RESUMEN
Legumes have the ability to establish a nitrogen-fixing symbiosis with soil rhizobia that they house in specific organs, the nodules. In most rhizobium-legume interactions, nodulation occurs on the root. However, certain tropical legumes growing in wetlands possess a unique trait: the capacity to form rhizobia-harbouring nodules on the stem. Despite the originality of the stem nodulation process, its occurrence and diversity in waterlogging-tolerant legumes remains underexplored, impeding a comprehensive analysis of its genetics and biology. Here, we aimed at filling this gap by surveying stem nodulation in legume species-rich wetlands of Madagascar. Stem nodulation was readily observed in eight hydrophytic species of the legume genera, Aeschynomene and Sesbania, for which significant variations in stem nodule density and morphology was documented. Among these species, A. evenia, which is used as genetic model to study the rhizobial symbiosis, was found to be frequently stem-nodulated. Two other Aeschynomene species, A. cristata and A. uniflora, were evidenced to display a profuse stem-nodulation as occurs in S. rostrata. These findings extend our knowledge on legumes species that are endowed with stem nodulation and further indicate that A. evenia, A. cristata, A. uniflora and S. rostrata are of special interest for the study of stem nodulation. As such, these legume species represent opportunities to investigate different modalities of the nitrogen-fixing symbiosis and this knowledge could provide cues for the engineering of nitrogen-fixation in non-legume crops.
Asunto(s)
Fabaceae , Rhizobium , Sesbania , Fabaceae/genética , Madagascar , Humedales , Fijación del Nitrógeno , Verduras , Nitrógeno , Simbiosis/genética , Nodulación de la Raíz de la Planta/genética , Nódulos de las Raíces de las PlantasRESUMEN
OBJECT: In this report the author presents surgery-related outcomes after application of a new technique. A posterior microendoscopic laminoforaminotomy was used for the surgical treatment of unilateral cervical radiculopathy secondary to intervertebral disc herniations and/or spondylotic foraminal stenosis. The results of this procedure are compared with those achieved using traditional laminoforaminotomy and anterior cervical discectomy with or without fusion. METHODS: One hundred consecutive patients who experienced unilateral cervical radicular syndromes, which were refractory to conservative therapy, and in whom imaging studies had confirmed lateral canal or foraminal compression, underwent surgical treatment. An endoscopy-assisted posterior laminoforaminotomy was performed using a microendoscopic visualization system for removal of herniated disc and foraminal decompression while the patient was in the sitting position. Excellent or good results were obtained in 97 patients. who returned to their preoperative employment and baseline level of physical activity. One patient returned to work but was unable to perform at baseline level; two patients returned to prior sedentary work but continued to have some activity-related pain and paresthesias. Two patients reported experiencing intermittent paresthesias or numbness, but this did not limit their activities. There were two cases of dural punctures, one case of superficial wound infection, and no deaths. CONCLUSIONS: The microendoscopic posterior laminoforaminotomy is an effective alternative for the treatment of unilateral cervical radiculopathy secondary to lateral or foraminal disc herniations or spondylosis. In this group of patients, it is preferable because it does not require the sacrifice of a cervical motion segment, has a low incidence of complications, and is associated with a much quicker return to unrestricted full activity than that obtained with other techniques.
Asunto(s)
Vértebras Cervicales/cirugía , Discectomía/instrumentación , Endoscopios , Desplazamiento del Disco Intervertebral/cirugía , Laminectomía/instrumentación , Microcirugia/instrumentación , Radiculopatía/cirugía , Osteofitosis Vertebral/cirugía , Estenosis Espinal/cirugía , Adulto , Anciano , Descompresión Quirúrgica/instrumentación , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/cirugía , Raíces Nerviosas Espinales/cirugía , Resultado del TratamientoRESUMEN
It generally is believed that physicians who have poor relationships with their patients are more likely to be sued. We studied certain physician characteristics and related them to their number of malpractice suits and the amount paid to settle those claims. Physicians with better rapport with their patients, who took more time to explain, and who were available had fewer malpractice suits. The most significant correlation was found in time spent with the patient. As the time spent increased, the number of suits decreased.
