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PubMed1998

The role of veterinary research laboratories in the provision of veterinary services.

Veterinary research laboratories play an essential role in the provision of veterinary services in most countries. These laboratories are the source of new knowledge, innovative ideas and improved technology for the surveillance, prevention and control of animal diseases. In addition, many laboratories provide diagnostic and other services. To ensure the optimal integration of various veterinary activities, administrators must understand the functions and constraints of research laboratories. Therefore, a brief discussion is presented of the following: organisational structures methods for developing research programmes outputs of research scientists and how these are measured the management of quality assurance funding of research. Optimal collaboration can only be attained by understanding the environment in which a research scientist functions and the motivational issues at stake.

Animals↗
PubMed2006

Computer-assisted reader software versus expert reviewers for polyp detection on CT colonography.

OBJECTIVE: The purpose of our study was to assess the sensitivity of computer-assisted reader (CAR) software for polyp detection compared with the performance of expert reviewers. MATERIALS AND METHODS: A library of colonoscopically validated CT colonography cases were collated and separated into training and test sets according to the time of accrual. Training data sets were annotated in consensus by three expert radiologists who were aware of the colonoscopy report. A subset of 45 training cases containing 100 polyps underwent batch analysis using ColonCAR version 1.2 software to determine the optimum polyp enhancement filter settings for polyp detection. Twenty-five consecutive positive test data sets were subsequently interpreted individually by each expert, who was unaware of the endoscopy report, and before generation of the annotated reference via an unblinded consensus interpretation. ColonCAR version 1.2 software was applied to the test cases, at optimized polyp enhancement filter settings, to determine diagnostic performance. False-positive findings were classified according to importance. RESULTS: The 25 test cases contained 32 nondiminutive polyps ranging from 6 to 35 mm in diameter. The ColonCAR version 1.2 software identified 26 (81%) of 32 polyps compared with an average sensitivity of 70% for the expert reviewers. Eleven (92%) of 12 polyps > or = 10 mm were detected by ColonCAR version 1.2. All polyps missed by experts 1 (n = 4) and 2 (n = 3) and 12 (86%) of 14 polyps missed by expert 3 were detected by ColonCAR version 1.2. The median number of false-positive highlights per case was 13, of which 91% were easily dismissed. CONCLUSION: ColonCAR version 1.2 is sensitive for polyp detection, with a clinically acceptable false-positive rate. ColonCAR version 1.2 has a synergistic effect to the reviewer alone, and its standalone performance may exceed even that of experts.

Adult↗
PubMed1996

Metabolic bone disease of prematurity.

Metabolic bone disease is recognized with increasing frequency in very-low-birth-weight infants. Radiological changes characteristic of rickets have been found in 55% of infants with a birth weight of less than 1000 g and in 23% of infants weighing less than 1500 g at birth. Twenty-four per cent of infants with a birth weight of less than 1500 g have fractures. The main aetiological factor is insufficient phosphorus supplementation. The aetiology is, however, multifactorial and also includes calcium deficiency, vitamin D deficiency, certain drugs, aluminium loading and immobilisation. The method of choice in detecting subclinical mineral bone disease of prematurity is measurement of bone mineral density, but there is as yet no single good diagnostic method available for premature infants. The optimal mineral and vitamin D requirement of the premature infant must be established so that proper recommendations can be given. The current recommended vitamin D dose in Europe (ESPGAN 800-1000 IU/day) is probably too high when extra minerals are supplied. Moreover, the duration of mineral supplementation may need to be continued until the infant has reached a body weight of 3.5 kg. This article deals with the aetiology, pathogenesis, diagnosis and future prospects of metabolic bone disease of prematurity.

Bone Diseases, Metabolic↗
PubMed2001

Detection and evaluation of a palpable breast mass.

