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PubMed2005

Use of history science methods in exposure assessment for occupational health studies.

AIMS: To show the power of history science methods for exposure assessment in occupational health studies, using the dry cleaning industry in Denmark around 1970 as the example. METHODS: Exposure data and other information on exposure status were searched for in unconventional data sources such as the Danish National Archives, the Danish Royal Library, archives of Statistics Denmark, the National Institute of Occupational Health, Denmark, and the Danish Labor Inspection Agency. Individual census forms were retrieved from the Danish National Archives. RESULTS: It was estimated that in total 3267 persons worked in the dry cleaning industry in Denmark in 1970. They typically worked in small shops with an average size of 3.5 persons. Of these, 2645 persons were considered exposed to solvents as they were dry cleaners or worked very close to the dry cleaning process, while 622 persons were office workers, drivers, etc in shops with 10 or more persons. It was estimated that tetrachloroethylene constituted 85% of the dry cleaning solvent used, and that a shop would normally have two machines using 4.6 tons of tetrachloroethylene annually. CONCLUSION: The history science methods, including retrieval of material from the Danish National Archives and a thorough search in the Royal Library for publications on dry cleaning, turned out to be a very fruitful approach for collection of exposure data on dry cleaning work in Denmark. The history science methods proved to be a useful supplement to the exposure assessment methods normally applied in epidemiological studies.

Air Pollutants, Occupational↗
PubMed2000

PROfusion: genetically tagged proteins for functional proteomics and beyond.

As a new enabling technology in functional genomics, Phylos, Inc. has pioneered PROfusiontrade mark technology, whereby proteins are covalently tagged with their own genetic information (mRNA). Using this technology, both synthetic and natural libraries (representing the repertoire of proteins naturally expressed in a given cell type or tissue source) have been constructed. Due to the in vitro nature of library construction, Phylos libraries are the largest described to date, up to 10(14) in size. From a library of such molecules, one can select for a protein function of choice with the benefit that the genetic material is linked to the protein for subsequent PCR amplification, enrichment, and, ultimately, identification.

Genetic Techniques↗
PubMed1996

14q+ chromosome marker in a T-cell-rich B-cell lymphoma.

Cytogenetic, in situ hybridization, and molecular studies were performed in a case of T-cell-rich B-cell lymphoma. Demonstration of Ig gene rearrangements for both heavy and light chains confirmed the B-lineage restriction of the neoplastic cell population. Moreover, as expected in B-cell malignancies, all abnormal karyotypes showed a 14q+ chromosome marker involving 14q32. The origin of the extra material on the derivative 14q+, as defined by chromosome painting with a library for chromosome 11, and Southern blotting for c-myc and bcl-2 rearrangements, remains unknown.

Blotting, Southern↗
PubMed2006

Microwave-assisted Suzuki coupling reactions with an encapsulated palladium catalyst for batch and continuous-flow transformations.

This article describes the design, optimisation and development of a Suzuki cross-coupling protocol mediated by an efficient palladium-encapsulated catalyst (Pd EnCat) under microwave irradiation. The methodology has been used in both batch mode for classical library preparation and in continuous-flow applications furnishing multigram quantities of material. Described is a method that uses direct focused microwave heating whilst applying an external cooling source. This enables a lower than normal bulk temperature to be maintained throughout the reaction period leading to significant improvements in the overall yield and purity of the reaction products. Additional aspects of this novel heating protocol are discussed in relation to the prolonged lifetime and enhanced reactivity of the immobilised catalyst system.

Catalysis↗
PubMed1991

Laser microdissection of the fragile X region: identification of cosmid clones and of conserved sequences in this region.

Laser microdissection has been used to dissect material from the X-chromosome region involved in fragile-X-linked mental retardation. After dissection, single chromosome slices corresponding to this fragile site were subjected to DNA amplification using either a vector ligation method (to provide known anchor sequences) or primer oligonucleotides corresponding to the ubiquitous Alu sequences. Amplified material was then cloned or, alternately, used to screen a gridded cosmid library. Eight cosmid clones identified in this way were regionally mapped using a panel of hybrid cell lines and shown to originate from a narrow interval centered on the fragile X site. Two clones are included in the approximately 6-cM interval defined by probes RNI (DXS369, 5 cM proximal) and VK21 (DXS 296, 1-2 cM distal) and which includes the fragile site, and at least one clone contains sequences conserved across species suggestive of a gene. This method combines the focused approach of microdissection and the convenience of obtaining cosmid (rather than small-insert) clones; it may be useful for studies of other defined chromosomal regions.

