Info-Santé CLSC, the Québec telenursing service, is a telephone health line nursing service that was implemented in 1995 in every local community service center (CLSC; n = 141) of 15 regional health authorities in the Province of Québec, Canada. It is, at present, one of the most important first-line health services and it operates in continuity with the other resources in the health and social service system. Info-Santé CLSC operates 24 hours a day, 7 days a week, and received more than 2,260,000 calls in 1997. This article will report the findings from the first province-wide survey of the service, based on a stratified random sample of 4,696 callers. The findings revealed that most respondents were highly satisfied with the service; they followed the nurses' advice and carried out self-care measures as recommended. Nursing interventions helped respondents feel self-reliant, like they could solve the same or similar problems should they occur in the future. The vast majority of respondents considered that the call they made to Info-Santé CLSC was useful in finding a solution to their problems. The vast majority also claimed that they would certainly call Info-Sante CLSC again should another problem occur. The majority reported they would have turned to another type of resource if Info-Santé CLSC had not existed; half of the respondents stated that they would have used emergency departments and a third would have consulted a doctor in private practice.

Adolescent↗

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Thermodynamic study of iodocyanopindolol beta-adrenoceptors interactions with rat lung and cerebral cortex.

(+/-)125 I-cyanopindolol ((+/-) I CYP) was used to characterize beta-adrenoceptors on rat lung and cerebral cortex membranes. The affinity of (+/-) ICYP was higher for lung (Kd = 64.3 pM) at 37 degrees C. The association reaction of (+/-) ICYP was faster with lung (k+1 = 1.52 X 10(9) M-1.min-1) than with cerebral cortex beta-adrenoceptors (k+1 = 1.75 X 10(8) M-1.min-1). In both tissues, the dissociation reaction followed a biphasic process with a fast (t 1/2 = 15.4 min and 5.6 min for lung and cerebral cortex respectively) and a slow component (t 1/2 = 474 min and 255 min for lung and cerebral cortex respectively). The thermodynamic parameters for (+/-) ICYP - beta-adrenoceptors binding have been determined from kinetics and equilibrium studies, for the two tissues, at several temperatures between 0 degrees and 44 degrees C. For lung and cerebral cortex, Arrhenius plots were linear with different energies of activation. Van't Hoff plot was not linear for lung and the standard enthalpy and entropy changes of (+/-) ICYP - beta-adrenoceptors interaction decreased linearly with temperature: the binding occurred with a negative heat capacity change (delta Cp degrees = -368.9 cal. moles-1.K-1) at 25 degrees C. Thermodynamic and kinetic results show that binding of (+/-) ICYP to lung beta-adrenoceptors could involve two successive equilibria with a conformational change of the beta-adrenergic receptor.

Animals↗

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[Info-Santé CLSC: accessibility, quality and efficiency are recognized].

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Community Health Centers↗

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[Medicines interacting with mitochondria: anti-ischemic effects of trimetazidine].

While mitochondria are key factors in energy production in cells they are also key factors in their life cycle because under certain circumstances they can provoke cellular apoptosis. Some 45 per cent of myocardial volume is taken up by mitochondria. Furthermore, mitochondria are key to many aspects of neuronal activity and can trigger neurodegenerative processes. Lipid oxidation is responsible for the production of much ATP resynthesis in the heart but this process is less oxygen efficient than glucose oxidation. During ischaemia, lipid oxidation is suddenly blocked, but markedly increased during reperfusion, causing accumulation of potentially toxic metabolites (acylcarnitines, acyl-CoA, lysophospholipids). These metabolites can change calcium handling, inducing arrhythmias. Trimetazidine, and another product in development, ranolazine, by inhibiting lipid oxidation favours glucose oxidation and inhibits the production of deleterious lipid metabolites. Thus this class of drugs can have beneficial effects on myocardial metabolism without direct haemodynamic effects.

Acetanilides↗

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[Are sigma receptors implicated in ischemic injury?].

