Treatment of hypogonadal adolescent boys with long acting subcutaneous testosterone pellets

AIMS: Long acting subcutaneous testosterone pellets are of proved efficacy for the treatment of hypogonadal men, but have not been reported as a treatment modality in adolescent boys. Pharmacodynamic studies of subcutaneous testosterone release have shown prolonged normalisation of testosterone levels for at least four months. Administration of a long acting, safe, effective, and convenient form of treatment is desirable when life-long treatment is indicated. PATIENTS AND METHODS: Eighteen boys (aged 13.9-17.5 years at the start of treatment)-seven with primary hypogonadism, nine with secondary hypogonadism, and two boys being treated with testosterone for tall stature--were given testosterone pellets (8-10 mg/kg) every six months for 18 months. Height, weight, pubertal status, and psychosocial parameters were assessed and follicle stimulating hormone, luteinising hormone, testosterone, prolactin, and lipids were measured at 0, 1, 3, 6, 12, and 18 months. Bone age was measured at 0 and 12 months. RESULTS: In all boys growth velocity continued appropriately for bone age. Puberty continued to progress in all boys and in two boys the amount of virilisation exceeded that seen with previous treatment with intramuscular testosterone. After testosterone administration, follicle stimulating hormone and luteinising hormone suppressed incompletely in the boys with primary hypogonadism. Serum testosterone ranged from 4.3 to 26.7 nmol/l at three months to less than 10 nmol/l at six months after implantation. Prolactin and lipid levels were normal throughout the study. By report, there was an improvement in mood and emotional wellbeing. No pellet extrusions occurred in a total of 156 pellet insertions. CONCLUSIONS: All boys preferred this mode of testosterone administration to intramuscular injections. Long acting subcutaneous testosterone pellets are safe, efficacious, well tolerated, and convenient, and result in normal physical growth and improved psychological outlook in adolescent hypogonadal boys.     

论卫生船舶在登陆作战中的配置

在大规模登陆作战中需要大量的卫生船舶实施各种保障,因此必须对卫生船舶进行合理的配置,保证其既能有效地完成保障任务,又能避免重叠配置造成浪费．卫生船舶的配置应与指挥关系、保障任务战时分类相适应,具体配置时按医院船、卫生运输船、卫生救护艇的保障要求配置,并可根据保障任务的变化进行相应的调整．     

Pace-Termination and Pacing for Prevention of Atrial Tachyarrhythmias: Results from a Multicenter Study with an Implantable Device for Atrial Therapy

INTRODUCTION: Patients with bradycardia requiring permanent pacing frequently suffer from additional atrial tachyarrhythmias (ATs). This study evaluated the safety and efficacy of atrial antitachycardia pacing (ATP) and the performance of pacing for AT prevention implemented into a new pacemaker. METHODS AND RESULTS: In patients with conventional indications for permanent pacing, an investigational DDDRP pacemaker (Medtronic AT500, model 7253) was implanted. The primary study objectives were to determine the safety of overall device functioning and its efficacy in terminating spontaneous AT. A secondary endpoint was to determine the reliability of AT detection. Pacemaker memory functions were used to analyze the impact of dedicated pacing algorithms on AT prevention. In 33 European and Canadian centers, 325 patients were enrolled (mean follow-up 2.3+/-1.3 months). Complication-free survival at 3 months was 88%. In 2,145 episodes stored with atrial electrograms, AT detection was confirmed in 97%. The algorithm for continuous overdrive pacing increased the percentage of atrial pacing to 97%. After ATP activation, 16,683 of 52,468 AT episodes were treated (120 patients). Of these, 8,903 episodes (53%) were terminated successfully by ATP. No proarrhythmic effect of preventive pacing or atrial ATP was observed. Preventive pacing algorithms increased the median percentage of atrial pacing from 62% to 97%. However, the number of AT/AF (atrial fibrillation) episodes (4.1 vs 4.1 per patient per day) and the time in AT/AF (13.7% vs 12.8%) was not significantly different before and after activation of preventive pacing. CONCLUSION: DDDRP pacing with a new system for AT therapy was safe and associated with successful pace-termination of AT in 53% of episodes. Preventive pacing and atrial ATP algorithms represent two new functions that can be implemented safely into pacemaker systems for nonpharmacologic treatment of ATs in patients requiring pacemaker therapy.     

