Cardiac pain: discover the unexpected.
Learn how to rapidly identify myocardial ischemia, injury, and infarction, and initiate appropriate treatment.
Abbreviations as Topic↗
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Transient spatial deficit associated with bilateral lesions of the lateral mammillary nuclei.
The mammillary bodies have long been implicated in spatial memory, and lesions of this structure in rats can impair some spatial memory tasks. The mammillary bodies, however, comprise two main nuclei that have different electrophysiological and anatomical properties. It is therefore possible that they have different functions. The present study determined whether selective lesions of one of these components, the lateral mammillary nucleus, are sufficient to induce spatial memory deficits. While selective lateral mammillary nuclei lesions induced deficits on a working memory task in the water maze, this impairment was milder and not as persistent as that seen with complete mammillary body lesions. Furthermore, lateral mammillary nuclei lesions did not impair T-maze alternation, which is sensitive to complete mammillary body lesions. From these results it appears that lesions confined to the lateral mammillary nuclei are sufficient to produce mild impairments when rapid, new spatial learning is at a premium. At the same time, the remaining mammillary nuclei also contribute to spatial learning, though this may be in a qualitatively different manner.
Animals↗
Complications of port-access cardiac surgery.
Port-Access cardiac surgery is a recent technology that is undergoing rapid development. The learning curve associated with this technique is a challenge even for the skilled and experienced cardiac surgeon. Mainly because of femoral cannulation, the use of guidewires, and working through small incisions, Port-Access cardiac surgery contains certain pitfalls that are clearly associated with the technology involved. These pitfalls currently require troubleshooting, but as the technology progresses, this may become less of an issue. Communicating these pitfalls to others is important to help others to avoid or better manage complications and to contribute to improving the technology of Port-Access techniques.
Cardiac Surgical Procedures↗
Normative developmental behavior with implications for health and health promotion among adolescents: a Swedish cross-sectional survey.
I describe behavior with impact on health in adolescents against the background of characteristics of the Swedish society and analyse possible areas for improvement. A total of 4500 adolescents, aged 13-18 yr, in seven areas answered an anonymous questionnaire. Their socioeconomic backgrounds reflected mainstream adolescents. The response rate was 80-85%. Questions concerned health habits, exploratory behaviors regarding sexuality, use of alcohol and tobacco, problem behaviors, such as getting drunk, and life quality. There was very little experimentation with regard to health habits learned in childhood. Rapid adaptation to adult life-styles occurred, which was similar in both sexes in the younger age groups, but there were significant differences among older students. Alcohol use is of considerable concern. Adolescent prediction of future behavior indicated that negative behaviors require intervention. Parental influence on adolescent behavior needs to be explored. Peer groups could be an additional area for intervention.
Adolescent↗
Tolerance and ways to break it.
The overall picture as regards cellular mechanisms in immunologic tolerance is thus clear. Thymic negative selection is an important and dominant mechanism for both CD4+ and CD8+ T cells for those antigens (and they may be very many indeed), the peptides of which get expressed within the thymus. The induction of anergy among peripheral T lymphocytes may represent an ancillary mechanism in some cases, but this is not as clear as it appeared 2 or 3 years ago. Evidently, in many cases, T cells simply ignore antigens present only within specialized organs, and these T cells, even if only of low affinity for the antigen in question, could be provoked into autoimmunity if sufficient help is provided, for example, through localized production of IL-2 or through provision of cross-reactive help. B-cell tolerance is also proven and involves deletional mechanisms (most likely maturation arrest) or functional inactivation (clonal anergy). The former phenomenon dominates for self-antigens that strongly cross-link the B cell's Ig receptors and the latter for weaker negative signals. Despite these two mechanisms, clonal ignorance prevails for many self-antigens. The secondary B-cell repertoire is also largely free of anti-self B cells, lack of T-cell help being a major factor in preventing the development of anti-self memory B cells. Therefore, to have the best chance of creating an immunogenic antitumor vaccine, a few simple and rather obvious rules must be followed. The antigen in question must be presented in such a way as to be palatable to "professional" antigen-presenting cells, particularly dendritic cells and macrophages. Immunotherapy protocols should avoid at all costs the widespread distribution of the antigen in question through the extracellular fluids. Indeed, it is possible that widespread circulation of a tumor-associated antigen through the serum and lymph because of large-scale shedding from the tumor cell may already have created a substantial degree of tolerance to the antigen in question in both T- and B-cell populations. If that has happened, it becomes particularly important to create a cancer vaccine capable of inducing help. This may well involve coupling of the most important epitopes to some highly immunogenic and foreign carrier. A wide choice of adjuvants is available for the designer of tumor vaccines, and in this regard the cancer immunotherapy community has much to learn from the rapidly developing field of infectious disease vaccinology using recombinant and other vaccines.(ABSTRACT TRUNCATED AT 400 WORDS)
Animals↗
The brain-computer: origin of the idea and progress in its realization.
