Description of response to aspirin and clopidogrel in outpatients with coronary artery disease using multiple electrode impedance aggregometry

Identification of outpatients with high platelet reactivity (HPR) on antiplatelet treatment is an unmet need. The present study was conducted in healthy individuals (n = 50) and in outpatients with coronary artery disease (CAD) at a distance from the acute ischemic episode (aspirin group, n = 71; aspirin/clopidogrel group, n = 106). We studied the feasibility and the precision of whole blood multiple electrode aggregometry (MEA) after triggering platelet aggregation by arachidonic acid or adenosine diphospate (ADP). The MEA can be performed on whole blood within 2 hours after sample venipuncture. The threshold for the diagnosis of HPR is situated at 55 and 50 U for the arachidonic acid and ADP test, respectively. Frequency of HPR was 7% and 20% in aspirin and aspirin/clopidogrel groups, respectively. In 3.8% of patients in aspirin/clopidogrel group, combined HPR on aspirin and clopidogrel was found. In outpatients with CAD, use of MEA is feasible for the diagnosis of HPR.     

A review of dramatherapy research in schizophrenia: methodologies and outcomes

Abstract

This article aims to examine all the different types of research studies in the existing literature regarding the impact of dramatherapy on patients with a schizophrenic disorder to provide a springboard for future advances in the application of dramatherapy as an adjunct therapeutic approach for this client group. Quantitative research approaches in the form of randomized clinical trials have proven to be feasible in dramatherapy when they aim at providing evidence of the improvement in the condition of patients with schizophrenia or of the diminution of their symptoms. Qualitative approaches explore the therapeutic processes through which dramatherapy practice can confront more effectively the schizophrenic psychopathology. Furthermore, theater-based research brings to light the creative side of patients with schizophrenia despite their psychopathology and promotes through action the discourse between patients “in role” and their audience in relation to the social stigma attached to people with schizophrenia.

Dieser Artikel zielt darauf ab, alle unterschiedlichen Arten der Untersuchung der Effekte von Dramatherapie bei Patienten mit einer schizophrenen Störung durchzugehen, um einen Fortschritt in der Anwendung von Dramatherapie als einem Hilfsprogramm für diese Patientengruppe zu ermöglichen. Quantitative Untersuchungen in Form von randomisierten klinischen Studien haben sich für Dramatherapie als möglich erwiesen, wenn sie auf der Basis einer Verbesserung des Zustandes der Schizophreniepatienten durchgeführt werden oder auf eine Verringerung ihrer Symptome abzielen. Qualitative Vorgehensweisen erforschen die therapeutischen Prozesse, durch die die Anwendung von Dramatherapie schizophrene Psychopathologie positiv beeinflussen kann. Darüber hinaus zeigen Theater-basierte Untersuchungen die kreativen Seiten von schizophrenen Patienten auf, die sie trotz ihrer bestehenden Psychopathologie haben und fördern den handlungsbezogenen Diskurs zwischen Patienten in einer Rolle und ihre Zuhörerschaft hinsichtlich des sozialen Stigmas, das Menschen mit Schizophrenie anhaftet.

Cet article vise à examiner les différents types de recherches dans la littérature sur l'impact de la thérapie par le théâtre (dramatherapy) pour les patients avec un trouble schizophrénique dans le but de fournir un tremplin pour des avancées futures dans l'application de la thérapie par le théâtre comme approche thérapeutique complémentaire pour ce groupe de patients. Les approches quantitatives, sous la forme d’études randomisées contrôlées, ont démontré leur faisabilité pour la thérapie par le théâtre lorsque celle-ci vise à fournir la preuve de l'amélioration de la condition des patients schizophrènes ou de la diminution de leurs symptômes. Les approches qualitatives explorent les processus par lesquels la pratique de la thérapie par le théâtre peut faire face plus efficacement à la psychopathologie schizophrénique. En outre, les recherches basées sur le théâtre éclairent le côté créatif des patients avec une schizophrénie et encouragent par l'action un discours entre le patient «?dans son rôle?» et son audience en relation avec la stigmatisation sociale attachée au personnes avec une schizophrénie.

