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139 records · Page 8Linked to original sources
PubMed1997

Complexity of the thoracic spine pedicle anatomy.

Transpedicular screw fixation provides rigid stabilization of the thoracolumbar spine. For accurate insertion of screws into the pedicles and to avoid pedicle cortex perforations, more precise knowledge of the anatomy of the pedicles is necessary. This study was designed to visualize graphically the surface anatomy and internal architecture of the pedicles of the thoracic spine. Fifteen vertebrae distributed equally among the upper, middle, and lower thoracic regions were used. For the purpose of mapping surface anatomy, each pedicle was cleaned, spray-painted white, and marked with more than 100 fine points. Using an optoelectronic digitizer, three-dimensional coordinates of the marked points and three additional points, representing a coordinate system, were digitized. A solid modeling computer program was used to create three-dimensional surface images of the pedicle. To obtain cross-sectional information, each pedicle was sectioned with a thin diamond-blade saw to obtain four slices, 1 mm in thickness and 0.5 mm apart. The pedicle slices were X-rayed and projected onto a digitizer. The internal and external contours were digitized and converted into graphs by a computer. The pedicles exhibited significant variability in their shape and orientation, not only from region to region within the thoracic spine, but also within the same region and even within the same pedicle. These variations are extremely significant in light of current techniques utilized in transpedicular screw fixation in the thoracic spine. Information documenting the three-dimensional complexity of pedicle anatomy should be valuable for surgeons and investigators interested in spinal instrumentation.

Adult↗
PubMed1996

Differences in factors of health orientation of older women.

The purpose of this exploratory study was to examine the factor structure of health orientation. A secondary purpose was to determine differences in the stability and lability of health orientation. The sample consisted of four women in their sixties and four women in their eighties. A replicated, single-subject design was used to assess short-term intraindividual change in health orientation. Participants completed the Health Orientation Scale questionnaire for 100 days, and P-technique factor analysis was used to determine the factor structure of health orientation. These health orientation factors were graphed over time to assess stability and change. Results indicate that health orientation is more complex for participants in their eighties than for those in their sixties; this may represent age-appropriate development. Health orientation factors were found to be more labile or statelike for women in their eighties. These findings may help health care providers understand differences in interest or adherence to health-seeking behavior in the elderly and improve age-appropriate health care for this population.

Age Factors↗
PubMed1994

Cyclosporine challenge in the decision of combined kidney-pancreas versus solitary pancreas transplantation.

Combined kidney-pancreas transplantation has become the treatment of choice for many patients with end-stage diabetic nephropathy. Pancreas transplantation (PTx) alone is an option for type I diabetic patients without end-stage diabetic nephropathy. Knowledge of factors contributing to or predicting the rate of renal deterioration (including the effect of CsA on the patient's renal function before transplantation) is necessary to determine candidacy for either kidney-pancreas transplantation or PTx alone. To address this issue, we selected 12 pre-uremic patients with creatinine clearances (CrCl) above 40 ml/min and less than 100 ml/min to participate in a 6-week oral CsA challenge test. Serum chemistries, including serum creatinine (SCr) and CsA level, were measured weekly. Urinary protein and CrCl were measured at 0, 2, 4, and 6 weeks. Glomerular filtration rate (GFR) (by 125I-sodium iothalamate clearance) was measured at 0, 3, and 6 weeks. All patients initially received oral CsA at 10 mg/kg/day in 2 divided doses. Doses were adjusted to maintain a 12-hr trough level of 500-1000 ng/ml using a whole blood polyclonal TDX assay. Data are presented as mean +/- SEM and as box-plot graphs. One patient was a CsA challenge test failure because SCr exceeded 3.0 mg/dl despite a reduction in CsA dose and level. Therefore, this patient was not a candidate for PTx alone and was excluded from further analysis. Among the 11 nonfailures, the mean CsA level at 6 weeks was 640 +/- 76 ng/ml. SCr increased from 1.2 +/- 0.1 mg/dl to 1.6 +/- 0.1 mg/dl (33% increase) (P = 0.0001). CrCl decreased from 82 +/- 9 ml/min to 63 +/- 8 ml/min (24% decrease) (P = 0.03). GFR decreased from 95 +/- 15 ml/min to 70 +/- 10 ml/min (26% decrease) (P = 0.009). CrCl and GFR did not differ from one another at 0 and 6 weeks (r = 0.77 and 0.98; P = 0.3 and 0.7, respectively). Urinary protein decreased from 1.0 +/- 0.3 g/day to 0.7 +/- 0.3 g/day at both 4 and 6 weeks (P = 0.03 and 0.06, respectively). Three of the 11 patients have not yet received transplants. Eight patients subsequently received PTx alone and were followed prospectively. Two allografts were lost early to rejection. Six were followed from 5 to 19 months after PTx alone. Serum creatinine and CrCL measurements during the CsA challenge test predicted post-PTx levels: SCr 1.6 +/- 0.1 vs. 1.7 +/- 0.3 mg/dl, P = 0.48, and CrCl 68 +/- 10 vs. 53 +/- 3 ml/min, P = 0.17, respectively.

