Agreement between Emergency Physicians and Psychiatrists Regarding Admission Decisions

Objective: To determine the level of agreement between emergency physicians (EPs) and psychiatrists regarding the need for acute psychiatric hospitalization and treatment for patients presenting with alleged psychiatric complaints.
Methods: A prospective, cross-sectional assessment of concordance between EPs and psychiatrists in psychiatric admission decisions was performed at an urban county, teaching hospital ED. The participants had been brought to the ED for psychiatric evaluation. The patients were interviewed by an attending EP or a senior-level resident, and a tentative impression and disposition were determined pfior to an independent examination and final disposition by a psychiatrist. Strength of physician group agrement was determined using the k statistic.
Results: The patient mean age was 37.5 ± 15 years; 51% were men. The most common reasons for evaluation were disruptive behavior (28%), overdose (24%), and danger to self (23%). Of the 156 patients, 47 (28.7%) were sent home without treatment, 10 (6.3%) were determined to need only medical treatment, and 6 (3.7%) were released with outpatient psychiatric treatment. There were 84 (55.7%) patients admitted for psychiatric treatment. The EPs and psychiatrists had only moderate agreement regarding danger to self (k = 0.44), danger to others (k = 0.40). substance abuse as the primary problem (k = 0.50), and need for psychiatric hospitalization (k = 0.54).
Conclusion: Moderate agreement between EPs and psychiatrists in key impressions and admission decisions suggests that shared training in psychiatric decision making, especially during residency training, is desired in this setting.     

Induction of functional lipoxin A4 receptors in HL-60 cells

The appearance of [11,12-3H]lipoxin A4 (LXA4) specific binding sites was examined with human acute promyelocytic leukemic cell line 60 (HL- 60) cells exposed to either retinoic acid, phorbol 12-myristate 13- acetate (PMA), or dimethyl sulfoxide (DMSO). All three agents induced a threefold to fivefold increase in the expression of specific [11,12- 3H]LXA4 binding. Similar results were obtained in parallel with [14,15- 3H]leukotriene (LT) B4. For both 3H-ligands, homologous displacement curves were similar and independent of the agent used to induce differentiation. Specific binding of [11,12-3H]LXA4 to differentiated HL-60 cells gave a kd = 0.6 +/- 0.3 nmol/L. The appearance of both [11,12-3H]LXA4 and [14,15-3H]LTB4-specific binding sites was inhibited by actinomycin D, and LXA4 binding was sensitive to protease treatment. Specific binding of [11,12-3H]LXA4 was not evident with human platelets, red blood cells (RBCs) or the cultured B-cell (Raji), T-cell (Jurkat) lines save human endothelial cells (kd = 11.0 +/- 0.3 nmol/L). The structural specificity of induced [11,12-3H]-LXA4 recognition sites was assessed with LXB4, LTC4, LTB4, and trihydroxyhepatanoic methyl ester. Only LTC4, at 3-log molar excess, competed for 3H-LXA4-specific binding with HL-60 cells and gave a 30% reduction. The leukotriene D4 receptor antagonist SKF 104353 was ineffective in blocking [11,12- 3H]LXA4-specific binding with HL-60 cells while it competed for specific [11,12-3H]LXA4 binding with endothelial cells where LTD4 binding appears to be virtually identical to that of LXA4 binding. In addition, the LTB4 receptor antagonist ONO 4057 was ineffective at competing for [11,12-3H]LXA4 binding. When phospholipase D activation was monitored in human polymorphonuclear leukocytes (PMN) and HL-60 cells, a correlation was shown between activation and specific 3H-LXA4 binding. LXA4-induced phospholipase D (PLD) activation gave a biphasic concentration-dependent response comprised of at least two components: one phase being islet-activating protein (IAP)-sensitive (LXA4 10(-9) mol/L peak activity) and the other was staurosporine-sensitive (LXA4 10(-7) mol/L peak activity). Results indicate that HL-60 cells exposed to differentiating agents express [11,12-3H]LXA4 recognition sites also present in PMN. In addition, specific LXA4 recognition sites of myeloid cells can be distinguished by competition binding with SKF 104353 and 3H-LXA4 cross-reactivity with putative LTD4 receptors present on human endothelial cells. Moreover, they provide evidence indicating that binding of LXA4 to its recognition sites confers functional responses.     

