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Chimaera and its modern virus-like descendants.

Chimaera was a monster in ancient Greek mythology combining elements from different animal species in its body. Modern molecular biology enabled the generation of harmless but useful chimaeras consisting of elements from different nonrelated viruses. The objective is that the resulting chimaeras form highly immunogenic virus-like particles (VLPs). Such chimaeric VLPs can be used as highly efficient carriers for sequential and conformational B cell epitopes and T cell epitopes. Most VLPs are readily produced in heterologous hosts and are easy to purify. This article deals with various systems of VLPs described in this topical issue of Intervirology and makes comparisons with chimaeric replication-competent viruses, recombinant virus vectors expressing foreign proteins, and DNA vaccines.

Animals↗

Genetic relationships of Europeans, Asians and Africans and the origin of modern Homo sapiens.

To study the evolutionary relationships of the three major groups of humans, Europeans, Asians and Africans, the genetic distances between them were computed by using 4 different sets of genetic loci (84 protein loci, 33 blood group loci, 8 HLA and immunoglobulin loci, and 61 DNA markers). The results obtained indicate that the overall genetic distance between Europeans and Asians is significantly lower than that between Europeans and Africans of that between Asians and Africans and support the hypothesis of an African origin of modern humans. This seems to be the first study to establish the evolutionary relationships of the three major groups of humans at a statistically significant level.

Africa↗

An acoustic study of the effects of tempo and stress on segmental intervals in Modern Greek.

Changes in stress and rate of speech have been shown to have different effects on the durations of speech intervals. We examined the effects of such changes on syllable and intrasyllabic segment durations in the word-initial syllable of three-syllable words in Modern Greek, and in conflict with previously reported results for other languages, found rate and stress to have equal effects. We propose that languages may differ in terms of temporal programming in the same sense as they differ in terms of syntactic or phonological rule systems.

Greece↗

Classic and modern prognostic indicators in renal cell carcinoma. Review of the literature.

The value of classic and modern prognostic factors in renal cell carcinoma as reported in the literature is determined in a review. Tumor stage is the most important single independent prognostic factor. The presence or absence of distant metastases is highly prognostic and presence of lymph node metastases is of higher prognostic value than the presence of renal vein invasion. For each given tumor stage tumor grade (especially nuclear grade) is the most reliable additional independent prognostic factor predicting patient survival. The significance of DNA cytometry as an independent prognostic factor is less clear, though it might be useful in combination with nuclear grading. Patient-related potential prognostic factors such as age, sex and serologic parameters are of lesser, if any, importance. In the future, data from molecular analysis on oncogenes and suppressor genes are likely to provide additional prognostic information.

Carcinoma, Renal Cell↗

Recognizing the role of bereavement and reactive depression in modern psychiatry.

In the modern world the recognition, understanding and treatment of bereavement in recent widows, widowers, those who experienced severe medical and surgical trauma, and victims of disasters is essential for all physicians, rescue workers such as the International Red Cross, and the community in general. This paper reviews the consequences of personal encounters with catastrophic events, as well as methods of immediate and long-term management. Similarly, the dynamic manifestations and treatment of psychologic dissonance in the family of victims, the community, and survivors are addressed. Of special interest are the problems of rescue workers, witnesses and reporters involved in disasters.

Adjustment Disorders↗

Incubation as a form of psychotherapy in the care of patients in ancient and modern Greece.

Incubation or temple sleep in sanctuaries of Aesculapius, Amphiaraos, Trophonios, etc., for the care of patients was practised even in the older times of ancient Greece and may be viewed as a form of psychotherapy and especially as 'dream-psychotherapy'. In Greek antiquity, as it is known, dreams were considered as a way of communication between gods and men. Survival of the custom of incubation exists even in our times in modern Greece, but are disappearing slowly. An attempt is made to find an explanation, if any, of those miraculous cures in accordance with the scientific thought of today.

Dreams↗

The grand multipara in modern obstetrics.

