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The Registry of the International Society for Heart Transplantation: seventh official report--1990.

During the past decade we have witnessed a continuing evolution in intrathoracic transplantation. The role of heart transplantation in end-stage heart disease has been well established; and combined heart-lung and lung transplantation techniques developed during the past 10 years have been applied to an expanding array of diseases associated with end-stage pulmonary failure. Recently a plateau in number of transplants per year has become evident. Although the areas of pediatric heart and single lung transplantation continue to expand, it appears that further overall growth in heart and lung transplantation is now limited by donor availability. Although operative mortality has shown gradual improvement, organ preservation and other intraoperative complications remain major factors associated with early death, especially in combined heart-lung and lung transplantation. Infection and rejection are the most common causes of late deaths for all types of intrathoracic transplantation. Although long-term survival has shown improvement over the past 10 years, an increasing number of patients now require retransplantation because of chronic rejection. Results with heart, combined heart-lung, and lung retransplantation, in operative mortality and in long-term survival, have not been as encouraging as with the primary transplant procedure. We await further developments in heart and lung transplantation during the new decade.

Europe↗
PubMed1992

On the evolution of language and generativity.

One of the properties that most conspicuously distinguishes human language from any other form of animal communication is generativity. Language with this property therefore presumably evolved with the Homo line somewhere between H. habilis and H. sapiens sapiens. Some have suggested that it emerged relatively suddenly and completely with H. sapiens sapiens, and this view is consistent with (a) linguistic estimates as to when vocal language emerged, (b) the relatively late "explosion" of manufacture and cultural artifacts such as body ornamentation and cave drawings, and (c) evidence on changes in the vocal apparatus. However, evidence on brain size and developmental patterns of growth suggests an earlier origin and a more continuous evolution. I propose that these scenarios can be reconciled if it is supposed that generative language evolved, perhaps from H. habilis on, as a system of manual gestures, but switched to a predominantly vocal system with H. sapiens sapiens. The subsequent "cultural explosion" can then be attributed to the freeing of the hands from primary involvement in language, so that they could be exploited, along with generativity, for manufacture, art, and other activities.

Brain↗
PubMed1987

Evolution of anticodons: variations in the genetic code.

Clues to evolution of the genetic code can be found by comparing usage of anticodons in various organisms and organelles. GC content of DNA varies, as a result of directional mutation pressure (AT/GC pressure), especially in bacteria. Low GC in Mycoplasma is accompanied by use of UGA for tryptophan and, in ciliated protozoa, by use of UAA and UAG for glutamine. These are examples of "stop codon capture," which has been preceded by duplication of tRNA genes followed by nucleotide substitutions in their sequences, including mutational changes in their anticodons. Evolutionary changes in the code may have resulted from disappearance of codons and anticodons resulting from GC pressure and from their reappearance when the direction of the pressure was reversed. In this manner, codon UGA and anticodon UCA for tryptophan could have disappeared under GC pressure and reappeared in Mycoplasma under AT pressure. Stop codon UGA may have been the third of the three stop codons to appear, originating from mutations in UAA. Changes in the code are adaptive and nondeleterious. We propose that the number of anticodons has increased and that evolution continued until three existing forms of the universal code were produced: eukaryotic, eubacterial, and the code for halobacteria and methanococci. These three codes are distinguished from each other by their anticodon pattern. The eukaryotic code contains eight INN (ANN) anticodons that have replaced GNN anticodons as a result of AT pressure. Mitochondrial and chloroplast codes have evolved from the eubacterial code through genomic economization and AT pressure, leading to losses of GNN and CNN anticodons.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗
PubMed1988

Class II genes of miniature swine. I. Class II gene characterization by RFLP and by isolation from a genomic library.

