Adolescent Day Treatment: A School and Community Based Alternative to Residential Care

This article describes a school and community based day treatment program which is the result of cooperative efforts between a school district and a community mental health agency. It is designed as the last, in-district placement available for students prior to residential care. Using a systemic approach, the program serves students in grades 7 to 12, with a variety of disabilities including emotional and behavioral disorders, physical disabilities, and special education classifications. This article describes the program's treatment components, provides a case study of a student who attended the program, and presents the results of a 5-year review of the program's effectiveness.     

硝苯地平阻断豚鼠心室肌细胞L型钙流特性的研究

选择性L型钙通道阻断剂硝苯地平 (Nif)为常用的工具药 ,因此必须了解它对L型钙流 (ICa(L) )浓度、状态依赖性阻断 ,使用和非使用依赖性阻断等特性。以豚鼠分离的单个心室肌细胞为对象 ,采用膜片钳全细胞记录技术 ,给予 35℃的各种含药物细胞外液快速灌流 ,记录ICa(L) 。结果 :①保持电位 - 80mV ,使用含铯离子的细胞内、外液 ,在 +10mV的钳制电压 ,Nif抑制ICa(L) 的IC50 为 0 .3μmol·L-1;当保持电位为 - 40mV时 ,IC50 为 0 .0 5 μmol·L-1,显示Nif优先选择与失活态钙通道结合。②使用富含钾离子的细胞内、外液 ,对ICa(L) 的非使用依赖性阻断 ,随Nif使用浓度 (30～ 10 0 μmol·L-1)的增加和药物作用时间的延长而加强 ,同时对ICa(L) 的使用依赖性阻断则减小。③在 10s的静息间隔药物作用时间后的第一个实验刺激 ,Nif 3μmol·L-1或 30 μmol·L-1加速ICa(L) 的失活 ,提示Nif对ICa(L) 可能存在激活态阻断。结论 :在生理条件下 ,Nif对ICa(L) 的阻断呈浓度、状态依赖性 ,对ICa(L) 的非使用依赖性阻断随使用浓度的增加和作用时间的延长而加强 ,对ICa(L) 的使用依赖性阻断则随之减弱。     

6-month follow-up of VIALE-C demonstrates improved and durable efficacy in patients with untreated AML ineligible for intensive chemotherapy

VIALE-C compared the safety and efficacy of venetoclax or placebo plus low-dose cytarabine (+LDAC) in patients with untreated AML ineligible for intensive chemotherapy. Overall, 211 patients were enrolled (n = 143, venetoclax; n = 68, placebo). At the primary analysis, the study did not meet its primary endpoint of a statistically significant improvement in overall survival (OS), however, ~60% of patients had been on study for ≤6-months. Here, we present an additional 6-months of follow-up of VIALE-C (median follow-up 17.5 months; range 0.1–23.5). Median OS was (venetoclax +LDAC vs. placebo +LDAC) 8.4 vs. 4.1 months (HR = 0.70, 95% CI 0.50,0.99; P = 0.040); a 30% reduction in the risk of death with venetoclax. Complete response (CR)/CR with incomplete hematologic recovery (CRi) rates were 48.3% vs. 13.2%. Transfusion independence rates (RBC) were 43% vs.19% and median event-free survival was 4.9 vs. 2.1 months (HR = 0.61; 95% CI 0.44,0.84; P = 0.002). These results represent improved efficacy over the primary analysis. Incidence of grade ≥3 adverse events were similar between study arms and overall safety profiles were comparable to the primary analysis. These data support venetoclax +LDAC as a frontline treatment option for patients with AML ineligible for intensive chemotherapy.This trial was registered at www.clinicaltrials.gov as #{"type":"clinical-trial","attrs":{"text":"NCT03069352","term_id":"NCT03069352"}}NCT03069352.Subject terms: Targeted therapies, Acute myeloid leukaemia     

Sputum smear-positive tuberculosis: empiric evidence challenges the need for confirmatory smears.

OBJECTIVE: To determine the frequency of single scanty or positive sputum smear results and its impact on the surveillance definition of sputum smear-positive tuberculosis (TB). SETTING: Moldova, Mongolia, Uganda and Zimbabwe. METHODS: A representative sample of laboratories was selected in each country. Data were double-entered and discordances resolved by rechecking the register. RESULTS: The dataset comprised 128808 examinees with valid information from 23 laboratories in Moldova, all 31 in Mongolia, 30 in Uganda and 23 in Zimbabwe, each covering at least one calendar year. The reason for the examination was diagnostic for 89362, of which 15.2% (n = 13577) were defined as laboratory cases with at least one bacillus on at least one examination. Cases were confirmed by another examination in 72.6% (n = 9861). Of the 9014 cases who had a full set of three examinations, confirmation was obtained in 92.4% (n = 8325). CONCLUSION: One quarter of laboratory cases had no confirmatory result, almost entirely attributable to not examining another specimen. The current definition of sputum smear-positive TB requires two positive smears or one positive smear result plus more complex confirmatory evidence. Accepting a single positive examination as sufficient for the definition would greatly increase the sensitivity of the surveillance definition without sacrificing its specificity.     