Adult↗
PubMed1994

Expert system support using Bayesian belief networks in the diagnosis of fine needle aspiration biopsy specimens of the breast.

AIM: To develop an expert system model for the diagnosis of fine needle aspiration cytology (FNAC) of the breast. METHODS: Knowledge and uncertainty were represented in the form of a Bayesian belief network which permitted the combination of diagnostic evidence in a cumulative manner and provided a final probability for the possible diagnostic outcomes. The network comprised 10 cytological features (evidence nodes), each independently linked to the diagnosis (decision node) by a conditional probability matrix. The system was designed to be interactive in that the cytopathologist entered evidence into the network in the form of likelihood ratios for the outcomes at each evidence node. RESULTS: The efficiency of the network was tested on a series of 40 breast FNAC specimens. The highest diagnostic probability provided by the network agreed with the cytopathologists' diagnosis in 100% of cases for the assessment of discrete, benign, and malignant aspirates. Atypical probably benign cases were given probabilities in favour of a benign diagnosis. Suspicious cases tended to have similar probabilities for both diagnostic outcomes and so, correctly, could not be assigned as benign or malignant. A closer examination of cumulative belief graphs for the diagnostic sequence of each case provided insight into the diagnostic process, and quantitative data which improved the identification of suspicious cases. CONCLUSION: The further development of such a system will have three important roles in breast cytodiagnosis: (1) to aid the cytologist in making a more consistent and objective diagnosis; (2) to provide a teaching tool on breast cytological diagnosis for the non-expert; and (3) it is the first stage in the development of a system capable of automated diagnosis through the use of expert system machine vision.

Bayes Theorem↗
PubMed1990

The prenatal development of the normal human skeleton: a combined ultrasonographic and post-mortem radiographic study.

Post-mortem radiography of fetuses with skeletal dysplasia is essential for diagnostic classification. Interpretation of the radiographs should be based on the knowledge of morphology and dimensions of the normal skeleton in all stages of development. A retrospective post-mortem radiographic study is presented with measurements of the lengths of the long bones and thoracic and lumbar spine. The study included 69 fetuses and neonates with a normal skeleton, whose gestational age ranged from 13-42 weeks and who died perinatally or lived for less than one week. The measurements of the long bones were plotted on growth curves obtained from a prospective longitudinal ultrasonographic investigation of another group of 63 normal fetuses from 12-40 weeks of gestation. Thoracic and lumbar spine measurements by ultrasonography were not available. The radiographic data of thoracic and lumbar spine were, therefore, compared to radiographic studies from the literature. No disagreement with these studies was found. It can be concluded that measurements of bones from standardized post-mortem radiographs in cases of questionable gestational age or defects of bone development can be compared with ultrasonographic measurements. To illustrate the usefulness of the graphs, 13 fetuses with various types of skeletal dysplasia were evaluated retrospectively.

Bone Diseases, Developmental↗
PubMed1997

Spontaneous changes of unilateral nasal airflow in man. A re-examination of the 'nasal cycle'.

