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PubMed2004

Detection of alcohol use disorders in general hospital admissions in the United States.

BACKGROUND: Previous studies in which research-based assessment for alcohol problems at admission was compared with physician diagnoses indicated that many alcohol diagnoses in hospitalized patients were missed. We estimated the extent to which hospital records documented detection of alcohol abuse or dependence and other alcohol-related problems in a national sample of hospital admissions having a research-based diagnosis of alcohol use disorder ("interview-positive admissions"). We also estimated rates of inpatient alcohol intervention and referral for treatment. METHODS: A complex, multistage, probability sample was designed to represent nonmaternity, acute-care admissions to nonfederal, short-stay, general hospitals in the contiguous United States. The study included 2040 admissions, 1613 male and 427 female. Research-based diagnoses of current (ie, past 12 months) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition alcohol use disorder were derived from a structured, computer-assisted, personal interview containing the Alcohol Use Disorders and Associated Disabilities Interview Schedule. Information on detection, inpatient intervention, and treatment referral were obtained via retrospective analysis of closed hospital records covering the index visit. RESULTS: Record-documented diagnoses of alcohol-related problems were found in 40% to 42% of interview-positive admissions. Inpatient intervention rate was estimated at 21% for interview-positive admissions, and treatment referral rate, 24%. For detected interview-positive admissions, estimated rates of intervention and referral were 50% and 53%, respectively. CONCLUSIONS: Estimated rates of detection, inpatient intervention, and treatment referral of alcohol use disorders in hospital admissions were low. Current-drinking hospital admissions should be screened for alcohol problems as part of the admission routine, with further professional evaluation, intervention, and treatment referral as indicated.

Adolescent↗

PubMed2004

[New systems of mapping and navigation in electrophysiology].

The indications of radiofrequency ablation of arrhythmias have considerably increased since the introduction of the technique in the early 1990s. Interventional rhythmologists now treat arrhythmias which are more and more complex by their mechanism. This requires accurate representation of the ablation catheter position and the integration of spatial and temporal data to identify the arrhythmogenic substrate. The systems of mapping and navigation developed over the last ten years are important tools for interventional rhythmologists. They are very useful for the identification of complex arrhythmogenic substrates which require "individualised" ablations in specific cases. The aim of this article is to review different systems of mapping, and/or navigation currently on the market and their principal characteristics without entering into the details of their use in interventional electrophysiology.

Arrhythmias, Cardiac↗

PubMedDate not supplied

Elder mistreatment: dental assessment and intervention.

Elder mistreatment has increasingly been recognized as a serious and complex health issue affecting large numbers of elders each year. Dependent elder populations are often at heightened risk for mistreatment by those individuals and institutions that care for them. Health professionals have been found to lack knowledge regarding assessment, diagnosis, intervention, and reporting criteria of elder mistreatment. This article reviews the types and prevalence of elder mistreatment, risk factors, signs and symptoms, preventive interventions, and ethical considerations.

Aged↗

PubMed1997

[A new family intervention method].

PROBLEM BEING ADDRESSED: Family medicine residents have difficulty developing the complex skills needed to work with families. OBJECTIVE OF PROGRAM: To develop an educational program to teach family medicine residents at Laval University a new type of family intervention technique, based on the systems approach, using a practical and interactive method. MAIN COMPONENTS OF PROGRAM: Using Brien's systematic planning model, the authors developed and tested a series of six interactive workshops on three themes. The first theme aims to motivate residents by showing them why it is important to use a systems approach with their patients. The second theme explores a family situation in an individual interview. The third enables residents to conduct a family interview. The whole program has been tested and evaluated. All of the materials needed to teach these skills are contained in a trainer's guide and a video cassette. CONCLUSION: This educational program's originality lies in its combination of the systems approach and interactive training for residents. The program could easily be presented as a continuing medical education activity.

Clinical Competence↗

PubMed2002

Nutrition and disease: challenges of research design.

This review discusses research methodology in the relation between diet and disease. Medical research can be divided into two types: complex research (the detailed study of disease mechanisms using such methods as biochemistry and molecular genetics) and simple research (the investigation of the factors that cause or prevent disease using methods such as epidemiology, intervention trials, and analagous studies on animals). Although complex research has received the bulk of resources, the large majority of our information of practical value has come from simple research. This general principle is illustrated in the area of diet and disease by examples from various areas: selenium, carotenoids, and cancer; vitamin E, omega-3 fatty acids, and coronary heart disease; dietary fat and obesity; dietary sodium and hypertension; and alcohol and stroke. Discussion then turns to aspects of the design of cohort (prospective) studies. Because of problems of sample size and relative lack of diversity, previous studies often failed to give clear-cut results. Suggestions are made concerning the design of cohort studies, notably the use of much larger numbers of subjects and with greater diversity in their diets. The problem of confounding also is discussed. Lifestyle factors often cluster together but cohort studies may not have fully unraveled this.