Lymphoblastic lymphoma in adults: results of a pilot protocol

Thirteen adult patients with histologically confirmed lymphoblastic lymphoma were treated with an intensive chemotherapy program consisting of induction with cyclophosphamide, adriamycin, vincristine, and prednisone (modified CHOP); consolidation and central nervous system (CNS) prophylaxis with methotrexate intrathecally and by high-dose intravenous injection, citrovorum factor and L-asparaginase; reinforcement with CHOP; and maintenance with 6-mercaptopurine and methotrexate. Treatment duration was 1 yr. A 14th patient with T-cell acute lymphoblastic leukemia was also treated at presentation by the same regimen. Thirteen patients had at least a mediastinal mass or abnormal cells in the bone marrow; one presented with CNS disease. The median age was 22 yr (range 16--50), and male--female ratio was 2.5:1. All patients had a rapid complete clinical response. Of the 13 patients without initial CNS disease, 4 have relapsed, 3 with primary CNS relapse and 1 with a recurrent abdominal mass. Five patients have died, 2 from drug toxicity, 2 from CNS relapse, and 1 from chronic myelogenous leukemia, which was diagnosed simultaneously with the lymphoblastic lymphoma. The median follow-up is 19 mo, and all patients have completed their planned therapy. At 3 yr, the actuarial survival is 61% and relapse-free survival is 56%.     

The problem of obesity among adolescents in Hong Kong: a comparison using various diagnostic criteria

Background  

Obesity is now a global epidemic. In this study, we aimed to assess the rates of obesity using several major diagnostic criteria in Chinese school adolescents in Hong Kong.     

The use of Bi-level positive pressure ventilation in the treatment of acute respiratory failure within the emergency department

Acute respiratory failure (ARF) is one of the eight leading causes of death for over 65-year-olds in Australia. Bi-level positive pressure (BiPAP) ventilation is the preferred form of non-invasive ventilation in the treatment of acute respiratory failure in the emergency department (ED) because, when used appropriately, it reduces the need for intubation. The patient on whom BiPAP is applied is able to protect their own airway, remaining cooperative with a normal mental state. In this paper, I explain acute respiratory failure, the appropriateness of BiPAP in the treatment of ARF, patient selection and exclusion from BiPAP treatment, current practice and recommendations for future practice. While BiPAP is commonly used in Australian EDs as part of the treatment of acute respiratory failure, evidence supporting its use is limited and more high level research is recommended.     

Efficacy of Raphanus sativus in the treatment of paracetamol-induced hepatotoxicity in albino rats

In the present study, the efficacy of a methanol extract of Raphanus sativus root (RSME) is tested in albino rats that developed hepatic damage due to administration of paracetamol (100 mg/kg body weight) for 30 days. Twenty rats were divided into three experimental groups (E1, E2, E3) and one control group (EC). Two doses of RSME (80 and 120 mg/kg body weight) were administered orally to E1 and E2, respectively, and a mixture of RSME (120 mg/kg) and paracetamol (100 mg/kg) was administered to E3 for 21 days. Group EC and another group of normal rats (EN) that served as controls were administered distilled water. At the end of the experiment rats were bled to assay thiobarbituric acid reactive substances (TBARS), serum glutamate oxaloacetate transaminase (SGOT) and serum glutamate aspartate transaminase (SGPT), reduced glutathione (GSH) and catalase. Results indicated that RSME reduced the levels of TBARS, SGOT and SGPT, and increased the level of GSH and the catalase activity in E1 and E2 as compared to the EC group. Group E3 showed decreases in TBARS, SGOT and SGPT levels, but the results were not statistically significant compared with the EN group. There was also a marked depletion in GSH level and catalase activity in this group. RSME reduced lipid peroxidation induced by paracetamol and brought the levels of SGOT and SGPT to normal, indicating liver recovery. It also brought about repletion of GSH levels and recovery of catalase activity. Results for group E3 indicated that RSME was not able to reverse the effects of paracetamol if administration continued.     

4-(2-酰胺基-2-乙氧羰基)乙硫基-4-脱氧-4′-去甲表鬼臼毒素衍生物的合成与抗肿瘤活性

为考察4′-去甲基表鬼臼毒素4位上取代基结构变化与抗肿瘤活性的关系,设计并合成了23个标题化合物。体外L₁₂₁₀白血病细胞与KB细胞生长抑制试验的结果表明,化合物11,16和18的抗肿瘤活性超过依托泊甙,化合物8的活性与依托泊甙相当。