It is now over 100 years since Kayser (Archiv für Laryngol Rhinol 1895; 3: 101-120) first reported in the scientific literature that the human nasal passages exhibit spontaneous changes in unilateral nasal airway resistance, yet our understanding of this unusual phenomenon is still very confused. Spontaneous, reciprocal changes in unilateral nasal resistance are often referred to as a "nasal cycle" and although this term is now commonly used to describe spontaneous changes in nasal resistance in man and animals, there is little evidence for any true periodicity. A major problem in increasing our knowledge and understanding of the so-called "nasal cycle" is that most studies have relied on simple descriptions of the changes in nasal resistance and have not developed any numerical parameters to quantify the changes in resistance over time. This lack of definition of what actually constitutes a nasal cycle has meant that the literature of the present day generally accepts the views put forward by Heetderks (Am J Med Sci 1927; 174; 231-244) and Stoksted (Acta Otolaryngol (Stockh) 1953; Suppl 109: 159-175) that around 80% of the healthy population exhibit a regular cycle. In order to define the characteristics of the spontaneous changes in nasal airway resistance we have used numerical measures of reciprocity and also developed a measurement of the division of airflow between the nasal passages over time. With these two parameters it is possible to describe the nature of the spontaneous changes in airflow in numerical terms and to define what exactly constitutes a nasal cycle. Fifty-two volunteers underwent hourly measurement of unilateral nasal airflow for 8 h. For each volunteer, two values were derived from the graph of unilateral nasal airflows against time; the correlation coefficient between unilateral airflows (r) and the airflow distribution ratio between the two nasal airways (ADR). The spread of different types of airflow pattern (nasal cycle) throughout the population was illustrated by plotting r against ADR for each subject. A nasal cycle was defined as having an r value between -0.6 and -1.0, and an ADR value between 0.7 and 1.0. Only 21% (11 of the 52 volunteers) exhibited airflow patterns that could be defined as a nasal cycle in these terms. This finding contradicts the generally accepted, but undefined, view that around 80% of the population exhibit a regular nasal cycle. The numerical definition of a nasal cycle in terms of both reciprocity and airflow distribution, as described in this paper may help to clarify our understanding of this interesting phenomenon and allow rhinologists to describe the spontaneous changes in nasal airflow in more exact terms than have been used previously in the literature.

Adult↗
PubMed1999

Fitness Landscapes and the Precautionary Principle: The Geometry of Environmental Risk.

/ A generalized mathematical model for exploring the implications of the Precautionary Principle is developed. This model draws on recent developments in the field of complex adaptive systems theory. The existence and importance of the Precautionary Principle in the field of environmental law is taken as given and used as justification for the development of models for exploring the principle's implications.The Precautionary Principle is a legal mechanism for managing the environmental risk arising from incomplete scientific knowledge of a proposal's impacts. The Precautionary Principle is applied to actions that carry with them the potential for serious or irreversible environmental change. The model proposed in this paper draws on methods used in a range of disciplines for modeling (potentially highly nonlinear) interactions between multiple parts of a complex system. These methods have been drawn together under the common mathematical umbrella of Fitness Landscape Theory. It is argued that the model, called "Environmental Impact Fitness Landscapes," allows statements about the sensitivity of the gross effect from a set of impacts to be made when the number of impacts in the set, and/or their degree of interaction, is varied. It is argued that this can be achieved through identification of "meta" or "emergent" properties of the set itself, without reference to the specific causal chains determining behavior in specific instances. While such properties are very general, they may at least allow for the parameterization of the effects of sets of impacts where interactions are highly uncertain and empirical data severely limited, i.e., situations that would typically invoke the Precautionary Principle.KEY WORDS: Fitness landscapes; Precautionary Principle; Nonlinear interactions; Graph theoryhttp://link.springer-ny.com/link/service/journals/00267/bibs/24n1p121.html

Journal Article↗
PubMedDate not supplied

[Evaluation of the effect of the health education intervention project "Healthy School"].

