Nodular focal fatty infiltration of the liver in acquired porphyria cutanea tarda

A case is reported of acquired porphyria cutanea tarda (PCT) due to administered valproate acid in an epileptic patient. Sonography (US) and computed tomography (CT) showed multiple nodular, well-defined lesions of the liver. Biopsy confirmed the diagnosis of focal fatty infiltration and revealed additionally the signs of hepatic involvement in PCT. Focal fatty infiltration should be considered in patients with multiple liver lesions if there is a predisposing condition. PCT can be a further cause of this type of infiltration.     

Rediscovering a history of nursing management: From Nightingale to the modern matron

Objectives

This paper presents an examination of distinct periods in the development of nursing in order to rediscover a history of nursing management in England. The overall purpose is to demonstrate that uncritical accounts written in the past have not adequately explained the complex factors that have shaped nursing management in England. It is also suggested that the approach taken may be usefully applied to other national contexts.

Design

This is a review article which first establishes the value of historical perspectives in increasing understanding of nursing and then goes on to analyse the professional, social and political forces that contributed to the development of nursing management.

Data sources

A range of historical and contemporary sources is accessed to support the review.

Review methods

The review is informed by an historical approach which also seeks recourse to current literature to develop a critical narrative analysis which has an international dimension.

Conclusions

The history of nursing management has been ‘lost’ in celebratory and uncritical accounts of nursing as a whole. The important influence of key figures other than Nightingale has been overlooked and it emerges that nursing management has a longer and more complex history than is generally accepted.     

From policeman to drug user: a personal perspective on the use of khat

Most countries drug strategies comprise a combination of drug treatment, drug enforcement, and drug prevention. While there has been a tendency in public policy documents over the last few years to emphasise the importance of basing policy on evidence of need and impact, in fact, the evidential basis across these three domains is highly skewed with most evidence being focused on drug treatment, some evidence focused on drug prevention, and relatively little evidence focused specifically on the impact of drug law enforcement. In this article, we report on drug users’ views of major drug enforcement operations in their local area. The three drug enforcement operations we were looking at were carried out by the police in three different geographical areas. In each area, we interviewed a snowball sample of local heroin users to establish their views and experience of both the specific operations that had occurred in the recent past and their overall assessment of the impact of police activity in their local area. Most of those interviewed who had been involved in a drug raid described the experience as shocking, upsetting, and profoundly unsettling. However, according to the drug users interviewed, police activity had little sustained impact on the price, purity, and/or availability of illegal drugs locally. The article concludes by considering the policy implications of this research.     

Spectrophotometric quantification of total urinary porphyrins as a screening test for porphyrias: Threshold value revisited

Objectives

The quantification of total urinary porphyrins based on spectrophotometry or spectrofluorimetry is a key screening test in cutaneous or mixed porphyria, performed before the quantitative fractionation of porphyrin isomers by chromatography. The aim of the present study was to determine the best threshold value for a spectrophotometric screening test and to estimate its diagnostic performances.

Design and methods

Data from samples sent to the laboratory between January 2006 and July 2013 from patients with a suspicion of cutaneous or mixed porphyria were retrospectively collected. The final diagnosis was based on the clinical presentation and biochemical results performed on appropriate specimens. Control samples were obtained from 91 non-porphyria patients and 58 healthy individuals and patient samples were obtained from 38 patients with symptomatic porphyria. The sensitivity and specificity of the spectrophotometric screening test were calculated at different cutoff values expressed in nmol/L and nmol/mmol creatinine using receiver operator curves.

Results and conclusion

A threshold of 18.8 nmol/mmol creatinine was considered as the best cutoff value for the screening test, achieving a sensitivity of 100% and a specificity of 93.2%.     

Helix and Drugs: Snails for Western Health Care From Antiquity to the Present

The land helix, or snail, has been used in medicine since antiquityand prepared according to several formulations. This historicalreport traces the understanding of their properties from thetime of Hippocrates, who proposed the use of snail mucus againstprotoccle and Pliny who thought that the snail increased thespeed of delivery and was "a sovereign remedy to treat painrelated to burns, abscesses and other wounds", Galien recommendedsnails against hydrops foetails. In the 18th century, varioussnail "preparations" were also recommended for external usewith dermatological disorders and internally for symptoms associatedwith tuberculosis and nephritis. Surprisingly, the 19th centurysaw a renewed interest in the pharmaceutical and medical useof snails with numerous indications for snail preparations.This interest in snails did not stop at the end of the 19thcentury. The 1945 edition of Dorvault devotes an entire paragraphto snails, indicating that the therapeutic usage of snails wasstill alive at that time. Recently the FDA has also shown aninterest in snails. Ziconotide (SNXIII), a synthetic peptidecoming from snail venom, has been under FDA review since 1999.Pre-clinical and clinical studies of this new drug are promising.     