Este artículo se propone examinar los diferentes tipos de investigaciones en la literatura existente sobre el impacto de la dramaterapia en pacientes con desorden esquizofrénico, a fin de proveer un trampolín para futuros avances en la aplicación de la dramaterapia como adjunto terapéutico para este grupo de clientes. Los enfoques de investigación cuantitativa en forma de ensayos clínicos randomizados han demostrado ser factibles en dramaterapia cuando buscan evidencia de mejoría en la condición de pacientes con esquizofrenia o en la disminución de sus síntomas. Los enfoques cualitativos exploran los procesos terapéuticos a través de los cuales la práctica de la dramaterapia puede hacer frente más eficazmente a la psicopatología esquizofrénica. Más aún, la investigación basada en el teatro trae a luz el aspecto creativo de los pacientes con esquizofrenia a pesar de su psicopatología y promueve, a través de la acción, el discurso entre pacientes “en el rol” y su audiencia, en relación con el stigma social que afecta a las personas con esquizofrenia.

Este artigo procura examinar todos os diferentes tipos de estudos de investigação existentes na literatura existente relativos ao impacto da terapia de drama nos pacientes com perturbaç[otilde]es de esquizofrenia, para assim providenciar uma plataforma para futuros avanços na aplicação desta terapia como uma abordagem terapêutica adicional para este grupo de pacientes. Os estudos de abordagens quantitativas com grupos clínicos aleatoriamente seleccionados têm-se mostrado serem viáveis para a terapia de drama quando o seu objectivo era fornecer evidência para melhorias nas condiç[otilde]es dos pacientes com esquizofrenia ou para a diminuição dos seus sintomas. As abordagens qualitativas exploram os processos terapêuticos através da prática da terapia de drama podem mais eficazmente abordar a psicopatologia esquizofrénica. Para além disso, estudos baseados no teatro evidenciam o aspecto criativo do paciente com esquizofrenia, apesar da sua psicopatologia, e promovem através da acção o discurso entre pacientes “a representar” e a sua audiência em relação ao estigma social associado às pessoas com esquizofrenia.

Questo articolo ha lo scopo di esaminare tutti i differenti tipi di studi di ricerca nella letteratura esistente per quanto riguarda l'effetto della dramma-terapia sui pazienti con schizofrenia, per fornire un trampolino di lancio per progressi futuri nell'applicazione della dramma-terapia come approccio terapeutico aggiuntivo per questo gruppo di pazienti.

I metodi di ricerca quantitativi, nella forma degli esperimenti clinici randomizzati, sono risultati essere fattibili nella dramma-terapia quando mirano a provare l'evidenza del miglioramento nei pazienti con schizofrenia o della diminuzione dei loro sintomi.

I metodi qualitativi esplorano i processi terapeutici con cui la pratica della dramma-terapia può confrontare pi[ugrave] efficacemente la psicopatologia schizofrenica.

Ancora, la ricerca basata sul teatro mette in luce il lato creativo dei pazienti con schizofrenia malgrado la loro psicopatologia e promuove, attraverso l'azione, il discorso tra i pazienti “nel ruolo” e il loro uditorio rispetto allo stigma sociale, attaccato alle persone con schizofrenia.

     

The forehead lift: techniques to avoid complications and produce optimal results

This discussion of forehead lifting, based on modifications of Vinas, Caviglia, and Cortinas, shares the authors' methods of patient evaluation, diagnostic details, architectural planning, and surgical concepts for forehead rhytidectomy along with correction of malpositioned and ptosis of the eyebrows and also glabellar frown problems. In addition, the nasal deformities associated with the sagging of the skin and subcutaneous tissue onto the upper fourth of the nose may make the nose look too short for a pleasing balance of the face and the upper fourth may appear disagreeably wide. A contribution to this excessive width is made by a sometimes thick and wide procerus muscle along with bilateral thick depressor supercilii muscles. When this nasal deformity is corrected, glabellar frown problems are also corrected. Attention to the details of the above-mentioned factors results in very long-lasting, sometimes permanent, and almost complication-free results that please the surgeon and the patient. Complications such as adherence of the dermis to the underlying pericranium, lack of motion in a portion of or the entire forehead, hyperactivity around areas of immobility, muscle irregularities, and also surgically produced depressions which require grafting, skin sloughing, permanent nerve injury, persistent sensory nerve loss, and short-term improvement have been avoided by paying attention to diagnosis, surgical planning, and technique, and postoperative care. Most patients can return to work in four or five days with minimal discoloration and swelling if they have not had aspirin or vitamin E one month before surgery, and there is hemostasis and the use of drains when indicated. Minimizing detection of the surgical incisions is accomplished by detailed preoperative planning of their location, architectural design development and drawing at the time of surgery, special surgical techniques, and excision of the skin or scalp. For patients with male pattern baldness use of specially designed V-Y advancement flaps with the browlift procedure improve the appearance of the hair's thickness and distribution.     

