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PubMed1997

Insect chitinases: molecular biology and potential use as biopesticides.

Chitin, an insoluble structural polysaccharide that occurs in the exoskeletal and gut linings of insects, is a metabolic target of selective pest control agents. One potential biopesticide is the insect molting enzyme, chitinase, which degrades chitin to low molecular weight, soluble and insoluble oligosaccharides. For several years, our laboratories have been characterizing this enzyme and its gene. Most recently, we have been developing chitinase for use as a biopesticide to control insect and also fungal pests. Chitinases have been isolated from the tobacco hornworm, Manduca sexta, and several other insect species, and some of their chemical, physical, and kinetic properties have been determined. Also, cDNA and genomic clones for the chitinase from the hornworm have been isolated and characterized. Transgenic plants that express hornworm chitinase constitutively have been generated and found to exhibit host plant resistance. A transformed entomopathogenic virus that produces the enzyme displayed enhanced insecticidal activity. Chitinase also potentiated the efficacy of the toxin from the microbial insecticide, Bacillus thuringiensis. Insect chitinase and its gene are now available for biopesticidal applications in integrated pest management programs. Current knowledge regarding the molecular biology and biopesticidal action of insect and several other types of chitinases is described in this mini-review.

Amino Acid Sequence↗

PubMed2001

Combined left pneumonectomy and off-pump coronary artery bypass through left thoracotomy.

Concomitant pneumonectomy and coronary artery bypass grafting (CABG) carry a high morbidity and mortality rate. We present the case of a patient operated on for left pneumonectomy and off pump CABG through a left thoracotomy incision in a one-stage procedure with a 1-year disease-free follow-up. To the best of our knowledge, simultaneous surgical management as presented in this patient has not been previously reported.

Aged↗

PubMed2004

An evaluation of parameters for the detection of subclinical rumen acidosis in dairy herds.

An observational study was conducted in six Danish dairy herds. A specially designed stomach tube was compared to the rumenocentesis technique as part of the monitoring of rumen pH. In contrast to a previous study, the use of the stomach tube appeared to reduce saliva contamination. However, correlation with the rumenocentesis technique was poor ( r = 0.33; p = 0.019) and a linear model could only partly explain variations between either results. The presence of subclinical rumen acidosis (SRA) was evidenced in one herd only, as judged by results obtained by the rumenocentesis technique. The present study revealed some limitations of the rumenocentesis technique in small or medium-sized herds due to difficulties in selecting sufficient numbers of cows in the respective groups at risk. The finding of two apparently clinical normal cows with rumen pH values below 5.0 leads to the consideration that such fluctuations may be temporary and at least does not give rise to clinical symptoms. However, the long-term effect of such fluctuations is not known. In general, primiparous cows seemed more prone to low ruminal pH values (< 6.0), higher ruminal concentrations of short-chain fatty acids, and possibly to metabolic acidosis, than were multiparous cows. Ruminal propionate was the most precise predictor of rumen pH, whereas milk fat percentage varied greatly between lactational groups. Blood lactate dehydrogenase (LDH), beta-hydroxybutyrate (BHB) and fructosamine as well as urine phosphorus excretion and renal net acid-base excretion (NABE) were related to ruminal acid load, but were not predictive of rumen pH. Monitoring of dairy herds for SRA should be performed routinely and employ several diagnostic tools (rumenocentesis, renal NABE determination) as well as specific knowledge of herd management and feeding routines.

3-Hydroxybutyric Acid↗

PubMed2006

[Family therapy within the treatment of eating disorders].

The families of patients suffering from eating disorders such as Anorexia nervosa (AN) und Bulimia nervosa (BN) are, owing to the illness, subject to considerable emotional strain and are furthermore often characterised by significant structures and patterns of interaction within the family. Consequently the inclusion of patients' family members, whose status can be seen as increasingly gaining in scientific approval, plays an important role within both diagnosis and therapy. Of particular importance is the medical informative discussion with both patients and their parents which takes place in a primarily medical context and aims to develop and increase therapy motivation. For this purpose the doctor should possess basic knowledge concerning dialogue management with families, as will be presented in the current article. Within further stages of the therapeutic process the spectrum of interventions at the level of the family ranges from educational and supportive measures to family therapy in a more narrow sense, which is carried out by specialist psychotherapists either as outpatient-treatment or within the framework of therapy with inpatients of a clinic.

Family Therapy↗

PubMed2002

Improvement in resuscitation knowledge after a one-day paediatric life-support course.

