Electronic patient record development in Norway: The case for an evolutionary strategy

With the failure of many large-scale “big-bang” projects, combined with the lack of influence associated with many small-scale projects, we need to look for alternative strategies for implementing ICT in healthcare. One such strategy is to focus on the processes that enable successful scaling of locally developed ICT systems and how these gain a foothold in a larger market. In this paper, we contribute with empirical insight into one such scaling process. We illustrate how scale is both connected to a vendor's strategy of maintaining close user contact and influenced by how the authorities choose to organize the healthcare system. Empirically, the study draws on the establishment and growth of the Norwegian company DIPS ASA over a period of nearly 25 years, which today claims the lion's share of the electronic patient records market in Norwegian hospitals.     

Superficial femoral artery recanalization with self-expanding nitinol stents: long-term follow-up results.

PURPOSE: Since long-term patency and device integrity of nitinol stents in SFA lesions are not well studied, we examined clinical outcome, patency and device integrity after stenting long lesions using a standardized implantation technique. METHODS: Between 2001 and 2006, 59 patients (74 lesions) were treated with the same nitinol self-expandable stent (Zilver, Cook, USA) and technique for SFA recanalization. Clinical charts and imaging were retrospectively reviewed for patency (primary and assisted-primary), and device integrity. RESULTS: Patients were 74.5 (10.9) years old (range 49 to 93), 64% male, 42% diabetic, 62% hypertensive and 67% current or former smokers. Lesions were 23% TASC B, 16% TASC C, or 61% TASC D. Mean recanalization length was 19 cm (range 3 to 53). Mean number of stents per patient was 2.8 (total 210). Mean follow-up time was 2.4 years (range 3 days to 4.8 years). Kaplan-Meier estimates for primary patency rates were 90%, 78%, 74%, 69%, and 69% at 1, 2, 3, 4 and 4.8 years, respectively. Ten restenoses at a mean of 500 (388) days (1-1251 days) were successfully recanalized. The assisted primary patency rates were 96%, 90%, 90%, 90% and 90% at 1, 2, 3, 4 and 5 years, respectively. Six complete occlusions could not be reverted by a second recanalization procedure, and were treated by surgical bypass (1 case), amputation (3 cases), or medical management (2 cases). One (1.04%) Class II stent fracture was noted. CONCLUSIONS: SFA recanalization with a standardized implantation technique and nitinol stents provides good long-term primary and assisted-primary patency.     

Controlled Trial of Liquid Monopolar Electrocoagulation in Bleeding Peptic Ulcers

The aim of this study was to evaluate the efficacy and the safety of liquid monopolar electrocoagulation in the endoscopic control of major haemorrhage from peptic ulcers. During the 24-month period of the trial, emergency endoscopy was performed on 480 patients consecutively admitted with acute upper gastrointestinal tract hemorrhage. Ulcers were seen in 168 cases (35%). Seventy-eight of these were included in the trial. Active bleeding was present in 21 cases and stigmata of recent bleeding were observed in 57. Immediate hemostasis was achieved in nine of 11 patients with active bleeding ulcers. However, active bleeding can stop spontaneously (as in four of 10 control patients), which reemphasizes the importance of randomized studies. There was a trend toward hemostatic benefit for the electrocoagulation-treated patients with actively bleeding ulcers. In the group of 31 patients with visible vessels, the electrocoagulation treatment reduced significantly both the rate of rebleeding and the emergency surgery. In the group of 26 patients with other stigmata of recent bleeding (fresh or altered clot, or black spots), only in two cases allocated to placebo treatment occurred rebleeding. These patients are at minimal risk of further bleeding. The results offer support to the contention that liquid monopolar electrocoagulation is a safe and effective method of reducing the incidence of further bleeding and emergency surgery. This new technique has the advantages of low cost, easy maintenance, durability, and portability.     

