Code gray case studies

Stroke in an inpatient poses many complex, and frequently very challenging, issues. Not only does the patient present with past medical history and various comorbidities, but also has been admitted to the hospital for some other diagnosis. In addition, any organized response to these stroke patients has been largely ignored by health care. As a result, the response to stroke-like symptoms may vary from facility to facility, and patient to patient. This article presents 5 case studies in the emergency response to inpatient stroke occurrences in one urban medical center. The histories, admitting diagnoses, signs and symptoms, as well as therapeutic interventions and outcome are reviewed.     

7,12-Dimethylbenz[a]anthracene inhibition of steroid production in MA-10 mouse Leydig tumor cells is not directly linked to induction of CYP1B1

Testosterone, which is essential for spermatogenesis, is synthesized in the Leydig cells of the testis. This study addresses whether male reproductive toxicity from exposure to polycyclic or polychlorinated aromatic hydrocarbons, such as 7,12-dimethylbenz[a]anthracene (DMBA) or 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), may be due to direct effects on Leydig cell function. Using a cell-based assay, the effects of TCDD, benz[a]anthracene (BA), and DMBA on steroid production and cytochrome P4501B1 (CYP1B1) expression in treated MA-10 mouse Leydig tumor cells or primary cultures of rat Leydig cells was determined. (Bu)(2)cAMP-stimulated steroid production was inhibited approximately 25% and approximately 80% by DMBA treatment of MA-10 cells and rat Leydig cells, respectively, while BA or TCDD were without effect. Conversely, male Sprague-Dawley rats treated with TCDD displayed a 75% decrease in serum testosterone levels, while DMBA-treated rats had circulating testosterone levels comparable to control rats. Injection of human chorionic gonadotropin (hCG) 1 h prior to euthanasia restored testosterone levels in TCDD-treated rats to 79% of the hCG-stimulated levels in control rats. Steady-state levels of CYP1B1 mRNA, as detected by RT-PCR, are present in the MA-10 cells and treatment with TCDD, BA, DMBA, or the cAMP analog (Bu)(2)cAMP induced CYP1B1 mRNA expression levels. CYP1B1 was constitutively expressed in rat testis, adrenal, liver, and kidney tissues while CYP1A1 was undetectable. TCDD treatment induced CYP1B1 expression in the adrenal and liver and CYP1A1 in the kidney and liver. DMBA treatment induced only CYP1A1 levels in kidney and liver. In sum, DMBA or a reactive DMBA metabolite, but not TCDD, has a direct effect on steroidogenesis in isolated Leydig cells. CYP1B1 expression levels, however, cannot be directly correlated to potential in vitro or in vivo toxic effects of TCDD or DMBA.     

Gamma hydroxybutyrate (GHB) and gamma butyrolactone (GBL) withdrawal: five case studies

There is little medical information available about gamma-hydroxybutyrate (GHB) or gamma-butyrolactone (GBL) dependence or withdrawal. In this study the authors treated and reviewed multiple cases of GHB and GBL withdrawal in high-dose users. Five patients during nine hospitalizations were treated for GHB or GBL withdrawal. The authors describe a spectrum of GHB or GBL withdrawal from mild to severe and discuss medications used for treatment. They conclude that patients with GHB or GBL withdrawal may present with agitated psychosis, delirium, and autonomic instability. In this sample, relapse to GHB or GBL use occurred soon after treatment of withdrawal.     

Mergers and acquisitions in professional organizations: a complex adaptive systems approach

Nurse managers face unique challenges as they cope with mergers and acquisitions among health care organizations. These challenges can be better understood if it is recognized that health care institutions are professional organizations and that the transformations required are extremely difficult. These difficulties are caused, in part, by the institutionalized nature of professional organizations, and this nature is explicated. Professional organizations are stubborn. They are repositories of expertise and values that are societal in origin and difficult to change. When professional organizations are understood as complex adaptive systems, complexity theory offers insight that provide strategies for managing mergers and acquisitions that may not be apparent when more traditional conceptualizations of professional organizations are used. Specific managerial techniques consistent with both the institutionalized characteristics and the complex adaptive systems characteristics of professional organizations are offered to nurse managers.     

Physician participation in hospital strategic decision making: the effect of hospital strategy and decision content.

An exploratory study examined variation in the participation of physicians in hospital strategic decision making as a function of (1) strategic decision content or (2) hospital strategy, or both. The findings revealed that who participates is a function of decision content while how physicians participate is a function of decision content and the interaction of decision content and hospital strategy.     

新缩瞳剂包公藤甲素人工合成研究

包公藤甲素是从包公藤(Erycibe obtusifolia Benth.)茎中提得的一个新莨菪烷生物碱,具有强烈的缩瞳作用,临床用于治疗青光眼。本文报道用合成的6β-乙酰氧基托品酮为原料,经卤代、水解、还原和N-去甲基化等反应合成包甲素(8)。经光谱测定证实8与天然包甲素的结构完全一致。合成品系外消旋体,其作用机理与天然品相同,而强度则减半。