Is the Application of SNOMED CT Concept Model sufficiently Quality Assured?

The terminological content of SNOMED CT, the world's largest clinical terminology is linked to description logics expressions, which give support to consider SNOMED CT a formal ontology. The Terminology Quality Assurance (TQA) of such a terminology resource is hampered by errors in modeling, which act as a barrier for the successful use of electronic health records to ensure semantic interoperability. One application case is the new version of ICD, now in its pre-final form, the content of which is based on a subset of SNOMED CT. The ongoing alignment exercise has highlighted significant modeling issues in more than one third of cases that contrasted SNOMED CT concept model instances with the intuitive meaning given by their Fully Specified Names or synonyms lexically mapped to ICD-11 class names. We recommend prioritizing SNOMED CT TQA on the subset of the core SNOMED CT content to constitute the always true common ontology between SNOMED CT and ICD-11.

Cell therapy with human MSCs isolated from the umbilical cord Wharton jelly associated to a PVA membrane in the treatment of chronic skin wounds

The healing process of the skin is a dynamic procedure mediated through a complex feedback of growth factors secreted by a variety of cells types. Despite the most recent advances in wound healing management and surgical procedures, these techniques still fail up to 50%, so cellular therapies involving mesenchymal stem cells (MSCs) are nowadays a promising treatment of skin ulcers which are a cause of high morbidity. The MSCs modulate the inflammatory local response and induce cell replacing, by a paracrine mode of action, being an important cell therapy for the impaired wound healing. The local application of human MSCs (hMSCs) isolated from the umbilical cord Wharton's jelly together with a poly(vinyl alcohol) hydrogel (PVA) membrane, was tested to promote wound healing in two dogs that were referred for clinical examination at UPVET Hospital, showing non-healing large skin lesions by the standard treatments. The wounds were infiltrated with 1000 cells/µl hMSCs in a total volume of 100 µl per cm(2) of lesion area. A PVA membrane was applied to completely cover the wound to prevent its dehydration. Both animals after the treatment demonstrated a significant progress in skin regeneration with decreased extent of ulcerated areas confirmed by histological analysis. The use of Wharton's jelly MSCs associated with a PVA membrane showed promising clinical results for future application in the treatment of chronic wounds in companion animals and humans.

Proficiency testing for the determination of pesticides in mango pulp: a view of the employed chromatographic techniques and the evaluation of laboratories' performance

The proficiency testing for determination of pesticides residues in mango pulp was the third work of the partnership established by INMETRO and INCQS/Fiocruz. Three mango pulp samples were sent to each participant laboratory, two being spiked with the pesticides and one exempt of pesticides. The added pesticides were: deltamethrin, ethion, fenitrothion, malathion, and permethrin. The evaluation of the results of the homogeneity and the stability tests, as well as the determination of the assigned value was made in agreement with ISO GUIDE 35 and ISO 13528, assuming the samples were considered homogeneous and stable for the studied period. The assigned values and the standard deviation for proficiency evaluation was calculated using the robust algorithm, according to ISO 13528, and the evaluation of the results was carried through in accordance with ABNT ISO/IEC Guide 43-1. The z-score graphs and confidence ellipse was also used in the evaluation of the results. In the evaluation carried through from the values of the z-scores, 71% of the reported results were considered satisfactory based on the results found for this index. The evaluation of the analytical viability for the determination of each pesticide and of the analytical capacity of the participant laboratories was carried through. A summarized view of the chromatographic techniques and of preparation of sample used by the participant laboratories was also carried through in this work.

Neural cell transplantation effects on sciatic nerve regeneration after a standardized crush injury in the rat

The goal of the present study was to assess whether in vitro-differentiated N1E-115 cells supported by a collagen membrane would enhance rat sciatic nerve regeneration after a crush injury. To set up an appropriate experimental model for investigating the effects of neural cell transplantation, we have recently described the sequence of functional and morphologic changes occurring after a standardized sciatic nerve crush injury with a nonserrated clamp. Functional recovery was evaluated using the sciatic functional index, the static sciatic index, the extensor postural thrust, the withdrawal reflex latency, and ankle kinematics. In addition, histomorphometric analysis was carried out on regenerated nerve fibers by means of the 2D-disector method. Based on the results of the EPT and of some of the ankle locomotor kinematic parameters analyzed, the hypothesis that N1E-115 cells may enhance nerve regeneration is partially supported although histomorphometry disclosed no significant difference in nerve fiber regeneration between the different experimental groups. Therefore, results suggest that enrichment of equine type III collagen membrane with the N1E-115 cellular system in the rat sciatic nerve crush model may support recovery, at least in terms of motor function. The discrepancy between functional and morphological results also suggests that the combined use of functional and morphological analysis should be recommended for an overall assessment of recovery in nerve regeneration studies.

Encapsulation of insulin–cyclodextrin complex in PLGA microspheres: a new approach for prolonged pulmonary insulin delivery

The insulin administration by pulmonary route has been investigated in the last years with good perspectives as alternative for parenteral administration. However, it has been reported that insulin absorption after pulmonary administration is limited by various factors. Moreover, in the related studies one daily injection of long-acting insulin was necessary for a correct glycemic control. To abolish the insulin injection, the present study aimed to develop a new formulation for prolonged pulmonary insulin delivery based on the encapsulation of an insulin:dimethyl-beta-cyclodextrin (INS:DM-beta-CD) complex into PLGA microspheres. The molar ratio of insulin/cyclodextrin in the complex was equal to 1:5. The particles were obtained by the w/o/w solvent evaporation method. The inner aqueous phase of the w/o/w multiple emulsion contained the INS:DM-beta-CD complex. The characteristics of the INS:DM-beta-CD complex obtained were assessed by 1H-NMR spectroscopy and Circular Dichroism study. The average diameter of the microspheres prepared, evaluated by laser diffractometry, was 2.53 +/- 1.8 microm and the percentage of insulin loading was 14.76 +/- 1.1. The hypoglycemic response after intratracheal administration (3.0 I.U. kg(-1)) of INS:DM-beta-CD complex-loaded microspheres to diabetic rats indicated an efficient and prolonged release of the hormone compared with others insulin formulations essayed.

