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Frequency of left ventricular free wall rupture complicating acute myocardial infarction since the advent of thrombolysis.
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Mortality of coronary artery bypass grafting before and after the advent of angioplasty.
In an effort to determine whether the population of patients undergoing isolated coronary artery bypass grafting and the outcome of these operations have changed, we analyzed the records of two patient populations from our institution. Interventional cardiology techniques (angioplasty, thrombolysis) were not used at our institution before 1982. The records of 736 patients (group 1) who underwent isolated coronary artery bypass grafting from January 1975 to July 1981 were reviewed and compared with a group of 603 patients (group 2) who underwent operation from July 1985 to December 1987. The techniques of operation and myocardial preservation were virtually identical during the two periods. During the group 2 analysis period, 343 angioplasty procedures were performed. The patients in group 2 were significantly older, had increased preoperative New York Heart Association classification, had sustained more previous myocardial infarctions, and had more associated morbid medical conditions. There was a threefold increase in patients seen for reoperative revascularization procedures and a fourfold increase in emergency operations. Overall mortality, although not significantly different, did increase slightly from 2.69% in group 1 to 3.83% in group 2. Mortality after elective procedures remained essentially unchanged (2.05% for group 1 and 1.90% for group 2).
Observations on the expected decrease in proprioceptive discharge and purported advent of non-proprioceptive activity from the chronically tenotomized muscle.
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'Pulsed' cytochrome oxidase may be produced without the advent of dioxygen.
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The advent of integrated health services in India.
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Has the advent of plastics in dentistry proved of great scientific value?
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Treatment of severe malarial anaemia in East Africa's underfives-an unsolvable problem since the advent of AIDS?
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Diagnosis of viral disease and the advent of antiviral drugs.
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Orthodontics in 3 millennia. Chapter 7: Facial analysis before the advent of the cephalometer.
The cephalometer was not invented in a vacuum. It was the culmination of centuries of efforts on the part of artists, anthropologists, and scientists to fathom nature's vicissitudes. Whereas Renaissance investigators "caged" the human face in a series of grids in an effort to find proportional relations, 20th-century orthodontists were more interested in knowing how the teeth and jaws related to the face and cranial base. Primarily a research tool, the cephalometer became a means of unmasking a patient's whole developmental pattern, becoming our most important diagnostic tool since study models.
Extrahepatic manifestations in transgenic mice of osteopontin in hepatocytes-A clue to advent of pathological state in various organs of chronic hepatitis C patients.
Osteopontin is a cytokine essential for initiation of Th1 immune reaction. We established transgenic mice expressing osteopontin in hepatocyte, in which liver necrosis with lymphocyte infiltration developed gradually from 12 weeks of age with up-regulated osteopontin levels in the circulation, suggesting that extrahepatic manifestations might also occur as a result of excessive Th1 immune reaction. We examined histological and immunohistochemical features of various organs in these mice. Splenomegaly and enlargement of lymph nodes around the liver and intestine became apparent with marked infiltration of small lymphocytes in the transgenic mice later than 24 weeks of age. Immunostaining revealed that lymphocytes in the spleen and lymph nodes were positive for either CD3 or CD20, suggesting that the infiltrating lymphocytes were both B and T cells. Similar lymphocyte infiltration was found in the lung, kidney and submandibular gland. Alveolar septa became hypertrophic with lymphocyte infiltration, and the lung showed the appearance of interstitial pneumonia. These lesions are similar to extrahepatic manifestations in chronic hepatitis C patients, suggesting that augmented Th1 immune reaction to hepatitis C virus (HCV) proteins or the proteins with molecular mimicry of HCV may be a contributing factor for the formation of the pathological state not only in the liver but also in various organs under chronic infection of hepatitis C virus.
The advent of precision nutrigeroscience in cancer: from clinic towards molecular biology.