Microglandular adenosis or microglandular adenoma? A molecular genetic analysis of a case associated with atypia and invasive carcinoma

Aims: Microglandular adenosis (MGA) is a rare breast lesion, which has long been considered to be hyperplastic. However, atypical forms of MGA (AMGA) and invasive carcinomas arising in the background of MGA are recorded. Recent studies have suggested that MGA may be a non‐obligate precursor of invasive carcinomas that are negative for hormone receptors and lack HER‐2 overexpression (triple‐negative phenotype). The aim of this study was to determine whether MGA is clonal and whether it harbours chromosomal aberrations similar to those found in matched invasive ductal carcinoma of no special type (IDC‐NST). Methods and results: We report on a case comprising MGA, AMGA and a high‐grade IDC‐NST. The three components were separately microdissected and subjected to genetic analysis with high‐resolution microarray comparative genomic hybridisation. Identical genetic changes were detected in all components with subsequent acquisition of additional genetic aberrations in the invasive component, suggesting that MGA was the substrate for the development of the invasive carcinoma. Immunohistochemistry revealed concordant profiles across all components, characterized by triple‐negative phenotype and variable positivity for basal markers. Conclusions: Similar to adenomas, MGA is, at least in some cases, a clonal lesion and may be a non‐obligate precursor of a subgroup of high‐grade triple‐negative and basal‐like breast carcinomas.     

Special Education Services for Children Involved with Child Welfare/Child Protective Services

This paper examines educational and behavioral characteristics and special education service use for a subsample of 2477 children enrolled in the National Survey of Child and Adolescent Wellbeing (NSCAW), the first national, longitudinal study of youth following investigation for alleged maltreatment through the child welfare system (CW). Almost one-fifth of children were characterized as severe on educational indices and 47% as severe on behavioral indices. Nineteen percent were currently receiving special education services, 17% had previously received these services, and the remainder had never received them. Over half (51%) of children characterized as severe on educational or behavioral indices were not receiving special education services. Caregivers indicated that youth were being served primarily under categories of Emotional Disturbance (35%) and Speech and Language Impairment (30%). Further exploration of the role of schools, particularly school psychologists, in providing supports for children involved with CW is discussed.     

The cytoprotective effect of amifostine in acute radiation dermatitis: a retrospective analysis

To study the impact of amifostine as a cytoprotective agent against acute radiation dermatitis, we reviewed 220 patient records. One hundred cancer patients, with tumors localised in the pelvis (bladder, rectum, prostatic carcinomas, or gynecological cancer), who received radiotherapy and cytoprotective treatment with intravenous infusion of amifostine (group A) were included in this study. Retrospectively, we randomly selected from a database in our hospital 120 historical controls, who received only radiotherapy without cytoprotection (group B). Mean gross dermatitis score (MGDS) was the mean value of recorded acute radiation dermatitis according to common toxicity criteria. In group A versus B patients, a significantly reduced severity of dermatitis (P < 0.001, Fisher's exact test) and significant reduction of MGDS as well as mean interruption treatment time (P < 0.001, Mann-Whitney U test) was observed. The relative risk of the outcome of the two study groups was 0.23 (95% CI: 0.15 to 0.34). The significant dermato-cytoprotective effect of amifostine noticed in our retrospective analysis warrants further investigation with randomised trials.