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Subsequent Treatment (subsequent + treatment)
Selected AbstractsA Case of Multiple Keratoacanthoma Centrifugum MarginatumDERMATOLOGIC SURGERY, Issue 5 2004Cristina Mangas MD Background. Keratoacanthoma centrifugum marginatum is a rare variety of keratoacanthoma, usually presented and classified as solitary keratoacanthoma. Reported cases of multiple keratoacanthoma centrifugum marginatum are exceptional in the literature. Observations. A 21-year-old man presented for evaluation of erythematous papules and plaques on both legs that had had a peripheral growth over the past year. Clinical and histologic examination showed typical features of keratoacanthoma centrifugum marginatum. Owing to the multiplicity and size of the lesions, treatment with oral isotretinoin was started. It was ineffective. Subsequent treatment with methotrexate combined with oral prednisone led to the regression of all lesions. Conclusions. The exceptional case of a man with multiple keratoacanthoma centrifugum marginatum is reported. Treatment with methotrexate combined with oral prednisone was effective. This case illustrates how some variants of keratoacanthomas do not really fit into the current classification and how complex the treatment of these tumors is. [source] Decreased Tear Expression with an Abnormal Schirmer's Test Following Botulinum Toxin Type A for the Treatment of Lateral Canthal RhytidesDERMATOLOGIC SURGERY, Issue 2 2002Seth L. Matarasso MD background. Inactivation of muscles of facial expression by chemodenervation with botulinum toxin remains an off-label indication. Nevertheless, it continues to be a safe and effective technique to improve dynamic rhytides and is the treatment of choice for the hypertrophic lateral fibers of the orbicularis oculi muscle that can cause the superimposed crow's feet. objective. Although infrequent and self-limiting, the complication of unexpected muscle weakness from toxin diffusion or erroneous placement is documented. methods. However, injection into the pretarsal portion of the orbicularis oculi muscle resulting in unilateral ocular irritation and diminished tear expression as evidenced by a dry eye and an abnormal Schirmer's test has rarely been reported. Direct injection into the pretarsal fibers of the muscle as opposed to diffusion of the toxin into the muscle fibers or the lacrimal gland was consistent with the onset of action of the toxin and the prolonged duration of the ocular symptoms. results. Treatment consisted of ocular lubrication until the effects of the toxin dissipated and muscle tone returned. Subsequent treatment did not result in a result in a recurrence of adverse sequelae. conclusions. Facial muscles are small, not isolated, and often have fibers that interdigitate. An important factor in the administration of botulinum toxin is the identification of the muscles responsible for the corresponding rhytide. Precise knowledge of muscular anatomy and function will aid in minimizing this and other potential complications. [source] Dinuclear Potassium-Chromium and Potassium-Tungsten Carbonyl ComplexesEUROPEAN JOURNAL OF INORGANIC CHEMISTRY, Issue 5 2004Vladimir Kirin Abstract The tetracarbonyl complexes [M(CO)4{,2 -(Ph2P)2NH}] [M = Cr (1a), W (1b)] have been synthesised by reaction of M(CO)6, Me3NO·2H2O, and (Ph2P)2NH. Subsequent treatment of complexes 1a,b with an excess of KH in THF at room temperature yields the potassium salts [Cr(CO)4{,2 -(Ph2P)2N}K(THF)3]n (2a) and [W(CO)4{,2 -(Ph2P)2N}K(THF)2]n (2b), respectively, in almost quantitative yields. The ionic compounds 2a,b are stable at room temperature. All four compounds 1a,b and 2a,b were characterised by single-crystal X-ray diffraction. Compounds 2a,b form infinite chains via isocarbonyl bridges in the solid state. (© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2004) [source] Selective Synthesis of 1,4-Dialkylbenzenes from Terephthalic AcidADVANCED SYNTHESIS & CATALYSIS (PREVIOUSLY: JOURNAL FUER PRAKTISCHE CHEMIE), Issue 13 2010Andrea Bramborg Abstract Terephthalic acid reacts with alkyl halides under Birch conditions to substituted 1,4-cyclohexadienes in high yields and good stereoselectivities. Electrophiles containing ester or nitrile groups undergo a surprising fragmentation under the reaction conditions. Subsequent treatment with chlorosulfonic acid proceeds by an interesting tandem decarbonylation/decarboxylation, affording 1,4-dialkylbenzenes in excellent regioselectivity. Thus our new method is superior to classical Friedel,Crafts alkylations. [source] Promotion of axonal maturation and prevention of memory loss in mice by extracts of Astragalus mongholicusBRITISH JOURNAL OF PHARMACOLOGY, Issue 5 2006C Tohda Background and purpose: Neurons with atrophic neurites may remain alive and therefore may have the potential to regenerate even when neuronal death has occurred in some parts of the brain. This study aimed to explore effects of drugs that can facilitate the regeneration of neurites and the reconstruction of synapses even in severely damaged neurons. Experimental approach: We investigated the effects of extracts of Astragalus mongholicus on the cognitive defect in mice caused by injection with the amyloid peptide A,(25-35). We also examined the effect of the extract on the regeneration of neurites and the reconstruction of synapses in cultured neurons damaged by A,(25-35). Key results: A. mongholicus extract (1 g kg,1 day,1 for 15 days, p.o.) reversed A,(25-35)-induced memory loss and prevented the loss of axons and synapses in the cerebral cortex and hippocampus in mice. Treatment with A,(25-35) (10 ,M) induced axonal atrophy and synaptic loss in cultured rat cortical neurons. Subsequent treatment