Plasma concentrations and bioavailability of propranolol by oral, rectal, and intravenous administration in man

Eight normal male volunteers received 80 mg doses of propranolol by the oral and rectal routes and 2.2 mg by intravenous administration in a crossover fashion. Plasma concentrations of propranolol were measured by a gas chromatographic method using an electron capture detector. Individual subject concentration-time data were analysed and results indicated that the data fit a two compartment model with first order absorption. An approximately two-fold higher plasma propranolol concentration was observed after rectal administration as compared with oral dosing. Statistical analysis of the difference in the total AUCs indicates a significantly higher bioavailability of propranolol administered by the rectal route. The reduced bioavailability after oral administration indicates a substantial first pass effect but that it is possible to bypass the liver, at least partially, by giving the drug rectally to man.     

Chronic eyelid closure and its effect upon the human cone and rod electroretinogram

The human rod and cone systems have different spectral and adaptive sensitivities. Ganzfeld electroretinogram responses show that chronic eyelid closure, such as extensive symblepharon, can lead to dark-adaptation of the rods but simultaneously permit light-adaptation of the cones of the same eye. This effect is due to the red-filtering properties of the closed eyelid and the differential sensitivity of the two photoreceptor systems to the long wavelengths.     

Mapping of retinal and geniculate neurons onto striate cortex of macaque

A unity ratio between geniculate and ganglion cells can be shown in the macaque visual system. Comparison of the densities (cells/deg2) in the dorsal lateral geniculate nucleus (dLGN) of parvocellular (P) and magnocellular (M) cells, respectively, representing color-opponent and broad-band ganglion cells, with cortical magnification (mm2/deg2) gives the number of afferents per square millimeter in striate cortex (V1). For P cells, this afferent density rises only slightly with eccentricity, indicating that V1 magnification is approximately proportional to the density of P cells. The density of cytochrome oxidase puffs in V1 also rises only slightly with eccentricity. As a result, the number of P-cell afferents per puff-centered module is remarkably constant throughout V1. Our findings thus support a novel hypothesis of peripheral scaling, in which V1 cortical magnification is based on the mapping of just 1 class of afferent onto V1 modules. This "P-cell module" in V1 may be composed of submodules corresponding anatomically to the honeycomb cell in layer 4A of V1 and physiologically to a minimal complete set of color-opponent ganglion cells. In contrast, the afferent density of M cells rises steeply with eccentricity, so that the reciprocal of their afferent density, the cortical "domain" of M cells, declines with eccentricity. This decline is similar to that of point-image area in V1. As a result, the number of M cells per point-image area is nearly constant. This quantity is analogous to the receptive-field coverage factor in the retina, which for M cells is fairly constant and greater than unity at all eccentricities. The results show fundamental differences between the neural maps of these 2 major cell types, differences that are likely to have psychophysical consequences.     

Endoscopic intracranial craniofacial and monobloc osteotomies with the aid of a malleable high-speed pneumatic drill: a cadaveric and clinical study

Endoscopic techniques are now an accepted part of the surgical armamentarium and are used routinely in a number of aesthetic and reconstructive procedures. Endoscopic techniques are now being used commonly by plastic surgeons in forehead and face lifts. In both craniofacial surgery and in neurosurgery, the application of endoscopy potentially allows the surgical team to perform wide dissection of the dura mater in a minimally invasive fashion, thereby potentially reducing the risk of dural and brain injury. Also reduced by this surgical approach is potential injury to the major venous structures, such as the sagittal sinus, along with overall reduced bleeding. After an extensive laboratory study of 10 cadaveric dissections, the authors have refined a new endoscopic technique for completing an endoscopic intracranial craniofacial osteotomy. This study was conducted in the Department of Pathology at the University of Brno (Czech Republic), and was performed as a cooperative multicenter project between the University of Palermo, the Albert Einstein College of Medicine/ Montefiore Medical Center, the Hospital Infantil de Mexico, "Federico Gomez," and the Medtronic Midas Rex Institute, (Fort Worth, TX). During this cadaveric anatomic study and using small trephinations and skin incisions the authors were able to develop several different craniofacial and endoscopic monobloc procedures. To accomplish intracranial and facial osteotomies, a new malleable high-speed drill was designed for use in the endoscopic craniofacial approach. Using these newly developed cadaveric techniques and instrumentation, the authors performed two intracranial craniofacial procedures on children with congenital craniofacial anomalies. There would appear to be several significant advantages for the craniofacial patient as result of these new techniques: reduced surgical trauma, operative bleeding, surgical time, and hospitalization, along with a reduced risk of infection. It became quickly apparent, as a result of these cadaveric studies, that the learning curve for this endoscopic procedure is quite steep. Tutino M, Chico F, Tutino M, Goodrich JT, Ortiz Monasterio F. Endoscopic intracranial craniofacial and monobloc osteotomies with the aid of a malleable high-speed pneumatic drill: a cadaveric and clinical study.     

