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[Response of pituitary and adrenal elements in a state of cardiorespiratory system integration].

Morpho-functional equivalents of reaction of the hypophyseal and adrenal elements have been studied in 7 test and 10 control dogs biometrically, histologically, histoenzymatically and electron microscopically under the condition of integration in the cardio-respiratory systems. The condition has been modelled by individually chosen physical loading (running in the treadmill) up to the IV stage of the organism's adaptation according to the author's technique. The integration state is developing instead of the starting desintegration state (the beginning of the work) and is characterized by an economical and effective functioning of the cardio-respiratory system elements. At the integration of the cardio-respiratory apparatus, the hypophysial-adrenal system is activating. The principle of the zonal reaction in the adrenals and that of the selective activity of the adenohypophysis is clearly followed, that is demonstrated in the predominant activation of the bundle zone elements, chromophobic and basophilic adenocytes where certain signs of the secretory excretion predominate. In cells of the glomerular zone the signs of synthetic processes prevail over those of the secretory excretion. In cells of the medullary substance the signs of the preceding forced secretory excretion are clearly seen. A suggestion is made that it is expedient to elaborate training regimes according to the loading determining integration of the organism's cardio-respiratory systems.

11-Hydroxycorticosteroids

Systems integration for PACS.

A successful PACS (Picture Archiving and Communications System) implementation requires an eclectic integration of a number of key technologies. Among these are equipment interfaces, communications, storage, and display. Coincident with this, the software architecture must support a distributed system of heterogeneous structures, provide for protocol and format conversions to a unified system standard, be scalable to accommodate expansion, and provide a measure of fault tolerance. In this paper we survey the current state of the UCLA PACS components and architecture.

Computer Systems

Fetal heart rate monitoring by telephone. I. Development of an integrated system in Cardiff.

We report the development of a practical dedicated system for domiciliary fetal monitoring integrated in a scheme for its rational application. From experience of 1120 domiciliary recordings in 74 women (64 with high-risk pregnancies), we suggest that domiciliary monitoring applied within a structured clinical context should be as safe as monitoring in hospital.

Female

Deciphering the hippocampal polyglot: the hippocampus as a path integration system.

Hippocampal 'place' cells and the head-direction cells of the dorsal presubiculum and related neocortical and thalamic areas appear to be part of a preconfigured network that generates an abstract internal representation of two-dimensional space whose metric is self-motion. It appears that viewpoint-specific visual information (e.g. landmarks) becomes secondarily bound to this structure by associative learning. These associations between landmarks and the preconfigured path integrator serve to set the origin for path integration and to correct for cumulative error. In the absence of familiar landmarks, or in darkness without a prior spatial reference, the system appears to adopt an initial reference for path integration independently of external cues. A hypothesis of how the path integration system may operate at the neuronal level is proposed.

Animals

Progressive integrated system for the rehabilitation of long-term schizophrenic patients.

An integrative stepwise rehabilitation model for schizophrenics, especially those hospitalized for long periods, is described. The basic entities of this model are rehabilitation homes. The client moves from one step to the next according to their particular needs. The steps for living are: small homes, supported lodgings, rented quarters and own apartments. The steps of activities are: day care homes and day clubs, therapeutic sheltered workshop, test working, vocational training and labour market. The central rehabilitative aspects are the therapeutic community, living learning experiences, supporting of selfesteem and integrating with the social network. The psychiatric care system on the other hand and an important work of volunteers and friend services on the other support the rehabilitation. This work has shown during 14 years that the majority of clients can be rehabilitated to live as fairly independent and responsible persons.

Combined Modality Therapy

Connective tissue as an integral system: role of cell-cell and cell-matrix interactions.

We have applied the systems approach, to the analysis of mechanisms whereby connective tissue (CT) is integrated into one functional system. The primary CT functions in health and in disease (biomechanical, trophic, protective, reparative, and morphogenetic) are carried out by means of cell-cell, cell-matrix and intertissue interactions based on feedback between these components. Both CT as a whole and its cellular and extracellular elements exhibit structural and functional heterogeneity which increases the capacity of CT for adaptation. The intercellular interactions take place via soluble and insoluble mediators, direct cellular contacts, and cell/matrix degradation products. Results of this study support the concept of internal "network" regulation of the CT composition, functions and growth through intercellular interactions at different structural levels. Feedback mechanisms between degradation and production of collagen and interactions between collagen, macrophages and fibroblasts play a special role in the self-regulation of reparative CT growth. Collagen restores an impaired self-regulation and exerts a marked therapeutic effect on wounds, burns, trophic ulcers, and other lesions. A similar function may be performed by other matrix components and degradation/secretion products of macrophages and fibroblasts.