with A. mongholicus extract (100 ,g/ml) resulted in significant axonal regeneration, reconstruction of neuronal synapses, and prevention of A,(25-35)-induced neuronal death. Similar extracts of A. membranaceus had no effect on axonal atrophy, synaptic loss, or neuronal death. The major known components of the extracts (astragalosides I, II, and IV) reduced neurodegeneration, but the activity of the extracts did not correlate with their content of these three astragalosides. Conclusion and implications: A. mongholicus is an important candidate for the treatment of memory disorders and the main active constituents may not be the known astragalosides. British Journal of Pharmacology (2006) 149, 532,541. doi:10.1038/sj.bjp.0706865 [source] Hair Growth Induced by Diode Laser TreatmentDERMATOLOGIC SURGERY, Issue 5 2005Eric F. Bernstein MD background. Although hair reduction by long-pulsed red and infrared lasers and light sources is generally quite effective, paradoxical hair growth has rarely been observed following treatment. objective. To report a case of thick hair growth following 810 nm diode laser treatment and its subsequent treatment. methods. A 24-year-old man who had previously had laser hair reduction on his posterior neck was treated to a test area on his upper back. results. Thick terminal hair developed in the treated area subsequent to laser treatment. Further treatment of this area removed the terminal hair but resulted in terminal hair growth in an annular distribution surrounding the treatment site. conclusions. Diode laser treatment rarely stimulates terminal hair growth. This phenomenon should be studied to better understand hair growth cycles and to help develop more effective treatments for hair loss and hair growth. [source] The Relative Influence of Epileptic EEG Discharges, Short Nonconvulsive Seizures, and Type of Epilepsy on Cognitive FunctionEPILEPSIA, Issue 1 2004Albert Aldenkamp Summary: Purpose: This study addressed whether cognitive impairment in children with epilepsy is caused by disease-related stable factors, such as the type of epilepsy, or by acute effects of paroxysmal epileptic activity such as epileptic EEG discharges. We studied a nonselected group with short nonconvulsive seizures, as these seizures may elude detection and may therefore persist over a longer period. In this group, the diagnostic issue is to differentiate between the combined effects of several epilepsy-related factors on cognition. Methods: All children were assessed with 32-channel EEG, synchronized with a computerized cognitive test system and a video-monitoring system. Recording time was 2 h. The primary inclusion criteria were unclear seizures and fluctuations in cognitive performance and/or frequent epileptic EEG discharges in a recent EEG. Results: One hundred fifty-two patients met the inclusion criteria; 31 patients appeared not to have a diagnosis of epilepsy and were used as a nonepilepsy control group. Our results show that type of epilepsy has an impact on stable cognitive functions, such as educational achievement. Paroxysmal epileptic activity (acute effects of seizures and epileptic EEG discharges) affects primarily transient mechanistic cognitive processes (alertness, mental speed). Conclusions: These results suggest that the effects of paroxysmal epileptic activity on transient cognitive mechanisms may accumulate over time and consequently affect the more stable aspects of cognitive function such as educational achievement. The clinical relevance is that early detection of the cognitive impact of seizure-related activity and subsequent treatment may prevent its detrimental impact on cognitive and educational development. [source] Total Synthesis of Silyl-Protected Early Intermediates of Polyketide Biosynthesis,EUROPEAN JOURNAL OF ORGANIC CHEMISTRY, Issue 16 2010Karsten Krohn Abstract The ketal- or dithioketal-protected isocoumarins 15,18 gave the corresponding 1-naphthols 21,26 in their reactions with the acetoacetate (10) or pentane-2,4-dione (19) dianions and the acetone monoanion. Subjection of the dithioketal-protected ester 28 to Baker,Venkataraman reaction conditions led to the 8-deoxy tautomeric, protected forms 29/30 of the early decaketide antibiotic intermediate 2b. However, the dithioketal protecting groups could not be removed without destruction of the molecule. Consequently the silyl-protected unstable early tri- and tetracyclic decaketide biosynthesis intermediates 37a, 37b, and 38a (precursors of angucycline and anthracycline antitumor antibiotics) were prepared through silylation of 33a and 33b, to afford 34a and 34b, and subsequent treatment with acetylacetone dianion. The ultimate synthetic goal, the silyl-protected 2,3-dialkylated naphthol derivative 41, was achieved by selective elongation of the bottom chain of the bis-silyl-protected methyl ester 36 with acetylacetone dianion. [source] Patterns of pseudo-reticulocytosis in malaria: fluorescent analysis with the Cell-Dyn® CD4000INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 1 2002C. S. SCOTT This study of Plasmodium falciparum malaria evaluated patterns of fluorescent reticulocyte measurements as determined with the Abbott Cell-Dyn® CD4000. The parasitaemia of positive samples (n=180) ranged from 0.04% to 25.5%, with those (19/180) showing gametocytes having lower parasitaemia levels (mean 0.31%, median 0.2%) compared to those that did not (mean 2.59%, median 0.8%). There was a reasonable association (R2=0.60) between parasitaemia level and CD4000 reticulocyte percentages, although there was overall a small statistical bias towards higher parasitaemia estimates determined microscopically. Consistently high immature reticulocyte fraction (IRF) values of >0.5 were observed