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PubMed1999

Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume.

BACKGROUND: Postoperative liver failure is a life-threatening complication after hepatic resection. Because of recent advances in liver surgery technique and a more stringent patient selection, mortality after hepatic resection has steadily decreased, but its incidence still ranges from 10% to 20%. The factors linked to postoperative liver failure in major hepatic resection in the modern era should be reevaluated. STUDY DESIGN: Of 80 patients with viral markers (hepatitis C viral antibody or hepatitis B surface antigen) who underwent major hepatic resections (no less than bisegmentectomies) for hepatocellular carcinoma between 1990 and 1996, 7 patients (8.8%) died of postoperative liver failure within 6 months after hepatectomy. The cause of liver failure was analyzed based on both the preoperative data and the intraoperative findings. In addition, since all the patients who died of liver failure underwent a right hepatic lobectomy, a further data analysis was also done in 47 patients who underwent a right lobectomy of the liver. A volumetric analysis by CT was then done to evaluate the remnant liver volume. RESULTS: Between the patients with liver failure and those without liver failure who underwent a right lobectomy, there were no significant differences in preoperative data or intraoperative findings. Volumetric analysis revealed that the remnant liver volume of patients who died of liver failure was significantly smaller than that of patients who lived (p = 0.008). The incidence of liver failure in patients with a remnant liver volume of less than 250 mL/m2 was 7 of 20 (38%), while it was 0 of 27 in patients with a liver volume of no less than 250 mL/m2 (p = 0.0012). The only significant risk factor for liver failure in patients with a remnant liver volume of less than 250 mL/m2 was diabetes mellitus (p = 0.0072). CONCLUSIONS: The expected remnant liver volume appears to be a good predictor for liver failure in patients who undergo a right lobectomy of the liver. In patients with diabetes mellitus and an expected remnant liver volume of less than 250 mL/m2, a major hepatectomy should be avoided. Careful patient selection based on volumetric analysis in major hepatectomy cases could help prevent the occurrence of postoperative liver failure.

Aged↗

PubMed2003

Rapid morphological change in living humans: implications for modern human origins.

Human body size and body proportions are interpreted as markers of ethnicity, 'race,' adaptation to temperature, nutritional history and socioeconomic status. Some studies emphasize only one of these indicators and other studies consider combinations of indicators. To better understand the biocultural nature of human size and proportions a new study of the growth of Maya-American youngsters was undertaken in 1999 and 2000. One purpose of this research is to assess changes in body proportion between Maya growing up in the US and Maya growing up in Guatemala. Height and sitting height of 6-12-year-old boys and girls (n=360) were measured and the sitting height ratio [sitting height/height]x100, a measure of proportion, was calculated. These data are compared with a sample of Maya of the same ages living in Guatemala and measured in 1998 (n=1297). Maya-American children are currently 10.24 cm taller, on average, and have a significantly lower sitting height ratio, (i.e. relatively longer legs, averaging 7.02 cm longer) than the Guatemala Maya. Maya-American children have body proportions more like those of white children in the US than like Maya children in Guatemala. Improvements in the environment for growth, in terms of nutrition and health, seem to explain both the trends in greater stature and relatively longer legs for the Maya-Americans. These findings are applied to the problem of modern human origins as assessed from fossil skeletons. It has been proposed that heat adapted, relatively long-legged Homo sapiens from Africa replaced the cold adapted, relatively short-legged Homo neandertalensis of the Levant and Europe [J Hum Evol 32 (1997a) 423]. Skeletal samples of Maya adults from rural Guatemala have body proportions similar to adult Neandertals and to skeletal samples from Europe with evidence of nutritional and disease stress. Just as nutrition and health status explains the differences in the body proportions of living Maya children, these factors, along with adaptation to climate, may also explain much of the differences between the Neandertal and African hominid samples.

Animals↗

PubMed2004

(Re)placing health and health care: mapping the competing discourses and practices of 'traditional' and 'modern' Thai medicine.

