Epidemic of health care reforms

An epidemic of health care reforms is spreading through the world. The basic reason behind the epidemic is the concept of these reforms. Namely, at the time in which Modernity (the main context of mechanicism) has worn out its potentials, they are based on the principles of mechanistic paradigm. Epidemic could fade away if health care reformers would abandon their role of engeneers and turn to catalist role. In that role they could work on reforms which would rely on priciples of evolution. The first result of this reform orientation would be creation of the germ of pluralistic health care systems.     

History of surgical treatment of atherosclerosis of the coronary arteries--the first 100 years

Atherosclerotic coronary artery disease is the most common cause of morbidity and mortality. The incidence of cardiovascular morbidity and mortality has been doubled in our country during the period 1980 through 1996. Surgical treatment of the atherosclerotic coronary artery disease is already a century old, ever since Francois-Franck (in 1899) tried to achieve sympathetic denervation of the cervical ganglion. After the interim period of indirect myocardial revascularization, during the last 30 years, direct surgical revascularization has reached excellent early and long-term results, and became one of the most frequently performed procedures in the surgical practice. Use of arterial grafts and, introduced recently, procedures on the beating heart, minimally invasive procedures and, so called, port-access procedures became a daily routine in many centers. Surgical revascularization of the ischaemic cardiac muscle is the rapidly changing entity, along with diagnostic, technical and other improvements. We present a brief historical overview of the efforts of cardiac surgeons to combat the "disease of the century" atherosclerotic coronary artery disease.     

Clinical significance of understanding lateral and medial circumflex femoral artery origin variability

The common femoral artery (CFA) divides into the superficial femoral artery (SFA) and deep femoral artery (DFA). The lateral circumflex femoral artery (LCFA) and medial circumflex femoral artery (MCFA) are most often branches of the DFA, although a large number of different variations in their origin has been described. We performed microdissection on both lower limbs of 30 fetuses, gestational age from 7 to 10 lunar months. Our results show that the LCFA and MCFA usually arise from the DFA. In 78.3% of cases, the MCFA originated from the DFA. In 11.7% of cases, the MCFA originated from the CFA, and in 5% of cases from the SFA. One case showed a common trunk with the DFA. Also, the MCFA was missing in one case, and it had a common trunk with the LCFA in one case. In 83.3% of cases, the LCFA arose from the DFA and in 6.7% of cases from the CFA. In one case, it had a common trunk with the DFA, and in one case with the MCFA. In 3.3% of cases, the LCFA was missing. In 66.7% of cases, both arteries originated from the DFA, in 15% of cases one originated from the DFA and the other from the CFA or SFA. Our results are in accordance with some published studies but also differ from the outcomes of other studies. Comprehensive knowledge of different variation types is imperative in order to prevent complications during surgical and orthopedic interventions.     

A Potent Inhibitor of the Cystic Fibrosis Transmembrane Conductance Regulator Blocks Disease and Morbidity Due to Toxigenic Vibrio cholerae

Vibrio cholerae uses cholera toxin (CT) to cause cholera, a severe diarrheal disease in humans that can lead to death within hours of the onset of symptoms. The catalytic activity of CT in target epithelial cells increases cellular levels of 3′,5′-cyclic AMP (cAMP), leading to the activation of the cystic fibrosis transmembrane conductance regulator (CFTR), an apical ion channel that transports chloride out of epithelial cells, resulting in an electrolyte imbalance in the intestinal lumen and massive water loss. Here we report that when administered perorally, benzopyrimido-pyrrolo-oxazinedione, (R)-BPO-27), a potent small molecule inhibitor of CFTR, blocked disease symptoms in a mouse model for acute diarrhea caused by toxigenic V. cholerae. We show that both (R)-BPO-27 and its racemic mixture, (R/S)-BPO-27, are able to protect mice from CT-dependent diarrheal disease and death. Furthermore, we show that, consistent with the ability of the compound to block the secretory diarrhea induced by CT, BPO-27 has a measurable effect on suppressing the gut replication and survival of V. cholerae, including a 2010 isolate from Haiti that is representative of the most predominant ‘variant strains’ that are causing epidemic and pandemic cholera worldwide. Our results suggest that BPO-27 should advance to human Phase I studies that could further address its safety and efficacy as therapeutic or preventative drug intervention for diarrheal syndromes, including cholera, that are mediated by CFTR channel activation.     