OBJECTIVE: To assess the effect of a one-day paediatric life-support course on the knowledge of paediatric trainees. METHODS: A telephone survey was performed prior to and at set intervals following the course. Responses to individual questions before and after the course were analysed and an overall test score was calculated. The acquisition and retention of knowledge was measured by comparing test scores for the same group of trainees at time intervals after the course. RESULTS: All candidates were surveyed. The median duration of paediatric training prior to the course was 3 years. Eighteen candidates (78%) had previously intubated a child and 13 (57%) had previously used an intraosseous needle. Prior to the course, few of the 23 candidates had adequate knowledge of either the management of the cervical spine in the seriously injured child (17%), fluid resuscitation in meningococcal septicemia (52%), shock dose in ventricular fibrillation (61%), or the management of anaphylactic shock (35%). There was a significant improvement in the knowledge of the group after the course, with median test scores increasing from 19 to a maximum of 22 (P < 0.001). This knowledge was retained at 4 months after the course. CONCLUSION: Despite a high level of experience and previous training in paediatric resuscitation, many candidates lacked the basic knowledge necessary for the resuscitation of seriously ill or injured children. There was a significant improvement in this knowledge after the course, and this was maintained for 4 months. The paediatric life-support course is an important means of resuscitation training for junior doctors.

Australia↗

PubMed2003

Use of bisphosphonate therapy for osteoporosis in childhood and adolescence.

Congenital and acquired forms of osteoporosis in childhood and adolescence can result in morbidity from fracture and pain in childhood, and place an individual at significant risk for problems in adult life. A range of therapies exist for the prevention and treatment of osteoporosis, including optimization of daily calcium intake, adequate vitamin D status, weight-bearing exercise, treatment with sex steroids where delayed puberty is a problem and, more recently, use of bisphosphonate therapy. Intravenous pamidronate therapy (a bisphosphonate) has been shown to reduce fractures and improve bone density in children with osteogenesis imperfecta, and might prove to be of benefit in other osteoporotic conditions in childhood. However, a number of issues regarding the optimal use of bisphosphonate therapy in children and adolescents remain to be resolved, including total annual dose and frequency and duration of administration. Bisphosphonate therapy should, therefore, be used only in the context of a well-run clinical programme with specialist knowledge in the management of osteopenic disorders in childhood.

Absorptiometry, Photon↗

PubMed2002

The therapeutic challenges in the older Parkinson's disease patient.

The information explosion in Parkinson's disease challenges the individual clinician to apply available knowledge to the management of individual patients. The application of current algorithms and guidelines is not straightforward in the older patient. Decision analysis reveals that clinical decisions may be simple, complex or chaotic. The more factors that have to be taken into account in making a decision, the more that decision moves from being evidence-based to intuitive. Decisions are made within conceptual frameworks. The dominant models in Parkinson's disease are biomedical or rehabilitation-based. Although the rehabilitation model lacks a sound evidence base, it is the principles of rehabilitation that dominate the management of the older patient. Analysis of the decisions made in a Parkinson's disease clinic demonstrates that the doctor's role is complex and many decisions taken are not evidence-based. Parkinson's disease is not a simple movement disorder but a neuro-psychiatric complex. The incurable nature and chronicity of the disease dictate the need for multidisciplinary working. Quality of life studies reveal wide variations in the expectations and needs of patients. Studies of the impact and costs of the disease put the cost of drugs into perspective. Studies in Parkinson's disease can involve very different populations. A cohort of elderly patients shows significant differences from the populations who are selected to participate in multi-centre trials. There is an increasing challenge for geriatricians to ensure that pragmatic trials are undertaken. Psychiatric problems - dementia, depression, and hallucinations - are common in the elderly and best management of these problems is unclear. Choices in drug regimes need to take into account the complex interactions between ageing, comorbility and Parkinson's disease.

Age Factors↗

PubMedDate not supplied

Lake Superior Rural Cancer Care Project, part I: an interventional trial.

PURPOSE: To date, effective cancer care and control intervention studies have been carried out largely in urban and suburban populations. This study was conducted to test innovative interventions, using experimental designs, to improve the care and outcomes of patients with cancer in rural settings. DESCRIPTION OF STUDY: The Lake Superior Rural Cancer Care Project (LSRCCP) tested an innovative, multimodal, multidisciplinary intervention that involved rural healthcare providers and their healthcare system. An experimental design was used, with the rural community as the unit of randomization. Outcomes were measured at three levels: rural providers' knowledge of cancer management, providers' practice performance, and patient outcomes. This 5-year study was conducted in rural areas of northern Minnesota, Wisconsin, and the western part of the Upper Peninsula of Michigan. RESULTS: Baseline data from the study are provided, and details of the design and methods are presented. The study outcomes are reported in part in "Lake Superior Rural Cancer Care Project Part II" in this issue and will be reported further in future issues. CLINICAL IMPLICATIONS: This article describes the hypotheses, design, and methods of the LSRCCP. The design and methods as well as the results of this study may be useful to cancer researchers and clinicians in rural areas across the United States.