Sigma receptors are present in many organs and several functions are allotted to them but the specificity of their effect remains to be established. Indeed, all the molecules known to interact with these receptors also have affinities for other receptors. Recently, sigma-1 receptors were implied in the processes of cellular protection, several of their ligands showing a neuroprotector effect in various models of cerebral ischaemia. S-16950, a trimetazidine derivative, is a powerful anti-ischaemic drug on a hepatic model of ischaemia-reperfusion. It is structurally closely related to SA4503, a sigma receptor ligand showing also an anti-ischaemic action. Our study shows that S-16950 inhibits the binding of [3H]pentazocine, a selective sigma-1 receptor radioligand, to rat brain membranes with a high affinity (IC50 = 7 nM). This affinity is equivalent to the most potent sigma ligand such as haloperidol. Its affinity is 170 times higher for the sigma-1 subtype than for the sigma-2 subtype. The effect of Gpp[NH]p on S-16950 inhibition of [3H]pentazocine binding and the potentiation of the convulsivant effect of cocaine under the action of S-16950 suggest that this molecule may act as an agonist. These results indicate that S-16950 is a new sigma ligand and reinforce the assumption of a link between sigma receptors and a cytoprotective activity.

Animals↗

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[Effect of preservation of the kidney on the long-term function following autotransplantation].

The consequences of ischaemia-reperfusion injury from kidney recipients on delayed graft function and graft survival still remain a matter of debate. Using an autotransplanted pig kidney model, the influence of trimetazidine added to two standard preservation solutions (Euro-Collins and University of Wisconsin) was studied. The renal parameters were analysed over a period of 12 weeks after transplantation. The degree of interstitial fibrosis, and the number of CD4, CD8 and macrophage positive cells were analysed at 2, 4-5 and 11-12 weeks after the transplantation. Glomerular filtration and sodium reabsorption were significantly more improved after cold-flush and preservation with trimetazidine-supplemented solutions than with trimetazidine-free solutions. The cytoprotective action of trimetazidine also reduced interstitial fibrosis and the number of infiltrating CD4 and CD8-positive cells. These results indicate that the condition of cold preservation may influence long-term kidney graft functions and that trimetazidine reduces to a certain extent the degree of interstitial fibrosis.

Adenosine↗

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[Trimetazidine prevents ischemia-reperfusion injury in hepatic surgery under vascular clamping].

Clamping the hepatic pedicle (or Pringle's manoeuvre) is frequently used to reduce blood loss during liver surgery. This induces a normothermic ischaemia of the overall liver. In this study we have investigated the anti-ischaemic effect of trimetazidine during surgery on hydatid cysts of the liver requiring vascular clamping of the hepatic pedicle. Seventy-six hepatic pericystectomies were performed under a 40 min normothermic ischaemia. Two randomized groups including 38 patients each received daily either trimetazidine (80 mg/kg, group 1) or placebo (group 2) for 5 days before surgery. The effect of trimetazidine was evaluated on different parameters, the macroscopic appearance of the tissue, the ATP content in liver biopsies obtained before and after 15, 30 and 60 min reperfusion, the activity of the aminotransferase in the plasma and the plasma concentrations of reduced and oxidized gluthatione. No mortality was observed. The duration of hospital stay was reduced for patients treated with trimetazidine (8 +/- 1 days compared with 11 +/- 1.5 days for patients in group 2; p < 0.05). Morbidity rate was lower in group 1 (11 per cent) than in group 2 (18.5 per cent) but the decrease was not significant. Trimetazidine treatment reduced cytolysis (p < 0.05 on day 1, day 3, day 5), increased liver ATP content and limited the increase of reduced and oxidized gluthatione in the plasma during reperfusion. These results suggest that trimetazidine alleviates ischaemia-reperfusion injury during liver surgery and may allow extension of the ischaemic period without damage to the liver.

Adult↗

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[A new approach to psychosis. Is psychosis a disorder of mental reality?].

World's knowledge is but imperfectly intelligible to thinking beings by binding Possible with Reality of the experience meaning what resists them (matter or form) as sensible organ, while time perception remains out of feeling. Although the Reason seeks coherence in its seizing of the World, only consisting in experiences, yet the various experiences are not ordered a-priori towards coherence as an aim. The Reason ascribes the experiences to be pre-classified according to three modes: Continuity-Successiveness-Reversibility, connecting a physical fact (temporarily) to a thought fact (classifying). This motion towards a coherent understanding of the World proceeds by leaps over representations in three ways: 1-induction without requirement nor warranties. 2-analogical interpretation in which the middle term offers a slight validity. 3-demonstration where experiences get authentified but needs term successiveness undoubtedly marked in time. In case of a time mark deficiency, the demonstrative way gets out of warranty. The subject loses his free choice between Possible and Reality, causing psychosis. Yet the thought, getting improper to appreciate and correct the less gap between itself and experiences becomes else: thence, filtered by matter, it responds to chemotherapeutic strategies. The various symptoms in Psychosis can be brought to a selective deficit of the experience's pre classifying such as: -lack of "reversibility" troubling the course of thoughts, causing hermetism etc... -lack of "continuity" making easier experience materiality causing hallucinations. -defect of "successiveness" supporting the Possible for loss of the Reality causing delusion conviction.(ABSTRACT TRUNCATED AT 250 WORDS)

Awareness↗

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Guinea pig and rat hepatic microsomal metabolism of monocrotaline.