The Brain-Computer is a physical analogue of a real organism which uses both a brain-inspired memory-based architecture and an output-driven learning algorithm. This system can be realized by creating a scaled-down model car that learns how to drive by heuristically connecting image processing with behavior control. This study proves that learning efficiency progresses rapidly when the acquired behaviors are prioritized. We develop a small real-world device that moves about purposefully in an artificial environment. The robot uses imaging information acquired through its random actions to make a mental map. This map, then, provides the cognitive structure for acquiring necessary information for autonomous behavior.
Algorithms↗
Properties of synergies arising from a theory of optimal motor behavior.
We consider the properties of motor components, also known as synergies, arising from a computational theory (in the sense of Marr, 1982) of optimal motor behavior. An actor's goals were formalized as cost functions, and the optimal control signals minimizing the cost functions were calculated. Optimal synergies were derived from these optimal control signals using a variant of nonnegative matrix factorization. This was done using two different simulated two--joint arms--an arm controlled directly by torques applied at the joints and an arm in which forces were applied by muscles--and two types of motor tasks-reaching tasks and via-point tasks. Studies of the motor synergies reveal several interesting findings. First, optimal motor actions can be generated by summing a small number of scaled and time-shifted motor synergies, indicating that optimal movements can be planned in a low-dimensional space by using optimal motor synergies as motor primitives or building blocks. Second, some optimal synergies are task independent--they arise regardless of the task context-whereas other synergies are task dependent--they arise in the context of one task but not in the contexts of other tasks. Biological organisms use a combination of task--independent and task--dependent synergies. Our work suggests that this may be an efficient combination for generating optimal motor actions from motor primitives. Third, optimal motor actions can be rapidly acquired by learning new linear combinations of optimal motor synergies. This result provides further evidence that optimal motor synergies are useful motor primitives. Fourth, synergies with similar properties arise regardless if one uses an arm controlled by torques applied at the joints or an arm controlled by muscles, suggesting that synergies, when considered in "movement space," are more a reflection of task goals and constraints than of fine details of the underlying hardware.
Animals↗
Laparoscopic resection of colonic cancer.
Laparoscopic resection of colonic cancer can be regarded as a safe and efficacious procedure. Short-term outcome is better after laparoscopic colectomy than after open colectomy. Long-term results of the first published randomized clinical trial indicate improved cancer related survival following laparoscopic resection of colonic cancer. However, patients included in this single center study were operated on by highly experienced laparoscopic surgeons and included relative small numbers of patients. Results of other large randomized controlled trials have to be awaited before laparoscopic resection can be recommended for colonic cancer. Higher in-hospital costs and a long learning curve hinder rapid implementation of laparoscopic colectomy into general surgical practice. Integration of laparoscopic surgery into surgical training programs is mandatory.
Colectomy↗
Integration of telemedicine in graduate medical informatics education.
An essential part of health informatics is telemedicine, the use of advanced telecommunications technologies to bridge distance and support health care delivery and education. This report discusses the integration of telemedicine into a medical informatics curriculum and, specifically, a framework for a telemedicine course. Within this framework, the objectives and exit competencies are presented and course sections are described: definitions, introduction to technical aspects of telemedicine, evolution of telemedicine and its impact on health care delivery, success and failure factors, and legal and ethical issues. The emphasis is on literature review tools, practical exposure to products and applications, and problem-based learning. Given the rapid advances in the telecommunication field, keeping the course material up to date becomes a challenge for the instructor who at the same time aims to equip students with the knowledge and tools they will need in their future role as decision makers to detect a need for, design, implement, maintain, or evaluate a telemedicine application.
Cost Savings↗
Conditioning shelter dogs to sit.
Human contact in the shelter may lessen effects of change in environment and smooth transition into a home. Training can increase a dog's interaction with people in a shelter environment. Experiments were conducted to determine how rapidly shelter dogs learn to sit, if the dogs can retain sitting behavior over time, and if sitting transfers to novel locations and people. Two experiments trained shelter dogs (n = 21) to sit when a stranger approached over a 10-trial session. Food and a verbal cue or a clicker reinforced the sit. The experiments measured latency to sit for each trial. Latency to sit decreased significantly over trials. Another experiment included reinforcement given to dogs (n = 20) on a noncontingent basis or for sitting. Five days of the experiment (condition training) were in the same room with the same experimenter. The last 4 days (testing) varied by both experimenter and location (familiar or strange). Results indicate that short training sessions are effective for teaching shelter dogs to sit, that dogs can retain sitting behavior over 2 days, and that training transfers to novel people and situations.
Analysis of Variance↗
The new generation of executive performance research: its implications for health care.
Much recent attention in the business press has focused on how executives think. That is a radical departure from the traditional research emphasis on simple behavior. This article reviews current research to document what is different about the way successful executives think. Many common assumptions about executives being rational, deliberate, and systematic have been disproven. Instead, executives are found to think in ways not suspected by most researchers. As health care enters times of rapid change, lessons learned from executives in other sectors can offer much to our understanding of executive performance. Current documents from the academic and popular business presses are reviewed in this article.
Decision Making, Organizational↗
[Gait characteristics in hemiparetic patients after stroke].
