Blended east-west medical theories, treatment methods gain acceptance.
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Complementary Therapies↗
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Guidelines for detection of penicillin tolerance in Streptococcus pyogenes by MIC-MBC method.
Disagreement on a uniform and accepted method of testing penicillin tolerance in Streptococcus pyogenes prevents a meaningful comparison of results of various studies on tolerance and an assessment of the contribution of this phenomenon to treatment failure. Therefore guidelines are needed.
Humans↗
Effect of nucleoside transport blockade on the interstitial adenosine level characterized by a novel method in guinea pig atria.
Several accepted methods are available to estimate the adenosine (Ado) concentration of interstitial fluid ([Ado]ISF) in functioning heart, providing results spanning over nano- to micromolar concentrations. This extremely large range points to the necessity of novel approaches for estimating [Ado]ISF or at least the alteration from basal [Ado]ISF. In the present study, the change in [Ado]ISF was characterized following nucleoside transport (NT) blockade elicited by 10 micromol/L dipyridamole or 10 micromol/L nitrobenzylthioinosine in isolated guinea pig atria, by means of our novel procedure referred to as receptorial responsiveness method (RRM). The RRM provided an index of the change in [Ado]ISF under NT blockade, namely the concentration of N-cyclopentyladenosine (CPA; a relatively stable A1 Ado receptor agonist), which is equieffective with the change in [Ado]ISF regarding the contractility. Our results show that dipyridamole or nitrobenzylthioinosine produced an elevation in [Ado]ISF at the cardiomyocyte A1 Ado receptors equivalent to about 16 or 20 nmol/l CPA, respectively. In addition, nitrobenzylthioinosine was found more appropriate for selective NT blockade than dipyridamole.
Adenosine↗
Value of Etest penicillin V and penicillin G strips for penicillin susceptibility testing of Neisseria meningitidis.
The NCCLS agar dilution method and Etest are currently accepted methods for susceptibility testing of Neisseria meningitidis to penicillin. We determined the MIC of penicillin V and penicillin G by both the agar dilution method and Etest using 43 strains of N. meningitidis. Although results for reference strains were within the accepted quality control range of penicillin MICs for both drugs, differences of two to three dilutions were seen between the two antibiotics with both methods. Penicillin V results cannot correctly predict the susceptibility to penicillin G for N. meningitidis if penicillin G breakpoints are used for penicillin V. However, adjusting the penicillin V breakpoints two dilutions higher (i.e., S < or = 0.25 and R > or = 8 microg/ml), concordance could be achieved for susceptibility categorization by the two compounds. An agreement of 98% +/- 1 dilution was obtained between Etest and the reference method when using penicillin G strips. We conclude that Etest with penicillin G strips is a convenient and reliable alternative method for determining the MICs of penicillin for N. meningitidis.
Culture Media↗
Estimation of cardiac output by noninvasive echocardiographic techniques in the critically ill subject.
We evaluated the accuracy of cardiac output estimations by three transthoracic echocardiographic techniques in critically ill subjects. This study was a prospective comparison study carried out in a general intensive care unit of a teaching hospital. The subjects had a broad range of diagnoses including pulmonary embolus, cardiogenic shock, septic shock, Legionnaire's disease and perioperative myocardial infarction. All patients requiring pulmonary artery catheterization underwent echocardiographic cardiac assessment with comparison of findings to those obtained by thermodilution techniques. Nineteen studies on eighteen patients were performed, with cardiac output calculated by the two-chamber Simpson's, four-chamber Simpson's, and left ventricular outflow tract (LVOT) Doppler methods. Acceptable data was obtained in those patients without mitral regurgitation. There was good correlation between the thermodilution technique and Simpson's two-chamber method (r = 0.91), but less so with the Simpson's four-chamber method (r = 0.77). All studies were included in the LVOT Doppler method with a good correlation (r = 0.94). A plot of differences between methods using the Bland and Altman statistical method indicated that only the LVOT Doppler method demonstrated acceptable agreement with a mean of 0.2 litres/minute, standard deviation of 0.82 litres/minute and 95% limits of agreement of -1.5 to +1.9 litres/minute. We concluded that the LVOT Doppler method was the only one which demonstrated acceptable agreement between the thermodilution method and echocardiographic techniques in all critically ill patients studied.
