WorldWideScience

Sample records for clinically important phenomenon

  1. Immunosuppression by hypoxic cell radiosensitizers: a phenomenon of potential clinical importance

    Energy Technology Data Exchange (ETDEWEB)

    Rockwell, S.; Kapp, D.S.

    1982-06-01

    The nitroimidazoles metronidazole, misonidazol, and desmethyl misonidazole are currently undergoing clinical trials as possible adjuncts to radiotherapy. Ongoing clinical trials are evaluating the effectiveness of these agents and also documenting the pharmacokinetics and toxicities of radiosensitizing doses of these drugs in man. A variety of toxic effects have been noted in man, including anorexia, nausea and vomiting, peripheral neuropathy, central nervous system symptoms, ototoxicity, allergy, and fear. Laboratory studies have also suggested that these agents have potential to be mutagenic, carcinogenic, and teratogenic. In the editorial presented, the author attempts to draw attention to an additional toxic effect of nitroimidazoles - the inhibition of cell-mediated immune responses. (JMT)

  2. Ambiguity——an Important Phenomenon in English

    Institute of Scientific and Technical Information of China (English)

    李卫东; 李英

    2009-01-01

    In this article,the writer analyzes"ambiguity"from many different aspects:its definition,category,practical use and so on.By doing so,the writer thinks that ambiguity is an important phenomenon in English and English learners should pay enough attention to it.

  3. Opioid-induced hyperalgesia: clinically relevant or extraneous research phenomenon?

    Science.gov (United States)

    Tompkins, D Andrew; Campbell, Claudia M

    2011-04-01

    Opioids have become the unequivocal therapy of choice in treating many varieties of chronic pain. With the increased prescription of opioids, some unintended consequences have occurred. After prolonged opioid exposure, opioid-induced hyperalgesia (OIH), the paradoxical effect that opioid therapy may in fact enhance or aggravate preexisting pain, may occur. Over the past several decades, an increasing number of laboratory and clinical reports have suggested lowered pain thresholds and heightened atypical pain unrelated to the original perceived pain sensations as hallmarks of OIH. However, not all evidence supports the clinical importance of OIH, and some question whether the phenomenon exists at all. Here, we present a nonexhaustive, brief review of the recent literature. OIH will be reviewed in terms of preclinical and clinical evidence for and against its existence; recommendations for clinical evaluation and intervention also will be discussed.

  4. The digital divide phenomenon in a hand surgery outpatient clinic.

    Science.gov (United States)

    Parekh, Selene G; Sodha, Samir; McGuire, Kevin J; Bozentka, David J; Rozental, Tamara D; Beredjiklian, Pedro K

    2004-04-01

    The Internet has become an important source of medical information for patients. However, the availability of this resource for individuals in the lower socioeconomic groups is limited, a concept termed the digital divide. To evaluate this phenomenon, we conducted a survey study to quantify the accessibility and use of the Internet for obtaining medical information in an outpatient hand surgery clinic population. A 28-question survey was distributed to 207 patients concerning computer accessibility, Internet use for medical and nonmedical information, Internet trust and security, and patient economic demographics. After analysis of the data, we found individuals in households with higher incomes had a greater likelihood of owning computers than those in lower income brackets. As income increases, the time spent on the Internet also increases. Another statistically significant trend was that higher income patient households thought that Internet information was trustworthy, secure, and private compared with the lower income brackets. We concluded that clinical settings where the predominant patient population earns less than $18,000 may not benefit or use physician Internet-based services or information. The concept of the digital divide seems to be a real phenomenon in the clinical practice of orthopaedics.

  5. [Eluding clinical medicine: a phenomenon that can be stopped].

    Science.gov (United States)

    Benor, Dan E

    2010-04-01

    A study published in this issue (Lotan et at.) reveals distressing data on the percentage of 4th year students, after their first clerkship, that regret their choice of medicine as a career and contemplate a non-clinical vocational path. This phenomenon, entitled "eluding clinical medicine", is analyzed in terms of early professional socialization of the students toward sciences and their difficulty to tolerate ambiguity and uncertainty, so typical to clinical medicine. Also discussed is the student's incapability to integrate acquired knowledge across disciplines and to interweave it into clinical reality. Rectification of this escape from clinical medicine" may require modification of the pattern of the students' professional socialization during their first years of studies by such measures as early clinical exposure, interdisciplinary integration and practice in decision-making and problem-solving throughout the so-called "preclinical phase". The alarming findings presented in the above-mentioned study call for immediate response.

  6. The clinical and neurophysiological characteristics of the deja vu phenomenon in epilepsy

    Directory of Open Access Journals (Sweden)

    P. N. Vlasov

    2012-01-01

    Full Text Available Objective: to study the clinical and neurophysiological characteristics of the deja vu phenomenon in epilepsy. Patients and methods. The manifestations of the dВjЕ vu phenomenon were compared in 154 examinees in two groups: 1 139 healthy individuals and 2 25 patients with epilepsy (mean age 25.17±9.19 years; women, 63.2% The characteristics of the phenomenon were determined, by questioning the examinees; 12—16-hour ambulatory electroencephalogram (EEG monitoring was made. Results. The deja vu phenomenon occurred with cryptogenic and symptomatic focal epilepsy with equal frequency; however, the phenomenon was also seen in the idiopathic generalized form of the latter and could be concurrent virtually with any types of seizures and observed as an individual seizure and in the structure of a partial and secondarily generalized seizure. In epileptic patients, the main clinical characteristics of the deja vu vu phenomenon are its frequency, fear before its onset, and emotional coloring. The most important criterion is a change in the characteristics of deja vu vu: prolongation, more frequencies, and the emergence of negative emotions. On EEG, the phenomenon was characterized by the onset of polyspike activity in the right temporal leads and, in some cases, ended with slow-wave, theta-delta activity in the right hemisphere.

  7. SLIT-ventricle - clinical syndrome or radiological phenomenon

    Energy Technology Data Exchange (ETDEWEB)

    Kalff, R.; Brenner, A.; Kocks, W.; Roosen, K.; Loehr, E.

    1985-09-01

    Between 1976 and 1982 336 patients with an age range from several days to 65 years, were treated by ventriculo-atrial or peritoneal shunt, because of internal hydrocephalus of different origins. Regular computerized tomographies demonstrated slit-ventricles in 36 patients. Twenty-eight patients were free of complaints. In 8 patients there were symptoms like nausea and vomiting. In 5 patients these complaints were explainable by other diseases. In only 3 patients were these signs caused by increased intracranial pressure because of ventricular-catheter obliteration. In these 3 cases an enlargement of the ventricles at the time of obliteration was seen. In our series slit-ventricles were seen only as a radiological phenomenon. There was no necessity for neurosurgical treatment at all.

  8. Clinical and image improvement of Raynaud's phenomenon after botulinum toxin type A treatment.

    Science.gov (United States)

    Zhao, HongMei; Lian, YaJun

    2015-08-01

    Raynaud's phenomenon is often accompanied by pain, digital ulceration and compromised daily activities. Pharmacological therapy or sympathectomies have been administered to diminish these symptoms but existing treatments are not invariably efficacious. A recent case series has described the use of botulinum toxin type A in the treatment of Raynaud's phenomenon. We report two patients with severe or mild Raynaud's phenomenon who were injected with BTX-A; both of whom experienced clinical and image improvement after treatment.

  9. The importance of early diagnosis and treatment of kaposiform hemangioendothelioma complicated by Kasabach-Merritt phenomenon

    Science.gov (United States)

    Vivas-Colmenares, Grecia V.; Ramirez-Villar, Gema L.; Bernabeu-Wittel, Jose; Matute de Cardenas, Jose A.; Fernandez-Pineda, Israel

    2015-01-01

    Kaposiform hemangioendothelioma (KHE) is a locally aggressive vascular tumor that may be complicated by Kasabach-Merritt phenomenon (KMP), a profound thrombocytopenia resulting from platelet trapping within a vascular tumor, either KHE or tufted angioma (TA). Typical features also include low fibrinogen and elevated D-dimers. It is well known that KMP is not caused by infantile hemangiomas. Management of vascular tumors complicated by KMP is challenging, and it is common for referral centers to receive patients in critical medical condition after multimodality treatment failure of vascular anomalies. Our aim is to communicate the importance of early diagnosis and treatment of KHE associated with KMP. A full-term male newborn with KHE complicated by KMP is reported. Treatment with vincristine, aspirin and ticlopidine normalized the coagulation parameters within one week, requiring a total of six doses of vincristine, seven months of ticlopidine and 17 months of aspirin. Early diagnosis and treatment of KHE complicated by KMP may allow the administration of fewer doses of vincristine and avoid the use of corticosteroids. PMID:25692091

  10. Children and Clinical Studies: Why Clinical Studies Are Important

    Medline Plus

    Full Text Available ... Children & Clinical Studies NHLBI Trials Clinical Trial Websites Children and Clinical Studies Learn more about Children and Clinical Studies Importance of Children in Clinical Studies Children have often had to ...

  11. [Retroperitoneal germinal tumor: extragonadal or burned out phenomenon of testicular primary? Presentation of a clinical case].

    Science.gov (United States)

    Borrego Hernándo, J; Guinda Sevillano, C; Laguna Pes, M P; Zazo, A; Gimeno, A; Cuesta, R; Amigo, A

    1998-02-01

    Clinical record case of a retroperitoneal seminoma with "burned-out" phenomenon in the testicular primary, in a 38 year old male with no background of interest who consults for a picture of left nephritic colic. The ipsilateral testis study detects a fibrotic area with hyalinosis and hemosiderin deposits, although there are no tumoral debris, compatible with the "burned-out" phenomenon. Management is through surgery plus a chemotherapy protocol. Discussion of the diagnostic algorithm of retroperitoneal tumours and the literature on extragonadal germinal tumours.

  12. Wide pH range tolerance in extremophiles: towards understanding an important phenomenon for future biotechnology.

    Science.gov (United States)

    Dhakar, Kusum; Pandey, Anita

    2016-03-01

    Microorganisms that inhabit the extreme pH environments are classified as acidophiles and alkaliphiles. A number of studies emerged from extreme high (hot springs, hydrothermal vents) as well as low temperature (arctic and antarctic regions, sea water, ice shelf, marine sediments, cold deserts, glaciers, temperate forests, and plantations) environments have highlighted the occurrence of microorganisms (thermophiles/psychrophiles) with the ability to tolerate wide pH range, from acidic to alkaline (1.5-14.0 in some cases), under laboratory conditions. However, the sampling source (soil/sediment) of these microorganisms showed the pH to be neutral or slightly acidic/alkaline. The aim of the present review is to discuss the phenomenon of wide pH range tolerance possessed by these microorganisms as a hidden character in perspective of their habitats, possible mechanisms, phylogeny, ecological and biotechnological relevance, and future perspectives. It is believed that the genome is a probable reservoir of the hidden variations. The extremophiles have the ability to adapt against the environmental change that is probably through the expression/regulation of the specific genes that were already present in the genome. The phenomenon is likely to have broad implications in biotechnology, including both environmental (such as bioremediation, biodegradation, and biocontrol), and industrial applications (as a source of novel extremozymes and many other useful bioactive compounds with wide pH range tolerance).

  13. Vacuum phenomenon in the temporomandibular joint: a clinical, computed tomography and magnetic resonance case report.

    Science.gov (United States)

    Moncada, G; Oyarzo, J F; Moncada, M; Marholz, C; Millas, R

    2008-05-01

    A 28-year-old woman presented with a history of clicking and mandibular clenching. She was studied clinically and with axial and coronal CT. The patient was going through a tense emotional period and reported tightening of her teeth (clenching); she was under psychological and neurological treatment for depression including pharmacological therapy. She presented slight pain only at maximum mouth opening at the right temporomandibular joint (TMJ) and in the lateral pole on palpation; there was no coincidence between initial and maximal interocclusal contacts because of premature dental contacts. She showed occlusal group function in the right side and canine guidance in the left side with a right contact of balance, local muscular pain in the right deep masseter muscle and in the superior and middle portion of the right trapezium on palpation. On CT, a spherical area of 3 mm diameter with an average density of -647 HU (SD+/-4.7) was found in the upper and posterior area of the lower space of the right TMJ, together with a thicker lower synovial tissue. This observation was confirmed by MRI. Like other joints, the TMJ could present vacuum phenomenon images inside synovial tissue in the presence of degenerative disease. It is important for radiologists to recognize this rare entity.

  14. Differential susceptibility of PCR reactions to inhibitors: an important and unrecognised phenomenon

    Directory of Open Access Journals (Sweden)

    Miller Robert F

    2008-08-01

    Full Text Available Abstract Background PCR inhibition by nucleic acid extracts is a well known yet poorly described phenomenon. Inhibition assessment generally depends on the assumption that inhibitors affect all PCR reactions to the same extent; i.e. that the reaction of interest and the control reaction are equally susceptible to inhibition. To test this assumption we performed inhibition assessment on DNA extracts from human urine samples, fresh urine and EDTA using different PCR reactions. Results When copurified inhibitors were assessed using two different PCR reactions one reaction appeared to be inhibited whilst the other was not. Further experiments using various concentrations of unextracted urine to inhibit six different PCR reactions revealed that susceptibility to inhibition was highly variable between reactions. Similar results were obtained using EDTA as the PCR inhibitor. We could find no obvious explanation why one reaction should be more susceptible to inhibition than another, although a possible association with amplicon GC content was noted. Conclusion These findings have serious implications for all PCR-based gene expression studies, including the relatively new PCR array method, and for both qualitative and quantitative PCR-based molecular diagnostic assays, suggesting that careful consideration should be given to inhibition compatibility when conducting PCR analyses. We have demonstrated unequivocally that it is not safe to assume that different PCR reactions are equally susceptible to inhibition by substances co-purified in nucleic acid extracts.

  15. Topology simplification: Important biological phenomenon or evolutionary relic?. Comment on "Disentangling DNA molecules" by Alexander Vologodskii

    Science.gov (United States)

    Bates, Andrew D.; Maxwell, Anthony

    2016-09-01

    The review, Disentangling DNA molecules[1], gives an excellent technical description of the phenomenon of topology simplification (TS) by type IIA DNA topoisomerases (topos). In the 20 years since its discovery [2], this effect has attracted a good deal of attention, probably because of its apparently magical nature, and because it seemed to offer a solution to the conundrum that all type II topos rely on ATP hydrolysis, but only bacterial DNA gyrases were known to transduce the free energy of hydrolysis into torsion (supercoiling) in the DNA. It made good sense to think that the other enzymes are using the energy to reduce the level of supercoiling, knotting, and particularly decatenation (unlinking), below equilibrium, since the key activity of the non-supercoiling topos is the removal of links between daughter chromosomes [3]. As Vologodskii discusses [1], there have been a number of theoretical models developed to explain how the local effect of a type II topo can influence the global level of knotting and catenation in large DNA molecules, and he explains how features of two of the most successful models (bent G segment and hooked juxtapositions) may be combined to explain the magnitude of the effect and overcome a kinetic problem with the hooked juxtaposition model.

  16. Possession as a clinical phenomenon: a critique of the medical model

    Directory of Open Access Journals (Sweden)

    Owe Wikström

    1982-01-01

    Full Text Available The focus of this article is on the individual's specific experience of his personality being possessed, either partially or completely, momentarily or for an extended period of time, by evil spirits. It must be seen as necessary to supplement the narrow medical model for interpreting states of possession. The clinically interested psychologist of religion, in particular, needs consider aspects of the phenomenology of religion and clinical psychology in order to gain a broader understanding of this phenomenon. To declare that possession experiences are "nothing but psychosis, mania, epilepsy or schizophrenia, are examples of this type of over-simplification. The structure of possession can above all be understood as an interaction between a cognitive, linguistic level, and an emotional, affective level. Only if one unites these two levels can one attain a deeper understanding of the individual's possession experience. It is, in other words, important to remember that to increase understanding of the structure of possession, we must relate the individual's (bio-chemically conditioned intensive feeling experience to the surrounding subculture's way of defining these intensive feelings. Religious language provides one way of dealing verbally with the unstructured and terrifying aspects of a developing psychosis. It is, for example, possible to describe the personal transformation as a dynamic relationship between the verbal representatives for evil or the Evil One in the world of mythological language, and the intrapsychic, anxiety-filled emotive state, regardless of whether this inner state is considered to be the result of neurosis, psycho-sis, or the consequence of intensive suggestion.

  17. Children and Clinical Studies: Why Clinical Studies Are Important

    Medline Plus

    Full Text Available ... about Children and Clinical Studies Importance of Children in Clinical Studies Children have often had to accept ... treatments based on what is known to work in adults. To improve clinical care of children, more ...

  18. [Raynaud's phenomenon].

    Science.gov (United States)

    Saavedra Salinas, Miguel Ángel; Carrillo Vázquez, Sandra Miriam

    2006-11-01

    Raynaud's phenomenon is characterized by repeated daily attacks of ischemia followed by reperfusion at the acrallevel. It is a frequent syndrome found in medical practice; and it can be considered as primary or secondary to other conditions, including rheumatic autoimmune diseases. Current classification had clinical and therapeutic implications. Careful clinical evaluation is the most reliable and reproducible method in the diagnosis of Raynaud's phenomenon. Several risk factors had been associated in the genesis of Raynaud's phenomenon; however, its pathogenesis remains elusive although recently, considerable progress in disease mechanism had been described. Such advances are directing new lines of therapy.

  19. Artifactual Hypoglycaemia in Systemic Sclerosis and Raynaud's Phenomenon: A Clinical Case Report and Short Review

    Science.gov (United States)

    Suryawanshi, A.

    2016-01-01

    Background. Artifactual hypoglycaemia, defined as a discrepancy between glucometer (capillary) and plasma glucose levels, may lead to overtreatment and costly investigations. It is not infrequently observed in patients with Raynaud's phenomenon due to vascular capillary distortion, yet this is clinically underappreciated. Case Report. We report a 76-year-old woman with systemic sclerosis and Raynaud's phenomenon, who presented with upper gastrointestinal bleeding and found to have concomitant persistent hypoglycaemia (1.0–2.7mmol/L) on a point-of-care glucometer in the absence hypoglycaemic symptoms. She underwent a 2-week hospital admission, repeated glucose monitoring, hydrocortisone replacement and dextrose infusions, with consequent hyperglycaemia on plasma measurements. Clinically, she did not satisfy Whipple's triad and radiological investigations failed to identify pituitary or pancreatic pathology. A 72-hour fast was negative for hyperinsulinaemia or exogenous insulin use and her sulphonylurea metabolite urinary screen was negative. Discussion. Treatment of low capillary blood glucose is usually met with clinical impetus to treat, even when hypoglycaemic symptoms are lacking. The correct diagnosis may have been achieved had there been an observation of her cold hands, scleroderma facies, and consideration of the likely distorted peripheral microvasculature. Early identification of this presumably rare clinical scenario may have prevented overtreatment, altered methods of monitoring, and avoided unnecessary investigations. PMID:28116181

  20. Artifactual Hypoglycaemia in Systemic Sclerosis and Raynaud's Phenomenon: A Clinical Case Report and Short Review.

    Science.gov (United States)

    Bishay, R H; Suryawanshi, A

    2016-01-01

    Background. Artifactual hypoglycaemia, defined as a discrepancy between glucometer (capillary) and plasma glucose levels, may lead to overtreatment and costly investigations. It is not infrequently observed in patients with Raynaud's phenomenon due to vascular capillary distortion, yet this is clinically underappreciated. Case Report. We report a 76-year-old woman with systemic sclerosis and Raynaud's phenomenon, who presented with upper gastrointestinal bleeding and found to have concomitant persistent hypoglycaemia (1.0-2.7mmol/L) on a point-of-care glucometer in the absence hypoglycaemic symptoms. She underwent a 2-week hospital admission, repeated glucose monitoring, hydrocortisone replacement and dextrose infusions, with consequent hyperglycaemia on plasma measurements. Clinically, she did not satisfy Whipple's triad and radiological investigations failed to identify pituitary or pancreatic pathology. A 72-hour fast was negative for hyperinsulinaemia or exogenous insulin use and her sulphonylurea metabolite urinary screen was negative. Discussion. Treatment of low capillary blood glucose is usually met with clinical impetus to treat, even when hypoglycaemic symptoms are lacking. The correct diagnosis may have been achieved had there been an observation of her cold hands, scleroderma facies, and consideration of the likely distorted peripheral microvasculature. Early identification of this presumably rare clinical scenario may have prevented overtreatment, altered methods of monitoring, and avoided unnecessary investigations.

  1. Fallow practices in West Africa: A comparative importance of phenomenon in Cameroon and Nigeria

    OpenAIRE

    Nkamleu, Guy Blaise

    1999-01-01

    There is a clear need to understand the characteristics of fallow in order to seek appropriate alternatives. From a simultaneous study done in Cameroon and Nigeria, we assessed the specificity of fallow techniques in both countries and discovered that fallow practices remain important in traditional farming systems. Fallow is specifically applied in food crops and forest fields. There are less common in perennial fields and homegardens. Fallow practices remain the major land use technologies ...

  2. Simulation of the Clustering Phenomenon in a Fast Fluidized Bed: The Importance of Drag Correlation

    Institute of Scientific and Technical Information of China (English)

    李佑楚

    2004-01-01

    Drag force is a key parameter in the numerical modeling of gas-particle flow in circulating fluidized beds. The reliability of current drag force correlations over the regime of fast fluidization has, however, not been thoroughly investigated. In this article, a drag force correlation accounting for the clustering effects for Geldart A particles is used to simulate the behaviors typical of fast fluidization, including dynamic evolution of clusters as well as time- averaged axial and lateral voidage profiles. Diverse images of clusters are captured and the time-averaged profiles of voidage are shown to be in quantitative agreement with the present empirical correlation. The results based on different constitutive correlations of drag force show the importance of the choice of drag force in modeling fast-fluidized beds. This drag force correlation, based on a simple averaging assumption, could give some basic insights about the magnitude of the drag reduction.

  3. Vacuum phenomenon.

    Science.gov (United States)

    Yanagawa, Youichi; Ohsaka, Hiromichi; Jitsuiki, Kei; Yoshizawa, Toshihiko; Takeuchi, Ikuto; Omori, Kazuhiko; Oode, Yasumasa; Ishikawa, Kouhei

    2016-08-01

    This article describes the theory of the formation of the vacuum phenomenon (VP), the detection of the VP, the different medical causes, the different locations of the presentation of the VP, and the differential diagnoses. In the human body, the cavitation effect is recognized on radiological studies; it is called the VP. The mechanism responsible for the formation of the VP is as follows: if an enclosed tissue space is allowed to expand as a rebound phenomenon after an external impact, the volume within the enclosed space will increase. In the setting of expanding volume, the pressure within the space will decrease. The solubility of the gas in the enclosed space will decrease as the pressure of the space decreases. Decreased solubility allows a gas to leave a solution. Clinically, the pathologies associated with the VP have been reported to mainly include the normal joint motion, degeneration of the intervertebral discs or joints, and trauma. The frequent use of CT for trauma patients and the high spatial resolution of CT images might produce the greatest number of chances to detect the VP in trauma patients. The VP is observed at locations that experience a traumatic impact; thus, an analysis of the VP may be useful for elucidating the mechanism of an injury. When the VP is located in the abdomen, it is important to include perforation of the digestive tract in the differential diagnosis. The presence of the VP in trauma patients does not itself influence the final outcome.

  4. [Listeriosis in Mexico: Clinical and epidemiological importance].

    Science.gov (United States)

    Castañeda-Ruelas, Gloria; Eslava-Campos, Carlos; Castro-Del Campo, Nohelia; León-Félix, Josefina; Chaidez-Quiroz, Cristóbal

    2014-01-01

    Listeriosis is caused by Listeria monocytogenes, an important food-borne disease due to its clinical forms, high mortality rate, and the economic impact in both clinical and food production industries. In Mexico, the lack of epidemiological surveillance systems leads to the need of accurate data on the incidence of listeriosis and its association with food-borne disease. In this paper, we present data about the presence of this bacterium in food, reports related to clinical cases of listeriosis, and information of diseases in which L. monocytogenes may be involved. However, in most of these cases the etiology was not established. Given this, there's a need to inform and warn the appropriate entities, to define strategies for the mandatory search of L. monocytogenes through the whole food production chain and clinical suspects, for the epidemiological importance and control of listeriosis in Mexico.

  5. Listeriosis in Mexico: Clinical and epidemiological importance

    Directory of Open Access Journals (Sweden)

    Gloria Castañeda-Ruelas

    2014-11-01

    Full Text Available Listeriosis is caused by Listeria monocytogenes, an important food-borne disease due to its clinical forms, high mortality rate, and the economic impact in both clinical and food production industries. In Mexico, the lack of epidemiological surveillance systems leads to the need of accurate data on the incidence of listeriosis and its association with food-borne disease. In this paper, we present data about the presence of this bacterium in food, reports related to clinical cases of listeriosis, and information of diseases in which L. monocytogenes may be involved. However, in most of these cases the etiology was not established. Given this, there´s a need to inform and warn the appropriate entities, to define strategies for the mandatory search of L. monocytogenes through the whole food production chain and clinical suspects, for the epidemiological importance and control of listeriosis in Mexico.

  6. Responsiveness and minimal clinically important change

    DEFF Research Database (Denmark)

    Christiansen, David Høyrup; Frost, Poul; Falla, Deborah

    2015-01-01

    Study Design A prospective cohort study nested in a randomized controlled trial. Objectives To determine and compare responsiveness and minimal clinically important change of the modified Constant score (CS) and the Oxford Shoulder Score (OSS). Background The OSS and the CS are commonly used...... to assess shoulder outcomes. However, few studies have evaluated the measurement properties of the OSS and CS in terms of responsiveness and minimal clinically important change. Methods The study included 126 patients who reported having difficulty returning to usual activities 8 to 12 weeks after...... were observed for the CS and the OSS. Minimal clinically important change ROC values were 6 points for the OSS and 11 points for the CS, with upper 95% cutoff limits of 12 and 22 points, respectively. Conclusion The CS and the OSS were both suitable for assessing improvement after decompression surgery....

  7. Importance of clinical examination in dentoalveolar trauma.

    Science.gov (United States)

    Marão, Heloisa Fonseca; Panzarini, Sônia Regina; Manrrique, Gustavo Rodrigues; Luvizuto, Eloá Rodrigues; Evangelista Melo, Moriel

    2012-09-01

    Dental injuries are often the result of direct trauma. The most affected teeth are the upper incisors, and the most frequent lesions are coronal fractures, contusions, and lip and alveolar mucosa lacerations. The objective of this study was to draw attention to the importance of the correct management of cases of crow fractures associated with soft tissue lacerations when the fragment is not located. This is a clinical case of crown fracture, the fragment of which remained lodged inside the lip. After fragment removal, the clinical case showed a satisfactory repair emphasizing the importance of a meticulous clinical examination to achieve a correct diagnosis and an appropriate treatment plan, which is essential for a favorable prognosis.

  8. PDE-5 Inhibitors in Scleroderma Raynaud Phenomenon and Digital Ulcers: Current Status of Clinical Trials

    Directory of Open Access Journals (Sweden)

    Ann J. Impens

    2011-01-01

    Full Text Available Systemic sclerosis- (SSc- related vasculopathy, as manifested by Raynaud's Phenomenon (RP and digital ulcers (DUs, is associated with significant impairment of the quality of life and morbidity. The current vasoactive approach for SSc-RP, although employing vasodilators, is entirely off-label. PDE-5 inhibitors improve peripheral circulation, are well tolerated, and are widely used for various forms of constrictive vasculopathies. This class of medications has become one of the first lines of treatment of SSc-RP and SSc-DUs among rheumatologists that routinely treat SSc patients. Due to the lack of robust randomized clinical trials of PDE-5 inhibitors in SSc-RP/DUs, the PDE-5 inhibitors have not been FDA approved for these particular indications, which constitutes a significant barrier to prescribing this category of drugs. This paper reviews the current state of evidence-based knowledge in SSc-related vasculopathy and the use of PDE-5 inhibitors.

  9. Clinical importance of the middle meningeal artery.

    Science.gov (United States)

    Chmielewski, Przemyslaw; Skrzat, Janusz; Walocha, Jerzy

    2013-01-01

    Middle meningeal artery (MMA)is an important branch which supplies among others cranial dura mater. It directly attaches to the cranial bones (is incorporated into periosteal layer of dura mater), favors common injuries in course of head trauma. This review describes available data on the MMA considering its varability, or treats specific diseases or injuries where the course of MMA may have clinical impact.

  10. Giant U waves: an important clinical clue

    Directory of Open Access Journals (Sweden)

    Verma N

    2011-04-01

    Full Text Available Nitin Verma, Vincent M Figueredo, Allan M Greenspan, Gregg S PressmanAlbert Einstein Medical Center, Philadelphia, PA, USAAbstract: Electrocardiographic U waves are a common clinical finding, and yet are poorly understood by many physicians. They can be seen in many clinical conditions, most importantly hypokalemia and ischemic heart disease. Over the years, many theories have been put forth to explain their origin. While still not completely understood, it now appears that mechanoelectrical interactions are responsible for normal U waves. Pathologic U waves may be seen in ischemic heart disease where they sometimes point to acute ischemic events. The large U waves of hypokalemia are most likely not true U waves but rather the terminal deflection in a bifid T wave.Keywords: U waves, hypokalemia, myocardial ischemia, electrocardiogram

  11. [Clinical importance of thyroid gland cytology].

    Science.gov (United States)

    Ting, S; Synoracki, S; Bockisch, A; Führer, D; Schmid, K W

    2015-11-01

    The cytological evaluation of fine needle biopsies (FNB) of the thyroid gland crucially depends on a close cooperation between clinicians and cytopathologists. Scintigraphy, sonography as well as clinical data and patient history are necessary for a correct interpretation of the indications for FNB; moreover, these data are of outstanding importance for cytopathologists for the correct interpretation of the cytomorphological findings. This overview describes the present standards in the acquisition, technical workup and cytopathological interpretation of thyroid gland tissue obtained by FNB, particularly focusing on the rapidly growing relevance of additional molecular pathological investigations to increase the diagnostic accuracy of thyroid FNB.

  12. Cerebral hemodynamics: concepts of clinical importance

    Directory of Open Access Journals (Sweden)

    Edson Bor-Seng-Shu

    2012-05-01

    Full Text Available Cerebral hemodynamics and metabolism are frequently impaired in a wide range of neurological diseases, including traumatic brain injury and stroke, with several pathophysiological mechanisms of injury. The resultant uncoupling of cerebral blood flow and metabolism can trigger secondary brain lesions, particularly in early phases, consequently worsening the patient's outcome. Cerebral blood flow regulation is influenced by blood gas content, blood viscosity, body temperature, cardiac output, altitude, cerebrovascular autoregulation, and neurovascular coupling, mediated by chemical agents such as nitric oxide (NO, carbon monoxide (CO, eicosanoid products, oxygen-derived free radicals, endothelins, K+, H+, and adenosine. A better understanding of these factors is valuable for the management of neurocritical care patients. The assessment of both cerebral hemodynamics and metabolism in the acute phase of neurocritical care conditions may contribute to a more effective planning of therapeutic strategies for reducing secondary brain lesions. In this review, the authors have discussed concepts of cerebral hemodynamics, considering aspects of clinical importance.

  13. Nutcracker or left renal vein compression phenomenon: multidetector computed tomography findings and clinical significance

    Energy Technology Data Exchange (ETDEWEB)

    Cuellar i Calabria, Hug; Quiroga Gomez, Sergi; Sebastia Cerqueda, Carmen; Boye de la Presa, Rosa; Miranda, Americo; Alvarez-Castells, Agusti [Hospitals Universitaris Vall D' Hebron, Institut de Diagnostic Per La Imatge, Servei De Radiodiagnostic, Barcelona (Spain)

    2005-08-01

    The use of multidetector computed tomography (MDCT) in routine abdominal explorations has increased the detection of the nutcracker phenomenon, defined as left renal vein (LRV) compression by adjacent anatomic structures. The embryology and anatomy of the nutcracker phenomenon are relevant as a background for the nutcracker syndrome, a rare cause of hematuria as well as other symptoms. MDCT examples of collateral renal vein circulation (gonadal, ureteric, azygous, lumbar, capsular) and aortomesenteric (anterior) and retroaortic (posterior) nutcracker phenomena in patients with no urologic complaint are shown as well as studies performed on patients with gross hematuria of uncertain origin. Incidental observation of collateral veins draining the LRV in abdominal MDCT explorations of asymptomatic patients may be a sign of a compensating nutcracker phenomenon. Imbalance between LRV compression and development of collateral circulation may lead to symptomatic nutcracker syndrome. (orig.)

  14. Is Cervical Inlet Patch Important Clinical Problem?

    Science.gov (United States)

    SAHIN, Gurol; ADAS, Gokhan; KOC, Bora; AKCAKAYA, Adem; DOGAN, Yasar; Goksel, Suha; Yalcin, Ozben

    2014-01-01

    AIM: In this study we aim to determine the frequency of Inlet Patch (IP) and its association to clinical symptoms and draw attention to be aware of this heterotopic gastric mucosa. METHODS: This study was a prospective case series that IP was detected in the upper gastrointestinal endoscopy. Patients with laringopharyngeal reflux symptoms underwent endoscopy between March 2009 and July 2012 in two different institutions. All the biopsies were obtained from if there is the IP lesion and antral or/and gastric mucosa. The data was prospectively evaluated. The prevalence was compared with those of patients that did not determine IP in the study period. RESULTS: 3907 upper gastrointestinal system endoscopy was performed while 123 patients consist of 51 male and 72 female was determined as IP. The prevalence of IP in patiens who underwent upper gastrointestinal endoscopy was 3.14% in our study. The majority of symptoms of those who had IP were laringopharyngeal reflux symptoms. Heterotopic gastric mucosa was fixed in 114 cases while 28 chronic inflammation, 9 esophagitis, 5 intestinal metaplasia, 4 glicogenic acanthosis were obtained as additional findings in pathological examinations. CONCLUSION: Heterotopic gastric mucosa in the proximal esophagus is a frequent finding if the endoscopist is aware of this entity. The importance of IP is the increasing number of cases of neoplastic transformation. Symptomatic patients should be treated and should be considered of the complications of heterotopic gastric mucosa. PMID:25018682

  15. [Raynaud's phenomenon].

    Science.gov (United States)

    Sprynger, M

    2004-06-01

    Raynaud's phenomenon (RP) is a common vascular disorder characterized by a recurrent transient vasospasm of the fingers and toes on exposure to cold or with emotional stress. Clinical criteria are used to distinguish patients with primary or idiopathic RP (formely Raynaud's disease) from those with secondary RP (formely Raynaud's syndrome). They include history, general physical examination, capillaroscopy, test for antinuclear antibody and erythrocyte sedimentation rate. More specific exams may be needed in selective cases. Excluding RP of occupational origin, the most common cause of secondary RP is a connective tissue disease (particularly scleroderma). RP may precede other clinical symptoms by several years, but most patients with RP will not progress to systemic disease. Nevertheless, primary RP may cause significant disability. We review the pathophysiology and clinical criteria of the disorder. Unfortunately, management of PR is still empirical and largely supportive.

  16. Children and Clinical Studies: Why Clinical Studies Are Important

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  17. Dermatophytid in tinea capitis: rarely reported common phenomenon with clinical implications.

    Science.gov (United States)

    Cheng, Nancy; Rucker Wright, Dakara; Cohen, Bernard A

    2011-08-01

    Tinea capitis may be associated with a dermatophytid, which appears as a disseminated eczematous eruption. This phenomenon may occur before or after initiation of systemic antifungal drug therapy and is not an indication for stopping medication. We present here a series of cases that involve 5 children with tinea capitis who developed a dermatophytid before or during the course of their management. In each child, the eruption resolved despite continuation of oral antifungal therapy. Our experience suggests that dermatophytid secondary to tinea capitis is much more common than reported. Furthermore, parents and clinicians frequently mistake dermatophytid for drug allergy. Recognition of this phenomenon, distinction of dermatophytid from drug allergy, and continuation of systemic treatment is essential for clearing the infection and dermatophytid.

  18. Statistics in clinical research: Important considerations.

    Science.gov (United States)

    Barkan, Howard

    2015-01-01

    Statistical analysis is one of the foundations of evidence-based clinical practice, a key in conducting new clinical research and in evaluating and applying prior research. In this paper, we review the choice of statistical procedures, analyses of the associations among variables and techniques used when the clinical processes being examined are still in process. We discuss methods for building predictive models in clinical situations, and ways to assess the stability of these models and other quantitative conclusions. Techniques for comparing independent events are distinguished from those used with events in a causal chain or otherwise linked. Attention then turns to study design, to the determination of the sample size needed to make a given comparison, and to statistically negative studies.

  19. A clinical survey of laryngectomy patients to detect presence of the false perception of an intact larynx or the "phantom larynx" phenomenon

    Directory of Open Access Journals (Sweden)

    Pankaj Chaturvedi

    2013-01-01

    Full Text Available Hypothesis: The Phantom larynx phenomenon (the false perception on an intact larynx in a laryngectomee exists and is an important issue in the post-laryngectomy rehabilitation of such patients. Objectives: The phantom limb phenomenon has been described after amputation of a limb or other parts of the body. Amputation or removal of any part is usually associated with a global feeling that the missing part is still present. We undertook this study to identify whether a phantom larynx phenomenon actually exists in laryngectomees. We also aimed to elicit its association with the duration following surgery. Patients and Methods: We did a clinical survey of 66 post-laryngectomy patients (30-80 years of age. Twenty-two of these patients were assessed within 6 months following surgery, whereas 44 patients were assessed at least 6 months later. A questionnaire containing 11 questions was served to these laryngectomees pertaining to false perception of persistent laryngeal functions and adaptation to the post-laryngectomy status. Results: All patients showed an evidence of a phantom larynx phenomenon. In the majority of these patients, it persisted even after 6 months following surgery. There was no significant difference in the two groups (less than or more than 6 months except for one question pertaining to occlusion of stoma for speech (77% vs. 29%. False perception of nasal breathing (59% and 43% and olfactory sensation (63% in both groups were the most common. Conclusion: Phantom larynx phenomenon following laryngectomy exists and may cause anxiety and poor rehabilitation among patients. Education and rehabilitation with regards to such a phenomenon is therefore needed in all patients.

  20. Children and Clinical Studies: Why Clinical Studies Are Important

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  1. The importance of clinical and management scripts.

    Science.gov (United States)

    Levin, Roger P

    2004-07-01

    Simply having excellent clinical skills is not enough to enable you to achieve practice goals. In the end, people will validate the quality of the practice based on the way you and your team communicate. It is amazing to realize how much impact we have on other individuals, based purely on what we say. A well-groomed dentist and staff possessing very attractive features and beautiful teeth almost invariably will work in the practice's favor. However, these traits, powerful as they may be, are incomplete without the ability to say the right thing at the right time. In the practice, the easiest way to ensure consistently excellent communication is to use clinical and management scripts. Nothing you do in your practice will equal the impact of what you say because it affects patient perceptions of quality and overall customer service experiences. Your goal is to have all routine communications in the practice turned into written scripts within 6 months.

  2. [Raynaud's phenomenon].

    Science.gov (United States)

    Piérard-Franchimont, C; Piérard, G E; Hermanns-Lê, T

    2012-12-01

    Raynaud's phenomenon is a vascular acrosyndrome caused by a variety of diseases. There is a distinction between the idiopathic Raynaud's disease, the secondary types and the suspicious idiopathic Raynaud's phenomenon.

  3. Electrical storm: definitions, clinical importance, and treatment.

    Science.gov (United States)

    Gao, Dongsheng; Sapp, John L

    2013-01-01

    With increasing use of implantable cardioverter defibrillators, physicians are increasingly called upon to manage recurrent ventricular tachycardia, sometimes in the form of frequent recurrences known as electrical storm (or ventricular tachycardia storm). Standard antiarrhythmic drug therapy may suppress storms, but, when refractory, interventions such as catheter ablation or in some cases surgical cardiac denervation may be helpful. Earlier interventional management may confer better outcomes than persisting with antiarrhythmic pharmacologic therapy. The clinical syndrome of electrical storm has been defined empirically. An outcome-derived definition may better guide clinicians on when and how to treat this emergent problem. When available, an early interventional approach is preferred.

  4. Fluorescence characterization of clinically-important bacteria.

    Directory of Open Access Journals (Sweden)

    Lewis R Dartnell

    Full Text Available Healthcare-associated infections (HCAI/HAI represent a substantial threat to patient health during hospitalization and incur billions of dollars additional cost for subsequent treatment. One promising method for the detection of bacterial contamination in a clinical setting before an HAI outbreak occurs is to exploit native fluorescence of cellular molecules for a hand-held, rapid-sweep surveillance instrument. Previous studies have shown fluorescence-based detection to be sensitive and effective for food-borne and environmental microorganisms, and even to be able to distinguish between cell types, but this powerful technique has not yet been deployed on the macroscale for the primary surveillance of contamination in healthcare facilities to prevent HAI. Here we report experimental data for the specification and design of such a fluorescence-based detection instrument. We have characterized the complete fluorescence response of eleven clinically-relevant bacteria by generating excitation-emission matrices (EEMs over broad wavelength ranges. Furthermore, a number of surfaces and items of equipment commonly present on a ward, and potentially responsible for pathogen transfer, have been analyzed for potential issues of background fluorescence masking the signal from contaminant bacteria. These include bedside handrails, nurse call button, blood pressure cuff and ward computer keyboard, as well as disinfectant cleaning products and microfiber cloth. All examined bacterial strains exhibited a distinctive double-peak fluorescence feature associated with tryptophan with no other cellular fluorophore detected. Thus, this fluorescence survey found that an emission peak of 340nm, from an excitation source at 280nm, was the cellular fluorescence signal to target for detection of bacterial contamination. The majority of materials analysed offer a spectral window through which bacterial contamination could indeed be detected. A few instances were found of

  5. Artifactual Hypoglycaemia in Systemic Sclerosis and Raynaud’s Phenomenon: A Clinical Case Report and Short Review

    Directory of Open Access Journals (Sweden)

    RH Bishay

    2016-01-01

    Full Text Available Background. Artifactual hypoglycaemia, defined as a discrepancy between glucometer (capillary and plasma glucose levels, may lead to overtreatment and costly investigations. It is not infrequently observed in patients with Raynaud’s phenomenon due to vascular capillary distortion, yet this is clinically underappreciated. Case Report. We report a 76-year-old woman with systemic sclerosis and Raynaud’s phenomenon, who presented with upper gastrointestinal bleeding and found to have concomitant persistent hypoglycaemia (1.0–2.7mmol/L on a point-of-care glucometer in the absence hypoglycaemic symptoms. She underwent a 2-week hospital admission, repeated glucose monitoring, hydrocortisone replacement and dextrose infusions, with consequent hyperglycaemia on plasma measurements. Clinically, she did not satisfy Whipple’s triad and radiological investigations failed to identify pituitary or pancreatic pathology. A 72-hour fast was negative for hyperinsulinaemia or exogenous insulin use and her sulphonylurea metabolite urinary screen was negative. Discussion. Treatment of low capillary blood glucose is usually met with clinical impetus to treat, even when hypoglycaemic symptoms are lacking. The correct diagnosis may have been achieved had there been an observation of her cold hands, scleroderma facies, and consideration of the likely distorted peripheral microvasculature. Early identification of this presumably rare clinical scenario may have prevented overtreatment, altered methods of monitoring, and avoided unnecessary investigations.

  6. [Clinical microbiology laboratory and imported parasitic diseases].

    Science.gov (United States)

    Martín-Rabadán, Pablo; Martínez-Ruiz, Rocío; Cuadros, Juan; Cañavate, Carmen

    2010-12-01

    Imported parasitosis represents an increasingly frequent diagnostic challenge for microbiology laboratories. A surge in immigration and international travel has led to a rise in the number of imported cases of parasitosis, and this trend is expected to continue in the future. The present article addresses this challenge by reviewing recommended diagnostic approaches and tests. Currently, microscopy is always recommended when analysing blood samples for parasites. If malaria is suspected, rapid antigen testing (including at least HRP2 antigen) should also be performed. The work-up for suspected leishmaniasis should include serology, culture, and in selected cases detection of antigen in urine. In suspected Chagas disease, two different serological tests should be performed. PCR for blood protozoa is highly sensitive, although it cannot be used to rule out Chagas disease, since this condition may be present without parasitemia. Accurate diagnosis of intestinal amebiasis usually requires PCR or antigen detection tests. In helminthiasis, traditional microscopy may need to be complemented with other tests, such as agar plate culture for strongyloidiasis, Og4C3 antigen detection for bancroftian filariasis, and antibody detection test for filariasis and schistosomiasis.

  7. [Ectoparasitosis of clinical importance in Chile].

    Science.gov (United States)

    Moreno M, Claudia

    2011-10-01

    Several parasitic diseases affect the skin and appendages in humans, the most common are head lice and scabies. Both diseases have worldwide distribution with geographical variations. In Chile, the reported prevalence of head lice is 20-25% and of scabies 1-5%. Other ectoparasites include fleas and mite, causing transient parasitosis related to human and animal contact. These parasites are associated with various factors such as poor personal hygiene, promiscuity, long hair, crowding, and sharing of combs, among others. Various effective pharmacological therapies are available, which base on several active compounds. Important therapeutic options include topical treatments with pyrethroids, lindane, crotamiton, and malathion as well as oral medications such as ivermectin, which is used in case of drug intolerance, poor treatment response, infections with multiple parasites or concomitant bacterial infections. For some drugs, resistance has been reported in patients received multiple dosis.

  8. Children and Clinical Studies: Why Clinical Studies Are Important

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  9. Children and Clinical Studies: Why Clinical Studies Are Important

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    Full Text Available ... of Intramural Research Research Resources Research Meeting Summaries Technology Transfer Clinical Trials What Are Clinical Trials? Children & ... the general public. Last Updated: August 3, 2015 Resources Educational Website - English / Spanish ... FEAR ACT OIG CONTACT US National Institutes of Health Department of Health and Human Services USA.gov

  10. Clinically important factors influencing endothelial function.

    Science.gov (United States)

    Vapaatalo, H; Mervaala, E

    2001-01-01

    The endothelium, a continuous cellular monolayer lining the blood vessels, has an enormous range of important homeostatic roles. It serves and participates in highly active metabolic and regulatory functions including control of primary hemostasis, blood coagulation and fibrinolysis, platelet and leukocyte interactions with the vessel wall, interaction with lipoprotein metabolism, presentation of histocompatibility antigens, regulation of vascular tone and growth and further of blood pressure. Many crucial vasoactive endogenous compounds like prostacyclin, thromboxane, nitric oxide, endothelin, angiotensin, endothelium derived hyperpolarizing factor, free radicals and bradykinin are formed in the endothelial cells to control the functions of vascular smooth muscle cells and of circulating blood cells. These versatile and complex systems and cellular interactions are extremely vulnerable. The balances may be disturbed by numerous endogenous and exogenous factors including psychological and physical stress, disease states characterized by vasospasm, inflammation, leukocyte and platelet adhesion and aggregation, thrombosis, abnormal vascular proliferation, atherosclerosis and hypertension. The endothelial cells are also the site of action of many drugs and exogenous toxic substances (e.g. smoking, alcohol). As markers and assays for endothelial dysfunction, direct measurement of nitric oxide, its metabolites from plasma and urine, functional measurement of vascular nitric oxide dependent responses and assay of different circulating markers have been used. In numerous pathological conditions (e.g. atherosclerosis, hypertension, congestive heart failure, hyperhomocysteinemia, diabetes, renal failure, transplantation, liver cirrhosis) endothelial dysfunction has been described to exist. Some of them, as well as hormonal and nutritional factors and drug treatment will be discussed in this short review.

  11. [Clinical importance and diagnosis of halitosis].

    Science.gov (United States)

    Akos, Nagy; Zsolt, Brugoviczky; Péter, Novák; Gábor, Nagy

    2012-09-01

    The origin of halitosis comes from the Latin word "halitus" meaning 'breath, exhaled air', and in the Hungarian terminology it means bad and smelly breath. The human body emits a number of volatile molecules, which have a peculiar odour. Their presence is influenced by several factors, such as genetic, nutritional and psychological factors. Since bad breath belongs to taboo subjects, halitosis can often lead to social isolation. To determine the incidence of halitosis, an exact diagnosis is needed which sometimes predestinates the possible treatment as well. Investigators estimate the incidence about 50% in the whole population. The male/female ratio is the same and the incidence is growing with age. The diagnosis can be genuine halitosis, pseudo halitosis and halitophobia. We can divide the genuine type into physiological and pathophysiological subtypes. The cause of the halitosis usually can be found in the oral cavity. The volatile sulfur compounds (VSC) produced by some of the oral bacteria are responsible for its development. Only 10% of the causes are extraoral, mostly inflammation of airways or gastrointestinal disorders. The judgment of halitosis is based on three objective methods: the organoleptic, the sulphide monitoring and the gas cromatography methods. Since the origin of the halitosis is mainly the oral cavity, dentists should treat them. Beyond the dental treatments the enhancement of the oral hygiene, the continuous motivation and monitoring are also very important, such as the use of tongue cleansing and special anti-malodour rinses.

  12. Children and Clinical Studies: Why Clinical Studies Are Important

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  13. Children and Clinical Studies: Why Clinical Studies Are Important

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    Full Text Available ... Topics News & Resources Intramural Research Public Health Topics Education & Awareness Resources Contact The Health Information Center Health ... Systematic Evidence Reviews & Clinical Practice Guidelines Resources Continuing Education Researchers Funding Training & Career Development Division of Intramural ...

  14. Children and Clinical Studies: Why Clinical Studies Are Important

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    Full Text Available ... Topics News & Resources Intramural Research Public Health Topics Education & Awareness Resources Contact The Health Information Center Health ... Systematic Evidence Reviews & Clinical Practice Guidelines Resources Continuing Education Researchers Funding Training & Career Development Division of Intramural ...

  15. Opioid-induced hyperalgesia (OIH): a real clinical problem or just an experimental phenomenon?

    Science.gov (United States)

    Eisenberg, Elon; Suzan, Erica; Pud, Dorit

    2015-03-01

    Although opioid-induced hyperalgesia (OIH) is mentioned as a potential cause of opioid dose escalation without adequate analgesia, true evidence in support of this notion is relatively limited. Most studies conducted in the context of acute and experimental pain, which seemingly demonstrated evidence for OIH, actually might have measured other phenomena such as acute opioid withdrawal or tolerance. OIH studies in patients with chronic pain have used various experimental pain models (such as cold pain tolerance or heat pain intensity). Therefore, the fact that they have yielded inconsistent results is hard to interpret. Thus far, with the exception of a few clinical case reports on OIH in patients with cancer pain and one prospective study in patients with chronic neuropathic pain, evidence for OIH in patients with chronic or cancer-related pain is lacking. Whether experimental pain models are necessary for establishing the clinical diagnosis of OIH, and which specific model is preferred, are yet to be determined.

  16. Children and Clinical Studies: Why Clinical Studies Are Important

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    Full Text Available ... to fill an important gap in information and education for parents, clinicians, researchers, children, and the general public. Last Updated: August 3, 2015 ... US National Institutes of Health Department of Health and Human Services USA.gov

  17. The reverse redistribution phenomenon with Tl-201: Coronary angiographic and clinical correlation

    Energy Technology Data Exchange (ETDEWEB)

    Silberstein, E.B.; DeVries, D.F.

    1984-01-01

    Poor perfusion with Tl-201 in a myocardial segment at rest with apparently normal distribution immediately post-exercise, (reverse redistribution, RR) has been correlated with a high probability of coronary artery disease (CAD) in two previous studies of 20 and of 5 patients. In 785 consecutive Tl-201 exercise studies over a 15 month period the authors re-examined the clinical and coronary angiographic correlates of this finding. RR was read on 38 studies (5%) and of these, 20 patients had coronary angiograms. Of these 20, 9 (5 male, 4 female) had coronary arteries with <50% stenosis but three of these 9 had other diseases involving the heart (idiopathic cardiomyopathy, 2: familial Mediterranean fever). Six of these false positives with RR had no defect immediately post stress, while three also had perfusion defects post stress which improved. Of the 11 true positives with abnormal angiography and RR, 4 had only RR while 7 had RR plus other post stress defects. Contrary to prior reports, in only 7 of the 11 was the vessel supplying the area of RR the least obstructed coronary artery. RR therefore had a positive predictive value for C.A.D. 11/20 = 55%, also contrary to prior reports. For all heart disease the predictive value rises to 14/20 = 70%.

  18. Raynaud's phenomenon

    DEFF Research Database (Denmark)

    Nielsen, S L; Christensen, N J; Olsen, N

    1980-01-01

    The reaction to body and finger cooling was recorded in seven patients with relapse of primary Raynaud's phenomenon after sufficiently performed bilateral upper thoracic sympathectomy and for comparison in eight young women with primary Raynaud's phenomenon as well as in seven normal women......,05). There was no significant correlation between the vasoconstrictor response to cooling of a finger and the noradrenaline concentration probably due to the fact that skin vasoconstriction impeded release of noradrenaline from the skin. The relapse of Raynaud's phenomenon after surgically sufficient sympathectomy could...

  19. The importance of fluid balance in clinical practice.

    Science.gov (United States)

    Scales, Katie; Pilsworth, Julie

    This article reviews the physiology that underpins normal fluid balance and discusses how fluid balance can be affected by illness. Clinical assessment of hydration and the importance of fluid balance record keeping are explained. Recommendations are made to improve fluid balance management in clinical practice and the professional importance of record keeping is highlighted.

  20. The importance of practice guidelines in clinical care.

    Science.gov (United States)

    Sciarra, Erica

    2012-01-01

    This position paper is a brief review of the importance of practice guidelines in clinical use. Emphasis is placed on evidence-based practice guidelines and research. This position paper attests to the importance of the use of guidelines that direct clinical nursing practice.

  1. Change in molecular weight due to important pfatp6 and pfmdr1 polymorphisms and susceptibility to antimalarial drug: Possible role of epigenetic phenomenon

    Directory of Open Access Journals (Sweden)

    Somsri Wiwanitkit

    2017-03-01

    Full Text Available Malaria is an important tropical mosquito borne infection. It is still the present global public health issue. The management of malaria requires antimalarial drugs. The resistance to antimalarial drugs is a very big problem. The genetic variant is proposed to be an important factor affecting susceptibility to antimalarial drug. Here, the authors studied the change in molecular weight due to important pfatp6 and pfmdr1 polymorphisms and further implied the interrelationship with susceptibility to antimalarial drug. The greatest change can be seen in case of G639D (of pfatp6 polymorphism while the least change can be seen in the case of N1042D (of pfmdr1 polymorphism. The results from some studies imply that there must be other factors that affect the susceptibility to antimalarial drugs. Those factors might be protein conformation factors, epigenetic factors or environmental factors. Further studies on these aspects should be carried out. It is concluded for possible role of epigenetic phenomenon.

  2. Raynaud's phenomenon in primary Sjögren's syndrome. Prevalence and clinical characteristics in a series of 320 patients.

    Science.gov (United States)

    García-Carrasco, Mario; Sisó, Antoni; Ramos-Casals, Manuel; Rosas, José; de la Red, Gloria; Gil, Victor; Lasterra, Susana; Cervera, Ricard; Font, Josep; Ingelmo, Miguel

    2002-04-01

    To determine the prevalence of Raynaud's phenomenon (RP) in a large series of patients with primary Sjögren's syndrome (SS) and to identify the clinical and immunological features related to its presence. In a cross sectional study, we investigated 320 consecutive patients with primary SS (294 women, 26 men; mean age at onset 60 yrs, range 16-87 yrs). All patients fulfilled 4 or more of the diagnostic criteria for SS proposed by the European Community Study Group in 1993. Diagnosis of RP in patients with SS was defined as intermittent attacks of digital pallor and/or cyanosis in the absence of any other associated disease or anatomical abnormalities. RP was present in 40 (13%) patients. All were women, with a mean age of 57 yrs (range 18-78). RP preceded onset of sicca symptomatology in 18 (45%) patients. The main triggering factor was exposure to cold, which induced RP in all patients, while emotional stress was a factor in 12 patients, as was job related predisposition in 2. Fifteen (38%) patients required pharmacological treatment with calcium channel blockers (12 patients) or angiotensin converting enzyme inhibitors (2 patients) during colder months, and one patient required treatment with intravenous prostacyclin for ischemic complications. Compared with SS patients without RP, those with RP showed a higher prevalence of articular involvement (50 vs 31%; p = 0.031), cutaneous vasculitis (30 vs 11%; p = 0.003), antinuclear antibodies (95 vs 65%; p treatment needed in only 40% of patients.

  3. Interprofessional clinical education: clinicians' views on the importance of leadership.

    Science.gov (United States)

    Missen, Karen; Jacob, Elisabeth R; Barnett, Tony; Walker, Lorraine; Cross, Merylin

    2012-01-01

    The current shortage of health professionals necessitates new approaches to clinical education that can expand the number of undergraduate students undertaking clinical placements without increasing the burden on clinical staff or placing patients at risk. Interprofessional education has the potential to help increase clinical capacity whilst enriching students' clinical experience. This paper reports on a project which investigated the potential for interprofessional education to increase undergraduate clinical placement capacity in clinical settings. The project utilised an exploratory descriptive methodology to obtain the views of health care professionals about the use of interprofessional education in clinical education at three rural health facilities in Victoria, Australia. Participants (n = 57) had a key role with each health care facility in coordinating and facilitating undergraduate clinical placements. This paper examines the clinicians' views about the central role that leadership plays in actioning interprofessional education in the clinical setting. Whilst interprofessional education was regarded favourably by the majority of participants, data indicated that leadership from education providers, health services, and regulatory authorities was crucial to enable interprofessional education to be implemented and sustained within the clinical learning environment. Without leadership from each of these three spheres of influence, interprofessional education will continue to be difficult to implement for undergraduate students and compromise their exposure to an important aspect of the working life of health care professionals. Such a failure will limit graduates' readiness for collaborative and cross-disciplinary practice.

  4. Students' Assessment and Self-assessment of Nursing Clinical Faculty Competencies: Important Feedback in Clinical Education?

    Science.gov (United States)

    Lovrić, Robert; Prlić, Nada; Zec, Davor; Pušeljić, Silvija; Žvanut, Boštjan

    2015-01-01

    The students' assessment of clinical faculty competencies and the faculty members' self-assessment can provide important information about nursing clinical education. The aim of this study was to identify the differences between the students' assessment of the clinical faculty member's competencies and the faculty member's self-assessment. These differences can reveal interesting insights relevant for improving clinical practice.

  5. [Raynaud's phenomenon].

    Science.gov (United States)

    Tomčík, Michal

    2016-01-01

    Raynaud's phenomenon (RP) is a very common sign which can usually be seen across all medical specialties. It is characterized by episodic color changes of acral parts of the body (palor, cyanosis, rubor) lasting from a few minutes to hours, which are usually triggered by cold temperature and/or stress. The primary RP occurs alone, without concomitant diseases, is usually benign and has favorable prognosis. Secondary RP occurs in a variety of diseases with a very variable progression and prognosis, mostly unfavorable one due to the development of ischemic tissue necrosis and gangrene. This work provides a comprehensive overview of the history, current knowledge about the epidemiology and pathogenesis and the recommended evaluation and treatment of RP.

  6. Graduate admissions in clinical neuropsychology: the importance of undergraduate training.

    Science.gov (United States)

    Karazsia, Bryan T; Stavnezer, Amy Jo; Reeves, Jonathan W

    2013-11-01

    Discussions of and recommendations for the training of clinical neuropsychologists exist at the doctoral, internship, and post-doctoral level. With few exceptions, the literature on undergraduate preparations in clinical neuropsychology is sparse and lacks empirical evidence. In the present study, graduate-level faculty and current trainees completed surveys about graduate school preparations. Faculty expectations of minimum and ideal undergraduate training were highest for research methods, statistics, and assessment. Preferences for "goodness of fit" also emerged as important admissions factors. These results offer evidence for desirable undergraduate preparations for advanced study in clinical neuropsychology. Although undergraduate training in psychology is intentionally broad, results from this study suggest that students who desire advanced study in clinical neuropsychology need to tailor their experiences to be competitive in the application process. The findings have implications for prospective graduate students, faculty who train and mentor undergraduates, and faculty who serve on admissions committees.

  7. Pathogenesis of Raynaud's phenomenon.

    Science.gov (United States)

    Herrick, A L

    2005-05-01

    The pathogenesis of Raynaud's phenomenon is not fully understood. However, the last 20 yr have witnessed enormous increases in our understanding of different mechanisms which, singly or in combination, may contribute. A key point is that Raynaud's phenomenon can be either primary (idiopathic) or secondary to a number of underlying conditions, and that the pathogenesis and pathophysiology vary between these conditions. This review concentrates upon those subtypes of Raynaud's phenomenon of most interest to rheumatologists: systemic sclerosis-related Raynaud's phenomenon, primary Raynaud's phenomenon and Raynaud's phenomenon secondary to hand-arm vibration syndrome. In this review, I shall discuss the main mechanisms thought to be important in pathophysiology under the three broad headings of 'vascular', 'neural' and 'intravascular'. While these are false distinctions because all interrelate, they facilitate discussion of the key elements: the blood vessel wall (particularly the endothelium), the neural control of vascular tone, and the many circulating factors which can impair blood flow and/or cause endothelial injury. Vascular abnormalities include those of both structure and function. Neural abnormalities include deficiency of the vasodilator calcitonin gene-related peptide (released from sensory afferents), alpha(2)-adrenoreceptor activation (possibly with up-regulation of the normally 'silent' alpha(2C)-adrenoreceptor) and a central nervous system component. Intravascular abnormalities include platelet activation, impaired fibrinolysis, increased viscosity and probably oxidant stress. As our understanding of the pathophysiology of Raynaud's phenomenon increases, so do our possibilities for identifying effective treatments.

  8. Treatment of Raynaud's phenomenon.

    Science.gov (United States)

    García-Carrasco, Mario; Jiménez-Hernández, Mario; Escárcega, Ricardo O; Mendoza-Pinto, Claudia; Pardo-Santos, Rodrigo; Levy, Roger; Maldonado, Claudio Galarza; Chávez, Gonzalo Pérez; Cervera, Ricard

    2008-10-01

    Raynaud's phenomenon is an episodic vasospasm of the peripheral arteries, causing pallor followed by cyanosis and redness with pain and sometimes paraesthesia, and, rarely, ulceration of the fingers and toes. Primary or idiopathic Raynaud's phenomenon (Raynaud's disease) occurs without an underlying disease. Secondary Raynaud's phenomenon (Raynaud's syndrome) occurs in association with an underlying disease. Initially conservative, non-pharmacologic approach is important for these patients, although pharmacologic therapy may ultimately be necessary. Advances in vascular physiology have showed the role of the endothelium as well as endothelium-independent mechanisms in the altered vasoregulation of Raynaud's phenomenon. This has opened promising therapeutic avenues, and it is likely that therapies targeted towards specific pathophysiologic steps become available in the near future.

  9. The Lazarus phenomenon.

    Science.gov (United States)

    Sahni, Vaibhav

    2016-08-01

    The Lazarus phenomenon or the unassisted return of spontaneous circulation after cardiac arrest is a grossly underreported phenomenon in medical literature which essentially implies the 'resurrection' of an individual after cardiac arrest. Although there have been a handful of such cases reported, the clinical incidence and significance may be underestimated. Because of the presumed infrequency of this condition, there are no studies specifically researching Lazarus phenomenon in scientific literature. This review intends to systematically present current and past knowledge on this rare but definitive phenomenon. Research databases namely Google Scholar, Science Direct, Medline and PubMed were utilized. Only articles which identified cases where the return of spontaneous circulation occurred after cessation of Cardiopulmonary Resuscitation (CPR), and review articles on the entity were included. The mentioned databases were searched using the terms 'Lazarus phenomenon', 'cardiopulmonary resuscitation' and 'return of spontaneous circulation'. A literature review was synthesised based on articles meeting the eligibility criteria to better understand the phenomenon of return of spontaneous circulation.

  10. The Clinical Importance of the Heterogeneity of HER2 neu

    Directory of Open Access Journals (Sweden)

    Enrique Davila

    2010-07-01

    Full Text Available We report on a patient with breast cancer in whom there were areas of the tumor that were 3+ positive and negative for HER2 neu by immunohistochemistry, adjacent to each other. Depending on the area tested the results were completely different. The clinical implications are important. We recommend retesting a large portion of the tumor in all cases of initially negative test results.

  11. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations

    DEFF Research Database (Denmark)

    Dworkin, R.H.; Turk, D.C.; Wyrwich, K.W.;

    2008-01-01

    . Provisional benchmarks for identifying clinically important changes in specific outcome measures that can be used for outcome studies of treatments for chronic pain are proposed. PERSPECTIVE: Systematically collecting and reporting the recommended information needed to evaluate the clinical importance......A consensus meeting was convened by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) to provide recommendations for interpreting clinical importance of treatment outcomes in clinical trials of the efficacy and effectiveness of chronic pain treatments. A group...... of 40 participants from universities, governmental agencies, a patient self-help organization, and the pharmaceutical industry considered methodologic issues and research results relevant to determining the clinical importance of changes in the specific outcome measures previously recommended by IMMPACT...

  12. [The importance of clinical observations for medical research].

    Science.gov (United States)

    Koller, F

    1976-10-30

    Medical progress owes a great deal to the fundamental medical sciences and to the application of chemistry, physics and mathematics to medical problems. However, clinical observations and investigations are still of decisive importance in any field of medicine. By a feed-back mechanism they may even stimulate and fertilize fundamental medical sciences. Thus, our knowledge of the blood coagulation mechanism has been considerably enlarged by clinical analysis of hereditary bleeding disorders. - Chemotherapy of neoplastic diseases started from clinical observations during World War I (production of leucopenia by sulfur mustard gas). - Surgical procedures and their consequences have contributed greatly to our knowledge of thyroid function, of the segmental anatomy of the lung, and of the conduction system of the heart. - Observations of side effects of drugs have often enlarged or completely changed their primary clinical indications: from antibacterial sulfonamides, anti-diabetic, antihypertensive and powerful diuretic drugs have been developed, and from histaminics the modern neuroleptics and antidepressants. - Fundamental immunology has been enormously activated by clinical transplantation of kidney and bone marrow. Selective immunological defects in men, real experiments of nature, contributed much to our knowledge of the various types of allergic response. The quality of clinical investigations, particularly of controlled clinical trials, has been considerably improved during the last two decades. Although it is an applied science the reliability of its results is to-day comparable with that of "pure" natural sciences. However, medicine is more than a natural science: examples of outstanding scientists who at the same time were great and human physicians are presented.

  13. Interpreting the clinical importance of group differences in chronic pain clinical trials: IMMPACT recommendations.

    Science.gov (United States)

    Dworkin, Robert H; Turk, Dennis C; McDermott, Michael P; Peirce-Sandner, Sarah; Burke, Laurie B; Cowan, Penney; Farrar, John T; Hertz, Sharon; Raja, Srinivasa N; Rappaport, Bob A; Rauschkolb, Christine; Sampaio, Cristina

    2009-12-01

    An essential component of the interpretation of results of randomized clinical trials of treatments for chronic pain involves the determination of their clinical importance or meaningfulness. This involves two distinct processes--interpreting the clinical importance of individual patient improvements and the clinical importance of group differences--which are frequently misunderstood. In this article, we first describe the essential differences between the interpretation of the clinical importance of patient improvements and of group differences. We then discuss the factors to consider when evaluating the clinical importance of group differences, which include the results of responder analyses of the primary outcome measure, the treatment effect size compared to available therapies, analyses of secondary efficacy endpoints, the safety and tolerability of treatment, the rapidity of onset and durability of the treatment benefit, convenience, cost, limitations of existing treatments, and other factors. The clinical importance of individual patient improvements can be determined by assessing what patients themselves consider meaningful improvement using well-described methods. In contrast, the clinical meaningfulness of group differences must be determined by a multi-factorial evaluation of the benefits and risks of the treatment and of other available treatments for the condition in light of the primary goals of therapy. Such determinations must be conducted on a case-by-case basis, and are ideally informed by patients and their significant others, clinicians, researchers, statisticians, and representatives of society at large.