In the wake of the AIDS crisis, 'traditional' Thai medicine has received new attention as a means by which people living with HIV and AIDS (PLWHA) can receive some level of care. The revitalization of Thai medicine, however, is complicated by the competing organizational politics and social dynamics that regulate discourses and practices of health and health care in Thailand. This paper examines how Thai medicine is being (re)placed in the context of competing health-care systems and practices. Specifically, this analysis focuses on the complex interrelationships between 'traditional,' holistic medicine and 'modern,' allopathic medicine in a Thai context; and investigates the role of 'Thai medicine' (phaet phaen thai) and 'village medicine' (phaet pheun baan) as part of governmental and non-governmental efforts to provide health care to PLWHA in Chiang Mai, Thailand. The provision of such health care, however, takes place within the context of a struggle over 'local knowledge' and 'global change' and the ways in which places are organized in relation to the available treatment regimens for HIV/AIDS care. What this paper suggests is that the meanings of health and health care are inextricably linked to the complex, contested nature of social relations as they flow in, and are reworked through, particular places.

Anthropology, Cultural↗

PubMed2003

Current trends in modern pharmaceutical analysis for drug discovery.

Traditionally, pharmaceutical analysis referred to the chemical analysis of drug molecules. However, over the years, modern pharmaceutical analysis has evolved beyond this to encompass combination techniques, high-throughput technologies, chemometrics, microdosing studies, miniaturization and nanotechnology. These analytical advances are now being employed in all stages of drug discovery and the focus of this review will be on how these technologies are being employed within this process. With new, improved and evolving technologies, as well as new applications for existing technology, the search for new drugs for the prevention and treatment of human diseases continues.

Chemistry Techniques, Analytical↗

PubMed1999

Shaping the modern pharmaceutical development facility.

The modern pharmaceutical development facility is vastly different from previous designs. In this review, the authors describe the trends and types of facility currently used in the development of pharmaceutical products, and discuss some of the trends that will shape those facilities of the future.

Journal Article↗

PubMed2003

Ethical issues in modern biological technologies.

Today's biology-based technologies have emerged from a historical imperative and as an inevitable consequence of developments in modern biology beginning in the last half-century. They can be classified into almost 30 different areas, ranging from the use of gene therapy for human beings, enzyme engineering, stem cells and cloning, to marine biotechnology, bioinformatics, nanotechnology and biological warfare among many others. Many of them have major sociopolitico-economic, moral, ethical and legal implications. They include genetic engineering, gene therapy, tissue culture, stem cell work, the new DNA technologies, commercialization of traditional plant-based drug formulations, assisted reproduction techniques, cloning technologies, organ transplantation, bioinformatics, and biological weapons. Examples of the ethical implications of several of these items will be considered. They will be assessed with special reference to ethical implications in respect of assisted reproduction techniques, of worldwide importance today, particularly for a country such as India.

Biological Warfare↗

PubMed2003

Modern laboratory diagnosis of tuberculosis.

One-third of the global population is believed to be infected with bacteria of the Mycobacterium tuberculosis complex, the causative agent of tuberculosis. More than 8 million new cases of tuberculosis occur annually leading to 2 million deaths. Mortality is particularly high in those coinfected with HIV and where the bacteria are multiple-drug-resistant strains--ie, strains resistant to at least isoniazid and rifampicin. Early diagnosis of tuberculosis and drug resistance improves survival and by identifying infectious cases promotes contact tracing, implementation of institutional cross-infection procedures, and other public-health actions. This review addresses significant advances made in the diagnosis of infection, clinical disease, and drug resistance over the past decade. It proposes operational criteria for a modern diagnostic service in the UK (as a model of a low-incidence country) and explores some of the economic issues surrounding the use of these techniques.

Antitubercular Agents↗

PubMed1997

On the estimation of ancestral population sizes of modern humans.

The theory developed by Takahata and colleagues for estimating the effective population size of ancestral species using homologous sequences from closely related extant species was extended to take account of variation of evolutionary rates among loci. Nuclear sequence data related to the evolution of modern humans were reanalysed and computer simulations were performed to examine the effect of rate variation on estimation of ancestral population sizes. It is found that the among-locus rate variation does not have a significant effect on estimation of the current population size when sequences from multiple loci are sampled from the same species, but does have a significant effect on estimation of the ancestral population size using sequences from different species. The effects of ancestral population size, species divergence time and among-locus rate variation are found to be highly correlated, and to achieve reliable estimates of the ancestral population size, effects of the other two factors should be estimated independently.