Treatment of critical defects produced in calvaria of mice with mesenchymal stem cells

Mesenchymal stem cells (MSC) are present in specialized niches in perivascular regions of adult tissues and are able to differentiate into various cell types, such as those committed to repairing. Bone marrow derived MSC from eight young mice C57BL/ 6 gfp+ were expanded in culture for repairing critical defects in calvarial bone produced in twenty-four young isogenic adult C57BL/6 mice. The animals were subjected to a cranial defect of 6.0mm diameter and divided into two equal experimental groups. Control group did not receive any treatment and the treated group received a MSC pellet containing 1.0 x 10(7) cells/mL into the defects. The group treated with MSC showed increased angiogenesis and amount of new bone deposited on the defect limits than that observed in the control group. The results demonstrated that transplantation of bone marrow-derived MSC of C57BL/6 gfp+ mice to bone critical defects produced in mice calvarial contributes positively to the bone repair process. MSC presets ability to influence the correct functioning of osteoblasts, increases the amount of mobilized cells for the repairing process, speeds up growth, and increases deposition of bone matrix.     

Targeting exosites on blood coagulation proteases

The high specificity of blood coagulation proteases has been attributed not only to residues surrounding the active site but also to other surface domains that are involved in recognizing and interacting with macromolecular substrates and inhibitors. Specific blood coagulation inhibitors obtained from exogenous sources such as blood sucking salivary glands and snake venoms have been identified. Some of these inhibitors interact with exosites on coagulation enzymes. Two examples are discussed in this short revision. Bothrojaracin is a snake venom-derived protein that binds to thrombin exosites 1 and 2. Complex formation impairs several exosite-dependent activities of thrombin including fibrinogen cleavage and platelet activation. Bothrojaracin also interacts with proexosite 1 on prothrombin thus decreasing the zymogen activation by the prothrombinase complex (FXa/FVa). Ixolaris is a two Kunitz tick salivary gland inhibitor, that is homologous to tissue factor pathway inhibitor. Recently it was demonstrated that ixolaris binds to heparin-binding exosite of FXa, thus impairing the recognition of prothrombin by the enzyme. In addition, ixolaris interacts with FX possibly through the heparin-binding proexosite. Differently from FX, the ixolaris-FX complex is not recognized as substrate by the intrinsic tenase complex (FIXa/FVIIIa). We conclude that these inhibitors may serve as tools for the study of coagulation exosites as well as prototypes for new anticoagulant drugs.     

Assessment of moisturizers and barrier function restoration using dynamic methods

Background/purpose: Dynamic methods, such as the mathematical modelling of the transepidermal water loss curves that result from a plastic occlusion stress test (POST), enable the complete characterization of the dynamic water balance established between the deep and the superficial skin structures. Previous studies have indicated that this methodology was able to detect impaired barrier function and differentiate normal and dry skin. The objective of the present study is to apply the discriminative capacity of the model to the efficacy testing of moisturizing products.
Methods: A moisturizing cream containing urea was applied for 2 weeks to the lower leg of volunteers with dry skin. After this period, a POST was performed in the treated and control untreated site and a mathematical model was adjusted to the resulting desorption curves.
Results: Results indicate that, after treatment of the skin with the cream for 2 weeks, statistically different kinetic parameters are obtained in the treated site, which suggests an improvement in the water dynamic balance and skin barrier. The data generated by this study was compared with that obtained in a similar investigation that was performed a year earlier. Analysis of the dispersion of results indicates that the method has good reproducibility.
Conclusions: These findings confirm that the method has enough sensitivity to assess in vivo the effect of moisturizers on human skin, and also that this evaluation can be performed in a shorter period than that required by the regression method. This methodology can also be considered more informative, because the analysis of the different parameters obtained by the model is indicative of the mechanism of action of the product applied to the skin.     

Fas分子与肝细胞凋亡

近年来细胞分子生物学领域中的两个重要进展,即细胞凋亡概念的提出和Ｆａｓ分子的分离与鉴定对肝病的研究有重要影响,加深了人们对肝细胞损伤与死亡的认识．１９９３年Ｏｇａｓａｗａｒａｅｔａｌ［１］进行的Ｆａｓ单抗毒性实验证实了Ｆａｓ分子系统在肝细胞凋亡或损伤...     

Modafinil Prevents Inhibitory Avoidance Memory Deficit Induced by Sleep Deprivation in Rats

Study Objectives:

Evaluation of modafinil effects on the inhibitory avoidance task (IA).