The discovery of a breast mass, either self-detected or identified by a clinician, is a common, often distressing occurrence for many women. Although most detected breast masses are benign, every woman presenting with a breast mass should be evaluated to exclude or establish a diagnosis of cancer. This article provides a succinct overview of normal breast anatomy and reviews common causes of breast masses. The role of the clinical breast examination is discussed, and an algorithm is provided for optimal utilization of available tools in the diagnostic evaluation of a breast mass. The evaluation should be performed expeditiously and the results communicated promptly to the patient. Regardless of the age of the woman, a clinically suspicious mass must be evaluated even if findings on a mammogram are normal.

Adult↗
PubMed2004

The treatment of ventilator-associated pneumonia.

OBJECTIVE: This manuscript attempts to provide insight into current concepts of prevention, diagnosis, and management of ventilator-associated pneumonia (VAP). DATA SOURCES: A Medline search from 1996 to May 2004 was performed. Search terms included: ventilator-associated pneumonia with prevention, diagnosis, management, duration, resistance, and outcome. DATA SELECTION: Emphasis was placed on the recent peer-reviewed literature. Human data were preferentially included. DATA EXTRACTION: Where possible, recent publications (within the last year) were used in preference to older data. The references were chosen to present key citations. DATA SYNTHESIS: Data selection was prioritized to address specific subtopics. CONCLUSIONS: The treatment and prevention of VAP is evolving rapidly based on improved diagnostic skills and a better understanding of optimal antimicrobial therapy. An overview of new and key data guiding clinicians in the management of this important disease is presented.

Journal Article↗
PubMed2001

Impact of canine control on the epidemiology of canine and human visceral leishmaniasis in Brazil.

Brazil is the only country endemic for zoonotic visceral leishmaniasis (ZVL) that regularly conducts epidemiologic and prophylactic control programs that involve the treatment of human cases, insect vector control, and the removal of seropositive infected dogs. This report reviews 60 studies reporting data on the efficacy of these recommended control tools and concludes that in Brazil 1) eradication of the disease in Minas Gerais was achieved by the concomitant use of the three control methods, 2) although seropositivity by an immunofluorescent assay is not completely related to infectiousness, the removal of seropositive dogs leads to a significant reduction of canine and human incidence, 3) improvement of the sensitivity of the diagnostic tool used for canine control should optimize the efficacy of control, and 4) although difficult and expensive, the public health dog control campaigns performed in Brazil reduced the incidence of ZVL and should be maintained since treatment of dogs is an unrealistic intervention, both because of its prohibitive cost and relatively poor effectiveness.

Animals↗
PubMed2000

[Cost-effectiveness of imaging procedures in knee injuries].

It is clear to experts in the health care industry that with regard to medical decision-making, considering costs of medical devices is not a good index, but it is highly important to include medical aspects. This approach guarantees an advance and an appropriate method. We present a cost-effectiveness analysis to target the optimal strategy of how to use medical diagnostic devices in cases of knee injuries. Today, one of the more common medical emergency referrals seen worldwide is in the area of orthopedics, knee injuries in particular. They can harm soft tissue, bone tissue, or both simultaneously. The diagnosis of soft tissue injury is difficult at best. Among the devices helping the clinician make an accurate diagnosis are MRI and ultrasound (US). We conclude that US is superior to MRI in this condition. This is especially true when the orthopedic examination leads to the suggestion of arthroscopy. The results were not modified, and a sensitive study of the parameters that influence the decision-making process was undertaken. Decision-makers should not consider medical outcome alone, but should take into account the costs. A clinical study should validate the assumption on which this study was based.

Cost-Benefit Analysis↗
PubMed2000

[Use of photodynamic methods in diagnosis and therapy of epithelial vulvar diseases].

Therapy of squamous vulvar diseases creates main problems in modern gynecology. Except some useful and tried, but sometimes not optimal, therapeutical methods, medicine still discovers new diagnostic and therapeutical procedures. Authors describe new trends in photodynamic diagnostics and treatment (PDD and PDT) of some vulvar epithelial diseases: condylomata acuminata and squamous cell vulvar cancer.