From April 1985 to March 1986, 1,252 women were admitted for delivery at the Al Hada Armed Forces Hospital, Taif, Saudi Arabia. Of these, 224 (17.9%) were grand multiparas (GM) defined as mothers of parity greater than or equal to 6. History, labor and delivery as well as postpartum and neonatal courses were recorded using computerized records for later statistical calculations. The obstetric and perinatal outcome was calculated comparing the GMs to para-1 mothers and para-2-5 patients (P2-5), respectively. The latter group being empirically considered as the 'ideal' patient group. On comparing the GM group to that of P2-5, significantly higher frequencies of intercurrent diseases, especially diabetes mellitus and gestational diabetes, were found. Among GMs, transverse lie, primary uterine inertia, fetal heart rate abnormalities, failure to progress and postpartum hemorrhage were encountered significantly more often than in the other groups. The incidence of placenta previa was likewise significantly increased among the GMs as was the number of cesarean sections, particularly those of the primary emergency type. There was no maternal mortality. The perinatal morbidity was significantly higher in the GM group. However, no significant difference in perinatal mortality was found between the groups. It is concluded that with few exceptions the GM can be safely delivered by means of modern obstetric management.

Adult↗

Cesarean section: a controversial feature of modern obstetric practice.

Cesarean section (CS) has been an integral part of modern obstetrics during the last decades. As safety has increased, so too has the range of problems that CS is used to solve, to a degree that it must cause medical concern. There is a great danger in the blind faith that CS is the only way out in every difficult obstetric situation. The problem can always be easily solved by CS in an acute difficult obstetrical situation. However, CS is a major abdominal surgery and it may present any complication that besets major surgery including severe intraoperative and postoperative complications, a much greater risk for maternal death compared to vaginal delivery and also late complications, i.e. secondary involuntary infertility. Therefore, CS should never be undertaken lightly and without serious consideration of the justifications, preparations and all ancillary support.

Abortion, Induced↗

Historical development of Chinese dietary patterns and nutrition from the ancient to the modern society.

Actually, food, diet and diet therapy germinated together with the change of meal patterns and traditional Chinese medicine from very ancient China; they appeared in an embryonic form till the Shang and Zhou Dynasties and received great importance from the governors who arranged officials to manage their diets and banquets. Moreover, food, diet and meal patterns were replenished through the Zhou, Qin, Han and Jin Dynasties and epitomized and reached thriving and prosperous standards till the Tang Dynasty. They then became perfected, developed, and formed a complete theory in the dynasties of Song, Jin, Yuan, Ming and Qing. The basis of modern nutrition was made up until the end of 19th century and the beginning of 20th century, which was the time when natural science, including microbiology, chemistry, food industry, etc. were extended into China, yet it was not fully formed until the established of the People's Republic of China. Practicing, teaching, training and research activities started regularly in 1950. With a big population and poor economy basis, the first problem that the Chinese people has now been basically solved. Chinese nutritional scientists worked hard to find out the nutritional problems and status of the people. Through the broad-scale 'Nationwide Nutrition Survey', we now understand our main problems. On this basis, RDA, dietary goal and dietary guidance have been put forward. Although the problem of adequate food and clothing has been basically solved, the Chinese are still facing both the problem of nutrition insufficiency and nutrition excess. However, although nutrition insufficiency and deficiency still extensively exist, nutrition excess and imbalance are emerging in other sections of the population. There is still a shortage of qualified nutritional scientists and technicians, and the training of nutritionists is urgent. Food supplies, including milk, beef, green vegetables and fruit should be increased, especially for some rural and remote areas. The good traditional eating habits and meal patterns should be kept, e.g., breakfast and lunch cannot be neglected, and plant protein meals and Chinese medicinal diets should be promoted. Animals fat intake and fried foods should be reduced, and exercise and fitness programs should be recommended for the overweight population. In the future, our meal pattern take on a mixed form with the advantages of both the eastern and western diets. Chinese scientists are confident of solving the nutritional problems and improving the whole nation's physical fitness and physique under the situation of gradual improvements of the economy and nutritional status of people.

Aged↗

The development of modern endoscopy.

The development of endoscopic techniques and instruments is traced from Bozzini's light transmitter in the early 1800's to the present. Early use of laparoscopes, cystoscopes, hysteroscopes and culdoscopes is described. While the site of use of these instruments differs, certain general aspects are similar. Modern instrumentation permits visualization into almost any body cavity.

Animals↗

Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials.