Humans↗

PubMed2002

[Therapy of elderly patients with colorectal carcinoma].

Treating elderly patients with colorectal cancer is a challenging task for which many aspects have to be taken into account. Almost 70% of patients with colorectal cancer are 65 years or older and the number of elderly patients is expected to increase. As elderly patients frequently exhibit adverse physical or socio-economic conditions, a thorough geriatric assessment of the patient's suitability for therapy is essential before making a decision. The first line treatment for colorectal cancer is surgery. Complete resection of the tumor should also be attempted in elderly patients, as there are little differences in cancer--specific survival in selected elderly patients compared to younger patients. Surgery with palliative intention can be attempted for symptom control or to prevent later local complications caused by the primary tumor. At present, adjuvant 5-FU based chemotherapy (in colon cancer) and adjuvant radio-chemotherapy (in rectal cancer) in the elderly is recommended for locally advanced or node positive tumor after tumor resection, since the benefit seems to be comparable to that achieved in younger patients. There is also enough data to support the use of 5-FU based chemotherapy in elderly patients in the palliative setting. New drugs have recently been added to the armentarium for the treatment of metastatic colorectal cancer. However, there is as yet not sufficient data to guide the use of these new drugs (such as oxaliplatin or irinotecan) in elderly patients. However, first clinical studies seem to indicate a comparable efficacy and toxicity in elderly patients to that observed in younger patients. Further clinical trials of chemotherapy in elderly patients with colorectal cancer are necessary to gain information about treatment recommendations. It is the aim of this manuscript to summarize the current knowledge about the management of colorectal cancer in elderly patients.

Aged↗

PubMed2001

Drugs in pregnancy. Respiratory disease.

Respiratory illnesses are the commonest cause of patient visits to physicians. Although the common cold, sinusitis and bronchitis may be lacking in drama, they account for a substantial amount of morbidity among women of reproductive age and are frequently encountered by physicians caring for pregnant women. Present knowledge about the management of these common conditions and the safety of the medications often used to treat them are reviewed in this chapter. Asthma and community-acquired pneumonia are more serious respiratory illnesses that are also often encountered in pregnancy. Present evidence suggests that community-acquired pneumonia is best treated empirically, with additional investigation usually necessary only if there is a failure of initial treatment. The recognition of asthma as an inflammatory condition has led to a very specific approach to its management that can readily and safely be applied to the pregnant woman. Treatment of HIV and tuberculosis should not be withheld during pregnancy because of the life-threatening nature of these infections and the importance of preventing vertical transmission.

Acute Disease↗

PubMed2001

Hypercalcaemia, parathyroid hormone-related protein and malignancy.

Hypercalcaemia is the most common serious metabolic complication of malignancy. Recent advances have significantly increased our understanding of the pathophysiology of hypercalcaemia of malignancy and revealed the importance of parathyroid hormone-related protein (PTHrP) in a wide range of physiological and pathological processes. This review examines the pathophysiology of hypercalcaemia of malignancy, focusing on the role of PTHrP before discussing further pathological and physiological processes in which PTHrP may be implicated, and the impact of this knowledge on the management of malignant disease.

Bone Neoplasms↗

PubMed2000

[Public health in homes for the aged and nursing homes--experiences from monitoring by the public health office in Frankfurt am Main from 1989 to 1998].

UNLABELLED: Hygiene conditions in residential homes for the aged must be surveyed by the Public Health services according to German legislation (Bundesseuchengesetz, Law for Protection against Infectious Diseases). We report here on the data of the routine controls of the public health department in Frankfurt am Main in all of the 31 residential homes for the aged of the city. RESULTS: In 1989, a special plan for cleaning and disinfection was available in one home only, whereas a hygiene plan was not available in any of the homes. Up to 1998, plans for cleaning and disinfection were established in 29 of the homes, and more than 50% of them had fulfilled their hygiene plan. The supply and maintenance of dispersers for disinfectants, the usage of disinfectants and the knowledge regarding proper disinfection and sterilisation procedures could be improved. The same was true of the kitchens: there, up to 1998 testing of samples set aside for later reassessment was properly done in most of the homes. CONCLUSION: Hygiene in the homes and the knowledge of the staff members were markedly improved during the last years. Some of the most relevant hygienic problems are today: wearing private clothing instead of special working clothes, or deficits in the knowledge of the management of MRSA-colonised residents.

Aged↗

PubMedDate not supplied

[Experience using transcutaneous pO2 measurement (tcpO2 measurement) during the transport of premature and newborn infants with artificial respiration].