Coronary Disease↗

PubMedDate not supplied

Complexation versus hemodialysis to reduce elevated aminoglycoside serum concentrations.

Seven patients with acutely elevated aminoglycoside serum concentrations were studied comparing the effect of hemodialysis (n = 3) with removal by complexation using ticarcillin or carbenicillin (n = 4). Aminoglycoside serum half-life before intervention averaged 96 hours for the dialysis group and 67 hours for the complexation group. Ticarcillin was used for a minimum of 48 hours, while hemodialysis removal was estimated over 48 hours, which included two 4-hour dialysis periods. Aminoglycoside serum half-life was reduced to an average of 11 hours with hemodialysis, while with complexation using ticarcillin, it was reduced to 12 hours. During the 48-hour comparison period, complexation removed approximately 50% more aminoglycoside than did hemodialysis, primarily because the improved removal technique was sustained over the entire time. Complexation appears to be as effective as continuous hemodialysis in lowering excessive aminoglycoside serum concentrations. Complexation with ticarcillin can be more rapidly initiated, is less expensive and there is a low risk of adverse reactions. This method provides continued treatment of infections in patients with elevated serum concentrations and/or nephrotoxicity who require cessation of aminoglycoside therapy.

Aged↗

PubMed2026

Multi-omics reveals that burdock seed aglycone alleviates renal fibrosis by restoring mitochondrial oxidative phosphorylation function.

Renal fibrosis (RF), a common pathological process driving chronic kidney disease (CKD) progression to end-stage renal failure, is closely associated with oxidative phosphorylation (OXPHOS). Arctigenin (ATG), the main active component of burdock seed, exhibits anti-inflammatory and anti-fibrotic activities, but its mechanisms in RF treatment remain unclear. Here, we performed integrated transcriptomic and proteomic analyses to identify key targets and pathways of ATG in a unilateral ureteral obstruction-induced rat RF model. Multi-omics enrichment analysis revealed that NDUFS8 and NDUFS2 were the core targets of ATG, with the OXPHOS pathway as the central intersecting pathway. Our results suggest that ATG exerts anti-renal fibrosis effects by targeting the OXPHOS pathway to inhibit excessive reactive oxygen species production and oxidative stress. SIGNIFICANCE: Chronic kidney disease (CKD) continues to impose an escalating global health and socioeconomic burden, while renal fibrosis (RF), as the convergent pathological endpoint of virtually all progressive nephropathies, remains the principal determinant of irreversible renal failure and adverse clinical outcomes. Despite extensive efforts to develop antifibrotic therapies, effective clinical interventions remain elusive, largely due to the complex and multifactorial nature of RF pathogenesis. In this study, we employed an integrated multi-omics framework encompassing transcriptomics, proteomics, and metabolomics to systematically decipher the antifibrotic mechanism of arctigenin (ATG), a bioactive natural compound derived from traditional Chinese medicine. Our findings identify mitochondrial oxidative phosphorylation as the pivotal regulatory axis underlying the renoprotective effects of ATG and further establish key catalytic subunits of mitochondrial complex I as its direct molecular targets. Mechanistically, ATG not only restores complex I activity and reprograms mitochondrial energy metabolism but also preserves the intracellular stability and localization of these subunits, thereby preventing their aberrant release-mediated inflammatory activation and disrupting the self-perpetuating cycle linking metabolic dysfunction, inflammation, and fibrosis progression. Beyond revealing a previously unrecognized dual mechanism integrating metabolic and inflammatory regulation, this study provides compelling evidence that mitochondrial dysfunction is not merely a secondary consequence of tissue injury but a fundamental driver of fibrotic remodeling. Importantly, our work highlights the translational potential of natural product-based mitochondrial interventions for CKD treatment and supports a broader conceptual shift toward metabolism-centered therapeutic strategies for chronic fibrotic diseases. Given the central role of mitochondrial dysfunction across multiple organs, these findings may also have far-reaching implications for the treatment of systemic fibrosis-related disorders beyond the kidney.

Animals↗

PubMed1990

Intervention policy in endemic goitre areas.

