RESUMEN
The aim of this study was to investigate lymph circulation before and after breast reduction mammaplasty in different parts of the breast and with two different carriers of the radiopharmaceutical. Nine patients with breast hypertrophy planned for bilateral breast reduction mammaplasty were prospectively included in the study. The breast operation procedure was decided on intraoperatively. The regional lymph circulation in the breast was measured preoperatively by Technetium (99mTc) clearance in 4 different locations in each breast 1, 2 and 3 hours after injection. The procedure was repeated at one month and in six of the nine women also five years postoperatively with injection sites chosen to correspond to the preoperative location of that breast pedicle. Two different types of carriers of the radiopharmaceutical were tested, dextran in the right and nanocoll in the left breast. Dextran had a much more rapid clearance than nanocoll. There was no significant regional difference in lymph drainage up to five years after the mammaplasty, independent of dextran or nanocoll as being the carrier of the radiopharmaceutical.
Asunto(s)
Mama/cirugía , Vasos Linfáticos/diagnóstico por imagen , Mamoplastia , Adulto , Mama/anomalías , Mama/diagnóstico por imagen , Dextranos , Femenino , Humanos , Hipertrofia , Vasos Linfáticos/fisiología , Vasos Linfáticos/fisiopatología , Linfedema/diagnóstico por imagen , Linfedema/fisiopatología , Linfocintigrafia , Persona de Mediana Edad , Compuestos de Organotecnecio , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/fisiopatología , Periodo Preoperatorio , Estudios Prospectivos , Radiofármacos , Agregado de Albúmina Marcado con Tecnecio Tc 99mRESUMEN
BACKGROUND AND PURPOSE: Cluster headache (CH) is an episodic headache disorder characterized by recurrent, unilateral attacks of excruciating pain in the temporal/orbital region. The pathophysiology of CH is largely unknown although involvement of immunological mechanisms has been suggested. The aim of our study was to investigate whether patients with CH show signs of intracranial inflammation, when using white blood cell single-photon emission computer tomography (WBC-SPECT). METHODS: We have examined 14 patients with CH, both in active period and in remission, and five control subjects at one occasion, with WBC-SPECT. To be able to precisely define regions of interest (ROI:s) in the brain, all patients with CH and control subjects underwent magnetic resonance imaging (MRI) of the brain. RESULTS: We found no significant difference in (99m)Tc-labeled WBC uptake between patients with CH in active period and controls. Furthermore, patients with CH in active period were not significantly different in uptake compared with patients with CH in remission. CONCLUSIONS: These results did not provide conclusive support for a hypothesis of a pathophysiological role of inflammation intracranially. Our conclusions are restricted to the advantages and limitations of the chosen method.
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Encéfalo/diagnóstico por imagen , Cefalalgia Histamínica/diagnóstico por imagen , Leucocitos/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único/métodos , Adulto , Anciano , Mapeo Encefálico , Femenino , Humanos , Inflamación/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND/AIMS: Our purpose was to investigate whether the new research criteria for Alzheimer's disease proposed in 2007 by Dubois et al. are valid in a naturalistic memory clinic sample. METHOD: Retrospective diagnostic analyses were carried out to compare the traditional diagnostic criteria for dementia with the new criteria suggested by Dubois et al. No patient had gone through all procedures postulated as additional features in the proposed new Dubois criteria. MATERIAL: Two independent experienced geriatricians re-examined 150 complete patients' records. The study physicians were blinded to any of the results of the core and additional features suggested by Dubois et al. to avoid circular diagnostic bias. RESULTS: Among our 96 patients with a clinical diagnosis of subjective cognitive impairment and/or mild cognitive impairment, 2 of the patients with subjective cognitive impairment and 5 patients with mild cognitive impairment would classify as pre-dementia Alzheimer's disease according to the Dubois criteria. In our 23 Alzheimer patients diagnosed clinically, only 12 of the cases fulfilled the criteria for Alzheimer's disease suggested by Dubois et al. INTERPRETATION: The proposed new criteria for Alzheimer's disease are valid in 55% of our patients clinically diagnosed as having full-blown Alzheimer dementia. Additionally, 7.3% 'true' Alzheimer cases will be identified in a group of 96 clinically non-demented patients. Our results show that there is a large heterogeneity in a clinical naturalistic sample of patients with an Alzheimer phenotype. CONCLUSION: There is a need to further validate the currently existing biomarkers in large unselected samples and avoid the pitfall of workup bias and circular diagnostic processes. Additionally, valid age-specific cut-off values for the diagnostic markers in question have to be defined.
Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Encéfalo/patología , Demencia/diagnóstico , Recuerdo Mental , Pruebas Neuropsicológicas/normas , Adulto , Anciano , Enfermedad de Alzheimer/clasificación , Enfermedad de Alzheimer/patología , Demencia/clasificación , Demencia/patología , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad , Estadísticas no ParamétricasRESUMEN
BACKGROUND: Somatostatin receptor (SSTR) scintigraphy with (99m)Tc-depreotide is used for differential diagnosis of solitary pulmonary nodules. The method is based on SSTR expression in cancer tissue. PURPOSE: To estimate the expression of SSTRs in non-small-cell lung cancer (NSCLC) in vitro, and to determine the correlation between (99m)Tc-depreotide uptake in vivo and different tumor characteristics determined in vitro, such as tumor grade, and presence of SSTR2, MIB-1, and p53. MATERIAL AND METHODS: A total of 127 patients with lung lesions detected on computed tomography (CT) were investigated with SSTR scintigraphy after injection of 740 MBq (99m)Tc-depreotide. This study includes 19 patients with NSCLC with histologically proven diagnosis. The quantitative evaluation of (99m)Tc-depreotide was performed using region-of-interest analysis and includes tumor counts/cm(3), background counts/cm(3), and the ratio between tumor and background counts. RESULTS: 99mTc-depreotide uptake was found in all NSCLC tumors, which expressed SSTR2 defined in vitro by immunochemical methods. SSTR2 expression was negatively correlated to the degree of the tumor's differentiation (P<0.05). 99mTc-depreotide uptake in tumor cells did not correlate with tumor grade, or SSTR2, MIB-1, or p53 expression. CONCLUSION: There is an expression of SSTRs in NSCLC. The degree of tumor differentiation correlates negatively with SSTR2 measured in vitro and positively with MIB-1 expression in tumor tissue. No correlation was found between (99m)Tc-depreotide uptake and possible prognostic factors such as MIB-1 and p53 expression in tumor cells in NSCLC. Lastly, no correlation was found between (99m)Tc-depreotide uptake and tumor grade or SSTR2 expression.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Compuestos de Organotecnecio/farmacocinética , Somatostatina/análogos & derivados , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/metabolismo , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Técnicas para Inmunoenzimas , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Cintigrafía , Receptores de Somatostatina/metabolismo , Somatostatina/farmacocinéticaRESUMEN
BACKGROUND: Contrast-enhanced ultrasound (CEUS) has gained interest because of its ability to gather vascular information in various organs. There is still a matter of debate concerning its value in breast lesions. The method of choice on how to administer the contrast agent varies depending on the organ to be studied. Infusion of microbubbles is used in echocardiography, while bolus administration is the preferred technique for abdominal organs. PURPOSE: To compare-in equal doses-bolus versus continuous infusion of microbubbles, using real-time contrast harmonic imaging in breast tumors. MATERIAL AND METHODS: A total of 29 female patients (mean age 54 years) with either clear malignant or benign findings in the breast or axilla were included. Contrast harmonic imaging (CHI US) was performed with a Philips iU22 using an L9-3 MHz linear probe, especially designed for this purpose. A low mechanical index (0.06-0.07) was used to avoid massive destruction of the microbubbles. A dose of 2.4 ml of Sono Vue was first infused intravenously over 1 min with an infusion pump. After 10 min, the same dose was injected as a bolus over 2 s, followed by a flush of 10 ml of saline solution. Contrast uptakes by the tumors were recorded 2 min from the moment of injection, with both methods for each patient. RESULTS: Bolus administration of contrast agent provided a sharply demarcated enhancement and wash-out pattern for all lesions. The continuous infusion of the same contrast agent failed to show any wash-in/wash-out or time-to-peak/peak intensity phenomena in all cases. CONCLUSION: CEUS using real-time harmonic imaging in order to evaluate breast tumors should be performed with bolus administration of contrast agent in order to achieve better intensity/time curve outcomes.
Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Medios de Contraste/administración & dosificación , Fosfolípidos/administración & dosificación , Hexafluoruro de Azufre/administración & dosificación , Ultrasonografía Mamaria , Adulto , Anciano , Axila , Neoplasias de la Mama/patología , Femenino , Humanos , Infusiones Intravenosas , Inyecciones , Persona de Mediana EdadRESUMEN
BACKGROUND: Current diagnosis of Alzheimer disease is made by clinical, neuropsychologic, and neuroimaging assessments. Neuroimaging techniques such as magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) could be valuable in the differential diagnosis of Alzheimer disease, as well as in assessing prognosis. PURPOSE: To compare SPECT and MRI in a cohort of patients examined for suspected dementia, including patients with no objective cognitive impairment (control group), mild cognitive impairment (MCI), and Alzheimer disease (AD). MATERIAL AND METHODS: 24 patients, eight with AD, 10 with MCI, and six controls, were investigated with SPECT using (99m)Tc-hexamethylpropyleneamine oxime (HMPAO, Ceretec; GE Healthcare Ltd., Little Chalsont UK) and dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) with a contrast-enhancing gadobutrol formula (Gadovist; Bayer Schering Pharma, Berlin, Germany). Voxel-based correlation between coregistered SPECT and DSC-MR images was calculated. Region-of-interest (ROI) analyses were then performed in 24 different brain areas using brain registration and analysis of SPECT studies (BRASS; Nuclear Diagnostics AB, Stockholm, Sweden) on both SPECT and DSC-MRI. RESULTS: Voxel-based correlation between coregistered SPECT and DSC-MR showed a high correlation, with a mean correlation coefficient of 0.94. ROI analyses of 24 regions showed significant differences between the control group and AD patients in 10 regions using SPECT and five regions in DSC-MR. CONCLUSION: SPECT remains superior to DSC-MRI in differentiating normal from pathological perfusion, and DSC-MRI could not replace SPECT in the diagnosis of patients with Alzheimer disease.
Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Medios de Contraste , Aumento de la Imagen/métodos , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada de Emisión de Fotón Único/métodos , Anciano , Mapeo Encefálico/métodos , Estudios de Cohortes , Diagnóstico Diferencial , Imagen Eco-Planar/métodos , Femenino , Humanos , Imagenología Tridimensional/métodos , Masculino , Persona de Mediana Edad , Compuestos Organometálicos , Valor Predictivo de las Pruebas , Radiografía , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Exametazima de Tecnecio Tc 99mRESUMEN
BACKGROUND: In Sweden, there are over 3000 new lung cancer cases every year. There are still numerous patients with undetermined lesions after routine diagnostic evaluation by clinical examination, chest radiography, computed tomography (CT) of the thorax, and bronchoscopy. An appropriate method for further diagnostic workup is therefore needed. PURPOSE: To evaluate the diagnostic value of the somatostatin analogue depreotide in patients with suspected lung cancer, and to determine in which clinical settings it would be beneficial to use 99mTc-depreotide scintigraphy. MATERIAL AND METHODS: We included 99 consecutive patients referred to our hospital with suspected lung cancer. A clinical examination, bronchoscopy, chest radiography, CT of the thorax and upper abdomen, and scintigraphy were done. Scintigraphy was performed after injection of 740 MBq (99m)Tc depreotide with tomographical imaging of the thorax and whole-body scanning. The diagnostic outcome of the scintigrams was compared to CT, using morphology or clinical outcome as the endpoint. RESULTS: 99mTc-depreotide uptake was found in 62 out of 66 malignancies, including 57 of 58 primary lung cancer cases. Two cases of lung metastasis (one from a colon cancer and one from an adenoid cystic carcinoma originating in the palate) and one rib chondrosarcoma did not show depreotide uptake. There were 33 patients with benign lesions, of whom 16 displayed false-positive 99mTc-depreotide uptake, whereof 11 were pneumonias. Tc-99m-depreotide uptake was absent in 17 patients with benign lesions, including all 10 hamartomas. The sensitivity in detecting malignancy was 94%, and in detecting lung cancer 98%. The specificity was calculated based on two sets of data. When all cases were used, the specificity was 52%. If the 12 pneumonias are excluded, the specificity was 77%. CONCLUSION: 99mTc-depreotide scintigraphy has a high sensitivity in detecting lung cancer. The method is useful in decision-making with respect to surgery.
