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PubMed1997

Regional phenotypic specialization of intraepithelial lymphocytes in the rat intestine does not depend on microbial colonization.

Recent studies in mice and humans have provided evidence for regional specialization of gut intraepithelial lymphocytes (IEL). Here the authors report striking regional variability in the composition of IEL in rat small and large intestine. Two-colour immunofluorescence in situ analysis showed that the distribution of the CD3+ and CD3- IEL subpopulations varied, the proportion of T cells (CD3+) being higher in the ileum than in the jejunum and smallest in the colon. These differences were explained by variable numbers of the T-cell receptor (TCR)alpha/beta + (both CD8+ and CD4+) but not the TCR gamma/delta + subset. Moreover, the various IEL subpopulations showed distinct intraepithelial distribution patterns with CD4+ and CD8 alpha beta + T cells situated near the lamina propria, while CD3- IEL were located preferentially towards the adluminal part of the epithelium. Regional phenotypic variation did not depend on intestinal colonization because analogous results were obtained in germ-free rats. Conventionalization nevertheless caused a marked relative increase of small intestinal TCR alpha/beta + but not TCR gamma/delta + IEL. This increase was more sustained in the jejunum than ileum and eventually reduced the phenotypic IEL differences between the two sites. By contrast, microbial colonization of the colon induced only a transient increase of intraepithelial TCR alpha/beta + cells with no permanent phenotypic alterations. Both CD3+ and CD3- IEL contained subpopulations that expressed NKR-P1 independent of intestinal colonization. These results demonstrate phenotypic specialization of IEL at different levels of the gut and suggest that the indigenous flora is not essential to this end.

Animals↗
PubMed2000

Improvement in transfusion safety using a specially designed transfusion wristband.

Fatal haemolytic transfusion reaction due to ABO incompatibility occurs mainly as a result of clerical error. A blood sample drawn from the wrong patient and labelled as another patient's will not be detected by the blood bank unless there is a previous ABO grouping result. We report here the detection of such clerical error by the use of a specially designed transfusion wristband. The wristband has the following special features: (i) once attached, it cannot be removed except by cutting; (ii) it has a pocket containing a transfusion label; (iii) a unique transfusion barcode is printed on each transfusion label and the corresponding wristband simultaneously by computer technology; (iv) a transfusion label removed from the wristband after attachment to the patient has a characteristic tear-mark distinguishing it from one removed prior to attachment. The blood bank only accepted those specimens bearing the tear-marked transfusion labels. All blood units for this patient were labelled with this unique transfusion code together with the patient's details. The nurses counter-checked the transfusion code on the blood units against the transfusion code on the patient's transfusion wristband prior to transfusion. If the blood sample for compatibility testing was drawn from the 'wrong' patient, the intended patient either did not carry a wristband or the transfusion codes did not match at all. Pretransfusion compatibility tests were performed on 2189 patient samples using this procedure. It was well accepted by both ward and blood bank staff. Two potential mismatched transfusions were avoided. These two clerical errors would not have been detected because neither patient had previous ABO grouping results.

Blood Banks↗
PubMed2003

The pyramidal neuron in occipital, temporal and prefrontal cortex of the owl monkey (Aotus trivirgatus): regional specialization in cell structure.

Recent studies have revealed marked regional variation in pyramidal cell morphology in primate cortex. In particular, pyramidal cells in human and macaque prefrontal cortex (PFC) are considerably more spinous than those in other cortical regions. PFC pyramidal cells in the New World marmoset monkey, however, are less spinous than those in man and macaques. Taken together, these data suggest that the pyramidal cell has become more branched and more spinous during the evolution of PFC in only some primate lineages. This specialization may be of fundamental importance in determining the cognitive styles of the different species. However, these data are preliminary, with only one New World and two Old World species having been studied. Moreover, the marmoset data were obtained from different cases. In the present study we investigated PFC pyramidal cells in another New World monkey, the owl monkey, to extend the basis for comparison. As in the New World marmoset monkey, prefrontal pyramidal cells in owl monkeys have relatively few spines. These species differences appear to reflect variation in the extent to which PFC circuitry has become specialized during evolution. Highly complex pyramidal cells in PFC appear not to have been a feature of a common prosimian ancestor, but have evolved with the dramatic expansion of PFC in some anthropoid lineages.

