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At least 1,423 records · Page 79Linked to original sources
PubMed1996

[Erythrocytes modulate the anti-aggregation effect of aspirin and dipyridamole. Study under static conditions and in a flow system].

PURPOSE: The modulating role played by red cells on platelet function is well known, yet its mechanism of action in the presence of antiaggregating agents is not clearly defined. We tried to assess the influence of aspirin (ASA) or dipyridamole (DIP) treated red cells on platelet aggregation in plasma, with the samples in static conditions and under flow in a perfusion system. MATERIAL AND METHODS: Platelet-rich plasma (PRP) was adjusted to 4 x 10(9)/L. Red cells were washed with a 0.9% sodium chloride and 5mM glucose solution, then resuspended in PRP until a 40% haematocrit was attained. The drugs were added separately or together and the mixture was incubated for 10 minutes at 37 degrees C. Three series of tests were carried out: a) with reconstituted blood; b) with red cells alone; c) with the red cells washed in a 10-fold volume so as to eliminate all the drugs. The samples were divided in two parts: one was let to rest and the other was circulated through a perfusion system with a peristaltic pump. Simultaneous tests with untreated red cells and PRP were run as control in each session. A multichannel aggregameter was used to assess platelet aggregation according to Born's turbidimetric method. Variance analysis (ANOVA) or Student's t test were used for the statistical evaluation. RESULTS: Platelets attained from control samples under flow conditions showed partial inhibition of the maximal aggregation (58.02 +/- 9.92%). The inhibitory power of ASA was higher than that of DIP in all cases. Aggregation was totally inhibited by ASA from the beginning in treated whole blood, but the inhibitory effect appeared later when working with red cells alone, suggesting that red cells must retain part of the drug, which cannot exert its effect until it has been released after several minutes. The inhibition of platelet aggregation when working with washed treated red cells was more effective under flow conditions, chiefly with combined treatment with ASA+DIP. CONCLUSION: These studies stress the importance of flow conditions in the red cells-platelets interaction and in the regulation of the therapeutic agents used to modify platelet function.

Adenosine Diphosphate↗
PubMed1995

Determination of the mycotoxin deoxynivalenol in beer by commercial elisa tests and estimation of the exposure dose from beer for the population in the Czech Republic.

About 150 litres of beer per person is consumed yearly in the Czech Republic. It is one of the highest consumptions in international comparison. Thus, beer can be a significant source of exposure of man to some contaminants. Among natural contaminants of beer belongs also deoxynivalenol (DON). 77 samples of beer being sold in the shopping network in the Czech Republic were examined by means of commercial ELISA sets for determination of deoxynivalenol (RIDASCREEN DON) at the end of the year 1994 and at the beginning of the year 1995. 23% of the beer samples were under a detection limit of the ELISA test (6 mu g of DON/litre). The other samples contained DON in amount of 7-70 mu g/litre. The median came up to 12.6 mu g of DON/litre. By variance analysis, statistically conclusive (P = 0.01) lower concentrations of DON were found in 11-12% light beer in comparison with 10% light beer and other beer. On the basis of results, the average exposure of beer consumers in the Czech Republic was estimated at a level of 0.146 mu g of DON/kg of b.w./day. The calculation was based on a geometric mean of DON concentrations and on an average corrected consumption of individual kinds of beer. This exposure represents about 11.7% of the proposed TDI (1.25 mu g of DON/kg of b.w./day, determined from the view of the immunosuppression effect of DON). The detected exposure to DON from beer does not represent a serious health risk for a consumer in the Czech Republic. In calculations of the total exposure dose of DON for man from cereal sources is it, however, appropriate to include also beer.

Beer↗
PubMed1996

Experimental study of ureteral free grafts. IV. Histomorphometric study.