Asunto(s)
Hamartoma/diagnóstico , Neoplasias Pulmonares/diagnóstico , Pulmón/diagnóstico por imagen , Compuestos de Organotecnecio , Radiofármacos , Somatostatina/análogos & derivados , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Reacciones Falso Negativas , Reacciones Falso Positivas , Femenino , Humanos , Aumento de la Imagen/métodos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Neumonía/diagnóstico , Valor Predictivo de las Pruebas , Cintigrafía , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/métodosRESUMEN
BACKGROUND: Early postoperative hepatobiliary scintigraphy after liver transplantation is performed worldwide, but data on its significance for graft function are currently limited. PURPOSE: To examine the correlation between the result of early postoperative hepatobiliary scintigraphy and pre- and postoperative biochemical parameters in liver transplantation (LTx) patients. MATERIAL AND METHODS: Six parameters of hepatobiliary scintigraphy using (99m)Tc mebrofenin were statistically analyzed in 108 LTx patients: 1) half-life of the activity of elimination of mebrofenin from the blood; 2) total clearance of mebrofenin from the blood due to all possible routes; 3) half-life of the activity due to liver uptake; 4) clearance of mebrofenin from the blood due to liver uptake; 5) time to maximal uptake in the liver; and 6) the hepatic extraction fraction (HEF) and biochemical data. Analysis between patients with preoperative normal liver function, familial amyloid polyneuropathy (FAP), and end-stage liver disease (non-FAP) was also performed. RESULTS: Univariate and multivariate analysis revealed that total bilirubin postoperative day 3 correlated with all three scintigraphic parameters, and peak aspartate aminotransferase and alanine aminotransferase correlated with HEF. The analysis between patients with FAP and non-FAP revealed no significant difference of scintigraphic data between the two groups. CONCLUSION: A significant correlation between early postoperative scintigraphic results and biochemical parameters was demonstrated.
Asunto(s)
Sistema Biliar/diagnóstico por imagen , Iminoácidos , Hepatopatías/diagnóstico por imagen , Trasplante de Hígado/diagnóstico por imagen , Hígado/diagnóstico por imagen , Compuestos de Organotecnecio , Adolescente , Adulto , Anciano , Alanina Transaminasa/sangre , Neuropatías Amiloides Familiares/diagnóstico por imagen , Compuestos de Anilina , Aspartato Aminotransferasas/sangre , Bilirrubina/sangre , Biomarcadores/sangre , Niño , Preescolar , Femenino , Glicina , Humanos , Iminoácidos/farmacocinética , Hepatopatías/cirugía , Pruebas de Función Hepática/métodos , Masculino , Persona de Mediana Edad , Compuestos de Organotecnecio/farmacocinética , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Cintigrafía , Estudios Retrospectivos , TiempoRESUMEN
The key question addressed in this study is whether performance-based reimbursement (PBR) is a useful way to create the right incentive for efficiency improvements in health care. In this 4-year prospective cohort study, physicians in one council with PBR and in ten councils without such a system were studied. The results of this study indicate that PBR, compared to an annual budget system, creates a different incentive, an 'inner incentive' which may be stronger than the external incentive of financial pressures. PBR may result in a greater cost awareness and shorter average length of stay, but it may also lead to negative effects on the quality of care. A strong cost awareness was found to be a negative predictor of quality of care indicating that it is a difficult balancing act to maintain cost considerations at a 'good' level in order to retain the benefits of cost awareness without adversely impacting quality of care. There is a need for further studies of the impact of PBR on financial performance and quality of care issues.
