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The production of human papillomavirus type 16 L1 vaccine product from Escherichia coli inclusion bodies.

The major capsid protein L1 of the human papillomavirus type 16 (HPV16) has been previously expressed recombinantly in Escherichia coli cells as inclusion bodies (IBs). The HPV16 L1 protein offers potential as a vaccine candidate against cervical cancer, but the reported E. coli process is limited in its ability to economically produce significant quantities of material. In this study, a scaleable laboratory process for the purification of recombinant His-tagged L1 protein and its processing to give an immunogenic product is developed. The performances of ion-exchange chromatography (IEX) and immobilised metal affinity chromatography (IMAC) for the purification of L1 protein in the presence of concentrated denaturant are compared. IEX was found to be superior to IMAC when taking into account the complexity of operation, cost of adsorbent, selectivity and purity of the final product. Following purification, reduction of denaturant concentration was performed by dilution to yield a product suitable for formulation. The simplicity and ease of scale-up of dilution makes it an attractive option for process scale production and superior to the existing approach employing dialysis. It was found that direct dilution of denaturant into suitable buffer can give rise to products which have neutralising conformational epitopes identified by strong antibody-binding properties, as assessed by ELISA with a conformational monoclonal antibody. Analysis of the results showed negative main effects of protein concentration and PEG addition on antibody-binding yields, but positive main effects of the addition of detergent and L-arginine to the buffer. The diluted product had antigenic properties as assessed by ELISA and may be formulated easily for use by diafiltration and the addition of adjuvant. This work demonstrates the feasibility of producing viral vaccines using E. coli and scaleable unit operations.

Journal Article↗

Is a dissection balloon beneficial in totally extraperitoneal endoscopic hernioplasty (TEP)? A randomized prospective multicenter study.

BACKGROUND: Laparoscopic hernioplasty has been criticized because of its technical complexity and increased costs. Disposable dissection balloons can be used to facilitate the creation of the initial working space in totally extraperitoneal endoscopic hernioplasty (TEP), but their use adds to the cost of the operation. METHODS: A total of 322 men with unilateral, primary, or recurrent inguinal hernias were randomized to undergo TEP with or without a dissection balloon. RESULTS: In the group with the balloon, three of 161 patients (2.5%) required conversion to transabdominal preperitoneal hernioplasty (TAPP), or open herniorraphy, whereas 17 of 161 patients (10.6%) were converted to TAPP or open herniorraphy in the group without the balloon (p = 0.002). The mean operation time was 55 min in the group with the balloon and 63 min in the group without the balloon (p = 0.004). There was no difference between them in postoperative morbidity, and there were no major complications in either group. The recurrence rate was 3.1% in the group with the balloon and 3.7 % in the group without the balloon (p = 0.8). CONCLUSION: The use of a dissection balloon in TEP reduces the conversion rate and may be especially beneficial early in the learning curve.

Adult↗

The effect of high-definition imaging on surgical task efficiency in minimally invasive surgery: an experimental comparison between three-dimensional imaging and direct vision through a stereoscopic TEM rectoscope.

BACKGROUND: In 1995, when we first used a high-definition television (HDTV) video system during a laparoscopic cholecystectomy in Tuebingen, we were surprised by the excellence of the spatial impression achieved by an image with improved resolution. Although any improvement in vision systems entails a trade-off among cost, quality, and complexity, high-definition imaging may well become an essential part of 3-D video systems. The aim of this experimental study was to assess the impact of high definition on surgical task efficiency in minimally invasive surgery and to determine whether it is preferable to use a 3-D system or a 2-D system with perfect resolution and color--for instance, HDTV or the three-chip charge-coupled device (3CCD). METHODS: We compared a 3-D video system with the vision through a stereoscopic rectoscope for transanal endoscopic microsurgery (TEM). Because its stereoscopic direct vision is not restricted to either shutter technology or video resolution, TEM optics represents the state of the art. For objective comparison, inanimate phantom models with suturing tasks were set up. The setups allowed the approach of parallel instruments as in TEM operations or via a laparoscopic approach, with oblique instruments coming laterally. Both types of procedure were carried out by highly experienced laparoscopic surgeons as well as those inexperienced in endoscopic surgery. These volunteers worked under 3-D video vision and/or TEM vision. Altogether, the model tasks were performed by 54 different persons. RESULTS: The evaluation did not show a significant (p > 0.05) difference in performance time in all models, but there was a clear trend showing the benefit of a higher resolution. CONCLUSION: We found a tendency for both endoscopically inexperienced and experienced surgeons to benefit from the use of a system with improved resolution (direct vision) rather than a 3-D shutter video system.

