The role of protective clothing in infection prevention in patients undergoing autologous bone marrow transplantation.

PURPOSE/OBJECTIVES: To determine the efficacy of cover gowns and shoe covers in the prevention of infection in patients undergoing autologous bone marrow transplantation (BMT). DESIGN: Randomized two-group controlled clinical trial. SETTING: Adult BMT unit of a university teaching hospital in the Southeastern United States. SAMPLE: 40 women and men receiving an autologous BMT for hematologic and solid tumor malignancies. Patients were assigned randomly to control or experimental groups. Thirty-one patients completed the study. Inclusion criteria required that patients be at least 18 years of age and not have received a previous autologous BMT. METHODS: Data were collected from the patients' medical records. Characteristics of the distributions for the main research variables were compared between the control group (caregivers who wore cover gowns and shoe covers) and experimental group (caregivers who wore no covers). MAIN RESEARCH VARIABLES: Time to first antibiotic treatment and length of antibiotic therapy. FINDINGS: Cover gowns and shoe covers worn by caregivers provided no benefit for this group of 31 patients. The differences in time to first antibiotic and length of antibiotic treatment were not statistically significant between the two groups. CONCLUSIONS: The mean and median number of hours to first antibiotic treatment for adult autologous BMT recipients in the control group exceeded the corresponding time for those in the experimental group by only one hour and four hours, respectively. The potential benefits and risks of cover gown and shoe cover usage by caregivers of autologous BMT recipients should be reexamined in larger randomized trials. IMPLICATIONS FOR NURSING PRACTICE: The elimination of cover gowns and shoe covers in caring for patients undergoing autologous BMT will save nursing time and hospital resources as well as eliminate one isolation barrier experienced by patients.     

The Addenbrooke's cognitive examination (ACE) in the differential diagnosis of early dementias versus affective disorder.

OBJECTIVE: The authors describe the profile of performance of patients whose cognitive complaint is due to dementia, affective disorder, or combinations thereof on the Addenbrooke's Cognitive Examination (ACE) test battery. METHODS: Authors tested 90 subjects with dementia (63 Alzheimer disease [AD]; 27 fronto-temporal dementia [FTD]), 60 subjects with "pure" affective disorder (23 major depression [MDD], 37 whose affective symptoms did not meet criteria for major depression [Affective]); 22 patients with symptoms of affective disorder and organic dementia (Mixed); and 127 healthy volunteers (NC). RESULTS: The total ACE scores for the AD, FTD, and Mixed groups were significantly lower than for the NC group. Likewise, on total score, the AD and FTD groups scored significantly lower than either of the "pure" affective-disorder groups. Within the dementia group, the AD group scored significantly lower than the fronto-temporal group. CONCLUSIONS: The profile of performance on the ACE of patients with dementia is different from that of patients suffering from affective illness. Mild impairment in the total ACE score, along with a low score on the memory domain tasks and letter fluency (in contrast to normal category fluency), are strongly indicative of an affective, as opposed to organic, pathology. A total score of <88 in suspected dementia patients with affective symptoms appears strongly predictive of an underlying organic disorder.     

The endogenous cannabinoid anandamide has effects on motivation and anxiety that are revealed by fatty acid amide hydrolase (FAAH) inhibition

Converging evidence suggests that the endocannabinoid system is an important constituent of neuronal substrates involved in brain reward processes and emotional responses to stress. Here, we evaluated motivational effects of intravenously administered anandamide, an endogenous ligand for cannabinoid CB1-receptors, in Sprague-Dawley rats, using a place-conditioning procedure in which drugs abused by humans generally produce conditioned place preferences (reward). Anandamide (0.03-3 mg/kg intravenous) produced neither conditioned place preferences nor aversions. However, when rats were pre-treated with the fatty acid amide hydrolase (FAAH) inhibitor URB597 (cyclohexyl carbamic acid 3'-carbamoyl-3-yl ester; 0.3 mg/kg intraperitoneal), which blocks anandamide's metabolic degradation, anandamide produced dose-related conditioned place aversions. In contrast, URB597 alone showed no motivational effects. Like URB597 plus anandamide, the synthetic CB1-receptor ligand WIN 55,212-2 (50-300 microg/kg, intravenous) produced dose-related conditioned place aversions. When anxiety-related effects of anandamide and URB597 were evaluated in a light/dark box, both a low anandamide dose (0.3 mg/kg) and URB597 (0.1 and 0.3 mg/kg) produced anxiolytic effects when given alone, but produced anxiogenic effects when combined. A higher dose of anandamide (3 mg/kg) produced anxiogenic effects and depressed locomotor activity when given alone and these effects were potentiated after URB597 treatment. Finally, anxiogenic effects of anandamide plus URB597 and development of place aversions with URB597 plus anandamide were prevented by the CB1-receptor antagonist AM251 (3 mg/kg intraperitoneal). Thus, additive interactions between the effects of anandamide on brain reward processes and on anxiety may account for its aversive effects when intravenously administered during FAAH inhibition with URB597.     

