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At least 343 records · Page 19Linked to original sources
PubMed2000

Closed tibial shaft fractures: management and treatment complications. A review of the prospective literature.

OBJECTIVE: To compare the results and complications of the various modalities for treating closed fractures of the tibial shaft described in the prospective literature. DATA SOURCES: A MEDLINE search of the English language literature from 1966 to 1999 was conducted using the MeSH heading "tibial fractures." Studies pertaining to the management of closed tibial shaft fractures were reviewed, and their reference lists were searched for additional articles. STUDY SELECTION: An analysis of the relevant prospective, randomized controlled trials was performed. Studies including confounding data on open fractures or fractures in children were excluded. The 13 remaining studies were reviewed. DATA EXTRACTION: Raw data were extracted and pooled for each method of treatment. DATA SYNTHESIS: The 13 studies described 895 tibial shaft fractures treated by application of a plaster cast, fixation with plate and screws, and reamed or unreamed intramedullary nailing. Although definitions varied, the combined incidence of delayed and nonunion was lower with operative treatment (2.6% with plate fixation, 8.0% with reamed nailing and 16.7% with unreamed nailing) than with closed treatment (17.2%). The incidence of malunion was similarly lower with operative treatment (0% with plate fixation, 3.2% with reamed nailing and 11.8% with unreamed nailing) than with closed treatment (31.7%). Superficial infection was most common with plate fixation (9.0%) compared with 2.9% for reamed nailing, 0.5% for unreamed nailing and 0% for closed treatment. The incidence of osteomyelitis was similar for all groups. Rates of reoperation ranged from 4.7% to 23.1%. CONCLUSIONS: All forms of treatment for tibial shaft fractures are associated with complications. A knowledge of the incidence of each complication facilitates the consent process. To fully resolve the controversy as to the best method of treatment, a large, randomized, controlled trial is required. This review more precisely predicts the expected incidence of complications, allowing the numbers of required patients to be more accurately determined for future randomized controlled studies.

Adult↗
PubMed1999

Mood stabilizers in children and adolescents.

OBJECTIVE: The efficacy of mood stabilizers in children and adolescents has not been studied adequately. This article will review existing studies and highlight some important issues in designing future studies on these agents. METHOD: Electronic databases including Medline, Psycholnfo, and CRISP were searched for data in children receiving compounds that have mood-stabilizing properties in adults. RESULTS: Some open clinical data and an extremely modest amount of controlled research data suggest lithium, carbamazepine, and valproate may be effective mood stabilizers in children and adolescents. There are no controlled data on other potential mood stabilizers in children. CONCLUSIONS: The disorders that may be responsive to mood stabilizers are among the most morbid in child psychiatry. More studies are needed to clarify the efficacy of these compounds in children and adolescents and to provide a rational basis for choosing among them.

Adolescent↗
PubMed2026

Artificial Intelligence for Colorectal Surgeons-Part II: Research Applications, Challenges in Adoption, and Practical Resources.

BACKGROUND: This is part II of a 2-part series examining artificial intelligence in colorectal surgery. Part I established foundational concepts and clinical applications. Implementation, however, requires understanding research methodologies, available resources, and the specific challenges currently limiting widespread adoption. These topics are the focus of part II. OBJECTIVE: To examine artificial intelligence's transformation of surgical research, provide practical implementation resources, address adoption challenges, and explore future directions in colorectal surgery. METHODS: Comprehensive literature review focusing on artificial intelligence research methodology, implementation barriers, educational resources, and emerging technologies relevant to colorectal surgeons. RESULTS: Artificial intelligence streamlines clinical trial design through predictive modeling and natural language processing, reducing enrollment challenges that contribute to failed or inadequate trial accrual. Machine learning enables heterogeneity analysis within clinical trials, identifying treatment-responsive subgroups. Foundation models unlock analysis of unstructured electronic health record data at scale. Professional societies and universities offer specialized artificial intelligence education programs, with open-access data sets facilitating research participation. However, implementation faces multifaceted challenges: technical infrastructure demands, with real-time processing requiring dedicated graphics processing unit clusters; regulatory frameworks struggling with continuously evolving algorithms; undefined liability distribution for artificial intelligence-assisted decisions; algorithmic bias risking health care disparities; and the "black box" problem limiting clinical trust. Economic barriers include substantial initial costs without clear reimbursement pathways. Future directions include multimodal artificial intelligence integrating imaging, genomics, and histopathology; cognitive robotic systems with real-time decision support; digital twin technology for patient-specific surgical simulation; and global surgical artificial intelligence networks enabling distributed learning across institutions. CONCLUSIONS: Although artificial intelligence offers transformative potential for colorectal surgery research and practice, successful implementation requires addressing technical, regulatory, ethical, and economic challenges. The surgeon's evolving role demands both traditional expertise and computational fluency. Future advances in multimodal integration, autonomous systems, and global collaboration will fundamentally reshape surgical practice but will require thoughtful implementation prioritizing patient benefit and clinical value.

