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PubMedDate not supplied

[An enteral modular formula in dibasic amino aciduria].

Lysinuric protein intolerance (LPI) or dibasic amino acid aminoaciduria is an unusual metabolic illness which, in countries where it is most common, affects one individual for every 60,000-80,000 births, and which is characterised by the inability to transport dibasic amino acids to the interior of the different cells of the organism. This paper sets out the design for an enteral modular formula for a pediatric patient very probably suffering from LPI. The formula has a very limited protein content, and incorporates L-citruline, a non-proteinogenic amino acid which intervenes in the urea cycle.

Amino Acid Metabolism, Inborn Errors↗
PubMed1994

Modular uncemented prosthetic reconstruction after resection of tumours of the distal femur.

We report the use of the uncemented Kotz modular femur and tibia reconstruction system after 95 distal femoral resections performed from 1983 to 1989. The average follow-up was 51 months; 62 patients had at least 36 months' follow-up and 36 at least 60 months. Complications required reoperation in 55%. The postoperative infection rate was 5% for primary cases, 6% for revision cases, and 43% for revision of previously infected cases. The polyethylene bushes failed in 42% of cases at an average of 64 months postoperatively. Stem breakage occurred in 6% and was associated with the use of narrow stems and extensive quadriceps excision. The radiological results were excellent or good in most cases and were related to the initial screw fixation, but not to age, chemotherapy, length of resection or size of stem. The clinical results were excellent or good in 75%, failure usually being associated with a complication, especially infection.

Adolescent↗
PubMed1994

Evidence that an archaeal alpha-like DNA polymerase has a modular organization of its associated catalytic activities.

In this study we report on the evidence that an alpha-like DNA polymerase purified from the thermoacidophilic archaeon Sulfolobus solfataricus has a modular organization of its associated catalytic activities (polymerase and 3'-5' exonuclease). This enzyme, a monomer of about 100 kDa whose complete primary structure is available, has a protease hypersensitive site that is likely to be cleaved by the action of endogenous proteases during the purification procedure. As a consequence of that, two proteolytic fragments of about 50 and 40 kDa, in addition to the intact 100-kDa molecular species, can be detected upon SDS-PAGE of highly purified S. solfataricus DNA polymerase samples. The amino-terminal microsequence analysis by Edman degradation has revealed that the 50- and the 40-kDa polypeptides correspond to the carboxyl- and the amino-terminal portion of the protein molecule, respectively. Using the bidimensional activity gel assay procedure, recently described by Longley and Mosbaugh (Longley, M. J., and Mosbaugh, D. W. (1991) Biochemistry 30, 2655-2664), we have demonstrated that the 50-kDa fragment retains a Mg(2+)-dependent DNA polymerizing activity, whereas the 40-kDa polypeptide is able to catalyze the excision of mispaired nucleotides at the 3'-OH terminus of a primer/template DNA substrate in the presence of Mn2+ ions. On the other hand, the 100-kDa protein possess both activities. To date, this is the first report indicating, on the basis of direct functional data, that the polymerization and the 3'-5' exonuclease activity of a family B DNA polymerase can be ascribed to physically distinct modules of the enzyme molecule.

Amino Acid Sequence↗
PubMed1993

A comparison of the disassociation strength of modular acetabular components.

Five short-term in vivo disassembly of two-piece acetabular cup designs have been reported. This study evaluates the liner retention strengths of eight contemporary cup systems. Both push-out (663 +/- 65.5 pounds force to 29 +/- 1.4 pounds force) and lever-out (684 +/- 114 inch-pounds to 43 +/- 1.5 inch-pounds) test modes show a wide variation in retention strength. Repeat liner separation testing demonstrates a 26% and 32% respective decrease in locking mechanism integrity. These findings indicate that reseating modular liners at the time of surgery or reassembling a previously separated liner should be avoided.

Acetabulum↗
PubMedDate not supplied

[The translation symmetry in cell mosaics of amphibian embryonic ectoderm as a manifestation of their modular structure].

A theoretical proposition that the cell mosaics possess translation symmetry has been experimentally confirmed by scanning electron microscopy of the common frog embryonic ectoderm. This symmetry is a manifestation of the tissues modular structure and it provides new data for quantitative estimation of composition and structure of tissue morphofunctional element as well as for diagnostics and prediction of tissue development.

