Case report: Oral pemphigus vulgaris with multiple oral polyps in a young patient

A rare case of oral pemphigus vulgaris is presented, which developed initially in a 9-year old Jordanian male. The disease was not well controlled with immunosuppressive therapy and was complicated by the development of multiple oral polyps approximately one year after the onset of symptoms. These lesions were smooth, painless and located particularly on the upper labial gingiva, the labial and buccal mucosae and the tongue. Disease activity continued for approximately nine years until the patient was referred to an oral medicine specialist. Histological examination of the polyps revealed exuberant granulation tissue. Adjustment of the steroid dosage lead to resolution of the oral symptoms and the polyps reduced in number and in size. This case highlights the occurrence of pemphigus vulgaris in young patients, illustrates a rare complication of persistent ulcero-inflammatory disease and emphasises the importance of specialist referral in the management of oral disease.     

In vivo evaluation of microleakage from composites with new dentine adhesives

The purpose of this study was to investigate microleakage in V class composite restorations with total etch versus self-etching adhesives. Experiments were conducted in vivo and were also evaluated interfacial micromorphology. Forty class V cavities were prepared on the buccal surfaces of teeth in three healthy dogs. The cavities were randomly assigned into five groups of eight teeth and restored with one of the following adhesive systems: Etch and Prime 3.0/Definite flow/Definite, Prompt L-pop/Filtek flow/P-60, Admira bond/Admira Flow /Admira, Bond 1/Flow it/Alert, Stae/Wave/Glacier. After 60 days the animals were killed and the teeth were extracted. The teeth were then immersed in a solution of 0.5% basic fuchsin dye for 24 h, sectioned and scored for microleakage. Features of the tooth/restoration interfaces were also examined using Scanning electron microscopy. Student-Newman-Keuls and one-way anova revealed significance differences among the groups for overall wall scores (P < 0.05). The total-etch adhesives revealed significantly less microleakage scores than the self-etching adhesive systems tested. Wilcoxon Signed Ranks Test revealed significant differences between the occlusal and gingival microleakage scores for each adhesive restorative system, with the exception of Admira (P < 0.05).     

Effects of various light curing methods on the leachability of uncured substances and hardness of a composite resin

The purpose of this study was to evaluate the effect of the various light curing units (plasma arc, halogen and light-emitting diodes) and irradiation methods (one-step, two-step and pulse) using different light energy densities on the leachability of unreacted monomers (Bis-GMA and UDMA) and the surface hardness of a composite resin (Z250, 3M). Leachability of the specimens immersed for 7 days in ethanol was analysed by HPLC. Vicker's hardness number (VHN) was measured immediately after curing (IC) and after immersion in ethanol for 7 days. Various irradiation methods with three curing units resulted in differences in the amount of leached monomers and VHN of IC when light energy density was lower than 17.0 J cm(-2) (P = 0.05). However, regardless of curing units and irradiation methods, these results were not different when the time or light energy density increased. When similar light energy density was irradiated (15.6-17.7 J cm(-2)), the efficiency of irradiation methods was different by the following order: one-step > or = two-step > pulse. These results suggest that the amount of leached monomers and VHN were influenced by forming polymer structure in activation and initiation stages of polymerization process with different light source energies and curing times.     

Development of photocrosslinked polyacrylic acid hydrogel as an adhesive for dermatological patches: involvement of formulation factors in physical properties and pharmacological effects

Photocrosslinked polyacrylic acid hydrogel is a promising candidate adhesive for dermatological patches. In this study, we investigated the effects of the composition and molecular weight of the polymer on the characteristics of the hydrogel. Several photocrosslinkable polymers with different photocrosslinkable moieties or molecular weights were prepared, and various physical properties were measured. Differences in photocrosslinkable modifications markedly affected the swelling behavior of the hydrogel. The molecular weight of the polymer had a significant effect on various physical properties, such as the viscosity of the polymer solution, gel formation, and the swelling behavior of the prepared hydrogels. The pharmacological effects of the hydrogel were also evaluated using carrageenan-induced edema in rats. Application of the hydrogels maintained the skin surface at a reduced temperature throughout the experimental period, and the cooling effect was accompanied by an anti-inflammatory response. Because we can freely control the physical properties of the hydrogel and anticipate the significant pharmacological effects, photocrosslinked polyacrylic acid hydrogel is an attractive candidate adhesive for dermatological patches.     

Process and formulation characterizations of the thermal adhesion granulation (TAG) process for improving granular properties

In this study, we demonstrate the feasibility of using the thermal adhesion granulation (TAG) method to improve granular properties for preparing highly compressible excipients as direct tabletting aids. The TAG method subjects a mixture containing excipients, such as microcrystalline cellulose (MCC), lactose, starch, or dibasic calcium phosphate (DCP), under closed conditions with a low moisture content and low content of polyvinyl pyrrolidone (PVP) as a binder, to heating during mixing by tumble rotation to produce highly compressible granules. Results demonstrated that a closed system is more efficient than an open system at such a low moisture content, and both water and ethanol were able to fulfill the role of a granulation liquid, but water was more appropriate than ethanol for successfully producing granules suitable for use as direct tabletting aids by the TAG method. It was also found that a 5% moisture content in the powder mixture containing MCC and PVP is optimal in the TAG process to produce granules with the desired characteristics for pharmaceutical applications. On the contrary, increasing the moisture content led to further decreases in the mean size and deterioration of the flowability. It was further demonstrated that the TAG process is able to imbue these commonly used diluents with more-desirable physical characteristics of granules for direct tabletting, enabling the processing of these commonly used diluents with 50% PVP into directly compressible matrix materials.     

