Medical home care services for the housebound elderly.

In our health jurisdiction the proportion of elderly people is more than double the national average, and there is a severe shortage of both home care services and long-term care beds. To help the many elderly housebound people without primary medical care we initiated a medical services home care program. The goals were patient identification, clinical assessment, medical and social stabilization, matching of the housebound patient with a nearby family physician willing and able to provide home care and provision of a backup service to the physician for consultation and help in arranging admission to hospital if necessary. In the program''s first 2 years 105 patients were enrolled; the average age was 78.9 years. More than 50% were widowed, single, separated or divorced, over 25% lived alone, and more than 40% had no children living in the city. In almost one-third of the cases there had never been a primary care physician, and in another third the physician refused to do home visits. Before becoming housebound 15% had been seeing only specialists. Each patient had an average of 3.2 active medical problems and was functionally quite dependent. Thirty-five of the patients were surveyed after 1 year: 24 (69%) were still at home, and only 1 (3%) was in a long-term care institution; 83% were satisfied with the care provided, and 79% felt secure that their health needs were being met. One-third of the patients or their families said that it was not easy to reach the physician when necessary. We recommend that programs similar to ours be set up in health jurisdictions with a high proportion of elderly people. To recruit and retain cooperative physicians hospital geriatric services must be willing to provide educational, consultative and administrative support.     

Age,pattern of consultation,and functional disability in elderly patients in one general practice.

OBJECTIVE--To examine how functional disability varies with sex, age, and other variables in patients aged 75 and over living in the community and to ascertain whether a statistical model derived from the variables in this population usefully predicted functional disability in another of similar age. DESIGN--Retrospective study of data collected by interview and by examination of medical records. SETTING--An urban general practice with five partners and a list of 15,000 patients, very few of whom belonged to ethnic minorities. PATIENTS--775 Patients (252 men, 523 women) aged 75 and over living in the community between September 1985 and August 1986; 13 other patients considered to be unsuitable and 14 who declined an interview were excluded. Also 94 patients who became 75 or joined the practice after August 1986. MAIN OUTCOME MEASURE--The proportions of fit, partially disabled, and severely disabled (housebound) patients. RESULTS--90 Men (35.7%) and 128 women (24.5%) were fit, and 27 men (10.7%) and 116 women (22.2%) were housebound; in all age groups women were significantly more likely to be disabled than men. A significant trend towards greater disability was shown with increasing age and, more noticeably, with pattern of consultation when patients were divided into three categories based on the number of times they had attended the surgery and been visited at home over about two years. Statistical models gave the forecast percentage of fit and severely disabled patients for each sex, age group, and pattern of consultation, and a simple scheme was derived to identify from information wholly contained in medical records most of those patients most prone to severe disability. The scheme was verified applying it to a population of 94 elderly patients in 1988-9. CONCLUSION--Sex, age, and pattern of consultation together provide a quick indication of elderly patients'' tendency to severe disability, which can help in screening and in day to day consultations.     

Seasonally modified forms of the revised Janoschek function

Early attempts for modifying growth functions to annual variations dating back up to 2 decades are recalled together with examples for their application showing rather different degrees of approximation. In order to secure independence from special functions, Sager (1982) has proposed a general concept for the modification of growth functions. In this way, examples were treated with the Pütter-Bertalanffy's for crustaceans and clams, with the Gompertz' for the goby, and with the Richards' for the pollack - a near relative of the cod. In continuation of these endevours, the revised Janoschek's is presented in 2 forms, namely one adapted to birth data or in an unbound variant. Special attention is given to the evaluation of the parameters used in nonlinear regressions for both forms. The new equation for bound growth opens a chance for giving real birth values even in seasonally changing growth if one deciding parameter will surmount 1 as has been the case in many applications heretofore. As an example the mussel Mytilus edulis taken from marine "farms" in the Menai-Straits of North Wales is treated with the seasonally modified Janoschek function. Although the special case cannot be realized in this case, the curves for length growth and growth increase are rather instructive compared with the basic behaviour with lacking annual variations. Approximations from 0.5 to 2.7 a show very close agreement with natural values of length as can be verified from numerical and graphical displays.     

The effect of SH-SS transition in the structural organization of mitotic chromosomes

Summary Human lymphoid cell cultures were treated with 2,2-dithiodipyridine, a thiol reacting agent which produces SS bridges inside the living cells. After 1 to 4h treatment chromosome preparations were made. The chromosomes acquired a peculiar segmentation along the chromatids. The results suggest that the alteration might arise from a direct reaction of the agent with special chromosomal proteins. The resistance of treated chromosomes to alkali-heat treatment used in C-banding technique was different from that of untreated chromosomes. This prefixational procedure seems to be advantageous in analysing both the chromosome organization and the banding mechanism.     