OBJECTIVES: The ureteral changes that occur when rat ureter is used as an autologous free graft were evaluated using histomorphometrical methods. METHODS: The normal values were determined in ureters from normal rats (NU group) and compared with those of a control group undergoing ureterolysis, as well as with two groups in which the ureter was used as an autologous free graft (in one of these groups the ureter was integrated into the urinary tract by anastomosis, whereas in the other group the ureter was not integrated). The main histomorphometrical parameters were thickness or length and surface or area. Thickness measurements were made using a micrometer. For area determinations, paper prints of light micrographs from each segment were measured using a Koizumi KP-90 digital planimeter. A non-parametric variance analysis (Kruskal-Wallis test) was used to compare the results. These results were compared with those of the Wilcoxon test. The results are expressed as different levels of alpha, (0.05, 0.01 and 0.001). RESULTS: When p < 0.01, there were practically no statistically different variables between NU and AU. Comparison of NU to SC and SC to AU showed only seven statistically different variables. Muscle layer thickness was different only when the comparison was made with the RUb group. When p < 0.001, RUa and RUb were not different, nor were NU and AU or SC and NU. Differences were observed between RUb and all the other groups. RUa was different from NU, SC, or AU in 3, 4 or 5 of the 18 variables analyzed. Most of the surface variables were significantly different in RUb in comparison to the other groups. There were also differences between RUa and NU, as well as between NU and SC, in the area of the lamina propria. CONCLUSIONS: Initial ischemia and denervation are not the cause of the observed changes, as these changes are different in both types of free graft. Histomorphometrical studies constitute a useful method in the assessment of differences between ureteral free graft groups. None of the histomorphometric findings is inconsistent with the use of the rat ureter as a free graft.

Animals↗
PubMed1977

Strength of knots in surgery in relation to type of knot, type of suture material and dimension of suture thread.

The 12 commonest types of suture material in dimensions 7/0, 5/0, 000, 0 and 2 (USP, 1965) were tested in 16 types of knot with regard to tensile strength of knot using the loop method. The results are given in tabular form as the strength of the loop for alltypes of knot tested, and as the mean knoe efficiency for certain groups of knots. The knot efficiencies are compared with regard to the different types of knot, the various types of suture material, and the different dimensions of thread using statistical methods including variance analysis. The strength of unknotted thread within a given dimension showed considerable variations for different suture materials: a given material could be more than twice as strong as the weakest material of the same dimension. With very few exceptions, the knot was the weakest point in a suture loop subjected to disrupting forces. The knot efficiency depended very largely on the type of knot and the strength of different types of knots varied from 3% to 99% of the corresponding unknotted thread. With the exception of two types of steel thread and both types of catgut, the efficiency was low for most simple crossed knots and for many simple parallel knots, and here considerable variations were recorded. Knot efficiency was clearly highest and showed least fluctuation with complex and particularly complex knots, and was closely similar for these. The dependency of knot efficiency on the type of suture material (mean for 16 knots) varied from 44% (polyethylene) to 90% (multifil steel). The variations in dependency on material were greatest with simple knots and with certain materials, and decreased with increasing knot complexity. The dependency of knot efficiency on the dimension of any particular suture material was apparently of much less importance than the type of knot and type of material.

Polymers↗
PubMed1996

[Is the recent decrease in cholesterolemia in the Czech Republic convincing evidence?].

BACKGROUND: The objective of the study was to evaluate the 8-year trend of serum cholesterol levels in six districts of the Czech Republic, to assess whether the reduction of mean values of total cholesterol recorded during the period between 1985 and 1992 was convincing and to discuss possible causes and consequences of this development. METHODS AND RESULTS: Three cross-sectional surveys of risk factors were implemented in independent random 1% samples of the population aged 25-64 years. In 1985 1256 men (respondence rate 81.5%) and 1317 women (85%) were examined, In 1988 1357 men (85.2%) and 1412 women (88.4%), in 1992 1142 men (73.2%) and 1211 women (76.7%). A detailed check of the deviations in estimations during different time intervals from reference values provided evidence that the analytical method did not have an impact on the revealed changes. In men the mean total cholesterol level was 6.21 (95% confidence limit 6.14-6.28 mmol/l in 1985; 6.29 (6.23-6.35) mmol/l in 1988; 5.99 (5.91-6.06) mmol/l in 1992. In women the mean value of the total cholesterol level was 6.19 (6.12-6.25) mmol/l in 1985; 6.23 (6.17-6.30) mmol/l in 1988; 5.95 (5.88-6.02) mmol/l in 1992. According to variance analysis (ANOVA) the serum cholesterol in 1992 was lower by 0.22 mmol/l (p < 0.0001) than in 1985 and by 0.28 mmol/l (p < 0.0001) lower than in 1988. The drop of cholesterol between 1988-1992 may have been caused by dietary changes recorded in the population. According to nationwide data after 1990 there was a marked drop of the consumption of meat and meat products, milk and dairy products and animal fats, while the consumption of vegetable fats increased. Despite these dietary improvements, in six districts in 1992 fats accounted for 37% of the energy intake, the P/S ratio was only 0.41 in men and 0.46 in women. In these districts in 1992 and 1993 a decline of the standardized mortality rate from IHD in men was recorded. CONCLUSIONS: During an eight-year period the mean serum cholesterol level of men and women decreased significantly in six districts of the Czech Republic. This change was probably associated with a restricted intake of foods which have an impact on the serum cholesterol level.

