Influence of intravenous fat emulsion on serum bilirubin in very low birthweight neonates.

Thirty nine very low birthweight neonates (with a birth weight of 820 to 1500 g and gestation of 27 to 34 weeks) who required total parenteral nutrition were randomly assigned to one of three regimens of administration of fat emulsion for a period of eight days. Groups 1 and 2 received the emulsion at a constant rate over 24 and 16 hours, respectively, beginning with a daily dosage of 1 g/kg and increasing daily by 1 g/kg to a maximum of 4 g/kg. Group 3 received the emulsion at a constant rate of 4 g/kg a day over 24 hours. Plasma concentrations of free fatty acids and serum concentrations of total bilirubin, apparent unbound bilirubin, and albumin were measured at regular intervals. Effects of the three regimens on serum bilirubin measurements were determined. The regimen of fat infusion and rate of infusion seemed to have no effect on serum concentrations of total and apparent unbound bilirubin, although there was a trend towards greater variability in apparent unbound concentrations with the intermittent regimen.     

Balint's syndrome in a 10-year-old male

A 10-year-old male was referred with difficulties at school. He had particular difficulty with reading long words, following the sequence of text down a page, writing words in the correct order, writing words in line, and copying from the blackboard. He had a history of infective endocarditis complicated by intracerebral haemorrhage at the age of three years. Detailed history taking revealed symptoms typical of 'dorsal stream' pathology, namely a deficit of 'vision for action'. This included a spatial disorder of attention (simultanagnosia), defective hand and foot movements under visual control (optic ataxia), and acquired oculomotor apraxia which are consistent with Balint's syndrome. Strategies were suggested for coping with the symptoms and one year later a distinct improvement in adapting to the disability was found.     

Personality dynamics of intimate abusiveness

A new theory is proposed to account for individual differences in the tendency to be abusive, assaultive, or homicidal in intimate relationships. The focus of this theory is on men whose abuse is specific to intimate relationships and is manifested through cyclical mood swings. This group, which appears to comprise about 40% of all men who present for treatment for wife assault, appears to have a borderline personality structure. For these men, abusiveness is triggered by internal mood states rather than by external events. Several studies are cited indicating that intimate attachment generates rage in wife assaulters. The origins of this attachment-rage are traced to early development. This template generates a complex of perceptions (attributions and projections) and behaviors (abusiveness) specific to intimate relationships. A personality profile of intimately abusive males has been strongly related to intimate partners' reports of psychological abusiveness in several samples of males, including physically assaultive males, non-violent controls, clinical outpatients, college students, and gay males.     

反应停治疗难治性多发性骨髓瘤25例

1临床资料我院2001-02/2004-01接受2个疗程卡氮芥 环磷酰胺 马法兰 泼尼松 长春新碱或2个疗程长春新碱 阿霉素 地塞米松方案化疗无效或复发的难治性多发性骨髓瘤患者25(男16,女9)例,年龄42～80(中位年龄57.2)岁.单用反应停口服治疗,起始剂量200 mg/d,如无不良反应,每周增加100 mg,根据患者耐受情况,最高剂量为600 mg/d,3 mo为1疗程.服药期间禁止使用糖皮质激素类药物及细胞毒药物.     

Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals

Background  

Theories of behavior change indicate that an analysis of barriers to change is helpful when trying to influence professional practice. The aim of this study was to assess the perceived barriers to practice change by eliciting nurses' opinions with regard to barriers to, and facilitators of, implementation of a Fall Prevention clinical practice guideline in five acute care hospitals in Singapore.     

The quantitative analysis of zearalenone and its derivatives in plasma of patients with breast and cervical cancer.

Zearalenone (6-[10-hydroxy-6-oxo-trans-1-undecenyl]-beta-resorcylic acid-p-lactone), a mycotoxin produced in corn, is able to adopt a conformation which sufficiently resembles 17beta-oestradiol to allow it to bind to the oestrogen receptor in target cells of the body and exert (agonist) oestrogenic action. We adopted an analytical approach to isolate and quantify the mycotoxin and its derivatives using high-performance liquid chromatography and gas chromatography-mass spectrometry. In this study, the quantity of zearalenone and its congeners (alpha-zearalenol and beta-zearalenol) present in the plasma of patients with breast (n = 28) and cervical carcinoma (n=54) were compared with levels in patients presenting with other diagnoses (n = 26) and healthy volunteers (n = 24). There were no significant differences between the groups in the levels of zearalenone and its congeners, using analysis of covariance (0.2 < p < 0.6). These results suggest that the presence of this mycotoxin in blood does not indicate causal relationship between exposure to this exogenous myco-oestrogen and the subsequent biological effect in our study population but may be used as an indicator of exposure. The presence of zearalenone in the study groups is, however, of growing concern, due to the possible effects of cumulative long-term exposure of oestrogenic target organs to this compound.