Asunto(s)
Ortopedia , Relaciones Médico-Paciente , Humanos , Mala Praxis , Ortopedia/legislación & jurisprudencia , Estados UnidosRESUMEN
Imprinting in the 15q11-q13 region involves an 'imprinting centre' (IC), mapping in part to the promoter and first exon of SNRPN. Deletion of this IC abolishes local paternally derived gene expression and results in Prader-Willi syndrome (PWS). We have created two deletion mutations in mice to understand PWS and the mechanism of this IC. Mice harbouring an intragenic deletion in Snrpn are phenotypically normal, suggesting that mutations of SNRPN are not sufficient to induce PWS. Mice with a larger deletion involving both Snrpn and the putative PWS-IC lack expression of the imprinted genes Zfp127 (mouse homologue of ZNF127), Ndn and Ipw, and manifest several phenotypes common to PWS infants. These data demonstrate that both the position of the IC and its role in the coordinate expression of genes is conserved between mouse and human, and indicate that the mouse is a suitable model system in which to investigate the molecular mechanisms of imprinting in this region of the genome.
Asunto(s)
Impresión Genómica , Mutación , Síndrome de Prader-Willi/genética , Ribonucleoproteínas Nucleares Pequeñas , Animales , Autoantígenos/genética , Modelos Animales de Enfermedad , Femenino , Humanos , Masculino , Ratones , Ratones Mutantes , Fenotipo , Eliminación de Secuencia , Proteínas Nucleares snRNPRESUMEN
We studied the relationship of malpractice claims and the personal, educational, and practice characteristics of a sample of surgeons (n = 427). The surgeons were members of a physician-owned malpractice trust and represented all those who had fewer than 0.13 malpractice claims per year and those with more than 0.54 claims per year. Data are reported separately for orthopedic surgeons (148), obstetrician-gynecologists (115), and a mixed group of other surgeons (164). The last group included otolaryngologists, neurosurgeons, and general, vascular, thoracic, and plastic surgeons. We studied the relationship between the number of malpractice claims (ranging from no history of claims to those terminated from the trust because of high rates of claims) and the surgeon's personal, educational, and practice characteristics. The major differences were between the surgeons who were terminated because of a high number of claims and those with few or no claims. Terminated surgeons were less likely to have completed a fellowship, belong to a clinical faculty, be members of professional societies, be graduates of an American or Canadian medical school, have specialty board certification, or be in a group practice. The data also suggest that orthopedists with high numbers of claims may be less likely to have a religious affiliation or to have a registered nurse working in their office practice. These findings suggest that surgeons with lower claim rates may be more likely to manifest exemplary modes of professional peer relationships and responsible clinical behavior.
Asunto(s)
Cirugía General , Mala Praxis , Certificación , Ética Médica , Docentes Médicos , Becas , Cirugía General/educación , Práctica de Grupo , Ginecología , Humanos , Relaciones Interprofesionales , Masculino , Mala Praxis/estadística & datos numéricos , Persona de Mediana Edad , Neurocirugia , Enfermeras y Enfermeros , Obstetricia , Ortopedia , Otolaringología , Grupo de Atención al Paciente , Práctica Profesional , Religión y Medicina , Facultades de Medicina , Sociedades Médicas , Consejos de Especialidades , Cirugía Plástica , Cirugía Torácica , Estados Unidos/epidemiología , Procedimientos Quirúrgicos VascularesRESUMEN
The relationship between moral reasoning and malpractice claims was studied in 53 orthopedic surgeons. Levels of moral reasoning were defined by the percentage of principled responses (P-score) on Rest's Defining Issues Test, while annualized rates of malpractice claims were computed on the basis of data from a regional, physician-owned, interindemnity/liability protection trust. Orthopedic surgeons with fewer than 0.20 claims per year demonstrated significantly (P = 0.04) higher levels of moral reasoning (mean P-score of 43.8) than did those with claims rates higher than 0.40 claims per year (mean P-score of 38.0). Only 1 of 13 orthopedists with P-scores over 50 was found in the higher claims group, suggesting that high levels of moral reasoning may provide a protective element against malpractice claims.
