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Recent clinical trials with experimental immunotherapeutic agents for sepsis have not proven their overall benefit yet although some studies suggested significant effect of these antisepsis therapies. This review article summarizes the results of these trials, their analysis, lessons learned from past failure, and future perspectives for immunotherapies as anti-sepsis treatments.
During individual interviews, 708 people between the ages of 65 and 90 expressed a wide variety of personal goals and aspirations through sentences they were asked to complete. The distribution of answers in temporal categories provides an index of the broadening of future perspectives (PF). The values of that index were put in relation with subjective assessments that can be looked upon as clues to mental health. Results confirm the hypothesis of a positive relation between PF and perception of health (0.27), meaning of life (0.29), living satisfaction (0.30) and perception of having personal control (0.18). However, PF does not appear to be connected with the person's attitude toward death. These results seem to indicate that PF represents a factor of mental health and "healthy aging". Consequently, they justify the relevance of developing interventions that aim to strengthen this "personal resource".
1. The impact which pharmacokinetics and drug metabolism studies have made to drug discovery programmes is reviewed with examples from the anti-infective, cardiovascular, anti-inflammatory and CNS therapeutic areas. 2. Contributions that advances in analytical technology have made to the early application of pharmacokinetics and drug metabolism are discussed. 3. Some future perspectives are given on the advances being made in basic science and technology and how this will provide the basis for further growth in the contribution to the drug discovery process.
Replantation is a method in which an avulsed dental element is replaced into its alveolar socket. The dental traumatic exarticulation occurs in any age, but most frequently in the juvenile population. The aim of this paper is to rewiew the risks and benefits of tooth replantation and to discuss the present therapeutic orientations and future perspectives for avulsion management.
Acute lung injury/acute respiratory distress syndrome (ALI/ARDS), which manifests as non-cardiogenic pulmonary edema, respiratory distress and hypoxemia, could be resulted from various processes that directly or indirectly injure the lung. Extensive investigations in experimental models and humans with ALI/ARDS have revealed many molecular mechanisms that offer therapeutic opportunities for cell or gene therapy. Herein the present strategies and future perspectives of the treatment for ALI/ARDS, include the ventilatory, pharmacological, as well as cell therapies.
The continuous progress in ventricular-assist device (VAD) technology and the management of patients with VADs has broadened the treatment options for end-stage heart failure patients. The available line-up of clinical devices provides the current optimal therapies to meet the specific needs of each patient. The extended durability, safety, efficacy and improved quality of life of the patients provides sufficient proof for the VAD to be a likely alternative therapy to heart transplantation. The sequential progress from the first-, to the second- and to the third-generation VAD technology is expected to bring increasing benefits to clinical outcomes. This article reviews the current status, capabilities, limitations and future perspectives of currently available VADs by generally classifying them via support duration, alignment of pump devices and via pulsatile or nonpulsatile mode of perfusion. Furthermore, the future direction of research and development for next-generation VADs is presented based on the lessons learned from currently available VADs.
Results of a retrospective study of 72 patients with urogenital tuberculosis admitted to Hôpital Cochin Paris, from 1970 to 1980, were compared with those of studies conducted since 1945. Though there has been a marked reduction in the number of cases of tuberculosis in absolute terms, morbidity has not altered as a nephrectomy was performed in 44 p. cent of cases both in the period 1970 to 1980, and the year 1950. There has, however, been a noticeable increase in the use of plastic surgery. Future perspectives involve both the medical and surgical fields, in the former leading to a shorter period (9 months) of treatment, and in the latter by the development of new endoscopic procedures: modelling ureteral sounds, and hydrostatic bladder distention. It is reasonable to assume that surgery will be required less often in the future, medical treatment involving endoscopic procedures being sufficient to treat the majority of urogenital tuberculosis cases.
This review will address the recent history in HIV vaccine trials in the pediatric population while giving due respect to the pediatric vaccine successes achieved over the past decades. Success and failure seen when utilizing the neonatal macaque model of SIV infection and the ramifications of these studies will be discussed. The short list of pediatric HIV vaccine trials currently in progress and those in early planning stages will be reviewed. Finally, future perspectives on the impact of a vaccine that could be used to potentially avert mother-to-child transmission of HIV and lead ultimately to the establishment of immunity throughout adolescence and beyond will be presented.
The genome of aquatic animals is poorly understood and information from different taxonomic groups is sketchy. While there have been intensive genomic studies on some fish models, investigations on other fishes and invertebrates have been scarce. Yet there are recently some coordinated studies on genome mapping in a number of aquaculture animals of economic importance. This review summarizes information available on genome mapping of the important fish models and aquaculture animals. The future perspectives of this field of studies are discussed.
Isolated hepatic perfusion (IHP) involves a method of complete vascular isolation of the liver to enable treatment of liver tumors with high drug doses without systemic toxicity. Recent clinical studies have mainly employed IHP with melphalan with or without tumor necrosis factor-alpha and mild hyperthermia. The results of these studies demonstrate that high response and survival rates can be achieved with IHP. The current status, recent developments and future perspectives of IHP are discussed in this review.