Efficiency↗

State-of-the-art on cone beam CT imaging for preoperative planning of implant placement.

Orofacial diagnostic imaging has grown dramatically in recent years. As the use of endosseous implants has revolutionized oral rehabilitation, a specialized technique has become available for the preoperative planning of oral implant placement: cone beam computed tomography (CT). This imaging technology provides 3D and cross-sectional views of the jaws. It is obvious that this hardware is not in the same class as CT machines in cost, size, weight, complexity, and radiation dose. It is thus considered to be the examination of choice when making a risk-benefit assessment. The present review deals with imaging modalities available for preoperative planning purposes with a specific focus on the use of the cone beam CT and software for planning of oral implant surgery. It is apparent that cone beam CT is the medium of the future, thus, many changes will be performed to improve these. Any adaptation of the future systems should go hand in hand with a further dose optimalization.

Anatomy, Cross-Sectional↗

Determinants of geropsychiatric inpatient length of stay.

Despite efforts to decrease lengths of acute psychiatric hospital stays, some geriatric inpatients continue to have extended stays. This research examined factors related to length of stay (LOS), including legal and administrative factors not traditionally included in prior studies. The charts of 384 patients, representing all 464 discharges from an inpatient geropsychiatric unit over a one-year period, were evaluated retrospectively and analyzed using logistic regression and logarithmic transformation. The LOS of over 12% of the inpatients was 26 days or more (average LOS 14.1). Factors significantly associated with longer LOS were: receiving electroconvulsive therapy (ECT), higher Brief Psychiatric Rating Scale (BPRS) positive symptoms scores, falling, pharmacology complications, multiple prior psychiatric hospitalizations, requiring court proceedings to continue hospitalization or medicate against will, consultation delays and not performing ECT on weekends. Neither demographics nor diagnoses alone had influence on length of stay. Incorporation of LOS predictors into Medicare Inpatient Prospective Payment System (IPPS) would more accurately account for the complexity in the cost of caring for geropsychiatry patients.

Aged↗

Ultrasonic phased array controller for hyperthermia applications.

Multiple and mechanically scanned ultrasound transducer systems have demonstrated the efficacy of using ultrasound to produce deep localized hyperthermia. The use of ultrasonic phased arrays has been proposed as an alternative to these systems. A phased array offers a more flexible approach to heating tumours in that the size, shape, and position of its focal region can be altered during the course of treatment in order to achieve the desired temperature distribution. This added flexibility comes at the cost of increased complexity of the hardware necessary to drive the transducer because each element requires its own amplifer with both phase and amplitude control. In order for phased arrays with large numbers of elements to be feasible for hyperthermia applications, the complexity of this circuitry must be minimized. This paper describes a circuit design which simplifies the electronics required to control a phased array transducer system for hyperthermia applications. The design is capable of controlling virtually any type of phased array transducer operating at frequencies less than 2 MHz. The system performance was verified through beam profile measurements using a 48-element tapered phased array transducer.

Hyperthermia, Induced↗

A simplified method for the preparation of tetanus toxin binding fragment for neurobiology.

The non-toxic binding fragment of tetanus toxin (fragment C) binds avidly to neural tissue and has a growing number of neurobiological uses. Its current utility is limited by both its high commercial cost and the complex procedure for its preparation requiring highly purified tetanus toxin. We have developed a short procedure which prepares fragments of tetanus toxin from crude C. tetani extracts. The resultant proteins are atoxic with molecular sizes and immunological properties closely resembling fragment C. These proteins undergo retrograde axonal and apparent transneuronal transport in a fashion similar to fragment C.

