Uroscopy in the 21st century: high-field NMR spectroscopy

From the experiments described, it can be seen that there are different research approaches that can be taken and these are summarized in Table 1. Whereas much scientific research is principally hypothesis led, there remains, nevertheless, an important place for exploratory research. High resolution NMR can measure, directly and simultaneously, a wide range of endogenous metabolites in biological fluids and has the unique capability of providing structural information on the metabolites detected. It has proved to be a powerful research tool with which to study inherited metabolic diseases, renal disease, drug metabolism, and toxicity, and can be used to monitor the effects of drug therapy. For instance, by using a library of experimental toxins one can map the metabolic profile of site-specific nephron injury. With this approach in man one could eventually take an unknown disease such as Balkan nephropathy and predict the initial site of tubular injury, the mode of injury and therefore the kind of toxin capable of producing that injury. NMR spectroscopic techniques are still advancing rapidly, with ever increasing sensitivity and sophistication of NMR pulse sequences to enhance structural elucidation in complex mixtures. Given the advances in directly coupled HPLC-NMR and even HPLC-NMR-mass spectroscopy it is likely that these technologies in conjunction with pattern recognition will make major contribution to our understanding of renal processes and provide new diagnostic insights in the 21st century.      

Decision support in psychiatry – a comparison between the diagnostic outcomes using a computerized decision support system versus manual diagnosis

Background  

Correct diagnosis in psychiatry may be improved by novel diagnostic procedures. Computerized Decision Support Systems (CDSS) are suggested to be able to improve diagnostic procedures, but some studies indicate possible problems. Therefore, it could be important to investigate CDSS systems with regard to their feasibility to improve diagnostic procedures as well as to save time.     

Immunohistochemical and ultrastructural analysis of a mammary cystic hypersecretory carcinoma

Cystic hypersecretory carcinoma (CHC) is a rare variant of intraductal carcinoma. A CHC in a 50-year-old woman was excised and processed for light and electron microscopy and immunohistochemistry. The tumor had a marked cystic appearance. The walls of the cysts consisted of epithelial and myoepithelial cells and a well-developed basement membrane. The epithelial cells contained well-developed rough-surfaced endoplasmatic reticulum and Golgi apparatus. Secretory granules were not detected, with the exception of a few mucus-producing cells. The secretion was predominantly homogenous, reminiscent of thyroid colloid, and demonstrated distinct PAS positivity. The cells displayed a strong labeling with epithelial membrane antigen (EMA) and EMA-positive structures were observed within the intraluminal secretion, too. Some of these were stained by alcian blue. In addition, the colloid-like material was admixed with mucus showing a filamentous internal structure and lipid droplets resulting in some heterogenity of the secretion. Intraductal micropapillary proliferation in some of the cysts and adjacent nondistended ducts was a further defining feature of the tumor. Steroid hormone receptor and Ki-67 proliferation marker immuno his Tochemistry showed scattered positivity among the tumor cells. These results are in agreement with previous observations and further clarify the nature of this low-grade in situ cancer.     

Impact of minimal injuries on a level I trauma center.

Overtriage (i.e.; transport of patients with minimal injuries to a trauma center) has been accepted as necessary to avoid missing clinically significant injuries. We reviewed our experience with 344 patients (ISS less than or equal to 4) who were admitted to a level I trauma center during a 2-year period. The trauma team was activated for 209 patients (TA), and emergency department referrals accounted for 135 (ED). One hundred seventy-three patients (TA = 64%, ED = 36%) met American College of Surgeons' Committee on Trauma (ACSCOT) field triage criteria (FTC). Mechanism of injury, especially ejection from a motor vehicle, was the most frequently utilized FTC indicator. We found no differences between the TA and ED groups relative to Trauma Score, Glasgow Coma Scale score, Injury Severity Score, length of stay, or ICU days. Mean total costs were higher for the TA group than for the ED group. The TA group had a higher nursing acuity level than the ED group. Compliance with FTC yields an inherent overtriage of minimally injured patients; however, noncompliance with FTC compounds the overtriage rate. Failure to comply with FTC is costly, labor intensive, and may represent misuse of the trauma system. We propose continual re-education of prehospital personnel, increased responsibility of all hospitals in the trauma center catchment area, and protocols for "downstaging" trauma resuscitation in minimally injured patients.     

A study of recovery in trauma patients.

Although the majority of trauma patients are discharged home rather than to a rehabilitation facility, the timeliness of their return to function (RTF) has received little study. The present prospective study attempted to identify those factors that would predict delayed RTF. The study group consisted of patients admitted to a level I trauma center for at least 24 hours, who were of working age (18-64 years), who passed a cognitive screening examination, and who were discharged home. Demographic data and psychological profiles were collected on all participants. Patients were followed by telephone at approximately 1 1/2, 3, and 6 months after discharge. Five hundred seventy patients were entered into the study; complete follow-up data were available for 441. Statistical methods were modeled after survival analysis using a proportional hazards multiple regression to identify variables prognostic of RTF time. This type analysis is independent of time, providing a "risk" of RTF at any point in time after the injury. It also allowed the calculation a relative hazards ratio (RHR), which quantifies the impact of a prognostic variable on RTF time. Injury Severity Score (ISS) and age were found to be associated with RTF (p < 0.0001 for each). After correcting for ISS and age, five additional factors were found to be associated with RTF. Higher educational level and living in a non-family household were associated with faster RTF. Less than 100% income replacement by disability income, pre-injury hostility, and litigation related to the injury were associated with slower RTF. There were a number of other demographic, work-related, and psychosocial factors that were not related with RTF.(ABSTRACT TRUNCATED AT 250 WORDS)     

Protective effect of flavonoids against red blood cell hemolysis by free radicals

BACKGROUND:

Flavonoids are polyphenolic substances with antioxidant properties, and they are found in different vegetables and fruits. Epidemiological studies have shown that the consumption of flavonoids reduces the prevalence of cardiovascular diseases. The use of synthetic antioxidants, however, has been limited because of their toxicity. Therefore, medical researchers have intensified their quest to find natural antioxidants.