上海市奉贤区中心医院2008年-2010年门急诊麻醉药品处方分析

目的分析上海市奉贤区中心医院2008年-2010年门、急诊麻醉药品的使用情况,促进麻醉药品使用的合理化和规范化。方法对2008年-2010年门急诊麻醉药品处方共5 461张进行统计分析,包括不合理处方比例及存在的问题、各年度处方总数、临床使用分布、各类麻醉药品的用药总量、各类麻醉药品的处方比例和等。对非癌痛处方以用药频率、药物利用指数为指标,癌症处方以用药天数和平均日剂量为指标进行分析、评价。结果门急诊的麻醉药品有9种,盐酸吗啡缓释片的总用量居首位,盐酸吗啡针在急诊处方中比例最高,药物利用指数<1,不合理处方共770张,占14.10%。结论该院门急诊麻醉药品使用基本合理,但需对部分医师加强麻醉药品使用培训。     

Potential applications of breath isoprene as a biomarker in modern medicine: a concise overview

Summary Human breath contains hundreds of trace volatile organic compounds. These volatile substances may be generated in the body or may be absorbed as contaminants from the environment. Some of the endogenous substances are characteristic markers of pathophysiological processes and clinicians are already using breath testing of such substances as an additional non-invasive diagnostic tool for certain diseases. Isoprene, another volatile compound, is formed endogenously in humans, and while the biochemical pathways of biosynthesis and exact origins of isoprene found in human breath have not been elucidated in sufficient depth, its measurement in exhaled breath has been suggested as a non-invasive indicator with diagnostic potential. This test has not yet reached the level of routine clinical methods and is still under development. Breath isoprene levels have been reported to be altered in a number of clinical conditions; however, the physiological meaning of these changes has not been established. Various lines of supportive evidence suggest that isoprene is related to cholesterol biosynthesis. Therefore, breath isoprene measurements could potentially be used for mass screening for lipid disorders and could, at minimum, serve as an additional parameter to complement invasive tests for monitoring the efficacy of lipid-lowering therapy, pharmacological and dietary or lifestyle. As a potentially useful biomarker of mevalonate synthesis in humans, it may have non-invasive applications, not only in metabolic disorders, but possibly also in cancer screening. In the present work, we aim to give a concise overview of breath isoprene, its measurement techniques, problems concerning its physiological meaning, and potential applications as a non-invasive biomarker in modern medicine.

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Isopren in der Atemluft als potenzieller Biomarker in der modernen Medizin

Zusammenfassung Der menschliche Atem enthält hunderte flüchtige Spurenelemente. Diese volatilen Substanzen können Produkte des Körpers sein oder von absorbierten Verunreinigungen der Umwelt stammen. Manche der endogenen Substanzen sind charakteristische Marker von pathophysiologischen Vorgängen. Klinisch werden daher Bestimmungen solcher Substanzen in der Atemluft bereits als zusätzliche nicht-invasive diagnostische Hilfsmittel für bestimmte Erkrankungen verwendet. Die volatile Substanz Isopren wird endogen im menschlichen Körper erzeugt. Die biochemische Biosynthese und der genaue Herkunftsort dieser Substanz im menschlichen Atem ist bis jetzt unzureichend geklärt. Trotzdem wird ihrer Bestimmung in der Ausatemluft ein diagnostisches Potenzial zugeschrieben. Dieser nicht-invasive Test ist allerdings noch in Entwicklung und hat noch nicht in die klinische Routine Eingang gefunden. Die Konzentration von Isopren in der Atemluft scheint bei verschiedenen klinischen Bedingungen verändert zu sein. Die physiologische Bedeutung dieser Beobachtung ist jedoch unklar. Vieles deutet darauf hin, dass die Cholesterin-Biosynthese mit Isopren im Zusammenhang steht. Ein mögliche Verwendung ist daher der Einsatz im Massen-Screening auf Störungen des Fettstoffwechsels. Zumindest könnte es als zusätzlicher nicht-invasiver Parameter zur Beurteilung der Wirksamkeit von lipidsenkenden Maßnahmen (pharmakologisch, diätetisch oder Lebensstil) dienen. Aber nicht nur bei Stoffwechselerkrankungen ist ein Einsatz denkbar: auch beim Screening auf Krebserkrankungen ist es als Biomarker der Mevalonat-Synthese vorstellbar. In der vorliegenden Arbeit haben wir versucht, einen einen konzisen Überblick über Isopren in der Atemluft zu geben. Die Bestimmungsmethoden, die Probleme seiner physiologischen Bedeutung, sowie sein möglicher Einsatz als nicht-invasiver Biomarker in der modernen Medizin werden dargelegt.