Animals

A psychiatric diagnostic system integrating probabilistic and categorical reasoning.

We describe a diagnostic support system for clinical psychiatry and its evaluation results. The system has two inter-related components: a rule-based reasoning part associated with uncertainty, and a deterministic part, that uses heuristics to perform categorical reasoning. The system includes the 30 groups of psychiatric diagnoses which are classified under the categories 290 to 319 of the DSM-III-R and the ICD-9. There are, in fact, 1508 rules relating 208 clinical findings with 257 diagnoses. The reasoning strategy is based on selecting and differentiating diagnostic categories in a hierarchical classification tree. The system is intended to be used for education of medical students, and to help non-specialist clinicians, residents in psychiatry, or experts with few years of experience in decision making. We tested the diagnostic performance of the system using case reports extracted from a specialized journal. In 52.8% of the cases, the correct diagnosis was ranked as the first hypothesis using only the rule-based part. In combination with the deterministic strategy, the correct diagnosis could be made for 73.6% of the analyzed cases.

Artificial Intelligence

A novel strategy for the isolation of defined pyrG mutants and the development of a site-specific integration system for Aspergillus awamori.

A homologous gene transfer system for Aspergillus awamori for site-specific integration is described, based on two components. First, a defined A. awamori pyrG mutant strain constructed by a selection strategy for gene-replacement in fungi. Second, a vector with a homologous pyrG selection marker containing a defined mutation at a site different from that of the mutations in the pyrG gene of the defined mutant strain. Defined mutation in the A. awamori pyrG gene, isolated from a genomic library by heterologous hybridisation with the A. niger pyrG gene as a probe, were introduced by specifically altering sequences at restriction sites in the coding region of the gene. After transformation of the A. awamori wild-type strain with vectors containing these mutated pyrG genes, and selection for 5-fluoro-orotic acid resistance (5-FOAR), on the average 60% of the 5-FOAR colonies originated from replacement of the wild-type pyrG gene by the mutated pyrG allele. After transformation of a mutant strain, carrying a mutation near the 5' end of the pyrG gene with vectors containing a mutation near the 3' end of the pyrG gene, 35% of the resulting transformants contained one copy of the vector at the pyrG locus.

Amino Acid Sequence

Corticotropin and cortisol response to human CRH as a probe for HPA system integrity in major depressive disorder.

To explore the integrity of the hypothalamic-pituitary-adrenal (HPA) system in major depressive disorder, 12 patients and normal controls matched for sex, age, and body weight received 100 micrograms synthetic human corticotropin-releasing hormone (hCRH) as an i.v. bolus dose. Compared to controls, depressed patients showed an elevation in baseline cortisol and a significant attenuation of net adrenocorticotropin (ACTH) responses, while cortisol secretion in response to hCRH was normal. These abnormalities in HPA axis function and apparent discordances in the interrelationships of ACTH and cortisol baseline and net stimulation responses between depressed patients and normal controls indicate, at least in part, a derangement of the glucocorticoid-dependent negative feedback circuitry and support the hypothesis that HPA hyperactivity in depression involves neurotransmitter-mediated hypothalamic hypersecretion of CRH.

Adolescent

Using system integration to revise documentation.

Within a 10-month time period, a new system-wide documentation common to five hospitals in the Evangelical Health System was designed and implemented. The documentation system is comprised of the Nursing Admission Assessment, Patient Care Plan, Patient Care Flowsheet, and Patient/Family Education Record. Examples of barriers and success factors as well as the system's framework are presented.

Documentation

An integrated system grows in Boston. Interview by Karen Gardner.

After news reports highlighting discussions among the major teaching hospitals in Boston last year, two leading academic medical centers--Massachusetts General Hospital (MGH) and Brigham and Women's Hospital--teamed up to form Partners Healthcare System Inc. Ferdinand Colloredo-Mansfield, the former chairman of MGH and the current co-chair of the new system, spoke recently with TRUSTEE editor Karen Gardner about the integration process now taking place between the two hospitals. Colloredo-Mansfeld, president of Cabot Partners, a real estate investment counseling firm in Boston, has been a trustee of MGH since 1982 and has served as chairman since 1992. He has also been an active participant in the process.