Animals↗

Enoximone improves selection of candidates for urgent cardiac transplantation.

Immediate cardiac transplantation, or urgent implantation of devices for mechanical support of the failing heart, has been shown to be effective as life-saving procedures in patients with cardiogenic shock unresponsive to maximal sympathomimetic treatment. The intravenous administration of enoximone in these patients, in addition to previous inotropic support, should permit a 'buying of time' strategy, leading to a reduction in the need for complex, invasive and costly techniques, such as artificial hearts. In addition, it should permit improved selection of candidates for cardiac transplantation. A prospective study was started in 1985 to obtain data on the haemodynamic and clinical efficacy of intravenous enoximone in these critically ill patients, and to determine the time gained for evaluation of the need for urgent transplantation. Cardiac index rose from 1.82 +/- 0.26 litres/minute/m2 to 2.67 +/- 0.56 litres/minute/m2 after 30 minutes, while pulmonary capillary wedge pressure decreased from 29.9 +/- 7 mm Hg to 18.0 +/- 7 mm Hg (n = 30). This early beneficial effect waned progressively after 6 hours. Prior to the next intravenous infusion at 8 hours, cardiac index was 2.07 +/- 0.53 litres/minute/m2 and pulmonary capillary wedge pressure was 25 +/- 8.5 mm Hg. Only four patients could not wait for a biological graft and had to be implanted with a complete artificial heart (3 patients), or a ventricular assist device (1 patient). In all, 30 patients improved and their increased survival allowed a re-evaluation for cardiac transplantation itself; 13 were rapidly (1.7 days; range 0.5-5) confirmed as good candidates. As a whole, this strategy compares favourably with the results of a strategy based on mechanical bridging alone.

Adult↗

Biological life-support systems for Mars mission.

Mars mission like the Lunar base is the first venture to maintain human life beyond earth biosphere. So far, all manned space missions including the longest ones used stocked reserves and can not be considered egress from biosphere. Conventional path proposed by technology for Martian mission LSS is to use physical-chemical approaches proved by the experience of astronautics. But the problem of man living beyond the limits of the earth biosphere can be fundamentally solved by making a closed ecosystem for him. The choice optimum for a Mars mission LSS can be substantiated by comparing the merits and demerits of physical-chemical and biological principles without ruling out possible compromise between them. The work gives comparative analysis of ecological and physical-chemical principles for LSS. Taking into consideration universal significance of ecological problems with artificial LSS as a particular case of their solution, complexity and high cost of large-scale experiments with manned LSS, it would be expedient for these works to have the status of an International Program open to be joined. A program of making artificial biospheres based on preceding experience and analysis of current situation is proposed.

Air Conditioning↗

Applications of modified cyclodextrins.

One of the key areas of importance in biotechnology and bioengineering is molecular complexation (MC). MC is useful in selectivity, separation, and solubilization of biomolecules. While many complex, natural MC agents exist, such as proteins and antibodies, relatively few engineered MC materials are available. Inorganic, insoluble MC agents, such as zeolites, are widely used in petroleum catalysis. Carbon Buckminster fullerenes ("bucky balls") can complex small neutral molecules, but are relatively insoluble and difficult to manufacture. Crown ethers have been used for molecular complexation, but are costly to synthesize and have limited capacities. One class of highly useful MC agents are cyclodextrins (CDs). These naturally-occurring, water-soluble cyclic glucans are used in a variety of food, pharmaceutical, and analytical applications. Due to the availability of multiple reactive hydroxyl groups, the functionality of CDs can be greatly increased through chemical modification. A host of new applications are being explored, including enzyme mimicry, molecular recognition, chromatographic separation, and solubilization. This review describes recent applications of modified cyclodextrins in bioprocessing and medicine.

Journal Article↗

Adjuvant chemotherapy in 2005: standards and beyond.