in cases with a parasitaemia exceeding 5%, while samples with lower parasitaemia levels showed more variable IRF values. Visual examination of CD4000 reticulocyte histograms revealed that 81/100 malaria-positive samples with an IRF above 0.5 showed the presence of a fluorescent population `spike' consistent with the staining of intracellular malaria parasites. Only three of the 80 malaria-positive samples with an IRF below 0.5, and none of the 237 malaria-negative samples, showed this histogram pattern. These observations indicate that samples with malaria parasites give erroneously high CD4000 reticulocyte estimates that essentially comprise the sum total of true reticulocytes and parasite-infected red cells (pseudo-reticulocytes). This limitation is common to all automated reticulocyte procedures but recognizing the differences between homogenous staining parasitized red cells and heterogeneous staining reticulocytes has potential applications in monitoring parasitaemia levels both at patient presentation and during subsequent treatment. [source] Decolourisation of aqueous dyes by sequential oxidation treatment with ozone and Fenton's reagentJOURNAL OF CHEMICAL TECHNOLOGY & BIOTECHNOLOGY, Issue 7 2002M Mahbubul Hassan Abstract Combined oxidation with ozone and Fenton's reagent (,Fentozone' process) for decolourisation of aqueous dyes was studied and compared with traditional Fenton's reagent. Although the ,Fentozone' process was found to be effective at a wide range of pH values, the maximum colour removal was achieved at pH 4. The effect of pre-ozonation on colour removal efficiency of aqueous dyestuffs in the subsequent treatment with Fenton's reagent was investigated. The reaction kinetics using water-soluble acid and reactive dyes were also studied. Our experimental results show that pre-ozonation can considerably accelerate decomposition of dyestuffs in the subsequent treatment with Fenton's reagent. Different concentrations of ferrous sulfate were used to investigate their influences on the removal of colour. The rate of reaction increased with increasing doses of ferrous sulfate. © 2002 Society of Chemical Industry [source] Myxoid liposarcoma of the oral cavity with involvement of the periodontal tissuesJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2 2001Gianfranco Favia Abstract Background, aims: Liposarcoma is the 2nd most frequent soft tissue sarcoma in adults, but it is extremely rare in the head and neck and, particularly, in the oral cavity. We report on a 25-year-old female who presented with a periodontal mass, extended from the right upper 3rd molar to the right upper 2nd premolar, covered by intact oral mucosa. The clinical differential diagnosis included peripheral giant cell granuloma, salivary gland neoplasms, squamous cell carcinoma of the gingiva, sarcoma and malignant lymphoma. Methods: To accurately plan subsequent treatment, an excisional biopsy was performed and a myxoid liposarcoma was diagnosed. Consequently, the patient underwent wide excision of the neoplasm with maxillary en-block resection. Results: The post-operative course was uneventful and the patient is alive and well 8 years after the original diagnosis. The authors stress the importance of considering soft tissue sarcomas in the diagnostic approach to patients with unusual periodontal neoplasms and to plan adequate surgical sampling of the lesion (i.e. excisional biospy). Conclusions: This appears of pivotal importance as more limited specimens may result in inaccurate pre-operative diagnosis. [source] Integrative outpatient treatment for returning service membersJOURNAL OF CLINICAL PSYCHOLOGY, Issue 8 2008Sonja V. Batten Abstract Veterans returning from Operations Enduring and Iraqi Freedom (OEF/OIF) frequently present with multiple psychological and physical symptoms. The authors propose an innovative approach in which primary care providers, polytrauma specialists, vocational rehabilitation specialists, and mental health clinicians work together to provide care that is not simply concurrent, but truly integrated. All members of this interdisciplinary team must provide a consistent message that supports treatment engagement and progress. The authors illustrate this approach with a case report of a soldier deployed to both OEF and OIF, requiring subsequent treatment for joint pain, headaches, mild traumatic brain injury, posttraumatic stress disorder, depression, and substance abuse. Despite the emphasis on early intervention, treatment engagement and retention remain challenges in this population. © 2008 Wiley Periodicals, Inc. J Clin Psychol: In Session 64:1,12;, 2008. [source] Experiences of diagnosis and treatment among people with multiple sclerosisJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2008Rhiannon G. Edwards MSc Abstract Rationale, aims and objectives, The aim of this qualitative study was to examine patients' experiences of being diagnosed with multiple sclerosis (MS), the information that they were given at this time, subsequent treatment and its impact on their lives. Method, Data were collected through semi-structured interviews with 24 people with MS. The use of interviews allowed participants' experiences to be explored in depth. Participants were recruited by the MS Society through membership details and through a press release in a local newspaper. Telephone interviews lasted between 30 and 60 minutes, were tape-recorded and transcribed verbatim. Data were analysed using thematic content analysis. Results, The majority of participants were female (n = 17), with ages ranging from 35 to 72 years. Disease duration ranged from 1 to 37 years. Many participants' diagnosed before and after 2000 had experienced long delays in diagnosis. At the point