Animals↗
PubMed1995

Diagnosing dengue virus infection in archived autopsy tissues by means of the in situ PCR method: a case report.

BACKGROUND: The pathogenesis of the severe form of dengue virus infection, dengue hemorrhagic fever, is still obscure. A major research objective has been to determine which body organs are being damaged by dengue virus in this form of dengue. Research has been difficult because dengue hemorrhagic fever is sporadic and tends to occur in parts of the world where modern facilities are scarce and fresh or frozen patient materials are not available. However, major hospitals in these areas have accumulated libraries of paraffin-embedded surgical and autopsy tissues over the years. These tissues may have been subjected to less than optimal fixation and storage. Attempts to localize dengue virus using antigen detection in the stored tissue have encountered many difficulties. OBJECTIVE: Since viral nucleic acid may be preserved under circumstances which destroy protein antigens, our objective was to detect dengue viral RNA in situ in histologic sections of tissues from patients dying of dengue hemorrhagic fever in Thailand. STUDY DESIGN: Tissues from an 11-year-old boy who died at Ramathibodi Hospital, Bangkok, Thailand in November, 1987 with the clinical diagnosis of dengue hemorrhagic fever were treated by transcribing the dengue viral RNA to DNA followed by amplification using the polymerase chain reaction with subsequent in situ hybridization in order to visualize the cells infected with dengue virus. RESULTS: Viral RNA was detected in hepatocytes in the mid-zonal region of the liver, as well as scattered macrophages in skin and lymph nodes. CONCLUSION: Dengue virus infection can be detected in paraffin-embedded autopsy tissues which have been stored for five years. The same procedure can be used for diagnosing dengue viral infection and for studying the pathogenesis of dengue hemorrhagic fever.

Journal Article↗
PubMed2004

Efficacy of mycophenolate mofetil versus azathioprine after renal transplantation: a systematic review.

INTRODUCTION: Our objective was to evaluate the efficacy of mycophenolate acid (MMF) versus azathioprine (AZA) after renal transplantation. MATERIALS AND METHODS: The following electronic databases were searched: Medline, Embase, Cochrane library, and Chinese Biomedicine database (CBM). Randomized controlled trials (RCTs) were subjected to Revman 4.11 for statistical analyses. RESULTS: Twenty-three RCTs were identified to compare MMF and AZA for antirejection, prophylaxis after renal transplantation. The data showed that MMF (2 g/d) was more beneficial than AZA to improve graft and long-term patient survivals, but there was no statistical differences between MMF (3 g/d) and AZA. Whether at 6 months or at 1 year after renal transplantation, the use of MMF (2 g/d) or MMF (3 g/d) markedly reduced the incidence of biopsy-proven rejection. CONCLUSION: Compared with AZA, MMF is a more potent immunosuppressive drug, that is more efficient in reducing the incidence of acute rejection episodes after renal transplantation. MMF can improve the graft and patient survival rate. The 2 g per day dosage is more acceptable.

Azathioprine↗
PubMed2006

Conscious sedation guidance.