Treatment with encapsulated Hsp60 peptide (p277) prolongs skin graft survival in a murine model of minor antigen disparity

The increased expression of heat shock protein (Hsp)60 in different kinds of graft tissues has been associated with a proinflammatory role and rejection. However, there are very few reports in which treatment with Hsp60 delays skin allograft rejection. The aim of this work was to evaluate the capacity of encapsulated human Hsp60-derived peptide p277 to delay graft rejection in two murine models of skin transplantation with minor antigen disparities. Briefly, BALB/c mice and C57BL/6 were intranasally pre-treated with five doses of Hsp60 p277 peptide encapsulated in polylactide-co-glycolide acid microspheres (PLGM), and received skin grafts from DBA2 mice and 129/B6 (F1) mice respectively. The treatment with the peptide increased skin graft survival more than 20 days in both the mouse strains, mainly in C57BL/6 recipients (P < 0.05). Also, p277-treated BALB/c and C57BL/6 mice showed IL-10 and IFN-gamma production, induced by p277 peptide. For the first time, a mucosal schedule using the Hsp60 C-terminal peptide p277 encapsulated in PLGM showed some survival prolongation of skin grafts bearing minor antigen disparities. Our results suggest a potential role for Hsp60-based therapy and the mucosal route as a useful tool to control the inflammatory response to allografts.

Maxilla osseus sequestre and oral exposure: effects of the treatment of multiple myeloma with bisphosphonates

Multiple myeloma, the second most common haematopoietic cancer, represents a collection of plasma-cell neoplasms that invariably become fatal when self-renewing myeloma cells begin unrestrained proliferation. The major clinical manifestation of multiple myeloma is related to loss of bone through osteolysis. The bone disease can lead to pathologic fractures, spinal cord compression, hypercalcemia, and pain. It is also a major cause of morbidity and mortality in these patients. These patients frequently require radiation therapy, surgery and analgesic medications. Bisphosphonates are specific inhibitors of osteoclastic activity, and are currently used to prevent bone complications and to treat malignant hypercalcemia in patients with multiple myeloma, or bone metastases from breast and prostate cancers. Recent published reports have documented a possible link between treatment with intravenous bisphosphonates and osteonecrosis of the jaw. Bisphosphonates have been demonstrated to alter the normal bone microenvironment and appear to have direct effects on tumours as well. These changes may contribute to the development of osteonecrosis of the jaw in these patients, particularly after tooth extractions or other invasive dental procedures. Osteonecrosis of the mandible has been reported in 3 patients from Centro Hospitalar de Vila Nova de Gaia (CHVNG) with multiple myeloma treated for over 18 to 48 months with intravenous bisphosphonate zoledronate. It has been postulated that bisphosphonates may cause oral avascular bone necrosis due to antiangiogenic effect leading to disruption of osteoclast-mediated bone resorption. Although this report serves to alert clinicians about the potential complication of bone necrosis in patients receiving bisphosphonates therapy, many questions remain concerning the underlying pathogenesis of this process. In these 3 described clinical cases, surgical debridment without flap elevation, intensive antibiotherapy and zolendronate treatment arrest made possible the partial recovery of the patients. We purpose this type of clinical approach in patients suffering from multiple myeloma and bone osteonecrosis induced by bisphosphonate treatment. Research to determine the mechanism of this dental phenomenon is needed to fully validate and substantiated the possible link between bisphosphonates treatment of multiple myeloma or other cancer diseases with avascular osteonecrosis of the jaws. Until then, clinicians involved in the care of patients at risk should consider this possible complication.

Long-term functional and morphological assessment of a standardized rat sciatic nerve crush injury with a non-serrated clamp

We have recently described the sequence of functional and morphologic changes occurring after a standardized sciatic nerve crush injury. An 8-week post-injury time was used because this end point is the far most used. Unexpectedly, both functional and morphological data revealed that animals had still not recovered to normal pre-injury levels. Therefore, the present study was designed in order to prolong the observation up to 12 weeks. Functional recovery was evaluated using sciatic functional index (SFI), static sciatic index (SSI), extensor postural thrust (EPT), withdrawal reflex latency (WRL) and ankle kinematics. In addition, quantitative morphology was carried out on regenerated nerve fibers. A full functional recovery was predicted by SFI/SSI, EPT and WRL but not all ankle kinematics parameters. Moreover, only two morphological parameters (myelin thickness/axon diameter ratio and fiber/axon diameter ratio) returned to normal values. Data presented in this paper provide a baseline for selecting the adequate end-point and methods of recovery assessment for a rat sciatic nerve crush study and suggest that the combined use of functional and morphological analysis should be recommended in this experimental model.

