Treatment of adverse digitalis effects by hemoperfusion through columns with antidigoxin antibodies bound to agarose polyacrolein microsphere beads

Ten patients with an array of moderate to severe adverse effects resulting from digitalis were effectively treated by hemoperfusion through small columns which contained antidigoxin antibodies bound to polyacrolein microspheres in agarose macrospheres (APAMB). The procedure was well tolerated. There was no detectable damage to formed blood elements and no changes in electrolytes, liver enzymes, or other related biochemical parameters. Despite some theoretic considerations to the contrary, the removal of a relatively small load of digoxin resulted in amelioration of the clinical symptoms and ECG abnormalities associated with digitalis. No rebound phenomena of intoxication or posthemoperfusion increase in digoxin serum levels were noted over the subsequent 5 to 6 days. A further increase in the capacity of the columns may render this method a safe and convenient emergency procedure for patients with digitalis toxicity.     

Aspects of the nurse tutor-student nurse relationship

This paper is focused on selected items from an exploratory study of nurse tutor-student nurse role-relationships. Aspects of the teacher-student and counsellor-client dimensions of the relationship are reported. The research was conducted from a sociological perspective using role theory as the organizing theoretical framework. An 'ideal type' tutor-student relationship was proposed from the findings. There was concensus between tutors and students that tutors acted in a caring way towards students but many constraints were identified which inhibited students with problems from seeking help from tutors and prevented tutors from offering all the help which they wished to give to students.     

自体髂骨植骨带锁钢板内固定材料置入并一期前后路减压治疗多节段脊髓型颈椎病12例:临床资料回顾分析

目的:严重的多节段脊髓型颈椎病单纯前路或后路手术都有其局限性。观察一期前后路联合手术并自体髂骨植骨及带锁钢板内固定材料置入在治疗多节段脊髓型颈椎病中的应用价值。方法:选择2004-11/2006-12本院12例多节段脊髓型颈椎病患者,均采用一期前后路减压、自体髂骨植骨融合、带锁钢板内固定联合手术。其中男9例,女性3例,年龄49～75岁;3节段受累9例,4节段受累3例(突出节段分布:C3～66例,C4～73例,C3～73例)。全部病例进行临床随访,患者均对本试验知情同意。采用mJOA评分标准对患者神经功能改善情况进行评定;术前颈椎侧位片测量,以D值(C4椎体后下缘到齿突后缘与C7椎体后下缘连线的垂直距离)评价颈椎(C2～7)弧度;根据颈椎伸屈动态侧位片C2和C7椎体后缘切线相交所成的夹角之和评价颈椎(C2～7)活动范围。主要以电话随访和问卷填写的方式,分别从神经功能改善情况、颈椎弧度、活动范围及术后并发症等进行随访观察。结果:①12例患者全部得到随访,术后随访时间6～28个月,平均(16±6)个月。②所有植骨均获得骨性愈合;疗效结果中优4例(33.3%);良6例(50%);无效2例(16.7%);颈椎D值术前(3.9±1.4)mm,术后即刻(8.5±1.7)mm,随访时(8.1±2.5)mm。术前与术后差异有显著性(P<0.01),术后与随访时差异无显著性(P=0.251);颈椎活动范围术前(36.3±4.0)°,随访时(10.6±2.7)°,与术前相比差异具有显著性(P<0.01)。③术后C5神经根麻痹1例,为感觉及运动混合型,8个月随访时,感觉功能恢复,肩关节外展肌力从术后Ⅱ级恢复至Ⅳ级;1例术后6个月出现"S"畸形而再次压迫脊髓,神经功能改善停滞,目前处于随访中。结论:一期前后路手术并自体髂骨植骨及带锁钢板内固定材料置入减压充分、彻底,而且前路手术能重建颈椎稳定性,恢复颈椎生理前凸和椎间高度,并且后路减压术又能预防相邻颈椎退变引起的脊髓继发的压迫。     

Cluster Analysis of Extracardiac Control of the Heart Rate in Random-Bred Albino Rats at Rest

Heart rate variability was examined in random-bred albino rats at rest. The rats were clusterized according to activity of autonomic contour of heart rate control. Combination of factor and cluster analyses enhanced informative value of spectrum parameters of the heart rate variability in nonlinear rats grouped by initial neurovegetative status. The contours of central and autonomic regulation describe the most general features of the control influences that realize modulating influences at the heart level via sympathetic and parasympathetic control pathways. Their activity is comprehensively assessed by the normalized power spectrum of variations in the heart rate. Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 147, No. 1, pp. 16–19, January, 2009     

Comparison of the influence of thyroglobulin antibodies on serum thyroglobulin values from two different immunoassays in post surgical differentiated thyroid carcinoma patients

