Minor histocompatibility antigens: time for a paradigm shift?

Minor histocompatibility antigens (mH-Ags) are polymorphic proteins that are capable of eliciting immune responses between HLA-matched donor and transplant recipient. These immune responses are mediated by T cells that recognize antigenic peptides generated from mH proteins. Although the prerequisite of matching the major histocompatibility complex encoding alleles for successful transplant acceptance is well appreciated, knowledge on the role of mH-Ags in graft rejections and their use in immunotherapeutic applications is far from complete. Therefore, the first objective of this review is to compile comprehensive information regarding murine and human mH-Ags. Secondly, recent studies have revealed that several full-length mH proteins possess novel cellular and immunological functions. Because these specialized functions of mH proteins have the potential to modulate clinical outcomes, this review will attempt to summarize all known functions of mH proteins and discuss a paradigm shift that is currently taking place to redefine the immunobiology of these antigens.     

Pregabalin for acute pain management: a shift in paradigm

Editor—We would like to commend the authors for this interestingand intriguing use of pregabalin for perioperative pain relief.¹The use of pregabalin in the management of acute pain control     

Tendinopathies in the upper extremity: a paradigm shift.

Epicondylitis and de Quervain's tenosynovitis are two common diagnoses seen by hand therapists in clinical practice. Traditionally, these conditions have been viewed as being due to an inflammatory process and treated as such. New research shows that tendons exhibit areas of degeneration and a distinct lack of inflammatory cells. Tendinosis is degeneration of the collagen tissue due to aging, microtrauma, or vascular compromise. This article reviews key literature related to tendinopathies in the lower extremity and comments on the dearth of similar articles for the elbow and forearm. Hand therapists are encouraged to embrace this new terminology and to engage in research in this difficult area to improve treatment regimens and outcome measures.     

Osteopathic research: the needed paradigm shift

The purposes of this article are twofold: (1) To assist scientists on the faculties of colleges of osteopathic medicine in the design of research projects relevant to osteopathic medical theory and practice; and (2) to assist clinical investigators in the development of research protocols that are best suited to the assessment of clinical outcomes of osteopathic medical practice. Toward this end, the central osteopathic medical principles are heuristically interpreted and elaborated, with the intention of facilitating the formulation of fundamental questions by researchers in the various biomedical disciplines and the design of clinical research projects by osteopathic physicians. A few of the questions evoked by such elaboration of the osteopathic medical principles and awaiting study are suggested for consideration by researchers. Such research questions require and, in part, compose a research paradigm that differs basically from, yet complements and "completes," the prevailing and highly productive reductionist paradigm. It is, in the original sense of the word, a "holistic" paradigm that places emphasis on the organismic context in which the biological mechanisms exist and operate. Conventional clinical research protocols for the assessment of efficacy of most chemical and physical therapeutic agents are ill-suited for the assessment of osteopathic medical care, of manipulative treatment in particular. It is emphasized that osteopathic medical care must be evaluated as it is practiced and not as a contrived, unreal version; and that it must be tested as a derivative of, and in the context of, that philosophy by criteria consonant with that philosophy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Flexible robotics: a new paradigm

PURPOSE OF REVIEW: The use of robotics in urologic surgery has seen exponential growth over the last 5 years. Existing surgical robots operate rigid instruments on the master/slave principle and currently allow extraluminal manipulations and surgical procedures. Flexible robotics is an entirely novel paradigm. This article explores the potential of flexible robotic platforms that could permit endoluminal and transluminal surgery in the future. RECENT FINDINGS: Computerized catheter-control systems are being developed primarily for cardiac applications. This development is driven by the need for precise positioning and manipulation of the catheter tip in the three-dimensional cardiovascular space. Such systems employ either remote navigation in a magnetic field or a computer-controlled electromechanical flexible robotic system. We have adapted this robotic system for flexible ureteropyeloscopy and have to date completed the initial porcine studies. SUMMARY: Flexible robotics is on the horizon. It has potential for improved scope-tip precision, superior operative ergonomics, and reduced occupational radiation exposure. In the near future, in urology, we believe that it holds promise for endoluminal therapeutic ureterorenoscopy. Looking further ahead, within the next 3-5 years, it could enable transluminal surgery.     

Differentiated carcinoma of the thyroid: a paradigm shift in surgical approach

Thyroid cancer commonly present with a thyroid nodule, a few with cervical lymphadenopathy or metastases. Total of 1320 patients with differentiated thyroid cancer (DTC) managed in Surgical department, Government General Hospital, Chennai, India for a period of 11 years (1990-2001) were analyzed and 600 patients followed up for a mean of 5.5 years (range, 1-11 years). Aim was to discuss the advantage of ultrasound guided fine needle aspiration cytology (FNAC) in increasing the preoperative pick up of DTC, Papillary microcarcinoma, advantages of total thyroidectomy as the initial operation for DTC and management of thyroid remnant by completion thyroidectomy or radioiodine I 131 ablation. McNemer's test used for estimating efficacy of ultra sound guided (USG) FNAC, Kaplan-meier survival analysis to calculate mortality and Cox's proportional hazards regression analysis for disease free survival were used in the study.