Asunto(s)
Eficiencia Organizacional , Planes de Incentivos para los Médicos/economía , Reembolso de Incentivo/organización & administración , Medicina Estatal/organización & administración , Adulto , Estudios de Cohortes , Femenino , Costos de la Atención en Salud , Investigación sobre Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Calidad de la Atención de Salud , Encuestas y Cuestionarios , SueciaRESUMEN
Maturation of [NiFe]-hydrogenases requires the action of several groups of accessory genes. Homologues of one group of these genes, the so-called hyp genes, putatively encoding proteins participating in the formation of an active uptake hydrogenase in the filamentous, heterocyst-forming cyanobacterium Nostoc PCC 73102, were cloned. The cluster, consisting of hypF, hypC, hypD, hypE, hypA, and hypB, is located 3.8 kb upstream from the uptake hydrogenase-encoding hupSL. Gene expression analyses show that these hyp genes are, like hupL, transcribed under N(2)-fixing but not under non-N(2)-fixing growth conditions. Furthermore, the six hyp genes are transcribed together with an open reading frame upstream of hypF, as a single mRNA. Analysis of the DNA region upstream of the experimentally determined transcriptional start site revealed putative -10 and -35 sequence elements and putative binding sites for the global nitrogen regulator NtcA.
Asunto(s)
Clonación Molecular , Cianobacterias/genética , Genes Bacterianos , Hidrogenasas/metabolismo , Proteínas , Secuencias de Aminoácidos , Proteínas Bacterianas/química , Proteínas Bacterianas/genética , Secuencia de Bases , Proteínas Portadoras/química , Proteínas Portadoras/genética , Cianobacterias/enzimología , Proteínas de Unión al GTP/química , Proteínas de Unión al GTP/genética , Expresión Génica , Hidrogenasas/genética , Datos de Secuencia Molecular , Familia de Multigenes , Fijación del Nitrógeno , Sistemas de Lectura Abierta , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Análisis de Secuencia de Proteína , Transcripción GenéticaRESUMEN
The key question addressed in this study is whether performance-based reimbursement in health care affects the professional power and autonomy of physicians, and if so, whether this has any consequences for the quality of care. This cohort study examines the period 1994-98 in 11 Swedish county councils. Four hundred and eighteen physicians were studied in Stockholm County Council, which has a performance-based reimbursement system, and in ten councils without such a system. The results show that professional power and autonomy are considered to be very limited in all councils, and that they have decreased during the period studied. Professional autonomy is, however, more limited in Stockholm. The limitations in Stockholm are more related to financial considerations, whereas the limitations in the other councils are more due to guidelines and lists of recommended drugs. Professional autonomy and power were found to be important determinants for quality of care, and the physicians in Stockholm estimated the quality of care lower than their colleagues in the ten other councils. Thus, our study suggests that the performance-based reimbursement system might fail to reach the desired results due to its negative impact on professional power and autonomy.