Aminolevulinic Acid↗
PubMed1999

Male reproductive health research needs and research agenda: Asian and Chinese perspective.

Research that addresses male reproductive health should assist in the development of reproductive health programmes and policy; identify and test new leads in male contraceptive technology; establish effective male involvement initiatives which are likely to have a positive impact on the reproductive health of men and women; guide the allocation of health care resources to ensure cost-effectiveness of interventions; generate new knowledge, develop diagnostic technology in reproductive health and offer optimal treatment/care regimens. In considering the needs and demands of male reproductive health research in Asia and the Pacific, the following six research topics are recommended as the priority research areas: male contraceptive technology; male reproductive health behaviour and male adolescent reproductive health; male reproductive aging including male menopause and other diseases; male RTIs, STDs, HIV/AIDS; prevalence, management and prevention of male infertility; environment and semen quality and other male reproductive problems. One of the major challenges now facing us is the elaboration of a comprehensive, yet realistic male reproductive health research agenda that reflect the needs and demands of Asian developing countries. To this end, to make use of an interdisciplinary approach is of strategic importance. The most creative insights and productive leads are likely to emerge from a research team that is interdisciplinary especially in the field of reproductive health.

Adolescent↗
PubMed2001

Meeting the challenges of vascular dementia. Introduction.

Ongoing controversy over the challenges associated with the diagnosis and management of patients with vascular dementia (VaD) or Alzheimer's disease with cerebrovascular disease (CVD) has led to difficulties with establishing epidemiology and diagnostic guidelines, as well as deciding upon optimal management practices. In March 2001, an international group of physicians and researchers gathered to resolve some of these issues and provide clinicians with useful information relating to this large patient group. In addition to simple coexistence, VaD and Alzheimer's disease appear to share common pathophysiological mechanisms, such as neurotransmitter abnormalities. Treatments that target the common pathophysiology of the two conditions may prove useful. To date, no reports have been published of any agent demonstrating broad efficacy (on cognitive and noncognitive outcomes) in VaD and Alzheimer's disease with CVD in randomised, controlled trials. Recent developments in understanding the pathophysiology of the conditions, however, have taken researchers an important step closer to finding an effective treatment, not only for patients with Alzheimer's disease, but also for those with coexisting CVD and those with VaD.

Alzheimer Disease↗
PubMed2001

Osteochondral fractures of the talus.

Osteochondral fractures of the talus have become increasingly reported as awareness of this injury following ankle trauma has grown. Because hyaline cartilage does not have the ability to repair itself fully, surgical intervention is often necessary to create an optimal healing environment. Early recognition and appropriate diagnostic studies can aid the surgeon in producing favorable results.

Ankle Joint↗
PubMed2002

Development and validation of a method for using breast core needle biopsies for gene expression microarray analyses.

PURPOSE: Gene expression microarray technologies have the potential to define molecular profiles that may identify specific phenotypes(diagnosis), establish a patient's expected clinical outcome (prognosis), and indicate the likelihood of a beneficial effect of a specific therapy (prediction). We wished to develop optimal tissue acquisition, processing, and analysis procedures for exploring the gene expression profiles of breast core needle biopsies representing cancer and noncancer tissues. EXPERIMENTAL DESIGN: Human breast cancer xenografts were used to evaluate several processing methods for prospectively collecting adequate amounts of high-quality RNA for gene expression microarray studies. Samples were assessed for the preservation of tissue architecture and the quality and quantity of RNA recovered. An optimized protocol was applied to a small study of core needle breast biopsies from patients, in which we compared the molecular profiles from cancer with those from noncancer biopsies. Gene expression data were obtained using Research Genetics, Inc. Named Genes cDNA microarrays. Data were visualized using simple hierarchical clustering and a novel principal component analysis-based multidimensional scaling. Data dimensionality was reduced by simple statistical approaches. Predictive neural networks were built using a multilayer perceptron and evaluated in an independent data set from snap-frozen mastectomy specimens. RESULTS: Processing tissue through RNALater preserves tissue architecture when biopsies are washed for 5 min on ice with ice-cold PBS before histopathological analysis. Cell margins are clear, tissue folding and fragmentation are not observed, and integrity of the cores is maintained, allowing optimal pathological interpretation and preservation of important diagnostic information. Adequate concentrations of high-quality RNA are recovered; 51 of 55 biopsies produced a median of 1.34 microg of total RNA (range, 100 ng to 12.60 microg). Snap-freezing or the use of RNALater does not affect RNA recovery or the molecular profiles obtained from biopsies. The neural network predictors accurately discriminate between predominantly cancer and noncancer breast biopsies. CONCLUSIONS: The approaches generated in these studies provide a simple, safe, and effective method for prospectively acquiring and processing breast core needle biopsies for gene expression studies. Gene expression data from these studies can be used to build accurate predictive models that separate different molecular profiles. The data establish the use and effectiveness of these approaches for future prospective studies.