     

From clinical experience to a model for the human fascial system

Studies of fascial anatomy, histology, and physiology are changing comprehension of the role of fascia in many body functions. In the light of these studies, evidence-based models of the human fascial system that provide immediate clinical applications for manual therapists working with movement dysfunctions and pain are necessarily evolving. This paper presents an overview of one proposed biomechanical model and discusses some of its underlying hypotheses. Developed initially from extensive review of anatomical texts and clinical experience, subsequent anatomical dissections, histological, biomechanical, and some clinical studies have investigated this model. These studies are discussed, also in reference to other contemporary musculoskeletal research. This model for the human fascial system could represent new perspectives for clinicians and researchers regarding the functional integration of fascia within the musculoskeletal system.     

2008年-2010年心血管系统药物利用情况分析

目的评价临床心血管系统药物的利用情况与趋势。方法利用excel表格对四川省建筑医院2008年1月-2010年12月全部心血管系统药物处方的种类、销售金额、用药频度值（DDDs）等进行统计分析。结果 3年中,心血管系统药物的销售金额呈逐年上升趋势。在销售金额和DDDs的前10名排名中主要包括钙通道阻滞类药物、调血脂药物和中成药等。结论临床心血管系统药物应用基本合理,对于疗效显著、不良反应轻微、价格合理的药物患者依从性好,临床使用广泛     

The European ACuteTox project: a modern integrative in vitro approach to better prediction of acute toxicity

ACuteTox (optimization and prevalidation of an in vitro test strategy for predicting human acute toxicity) is an integrated European Union project under the Sixth Framework Programme with the aim of demonstrating that animal tests for acute systemic toxicity currently used for regulatory purposes could be replaced by a combination of alternative assays. Validated alternative test methods are urgently required for safety toxicology testing of chemicals, cosmetics, and drugs.     

我院住院医嘱中不合理用药问题的调查分析

目的:促进临床合理用药。方法:随机抽取我院2003~2004年住院医嘱,根据药品说明书、国内外文献资料及临床药理学知识,对不合理用药的医嘱进行统计分析。结果:不合理用药医嘱占全部抽查医嘱的6.43%,其中占比例最大的属抗生素的不合理应用,占全部不合格医嘱的82.27%。不合理用药主要表现在联合用药不当、重复性给药、给药时间不当、给药剂量过大或过小、缓控释制剂使用不合理等方面。结论:医院药房调剂工作中的审核行为是药学服务的有效措施,应充分发挥临床药师的作用,进一步促进临床合理用药。     

Porphyrias and photosensitivity: pathophysiology for the clinician

Porphyrias are disorders caused by defects in the biosynthetic pathway of heme. Their manifestations can be divided into three distinct syndromes, each attributable to the accumulation of three distinct classes of molecules. The acute neurovisceral syndrome is caused by the accumulation of the neurotoxic porphyrin precursors, delta aminolevulinic acid, and porphobilinogen; the syndrome of immediate painful photosensitivity is caused by the lipid-soluble protoporphyrin IX and, the syndrome of delayed blistering photosensitivity, caused by the water-soluble porphyrins, uroporphyrin, and coproporphyrin. Porphyrias can manifest with one, or with a combination, of these syndromes, depending on whether one or more types of molecules are being accumulated. Iron plays a significant role in some of these conditions, as evidenced by improvements in both clinical manifestations and laboratory parameters, following iron depletion in porphyria cutanea tarda, or iron administration in some cases of X-linked erythropoietic protoporphyria. While the pathophysiology of a specific type of porphyrias, the protoporphyrias, appears to favor the administration of zinc, results so far have been conflicting, necessitating further studies in order to assess its potential benefit. The pathways involved in each disease, as well as insights into their pathobiological processes are presented, with an emphasis on the development of photosensitivity reactions.     

Human models of pain for the prediction of clinical analgesia

Human experimental pain models are widely used to study drug effects under controlled conditions. However, efforts to improve both animal and human experimental model selection, on the basis of increased understanding of the underlying pathophysiological pain mechanisms, have been disappointing, with poor translation of results to clinical analgesia. We have developed an alternative approach to the selection of suitable pain models that can correctly predict drug efficacy in particular clinical settings. This is based on the analysis of successful or unsuccessful empirical prediction of clinical analgesia using experimental pain models. We analyzed statistically the distribution of published mutual agreements or disagreements between drug efficacy in experimental and clinical pain settings. Significance limits were derived by random permutations of agreements. We found that a limited subset of pain models predicts a large number of clinically relevant pain settings, including efficacy against neuropathic pain for which novel analgesics are particularly needed. Thus, based on empirical evidence of agreement between drugs for their efficacy in experimental and clinical pain settings, it is possible to identify pain models that reliably predict clinical analgesic drug efficacy in cost-effective experimental settings.     