Nutrimental patterns have been deemed to have an impact on cancer development and the response to cancer therapy. Our growing understanding of cancer and host metabolism has highlighted that nutrient availability in the tumor ecosystem is a key factor in inhibiting tumor development. Subsequently, dietary interventions must take into account the specific characteristics of both the cancer and the host, which requires a detailed understanding of the mechanisms that determine the metabolic vulnerabilities in the tumor ecosystem. In this review, we provide an overview of various dietary regimens as interventions in both preclinical models and clinical studies. We discuss how dietary intervention can affect the homeostasis of the tumor ecosystem, including neoplastic, micro- and macro-environmental states that impact cancer progression and therapy. Our emphasis is on the prospects of precision nutrigeroscience, which involves developing individualized therapeutic approaches and predictors based on a thorough exploration of the mechanisms and critical factors. This approach has the potential to enhance the efficacy of anti-cancer treatments and prevention strategies.
The advent of equitation science.
The lengthy association of humans with horses has established traditional equestrian techniques that have served military and transport needs well. Although effective, these techniques have by-passed the research findings of modern psychologists, who developed the fundamentals of learning theory. That said, the pools of equestrian debate are far from stagnant. The latest wave of horse whisperers has offered some refinements and some novel interpretations of the motivation of horses undergoing training. Additionally, the Fédération Equestre Internationale (FEI) has introduced the concept of the 'happy equine athlete' and, in the light of the hyperflexion (Rollkür) debate, recently examined the possible effects of some novel dressage modalities on equine 'happiness'. However, many still question the welfare of the ridden horse since it is largely trained using negative reinforcement, has to respond to pressure-based signals and is seldom asked to work for positive rewards. Science holds tremendous promise for removing emotiveness from the horse-riding welfare debate by establishing how much rein tension is too much; how much contact is neutral; how contact can be measured; how discomfort can be measured; how pain can be measured; and how learned helplessness manifests in horses. These are some of the topics addressed by equitation science, an emerging discipline that combines learning theory, physics and ethology to examine the salience and efficacy of horse-training techniques.
[Neurogenesis in the adult brain: the demise of a dogma and the advent of new treatments].
Since the early sixties, many concepts concerning neurogenesis have been progressively ruled out. Proof of the persistence of a physiological neurogenesis in adult mammals, including humans, raised the concept of a unique precursor cell giving birth to neurons and glial cells. According to this concept, a real continuum between neuroepithelial cells, radial glia and astrocytes exists from the embryonic period to adult age and generates both neurons and glial cells. Different factors, either secreted in situ or transported by blood, can influence this physiological neurogenesis process. The targets and role of newborn neurons are not clearly understood. In pathological conditions (ischemia, epilepsy, lesions), the physiological neurogenesis process is enhanced; however the significance of this neurogenesis excess (beneficial or deleterious) is not completely known. Advances in understanding the regulation of neurogenesis in these different conditions represent hopes of new therapeutic procedures, not only by improving the control of differentiation and survival of transplanted stem cells, but also by the possibility of modifying the processes of "endogenous neurogenesis".
The advent of highly selective inhibitors of cyclooxygenase--a review.
Cyclooxygenase (COX) exists in two isoforms, COX-1 and COX-2, COX-1 is present and is constitutively expressed in most cells and tissues, whereas COX-2 is felt to principally mediate inflammation. However, this distinction appears to be challenged by recent observations. This review addresses the roles of COX-1 and COX-2 isoforms in physiologic and pathophysiologic states and reviews potential therapeutic roles for selective COX inhibitors.
Use of nonsteroidal anti-inflammatory drugs and gastroprotective agents before the advent of cyclooxygenase-2-selective inhibitors: analysis of a large United States claims database.