UNLABELLED: Contemporary health-education intervention programs are increasingly used as a tool for improving health of school children [1-4]. Since 1992 a Network of 13 elementary Health Promoting Schools established in Yugoslavia (though not yet admitted to the European Network) has been operational. The Project was approved by the Ministries of Health, Education and Ecology from the very beginning, and financially supported by the Government of Serbia since 1995. The team of up to 40 health professionals, school principals and school project managers worked together for four years to change the working conditions in schools knowledge, attitudes and behaviour of school children and staff in order to improve their health [5]. The goal of this paper is to present results of health education intervention in changing of hygienic conditions in schools, as well as some of the attitudes, behaviour and knowledge of pupils and their parents. METHOD: The study took place before and after the intervention--at two points in time--during 1993 and 1996. The tri-angular approach including (1) pupils, (2) schools (teachers, school environment), and (3) parents, was used. A random pretest and post-test study design with control group (12 experimental and two control schools) has been implemented. The multiphase cluster sample was employed in order to represent all of the country typical regions. Six types of especially designed questionnaires were used to provide comparable variables in the sample of pupils, their parents and teachers. Exception were 1st-graders and 4th-graders for whom information were gathered by means of a "draw-and-write" investigation technique [6]. The response rate was 88.70% before and 98.28% after intervention. Data were analyzed by descriptive and inferential statistics using SPSS/PC software. RESULTS: Schools are somewhat less overcrowded, much cleaner and better maintained after the four-year intervention. Toilets are in a better condition, but there is still much more to be done. The 1st- and 4th-graders, surveyed by the draw-and-write method, mentioned numerous ways of keeping and improving health, which were summarized as fifteen health-improvement measures (Graph 1). The most frequently mentioned measures were nutrition, physical activity, general hygiene, oral and dental hygiene, sleeping and fresh air. Each of these measures was mentioned by over 20% of the surveyed pupils. Eleven of 15 variables showed significant increase in frequencies (at the level of at least p < 0.01) after the intervention. As an indicator of a nutrition behaviour, the regularity of main meals is analyzed (Graph 2). The majority of children eat regularly and the difference before and after intervention is significant only for the school meal (c2 = 30.715, p < 0.001). Although over 70% of children learn that general hygiene is good for health in junior graders, only about little more than 30% of senior graders have a bath or shower every day, while others only once or twice a week. The differences are significant before and after the intervention (c2 = 10.648, p < 0.05) only for everyday practice. More than 90% of senior-grade pupils brush their teeth at least once or several times a day. Over 60% of children in our survey go in for sport, whereas about 20% never do so. It seems that the intervention contributed symbolically to this practice important for health, though before-after difference is significant (c2 = 6.673, p < 0.05). However, in the control group schools children have much less physical activity in 1996, and this difference is significant (c2 = 14.070, p < 0.010). The psycho-emotional status of Yugoslav young people is strongly influenced by the situation in the country the war, the economic disaster and the impact of international sanctions. Consequently, more than one-fourth of the children complained of frequent exhaustion and concentration problems, which their parents also noticed. (ABSTRACT TRUNCATED)

Child↗
PubMed2025

Learning directed acyclic graphs for ligands and receptors based on spatially resolved transcriptomic data of ovarian cancer.

To unravel the mechanism of immune activation and suppression within tumors, a critical step is to identify transcriptional signals governing cell-cell communication between tumor and immune/stromal cells in the tumor microenvironment. Central to this communication are interactions between secreted ligands and cell-surface receptors, creating a highly connected signaling network among cells. Recent advancements in in situ-omics profiling, particularly spatial transcriptomic (ST) technology, provide unique opportunities to directly characterize ligand-receptor signaling networks that power cell-cell communication. In this paper, we propose a novel statistical method, LRnetST, to characterize the ligand-receptor interaction networks between adjacent tumor and immune/stroma cells based on ST data. LRnetST utilizes a directed acyclic graph model with a novel approach to handle the zero-inflated distributions of ST data. It also leverages existing ligand-receptor regulation databases as prior information, and employs a bootstrap aggregation strategy to achieve robust network estimation. Application of LRnetST to ST data of high-grade serous ovarian tumor samples revealed both common and distinct ligand-receptor regulations across different tumors. Some of these interactions were validated through both a MERFISH dataset and a CosMx SMI dataset of independent ovarian tumor samples. These results cast light on biological processes relating to the communication between tumor and immune/stromal cells in ovarian tumors. An open-source R package of LRnetST is available on GitHub at https://github.com/jie108/LRnetST.

Humans↗
PubMed1991

[The effect of synchronization on estrus and pregnancy in sheep and on levels of thyroxine, triiodothyronine, 17 beta-estradiol, progesterone and cholesterol].