Adult↗
PubMed1996

[Laser-Doppler flowmetry and arterial diseases of the limbs. Correlations with measurement of transcutaneous oxygen pressure].

The place of laser-Doppler flowmetry is not well established among the other techniques of evaluation of local microcirculatory blood flow. We conducted a study in 15 controls (mean age 49.5 yrs, 30 limbs) and 37 patients with peripheral arterial occlusive disease (PAOD) (mean age 59.1 yrs, 67 limbs, 50 mild ischemia and 17 severe ischemia) and assessed the local blood flow with laser-Doppler (Perimed PF3) and transcutaneous oximetry (Hellige Oxymonitor); both probes being heated at 44 degrees C. Transcutaneous oxygen tension (TcpO2 mmHg) and laser-Doppler fluxes (LDF in perfusion units PU) were measured at the foot dorsum in resting horizontal supine position and leg dependency (30 controls, 67 PAOD) and during post-ischemic reactive hyperemia (36 PAOD). The results (mean +/- sd) were compared within each group (controls, mild ischemia, severe ischemia) by means of a paired t-test, between the different groups by a variance analysis and correlations by a Spearman test. LDF decreased from supine position to leg dependency in the control group (24.1 +/- 22.2 PU horizontal vs 19.0 +/- 26.2 dependent, N = 30, p < .05) but not in the PAOD group (mild ischemia respectively 46.0 +/- 41 vs 42.9 +/- 35 PU, N = 50; severe ischemia 41.3 +/- 27 vs 48.6 +/- 42 PU, N = 17). LDF was significantly higher at rest: mild ischemia 46 +/- 41 (N = 50), severe ischemia 41.3 +/- 27 (N = 17) vs controls 24.1 +/- 22 PU (p < .005). LDF increased during hyperemia in controls (peak flux 42.4 +/- 28.9 PU, p < .00001) and in patients with mild ischemia (46.0 +/- 42 vs 32.5 +/- 39 PU at rest, N = 29, p < .005) but not in severe ischemia (29.4 +/- 18 vs 28.7 +/- 33 PU at rest, N = 7). TcpO2 at rest (65.9 +/- 14 mmHg in 30 controls) decreased significantly in mild ischemia (55.6 +/- 16 mmHg, N = 48) and severe ischemia (32.1 +/- 26 mmHg, N = 17, p < .005). On leg dependency, TcpO2 increased in mild ischemia (70.2 +/- 13 leg dependent vs 52.6 +/- 12 mmHg horizontal, N = 21, p < .001) and severe ischemia (respectively 35.6 +/- 24 and 26.1 +/- 15 mmHg, N = 10, p < .01). No correlations were found between LDF parameters and TcpO2 except in patients with severe ischemia (LDF horizontal and dependent with TcpO2 dependent).

Adolescent↗
PubMed1997

Managing patient care in a case management model: elements for success.

The challenge in the current health care environment is providing high-quality patient care at low cost. This shift to managed care has made the delivery of patient care more complex. Case management models continue to evolve to meet the demands for cost-effective care with measurable quality outcomes. Essential management skills for first-line managers and case managers are discussed. Education, training, and performance requirements for a case management model are presented. The development and implementation of clinical protocols as a tool to guide the delivery of patient care across the continuum and the requirement for variance analysis are included.

Case Management↗
PubMedDate not supplied

[Composition of the cerebrospinal fluid in the premature newborn infant].

