Home About us Contact
|
Home About us Contact | ||
|
|
||
Specific Protocol (specific + protocol)
Selected AbstractsChemistry of ,-hydroxymethylserine: problems and solutions,JOURNAL OF PEPTIDE SCIENCE, Issue 11 2008Marcin Stasiak Abstract Further improvements related to the synthesis of peptides containing HmS are presented. Efficient synthetic protocols have been developed to synthesize "difficult" sequences containing a C -terminal HmS residue, MeA,HmS or consecutive HmS. Preparative methods for orthogonal N - and/or C -protected HmS(Ipr) derivatives are described. Their compatibility with standard solution or solid-phase peptide chemistry protocols allows synthetic flexibility toward HmS-containing peptides. In the synthesis of the sterically hindered dipeptides with the C -terminal HmS(Ipr) residue, HATU proves the highest efficiency, as compared with the fluoride and PyBroP/DMAP coupling methods. The HATU method also outperforms the fluoride activation in the solid-phase assembly of HmS homosequence. Specific protocols are described to overcome an undesired cyclization to diketopiperazines that occurs during the removal of Fmoc from dipeptides with the C -terminal HmS(Ipr) or HmS residues, thus precluding their C , N elongation. The successful protocols involve: (i) the 2 + 1 condensation using mixed anhydride activation yielding the desired product with the highest optical integrity or (ii) use of the 2-chlorotrityl resin as a solid support sterically suppressing the undesired cleavage due to diketopiperazine formation. The latter approach allows the mild conditions of peptide cleavage from solid support, preserving the isopropylidene protection and minimizing the undesired N , O -acyl migration that was observed under prolonged acid treatment used for cleaving the HmS peptide from the Wang resin. Copyright © 2008 European Peptide Society and John Wiley & Sons, Ltd. [source] Comparison of the Medical Priority Dispatch System to an Out-of-hospital Patient Acuity ScoreACADEMIC EMERGENCY MEDICINE, Issue 9 2006Michael J. Feldman MD Abstract Background: Although the Medical Priority Dispatch System (MPDS) is widely used by emergency medical services (EMS) dispatchers to determine dispatch priority, there is little evidence that it reflects patient acuity. The Canadian Triage and Acuity Scale (CTAS) is a standard patient acuity scale widely used by Canadian emergency departments and EMS systems to prioritize patient care requirements. Objectives: To determine the relationship between MPDS dispatch priority and out-of-hospital CTAS. Methods: All emergency calls on a large urban EMS communications database for a one-year period were obtained. Duplicate calls, nonemergency transfers, and canceled calls were excluded. Sensitivity and specificity to detect high-acuity illness, as well as positive predictive value (PPV) and negative predictive value (NPV), were calculated for all protocols. Results: Of 197,882 calls, 102,582 met inclusion criteria. The overall sensitivity of MPDS was 68.2% (95% confidence interval [CI] = 67.8% to 68.5%), with a specificity of 66.2% (95% CI = 65.7% to 66.7%). The most sensitive protocol for detecting high acuity of illness was the breathing-problem protocol, with a sensitivity of 100.0% (95% CI = 99.9% to 100.0%), whereas the most specific protocol was the one for psychiatric problems, with a specificity of 98.1% (95% CI = 97.5% to 98.7%). The cardiac-arrest protocol had the highest PPV (92.6%, 95% CI = 90.3% to 94.3%), whereas the convulsions protocol had the highest NPV (85.9%, 95% CI = 84.5% to 87.2%). The best-performing protocol overall was the cardiac-arrest protocol, and the protocol with the overall poorest performance was the one for unknown problems. Sixteen of the 32 protocols performed no better than chance alone at identifying high-acuity patients. Conclusions: The Medical Priority Dispatch System exhibits at least moderate sensitivity and specificity for detecting high acuity of illness or injury. This performance analysis may be used to identify target protocols for future improvements. [source] Quantification of urinary 8-iso-prostaglandin F2, using liquid chromatography,tandem mass spectrometry during cardiac valve surgeryJOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 4 2010Yun-Hui Teng Abstract Oxidative stress is an unavoidable event during many complex surgical procedures. 