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PubMed1991

What are the possibilities and limits of therapy with European native drugs in modern clinical medicine?

Concerning therapy with European native drugs in modern clinical medicine, a clear distinction has to be made between its possibilities and limits on a scientific basis and its possibilities and limits according to the present position of phytotherapy in the different countries of the European Community. On a scientific basis phytopharmaceuticals are used for therapy in a variety of diseases in the clinic as well as in medical practice. The clinical use of phytopharmaceuticals is limited by the kind of acute and severe diseases predominantly treated in the hospital. These diseases require immediate measures with strong acting pharmaceuticals. In the practice of the general practitioner indications for phytopharmaceuticals in principle are the same as in the hospital. The relatively more frequent use of phytopharmaceuticals by the practitioner is related to the fact that he is mainly concerned with mild health disturbances and diseases and chronic sufferings which are destined for treatment with herbal medicines.

Europe↗
PubMed1984

Optimization of detectors for modern liquid chromatography.

The development of modern liquid chromatographic methods depends strongly on the development of suitable measuring systems for the separated compounds. This is the case as generally an on-line coupling of separation and detection is preferred because of ease of operation, reliability and more efficient data handling. Unfortunately, the best conditions for the separation are often not optimal from the detection point of view. Conflicts arise in various respects and compromises have to be made. Depending on the complexity, cost and performance of each, either the chromatographic separation, or the detection process, has to be adapted, the one to the other. A number of contemporary developments in the techniques of liquid chromatography tend to sharpen these conflicts. Further reduction in particle size, reduction of the column diameter, introduction of multicolumn operation and the exploration of open tubular liquid chromatography can be mentioned in this respect. From this point of view a broad discussion of the role of detection techniques in the development and performance of liquid chromatographic analytical procedures is given.

Journal Article↗
PubMed1990

Modern approaches to the therapy of septic shock.

Bacteremia from gram-negative rods is a great cause of concern for hospital physicians today. Shock-complicating gram-negative sepsis has a mortality rate of 60% and above, despite early diagnosis and treatment. Intensive research efforts have shown new pathophysiological mechanisms and mediators involved in septic shock, with changes in recommended treatment protocols. In this report, the authors review the use of corticosteroids, fibronectin, naloxone hydrochloride, and immunotherapy, with emphasis on theoretical considerations and relevant clinical experience. Although these treatment methods may have been promising initially, data from large double-blind human trials are either lacking or unencouraging. While continued research and modern therapeutic approaches should improve future survival rates from septic shock, use of the therapies reviewed should be considered experimental at this time.

Adrenal Cortex Hormones↗
PubMed1996

Patient education and counseling in the context of modern patient-physician-family communication.

The modern understanding of patient education derives from a robust literature from public health and clinical medicine that started to become empirical and rigorous in the mid-1960s. Patient education is one of three functions of the medical interview, each of which must each be accomplished skillfully if the others are to be maximally effective. This article discusses the new conceptualization of patient education and provides examples of how it works. The rule of patient activation is discussed and implications for future research are presented.

Clinical Competence↗
PubMed1993

The modern concept of association cortex.

Although enormous amounts of new neuroanatomical, neurophysiological and neurobehavioral data have been gathered on the association cortices in the past decade, it seems more permissible now than ever to use this functionally loaded concept. Its generality helps enormously, but the modern recognition of multiple interactive neural systems all contributing to cognition has diffused previous concerns relating to strict localization.

Animals↗
PubMed1993

Does modern cardiac surgery require conventional intensive care?

We considered that, with modern perfusion equipment and mildly hypothermic cardiopulmonary bypass, protracted post-operative ventilation in an intensive care unit (ITU) is no longer required after most cardiac operations. We used a three-bedded cardiac recovery area (CRA) within the operating suite for 1,000 patients between January 1990 and June 1991. Forty-five patients with special needs were managed in the ITU. The time to extubation (T50%; range) for coronary bypass, aortic valve, mitral valve, and double-valve patients was 2.0 (0-42), 2.5 (0-12), 3.0 (0-15), and 3.0 (1-36) hours, respectively. Recovery beds were re-used allowing 5-6 operations daily. The difference in nursing staff complement for a CRA versus ITU bed was 4.5/7.8. Patient management was by nurse specialists supported by cardiac surgeons. Intervention by cardiac anaesthetists or intensivists was limited to specific ventilatory problems or renal failure. The early extubation policy failed in ten patients (five coronary, three aortic, one mitral and one double-valve patient) through poor pre-operative respiratory function, left ventricular failure or intra-operative events. The overall mortality in CRA was 1.4%. The mean duration of post-operative stay was 7 days (range 5-12). We conclude that a CRA staffed by nurse practitioners provides a safe and effective alternative to the anaesthetist-managed ITU. A rapid turnover of CRA beds removes the constraints of ITU bed availability.