A road from health care classifications and coding systems to biomedical ontology: the CEN categorial structure for terminologies of human anatomy: Catanat

There is an increasing need for updated and harmonised health care classifications and coding systems to allow international comparisons and cooperation for instance for population based WHO indicators, Electronic Health Record safety, trans border migration of population, case mix and procedure payment. It is not feasible to propose a standardisation of the linguistic expressiveness of different health care professionals and of the citizens. Natural language expressions show inconsistencies and ambiguities as assessed by biomedical ontology driven tools. In order to build a road towards standardisation the European Standard Body CEN has stated that it was not possible to convince the different European member states using different national languages to agree on a reference clinical terminology as Snomed-CT or to standardise a detailed language independent biomedical ontology. It has developed since 1990 an approach named categorial structure as a step standardising only the terminologies model structure. The categorial structure for terminologies of human anatomy currently in the phase of final approval is presented as a methodology for bridging between classifications and coding systems and biomedical ontology on the way to semantic interoperability between different languages, legacies and goals.

Jaw avascular osteonecrosis after treatment of multiple myeloma with zoledronate

PURPOSE

Multiple myeloma, the second most common haematopoietic cancer, which represents the collection of plasma-cell neoplasms that invariably becomes fatal when self-renewing myeloma cells begin unrestrained proliferation. The major clinical manifestation of multiple myeloma is related to the loss of bone through osteolysis. This can lead to pathologic fractures, spinal cord compression, hypercalcaemia, and pain. It is also a major cause of morbidity and mortality in these patients, who frequently require radiation therapy, surgery and analgesic medications. Bisphosphonates are specific inhibitors of osteoclastic activity, and are currently used to prevent bone complications and to treat malignant hypercalcaemia in patients with multiple myeloma, or bone metastases from breast and prostate cancers. Hence, osteonecrosis of the mandible has been reported in three patients from Centro Hospitalar de Vila Nova de Gaia (CHVNG) with multiple myeloma treated for over 18-48 months with intravenous zoledronate, commonly prescribed for multiple myeloma therapy. Although, this report alerts clinicians about the potential complication of bone necrosis in patients receiving bisphosphonate therapy, many questions remain concerning the underlying pathogenesis of this process.

PATIENTS AND METHODS

The medical and dental records of three patients with multiple myeloma, who were treated in CHVNG in the past 4 years, were reviewed. These three patients presented exposed bone and osteonecrosis of the mandible, and shared one common clinical feature: all of them were treated with bisphosphonate zoledronate, administered intravenously for long periods. Sequential orthopantomograms (OPGs) and histological evaluation have been analysed from the biopsies of the non healing dental extraction sites of these patients.

RESULTS

After a routine dental extraction, these patients developed avascular osteonecrosis of the mandible and secondary bone infection with Actinomyces israelii (actinomycotic osteomyelitis), with no evidence of metastatic disease evaluated by biopsy. In these three described clinical cases, surgical debridment without flap elevation, intensive antibiotherapy and the suspension of the zoledronate treatment allowed a partial recovery of the patients. The purpose of this clinical report is to point out that patients suffering from multiple myeloma can develop bone osteonecrosis induced by treatment with bisphosphonates. Research to determine the mechanism of this dental phenomenon is needed to fully validate and substantiate the possible link between bisphosphonate treatment of multiple myeloma or other cancer diseases and avascular osteonecrosis of the jaws. Until then, clinicians involved in the care of patients at risk should consider this possible complication.

Intracellular Ca2+ concentration in the N1E-115 neuronal cell line and its use for peripheric nerve regeneration

Entubulation repair of peripheral nerve injuries has a lengthy history. Several experimental and clinical studies have explored the effectiveness of many biodegradable and non-degradable tubes with or without addition of molecules and cells. The main objective of the present study was to develop an economical and also an easy way for culturing a neural cell line which is capable of growing, differentiating and producing locally nerve growth factors, that are otherwise extremely expensive, inside 90 PLA/10 PLG nerve guides. For this purpose the authors have chosen the N1E-115 cell line, a clone of cells derived from mouse neuroblastoma C-1300 with the perspective of using this differentiated cellular system to cover the inside of 90 PLA/10 PLG nerve guides placed to bridge a nerve gap of 10 mm in the rat sciatic nerve experimental model. The N1E-115 cells proliferate in normal culture medium but undergo neuronal differentiation in response to DMSO. Upon induction of differentiation, proliferation of N1E-115 cells ceases, extensive neurite outgrowth is observed and the membranes become highly excitable. While it is known that Ca2+ serves as an important intracellular signal for cellular various processes, such as growth and differentiation, be toxic to cells and be involved in the triggering of events leading to excitotoxic cell death in neurons. The [Ca2+]i in non-differentiated N1E-115 cells and after distinct periods of differentiation, have been determined by the epifluorescence technique using the Fura-2-AM probe. The results of this quantitative assessment, revealed that N1E-115 cells which undergo neuronal differentiation for 48 hours in the presence of 1.5% DMSO are best qualified to be used to cover the interior of the nerve guides since the [Ca2+]i was not found to be elevated indicating thus that the onset the cell death processes was not occurred.

Parotid surgery: review of 107 tumors (1990-2002)

Tumors of the parotid gland are uncommon. We performed a retrospective study to analyze the clinical, diagnostic, and therapeutic features of a group of patients. We reviewed the clinical and the surgical records of a series of 109 patients who were recommended for surgery because of parotid tumors by the Plastic and Reconstructive Service of São João Hospital, Portugal, between 1990 and 2002. The following parameters were evaluated: age, sex, gland afflicted, symptoms, and duration of symptoms, diagnostic procedures, treatment methods, follow-up, and recurrences. Pleomorphic adenoma was the most common tumor (63.5%). In the majority of cases, fine-needle aspiration cytology was used. Swelling was the most frequent clinical finding. In 68.2%, superficial parotidectomy was performed. There were five cases of permanent facial palsy, and 10 patients developed Frey's syndrome. Recurrent disease was seen in six patients. For the majority of tumors, superficial parotidectomy is an effective treatment with acceptable morbidity.