Animals↗
PubMed2002

The morphology of the specialized atrioventricular junctional area: the evolution of understanding.

Although knowledge of its existence has barely exceeded one century, the anatomic pathway for conduction of the cardiac impulse from atria to ventricles has been the source of much controversy, controversy that continues to the present day. This article describes how attention to the original descriptions, along with adherence for sensible definitions for the histological distinction of conduction tissues, could have defused many of these disagreements. One of the problems with the initial descriptions was that they were written in German. Even this is no longer a problem, since the major text devoted to the topic has recently been translated into English, and is now available for all to study. This key work was the monograph produced by Sunao Tawara, a Japanese pathologist who studied in the first decade of the 20th century in the laboratory of Ludwig Aschoff. Tawara showed that the atrial impulse was conducted to the ventricular myocardium by a solitary pathway of specialized myocardium. He likened this pathway to a tree, with its roots in the base of the atrial septum, and its branches straddling the crest of the muscular ventricular septum. Significantly, he showed that the pathway became insulated as it crossed from atrial to ventricular musculatures, and suggested that the point at which the muscle became engulfed in fibrous tissue should be taken as the boundary between the "knoten," or atrioventricular node, and the penetrating bundle described earlier by Wilhelm His. The authors' findings are entirely compatible with the account given by Tawara. Like Tawara, they recognize atrial transitional cells, a compact node, the penetrating bundle, and the ventricular conduction pathways as the segments of the conduction axis which can be considered to represent the specialized atrioventricular junction.

Atrioventricular Node↗
PubMed2001

Impact of surgeon organization and specialization in rectal cancer outcome.

PURPOSE: The present study was designed to assess the differences in the outcome of patients with rectal cancer treated by a group of surgeons before and after being organized as a Coloproctology Unit at the same University Department of Surgery. METHODS: Comparison of two periods of rectal cancer surgery: I (1986-91) and II (1992-95). Period I: 94 patients were operated on by 14 general surgeons. Period II: 108 patients were operated on by only 4 surgeons of the same group organized as a Colorectal Surgery Unit after visiting referral centres abroad, adopting techniques such as total mesorectal excision (TME) for middle and low rectal cancer and washout of rectal stump. Mean follow-up during periods I and II was 69.1 and 42.0 months, respectively. A prospective data base analysis was used. Survival and local recurrence rates were calculated by the actuarial method. For comparison between groups the log rank method was used. RESULTS: The two groups were comparable with respect to mean age, gender, TNM and rectal tumour location. A significant increase in radical resectability and a decrease of the Abdominoperineal resection (APR)/Low anterior resection (LAR) ratio were observed in the second period. The overall pelvic recurrence rate was 25% in the first period and 11 in the second (P < 0.01). Significant differences were also found when the patients with LAR were compared between both periods, 30% vs 9% (P < 0.01) and specially when the 10 cm anal verge distance was considered to divide the LAR groups. No differences were found regarding the APR procedures in both periods. There was improved cancer-specific survival for the LAR group in the second period (P=0.03). CONCLUSION: Specialization and centralization influence the quality of rectal cancer surgery, mainly local recurrence rates and survival after low anterior resection.

Journal Article↗
PubMed2003

Ocular and visual defects amongst people with intellectual disabilities participating in Special Olympics.

