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PubMed2005

Mathematical modeling of cancer: the future of prognosis and treatment.

BACKGROUND: Cancer research has undergone radical changes in the past few years. Producing information both at the basic and clinical levels is no longer the issue. Rather, how to handle this information has become the major obstacle to progress. Intuitive approaches are no longer feasible. The next big step will be to implement mathematical modeling approaches to interrogate the enormous amount of data being produced and extract useful answers (a "top-down" approach to biology and medicine). METHODS: Quantitative simulation of clinically relevant cancer situations-based on experimentally validated mathematical modeling-provides an opportunity for the researcher, and eventually the clinician, to address data and information in the context of well-formulated questions and "what if" scenarios. RESULTS AND CONCLUSIONS: At the Vanderbilt Integrative Cancer Biology Center (VICBC), we are integrating cancer researchers, oncologists, chemical and biological engineers, computational biologists, computer modelers, theoretical and applied mathematicians, and imaging scientists, in order to implement a vision for a combined web site and computational server that will be a home for our mathematical modeling of cancer invasion. The web site (www.vanderbilt.edu/VICBC/) will serve as a portal to our code, which simulates tumor growth by calculating the dynamics of individual cancer cells (an experimental "bottom-up" approach to complement the top-down model). Eventually, cancer researchers outside of Vanderbilt will be able to initiate a simulation based on providing individual cell data through a web page. We envision placing the web site and computer cluster directly in the hands of biological researchers involved in data mining and mathematical modeling. Furthermore, the web site will also contain teaching props for a new generation of biomedical researchers fluent in both mathematics and biology. This is unconventional bioinformatics: We will be incorporating biological data and functional information into a unified community-based mathematical framework. The result will be a tool for cancer modeling that will ultimately have basic research, therapeutic and educational value.

Animals↗

PubMed1992

Do older internists use more hospital resources than younger internists for patients hospitalized with chest pain? A study of patients hospitalized in the coronary care and intermediate care units.

OBJECTIVES: Recent concern about escalating healthcare expenditures has prompted healthcare payers and hospitals to identify physicians whose hospital resource consumption exceeds expected norms. The goals of this study were to determine whether analyses of practice patterns in this manner may a) systematically identify older physicians as big resource "spenders," and b) provide misleading information caused by the failure to adjust utilization data for severity of illness. DESIGN: A prospective, observational study. SETTING: The coronary care and intermediate care unit in an 1,100-bed community hospital. PATIENTS: A total of 217 patients hospitalized for chest pain cared for by noncardiologists. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: On initial inspection, it appeared that the patients of older physicians had longer lengths of stay and greater charge expenditures than the patients of younger physicians. However, further evaluation demonstrated that older physicians cared for older (76 vs. 67 yrs old, p = .0001) and more severely ill patients (judged by risk of complications, risk of acute ischemic heart disease, and disease staging). Older physicians cared for more severely ill myocardial infarction patients than did younger physicians (Killip Classification 2.0 vs. 1.1, p less than .00003). After adjusting for severity of illness, there were fewer differences in hospital charges and consultant use between older and younger physicians, although the patients of older physicians remained hospitalized longer. CONCLUSIONS: There is little difference in resource utilization between patients cared for by older and younger internists after controlling for severity of illness. This investigation highlights the potential hazards of ignoring severity of illness when judging physician efficiency in the coronary care unit.

Age Factors↗

PubMed1999

Comparative efficacy and safety of chloroquine and alternative antimalarial drugs: a meta-analysis from six African countries.