Th1/Th17/Th22 immune response and their association with joint pain,imagenological bone loss,RANKL expression and osteoclast activity in temporomandibular joint osteoarthritis: A preliminary report

It is well accepted that the presence of cytokines belonging to the Th1/Th17/Th22 axis of immuno‐inflammatory response in the joint environment, such as IL‐1β, IL‐17 and IL‐22, respectively, are associated with pathogenesis of several synovial joint degenerative disorders. During temporomandibular joint osteoarthritis (TMJ‐OA), IL‐1β and IL‐17 have been implicated in the inflammation and resorption of sub‐chondral bone; however, the role of Th22 response in the TMJ‐OA pathophysiology has not been established. This study aimed to compare the expression of Th1/Th17/Th22‐type cytokines, chemokines and chemokine receptors in synovial fluid samples obtained from TMJ‐OA or disk displacement with reduction (DDWR) patients. In addition, it aimed to associate these levels with joint pain, imagenological signs of bone degeneration, RANKL production, osteoclastogenesis and osteoclast‐induced bone resorption. Higher levels of IL‐1β, IL‐17 and IL‐22 were expressed in TMJ‐OA compared with DDWR subjects, and these increased levels significantly correlated with RANKL expression, joint pain and articular bone degeneration. Higher levels of CCR5, CCR6 and CCR7, as well as their respective ligands CCL5 and CCL20, responsible for recruitment of IL‐1β, IL‐17 and IL‐22‐producing cells, were over‐expressed in TMJ‐OA compared with DDWR subjects. Osteoclastogenesis and osteoclast‐induced bone resorption were significantly greater in presence of synovial fluid from TMJ‐OA compared with DDWR subjects. These data demonstrate that cytokines, CCLs and CCRs associated with the Th1/Th17/Th22 axis of immuno‐inflammatory response are involved in TMJ‐OA pathogenesis. These findings suggest that IL‐22 is involved in the RANKL expression in TMJ‐OA, which in turn induces differentiation of osteoclasts and subsequent resorption of sub‐chondral bone.     

HIV Primary Care Curriculum Improves HIV Knowledge,Confidence and Attitudes

To meet the goals of the National HIV/AIDS Strategy and the need for a human immunodeficiency virus (HIV)-competent primary care workforce, education and training of nurse practitioners are critical. The University of California, San Francisco School of Nursing developed and implemented an HIV primary care curriculum and evaluated this curriculum for a graduating cohort of 55 students. Results show gains in students’ HIV knowledge and confidence in providing basic HIV care and improvements in attitudes toward people living with HIV. We have been able to show that HIV content can be successfully integrated into a nurse practitioner generalist curriculum.     

Esophageal lichen planus: Current knowledge,challenges and future perspectives

Lichen planus (LP) is a frequent, chronic inflammatory disease involving the skin, mucous membranes and/or skin appendages. Esophageal involvement in lichen planus (ELP) is a clinically important albeit underdiagnosed inflammatory condition. This narrative review aims to give an overview of the current knowledge on ELP, its prevalence, pathogenesis, clinical manifestation, diagnostic criteria, and therapeutic options in order to provide support in clinical management. Studies on ELP were collected using PubMed/Medline. Relevant clinical and therapeutical characteristics from published patient cohorts including our own cohort were extracted and summarized. ELP mainly affects middle-aged women. The principal symptom is dysphagia. However, asymptomatic cases despite progressed macroscopic esophageal lesions may occur. The pathogenesis is unknown, however an immune-mediated mechanism is probable. Endoscopically, ELP is characterized by mucosal denudation and tearing, trachealization, and hyperkeratosis. Scarring esophageal stenosis may occur in chronic courses. Histologic findings include mucosal detachment, T-lymphocytic infiltrations, epithelial apoptosis (Civatte bodies), dyskeratosis, and hyperkeratosis. Direct immuno-fluorescence shows fibrinogen deposits along the basement membrane zone. To date, there is no established therapy. However, treatment with topical steroids induces symptomatic and histologic improvement in two thirds of ELP patients in general. More severe cases may require therapy with immunosuppressors. In symptomatic esophageal stenosis, endoscopic dilation may be necessary. ELP may be regarded as a precancerous condition as transition to squamous cell carcinoma has been documented in literature. ELP is an underdiagnosed yet clinically important differential diagnosis for patients with unclear dysphagia or esophagitis. Timely diagnosis and therapy might prevent potential sequelae such as esophageal stenosis or development of invasive squamous cell carcinoma. Further studies are needed to gain more knowledge about the pathogenesis and treatment options.     

Effect of Baduanjin on physical functioning and balance in adults with mild-to-moderate intellectual disabilities: A comparative study

Background

Adults with intellectual disabilities often experience mobility limitations. Baduanjin, a mindfulness-based exercise intervention, can exert positive effects on functional mobility and balance. This study examined the impact of Baduanjin on physical functioning and balance of adults with intellectual disabilities.

Method

Twenty-nine adults with intellectual disabilities participated in the study. Eighteen received a Baduanjin intervention for 9-months; 11 participants did not receive any intervention (comparison group). Physical functioning and balance were assessed using the short physical performance battery (SPPB) and stabilometry.

Results

Participants in the Baduanjin group experienced significant changes in the SPPB walking test (p = .042), chair stand test (p = .015), and SPPB summary score (p = .010). No significant changes between groups were observed in any of the variables assessed at the end of the intervention.

Conclusions

Baduanjin practice may cause significant, albeit small, improvements in physical functioning of adults with intellectual disabilities.