Retrospective Study of 1251 Maxillofacial Fractures in Children and Adolescents

BACKGROUND

Fractures of the facial skeleton are relatively uncommon in children and adolescents, and only a few reports review a significant number of patients. The authors performed a retrospective study to analyze the different characteristics of such fractures in the pediatric population of Portugal.

METHODS

The authors reviewed the clinical records of a series of 912 patients 18 years of age or younger with facial fractures treated by the Departments of Plastic, Reconstructive, and Aesthetic Surgery and of Maxillofacial Surgery, São João Hospital, in Porto, Portugal, between the years 1993 and 2002. The following parameters were evaluated: age; sex; cause of accident; hour, day, and month of hospital admission; location and type of fractures; presence and location of associated injuries; treatment methods; length of in-hospital stay; and complications.

RESULTS

A total of 1251 fractures were treated. The ratio of boys to girls was 3.1:1. Patients between 16 and 18 years old were the major group (47.8 percent). Motor vehicle accident was the most common cause of injury (53.3 percent of patients). Mandibular fracture was the most common type of fracture (48.8 percent). Associated injuries occurred in 558 patients (64.5 percent).

CONCLUSIONS

Pediatric facial fractures are usually associated with severe trauma. The number of fractures caused by automobile accidents has decreased (p < 0.05). The incidence of this type of fracture is high in Portugal.

Immunotherapy with plasmid DNA encoding mycobacterial hsp65 in association with chemotherapy is a more rapid and efficient form of treatment for tuberculosis in mice

Tuberculosis (TB) remains a threat for public health, killing around 3 million people a year. Despite the fact that most cases can be cured with antibiotics, the treatment is long and patients relapse if chemotherapy is not continued for at least 6 months. Thus, a better characterization of the working principles of the immune system in TB and identification of new immunotherapeutic products for the development of shorter regimens of treatment are essential to achieve an effective management of this disease. In the present work, we demonstrate that immunotherapy with a plasmid DNA encoding the Mycobacterium leprae 65 kDa heat-shock protein (hsp65) in order to boost the efficiency of the immune system, is a valuable adjunct to antibacterial chemotherapy to shorten the duration of treatment, improve the treatment of latent TB infection and be effective against multidrug-resistant bacilli (MDR-TB). We also showed that the use of DNA-hsp65 alone or in combination with other drugs influence the pathway of the immune response or other types of inflammatory responses and should augment our ability to alter the course of immune response/inflammation as needed, evidencing an important target for immunization or drug intervention.

Determination of the intracellular Ca2+ concentration in the N1E-115 neuronal cell line in perspective of its use for peripheric nerve regeneration

Entubulation repair of peripheral nerve injuries has a lengthy history. Several experimental and clinical studies have explored the effectiveness of many biodegradable and non-degradable tubes with or without addition of molecules and cells. The main objective of the present study was to develop an economical and also an easy way for culturing a neural cell line which was capable of growing, differentiating and producing locally nerve growth factors that are otherwise extremely expensive, inside 90 PLA/10 PLG nerve guides. For this purpose the authors have chosen the N1E-115 cell line, a clone of cells derived from mouse neuroblastoma C-1300 with the perspective of using this differentiated cellular system to cover the inside of 90 PLA/10 PLG nerve guides placed to bridge a gap in the rat sciatic nerve experimental model. The N1E-115 cells proliferate in normal culture medium but undergo neuronal differentiation in response to DMSO. Upon induction of differentiation, proliferation of N1E-115 cells ceases, extensive neurite outgrowth is observed and the membranes become highly excitable. While it is known that Ca2+ serves as an important intracellular signal for various cellular processes, such as growth and differentiation. It is also known that can be toxic to cells and is involved in the triggering of events leading to excitotoxic cell death in neurons. The [Ca2+]i in non-differentiated N1E-115 cells and after distinct periods of differentiation, have been determined by the epifluorescence technique using the Fura-2-AM probe. The results of this quantitative assessment revealed that N1E-115 cells which undergo neuronal differentiation for 48 hours in the presence of 1.5% DMSO are best qualified to be used to cover the interior of the nerve guides since the [Ca2+]i was not found to be elevated indicating thus that the onset the cell death processes was not occurred.

Integrating the Modelling of EN 1828 and Galen CCAM Ontologies with Protégé: towards a Knowledge Acquisition Tool for Surgical Procedures

The presentation assess the usability of the ontology platform protégé integrated with the terminology reasoning tool RACER to represent different terminology systems as the CEN European standard EN 1828 which is a categorical structure and the extensive French coding system CCAM supported by a GALEN representation. We present the 2 systems and some results showing the easiness to test the consistence of the ontology or of instances of terminology systems.This type of software tool which is accessible as open source could support a convergent "reference terminology representation" approach. Based on a formal representation development and allowing diversity in linguistic expressiveness of end users this approach can associate shared knowledge acquisition in the public domain and competing systems, software developers and researchers.

