Minimally invasive surgery. Future developments.

The rapid development of minimally invasive surgery means that there will be fundamental changes in interventional treatment. Technological advances will allow new minimally invasive procedures to be developed. Application of robotics will allow some procedures to be done automatically, and coupling of slave robotic instruments with virtual reality images will allow surgeons to perform operations by remote control. Miniature motors and instruments designed by microengineering could be introduced into body cavities to perform operations that are currently impossible. New materials will allow changes in instrument construction, such as use of memory metals to make heat activated scissors or forceps. With the reduced trauma associated with minimally invasive surgery, fewer operations will require long hospital stays. Traditional surgical wards will become largely redundant, and hospitals will need to cope with increased through-put of patients. Operating theatres will have to be equipped with complex high technology equipment, and hospital staff will need to be trained to manage it. Conventional nursing care will be carried out more in the community. Many traditional specialties will be merged, and surgical training will need fundamental revision to ensure that surgeons are competent to carry out the new procedures.     

Reducing salt intake for prevention of cardiovascular diseases in high-risk patients by advanced health education intervention (RESIP-CVD study), Northern Thailand: study protocol for a cluster randomized trial

ABSTRACT: BACKGROUND: Decreasing salt consumption can prevent cardiovascular diseases (CVD). Practically, it is difficult to promote people's awareness of daily salt intake and to change their eating habits in terms of reducing salt intake for better cardiovascular health. Health education programs visualizing daily dietary salt content and intake may promote lifestyle changes in patients at high risk of cardiovascular disease. METHODS: This is a cluster randomized trial. A total of 800 high-CVD-risk patients attending diabetes and hypertension clinics at health centers in Muang District, Chiang Rai province, Thailand, will be studied with informed consent. A health center recruiting 100 participants is a cluster, the unit of randomization. Eight clusters will be randomized into intervention and control arms and followed up for 1 year. Within the intervention clusters the following will be undertaken: (1) salt content in the daily diet will be measured and shown to study participants; (2) 24-hour salt intake will be estimated in overnight-collected urine and the results shown to the participants; (3) a dietician will assist small group health education classes in cooking meals with less salt. The primary outcome is blood pressure change at the 1-year follow-up. Secondary outcomes at the 1-year follow-up are estimated 24-hoursalt intake, incidence of CVD events and CVD death. The intention-to-treat analysis will be followed.Blood pressure and estimated 24-hour salt intake will be compared between intervention and control groups at the cluster and individual level at the 1-year follow-up. Clinical CVD events and deaths will be analyzed by time-event analysis. Retinal blood vessel calibers of CVD-risk patients will be assessed cross-sectionally. Behavioral change to reduce salt intake and the influencing factors will be determined by structured equation model (SEM). Multilevel regression analyses will be applied. Finally, the cost effectiveness of the intervention will be analyzed. DISCUSSION: This study is unique as it will recruit the individuals most vulnerable to CVD morbidity and mortality by applying the general Framingham CVD risk scoring system. Dietary salt reduction will be applied as a prioritized, community level intervention for the prevention of CVD in a developing country.Trial registrationISRCTN39416277.     

The biosynthesis of biologically active proteins in mRNA-microinjected Xenopus oocytes

The basic properties of mRNA-injected Xenopus oocytes as a heterologous system for the production of biologically active proteins will be reviewed. The advantages and limitations involved in the use of this in ovo system will be discussed, as compared with in vitro cell-free translation systems and with in vivo microinjected mammalian cells in culture. The different assay systems that have been utilized for the identification of the biological properties of oocyte-produced proteins will be described. This section will review the determination of properties such as binding of natural ligands, like heme or alpha-bungarotoxin; immunological recognition by antibodies; subcellular compartmentalization and/or secretion; various enzymatic catalytic activities; and induction in ovo of biological activities that affect other living cells in culture, such as those of interferon and of the T-cell receptor. The limitations involved in interpretation of results obtained using mRNA-injected oocytes will be critically reviewed. Special attention will be given to the effect of oocyte proteases and of changes in the endogenous translation rate on quantitative measurements of oocyte-produced proteins. In addition, the validity of the various measurement techniques will be evaluated. The various uses of bioassays of proteins produced in mRNA-injected Xenopus oocytes throughout the last decade will be reviewed. Nuclear and cytoplasmic injections, mRNA and protein turnover measurements and abundance calculations, and the use of in ovo bioassays for molecular cloning experiments will be discussed in this section. Finally, potential future uses of the oocyte system in various fields of research, such as immunology, neurobiology, and cell biology will be suggested.     