OBJECTIVE: To evaluate the safety and efficacy of the currently used antimalarial drugs in six African countries. DESIGN: A meta-analysis. MAIN OUTCOME MEASURES: The role of efficacy, safety and cost on the selection of antimalarial drugs. RESULTS: The comparative efficacy study showed that amodiaquine (with > 90% cure rate) was superior to chloroquine and sulphadoxine-pyrimethamine at seven days schedule. The efficacy of amodiaquine was also observed to be comparable to that of mefloquine and halofantrine. The parasite clearance time (PCT) of these drugs ranged between two days and a week and the fever clearance time (FCT) was within 48 hours. The recrudescence rate at D14-D21 was found to be 12-17% in chloroquine and amodiaquine, while sulphadoxine-pyrimethamine showed a trend similar to halofantrine and mefloquine (0-12% recrudescence rate). Similarly, a big difference was also noted in the cost of the different antimalarial drugs. The pharmacokinetic data, however, showed that they are of similar profile, except in adverse features and contraindications, and values like their half-life (t1/2) where the long (t1/2) in drugs like sulphadoxine-pyrimethamine endows them with suppressive-cure feature, especially against recrudescent strains. Nevertheless, as these data are obtained from resident population in Africa, who however naive are exposed to few malaria challenges in their life, the results should not be directly extrapolated to total non immunes such as visitors from Europe. CONCLUSION: The choice of alternative antimalarial drugs should be mainly based on their relative efficacy, safety and cost.

Africa, Eastern↗

PubMed2000

Reduced myocardial cellular damage and lipid peroxidation in off-pump versus conventional coronary artery bypass grafting.

BACKGROUND: The development of new surgical devices and techniques allows off pump coronary artery bypass grafting (OPCAB) without the use of CPB and cardioplegia. This study tested whether OPCAB reduces myocardial cell damage, lipid peroxidation and systemic endothelin release when compared to conventional coronary artery bypass grafting. METHODS: Twenty-six patients were assigned to either the OPCAB procedure using a suction device and regular sternotomy (n = 13) or were treated conventionally using extracorporeal circulation, blood cardioplegia and hypothermic arrest (29-31 degrees C; n = 13). Troponin I and creatine kinase - MB were determined for cardiac specific cell damage. Myocardial and systemic malondialdhyde levels were measured to account for oxyradical mediated lipid peroxidation. Systemic big-endothelin levels were determined as a marker for endothelial cell activation. RESULTS: A significant reduction of the cardiac specific cell damage was observed in the OPCAB group vs. the CABG group over time in the absence of acute myocardial ischemia or infarction. In addition, systemic and myocardial lipid peroxidation as measured by the malondialdehyde (MDA) levels were lower in the OPCAB group when compared to CABG. Finally, plasma levels of big-Endothelin (big-ET) significantly rose in the CABG but not in the OPCAB group. CONCLUSIONS: The data of the present study indicate that OPCAB revascularization without the use of CPB and cardioplegic arrest reduces myocardial cell damage and lipid peroxidation. It is also associated with a reduced activation of the potent vasoconstrictor peptide endothelin. All of this may contribute to improved myocardial function and faster postoperative recovery from surgical revascularization procedures, particularly in critically ill patients.

Aged↗

PubMed2000

Confronting HIPAA.

UNLABELLED: Just when you thought it was safe to come out after Y2K, along comes the Health Insurance Portability & Accountability Act, which--if you're not there yet--will force you head first into the electronic age. HIPAA comes with a big price tag, but it may save you money in the long run by standardizing data. BOTTOM LINE: Compliance is not an option.

Computer Communication Networks↗

PubMed2003

Functioning of care-and-treatment health centers and nursing-and-care health centers illustrated by the Province of Lublin.

A commonly felt problem in the Polish system of health protection is the lack of long-term care in the properly functioning family. With the introduction of a new system of health insurance, chronically ill patients with an established diagnosis and therapy and not requiring hospitalization are considered not eligible for hospital care. It concerns a big group of patients with a considerable limitation of self-caring activities. The demographic data imply that this problem is growing systematically. A bigger and bigger part of the society is at their post-production age in which many diseases limiting independent functioning develop. Problems arising from the disease influence not only the family but also the whole society. In many cases a chronic disease leads to disability, which results in the requirement for nursing care. Year by year there is an increasing number of people requiring everyday at least 2-hour nursing care. A considerable number of these patients qualify for stationary long-term care. There is a great deficit of services in the long-term care at present. New principles of financing health services force the health care settings to use the beds in the optimum way, to make a quick diagnosis and treatment without extending the patient's stay in hospital by a period that would not influence the change of health condition. Therefore, long-term care should comprise about 60% of the whole potential of stationary care. In our country the deficit of stationary forms of long-term care is felt. It creates the opportunity for many hospitals providing the short-term care to transform to treatment-care settings or nursing-and-care settings which will be performing longterm care.