Analysis of drugs and personal care products in French source and drinking waters: the analytical challenge and examples of application

This paper illustrates the challenge faced by analytical chemists when trying to measure selected compounds representative of various classes of prescription and hospital drugs. Because hundreds of drugs belonging to a wide variety of chemical groups are allowed for use, an array of analytical methods has to be implemented. As an example, as part of the European Poseidon Project, five different methods were required to measure eight drugs and personal care products. These methods are discussed in detail. Examples of application to surface and ground waters from the Paris area are also reported. The antibiotics roxithromycin and sulfamethoxazole were detected for the first time in the Seine River downstream of Paris. The behaviour of the eight target compounds during aquifer recharge and drinking water treatment is described. An incident involving the detection of micrograms per litre levels of the personal care product Galaxolide in a drinking water distribution system is reported. The value of the pharmaceuticals and personal care products selected as potential indicators is also discussed.

Cervical Impalement Injury

Impacted injuries of the head and neck are uncommon. Associated injuries can be present and can be a serious problem. We present an unusual clinical case and discuss the management of this complex injury. Head and neck injuries deserve special attention because of their enormous functional and esthetic significance. Contusion, abrasion, retained foreign bodies, laceration, and avulsion are some of the most frequent injuries. Impalement injuries are not so common. These lesions combine aspects of blunt and penetrating trauma and usually result from penetration by a large, rigid, blunt-tipped object that traverses a certain body area in a through-and-through fashion and often remains in situ at the time of presentation. There have been many case reports describing these injuries in the trunk and extremities; however, cases of head and neck impalement are still lacking in number. A case of an unusual cervical impalement is presented, together with a discussion of the management of this complex injury.

Etiology and Patterns of Pediatric Mandibular Fractures in Portugal: A Retrospective Study of 10 Years

OBJECTIVE

To determine the pattern of occurrence of mandibular fractures in the pediatric population in Portugal.

MATERIALS AND METHODS

This retrospective study reviews the records of patients 18 years of age or younger from the 10-year period 1993 to 2002. Age, gender, anatomic site, cause of the accident, weekly and monthly variation, location and type of fractures, presence and location of associated injuries, treatment methods, and complications were reviewed.

RESULTS

During this 10-year period, 521 patients with 681 mandibular fractures were treated. Motor-vehicle accident (MVA) was the most common (53.9% patients) cause of fracture. Almost half of the patients (48.8%) were in the oldest age group (16 to 18 years old). The condyle of the mandible was involved in 31.0% of the fractures. Maxillomandibular (MMF) fixation was used in 534 (78.4%) fractures. Overall mortality in this series was 0.6% (3 patients); mortality was caused by multiple traumas, mainly head trauma.

CONCLUSION

There is a need to reinforce legislation aimed to prevent MVA and the total enforcement of existing laws to reduce maxillofacial injuries among children and adolescents.

Efficacy of DNA–hsp65 vaccination for tuberculosis varies with method of DNA introduction in vivo

A DNA vaccine codifying the mycobacterial hsp65 can prevent infection with Mycobacterium tuberculosis in a prophylactic setting and also therapeutically reduce the number of bacteria in infected mice. The protective mechanism is thought to be related to Th1-mediated events that result in bacterial killing. To determine the best method of hsp65 introduction for vaccination efficacy against tuberculosis (TB), we evaluated the immunogenicity and protection of DNA-hsp65 administered by gene gun bombardment or intramuscular (i.m.) injection of naked DNA. Immunization by gene gun induced immune response with plasmid doses 100-fold lower than those required for intramuscular immunization. However, in contrast to intramuscular immunization, which was protective in these studies, gene gun immunization did not protect BALB/c mice against challenge infection.

Single dose of a vaccine based on DNA encoding mycobacterial hsp65 protein plus TDM-loaded PLGA microspheres protects mice against a virulent strain of Mycobacterium tuberculosis

The high incidence of tuberculosis around the world and the inability of BCG to protect certain populations clearly indicate that an improved vaccine against tuberculosis is needed. A single antigen, the mycobacterial heat shock protein hsp65, is sufficient to protect BALB/c mice against challenge infection when administered as DNA vaccine in a three-dose-based schedule. In order to simplify the vaccination schedule, we coencapsulated hsp65-DNA and trehalose dimicolate (TDM) into biodegradable poly(DL-lactide-co-glycolide) (PLGA) microspheres. BALB/c mice immunized with a single dose of DNA-hsp65/TDM-loaded microspheres produced high levels of IgG2a subtype antibody and high amounts of IFN-gamma in the supernatant of spleen cell cultures. DNA-hsp65/TDM-loaded microspheres were also able to induce high IFN-gamma production in bulk lung cells from challenged mice and confer protection as effective as that attained after three doses of naked DNA administration. This new formulation also allowed a ten-fold reduction in the DNA dose when compared to naked DNA. Thus, this combination of DNA vaccine and adjuvants with immunomodulatory and carrier properties holds the potential for an improved vaccine against tuberculosis.

VUMeF: extending the French involvement in the UMLS Metathesaurus

A considerable number of robust vocabularies and thesauri have been developed for the healthcare and biomedical domain. No single vocabulary, however; provides complete coverage of the information needs from a public health perspective. The results of an investigation of vocabulary sources for the development of a comprehensive controlled vocabulary for the public health domain at the Centers for Disease Control and Prevention (CDC) is presented.

