However, a substantial increase in signal-to-noise ratio was achieved by pooling the signal over the complete fiber tract. Adopting such a tract-based statistics enabled us to measure the signal within a practically feasible time period. Activation in the sensory thalamocortical tract and optic radiation in eight healthy human subjects was found during tactile and visual stimulation, respectively. The results of our experiments indicate that these FA changes may serve as a functional contrast mechanism for white matter. This noninvasive fDTI method may provide a new approach to study functional neural networks in the human brain. | 18,982,065 |
A practical synthesis of the 16C/15N-labelled tripeptide N-formyl-Met-Leu-Phe, useful as a reference in solid-state NMR spectroscopy. | A mild synthetic method for N-formyl-Met-Leu-Phe-OH (1) is described. After Fmoc solid phase peptide synthesis, on-bead formylation and HPLC purification, more than 30 mg of the fully (13)C/(15)N-labelled tripeptide 1 could be isolated in a typical batch. This peptide can be easily crystallised and is therefore well suited as a standard sample for setting up solid-state NMR experiments. | 18,982,075 |
Suicidality and antidepressants in the elderly. | Suicide has reached epidemic proportions in the elderly, particularly in non-Hispanic white men. Unfortunately, the risk is underappreciated in this population. Known risk correlates for suicide in this population fall into three interrelated categories. Sociologic factors include such considerations as living alone and having few social interactions. Physical health factors include having more medical comorbidity and being a current smoker. The mental health risk factors include the presence of mood and anxiety disorders with a focus on the greater severity of symptoms, especially hypersomnia, hopelessness, and a history of suicide attempts. Suicide is a spectrum comprising ideation, intent, and plan. Clinical depression is never a normal part of aging and warrants aggressive treatment. Recent warnings linking antidepressants and suicide may have special relevance in the elderly. Based on preliminary studies with antipsychotic drugs, a subgroup of patients who experience akathisia may be particularly vulnerable to suicide. Upon initiation of antidepressants, it is recommended that adults be seen in follow-up three times within the first 12 weeks of treatment; if medically indicated, the first contact should be during the first week. | 18,982,077 |
Pulmonary invasive mucormycosis in a patient with secondary iron overload following deferoxamine therapy. | Mucormycosis (zygomycosis) is an acute and often fatal opportunistic fungal infection. Predisposing factors in the development of mucormycosis are nonspecific and include hyperglycemia, hematologic malignancies, neutropenia, pharmacologic immunosuppression, solid organ or bone marrow/stem cell transplantation, burns, trauma, malnutrition, and intravenous drug use. Mucormycosis has also been described in patients with iron and aluminum overload, patients on dialysis, and patients receiving iron chelating therapy. We describe a 75-year-old man with myelodysplastic syndrome and iron overload secondary to multiple red blood cell transfusions who had been treated with deferoxamine chelation therapy. He was admitted to the hospital for atrial fibrillation, developed multiple organ failure, and died. Pulmonary invasive mucormycosis was demonstrated at autopsy. This case further documents an association between invasive mucormycosis, iron overload, and deferoxamine therapy. | 18,982,078 |
Network model of spontaneous activity exhibiting synchronous transitions between up and down States. | Both in vivo and in vitro recordings indicate that neuronal membrane potentials can make spontaneous transitions between distinct up and down states. At the network level, populations of neurons have been observed to make these transitions synchronously. Although synaptic activity and intrinsic neuron properties play an important role, the precise nature of the processes responsible for these phenomena is not known. Using a computational model, we explore the interplay between intrinsic neuronal properties and synaptic fluctuations. Model neurons of the integrate-and-fire type were extended by adding a nonlinear membrane current. Networks of these neurons exhibit large amplitude synchronous spontaneous fluctuations that make the neurons jump between up and down states, thereby producing bimodal membrane potential distributions. The effect of sensory stimulation on network responses depends on whether the stimulus is applied during an up state or deeply inside a down state. External noise can be varied to modulate the network continuously between two extreme regimes in which it remains permanently in either the up or the down state. | 18,982,119 |
Persistently active, pacemaker-like neurons in neocortex. | The neocortex is spontaneously active, however, the origin of this self-generated, patterned activity remains unknown. To detect potential "pacemaker cells," we use calcium imaging to directly identify neurons that discharge action potentials in the absence of synaptic transmissionin slices from juvenile mouse visual cortex. We characterize 60 of these neurons electrophysiologically and morphologically, finding that they belong to two classes of cells: one class composed of pyramidal neurons with a thin apical dendritic tree and a second class composed of ascending axon interneurons (Martinotti cells) located in layer 5. In both types of neurons, persistent sodium currents are necessary for the generation of the spontaneous activity. Our data demonstrate that subtypes of neocortical neurons have intrinsic mechanisms to generate persistent activity. Like in central pattern generators (CPGs), these neurons may act as "pacemakers" to initiate or pattern spontaneous activity in the neocortex. | 18,982,123 |
Conservative approach in the management of severe acute pancreatitis: eight-year experience in a single institution. | Recognition of severe acute pancreatitis (SAP), intensive care, shifting away from early surgical treatment, and monitoring of the intra-abdominal pressure (IAP) is important in the management of SAP. The aim of our study was retrospective evaluation and critical assessment of the experience with SAP management protocol involving new strategy in the university hospital. Protocols of 274 SAP patients treated in our institution during the last eight years were reassessed. APACHE II, CRP and SOFA score, IAP, pulmonary complications, ventilatory support and infection rate were evaluated. The success of the conservative treatment, surgical interventions and mortality was analysed comparing period 1 from 1999 to 2002 and period 2 from 2003 to 2006. More patients with necrotising SAP were treated in period 2. The average CRP and SOFA score was higher in period 2, p=0.018; p=0.011. A total of 139 patients underwent continuous veno-venous haemofiltration (CVVH) as a component of fluid resuscitation and IAP control. Application of CVVH increased in period 2, p<0.005. Only 5-8% of patients were managed with ventilatory support. The overall infection rate decreased in period 2 comprising 21%, p<0.005. Success rate of the conservative therapy reached 69% in period 2, p<0.01. Surgical treatment was performed in 41% of patients in period 1 vs. 19% in period 2, p<0.001. Overall mortality was 19%, with a reduction to 12% in year 2006. The conservative protocol-based approach is a rational treatment strategy for the management of SAP and can be successfully implemented in the setting of the university hospital. | 18,982,151 |
The anatomic location of pancreatic cancer is a prognostic factor for survival. | Pancreatic cancers of the body and tail (BT) appear to have poorer survival compared with head (HD) lesions. We hypothesized that potential disparities in outcome may be related to tumor location. Our objective was to examine the relationship between tumor location and survival. The Surveillance, Epidemiology, and End Results registry identified 33,752 patients with pancreatic adenocarcinoma and 6443 patients who underwent cancer-directed surgery between 1988 and 2004. Differences in survival and relationships between tumor location and clinical factors were assessed. Multivariate analysis was performed to determine the prognostic significance of tumor location. Median survival for the entire cohort was five months and was significantly lower for BT compared to HD lesions (four vs. six months, p<0.001). Distant metastases (67% vs. 36%, p<0.001) were greater and cancer-directed surgery (16% vs. 30%, p<0.001) was lower for BT tumors. Of 6443 resected patients, HD patients (n=5118) were younger, had a greater number of harvested lymph nodes, were more likely to be lymph node-positive, and had a higher proportion of T3/T4 lesions. Significant univariate predictors of survival included age, T-stage, number of positive and harvested lymph nodes. On multivariate analysis, BT location was a significant prognostic factor for decreased survival (OR 1.11, 95% CI 1.00-1.23, p=0.05). Pancreatic BT cancers have a lower rate of resectability and poorer overall survival compared to HD lesions. Prospective large-cohort studies may definitively prove that tumor location is a prognostic factor for survival in patients with pancreatic cancer. | 18,982,154 |
Following the cytokine signaling pathway to leukemogenesis: a chronology. | Studies over the past 50 years revealing the molecular events that promote normal T lymphocyte cycle competence and progression led to a detailed understanding of how cytokines function to regulate normal hematopoietic cell proliferation. During that same period, the molecular and genetic changes introduced by the Philadelphia chromosome in chronic myelogenous leukemia were unraveled, and these have led to an understanding of how mutations that constitutively activate normal cytokine signaling pathways can cause unregulated cell proliferation and malignant transformation. Based on the paradigm established by these data, it is inescapable that going forward, investigators will operate under the hypothesis that transformation of additional cells and tissues will have a similar pathogenesis. | 18,982,163 |
Serotonin2A receptor binding potential in people with aggressive and violent behaviour. | Indexes of brain serotonin2A (5-HT2A) density have never been investigated in a sample of humans with violent aggressive behaviour unbiased by medication use or current axis I psychiatric disorders. The objective of this study was to investigate prefrontal cortex 5-HT2A binding potential (BPND), an index of 5-HT2A density, in an unbiased sample of people with violent aggressive behaviour. We used [18F] setoperone positron emission tomography to measure 5-HT2A BPND in the dorsolateral prefrontal cortex (primarily sampling Brodmann area 9) in 16 participants with violent aggressive behaviour and 16 healthy control participants. In people with violent aggressive behaviours, the slope of 5-HT2A BPND decline in the dorsolateral prefrontal cortex is 44% less than in healthy control participants (analysis of variance group by age interaction, p = 0.004). Prefrontal cortex 5-HT2A BPND was significantly lower in participants with more severe impulsivity and aggression (multiple linear regression with age and Barratt Impulsivity Scale [BIS] as predictor variables and regional 5-HT2A BPND as dependent variable; effect of BIS, dorsolateral prefrontal cortex: F1,13 = 7.95, p = 0.014). Lower prefrontal 5-HT2A BPND is related to violent aggression. Lower 5-HT2A BPND occurs at a younger age, when violent behaviour is more frequent, and is more prominent when impulsivity and aggression are more severe. | 18,982,172 |
Stress fractures and stress reactions of the diaphyseal femur in collegiate athletes: an analysis of 25 cases. | In this review of prospectively collected data, representing the largest series of its kind, we identified 25 stress injuries of the diaphyseal femur in 20 athletes at an NCAA (National Collegiate Athletic Association) Division I university. All 20 patients successfully completed rehabilitation and returned to activity without limitations. Seventeen of these patients (representing 22 injuries) were female, and all 5 patients who sustained 2 stress injuries were female. The higher proportion of injured females in this study, and the histories of menstrual irregularities and disordered eating, raised the concern that the female athlete triad may be a factor. It is important to consider the diagnosis of stress injuries of the diaphyseal femur when evaluating thigh pain in running athletes, especially females, as early diagnosis and treatment lead to excellent outcomes and full return to activity. Magnetic resonance imaging should be considered the gold standard in the diagnostic evaluation of these injuries. Further, as stress fractures may be the first presentation of the female athlete triad, it is also important for orthopedic surgeons to identify the presence of risk factors that may predispose athletes to recurrent stress injuries and other health problems. | 18,982,185 |