The composition of the spinal fluid was determined in 54 healthy premature infants in the first week of life. The infants were divided into three groups according to their gestational age; the results in each group, submitted to variance analysis, indicated similar values. The results in these premature infants were then compared with those in 79 normal full-term infants. The spinal fluid of the pre-term children showed higher bilirubin concentrations, more hemoglobin and higher levels of protein, indicating a greater permeability and immaturity of the blood-brain barrier. There were more erythrocytes in the premature infants, while the number of leukocytes and their differential count were similar in both groups; the only difference was the number of eosinophils, which were absent in the premature infants.

Anthropometry↗
PubMedDate not supplied

Critical pathways: the next generation of outcomes tracking.

In summary, for each critical path you should have financial, quality, variance analysis, health-related quality of life and patient satisfaction outcome measures that should be reported as a package in a frequency established by the organization. These measures must complement the overall critical path program goals and objectives. The data must also be provided to the critical path teams to analyze and define where there may be opportunities for improvement. This puts the data analysis and responsibility of care processes into the hands of the clinicians where it belongs and not with administration. Administration provides the vehicles for the data; the clinicians provide the analysis.

Case Management↗
PubMedDate not supplied

The ABCs of case management. A review of the basics.

As managed care continues to emerge as a dominant structure for delivering and reimbursing health care, nursing is responding and assisting in reshaping the health care system. Nursing case management as a new delivery of care includes providing and coordinating care across the continuum. The continuum includes prevention, wellness, acute, rehabilitation, long term, and hospice care. Various definitions of case management exist and are dependent on the discipline that employs them, the setting in which they are implemented, and the personnel and staff mix used in their implementation. Patient identification, assessment, planning, implementing and coordinating and evaluating the delivery of service and patient outcomes are components common to all case management models. The nurse case manager should be minimally educationally prepared at the baccalaureate level. She/he should also have expert clinical skills, knowledge of the health care system, health care finances, and legal issues and be an effective communicator. Within the case management model the case manager will use various tools to achieve clinical, quality, and economic outcomes. Some of these tools include practice guidelines, critical paths, variance analysis, protocols/algorithms, risk assessment, and outcome measurement tools.

Case Management↗
PubMedDate not supplied

Value of 99m-Tc MIBI and 99m-Tc(V) DMSA scintigraphy in evaluation of breast mass lesions.

Among several investigative methods currently undergoing evaluation for the differentiation of biological features of breast mass lesions, mammoscintigraphy with different radiopharmaceuticals appears promising. This study evaluated the efficacy of 99m-Tc MIBI and 99m-Tc(V) DMSA mammoscintigraphy in the detection of malignant focal breast lesions. Mammography, ultrasonography, 99m-Tc MIBI and 99m-Tc(V) DMSA mammoscintigraphy were performed in 51 women with palpable breast mass lesions. Following surgical removal of the abnormalities, histological examination revealed 40 malignant and 11 benign breast mass lesions. In mammoscintigraphy, early (5 minute p.i. of MIBI, 2 hours p.i. of DMSA) and late (2 hours p.i. of MIBI and 5 hours p.i. of DMSA) planar images of the breast and the axillary regions were evaluated visually and quantitatively. The efficacy of the methods was assessed via ROC curves and variance analysis. The visual scores and the quantitative T/NT values with MIBI demonstrated a significant difference between malignant and benign breast mass lesions. A significant difference was also found as concerns the grade of malignancy from the MIBI accumulation. The late MIBI images seemed optimal. The DMSA values indicated no relationship with the breast lesion malignancy. In the detection of metastatic lymph node involvement the sensitivity and specificity with mammography and ultrasonography were 57% and 85%, with MIBI 53% and 81%, and with DMSA 53% and 95%, respectively. It is concluded that MIBI (2 hours p.i.) mammoscintigraphy is a useful and simple method for differentiation of malignant breast abnormalities from benign lesions and for determination of the grade of malignancy. DMSA mammoscintigraphy appears superior to MIBI only in the detection of axillary lymph node metastases.

Adult↗
PubMedDate not supplied

[Impact of the cellular concentration of milk in goats on its production and its composition].