Thoracic Actinomycosis as a Cause of Superior Vena Cava Syndrome: Report of a Case

We report an unusual case of superior vena cava syndrome (SVCS) caused by thoracic actinomycosis in a 35-year-old man. The patient presented with a mediastinal mass and the diagnosis was confirmed by a right exploratory thoracotomy. Treatment with penicillin for a 15-month period resulted in a reduction in the size of the mediastinal mass and improvement of his clinical symptoms.     

Glycerol suppresses proliferation of rat hepatocytes and human HepG2 cells

BACKGROUND: In fulminant hepatic failure (FHF), the ability of surviving hepatocytes to proliferate is diminished. Therefore, it is important that medical therapy cause no further impairment of liver regeneration. In FHF, intracranial hypertension secondary to brain edema is the most common cause of brain injury and death and glycerol is used in some countries to treat this complication. Glycerol has been long known to suppress the growth of various cell types. We therefore decided to examine the effect of glycerol on hepatocyte proliferation in vitro and in vivo in rats subjected to partial (2/3) hepatectomy. Additionally, we investigated the effect of glycerol on the proliferation of HepG2 cells. MATERIALS AND METHODS: Mitogen-induced primary rat hepatocytes were cultured in a hormonally defined Dulbecco's modified Eagle's medium containing increasing amounts of glycerol (0.5, 1.0, 2.0, 4.0%). HepG2 cells were cultured in minimal essential medium/10% FBS. After 2 days, HepG2 cells were exposed to glycerol (1.0-2.0-4.0%) and harvested after 48 h. Control dishes contained no glycerol. Cell proliferation was measured by the incorporation of [(3)H]thymidine and/or bromodeoxyuridine (BrdU). In vivo, Sprague-Dawley rats were subjected to standard partial 2/3 hepatectomy and assigned to intraportal administration of either 400 microl of glycerol or saline. Rats were killed after 1, 2, 3, 5, and 7 days. Liver weight/body weight ratio and BrdU uptake were measured. RESULTS: In all cultures tested, glycerol suppressed the growth of cells in a dose-dependent manner. In vivo, a single intraportal dose of glycerol slowed the liver regenerative response. CONCLUSIONS: This study demonstrated that glycerol has a potent growth-inhibitory effect on hepatocyte proliferation in vivo and in vitro. Remarkably, glycerol inhibited the proliferation of liver cancer cells as well. The results of this study have important clinical implications.     

Polyherbal formulations with wide spectrum antimicrobial activity against reproductive tract infections and sexually transmitted pathogens

PROBLEM: Recent reports indicate high incidence of genital infections, most of which are sexually transmitted. Although specific drugs and antibiotics are available for some, a safe spermicidal formulation with wide spectrum antimicrobial action would be a desirable addition to the presently available spermicides. METHODS: Formulations at different dilutions were tested in culture systems on standard strains and clinical isolates including some isolates resistant to drugs. The effect on (HSV)-2 and Chlamydia trachomatis was determined in vivo in progestin sensitized mice. The effect on HIV-1 was investigated in two standardized systems. RESULTS: Polyherbal cream inhibited the growth in culture of clinical isolates of Candida albicans, Candida krusei and Candida tropicalis. Both the polyherbal cream and the Praneem polyherbal pessary inhibited urinary tract Escherichia coli (including multidrug resistant strains), and Neisseria gonorrhoeae (including 2 strains resistant to penicillin). Both formulations manifested virucidal activity against HIV-1 at >2 and 50% dilutions (in two different test systems) on contact for 1-2 min. Intravaginal inoculation of the cream and the pessary suspensions before inoculation of the pathogen prevented lesions and vaginal transmission of HSV-2 and C. trachomatis in progestin sensitized mice. CONCLUSIONS: Polyherbal formulations have wide spectrum antibacterial, antifungal and antiviral effect against the tested sexually transmitted pathogens.     

Epinephrine and the pacemaking mechanisms at plateau potentials in sheep cardiac Purkinje fibers

1. In 1.35 mM [K+]0, sheep cardiac Purkinje fibers depolarized to about -40 mV. Whereas some fibers oscillated spontaneously at plateau potentials, others could be made to oscillate when polarized by intracellular currents. Pacemaker activity at plateau potentials (-50 to 0 mV) was distinct from that caused by the iK2 pacemaker at more negative potentials (-60 to -100 mV). 2. Epinephrine induced spontaneously occurring action potentials and increased pacemaker activity in depolarized Purkinje fibers. The ED50 for the positive chronotropic effect of epinephrine was about 5 x 10(-7) M. This concentration is similar to that reported for the effect of epinephrine on plateau amplitude (Carmeliet and Vereecke, 1969) and the slow inward current (isi, Reuter, 1974). 3. In voltage clamp experiments, epinephrine, increased the magnitude of isi and of an outward plateau current, ixi. It is concluded that epinephrine effects pacemaking at plateau potentials by increasing isi and without shifting the voltage dependence of these currents. The onset of pacemaker activity by epinephrine was preceded by membrane depolarization that results from an inward shift of the steady-state current-voltage relation. This current may flow through isi channels that are activated but not completely inactivated.