  14. Anomalous posterior clinoid process and its clinical importance

    Directory of Open Access Journals (Sweden)

    Shipra Paul

    2007-09-01

    Full Text Available The anterior, middle and the posterior clinoid processes are located in the middle cranial fossa of the skull. The posterior boundary of the pituitary fossa is formed by the dorsum sellae, the supero-lateral angles of which are raised to form the posterior clinoid process. Unlike the anterior clinoid process, the posterior clinoid process has received less attention in past research studies. The anatomy textbooks do not mention about the anomalies pertaining to the posterior clinoid process and the main source of information are the research reports. The present osteological study describes anomalous posterior clinoid process, detected in two human skulls, during routine undergraduate medical teaching and also discusses its clinical importance. The posterior clinoid process anomalies may be responsible for the altered arrangement of the tentorium cerebelli which is attached to it. The internal carotid artery is often explored by the neuro-surgeon and any bony abnormalities in its vicinity, would result in a difficult situation, while performing clinoidectomy operations. Anomalous posterior clinoid process, may compress the internal carotid artery. The close position of the superior petrosal sinus and the internal carotid artery to the posterior clinoid process, makes it vulnerable to injuries and thus it is important for the neuro-surgeons performing clinoidectomy operations. The anatomy of the posterior clinoid process may be important for neuro surgeons and radiologists in day to day clinical practice.

  15. Anomalous posterior clinoid process and its clinical importance.

    Directory of Open Access Journals (Sweden)

    Shipra Paul

    2009-11-01

    Full Text Available The anterior, middle and the posterior clinoid processes are located in the middle cranial fossa of the skull. The posterior boundary of the pituitary fossa is formed by the dorsum sellae, the supero-lateral angles of which are raised to form the posterior clinoid process. Unlike the anterior clinoid process, the posterior clinoid process has received less attention in past research studies. The anatomy textbooks do not mention about the anomalies pertaining to the posterior clinoid process and the main source of information are the research reports. The present osteological study describes anomalous posterior clinoid process, detected in two human skulls, during routine undergraduate medical teaching and also discusses its clinical importance. The posterior clinoid process anomalies may be responsible for the altered arrangement of the tentorium cerebelli which is attached to it. The internal carotid artery is often explored by the neuro-surgeon and any bony abnormalities in its vicinity, would result in a difficult situation, while performing clinoidectomy operations. Anomalous posterior clinoid process, may compress the internal carotid artery. The close position of the superior petrosal sinus and the internal carotid artery to the posterior clinoid process, makes it vulnerable to injuries and thus it is important for the neuro-surgeons performing clinoidectomy operations. The anatomy of the posterior clinoid process may be important for neuro surgeons and radiologists in day to day clinical practice.

  16. The Lazarus phenomenon

    Science.gov (United States)

    2016-01-01

    The Lazarus phenomenon or the unassisted return of spontaneous circulation after cardiac arrest is a grossly underreported phenomenon in medical literature which essentially implies the ‘resurrection’ of an individual after cardiac arrest. Although there have been a handful of such cases reported, the clinical incidence and significance may be underestimated. Because of the presumed infrequency of this condition, there are no studies specifically researching Lazarus phenomenon in scientific literature. This review intends to systematically present current and past knowledge on this rare but definitive phenomenon. Research databases namely Google Scholar, Science Direct, Medline and PubMed were utilized. Only articles which identified cases where the return of spontaneous circulation occurred after cessation of Cardiopulmonary Resuscitation (CPR), and review articles on the entity were included. The mentioned databases were searched using the terms ‘Lazarus phenomenon’, ‘cardiopulmonary resuscitation’ and ‘return of spontaneous circulation’. A literature review was synthesised based on articles meeting the eligibility criteria to better understand the phenomenon of return of spontaneous circulation. PMID:27540490

  17. Niacin revisited: clinical observations on an important but underutilized drug.

    Science.gov (United States)

    Henkin, Y; Oberman, A; Hurst, D C; Segrest, J P

    1991-09-01

    To evaluate the efficacy and side effects of niacin therapy in dyslipidemic individuals. A retrospective analysis of patients' charts. An outpatient referral-based clinic specializing in the treatment of lipid disorders. All patients with dyslipidemia treated by niacin (n = 82) at the Atherosclerosis Detection and Prevention Clinic during 1987 to 1990, including a subgroup of 17 dyslipidemic heart transplant recipients. Niacin was well tolerated in 83% of the nontransplant group (n = 65) at an average dose of 2.5 +/- 0.9 g/day. Similar beneficial lipoprotein effects were found in the transplant and nontransplant patients. The high-density lipoprotein cholesterol (HDL-C) response to niacin therapy was independent of the baseline (HDL-C level. In the transplant group, 11 patients (65%) discontinued treatment, primarily because of hyperglycemia; this was especially prominent in those patients with pretreatment diabetes mellitus. Of the 15 patients using sustained-release niacin, eight cases of hepatitis were recorded, some during therapy with relatively low niacin doses. Several different sustained-release preparations were responsible for this phenomenon, suggesting that the cause was not a contaminant in the preparation. No cases of hepatitis were documented in the 67 patients using regular niacin. One case of hepatitis was recently observed in a patient who switched from one type to regular niacin to another; however, we have data to suggest that the substituted preparation was not an immediate-release niacin. A familial predisposition to hepatitis is suggested by the occurrence of this side effect in identical twin brothers and two sisters. A pharmacy survey disclosed that most pharmacists are unaware of the relationship of sustained-release niacin to hepatitis, have a negative impression of regular niacin, and do not stock this formulation. Finally, we found that in this small sample of patients, niacin used with lovastatin is a particularly effective drug

  18. MARTIN–GRUBER ANASTOMOSIS AND ITS CLINICAL IMPORTANCE

    Directory of Open Access Journals (Sweden)

    I. G. Mikhaylyuk

    2015-01-01

    Full Text Available The communication between the median and ulnar nerves on the forearm, known as the Martin–Gruber anastomosis, is widespread in the general population. Despite the fact that this connection is described by anatomists in XVIII century, its importance has only recently been appreciated because of the widespread of the electrophysiological techniques in clinical practies. However, in the Russian literature aspects of its practical value described so far is not enough. This article deals with the prevalence of the anastomosis, its anatomical and electrophysiological classification, options innervation of muscles of the hand, is carried out through him, described electrophysiological methods and criteria for its diagnosis, including the collision technique, in healthy subjects and patients with lesions of the median and ulnar nerves, given its practical value. Such a course of nerve fibers through this anastomosis can have a significant impact on the clinical manifestations in patients with lesions of the median and ulnar nerves, as well as the results of an electrophysiological study. Martin–Gruber anastomosis provides variability innervation muscles of the hand, which can make it difficult topic diagnostic damage to the median and ulnar nerves, in addition, because of the connection between the nerves of the clinical presentation may not reflect the extent of their defeat: the hand muscles function can be preserved with full nerve damage or, conversely, significantly disrupted with minimal nerve lesions. Moreover, different electrophysiological findings on patients with pathology of the median or ulnar nerves in the conditions of functioning anastomosis may also complicate the interpretation of the clinical data. Thus, knowledge of the anatomy and physiology of the Martin–Gruber communication as necessary for the electrophysiologist for correct interpretation of the finding and the clinician to accurately diagnose the pathology of the median

  19. [Clinical importance and diagnostic methods of minimal hepatic encephalopathy].

    Science.gov (United States)

    Stawicka, Agnieszka; Zbrzeźniak, Justyna; Świderska, Aleksandra; Kilisińska, Natalia; Świderska, Magdalena; Jaroszewicz, Jerzy; Flisiak, Robert

    2016-02-01

    Minimal hepatic encephalopathy (MHE) encompasses a number of neuropsychological and neurophysiological disorders in patients suffering from liver cirrhosis, who do not display abnormalities during a medical interview or physical examination. A negative influence of MHE on the quality of life of patients suffering from liver cirrhosis was confirmed, which include retardation of ability of operating motor vehicles and disruption of multiple health-related areas, as well as functioning in the society. The data on frequency of traffic offences and accidents amongst patients diagnosed with MHE in comparison to patients diagnosed with liver cirrhosis without MHE, as well as healthy persons is alarming. Those patients are unaware of their disorder and retardation of their ability to operate vehicles, therefore it is of utmost importance to define this group. The term minimal hepatic encephalopathy (formerly "subclinical" encephalopathy) erroneously suggested the unnecessity of diagnostic and therapeutic procedures in patients with liver cirrhosis. Diagnosing MHE is an important predictive factor for occurrence of overt encephalopathy - more than 50% of patients with this diagnosis develop overt encephalopathy during a period of 30 months after. Early diagnosing MHE gives a chance to implement proper treatment which can be a prevention of overt encephalopathy. Due to continuing lack of clinical research there exist no commonly agreed-upon standards for definition, diagnostics, classification and treatment of hepatic encephalopathy. This article introduces the newest findings regarding the importance of MHE, scientific recommendations and provides detailed descriptions of the most valuable diagnostic methods.

  20. The Alienation Phenomenon and the Situation of the Clinical Doctor%异化现象与临床医生的处境

    Institute of Scientific and Technical Information of China (English)

    周光峰

    2011-01-01

    The alienation phenomenon is revealed to be universal by reviewing of the alienationtheory. The idea and the judgement of clinical doctors are severely restricted by the alienation phenomenon from the hospital management, the health care system to the medical technology. Finally we conclude that only can we weaken the negative effect of the alienation by returnirtg to the human-oriented means.%通过对异化理论的阐述,揭示了异化现象的普遍存在性,从医院管理、医疗体制、医疗技术等各个方面分析了异化现象对于临床医生的思维和判断的制约,提出向"以人为本"的思想回归才是弱化异化的消极影响的途径.

  1. Taxonomy and antifungal susceptibility of clinically important Rasamsonia species

    DEFF Research Database (Denmark)

    Houbraken, J.; Giraud, S.; Meijer, M.

    2013-01-01

    In recent years, Geosmithia argillacea has been increasingly reported in humans and animals and can be considered an emerging pathogen. The taxonomy of Geosmithia was recently studied, and Geosmithia argillacea and related species were transferred to the new genus Rasamsonia. The diversity among...... a set of Rasamsonia argillacea strains, including 28 clinical strains, was studied, and antifungal susceptibility profiles were generated. Data obtained from morphological studies and from phylogenetic analyses of internal transcribed spacer (ITS) and partial _-tubulin and calmodulin sequences revealed...... was the least active of the antifungals tested. The phenotypically similar species R. brevistipitata and R. cylindrospora had different antifungal susceptibility profiles, and this indicates that correct species identification is important to help guide appropriate antifungal therapy....

  2. Variations in Transverse Foramina of Cervical Vertebrae: Morphology & Clinical Importance

    Directory of Open Access Journals (Sweden)

    Vaishakhi Gonsai

    2015-12-01

    Full Text Available Background: The purpose of this study is to investigate variations in transverse foramina in the cervical vertebrae and its morphological and clinical importance. Materials and Method : The variations in the number and size of transverse foramina was studied in total 200 human dried cervical vertebrae, which were taken from the Department of Anatomy, B.J.Medical College, Ahmedabad. All the vertebrae were observed for variation in number and size of transverse foramina. Results: Out of 200 cervical vertebrae, complete double transverse foramina were observed in 40 vertebrae (20%, among them unilateral double foramina were found in 31 vertebrae (15.5% and the bilateral double foramina were found in 9 vertebrae (4.5%. Incomplete double transverse foramina were observed in 22 vertebrae (11%, among them unilateral double foramina were found in 16 vertebrae (8% and bilateral double foramina were observed in 6 vertebrae (3%. Conclusion: Complete unilateral double transverse foramina of cervical vertebrae were more common than bilateral. Also unilateral small size transverse foramina of cervical vertebrae were also common. This variation is important for the neurosurgeon during cervical surgery. Under such condition the course of the vertebral artery may be distorted. It is also useful for Radiologist during CT and MRI scan.

  3. The Clinical Importance of Changes in Diabetic Retinopathy Severity Score.

    Science.gov (United States)

    Ip, Michael S; Zhang, Jiameng; Ehrlich, Jason S

    2017-05-01

    To investigate the clinical importance of changes in diabetic retinopathy severity score (DRSS) in patients with diabetic macular edema (DME) treated with intravitreal ranibizumab. Post hoc analysis of the phase III RIDE and RISE studies of ranibizumab for treatment of DME. Four hundred sixty-eight eyes treated with ranibizumab from randomization with gradable DRSS on baseline fundus photographs. Visual and anatomic outcomes were examined in eyes grouped according to DRSS change from baseline to month 24. Mean best-corrected visual acuity (BCVA) letter score change, proportion of patients with 15 or more Early Treatment Diabetic Retinopathy Study (ETDRS) letter score change, mean contrast sensitivity change, proportion of patients with resolved macular edema, and leakage on fluorescein angiography. Most (56.8%) patients treated with ranibizumab experienced 1-step or more improvement in DRSS from baseline to month 24; 40.0% had no change, and 3.2% experienced DRSS worsening. Patients with DRSS stability or improvement had greater mean BCVA letter score changes (+15.1, +14.2, +11.3, and +11.2 letters for ≥3-step improvement, ≥2-step improvement, 1-step improvement, and no DRSS change, respectively) compared with +5.0 letters in patients who had any DRSS worsening. Best-corrected visual acuity letter score gain of 15 letters or more was more common in patients with 2-step or 3-step or more DRSS improvement (51.9% and 44.6%, respectively) compared with those with a 1-step DRSS improvement, no change, or worsening (37.9%, 39.6%, and 26.7%, respectively). A loss of 15 letters or more in BCVA was more common in patients with any DRSS worsening (13.3%) compared with patients who had stable or improved DRSS (0%-2.8%). Resolution of macular edema was more common in patients with DRSS improvement: 84.2%, 87.7%, and 92.3% of patients with 1-step, 2-step or more, and 3-step or more improvement in DRSS achieved central foveal thickness of 250 μm or less, compared with

  4. The importance of Good Clinical Practice guidelines and its role in clinical trials.

    Science.gov (United States)

    Vijayananthan, A; Nawawi, O

    2008-01-01

    Good Clinical Practice (GCP) is an international ethical and scientific quality standard for the design, conduct, performance, monitoring, auditing, recording, analyses and reporting of clinical trials. It also serves to protect the rights, integrity and confidentiality of trial subjects. It is very important to understand the background of the formation of the ICH-GCP guidelines as this, in itself, explains the reasons and the need for doing so. In this paper, we address the historical background and the events that led up to the formation of these guidelines. Today, the ICH-GCP guidelines are used in clinical trials throughout the globe with the main aim of protecting and preserving human rights.

  5. PET: the importance of physicists for the clinical arena

    CERN Multimedia

    2005-01-01

    David Townsend giving a seminar at CERN on 9 February. The past few years have seen significant advances in the development of instrumentation for Positron Emission Tomography (PET). The recent appearance of combined PET and Computed Tomography (CT) scanners that can simultaneously image both anatomy and function is of particular importance. This was the main subject of "Advances in PET imaging: from physics to physician", a seminar presented at CERN by David Townsend on Wednesday 9 February  and organized by the TT and PH groups. David Townsend, who started his career at CERN in the 1970s, is now Professor at the Department of Medicine, University of Tennessee Medical Center (Knoxville, TN). Recipient of the 2004 Clinical Scientist of the Year Award, he is an internationally renowned researcher and PET physicist, with over 25 years of experience in the field. His 1999 image of the year, an award from the Society of Nuclear Medicine in the US, was produced using a combined state-of-the art PET and a true d...

  6. Raynaud's phenomenon of the nipple associated with labetalol use.

    Science.gov (United States)

    McGuinness, Naomi; Cording, Vicky

    2013-02-01

    Raynaud's phenomenon of the nipple is an unusual cause of severe nipple pain. Precipitants for Raynaud's phenomenon of the nipple are known to be cold temperatures, caffeine, and emotional stress. Nipple pain is quoted as the most common cause of cessation of breastfeeding. It is important that lactation consultants and other health care professionals are aware of Raynaud's phenomenon of the nipple and the treatment options available. This is a case of a 37-year-old woman, Gravida 2, Para 1, who was first seen in the antenatal clinic at 34 weeks gestation. A diagnosis of Raynaud's phenomenon of the nipple was made after she began taking labetalol for pregnancy-induced hypertension. The phenomenon had occurred in both of her previous pregnancies on commencing labetalol and resolved postnatally on cessation of the drug. We aim to raise awareness of both the condition itself and the potential role of labetalol in the development of Raynaud's phenomenon of the nipple.

  7. Raynaud’s phenomenon

    Directory of Open Access Journals (Sweden)

    F. Ingegnoli

    2011-09-01

    Full Text Available Raynaud’s phenomenon (RP is a vasospastic disorder characterized by episodic color changes of blanching, cyanosis, and hyperemia in response to cold and/or emotional stress. Although most typically noted in the fingers, the circulation of the toes, ears, nose and tongue is also frequently affected. Population studies have shown that RP in adults is more common in women than men, with prevalence estimates ranging from 4% to 30%. Geographic variations in the prevalence reflect differences in climate. RP may be a primary or a secondary process. LeRoy and Medsger suggested criteria for primary RP: symmetric attacks, the absence of tissue necrosis, ulceration or gangrene, the absence of a secondary cause, negative antinuclear antibodies, normal nailfold capillaroscopy and a normal erythrocyte sedimentation rate. Secondary RP is characterized by an age of onset of more than 30 years, painful and asymmetric attacks, ischemic skin lesions, positive autoautoantibodies, capillaroscopic abnormalities and/or clinical features suggestive of connective tissue diseases (CTDs. Among the CTDs, systemic sclerosis has the highest frequency of RP. Finding a cause for RP requires a knowledge of the patient’s occupational, smoking, drug history, physical examination, nailfold capillaroscopy, routine laboratory tests and autoantibodies. Furthermore, RP should be distinguished from acrocyanosis, a condition characterized by continuous cyanosis of the hands or feet that is aggravated by cold temperature. The most important instruction to the patient is abstinence from any smoking, offending drugs should be discontinued, and abrupt changes in temperature. If these measures are inadequate, calcium-channel blockers are the most widely used (nifedipine 30 mg up to 90 mg daily. Alternatively, sympatholytic agent (prazosin, angiotensin II -receptor type I antagonist (losartan, selective sertonin-reuptake inhibitor (fluoxetine may be useful. In the severe cases the role of

  8. Brief pain inventory--facial minimum clinically important difference.

    Science.gov (United States)

    Sandhu, Sukhmeet K; Halpern, Casey H; Vakhshori, Venus; Mirsaeedi-Farahani, Keyvan; Farrar, John T; Lee, John Y K

    2015-01-01

    Neurosurgeons are frequently the primary physicians measuring pain relief in patients with trigeminal neuralgia (TN). Unfortunately, the measurement of pain can be complex. The Brief Pain Inventory-Facial (BPI-Facial) is a reliable and validated multidimensional tool that consists of 18 questions. It measures 3 domains of pain: 1) pain intensity (worst and average pain intensity), 2) interference with general activities of daily living (ADL), and 3) face-specific pain interference. The objective of this paper is to determine the patient-reported minimum clinically important difference (MCID) using the BPI-Facial. The authors conducted a retrospective study of 234 patients with TN seen in a single neurosurgeon's office. Patients completed baseline and 1-month follow-up BPI-Facial questionnaires. The MCID was calculated using an anchor-based approach in which the defined anchor was the 7-point patient global impression of change (PGIC). Two statistical methods were employed: mean change score and optimal cutoff point. Using the mean change score method, the investigators calculated the MCID for the 3 domains of the BPIFacial: 44% and 30% improvement in pain intensity at its worst and average, respectively, 54% improvement in interference with general ADL, and 63% improvement in interference with facial ADL. Using the optimal cutoff point method, they also calculated the MCID for the 3 domains of the BPI-Facial: 57% and 28% improvement in pain intensity at its worst and average, respectively, 75% improvement in interference with general ADL, and 62% improvement in interference with facial ADL. The BPI-Facial is a multidimensional pain scale that measures 3 domains of pain. Although 2 statistical methods were used to calculate the MCID, the optimal cutoff point method was the superior one because it used data from the majority of subjects included in this study. A 57% improvement in pain intensity at its worst and a 28% improvement in pain intensity at its average were

  9. Clinically important drug-drug interactions in primary care.

    Science.gov (United States)

    Dhabali, A A H; Awang, R; Zyoud, S H

    2012-08-01

    Drug-drug interactions (DDIs) cause considerable morbidity and mortality worldwide and may lead to hospital admission. Sophisticated computerized drug information and monitoring systems, more recently established in many of the emerging economies, including Malaysia, are capturing useful information on prescribing. Our aim is to report on an investigation of potentially serious DDIs, using a university primary care-based system capturing prescription records from its primary care services. We retrospectively collected data from two academic years over 20 months from computerized databases at the Universiti Sains Malaysia (USM) from users of the USM primary care services. Three hundred and eighty-six DDI events were observed in a cohort of 208 exposed patients from a total of 23,733 patients, representing a 2-year period prevalence of 876·4 per 100,000 patients. Of the 208 exposed patients, 138 (66·3%) were exposed to one DDI event, 29 (13·9%) to two DDI events, 15 (7·2%) to three DDI events, 6 (2·9%) to four DDI events and 20 (9·6%) to more than five DDI events. Overall, an increasing mean number of episodes of DDIs was noted among exposed patients within the age category ≥70 years (P=0·01), an increasing trend in the number of medications prescribed (P<0·001) and an increasing trend in the number of long-term therapeutic groups (P<0·001). We describe the prevalence of clinically important DDIs in an emerging economy setting and identify the more common potentially serious DDIs. In line with the observations in developed economies, a higher number of episodes of DDIs were seen in patients aged ≥70 years and with more medications prescribed. The easiest method to reduce the frequency of DDIs is to reduce the number of medications prescribed. Therapeutic alternatives should be selected cautiously. © 2011 Blackwell Publishing Ltd.

  10. Copy number variation plays an important role in clinical epilepsy

    Science.gov (United States)

    Olson, Heather; Shen, Yiping; Avallone, Jennifer; Sheidley, Beth R.; Pinsky, Rebecca; Bergin, Ann M.; Berry, Gerard T.; Duffy, Frank H.; Eksioglu, Yaman; Harris, David J.; Hisama, Fuki M.; Ho, Eugenia; Irons, Mira; Jacobsen, Christina M.; James, Philip; Kothare, Sanjeev; Khwaja, Omar; Lipton, Jonathan; Loddenkemper, Tobias; Markowitz, Jennifer; Maski, Kiran; Megerian, J. Thomas; Neilan, Edward; Raffalli, Peter C.; Robbins, Michael; Roberts, Amy; Roe, Eugene; Rollins, Caitlin; Sahin, Mustafa; Sarco, Dean; Schonwald, Alison; Smith, Sharon E.; Soul, Janet; Stoler, Joan M.; Takeoka, Masanori; Tan, Wen-Han; Torres, Alcy R.; Tsai, Peter; Urion, David K.; Weissman, Laura; Wolff, Robert; Wu, Bai-Lin; Miller, David T.; Poduri, Annapurna

    2015-01-01

    Objective To evaluate the role of copy number abnormalities detectable by chromosomal microarray (CMA) testing in patients with epilepsy at a tertiary care center. Methods We identified patients with ICD-9 codes for epilepsy or seizures and clinical CMA testing performed between October 2006 and February 2011 at Boston Children’s Hospital. We reviewed medical records and included patients meeting criteria for epilepsy. We phenotypically characterized patients with epilepsy-associated abnormalities on CMA. Results Of 973 patients who had CMA and ICD-9 codes for epilepsy or seizures, 805 patients satisfied criteria for epilepsy. We observed 437 copy number variants (CNVs) in 323 patients (1–4 per patient), including 185 (42%) deletions and 252 (58%) duplications. Forty (9%) were confirmed de novo, 186 (43%) were inherited, and parental data were unavailable for 211 (48%). Excluding full chromosome trisomies, CNV size ranged from 18 kb to 142 Mb, and 34% were over 500 kb. In at least 40 cases (5%), the epilepsy phenotype was explained by a CNV, including 29 patients with epilepsy-associated syndromes and 11 with likely disease-associated CNVs involving epilepsy genes or “hotspots.” We observed numerous recurrent CNVs including 10 involving loss or gain of Xp22.31, a region described in patients with and without epilepsy. Interpretation Copy number abnormalities play an important role in patients with epilepsy. Given that the diagnostic yield of CMA for epilepsy patients is similar to the yield in autism spectrum disorders and in prenatal diagnosis, for which published guidelines recommend testing with CMA, we recommend the implementation of CMA in the evaluation of unexplained epilepsy. PMID:24811917

  11. What Is Raynaud's Phenomenon?

    Science.gov (United States)

    ... Phenomenon PDF Version Size: 59 KB November 2014 What Is Raynaud’s Phenomenon? Fast Facts: An Easy-to- ... use tools that vibrate, such as a jackhammer. What Are the Symptoms of Raynaud’s Phenomenon? The body ...

  12. Importance of clinical microbiologists for U.S. healthcare infrastructure.

    Science.gov (United States)

    Carvalho, John

    2011-01-01

    Clinical microbiologists are highly skilled scientists within national hospitals and reference laboratories who diagnose patients with infections by emerging pathogens. Most advanced training for clinical microbiologists occurs at universities, where an individual can receive certification as a "Medical Laboratory Scientist" (MLS). Unfortunately, many MLS programs have closed in the United States and this has caused a shortage of clinical microbiologists at U.S. hospitals and reference laboratories. This paper explores the present crisis in MLS training and its ramifications for the emergence of antibiotic-resistant bacteria, the economics of hospitals, and the overall health of the nation, and provides resolutions for better public health policy with respect to MLS education.

  13. Clinical and Business Intelligence: Why It's Important to Your Pharmacy.

    Science.gov (United States)

    Pinto, Brian; Fox, Brent I

    2016-07-01

    According to the Healthcare Information Management and Systems Society, "Clinical & Business Intelligence (C&BI) is the use and analysis of data captured in the healthcare setting to directly inform decision-making" (http://www.himss.org/library/clinical-business-intelligence). Some say that it is the right information given to the right person at the right time in the right way. No matter how you define it, the fact remains that timely access, synthesis, and visualization of clinical data have become key to how health professionals make patient care decisions and improve care delivery.

  14. Raynaud's phenomenon: pathogenesis and management.

    Science.gov (United States)

    Bakst, Richard; Merola, Joseph F; Franks, Andrew G; Sanchez, Miguel

    2008-10-01

    Raynaud's phenomenon is a common clinical disorder for which patients frequently seek the expertise and care of dermatologists. It is manifested by recurrent vasospasm of the fingers and toes, often associated with exposure to cold temperature or emotional stress. The phenomenon is named after Maurice Raynaud, who, as a medical student, defined the first case in 1862 as episodic, symmetric, acral vasospasm characterized by pallor, cyanosis, suffusion, and a sense of fullness or tautness, which may be painful. Despite more than 140 years of research, the pathophysiology of Raynaud's phenomenon continues to elude investigators. Accordingly, although many pharmacologic treatments have been reported, there is still no cure or gold standard therapy. Further, response to treatment varies and is difficult to predict. Recently, there has been renewed interest in finding the pathogenetic mechanisms of Raynaud's phenomenon, an effort that has led to more potential targeted therapeutics. The purpose of this review is to discuss recent breakthroughs in the pathogenesis and treatment of Raynaud's phenomenon.

  15. public health importance of lassa fever epidemiolggy, clinical features

    African Journals Online (AJOL)

    important precautive measures to take when handling a patient with Lassa fever. ... protective devices are important preventive measures when managing a patient with Lassa fever infection. As Lassa fever ... ness, as well as sexual contact with a partner during ... countries in Africa have reported Lassa outbreaks and.

  16. Is the Hegemonic Position of American Culture Able to Subjugate Local Cultures of Importing Countries? A Constructive Analysis on the Phenomenon of Cultural Localization

    Science.gov (United States)

    Chiang, Tien-Hui

    2014-01-01

    It has been argued that globalization assists the USA to gain a hegemonic position, allowing it to export its culture. Because this exportation leads to the domination by American culture of the local cultures of importing countries, which are the key element in sustaining their citizens' national identity, citizens of these countries are…

  17. Is the Hegemonic Position of American Culture Able to Subjugate Local Cultures of Importing Countries? A Constructive Analysis on the Phenomenon of Cultural Localization

    Science.gov (United States)

    Chiang, Tien-Hui

    2014-01-01

    It has been argued that globalization assists the USA to gain a hegemonic position, allowing it to export its culture. Because this exportation leads to the domination by American culture of the local cultures of importing countries, which are the key element in sustaining their citizens' national identity, citizens of these countries are…

  18. [Clinical research I. The importance of the research design].

    Science.gov (United States)

    Talavera, Juan O

    2011-01-01

    The endeavor of clinical research to study a group of patients is to make a diagnosis, estimate the prognosis and prove a treatment. For this purpose is used the scientific method: 1) the architectural arrangement, which can be divided into cause-effect and the process of research; 2) the methodological approach, which includes controlled clinical trials, cohorts, case control, and cross-sectional designs; 3) the goal-oriented approach, in which studies on diagnostic tests, prognosis, treatment and risk or causal factors are grouped. The designs mentioned above are considered primary studies; it means that the information was obtained directly from the subjects studied. There is a second category of studies, which uses information obtained from the primary studies. This is the reason why they are considered as secondary or integrative studies.

  19. [Recurrent clinical mastitis in dairy cattle - importance and causes].

    Science.gov (United States)

    Grieger, A-S; Zoche-Golob, V; Paduch, J-H; Hoedemaker, M; Krömker, V

    2014-01-01

    Clinical mastitis as a frequently recurrent event can cause substantive economic loss on dairy farms. The reason for recurrent mastitis can be either a persistent infection of the bovine mammary gland by a mastitis pathogen or a reinfection of a quarter or udder after bacteriological cure. The virulence properties of a mastitis pathogen and the cure odds of an individual cow determine the development of persistent infections. Clinical episodes may alternate with periods without symptoms in the course of persistent infections. Strategies to reduce cases of recurrent mastitis have to include improved treatment concepts and measures to decrease new infection rates. The present literature review summarises the knowledge of definitions, frequencies, causes and effects of recurrent mastitis.

  20. Important compositional characteristics in the clinical use of adhesive systems.

    Science.gov (United States)

    Miyazaki, Masashi; Tsujimoto, Akimasa; Tsubota, Keishi; Takamizawa, Toshiki; Kurokawa, Hiroyasu; Platt, Jeffrey A

    2014-03-01

    Improvements in dentin bonding systems have influenced modern restorative dentistry. The desire for minimal invasiveness has resulted in more-conservative cavity design, which basically relies on the effectiveness of current dentin bonding systems. Interaction of adhesives with enamel and dentin is based on two systems, commonly described as etch-and-rinse and self-etch. Priming and bonding agents can be separate or combined, resulting in two- or three-step systems for etch-and-rinse adhesives and one- or two-step systems for self-etch adhesives. Self-etch systems use acidic functional monomers that simultaneously demineralize and impregnate tooth structures. Etch-and-rinse and self-etch systems have advantages and disadvantages, which are primarily related to the simplified bonding procedures required under clinical conditions. Knowledge of the composition, characteristics, and mechanisms of adhesion for each adhesive system is critical in selecting the ideal adhesive materials for clinical use.

  1. Minimal clinically important difference in radiological progression of joint damage. A definition based on patient perspective.

    NARCIS (Netherlands)

    Welsing, P.M.J.; Borm, G.F.; Riel, P.L.C.M. van

    2006-01-01

    OBJECTIVE: To estimate a threshold for minimal clinically important radiological progression of joint damage using its longitudinal relation with functional disability in patients with rheumatoid arthritis (RA). To validate existing estimates of minimal clinically important difference (MCID) using

  2. CLINICAL IMPORTANCE OF INTERLEUKIN-4 IN SYSTEMIC SCLERODERMA

    Directory of Open Access Journals (Sweden)

    T A Nevskaya

    2002-01-01

    Full Text Available The aim of the study was to investigate whether serum levels of interleukin-4 ( IL-4 reflects the clinical disease status and laboratory features of systemic sclerosis (SSc. IL-4 was measured by ELISA in forty patients wilh SSc. We revealed IL-4 (Ю-lOOOpg/ml in sera from 12 of 40 pts (30%. These pts had significantly less duration of disease, the progression of skin and visceral involvement by the time of investigation and a trend lo the greater frequency of lung fibrosis. There was no correlation of IL-4 level with type of SSc. The pts with increased scrum levels of IL-4 had higher levels of circulated immune complexes, y-globulins, but the levels of acute phase reactants (CRP, fibrinogen were lower compared with the of others. We suggest that serum IL-4 may serve a biologic marker for the progression of skin and lung fibrosis, but the results require confirmation in longitudinal study.

  3. A STUDY ON THORACIC VERTEBRAL SYNOSTOSIS & ITS CLINICAL IMPORTANCE

    Directory of Open Access Journals (Sweden)

    Md. Khaleel

    2015-01-01

    Full Text Available Vertebral anomalies are of interest not only to anatomist, but also to orthopedician, neurologist & neurosurgeons. Various vertebral anomalies of anatomic interest have been reported namely; occipitalisation, sacralisation, lumbarisation, absence of posterior elements of vertebral arch & vertebral s ynostosis. The fusion of vertebral column is rare anomalies usually congenital in origin. The fusion of thoracic vertebrae can present many clinical sign including congenital scoliosis. A study on 594 dry adult human vertebrae of unknown age & sex collected from the department of anatomy and phase I students of KBNIMS, Kalaburagi, Karnataka. The study was done over a period of 6 months (July to December 2014 during routine osteology classes for 1 year MBBS, we found the fusion of typical thoracic vertebrae between T 3 & T 4 . The cause could be failure of re - segmentation of somitomeres or acquired.

  4. Is clinical breast examination important for breast cancer detection?

    Science.gov (United States)

    Provencher, L.; Hogue, J.C.; Desbiens, C.; Poirier, B.; Poirier, E.; Boudreau, D.; Joyal, M.; Diorio, C.; Duchesne, N.; Chiquette, J.

    2016-01-01

    Background Screening clinical breast examination (cbe) is controversial; the use of cbe is declining not only as a screening tool, but also as a diagnostic tool. In the present study, we aimed to assess the value of cbe in breast cancer detection in a tertiary care centre for breast diseases. Methods This retrospective study of all breast cancers diagnosed between July 1999 and December 2010 at our centre categorized cases according to the mean of detection (cbe, mammography, or both). A cbe was considered “abnormal” in the presence of a mass, nipple discharge, skin or nipple retraction, edema, erythema, peau d’orange, or ulcers. Results During the study period, a complete dataset was available for 6333 treated primary breast cancers. Cancer types were ductal carcinoma in situ (15.3%), invasive ductal carcinoma (75.7%), invasive lobular carcinoma (9.0%), or others (2.2%). Of the 6333 cancers, 36.5% (n = 2312) were detected by mammography alone, 54.8% (n = 3470) by mammography and cbe, and 8.7% (n = 551) by physician-performed cbe alone (or 5.3% if considering ultrasonography). Invasive tumours diagnosed by cbe alone were more often triple-negative, her2-positive, node-positive, and larger than those diagnosed by mammography alone (p < 0.05). Conclusions A significant number of cancers would have been missed if cbe had not been performed. Compared with cancers detected by mammography alone, those detected by cbe had more aggressive features. Clinical breast examination is a very low-cost test that could improve the detection of breast cancer and could prompt breast ultrasonography in the case of a negative mammogram. PMID:27536182

  5. Leprosy as a multilayered biosocial phenomenon: The comparison of institutional responses and illness narratives of an endemic disease in Brazil and an imported disease in Portugal.

    Science.gov (United States)

    Cruz, Alice

    2016-01-01

    This paper questions the relation between human health and society from the case study of leprosy. To discuss the cultural and social mediator factors of both the experience of leprosy and outcomes of medical practices, it examines the biomedical twist in the dialectic between citizenship and public good that aimed to turn leprosy into a disease like any other, with the advent of multidrug therapy during the 1980s. Such analysis is based on a multisited ethnography, developed between 2008 and 2013 in two divergent contexts from the global South and North: Brazil, which remains the country in the world with the highest relative cases of leprosy, and Portugal, in which leprosy has become an imported disease. The main results of this research point to the limits of a pharmaceuticalized governmentality of leprosy and to heterogeneous medicalization's processes, which evince the determinacy of historical intersections between the State and civil society, as well as the corollaries of the former in medical care. This paper concludes with an analysis of the partition between biomedical cure and the healing of leprosy, which unveils the intermediation of institutional and extrainstitutional factors in access to health and in the cure of leprosy. It is finally argued that such intermediation requires a public health approach that might resocialize leprosy through a paradigmatic shift toward intersectoral and participatory operational strategies.

  6. Prozone phenomenon in secondary syphilis

    Directory of Open Access Journals (Sweden)

    Ruchi Sidana

    2011-01-01

    Full Text Available Prozone phenomenon is a false negative response resulting from high antibody titer which interferes with formation of antigen- antibody lattice, necessary to visualize a positive flocculation test. We present a case of secondary syphilis who presented to us with features of contact irritant dermatitis. She initially tested non- reactive for VDRL testing but tested positive with higher dilution. The prozone phenomenon is attaining importance because of increasing prevalence of Acquired immune deficiency syndrome. So one needs to be familiar with the occurrence of prozone phenomenon.

  7. Clinical practice: the diagnosis of imported malaria in children.

    Science.gov (United States)

    Maltha, Jessica; Jacobs, Jan

    2011-07-01

    The present paper reviews the diagnosis of imported malaria in children. Malaria is caused by a parasite called Plasmodium and occurs in over 100 countries worldwide. Children account for 10-15% of all patients with imported malaria and are at risk to develop severe and life-threatening complications especially when infected with Plasmodium falciparum. Case-fatality ratios vary between 0.2% and 0.4%. Children visiting friends and relatives in malaria endemic areas and immigrants and refugees account for the vast majority of cases. Symptoms are non-specific and delayed infections (more than 3 months after return from an endemic country) may occur. Microscopic analysis of the thick blood film is the cornerstone of laboratory diagnosis. For pragmatic reasons, EDTA-anticoagulated blood is accepted, provided that slides are prepared within 1 h after collection. Information about the Plasmodium species (in particular P. falciparum versus the non-falciparum species) and the parasite density is essential for patient management. Molecular methods in reference settings are an adjunct for species differentiation. Signals generated by automated hematology analyzers may trigger the diagnosis of malaria in non-suspected cases. Malaria rapid diagnostic tests are reliable in the diagnosis of P. falciparum but not for the detection of the non-falciparum species. They do not provide information about parasite density and should be used as an adjunct (and not a substitute) to microscopy. In case of persistent suspicion and negative microscopy results, repeat testing every 8-12 h for at least three consecutive samplings is recommended. A high index of suspicion and a close interaction with the laboratory may assure timely diagnosis of imported malaria.

  8. Local anesthetics: dentistry's most important drugs, clinical update 2006.

    Science.gov (United States)

    Malamed, Stanley F

    2006-12-01

    Local anesthetics are the safest most effective drugs in medicine for the control and management of pain. They also represent the most important drugs in dentistry. Today, dentistry has a spectrum of local anesthetics that permit pain control to be tailored to the specific needs of the patient: short-, intermediate-, and long-acting drugs. Bupivacaine has become a standard part of the armamentarium for postsurgical pain control while articaine has become the second-most used local anesthetic in the United States since its introduction in 2000. Despite an increase in anecdotal reports of paresthesia since articaine's introduction there is yet, no supporting scientific evidence.

  9. The clinical importance of dynamic lung hyperinflation in COPD.

    Science.gov (United States)

    O'Donnell, Denis E; Laveneziana, Pierantonio

    2006-12-01

    Lung hyperinflation commonly accompanies expiratory flow-limitation in patients with Chronic Obstructive Pulmonary Disease (COPD) and contributes importantly to dyspnea and activity limitation. It is not surprising, therefore, that lung hyperinflation has become an important therapeutic target in symptomatic COPD patients. There is increasing evidence that acute dynamic increases in lung hyperinflation, under conditions of worsening expiratory flow-limitation and increased ventilatory demand (or both) can seriously stress cardiopulmonary reserves, particularly in patients with more advanced disease. Our understanding of the physiological mechanisms of dynamic lung hyperinflation during both physical activity and exacerbations in COPD continues to grow, together with an appreciation of its serious negative mechanical and sensory consequences. In this review, we will discuss the basic pathophysiology of COPD during rest, exercise and exacerbation so as to better understand how this can be pharmacologically manipulated for the patient's benefit. Finally, we will review current concepts of the mechanisms of symptom relief and improved exercise endurance following pharmacological lung volume reduction.

  10. Bone biology in the elderly: clinical importance for fracture treatment

    Directory of Open Access Journals (Sweden)

    Rolvien Tim

    2016-12-01

    Full Text Available Age-related bone impairment often leads to fragility fractures in the elderly. Although excellent surgical care is widely provided, diagnosis and treatment of the underlying bone disorder are often not kept in mind. The interplay of the three major bone cells – osteoblasts, osteoclasts, and osteocytes – is normally well regulated via the secretion of messengers to control bone remodeling. Possible imbalances that might occur in the elderly are partly due to age, genetic risk factors, and adverse lifestyle factors but importantly also due to imbalances in calcium homeostasis (mostly due to vitamin D deficiency or hypochlorhydria, which have to be eliminated. Therefore, the cooperation between the trauma surgeon and the osteologist is of major importance to diagnose and treat the respective patients at risk. We propose that any patient suffering from fragility fractures is rigorously screened for osteoporosis and metabolic bone diseases. This includes bone density measurement by dual-energy X-ray absorptiometry, laboratory tests for calcium, phosphate, vitamin D, and bone turnover markers, as well as additional diagnostic modalities if needed. Thereby, most risk factors, including vitamin D deficiency, can be identified and treated while patients who meet the criteria for a specific therapy (i.e. antiresorptive and osteoanabolic receive such. If local health systems succeed to manage this process of secondary fracture prevention, morbidity and mortality of fragility fractures will decline to a minimum level.

  11. The influence of Multiwave Locked System (MLS) laser therapy on clinical features, microcirculatory abnormalities and selected modulators of angiogenesis in patients with Raynaud's phenomenon.

    Science.gov (United States)

    Kuryliszyn-Moskal, Anna; Kita, Jacek; Dakowicz, Agnieszka; Chwieśko-Minarowska, Sylwia; Moskal, Diana; Kosztyła-Hojna, Bożena; Jabłońska, Ewa; Klimiuk, Piotr Adrian

    2015-03-01

    The aim of this study was to investigate the influence of the Multiwave Locked System (MLS) laser therapy on clinical features, microvascular changes in nailfold videocapillaroscopy (NVC) and circulating modulators releasing as a consequence of vascular endothelium injury such as vascular endothelial growth factor (VEGF) and angiopoietin 2 (Ang-2) in patients with primary and secondary Raynaud's phenomenon. Seventy-eight RP patients and 30 healthy volunteers were recruited into the study. All patients with RP received MLS laser irradiation for 3 weeks. Clinical, NVC and laboratory investigations were performed before and after the MLS laser therapy. The serum concentration of VEGF and Ang-2 were determined by an enzyme-linked immunosorbent assay (ELISA). After 3 weeks of MLS laser therapy, the clinical improvement manifested by decreasing of the number of RP attacks, mean duration of Raynaud's attack and pain intensity in RP patients was observed. After MLS laser therapy in 65% of patients with primary and in 35% with secondary RP, an increase in the loop number and/or a reduction in avascular areas in NVC were observed. In comparison with a control group, higher serum concentration of VEGF and Ang-2 in RP patients was demonstrated. After MLS laser therapy, a reduction of Ang-2 in both groups of RP patients was found. Our results suggest that NVC may reflect microvascular changes associated with clinical improvement after MLS laser therapy in patients with primary and secondary RP. Ang-2 serum levels may be a useful marker of microvascular abnormalities in RP patients treated with MLS laser therapy.

  12. Characterisation of a haemolysin related to Vp-TDH produced by a Kanagawa phenomenon-negative clinical isolate of Vibrio parahaemolyticus.

    Science.gov (United States)

    Nagayama, K; Yamamoto, K; Mitawani, T; Honda, T

    1995-02-01

    The production of a family of haemolysins--thermostable direct haemolysin (Vp-TDH), Vp-TDH-related haemolysin (Vp-TRH) and Vp-TDH/I--has been reported in clinical isolates of Vibrio parahaemolyticus. This paper describes a fourth type of haemolysin--Vp-TDH/II--produced by a Kanagawa phenomenon-negative clinical isolate of V. parahaemolyticus (O13:K, untypable). Vp-TDH/II was purified by ammonium sulphate precipitation and successive filtrations on DEAE-cellulose, hydroxyapatite, Sepharose 4B and Mono Q columns. Vp-TDH/II was biophysicochemically and immunologically similar to, but not identical to Vp-TDH, Vp-TRH and Vp-TDH/I. Vp-TDH/II stimulated vascular permeability in rabbit skin and was lethal to mice. Purified Vp-TDH/II and viable cells of the Vp-TDH/II-producing strain both induced fluid accumulation in ligated rabbit intestine. The plasmid-determined structural gene for Vp-TDH/II was cloned and the nucleotide sequence determined. The deduced amino acid sequence of Vp-TDH/II differed from those of Vp-TDH, Vp-TRH and Vp-TDH/I.

  13. [Methylphenidate and secondary Raynaud's phenomenon].

    Science.gov (United States)

    Iglesias Otero, M; Portela Romero, M; Bugarín González, R; Ventura Victoria, M A

    2013-09-01

    Raynaud's phenomenon is a clinical disease characterized by episodic attacks of vasoconstriction of the arteries and arterioles of the extremities such as fingers and toes, sometimes the ears and nose, in response to cold or emotional stimuli. A classic attack is the pallor of the distal extremity, followed by cyanosis and redness, accompanied by paresthesia, usually as heat. When it occurs without apparent cause is called primary Raynaud's phenomenon. When associated with other disease, is called secondary Raynaud's phenomenon. The secondary table is associated with increased frequency of rheumatic diseases of collagen. They can also present certain drugs that cause vasoconstriction, such as ergotamine, beta-adrenergic antagonists, contraception and sympathomimetic drugs. Regarding the latter, we present a case of Raynaud's phenomenon secondary to methylphenidate in a 14 years.

  14. Host response to nontuberculous mycobacterial infections of current clinical importance.

    Science.gov (United States)

    Orme, Ian M; Ordway, Diane J

    2014-09-01

    The nontuberculous mycobacteria are a large group of acid-fast bacteria that are very widely distributed in the environment. While Mycobacterium avium was once regarded as innocuous, its high frequency as a cause of disseminated disease in HIV-positive individuals illustrated its potential as a pathogen. Much more recently, there is growing evidence that the incidence of M. avium and related nontuberculous species is increasing in immunocompetent individuals. The same has been observed for M. abscessus infections, which are very difficult to treat; accordingly, this review focuses primarily on these two important pathogens. Like the host response to M. tuberculosis infections, the host response to these infections is of the TH1 type but there are some subtle and as-yet-unexplained differences.

  15. [Importance of using basic statistics adequately in clinical research].

    Science.gov (United States)

    Rodrigues, Célio Fernando de Sousa; Lima, Fernando José Camello de; Barbosa, Fabiano Timbó

    2017-04-10

    The inadequate use of basic statistics is the main responsible for scientific article misinterpretation. The purpose of this review article was to review some basic statistical topics to alert authors and readers about the importance of basic statistics proper reporting. A bibliographical and cross-sectional study was carried out,which analyzed publications in books and articles in the following databases: SciELO (Scientific Electronic Library Online) and PubMed (Available from the National Center for Biotechnology Information). Medical research is not free from the risk of false positive and false negative results due to the choice of statistical tests and presence of small sample sizes. Understanding the correct use of basic statistics leads to fewer errors in reporting the results of studies performed and in the interpretation of their conclusions. Copyright © 2017. Publicado por Elsevier Editora Ltda.

  16. 周德生教授治疗帕金森病开关现象的临床经验总结%Professor Zhou Desheng's clinical experience in the treatment of Parkinson's disease "switch phenomenon"

    Institute of Scientific and Technical Information of China (English)

    丁瑞丛; 胡华; 袁雅洁; 李中

    2013-01-01

    主要介绍周德生教授对帕金森病开关现象的中医认识,以及辨证治疗帕金森病开关现象的临床经验。%This paper mainly introduces the understanding of Chinese medicine Professor Zhou Desheng on Parkinson's disease switch phenomenon ,and the clinical experience of syndrome differentiation and treatment of Parkinson disease switch phenomenon .

  17. The Importance of Children in Clinical Trials | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... please turn Javascript on. Feature: Medicines for Children The Importance of Children in Clinical Trials Past Issues / ... rare event. Can you point to some of the successes with children from clinical trials research in ...

  18. The clinical importance of changes in outcome scores after treatment for chronic low back pain

    National Research Council Canada - National Science Library

    Hägg, O; Fritzell, P; Nordwall, A

    2003-01-01

    ... importance of the outcome scores. The aims of the present study were three-fold. Firstly, it aimed to estimate the minimal clinically important difference of three multi-item outcome instruments...

  19. Cozen's phenomenon: a reminder.

    Science.gov (United States)

    Dorman, S; Jariwala, A; Campbell, D

    2013-08-01

    A four-year-old child attended Accident and Emergency following a fall from a slide with a displaced and angulated proximal tibial metaphyseal fracture. Treatment included closed manipulation under anaesthesia and an above knee cast for seven weeks. Serial radiographs over the following few months were satisfactory demonstrating good alignment and evidence of healing. However, at four-months review new-onset genu valgum with mechanical axis deviation was noted. No evidence of spontaneous resolution was noted over the following 12 months and hence a corrective hemi-epiphysiodesis was performed. At 12-months post-operatively, there was marked clinical and radiographical improvement in alignment. Classically Cozen's phenomenon is described as the late-onset post-traumatic valgus deformity associated with proximal tibial metaphyseal fractures in children. We want to reemphasise the early recognition of children at risk of this unique complication. In addition, we wish to highlight the progression of the late-onset valgus and its subsequent management.

  20. Clinical Analysis of 42 Cases of Systemic Lupus Erythematosus With Raynaud's Phenomenon%伴雷诺现象的系统性红斑狼疮42例分析

    Institute of Scientific and Technical Information of China (English)

    林俊; 刘湘源; 黄次波; 黄烽

    2001-01-01

    Objective To study the clinical features of the patients with systemic lupus erythematosus (SLE) with Raynaud's phenomenon. Methods The clinical manifestations and laboratory findings of 42 SLE patients with Raynaud's phenomenon were analyzed and compared with those of 116 SLE patients without Raynaud's phenomenon. Results As compared with SLE patients without Raynaud's phenomenon, the SLE patients with Raynaud's phenomenon were more likely to have myalgia/myopathy(9.48% vs 23.81%,P0.05)。对125例患者进行了平均2.15年的随访,其中包括全部的11例肺动脉高压患者,死亡3例,其中1例死于肺动脉高压并发右心衰竭(有RP组)。结论SLE患者出现雷诺现象提示较易发生肺动脉高压、心脏受累和免疫学异常,对伴雷诺现象的SLE患者应注意其心肺状态,以便早期诊断和治疗。

  1. The Offshoring Phenomenon

    Directory of Open Access Journals (Sweden)

    Mery Patricia Tamayo Plata

    2014-06-01

    Full Text Available This paper explains some definitions which are necessary in order to understand the offshoring concept, going through the most relevant works about the development of the offshoring phenomenon and its impact on the demand for labor and on the most skilled workers' income. It is evidenced that the offshoring processes not only deal with the purchase and sale of goods anymore, but that the service sector has an increasingly important role, and that the lower cost is not the only aspect that matters when offshoring, but aspects such as the language and culture are also considered. It is also found that technology and research related services flow not only from the parent companies towards its subsidiaries, but from firms in less developed countries to other companies in advanced countries. It concludes with a review of the works that explores the relationship between offshoring, employment and wages, from both, a macro and microeconomic outlook. In the latter case, special consideration is given to the work carried out by Amity and Wei (2006, Crinó (2010, and Geishecker and Görg (2013.

  2. 贝前列素钠治疗雷诺现象的临床观察%Clinical observation on treating Raynaud's phenomenon with beraprost sodium

    Institute of Scientific and Technical Information of China (English)

    徐雯

    2015-01-01

    Objective To observe the effectiveness and safety of Beraprost sodium in the treatment of Raynaud's Phenomenon .Methods 63 cases of Raynaud's Phenomenon patients were divided into treatment group (33 cases) and control group (30 cases).In treatment group, Beraprost sodium was implemented, in control group , Nifedipine Tablets was given .The advanced imaging technique was used to check the hemodynamics in the two groups.To observe the data of the average value of the index finger ulnar , radial palmar artery diameter (D), the systolic peak velocity (Vmax), pulsatility index (PI) and resistance index (RI).The symptom score, cold water test and the temperature recovery time were measured as a clinical indicator , hemodynamic data as the laboratory evaluation index .Results 11 cases were markedly effective and 13 cases were effective in the treatment group, the total efficiency was 72.73%which was higher than that in control group (P<0.05).In the hemodynamics , after treatment , the artery diameter ( D ) , peak systolic velocity ( Vmax ) were significantly increased compared with the treatment group before treatment and control group after treatment (P<0.05).The pulsatility index (PI), resistance index (RI) and I) compared with those before treatment and control group after treatment was significantly decreased, there were significant differences (P <0.05).Reflect the ulnar, high resistance and low compliance of radial palmar artery has improved significantly after treatment .Conclusions In the treatment of Raynaud's phenomenon , the use of oral beraprost sodium treatment , can significantly improve the symptoms of patients with acromegaly , increase blood flow and improve vascular compliance .%目的:本研究在于观察口服贝前列素钠治疗雷诺现象的临床疗效。方法63例雷诺现象患者随机分为对照组与治疗组,治疗组33例给予贝前列素钠片口服治疗,对照组30例给予硝苯地平片口服治疗,二组均应用高级

  3. A new phenomenon?

    Science.gov (United States)

    Ganci, S.

    2017-03-01

    This letter describes an interesting optical phenomenon engaging the reflected images of a new tube LED lamp (an array of high luminosity LEDs substituting the old fluorescent lamps) on any convex glossy black surface.

  4. The Root Pressure Phenomenon

    Science.gov (United States)

    Marsh, A. R.

    1972-01-01

    Describes experiments demonstrating that root pressure in plants is probably controlled by a circadian rhythm (biological clock). Root pressure phenomenon plays significant part in water transport in contradiction with prevalent belief. (PS)

  5. Asphalts’ aging phenomenon

    OpenAIRE

    Xiomara Vargas; Freddy Reyes

    2010-01-01

    This work presents a state of the art revision of the results from studies of asphalt aging found by researchers aimed at deepening understanding of this complex phenomenon. The background shows the evolution of asphalt aging, initially considering it as physical hardening and progressively ecognizing it as a complex phenomenon having repercussions on asphalt durability and physical-chemical properties. This document aims to be a guide for understanding future investigations for developing ne...

  6. The superosmic phenomenon.

    Science.gov (United States)

    Philpott, C M; Goonetilleke, P; Goodenough, P C; Clark, A; Murty, G E

    2008-08-01

    Olfaction studies in the institution of Department of Otorhinolaryngology at Leicester Royal Infirmary have detected a previously unreported, variable phenomenon--'superosmia'--in which subjects' olfaction threshold concentrations are up to 100,000 smaller than the average value. The aim of this report is to define and quantify this phenomenon. Two hundred and thirty subjects, who had been screened for active nasal pathology (age range 20-60 years), underwent individual olfactory threshold tests for phenylethyl alcohol or eucalyptol, using a computer-driven olfactometer in a controlled laboratory setting. Some tests were single tests and others were repeated on a small cohort. Two per cent of subjects demonstrated the superosmic phenomenon on single testing, and 10 per cent demonstrated this phenomenon on variable occasions during repeated testing. The superosmic phenomenon was defined by: (1) confident olfactory perception of a threshold at least equal to if not greater than three threshold levels below the subject's average threshold; (2) repeated perception of the odour at this level for at least 10 responses (1:1024 probability of chance finding); and (3) (where time permitted) a sudden, rapid loss of superosmia. Superosmia is a distinct phenomenon, the stimulus or mechanism of which is currently the subject of further research. The enhancement of olfactory ability may be possible through activation of an accessory pathway or modulation of the existing olfactory apparatus.

  7. [The importance of clinical data management in improvement of drug evaluation].

    Science.gov (United States)

    Huang, Qin; Wang, Jun

    2015-11-01

    Although the importance of clinical data is drawing more attention in drug development in China, the clinical data management is not good enough in the clinical trials right now. With the development of internet and progress of information technology, especially with the setup of the state innovation strategy for drug development, it is necessary and urgent to improve the clinical data quality. Good data quality is the primary basis of technical evaluation of drug at the marketing authorization. So Center for Drug Evaluation of CFDA has made some endeavors to enhance data management in the clinical trials in recent years. This article is focused on these aspects of data managment.

  8. From the NIH Director: The Importance of Clinical Trials | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. From the NIH Director: The Importance of Clinical Trials Past Issues / Summer 2011 ... Francis S. Collins, M.D., Ph.D., Director of the National Institutes of Health, led the successful effort ...

  9. [Phenomenon of dental fear].

    Science.gov (United States)

    Moore, R; Birn, H

    1990-01-01

    Odontophobia is a rather unique phobia with special psychosomatic components that impact on the dental health of odontophobic persons. It also has psychosocial components largely as a result of destruction of the teeth and subsequent embarrassment that can affect a person and cause a vicious cycle of dental fear. The phenomenon is facilitated by misunderstandings and myths generated by both patients and dentists. The most common reasons given in the literature for such strong fears of dental treatment are: 1) bad experiences in childhood for 85% of cases, 2) feeling of powerlessness and lack of control over personal emotional reactions and over the social situation in the dental chair, 3) social learning processes in which the image of the dentist is cast in a negative light by the mass media or by the person's relatives or friends and 4) that the person has other psychologic problems (in 20% of cases), such as serious phobias and/or neuroses. A strategy of researching and thus tackling the problem is presented which focuses on three essential targets that require studying and change: 1) the community at large and their image of the dentist, 2) the patient role and 3) the dentist role. Various model projects are presented along with their diagnostic systems. These are seen to focus in varying degrees on different elements of the target groups that effect the dentist-patient relationship but the need to come out into the community and make the social environment right for these patients is an important factor in all strategies.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Health status instruments for patients with COPD in pulmonary rehabilitation: defining a minimal clinically important difference

    OpenAIRE

    Alma, Harma; Jong, Corina de; Jelusic, Danijel; Wittmann, Michael; Schuler, Michael; Blok, Bertine Flokstra-de; Kocks, Janwillem; Schultz, Konrad; van der Molen, Thys

    2016-01-01

    The minimal clinically important difference (MCID) defines to what extent change on a health status instrument is clinically relevant, which aids scientists and physicians in measuring therapy effects. This is the first study that aimed to establish the MCID of the Clinical chronic obstructive pulmonary disease (COPD) Questionnaire (CCQ), the COPD Assessment Test (CAT) and the St George’s Respiratory Questionnaire (SGRQ) in the same pulmonary rehabilitation population using multiple approache...

  11. Examining the tsetse teneral phenomenon

    Directory of Open Access Journals (Sweden)

    L R eHaines

    2013-11-01

    Full Text Available Tsetse flies are the most important vectors of African trypanosomiasis but, surprisingly, are highly refractory to trypanosome parasite infection. In populations of wild caught flies, it is rare to find mature salivarian and mouthpart parasite infection rates exceeding 1% and 15%, respectively. This inherent refractoriness persists throughout the lifespan of the fly, although extreme starvation and suboptimal environmental conditions can cause a reversion to the susceptible phenotype. The teneral phenomenon is a phenotype unique to newly emerged, previously unfed tsetse, and is evidenced by a profound susceptibility to trypanosome infection. This susceptibility persists for only a few days post emergence and decreases with fly age and bloodmeal acquisition. Researchers investigating trypanosome-tsetse interactions routinely exploit this phenomenon by using young, unfed (teneral flies to naturally boost trypanosome establishment and maturation rates. A suite of factors may contribute, at least in part, to this unusual parasite permissive phenotype. These include the physical maturity of midgut barriers, the activation of immunoresponsive tissues and their effector molecules, and the role of the microflora within the midgut of the newly emerged fly. However, at present, the molecular mechanisms that underpin the teneral phenomenon still remain unknown. This review will provide a historical overview of the teneral phenomenon and will examine immune-related factors that influence, and may help us better understand, this unusual phenotype.

  12. Asphalts’ aging phenomenon

    Directory of Open Access Journals (Sweden)

    Xiomara Vargas

    2010-10-01

    Full Text Available This work presents a state of the art revision of the results from studies of asphalt aging found by researchers aimed at deepening understanding of this complex phenomenon. The background shows the evolution of asphalt aging, initially considering it as physical hardening and progressively ecognizing it as a complex phenomenon having repercussions on asphalt durability and physical-chemical properties. This document aims to be a guide for understanding future investigations for developing new types and mixtures of asphalt having improved properties.

  13. Mask Phenomenon in Communication

    Institute of Scientific and Technical Information of China (English)

    郎丽璇

    2013-01-01

    People sometimes wear masks. Abusive expression may be used to convey love while polite words can be exchanged among enemies. This essay describes and discusses this special phenomenon in communication and analyzes the elements that con-tribute to the success of a mask communication.

  14. Important considerations for designing and reporting epidemiologic and clinical studies in dental traumatology

    DEFF Research Database (Denmark)

    Andersson, Lars; Andreasen, Jens O

    2011-01-01

    The purpose of this article is to suggest important considerations for epidemiologic and clinical studies in the field of dental traumatology. The article is based on the authors' experiences from research in this field and editorial board work for the scientific journal Dental Traumatology....... Examples are given of issues where development is important. The importance of planning ahead of the study and consulting with experts in other fields is emphasized....

  15. Effect of biofeedback and deep oscillation on Raynaud's phenomenon secondary to systemic sclerosis: results of a controlled prospective randomized clinical trial.

    Science.gov (United States)

    Sporbeck, Birte; Mathiske-Schmidt, Kirsten; Jahr, Silke; Huscher, Dörte; Becker, Mike; Riemekasten, Gabriela; Taufmann, Ines; Burmester, Gerd-Rüdiger; Pögel, Stephanie; Reisshauer, Anett

    2012-05-01

    Our aim was to evaluate the effect of deep oscillation and biofeedback on Raynaud's phenomenon (RP) secondary to systemic sclerosis (SSc). A prospective randomized study was performed in SSc patients receiving either deep oscillation (n = 10) or biofeedback (n = 8) thrice a week for 4 weeks, or patients were randomized into the waiting group untreated for vasculopathy (n = 10) in time of running the study interventions. Biofeedback resulted in an improvement of RP as determined by score reduction of visual analogue scale compared with patients of the control group (P physiotherapy for the treatment of SSc-related RP.

  16. Raynaud's phenomenon in children.

    Science.gov (United States)

    Ortega Vicente, Elena; Garrido Redondo, Mercedes

    Raynaud's Phenomenon is caused by spasm of the small arteries and arterioles of the fingers. It is triggered by various stimuli including exposure to cold or a stressful event. It may be symmetrical or wrap one end. The appearance of this entity in children is rare. We report the case of a 4 year old male consultation health center by episodes of coldness, pallor and pain in both feet.

  17. Zika virus and the risk of imported infection in returned travelers: Implications for clinical care.

    Science.gov (United States)

    Goorhuis, Abraham; von Eije, Karin J; Douma, Renée A; Rijnberg, Noor; van Vugt, Michele; Stijnis, Cornelis; Grobusch, Martin P

    2016-01-01

    Since late 2015, an unprecedented outbreak of Zika virus is spreading quickly across Southern America. The large size of the current outbreak in The Americas will also result in an increase in Zika virus infections among travelers returning from endemic areas. We report five cases of imported Zika virus infection to The Netherlands. Although the clinical course is usually mild, establishing the diagnosis is important, mainly because of the association with congenital microcephaly and the possibility of sexual transmission.

  18. The attitudes of medical students in Europe toward the clinical importance of embryology.

    Science.gov (United States)

    Moxham, Bernard John; Emmanouil-Nikoloussi, Elpida; Standley, Henrietta; Brenner, Erich; Plaisant, Odile; Brichova, Hana; Pais, Diogo; Stabile, Isobel; Borg, Jordy; Chirculescu, Andy

    2016-03-01

    Although there have been many studies reporting the attitudes of medical students to the clinical importance of gross anatomy, little is known about their opinions concerning the clinical importance of embryology. Using Thurstone and Chave methods to assess attitudes, nearly 1,600 medical students across Europe in the early stages of their training provided responses to a survey that tested the hypothesis that they do not regard embryology as highly clinically relevant. Indeed, we further proposed that student attitudes to gross anatomy are much more positive than those toward embryology. Our findings show that our hypotheses hold, regardless of the university and country surveyed and regardless of the teaching methods employed for embryology. Clearly, embryology has a significant part to play in medical education in terms of understanding prenatal life, of appreciating how the organization of the mature human body has developed, and of providing essential information for general medical practice, obstetrics and pediatrics, and teratology. However, while newly recruited medical students understand the importance of gross anatomy in the development of professional competence, understanding the importance of embryology requires teachers, medical educationalists, and devisors of medical curricula to pay special attention to informing students of the significant role played by embryology in attaining clinical competence and achieving the knowledge and understanding of the biomedical sciences that underpins becoming a learned member of a health care profession. © 2015 Wiley Periodicals, Inc.

  19. [The importance of test control for the post-graduate education in clinical rhinology].

    Science.gov (United States)

    Nosulia, E V; Kim, I A; Kosiakov, S Ia; Piskunov, G Z; Vinnikov, A K

    2014-01-01

    This publication deals with the problems pertaining to the improvement of the system of the post-graduate education in otorhinolaryngology with special reference to one of its topical fields, clinical rhinology. The authors emphasize the importance of one of the principal components of the post-graduate education under the present-day conditions, namely organization of control and self-control of learning the new material, self-monitoring and individual correction of the level of knowledge. Special attention is given to the training tests that can be used to adequately simulate the decision-making process with respect to a concrete clinical situation. It is concluded that the systematic application of test control is one of the most important prerequisites for the enhancement of the effectiveness of the post-graduate education in clinical otorhinolaryngology.

  20. Incidental extracerebral findings on brain nonenhanced magnetic resonance imaging: frequency, nondetection rate, and clinical importance

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Ming-Liang; Wei, Xiao-Er [School of Medicine, Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Shanghai (China); Lu, Li-Yan [Nanjing Medical University, Department of Radiology, Nanjing First Hospital, Nanjing (China); Li, Wen-Bin [School of Medicine, Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Shanghai (China); Kashgar Prefecture Second People' s Hospital, Imaging Center, Kashgar (China)

    2017-03-15

    This study aims to elucidate the frequency, nondetection rate, and clinical importance of incidental extracerebral findings (IECFs) on brain nonenhanced magnetic resonance imaging (MRI). A total of 8284 brain MRIs performed between January 1, 2015 and December 31, 2015 were evaluated for the presence of IECFs and the distribution of IECFs was analyzed. IECFs were categorized as E1 (clinically unimportant, e.g., sinus mucosal thickening); E2 (likely unimportant, e.g., pharyngeal mucosal symmetrical thickening); and E3 (potentially important, e.g., pharyngeal mucosal asymmetrical thickening). The nondetection rate was determined by comparing the results of the structured approach with the initial MRI reports. The medical records were examined for patients with E3 IECFs to assess clinical importance and outcome of these lesions. A total of 5992 IECFs were found in 4469 of the 8284 patients (54.0%). E1 findings constituted 82.2% (4924/5992) of all IECFs; E2 constituted 16.6% (995/5992) and E3 constituted 1.2% (73/5992). Overall IECFs and E1 findings were significantly more common in male patients (P < 0.05). Statistically significant difference was also seen between the different age groups (P < 0.001). The nondetection rate was 56.9% (3409/5992) for overall IECFs and 32.9% (24/73) for E3 IECFs. Of the 73 patients with E3 IECFs, 34 (46.6%) received final diagnosis and appropriate treatment during the study period. IECFs are prevalent in clinical patients on brain MR images with a nondetection rate of 32.9% for potentially important (E3) findings. The reporting of IECFs according to clinical importance is helpful for patients' management. (orig.)

  1. Implementation of new clinical programs in the VHA healthcare system: the importance of early collaboration between clinical leadership and research.

