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PubMedDate not supplied

[Importance of external reality on the psychoanalytic situation. Contribution to the problem of psychoanalytical setting].

This paper deals with the influence of the "external" arrangement of the psychoanalytic setting on transference/counter-transference. It is based upon a comparison between the classical psychoanalytic situation and that of the analytically orientated treatment in the hospital. Its theme is that the theory behind the psychoanalytic technique contains no concept for handling a variable external reality. Continuing Leo Stones study of the psychoanalytic situation, in this paper the "immanent suggestion" of the structure of the external arrangement is more closely investigated and defined as a primary and general valence of transference. A particular emphasis of this study lies in the discussion of that specific level of information exchange between analyst and patient which is dependent on setting and which is stimulated by the "positional structure" of the external arrangement. Positional structure is defined and described in detail. Further the following questions are discussed: to which forms of communication does the psychoanalytic setting per se give most support; which forms of transference and counter--transference follow "logically" from the external arrangement and are consciously or unconsciously allowed by analyst and patient in the selection of the classical psychoanalytic setting? The paper reaches the conclusion that the setting of the psychoanalytic situation reproduces primarily pre-oedipal conflicts and early experiences of separation in the mother-child-relationship. In contrast, the face-to-face situation reproduces primarily pre-oedipal conflicts and early experiences of bring into focus a priori oedipal conflicts. Both analyst and patient are subject to the influence of the setting on the unconscious. This study suggests further investigations of those transference and counter-transference valences which are dependent on setting and to take into consideration their technical implications.

Adult↗
PubMed2005

[A role for combination therapy in pulmonary arterial hypertension].

For patients with pulmonary arterial hypertension (PAH) two first line therapies - iloprost inhalation (Ventavis) and bosentan (Tracleer) -- are available in Germany. A third substance, sildenafil, is already approved in the US and will be approved for this indication in the European Union soon. Patients with PAH can be stabilized or improved with a specific mono-therapy for a limited period of time only. Therefore, the question arises when and how to initiate treatment escalation. The available data from controlled clinical trials are insufficient to give a definite answer to these questions. Moreover, it is still unclear which combination of the above mentioned substances may be superior in the treatment of PAH. On the other hand, combination therapy is already reality in clinical practice. Based on this background experts from specialized centers dealing with PAH discussed the scientific basis of the role of combination therapy in PAH patients during a workshop held on April 22/23. 2005 in Wiesbaden. The goal of this workshop was to formulate a common position with regard to combination therapy of PAH on the basis of the available scientific data and clinical experience.

Administration, Inhalation↗
PubMed1996

[Gene therapy for alpha 1-antitrypsin deficiency. Hopes, realities and perspectives].

Alpha 1 antitrypsin deficiency (alpha 1 AT) is an autosomal recessive disease due to mutations in the gene coding for alpha 1 antitrypsin and characterised by very reduced serum levels of the anti-protease. Alpha 1 antitrypsin is primarily produced in the liver by hepatocytes and then passes into the general circulation to diffuse into the pulmonary tissue. Its function is to inhibit the elastase secreted by the polymorpho-nuclear neutrophils. When the quantity of alpha 1 antitrypsin secreted into the circulation is insufficient to inhibit the elastase, the pulmonary tissue is progressively destroyed, leading to the appearance of emphysema around 30 to 40 years of age. Gene therapy in alpha 1 antitrypsin deficiency rests on the transfer and the expression of a copy of the normal human alpha 1 antitrypsin gene by the cells of an organism of a subject suffering from the disease. The aim is to restore a sufficient level of alpha 1 antitrypsin to inactivate the elastase in the pulmonary tissue and thus prevent the appearance of emphysema. Numerous experimental protocols have been developed in vivo in animals since 1987. They identify the two principal current difficulties for the development of clinical trials: the brevity of the duration of expression of the transferred gene which does not last more than a few months, and insufficient levels of alpha 1 antitrypsin which are obtained, usually less than the therapeutic level required.

Animals↗
PubMed2002

Recombinant adeno-associated viral vectors bring gene therapy for Parkinson's disease closer to reality.