Adolescent↗
Gross alpha and beta activity analysis in water--a routine laboratory method using liquid scintillation analysis.
The generally accepted method for gross alpha and beta activity analysis of drinking water in Australia is based on ISO methods; ISO9696, water quality--measurement of gross alpha activity in non-saline water--thick source method, and ISO9697, water quality--measurement of gross beta activity in non-saline water. A liquid scintillation (LSA) based method that requires smaller sample quantities, less sample preparation time and operator intervention, and produces adequate minimum detection levels for local drinking water guidelines has been developed. A synthetic groundwater sample was analysed using the LSA method and compared with results from ISO method techniques used by two independent Australian laboratories. The results show that the LSA method exceeds performance of the ISO methods in measurement accuracy.
Alpha Particles↗
Method comparison--a different approach.
The commonly accepted method of analysing data from method comparison studies is regression analysis, a method which has limitations. This study illustrates the use of a graphical presentation of data, the difference plot, which can be used as an alternative to least squares regression analysis. The data from comparison studies performed on five methods were analysed both by Deming's regression analysis, with calculation of the correlation coefficient, and by the difference plot. The results show that in most cases much more relevant information was obtained from the difference plot.
Androstenedione↗
[The interactive lecture. A simple form of student-activating learning].
INTRODUCTION: Activation of students in lectures to enhance learning by means of questions to be answered in buzz groups has been described in pedagogic handbooks and articles. We tried the concept in three lectures in biochemistry in order to evaluate use of time, training requirements of the lecturer, and method acceptance by students. MATERIAL AND METHODS: The experiment was carried out with a group of 87 medical students from a 4th semester course in biochemistry. Evaluation was made by direct observation and analysis of quantitative and qualitative data from a student questionnaire. RESULTS: Buzz groups and questions took less time than anticipated and not more than ten minutes of the lecture time. The lecturer needed supervision from a colleague to function well. Acceptance of the procedure was high among the students. Qualitative data indicate that students used more time for self-studies and moved towards deep learning. DISCUSSION: We conclude that interactive lecture could be implemented without major problems in lecture based educational programmes and that it is useful for the learning of the students.
Biochemistry↗
Single catheter technique for accurate cardiac outputs from left ventricle.
We report our experience in cardiac output measurements using a single catheter for left ventricular green dye injection with sampling from the side arm of a femoral artery introducer sheath. This technique is compared to thermal dilution (20 patients) and pulmonary artery green dye injection (20 patients). There were no significant differences between the single catheter left ventricular method and the other two accepted methods for measuring cardiac output.
Cardiac Catheterization↗
Introduction of solvent-accessible surface area in the calculation of the hydrophobicity parameter log P from an atomistic approach.
A conventional atomistic approach of estimating molecular hydrophobicity (log P) was improved by taking into account the proximity effect of substituent groups as well as the importance of solute-solvent interaction in the partition phenomena. The new method reassigns atomic parameters when the molecule is fully exposed to surrounding solvent. Each atom in a molecule contributes to the log P by an amount of its atomic parameter multiplied by the degree of exposure to the surrounding solvent. This degree of exposure is calculated from the solvent-accessible surface area (SASA). In carrying out actual calculations, the necessary parameters were determined with the log P values of 500 compounds that were used as training data. This method, which may be called SASA-scaled atomistic method, gave satisfactory results when compared with the original method of estimating log P from atomic parameters. The ability of the new method to predict log P for compounds other than those used as the training data was also tested. The newly proposed SASA-scaled atomistic method was also compared with other methods available for the calculation of log P. The SASA-scaled atomistic method gave better estimations from fewer training data. Finally, the ability of the proposed method to predict differences in log P for steric isomers was tested. The new method was superior to other methods, including CLOGP, a widely accepted method of estimating log P for a variety of compounds.
Chemistry, Pharmaceutical↗
Estimation of transfused red cell survival using an enzyme-linked antiglobulin test.
