Myoelectric prostheses: state of the art

The following is a brief introduction to powered prosthetics and myoelectric control. This paper reviews the present availability and clinical impact of myoelectric prostheses. A significant observation is that these systems have reached a sufficient degree of maturity that they are accepted by many health-care funding agencies as reasonable and cost-effective components of the rehabilitation process. The limitations of both the mechanical systems and the myoelectric controls are discussed in some detail, from the viewpoint of the potential user. Finally, an overview is given of current research in this field with comments on probable directions of development.     

Mastocytosis: state of the art.

Mastocytosis is a neoplastic disease involving mast cells (MC) and their CD34+ progenitors. Symptoms in mastocytosis are caused by biological mediators released from MC and/or the infiltration of neoplastic MC in various organs, the skin and the bone marrow being predominantly involved. A WHO consensus classification for mastocytosis exists, which is widely accepted and includes three major categories: (1) Cutaneous mastocytosis (CM), a benign disease in which MC infiltration is confined to the skin, is preferentially seen in young children and exhibits a marked tendency to regress spontaneously. (2) Systemic mastocytosis (SM) which is commonly diagnosed in adults and includes four major subtypes: (i) indolent SM (ISM, the most common form involving mainly skin and bone marrow); (ii) a unique subcategory termed SM with an associated non-mast cell clonal hematological disease (SM-AHNMD); (iii) aggressive SM usually presenting without skin lesions, and (iv) MC leukemia, probably representing the rarest variant of human leukemias. (3) The extremely rare localized extracutaneous MC neoplasms, either presenting as malignancy (MC sarcoma) or as benign tumor termed extracutaneous mastocytoma. Diagnostic criteria for mastocytosis are available and are widely accepted. SM criteria include one major criterion (multifocal compact tissue infiltration by MC) and four minor criteria: (1) prominent spindling of MC; (2) atypical immunophenotype of MC with coexpression of CD2 and/or CD25 (antigens which have not been found to be expressed on normal/reactive MC); (3) activating (somatic) point mutations of the c-kit proto-oncogene usually involving exon 17, with the imatinib-resistant type D816V being most frequent, and (4) persistently elevated serum tryptase level (>20 ng/ml). To establish the diagnosis of SM, at least one major and one minor criterion, or at least three minor criteria, have to be fulfilled. The natural clinical course of mastocytosis is variable. Most patients, in particular those with CM and ISM, remain in an indolent stage over many years or even decades, while others, in particular those with aggressive SM, SM-AHNMD, or mast cell leukemia, show a progressive course, usually with a fatal outcome.     

Autoimmune prostatitis: state of the art

The prostate is one of the main male sex accessory glands and the target of many pathological conditions affecting men of all ages. Pathological conditions of the prostate gland range from infections, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) of a still unknown aetiology to benign hyperplasia and cancer. CP/CPPS is one of the most prevalent diseases in the urologic clinic and affects men younger than 50 years old. A significant advance in the understanding of CP/CPPS was made when an autoimmune response against prostate antigens was revealed in a considerable number of patients. During the last 30 years, extensive work has been done regarding the development and characterization of different rodent models of experimental autoimmune prostatitis (EAP). It has been demonstrated that tolerance to prostate antigens can be disrupted in some strains of rats and mice and cellular and humoral responses to prostate antigens are elicited. A Th1 pattern has been described and the cellular response seems to be the major pathogenic mechanism involved. Immune cells infiltrate the gland and induce prostate lesions. The genetic background and hormonal imbalance are factors that could contribute to the onset of the disease in susceptible young males. Moreover, spontaneous autoimmune prostatitis could also occur with advanced age in susceptible strains. In this review, we summarize the current knowledge regarding rodent models of EAP and the immunological alterations present in CP/CPPS patients. We also discuss the reliability of these experimental approaches as genuine tools for the study of human disease.     

