Educating on CS or 'tear gas'

Chlorobenzalmalononitrile or 2-chlorobenzylidene malononitrile (CS) is a commonly used riot control agent. Although generally deemed to be safe for this application, it is known that CS can cause a number of adverse effects in those exposed to it. Understanding its properties and its side effects is important in ensuring optimal medical management of its complications and, indeed, this principle applies to every chemical. As the need for CS and other law enforcement devices increases, it is important for the emergency medicine team and other specialties to be aware of correct management protocols.     

Calcium-activated neutral protease from muscle and platelets of Duchenne muscular dystrophy cases

Calcium-activated neutral protease (CANP) has been purified from its endogenous inhibitor and its activity is monitored in the muscle of Duchenne Muscular Dystrophy (DMD) patients. The specific activity of the enzyme is found to be significantly higher as compared to normal. CANP from platelets of DMD patients is significantly higher as compared to activities in other myopathies and controls. Platelet CANP, therefore, may prove to be an index of pathological condition in DMD, since other myopathies do not show such a significant change.     

壳聚糖支架应用在组织工程中：组成复合支架及改性支架的前景

背景：壳聚糖具有无毒性、无刺激性、生物相容性、生物可降解性等优良性能,对多种组织细胞的黏附和增殖具有促进作用,目前已成为组织工程学支架研究方面的一个热点。目的：综述壳聚糖及其衍生物支架在组织工程上的应用进展。方法：应用计算机检索中国生物文献数据库及PubMed数据库1989至2013年,有关壳聚糖及其衍生物支架在组织工程中应用的文献,关键词为“壳聚糖,支架,组织工程;Chitosan,scaffold, tissue engineering”。结果与结论：壳聚糖及其衍生物支架在组织工程中的应用主要集中在几方面：作为细胞培养支架;与各种材料形成复合支架使用;改性壳聚糖支架。壳聚糖及其衍生物是一类有独特生物活性的天然高分子材料,在组织工程研究中有广阔的应用前景,与其他生物材料组成复合材料及制成改性支架将是它今后的研究重点。     

Optimising the medical management of hyperglycaemia in type 2 diabetes in the Middle East: pivotal role of metformin

Aims: Increases in the prevalence of type 2 diabetes will likely be greater in the Middle East and other developing countries than in most other regions during the coming two decades, placing a heavy burden on regional healthcare resources. Methodology: Medline search, examination of data from major epidemiological studies in the Middle Eastern countries. Results: The aetiology and pathophysiology of diabetes appears comparable in Middle Eastern and other populations. Lifestyle intervention is key to the management of diabetes in all type 2 diabetes patients, who should be encouraged strongly to diet and exercise. The options for pharmacologic therapy in the management of diabetes have increased recently, particularly the number of potential antidiabetic combinations. Metformin appears to be used less frequently to initiate antidiabetic therapy in the Middle East than in other countries. Available clinical evidence, supported by current guidelines, strongly favours the initiation of antidiabetic therapy with metformin in Middle Eastern type 2 diabetes patients, where no contraindications exist. This is due to its equivalent or greater efficacy relative to other oral antidiabetic treatments, its proven tolerability and safety profiles, its weight neutrality, the lack of clinically significant hypoglycaemia, the demonstration of cardiovascular protection for metformin relative to diet in the UK Prospective Diabetes Study and in observational studies, and its low cost. Additional treatments should be added to metformin and lifestyle intervention as diabetes progresses, until patients are receiving an intensive insulin regimen with or without additional oral agents. Conclusions: The current evidence base strongly favours the initiation of antidiabetic therapy with metformin, where no contraindications exist. However, metformin may be under‐prescribed in the Middle East.     

Just heavy menses or something more? Raising awareness of von Willebrand disease

OVERVIEW: Von Willebrand disease is the most common inherited bleeding disorder, with an estimated prevalence of up to 1.3% of the U.S. population, or 4 million Americans. It's caused by a deficiency of or defects in von Willebrand factor, a protein necessary for blood to clot. Many nurses and other health care providers, as well as patients, are unaware of the disorder, its symptoms, and its associated risks. Although the disorder occurs equally in males and females, it can be more troublesome in females. Heavy menses beginning at menarche is one of the most common presentations, but because the disorder is inherited and other family members may have similarly heavy menses, the assumption may be that this is normal. This article describes von Willebrand disease and its three types, explains how to recognize and investigate suggestive symptoms, and outlines management strategies.     