Mechanisms of Action of Antiarrhythmic Drugs: From Ion Channel Blockage to Arrhythmia Termination

Over the past decade, the strategies for arrhythmia management have been in transition. Physical methods to treat arrhythmias, such as ICDs and RF ablation, have undergone considerable refinement and wider application. Ischemic heart disease and congestive heart failure have been identified as clinical situations in which antiarrhythmic drugs have a significant proarrhythmic potential. However, drugs retain an important role in arrhythmia management. Strategies to mitigate the structural and functional changes that occur in hypertrophy, ischemia, and infarction have not been thoroughly explored. Membrane ion channels and receptors are the targets for the action of currently available drugs. The cloning and sequencing of these ion channels and receptors should improve the efficacy and specificity of drug design. Cardiac Na⁺, Ca²⁺, K⁺, and nonspecific cation channels have a clearly defined role in the generation of the normal action potential. Their specific roles in the various clinical arrhythmias is less certain. There are sufficient data to associate specific ionic channels with normal and abnormal automaticity and with reentry occurring in specific regions of the heart. A rational choice of antiarrhythmic drugs can be made when an arrhythmogenic mechanism and the putative underlying membrane currents can be identified based on the clinical characteristics of the arrhythmia. For a majority of clinical arrhythmias, this ideal has not been achieved. When a particular drug is used to treat an arrhythmia, the full complement of its actions will depend on which multiple ion channels or receptors are blocked and the kinetics of drug interaction with these sites.     

经皮支气管动脉/体动脉植入药物输注系统灌注化疗治疗中晚期肺癌初步探讨

目的：研究经皮支气管动脉／体动脉植入药物输注系统（DIS）灌注化疗治疗中晚期肺癌。方法：Seldinger＇s技术经右侧股动脉进路选择性肺癌供血体动脉造影后行超选择性插管并留置植入导管,连接植于右髂窝皮下囊的药盒组成DIS,经DIS进行灌注化疗。结果：3例晚期肺癌,分别采用4F-C2／Yashim超滑导管-ImplantofixⅡ／Soph-A-Port成功行左锁骨下动脉、右叶支气管动脉植入DIS,多次灌注化疗。结论：支气管动脉或供血体动脉植入DIS进行灌注化疗,是一种值得进一步研究应用的肺癌介入治疗方法。     

Therapeutic effects of Aloe spp. in traditional and modern medicine: A review

Traditional medicine is a useful guide in medical sciences. In the Islamic Iranian traditional medicine, the medicinal properties of many plants have been mentioned that could be exploited in drug discovery. We aimed to explore the nature and properties of Aloe spp. As described in some major Islamic traditional texts including Ferdows al-Hekmah fi’l-Tibbe (The Paradise of Wisdom in Medicine), Al-Hawi fi’l-Tibb (Comprehensive Book of Medicine), Kamel al-Sanaat al-Tibbyyah (Complete Book of the Medical Art), Al-Qanun fi’l-Tibb (Canon of Medicine), Zakhireh Kharazmshahi (Treasure of Kharazmshah), and Makhzan al-Adwiah (Drug Treasure), and assess the conformity of traditional medicine instructions with the findings of modern pharmacological studies. Gastrointestinal activities, hepato-protective properties, beneficial effects against skin problems such as wounds, injuries, and infective diseases are among the most frequently mentioned properties of Aloe spp. Several activities of Aloe spp. described in traditional medicine have been the subject of recent in vitro and in vivo studies as well as clinical trials. Owing to the positive findings, different preparations of Aloe spp. are now present in pharmaceutical markets such as Aloe cosmetic products. On the other hand, there are many traditional therapeutic effects of Aloe spp. which have not been studied and require confirmatory experimental or clinical investigations. It is hoped that the present study could stimulate further research on the unexplored aspects of the medicinal properties of Aloe spp.     

有机磷农药中毒患者给药方法的临床观察

目的 探讨有机磷农药中毒患者不同给药方法与临床治疗护理效果的关系。方法将186例有机磷农药中毒患者随机分为3组A组、B组、C组。静脉推注给药（A组）113例，微量泵给药（B组）26例，先静脉推注达阿托品化后微量泵给药（C组）47例，对3组进行比较。主要评价内容为阿托品化时间、给药次数、平均住院天数。结果A组给药次数明显多于其他2组（P〈0．05）；B组阿托品化时间明显延长（P〈0．05），且平均住院天数也延长（P〈0．05），有统计学意义。结论有机磷农药中毒患者采用静脉推注达阿托品化后微量泵给药，既能快速达到阿托品化，减少给药次数，缩短平均住院天数，又能保持血药浓度稳定，生命体征渡动范围小，有利于治疗与护理效果的提高，值得临床推广。