Knowledge of pathogenesis of sexual dysfunctions at altered thyroid activity is limited by the knowledge of multiple and ubiquitous action of its hormones throughout the organism. One of the possibilities of modulatory influence of thyroid hormones on sexual functions can be realized through the participation of thyroxine and triiodothyronine in the synthesis and metabolism of primary substrate of steroid synthesis--cholesterol. The presented work is aimed at the study of simultaneous dynamic changes of concentrations of thyroxine (T4), triiodothyronine (T3), 17 beta-estradiol (E2), progesterone (P4) and cholesterol (Chol) during synchronization of the rutting period and gravidity at parallel correlative evaluation of mutual relations of the followed parameters in ten Merino sheep in the seasonal period. Synchronization was achieved by chlorsuperlutin (Agelin--vaginal swabs, Spofa; 20 mg of chlorsuperlutin/swab) and PMSG (500 I. U./animal). Blood was sampled by means of a jugular vein puncture at the time of swab insertion (-13th day) and after three (-10th day) and seven (-7th day) following days, at the removal of swabs and application of PMSG (-3rd day), on the day of insemination (zero day), on the 7th, 14th and 17th day and in the middle of the 2nd, 3rd, 4th and 5th month of gravidity. In the phase of oestrus synchronization a significant increase of E2 concentrations on days -7 and -3 of the experiment (0.47 +/- 0.079 and 0.542 +/- 0.177 nmol.l-1 of serum, P less than 0.001; P less than 0.001) was observed compared to the E2 values on day -13 (0.084 +/- 0.036 nmol.l-1 of serum). Parallel to these observations, marked intermittent changes of T4 (Tab. I, Graph 1) were recorded with the lowest values of this parameter observed on days -10 (41.75 +/- 20.23, P less than 0.05) and -3 (50.22 +/- 18.77, P less than 0.05) and the highest on day -7 (96.77 +/- 17.51 nmol.l-1, P less than 0.01) and day zero (85.40 +/- 19.59 nmol.l-1 of serum, P less than 0.05) in comparison with the -13th day (67.22 +/- 18.29 nmol.l-1 of serum). Concentrations of P4 (Tab. I, Graph 4) declined to the lowest values on day zero observation (0.09 +/- 0.08 nmol.l-1 of serum, P less than 0.05 vs 3.40 +/- 3.61 nmol.l-1 on day -13). No significant changes of concentrations of T3 (Tab. I, Graph 2) and Chol (Tab. I, Graph 5) were observed during oestrus synchronization. During gravidity, concentrations of E2 (Tab. I Graph 3) showed an increasing trend compared to the -13th day.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

[An experimental study of a hypertext as an innovative teaching tool in learning about occupational risks].

Among innovative techniques, computer-assisted instruction methods and hypertexts deserve particular attention due to the increasing availability of educational software. A hypertext is not a specific programme, rather a type of programme: hypertexts provide different combinations of texts, pictures, graphs, tables, so that learners can browse through information according to their wishes. This study was performed with the aim of comparing two teaching techniques (1. browsing a hypertext with the assistance of a computer, and 2. attending traditional lectures) in the field of occupational and environmental risks for human health. The whole second-year course (21 students) of the School of Environmental and Occupational Hygiene, Faculty of Medicine, University of Pavia, participated in the study. The experimental strategy consisted of 14 working sessions. Students were randomly assigned to 2 groups; one browsed the hypertext and the other attended the lectures. At the end of each session, students performed a 16-item multiple-choice test on the topic covered to assess learning levels. Each student was also requested to judge clarity, interest and usefulness on a 5-point scale. The performance of the students, expressed as a percentage of correct answers, showed that learning lectures is slightly more effective than learning from hypertext browsing. However, the chi 2-test revealed no significant differences between the 2 methods regarding performance when students with more than 75% correct answers were compared. Regarding acceptability of the techniques used, the students considered them equivalent as to interest and usefulness, whereas clarity of the lectures was slightly but significantly higher than the hypertext. Acceptability of hypertext browsing as a learning method was greatly appreciated. Most of the students considered their experience as highly positive: hypertext browsing was considered easy and amusing and the use of the computer for learning was judged most satisfying. Most of the students would like to have the possibility of learning at home, to repeat the experience and extend it to other disciplines. The negative characteristic of hypertext browsing was the "lack of human contact", which makes it impossible to widen knowledge.

Computer-Assisted Instruction↗
PubMed1983

[Mechanical strain in the forearm bones].

