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At least 1,315 records · Page 73Linked to original sources
PubMed2005

Stair climbing is more critical than walking in pre-clinical assessment of primary stability in cementless THA in vitro.

Pre-clinical testing of hip endoprostheses is a mandatory requirement before clinical release. Inadequate loading conditions may lead to lower elastic and plastic interface movements than those occurring post-operatively in vivo. This study investigated the influence of patient activity on the primary stability of cementless prostheses with a special emphasis on active simulation of muscle forces. A loading setup, based on validated musculo-skeletal analyses, was used to generate the hip contact force during walking and stair climbing by transmitting muscle forces through the femur. In addition, a loading configuration which only generated the hip contact force occurring during stair climbing at the prosthesis head was simulated. CLS prostheses were implanted in 18 composite femora and subjected to cyclical loading. The relative micro-movements at the bone-prosthesis interface were determined and appeared to be extremely sensitive to the specific patient activity. Compared to walking, stair climbing generated higher micro-movements, with pronounced axial and rotational components. Stair climbing with the femur loaded by the resultant hip contact force only exhibited a characteristic valgus tilt of the stem with significantly lower interface micro-movements than under active simulation of muscle forces. The analyses suggest that stair climbing induced the highest mechanical instability at the bone-prosthesis interface, a level which may compromise the necessary osseointegration process. Active simulation of muscle forces considerably affects the primary stability of cementless hip endoprostheses. Pre-clinical in vitro tests should therefore simulate stair climbing and include muscle activity in the assessment of initial implant stability, otherwise micro-movements may be underestimated and the primary stability overestimated.

Cementation↗
PubMed1994

In vitro and in vivo validation tests for total artificial heart.

Properly planned in vitro and in vivo studies are mandatory to validate blood pump performance. However, standard procedures for in vitro and in vivo tests of total artificial heart (TAH) performance still do not exist. At Baylor College of Medicine, standard tests procedures for performance validation of the totally implantable TAH have been established. In this paper, these in vitro tests protocols (performance mapping tests, accelerated endurance test, hemolysis test, flow visualization tests, etc.) are described as well as in vivo test procedures (TAH implantation procedure, including surgical technique, postoperative management and tests, etc.). In addition, pathological protocols are presented. In our experience, these procedures are very simple, easy to perform, and inexpensive. These protocols are proposed as standard in vitro and in vivo tests for a TAH.

Animals↗
PubMed2005

17 Beta-estradiol-induced antidepressant-like effect in the forced swim test is absent in estrogen receptor-beta knockout (BERKO) mice.

RATIONALE: The decrease in levels of estrogens (ER) that occurs in menopause has been correlated with depressive disorders, probably due to ER direct and/or indirect effects in the brain, where these hormones act through both genomic (i.e. interaction as transcription factors with nuclear receptors ER-alpha and ER-beta) and non-genomic (i.e. binding with cell-membrane receptors) mechanisms. With respect to mood related disorders the interaction between ER-beta and the serotonin (5-HT) system is highly relevant. 17beta-Estradiol (E2) induces expression of the enzyme implicated in 5-HT synthesis - tryptophan hydroxylase (TPH), and this effect is mediated through ER-beta located in 5-HT cell bodies of the dorsal raphe nucleus (DRN). OBJECTIVE: The present studies tested the hypothesis that E2 induces antidepressant-like effects in female ovariectomized (OVX) mice, and that expression of ER-beta is mandatory for such effects. METHODS: The Forced Swim Test (FST) was used in three experiments to assess (a) dose response effect of E2 in outbred and inbred mouse strains, (b) length of treatment necessary for effect, (c) and role of ER-beta receptors. RESULTS: E2 (100 or 200 microg/kg), as well as the antidepressant desipramine (DMI), significantly reduced total duration of immobility in the FST in mice from different strains. Four consecutive daily doses (200 microg/kg) were required for such effect, which was absent in mice lacking the gene coding for ER-beta (BERKO mice). CONCLUSION: These data suggest that E2-induced antidepressant-like effects in mice are mediated through activation of ER-beta. They offer preliminary support to the hypothesis that specific compounds acting at ER-beta may influence mood in postmenopausal women.

Animals↗
PubMed2000

[Evidence-based laboratory medicine--a new trend in laboratory medicine].