    Science.gov (United States)

    Wu, R Ryanne; Kinsinger, Linda S; Provenzale, Dawn; King, Heather A; Akerly, Patricia; Barnes, Lottie K; Datta, Santanu K; Grubber, Janet M; Katich, Nicholas; McNeil, Rebecca B; Monte, Robert; Sperber, Nina R; Atkins, David; Jackson, George L

    2014-12-01

    Collaboration between policy, research, and clinical partners is crucial to achieving proven quality care. The Veterans Health Administration has expended great efforts towards fostering such collaborations. Through this, we have learned that an ideal collaboration involves partnership from the very beginning of a new clinical program, so that the program is designed in a way that ensures quality, validity, and puts into place the infrastructure necessary for a reliable evaluation. This paper will give an example of one such project, the Lung Cancer Screening Demonstration Project (LCSDP). We will outline the ways that clinical, policy, and research partners collaborated in design, planning, and implementation in order to create a sustainable model that could be rigorously evaluated for efficacy and fidelity. We will describe the use of the Donabedian quality matrix to determine the necessary characteristics of a quality program and the importance of the linkage with engineering, information technology, and clinical paradigms to connect the development of an on-the-ground clinical program with the evaluation goal of a learning healthcare organization. While the LCSDP is the example given here, these partnerships and suggestions are salient to any healthcare organization seeking to implement new scientifically proven care in a useful and reliable way.

  2. The attitudes of medical students in Europe toward the clinical importance of histology.

    Science.gov (United States)

    Moxham, Bernard John; Emmanouil-Nikoloussi, Elpida; Brenner, Erich; Plaisant, Odile; Brichova, Hana; Kucera, Tomas; Pais, Diogo; Stabile, Isobel; Borg, Jordy; Scholz, Michael; Paulsen, Friedrich; Luis Bueno-López, José; Alfonso Arraez Aybar, Luis; De Caro, Raffaele; Arsic, Stojanka; Lignier, Baptiste; Chirculescu, Andy

    2017-07-01

    Many studies have been undertaken to assess the attitudes of medical students to the clinical importance of gross anatomy. However, much less is known about their attitudes toward the clinical importance of histology. Using Thurstone and Chave methods to assess attitudes, over 2,000 early stage medical students across Europe provided responses to a survey that tested the hypothesis that the students have a high regard for histology's clinical relevance. Regardless of the university and country surveyed, and of the teaching methods employed for histology, our findings were not consistent with our hypotheses, students providing a more moderate assessment of histology's importance compared to gross anatomy but more positive than their attitudes toward embryology. Histology should play a significant role in medical education in terms of appreciating not just normal structure and function but also pathology. We conclude that teachers of histology should pay special attention to informing newly-recruited medical students of the significant role played by histology in attaining clinical competence and in underpinning their status as being learned members of a healthcare profession. This work was conducted under the auspices of the Trans-European Pedagogic Research Group (TEPARG). Clin. Anat. 30:635-643, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  3. Inflammation: an important mechanism for different clinical entities of coronary artery diseases

    Institute of Scientific and Technical Information of China (English)

    LI Jian-jun

    2005-01-01

    @@ Although atherosclerosis has been considered to be multi-factorial disease in which genetic, environmental, metabolic factors have been implicated, the gaps remain in our knowledge of the etiopathogenesis of atherosclerosis. There is mounting evidence that inflammation plays an important role in the initiation, development as well as evolution of atherosclerosis, suggesting that atherosclerosis is an inflammation disease.1,2 Although triggers and pathways of inflammation are probably multiple and different in different clinical settings, the data from animals as well as humans including our groups indicated that an inflammatory process was involved in all stages of atherosclerosis appeared in different clinical entities.

  4. Occurrence and diversity of clinically important Vibrio species in the aquatic environments of Georgia

    Directory of Open Access Journals (Sweden)

    Tamari eKokashvili

    2015-10-01

    Full Text Available Among the more than 70 different Vibrio species inhabiting marine, estuarine, and freshwater ecosystems, 12 are recognized as human pathogens. The warm subtropical climate of the Black Sea coastal area and inland regions of Georgia likely provides a favorable environment for various Vibrio species. From 2006 to 2009, the abundance, ecology, and diversity of clinically important Vibrio species were studied in different locations in Georgia and across seasons. Over a 33-month period, 1,595 presumptive Vibrio isolates were collected from the Black Sea (n=657 and freshwater lakes around Tbilisi (n=938. Screening of a subset of 440 concentrated and enriched water samples by PCR-electrospray ionization/mass spectrometry (PCR-ESI/MS detected the presence of DNA from eight clinically important Vibrio species: V. cholerae, V. parahaemolyticus, V. vulnificus, V. mimicus, V. alginolyticus, V. harveyi, V. metschnikovii, and V. cincinnatiensis. Almost ninety percent of PCR/ESI-MS samples positive for Vibrio species were collected from June through November. Three important human pathogenic Vibrio species (V. cholerae, V. parahaemolyticus, and V. vulnificus were detected in 62.8%, 37.8%, and 21.4% of samples testing positive for vibrios, respectively. The results of these activities suggest that natural reservoirs for human-pathogenic Vibrios exist in Georgian aquatic environments. Water temperature at all sampling sites was positively correlated with the abundance of clinically important Vibrio spp. (except V. metschnikovii and salinity was correlated with species composition at particular Black Sea sites as well as inland reservoirs.

  5. Capilaroscopia periungueal: importância para a investigação do fenômeno de Raynaud e doenças do espectro da esclerose sistêmica Importance of the nailfold capillaroscopy in the investigation of Raynaud's phenomenon and scleroderma-spectrum syndromes

    Directory of Open Access Journals (Sweden)

    Cristiane Kayser

    2004-02-01

    Full Text Available A capilaroscopia periungueal é um exame não invasivo e extremamente útil para avaliação do componente morfológico da microcirculação. Permite o diagnóstico diferencial precoce entre indivíduos com fenômeno de Raynaud (FRy primário e secundário. Na esclerose sistêmica e síndromes correlatas ocorrem alterações capilaroscópicas facilmente distinguíveis do padrão encontrado em indivíduos normais, sendo caracterizadas pela presença de ectasia capilar e áreas de deleção vascular, além de diminuição difusa da quantidade de alças. Em razão de sua relevância diagnóstica, a familiarização do médico clínico e do reumatologista com a CPU é de fundamental importância.Nailfold capillaroscopy is a noninvasive method useful for the evaluation of microcirculation morphologic component. It allows an early differential diagnosis between subjects with primary Raynaud's phenomenon and patients with secondary Raynaud's phenomenon. In systemic sclerosis and sclerodermaspectrum syndromes there are capillaroscopic findings easily distinguished from the pattern of healthy controls, and characterized by the presence of enlarged loops, avascular areas and diffuse loss of capillaries. Because of their diagnostic relevance, the acquaintance of internists and rheumatologists with nailfold capillaroscopy is of utmost importance.

  6. Nuclear Glory Phenomenon

    CERN Document Server

    Kopeliovich, V B; Potashnikova, I K

    2014-01-01

    Analytical explanation of the nuclear glory effect, which is similar to the known optical (atmospheric) glory phenomenon, is presented. It is based on the small phase space method for the multiple interaction processes probability estimates and leads to the characteristic angular dependence of the production cross section $d\\sigma \\sim 1/ \\sqrt {\\pi - \\theta}$ in the vicinity of the strictly backward direction, for any number of interactions $N\\geq 3$, either elastic or inelastic. Rigorous proof of this effect is given for the case of the optimal kinematics, as well as for arbitrary polar scattering angles in the case of the light particle rescattering, but the arguments in favor of the backward azimuthal (axial) focusing are quite general and hold for any kind of the multiple interaction processes. Such behaviour of the cross section near the backward direction agrees qualitatively with available data. In the small interval of final angles including the value $\\theta =\\pi$ the angular dependence of the cumul...

  7. The statistical stability phenomenon

    CERN Document Server

    Gorban, Igor I

    2017-01-01

    This monograph investigates violations of statistical stability of physical events, variables, and processes and develops a new physical-mathematical theory taking into consideration such violations – the theory of hyper-random phenomena. There are five parts. The first describes the phenomenon of statistical stability and its features, and develops methods for detecting violations of statistical stability, in particular when data is limited. The second part presents several examples of real processes of different physical nature and demonstrates the violation of statistical stability over broad observation intervals. The third part outlines the mathematical foundations of the theory of hyper-random phenomena, while the fourth develops the foundations of the mathematical analysis of divergent and many-valued functions. The fifth part contains theoretical and experimental studies of statistical laws where there is violation of statistical stability. The monograph should be of particular interest to engineers...

  8. [Allergic fungi: importance of the standardization of fungal extracts and their application on clinical practice].

    Science.gov (United States)

    Ruiz Reyes, Héctor; Rodríguez Orozco, Alain R

    2006-01-01

    Among the aeroallergens associated to asthma and allergic rhinitis, the fungi are a common cause of diagnostic and therapeutic problems. The wide variety and distribution of fungal species and the complex characterization of their allergenicity, is a complex item. The fungus extracts used to diagnose and treat sensitizations are frequently non effective, and different varieties of extracts are globally distributed. The standardization of commercial fungi extracts results extremely important as diagnostic procedure as well as to decide an efficacious and safe immunotherapy. This paper reviews important methodological steps to the standardization of fungi extracts, and finally the clinical use of these extracts.

  9. Autonomic Dysfunction in Early Breast Cancer: Incidence, Clinical Importance, and Underlying Mechanisms

    OpenAIRE

    2015-01-01

    Autonomic dysfunction represents a loss of normal autonomic control of the cardiovascular system associated with both sympathetic nervous system overdrive and reduced efficacy of the parasympathetic nervous system. Autonomic dysfunction is a strong predictor of future coronary heart disease, vascular disease and sudden cardiac death. In the current review, we will discuss the clinical importance of autonomic dysfunction as a cardiovascular risk marker among breast cancer patients. We will rev...

  10. Outcome tools used for ambulatory children with cerebral palsy: responsiveness and minimum clinically important differences

    OpenAIRE

    Oeffinger, D; Bagley, A; Rogers, S.; Gorton, G; Kryscio, R; Abel, M.; Damiano, D; Barnes, D.; Tylkowski, C

    2008-01-01

    This prospective longitudinal multicenter study of ambulatory children with cerebral palsy (CP) examined changes in outcome tool score over time, tool responsiveness, and used a systematic method for defining minimum clinically important differences (MCIDs). Three hundred and eighty-one participants with CP (Gross Motor Function Classification System [GMFCS] Levels I–III; age range 4–18y, mean age 11y [SD 4y 4mo]; 265 diplegia, 116 hemiplegia; 230 males, 151 females). At baseline and follow-u...

  11. Prevalence of clinically important posterior fossa emissary veins on CT angiography

    Directory of Open Access Journals (Sweden)

    Yeliz Pekcevik

    2014-01-01

    Full Text Available Purpose: We assessed the prevalence of the clinically important posterior fossa emissary veins detected on computed tomography (CT angiography. Materials and Methods: A total of 182 consecutive patients who underwent 64-slice CT angiography were retrospectively reviewed to determine the clinically important posterior fossa emissary veins. Results: Of 166 patients, the mastoid emissary vein (MEV was not identified in 37 (22.3% patients. It was found bilaterally in 82 (49.4% and unilaterally in 47 (28.3% patients. Only six patients had more than one MEV that were very small (5 mm veins. The posterior condylar vein (PCV was not identified in 39 (23.5% patients. It was found bilaterally in 97 (58.4% and unilaterally in 30 (18.1% patients. Only 15 patients had a very large (>5 mm PCV. The petrosquamosal sinus (PSS was identified only in one patient (0.6% on the left side. The occipital sinus was found in two patients (1.2%. Conclusions: The presence of the clinically important posterior fossa emissary veins is not rare. Posterior fossa emissary veins should be identified and systematically reported, especially prior to surgeries involving the posterior fossa and mastoid region.

  12. Open source innovation phenomenon, participant behaviour, impact

    CERN Document Server

    Herstatt, Cornelius

    2015-01-01

    Open Source Innovation (OSI) has gained considerable momentum within the last years. Academic and management practice interest grows as more and more end-users consider and even participate in Open Source product development like Linux, Android, or Wikipedia. Open Source Innovation: Phenomenon, Participant Behaviour, Impact brings together rigorous academic research and business importance in scrutinizing OCI from three perspectives: The Phenomenon, Participants' Behavior, and Business Implications. The first section introduces OCI artefacts, including who is participating and why, and provide

  13. Clinical risk factor analysis of slow coronary flow phenomenon%冠状动脉慢血流现象的临床影响因素分析

    Institute of Scientific and Technical Information of China (English)

    陈晖

    2015-01-01

    Objective To explore the risk factor of slow coronary flow (SCF) phenomenon. Methods 200 cases without obvious pathological changes of epicardial coronary artery by coronary angiography from January 2011 to June 2013 in our hospital were selected as the research object,the adjusted TIMI frame was more than 2 standard deviation of normal coronary flow velocity were defined as SCF.The comparison of age,gender,smoking history,body mass index(BMI),comor-bidities(including hypertension,diabetes,and hyperlipidemia),the level of and serum uric acid,C-reactive protein,platelet aggregation were analysed between the SCF group and the coronary artery normal group.The risk factor of SCF was analysed and observed by multiple regression analysis. Results BMI,the proportion of smoking history in the SCF group was higher than that in the coronary artery normal group,with significant difference (P<0.05).The level of serum uric acid,homocysteine,C reactive protein and platelet aggregation rate in the SCF group was higher than that in the normal group,with significant difference(P<0.05).Multivariate regression analysis showed that age,smoking,hyperlipidemia,serum uric acid,homocysteine,C reactive protein,platelet aggregation rate were the risk factors of SCF. Conclusion Age,smok-ing,high fat metabolism and inflammation status and high platelet aggregation are all risk factors of SCF phenomenon.%目的:探讨冠状动脉慢血流现象的相关影响因素。方法选取本院2011年1月~2013年6月冠状动脉造影显示心外膜主要冠状动脉无明显病变的200例患者作为研究对象,将校正的TIMI帧数大于正常冠状动脉血流速度2个标准差者定义为冠状动脉慢血流,分析冠状动脉慢血流组和冠状动脉正常组的年龄、性别、吸烟史、体重指数(BMI)、合并症(包括高血压、糖尿病和高脂血症)、以及血尿酸水平、同型半胱氨酸浓度、C反应蛋白水平、血小板聚集率等的差异,同时

  14. Discussion on macro, meso and microstructures in the mass migration Mexico-United States: late twentieth century and the early twenty-first. A different perspective to understanding the phenomenon of great importance for Mexico

    Directory of Open Access Journals (Sweden)

    Eduardo Fernández Guzmán

    2012-11-01

    Full Text Available En este artículo se propone, a la luz de novedosos planteamientos teórico e historiográficos,This paper proposes a novel view of theoretical and historiographical approaches, as a first attempt, discussing the multicausal nature of contemporary international migration Mexico- United States. The intention is not going deeper into the different causal mechanisms, but only list them and ponder their interaction to better understand this phenomenon that goes beyond the macro-level considerations (economic and political. Migration, understood as a social process, manifests various causes and consequences in their past and present. And, in the case of the mass migration of Mexicans to the United States in recent decades, it is givable to think that this is a product of historical trends, economic asymmetries, of deep social inequalities and poverty in Mexico, of push and the pull factors, tradition and socialization migrant, social networks, transnational communities, symbolisms and collective imaginaries, modernization in transport and communication, migration industry, cultural values and psychological components, among others. It proposal is to analyze briefly this binational contemporary phenomenon under the epistemological consideration that migration is a social process. For this, macro, meso and microstructures will be essential in the explanation.

  15. Occurrence and Diversity of Clinically Important Vibrio Species in the Aquatic Environment of Georgia

    Science.gov (United States)

    Kokashvili, Tamar; Whitehouse, Chris A.; Tskhvediani, Ana; Grim, Christopher J.; Elbakidze, Tinatin; Mitaishvili, Nino; Janelidze, Nino; Jaiani, Ekaterine; Haley, Bradd J.; Lashkhi, Nino; Huq, Anwar; Colwell, Rita R.; Tediashvili, Marina

    2015-01-01

    Among the more than 70 different Vibrio species inhabiting marine, estuarine, and freshwater ecosystems, 12 are recognized as human pathogens. The warm subtropical climate of the Black Sea coastal area and inland regions of Georgia likely provides a favorable environment for various Vibrio species. From 2006 to 2009, the abundance, ecology, and diversity of clinically important Vibrio species were studied in different locations in Georgia and across seasons. Over a 33-month period, 1,595 presumptive Vibrio isolates were collected from the Black Sea (n = 657) and freshwater lakes around Tbilisi (n = 938). Screening of a subset of 440 concentrated and enriched water samples by PCR-electrospray ionization/mass spectrometry (PCR-ESI/MS) detected the presence of DNA from eight clinically important Vibrio species: V. cholerae, V. parahaemolyticus, V. vulnificus, V. mimicus, V. alginolyticus, V. harveyi, V. metschnikovii, and V. cincinnatiensis. Almost 90% of PCR/ESI-MS samples positive for Vibrio species were collected from June through November. Three important human-pathogenic Vibrio species (V. cholerae, V. parahaemolyticus, and V. vulnificus) were detected in 62.8, 37.8, and 21.4% of samples testing positive for Vibrios, respectively. The results of these activities suggest that natural reservoirs for human-pathogenic Vibrios exist in Georgian aquatic environments. Water temperature at all sampling sites was positively correlated with the abundance of clinically important Vibrio spp. (except V. metschnikovii), and salinity was correlated with species composition at particular Black Sea sites as well as inland reservoirs. PMID:26528464

  16. [Anaesthetists learn--do institutions also learn? Importance of institutional learning and corporate culture in clinics].

    Science.gov (United States)

    Schüpfer, G; Gfrörer, R; Schleppers, A

    2007-10-01

    In only a few contexts is the need for substantial learning more pronounced than in health care. For a health care provider, the ability to learn is essential in a changing environment. Although individual humans are programmed to learn naturally, organisations are not. Learning that is limited to individual professions and traditional approaches to continuing medical education is not sufficient to bring about substantial changes in the learning capacity of an institution. Also, organisational learning is an important issue for anaesthesia departments. Future success of an organisation often depends on new capabilities and competencies. Organisational learning is the capacity or processes within an organisation to maintain or improve performance based on experience. Learning is seen as a system-level phenomenon as it stays in the organisation regardless of the players involved. Experience from other industries shows that learning strategies tend to focus on single loop learning, with relatively little double loop learning and virtually no meta-learning or non-learning. The emphasis on team delivery of health care reinforces the need for team learning. Learning organisations make learning an intrinsic part of their organisations and are a place where people continually learn how to learn together. Organisational learning practice can help to improve existing skills and competencies and to change outdated assumptions, procedures and structures. So far, learning theory has been ignored in medicine, due to a wide variety of complex political, economic, social, organisational culture and medical factors that prevent innovation and resist change. The organisational culture is central to every stage of the learning process. Learning organisations move beyond simple employee training into organisational problem solving, innovation and learning. Therefore, teamwork and leadership are necessary. Successful organisations change the competencies of individuals, the systems

  17. Minimal Clinically Important Difference of Patient Reported Outcome Measures of Lower Extremity Injuries in Orthopedics

    Science.gov (United States)

    Çelik, Derya; Çoban, Özge; Kılıçoğlu, Önder

    2017-01-01

    Purpose: MCID scores for outcome measures are frequently used evidence-based guides to gage meaningful changes. To conduct a systematic review of the quality and content of the the minimal clinically important difference (MCID) relating to 16 patient-rated outcome measures (PROM) used in lower extremity. Methods: We conducted a systematic literature review on articles reporting MCID in lower extremity outcome measures and orthopedics from January 1, 1980, to May 10, 2016. We evaluated MCID of the 16 patient reported outcome measures (PROM) which were Harris Hip Score (HHS), Oxford Hip Score (OHS), Hip Outcome Score (HOS), Hip Disability and Osteoarthritis Outcome Score (HOOS), The International Knee Documentation Committee Subjective Knee Form (IKDC), The Lysholm Scale, The Western Ontario Meniscal Evaluation Tool (WOMET), The Anterior Cruciate Ligament Quality of Life Questionnaire (ACL-QOL), The Lower Extremity Functional Scale (LEFS), The Western Ontario and Mcmaster Universities Index (WOMAC), Knee İnjury And Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), Kujala Anterior Knee Pain Scale, The Victorian Institute of Sports Assessment Patellar Tendinosis (Jumper’s Knee) (VİSA-P), Tegner Activity Rating Scale, Marx Activity Rating Scale, Foot And Ankle Outcome Score (FAOS), The Foot Function Index (FFI), Foot And Ankle Ability Measure (FAAM), The Foot And Ankle Disability Index Score and Sports Module, Achill Tendon Total Rupture Score(ATRS), The Victorian İnstitute Of Sports Assesment Achilles Questionnaire(VİSA-A), American Orthopaedic Foot and Ankle Society (AOFAS). A search of the PubMed/MEDLINE, PEDro and Cochrane Cen¬tral Register of Controlled Trials and Web of Science databases from the date of inception to May 1, 2016 was conducted. The terms “minimal clinically important difference,” “minimal clinically important change”, “minimal clinically important improvement” “were combined with one of the PROM as mentioned above

  18. Adaptive behavior in autism: Minimal clinically important differences on the Vineland-II.

    Science.gov (United States)

    Chatham, C H; Taylor, K I; Charman, T; Liogier D'ardhuy, X; Eule, E; Fedele, A; Hardan, A Y; Loth, E; Murtagh, L; Del Valle Rubido, M; San Jose Caceres, A; Sevigny, J; Sikich, L; Snyder, L; Tillmann, J E; Ventola, P E; Walton-Bowen, K L; Wang, P P; Willgoss, T; Bolognani, F

    2017-09-21

    Autism Spectrum Disorder (ASD) is associated with persistent impairments in adaptive abilities across multiple domains. These social, personal, and communicative impairments become increasingly pronounced with development, and are present regardless of IQ. The Vineland Adaptive Behavior Scales, Second Edition (Vineland-II) is the most commonly used instrument for quantifying these impairments, but minimal clinically important differences (MCIDs) on Vineland-II scores have not been rigorously established in ASD. We pooled data from several consortia/registries (EU-AIMS LEAP study, ABIDE-I, ABIDE-II, INFOR, Simons Simplex Collection and Autism Treatment Network [ATN]) and clinical investigations and trials (Stanford, Yale, Roche) resulting in a data set of over 9,000 individuals with ASD. Two approaches were used to estimate MCIDs: distribution-based methods and anchor-based methods. Distribution-based MCID [d-MCID] estimates included the standard error of the measurement, as well as one-fifth and one-half of the covariate-adjusted standard deviation (both cross-sectionally and longitudinally). Anchor-based MCID [a-MCID] estimates include the slope of linear regression of clinician ratings of severity on the Vineland-II score, the slope of linear regression of clinician ratings of longitudinal improvement category on Vineland-II change, the Vineland-II change score maximally differentiating clinical impressions of minimal versus no improvement, and equipercentile equating. Across strata, the Vineland-II Adaptive Behavior Composite standardized score MCID estimates range from 2.01 to 3.2 for distribution-based methods, and from 2.42 to 3.75 for sample-size-weighted anchor-based methods. Lower Vineland-II standardized score MCID estimates were observed for younger and more cognitively impaired populations. These MCID estimates enable users of Vineland-II to assess both the statistical and clinical significance of any observed change. Autism Res 2017. © 2017

  19. The importance of inducible clindamycin resistance in enterotoxin positive S. aureus isolated from clinical samples

    Directory of Open Access Journals (Sweden)

    Memariani M

    2009-07-01

    Full Text Available "nBackground: Clindamycin is a suitable antibiotic for treatment of skin and soft tissue infections. Moreover, it can suppress toxin production in many pathogenic bacteria such as S. aureus. There are two mechanisms of resistance in this antibiotic. Constitutive resistance can be detected by standard disk diffusion method but in the case of inducible resistance, D-test should be carried out. The main aim of this study is to determine prevalence of clindamycin inducible resistance among methicillin resistant and susceptible isolates of S. aureus isolated from different clinical samples. "nMethods: A total of 87 clinical isolates from clinical samples were collected. Methicillin resistance was determined using standard disk diffusion method. Subsequently, D-test was carried out according to CLSI guideline. Presence of the sea gene (enterotoxin A was detected by PCR using specific primers. "nResults: Out of 87 isolates, 18(20.7% were clindamycin inducible resistant while constitutive resistance was detected among 21(24.1% isolates. The 95% Confidence intervals for the proportion of inducible clindamycin resistance among clinical isolates of S. aureus was 12.2% to 29.2%. The inducible phenotype in MRSA isolates was more common than that of MSSA isolates (33.3% vs 5.1%.Significant differences were found between prevalence of inducible clindamycin resistance and type of infection (p=0.045. Importantly, there was a significant correlation between sea gene and the constitutive/inducible resistance (p<0.0001. "nConclusions: Due to the high prevalence of clindamycin inducible resistance among clinical isolates of S. aureus, we recommend D-test to avoid treatment failure.

  20. Republished: Importance of carcinoma-associated fibroblast-derived proteins in clinical oncology.

    Science.gov (United States)

    Valcz, Gabor; Sipos, Ferenc; Tulassay, Zsolt; Molnar, Bela; Yagi, Yukako

    2015-05-01

    Carcinoma-associated fibroblast (CAF) as prominent cell type of the tumour microenvironment has complex interaction with both the cancer cells and other non-neoplastic surrounding cells. The CAF-derived regulators and extracellular matrix proteins can support cancer progression by providing a protective microenvironment for the cancer cells via reduction of chemotherapy sensitivity. On the other hand, these proteins may act as powerful prognostic markers as well as potential targets of anticancer therapy. In this review, we summarise the clinical importance of the major CAF-derived signals influencing tumour behaviour and determining the outcome of chemotherapy.

  1. Importance of carcinoma-associated fibroblast-derived proteins in clinical oncology.

    Science.gov (United States)

    Valcz, Gabor; Sipos, Ferenc; Tulassay, Zsolt; Molnar, Bela; Yagi, Yukako

    2014-12-01

    Carcinoma-associated fibroblast (CAF) as prominent cell type of the tumour microenvironment has complex interaction with both the cancer cells and other non-neoplastic surrounding cells. The CAF-derived regulators and extracellular matrix proteins can support cancer progression by providing a protective microenvironment for the cancer cells via reduction of chemotherapy sensitivity. On the other hand, these proteins may act as powerful prognostic markers as well as potential targets of anticancer therapy. In this review, we summarise the clinical importance of the major CAF-derived signals influencing tumour behaviour and determining the outcome of chemotherapy.

  2. Radiographic superimposition and mandibular peripheral osteoma: the importance of clinical and CT findings.

    Science.gov (United States)

    Boffano, Paolo; Gallesio, Cesare; Roccia, Fabio; Berrone, Sid

    2013-03-01

    Peripheral osteomas are benign, slow-growing osteogenic tumors that are caused by centrifugal growth of the periosteum and develop as masses attached to the cortical plates.The pathogenesis of osteomas is unclear, and embryologic, traumatic, inflammatory, metaplastic, and genetic causes have been proposed. A solitary peripheral osteoma of the jaws is uncommon.The purpose of this paper is to present a peculiar case of mandibular peripheral osteoma with a particular radiographic superimposition that stress the importance of clinical and CT findings.

  3. New Phenomenon of Commercial Corruption

    Directory of Open Access Journals (Sweden)

    Krzysztof Nowakowski

    2011-07-01

    Full Text Available This article is about increase corruption in private sector as commercial corruption. This establishes a wide understanding of that phenomenon in social science and law. Corruption and bribery are types of fraud and are linked with the private sector too. Although certain types of corruption will decline as the private sector grows and consolidates, other new types involving private sector firms may increase. The commercial corruption can be described as relation inside of an organization and as relation between firms. Corruption in private sector in Poland is connected with social distrust and specific organizational culture, too. Commercial corruption is a familiar feature of their societies and has been the focus of law enforcement and institutional reform. Many others problems do not change the fact that such corruption is a new important problem and causes lost of competitiveness and creates a substitute for fair market and competition in Polish economy and abroad.

  4. Clinic expert information extraction based on domain model and block importance model.

    Science.gov (United States)

    Zhang, Yuanpeng; Wang, Li; Qian, Danmin; Geng, Xingyun; Yao, Dengfu; Dong, Jiancheng

    2015-11-01

    To extract expert clinic information from the Deep Web, there are two challenges to face. The first one is to make a judgment on forms. A novel method based on a domain model, which is a tree structure constructed by the attributes of query interfaces is proposed. With this model, query interfaces can be classified to a domain and filled in with domain keywords. Another challenge is to extract information from response Web pages indexed by query interfaces. To filter the noisy information on a Web page, a block importance model is proposed, both content and spatial features are taken into account in this model. The experimental results indicate that the domain model yields a precision 4.89% higher than that of the rule-based method, whereas the block importance model yields an F1 measure 10.5% higher than that of the XPath method.

  5. Late radiation-induced heart disease after radiotherapy. Clinical importance, radiobiological mechanisms and strategies of prevention.

    Science.gov (United States)

    Andratschke, Nicolaus; Maurer, Jean; Molls, Michael; Trott, Klaus-Rüdiger

    2011-08-01

    The clinical importance of radiation-induced heart disease, in particular in post-operative radiotherapy of breast cancer patients, has been recognised only recently. There is general agreement, that a co-ordinated research effort would be needed to explore all the potential strategies of how to reduce the late risk of radiation-induced heart disease in radiotherapy. This approach would be based, on one hand, on a comprehensive understanding of the radiobiological mechanisms of radiation-induced heart disease after radiotherapy which would require large-scale long-term animal experiments with high precision local heart irradiation. On the other hand - in close co-operation with mechanistic in vivo research studies - clinical studies in patients need to determine the influence of dose distribution in the heart on the risk of radiation-induced heart disease. The aim of these clinical studies would be to identify the critical structures within the organ which need to be spared and their radiation sensitivity as well as a potential volume and dose effect. The results of the mechanistic studies might also provide concepts of how to modify the gradual progression of radiation damage in the heart by drugs or biological molecules. The results of the studies in patients would need to also incorporate detailed dosimetric and imaging studies in order to develop early indicators of impending radiation-induced heart disease which would be a pre-condition to develop sound criteria for treatment plan optimisation. Copyright © 2010. Published by Elsevier Ireland Ltd.

  6. Pulsed light for the inactivation of fungal biofilms of clinically important pathogenic Candida species.

    Science.gov (United States)

    Garvey, Mary; Andrade Fernandes, Joao Paulo; Rowan, Neil

    2015-07-01

    Microorganisms are naturally found as biofilm communities more than planktonic free-floating cells; however, planktonic culture remains the current model for microbiological studies, such as disinfection techniques. The presence of fungal biofilms in the clinical setting has a negative impact on patient mortality, as Candida biofilms have proved to be resistant to biocides in numerous in vitro studies; however, there is limited information on the effect of pulsed light on sessile communities. Here we report on the use of pulsed UV light for the effective inactivation of clinically relevant Candida species. Fungal biofilms were grown by use of a CDC reactor on clinically relevant surfaces. Following a maximal 72 h formation period, the densely populated biofilms were exposed to pulsed light at varying fluences to determine biofilm sensitivity to pulsed-light inactivation. The results were then compared to planktonic cell inactivation. High levels of inactivation of C. albicans and C. parapsilosis biofilms were achieved with pulsed light for both 48 and 72 h biofilm structures. The findings suggest that pulsed light has the potential to provide a means of surface decontamination, subsequently reducing the risk of infection to patients. The research described herein deals with an important aspect of disease prevention and public health.

  7. The "split hand" phenomenon : evidence of a spinal origin

    NARCIS (Netherlands)

    Schelhaas, H J; van de Warrenburg, B P C; Kremer, H P; Zwarts, M J

    2003-01-01

    The clinical phenomenon of a split hand, dominant muscle atrophy in the thenar as compared to the hypothenar complex, has been used to support the theory of primary cortical degeneration in amyotrophic lateral sclerosis. However, the same phenomenon, both clinically and electrophysiologically, was

  8. The "split hand" phenomenon : evidence of a spinal origin

    NARCIS (Netherlands)

    Schelhaas, H J; van de Warrenburg, B P C; Kremer, H P; Zwarts, M J

    2003-01-01

    The clinical phenomenon of a split hand, dominant muscle atrophy in the thenar as compared to the hypothenar complex, has been used to support the theory of primary cortical degeneration in amyotrophic lateral sclerosis. However, the same phenomenon, both clinically and electrophysiologically, was o

  9. What is clinical leadership and why might it be important in dentistry?

    Science.gov (United States)

    Brocklehurst, P; Ferguson, J; Taylor, N; Tickle, M

    2013-03-01

    The concept of leadership means different things to different people. At present there is no single definition of leadership nor an established theoretical approach. Despite this, leadership in the clinical environment is becoming increasingly cited as an important component in the transition of the National Health Service (NHS) and in the development of clinician led services. In medicine, clinical commissioning groups (CCGs) will soon be operational and the Department of Health (DH) seeks to establish a similar approach in dentistry, where local clinicians drive forward a quality agenda with a focus on patient outcomes. To facilitate this, the NHS Commissioning Board (NHSCB) are in the process of developing Local Professional Networks (LPNs) for dentistry. Given this shift towards localism and clinician led services it would appear that leadership will have a significant role in both medicine and dentistry. This paper explores what leadership is, before determining why it might be important in providing a clinician-led, patient-based and outcomes-focused service.

  10. The Contradictional Phenomenons and Management in the Process of Clinical Living Related Small Bowel Transplantation%临床活体部分小肠移植过程中矛盾现象及处理

    Institute of Scientific and Technical Information of China (English)

    张洪伟; 王为忠; 凌瑞; 李开宗

    2001-01-01

    Clinical living related small bowel transplantation has been performed on two patients with short-gut syndromes in our hospital since 1999.There were many contradictional phenomenons during operative period.For example:1.To correct the severe malnutrition,the patients must be given total parenteral nutrition (TPN),but long period TPN could damage the liver function;2.The longer the intestinal graft was,the better nutrition could be obtained for the recipients ,but the donor was not allowed to afford such a long small intestine in living related small bowel transplantation;3.The administration of immunosuppressive drugs to prevent acute rejection would increase the tendency of infection (virus,and bacteria);4.To prevent the formation of thrombosis,antithrombosis (heparin) must be used,but on the other hand,antithrombosis would cause intestinal hemorrhage,etc.Paying more attention to the principal aspect of a contradiction and handle it properly is very important in the process of successful clinical living related small bowel transplantation.%从1999年至今,在国内我们率先成功地施行两例临床活体部分小肠移植术。在整个处置过程中出现许多的矛盾现象。如术前为纠正患者严重的营养不良,必须给予肠外营养支持。但是,长期的肠外营养又引起患者肝功能损害,使患者无法耐受手术;对受体来讲,当然是移植的肠管越长越有利,但是在活体移植的情况下供体只能有限地提供肠管,且肠管过长受体也无法接受;手术后患者必须应用有效的免疫抑制剂来防治免疫排斥反应,而机体在免疫抑制下极易发生感染,应用强效而广谱的抗菌素虽然可防治细菌的感染,但是可引起菌群的失调导致真菌感染;为防止血管内血栓的形成,需应用有效的抗凝剂,但同时可导致出血倾向等等。我们体会:正确地处理这些矛盾现象是我们成功的关键。首先要抓重点、

  11. Doctor shopping: a phenomenon of many themes.

    Science.gov (United States)

    Sansone, Randy A; Sansone, Lori A

    2012-11-01

    Doctor shopping is defined as seeing multiple treatment providers, either during a single illness episode or to procure prescription medications illicitly. According to the available literature, prevalence rates of doctor shopping vary widely, from 6.3 to 56 percent. However, this variability is partially attributable to research methodology, including the study definition of doctor shopping as well as the patient sample. The reasons for doctor shopping are varied. Some patient explanations for this phenomenon relate to clinician factors, such as inconvenient office hours or locations, long waiting times, personal characteristics or qualities of the provider, and/or insufficient communication time between the patient and clinician. Some patient explanations relate to personal factors and include both illness factors (e.g., symptom persistence, lack of understanding or nonacceptance of the diagnosis or treatment) as well as psychological factors (e.g., somatization, prescription drug-seeking). Importantly, not all doctor shopping is driven by suspect motivations. Being aware of these various patient justifications for doctor shopping is important in understanding and managing these challenging patients in the clinical setting, whether they emerge in psychiatric or primary care environments.

  12. HOOLIGANISM – CONTEMPORARY SOCIAL PHENOMENON

    Directory of Open Access Journals (Sweden)

    MARIA LULESCU

    2012-05-01

    Full Text Available The proposed scientific theme is going to approach and study the hooliganism phenomenon as a contemporary social matter, in terms of conceptual and etiological. The present work has four main purposes: (1- that of explaining the meaning of hooliganism social phenomenon; (2- that of discovering the origins of hooliganism; (3- that of knowing which are the causes that encourages the occurence of the hooliganism; (4- that of knowing how to control and minimize this phenomenon.

  13. Radioactivity: A Natural Phenomenon.

    Science.gov (United States)

    Ronneau, C.

    1990-01-01

    Discussed is misinformation people have on the subject of radiation. The importance of comparing artificial source levels of radiation to natural levels is emphasized. Measurements of radioactivity, its consequences, and comparisons between the risks induced by radiation in the environment and from artificial sources are included. (KR)

  14. [Raynaud's phenomenon: pathogenesis and prevalence].

    Science.gov (United States)

    Mikulska, Danuta

    2010-01-01

    Raynaud's phenomenon is defined as occasional ischemia of the distal parts of the extremities. Ischemia may be idiopathic as in primary Raynaud's disease or instigated by a comorbidity as in Raynaud's syndrome. Opinions on the etiopathogenesis of Raynaud's phenomenon have changed during recent years. Research has shown that enhanced vascular reactivity is attributable more to local factors and less to abnormalities in the central nervous system. Local factors are classified as vascular, nervous, and intravascular. Changes in our understanding of the etiopathogenesis of Raynaud's phenomenon have resulted in modified therapeutic guidelines. The present work reviews current opinions on the etiopathogenesis of Raynaud's phenomenon.

  15. Clinical cases of parasitoses and fungal infections important from medical point of view

    Science.gov (United States)

    Błaszkowska, Joanna; Góralska, Katarzyna

    Most important infectious diseases which pose a risk to human health and life are associated with parasites transmitted by a variety of arthropod vectors, or from animal to man. Some of these (malaria, toxoplasmosis, leishmaniosis, dirofilariosis, alveococcosis, cystic echinococcosis) still represent a serious public health problem in many regions in the world. This review describes the epidemiological and clinical aspects of important parasitoses and fungal infections from a medical point of view. It should be emphasized that the development of invasive disease depends on both host (susceptibility/resistance) and parasite factors (pathogenicity/virulence); an immunocompromised state can favour opportunistic parasitic infections: toxoplasmosis, cryptosporidiosis, giardiosis, cyclosporidiosis, blastocystosis and strongyloidosis. This article highlights the role of free-living amoebae in the pathogenesis and transmission of human diseases, the high pathogenicity of Echinococcus multilocularis, and the growing importance of ticks as a reservoir and vector for numerous dangerous pathogens (e.g., Borrelia burgdorferi, Anaplasma phagocytophilum, Babesia microti). It also discusses the diagnostic problems of toxoplasmosis including cross-reactions in serological tests and reviews the search for new drugs and vaccines against toxoplasmosis. Attention is increasingly paid to the role played by the human microbiome in maintaining homeostasis and in the development of fungal infections. This review also presents the most common human superficial fungal infections and the role of Candida albicans infection in the pathogenesis of irritable bowel syndrome.

  16. A visitor's guide to effect sizes: statistical significance versus practical (clinical) importance of research findings.

    Science.gov (United States)

    Hojat, Mohammadreza; Xu, Gang

    2004-01-01

    Effect Sizes (ES) are an increasingly important index used to quantify the degree of practical significance of study results. This paper gives an introduction to the computation and interpretation of effect sizes from the perspective of the consumer of the research literature. The key points made are: 1. ES is a useful indicator of the practical (clinical) importance of research results that can be operationally defined from being "negligible" to "moderate", to "important". 2. The ES has two advantages over statistical significance testing: (a) it is independent of the size of the sample; (b) it is a scale-free index. Therefore, ES can be uniformly interpreted in different studies regardless of the sample size and the original scales of the variables. 3. Calculations of the ES are illustrated by using examples of comparisons between two means, correlation coefficients, chi-square tests and two proportions, along with appropriate formulas. 4. Operational definitions for the ES s are given, along with numerical examples for the purpose of illustration.

  17. Come fly with me: review of clinically important arboviruses for global travelers.

    Science.gov (United States)

    Cleton, Natalie; Koopmans, Marion; Reimerink, Johan; Godeke, Gert-Jan; Reusken, Chantal

    2012-11-01

    Western tourists are increasingly traveling to exotic locations often located in tropical or subtropical regions of the world. The magnitude of international travel and the constantly changing dynamics of arbovirus diseases across the globe demand up-to-date information about arbovirus threats to travelers and the countries they visit. In this review, the current knowledge on arbovirus threats to global travelers is summarized and prioritized per region. Based on most common clinical syndromes, currently known arboviruses can be grouped to develop diagnostic algorithms to support decision-making in diagnostics. This review systematically combines and structures the current knowledge on medically important travel-related arboviruses and illustrates the necessity of a detailed patient history (travel history, symptoms experienced, vaccination history, engaged activities, tick or mosquito bite and use of repellent and onset of symptoms), to guide the diagnosis.

  18. Importance/performance analysis: a tool for service quality control by clinical laboratories.

    Science.gov (United States)

    Scammon, D L; Weiss, R

    1991-01-01

    A study of customer satisfaction with clinical laboratory service is used as the basis for identifying potential improvements in service and more effectively targeting marketing activities to enhance customer satisfaction. Data on customer satisfaction are used to determine the aspects of service most critical to customers, how well the organization is doing in delivery of service, and how consistent service delivery is. Importance-performance analysis is used to highlight areas for future resource reallocation and strategic emphasis. Suggestions include the establishment of performance guidelines for customer contact personnel, the enhancement of timely delivery of reports via electronic transmission (computer and fax), and the development of standardized graphics for request and report forms to facilitate identification of appropriate request forms and guide clients to key items of information on reports.

  19. Autonomic dysfunction in early breast cancer: Incidence, clinical importance, and underlying mechanisms.

    Science.gov (United States)

    Lakoski, Susan G; Jones, Lee W; Krone, Ronald J; Stein, Phyllis K; Scott, Jessica M

    2015-08-01

    Autonomic dysfunction represents a loss of normal autonomic control of the cardiovascular system associated with both sympathetic nervous system overdrive and reduced efficacy of the parasympathetic nervous system. Autonomic dysfunction is a strong predictor of future coronary heart disease, vascular disease, and sudden cardiac death. In the current review, we will discuss the clinical importance of autonomic dysfunction as a cardiovascular risk marker among breast cancer patients. We will review the effects of antineoplastic therapy on autonomic function, as well as discuss secondary exposures, such as psychological stress, sleep disturbances, weight gain/metabolic derangements, and loss of cardiorespiratory fitness, which may negatively impact autonomic function in breast cancer patients. Lastly, we review potential strategies to improve autonomic function in this population. The perspective can help guide new therapeutic interventions to promote longevity and cardiovascular health among breast cancer survivors.

  20. Anomalous extensor tendons of hand: a case report with clinical importance

    Directory of Open Access Journals (Sweden)

    Shipra Paul

    2007-06-01

    Full Text Available The extensor digitorum muscle of the hand originates from the common extensor origin i.e., from the lateral epicondyle of the humerus and ends in four tendons, one for each digit except for the thumb. This paper reports a case, in which the tendon of the extensor digitorum ended as four tendons to the index, middle, ring and little fingers, but displayed variations in the number of tendons to each finger. Two tendons of extensor digitorum were observed in the ring and the little finger. Such an arrangement of the tendons of the extensor digitorum may have clinical importance. The presence of multiple tendons may also alter the kinematics around the site of attachment to the phalanx. Knowledge of abnormal and normal anatomy of the extensor tendons, may be helpful while performing graft and tendon transfer operations.

  1. Anomalous extensor tendons of hand: a case report with clinical importance.

    Directory of Open Access Journals (Sweden)

    Shipra Paul

    2009-11-01

    Full Text Available The extensor digitorum muscle of the hand originates from the common extensor origin i.e., from the lateral epicondyle of the humerus and ends in four tendons, one for each digit except for the thumb. This paper reports a case, in which the tendon of the extensor digitorum ended as four tendons to the index, middle, ring and little fingers, but displayed variations in the number of tendons to each finger. Two tendons of extensor digitorum were observed in the ring and the little finger. Such an arrangement of the tendons of the extensor digitorum may have clinical importance. The presence of multiple tendons may also alter the kinematics around the site of attachment to the phalanx. Knowledge of abnormal and normal anatomy of the extensor tendons, may be helpful while performing graft and tendon transfer operations.

  2. Is daily routine important for sleep? An investigation of social rhythms in a clinical insomnia population.

    Science.gov (United States)

    Moss, Taryn G; Carney, Colleen E; Haynes, Patricia; Harris, Andrea L

    2015-02-01

    Social rhythms, also known as daily routines (e.g. exercise, of school or work, recreation, social activities), have been identified as potential time cues to help to regulate the biological clock. Past research has shown links between regularity and healthy sleep. This study examined the regularity and frequency of daytime activities in a clinical insomnia population and a good sleeper comparison group. Participants (N = 69) prospectively monitored their sleep and daily activities for a 2-week period. Although participants with insomnia and good sleepers had similar levels of activity, relative to good sleepers, those with insomnia were less regular in their activities. Findings from this study add to the growing number of studies that highlight the relative importance of the regularity of daytime activities on sleep. Accordingly, future research should test treatment components that focus on regulating daytime activities, which would likely improve treatment outcomes.

  3. Comparison of medication reconciliation and medication review: errors and clinical importance

    DEFF Research Database (Denmark)

    Bjeldbak-Olesen, Mette; Danielsen, Anja Gadsbølle; Tomsen, Dorthe Vilstrup

    2013-01-01

    Introduction: The objective of this study was to compare medication reconciliation and medication review based on number, type and severity of discrepancies and drug-re­lated problems (DRPs), denoted errors. Material and methods: This was a retrospective study conducted at the Department...... of Cardiology, Hillerød Hos­pital. Medication reconciliation compared the prescriptions in patient records, an electronic medication system (EMS) and in discharge summaries (DS). The medication review was based on the EMS. The two methods were performed on the same data material. To assess the clinical...... importance of the errors, a four-point scale was applied. Results: A total of 75 patient records were included. In all, 198 discrepancies were identified by medication reconcili­ation, 2.6 per patient. The most frequent discrepancies were omission of a drug in the DS and discrepancy between the drugs noted...

  4. Chronic Chagas cardiopathy in Chile. Importance of Trypanosoma cruzi burden and clinical evaluation.

    Science.gov (United States)

    Apt, Werner; Arribada, Arturo; Zulantay, Inés; Saavedra, Miguel; Muñoz, Catalina; Toro, Bruno; Vega, Bastián; Rodríguez, Jorge

    2016-10-01

    Currently there are no biological markers to indicate which individuals with chronic indeterminate period of Chagas disease develop heart disease and who will remain all his life in this phase. The aim of this survey was to determine if Trypanosoma cruzi burden is related to the presence of heart disease in patients with chronic Chagas disease. 200 patients who had not been treated, 100 with cardiopathy and 100 without, groups A and B respectively, were submitted to clinical study and electrocardiogram, Echo-Doppler was performed for group A in which all important known causes of cardiopathy were discarded. In both groups xenodiagnosis, conventional PCR and quantitative PCR were undertaken. The 100 cardiopaths had 133 electrocardiographic alterations most of them in grade II of the New York Heart Association classification. 98 cardiopaths were classified in grade I by Echo-Doppler and only 2 cases were in grade III due to low ejection fraction. The difference in average parasitemia in patients of group A and B was not significant and no statistically differences were observed between average parasitemia of cardiopaths grade II versus grade I of NYHA. This results allow to characterize same clinical, electrocardiographical and parasitological features in chagasic cardiopaths of Chile.

  5. Minimal clinically important difference in Parkinson's disease as assessed in pivotal trials of pramipexole extended release.

    Science.gov (United States)

    Hauser, Robert A; Gordon, Mark Forrest; Mizuno, Yoshikuni; Poewe, Werner; Barone, Paolo; Schapira, Anthony H; Rascol, Olivier; Debieuvre, Catherine; Fräßdorf, Mandy

    2014-01-01

    Background. The minimal clinically important difference (MCID) is the smallest change in an outcome measure that is meaningful for patients. Objectives. To calculate the MCID for Unified Parkinson's Disease Rating Scale (UPDRS) scores in early Parkinson's disease (EPD) and for UPDRS scores and "OFF" time in advanced Parkinson's disease (APD). Methods. We analyzed data from two pivotal, double-blind, parallel-group trials of pramipexole ER that included pramipexole immediate release (IR) as an active comparator. We calculated MCID as the mean change in subjects who received active treatment and rated themselves "a little better" on patient global impression of improvement (PGI-I) minus the mean change in subjects who received placebo and rated themselves unchanged. Results. MCIDs in EPD (pramipexole ER, pramipexole IR) for UPDRS II were -1.8 and -2.0, for UPDRS III -6.2 and -6.1, and for UPDRS II + III -8.0 and -8.1. MCIDs in APD for UPDRS II were -1.8 and -2.3, for UPDRS III -5.2 and -6.5, and for UPDRS II + III -7.1 and -8.8. MCID for "OFF" time (pramipexole ER, pramipexole IR) was -1.0 and -1.3 hours. Conclusions. A range of MCIDs is emerging in the PD literature that provides the basis for power calculations and interpretation of clinical trials.

  6. The importance of bacterial and viral infections associated with adult asthma exacerbations in clinical practice.

    Directory of Open Access Journals (Sweden)

    Motoyasu Iikura

    Full Text Available Viral infection is one of the risk factors for asthma exacerbation. However, which pathogens are related to asthma exacerbation in adults remains unclear.The relation between various infections and adult asthma exacerbations was investigated in clinical practice.The study subjects included 50 adult inpatients due to asthma exacerbations and 20 stable outpatients for comparison. The pathogens from a nasopharyngeal swab were measured by multiplex PCR analysis.Asthma exacerbations occurred after a common cold in 48 inpatients. The numbers of patients with viral, bacterial, or both infections were 16, 9, and 9, respectively. The dominant viruses were rhinoviruses, respiratory syncytial virus, influenza virus, and metapneumovirus. The major bacteria were S. pneumoniae and H. influenzae. Compared to pathogen-free patients, the patients with pathogens were older and non-atopic and had later onset of disease, lower FeNO levels, lower IgE titers, and a higher incidence of comorbid sinusitis, COPD, or pneumonia. Compared to stable outpatients, asthma exacerbation inpatients had a higher incidence of smoking and comorbid sinusitis, COPD, or pneumonia. Viruses were detected in 50% of stable outpatients, but a higher incidence of rhinovirus, respiratory syncytial virus, and metapneumovirus infections was observed in asthma exacerbation inpatients. H. influenzae was observed in stable asthmatic patients. Other bacteria, especially S. pneumoniae, were important in asthma exacerbation inpatients.Viral or bacterial infections were observed in 70% of inpatients with an asthma exacerbation in clinical practice. Infection with S. pneumoniae was related to adult asthma exacerbation.

  7. Importance of patient-centred signage and navigation guide in an orthopaedic and plastics clinic.

    Science.gov (United States)

    Maqbool, Talha; Raju, Sneha; In, Eunji

    2016-01-01

    Gulshan & Nanji Orthopaedic and Plastics Center at the North York General Hospital is the second busiest site after the emergency department serving more than 26,000 patients annually. Increase in patient flow, overworked staff, and recent renovations to the hospital have resulted in patients experiencing long wait times, and thusly patient dissatisfaction and stress. Several factors contribute to patient dissatisfaction and stress: i) poor and unfriendly signage; ii) inconsistent utilization of the numbering system; and iii) difficulty navigating to and from the imaging center. A multidisciplinary QI team was assembled to improve the patient experience. We developed a questionnaire to assess patient stress levels at the baseline. Overall, more than half of the patients (54.8%) strongly agreed or agreed to having a stressful waiting experience. Subsequently, based on patient feedback and staff perspectives, we implemented two PDSA cycles. For PDSA 1, we placed a floor graphic (i.e. black tape) to assist patients in navigating from the clinic to the imaging centre and back. For PDSA 2, we involved creating a single 21"×32" patient-friendly sign at the entrance to welcome patients, with clear instructions outlining registration procedures. Surveys were re-administered to assess patient stress levels. A combination of both interventions caused a statistically significant reduction in patient stress levels based on the Kruskal-Wallis and Mann-Whitney U Tests. The present project highlighted the importance of involving stakeholders as well as frontline staff when undertaking quality improvement projects as a way to identify bottlenecks as well as establish sustainable solutions. Additionally, the team recognized the importance of incorporating empirical based solutions and involving experts in the field to optimize results. The present project successfully implemented strategies to improve patient satisfaction and reduce stress in a high flow community clinic. These

  8. Management of Raynaud Phenomenon and Digital Ulcers in Scleroderma.

    Science.gov (United States)

    Cappelli, Laura; Wigley, Fredrick M

    2015-08-01

    Raynaud phenomenon (RP) and associated digital ischemia can be among the most vexing clinical problems for patients with systemic sclerosis (scleroderma). Understanding the treatment approach to RP and associated ischemia and how to prevent digital ulcers is important for clinicians caring for these patients. This article reviews the management of RP and digital ischemic ulcers. The magnitude of the problem and pathophysiology of RP are first discussed, with an emphasis on recent advances in understanding of the disease process. Options for the practical pharmacologic and nonpharmacologic interventions for RP and digital ischemic ulcers are detailed.

  9. Mesoglycan treatment in Raynaud phenomenon: a case series.

    Science.gov (United States)

    Di Biase, A

    2013-06-01

    Raynaud's phenomenon (RP) is a common clinical disorder without cure or gold standard therapy. Mesoglycan is an well-balanced extract of glycosaminoglycans active on endothelial layers at microcirculatory level. Herein we investigated for the first time the efficacy and tolerability of mesoglycan on vasospastic attacks and videocapillaroscopy patterns in 25 consecutive patients with primary or secondary RP. During 12 months of add-on therapy, mesoglycan obtained a remarkable and significant reduction in the frequency of Raynaud attacks and an improvement of the capillaroscopy abnormalities in most patients, without important adverse effects, revealing a good convenience in the management if this condition.

  10. Ringing phenomenon in silica microspheres

    Institute of Scientific and Technical Information of China (English)

    Chunhua Dong; Changling Zou; Jinming Cui; Yong Yang; Zhengfu Han; Guangcan Guo

    2009-01-01

    Whispering gallery modes in silica microspheres are excited by a tunable continuous-wave laser through the fiber taper. Ringing phenomenon can be observed with high frequency sweeping speed. The thermal nonlinearity in the microsphere can enhance this phenomenon. Our measurement results agree very well with the theoretical predictions by the dynamic equation.

  11. Historical memory as an ethnopolitical phenomenon

    Directory of Open Access Journals (Sweden)

    Gribanov Valeriy Vladimirovich

    2013-02-01

    Full Text Available Historical memory turns out to be an important ethnopolitical phenomenon, when the events of the past of the peoples are used as an argument in the political activities of any entity. The example of the Finno-Ugric peoples of the Russian Federation is used to show the practice of using facts of the past for political purposes.

  12. Statin escape phenomenon: Fact or fiction?

    Science.gov (United States)

    Barkas, Fotios; Elisaf, Moses; Klouras, Eleftherios; Dimitriou, Theodora; Tentolouris, Nikolaos; Liberopoulos, Evangelos

    2017-01-01

    AIM To evaluate the presence of the so called “statin escape” phenomenon among hyperlipidemic subjects attending a lipid clinic. METHODS This was a retrospective analysis of 1240 hyperlipidemic individuals followed-up for ≥ 3 years. We excluded those individuals meeting one of the following criteria: Use of statin therapy at baseline visit, discontinuation of statin treatment at most recent visit, change in statin treatment during follow-up and poor compliance to treatment. Statin escape phenomenon was defined as an increase in low-density lipoprotein cholesterol (LDL-C) levels at the most recent visit by > 10% compared with the value at 6 mo following initiation of statin treatment. RESULTS Of 181 eligible subjects, 31% exhibited the statin escape phenomenon. No major differences regarding baseline characteristics were found between statin escapers and non-statin escapers. Both escapers and non-escapers had similar baseline LDL-C levels [174 (152-189) and 177 (152-205) mg/dL, respectively]. In comparison with non-escapers, statin escapers demonstrated lower LDL-C levels at 6 mo after treatment initiation [88 (78-97) mg/dL vs 109 (91-129) mg/dL, P statin-treated individuals. The clinical significance of this phenomenon remains uncertain.

  13. Are complement deficiencies really rare? Overview on prevalence, clinical importance and modern diagnostic approach.

    Science.gov (United States)

    Grumach, Anete Sevciovic; Kirschfink, Michael

    2014-10-01

    Complement deficiencies comprise between 1 and 10% of all primary immunodeficiencies (PIDs) according to national and supranational registries. They are still considered rare and even of less clinical importance. This not only reflects (as in all PIDs) a great lack of awareness among clinicians and general practitioners but is also due to the fact that only few centers worldwide provide a comprehensive laboratory complement analysis. To enable early identification, our aim is to present warning signs for complement deficiencies and recommendations for diagnostic approach. The genetic deficiency of any early component of the classical pathway (C1q, C1r/s, C2, C4) is often associated with autoimmune diseases whereas individuals, deficient of properdin or of the terminal pathway components (C5 to C9), are highly susceptible to meningococcal disease. Deficiency of C1 Inhibitor (hereditary angioedema, HAE) results in episodic angioedema, which in a considerable number of patients with identical symptoms also occurs in factor XII mutations. New clinical entities are now reported indicating disease association with partial complement defects or even certain polymorphisms (factor H, MBL, MASPs). Mutations affecting the regulators factor H, factor I, or CD46 and of C3 and factor B leading to severe dysregulation of the alternative pathway have been associated with renal disorders, such as atypical hemolytic uremic syndrome (aHUS) and - less frequent - with membranoproliferative glomerulonephritis (MPGN). We suggest a multi-stage diagnostic protocol starting based on the recognition of so called warning signs which should aid pediatricians and adult physicians in a timely identification followed by a step-wise complement analysis to characterize the defect at functional, protein and molecular level.

  14. Clinical importance of personality difficulties: diagnostically sub-threshold personality disorders.

    Science.gov (United States)

    Karukivi, Max; Vahlberg, Tero; Horjamo, Kalle; Nevalainen, Minna; Korkeila, Jyrki

    2017-01-14

    Current categorical classification of personality disorders has been criticized for overlooking the dimensional nature of personality and that it may miss some sub-threshold personality disturbances of clinical significance. We aimed to evaluate the clinical importance of these conditions. For this, we used a simple four-level dimensional categorization based on the severity of personality disturbance. The sample consisted of 352 patients admitted to mental health services. All underwent diagnostic assessments (SCID-I and SCID-II) and filled in questionnaires concerning their social situation and childhood adversities, and other validated tools, including the Beck Depression Inventory (BDI), Alcohol Use Disorders Identification Test (AUDIT), health-related quality of life (15D), and the five-item Mental Health Index (MHI-5). The patients were categorized into four groups according to the level of personality disturbance: 0 = No personality disturbance, 1 = Personality difficulty (one criterion less than threshold for one or more personality disorders), 2 = Simple personality disorder (one personality disorder), and 3 = Complex/Severe personality disorder (two or more personality disorders or any borderline and antisocial personality disorder). The proportions of the groups were as follows: no personality disturbance 38.4% (n = 135), personality difficulty 14.5% (n = 51), simple personality disorder 19.9% (n = 70), and complex/severe personality disorder 24.4% (n = 86). Patients with no personality disturbance were significantly differentiated (p personality disorders stood out as being worst off. Social dysfunction was related to the severity of the personality disturbance. Patients with a personality difficulty or a simple personality disorder had prominent symptoms and difficulties, but the differences between these groups were mostly non-significant. An elevated severity level of personality disturbance is associated with an

  15. Management of deep brain stimulator battery failure: battery estimators, charge density, and importance of clinical symptoms.

    Directory of Open Access Journals (Sweden)

    Kaihan Fakhar

    Full Text Available OBJECTIVE: We aimed in this investigation to study deep brain stimulation (DBS battery drain with special attention directed toward patient symptoms prior to and following battery replacement. BACKGROUND: Previously our group developed web-based calculators and smart phone applications to estimate DBS battery life (http://mdc.mbi.ufl.edu/surgery/dbs-battery-estimator. METHODS: A cohort of 320 patients undergoing DBS battery replacement from 2002-2012 were included in an IRB approved study. Statistical analysis was performed using SPSS 20.0 (IBM, Armonk, NY. RESULTS: The mean charge density for treatment of Parkinson's disease was 7.2 µC/cm(2/phase (SD = 3.82, for dystonia was 17.5 µC/cm(2/phase (SD = 8.53, for essential tremor was 8.3 µC/cm(2/phase (SD = 4.85, and for OCD was 18.0 µC/cm(2/phase (SD = 4.35. There was a significant relationship between charge density and battery life (r = -.59, p<.001, as well as total power and battery life (r = -.64, p<.001. The UF estimator (r = .67, p<.001 and the Medtronic helpline (r = .74, p<.001 predictions of battery life were significantly positively associated with actual battery life. Battery status indicators on Soletra and Kinetra were poor predictors of battery life. In 38 cases, the symptoms improved following a battery change, suggesting that the neurostimulator was likely responsible for symptom worsening. For these cases, both the UF estimator and the Medtronic helpline were significantly correlated with battery life (r = .65 and r = .70, respectively, both p<.001. CONCLUSIONS: Battery estimations, charge density, total power and clinical symptoms were important factors. The observation of clinical worsening that was rescued following neurostimulator replacement reinforces the notion that changes in clinical symptoms can be associated with battery drain.

  16. Three important clinical processes in individual and group interpersonal psychotherapy sessions.

    Science.gov (United States)

    Kivlighan, Dennis M

    2014-03-01

    I describe three clinical processes: (a) bringing the discussion into the here-and-now; (b) making impact disclosures; and (c) creating a corrective emotional experience, derived from interpersonal theory, that occurs in most of my individual and group therapy sessions. For each of these clinical processes, I provide: (a) the theoretical principals that support the clinical process, (b) clinical descriptions and dialogue that demonstrate the process, and (c) a review of some of the research examining the clinical process. Finally, I propose a task model of interpersonal therapy, which illustrates how the three clinical processes come together in interpersonal therapy.

  17. The Minimal Clinically Important Difference after Simple Decompression for Ulnar Neuropathy at the Elbow

    Science.gov (United States)

    Malay, Sunitha; Chung, Kevin C.; Gaston, Glenn; Haase, R. Steven C.; Hammert, Warren C.; Lawton, Jeff; Merrell, Greg A.; Nassab, Paul F.; Song, Jae W.; Yang, Lynda J.S.

    2013-01-01

    Purpose Establishing minimally clinically important difference (MCID) for patient-reported outcomes questionnaires is an important component of outcomes research to understand treatment effectiveness from the patient’s perspective. For patients with ulnar neuropathy at the elbow (UNE), these assessments are vital to examine how much change in the questionnaire scores equate to patient satisfaction. Methods We calculated the change in scores of Michigan Hand Outcomes Questionnaire (MHQ), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), and Carpal Tunnel Questionnaire (CTQ) from preoperative to 3,6 and 12 months postoperatively after ulnar nerve simple decompression procedure. We used the anchor based approach of receiver operating characteristic curves to determine the MCID. Results On average, MCID of 10, 12, and 7 points were identified for pain, function, and ADL domains of MHQ. Similarly, DASH, CTQ-symptom severity scale, and CTQ-function severity scale had an average MCID of 7, 0.7, and 0.3 points respectively. At the 3, 6, and 12 months’ time-points, an MCID of 9, 8, and 13 points for pain, 12, 12, and 12 points for function, and 6, 8, and 6 points for ADL domains of the MHQ were identified; similarly an MCID of 8, 7, and 7 points for DASH; 0.4, 0.7, and 0.7 points for CTQ- symptom severity scale; and 0.3, 0.3, and 0.4 points for CTQ-function severity scale were established. Conclusion The smaller MCIDs of MHQ, DASH, and even smaller MCIDs of CTQ found in our study indicate that a small change in the scores identified satisfied patients. Simple decompression surgery for UNE produced patient satisfaction with only a small change in their questionnaire scores. The implications of this finding are that simple decompression surgery for UNE is a highly effective procedure and the outcomes questionnaires used are highly responsive, which minimizes sample size requirements for future research studies relating to UNE. PMID:23474160

  18. Cardiac Alpha1-Adrenergic Receptors: Novel Aspects of Expression, Signaling Mechanisms, Physiologic Function, and Clinical Importance

    Science.gov (United States)

    O’Connell, Timothy D.; Jensen, Brian C.; Baker, Anthony J.

    2014-01-01

    Adrenergic receptors (AR) are G-protein-coupled receptors (GPCRs) that have a crucial role in cardiac physiology in health and disease. Alpha1-ARs signal through Gαq, and signaling through Gq, for example, by endothelin and angiotensin receptors, is thought to be detrimental to the heart. In contrast, cardiac alpha1-ARs mediate important protective and adaptive functions in the heart, although alpha1-ARs are only a minor fraction of total cardiac ARs. Cardiac alpha1-ARs activate pleiotropic downstream signaling to prevent pathologic remodeling in heart failure. Mechanisms defined in animal and cell models include activation of adaptive hypertrophy, prevention of cardiac myocyte death, augmentation of contractility, and induction of ischemic preconditioning. Surprisingly, at the molecular level, alpha1-ARs localize to and signal at the nucleus in cardiac myocytes, and, unlike most GPCRs, activate “inside-out” signaling to cause cardioprotection. Contrary to past opinion, human cardiac alpha1-AR expression is similar to that in the mouse, where alpha1-AR effects are seen most convincingly in knockout models. Human clinical studies show that alpha1-blockade worsens heart failure in hypertension and does not improve outcomes in heart failure, implying a cardioprotective role for human alpha1-ARs. In summary, these findings identify novel functional and mechanistic aspects of cardiac alpha1-AR function and suggest that activation of cardiac alpha1-AR might be a viable therapeutic strategy in heart failure. PMID:24368739

  19. In vitro interactions between primycin and different statins in their effects against some clinically important fungi.

    Science.gov (United States)

    Nyilasi, Ildikó; Kocsubé, Sándor; Pesti, Miklós; Lukács, Gyöngyi; Papp, Tamás; Vágvölgyi, Csaba

    2010-02-01

    The in vitro antifungal activities of primycin (PN) and various statins against some opportunistic pathogenic fungi were investigated. PN completely inhibited the growth of Candida albicans (MIC 64 microg ml(-1)) and Candida glabrata (MIC 32 microg ml(-1)), and was very effective against Paecilomyces variotii (MIC 2 microg ml(-1)), but had little effect on Aspergillus fumigatus, Aspergillus flavus or Rhizopus oryzae (MICs >64 microg ml(-1)). The fungi exhibited different degrees of sensitivity to the statins; fluvastatin (FLV) and simvastatin (SIM) exerted potent antifungal activities against a wide variety of clinically important fungal pathogens. Atorvastatin, rosuvastatin and lovastatin (LOV) had a slight effect against all fungal isolates tested, whereas pravastatin was completely ineffective. The in vitro interactions between PN and the different statins were investigated using a standard chequerboard titration method. When PN was combined with FLV, LOV or SIM, both synergistic and additive effects were observed. The extent of inhibition was higher when these compounds were applied together, and the concentrations of PN and the given statin needed to block fungal growth completely could be decreased by several dilution steps. Similar interactions were observed when the variability of the within-species sensitivities was investigated.

  20. Inhibitory effect of Allium sativum and Zingiber officinale extracts on clinically important drug resistant pathogenic bacteria

    Directory of Open Access Journals (Sweden)

    Gull Iram

    2012-04-01

    Full Text Available Abstract Background Herbs and spices are very important and useful as therapeutic agent against many pathological infections. Increasing multidrug resistance of pathogens forces to find alternative compounds for treatment of infectious diseases. Methods In the present study the antimicrobial potency of garlic and ginger has been investigated against eight local clinical bacterial isolates. Three types of extracts of each garlic and ginger including aqueous extract, methanol extract and ethanol extract had been assayed separately against drug resistant Escherichia coli, Pseudomonas aeruginosa, Bacillus subtilis, Staphylococcus aureus, Klebsiella pneumoniae, Shigella sonnei, Staphylococcusepidermidis and Salmonella typhi. The antibacterial activity was determined by disc diffusion method. Results All tested bacterial strains were most susceptible to the garlic aqueous extract and showed poor susceptibility to the ginger aqueous extract. The (minimum inhibitory concentration MIC of different bacterial species varied from 0.05 mg/ml to 1.0 mg/ml. Conclusion In the light of several socioeconomic factors of Pakistan mainly poverty and poor hygienic condition, present study encourages the use of spices as alternative or supplementary medicine to reduce the burden of high cost, side effects and progressively increasing drug resistance of pathogens.