Asunto(s)
Ética Médica , Principios Morales , Ortopedia , Humanos , Juicio , Mala Praxis , Proyectos Piloto , Pruebas PsicológicasRESUMEN
We report on the generation and phenotype of mutant alleles of multiple edematous wings (mew), the gene encoding the alpha PS1 subunit of the PS1 integrin of Drosophila. None of the six alleles examined makes detectable protein, and one allele results from a chromosome break near the middle of the translated sequence, so we are confident that we have described the null phenotype. In contrast to if (alpha PS2) and mys (beta PS) mutants, most mutant mew embryos hatch, to die as larvae. Mutant mew embryos display abnormal gut morphogenesis but, unlike mys or if embryos, there is no evidence of defects in the somatic muscles. Thus, the complementary distributions of PS1 (alpha PS1 beta PS) and PS2 (alpha PS2 beta PS) integrin on tendon cells and muscle, respectively, do not reflect equivalent requirements at the myotendinous junction. Dorsal herniation, characteristic of the mys lethal phenotype, is not observed in mew or in mew if embryos. Clonal analysis experiments indicate that eye morphogenesis is disrupted in mew clones, but if clones in the eye are relatively normal in morphology. Adult wings display blisters around large dorsal but not ventral mew clones. In contrast to dorsal mys clones, small mew patches do not necessarily display morphogenetic abnormalities. Thus, another integrin in addition to PS1 appears to function on the dorsal wing surface.
Asunto(s)
Proteínas de Drosophila , Drosophila/genética , Integrinas/genética , Músculos/embriología , Tendones/embriología , Alelos , Animales , Southern Blotting , Ojo/embriología , Immunoblotting , Cadenas alfa de Integrinas , Intestinos/anomalías , Intestinos/embriología , Morfogénesis/genética , Mutagénesis , Fenotipo , Alas de Animales/embriologíaRESUMEN
While neurological complications are common in sickle cell disease, aneurysmal subarachnoid hemorrhage has been rarely reported. A case is presented of a young man with sickle cell disease and subarachnoid hemorrhage found to have two mid-basilar aneurysms, the largest of which had bled. Available literature suggests that this patient may be quite representative as nearly one half of documented cases have been noted to harbor multiple aneurysms, and posterior circulation involvement appears to be common. These anatomic features may relate to the pathophysiology of arterial destruction common in sickle cell disease.
Asunto(s)
Anemia de Células Falciformes/complicaciones , Aneurisma Intracraneal/etiología , Hemorragia Subaracnoidea/etiología , Adulto , Arteria Basilar , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Radiografía , Hemorragia Subaracnoidea/diagnóstico por imagenAsunto(s)
Malformaciones Arteriovenosas/cirugía , Laminectomía/métodos , Neoplasias de la Médula Espinal/cirugía , Médula Espinal/irrigación sanguínea , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Arterias , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , VenasRESUMEN
Surgical specimens of 104 craniopharyngiomas from 93 patients were reviewed and characterized histopathologically. They were found to have either a classic adamantinous or a squamous papillary structure. The clinical features of each group were then assessed. The frequently solid (50%), always uncalcified squamous papillary tumor type was found in one-third of the adult patients (greater than or equal to 20 years) but did not occur in children. It was associated with a good functional postoperative outcome (84.6%). There have been no cases of tumor recurrence in the squamous papillary group. However, in the group with the adamantinous type of craniopharyngioma, the recurrence rate was 13% in adult patients and 9% in children. When compared to the adult adamantinous cases, the incidence of visual deficits was lower in the squamous papillary group (75% vs. 84%) but the incidence of endocrine abnormalities was higher (75% vs. 52%). Thus, the preoperative, operative, and postoperative features of the two types of craniopharyngioma were found to be distinctly different in adults and children.