Measurement of serum thyroglobulin (Tg) is a highly specific test in the management of patients with differentiated thyroid cancer (DTC) after surgical treatment. The aim of our study was to evaluate and compare Tg levels in these patients found by radioimmunoassay (RIA) and immunoradiometric assay (IRMA) and to assess the influence of Tg antibodies (TgAbs) on the values obtained for Tg concentration. Both Tg and TgAb were determined postoperatively in the serum of 71 DTC patients using RIA Tg‐PEG (INEP) and Tg IRMA (CIS) for Tg, together with TgAb (CIS) for circulating endogenous anti‐TgAbs. The obtained concentrations were evaluated statistically. We found a significant difference of Tg concentrations between paired samples from the IRMA and RIA, although the intermethod comparison yielded satisfactory concordance of the twoassays (Spearman correlation coefficient ?0.792). Positive TgAb was found in 28.2% of the serum samples analyzed. Spearman rank correlation analysis revealed a significant negative relationship between serum TgAb and Tg level measured by IRMA (P=0.02), but not by RIA (P=0.417). On the other hand, our clinical data revealed that 1/18 and 3/18 patients with proven lymph node metastasis had Tg values below the detection limit by RIA and IRMA assay, respectively. Their sera were TgAb positive. We concluded that RIA was less prone to influence of TgAb than IRMA. As the presence of TgAbs may interfere in Tg measurement irrespective of the method selected for determination, this should be considered during the clinical management of these patients. J. Clin. Lab. Anal. 23:341–346, 2009. © 2009 Wiley‐Liss, Inc.     

Neuronal hyperexcitability induced by repeated brief episodes of hypoxia in rat hippocampal slices: involvement of ionotropic glutamate receptors and L-type Ca(2+) channels

Repeated exposures of rat hippocampal slices to short episodes of hypoxia induce a sustained decrease in the threshold of the development of stimulus-evoked epileptiform discharges in CA1 pyramidal neurons. We have previously demonstrated that the K(+)(o)-induced hyperexcitability required functional L-type voltage-dependent Ca(2+) channels and NMDA-receptors, but was independent of AMPA/kainate-receptor activation. As hypoxia/ischaemia can lead to increased K(+)(o), the epileptiform activity observed after exposure to these challenges could also result from high K(+)(o). The purpose of this study was: (i) to determine whether ionotropic glutamate receptors and L-type Ca(2+) channels are involved in the development of epileptiform activity induced by repeated exposures of hippocampal slices to hypoxia; and (ii) to compare the properties of hypoxia- and high K(+)(o)-induced hyperexcitability. Population spike of presynaptic fibres with field excitatory postsynaptic potential from the stratum radiatum, and population spike of CA1 pyramidal neurons from the stratum pyramidale, were recorded simultaneously in the CA1 area of rat hippocampal slices in response to electrical stimulation of the Schaffer collateral/commissural fibres. Repeated, brief hypoxic episodes induced a sustained decrease in the threshold for development of evoked epileptiform discharges that was associated with long-term potentiation of the CA3-CA1 synapses, but without EPSP-spike potentiation (i.e. in contrast to high K(+)(o)-induced hyperexcitability). The selective antagonist of NMDA receptors, D-APV (25 microM), and the selective blocker of L-type Ca(2+) channels, nifedipine (10 microM) depressed the development of hypoxia-induced hyperexcitability. However, in contrast to high K(+)(o)-induced hyperexcitability, hypoxia-induced hyperexcitability was also blocked by the AMPA/kainite-receptor antagonist, CNQX (5 microM). The present findings confirm that repeated, brief episodes of hypoxia, like exposure to high extracellular K(+), can induce a pro-epileptic state in the CA1 neuronal network, but that the mechanisms leading to hyperexcitability are different for the two stimuli.     

Randomized trial evaluating a new 0.5% fluorouracil formulation demonstrates efficacy after 1-, 2-, or 4-week treatment in patients with actinic keratosis

The efficacy and safety of a new 0.5% fluorouracil topical cream were compared with vehicle control for the treatment of actinic keratosis (AK). Active treatment applied once daily for 1, 2, or 4 weeks was more effective than vehicle control in achieving reduction from baseline in lesion counts and lesion clearance. Active treatment also resulted in significantly better global assessments of overall improvement. Treatment was effective regardless of the number of baseline lesions. Although longer treatment duration correlated with greater efficacy, treatment for 1, 2, or 4 weeks was effective. This new microsphere-based fluorouracil formulation was generally well tolerated; adverse events were primarily limited to facial irritation that resolved quickly after treatment. This new treatment provides a safe alternative to the topical fluorouracil formulations currently available for the 1-, 2-, or 4-week treatment of AK.     

In vivo hippocampal kindling occludes the development of in vitro kindling-like state in CA1 area of rat hippocampal slices

In our previous work (Semyanov and Godukhin, 1997), we showed that the repeated short-term extracellular K+ (K0+) increases induced long-lasting reduction of the threshold of evoked epileptiform discharges in CA1 hippocampal slices isolated from normal (nonkindled) rats. This state had some features characteristic of traditional in vivo kindling and was described as in vitro kindling-like state (VKLS). The aim of the present investigations was to determine the features of the VKLS development in CA1 slices isolated from electrical hippocampal kindled (nonepileptic) rats and from genetically-prone to audiogenic seizures audiokindled rats. We found that both forms of in vivo kindling occluded the VKLS development induced by the repeated K& increases in CA1 slices. These data provide more evidence that the in vivo kindling and VKLS developments in CA1 region of hippocampus are based on activation of similar cellular mechanisms. It is suggested that the described model of in vitro kindling can be useful for further studies of the cellular-molecular mechanisms of plastic alterations in neurons associated with the start of kindling induced epileptogenesis.