of diagnosis, participants had to make sense of and understand their diagnosis often with insufficient support. Some participants expressed anger about the way they had been given their diagnosis. Many felt they had not received sufficient information about their illness at this time and had responded by conducting their own searches for information to satisfy this need. Conclusion, Improving the way in which doctors communicate with patients experiencing diagnostic delay and at the point of diagnosis deserves further study, in order to avoid later adjustment problems. [source] Synthesis and biological evaluation of novel methylene-bis-[1,5]-benzodiazepinesJOURNAL OF HETEROCYCLIC CHEMISTRY, Issue 4 2008M. Raghu A series of novel methylene-bis-chalcones 3 was prepared by the reaction of 5-(3-formyl-4-hydroxybenzyl)-2-hydroxy benzaldehyde 2 with different acetophenones, subsequent treatment of compound 3 with an appropriate o -phenylenediamine gave the corresponding methylene-bis-[1,5]-benzodiazepines 4/5 in good yields. Characterization of the new compounds has been done by means of IR, 1H NMR, MS and elemental analyses. The antibacterial and antifungal activity of the compounds has also been evaluated. [source] Fused quinoline heterocycles VI: Synthesis of 5H -1-thia-3,5,6-triazaaceanthrylenes and 5H -1-thia-3,4,5,6-tetraazaaceanthrylenesJOURNAL OF HETEROCYCLIC CHEMISTRY, Issue 4 2005Ramadan Ahmed Mekheimer Ethyl 3-amino-4-chlorothieno[3,2-c]quinoline-2-carboxylate (4) is a versatile synthon, prepared by reacting an equimolar amount of 2,4-dichloroquinoline-3-carbonitrile (1) with ethyl mercaptoacetate (2). Ethyl 5-alkyl-5H -1-thia-3,5,6-triazaaceanfhrylene-2-carboxylates 9a-c, novel perianellated tetracyclic heteroaro-matics, were prepared by refluxing 4 with excess of primary amines 7a-c to yield the corresponding amino-thieno[3,2-c]quinolines 8a-c. Subsequent reaction with an excess of triethyl orthoformate (TEO) furnished 9a-c. Reaction of 4 with TEO in Ac2O at reflux, gave the simple acetylated compounds, thieno[3,2- c]-quinolines 12 and 13. Refluxing 4 with benzylamine (7d) gave 10, and subsequent treatment with TEO gave the tetracyclic compound 11. Refluxing 13 with an excess of alkylamines 7a-d gave the fhieno[3,2- c]quino-lines 15. Refluxing the aminothienoquinolines 8b with an excess of triethyl orthoacetate gave thieno[3,2- c]quinoline 17, while heating with Ac2O gave 18 and 19, with small amounts of 16. Reaction of 8a,b with ethyl chloroformate and phenylisothiocyanate generated the new 1-thia-3,5,6-triazaaceanthrylenes 20a,b and 21a,b, respectively. Diazotization of 8a-c afforded the novel tetracyclic ethyl 5-alkyl-5H -1-fhia-3,4,5,6-tetraazaaceanthrylene-2-carboxylates 22a-c in good yields. [source] PREDICTING 2-YEAR MARITAL SATISFACTION FROM PARTNERS' DISCUSSION OF THEIR MARRIAGE CHECKUPJOURNAL OF MARITAL AND FAMILY THERAPY, Issue 4 2002Christina B. Gee This study tested whether the observed marital interactions of partners follwing a marriage checkup predicted marital satisfaction 2 years later. In addition, this study examined whether recommendations to pursue therapy predicted subsequent treatment seeking and whether changes in marital distress follwing the checkup remained stable over 2 years. Results suggest that the affective tone of a couple's interaction predicts later marital satisfaction. Further, receiving a treatment recommendation predicted subsequent treatment seeking for wives. Finally, support was found for the hypothesis that changes in marital distress are self-sustaining. [source] Aortic Dissection Presenting as an Acute Ischemic Stroke for ThrombolysisJOURNAL OF NEUROIMAGING, Issue 3 2005Ken Uchino MD ABSTRACT Thrombolysis for the treatment of acute ischemic stroke requires careful selection of patients. The authors report a case of aortic dissection presenting with acute ischemic stroke for which emergent ultrasonographic evaluation was helpful in the diagnosis and subsequent treatment. The patient presented with acute middle cerebral artery ischemic stroke symptoms and complained of bilateral ear and chest pain. Chest x-ray, cardiac enzymes, and transthoracic echocardiogram were normal, and she was considered for thrombolytic therapy. Carotid ultrasound revealed right common carotid occlusion that led to the diagnosis of aortic dissection, confirmed by chest computed tomography. An experienced sonographer with skills to perform rapid intra- and extracranial examinations may help to change the treatment plan for acute stroke patients. [source] Possible association between screening BV at the prenatal visit and reduced cervical cerclage: Multi-center questionnaire in Hokkaido, JapanJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 2 2009Satoshi Shimano Abstract Aims:, To study the screening frequency for cervical cancer, Chlamydia trachomatis (CT) infection, and bacterial vaginosis (BV) among pregnant women, and to study the association between administration of these three screening tests and performance of cervical cerclage (CC) in Hokkaido during 2004. Methods:, Questionnaires were mailed to 70 clinics providing prenatal care only and to 113 hospitals providing prenatal care and performing deliveries. Responses were obtained anonymously. Results:, A total of 6744 pregnant women received prenatal care at the 36 responding clinics and 24 050 deliveries were performed at the 56 hospitals. The percentage of clinics that screened all pregnant women for cervical cancer, CT infection or BV was 66.7%, 69.4% and 33.3%, respectively, and the corresponding percentages among the hospitals were 87.5%, 87.5% and 57.1%, respectively. Pregnant women found to have CT infection or BV, were all treated. Screening for cervical cancer or CT infection