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PubMed2002

Potential of modern sonographic techniques in paediatric uroradiology.

OBJECTIVE: To describe the potential of modern sonographic techniques in paediatric uroradiology. METHOD: Ultrasound (US)-now being the primary imaging tool-has revolutionised imaging diagnostic in the urinary tract. Constant developments and technical refinements have secured the role of US in uroradiology. Colour Doppler Sonography (CDS) and innovative applications such as the transperineal approach or application of m-mode US to the urinary tract have helped to develop US from just a basic tool to a sophisticated and respected method. The ongoing introduction of new and even more sophisticated methods further enhance the sonographic potential, which shall be demonstrated by a more detailed discussion of these methods. RESULTS: Harmonic imaging, extended field of view US, amplitude coded CDS, echo-enhanced US, and three-dimensional US as the most recent new sonographic techniques are successfully applicable to paediatric urinary tract disease. They improve sonographic diagnosis in many conditions, such as detection of vesico-ureteral reflux, renal parenchymal volume assessment, comprehensive visualisation of hydronephrosis and complex pathology, evaluation of renal perfusional disturbances or defects, superior documentation with improved comparability for follow-up, or simply by offering clearer tissue delineation and differentiation. CONCLUSION: Modern US techniques are successfully applicable to neonates, infants, and children, further boosting the value of US in the paediatric urinary tract. However, as handling became more sophisticated, and artefacts have to be considered, modern urosonography became not only a more powerful, but also a more demanding method, with the need for expert knowledge and dedicated training.

Child↗
PubMed2000

The impact of heavy passive smoking on arterial endothelial function in modernized Chinese.

OBJECTIVES: The study evaluated whether heavy exposure to environmental tobacco smoke (passive smoking) might damage arterial function in modernized Chinese. BACKGROUND: Heavy passive smoking is associated with arterial endothelial dysfunction in Caucasian, but not rural Chinese, subjects. METHODS: We studied 20 young (mean age 36.6 +/- 7.0 years) nonsmoking asymptomatic casino workers (9 men) in Macau who were exposed to environmental tobacco smoke for over 8 h/day for at least two years and 20 normal subjects (control subjects). These two groups were carefully matched for age, gender, body mass index (BMI), blood pressure, vessel diameter, cholesterol and glucose levels. Brachial artery diameter was measured by high-resolution B-mode ultrasound at rest, after flow increase (causing flow-mediated endothelium-dependent dilation) and after sublingual nitroglycerin (an endothelium-independent dilator). RESULTS: Flow-mediated dilation (mean +/- SD% of diameter changes) was significantly lower in passive smokers (6.6 +/- 3.4%) compared with the controls (10.6 +/- 2.3%) (p < 0.0001). Nitroglycerin-induced dilation of the two groups were similar. Upon multivariate analysis, passive smoking exposure was the strongest independent predictor (beta = -0.59; p = 0.0001) for impaired flow-mediated endothelium-dependent dilation (model R2 = 0.75, F value = 6.1, p = 0.0001). CONCLUSIONS: In modernized Chinese, as in Caucasians, exposure to heavy environmental tobacco smoke causes arterial endothelial dysfunction, a key early event in atherosclerosis. This may have serious implications for cardiovascular health in China, currently in a process of rapid modernization.

Administration, Sublingual↗
PubMed1987

Integrating ancient and modern medicine in Chinese hospitals. The interaction among technology, traditional Chinese medicine, and health care.

Modern industrial society and its industrial processes can sometimes discourage the practice of traditional medicine. The existence and use of traditional Chinese medicine for several thousands of years indicates that it has sound elements. As has been true with features of other ancient, highly developed civilizations, the discipline of traditional Chinese medicine offers a valuable resource in the treatment and prevention of disease. Its scientific aspects and valuable experiences must continue to be developed according to Western scientific methodology. China has initiated a program to utilize modern industrialized technology in the integration of the traditional Chinese and modern Western medical systems. The policy and process aimed at integrating traditional Chinese medicine with Western medicine are presented in this paper. These measures have resulted in considerable utilization and development of the traditional Chinese medicine system, and have had a major impact on the development of public health care, as well as medical technology and science. The positive interactions between these fields of study and existing problems are discussed, and some comments on future expectations are presented.

China↗
PubMed1998

Incurable suffering from the "hiatus theoreticus"? Some epistemological problems in modern medicine and the clinical relevance of philosophy of medicine.

