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91.
Loes?AM?Leenen Ben?FM?WijnenEmail author Reina?JA?de Kinderen Marian?HJM?Majoie Caroline?M?van Heugten Silvia?MAA?Evers 《BMC neurology》2014,14(1):255
Background
In patients with epilepsy, poor adherence to anti-epileptic drugs has been shown to be the most important cause of poorly controlled epilepsy. Furthermore, it has been noted that the quality of life among patients with epilepsy can be improved by counseling and treatments aimed at increasing their self-efficacy and concordance, thus stimulating self-management skills. However, there is a need for evidence on the effectiveness of such programs, especially within epilepsy care. Therefore, we have developed a multi-component intervention (MCI) which combines a self-management/education program with e-Health interventions. Accordingly, the overall objective of this study is to assess the (cost)-effectiveness and feasibility of the MCI, aiming to improve self-efficacy and concordance in patients with epilepsy.Methods
A RCT in two parallel groups will be conducted to compare the MCI with a control condition in epilepsy patients. One hundred eligible epilepsy patients will be recruited and allocated to either the intervention or control group. The intervention group will receive the MCI consisting of a self-management/education program of six meetings, including e-Health interventions, and will be followed for 12 months. The control group will receive care as usual and will be followed for 6 months, after which patients will be offered the possibility of participating in the MCI. The study will consist of three parts: 1) a clinical effectiveness study, 2) a cost-effectiveness study, and 3) process evaluation. The primary outcome will be self-efficacy. Secondary outcomes include adherence, side effects, change in seizure severity & frequency, improved quality of life, proactive coping, and societal costs. Outcome assessments will be done using questionnaires at baseline and after 3, 6, 9, and 12 months (last two applicable only for intervention group).Discussion
In times of budget constraints, MCI could be a valuable addition to the current healthcare provision for epilepsy, as it is expected that higher concordance and self-efficacy will result in reduced use of healthcare resources and an increased QOL. Accordingly, this study is aimed helping patients to be their own provider of health care, shifting epilepsy management from professionals to self-care by patients equipped with appropriate skills and tools.Trial registration number
NTR4484.92.
93.
Price DJ Campbell PG Sutton AG Grech ED Davies A Hall JA De Belder MA 《International journal of cardiovascular interventions》2001,4(1):15-20
BACKGROUND: The EPISTENT trial reported improved early outcomes with routine use of abciximab after coronary stenting. Increasing use of stents means that routine abciximab adds significantly to costs of percutaneous coronary intervention (PCI). This paper reports the results of a protocol encouraging restriction of abciximab therapy to high-risk patients only. METHODS: Data were collected prospectively over a 34-month period for patients undergoing PCI with stenting. In addition to those who fulfilled criteria for inclusion in the EPISTENT trial, patients treated in the setting of acute myocardial infarction (AMI) were studied. Demographic data, procedural details and early clinical outcomes were recorded. RESULTS: Of 808 patients studied, 601 fulfilled EPISTENT inclusion criteria and comprised 367 patients (45%) treated for stable angina and 234 (30%) treated for unstable or post-infarct angina. The additional 207 patients (25%) were treated during AMI. The 808 patients received a total of 981 stents. Abciximab was given in only 88 cases (10.9%). Major adverse clinical events occurred in 39 patients (4.8%). CONCLUSION: Selective use of abciximab for patients undergoing coronary stenting can be associated with outcomes equivalent to those reported for routine use, but with significant cost savings. 相似文献
94.
