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Good manufacturing practice (GMP) compliance in the biologics sector: plasma fractionation.

The U.S. blood supply is the safest it has ever been. Due to blood safety and the introduction of viral inactivation/clearance technologies, protein therapies derived from human blood have also in recent years had a history of product safety. Nevertheless, since 1995, the plasma-fractionation industry has experienced increased compliance-related actions by the Food and Drug Administration (FDA), as shown by a substantive increase in the number of FDA 483 inspectional observations, FDA warning letters and other FDA regulatory action. An evaluation of these trends shows that they reflect the implementation by the FDA of increased inspectional interest in the plasma-fractionation industry and an evolution of inspectional practices and standards of current good manufacturing practice (cGMP). Plasma fractionators have responded to FDA actions by carefully evaluating and addressing each inspectional observation, assessing impact to product and taking appropriate actions, including corrective actions to prevent future occurrence. They have made major investments in facilities, quality systems, personnel and training to meet the evolving standards of cGMP and in an effort to implement these standards systemically. Through industry associations, manufacturers have further enhanced product safety by adopting additional voluntary standards for plasma to prevent the entry of potentially unsuitable plasma into the production process. The industry remains committed to application of cGMP and to working with the FDA in further evolution of these standards while striving to assure a continued supply of safe, pure and effective plasma-derived therapies.

Biotechnology↗

Genetic algorithm in the control optimization.

Genetic algorithm (GA) represents an exploratory search mathematical technique, which uses statistical methods of selection. They are named blind search technique as they usually operate without knowledge of the task domain. GA is inspired from the evolutionary features of biological systems. The natural individual selection of offspring that are better adapted will resist in time (3). The pioneer worker in this field was John Holland and the University of Michigan staff from 1975. The beginning study was in natural adaptive process explanation and continues with computed artificial systems developing that exploit the evolution natural principles. A GA technique was applied for a controller parameter optimization that regulates the mean blood pressure. The intelligent system adjusts the anesthetic agent in order to maintain the pressure constant with small variations from a desired set value. This is usually necessary for anesthesia control (mathematical model from 11, 12). Such a system was developed and tested using computer simulations. This paper describes some aspects about the GA mathematical method and finally the results of the controller implementation are presented.

Algorithms↗

Surgical staging of esophageal cancer.

The rising incidence of adenocarcinoma of the esophagus and the poor overall 5-year survival using current treatment regimens make it essential that clinical trials continue to search for more effective regimens for specific stages of esophageal cancer. It is clear from work in non-small cell lung cancer that clinical efficacy for platinum-based chemotherapeutic regimens has shown promise only in specific subsets of patients, such as those with stage IIIa tumors, but no benefit at all for earlier stages. In lung cancer, mediastinoscopy has been shown to be the most accurate method to stage locoregional lymph nodes and is considered to be the gold standard for clinical trials. In esophageal cancer, accurate surgical staging of all locoregional lymph nodes is more complex and may involve abdominal, thoracic, and cervical areas. Molecular evidence of lymph node involvement in esophageal cancer suggests that even histologically negative nodes may harbor micrometastases in a significant number of cases. Laparoscopy and thoracoscopy now offer a more accurate alternative to conventional staging of esophageal cancer. For distal esophageal cancers near the gastroesophageal junction, laparoscopic staging alone may suffice in most cases. Associated costs and the requirement for a surgical procedure should encourage the continued evaluation of new noninvasive modalities and the further evolution of endoscopic ultrasound. Currently, we recommend the application of minimally invasive surgical staging to assess new noninvasive technologies, such as PET scanning, and for use in clinical trials until the definitive approach to staging esophageal cancer is established. We are currently participating in an ongoing multicenter study of thoracoscopic and laparoscopic staging for esophageal cancer.

Endosonography↗

The intrastromal corneal ring segments: Intacs.

Although evolution of the intrastromal corneal ring technology will unquestionably continue, the ICRS in its current design is remarkably safe and offers several potential advantages, including preservation of the central cornea, reversibility and adjustability. The approval of this technology by the FDA has added a potentially unique procedure to the refractive surgeon's surgical inventory.

Corneal Stroma↗

Contemporary management of stage T1 transitional cell carcinoma of the bladder.