The comparative metabolism of the pyrrolizidine alkaloid, [14C]monocrotaline, was studied using rat and guinea pig hepatic microsomes. Metabolites were quantified to the nanomole level using HPLC and radiometric detection. Triorthocresylphosphate and carbon monoxide were used to assess the involvement of carboxylesterases and cytochrome P-450 in the hepatic microsomal metabolism of monocrotaline, respectively. Esterase hydrolysis accounted for 92% of the metabolism in the guinea pig; the rat displayed no esterase activity. This result may explain the guinea pig's resistance to pyrrolizidine alkaloid toxicity. Dehydropyrrole was found to be the major pyrrolic metabolite in the guinea pig, although colorimetric analysis indicated multiple pyrrolic moieties in the rat microsomal incubations.

Animals↗

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[14C]monocrotaline kinetics and metabolism in the rat.

The pyrrolizidine alkaloid monocrotaline (MCT) has been shown to cause hepatic necrosis and pulmonary hypertension in the rat. To better understand the mechanism of action, tissue distribution and covalent binding studies were conducted at 4 and 24 hr following administration of [14C]MCT (60 mg/kg, 200 microCi/kg, sc). For the 4 hr study, the levels of MCT equivalents were 85, 74, 67, 36, and 8 nmol/g of tissue for red blood cells (RBC), liver, kidney, lung, and plasma, respectively, while the covalent binding levels were 125, 132, 39, 64, 44 pmol/mg of protein for tissues as listed above. The 24-hr tissue distribution levels were 49, 25, 9, 10, 2 nmol/g of tissue for RBC, liver, kidney, lung, and plasma, respectively, while covalent binding was 74, 28, and 55 pmol/mg of protein for liver, kidney, and lung, respectively. We also studied the kinetics of [14C]MCT (60 mg/kg, 10 microCi/kg, iv), which demonstrated rapid elimination of radioactivity with approximately 90% recovery of the injected radioactivity in the urine and bile by 7 hr. The plasma levels of radioactivity dropped from 113 nmol/g of MCT equivalents to 11 nmol/g at 7 hr while RBC levels decreased from 144 to only 81 nmol/g at the same time point. The apparent retention of MCT equivalents in the RBC suggests that this organ may act as the carrier of metabolites from the liver to other organs including the lung and may play a role in the pulmonary toxicity.

Animals↗

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Metabolism of [14C]monocrotaline by isolated perfused rat liver.

The metabolism of the pyrrolizidine alkaloid [14C]monocrotaline [( 14C]MCT) was examined using the in situ isolated perfused rat liver. Hepatic tissue was perfused in a recirculatory fashion for 90 min and the distribution of metabolites between the bile and perfusate was analyzed. Monocrotalic acid (MCA) was found to be the major acidic metabolite of [14C]MCT, with trace amounts of 1-formyl-7-hydroxy-6,7-dihydro-5H-pyrrolizine, 6,7-dihydro-7-hydroxy-1-hydroxymethyl-5H-pyrrolizine (DHP), and 1-hydroxymethyl-7-oxo-6,7-dihydro-5H-pyrrolizine (tentative assignment) being identified in the perfusates using GC/MS. MCT N-oxide was also identified but represented less than 4% of the perfusate 14C. The simple necine base retronecine was not present at detectable levels in the perfusion medium. A large portion of the 14C recovered from both the bile and perfusate was not extractable, under acidic or basic conditions, into organic solvents. Using fast atom bombardment MS/MS, a portion of this material was identified as a glutathione conjugate of DHP. In addition, this nonextractable material retained a portion of the radioactivity that was equivalent to the acidic fraction. Given these findings and the absence of retronecine, the major pathway for the metabolism of MCT could potentially involve the production of MCT pyrrole, which subsequently reacts with cellular nucleophiles producing MCA in addition to highly water-soluble conjugated pyrroles and possibly macromolecular adducts.

Animals↗

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[Factors of variation in plasma protein binding of drugs in patients with chronic renal failure].

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Carrier Proteins↗