Using records from the Milk Registration Organization for 254 dairy-goat farms located in western France, the economical impact of mammary gland inflammation on milk yield and composition was measured after 200 days of lactation. This assessment was performed in groups of goats belonging to the same farm and the same breed and having the same parity. Three levels of somatic cell count (SCC) were defined in order to discriminate goats on the basis of the intensity of inflammatory reaction of their udder: < 750,000 cells/mL (CCI1), between 750,000 and 1,750,000 cells/mL (CCI2), > 1,750,000 cells/mL (CCI3). From 404 groups characterized by an average number of 12,4 CCI1 goats and 14,2 (CCI2 + CCI3) goats, the average milk yield of the goats whose SCC was superior to 750,000 cells/mL was inferior to that of the CCI1 goats in 79.2% of the groups. In a sub-sample of 366 groups, the average loss of milk production for the CCI2 goats compared to the CCI1 ones was 55 kg. In an other sub-sample of 41 groups, the milk production average loss of the CCI3 goats reached 132 kg. For all of the 404 groups, (CCI2 + CCI3) goats had a lower fat content of 0.3 g/kg and in contrast a higher protein content of 0.6 g/kg. A second evaluation using a multidimensional variance analysis model in a population of 20796 goats showed the same results.

Animals↗
PubMed1995

Nonspecific immunity in diabetes: hyperglycemia decreases phagocytic activity of leukocytes in diabetic patients.

Phagocytic activity of leukocytes in blood was examined in 70 patients with diabetes mellitus. 40 of them had insulin-dependent diabetes--(IDDM) or type I, while there were 30 patients with noninsulin-dependent diabetes (NIDDM) or type II. Phagocytic activity of leukocytes was determined by quantitative method of ingestion, on the principle of quantifying phagocytized fungi (Saccharomyces cerevisiae) and free phagocytes (nonphagocytizing leukocytes) by means of a phase-contrast microscope. The data have been statistically processed by the Student t-test and variance analysis test (Duncan test). The index of phagocytosis amounted to 3.2 +/- 0.77 in diabetic patients, while it was 3.47 +/- 0.29 in healthy examinees from the control group, thus yielding a statistically significant difference, p < 0.05. Out of all examined parameters (blood glucose, glycosylized hemoglobin, mean glucose value) phagocytic activity of leukocytes showed a statistically significant correlation with mean value of glucose in blood. Patients with mean glucose value higher than 12 mmol/l showed a significantly lower index of phagocytosis (2.9 +/- 0.84) than patients whose mean glucose value was lower than 12 mmol/l (3.5 +/- 0.59), p < 0.05. Neither age and sex of the patients nor chronic complications caused by diabetes affected the phagocytic activity of leukocytes in diabetic patients. There was no significant difference in the phagocytic activity of leukocytes between patients with IDDM and those with NIDDM.

Blood Glucose↗
PubMedDate not supplied

Determining the cost of care through clinical pathways.

Using the steps from the first approach, the costing of clinical pathways is useful to both the clinical and administrative teams. With knowledge of pathway cost, clinicians can plan cost-effective changes in the pathway or consider cost factors when deliberating on different approaches to care. Using the patient classification system to unbundle the nursing component and using the number of nursing hours per day of care provides an opportunity to describe the intensity of the pathway in its entirety, and by each day of care. One is provided with an opportunity to learn from the cost variances by reviewing the standardized costs for the pathway, and the actual cost of care of patients on the pathway provides an opportunity to learn from the cost variances. This learning, coupled with the clinical variance analysis, can suggest new opportunities for improving care and potential cost savings. Lastly, the cost associated with a pathway is useful knowledge in negotiating managed care contracts.$

Acute Disease↗
PubMed1997

Quantitative genetic analysis of arterial oxygen saturation in Tibetan highlanders.

This study was designed to test the hypothesis that genetic differences inferred from biological kinship relationships among individuals contribute to individual variation in percentage of oxygen saturation of arterial hemoglobin (SaO2) in a high-altitude native population. SaO2 data were obtained by pulse oximetry from 354 nonpregnant, healthy Tibetan residents of Pen-Dri, two rural agropastoral villages at 3800-4065 m altitude in Lhasa Municipal District, Tibet Autonomous Region, China. Statistical analyses of these data from 46 pedigrees tested the hypothesis of a significant genetic contribution to SaO2 variation. The average SaO2 was 89.4 +/- 0.2%, with a range of 76-97%. Additive genetic effects account for 44% of the interindividual phenotypic variation in SaO2 in the sample. Complex segregation analysis and variance decomposition analysis determined that 21% of the total phenotypic variation could be explained by a major gene influencing SaO2. Homozygotes for the low-SaO2 allele have a mean SaO2 of 83.6%, whereas heterozygotes and homozygotes for the high-SaO2 allele have means of 87.6% and 88.3%, respectively. This confirms findings in another Tibetan sample and extends the known geographic distribution of the major gene. These results suggest the hypothesis that individuals with the dominant allele for higher SaO2 have a selective advantage in their high-altitude hypoxic environment.