PURPOSE: Transitional cell carcinoma involving the lamina propria (stage T1) is associated with a high recurrence and progression rate with implications for patient survival and quality of life. A better understanding of the natural history of and treatment alternatives for this tumor may improve the outcome in patients with this stage of bladder cancer. MATERIALS AND METHODS: Literature of the last decade was comprehensively reviewed in regard to clinical and pathological diagnosis, adjuvant treatments, prognosis, and the role and timing of cystectomy. The information was gathered from MEDLINE, current urology journals, abstracts from recent urological meetings and personal experience. RESULTS: High grade and the depth of lamina propria invasion are important prognostic factors. Early diagnosis and accurate pathological assessment are essential for determining the most adequate treatment pathway. Initial treatment consists of complete transurethral resection and adjuvant treatment with intravesical instillation of bacillus Calmette-Guerin (BCG). Immediate postoperative instillation of mitomycin C decreases the risk of recurrence possibly related to tumor implantation. Intravesical treatment does not substantially decrease the chance of progression. Lack of a complete response to BCG at 3 to 6 months, high grade, the depth of lamina propria invasion, the association of carcinoma in situ and prostate mucosa or duct involvement represent significant predictors for progression. Cystectomy should be suggested for recurrent stage T1 tumor after BCG, new onset or persistent carcinoma in situ, tumor located at a difficult site for resection, prostatic duct or stromal involvement and muscle invasion. CONCLUSIONS: High grade stage T1 transitional cell carcinoma is a highly malignant tumor. Complete resection followed by immediate mitomycin C instillation and 6 weekly BCG instillations results in an acceptably low recurrence and progression rate. Rigorous long-term surveillance and continuous reconsideration of radical cystectomy in concordance with the evolution of the disease are essential.

Carcinoma, Transitional Cell↗

Psychopathological assessment in children affected by Duchenne de Boulogne muscular dystrophy.

BACKGROUND: Several studies on the intelligence of children suffering from Duchenne muscular dystrophy (DMD) found impairments in linguistic functions, memory and affective development. Memory deficit mainly involves long-term memory; short-term memory impairment was also present, even if less frequently. Some studies tried to establish a correlation between the distal deletion of the dystrophin gene and low intelligence levels. METHODS: The present study investigated the cognitive, emotional and relational states in a group of DMD children. The patients were selected on the basis of physical examination, muscle biopsy, histochemical analysis, genetic testing, regular schooling. Molecular genetic testing detected a deletion in 2 high frequency deletion regions in all subjects. The following psychodiagnostic tests were used for assessment: WISC-R, Spontaneous Drawing, Draw-A-Person test, Family Drawing, Thematic Apperception test and Rorschach test. RESULTS: No impairment of the intellectual function was detected in the group of children we examined; only 2 subjects had a total IQ below average. Instead, psychic disorders were detected such as proneness to isolation, self-depreciation, past experiences of marginalization, minor depressive symptoms, insecurity signs, hypochondriac worries and high level of anxiety. In addition children exhibited poor adaptation to the environment and labile affectivity, scarcely controlled by the higher conscious levels. CONCLUSIONS: These disorders are often a dynamic prolongation of a psychological process starting when the diagnosis is made and continuing in a slow and latent fashion throughout the evolution of the disease.

Anxiety↗

Primary biliary cirrhosis: a Mount Sinai perspective.

Individuals afflicted with primary biliary cirrhosis (PBC) first undergo chronic, nonsuppurative destruction of their intrahepatic bile ducts, eventually leading to cirrhosis. Over nearly 50 years, many faculty members at the Mount Sinai School of Medicine, including Dr. Hans Popper and Dr. Fenton Schaffner, have made important contributions to our understanding of the natural history and histopathologic evolution of PBC. And today, many patients with PBC continue to be cared for at Mount Sinai. In the absence of a cure for the disease, these patients continue to be enrolled in clinical trials and, when necessary, in the Mount Sinai liver transplant program. The establishment of the Center for the Study of Primary Biliary Cirrhosis at Mount Sinai, supported by the Artzt Family Foundation Trust, has enabled the faculty to expand both clinical and basic science initiatives related to primary biliary cirrhosis. Several of these new initiatives are described below and placed in the context of our current understanding of the immunopathogenesis of PBC.

Antigens↗

[Effect of secondary contamination in the dairy industry].