SCOPE AND PURPOSE: This guidance is intended to promote good clinical practice for the provision in dentistry of conscious sedation that is both safe and effective. It is not a recipe book for sedation and therefore does not include details of drug dosages. The recommendations are applicable to all patients receiving conscious sedation, to facilitate the provision of any type of dental treatment whether it is delivered in a dental practice, a community dental service clinic or a hospital setting. It also covers the provision of conscious sedation for dental treatment provided on a domiciliary basis. Specifically excluded from this guidance, however, are patients who require assisted ventilation, intensive care sedation, premedication for general anaesthesia, postoperative analgesia, sedation in palliative care, night sedation and sedation in the home setting other than for the provision of dental treatment on a domiciliary basis. METHODS: Existing guidelines, relevant systematic reviews, policy documents, legislation or other recommendations were reviewed and appraised for their quality of development, evidence base and applicability to the remit of the guidance under development. To supplement this information, key questions were formulated by the Guidance Development Group and used as the basis for designing systematic literature search strategies to identify further research evidence that may address these questions, including unpublished work where relevant.The following internet sites were searched for guidelines: New Zealand Guidelines Group, Canadian Collaboration on Clinical Practice Guidelines in Dentistry, National Guidelines Clearinghouse, FDI World Dental Federation, National Electronic Library for Health Guideline Finder, and Medline. The Cochrane Library was searched for systematic reviews and Medline, Embase and the Cochrane Library for studies to address key questions. The searches were supplemented by material already known to members of the Guidance Development Group. Titles and abstracts of the identified references were screened for relevance independently by two researchers who were not members of the Guidance Development Group. Disagreement about the inclusion of specific individual references for further consideration was resolved by discussion and if necessary the opinion of a third researcher was sought. Included references were appraised and data was abstracted independently by two researchers using a specifically designed data-abstraction form. This information was then checked for inconsistencies, which were resolved by discussion, and used to construct evidence tables. The evidence tables were presented to the Guidance Development Group to inform their decision-making and their recommendations related to the key question under consideration. Levels of evidence were assigned by two researchers who were not members of the Guidance Development Group. Formulation of each recommendation was achieved by consensus reached through discussion, drawing on the broad range of interest and experience of sedation related to dentistry within the membership of the Guidance Development Group. Consultation and peer review were conducted prior to publication. A draft of the guidance was the subject of discussion at the Dental Sedation Teachers Group annual symposium in April 2004. Subsequently, approximately 100 copies were distributed throughout the UK to a range of professional organisations and individuals who have an interest in dental sedation, and comments were requested. In addition, all dentists in Scotland who recently claimed the National Health Service allowance for treatment with sedation were invited to comment. The consultation draft was also made available on the group's website (www.scottishdental.org/cep). All comments received through this consultation were considered and the guidance was amended accordingly prior to peer review. Further amendments were made in response to feedback from peer reviewers before publication. REVIEW AND UPDATING: The guidance will be reviewed in 2 years' time (2008) and if there have been significant changes it will be updated accordingly. RECOMMENDATIONS: The detailed guidance make 48 recommendations in a range of areas: REFERRAL: Discuss alternative methods of anxiety management with patient and ensure that dental care with sedation meets agreed definition of conscious sedation. ASSESSMENT AND RECORD KEEPING: As part of a thorough assessment, discuss with patient all aspects of their conscious sedation treatment and also provide written instructions. Obtain patient's written consent; maintain comprehensive and contemporaneous patient records. ENVIRONMENT AND FACILITIES: Ensure that environment for sedation is safe and that correct equipment and drugs are provided for each sedation technique used. Ensure that equipment and drugs for dealing with medical emergencies or complications related to sedation are immediately available. TRAINING: Ensure all members of dental team are correctly trained in sedation techniques used, including monitoring of patient during treatment and management of any sedation-related complications. For oral and transmucosal sedation, ensure that sedationist is trained in other titratable techniques and skilled in performing venous cannulation. Ensure that teams giving conscious sedation provide treatment for patient groups they are experienced in managing. CONSCIOUS SEDATION TECHNIQUES: For inhalation sedation, ensure that a titrated dose of nitrous oxide is administered using dedicated purpose-designed equipment. Oral, transmucosal and intravenous sedation require pulse oximetry and blood-pressure monitoring. A titrated dose of midazolam is recommended for intravenous sedation. AFTERCARE: Monitor patients throughout the recovery period until discharge by sedationist into the care of responsible adult escort who has also been given written postoperative instructions. An escort might not be required after nitrous oxide inhalation sedation. RESEARCH RECOMMENDATIONS: A number of recommendations were made regarding the future conduct and reporting of clinical trials. The following areas were highlighted as requiring further high-quality research: Fasting before conscious sedation. Conscious sedation of paediatric dental patients. Dental conscious sedation using combinations of drugs. Dental conscious sedation using continuous infusion. The choice of sedation method for dental patients. Cognitive and behavioural effects of conscious sedation. The interaction of pharmacological and nonpharmacological anxiety management techniques. The complete guidance is available for download at www.scottishdental.org/cep/guidance/dentalsedation.htm.

Anesthesia, Dental↗
PubMed2002

Familial abdominal aortic aneurysm: a systematic review of a genetic background.

BACKGROUND: Familial clustering of the abdominal aortic aneurysm (AAA) is clear, 12-19% of AAA patients have one or more first-degree relatives with an aneurysm and 4-19% is detected with ultrasound screening. OBJECTIVES: To review the genetic background of AAA. DESIGN, METHODS AND MATERIALS: Computer searches of the MEDLINE, EMBASE, SUMsearch database and the Cochrane Library and searched reference lists of English language articles concerning the genetics of AAA, candidate gene approach and linkage analysis. RESULTS: Brothers of AAA patients are at high risk to develop an AAA. The candidate gene approach was performed to detect defects in one of the components of the connective tissue, i.e. type I and III collagen, elastin and fibrillin, the inflammatory cell-derived matrix metalloproteinase, there inhibitors, auto-immune components and components related to atherosclerosis. CONCLUSION: These studies give us insight in the pathology but do not lead to the specific genetic factor(s) responsible for (familial) AAA. Considering the supposed autosomal dominant inheritance, a gene mutation in one of the structural proteins of the connective tissue is expected. In the future, linkage analysis may resolve the genetic background of AAA.