The catcher in the why: developing an evidence-based approach to the organization, delivery and evaluation of pre-registration nurse educational programmes

Changes to the pedagogy of pre-registration nurse education and training have become a global phenomenon. However, the evidence base to inform responses to these changes and the impact on nursing practice is limited. This paper explores the outcomes of an innovative approach aimed at ensuring responses to these drivers for change, particularly in curriculum development, the organisation, management and delivery of programmes and the enhancement of the student experience, are evidence based. This paper reports on an organisational change project undertaken in a School of Nursing in the North West of England, UK. The project involved 12 interrelated work streams used to explore aspects of the student journey from recruitment through progression to eventual employment. An evidence base was developed through a methodological bricolage that drew upon a robust and authentic mixture of systematic literature reviews, contemporaneous analysis of educational practice and evaluation of the student experience. This was used to underpin the decision making processes required to promote innovation in programme design, to increase the involvement of students in the facilitation and evaluation of their learning experiences, and helped shape the organisational changes required for embedding an evidenced-based culture in the School. Consistent and transformational leadership has been key to the project's success in communicating and managing the changes.     

Comparison of the critical concentration and critical volume hypotheses to model non-specific toxicity of individual compounds

The critical concentration and critical volume hypotheses for non-specific toxicity require the molar concentration (CC) and volume fraction (VF) of toxicant in target tissue to be constant. Thus these factors should be independent of the octanol-water partition coefficient (Kow) for individual compounds. CC and VF values were calculated based on acute sub-lethal, acute and chronic lethal toxicity data, Kow and pure component molar volume (MV) data. When these values were plotted against log Kow, the slopes of the regression equations were significantly different to zero but were not significantly different from each other. The observed slight increase in CC and VF with increasing log Kow was attributed predominantly, to the use of Kow values which overestimate the target tissue-water partition coefficient (Kow). An additional error associated with the volume fraction calculations was the use of the molar volume instead of partial molar volume. VF and CC values were calculated correcting for both these factors and regressed against log Kow. The resulting equation for VF had a gradient not significantly different from zero, while that for CC was, thus indicating the superiority of the critical volume hypothesis in modelling non-specific toxicity of individual compounds.     

Issues in the development of geriatric medicine in Britain and Australia

Alloimmune neonatal neutropenia is due to maternal IgG neutrophil-specific antibodies that cross the placenta to sensitize fetal neutrophils and cause neutropenia in the neonate. Within the first few weeks of life, the infant may succumb to localized or generalized bacterial infections. Haematologically, the mother is normal, but the infant is severely neutropenic. The incidence of this condition is one in 2000 neonates, but it can be overlooked easily if specialized testing is not performed in neonates with unexplained neutropenia. It is generally a self-limiting disorder, but severe infection may result in a 5% mortality. The clinical and serological features of four cases are described. The treatment of severe infections in infants with alloimmune neonatal neutropenia is essential, but the use of prophylactic antibiotic therapy during the period of neutropenia is not warranted.     

Ossicular erosions in the dry ear: CT diagnosis

Erosions of the ossicular chain that occurred as a complication of noncholesteatomatous chronic otitis media were studied with computed tomography (CT) in 55 patients. The incus (particularly the long and lenticular processes) was the ossicle most commonly involved (50 cases). Coronal and axial CT sections were complementary in the diagnosis of these erosions. Fibrous replacement of the incudostapedial articulation was diagnosed in four cases on axial CT scans when an unusually wide joint was present.