The evolution that has characterized the cheesemaking technique, which has continued to based on automation, has produced an alteration in the causes of contamination of dairy products. It is essential to locate the points of possible pollution and monitor them with appropriate modalities for a good quality of finished products. The purpose of this study was to determine quantitatively and qualitatively the secondary contamination in the production environments of 10 Dairy Industries. Particularly, air, pasteurized milk, curd, surfaces of manufacturing area and water were selected for microbiological tests. Moreover, fresh and ripened cheeses have been checked for microbial contamination. The results of our survey show a large contamination of production environments by Enterobacteriaceae and yeasts, that often cause alterations of dairy products. From the experimental results obtained, some conclusions may be drawn: the microbiological situation of the production environment is precisely reflected on the qualities of processed products. The persistence of an high microbic number/gr. of product and the frequent isolation of pathogenic Staphylococci make doubtful the healthiness of these very common foods. Finally, the A.A. point out the water pollution of the most of dairy industries. It show that disinfections plants are not run correctly.

Air Microbiology↗

[Malaria in the islands of the Comoro archipelago. Historical and geophysical aspects. Epidemiologic considerations].

Located on the maritime road to India, important harbour during slavery period, Comoro Archipelago was therefore free of malaria in the XVIIth century in spite of the presence of infected persons. In the XIXth century, malaria became endemic in Mayotte, Mohéli and Anjouan but only at the beginning of the XXth century in Grande Comore. The origin of vectors and main parasite, P. falciparum, are african. After quite a "natural" evolution, the situation is the same in these islands (continual high transmission) except Mayotte where a malaria programme is performed since 1976. But the historical differences, island by island, in the outbreak of malaria suggest various ecological balance which would be underlined by antimalarial activities.

Animals↗

Perspectives in occupational dermatology.

Because large surface areas of the skin are exposed directly to the environment, skin is an organ particularly vulnerable to occupationally induced disease. Statistics show that, excluding accidental injury, nearly half of all occupational illnesses occur in this organ; a fourth of all workers suffering from occupational skin disease lose an average of 10 to 12 workdays. The constant evolution of new industrial chemicals and methods of manufacture continue to bring new skin hazards and disease into the workplace. Occupational health physicians and practitioners, who usually have minimal training in dermatology, must diagnose and treat unfamiliar diseases in a setting of even less familiar, often overwhelming, technology. A thorough understanding of cutaneous defense mechanisms, clinical patterns of occupational skin disease and methods for establishing accurate diagnoses is essential.

Dermatitis, Occupational↗

Myocardial infarct size. Measurements and predictions.

Because patient prognosis is related in part to infarct size, therapies that could limit infarct size should be beneficial. The development of such therapies has been hampered by the lack of proven techniques to measure infarct size or to assess the effect of therapy in living patients. In addition, the evolution of ischemic cell death in human infarcts is not understood, and therefore the amount of ischemic myocardium that might be salvageable at various times after the onset of myocardial infarction is unknown. Experimental studies have contributed to our understanding of the evolution of acute myocardial infarcts. However, there is a continuing need for experimental and human anatomical studies to validate indirect in vivo techniques of estimating infarct size. In addition, reliable experimental models in which potential therapies can be tested are needed. In dogs, infarct size is predetermined in part by the amount of myocardium at risk and the amount of collateral flow in this risk region. Measuring these parameters should provide a framework within which the effects of therapy on infarct size can be assessed.

Animals↗

Staff governance. The experience of one nursing unit.

Professionalization is a common theme in nursing. As this process progresses, the utility of more traditional methods and procedures will continue to come under scrutiny. The authors describe the evolution of a system of staff governance on one nursing unit in a large urban medical center. Factors contributing to the decision to abolish line positions on the unit are discussed, as are the dilemmas the staff faced in undertaking management of the unit.

Hospital Bed Capacity, 500 and over↗

Surgical technique and colorectal cancer: impaction on local recurrence and survival.

The survival of patients with large bowel cancer continues to improve. This may be explained by an evolution in surgical technique for cancer resection. Survival statistics between 30% and 75% can be found for the same stage of disease by different surgeons and at different institutions. The absolute requirement for survival is a complete resection of cancer with free margins of dissection. The etiology of local recurrence was suggested to be spilled tumor cells from venous blood, trasected lymphatics or from tissue trauma at narrow margins of dissection. Blunt dissection technique may be responsible for an increased incidence of local recurrence and cancer related death especially in metastatically insufficient cancers. Although no touch technique may not be important, the wide dissection that it promotes is of benefit. Even if adjacent structures are involved, an anatomically disciplined en bloc sharp or electrosurgical dissection are the surgical techniques that are of paramount importance. Adjuvant intraperitoneal cytostatic agents may in the future be used to eliminate spilled tumor cells that may occur even though the surgical approach is optimized.

