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The Arizona program: development of a modular, interactive anesthesia delivery system.

Research by the Advanced Biotechnology Group, Department of Anesthesiology, the University of Arizona, has led to the development of many of the physical and theoretic elements necessary to the creation of a new automated anesthesia delivery system. Recognizing the obligation to provide means of the highest reliability and safety for anesthesia delivery, this group is endeavoring to bring together a compact, integrated modular system of the greatest utility to the practicing anesthesiologist.

Anesthesia, Inhalation

[Modular organization of callosal neurons in the sensomotor area of the cerebral cortex in the rabbit].

The density of distribution of callosal neurons in rabbit sensorimotor cortex was studied by means of horseradish peroxidase injection into the homotopic cortical area. The irregularity of density was evaluated visually and/or computed. Labelled callosal units were mostly small and medium-size pyramidal cells located primarily in layer III-IV and more rarely in layers V and VI. Layer III-IV revealed different patterns of labelled units grouping: in pairs, in 5-8 vertically situated cells, in clusters 120-200 micron wide, separated by areas with decreased density. The obtained results confirm previously made conclusion based on electrophysiological studies about the modular organization of callosal connections in sensorimotor cortex of rabbits.

Animals

[Modular system for the total replacement of the femur--Endo-model].

Total femur replacement may offer a useful solution in cases of severe trauma or neoplasia and in revision arthroplasty after failed total joint replacement when gross losses of bone have resulted in an unloadable femur and all other methods of treatment would fail to provide the patient with a stable leg. Until recently, total femur components were custom-made, but now we have a comprehensive modular total femur implant available reducing problems of preoperative preparation and simplifying the manufacture of custom-made designs. The new device can be shaped and adapted to the conditions encountered at the time of operation. The "push-through" type of prosthesis can be mounted step by step and converted into a total femur replacement with either a conventional head or a saddle at the proximal end and a total axial rotating knee prosthesis at the distal end. Elongation of the entire system is feasible.

Adult

Clinical and radiographic evaluation of modular knee replacement. A review of 95 cases.

Ninety-five modular total knee replacements, 54 of them unicompartmental, have been reviewed. The average follow-up was three years. The major indication for operation was pain. A precise reoperative radiographic evaluation and a technique for a positioning the components are described. This had led to a significant improvement in the clinical and radiographic results in 67 out of 95 knees which were operated on. The modifications concern the orientation of the tibial cut, the placing of the femoral components and the correction of axial deviation. The main causes of the 13% of failures in our series were either errors in positioning the components or a preoperative diagnosis of rheumatoid arthritis. Unicompartmental replacement gave similar results in both valgus and varus knees, and the morbidity was lower than in the biocompartmental replacements. The best results were obtained in osteoarthritic knees in elderly patients and in posttraumatic osteoarthritis.

Adult

Modular design of microcomputer-based medical instruments.

A modular design approach is effective for developing compact microcomputer-based medical instruments. Each instrument consists of two modules: a microcomputer instrument module that provides data conversion and computing functions and a characteristic module that does analog signal conditioning and includes all interfaces to the environment. The five instruments summarized here are: (a) a portable, battery-operated arrhythmia monitor for ambulatory patients; (b) a physician's computer for remote telephone communication with the portable monitor; (c) a battery-powered arrhythmia monitor/recorder for the operating room; (d) a portable, battery-operated biofeedback device for speech therapy; and (e) a neuromuscular blockade monitor for the operating room.

Computers

A modular learning environment for protein modeling.

We propose in this paper a modular learning environment for protein modeling. In this system, the protein modeling problem is tackled in two successive phases. First, partial structural informations are determined via numerical learning techniques. Then, in the second phase, the multiple available informations are combined in pattern matching searches via dynamic programming. It is shown on real problems that various protein structure predictions can be improved in this way, such as secondary structure prediction, alignment of weakly homologous protein sequences or protein model evaluations.

Amino Acid Sequence

Discrete modular system for automation of radioimmunoassay of serum choriomammotropin.

We describe a discrete automated radioimmunoassay system for determining choriomammotropin (placental lactogen) in human serum. With the present system it can be measured in as many as 37 unknown sera (50 muL) and three quality-control sera, in duplicate, within 1.5 h. The time required for sample preparation, incubation (15 min), and separation of free and bound radioactivities (a 150 mL/L polyethylene glycol solution is superior to a twofold volume of absolute ethanol) is less than 45 min. The remaining time required is for counting and data processing. Intra-assay precision is 4.6% (CV). The modular approach endows the instrumentation with much flexibility, and consequently is suitable for automation of a wide range of assay protocols.