Class II genes of miniature swine have been characterized by restriction fragment length polymorphism (RFLP) analysis and by analysis of a series of clones isolated from a lymphocyte genomic library. For RFLP analysis, DNA samples from three independent major histocompatibility complex homozygous lines and three intra-MHC recombinant lines were digested with a variety of restriction enzymes and analyzed in Southern blots using human cDNA probes for DP, DQ, DR, and DZ alpha genes, and DP, DQ, DR, and DO beta genes. One, or at most two, unique fragments were detected by hybridization with each of the human alpha probes tested. In contrast, multiple bands (five to six for most enzymes examined) were detected by each of the human beta probes tested, the majority of which were found to cross-react with at least three of these probes under conditions of moderate stringency. Genomic DNA from the SLAc haplotype was cloned into an EMBL-3 bacteriophage vector, and the corresponding genomic library was screened with each of these human cDNA probes. The class II genes thereby isolated from this library showed characteristics consistent with those anticipated from the RFLP analysis. Thus, unique alpha genes were obtained which showed no evidence of cross-hybridization, while beta genes showed extensive cross-hybridization and were frequently detected in the library by more than one human beta gene probe. These data are consistent with early evolutionary divergence of alpha genes, prior to mammalian speciation, and with continuing evolution of beta genes, with possible shared usage of these genes by different alpha loci. The data also imply that alpha genes can readily be assigned to loci homologous to their human counterparts, but that beta genes will require further mapping and/or sequence analysis to confirm assignments.

Animals↗
PubMed2026

Gastric carcinoma classification in the WHO 6th edition (2026): Updated framework and emerging entities.

The sixth edition of the WHO Classification of Digestive System Tumours (2026) represents an important step in the continuing evolution of gastric carcinoma classification. While preserving morphology as the foundation of diagnosis, it incorporates advances in molecular pathology, genotype-phenotype correlations, tumour evolution, and predictive biomarker assessment. This review summarizes the development of the WHO classification from the third edition (2000) to the sixth edition (2026) and highlights its relationship with other major classification systems, including those of Laurén, Nakamura, and the Japanese Gastric Carcinoma Association (JGCA). Major histological categories remain largely unchanged; however, several important conceptual and diagnostic refinements have been introduced. These include recognition of crawling-type adenocarcinoma as a distinctive variant of tubular adenocarcinoma, subclassification of poorly cohesive carcinoma into signet-ring cell and non-signet-ring cell subtypes, introduction of the concept of pure signet-ring cell carcinoma, and increased emphasis on tumour evolution. The sixth edition also expands and refines the spectrum of uncommon gastric carcinoma subtypes, including gastric carcinoma with lymphoid stroma, AFP-producing carcinoma, micropapillary adenocarcinoma, gastric adenocarcinoma of fundic-gland type, and gastric sarcomatoid carcinoma. Crucially, molecular subgroups originally proposed by The Cancer Genome Atlas (TCGA) and actionable biomarkers-including HER2 (ERBB2), Claudin 18.2, mismatch repair deficiency/microsatellite instability (dMMR/MSI), and programmed death-ligand 1 (PD-L1)-have transitioned from research-based categories into essential tools for precision oncology. Rather than providing exhaustive diagnostic criteria, this review offers a conceptual framework and encourages consultation of the original WHO text for full details. These advances illustrate the transition of gastric carcinoma classification from a predominantly morphology-based system toward an integrated histomolecular framework that more closely links pathological diagnosis with tumour biology, prognostication, and therapeutic stratification.

Crawling-type adenocarcinoma↗
PubMed1991

Inflatable penile prosthesis: effect of device modification on functional longevity.

The Scott inflatable penile prosthesis has undergone a continual evolution since its introduction in 1973. A review of 266 patients at Duke University Medical Center who received primary implantation of AMS inflatable penile prostheses from 1979 to 1988 revealed the modifications in the prosthesis have increased the functional longevity and hence the reliability of this surgical treatment for erectile impotence.

Erectile Dysfunction↗
PubMed1989

Mammographic localization and biopsy: the experience of a gynecologic oncology group.