G-Band Position Effects on Meiotic Synapsis and Crossing over

An examination of synaptic data from a series of X-autosome translocations and crossover data from an extensive series of autosome-autosome translocations and autosomal inversions in mice has lead to the development of a hypothesis which predicts synaptic and recombinational behavior of chromosomal aberrations during meiosis. This hypothesis predicts that in heterozygotes for chromosomal rearrangements that meiotically align G-light chromatin with G-light chromatin lack of homology will be recognized. If homologous synapsis cannot proceed, synaptonemal complex formation will cease and there will be no physical suppression of crossing over in such rearrangements. However, if a chromosomal rearrangement aligns G-light chromatin with G-dark chromatin at the time of synapsis, lack of homology will not be recognized and synaptonemal complex formation will proceed nonhomologously through the G-dark chromatin. Crossing over will be physically suppressed in this region and this suppression of crossing over will be confined to the chromosome in which the G-light chromatin is nonhomologously synapsed with G-dark chromatin. When G-light chromatin is once again aligned with G-light chromatin, lack of homology again will be recognized and either homologous synapsis will be reinitiated (as in an inversion loop), or will cease altogether (as in some translocations). Unlike the previously described "synaptic adjustment", this nonhomologous synapsis of G-light with G-dark chromatin appears to compete with homologous synapsis during early pachynema.     

Protein translocation across and integration into membranes

This review concentrates mainly on the translocation of proteins across the endoplasmic reticulum membrane and cytoplasmic membrane in bacteria. It will start with a short historical review and will pinpoint the crucial questions in the field. Special emphasis will be given to the present knowledge on the molecular details of the first steps, i.e., on the function of the signal recognition particle and its receptor. The knowledge on the signal peptidase and the ribosome receptor(s) will also be summarized. The various models for the translocation of proteins across and the integration of proteins into membranes will be critically discussed. In particular, the function of signal, stop-transfer, and insertion sequences will be dealt with and molecular differences discussed. The cotranslational mode of membrane transfer will be compared with the post-translational transport found for mitochondria and chloroplasts. This review will conclude with open questions and an outlook.     

Monitoring of neuromuscular function in the clinical setting.

This paper will review the basics of neurostimulation in the perioperative period. Following a brief overview of neuromuscular physiology, the mechanism of action of depolarizing and non-depolarizing relaxants will be discussed. The principles of neurostimulation will then be applied clinically when different patterns of stimulation (single twitch, train-of-four, post-tetanic twitch count, double burst) are described. Clinical assessment of neuromuscular function will then be compared with both subjective and objective means of assessment of adequacy of intraoperative relaxation and postoperative reversal. The principles reviewed in this paper will then be applied in the clinical setting, and risks and benefits associated with perioperative use of muscle relaxants will be discussed.     

The essential characteristics of a rating system

The principles of the Tanner-Whitehouse-Healy system for assessing skeletal maturity will be described and in particular the statistical basis for the scores given to each stage of each bone in the hand and wrist. The uses of the system, particularly in clinical cases, will be discussed together with reliability of the ratings. A revised system will be presented in which a part of the stages are amalgamated and the possibility of dropping some of the bones will be discussed. General discussion will be invited on the logical basis for selecting certain stages of certain bones as superior to others as assessors of maturity.     

Testosterone control of male courtship in birds

A sequence of behaviours which we call courtship initiates reproduction in a large number of species. In vertebrates, as a component of male sexual behaviour courtship is strongly influenced by testicular androgen. Here I will review some salient issues about the regulation of courtship by testosterone in birds. The first section will briefly summarize the first 100 years of research on this topic. The specific role of testosterone or its oestrogenic metabolites in the control of different components of courtship will be the subject of the second section. Then, I will discuss how behavioural patterns can be recruited into courtship and modified in their structure by testosterone action. In the following section, the role of sexual selection and female choice in shaping the link between testosterone and courtship will be addressed. The problematic nature of the quantitative relationships between testosterone and behaviour will be topic of the fifth section. Finally, I will discuss how courtship traits that are activated by testosterone can be apparently independent of hormone blood concentrations. These issues will be examined in an evolutionary perspective, in an attempt to understand how natural and sexual selection have shaped the links between the hormone and the behaviour.     