Adolescent↗
PubMedDate not supplied

New aspects of bacterial ultrastructure as revealed by modern acrylics for electron microscopy.

Modern acrylics can be used over a wide temperature range (+60 degrees C to -80 degrees C) for infiltration, embedding, and polymerization. They can be used in procedures involving chemical fixation or rapid freezing. This flexibility allows for studies to be carried out upon the effects that different parameters involved in preparing biological tissue for microscopy have upon structure and retention of immunoreactivity. With most preparative methods contributions have been made to our knowledge on bacterial structure in gram-negative and gram-positive cells. The future should lie in integrating the advantages of the various methods for the purpose of advancing our understanding of bacterial structure/function.

Acrylic Resins↗
PubMed2026

MetaGLIMPSE: Meta-imputation of low-coverage sequencing data for modern and ancient genomes.

The advent of efficient and accurate imputation for low-coverage sequencing offers an unbiased alternative to SNP array imputation, increasing the accuracy of rare variant imputation across all populations. Since imputation accuracy generally increases with larger reference panels and closer ancestry match between target and reference samples, leveraging imputation from multiple reference panels improves imputation accuracy; however, individual reference panel genotypes are often privacy protected. Meta-imputation bypasses individual-level data by combining single-panel imputed genotypes through estimating panel- and marker-specific weights. We present a meta-imputation method, MetaGLIMPSE, that combines estimates from multiple reference panels for low-coverage sequencing imputation. Across all our scenarios, for both modern and ancient DNA samples, MetaGLIMPSE consistently outperforms the best single-panel imputation for coverages of 0.1×-8× and across all minor-allele frequencies, equaling the combined panel imputation for some parameters. Finally, MetaGLIMPSE is computationally efficient, meta-imputing 500 whole genomes in 16% of the time of GLIMPSE2.

Humans↗
PubMed2006

Left ventricular remodeling after anterior wall acute myocardial infarction in modern clinical practice (from the REmodelage VEntriculaire [REVE] study group).

Left ventricular (LV) remodeling after acute myocardial infarction (AMI) has been well described in previous studies. However, there is a paucity of data on the incidence of and risk factors for LV remodeling in modern clinical practice that incorporates widespread use of acute reperfusion strategies and almost systematic use of "antiremodeling" medications, such as angiotensin-converting enzyme inhibitors and beta blockers. We enrolled 266 patients with anterior wall Q-wave AMI who had >or=3 segments of the infarct zone that were akinetic on echocardiography before discharge. Echocardiographic follow-up was performed 3 months and 1 year after AMI. LV volumes, ejection fraction, wall motion score index, and mitral flow velocities were determined in a blinded analysis at a core echocardiographic laboratory. Acute reperfusion was attempted in 220 patients (83%; primary angioplasty in 29% and thrombolysis in 54%). During hospitalization, 99% of patients underwent coronary angiography and 87% underwent coronary stenting of the infarct-related lesion. At 1 year, 95% of patients received an antiplatelet agent, 89% a beta blocker, 93% an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, and 93% a statin. Echocardiographic follow-up was obtained in 215 patients. There was recovery in LV systolic function as shown by a decrease in wall motion score index and an increase in ejection fraction. There was a significant increase in end-diastolic volume (EDV; 56.4 +/- 14.7 ml/m2 at baseline, 59.3 +/- 15.7 ml/m2 at 3 months, 62.8 +/- 18.7 ml/m2 at 1 year, p <0.0001). LV remodeling (>20% increase in EDV) was observed in 67 patients (31%). Peak creatine kinase level, systolic blood pressure, and wall motion score index were independently associated with changes in EDV. In conclusion, recent improvements in AMI management do not abolish LV remodeling, which remains a relatively frequent event after an initial anterior wall AMI.

Adult↗
PubMed2006

Modern human molar enamel thickness and enamel-dentine junction shape.