The most important target of "evidence-based laboratory medicine(EBLM)", based on the fundamental concept of evidence-based medicine(EBM) is to improve appropriate, effective utilization of laboratory tests through close communication between clinical laboratories and clinicians. It is mandatory for clinicians to know of analytical uncertainty for better utilization of laboratory tests in clinical practice. Furthermore, the improvement of clinical utilization and interpretation of laboratory tests can be expected by supplying the evidences obtained through systematic reviewing or meta-analysis of laboratory tests. In order to pursue these purposes, closer communication and cooperation between laboratories and clinicians are important to obtain an effective consensus. Clinical laboratory must work together with interested clinician(s) for systematic review of laboratory tests. Construction of the ways of better laboratory-clinician communication should be an important paradigm for EBLM which will be an important factor for new revolution of laboratory medicine in future.

Clinical Laboratory Techniques↗
PubMed1999

Head and neck reconstruction using lateral thigh free flap: flap design.

Eleven lateral thigh free flaps were used in head and neck reconstruction, transferred on the basis of the second perforator as well as the third perforator of the profunda femoris artery. The lateral thigh free flap was useful and reliable in head and neck reconstruction and was versatile in flap design. Due to the wide cutaneous territory of the lateral thigh flap, the skin island could be designed freely in the lateral thigh region. Careful patient selection is mandatory for good results. The pinch test and an understanding of the variety of subcutaneous thicknesses in the lateral thigh region are helpful in designing a skin island of adequate thickness. Other considerations in flap design are discussed.

Adult↗
PubMed2005

Proposed [corrected] Japanese guidelines for the use of infliximab for rheumatoid arthritis.

Differences in ethnic backgrounds as well as in medical and socioeconomic status often affect both the efficacy and adverse effects of medications. Recent data suggest an increased risk of opportunistic infections, especially tuberculosis (TB), among rheumatoid arthritis (RA) patients receiving infliximab, a chimeric monoclonal anti-tumor necrosis factor alpha (TNF-alpha) antibody. In this regard, the annual incidence of TB is approximately five times higher in Japan than in the United States. Furthermore, since Bacillus Calmette-Guérin vaccination is mandatory in childhood when the skin test for purified protein derivative (PPD) is negative, a high incidence of false-positive PPD skin tests is observed among the Japanese population. In addition, the upper limit of methotrexate dosage to be used for RA is lower in Japan. We have therefore established official guidelines for the proper use of infliximab in Japanese RA patients. In this review, an algorithm for the diagnosis and management of TB in RA is presented in an evidenced-based form.

Journal Article↗
PubMed1999

Non-Alcoholic Steatohepatitis (NASH).

Non-alcoholic steatohepatitis (NASH) is an increasingly common cause of persistently abnormal liver tests. Establishing a diagnosis of NASH requires the secure exclusion of alcohol abuse and hepatitis C as an alternate cause of liver injury. The gold standard of diagnosis is liver biopsy. Unfortunately, NASH, although a common entity, is without a satisfactory treatment. Weight reduction, optimum blood glucose control, and elimination of medications implicated in causing the disorder are sensible first steps in treatment. Drug therapy should not be used unless there is histologic evidence of necro-inflammatory injury and/or fibrosis. Ursodeoxycholic acid (UDCA) has been reported to be of benefit in non-controlled trials and anecdotal case reports. Our approach is to use ursodeoxycholic acid in a dose of 15 mg/kg, and to monitor serial liver enzyme tests. Predictable normalization of liver tests often results, but relentless progression of liver injury can occur in the face of consistently normal liver tests. Close follow-up is mandatory after establishing a diagnosis of NASH. Newer, more effective drugs are needed to treat NASH in a controlled trial environment.

Journal Article↗
PubMed2004

[Surgical management for slow-transit constipation].

Less than 10% of patients with slow-transit constipation require surgical management after failure of medical treatment. Preoperative clinical, psychological and colorectal routine investigations (ie colonic transit test, anorectal manometry and defecography) are mandatory in order to highly select the patients. To day, the surgical management of slow-transit constipation consists of subtotal colectomy with ileorectal anastomosis, eventually by laparoscopic approach. Although, surgical management improves slow-transit constipation in two thirds of the patients, small bowel obstruction, abdominal pain and constipation recurrence can occur in 25%, 50%, and 10% of the patients respectively.

Constipation↗
PubMed2026

Two new cases of fragile X syndrome without CGG triplet expansion. Clinical-molecular characterization and review of the literature.

Fragile X syndrome (FXS) is classically caused by CGG repeat expansion in the FMR1 gene leading to gene silencing. We describe two unrelated patients with clinical features consistent with FXS but harbouring distinct molecular mechanisms. The first patient had a pathogenic intronic variant in FMR1, predicted to impair protein function, and no repeat expansion. The second patient carried a complete deletion of the FMR1 gene, resulting in loss of gene expression. Both individuals presented with developmental delay, intellectual disability, and behavioural manifestations typical of FXS. These cases expand the causal heterogeneity underlying a clinically recognizable phenotype. They reinforce the concept that comprehensive molecular testing beyond repeat expansion analysis is mandatory in individuals with a strong clinical suspicion of FXS, in absence of a typical CGG triplet expansion.