Heterogeneous natures of the microbial steroid 9alpha-hydroxylase in nocardioforms. | Steroid 9alpha-hydroxylase is an enzyme found in nocardioform microorganisms which can utilize steroids as a sole carbon source. After fractional centrifugation of the cell homogenates, the enzyme activity inNocardia andRhodococcus was found in cytoplasmic membrane fraction. On the contrary,Mycobacterium had its 9alpha-hydroxylation activity in cytosolic fraction. To characterize the enzyme in these microorganisms, several potential inhibitors of 9alpha-hydroxylase were tested and the cofactor requirement for the same enzyme was also examined. The inhibitory effect of ferrous ion chelators indicated involvement of iron containing proteins in the 9alpha-hydroxylase system. On the other hand, metyrapone, an inhibitor known to be specific for cytochrome P450 interfered with the enzyme inMycobacterium, but didn't inhibit the enzyme activity inNocardia andRhodococcus. While the 9alpha-hydroxylase system inNocardia andRhodococcus required NADPH, NADH was required as an election donor inMycobacterium. | 18,982,252 |
Antihepatotoxic zeaxanthins from the fruits ofLycium chinense. | A CHCl(3): MeOH extract of the fruit ofLycium chinense Mill. (Solanaceae) was found to afford significant protection against carbon tetrachloride-induced toxicity in primary cultures of rat hepatocytes. Subsequent activity-guided fractionation resulted in the isolation of zeaxanthin and zeaxanthin dipalmitate as antihepatotoxic components. Incubation of injured hepatocytes with zeaxanthin dipalmitate reduced the levels of glutamic pyruvic transaminase (GPT) and sorbitol dehydrogenase (SDH) released from damaged cells to 60.5% and 76.3% of those released from untreated controls, respectively. Zeaxanthin also reduced the levels of GPT and SDH to 68.5% and 61.3% of the levels of those released from the untreated control. The results confirm the hepatoprotective activities of zeaxanthins. Antihepatotoxic activities of zeaxanthins are comparable to that of silybin. | 18,982,254 |
Interactive two-dimensional fresh blood imaging: a feasibility study. | This paper presents work on interactive 2D projection magnetic resonance angiography, based on fresh blood imaging (FBI), which integrates navigation and triggering optimisation into a continuous fluoroscopic procedure. The technique was developed on a clinical 1.5-T MRI system and performed in five healthy volunteers. Initial feasibility study compared FBI projection angiograms with maximum intensity projection reformats from multi-slice, ECG-gated, 2D time-of-flight (TOF) in the lower peripheral arteries. A technical performance evaluation of 40 vessel segments showed that FBI generated angiograms of comparable diagnostic quality (P < 0.074) with fewer artefacts (P < 0.003). Quantitative vessel-to-background contrast measurements were higher in FBI (P < 0.014). The technique has potential application as an interactive vascular imaging tool in interventional or multi-location MRI examinations. | 18,982,330 |
Subnuclear compartmentalization and function of actin and nuclear myosin I in plants. | Actins are highly conserved proteins that serve as the basic building blocks of cytoskeletal microfilaments. In animal cells, specific nuclear actin adopts unconventional conformations that are involved in multiple nuclear functions and that associate with nuclear actin binding proteins. However, there is practically no information available about nuclear actin in plants. Indeed, actin has not been detected in the nuclear proteomes of many plants, and orthologs of the main structural nuclear actin-binding proteins have yet to be identified. Here, we have investigated the characteristics, intranuclear compartmentalization, and function of actin in isolated Allium cepa nuclei as well as that of its motor protein nuclear myosin I (NMI). Using conformation-specific antibodies for nuclear actin isoforms, ss-actin, and NMI, the distribution of these proteins was studied in Western blots and by immunocytochemistry. Moreover, the participation of nuclear actin in transcription was analyzed in run on in situ assays and inhibition of RNA polymerases I and II. We show that actin isoforms with distinct solubilities are present in onion nuclei with a consistent subnuclear compartmentalization. Actin and NMI are highly enriched in foci that are similar to transcription foci, although actin is also distributed diffusely in the nucleus and nucleolus as well as accumulating in a subset of the Cajal bodies. Immunogold labeling identified both proteins in the nuclear transcription subdomains and in other subnuclear compartments. In addition, actin and NMI were diffusely distributed in the nuclear matrix. | 18,982,342 |
Ocular involvement in Adamantiades-Behçet's disease in Berlin, Germany. | Epidemiological studies demonstrate a prevalence of Adamantiades-Behçet's disease (ABD) in the range of 0.12-420 per 100,000 inhabitants, with the highest rates in Istanbul, Turkey, and the lowest rates in the USA. Ophthalmological data on the prevalence of ocular involvement are limited for ABD in Germany, because most epidemiological studies are based on rheumatological or dermatological data. Berlin is the city with the highest number of non-native German inhabitants, and its multi-ethnic character renders it uniquely appropriate for epidemiological studies on ABD. We retrospectively analyzed all ABD patients seen in our department since 1982. All patients fulfilled the criteria of the International Study Group for Behçet's Disease. We found 140 patients (63 female, 77 male), with a mean follow-up of 6.4 years (0.5-22 years). The mean age was 23 at the first manifestation and 32 when the full-blown disease was noted. The mean age at onset of ocular involvement was 30. Most of the patients were of Turkish (n = 73) or German (n = 34) origin. Fifty-six percent developed ocular involvement, which was the first manifestation in 8.6% and the second manifestation in 19.3% of cases. More than half the patients developed ocular involvement. The calculated prevalence of ocular involvement in ABD is 1.77/100,000 inhabitants for the municipality of Berlin. | 18,982,344 |
Hospital admission in children up to the age of 2 years. | The description and analysis of the utilisation of medical services is of particular importance reflecting childhood morbidity. Therefore, our aim was to describe episode- and person-based rates of hospital admission in Germany, by focusing on the three most important clinically relevant categories, accident injuries, respiratory and digestive diseases in children up to the age of 2 years. The analysis was based on data from the LISA-study, a prospective population based birth cohort study including 3097 full-term infants. Information was collected by parent questionnaires and data was analysed concerning gender, region and social status. In the age-group 7-24 months, 14.5% of all children were at least once hospitalised, 2.5% for accident injuries, 3.0% for respiratory and 4.7% for digestive diseases. More boys than girls were admitted to hospital due to respiratory diseases (4.2% vs. 1.7%) and more children from East compared to West Germany due to digestive diseases (7.2% vs. 3.5%). In families with median or low level education more children were admitted for digestive diseases than with high (6.5% and 6.5% vs. 3.6%). The number of hospitalisation episodes per person showed that most children were hospitalised only once during the period from 7 to 24 months. In conclusion this analysis shows that hospital admission is common and not equally distributed concerning sex, parental education and region in German children. Physicians should pay special attention to these susceptive subgroups and differences in health related behaviour and in the distribution of health facilities have to be reduced. Additionally, multiple admissions play only a minor role concerning hospital admission in children up to the age of 2 years. | 18,982,350 |
Replenishment success linked to fluctuating asymmetry in larval fish. | Fluctuating asymmetry (FA), defined as random deviations from perfect symmetry, has become a popular tool with which to examine the effects of stress during the development of bilaterally symmetrical organisms. Recent studies have suggested that FA in otoliths may serve as an indicator of stress in fish larvae. We examined the relationship between otolith asymmetry and temporal patterns in the occurrence of late-stage larvae to a tropical reef (i.e. replenishment) for the Caribbean lizardfish, Saurida suspicio (family Synodontidae). Late-stage larvae were collected in light traps over a period of 18 consecutive lunar months in the San Blas Archipelago, Panama. Asymmetry within otolith pairs was calculated from 24 variables: area, perimeter, longest and shortest axis of the otolith and 20 shape descriptors (Fourier harmonics). Otolith asymmetry was correlated strongly with fluctuations in lunar light trap catches. Two measured variables, otolith area and one of the 20 shape descriptors, accounted for 60% of the variability in lunar replenishment of S. suspicio. Individuals from small replenishment pulses exhibited higher levels of asymmetry compared to larvae from large pulses. When dry and wet seasons were analysed separately, otolith asymmetry explained a surprising 70 and 97% of the variation, respectively. Although the generality of these results remain to be tested among other populations and species, otolith asymmetry may be an important indicator, and potentially a predictor, of larval quality and replenishment success. | 18,982,353 |
Testing the threat-sensitive predator avoidance hypothesis: physiological responses and predator pressure in wild rabbits. | Predation is a strong selective force with both direct and indirect effects on an animal's fitness. In order to increase the chances of survival, animals have developed different antipredator strategies. However, these strategies have associated costs, so animals should assess their actual risk of predation and shape their antipredator effort accordingly. Under a stressful situation, such as the presence of predators, animals display a physiological stress response that might be proportional to the risk perceived. We tested this hypothesis in wild European rabbits (Oryctolagus cuniculus), subjected to different predator pressures, in Doñana National Park (Spain). We measured the concentrations of fecal corticosterone metabolites (FCM) in 20 rabbit populations. By means of track censuses we obtained indexes of mammalian predator presence for each rabbit population. Other factors that could modify the physiological stress response, such as breeding status, food availability and rabbit density, were also considered. Model selection based on information theory showed that predator pressure was the main factor triggering the glucocorticoid release and that the physiological stress response was positively correlated with the indexes of the presence of mammalian carnivore predators. Other factors, such as food availability and density of rabbits, were considerably less important. We conclude that rabbits are able to assess their actual risk of predation and show a threat-sensitive physiological response. | 18,982,355 |
Progression of coronary calcification in pediatric chronic kidney disease stage 5. | Coronary artery calcification (CAC) is common in adults with chronic kidney disease (CKD) and progresses with time. However, data are limited for younger patients. We have previously reported CAC in eight of 53 children with CKD. After 2 years, CAC evaluation was repeated in 48 patients. The median CAC score (CACS) increased from 101.3 (1473.6 +/- 1978.6, range 8.5-4332) to 1759.2 (2236.4 +/- 2463.3, range 0-5858) Agatston units (AU). When the individual changes in CACS were evaluated one by one, we showed a mild decrease in two patients on hemodialysis (HD) and in one transplant (Tx) recipient, a moderate increase in one patient on HD, one on peritoneal dialysis (PD) and one Tx recipient, and a large increase in one HD patient. Also, CAC disappeared in one HD patient. All patients with no calcification at baseline remained calcification-free at follow-up. To obtain the individual cumulative exposure, we calculated time-averaged mean values, using the laboratory values from the beginning of dialysis to the first and second multidetector spiral computed tomography (MDCT) scans (baseline and final values, respectively). Final CACS was positively related to final calcium-phosphorus (CaxP) product, while CAC progression was inversely associated with final serum albumin level. This report is the first study with the largest number and the youngest cohort to document the natural history of coronary calcification. | 18,982,357 |