BACKGROUND: Previous studies have shown that 20% to 40% of patients requiring nonsteroidal anti-inflammatory drugs (NSAIDs) are concomitantly prescribed gastroprotective agents (GPAs) such as proton pump inhibitors (PPIs) and H2-receptor antagonists. OBJECTIVE: The purpose of this study was to examine NSAID prescription patterns and the concurrent use of GPAs in a large national sample of patients who were prescribed NSAIDs for the first time. METHODS: Patterns of NSAID use, particularly chronic NSAID use, and of concomitant use of GPAs were examined using a large US-based prescription database. Patients with at least 1 NSAID prescription dispensed between May 1 and August 31, 1998, were identified. Persons with any NSAID prescription within 4 months prior to the first (index) prescription were excluded. The remaining patients were defined as new NSAID users and then classified as chronic users (> or = 30 days of supply of NSAIDs during the 120 days of follow-up after the first NSAID prescription) or acute users (<30 days of NSAID supply during the 120 days of follow-up). Concomitant GPA use was defined as receipt of any GPA prescription between the fill date of NSAID prescription and 125% of days of supply. NSAIDs included diclofenac/misoprostol (in a fixed combination), diclofenac, naproxen, nabumetone, ibuprofen, and "other" (comprising several less frequently prescribed agents). Patients were classified as users of a particular NSAID based on the first NSAID prescription they received. GPAs included PPIs, H2-receptor antagonists, and misoprostol. RESULTS: A total of 3,028,808 new NSAID users were identified. Chronic NSAID users (47.8% of the sample) were older than acute users. The percentage of new chronic users aged > or = 65 years for each of the NSAIDs was 41.2% for diclofenac/ misoprostol, 33.0% for nabumetone, 30.8% for diclofenac, 20.4% for naproxen, and 20.3% for ibuprofen. The percentage of women was higher among patients treated with diclofenac/misoprostol than among patients treated with all other NSAIDs (P < 0.001). During the 120 days of follow-up, the percentages of NSAID users with concomitant GPA use were 22.7% for diclofenac/misoprostol, 16.3% for diclofenac, 11.5% for naproxen, 18.0% for nabumetone, 12.3% for ibuprofen, and 14.8% for other NSAIDs. Based on days of supply, the rates of concomitant GPA use were 31.1%, 23.6%, 17.6%, 27.3%, 18.8%, and 22.5% for diclofenac/misoprostol, diclofenac, naproxen, nabumetone, ibuprofen, and other NSAID users, respectively. Among those who were taking GPAs before the NSAID index prescription date, -89% continued GPA therapy. CONCLUSIONS: Approximately 22% of the days of NSAID supply were covered by GPAs. Prior GPA use was the strongest predictor of subsequent concomitant GPA/ NSAID use. Differences in GPA use were observed among patients using different NSAIDs.
Periorbital and orbital cellulitis before and after the advent of Haemophilus influenzae type B vaccination.
OBJECTIVE: To evaluate the effect of the introduction of the Haemophilus influenzae B (Hib) vaccine (introduced first in 1985, then extended in 1990 to children at least 2 months of age) on the epidemiologic features of periorbital and orbital cellulitis. DESIGN: Retrospective, comparative case series. PARTICIPANTS: Three hundred fifteen pediatric inpatients. METHODS: Children at Massachusetts General Hospital and Massachusetts Eye and Ear Infirmary with discharge diagnosis of periorbital or orbital cellulitis from 1980 through 1998 were reviewed. MAIN OUTCOME MEASURES: Case rate, culture-positive isolates, and associated conditions. RESULTS: A total of 297 cases of periorbital cellulitis and 18 cases of orbital cellulitis were reviewed. Before 1990, there were 27 cases of Hib-related cellulitis (11.7% of total in that period), whereas after 1990, there were only three (3.5% of total; P = 0.028). The number of cases per year was significantly lower after 1990 (21.2 +/- 10.4 vs. 8.7 +/- 3.9; P = 0.008), as were the number of positive culture isolates (for any organism) after 1990 (76 [33. 0%] vs. 9 [10.6%]; P < 0.001). The medical conditions most commonly associated with periorbital cellulitis were sinusitis (44 [14.5%]) and upper respiratory infections (73 [26.6%]). All cases of orbital cellulitis were associated with sinusitis. CONCLUSIONS: The introduction of the Hib vaccine coincided with a sharp decline not only in the number of periorbital and orbital cellulitis cases related to H. influenzae, but also in the annual case rate. These data are consistent with a facilitative role for H. influenzae in the development of cellulitis secondary to other pathogens. They also may support restriction of the spectrum of antibiotics used to manage these conditions.
On the advent of dermatologic plastic surgery.
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