An overview of the CERC ARTEMIS project

The basic premise of this effort is that health care can be made more effective and affordable by applying modern computer technology to improve collaboration among diverse and distributed health care providers. Information sharing, communication, and coordination are basic elements of any collaborative endeavor. In the health care domain, collaboration is characterized by cooperative activities by health care providers to deliver total and real-time care for their patients. Communication between providers and managed access to distributed patient records should enable health care providers to make informed decisions about their patients in a timely manner. With an effective medical information infrastructure in place, a patient will be able to visit any health care provider with access to the network, and the provider will be able to use relevant information from even the last episode of care in the patient record. Such a patient-centered perspective is in keeping with the real mission of health care providers. Today, an easy-to-use, integrated health care network is not in place in any community, even though current technology makes such a network possible. Large health care systems have deployed partial and disparate systems that address different elements of collaboration. But these islands of automation have not been integrated to facilitate cooperation among health care providers in large communities or nationally. CERC and its team members at Valley Health Systems, Inc., St. Marys Hospital and Cabell Huntington Hospital form a consortium committed to improving collaboration among the diverse and distributed providers in the health care arena. As the first contract recipient of the multi-agency High Performance Computing and Communications (HPCC) Initiative, this team of computer system developers, practicing rural physicians, community care groups, health care researchers, and tertiary care providers are using research prototypes and commercial off-the-shelf technologies to develop an open collaboration environment for the health care domain. This environment is called ARTEMIS--Advanced Research TEstbed for Medical InformaticS.

[Careful dissection of the pelvic plexus helps alleviate urinary retention following radical hysterectomy]

Radical hysterectomy remains to be the treatment of choice for carcinoma of the uterine cervix. As pelvic nerve plexuses are distributed in the operative field, damage to the plexuses is likely to occur, which is responsible for the post-operative atonia of the urinary bladder and urinary retention. To reduce the incidence of this postoperative complication, the composition and distribution of the pelvic nerve plexuses in relation to the utero-sacral ligament and cardinal ligament of the uterus and paravaginal tissues were carefully dissected on 11 adult female cadavers. Based on the anatomic study, due precautions were made to avoid damage to the pelvic nerve plexuses during pelvic dissection for radical hysterectomy. As a result, the duration of postoperative urinary retention was significantly reduced while the 5- and 10-year survival rates remained unchanged.

Response to HMG CoA reductase inhibitors in heterozygous familial hypercholesterolemia due to the 10-kb deletion ("French Canadian mutation") of the LDL receptor gene

The 10-kb deletion ("French Canadian mutation") of the low-density lipoprotein (LDL) receptor gene is the most common mutation causing familial hypercholesterolemia among subjects of French Canadian descent. In affected subjects, it results in a null allele of the LDL receptor gene and provides a unique opportunity to examine single-allele regulation of this gene in humans. We sought to ascertain the response of inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase in subjects with the French Canadian mutation of the LDL receptor gene and to correlate this response with biochemical variables and the haplotype of the nondeletion LDL receptor allele. The prevalence of non-responders to high doses of HMG CoA reductase inhibitors (defined as < 15% decrease in LDL cholesterol [LDL-C] from baseline values after dietary intervention) was ascertained in 105 patients heterozygous for the 10-kb deletion after excluding first-degree relatives and those on combined lipid-lowering therapy or other lipid-lowering agents. Lipoprotein cholesterol levels were examined after a diet period (30% calories as fat) and after receiving HMG CoA reductase inhibitors as mono-therapy for a minimum of 3 months. The mean reduction in total cholesterol was 45 +/- 23%, in LDL-C 33 +/- 15%, and in triglycerides 32 +/- 49% (all P < .005). There was a slight increase in high-density lipoprotein cholesterol of 8.5 +/- 18% (P > .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Aspirin versus heparin to prevent myocardial infarction during the acute phase of unstable angina

BACKGROUND

Antiplatelet therapy with aspirin and antithrombotic therapy with heparin both prevent the complications of unstable angina; however, no definitive data exist on the relative clinical efficacy of the two drugs.

METHODS AND RESULTS

Aspirin (325 mg bid) or heparin (5000-U intravenous bolus followed by a perfusion titrated to the APTT) were compared in a double-blind randomized trial of 484 patients in two cohorts enrolled sequentially. The study was initiated at admission to hospital at a mean of 8.3 +/- 7.8 hours after the last episode of pain. End points were assessed 5.7 +/- 3.3 days later, when the decision for long-term management was made. Myocardial infarction occurred in 2 (0.8%) of the 240 patients randomized to heparin and in 9 (3.7%) of the 244 randomized to aspirin (P = .035), an odds ratio of 0.22 and a risk difference of 2.9% (95% confidence limits, 0.3% to 5.6%) with heparin. The only death resulted from a myocardial infarction in an aspirin patient. Survival curves with Cox logistic regression analysis showed that the improvement in survival without myocardial infarction with heparin (P = .035) was independent of other baseline characteristics.