The use of IVIg in fetal and neonatal alloimmune thrombocytopenia— Principles and mechanisms

Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a rare neonatal disorder that is caused by alloimmunization against platelet antigens during pregnancy. Although rare, affecting only 1 in 1000 live births, it can cause intracranial hemorrhage and other bleeding complications that can lead to miscarriage, stillbirth and life-long neurological complications. One of the gold-standard therapies for at risk pregnancies is the administration of IVIg. Although IVIg has been used in a variety of different disorders for over 40 years, its exact mechanism of action is still unknown. In FNAIT, the majority of its therapeutic effect is thought the be mediated through the neonatal Fc receptor, however other mechanisms cannot be excluded. Due to safety, supply and other concerns that are associated with IVIg use, alternative therapies that could replace IVIg are additionally being investigated. This includes the possibility of a prophylaxis regimen for FNAIT, similarly to what has been successfully used in hemolytic disease of the fetus and newborn for over 50 years.     

Hemicrania Continua and Symptomatic Medication Overuse

SYNOPSIS
Hemicrania continua (HC) is a rare, strictly unilateral, non-paroxysmal headache disorder characterized by its absolute responsiveness to indomethacin. The pain is usually moderate in intensity and frequently associated with a superimposed"jabs and jolts" headache.
We report two cases of HC which presented as chronic daily headache (CDH) with abortive medication overuse.
CDH can be due to transformed migraine (TM), new daily persistent headache (NDPH), chronic tension-type headache, and HC. All can be unilateral, and all can be associated with medication overuse. Our two cases meet the criteria for HC based on indomethacin responsiveness. One meets the criteria for TM, the other NDPH. Is HC a distinct disorder, or a subset of these other disorders? CDH with medication overuse includes in its differential diagnosis HC.     

生物性材料硫酸钙作为复合材料的应用研究与进展

背景:将硫酸钙与其他生物材料混合可以克服硫酸钙本身的缺点。目的:探讨生物性材料硫酸钙作为复合材料在局部药物释放载体及骨生物材料应用方面的性能。方法:以"硫酸钙,骨修复材料,缓释系统,生物学材料,复合材料"为中文关键词,以"Calcium sulfate,Mixture,Bone defect,Drug release"为英文关键词,采用计算机检索万方数据库、PubMed数据库等1980年1月至2012年3月有关硫酸钙作为复合材料在局部药物释放载体及骨生物材料中应用的文章。结果与结论:硫酸钙作为骨缺损修复材料具有很多优点,但吸收快、缓释药物慢等缺点限制了其应用。因此对硫酸钙作为复合材料的研究开始增多,无论是作为药物释放载体还是作为骨替代材料,硫酸钙与其他材料混合发挥了复合材料的互补特性,很大程度上满足了生物材料应具有的综合特点。这样既保留了硫酸钙的成骨和骨诱导等优点,又克服了其不足。但关于这方面研究仍处于起步阶段,复合材料的配比、体内特性、临床应用等仍需进一步研究。     

Albumine humaine comme traitement adjuvant du sepsis et du choc septique : mythe et réalité

Albumin is a multifunctional protein which plays a major role in physiology, drugs pharmacokinetics, and detoxication, partly due to its ligand specificity and its ability to bind a large number of endogenous and exogenous substances. Albumin is the main determinant of oncotic pressure and is therefore used for volume expansion in hypovolemia, shock, burns, liver failure or chronic liver disease, and denutrition. If albumin appears to be safe as far as hemodynamic effects, renal function and survival are concerned, its benefice as fluid expander in septic shock is controversial and experimental as well as clinical data are contradictory. Compared to other plasma expanders, it is a blood-derived and expensive product. Albumin would finally have antioxidative properties and modulate inflammation, thus decreasing capillary permeability. Human albumin is indeed involved in the inflammatory and oxidative stress pathways modulation and may thus be beneficial in septic shock, through improvement of endothelial dysfunction. Albumin is also less pro-inflammatory than other plasma expanders, decreasing neutrophils activation and infiltration. It would even exhibit immunosuppressive effects. All these properties seem to be dose-dependent. In severe sepsis, albumin could be useful for fluid resuscitation and as an antioxidative or anti-inflammatory adjuvant therapy. Albumin use for volume expansion is controversial, as experimental and clinical data diverge. Albumin is more expansive and at risk of blood pathogens transmission compared to cristalloids and other colloids. This review provides an update on albumin characteristics and properties and albumin indication in the treatment of sepsis and septic shock.     