Amphibians↗
PubMed1993

A modular knowledge base for the follow-up of clinical protocols.

From the knowledge engineering point of view, the observation of patients subjected to clinical protocols of therapy constitutes a domain characterized by the existence of strongly structured knowledge. We have approached the problem from the perspective of a homogeneous and modular knowledge representation theory, based on the concept of Generalized Magnitude. This concept arises from identifying and collecting all possible facts of a domain established a priori, and being inspired by the concept of physical magnitudes. The Generalized Magnitudes scheme includes temporal extensions necessary to solve a medical problem for which exists a therapy and a follow-up plan with temporal specifications, and also facilitates the creation of advisory expert systems.

Drug Therapy, Computer-Assisted↗
PubMedDate not supplied

Development of steerable instruments for minimal invasive surgery in modular conception.

The augmenting complexity of minimal invasive interventions requests a continuous improvement of technologies. Extended endoscopic procedures, e.g. laparoscopic-transanal sigmoidectomy or thoracoscopic esophagus dissection require difficult surgical manipulations like mobilisation, sceletonization as well as ligatures and sutures. They are difficult to perform with the present endo-surgical instruments. A major instrumental weakness is represented by the restricted steerability because of the rigid shaft axis and the resulting low degrees of freedom (DOF). Therefore a series of steerable flexible instruments has been developed in interdisciplinary cooperation between surgeons and engineers. The prototypes provide a multi-joint working as the instrument's elbow, which allows to incline the tip around +/- 280 degrees. The second additional DOF is the rotation of the surgical tool. The prototypes have been experimentally tested in laparoscopy and thoracoscopy, showing a clear improvement in the carrying out of complex operative manipulations. The further development is performed in modular conception, including electric drives.

Animals↗
PubMed1993

Torsional fixation of a modular femoral hip component.

Standard range of motion (S-ROM) modular total hip femoral stem has been designed to achieve precise fit in the diaphysis and metaphysis. This study compares torsional fixation of the S-ROM stem implanted with tight fixation of both the metaphyseal and diaphyseal components, tight metaphyseal and loose diaphyseal fixation. The mean load to failure was significantly greater in those implanted with tight fixation proximally and distally. Rotational micromotion was significantly decreased by fixation proximally, but permanent rotational displacement was improved primarily by distal fixation. Tight proximal and distal fixation were necessary to control both micromotion and permanent rotational displacement caused by torsional loading. Clinical success of this implant will depend on achieving tight proximal and distal fixation.

Biomechanical Phenomena↗
PubMedDate not supplied

[Modular organization of the cerebral cortex].

Light and electron microscopy original data and other physiological and morphological findings testify that neurons of the cerebral cortex were joined in compact cell ensembles (modules, block). These neuronal modules are self organized in a united morpho-functional system under the repeating impulses which are converged via association callosal and projectional thalamic afferents. A comparative analysis of original and literature data concerning modular organization of the cerebral cortex was performed. A hypothetical model of distinguishing and self assembling of the cortical modules is discussed.

Cerebral Cortex↗
PubMed1977

Urinalysis by modular learning.

A self-instructional approach to the entry-level presentation of urinalysis in a written modular format was used by a class of medical laboratory technician students. The course consisted of 13 modules based upon behavioral objectives. The modules used no audio or visual media but required "hands-on" performance of laboratory procedures. The achievements of a test sample of 12 students were compared with those of a previous class in which the same material was presented in lectures. Evaluation by written tests given to both classes showed no statistical difference. The self-instructed students performed adequately in their practical laboratory work, but the overall learning time was increased by 50 percent when self-pacing was used. A measurement questionnaire revealed that the students preferred instructor-led courses to self-instructional units for a variety of reasons which lead to some further considerations.

Attitude↗
PubMedDate not supplied

On-site modular management training for junior doctors.

A structured, modular management training programme has been developed to introduce junior doctors to basic management skills and concepts, successfully improving the efficiency of the organization.

Education, Medical, Continuing↗
PubMed1996

Clinical evaluation of the Modular Electromechanical Lock Actuator (MELA) for above-elbow prostheses: a final report.