GALEN: a third generation terminology tool to support a multipurpose national coding system for surgical procedures

Generalised architecture for languages, encyclopedia and nomenclatures in medicine (GALEN) has developed a new generation of terminology tools based on a language independent model describing the semantics and allowing computer processing and multiple reuses as well as natural language understanding systems applications to facilitate the sharing and maintaining of consistent medical knowledge. During the European Union 4 Th. framework program project GALEN-IN-USE and later on within two contracts with the national health authorities we applied the modelling and the tools to the development of a new multipurpose coding system for surgical procedures named CCAM in a minority language country, France. On one hand, we contributed to a language independent knowledge repository and multilingual semantic dictionaries for multicultural Europe. On the other hand, we support the traditional process for creating a new coding system in medicine which is very much labour consuming by artificial intelligence tools using a medically oriented recursive ontology and natural language processing. We used an integrated software named CLAW (for classification workbench) to process French professional medical language rubrics produced by the national colleges of surgeons domain experts into intermediate dissections and to the Grail reference ontology model representation. From this language independent concept model representation, on one hand, we generate with the LNAT natural language generator controlled French natural language to support the finalization of the linguistic labels (first generation) in relation with the meanings of the conceptual system structure. On the other hand, the Claw classification manager proves to be very powerful to retrieve the initial domain experts rubrics list with different categories of concepts (second generation) within a semantic structured representation (third generation) bridge to the electronic patient record detailed terminology.

Galen: a third generation terminology tool to support a multipurpose national coding system for surgical procedures

GALEN has developed a new generation of terminology tools based on a language independent concept reference model using a compositional formalism allowing computer processing and multiple reuses. During the 4th framework program project Galen-In-Use we applied the modelling and the tools to the development of a new multipurpose coding system for surgical procedures (CCAM) in France. On one hand we contributed to a language independent knowledge repository for multicultural Europe. On the other hand we support the traditional process for creating a new coding system in medicine which is very much labour consuming by artificial intelligence tools using a medically oriented recursive ontology and natural language processing. We used an integrated software named CLAW to process French professional medical language rubrics produced by the national colleges of surgeons into intermediate dissections and to the Grail reference ontology model representation. From this language independent concept model representation on one hand we generate controlled French natural language to support the finalization of the linguistic labels in relation with the meanings of the conceptual system structure. On the other hand the classification manager of third generation proves to be very powerful to retrieve the initial professional rubrics with different categories of concepts within a semantic network.

DRGs and inequities among French hospitals: from a new dilemma to another health care policy

The unpredictable French health care reform of 1995-96 introduced casemix tools to fund French hospitals at a regional level. After two years (1997-98), health care authorities and hospitals are facing great inequities and inefficiencies (1 to 3) in 22 French regions. Only one region (Ile de France, Paris) is above the national casemix index mean, the Index Synthétique d' Activité, and very few are equal to this national mean. The dilemma for most of the 22 regions under this national mean, and within a region like Rhône-Alpes (Saint Etienne), with inequities from 1 to 2, is to decide whether the main goal of the new health care policy is to reduce inequities and inefficiencies.

Improvement of in vitro and in vivo antileishmanial activities of 2', 6'-dihydroxy-4'-methoxychalcone by entrapment in poly(D,L-lactide) nanoparticles

The inhibition of intracellular Leishmania amazonensis growth by 2', 6'-dihydroxy-4'-methoxychalcone (DMC) isolated from Piper aduncum was further enhanced after encapsulation of DMC in polymeric nanoparticles. Encapsulated DMC also showed increased antileishmanial activity in infected BALB/c mice, as evidenced by significantly smaller lesions and fewer parasites in the lesions.

Galen-In-Use: using artificial intelligence terminology tools to improve the linguistic coherence of a national coding system for surgical procedures

GALEN has developed a language independent common reference model based on a medically oriented ontology and practical tools and techniques for managing healthcare terminology including natural language processing. GALEN-IN-USE is the current phase which applied the modelling and the tools to the development or the updating of coding systems for surgical procedures in different national coding centers co-operating within the European Federation of Coding Centre (EFCC) to create a language independent knowledge repository for multicultural Europe. We used an integrated set of artificial intelligence terminology tools named CLAssification Manager workbench to process French professional medical language rubrics into intermediate dissections and to the Grail reference ontology model representation. From this language independent concept model representation we generate controlled French natural language. The French national coding centre is then able to retrieve the initial professional rubrics with different categories of concepts, to compare the professional language proposed by expert clinicians to the French generated controlled vocabulary and to finalize the linguistic labels of the coding system in relation with the meanings of the conceptual system structure.

Full text multilingual automatic morphosemantems for stand-alone or Internet based applications

The authors present an automatic tool able to provide real-time morphosemantic decomposition of natural language sentences in French, German and English. This tool demonstrates the feasibility of Natural Language Processing on standard PC computers and the technology involved has been successfully implemented in daily used applications in several European hospitals. It considerably alleviates the burden of coding with various international classification and enhances the quality of the final results. This tool, delivered on PC platforms, is highly convivial and provides a versatile interface to any existing applications based on the Microsoft Windows standards. Moreover, all high levels functions have been encapsulated in Object Oriented Components and can therefore be reused using the Common Object Model standards to develop stand-alone or Internet applications.

Model-based semantic dictionaries for medical language understanding

Semantic dictionaries are emerging as a major cornerstone towards achieving sound natural language understanding. Indeed, they constitute the main bridge between words and conceptual entities that reflect their meanings. Nowadays, more and more wide-coverage lexical dictionaries are electronically available in the public domain. However, associating a semantic content with lexical entries is not a straightforward task as it is subordinate to the existence of a fine-grained concept model of the treated domain. This paper presents the benefits and pitfalls in building and maintaining multilingual dictionaries, the semantics of which is directly established on an existing concept model. Concrete cases, handled through the GALEN-IN-USE project, illustrate the use of such semantic dictionaries for the analysis and generation of multilingual surgical procedures.