Dual antiplatelet therapy in patients with aspirin resistance following coronary artery bypass grafting: study protocol for a randomized controlled trial [NCT01159639

ABSTRACT: BACKGROUND: Coronary artery disease remains the dominant cause of mortality in developed countries. While platelets have been recognized to play a pivotal role in atherothrombosis, the ideal antiplatelet regime after coronary artery surgery remains elusive.The evolution of CABG has presently moved beyond technical improvements to involve modulation of pharmacologic management designed to improve patient outcomes. The aim of this trial will be to test the hypothesis that the addition of clopidogrel to patients with documented postoperative aspirin resistance will reduce the incidence of major cardiovascular events. METHODS: Patients scheduled for isolated coronary artery surgery will be eligible for the study. Patients in whom postoperative multiple electrode aggregometry documents aspirin resistance will be randomized into two groups. The control group will receive 300 mg of aspirin. The dual antiplatelet group will receive 75 mg of clopidogrel in addition to 300 mg of aspirin. Patients will be followed for 6 months. Major adverse cardiac and cerebrovascular events (death from any cause, myocardial infarction, stroke, hospitalization due to cardiovascular pathology) as well as bleeding events will be recorded. DISCUSSION: This will be the first trial that will specifically address the issue of dual antiplatelet therapy in patients undergoing coronary artery surgery who have been found to be aspirin resistant. In the event that the addition of clopidogrel proves to be beneficial in this subset of surgical patients, this study could significantly impact their future antiplatelet management.This randomized controlled trial has been registered at the ClinicalTrials.gov website (Identifier NCT01159639).     

Thin filament proteins and thin filament-linked regulation of vertebrate muscle contraction

Recent developments in the field of myofibrillar proteins will be reviewed. Consideration will be given to the proteins that participate in the contractile process itself as well as to those involved in Ca-dependent regulation of striated (skeletal and cardiac) and smooth muscle. The relation of protein structure to function will be emphasized and the relation of various physiologically and histochemically defined fiber types to the proteins found in them will be discussed.     

Predictive modelling—or is it?

The Editors of Letters in Applied Microbiology will, at their discretion, publish invited and submitted 'Opinions' on subjects in the general area of Applied Microbiology. They will not be subjected to the normal refereeing procedures and reprints will not be provided. The 'Opinions' will not necessarily represent the views of the Society for Applied Bacteriology or of the Editors. The Editors may invite or readers may submit 'Responses' to published 'Opinions' provided that they are not merely polemics, and these will also be published at the discretion of the Editors. 'Responses' will be treated precisely like 'Opinions' . They should clearly indicate, in their first sentence, the 'Opinions' to which they are a response.     

Salmonella control in poultry: the need for the satisfactory evaluation of probiotics for this purpose

The Editors of Letters in Applied Microbiology will, at their discretion, publish invited and submitted 'Opinions' on subjects in the general area of Applied Microbiology. They will not be subjected to the normal refereeing procedures and reprints will not be provided. The 'Opinions' will not necessarily represent the views of the Society for Applied Bacteriology or of the Editors. The Editors may invite or readers may submit 'Responses' to published 'Opinions' , provided that they are not merely polemics, and these will also be published at the discretion of the Editors. 'Responses' will be treated precisely like 'Opinions' . They should clearly indicate, in their first sentence, the 'Opinion' to which they are a response.     

Gene transfer in staphylococci: stimulation and suppression by antibacterial agents

The Editors of Letters in Applied Microbiology will, at their discretion, publish invited and submitted 'Opinions' on subjects in the general area of Applied Microbiology. They will not be subjected to the normal refereeing procedures and reprints will not be provided. The 'Opinions' will not necessarily represent the views of the Society for Applied Bacteriology or of the Editors. The Editors may invite or readers may submit 'Responses' to published 'Opinions' , provided that they are not merely polemics, and these will also be published at the discretion of the Editors. 'Responses' will be treated precisely like 'Opinions' . They should clearly indicate, in their first sentence, the 'Opinion' to which they are a response.     

The investigation of food poisoning

The Editors of Letters in Applied Microbiology will, at their discretion, publish invited and submitted 'Opinions' on subjects in the general area of Applied Microbiology. They will not be subjected to the normal refereeing procedures and reprints will not be provided. The 'Opinions' will not necessarily represent the views of the Society for Applied Bacteriology or of the Editors. The Editors may invite or readers may submit 'Responses' to published 'Opinions' , provided that they are not merely polemics, and these will also be published at the discretion of the Editors. 'Responses' will be treated precisely like 'Opinions'. They should clearly indicate, in their first sentence, the 'Opinion' to which they are a response.     