Aged↗

PubMed2005

Suicide and suicide attempts in adolescents and young adults in Kraków in the years 2002-2003.

The aim of the study was to present the increasingly alarming phenomenon of completed suicide in adolescents and young adults. The material analysed had been drawn from the records of post-mortem examinations conducted by the Institute of Forensic Medicine in Kraków. The analysis covered cases of completed suicide committed by 15-30 years old inhabitants of Kraków or its environs between the September 2002 and the September 2003. The group of subjects analysed comprised 47 individuals (9 females and 38 males); 57.4% of these had resided in a big city (Kraków), and the remaining 42.6%--in villages or little towns near Kraków. The data regarding cases of completed suicide were compared with the data regarding suicide attempts by self-intoxication in the period under consideration, extracted from the documentation of the Department of Clinical Toxicology in Kraków. The latter data encompassed 233 cases of suicide attempts by individuals ranging in age from 15 to 29 years, with females constituting 62.2% of these, and males--37.8%. 65% of the attempters had been residents of Kraków. The analysis of the data from the Institute of Forensic Medicine revealed that nearly half of the suicide victims concerned had been treated for mental disorders, mainly depression and addictive disorders. The occurrence of suicide attempts prior to the fatal act was established in the case of 17 subjects (18.5%). Over half of the subjects (48.9%) committed suicide by hanging themselves, 17%--by falling from a height, 8.6%--by drowning, and 19.1%--by self-intoxication with medicaments. 77.2% of the subjects committed suicide at home. In the case of 23 subjects (48.9%), the post-mortem examination revealed the presence of alcohol. The analysis of the cases of suicide attempts by self-intoxication revealed a significant percentage of depressive disorders (26%)--of high occurrence especially in the case of females, whereas alcohol addiction was the predominant diagnosis in the case of males. Furthermore, the majority of the attempters exhibited situational reactions or personality disorders. Suicide attempts constitute an essential part of the issue of suicide in adolescents and young adults and require further research. What attracts notice, is a high percentage of males among suicide victims, and a high percentage of suicide victims with earlier suicide attempts. The results of the study should be taken into consideration in suicide prevention in groups especially endangered by the risk of completed suicide, such as adolescents and young adults after suicide attempts.

Adolescent↗

PubMed2006

[The effect of early diagnosis of recurrence and revision after resection of primary spine tumors].

OBJECTIVE: To explore the effect of early diagnosis of recurrence and early revision after resection of primary spine tumors. METHODS: From March 1989 to September 2005, the relate clinic data of 55 patients with giant cell tumors, osteoblastomas, chondrosarcomas and chordomas in spine in big piecemeal and current fashion was analysed. RESULTS: In 55 cases, 43 patients were followed up and had complete materials. The follow-up time ranged from 1.6 to 16.5 years, averagely 5.8 years. Thirty-four patients followed up regularly, and 12 were found recurrent, in which one C(1) giant cell tumor was found extensively large 3 months after initial surgery and was undertaken palliatory curet. The other eleven lesions were small and re-operated with wide margin. As a result, six patients lived without tumors during the 1 approximately 9.5 years follow-up, one patient gave up revision when found recurred again for economic reason, another four patients recurred repeatedly, but they persisted in regular follow-up and took revision surgeries whenever the recurred lesion were found. As a result, 3 of them lived without tumor and the other one died of other disease without sign of recurrence. In contrast, there were another nine patients who came to follow up until they had symptoms and were confirmed recurrent extensively. Two of them were excised radically for the tumors located in the relatively easily exposed segments of spine and lived without tumor now. While the other seven patients only received palliatory curet and all died of tumors. CONCLUSIONS: Regular follow-up, early diagnosis of recurrence and early revision need to be regarded as part of radical excision and are very important of surgical treatment of spinal tumors, which can prolong the patients' survival time.

Adolescent↗

PubMed1990

[Complex automatic data processing in multi-profile hospitals].