Multi-method assessment of behavior adjustment in children with chronic kidney disease. | To describe the psychological adjustment in children with chronic kidney disease (CKD), we studied behavioral problems in 19 patients with CKD stage 5 on regular hemodialysis, 19 patients in the predialysis stage, and 19 control children, using the child behavior checklist (CBCL) and the semi-structured clinical interview for children and adolescents (SCICA). For CBCL scales, the mean score on the internalizing scale was significantly higher in the children on dialysis than in predialysis and control children. No significant differences in the mean scores of the total problem or externalizing scales were found between the groups studied. The mean score of SCICA observed problems and total self-reports were significantly higher in the control group than in the CKD groups. The mean score on total self-report was significantly higher in the control children than in the predialysis group. There were significant positive correlations between SCICA self-report and all CBCL scales. No significant correlations were found between these CBCL and SCICA scales and age, gender, severity of anemia, duration of CKD or the efficiency or the duration of hemodialysis in the CKD patients. In conclusion, multi-method assessment of children's adjustment through different informants yields a comprehensive view of child psychopathology in CKD that calls for psychosocial support and early identification of maladjustment. | 18,982,359 |
Temporal information coding properties of a network of inhibitory interneurons. | Inhibitory interneurons are coupled by electrical and inhibitory synapses and exert a powerful control of the discharges of principal cells. In this paper, the transmission properties of excitatory synaptic inputs by a network of interneurons, are studied by using a computational approach. It is shown that both the rise and decay time constants, describing the time course of the excitatory synaptic inputs, have a strong effect on the output jitter of the fired spikes. Similar results were found by changing the values of the other parameters describing the network. Lastly, it is shown that the presence of the electrical coupling between interneurons confers to the network the capability of transmitting, with less temporal spread, the timing information contained in its inputs. | 18,982,371 |
Effect of a seaweed extract on fatty acid accumulation and glycerol-3-phosphate dehydrogenase activity in 3T3-L1 adipocytes. | This study was to determine the effect of a seaweed Ascophyllum nodosum extract (SE) containing 220 mg g(-1) phlorotannins on differentiation and fatty acid accumulation in differentiating 3T3-L1 adipocytes. 3T3-L1 cells (2 x 10(4) mL(-1)) were seeded to 24-well plates and proliferated to reach confluence and then were treated with media containing 0, 12.5, 25, 50, 75 and 100 mug mL(-1) SE for 8 days. Dexamethasone, methyl-isobutylxanthine and insulin (DMI) were added to the media in the first 2 days to induce cell differentiation. On day 8 the adipocytes were harvested for measuring cellular fatty acid concentration and the activity of glycerol-3-phosphate dehydrogenase (GPDH). It was found that treatment with SE increased (P < 0.01, n = 6) cellular myristoleic acid (C14:1), palmitoleic acid (C16:1) and oleic acid (C18:1) and total monounsaturated fatty acids (MUFA) without significantly affecting the cell number and saturated fatty acid (SFA). Ratios of MUFA/SFA, C14:1/C14:0, C16:1/C16:0 and C18:1/C18:0 in cellular lipids increased (P < 0.05, n = 6) with the SE treatment in a dose dependent manner (P < 0.001). Treatment with 75 microg mL(-1) SE depressed (P < 0.05) cellular GPDH activity. The results indicate that the biological factors in the SE may be involved in differentiation and MUFA accumulation in adipocytes. | 18,982,374 |
Angioplasty within 24 h after thrombolysis in patients with acute ST-elevation myocardial infarction: current use, predictors and outcome. Results of the MITRA plus registry. | Percutaneous coronary intervention (PCI) early after thrombolysis (early PCI) in patients with ST-elevation myocardial infarction (STEMI) is currently advised by clinical guidelines, but little is known about its use in clinical practice. We analysed the MITRA (Maximal Individual Therapy of Acute Myocardial Infarction) plus registry. Out of a total of 34276 patients with STEMI, 10600 (30.9%) were treated with intravenous thrombolysis. Out of these patients, 487 (4.6%) patients received an angioplasty between 61 min and 24 hours after thrombolysis. They were compared to 10113 (95.4%) patients who received PCI either later than 24 hours after thrombolysis or not at all. A continuous increase in the frequency of early PCI between the years 1994 (2%)-2002 (16.7%) was observed. After adjusting for confounding variables independent predictors to use early PCI were the increasing year of inclusion, the facility of the hospital to perform PCI, younger age and male gender. Hospital mortality was 7.2% in patients receiving early PCI, compared to 11.2% in the other group (<0.01). Independent predictors for a higher hospital mortality were shock, age >65 years, female gender, an anterior STEMI and a prehospital delay of >3 hours. However, early PCI was not longer associated with a lower mortality (OR 0.95, 95% CI 0.64-1.14). Early PCI after thrombolysis is used infrequently in current clinical practice in Germany. Especially 'low risk' patients were treated with an early PCI, which may contribute to the missing effect on mortality compared to no or late PCI after thrombolysis. | 18,982,378 |
A case of familial tumoral calcinosis/hyperostosis-hyperphosphatemia syndrome due to a compound heterozygous mutation in GALNT3 demonstrating new phenotypic features. | A new case of familial tumoral calcinosis (FTC)/hyperostosis-hyperphosphatemia syndrome (HHS) due to a novel compound heterozygous mutation in N-acetylgalactosaminyltransferase 3 (GALNT3) and with new phenotypic findings is presented. The response in serum phosphate and fibroblast growth factor 23 (FGF23) to medical treatment is detailed. This case expands the genotype and phenotype of FTC/HHS and gives insight into its treatment and pathophysiology. FTC and HHS are caused by mutations in FGF23, GALNT3, or KLOTHO. They are characterized by hyperphosphatemia, increased phosphate reabsorption, and elevated or inappropriately normal serum 1,25-dihydroxyvitamin D(3) (1,25-D(3)); FTC is associated with calcific masses, and HHS with diaphyseal hyperostosis. A 36-year-old woman presented with abnormal dental X-rays at age 12 and was hyperphosphatemic at 22. She underwent radiographic, biochemical and genetic testing, and medical treatment. Serum phosphorus was 7.3 mg/dL (2.5-4.8), TmP/GFR 6.99 mg/100 mL (2.97-4.45), 1,25-D(3) 35 pg/mL (22-67). Radiographs revealed tooth anomalies, thyroid cartilage calcification, calcific masses in vertebral spaces, calcification of the interstitial septa of the soft tissue in the lower extremities, and cortical thickening of the long bones. Her total hip Z score was 1.9. C-terminus serum FGF23 was 1,210 RU/mL (20-108), but intact FGF23 was 7.4 pg/mL (10-50). DNA sequencing determined she was a compound heterozygote for mutations in GALNT3. Treatment with niacinamide and acetazolamide decreased TmP/GFR and serum phosphate, which was paralleled by a decrease in serum C-terminus FGF23. This case broadens the spectrum of phenotypic and genotypic features of FTC/HHS and suggests treatments to decrease renal phosphate reabsorption in the setting of a low intact FGF23. | 18,982,401 |
Significant influence of the primary liver disease on the outcomes of hepatic retransplantation. | There are many indications for hepatic retransplantation. To identify factors influencing retransplantation needs and outcomes. Retransplantation records from January 1993 to March 2005 were analysed. Patient and disease characteristics and survival outcomes for retransplantation were compared between various groups. Totally, 286 primary and 42 hepatic retransplantations were performed. Retransplantation indications included primary sclerosing cholangitis (PSC), primary biliary cirrhosis, chronic hepatitis C (HCV), chronic active hepatitis (CAH), and alcohol-related disease. Mean follow-up post-retransplantation was 31 +/- 9 months. Actuarial patient survival at 3 months, 1 year, 3 years, 5 years, and at the end of study was 71.4, 69, 59.5, 54.7, and 50%, respectively. Early and late retransplantation had 1-year survival of 73 and 68.5%, respectively. Retransplantation need was significantly higher for PSC, HCV, and CAH. Hepatic retransplantation remains a successful salvage option for transplant complications; however, its need is significantly influenced by the primary liver disease. | 18,982,406 |
A depression preventive intervention for rural low-income African-American pregnant women at risk for postpartum depression. | Postpartum depression (PPD) is a major health problem for many women, including rural low-income African-American women. Researchers have documented the long lasting consequences of PPD. The purpose of this pilot study was to examine the initial acceptability, feasibility, and effectiveness of the ROSE Program, a brief, interpersonally-based intervention in a group of low-income, rural African-American pregnant women at risk for PPD. Participants were 36 African-American pregnant women at risk for PPD who attended a rural hospital-affiliated prenatal clinic. Participants were randomly assigned to the ROSE Program or to treatment as usual (TAU). Outcomes included measures of depressive symptoms, postpartum adjustment, and parental stress at 3 months postpartum. At 3 months postpartum, the study found no significant differences between the two conditions in degree of depressive symptoms or level of parental stress. The women in the intervention condition reported significantly better postpartum adjustment at 3 months postpartum than women in the TAU group. Those in the ROSE Program reported improvement in depressive symptoms over time, whereas women in the TAU group did not evidence such changes. These results provide initial effectiveness for the ROSE Program in improving postpartum functioning in a group of low-income, rural African-American pregnant women. | 18,982,408 |
Impact of DNA gyrase inhibition by antisense ribozymes on rec A in E. coli. | The chromosome of E. coli is maintained in a negatively supercoiled state, and supercoiling levels are affected by growth phase and a variety of environmental stimuli. Regulation of DNA supercoiling yields a complex spectrum of effects on the E. coli recA system. Previous studies indicated that inhibition of DNA gyrase by antibiotics that act on the DNA gyrase A subunit results in turning on the recA system. Here we show that antisense ribozymes that act on the DNA gyrase A subunit can also induce recA. We used real time PCR and immunoblot to analyze the impact of DNA gyrase A inhibition by antisense ribozymes on recA expression. When gyrase A was inhibited by the RNase P mediated antisense ribozymes the expression of recA was induced around 130-fold as seen by real time PCR analysis. This suggests that repair pathway is induced by antisense ribozymes against DNA gyrase A and the damage produced by these ribozymes may be similar to that produced by fluoroquinolones. | 18,982,424 |
Local inflammation exacerbates cyclosporine a-induced gingival overgrowth in rats. | Gingival overgrowth (GO) is a common side effect of long-term cyclosporine A (CsA) treatment. The risk factors appraised include drug interactions with calcium channel blockers, age, cyclosporine dose, dental bacterial plaque, duration of treatment, and genetic predisposition. The relationship and mechanism between GO and local inflammation caused by dental bacterial plaque have not been clearly defined. This research was carried out to investigate the histomorphometrical alterations and serum levels of transforming growth factor beta1 (TGF-beta1) in CsA-induced GO with or without local inflammation. Thirty-four male Sprague-Dawley rats were divided into 4 groups: Group I (control); Group II (ligation); Group III (CsA); Group IV (ligation and CsA). After 9 weeks the rats were sacrificed. The morphological examination was made and the histological changes with hematoxylin and eosin (HE) staining were observed. TGF-beta1 levels in serum were detected by enzyme-linked immunosorbent assay (ELISA). We report here that obvious GO are found in Group III and Group IV after CsA treatment, especially those rats with existed gingivitis presented an aggravation of GO. TGF-beta1 levels in CsA-exposed groups were significantly higher than untreated groups, but ligation did not affect TGF-beta1 level. These findings suggest that CsA-induced GO can be exacerbated by local inflammation. TGF-beta1 may be a key factor for the development of GO. | 18,982,435 |