Chemotherapy, Adjuvant↗

Frequency and significance of conduction defects early after orthotopic heart transplantation.

To define the clinical significance of conduction defects after orthotopic heart transplantation sequential electrocardiograms (ECG) of 124 patients were analyzed during their postoperative hospital stay. The first ECG was abnormal in 90 patients (73%), with a predominance of right bundle branch block, and normal in 34 (27%). Sex, age, mean donor ischemic time, duration of aortic cross clamping and use of previous antiarrhythmic therapy were not significantly different in the 2 groups. During hospital follow-up, patients were grouped according to evolution of the initial electrocardiographic abnormalities. In group 1, 25 patients continued to have an initially normal ECG. In groups 2 and 3, 30 and 48 patients, respectively, had evidence of transient and permanent conduction defects. The 21 patients in group 4 showed progressive deterioration of conduction with either a new (9 patients) or worsening preexisting conduction defect (12 patients). The evolution of the initial ECG was strongly dependent on the duration of the donor heart ischemic time and the severity of the in-hospital cardiac rejection. Patients with persistent conduction abnormalities had a statistically longer ischemic time than either patients with normal or transient conduction defects (182 +/- 84 vs 144 +/- 68 and 130 +/- 66 minutes, p = 0.04). Although the overall percentage of patients with histologic evidence of moderate to severe rejection was similar across the groups, 66.6 and 46.1% of patients in groups 3 and 4, respectively, had multiple episodes of rejection compared with 16.6 and 0% in the remaining 2 groups (p = 0.044).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Evolving disease resistance genes.

Defenses against most specialized plant pathogens are often initiated by a plant disease resistance gene. Plant genomes encode several classes of genes that can function as resistance genes. Many of the mechanisms that drive the molecular evolution of these genes are now becoming clear. The processes that contribute to the diversity of R genes include tandem and segmental gene duplications, recombination, unequal crossing-over, point mutations, and diversifying selection. Diversity within populations is maintained by balancing selection. Analyses of whole-genome sequences have and will continue to provide new insight into the dynamics of resistance gene evolution.

Evolution, Molecular↗

Detecting adaptive molecular evolution: additional tools for the parasitologist.

It is likely that infectious diseases have shaped the evolution of many vertebrates, including humans. The etiological agents of disease continuously strive to evade the immune response and the immune response, in turn, seeks to change in order to keep pace with the invaders. This 'arms race' may be characterized by the selection for new variant hosts and new variant parasites. Here we discuss the utility of phylogenetics in detecting adaptive evolution at the molecular level and, for illustration, we concentrate on a family of surface-exposed proteins (the rifins) found in the recently sequenced genome of Plasmodium falciparum. We employed phylogeny-based methods in order to characterize adaptive evolution in these proteins. We found evidence for adaptive evolution in many of the amino acid residues in at least one lineage. These results indicate that there has been selection for those strains of P. falciparum that contain the new genotypes. These proteins are likely to be of great importance for the survival of the parasite. Studies of the interaction of these proteins with the antigen-presenting cells of the immune system should lead to a better understanding of malarial infection.

Adaptation, Physiological↗

On the evolution of multigene families.

Multigene families are classified into three groups: small families as exemplified by hemoglobin genes of mammals; middlesize multigene families, by genes of mammalian histocompatibility antigens; and large multigene families, by variable region genes of immunoglobulins. Facts and theories on these evolving multigene families are reviewed, with special reference to the population genetics of their concerted evolution. It is shown that multigene families are evolving under continued occurrence of unequal (but homologous) crossing-over and gene conversion, and that mechanisms for maintaining genetic variability are totally different from the conventional models of population genetics. Thus, in view of widespread occurrence of multigene families in genomes of higher organisms, the evolutionary theory based mainly on change of gene frequency at each locus would appear to need considerable revision.

Biological Evolution↗

Sex among the flowers: the distribution of plant mating systems.

Previous reviews of plant outcrossing rate survey data have agreed that predominant selfing and predominant outcrossing are alternative stable states of mating system evolution. We reanalyzed the most recent data and plot outcrossing rates as a continuous variable rather than as a class variable. Wind-pollinated species are indeed bimodal. However, the shape of the distributions for animal-pollinated species reveals that intermediate rates of outcrossing are common (49% of species fall between 20% and 80% outcrossing). Consequently, we suggest that mating system is best considered a continuous rather than a discrete character of plant populations.

Adaptation, Physiological↗