Humans↗
PubMed2004

[Prediction of mandibular movement by observation of facial skin markers].

PURPOSE: Various methods have been used for observation of mandibular movement. However, many methods disturb physiological movement as the subject must wear a sensor. Therefore, to predict mandibular movement from the motion of facial skin, the correlation between the movements of mandibular incisor-tooth point and facial skin markers was evaluated by multiple regression analysis. METHODS: Nine retro-reflective markers were placed on the lower facial skin of 8 dentulous subjects and three markers on the wire frame attached to the mandibular tooth, respectively. Movement of markers was repeatedly recorded by 6 video cameras from centric occlusion to maximal opening position. Data was analyzed and the movements were constructed in 3D. In order to predict movement (opening, vertical, anterior-posterior) at an incisor-tooth point, multiple regression analysis was performed by making the 27 amounts of 3D movements (X, Y, Z components) of nine facial skin markers as explanatory variables. The difference between the actual value and the predicted value by multiple regressions was calculated, and compared in the 5 ranges of analysis (0-5 mm, 0-10 mm, 0-15 mm, 5-10 mm, 10-15 mm). RESULTS: The movements of mouth opening and vertical direction could be predicted with the accuracy of 0.76 mm (3.7%)and 0.69 mm (4.9%) in the range of 0-15 mm with nine variables, respectively. However, the accuracy of movements in the anterior-posterior direction was 0.40 mm (9.7%) with ten variables. The ratio was larger than these in the movements of mouth opening and vertical direction. CONCLUSIONS: It was suggested that movement of mandibular incisor-tooth point in mouth opening and vertical direction to 15 mm could be predicted from the facial skin markers.

English Abstract↗
PubMed2002

[Open vs. laparoscopic appendectomy].

This article discusses the question of whether open or laparoscopic appendectomy is preferable in today's clinical routine. The article is based on data from randomized studies, evaluation of meta-analyses, and data from nonrandomized, multicentric studies evaluating the treatment of appendicitis in routine clinical practice. According to the data analysis, open appendectomy (OA) offers advantages with regard to a significantly shorter operative time and lower hospital costs. Laparoscopic appendectomy (LA) is characterized by a significantly decreased rate of failed septic wound healing and faster recovery. Both procedures can be performed with the same degree of safety and comparable outcome for acute appendicitis. Laparoscopic appendectomy offers significant advantages for establishing a precise diagnosis in young fertile women and overweight patients suffering from lower abdominal pain. The currently available data do not provide precise guidelines for the treatment of perforating appendicitis. However, we found significant evidence indicating an increased rate of postoperative intra-abdominal abscess after laparoscopic appendectomy. Thus, a laparoscopic approach cannot be regarded as a standard technique in advanced appendicitis.

Abdominal Abscess↗
PubMed1989

Critical evaluation of treatment of staghorn calculi by percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy.

The combined use of percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy in patients with staghorn calculi has become an established treatment regimen. We evaluated the results of 90 staghorn calculi-bearing kidneys treated with such combination therapy after a mean follow-up of approximately 2 years. A total of 69 kidneys (76.7 per cent) became free of stones at some point after treatment. However, due to stone recurrence this number decreased to 55 kidneys (61.1 per cent) at the end of follow-up. Patients who had undergone a previous open operation on the stone-bearing kidney showed less favorable results than the over-all group. When our results were compared to reported data on open surgery or percutaneous nephrolithotomy alone even better results may have been obtained by such treatment modalities. However, our data indicate that percutaneous stone debulking combined with further destruction of residual stone fragments by shock wave lithotripsy certainly is less invasive than an open operation and provides an alternative to percutaneous treatment alone, which can yield comparable results.

Adult↗
PubMed2003

Ischaemic preconditioning inhibits opening of mitochondrial permeability transition pores in the reperfused rat heart.