Adaptation, Physiological↗
PubMed1997

[Glycemic thresholds in spontaneous abortion during the first trimester in pregnant women with insulin dependent diabetes].

BACKGROUND AND AIM: To evaluate the hypothesis that insulin-dependent diabetic (IDDM) pregnant women have a threshold of glycemic control during the first trimester of pregnancy for an increased risk of spontaneous abortion. MATERIALS AND METHODS: Seventy IDDM pregnant women were enrolled before the 9th week of gestation and monitored throughout pregnancy. Fifteen pregnancies (21.4%) led to spontaneous abortion within the first trimester (study group) and 55 (76%) continued until term (control group). In order to evaluate the differences between the study group and the control group variance analysis and Student's t-test were used for constant variables and chi 2 and Fisher's exact test for discrete variables; p < 0.05 was considered statistically significance. RESULTS: Mean levels of glycosylated hemoglobin (HbA1c) and fructosamine at the initial prenatal visit were significantly higher in the study group (p < 0.03) compared to the control group. The threshold for an increased risk of spontaneous abortion in the first trimester was found to be initial concentrations > 8% for HbA1c and > 300 mmol/l for fructosamine. CONCLUSIONS: Pregnant women suffering from IDDM with initial HbA1c levels higher than 8% and fructosamine > 3 mmol/l have an increased risk of spontaneous abortion in the first trimester of pregnancy. Below this threshold the risk of spontaneous abortion during the first trimester of pregnancy is similar to that for non-diabetic pregnant women.

Abortion, Spontaneous↗
PubMed1998

Participation in a pharmacological hypolipidaemic trial does not alter participants' dietary habits.

OBJECTIVE: The aim of this study was to observe whether the act of participation in a well-controlled clinical trial can, co-incidentally, modify the dyslipaemic patient's adherence to his/her diet. DESIGN AND SUBJECT: Food diaries of 55 men and 51 women (aged 46.4 +/- 10.6 and 55.8 +/- 12.1 years respectively) were analyzed at the beginning and the end of the double-blind stage of treatment (12 weeks). STATISTICS: Variance analysis and multi-variant analysis with repeated data by SPSS/PC statistical package. RESULTS: In neither sex were there any statistically significant differences between the start and end of the study with respect to the intake of energy, proteins, total lipids, carbohydrates, saturated fatty acids, polyunsaturated fatty acids, cholesterol, fibre and alcohol. CONCLUSIONS: Although in individual cases some changes in dietary awareness can occur, on a larger scale, the hypocholesterolaemic intervention trial induced no significant overall changes in the participants dietary/lifestyle patterns and, as such, augurs well for other such trials in which the effect of the therapy may sometimes be confounded by changes in the patients' life-style patterns coincidental to the act of participation in the trial.

Adult↗
PubMed1998

[Results of transrectal echography in the study of female urinary stress incontinence].

The development of echographic transducers allows now to study Female Urinary Exertional Incontinence (FUEI) using different approaches (vaginal, perineal and transrectal). A total of 122 transrectal echographies were performed. Based on the clinical symptoms: 14 patients are continent, 15 report micturition urgency, 11 micturition urgency plus FUEI, and 82 FUEI. All parameters Xrest, Yrest, AUVPrest, Xexertion, Yexertion, AUVPexertion, X', Y', AUVP' were measured. Three groups were defined: Group I, normal ultrasound diagnosis; Group II, vesical neck hypermobility; Group III, FUEI using Kolmogorov-Smirnov's test, the data fits a standard distribution curve and the results were analyzed through a variance analysis and Newman-Keul's test. During Valsalva's manoeuvre, patients with FUEI show greater caudal mobility of the vesical neck which becomes more significant as the degree of FUEI increases. Dorsal mobility is also greater in patients with FUEI although this parameter is of no use to quantify the degree of FUEI. Posterior urethro-vesical angle variability only discriminates patients with no FUEI from those with a higher degree of FUEI.

Female↗