PURPOSE: To analyse data from vision screening of people with intellectual disabilities from the UK participating in Special Olympics during the National Summer Games in Cardiff 2001, in order to determine visual status and access to eye care. METHODS: Athletes were invited to take part in vision screening, according to Special Olympics protocols. RESULTS: Testability rates were high. Findings confirmed the high prevalence of eye and vision defects reported in other studies of people with intellectual disabilities. In particular, visual acuity was below normal for most athletes. Significant improvement to acuity could be achieved with spectacles although correction after full refraction did not always provide normal vision. Over 40% of athletes undergoing full refraction had below normal corrected acuity. CONCLUSIONS: Athletes with intellectual disabilities were no more likely to access eye care and have adequate spectacle correction than other people with intellectual disabilities. Optometrists and carers need to be aware of the high prevalence of defects and the importance of regular eye examinations in people with intellectual disabilities.

Adolescent↗
PubMedDate not supplied

Finnish families' need for special support as evaluated by public health nurses working in maternity and child welfare clinics.

The purpose of this study was to describe public health nurses' views of the everyday problems of families and their needs for special support. Seventy-four nurses filled in a tripartite questionnaire. The needs varied by region and were seen in 4% to 23% of all families expecting a baby or with a child younger than 3 age in the nurses' clientele. Approximately one-third of the families were considered to have a pressing need for support. More than half of families (54%) had difficulties coping with parenthood and family structure, almost one-third (30%) with raising their children and with childcare, and nearly one-third (27%) with their social network. In 20% of the families, the parents experienced problems relating to their relationship as a couple; 20% of the families had problems connected to the children's development, growth, and health; and in 19% of the families, the parents had health problems. Special needs were also caused by the parents' use of alcohol (15%) and by disputes over the children's custody and visiting rights (7%). The information provided by the study can be used in developing clinical services and the family work supporting them.

Adaptation, Psychological↗
PubMed2003

Safety of a patented special butterbur root extract for migraine prevention.

OBJECTIVE: To report on the safety of a patented special butterbur root extract used for migraine prevention. BACKGROUND: Two placebo-controlled clinical trials have been conducted supporting the beneficial use in humans. METHODS: Results from acute, subchronic and chronic animal toxicity studies as well as from mutagenicity studies are reported. Safety data gained from clinical trials, postmarketing surveillance studies and pharmacovigilance are evaluated and discussed. CONCLUSION: The patented special butterbur root extract is safe for the treatment in humans.

Adolescent↗
PubMed2000

Increasing paramedics' comfort and knowledge about children with special health care needs.

This study evaluated a continuing education program for paramedics about children with special health care needs (CSHCN). Pretraining, posttraining, and follow-up surveys containing two scales (comfort with CSHCN management skills and comfort with Pediatric Advanced Life Support [PALS] skills) were administered. Objective measures of knowledge were obtained from pre- and posttraining tests. Differences in average scores were assessed using t-tests. Response rates for paramedics completing the program ranged from 94% for the posttraining survey, 81% for the initial comfort survey, 56% for the knowledge pretest, and 56% for the follow-up survey. PALS comfort scores were significantly higher than CSHCN comfort scores both before and after training, both P < .01. Posttraining surveys showed an increase in CSHCN comfort, P < .01. The follow-up surveys showed a significant decline in CSHCN comfort, P = .05. Scores on the tests showed a similar pattern, with a significant increase in knowledge from pre- to posttraining (P = .02) and a significant decrease in knowledge from posttraining to follow-up (P < .01). Comfort was significantly higher for standard pediatric skills than for specialized management skills. Completion of the self-study program was associated with an increase in comfort and knowledge, but there was some decay over time.

Adult↗
PubMed2006

Impact of specialization of primary nephrologist on the care of pediatric hemodialysis patients.