Malaria: state of art

Some actual aspects of malaria are here described. After an outline of the actual epidemiological situation of malaria endemic in the world and some historical reports on Italian malaria phenomena before the institution of malaria control measures, chemoprophylaxis and its more problematic aspects, mainly related to multiresistant drug Plasmodium falciparum strains, are discussed in the first part. In the second part the factors potentially implicated in a reintroduction of malaria in free areas are analyzed; with a special reference to climatic changes. Finally the more recent vaccine perspectives are summarized; the authors discuss the principal experiences made using synthetic peptides of different plasmodial origin.     

Current state of the art in myocardial tissue engineering

Myocardial tissue engineering aims to repair, replace, and regenerate damaged cardiac tissue using tissue constructs created ex vivo. This approach may one day provide a full treatment for several cardiac disorders, including congenital diseases or ventricular dysfunction after myocardial infarction. Although the ex vivo construction of a myocardium-like tissue is faced with many challenges, it is nevertheless a pressing objective for cardiac reparative medicine. Multidisciplinary efforts have already led to the development of promising viable muscle constructs. In this article, we review the various concepts of cardiac tissue engineering and their specific challenges. We also review the different types of existing biografts and their physiological relevance. Although many investigators have favored cardiomyocytes, we discuss the potential of other clinically relevant cells, as well as the various hypotheses proposed to explain the functional benefit of cell transplantation.     

Menopause and HRT--the state of the art in Europe

The HRT field has been dramatically affected by the publication on major randomised controlled trials of the long-term effects of HRT. The publicity surrounding the publication of these data has affected public and regulatory perceptions of HRT and its role in healthcare, including the relatively short-term use of HRT for the relief of menopausal symptoms. An evidence-based appraisal of the role of HRT today is best achieved by considering the different components of the effects of HRT individually, based on the best trial evidence, and then considering these together in the context of the age of woman concerned and the specific components relevant to that woman's health profile. This paper summarises the effects of HRT using this approach in the context of European practice today and describes the events surrounding the regulatory and scientific society position statements.     

Emergence of cooperation: state of the art

This review presents a review of prevalent results within research pertaining to emergent cooperation in biologically inspired artificial social systems. Results reviewed maintain particular reference to biologically inspired design principles, given that current mathematical and empirical tools have provided only a partial insight into elucidating mechanisms responsible for emergent cooperation, and then only in systems of an abstract nature. This review aims to provide an overview of important and disparate research contributions that investigate utilization of biologically inspired concepts such as emergence, evolution, and self-organization as a means of attaining cooperation in artificial social systems. An introduction and overview of emergent cooperation in artificial life is presented, followed by a survey of emergent cooperation in swarm-based systems, the pursuit-evasion domain, and RoboCup soccer. The final section draws conclusions regarding future directions of emergent cooperation as a problem-solving methodology that is potentially applicable in a wide range of problem domains. Within each of these sections and their respective themes of research, the mechanisms deemed to be responsible for emergent cooperation are elucidated and their key limitations highlighted. The review concludes that current studies in emergent cooperative behavior are limited by a lack of situated and embodied approaches, and by the research infancy of current biologically inspired design approaches. Despite these limiting factors, emergent cooperation maintains considerable future potential in a wide variety of application domains where systems composed of many interacting components must cooperatively perform unanticipated global tasks.     

Uremic toxicity: present state of the art

The uremic syndrome is a complex mixture of organ dysfunctions, which is attributed to the retention of a myriad of compounds that under normal condition are excreted by the healthy kidneys (uremic toxins). In the area of identification and characterization of uremic toxins and in the knowledge of their pathophysiologic importance, major steps forward have been made during recent years. The present article is a review of several of these steps, especially in the area of information about the compounds that could play a role in the development of cardiovascular complications. It is written by those members of the Uremic Toxins Group, which has been created by the European Society for Artificial Organs (ESAO). Each of the 16 authors has written a state of the art in his/her major area of interest.     