Animals↗
PubMedDate not supplied

[Radiation diagnosis of abdominal aortic aneurysms].

Four hundred and forty seven patients with aneurysms of the abdominal aorta (AAA), including 238 patients with aneurysmal rupture, were admitted to the Research Institute of Emergency Care in 1990 to 2000. The results of studies in 225 patients (ultrasonography in 197, computed tomography in 59, and angiography in 104), including 155 patients with aneurysmal rupture were analyzed. Computed tomography (CT) has proved to be the most accurate technique in the detection and estimation of the size of aneurysms, as well as in the identification of ruptures (83.9%) and inferior to angiography (AG) in the study of involvement of the branches of the abdominal aorta. Ultrasound study (US) ranks below CT in its accuracy (US detects ruptures in 67.8%); however, US surpasses CT and AS in screening, particularly valuable at an admission unit and an intensive care unit, which permits repeated studies. AG has turned out to be the most valid method in identifying the involvement of renal and iliac arteries in aneurysm and in detecting aortocaval anastomoses; yet it is inferior to US and CT (the former revealed rupture and dissection in 18.6% of cases) in solving other diagnostic tasks. Based on the analysis, the optimal sequence of studies in the patients is US, CT, and AG.

Aged↗
PubMed2002

[Diagnosis of abdominal injuries in combined injury].

Diagnostic value of verification methods for abdominal injuries in patients with combined trauma (CT) was analyzed, severity of injuries by Injuries Severity Scale (ISS) was specified. From 503 patients with CT (ISS = 17.6 +/- 9) diagnostic laparocentesis (DLC) was used in 224 (44.6%), USI--in 204 (40.4%), diagnostic laparoscopy (DLS)--in 49 (9.8%). Diagnostic value of each method is not optimal as they do not confirm or exclude injuries of abdominal organs requiring emergency surgery. Absence of clear criteria of diagnosis of intraabdominal catastrophe leads to significant number of unnecessary laparotomies (DLC--39%, USI--43%, DLS--48.6%) that makes graver state of patients with CT and prognosis.

Abdominal Injuries↗
PubMed2003

[Usefulness of cranial and chest imaging in the diagnosis of tuberculous meningitis among infants and young children].