was not associated with the frequency of CC. On the other hand, screening for BV was significantly associated with the frequency of CC (P = 0.0006). The frequency of emergency CC was 0.8% among women who received prenatal care at hospitals that did not perform BV screening, while it was only 0.2 or 0.3% among women who received prenatal care at hospitals that performed BV screening on all pregnant women or on those women who were suspected of having BV, respectively. Conclusion:, Our results suggest that the frequency of emergency CC may be reduced in women who receive BV screening and subsequent treatment of positive cases during pregnancy. [source] Ring-opening graft copolymerization of epoxide with polyaniline: Chemical properties and lithium ionic conductivity of the copolymerJOURNAL OF POLYMER SCIENCE (IN TWO SECTIONS), Issue 18 2001Isao Yamaguchi The NaH-promoted deprotonation of leucoemeraldine base polyaniline (LEB) and its subsequent treatment with phenyl glycidyl ether (PGE) caused the ring-opening polymerization of PGE to give a graft copolymer (LEB- g -PGE). LEB- g -PGE was soluble in acetone and chloroform, which were poor solvents for LEB. An LEB- g -PGE/LiBF4 composite film was obtained through the evaporation of a dimethylformamide solution containing LEB- g -PGE and LiBF4; the film showed an electroconductivity of 1.0 × 10,6 S cm,1 at 295 K, as determined by complex impedance analysis. [source] Are chronic fatigue syndrome and fibromyalgia the same?JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 10 2009Implications for the provision of appropriate mental health intervention Accessible summary ,,This paper views the historical perspectives of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and fibromyalgia (FM) that gives an understanding of the background to these complex syndromes. ,,The relationship between CFS/ME and FM are considered based on the evidence presented, which identifies that there is compelling evidence that these two syndromes may in fact be the same. This is interesting as current evidence suggests that these two syndromes are currently treated differently. ,,The long-standing controversy surrounding the aetiology CFS/ME is discussed in relation to the issues of mental health, in particular anxiety and/or depression that has been associated with this condition. In contrast, FM is reviewed in relation to the associated symptomology of anxiety and/or depression. ,,This review provides the reader with compelling evidence to suggest that the initial presenting symptoms of these two diseases may dictate differential diagnosis and the subsequent treatment they receive if any and, moreover, if indeed these syndromes are confused with that of a psychiatric disorder. ,,This paper will give the reader time for thought over the issue that: just because there is at present no specific diagnostic test or treatment for this condition, why then is the conclusion reached that this must be a psychiatric condition. Abstract Chronic fatigue syndrome and fibromyalgia represent distinct diagnostic entities within both the clinical and research literature. A common feature of both presentations is that they are often accompanied by a significant mental health burden. A further salient feature of both conditions is that there is no consistent consensus on aetiology. Evaluation of the features of each disorder seems to present a convincing case that both disorders may indeed have a common aetiology and further, the possibility exists that chronic fatigue syndrome and fibromyalgia represent the same underlying disorder. Paradoxically, given this possibility it is remarkable that both patient groups are treated clinically with considerably different approaches to care and management. Mental health practitioners will come into contact with both groups of patients when support for the psychological consequences of diagnosis are necessary; however, many practitioners will be unaware of the debate regarding the aetiological ambiguities surrounding these presentations. The purpose of this review is to highlight the above issues in order to both facilitate awareness of the current aetiological/diagnostic impasse and facilitate provision of optimum mental health support. [source] Trauma in organizations: Prevention and treatment with emergent strategies from alternative psychologyJOURNAL OF PSYCHOLOGICAL ISSUES IN ORGANIZATIONAL CULTURE, Issue 1 2010John Hartung Ph.D. Effective organizations intend to select employees who are already emotionally healthy and can be resilient in the face of difficult challenges. There is also growing interest in helping employees learn to be even more resilient, on the principle that prevention is preferred to subsequent treatment. Plans are also made for treatment for situations where selection and prevention efforts prove inadequate and when employees become negatively affected by difficult events. This article describes innovative strategies that can be used for both prevention and treatment. [source] Injury Risk Among Medically Identified Alcohol and Drug AbusersALCOHOLISM, Issue 1 2001Ted R. Miller Background: Although nonfatal injury prevalence is higher among substance abusers than in the general population, few studies have estimated the injury risk for clinically recognized substance abusers. The extant studies, moreover, analyze rates of visits for injury treatment rather than rates of injury events. This study estimates the excess risk of medically treated and hospitalized nonoccupational injury for people under age 65 with medically identified substance abuse problems and private health care coverage. Method: We conducted a retrospective cohort study by using medical claims data from Medstat Systems, Inc., with a