8-iso-prostaglandin F2, (8-iso-PGF2,) is a reliable biomarker for the evaluation of oxidative stress in vivo. The aim of this study is to develop simple and accurate liquid chromatography,tandem mass spectrometry (LC-MS/MS) methods for the detection of urinary 8-iso-PGF2, in samples collected from patients who received a cardiopulmonary bypass (CPB) during cardiac valve surgery. Urine samples of 14 patients with cardiac valve diseases were collected before, during, and after CPB. The level of 8-iso-PGF2, was detected via selected-reaction monitoring triple quadrupole MS/MS and the result was compared with 12 healthy volunteers. The method's detection limit (3S/N) was 0.25,pg for 8-iso-PGF2,, with a linear working range of 0.25,20,ng/ml. For patients with cardiac valve disease, the 8-iso-PGF2, levels before the bypasses were the same as those of healthy individuals (P>0.05) and the 8-iso-PGF2, levels during and after CPB were significantly higher than those before the bypasses (P<0.05). In conclusion, we present a simple and specific protocol for LC-MS/MS quantification of urinary 8-iso-PGF2, collected during CPB. Using this technique, it would be feasible to assess the levels of oxidative stress during cardiac surgery and thereby helpful for the management of oxidative injury. J. Clin. Lab. Anal. 24:237,245, 2010. © 2010 Wiley-Liss, Inc. [source] A 15 - minute [13C]-urea breath test for the diagnosis of Helicobacter pylori infection in patients with non-ulcer dyspepsiaJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 3 2000Nan-Jing Peng Abstract Background: Non-ulcer dyspepsia (NUD) accounts for the majority of dyspeptic patients and studies on the epidemiology of Helicobacter pylori infection in NUD depend on a non-invasive and rapid diagnostic test. This study was performed to determine the sensitivity and specificity of a 15-min simplified protocol of the [13C]-urea breath test ([13C]-UBT) for the diagnosis of H. pylori infection in patients with NUD. Methods: One hundred and thirty-six patients with a clinical and endoscopic diagnosis of NUD were included. The [13C]-UBT was modified from the European standard protocol. The baseline breath sample was collected 5 min after the patient took a test meal and the 13CO2 was collected 15 min after the patient drank 100 mg [13C]-urea. The gold standard used for comparison was either a positive culture or positive histology + positive rapid urease test sampled on upper gastrointestinal endoscopy. Results: The prevalence of H. pylori infection in NUD by the gold standard was 59.6%, whereas that calculated by the [13C]-UBT was 60.3%. The sensitivity and specificity of [13C]-UBT was 93.8 and 89.1% compared with the gold standard. The shortened collection time and simplification of the procedure may have led to a decline in specificity. Conclusion: The 15-min [13C]-UBT is a rapid but less specific protocol for detecting the presence of H. pylori infection in patients with NUD. © 2000 Blackwell Science Asia Pty Ltd [source] Evaluation of megavoltage CT imaging protocols in patients with lung cancerJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 1 2010S Smith Summary Currently, megavoltage CT studies in most centres with tomotherapy units are performed prior to every treatment for patient set-up verification and position correction. However, daily imaging adds to the total treatment time, which may cause patient discomfort as well as results in increased imaging dose. In this study, four alternative megavoltage CT imaging protocols (images obtained: during the first five fractions, once per week, alternating fractions and daily on alternative weeks) were evaluated retrospectively using the daily position correction data for 42 patients with lung cancer. The additional uncertainty introduced by using a specific protocol with respect to the daily imaging, or residual uncertainty, was analysed on a patient and population bases. The impact of less frequent imaging schedules on treatment margin calculation was also analysed. Systematic deviations were reduced with increased imaging frequency, while random deviations were largely unaffected. Mean population systematic errors were small for all protocols evaluated. In the protocol showing the greatest error, the treatment margins necessary to accommodate residual errors were 1.2, 1.3 and 1.7 mm larger in the left,right, superior,inferior and anterior,posterior directions, respectively, compared with the margins calculated using the daily imaging data. The increased uncertainty because of the use of less frequent imaging protocols may be acceptable when compared with other sources of uncertainty in lung cancer cases, such as target volume delineation and motion because of respiration. Further work needs to be carried out to establish the impact of increased residual errors on dose distribution. [source] Variability of sleep parameters across multiple laboratory sessions in healthy young subjects: The "very first night effect"PSYCHOPHYSIOLOGY, Issue 4 2002José-Luis Lorenzo Many studies have been carried out to assess the variability of sleep parameters. The first night effect is one of the most important factors in this variability and has been extensively studied. However, the readaptation phenomenon when subjects returned to the sleep laboratory after spending a certain period of time at home has been not systematically evaluated. To investigate this phenomenon across multiple sleep laboratory sessions, polysomnographic