From 1976 through 1986, two hundred eighty or 9% of all breast biopsies performed by a private gynecologic oncology group were for mammographically suspicious but occult breast lesions. Sixteen percent were found to be malignant. There has been improvement in mammographic techniques, and localization procedures have evolved to the current use of hooked-wire needles, which allow for the excision of smaller amounts of tissue and use of outpatient surgery facilities. Recently, the cancers encountered have been more often carcinoma in situ rather than invasive lesions. With the current increase in mammographic screening, there needs to be a continuing evolution in diagnostic modalities.

Adult↗
PubMed1990

Amygdala kindling and associated changes of entorhinal responses in suckling rats.

Entorhinal field potential with amygdala stimulation in suckling (16-18 days old) and adult rats was recorded with a tungsten wire electrode (tip diameter 2-5 microns) to study the developmental changes in behavioral seizures and long-term potentiation (LTP) in the responses to amygdala kindling stimulations. Stimulating (twisted enamel-coated wires) and recording electrodes were implanted in anesthetized rats 2-3 days before kindling. The mean amplitude of the responses to test pulses (600 microA, 0.3 Hz) in the sucklings (0.58 mV) was smaller than in the adults (1.32 mV), and latency was about 3.3 ms longer. Kindling stimulations consisted of 0.5-ms monophasic rectangular pulses of 10 Hz with a 10-s train duration; the intensity was the afterdischarge (AD) threshold. Kindling stimulation in the sucklings usually increased the amplitude of the test responses evoked 10 min or 1 h after the kindling stimulation. The increased amplitude persisted for at least 24 h, showing LTP in the synaptic transmission. The LTP was especially prominent in the first kindling stimulation, and the LTP gradually increased with successive stimulations, with gradual progression of AD and the behavioral seizure stage as well. The mean number of kindling stimulations to cause generalized seizures in the suckling rats (10.5) was less than that for adults (12.5), and the continued evolution of LTP over the course of kindling was more or less easier in the sucklings than in the adults.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed1991

Developmental and age-related changes in reflexes of the human jaw-closing system.

Reflex responses of the jaw-closing system to innocuous mechanical stimulation of the tongue and palate were examined in a group of 25 girls aged 7-8 years and in a group of 25 women aged 70-80 years. Responses were measured both as changes in background biting force and from bilateral recordings of masseter EMGs. For comparative purposes, results from an earlier study of 35 young adult women (aged 18-25 years) were available. Compared to younger groups of subjects, reflex responses of the elderly were reduced in numbers and amplitude, were characterized by fewer initial excitatory component responses, and had longer latency to onset. Analyses of responses of the children indicated that age 7-8 years is a transitional period. Some children show adult-like responses, while others display responses that appear to represent earlier forms or transitional responses. These results suggest that oral-motor reflexes are not fixed response patterns upon which more complex motor skills, such as speech, are built. Rather, oral reflex development appears to occur in concert with the acquisition of complex motor skills. Systematic changes in reflex responses also occur in the period from young adulthood to seventh decade of life. This result indicates a continuous evolution of oral sensorimotor systems throughout the human life span.

Adult↗
PubMed1985

Selective nontreatment of handicapped newborns: a critical essay.

The neonatal intensive care unit is the site of some of the most dramatic technology, complex decision-making and costly activity in the current range of medical institutions. Thus, the decisions made there are particularly visible, and of concern to a society which has increasingly scrutinized and challenged medical practices. Questions of marginal utility and cost-benefit relationships are becoming increasingly prominent. These concerns are heightened by the social and political tensions over issues of the time of initiation of life, quality of life, and assurances of equity for those less well off or handicapped from birth. Robert Weir's book, Selective Nontreatment of Handicapped Newborns, successfully summarizes the current dilemmas and identifies areas of uncertainty and lack of knowledge which cloud the decision-making processes. The book reviews the positions of the major protagonists of the last several years; inevitably, their positions will undergo continuous evolution in response to new data and vigorous political and public policy activity. Weir appropriately identifies the difficulty in arriving at an accurate prognosis as an important and prominent problem in decision-making about defective newborns. The population of surviving, compromised newborns is relatively unfamiliar and their problems remain largely unstudied. Weir's discussion of the desirability of the establishment of Infant Care Review Committees in those institutions which care for defective and handicapped newborns thoughtfully concludes that such committees are, on the balance, desirable. As experience accumulates with Infant Care Review Committees, they should serve the positive purpose of generating open discussion of legitimate disagreements. These committees will provide a forum in which decision-makers can disclose uncertainty, consider alternatives, and receive counsel.(ABSTRACT TRUNCATED AT 250 WORDS)