Aortic Aneurysm, Abdominal↗
PubMed2003

Cloning and engineering of the cinnamycin biosynthetic gene cluster from Streptomyces cinnamoneus cinnamoneus DSM 40005.

Lantibiotics are ribosomally synthesized oligopeptide antibiotics that contain lanthionine bridges derived by the posttranslational modification of amino acid residues. Here, we describe the cinnamycin biosynthetic gene cluster (cin) from Streptomyces cinnamoneus cinnamoneus DSM 40005, the first, to our knowledge, lantibiotic gene cluster from a high G+C bacterium to be cloned and sequenced. The cin cluster contains many genes not found in lantibiotic clusters from low G+C Gram-positive bacteria, including a Streptomyces antibiotic regulatory protein regulatory gene, and lacks others found in such clusters, such as a LanT-type transporter and a LanP-type protease. Transfer of the cin cluster to Streptomyces lividans resulted in heterologous production of cinnamycin. Furthermore, modification of the cinnamycin structural gene (cinA) led to production of two naturally occurring lantibiotics, duramycin and duramycin B, closely resembling cinnamycin, whereas attempts to make a more widely diverged derivative, duramycin C, failed to generate biologically active material. These results provide a basis for future attempts to construct extensive libraries of cinnamycin variants.

Anti-Bacterial Agents↗
PubMed1977

The formulation of tissue substitute materials using basic interaction data.

An analytical procedure has been developed for the formulation of tissue substitute materials for use with photons and electrons. This method, called the basic data method, is based upon interaction data and enables two-component substitutes to be formulated with radiation characteristics within specified limits. Another feature of the procedure is the ability, once a primary material has been chosen, to select the best corrective additives from a library of compounds. The theoretical aspects are discussed followed by a discussion of the practical applications of the method.

Electrons↗
PubMed2005

Is orthotopic bladder replacement the new gold standard? Evidence from a systematic review.

PURPOSE: In this systematic review we determined whether the outcome of orthotopic bladder replacement is superior to that of continent and incontinent urinary diversion. MATERIALS AND METHODS: We searched MEDLINE, PubMed, EMBASE, CINAHL and the Cochrane Library from January 1990 to January 2003. A total of 3,370 abstracts were reviewed, including all types of studies from prospective, randomized, controlled studies to small, retrospective series. All relevant articles with at least 10 patients and a mean followup of at least 1 year were retrieved. There were no language restrictions. NonEnglish articles were translated. Comparisons were made between the major surgery types, including ileal conduit, continent diversion, bladder reconstruction and bladder replacement. All studies were scored using a predetermined quality assessment checklist to assess internal validity (bias and confounding) and external validity. RESULTS: A total of 405 studies met inclusion criteria. There were 32 prospective and 373 retrospective studies describing a total of 32,795 patients. The majority of studies were incompletely or poorly described and outcomes were often not defined. When they were defined, definitions varied. In clinical outcomes ileal conduit diversions had the lowest operative complications rate but highest reported postoperative morbidity. They also had a higher reported incidence of symptomatic urinary tract infections. The rates of postoperative morbidity, mortality and need for reoperation varied widely among studies even for the same procedure. Of physiological outcomes metabolic acidosis was the most commonly reported metabolic complication in patients with various urinary diversions. The quality of the reported literature was poor. There were no studies of the health economic implications of performing 1 type of surgery vs another type. CONCLUSIONS: While enthusiasts regard orthotopic bladder replacement as the new gold standard when lower urinary tract function must be replaced, the level and quality of current evidence are poor. The immediate concern must be to rectify this paucity of evidence with well designed and well reported prospective studies, ideally in a randomized setting, comparing the various major forms of urinary diversion and bladder replacement surgery.

Humans↗
PubMed2005

Origin and development of forensic medicine in India.