The first and major criterion of success in broadly understood management of patients with stroke is to regain motor ability, at least minimally. It starts as early as possible with mobilisation of patients in bed, in a room or ward since the first days after stroke onset. Standing up and gait learning are subsequent, rapidly coming stages of rehabilitation that are of key importance in reaching the outcome of treatment, prevention of likely complications and change in the quality of life. However, reports on gait impairment have been mostly very brief and limited, and pathological gait of patients with hemiparesis has been thought to be merely "helicopod one". Physiological mechanisms of gait programming, following a focal brain lesion, impairment of gait steering and its clinical manifestation, and some practical suggestions of assessment and prognosis of gait impairment are presented in this article.
Gait↗
The role of the mucosal immune system in inflammatory bowel disease.
Continued delineation of the major factors that lead to intestinal inflammation will provide critical insights into many of the pathophysiologic events leading to tissue destruction in IBD. The exploration of exciting and important new areas, such as the role of adhesion molecules, proinflammatory cytokines, and the activation of lymphocytes and phagocytes, will contribute significantly to a better understanding of the mechanisms that sustain the intestinal inflammatory process. Determining the mechanisms of amplification and perpetuation of intestinal inflammation as well as learning more about the natural suppression of intestinal inflammation by the normal cellular and cytokine networks of the mucosal immune system will open exciting new therapeutic approaches. It is encouraging to see realistic and testable working models emerge from the combined efforts of many committed investigators who have been engaged in studying the role of the mucosal immune system in the pathophysiology of IBD. A great deal more remains to be learned in this rapidly advancing area, and we can look forward with confidence to continued advances in the study of IBD.
Antibody Formation↗
[The methodological position of frontal feedbacks during work with large groups of dental students].
Single-channel feedback installations without revertive communication to the single work place and without possibility for evaluating the student's performance may be used with success in lectures and diagnostic exercises for large groups of dental students. Dispensing deliberately with the evaluation of performance permits to carry on a dialogue with the student, which offers the possibility of acting rapidly on the learning process during the very same teaching event. This control procedure allows to activate and motivate the students considerably. The methodical approach is explained.
Computers↗
Simple, accurate, safe, and cost-effective percutaneous transperineal template technique for permanent 125iodine interstitial brachytherapy of prostate cancer.
We present the technique, intraoperative and postoperative complications of percutaneous transperineal template permanent 125iodine interstitial brachytherapy of prostate cancer. The percutaneous transperineal template permanent iodine interstitial brachytherapy under "C-arm" fluoroscopic guidance is a simple, easily-learned, accurate and rapid procedure which can be performed without subjecting the patient to celiotomy. We have treated 58 patients by the transperineal percutaneous permanent interstitial brachytherapy. 33 of 58 patients also had a staging celiotomy just prior to the brachytherapy. In the group of 22 patients undergoing brachytherapy without celiotomy and without adjuvant external-beam pelvic radiotherapy, there were no major complications. Blood transfusions were not required by any patients who underwent percutaneous transperineal permanent iodine interstitial brachytherapy without celiotomy.
Brachytherapy↗
Fluoroscopy guided transperineal percutaneous permanent 125iodine implantation of prostate cancer.
The transperineal percutaneous template permanent iodine interstitial brachytherapy under "C-arm" fluoroscopic guidance is a simple, easily-learned, accurate and rapid procedure which can be performed without subjecting the patient to celiotomy. We have treated 58 patients by the transperineal percutaneous permanent interstitial brachytherapy. The use of transperineal percutaneous technique with C-arm fluoroscopic guidance improves the symmetry and dosimetry of the implant. This results in reduction of the incidence of chronic radiation-induced complications. In the group of 22 patients who underwent brachytherapy without celiotomy and lymphadenectomy and without adjuvant external-beam radiotherapy, there were no major complications.
Brachytherapy↗
[Use of the dia-contact method in ophthalmology. A new method of fluorescein angiography presentation].
An innovative presentation of fluorescein angiograms on radiographic film, called "dia-contact", is described. Photographs are produced by the classical procedure of contact-printing on subtraction film and are of very high quality resolution. Less expensive than conventional prints, the resultant document is easy to copy and file. The reading of this document with the help of two + 10 lenses, allows a sequential analysis of the angiogram and a stereoscopic interpretation alternatively. The image can be enlarged without loss of resolution by means of a microfilm reader device. This method requires a certain amount of self discipline, in that a new habit must be learned. However it rapidly proved itself invaluable in the author's daily practice.
Fluorescein Angiography↗
Restoration of primary molars using a new "compomer" material.
The primary advantages of glass ionomer restorative materials are adhesion to tooth structure and release of fluoride. A new material has been recently introduced for the restoration of cervical lesions and Class I defects in primary teeth. The material combines the properties of glass ionomers with the advantages of a single-component, light-activated composite resin and is known as a "compomer". This new material contains two resins, instead of the acidic polymers found in conventional glass ionomers. The restorative material releases fluoride and can be infected directly into the cavity. With its own bonding agent, the compomer offers a simple and relatively rapid technique. The learning objective of this paper is to describe the utilization of the new restorative material in conjunction with a bonding agent to restore conservative cavity preparations in primary molars. Two clinical cases are used to illustrate the presentation.
Child↗