A rate-independent technique for analysis of nucleic acid sequences: evolutionary parsimony 总被引:24,自引:1,他引:23
The method of evolutionary parsimony--or operator invariants--is a
technique of nucleic acid sequence analysis related to parsimony analysis
and explicitly designed for determining evolutionary relationships among
four distantly related taxa. The method is independent of substitution
rates because it is derived from consideration of the group properties of
substitution operators rather than from an analysis of the probabilities of
substitution in branches of a tree. In both parsimony and evolutionary
parsimony, three patterns of nucleotide substitution are associated
one-to-one with the three topologically linked trees for four taxa. In
evolutionary parsimony, the three quantities are operator invariants. These
invariants are the remnants of substitutions that have occurred in the
interior branch of the tree and are analogous to the substitutions assigned
to the central branch by parsimony. The two invariants associated with the
incorrect trees must equal zero (statistically), whereas only the correct
tree can have a nonzero invariant. The chi 2-test is used to ascertain the
nonzero invariant and the statistically favored tree. Examples, obtained
using data calculated with evolutionary rates and branchings designed to
camouflage the true tree, show that the method accurately predicts the
tree, even when substitution rates differ greatly in neighboring peripheral
branches (conditions under which parsimony will consistently fail). As the
number of substitutions in peripheral branches becomes fewer, the parsimony
and the evolutionary-parsimony solutions converge. The method is robust and
easy to use.
相似文献
95.
96.
97.
Carbamoylphosphate synthetase (CPS) catalyzes the first committed step in
pyrimidine biosynthesis, arginine biosynthesis, or the urea cycle.
Organisms may contain either one generalized or two specific CPS enzymes,
and these enzymes may be heterodimeric (encoded by linked or unlinked
genes), monomeric, or part of a multifunctional protein. In order to help
elucidate the evolution of CPS, we have performed a comprehensive
phylogenetic analysis using the 21 available complete CPS sequences,
including a sequence from Sulfolobus solfataricus P2 which we report in
this paper. This is the first report of a complete CPS gene sequence from
an archaeon, and sequence analysis suggests that it encodes an enzyme
similar to heterodimeric CPSII. We confirm that internal similarity within
the synthetase domain of CPS is the result of an ancient gene duplication
that preceded the divergence of the Bacteria, Archaea, and Eukarya, and use
this internal duplication in phylogenetic tree construction to root the
tree of life. Our analysis indicates with high confidence that this
archaeal sequence is more closely related to those of Eukarya than to those
of Bacteria. In addition to this ancient duplication which created the
synthetase domain, our phylogenetic analysis reveals a complex history of
further gene duplications, fusions, and other events which have played an
integral part in the evolution of CPS.
相似文献
98.
Formation of enlarged mitochondria in a liver cell line in response to a synthetic glucocorticoid
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JA Berliner 《The Journal of cell biology》1975,64(3):711-716
For a number of years it has been recognized that glucocorticoids cause alterations in liver cell morphology (6, 9). Several investigators have shown that in liver in vivo mitochondria can be enlarged to many times their normal volume by treatment with cortisone (13, 15). There is a concomitant decrease in mitochondrial number, and the results of Kimberg and Loeb suggest that this is due to mitochondrial fusion (7). However, the exact mechanism whereby mitochondrial volume is altered and whether in fact cortisone is the direct causal agent are not known due to the complexity of studying these questions in a whole animal system. We have found that dexamethasone sodium phosphate (dex), a synthetic glucocorticoid, causes the formation of enlarged mitochondria in a liver cell line RLC-GAI, which grows in defined medium. In this paper we present our observations on the amount of enlargement that occurs after 5 days of treatment. The formation of enlarged mitochondria is reversible upon removal of the hormone from the medium, and we have attempted to determine whether "mitochondrial" or "nonmitochondrial" inhibitors are more effective in blocking the return of mitochondria to their normal size when the hormone is removed. 相似文献
99.