Autoanalysis

[Osteosynthesis of proximal femoral fractures with the modular interlocking system of unreamed AO femoral intramedullary nail. Initial clinical results].

The unreamed femoral nail system (UFN) features highly versatile proximal interlocking options for the treatment of a wide range of femoral fracture patterns and combinations. Besides standard interlocking modes for diaphyseal fractures, special interlocking options for subtrochanteric fractures and ipsilateral neck/shaft fractures are available. Two aiming arms can be attached to the insertion handle of the nail in a modular fashion. The standard aiming arm is designed for transverse static or dynamic locking. The special aiming arm permits spiral blade, 130 degrees, and miss-a-nail interlocking. From August 1992 to July 1994, in 10 out of 55 UFN implantations the special interlocking options were used. In 9 subtrochanteric fractures the spiral blade interlocking and in one ipsilateral neck/shaft fracture the miss-a-nail cancellous screw interlocking was applied. ASIF type A fractures with closed soft tissue damage prevailed. Fracture healing was uneventful and no implant complications or loss of reduction have been observed.

Adult

[Modular construction (2 HS-1 SH), using Cotrel-Dubousset's universal instrumentation for comminuted fractures of the thoracolumbar junction. Comparison with various other constructions].

INTRODUCTION: The authors' objective was to study the anatomical and functional results of an original construct using the Cotrel-Dubousset instrumentation. MATERIAL AND METHODS: This construct is called "Modular construct" or "2 H.S.-1 S.H." fits up two vertebrae above the fracture and a single below. So if the fracture is situated on the L1 level, a supra-laminar hook is set up on each side of T11, and two pedicular screws in T12 (2 H.S.). In the same way, a pedicular screw and an infra-laminar hook are set up on each side of L2 (1.S.H.). Two transverse bars connect together the right and the left rod. This retrospective work is based on the study of 24 patients who had a Thoraco-lumbar burst fracture according to Denis'classification, who were operated on in our Department, and started again to walk without external contention. All the patients had a postero-lateral bone graft. There were no [corrected] anterior arthrodesis performed. The average follow up was 4 years. This series was compared with a concomitant series of miscellaneous constructs realized by the same operators with the C.D. instrumentation. RESULTS: The average regional kyphosis angles went from 16.9 degrees in pre-operative to 3.9 degrees in post-operative, and 8 degrees at the maximum follow up. The average vertebral kyphosis angles went from 18 degrees in pre-operative to 3.8 degrees in post-operative, and 6.3 degrees at the maximum follow up. The miscellaneous constructs had poorer results. There were two severe infections, one early the other late. DISCUSSION: These results compared with the literature show that the 2 H.S.-1 S.H. construct is a competitive one. We think that its mechanical qualities arise from adding systematically hooks at the ends of the construct. These hooks protect the screws during flexion and from pull out constraints.

Female

Modular shoulder hemiarthroplasty for acute fractures. Surgical considerations.

Displaced fractures of the proximal humerus with concomitant comminution, interruption of vascular supply, and articular incongruity often require prosthetic replacement for successful treatment. In these difficult cases, the success of prosthetic replacement is dependent on proper patient selection, appropriate surgical technique, and a well-supervised postoperative rehabilitation program. Careful surgical technique should ensure proper placement of the humeral component at the correct height and version, and proper position and fixation of the displaced tuberosities. Supervised rehabilitation emphasizing early range of motion and strength when the tuberosities have healed improves results. The authors found that a modular design humeral implant allows for improved tensioning of the soft tissues and reconstruction of the tuberosities.

Arthroplasty

Clinical evaluation of the modular electromechanical lock actuator for above-elbow prostheses: a preliminary report.

The Modular Electromechanical Lock Actuator (MELA) is the result of research and development (R&D) conducted under the direction of Dudley S. Childress, PhD, at the Northwestern University Prosthetics Research Laboratory (NUPRL), Chicago, Illinois. NUPRL, based upon their experience with prostheses for persons with high-level, upper-limb amputations, developed MELA to provide users with more efficient, versatile control and operation of their existing, cable-operated, positive-locking elbow and wrist components. The design of MELA has advanced to the point where it has the potential to improve the functionality and effectiveness of existing, body-powered or manually positioned above-elbow prostheses. This R&D effort has resulted in a pre-market model that is now ready for the national field evaluation part of the technology transfer process coordinated through the VA Rehabilitation Research and Development Service, Technology Transfer Section.