The multifactorial nature and complex interactions of regionspecific environmental conditions with host factors in the pathogenesis of endemic goitre constitute a major challenge to the understanding and control of the problem in endemic areas. However, to control and prevent this important public health problem, the most obvious but difficult initial step requires substantial socioeconomic improvements in the affected areas of less developed countries, including, first, provision of efficient iodine prophylaxis programs, second, diversification of dietary constituents with adequate daily protein-calorie intake, and third, institution of proper sanitary conditions with effective water treatment to eliminate organic and bacterial pollutants. This last intervention is also a requirement to control and prevent goitre in the iodine-sufficient more developed countries. In this regard, more research is needed to provide effective ways of water treatment that can be applied in individual households or at the community level.

Age Factors↗

PubMed2005

Gene delivery of Tim44 reduces mitochondrial superoxide production and ameliorates neointimal proliferation of injured carotid artery in diabetic rats.

Hyperglycemia induces the production of reactive oxygen species (ROS) from mitochondria, which is closely related to diabetic vascular complications. Mammalian translocase of inner mitochondrial membrane (Tim)44 was identified by upregulation in streptozotocin (STZ)-induced diabetic mouse kidneys; Tim44 functions as a membrane anchor of mtHsp70 to TIM23 complex and is involved in the import of preproteins with mitochondria-targeted presequence into mitochondrial matrix. The process is dependent on inner membrane potential (Delta psi) and ATP hydrolysis on ATPase domain of mtHsp70. Here, we show that the gene delivery of Tim44 using pcDNA3.1 vector (pcDNA3.1/TIM44) into the balloon injury model of STZ-induced diabetic rats ameliorated neointimal proliferation. ROS production, inflammatory responses, and cell proliferation in injured carotid artery were diminished by delivery of pcDNA3.1/TIM44. In vitro experiments using human aortic smooth muscle cells (HASMCs) revealed that the gene delivery of Tim44 normalized high-glucose-induced enhanced ROS production and increased ATP production, alterations in inner membrane potential, and cell proliferation. Transfection of siRNA and pcDNA3.1/TIM44 using HASMC culture clarified that import of antioxidative enzymes such as superoxide dismutase and glutathione peroxidase was facilitated by Tim44. Tim44 and its related molecules in mitochondrial import machinery complex are novel targets in the therapeutic interventions for diabetes and its vascular complications.

Adenosine Triphosphate↗

PubMed2001

A bibliography of cost-effectiveness practices in physical medicine and rehabilitation: AAPM&R white paper.

Cost-effectiveness studies attempt to determine the ratio of costs to outcomes of a particular intervention or treatment and to compare a standard intervention with an alternative intervention to determine if the alternative is more cost effective. The goal is to establish priorities for the resources allocation and to decide among alternative interventions for the same medical condition. The global process of rehabilitation does not usually lend itself to cost-effective analysis (due to the complex set of treatments provided) but rather to specific interventions and specific aspects of outcome. The American Academy of Physical Medicine and Rehabilitation has published a cost effectiveness annotated bibliography on the Internet (http://www.aapmr.org/memphys/cebfinala.htm) that identifies 132 studies in the literature that meet specified criteria and are related to the field of rehabilitation. This White Paper attempts to interpret and synthesize the studies in that bibliography that relate to stroke, spinal cord injury (SCI), orthopedic conditions, pain syndromes, amputations, and traumatic brain injury (TBI). Most studies support the cost effectiveness of care for stroke and SCI in dedicated units or centers rather than in a general medical unit. Studies also support back programs and revascularization procedures in limb ischemia. Studies in TBI underscore the significant financial resources for the care of these patients as well as the potential benefit from rehabilitation services even in the most severely injured. Further high quality research in this area is needed.

Academies and Institutes↗

PubMedDate not supplied

Family therapy in complex temporomandibular joint dysfunction. A case study in collaboration.

The purpose of this paper is to offer the oral and maxillofacial surgeon a collaborative approach to the treatment of complex temporomandibular joint (TMJ) dysfunction. Through a positive relationship with a family therapist, the oral and maxillofacial surgeon in this case reports family therapy intervention as an additive solution to resolving apparent recurrent surgical failures. After three surgical procedures, the oral and maxillofacial surgeon noted continued muscle hyperactivity brought on by family environmental stress and arranged for family therapy treatment before a fourth surgical procedure. This paper presents a complicated TMJ case history, documentation for including the family in treatment of pain problems, collaborative efforts necessary for acceptance of referral for psychological intervention, and a family therapy approach to treatment in complex TMJ dysfunction.

Adult↗

PubMed2004

Mandibular distraction for micrognathia and severe upper airway obstruction.