Persons with Disabilities↗
PubMed1991

From quality assurance to quality management in long term care.

This article describes the continuing evolution of the quality assurance program at Crown Nursing Home, a privately owned, skilled long-term care facility in Brooklyn, New York, into quality management. Activities are intended to improve the systems and processes of resident care, develop and implement practice guidelines, integrate suppliers and vendors into the facility processes, use information systems for indicator monitoring, encourage residents and family participation, provide care through a team approach, and promote human resource management and staff enhancement.

Clinical Protocols↗
PubMed1986

The pH dependence of proton-deuterium exchange, hydrogen production and uptake catalyzed by hydrogenases from sulfate-reducing bacteria.

Different patterns have been found in the pH dependence of hydrogenase activity with enzymes purified from different species of Desulfovibrio. With the cytoplasmic hydrogenase from Desulfovibrio baculatus strain 9974, the pH optima in H2 production and uptake were respectively 4.0 and 7.5 with a higher activity in production than in uptake. The highest D2-H+ exchange activity was found also at pH 4.0 but the optima differed for the HD and the H2 components. Both similarly rose when the pH decreased from 9.0 to 4.5, but the rate of H2 evolution slowed whereas the HD evolution continued rising till pH values around 3.0 were reached. The H2 to HD ratio at pH above 4.5 was higher than one. With the periplasmic hydrogenase from Desulfovibrio vulgaris Hildenborough, the highest exchange activity was near pH 5.5, the same value as in hydrogen production. The periplasmic hydrogenase from Desulfovibrio gigas had in contrast the same pH optimum in the exchange (7.5-8.0) as in the H2 uptake. The ratio of H2 to HD was below one for both enzymes. These different patterns may be related to functional and structural differences in the three hydrogenases so far studied, particularly in the composition of their catalytic centers.

Cytoplasm↗
PubMed1992

A randomized controlled trial of early surgery in Duchenne muscular dystrophy.

We performed a randomized controlled trial of early surgical treatment of contractures in 20 boys with Duchenne muscular dystrophy, age 4-6 yr. Surgery consisted of release of hip flexors, removal of iliotibial bands, and lengthening of tendo Achilles bilaterally. All patients were monitored for at least 12 months post-randomization, and assessed quantitatively for muscle strength and function. Surgery corrected the deformities, but had no beneficial effect on strength or function. Indeed, data in the second year showed more rapid deterioration of function in some of the operated boys. There appeared to be continued evolution of pathology following surgery, as assessed by sequential muscle ultrasound and muscle biopsy. We cannot recommend this type of surgery as a routine treatment.

Biopsy↗
PubMed1987

Combined therapy as an alternative to exenteration for locally advanced vulvovaginal cancer. II. Results, complications, and dosimetric and surgical considerations.

