Multiple symptoms in patients with chronic obstructive pulmonary disease in Norway

This paper examines the prevalence of multiple symptoms and the relationships between future expectations and multiple symptoms in a cross‐sectional study of 100 patients with chronic obstructive pulmonary disease. A questionnaire was used to examine the patients’ symptoms of breathlessness, anxiety, depression, sleeplessness, fatigue, and pain, and their outlook for the future. All patients reported breathlessness, 64% anxiety, 69% depression, 28% sleeplessness, 72% fatigue, and 45% pain. Those with anxiety reported significant depression (P < 0.001), and those with fatigue reported significant depression (P = 0.004). Patients who reported pain also reported significant sleeplessness (P = 0.022). A negative outlook for the future was reported by 42% of patients who also reported significantly more anxiety, depression, sleeplessness, fatigue, and pain (P ≤ 0.049). Multiple symptoms are common in chronic obstructive pulmonary disease, and patients with a pessimistic view of the future reported more symptoms. Those with multiple symptoms and a negative outlook toward the future may benefit from interventions to help them achieve a more positive outlook for the future, which may relieve symptom burden.     

Assessment of the steady-state pharmacokinetic interaction between etravirine administered as two different formulations and tenofovir disoproxil fumarate in healthy volunteers

Objective

Two open‐label, randomized, cross‐over trials in healthy volunteers were conducted to investigate the pharmacokinetic interaction between etravirine and tenofovir disoproxil fumarate.

Methods

Etravirine was administered as either 800 mg twice a day (bid) (phase II formulation in Study 1) or 200 mg bid (phase III formulation in Study 2) for 8 days followed by a 12 h pharmacokinetic evaluation. After a minimum of 14 days washout, tenofovir disoproxil fumarate 300 mg once a day was administered for 16 days. Volunteers were randomized to receive co‐administration of etravirine with tenofovir disoproxil fumarate on either days 1–8 or days 9–16 followed by a 12 h pharmacokinetic evaluation for etravirine on day 8 or 16, respectively. Plasma and urine tenofovir concentrations were determined on days 8 and 16 over 24 h.

Results

The least square mean (LSM) ratio [90% confidence interval (CI)] for the area under the plasma concentration–time curve from 0 to 12 h (AUC_{12 h}) for etravirine co‐administered with tenofovir disoproxil fumarate vs. etravirine alone was 0.69 (0.61–0.79) and 0.81 (0.75–0.88) in Studies 1 and 2, respectively. The LSM ratio (90% CI) for the effect of etravirine on tenofovir AUC_{24 h} was 1.16 (1.09–1.23) in Study 1 and 1.15 (1.09–1.21) in Study 2.

Conclusions

These alterations are not considered clinically relevant for either drug and no dose adjustment is necessary when etravirine and tenofovir disoproxil fumarate are co‐administered.     

Implementation of an image-guided radiation therapy program: Lessons learnt and future challenges

The aim of this paper is to detail the experience obtained in implementing an image-guided radiation therapy program at the Northern Sydney Cancer Centre. This required retrofitting a Varian Clinac 21EX with an on-board imager. The commissioning and quality assurance procedures, organisation of a multidisciplinary image guided radiation therapy group, and the development of clinical protocols for orthogonal kV and cone beam computed tomography implementation are described. Reassessment of the image-guided radiation therapy program has continued as new equipment and software versions were made available in the department.     

水体中克雷伯菌属的分布及其在水源性急性肠道感染中的价值

俄罗斯不同气候地区不同功能水体中克雷伯菌属广泛分布。克雷伯菌属可见于遭受生物、化学污染的集中供水的地表水源,无防护的地下蓄水层,缺乏有效清洁、消毒系统的饮用水。研究表明,水体中的克雷伯菌属具有致病性和毒性,对现代药物和消毒剂(氯、紫外线)具有抗性,很容易穿透进入地下蓄水层。克雷伯菌属细菌有很强的致病性(粘附力、侵袭力、磷酸酯酶、卵磷脂酶、脱氧核糖核酸酶、溶血活性),含有致病性遗传标记cnf-1。克雷伯菌属(100 CFU/dm³)可引起急性肠道感染。在不检测总大肠菌群的情况下,检测水体尤其是饮用水中的克雷伯菌属,可以评估所用水的流行病学危险。     

Reference values for arterial stiffness indices in an Omani Arab population

Objectives:

To determine the reference values of arterial stiffness indices, particularly augmentation index (AIx) and pulse wave velocity (PWV) using applanation tonometry in a healthy Omani Arab population.

Methods:

This prospective study was carried out in the Department of Clinical Physiology, Sultan Qaboos University Hospital, Muscat, Oman over a 2-year period from June 2011 to June 2013. The central AIx, aortic PWV (AoPWV), and central pulse pressure (CPP) were recorded from 120 healthy subjects recruited randomly from a normal population using a SphygmoCor device. The 2.5th and 97.5th percentiles were used to determine the reference ranges for men and women separately. Analyses were performed using univariate statistics.