Child, Preschool↗
PubMed1978

Monitoring of ovulation induction.

The plasma hormonal patterns of the normal menstrual cycle have been reviewed. A consistent cyclic pattern of plasma hormone levels is observed in LH, FSH, estrogens, and progestins in the menstrual cycle. Other plasma hormones, such as ACTH, growth hormone, TSH, and PRL, as well as androgens and corticosteroids, fluctuate throughout the menstrual cycle without any consistent pattern during the ovulatory cycle. FSH, LH, E2, E1, P, T, and A levels during the induced ovulatory cycle are presneted for comparison. In the gonadotropin-induced ovulatory cycle most hormones behave in a manner similar to that in the normal ovulatory cycle, except for FSH levels, which rise continuously throughout the follicular phase of the cycle. Following ovulation in the gonadotropin-induced cycle, T rises above normal levels. Early in the clomiphene-induced ovulatory cycle, unlike the normal cycle, LH is distinctly elevated. Levels of both LH and FSH in the rest of the cycle simulate those in the normal cycle. However, T and A levels rise from the very beginning of clomiphene therapy and continue to rise throughout the clomiphene-induced ovulatory cycle. Levels of E and P are higher than in the normal ovulatory cycle, but a similar pattern is preserved. Because of the potential dangers of gonadotropin therapy, monitoring by frequent examination and laboratory tests is required. E monitoring is mandatory to evaluate follicular maturation, to time hCG administration, and to minimize hyperstimulation. Cervical mucus is an unreliable parameter for monitoring gonadotropin therapy alone. In addition to cervical mucus, plasma or urinary E should be monitored regularly. Clomiphene therapy is less dangerous than gonadotropin therapy. Because of its lesser risk, monitoring is rarely performed during clomiphene use. An active monitoring approach has been described. While this approach may not necessarily improve the outcome of clomiphene therapy, it may hasten the process of selecting the appropriate dose. Although other ovulation-inducing agents are available, their use is rarely associated with serious medical complications, and monitoring would seem unnecessary.

Cervix Mucus↗
PubMed2003

Operational feasibility of routine bacterial monitoring of platelets.

Bacterial contamination of platelets poses the greatest risk of mortality and morbidity to platelet transfusion recipients. Some European countries have introduced routine bacterial monitoring of platelets to reduce the risk of transmission of bacteria. A pilot study was carried out at the Northern Ireland Blood Transfusion Service, using the BacT/ALERT automated culture system, to assess the operational feasibility of routine bacterial monitoring of platelets. About 4885 platelet concentrates (PCs) were tested in a 1-year period. Of the 28 (0.57%) initial reactive cultures, 13 (46%) were reproducible on repeat culturing. Of these, 10 were detected within 24 h of incubation either in aerobic or both aerobic and anaerobic culture bottles. A sample of time-expired units (423) that had initial negative culture results remained negative when retested on day 8. About 213 time-expired units were subjected to routine quality assessment and more than 85% were found to conform to quality standards specified in the UKBTS guidelines for platelet count (> or =240 x 10(9) per adult dose PC) and pH (6.4-7.4). There was a reduction in the platelet count because of the volume removed (15 mL) for sampling. Routine bacterial testing with day 2 sampling and a negative culture result after 24 h as a mandatory release criterion would improve product safety. Implementation of 100% testing would be operationally feasible but may require extension of the shelf life if unacceptable wastage is to be avoided.

Aerobiosis↗
PubMed1990

Prevention of infections in neutropenic patients with pefloxacin.

Bacterial infections remain a major source of morbidity and mortality in neutropenic patients. Therefore, optimal methods of prevention seem mandatory and various means have been tested, in particular specific modalities such as chemoprophylaxis, which remains controversial. Overall, non-absorbable antibiotics have been disappointing and are less commonly used because of the poor compliance of most patients. Co-trimoxazole has been shown to be effective under certain circumstances but the emergence of resistance, and the risk of prolonging the duration of neutropenia are major drawbacks despite the advantages of co-trimoxazole being well tolerated and effective in preventing Pneumocystis carinii infections. Recently, fluoroquinolones have been developed and numerous studies of prophylaxis have been performed with norfloxacin, enoxacin, ciprofloxacin, and other agents from this class, including pefloxacin. These data show a significant reduction of bacteraemia caused by Gram-negative bacilli in neutropenic patients but a high incidence of infection caused by Gram-positive cocci, mainly streptococci. The sources of those infections are many including mucositis due to chemotherapy and/or total body irradiation, as well as changes in the patient's flora due to more effective cover against Gram-negative bacilli. Future studies should further investigate regimens to achieve optimal prophylaxis for infections caused by either Gram-negative or Gram-positive pathogens during neutropenia.