longitudinal database of health care claims for 1.5 million people with health care coverage from 70 large corporations. Claims histories for anyone who had an alcohol-related or drug-related primary or secondary diagnosis during 1987 to 1989 were analyzed. A random sample was selected from the remaining people without a substance abuse diagnosis in their medical records. Injury rates were compared among groups. We used logistic regression to estimate odds of medically treated and hospitalized injury, controlling for demographics. Results: Medically identified substance abusers had an elevated risk of injury in a 3-year period; alcohol and drug abusers had the highest risk (58%), followed by drug-only abusers (49%), alcohol-only abusers (46%), and controls (38%). Alcohol and drug abusers were almost four times as likely to be hospitalized for an injury in a 3-year period when compared with controls. Injury risks were elevated substantially more for female then male substance abusers. Conclusions: This study greatly improves on available information about the risk of injury for drug and multiple-substance abusers. Medically identified substance abusers, especially adult women, have a higher probability of injury, more hospitalized injuries, and more injury episodes per person injured than nonabusers. More aggressive identification and subsequent treatment of female substance abusers appear warranted. [source] Management of bacterial peritonitis and exit-site infections in continuous ambulatory peritoneal dialysis,NEPHROLOGY, Issue 6 2002Merlin C THOMAS SUMMARY: Peritonitis and exit-site infections remain the most important limitations to the delivery of continuous ambulatory peritoneal dialysis (CAPD). Contamination of the peritoneum, from endogenous or exogenous sources, is responsible for most peritonitis episodes. Patients usually present with a cloudy bag, although other causes should be distinguished. Clinical suspicion of peritonitis should be followed rapidly by microbiological examination and empirical treatment. Microbiological confirmation allows for subsequent treatment based on sensitivities. Other interventions such as catheter removal may be appropriate in some patients. Exit-site infections should also be identified and treated early. Peritonitis may be further prevented by adequate exit-site care, hygienic methods, and techniques to minimise early contamination of the exit site. Mupirocin may also have a role in preventing infections caused by Staphylococcus aureus. [source] Latest news and product developmentsPRESCRIBER, Issue 18 2008Article first published online: 3 OCT 200 Inhaled steroids for all children with asthma? Some children with mild well-controlled asthma may not need a daily inhaled steroid, a Scandinavian study suggests (Arch Dis Child 2008;93:654-9). A total of 176 children aged 5-10 years were randomised to treatment with cromoglicate (Intal) or budesonide. Initially high doses of budesonide (400,g twice daily) were reduced after one month to 200,g twice daily for four months; subsequent treatment for a further year was 100,g twice daily as required for exacerbations or 100,g twice daily regularly. Budesonide was associated with greater improvement in lung function and fewer exacerbations compared with cromoglicate, but after 18 months lung function improvements did not differ. Regular budesonide was associated with fewer exacerbations than as-required administration (0.97 vs 1.69 per patient in months 7-18) but no difference in asthma-free days or use of rescue medication. Growth suppression was slightly greater with continuous budesonide. Interventions to reduce atypicals weight gain A systematic review has found that techniques such as cognitive behaviour therapy and nutritional counselling can reduce weight gain associated with atypical antipsychotics (Br J Psychiatry 2008;193:101-7). Analysis of 10 randomised trials lasting eight weeks to six months found that nonpharmacological intervention increased mean weight loss by about 2.5kg compared with usual care. Check flu vaccine delivery Production of flu vaccine is proceeding according to plan, the Director of Immunisation has told GPs. Practices should now contact their suppliers to confirm a delivery schedule so that clinics can be arranged. New BNF for Children The fourth BNF for Children has been published, containing new sections on HPV vaccination, contraception, treatment of pelvic inflammatory disease and the use of continuous iv infusions in neonates. BNFC 2008 is available online at bnfc.org/bnfc. MMR catch-up ,urgent' The DoH has called for urgent action to reduce the risk of a measles epidemic. Following years of relatively low uptake of MMR vaccine, the pool of unprotected children is now large enough to raise the prospect of 30 000-100 000 measles cases in England. A catch-up campaign will now target children and young people who have never been vaccinated, followed by those who have not completed their course of immunisation. Resource materials are available at www.immunisation.nhs.uk. , A new brand of MMR vaccine is now available. Sanofi Pasteur MSD has replaced MMRII with a new formulation and presentation, MMRvaxPro. The new vaccine is equivalent to its predecessor and interchangeable with Priorix. Early primary prevention with low-dose aspirin? GPs should consider prescribing low-dose aspirin for primary prevention for men aged 48 and women aged 57, say UK researchers (Heart 2008; published online 15 August 2008. doi:10.1136/hrt.2008.150698). Using data from the THIN network of electronic patient records, they modelled the age at which 10-year coronary risk changed from <10 per cent to >10 per cent in men and women without diabetes, not taking lipid-lowering therapy