The rearrangement and amplification of C-erbB-1 gene in the development of MDS and their clinical significance in diagnoses and prognoses

In order to explore whether the rearrangement and amplification of C-erbB-l gene were associatedwith the development of MDS and their clinicalsignificance in diagnoses and prognoses. digitoxin-labelled oligonucleotide probes were used to detect 33     

International perspectives in PMR education and training

Generalities Physiatry training differs markedly between countries.There is no universal agreed upon residency training curriculum,there is no uniformity with respect to training duration,or requirements,and no universal PM & R celti fication process.There is little reciprocity among countries with respect to physiatry training and certification.     

Children and Adolescents in Cognitive–Behavioral Therapy: Some Past Efforts and Current Advances, and the Challenges in Our Future

The last two decades have been witness to advances in cognitive-behavioral therapy for children and adolescents, and certain treatments have been labeled empirically supported. However, not all cases show irrefutable gains and much treatment development and research remains. Following a brief precis of the past and present, we identify and examine several important directions for future research in child and adolescent therapy. Specifically, we consider (a) the nature and magnitude of improvement, including the need to assess the clinical significance of improvement, (b) general issues in assessment, such as parent-child agreement, method variance, and measurement equivalence, (c) the optimal role of parents in child and adolescent treatment, (d) potential moderators and mediators of positive outcomes, (e) the place of medications, and the potential role of parental expectations and/or preferences surrounding treatment selection, (f) therapist factors that may contribute to outcome, and (g) the effects of treatment on the sequelae of the target disorder. Last, the need to consider developmental issues and the transportability of CBT across settings are discussed.     

Is there a difference between women and men in characteristics and outcome after in hospital cardiac arrest?

AIM: To describe the characteristics and outcome among patients suffering from an in-hospital cardiac arrest in women and men. METHODS: All patients who suffered an in-hospital cardiac arrest during a 4 year period in Sahlgrenska Hospital G?teborg, Sweden, where the cardiopulmonary resuscitation (CPR) team was called, were recorded and described prospectively in terms of characteristics and outcome. RESULTS: There were 557 patients suffering in-hospital cardiac arrest in whom the CPR-team was alerted. Among them, 217 (39%) were women. Women differed from men having a lower prevalence of earlier myocardial infarction, angina pectoris, renal disease and a higher prevalence of rheumatic disease. In terms of aetiology of the cardiac arrest, 47% men and 48% women were judged to have had a confirmed or possible AMI. More men than women were found in ventricular fibrillation/ventricular tachycardia (VF/VT) (57 vs. 41%; P<0.001), whereas more women were found in pulseless electrical activity (30 vs. 15%; P<0.0001). Cerebral performance categories (CPC)-score at discharge did not differ between men and women. Among women, 36.4% survived to discharge as compared with 38.0% among men (NS). Survival from VF/VT was 64.3% in women and 52.7% in men (NS). When correcting for dissimilarities at baseline, the adjusted odd ratio for being discharged alive from hospital among women as compared with men was 1.66 (95% confidence limit 1.06-2.62; P=0.028). CONCLUSION: Thirty nine percent of patients suffering in-hospital cardiac arrest for whom the CPR-team was alerted, were women. Women were less frequently found in VF/VT than men. After correcting for dissimilarities at baseline, female gender was associated with a small improvement in survival.     

Regulation of κ-opioid receptor signaling in peripheral sensory neurons in vitro and in vivo