We retrospectively evaluated the clinical and laboratory data of children with tuberculous meningitis (TBM) treated at our hospital from 1990 to 1999 to determine the optimal method of diagnosing TBM. The evaluated diagnostic criteria for TBM were as follows: (1) fever and malaise as symptoms of acute/subacute inflammation, (2) positive cerebrospinal fluid and/or gastric aspirate cultures for Mycobacterium tuberculosis, (3) pleocytosis of cerebrospinal fluid, and (4) a good response to anti-tuberculous therapy. The data for eleven patients (6 boys, 5 girls) with TBM (mean age, 10.7 months) were reviewed. Three patients (27%) were previously vaccinated with BCG. A known contact with tuberculosis was established at the time of admission in four patients (36%). Symptoms related to tuberculosis appeared on the average 14.8 days before the diagnosis. Three patients (27%) were diagnosed as clinical stage I, three (27%) as stage II, and five (46%) as stage III; all patients had fever (100%). With regard to the cerebrospinal fluid examinations, pleocytosis with mononuclear predominance was noted in all patients but one (91%), and mycobacterial staining was positive in three patients (27%). Tuberculin skin test was positive in four out of 10 patients (40%). Mycobacterial staining of gastric aspirate was positive in four patients (36%). Chest radiological examinations showed a swelling of the mediastinal lymphonodes and/or parenchymal infiltration in all patients (100%). A cranial CT examination demonstrated a basal meningeal enhancement in all patients (100%), hydrocephalus in nine patients (82%), and infarction in eight patients (73%). These results suggest that chest and cranial CT examinations are useful adjunct methods for diagnosis of TBM in infants and young children suffering from meningitis with pleocytosis of the cerebrospinal fluid and mononuclear predominance, in addition to conventional methods such as the tuberculin skin test, plain chest radiography, and staining for mycobacteria in body fluids.

Brain↗
PubMed2003

[Clinical analysis of brain injury in patients injured by high voltage electricity].

OBJECTIVE: To explore the pathogenic characteristics and management of brain injury in patients injured by high voltage electricity. METHODS: One hundred and thirty eight patients injured by electricity were enrolled in this study. Postburn brain injury was diagnosed by clinical sighs and imaging analysis. The brain injury was graded as mild, moderate, severe and most severe. The relationships among the inlet of the electric current and the electric voltage and the degree of brain injury were analyzed, and the causes and pathogenesis of the brain injury were suggested. Treatment modality was optimized for the patients according to the diagnostic data. RESULTS: In this group of patients, brain injury was identified in 106 cases, mostly rated as mild and moderate. Only 4 cases were ranked as severe degree with positive imaging findings. The electric voltage seemed to be not correlated with the incidence of postburn brain injury. But the intensity of electric current and the locations of electrical current inlet and outlet were closely related to the degree of brain injury. Among all the patients in this group, 131 survived and 7 died after treatment. But there was no death due directly to brain injury. CONCLUSION: There was high incidence of postburn brain injury in patients injured by high voltage electricity. The injury might be related to the direct effect of electrical current on the brain tissue, to mechanical injury, to the cardio-pulmonary lesions caused by electrical current, or to massive skin burn. Early and accurate diagnosis of the injury was of key importance for lowering both mortality and disability.

Adolescent↗
PubMed2002

[Evaluation criterion for nuclear chromatin state of human spermatozoa using flow cytometry--a fertility test].

On the basis of the previously described method for estimating the state of the human spermatozoan nuclear chromatin by flow cytometry, we developed a modified system of calculation and presentation of our data. We propose a criterion that allows to classify samples of seminal material according to their fertility potential that could be used for male sterility diagnostics and as a prognostic test for optimization of reproduction programs. The most important theoretical and methodical aspects of the suggested approach are discussed, and comparative analysis of suggested approach and routine flow cytometry SCSA method is made.

Cell Nucleus↗
PubMedDate not supplied

[Special methods of examination and their role in the selection of the extent and type of surgical intervention in patients with pelvic osteomyelitis].

The article analyses the results of radiological and computer methods of examination applied in 117 patients with chronic osteomyelitis of the pelvis to determine the site and activity of the process and choose the most rational surgical approach. The localization of the process is determined by radiography, fistulography (if a fistula exists), scanning of the skeleton, and computer tomography. Scanning of the skeleton makes it possible to determine the activity of the process. The optimal operative approach and volume of operation are chosen by comparing the radiological findings (radio- and fistulography) and the results of computer tomography. The success of surgical treatment of patients with chronic osteomyelitis of the pelvis is determined to a great measure by the informativeness of the results of preoperative examination of the patient. With this in view, the most optimal combinations of the range of modern diagnostic measures should be used more widely.

Adolescent↗