  1. Dental Erosion and Its Growing Importance in Clinical Practice: From Past to Present

    Directory of Open Access Journals (Sweden)

    Ann-Katrin Johansson

    2012-01-01

    Full Text Available Since the mid-1990s, the focus of studies on tooth wear has steadily shifted from the general condition towards the more specific area of dental erosion; equally, a shift has occurred from studies in adults to those in children and adolescents. During this time, understanding of the condition has increased greatly. This paper attempts to provide a critical overview of the development of this body of knowledge, from earlier perceptions to the present. It is accepted that dental erosion has a multifactorial background, in which individual and lifestyle factors have great significance. Notwithstanding methodological differences across studies, data from many countries confirm that dental erosion is common in children and young people, and that, when present, it progresses rapidly. That the condition, and its ramifications, warrants serious consideration in clinical dentistry, is clear. It is important for the oral healthcare team to be able to recognize its early signs and symptoms and to understand its pathogenesis. Preventive strategies are essential ingredients in the management of patients with dental erosion. When necessary, treatment aimed at correcting or improving its effects might best be of a minimally invasive nature. Still, there remains a need for further research to forge better understanding of the subject.

  2. Adhesive systems: important aspects related to their composition and clinical use

    Directory of Open Access Journals (Sweden)

    Mario Honorato Silva e Souza Junior

    2010-06-01

    Full Text Available This literature review article addresses the types and the main components of different etch-and-rinse and self-etch adhesive systems available in the market, and relates them to their function, possible chemical interactions and infuence of handling characteristics. Scanning electron microscopy (SEM images are presented to characterize the interface between adhesives and dentin. Adhesive systems have been recently classifed according to their adhesion approaches in etch-and-rinse, self-etch and glass ionomer. The etch-and-rinse systems require a specifc acid-etch procedure and may be performed in two or three steps. Self-etch systems employ acidic monomers that demineralize and impregnate dental substrates almost at the same time. These systems are separated in one or two steps. Some advantages and defciencies were noted for etch-and-rinse and self-etch approaches, mainly for the simplifed ones due to some chemical associations and interactions. The SEM micrographs illustrate different relationships between adhesive systems and dental structures, particularly dentin. The knowledge of composition, characteristics and mechanisms of adhesion of each adhesive system is of fundamental importance to permit the adoption of ideal bonding strategies under clinical conditions.

  3. Dental Erosion and Its Growing Importance in Clinical Practice: From Past to Present

    Science.gov (United States)

    Johansson, Ann-Katrin; Omar, Ridwaan; Carlsson, Gunnar E.; Johansson, Anders

    2012-01-01

    Since the mid-1990s, the focus of studies on tooth wear has steadily shifted from the general condition towards the more specific area of dental erosion; equally, a shift has occurred from studies in adults to those in children and adolescents. During this time, understanding of the condition has increased greatly. This paper attempts to provide a critical overview of the development of this body of knowledge, from earlier perceptions to the present. It is accepted that dental erosion has a multifactorial background, in which individual and lifestyle factors have great significance. Notwithstanding methodological differences across studies, data from many countries confirm that dental erosion is common in children and young people, and that, when present, it progresses rapidly. That the condition, and its ramifications, warrants serious consideration in clinical dentistry, is clear. It is important for the oral healthcare team to be able to recognize its early signs and symptoms and to understand its pathogenesis. Preventive strategies are essential ingredients in the management of patients with dental erosion. When necessary, treatment aimed at correcting or improving its effects might best be of a minimally invasive nature. Still, there remains a need for further research to forge better understanding of the subject. PMID:22505907

  4. Adhesive systems: important aspects related to their composition and clinical use.

    Science.gov (United States)

    Silva e Souza, Mario Honorato; Carneiro, Karina Gama Kato; Lobato, Marcelo Figueiredo; Silva e Souza, Patrícia de Almeida Rodrigues; de Góes, Mário Fernando

    2010-01-01

    This literature review article addresses the types and the main components of different etch-and-rinse and self-etch adhesive systems available in the market, and relates them to their function, possible chemical interactions and influence of handling characteristics. Scanning electron microscopy (SEM) images are presented to characterize the interface between adhesives and dentin. Adhesive systems have been recently classified according to their adhesion approaches in etch-and-rinse, self-etch and glass ionomer. The etch-and-rinse systems require a specific acid-etch procedure and may be performed in two or three steps. Self-etch systems employ acidic monomers that demineralize and impregnate dental substrates almost at the same time. These systems are separated in one or two steps. Some advantages and deficiencies were noted for etch-and-rinse and self-etch approaches, mainly for the simplified ones due to some chemical associations and interactions. The SEM micrographs illustrate different relationships between adhesive systems and dental structures, particularly dentin. The knowledge of composition, characteristics and mechanisms of adhesion of each adhesive system is of fundamental importance to permit the adoption of ideal bonding strategies under clinical conditions.

  5. Radiation-induced bystander effect: The important part of ionizing radiation response. Potential clinical implications

    Directory of Open Access Journals (Sweden)

    Maria Wideł

    2009-08-01

    Full Text Available It has long been a central radiobiological dogma that the damaging effects of ionizing radiation, such as cell death, cytogenetic changes, apoptosis, mutagenesis, and carcinogenesis, are the results of the direct ionization of cell structures, particularly DNA, or indirect damage via water radiolysis products. However, several years ago attention turned to a third mechanism of radiation, termed the “bystander effect” or “radiation-induced bystander effect” (RIBE. This is induced by agents and signals emitted by directly irradiated cells and manifests as a lowering of survival, cytogenetic damage, apoptosis enhancement, and biochemical changes in neighboring non-irradiated cells. The bystander effect is mainly observed in in vitro experiments using very low doses of alpha particles (range; mGy, cGy, but also after conventional irradiation (X-rays, gamma rays at low as well as conventional doses. The mechanisms responsible for the bystander effect are complex and still poorly understood. It is believed that molecular signals released from irradiated cells induce different signaling ways in non-irradiated neighboring cells, leading to the observed events. The molecular signals may be transmitted through gap junction intercellular communication and through a medium transfer mechanism. The nature of these transmitted factors are diverse, and still not defi nitely established. It seems that RIBE may have important clinical implications for health risk associated with radiation exposure. Potentially, this effectmay have important implications in the creation of whole-body or localized side effects in tissues beyond the irradiation fi eld and also in low-dose radiological and radioisotope diagnostics. Factors emitted by irradiated cells may result in the risk of genetic instability, mutations, and second primary cancer induction. They might also have their own part in inducing and extending post-radiation side effects in normal tissue. The

  6. [Raynaud's phenomenon, disease or syndrome?].

    Science.gov (United States)

    Fiessinger, Jean-Noël

    2011-09-01

    Raynaud's phenomenon is a common symptom. More often it is usually an idiopathic and benign condition. But it can be an early manifestation of a connective tissue disease especially scleroderma and primary Sjogren's syndrom. Thus it is necessary to develop reasonable screening model. If the vasomotor symptoms are localized, a diagnosis of secondary Raynaud's phenomenon is highly probable and the main etiology is an arterial disease. Occupational arterial lesions are a particularly aspect of secondary Raynaud's phenomenon. Calcium channel blockers are the reference for the symptomatic treatment of Raynaud's phenomenon. In severe secondary forms, intravenous iloprost infusion is effective. New drugs as endothelin antagonist and phospodiesterase type 5 inhibitors are still to be evaluated.

  7. Phenomenon of isomorphic provoking responses in cases of limited scleroderma

    Directory of Open Access Journals (Sweden)

    Talnikova Е.Е.

    2015-09-01

    Full Text Available The article presents the historical origin of the term "Koebner phenomenon". The literature data reflect the etiology, pathogenesis and epidemiology of isomorphic mechanisms provoking responses in lichen planus, psoriasis, scleroder-ma, syphilis. Variants of the Koebner phenomenon's classifications are given. The clinical cases of limited scleroderma after mechanical injury are described.

  8. EDUCATION AS A SOCIO-CULTURAL PHENOMENON

    Directory of Open Access Journals (Sweden)

    Victor A. SHTURBA

    2016-01-01

    Full Text Available In the article author analyze the socio-cultural phenomenon of education through the prism of its values and target components. Understanding of the role and place of education in society is not possible out of the human essence context. In living nature man appears as a phenomenon - this thesis is recognized the absolute majoriy of scientific and philosophical theories, concepts and doctrines, including non-humanistic oriented. It is known that man is a social being - society is environment for its full life. As Aristotle said, only the gods and the animals can live outside society. However, human nature does not imply a simple social existence in the form of an intensive exchange of information with similar entities and, based on this, building complex collective actions. The man has a mind that is capable of abstract thought, speech, language, complex psyche, important component of which is imagination. These features formed the basis of theoretical and methodological basis of the analysis of education as a phenomenon. The author indicated value and target measurement of socio-cultural phenomenon of education, which led to the conclusion about the need to rely on a properly organized philosophical and pedagogical knowledge, the importance of implementation in the educational process of program-target approach and the relevance of the audit of modern educational models for nonborrowed trainings, upbringing and socialization. doi: 10.17748/2075-9908-2016-8-2/1-124-126. [en

  9. Prevention of clinically important deteriorations in COPD with umeclidinium/vilanterol

    Directory of Open Access Journals (Sweden)

    Singh D

    2016-06-01

    Full Text Available Dave Singh,1 M Reza Maleki-Yazdi,2 Lee Tombs,3 Ahmar Iqbal,4 William A Fahy,5 Ian Naya5 1Medicines Evaluation Unit, University of Manchester, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK; 2Division of Respiratory Medicine, Women’s College Hospital, University of Toronto, ON, Canada; 3Precise Approach LTD, London UK; 4Respiratory Medical Franchise, GSK, Research Triangle Park, NC, USA; 5Respiratory Medicines Development Centre, GSK, Stockley Park, Middlesex, UK Background: Minimizing the risk of disease progression and exacerbations is the key goal of COPD management, as these are well-established indicators of poor COPD prognosis. We developed a novel composite end point assessing three important aspects (lung function, health status, and exacerbations of worsening in COPD. The objective was to determine whether dual bronchodilation with umeclidinium/vilanterol (UMEC/VI reduces clinically important deteriorations (CIDs in COPD versus placebo or bronchodilator monotherapy.  Methods: This study is a post hoc analysis of two 24-week trials comparing UMEC/VI 62.5/25 µg with UMEC 62.5 µg, VI 25 µg, or placebo (Study A; NCT01313650, or UMEC/VI 62.5/25 µg with tiotropium (TIO 18 µg (Study B; NCT01777334 in patients with symptomatic COPD, without a history of frequent exacerbations. Deterioration was assessed as the time to a first CID, a composite measure defined as a decrease of ≥100 mL in trough forced expiratory volume in 1 second or ≥4-unit increase in St George’s Respiratory Questionnaire total score or an on-treatment moderate-to-severe COPD exacerbation.  Results: In Study A, fewer patients experienced a first CID with UMEC/VI (44% versus UMEC (50%, VI (56%, and placebo (75%. The risk of a first CID was reduced with UMEC/VI (hazard ratio [HR]: 0.37 [95% confidence interval, CI: 0.30, 0.45], UMEC (HR: 0.46 [95% CI: 0.38, 0.56], and VI (HR: 0.55 [95% CI: 0.45, 0.66]; all P<0.001 versus placebo

  10. Retroaortic Left Renal Vein: Multidetector Computed Tomography Angiography Findings and Its Clinical Importance

    Energy Technology Data Exchange (ETDEWEB)

    Karaman, B.; Koplay, M.; Oezturk, E.; Basekim, C.C.; Ogul, H.; Mutlu, H.; Kizilkaya, E.; Kantarci, M. [Dept. of Radiology, Sivas Military Hospital, Sivas (Turkey)

    2007-04-15

    Purpose: To evaluate the appearance, type, frequency, and clinical importance of retroaortic left renal vein (RLRV) in patients examined with multidetector computed tomography (MDCT) angiography. Material and Methods: A total of 1856 patients who underwent CT with urological symptoms (hematuria, flank and abdominal pain, left gonadal vein varicocele) (n = 889) or with symptoms other than urological ones (n = 967) were prospectively evaluated for the presence of RLRV. CT was performed with 110 ml of iodinated contrast material through the antecubital vein at a rate of 3.5 ml/s. Late arterial and early venous phase volumetric data sets were acquired at 30 and 65 s, respectively, from the start of the intravenous injection of contrast medium. In addition to axial images, multiplanar reconstructions (MPR), maximum-intensity projection (MIP), and three-dimensional volume-rendering (3D VR) images were used to assess left renal vein anomalies. Left renal vein anomalies were classified into four types according to their appearance: I) RLRV joining the inferior vena cava (IVC) in the orthotopic position; II) RLRV joining the IVC at level L4-L5; III) circumaortic or collar left renal vein; IV) RLRV joining the left common iliac vein. Results: RLRV was detected in 68 (3.6%) of the 1856 patients, with 26, 22, 17, and three of types I, II, III, and IV, respectively. Forty-four of the 68 patients with RLRV (65%) were in the group with urological symptoms, while 24 patients (35%) were in the group without urological symptoms. Compression of the RLRV was found in 16 patients in the urological symptoms group, while compression was detected in only three patients in the other group. This difference was statistically significant (P<0.05). The most common urological symptom was hematuria. The frequency of urological symptoms was higher in groups II and IV compared to the other groups. Conclusion: MDCT angiography with axial, MPR, MIP, and 3D VR images is effective in the detection of

  11. [Clinical analysis of the first patient with imported Middle East respiratory syndrome in China].

    Science.gov (United States)

    Ling, Yun; Qu, Rong; Luo, Yufeng

    2015-08-01

    To report the treatment of the first imported Middle East respiratory syndrome ( MERS ) in China, and to investigate the clinical features and treatment of the patient. On May 28th, 2015, the first patient of imported MERS to China was admitted to Department of Critical Care Medicine of Huizhou Municipal Central Hospital. The clinical features and treatments of this patient were analyzed. (1) A 43 years old male of South Korean nationality was admitted with the complaint of back ache for 7 days and fever 2 days with the following characteristics: back ache 7 days ago, without fever or cough or expectoration. He had been suspected to suffer from infection of Middle East respiratory syndrome coronavirus ( MERS-CoV ) by the Disease Control Department of South Korea, but no specific treatment was given. He had fever for 2 days with maximum body temperature of 39.7 centigrade. He had no chills, cough, expectoration, short of breath, abdominal pain, diarrhea, frequent micturition, or urgency or pain of urination, and no sore throat. The patient had a history of exposure to MERS-CoV patient. He was considered to be a patient of the second batch of South Korean epidemic. (2) Auxiliary examination: 3 copies of throat swab specimens for virus nucleic acid detection were performed by the Disease Prevention Control Center of China ( China CDC ), and they were positive on May 29th, 2015, and also for serum, sputum and stool. Based on the results of whole genome sequence analysis, the virus strains were implicated to be derived from Riyahh and Jeddah regions of Saudi Arabia. On admission, the patient's blood test showed that the white blood cell count was low ( 3.22×10(9)/L ), the proportion of the neutrophils was high ( 0.73 ), and that of the platelet was low ( 81×10(9)/L ). On admission, the patient's chest X-ray showed that a small amount of infiltration in the lung. (3) TREATMENT: a high-flow nasal cannula ( HFNC ) with oxygen concentration of 0.50-0.80 was given, with a

  12. Quorum sensing in veterinary pathogens: mechanisms, clinical importance and future perspectives.

    Science.gov (United States)

    Boyen, F; Eeckhaut, V; Van Immerseel, F; Pasmans, F; Ducatelle, R; Haesebrouck, F

    2009-03-30

    Under certain circumstances the individuals of a bacterial population may find advantages in acting together and making "collective decisions". This phenomenon is better known as quorum sensing. When the concentration of signal molecules produced by the surrounding bacteria exceeds a certain threshold, the bacterial population acts as a single organism, collectively expressing virulence genes, biofilm forming genes, etc. Several mechanisms of quorum sensing are discussed, each with its distinct signal molecules and respective receptors. Some of these mechanisms are restricted to sensing intraspecies signalling, but interspecies and even interkingdom signalling have also been described. Several veterinary pathogens such as Staphylococcus aureus, Staphylococcus pseudintermedius, Pseudomonas aeruginosa and Salmonella Typhimurium use quorum sensing as a means to optimize virulence gene expression and host colonization. Therefore, targeting of the QS mechanisms may provide a novel strategy for combating bacterial infections, also in veterinary medicine.

  13. Social outcomes of early childbearing: important considerations for the provision of clinical care.

    Science.gov (United States)

    Fessler, Kathryn Bondy

    2003-01-01

    Traditional understanding of adolescent childbearing includes a belief that the social and economic consequences for both mother and child are almost universally negative. Recent research, however, reveals that the outcomes resulting from the birth of children to young mothers are diverse and complex. Social circumstances contributing to adolescent pregnancy and parenting, such as poverty, poor educational opportunity, and violence, are also causes of less than optimal outcomes for young mothers and their children; thus, attributions of cause and effect are difficult to make. By reviewing outcomes research that approaches this question in a number of more creative ways, clinicians can gain a more complete understanding of this phenomenon. It is hoped that health care providers with access to new evidence about the social consequences of adolescent childbearing will have improved success and satisfaction in providing competent, compassionate care to pregnant and parenting adolescents.

  14. Remarkable anatomic variations in paranasal sinus region and their clinical importance

    Energy Technology Data Exchange (ETDEWEB)

    Kantarci, Mecit E-mail: akkanrad@hotmail.com; Karasen, R. Murat; Alper, Fatih; Onbas, Omer; Okur, Adnan; Karaman, Adem

    2004-06-01

    With the advent of functional endoscopic sinus surgery (FESS) and coronal computed tomography (CT) imaging, considerable attention has been directed toward paranasal region anatomy. Detailed knowledge of anatomic variations in paranasal sinus region is critical for surgeons performing endoscopic sinus surgery as well as for the radiologist involved in the preoperative work-up. To be in the known anatomical variants with some accompanying pathologies, directly influence the success of diagnostic and therapeutic management of paranasal sinus diseases. A review of 512 (1024 sides) paranasal sinus tomographic scans was carried out to expose remarkable anatomic variations of this region. We used only coronal sections, but for some cases to clear exact diagnosis, additional axial CT scan, magnetic resonance imaging (MRI) and nasal endoscopy were also performed. In this pictorial essay, rates of remarkable anatomic variations in paranasal region were displayed. The images of some interesting cases were illustrated, such as the Onodi cell in which isolated mucocele caused loss of visual acuity, agger nasi cell, Haller's cell, uncinate bulla, giant superior concha bullosa, inferior concha bullosa, bilateral carotid artery protrusion into sphenoid sinus, maxillary sinus agenesis, bilateral secondary middle turbinate (SMT) and sphenomaxillary plate. The clinical importance of all these variations were discussed under the light of the literature. It was suggested that remarkable anatomic variations of paranasal region and their possible pathologic consequences should be well defined in order to improve success of management strategies, and to avoid potential complications of endoscopic sinus surgery. The radiologist must pay close attention to anatomical variations in the preoperative evaluation.

  15. Clinical import of Horner syndrome in internal carotid and vertebral artery dissection.

    Science.gov (United States)

    Lyrer, Philippe A; Brandt, Tobias; Metso, Tiina M; Metso, Antti J; Kloss, Manja; Debette, Stephanie; Leys, Didier; Caso, Valeria; Pezzini, Alessandro; Bonati, Leo H; Thijs, Vincent; Bersano, Anna; Touzé, Emmanuel; Gensicke, Henrik; Martin, Juan J; Lichy, Christoph; Tatlisumak, Turgut; Engelter, Stefan T; Grond-Ginsbach, Caspar

    2014-05-06

    To study the prognostic importance of Horner syndrome (HS) in patients with internal carotid artery dissection (ICAD) or vertebral artery dissection (VAD). In this observational study, characteristics and outcome of patients with ICAD or VAD from the CADISP (Cervical Artery Dissection and Ischemic Stroke Patients) database were analyzed. The presence of HS was systematically assessed using a standardized questionnaire. Patients with HS (HS+) were compared with HS- patients. Crude odds ratios (ORs) with 95% confidence intervals and ORs adjusted for age, sex, center, arterial occlusion, bilateral dissection, stroke severity, and type of antithrombotic treatment were calculated. We analyzed 765 patients (n = 496 with ICAD, n = 269 with VAD, n = 303 prospective, n = 462 retrospective). HS was present in 191 (38.5%) of the patients with ICAD and 36 (13.4%) of the patients with VAD (p < 0.001). HS+ ICAD patients presented less often with stroke or TIA (p < 0.001), less often had bilateral (p = 0.019) or occlusive (p = 0.001) dissections, and had fewer severe strokes (p = 0.041) than HS- ICAD patients. HS+ ICAD patients had a better functional 3-month outcome than those without HS (ORcrude = 4.0 [2.4-6.7]), and also after adjustment for outcome-relevant covariates (ORadjusted = 2.0 [1.1-4.0]). HS+ ICAD patients were less likely to have new strokes than HS- ICAD patients (p = 0.039). HS+ VAD patients more often had vessel occlusion (p = 0.014) than HS- patients but did not differ in any of the other aforementioned variables. In patients with ICAD, HS is an easily assessable marker that might indicate a more benign clinical course. HS had no prognostic meaning in patients with VAD.

  16. The biological and clinical importance of epithelial-mesenchymal transition in circulating tumor cells.

    Science.gov (United States)

    Liu, Huiying; Zhang, Xiaofeng; Li, Jun; Sun, Bin; Qian, Haihua; Yin, Zhengfeng

    2015-02-01

    Movement of tumor cells from a primary tumor to a nonadjacent or distant site is a contiguous and complex process. Among the multiple natural cellular programs that promote initiation and progression of tumor metastasis, epithelial-mesenchymal transition (EMT) may play a key role in the ultimate generation of a metastatic foci. Acquisition of the EMT phenotype by tumor cells not only increases their migration and invasion potentials, thereby facilitating their ability to infiltrate blood vessels and to produce circulating tumor cells (CTCs), but also promotes survival of CTCs in the bloodstream and their ability to extravasate out of the circulatory system and invade proximal tissues. In organs distal to the primary tumor, the phenotypic switching mechanism of mesenchymal-epithelial transition (MET) enables CTCs to grow and colonize, enhancing the likelihood of establishing metastasis. In addition, CTCs that have undergone EMT attain increased resistance to chemotherapy and targeted therapy. CTCs with the EMT phenotype have become recognized as an active source of metastases, and targeting EMT/MET processes during the individual steps of tumor metastasis represents a promising new approach for alleviating cancer metastasis and recurrence. In this article, we focus on the biological and clinical importance of EMT and/or MET in CTCs during the individual steps of tumor metastasis, summarizing the recent findings of the regulatory roles played by EMT and/or MET in the generation, survival, and recolonization of CTCs and discussing the EMT-targeting strategies developed for tumor diagnosis as well as their potential for management of metastatic malignant diseases.

  17. Recent achievements in the management of Raynaud's phenomenon.

    Science.gov (United States)

    Baumhäkel, Magnus; Böhm, Michael

    2010-04-15

    Raynaud's phenomenon is a clinical disorder with episodic digital ischemic vasospasm triggered by cold- or emotional-stress. It was first mentioned by Maurice Raynaud in 1862 describing "a local asphyxia of the extremities" and was further divided into primary Raynaud's disease and secondary Raynaud's phenomenon, which is often related to connective tissue diseases, but also physical or chemical strain. Though pathophysiology of Raynaud's phenomenon is still poorly understood, systemic and local vascular effects are most likely to be involved in primary Raynaud's disease. In secondary Raynaud's phenomenon additional abnormalities in vascular structure and function may play the major role. Thus, medical treatment of Raynaud's phenomenon remains unsatisfactory, due to limited understanding of pathophysiological mechanisms. This review addresses current evidence for medical treatment of primary and secondary Raynaud's phenomenon with regard to pathophysiological mechanisms as well as future perspectives.

  18. Important options available - from start to finish -for translating proteomics results to clinical chemistry

    DEFF Research Database (Denmark)

    Heegaard, Niels H H; Ostergaard, Ole; Bahl, Justyna M C

    2015-01-01

    In the realm of clinical chemistry the field of clinical proteomics, i.e., the application of proteomic methods for understanding mechanisms and enabling diagnosis, prediction, measurement of activity, and treatment response in disease, is first and foremost a discovery and research tool that fee...

  19. The importance of evaluation in clinical competence in the presence of college teaching in health

    Directory of Open Access Journals (Sweden)

    Correa-Bautista Jorge Enrique

    2012-04-01

    Full Text Available Competency assessment (CA has renewed the way to determine the clinical performance ofhealth professionals. To this end, the university teaching requires conceptual and methodologicaldomain on the various techniques of formative assessment. This article reports the main technicalcompetency assessment in clinical settings, considering it as a core competency for universityteaching in health.

  20. Automated realtime data import for the i2b2 clinical data warehouse: introducing the HL7 ETL cell.

    Science.gov (United States)

    Majeed, Raphael W; Röhrig, Rainer

    2012-01-01

    Clinical data warehouses are used to consolidate all available clinical data from one or multiple organizations. They represent an important source for clinical research, quality management and controlling. Since its introduction, the data warehouse i2b2 gathered a large user base in the research community. Yet, little work has been done on the process of importing clinical data into data warehouses using existing standards. In this article, we present a novel approach of utilizing the clinical integration server as data source, commonly available in most hospitals. As information is transmitted through the integration server, the standardized HL7 message is immediately parsed and inserted into the data warehouse. Evaluation of import speeds suggest feasibility of the provided solution for real-time processing of HL7 messages. By using the presented approach of standardized data import, i2b2 can be used as a plug and play data warehouse, without the hurdle of customized import for every clinical information system or electronic medical record. The provided solution is available for download at http://sourceforge.net/projects/histream/.

  1. A study of practical parameters and their relative importance as perceived by various stakeholders in clinical trials.

    Science.gov (United States)

    Pant, R; Joshi, Y

    2011-01-01

    A contract research organization (CRO) is a company which conducts a Good Clinical Practice (GCP) in clinical trial. There are literally hundreds of CROs worldwide employing a workforce of nearly 100,000 professionals. The project proposes the study of practical parameters and their relative importance as perceived by the various stakeholders in clinical trials. The survey was conducted in Bangalore and New Delhi. Primary market data was obtained by primary market research which included 80 clinical trial stakeholders by having a preliminary communication with them, followed by administering a questionnaire along with prior permission. There were 15 Sponsors/ CROs, 27 Investigators /Monitors and 38 Ethics committee members involved in the study. It was shown from the study that a clinical investigator involved in a clinical trial is responsible for ensuring that an investigation is conducted according to the signed investigator statement, the investigational plan, and applicable regulations; for protecting the rights, safety, and welfare of the subjects under the investigator's care; and for the control of drugs under investigation. It was also shown from the study that the sponsors of a clinical trial carry the ultimate responsibility for the initiation, management and financing of the clinical trial. The study has identified a specific training need at the level of the individual stakeholder to perform a particular job function and to identify the actual practical parameters in the Indian context important for the conduction of clinical trials (GCP) with respect to the different stakeholders, to determine the relative importance of these parameters as perceived by various stakeholders involved in clinical trials, and to identify the relative contributions of different stakeholders to the success/ satisfactory conduct of a clinical trial.

  2. The importance of knowledge, skills, and attitude attributes for veterinarians in clinical and non-clinical fields of practice: a survey of licensed veterinarians in Quebec, Canada.

    Science.gov (United States)

    Doucet, Michèle Y; Vrins, André

    2009-01-01

    To improve content validity and the pertinence of outcome assessment tools used for the undergraduate Doctor of Veterinary Medicine program at the University of Montreal's Faculté de médecine vétérinaire, a survey of members of the Quebec veterinary association was conducted. This survey aimed to determine the importance of a list of 71 attributes-categorized as knowledge, general skills, specific skills, and attitudes-for clinical and non-clinical types of professional activities. The results indicated that all basic knowledge components, general skills, and attitudes were equally important for all types of veterinary professional activities, while the importance of specific skills was significantly different for clinical practice and non-clinical fields. It was therefore proposed that outcomes assessment surveys of stakeholders, such as alumni and employers, be analyzed separately for each type of career option.

  3. Koebner Phenomenon and Mycosis Fungoides

    Directory of Open Access Journals (Sweden)

    Eve Lebas

    2015-10-01

    Full Text Available Mycosis fungoides (MF is the most frequent type of primary cutaneous T-cell/NK-cell lymphoma. The Koebner phenomenon is defined as the appearance of cutaneous lesions on previously noninvolved skin following trauma and is observed in a series of cutaneous diseases including psoriasis, lichen planus, viral warts, molluscum contagiosum, etc. In this case report, 3 patients with longstanding MF are presented, the 1st with the appearance of a circumscribed early-stage type MF lesion rapidly following a surgical excision of an infundibular cyst, the 2nd with the appearance of a unique unilateral palmar tumoral MF lesion at the pressure site of a crutch, and the 3rd presented localized MF early stage lesions at the friction site of a belt. This report suggests that some MF patients may experience Koebner phenomenon-induced MF lesions and that MF should be added to the long list of skin diseases potentially exhibiting the Koebner phenomenon.

  4. POSITIVE CLINICAL INTERVENTIONS: WHY ARE THEY IMPORTANT AND HOW DO THEY WORK?

    Directory of Open Access Journals (Sweden)

    E.T. Bohlmeijer

    2017-01-01

    Full Text Available In this paper we discuss positive clinical psychology as an emerging field within clinical psychology. Positive clinical psychology is based on research demonstrating that mental health is more than the absence of mental illness, on research showing that wellbeing has buffering effects on the incidence of psychopathology and mental illnesses and on studies demonstrating that positive characteristics, such as positive emotions and gratitude, can predict pathology beyond the predictive power of negative characteristics. In this paper we present three distinct forms of well-being: emotional, psychological and social. In addition we review three types of positive clinical interventions: well-being therapy, positive psychotherapy and acceptance and commitment therapy. The paper ends with a call for a transformation of mental health care in which illness oriented treatments are complemented with well-being oriented treatments.

  5. Lies, damned lies and statistics: Clinical importance versus statistical significance in research.

    Science.gov (United States)

    Mellis, Craig

    2017-02-28

    Correctly performed and interpreted statistics play a crucial role for both those who 'produce' clinical research, and for those who 'consume' this research. Unfortunately, however, there are many misunderstandings and misinterpretations of statistics by both groups. In particular, there is a widespread lack of appreciation for the severe limitations with p values. This is a particular problem with small sample sizes and low event rates - common features of many published clinical trials. These issues have resulted in increasing numbers of false positive clinical trials (false 'discoveries'), and the well-publicised inability to replicate many of the findings. While chance clearly plays a role in these errors, many more are due to either poorly performed or badly misinterpreted statistics. Consequently, it is essential that whenever p values appear, these need be accompanied by both 95% confidence limits and effect sizes. These will enable readers to immediately assess the plausible range of results, and whether or not the effect is clinically meaningful.

  6. [Epidemiology of heart failure in Spain and the importance of adhering to clinical practice guidelines].

    Science.gov (United States)

    Muñiz García, Javier; Crespo Leiro, María G; Castro Beiras, Alfonso

    2006-07-01

    This article focuses on the magnitude of the challenge of heart failure, with particular reference to the disease burden in Spain. The text also deals with the difficulty of estimating the size of the problem, which stems from the fact that heart failure is a common end-point of numerous conditions. The second part of the article presents some reflections on the value of clinical practice guidelines and on the difficulty of incorporating interventions that have proven their efficacy under the controlled conditions of a clinical trial into everyday clinical practice, thereby maximizing their potential benefits. Finally, some suggestions are made on improving both professionals' adherence to clinical practice guidelines and patients' adherence to recommended treatment.

  7. Clinical importance of neutralising antibodies against interferon beta in patients with relapsing-remitting multiple sclerosis

    DEFF Research Database (Denmark)

    Sorensen, Per Soelberg; Ross, Christian; Clemmesen, Katja Maria;

    2003-01-01

    Interferon beta is the first-line treatment for relapsing-remitting multiple sclerosis, but the drug can induce neutralising antibodies against itself, which might reduce effectiveness. We aimed to assess the clinical effect of neutralising antibodies.......Interferon beta is the first-line treatment for relapsing-remitting multiple sclerosis, but the drug can induce neutralising antibodies against itself, which might reduce effectiveness. We aimed to assess the clinical effect of neutralising antibodies....

  8. Clinical importance of neutralising antibodies against interferon beta in patients with relapsing-remitting multiple sclerosis

    DEFF Research Database (Denmark)

    Sorensen, Per Soelberg; Ross, Christian; Clemmesen, Katja Maria

    2003-01-01

    Interferon beta is the first-line treatment for relapsing-remitting multiple sclerosis, but the drug can induce neutralising antibodies against itself, which might reduce effectiveness. We aimed to assess the clinical effect of neutralising antibodies.......Interferon beta is the first-line treatment for relapsing-remitting multiple sclerosis, but the drug can induce neutralising antibodies against itself, which might reduce effectiveness. We aimed to assess the clinical effect of neutralising antibodies....

  9. IMPORTANCE OF ENGLISH LANGUAGE CLINICS FOR REMEDIAL TEACHING: CONCEPT, FUNCTIONING AND CHALLENGES

    OpenAIRE

    Ameerchund Maharaj,; Intakhab Alam Khan King

    2017-01-01

    Although EFL students learn English at schools and colleges, the time allotted for their English lessons per day is very limited. Setting up English Language Clinics at EFL colleges/institutes will help students improve and develop their language skills. This paper aims at helping EFL students develop their English language skills by opening English language clinics in schools and colleges. The paper presents the concept and scope of ELC and its usefulness. It also provides an overview of som...

  10. Resurrecting Dead-water Phenomenon

    CERN Document Server

    Mercier, Matthieu; Dauxois, Thierry

    2011-01-01

    We revisit experimental studies performed by Ekman on dead-water using modern techniques in order to present new insights on this peculiar phenomenon. We extend its description to more general situations such as a three-layer fluid or a linearly stratified fluid in presence of a pycnocline, showing the robustness of dead-water phenomenon. We observe large amplitude nonlinear internal waves which are coupled to the boat dynamics, and we emphasize that the modeling of the wave-induced drag requires more analysis, taking into account nonlinear effects.

  11. Rational use of intensity-modulated radiation therapy: the importance of clinical outcome.

    Science.gov (United States)

    De Neve, Wilfried; De Gersem, Werner; Madani, Indira

    2012-01-01

    During the last 2 decades, intensity-modulated radiation therapy (IMRT) became a standard technique despite its drawbacks of volume delineation, planning, robustness of delivery, challenging quality assurance, and cost as compared with non-IMRT. The theoretic advantages of IMRT dose distributions are generally accepted, but the clinical advantages remain debatable because of the lack of clinical assessment of the effort that is required to overshadow the disadvantages. Rational IMRT use requires a positive advantage/drawback balance. Only 5 randomized clinical trials (RCTs), 3 in the breast and 2 in the head and neck, which compare IMRT with non-IMRT (2-dimensional technique in four fifths of the trials), have been published (as of March 2011), and all had toxicity as the primary endpoint. More than 50 clinical trials compared results of IMRT-treated patients with a non-IMRT group, mostly historical controls. RCTs systematically showed a lower toxicity in IMRT-treated patients, and the non-RCTs confirmed these findings. Toxicity reduction, counterbalancing the drawbacks of IMRT, was convincing for breast and head and neck IMRT. For other tumor sites, the arguments favoring IMRT are weaker because of the inability to control bias outside the randomized setting. For anticancer efficacy endpoints, like survival, disease-specific survival, or locoregional control, the balance between advantages and drawbacks is fraught with uncertainties because of the absence of robust clinical data.

  12. Automated EEG detection algorithms and clinical semiology in epilepsy: importance of correlations.

    Science.gov (United States)

    Hogan, R Edward

    2011-12-01

    With advances in technological innovation, electroencephalography has remained the gold standard for classification and localization of epileptic seizures. Like other diagnostic modalities, technological advances have opened new avenues for assessment of data, and hold great promise to improve interpretive capabilities. However, proper overall interpretation and application of electroencephalographic findings relies on valid correlations of associated clinical semiology. This article addresses interpretation of clinical signs and symptoms in the context of the diagnostic predictive value of electroencephalographic, clinical, and electrographic definitions of seizures, and upcoming challenges of interpreting intracranial high-frequency electroencephalographic data. This article is part of a Supplemental Special Issue entitled The Future of Automated Seizure Detection and Prediction. Copyright © 2011 Elsevier Inc. All rights reserved.

  13. The Diagnostic importance of clinical and radiologic features of the Multiple Cemento-osseous dysplasia

    Energy Technology Data Exchange (ETDEWEB)

    Han, M. R.; Kim, Y. H.; Kang, B. C. [College of Dentistry, Chonam National University, Kwangju (Korea, Republic of)

    1998-02-15

    This case was diagnosed as multiple cementoosseous dysplasia on the basis of clinical and radiological features but was diagnosed as ossifying fibroma on the basis of histopathological feature. The histopathologic features of the multiple cementoosseous dysplasia and cementoossifying fibroma have common features of cementum, fibrous network and bone. Multiple cementoosseous dysplasia is reactive lesion and shows restricted lesion size, occurred on anterior and posterior tooth of the mandible and needs no treatment except periodic follow up. But Cementoossifying fibroma is the true neoplasm and grows continuously and needs surgical removal. The final diagnosis of the multiple cementoosseous dysplasia requires good correlation of the clinical histopathological, and radiological features.

  14. Clinical trial success rates of anti-obesity agents: the importance of combination therapies.

    Science.gov (United States)

    Hussain, H T; Parker, J L; Sharma, A M

    2015-09-01

    The objective of this study was to construct a clinical trial profile assessing the risk of drug failure among anti-obesity agents. Research was conducted by looking at anti-obesity therapies currently on the market or in clinical trials (phases I to III) conducted from 1998 to September 2014, with the exclusion of any drugs whose phase I trial was conducted prior to January 1998. This was completed primarily through a search on http://clinicaltrials.gov where a total of 51 drugs met the search criteria. The transition probabilities were then calculated based on various classifications and compared against industry standards. The transition probability of anti-obesity agents was 8.50% whereas the transition probability of industry standards was 10.40%. Combination therapies had four times the transition probability than monotherapies, 40% and 4.75%, respectively. Therefore, it was determined that 92% of drugs fail during clinical trial testing for this indication and combination therapy appears to improve clinical trial success rates to 10-fold. © 2015 World Obesity.

  15. Clinical and diagnostic importance of changes of colon at chronic prostatitis

    Directory of Open Access Journals (Sweden)

    V.M. Popkov

    2010-06-01

    Full Text Available The aim of researches was studying clinical, microbiological and morphological characteristic of colon at patients at chronic prostatitis, definition of method of pathogenetic therapy on the basis of the received results. Material and methods of investigation. 50 patients at chronic bacterial prostatitis, 50 patients at asymptomatic inflammatory prostatitis and 30 practically healthy males were inspected. Microflora of prostata's secret and colon, morphology and structure of components of diffuse neuroendocrine system of colon were studied. Clinical, microbiological, иммуногистохимические methods and morphometrical analysis were applied. Results. It is defined, that at 74% patients with asymptomatic inflammatory prostatitis irritable bowel syndrome and at 26% - chronic nonulcerative colitis were diagnosed. At all patients at chronic bacterial prostatitis chronic nonulcerative colitis were detected. These variants were correlleted with different types of intestinal dysbiosis and degree of microbe producing of prostate. Use probiotic Bactistatin® at patients with a chronic prostatitis raises clinical efficiency of antibacterial therapy, promotes reduction of inflammatory changes, restoration of its microbic landscape and neuroendocrine homeostasis of colon. inclusion. At chronic prostatitis structural and functional pathology of colon are often registered, they are connected with clinical variant of prostatitis and can mask of prostata's pathology. Using Bactistatin® at patients with a chronic prostatitis is proved and effective

  16. Small-Fiber Neuropathy: A Diabetic Microvascular Complication of Special Clinical, Diagnostic, and Prognostic Importance.

    Science.gov (United States)

    Körei, A E; Istenes, I; Papanas, N; Kempler, P

    2016-01-01

    Damage of small nerve fibers may lead to a large variety of clinical symptoms. Small-fiber neuropathy underlies the symptoms of painful diabetic neuropathy, which may decrease quality of life. It also contributes to the poor prognosis of diabetic neuropathy because it plays a key role in the pathogenesis of foot ulceration and autonomic neuropathy. Impairment of small nerve fibers is considered the earliest alteration in the course of diabetic neuropathy. Therefore, assessment of functional and morphological abnormalities of small nerve fibers may enable timely diagnosis. The definition, symptoms, and clinical significance of small-fiber neuropathy are considered in the present review. An apparently more complex interaction between small-fiber impairment and microcirculation is extensively discussed. Diagnostic modalities include morphometric and functional methods. Corneal confocal microscopy and punch skin biopsy are considered gold standards, but noninvasive functional tests are also diagnostically useful. However, in routine clinical practice, small-fiber neuropathy is diagnosed by its typical clinical presentation. Finally, prompt treatment should be initiated following diagnosis.

  17. Multicenter epidemiological and clinical study on imported Chagas diseases in Alicante, Spain

    NARCIS (Netherlands)

    Ramos, J.M.; Torrus, D.; Amador, C.; Jover, F.; Perez-Chacon, F.; Ponce, Y.; Arjona, F.J.; Caro, E.; Martinez-Peinado, C.; Gallegos, I.; Cuadrado, J.M.; Tello, A.; Gutierrez, F.

    2012-01-01

    Recently, there has been an increase in the number of patients with Chagas disease outside of areas that are generally considered endemic. The aim of this investigation is to describe the clinical profile of a series of patients with Chagas disease in Alicante, Spain, which is a province located on

  18. [The importance of social psychological and clinical factors for prescribing group psychotherapy for neurosis patients].

    Science.gov (United States)

    Grineva, I M; Khokholeva, A A; Obora, V V; Karagodina, E G; Lazarenko, A N

    1989-11-01

    Socio-psychological and clinical factors and their significance for group psychotherapy were investigated in 62 patients with neuroses. The obtained statistically valid differences of some characteristic aspects between groups of patients with positive and negative directives. This indicates the necessity of differential approach to group psychotherapy and active individual and group work on the creation of positive motivation to this type of treatment.

  19. 伴雷诺现象的结缔组织病25例临床分析%Clinical analysis of Raynaud' s phenomenon in patients with connective tissue disease

    Institute of Scientific and Technical Information of China (English)

    赵顺芳; 何敏华; 杜茜茹

    2011-01-01

    Objective To explore the clinical manifestations, treatment of patients with connective tissue dis ease (CTD) presenting with Raynaud' s phenomenon (RP). Methods We retrospectively analyzed the clinical mani festations, treatment and prognosis of 25 CTD patients with RP admitted consecutively in the Affiliated Hospital of Dali University from 2004 to 2009. Results Through general treatment, vasodilatation and promoting circulation treatment, the total effective rate was 92% for CTD patients with RP. However, one patient died of repeated heart fail ure, and another patient with rheumatoid arthritis (RA) died of sudden death. Conclusion Patients with CTD present ing with RP were susceptible to pulmonary hypertension, cardiac involvement and immunologic abnormalities, and the prognosis is poor. We should pay special attention to the pulmonary and heart function in CTD patients with RP, in order to avoid unfavorable consequences.%目的 探讨伴雷诺现象(RP)的结缔组织(CTD)患者临床特征、治疗及预后转归.方法 对2005-2010年在我院住院的伴RP的25例CTD患者的临床表现、治疗方法、结果及其预后进行回顾性分析与总结.结果 伴RP的CTD患者经一般治疗、治疗原发疾病和扩血管、活血化瘀等,其总有效率为92%,但1例因反复发作心衰死亡,1例伴RP的类风湿性关节炎(RA)患者猝死.结论 CTD患者出现RP提示较易发生肺动脉高压,心脏受累和免疫学异常,预后较差.对伴RP的CTD患者应注意其心肺状态,早期诊断和治疗,以防不良后果发生.

  20. Ovarian cancer cell line panel (OCCP: clinical importance of in vitro morphological subtypes.

    Directory of Open Access Journals (Sweden)

    Corine M Beaufort

    Full Text Available Epithelial ovarian cancer is a highly heterogeneous disease and remains the most lethal gynaecological malignancy in the Western world. Therapeutic approaches need to account for inter-patient and intra-tumoural heterogeneity and detailed characterization of in vitro models representing the different histological and molecular ovarian cancer subtypes is critical to enable reliable preclinical testing. There are approximately 100 publicly available ovarian cancer cell lines but their cellular and molecular characteristics are largely undescribed. We have characterized 39 ovarian cancer cell lines under uniform conditions for growth characteristics, mRNA/microRNA expression, exon sequencing, drug response for clinically-relevant therapeutics and collated all available information on the original clinical features and site of origin. We tested for statistical associations between the cellular and molecular features of the lines and clinical features. Of the 39 ovarian cancer cell lines, 14 were assigned as high-grade serous, four serous-type, one low-grade serous and 20 non-serous type. Three morphological subtypes: Epithelial (n = 21, Round (n = 7 and Spindle (n = 12 were identified that showed distinct biological and molecular characteristics, including overexpression of cell movement and migration-associated genes in the Spindle subtype. Comparison with the original clinical data showed association of the spindle-like tumours with metastasis, advanced stage, suboptimal debulking and poor prognosis. In addition, the expression profiles of Spindle, Round and Epithelial morphologies clustered with the previously described C1-stromal, C5-mesenchymal and C4 ovarian subtype expression profiles respectively. Comprehensive profiling of 39 ovarian cancer cell lines under controlled, uniform conditions demonstrates clinically relevant cellular and genomic characteristics. This data provides a rational basis for selecting models to develop

  1. Dopamine transporter imaging in clinically unclear cases of parkinsonism and the importance of Scans Without Evidence of Dopaminergic Deficit (SWEDDs

    Directory of Open Access Journals (Sweden)

    Marco A. T. Utiumi

    2012-09-01

    Full Text Available The clinical diagnosis of Parkinson's disease (PD is susceptible to misdiagnosis, especially in the earlier stages of the disease. Recently, in vivo imaging techniques assessing the presynaptic dopamine transporter (DAT have emerged as a useful tool in PD diagnosis, improving its accuracy. OBJECTIVE: It was to illustrate the clinical usefulness of a brain single-photon emission computed tomography (SPECT DAT ligand, and highlight relevant aspects of scans without evidence of dopaminergic deficit (SWEDDs in this context. CASES: We described four representative patients with clinically unclear parkinsonian syndromes who underwent [99mTc]-TRODAT-1 SPECT and reviewed the clinical implications. CONCLUSION: DAT-SPECT is an important, cost-effective, technique for the differential diagnosis of parkinsonian syndromes. Additionally, SWEDD cases present clinical and paraclinical peculiarities that may retrospectively identify them as essential/dystonic tremor. The lack of histopathological data limits further conclusions.

  2. Prevalence of clinically important traumatic brain injuries in children with minor blunt head trauma and isolated severe injury mechanisms.

    Science.gov (United States)

    Nigrovic, Lise E; Lee, Lois K; Hoyle, John; Stanley, Rachel M; Gorelick, Marc H; Miskin, Michelle; Atabaki, Shireen M; Dayan, Peter S; Holmes, James F; Kuppermann, Nathan

    2012-04-01

    To determine the prevalence of clinically important traumatic brain injuries (TBIs) with severe injury mechanisms in children with minor blunt head trauma but with no other risk factors from the Pediatric Emergency Care Applied Research Network (PECARN) TBI prediction rules (defined as isolated severe injury mechanisms). Secondary analysis of a large prospective observational cohort study. Twenty-five emergency departments participating in the PECARN. Children with minor blunt head trauma and Glasgow Coma Scale scores of at least 14. Treating clinicians completed a structured data form that included injury mechanism (severity categories defined a priori). Clinically important TBIs were defined as intracranial injuries resulting in death, neurosurgical intervention, intubation for more than 24 hours, or hospital admission for at least 2 nights. We investigated the rate of clinically important TBIs in children with either severe injury mechanisms or isolated severe injury mechanisms. Of the 42,412 patients enrolled in the overall study, 42,099 (99%) had injury mechanisms recorded, and their data were included for analysis. Of all study patients, 5869 (14%) had severe injury mechanisms, and 3302 (8%) had isolated severe injury mechanisms. Overall, 367 children had clinically important TBIs (0.9%; 95% CI, 0.8%-1.0%). Of the 1327 children younger than 2 years with isolated severe injury mechanisms, 4 (0.3%; 95% CI, 0.1%-0.8%) had clinically important TBIs, as did 12 of the 1975 children 2 years or older (0.6%; 95% CI, 0.3%-1.1%). Children with isolated severe injury mechanisms are at low risk of clinically important TBI, and many do not require emergent neuroimaging.

  3. Restenosis after infrapopliteal angioplasty - clinical importance, study update and further directions.

    Science.gov (United States)

    Baumann, Frederic; Diehm, Nicolas

    2013-11-01

    Patients with critical limb ischemia (CLI) represent the most severe form of peripheral arterial disease (PAD) and exhibit high mortality rates. Frequently, PAD in CLI patients involves the infrapopliteal arterial segment challenging endovascular revascularization strategies. Restenosis remains the major drawback of tibial angioplasty encountered in more than two thirds of CLI patients undergoing tibial revascularization. In contrast to earlier observations, tibial patency was recently shown to be essential to attain an optimal clinical outcome in CLI patients subsequent to tibial angioplasty. The exact pathopyhsiological mechanisms of tibial restenosis remains unclear. To date, most of our knowledge on tibial restenosis and its pathophysiology is derived from coronary arteries, based on the similarity of coronary arteries to tibial artery morphology. Nervertheless, multiple antirestenosis concepts are investigated within clinical trials to reduce tibial restenosis.Purpose of the present manuscript is to provide a current update on the pathophysiology of tibial restenosis and potential antirestenosis strategies.

  4. A Rare Variant of the Ulnar Artery with Important Clinical Implications: a Case Report

    OpenAIRE

    Casal Diogo; Pais Diogo; Toscano Tiago; Bilhim Tiago; Rodrigues Luís; Figueiredo Inês; Aradio Sónia; Angélica-Almeida Maria; Goyri-O’Neill João

    2012-01-01

    Abstract Background Variations in the major arteries of the upper limb are estimated to be present in up to one fifth of people, and may have significant clinical implications. Case presentation During routine cadaveric dissection of a 69-year-old fresh female cadaver, a superficial brachioulnar artery with an aberrant path was found bilaterally. The superficial brachioulnar artery originated at midarm level from the brachial artery, pierced the brachial fascia immediately proximal to the elb...

  5. Do clinical diagnoses correlate with pathological diagnoses in cardiac transplant patients? The importance of endomyocardial biopsy

    DEFF Research Database (Denmark)

    Luk, Adriana; Metawee, Mohammed; Ahn, Eric

    2009-01-01

    . Patient records were reviewed for preoperative clinical diagnoses and other relevant data, including pretransplant endomyocardial biopsy (EMB) results, information regarding left ventricular assist devices and, finally, evidence of disease recurrence in the grafted heart. RESULTS: A shift......, arrhythmogenic right ventricle dysplasia (100%), cardiac sarcoidosis (83%) and iron overload toxicity- associated cardiomyopathy (100%) had been misdiagnosed in pretransplantation investigations. Investigations before transplantation did not include an EMB. Of all 296 patients, 51 patients (17%) were...

  6. Certification of Electronic Health Record systems and the importance of the validation of clinical archetypes.

    Science.gov (United States)

    De Moor, Georges; Kalra, Dipak; Devlies, Jos

    2008-01-01

    If Electronic Health Record (EHR) systems are to provide an effective contribution to healthcare across Europe, a set of benchmarks need to be set to ensure the quality of such systems. This article describes the results of the EU funded QRec- project and emphasizes the need for validation of clinical archetypes to support the semantic interoperability between EHR systems and other interacting eHealth applications.

  7. Clinical Findings in Patients with Splenic Injuries: Are Injuries to the Left Lower Chest Important?

    Directory of Open Access Journals (Sweden)

    Schneir, Aaron

    2001-07-01

    Full Text Available The purpose of this study was to describe the clinical findings in patients with splenic injury and to determine if isolated left lower chest injury may be the single clinical indicator of splenic injury. The medical records of all adult blunt trauma patients with splenic injury over a 14 month period were reviewed. Significant left lower chest injury was considered present if the patient had left sided pleuritic chest pain with tenderness to ribs 7-12 or if these ribs were visualized as fractured on any imaging study. Patients were considered to have clinical findings suggestive of splenic injury if they had pre-hospital or emergency department hypotension, abdominal pain or tenderness, a Glasgow coma scale < 15, or gross hematuria. Ninety patients had splenic injury. Thirty-nine (43%. 95% CI 33, 54% patients had significant left lower chest injury. In five (6%. 95% CI 2, 12% patients, injury to this portion of the chest was the single indicator of splenic injury. Nearly half the patients with splenic injury will have significant injury to the left lower chest and this finding may be the only indicator of splenic injury.

  8. Clinical importance of achieving biochemical control with medical therapy in adult patients with acromegaly

    Science.gov (United States)

    Christofides, Elena A

    2016-01-01

    In acromegaly, achieving biochemical control (growth hormone [GH] level acromegaly is challenging because it is rooted in observing subtle clinical manifestations, and it is typical for acromegaly to evolve for up to 10 years before it is recognized. This results in chronic exposure to elevated levels of GH and IGF-1 and delay in patients receiving appropriate treatment, which consequently increases mortality risk. In this review, the clinical impact of elevated GH and IGF-1 levels, the effectiveness of current therapies, and the potential role of novel treatments for acromegaly will be discussed. Clinical burden of acromegaly and benefits associated with management of GH and IGF-1 levels will be reviewed. Major treatment paradigms in acromegaly include surgery, medical therapy, and radiotherapy. With medical therapies, such as somatostatin analogs, dopamine agonists, and GH receptor antagonists, a substantial proportion of patients achieve reduced GH and normalized IGF-1 levels. In addition, signs and symptoms, quality of life, and comorbidities have also been reported to improve to varying degrees in patients who achieve biochemical control. Currently, there are several innovative therapies in development to improve patient outcomes, patient use, and access. Timely biochemical control of acromegaly ensures that the patient can ultimately improve morbidity and mortality from this disease and its extensive consequences. PMID:27471378

  9. [Idiopathic mental retardation--importance of clinical diagnostic scores for case selection].

    Science.gov (United States)

    Caba, Lavinia; Rusu, Cristina; Voloşciuc, M; Butnariu, Lăcrămioara; Braha, Elena; Grămescu, Mihaela; Bujoran, C; Gorduza, E V; Covic, M

    2009-01-01

    We present a retrospective study aimed to identify the correlation between de Vries clinical score and the detection of chromosomal abnormalities in mentally retarded (MR) children. We have used the score to identify patients who should be tested by karyotyping and subsequently MLPA (multiplex ligation dependent probe amplification) for subtelomeric rearrangements. Our group is formed of 36 children with variable MR associated with other anomalies. 18 children had chromosomal defects, whereas 18 had normal karyotypes. In the first group, total scores varied between 3 and 7. Chromosomal anomalies identified were: numerical (4) and structural (14). Chromosomes involved were: 1, 4, 5, 7, 8, 9, 17, X. Deletions were the most common and correlate with a greater score (> or = 4). Common clinical features were: short stature, microcephaly, nasal, ear and hand anomalies. In the second group the most frequent clinical feature was hand anomaly (61.2%) and cases with a high score have to be further tested (e.g. using MLPA) in order to identify minor defects. In our opinion a high score indicates the karyotype and then a MLPA testing. In conclusion, we present a retrospective study that proves the use of de Vries diagnostic score in the identification of chromosomal abnormalities in MR children.

  10. Monitoring of disease biomarkers activity and immunophenotyping as important factors in SLE clinical management.

    Science.gov (United States)

    Subasic, Djemo; Karamehic, Jasenko; Delic-Sarac, Marina; Kasumovic, Mersija; Mekic, Mevludin; Eminovic, Izet; Hasanagic, Nermina

    2012-01-01

    The highly specific biomarkers for monitoring of SLE disease activity are not yet defined up to date, due to existing of different clinical SLE phenotypes caused by individual genetic variation. Basically, numerous clinical complications follow SLE patients such as nephritis, atherosclerosis and cardial, CNS, gastrointestinal and ophthalmological complications, as well. Their monitoring in clinical SLE management can be evaluated by analysing of specific biochemical parameters and require permanent clinical observation. The presence of ANAs and anti-ds-DNAs are usual diagnostic SLE autoimmunity parameters, while SLE disease activity biomarkers are C3 and C4 level, anticardiolipin antibodies, anti-Sm/RNPs and, recently level of CD4 and CD8 lymphocytes. However, the number of TCR molecules on the T-cells surface at SLE patients is lower then in normal condition, and otherwise for these receptors CD molecules make specific connection. On the other hand, the T lymphocytes can be also, therapeutical targets at SLE patients, because of their clear direct involving in SLE pathogenesis. The SLE phenotypes are characterized by double CD negativity ( CD3 +/-, CD4-) caused by abnormal level of IL-2 and IL-17. T-lymphocytes have usually alpha-beta and gamma-delta TCR receptors, but for SLE patients is characteristic lower number gama-delta TCR molecules, detected in the peripheral blood specimens. Taking into account all of the facts, we investigated the level of specific usual SLE activity biomarkers (anti-ds-DNAs, C3, C4, anticardiolipin antibodies (beta-2-IgG, beta-2-IgM, ACA-G, ACA-M, CD4 and CD8 level) in serum specimens of SLE patients who underwent to the corresponding chemotherapy in combination with other biochemical and clinical parameters. Once again proved to be, that SLE biomarker monitoring, could be useful aproach for SLE activity disease and prediction organ damage, as well. In our investigation we used the following methods: immunofluorescence microscopy (IFA

  11. Amino Acid Compositions of 27 Food Fishes and Their Importance in Clinical Nutrition

    Directory of Open Access Journals (Sweden)

    Bimal Mohanty

    2014-01-01

    Full Text Available Proteins and amino acids are important biomolecules which regulate key metabolic pathways and serve as precursors for synthesis of biologically important substances; moreover, amino acids are building blocks of proteins. Fish is an important dietary source of quality animal proteins and amino acids and play important role in human nutrition. In the present investigation, crude protein content and amino acid compositions of important food fishes from different habitats have been studied. Crude protein content was determined by Kjeldahl method and amino acid composition was analyzed by high performance liquid chromatography and information on 27 food fishes was generated. The analysis showed that the cold water species are rich in lysine and aspartic acid, marine fishes in leucine, small indigenous fishes in histidine, and the carps and catfishes in glutamic acid and glycine. The enriched nutrition knowledge base would enhance the utility of fish as a source of quality animal proteins and amino acids and aid in their inclusion in dietary counseling and patient guidance for specific nutritional needs.

  12. Amino Acid compositions of 27 food fishes and their importance in clinical nutrition.

    Science.gov (United States)

    Mohanty, Bimal; Mahanty, Arabinda; Ganguly, Satabdi; Sankar, T V; Chakraborty, Kajal; Rangasamy, Anandan; Paul, Baidyanath; Sarma, Debajit; Mathew, Suseela; Asha, Kurukkan Kunnath; Behera, Bijay; Aftabuddin, Md; Debnath, Dipesh; Vijayagopal, P; Sridhar, N; Akhtar, M S; Sahi, Neetu; Mitra, Tandrima; Banerjee, Sudeshna; Paria, Prasenjit; Das, Debajeet; Das, Pushpita; Vijayan, K K; Laxmanan, P T; Sharma, A P

    2014-01-01

    Proteins and amino acids are important biomolecules which regulate key metabolic pathways and serve as precursors for synthesis of biologically important substances; moreover, amino acids are building blocks of proteins. Fish is an important dietary source of quality animal proteins and amino acids and play important role in human nutrition. In the present investigation, crude protein content and amino acid compositions of important food fishes from different habitats have been studied. Crude protein content was determined by Kjeldahl method and amino acid composition was analyzed by high performance liquid chromatography and information on 27 food fishes was generated. The analysis showed that the cold water species are rich in lysine and aspartic acid, marine fishes in leucine, small indigenous fishes in histidine, and the carps and catfishes in glutamic acid and glycine. The enriched nutrition knowledge base would enhance the utility of fish as a source of quality animal proteins and amino acids and aid in their inclusion in dietary counseling and patient guidance for specific nutritional needs.

  13. Wellness as a worldwide phenomenon?

    Science.gov (United States)

    Elliott, Heather; Bernstein, Jennifer; Bowman, Diana M

    2014-10-01

    This article examines the concept of wellness through a comparative political economy and legal framework. It asks whether wellness, an increasingly defined term within US federal and state legislative instruments including, for example, the Patient Protection and Affordable Care Act, is primarily a US-centric phenomenon. Or is wellness, in its various different guises, a worldwide phenomenon? By focusing on three distinctly different jurisdictions - the United States, Germany, and Australia - this article examines wellness through the lens of employers, the health care system, employment and tort law, and the greater political economy. It notes that while improving employee health, well-being, and productivity is common across the three countries and their respective cultures, the focus on wellness as a distinct legal concept is unique to the United States. Copyright © 2014 by Duke University Press.

  14. DNA methylation profiles delineate etiologic heterogeneity and clinically important subgroups of bladder cancer.

    Science.gov (United States)

    Wilhelm-Benartzi, C S; Koestler, D C; Houseman, E A; Christensen, B C; Wiencke, John K; Schned, A R; Karagas, M R; Kelsey, K T; Marsit, C J

    2010-11-01

    DNA methylation profiles can be used to define molecular cancer subtypes that may better inform disease etiology and clinical decision-making. This investigation aimed to create DNA methylation profiles of bladder cancer based on CpG methylation from almost 800 cancer-related genes and to then examine the relationship of those profiles with exposures related to risk and clinical characteristics. DNA, derived from formalin-fixed paraffin-embedded tumor samples obtained from incident cases involved in a population-based case-control study of bladder cancer in New Hampshire, was used for methylation profiling on the Illumina GoldenGate Methylation Bead Array. Unsupervised clustering of those loci with the greatest change in methylation between tumor and non-diseased tissue was performed to defined molecular subgroups of disease, and univariate tests of association followed by multinomial logistic regression was used to examine the association between these classes, bladder cancer risk factors and clinical phenotypes. Membership in the two most methylated classes was significantly associated with invasive disease (P class 3 and 4). Male gender (P = 0.04) and age >70 years (P = 0.05) was associated with membership in one of the most methylated classes. Finally, average water arsenic levels in the highest percentile predicted membership in an intermediately methylated class of tumors (P = 0.02 for both classes). Exposures and demographic associated with increased risk of bladder cancer specifically associate with particular subgroups of tumors defined by DNA methylation profiling and these subgroups may define more aggressive disease.

  15. Clinical importance of achieving biochemical control with medical therapy in adult patients with acromegaly

    Directory of Open Access Journals (Sweden)

    Christofides EA

    2016-07-01

    Full Text Available Elena A Christofides Endocrinology Associates, Inc., Columbus, OH, USA Abstract: In acromegaly, achieving biochemical control (growth hormone [GH] level <1.0 ng/mL and age- and sex-normalized levels of insulin-like growth factor 1 [IGF-1] through timely diagnosis and appropriate treatment provides an opportunity to improve patient outcomes. Diagnosis of acromegaly is challenging because it is rooted in observing subtle clinical manifestations, and it is typical for acromegaly to evolve for up to 10 years before it is recognized. This results in chronic exposure to elevated levels of GH and IGF-1 and delay in patients receiving appropriate treatment, which consequently increases mortality risk. In this review, the clinical impact of elevated GH and IGF-1 levels, the effectiveness of current therapies, and the potential role of novel treatments for acromegaly will be discussed. Clinical burden of acromegaly and benefits associated with management of GH and IGF-1 levels will be reviewed. Major treatment paradigms in acromegaly include surgery, medical therapy, and radiotherapy. With medical therapies, such as somatostatin analogs, dopamine agonists, and GH receptor antagonists, a substantial proportion of patients achieve reduced GH and normalized IGF-1 levels. In addition, signs and symptoms, quality of life, and comorbidities have also been reported to improve to varying degrees in patients who achieve biochemical control. Currently, there are several innovative therapies in development to improve patient outcomes, patient use, and access. Timely biochemical control of acromegaly ensures that the patient can ultimately improve morbidity and mortality from this disease and its extensive consequences. Keywords: disease burden, growth hormone, insulin-like growth factor 1, medical therapy, pituitary

  16. Enhanced culture detection of Kingella kingae, a pathogen of increasing clinical importance in pediatrics.

    Science.gov (United States)

    Gené, Amadeu; García-García, Juan-José; Sala, Pere; Sierra, Montse; Huguet, Ramon

    2004-09-01

    Osteoarticular infection and occult bacteremia are the 2 invasive infectious pathologies most frequently associated in childhood with Kingella kingae. We report a series of 11 patients in whom osteomyelitis predominates over septic arthritis, which is the reverse of other series, probably as a consequence of inoculation of samples during surgery on agar media, used in combination with or as an alternative to inoculation into blood culture bottles. Although K. kingae infections usually follow a benign clinical course, we noted 2 patients with mild orthopedic sequelae.

  17. Robot decisions: on the importance of virtuous judgment in clinical decision making.

    Science.gov (United States)

    Gelhaus, Petra

    2011-10-01

    The aim of this article is to argue for the necessity of emotional professional virtues in the understanding of good clinical practice. This understanding is required for a proper balance of capacities in medical education and further education of physicians. For this reason an ideal physician, incarnating the required virtues, skills and knowledge is compared with a non-emotional robot that is bound to moral rules. This fictive confrontation is meant to clarify why certain demands on the personality of the physician are justified, in addition to a rule- and principle-based moral orientation and biomedical knowledge and skills. Philosophical analysis of thought experiments inspired by science fiction literature by Isaac Asimov. Although prima facie a rule-oriented robot seems more reliable and trustworthy, the complexity of clinical judgment is not met by an encompassing and never contradictory set of rules from which one could logically derive decisions. There are different ways how the robot could still work, but at the cost of the predictability of its behaviour and its moral orientation. In comparison, a virtuous human doctor who is also bound to these rules, although less strictly, will more reliably keep at moral objectives, be understandable, be more flexible in case the rules come to their limits, and will be more predictable in these critical situations. Apart from these advantages of the virtuous human doctor referring to her own person, the most problematic deficit of the robot is its lacking deeper understanding of the inner mental events of patients which makes good contact, good communication and good influence impossible. Although an infallibly rule-oriented robot seems more reliable at first view, in situations that require complex decisions like clinical practice the agency of a moral human person is more trustworthy. Furthermore, the understanding of the patient's emotions must remain insufficient for a non-emotional, non-human being. Because

  18. The importance of communication for clinical leaders in mental health nursing: the perspective of nurses working in mental health.

    Science.gov (United States)

    Ennis, Gary; Happell, Brenda; Broadbent, Marc; Reid-Searl, Kerry

    2013-11-01

    Communication has been identified as an important attribute of clinical leadership in nursing. However, there is a paucity of research on its relevance in mental health nursing. This article presents the findings of a grounded theory informed study exploring the attributes and characteristics required for effective clinical leadership in mental health nursing, specifically the views of nurses working in mental health about the importance of effective communication in day to day clinical leadership. In-depth interviews were conducted to gain insight into the participants' experiences and views on clinical leadership in mental health nursing. The data that emerged from these interviews were constantly compared and reviewed, ensuring that any themes that emerged were based on the participants' own experiences and views. Participants recognized that effective communication was one of the attributes of effective clinical leadership and they considered communication as essential for successful working relationships and improved learning experiences for junior staff and students in mental health nursing. Four main themes emerged: choice of language; relationships; nonverbal communication, and listening and relevance. Participants identified that clinical leadership in mental health nursing requires effective communication skills, which enables the development of effective working relationships with others that allows them to contribute to the retention of staff, improved outcomes for clients, and the development of the profession.