The recombinant adeno-associated viral (rAAV) vector is a powerful tool for delivering therapeutic genes into mammalian brains. In rodents and non-human primates, a substantial number of striatal neurons can be transduced with high titer rAAV vectors by simple stereotaxic injection. Efficient and long-term expression of genes for dopamine (DA)-synthesizing enzymes in the striatum restored local DA production and achieved behavioral recovery in animal models of Parkinson's disease (PD). Moreover, sustained expression of a glial cell line-derived neurotrophic factor gene in the striatum rescued nigral neurons and led to functional recovery in a rat model of PD, even when treatment was delayed until after the onset of progressive degeneration. These results suggest that gene therapy using rAAV vectors may become a novel and feasible treatment for PD.

Animals↗
PubMed1997

[Somatic gene therapy of mucoviscidosis using recombinant adenovirus: the start of a long course].

The identification of the gene on which mutations cause cystic fibrosis has opened the way to the concept of gene therapy of this disease. Somatic gene therapy for cystic fibrosis should be directed to the epithelial cells of the bronchi where the biological defect is the most deleterious. In order to have the normal DNA coding sequence penetrate the bronchial epithelial cells of a patient, a gene vector is necessary, and recombinant adenoviruses have been the subject of extensive studies in this regard. Data are available from many laboratories as well as from several phase I clinical trials. Successes and limits of this approach are reviewed here. The advantage of non-viral vectors, in particular cationic liposomes, as an alternative to recombinant adenoviruses is briefly discussed. Significant advances still need to be made before gene therapy becomes a reality in cystic fibrosis. These future improvements should include the construction of more efficient gene vectors, and also the development of better tools for the evaluation of a biological effect of gene therapy in individual patients.

Adenoviridae↗
PubMed1981

[Possibilities for rehabilitation in a county hospital].

A county hospital with an infirmary surely offers the possibilities for rehabilitation as much as any other institution. Due to its manageable size, the county hospital can probably guarantee deeper personal care. The following possibilities are discussed: activating care, mental stimulation in a reality orientation program, dance and music therapy, plus the opening of the infirmary outwards, which remains a very important aspect. The rehabilitation in a county hospital can be guaranteed only by the complete cooperation between hospital internal and external medicine. An outpatient ward such as the day- and night-clinic is also a useful institution. In the future, the employment of volunteers in and outside the hospital will be of greater importance. Already now, greater efforts should be made on behalf of continued training and greater social prestige for these volunteers.

Cooperative Behavior↗
PubMed2004

Development of gene therapy to target pancreatic cancer.

Pancreatic cancer remains one of the most difficult cancers to treat. Its high propensity to infiltrate and metastasize early from a small primary focus necessitates development of a new therapy which can track down the disseminated cancer cells in vivo. Gene therapy may offer new opportunities for a variety of targeting strategies, and we review here some of our work related to the development of targeted gene therapy: 1) Targeting by specific molecular abnormality: Many pancreatic cancer cells show "addiction" to K-ras mutation, while normal cells appear resistant to suppression of K-ras-mediated signaling by antisense K-ras RNA expression adenoviral vector. 2) Targeting by in vivo tumor characteristics: In a peritoneal dissemination model, intraperitoneal lipofection/polyfection can deliver and express transgenes highly preferentially in tumor nodules. 3) Targeting by vector: An efficient protocol for construction of an adenovirus expression vector library has been developed, which will enable a direct functional selection of fiber knob-modified targeting vector species for given cells. 4) Targeting by tumor immunity: Several cytokines not only induce direct cytotoxicity, but are also expected to activate specific immunity to achieve targeted suppression of cancer cells in vivo. Unlike parenteral administration of short-lived recombinant interferon protein, local interferon gene transfer can provide a target tissue-restricted distribution and sustained expression, which may improve the efficacy/safety balance of cytokine therapy. Cancer gene therapy development is, in general, at the stage of proof of principles and safety. However, it is an art of integrated science. The recent rapid progress of related sciences and technologies will expand the potential and consolidate the clinical reality of gene therapy.

Adenocarcinoma↗
PubMed1984

Eleanor Clarke Slagle Lectureship, 1984: transformation of a profession.