The Modular Electromechanical Lock Actuator (MELA) is the result of research and development (R&D) conducted under the direction of Dudley S. Childress, PhD, at the Northwestern University Prosthetics Research Laboratory (NUPRL), Chicago, Illinois. NUPRL, based upon experience with prostheses for persons with high-level, above-elbow amputations, developed the MELA to assist those persons with amputation who experience difficulty in operating existing manual elbows, whether with a conventional harness, nudge control, excursion amplifier, or other arrangement. Technology Transfer Section, VA Rehab R&D, with collaboration from Frederick Downs, Jr., Director, and John Clements, Prosthetic Regional Manager, VA National Prosthetic and Sensory Aids Service, managed a multicenter clinical evaluation of the MELA. The purpose was to objectively assess and affirm its performance, safety, clinical application, and commercial readiness. The following VA Prosthetic Treatment Centers served as evaluation sites: Baltimore, MD, Huntington, WV, and New York, NY. A VA-wide screening process yielded 10 candidates for review. A total of seven subjects met the selection criteria and were accepted for participation. In addition, several prosthetists provided their comments on the MELA. Overall, the performance of the MELA demonstrated that it could be fit to existing body-powered arms and used as an alternative control method for manual elbows. Consensus of participant feedback indicated general satisfaction and improved elbow lock function. In addition, several modifications were identified for the commercial version. The primary issues focused on 1) increasing speed (alternating response time); 2) unloading forearm (sometimes required to cycle the MELA); 3) providing mechanical back-up in case of unit failure; 4) reducing gear-motor noise; 5) improving integrity of wiring and retaining clip; and 6) marketing the MELA as a stand-alone product. Hosmer-Dorrance Corp., in collaboration with the developer, has indicated that resolution for most of the identified issues is readily achievable. Increasing speed (response time) and unloading forearm will require more investigation and consumer feedback from the commercial market. Based upon the clinical findings, the MELA was recommended for commercial production and availability, upon prescription, to appropriate veteran beneficiaries.

Arm↗
PubMed1996

Molecular characterization and modular analysis of human MyD88.

MyD88 was first characterized as a myeloid differentiation primary response gene in mice, activated in M1 myeloleukemic cells following interleukin-6 (IL-6) induced growth arrest and terminal differentiation. Analysis of expressed sequence tags (ESTs) from activated dendritic cell libraries led to the indentification of cDNAs encoding the human homolog (hMyD88). The original description of MyD88 as a 243 aa protein may reflect a truncated mouse cDNA since the 2682 nt hMyD88 cDNA predicts a 296 aa cytoplasmic protein. Consistent with this proposal is the detection of a 33 kDa protein in human heart, kidney and liver tissue. The expression pattern of MyD88 is also more widespread than originally believed: a 2.6 kb hMyD88 mRNA species was found to be constitutively expressed in many adult human tissues; in addition MyD88 expression was observed in monocyte, T, B, NK and dendritic cells. The MyD88 protein has a modular structure composed of an N-terminal 'death domain' (DD) similar to the intracellular segments of TNF receptor 1 (TNFR1) and FAS and a C-terminal region related to the signaling domains of vertebrate interleukin-1 receptors (IL-1R) and the Drosophila morphogen Toll. This intriguing structural framework may endow MyD88 with unique signaling capabilities.

Adaptor Proteins, Signal Transducing↗
PubMed1996

Initial stability of a modular uncemented, porous-coated femoral stem: a mechanical study.

A versatile modular hip system was used to evaluate the initial stability of a cementless femoral stem in anatomically consistent composite bones. Four implant bone configurations of varying proximal and distal fit/fill were tested. The implanted femurs were tested on an Instron 1331 materials testing machine in neutral loading and flexion loading; both translational micromotions and rotations of the implant relative to the bone were recorded on all three axes of motion, accounting for all 6 degrees of freedom of joint motion. Implants were then sectioned, and both endosteal canal fit and intramedullary canal fill were measured. Results indicate that (1) loading the implant in flexion by out-of-plane forces significantly increases both relative translation and rotation at the interface, (2) increasing the proximal fit reduces implant rotation about its longitudinal axis in flexion loading and (3) increasing the distal canal fit and fill increases prosthesis rotation about its longitudinal axis in flexion loading. These results indicate that the femoral stem is more unstable in out-of-plane loading, such as during stair climbing, and that increasing the proximal fit may enhance the initial rotational stability of an uncemented femoral stem.