  19. Clinical importance of the middle meningeal artery: A review of the literature

    Science.gov (United States)

    Yu, Jinlu; Guo, Yunbao; Xu, Baofeng; Xu, Kan

    2016-01-01

    The middle meningeal artery (MMA) is a very important artery in neurosurgery. Many diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm, traumatic arteriovenous fistula (AVF), moyamoya disease (MMD), recurrent chronic subdural hematoma (CSDH), migraine and meningioma, can involve the MMA. In these diseases, the lesions occur in either the MMA itself and treatment is necessary, or the MMA is used as the pathway to treat the lesions; therefore, the MMA is very important to the development and treatment of a variety of neurosurgical diseases. However, no systematic review describing the importance of MMA has been published. In this study, we used the PUBMED database to perform a review of the literature on the MMA to increase our understanding of its role in neurosurgery. After performing this review, we found that the MMA was commonly used to access DAVFs and meningiomas. Pseudoaneurysms and true aneurysms in the MMA can be effectively treated via endovascular or surgical removal. In MMD, the MMA plays a very important role in the development of collateral circulation and indirect revascularization. For recurrent CDSHs, after burr hole irrigation and drainage have failed, MMA embolization may be attempted. The MMA can also contribute to the occurrence and treatment of migraines. Because the ophthalmic artery can ectopically originate from the MMA, caution must be taken to avoid causing damage to the MMA during operations. PMID:27766029

  20. The importance of hydration in wound healing: reinvigorating the clinical perspective.

    Science.gov (United States)

    Ousey, K; Cutting, K F; Rogers, A A; Rippon, M G

    2016-03-01

    Balancing skin hydration levels is important as any disruption in skin integrity will result in disturbance of the dermal water balance. The discovery that a moist environment actively supports the healing response when compared with a dry environment highlights the importance of water and good hydration levels for optimal healing. The benefits of 'wet' or 'hyper-hydrated' wound healing appear similar to those offered by moist over a dry environment. This suggests that the presence of free water may not be detrimental to healing, but any adverse effects of wound fluid on tissues is more likely related to the biological components contained within chronic wound exudate, for example elevated protease levels. Appropriate dressings applied to wounds must not only be able to absorb the exudate, but also retain this excess fluid together with its protease solutes, while concurrently preventing desiccation. This is particularly important in the case of chronic wounds where peri-wound skin barrier properties are compromised and there is increased permeation across the injured skin. This review discusses the importance of appropriate levels of hydration in skin, with a particular focus on the need for optimal hydration levels for effective healing. Declaration of interest: This paper was supported by Paul Hartmann Ltd. The authors have provided consultative services to Paul Hartmann Ltd.

  1. 77 FR 38084 - Importer of Controlled Substances; Notice of Registration; Clinical Supplies Management, Inc.

    Science.gov (United States)

    2012-06-26

    ... the company's physical security systems, verification of the company's compliance with state and local laws, and a review of the company's background and history. Therefore, pursuant to 21 U.S.C. 952(a) and... Sufentanil (9740), a basic class of controlled substance listed in schedule II. The company plans to import...

  2. 78 FR 5497 - Importer of Controlled Substances; Notice of Registration; Fisher Clinical Services, Inc.

    Science.gov (United States)

    2013-01-25

    ... the company's physical security systems, verification of the company's compliance with state and local laws, and a review of the company's background and history. Therefore, pursuant to 21 U.S.C. 952(a) and...), a basic class of controlled substance listed in schedule II. The company plans to import the listed...

  3. A Visitor's Guide to Effect Sizes--Statistical Significance versus Practical (Clinical) Importance of Research Findings

    Science.gov (United States)

    Hojat, Mohammadreza; Xu, Gang

    2004-01-01

    Effect Sizes (ES) are an increasingly important index used to quantify the degree of practical significance of study results. This paper gives an introduction to the computation and interpretation of effect sizes from the perspective of the consumer of the research literature. The key points made are: (1) "ES" is a useful indicator of the…

  4. Name Changes in Medically Important Fungi and Their Implications for Clinical Practice

    DEFF Research Database (Denmark)

    de Hoog, G. Sybren; Chaturvedi, Vishnu; Denning, David W.

    2015-01-01

    Recent changes in the Fungal Code of Nomenclature and developments in molecular phylogeny are about to lead to dramatic changes in the naming of medically important molds and yeasts. In this article, we present a widely supported and simple proposal to prevent unnecessary nomenclatural instability....

  5. Clinical importance and cost of bacteremia caused by nosocomial multi drug resistant acinetobacter baumannii

    Directory of Open Access Journals (Sweden)

    Tugba Arslan Gulen

    2015-09-01

    Conclusion: Our results suggest that the occurrence of MDR A.baumannii bacteremia was related with the usage of the wide spectrum antibiotics, and mortality rates were increased in patients that high SAPS II scores, long term hospitalization. Infection control procedures and limited antibiotic usage are very important for prevent nosocomial infections.

  6. PHENOMENON OF CARVED DRIVING WHEELS

    Institute of Scientific and Technical Information of China (English)

    LI Xianghua; ZHANG Jianwu

    2007-01-01

    A newly found phenomenon of carved driving wheels of a rea-wheel-drive tractor used in an airport is discussed. The circum of every driving wheel is damaged at three regions, which distribute regularly and uniformly. Everyday, the tractor tows a trailer which are times heavier than the tractor, and moves on the same road in the airport. The phenomenon is explained by the torsional self-excited vibration system of the powertrain. The simplified torsional vibration system is discribed by a 2-order ordinary differential equation, which has a limit circle. Experiments and numerical simulations show the followings: Because of the heavy trailer, the slip ratio of the tractor's driving wheels is very large. Therefore, there is severe torsional self-excited vibration in the tractor's drivetrain, and the self-excited vibration results in severe and regular fluctuations of the rear wheel's velocity. The severe fluctuations in velocity fastens the damage of the driving wheels. At the same time, the time interval in which an arbitrary point in the circum of the driving wheel contacts with the road twice is two times more than the period of the torsional self-excited vibration, and this times explained the existence of three damaged regions. At last, it points out that the phenomenon can be avoided when the torsional damping is large enough.

  7. Responsiveness and Minimal Clinically Important Change of the Pain Disability Index in Patients With Chronic Back Pain

    NARCIS (Netherlands)

    Soer, Remko; Reneman, Michiel F.; Vroomen, Patrick C. A. J.; Stegeman, Patrick; Coppes, Maarten H.

    2012-01-01

    Study Design. Prospective cohort study. Objective. The objective of this study was to test the responsiveness and minimal clinically important change (MCIC) of the Pain Disability Index (PDI) in patients with chronic back pain (CBP). Summary of Background Data. Treatment of patients with CBP is prim

  8. Rehabilitation Counselor Educators' Perceptions of Importance, Student Preparedness, and Teaching Proficiency in Clinical Judgment Skill Domains

    Science.gov (United States)

    Austin, Bryan Scott

    2012-01-01

    Given the importance of clinical judgment in rehabilitation counseling (Strohmer & Leierer, 2000), prevalence and consequences of rehabilitation counselor biases (Berven & Rosenthal, 1999), and the emerging trend to educate rehabilitation counselors in evidence-based practice (EBP) (Leahy & Arokiasamy, 2010), the explicit teaching of…

  9. A rare variant of the ulnar artery with important clinical implications: a case report

    Directory of Open Access Journals (Sweden)

    Casal Diogo

    2012-11-01

    Full Text Available Abstract Background Variations in the major arteries of the upper limb are estimated to be present in up to one fifth of people, and may have significant clinical implications. Case presentation During routine cadaveric dissection of a 69-year-old fresh female cadaver, a superficial brachioulnar artery with an aberrant path was found bilaterally. The superficial brachioulnar artery originated at midarm level from the brachial artery, pierced the brachial fascia immediately proximal to the elbow, crossed superficial to the muscles that originated from the medial epicondyle, and ran over the pronator teres muscle in a doubling of the antebrachial fascia. It then dipped into the forearm fascia, in the gap between the flexor carpi radialis and the palmaris longus. Subsequently, it ran deep to the palmaris longus muscle belly, and superficially to the flexor digitorum superficialis muscle, reaching the gap between the latter and the flexor carpi ulnaris muscle, where it assumed is usual position lateral to the ulnar nerve. Conclusion As far as the authors could determine, this variant of the superficial brachioulnar artery has only been described twice before in the literature. The existence of such a variant is of particular clinical significance, as these arteries are more susceptible to trauma, and can be easily confused with superficial veins during medical and surgical procedures, potentially leading to iatrogenic distal limb ischemia.

  10. Clinical importance of detection of bacterial vaginosis, trichomonas vaginalis, candida albicans and actinomyces in Papanicolaou smears.

    Science.gov (United States)

    Güdücü, N; Gönenç, G; Işçi, H; Yiğiter, A Başgül; Başsüllü, N; Dünder, I

    2012-01-01

    The aim of this study was to determine the role of Papanicolaou (pap) smears in the diagnosis of lower genital tract infections. A retrospective study was planned by reviewing charts of patients for trichomonas vaginalis, bacterial vaginosis, actinomyces, candida and nonspecific vaginitis. Charts of 9,080 patients were reviewed and 1,733 women had a diagnosis of lower genital tract infection in the pap smear or had had a clinically treated lower genital tract infection. Only 33.5%, 30.4%, 43.3%, and 0% of patients with bacterial vaginosis, trichomonas vaginalis, candida and actinomyces, respectively on pap smear were diagnosed and treated clinically. Postmenopausal patients had a higher rate of trichomonas vaginalis infection and a lower rate of candida infection when compared to women of the reproductive age group. Patients using an intrauterine device for contraception had a statistically significantly increased rate of trichomonas vaginalis and candida infection when compared to women using other contraceptive methods or those who were not using any contraception. Finding trichomonas vaginalis, bacterial vaginosis and actinomyces infections in pap smears might be considered an indication for treatment without performing other diagnostic tests. Treatment of asymptomatic infections can prevent complications in selected patients. Candida can be a commensal bacteria in the vagina, therefore asymptomatic patients may not require treatment. Detection of a higher rate of trichomonas vaginalis and candida infection in IUD users shows that IUDs can increase the risk of vaginal infections and associated complications.

  11. The coxib NSAIDs: potential clinical and pharmacologic importance in veterinary medicine.

    Science.gov (United States)

    Bergh, Mary Sarah; Budsberg, Steven C

    2005-01-01

    Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to control acute and chronic pain as well as to manage oncologic and neurologic diseases in human and veterinary patients. Despite ongoing research and efforts to improve the safety and efficacy of existing drugs, adverse effects such as gastrointestinal irritation, renal and hepatic toxicity, interference with hemostasis, and reproductive problems persist. The true incidence of NSAID-induced adverse effects in animals is unknown, but is likely underestimated, because cats and dogs may be more sensitive than humans to NSAIDs due to alterations in drug metabolism, absorption, and enterohepatic recirculation. NSAIDs produce both analgesia and toxic adverse effects primarily by inhibiting cyclooxygenase (COX), thereby decreasing the production of prostaglandins that signal inflammation and pain as well as mediate physiologic functions such as platelet aggregation, gastric protection, and electrolyte balance in the kidney. The presence of at least 2 COX isoforms may account for variability in NSAID efficacy and toxicity both within and among species. This paper reviews and evaluates the published literature on the safety, pharmacology, uses, and complications of a subclass of COX-1-sparing drugs, the coxibs, in veterinary medicine. Coxibs and other COX-1-sparing drugs provide a clinically useful improvement over traditional NSAIDs, but data are incomplete and more in vivo species-specific, target-tissue, and clinical studies are needed.

  12. QUALITY OF LIFE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: importance of clinical, demographic and psychosocial factors

    Directory of Open Access Journals (Sweden)

    Joana MAGALHÃES

    2014-09-01

    Full Text Available Context Inflammatory bowel disease causes physical and psychosocial consequences that can affect the health related quality of life. Objectives To analyze the relationship between clinical and sociodemographic factors and quality of life in inflammatory bowel disease patients. Methods Ninety two patients with Crohn’s disease and 58 with ulcerative colitis, filled in the inflammatory bowel disease questionnaire (IBDQ-32 and a questionnaire to collect sociodemographic and clinical data. The association between categorical variables and IBDQ-32 scores was determined using Student t test. Factors statistically significant in the univariate analysis were included in a multivariate regression model. Results IBDQ-32 scores were significantly lower in female patients (P<0.001, patients with an individual perception of a lower co-workers support (P<0.001 and career fulfillment (P<0.001, patients requiring psychological support (P = 0.010 and pharmacological treatment for anxiety or depression (P = 0.002. A multivariate regression analysis identified as predictors of impaired HRQOL the female gender (P<0.001 and the perception of a lower co-workers support (P = 0.025 and career fulfillment (P = 0.001. Conclusions The decrease in HRQQL was significantly related with female gender and personal perception of disease impact in success and social relations. These factors deserve a special attention, so timely measures can be implemented to improve the quality of life of patients.

  13. Effective case presentations--an important clinical skill for nurse practitioners.

    Science.gov (United States)

    Coralli, Connie H

    2006-05-01

    Effective case presentations are an important component of the nurse practitioner's skills, yet very little literature exists to guide the development of this skill, and frequently little priority is given to teaching this skill during the education of the nurse practitioner. This report discusses the importance of effective case presentations, describes the organization of the presentation, and outlines the appropriate information to be included. The main components of a case presentation-introduction, history of the present illness, physical examination, diagnostic studies, differential diagnosis, management, and summary of the case-are discussed in detail. Examples of a formal and an informal case presentation are presented and used to illustrate key points in the text.

  14. Clinical importance of carbapenem hypersensitivity in patients with self-reported and documented penicillin allergy.

    Science.gov (United States)

    Prescott, William A; Kusmierski, Kristen A

    2007-01-01

    The risk of carbapenem hypersensitivity in patients with self-reported or documented penicillin allergy needs to be determined so that practitioners can make better-informed decisions regarding antibiotic therapy for this patient population. The risk of cross-reactivity between penicillin and carbapenem antibiotics initially was reported to approach 50%. Recent retrospective studies have suggested that the clinical risk of cross-hypersensitivity between these two drug classes is 9.2-11%, which is significantly lower than initially reported. Patients whose history of penicillin allergy is self-reported and is not type 1 may be at moderate risk for hypersensitivity when treated with a carbapenem antibiotic. The risk of hypersensitivity appears to be higher in patients whose penicillin allergy was documented by a health care provider, those with several antibiotic allergies, and those with a positive penicillin skin test result or a history of type 1 penicillin hypersensitivity.

  15. [Presumptive identification of Candida spp. and other clinically important yeasts: usefulness of Brilliance Candida Agar].

    Science.gov (United States)

    Alfonso, Claudia; López, Mónica; Arechavala, Alicia; Perrone, María Del Carmen; Guelfand, Liliana; Bianchi, Mario

    2010-06-30

    Fungal infections caused by yeasts have increased during the last decades and invasive forms represent a serious problem for human health. Candida albicans is the species most frequently isolated from clinical samples. However, other emerging yeast pathogens are increasingly responsible for mycotic infections, and some of them are resistant to some antifungal drugs. Consequently, it is necessary to have methods that can provide a rapid presumptive identification at species level. Numerous chromogenic agar media have been shown to be of value as diagnostic tools. We have compared a chromogenic medium, Brilliance Candida Agar, with CHROMagar Candida, the chromogenic medium most used in our country. A multicentre study was conducted in 16 Hospitals belonging to the Mycology Net of Buenos Aires City Government. A total of 240 yeast isolates were included in this research. The new chromogenic agar showed results very similar to those obtained with CHROMagar Candida. Copyright 2009 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

  16. Cannabidiol for neurodegenerative disorders: important new clinical applications for this phytocannabinoid?

    Science.gov (United States)

    Fernández-Ruiz, Javier; Sagredo, Onintza; Pazos, M Ruth; García, Concepción; Pertwee, Roger; Mechoulam, Raphael; Martínez-Orgado, José

    2013-02-01

    Cannabidiol (CBD) is a phytocannabinoid with therapeutic properties for numerous disorders exerted through molecular mechanisms that are yet to be completely identified. CBD acts in some experimental models as an anti-inflammatory, anticonvulsant, anti-oxidant, anti-emetic, anxiolytic and antipsychotic agent, and is therefore a potential medicine for the treatment of neuroinflammation, epilepsy, oxidative injury, vomiting and nausea, anxiety and schizophrenia, respectively. The neuroprotective potential of CBD, based on the combination of its anti-inflammatory and anti-oxidant properties, is of particular interest and is presently under intense preclinical research in numerous neurodegenerative disorders. In fact, CBD combined with Δ(9)-tetrahydrocannabinol is already under clinical evaluation in patients with Huntington's disease to determine its potential as a disease-modifying therapy. The neuroprotective properties of CBD do not appear to be exerted by the activation of key targets within the endocannabinoid system for plant-derived cannabinoids like Δ(9)-tetrahydrocannabinol, i.e. CB(1) and CB(2) receptors, as CBD has negligible activity at these cannabinoid receptors, although certain activity at the CB(2) receptor has been documented in specific pathological conditions (i.e. damage of immature brain). Within the endocannabinoid system, CBD has been shown to have an inhibitory effect on the inactivation of endocannabinoids (i.e. inhibition of FAAH enzyme), thereby enhancing the action of these endogenous molecules on cannabinoid receptors, which is also noted in certain pathological conditions. CBD acts not only through the endocannabinoid system, but also causes direct or indirect activation of metabotropic receptors for serotonin or adenosine, and can target nuclear receptors of the PPAR family and also ion channels. © 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.

  17. What do evidence-based secondary journals tell us about the publication of clinically important articles in primary healthcare journals?

    Directory of Open Access Journals (Sweden)

    Wilczynski Nancy L

    2004-09-01

    Full Text Available Abstract Background We conducted this analysis to determine i which journals publish high-quality, clinically relevant studies in internal medicine, general/family practice, general practice nursing, and mental health; and ii the proportion of clinically relevant articles in each journal. Methods We performed an analytic survey of a hand search of 170 general medicine, general healthcare, and specialty journals for 2000. Research staff assessed individual articles by using explicit criteria for scientific merit for healthcare application. Practitioners assessed the clinical importance of these articles. Outcome measures were the number of high-quality, clinically relevant studies published in the 170 journal titles and how many of these were published in each of four discipline-specific, secondary "evidence-based" journals (ACP Journal Club for internal medicine and its subspecialties; Evidence-Based Medicine for general/family practice; Evidence-Based Nursing for general practice nursing; and Evidence-Based Mental Health for all aspects of mental health. Original studies and review articles were classified for purpose: therapy and prevention, screening and diagnosis, prognosis, etiology and harm, economics and cost, clinical prediction guides, and qualitative studies. Results We evaluated 60,352 articles from 170 journal titles. The pass criteria of high-quality methods and clinically relevant material were met by 3059 original articles and 1073 review articles. For ACP Journal Club (internal medicine, four titles supplied 56.5% of the articles and 27 titles supplied the other 43.5%. For Evidence-Based Medicine (general/family practice, five titles supplied 50.7% of the articles and 40 titles supplied the remaining 49.3%. For Evidence-Based Nursing (general practice nursing, seven titles supplied 51.0% of the articles and 34 additional titles supplied 49.0%. For Evidence-Based Mental Health (mental health, nine titles supplied 53.2% of the

  18. THE PHENOMENON OF MIGRATION. OPPORTUNITIES AND CHALLENGES

    Directory of Open Access Journals (Sweden)

    Carmen BOGHEAN

    2016-07-01

    Full Text Available Migration is not a new phenomenon, neither for Europe, nor for the entire world and it exists since the beginning of mankind. Over time, this kind of international mobility generated many opportunities, but many challenges as well. Being an extremely important and complex phenomenon, both in economic terms and mostly from the social perspective, mass emigration has never been more intense as nowadays. Together with this particular complexity, the intensity of the migration phenomenon reveals each individual’s profound freedom desire, but also the acute need to ensure a better future for himself and especially for his family. Currently, an ever increasing number of individuals migrate in search of a better place, changing regions, countries or even continents. Witnessing the events that transcend the people all around the world, we consider that migration generates economic, social and cultural, but also political profound changes. These major changes require the involvement of the political actors, namely the governments, in creating a favorable and reliable framework so as the society and decision makers to understand that immigrants represent an opportunity for the emerging economies and not a phenomenon that should be criticized. In this paper we aim to follow the theories regarding the migration process, as well as the changes it generates, taking into consideration that of the 507 million current inhabitants of the EU, approximately 20 million are from countries outside the EU. We consider this research to be underlain, taking into consideration that regardless of the form it takes, in Europe immigration is and will remain a difficult to manage reality.

  19. Lucio's phenomenon: exuberant case report and review of Brazilian cases*

    Science.gov (United States)

    Rocha, Rafael Henrique; Emerich, Paulo Sergio; Diniz, Lucia Martins; de Oliveira, Marcela Bahia Barretto; Cabral, Aline Neves Freitas; do Amaral, Ana Cristina Vervloet

    2016-01-01

    Lucio’s phenomenon is an uncommon reaction characterized by severe necrotizing cutaneous lesions that occurs in patients with Lucio’s leprosy and lepromatous leprosy. It is considered by some authors as a variant of type 2 or 3 reaction. Death can occur because of blood dyscrasia or sepsis. Precipitating factors include infections, drugs and pregnancy. We report a 31-year-old female patient exhibiting both clinical and histopathological features of lepromatous leprosy and Lucio’s phenomenon presenting favorable response to treatment. We complement our report with a literature review of the Brazilian cases of Lucio’s phenomenon published in Portuguese and English.

  20. PCR-RFLP on β-tubulin gene for rapid identification of the most clinically important species of Aspergillus.

    Science.gov (United States)

    Nasri, Tuba; Hedayati, Mohammad Taghi; Abastabar, Mahdi; Pasqualotto, Alessandro C; Armaki, Mojtaba Taghizadeh; Hoseinnejad, Akbar; Nabili, Mojtaba

    2015-10-01

    Aspergillus species are important agents of life-threatening infections in immunosuppressed patients. Proper speciation in the Aspergilli has been justified based on varied fungal virulence, clinical presentations, and antifungal resistance. Accurate identification of Aspergillus species usually relies on fungal DNA sequencing but this requires expensive equipment that is not available in most clinical laboratories. We developed and validated a discriminative low-cost PCR-based test to discriminate Aspergillus isolates at the species level. The Beta tubulin gene of various reference strains of Aspergillus species was amplified using the universal fungal primers Bt2a and Bt2b. The PCR products were subjected to digestion with a single restriction enzyme AlwI. All Aspergillus isolates were subjected to DNA sequencing for final species characterization. The PCR-RFLP test generated unique patterns for six clinically important Aspergillus species, including Aspergillus flavus, Aspergillus fumigatus, Aspergillus nidulans, Aspergillus terreus, Aspergillus clavatus and Aspergillus nidulans. The one-enzyme PCR-RFLP on Beta tubulin gene designed in this study is a low-cost tool for the reliable and rapid differentiation of the clinically important Aspergillus species.

  1. Ossification of caroticoclinoid ligament and its clinical importance in skull-based surgery

    Directory of Open Access Journals (Sweden)

    Srijit Das

    Full Text Available CONTEXT: The medial end of the posterior border of the sphenoid bone presents the anterior clinoid process (ACP, which is usually accessed for operations involving the clinoid space and the cavernous sinus. The ACP is often connected to the middle clinoid process (MCP by a ligament known as the caroticoclinoid ligament (CCL, which may be ossified, forming the caroticoclinoid foramen (CCF. Variations in the ACP other than ossification are rare. The ossified CCL may have compressive effects on the internal carotid artery. Thus, anatomical and radiological knowledge of the ACP and the clinoid space is also important when operating on the internal carotid artery. Excision of the ACP may be required for many skull-based surgical procedures, and the presence of any anomalies such as ossified CCL may pose a problem for neurosurgeons. CASE REPORT: We observed the presence of ossified CCL in a skull bone. A detailed radiological study of the CCL and the CCF was conducted. Morphometric measurements were recorded and photographs were taken. The ACP was connected to the MCP and was converted into a CCF. Considering the fact that standard anatomy textbooks do not provide morphological descriptions and radiological evaluations of the CCL, the present study may be important for neurosurgeons operating in the region of the ACP.

  2. Neuroimaging in clinical studies of craving: importance of reward and control networks.

    Science.gov (United States)

    Thayer, Rachel E; Hutchison, Kent E

    2013-06-01

    Research on neurobiological mechanisms, especially the function of networks that underlie reward and cognitive control, may offer an opportunity to explore how existing treatments work and provide means for developing new treatments for substance use disorders. In this respect, the special issue of Psychology of Addictive Behaviors highlights efforts to integrate translational neuroimaging with clinical research by actively linking neuroimaging measures with psychosocial treatment mechanisms. Based on several of the articles in this special issue, mindfulness-based approaches appear poised to make rapid progress in terms of integrating neuroimaging with research on mechanisms that mediate treatment success. This commentary briefly discusses research on incentive salience and cognitive control networks in the context of addiction, followed by a discussion of specific studies within this special issue that address the integration of neuroimaging assessments in the context of mindfulness approaches. Future work may be able to leverage measures of changes in networks and regions that underlie reward processing and cognitive control to better understand how treatments work, especially for mindfulness-based approaches. 2013 APA, all rights reserved

  3. Anatomical variations within the deep posterior compartment of the leg and important clinical consequences.

    Science.gov (United States)

    Hislop, M; Tierney, P

    2004-09-01

    The management of musculoskeletal conditions makes up a large part of a sports medicine practitioner's practice. A thorough knowledge of anatomy is an essential component of the armament necessary to decipher the large number of potential conditions that may confront these practitioners. To cloud the issue further, anatomical variations may be present, such as supernumerary muscles, thickened fascial bands or variant courses of nerves and blood vessels, which can themselves manifest as acute or chronic conditions that lead to significant morbidity or limitation of activity. There are a number of contentious areas within the literature surrounding the anatomy of the leg, particularly involving the deep posterior compartment. Conditions such as chronic exertional compartment syndrome, tibial periostitis (shin splints), peripheral nerve entrapment and tarsal tunnel syndrome may all be affected by subtle anatomical variations. This paper primarily focuses on the deep posterior compartment of the leg and uses the gross dissection of cadaveric specimens to describe definitively the anatomy of the deep posterior compartment. Variant fascial attachments of flexor digitorum longus are documented and potential clinical sequelae such as chronic exertional compartment syndrome and tarsal tunnel syndrome are discussed.

  4. [Monogenic obesity - current status of molecular genetic research and clinical importance].

    Science.gov (United States)

    Aldhoon-Hainerová, Irena; Včelák, Josef; Zamrazilová, Hana

    2014-01-01

    Obesity and its comorbidities represent one of the major health problems worldwide. A positive energy balance due to inappropriate life-style changes plays a key role in the current obesity epidemic. The influence of genetic factors is also significant - several studies concluded that genes contribute to the development of obesity by 40-70%. Genetic variability predisposes an individual to tendency or resistance to increase body weight in obesogenic environment. Polygenic type of inheritance is responsible in most of obese individuals. However, an intensive research of the past 20 years has led to an identification of several genes causing monogenic forms of obesity. To date, several monogenic genes (leptin, leptin receptor, prohormon convertase 1, proopiomelanocortin, melanocortin 4 receptor, single-minded homolog 1, brain-derived neurotrophic factor, neurotrophic tyrosine kinase receptor type 2) that are either involved in the neuronal differentiation of the paraventricular nucleus or in the leptin-melanocortin pathway are known to cause obesity. Mutation carriers apart from severe early onset obesity manifest with additional phenotypic characteristics as adrenal insufficiency, impaired immunity and impaired fertility. This review provides an overview of molecular-genetic and clinical research in the field of monogenic obesities including therapeutical approaches.

  5. Clinically important features of porphyrin and heme metabolism and the porphyrias.

    Science.gov (United States)

    Besur, Siddesh; Hou, Wehong; Schmeltzer, Paul; Bonkovsky, Herbert L

    2014-11-03

    Heme, like chlorophyll, is a primordial molecule and is one of the fundamental pigments of life. Disorders of normal heme synthesis may cause human diseases, including certain anemias (X-linked sideroblastic anemias) and porphyrias. Porphyrias are classified as hepatic and erythropoietic porphyrias based on the organ system in which heme precursors (5-aminolevulinic acid (ALA), porphobilinogen and porphyrins) are chiefly overproduced. The hepatic porphyrias are further subdivided into acute porphyrias and chronic hepatic porphyrias. The acute porphyrias include acute intermittent, hereditary copro-, variegate and ALA dehydratase deficiency porphyria. Chronic hepatic porphyrias include porphyria cutanea tarda and hepatoerythropoietic porphyria. The erythropoietic porphyrias include congenital erythropoietic porphyria (Gűnther's disease) and erythropoietic protoporphyria. In this review, we summarize the key features of normal heme synthesis and its differing regulation in liver versus bone marrow. In both organs, principal regulation is exerted at the level of the first and rate-controlling enzyme, but by different molecules (heme in the liver and iron in the bone marrow). We also describe salient clinical, laboratory and genetic features of the eight types of porphyria.

  6. Clinically Important Features of Porphyrin and Heme Metabolism and the Porphyrias

    Science.gov (United States)

    Besur, Siddesh; Hou, Weihong; Schmeltzer, Paul; Bonkovsky, Herbert L.

    2014-01-01

    Heme, like chlorophyll, is a primordial molecule and is one of the fundamental pigments of life. Disorders of normal heme synthesis may cause human diseases, including certain anemias (X-linked sideroblastic anemias) and porphyrias. Porphyrias are classified as hepatic and erythropoietic porphyrias based on the organ system in which heme precursors (5-aminolevulinic acid (ALA), porphobilinogen and porphyrins) are chiefly overproduced. The hepatic porphyrias are further subdivided into acute porphyrias and chronic hepatic porphyrias. The acute porphyrias include acute intermittent, hereditary copro-, variegate and ALA dehydratase deficiency porphyria. Chronic hepatic porphyrias include porphyria cutanea tarda and hepatoerythropoietic porphyria. The erythropoietic porphyrias include congenital erythropoietic porphyria (Gűnther’s disease) and erythropoietic protoporphyria. In this review, we summarize the key features of normal heme synthesis and its differing regulation in liver versus bone marrow. In both organs, principal regulation is exerted at the level of the first and rate-controlling enzyme, but by different molecules (heme in the liver and iron in the bone marrow). We also describe salient clinical, laboratory and genetic features of the eight types of porphyria. PMID:25372274

  7. Importance of clinical posting for awareness on bio-medical waste in medical and paramedical students

    Directory of Open Access Journals (Sweden)

    Jemil S Makadia

    2014-10-01

    Full Text Available Background: The management of health care waste is the subject of considerable concern to public health. Unscientific disposal of health care waste may lead to the transmission of communicable disease which is a risk for health care professionals. Objective: The main objective of this study was to assess the awareness in the medical and paramedical students about bio-medical waste (BMW hazards and management and to see the impact of clinical posting in knowledge regarding BMW handling. Materials and Methods: This was a cross-sectional type of study. A total of 240 subjects was enrolled, 60 each from 1 st year students of MBBS, BDS, nursing, and MLT. They were interviewed for health care waste management practices. Results: Study shows overall awareness regarding BMW in nursing and MLT students were better than MBBS and BDS students. We found that about the infection like HIV almost all the students were equally aware but awareness about hepatitis B infection was more in MBBS and BDS students and also in nursing students compared with MLT students. All the students from four groups were almost vaccinated for tetanus toxoid but only 50% students were vaccinated for hepatitis B. Conclusion: The nursing and MLT students comparatively were having better knowledge and attitude than BDS and MBBS students in many aspects. However, overall knowledge of 1 st year students from all the groups was not satisfactory and number of students those who were vaccinated for hepatitis B was also low which put them at risk.

  8. Clinically Important Features of Porphyrin and Heme Metabolism and the Porphyrias

    Directory of Open Access Journals (Sweden)

    Siddesh Besur

    2014-11-01

    Full Text Available Heme, like chlorophyll, is a primordial molecule and is one of the fundamental pigments of life. Disorders of normal heme synthesis may cause human diseases, including certain anemias (X-linked sideroblastic anemias and porphyrias. Porphyrias are classified as hepatic and erythropoietic porphyrias based on the organ system in which heme precursors (5-aminolevulinic acid (ALA, porphobilinogen and porphyrins are chiefly overproduced. The hepatic porphyrias are further subdivided into acute porphyrias and chronic hepatic porphyrias. The acute porphyrias include acute intermittent, hereditary copro-, variegate and ALA dehydratase deficiency porphyria. Chronic hepatic porphyrias include porphyria cutanea tarda and hepatoerythropoietic porphyria. The erythropoietic porphyrias include congenital erythropoietic porphyria (Gűnther’s disease and erythropoietic protoporphyria. In this review, we summarize the key features of normal heme synthesis and its differing regulation in liver versus bone marrow. In both organs, principal regulation is exerted at the level of the first and rate-controlling enzyme, but by different molecules (heme in the liver and iron in the bone marrow. We also describe salient clinical, laboratory and genetic features of the eight types of porphyria.

  9. Changes in Heart Rate Variability after Coronary Artery Bypass Grafting and Clinical Importance of These Findings.

    Science.gov (United States)

    Lakusic, Nenad; Mahovic, Darija; Kruzliak, Peter; Cerkez Habek, Jasna; Novak, Miroslav; Cerovec, Dusko

    2015-01-01

    Heart rate variability is a physiological feature indicating the influence of the autonomic nervous system on the heart rate. Association of the reduced heart rate variability due to myocardial infarction and the increased postinfarction mortality was first described more than thirty years ago. Many studies have unequivocally demonstrated that coronary artery bypass grafting surgery generally leads to significant reduction in heart rate variability, which is even more pronounced than after myocardial infarction. Pathophysiologically, however, the mechanisms of heart rate variability reduction associated with acute myocardial infarction and coronary artery bypass grafting are different. Generally, heart rate variability gradually recovers to the preoperative values within six months of the procedure. Unlike the reduced heart rate variability in patients having sustained myocardial infarction, a finding of reduced heart rate variability after coronary artery bypass surgery is not considered relevant in predicting mortality. Current knowledge about changes in heart rate variability in coronary patients and clinical relevance of such a finding in patients undergoing coronary artery bypass grafting are presented.

  10. Clinical characteristics of importance to outcome in patients with axial spondyloarthritis

    DEFF Research Database (Denmark)

    Andreasen, Rikke Asmussen; Kristensen, Lars Erik; Ellingsen, Torkell

    2017-01-01

    the PDQ and other phenotypical patient characteristics are prognostically important for response to biological therapy according to established response criteria like 50% improvement in the Bath Ankylosing Spondylitis Disease Activity Index (50%) and Ankylosing Spondylitis Disease Activity Score. ETHICS......INTRODUCTION: Spondyloarthritis (SpA) is a heterogeneous spectrum of rheumatic diseases with either predominantly axial inflammatory symptoms of the spine and sacroiliac joints or predominantly peripheral arthritis. The two main entities of axial SpA (axSpA) are ankylosing spondylitis or non......-radiographic axSpA (nr-axSpA). Tumour necrosis factor-α inhibitors have revolutionised the treatment of patients with axSpA who failed to respond to non-steroidal anti-inflammatory drugs and physical therapy. Chronic pain is common in patients with SpA and may still persist despite the lack of signs...

  11. Religion as a Natural Phenomenon

    Energy Technology Data Exchange (ETDEWEB)

    Dennett, Daniel (Tufts University)

    2006-02-15

    Religion is a costly human activity that has evolved over the millennia. Why does it exist and how does it foster such powerful allegiances? To undertake a serious scientific study of religious practices and attitudes we must set aside a traditional exemption from scrutiny which religions have enjoyed. Religious adherents may not welcome this attention, but we should press ahead with it, since if we don't come to understand religion as a natural phenomenon, our attempts to deal with the problems that loom in the twenty-first century will likely be counterproductive.

  12. Binary toxin and its clinical importance in Clostridium difficile infection, Belgium.

    Science.gov (United States)

    Pilate, T; Verhaegen, J; Van Ranst, M; Saegeman, V

    2016-11-01

    Binary toxin-producing Clostridium difficile strains such as ribotypes 027 and 078 have been associated with increased Clostridium difficile infection (CDI) severity. Our objective was to investigate the association between presence of the binary toxin gene and CDI severity and recurrence. We performed a laboratory-based retrospective study including patients between January 2013 and March 2015 whose fecal samples were analyzed by polymerase chain reaction (PCR) for the presence of the genes for toxin B and binary toxin and a deletion in the tcdC gene, specific for ribotype 027. Clinical and epidemiological characteristics were compared between 33 binary toxin-positive CDI patients and 33 binary toxin-negative CDI patients. Subsequently, the characteristics of 66 CDI patients were compared to those of 66 diarrhea patients who were carriers of non-toxigenic C. difficile strains. Fifty-nine of 1034 (5.7 %) fecal samples analyzed by PCR were binary toxin-positive, belonging to 33 different patients. No samples were positive for ribotype 027. Binary toxin-positive CDI patients did not differ from binary toxin-negative CDI patients in terms of disease recurrence, morbidity, or mortality, except for a higher peripheral leukocytosis in the binary toxin-positive group (16.30 × 10(9)/L vs. 11.65 × 10(9)/L; p = 0.02). The second part of our study showed that CDI patients had more severe disease, but not a higher 30-day mortality rate than diarrhea patients with a non-toxicogenic C. difficile strain. In our setting with a low prevalence of ribotype 027, the presence of the binary toxin gene is not associated with poor outcome.

  13. Susceptibility of clinically important dermatophytes against statins and different statin-antifungal combinations.

    Science.gov (United States)

    Nyilasi, Ildikó; Kocsubé, Sándor; Krizsán, Krisztina; Galgóczy, László; Papp, Tamás; Pesti, Miklós; Nagy, Katalin; Vágvölgyi, Csaba

    2014-02-01

    The investigation of the antifungal activities of drugs whose primary activities are not related to their antimicrobial potential is in the current forefront of research. Statin compounds, which are routinely used as cholesterol-lowering drugs, may also exert direct antimicrobial effects. In this study, the in vitro antifungal activities of various statins (lovastatin, simvastatin, fluvastatin, atorvastatin, rosuvastatin and pravastatin) were examined against one isolate each of four dermatophyte species (Trichophyton mentagrophytes, Trichophyton rubrum, Microsporum canis and Microsporum gypseum). Basically, statins were effective in inhibiting all dermatophyte studied, but were particularly active against M. canis and T. mentagrophytes. Fluvastatin and simvastatin were active against all of the tested fungi causing a complete inhibition of their growth at very low concentrations (6.25-12.5 μg/ml). Lovastatin and rosuvastatin had inhibitory effects at higher concentrations (25-128 μg/ml), while atorvastatin and pravastatin proved the less effective. The in vitro interactions between statins and different antifungals (ketoconazole, itraconazole, fluconazole, amphotericin B, nystatin, griseofulvin, terbinafine and primycin) were also investigated using a standard chequerboard broth microdilution method. Synergetic interactions were observed in several cases, most of them were noticed when statins were combined with terbinafine and the different azoles. Some combinations were particularly active (ketoconazole-simvastatin or terbinafine-simvastatin), as they were found to exert synergistic effect against all of the investigated isolates. The other antifungals showed synergistic interactions with statins in only certain cases. These results suggest that statins exert substantial antifungal effects against dermatophyte fungi and they should be promising components in a combination therapy as they can act synergistically with a number of clinically used antifungal

  14. Is iloprost effective in secondary Raynaud's phenomenon?

    Science.gov (United States)

    Lustig, Nicole; Rada, Gabriel

    2015-03-09

    Patients with systemic sclerosis frequently have Raynaud's phenomenon and digital ischemic ulcers. Iloprost, a synthetic prostacyclin analogue, may be effective in these cases. Searching in Epistemonikos database, which is maintained by screening 20 databases, we identified three systematic reviews including seven randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded iloprost may lead to little or no difference in the frequency or severity of secondary Raynaud, and it is associated to adverse effects and important costs.

  15. Import and visualization of clinical medical imagery into multiuser VR environments

    Science.gov (United States)

    Mehrle, Andreas H.; Freysinger, Wolfgang; Kikinis, Ron; Gunkel, Andreas; Kral, Florian

    2005-03-01

    The graphical representation of three-dimensional data obtained from tomographic imaging has been the central problem since this technology is available. Neither the representation as a set of two-dimensional slices nor the 2D projection of three-dimensional models yields satisfactory results. In this paper a way is outlined which permits the investigation of volumetric clinical data obtained from standard CT, MR, PET, SPECT or experimental very high resolution CT-scanners in a three dimensional environment within a few worksteps. Volumetric datasets are converted into surface data (segmentation process) using the 3D-Slicer software tool and saved as .vtk files and exported as a collection of primitives in any common file format (.iv, .pfb). Subsequently this files can be displayed and manipulated in the CAVE virtual reality center. The CAVE is a multiuser walkable virtual room consisting of several walls on which stereoscopic images are projected by rear panel beamers. Adequate tracking of the head position and separate image calculation for each eye yields a vivid impression for one or several users. With the use of a seperately tracked 6D joystick manipulations such as rotation, translation, zooming, decomposition or highlighting can be done intuitively. The usage of the CAVE technology opens new possibilities especially in surgical training ("hands-on-effect") and as an educational tool (availability of pathological data). Unlike concurring technologies the CAVE permits a walk-through into the virtual scene but preserves enough physical perception to allow interaction between multiple users, e.g. gestures and movements. By training in a virtual environment on one hand the learning process of students in complex anatomic findings may be improved considerably and on the other hand unaccustomed views such as the one through a microscope or endoscope can be trained in advance. The availability of low-cost PC based CAVE-like systems and the rapidly decreasing price

  16. Importance of high-throughput cell separation technologies for genomics/proteomics-based clinical diagnostics

    Science.gov (United States)

    Leary, James F.; Szaniszlo, Peter; Prow, Tarl W.; Reece, Lisa M.; Wang, Nan; Asmuth, David M.

    2002-06-01

    be about 100 times more sensitive than they are now to be able to do many biologically and biomedically meaningful experiments and clinical tests.

  17. Situational judgment tests reliably measure professional attributes important for clinical practice

    Directory of Open Access Journals (Sweden)

    Petty-Saphon K

    2016-12-01

    Full Text Available Katie Petty-Saphon,1 Kim A Walker,2 Fiona Patterson,3,4 Vicki Ashworth,4 Helena Edwards4 1Medical Schools Council, London, UK; 2United Kingdom Foundation Programme Office, Birmingham, UK; 3Department of Psychology, University of Cambridge, Cambridge, UK; 4Work Psychology Group, Derby, UK Abstract: Over the course of more than 40 years, international research has consistently shown situational judgment tests (SJTs to be a reliable and valid selection method for assessing a range of professional attributes. However, SJTs still represent a relatively new selection method within the medical profession, and as such it is to be expected that applicant reactions will vary. In this Expert Opinion piece, we respond to Najim et al’s article “The situational judgement test: a student’s worst nightmare” by highlighting three key clarifications. We outline that 1 the UK Foundation Programme’s SJT deliberately measures only a subset (five of the nine professional attributes important for the role of Foundation Trainee doctor, 2 these attributes are measured in addition to academic attainment, and 3 the SJT represents a cost-effective approach to selection rather than attempting to interview approximately 8,000 candidates each year, which would be logistically impossible. We present these points to inform future research and encourage debate, and conclude that the SJT is an appropriate and fair measurement method to be used as one part of selection to the UK Foundation Programme. Keywords: situational judgment test, reliability, validity, fairness, candidate perceptions

  18. Use of goal attainment scaling in measuring clinically important change in the frail elderly.

    Science.gov (United States)

    Rockwood, K; Stolee, P; Fox, R A

    1993-10-01

    The selection of appropriate outcome measures is important in evaluating specialized geriatric programs, but how the various measures compare, and which are most appropriate, are matters still largely unexplored. We compared several outcome measures, including goal attainment scaling, to assess their sensitivity to changes in the health status of frail elderly patients admitted to two geriatric medicine wards. GAS is a measurement approach which accommodates multiple individual patient goals, and has a scoring system which allows for comparisons between patients. Forty-five patients (mean age 81 years, 30 females) received comprehensive assessments. GAS yielded a mean 5 goals per patient. The mean gain in the GAS score was 22 points (SD = 7) which was compared with the change in the Barthel Index (r = 0.59), the Functional Independence Measure (r = 0.45), the Physical Self-Maintenance Scale (r = 0.54), the Katz Activities of Daily Living Index (r = 0.49) and the Spitzer Quality of Life Index (r = 0.38). The inter-rater reliability of scoring the GAS follow-up guides was 0.91. Using a relative efficiency statistic, GAS proved more efficient than any other measure. The effect size statistic also demonstrated an increased responsiveness to change of GAS compared with standard measures. GAS is an individualized measurement approach which shows promise as a responsive measure in frail elderly patients.

  19. Zika virus infections imported to Italy: clinical, immunological and virological findings, and public health implications.

    Science.gov (United States)

    Zammarchi, Lorenzo; Stella, Giulia; Mantella, Antonia; Bartolozzi, Dario; Tappe, Dennis; Günther, Stephan; Oestereich, Lisa; Cadar, Daniel; Muñoz-Fontela, César; Bartoloni, Alessandro; Schmidt-Chanasit, Jonas

    2015-02-01

    We report the first two cases of laboratory confirmed Zika virus (ZIKV) infections imported into Italy from French Polynesia. Both patients presented with low grade fever, malaise, conjunctivitis, myalgia, arthralgia, ankle oedema, and axillary and inguinal lymphadenopathy. One patient showed leukopenia with relative monocytosis and thrombocytopenia. The diagnosis was based on ZIKV seroconversion in both cases and on ZIKV RNA detection in one patient from acute serum sample. Sera from both patients exhibited cross-reactivity with dengue virus antigens. Our immunological analysis demonstrated that recovery from ZIKV infection is associated with restoration of normal numbers of immune cells in the periphery as well as with normal function of antigen-presenting cells. ZIKV is an emerging arbovirus, which has recently spread extensively in tourist destinations on several West Pacific islands. Returning viremic travelers may ignite autochthonous infections in countries like Italy, which are infested by Aedes albopictus, a suitable vector for ZIKV. The role of clinicians is crucial and includes early diagnosis and timely notification of public health authorities in order to quickly implement adequate focal vector control measurements.

  20. Cell phenomenology: The first phenomenon.

    Science.gov (United States)

    Pattee, H H

    2015-12-01

    As a broad academic discipline phenomenology may be summarized as the study from a first person point of view of what appears to subjective human conscious experience. As a historical philosophical movement phenomenology was often motivated by the belief that subjective human experience is the proper foundation of all philosophy. I explore phenomena from a broader evolutionary and physical point of view. I consider a phenomenon as the subjective consequence of a physical interaction with an individual organism. In physical terms, a phenomenon requires some form of detection or measurement. What is detected is determined by the organism, and is potentially functional for the organism as a self or subject. The concept of function has meaning only for living organisms. The classical human mind-body problem is an ill-defined complicated case of the more general epistemic subject-object problem, which at the origin of life I reduce to the primitive symbol-matter problem. I argue that the first memory-based self-replicating unit, like a cell, is the most primitive case of a necessary symbol-matter distinction. The first phenomena, which include all forms or sensing, detection, and measurement, require a subject-object distinction, called the epistemic cut. It is only because of such a subject-object distinction that populations of individual subjects can selectively adapt to their environment by heritable variations. This basic evolutionary process requires distinguishing the individual's subjective phenomena from the objective events of inexorable physical laws.

  1. An Unusual Course of Segmental Renal Artery Displays a Rare Case of Hilar Nutcracker Phenomenon

    Science.gov (United States)

    Sawant, Devendra A.; Moore, Thomas F.

    2015-01-01

    Nutcracker phenomenon or renal vein entrapment is classically seen as a compression of renal vein in between abdominal aorta and superior mesenteric artery with patients being asymptomatic or clinically manifested in the form of nutcracker syndrome as proteinuria, hematuria, flank pain, pelvic congestion in women, and varicocele in men. In this report, we are presenting a case of rare variant of nutcracker phenomenon along with brief review of anatomy, pathophysiology, public health, and clinical significance of nutcracker syndrome. On a routine dissection of an adult male cadaver, we noticed an unusual arrangement of the structures at the hilum of the left kidney showing entrapment of renal vein between left anterior inferior and posterior segmental renal arteries. The variation in the course of left anterior inferior segmental renal artery leads to compression of left renal vein at renal hilum. Therefore, we have named this rare abnormal anatomical entity as hilar nutcracker phenomenon. The structures in the right renal hilum are normal. The objective of this paper is to report an unusual but important variant of nutcracker phenomenon and also give collective knowledge of such anatomical variations in renal vasculature that will help in diagnosing and treating such rare renal disorder. PMID:26448765

  2. An Unusual Course of Segmental Renal Artery Displays a Rare Case of Hilar Nutcracker Phenomenon

    Directory of Open Access Journals (Sweden)

    Devendra A. Sawant

    2015-01-01

    Full Text Available Nutcracker phenomenon or renal vein entrapment is classically seen as a compression of renal vein in between abdominal aorta and superior mesenteric artery with patients being asymptomatic or clinically manifested in the form of nutcracker syndrome as proteinuria, hematuria, flank pain, pelvic congestion in women, and varicocele in men. In this report, we are presenting a case of rare variant of nutcracker phenomenon along with brief review of anatomy, pathophysiology, public health, and clinical significance of nutcracker syndrome. On a routine dissection of an adult male cadaver, we noticed an unusual arrangement of the structures at the hilum of the left kidney showing entrapment of renal vein between left anterior inferior and posterior segmental renal arteries. The variation in the course of left anterior inferior segmental renal artery leads to compression of left renal vein at renal hilum. Therefore, we have named this rare abnormal anatomical entity as hilar nutcracker phenomenon. The structures in the right renal hilum are normal. The objective of this paper is to report an unusual but important variant of nutcracker phenomenon and also give collective knowledge of such anatomical variations in renal vasculature that will help in diagnosing and treating such rare renal disorder.

  3. Expression of IAP family proteins and its clinical importance in breast cancer patients.

    Science.gov (United States)

    Pluta, P; Jeziorski, A; Cebula-Obrzut, A Pluta B; Wierzbowska, A; Piekarski, J; Smolewski, P

    2015-01-01

    Inhibitor of apoptosis (IAP) family proteins is involved in mechanisms of resistance to apoptosis in various cancer cells. The aim of this study was to assess the expression of selected IAP proteins such as XIAP, cIAP-1, cIAP-2 and survivin in breast cancer patients and evaluates their relationship with the prognostic and predictive factors and their impact to overall survival (OS) and progression free survival (PFS). The study was conducted with the use of tissue samples prospectively collected from 92 previously untreated female breast cancer patients. The control encompassed 10 fibroadenoma patients. The expression of XIAP, cIAP-1, cIAP-2 and survivin was assessed using flow multicolor cytometry. XIAP expression was present in 99 % of the breast cancer patients (91/92) with the median expression 13.65% (range 1-66.8%). Expression of XIAP in breast cancer was significantly higher compared to the control group (p=0.006). Median expression of cIAP-1, cIAP-2 and survivin in the study group was 25.95% (range 0.8-83.7%), 16.7% (range 1-53.2%) and 4.6% (range 0-43%) respectively. In the rank Spearman test, strong correlations (pproteins and survival. However, low expression of XIAP in breast cancer showed trend to longer PFS (p=0.08). XIAP, cIAP-1 cIAP-2 and survivin participate in antiapoptotic mechanisms in breast cancer and XIAP and survivin seem to have the most significant prognostic importance. Further studies are needed to establish more complete prognostic and predictive values of IAP family proteins in breast cancer patients.

  4. Clinical importance of elevated CK-MB and troponin I levels in congestive heart failure.

    Science.gov (United States)

    Yilmaz, Ahmet; Yalta, Kenan; Turgut, Okan Onur; Yilmaz, Mehmet Birhan; Ozyol, Ali; Kendirlioglu, Omer; Karadas, Filiz; Tandogan, Izzet

    2006-01-01

    coronary artery disease, hypertension, and diabetes mellitus (P>.05). The mean EF in group 2 was significantly lower than that in group 1 and in the control group (P.05), but group 2 had significantly higher mean values of CK-MB and Tn-I than were noted in the control group (P<.05). The uphill course of CK-MB and Tn-I values from the control group to group 2 (NYHA class III-IV) was statistically significant (P<.05). Serum concentrations of CK-MB and Tn-I may become elevated in severely symptomatic patients with CHF (particularly NYHA class III-IV), demonstrating a relationship between clinical severity of the disease and elevation of myocardial enzymes (CK-MB and Tn-I).

  5. A reappraisal of the prevalence and clinical importance of left ventricular false tendons in children and adults.

    OpenAIRE

    1986-01-01

    The prevalence and clinical importance of false tendons were studied in 488 consecutive patients referred for echocardiography. Two hundred and eighty three (58%) patients had acquired heart disease, 91 (19%) had congenital heart disease, and 114 (23%) had normal hearts. Sixty six patients with normal hearts had innocent systolic murmurs and one had recurrent ventricular tachycardia. The overall prevalence of false tendons was 25% compared with 1.6% in a retrospective analysis of 763 cross se...

  6. 2-(Nitroaryl)benzothiazole and benzoxazole derivatives as fluorogenic substrates for the detection of nitroreductase activity in clinically important microorganisms.

    Science.gov (United States)

    Cellier, Marie; Gignoux, Amandine; James, Arthur L; Orenga, Sylvain; Perry, John D; Robinson, Shaun N; Stanforth, Stephen P; Turnbull, Graeme

    2015-12-15

    A series of carboxy-substituted 2-(nitroaryl)benzothiazole derivatives and carboxy-substituted 2-(nitroaryl)benzoxazole derivatives were prepared and evaluated as potential nitroreductase substrates for the purpose of detecting clinically important microorganisms. Several of the substrates produced highly fluorescent colonies with the majority of a panel of 10 Gram-negative bacteria and also with two of a panel of 8 Gram-positive bacteria.

  7. A lack of genetic basis for biovar differentiation in clinically important Corynebacterium diphtheriae from whole genome sequencing.

    Science.gov (United States)

    Sangal, Vartul; Burkovski, Andreas; Hunt, Alison C; Edwards, Becky; Blom, Jochen; Hoskisson, Paul A

    2014-01-01

    The differentiation of clinically important Corynebacterium diphtheriae into specific biovars is complex and phylogenetically unclear. Comparative genomic analyses of 17 strains indicate that the division of C. diphtheriae into different biovars does not correlate with the variation in the gene content in the relevant metabolic categories that are potentially involved in the biovar discrimination. The biochemical separation is also not supported by phylogenetic analyses, suggesting molecular methods of typing C. diphtheriae strains should be adopted much more widely.

  8. [Clinical importance of tympanometry in the diagnosis of chronic secretory otitis].

    Science.gov (United States)

    Spremo, S; Markić, Z; Kurbalija

    1998-01-01

    Secretory otitis media is defined as a fluid in the middle ear without signs or symptoms of infection. As the aetiology and pathogenesis of the disease are unknown, and as it affects children aged from 3 to 12 years, treatment procedures proposed for management of secretory otitis media, are not uniform. Some authors [1, 4, 6] consider that functional or mechanical obstructions of the Eustachian tube could provoke secretory otitis. The purpose of the treatment is to remove exudate from the middle ear and appropriately ventilate it for a longer period. That could instantly normalize the hearing and exclude the appearance of late complications of secretory otitis. Although the disease could heal spontaneously, the treatment should be performed immediately for preventing sequelae of secretory otitis. The aim of the study was to evaluate possible aetiologic factors of secretory otitis in our population, and to evaluate results of lympanometry in children with exudate in the middle ear. There were 65 children, aged from 3 to 12 years (Table 1), who complained of deafness and were examined at the ORL Department in Banja Luka. The clinical examination revealed the integrity and color of tympanic membrane, scars, adhesions and atrophic areas. Audiometry and tympanometry had been performed in addition. Patients who proved to have exudate in the middle ear received nasal decongestants and mucolitics during three months, and were evaluated every three weeks by audiometry and tympanometry. Pathologic findings in the nose and epipharynx were the most common findings: enlarged adenoids in 38 (58%) patients, hypetrophic rhinitis in 15 (23%) and allergic rhinitis in 5 (8%) patients. Frequent relapses of middle ear infection in the first three years of life were found in 26 (40%) patients and early first attacks in the first year of life in 15 (23%) patients (Table 2). Premature onset (15%) and allergy (21%) had also been frequently found. Results of tympanometry and audiometry are

  9. [THE CONDITION AND TENDENCIES OF DEVELOPMENT OF CLINICAL AND SANITARY MICROBIOLOGY IN THE RUSSIAN FEDERATION AND PROBLEM OF IMPORT SUBSTITUTION].

    Science.gov (United States)

    Dyatlov, I A; Mironov, A Yu; Shepelin, A P; Aleshkin, V A

    2015-08-01

    The import substitution becomes one of the strategic tasks of national economy as a result of prolongation of economic sanctions concerning the Russian Federation of part of the USA, EU countries, Japan and number of other countries. It is not proper to be limited in import substitution only by goods because in conditions ofsanctions when access toforeign technologies is complicated Russia is needed to substitute foreign technologies by national designs in faster manner One of directions of effective import substitution is localization of production of laboratory equipment and consumables for clinical and sanitary microbiology on the territory ofthe Russian Federation and countries of Customs union. In Russia, in the field ofdiagnostic of dangerous and socially significant infections, all components for import substitution to implement gene diagnostic, immune diagnostic. bio-sensory and biochip approaches, isolation and storage of live microbial cultures, implementation of high-tech methods of diagnostic are available. At the same time, national diagnostic instrument-making industry for microbiology is factually absent. The few devices of national production more than on 50% consist of import components. The microbiological laboratories are to be equipped only with import devices of open type for applying national components. The most perspective national designs to be implemented are multiplex polimerase chain reaction test-systems and biochips on the basis of national plotters and readers. The modern development of diagnostic equipment and diagnostic instruments requires supplement of national collections of bacterial and viral pathogens and working-through of organizational schemes of supplying collections with strains. The presented data concerning justification of nomenclature of laboratory equipment and consumables permits to satisfy in fill scope the needs of clinical and sanitary microbiology in devices, growth mediums, consumables of national production

  10. The Phenomenon of Dental Fear

    DEFF Research Database (Denmark)

    Moore, Rod

    Odontophobia is a rather unique phobia with special psychosomatic components that impact on the dental health of odontophobic persons. It also has psychosocial components largely as a result of destruction of the teeth and subsequent embarrassment that can affect a person and cause a vicious cycle...... of dental fear (see fig. 1). The phenomenon is facilitated by misunderstandings and myths generated by both patients and dentists (see table 1 for examples). The most common reasons given in the literature for such strong fears of dental treatment are: 1) bad experiences in childhood for 85% of cases, 2......) feeling of powerlessness and lack of control over personal emotional reactions and over the social situation in the dental chair, 3) social learning processes in which the image of the dentist is cast in a negative light by the mass media or by the person's relatives or friends and 4) that the person has...

  11. Are Earthquakes a Critical Phenomenon?

    Science.gov (United States)

    Ramos, O.

    2014-12-01

    Earthquakes, granular avalanches, superconducting vortices, solar flares, and even stock markets are known to evolve through power-law distributed events. During decades, the formalism of equilibrium phase transition has coined these phenomena as critical, which implies that they are also unpredictable. This work revises these ideas and uses earthquakes as the paradigm to demonstrate that slowly driven systems evolving through uncorrelated and power-law distributed avalanches (UPLA) are not necessarily critical systems, and therefore not necessarily unpredictable. By linking the correlation length to the pdf of the distribution, and comparing it with the one obtained at a critical point, a condition of criticality is introduced. Simulations in the classical Olami-Feder-Christensen (OFC) earthquake model confirm the findings, showing that earthquakes are not a critical phenomenon. However, one single catastrophic earthquake may show critical properties and, paradoxically, the emergence of this temporal critical behaviour may eventually carry precursory signs of catastrophic events.

  12. The accuracy of different biopsy strategies for the detection of clinically important prostate cancer: a computer simulation.

    Science.gov (United States)

    Lecornet, Emilie; Ahmed, Hashim Uddin; Hu, Yipeng; Moore, Caroline M; Nevoux, Pierre; Barratt, Dean; Hawkes, David; Villers, Arnaud; Emberton, Mark

    2012-09-01

    The true accuracy of different biopsy strategies for detecting clinically significant prostate cancer is unknown, given the positive evaluation bias required for verification by radical prostatectomy. To evaluate how well different biopsy strategies perform at detecting clinically significant prostate cancer we used computer simulation in cystoprostatectomy cases with cancer. A computer simulation study was performed on prostates acquired at radical cystoprostatectomy. A total of 346 prostates were processed and examined for prostate cancer using 3 mm whole mount slices. The 96 prostates that contained cancer were digitally reconstructed. Biopsy simulations incorporating various degrees of random localization error were performed using the reconstructed 3-dimensional prostate computer model. Each biopsy strategy was simulated 500 times. Two definitions of clinically significant prostate cancer were used to define the reference standard, including definition 1--Gleason score 7 or greater, and/or lesion volume 0.5 ml or greater and definition 2--Gleason score 7 or greater, and/or lesion volume 0.2 ml or greater. A total of 215 prostate cancer foci were present. The ROC AUC to detect and rule out definition 1 prostate cancer was 0.69, 0.75, 0.82 and 0.91 for 12-core transrectal ultrasound biopsy with a random localization error of 15 and 10 mm, 14-core transrectal ultrasound biopsy and template prostate mapping using a 5 mm sampling frame, respectively. To our knowledge our biopsy simulation study is the first to evaluate the performance of different sampling strategies to detect clinically important prostate cancer in a population that better reflects the demographics of a screened cohort. Compared to other strategies standard transrectal ultrasound biopsy performs poorly for detecting clinically important cancer. Marginal improvement can be achieved using additional cores placed anterior but the performance attained by template prostate mapping is optimal. Copyright

  13. EVOLUTION OF THE PHENOMENON INTEGRATION IN LATIN AMERICA (SOUTH AMERICA

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    EMILIAN M. DOBRESCU

    2013-05-01

    Full Text Available With the end of the Cold War, the creation of a South American economic space has become an important priority of regional powers (Brazil, Argentina, Chile, and the great powers after the war, the U.S. and the European Union (the current name. This integration process has had particular features derived from characteristics of Latin American countries. Multitude of organizations integrative role once again demonstrates the specificity of this process in Latin America to other areas of the world: Africa, Asia, Europe, etc. Contradictory developments phenomenon / Latin American integration process gives substance its characteristic and I will make, probably deeply and future. The purpose of the work and objectives are: know the main features of the phenomenon in Latin American integrationist Objectives: following our vision of a historical phenomenon; brief characterization of the most important Latin American organizations, establishing current and future consequences of integrationist phenomenon in this part of the world.

  14. Deep brain stimulation may reduce the relative risk of clinically important worsening in early stage Parkinson's disease.

    Science.gov (United States)

    Hacker, Mallory L; Tonascia, James; Turchan, Maxim; Currie, Amanda; Heusinkveld, Lauren; Konrad, Peter E; Davis, Thomas L; Neimat, Joseph S; Phibbs, Fenna T; Hedera, Peter; Wang, Lily; Shi, Yaping; Shade, David M; Sternberg, Alice L; Drye, Lea T; Charles, David

    2015-10-01

    The Vanderbilt pilot trial of deep brain stimulation (DBS) in early Parkinson's disease (PD) enrolled patients on medications six months to four years without motor fluctuations or dyskinesias. We conducted a patient-centered analysis based on clinically important worsening of motor symptoms and complications of medical therapy for all subjects and a subset of subjects with a more focused medication duration. Continuous outcomes were also analyzed for this focused cohort. A post hoc analysis was conducted on all subjects from the pilot and a subset of subjects taking PD medications 1-4 years at enrollment. Clinically important worsening is defined as both a ≥ 3 point increase in UPDRS Part III and a ≥ 1 point increase in Part IV. DBS plus optimal drug therapy (DBS + ODT) subjects experienced a 50-80% reduction in the relative risk of worsening after two years. The DBS + ODT group was improved compared to optimal drug therapy (ODT) at each time point on Total UPDRS and Part III (p = 0.04, p = 0.02, respectively, at 24 months). Total UPDRS, Part IV, and PDQ-39 scores significantly worsened in the ODT group after two years (p early PD may reduce the risk of clinically important worsening. These findings further confirm the need to determine if DBS + ODT is superior to medical therapy for managing symptoms, reducing the complications of medications, and improving quality of life. The FDA has approved the conduct of a large-scale, pivotal clinical trial of DBS in early stage PD. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Prevalence of Raynaud's phenomenon in young Greek males.

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    Tzilalis, Vassilios; Panagiotopoulos, Nikolaos; Papatheodorou, George; Rallis, Efstathios; Kassimos, Dimitrios

    2011-01-01

    The aim of this paper is to study the prevalence of Raynaud's phenomenon in young males. Young males were examined prospectively in a district hospital, and laboratory tests were performed on the basis of the clinical history. Young males (3.912), age 18-28 years old, were examined. Raynaud's phenomenon was present in seven men (1,79 per 1.000, 95% CI 0.72-3.68). Three of them had at least one member in their family diagnosed with Raynaud's phenomenon. Three were smokers. All had negative immunological test. Five patients reported having severe attacks and two had only mild ischemic attacks. The treatment was conservative for all patients, two of them necessitated vasodilators. Very low prevalence of Raynaud's phenomenon was observed in this young male group compared with the previous studies.

  16. Kasabach-Merritt Phenomenon: Classic Presentation and Management Options.

    Science.gov (United States)

    Mahajan, Priya; Margolin, Judith; Iacobas, Ionela

    2017-01-01

    Kasabach-Merritt phenomenon (KMP) is a rare consumptive coagulopathy associated with specific vascular tumors, kaposiform hemangioendothelioma, and tufted angioma. Kasabach-Merritt phenomenon, characterized by profound thrombocytopenia, hypofibrinogenemia, elevated fibrin split products, and rapid tumor growth, can be life-threatening. Severe symptomatic anemia may also be present. With prompt diagnosis and management, KMP can resolve and vascular tumors have been shown to regress. This review highlights the clinical presentation, histopathology, management, and treatment of KMP associated with kaposiform hemangioendothelioma, and less frequently tufted angioma. A classic clinical case is described to illustrate the presentation and our management of a patient with KMP.

  17. Management of Raynaud's phenomenon and digital ischemia.

    Science.gov (United States)

    Herrick, Ariane L

    2013-01-01

    This review focuses on new findings and developments relevant to the clinician caring for patients with primary and secondary [especially systemic sclerosis (SSc)-related] Raynaud phenomenon (RP). In the last 18 months, several clinical trials and observational studies of RP and of SSc-related digital ulceration have been published, reflecting increased awareness of disease burden and increased interest by pharmaceutical companies: new insights into pathophysiology are driving new approaches to treatment. Key developments are the increased use of phosphodiesterase type V inhibitors in severe RP, and of bosentan (an endothelin-1 receptor antagonist) for prevention of recurrent SSc-related digital ulcers. Other treatments being researched include topical glyceryl trinitrate (applied locally to the digits), botulinum toxin (for severe digital ischemia/ulceration), and several other drugs including oral prostanoids. Increased availability and interest in nailfold capillaroscopy, by facilitating early diagnosis of SSc, should pave the way for studies of early intervention and vascular protection.