An enzyme-linked antiglobulin test (ELAT) method was developed to estimate survival of transfused red cells. This procedure is based on a principle analogous to that of the Ashby technique were antigenically distinct red cells are transfused and their survival studied. We compared the ELAT survival to the 51Chromium method (51Cr) in four patients. Three patients with hypoproliferative anemias showed T 1/2 by ELAT of 17.5, 18, and 17 days versus 18.5, 20, and 19 days by the 51Cr method. A fourth patient with traumatic cardiac hemolysis had two studies performed. In this case, the ELAT showed a T 1/2 of 10 and 8.1 days while 51Cr T 1/2 values were 11 and 10.5 days. The ELAT method for measuring red cell survival yielded data which agreed closely with the results of the 51Cr method. Although 51Cr is the accepted method for red cell survival, the ELAT method can be used to estimate transfused red cell survival.
Anemia↗
A randomized trial comparing coronary angioplasty with coronary bypass surgery. Emory Angioplasty versus Surgery Trial (EAST)
BACKGROUND: The clinical benefit of percutaneous transluminal coronary angioplasty (PTCA) as compared with coronary-artery bypass grafting (CABG) for patients with multivessel coronary artery disease has not been established. To determine the outcomes of these treatments in patients referred for the first time for coronary revascularization, we conducted a three-year prospective, randomized trial comparing the two procedures. METHODS: Revascularization was performed by accepted methods. Follow-up clinical information was collected every six months, and coronary arteriography and thallium stress scanning were performed at one and three years. The primary end point was a composite of death, Q-wave myocardial infarction, and a large ischemic defect identified on thallium scanning at three years. Secondary end points included clinical and angiographic status and the need for additional revascularization procedures. Data were analyzed according to the intention-to-treat principle. RESULTS: Of the 5118 patients screened for the trial, 842 (16.5 percent) were eligible for enrollment, and 392 (7.7 percent) agreed to participate. A total of 194 patients were randomly assigned to the CABG group, and 198 to the PTCA group. The primary end point occurred in 27.3 percent of the CABG group and 28.8 percent of the PTCA group (P = 0.81). Death occurred in 6.2 percent of the CABG group and 7.1 percent of the PTCA group (P = 0.73 by log-rank test). At three years, the proportions of patients in the CABG group who required repeated bypass surgery (1 percent) or angioplasty (13 percent) were significantly lower than the proportions in the PTCA group (22 and 41 percent, respectively; P < 0.001). Angiographic studies at three years showed a greater degree of revascularization in the CABG group. Angina was more frequent in the PTCA group (20 percent) than in the CABG group (12 percent). CONCLUSIONS: We found that CABG and PTCA did not differ significantly with respect to the occurrence of the composite primary end point. Consequently, the selection of one procedure over the other should be guided by patients' preferences regarding the quality of life and the possible need for subsequent procedures.
Angioplasty, Balloon, Coronary↗
Evaluation of the vasoconstrictive effects of topical steroids by laser-Doppler-perfusion-imaging.
Corticosteroids are one of the most frequently prescribed local therapeutic treatments. Their potency and bioavailability are tested with different methods. One of the most accepted methods is the skin-blanching test designed by McKenzie. In this study we investigated whether the skin-blanching test designed by McKenzie for screening topically active corticosteroids, producing vasoconstriction, is sufficiently detectable by a laser-Doppler-perfusion-imager (LDPI). Eight sites in two rows on the right forearm of 10 healthy volunteers were treated with a topical glucocorticosteroid (clobetasol-17-propionate 0.05% (Dermovate), and the bloodflow at each site was measured by the LDPI at different timesteps. Four sites per row were chosen to evaluate the dependency of bioavailability according to anatomical differences due to skin changes within the forearm. Furthermore, half of the sites were occluded to demonstrate the difference between occluded and non-occluded sites in bioavailability. The results show that the LDPI can easily detect changes in bloodflow due to the vasoconstriction caused by topical corticosteroid. The results showed significant changes during the different measurements, with a maximum reaction 30 h after the application of the corticosteroid. The sites under occlusion showed a slower decrease of laser values than those without occlusion, so that it can be pointed out that occlusion prolongs the bioavailability of corticosteroids but does not influence the speed of onset. So far we conclude that this technique is a simple and non-traumatic method for assessing steroid potency. Blanching, as a result of vasoconstriction, can be quantified by LDPI measurement. However, LDPI measurements have to be compared with other techniques, such as the non-traumatic 133Xe washout technique, to find out if the two technologies respond in a similar way.
Administration, Topical↗
Comparison of laser Doppler and Doppler ultrasound in lower limb vascular diagnosis.