Animals↗

PubMed2006

Effect of family planning services on modern contraceptive method continuation in Vietnam.

Access to and quality of services have increasingly been the focus of family planning programme managers, implementers and researchers in the developing world. In Vietnam, a country characterized by recent significant achievements in family planning, not much is known about the linkages between service accessibility and quality and contraceptive behaviour. Data for this study come from the Vietnam 1997 Demographic and Health Survey, with individual contraceptive use information recorded in the calendar section. Measures of access to and quality of services come from the Community/Health Facility Questionnaire, with key informant interviews and facility visits. The study focuses on the effects of the outreach programme and commune health centres on contraceptive method discontinuation for three modern, temporary methods: the IUD, oral pills and condoms. Longer travel time to commune health centres is found to be associated with significantly increased risks of first- and all-method discontinuation for any reason, while residence in communities with higher quality health centres is associated with significantly lower risks of method discontinuation. Access to and quality of the outreach programme are, in contrast, not significant determinants of method discontinuation for any reason. Similar results are found for first- and all-method discontinuation for service-related reasons. The effects of programmatic factors are more pronounced among older women and during the first three months of method use. This study provides evidence for the importance of family planning services for contraceptive method continuation in Vietnam. The results also highlight the need for a thorough evaluation of the family planning outreach programme in terms of its facilitation of women's continued use of contraception.

Adolescent↗

PubMed2006

When ancient meets modern: the relationship between postpartum non-susceptibility and contraception in sub-Saharan Africa.

Extended durations of postpartum non-susceptibility (PPNS) comprising lactational amenorrhoea and associated taboos on sex have been a central component of traditional reproductive regimes in sub-Saharan Africa. In situations of rising contraceptive prevalence this paper draws on data from the Demographic Health Surveys to consider the neglected interface between ancient and modern methods of regulation. The analysis reports striking contrasts between countries. At one extreme a woman's natural susceptibility status appears to have little bearing on the decision to use contraception in Zimbabwe, with widespread 'double-protection'. By contrast, contraceptive use in Kenya and Ghana builds directly onto underlying patterns of PPNS. Possible explanations for the differences and the implications for theory and policy are discussed.

Adolescent↗

PubMed1979

Wound infections after surgery in a modern operating suite: clinical, bacteriological and epidemiological findings.

A prospective study of 2983 operations in general and orthopaedic surgery during 3 years performed in four operating theatres in a modern operating suite was carried out in order to evaluate the importance of airborne infection. Weekly nose-and-throat samples were taken from the surgical staff and pre-operative samples were taken from the nose, throat, skin and perineum of the patients. The air contamination was followed by using settle plates, which showed low mean counts of total bacteria of between 9 and 15 c.f.u./m(2)/min, with mean counts of Staph. aureus of between 0.03 and 0.06 c.f.u./m(2)/min. No correlation was found between the total number of bacteria and the incidence of post-operative infections or between the amount of Staph. aureus in the air and post-operative Staph. aureus infections. It was concluded that further increases in ventilation could, at best, only marginally affect the incidence of post-operative infection.The post-operative wound-infection rate was 9.0%. In various types of surgery, the infection rates varied from 5.3% in clean operations to 47.6% in dirty surgery. About one third of the infections were classified as moderate or severe.Adverse patient factors, such as immunodeficiency, steroid treatment, intensive care, etc., increased the rate to 15.0%; in ;normal' patients it was 3.8%.Among the bacteria isolated, gram-negative bacilli (31% of wounds), often together with other bacteria, and Staph. aureus (28%) predominated, but in 25% no specimens were taken.Of 76 post-operative Staph. aureus infections, 32 were caused by the patients' own strains, and of the remaining 44 infections, 22, or 8% of all infections, could be traced to strains present in the air and/or the respiratory tracts of staff during the operation.The length of pre-operative hospital stay had no influence on the carrier rate of Staph. aureus in patients. The incidence of post-operative wound infection was significantly higher in patients carrying Staph. aureus and was even higher if these bacteria were found on the skin.Patients with wound infections stayed, on an average, 15 days longer than patients without infections. In serious infections the increase in duration of stay was > 20 days. Although infections were commoner in older patients, the average additional hospital stay of infected patients did not increase with age. If the post-operative infections studied in a concurrent retrospective study are taken into account more than 12 000 bed-days were due to post-surgical wound infections in the period studied or, in other words, some 12 beds (corresponding to 5.5% of the total) were always occupied by infected patients.