Reconciling users' needs and formal requirements: issues in developing a reusable ontology for medicine

A common language, or terminology, for representing what clinicians have said and done is an important requirement for individual clinical systems, and it is a pre-requisite for integrating disparate applications in a distributed telematic healthcare environment. Formal representations based on description logics or closely related formalisms are increasingly used for representing medical terminologies. GALEN's experience in using one such formalism raises two major issues, as follows: how to make ontologies based on description logics easy to use and understand for both clinicians and applications developers; what features are required of the ontology and description logic if they are to achieve their aims. Based on our experience we put forward four contentions: two relating to each of these two issues, as follows: that natural language generation is essential to make a description logic based ontology accessible to users; that the description logic based ontology should be treated as an "assembly language" and accessed via "intermediate representations" oriented to users and "perspectives" adapting it to specific applications; that independence and reuse are best supported by partitioning the subsumption hierarchy of elementary concepts into orthogonal taxonomies, each of which forms a pure tree in which the branches at each level are disjoint but nonexhaustive subconcepts of the parent concept; that the expressivity of the description logic must include support for transitive relations despite the computational cost, and that this computational cost is acceptable in practice. The authors argue that these features will be necessary, though by no means sufficient, for the development of any large reusable ontology for medicine.

In-vivo therapeutic efficacy in experimental murine mycoses of a new formulation of deoxycholate-amphotericin B obtained by mild heating

Heat-induced 'superaggregation' of deoxycholate-amphotericin B (AmB-DOC, Fungizone) was shown previously to reduce the in-vitro toxicity of this antifungal agent. We compared AmB-DOC with the formulation obtained by heating the commercial form (Fungizone, Bristol Myers Squibb, Paris, France) for 20 min at 70 degrees C, in the treatment of murine infections. An improvement of antifungal activity was obtained with heated AmB-DOC formulations due to a lower toxicity which allowed the administration of higher drug doses than those achievable with the commercial preparation. Single intravenous injections of heated AmB-DOC solutions were demonstrated to be two-fold less toxic than unheated ones to healthy mice. For mice infected with Candida albicans, the maximum tolerated dose was higher with heated than with unheated AmB-DOC solutions. In the model of murine candidiasis, following a single dose of heated AmB-DOC 0.5 mg/kg, 85% of mice survived for 3 weeks, whereas at this dose the immediate toxicity of the standard formulation in infected mice restricted the therapeutic efficacy to 25% survival. Both formulations were equally effective in increasing the survival time for murine cryptococcal pneumonia and meningoencephalitis. Injection of heated AmB-DOC solutions at a dose two-fold higher than the maximal tolerated dose observed with the unheated preparation (1.2 mg/kg) increased the survival time by a factor of 1.4 in cryptococcal meningoencephalitis. These results indicate that mild heat treatment of AmB-DOC solutions could provide a simple and economical method to improve the therapeutic index of this antifungal agent by reducing its toxicity on mammalian cells.

Galen-In-Use: an EU Project applied to the development of a new national coding system for surgical procedures: NCAM

GALEN has developed a language independent common reference model based on a medically oriented ontology and practical tools and techniques for managing healthcare terminology including natural language processing. GALEN-IN-USE is the current phase which applied the modelling and the tools to the development or the updating of coding systems for surgical procedures in different national coding centre co-operating within the European Federation of Coding Centre (EFCC) to create a multilingual knowledge repository for multicultural Europe. NCAM (Nomenclature Commune des Actes Médicaux) is the new French multipurpose coding system for surgical procedures. The labels are processed from the intermediate dissections to the Grail representation and the natural language generation by the electronically related Medical Informatics research centres network of Saint Etienne, Manchester, Geneva and Nijmegen. The national coding centre is able to retrieve the initial labels with different categories of concepts, to compare the professional language proposed by expert clinicians to the French generated controlled vocabulary and to finalize the linguistic labels of the coding system in relation with the meanings of the conceptual system structure.

Effect of polymeric nanoparticle administration on the clearance activity of the mononuclear phagocyte system in mice

We investigated the consequences of acute and subacute administration of mice with polyisobutylcyanoacrylate (PIBCA), polyisohexylcyanoacrylate (PIHCA), poly(D,L-lactic) acid (PLA), and polystyrene (PS) nanoparticles on the mononuclear phagocyte system phagocytic function. This was done by measuring the clearance rate of colloidal carbon. Single administration of PIBCA and PIHCA (but not PLA and PS) nanoparticles reduced carbon clearance in both a time- and dose-dependent fashion. Since clearance of preopsonized carbon was normal, it was assumed that PIBCA and PIHCA nanoparticles deplete opsonins specific for carbon recognition. A decrease in plasma fibronectin levels resulting from nanoparticle administration suggested its implication in their removal from blood. However, fibronectin does not seem to be responsible for PIBCA and PIHCA blockade. Phagocytic function was preserved after repeated treatment with nanoparticles, probably as a result of increased Kupffer cell phagocytic activity and the contribution of spleen macrophages. Neither toxicity nor effects due to nanoparticle hepatic accumulation were observed.

Retrovirus budding may constitute a port of entry for drug carriers

This paper investigates the relation between viral infection and cell uptake of liposomes and nanoparticles. A defective virus was used to infect two types of cells: cells allowing virus budding (psi2neo cells) and cells bereft of a virus exit process (NIH 3T3 cells). This study has revealed that cell uptake of pH-sensitive-liposomes is highly dependent on the virus exit process, since it ensued only when virus budding occurred. This preferential uptake of pH-sensitive liposomes by infected cells was not carrier-specific because similar uptake was observed with non-biodegradable fluorescent nanoparticles using confocal microscopy. Also, inhibition of neo gene expression by oligonucleotide pH-sensitive-liposomes was only observed in the cell system (psi2neo) endowed with a virus exit process. Finally, increased membrane fluidity was noted in the infected cells, possibly reflecting membrane perturbation due to virus budding. We suggest that this membrane perturbation may be the key to the uptake of the different colloidal carriers. Infected cells could, thus, constitute a natural target for particulate drug carriers.