A compensated radiolucent electrode array for combined EIT and mammography

Electrical impedance tomography (EIT), a non-invasive technique used to image the electrical conductivity and permittivity within a body from measurements taken on the body's surface, could be used as an indicator for breast cancer. Because of the low spatial resolution of EIT, combining it with other modalities may enhance its utility. X-ray mammography, the standard screening technique for breast cancer, is the first choice for that other modality. Here, we describe a radiolucent electrode array that can be attached to the compression plates of a mammography unit enabling EIT and mammography data to be taken simultaneously and in register. The radiolucent electrode array is made by depositing thin layers of metal on a plastic substrate. The structure of the array is presented along with data showing its x-ray absorbance and electrical properties. The data show that the electrode array has satisfactory radiolucency and sufficiently low resistance.     

Prostate-specific antigen: a cancer fighter and a valuable messenger?

BACKGROUND: Prostate-specific antigen (PSA) is a valuable prostatic cancer biomarker that is now widely used for population screening, diagnosis, and monitoring of patients with prostate cancer. Despite the voluminous literature on this biomarker, relatively few reports have addressed the issue of its physiological function and its connection to the pathogenesis and progression of prostate and other cancers. APPROACH: I here review literature dealing with PSA physiology and pathobiology and discuss reports that either suggest that PSA is a beneficial molecule with tumor suppressor activity or that PSA has deleterious effects in prostate, breast, and possibly other cancers. CONTENT: The present scientific literature on PSA physiology and pathobiology is confusing. A group of reports have suggested that PSA may act as a tumor suppressor, a negative regulator of cell growth, and an apoptotic molecule, whereas others suggest that PSA may, through its chymotrypsin-like activity, promote tumor progression and metastasis. SUMMARY: The physiological function of PSA is still not well understood. Because PSA is just one member of the human kallikrein gene family, it is possible that its biological functions are related to the activity of other related kallikreins. Only when the physiological functions of PSA and other kallikreins are elucidated will we be able to explain the currently apparently conflicting experimental data.     

Gamma-hydroxybutyrate (GHB): a newer drug of abuse

Gamma-hydroxybutyrate (GHB) is an illicitly marketed substance that has recently gained popularity among body builders and party attendees as a drug of abuse. GHB is a depressant that acts on the central nervous system. It is purported as a strength enhancer, euphoriant and aphrodisiac and is one of several agents reported as being used as a "date rape" drug. Because of its central nervous system depressant effects, GHB can be lethal when combined with alcohol or other depressants. Currently, there is no accepted medical use for GHB, and the U.S. Food and Drug Administration has prohibited its manufacture and sale. Clinicians should be familiar with the typical clinical presentation of GHB and its adverse effects. In addition, patients should be warned of its potential toxicity and be cautioned to avoid the use of GHB.     

RANKL vaccination

A therapeutic vaccine approach, targeting RANKL, can be used to inhibit bone destruction in pathological bone loss conditions such as osteoporosis, rheumatoid arthritis and bone metastasis. Compared to other therapeutic recombinant protein against pathological antigen such as monoclonal antibodies, soluble receptor or other antagonists, a vaccine needs small doses of protein to induce its affect. Once the immune response is established by vaccination, it is maintained by boosting with the vaccine. This RANKL vaccination would be a novel approach to any kind of pathological bone     

New Diagnosis: Caregiver Role Strain

Caregiver role strain is a new diagnosis accepted by NANDA in 1992. The diagnosis is a well-described family phenomenon that can be measured and predicted. Sources of variance for the various defining characteristics have been identified. The diagnosis is also important to society. Nurses can play a significant part in reducing the role strain caregivers feel or preventing its occurrence.
Summary
Caregiver role strain is an important diagnosis to add to the nursing taxonomy. It is a phenomenon that has been well-described and studied from many perspectives. It can be measured and identified by nurses. It can be predicted, and interventions can be instituted to diminish its effects or decrease the likelihood of its onset. It is a diagnosis that has boundaries and can be distinguished from other kinds of family problems related to health and illness of family members. It is also a significant issue in society that needs to be addressed by nurses working in many settings and roles.     

