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1.
Health Policy ; 132: 104769, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-37018883

RESUMEN

Improving population health and reducing inequalities through better integrated health and social care services is high up on the agenda of policymakers internationally. In recent years, regional cross-domain partnerships have emerged in several countries, which aim to achieve better population health, quality of care and a reduction in the per capita costs. These cross-domain partnerships aim to have a strong data foundation and are committed to continuous learning in which data plays an essential role. This paper describes our approach towards the development of the regional integrative population-based data infrastructure Extramural LUMC (Leiden University Medical Center) Academic Network (ELAN), in which we linked routinely collected medical, social and public health data at the patient level from the greater The Hague and Leiden area. Furthermore, we discuss the methodological issues of routine care data and the lessons learned about privacy, legislation and reciprocities. The initiative presented in this paper is relevant for international researchers and policy-makers because a unique data infrastructure has been set up that contains data across different domains, providing insights into societal issues and scientific questions that are important for data driven population health management approaches.


Asunto(s)
Gestión de la Salud Poblacional , Humanos , Países Bajos , Salud Pública , Centros Médicos Académicos
2.
Urologe A ; 58(11): 1313-1323, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31659368

RESUMEN

In this review article, the authors describe all relevant aspects of the new S2k guideline from the German Society of Urology (Deutschen Gesellschaft für Urologie, DGU) for the diagnosis and treatment of IC/PBS (interstitial cystitis/painful bladder syndrome). A list of necessary and optional examinations and the necessity of diagnosis of exclusion are summarized and evaluated. The treatment options listed (ranging from conservative, oral drug, and complementary medicine to interventional surgical procedures) also give the reader a good overview of the contents of the guideline and possible therapeutic approaches. Finally, the recommendations including consensus of the guideline group are also summarized in various information boxes.


Asunto(s)
Cistitis Intersticial/diagnóstico , Cistitis Intersticial/terapia , Guías de Práctica Clínica como Asunto , Urología/normas , Alemania , Humanos , Dolor , Examen Físico , Sociedades Médicas
3.
Eur J Clin Nutr ; 70(1): 116-22, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26220568

RESUMEN

BACKGROUND/OBJECTIVES: Gait is an important health indicator, relating strongly to the risk of falling, morbidity and mortality. In a community-dwelling population, we investigated associations of alcohol, coffee and tobacco consumption with gait. SUBJECTS/METHODS: Two thousand forty-six non-demented participants from the Rotterdam Study underwent gait assessment by electronic walkway. We measured gait velocity and Global Gait, which is the average of seven gait domains: Rhythm, Phases, Variability, Pace, Tandem, Turning and Base of Support. Alcohol, coffee and tobacco consumption was assessed by questionnaires. With analysis of covariance, we investigated associations of consumption of alcoholic beverages, coffee consumption and smoking with Global Gait, gait velocity and the seven individual gait domains. RESULTS: In all, 81.9% of participants drank alcohol, 92.4% drank coffee, 17.3% were current smokers and 50.9% were past smokers. Moderate alcohol consumption (1-3 glasses per day) associated with better gait, as measured by Global Gait (0.20 standard deviations (s.d.) (95% confidence interval: 0.10; 0.31)), gait velocity (2.65 cm/s (0.80; 4.50)), Rhythm and Variability. Consuming high amounts of coffee (>3 cups per day) associated with better Global Gait (0.18 s.d. (0.08; 0.28)), gait velocity (2.63 cm/s (0.80; 4.45)), Pace, Turning and Variability. Current smoking associated with worse Global Gait (-0.11 s.d. (-0.21; 0.00)), gait velocity (-3.47 cm/s (-5.33; -1.60)), Rhythm and Pace, compared with non-smokers. CONCLUSIONS: In a community-dwelling population, consuming >1 cup of coffee and 1-3 glasses of alcohol relate to better gait, whereas smoking is related to worse gait. Further studies are required to evaluate whether interventions targeting substance consumption may aid to prevent or reduce gait deterioration and thereby related health problems.


Asunto(s)
Consumo de Bebidas Alcohólicas , Café , Marcha , Fumar , Anciano , Anciano de 80 o más Años , Bebidas Alcohólicas , Coffea , Etanol/farmacología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Productos de Tabaco/efectos adversos
4.
Osteoporos Int ; 26(5): 1595-604, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-25792489