Up to now neither the question, whether all theoretical medical knowledge can at least be described as scientific, nor the one how exactly access to the existing scientific and theoretical medical knowledge during clinical problem-solving is made, has been sufficiently answered. Scientific theories play an important role in controlling clinical practice and improving the quality of clinical care in modern medicine on the one hand, and making it vindicable on the other. Therefore, the vagueness of unexplicit interrelations between medicine's stock of knowledge and medical practice appears as a gap in the theoretical concept of modern medicine which can be described as "Hiatus theoreticus" in the anatomy of medicine. A central intention of the paper is to analyze the role of philosophy of medicine for the clarification of the theoretical basis of medical practice. Clinical relevance and normativity in the sense of modern theory of science are suggested as criteria to establish a differentiation between philosophy of medicine as a primary medical discipline and the application of general philosophy in medicine.

Decision Making↗
PubMed2003

[Tuberculosis and the modern ideal of living].

Sunlight and fresh air belong to the everyday life's myths. It has influenced our times and personal lives as much as industrialization. Today we are hardly aware of the multiple and omnipresent consequences of this myth. The modern movement with all its facets including modern architecture is barely conceivable without it. What is the link between this triad with all its effects and tuberculosis, the oldest and most important infectious disease which still claims more than 3 million deaths per year worldwide? Tuberculosis was treated by sunlight and fresh air at all times. This treatment was at its zenith during the second half of the 19th century after Hermann Brehmer had initiated this treatment within sanatoria in 1862. The sanatorium vogue lasted until the middle of the last century when streptomycin was isolated by Selman Waksman 1943. A new type of hospital was necessary for treating the patients with sunlight and fresh air: the sanatorium with its wide windows, sheltered open balconies, terraces and "Liegehallen". In return, this airy type of building was the forrunner of a new architectural style, called "Neues Bauen". The latter has profoundly influenced our modern ideal of living since Le Corbusiier built the Villa Savoye, one of the architectural highlights of the 20th century.

Air↗
PubMed1990

ESR dating evidence for early modern humans at Border Cave in South Africa.

The archaeological and hominid site of Border Cave (KwaZulu, South Africa) has a stratigraphic sequence covering the Middle and Later Stone Ages (MSA and LSA). It has been proposed that four hominid specimens recovered there (BC1 and BC2 of uncertain provenance, and BC3 and BC5 recovered from MSA layers) represent very early examples of anatomically modern humans, supporting an early late-Pleistocene appearance of modern Homo sapiens in Africa. This early appearance, however, has been questioned, largely because of doubts about the stratigraphic positions associated with the specimens and because of the lack of a reliable chronology for the stratigraphic sequence. We now report on the first comprehensive radiometric dating analysis of Border Cave, using electron spin resonance (ESR) on teeth within sediment layers. BC3 is likely to be approximately 70-80 kyr old, and BC5, 50-65 kyr old. BC1 and BC2 are almost certainly less than 90 kyr old. These results, although younger than some age estimates, support the early occurrence of anatomically modern humans at Border Cave. In addition, our results suggest that the Howiesons Poort lithic industry (approximately 45-75 kyr) and the MSA-LSA transition (approximately 35 kyr) are younger than often believed.

Animals↗
PubMed1993

Mass-spectrometric U-series dates for Israeli Neanderthal/early modern hominid sites.

The nature of the relationship between Neanderthals and early modern Homo sapiens is controversial, yet it is fundamental to our understanding of early human evolution. The Middle Palaeolithic sites of Israel are critical to this debate, because unlike those of western Europe and Africa they contain both Neanderthal (at Tabun and Kebara for example) and anatomically modern hominids (as at Skhul and Qafzeh). Here we present new mass spectrometric 230Th/234U dates for dental fragments from the Middle Palaeolithic burial sites of Tabun, Qafzeh and Skhul. These data, combined with published ages from electron spin resonance (ESR), provide compelling evidence that the Tabun Neanderthals and Qafzeh early modern Homo sapiens were approximately coeval in the southern Levant some 100 +/- 5 kyr ago, but indicate that some of the Skhul material is younger. The study also shows that combined mass-spectrometric 230Th/234U and ESR dating is an invaluable technique for dating archaeological sites beyond the range of radiocarbon dating.

Animals↗
PubMed2005

Stratigraphic placement and age of modern humans from Kibish, Ethiopia.