BACKGROUND: There are limited studies of stent thrombosis in the modern era of second-generation stents, high-pressure deployment, and current antithrombotic regimens. METHODS AND RESULTS: Six recently completed coronary stent trials and associated nonrandomized registries that enrolled 6186 patients (6219 treated vessels) treated with >/=1 coronary stent followed by antiplatelet therapy with aspirin and ticlopidine were pooled for this analysis. Within 30 days, clinical stent thrombosis developed in 53 patients (0.9%). The variables most significantly associated with the probability of stent thrombosis were persistent dissection NHLBI grade B or higher after stenting (OR, 3.7; 95% CI, 1.9 to 7.7), total stent length (OR, 1.3; 95% CI, 1.2 to 1.5 per 10 mm), and final minimal lumen diameter within the stent (OR, 0.4; 95% CI, 0.2 to 0.7 per 1 mm). Stent thrombosis was documented by angiography in 45 patients (0.7%). Clinical consequences of angiographic stent thrombosis included 64.4% incidence of death or myocardial infarction at the time of stent thrombosis and 8.9% 6-month mortality. CONCLUSIONS: Stent thrombosis occurred in <1.0% of patients undergoing stenting of native coronary artery lesions and receiving routine antiplatelet therapy with aspirin plus ticlopidine. Procedure-related variables of persistent dissection, total stent length, and final lumen diameter were significantly associated with the probability of stent thrombosis. Continued efforts to eliminate this complication are warranted given the serious clinical consequences.

Aspirin↗

Direct costs of modern treatment of aneurysmal subarachnoid hemorrhage in the first year after diagnosis.

BACKGROUND AND PURPOSE: The purpose of this study was to investigate the current direct costs of modern management of patients with aneurysmal subarachnoid hemorrhage in the first year after diagnosis. METHODS: During a 1-year period, we studied all admitted patients with subarachnoid hemorrhage from a population of 2 million people. We calculated the direct costs of treatment, which included the costs of medical and nursing care and the related travel expenses of patients. We calculated true costs for all major healthcare resources. National census data, if available, and standard charges were used to determine healthcare resource expenses. RESULTS: Hospital admissions and diagnostic and therapeutic interventions in 110 patients accounted for 85% of all costs; 64% of the total direct medical costs during admission were the medical, nursing, and overhead costs alone. Patients discharged directly to home generated 4% of the total budget, whereas admission to a nursing home accounted for the remaining 11% of the total costs. Of the diagnostic and therapeutic costs, 45% was caused by imaging and 42% by surgery or coiling. Angiography alone accounted for 52% of the total imaging costs and 24% of the total diagnostic and therapeutic costs. Prescribed medication accounted for only 3% of the total budget of diagnostic and therapeutic costs. CONCLUSIONS: Most direct costs during the first year after aneurysmal subarachnoid hemorrhage are caused by the hospital inpatient days, accounting for two thirds of the total costs generated during the first year after the initial bleeding. If new costly treatments succeed in reducing the average length of inpatient hospital stays, then progress in therapy may prove cost effective and might even be cost saving.

Cohort Studies↗

Are stentless valves superior to modern stented valves? A prospective randomized trial.

BACKGROUND: It is presumed that stentless aortic bioprostheses are hemodynamically superior to stented bioprostheses. A prospective randomized controlled trial was undertaken to compare stentless versus modern stented valves. METHODS AND RESULTS: Patients with severe aortic valve stenosis (n=161) undergoing aortic valve replacement (AVR) were randomized intraoperatively to receive either the C-E Perimount stented bioprosthesis (n=81) or the Prima Plus stentless bioprosthesis (n =80). We assessed left ventricular mass (LVM) regression with transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI). Transvalvular gradients were measured postoperatively by Doppler echocardiography to compare hemodynamic performance. There was no difference between groups with regard to age, symptom status, need for concomitant coronary artery bypass surgery, or baseline LVM. LVM regressed in both groups but with no significant difference between groups at 1 year. In a subset of 50 patients, MRI was also used to assess LVM regression, and again there was no significant difference between groups at 1 year. Hemodynamic performance of the 2 valves was similar with no difference in mean and peak systolic transvalvular gradients 1 year after surgery. In patients with reduced ventricular function (left ventricular ejection fraction [LVEF] <60%), there was a significantly greater improvement in LVEF from baseline to 1 year in stentless valve recipients. CONCLUSIONS: Both stented and stentless bioprostheses are associated with excellent clinical and hemodynamic outcomes 1 year after AVR. Comparable hemodynamics and LVM regression can be achieved using a second-generation stented pericardial bioprosthesis. In patients with ventricular impairment, stentless bioprostheses may allow for greater improvement in left ventricular function postoperatively.