Air Microbiology↗

PubMed1978

Bacterial contamination in a modern operating suite, 2. Effect of a zoning system on contamination of floors and other surfaces.

In this investigation the bacterial contamination of surfaces such as walls and floors in a modern operating suite, together with surfaces of lamps in the operating theatres, and the clogs worn by staff, was studied. Counts of colony-forming units were made on impression plates containing blood-agar with Tween 80 for total bacterial counts, Baird Parker medium with egg yolk and tellurite for Staphylococcus aureus and trypticase peptone agar with neomycin and polymyxin for Clostridium spp. The areas examined were divided into the patients' route to the operating theatre, the staff's route, and the central area containing the operating rooms, anaesthetic rooms, and exit and scrub-up areas. In the patients' route counts of total organisms ranged from about 10000 to 30000/m2; for Staph. aureus the range was from 70 to 540/m2. In the staff's route the highest count was about 70000/m2 in the dressing area, and the numbers of Staph. aureus were about the same as along the patients' route. In the inner zone the counts were somewhat lower for both total organisms and Staph. aureus. Total counts on the floor from all areas of the inner zone were significantly higher just before the second operation than before the first operation on the same day. The total and Staph. aureus counts on walls, floors and lamps were the same after clean operations as after operations classified as "contaminated" or "dirty".

Air Microbiology↗

PubMed1987

Demonic possession and mental disorder in medieval and early modern Europe.

Western European belief in demonic possession as a cause of mental disorder has been traced through the medieval and early modern periods. Generally it appears that the range of disorders attributed to demonic possession has gradually narrowed. In any period, however, there seem to have been marked individual and cultural differences in outlook; some of these differences are still evident today in the survival of belief in demonic possession in pentecostal sects.

Christianity↗

PubMed2000

The phonological acquisition of Putonghua (Modern Standard Chinese).

The phonological acquisition of 129 monolingual Putonghua-speaking children, aged 1;6 to 4;6, is described. Putonghua (Modern Standard Chinese) syllables have four possible elements: tone, syllable-initial consonant, vowel, and syllable-final consonant. The children's errors suggested that Putonghua-speaking children mastered these elements in the following order: tones were acquired first; then syllable-final consonants and vowels; and syllable-initial consonants were acquired last. Phonetic acquisition of the 21 syllable-initial consonants was complete by 3;6 for 75% of children. By 4;6 the children were using the syllable-initial consonants correctly on two thirds of occasions (with the exception of four affricates). Simple vowels emerged early in development. However, triphthongs and diphthongs were prone to systematic errors. Tone errors were rare, perhaps because of their role in distinguishing lexical meaning. In contrast, acquisition of 'weak stress' and 'rhotacized feature' was incomplete in the oldest children assessed. Phonological processes used by the children were identified. Two of these processes, syllable-initial consonant deletion and backing, would be considered atypical error patterns in English. Existing theories of phonological acquisition (e.g. concepts of markedness, functional load, feature hierarchies) cannot account for some of the patterns revealed. A satisfactory explanation of the findings requires more attention to the specific characteristics of the linguistic system the children are learning. It is proposed that the saliency of the components in the language system determines the order of acquisition.

Child, Preschool↗

PubMed1989

Vitamin B12 monocarboxylic acids: unambiguous isomer assignments by modern two-dimensional NMR spectroscopy.