Biomechanical Phenomena↗
PubMed1997

Arthrodesis of the knee with a modular titanium intramedullary nail.

We retrospectively studied the results of arthrodesis of the knee with a modular titanium intramedullary nail that couples at the knee. The study group consisted of thirteen patients who had a malignant tumor around the knee, five who had failure of a total knee arthroplasty, and three who had a locally destructive benign tumor about the knee. All of the patients were followed for a minimum of two years. Through a single incision at the knee, one nail was inserted retrograde into the femur and the other, antegrade into the tibia; the two nails were joined at the level of the knee by a conical couple and were secured with locking screws. The diameters of the nails were different, to accommodate the dissimilar sizes of the tibial and femoral intramedullary canals. A solid osseous fusion was achieved in nineteen (90 per cent) of the twenty-one patients (sixteen who had had resection of a tumor and three who had had a failed arthroplasty), at an average of 8.4 months (range, three to nineteen months) after the operation. One patient had a delayed union, but fusion was achieved after additional bone-grafting. Of the sixteen patients who were available for clinical and radiographic evaluation at the time of the study, fifteen were satisfied with the over-all outcome and thirteen had either less pain or the same amount of pain as they had had preoperatively. There were no mechanical failures of the implant and no recurrences of tumor. Complications occurred in eight (38 per cent) of the twenty-one patients: three patients had a stress fracture, three had a peroneal nerve palsy (one of which was transient), one had a superficial wound infection, and one had reflex sympathetic dystrophy.

Adolescent↗
PubMed1996

[Modular concept for quality in the hospital--"Heidelberg model"].

The Heidelberg University Hospital meets the standards required of medical services in terms of efficiency, optimizing procedures, cost-effectiveness, staff-satisfaction, and reducing infection rates etc., by implementing the Modular concept for quality within hospitals that has now proven its worth in practice. This concept combines a number of functional modules, including the hygiene, nursing, environment, and casualty modules, to name just four of them, within an overall framework incorporating guidelines focusing on quality, strategies, and management policies. Relevant European quality guidelines and the principles of Good Laboratory Practice (GLP), and Good Manufacturing Practice (GMP) are all taken into account to facilitate the required inter-hospital comparison with regard to continuous improvement of quality. It clearly demonstrates that expertise within the hospital and proven practicability in terms of numbers take definite precedence over theoretical approaches from outside experts.

Cost Control↗
PubMed1996

[Health promotion in the 2nd half of life. A modular concept for public health insurance patients: the preventive program "healthy aging"].

A modular concept for persons members of health insurances: the prevention programme entitled becoming old and remaining healthy. Prevention is sensible in the second half of the life span. In these later years, key objectives include such concrete classical themes like nutrition and mobility as well as prevention of falls and psychosocial support for family care providers. Such prevention requires a multi-step procedure if the goal of a self-determination in health behavior is to be reached. The prevention programme "Becoming Old and Remaining Healthy", an example of such a concept, is presented in this article. Selected components of these programme should give an impression how psychological and educational approaches can be used to help students understand the health implications of their own life circumstances. This paper is to familiarize the reader with the basic concept of prevention and health promotion.

Aged↗
PubMed1996

Minimum four-year radiographic and clinical evaluation of results following femoral revision surgery with the S-ROM modular hip system.

Thirty-four patients were reviewed following revision modular cementless reconstruction for proximal femoral deficiency. One patient underwent a Girdlestone conversion for sepsis at 3 years postoperatively, leaving 33 patients with an average follow-up of 51 months (range 48 to 62 months). The average age at surgery was 60 years, and there were 17 right and 16 left hips. Patients were assessed clinically using the Merle d'Aubigné and Postel hip rating system. Radiographic assessment was performed on preoperative and postoperative films. Femoral assessment was performed using the Engh fixation stability score, Gruen zonal system for radiolucencies and observing for the presence or absence of osteolysis. The average pain score was 5.4/6 with 88% having slight or no pain. Only one patient (3%) had thigh pain. Radiographically, the average fixation stability score was 21.7 with features of bony ingrowth present in 97%, and one case with features of stable fibrous ingrowth. There was no evidence of osteolysis.

Adult↗