Aged↗

Aerosol delivery and modern mechanical ventilation: in vitro/in vivo evaluation.

Aerosol delivery via a mechanical ventilator remains unregulated with no standards for drug delivery to intubated patients. Bench models predicting drug delivery have not been validated in vivo. For modern ventilator designs, we chose to identify, on the bench, the most important variables affecting aerosol delivery and to correlate in vitro predictions of aerosol delivery with in vivo end points independent of patient response. Test aerosols of albuterol and antibiotics were compared. Bench measurements of inhaled mass (percentage of nebulizer charge, mean +/- SEM) ranged from 5.7 +/- 0.5% to 37.4 +/- 1.6%, with breath-actuated nebulization and humidity identified as the most important factors determining aerosol delivery. In patients, sputum levels of deposited antibiotics varied from 1.10 to 19.6 microg/ml/mg. Variation in sputum levels correlated with predictions from the in vitro model. Aerosol delivery in ventilated patients can be efficient and reproducible only if defined ventilator parameters are tightly controlled. Key parameters can be determined via in vitro bench testing defining delivery standards for clinical trials of drugs with narrow therapeutic/toxicity ratios.

Administration, Inhalation↗

Endothelial cell culture: beginnings of modern vascular biology.

Endothelial cells derived from human umbilical veins were first successfully cultured in vitro in 1973. Weibel-Palade bodies and the von Willebrand factor antigen were used as morphological, immunohistochemical, and functional markers to unequivocally identify the cells. These landmark studies helped initiate the growth of modern vascular biology.

Cell Culture Techniques↗

Modern diagnosis schizophrenia in hospitalized psychiatric patients.

The authors applied modern criteria to the diagnosis of 254 patients admitted to the psychiatric wards of an urban hospital. They found that only 16 (6.3%) met the St. Louis criteria for schizophrenia. Other studies using similar criteria also reported a consistently low prevalence of schizophrenia in general psychiatric inpatient populations. However, 30 "undiagnosed" patients (12%) in this study narrowly missed the definite diagnosis of schizophrenia because of the presence of affective disorder and/or insufficient duration of symptoms. The authors discuss the clinical and research implications of these findings.

Affective Disorders, Psychotic↗

Religiousness, conversion, and subjective well-being: the "healthy-minded" religion of modern American women.

Data from a survey of 2,500 American women were examined to determine 1) the nature of religiousness among women and, in particular, whether modern religiousness corresponds to William James' conception of "healthy-minded" religion; 2) how religiousness is related to self-reports of mental and physical health; and 3) differences between converts (mainly to Protestant denominations) and women who have maintained the same religious affiliation all their lives. The authors found that healthy-mindedness described the nonconverts (the majority) fairly well, and that certainty of beliefs (either strong religiousness or confident nonreligiousness) was associated with better mental and physical health. Converts were distinguished from nonconverts by the former's relatively happy and less religious childhoods, stronger adult religiousness, and greater authoritarian tendencies.

Adaptation, Psychological↗

Modern Christian healing of mental illness.

Healing of mental illness through religious practices was a key element of early Christianity. In the early twentieth century such healing was associated with blue-collar and rural Fundamentalists, but religious healing practices have gained widespread acceptance by many middle-class, conservative Christian groups. "Evil demons" are now equated with envy, pride, avarice, hatred, and obsessions with alcohol and gambling. Many psychotherapeutic techniques of modern Christian healers appear to be rediscoveries of psychoanalytic insights expressed in religious metaphors. Most responsible healers encourage clients to seek medical and psychiatric help, especially for serious mental disorders. Psychiatrists need not share patients' religious beliefs, but for treatment to be effective these beliefs must be understood and respected.

Humans↗