Academic Medical Centers

[How are psychological processes, the neuroendocrine system and immune system integrated?].

This short overview shows that there are bidirectional interactions between the central nervous system (CNS) and the immune system and deals with their anatomical and physiological correlates. Moreover, a number of immunological findings related to exogenous stress, depressive disorders and schizophrenias are discussed. An attempt is made to cautiously interpret the data presented and to demonstrate that the field of psychoneuroimmunology provides plenty of rewarding challenges for future research.

Antibody Formation

An integrated system for patient assessment and classification and nurse staff allocation for long term care facilities.

An integrated approach to patient classification and nurse staffing for long term care facilities is constructed, based on the quantification of patient care needs as reflected by formal assessment of a variety of key functioning status items, behavioral status indicators, and medically defined conditions. Nonlinear multiple regression techniques are employed in order to cluster these key assessment indicators in to an easily applied level of care classification method that can be used to determine placement of patients within the long term care system and to indicate the particular nursing care activities called for. Given the classification of patients into the various levels of care required (e.g., Chronic, Skilled Nursing Care, Intermediate A or B) a mixed integer/linear programming model is used to permit presentation of alternative nurse staffing strategies within a long term care facility or program. Extensions to the model portray the effects of changing budgetary, service, and legal restrictions.

Activities of Daily Living

An integrated system for quantitation of chemotaxis using a 48-well millipore filter assay.

We have established a computerized system for quantification of human neutrophil motility using a 48-well chemotaxis assay. The software is primarily written in the Unix C-shell and is designed to integrate with standard statistical and graphics packages and permit analysis either under Unix or MS-DOS. We demonstrate how simple image analysis techniques may be used to count neutrophils that have traversed a polycarbonate filter. Methods of optical optimization, cell counting and integration with the Statistical Analysis System (SAS) are presented.

Chemotaxis, Leukocyte

A new integrated system for three-dimensional echocardiographic reconstruction: development and validation for ventricular volume with application in human subjects.

OBJECTIVES: The purpose of this study was to improve three-dimensional echocardiographic reconstruction by developing an automated mechanism for integrating spark gap locating data with corresponding images in real time and to validate use of this mechanism for the measurement of left ventricular volume. BACKGROUND: Initial approaches to three-dimensional echocardiographic reconstruction were often limited by inefficient reconstructive processes requiring manual coordination of two-dimensional images and corresponding spatial locating data. METHODS: In this system, a single computer overlays the binary-encoded positional data on the two-dimensional echocardiographic image, which is then recorded on videotape. The same system allows images to be digitized, traced, analyzed and displayed in three dimensions. This system was validated by using it to reconstruct 11 ventricular phantoms (19 to 271 ml) and 11 gel-filled excised ventricles (21 to 236 ml) imaged in intersecting long- and short-axis views and by apical rotation. To measure cavity volume, a surface was generated by an algorithm that takes advantage of the full three-dimensional data set. RESULTS: Reconstructed cavity volumes agreed well with actual values: y = 0.96x + 2.2 for the ventricular phantoms in long- and short-axis views (r = 0.99, SEE = 2.7 ml); y = 0.95x + 2.9 for the phantoms, reconstructed by apical rotation (r = 0.99, SEE = 2.7 ml); and y = 0.99x + 0.11 ml for the excised ventricles (reconstructed in long- and short-axis views; r = 0.99, SEE = 5.9 ml). The mean difference between three-dimensional and actual volumes was 3% of the mean (3.0 ml) for the phantoms and 6% (4.6 ml) for the excised ventricles. Observer variability was 2.3% for the phantoms and 5.6% for the excised ventricles. Application to 14 normal subjects demonstrated feasibility of left ventricular reconstruction, which provided values for stroke volume that agreed well with an independent Doppler measure (y = 0.97x + 0.94; r = 0.95, SEE = 3.2 ml), with an observer variability of 4.9% (2.4 ml). CONCLUSIONS: A system has therefore been developed that automatically integrates locating and imaging data in no more time than the component two-dimensional echocardiographic scans. This system can accurately reconstruct ventricular volumes in vitro over a wide range and is feasible in vivo, thus laying the foundation for further applications. It has increased the efficiency of three-dimensional reconstruction and enhanced our ability to address clinical and research questions with this technique.

Adult