Design:

Rats were trained on a multiple trial IA task after receiving modafinil or vehicle injections. In experiment 1 they were trained with a weak protocol under baseline condition and in experiment 2, with a stronger protocol under sleep-deprivation condition.

Results:

In experiment 1 modafinil improved rats'' acquisition whereas the retention test remained unaffected. In Experiment 2 modafinil did not interfere with training performance, but the lower dose prevented the retention impairment in sleep-deprived animals.

Conclusions:

Modafinil is able to improve acquisition in normal rats and reverse the long-term memory impairment induced by sleep-deprivation.

Citation:

Moreira KM; Ferreira TL; Hipolide DC; Fornari RV; Tufik S; Oliveira MGM. Modafinil prevents inhibitory avoidance memory deficit induced by sleep deprivation in rats. SLEEP 2010;33(7):990-993.     

<Emphasis Type="Italic">Helicobacter pylori</Emphasis> Virulence Genotypes in Portuguese Children and Adults with Gastroduodenal Pathology

The aim of this study was to evaluate the prevalence of virulence genotypes, namely cagA, vacA and babA2, of Helicobacter pylori strains isolated from Portuguese adults and children presenting gastroduodenal pathology. One hundred thirty-six strains were studied, 82 isolated from adult patients (50 with nonulcerative gastritis and 32 with active peptic ulcer) and 58 isolated from children (54 with nonulcerative gastritis and 4 with duodenal ulcer). Genotyping of cagA, vacA and babA2 was assessed by polymerase chain reaction. Overall, Helicobacter pylori strains carrying more virulent genotypes were much more prevalent in adults than in children, particularly the type I (vacAs1- and cagA-positive) and the triple-positive (vacAs1-, cagA- and babA2-positive) strains (P<0.001). A subpopulation of adults and children with nonulcerative gastritis was also studied, and differences in the prevalence of virulent genotypes were observed, either for individual genotypes (P=0.017 for cagA, P=0.010 for vacAs1) or in combinations, i.e. the type I genotype (P=0.005) and the triple-positive strains (P=0.031). There was no difference between the two populations in the distribution of babA2 and m1/m2 genotypes. Considering the cohort effect in the epidemiology of Helicobacter pylori infection, these results suggest that different strains might circulate during different periods of time, or that, after infection in childhood, individual strains will undergo changes during the course of infection. Electronic Publication     

Factors associated with leisure-time physical activity among patients undergoing hemodialysis

Intermedin (IMD) is a novel member of the calcitonin/calcitonin gene-related peptide family. Endoplasmic reticulum stress (ERS) has been implicated in the pathology of renal ischemia/reperfusion (IRI). In the present study, we investigated whether IMD could reduce ERS damage after renal ischemia. The kidneys of SD rats were subjected to 45 min of warm ischemia followed by 24 h of reperfusion. The hypoxia/reoxygenation(H/R) model in NRK-52E cells consisted of hypoxia for 1 h and reoxygenation for 2 h. IMD was over-expressed in vivo and in vitro using the vector pcDNA3.1-IMD. The serum creatinine concentration and lactate dehydrogenase (LDH) activity in the plasma were determined. Histologic examinations of renal tissues were performed with PAS staining. Real-time PCR and Western blotting were used to determine the mRNA and protein levels, respectively. Additionally, ER staining was used to detect the ERS response. In the rat renal IRI model, we found that IMD gene transfer markedly improved renal function and pathology and decreased LDH activity and cell apoptosis compared with the kidneys that were transfected with the control plasmid. IMD significantly attenuated the ERS stress parameters compared with IRI group. Indeed, IMD down-regulated glucose-regulated protein 78 (GRP78), C/EBP homologous protein(CHOP), and caspase 12 protein and mRNA levels. Moreover, in the NRK-52E cell H/R model, IMD overexpression prevented the apoptosis induced by H/R. Furthermore, IMD ameliorated the ER structural changes and concomitantly decreased the levels of GRP78, CHOP and caspase-12. This study revealed that IMD protects against renal IRI by suppressing ERS and ERS-related apoptosis.