data from 12 healthy young subjects for 12 nights (three periods each of 4 consecutive nights, with a minimum of 1 month between them) were collected. The first night effect was present only in the first night of the first period ("very first night") and was significant only for REM sleep-related variables. We conclude that the results from the first nights of consecutive periods within a specific protocol with healthy young subjects need not be discarded in subsequent analyses. [source] Safety of cardiac surgery without blood transfusion: a retrospective study in Jehovah's Witness patientsANAESTHESIA, Issue 4 2010S. R. El Azab Summary The aim of this retrospective study was to compare the utilisation of blood products and outcomes following cardiac surgery for 123 Jehovah's Witnesses and 4219 non-Jehovah's Witness patient controls. The study took place over a 7-year period at the Amphia Hospital in Breda, the Netherlands. A specific protocol was used in the management of Jehovah's Witness patients, while the control group received blood without restriction according to their needs. Patients' characteristics were comparable in both groups. Pre-operatively, the mean (SD) Euro Score was higher in the Jehovah's Witness group (3.2 (2.6) vs 2.7 (2.5), respectively; p < 0.02). Pre-operative haemoglobin concentration was higher in the Jehovah's Witness group (8.9 (0.7) vs 8.6 (0.9) g.dl,1, respectively; p < 0.001). The total cardiopulmonary bypass time did not differ between groups. The requirement for allogenic blood transfusion was 0% in the Jehovah's Witness group compared to 65% in the control group. Postoperatively, there was a lower incidence of Q-wave myocardial infarction (2 (1.8%) vs 323 (7.7%), respectively; p < 0.02), and non Q-wave infarction (11 (9.8%) vs 559 (13.2%), respectively; p < 0.02) in the Jehovah's Witness group compared with controls. Mean (SD) length of stay in the intensive care unit (2.3 (3.2) vs 2.6 (4.2) days; p = 0.26), re-admission rate to the intensive care unit (5 (4.5%) vs 114 (2.7%); p = 0.163), and mortality (3 (2.7%) vs 65 (1.5%); p = 0.59), did not differ between the Jehovah's Witness and control groups, respectively. [source] Complete and sustained remission of juvenile dermatomyositis resulting from aggressive treatmentARTHRITIS & RHEUMATISM, Issue 6 2009Susan Kim Objective To assess the time needed to achieve sustained, medication-free remission in a cohort of patients with juvenile dermatomyositis (DM) receiving a stepwise, aggressive treatment protocol. Methods Between 1994 and 2004, a cohort of 49 children with juvenile DM who were followed up at a single tertiary care children's hospital using disease activity measures according to a specific protocol received standardized therapy with steroids and methotrexate. If a patient's strength or muscle enzyme levels did not normalize with this initial therapy, additional medications were added in rapid succession to the treatment regimen. The primary outcome measure was time to complete remission. Additional outcome measures were onset of calcinosis, effect of treatment on height, and complications resulting from medications. Results Forty-nine patients were followed up for a mean ± SD of 48 ± 30 months. All but 1 patient received 2 or more medications simultaneously. Transient localized calcifications occurred in 4 patients (8%), and 2 additional patients (4%) had persistent calcinosis. Despite the aggressive therapy, complications associated with treatment were mild and were primarily attributable to steroids. No persistent effect on longitudinal growth was observed. A complete, medication-free remission was achieved in 28 patients; the median time to achievement of complete remission was 38 months (95% confidence interval 32,44 months). None of these patients experienced a disease flare that required resumption of medications during the subsequent period of observation (mean ± SD 36 ± 19.7 months). Conclusion Our findings suggest that aggressive treatment of juvenile DM aimed at achieving rapid, complete control of muscle weakness and inflammation improves outcomes and reduces disease-related complications. In more than one-half of the children whose disease was treated in this manner (28 of 49), a prolonged, medication-free remission was attained within a median of 38 months from the time of diagnosis. [source] External modulation of HT-1080 human fibrosarcoma cells improves urokinase productionBIOTECHNOLOGY PROGRESS, Issue 6 2008Shilpa S. Khaparde Abstract Urokinase was produced in a hollow fiber reactor using HT-1080 human fibrosarcoma cells. External modulation comprised replenishing of the medium in the extracapillary space, reducing the serum concentration in the extracapillary space from 10% to 2% and increasing flow rate of the circulating medium in the intracapillary space from 20 to 80 mL/min, each according to a specific protocol. More than sixfold increase was