RESUMEN

UNLABELLED: Early life nutrition affects peak bone mass attainment. In this prospective cohort study, children with high adherence to a "dairy and whole grains" pattern in infancy had higher bone mineral density at the age of 6 years. Although the observed effects are small, our study provides insight into mechanisms linking early nutrition to bone acquisition in childhood. INTRODUCTION: Nutrition in early life may affect peak bone mass attainment. Previous studies on childhood nutrition and skeletal health mainly focused on individual nutrients, which does not consider the cumulative effects of nutrients. We investigated the associations between dietary patterns in infancy and childhood bone health. METHODS: This study included 2850 children participating in a population-based prospective cohort study. Dietary information was obtained from a food frequency questionnaire at the age of 13 months. Using principal component analysis, three major dietary patterns were extracted, explaining in total 30% of the variation in dietary intake. At the age of 6 years, a total body dual-energy X-ray absorptiometry (DXA) scan was performed, and bone mineral density (BMD), bone mineral content (BMC), area-adjusted BMC (aBMC), and bone area (BA) were analyzed. RESULTS: Higher adherence score to a "dairy and whole grains" pattern was positively associated with BMD and aBMC, but not with BMC and BA. Accordingly, children in the highest quartile of the "dairy and whole grains" pattern had higher BMD (difference 3.98 mg/cm(2), 95% confidence interval (CI) 0.36 to 7.61) and aBMC (difference 4.96 g, 95% CI 1.27 to 8.64) than children in the lowest quartile. Stratification for vitamin D supplementation showed that the positive associations between the "dairy and whole grains" pattern and bone outcomes were only observed in children who did not receive vitamin D supplementation. A "potatoes, rice, and vegetables" and a "refined grains and confectionery" pattern were not consistently associated with bone outcomes. CONCLUSIONS: An infant dietary pattern characterized by high intakes of dairy and cheese, whole grains, and eggs is positively associated with bone development in childhood. Further research is needed to investigate the consequences for bone health in later life.


Asunto(s)
Densidad Ósea/fisiología , Conducta Alimentaria/fisiología , Fenómenos Fisiológicos Nutricionales del Lactante/fisiología , Absorciometría de Fotón/métodos , Adulto , Desarrollo Óseo/fisiología , Productos Lácteos/estadística & datos numéricos , Dieta/estadística & datos numéricos , Encuestas sobre Dietas , Suplementos Dietéticos , Femenino , Humanos , Lactante , Masculino , Estudios Prospectivos , Vitamina D/administración & dosificación , Granos Enteros
5.
J Anim Sci ; 92(8): 3471-81, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24987063

RESUMEN

Four experiments were conducted to examine effects of dietary wheat middlings (midds), corn dried distillers grains with solubles (DDGS), and NE formulation on nursery pig performance and caloric efficiency. In Exp. 1, 180 nursery pigs (11.86 ± 0.02 kg BW and 39 d of age) were fed 1 of 5 diets for 21 d, with 6 pigs per pen and 6 replications per treatment. Diets were corn-soybean meal based and included 0, 5, 10, 15, or 20% wheat midds. Increasing wheat midds decreased (linear; P < 0.05) ADG and ADFI. Caloric efficiency improved (linear; P < 0.05) on both an ME (NRC, 1998) and NE (Sauvant et al., 2004) basis as dietary wheat midds increased. In Exp. 2, 210 pigs (6.85 ± 0.01 kg BW and 26 d of age) were fed 1 of 5 diets for 35 d, with 7 pigs per pen and 6 replications per treatment. Diets were corn-soybean meal based and contained 0, 5, 10, 15, or 20% wheat midds. Increasing wheat midds did not affect overall ADG or ADFI but decreased (quadratic; P < 0.013) G:F at 20%. Caloric efficiency for both ME and NE improved (quadratic; P < 0.05) as dietary wheat midds increased. In Exp. 3, 180 pigs (12.18 ± 0.4 kg BW and 39 d of age) were fed 1 of 6 experimental diets arranged in a 2 × 3 factorial with main effects of DDGS (0 or 20%) and wheat midds (0, 10, or 20%) for 21 d, with 6 pigs per pen and 5 replications per treatment. No DDGS × wheat midds interactions were observed, and DDGS did not influence ADG, ADFI, or G:F, but increasing dietary wheat midds decreased (linear; P < 0.05) ADG, G:F, and final BW. In Exp. 4, 210 pigs (6.87 kg BW and 26 d of age) were allotted to 1 of 5 dietary treatments, with 7 pigs per pen and 6 replications per treatment. Wheat middlings (0, 10, or 20%) were added to the first 3 diets without balancing for energy. In diets 4 and 5, soybean oil was added (1.4 and 2.8%) to 10 and 20% wheat midds diets to balance to the same NE as the positive control (0% wheat midds). Overall, no wheat midds × fat interactions occurred. Regardless of formulated energy value, caloric efficiency and G:F were poorer (P < 0.05) on an ME basis as wheat midds increased from 10 to 20% of the diet but did not change when calculated on an NE basis. Results of these experiments indicate that wheat midds may be fed up to 10 to 15% of the diet without negatively affecting nursery pig performance and with no interactive effects when fed in combination with DDGS. Also, formulating on an NE basis provided for similar performance with increasing dietary wheat midds compared with a corn-soybean meal control diet.