  18. Quantitative proteomic view associated with resistance to clinically important antibiotics in Gram-positive bacteria: A systematic review

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    Chang-Ro eLee

    2015-08-01

    Full Text Available The increase of methicillin-resistant Staphylococcus aureus (MRSA and vancomycin-resistant Enterococcus (VRE poses a worldwide and serious health threat. Although new antibiotics, such as daptomycin and linezolid, have been developed for the treatment of infections of Gram-positive pathogens, the emergence of daptomycin-resistant and linezolid-resistant strains during therapy has now increased clinical treatment failures. In the past few years, studies using quantitative proteomic methods have provided a considerable progress in understanding antibiotic resistance mechanisms. In this review, to understand the resistance mechanisms to four clinically important antibiotics (methicillin, vancomycin, linezolid, and daptomycin used in the treatment of Gram-positive pathogens, we summarize recent advances in studies on resistance mechanisms using quantitative proteomic methods, and also examine proteins playing an important role in the bacterial mechanisms of resistance to the four antibiotics. Proteomic researches can identify proteins whose expression levels are changed in the resistance mechanism to only one antibiotic, such as LiaH in daptomycin resistance and PrsA in vancomycin resistance, and many proteins simultaneously involved in resistance mechanisms to various antibiotics. Most of resistance-related proteins, which are simultaneously associated with resistance mechanisms to several antibiotics, play important roles in regulating bacterial envelope biogenesis or compensating for the fitness cost of antibiotic resistance. Therefore,

  19. The happy victimizer phenomenon: Not found here

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    Jevtić Ana

    2014-01-01

    Full Text Available Children’s attribution of emotions to a moral transgressor is an important research topic in the psychology of moral and emotional development. This is especially because of the so-called Happy Victimizer Phenomenon (HVP where younger children attribute positive emotions to a moral transgressor described in a story. In the two studies that we have conducted (children aged 5, 7 and 9, 20 of each age; 10 of each age in the second study we have tested the possible influence of the fear of sanctions and the type of transgression (stealing and inflicting body injuries on the attribution of emotions. Children were presented with stories that described transgressions and they were asked to answer how the transgressor felt. The fear of sanctions did not make a significant difference in attribution but the type of transgression did - more negative emotions were attributed for inflicting body injuries than for stealing. Positive emotions were explained with situational-instrumental explanations in 84% of cases while negative emotions were explained with moral explanations in 63,5%. Girls attributed more positive emotions (61% than boys (39%. However, our main finding was that, for the aforementioned age groups, we did not find the HVP effect although it has regularly been registered in foreign studies. This finding denies the generalizability of the phenomenon and points to the significance of disciplining styles and, even more so, culture for children’s attribution of emotions to moral transgressors.

  20. The Research of Polarization Phenomenon in Blogosphere

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    Ying’an Cui

    2012-09-01

    Full Text Available Opinion polarization in blogosphere is an special and important group behavior which often foreshow the emergence of some significant public social events.  In this paper, we first analyze the original blog dissemination characteristics include dissemination networked, free agenda-setting and against the spiral of silence phenomenon. Then, we construct a opinion dissemination dynamic model with the method of reductionism and holism. We decompose the blogosphere into different subnets according to the degree distribution, and build the basic dynamic equations with the k-degree subnet, then extended to the whole network to study the polarization phenomenon.  After that , we point out the weakness of scale free network to depict the blogosphere in brief and give a new novel model and  simulate the process of the opinion dissemination influenced by the composition of the initial opinion, the fixed opinion groups and subjective mental preference of interactive groups. Empirical research shows that polarization will surely happen,  consensus is impossible in blogosphere.

  1. The coronary slow flow phenomenon: a new cardiac "Y" syndrome?

    Science.gov (United States)

    Leone, Maria Cristina; Gori, Tommaso; Fineschi, Massimo

    2008-01-01

    The coronary slow flow phenomenon (CSFP) is an angiographic finding that is characterised by delayed progression of the contrast medium during coronary angiography. The mechanism of this phenomenon remains unknown. In the present paper, we revise the current evidence regarding this phenomenon and discuss recent findings from our group reporting increased resting resistances in patients with the CSFP. We report that these patients had preserved blood flow responses to the intracoronary infusion of the vasodilator papaverine, demonstrating that the CSFP is not necessarily associated with an abnormal coronary flow reserve. Based on these findings and on the review of the current literature, we concur with the concept proposed by Beltrame et al. that the CSFP should be considered a separate clinical entity. Further studies are necessary to describe the clinical characteristics, including the prognosis, of these patients and to identify potential treatments.

  2. Epidemiological survey of mucus extravasation phenomenon at an oral pathology referral center during a 43 year period

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    Thâmara Manoela Marinho Bezerra

    Full Text Available ABSTRACT INTRODUCTION: Mucoceles are common benign pseudocystic lesions of the oral cavity; their main etiological factors are trauma and ductal obstruction. Two histological patterns are found: mucus retention phenomenon (MRP and mucus extravasation phenomenon (MEP. Mucus extravasation phenomenon is the more common histological subtype and it mainly affects the lower lip. The knowledge of its main clinical features and management is important to assist health professionals in clinical practice. OBJECTIVE: This study aimed to determine the relative frequency and distribution of oral mucoceles in an oral pathology reference center. METHODS: Cross-sectional historical study that analyzed all cases pathologically diagnosed as mucus extravasation phenomenon by the department of anatomic pathology of an oral pathology referral center from June of 1970 to May of 2014, considering the clinical characteristics of the lesion and those relating to the patient. SPSS v. 20.0 software for Windows was used for descriptive analysis. RESULTS: During 43 years, 719 cases of mucus extravasation phenomenon (54.7% men and 45.3% women were registered, with the lower lip as the most commonly affected site (n = 484; 67.3%. The average age of patients was 20.8 years (SD ± 14.4 with a peak occurrence in the second decade of life. Most professionals had oral mucocele/ranula (n = 606; 84.3% as the initial clinical impression. CONCLUSION: Mucus extravasation phenomenon is a lesion that primarily affects young patients, affecting mainly the lower lip, and is commonly found in oral diagnostic services.

  3. Clinical impact of IMPORT HIGH trial (CRUK/06/003) on breast radiotherapy practices in the United Kingdom

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    Ciurlionis, Laura; Kirby, Anna M; Locke, Imogen; Venables, Karen; Yarnold, John R; Titley, Jenny; Bliss, Judith; Coles, Charlotte E

    2015-01-01

    Objective: IMPORT HIGH is a multicentre randomized UK trial testing dose-escalated intensity-modulated radiotherapy (IMRT) after tumour excision in females with early breast cancer and higher than average local recurrence risk. A survey was carried out to investigate the impact of this trial on the adoption of advanced breast radiotherapy (RT) techniques in the UK. Methods: A questionnaire was sent to all 26 IMPORT HIGH recruiting RT centres to determine whether the trial has influenced non-trial breast RT techniques in terms of volume delineation, dosimetry, treatment delivery and verification. In order to compare the clinical practice of breast RT between IMPORT HIGH and non–IMPORT HIGH centres, parts of the Royal College of Radiologists (RCR) breast RT audit result were used in this study. Results: 26/26 participating centres completed the questionnaire. After joining the trial, the number of centres routinely using tumour bed clips to guide whole-breast RT rose from 5 (19%) to 21 (81%). 20/26 (77%) centres now contour target volumes and organs at risk (OARs) in some or all patients compared with 14 (54%) before the trial. 14/26 (54%) centres offer inverse-planned IMRT for selected non-trial patients with breast cancer, and 10/14 (71%) have adopted the IMPORT HIGH trial protocol for target volume and OARs dose constraints. Only 2/26 (8%) centres used clip information routinely for breast treatment verification prior to IMPORT HIGH, a minority that has since risen to 7/26 (27%). Data on 1386 patients was included from the RCR audit. This suggested that more cases from IMPORT HIGH centres had surgical clips implanted (83 vs 67%), were treated using CT guided planning with full three-dimensional dose compensation (100 vs 75%), and were treated with photon boost RT (30 vs 8%). Conclusion: The study suggests that participation in the IMPORT HIGH trial has played an important part in providing the guidance and support networks needed for the safe integration of

  4. Gorlin syndrome: Importance of clinical signs and danger of delayed diagnosis - A case report with eight years follow-up

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    Erica Dorigatti de-Avila

    2015-02-01

    Full Text Available Nevoid basal cell carcinoma (NBCCS or Gorlin-Goltz syndrome (GS is a multidisciplinary problem, the early diagnosis of which allows secondary prophylaxis that follows an appropriate regimen to delay progression of the syndrome. The aim of this study was to present a case of delayed diagnosis of GS in a young patient who received multidisciplinary treatment 5 years after onset. The patient presented for evaluation with painless swelling of the left maxilla. Histological examination confirmed the diagnosis of a keratocyst odontogenic tumor (KOT that was enucleated. On presentation, the patient's symptoms and clinical signs were not related to complications of GS, and the possibility of GS was initially rejected, as he did not have a family history of the syndrome. Four years after the first surgery to remove the lesion, the patient came to our clinic with a brown, pigmented lesion. Computed tomography revealed ectopic lamellar calcification of the falx cerebri, which was the conclusive factor for the diagnosis of GS. It is important that clinicians recognize the clinical signs of GS, which mainly manifests itself as multiple basal cell carcinomas in the skin. [Arch Clin Exp Surg 2015; 4(1.000: 49-53

  5. The effect of monosialylganglioside mix modifying the PEGylated liposomal epirubicin on the accelerated blood clearance phenomenon

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    Ting Zhang

    2017-03-01

    Full Text Available PEGylated liposomes are potential candidates to improve the pharmacokinetic characteristics of encapsulated drugs, to extend their circulation half-life and facilitate their passive accumulation at tumour sites. However, PEG-modified liposomes can induce accelerated blood clearance (ABC upon repeated administration, and the extent of ABC phenomenon on the cytotoxic drugs-containing PEGylated liposomes is related to the dose of the cytotoxic drugs. In this study, EPI served as a model cytotoxic drug, a hydrophilic surfactant molecule, monosialylganglioside (GM1 was chosen and modified on the liposomes together with PEG. It was shown that upon mixed modification, when GM1 contents reached 10% or 15% mol, the ABC phenomenon of the PEGylated liposomal EPI significantly reduced. We also found that GM1 played an important role in abrogating the ABC phenomenon in both the induction phase and the effectuation phase. The results suggested that GM1 incorporation unfortunately did not avoid occurrence of ABC phenomenon completely, but GM1 modification on PEGylated liposomes may provide a significant improvement in clinical practice of PEGylated liposomes. Further study must be necessary.

  6. An imported case of severe falciparum malaria with prolonged hemolytic anemia clinically mimicking a coinfection with babesiosis.

    Science.gov (United States)

    Na, Young Ju; Chai, Jong-Yil; Jung, Bong-Kwang; Lee, Hyun Jung; Song, Ji Young; Je, Ji Hye; Seo, Ji Hye; Park, Sung Hun; Choi, Ji Seon; Kim, Min Ja

    2014-12-01

    While imported falciparum malaria has been increasingly reported in recent years in Korea, clinicians have difficulties in making a clinical diagnosis as well as in having accessibility to effective anti-malarial agents. Here we describe an unusual case of imported falciparum malaria with severe hemolytic anemia lasting over 2 weeks, clinically mimicking a coinfection with babesiosis. A 48-year old Korean man was diagnosed with severe falciparum malaria in France after traveling to the Republic of Benin, West Africa. He received a 1-day course of intravenous artesunate and a 7-day course of Malarone (atovaquone/proguanil) with supportive hemodialysis. Coming back to Korea 5 days after discharge, he was readmitted due to recurrent fever, and further treated with Malarone for 3 days. Both the peripheral blood smears and PCR test were positive for Plasmodium falciparum. However, he had prolonged severe hemolytic anemia (Hb 5.6 g/dl). Therefore, 10 days after the hospitalization, Babesia was considered to be potentially coinfected. A 7-day course of Malarone and azithromycin was empirically started. He became afebrile within 3 days of this babesiosis treatment, and hemolytic anemia profiles began to improve at the completion of the treatment. He has remained stable since his discharge. Unexpectedly, the PCR assays failed to detect DNA of Babesia spp. from blood. In addition, during the retrospective review of the case, the artesunate-induced delayed hemolytic anemia was considered as an alternative cause of the unexplained hemolytic anemia.

  7. Impact of routine real-time PCR testing of imported malaria over 4 years of implementation in a clinical laboratory.

    Science.gov (United States)

    Shokoples, Sandra; Mukhi, Shamir N; Scott, Allison N; Yanow, Stephanie K

    2013-06-01

    In clinical laboratories, diagnosis of imported malaria is commonly performed by microscopy. However, the volume of specimens is generally low and maintaining proficiency in reading blood smears, particularly at the species level, is challenging in this setting. To address this problem, the Provincial Laboratory for Public Health (ProvLab) in Alberta, Canada, implemented real-time PCR for routine confirmation of all smear-positive samples in the province. Here we report our experience over a 4-year period (2008 to 2012) with this new diagnostic algorithm. While detection of Plasmodium falciparum by microscopy alone was accurate, real-time PCR served as an important adjunct to microscopy for the identification of non-falciparum species. In 18% of cases, the result was reported as non-falciparum or the species could not be identified by microscopy alone, and in all cases, the species was resolved by real-time PCR. In another 4% of cases, the species was misidentified by microscopy. To enhance surveillance for malaria, we integrated our demographic, clinical, and laboratory data into a new system developed by the Canadian Network for Public Health Intelligence, called the Malaria System for Online Surveillance (SOS). Using this application, we characterized our patient populations and travel history to identify risk factors associated with malaria infection abroad.

  8. [Raynaud's phenomenon - first sign of malignancy: case report].

    Science.gov (United States)

    Sutić, Anamarija; Gračanin, Gudelj; Morović-Vergles, Jadranka

    2014-06-01

    Raynaud's phenomenon is a common phenomenon in the general population. It most commonly occurs in healthy individuals, in whom there is no associated illness or any other cause of Raynaud's phenomenon (primary or idiopathic Raynaud's phenomenon). Secondary Raynaud's phenomenon is common with rheumatic diseases (systemic sclerosis, systemic lupus erythematosus, primary Sjögren's syndrome, mixed connective tissue disease, etc.), occlusive vascular diseases, hematologic disorders, use of vibrating tools and use of some medications, and rarely with malignancy. We report on a patient who presented with a three-week history of painful Raynaud's attacks, which was the reason for seeking assistance of internists in emergency clinic. Upon admission to the hospital and diagnostic work-up, adenocarcinoma of the lung was found. Antinuclear antibodies (ANA), anti-dsDNA antibodies, anticardiolipin IgM and IgG antibodies were present in a lower titer. It is known that rheumatoid factor or ANA characteristic of rheumatic disease are often present in patients with paraneoplastic rheumatic syndromes, which can lead to wrong conclusions about the possible systemic connective tissue diseases and ultimately delay the correct diagnosis. The first appearance of Raynaud's phenomenon as an isolated symptom in people older than 50, with painful signs of ischemia, as in our patient, or the occurrence of asymmetric grasping fingers, especially in men, regardless of the presence of RF, ANA, anti-dsDNA or other autoantibodies, requires broader diagnostic evaluation for malignancy.

  9. Recurrence Incidence in Differentiated Thyroid Cancers and the Importance of Diagnostic Iodine-131 Scintigraphy in Clinical Follow-up

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    Filiz Hatipoğlu

    2016-06-01

    Full Text Available Objective: Differentiated thyroid cancers (DTC are tumors with good prognosis. However, local recurrence or distant metastasis can be observed. In our study, we aimed to investigate the incidence of recurrence and the importance of diagnostic iodine-131 whole body scan (WBS in clinical follow-up in patients with DTC. Methods: The clinical data of 217 patients with DTC who were followed-up more than 3 years were reviewed retrospectively. The incidence of recurrence was investigated in a group of patients who had radioactive iodine (RAI treatment and showed no sign of residual thyroid tissue or metastasis with diagnostic WBS that was performed at 6-12 months after therapy and had a thyroglobulin (Tg level lower than 2 ng/dl. Results: At the time of diagnosis, ten cases had thyroid capsule invasion, 25 cases had extra-thyroid soft tissue invasion, 11 patients showed lymph node metastasis and four patients had distant organ metastasis. One hundred forty-five patients had RAI treatment at ablation dose (75-100 mCi, whereas 35 patients had RAI treatment at metastasis dose (150-200 mCi. Thirty-seven patients with papillary microcarcinoma did not receive RAI treatment. In 12 (%7.5 of the 160 patients who were considered as “successful ablation”, a recurrence was identified. Recurrence was detected by diagnostic WBS in all cases and stimulated Tg level was <2 ng/dL with the exception of the two cases who had distant metastasis. Conclusion: Identification of pathological findings with WBS in patients who developed local recurrence in the absence of elevated Tg highlights the importance of diagnostic WBS in clinical follow-up.

  10. Importance of clinical examination in diagnostics of Osgood-Schlatter Disease in boys playing soccer or basketball

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    Amela Halilbasic

    2012-04-01

    Full Text Available Introduction: Osgood–Schlatter disease is an irritation of the patellar tendon at the tibial tubercle. Sports with jumps, running, and repeated contractions of knee extension apparatus are considered to be importantexternal risk-factors which could cause Osgood–Schlatter disease.Objectives of the study are to draw attention to the importance of clinical examination in diagnostics of Osgood–Schlatter disease in boys playing soccer or basketball.Methods: The research included data obtained from 120 boys, average age of 14 years. Examinees were split into two groups, one with young athletes which regularly have soccer or basketball trainings and thesecond one with boys who do not participating in sports. We performed anthropological measurements and clinical examinations of both knees and hips for both groups. For the statistical analysis we used pointbiserialcorrelation coefficient.Results: Based on clinical examination, Osgood–Schlatter disease was diagnosed in 51 examinees (42.5%. In “athletic group” Osgood–Schlatter disease had 31 boys or 52%, comparing with “non-athletic group” wherewe found 20 adolescents with disease (33%. Number of boys with Osgood–Schlatter disease was higher for 19% in “athletic group” comparing with “non-athletic group”. Comparing incidence rate for boys in both groups with diagnosed II and III level of Osgood–Schlatter disease we found that rate is higher in “athletic group” 2.25 times comparing with “non-athletic group”.Conclusions: Clinical examination is critical method in the process of diagnosing Osgood–Schlatter disease especially for identifying II and III level of this disease.

  11. READING THE HISTORICAL PHENOMENON OF AUSTRALIAN BUSHRANGERS

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    Yohanes Hartadi

    2009-05-01

    Full Text Available Outlaws in their various images have been important parts of history. In Australia, the longestlasting image of outlaws is the bushranger. Despite its popularity, there is a range of depictions ofbushrangers and these are not necessarily similar. Interpretation of the bushrangers in colonial timediffers from contemporary imagining. This papers aims at unfolding the various interpretations of thebushrangers in different periods in many types of artifact. Information was collected and interpretedby library research. The artifact analysis will be seen through a postmodernism theory by MichelFoucault and Roland Barthes. Since the phenomenon of bushranger stemmed from the colonialperiod, this study will commence from the period up to contemporary period. It can be concluded thata study of the different periods finds out that knowledge of the bushrangers does not make up a linearhistory, but rather a discontinuity in the historical narratives.

  12. READING THE HISTORICAL PHENOMENON OF AUSTRALIAN BUSHRANGERS

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    Yohanes Hartadi

    2009-04-01

    Full Text Available Outlaws in their various images have been important parts of history. In Australia, the longest lasting image of outlaws is the bushranger. Despite its popularity, there is a range of depictions of bushrangers and these are not necessarily similar. Interpretation of the bushrangers in colonial time differs from contemporary imagining. This papers aims at unfolding the various interpretations of the bushrangers in different periods in many types of artifact. Information was collected and interpreted by library research. The artifact analysis will be seen through a postmodernism theory by Michel Foucault and Roland Barthes. Since the phenomenon of bushranger stemmed from the colonial period, this study will commence from the period up to contemporary period. It can be concluded that a study of the different periods finds out that knowledge of the bushrangers does not make up a linear history, but rather a discontinuity in the historical narratives.

  13. Raynaud's phenomenon: from molecular pathogenesis to therapy.

    Science.gov (United States)

    Prete, Marcella; Fatone, Maria Celeste; Favoino, Elvira; Perosa, Federico

    2014-06-01

    Raynaud's phenomenon (RP) is a well defined clinical syndrome characterized by recurrent episodes of digital vasospasm triggered by exposure to physical/chemical or emotional stress. RP has been classified as primary or secondary, depending on whether it occurs as an isolated condition (pRP) or is associated to an underlying disease, mainly a connective tissue disease (CTD-RP). In both cases, it manifests with unique "triple" (pallor, cyanosis and erythema), or "double" color changes. pRP is usually a benign condition, while sRP can evolve and be complicated by acral digital ulcers and gangrene, which may require surgical treatment. The pathogenesis of RP has not yet been entirely clarified, nor is it known whether autoantibodies have a role in RP. Even so, recent advances in our understanding of the pathophysiology have highlighted novel potential therapeutic targets. The aim of this review is to discuss the etiology, epidemiology, risk factors, clinical manifestations, recently disclosed pathogenic mechanisms underlying RP and their correlation with the available therapeutic options, focusing primarily on pRP and CTD-RP. Copyright © 2014 Elsevier B.V. All rights reserved.

  14. Minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) in total hip arthroplasty (THA) patients 1 year postoperatively

    DEFF Research Database (Denmark)

    Paulsen, Aksel; Roos, Ewa M.; Pedersen, Alma B;

    2013-01-01

    Background and purpose - The increased use of patient-reported outcomes (PROs) in orthopedics requires data on estimated minimal clinically important improvements (MCIIs) and patient-acceptable symptom states (PASSs). We wanted to find cut-points corresponding to minimal clinically important PRO ...

  15. Comparisons between the attitudes of medical and dental students toward the clinical importance of gross anatomy and physiology.

    Science.gov (United States)

    Olowo-Ofayoku, Anthony; Moxham, Bernard John

    2014-10-01

    Marked changes are occurring within both the medical and dental curricula and new ways of teaching the basic sciences have been devised and traditional methods (e.g., dissection for gross anatomy and of bench-based animal preparations for physiology) are increasingly no longer the norm. Although there is much anecdotal evidence that students are not in favor of such changes, there is little evidence for this based on quantitative analyses of students' attitudes. Using Thurstone and Chave attitude analyses, we assessed the attitudes of first year medical and dental students at Cardiff University toward gross anatomy and physiology in terms of their perceived clinical importance. In addition, we investigated the appropriateness ("fitness for purpose") of teaching methodologies used for anatomy and physiology. The hypotheses tested recognized the possibility that medical and dental students differed in their opinions, but that they had a preference to being taught gross anatomy through the use of dissection and had no preference for physiology teaching. It was found that both medical and dental students displayed positive attitudes toward the clinical relevance of gross anatomy and that they preferred to be taught by means of dissection. Although both medical and dental students displayed positives attitudes toward the clinical relevance of physiology, this was greater for the medical students. Both medical and dental students showed a preference for being taught physiology through didactic teaching in small groups but the medical students also appreciated being taught by means of practicals. Overall, this study highlights the expectations that students have for the basic science foundation teaching within their professional training and signals a preference for being taught experientially/practically. Differences were discerned between medical and dental students that might reflect the direct association between systems physiology and pathophysiology and the

  16. Assessment of first-year veterinary students' communication skills using an objective structured clinical examination: the importance of context.

    Science.gov (United States)

    Hecker, Kent G; Adams, Cindy L; Coe, Jason B

    2012-01-01

    Communication skills are considered to be a core clinical skill in veterinary medicine and essential for practice success, including outcomes of care for patients and clients. While veterinary schools include communication skills training in their programs, there is minimal knowledge on how best to assess communication competence throughout the undergraduate program. The purpose of this study was to further our understanding of the reliability, utility, and suitability of a communication skills Objective Structured Clinical Examination (OSCE). Specifically we wanted to (1) identify the greatest source of variability (student, rater, station, and track) within a first-year, four station OSCE using exam scores and scores from videotape review by two trained raters, and (2) determine the effect of different stations on students' communication skills performance. Reliability of the scores from both the exam data and the two expert raters was 0.50 and 0.46 respectively, with the greatest amount of variance attributable to student by station. The percentage of variance due to raters in the exam data was 16.35%, whereas the percentage of variance for the two expert raters was 0%. These results have three important implications. First, the results reinforce the need for communication educators to emphasize that use of communication skills is moderated by the context of the clinical interaction. Second, by increasing rater training the amount of error in the scores due to raters can be reduced and inter-rater reliability increases. Third, the communication assessment method (in this case the OSCE checklist) should be built purposefully, taking into consideration the context of the case.

  17. Florid cemento-osseous dysplasia: review of an uncommon fibro-osseous lesion of the jaw with important clinical implications.

    Science.gov (United States)

    Fenerty, Sarah; Shaw, Wei; Verma, Rahul; Syed, Ali B; Kuklani, Riya; Yang, Jie; Ali, Sayed

    2017-05-01

    Florid cemento-osseous dysplasia (FCOD) is a rare, benign, multifocal fibro-osseous dysplastic process affecting tooth-bearing areas of the jaw, characterized by replacement of normal trabecular bone with osseous tissue and dense acellular cementum in a fibrous stroma. It is one clinicopathologic variant in a spectrum of related non-neoplastic fibro-osseous lesions known as cemento-osseous dysplasias (CODs), thought to arise from elements of the periodontal ligament. Diagnosis primarily relies upon radiographic and clinical findings; unnecessary biopsy should be avoided, as inoculation with oral pathogens may precipitate chronic infection in these hypovascular lesions. Appropriate management of uncomplicated FCOD consists of periodic radiographic follow-up. Accordingly, it is important that both radiologists and clinicians performing endodontic interventions possess familiarity with this entity in order to prevent misdiagnosis and inappropriate intervention, which may result in a protracted clinical course. Lesions are usually asymptomatic in the absence of infection, typically discovered on routine dental radiographs or imaging performed for unrelated indications. Radiographically, the condition typically manifests as widespread non-expansile intraosseous masses of varying internal lucency and sclerosis that surround the root apices of vital teeth or edentulous areas in the posterior jaw. While all CODs share similar microscopic features, FCOD is distinguished by its multifocal distribution, involving two or more quadrants of the maxilla and mandible, often in a bilateral symmetric fashion. The vast majority of cases are sporadic, though few exhibit an autosomal dominant familial inheritance pattern. In this pictorial review, we discuss the radiologic characteristics of this entity, pertinent clinical and histologic features, differential diagnoses, and management options.

  18. [Serum uric acid is associated with disease severity and an important predictor for clinical outcome in patients with pulmonary hypertension].

    Science.gov (United States)

    Luo, D L; Zhang, C J; Huang, Y G; Huang, T; Li, H Z

    2017-06-24

    Objective: The growing body of literature showed a link between uric acid and pulmonary hypertension (PH), but the impact of hyperuremia on outcome of patients with PH has not been well defined. Therefore, the present study was performed to analyze the impact of uric acid on outcome of PH patients. Methods: One hundred seventy-three PH patients (112 females, mean age 38 years old), who were hospitalized in our department between January 2010 and December 2015, were included in our study, the PH diagnosis was made based on right heart catheterization examination result (mean pulmonary artery pressure≥25 mmHg(1 mmHg=0.133 kPa)). PH patients were divided into mild to moderate PH group (Rp/Rs≤0.6, n=97) and severe PH group (Rp/Rs>0.6, n=76). Fifty-one patients (33 females, mean age 45 years old) without PH based on right heart catheterization were included as control subjects. All participants were followed up for a median of 24 months(6-71 months). Clinical endpoints were defined as cardiogenic death or heart-and-lung transplantation. Results: Uric acid was positively correlated with pulmonary vascular resistance(r=0.398, Puric acid level was significantly higher in patients with severe PH than in patients with mild-to-moderate PH and the control subjects (both Puric acid level to predict the outcome of PH patients (sensitivity 50%, specificity 72%). During follow-up, patients with higher level of uric acid (>425.5 μmol/L) were linked with poorer clinical outcome compared to patients with uric acid uric acid is associated with the severity of PH and higher uric acid level serves as an important predictor for poor clinical outcome of PH patients.

  19. Importance of epigenetic changes in cancer etiology, pathogenesis, clinical profiling, and treatment: what can be learned from hematologic malignancies?

    Science.gov (United States)

    Vecchio, Lorella; Seke Etet, Paul Faustin; Kipanyula, Maulilio John; Krampera, Mauro; Nwabo Kamdje, Armel Hervé

    2013-08-01

    Epigenetic alterations represent a key cancer hallmark, even in hematologic malignancies (HMs) or blood cancers, whose clinical features display a high inter-individual variability. Evidence accumulated in recent years indicates that inactivating DNA hypermethylation preferentially targets the subset of polycomb group (PcG) genes that are regulators of developmental processes. Conversely, activating DNA hypomethylation targets oncogenic signaling pathway genes, but outcomes of both events lead in the overexpression of oncogenic signaling pathways that contribute to the stem-like state of cancer cells. On the basis of recent evidence from population-based, clinical and experimental studies, we hypothesize that factors associated with risk for developing a HM, such as metabolic syndrome and chronic inflammation, trigger epigenetic mechanisms to increase the transcriptional expression of oncogenes and activate oncogenic signaling pathways. Among others, signaling pathways associated with such risk factors include pro-inflammatory nuclear factor κB (NF-κB), and mitogenic, growth, and survival Janus kinase (JAK) intracellular non-receptor tyrosine kinase-triggered pathways, which include signaling pathways such as transducer and activator of transcription (STAT), Ras GTPases/mitogen-activated protein kinases (MAPKs)/extracellular signal-related kinases (ERKs), phosphatidylinositol 3-kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR), and β-catenin pathways. Recent findings on epigenetic mechanisms at work in HMs and their importance in the etiology and pathogenesis of these diseases are herein summarized and discussed. Furthermore, the role of epigenetic processes in the determination of biological identity, the consequences for interindividual variability in disease clinical profile, and the potential of epigenetic drugs in HMs are also considered.

  20. [Paradoxical kinesis phenomenon in focal hand dystonia--writer's cramp].

    Science.gov (United States)

    Shavlovskaia, O A; Orlova, O R; Golubev, V L

    2005-01-01

    Paradoxical kinesis (PK) phenomenon and its variants, exerting a beneficial influence on dystonia dynamics, are described using self clinical examination of 57 writer's cramp patients. PK was found in all the patients independently of writer's cramp variant, duration and severity. The most frequent writing maneuvers were as follows: hand printed (100%), proximal arm muscles writing (82.5%), individually selected writing instrument (67.5-80%), unusual means (67.5-75%), writing imitation with unlike-pen object (70%), marked papers (52.5%). The beneficial influence of PK phenomenon on dystonia expression may be considered as one of the directions of writer's cramp rehabilitation.

  1. Monostotic fibrous dysplasia with Raynaud's phenomenon.

    Science.gov (United States)

    Kumar, K V S Hari; Aravinda, K; Narayanan, K

    2015-01-01

    Fibrous dysplasia (FD) is a benign bone disorder characterized by alteration in bone morphology. Monostotic FD is the commonest variant and affects the craniofacial bones. Raynaud's phenomenon is recurrent vasospasm of the fingers and toes due to cold exposure. The disease is usually idiopathic or secondary to connective tissue disorders. Raynaud's phenomenon is not described previously with FD. We recently encountered two interesting patients of craniofacial monostotic FD with Raynaud's phenomenon and report the same in this report.

  2. Population of antithyroid autoantibodies as a source of antibodies of various levels of specificity and functionality: the clinical importance of a phenomenon of combination theory at monitoring of patients with autoimmune diseases of a thyroid gland

    Directory of Open Access Journals (Sweden)

    A V Andreeva

    2011-06-01

    Full Text Available The review of literature is dedicated to comparative analysis of pathogenetic and clinicodiagnostic significance of antithyroid autoantibodies (autoAB differing in their specificity (АB to thyroglobulin (anti-TG and АB to thyroid peroxidase (anti-TPO, anti-TGPO, and functionality TG- and TPO-antibodies, namely antibodies-proteases in pathogenesis autoimmune diseases thyroid gland and possibility of their use in modern diagnostics of autoimmune thyroid diseases.

  3. Statistical Agent Based Modelization of the Phenomenon of Drug Abuse

    Science.gov (United States)

    di Clemente, Riccardo; Pietronero, Luciano

    2012-07-01

    We introduce a statistical agent based model to describe the phenomenon of drug abuse and its dynamical evolution at the individual and global level. The agents are heterogeneous with respect to their intrinsic inclination to drugs, to their budget attitude and social environment. The various levels of drug use were inspired by the professional description of the phenomenon and this permits a direct comparison with all available data. We show that certain elements have a great importance to start the use of drugs, for example the rare events in the personal experiences which permit to overcame the barrier of drug use occasionally. The analysis of how the system reacts to perturbations is very important to understand its key elements and it provides strategies for effective policy making. The present model represents the first step of a realistic description of this phenomenon and can be easily generalized in various directions.

  4. Statistical Agent Based Modelization of the Phenomenon of Drug Abuse

    CERN Document Server

    Di Clemente, Riccardo; 10.1038/srep00532

    2012-01-01

    We introduce a statistical agent based model to describe the phenomenon of drug abuse and its dynamical evolution at the individual and global level. The agents are heterogeneous with respect to their intrinsic inclination to drugs, to their budget attitude and social environment. The various levels of drug use were inspired by the professional description of the phenomenon and this permits a direct comparison with all available data. We show that certain elements have a great importance to start the use of drugs, for example the rare events in the personal experiences which permit to overcame the barrier of drug use occasionally. The analysis of how the system reacts to perturbations is very important to understand its key elements and it provides strategies for effective policy making. The present model represents the first step of a realistic description of this phenomenon and can be easily generalized in various directions.

  5. Biomechanics of the press-fit phenomenon in dental implantology: an image-based finite element analysis

    OpenAIRE

    Frisardi Gianni; Barone Sandro; Razionale Armando V; Paoli Alessandro; Frisardi Flavio; Tullio Antonio; Lumbau Aurea; Chessa Giacomo

    2012-01-01

    Abstract Background A fundamental pre-requisite for the clinical success in dental implant surgery is the fast and stable implant osseointegration. The press-fit phenomenon occurring at implant insertion induces biomechanical effects in the bone tissues, which ensure implant primary stability. In the field of dental surgery, the understanding of the key factors governing the osseointegration process still remains of utmost importance. A thorough analysis of the biomechanics of dental implanto...

  6. Telescoping phenomenon in pathological gambling

    DEFF Research Database (Denmark)

    Grant, Jon E; Odlaug, Brian Lawrence; Mooney, Marc E

    2012-01-01

    The course of pathological gambling (PG) in women has been described as having a later age of initiation but a shorter time to problematic gambling ("telescoped"). This study examined evidence for telescoping and its relationship with comorbidities. Seventy-one treatment-seeking individuals with PG...... underwent a diagnostic interview to examine gambling behaviors, age at initiation of gambling, and time from initiation to meeting criteria for PG. The women had a higher mean age at gambling initiation compared with that of the men (mean [SD] age, 31.3 [13.0] years, compared with 22.4 [7.9] years; p = 0...... and suggests a need for greater clinical focus on the gender differences of gambling behavior....

  7. The importance of central corneal thickness measurements and decision making in general ophthalmology clinics: a masked observational study

    Directory of Open Access Journals (Sweden)

    Mollan Susan P

    2008-01-01

    Full Text Available Abstract Background To assess the impact of knowing central corneal thickness (CCT on glaucoma management in a United Kingdom district general hospital. Methods A masked observational non-interventional study included 304 eyes of 152 consecutive glaucoma cases attending general clinic. CCT was measured using a hand-held pachymeter. IOP, as measured by the Goldmann applanation tonometer (GAT, was adjusted for CCT using a normogram. Two identical study sheets were retrospectively constructed from each subject's case notes: one included the CCT and adjusted IOP information, the other excluded. Study sheets were randomly presented to a single masked observer to decide glaucoma management. The difference in management decision was noted. Results The mean ± standard deviation CCT was 561.5 ± 35.7 μm, 538.9 ± 41.4 μm, 538.3 ± 40.3 μm for ocular hypertension (OHT, primary open angle glaucoma (POAG and normal pressure glaucoma (NPG subjects respectively. IOP adjustment was greater than ±2 mmHg in 33.9%(103/304 of eyes. CCT and adjusted IOP information led to different treatment option in 37%(55/152. Of the most important changes 20.4%(31/152 cases would have been commenced on additional IOP-lowering medication, 2.0%(3/152 would have been counselled for trabeculectomy surgery and 3.3%(5/152 of the cohort would have been observed rather than treated. Conclusion CCT and adjusted IOP measurement can influence glaucoma management in a clinical context. It helps attribute risk and hence aids patient management decisions.

  8. Minimal Clinically Important Difference in Parkinson’s Disease as Assessed in Pivotal Trials of Pramipexole Extended Release

    Directory of Open Access Journals (Sweden)

    Robert A. Hauser

    2014-01-01

    Full Text Available Background. The minimal clinically important difference (MCID is the smallest change in an outcome measure that is meaningful for patients. Objectives. To calculate the MCID for Unified Parkinson’s Disease Rating Scale (UPDRS scores in early Parkinson’s disease (EPD and for UPDRS scores and “OFF” time in advanced Parkinson’s disease (APD. Methods. We analyzed data from two pivotal, double-blind, parallel-group trials of pramipexole ER that included pramipexole immediate release (IR as an active comparator. We calculated MCID as the mean change in subjects who received active treatment and rated themselves “a little better” on patient global impression of improvement (PGI-I minus the mean change in subjects who received placebo and rated themselves unchanged. Results. MCIDs in EPD (pramipexole ER, pramipexole IR for UPDRS II were −1.8 and −2.0, for UPDRS III −6.2 and −6.1, and for UPDRS II + III −8.0 and −8.1. MCIDs in APD for UPDRS II were −1.8 and −2.3, for UPDRS III −5.2 and −6.5, and for UPDRS II + III −7.1 and −8.8. MCID for “OFF” time (pramipexole ER, pramipexole IR was −1.0 and −1.3 hours. Conclusions. A range of MCIDs is emerging in the PD literature that provides the basis for power calculations and interpretation of clinical trials.

  9. Terrorism as a Social and Legal Phenomenon

    Science.gov (United States)

    Serebrennikova, Anna; Mashkova, Yekaterina

    2017-01-01

    This article examines the concept of terrorism as a social and legal phenomenon, its international legal and criminal-legal characteristics. Highlighted are the main aspects of cooperation of the states and the international community to counter terrorist activities. Terrorism as a social phenomenon is determined by paragraph 1 of article 3 of the…

  10. Clinical importance and representation of toxigenic and non-toxigenic Clostridium difficile cultivated from stool samples of hospitalized patients

    Directory of Open Access Journals (Sweden)

    Predrag Stojanovic

    2012-03-01

    Full Text Available The aim of this study was to fortify the clinical importance and representation of toxigenic and non-toxigenic Clostridium difficile isolated from stool samples of hospitalized patients. This survey included 80 hospitalized patients with diarrhea and positive findings of Clostridium difficile in stool samples, and 100 hospitalized patients with formed stool as a control group. Bacteriological examination of a stool samples was conducted using standard microbiological methods. Stool sample were inoculated directly on nutrient media for bacterial cultivation (blood agar using 5% sheep blood, Endo agar, selective Salmonella Shigella agar, Selenite-F broth, CIN agar and Skirrow's medium, and to selective cycloserine-cefoxitin-fructose agar (CCFA (Biomedics, Parg qe tehnicologico, Madrid, Spain for isolation of Clostridium difficile. Clostridium difficile toxin was detected by ELISA-ridascreen Clostridium difficile Toxin A/B (R-Biopharm AG, Germany and ColorPAC ToxinA test (Becton Dickinson, USA. Examination of stool specimens for the presence of parasites (causing diarrhea was done using standard methods (conventional microscopy, commercial concentration test Paraprep S Gold kit (Dia Mondial, France and RIDA®QUICK Cryptosporidium/Giardia Combi test (R-Biopharm AG, Germany. Examination of stool specimens for the presence of fungi (causing diarrhea was performed by standard methods. All stool samples positive for Clostridium difficile were tested for Rota, Noro, Astro and Adeno viruses by ELISA - ridascreen (R-Biopharm AG, Germany. In this research we isolated 99 Clostridium difficile strains from 116 stool samples of 80 hospitalized patients with diarrhea. The 53 (66.25% of patients with diarrhea were positive for toxins A and B, one (1.25% were positive for only toxin B. Non-toxigenic Clostridium difficile isolated from samples of 26 (32.5% patients. However, other pathogenic microorganisms of intestinal tract cultivated from samples of 16 patients

  11. MOBBING PHENOMENON - FACTORS OF DISCRIMINATION AND STRESS

    Directory of Open Access Journals (Sweden)

    ROMANESCU MARCEL LAURENTIU

    2017-02-01

    Full Text Available This article focuses on exemplifying the features of discrimination phenomenon in the workplace, a phenomenon that has appeared in the Romanian social studies only in the last 4 years. Mobbing phenomenon has been analyzed by several countries in Europe such as England, France, Germany; after these analyzes it has been found that this phenomenon refers only to actions of intense psychological pressure. Actions are geared to a single employee, in order to cause it to leave its job. Without these measures, dismissal of the employee would lead to numerous legal problems on the employer. In conclusion, employee who is the subject of mobbing phenomenon must endure a long period of time a series of injustices focused on himself, but also extremely high humiliation, which determines him to mentally give up and take the decision to resign.

  12. Electromagnetic Fields and Bioenergy Phenomenon

    Directory of Open Access Journals (Sweden)

    İlhan Koşalay

    2014-08-01

    Full Text Available Electromagnetic energy is defined in the large frequency range and it shows its existence in different manners for every frequency range. When considering history of mankind, discovery of the electricity and presence of electrical and electronics based equipments is not very old. Human beings are exposed to electromagnetic fields and waves which they aren't used to live with those fields for ages. In this connection, lots of studies were done for the thesis of that these fields can produce harmful effects on people. Although results of the studies which were done in this area point out important subjects, sufficient outputs and judgments haven't been appeared yet in general meaning. This study was done to introduce findings which support that electromagnetic energy in some frequency can have beneficial effects on the living being.

  13. Ischemic pain in the extremities and Raynaud's phenomenon.

    NARCIS (Netherlands)

    Devulder, J.; Suijlekom, H. van; Dongen, R.T.M. van; Diwan, S.; Mekhail, N.; Kleef, M. van; Huygen, F.

    2011-01-01

    Two important groups of disorders result from an insufficient blood supply to the extremities: critical vascular disease and the Raynaud's phenomenon. The latter can be subdivided into a primary and a secondary type. Critical ischemic disease is often caused by arteriosclerosis due to hypertension o

  14. Importância da avaliação genético-clínica na hidrocefalia Importance of the clinical genetics evaluation on hydrocephalus

    Directory of Open Access Journals (Sweden)

    Marta Wey-Vieira

    2004-06-01

    hydrocephalus and reinforce the importance of dysmphology evaluation as an important complementary investigation.

  15. Urban riverine environment is a source of multidrug-resistant and ESBL-producing clinically important Acinetobacter spp.

    Science.gov (United States)

    Maravić, Ana; Skočibušić, Mirjana; Fredotović, Željana; Šamanić, Ivica; Cvjetan, Svjetlana; Knezović, Mia; Puizina, Jasna

    2016-02-01

    Some Acinetobacter species have emerged as very important opportunistic pathogens in humans. We investigated Acinetobacter spp. from the polluted urban riverine environment in Croatia in regard to species affiliation, antibiotic resistance pattern, and resistance mechanisms. Considerable number of isolates produced acquired extended-spectrum β-lactamase(s) (ESBLs), CTX-M-15 solely or with TEM-116. By Southern blot hybridization, bla TEM-116 was identified on plasmids ca. 10, 3, and 1.2 kb in Acinetobacter junii, A. gandensis, and A. johnsonii. The bla TEM-116-carrying plasmid in A. gandensis was successfully transferred by conjugation to azide-resistant Escherichia coli J53. A. radioresistens isolate also carried an intrinsic carbapenemase gene bla OXA-133 with ISAba1 insertion sequence present upstream to promote its expression. Majority of ESBL-producing isolates harbored integrases intI1 and/or intI2 and the sulfamethoxazole resistance gene sul1. Almost all isolates had overexpressed resistance-nodulation-cell division (RND) efflux system, indicating that this mechanism may have contributed to multidrug resistance phenotypes. This is the first report of environmental CTX-M-15-producing Acinetobacter spp. and the first identification of CTX-M-15 in A. johnsonii, A. junii, A. calcoaceticus, A. gandensis, A. haemolyticus, and A. radioresistens worldwide. We identified, also for the first time, the environmental Acinetobacter-producing TEM ESBLs, highlighting the potential risk for human health, and the role of these bacteria in maintenance and dissemination of clinically important antibiotic resistance genes in community through riverine environments.

  16. The nociceptin receptor (NOPR) and its interaction with clinically important agonist molecules: a membrane molecular dynamics simulation study.

    Science.gov (United States)

    Kothandan, Gugan; Gadhe, Changdev G; Balupuri, Anand; Ganapathy, Jagadeesan; Cho, Seung Joo

    2014-12-01

    The nociceptin receptor (NOPR) is an orphan G protein-coupled receptor that contains seven transmembrane helices. NOPR has a distinct mechanism of activation, though it shares a significant homology with other opioid receptors. Previously there have been reports on homology modeling of NOPR and also molecular dynamics simulation studies for a short period. Recently the crystal structure of NOPR was reported. In this study, we analyzed the time dependent behavior of NOPR docked with clinically important agonist molecules such as NOP (natural agonist) peptide and compound 10 (SCH-221510 derivative) using molecular dynamics simulations (MDS) for 100 ns. Molecular dynamics simulations of NOPR-agonist complexes allowed us to refine the system and to also identify stable structures with better binding modes. Structure activity relationships (SAR) for SCH221510 derivatives were investigated and reasons for the activities of these derivatives were determined. Our molecular dynamics trajectory analysis of NOPR-peptide and NOPR-compound 10 complexes found residues to be crucial for binding. Mutagenesis studies on the residues identified from our analysis could prove useful. Our results could also provide useful information in the structure-based drug design of novel and potent agonists targeting NOPR.

  17. Chiral separation of the clinically important compounds fucose and pipecolic acid using CE: determination of the most effective chiral selector.

    Science.gov (United States)

    Hadjistasi, Christoforos A; Stavrou, Ioannis J; Stefan-Van Staden, Raluca-Ioana; Aboul-Enein, Hassan Y; Kapnissi-Christodoulou, Constantina P

    2013-09-01

    In this study, simple electrophoretic methods were developed for the chiral separation of the clinically important compounds fucose and pipecolic acid. In recent years, these analytes, and particularly their individual enantiomers, have attracted considerable attention due to their role in biological functions and disorders. The detectability and sensitivity of pipecolic acid and fucose were improved by reacting them with fluorenylmethyloxycarbonyl chloride (FMOC-Cl) and 5-amino-2-naphthalene-sulfonic acid (ANSA), respectively. The enantioseparation conditions were optimized by initially investigating the type of the chiral selector. Different chiral selectors, such as polymeric surfactants and cyclodextrins, were used and the most effective ones were determined with regard to resolution and analysis time. A 10-mM β-cyclodextrin was able to separate the enantiomers of ANSA-DL-fucose and the polymeric surfactant poly(sodium N-undecanoyl-LL-leucine-valinate) was able to separate the enantiomers of FMOC-DL-pipecolic acid, with resolution values of 3.45 and 2.78, respectively. Additional parameters, such as the concentration and the pH of the background electrolyte (BGE), the concentration of the chiral selector, and the addition of modifiers were examined in order to optimize the separations. The addition of the chiral ionic liquid D-alanine tert-butyl ester lactate into the BGE was also investigated, for the first time, in order to improve resolution of the enantiomers.

  18. The AGN phenomenon: open issues

    CERN Document Server

    Beckmann, Volker

    2013-01-01

    The aim of this short paper is to motivate and encourage research in the field of Active Galactic Nuclei (AGN). Here we summarize the main open questions concerning the central engine. Is the central black hole rapidly spinning and can we prove this? What is the dominant accretion mechanism in AGN? Why do some AGN form jets while others don't and how do the jets originate? What keeps jets collimated out to distances of 100 kpc? Is the emission of blazars dominated rather by synchrotron self-Compton or by external Compton processes? Which parameters are important in the unified model? We outline the status of related research, formulate the questions and try to hint at research projects able to tackle these fundamental topics. Deep surveys, polarization measurements, improved models, faster and more accurate simulations as well as bridging the gap in the MeV range can be part of the tools to bring us closer to an understanding of AGN.

  19. A generalized analytic solution to the win ratio to analyze a composite endpoint considering the clinical importance order among components.

    Science.gov (United States)

    Dong, Gaohong; Li, Di; Ballerstedt, Steffen; Vandemeulebroecke, Marc

    2016-09-01

    A composite endpoint consists of multiple endpoints combined in one outcome. It is frequently used as the primary endpoint in randomized clinical trials. There are two main disadvantages associated with the use of composite endpoints: a) in conventional analyses, all components are treated equally important; and b) in time-to-event analyses, the first event considered may not be the most important component. Recently Pocock et al. (2012) introduced the win ratio method to address these disadvantages. This method has two alternative approaches: the matched pair approach and the unmatched pair approach. In the unmatched pair approach, the confidence interval is constructed based on bootstrap resampling, and the hypothesis testing is based on the non-parametric method by Finkelstein and Schoenfeld (1999). Luo et al. (2015) developed a close-form variance estimator of the win ratio for the unmatched pair approach, based on a composite endpoint with two components and a specific algorithm determining winners, losers and ties. We extend the unmatched pair approach to provide a generalized analytical solution to both hypothesis testing and confidence interval construction for the win ratio, based on its logarithmic asymptotic distribution. This asymptotic distribution is derived via U-statistics following Wei and Johnson (1985). We perform simulations assessing the confidence intervals constructed based on our approach versus those per the bootstrap resampling and per Luo et al. We have also applied our approach to a liver transplant Phase III study. This application and the simulation studies show that the win ratio can be a better statistical measure than the odds ratio when the importance order among components matters; and the method per our approach and that by Luo et al., although derived based on large sample theory, are not limited to a large sample, but are also good for relatively small sample sizes. Different from Pocock et al. and Luo et al., our approach is a

  20. Measurement of cold challenge responses in primary Raynaud's phenomenon and Raynaud's phenomenon associated with systemic sclerosis.

    OpenAIRE

    O'Reilly, D; Taylor, L.; el-Hadidy, K; Jayson, M I

    1992-01-01

    Using computed thermography continuous temperature recordings were made before and after cold challenge of the fingers of control subjects and patients with primary Raynaud's phenomenon and Raynaud's phenomenon associated with systemic sclerosis. Basal skin temperature measurements (Tpre) were significantly lower in patients with primary Raynaud's phenomenon and Raynaud's phenomenon associated with systemic sclerosis than in the controls. Temperatures immediately after cold challenge (T0) wer...

  1. The likelihood of reaching minimum clinically important difference and substantial clinical benefit at 2 years following a 3-column osteotomy: analysis of 140 patients.

    Science.gov (United States)

    Fakurnejad, Shayan; Scheer, Justin K; Lafage, Virginie; Smith, Justin S; Deviren, Vedat; Hostin, Richard; Mundis, Gregory M; Burton, Douglas C; Klineberg, Eric; Gupta, Munish; Kebaish, Khaled; Shaffrey, Christopher I; Bess, Shay; Schwab, Frank; Ames, Christopher P

    2015-09-01

    Three-column osteotomies (3COs) are technically challenging techniques for correcting severe rigid spinal deformities. The impact of these interventions on outcomes reaching minimum clinically important difference (MCID) or substantial clinical benefit (SCB) is unclear. The objective of this study was to determine the rates of MCID and SCB in standard health-related quality of life (HRQOL) measures after 3COs in patients with adult spinal deformity (ASD). The impacts of location of the uppermost instrumented vertebra (UIV) on clinical outcomes and of maintenance on sagittal correction at 2 years postoperatively were also examined. The authors conducted a retrospective multicenter analysis of the records from adult patients who underwent 3CO with complete 2-year radiographic and clinical follow-ups. Cases were categorized according to established radiographic thresholds for pelvic tilt (> 22°), sagittal vertical axis (> 4.7 cm), and the mismatch between pelvic incidence and lumbar lordosis (> 11°). The cases were also analyzed on the basis of a UIV in the upper thoracic (T1-6) or thoracolumbar (T9-L1) region. Patient-reported outcome measures evaluated preoperatively and 2 years postoperatively included Oswestry Disability Index (ODI) scores, the Physical Component Summary and Mental Component Summary (MCS) scores of the 36-Item Short Form Health Survey, and Scoliosis Research Society-22 questionnaire (SRS-22) scores. The percentages of patients whose outcomes for these measures met MCID and SCB were compared among the groups. Data from 140 patients (101 women and 39 men) were included in the analysis; the average patient age was 57.3 ± 12.4 years (range 20-82 years). Of these patients, 94 had undergone only pedicle subtraction osteotomy (PSO) and 42 only vertebral column resection (VCR); 113 patients had a UIV in the upper thoracic (n = 63) orthoracolumbar region (n = 50). On average, 2 years postoperatively the patients had significantly improved in all HRQOL

  2. Self-fulfilling prophecy: the phenomenon and its implications

    Directory of Open Access Journals (Sweden)

    Simona Gomboc

    2011-08-01

    Full Text Available The article presents the phenomenon of self-fulfilling prophecy and provides some critical thoughts about the possibilities of using it constructively as well as preventing its possible detrimental effects. The phenomenon is first presented historicaly: from the first definition by Merton, through Rosenthal's classical Pygmalion study that brought the topic into social psychology, to an analysis of the extremeness of both positive and negative reactions that the study spawned. This is followed by an overview of modern research regarding the existence of self-fulfilling prophecy; its magnitude, practical importance, and prevalence. Then, Rosenthal's Ten-arrow model and Four-factor theory that aim to explain the factors and mechanism of self-fulfilling prophecy are described. The presentation is completed by an analysis of cultural-historical as well as paradigmatic context that importantly contributed to the importance of self-fulfilling prophecy research in social psychology. In conclusion, some possibilities for diminishing the prevalence of the phenomenon are presented. In regard to this, the role of awareness is especially emphasized, both in the sense of being aware of phenomenon's existence as well as in the sense of understanding its workings.

  3. Measuring surgical outcomes in cervical spondylotic myelopathy patients undergoing anterior cervical discectomy and fusion: assessment of minimum clinically important difference.

    Directory of Open Access Journals (Sweden)

    Brenda M Auffinger

    Full Text Available OBJECT: The concept of minimum clinically important difference (MCID has been used to measure the threshold by which the effect of a specific treatment can be considered clinically meaningful. MCID has previously been studied in surgical patients, however few studies have assessed its role in spinal surgery. The goal of this study was to assess the role of MCID in patients undergoing anterior cervical discectomy and fusion (ACDF for cervical spondylotic myelopathy (CSM. METHODS: Data was collected on 30 patients who underwent ACDF for CSM between 2007 and 2012. Preoperative and 1-year postoperative Neck Disability Index (NDI, Visual-Analog Scale (VAS, and Short Form-36 (SF-36 Physical (PCS and Mental (MCS Component Summary PRO scores were collected. Five distribution- and anchor-based approaches were used to calculate MCID threshold values average change, change difference, receiver operating characteristic curve (ROC, minimum detectable change (MDC and standard error of measurement (SEM. The Health Transition Item of the SF-36 (HTI was used as an external anchor. RESULTS: Patients had a significant improvement in all mean physical PRO scores postoperatively (p<0.01 NDI (29.24 to 14.82, VAS (5.06 to 1.72, and PCS (36.98 to 44.22. The five MCID approaches yielded a range of values for each PRO: 2.00-8.78 for PCS, 2.06-5.73 for MCS, 4.83-13.39 for NDI, and 0.36-3.11 for VAS. PCS was the most representative PRO measure, presenting the greatest area under the ROC curve (0.94. MDC values were not affected by the choice of anchor and their threshold of improvement was statistically greater than the chance of error from unimproved patients. CONCLUSION: SF-36 PCS was the most representative PRO measure. MDC appears to be the most appropriate MCID method. When MDC was applied together with HTI anchor, the MCID thresholds were: 13.39 for NDI, 3.11 for VAS, 5.56 for PCS and 5.73 for MCS.

  4. [Phenomenon of polyembryony. Genetic heterogeneity of seeds].

    Science.gov (United States)

    Batygina, T B; Vinogradova, G Iu

    2007-01-01

    Different concepts of polyembryony and genetic heterogeneity of seeds in flower plants have been reviewed. Different types, ways, and forms of plant reproduction appeared in the course of evolution as a consequences of the attached mode of life and autotrophy. This is ascribed to totipotency, "stemminess" of plant cells, and presence of constantly functioning meristems, which determined to a great extent the system of plant safety. There are two ways of formation of a new individual: sexual process --> gamospermy involving meiosis and gamete fusion and asexual process --> agamospermy without meiosis and gamete fusion and two types of reproduction: seed and vegetative. Both processes may take place simultaneously in one seed, as a result of which many embryos of different origins are formed: uniparental and biparental inheritance. Traditionally, this phenomenon is called polyembryony. It comprises embryoidogeny (a new category of vegetative reproduction): formation of somatic embryos (= embryoids) in the flower, seed, and on vegetative organs. Genetic heterogeneity is one of the most important characteristics of seeds, which is based on different phenomena, such as embryogeny, embryoidogeny, and gametophytic and sporophytic apomixes. When describing two types of polyembryony, sporophytic (nucellar, integumental, cleavage) and gametophytic (synergidal, antipodal), a great attention is paid to characterization of initial cells of the sexual and adventive embryos. A new concept of apogamety is developed from new positions (totipotency and "stemminess"), which is based on different genesis of cells of the egg and antipodal systems. Five possible pathways of formation of the adventive embryos have been proposed from cells of the egg apparatus. Specific features of the formation of adventive embryos in the case of gametophytic apomixis, such as androgenesis and semigamy, are discussed. Morphogenesis of the sexual and adventive embryos proceeds in the mother organism and

  5. Laboratory diagnosis, clinical manifestations, epidemiological situation and public health importance of cutaneous leishmaniasis in Shushtar County, Southwestern Iran

    Institute of Scientific and Technical Information of China (English)

    Hamid Kassiri; Ali kassiri; Masoud Lotfi; Parvaneh Farajifard; Elnaz Kassiri

    2014-01-01

    Objective:To investigate as a descriptive and cross sectional study on epidemiology, the laboratory diagnosis and clinical manifestation ofCutaneousLeishmaniasis(CL) inShushtar County.Methods:The investigation was carried out on referrals from different districts of ShushtarCounty and was diagnosed based on their ulcer clinical manifestations withCL using laboratory method.This study was actively developed over the period of2008 to2010.Surface of a clean slide was pressed on to the scraped part of the lesions and moved along to produce a smear on the slide.The slides were fixed with methanol, stained with standardGiemsa, and examined carefully under high magnification for an hour or more to look for amastigotes by a trained person.Two smears were prepared and examined from each patient and data were collected using different correlative patients characteristics to analyze information.The essential records including residential area, type and location of lesion, age, sex, the number of ulcers, season, and the history of traveling to endemic areas for this disease were carefully gathered. Results:Parasites presumed to beLeishmania major (L. major) based on the existence of a large vacuole in the cytoplasm.Totally206 patients were referred to the central laboratory and their manifestation lesions were clinically examined.Of these,64 cases(31.1%) were female and142 cases(68.9%) were male.The findings documented that the rate of incidence ofCL was in fall61 cases(29/6%) and winter80 cases(38/8%), which is one of the most important characteristics of zoonoticCL.Sixty-eight cases(33%) had ulcers on hands,63 cases(30.6%) on feet and30 cases (14.6%) on hands and feet.A total of120 patients(58.3%) had only one ulcer.But70 cases(34%) had2 ulcers.The highest incidence was found among patients with two age groups of20-29 years old(43.2%) and10-19 years old(18%).The most cases resided in rural areas with164 cases(79.6%). Conclusions:Analyzing of the composed results revealed

  6. [A negative first-line work-up of Raynaud's phenomenon: And what if it were cancer?].

    Science.gov (United States)

    Auboire, L; Landy, S; Perrot, J-Y; Maïza, D; Le Hello, C

    2010-02-01

    Raynaud's phenomenon is a transient paroxysmal vasomotor phenomenon affecting the extremities including manifestations of ischemia. It is a common phenomenon in the general population. In a routine clinical situation, the first step is to differentiate Raynaud's disease from a secondary Raynaud's phenomenon, the latter requiring complementary investigations. We report here the case of an 80-year-old woman who presented a secondary Raynaud's phenomenon. First-line investigations remained negative. A mammography was performed and revealed breast cancer. Raynaud's phenomenon disappeared after treatment of the breast carcinoma and did not recur during the 2-year follow-up.

  7. New Lesions Detected by Single Nucleotide Polymorphism Array–Based Chromosomal Analysis Have Important Clinical Impact in Acute Myeloid Leukemia

    Science.gov (United States)

    Tiu, Ramon V.; Gondek, Lukasz P.; O'Keefe, Christine L.; Huh, Jungwon; Sekeres, Mikkael A.; Elson, Paul; McDevitt, Michael A.; Wang, Xiao Fei; Levis, Mark J.; Karp, Judith E.; Advani, Anjali S.; Maciejewski, Jaroslaw P.

    2009-01-01

    Purpose Cytogenetics is the primary outcome predictor in acute myeloid leukemia (AML). Metaphase cytogenetics (MC) detects an abnormal karyotype in only half of patients with AML, however. Single nucleotide polymorphism arrays (SNP-A) can detect acquired somatic uniparental disomy (UPD) and other cryptic defects, even in samples deemed normal by MC. We hypothesized that SNP-A will improve detection of chromosomal defects in AML and that this would enhance the prognostic value of MC. Patients and Methods We performed 250K and 6.0 SNP-A analyses on 140 patients with primary (p) and secondary (s) AML and correlated the results with clinical outcomes and Flt-3/nucleophosmin (NPM-1) status. Results SNP-A is more sensitive than MC in detecting unbalanced lesions (pAML, 65% v 39%, P = .002; and sAML, 78% v 51%, P = .003). Acquired somatic UPD, not detectable by MC, was common in our AML cohort (29% in pAML and 35% in sAML). Patients with SNP-A lesions including acquired somatic UPD exhibited worse overall survival (OS) and event-free survival (EFS) in pAML with normal MC and in pAML/sAML with abnormal MC. SNP-A improved the predictive value of Flt-3 internal tandem duplication/NPM-1 status, with inferior survival seen in patients with additional SNP-A defects. Multivariate analyses confirmed the independent predictive value of SNP-A defects for OS (hazard ratio [HR] = 2.52; 95% CI, 1.29 to 5.22; P = .006) and EFS (HR = 1.72; 95% CI, 1.12 to 3.48; P = .04). Conclusion SNP-A analysis allows enhanced detection of chromosomal abnormalities and provides important prognostic impact in AML. PMID:19770377

  8. The clinical importance of the thyroid nodules during anti-tumor necrosis factor therapy in patients with axial spondyloarthritis.

    Science.gov (United States)

    Terlemez, Rana; Akgün, Kenan; Palamar, Deniz; Boz, Sinan; Sarı, Hidayet

    2017-03-30

    The clinical importance of the thyroid nodules in patients with axial spondyloarthritis (ax-SpA) rests with the need to exclude thyroid malignancy. The aim of this study is to assess the risk of thyroid malignancy in ax-SpA patients receiving anti-TNF therapy. From September 2015 until December 2015, 70 patients diagnosed with ax-SpA were included in the research. Forty of the patients had received anti-TNF therapy, and 30 of the patients were anti-TNF naive. All cases were screened for the presence of nodules in the thyroid gland with ultrasound. Of the patients that received anti-TNF therapy, 15 (37.5%); and of the anti-TNF naive patients, 11 (36.7%) had thyroid nodule(s). Four patients from the anti-TNF group underwent fine needle aspiration biopsy of the nodules, and two of them were diagnosed with papillary thyroid carcinoma. None of the nodules in anti-TNF naive patients required biopsy. When compared to the normal population, the standardized incidence ratio (SIR) was found to be increased in both male (SIR 2.03, 95% CI 1.9 to 18) and female (SIR 2.7, 95% CI 2.6 to 24) cases. It is not yet established whether the development of cancer during the treatment process is the effect of the treatment or if it is a part of the natural course of the disease or if it is coincidental. We saw a mild increase in thyroid malignancies in ax-SpA patients who received anti-TNF therapy. Therefore, we believe that the thyroid gland should also be taken into consideration while screening for malignancy before anti-TNF therapy.

  9. A classical case of the Gasul phenomenon.

    Science.gov (United States)

    Sabnis, Girish R; Phadke, Milind S; Kerkar, Prafulla G

    2016-02-01

    This case demonstrates the development of secondary infundibular stenosis in a 10-year-old male child with documented large non-restrictive perimembranous ventricular septal defect in infancy - the classical Gasul phenomenon.

  10. Professor Nambu, String Theory and Moonshine Phenomenon

    CERN Document Server

    Eguchi, Tohru

    2016-01-01

    I first recall the last occasion of meeting the late Professor Yoichiro Nambu in a hospital in Osaka. I then present a brief introduction to the moonshine phenomenon in string theory which is under recent investigations.

  11. CHINCHIRISI: THE PHENOMENON OF "SPIRIT CHILDREN ...

    African Journals Online (AJOL)

    religio-cultural phenomenon a challenge to euthanasia, human rights and ..... Other ways for confinning these cases as chinchirisi include divination or ..... bound by its terms, but the international legal obligations assumed by a state under ...

  12. Partial fingertip necrosis following a digital surgical procedure in a patient with primary Raynaud's phenomenon.

    Science.gov (United States)

    Uygur, Safak; Tuncer, Serhan

    2014-12-01

    Raynaud's phenomenon is a common clinical disorder consisting of recurrent, long-lasting and episodic vasospasm of the fingers and toes often associated with exposure to cold. In this article, we present a case of partial fingertip necrosis following digital surgical procedure in a patient with primary Raynaud's phenomenon.

  13. Spatially discontinuous ionization phenomenon in inhomogeneous soil

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    By using X-ray film imaging technology,a phenomenon of discontinuous ionization was observed in the inhomogeneous soil around the grounding electrode on which a surge voltage was applied.A simplified two-phase solid-gas model was built to study the electric field distribution in the soil to explain the discontinuous ionization phenomenon.Analysis showed the differences of the dielectric properties,the shapes and sizes of soil particles can cause discontinuous ionization in the soil.

  14. Koebner phenomenon of the ear canal skin.

    LENUS (Irish Health Repository)

    Young, O

    2009-02-01

    The Koebner phenomenon originally described the appearance of psoriatic lesions in the uninvolved skin of patients with psoriasis as a consequence of trauma. We describe a case of concurrent lichen planus and sarcoidosis in the auditory canal, which represents an unusual manifestation of the Koebner phenomenon. This is the first case of concurrent lichen planus and sarcoidosis in the head and neck region and highlights the need for biopsy to allow accurate histopathological diagnosis and treatment.

  15. Koebner phenomenon of the ear canal skin.

    LENUS (Irish Health Repository)

    Young, O

    2012-02-01

    The Koebner phenomenon originally described the appearance of psoriatic lesions in the uninvolved skin of patients with psoriasis as a consequence of trauma. We describe a case of concurrent lichen planus and sarcoidosis in the auditory canal, which represents an unusual manifestation of the Koebner phenomenon. This is the first case of concurrent lichen planus and sarcoidosis in the head and neck region and highlights the need for biopsy to allow accurate histopathological diagnosis and treatment.

  16. Job Insecurity as a Social Psychological Phenomenon

    Directory of Open Access Journals (Sweden)

    Chuykova T.S.

    2015-12-01

    Full Text Available The paper addresses a relatively new phenomenon of job insecurity. It provides an analysis of the various interpretations of the phenomenon given by Russian and foreign researchers, focuses on its social economical determinants and consequences for individuals and organizations. The paper concludes with an outline of some possible ways of overcoming the negative consequences of job insecurity — as for individuals, as for organizations, as for the society as a whole.

  17. Validation of the Impostor Phenomenon among Managers.

    Science.gov (United States)

    Rohrmann, Sonja; Bechtoldt, Myriam N; Leonhardt, Mona

    2016-01-01

    Following up on earlier investigations, the present research aims at validating the construct impostor phenomenon by taking other personality correlates into account and to examine whether the impostor phenomenon is a construct in its own right. In addition, gender effects as well as associations with dispositional working styles and strain are examined. In an online study we surveyed a sample of N = 242 individuals occupying leadership positions in different sectors. Confirmatory factor analyses provide empirical evidence for the discriminant validity of the impostor phenomenon. In accord with earlier studies we show that the impostor phenomenon is accompanied by higher levels of anxiety, dysphoric moods, emotional instability, a generally negative self-evaluation, and perfectionism. The study does not reveal any gender differences concerning the impostor phenomenon. With respect to working styles, persons with an impostor self-concept tend to show perfectionist as well as procrastinating behaviors. Moreover, they report being more stressed and strained by their work. In sum, the findings show that the impostor phenomenon constitutes a dysfunctional personality style. Practical implications are discussed.