The three cyanocobalaminmonocarboxylic acid isomers known to be produced by the mild acid hydrolysis of the b-, d-, and e-propionamide side chains of vitamin B12 have been unambiguously assigned by modern 2D NMR methods. Previously, structural assignments had been made by less definitive NMR methods, and both X-ray and neutron diffraction studies had failed to locate unambiguously the position of the carboxyl group. The b and e isomers were structurally assigned in this study, on the basis of the assignment of the 13C NMR signal of the carboxyl group from HMBC (1H-detected heteronuclear multiple-bond correlation) spectra. The carboxyl group resonances exhibited the greatest changes in chemical shift between the protonated (pH 2) and deprotonated (pH greater than 7) forms of the acids. The d isomer was assigned by difference. Since the HMBC experiments required the assignments of side-chain CH2 signals, homonuclear Hartmann-Hahn, 2D homonuclear correlation, 2D nuclear Overhauser effect, 1H-detected heteronuclear multiple quantum coherence, and HMBC spectroscopies were used to assign completely the 1H and 13C NMR spectra of the b and e isomers at pH approximately 7. By comparison with the 13C NMR spectra of the b and e isomers, nearly one-fourth of the resonances of the 13C NMR spectrum of vitamin B12 have been reassigned. The sites of incorporation of 13C-labeled precursors in B12 biosynthesis found in previous studies have been verified by a comparison of 13C assignments. The results of studies using cobalamins modified at the b-, d-, and e-propionamide side chains in which the incorrect structural assignments were used (before 1980), particularly studies of B12-dependent enzymes, require reinterpretation using the correct structural assignments.

Carboxylic Acids↗

PubMed2005

Influence of mobile air-conditioning on vehicle emissions and fuel consumption: a model approach for modern gasoline cars used in Europe.

The influence of air-conditioning activity on the emissions and fuel consumption of passenger cars is an important issue, since fleet penetration and use of these systems have reached a high level. Apart from the MOBILE6 study in the United States, little data is available on the impact of air-conditioning devices (A/Cs). Since weather conditions and A/C technologies both differ from those in the U. S., a test series was designed for the European setting. A fleet of six modern gasoline passenger cars was tested in different weather conditions. Separate test series were carried out for the initial cooldown and for the stationary situation of keeping the interior of the vehicle cool. As assumed, CO2 emissions and fuel consumption rise with the thermal load. This also causes a notable rise in CO and hydrocarbons (HCs). Moreover, A/Cs do not stop automatically at low ambient temperatures; if necessary, they produce dry air to demist the windscreen. A model is proposed that shows a constant load for lower temperatures and a linear trend for higher temperatures. The initial cooldown tests highlight significant differences among cars but show that A/C operation for the initial cooling of an overheated passenger compartment does not result in any extra emissions for the fleet as a whole.

Air Conditioning↗

PubMed2005

Structural understanding of a molecular material that is accessed only by a solid-state desolvation process: the scope of modern powder X-ray diffraction techniques.

Many molecular materials cannot be prepared as a "pure" (nonsolvate) crystalline phase by conventional crystal growth from solution due to the facile formation of solvate structures. In such cases, it may be possible to obtain the pure phase by a solid-state desolvation process, although such processes are generally associated with loss of crystal integrity, yielding a microcrystalline powder of the pure phase. This paper demonstrates the utility of modern powder X-ray diffraction techniques for obtaining structural understanding in such cases, focusing on a particular member of a structural family that is of wider relevance within the context of crystal engineering and design.

Journal Article↗

PubMed1998

Silver development in microscopy and bioanalysis: a new versatile formulation for modern needs.

Potentially, silver development could unify most modern demands for clean, accurately localized marker amplification in microscopy and bioanalysis. However, the existing technology leaves room for improvement in developer design. A new formulation has been devised which, by using principles of silver chelation, avoids problems of self-nucleation and catalysis by light. It is made, just before use, by mixing together equal amounts of stock solutions containing high molarity, Tris-buffered silver nitrate and alcoholic, buffered pyrogallol. The two stocks are easily prepared and have very long shelf-lives. The developer is light insensitive for up to an hour at room temperature, so that development can proceed under ambient light conditions and at the neutral pH most suited to biological systems. The powerful reducer in the suggested formulation should allow the detection of low concentrations of marker signal in a wide range of applications.

Humans↗