observed in the cumulative urokinase production for two and three medium replenishing modulations of the extracapillary space. After 15 days of continuous operation, the highest cumulative urokinase obtained was 1.63 × 106 PU/mL. SDS-PAGE and zymogram study established that the urokinase obtained was in the high molecular weight range of 54 kDa. The effect of external modulation on cumulative urokinase production was visualized as trajectories with respect to the ratio of lactic acid production rate (LPR) to the glucose uptake rate (GUR). The collective external modulation data showed two separate physiological regions in the cumulative urokinase vs. LPR/GUR plane. The HT-1080 cells exhibited two distinct morphologies in these regions that may be related to acidosis and metastasis. These regions also correspond to low and high urokinase productivity. [source] A multi-institutional studyof orthotopic neobladders: functional results in men and womenBJU INTERNATIONAL, Issue 6 2004R. Carrion Multi-institutional studies are extremely valuable whena new surgical technique is being introduced. The Confederationof American Urology conducted such a study into the functional results inmales and females of the orthotopic bladder. In a series of 138patients they found many interesting outcomes, which they presenthere. Authors from Sheffield describe their experience in developing tissue-engineeredbuccal mucosa for use in urethral reconstruction. They describetheir technique and report the successful culture of full-thicknessbuccal mucosa, which they found to be robust and safe for clinicaluse. OBJECTIVES To analyse the incidence of diurnal incontinence (DI) and nocturnalincontinence (NI), the need for intermittent catheterization (IC),and the rate of ureteric obstruction (UO) among a group of men andwomen with ileal and colonic orthotopic neobladders in four countries. PATIENTS AND METHODS In all, 138 patients (113 men and 25 women) had an orthotopicneobladder constructed after radical cystectomy for carcinoma. The mean(range) age was 61.3 (28,76) years and thefollow-up 41 (6,144) months. All patients underwentsurgery by experienced surgeons associated with the Confederationof American Urology. A retrospective evaluation was designed toreview the functional results and the incidence of UO. The techniqueof orthotopic neobladder construction was at each surgeon's discretion. Various detubularized bowelsegments were used, including ileum, colon or sigmoid. Patients werefollowed by chart reviews and personal interviews at 1, 3 and 6 monthsafter surgery and then every 6 months, and were evaluated bya physical examination, urine analysis, cytology and renal ultrasonography. RESULTS An ileal or colonic neobladder was constructed in 74 and 64 patients, respectively. Five (7%), 23 (31%), 10 (14%) and 14(9.6%) with an ileal neobladder developed DI, NI, IC andUO, respectively; the respective values for patients with a colonicneobladder were eight (12%), 19 (30%), seven (11%)and 15 (12%). Statistical analysis by Fisher'sexact test showed no significant differences between the ileal andcolonic neobladder groups or with gender. CONCLUSIONS Using this specific protocol for evaluating many men and womenwith ileal and colonic orthotopic neobladders showed no significant differencesin the incidence of DI, NI, IC or UO. Neobladders constructed fromdetubularized bowel, irrespective of bowel segment(s) used, canprovide satisfactory diurnal results. A moderate incidence of NIand UO continue to be a problem. [source] Reduction in hospitalizations of childrenACTA PAEDIATRICA, Issue 12 2008Erica Santos Abstract Aim: The aim of the study was to reduce the number of hospitalizations in a population of children enrolled in the Einstein Program of the Paraisópolis Community, in São Paulo, Brazil, particularly hospitalizations caused by respiratory diseases. Methods: All hospitalizations of this paediatric population enrolled in the Einstein Program of the Paraisópolis Community Outpatient Clinic were followed up between 2002 and 2004. The following four strategies to reduce or control respiratory diseases with an impact on hospitalizations were established: specific protocol, educational activities, vaccination against pneumococci and vaccination against influenza. Results: In 2002, 1025 hospitalizations due to all causes were recorded. This number significantly decreased to 862 hospitalizations in 2004 after implementation of the program, corresponding to a reduction of 15.9% (p < 0.0001). Hospitalizations due to respiratory diseases decreased by 23.37% (p < 0.02), and those due to cases of wheezing bronchitis fell by 51.61% (p < 0.001). Conclusion: The strategies chosen and implemented in the Einstein Program of the Paraisópolis Community Outpatient Clinic over the first 6 months of 2003 were effective in reducing the number of children's hospital admissions due to respiratory disease. [source] | ||||||||||