In 1967 the Kibish Formation in southern Ethiopia yielded hominid cranial remains identified as early anatomically modern humans, assigned to Homo sapiens. However, the provenance and age of the fossils have been much debated. Here we confirm that the Omo I and Omo II hominid fossils are from similar stratigraphic levels in Member I of the Kibish Formation, despite the view that Omo I is more modern in appearance than Omo II. 40Ar/39Ar ages on feldspar crystals from pumice clasts within a tuff in Member I below the hominid levels place an older limit of 198 +/- 14 kyr (weighted mean age 196 +/- 2 kyr) on the hominids. A younger age limit of 104 +/- 7 kyr is provided by feldspars from pumice clasts in a Member III tuff. Geological evidence indicates rapid deposition of each member of the Kibish Formation. Isotopic ages on the Kibish Formation correspond to ages of Mediterranean sapropels, which reflect increased flow of the Nile River, and necessarily increased flow of the Omo River. Thus the 40Ar/39Ar age measurements, together with the sapropel correlations, indicate that the hominid fossils have an age close to the older limit. Our preferred estimate of the age of the Kibish hominids is 195 +/- 5 kyr, making them the earliest well-dated anatomically modern humans yet described.

Aluminum Silicates↗
PubMed2005

Radiocarbon dating of interstratified Neanderthal and early modern human occupations at the Chatelperronian type-site.

The question of the coexistence and potential interaction between the last Neanderthal and the earliest intrusive populations of anatomically modern humans in Europe has recently emerged as a topic of lively debate in the archaeological and anthropological literature. Here we report the results of radiocarbon accelerator dating for what has been reported as an interstratified sequence of late Neanderthal and early anatomically modern occupations at the French type-site of the Chatelperronian, the Grotte des Fées de Châtelperron, in east-central France. The radiocarbon measurements seem to provide the earliest secure dates for the presence of Aurignacian technology--and from this, we infer the presence of anatomically modern human populations--in France.

Animals↗
PubMed2003

Lower glucose-dependent insulinotropic polypeptide (GIP) response but similar glucagon-like peptide 1 (GLP-1), glycaemic, and insulinaemic response to ancient wheat compared to modern wheat depends on processing.

OBJECTIVE: To test the hypothesis that bread made from the ancient wheat Einkorn (Triticum monococcum) reduces the insulin and glucose responses through modulation of the gastrointestinal responses of glucose-dependent insulinotrophic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) compared to the responses to bread of modern wheat (Triticum aestivum). DESIGN: The 3-h postprandial insulinaemic, glycaemic, GIP, and GLP-1 responses to bread made from Einkorn were compared to responses to a traditional Danish wheat loaf. The bread from Einkorn was prepared by 3 different processing methods: leavening with honey-salt added, leavening crushed whole grain, and conventional leavening with yeast added. Bread made from modern wheat was prepared by conventional leavening with yeast added. SUBJECTS: A total of 11 healthy young men. RESULTS: The postprandial GIP response was significantly (P<0.001) reduced by the Einkorn breads processed with honey-salt leavening and by using crushed whole grain bread compared to the yeast leavened bread made from modern wheat or from Einkorn. No significant differences were found in the responses of GLP-1, insulin or glucose. CONCLUSION: Einkorn honey-salt leavened and Einkorn whole grain bread elicit a reduced gastrointestinal response of GIP compared to conventional yeast bread. No differences were found in the glycaemic, insulinaemic and GLP-1 responses. Processing of starchy foods such as wheat may be a powerful tool to modify the postprandial GIP response.

Adult↗
PubMed1998

On the success, cost and efficiency of modern medicine: an international comparison.

OBJECTIVE: To study the success and cost of modern medicine in industrialized, rich countries from 1980 to 1990. DESIGN: Cost per capita and per cent of gross domestic product (GDP) spent on health was related to: (i) mortality in six diseases amenable to treatment by modern medicine; (ii) the sum of those six diseases (avoidable disease); (iii) death due to other, unavoidable diseases; (iv) maternal and infant mortality; (v) life expectancy at birth; (vi) renal dialysis and transplantation rates. Efficiency was studied by comparing a country's avoidable mortality rates multiplied by expenses, to the mean for all countries. RESULTS: During the 10 years, avoidable death rate decreased 38% but unavoidable death rate only 10%. Life expectancy increased 3%. Cost per capita increased 107% but health expenditures, as per cent of GDP only 10%. There was a reasonable correlation between expenses and avoidable mortality but none between expenses and unavoidable death rate. In 1990 avoidable mortality was lowest in Canada, and highest in Japan. Cost was lowest in New Zealand, and highest in the USA. The efficiency index was highest for Australia, and lowest in the USA. CONCLUSION: Modern medicine as we have studied it is successful. Avoidable death rate shows a steep uninterrupted decline over the last 50 years while unavoidable death rate shows only small decreases. Cost as per cent of GDP has increased only moderately. There is a correlation between expenses and mortality from avoidable but not from unavoidable diseases, and a large variation in efficiency.