We have introduced a therapeutic alternative to exenteration for locally advanced vulvovaginal cancer using surgery for the vulvar (external genital) phase of this disease presentation, combined with radiotherapy for the internal genital phase (with adequate overlap of fields to protect surgical margins). The rationale is that this approach treats the cancer and its dual regional spread patterns, while at the same time preserving the bladder and/or rectum, and should be associated with less morbidity and mortality than exenterative surgery. This report updates our experience with a total of 48 treated cases (37 primary cases and 11 cases of recurrent disease). Of the 37 primary cases, 20 were FIGO stage III, 4 were FIGO stage IV, and 3 other cases represented "field" cancers involving vulva and/or cervix and/or vagina. Utilizing a Life Table analysis, the 5-year survival for the primary cases was 75.6%. Published FIGO survival for stage III is 32% and for stage IV 10.5%. Life Table analysis projects a 62.6% survival for recurrent cases and an overall 72% 5-year survival for all 48 cases treated. With 48 patients treated, 48 bladders and 48 rectums were at risk for surgical removal had exenteration been employed. One patient had a total pelvic exenteration for local failure, and one had a posterior exenteration for local failure. One bladder and one rectum were lost to permanent diversion because of radiation injury. Thus, 5 of these major viscera were lost of the 96 total, and 91 (94.8%) were retained. Radiation therapy and surgical details have been reviewed relevant to local control and local failure and complications. The continuing evolution of treatment modifications of all modalities will be discussed. The apparent advantages of this combined therapeutic approach over exenterative surgery include high probability of bladder and/or rectal preservation, low primary mortality, low treatment morbidity, and very good results in cancer control.

Brachytherapy↗
PubMed1988

Red cell size heterogeneity during ontogeny.

To determine the manner in which erythrocyte changes occur during ontogeny, several red cell parameters were analyzed in fetuses, newborn infants, children, and adults. Although mean cell volume (MCV) and hemoglobin F (HbF) levels decreased as expected during in utero development, the coefficient of variation of red cell size (%CV), or red cell distribution width (RDW), increased from fetuses to newborn infants. In normal adults, the %CV was 15 (RDW was 13). The %CV in fetuses at 18-24 weeks gestation was 18, and it was 21 at term birth. High values for %CV or RDW indicate significant anisocytosis. Erythropoiesis at the time of birth is not a steady-state condition. Erythrocytes of a wide variety of sizes are present, with the appearance of new small cells on a background of older, larger red cells. This increased anisocytosis suggests that these new erythrocytes do not appear to be due to a smooth, continuous evolution of red cell size, but rather to discrete, perhaps clonal, changes.

Adolescent↗
PubMed1989

The therapeutic community: exploring the boundaries.

The past 20 years have demonstrated the effectiveness of therapeutic community (TC) treatment for drug abuse as it evolved in the United States. We now better understand the influence that psychodynamic features of TC treatment have on character disorder. Best perceived as a setting designed--as society is not--to encourage and support social learning, the TC has succeeded in modifying its programs and adapting self-help methods to serve drug abusers of all kinds and abusers of all drugs. Continued evolution of the TC depends upon development of its already-demonstrated capacity to affect disordered behaviour other than drug abuse. The growth of disordered populations in the United States and increasingly in Great Britain gives urgency to such future employment. Therapeutic communities and TC-like programs for non-drug abusers already exist. But widespread use depends upon strengthening the theoretical underpinnings of TC treatment and establishing closer working relationships between TC's and mainstream medical, mental health and social service institutions.

Humans↗
PubMed1978

Behavioral marriage therapy. III. The contents of Gurman et al. may be hazardous to our health.

This paper was written as a reply to a critique of behavioral marital therapy (BMT) by Gurman, Kniskern, and Knudson (6, 7). The reply is divided into four sections. First, the paper addresses the critics' comments on the conceptual model put forth by BMT, correcting and clarifying various misconceptions, and restating some of the basic ideological principles in the behavioral model. Second, the paper discusses behavioral change techniques and technology, along with extratechnological treatment considerations. Again, misrepresentations of BMT are corrected. Third, an analysis of the literature investigating the therapeutic efficacy of BMT is reviewed, and the conclusion is reached that BMT is demonstrably effective, at least for a substantial number of mildly to moderately distressed couples. Criticisms are made of the analysis of the same literature conducted by Gurman et al. We conclude that, contrary to the spirit of the paper by Gurman et al., BMT is a viable framework for conceptualizing and treating relationship problems and that the commitment of its adherents to experimental investigation promises continued evolution, refinement, and improvement.

Behavior Therapy↗