Administration, Oral↗
PubMed1989

Current diagnosis and management of Zollinger-Ellison syndrome.

The treatment of patients with Zollinger-Ellison syndrome (ZES) has undergone dramatic evolution during the past decade. Although initially regarded as an incurable tumor, resection of gastrinoma for potential cure has been reported in 30% to 40% of selected patients in recent series. Conversely, although definitive control of acid hypersecretion is achieved by total gastrectomy, histamine (H2)-receptor antagonists and the newly introduced agents omeprazole and somatostatin analogues allow effective medical therapy of gastric acid overproduction. Confirmation of the diagnosis is best achieved with the I.V. secretin stimulation test, and tumor localization techniques are mandatory to identify candidates for operative tumor resection. Intraoperative sonography and careful exploration are required for tumor removal; successful tumor resection is associated with prolonged survival. The majority of patients (60%) are still found to have malignant disease at the time of diagnosis, but 10-year overall survival commonly exceeds 40%. The presence of multiple endocrine neoplasia type I (MEN-I) is seen in 10% to 25% of patients; correction of hypercalcemia alone may have therapeutic benefit in some ZES patients, and while gastrinoma resection is rarely possible, MEN-I patients demonstrate prolonged survival. The choice of medical rather than surgical therapy for acid hypersecretion depends on the suitability of each patient for careful and repeated endoscopic and chemical studies, versus the likelihood of a successful postoperative outcome. Socioeconomic, geographic, and related medical factors in each case may dictate the form of long-term antisecretory therapy. Exploration for possible tumor resection is indicated for virtually all patients who have no documented metastatic disease.

Gastric Acid↗
PubMed2006

Kidney transplantation from anti-HBc+ donors: results from a retrospective Italian study.

BACKGROUND: The risk of transmitting a hepatitis B virus (HBV) infection from donor kidneys with a past HBV serological profile may be negligible. Data on HBV transmission to kidney transplant recipients from donor organs that were anti-HBc/HBsAg in Italy has not been previously reported. Anti-HBc testing in cadaver organ donors has been mandatory in Italy since 2002, when anti-HBc determinations were included in the National Guidelines for donor evaluation. Therefore, prior to that date kidney recipients from anti-HBc/HBsAg donors can be identified retrospectively where stored serum is available for testing. METHODS: The prevalence of anti-HBc Italian organ donors, the incidence of HBV transmission according to the recipients' HBV status (vaccinated, recovered, or naive), and the clinical impact (5-year graft and patient survival rates) in the North Italy Transplant program was evaluated by retrospectively screening for anti-HBc antibodies in the sera of cadaver kidney donors used in transplants from 1997 to 1999. RESULTS: Two hundred and ten donors were found to have been anti-HBc. At the time of the study, no active infection was observed in any of the 344 HBsAg recipients, but 4/140 (2.86%) of the vaccinated recipients were found to have been anti-HBc/HBsAg. None of these patients, however, had any biochemical or clinical history of HBV infection. Patient and graft survival rates of anti-HBc or anti-HBc kidney recipients did not differ statistically. CONCLUSION: Kidney grafts from anti-HBc donors should be considered in all recipients because the benefit obtained from the transplantation out weighs the negligible risk of HBV transmission.

Adolescent↗
PubMed2005

Safety of the blood supply in Latin America.

Appropriate selection of donors, use of sensitive screening tests, and the application of a mandatory quality assurance system are essential to maintain the safety of the blood supply. Laws, decrees, norms, and/or regulations covering most of these aspects of blood transfusion exist in 16 of the 17 countries in Latin America that are the subject of this review. In 17 countries, there is an information system that, although still incomplete (there are no official reports on adverse events and incidents), allows us to establish progress made on the status of the blood supply since 1993. Most advances originated in increased screening coverage for infectious diseases and better quality assurance. However, in 2001 to 2002, tainted blood may have caused infections in 12 of the 17 countries; no country reached the number of donors considered adequate, i.e., 5% of the population, to avoid blood shortages, or decreased significantly the number of blood banks, although larger blood banks are more efficient and take advantage of economies of scale. In those years, paid donors still existed in four countries and replacement donors made up >75% of the blood donors in another eight countries. In addition, countries did not report the number of voluntary donors who were repeat donors, i.e., the healthiest category. In spite of progress made, more improvements are needed.

Blood Banks↗