Opening of the mitochondrial permeability transition pore (MPTP) is thought to be a critical event in mediating the damage to hearts that accompanies their reperfusion following prolonged ischaemia. Protection from reperfusion injury occurs if the prolonged ischaemic period is preceded by short ischaemic periods followed by recovery. Here we investigate whether such ischaemic preconditioning (IPC) is accompanied by inhibition of MPTP opening. MPTP opening in Langendorff-perfused rat hearts was determined by perfusion with 2-deoxy[3H]glucose ([3H]DOG) and measurement of mitochondrial [3H]DOG entrapment. We demonstrate that IPC inhibits initial MPTP opening in hearts reperfused after 30 min global ischaemia, and subsequently enhances pore closure as hearts recover. However, MPTP opening in mitochondria isolated from IPC hearts occurred more readily than control mitochondria, implying that MPTP inhibition by IPC in situ was secondary to other factors such as decreased calcium overload and oxidative stress. Hearts perfused with cyclosporin A or sanglifehrin A, powerful inhibitors of the MPTP, also recovered better from ischaemia than controls (improved haemodynamic function and less lactate dehydrogenase release). However, the mitochondrial DOG entrapment technique showed these agents to be less effective than IPC at preventing MPTP opening. Our data suggest that protection from reperfusion injury is better achieved by reducing factors that induce MPTP opening than by inhibiting the MPTP directly.

Animals↗
PubMed1993

New trends in serial ECG analysis.

The prerequisite for future development and assessment of serial electrocardiographic analysis programs is the availability of easy to use database management systems for storage and retrieval of electrocardiographic data and results and efficient means for electronic interchange of digital electrocardiographic data. The basic aim of project 2026 of the European program for advanced informatics in medicine is to encourage "open European data interchange and processing for electrocardiography" (OEDIPE) and to provide objective decision support techniques in the field of quantitative electrocardiology. The final objective is to develop demonstration systems for the follow-up evaluation of (1) selected populations with heart disease, (2) integrating serial analysis, (3) decision support, (4) open databases, and (5) communication protocols, which will foreshadow large-scale monitoring of ambulatory or critically ill patients at home, during their transportation in an emergency vehicle, or during their stay in a hospital. The first-year objectives and achievements of the OEDIPE project are briefly described. Emphasis is put on the management of serial electrocardiographic records and data and on the control strategies for the management of the serial analysis process.

Aged↗
PubMed1997

Implementation of Varian's EDW 5.2 on a Clinac 2300C/D for use with Helax TMS 3.1 dose planning system.

An EDW field is in principle a sum of fields with different sizes. The Helax TMS 3.1 dose planning system uses pre-existing open beam data and information specific to the geometry of the accelerator treatment head including flattening filter and collimators to generate open fields. These open fields are then summed using the Segmented Treatment Tables (STT) to generate the Enhanced Dynamic Wedge fields. Verification of predicted fields and output factors against measured data are discussed for different wedge angles, asymmetric fields and shaped fields.

Algorithms↗
PubMed2006

Durable efficacy of tipranavir-ritonavir in combination with an optimised background regimen of antiretroviral drugs for treatment-experienced HIV-1-infected patients at 48 weeks in the Randomized Evaluation of Strategic Intervention in multi-drug reSistant patients with Tipranavir (RESIST) studies: an analysis of combined data from two randomised open-label trials.

BACKGROUND: Treatment options for HIV-1 infected individuals who have received extensive previous antiretroviral therapy are limited. We compared efficacy and safety of the novel non-peptidic protease inhibitor tipranavir co-administered with ritonavir plus an optimised background regimen with that of an investigator-selected ritonavir-boosted comparator protease inhibitor (CPI-ritonavir) in such patients. METHODS: We did a combined analysis of 48-week data from two ongoing, randomised, open-label, multinational, phase III, RESIST studies. HIV-1-infected adults with 3 months or longer previous triple antiretroviral class experience, two or more previous protease inhibitor regimens, HIV-1 RNA 1000 copies per mL or greater, and genotypically demonstrated primary resistance to protease inhibitor, were eligible. Primary endpoints were proportion of treatment responders (with reduction in viral load of 1 log(10) copies per mL or greater below baseline without treatment change) at 48 weeks and time to treatment failure through 48 weeks (intention-to-treat analysis). The RESIST studies are registered with ClinicalTrials.gov, numbers NCT00054717 (RESIST-1) and NCT00144170 (RESIST-2). FINDINGS: 3324 patients were screened; 746 received tipranavir-ritonavir and 737 CPI-ritonavir. 486 (65.1%) patients on tipranavir-ritonavir and 192 (26.1%) on CPI-ritonavir remained on assigned treatment until week 48. At week 48, more patients achieved and maintained treatment response in the tipranavir-ritonavir group than in the CPI-ritonavir group (251 [33.6%] vs 113 [15.3%]; p<0.0001). Median time to treatment failure was significantly longer in the tipranavir-ritonavir group than in the CPI-ritonavir group (113 days vs 0 days; p<0.0001). Gastrointestinal system disorders and raised transaminase, cholesterol, and triglycerides were more frequent in the tipranavir-ritonavir group than in the CPI-ritonavir group. INTERPRETATION: Compared with CPI-ritonavir, tipranavir-ritonavir with an optimised background regimen provides better virological and immunological responses over 48 weeks in patients who have received extensive previous antiretroviral treatment.