Abnormal lead exposure in globally threatened Cinereous vultures (Aegypius monachus) wintering in South Korea. | Globally threatened Cinereous vultures (Aegypius monachus) regularly over-winter in South Korea, and they have frequently been found dead in their natural habitats. As one possible factor for their mortality, we investigated tissues for heavy metal contaminants along with necropsies on 20 dead Cinereous vultures. Severe emaciation was found in the survey, being associated with 19 of the deaths. Two of the 19 showed lesions suggestive of lead poisoning in the tissues; there was no indication of trauma, embedded shot, lead bullets in the stomach, or signs of electrocution in the specimens. Of 20 vultures, two showed lesions compatible with death from lead poisoning with 19.7 ppm dry weight (6.9 ppm wet weight) and 34.1 ppm dry weight (11.1 ppm wet weight), and 14 individuals had a potentially toxic level of lead with >6 ppm dry weight (about 2 ppm wet weight) in liver or kidney. The ingestion of lead-contaminated carcasses probably occurs along their migratory route. The possibility of lead exposure from the breeding site (Mongolia) or stopover area (China) should also be considered because some individuals are likely to die at or upon arrival. Our results suggest that most of the dead Cinereous vultures may be suffering from abnormally high lead exposure, indicating a potentially important cause of mortality in this endangered species. | 18,982,447 |
Regulation of IGFBP6 gene and protein is mediated by the inverse expression and function of c-jun N-terminal kinase (JNK) and NFkappaB in a model of oral tumor cells. | The aim of this study is to identify potential gene and protein targets when nuclear factor kappa B (NFkappaB) and c-jun N-terminal kinase (JNK) were inversely expressed in oral tumors. To determine which genes were regulated synergistically by the inverse expression of NFkappaB and JNK, a pathway specific microarray analysis was performed. While either inhibition of NFkappaB or activation of JNK alone was unable to affect the IGFBP6 gene expression in microarray analysis, concomitant increase in JNK activation in the presence of NFkappaB inhibition increased the expression of this gene significantly. Synergistic increase in IGFBP6 gene expression was also confirmed by RT-PCR and Northern blot analysis of transfected cells. Accordingly, the levels of IGFBP6 protein secretion rose synergistically when JNK was over-expressed in NFkappaB knock down cells. In addition, increased expression of JNK in the absence of NFkappaB resulted in a significant induction of cell death in oral tumors when either left untreated or treated with TNF-alpha and TPA. Moreover, when JNK was inhibited by dominant negative JNK (APF), a significant decrease in cell death could be observed in TNF-alpha and TPA treated NFkappaB knock down oral tumors. Therefore, increased induction of IGFBP6 gene or protein expression in oral tumors could be regarded as a potential predictive marker of tumor sensitivity and could be used for prognostic purposes, since a significant correlation could be observed between increased induction of apoptotic cell death and elevated levels of IGFBP6 in these tumors. | 18,982,452 |
Optimal scan time of oxygen-15-labeled gas inhalation autoradiographic method for measurement of cerebral oxygen extraction fraction and cerebral oxygen metabolic rate. | Regional cerebral blood flow (CBF), cerebral blood volume, oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO2) can be estimated from C15O, H(2)15O, and 15O2 tracers and positron emission tomography (PET) using an autoradiographic (ARG) method. Our objective in this study was to optimize the scan time for 15O2 gas study for accurate estimation of OEF and CMRO2. We evaluated statistical noise in OEF by varying the scan time and error caused by the tissue heterogeneity in estimated OEF and CMRO2 using computer simulations. The characteristics of statistical noise were investigated by signal-to-noise (S/N) ratio from repeated tissue time activity curves with noise, which were generated using measured averaged arterial input function and assuming CBF=20, 50, and 80 (ml/100 g per minute). Error caused by tissue heterogeneity was also investigated by estimated OEF and CMRO2 from tissue time activity curve with mixture of gray and white matter varying fraction of mixture. In the simulations, three conditions were assumed (i) CBF in gray and white matter (CBFg and CBFw) was 80 and 20, OEF in gray and white matter (Eg and Ew) was 0.4 and 0.3, (ii) CBFg and CBFw decreased by 50%, and Eg and Ew increased by 50% when compared with conditions (i) and (iii). CBFg and CBFw decreased by 80%, and Eg and Ew increased by 50% when compared with condition (i). The longer scan time produced the better S/N ratio of estimated OEF value from three CBF values (20, 50, and 80). Errors of estimated OEF for three conditions owing to tissue heterogeneity decreased, as scan time took longer. Meanwhile in the case of CMRO2, 3 min of scan time was desirable. The optimal scan time of 15O2 inhalation study with the ARG method was concluded to be 3 min from taking into account for maintaining the S/N ratio and the quantification of accurate OEF and CMRO2. | 18,982,469 |
Cloning and expression of human liver UDP-glucuronosyltransferase cDNA, UDPGTh2. | The human liver cDNA clone UDPGTh2, encoding a liver UDP-glucuronosyltransferase (UDPGT) was isolated from a lambda gt 11 cDNA library by hybridization to mouse transferase cDNA clone, UDPGTm1. UDPGTh2 encoded a 529 amino acid protein with an amino terminus membrane-insertion signal peptide and a carboxyl terminus membrane-spanning region. There were three potential asparagine-linked glycosylation sites at residues 67, 68, and 315. In order to obtain UDPGTh2 protein encoded from cloned human liver UDP-glucuronosyltransferase cDNA, the clone was inserted into the pSVL vector (pUDPGTh2) and expressed in COS 1 cells. The presence of a transferase with Mr approximately 52,000 in transfected cells cultured in the presence of [(35)S]methionine was shown by immunocomplexed products with goat antimouse transferase IgG and protein A-Sepharose and analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and autoradiography. The expressed UDPGT was a glycoprotein as indicated by electrophoretic mobility shift in Mr approximately 3,000-4,000 when expressed in the presence of tunicamycin. The extent of glycosylation was difficult to assess, although one could assume that glycosyl structures incorporated at the level of endoplasmic reticulum were always the core oligosaccharides. Thus, it is likely that at least two moieties inserted can account for the shift of Mr approximately 3,000-4,000. This study demonstrates the cDNA and deduced amino acid sequence of human liver UDP-glucuronosyltransferase cDNA, UDPGTh2. | 18,982,490 |
Spray-freeze-dried dry powder inhalation of insulin-loaded liposomes for enhanced pulmonary delivery. | Nowadays, growing attention has been paid to the pulmonary region as a target for the delivery of peptide and protein drugs, especially macromolecules with systemic effect like insulin, since the pulmonary route exhibits numerous benefits to be an alternative for repeated injection. Furthermore, encapsulation of insulin into liposomal carriers is an attractive way to increase drug retention time and control the drug release in the lung; however, its long-term stability during storage in the reservoir and the process of aerosolization might be suspected when practically applied. Thus, the aim of this study was to design and characterize dry powder inhalation of insulin-loaded liposomes prepared by novel spray-freeze-drying method for enhanced pulmonary delivery. Process variables such as compressed air pressure, pump speed, and concentration were optimized for parameters such as mean particle diameter, moisture content, and fine particle fraction of the produced powders. Influence of different kinds and amounts of lyoprotectants was also evaluated for the best preservation of the drug entrapped in the liposome bilayers after the dehydration-rehydration cycle. The in vivo study of intratracheal instillation of insulin-loaded liposomes to diabetic rats showed successful hypoglycemic effect with low blood glucose level and long-lasting period and a relative pharmacological bioavailability as high as 38.38% in the group of 8 IU/kg dosage. | 18,982,512 |
Antimetastatic activities of pegylated liposomal doxorubicin in a murine metastatic lung cancer model. | To determine whether pegylated liposomal doxorubicin (PLD) could control the metastasis beyond primary tumor, the efficacy of PLD was evaluated in terms of metastatic growth inhibition and increasing life span in a murine lung metastasis model. As early as 20 days after C57BL/6 mice were inoculated with 2 x 10(6) murine Lewis lung carcinoma cells into the right legs, metastases could be observed in the lungs. Comparing the metastatic status of the PLD treatment conducted one day with one week after the tumor implantation, pathological study of the metastasis in the lungs indicated that without the removal of primary tumor, PLD could prevent metastasis by suppressing the growth of primary tumor. To evaluate the direct antimetastasis ability of PLD with clinical relevance, a surgery was performed to resect the tumor-bearing limb. The treatment was started 3 days after the amputation with free doxorubicin or PLD. In this therapeutic model, PLD targeted directly to the metastasis in the lungs, which resulted in substantially longer survival time than free doxorubicin. Despite the superiority of PLD over free doxorubicin in treating pulmonary metastasis, our observation suggested that without the removal of primary tumor, the effect of PLD was only modest, and surgery plus multiple injections of PLD will be the best choice for patients with metastatic disease. | 18,982,516 |
Investigating the stabilising and mobilising features of footedness. | This study investigated lower limb laterality for stabilising and mobilising actions in 10 right- and 10 mixed-footed participants by determining, via the Waterloo Footedness Questionnaire--Revised (WFQ-R), the preferred foot in carrying out a range of stabilising and mobilising activities and by recording foot performance on standing balance and ball juggling. The log odds ratio (lambda score) was used to quantify the degree of laterality in task performance. Differences between the stability and mobility scores and the two groups were analyzed using a 2 (Group) x 2 (Task) ANOVA model with repeated measures on Task. Right- and mixed-footed participants differed significantly in the stability but not in the mobility items of the WFQ-R. No significant between-group differences were noted in either ball-juggling or standing balance performance. Mixed-footed participants had a significant right-left foot difference in standing balance, whereas both groups had a significant right-left foot difference in ball juggling. It is concluded that preference is not a steady attribute across the mobility and stability items of the WFQ-R and appears to be dependent on the behavioural context of a particular task. Results further indicated a lack of concordance between questionnaire and performance-based measures suggesting that these two methods of measuring laterality may be indicators of different underlying factors. | 18,982,521 |
Therapist perspectives on their dreams about clients: a qualitative investigation. | The authors interviewed eight experienced therapists regarding their dreams about clients and analyzed the transcribed interview data using consensual qualitative research. Results indicated that dreams typically were about difficulties with clients, intense personal concerns, and negative interpersonal interactions. Therapists used multiple methods to work with the dreams and made gains in insight focusing on countertransference or overidentification and the need to make fundamental changes in the therapeutic relationship or in the therapist's life. On the basis of the insight, therapists made changes in the treatment of the dreamed-about clients and in their personal lives. Implications for practice and research are discussed. | 18,982,525 |
Patients' experience of groups in outpatient mental health services and its significance for daily occupations. | The prevalence of mental health problems such as depression and anxiety in the Swedish population is increasing and individuals' daily occupations are seriously affected. Occupational therapy groups have long been used in mental health services. Now, with the increase in the number of outpatients and the current principle of patients' participation there is a need for further knowledge of this group of patients' perspective on the method. The aim of this study was thus to explore how outpatients in mental health services experience treatment in occupational therapy groups and what significance the treatment has for daily occupations. The focus group method was used. Four groups, with a total of 14 participants, were formed and met on one occasion. A number of factors for positive change in occupational therapy groups were found, i.e. "timing", "belonging", "involvement", "challenge", "meaningful occupation", and "balanced focus on disease". The participants' active use of the treatment and the transfer of experiences and knowledge from treatment to daily life were important for success. The abilities "to manage" and "to dare" developed in occupational therapy groups helped participants in the process of making changes in daily occupations. The findings show how a traditional method in occupational therapy in mental health services can be used to meet current needs and principles. | 18,982,528 |