Asunto(s)
Hospitales Públicos/normas , Médicos/economía , Poder Psicológico , Autonomía Profesional , Calidad de la Atención de Salud , Reembolso de Incentivo , Adulto , Estudios de Cohortes , Eficiencia Organizacional , Hospitales Públicos/economía , Humanos , Satisfacción en el Trabajo , Persona de Mediana Edad , Análisis de Regresión , Encuestas y Cuestionarios , SueciaRESUMEN
The aim of this study was to assess changes in attitudes and behaviour related to efficiency and quality of care after introduction of performance-based reimbursement. The study consisted of two parts. Part One was performed in 1992-94 as a repeated cross-sectional study of physicians in Stockholm County Council working with a newly introduced performance-based reimbursement system. Part Two was a similar study conducted in 1994 in 11 Swedish councils without performance-based reimbursement. The results show a significant difference between the two groups of physicians in attitudes concerning changes in quality of care and premature discharge from hospital. Despite concern about quality and premature discharge, physicians in Stockholm were found to have changed their behaviour in that the average length of stay in 1994 was about one day shorter in Stockholm than in the other 11 county councils. This indicates that the performance-based reimbursement system may strengthen the incentive to increase efficiency.
Asunto(s)
Eficiencia Organizacional , Médicos/psicología , Calidad de la Atención de Salud , Reembolso de Incentivo , Medicina Estatal/economía , Actitud del Personal de Salud , Recolección de Datos , Toma de Decisiones , Eficiencia Organizacional/economía , Hospitalización , Humanos , Hombres , Médicos/estadística & datos numéricos , Calidad de la Atención de Salud/economía , Regionalización , Responsabilidad Social , Medicina Estatal/organización & administración , Medicina Estatal/normas , SueciaRESUMEN
In recent years, there have been a number of large-scale changes in the organization of healthcare in Sweden, as in many other countries. From a longer time perspective, however, there has been a more or less permanent oscillation between centralization and decentralization, and also between competition and co-operation, in Swedish healthcare organizations. In fact, there seems to be something like a pendulum moving all the time between opposite forms of organization. The frequency of these changes has been increasing during the last fifteen years, as different organizational models have replaced each other at shorter and shorter intervals. This development is partly due to the increasing rate of change in modern society, but partly also due to an element of fashion in the area of management. There is, however, a growing change fatigue in many healthcare organizations, and also increasing demands for empirical evidence on the efficiency and effectiveness of different organizational models before they are introduced into the healthcare system.
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Atención a la Salud/historia , Atención a la Salud/organización & administración , Atención a la Salud/tendencias , Medicina Basada en la Evidencia/historia , Historia del Siglo XIX , Historia del Siglo XX , Política , Suecia , Gestión de la Calidad Total/historiaRESUMEN
The objective of this study was to characterize the behavior induced by the N-methyl-D-aspartate receptor antagonist MK-801 (dizocilpine maleate) in rats as a model of psychosis. The temporal profile, dose dependence, age, and sex differences of the behavior are described. A gas chromatographic method for the analysis of MK-801 in plasma and brain was developed. Female rats showed 4 to 10 times more MK-801-induced behavior and displayed around 25 times higher serum and brain concentrations of MK-801 than male rats. Twenty-one neuroactive compounds, including a number of excitatory amino acid-active substances, were tested for the effect on MK-801-induced behavior. Neuroleptics blocked MK-801-induced behavior in a dose-dependent manner that correlated to their antipsychotic potency in humans. Adenosine receptor agonists and an N-methyl-D-aspartate receptor-associated glycine site antagonist showed putative antipsychotic effects. In conclusion, MK-801-induced behavior represents a rat excitatory amino acid hypofunction model of psychosis that appears to be of clinical relevance and may be of value in the search for new antipsychotic agents.