Knowledge of the physiologic distribution of strain in bone is essential for a successful osteosynthesis by means of compression plate. This method guarantees optimum stability if the plate acts as a tension band. If the side of tensile stresses varies within the bone, strain may not only occur on the side of the plate but also on the opposite cortex. In such cases the distribution of pressure in the fracture gap is of special importance. For determining the distribution of strain on the radius, it is necessary to examine the forces caused by the flexor- and extensor muscles of the wrist and fingers. Additional forces come also from flexor- and extensor muscles of the elbow. The frame formed by the bow-shaped radius and the ulna is of further importance for the distribution of strain. Kind and amount of tension is fundamentally influenced by forearm rotation. Anatomic studies on post-mortem specimens showed how the direction of muscle action to wrist and fingers changed in relation to the position of a plate fixed to the proximal shaft of the radius. This already demonstrates possible variations in the bending forces caused by forearm rotation. An analysis of the distribution of strain in the forearm bones was carried out on a biomechanical model using strain gauges. This method allows the simulation of strain to the skeleton caused by muscle force and the influence of load. The distribution of strain can be studied on the same model in various different positions of elbow and forearm. Six muscles and two muscle groups were simulated by means of wire pulls with calibrated strain gauges; these muscles and muscle groups act, on account of the physiological cross section and their position, as bending forces to the forearm bones in a dorsovolar plane. The tensile force on radius and ulna were each controlled by three strain gauges in four sections. The characteristic quantities of these sections were determined by evaluation of the appropriate computertomograms. With the aid of three strain gauges per section it was possible to assess the strain at any one desired point. Distribution of strain was determined by pull to each "muscle" in the extreme position of forearm rotation and three different positions of flexion to the elbow. The tensile force was expressed on graphs as muscle tension of 2 kp/cm2 per cross section (ill. 6 to 12).(ABSTRACT TRUNCATED AT 400 WORDS)

Biomechanical Phenomena↗
PubMed1995

A classification manager for compositional concept systems exemplarily shown by the AO/ASIF classification of fractures of long bones.

Conventional classification and coding systems represent concept systems by strict hierarchical enumeration and are supported by meaningful codes. Compositional classification is a means for representing concept systems by semantic descriptions. Classification is based on the structure of concept descriptions and explicit hierarchical relationships between their constituents. A classification manager will be presented which is based on the BERNWARD model [1]. BERNWARD is a conceptual graphs formalism and allows the constrained composition of concept descriptions by primitive concepts and roles. It stresses the distinction between generic and partitive relations. Concept descriptions can be classified on the basis of structural criteria for subsumption and part-whole relation. The capabilities of the model, compared to the principles of conventional classification and coding systems, will be exemplified by the AO/ASIF classification of fractures of long bones [2]. This classification is based on 2 axes: topography (long bone and segment) and morphology (type, group, subgroup and quality). It consists of the enumeration of all relevant fractures of long bones which are represented by a compositional meaningful code and by a line drawing. In the demonstrated system, the composition of fracture descriptions is supported by lists of terms and by graphics. The interactive selection of concepts from the space of concepts defined by the implemented classifications is supported by combining the following strategies: entering terms, selecting graphics, adding relevant characteristics to a concept selected before, and navigating through various hierarchies e.g.,generic or partitive hierarchies. These strategies are controlled by different types of compositional restrictions which are: role restrictions, hierarchical restrictions, and coordination restrictions. Role restrictions constrain the addition of specializing characteristics to elements of concept descriptions e.g., the possible complexities of fractures are simple, wedge, and multifragmented. Hierarchical restrictions constrain the generic or partitive refinement of concept elements. For example, every long bone can have the segment "proximal metaphyseal," but only tibia/fibula can have the region "malleolar." Coordination restrictions constrain the coordination of concepts e.g., a frontal fracture of the capitellum can affect the trochlea. Therefore, it is allowed to define a frontal fracture of capitellum and trochlea. Medical observations can be documented by association of selected concepts e.g., a fracture of radius and ulna can be associated to the patient Mr. X. The tools implemented for interactive selection of concepts can be used to rescan documented cases. In contrast to common classification systems, a case can be selected by combining different criteria in BERNWARD. It is possible to look for all female patients with a complex fracture of a long bone of the left upper extremity or to look for all bifocal fractures of the forearm with a wedge fracture of the radius. There is no problem to add new knowledge to the classification manager in the form of another classification. A new classification can be built by using elements of old ones e.g., the classification of the human skeleton is also useful for the AO/ASIF classification. Therefore, parts of classifications can be stored on and loaded from the disk by the demonstrated system. he user environment does not have to be changed to document a different area of medicine because of the conceptual representation of medical knowledge in BERNWARD. The user front-end can be used for all classifications e.g., a relational DBMS for Apple Macintosh systems. Some recursive functions are implemented in a linked Prolog system for effective computation of formal relations between concepts.

Computer Graphics↗