Relationships among particle number, surface area, and respirable mass concentrations in automotive engine manufacturing. | This study investigated the relationships between particle number, surface area, and respirable mass concentration measured simultaneously in a foundry and an automotive engine machining and assembly center. Aerosol concentrations were measured throughout each plant with a condensation particle counter for number concentration, a diffusion charger for active surface area concentration, and an optical particle counter for respirable mass concentration. At selected locations, particle size distributions were characterized with the optical particle counter and an electrical low pressure impactor. Statistical analyses showed that active surface area concentration was correlated with ultrafine particle number concentration and weakly correlated with respirable mass concentration. Correlation between number and active surface area concentration was stronger during winter (R2 = 0.6 for both plants) than in the summer (R2 = 0.38 and 0.36 for the foundry and engine plant respectively). The stronger correlation in winter was attributed to use of direct-fire gas fired heaters that produced substantial numbers of ultrafine particles with a modal diameter between 0.007 and 0.023 mu m. These correlations support findings obtained through theoretical analysis. Such analysis predicts that active surface area increasingly underestimates geometric surface area with increasing particle size, particularly for particles larger than 100 nm. Thus, a stronger correlation between particle number concentration and active surface area concentration is expected in the presence of high concentrations of ultrafine particles. In general, active surface area concentration may be a concentration metric that is distinct from particle number concentration and respirable mass concentration. For future health effects or toxicological studies involving nano-materials or ultrafine aerosols, this finding needs to be considered, as exposure metrics may influence data interpretation. | 18,982,535 |
In vivo metabolism of alpha-methyltryptamine in rats: identification of urinary metabolites. | 1. The in vivo metabolism of alpha-methyltryptamine (AMT), a psychoactive tryptamine analogue, was studied in rats. 2. Male Wistar rats were administered 10 mg kg(-1) AMT orally and 24-h urine fractions were collected. After enzymatic hydrolysis of the urine sample, the metabolites were extracted by liquid-liquid extraction and analysed by gas chromatography/mass spectrometry (GC/MS). 3. 2-Oxo-AMT, 6-hydroxy-AMT, 7-hydroxy-AMT and 1'-hydroxy-AMT were detected as metabolites of AMT. | 18,982,537 |
[Protective effects of taurine on myocardial mitochondria and their enzyme activities in rate with severe burn]. | To investigate the effects of taurine on myocardial mitochondria and their enzyme activities in rats with severe burn. One hundred and twenty healthy adult Wistar rats were subjected to 30% TBSA full-thickness burn. They were randomly divided into burn group (B, with intraperitoneal injection of isotonic saline), treatment group (T, with intraperitoneal injection of taurine, 200 mg/kg),with 60 rats in each group . Ten rats with sham scald were used as control (S group). The myocardial tissue samples in B and T groups were harvested at 1, 3, 6, 12, 24 and 48 postburn hours (PBH) for determination of activity respectively of succinate dehydrogenase (SDH), cytochrome oxidase (CCO), the superoxide dismutase (SOD), Ca2+ -ATPase in mitochondria, and contents of cytochrome c (Cyt c), cytochrome aa3 (Cyt aa3), malondialdehyde (MDA), and Ca2+ in mitochondria and cytoplasm . The myocardial tissue samples of controls were harvested at 1 PBH for determination of above indices. The activity of CCO in B group was decreased at 1 PBH , especially at 6 ,12 PBH. The activity of SDH in B group was decreased to lowest level at 6 PBH, and its value was lower than that of S group at each time point. The activity of CCO or SDH in T group was not obviously decreased, and the activity of CCO at 3, 6, 12 PBH showed significant difference compared with B group (P < 0.05). The contents of Cyt aa3 and Cyt c in B group at 3, 6, 12, 24 PBH were obviously decreased, which were significantly lower than those in T group (P < 0.05). The activity of SOD in B group at 3, 6, 12 PBH was obviously decreased, the activity of Ca2+ -ATPase at 3, 6, 12 and 24 PBH was decreased to different extent, which was significantly lower than those in T group (P < 0.05). The MDA contents in B and T groups were higher than that in S group at 3-48 PBH ,and it was highest in B group (P < 0.05). The Ca2+ content of mitochondria in B group at 1 PBH was increased (13.7 +/- 1.5), and it was (24.8 +/- 2.6), (29.7 +/- 3.1), (16.3 +/- 1.9) and (13.5 +/- 1.7) at 3, 6, 12, 24 PBH respectively,and they were all higher than that of S group (10.7 +/- 1.6, P < 0.05). The Ca2 contents of cytoplasm in group B at 3 - 24 PBH were also higher than that in S group (P < 0.05). The Ca2+ content of mitochondria in T group at 3, 6, 12, 24 PBH was (16.8 +/- 2.8), (18.7 +/- 1.9), (10.5 +/- 1.8) and (13.3 +/- 1.7)respectively, which were lower than that in B group at every time point. Taurine have protective effect on mitochondria and their enzyme activities in myocardium in rats with severe burn, and it may be attributable to improving the ability of eradicating oxygen free radicals and alleviating Ca2+ overload in the mitochondria. | 18,982,558 |
[Repair of facial and cervical scars with expanded deltopectoral flaps]. | To explore the methods for repair of facial and cervical scars after burn. One hundred and two patients with facial and cervical scars as a result of burn injury were repaired by unilateral or bilateral deltopectoral flaps after expansion with pedicles. First, facial scars were excised and contractures were released to restore eye, mouth and nose to normal anatomical position. The facial scar flaps were overturned to join with the pedicles of deltopectoral flap for closing the wounds. The residual wounds were repaired by delayed flaps without pedicles 3 weeks later. Among 102 patients, the flaps survived well in 94 cases, and blood supply insufficiency was found in distal end of unilateral flap in 7 cases (depigmentation after primary healing ). Necrosis of unilateral flap occurred in one patient, and it healed after skin grafting. Expanded deltopectoral flap is efficacious procedure for repair of massive cervical and facial scars. | 18,982,567 |
[Repair of occipital and nuchal wounds with inferior trapezius myocutaneous flaps in patients after high voltage electrical burn]. | To explore the methods and effects of repair of occipital and nuchal wounds with inferior trapezius myocutaneous flap after deep electrical bum. Twelve patients with high-voltage electrical burn in occipital and nuchal regions were hospitalized to our ward from March 2003 to September 2007. They were repaired with improved inferior trapezius myocutaneous flaps after debridement. Flaps were of two types: (1) blood supply from cutaneous and perforator branches of the original segment of the superficial descending branch of transverse cervical artery. (2) combined blood supply from both superficial and deep descending branches of transverse cervical artery C, i.e., dorsal scapular artery). All flaps carried segmental and limited trapezius muscle cuff surrounding the vascular pedicle of the flap similar to a perforator flap. Flaps survived completely primarily in eight cases. In two patients, infection developed in flaps adjacent to wounds with lignification; they healed after dress change. Necrosis appeared in distal end of flap (one case), it healed after re-operation. One patient with surviving flaps died of sepsis and multiple organ failure 21 days after operation. The flaps which survived were not swollen ; the donor sites at scapular region looked normal without pterygoid or pendulous scapula deformities. Inferior trapezius myocutaneous flaps can be used to repair occipital and nuchal wounds, with the advantages of constant blood vessels, reliable blood supply, convenience for application. | 18,982,568 |
Evaluation of rigid and non-rigid motion compensation of cardiac perfusion MRI. | Although the evaluation of cardiac perfusion using MRI could be of crucial importance for the diagnosis of ischemic heart diseases, it is still not a routinely used technique. The major difficulty is that MR perfusion images are often corrupted by inconsistent myocardial motion. Although motion compensation methods have been studied throughout the past decade, no clinically accepted solution has emerged. This is partly due to the lack of comprehensive validation. To address this deficit we collected a large multi-centre MR perfusion dataset and used this to characterize typical myocardial motion and confirmed that under clinically relevant conditions motion correction is a frequent requirement (67% of all 586 cases). We then developed a proposed solution which includes both rigid/affine and the non-rigid image registration. Quantitative validation has been conducted using 6 different statistics to provide a comprehensive evaluation, showing the proposed techniques to be highly robust to different myocardial anatomy and motion patterns as well as to MR imaging acquisition parameters. | 18,982,587 |
Bayesian motion recovery framework for myocardial phase-contrast velocity MRI. | Detailed assessment of myocardial motion provides a key indicator of ventricular function, enabling the early detection and assessment of a range of cardiac abnormalities. Existing techniques for myocardial contractility analysis are complicated by a combination of factors including resolution, acquisition time, and consistency of quantification results. Phase-contrast velocity MRI is a technique that provides instantaneous, in vivo measurement of tissue velocity on a per-voxel basis. It allows for the direct derivation of contractile indices with minimal post-processing. For this method to be clinically useful, SNR and image artifacts need to be addressed. The purpose of this paper is to present a Maximum a posteriori (MAP) restoration technique for high quality myocardial motion recovery. It employs an accurate noise modeling scheme and a generalized Gaussian Markov random field prior tailored for the myocardial morphology. The quality of the proposed method is evaluated with both simulated myocardial velocity data with known ground truth and in vivo phase-contrast MR velocity acquisitions from a group of normal subjects. | 18,982,592 |
Human brain myelination from birth to 4.5 years. | The myelination of white matter from birth through the first years of life has been studied qualitatively and it is well know the myelination occurs in a orderly and predictable manner, proceeding in a caudocranial direction, from deep to superficial and from posterior to anterior. Even if the myelination is a continuous process, it is useful to characterize myelination evolution in normal brain development in order to better study demyelinating diseases. The quantification of myelination has only been studied for neonates. The original contribution of this study is to develop a method to characterize and visualize the myelination pattern using MRI data from a group of normal subjects from birth to just over 4 years of age. The method includes brain extraction and tissue classification in addition to the analysis of T2 relaxation times to attempt to separate myelinated and unmyelinated white matter. The results agree previously published qualitative observations. | 18,982,604 |
Colon unfolding via skeletal subspace deformation. | We present an efficient method to digitally straighten a colon volume using mesh skinning, a technique well known in computer graphics to deform a polygonal mesh attached to a skeleton hierarchy. In our case, the colon centerline is used as the skeleton structure and the polyhedral model of the lumen as the skin that is to be deformed as the centerline is straightened. Once the colon has been straightened, we use standard rendering techniques to compute the virtual dissection. Our approach is significantly more efficient than previously proposed techniques. | 18,982,607 |