Asunto(s)
Dieta/veterinaria , Grano Comestible/química , Ingestión de Energía/fisiología , Sus scrofa/crecimiento & desarrollo , Triticum/química , Zea mays/química , Animales , Aceite de Soja , Glycine max , Porcinos
6.
Schizophr Res ; 122(1-3): 136-43, 2010 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-20554159

RESUMEN

BACKGROUND: Deficits in emotion perception are a well-established phenomenon in schizophrenic patients and studies have typically used unimodal emotion tasks, presenting either emotional faces or emotional vocalizations. We introduced bimodal emotion conditions in two previous studies in order to study the process of multisensory integration of visible and audible emotion cues. We now build on our earlier work and address the regulatory effects of selective attention mechanisms on the ability to integrate emotion cues stemming from multisensory channels. METHODS: We added a neutral secondary distractor condition to the original bimodal paradigm in order to investigate modality-specific selective attention mechanisms. We compared schizophrenic patients (n=50) to non-schizophrenic psychotic patients (n=46), as well as to healthy controls (n=50). A trained psychiatrist used the Schedules of Clinical Assessment in Neuropsychiatry (SCAN 2.1) to diagnose the patients. RESULTS: As expected, in healthy controls, and to a lesser extent in non-schizophrenic psychotic patients, modality-specific attention attenuated multisensory integration of emotional faces and vocalizations. Conversely, in schizophrenic patients, auditory and visual distractor conditions yielded unaffected and even exaggerated multisensory integration. CONCLUSIONS: These results suggest that schizophrenics, as compared to healthy controls and non-schizophrenic psychotic patients, have modality-specific attention deficits when attempting to integrate information regarding emotions that stem from multichannel sources. Various explanations for our findings, as well as their possible consequences, are discussed.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/etiología , Emociones , Trastornos de la Percepción/etiología , Esquizofrenia/complicaciones , Psicología del Esquizofrénico , Estimulación Acústica/métodos , Adulto , Análisis de Varianza , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Percepción Auditiva/fisiología , Discriminación en Psicología , Cara , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reconocimiento Visual de Modelos/fisiología , Trastornos de la Percepción/diagnóstico , Estimulación Luminosa/métodos , Tiempo de Reacción/fisiología
7.
Cochrane Database Syst Rev ; (3): CD006158, 2009 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-19588382

RESUMEN

BACKGROUND: Tumour hypoxia increases tumour invasiveness and has a negative impact on response to therapy. Hypoxic tumours are also associated with severely anaemic individuals. It has therefore been hypothesised that correcting anaemia, by increasing haemoglobin levels using erythropoietin, improves tumour oxygenation and consequently the patient's prognosis. OBJECTIVES: To assess whether combined treatment with radiotherapy and erythropoietin (RT plus EPO) is better than standard radiotherapy (RT alone) for the treatment of head and neck cancer patients. SEARCH STRATEGY: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent search was 24 February 2009. SELECTION CRITERIA: Two independent authors assessed identified studies according to the eligibility criteria: RCTs which delivered radiotherapy combined with or without erythropoietin, in patients of any age with head and neck cancer of any stage or type. In addition, trials administering concomitant iron therapy among one or both arms were also eligible. DATA COLLECTION AND ANALYSIS: For statistical analysis of survival data, we computed a weighted estimate of the typical treatment effect across studies. We used Chi(2) heterogeneity tests to test for statistical heterogeneity among trials and performed the statistical analyses using Review Manager 5.0. MAIN RESULTS: Five RCTs with a total of 1397 patients were included. Pooled data yielded a significantly worse overall survival (OS) for RT plus EPO as compared to RT alone (Peto odds ratio 0.73; 95% confidence interval (CI) 0.58 to 0.91; P = 0.005, five trials). For local regional tumour control (LRTC) analyses resulted in a small but non-significant difference between the RT alone group and the RT plus EPO group (RR 0.92; 95% CI 0.81 to 1.03; P = 0.15, four trials). In addition, the local regional progression free survival (LRPFS) measured in four studies was significantly different between groups (Peto odds ratio 0.63; 95% CI 0.49 to 0.80; P = 0.0002, four trials), in favour of the RT alone group. Two studies used supplemental iron in the RT plus EPO group and not in the RT alone group. When excluding these studies from the analyses, the statistically (non-) significant differences in OS, LRTC and LRPFS are maintained. AUTHORS' CONCLUSIONS: There are strong suggestions that RT plus EPO has a negative influence on outcome as opposed to RT alone. However, the target haemoglobin concentration, which was higher than recommended in four of the five included RCTs, may have had a significant role. Nevertheless, based on these findings EPO should not be administered as an addition to RT outside the experimental setting for patients with head and neck cancer.