There is considerable interest in understanding the regulation of peripheral opioid receptors to avoid central nervous system side effects associated with systemically administered opioid analgesics. Here, we investigated the regulation of the κ-opioid receptor (KOR) on rat primary sensory neurons in vitro and in a rat model of thermal allodynia. Under basal conditions, application of the KOR agonist trans-(1S,2S)-3,4-dichloro-N-methyl-N-[2-(1-pyrrolidinyl)cyclohexyl]benzeneacetamide hydrochloride hydrate (U50488) did not inhibit adenylyl cyclase (AC) activity nor release of calcitonin gene-related peptide (CGRP) in vitro and did not inhibit thermal allodynia in vivo. However, after 15-min pretreatment with bradykinin (BK), U50488 became capable of inhibiting AC activity, CGRP release, and thermal allodynia. Inhibition of AC by 5-hydroxytryptamine 1 or neuropeptide Y(1) receptor agonists and stimulation of extracellular signal-regulated kinase activity by U50488 did not require BK pretreatment. The effect of U50488 in BK-primed tissue was blocked by the KOR antagonist nor-binaltorphimine both in vitro and in vivo. The effect of BK in vitro was blocked by either indomethacin or bisindolylmaleimide, suggesting that an arachidonic acid (AA) metabolite and protein kinase C (PKC) activation mediate BK-induced regulation of the KOR system. Furthermore, the effect of U50488 in BK-treated tissue was blocked by a soluble integrin-blocking peptide (GRGDSP), but not the inactive reverse sequence peptide (GDGRSP), suggesting that, in addition to AA and PKC, RGD-binding integrins participate in the regulation of KOR signaling in response to U50488. Understanding the mechanisms by which peripheral KOR agonist efficacy is regulated may lead to improved pharmacotherapy for the treatment of pain with reduced adverse effects.     

TNF-α in CRPS and 'normal' trauma--significant differences between tissue and serum

Posttraumatic TNF-alpha signaling may be one of the factors responsible for pain and hyperalgesia in complex regional pain syndromes (CRPS). In order to further specify the role of TNF-alpha we investigated tissue (skin) and serum concentrations in three different patient groups: patients with osteoarthritis and planned surgery, with acute traumatic upper limb bone fracture waiting for surgery, and with CRPS I. Thirty patients (10 in each group) were recruited. Mean CRPS duration was 36.1 ± 8.1 weeks (range 8-90 weeks). Skin punch biopsies were taken at the beginning of the surgery in osteoarthritis and fracture patients and from the affected side in CRPS patients. Blood samples were taken before the respective procedures. Skin and serum TNF-alpha levels were quantified by ELISA. Compared to patients with osteoarthritis, skin TNF-alpha was significantly elevated in CRPS (p < 0.001) and fracture patients (p < 0.04). Skin TNF-alpha in CRPS patients was higher than in patients with acute bone fracture (p < 0.02). In contrast, serum TNF-alpha values were the same in osteoarthritis and CRPS, and lower in fracture patients (p < 0.03). Our results indicate a local but not systemic increase of TNF-alpha in CRPS patients. This increase persists for months after limb trauma and may offer the opportunity for targeted treatment.     

Phenotypic presentation and underlying mutations in carriers of β‐thalassaemia and α‐thalassaemia in the Danish immigrant population

Objective. The thalassaemia syndromes are the most common hereditary diseases in the world and now appear with relatively high frequency in non‐endemic regions. Guidelines recommend the use of mean corpuscular haemoglobin (MCH) alone or in combination with mean corpuscular volume (MCV) in screening for α‐ and β‐thalassaemia. This article deals with the viability of MCV < 78 fL alone as screening parameter for thalassaemia in non‐endemic regions. Material and methods. Data from the Center for Haemoglobinopathies, Herlev University Hospital, consist of MCV measurements from 438 patients with α‐thalassaemia and 450 patients with β‐thalassaemia referred between 1996 and 2005, and simultaneously measured MCV and MCH measurements in 86 patients referred between November 2004 and November 2005. Results. In 450 β‐thalassaemia patients and 117 α⁰‐thalassaemia patients diagnosed between 1996 and 2005, only two β‐thalassaemia patients had MCV ? 78 fL. All α⁰‐thalassaemia patients had MCV < 78 fL. In contrast, 38 % of patients with α⁺‐thalassaemia had MCV > 78 fL. When MCV and MCH were measured simultaneously, one patient with β‐thalassaemia was missed if MCV was used as a screening tool and one patient was missed if MCH was used. Forty‐four different β‐thalassaemic mutations were found. Conclusions. Our data support the notion that the use of MCV < 78 fL instead of MCH < 27 pg is acceptable as a screening criterion in a non‐endemic population. Only 0.5 % of the β‐thalassaemia patients were missed and all the patients with α⁰‐thalassaemia were diagnosed. Since the racial heterogeneity of the immigrant population in non‐endemic regions creates a scenario with a broad spectrum of mutations and haemoglobinopathy, laboratories should be equipped to detect a large variety of mutations.     