CONTEXT: : The medical profession is one of great antiquity in India. However, the history of medicine and, in particular, the role of medicine in the administration of justice in India has not been discussed very much. The present paper attempts to fill in this lacuna and traces the medicolegal practice from ancient times to British India. SOURCE: : This paper is based on archival materials collected from the Tamilnadu State Archives, Chennai, and Madras Medical College Library, Chennai, and University of Madras Library, Chennai. MAIN OBSERVATIONS: : The medical men in ancient India were considered as men of wisdom, and one of the ancient Tamil hymns equates the doctor-patient relationship to that of the dedicated love of a devotee to God. Kautilya's Arthashastra gives a list forensic evidence for establishing the cause of death and describes the necessity of autopsy in establishing the cause of death. In British India, the early incidence of custodial death and its certification by medical practitioners, issuance of medical certificate and wound certificate, and medicolegal autopsy are documented. The most outstanding contribution of India to legal medicine during this period is modern dactylography. It is recorded that there was a high ratio of homicidal poisonings in India.

Forensic Medicine↗
PubMed1995

Interpretation of emergency department radiographs by radiologists and emergency medicine physicians: teleradiology workstation versus radiograph readings.

PURPOSE: To compare accuracy of interpretation by radiologists and emergency medicine physicians of conventional radiographs and digitized images on a workstation. MATERIALS AND METHODS: One author selected 120 radiographs from the radiology department library, including 62 musculoskeletal, 20 abdominal, and 38 chest examinations. Analog radiographs were digitized. There were 60 positive and 60 control cases. Positive cases demonstrated clinically important disease and had a high degree of diagnostic difficulty. Thirty-one cases were judged to be critical to the patient's immediate care, requiring prompt accurate interpretation. Four groups of readers were used: staff radiologists and emergency medicine physicians and second-year radiology and emergency medicine residents. RESULTS: All reader groups performed better when interpreting conventional radiographs than digitized images. Differences in favor of radiograph reading were statistically significant for overall accuracy related to all cases and to critical cases (P < .05, one-tailed test). CONCLUSION: Results with the teleradiology system were found unacceptable for primary interpretation of the spectrum of radiographs seen in an emergency department.

Baltimore↗
PubMed2000

Best place of care for older people after acute and during subacute illness: a systematic review.

OBJECTIVES: To assess the evaluative research literature on the costs, quality and effectiveness of different locations of care for older patients. METHODS: A systematic review of evaluative research from 1988 using CRD4 guidelines. Twenty-five databases were searched, using processes developed specially for this review. Library OPACS, the Internet and research registers were also searched for relevant material. The final stage of the review was confined to randomised and pseudorandomised trials. Studies were selected for review by pairs of researchers working independently who then met to reach a decision. Analysis was predominantly descriptive; simple pooled odds ratios were used to explore some outcomes. RESULTS: Eighty-four papers from 45 trials were included. Firm conclusions were difficult to draw, except in relation to some outcomes for stroke units, early discharge schemes and geriatric assessment units. Few trials in this area have adequately addressed issues of patients' quality of life and costs to health services, social care providers, patients and their families. CONCLUSIONS: Despite considerable recent development of different forms of care for older patients, evidence about effectiveness and costs is weak. However, evidence is also weak for longer-standing care models. A substantial service evaluation agenda emerges from this review. This study also raises questions about the usefulness of systematic review techniques in the area of service delivery and organisation.

Acute Disease↗
PubMed2007

Long-term stability of orthodontic treatment and patient satisfaction. A systematic review.

OBJECTIVE: To evaluate morphologic stability and patient satisfaction at least 5 years after orthodontic treatment. MATERIALS AND METHODS: Published literature was searched through the PubMed and Cochrane Library electronic databases from 1966 to January 2005. The search was performed by an information specialist at the Swedish Council on Technology Assessment in Health Care. The inclusion criteria consisted of a follow-up period of at least 5 years postretention; randomized clinical trials, prospective or retrospective clinical controlled studies, and cohort studies; and orthodontic treatment including fixed or removable appliances, selective grinding, or extractions. Two reviewers extracted the data independently and also assessed the quality of the studies. RESULTS: The search strategy resulted in 1004 abstracts or full-text articles, of which 38 met the inclusion criteria. Treatment of crowding resulted in successful dental alignment. However, the mandibular arch length and width gradually decreased, and crowding of the lower anterior teeth reoccurred postretention. This condition was unpredictable at the individual level (limited evidence). Treatment of Angle Class II division 1 malocclusion with Herbst appliance normalized the occlusion. Relapse occurred but could not be predicted at the individual level (limited evidence). The scientific evidence was insufficient for conclusions on treatment of cross-bite, Angle Class III, open bite, and various other malocclusions as well as on patient satisfaction in a long-term perspective. CONCLUSIONS: This review has exposed the difficulties in drawing meaningful evidence-based conclusions often because of the inherent problems of retrospective and uncontrolled study design.

Humans↗