Asunto(s)
Anemia/tratamiento farmacológico , Eritropoyetina/análogos & derivados , Eritropoyetina/uso terapéutico , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/radioterapia , Anemia/mortalidad , Hipoxia de la Célula/fisiología , Quimioterapia Adyuvante/efectos adversos , Quimioterapia Adyuvante/mortalidad , Darbepoetina alfa , Eritropoyetina/efectos adversos , Neoplasias de Cabeza y Cuello/mortalidad , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Proteínas Recombinantes , Análisis de Supervivencia
8.
Planta ; 216(6): 1003-12, 2003 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-12687368

RESUMEN

Transgenic plants are increasingly used as production platforms for various proteins, yet protein expression levels in the range of the most abundant plant protein, ribulose-1,5-bisphosphate carboxylase have not yet been achieved by nuclear transformation. Suitable gene regulatory 5' and 3' elements are crucial to obtain adequate expression. In this study an abundantly transcribed member (rbcS1) of the ribulose-1,5-bisphosphate carboxylase small-subunit gene family of chrysanthemum (Chrysanthemum morifolium Ramat.) was cloned. The promoter of rbcS1 was found to be homologous to promoters of highly expressed rbcS gene members of the plant families Asteraceae, Fabaceae and Solanaceae. The regulatory 5' and 3' non-translated regions of rbcS1 were engineered to drive heterologous expression of various genes. In chrysanthemum, the homologous rbcS1 cassette resulted in a beta-glucuronidase (gusA) accumulation of, at maximum, 0.88% of total soluble protein (population mean 0.17%). In tobacco (Nicotiana tabacum L.), the gusA expression reached 10% of total soluble protein. The population mean of 2.7% was found to be 7- to 8-fold higher than for the commonly used cauliflower mosaic virus (CaMV) 35S promoter (population mean 0.34%). RbcS1-driven expression of sea anemone equistatin in potato (Solanum tuberosum L.), and potato cystatin in tomato (Lycopersicon esculentum Mill.) yielded maximum levels of 3-7% of total soluble protein. The results demonstrate, that the compact 2-kb rbcS1 expression cassette provides a novel nuclear transformation vector that generates plants with expression levels of up to 10% of total protein.


Asunto(s)
Chrysanthemum/genética , Regulación de la Expresión Génica de las Plantas , Regiones Promotoras Genéticas/genética , Ribulosa-Bifosfato Carboxilasa/genética , Regiones Terminadoras Genéticas/genética , Secuencia de Bases , Cistatinas/biosíntesis , Cistatinas/genética , Solanum lycopersicum/genética , Datos de Secuencia Molecular , Plantas Modificadas Genéticamente , Biosíntesis de Proteínas , Proteínas/genética , Homología de Secuencia de Ácido Nucleico , Solanum tuberosum/genética , Nicotiana/genética
9.
Br J Nutr ; 83(5): 533-40, 2000 May.
Artículo en Inglés | MEDLINE | ID: mdl-10953678

RESUMEN

A study was conducted with conventional and germ-free broiler chicks to obtain more information on the role of the intestinal microflora in the anti-nutritive effects of NSP in broiler chicks. As the NSP source, highly methylated citrus pectin (HMC) was used at a dose level of 30 g/kg in a maize-based diet. The diets fed to the germ-free chicks were gamma-irradiated, whereas those fed to the conventional chicks were not. Feeding the HMC diet to conventional birds depressed weight gain and food utilization (P < 0.05), whereas in germ-free birds only weight gain was reduced (P < 0.05). Feeding the HMC diet to conventional birds reduced digestibilities of energy and starch at the end of the jejunum. Ileal digestibilities of starch and energy were not strongly affected when birds were fed on the HMC-containing diet. Faecal digestibilities of organic matter, crude fat, starch and amino acids, N retention and metabolizable energy were reduced when conventional chicks were fed on the HMC diet. Feeding the HMC diet to germ-free birds hardly affected faecal digestibility of nutrients and N retention, whereas metabolizable energy was increased. Feeding the HMC diet to conventional or germ-free birds increased the viscosity of the digesta in the small intestine. This increase in digesta viscosity was more pronounced in conventional than in germ-free birds. The pH of ileal digesta was reduced when HMC was added to the diet of conventional chicks, but not in germ-free chicks. Feeding the HMC diet to conventional birds markedly affected morphology of the gut wall, whereas in germ-free chicks very little effect was found on gut morphology. Based on the results of the present study, it is concluded that the gastrointestinal microflora mediates the magnitude of the anti-nutritive effects of HMC in broiler chicks. However, the exact role of the microflora in chicks in the magnitude of the anti-nutritional effects of HMC could not be derived from the present study, since the results might have been influenced by gamma-irradiation of the diets fed to the germ-free chicks.