  18. Validation of the Impostor Phenomenon Among Managers

    Directory of Open Access Journals (Sweden)

    Sonja eRohrmann

    2016-06-01

    Full Text Available Following up on earlier investigations, the present research aims to validate the construct impostor phenomenon by taking personality correlates into account and to examine whether the impostor phenomenon is a construct in its own right. In addition, gender effects as well as effects on working style and stress or strain are examined. In an online study we surveyed a sample of N = 242 individuals occupying leadership positions in different sectors. Confirmatory factor analyses provide empirical evidence for the discriminant validity of the impostor phenomenon. In accord with earlier studies we show that the impostor phenomenon is accompanied by higher levels of anxiety, dysphoric moods, emotional instability and a generally negative self-evaluation. The study does not reveal any gender differences concerning the impostor phenomenon. With respect to working styles, persons with an impostor self-concept tend to show perfectionist as well as procrastinating behaviors. Moreover, they report being more stressed and strained by their work. In sum, the findings show that the impostor phenomenon constitutes a dysfunctional personality style. Practical implications are discussed.

  19. Early-phase of Clinical Phenomenon of Diabetes Caused by Clozapine in the Treatment of Schizophrenia%氯氮平治疗精神分裂症时引发糖尿病的前期临床特点

    Institute of Scientific and Technical Information of China (English)

    岳卫清; 姚明荣; 曹明; 袁天懿; 查显友; 夏江明

    2011-01-01

    目的 探讨抗精神病药物氯氮平引发糖尿病之前的临床特点.方法 采用临床开放研究,单一服用抗精神病药物氯氮平患者82例,每个月测定空腹血糖、餐后2 h血糖、三酰甘油(TG)、胆固醇(TC)、体质量、身高,计算体质量指数(BMI),采用国际体力活动短问卷(IPAQ-SF)评估患者的体力活动水平.观察1 a,发现糖尿病患者22例(糖尿病组),其余为未患糖尿病组60例,以发现糖尿病或研究结束为基线,对两组患者的相关监测指标进行分析.结果 糖尿病组和未患糖尿病组患者TG分别为2.95~3.94,1.93~2.31 mol·L-1,BMI分别为24.78~26.30,22.91~23.67(P<0.01);糖尿病组患者体力活动水平低于未患糖尿病组(P<0.01).结论 氯氮平引发糖尿病之前1 a就存在TG、BMI与体力活动水平的异常.%Objective To study the clinical features before development of diabetes caused by clozapine. Methods The clinical open surveys were used in 82 patients with schizophrenics who were given with clozapine only. The fasting plasma glucose,2 hours postprandial blood glucose, triglyceride( TG ), blood cholesterol( TC ), body weight, height, body mass index ( BMI ) were tested every month. The international physical activity questionnaire short form( IPAQ-SF ) was used to assess these patients' physical activity level. After one year follow-up ,22 patients were diagnosed as diabetes. The diagnosed diabetes or the end of study was regarded as baseline. the investigated indicators were analyzed. Results Triglyceride and BMI in both diabetes groups were 2.95 -3.94,1.93 -2.31 mol · L-1 and 24.78 -26.30,22.91-23.67, respectively( P<0.01 ), physical activity of the diabetes group was lower than that of the non-diabetes group( P<0.01 ). Conclusion Triglyceride, BMI and physical activity level were abnormal 1 a before diabetes caused by clozapine.

  20. Diagnosis of the nutcracker phenomenon by multislice helical computed tomography angiography

    Institute of Scientific and Technical Information of China (English)

    符伟军; 洪宝发; 肖越勇; 杨勇; 蔡伟; 高江平; 郭刚; 王晓雄

    2004-01-01

    @@ The nutcracker phenomenon refers to compression of the left renal vein between the aorta and the superior mesenteric artery, which results in renal venous hypertension and its clinical symptoms.1 This phenomenon is an unusual, but well-accepted cause of hematuria. As of now, it appears the nutcracker phenomenon is probably more common than previously suspected.2 To the best of our knowledge, however, there have been few trials investigating the use of multislice helical computed tomography angiography (CTA) of the renal vein along with measurements of the angles and distances between the aorta and the SMA in the diagnosis of the nutcracker phenomenon. The purpose of This work was to study the anatomic changes involved in the nutcracker phenomenon by comparing the vascular anatomy in patients with this phenomenon to that in healthy control subjects, and to assess the value of CTA in the diagnosis of this condition.

  1. 静脉肾盂造影在无症状血尿与胡桃夹现象的表现及其临床价值%Intravenous Pyelography in a Symptomatic Hematuria and presentation of phenomenon of nutcracker and its clinical value

    Institute of Scientific and Technical Information of China (English)

    牛克伟; 蔡曰新; 王立军

    2001-01-01

    目的为探讨无痛血尿的正确检查方法,研究胡桃夹现象的静脉肾盂造影(以下简称IVP)表现。方法选取13例无痛性血尿患者进行IVP检查并结合B超检查对比两者在无痛性血尿及胡桃夹现象的诊断价值。结果 13例患者中IVP表现异常考虑胡桃夹现象有6例,B超诊断7例(含IVP确诊的6例)。结论对无痛性血尿IVP既能排除泌尿系结石、结核、畸形、肿瘤等疾病,又能显示肾盂肾盏饱满、排空延迟等表现对胡桃夹现象提出参考诊断依据,结合B超、临床进一步确定诊断。%Objective To explore the correct method to examine painless hematuria,to study the phenomenon of nutcracker of representation of intravenous pyelography(IVP).Methods  13 patients with painless hematuria were conducted IVP,and combined with the examination of B ultrasound,and compared the diagnostic value between the painless hematuria and the phenomenon of nutcracker.Results In 13 patients,the IVP abnormalities apperaed the phenomenon of nutcracker in 6 patients,7 patients were diagnosed by B ultrasound (included 6 patients diagnosed by IVP).Conclusion For painless hematuria,the IVP can exclude the urethral concretion,tuberculosis,abnormalities,tumor etc,and show the fullness of renal calices,the manifestation of empty delayed,which provide a diagnostic base for the phenomenon of nutcracker,combined with B ultrasound,and further made with the clinical final diagnosis.

  2. The impact and importance of clinical learning experience in supporting nursing students in end-of-life care: cluster analysis.

    Science.gov (United States)

    Chow, Susan Ka Yee; Wong, Lina T W; Chan, Yik Kam; Chung, Tin Yu

    2014-09-01

    Nursing students are often expected to provide end-of-life care to patients during clinical practice. Little research has been conducted to examine the heterogeneity of the students and how learning outcomes are affected by their education experience and other demographic factors. The aim of this study was to identify and compare groups of nursing students based on their demographics, clinical experience, knowledge, perceived competency, and attitude towards end-of-life care. A group of 253 nursing students was asked to complete a cross-sectional survey to explore their clinical experience, knowledge, attitude, and perceived competency towards end-of-life care. Cluster analysis was used to determine whether specific groups of students could be identified within the study cohort. Three distinct clusters were identified. Students from the three clusters showed no significant differences in end-of-life knowledge. Significant differences were identified in clinical experience amongst the three clusters and in attitude and perceived competency within the clusters. The cluster of students that had greater clinical experience demonstrated higher perceived competency and a more positive attitude towards end-of-life care. Clinical experience was found to be crucial in enhancing the perceived competency and attitude of nursing students in end-of-life care. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Animal Rights as a Mainstream Phenomenon

    Science.gov (United States)

    Rollin, Bernard E.

    2011-01-01

    Simple Summary The twentieth century has witnessed a bewildering array of ethical revolutions, from civil rights to environmentalism to feminism. Often ignored is the rise of massive societal concern across the world regarding animal treatment. Regulation of animal research exists in virtually all western countries, and reform of “factory farming” is regnant in Europe and rapidly emerging in the United States. Opponents of concern for animals often dismiss the phenomenon as rooted in emotion and extremist lack of appreciation of how unrestricted animal use has improved human life. Such a view totally ignores the rational ethical basis for elevating legal protection for animals, as explained in this essay. Abstract Businesses and professions must stay in accord with social ethics, or risk losing their autonomy. A major social ethical issue that has emerged in the past four decades is the treatment of animals in various areas of human use. Society's moral concern has outgrown the traditional ethic of animal cruelty that began in biblical times and is encoded in the laws of all civilized societies. There are five major reasons for this new social concern, most importantly, the replacement of husbandry-based agriculture with industrial agriculture. This loss of husbandry to industry has threatened the traditional fair contract between humans and animals, and resulted in significant amounts of animal suffering arising on four different fronts. Because such suffering is not occasioned by cruelty, a new ethic for animals was required to express social concerns. Since ethics proceed from preexisting ethics rather than ex nihilo, society has looked to its ethic for humans, appropriately modified, to find moral categories applicable to animals. This concept of legally encoded rights for animals has emerged as a plausible vehicle for reform. PMID:26486217

  4. Sessile Drop Evaporation and Leidenfrost Phenomenon

    Directory of Open Access Journals (Sweden)

    A. K. Mozumder

    2010-01-01

    Full Text Available Problem statement: Quenching and cooling are important process in manufacturing industry for controlling the mechanical properties of materials, where evaporation is a vital mode of heat transfer. Approach: This study experimentally investigated the evaporation of sessile drop for four different heated surfaces of Aluminum, Brass, Copper and Mild steel with a combination of four different liquids as Methanol, Ethanol, Water and NaCl solution. The time of evaporation for the droplet on the hot metallic surface was measured and compared with a proposed correlation as well. With the time temperature plot of these experimental data, the Leidenfrost phenomena had been elucidated. In the pool boiling curve for liquid, just after the transition boiling region and before the film boiling region, the heat transfer approaches its minimum value. The corresponding temperature of this minimum value was termed as the Leidenfrost temperature and the phenomenon is known as Leidenfrost phenomena. According to the experimental data, the Leidenfrost temperature was within a range of 150-200°C for all the experimental conditions. Results: This revealed that Leidenfrost temperature was independent of thermo-physical properties of solid and liquid. Sessile drop evaporation time was the maximum for water, then decreases gradually for Nacl solution, methanol and was the minimum for ethanol for a particular solid material. On the other hand, this time was the highest for copper and the lowest for mild steel for a specific liquid. Conclusion: The experimental data for the evaporation time fairly agree with the proposed correlation within a certain range. The collected time and temperature data may be used as a good data bank for the researchers.

  5. THE BOOK PHENOMENON: (Theoretical-gnoseological aspects

    Directory of Open Access Journals (Sweden)

    Elnikov, Mikhail

    2006-12-01

    Full Text Available Any modern science that knows its object finally moves from a subject to a systemic cognitive level, from unambiguous to having multiple meanings, from linear to hierarchical, from singlemeasured to multi-dimensional, from co-ordination to subordination. The reason for this is to expand the cognitive borders of the object, to receive more knowledge about it and to form a system of this knowledge. Therefore, the subject of cognition changes from the structure and elements of an object to the relations of the elements, laws of organisational systems, the continuum of the interacting categories, specific causes, particularities, foundations and regularities. The complexity of the object of science, its main parameters, attributes and functions cause this process. Therefore, the first condition of cognition is to divide a system into qualitatively coherent entities (elements, parts, structures, attributes, etc.. The dissecting of a complex object into parts and attributes should eliminate the approach to it as to an aggregate of chaotic elements, structures, and particularities. From now on it is approached as a multi-systematic entity, marking relevant system of methodological factors, the limits and levels of the analysis of an object.All this can be applied to a book as to a complex, multi-systemic and multi-dimensional object. The aim of this article is to make an attempt to discuss a book as a theoretical and gnoseological phenomenon, to define the contours of its main qualitative entities. The objective is to distinguish the most important parts of a book as a system and to define their methodological factors.

  6. Sub aortic tendon induced ST segment elevation – a new echo electrocardiographic phenomenon?

    Directory of Open Access Journals (Sweden)

    Ker James

    2009-03-01

    Full Text Available Abstract The causes for ST-segment elevation other than myocardial infarction are numerous. The existence of left ventricular false tendons has been known for more than a century. Currently, the clinical entities associated with these left ventricular false tendons include innocent murmurs and premature ventricular contractions. A case report is presented where such a false tendon, attached to the interventricular septum, is responsible for striking ST-segment elevation in the anterior precordial leads. It is proposed that this is a newly observed entity – that of subaortic tendon-induced ST-segment elevation. This is proposed as a totally benign phenomenon with the clinical importance in that it should not be confused with other pathological processes, such as the Brugada syndrome.

  7. Randomized placebo-controlled crossover trial of tadalafil in Raynaud's phenomenon secondary to systemic sclerosis.

    Science.gov (United States)

    Schiopu, Elena; Hsu, Vivien M; Impens, Ann J; Rothman, Jennifer A; McCloskey, Deborah A; Wilson, Julianne E; Phillips, Kristine; Seibold, James R

    2009-10-01

    Raynaud's phenomenon (RP) is an important clinical feature of systemic sclerosis (SSc) for which consistently effective therapies are lacking. The study was designed to assess the safety, tolerability, and efficacy of tadalafil, a selective, long acting type V cyclic GMP phosphodiesterase (PDE-5) inhibitor, in this clinical syndrome. We performed a prospective, randomized, double-blind, placebo-controlled, crossover study comparing oral tadalafil at a fixed dose of 20 mg daily for a period of 4 weeks versus placebo in women with RP secondary to SSc. Thirty-nine subjects completed the study and were evaluable. There were no statistically significant differences in Raynaud Condition Score (RCS), frequency of RP episodes, or duration of RP episodes between treatment groups. Placebo response was a confounding factor. Tadalafil was well tolerated. Tadalafil appears to be safe and well tolerated but lacks efficacy in comparison to placebo as a treatment for RP secondary to SSc.

  8. Predicting failing performance on a standardized patient clinical performance examination: the importance of communication and professionalism skills deficits.

    Science.gov (United States)

    Chang, Anna; Boscardin, Christy; Chou, Calvin L; Loeser, Helen; Hauer, Karen E

    2009-10-01

    The purpose is to determine which assessment measures identify medical students at risk of failing a clinical performance examination (CPX). Retrospective case-control, multiyear design, contingency table analysis, n = 149. We identified two predictors of CPX failure in patient-physician interaction skills: low clerkship ratings (odds ratio 1.79, P = .008) and student progress review for communication or professionalism concerns (odds ratio 2.64, P = .002). No assessments predicted CPX failure in clinical skills. Performance concerns in communication and professionalism identify students at risk of failing the patient-physician interaction portion of a CPX. This correlation suggests that both faculty and standardized patients can detect noncognitive traits predictive of failing performance. Early identification of these students may allow for development of a structured supplemental curriculum with increased opportunities for practice and feedback. The lack of predictors in the clinical skills portion suggests limited faculty observation or feedback.

  9. “Love” Phenomenon and Neurobiology of Love Relations

    Directory of Open Access Journals (Sweden)

    Ali Evren Tufan

    2010-01-01

    Full Text Available The biology; especially the neurobiological features of the “love” phenomenon has recently started to attract attention. Love relations and attachment, which is closely related with them, are known to be important in health and disease. Love and love relations are found to be complex neurobiological phenomena based on activation of the limbic system of the brain. Those processes involve oxytocin, vasopressin, dopamine and serotonergic functions. Additionally, endorphine and endogenous opiate systems as well as nitrous oxide play role in those processes. The stages of love and love relations may demonstrate different neurochemical and neurophysiological features and may partially overlap with m aternal, romantic and sexual love and attachments. The aim of this article is to evaluate the common neurobiological pathways underlying the “love” phenomenon as well as their importance in medicine and health.

  10. [Ambulatory esophageal pH monitoring: critical review of methodology: (equipment, reproducibility, standards), clinical importance and personal experience].

    Science.gov (United States)

    Jonard, P; Fiasse, R; Tomé, G; Dive, C

    1990-01-01

    The authors review the recent literature about the methodology of oesophageal pH monitoring, which has a high sensitivity and a high specificity for assessing gastro-oesophageal reflux. Combined electrodes offer most advantages. Ambulatory recording should be done in hospital under standard conditions (meals), particularly for clinical studies. The best clinical indication is to detect pathological reflux in case of atypical symptoms with negative oesophagoscopy. The authors give their normal values in a series of measurements with two systems as well as their results in a series of cases of oesophagitis of various grades.

  11. Hysteresis phenomenon in nuclear reactor dynamics

    Energy Technology Data Exchange (ETDEWEB)

    Pirayesh, Behnam; Pazirandeh, Ali [Islamic Azad Univ., Tehran (Iran, Islamic Republic of). Dept. of Nuclear Engineering, Science and Research Branch; Akbari, Monireh [Shahid Rajaee Teacher Training Univ., Tehran (Iran, Islamic Republic of). Dept. of Mathematics

    2017-05-15

    This paper applies a nonlinear analysis method to show that hysteresis phenomenon, due to the Saddle-node bifurcation, may occur in the nuclear reactor. This phenomenon may have significant effects on nuclear reactor dynamics and can even be the beginning of a nuclear reactor accident. A system of four dimensional nonlinear ordinary differential equations was considered to study the hysteresis phenomenon in a typical nuclear reactor. It should be noted that the reactivity was considered as a nonlinear function of state variables. The condition for emerging hysteresis was investigated using Routh-Hurwitz criterion and Sotomayor's theorem for saddle node bifurcation. A numerical analysis is also provided to illustrate the analytical results.

  12. Methods to Minimize Zero-Missing Phenomenon

    DEFF Research Database (Denmark)

    da Silva, Filipe Miguel Faria; Bak, Claus Leth; Gudmundsdottir, Unnur Stella

    2010-01-01

    With the increasing use of high-voltage AC cables at transmission levels, phenomena such as current zero-missing start to appear more often in transmission systems. Zero-missing phenomenon can occur when energizing cable lines with shunt reactors. This may considerably delay the opening of the ci......With the increasing use of high-voltage AC cables at transmission levels, phenomena such as current zero-missing start to appear more often in transmission systems. Zero-missing phenomenon can occur when energizing cable lines with shunt reactors. This may considerably delay the opening...... of the circuit breaker, leaving the system unprotected and vulnerable to failures. Methods to prevent zero-missing phenomenon are still being studied and compared in order to identify effective countermeasures. This paper contributes to these efforts, by presenting several countermeasures that can be applied...

  13. Historical Aspects in Tolerance Phenomenon Research

    Directory of Open Access Journals (Sweden)

    Janat A. Karmanova

    2013-01-01

    Full Text Available The article examines the historical aspect of the tolerance phenomenon research, particularly the study of tolerance in the age of Antiquity, Middle Ages, New Times, Enlightenment. It is remarkable that the problem of tolerance, emerged in Western civilization on religious grounds, laid the foundation for all other freedoms, attained in many countries. Besides, the article attaches special attention to the researchers of the East, such as Abu Nasr al-Farabi, Khoja Ahmed Yasawi, studies the historical aspect of works by Kazakhstan thinkers A. Kunanbayev, C. Valikhanova, K.B. Zharikbayev, S.K. Kaliyev, A.N. Nysanbayev, A.I. Artemev and others. The analysis of historical research of the tolerance phenomenon brings the author to the conclusion that religious freedom was the starting point for the emergence of new areas of tolerance display. The content of this phenomenon changed according to the historical peculiarities of the societies’ development

  14. Orthostatic proteinuria with nutcracker phenomenon: case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Noh Hyuck; Song, Soon Young; Lee, En Ja; Kim, Mi Sung; Kim, Byung Gil [College of Medicine, Kwandong Univ., Koyang (Korea, Republic of)

    2004-07-01

    Orthostatic proteinuria has been recognized as a benign condition with a good prognosis and has not been associated with any underlying glomerular disease. The pathogenesis of orthostatic proteinuria is unclear. Recently, a few foreign reports suggested that the nutcracker phenomenon, which is known as a cause of asymptomatic hematuria, may also be a major cause of orthostatic proteinuria. We report a case of a 12-year-old female patient presenting only with orthostatic proteinuria, who was diagnosed as having nutcracker phenomenon by Doppler study and venography.

  15. Phenomenon of Plenty: Theory and diagnosis

    Directory of Open Access Journals (Sweden)

    Sergey Uzhegov

    2011-11-01

    Full Text Available Present study theoretically explores and empirically diagnoses the Phenomenon of Plenty - paradox of below-potential economic performance of nations generously endowed with natural resources, focusing on oil-rich CIS members: Russia, Azerbaijan, and Kazakhstan. Extending theoretical structure to proposed Four-Component Process it reports existence of direct de-servisation finding previously overlooked cause of oil paradox - downturn of non-tradable sector long-time lacking production forces. Application of elaborated 5-Sign Algorithm for Diagnosis of the Phenomenon of Plenty elicits its presence across evaluated nations.

  16. Social Media: A Phenomenon to be Analyzed

    Directory of Open Access Journals (Sweden)

    danah boyd

    2015-04-01

    Full Text Available The phenomenon of “social media” has more to do with its cultural positioning than its technological affordances. Rooted in the broader “Web 2.0” landscape, social media helped engineers, entrepreneurs, and everyday people reimagine the role that technology could play in information dissemination, community development, and communication. While the technologies invoked by the phrase social media have a long history, what unfolded in the 2000s reconfigured socio-technical practices in significant ways. Reflecting on the brief history of social media, this essay argues for the need to better understand this phenomenon.

  17. Parental Functioning in Families of Children with ADHD: Evidence for Behavioral Parent Training and Importance of Clinically Meaningful Change

    Science.gov (United States)

    Gerdes, Alyson C.; Haack, Lauren M.; Schneider, Brian W.

    2012-01-01

    Objective/Method: Statistically significant and clinically meaningful effects of behavioral parent training on parental functioning were examined for 20 children with ADHD and their parents who had successfully completed a psychosocial treatment for ADHD. Results/Conclusion: Findings suggest that behavioral parent training resulted in…

  18. Bottom–up protein identifications from microliter quantities of individual human tear samples. Important steps towards clinical relevance.

    Directory of Open Access Journals (Sweden)

    Peter Raus

    2015-12-01

    With 375 confidently identified proteins in the healthy adult tear, the obtained results are comprehensive and in large agreement with previously published observations on pooled samples of multiple patients. We conclude that, to a limited extent, bottom–up tear protein identifications from individual patients may have clinical relevance.

  19. Parental Functioning in Families of Children with ADHD: Evidence for Behavioral Parent Training and Importance of Clinically Meaningful Change

    Science.gov (United States)

    Gerdes, Alyson C.; Haack, Lauren M.; Schneider, Brian W.

    2012-01-01

    Objective/Method: Statistically significant and clinically meaningful effects of behavioral parent training on parental functioning were examined for 20 children with ADHD and their parents who had successfully completed a psychosocial treatment for ADHD. Results/Conclusion: Findings suggest that behavioral parent training resulted in…

  20. The challenge and importance of standardizing pre-analytical variables in surgical pathology specimens for clinical care and translational research.

    Science.gov (United States)

    Hicks, D G; Boyce, B F

    2012-01-01

    The introduction of targeted cancer therapies into clinical practice, in which patients are selected for novel treatments based on results of companion molecular testing of their tumor specimens, has created significant new challenges for the surgical pathology laboratory. These include standardization of tissue handling and sample preparation with accurate documentation to ensure optimal quality of clinical samples to reduce the risk of errors in molecular biology tests. The assay of tumor tissues for biomarkers that can provide predictive data for prognosis or treatment should enable selection of the most appropriate therapies (Yaziji et al. 2008, Hicks and Kulkarni 2008). Major advances have been made in the ability to profile clinical samples for research at the DNA, RNA and protein levels. To translate this new information into the clinical setting, however, the quality of the starting material, in this case the tumor tissue, determines the accuracy and reliability of companion diagnostic assay results and therefore optimal therapeutic strategies. Inaccurate results owing to compromised tissue quality can lead to false positive or false negative results with therapeutic consequences that can harm patients and affect their eventual outcome.

  1. Clinical evaluation of the Uni-Yeast-Tek system for rapid presumptive identification of medically important yeasts.

    Science.gov (United States)

    Cooper, B H; Johnson, J B; Thaxton, E S

    1978-04-01

    The results of over 400 tests for identification of clinical yeast isolates as to species using the Uni-Yeast-Tek (UYT) system in comparison with a more conventional system are reported. The conventional system utilized a total of 23 individual tests, including both fermentation and assimilation tests, whereas the UYT system included only 11 separate tests. In the initial phase of the study, coded unknown isolates were evaluated by each of two technologists using both methods independently. After this initial evaluation, the two methods were used in parallel for routine testing of yeast isolates as they were obtained from clinical specimens. A further evaluation of the UYT system was carried out by retrospectively analyzing the species reported from a clinical mycology laboratory during two separate time periods in which different approaches to yeast identification were employed. A total of 92% of the isolates tested with the UYT system were correctly reported within 72 h, 96% were correctly named after 1 week of incubation, and 97% were correctly reported after 2 weeks of incubation of UYT plates at 30 degrees C when results of the two phases of the study were analyzed together. With the conventional system, 88% of the isolates were correctly reported at 72 h, 96% at 1 week, and 98% after 2 weeks of incubation of biochemical tests. Retrospective analysis of laboratory records revealed no major changes in species reported after adoption of the UYT system for routine testing of clinical isolates. The data presented in this report suggest that the UYT system can be expected to yield rapid presumptive identification of clinical yeast isolates with reasonable confidence when certain minor limitations that are discussed in the text are taken into account.

  2. Growth hormone receptor exon 3 isoforms may have no importance in the clinical setting of multiethnic Brazilian acromegaly patients.

    Science.gov (United States)

    de Oliveira Machado, Evelyn; Lima, Carlos Henrique Azeredo; Ogino, Liana Lumi; Kasuki, Leandro; Gadelha, Mônica R

    2016-08-01

    Acromegaly is associated with significant morbidity and increased mortality, but has a variable severity phenotype. The presence of the exon 3-deleted isoform of the growth hormone receptor (d3-GHR) may influence the disease phenotype and treatment outcomes, including the frequency of biochemical discordance after medical treatment. The objective of this study was to analyze the influence of the d3-GHR isoform on clinical and biochemical characteristics and in the treatment outcomes of Brazilian multiethnic acromegaly patients. We retrospectively analyzed our acromegaly outpatient clinic databank and collected demographic, clinical, biochemical and treatment outcome data from those patients who agreed to participate in the study. A blood sample was collected from all patients, the DNA was extracted and the GHR isoforms were evaluated by PCR, with the full length (fl)-GHR represented by a 935-bp fragment and the d3-GHR represented by a 532-bp fragment. A total of 121 patients were included. Fifty-six patients (46.3 %) were full-length homozygous (fl/fl), 48 (39.7 %) were heterozygous (fl/d3) and 17 (14.0 %) were d3-GHR homozygous (d3/d3). There was no difference between patients homozygous for the fl isoform and those harboring at least one d3-GHR allele in the demographic, clinical and biochemical data or in the treatment outcomes, including somatostatin receptor ligands (SRL) monotherapy, combination therapy with SRL and cabergoline and pegvisomant treatment. There was also no difference between the groups for the frequency of GH and IGF-I discordance after medical treatment. GHR exon 3 genotyping appears to have no clinical significance, at least in Brazilian acromegaly patients.

  3. Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials.

    Science.gov (United States)

    Howlett, Jonathan G; McKelvie, Robert S; Arnold, J Malcolm O; Costigan, Jeannine; Dorian, Paul; Ducharme, Anique; Estrella-Holder, Estrellita; Ezekowitz, Justin A; Giannetti, Nadia; Haddad, Haissam; Heckman, George A; Herd, Anthony M; Isaac, Debra; Jong, Philip; Kouz, Simon; Liu, Peter; Mann, Elizabeth; Moe, Gordon W; Tsuyuki, Ross T; Ross, Heather J; White, Michel

    2009-02-01

    The Canadian Cardiovascular Society published a comprehensive set of recommendations on the diagnosis and management of heart failure in January 2006. Based on feedback obtained through a national program of heart failure workshops and through active solicitation of stakeholders, several topics were identified because of their importance to the practicing clinician. Topics chosen for the present update include best practices for the diagnosis and management of right-sided heart failure, myocarditis and device therapy, and a review of recent important or landmark clinical trials. These recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. The present update has been written from a clinical perspective to provide a user-friendly and practical approach. Specific clinical questions that are addressed include: What is right-sided heart failure and how should one approach the diagnostic work-up? What other clinical entities may masquerade as this nebulous condition and how can we tell them apart? When should we be concerned about the presence of myocarditis and how quickly should patients with this condition be referred to an experienced centre? Among the myriad of recently published landmark clinical trials, which ones will impact our standards of clinical care? The goals are to aid physicians and other health care providers to optimally treat heart failure patients, resulting in a measurable impact on patient health and clinical outcomes in Canada.

  4. Importancia clínica de la translocación bacteriana Clinical importance of bacterial translocation

    Directory of Open Access Journals (Sweden)

    A. García de Lorenzo y Mateos

    2007-05-01

    the translocation phenomenon, although studies with insufficient methodology, reduced populations, and conflicting results still leave open questions and others with no logical answer. This problem is also reflected when studying and assessing different therapeutic strategies used as well as on the methods used to detect translocation.

  5. [Correlation between clinical parameters and quantitative analysis of inflammatory infiltrate. Importance in the diagnosis of active periodontal disease].

    Science.gov (United States)

    Mendieta Fiter, C

    1989-05-01

    Recent studies have indicated that the destruction in chronic periodontal disease occurs in relatively short periods of time which are followed of prolonged periods of inactivity. These bursts of activity are characterized by an increase in the inflammatory reaction. It has been the purpose of this paper to study the correlation between the clinical measurements of periodontal disease and the histomorphometric quantification of areas of dense inflammatory infiltrate. The results of this study show that the clinical parameters that measure gingival inflammation or loss of periodontal attachment are useful to distinguish pathology from normal (p less than 0.003), but lack sensitivity to detect burst of periodontal disease activity (p greater than 0.05).

  6. Helicobacter cinaedi bacteremia in four renal transplant patients: clinical features and an important suggestion regarding the route of infection.

    Science.gov (United States)

    Imafuku, A; Araoka, H; Tanaka, K; Marui, Y; Sawa, N; Ubara, Y; Takaichi, K; Ishii, Y; Tomikawa, S

    2016-02-01

    Helicobacter cinaedi can cause bacteremia mainly in immunocompromised patients. We present the clinical characteristics of H. cinaedi bacteremia in 4 renal transplant patients. Interestingly, all cases showed triggers of bacterial translocation: 2 cases developed after colonic perforation caused by diverticulitis, 1 case developed post cholecystectomy, and the remaining patient had chronic diarrhea. Accordingly, bacterial translocation caused by severe gastrointestinal complication could be a cause of H. cinaedi bacteremia.

  7. Importance of time in therapeutic range on bleeding risk prediction using clinical risk scores in patients with atrial fibrillation.

    Science.gov (United States)

    Rivera-Caravaca, José Miguel; Roldán, Vanessa; Esteve-Pastor, María Asunción; Valdés, Mariano; Vicente, Vicente; Lip, Gregory Y H; Marín, Francisco

    2017-09-21

    Bleeding risk with vitamin K antagonists (VKAs) is closely related to the quality of anticoagulation in atrial fibrillation (AF) patients, reflected by time in therapeutic range (TTR). Here we compared the discrimination performance of different bleeding risk scores and investigated if adding TTR would improve their predictive value and clinical usefulness. We included 1361 AF patients stables on VKA for at least 6 months. Bleeding risk was assessed by the HAS-BLED, ATRIA, ORBIT and HEMORR2HAGES scores. Major bleeding events were recorded after a median of 6.5 years follow-up. In this period 250 patients suffered major bleeds. Comparison of receiver operating characteristic (ROC) curves demonstrated that HAS-BLED had the best discrimination performance, but adding the 'labile INR' criteria (i.e. TTR <65%) to ATRIA, ORBIT and HEMORR2HAGES increased their ability of discrimination and predictive value, with significant improvements in reclassification and discriminatory performance. Decision curve analyses (DCA) showed improvements of the clinical usefulness and a net benefit of the modified risk scores. In summary, in AF patients taking VKAs, the HAS-BLED score had the best predictive ability. Adding 'labile INR' to ATRIA, ORBIT and HEMORR2HAGES improved their predictive value for major bleeding leading to improved clinical usefulness compared to the original scores.

  8. Nothingness and the placebo effect phenomenon

    DEFF Research Database (Denmark)

    Jensen, Tine

    a posthuman angle, applying Karen Barad’s concept of agential realism to tackle the issue of nothingness. I argue that the placebo effect produces specific agencies in the placebo effect phenomenon – that is, both the subject under treatment and the placebo emerge in the placebo effect in the act of measuring it...

  9. Mesoscale Phenomenon Revealed by an Acoustic Sounder

    DEFF Research Database (Denmark)

    Lundtang Petersen, Erik; Jensen, Niels Otto

    1976-01-01

    A particular phenomenon observed on an acoustic sounder record is analyzed, and is interpreted as being associated with the passing of a land breeze front. A simple physical explanation of the frontal movements is suggested. The actual existence of the land breeze is demonstrated by examination...

  10. Abnormal Raman spectral phenomenon of silicon nanowires

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    The Raman spectra of two one-dimensional silicon nanowire samples with different excitation wavelengths were measured and an abnormal phenomenon was discovered that the Raman spectral features change with the wavelengths of excitation. Closer analysis of the crystalline structure of samples and the changes in Raman spectral features showed that the abnormal behavior is the result of resonance Raman scattering selection effect.

  11. Key-Phenomenon and Religious Meaning

    Directory of Open Access Journals (Sweden)

    Lomuscio Vincenzo

    2017-09-01

    Full Text Available In this paper I develop a phenomenology of religious experience through the notion of keyphenomenon. My analysis moves from a general phenomenology of situation, in which we have to relate different phenomena according to a sense. What does “according to a sense” mean? My suggestion is that we should look for a relationship among these data when we find a key-phenomenon (among a series of phenomena that would enlighten all the others. This key-phenomenon would show a non-phenomenal meaning which would make all the others understandable. Each other datum, therefore, becomes the witness of invisible meaning through a key-witness. The key-phenomenon we choose determines the role (i.e., the truth of each datum within its situation. This phenomenological relationship belongs to both the sense of day-life situations, and that one of possible religious situations. If the religious interpretation of a situation depends on our choice of key-phenomenon, or key-witness, we have to define what kind of keyphenomenon constitutes a religious intuition.

  12. A Phenomenon of Overqualification in Personnel Psychology

    Science.gov (United States)

    Fine, Saul; Nevo, Baruch

    2007-01-01

    This study examines the concept of overqualification as a phenomenon of nonlinearity in the upper deciles of the ability-performance relationship. In three job contexts (military, academic, and industrial), the ability-performance relationship is characterized by a strong linear component below the mean and a ceiling effect at various points above…

  13. Homocysteine and Raynaud's phenomenon: a review.

    Science.gov (United States)

    Lazzerini, Pietro Enea; Capecchi, Pier Leopoldo; Bisogno, Stefania; Cozzalupi, Mauro; Rossi, Pier Carlo; Pasini, Franco Laghi

    2010-01-01

    Raynaud's phenomenon, categorized as primary and secondary when occurring isolated or in association with an underlying disease, respectively, is a paroxysmal and recurrent acral ischemia resulting from an abnormal arterial vasospastic response to cold or emotional stress. The key issue in the pathogenesis of Raynaud's phenomenon is presumed to be a dysregulation in the mechanisms of vascular motility resulting in an imbalance between vasodilatation and vasoconstriction. Homocysteine, a non-protein forming sulphured amino acid proposed as an independent risk factor for atherothrombosis in the general population, clearly demonstrated to produce vascular damage through mechanisms also including endothelial injury and modifications in circulating mediators of vasomotion. The rationale for homocysteine involvement in the pathogenesis of Raynaud's phenomenon led some authors to investigate the possible association between mild hyperhomocysteinemia and such a vascular disturbance, particularly in the course of connective tissue disease. Here we review data regarding this putative association and the supposed mechanisms involved, also discussing the emblematic case of a patient with new-onset severe Raynaud's phenomenon and markedly elevated homocysteinemia.

  14. Geometrical optics and the diffraction phenomenon

    Energy Technology Data Exchange (ETDEWEB)

    Timofeev, Aleksandr V [Russian Research Centre ' Kurchatov Institute' , Moscow (Russian Federation)

    2005-06-30

    This note outlines the principles of the geometrical optics of inhomogeneous waves whose description necessitates the use of complex values of the wave vector. Generalizing geometrical optics to inhomogeneous waves permits including in its scope the analysis of the diffraction phenomenon. (methodological notes)

  15. [Serological and clinical proof of freedom from Equine Infectious Anemia (EIA) in imported and domestic horses in Switzerland].

    Science.gov (United States)

    Kaiser, A; Meier, H P; Doherr, M G; Perler, L; Zanoni, R; Gerber, V

    2009-04-01

    Since 1991, no cases of Equine Infectious Anemia (EIA) have been reported in Switzerland. Risk factors for introduction of the virus into Switzerland are still present or have even increased as frequent inapparent infections, large numbers of imported horses, (since 2003) absence of compulsory testing prior to importation, EIA cases in surrounding Europe, possible illegal importation of horses, frequent short-term stays, poor knowledge of the disease among horse owners and even veterinarians. The aim of this study was to provide evidence of freedom from EIA in imported and domestic horses in Switzerland. The serum samples from 434 horses imported since 2003 as well as from 232 domestic horses fifteen years of age or older (since older horses have naturally had a longer time of being exposed to the risk of infection) were analysed using a commercially available ELISA test. All samples were seronegative, indicating that the maximum possible prevalence that could have been missed with this sample was 0.5% (95% confidence).

  16. 进口药品注册临床试验的整体策略%Clinical research strategies for imported drugs registration

    Institute of Scientific and Technical Information of China (English)

    康彩练; 高晨燕

    2009-01-01

    The clinical trial requirements for imported drug are under seri-ous discussion. This article gives the answers for the following questions:are the clinical trials absolute necessary if the drugs want to launch on China's market? How to conduct clinical trials to fulfill the regulation re-quirements? Base on ICHE5 guideline, the amount and content of clini-cal trials depend on the "demand". The key point considered to the "de-mand" is the difference of ethnic and clinical practice, which lies on two important aspects: the disease being treated and molecular characters.Invesitegators should analysis the pharmaeokinetic and pharmakcoinetic/pharmacodynamic characters in different ethnics. And invesitegators should also analysis the clinical practice difference on efficacy and safe-ty. Aim at these difference, the investigators design the corresponding clinical trials. This article will give suggestions to the post-marketing clin-ical trials and global multi-national clinical trials too.%本文从进口药注册临床试验的争论入手,回答是否需要开展注册临床试验和需要开展什么样的注册试验.通过对于ICHE5的解读,阐明进口药的注册临床试验要遵循按需开展的原则,从疾病与分子2个方面分析药代动力学、药代动力学/药效、有效性和安全性的不同地区差异,针对这些差异开展相应的进口注册临床试验.本文也对上市后的试验和国际多中心试验举行了阐述.

  17. Tromboembolismo pulmonar: El valor de la clínica PULMONARY EMBOLISM: THE IMPORTANCE OF CLINICAL EVALUATION

    Directory of Open Access Journals (Sweden)

    MIGUEL ANTÚNEZ R.

    2002-04-01

    Full Text Available El tromboembolismo pulmonar constituye un problema clínico frecuente; sus síntomas y signos son inespecíficos y los exámenes habitualmente utilizados para su diagnóstico son a menudo poco sensibles y específicos. La Angiografía Pulmonar es el "Gold Standard", no obstante es de escasa disponibilidad en nuestro medio, de alto costo, constituye un método invasivo no exento de complicaciones y de difícil interpretación en algunas oportunidades. La tomografía helicoidal de tórax es una técnica nueva, de mayor accesibilidad, cuyo desarrollo tecnológico ha permitido lograr mejorías en su sensibilidad y especificidad diagnósticas y consecuentemente un cambio en nuestras decisiones terapéuticas. Presentamos el caso de un paciente con trombosis venosa de las extremidades inferiores y un cuadro clínico compatible con alta probabilidad para tromboembolismo pulmonar. Hubo desarrollo de infiltrados pulmonares bilaterales asociados a derrame pleural en ausencia de fiebre y leucocitosis. Se inició terapia anticoagulante con lo cual hubo mejoría clínica del cuadro. Sin embargo, la realización de una tomografía helicoidal de tórax no demostró presencia de émbolos en la vasculatura pulmonar. Es por ello que debemos ser cautos en el momento de tomar decisiones clínicas basadas en un solo test diagnóstico, sin importar cuan eficiente este seaPulmonary embolism is a common clinical problem. Its symptoms and signs are inespecific and the tests commonly used are either non sensitive or non specific. Pulmonary angiography is considered as the "gold standard" for pulmonary embolism diagnosis. However, it is usually unavailable, very expensive, invasive and sometimes of complex interpretation. Thoracic helical computed tomography is a new technique, available in our clinical setting. It has become the most sensitive and specific test for pulmonary embolism detection and whose results can change our therapy. We report a clinical case with a leg

  18. Review of important clinical advances in diabetes%糖尿病重要临床进展回顾

    Institute of Scientific and Technical Information of China (English)

    吕庆国; 童南伟

    2012-01-01

    在过去的2011年,国际糖尿病联盟(IDF)、美国内分泌医师协会(AACE)、中华医学会糖尿病学分会及内分泌学分会等组织,针对糖尿病的临床诊治、实验室检测及并发症的治疗等颁布了一些指南和共识;关于中国人糖尿病血管病变特点及糖尿病死因方面也有新的研究发布;同时,对于几种降糖药物的安全性问题,美国食品与药品管理局(FDA)和欧洲药品管理委员会(EMEA)也发布了声明.这些对于规范临床诊治及用药有重要意义.%During the past year of 2011,International Diabetes Federation ( IDF),American Association of Clinical Endocrinologists ( AACE),Chinese Diabetes Society,and Chinese Society of Endocrinology,etc had published some guidelines and consensuses on clinical diagnosis,treatment,laboratory test,and complication therapy of diabetes.Characters of diabetic angiopathy in Chinese and death cause of diabetes were also announced by several new studies.Meanwhile,Food and Drug Administration ( FDA ) and The European Agency for the Evaluation of Medicinal Products(EMEA) declared their statements on safety of several hypoglycemic agents.These guidelines and consensuses will play key roles on standard clinical diagnosis,treatment,and medication.

  19. [Valuation the tropism of the region V3 of the HIV for sequence. Clinic and therapeutic importance].

    Science.gov (United States)

    Maroto Vela, M del Carmen

    2009-01-01

    The structure of the VIH is studied, with special mention of the curl V3 of the gp120, given your capacity of union to the coreceptors of the lymphocyte TCD4. Due to the existence of a new antirretroviral antagonist of the vinestocks R5, carried out a sequence of V3 for the application of algorithms of interpretation of the results that were allowing us your use in clinic. There was demonstrated that of seven used algorithms, the use of four with them provides a better prediction that when an only one is in use system.

  20. Legal socialization of personality as a phenomenon of legal psychology

    Directory of Open Access Journals (Sweden)

    Borisova S.E.

    2017-01-01

    Full Text Available The relevance of the topic to the continuing importance of legal regulation of human behavior, the necessity of foreseeing the adverse consequences of social disorders and urgency of the prevention of deconditioning and deviant behavioral manifestations. In this regard, it is important to examine the phenomenon of legal socialization, causing interest among the representatives of the human Sciences and specialists in different branches of psychological knowledge. Taking into account the multidimensional nature of this phenomenon, it is an essential consideration of the trajectories of its occurrence in correlation with different interacting with other determinants. Such determinants include age psychological characteristics, experience crises of mental development, socially conditioned factors, and the influence of the professional environment. In article are characterized by individual patterns of legal socialization of a personality, revealing its essence, on the basis of summarizing opinions of scientists based on their own point of view. On the basis of the theoretical analysis made assumptions about the peculiarities of legal socialization of the individual occurring in different age periods of life; formulated likely areas for further study the phenomenon under research legal psychology.

  1. Neopterin and procalcitonin are suitable biomarkers for exclusion of severe Plasmodium falciparum disease at the initial clinical assessment of travellers with imported malaria

    NARCIS (Netherlands)

    R. te Witt (René); M.E. van Wolfswinkel (Marlies); P.L. Petit (Pieter); J.J. van Hellemond (Jaap); R. Koelewijn (Rob); A.F. van Belkum (Alex); P.J.J. van Genderen (Perry)

    2010-01-01

    textabstractBackground. Most clinicians in developed, non-malaria endemic countries have limited or no experience in making clinical assessments of malaria disease severity and subsequent decisions regarding the need for parenteral therapy or high-level monitoring in febrile patients with imported

  2. A case report concerning the importance of the patients’ symptoms and clinical findings in the management of patients

    Directory of Open Access Journals (Sweden)

    Bodil Ohlsson

    2010-01-01

    Full Text Available The gastrointestinal tract has always been difficult to visualize in its entire length. New technology such as magnetic resonance imaging enterography, computed tomography ente­ro­­graphy, single- and double-balloon entero­scopy, and video capsule enteroscopy have improved the possibilities for visualizing mucosal changes and pathology in the small intestine. We describe here a case of a patient with gastrointestinal signs and symptoms suggesting recurrent intestinal obstruction over a period of several years, who had mostly normal morphology on endoscopic examination. Nonetheless, after some delay, the patient underwent explorative surgery because of his accelerating symptoms. Abdominal exploration revealed a Meckel’s diverticulum, which had led to inflammatory adhesions of the small intestine with a sharp bend and proximal intestinal dilation. After the operation the patient’s health was restored. We concluded that in certain situations the clinician should rely on the patients’ symptoms and clinical findings more than on technological examinations and the clinical picture should guide clin­icians’ interventions, even though we live in a high-technique era.

  3. Multilocus phylogeny reveals an association of agriculturally important Fusarium solani species complex (FSSC) 11, and clinically important FSSC 5 and FSSC 3 + 4 with soybean roots in the north central United States.

    Science.gov (United States)

    Chitrampalam, P; Nelson, B

    2016-02-01

    The Fusarium solani species complex (FSSC) includes important root pathogens of soybean in the United States, but the evolutionary lineages associated with soybean root rot are unknown. A multilocus phylogeny based on 93 isolates from soybean and pea roots from North Dakota and Minnesota revealed that root rot was associated with three known phylogenetic species, FSSC 3 + 4 (=Fusarium falciforme) (3 % of isolates), FSSC 5 (60 %), FSSC 11 (34 %), and one unknown species, FSSC X (2 %). Of these species FSSC 5 and FSSC 3 + 4 are clinically important while FSSC 11 is a plant pathogen. Isolates from FSSC 11 were pathogenic on soybean, dry bean, pea and lentil, and did not grow at 37 °C. However, isolates from FSSC 5 were weakly to non-pathogenic, but grew at 37 °C. Isolates from both FSSC 5 and FSSC 11 were highly resistant to fludioxonil in vitro. This is the first study revealing the pathogenic robustness of FSSC 11 in causing root rot among Fabaceae crops and also the association of clinically important members of the FSSC with roots of a widely grown field crop in the United States.

  4. Structural insights from binding poses of CCR2 and CCR5 with clinically important antagonists: a combined in silico study.

    Directory of Open Access Journals (Sweden)

    Gugan Kothandan

    Full Text Available Chemokine receptors are G protein-coupled receptors that contain seven transmembrane domains. In particular, CCR2 and CCR5 and their ligands have been implicated in the pathophysiology of a number of diseases, including rheumatoid arthritis and multiple sclerosis. Based on their roles in disease, they have been attractive targets for the pharmaceutical industry, and furthermore, targeting both CCR2 and CCR5 can be a useful strategy. Owing to the importance of these receptors, information regarding the binding site is of prime importance. Structural studies have been hampered due to the lack of X-ray crystal structures, and templates with close homologs for comparative modeling. Most of the previous models were based on the bovine rhodopsin and β2-adrenergic receptor. In this study, based on a closer homolog with higher resolution (CXCR4, PDB code: 3ODU 2.5 Å, we constructed three-dimensional models. The main aim of this study was to provide relevant information on binding sites of these receptors. Molecular dynamics simulation was done to refine the homology models and PROCHECK results indicated that the models were reasonable. Here, binding poses were checked with some established inhibitors of high pharmaceutical importance against the modeled receptors. Analysis of interaction modes gave an integrated interpretation with detailed structural information. The binding poses confirmed that the acidic residues Glu291 (CCR2 and Glu283 (CCR5 are important, and we also found some additional residues. Comparisons of binding sites of CCR2/CCR5 were done sequentially and also by docking a potent dual antagonist. Our results can be a starting point for further structure-based drug design.

  5. Impact of various continuing medical education activities on clinical practice - a survey of Malaysian doctors on its perceived importance.

    Science.gov (United States)

    Loh, Li-Cher; Ong, Hean-Teik; Quah, Soon-Hoe

    2007-04-01

    Medical talks, newsletter circulars, scientific meetings and conferences, and interaction with members of the pharmaceutical industry, have become convenient means of carrying out continuing medical education (CME) for many busy doctors. To study the perceived importance of these various CME activities, a self-completed posted questionnaire survey was conducted among registered practitioners of a densely populated urban state in Malaysia. Of the 172 respondents [male, 77%; hospital-based, 37%; general practitioner (GP), 55%; private practice, 70%; respondent rate of 19.5%], most preferred local conferences and endorsements by local experts to their foreign counterparts. Meetings or conferences sponsored by the pharmaceutical industry were ranked similarly with those without such links, while the reputation of the pharmaceutical firms was of foremost importance. Among GPs (n = 95) and non-GPs (n = 77), medical society newsletters were rated significantly higher by GPs while overseas conferences were rated higher by non-GPs. Our findings provide an important first look at this under-explored area among Malaysian doctors and described a high degree of acceptance for the involvement of the pharmaceutical industry in CME activities.

  6. The importance of clinical mistletoe cancer therapy and korean mistletoe pharmacopuncture preparation development and application possibility for oriental medicine

    Directory of Open Access Journals (Sweden)

    Ok-Byung Choi

    2009-03-01

    Full Text Available Objectives : Mistletoe extracts have been in use for around 85 years, predominantly in the area of cancer therapy. Today mistletoe preparations are among the most prescribed drugs in cancer medicine, thus constituting a standard biological therapy in the area of oncology. The purpose of this study is to analyze the practical implications of mistletoe cancer therapy, their clinical status, their preparation techniques and companies. Contents : Mistletoe therapy for cancer has been developed within the context of anthroposophical medicine. One major effect of mistletoe extract is that it stimulates the immune system and cancer defences. In Germany, a total of eight different mistletoe preparations are available, five developed by Anthroposophic Medicine and three evolved from research in phytotherapy. Therapy always consists of an introductory phase in order to test the patient′s tolerance, find the right dosage and choose the most suitable preparation. This paper covers the background of mistletoe medical plant materials, mistletoe therapy for cancer, the anthroposophical medicine and clinical research, the practical regulation of treatment, preparation of mistletoe drugs. Result & suggestion : Mistletoe extracts are a complementary teratment of cancer, widely used in intergrative cancer care. The study of the integration of korean mistletoe extracts to oriental cancer medicine, its development and feasibility in Korea are urgently needed. The products, substances, compositions of european mistletoe drugs are very similar to those of oriental medicine theory. Applying the mistletoe cancer therapy and its preparation techniques to oriental medicine, the herbal acupuncture preparation should be modernized and korean mistletoe products are to be developed. To this end, government and herbal acupuncture society need to interact each other for the development of oriental mistletoe cancer medicine.

  7. The clinical importance of myeloid antigen coexpression and TEL-AML1 mutation in patients with childhood acute lymphoblastic leukemia

    Directory of Open Access Journals (Sweden)

    Ayşen Türedi Yıldırım

    2013-03-01

    Full Text Available Objective: In this study, we aim to investigate the relationship,if any, between clinical features, prognosis, and thecoexpressions and TEL-AML1 mutation in patients withacute lymphoblastic leukemia (ALL.Methods: Eigthy-three patients with acute lymphoblasticleukemia were retrospectively examined. Age, gender,White blood cell count, hemoglobin level, platelet count,ALL subtypei (B or T ALL, risk groups, surface antigensdeteceted by flow cytometry, existence of TEL-AML1 mutations,response, remission and relapse status at 8., 15.ve 33. Days of treatment were recorded and analyzed.Results: 15 (18% out of 83 were identified with aberrantantigen expression. Of these patients, twelve (14.4%had myeloid antigen coexpression (CD13 and/or CD33,two with B cell ALL had CD2 and CD7 coexpressions respectively,one with T cell ALL had CD19 coexpression.No significant differences were found between patientswith and without myeloid antigen coexpression in terms ofhemoglobin levels, white blood cells and platelet counts,responses given on the 8th, 15th, and 30th days on the treatment,risk groups, and relapse (p>0.05. Myeloid antigencoexpression was found in 4 of 13 patients who were identifiedwith TEL-AML1 mutation. No significant relationshipwas found between this mutation and coexpressions. Norelapse and exitus were observed in four patients with coexpressionand TEL-AML1.Conclusion: The prognosis and clinical features showsno statistically significant relationship with the presence ofneither Myeloid antigen expression nor TEL-AML1 mutation.We believe, however, the future studies involving biggersample sizes will prove to be useful in terms of moreconvincing results. J Clin Exp Invest 2013; 4(1: 90-94Key words: Acute lenfoblastic leukemia, coexpression,TEL-AML1 mutation, prognosis

  8. Dissymmetric flow phenomenon in a multistrand tundish

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The dissymmetric flow phenomenon exists in a symmetric multistrand tundish. It was studied by the physical simulation experiment. The fundamental flow characteristic of dissymmetry was analyzed. The asymmetry of the flow field, the temperature field, and the inclusions distribution without flow-control devices (FCDs) were compared with those with FCDs. It is proved that the asymmetry of the flow and temperature field along the outlets at the long range is more obvious. The symmetric FCDs installation has a slight effect on the dissymmetric temperature field, simultaneously, the symmetry of the average residence time and the fluid flow pattern has improved, and the fluid flow in the tundish has been more reasonable. In case of a symmetric multistrand tundish having a large volume, the influence of the dissymmetric phenomenon should be considered and the flow behaviors in the whole tundish should be studied completely.

  9. When does lasing become a condensation phenomenon?

    CERN Document Server

    Fischer, Baruch

    2012-01-01

    We present a generic classical light condensation (LC) phenomenon in linear photonic mode systems, such as cw laser cavities, in a noisy environment (spontaneous emission, etc.), based on weighting the modes in a loss-gain scale rather than in photon energy. It is characterized by a sharp transition from multi- to single-mode oscillation. The study uses a linear multivariate Langevin formulation which gives a mode occupation hierarchy that functions like Bose-Einstein statistics. We find that condensation occurs when the spectral filtering has near the lowest loss mode a power law dependence with exponent smaller than 1. We then discuss how and when condensation occurs in photon systems, how it relates to lasing, and the difficulties to observe regular photon Bose-Einstein condensation (BEC) in laser cavities. We raise the possibility that recent experiments on photon condensation in optical cavities fall in a classical LC or lasing category rather than being a thermal-quantum BEC phenomenon.

  10. Multiple steady state phenomenon in martensitic transformation

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Based on the basic facts that the martensitic transformation is a physical phenomenon which occurs in non-equilibrium conditions and there exists the feedback mechanism in the martensitic transformation, the dynamical processes of the isothermal and athermal martensitic transformations were analyzed by using nonlinear theory and a bifurcation theory model was established. It is shown that a multiple steady state phenomenon can take place as austenite is cooled, and the transitions of the steady state temperature between the branches of stable steady states can be considered the transformation from austenite to martensite. This model can estimate the starting temperature of the martensitic transformation and explain some experimental features of the martensitic transformation such as the effects of cooling rate, fluctuation and austenitic grain size on the martensitic transformation.

  11. Diffusion phenomenon for linear dissipative wave equations

    KAUST Repository

    Said-Houari, Belkacem

    2012-01-01

    In this paper we prove the diffusion phenomenon for the linear wave equation. To derive the diffusion phenomenon, a new method is used. In fact, for initial data in some weighted spaces, we prove that for {equation presented} decays with the rate {equation presented} [0,1] faster than that of either u or v, where u is the solution of the linear wave equation with initial data {equation presented} [0,1], and v is the solution of the related heat equation with initial data v 0 = u 0 + u 1. This result improves the result in H. Yang and A. Milani [Bull. Sci. Math. 124 (2000), 415-433] in the sense that, under the above restriction on the initial data, the decay rate given in that paper can be improved by t -γ/2. © European Mathematical Society.

  12. Social Media: A Phenomenon to be Analyzed

    OpenAIRE

    danah boyd

    2015-01-01

    The phenomenon of “social media” has more to do with its cultural positioning than its technological affordances. Rooted in the broader “Web 2.0” landscape, social media helped engineers, entrepreneurs, and everyday people reimagine the role that technology could play in information dissemination, community development, and communication. While the technologies invoked by the phrase social media have a long history, what unfolded in the 2000s reconfigured socio-technical practices in signific...

  13. Glomus Tumor Presenting as Raynaud's Phenomenon

    Directory of Open Access Journals (Sweden)

    M. H. Abdelrahman

    2012-01-01

    Full Text Available Glomus tumors are rare tumors that often include hands and feet; they present characteristically with paroxysmal pain, exquisite point tenderness, and cold sensitivity. Such diagnosis needs to be confirmed by imaging like ultrasound and magnetic resonance imaging (MRI. Surgical excision is the treatment of choice for glomus tumors. There are only few case reports of glomus tumors in association with Raynaud’s phenomenon; this is considered to be the 4th case.

  14. Nonequilibrium Goldstone phenomenon in Hybrid Inflation

    CERN Document Server

    Borsanyi, S; Sexty, D; Borsanyi, Sz.

    2003-01-01

    We study the onset of Goldstone phenomenon in a hybrid inflation scenario. The physically motivated range of parameters is analyzed in order to meet the cosmological constraints. Classical equations of motion are solved and the evolution through the spontaneous symmetry breaking is followed. We emphasize the role of topological defects that partially maintain the disordered phase well after the waterfall. We study the emergence of the Goldstone excitations and their role in the onset of the radiation dominated universe.

  15. Medical physics in radiotherapy: The importance of preserving clinical responsibilities and expanding the profession's role in research, education, and quality control

    Science.gov (United States)

    Malicki, Julian

    2015-01-01

    Medical physicists have long had an integral role in radiotherapy. In recent decades, medical physicists have slowly but surely stepped back from direct clinical responsibilities in planning radiotherapy treatments while medical dosimetrists have assumed more responsibility. In this article, I argue against this gradual withdrawal from routine therapy planning. It is essential that physicists be involved, at least to some extent, in treatment planning and clinical dosimetry for each and every patient; otherwise, physicists can no longer be considered clinical specialists. More importantly, this withdrawal could negatively impact treatment quality and patient safety. Medical physicists must have a sound understanding of human anatomy and physiology in order to be competent partners to radiation oncologists. In addition, they must possess a thorough knowledge of the physics of radiation as it interacts with body tissues, and also understand the limitations of the algorithms used in radiotherapy. Medical physicists should also take the lead in evaluating emerging challenges in quality and safety of radiotherapy. In this sense, the input of physicists in clinical audits and risk assessment is crucial. The way forward is to proactively take the necessary steps to maintain and advance our important role in clinical medicine. PMID:25949219

  16. Medical physics in radiotherapy: The importance of preserving clinical responsibilities and expanding the profession's role in research, education, and quality control.

    Science.gov (United States)

    Malicki, Julian

    2015-01-01

    Medical physicists have long had an integral role in radiotherapy. In recent decades, medical physicists have slowly but surely stepped back from direct clinical responsibilities in planning radiotherapy treatments while medical dosimetrists have assumed more responsibility. In this article, I argue against this gradual withdrawal from routine therapy planning. It is essential that physicists be involved, at least to some extent, in treatment planning and clinical dosimetry for each and every patient; otherwise, physicists can no longer be considered clinical specialists. More importantly, this withdrawal could negatively impact treatment quality and patient safety. Medical physicists must have a sound understanding of human anatomy and physiology in order to be competent partners to radiation oncologists. In addition, they must possess a thorough knowledge of the physics of radiation as it interacts with body tissues, and also understand the limitations of the algorithms used in radiotherapy. Medical physicists should also take the lead in evaluating emerging challenges in quality and safety of radiotherapy. In this sense, the input of physicists in clinical audits and risk assessment is crucial. The way forward is to proactively take the necessary steps to maintain and advance our important role in clinical medicine.

  17. Clinical importance of risk variants in the dihydropyrimidine dehydrogenase gene for the prediction of early-onset fluoropyrimidine toxicity.

    Science.gov (United States)

    Froehlich, Tanja K; Amstutz, Ursula; Aebi, Stefan; Joerger, Markus; Largiadèr, Carlo R

    2015-02-01

    We investigated the clinical relevance of dihydropyrimidine dehydrogenase gene (DPYD) variants to predict severe early-onset fluoropyrimidine (FP) toxicity, in particular of a recently discovered haplotype hapB3 and a linked deep intronic splice site mutation c.1129-5923C>G. Selected regions of DPYD were sequenced in prospectively collected germline DNA of 500 patients receiving FP-based chemotherapy. Associations of DPYD variants and haplotypes with hematologic, gastrointestinal, infectious, and dermatologic toxicity in therapy cycles 1-2 and resulting FP-dose interventions (dose reduction, therapy delay or cessation) were analyzed accounting for clinical and demographic covariates. Fifteen additional cases with toxicity-related therapy delay or cessation were retrospectively examined for risk variants. The association of c.1129-5923C>G/hapB3 (4.6% carrier frequency) with severe toxicity was replicated in an independent prospective cohort. Overall, c.1129-5923G/hapB3 carriers showed a relative risk of 3.74 (RR, 95% CI = 2.30-6.09, p = 2 × 10(-5)) for severe toxicity (grades 3-5). Of 31 risk variant carriers (c.1129-5923C>G/hapB3, c.1679T>G, c.1905+1G>A or c.2846A>T), 11 (all with c.1129-5923C>G/hapB3) experienced severe toxicity (15% of 72 cases, RR = 2.73, 95% CI = 1.61-4.63, p = 5 × 10(-6)), and 16 carriers (55%) required FP-dose interventions. Seven of the 15 (47%) retrospective cases carried a risk variant. The c.1129-5923C>G/hapB3 variant is a major contributor to severe early-onset FP toxicity in Caucasian patients. This variant may substantially improve the identification of patients at risk of FP toxicity compared to established DPYD risk variants (c.1905+1G>A, c.1679T>G and c.2846A>T). Pre-therapeutic DPYD testing may prevent 20-30% of life-threatening or lethal episodes of FP toxicity in Caucasian patients. © 2014 UICC.

  18. Two Japanese siblings affected with Chikungunya fever with different clinical courses: Imported infections from the Cook Islands.

    Science.gov (United States)

    Kondo, Makoto; Akachi, Shigehiro; Ando, Katsuhiko; Nomura, Tatsuma; Yamanaka, Keiichi; Mizutani, Hitoshi

    2016-06-01

    Two Japanese siblings visited the Cook Islands on business and stayed for 2 months. The sister developed a high fever, arthralgia, erythema and leg edema on the day after returning to Japan. The brother also developed neck and joint pain on the day following the sister's onset. Subsequently, his erythematous lesions spread over his whole body. Chikungunya virus was detected from the sister's blood and urine by specific reverse transcription polymerase chain reaction, but not in the brother's samples. Retrospectively, his history of Chikungunya fever was confirmed by the presence of the anti-Chikungunya virus immunoglobulin (Ig)M and IgG antibodies using the specific enzyme-linked immunoassay. In Japan, no autochthonous case of Chikungunya fever was reported previously. We should give attention to the imported infectious diseases for epidemic prevention. This report warns about the danger of the imported infectious diseases, and also suggests that covering the topic of infectious disease in the world is critical to doctors as well as travelers. © 2016 Japanese Dermatological Association.

  19. In vitro effects of citrus oils against Mycobacterium tuberculosis and non-tuberculous Mycobacteria of clinical importance.

    Science.gov (United States)

    Crandall, Philip G; Ricke, Steven C; O'Bryan, Corliss A; Parrish, Nicole M

    2012-01-01

    We evaluated the in vitro activity of citrus oils against Mycobacterium tuberculosis and other non-tuberculous Mycobacterium species. Citrus essential oils were tested against a variety of Mycobacterium species and strains using the BACTEC radiometric growth system. Cold pressed terpeneless Valencia oil (CPT) was further tested using the Wayne model of in vitro latency. Exposure of M. tuberculosis and M. bovis BCG to 0.025 % cold pressed terpeneless Valencia orange oil (CPT) resulted in a 3-log decrease in viable counts versus corresponding controls. Inhibition of various clinical isolates of the M. avium complex and M. abscessus ranged from 2.5 to 5.2-logs. Some species/strains were completely inhibited in the presence of CPT including one isolate each of the following: the M. avium complex, M. chelonae and M. avium subsp. paratuberculosis. CPT also inhibited the growth of BCG more than 99 % in an in vitro model of latency which mimics anaerobic dormancy thought to occur in vivo. The activity of CPT against drug-resistant strains of the M. avium complex and M. abscessus suggest that the mechanism of action for CPT is different than that of currently available drugs. Inhibition of latently adapted bacilli offers promise for treatment of latent infections of MTB. These results suggest that the antimycobacterial properties of CPT warrant further study to elucidate the specific mechanism of action and clarify the spectrum of activity.

  20. The importance of oral-clinical findings for the correct diagnosis of Ellis-van Creveld syndrome.

    Science.gov (United States)

    Pedro, Rafael Lima; Andrade, Lucia Helena Raymundo; Maia, Lucianne Cople

    2011-01-01

    Ellis-van Creveld syndrome (EVC), also known as chondroectodermal dysplasia, is a rare autosomal recessive disorder. It is characterized by a variable spectrum of clinical findings, and the most common tetrad is chondrodystrophy, polydactyly, ectodermal dysplasia, and cardiac defects. Among the oral findings, number anomalies, peg-shaped teeth, and alterations in soft tissues are noteworthy. The aim of this paper is to report a case in which the diagnosis of EVC was possible only with the oral findings of a dentist and to relate the dental treatment performed. A 2-year-old girl was brought for dental care due to a lack of teeth. Her condition was initially diagnosed as thanatophoric dysplasia by her pediatrician. After evaluation of the oral manifestations, the dentist referred her to a geneticist, with the suggestion of EVC. The dental report, together with the systemic manifestations, allowed the geneticist to confirm the EVC diagnosis. The necessary dental procedures were performed, and the patient, now age 5, is still monitored by a multidisciplinary team.

  1. Diffuse sclerosing variant of papillary carcinoma of the thyroid. Clinical importance, surgical treatment, and follow-up study

    Energy Technology Data Exchange (ETDEWEB)

    Fujimoto, Y.; Obara, T.; Ito, Y.; Kodama, T.; Aiba, M.; Yamaguchi, K. (Tokyo Women' s Medical College (Japan))

    1990-12-01

    A diffuse sclerosing variant is not very rare among papillary carcinomas of the thyroid when the patients are female and younger than 30 years of age. The variant is characterized by diffuse involvement of one or both thyroid lobes, with dense sclerosis, patchy lymphocytic infiltration, and abundant psammoma bodies. Controversy still exists concerning its prognosis. We reviewed our experience with 14 patients treated between 1958 and 1988. All patients were young females, their age being from 10 to 28 years with a mean of 19.6. Hashimoto's thyroiditis had been suspected in nine patients before they came to our clinic. Nowadays the diagnosis of this cancer is possible when we have this entity in mind and detect abundant psammoma bodies either by ultrasonography or by soft-tissue roentgenography of the neck. Total thyroidectomy with modified neck dissection was carried out in eight patients, subtotal thyroidectomy with neck dissection in five, and lobectomy with neck dissection in one. All of them are alive and well without distant metastasis at a mean follow-up of 16 years. Because most of the patients with this variant of papillary carcinoma are young women and the prognosis is favorable, a complete resection without causing later recurrence, but also cosmetic and complication-free surgery, should be considered.

  2. [Importance of Post-Marketing Studies in Gathering of Clinical Evidences for Proper Usage of Anti-Cancer Drugs, and the StudyRequirements for Their Credibility].

    Science.gov (United States)

    Inagaki, Osamu

    2016-04-01

    Pharmaceutical companies recognize the importance of post-marketing studies because they are crucial in the generation of clinical evidences for the usage of new medicines. To generate clinical evidences, quality of post-marketing studies should be well controlled from view point of "ethical conduction" and "reliability of results". In addition, control of conflict of interest (COI) between researchers and industries is also indispensable and is requested for the transparency of the studies. Japan Pharmaceutical Manufacturers Association(JPMA)stresses its commitment to the progressof transparency in post-marketing studies.

  3. Clinical importance of change in physical activity after endovascular treatment combined with exercise training in patients with peripheral arterial disease.