The computerization of data processing in multi-disciplinary hospitals is the key factor in raising the quality of medical care provided to the population, intensifying the work of the personnel, improving the curative and diagnostic process and the use of resources. Even a small experience in complex computerization at the Botkin Hospital indicates that due to the use of the automated system the quality of data processing in being improved, a high level of patients' examination is being provided, a speedy training of young specialists is being achieved, conditions are being created for continuing education of physicians through the analysis of their own activity. At big hospitals a complex solution of administrative and curative diagnostic tasks on the basis of general hospital network of display connection and general hospital data bank is the most prospective form of computerization.

Computer Systems↗

PubMed1989

A natural and broad spectrum nootropic substance for treatment of SDAT--the Ginkgo biloba extract.

The efficacy of the Ginkgo biloba extract was not only found clinically or in standardised ratings but also documented by objective data, obtained by a computerized EEG method, the DYNAMIC BRAIN MAPPING and BRAIN FUNCTION MONITORING SYSTEM (Dr. T. Itil, New York). A one year open trial comprise 25 parkinson patients with additional signs of SDAT. Data from 3 selected cases were given: The short time efficacy of the substance after the infusion and the long-term result after the oral medication. The maps showed less slower and more faster waves. Without any side effects the Ginkgo biloba extract seems to be a substance with a broad spectrum of influence. Our therapeutic findings in parkinsonian patients with SDAT and the data taken from healthy elderly volunteers revealed that the computerized EEG method may have another big advantage: It seems that the so-called anteriorisation of the Theta waves can be taken as a preclinical sign of an incipient change in brain metabolism. As a consequence--it might be that these changes are reversible by an adequate nootropic treatment. Further studies and treatment experiences must confirm these preliminary findings.

Aged↗

PubMed1993

[Problems and complications after implantation of automatic defibrillators].

Until now there are only few reports about problems and complications associated with the automatic implantable cardioverter-defibrillator (ICD). Therefore, we studied the follow-up of 295 patients, who underwent ICD therapy. Epicardial ICD implantation was performed in 206 patients (71%) and 89 patients (29%) received transvenous ICD systems. Infections or seroma of the pulse generator and/or lead systems were observed in 18 patients (6%), in nine patients after first ICD implant and in nine patients after generator replacement. General signs of inflammation were present in eleven patients, whereas local signs with seroma of the pocket were observed in seven patients. Explantation of the entire ICD hardware was performed in eleven patients and seven patients underwent partial removal of the ICD system. Lead complications occurred in 15 patients (5%), in eleven patients with epicardial and in four with transvenous ICD systems. All patients had inappropriate ICD shocks and had to undergo lead replacement. Inappropriate ICD shocks due to supraventricular tachyarrhythmias occurred in 24 patients (8%). Other complications (apoplexia, hematoma, pneumothorax) were observed in 15 patients (5%). Our data show that complications associated with the ICD are low. However, these complications can cause big problems and need appropriate diagnosis and treatment.

Adolescent↗

PubMed1983

Manipulation by tridemorph, a systemic fungicide, of the sterol composition of maize leaves and roots.

The roots of maize (Zea mays L. var LG11) seedlings were watered with a solution of Tridemorph (2,6-dimethyl-N-tridecyl-morpholine), a systemic fungicide, for 3 to 4 weeks from the onset of germination. Very few big up tri, open(5)-sterols, the major sterols of the control, were detected in the treated plants, and 9beta,19-cyclopropyl sterols accumulated dramatically in both roots and leaves. big up tri, open(8)-sterols were also found when low concentrations of the drug were used. The time course of the accumulation of the new sterols has been studied in plants treated with various concentrations (1-20 milligrams per liter) of Tridemorph. We found that: (a) cycloeucalenol-obtusifoliol isomerase, an enzyme opening the cyclopropane ring of cyclopropyl sterols, was strongly inhibited by the drug; and (b) the drug diffused readily from the roots to the whole plant and reached its enzymic targets in most of the leaf cells. The data obtained offer an opportunity to evaluate the physiological and biochemical consequence of the almost complete replacement of big up tri, open(5)-sterols by cyclopropyl sterols in higher plant cells.

Journal Article↗

PubMed1990