Asunto(s)
Ameloblastoma , Neoplasias Encefálicas , Craneofaringioma , Papiloma , Adolescente , Adulto , Anciano , Ameloblastoma/complicaciones , Ameloblastoma/patología , Ameloblastoma/fisiopatología , Ameloblastoma/cirugía , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/fisiopatología , Neoplasias Encefálicas/cirugía , Niño , Preescolar , Craneofaringioma/complicaciones , Craneofaringioma/patología , Craneofaringioma/fisiopatología , Craneofaringioma/cirugía , Enfermedades del Sistema Endocrino/etiología , Femenino , Humanos , Lactante , Masculino , Métodos , Persona de Mediana Edad , Papiloma/complicaciones , Papiloma/patología , Papiloma/fisiopatología , Papiloma/cirugía , Pronóstico , Trastornos de la Visión/etiologíaAsunto(s)
Encefalopatías/cirugía , Ventrículos Cerebrales/cirugía , Quistes/cirugía , Neurocirugia/métodos , Adolescente , Adulto , Anciano , Encefalopatías/diagnóstico por imagen , Niño , Quistes/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Técnicas EstereotáxicasRESUMEN
This study compared 51 San Francisco Bay Area family physicians and 47 general internists in their treatment of hypertensive patients. Charts from 2254 patients of these physicians were reviewed. The average age and percentage of board certification of both groups of physicians are similar. Patients of general internists were slightly older than the family practice patients (average age 61 vs 59 years). The general internists saw significantly fewer patients per hour (3.0) than the family physicians (3.6). Family physicians were more likely to employ a registered nurse (33%) than were general internists (17%), and family physicians were twice as likely to delegate patient education to office staff than were the general internists. The mean number and kinds of antihypertensive medications prescribed were similar. Internists did more laboratory testing, but the difference was not statistically significant. General internists were more likely to change medication when their patients' blood pressure was uncontrolled than were family physicians (in 60% vs 40% of patients, P = .02), and they were also more likely to recall uncontrolled patients within 3 months than were family physicians (50% vs 35% of patients, P = .05). There was no significant difference in mean diastolic blood pressure or in hypertension-related behaviors, such as medication adherence, aerobic exercise, alcohol consumption, or amount of dietary salt, between the two patient groups; however, over 35% of patients of both groups had elevated blood pressure readings despite taking medications. Overall, there were more similarities than differences in the care physicians provided. Efforts to change physician performance in the treatment of hypertensive patients are still warranted and equally applicable to both groups.
Asunto(s)
Hipertensión/terapia , Medicina Interna , Médicos de Familia , Pautas de la Práctica en Medicina , Adulto , Antihipertensivos/uso terapéutico , Presión Sanguínea , California , Ejercicio Físico , Femenino , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Visita a Consultorio Médico , Terapia por Relajación , Factores de TiempoRESUMEN
We assessed the relationship between patients' opinions about their physicians' communication skills and the physician's history of medical malpractice claims. The sample consisted of 107 physicians and 2,030 of their patients who had had an operation or a delivery. Although patients tended to give their physicians favorable ratings, they were least satisfied with the amount of explanations they received. Patients gave higher ratings to general surgeons and obstetrician-gynecologists and poorer ratings to orthopedists and anesthesiologists. Women and better-educated patients gave higher ratings on explanations and communication to physicians with fewer claims. Men and patients with less education, however, gave higher ratings on these dimensions to physicians with more claims. These findings suggest the need for physicians to tailor their communications to a patient's individual needs. Improved communication between physicians and patients may result in fewer nonmeritorious malpractice claims while leading to less costly resolution of meritorious claims.
Asunto(s)
Comunicación , Mala Praxis , Factores de Edad , Comportamiento del Consumidor , Escolaridad , Femenino , Humanos , Masculino , Medicina , Persona de Mediana Edad , Relaciones Médico-Paciente , Factores Sexuales , EspecializaciónRESUMEN
The American health care delivery system has traditionally emphasized the treatment of illness instead of the promotion of wellness. Traditional Health Maintenance Organizations (HMOs) have attempted to reduce costs by controlling utilization, discounting and/or sharing risk with providers rather than promoting wellness and prevention. These efforts have, for the most part, been unsuccessful and health care costs and HMO premiums continue to rise. The authors propose it is time for a change and we must look again at what wellness programs can accomplish. It is time to move from an ineffective "health maintenance" approach towards one of "health achievement." Models for the proposed change already exist in the business community where companies have successfully used wellness programs as a tool to decrease health benefits expenditures. The changes proposed must be addressed on multiple levels. Perceptions, attitudes and approaches must be changed. The benefits of wellness must be individually marketed to target groups: blue and white collar workers, business executives and professionals, home makers, preschool and school age children, the elderly and the unemployable.