    Science.gov (United States)

    Otsuka, Shota; Morisawa, Tomoyuki; Yuguchi, Satoshi; Hojo, Yu; Matsuo, Tomohiro; Nakajima, Masaharu; Ishida, Atsuhisa; Takahashi, Tetsuya

    2017-02-01

    We aimed to investigate the characteristics of changes in amount of physical activity of patients with peripheral arterial disease (PAD) before/after endovascular treatment (EVT) combined with exercise training. Twenty-two patients with peripheral arterial disease at stage-II of the Fontaine classification who received EVT combined with exercise training were included in this study. A tri-axial accelerometer was used to record physical activity every day from the day before surgery to 3 months after discharge from hospital. The mean number of walking steps before surgery was 2664 steps (611 steps-5404 steps), whereas those after surgery was 3393 (567 steps-7578 steps). Ankle Brachial Index (from 0.69 to 1.03; p important for short-term prognosis.

  4. Perspectives of biotechnologies based on dormancy phenomenon for space researches

    Science.gov (United States)

    Alekseev, V.; Sychev, V.; Layus, D.; Levinsky, M.; Novikova, N.; Zakhodnova, T.

    Long term space missions will require a renewable source of food and an efficient method to recycle oxygen Plants especially aquatic micro algae provide an obvious solution to these problems However long duration plant growth and reproduction in space that is necessary for transportation of a control ecological life support system CELSS from Earth to other planets are problematic The introduction of heterotrophs in space CELSS is a more formidable problem as the absence of gravity creates additional difficulties for their life Dormancy phenomenon protected a great many animals and plants in harsh environmental conditions within a special resting phases of life cycle lasting from months up to hundred years This phenomenon can be quite perspective as a tool to overcome difficulties with CELSS transportation in space missions Cryptobiotic stages of microbes fungi unicellular algae and protists can survive in open space conditions that is important for interplanetary quarantine and biological security inside spacecraft Searching for life outside the Earth at such planet like Mars with extremely variable environment should be oriented on dormancy as crucial phases of a life cycle in such organisms Five major research programs aimed on study dormancy phenomenon for exobiology purposes and creation of new biotechnologies are discussed List of species candidate components of CELSS with dormancy in their life cycle used in space experiments at the Russian segment of International Space Station now includes 26 species from bacteria to fish The

  5. The regenerative medicine in oral and maxillofacial surgery: the most important innovations in the clinical application of mesenchymal stem cells.

    Science.gov (United States)

    Tatullo, Marco; Marrelli, Massimo; Paduano, Francesco

    2015-01-01

    Regenerative medicine is an emerging field of biotechnology that combines various aspects of medicine, cell and molecular biology, materials science and bioengineering in order to regenerate, repair or replace tissues. The oral surgery and maxillofacial surgery have a role in the treatment of traumatic or degenerative diseases that lead to a tissue loss: frequently, to rehabilitate these minuses, you should use techniques that have been improved over time. Since 1990, we started with the use of growth factors and platelet concentrates in oral and maxillofacial surgery; in the following period we start to use biomaterials, as well as several type of scaffolds and autologous tissues. The frontier of regenerative medicine nowadays is represented by the mesenchymal stem cells (MSCs): overcoming the ethical problems thanks to the use of mesenchymal stem cells from adult patient, and with the increasingly sophisticated technology to support their manipulation, MSCs are undoubtedly the future of medicine regenerative and they are showing perspectives unimaginable just a few years ago. Most recent studies are aimed to tissues regeneration using MSCs taken from sites that are even more accessible and rich in stem cells: the oral cavity turned out to be an important source of MSCs with the advantage to be easily accessible to the surgeon, thus avoiding to increase the morbidity of the patient. The future is the regeneration of whole organs or biological systems consisting of many different tissues, starting from an initial stem cell line, perhaps using innovative scaffolds together with the nano-engineering of biological tissues.

  6. Effect of Erica sp. Honey against Microorganisms of Clinical Importance: Study of the Factors Underlying this Biological Activity

    Directory of Open Access Journals (Sweden)

    Leticia M. Estevinho

    2013-04-01

    Full Text Available This study aimed to determine the factors (phenolic compounds, flavonoids, sugars or H2O2 that contribute the most to the antimicrobial activity of heather honey samples against four yeasts and four bacteria with medical importance. To discard the effect of H2O2 in the antimicrobial activity, catalase was added. To evaluate the osmotic pressure’s effect, artificial honey was also used. Phenolic compounds and flavonoids were determined and Pearson’s correlation analysis was performed to assess whether these correlated with antimicrobial activity. The amount of phenolic compounds ranged from 630.89 ± 5.21 GAE kg−1 to 718.92 ± 4.41 GAE kg−1, while the flavonoids varied between 450.72 ± 5.67 CAE kg−1 and 673.98 ± 4.33 CAE kg−1. For the bacteria, the minimum inhibitory concentration (MIC of the honey without catalase ranged from 1.01 ± 0.50% to 10.00 ± 4.72% and was between 2.00 ± 0.94% and 13.27 ± 5.23% for honey with catalase. Concerning the yeasts, the MICs was between 13.16 ± 4.08% and 20.00 ± 5.09% for honey without catalase and between 14.95 ± 4.16% and 25.67 ± 5.50% for honey with catalase. The elucidation of the antimicrobial factors and action mechanisms is essential for the correct use of honey in therapeutic applications.

  7. Social capital among healthcare professionals: A prospective study of its importance for job satisfaction, work engagement and engagement in clinical improvements.

    Science.gov (United States)

    Strömgren, Marcus; Eriksson, Andrea; Bergman, David; Dellve, Lotta

    2016-01-01

    Social capital can be an important resource to facilitate the needed improvements in quality of care and efficiency in hospitals. To assess the importance of social capital (recognition, vertical trust, horizontal trust and reciprocity) for job satisfaction, work engagement and engagement in clinical improvements. A prospective cohort design was used. Intensive care units and emergency, surgical and medical units at five Swedish hospitals with ongoing development of their processes of care. Healthcare professionals (physicians, registered nurses, assistant nurses) at five Swedish midsize hospitals. The participants answered a questionnaire at two occasions, NN=1602 at baseline and NN=1548 at one-year follow-up. Mean hospital response rate was 53% at baseline and 59% at follow-up. Univariate, multivariate and logistic regression analyses were performed, and the prospective analysis was based on 477 respondents. Social capital was associated with healthcare professionals' general work engagement and job satisfaction. Analysis showed positive associations between all measured aspects of social capital and engagement in clinical improvements of patient safety and quality of care. The prospective analysis showed that increased social capital predicted increased job satisfaction, work engagement and engagement in clinical improvements of patient safety. Social capital is strongly related to job satisfaction and active engagement with clinical improvements. The findings contribute to a deeper knowledge of social capital as a predictive factor that influences patient safety and health among healthcare staff. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Importance of dose intensity in neuro-oncology clinical trials: summary report of the Sixth Annual Meeting of the Blood-Brain Barrier Disruption Consortium.

    OpenAIRE

    2001-01-01

    Therapeutic options for the treatment of malignant brain tumors have been limited, in part, because of the presence of the blood-brain barrier. For this reason, the Sixth Annual Meeting of the Blood-Brain Barrier Disruption Consortium, the focus of which was the "Importance of Dose Intensity in Neuro-Oncology Clinical Trials," was convened in April 2000, at Government Camp, Mount Hood, Oregon. This meeting, which was supported by the National Cancer Institute, the National Institute of Neurol...

  9. Clinical deterioration during antitubercular treatment at a district hospital in South Africa: the importance of drug resistance and AIDS defining illnesses.

    Directory of Open Access Journals (Sweden)

    Dominique J Pepper

    Full Text Available BACKGROUND: Clinical deterioration on drug therapy for tuberculosis is a common cause of hospital admission in Africa. Potential causes for clinical deterioration in settings of high HIV-1 prevalence include drug resistant Mycobacterium tuberculosis (M.tb, co-morbid illnesses, poor adherence to therapy, tuberculosis associated-immune reconstitution inflammatory syndrome (TB-IRIS and subtherapeutic antitubercular drug levels. It is important to derive a rapid diagnostic work-up to determine the cause of clinical deterioration as well as specific management to prevent further clinical deterioration and death. We undertook this study among tuberculosis (TB patients referred to an adult district level hospital situated in a high HIV-1 prevalence setting to determine the frequency, reasons and outcome for such clinical deterioration. METHOD: A prospective observational study conducted during the first quarter of 2007. We defined clinical deterioration as clinical worsening or failure to stabilise after 14 or more days of antitubercular treatment, resulting in hospital referral. We collected data on tuberculosis diagnosis and treatment, HIV-1 status and antiretroviral treatment, and investigated reasons for clinical deterioration as well as outcome. RESULTS: During this period, 352 TB patients met inclusion criteria; 296 were admitted to hospital accounting for 17% of total medical admissions (n = 1755. Eighty three percent of TB patients (291/352 were known to be HIV-1 co-infected with a median CD4 count of 89cells/mm(3 (IQR 38-157. Mortality among TB patients admitted to hospital was 16% (n = 48. The median duration of hospital admission was 9.5 days (IQR 4-18, longer than routine in this setting (4 days. Among patients in whom HIV-1 status was known (n = 324, 72% of TB patients (n = 232 had an additional illness to tuberculosis; new AIDS defining illnesses (n = 80 were the most frequent additional illnesses (n = 208 in HIV-1 co-infected patients (n

  10. A importância da qualidade da água reagente no laboratório clínico The importance of water quality in clinical laboratory reagent

    Directory of Open Access Journals (Sweden)

    Maria Elizabete Mendes

    2011-06-01

    Full Text Available A água é um reagente utilizado na maioria dos testes laboratoriais e por isso deve seguir um padrão de controle de qualidade rigoroso. O fornecimento urbano de água apresenta moléculas orgânicas, íons inorgânicos, partículas, coloides, gases, bactérias e seus produtos, que podem alterar os resultados dos exames laboratoriais e causar eventuais erros e falhas mecânicas em equipamentos analíticos. Para remover essas impurezas, é necessário recorrer a uma combinação de tecnologias de purificação. Há várias organizações que especificam normas sobre a água reagente, a fim de minimizar sua interferência nos ensaios laboratoriais. A maioria dos laboratórios utiliza as normas estabelecidas pelo Clinical and Laboratory Standards Institute (CLSI que classifica a água em: clinical laboratory reagent water (CLRW, special reagent water (SRW e instrumental feed water (IFW. O monitoramento da qualidade é realizado pela determinação de resistividade, condutividade, carbono orgânico total (TOC, controle microbiológico e endotoxinas. Os parâmetros são avaliados de acordo com a periodicidade estabelecida pela norma utilizada. Neste artigo, discutem-se a importância da água utilizada nos procedimentos laboratoriais, o controle da qualidade e as interferências nos ensaios laboratoriais.Water is a reagent used in most laboratory tests and, therefore, must follow stringent quality control standards. The urban water supply has organic molecules, inorganic ions, particles, colloids, gases, bacteria and their products, which may alter laboratory test results and cause occasional errors and mechanical failures in diagnostic equipment. To remove these impurities, it is necessary to use a combination of purification technologies. There are several organizations that specify reagent water standards to minimize its interference in laboratory assays. Most laboratories set standards established by the Clinical and Laboratory Standards

  11. Storage-recovery phenomenon in magnonic crystal.

    Science.gov (United States)

    Chumak, A V; Vasyuchka, V I; Serga, A A; Kostylev, M P; Tiberkevich, V S; Hillebrands, B

    2012-06-22

    The phenomenon of coherent wave trapping and restoration is demonstrated experimentally in a magnonic crystal. Unlike the conventional scheme used in photonics, the trapping occurs not due to the deceleration of the incident wave when it enters the periodic structure but due to excitation of the quasinormal modes of the artificial crystal. This excitation occurs at the group velocity minima of the decelerated wave in narrow frequency regions near the edges of the band gaps of the crystal. The restoration of the traveling wave is implemented by means of phase-sensitive parametric amplification of the stored mode.

  12. Psychological differentiation and the phenomenon of pain.

    Science.gov (United States)

    Feldman, H R

    1984-01-01

    This article deals with a theory of psychological differentiation, research supporting this theory and identified indicators of differentiation, and studies that connect several of these indicators with the phenomenon of pain. Problems for investigation are posed concerning the relationships between differentiation indicators and pain threshold, pain tolerance, relief measures, attention to pain, control, and counterirritation An understanding of the kinds of variables affecting the pain experience can lead to a clearer perception and more astute evaluation of that experience and a more organized approach to the implementation of nursing care.

  13. Culture phenomenon analysis on the forest tour activity of China

    Institute of Scientific and Technical Information of China (English)

    Jiang Minjin

    2006-01-01

    This paper analyzes culture and forest culture, the intension of culture and forest culture, combines the understanding of the main cultural factor with the forest tour activity of China, analyzes the compatible phenomenon of Chinese forest culture and traditional culture, and explores culture of forest tourist site containing the meaning in forest tour. The author thinks the tour of forest culture which will be the important component of forest tour in forest culture,This paper puts forward simple questions existing in exploitation and advantage of forest tour culture, and proposes some countermeasures.

  14. Unfolding the phenomenon of inter-rater agreement

    DEFF Research Database (Denmark)

    Slaug, Bjørn; Schilling, Oliver; Helle, Tina

    2011-01-01

    Objective: The overall objective was to unfold the phenomenon of inter-rater agreement: to identify potential sources of variation in agreement data and to explore how they can be statistically accounted for. The ultimate aim was to propose recommendations for in-depth examination of agreement...... of in-depth examination of agreement variation, as a strategy for increasing the level of inter-rater agreement. By identifying and limiting the most important sources of disagreement, ultimately instrument reliability can be improved. Keywords: inter-rater, reliability, sources of disagreement, kappa...

  15. Nursing care systematization as a multidimensional and interactive phenomenon.

    Science.gov (United States)

    Backes, Dirce Stein; Koerich, Magda Santos; Nascimento, Keyla Cristiane do; Erdmann, Alacoque Lorenzini

    2008-01-01

    This study aimed to understand the meaning of Nursing Care Systematization (NCS) for multiprofessional health team professionals based on the relationships, interactions and associations of Complex thought. This qualitative study uses Grounded Theory as a methodological reference framework. Data were obtained through interviews with three sample groups, totaling 15 professionals from different institutions. Simultaneous data codification and analysis identified the central theme: 'Glimpsing nursing care systematization as an interactive and multidimensional phenomenon' and the respective reference model. NCS appoints, in addition to interactivity and professional complementarity, the importance of dialog and connection between the academy, health practices and regulatory offices, based on new reference frameworks for the organization of health practices.

  16. Clinical trials and systematic reviews addressing similar interventions for the same condition do not consider similar outcomes to be important: a case study in HIV/AIDS.

    Science.gov (United States)

    Saldanha, Ian J; Li, Tianjing; Yang, Cui; Owczarzak, Jill; Williamson, Paula R; Dickersin, Kay

    2017-04-01

    The usefulness of clinical trials and systematic reviews is compromised when they report different outcomes. We compared outcomes in reviews of HIV/AIDS and the trials included in the reviews. We examined all Cochrane reviews of HIV/AIDS (as of June 2013) that included ≥1 trial and the trials that the reviews included. We compared outcomes within subgroups defined by type of intervention: clinical management, biomedical prevention, behavioral prevention, and health services. We included 84 reviews that encompassed 524 trials. Although the median number of outcomes per trial (8) and per review (7.5) was similar, the trials reported a considerably greater number of unique outcomes than the reviews (779 vs. 218), ranging from 2.3 times greater (clinical management) to 5.4 times greater (behavioral prevention). High proportions of trial outcomes were not in any review: 68% (clinical management) to 83% (behavioral prevention). Lower proportions of review outcomes were not in any trial: 11% (clinical management) to 39% (health services). Outcomes in trials and reviews are not well aligned for appropriate inclusion of trial results in reviews and meta-analyses. Differences in perspectives, goals, and constraints between trialists and reviewers may explain differences in outcomes they consider important. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  17. Temporo-mandibular disorders are an important comorbidity of migraine and may be clinically difficult to distinguish them from tension-type headache

    Directory of Open Access Journals (Sweden)

    Ariovaldo Alberto da Silva Júnior

    2014-02-01

    Full Text Available Clinical differentiation between the primary headaches and temporomandibular disorders (TMD can be challenging. Objectives : To investigate the relationship between TMD and primary headaches by conducting face to face assessments in patients from an orofacial pain clinic and a headache tertiary center. Method : Sample consists of 289 individuals consecutively identified at a headache center and 78 individuals seen in an orofacial pain clinic because of symptoms suggestive of TMD. Results : Migraine was diagnosed in 79.8% of headache sufferers, in headache tertiary center, and 25.6% of those in orofacial pain clinic (p<0.001. Tension-type headache was present in 20.4% and 46.1%, while the TMD painful occurred in 48.1% and 70.5% respectively (p<0.001. Conclusion : TMD is an important comorbidity of migraine and difficult to distinguish clinically from tension-type headache, and this headache was more frequent in the dental center than at the medical center.

  18. Kierkegaard and the Sheer Phenomenon of Love

    DEFF Research Database (Denmark)

    Søltoft, Pia

    2013-01-01

    In this article we will argue that Kierkegaard has a positive view of love as a sheer natural and universal phenomenon. This sheer phenomenon of love is rooted in God’s love and is implanted in human nature by its Creator. Therefore this natural urge to love, that manifests itself both as a lack...... and a surplus, should not be juxtaposed to Christian neighbor love. For Kierkegaard there is one love, but this one love, hidden in the ground in every person, puts on different shapes and lets itself be known through these different forms. In this article we are interested in the dreaming and searching desire...... as described in “The Immediate Erotic Stages or The Musical-Erotic” in the first part of Either/Or, as these first and unconscious forms of love are the presupposition for falling in love, another form of love that is investigated in the article. We will argue the original form of love is preferential love...

  19. Identification of cultured isolates of clinically important yeast species using fluorescent fragment length analysis of the amplified internally transcribed rRNA spacer 2 region

    Directory of Open Access Journals (Sweden)

    Muylaert An

    2002-07-01

    Full Text Available Abstract Background The number of patients with yeast infection has increased during the last years. Also the variety of species of clinical importance has increased. Correct species identification is often important for efficient therapy, but is currently mostly based on phenotypic features and is sometimes time-consuming and depends largely on the expertise of technicians. Therefore, we evaluated the feasibility of PCR-based amplification of the internally transcribed spacer region 2 (ITS2, followed by fragment size analysis on the ABI Prism 310 for the identification of clinically important yeasts. Results A rapid DNA-extraction method, based on simple boiling-freezing was introduced. Of the 26 species tested, 22 could be identified unambiguously by scoring the length of the ITS2-region. No distinction could be made between the species Trichosporon asteroides and T. inkin or between T. mucoides and T. ovoides. The two varieties of Cryptococcus neoformans (var. neoformans and var. gattii could be differentiated from each other due to a one bp length difference of the ITS2 fragment. The three Cryptococcus laurentii isolates were split into two groups according to their ITS2-fragment lengths, in correspondence with the phylogenetic groups described previously. Since the obtained fragment lengths compare well to those described previously and could be exchanged between two laboratories, an internationally usable library of ITS2 fragment lengths can be constructed. Conclusions The existing ITS2 size based library enables identification of most of the clinically important yeast species within 6 hours starting from a single colony and can be easily updated when new species are described. Data can be exchanged between laboratories.

  20. Moe fenomen. The Phenomenon of Fashion

    Directory of Open Access Journals (Sweden)

    Ines Piibeleht

    2012-06-01

    Full Text Available Since the last quarter of the 20th century, particularly after the “cultural turn”, the interest in fashion has been increasing in a variety of different disciplines. Fashion has begun to be investigated in many different contexts, using new theoretical approaches. Fashion can be regarded as a social phenomenon, a sign system, as art, myth, or the product of the fashion industry. The purpose of this article is not to provide a definition of fashion, but rather to raise the question of how to approach the experience of fashion analytically. The methodological issues discussed here emerged in the course of preparing for empirical research on fashion. The observations and comparisons that constitute the core of this article are the result of efforts to juxtapose different methods. The traditional history of fashion used a historical-epistemological strategy but, depending on how one defines culture, the meaning of fashion can also be analysed using methods based on different epistemological strategies. The phenomenological method elaborated by Edmund Husserl, which I have chosen for my analysis of the experience of fashion, defines culture through the experiential acts of individuals. Simply stated, phenomenology considers the world as it is given to us in our consciousness. What is most important for empirical research is that the phenomenological method makes it possible to study the structure of a concrete experience and to focus on the mechanisms of the subjective creation of meaning. Thus this article has two main foci: a theoretical analysis of how the experience of fashion can be analytically revealed using the phenomenological method, and a comparison of the phenomenological approach with methods based on other strategies. The analysis of descriptions in the first person makes it possible to highlight how experience has been constructed. People “see” fashion based on structures of meaning; when they describe their own experience

  1. Importance of diagnostic laboratory methods of beta hemolytic streptococcus group A in comparison with clinical findings in the diagnosis of streptococcal sore throat and unnecessary antibacterial therapy

    Directory of Open Access Journals (Sweden)

    Peiman Eini

    2012-04-01

    Full Text Available Background: Streptococcus Pyogenes (group A streptococcus, GAS is the most important cause of bacterial pharyngitis in children and adolescents. Acute pharyngitis is one of the most common conditions in all ages but it is most common in children. Over diagnosis of acute pharyngitis represents one of the major causes of antibiotic abuse. The goal of this study is to make an estimate of the frequency of group A streptococcus in sore throat patients in Farshchian hospital emergency department and clinic in Hamadan. Methods: For estimation of the clinical features role in diagnosis of streptococcal sore throat, we took samples of 100 patients with average age of 32.96±29.86 years with sore throat. We took samples from pharynx and used standard methods of bacteriology in order to detect streptococcus. Results: Group A Streptococcus (GAS accounts for 3 percent of all cases of pharyngitis. Clinically, all of the patients had sore throat. The percent breakdowns are as follows: 30% had exudate, 78% had fever, 8% had lymphadenopathy and 7.7 percent of exudative pharyngitis was streptococcal. The cost for unnecessary antibiotic therapy for every single patient who had negative pharynx culture was approximately 32160 Rails. Conclusion: The low frequency of streptococcus pharyngitis in treated patients reveal that diagnosis based on clinical features is not reliable. We recommend use of other diagnostic methods such as Rapid Antigen Detection Tests (RATs. Only reliable and scientific protocols for antibiotic to therapy.

  2. Student travel health and the role of universities and health clinics in New Zealand to prevent imported infections: a cross-sectional study.

    Science.gov (United States)

    Neave, Penny E; Nair, Balakrishnan; Heywood, Anita E

    2017-05-01

    Tertiary students are at risk of acquiring infectious diseases during overseas travel as they visit low-income countries, have low perceptions of risk and are unlikely to access travel health advice. Some will visit friends and relatives abroad, a group identified as disproportionately affected by imported infections. There is no national student travel health policy in NZ. This study aimed to explore travel health training of university-based health providers; academics' practices and perceptions of travel health; reasons for travel and countries visited by NZ university students, their travel health uptake and factors affecting decision making about this. A cross-sectional study consisting of surveys sent in 2014 to university clinics, senior academics and students. Surveys were completed by 251 respondents. Three of nine clinicians had only undertaken a short course in travel health. Competing resources and time constraints in health clinics were amongst the barriers to providing optimal services. Of the senior academics, only 14% were able to confirm their university collaborated with health clinics. Sixty seven percent of students were unaware that clinics provided travel health services and 19% had or intended to seek professional travel health advice. A national policy is warranted involving all stakeholders, utilizing innovative technologies to increase uptake of student travel health services.

  3. Shedding Phenomenon of Ventilated Partial Cavitation around an Underwater Projectile

    Institute of Scientific and Technical Information of China (English)

    WANG Yi-Wei; HUANG Chen-Guang; DU Te-Zhuan; WU Xian-Qian; FANG Xin; LIANG Nai-Gang; WEI Yan-Peng

    2012-01-01

    A new shedding phenomenon of ventilated partial cavitations is observed around an axisymmetric projectile in a horizontal launching experiment. The experiment system is established based on SHPB launching and high speed photography. A numerical simulation is carried out based on the homogeneous mixture approach, and its predicted evolutions of cavities are compared with the experimental results. The cavity breaks off by the interaction between the gas injection and the re-entry jet at the middle location of the projectile, which is obviously different from natural cavitation. The mechanism of cavity breaking and shedding is investigated, and the influences of important factors are also discussed.%A new shedding phenomenon of ventilated partial cavitations is observed around an axisymmetric projectile in a horizontal launching experiment.The experiment system is established based on SHPB launching and high speed photography.A numerical simulation is carried out based on the homogeneous mixture approach,and its predicted evolutions of cavities are compared with the experimental results.The cavity breaks off by the interaction between the gas injection and the re-entry jet at the middle location of the projectile,which is obviously different from natural cavitation.The mechanism of cavity breaking and shedding is investigated,and the influences of important factors are also discussed.

  4. GLOBALIZATION AS A POLITICAL, ECONOMIC AND SOCIAL PHENOMENON

    Directory of Open Access Journals (Sweden)

    María Victoria Flores Trujillo

    2016-07-01

    Full Text Available Globalization is defined as a process that integrates knowledge worldwide, has its historical reference on changes in the ways processes, methods and information are addressed; documented its inception in the late twentieth century, Castells, M. (2001 beyond the discrepancy about whether it is a product of technological development or an inevitable evolution of capitalism, research arises from the formulation of the following questions: How important is the study of globalization ?, What has produced important contributions in the scientific community about globalization? And What are the perspectives or approaches addressed? . This work aims to show how the scientific community has produced knowledge about this phenomenon addressing the political, economic and social approaches: From the economic point of view reconfigures how to address the processes of production, distribution and consumption of goods and services in the world, permeating this way all international economic events. From the political point of view, besides the redistribution of emerging geopolitical blocs, it establishes a new category of state, transnational state. From the social point of view, it shows evidence of the negative effects of globalization on resizing the category personal, local or regional or even in global risk-Global group. The research is documentary literature, their contribution to social science evidence to characterize globalization as political, economic and social phenomenon of the century that permeates all areas of study applied.

  5. Gravity as an emergent phenomenon: experimental signatures

    CERN Document Server

    Consoli, M

    2013-01-01

    According to some authors, gravity might be an emergent phenomenon in a fundamentally flat space-time. In this case the speed of light in the vacuum would not coincide exactly with the basic parameter "c" entering Lorentz transformations and, for an apparatus placed on the Earth's surface, light should exhibit a tiny fractional anisotropy at the level 10^{-15}. We argue that, most probably, this effect is now observed in many room-temperature ether-drift experiments and, in particular, in a very precise cryogenic experiment where this level of signal is about 100 times larger than the designed short-term stability. To fully appreciate what is going on, however, one should consider the vacuum as a true physical medium whose fundamental quantum nature gives rise to the irregular, non-deterministic pattern which characterizes the observed signal.

  6. PUBLIC RELATIONS AS AN INFORMATION PROCESS PHENOMENON

    Directory of Open Access Journals (Sweden)

    TKACH L. M.

    2016-06-01

    Full Text Available Formulation of the problem. If public relations as a phenomenon of information management are examined, we deal with the question of knowledge content and nature of relationship of PR with environment, ability to manage the perception and attitude of people to events in the environment; ensure priority of information over other resources. Goal. To investigate the concept of "public relations" of foreign and domestic experts; consider the typology of the public and the "laws" of public opinion; define the basic principles according to which relations with public should be built, and to identify PR activities as a kind of social communication. Conclusions. Public relations on the basis of advanced information and communication technologies create fundamentally new opportunities for information control and influence on public consciousness.

  7. On the 'Meishan Phenomenon' in Song culture

    Institute of Scientific and Technical Information of China (English)

    Zhu Shangshu

    2006-01-01

    The Song Dynasty enjoyed a splendid culture.Meishan,a small county in Southwest Sichuan,was one of the most developed cultural areas.This is closely related to a large-scale immigration after the collapse of the an area receiving more immigrants than other regions.A great number of distinguished families from North China brought with them the advanced culture of the Yellow River areas to Meishan,which combined with native culture,and produced many"cultural clans"from this"clan culture."Some of these people became elites in various areas through education and the Civil Service Examinations.The so-called"Meishan Phenomenon"was a result of cultural melting.

  8. Dependence phenomenon analysis of the stock market

    Science.gov (United States)

    Cheng, Wuyang; Wang, Jun

    2013-04-01

    A random financial stock price model is developed by the interacting contact process, which is one of the statistical-physics systems. The contact process is a continuous-time Markov process, one interpretation of this process is as a model for the spread of an infection, where the epidemic spreading mimics the interplay of local infections and the recovery of individuals. We investigate and analyze the long-term memory, the nonlinear correlations and the multifractal phenomenon of normalized returns of the price model by statistical analysis methods, which include autocorrelation analysis, the Gaussian copula method and the multifractal analysis method. Moreover, we consider the daily returns of the Shanghai Stock Exchange Composite Index and the Shenzhen Stock Exchange Composite Index, and the comparisons of statistical behaviors of returns between the actual data and the simulation data are presented.

  9. Statistical analysis of the migration phenomenon

    Directory of Open Access Journals (Sweden)

    Alina - Andreea CRUCERU

    2010-11-01

    Full Text Available On the basis of economic conditions being devalued in Romania, more and more persons were forced to find a work place – be it temporary or permanent – outside of the country’s borders. This phenomenon of international migration has, as a main effect, the emergence of a special category of persons, respectively that of children left behind under the care of one of the parents or of other people. The situation of these minors is extremely difficult because, lacking the careful supervision of their evolution by their parents, they arefrequently confronted with problems of social adaptation, with learning difficulties and even with situations of willful breaking of legal norms.

  10. [The enhancement phenomenon of serous cavity effusions].

    Science.gov (United States)

    Gaeta, M; Volta, S; Stroscio, S; Carella, I; Mantineo, G; Bartiromo, G; Pandolfo, I

    1990-01-01

    The enhancement of ascites following a high dose of contrast medium has been recently described. The CT behavior of 26 peritoneal, pleural or pericardial effusions has been studied in 23 patients after the administration of a high dose of urographic contrast medium. The effusions were enhanced in all patients but one. No difference between malignant and non-malignant effusions could be observed with ionic and non-ionic contrast medium. Low molecular weight of the urographic contrast medium (600-800 daltons) can explain the free passage of the solute through peritoneum, pleura, and pericardium. The knowledge of such a phenomenon is mandatory to avoid misdiagnosing hematic effusion or urinary-peritoneal fistula.

  11. Topological Mass Generation as an Interference Phenomenon

    CERN Document Server

    Ilha, A; Ilha, Anderson; Wotzasek, Clovis

    2000-01-01

    It is proposed a new mechanism for the phenomenon of topological mass generation in three spacetime dimensions as the result of the interference of two opposite massless chiral modes. This mechanism, already used to produce the massive vectorial mode of the 2D Schwinger model, is here exploited to produce the gauge invariant massive mode of the Maxwell-Chern-Simons theory. Moreover the procedure is clearly dimensionally independent: a new chiral boson action is proposed for odd and even dimensional space-times to be used as the basic building blocks of the interference schemes. This is a new result that extends the two-dimensional Floreanini-Jackiw action to higher dimensional spaces and is in clear contrast with the twice odd dimensional chiral form extensions.

  12. Interference Phenomenon for Different Chiral Bosonization Schemes

    CERN Document Server

    Abreu, Everton M C; Abreu, Everton M C; Wotzasek, Clovis

    1998-01-01

    We study the relationship between different chiral bosonization schemes (CBS) in the context of the soldering formalism\\cite{MS}, that considers the phenomenon of interference in the quantum field theory\\cite{ABW}. This analysis is done in the framework put forward by Siegel\\cite{WS} and by Floreanini and Jackiw\\cite{FJ} (FJ). We propose a field redefinition that discloses the presence of a noton, a non dynamical field, in Siegel's formulation for chiral bosons. The presence of a noton in the Siegel CBS is a new and surprising result, that separates dynamics from symmetry by diagonalising the Siegel action into the FJ and the noton action. While the first describes the chiral dynamics, the noton carries the symmetry contents, acquiring dynamics upon quantization and is fully responsible for the Siegel anomaly. The diagonal representation proposed here is used to study the effect of quantum interference between gauged rightons and leftons.

  13. The Trump phenomenon, an explanation from sociophysics

    CERN Document Server

    Galam, Serge

    2016-01-01

    The Trump phenomenon is argued to depart from current populist rise in Europe. According to a model of opinion dynamics from sociophysics the machinery of Trump's amazing success obeys well-defined counter-intuitive rules. Therefore, his success was in principle predictable from the start. The model uses local majority rule arguments and obeys a threshold dynamics. The associated tipping points are found to depend on the leading collective beliefs, cognitive biases and prejudices of the social group which undertakes the public debate. And here comes the sesame of the Trump campaign, which develops along two successive steps. During a first moment, Trump's statement produces a majority of voters against him. But at the same time, according to the model the shocking character of the statement modifies the prejudice balance. In case the prejudice is present even being frozen among voters, the tipping point is lowered at Trump's benefit. Nevertheless, although the tipping point has been lowered by the activation ...

  14. OPTIMIZATION OF X-RAY DIAGNOSIS OF ANKYLOSING SPONDYLITIS IN CLINICAL PRACTICE: IMPORTANCE OF A PLAIN X-RAY FILM OF THE PELVIS

    Directory of Open Access Journals (Sweden)

    A. V. Smirnov

    2015-01-01

    Full Text Available Ankylosing spondylitis (AS is a disease whose main clinical manifestation  is an inflammatory lesion in the axial skeleton with its gradual ankylosing. The peak incidence of AS occurs at a young age; and, if there is no timely adequate therapy, its disability rates are virtually as high as 50% ten years after disease onset, which determines the social importance of this disease The diagnosis of AS is based on its characteristic  clinical presentation  and the compulsory detection  of sacroiliitis on pelvic radiography. However, the existing reports of the X-ray stages of sacroiliac joint injuries in the literature provide little evidence and frequently misinterpret  radiographic changes. Based on their long-term  experience, the authors give expanded explanations of the standard X-ray stages of sacroiliitis and other radiographic signs that can make a diagnostic search in AS easier.

  15. Prussian phenomenon and its historical distortion

    Directory of Open Access Journals (Sweden)

    Oleg Y. Plenkov

    2016-03-01

    Full Text Available The article deals with the phenomenon of Prussia. Once, Prussia had been the largest continental Protestant state in Europe. The main issue of this phenomenon is that upon the tragic events of the World War II Prussian history and heritage had been considerably distorted, in order to compensate somehow for the dreadful casualties suffered by the victorious powers. The common European misconception implied that Prussia had been the bulwark of militarism, and therefore had to bear all the responsibility for the atrocities of war. Unfortunately, the majority of modern German historians share such misinterpretation of Prussian heritage in order to please false political correctness, perhaps, as an act of contrition for National Socialism and its crimes. However, the Prussian tradition and history go far beyond this militarism, and this article explains what ways. The authors believe that there should not be any prejudices and biases, that any subject should be examined sine ira et studio. Moreover, given that it is possible to characterize the Great French Revolution as a juristic one, and the Great October revolution – as a social one, the Prussian revolution “from above”, led by the first representatives of the Hohenzollern family, may be well considered as a pedagogical revolution. This revolution did bring definitely positive changes; they are surveyed in the article. The French Revolution has not eliminated the covetousness of the bourgeoisie after 1789; despotism of the authorities and people’s passiveness similarly have remained unaltered in Russia after 1917. On the contrary, Federal Republic of Germany of nowadays, distinctive for its law, order and effective responsible government is unthinkable without Prussian heritage.

  16. What are the important components of the clinical assessment of hand problems in older adults in primary care? Results of a Delphi study

    Directory of Open Access Journals (Sweden)

    Dziedzic Krysia

    2010-08-01

    Full Text Available Abstract Background To identify clinical questions and assessments regarded by health care practitioners as important when assessing undifferentiated hand pain or problems in adults aged 50 years and over presenting to primary care. Methods A purposively selected panel of 26 UK-based Health Care Practitioners comprising occupational therapists, physiotherapists, rheumatologists and general practitioners, were invited to take part in a consensus study involving three postal rounds of a Delphi questionnaire with accompanying case scenarios. Participants were asked to generate questions and assessments (round 1, rate their importance (round 2, and vote on which items were most important (round 3. Results Sixteen Health Care Practitioners agreed to participate with 11 completing all three rounds. The first round of the Delphi study generated 156 questions and 143 assessments. After three rounds agreement was reached on the importance of 25 questions and 19 assessments. Questions were weighted towards current symptoms, but also included the history of previous hand problems, self-reported hand function, co-morbidity and general health. Observation and palpation of features predominated in the choice of assessment, but specific tests, grip strength, evaluation of sensation and hand function were also included. Conclusions A pool of clinical questions and assessments were generated by Health Care Practitioners, and those considered most important for assessing older adults presenting with undifferentiated hand pain and hand problems in primary care were identified. Further evaluation is required to establish the reliability and feasibility of using these questions and assessments in primary care. In particular, the relative contribution of these questions and assessments in evaluating the nature and severity of hand problems, assisting diagnosis, indicating appropriate management, and predicting future course requires further investigation.

  17. Atrial myxoma in a primigravida presenting as Raynaud’s phenomenon

    Directory of Open Access Journals (Sweden)

    Mansoor C. Abdulla

    2015-10-01

    Full Text Available A 32-year-old primigravida at 8 weeks of gestation presented with gangrene of both great toe for 10 days. Two years back, she had an episode of Raynaud’s phenomenon involving left ring finger diagnosed as primary Raynaud’s phenomenon and was treated with nifedipine following which she improved. In the following months, she had 2-3 similar episodes of Raynaud’s phenomenon in the upper extremity which were less severe. On diagnostic evaluation she was found to have an intra cardiac mass arising from mitral leaflet. We present a case of atrial myxoma initially presenting as an isolated Raynaud’s phenomenon with a long asymptomatic period before the next clinical manifestation which to our knowledge is the first such report.

  18. Clinical importance of cine-MRI assessment of small bowel motility in patients with chronic intestinal pseudo-obstruction: a retrospective study of 33 patients.

    Science.gov (United States)

    Fuyuki, Akiko; Ohkubo, Hidenori; Higurashi, Takuma; Iida, Hiroshi; Inoh, Yumi; Inamori, Masahiko; Nakajima, Atsushi

    2017-05-01

    Although chronic intestinal pseudo-obstruction (CIPO) is a rare and extremely severe functional digestive disorder, its clinical course and severity show various patterns. We assessed small bowel peristalsis in CIPO patients using cine-MRI (video-motion MRI) and their clinical characteristics to evaluate the clinical importance of performing cine-MRI in patients with this intractable disease. The medical records of 131 patients referred to our institution with a suspected diagnosis of CIPO between 2010 and 2015 were retrospectively evaluated. Thirty-three patients (22 female/11 male; age range 16-79 years) who met the criteria for CIPO and underwent cine-MRI were enrolled. Mean luminal diameter (MLD), contraction ratio (CR), and contraction cycle (CC) were determined and compared with these parameters in healthy volunteers. Clinical outcomes in patients with CIPO were also evaluated. The median follow-up time was 25.2 months (range, 1-65 months). Of the 33 patients with CIPO, 23 (70 %) showed apparently disturbed small intestinal peristalsis, whereas 10 (30 %) did not. The percentage of patients requiring intravenous alimentation was significantly higher (p = 0.03), and the mean serum albumin level was significantly lower (p = 0.04), in patients with than without impaired small intestinal peristalsis. Although both cine-MRI and CT findings in the latter ten cases were within the normal range, MLD and CR differed significantly from healthy volunteers. Cine-MRI is useful in predicting severe clinical features in patients with CIPO, and in detecting slightly impaired small contractility that cannot be detected on CT.

  19. Pelvic floor muscle importance - Evidence based information with EMG-device about Pelvic floor muscle function: Booklet for the use of MediVITAL Clinic

    OpenAIRE

    Mesiniemi, Jenny

    2016-01-01

    The purpose of this Bachelor ́s thesis was to give evidence based information about pelvic floor importance, its physiotherapy, EMG-machine examination and to create a booklet about the subject for the use of MediVITAL CLINIC S.L. in Spain. Aim was to give understandable knowledge about pelvic floor structure, dysfunctions and how EMG is used as a part of evaluation and training in pelvic floor physiotherapy. The thesis includes a theoretical part about pelvic floor structure, most common...

  20. The importance of a full clinical examination: assessment of index lesions referred to a skin cancer clinic without a total body skin examination would miss one in three melanomas.

    Science.gov (United States)

    Aldridge, R Benjamin; Naysmith, Lisa; Ooi, Ee Ting; Murray, Caroline S; Rees, Jonathan L

    2013-11-01

    Traditional clinical teaching emphasises the importance of a full clinical examination. In the clinical assessment of lesions that may be skin cancer, full examination allows detection of incidental lesions, as well as helping in the characterisation of the index lesion. Despite this, a total body skin examination is not always performed. Based on two prospective studies of over 1,800 sequential patients in two UK centres we show that over one third of melanomas detected in secondary care are found as incidental lesions, in patients referred for assessment of other potential skin cancers. The majority of these melanomas occurred in patients whose index lesion turned out to be benign. Alternative models of care--for instance some models of teledermatology in which a total body skin examination is not performed by a competent practitioner--cannot be considered equivalent to a traditional consultation and, if adopted uncritically, without system change, will likely lead to melanomas being missed.

  1. Importância clínica e laboratorial do volume plaquetário médio The clinical and laboratory importance of mean platelet volume

    Directory of Open Access Journals (Sweden)

    Mariela Granero Farias

    2010-08-01

    Full Text Available Os índices plaquetários fornecidos pelos analisadores hematológicos são provavelmente os parâmetros mais ignorados pela maioria dos laboratórios clínicos, em virtude da dificuldade de sua padronização. Desses índices, o volume plaquetário médio (VPM vem merecendo destaque por sua grande utilidade, não só em casos de trombose e hemostasia, mas também em uma série de patologias, como diabetes, doenças da tireoide, doenças vasculares, entre outras. O VPM é um parâmetro plaquetário fornecido no hemograma que não gera custos adicionais para o laboratório. Junto com a contagem de plaquetas, ele é um sensível indicador de desordens plaquetárias in vivo, mas pode ser tecnicamente difícil de analisá-lo in vitro por causa dos interferentes pré-analíticos, como tempo de armazenamento da amostra e artefatos gerados pelos anticoagulantes. Neste artigo descrevemos as principais metodologias e seus interferentes na determinação da contagem plaquetária e do VPM, destacando a importância do laboratório de análises clínicas em validar esse parâmetro, proporcionando sua utilização no diagnóstico de desordens hematológicas e de outras patologias.The platelet indices provided by the hematological analyzers are probably the parameters mostly ignored by most clinical laboratories due to standardization difficulties. Among those indices, the mean platelet volume (MPV has stood out due to its usefulness not only in cases of thrombosis and hemostasy, but also in a series of pathologies, such as diabetes, thyroid and vascular diseases, among others. MPV is a platelet parameter provided by the hemogram, which does not represent additional costs to the laboratory. Along with platelet count, it is a sensitive indicator of platelet disorders in vivo. However, it may be technically difficult to analyze it in vitro owing to preanalytical interferences, such as sample storage time and anticoagulant artifacts. In this article we described

  2. Advances in the treatment of Raynaud’s phenomenon

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    Terri L Levien

    2010-03-01

    Full Text Available Terri L LevienDrug Information Pharmacist and Clinical Associate Professor, College of Pharmacy, Washington State University Spokane, WA, USAAbstract: Raynaud’s phenomenon is a common condition characterized by vasospasm of the digital arteries and resulting cyanosis and redness. It often does not require pharmacologic management, but in some cases symptoms are severe and pharmacologic management is necessary. Calcium channel blockers are often used first-line, but in some patients are ineffective. Patients with severe symptoms or intolerance to available therapies have prompted exploration of alternative therapies, including endothelin antagonists, phosphodiesterase-5 inhibitors, antioxidants, newer vasodilators, statins, and botulinum toxin. These newer therapies provide the focus for this review.Keywords: Raynaud, iloprost, bosentan, phosphodiesterase-5 inhibitors

  3. Assessment of the minimum clinically important difference in quality of life in schizophrenia measured by the Quality of Well-Being Scale and disease-specific measures.

    Science.gov (United States)

    Thwin, Soe Soe; Hermes, Eric; Lew, Robert; Barnett, Paul; Liang, Matthew; Valley, Danielle; Rosenheck, Robert

    2013-10-30

    This study examines the psychometric properties of the Quality of Well Being Scale (QWB), the Positive and Negative Syndrome Scale (PANSS), the Heinrich-Carpenter Quality of Life Scale (QOLS), and the Lenert PANSS-based utility measure in a cohort of patients with schizophrenia and identifies threshold values of clinically meaningful change using the Clinical Global Impressions scale (CGI), as the anchor. The correlation of these measures at baseline and change at 6 and 12 months post enrollment in a comparative effectiveness trial was evaluated in 350 veterans with schizophrenia or schizoaffective disorder. An equipercentile method was used to estimate the minimum clinically important difference (MCID) for each measure. Effect size of 0.30-0.50 for baseline quality of life associated with inpatient status supported concurrent validity. The QWB was moderately correlated with disease-specific measures. The MCID as detected by the CGI at 6 months was 0.17 for QWB, 0.15 for the Lenert utility score, 1.13 for the QOLS, and 20.2 for the PANSS. These differences were stable at 12 months. The QWB is significantly correlated with disease specific measures of health related quality of life in schizophrenia. Published by Elsevier Ireland Ltd.

  4. Importance of Client Orientation Domains in Non-Clinical Quality of Care: A Household Survey in High and Low Income Districts of Mashhad.

    Science.gov (United States)

    Fazaeli, Somayeh; Yousefi, Mehdi; Banikazemi, Seyed Hasan; Ghazizadeh Hashemi, Seyed Amir Hossein; Vakilzadeh, Ali Khorsand; Hoseinzadeh Aval, Narges

    2015-12-18

    Responsiveness introduced by WHO as a key indicator to assess the performance of health systems and measures by common set of domains that are categorized in to two main categories "Respect for persons" and "client orientation". This study measured importance of client orientation domains in high and low income districts of Mashhad. In this cross-sectional and explanatory study, Sample of 923 households were selected randomly from two high and low income districts of Mashhad. World Health Organization (WHO) questionnaire was used for data collection. Standard frequency analyses and Ordinal logistic regression (OLR) was employed for data analysis. In general, respondents selected quality of basic amenities as the most important domain and access to social support networks was identified as the least important domain. Households in high income area scored higher domains of prompt attentions and choice Compared to low income. There was a significant relationship between variables of ages, having member that need to care and self-assessed health with the ranking of client orientation domains.Study of households' view on ranking of non-clinical aspects of quality of care, especially when faced with limited resources, can help to conduct efforts towards subjects that are more important, and lead to improve the health system performance and productivity.

  5. Importance of clinical trial design and standardized implementation in ophthalmology%重视眼科临床试验的设计和实施管理

    Institute of Scientific and Technical Information of China (English)

    许迅

    2013-01-01

    临床试验是一种非常重要的医学研究方法,是转化医学的桥梁,其结果常常作为制定临床诊疗指南的科学依据.目前我国虽已在开展眼科临床试验方面积累了较多经验,但试验方案设计的科学性、规范性、伦理性仍存在一些问题,影响了研究结果的真实性和可靠性.因而,重视眼科临床试验的设计和实施管理是今后眼科临床试验的目标和发展方向.临床试验的设计应根据试验目的,遵循国际通用的伦理学准则和设计原则,重视随机化、盲法和对照设置,实施中应注意人员培训、管理和监察,尽可能减少方案偏离的发生和保证数据真实性.%Clinical trial is an important medical research method,as well as the bridge of translational medicine.The results of scientific evidences are useful to make clinical practice guidelines.At present,much experience of carrying out ophthalmology clinical trials has been obtained and achieved,but there are still some scientific,practical and ethical problems to be solved,because of their impact on the authenticity and reliability of the results.Therefore,attaching great importance to design of the clinical research and implement of the standardization would be the goal and the development direction.Clinical trial design rely on objective,follow international design principles on the ethics,randomization,blinding and placebo setting.During the trial implementation,personnel training,project management and monitoring would help to reduce protocol deviation and ensure data authenticity.

  6. Fenômeno de Raynaud Raynaud's phenomenon

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    Cristiane Kayser

    2009-02-01

    Full Text Available O fenômeno de Raynaud (FRy caracteriza-se por episódios reversíveis de vasoespasmos de extremidades, associados a palidez, seguido por cianose e rubor de mãos e pés, que ocorrem usualmente após estresse ou exposição ao frio. O FRy primário é um evento funcional benigno e não está associado a nenhuma doença ou condição subjacente. Já o FRy secundário pode estar associado a uma série de condições, principalmente a doenças reumáticas autoimunes. Na esclerose sistêmica (ES, o FRy é a manifestação inicial mais frequente. No FRy secundário às doenças do espectro da ES, complicações como lesões isquêmicas de extremidades são frequentes. Nos últimos anos, avanços no estudo da fisiopatologia do FRy e da doença vascular na ES propiciaram o surgimento de opções terapêuticas bastante promissoras para essa manifestação. Nesta revisão pretendemos discorrer principalmente sobre a patogênese, a investigação clínica e o tratamento do FRy, com ênfase nos novos tratamentos disponíveis.Raynaud's phenomenon (RP is an episodic vasospasm of the peripheral arterioles, causing pallor followed by cyanosis and redness of the fingers and toes, usually in response to stress or cold exposure. Primary Raynaud's phenomenon is a benign event and occurs without an underlying disease. In contrast, secondary Raynaud's phenomenon can occur in association with several underlying diseases or conditions, mostly autoimmune rheumatic diseases. In systemic sclerosis (SSc, RP is the most frequent initial manifestation. In RP secondary to SSc-related diseases, digital ischemic lesions are a frequent problem. In recent years, advances in the understanding of the physiopathology of RP have favored the development of novel promising therapeutic alternatives for this clinical condition. This article presents a review of the pathogenesis, clinical investigation and treatment of RP, with special emphasis in novel therapeutic modalities.

  7. Clinical importance and impact on the households of oseltamivir-resistant seasonal A/H1N1 influenza virus in healthy children in Italy

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    Esposito Susanna

    2010-08-01

    Full Text Available Abstract A resistance of A/H1N1 influenza viruses to oseltamivir has recently emerged in a number of countries. However, the clinical and socioeconomic importance of this resistance has not been precisely defined. As children have the highest incidence of influenza infection and are at high risk of severe disease, the aim of this study was to evaluate the clinical importance and the impact on the households of oseltamivir-resistant seasonal A/H1N1 influenza virus in an otherwise healthy pediatric population. A total of 4,726 healthy children younger than 15 years with influenza-like illness were tested for influenza viruses by real-time polymerase chain reaction in the winters of 2007-2008 and 2008-2009 in Italy. The influenza A virus-positive samples underwent neuraminidase gene analysis using pyrosequencing to identify mutations H275Y and N294 S in A/H1N1, and E119V, R292K, and N294 S in A/H3N2. Among the A/H1N1 subtypes, the H275Y mutation was found in 2/126 samples taken in 2007-2008 (1.6% and in all 17 samples (100%; p

  8. Importance of dose intensity in neuro-oncology clinical trials: summary report of the Sixth Annual Meeting of the Blood-Brain Barrier Disruption Consortium.

    Science.gov (United States)

    Doolittle, N D; Anderson, C P; Bleyer, W A; Cairncross, J G; Cloughesy, T; Eck, S L; Guastadisegni, P; Hall, W A; Muldoon, L L; Patel, S J; Peereboom, D; Siegal, T; Neuwelt, E A

    2001-01-01

    Therapeutic options for the treatment of malignant brain tumors have been limited, in part, because of the presence of the blood-brain barrier. For this reason, the Sixth Annual Meeting of the Blood-Brain Barrier Disruption Consortium, the focus of which was the "Importance of Dose Intensity in Neuro-Oncology Clinical Trials," was convened in April 2000, at Government Camp, Mount Hood, Oregon. This meeting, which was supported by the National Cancer Institute, the National Institute of Neurological Disorders and Stroke, and the National Institute of Deafness and Other Communication Disorders, brought together clinicians and basic scientists from across the U.S. to discuss the role of dose intensity and enhanced chemotherapy delivery in the treatment of malignant brain tumors and to design multicenter clinical trials. Optimizing chemotherapy delivery to the CNS is crucial, particularly in view of recent progress identifying certain brain tumors as chemosensitive. The discovery that specific constellations of genetic alterations can predict which tumors are chemoresponsive, and can therefore more accurately predict prognosis, has important implications for delivery of intensive, effective chemotherapy regimens with acceptable toxicities. This report summarizes the discussions, future directions, and key questions regarding dose-intensive treatment of primary CNS lymphoma, CNS relapse of systemic non-Hodgkin's lymphoma, anaplastic oligodendroglioma, high-grade glioma, and metastatic cancer of the brain. The promising role of cytoenhancers and chemoprotectants as part of dose-intensive regimens for chemosensitive brain tumors and development of improved gene therapies for malignant gliomas are discussed.

  9. Toxoplasmose na gestação: diagnóstico, tratamento e importância de protocolo clínico Toxoplasmosis in pregnancy: diagnosis, treatment and the importance of clinical protocol

    Directory of Open Access Journals (Sweden)

    Fabiana Burdini Margonato

    2007-12-01

    Full Text Available OBJETIVOS: comparar aspectos laboratoriais, terapêuticos e gastos com toxoplasmose em gestantes, em época prévia à implantação de protocolo clínico, a uma situação hipotética de aplicação de um protocolo. MÉTODOS: coorte histórica com gestantes inscritas no pré-natal de unidades básicas de saúde de Londrina, Paraná, que realizaram exames laboratoriais de rotina de pré-natal, incluindo sorologia para toxoplasmose aguda, no período de janeiro a novembro de 2004. Os dados foram obtidos na Secretaria Municipal de Saúde e no Hospital Universitário. A realização de exame confirmatório, tratamento e respectivos gastos foram comparados com dados provenientes de uma situação hipotética de implantação de um protocolo clínico. RESULTADOS: na situação real, em 75% das gestantes com IgM reagente para toxoplasmose não houve diagnóstico definitivo e, entre as que realizaram exame confirmatório, o tempo médio decorrido entre os dois exames foi de 23 semanas; 28,5% foram tratadas sem confirmação e no único caso confirmado não houve tratamento. Na comparação com a situação hipotética, a realização do exame confirmatório na mesma amostra de sangue possibilitaria diagnóstico definitivo a todas. Os menores gastos com medicamentos compensariam o aumento de custos com exames confirmatórios. CONCLUSÕES: os resultados demonstram a importância da implantação de protocolos clínicos de forma adequada, quer seja sob o ponto de vista de proteção à saúde, ou de economia.OBJECTIVES: to compare therapeutic and laboratory aspects of toxoplasmosis in pregnant women as well as its cost in a real situation and in a hypothetical situation employing a clinical protocol.METHODS: a time-series cohort study was carried out with pregnant women taking part between January and November 2004 in the prenatal program at the Primary Health Units in Londrina, Paraná, Brazil, whose prenatal routine laboratory tests included serology

  10. Importância da avaliação da hemoglobina fetal na clínica da anemia falciforme The importance of the evaluation of fetal hemoglobin in the clinical assessment of sickle cell disease

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    Rita de Cassia Mousinho-Ribeiro

    2008-04-01

    Full Text Available A anemia falciforme está entre as doenças genéticas mais comuns e mais estudadas em todo o mundo. Ela é causada por mutação no gene β, produzindo alteração estrutural na molécula da hemoglobina. As moléculas de HbS, decorrentes da mutação, sofrem processo de polimerização fisiologicamente provocado pela baixa tensão de oxigênio, acidose e desidratação. Com isso, os eritrócitos passam a apresentar a forma de foice, causando vaso-oclusão e outras conseqüências. O objetivo desse estudo foi revisar a importância da hemoglobina fetal na clínica de pacientes portadores de anemia falciforme. O significado clínico da associação da elevação da hemoglobina fetal na anemia falciforme mostra-se favorável em termos hematológicos, pois, nessa interação, as células-F têm baixas concentrações de HbS e, com isso, inibem a polimerização da HbS e a alteração da morfologia dos eritrócitos. O tratamento com hidroxiuréia, em função do aumento na expressão da hemoglobina fetal que este fármaco proporciona, traz aos pacientes falcêmicos uma melhora significativa em sua clínica. Portanto, a hemoglobina fetal consiste no maior inibidor da polimerização da desoxi-HbS e, com isso, evita a falcização do eritrócito, a anemia hemolítica crônica, as crises dolorosas vaso-oclusivas, o infarto e a necrose em diversos órgãos, melhorando a clínica e a expectativa de vida dos pacientes.Sickle cell disease is one of the commonest and most studied genetic diseases in the world. Caused by a mutation of the β gene, it changes the molecular structure of hemoglobin. Abnormal Hb S molecules suffer polymerization physiologically provoked by a low oxygen tension, acidosis and dehydration. As a result, red blood cells take on a sickle cell form, which causes microvascular occlusion with varying consequences. The objective of this study was to review the importance of fetal hemoglobin in the clinical assessment of sickle cell

  11. Transient alien limb phenomenon in right frontoparietal infarction

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    Panda Samhita

    2010-01-01

    Full Text Available Alien limb phenomenon is associated with different neurological disorders, such as stroke and corticobasal degeneration. It is usually caused by involvement of the corpus callosum, with or without the frontal regions. Rarely, it can result from insult in the posterior cerebral artery territory. Alien limb phenomenon is generally persistent. Here, an unusual case of transient alien hand phenomenon is reported.

  12. Both Clinical Thinking and Practical Skill are very important for Orthodontics Clinical Work%浅谈口腔正畸学中临床思维与实践技能的并重

    Institute of Scientific and Technical Information of China (English)

    宋少华; 庞煊奈; 莫水学

    2012-01-01

    口腔正畸学对临床思维和实践技能均有较高的要求.在口腔正畸医生的成长和发展中,一方面要注意培养临床哲学思维,如整体与局部、理论-实践-理论、限度的问题、发展与联系等观点;另一方面应在临床实践中通过临床前基本技能培训及临床技能训练逐渐夯实其临床能力.通过开展临床病例讨论、专题讲课、病例总结等可进一步有效地将二者结合以提高口腔正畸医生的临床综合业务素质.%The clinical philosophical thinking and practical skill play a very important role in orthodontic clinic. To train and develop a good orthodontic specialist, the development of clinical philosophical thinking such as system and local, theory-practice-theory,limitation,development and relationship, and so on, should be concerned and emphasized; on the other hand, the training of preclinical basic practical skill and clinical practical skill should be also used to improve specialists' clinical ability. Cases discussion, seminar and concluding analysis of clinical cases are effective ways to enhance specialis ts' integrated ability on problem solving by linking clinical thinking and practical skill together.

  13. [Imported histoplasmosis].

    Science.gov (United States)

    Stete, Katarina; Kern, Winfried V; Rieg, Siegbert; Serr, Annerose; Maurer, Christian; Tintelnot, Kathrin; Wagner, Dirk

    2015-06-01

    Infections with Histoplasma capsulatum are rare in Germany, and mostly imported from endemic areas. Infections can present as localized or disseminated diseases in immunocompromised as well as immunocompetent hosts. A travel history may be a major clue for diagnosing histoplasmosis. Diagnostic tools include histology, cultural and molecular detection as well as serology. Here we present four cases of patients diagnosed and treated in Freiburg between 2004 and 2013 that demonstrate the broad range of clinical manifestations of histoplasmosis: an immunocompetent patient with chronic basal meningitis; a patient with HIV infection and fatal disseminated disease; a patient with pulmonary and cutaneous disease and mediastinal and cervical lymphadenopathy; and an immunosuppressed patient with disseminated involvement of lung, bone marrow and adrenal glands.

  14. [The knowledge of animal respiration as a combustion phenomenon].

    Science.gov (United States)

    de Micheli, Alfredo

    2014-01-01

    The different stages leading to knowledge of the phenomenon of animal breathing are going from some writings in Corpus Hippocraticum to Aristoteles' and Galen's works, who considered the heart as the source of the animal heat. Later, Miguel Servet suggested that the inspired air can achieve other functions besides cooling the blood. After that, different explications of the animal heat were raised. About 1770, due to progress of knowledge in the chemistry field, first Mayow and later Black began to consider the animal respiration as a combustion. The important treatise Méthode de nomenclature chimique, published by Guyton de Morveau et al. in 1787 and soon after the Traité élémentaire de chimie de Lavoisier (1789) provided a solid support to Lavoisier's thought. This way on arrived to consider analogous the respiration and combustion phenomena. Studies on the animal respiration phenomenon continued in xix century and in the following century it was possible to apply thermodynamic principles to biology: "generalized thermodynamics". Copyright © 2013 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  15. 25. Ischemic pain in the extremities and Raynaud's phenomenon.

    Science.gov (United States)

    Devulder, Jacques; van Suijlekom, Hans; van Dongen, Robert; Diwan, Sudhir; Mekhail, Nagy; van Kleef, Maarten; Huygen, Frank

    2011-01-01

    Two important groups of disorders result from an insufficient blood supply to the extremities: critical vascular disease and the Raynaud's phenomenon. The latter can be subdivided into a primary and a secondary type. Critical ischemic disease is often caused by arteriosclerosis due to hypertension or diabetes. Primary Raynaud's is idiopathic and will be diagnosed as such if underlying systemic pathology has been excluded. Secondary Raynaud's is often a manifestation of a systemic disease. It is essential to try to establish a diagnosis as soon as possible in order to influence the evolution of the disease. A sympathetic nerve block can be considered in patients with critical ischemic vascular disease after extensive conservative treatment, preferably in the context of a study (2B±). If this has insufficient effect, spinal cord stimulation can be considered in a selected patient group (2B±). In view of the degree of invasiveness and the costs involved, this treatment should preferably be applied in the context of a study and with the use of transcutaneous pO(2) measurements. In case of primary Raynaud's, life style changes are the first step. Sympathectomy can be considered as a treatment of Raynaud's phenomenon (2C+), but only after multidisciplinary evaluation of the patient and in close consultation with the patient's rheumatologist, vascular surgeon or internist.

  16. Empirical Study on the Creative Accounting Phenomenon

    Directory of Open Access Journals (Sweden)

    Cernusca Lucian

    2016-06-01

    Full Text Available The present study aims to analyze the accounting professionals’ point of view as opposed to the students and master students’ one, regarding the creative accounting phenomenon existence and manifestation forms. In order to accomplish this objective, there has been used the poll/investigation, as a research method and the questionnaire, as a research instrument. Within the study, there is suggested the testing of more hypotheses that contribute to the clarifying of the aspects wished to be analyzed through the research. These hypotheses’ acceptance or rejection is based on the „chi-square“ (Karl Pearson statistical test and rank ordering method. Trying to elaborate a global conclusion of the questionnaire, there could be noticed the fact that over 50% from the questioned accounting students are not tempted to use the creative accounting practices and techniques in order to optimize the taxation without breaking the actual law regulations. At the opposite side, more than a half from the questioned accounting professionals would use these practices without breaking the law regulations that lead to the taxation’s optimization. The creative accounting has a negative connotation if the accurate image of the financial position and of the performance is not targeted because it represents the essential factor for elaborating and grounding the accounting policies. However, the positive side of the creative accounting is not excluded, given that one appeals to the „fair“ professional judgment of the accounting professionals and to the good faith of managers.

  17. Mapping The Phenomenon Of Students’ Entrepreneurial Intention

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    Yud Buana

    2016-09-01

    Full Text Available This research mapped the phenomena that occured in students who are taking classes entrepreneurship that was limited by entrepreneurial knowledge, personal attitude, social norms and self-efficacy. Using descriptive statistics on the answers of 794 respondents, who were students of Bina Nusantara University, produced a variety of results. Based on entrepreneurial knowledge, students still felt hesitant to be able to start and run the entrepreneurial process. On the other hand, self-efficacy and personal attitude reflect a positive thing associated, while the support of family and the environment around where they livevalued invariety. Although this research discovered phenomenon using all the attributes having impacts on entrepreneurship intention, potential students who are properly trained have a probability of playing a leading role in this regard. The benefits that can be expected from this research are useful in identifying suitable students for any entrepreneurial activity in the future with the support of educational institutions, families, and the government as a whole to form the atmosphere of an entrepreneurial culture.

  18. Priming intelligent behavior: an elusive phenomenon.

    Directory of Open Access Journals (Sweden)

    David R Shanks

    Full Text Available Can behavior be unconsciously primed via the activation of attitudes, stereotypes, or other concepts? A number of studies have suggested that such priming effects can occur, and a prominent illustration is the claim that individuals' accuracy in answering general knowledge questions can be influenced by activating intelligence-related concepts such as professor or soccer hooligan. In 9 experiments with 475 participants we employed the procedures used in these studies, as well as a number of variants of those procedures, in an attempt to obtain this intelligence priming effect. None of the experiments obtained the effect, although financial incentives did boost performance. A Bayesian analysis reveals considerable evidential support for the null hypothesis. The results conform to the pattern typically obtained in word priming experiments in which priming is very narrow in its generalization and unconscious (subliminal influences, if they occur at all, are extremely short-lived. We encourage others to explore the circumstances in which this phenomenon might be obtained.

  19. Interhemispheric sensorimotor integration; an upper limb phenomenon?

    Science.gov (United States)

    Ruddy, Kathy L; Jaspers, Ellen; Keller, Martin; Wenderoth, Nicole

    2016-10-01

    Somatosensory information from the limbs reaches the contralateral Primary Sensory Cortex (S1) with a delay of 23ms for finger, and 40ms for leg (somatosensory N20/N40). Upon arrival of this input in the cortex, motor evoked potentials (MEPs) elicited by Transcranial Magnetic Stimulation (TMS) are momentarily inhibited. This phenomenon is called 'short latency afferent inhibition (SAI)' and can be used as a tool for investigating sensorimotor interactions in the brain. We used SAI to investigate the process of sensorimotor integration in the hemisphere ipsilateral to the stimulated limb. We hypothesized that ipsilateral SAI would occur with a delay following the onset of contralateral SAI, to allow for transcallosal conduction of the signal. We electrically stimulated the limb either contralateral or ipsilateral to the hemisphere receiving TMS, using a range of different interstimulus intervals (ISI). We tested the First Dorsal Interosseous (FDI) muscle in the hand, and Tibialis Anterior (TA) in the lower leg, in three separate experiments. Ipsilateral SAI was elicited in the upper limb (FDI) at all ISIs that were greater than N20+18ms (all p<.05) but never at any earlier timepoint. No ipsilateral SAI was detected in the lower limb (TA) at any of the tested ISIs. The delayed onset timing of ipsilateral SAI suggests that transcallosal communication mediates this inhibitory process for the upper limb. The complete absence of ipsilateral SAI in the lower limb warrants consideration of the potential limb-specific differences in demands for bilateral sensorimotor integration.

  20. Capillaroscopic pattern in paraneoplastic Raynaud's phenomenon.

    Science.gov (United States)

    Lambova, S; Müller-Ladner, U

    2013-06-01

    The capillaroscopic pattern in paraneoplastic Raynaud's phenomenon (RP) has not been investigated systematically and is not well-defined. Here, we present three case reports of patients with paraneoplastic rheumatic conditions, manifested with severe secondary RP with emphasis upon capillaroscopic findings. The first patient is a 58-year-old male with known psoriasis and psoriatic arthritis, severe RP and scleroderma-like syndrome, resulting in a paraneoplastic syndrome in the context of a lung cancer. At capillaroscopic examination classic "scleroderma" pattern, an "early" type was found. The second patient is a 48-year-old woman with an abrupt onset of paraneoplastic dermatomyositis, severe RP, and a lung cancer. The capillaroscopic examination revealed frequent dilated and giant capillaries, hemorrhages and severe microvascular disarrangement-the so-called "scleroderma-like" pattern typical of the idiopathic forms of the disease. The third patient is a 56-year-old woman with paraneoplastic dermatomyositis, secondary RP, and thyroid cancer. The capillaroscopic examination showed dilated and giant capillaries, elongated capillaries, decreased mean capillary density with avascular areas, severe disarrangement, single hemorrhages, and clear evidence of neoangiogenesis. These capillaroscopic features characteristic of the "scleroderma-like" pattern are indistinguishable from those in idiopathic dermatomyositis like in the second case. Taken together, the cases illustrate the problem that capillaroscopic patterns in paraneoplastic RP in the context of scleroderma-like syndrome and dermatomyositis appear to be indistinguishable from the microvascular changes in the respective idiopathic rheumatic diseases.