The nature of electronic transitions in absorption spectra of phenyl-substituted 1,3,4-oxadiazoles and 1,3,4-sym-triazoles

The electronic absorption spectra of 1,3,4-oxadiazole, 1,3,4-sym-triazole and their phenyl derivatives were calculated within the -electron approximation, by the PPP-Cl procedure. The nature of the electronic transitions was analysed in terms of special quantum-mechanical excitation indices: excitation-localization indices and charge-transfer indices. An orbital analysis was performed within the framework of the structure-orbital approach. The transitions calculated for unsubstituted azoles should be treated as perturbed ones of the models-cys-azabutadiene molecule. In the case of phenyl derivatives one can classify the transitions as being either local or molecular in character. The dependence of their characteristics on the -system structure has been studied for the latter transitions. The results of the theoretical treatment are in good agreement with experimental data.     

Fluorescence microscopic distinction between elastin and collagen

Summary Distinction between elastin and collagen in arteriosclerotic lesions is difficult because immature and incompletely cross-linked collagen bind so-called elastica stains; furthermore, abnormal collagen can lack cross-striation and thus resemble elastin in electron microscopy. However, collagen and elastin differ significantly in their content of basic amino acids and hence in their affinity for heteropolyacids. This chemical difference was utilized for the development of a fluorescence microscopic method for distinction between collagen and elastin.Paraffin sections of human autopsy material were treated with a 1% aqueous solution of phosphomolybdic acid (PMA) for five minutes, rinsed in distilled water, dehydrated and mounted. Other series were treated with the PMA-molybdenum blue reaction and with various special stains.Only elastic membranes of aorta, the elastica interna and externa of sizable arteries, and true elastic fibers remained strongly fluorescent; the autofluorescence of collagen, reticulum fibers, basement membranes, pseudo-elastic fibers, and elastic membranes in small arteries was quenched. In other series PMA abolished the fluorescence of basic fluorochromes.Correlation of fluorescence and direct light microscopic observations with chemical and electron microscopic data showed that the PMA-fluorescence method permits distinction between elastin and various types of collagen.     

Pathways of the Maillard reaction under physiological conditions

Initially investigated as a color formation process in thermally treated foods, nowadays, the relevance of the Maillard reaction in vivo is generally accepted. Many chronic and age-related diseases such as diabetes, uremia, atherosclerosis, cataractogenesis and Alzheimer’s disease are associated with Maillard derived advanced glycation endproducts (AGEs) and α-dicarbonyl compounds as their most important precursors in terms of reactivity and abundance. However, the situation in vivo is very challenging, because Maillard chemistry is paralleled by enzymatic reactions which can lead to both, increases and decreases in certain AGEs. In addition, mechanistic findings established under the harsh conditions of food processing might not be valid under physiological conditions. The present review critically discusses the relevant α-dicarbonyl compounds as central intermediates of AGE formation in vivo with a special focus on fragmentation pathways leading to formation of amide-AGEs.     

A class of models of selectively neutral alleles

Using exchangeability as a statistical analog of neutrality, we derive a generalized sampling distribution for neutral alleles. The distribution depends upon a parameter that determines the underlying marginal distribution of the number of copies of a neutral allele and that can range from zero to infinity. The sampling model of Ewens (1972) is a special case characterized by an extreme value (0) of this parameter. Two other special cases are considered, one of which seems to be applicable to populations with a structure like that of the Yanomama Indians of South America. We then investigate the expected frequency spectra under these three special cases and discover that all three models yield a broad range of possible spectra with overlap between the special cases. We finally show that Ewens' sampling model cannot be used to construct tests of neutrality versus selection tending to maintain polymorphisms, but it can be used to construct tests of directional selection versus neutrality plus selection tending to yield polymorphic states.     

Evidence,information, and surprise

A numerical measure for evidence is defined in a probabilistic framework. The established mathematical concept of information or entropy (as defined in ergodic theory) can be obtained from this definition in a special case, although in general information is greater than evidence. In another, somewhat complementary, special case a numerical measure for surprise is derived from the definition of evidence. Some applications of the new concept of evidence are discussed, concerning statistics in general and the special kind of statistics performed by neurophysiologists, when they analyze the response of neurons, and perhaps by the neurons themselves.     