Asunto(s)
Actitud Frente a la Salud , Sistemas Prepagos de Salud/economía , Promoción de la Salud/economía , Participación de la Comunidad , Costos y Análisis de Costo , Recolección de Datos , Humanos , Comercialización de los Servicios de Salud/organización & administración , Estados UnidosRESUMEN
The relationships between self-reported hypertension-related patient behaviors and patient demographic characteristics were examined in a sample of 2,044 patients being treated for hypertension in 111 primary care medical practices. The patient behaviors of sodium intake, weight, alcohol, exercise, relaxation and adherence to medication regimen could be predicted to some extent by patient demographic characteristics. Whether patients recalled receiving advice from their physicians about these behaviors could also be predicted by patient demographic characteristics. Patients demographically similar to physicians, i.e., male, younger, more educated and White, reported receiving more advice from their physicians. Patients with behavioral problems who received relatively less advice from their physicians included: less educated younger patients whose sodium intake was relatively high; younger and less educated over-weight women; overweight Black patients; and older women who exercised less than average.
Asunto(s)
Actitud Frente a la Salud , Hipertensión/psicología , Rol del Enfermo , Anciano , Terapia Conductista , Terapia Combinada , Dieta Hiposódica , Femenino , Humanos , Hipertensión/terapia , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Esfuerzo Físico , Relaciones Médico-Paciente , Terapia por RelajaciónRESUMEN
The clinical records of 216 patients with proven acute cholecystitis treated by cholecystectomy form the basis of this retrospective study. Common bile duct stones were present in 12.4 per cent of these patients. Thirty per cent of the patients with elevated SGOT values, 26.2 per cent of the patients with elevated alkaline phosphatase, and 23.1 per cent of the patients with elevated amylase had common duct stones. The authors found that 17.6 per cent of patients with bilirubin between 1.5 and 2.9 mg/dl had common duct stones, whereas 71.4 per cent of common bile ducts with a bilirubin greater than 5 mg/dl contained stones. Six of 28 patients with common duct stones had normal bilirubin. Cholangiograms were normal in 115 of the 154 cholangiograms performed; six of these common ducts were explored, and no common duct stones found (false-negative cholangiograms 0.0%). Cholangiograms showed stones in 24 patients; common bile duct stones were recovered from 20 of these patients (accuracy rate 83%, false-positive cholangiograms 17%). Wound infections occurred in seven patients (3.7%). Sepsis resulted in death of three patients, and the other two deaths resulted from multi-system failure. This study demonstrates operative cholangiograms to be the most accurate method of detection of common duct stones, and its routine use in patients undergoing cholecystectomy is recommended.
Asunto(s)
Colecistitis/cirugía , Enfermedad Aguda , Adulto , Anciano , Colangiografía , Colangitis/cirugía , Colecistectomía/efectos adversos , Colelitiasis/cirugía , Conducto Colédoco/diagnóstico por imagen , Conducto Colédoco/cirugía , Enfermedades del Conducto Colédoco/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
A diabetes professional education program was conducted and evaluated with 31 physicians from a rural/suburban community. Treatment guidelines were established by diabetes experts and community practitioners. To document effectiveness, medical record and survey data on 397 patients of the physicians were collected before and after the program. Each participant received a profile of their baseline performance as compared with peers as part of the educational program. A syllabus was designed to complement both the treatment guidelines and the findings from the baseline data. A telephone conference call with a diabetes consultant also occurred. A comparison between data collected before and after the program showed no significant differences in blood glucose levels or hospitalization rates. Physicians were more likely to recommend self-monitoring of blood glucose (SMBG) (7% versus 20%, P less than 0.05) and to examine their patients' feet (47% versus 73%, P less than 0.05) after the program. More patient education was available in the office (53% versus 73%). Patients using insulin were more likely to test urine for ketones (48% versus 61%, P less than 0.05) and know that decreased sensation in the feet could lead to injury (42% versus 53%, P less than 0.05). However, no improvements were noted in monitoring other complications, regulating diet, or in most aspects of patient education after the program. The results indicated the need for increased emphasis on the value of brief appropriate examinations for monitoring complications of diabetes and the need for physicians to learn techniques for counseling patients in self-management as well as to refer their patients to educational resources.