Functional organization of the brain with malformations of cortical development

We examined the localization of cerebral functions in 28 patients with focal epilepsy and malformations of cortical development (MCDs). Polymicrogyria occurred in nine, hemimegalencephaly in four, heterotopia in eight, and focal cortical dysplasia (FCD) in nine cases. We used simple (sensomotor, visual) or complex (language, memory) functional magnetic resonance imaging (fMRI) paradigms. Two thirds of MCDs were activated by simple fMRI paradigms, whereas they less frequently showed activity during complex cognitive fMRI paradigms. During simple paradigms, all disturbances of cortical organization (polymicrogyria, schizencephaly, and mild-type FCD) showed activity, whereas other MCDs (disturbances of earlier steps of cortical development: hemimegalencephaly, Taylor-type FCD, and heterotopia) showed activity in only 44% (p < 0.01). The association between the pathophysiology and morphology of MCDs confirms the recently proposed classification system. Both focal neurological signs (p < 0.05) and focal electroencephalogram slowing (p < 0.05) independently correlated with MCD inactivity, confirming that fMRI showed neuronal functions of MCDs. Conclusively, fMRI visualizes the MCD functions and their relationship to the eloquent cortex, providing useful information before epilepsy surgery. Surgery of cortical organization disturbances should be cautiously performed because these malformations may participate to some degree in brain functions.     

Renaissance of NMDA receptor antagonists: do they have a role in the pharmacotherapy for alcoholism?

Long-term alcohol exposure leads to the development of alcohol dependence, which is possibly induced by changes in specific neurotransmitter functions. Accumulating evidence suggests that the N-methyl-D-aspartate (NMDA) type of ionotropic glutamate receptor is a particularly important site of action for ethanol. Ethanol potently and selectively inhibits NMDA receptors (NMDARs) and prolonged ethanol exposure produces a compensatory 'upregulation' of NMDAR functions. These changes are believed to underlie the development of ethanol tolerance and dependence as well as acute and delayed signs of withdrawal. Therefore, negative modulators of NMDARs may be useful agents for the pharmacotherapy of alcoholism. NMDAR antagonists attenuate not only the physical symptoms but also some affective and motivational components of alcohol withdrawal. Encouraging experimental results have been obtained with novel uncompetitive (memantine and neramexane (Merz & Co GmbH/Forest Laboratories Inc)), glycine site and NR2B subunit-selective NMDA antagonists (SSNAs). Recently emerged NR2B SSNAs (CP-101606 (Pfizer Inc), Co-101244 (Pfizer Inc/Purdue Neuroscience Corp/Senju Pharmaceutical Co Ltd), CI-1041 (Purdue Neuroscience Corp/Pfizer Inc) and indole-2-carboxamide derivatives) have demonstrated excellent in vitro potency against withdrawal-induced cytotoxicity. Although in vivo data are few, according to their in vitro efficacy and good tolerability, novel NMDA antagonists, especially the NR2B-selective antagonists, may offer a preferable alternative to the presently available pharmacotherapies for treating alcoholism.     

Honorary authorship and symbolic violence

This paper invokes the conceptual framework of Bourdieu to analyse the mechanisms, which help to maintain inappropriate authorship practices and the functions these practices may serve. Bourdieu’s social theory with its emphasis on mechanisms of domination can be applied to the academic field, too, where competition is omnipresent, control mechanisms of authorship are loose, and the result of performance assessment can be a matter of symbolic life and death for the researchers. This results in a problem of game-theoretic nature, where researchers’ behaviour will be determined more by the logic of competition, than by individual character or motives. From this follows that changing this practice requires institutionalized mechanisms, and change cannot be expected from simply appealing to researchers’ individual conscience. The article aims at showing that academic capital (administrative power, seniority) is translated into honorary authorship. With little control, undetected honorary authorship gives the appearance of possessing intellectual capital (scientific merit). In this way a dominant position is made to be seen as natural result of intellectual ability or scientific merit, which makes it more acceptable to those in dominated positions. The final conclusion of this paper is that undemocratic authorship decisions and authorship based performance assessment together are a form of symbolic violence.     