OBJECTIVE: To determine whether the use of mandibular distraction osteogenesis (DOG) can help to avoid tracheotomy or achieve decannulation in patients with mandibular hypoplasia and severe upper airway obstruction. DESIGN: Retrospective medical record review (spanning a 27-month period). SETTING: Tertiary care children's hospital. SUBJECTS: Group A (n=8) was composed of infants with Pierre Robin sequence and no tracheotomy (mean age, 2.5 months); group B (n=6), older nontracheotomized micrognathic children with obstructive sleep apnea (OSA) (mean age, 69 months); and group C (n=12), tracheotomized children with complex congenital syndromes (mean age, 33 months). INTERVENTION: Bilateral mandibular DOG with endoscopic (n=24) and/or radiographic (n=17) airway evaluation (mean follow-up, 16 months [range, 2-42 months]). OUTCOME MEASURES: Group A, tracheotomy avoidance; group B, resolution of OSA (clinically or on polysomnography); and group C, decannulation. RESULTS: Group A, 7 patients (88%) successfully avoided tracheotomy; group B, 5 patients (83%) had resolution of OSA; and group C, 2 patients (17%) underwent decannulation. CONCLUSIONS: Mandibular DOG (1) allows tracheotomy avoidance in infants with isolated Pierre Robin sequence and (2) relieves OSA in older micrognathic children without tracheotomy. However, mandibular DOG does not frequently lead to decannulation in tracheotomized patients with complex congenital syndromes.

Case-Control Studies↗

PubMed1995

The use of intraaortic balloon counterpulsation in acute myocardial infarction and high risk coronary angioplasty.

Patients with complex coronary arterial stenoses, decreased ejection fraction, or acute myocardial infarction are at increased risk during percutaneous coronary interventions. Intraaortic balloon counterpulsation (IABP) can provide benefit in such cases by several mechanisms. Myocardial perfusion is improved and left ventricular afterload is reduced by balloon counterpulsation. Patients with cardiogenic shock clearly benefit from balloon counterpulsation until revascularization can be performed. Recent studies have documented the utility of balloon counterpulsation in patients undergoing angioplasty as treatment for an acute myocardial infarction. Balloon counterpulsation is also an effective means to reduce ischemia and provide hemodynamic support during complex percutaneous coronary interventions. This review will summarize the benefits, indications, and complications of balloon counterpulsation during acute myocardial infarction and high-risk coronary angioplasty.

Angioplasty, Balloon, Coronary↗

PubMed1992

[Modification of the aerobic metabolism of human full skin complexes. An in vitro study].

The effect of increased oxygen supply on oxygen uptake of isolated human full-thickness skin grafts was investigated. Acute hyperoxic conditions led to temporary slight reductions of the cellular oxygen consumption rate, whereas pronounced longer-lasting effects could not be demonstrated. It was concluded that hyperoxic intervention is not suitable to compensate for the complex metabolic disorders arising in transplanted tissue.

Acid-Base Equilibrium↗

PubMed2004

A policy analysis of funding for ambitious interventional gerontology: the possibility of rejuvenation research at the National Institute on Aging.

Issues related to the development of ambitious interventional gerontology-rejuvenation research-at the National Institute on Aging (NIA) within the National Institutes of Health (NIH) are discussed. Creating a separate branch for rejuvenation research within the NIA is probably neither feasible nor desirable at this time. However, it may be both feasible and desirable to begin rejuvenation research by establishing a bioengineering laboratory offering technologies that complement the disease-orientated focus of other NIA intramural laboratories. Such a bioengineering lab could use modern engineering tools for cell and gene therapies to uncover mechanisms of aging and to attempt to repair age-associated pathogenic damage. It is argued that, even in the absence of a full understanding of the complex causes and manifestations of human aging, interventional bioengineering could create methods for reversing aging processes. Exploring technical interventions may both reverse aging processes and significantly advance current disease-specific research.

Aged↗

PubMed1991

Implantable cardioverter defibrillator: data storage and retrieval with Patientlog.

A pacemaker management system (Patientlog), implemented on a IBM personal computer (AT), was adapted for the control and the administrative management of patients with an implantable cardioverter defibrillator (ICD). Several parameters used for pacemakers were also suitable for ICDs, while some fields were defined within the available frame of the database, to cope with the specific technical information of ICDs. "Intervention-cards" display diagnostic (threshold) as well as complex surgical information (approach, lead systems, etc.). "Follow-up-cards" present charge time and the number of shocks in such a way that decision making is very easy. Fourteen patients were followed with a total of 21 interventions, six different types of devices, and more than 150 follow-ups. A correct control of ICD functions is easy. The system is adapted for programmable ICDs. Updated reports containing necessary information are generated immediately after each procedure or follow-up.