In 55 high-risk neonates of different birth-weight and gestational age, transcutaneous pO2 (tcpO2) was continuously monitored during transports from the Obstetric Units to the Neonatal Intensive Care Units. We were able to demonstrate that the need for oxygen was overestimated in most of the children and thus FiO2 could be reduced in nearly all cases. In this way, FiO2 can be adapted to the real need of the children and hypoxemias can be avoided as far as possible frequency and duration of hyperoxemias can be reduced. Moreover, valuable knowledge about further management of mechanical ventilation may be obtained. Complications, as e.g. obstruction of endotracheal tube, are more rapidly recognized than by ECG-monitoring alone.

Blood Gas Monitoring, Transcutaneous↗

PubMedDate not supplied

Establishing a collaborative trauma training program with a community trauma center for military nurses.

A mission of the Navy Nurse Corps is to deploy medical support for military forces on short notice. Navy nurses must possess a working knowledge of trauma management, but meeting this clinical experience is a challenge. Peacetime military hospitals do not routinely care for severely injured patients. This article describes how the Navy established a partnership with a Level 1 Trauma Center, the role and expectations for both Navy and civilian nurses, and an evaluation of the experience.

Alaska↗

PubMedDate not supplied

Research colloquium on occupational respiratory diseases: a conference in Cuba (1984).

At an international conference in Havana, Cuba, March 19-21, 1984, health professionals from the United States, Canada, and Cuba participated in a research colloquium on occupational lung diseases. Participants and speakers discussed the state of the art of knowledge, research, and management of key occupational lung diseases, and suggested directions for future efforts. Differences among the three countries in terms of the medical, economic, and social aspects of defining, treating, and compensating occupational diseases were also considered.

Congresses as Topic↗

PubMed2001

Pregnancy and twinning rates in Thoroughbred mares following the administration of human chorionic gonadotropin (hCG).

AIM: To determine the effect of hCG administration to cycling Thoroughbred mares, on pregnancy and twinning rates and the number of serves in the treated cycle. METHODS: A retrospective case control approach was conducted involving 2119 mare ovulatory cycles, on 1110 mares over a 7-year period. Data were collected by 1 of the authors during routine stud work at 3 commercial Thoroughbred farms in the Waikato region of New Zealand. The hCG (1500 IU) was administered by intravenous injection to selected mares 24 h before the expected time of breeding. Mares were scanned for pregnancy (singleton or twins) 14 days after the onset of dioestrus or detection of ovulation. Multilevel logistic regression analyses were used to identify the risk factors associated with the outcomes of interest while simultaneously controlling for possible confounding factors. RESULTS: Treatment with hCG tended to improve the odds of pregnancy (p=0.06), produced a 3-fold increase in the odds of twins (p<0.001), and increased the odds of a mare having a single serve in the treated ovulatory cycle (p=0.036). The first ovulatory cycle of a season in which a mare was bred was associated with a lower odds of pregnancy (p=0.02), and a lower odds of twins (p=0.003), when compared with subsequent cycles. Lactating mares were less likely to be diagnosed with twins (p=0.005), and were more likely to have a single serve (p<0.001), in any one ovulatory cycle than non-lactating mares. CONCLUSIONS: This report supports the role of hCG as an important therapeutic tool in veterinary management of broodmares for optimal reproductive performance. Mares treated with hCG must be managed in the knowledge that they have an increased likelihood of twins.

Journal Article↗

PubMed2004

Problems in quantifying bone response to exercise in horses: a review.

Detecting changes in bone during growth, training, rest from competition (spelling), and disease in horses requires imaging techniques that have a high level of accuracy and precision. Currently, most imaging techniques used in horses do not possess such characteristics and are more suitable for detecting end-stage disease than subtle changes. Some are incapable of detecting changes in bone size. Non-planar techniques should be used for estimating or determining bone strength. This review outlines available imaging techniques and shows why cross-sectional procedures are required to accurately estimate bone strength. If these can be validated and improved for use in the standing horse, serial examination can be used to show the magnitude of changes in bone strength that occur during training or varying management regimens. Such knowledge can then be used to improve training and spelling regimens for equine athletes, hopefully resulting in a reduction in racing or athletic injury.

Journal Article↗

PubMed2006

A change in career, from medical photographer to retinal screener / grader.

Retinal screening has become a growth industry since the Government's 2002 directive concluded that a national screening programme should be set up by 2006, and that by 2007 all diabetic patients over the age of twelve be given the option of having their retinas screened and graded. Country-wide there is going to be a rapid increase in the number of retinal screener positions and many medical photographers who undertake ophthalmic work may consider this as a career option. The diagnostic aspect of screening is the most rewarding part of the job; and professional relationships can help to develop the screener's knowledge of the management of diabetes as a whole.

Accreditation↗