JA Kiernan 《Biotechnic & histochemistry》2018,93(2):133-148
Previous investigators have disagreed about whether hemalum stains DNA or its associated nucleoproteins. I review here the literature and describe new experiments in an attempt to resolve the controversy. Hemalum solutions, which contain aluminum ions and hematein, are routinely used to stain nuclei. A solution containing 16 Al3+ ions for each hematein molecule, at pH 2.0–2.5, provides selective progressive staining of chromatin without cytoplasmic or extracellular “background color.” Such solutions contain a red cationic dye-metal complex and an excess of Al3+ ions. The red complex is converted to an insoluble blue compound, assumed to be polymeric, but of undetermined composition, when stained sections are blued in water at pH 5.5–8.5. Staining experiments with DNA, histone and DNA + histone mixtures support the theory that DNA, not histone, is progressively colored by hemalum. Extraction of nucleic acids, by either a strong acid or nucleases at near neutral pH, prevented chromatin staining by a simple cationic dye, thionine, pH 4, and by hemalum, with pH adjustments in the range, 2.0–3.5. Staining by hemalum at pH 2.0–3.5 was not inhibited by methylation, which completely prevented staining by thionine at pH 4. Staining by hemalum and other dye-metal complexes at pH ≤ 2 may be due to the high acidity of DNA-phosphodiester (pKa ~ 1). This argument does not explain the requirement for a much higher pH to stain DNA with those dyes and fluorochromes not used as dye-metal complexes. Sequential treatment of sections with Al2(SO4)3 followed by hematein provides nuclear staining that is weaker than that attainable with hemalum. Stronger staining is seen if the pH is raised to 3.0–3.5, but there is also coloration of cytoplasm and other materials. These observations do not support the theory that Al3+ forms bridges between chromatin and hematein. When staining with hematein is followed by an Al2(SO4)3 solution, there is no significant staining. Taken together, the results of my study indicate that the red hemalum cation is electrostatically attracted to the phosphate anion of DNA. The bulky complex cation is too large to intercalate between base pairs of DNA and is unlikely to fit into the minor groove. The short range van der Waals forces that bind planar dye cations to DNA probably do not contribute to the stability of progressive hemalum staining. The red cation is precipitated in situ as a blue compound, insoluble in water, ethanol and water-ethanol mixtures, when a stained preparation is blued at pH > 5.5. 相似文献
100.
Alves-Gomes JA; Orti G; Haygood M; Heiligenberg W; Meyer A 《Molecular biology and evolution》1995,12(2):298-318
The order Gymnotiformes (South American electric fishes) is a fascinating
assemblage of freshwater fishes that share the unusual ability to produce
and sense electric fields used for electrolocation and social
communication. In the last few decades, the electrogenic and electrosensory
systems (EES) of these fish have served as an excellent model to study
motor and sensory physiology in vertebrates. In an attempt to the evolution
of characters associated with the EES in the group, we applied
maximum-parsimony (MP), minimum-evolution (ME), and maximum-likelihood (ML)
methods to analyze 302 aligned bases of the mitochondrial 12S rRNA and 416
bases of the mitochondrial 16S rRNA of 19 gymnotiform genera representing
all six recognized families. Six catfish genera (order Siluriformes) were
also sequenced and used as outgroups. The phylogenetic hypothesis resultant
from molecular data analysis differs in some respects from previous
hypotheses based on morphological studies. Our results were most
informative within the family level, as we were unable to elucidate the
relationships among deeper branches in this order with sufficient
confidence by using molecular data alone. The phylogenetic information of
both mitochondrial DNA segments appears to be affected by functional
constraints, and the resultant topologies were sensitive to different
weighting schemes and the algorithm used. Nonetheless, we found unanimous
support for the following phylogenetic relationships: (1) the family
Sternopygidae is an unnatural group, and Sternopygus is the sole
representative of a unique lineage within the order; (2) the family
Hypopomidae is not monophyletic; and (3) the order Gymnotiformes is
composed of at least six natural clades: Sternopygus, family Apteronotidae,
a new clade consisting of the remaining sternopygids, families Hypopomidae
+ Rhamphicthyidae, family Electrophoridae, and family Gymnotidae. By
combining molecular, morphological, and physiological information, we
propose a new hypothesis for the phylogeny of this group and suggest a new
family Eigenmanniidae n. (order Gymnotiformes).
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