This study examines cross-sections of molar crowns in a diverse modern human sample to quantify variation in enamel thickness and enamel-dentine junction (EDJ) shape. Histological sections were generated from molars sectioned buccolingually across mesial cusps. Enamel cap area, dentine area, EDJ length, and bi-cervical diameter were measured on micrographs using a digitizing tablet. Nine landmarks along the EDJ were defined, and X and Y coordinates were digitized in order to quantify EDJ shape. Upper molars show greater values for the components of enamel thickness, leading to significantly greater average enamel thickness than in lower molars. Average enamel thickness increased significantly from M1 to M3 in both molar rows, due to significantly increasing enamel cap area in upper molars, and decreasing dentine area in lower molars. Differences in EDJ shape were found among maxillary molars in combined and individual populations. Sex differences were also found; males showed significantly greater dentine area, EDJ length, and bi-cervical diameters in certain tooth types, which resulted in females having significantly thicker average enamel. Differences in enamel thickness and EDJ shape within molars were also found among populations, although few consistent trends were evident. This study demonstrates that enamel thickness and EDJ shape vary among molars, between sexes, and among populations; these factors must be considered in the categorization and comparison of ape and human molars, particularly when isolated teeth or fossil taxa are included. Human relative enamel thickness encompasses most values reported for fossil apes and humans, suggesting limited taxonomic value when considered alone.

Animals↗
PubMed2005

Late fatigue fracture of a modern cemented [corrected] cobalt chrome stem for total hip arthroplasty: a report of 10 cases.

We report 10 fatigue fractures of a modern, cemented, cobalt chromium alloy stem (Osteonics Omnifit) for total hip arthroplasty occurring between 1995 and 2004. The primary total hip arthroplasties had been performed between 1989 and 1996. The average age at the time of surgery was 54 years (range, 34-70 years), and the average body mass index was 29 (range, 20-38). The time in situ of the prosthesis at the time of fracture averaged 8 years (range, 4-12 years). Intermediate follow-up radiographs before the fracture were available in 7 cases, all of which demonstrated loss of calcar support. Scanning electron microscopy of the fracture surfaces in 3 of the components showed porosity near the initiation site. Metallography of polished and etched cross sections near the fracture surface revealed large grain size. In the presence of a spontaneous onset of thigh pain at intermediate follow-up in patients with this stem, particularly if associated with loss of calcar support, a fatigue fracture should be considered.

Adult↗
PubMed2006

Early aseptic loosening of a modern acetabular component secondary to a change in manufacturing.

Cementless acetabular reconstruction with a hemispheric acetabular shell in primary total hip arthroplasty has shown reproducible results. Ingrowth of bone into a porous coating of beads, a titanium fiber mesh, or a hydroxylapatite-containing bioactive coating has been histologically documented. Early failures of ingrowth of an acetabular component have been reported using a threaded acetabular design. A series showing high early (<1 year) failure of ingrowth into a modern acetabular component has never before been reported. We report a series showing a 33% early loosening rate of the Sulzer Interop TM acetabular component (Sulzermedica, acquired by Zimmer, Warsaw, IN).

Acetabulum↗
PubMed2003

The development of the modern oxygenator.

From 1953 when Gibbon first successfully supported a patient with extracorporeal circulation to about 1980 many different types of oxygenators were developed. Since their introduction in the early 1980s, microporous hollow fiber oxygenators with blood flow outside the fiber have become the dominant type of oxygenator in use. Their success has been due to both the ability to specify the required properties for a good oxygenator and the application of modern design tools, especially computational fluid dynamics, to the design process. The result has been the availability of many oxygenators from different manufacturers that differ to some extent in their performance but all of which provide adequate performance for successful and safe clinical use.

Equipment Design↗
PubMed2004

Tricuspid valve repair: an old disease, a modern experience.

BACKGROUND: We review our experience in patients who required surgical correction of tricuspid valve disease with concomitant disease of the mitral or aortic valve, or both, operated on between 1987 and 1999. METHODS: We studied 232 consecutive patients (mean age, 59.8 years) followed for a mean of 6.8 years (range, 2 to 12 years). All patients were investigated by means of Doppler echocardiography, with hemodynamic studies in 135. Median tricuspid insufficiency was 3+. The cause was rheumatic heart disease in 186 patients and degenerative in 46. All patients underwent suture annuloplasty (De Vega or segmental) at the time of mitral or aortic valve surgery. Tricuspid lesions were functional in 128 patients and organic in 104. RESULTS: The hospital and late mortality rates were 8.1% and 23.3%, respectively. These figures were independent of the type of annuloplasty performed. Predictors of hospital mortality were biologic prosthesis, renal insufficiency, time of cardiopulmonary bypass, and use of inotropic drugs. Predictors of late mortality were age older than 60 years, left ventricular ejection fraction less than 0.50, and New York Heart Association functional class IV. At 12 years, the actuarial survival rate was 50.5% +/- 6.1%, and the actuarial curve free from reoperation 75.7% +/- 7.3%. The actuarial curve for freedom from valve-related complication was 39.0% +/- 6.3% at 11 years. CONCLUSIONS: Despite the use of modern technologic advances in the diagnosis and treatment of valvular hear disease, tricuspid insufficiency continues to be a poor prognostic factor in patients with concomitant disease of the mitral or aortic valve, or both.