Adult↗
PubMed2001

Can laparoscopy reduce hospital stay in the treatment of Crohn's disease?

PURPOSE: The aim of this article was to investigate the safety, outcome, length of stay, and cost of hospital admission in patients with Crohn's disease who underwent laparoscopy compared with open surgery. METHODS: Among 51 consecutive patients with inflammatory bowel disease (1996-2000), 46 with Crohn's disease were included in this nonrandomized prospective study. Of these, 20 patients underwent laparoscopic surgery and 26 underwent open surgery. Data collected included the following information: age, gender, body mass index, diagnosis, duration of disease, preoperative medical treatment, previous abdominal surgery, present indication for surgery, and procedure performed (comparability measures), as well as conversion to open surgery, operating time, time to resolution of ileus, morbidity, duration of hospital stay, and cost of hospital admission (outcome measures). RESULTS: There was no significant difference with respect to comparability measures between the laparoscopic and the open-surgery groups. There was no mortality. There was no intraoperative complication in either group and no conversion in the laparoscopic group. Operating time was significantly longer in the laparoscopic group (302 minutes) vs. the open group (244.7 minutes) (P < 0.05), but this difference disappeared when data were adjusted for the extra time required to perform the laparoscopic hand-sewn anastomoses (288.2 minutes vs. 244.7 minutes). Bowel function returned more quickly in the laparoscopic group vs. the open group in terms of passage of flatus (3.7 vs. 4.7 days) (P < 0.05) and resumption of oral intake (4.2 vs. 6.3 day) (P < 0.01). There were significantly fewer postoperative complications in the laparoscopic group (9.5 percent) vs. the open group (18.5 percent) (P < 0.05); the length of stay was significantly shorter in the laparoscopic group (8.3 days) vs. the open group (13.2 days) (P < 0.01); and the cost of hospital admission was significantly lower in the laparoscopic group ($6106, United States dollars) vs. the open group ($9829, United States dollars) (P < 0.05). CONCLUSION: There is a reduction in the postoperative ileus, length of stay, cost of hospital admission, and postoperative complication rate in the laparoscopic group. Laparoscopic surgery for Crohn's disease is safe, and it is potentially more cost-effective than traditional open surgery.

Adult↗
PubMed2003

Genetic variability of the marine mussel Mytilus galloprovincialis assessed using two-dimensional electrophoresis.

Two-dimensional electrophoresis (2-DE) has been used to measure the degree of genetic variability of the marine mussel Mytilus galloprovincialis. Genetic polymorphisms were detected in 33 of a total of 86 polypeptides scored among the most abundant proteins from foot samples in 38 individuals. Estimates of average heterozygosity were 0.101+/-0.018 and 0.114+/-0.021 in a natural and a cultured population, respectively, from the NW of the Iberian Peninsula. These are the highest estimates of average heterozygosity reported by 2-DE in an animal species to date. We consider that these data throw open the question of the level of genetic variability detectable by two-dimensional electrophoresis. Multilocus genotype data were used to infer haplotypic frequencies by means of the EM algorithm in order to detect linkage disequilibrium between loci coding abundant proteins. Significant associations were found in 22.7% of the 406 two-locus pairs analysed. Also, clusters of loci in which all pairwise combinations exhibit statistically significant associations were detected and physical linkage between some of these loci is postulated from the linkage disequilibrium data.