The methodology for conducting cancer clinical trials has undergone enormous changes over the past 25-30 years since the EORTC Data Center was created. The purpose of this paper is to highlight and to provide a historical perspective for the main methodological concepts, both practical and theoretical, which form the basis for the design and analysis of phase III cancer clinical trials within the EORTC Data Center. Some statistical aspects of other associated topics such as quality of life, health economics, meta-analysis and treatment outcome will also be briefly discussed. Finally, some future perspectives and topics for further statistical methodological research will be presented in order to spur statisticians to meet the challenge of efficiently designing and analysing the clinical trials of tomorrow.
In vivo somatostatin receptor-mediated scintigraphy has proven to be a valuable method for the visualisation of neuroendocrine tumours and their metastases. A new application is the use of radiolabelled analogues for somatostatin receptor-mediated therapy. This paper presents a review on the basic science, historical background and current knowledge of somatostatin receptor subtypes and their expression in neuroendocrine tumours. New somatostatin analogues, new chelators, "new" radionuclides and combinations thereof are also discussed. Due attention is given to limitations and future perspectives of somatostatin receptor-mediated imaging and therapy.
During the last fifteen years the field of erectile dysfunction has grown tremendously, offering several treatment options to impotent patients, such as intracavernosal pharmacotherapy, vacuum therapy, penile vascular surgery and penile prosthetic surgery. Several multicenter clinical trials have been undertaken and numerous studies have been published, showing that the 'gold standard' treatment does not exist. As new oral, intraurethral and intracavernosal medications are added to the armamentarium of physicians and even more will be available for physicians and patients in the near future, the question becomes apparent: which treatment and when? The present paper critically reviews the existing information on currently available treatment options, and discusses future perspectives based on data from ongoing clinical trials. Considerations for the development of a new management strategy are also discussed.
This article will review the published research on the elucidation of the mechanisms of pituitary adenoma formation. Mass spectrometry (MS) plays a key role in those studies. Comparative proteomics has been used with the long-term goal to locate, detect, and characterize the differentially expressed proteins (DEPs) in human pituitary adenomas; to identify tumor-related and -specific biomarkers; and to clarify the basic molecular mechanisms of pituitary adenoma formation. The methodology used for comparative proteomics, the current status of human pituitary proteomics studies, and future perspectives are reviewed. The methodologies that are used in comparative proteomics studies of human pituitary adenomas are readily exportable to other different areas of cancer research.
The apparatus for the respiratory function test have recently made a great progress and become very easy to handle owing to the development of computer technology and medical ordering system. However, the respiratory function tests depend its result on the cooperation of patients. Thus, it is important for the medical technician to obtain the maximum efforts and cooperation of the patients in the testing. In the sense, the standardization of the testing should be done urgently regarding procedures, softwares, hardwares and maintenance of apparatus. In the future perspectives, we would like to emphasize following 3 points. First, more noninvasive and sophisticated testing methods and instruments should be developed, since the patients' age will become more and more old and vigorous active cooperation may not be possible for the assessment of respiratory function. The testing for the transplantation of lung should also be developed. Second, the development of screening test and its performance for the routine medical check for the local inhabitants have been important for the early detection, treatment, and follow up of respiratory diseases. Finally, the medical technician should be prepared so that the testing is available when it is needed.
The discovery of X-rays in 1895 by Wilhelm Conrad Röntgen paved the way to a new scientific epoch in the management of cancer. Today, with the XXI century in sight, radiotherapy has matured and has become one of the mainstays in the management of cancer. Although long-term success with the use of ionizing radiation in cancer treatment can be achieved in about half of our patients, significant improvements in tumor control rates and/or reduction in side effects (i.e. quality of life) are needed. As a future perspective, the authors highlight the gains that can be anticipated from research in the field of 3-D conformal radiotherapy, in particular with regard to sparing critical structures (e.g. parotid glands) in cancers of the head & neck.
Narcolepsy is characterized by excessive daytime sleepiness and abnormal manifestations of rapid eye movement sleep such as cataplexy. The authors review the clinical features of narcolepsy, including epidemiology, symptoms, diagnosis, and treatment, in detail. Recent findings show that a loss of hypocretin-producing neurons lies at the root of the signs and symptoms of narcolepsy. The authors review the current state of knowledge on hypocretin anatomy, physiology, and function with special emphasis on the research regarding the hypocretin deficiency in narcolepsy, which may also explain associated features of the disorder, such as obesity. Lastly, they discuss some future perspectives for research into the pathophysiology of sleep/wake disorders, and the potential impact of the established hypocretin deficiency on the diagnosis and treatment of narcolepsy.
Within the wide range of severity of orbital fractures, the small group of complex fractures causes most of the sequelae. Therefore identification of severe injuries and adequate treatment is of major importance. The introduction of craniofacial techniques made possible a wide exposure of even large orbital wall defects and their reconstruction by grafts. In spite of significant progresses, repair of complex orbital wall defects remains a difficult surgical problem even for the experienced. This paper outlines the specific technical problems concerning surgical anatomy, exposure and defect reconstruction of this type of injuries. A number of new developments providing interesting future perspectives for orbital wall reconstruction such as intraoperative navigation, endoscopic techniques and new materials are discussed.