and with no history of cardiovascular disease. Does COPD therapy slow progression? Treatment with an inhaled steroid and long-acting beta-agonist may slow progression of COPD, according to a new analysis of the TORCH study (Am J Respir Crit Care Med 2008;178:332-8). TORCH was designed to determine the effects of COPD treatment on mortality; the primary analysis found no significant difference between fluticasone/salmeterol (Seretide) and placebo (N Engl J Med 2007;356:775-89). This analysis found that the rate of decline in FEV1 (a marker of disease progression) was significantly greater with placebo (55ml per year) than with salmeterol or fluticasone monotherapy (both 42ml per year) or their combination (39ml per year). Faster decline in FEV1 was associated with current smoking, lower BMI and more frequent exacerbations. Copyright © 2008 Wiley Interface Ltd [source] Changes in lung function and health status in patients with COPD treated with tiotropium or salmeterol plus fluticasoneRESPIROLOGY, Issue 2 2009Kazuyoshi KURASHIMA ABSTRACT Background and objective: The effects of tiotropium, a long-acting anticholinergic drug, were compared with those of the combination of salmeterol, a long-acting ,2 -agonist, and fluticasone, an inhaled corticosteroid, in patients with COPD. Methods: A 4-month, randomized, open cross-over study of tiotropium, 18 µg once daily, versus salmeterol, 50 µg, plus fluticasone, 200 µg, twice daily, was conducted in patients with COPD. Efficacy was assessed by spirometry and responses to the St George's Respiratory Questionnaire (SGRQ). After 4 months, patients were asked to select their subsequent therapy and indicate the reasons for their selection. Results: A total of 78 patients completed the study. There were no significant differences in the improvements in FEV1 or SGRQ scores between the therapies. Similar numbers of patients selected tiotropium (42.3%) and salmeterol plus fluticasone (57.7%). However, those who preferred one of the therapies demonstrated greater improvements in SGRQ scores with that therapy. One subgroup of patients (30.8%) showed greater improvements in dyspnoea and FEV1 in response to tiotropium, and the other subgroup of patients (35.9%) showed greater improvements in dyspnoea and FEV1 in response to salmeterol plus fluticasone. Some patients (14.1%) selected salmeterol plus fluticasone because of positive effects on sputum expectoration. Conclusions: The study was unblinded and the results need to be interpreted with caution. However, tiotropium and salmeterol plus fluticasone had similar overall effects on pulmonary function and SGRQ scores in patients with COPD. Responses to the two therapies were heterogeneous, and the patients who showed greater improvements in FEV1 or SGRQ scores with one of the therapies preferred it for their subsequent treatment. [source] The successful management of two pregnancies with wild type metastatic gastrointestinal stromal tumorsASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 3 2009Thean Hsiang TAN Abstract Aim: To discuss the management of the uncommon situation of metastatic gastrointestinal tumour coexisting with pregnancy. Method: We describe two cases of women with metastatic gastrointestinal stromal tumor (GIST) who successfully achieved a full-term pregnancy without complications and with the delivery of healthy infants. In both cases, treatment with imatinib mesylate was withheld during pregnancy because of its unknown effects and questionable safety for the developing fetus. The available data in the medical literature regarding the use and safety of imatinib and pregnancy are reviewed. We also examine whether the knowledge of the exon mutational status would have influenced treatment decisions. Results: Both women had wild type GIST, but with different tumor growth characteristics, treatment responses and outcomes. The first patient deferred imatinib therapy to fall pregnant and her disease progressed rapidly off treatment. The second patient had a more indolent GIST where active surgical management allowed her to experience a long durable clinical response. She potentially belongs to a pediatric subgroup which carries a better prognosis despite being off imatinib. Conclusion: While we have successfully managed two pregnant women with metastatic GIST, the issue of initiating imatinib therapy in treatment-naive women, and treatment interruption in women already on therapy, remain difficult areas. Patients and their partners need to make an informed choice regarding the associated risks and the potential long-term sequelae if pregnancies are contemplated. Further research into the natural history of wild type GIST and how to tailor subsequent treatment are needed. [source] Exploiting the intracellular compartmentalization characteristics of the S. cerevisiae host cell for enhancing primary purification of lipid-envelope virus-like particlesBIOTECHNOLOGY PROGRESS, Issue 1 2010Gaik Sui Kee Abstract This article demonstrates how the intracellular compartmentalization of the S. cerevisiae host cell can be exploited to impart selectivity during the primary purification of lipid-envelope virus-like particles (VLPs). The hepatitis B surface antigen (HBsAg) was used as the VLP model in this study. Expressed HBsAg remain localized on the endoplasmic reticulum and the recovery process involves treating cell homogenate with a detergent for HBsAg liberation. In our proposed strategy, a centrifugation step is introduced immediately following cell disruption but prior to the addition of detergent to allow the elimination of bulk cytosolic contaminants in the supernatant, achieving ,70% reduction of contaminating yeast proteins, lipids, and nucleic acids. Recovery and subsequent