Asunto(s)
Digestión/fisiología , Contenido Digestivo/química , Vida Libre de Gérmenes/fisiología , Intestinos/microbiología , Proteínas del Tejido Nervioso/metabolismo , Animales , Pollos/fisiología , Citrus/química , Metabolismo Energético/fisiología , Masculino , Valor Nutritivo , Pectinas/química , Viscosidad , Aumento de Peso
10.
Ther Drug Monit ; 21(3): 289-92, 1999 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-10365638

RESUMEN

The toxicity and pharmacokinetic properties of a drug determine whether hemodialysis and/or hemoperfusion are indicated in acute intoxications. Valproic acid is considered unremovable by hemodialysis because of the high protein binding of 90%-95%. A 27-year-old male with a history of seizures was admitted to the emergency room because of coma, hypernatriemia, and respiratory failure caused by an intoxication with a large dose of valproic acid. At admission, the plasma valproic acid level was 1414 mg/L (9.9 mmol/L) (therapeutic range: 50-100 mg/L (350-700 micromol/ L). The anion gap was 26 mmol/L (normal <12-14 mmol/L) and corresponded fairly well with this valproic acid level. Because of the potential toxicity of this high valproic acid level serial hemodialysis and hemoperfusion was performed. The first session was done with a charcoal column and the second session with a resin column. The patient recovered during the course of treatment. The valproic acid plasma clearances during treatment were: 80 mL/min (hemodialysis); 40 mL/min (hemoperfusion by charcoal) and 80 mL/min (hemoperfusion by resin, only in the first hour). The protein binding of valproic acid in plasma was only 32% at the start and was 54% at the end of the two sessions. In this specific case of a severe valproic acid intoxication, saturated protein binding resulted in an increased fraction of unbound valproic acid. This made hemodialysis an effective treatment, while hemoperfusion was relatively less effective because of saturation of the column. In conclusion, the toxicokinetics of valproate are quite different from the pharmacokinetics at therapeutic levels. The anion gap and protein binding are important parameters in toxicokinetics.


Asunto(s)
Anticonvulsivantes/envenenamiento , Hemoperfusión , Diálisis Renal , Ácido Valproico/envenenamiento , Adulto , Anticonvulsivantes/farmacocinética , Sobredosis de Droga , Humanos , Masculino , Ácido Valproico/farmacocinética
11.
J Neurobiol ; 39(1): 41-50, 1999 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-10213452

RESUMEN

By means of differential display techniques, we have previously identified an mRNA transcript whose expression is highly induced in the rat hippocampus by kainate-elicited seizures. Here, we report the cloning of a corresponding cDNA encoding a 55-amino-acid, serine-rich peptide which contains four predicted phosphorylation sites. The peptide was designated CaMK-related peptide (CARP) as it shares significant amino acid sequence identity with part of a novel putative calcium/calmodulin-dependent kinase (CaMK-VI) that was also cloned in this study. It appears that CARP and CaMK-VI are derived from the same gene through differential splicing. Intriguingly, CARP also exhibits 64% amino acid sequence identity with the C-terminal part of human doublecortin, encoded by a recently identified gene which is mutated in patients with X-linked lissencephaly and the double-cortex syndrome. In addition, the structure of CARP resembles the autoinhibitory, serine-rich N-terminal domain of CaMK-IV, suggesting a possible modulatory role of CARP with respect to CaMK activity. Northern blot analysis and in situ hybridization experiments showed that CARP mRNA is specifically induced by kainate-elicited seizures in the dentate gyrus and in the pyramidal layers CA1 and CA2, but not in CA3. In contrast, kainate-induced seizures did not change the level of expression of the CaMK-VI gene. We propose that CARP induction leads to the modulation of kinase activity in specific subregions of the rat hippocampus, providing a negative feedback mechanism for seizure-induced kinases.


Asunto(s)
Hipocampo/metabolismo , Ácido Kaínico/toxicidad , Proteínas Asociadas a Microtúbulos , Fosfoproteínas/genética , Convulsiones/metabolismo , Transcripción Genética/efectos de los fármacos , Secuencia de Aminoácidos , Animales , Proteínas Quinasas Dependientes de Calcio-Calmodulina/química , Proteínas Portadoras , Clonación Molecular , Secuencia de Consenso , ADN Complementario , Proteínas de Dominio Doblecortina , Proteína Doblecortina , Regulación de la Expresión Génica/efectos de los fármacos , Hipocampo/efectos de los fármacos , Hipocampo/patología , Humanos , Masculino , Datos de Secuencia Molecular , Neuropéptidos/química , Neuropéptidos/genética , Fosfoproteínas/biosíntesis , Fosfoproteínas/química , Ratas , Ratas Wistar , Proteínas Recombinantes/biosíntesis , Proteínas Recombinantes/química , Convulsiones/inducido químicamente , Convulsiones/genética , Alineación de Secuencia , Homología de Secuencia de Aminoácido
12.
Lepr Rev ; 69(4): 382-9, 1998 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-9927811