AutoGate: fast and automatic Doppler gate localization in B-mode echocardiogram. | In this paper, we propose an algorithm for fast and automatic Doppler gate localization in spectral Doppler echocardiography using the B-mode image information. The algorithm has two components: 1) cardiac standard view classification and 2) gate location inference. For cardiac view classification, we incorporate the probabilistic boosting network (PBN) principle to local-structure-dependent object classification, which speeds up the processing time as it breaks down the computational dependency on the number of classes. The gate location is computed using a data-driven shape inference approach. Clinical evaluation was performed by implementing the algorithm on an ultrasound system. Experiment results show that the performance of the proposed algorithm is comparable to the Doppler gate placement by an expert user. To the best of our knowledge, this is the first algorithm that provides a real time solution to the automated Doppler gate placement in the clinical environment. | 18,982,610 |
Consensus-locally linear embedding (C-LLE): application to prostate cancer detection on magnetic resonance spectroscopy. | Locally Linear Embedding (LLE) is a widely used non-linear dimensionality reduction (NLDR) method that projects multi-dimensional data into a low-dimensional embedding space while attempting to preserve object adjacencies from the original high-dimensional feature space. A limitation of LLE, however, is the presence of free parameters, changing the values of which may dramatically change the low dimensional representations of the data. In this paper, we present a novel Consensus-LLE (C-LLE) scheme which constructs a stable consensus embedding from across multiple low dimensional unstable LLE data representations obtained by varying the parameter (kappa) controlling locally linearity. The approach is analogous to Breiman's Bagging algorithm for generating ensemble classifiers by combining multiple weak predictors into a single predictor. In this paper we demonstrate the utility of C-LLE in creating a low dimensional stable representation of Magnetic Resonance Spectroscopy (MRS) data for identifying prostate cancer. Results of quantitative evaluation demonstrate that our C-LLE scheme has higher cancer detection sensitivity (86.90%) and specificity (85.14%) compared to LLE and other state of the art schemes currently employed for analysis of MRS data. | 18,982,622 |
Probabilistic anatomo-functional parcellation of the cortex: how many regions? | Understanding brain structure and function entails the inclusion of anatomical and functional information in a common space, in order to study how these different informations relate to each other in a population of subjects. In this paper, we revisit the parcellation model and explicitly combine anatomical features, i.e. a segmentation of the cortex into gyri, with a functional information under the form of several cortical maps, which are used to further subdivide the gyri into functionally consistent regions. A probabilistic model is introduced, and the parcellation model is estimated using a Variational Bayes approach. The number of regions in the model is validated based on cross-validation. It is found that about 250 patches of cortex can be delineated both in the left and right hemisphere based on this procedure. | 18,982,630 |
Dynamic view expansion for enhanced navigation in Natural Orifice Transluminal Endoscopic Surgery. | Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an emerging surgical technique with increasing global interest. It has recently transcended the boundaries of clinical experiments towards initial clinical evaluation. Although profound benefits to the patient have been demonstrated, NOTES requires highly skilled endoscopists for it to be performed safely and successfully. This predominantly reflects the skill required to navigate a flexible endoscope through a spatially complex environment. This paper presents a method to extend the visual field of the surgeon without compromising on the safety of the patient. The proposed dynamic view expansion uses a novel parallax correction scheme to provide enhanced visual cues that aid the navigation and orientation during NOTES surgery in periphery, while leaving the focal view undisturbed. The method was validated using a natural orifice simulated surgical environment and demonstrated on in vivo porcine data. | 18,982,638 |
Real-time 3D reconstruction for collision avoidance in interventional environments. | With the increased presence of automated devices such as C-arms and medical robots and the introduction of a multitude of surgical tools, navigation systems and patient monitoring devices, collision avoidance has become an issue of practical value in interventional environments. In this paper, we present a real-time 3D reconstruction system for interventional environments which aims at predicting collisions by building a 3D representation of all the objects in the room. The 3D reconstruction is used to determine whether other objects are in the working volume of the device and to alert the medical staff before a collision occurs. In the case of C-arms, this allows faster rotational and angular movement which could for instance be used in 3D angiography to obtain a better reconstruction of contrasted vessels. The system also prevents staff to unknowingly enter the working volume of a device. This is of relevance in complex environments with many devices. The recovered 3D representation also opens the path to many new applications utilizing this data such as workflow analysis, 3D video generation or interventional room planning. To validate our claims, we performed several experiments with a real C-arm that show the validity of the approach. This system is currently being transferred to an interventional room in our university hospital. | 18,982,645 |
Path planning and workspace determination for robot-assisted insertion of steerable electrode arrays for cochlear implant surgery. | In previous works, the authors showed that using robot-assisted steerable electrode array insertions can significantly reduce the insertion forces compared to non-steerable electrode arrays. In addition to steering the electrode array, it is possible to change its angle of approach with respect to the scala tympani. This paper focuses on determining the relevance of changing the angle of approach of the electrode array by comparing steerable electrode array insertions using a two Degrees-of-Freedom (DoF) robot versus a four DoF robot. Optimal insertion path planning strategies are presented for both two and four DoF insertions. Simulation results and experiments show that the four DoF insertions can improve over two DoF insertions. Moreover, changing the angle of approach can further reduce the insertion forces. The simulation results also provide the workspace requirements for designing a custom parallel robot for robot-assisted cochlear implant surgery. | 18,982,665 |
Modelling childbirth: comparing athlete and non-athlete pelvic floor mechanics. | There is preliminary evidence that athletes involved in high-intensity sports for sustained periods have a higher probability of experiencing a prolonged second stage of labour compared to non-athletes. The mechanisms responsible for these differences are not clear, although it is postulated that muscle hypertrophy and increased muscle tone in athletes may contribute to difficulties in vaginal delivery. In order to test these hypotheses, we have constructed individual-specific finite element models of the female pelvic floor (one athlete and one non-athlete) and the fetal head to simulate vaginal delivery and enable quantitative analysis of the differences. The motion of the fetal head descending through the pelvic floor was modelled using finite deformation elasticity with contact mechanics. The force required to push the head was compared between the models and a 45% increase in peak force was observed in the athlete model compared to the non-athlete. In both cases, the overall maximum stretch was induced at the muscle insertions to the pubis. This is the beginning of a quantitative modelling framework that is intended to help clinicians assess the risk of natural versus caesarean birth by taking into account the possible mechanical response of pelvic floor muscles based on their size and activation patterns prior to labour. | 18,982,672 |
Modelling mammographic compression of the breast. | We have developed a biomechanical model of the breast to simulate compression during mammographic imaging. The modelling framework was applied to a set of MR images of the breasts of a volunteer. Images of the uncompressed breast were segmented into skin and pectoral muscle, from which a finite element (FE) mesh of the left breast was generated using a nonlinear geometric fitting process. The compression plates within the breast MR coil were used to compress the volunteer's breasts by 32% in the latero-medial direction and the compressed breasts were subsequently imaged using MRI. The FE geometry of the uncompressed left breast was used to numerically simulate compression based on finite deformation elasticity coupled with contact mechanics, and individual-specific tissue properties. Accuracy of the simulated FE model was analysed by comparing the predicted surface data, and locations of three internal features within the compressed breast, with the equivalent experimental observations. Model predictions of the surface deformation yielded a RMS error of 1.5 mm. The Euclidean errors in predicting the locations of three internal features were 4.1 mm, 4.1 mm and 6.5 mm. Whilst the model reliably reproduced the compressive deformation, further investigations are required in order to test the validity of the underlying modelling assumptions. A reliable biomechanical model will provide a multi-modality imaging registration tool to help identify potential tumours observed between mammograms and other imaging modalities such as MRI or ultrasound. | 18,982,673 |
Reducing motion artifacts in 3-D breast ultrasound using non-linear registration. | Automated full-field 3-D breast ultrasound (3DBUS) has a high potential as a reproducible method for screening and intervention. Consecutive linear transducer scans yield a consistent breast ultrasound volume, yet individual slices are prone to tissue deformation and motion. To compensate resulting image distortions, we propose an efficient non-rigid registration method applied sequentially to pairs of 3DBUS volume slices, optionally either on-line or in post-processing. A quantitative evaluation of the method on synthetic deformations shows subvoxel registration accuracy. First application to clinical breast US images and preliminary results confirmed effectiveness and accuracy of the method. | 18,982,702 |
Radiofrequency ablation as locoregional therapy for unresectable hepatic malignancies: initial results in 24 patients with 5-years follow-up. | Radiofrequency ablation (RFA) is one treatment modality for unresectable liver metastases. Patients with hepatic malignancies (n = 24) underwent elective RFA. All tumors were ablated with a curative intent, with a margin of 1 cm, in a single session of RFA. The median diameter of tumor was 3.1 cm (range 1.7-6.9 cm). Studied patients were not candidates for resection due to multifocal hepatic disease, extrahepatic disease, proximity to major vascular structures or presence of cirrhosis with functional hepatic reserve inadequate to tolerate major hepatic resection. Complete tumor necrosis was achieved in 87.5% and tumor recurred in 3 patients (12.5%) with lesions larger than 5 cm. Distant intrahepatic recurrence was diagnosed in another 4 (16.7%). Distant metastases were found in 7 (29.2%) patients. Four of these 7 patients had also distant intrahepatic recurrence of disease. Two and 5-years survival rates were 41.7% (10 patients) and 8.3% (2 patients) respectively. RFA is safe and effective option for patients with unresectable hepatic malignancies smaller than 5 cm without distant metastatic disease. RF ablation resulted in complete tumor necrosis in 87.5% with 2 and 5-years survival rates much higher than with chemotherapy alone or only supportive therapy, when survival is measured in weeks or months. If RFA is unavailable, percutaneous ethanol injection therapy can be done but with inferior survival rates. | 18,982,741 |
Central venous catheters for chemotherapy of solid tumors--our results in the last 5 years. | Central venous catheters provide an easy access for intravenous medications. Having a central line in place will relieve a child from the discomfort and danger of multiple regular intravenous lines for chemotherapy. The use of indwelling central venous catheters has become commonplace in the management of children undergoing oncological treatment. There are two types of central lines commonly used. There are Broviac catheters and Port-A-Cath (PAC) catheters. In the last 5 years we inserted 194 catheters in 175 children. We inserted 121 Broviac catheters and 73 PAC catheters. During the follow up of 39382 catheter days 44 complications were observed. In Broviac group the median follow up was 155 days and in PAC group was 230 days. We observed differences in the incidence between two devices. In Broviac group infections were more frequent and in PAC group other complications were more frequent than infections. | 18,982,750 |