The 2003 St. Gallen consensus panel divided the many available adjuvant chemotherapy (CT) regimens into those with "standard efficacy" (ACx4, CMFx6) and those with "superior efficacy" (FA(E)Cx6, CA(E)Fx6, A(E)-->CMF, TACx6, ACx4--> paclitaxel (P)x4 or docetaxel (D)x4) but also greater complexity, toxicity and cost. This paper will summarize the latest information on long-term side effects of the "superior" regimens and 5-year benefits reported in taxane trials, including those of a "new" sequential regimen, FECx3--> docetaxelx3. Rapidly expanding evidence of marked heterogeneity in the magnitude of CT benefits according to the tumour oestrogen receptor (ER) status, a claim made for many years by IBCSG investigators, will be reviewed; it will lead to the conclusion that a revolution needs to take place in the way oncologists think about the CT added value and design adjuvant clinical trials. The conclusions proposed to the 2005 St. Gallen consensus panel are that: adequately dosed anthracycline-based CT regimens remain an acceptable standard for many women; a lower threshold for using taxanes in sequence or combination with anthracyclines (A) is justified in the presence of an ER-negative or low-ER tumour status, other aggressive biologic features (such as HER-2 overexpression), fear about A-induced cardiotoxicity; no recommendation can yet be made as far as the optimal taxane-A regimen, the best taxane or the best taxane schedule.

Antineoplastic Combined Chemotherapy Protocols↗

Courtship learning: scent of a woman.

Learning to predict an outcome based on previous experience is of considerable selective advantage. Getting it wrong can be costly. In a complex environment, however, using the appropriate predictor is not necessarily a trivial task.

Animals↗

Clinical trials for prevention of epileptogenesis.

Methods to evaluate treatments that could prevent epileptogenesis in subjects at risk are described. Epilepsy prevention trials are more complex, lengthy, and costly than standard epilepsy treatment trials for many reasons. Issues revolve around selection of subjects, consent for participation, length of follow-up, and selection of an appropriate endpoint. The use of biomarkers are a possible solution in future research.

Anticonvulsants↗

Bone graft substitutes in the upper extremity.

The development of effective bone graft substitutes is one of the most important innovations in musculoskeletal surgery. Bone graft substitutes provide an osteoconductive scaffolding similar to those of autogenous bone. They eliminate donor site morbidity,decrease operative time and complexity and treatment costs, and improve patient satisfaction. Osteoinductive and osteogenic elements may be added to further stimulate and enhance healing and incorporation of the scaffolding substance into the adjacent bone. Bone graft substitutes have proven effective in the spine and larger long bones of the extremities. The continuing development of bone graft substitutes, evaluation of their efficacy relative to autogenous bone grafts and to each other, and their use in the hand and wrist are emerging fields.

Arm Bones↗

Maxillofacial Injury Severity Score: proposal of a new scoring system.

In this study a new injury severity score system, the Maxillofacial Injury Severity Score (MFISS), was developed to evaluate the characteristics of injury from maxillofacial trauma. Nine hundred and two cases of maxillofacial trauma were included in this study to evaluate injury severity using the MFISS, which was designed on the basis of Abbreviated Injury Scale, 1990 revision (AIS-90), and defined as the product of the sum of the three highest maxillofacial AIS scores and the sum of the injury severity scores for three maxillofacial functional parameters, malocclusion (MO), limited mouth opening (LMO), and facial deformity (FD). The correlation analysis was undertaken with the dependent factor of cost and number of days of stay in hospital. The results demonstrated a significant difference (P < 0.01) between bone and soft-tissue injuries and among various regional fractures. There was correlation (P < 0.01) between the MFISS and the cost of treatment and days of stay in hospital. The newly established MFISS thus characterizes maxillofacial injury severity while reflecting the management costs and treatment complexity.

Adolescent↗

Video-assisted transumbilical appendectomy in children.