Clinical Medicine↗
PubMed2002

Mitochondrial DNA variation in Pleistocene and modern Atlantic salmon from the Iberian glacial refugium.

Current understanding of the postglacial colonization of Nearctic and Palearctic species relies heavily on inferences drawn from the phylogeographic analysis of contemporary generic variants. Modern postglacial populations are supposed to be representative of their Pleistocene ancestors, and their current distribution is assumed to reflect the different colonization success and dispersal patterns of refugial lineages. Yet, testing of phylogeographic models against ancestral genomes from glacial refugia has rarely been possible. Here we compare ND1 mitochondrial DNA variation in late Pleistocene (16,000-40,000 years before present), historical and contemporary Atlantic salmon (Salmo salar) populations from northern Spain and other regions of western Europe. Our study demonstrates the presence of Atlantic salmon in the Iberian glacial refugium during the last 40,000 years and points to the Iberian Peninsula as the likely source of the most common haplotype within the Atlantic lineage in Europe. However, our findings also suggest that there may have been significant changes in the genetic structure of the Iberian refugial stock since the last ice age, and question whether modern populations in refugial areas are representative of ice age populations. A common haplotype that persisted in the Iberian Peninsula during the Pleistocene last glacial maximum is now extremely rare or absent from European rivers, highlighting the need for caution when making phylogeographic inferences about the origin and distribution of modern genetic types.

Animals↗
PubMed2002

From instinct to intellect: the challenge of maintaining healthy weight in the modern world.

The global obesity epidemic is being driven in large part by a mismatch between our environment and our metabolism. Human physiology developed to function within an environment where high levels of physical activity were needed in daily life and food was inconsistently available. For most of mankind's history, physical activity has 'pulled' appetite so that the primary challenge to the physiological system for body weight control was to obtain sufficient energy intake to prevent negative energy balance and body energy loss. The current environment is characterized by a situation whereby minimal physical activity is required for daily life and food is abundant, inexpensive, high in energy density and widely available. Within this environment, food intake 'pushes' the system, and the challenge to the control system becomes to increase physical activity sufficiently to prevent positive energy balance. There does not appear to be a strong drive to increase physical activity in response to excess energy intake and there appears to be only a weak adaptive increase in resting energy expenditure in response to excess energy intake. In the modern world, the prevailing environment constitutes a constant background pressure that promotes weight gain. We propose that the modern environment has taken body weight control from an instinctual (unconscious) process to one that requires substantial cognitive effort. In the current environment, people who are not devoting substantial conscious effort to managing body weight are probably gaining weight. It is unlikely that we would be able to build the political will to undo our modern lifestyle, to change the environment back to one in which body weight control again becomes instinctual. In order to combat the growing epidemic we should focus our efforts on providing the knowledge, cognitive skills and incentives for controlling body weight and at the same time begin creating a supportive environment to allow better management of body weight.

Biological Evolution↗
PubMed2003

Modern statistical methods for handling missing repeated measurements in obesity trial data: beyond LOCF.

This paper brings together some modern statistical methods to address the problem of missing data in obesity trials with repeated measurements. Such missing data occur when subjects miss one or more follow-up visits, or drop out early from an obesity trial. A common approach to dealing with missing data because of dropout is 'last observation carried forward' (LOCF). This method, although intuitively appealing, requires restrictive assumptions to produce valid statistical conclusions. We review the need for obesity trials, the assumptions that must be made regarding missing data in such trials, and some modern statistical methods for analysing data containing missing repeated measurements. These modern methods have fewer limitations and less restrictive assumptions than required for LOCF. Moreover, their recent introduction into current releases of statistical software and textbooks makes them more readily available to the applied data analyses.

Clinical Trials as Topic↗
PubMed2002

A geometric morphometric study of regional differences in the ontogeny of the modern human facial skeleton.

This study examines interpopulation variations in the facial skeleton of 10 modern human populations and places these in an ontogenetic perspective. It aims to establish the extent to which the distinctive features of adult representatives of these populations are present in the early post natal period and to what extent population differences in ontogenetic scaling and allometric trajectories contribute to distinct facial forms. The analyses utilize configurations of facial landmarks and are carried out using geometric morphometric methods. The results of this study show that modern human populations can be distinguished based on facial shape alone, irrespective of age or sex, indicating the early presence of differences. Additionally, some populations have statistically distinct facial ontogenetic trajectories that lead to the development of further differences later in ontogeny. We conclude that population-specific facial morphologies develop principally through distinctions in facial shape probably already present at birth and further accentuated and modified to variable degrees during growth. These findings raise interesting questions regarding the plasticity of facial growth patterns in modern humans. Further, they have important implications in relation to the study of growth in the face of fossil hominins and in relation to the possibility of developing effective discriminant functions for the identification of population affinities of immature facial skeletal material. Such tools would be of value in archaeological, forensic and anthropological applications. The findings of this study underline the need to examine more deeply, and in more detail, the ontogenetic basis of other causes of craniometric variation, such as sexual dimorphism and hominin species differentiation.