BACKGROUND: Children with end-stage renal disease (ESRD) receiving hemodialysis may have their care overseen primarily by a pediatric nephrologist or internal medicine (IM) nephrologist. METHODS: To examine specific clinical outcomes by nephrologist specialization, a cross-sectional analysis of demographic and clinical data collected in the 2002 ESRD Clinical Performance Measures Project was performed. RESULTS: Of 653 pediatric patients meeting inclusion criteria, 27% were cared for by IM nephrologists, and 73%, by pediatric nephrologists. Pediatric nephrologists were significantly more likely than IM nephrologists to care for patients who were younger and of Hispanic ethnicity. Patients of pediatric compared with IM nephrologists also were more likely to have a congenital cause of ESRD, smaller body mass index, and longer time on dialysis therapy. No significant differences in achieving a mean Kt/V of 1.2 or greater or mean hemoglobin level of 11 g/dL or greater (> or =110 g/L) according to nephrologist specialization were observed. After adjustment for patient clinical characteristics, no significant difference in use of arteriovenous fistulae was observed. Patients cared for by pediatric nephrologists were less likely to achieve a mean serum albumin level of 4.0/3.7 g/dL (40/37 g/L; bromcresol green laboratory method/bromcresol purple laboratory method; adjusted odds ratio, 0.60; 95% confidence interval, 0.42 to 0.86). Patients cared for by pediatric nephrologists had significantly greater serum calcium levels, lower serum phosphate levels, and lower intact parathyroid hormone levels. CONCLUSION: Using adult-focused clinical care targets, care provided by pediatric and IM nephrologists to pediatric patients receiving hemodialysis in the United States is similar. However, differences exist, and the significance of these differences requires further study.

Adolescent↗
PubMed2002

An outbreak of Serratia marcescens infection in a special-care baby unit of a community hospital in United Arab Emirates: the importance of the air conditioner duct as a nosocomial reservoir.

We report an outbreak of Serratia marcescens infection in a special-care baby unit (SCBU) of a university-affiliated community hospital in the United Arab Emirates. The outbreak involved 36 infants and lasted for 20 weeks. Seven of the colonized infants developed invasive illnesses in the form of bacteraemia (four cases), bacteraemic meningitis (two) and clinical sepsis (one). Three other term infants had purulent conjunctivitis. There were five deaths with an overall mortality of 14%. S. marcescens was cultured from airflow samples from the air conditioning (AC) which was the reservoir of infection in this outbreak. Elimination of the nosocomial source and outbreak containment were eventually achieved by specialized robotic cleaning of the entire AC duct system of the SCBU. Strict adherence to the infection control policies was reinforced to prevent transmission of cross-infection.

Air Conditioning↗
PubMed2000

Medicaid managed care and children with special health care needs: a case study analysis of demonstration waivers in three states.

Although the number of states moving toward managed care for Medicaid beneficiaries is increasing, little is known about the extent to which managed care delivery systems are prepared to address the special needs of children with chronic illness and disabilities. This study explores the change in the process of care provided by the State Title V Programs for Children With Special Health Care Needs (CSHCN) and in parent and provider satisfaction when Medicaid changes the method of payment from fee-for-service to capitation. The findings suggest that CSHCN are vulnerable in a managed care environment and that states should proceed cautiously to integrate this population into their managed care arrangements.

Alabama↗
PubMed2001

Primary arthroplasty of infected hips and knees in special cases using antibiotic-loaded bone-cement for fixation.

As a consequence of successful 1-stage exchange of infected joint prostheses, we decided to treat bacterial infection of the hip or knee by joint resection, synovectomy, and primary implantation of a hip or stabilized knee prosthesis. Since 1984, we have performed this procedure on 51 hips and 32 knees. All operations were preceded by identification of the causative organism and choice of appropriate antibiotics for addition to the bone-cement. The long-term rate of success corresponds to that of 1-stage exchange of infected prostheses. The different anatomic conditions at the hip and knee have to be taken into consideration. This treatment is restricted to special cases and should be performed only in specialized clinics with competent assistance from a bacteriologist.

Aged↗
PubMed2000

CAM evaluation comes into the mainstream: NIH specialized Centers of research and the University of Maryland Center for Alternative Medicine Research in Arthritis.