Morphological differences of elite Croatian track-and-field athletes. | In this study we present the morphological characteristics of 54 Croatian national level track-and-field athletes. 21 anthropometric body measures were taken on a sample of 15 sprinters (S), 16 endurance sprinters (S4), 10 middle-distance runners (MD) and 13 long-distance runners (LD). Body fat percentage, body mass index and somatotype were also calculated. Canonical discriminative analysis showed significant difference between the athletes of various running events, in the measures of body volume and body fat, while no significant difference was found in the variables of longitudinal and transversal dimensions of the skeleton. ANOVA and Student t-test for independent samples showed statistically significantly higher thigh and lower leg circumference in sprinters, as well as greater upper arm skinfold in middle-distance runners. The mesomorphic component is a dominant characteristic of somatotype of the runners in all events, whereas the ectomorphic component is the least marked. | 18,982,762 |
[Serious mechanical complications associated with pulmonary artery catheters in cardiovascular and thoracic surgery]. | Although the use of pulmonary artery catheters (PACs) in managing critical patients is a subject of debate, they continue to be inserted in many cases and possible complications should be taken into account. Our objective was to review the serious or potentially serious complications associated with PACs in our hospital in the past 15 years. This was a retrospective study of seious mechanical complications of PAC use in patients who underwent vascular, cardiac, and thoracic surgery. The study included the records 7540 patients; 9 cases of serious complications were detected. These complications included 5 cases of pulmonary artery rupture (3 of which resulted in death), 1 perforated internal mammary vein, 1 knotted catheter, 1 bent one, and 1 case of a PAC becoming trapped in the surgical suture. The 0.12% incidence of complications is lower than rates found in the literature. Although these complications are rare, it is necessary to take precautions against their unexcepted appearance by carefully selecting the patients in whom PACs are placed and by paying special attention to the characteristic clinical and radiological signs of complications. | 18,982,786 |
Assessment of body composition in Sri Lankan children: validation of a skin fold thickness equation. | Morbidity associated with obesity is related to the fat mass (FM) of the body. The direct estimation of FM is difficult. Skin fold thickness (SFT) is a simple and cheap alternative for accurate assessment of FM, and population specific equations are necessary for accurate assessment of FM using SFT. To develop a SFT prediction equation to estimate FM of Sri Lankan children. DESIGN, SETTING AND METHOD: Across-sectional descriptive study was done at the University Paediatric Unit of Lady Ridgeway Hospital, Colombo. Data were collected from 5 to 15 year old healthy children. Triceps, biceps, supra-iliac and subscapular SFT were measured using Harpendens skin fold caliper. Total body water was assessed using an isotope dilution method (D2O), and fat free mass calculated. FM was assessed based on 2 compartment body composition model. Multiple regression analysis was used to develop prediction equation and validated using PRESS (prediction of sum of squares) statistical technique. Independent variables were age, triceps SFT, subscapular SFT and sex. Prediction equation for FM [(0.68 x age) + (0.246 x triceps SFT) + (0.383 x subscapular SFT) - (1.61 x sex code) -3.45] was able to predict 76.4% of variance with a root mean squared error (RMSE) of 3.4 kg. PRESS statistics was 3.4 kg with press residuals of 1.56 kg. Bland-Altman technique showed that the majority of the residuals were within mean bias +/-1.96 SD. Results of this study provide an SFT equation for the prediction of FM in Sri Lankan children. | 18,982,800 |
Accidental scrotal burns from paraquat while handling a patient. | The main risk of paraquat poisoning is from deliberate ingestion. Serious accidental or occupational poisoning is comparatively rare. We report two patients who had accidental exposure to paraquat, resulting in scrotal burns in both and systemic poisoning in one, while attending to a patient who had ingested paraquat for deliberate self harm. | 18,982,803 |
Pattern and outcome of antenatal care among women attending a Catholic mission hospital in Ibadan, Nigeria. | Antenatal care (ANC) services have the aim of monitoring the course of pregnancy, in order to promote favourable outcomes. In spite of the fact that its components have been found to improve pregnancy outcomes, maternal/infant morbidity and mortality still remain public health problems in most developing countries including Nigeria. These unacceptable health indicators form the basis of this study. The records of 581 women who attended ANC at the Catholic Hospital between October 2005 and September 2006 were accessed. The data collected with the aid of a checklist were processed using statistical package of social sciences (SPSS). The age range of the participants was 17-45; with the mean age of 30.3 (SD = 4.8). Three hundred and forty-seven (59.7%), sixty-nine (29.1%) of the women had tertiary and secondary education respectively. A total of 325 (55.9%) were nulliparous. Only 44 (7.6%) of the women began ANC at the first trimester. Out of 159 abortions recorded among the women, 72 (45%) were self-induced prior to marriage. Findings showed apparent low rate of first trimester booking, irregular antenatal clinic visits and initiation of ANC at the appearance of symptoms of illness among the women studied. Therefore the study recommends hospitals to adopt the WHO modified ANC with fewer visits to improve better compliance and coverage, provision of family life education especially on the benefits of early ANC booking and family planning services through available media. | 18,982,815 |
Big pharma and health care: unsolvable conflict of interests between private enterprise and public health. | A landmark paper on Game Theory showed that individual maximization of profit necessarily endangers the public good, and since the problem has no technical solution, "it requires a fundamental extension in morality" (1). We propose here that public health, as a public good, now emerges as a grave example of this problem. Recent events and reports increasingly suggest misalignment between the interests of the pharmaceutical industry and those of public health. Johnson & Johnson illegally and effectively promoted Propulsid off-label for children despite internal company documents raising safety concerns. Death in drug trial has been described as a "trade secret." On Vioxx, Topol wrote: "Sadly, it is clear that Merck's commercial interest exceeded its concern about the drug's toxicity" (2). More and more concerns are raised by scholars and major journal editors about the type and the quality of published evidence, often biased towards efficacy of new products. The industry, funding over 80% of trials, sets up a research agenda guided more by marketing than by clinical considerations. Smart statistical and epidemiological tactics help obtain the desired results. Budget for marketing is by far greater than for research. Massive advertising to physicians and to the public gets increasingly sophisticated: ghost writing, professional guidelines, targeting of consumer groups and manipulating media for disease mongering. Pervasive lobbying and political ties limit the independence of regulatory bodies. Obligation to shareholders overriding public health considerations is not unique to the pharmaceutical industry. The chemical, tobacco and food industries share similar tactics: proclaiming doubts about safety issues, buying researchers, infiltrating universities, boards, media and legislative agencies. By contrast, powerful and cheap health promoting activities, poorly supported by industry because they are too cheap and not patented, are markedly underutilized: technologies for changing behavior (e.g., cardiac rehabilitation), palliative care and use of old, effective and safe drugs - all could benefit from industry's tools of marketing and quality. As those most affected are the sick, the poor and the least educated, free market successes appear to pose unsolvable challenges to social justice in public health. | 18,982,834 |
Use of the lecompte procedure for ventriculoarterial connection abnormalities in infants and children with congenital heart diseases. | The Lecompte (REV) procedure is used to correct abnormal ventriculoarterial connections in patients with congenital heart diseases; it avoids the need for an extracardiac conduit for pulmonary outflow tract reconstruction. The present study aimed to investigate effectiveness and criteria of the REV procedure in children with abnormal ventriculoarterial connections. Thirty-eight children (mean age, (2.2 +/- 1.7) years; mean weight, (11.5 +/- 3.8) kg) with abnormal ventriculoarterial connections who had an REV procedure in our hospital from January 1998 to May 2006 were studied. Only 10 patients had the usual anteroposterior relationship of the two great arteries. The infundibular septum between the two semilunar valves was aggressively resected to enlarge it and construct a straighter left ventricular outflow tract and a wide tunnel between the ventricular septal defect (VSD) and the aorta. Eighteen cases had the original REV procedure; 20 had a modified REV procedure. All patients are alive; none developed severe complications. The postoperative right ventricular (RV) to left ventricular (LV) pressure ratio was 0.20-0.45. Five patients had RV dysfunction; 2 patients had a pressure gradient in the RV ventricular outlet of 30.0-34.5 mmHg; 3 cases had a 37.5-47.3 mmHg pressure difference in the RPA. All patients had an RV pressure less than half the systemic pressure. These gradients' magnitudes in all patients were consistent with the post-operative RV to LV pressure ratio (P < 0.05). During the follow-up (mean, (4.2 +/- 0.6) years), 2 patients had an RPA pressure gradient of 24.0-29.3 mmHg which abated to less than 10 mmHg after two years. The REV procedure provides satisfactory short- to medium-term results. It may be superior to the Rastelli procedure for treating ventriculoarterial connection abnormalities; it allows early, complete anatomic repair and reduces the need for late re-operation, since no extracardiac conduit is needed. Longer follow-up is needed to determine long-term outcomes. | 18,982,867 |
Diagnosis and endovascular treatment of spontaneous direct carotid-cavernous fistula. | Spontaneous direct carotid-cavernous fistula (CCF) is relatively rare and few reports have been found in the literature. The aim of this paper was to report the clinical characteristics, imaging findings and curative effect of endovascular treatment for patients with spontaneous direct CCF. We retrospectively analyzed the clinical data of nine patients with spontaneous direct CCF admitted between May 2003 and November 2007 and the outcomesof endovascular treatment. Sudden neuro-ophthalmological symptoms were the most common clinical presentation at diagnosis (n=8). No patients had a history of head trauma. Cerebral digital subtraction angiography (DSA) was performed on all cases under local anesthesia and seven cases received endovascular treatment. In eight patients, internal carotid angiograms recorded during the early arterial phase revealed aneurysms located in the cavernous sinuses, and in one patient, a dilated internal carotid artery (ICA) was seen. Among the nine cases, seven received endovascular treatment via a transarterial approach and complete occlusion of the fistula was obtained with no technique-related complications, one died suddenly before treatment and one gave up treatment. A detachable balloon was used as the embolic material in two cases, a detachable balloon and detachable coil as the embolic material in two cases, balloon-assisted coil embolization in two cases and covered stents were successfully placed in the parent vessel to exclude the aneurysm and fistula from circulation in one case. During a follow-up period of 3-48 months, all treated patients remained asymptomatic except for one patient who suffered from ipsilateral decreased vision. Most spontaneous direct CCF may be caused by a ruptured intracavernous aneurysm with direct shunting into the cavernous sinus. Endovascular treatment seems to be a safe and effective method for treating spontaneous direct CCF. | 18,982,868 |