Adolescent↗
PubMed2002

Demographic transition of the Swedish cystic fibrosis community--results of modern care.

Assessing the results of modern cystic fibrosis (CF)-care and estimating the future population and its demography is important to evaluate the treatment regimens and to calculate the future needs of health-care resources. This paper updates previous incidence calculations. It assesses the results of modern CF-care in terms of survival and changing demography in Sweden. The incidence of CF in Sweden was calculated as 1/5600 live-births. Of the CF-population alive in 1999, 45% were > or = 18 years old. The mean annual mortality rate since 1991 was 0.9% (+/-0.4) and the median age at death 26 years (range 0-72). Of those born > or = 1991, 95% were estimated to survive their 25th birthday. The incidence of CF in Sweden is low. Modern CF-care in Sweden shows good results. The CF-population is growing rapidly and the adult part of the population will soon be larger than the paediatric. Continuously adapted resources are required to assure the future treatment quality especially for the growing adult CF-population.

Adolescent↗
PubMed2000

A comparison of 2 modern femoral cementing techniques: analysis by cement-bone interface pressure measurements, computerized image analysis, and static mechanical testing.

Modern cementing techniques aim to improve microinterlock and to reduce aseptic loosening. The Norwegian and Swedish Arthroplasty Registers have shown an increased risk of revision using reduced-viscosity cement. We have compared 2 modern cementing techniques using retrograde insertion of normal-viscosity and reduced-viscosity cements. Laboratory-simulated arthroplasty was performed in paired human femora. Performance was evaluated by measuring pressures generated during cementation, cement penetration, and shear strength of the prosthesis-cement and bone-cement interfaces. Large differences exist between these 2 modern techniques. Despite no statistical differences between the pressure measurements with the 2 techniques, greater penetration of reduced-viscosity cement was found proximally, with a trend toward increased penetration of the more viscous cement distally. Areas of greater cement penetration with reduced-viscosity cement proximally produced higher values of ultimate shear strength. Both techniques showed a progressive increase in the shear strength as the level of the section progressed toward the tip of the prosthesis. There is a trend with both techniques for the distal fixation to be stronger.

Arthroplasty, Replacement, Hip↗
PubMed2003

[Modern management of bleeding disorders and haemorrhage in otorhinolaryngology].

BACKGROUND: Bleeding disorders and haemorrhages are recognized as common and serious problems in otorhinolaryngology. Over the past decade a number of innovative technologies and therapeutical options have been established to improve the management of them. The aim of this paper is to present diagnostical and therapeutical concepts proved to be medically effective and economically acceptable and to review the international literature. METHODS: Bleeding disorders observed over a period of 10 years were analysed retrospectively to determine their prevalence and causes in otorhinolaryngology. Selected cases were used to illustrate both the efficacy and the limits of modern therapeutical options. A medico-economical evaluation of preoperative hemostaseological tests was carried out. RESULTS: Activated partial thromboplastin time (aPTT), Quick's prothrombin time combined with a detailed bleeding history were found to be optimal parameters to screen most of the haemostaseological defects. The incidence and severity of perioperative diffuse haemorrhages could significantly be reduced by routineous use of modern anesthesiological procedures, like controlled hypotension, total intravenous anesthesia (TIVA) and augmented ventilation techniques. Advances in interventional radiology reduced the risk of embolization of hypervascularized tumors and led to increasing application in recurrent epistaxis. A new generation of endoscopes combined with different laser techniques made the surgical treatment of hemorrhage more precise, increased the comfortability for the bleeding patient and were helpfull to decrease the length of stay and blood transfusion rates. CONCLUSION: Prevention and treatment of diffuse haemorrhages located within the craniocervical region can currently be optimized by an interdisciplinary dialog enrolling first of all the haemostaseologist and the anesthesiologist. Nowadays, close cooperation with the interventional radiologist is mandatory in the modern treatment of hypervascular lesions and vascular malformations. Moreover, it is necessary in emergency when otolaryngological measures faile to arrest bleedings from arterial site. Neither new techniques nor innovative strategies will be capable to compensate the experience and careful otolaryngologist.

Emergencies↗