In September of 1999 the National Institutes of Health (NIH) announced the funding of five Specialized Centers of Research in complementary and alternative medicine (CAM), bringing the total number of centers being supported to nine. The NIH center grant model provides a tremendous boost to the scientific investigation of CAM, nurturing an emerging field through the support of a step-wise research program of clinical and pre-clinical trials and developmental and feasibility studies; the building of infrastructure; and the training of a new cadre of scientific investigators in the field. This article explains the overall objectives of the NIH Specialized Centers program and focuses on one of the oldest CAM research centers in the USA, exploring some of the challenges faced in conducting CAM research while developing a center, and some of the goals and activities of the center.

Academic Medical Centers↗
PubMed2003

Influence of race in heart failure and cardiac transplantation: mortality differences are eliminated by specialized, comprehensive care.

BACKGROUND: Differences in mortality are thought to exist between African Americans and Caucasians with heart failure. These differences may be due to a variety of factors, including differences in disease process, socioeconomic status, and access to health care. Additionally, little data exist on racial differences between these two groups after cardiac transplantation. This study examines a single center, urban experience in treating African Americans and Caucasians with heart failure and after cardiac transplantation. We hypothesize that treatment in a specialized, comprehensive heart failure/cardiac transplantation program results in similar survival between African Americans and Caucasians. METHODS: We retrospectively reviewed the Rush Heart Failure and Cardiac Transplant Database from July 1994 to August 2000. Variables analyzed in the cardiomyopathy patients included survival (until death, placement of left ventricular assist device or cardiac transplantation), number of hospitalizations per year, length of stay per year, and utilization of outpatient resources. Follow-up period was from initial visit to death, transplantation, or implantation of left ventricular assist device. In those who underwent cardiac transplantation, we examined rejection rates (cellular and humoral), rejection burden, hospitalization data, and 5-year survival. A subgroup bridged to cardiac transplantation with a left ventricular device was also analyzed. RESULTS: Seven hundred thirty-four cardiomyopathy patients were identified: 203 were African Americans and 531 were Caucasians. The etiology of cardiomyopathy was more commonly ischemic in Caucasians as compared to non-ischemic in African Americans (P <.01). African Americans had more admissions to the hospital per year compared with Caucasians, 1.2 +/- 2.1 versus.5 +/- 1.1 (P <.01) with longer length of stay per year, 1.4 +/- 25.2 days versus 4.4 +/- 14.3 days (P <.01). Utilization of outpatient resources was significantly higher in African Americans compared with Caucasians with more use of continuous inotropes (13% versus 6%, P <.01), intermittent inotropes (11% versus 5%, P <.01), and home nursing after hospital discharge (52% versus 32% of hospital discharges, P <.01). Survival by Kaplan-Meier analysis was comparable between the two groups (mean survival 1,470 +/- 72 days in African Americans versus 1521 +/- 46 days in Caucasians, log rank test [P =.6]). During this time, 30 African Americans and 73 Caucasians underwent cardiac transplantation. Fifty-three were bridged to transplantation with a left ventricular assist device (20 African Americans, 33 Caucasians). There were no differences in 5-year survival by Kaplan-Meier analysis despite higher peak preoperative panel reactive antibody levels in African Americans versus Caucasians (12% +/- 30% compared with 5% +/- 15%, P =.04), more overall treated rejection episodes per year in the African Americans (P <.01), as well as more posttransplant hospitalizations (2.2 +/- 1.2 times per year as compared with 1.7 +/- 2.1 times per year, P =.04). CONCLUSION: Delivery of care to heart failure patients in a comprehensive, specialized program results in similar survival regardless of race despite higher utilization of inpatient and outpatient resources. The finding that, after cardiac transplantation, African Americans do not have higher mortality rates, despite having higher rates of rejection overall and more hospitalizations, further supports the hypothesis that optimal care can improve outcomes despite unfavorable baseline clinical characteristics.

Black or African American↗
PubMed1996

The effects of a special Agnus castus extract (BP1095E1) on prolactin secretion in healthy male subjects.