RESUMEN

In northern Nigeria 60 leprosy patients, 49 outpatients and 11 in-patients, were interviewed about their help-seeking behaviour and explanatory models before their first contact with the leprosy services. Most patients showed a delay of more than 1 year. After leprosy was provisionally diagnosed by lay persons, 27% of patients found their way to the leprosy services within 3 months. Chemists (popular sector) and the professional sector frequently missed the diagnosis. If early case finding is to be improved, it is important to involve them in case finding activities and to train them in adequate diagnostic skills. No significant correlations were found between total delay and sex, age, religion or leprosy classification, except with visible deformity at the time of the interview and illiteracy. Consultation of folk healers was the major reason for delay. Most patients consulted folk healers, who, although they claimed to have a positive attitude towards modern medicine in the case of leprosy, never referred patients to the leprosy services. While many patients held a variety of causes responsible for leprosy, most patients explained the disease in traditional terms (58%), while only a minority used modern concepts (20%). This emphasizes the need for continuous attention for health education of diagnosed patients and their families. No significant difference was found between male and female patients concerning their concept of leprosy. Denial of the leprosy diagnosis was rare.


Asunto(s)
Actitud Frente a la Salud , Lepra/prevención & control , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto , Distribución por Edad , Recolección de Datos , Países en Desarrollo , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Lepra/diagnóstico , Lepra/epidemiología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Nigeria/epidemiología , Modelos de Riesgos Proporcionales , Distribución por Sexo
13.
Ned Tijdschr Geneeskd ; 141(30): 1487-91, 1997 Jul 26.
Artículo en Holandés | MEDLINE | ID: mdl-9542884

RESUMEN

During the first decade of the twentieth century the prolonged bath treatment was introduced as a therapy for restless patients in Dutch psychiatric institutions. They were kept for hours or days at a stretch in lukewarm water, in order to calm them down. It became a common treatment, which nevertheless was gradually replaced by occupational therapy. The rise of psychopharmacology during the fifties of this century marked the end of the prolonged bath treatment.


Asunto(s)
Hidroterapia/historia , Trastornos Mentales/historia , Historia del Siglo XX , Humanos , Hidroterapia/métodos , Trastornos Mentales/terapia , Países Bajos
14.
Poult Sci ; 76(2): 321-5, 1997 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-9057214

RESUMEN

The effect of DL-methionine and betaine supplementation on growth performance of 2,400 male broilers in the age period of 1 to 38 d, and on carcass composition of a subsample of 384 birds was examined. Three dose levels of DL-methionine (0, 0.05, and 0.10%) and two doses of betaine (0 and 0.04%) were supplemented in different combinations to methioninedeficient diets. Two types of diets were fed as starters and growers: either corn-soybean diets or practical diets typical for the Dutch broiler industry. All diets were fortified with 220 ppm choline in order to avoid a deficiency in methyl groups. Increasing DL-methionine supplementation significantly improved daily weight gain and feed conversion efficiency. Supplemental betaine did not affect bird growth. Betaine slightly improved feed conversion in diets without supplemental DL-methionine, but did not affect this parameter in diets with added DL-methionine. Breast meat yield was significantly increased by about 1.5 percentage points by the addition of 0.05% DL-methionine, whereas 0.04% betaine only tended to increase breast meat yield in the range of 0.3 to 0.6 percentage points. The type of diet did not have any effect on the responses obtained. In summary, there was no evidence for betaine to spare DL-methionine as an essential amino acid supplement in broiler diets.


Asunto(s)
Alimentación Animal , Betaína/farmacología , Composición Corporal/efectos de los fármacos , Alimentos Fortificados , Metionina/farmacología , Aumento de Peso/efectos de los fármacos , Análisis de Varianza , Animales , Pollos , Masculino , Carne , Desarrollo de Músculos , Músculo Esquelético/efectos de los fármacos , Músculo Esquelético/crecimiento & desarrollo , Estereoisomerismo
15.
Clin Cancer Res ; 2(7): 1123-7, 1996 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-9816277