RSV infection in infants and young children. What's new in diagnosis, treatment, and prevention?

RSV is the most important respiratory pathogen in infants and young children. About 1% of primary RSV infections result in hospitalization. The virus is spread by large droplets of secretions or contact with contaminated secretions. Infants infected with RSV may demonstrate poor feeding, rhinorrhea, apnea, lethargy, wheezing, and respiratory distress. Diagnosis may be made by clinical signs and symptoms (especially those observed during epidemics), by chest radiographs showing hyperinflation, or by rapid antigen detection with immunofluorescence of nasopharyngeal aspirates. Risk factors for severe disease accompanied by complications include chronic heart disease, chronic lung disease, immunodeficiency, HIV, and prematurity. Immunity is incomplete and of short duration, and reinfection is common. Treatment remains supportive and consists of oxygen administration, hydration, and diligent monitoring. Use of corticosteroids, bronchodilators, antibiotics, and ribavirin is controversial and is dependent largely on physician preference. Use of ribavirin should be reserved for patients who have severe underlying conditions associated with increased mortality rates. Intravenous RSV Ig has been replaced by palivizumab, which is generally recommended for infants at high risk for severe RSV, including those with a history of prematurity and those with chronic lung disease.     

PKCδ regulates hepatic insulin sensitivity and hepatosteatosis in mice and humans

C57BL/6J and 129S6/Sv (B6 and 129) mice differ dramatically in their susceptibility to developing diabetes in response to diet- or genetically induced insulin resistance. A major locus contributing to this difference has been mapped to a region on mouse chromosome 14 that contains the gene encoding PKCδ. Here, we found that PKCδ expression in liver was 2-fold higher in B6 versus 129 mice from birth and was further increased in B6 but not 129 mice in response to a high-fat diet. PRKCD gene expression was also elevated in obese humans and was positively correlated with fasting glucose and circulating triglycerides. Mice with global or liver-specific inactivation of the Prkcd gene displayed increased hepatic insulin signaling and reduced expression of gluconeogenic and lipogenic enzymes. This resulted in increased insulin-induced suppression of hepatic gluconeogenesis, improved glucose tolerance, and reduced hepatosteatosis with aging. Conversely, mice with liver-specific overexpression of PKCδ developed hepatic insulin resistance characterized by decreased insulin signaling, enhanced lipogenic gene expression, and hepatosteatosis. Therefore, changes in the expression and regulation of PKCδ between strains of mice and in obese humans play an important role in the genetic risk of hepatic insulin resistance, glucose intolerance, and hepatosteatosis; and thus PKCδ may be a potential target in the treatment of metabolic syndrome.     

The rise in legal highs: prevalence and patterns in the use of illegal drugs and first- and second-generation “legal highs” in South London gay dance clubs

Aim: To assess the prevalence of use of established illegal psychoactive drugs and emergent psychoactive drugs, the so-called “legal highs”, amongst gay club-goers who are considered to be “early adopters” of drug trends.

Design: Three in situ surveys were conducted in July 2010 with customers at two dance clubs (nightclubs) in an area known for its “gay-friendly” night time economy. The surveys assessed the prevalence of self-reported lifetime, past year, past month, fieldwork day use and planned use of illegal drugs and “legal highs”.

Setting: This is a field study.

Participants: The participants were 308 customers in two “gay-friendly” clubs in South London, United Kingdom.

Measurements: Two-page research instrument was designed for in situ drug surveys.