Activities of Daily Living

Urinalysis by modular learning.

A self-instructional approach to the entry-level presentation of urinalysis in a written modular format was used by a class of medical laboratory technician students. The course consisted of 13 modules based upon behavioral objectives. The modules used no audio or visual media but required "hands-on" performance of laboratory procedures. The achievements of a test sample of 12 students were compared with those of a previous class in which the same material was presented in lectures. Evaluation by written tests given to both classes showed no statistical difference. The self-instructed students performed adequately in their practical laboratory work, but the overall learning time was increased by 50 percent when self-pacing was used. A measurement questionnaire revealed that the students preferred instructor-led courses to self-instructional units for a variety of reasons which lead to some further considerations.

Attitude

Modular total knee-replacement arthroplasty. A review of eighty-nine patients.

Fifty-eight osteoarthritic and thirty-one rheumatoid patients underwent modular total knee-replacement arthroplasty. The major indication for the operation was relief of pain. Contraindications to this resurfacing arthroplasty included varus-valgus instability of over 20 degrees, combined varus-valgus instability with flexion contracture of over 40 degrees, marked recurvatum, and predominant patellofemoral symptoms. In 59 per cent of the osteoarthritic and 58 per cent of the rheumatoid patients, complete relief of pain was evident when they were evaluated twenty-four months after surgery, while another 35 per cent of each group had only mild pain related to inclement weather. Their ability to walk long distances without support or limp was increased. Range of motion and ability to climb stairs were not significantly improved.

Aged

The Modular (Marmor) knee: case report with a minimum follow-up of 2 years.

A follow-up of 2 years or more on 105 patients with the Modular (Marmor) knee replacement revealed that 88 per cent of the patients had a successful result. The complications and failures are analyzed in depth. Late loosening of the components was not observed except with the 6 mm tibial plateau. Pain relief was dramatic as well as improved function, stability and motion.

Adult

Modular computer programs for flow cytometry and sorting: the LACEL system.

A computer-based data acquisition, display and processing system for flow cytometers has been developed. The Los Alamos Cell Analysis (LACEL) programs and electronic hardware provide the capability to acquire list mode or histogram data for up to eight parameters and control bidirectional sorting based on up to four parameters for each direction. The programs described in this paper also enable the display of single parameter and bivariate histograms and the graphical manipulation of the list mode data. The electronic hardware is described in a companion paper.

Cell Separation

Modular structure of the beta-globin and the TK promoters.

Three regions important for transcription, the ATA box, the middle and the distal element, have been identified in the 5'-flanking region of both the rabbit beta-globin and herpes simplex virus thymidine kinase (TK) gene. To determine whether these elements are functionally equivalent, we constructed mosaic promoters containing all combinations of the three regions from both promoters and joined them to the beta-globin transcription unit. In an enhancer-dependent transient expression assay the beta-globin, the TK and all mosaic promoters retaining the beta-globin ATA box were about equally active, however, mosaic promoters with the TK ATA box were 4- to 10-fold less active. We conclude that homologous elements are, in principle, exchangeable and suggest an explanation why certain combinations of elements function poorly.

Animals

Modular structure of neuronal nitric oxide synthase: localization of the arginine binding site and modulation by pterin.

A putative dihydrofolate reductase (DHFR) module has been identified in neuronal nitric oxide synthase, consisting of amino acids 558-721, and is proposed to be the site of tetrahydrobiopterin (BH4) binding. This polypeptide has been expressed in E. coli as a fusion protein with glutathione S-transferase (GST), using the plasmid pGEX-4T1. The protein binds N omega-nitro-L-arginine (NNA) tightly, but this binding is not stimulated by BH4. cDNAs for Module II (residues 220-557) and Module III (residues 220-721) have been expressed as fusion proteins with GST. Module II does not bind NNA. However, Module III does bind NNA and binding is significantly stimulated by BH4. These observations are taken as strong evidence that the DHFR module contains the L-arginine binding site and, presumably, the BH4 binding site by analogy to its homology with DHFR, but that tight binding of BH4 requires amino acids 220-577.

Amino Acid Oxidoreductases