RESUMEN

Lometrexol (5,10-dideazatetrahydrofolic acid) is a new antifolate that is highly selective in inhibiting the key enzyme of purine synthesis glycinamide ribonucleotide formyltransferase. The most promising preclinical features of lometrexol in animal models were its significant activity against a broad panel of solid tumors, the schedule dependency of its antitumor activity, and the availability of a rescue regimen with folinic or folic acid. In the present study, lometrexol was first given daily for 3 consecutive days, repeated every 4 weeks (part I). The occurrence of delayed myelotoxicity prompted the development of a rescue regimen with lometrexol given in a single dose on day 1, followed by oral folinic acid, 15 mg four times a day, from day 3 to day 5 (part II). Longer time intervals between administration of lometrexol and start of rescue were then evaluated (part III), and in the last part of the study (part IV), the maximum tolerated dose of single intermittent doses of lometrexol with folinic acid given from day 7 to day 9 was established. Sixty adult patients entered the study. In part I, the highest daily dose that could be safely given was 4 mg/m2, for a total dose of 12 mg/m2. Cumulative early stomatitis and delayed thrombocytopenia were dose limiting. The use of oral folinic acid made it possible to escalate the dose up to 60 mg/m2, and the maximum tolerated dose was reached at this dose when folinic was given from day 7 to day 9, with anemia being the dose-limiting toxicity. A shorter time interval between lometrexol and folinic acid administrations (from day 5 to day 7) is recommended for Phase II evaluations to optimize the antitumor effect. Anemia was normochromic and macrocytic, possibly due to a deficiency of folic acid. One partial response of 8 months' duration was reported in a patient with epithelial cancer of the ovary, relapsing after cisplatin and alkylating agents. The use of folic acid as rescue, proposed on the basis of experimental data and pharmacological considerations, has also allowed the repeated administration of lometrexol at doses higher than in the previous studies. The advantages of rescue with folinic acid over supplementation with folic acid, however, are difficult to define.


Asunto(s)
Antagonistas del Ácido Fólico/efectos adversos , Leucovorina/administración & dosificación , Neoplasias/tratamiento farmacológico , Tetrahidrofolatos/efectos adversos , Adulto , Médula Ósea/efectos de los fármacos , Humanos , Tetrahidrofolatos/administración & dosificación , Tetrahidrofolatos/farmacocinética
17.
Chromosome Res ; 2(4): 315-25, 1994 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-7921647

RESUMEN

Synapsis and chiasma formation were studied in pollen mother cells of four meiotic mutants of tomato. The four mutants displayed defects in the assembly of the synaptonemal complex (SC) covering the whole range from almost complete absence of synapsis to complete synapsis at pachytene. In three mutants, we found a good correlation between the number of bivalents connected by at least one tripartite SC segment at pachytene and the number of chiasmatic bivalents at metaphase I. We suggest that in tomato functional chiasmata are only formed in the context of the tripartite SC.


Asunto(s)
Intercambio Genético , Mutación/fisiología , Solanum lycopersicum/genética , Complejo Sinaptonémico , Núcleo Celular/ultraestructura , Cromosomas/ultraestructura , Metafase/genética , Polen/citología , Polen/ultraestructura
18.
Poult Sci ; 73(2): 274-80, 1994 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-8146074

RESUMEN

Two experiments with individually caged laying hens were conducted to determine the requirement for TSAA. In Experiment 1, the corn-soybean basal diet contained .48% TSAA to which increasing dose levels of DL-methionine were added providing at the highest supplemental level .645% TSAA. The experimental diets were fed for 12 wk, covering the early stage of laying from 25 to 37 wk of age. In Experiment 2, a corn-soybean basal diet containing of .51% TSAA was used along with DL-methionine supplements to determine TSAA requirement during the entire laying cycle of 52 wk (25 to 77 wk of age). The highest supplemental level of DL-methionine in this experiment provided .76% TSAA. The TSAA requirement was found to be higher for maximum efficiency of feed utilization than for obtaining maximum egg production. Based on feed conversion efficiency and at an egg mass yield of 55 g per hen-day, the requirement for TSAA was estimated to be about 740 mg per hen-day, of which about 440 mg was methionine, throughout a laying period of 52 wk. It was calculated that the estimated TSAA requirement was equivalent to approximately 660 mg true digestible SAA per hen-day.


Asunto(s)
Aminoácidos Sulfúricos/administración & dosificación , Pollos/fisiología , Metionina/administración & dosificación , Alimentación Animal , Animales , Ingestión de Alimentos/efectos de los fármacos , Femenino , Alimentos Fortificados , Necesidades Nutricionales , Oviposición/efectos de los fármacos
19.
Ann Oncol ; 4(4): 295-301, 1993 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-8518219