treatment of the solids fraction with detergent then releases the HBsAg into a significantly enriched product stream with a yield of ,80%. The selectivity of this approach is further enhanced by operating under moderate homogenization pressure conditions (,400 bar). Observed improvements in the recovery of active HBsAg and reduction of contaminating host lipids were attributed to the low-shear conditions experienced by the HBsAg product and reduced cell fragmentation, which led to lower coextraction of lipids during the detergent step. As a result of the cleaner process stream, the level of product capture during the loading stage of a downstream hydrophobic interaction chromatography stage increased by two-fold leading to a concomitant increase in the chromatography step yield. The lower level of exposure to contaminants is also expected to improve column integrity and lifespan. © 2009 American Institute of Chemical Engineers Biotechnol. Prog., 2010 [source] Analysis of progression and survival after 10 years of a randomized prospective study comparing mitomycin-C and bacillus Calmette-Guérin in patients with high-risk bladder cancerBJU INTERNATIONAL, Issue 4 2007Truls Gårdmark OBJECTIVE To report the 10-year follow-up of a study randomizing between instillations of bacillus Calmette-Guérin (BCG) and mitomycin-C (MMC) for treating high-risk and not muscle-invasive urinary bladder cancer to assess progression, the need for more aggressive treatment and survival (cancer-specific and overall), as many of the published studies comparing different treatments for disease that is not muscle-invasive have a short follow-up. PATIENTS AND METHODS Between 1987 and 1992, 261 patients were included; they had frequently recurring Ta/T1G1,G2, T1G3 or primary Tis-dysplasia. The patients were randomized to treatment with either 40 mg of MMC or 120 mg of BCG (Danish strain 1331) given weekly for 6 weeks, then monthly up to a year and finally every third month for a further year. The 250 evaluable patients were followed using hospital files and national registers on causes of death. RESULTS The median follow-up for survivors was 123 months. The disease progressed in 58 (23%) of the patients, 34 in the MMC group and 24 in the BCG group (P = 0.26). Of the 140 patients who died, 68 were in the BCG and 72 in the MMC group (log-rank P = 0.98); most (95, 68%) died from other causes. CONCLUSION Based on the follow-up of the present patients it cannot be concluded that the drugs originally administered, MMC or BCG, differed in their effect on progression, need for subsequent treatment or survival. [source] Cystometric evaluation of reconstructed classical bladder exstrophyBJU INTERNATIONAL, Issue 4 2001S. Dave Objective To evaluate the association of urodynamic variables with continence and upper tract status after reconstruction in patients with classical bladder exstrophy. Patients and methods Thirty-one patients with bladder exstrophy were assessed 1 year after a modified bladder neck reconstruction. The evaluation included a detailed history, radioisotope renography, voiding cysto-urethrography, ultrasonography and artificial slow-filling cystometry. Results Fifteen of the 31 patients were satisfactorily continent; their maximum cystometric capacity was higher than that of the incontinent patients. The compliance, assessed as the maximum bladder capacity at a detrusor pressure of < 20 cmH2O, was significantly higher in the continent patients. There was a 45% incidence of unstable contractions in the 31 patients. Persistent sphincteric activity was detected on electromyography in 10 patients during voiding. Twenty-one patients could initiate a detrusor contraction during voiding. The residual volume was significant in nine of the 21 patients who attempted to void. Patients with a high end-fill pressure (> 40 cmH2O) had a significantly higher incidence of unobstructive hydronephrosis than had patients who had an end-fill pressure of < 40 cmH2O. Conclusions Bladder abnormalities are common after reconstruction of bladder exstrophy, with poor compliance, small capacity and unstable contractions. These factors hinder any increase in capacity and cause persistent incontinence. Hypocompliance and high end-fill pressure can lead to upper tract damage even in continent patients. Detailed urodynamic evaluation is vital to assess the results and to plan subsequent treatment. [source] Preparation of Pt,Ru Alloyed Thin Films Using a Single-Source CVD Precursor,CHEMICAL VAPOR DEPOSITION, Issue 3 2003S.-F. Huang Abstract Treatment of (dimethylaminomethyl)ruthenocene with cis -Pt(DMSO)2Cl2 led to the formation of a ruthenocenyl platinum complex [CpRu(,5 -C5H3CH2NMe2)Pt(DMSO)Cl] (1); subsequent treatment of 1 with [Na(hfac)] afforded an air-stable Pt,Ru complex [CpRu(,5 -C5H3CH2NMe2)Pt(hfac)] (2). Its volatility and other physical data relevant to CVD experiments were assessed by thermogravimetric analysis (TGA). The Pt,Ru thin films were then deposited at two deposition temperatures, 300,°C and 400,°C, using O2 as the reactive carrier gas. The as-deposited thin films were characterized using energy dispersive X-ray (EDX), scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), and X-ray diffraction (XRD). Results indicated the formation of a homogeneous Pt,Ru solid solution at the lower deposition temperature. However, upon raising the temperature to 400,°C, phase separation between Pt and Ru occurred, which then induced the growth of RuO2 grains at the substrate surface and caused depletion of the alloy in ruthenium. The electrocatalytic activities of the films, in respect of methanol oxidation, were investigated, in half-cell experiments, by cyclic voltammetry. [source] | |||||||||||||||||||||||||||||||||||||