This study represents a preliminary investigation into the use of laser Doppler flowmetry in lower limb vascular diagnosis. The method is compared with the accepted method of continuous wave Doppler ultrasound. Fifty-six patients with symptoms of lower limb vascular disease were investigated consecutively and independently using both techniques. In approximately two-thirds of patients the two methods showed broad agreement in their classification of disease severity (correlation coefficient = 0.63, P less than 0.001, n = 41). However, about 30% of those studied had impaired microvascular responses on laser Doppler evaluation with no detectable major vessel disease on continuous wave ultrasound investigation. The results indicate that more information is obtained about a subject's vascular status when results from both methods are combined. Thus laser Doppler flowmetry may be useful adjunct to Doppler ultrasound and segmental pressure measurements in the vascular laboratory.
Adult↗
[Clinico-statistical substantiation of the cryosurgery application in treatment of glial tumors].
The results of application of cryosurgical technology in treatment of 146 patients with glial tumor of various grade of anaplasia were analyzed. The prognostic significance of principal clinico-laboratory and instrumental indices was studied. The disease prognosis is determined by sum of diagnostical coefficients, prognostically favourable and unfavorable factors present. The higher efficacy of application of cryosurgical method in comparison with generally accepted method of surgical treatment was established.
Adult↗
Bile acid analysis: methods and problems.
What is the ideal method for analysis of faecal bile acids? Selection of an ideal system for a specific situation requires consideration of several factors, eg the information sought, availability of equipment and time constraints. Each laboratory will select procedures based on these constraints. A situation in which a large number of subjects are to be screened for total bile acid concentration might suggest use of single-day collections, lyophilization prior to homogenization, extraction using the Evrard and Janssen method and quantification by 3 alpha-hydroxysteroid dehydrogenase. However if the ratio of glycine to taurine conjugates and the daily excretion were of interest, separation of subclasses with Lipidex 1000 followed by both gas chromatography (of free bile acids) and HPLC (of conjugated bile acids) would be selected. There is not a best method for all situations. What does the future hold for improving this methodology in order to improve our ability to use faecal bile acid analysis clinically? The biggest problem facing the application of faecal bile acid analysis to clinical situations in the lack of ability to devise a rapid method (24-48 h) which retains the accuracy of current methods. One promising development is the potential application of immunological methods to faecal bile acids. These detection methods have been applied primarily to serum to date but if extraction and/or purification methods could be coupled with this method of quantification, a clinically acceptable method may result.(ABSTRACT TRUNCATED AT 250 WORDS)
Bile Acids and Salts↗
Blood sampling technique for measurement of plasma arginine vasopressin concentration in conscious and unrestrained rats.
A new technique for collecting blood from conscious and unrestrained rats is reported. Plasma arginine vasopressin (AVP) concentration has been known to be influenced by various procedures used for blood collection (e.g., manual contact and anesthesia). In the study reported here, the improvement of the routine jugular vein cannula method was undertaken by extending the connection tubing to allow use of a swivel mechanism. Plasma AVP, glucose, and corticosterone concentrations in virgin rats were measured in blood samples collected by use of the new method and of two generally accepted methods (decapitation and routine jugular vein cannula methods). All values of the three parameters obtained were the lowest when the new method was used, suggesting that this new swivel method induced the least stress in the rats.
Animals↗
Norplant implants acceptability and user satisfaction among women in two African countries.
An analysis of 350 users of Norplant contraceptive subdermal implants from six centers in two African countries (Ghana and Nigeria) indicates that method acceptability remained high among the women who used the method for five years. Overall, 90.1% of the 155 five-year users in these countries reported having a very favorable experience and 9.9% a favorable experience with Norplant implants. Ease of use was cited by 56.1% and duration of use by 13.6% of the women as the most liked characteristics of the method at study completion after five years. Menstrual disturbance was the least liked aspect, by 41.9% of the women. On average, women who discontinued early from the study had fewer living children and were more likely to desire additional children at method adoption than those who completed five years of use; the differences were statistically significant. Differences in level of education and previous use of contraception were not found to be statistically significant between completers and non-completers. Differences in age were not significant in Nigeria, but were marginally significant in Ghana, with completers being older than non-completers. Of the clients who completed this study, 79.2% indicated a desire to continue with contraception and 43.9% planned to have a second set of implants inserted. These findings have important implications for counseling, method access and service sustainability in African countries.
Adult↗