Opinion

The Editors of Letters in Applied Microbiology will, at their discretion, publish invited and submitted 'Opinions' on subjects in the general area of Applied Microbiology. They will not be subjected to the normal refereeing procedures and reprints will not be provided. The 'Opinions' will not necessarily represent the views of the Society for Applied Bacteriology or of the Editors. The Editors may invite or readers may submit 'Responses' to published 'Opinions' , provided that they are not merely polemics, and these will also be published at the discretion of the Editors. 'Responses' will be treated precisely like 'Opinions'. They should clearly indicate, in their first sentence, the 'Opinion' to which they are a response.     

Experience of the use of probiotics for Salmonellae control in poultry

The Editors of Letters in Applied Microbiology will, at their discretion, publish invited and submitted 'Opinions' on subjects in the general area of Applied Microbiology. They will not be subjected to the normal refereeing procedures and reprints will not be provided. The 'Opinions' will not necessarily represent the views of the Society of Applied Bacteriology or of the Editors. The Editors may invite or readers may submit 'Responses' to published 'Opinions' , provided that they are not merely polemics, and these will also be published at the discretion of the Editors. 'Responses' will be treated precisely like 'Opinions' . They should clearly indicate, in their first sentence, the 'Opinion' to which they are a response.     

Opinion

The Editors of Letters in Applied Microbiology will, at their discretion, publish invited and submitted 'Opinions' on subjects in the general area of Applied Microbiology. They will not be subjected to the normal refereeing procedures and reprints will not be provided. The 'Opinions' will not necessarily represent the views of the Society for Applied Bacteriology or of the Editors. The Editors may invite or readers may submit 'Responses' to published 'Opinions' , provided that they are not merely polemics, and these will also be published at the discretion of the Editors. 'Responses' will be treated precisely like 'Opinions' . They should clearly indicate, in their first sentence, the 'Opinion' to which they are a response.     

Opinion

The Editors of Letters in Applied Microbiology will, at their discretion, publish invited and submitted 'Opinions' on subjects in the general area of Applied Microbiology. They will not be subjected to the normal refereeing procedures and reprints will not be provided. The 'Opinions' will not necessarily represent the views of the Society for Applied Bacteriology or of the Editors. The Editors may invite or readers may submit 'Responses' to published 'Opinions' , provided that they are not merely polemics, and these will also be published at the discretion of the Editors. 'Responses' will be treated precisely like 'Opinions'. They should clearly indicate, in their first sentence, the 'Opinion' to which they are a response.     

Predictive modelling

The Editors of Letters in Applied Microbiology will, at their discretion, publish invited and submitted 'Opinions' on subjects in the general area of Applied Microbiology. They will not be subjected to the normal refereeing procedures and reprints will not be provided. The 'Opinions' will not necessarily represent the views of the Society for Applied Bacteriology or of the Editors. The Editors may invite or readers may submit 'Responses' to published 'Opinions' , provided that they are not merely polemics, and these will also be published at the discretion of the Editors. 'Responses' will be treated precisely like 'Opinions' . They should clearly indicate, in their first sentence, the 'Opinion' to which they are a response.     

Possible evolutionary futures for mankind

1. With the development of techniques of gene transfer, human genetic defects such as sickle cell anaemia, phenylketonurea, cystic fibrosis, haemophilia, Huntington's chorea, etc. will be eliminated. Ninety nine percent of humans in the year 2500 will be much the same as at present, but healthier. 2. Studies of Comparative Biochemistry and Physiology show that many strategies have been developed in the Animal Kingdom that could be advantageous in furthering human survival. Some of these strategies are discussed in the present article. 3. Commensal algae that will live in the epidermis of domestic animals (pigs, goats, cattle) will be developed enabling these animals to live in dry environments with minimal demands for food and water. Once successful in domestic animals, the algae could be adapted to live in some humans, i.e. the "Green Man". 4. Commensal protozoa and bacteria that digest cellulose and lignin will be developed so that they can live in the human gut and convert the material to sugars, volatile fatty acids and amino acids that can be absorbed and metabolized by Man, thus making many inexpensive vegetable food resources available. 5. Mammalian embryos will be able to develop through to full term in vitro in a cleidoic egg; and the in vitro fertilized egg will have to depend on finding a surrogate mother. 6. Some people will have an altered pattern of sexual activity. Many patterns will be available; one suggested here is of protogynous hermaphroditism, i.e. the individuals would be female for the first 30 years of life and male for the remaining years.(ABSTRACT TRUNCATED AT 250 WORDS)