Results:

The mean age of the cohort was 38 years for men, and 35 years for women, with the ages ranging from 20-53 years. The overall mean central AIx was 13±11%, and for AoPWV was 6.7±1.6 m/s. The central AIx was higher in women (17 versus 10%; p<0.001), whereas the AoPWV was higher in men (7.1 versus 6.3 m/s; p=0.003). Subjects were categorized according to the gender and age decade, and reference values for CPP, central AIx, and AoPWV were obtained.

Conclusion:

This study reports the reference values for arterial stiffness indices from an Omani Arab population; the results of which should be interpreted in the context of its limitations.Cardiovascular disease is the leading cause of mortality and morbidity worldwide.1 High central pulse pressure (CPP) and increased aortic pulse wave velocity (AoPWV) resulting from stiffness of large arteries have been recognized as an independent risk factor for cardiovascular disease.2-5 The European Hypertension Society guidelines recommended the pulse wave velocity (PWV) to be used for risk assessment stratification of hypertensive patients.6 Several non-invasive techniques have been developed to assess arterial stiffness parameters.7,8 Applanation tonometry developed by O’Rourke and other investigators9-12 is a simple, reproducible, and validated method used to assess arterial stiffness indices in healthy subjects and in subjects with various cardiovascular diseases. In addition to direct analysis of peripheral pulse wave forms to determine peripheral augmentation indices, this method can also be used to calculate central (aortic) augmentation indices and central blood pressure by using validated algorithms.12 A large number of studies from different European populations, African, and Asian nations have assessed reference ranges and correlates of arterial stiffness using applanation tonometry.13-16 However, studies on reference values of arterial stiffness in Arab populations are scant. Considering variations in genetic and environmental factors between populations, differences in arterial stiffness values in health and cardiovascular disease individuals are expected. There is a lack of previous studies on normal arterial stiffness indices in an Omani Arab population. Normal reference values from healthy subjects are particularly pertinent for proper clinical applications. Therefore, this study aimed to determine the reference values of arterial stiffness indices particularly augmentation index (AIx) and PWV using applanation tonometry in a healthy Omani Arab population.     

Proteoglycans in human long-term bone marrow cultures: biochemical and ultrastructural analyses

Proteoglycans within the extracellular matrix of human bone marrow have been implicated in the process of hematopoiesis, but little is known about the structure and composition of these macromolecules in this tissue. Hematopoietically active human long-term bone marrow cultures were incubated with medium containing 35S-sulfate and 3H-glucosamine as labeling precursors. Proteoglycans present in the medium and cell layer were extracted with 4 mol/L guanidine HCI and purified by diethylaminoethyl (DEAE)-Sephacel ion exchange and molecular sieve chromatography. Both culture compartments contain a large chondroitin sulfate proteoglycan (MI, CI) that eluted in the void volume of a Sepharose CL-4B column and contained glycosaminoglycan chains of molecular weight (mol wt) approximately 38,000. A second population of sulfate-labeled material was identified as a broad heterogenous peak (MII, CII) that was included on Sepharose CL-4B at Kav = 0.31. This material when chromatographed on Sepharose CL-6B could be further separated into a void peak (MIIa, CIIa) and an included peak eluting at Kav = 0.39 (MIIb, CIIb). The void peaks (MIIa, CIIa) were susceptible to chondroitinase ABC digestion (99%) but slightly less susceptible to chondroitinase AC digestion (90%). Papain digestion of these peaks revealed them to be proteoglycans with glycosaminoglycan chains of mol wt approximately 38,000. The included peaks on Sepharose CL-6B (MIIb, CIIb) from both medium and cell layer compartments resisted digestion with papain, indicating the presence of glycosaminoglycan chains of mol wt approximately 38,000 either free or attached to a small peptide. Although this material was susceptible to chondroitinase ABC (98%), it was considerably less susceptible to chondrotinase AC (approximately 60%), indicating that it contained dermatan sulfate. A small amount of heparan sulfate proteoglycan was also identified but constituted only approximately 10% of the total sulfated proteoglycan extracted from these cultures. Additionally, approximately 40% of the incorporated 3H- activity radioactivity was present as hyaluronic acid. Electron microscopy revealed a layer of adherent cells covered by a mat containing ruthenium red-positive granules that were connected by thin filaments. The extracellular matrix layer above the adherent cells contained a mixture of hematopoietic cells. Chondroitinase ABC treatment of the cultures completely removed the ruthenium red-positive granules overlying the cells and resulted in a loss of approximately 70% of the 35S-sulfate-labeled material from the cell layer.(ABSTRACT TRUNCATED AT 400 WORDS)