Database Management Systems↗

PubMed1999

Distensible venous malformations of the orbit: clinical and hemodynamic features and a new technique of management.

OBJECTIVE: To investigate distensible venous malformations of the orbit (DVMO) as part of a spectrum of orbital vascular malformations, including some that involved periorbital skin, extraorbital sites (central nervous system or nasal sinuses), or combinations of these. The authors also investigated the effectiveness of a new technique of management for selected cases. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Thirty patients had distensible venous anomalies, of which four were combined distensible venous-lymphatic vascular malformations. Distensible lesions were defined as those showing clinical or radiographic expansion with Valsalva maneuver or when the head was placed in a dependent position. These lesions were then classified as superficial (anterior to the equator of the globe), deep (posterior to the globe's equator), combined (deep and superficial), or complex (with intracranial or major extraorbital involvement). INTERVENTION: Surgery was performed on 15 patients (50%), mainly for pain or for cosmetic indications. Six patients underwent this new technique, which involved intraoperative direct venography with control of outflow via pressure at the superior or inferior orbital fissure. The venous malformation was then embolized (by use of cyanoacrylate glue) and excised. RESULTS: The mean age at presentation was 28.2 years (range, 8 months to 75 years). Sixty-six percent of cases involved the left orbit. Superior and medial orbital involvement was most common. Three cases (10%) were classified as superficial, and 13 (43%) as deep. Six patients (20%) had combined superficial and deep components. Eight (27%) had major extraorbital involvement (4 intracranial, 2 facial, and 2 paranasal sinus). Direct venography demonstrated complex multichannel anomalies draining to various sites, including the face and pterygopalatine fossa, without necessarily having a direct connection to the major orbital venous circulation. CONCLUSIONS: Distensible venous malformations of the orbit are part of a spectrum of developmental venous malformations that may be localized to the orbit or involve it as part of a more extensive lesion. The authors describe their clinical and radiologic features and report a new technique of management for selected cases. This method of vascular isolation and embolization of lesions may greatly facilitate excision.

Adolescent↗

PubMed2004

The external fixator: a tool for evaluation of complex low back pain problems.

BACKGROUND: The selection of patients with low back pain for fusion is especially difficult when previous surgical interventions failed and/or invasive tests (discograms, facet blocks) do not allow or do not clearly identify the painful motion segment. Test fixation with an external fixator may mimic a definite internal fixation, such as a fusion, and may help select patients for a more favorable result. The purpose of the study was to clarify if temporary back pain relief by external fixation is predictive for back pain relief after final internal fixation and fusion. METHODS: A retrospective study of 63 patients up to 6 years after evaluation of low back pain problems with an external fixator (index operation) was conducted. The data were collected from the charts based on a protocol that patients had to fill in during evaluation, and the actual state was checked during a clinical investigation at the outpatient clinic. The protocol monitored pain (Visual Analog Scale), pain medication, and work status. Based on the first two parameters, the effect of external fixation was defined as a general estimation as positive, doubtful, or negative. The same parameters were reassessed at follow-up control. RESULTS: In 38 patients, the immobilization test did improve the pain situation, in 11 it remained unchanged, and in 14 the pain got worse. Thirty-eight patients (not identical with the above) underwent definitive fusion afterward, whereas 25 were not operated on. Twenty-one of 30 patients with a positive effect undergoing surgery showed an improved situation after fusion, and 8 of 22 patients without further operation were improved at follow-up. Nine of 12 patients with a negative immobilization test did stay in a bad situation at follow-up. CONCLUSION: The external fixator as a tool for evaluation of patients with low back pain is an expensive measure with a considerable complication risk and only justified in selected patients when any other measure fails to assess and evaluate a patient's situation. If the test fixation reveals no benefit, the patients will remain in a bad situation whatever the therapeutic measure will be. Therefore the main value of the external fixator assessment is the selection of these patients that should not undergo surgery. A positive test fixation means a 72% chance for a satisfactory outcome at least two years after surgery, whereas without surgery the chance for some spontaneous improvement is 57% if the test immobilization did show some improvement. With respect of the "negative" selection of this group of patients (complex history, previous interventions) in our as well as in others series, the obtained results seem acceptable and the use of this invasive diagnostic measure in this group of patients seems justified. Statistical analysis did not show differences of significance as the numbers in the individual groups was too small.

Adult↗