Development of an injectable formulation of albendazole and in vivo evaluation of its efficacy against Echinococcus multilocularis metacestode

The loading of poly (D, L-lactide) nanoparticles with ABZ has led us to evaluate the potential of this new colloidal drug delivery system against E. multilocularis, using a murine model of hepatic alveolar echinococcosis. ABZ-loaded nanoparticles had a monodisperse size distribution between 100 and 150 nm. The efficiency of drug loading to nanoparticles was over 97%. In vitro, at an ABZ concentration of 1.0 microgram ml-1, the formulation had no toxicity for peritoneal macrophages harvested from uninfected mice. In vivo, the ABZ-loaded nanoparticles exhibited no signs of toxicity at any of the doses tested. Intravenous injections of 6 mg kg-1 of bound ABZ to infected mice had an equivalent antiparasitic effect on the metacestode growth to that of a treatment with 1500 mg kg-1 of orally administered free ABZ. The parasite hepatic superficial size as well as the peritoneal metastatic burden was significantly reduced by these 2 courses of treatment, as compared to those of untreated mice. Our results should encourage further study in order to explain the absence of dose-dependent efficacy of ABZ-loaded nanoparticles demonstrated in the present study.

Studies of baby hamster kidney natural cell aggregation in suspended batch cultures

Microcarrier cultures of animal cells of industrial relevance are known to shed aggregates into the suspension phase. For a BHK cell line, which is known to be prone to aggregate naturally, microcarrier and aggregate forms of culture are compared in spinner culture. In microcarrier cultures, it is shown that increasing initial microcarrier concentration yields decreasing concentration of smaller aggregates in suspension; roughly equivalent concentrations of total cells and single cells in suspension are obtained. In the absence of Cytodex 3, aggregate final size is hydrodynamically controlled in batch and semicontinuous suspension culture. Rate of agitation is the main variable controlling aggregate size in batch cultures. The range of agitation rates studied (20 to 70 rpm in 250 mL spinner flasks) produced aggregates with maximum sizes of 200 microns. Necrotic centers were not observed; this was confirmed by Trypan blue viability measurements after mechanical dissociation of aggregates and also by the constant productivity obtained from different aggregate sizes. Comparing aggregate and microcarrier culture conditions, it is shown that at 100 rpm maximum total cell concentration is larger in the absence of microcarriers; dead cell concentrations, most of which exist in suspension, are slightly larger in microcarrier culture. Total viable cell concentrations in aggregate, hydrodynamically controlled culture, are almost one order of magnitude higher than in microcarrier cultures. These results suggest that there might be advantages in using aggregate cultures under hydrodynamic control of aggregate size in lieu of microcarrier cultures for naturally aggregating cell lines.

[Public health education and health promotion in Hungary: the role of Canada. The TEMPUS consortium for a New Public Health in Hungary]

The economy of Hungary is undergoing a major transition. The prevalence of behavioural and environmental risk factors is high. The population's health status is among the worst in Europe, and has declined in recent years. The Prussian-style curriculum in the medical universities was rigid and dictated from Budapest and Moscow. The teaching of public health was didactic, there was an emphasis on subjects such as dialectic materialism and hygiene. "Development of Medical Education for a New Public Health in Hungary", a three-year project funded by the European Community's TEMPUS program, is established to develop undergraduate and graduate education. It is a joint program between the five Hungarian medical schools and ten universities in Western countries including Canada. The reformation includes a shift from didactic teaching methods to problem-based learning techniques and greater emphasis on health promotion and population health. Communication within the project is facilitated through an electronic 'list server' based in London, Ontario.

The activity and ultrastructural localization of primaquine-loaded poly (d,l-lactide) nanoparticles in Leishmania donovani infected mice

The activity of primaquine (PQ) was compared to that of PQ-loaded Poly (D,L-Lactide) (PLA) nanoparticles against Leishmania donovani. The association of PQ with PLA nanoparticles increased the antileishmanial in vitro and in vivo effects of intravenously administered drug while its toxicity was reduced. The effectiveness of PQ-loaded PLA nanoparticles was 3.3 times as high as that of free drug in the suppression of amastigotes in the liver of BALB/c mice. A total dose of 30 mg PQ bound/kg (600 mg PLA/kg) was well tolerated and no sign of acute toxicity was observed. A similar dose of free drug resulted in 15% weight loss. No significant leishmanicidal activity was observed for unloaded PLA nanoparticles. Ultrastructural studies showed the uptake of drug-loaded nanoparticles by Leishmania-infected Kupffer cells. Nanoparticles were identified closed to amastigotes.

[DRGs in Europe]

DRG projects developments in Europe are shown since 1982 until 1989 being much similar in Western Europe different countries just as Prospective Payment System was implemented in the US International intergovernmental organizations like Council of Europe, OECD, WHO Europe and European Economic Community have supported and support the new system. Diagnostics and procedures coding was the main technical issue and European countries found different ways to cope with. How to use DRGs in Europe is still the main challenge. The European use is mainly in favour of internal management, planning, performance measurement but recently the most advanced projects have decided to relate partly hospital budget to case mix bases on DRGs as an incentive to greater efficiency.