The effects of three doses of a special Agnus castus extract (BP1095E1)--extracts from 120 mg, 240 mg and 480 mg of drug per day--were examined within the framework of a placebo-controlled clinical study of tolerance and prolactin secretion in 20 healthy male subjects during a period of 14 days. There was good tolerance during the study as regards the following: adverse effects, the effects on blood pressure and heart rate, blood count, Quick's test, clinical chemistry as well as testosterone, FSH and LH values. During each study phase the 24-hour prolactin secretion profile was measured from the penultimate to the final day, and the amount of prolactin release was monitored an hour after TRH stimulation on the last day. A significant increase in the 24-hour profile was registered with the lowest dose in comparison to placebo, the opposite being the case with the higher doses, i.e. a slight reduction. In contrast to the administration of placebo, the 1-hour AUC after TRH stimulation resulted in a significant increase with the lowest dose and a significant reduction with the highest dose. The results suggest effects of the special Agnus castus extract which are dependent on the dose administered and the initial level of prolactin concentration.

Adult↗
PubMed2001

[Evaluation of a special project for treatment of psychiatrically ill Turkish migrants].

The in-patient treatment of migrants with psychiatric disorders causes particular difficulties. There is often a barrier of language and culture that raises problems for the diagnostic and therapeutic process. To solve these problems we developed a bilingual setting by integrating a Turkish psychologist who belongs to a counselling centre into our therapeutic team for at least once a week. This offers the possibility for a very qualified psychopathological assessment as the patient can talk to the Turkish psychologist in his native language and the Turkish psychologist can translate this and his own impression accurately also using the psychiatric language. All relevant themes can be discussed, including the possibility of continuing the therapy in the counceling centre. We investigated the impact of this kind of therapeutic approach on the duration of hospitalisation, remission in terms of psychopathology, rehabilitation level, ratio of readmission and contentment with therapy. The migrants were divided into two groups: Turkish migrants were treated in this special setting, non Turkish migrants were not treated in the manner described. There are shorter periods of hospital treatment for Turkish non-schizophrenic in-patients and Turkish schizophrenic patients achieve higher levels of rehabilitation. Turkish patients with all kinds of psychiatric diagnoses show lower ratios of readmission and express greater contentment with therapy. The psychopathological symptoms themselves, however, are not substantically reduced in this special setting.

Adult↗
PubMedDate not supplied

[Objective assessment of results of special hydrotherapy in inpatient rehabilitation following knee prosthesis implantation].

AIM: Based on our own previous surface EMG investigations (EMG mapping), it has been shown that disturbances in coordination, proprioception and strength measured before and after implantation of a total knee arthroplasty (TKA) can be treated successfully with standard physical therapy during in-patient rehabilitation. The objective of the present study was to evaluate the therapeutic effect of a special type of hydrotherapy. METHOD: 25 patients with TKA were treated for 3 weeks with a standardized hydrotherapy training during in-patient rehabilitation. Several diagnostic methods (EMG mapping, Isokinetics, Ultrasound) were applied to objectify and quantify changes in muscular coordination and strength at 4, 7, and 26 weeks postoperative. These results were compared with the results of 38 TKA patients treated with a "standard rehabilitation program" and with the results of 20 healthy persons. RESULTS: EMG mapping as well as isokinetics and ultrasound permitted an objective characterization of the results. Patients treated with the special hydrotherapy showed greater improvements in the investigated items of coordination and strength than patients treated with the "standard rehabilitation program". For example, in the hydrotherapy group a significantly better contraction capacity of the M. vastus intermedius was measured. The intensive hydrotherapy was tolerated by all patients and reached good acceptance. CONCLUSION: The investigated hydrotherapy technique leads to better muscular coordination and strength, which can provoke a better stabilization of the knee joint. Therefore, the early and intensive application of hydrotherapy for improving coordination and strength in the rehabilitation of patients with total knee arthroplasty is advisable.

Aged↗