Animals↗
PubMed1991

Chlamydia trachomatis contains a protein similar to the Legionella pneumophila mip gene product.

A 27kDa Chlamydia trachomatis L2 protein was characterized by the use of monoclonal antibodies and by two-dimensional gel electrophoresis. The protein was shown to be located in the membrane of reticulate bodies as well as elementary bodies. Its synthesis could be detected from 10 hours post-infection. Cloning and sequence analysis of the distal part of the gene revealed an open reading frame of 175 amino acids. Comparison of the deduced amino acid sequence with the NBRF data base revealed significant homology between the 27 kDa chlamydial membrane protein and the product of the macrophage infectivity potentiator (mip) gene of Legionella pneumophila.

Amino Acid Sequence↗
PubMed2006

The Medical Library Association Benchmarking Network: results.

OBJECTIVE: This article presents some limited results from the Medical Library Association (MLA) Benchmarking Network survey conducted in 2002. Other uses of the data are also presented. METHODS: After several years of development and testing, a Web-based survey opened for data input in December 2001. Three hundred eighty-five MLA members entered data on the size of their institutions and the activities of their libraries. The data from 344 hospital libraries were edited and selected for reporting in aggregate tables and on an interactive site in the Members-Only area of MLANET. The data represent a 16% to 23% return rate and have a 95% confidence level. RESULTS: Specific questions can be answered using the reports. The data can be used to review internal processes, perform outcomes benchmarking, retest a hypothesis, refute a previous survey findings, or develop library standards. The data can be used to compare to current surveys or look for trends by comparing the data to past surveys. CONCLUSIONS: The impact of this project on MLA will reach into areas of research and advocacy. The data will be useful in the everyday working of small health sciences libraries as well as provide concrete data on the current practices of health sciences libraries.

Benchmarking↗
PubMed1983

The strength of association between fragile (X) chromosome presence and mental retardation.

In order to obtain a quantitative estimate of the degree of association between presence of fragile X chromosome (fra(X] and mental retardation (MR), existing data from nonretarded males were analyzed. Clearly, fra(X) occurs less frequently among nonretarded compared to MR males. However, incidence estimates for fra(X) based upon existing data hold open the possibility that there may be significant numbers of nonretarded males with fra(X). Additional analyses of data from families with a pattern of fra(X) linked MR showed: (a) the probability that nonretarded male offspring will have fra(X) is very small, and (b) the probability that MR male offspring will have fra(X) is very large. Thus, accurate prognostic decisions can be based upon prenatal diagnosis of fra(X) presence, especially in families with a pattern of fra(X) linked MR.

Female↗
PubMed1995

A secY homologous gene in the crenarchaeon Sulfolobus acidocaldarius.

The nucleotide sequence of an open reading frame, located upstream of the gene for adenylate kinase, was determined in the thermoacidophile crenarchaeon Sulfolobus acidocaldarius. Data bank searches identified the sequence as a secY homologous gene. The DNA derived protein sequence of total 463 amino acids contains 10 hydrophobic domains. A sequence alignment with other prokaryotic and eukaryotic secY sequences reveals significant homology, but the secY primary sequence of S. acidocaldarius shows only a low degree of similarity with the secY counterparts of the euryarchaea Methanococcus vannielii and Haloarcula marismortui. A transcription analysis indicates, that the secY gene is cotranscribed with the gene coding for adenylate kinase.

Adenylate Kinase↗
PubMed2000

Study on the relationship between calcium-induced calcium release from mitochondria and PTP opening.

The permeability transition pore (PTP) is central for mitochondria function. PTP either open in low-conductance state to carry out mCICR (Ca2+-induced Ca2+ release from mitochondria) and play roles in cell phsyiological activities or open in high-conductance conformation to release harmful substances and play important roles in cell pathological responses and apoptosis. The results of study on the relationship between mCICR and PTP opening show Ca2+ concentrations but not the Ca2+ delivery mode determined the occurrence of mCICR or PTP opening. Ca2+-induced PTP opening began with and depended on mCICR. mCICR was a prerequisite for H2O2 and As2O3-induced PTP opening. The results indicated that the PTP opening was determined by Ca2+ stimulation intensity but not mode. PTP could switch from low- to high-conductance conformation and the PTP open by high-conductance began with low-conductance state. mCICR is necessary for Ca2+-dependent PTP opening. Our data suggested also that it would be possible to control cellular responses first by modulating mCICR, then by regulating PTP opening.

Animals↗