Findings: Our sample had higher rates of self-reported lifetime and recent use of established illegal drugs than the general population. Mephedrone emerged from near obscurity to become the most popular illegal drug in this survey, with 41% having taken it in the past month and 27% having either taken and/or planning to take it on the fieldwork night. Regarding second-generation “legal highs”, 11% of the sample had taken NRG-1 in the past month and 3% had taken and/or planned to take it on the fieldwork night.

Conclusions: This survey suggests that the popularity of mephedrone surpasses other drugs, both legal and illegal, despite having been banned by the UK government prior to this survey being conducted. “Early adopters” of drug trends appear to be undeterred by the legal classification of emergent psychoactive substances. Given the global nature of the trade in “legal highs”, this study has implications for other countries where mephedrone use is emerging.     

ADAM-9, ADAM-15, and ADAM-17 are upregulated in macrophages in advanced human atherosclerotic plaques in aorta and carotid and femoral arteries—Tampere vascular study

Background and aims. The expression of disintegrin and metalloprotease ADAM-9, ADAM-15, and ADAM-17 has been associated with cell-cell, cell-platelet, and cell-matrix interactions and inflammation. They are possibly implicated in the pathophysiology of atherosclerosis.

Methods and results. Whole-genome expression array and quantitative real-time polymerase chain reaction (PCR) analysis confirmed that ADAM-9, ADAM-15, and ADAM-17 are upregulated in advanced human atherosclerotic lesions in samples from carotid, aortic, and femoral territories compared to samples from internal thoracic artery (ITA) free of atherosclerotic plaques. Western analysis indicated that the majority of these ADAMs were in the catalytically active form. ADAM-9, ADAM-15, and ADAM-17-expressing cells were shown to co-localize with CD68-positive cells of monocytic origin in the atherosclerotic plaques using immunohistochemistry and double-staining immunofluorescence analysis. Co-localization was demonstrated in all vascular territories. In the carotid territory, cells expressing the ADAMs co-distributed also with smooth muscle cells and, in femoral territory, with CD31-positive endothelial cells, indicating that the ADAM expression pattern depends on vascular bed territory.

Conclusions. Present findings provide strong evidence for the involvement of catalytically active ADAM-9, ADAM-15, and ADAM-17 in advanced atherosclerosis, most notably associated with cells of monocytic origin.     

Geography and nursing: convergence in cyberspace?

During the last 3 years the interface between geography and nursing has provided fertile ground for research. Not only has a conceptual emphasis on space and place provided nurse researchers with a robust and subtly different way to deconstruct and articulate nursing environments, but also their studies have provided a much needed focus on certain areas of health-care, and in particular clinical practice, not currently prioritized by health geographers. We argue that, as something that is forcing fundamental re-considerations of the nature of both nursing and geography, cyberspace is a particularly important phenomenon that lies comparatively under-researched at this interface. To encourage some interest in researching nursing and cyberspace through a geographical lens, and at least to showcase a range of potentially useful and transportable concepts, we provide an overview of some of the key debates pertaining to cyberspace developed by human geographers, and make some initial and tentative connections to nursing.     

Manifestations and causes of psychological and behavioral problems in infant patients and patients of early age

Largeamountsclinicalfactsdemonstratethatmanydiseasescaninduceemotionaldisturbancesandpsychologicalproblemssuchasfear,anxiety,restlessness,agitationandirritabilityininfantilepatientsandpatientsofearlyage.Theauthorwouldliketodiscussbrieflyseveralcommonpsychologicalandbehavioralproblemsandthecorrespondingcausesofthem.1CommonpsychologicalandbehavioralproblemsininfantpatientsandpatientsofearlyageCryingandmakingnoise:Cryingandmakingnoiseisasignalinfantsandchildrenusetoconveylargeamountsofinformation…     

Manifestations and Causes of psychological and behavioral problems in infant patients and patients of early age

Lage amounts clinical facts demonstrate that many diseases can induce emotional disturbances and psychological problems such as fear,anxiety,restlessness,agitation and irritability in infantile patients and patients of early age.The author would like to discuss briefly several common psychological and behavioral problesms and the corresponding causes of them.