A comparative assessment of the potential of polysaccharide production and intracellular sugar composition within Lingzhi or Reishi medicinal mushroom, Ganoderma lucidum (W.Curt.:Fr.)P. Karst. (Aphyllophoromycetideae)

Ganoderma lucidum is a well-known medicinal mushroom species in which polysaccharides are one of the major sources of biological activity. The species was considered as a species-complex due to significant variations in morphological, biochemical, and genetic features among populations with a worldwide distribution. This fact was the basis for setting the aim of this research: to study intraspecific diversity in polysaccharide production and intracellular sugar composition among selected G. lucidum strains. The presence ofintraspecific diversity among 10 G. lucidum strains, from different areas worldwide, was noted. Values of produced mycelia biomass and intracellular polysaccharides were found in wide ranges (3.1 - 28.2 g L(-1) and 20.0 - 53.3 mg g(-1), respectively), while differences in extracellular polysaccharide amounts were minor (0.2 - 1.5 mg mL(-1)). The significant quantitative and qualitative differences in intracellular sugar composition were noted. Glucose was the predominant sugar in almost all strains except one (HAI 447), where sucrose was dominant. The potential of polysaccharide production and intracellular sugar composition could be one more taxonomic criterion for strain characterization within G. lucidum. The differences in intracellular sugar composition and proportions could be reflected in features of produced polysaccharides and also in their biological activities.     

The antipsychotic aripiprazole is a potent,partial agonist at the human 5-HT1A receptor

Aripiprazole, 7-[4-[4-(2,3-dichlorophenyl)-1-piperazinyl]butyloxy]-3,4-dihydro-2(1H)-quinolinone, a novel antipsychotic with partial agonist activity at dopamine D2 receptors, bound with high affinity to recombinant human 5-HT(1A) receptors (h5-HT(1A)) in Chinese hamster ovary cell membranes and displayed potent, partial agonism at 5-HT(1A) receptors in a guanosine-5'-O-(3-[(35)S]thio)-triphosphate ([(35)S]GTP gamma S)-binding assay that was blocked completely by a selective 5-HT(1A) receptor antagonist. An interaction with 5-HT(1A) receptors may contribute to the overall efficacy of aripiprazole against symptoms of schizophrenia, including anxiety, depression, cognitive and negative symptoms, and to its favorable side-effect profile. Combined with previous studies demonstrating the potent partial agonism of aripiprazole at dopamine D2 receptors, this study suggests aripiprazole is the first dopamine-serotonin system stabilizer.     

The management of nonconformities in blood establishments

With the introduction of quality management system as either a voluntary activity or based on legal regulation, a transfusion establishment is committed to consistent use of nonconformity management in all its activities. Nonconformities are mostly detected in blood products, in all steps of the manufacturing process. A product in broad sense also refers to the services offered. Nonconformities may be found in input materials, devices and equipment as well. Efficient management of these nonconformities is one of the key elements of the materiovigilance system. A special category are the nonconformities that need not be identified directly in the products, materials or equipment, but their occurrence may have adverse effects on the product and service quality, safety of those involved in the transfusion chain, user confidence, or transfusion establishment economy. Nonconformities may be detected in regular work process, or during internal and external quality assessment, inspections, evaluation of the quality system by the managing board, management of complaints, etc. Each blood establishment should have written procedure describing nonconformity management, while the personnel should undergo continuous education on all aspects of this segment of quality management. Along with making proper decision on the nonconforming product/nonconformity, in the procedure of nonconformity management it is of great importance to assess the potential impact of this nonconformity on other products or processes, and to prevent the possible additional damage on time. As the management of nonconformities has a critical role for the quality and safety of transfusion treatment and is involved in all transfusion service activities, it is no surprise that an array of quality indicators that serve as a basis for corrective measures and continuous quality improvement derive from this segment of quality management.     

Quality indicators: a tool for quality monitoring and improvement

Quality indicators are one of the quality management system (QMS) tools to monitor and control efficiency of the system key segments, while the results collected serve as a basis for implementation of corrective measures and continuous quality improvement. There are several classifications of quality indicators. According to the objectives of their establishment and utilization, they can be internal and external. In line with the tripartite quality model, quality indicators can be classified as structural indicators, process indicators and outcome indicators. Quality indicators should ideally possess a number of attributes. Besides objectivity (measurability), the most common requirements are as follows: importance and potential for use, reliability and validity. Quality indicators offer the possibility of fast and simple insight into the level of product and service quality and their pattern over time to the interested parties within and outside the institution. Although quality management has long been recognized as being of utmost importance in transfusion medicine, quality indicators as a QMS tool did not receive due attention until recently. Implementation of quality indicators is a complex process which requires scientific approach as well as testing and verification before routine usage. Quality indicators are defined on the basis of scientific concepts, own experiences, results of literature searches, discussion with experts within and outside the institution, etc. On setting quality indicators, the numerator and denominator should first be strictly defined. Quality indicators should be monitored continuously, including trend monitoring and detection of deviations. Whenever considered necessary, appropriate corrective measures have to be undertaken.