Professional evolution includes a period of disunity, a phase when old values and concepts are being examined, and new perspectives emerge. Disunity can be a positive impetus for dynamic change. Transformation provides a higher level reintegration through which new understanding and progress unfold. Occupational therapy's transformation is now; it is time for careful analysis and creative synthesis. Transformation is a three-fold process of integration of past, present, and future into an upward spiral of professional development. Transformation is a constant flow of activities influenced by both internal and external factors. Although there are multidimensions that influence occupational therapy's transformation, three major components are inherent in the profession's paradigm shift: society's decline in patriarchal authority; decline in allegiance to a biomedical model; and shift in values, dimensions of practice, and education that form the reality of occupational therapy. Transformation of our profession will be a paradigm shift: in our value system of purposeful activity to a new perspective of occupation and occupational, in our quest to develop a unifying theory for recognition of the unifying force of values, in our concepts and theories to include the science of occupation and the art of purposefulness from total allegiance to scientific knowledge to include intuitive knowledge, from being an allied medical field to an independent health profession that is both educationally and medically related, from a biomedical model to a paradigm of wellness, in balancing of feminine and masculine values of human nature in organizing educational curricula and entry-level requirements that reflect our value system and predicted practice dimensions.

Forecasting↗
PubMed1991

Antitachycardia devices: realities and promises.

Nonpharmacologic therapy for ventricular arrhythmias has gained growing attention with the development of the implantable cardioverter-defibrillator. In addition, the reports of adverse effects of drug therapy from several studies, including the Cardiac Arrhythmia Suppression Trial (CAST), have supported the need for these devices. The development of new implantable cardioverter-defibrillators that have the capability of antitachycardia pacing, bradycardia pacing, cardioversion and defibrillation has enhanced their clinical utility. The currently available implantable cardioverter-defibrillators have been shown to significantly improve survival after sudden cardiac arrest in patients with life-threatening ventricular arrhythmias. Newer devices with expanded capabilities may reduce mortality even further. In this report the features of currently available antitachycardia devices and implantable cardioverter-defibrillators are reviewed and the features and current implant data on newer antitachycardia devices are discussed.

Arrhythmias, Cardiac↗
PubMed2026

In vivo immune cell engineering from bench to clinical reality.

Adoptive immune cell therapies, exemplified by chimeric antigen receptor T cells, have transformed the treatment of hematological malignancies. However, their broader clinical application is limited by complex ex vivo manufacturing, high cost, and safety concerns. In vivo immune cell engineering has emerged as an alternative strategy that delivers genetic instructions directly to immune cells, thereby generating or modulating therapeutic immune cells within the body and reducing the reliance on individualized in vitro operations. These advances underscore the need for a systematic evaluation of this emerging field. Therefore, this review systematically summarizes the mechanistic principles and delivery strategies underlying in vivo immune cell engineering, with an emphasis on in vivo CAR-T cell generation and the engineering of other immune cells. We then discuss major viral and non-viral delivery platforms and clarify how these platforms influence cargo delivery, cell specificity, and functional immune-cell programming. We further discuss recent preclinical and emerging clinical advances across cancer, autoimmune diseases, and degenerative diseases, while examining key translational challenges, including delivery specificity, off-target effects, controllability, persistence, and manufacturing standardization. Overall, although the field of in vivo immune cell engineering is advancing rapidly, its clinical success will depend on coordinated improvements in delivery precision, therapeutic efficacy, safety, and controllable immune-cell programming.

Cancer immunotherapy↗
PubMed1997

Clinical realities and economic considerations: economics of intrathecal therapy.

The estimated annual cost of medical management of chronic back pain is $25 billion. Such management is often ineffective and overly costly. Most physicians who have employed intrathecal pain therapy attest to its efficacy in the management of intractable chronic pain. However, few economic analyses are available to evaluate the cost effectiveness of different modalities and to aid in clinical decision making and third-party reimbursement policies. Current analyses tend to focus on short-term cost-benefit measurements and to ignore variables such as quality of life and patient functioning. This bias has impaired the ability of payers to make appropriate decisions regarding the safety, cost effectiveness, and efficacy of intrathecal pain therapy in noncancer patients. Clinical data demonstrate that for cancer patients whose expectancies exceed 3 months, the overall costs of intrathecal pain therapy may be less than those of tunneled epidural catheters or external infusion devices. In nonmalignant pain, intrathecal therapy appears to be cost effective compared to conventional medical management at 22 months. Further debate and fine tuning of these economic models from all perspectives are required.