Asunto(s)
Maleato de Dizocilpina/farmacología , Antagonistas de Aminoácidos Excitadores/farmacología , Psicosis Inducidas por Sustancias/etiología , Conducta Estereotipada/efectos de los fármacos , Envejecimiento/efectos de los fármacos , Animales , Encéfalo/metabolismo , Modelos Animales de Enfermedad , Maleato de Dizocilpina/antagonistas & inhibidores , Maleato de Dizocilpina/sangre , Relación Dosis-Respuesta a Droga , Femenino , Antagonistas del GABA/farmacología , Isoxazoles/farmacología , Masculino , Actividad Motora/efectos de los fármacos , Psicosis Inducidas por Sustancias/fisiopatología , Ratas , Ratas Sprague-Dawley , Receptores de GABA/fisiología , Caracteres Sexuales , Trastorno de Movimiento Estereotipado/inducido químicamenteRESUMEN
Filamentous, heterocystous cyanobacteria may contain both an uptake hydrogenase (encoded by hupSL) and a bidirectional enzyme (encoded by hoxFUYH). The present study identifies three strains (Anabaena variabilis, Nostoc muscorum and Nostoc sp. strain PCC 73102) with a contiguous hupL in both vegetative cells and heterocysts. The two Nostoc strains differ in either containing a bidirectional enzyme (N. muscorum) or lacking this enzyme (N. PCC 73102). Transcriptional studies, using reverse transcriptase-polymerase chain reaction, demonstrated an induction of a hupL transcript approximately 24 h after a shift from non-nitrogen-fixing to nitrogen-fixing conditions (in parallel with the induction of an in vivo light-dependent H2-uptake activity) in N. muscorum. However, the level of hoxH transcripts did not change significantly during the induction of the H2-uptake activity.
Asunto(s)
Proteínas Bacterianas/genética , Cianobacterias/enzimología , Regulación Bacteriana de la Expresión Génica , Oxidorreductasas/genética , Transcripción Genética , Amoníaco/metabolismo , Anabaena/enzimología , Anabaena/genética , Proteínas Bacterianas/metabolismo , Secuencia de Bases , Southern Blotting , Cianobacterias/genética , Cianobacterias/crecimiento & desarrollo , ADN Bacteriano/análisis , Genes Bacterianos , Hidrógeno/metabolismo , Datos de Secuencia Molecular , Nitrógeno/metabolismo , Oxidorreductasas/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa InversaRESUMEN
Inspired by the development of Evidence Based Medicine, this article introduces a new approach for health care management called Evidence Based Management. This approach promises to improve the practice of health care management, at the same time as it may stimulate research on the organization and management of health care. Evidence Based Management means that health care managers should learn to search for and critically appraise evidence from management research as a basis for their practice. This will require some new managerial skills that should be included in the education and training of health care managers. It will also require a new orientation for research on health care management. There will be a demand for more applied research, and also for research with a more positivist orientation.
Asunto(s)
Medicina Basada en la Evidencia/organización & administración , Personal Administrativo/educación , Estudios de Evaluación como Asunto , Investigación sobre Servicios de Salud , Modelos Organizacionales , SueciaRESUMEN
"The impact of migration on income for Swedish multi-adult households is examined using panel data pertaining to a sample of stable household constellations during the period 1980-1990. In contrast to previous studies, data on household disposable income is employed in estimating the income function. The empirical results indicate no significant effect on real disposable income from migration. In addition, the hypothesis of no self-selection, or zero correlation between the errors in the decision function and the income function, cannot be rejected."
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Composición Familiar , Renta , Dinámica Poblacional , Demografía , Países Desarrollados , Economía , Emigración e Inmigración , Europa (Continente) , Población , Países Escandinavos y Nórdicos , Factores Socioeconómicos , SueciaRESUMEN
Systemic administration of N-methyl-D-aspartate (NMDA) receptor antagonists induces a well defined behaviour in rodents characterized by, for example increased locomotion and ataxia. It is not clear in what brain region(s) NMDA antagonists induce this behaviour. We have studied the possible involvement of olfactory pathways by making adult mice anosmic via intranasal injection of zinc sulphate, a procedure that is known to destroy the olfactory epithelium. The NMDA antagonist MK-801 was given intraperitoneally (0.1-1.0 mg/kg) and the animals were scored for locomotion and ataxia 60-90 min later. Before MK-801 administration, olfactory-lesioned mice did not differ from non-lesioned controls with regard to locomotion or ataxia. MK-801 caused locomotor activation (> or = 0.2 mg/kg) and ataxia (> or = 0.5 mg/kg) in both groups. In general, olfactory-lesioned animals showed more locomotion and less ataxia after MK-801 administration than non-lesioned animals. Lesioned animals displayed 2.0- (P < 0.05) and 3.7-fold (P < 0.05) more extensive locomotor activation than non-lesioned animals after 0.5 and 1.0 mg/kg of MK-801, respectively. No difference in the degree of ataxia was seen between the two groups at 0.5 mg/kg, whereas non-lesioned animals showed a 2.1-fold higher degree of ataxia after 1.0 mg/kg of MK-801, indicating that the enhanced MK-801-induced locomotor activation in olfactory-lesioned mice was not simply due to less ataxia. These results suggest that olfactory input is involved in NMDA antagonist-induced behaviour.