BACKGROUND: Video-assisted transumbilical appendectomy (VATA) is a combination of laparoscopic and open techniques and is not widely used in children. We are reporting our most recent experience with this technique. METHODS: After the institutional review board approval, the charts of patients who underwent VATA between December 2003 and October 2004 were retrospectively reviewed. All children presenting with a preoperative diagnosis of appendicitis were candidates. A 10-mm trocar was placed in the umbilicus. An operating laparoscope was used for mobilizing the appendix. The appendix was delivered through the umbilicus. A standard extracorporeal appendectomy was performed. The umbilical ring was closed and the wound irrigated. Demographic and outcome data were collected and is presented as mean +/- SD. RESULTS: Sixty-one males and 50 females underwent VATA (n = 111). Age and weight were 11 +/- 3.2 years and 49 +/- 22 kg, respectively. Six patients had previous abdominal surgery. Operative time was 36 +/- 24 minutes (range, 9-140 minutes). An additional trocar was placed in 2 patients, and 2 patients were converted to open. Five patients had additional procedures. Appendicitis was classified intraoperatively as acute (n = 44), suppurative (n = 5), gangrenous (n = 8), ruptured (n = 30), appendiceal colic (n = 13), and other (n = 11). Preoperative antibiotics were given to 95 patients and were continued in 35 patients postoperatively. Length of stay was 1.8 +/- 1.7 days (range, 1-11 days). Length of follow-up was 13 +/- 6.3 days (n = 90). Complications included intra-abdominal abscess (n = 1) and wound infection (n = 7). CONCLUSIONS: Video-assisted transumbilical appendectomy minimizes equipment needs, thus, potentially reducing cost. Simple and complex appendectomies can be performed even if the patient has had previous abdominal surgery. Our complication rate was low, and our operating times and length of stay were short. Video-assisted transumbilical appendectomy is a safe and effective technique in children and can be used in lieu of the 3-trocar laparoscopic technique.

Appendectomy↗

Patent pools and diagnostic testing.

There is increasing concern that overlapping patents in the field of genetics will create a costly and legally complex situation known as a patent thicket, which, along with the associated issues of accumulating royalty payments, can act as a disincentive for innovation. One potential means of preventing this is for the patent holders to enter into a so-called patent pool, such as those established in the electronics and telecommunications industries. Precedents for these also exist in the field of genetics, notably with the patents pertaining to the SARS genome. In this review, we initially address the patent pool concept in general and its application in genetics. Following this, we will explore patent pools in the diagnostic field in more detail, and examine some existing and novel examples of patent pools in genetics.

Animals↗

Studies of central nervous system disorders with single photon emission computed tomography and positron emission tomography: evolution over the past 2 decades.

Single photon emission computed tomography (SPECT) was introduced in the 1960s to detect breakdowns in the blood-brain barrier and was replaced by x-ray computed tomography in the mid-1970s. The development of the deoxyglucose (DG) technique to measure regional cerebral glucose metabolism by employing either autoradiography, using 14CDG, or positron emission tomography (PET), using 18FDG, added a major dimension to the investigation of brain function. In the late 1970s and early 1980s, the FDG-PET technique was widely used to examine a variety of neuropsychiatric disorders. It soon became apparent that functional imaging was more sensitive than anatomic imaging in detecting abnormalities of the brain related to aging, dementia, tumors, seizures, cerebral vascular accidents, and psychiatric problems. Because of its complexity and the cost involved, PET was used in a limited number of centers in the United States. However, the success of PET resulted in the resurgence of interest in SPECT as an alternative technology after almost a decade. This became possible because of the synthesis of iodine 123- and technetium 99m-labeled radiopharmaceuticals to determine regional cerebral blood flow. Since blood flow and metabolism are coupled in most pathological states, patterns of abnormality noted on SPECT were similar to those seen on PET in many disorders. Since the introduction of high resolution SPECT imaging instruments, the role of SPECT has been further enhanced. The successful synthesis of both positron and single emitting radioligands to image dopamine and other receptors has started a new era in neurosciences and will have a far-reaching impact on the day-to-day practice of neuropsychiatry.

Adult↗