Socio-demographic and clinical characteristics of 3129 heroin users in the first methadone maintenance treatment clinic in China

BACKGROUND: This study aimed to determine the characteristics of heroin users in the first methadone maintenance treatment (MMT) clinic in China. METHODS: In a retrospective chart review, the notes of 3127 heroin users who received both detoxification and MMT at the clinic were analyzed. Their socio-demographic and clinical data were collected, and the frequency of human immunodeficiency virus (HIV), Hepatitis C virus (HCV), and syphilis infections was investigated. RESULTS: The main findings are as follows: (1) 66.5% of the patients were younger than 35 years; (2) 55.1% were married at admission; (3) 32% were non-local residents; (4) the majority had high school level education, a history of smoking and alcohol consumption prior to the initial heroin use, and did not have stable jobs; (5) 28.4% were self-employed; (6) 5.4% of the sample had total hearing loss coupled with loss of speech; (7) 83.4% sniffed heroin or injected it intravenously at the time of admission, but 87.2% had smoked the drug when they first began abusing it; (8) a significant proportion of the patients were infected with HIV, HCV, and syphilis. CONCLUSIONS: Some of the above findings are not consistent with the results of previous studies conducted in Western countries and China. The unique socio-cultural and clinical characteristics of heroin abusers in different regions of China should be considered when MMT services are planned.     

Expression of Hsp70 in kidney cells exposed to ochratoxin A

Ochratoxin A (OTA) is a possible etiological agent of endemic nephropathy, a chronic renal disease with high prevalence in limited geographic areas. Ochratoxicosis has many characteristics of different pathological states in which heat shock proteins (Hsps) are usually induced. The most inducible heat shock proteins belong to the Hsp70 family. We determined the level of expression of Hsp70 by the Western blot analysis in kidneys of rats treated with low doses of OTA and in LLC-PK1 and MDCK cells exposed to OTA. Estimation of cell viability and release of lactate dehydrogenase (LDH) confirmed the toxic effects of OTA on cultured cells. OTA affects the relative distribution of two Hsp70 isoforms (68-kDa and 74-kDa isoforms), but does not change total amount of Hsp70 in rat kidney. No changes in the Hsp70 level were detected in LLC-PK1 and MDCK cells treated with OTA, although the cells were seriously injured, as was seen from the reduced cell viability and increased release of LDH. Both cell lines were capable of having Hsp70 induced following a heat shock. However, exposure of the cells to OTA before the heat shock challenge prevented Hsp70 induction. Results of the study show that OTA does not induce Hsp70 in rat kidney or in cultured kidney cells. The absence of Hsp70 protective effects in the cells and tissues might be a possible explanation for the cumulative destructive effects of OTA and a silent onset of endemic nephropathy in humans and of OTA-induced experimental nephrotoxicity in animals.     

Effects of Oxytocin on Attention to Emotional Faces in Healthy Volunteers and Highly Socially Anxious Males

Background:

Evidence suggests that individuals with social anxiety demonstrate vigilance to social threat, whilst the peptide hormone oxytocin is widely accepted as supporting affiliative behaviour in humans.

Methods:

This study investigated whether oxytocin can affect attentional bias in social anxiety. In a double-blind, randomized, placebo-controlled, within-group study design, 26 healthy and 16 highly socially anxious (HSA) male volunteers (within the HSA group, 10 were diagnosed with generalized social anxiety disorder) were administered 24 IU of oxytocin or placebo to investigate attentional processing in social anxiety. Attentional bias was assessed using the dot-probe paradigm with angry, fearful, happy and neutral face stimuli.

Results:

In the baseline placebo condition, the HSA group showed greater attentional bias for emotional faces than healthy individuals. Oxytocin reduced the difference between HSA and non-socially anxious individuals in attentional bias for emotional faces. Moreover, it appeared to normalize attentional bias in HSA individuals to levels seen in the healthy population in the baseline condition. The biological mechanisms by which oxytocin may be exerting these effects are discussed.

Conclusions:

These results, coupled with previous research, could indicate a potential therapeutic use of this hormone in treatment for social anxiety.