CONCLUSIONS

This study documents that heparin prevents myocardial infarction better than aspirin during the acute phase of unstable angina.

[Clinical analysis of the outcome of pregnancy with chronic renal disease]

Seventy-six cases of pregnancy with chronic renal disease, from Jan. 1971 to April 1992, were analysed. According to the value of serum creatinine, these cases were divided into four groups, i.e. normal, mild, moderate and severe renal insufficiency. The pregnancy outcome in the first two groups was satisfactory and that in the moderate and severe groups were poor. The prognosis was even worse when it complicated by chronic hypertension. Among the last two groups, 78.8% cases had superimposed preeclampsia, and 24.2% had deteriorated renal function. The perinatal mortality rate was 121.2/1000. The results suggested that the prognosis for mother and maternity baby is closely related to mother's renal function and whether chronic hypertension is complicated preeclampsia is the direct factor resulting deterioration of renal function. It was considered that if serum creatinine > 132.6 mumol/L and complicated by chronic hypertension, pregnancy must be avoided. If renal function is deteriorating, pregnancy must be interrupted.

[Antimicrobial activity of clarithromycin and its effect on bacterial adherence to medical material]

Antimicrobial activity of clarithromycin (CAM) in comparison with other 6 macrolides was determined against 419 recent clinical isolates including Streptococci, Enterococci, Staphylococci, Moraxella, Haemophilus and Bacteroides strains. MICs80's of CAM against Streptococcus pneumoniae, Streptococcus pyogenes and Streptococcus agalactiae were 0.78, 0.10 and 0.10 microgram/ml, respectively. MICs80's against Moraxella catarrhalis and Haemophilus influenzae were 0.05 and 1.56 micrograms/ml, respectively. Laboratory-induced resistance to CAM in strains of S. pneumoniae, Enterococcus faecalis or methicillin-sensitive Staphylococcus epidermidis occurred in stepwise fashion and at a very low rate. Adherence to silicon filter of strains of Pseudomonas aeruginosa or S. epidermidis was strongly repressed by the addition of sub-MIC of CAM or other macrolides. Although tosufloxacin (TFLX) alone had no bactericidal activity against the sessile cells of P. aeruginosa strains tested, TFLX showed synergistic bactericidal activity when combined with sub-MICs of CAM or erythromycin.

Plasma endothelin-1 levels in stable and unstable angina

Plasma levels of endothelin-1 are elevated in acute myocardial infarction with higher levels in complicated infarctions. Measurements of levels in unstable angina could help clarify whether the elevation is the consequence of cell necrosis or is in some way related to the pathophysiology of acute coronary syndromes. Plasma endothelin-1 levels were determined by radioimmunoassay in 29 patients with unstable angina and 6 with a myocardial infarction. Blood samples were obtained at admission before drug administration and 6 and 72 h later. Levels were also determined in 27 control subjects and in 29 patients with stable angina. Admission levels were similar in unstable angina, 0.635 +/- 0.052 pg/ml [log(1 + x)], and myocardial infarction, 0.746 +/- 0.122, and significantly higher than in controls, 0.428 +/- 0.047, and stable angina patients, 0.449 +/- 0.052 (p < 0.01). In unstable angina, levels decreased progressively to normal at 6 h, 0.557 +/- 0.049 pg/ml, and 72 h 0.474 +/- 0.054, as opposed to an increase to 0.868 +/- 0.109 (p < 0.05) after 6 h in myocardial infarction followed by a decrease to 0.597 +/- 0.122 at 72 h. The elevation in unstable angina did not correlate with other clinical or laboratory characteristics. Unstable angina is associated with an increase in endothelin-1 plasma levels during the acute phase, suggesting a role of this endothelium-derived vasoactive peptide in the pathophysiology of acute coronary artery syndromes.

[Effect of radix Astragali and radix ginseng in enhancing the metabolism of human myocardial cells in vitro]

Our experiment indicated that in Radix Astragali and Radix Ginseng treated human myocardial cell cultures the level of LDH and SDH elevated in varying degrees and in Radix Ginseng treated cells the cAMP showed higher levels but in Radix Ginseng treated ones the same was not observed. This suggests that the metabolism of myocardial cells is enhanced by Radix Astragali or Radix Ginseng.

[Microscopic study of the arch structure of trabeculae in normal and necrotic femoral heads]

The trabeculae structure in normal and necrotic femoral heads was studied by means of scanning electron microscope. In normal femoral heads, most of the trabeculae were seen in the form of arch structure, and in which the mineral columns were arranged in different directions on different layers. In necrotic femoral heads, the arch structure of trabeculae and the arrangement of the mineral columns over unresorbed area were practically normal, but over the resorbed area, the arch structure of trabeculae was broken and collapsed, and the mineral columns were sparse and disorganized. These findings provide a new explanation of the capability of the femoral head to bear high stress and also of the mechanism of its collapse after necrosis.