OBJECTIVES:

To investigate the effect of several pure flavonoids, such as kaempferol, quercetin, morin and rutin, on red blood cell hemolysis and evaluate their -SH capacity as an indicator of membrane protection.

METHODS:

The rate of hemolysis and cell membrane -SH capacity were determined by spectrophotometry. Red blood cell peroxidation was induced using 2,2′-azo-bis-(2-amidinopropane) dihydrochloride. The effect of each flavonoid on hemolysis was examined at three concentrations (0.5 μg/mL, 5 μg/mL and 10 μg/mL), however, only the greatest concentration (10 μg/mL) of each flavonoid was used to study the effect on -SH groups.

RESULTS:

In all cases, the antioxidant activity was dose-dependent. Rutin showed the highest inhibitory effect on hemolysis among flavonoids (42.5%). The protective effect of kaempferol, rutin and morin against -SH group oxidation measured 7.7%, 23.3% and 26.4%, respectively.

CONCLUSIONS:

Results showed that flavonoids and flavonoid-containing plants can be used as natural antioxidants for the treatment and prevention of disease conditions, the pathogenesis of which is mediated by lipid peroxidation.     

Maternal predictors of fetal demise in trauma during pregnancy

Trauma complicates 6 to 7 per cent of all pregnancies, but fetal demise secondary to maternal trauma occurs much less frequently. This study was done to analyze the incidence of fetal demise as a function of 21 maternal characteristics determined within the first 24 hours after trauma. Nine instances of fetal demise were identified from 73 pregnant patients with trauma admitted to four Level I trauma centers from a combined data base of 30,000 patients. Maternal factors examined by logistic regression were Injury Severity Score (ISS), Trauma Score (TS), Abbreviated Injury Scale (AIS), fluid requirements in the initial 24 hours, systolic blood pressure (SBP), heart rate (HR), hemoglobin, hematocrit and arterial blood gas analysis. Fetal demise was found to be associated with increasing ISS, increasing face and abdominal AIS, increasing fluid requirements, maternal acidosis and maternal hypoxia. Standard maternal laboratory and physiologic parameters, such as hemoglobin and hematocrit, oxygen and hemoglobin saturation, partial pressure of carbon dioxide, SBP and HR were not predictive. The TS was also found to be nonpredictive.     

Validation of new trauma triage rules for trauma attending response to the emergency department

INTRODUCTION: The American College of Surgeons Committee on Trauma has suggested triage criteria for the immediate attendance of a trauma surgeon to an injured patient in the emergency department. This study validates the accuracy of these criteria in identifying high-risk trauma patients and assesses the impact of trauma surgeon response time. METHODS: A study group of trauma patients with a systolic blood pressure (SBP) < 90 mm Hg, Glasgow Coma Scale (GCS) score < 8, airway compromise managed with endotracheal intubation (ETI) or surgical airway, or gunshot wound (GSW) to the neck or torso were compared with a control group of patients meeting none of these criteria. Outcome measurements included Injury Severity Score (ISS), duration of hospitalization (length of stay [LOS]), intensive care unit (ICU) days, direct transfer to the ICU or operating room, and mortality. For the study group, trauma surgeon response times, < or = 15 minutes and > 15 minutes, were compared for age, ISS, LOS, ICU days, mortality, and direct transfer to the ICU or operating room. Statistical analysis was performed using the t test and the Yates-corrected chi(2) test (p < 0.05), with odds ratios calculated on the basis of trauma activation criteria and outcome measures. Multiple logistic regression was used to assess the relation between the independent variables SBP, GCS, ETI, and GSW with direct transfer to the ICU or operating room and mortality. RESULTS: A total of 4,910 patients were identified, including 791 study group patients. The mean ISS, LOS, ICU days, and mortality were significantly higher in the study group (p < 0.01). Odds ratios of the study group for direct transfer to the ICU or operating room were 91 and 2 for ETI, 23 and 1.4 for GCS score < 8, 8 and 2.2 for GSW, and 7 and 1.6 for SBP < 90 mm Hg, respectively. The odds ratios for mortality were 39 for ETI, 104 for GCS score < 8, 12 for GSW, and 74 for SBP < 90 mm Hg. Regression analysis demonstrated that GSW, SBP < 90 mm Hg, and ETI predicted ICU admission; GSW, SBP < 90 mm Hg, and ETI predicted operative intervention; and GCS score < 8, SBP < 90 mm Hg, and ETI were associated with mortality. Trauma surgeon response times were available for 658 (83%) of the study group patients. No significant differences were found between the two response groups. CONCLUSION: Trauma patients meeting the triage criteria proposed by the American College of Surgeons Committee on Trauma have more severe injuries, a higher mortality rate, and longer hospital and ICU stays than control patients. SBP < 90 mm Hg, ETI, and GSW are predictive of urgent operating room use and ICU admission. A significantly higher mortality rate is associated with SBP < 90 mm Hg, ETI, and GCS score < 8. Incorporating these criteria into trauma center triage rules to identify high-risk injured patients is warranted. However, trauma surgeon response time < or = 15 minutes was not associated with improved patient outcome, and optimal response time remains uncertain.     

Outcome of major cardiac injuries at a Canadian trauma center

Background  

Canadian trauma units have relatively little experience with major cardiac trauma (disruption of a cardiac chamber) so injury outcome may not be comparable to that reported from other countries. We compared our outcomes to those of other centers.