Adult↗
PubMed2006

Short- and long-term results of triple valve surgery in the modern era.

BACKGROUND: Triple valve surgery is usually complex and carries a reported operative mortality of 25% and 10-year survival of 40%. We examined surgical results in the modern era. METHODS: A total of 174 consecutive patients, mean age 58 +/-12 years underwent triple valve surgery from 1990 to 2004. The most common aortic and mitral valve disease was rheumatic disease (61%), followed by prosthetic valve dysfunction (22%). Tricuspid valve disease was functional regurgitation in 72% of patients. Ninety-four percent of patients were in New York Heart Association class III and IV, and 60% had had previous cardiac operations. The aortic valve procedures consisted of 160 replacements and 14 repairs, the mitral valve procedures, 153 replacements and 21 repairs, and the tricuspid valve procedures, 12 replacements and 162 repairs. Univariate and multivariable analyses were performed to identify predictors of early and late survival. RESULTS: Operative mortality was 13% (n = 22). Univariate factors associated with mortality included urgent surgery, shock, tricuspid valve replacement, preoperative renal failure, and peripheral vascular disease. Survival at 5 and 10 years was 75% and 61%, respectively. Seventy-three percent of patients were in New York Heart Association class I and II at their most recent follow-up. Ten-year freedom from thromboembolism was 88%, from anticoagulation-related hemorrhage, 83%, from endocarditis, 96%, and from cardiac reoperation, 92%. CONCLUSIONS: Patients with advanced rheumatic valve disease and prosthetic valve dysfunction are at risk for requiring triple valve surgery. Compared with historic reports, the results of triple valve surgery, primary and reoperative, have improved. Although early mortality is high, long-term and event-free survival are comparable with that of patients undergoing single valve replacement.

Adult↗
PubMed2006

Catalytic autoantibodies in clinical autoimmunity and modern medicine.

Abzymes (catalytic autoantibodies) belong to an absolutely new group of physiologically active substances with dual characteristics: they represent a pool of canonical autoantibodies and possess catalytic activity. Among them, proteolytic and DNA-hydrolyzing autoantibodies are of special value. Abzymes are an important pathogenic factor in the progression of clinical autoimmunity syndrome. The presence of autoantibodies against various autoantigens is accompanied by their high catalytic potential. The increase in this activity correlates with serum levels of the autoantibodies, clinical manifestations of autoimmune disorders, disease severity and the rate of progressing disability. Abzymes are crucial for immune homeostasis regulation. They can be of practical value in the development of modern immunodiagnostic tools and schedules of immunotherapy.

Antibodies, Catalytic↗
PubMed2005

Tracing the history of Galalpha1-4Gal on glycoproteins in modern birds.

Galalpha1-4Gal is typically found in mammalian glycolipids in small quantities, and recognized by some pathogens, such as uropathogenic Escherichia coli. In contrast, glycoproteins containing Galalpha1-4Gal were rarely found in vertebrates except in a few species of birds and amphibians until recently. However, we had previously reported that pigeon (Columba livia) egg white and serum glycoproteins are rich in N-glycans with Galalpha1-4Gal at non-reducing termini. Our investigation with egg white glycoproteins from 181 avian species also revealed that the distribution of (Galalpha1-4Gal)-containing glycoproteins was not rare among avians, and is correlated with the phylogeny of birds. The differentiated expression was most likely emerged at earlier stage of diversification of modern birds, but some birds might have lost the facility for the expression relatively recently.

Animals↗
PubMed2005

Unexpected amino acid composition of modern Reptilia and its implications in molecular mechanisms of dinosaur extinction.

Dinosaur extinction is a great challenge to evolutionary biology. Although accumulating evidence suggests that an abrupt change of environment, such as a long period of low temperature induced by asteroid hit or other disasters, may be responsible for dinosaur extinction, little is known about the underlying molecular mechanisms. By analyzing the amino acid compositions of 13 biological classes, we found that the charged amino acid content of modern Reptilia, the sibling of dinosaur, is strikingly different from those of other classes, which inspires us to propose a possible molecular mechanism for dinosaur extinction.

Amino Acid Sequence↗