RESUMEN

BACKGROUND: The Comprehensive Cancer Center trial 82-01 is a prospective randomized study to investigate the value of the addition of high-dose medroxyprogesterone acetate (MPA) to chemotherapy in patients with node-positive operable breast cancer. MPA may be of advantage in this setting because of its activity in estrogen receptor ER-positive as well as ER-negative tumors and since it may protect against chemotherapy-induced myelosuppression and thus enable maintenance of the appropriate chemotherapeutic scheduling. PATIENTS AND METHODS: Four hundred eight evaluable patients with node-positive (N+) operable breast cancer (T1-3, N1) were entered in a multicenter randomized trial. Two hundred nine patients were randomized in the MPA- arm and 199 in the MPA+ arm. CAF chemotherapy was given as a short i.v. bolus infusion: cyclophosphamide 500 mg/m2 i.v. day 1, doxorubicin 40 mg/m2 i.v. day 1, and 5-fluorouracil 500 mg/m2 i.v. day 1, q 4 wks x 6. MPA was given intramuscularly (i.m.) 500 mg q d x 28 days, followed by 500 mg i.m. twice weekly during 5 months. RESULTS: The main side effects of MPA were weight gain with a mean of 5.5 kg as opposed to 1.8 kg in the control group (p = 0.01) and vaginal bleeding in 30/199 in the MPA+ group and 0 in the MPA- group. MPA ameliorated vomiting grade III, IV (45% vs. 28%, p < 0.001), nausea grade III, IV (50% vs. 34%, p < 0.001) and leucocyte nadir grade III, IV (20% vs. 11%, p = 0.003). Disease-free survival (DFS) after 5 years was 59% in the MPA+ and 49% in the MPA- group (p = 0.12). Patients > or = 60 years benefitted most from MPA treatment, in particular if freedom from distant metastases was taken as the endpoint (p = 0.02). Overall survival (OS) was not significantly different between the two treatment groups (p = 0.18), but within subgroups analysed there was an advantage for MPA+ in patients > or = 55 years (p = 0.002) and in pT1 patients (p = 0.045). CONCLUSIONS: High-dose MPA ameliorates CAF side effects and reduces the risk of metastatic disease, especially in elderly breast cancer patients.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Quimioterapia Adyuvante , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Femenino , Fluorouracilo/administración & dosificación , Estudios de Seguimiento , Humanos , Metástasis Linfática , Acetato de Medroxiprogesterona/administración & dosificación , Persona de Mediana Edad , Estudios Prospectivos , Tasa de Supervivencia
20.
J Thorac Cardiovasc Surg ; 100(3): 445-54, 1990 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-2391980

RESUMEN

Adenosine is known to induce rapid cardioplegic arrest and to improve postischemic recovery in the isolated rat heart. Long exposures to high doses of adenosine impair postischemic recovery, however. In this paper we tested the combination of low-dose adenosine (1 mmol/L) with potassium (26 mmol/L), with the aim of achieving rapid arrest (as with high-dose adenosine) but eliminating the need for postarrest washout of adenosine. Cardioplegic solutions studied were (1) Krebs-Henseleit potassium (26 mmol/L) (K); (2) K plus adenosine (1 mmol/L) (KA); (3) K plus an adenosine deaminase inhibitor [erythro-9-(2-hydroxy-3-nonyl)adenine] (0.1 mmol/L) (KE); and as control (4) Krebs-Henseleit potassium (6 mmol/L) (C). We induced cardiac arrest in Langendorff-perfused rat hearts by infusing the cardioplegic solution for 3 minutes at 3 ml/min. Total ischemia lasted 20 minutes at 37 degrees C, followed by reperfusion for 30 minutes. High potassium decreased the arrest time from 260 +/- 16 seconds (group C, mean values +/- standard error of the mean) to 22 +/- 4 seconds (group K). A further decrease to 10 +/- 2 seconds was observed with KA (p = 0.016 versus K). KE, which increased endogenous adenosine, gave intermediate effects. All hearts recovered during reperfusion; the product of developed tension and heart rate (grams per minute) was superior in KA hearts (6250 +/- 740 versus K hearts 4380 +/- 390; p = 0.050). KE gave an intermediate result (5290 +/- 900), while C showed the worst recovery (3180 +/- 830). Our electrophysiologic studies with sinus node and atrial tissue suggest that adenosine induced hyperpolarization and an increase in potassium permeability, thereby arresting the sinus node before depolarization of the membrane by potassium (26 mmol/L). We conclude that low-dose adenosine as an adjunct to potassium shortens the arrest time in this model and improves postischemic recovery.


Asunto(s)
Adenosina/administración & dosificación , Paro Cardíaco Inducido , Corazón/efectos de los fármacos , Compuestos de Potasio , Adenina/administración & dosificación , Adenina/análogos & derivados , Nucleótidos de Adenina/metabolismo , Animales , Combinación de Medicamentos , Electrofisiología , Metabolismo Energético/efectos de los fármacos , Corazón/fisiología , Potasio/administración & dosificación , Ratas
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