Controlling granule size by granulation liquid feed pulsing

The effects of inlet air humidity, granulation liquid feed rate and granulation liquid feed pulsing on the particle-size distribution of final granules were studied in a laboratory scale fluid-bed granulator using a central composite study design. The factors examined were modelled using three different particle-size measurement techniques (sieve analysis, laser light diffraction and the spatial filtering technique). Best goodness of fit (R² = 0.94) and goodness of prediction (Q² = 0.90) values were obtained using particle-size results of the spatial filtering technique. Increasing inlet air humidity and granulation liquid feed rate resulted in greater median granule size, as expected. When pulsing (interruption of granulation liquid feed in predetermined sequences) was used, the median granule size decreased clearly. This effect was strong, especially with high inlet air humidity and rapid liquid feed rate processes. Granulation liquid feed pulsing is an effective way to modify the particle size of final granules. Pulsing can be used as a controlling tool to compensate for excessive moisture content in the granulation process.     

一站式服务中心对门诊患者退款的协调与管理

目的 简化患者退款手续，缩短退款所需时间，提高病人的满意度。方法 患者将有效票据、未启封的药品，交一站式服务中心的护士，由护士认真核对后填写退款审批单，退款原因经经治医师核实后签字，药品经药房负责人检查认可签字，最后由护士到财务科领取退款现金后交还给患者。结果 2003年1月-2005年3月一站式服务中心共接待退款328例，退款成功286例，患者放弃退款42例，并表示愿意继续接受治疗。结论 护士处在一个很有优势的位置来扮演治疗协调的支持者，与患者的良好关系是医疗协调的有效基础，因此要为广大患者提供满意的护理服务，提供健康知识、用药知识的宣教，满足不同患者的需求和期望。     

高剪切条件下四臣止咳颗粒制备过程中润湿剂的动态分布

目的 研究高剪切条件下制备四臣止咳颗粒过程中润湿剂的动态分布。 方法 以四臣止咳方浸膏粉-可溶性淀粉质量比为1∶2制备混合粉体,将示踪剂荧光素钠加入80%乙醇中作为润湿剂,高速搅拌湿法制粒;检测制粒过程不同时间点、不同粒径颗粒中荧光素钠的量,分析颗粒中润湿剂分布情况。 结果 在制粒初期颗粒粒径出现两极分化,且出现少量团块,主要在大粒径颗粒中检出荧光素钠,而小粒径颗粒中几乎检测不出荧光素钠,说明润湿剂此时主要呈现局部分布的状态;而随着制粒时间推移,颗粒粒径差别逐步缩小,荧光素钠在各粒径颗粒中分布趋向均衡,说明润湿剂此时趋向均匀分布的状态。 结论 高速搅拌湿法制备四臣止咳颗粒过程中,润湿剂分布随时间变化而趋向均匀化。     

Process optimization for the enhanced stability of diclofenac potassium granules and capsules

This study aimed to investigate the effects of different process parameters on the physical properties, in vitro dissolution rate, and short and long-term stability of diclofenac potassium (DFP) granules and capsules. DFP granules exhibited low total amounts of impurities when prepared through the wet granulation method using a granulating solvent with a low water/ethanol ratio. The impurities of the wet DFP mass dried at 70 °C were higher than those dried at 50 °C or 60 °C. DFP granules were stable under strong light exposure during preparation. DFP granules prepared using a granulating solvent with a 1:4 water/ethanol ratio had a relatively smaller particle size and higher angle of repose than those prepared using granulating solvents with other water/ethanol ratios. The dissolution rate of DFP capsules prepared using four different water/ethanol ratios was less than 2% after 10 min of dissolution and increased to 95% within 30 min of dissolution. The total amount of drug impurities of DFP capsules prepared using a granulating solvent with 1:4 water/ethanol ratio was considerably lower than those of DFP capsules prepared using a granulating solvent with a 1:0 water/ethanol solvent ratio. Regardless of the water/ethanol ratio, the capsules showed poor stability when exposed to high temperature (60 °C) and strong light (4500±500 Lux) for 10 days, but were relatively stable at high humidity (92.5% RH). The results of the long-term stability (25±2 °C and 60%±10% relative humidity) study showed that DFP granules were more stable than DFP capsules, and were stable for 12 months. The type of encapsulating material did not affect the 2-month stability of DFP. DFP granules are sensitive to granulating solvent and drying temperature and DFP capsules should be stored away from high temperature and strong light.     

小儿豉翘清热颗粒一步造粒工艺研究

目的 对一步造粒法制备小儿豉翘清热颗粒的工艺进行优化.方法 采用一步造粒法制备小儿豉翘清热颗粒,以生产效率、粒度合格率、颗粒水分为考察指标,采用正交试验法对影响小儿豉翘清热颗粒一步造粒过程的因素进行考察.结果 确定最佳工艺为喷液流速为70g·min-1,浸膏相对密度为1.10～1.20,物料温度为50～70℃.结论该工艺合理可行,产品稳定性好.