Automated cytology. The state of the art

Analytical cytology is the science of automatically analyzing morphologic, biochemical, biophysical, and functional aspects of cells by machine. Two basic techniques are used: image cytometry, in which microscopic objects on a slide or in a photograph are analyzed; and flow cytometry, in which biologic particles in aqueous suspensions are forced to pass through a measuring device. The latter technique has the added power of sorting particles according to type for further study. Currently, analytic cytology is being studied for use in the following areas: WBC differentiation, cell-cycle kinetics, prescreening for uterine cancer, screening of high-risk groups, monitoring of tumor therapy, and microbial and chromosome analysis. In all these areas, analytic cytology has the potential to improve existing techniques and to make results more uniform; likewise, its sensitivity, accuracy, and speed may well allow a breadth and depth of analysis not presently allowed by human study.     

Cardiovascular tissue engineering: state of the art

In patients requiring coronary or peripheral vascular bypass procedures, autogenous arterial or vein grafts remain as the conduit of choice even in the case of redo patients. It is in this class of redo patients that often natural tissue of suitable quality becomes unavailable; so that prosthetic material is then used. Prosthetic grafts are liable to fail due to graft occlusion caused by surface thrombogenicity and lack of elasticity. To prevent this, seeding of the graft lumen with endothelial cells has been undertaken and recent clinical studies have evidenced patency rates approaching reasonable vein grafts. Recent advances have also looked at developing a completely artificial biological graft engineered from the patient's cells with surface and viscoelastic properties similar to autogenous vessels. This review encompasses both endothelialisation of grafts and the construction of biological cardiovascular conduits.     

Sudden cardiac death: state of the art

Sudden cardiac death (SCD) is an integral term for several heart diseases among which SCD caused by ischemic heart disease (IHD) designated as sudden coronary death (SCD) ranks first. SCD associated with alcoholic cardiomyopathy ranks second. Risk factors and pathologic manifestations of SCD correspond to those of IHD, atherosclerosis, myocardial infarction. Cardiac arrest takes place because of fibrillation of ventricular myocardium. Factor inducing fibrillation is an advanced irreversable myocardial ischemia complicated with reperfusion. The latter promotes elimination of arrythmogenic substances from the ishemic zone leading to electric unstability of the myocardium and fatal arrythmia. Possibility of idiopathic ventricular fibrillation and its mechanisms is discussed.     

Molecular biomarkers in malignant mesothelioma: state of the art

Malignant mesothelioma (MM) is an aggressive tumour affecting the mesothelial surfaces of the pleural and peritoneal cavities and, rarely, the pericardium and the tunica vaginalis testis. Despite a ban of asbestos in many industrialised nations, the present high incidence of MM is expected to continue, due to the long latency period between first asbestos exposure and occurrence of disease, making it an important health issue for the future. The diagnosis of MM can be difficult, both from a clinical and pathological perspective. It is not unusual for patients to undergo several medical investigations without definitive diagnosis early in their course of illness. Understandably, there is intense interest in the discovery of markers that can be assessed in pleural effusions, histological specimens, and serum to assist with the difficult early diagnosis of MM. Considering the primary aetiological role of asbestos, there is theoretically an easily identifiable target population for screening with a biomarker with adequate sensitivity and specificity or with a combination of biomarkers. In this review we focus on biomarkers that have been examined in the setting of either early diagnosis of MM in symptomatic patients or screening of asbestos-exposed individuals.     

The state of the art in joint replacement Part 1

This is the first of three articles in which the present state of joint replacement will be reviewed. The first article is concerned with the historical development and with features common to all joints, such as the materials and manufacturing techniques now used. The second will describe representatives of the designs now used at the various joints which are replaced in clinical practice, and the third will discuss the problems now apparent and the trends in development and practice.     

The state of the art in joint replacement Part 2

This is the second of three articles in which the present state of joint replacement will be reviewed. The first article was concerned with the historical development and with features common to ail joints, such as the materials and manufacturing techniques now used. The second describes representatives of the designs now used at the various joints which are replaced in clinical practice, and the third will discuss the problems now apparent and the trends in development and practice.