Analgesics, Opioid↗
PubMedDate not supplied

24 hour CVVH treatment on the intensive care unit: a reality.

Intermittent renal replacement therapy is a problem in haemodynamically unstable intensive care patients. Continuous renal replacement therapy may be of more benefit. 24 hour continuous venovenous haemofiltration (CVVH) treatment on the intensive care is attainable by adequate instruction of the intensive care staff.

Critical Care↗
PubMed2005

Drug therapy of cardiovascular risk factors: guidelines versus reality in primary health care service.

AIM: To determine the monthly costs of prescription drugs for the treatment of hypertension, hypercholesterolemia, and diabetes mellitus and their share in the total prescription drugs expenditures allowed by the Croatian Institute for Health Insurance. METHODOLOGY: Hypertension, hypercholesterolemia, and diabetes mellitus were diagnosed in 4,916 patients in three general practitioner (GP) offices in the Zagreb area in January 2005. The monthly cost of medications prescribed by the GPs for the treatment of these three diseases was obtained by summarizing the prices of all antihypertensive, lipid-lowering, and antidiabetic drugs prescribed in one month. The monthly medication costs for each disease separately and all three diseases together were compared with the total prescription drug expenditures approved by the Croatian Institute for Health Insurance. RESULTS: Hypertension was diagnosed in 1,112 (22.6%), hypercholesterolemia in 324 (6.5%), and diabetes mellitus in 359 (7.3%) patients. Monthly cost of all medications prescribed for these three diseases accounted for 81.2% of the total amount approved for medications by the Croatian Institute for Health Insurance. Antihypertensive drugs accounted for 51.1%, antidiabetic drugs for 11.7% for, and lipid-lowering treatment for 18.4%. The medications were prescribed most often to patients older than 65 years (93.6%). CONCLUSION: GPs are strongly obligated by the annual contract with the Croatian Institute for Health Insurance to keep the medication expenses within the approved amount. However, the approved amount is spent mostly on the drug treatment of hypertension, hypercholesterolemia, and diabetes mellitus as the main cardiovascular risk factors.

Adolescent↗
PubMed2005

Development of a VR therapy application for Iraq war military personnel with PTSD.

Post Traumatic Stress Disorder (PTSD) is reported to be caused by traumatic events that are outside the range of usual human experiences including (but not limited to) military combat, violent personal assault, being kidnapped or taken hostage and terrorist attacks. Initial data suggests that 1 out of 6 returning Iraq War military personnel are exhibiting symptoms of depression, anxiety and PTSD. Virtual Reality (VR) exposure therapy has been used in previous treatments of PTSD patients with reports of positive outcomes. The aim of the current paper is to specify the rationale, design and development of an Iraq War PTSD VR application that is being created from the virtual assets that were initially developed for theX-Box game entitled Full Spectrum Warrior which was inspired by a combat tactical training simulation, Full Spectrum Command.

Computer Simulation↗
PubMed2006

Antifibrotic agents for liver disease.

Complications from chronic hepatitis C (HCV) and recurrent HCV post-transplant are responsible for significant morbidity and mortality in the United States and Europe. Current antiviral therapies are at best, effective in up to 50% of patients in the pre-transplant setting, and in the post-transplant setting are associated with more limited efficacy and increased toxicity. With this reduced efficacy of antiviral strategies in the post-transplant setting, new approaches are urgently needed. Substantial progress has been made in understanding the pathogenesis of hepatic fibrosis over the last 20 years, which has yielded potential new therapeutic targets. The prospect of antifibrotic therapies is nearing reality in order to reduce progression to cirrhosis, thereby reducing morbidity, mortality and the need for re-transplantation. Current and evolving approaches primarily target the activated hepatic stellate cells, which are the main source of extracellular matrix, along with related fibrogenic cell types. Key issues yet to be clarified include the optimal duration of antifibrotic therapies, endpoints of clinical trials, indications in clinical practice and whether combination therapies might yield synergistic activity.

Drug Design↗