Asunto(s)
Conducta Animal/efectos de los fármacos , Maleato de Dizocilpina/farmacología , Trastornos del Olfato/psicología , Animales , Ataxia/inducido químicamente , Ataxia/psicología , Peso Corporal/efectos de los fármacos , Desnervación , Aminoácidos Excitadores/farmacología , Masculino , Ratones , Actividad Motora/efectos de los fármacos , Degeneración Nerviosa/fisiología , Neuronas Aferentes/fisiología , Trastornos del Olfato/inducido químicamente , Bulbo Olfatorio/fisiología , Tamaño de los Órganos/efectos de los fármacos , Sulfatos , Compuestos de Zinc , Sulfato de ZincRESUMEN
Using an enzyme-linked immunosorbent assay, significantly raised concentrations of immunoglobulin G with affinity for the neurotransmitter dopamine were demonstrated in cerebrospinal fluid from psychotic patients. We have varied the antigen presentation in order to find a conjugate with low unspecific binding. The conjugation of dopamine to carbodiimide-activated poly-L-glutamic acid and that to activated succinimide ester of biotin are described. The use of glutaraldehyde conjugation is not recommended because of the risk of formation of tetrahydroisoquinolines. A strong correlation (r = 0.94, P < 0.001) between the results obtained with dopamine conjugated to poly-L-glutamic acid and dopamine conjugated to biotin was observed. Forty-two human cerebrospinal fluid samples from 20 psychotic patients, (12 with a bipolar disorder and 8 with schizophrenia) and 22 control patients, with various neurological diseases but no apparent psychiatric diseases were investigated. A significantly higher incidence (P < 0.001) of antibodies with affinity for dopamine were found in the group of psychotic patients compared with the neurological control group.
Asunto(s)
Dopamina/inmunología , Inmunoglobulina G/líquido cefalorraquídeo , Trastornos Psicóticos/inmunología , Adolescente , Adulto , Anciano , Especificidad de Anticuerpos , Cromatografía Líquida de Alta Presión , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Psicóticos/líquido cefalorraquídeoRESUMEN
The concept of cycloid psychosis has gained increasing acceptance during recent decades. Using the diagnostic criteria of Perris and Brockington, an intelligible delineation of a group of patients has been obtained. Few epidemiological data on cycloid psychosis have been reported so far. The objective of the present study was to describe the one-year incidence of cycloid psychosis in a clinical sample. The diagnostic registers of all patients hospitalized for a functional or an organic psychosis and discharged in the year 1983, in Lund, Sweden were investigated. 514 patients were identified of whom 83 were admitted to hospital for the first time. 29 of these patients had a functional psychosis and were below the age of 50. In this age group 7 cases (4 women, 3 men) fulfilled the diagnostic criteria of cycloid psychosis and thus constituted almost one fourth of all first admissions of functional psychoses that year. The one-year incidence for first admission in cycloid psychosis was 5.0 per 100,000 inhabitants in women and 3.6 per 100,000 inhabitants in men within the age group 15-50 years in the catchment area of 163,175 persons. We conclude that cycloid psychosis constitutes a considerable proportion of functional psychoses in both sexes.