微孔法分离大鼠骨髓内皮祖细胞

用一种杂交瘤皿,根据内皮祖细胞集落形成单位(endothelial progenitor cells colony-forming units,EPCs-CFUs)的形态特征和EPCs表面特异性标记物分离EPCs.取大鼠股骨、胫骨骨髓,将全骨髓接种在聚苯乙烯制作的杂交瘤皿上,培养4～7天后出现CFUs,将这些集落分别挑选出来后,取单个集落的部分细胞免疫荧光鉴定EPCs表面特异性标记物CD133/VEGFR-2.CD133/VEGFR-2双阳性即为EPCs-CFUs.与此对应的余下一部分继续传代增殖,流式细胞术鉴定CD133/VEGFR-2/CD34,并把此方法命名为微孔法.发现接种后第4天,显微镜下可见明显的CFUs.免疫荧光鉴定大约7%的CFUs为CD133 /VEGFR-2 ,进一步传代培养,流式细胞术鉴定CD133 /VEGFR-2 /CD34 细胞纯度达70%以上.传代细胞可在体外形成血管样结构,并表达内皮细胞特异性标记物vWF.结果表明通过微孔法能成功地从大鼠骨髓分离到EPCs.     

Editorial: Systems biology and personalized medicine - the future is now

This special issue on "Systems biology and personalized medicine" includes five complementary articles that highlight how functional genomics and computational physiology can contribute to the development of predictive, preventive, personalized and participatory (P4) medicine. Edited by Prof. Leroy Hood and Prof. Charles Auffray.     

Normalisierung der geschlechtlichen Entwicklung kopfloser Fragmente junger ♀♀ vonPlatynereis dumerilii (Polychaeta) durch Behandlung mit konservierten Prostomien juveniler Individuen

Fragments taken from femalePlatynereis dumerilii are, at an early stage, characterized by small oocytes, unable to develop normal eggs and to complete the epitokous state if deprived of hormone supply from the prostomium. The question remained whether this inability to achieve normal sexual maturity is due to complete lack of common “juvenile brain hormone” or to absence of a special phase-specific “maturation hormone” whose existence has not yet been proved, but suggested on the basis of autoradiographic investigations of neurosecretory brain activity (Müller 1973). New experiments on such fragments demonstrate that fairly normal oogenesis can be induced and a more advanced epitoke formation attained by daily external treatment with dried isolated prostomia taken from juvenile specimens. Thus, there is no need to assume interference of a special “maturation hormone” in sexual development. The treated fragments show normal posterior regeneration followed by fairly normal sexual maturation, even if the supply of “juvenile brain hormone” is not changed throughout the experiment; hence it may be postulated that the fragment itself gradually alters its mode of response to the hormone.     

Unmasking Pachytriton labiatus (Amphibia: Urodela: Salamandridae), with description of a new species of Pachytriton from Guangxi, China

Examination of the lectotype and paralectotypes of Pachytriton labiatus ( Unterstein, 1930 ) from southern China revealed that the specimens do not represent a member of Pachytriton, but are identical with a newt of another genus, Paramesotriton ermizhaoi Wu et al., 2009 also described from southern China. We suggest that Pac. labiatus should be transferred to Paramesotriton as a senior synonym of Par. ermizhaoi. We compared the morphology of the northeastern and southwestern groups of newts previously called Pac. "labiatus" with special reference to age and sexual variations. As a result, we confirmed that the two groups are differentiated sufficiently to be treated as different species. In this report, we revive the name Pac. granulosus Chang, 1933 to refer to the northeastern group of Pac. "labiatus," and at the same time, describe a new species representing the southwestern group.     

Molecular mechanisms of survival and apoptosis in RAW 264.7 macrophages under oxidative stress

Organisms living in an aerobic environment are continuously exposed to reactive oxygen species (ROS). Apoptosis of cells can be induced by ROS and cells also develop negative feedback mechanisms to limit ROS induced cell death. In this study, RAW264.7 murine macrophage cells were treated with H₂O₂ and cDNA microarray technique was used to produce gene expression profiles. We found that H₂O₂ treatment caused up-regulation of stress, survival and apoptosis related genes, and down-regulation of growth and cell cycle promoting genes. Numerous genes of metabolism pathways showed special expression patterns under oxidative stress: glycolysis and lipid synthesis related genes were down-regulated whereas the genes of lipid catabolism and protein synthesis were up-regulated. We also identified several signaling molecules as ROS-responsive, including p53, Akt, NF- B, ERK, JNK, p38, PKC and INF- . They played important roles in the process of apoptosis or cell survival. Finally, an interactive pathway involved in cellular response to oxidative stress was proposed to provide some insight into the molecular events of apoptosis induced by ROS and the feedback mechanisms involved in cell survival.Y. Zhang and C.C. Fong contributed equally to this work.     