The meaning of consolation as experienced by nurses in a home-care setting

Aims and objective. The aim of this study was to illuminate nurses’ experiences of consolation and how these experiences relate to suffering and care. Background. Consolation is commonly associated with the relief of suffering. The question of consolation in terms of its definition and relevance for care has, however, been a matter of discussion among nurse researchers. The question raised concerns about the nature of consolation, its place and its role in relation to care and the caring sciences. Design. An explorative qualitative interview study with 12 participants, six registered and six enrolled nurses, was carried out in a home‐care context. Methods. A phenomenological‐hermeneutic method inspired by the French philosopher Paul Ricoeur was used for the text analysis. Results. Two main aspects of consolation appeared: ‘the present consolation’, which is flexible, sustaining and opening and ‘the absent consolation’, which conceals the suffering and is incapable of consoling. The result was interpreted from a philosophical‐ethical perspective, based on the works of Levinas and Lögstrup. Conclusions. Consolation appears as a complex phenomenon, both in terms of its existence and its absence consolation, constituting a caring and non‐caring consolation. A caring consolation entails meeting the other as different and being present in a way that gives the other space to be the one he or she really is. It requires acceptance, accepting the sufferer and his/her way of suffering as unique. Relevance to clinical practice. The clinical nurse is involved in complex care situations, which entails both reflecting upon and using intuition when consoling. A caring consolation is a contradictory phenomenon that requires a nurse to be capable of both reflecting upon and acting intuitively on the unique suffering of the other.     

A computerized patient registration and treatment randomization system for multi-institutional clinical trials

Computerized registration and randomization for a cooperative clinical trials group is a useful addition to its data gathering and managing process. An automated system eliminates unnecessary paperwork, allows more sophisticated randomization algorithms to be implemented, and makes available a variety of computer-generated reports such as confirmation of registration forms, accrual results, and other statistical tables. This paper describes the design and implementation of such a system for a relatively large cooperative group, the Eastern Cooperative Oncology Group (ECOG), as well as gives general recommendations for conversion of a manual registration and randomization process to an automated one. Our general interactive system, known as PRS for Patient Randomization System, was designed to be easily expandable as its functions increase over time, and transportable to other clinical trials settings.     

Developing a distance learning honours degree in health promotion for delivery using the Internet

Designing this programme for distance learning delivery, especially for the Internet has been a major learning experience for all the staff involved. However, addressing and resolving these issues has now provided us with a template for developing other programmes in distance learning mode. This was an endeavour that all our market research indicated we had to undertake since institutions of higher education, especially schools of healthcare are no different to commercial companies. Like commercial organizations, higher education institutions, too, are consumer facing and are in direct competition with other educational 'suppliers', i.e. other universities and colleges. If a university is to compete and to 'sell' its products well, it too must consider the Internet as a way of advertising its wares, streamlining its business model and eventually conducting its business. In our case, this means delivery of educational programmes. However, as Internet technologies are primarily designed for research and business, there is currently a lag in the development of tools that enable effective social learning. Our next programme via the Internet will be even better for the experiences we've undergone and the lessons we've learnt during this initiative.     

Clinical variants and masks of renal amyloidosis

A study of the clinical picture of renal amyloidosis in 110 patients has shown a possibility of the existence of different variants of its course making it similar to the other nephropathies. Its diagnostic difficulty is determined by relative significance of "aggravated" anamnesis (in 22% of the patients it was absent at all, and its presence did not exclude the development of other renal diseases). Correct diagnosis can be established using kidney biopsy only as amyloidosis in the rectal mucosa and hepatic tissue is detected much less frequently.     

Diagnosing and Treating Chronic Urticaria

Chronic urticaria is differentiated from the acute type by its persistence and by its causative agents. It can result from histamine, and other chemical mediators, released from damaged mast cells either by an antigen-antibody reaction or some other mechanism. The cause, often elusive, may be common foods or medications. External temperature changes can be manifested by urticaria through various mechanisms. The endogenous causes include chronic foci of infections such as in teeth, sinuses or tonsils, endocrine changes, parasitic infestations. Chronic urticaria may be a symptom of underlying more serious systemic diseases such as lymphomas.     

Methadone use in cancer patients with pain: a review

In recent years a better understanding of the pharmacologic and pharmacokinetic properties of methadone, including equianalgesic ratios has led to its increased use as a second line opioid for the treatment of pain in patients with cancer. Methadone may be an important alternative for those who have side effects related to the use of other opioids because it has no known active metabolites, is well absorbed by oral and rectal routes, and also has the advantage of very low cost. However, it has a long, unpredictable half-life, which can result in accumulation and toxicity in some patients. In addition, rotation to methadone as a second line agent is more complex than with other opioids because of its increased potency in those patients who are opioid tolerant, particularly those who have been on higher doses of other opioids. Future research should address the use of methadone as a first-line agent in the management of cancer pain, its use in patients with neuropathic pain, and in those who develop rapid tolerance to other opioids. In some patients with cancer the long half-life of methadone offers the advantage of extended dosing intervals to 12 and even 24 hours, further research is also needed in this area.