Personality, cognitive coping strategies, and adaptational outcomes in a sample from the general Spanish population. | The relationship among scores on two personality dimensions, Emotional Stability and Extraversion, and on two cognitive coping strategies, Positive Thinking and Wishful Thinking, and on the Consequences of Coping scale were examined in 169 Spanish persons (78 men and 91 women; Mage = 36.3 yr., SD = 12.1). Positive Thinking was associated with high scores on the two personality dimensions and positive consequences, whereas Wishful Thinking was associated with low scores on both Emotional Stability and Extraversion and with negative consequences. | 18,982,936 |
Predictors of responses to organizational wrongdoing: a study of intentions of management accountants. | It has been proposed that employees aware of organizational wrongdoing face two decisions: whether or not to blow the whistle and whether or not to leave their organizations. Of these only the decision to blow the whistle has received attention, leaving a gap in knowledge; thus, a survey of 330 management accountants was analyzed to examine potential predictors of intended responses to organizational wrongdoing. Analysis of ratings indicated that intent to leave increased with seriousness of wrongdoing and expected retaliation for whistleblowing and decreased with expected effectiveness of whistleblowing. Intent to stay and blow the whistle increased with expected effectiveness of whistleblowing and role responsibility for reporting and decreased with expected retaliation for whistleblowing; intent to leave and blow the whistle increased with expected effectiveness of whistleblowing and role responsibility for reporting. | 18,982,945 |
Psychometric properties of Scheier and Carver's Life Orientation Test in a sample of Australian prisoners. | The psychometric properties of Scheier and Carver's 1985 Life Orientation Test (LOT), which is a measure of optimism, were examined as part of a study of education, training, work experience, and expectations of sentenced adult prisoners in Western Australia. All prisoners at five metropolitan public prisons were invited to participate and 453 accepted. This represented a response rate overall of about 41%, with response rates at each of the individual prisons ranging from 13% to 90%. The average age of the prisoner sample was 34.4 yr. (SD = 10.2 yr.). The proportion of men in the sample was 79.7%. Mean sentence length was 66.9 mo. (58.5 for women and 69.2 for men), and the number of months of sentence remaining averaged 44.4 mo. (41.0 for women and 45.3 for men). Means and standard deviations of the LOT scores for prisoners were similar to those of other groups, and demographic differences between prisoners were not statistically significantly related to scores. The internal reliability of the LOT scores was acceptable. Confirmatory factor analyses indicated that the two-factor item-keying model fitted the prisoner data better than a one-factor model. However, the two factors did not simply reflect underlying optimism and pessimism constructs but were substantially affected by item keying. | 18,982,960 |
[Remote results for cases of non-small cell lung cancer treated by limited resection]. | The choice between the limited pulmonary resection and the standard anatomical resection depends on many factors. The most important are the tumor size, age and general condition of the patient. We present 12 patients with non-small cell lung cancer-IA stage, who underwent limited resection. The 5-year survival rate is 50% (6 patients), the 3-year survival rate is 75% (9 patients), and the 1-year survival rate is 91,6% (11 patients). We conclude that the limited resection for patients with non-small cell lung cancer-IA stage is associated with a lower 5-year survival, but less complications, which makes it suitable for elderly and compromised patients. | 18,983,002 |
[Could the transrectal prostate biopsy predict the rate of positive lymph nodes in prostate cancer patients?]. | Since 1989, when Hodge and al. demonstrated transrectal ultrasound guided prostate biopsy, it has become a "gold standard" for the diagnosis of prostate cancer. According to the experience gained in the period 1999-2003 in the Department of Urology-Medical University, Sofia, in a prospective follow-up of 20 prostate cancer patients, we found relationship between the positive tru-cut biopsy cores and the rate of positive lymph nodes. | 18,983,007 |
Evaluation of bean (Phaseolus vulgaris) seeds inoculation with Rhizobium phaseoli and plant growth promoting rhizobacteria on yield and yield components. | To study the effect of co-inoculation with plant growth-promoting rhizobacteria (PGPR) and Rhizobium, on yield and yield components of common bean (Phaseolus vulgaris L.) cultivars was investigated in 2 consecutive years under field condition of plant growing evidence indicates that soil beneficial bacteria can positively affect symbiotic performance of rhizobia. PGPR strains Pseudomonas fluorescens P-93 and Azospirillum lipoferum S-21 as well as two highly effective Rhizobium strains were used in this study. Common bean seeds of three cultivars were inoculated with Rhizobium singly or in a combination with PGPR to evaluate their effect on growth characters. A significant variation of plant growth in response to inoculation with Rhizobium strains was observed. Treatment with PGPR significantly increased pod per plant, number of seeds per pod, weight of 100 seed, weight of seeds per plant, weight of pods per plant, total dry matter in R6 as well as seed yield and protein content. Co-inoculation with Rhizobium and PGPR demonstrated a significant increase in the yield and yield components. The results showed that all treatments of bacteria increased yield; however, strains Rb-133 with Pseudomonas fluorescens P-93 gave the highest seed yield, number of pods per plant, weight of 100 seed, seed protein yield, number seed per pod, seed protein yield. | 18,983,036 |
Antimicrobial susceptibility pattern of microorganisms involved in the pathogenesis of surgical site infection (SSI); A 1 year of surveillance. | The aim of this study is to identify the antibiotic sensitivity pattern of pathogens involved in the process of surgical site infection, in surgical wards. Changes made in the pattern of antibiotic use will result in different microorganism susceptibility patterns, which needs correct determination for precise empiric antibiotic therapy. One thousand patients (62% men and 38% women, 18- 74-years-old, with mean age 43 +/- 8)) who underwent surgical treatment, in Alzahra University Hospital, Isfahan University of Medicine, Isfahan, Iran, were studied from 2005 to 2006. Surgical wound infections, based on the reported criteria, were aspirated for culturing within 1 plus gram staining of prepared smears. Minimum Inhibitory Concentrations (MICs) were determined for samples and all derived data were compared by SPSS 13 and WHO net 5 software. The prevalence of SSI was 13.3% with 150 positive cultures, totally. Of 150 bacteria, isolated from surgical site infections Staphylococcus aureus had most frequency (43%). Resistance of isolated organisms was 41.7% in amikacin, 65 and 78.6% in ceftazidime, 85.7% in ceftriaxone, 61.5% in ciprofloxacin, 78.8% in gentamicine, 6.4% in imipenem, 13% in meropenem and 70.6% in trimethoprim/sulfamethoxazole, respectively. 78.9% of Staphylococcus aureus isolates were MRSA and vancomycine was the most effective antibiotic without any resistance. Among 10 isolates of coagulase negative Staphylococcus, no vancomycine resistance was seen, but in contrast all cases were resistant to oxacillin. The most common gram negative organism was Klebsiella (18 isolates) in which 100 and 80% were sensitive to imipenem and meropenem, respectively. Seventeen cases were E. coli, in which the most sensitivity was to meropenem (80%) and imipenem (77.8%). Thirteen cases of Pseudomonas were detected, in which 16.7% were resistant to imipenem and 8.3% to meropenem. Our results demonstrated that the total antibiotic resistance is increasing among SSIs, with an up sloping pattern, which will contact with a constant empiric antibiotic therapy. So, precise up to date antibiogram tantalize us toward balancing the rate of total antibiotic resistance to SSIs. | 18,983,037 |
Future perioperative registered nurses: an insight into a perioperative programme for undergraduate nursing students. | An Australian College of Operating Room Nurses (ACORN) submission (ACORN 2002-2008) recently stated that the specialities that suffered significantly from the transition of hospital-based nursing training to university training were the perioperative specialty, critical care and emergency. The main reason for this was that perioperative nursing was not included in the undergraduate nursing curriculum. Less than a handful of universities in Australia offer the subject as a compulsory unit. The University of Notre Dame Australia (UNDA) is one of these universities. This paper will provide an insight into the perioperative nursing care unit embedded within the Bachelor of Nursing (BN) undergraduate curriculum. | 18,983,065 |
Dissociating people from nature. | Conservation measures that dissociate people from their native landscape can destroy traditional ecological knowledge and hurt the very biodiversity that the conservation policies aim to protect. | 18,983,073 |
Effects of organic carbon supply rates on uranium mobility in a previously bioreduced contaminated sediment. | Bioreduction-based strategies for remediating uranium (U)-contaminated sediments face the challenge of maintaining the reduced status of U for long times. Because groundwater influxes continuously bring in oxidizing terminal electron acceptors (O2, NO3(-)), it is necessary to continue supplying organic carbon (OC) to maintain the reducing environment after U bioreduction is achieved. We tested the influence of OC supply rates on mobility of previously microbial reduced uranium U(IV) in contaminated sediments. We found that high degrees of U mobilization occurred when OC supply rates were high, and when the sediment still contained abundant Fe(III). Although 900 days with low levels of OC supply minimized U mobilization, the sediment redox potential increased with time as did extractable U(VI) fractions. Molecular analyses of total microbial activity demonstrated a positive correlation with OC supply and analyses of Geobacteraceae activity (RT-qPCR of 16S rRNA) indicated continued activity even when the effluent Fe(II) became undetectable. These data support our hypothesis on the mechanisms responsible for remobilization of U under reducing conditions; that microbial respiration caused increased (bi)carbonate concentration and formation of stable uranyl carbonate complexes, thereby shifted U(IV)/U(VI) equilibrium to more reducing potentials. The data also suggested that low OC concentrations could not sustain the reducing condition of the sediment for much longer time. Bioreduced U(IV) is not sustainable in an oxidizing environment for a very long time. | 18,983,077 |
Polybrominated diphenyl ethers in peregrine falcon (Falco peregrinus) eggs from the northeastern U.S. | A total of 114 peregrine falcon eggs from nests in Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, and Vermont were analyzed for polybrominanted diphenyl ethers (PBDEs). Eggs were collected from 1996 to 2006, excluding 1997 and 1998. Total PBDE concentrations ranged from 74.5 to 6610 ng/g wet weight, with a median of 440. These levels were generally higher than those observed in European peregrine eggs, but comparable to those in North American seabird eggs. Congener patterns differed from such seabirds and were dominated by BDE-153, followed by BDE-99, -183, -209, -197, -207, -154, -100, and -196; with lesser contributions from BDE-47, -208, -203, -201, -206, -202, -138, and -119. Urban and rural falcon eggs contained similar total PBDE concentrations but different congener profiles. Urban eggs exhibited higher BDE-209 concentrations and greater percentages of other highly brominated congeners. BDE-209 was detectable in all eggs, with concentrations ranging from 1.4 to 420 ng/g wet weight Five octa- and three nona-brominated congeners were also frequently detected, some likely derived from the biodegradation of BDE-209. Temporal analyses indicated no significant changes in concentrations of total PBDEs, or most individual congeners, during the study period. An exception was BDE-209. It exhibited a significant increase, with a doubling time of 5 years. Current PBDE burdens may be insufficient to cause noticeable adverse effects at the population level, as the number of territorial pairs increased in the past decade. However, the high BDE-209 concentrations, short doubling time, and likely biodegradation observed in peregrine eggs from the northeastern U.S. may supportthe need for additional deca-BDE regulations. | 18,983,080 |
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