Versatile Utilization of Massive Bone Allografts in Orthopedic Surgery

The clinical use of massive bone allografts in orthopaedic surgery has become common practice in tumour operations and primary and revision total joint replacement. In certain special clinical situations associated with large bone loss, such as trauma, limb-length discrepancy repair or even infection, massive bone allografts can be successfully used. We present our treatment results of 47 patients who suffered from major bone loss due either to trauma, limb-length discrepancy repair, or infection. Our results (>2 years minimum follow-up to allow full-bone allograft incorporation) indicate that the use of massive bone allografts in these special and delicate medical conditions is feasible, and have good functional results.     

Hemmung der Wurzelneubildung durch saure und neutrale Kernproteine

Summary An acidic (Fs) and a nearly neutral (Fn) protein fraction were extracted from the chromatin of calf thymus and pea seedlings. Both fractions are able to combine with protein-free DNA to form a complex, which, however, has a lower thermal stability than a DNA-histone complex. Fs and Fn inhibit root initiation in a similar manner as histone, actinomycin-D, streptomycin and 5-bromouracil do when these substances are applied to regenerating pea epicotyls during different times after culture initiation.Oxidized and thermally denaturated Fs and Fn inhibit root initiation less than untreated proteins do. Furthermore the treated proteins act in a more specific way on special steps of development such as root differentiation or root growth. In a very similar manner inhibition of root regeneration is also restricted to special developmental steps by treatment of Fs or Fn with small amounts (1 g/ml) of IAA, GS or KI at pH8. With increasing acidity of the chromatin proteins treatment with IAA diminishes the inhibition of root growth, whereas root differentiation is preserved.The results support the suggestion that acidic and neutral proteins of the chromatin may act as regulators of DNA-activity as histone does. During IAA-induced root formation Fs acts as an antagonist to histone, because these two protein fractions are specialized in their action by IAA treatment in a contrary manner.     

常用医学图像“局部显微镜”程序的研究

在医学临床和科学研究中,常常需要将图像的某个感兴趣区域(ROI)进行放大显示,以便清晰地观察图像的细节.为了实现这一目标,采用IDL语言(Interactive Data Language)编写了应用程序,从而实现了医学图像“局部显微镜”的功能.一系列实验表明:对于各种常用的医学图像类型(灰度图像、RGB图像、DICOM图像等),程序均能较好地实现放大显示的功能.此外,该程序还具有人机交互性强、可移植性高等优点.     

Self-made frits for nanoscale columns in proteomics

We report here the production of self-made frits for nano-columns. The frits introduce a minor dead volume and can be placed in capillaries with a wide range of diameters (20-250 microm tested) in an extremely simple and low-cost procedure. The obtained columns appear to be comparable to "no-frit" columns with near-ideal chromatographic characteristics. We expect that this frit will be useful for the spotting of gradients onto MALDI plates but also where special ESI set-ups do not allow for "no-frit" solutions.     

Effects of hyperphenylalaninemia in the fetal stage on the postnatal development of fetal rat brain

The effect of exposure at different prenatal stages to maternal hyperphenylalaninemia (HyPhe) on the somatic and neurological development of fetuses in rats was studied, with special respect to the change of relevant enzyme activities in the brain. While evident somatic damage was found only in the fetuses exposed to maternal HyPhe at a last stage of gestation, distinct mental retardation seemingly due to some irreversible damage to the brain was observed in all the treated fetuses regardless of the timing of exposure, and a significantly reduced activity of 2, 3-cyclic nucleotide 3-phosphohydrolase (CNPase), a marker enzyme of myelin, was confirmed in the mantle region of the brain.Dedicated to Professor Yasuzo Tsukoda.     

Prediction and phylogenetic analysis of mammalian short interspersed elements (SINEs)

The presence of repetitive elements can create serious problems for sequence analysis, especially in the case of homology searches in nucleotide sequence databases. Repetitive elements should be treated carefully by using special programs and databases. In this paper, various aspects of SINE (short interspersed repetitive element) identification, analysis and evolution are discussed.