[A case of alexin with Braille writing].
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Agraphia↗
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Common denominators: shared governance and work place advocacy - strategies for nurses to gain control over their practice.
It is important to the future of health care that we identify strategies that provide support for nurses as they take on the challenges of the new century. Shared governance has long been stressed as an effective strategy for enhancing autonomy and providing avenues for nurses to gain control over their practice. A newer strategy, defined at the local, state, and/or national level, is work place advocacy. This strategy builds upon many of the principles contained in shared governance. This article identifies common denominators found in both shared governance and work place advocacy.
Decision Making, Organizational↗
ATP binding cassette multidrug transporters limit the anti-HIV activity of zidovudine and indinavir in infected human macrophages.
OBJECTIVES: To investigate whether P-glycoprotein (P-gp) and multidrug resistance proteins (MRPs), which limit the bioavailability of HIV protease inhibitors (PIs) and nucleoside reverse transcriptase inhibitors (NRTIs), modulate the anti-HIV activity of NRTIs, non-NRTIs and PIs in vitro. DESIGN: We used primary cultures of major HIV target cells: human monocyte-derived macrophages (MDMs) and lymphocytes. METHODS: P-gp and MRP expression in response to long-term zidovudine (3'-azido-3'-deoxythymidine; AZT) or indinavir treatment was quantified by RT-PCR. MDM and lymphocytes were infected in vitro with HIV-1/Ba-L and HIV-1-LAI, respectively, and treated with antiretroviral drugs. We evaluated the activity of these drugs in combination with PSC833, a P-gp inhibitor, and/or probenecid, an MRP1 inhibitor. Intracellular AZT triphosphate derivative (AZT-TP) was quantified by HPLC-MSMS. P-gp ATPase activity was measured with inside-out native membrane vesicles enriched in P-gp. RESULTS: Levels of MDR1, mrp4 and mrp5 mRNA were high following AZT treatment. In infected MDM, PSC833 and probenecid increased the anti-HIV activity of AZT and indinavir. AZT (5 nM) decreased HIV replication by 34% alone and by 72% in combination with P-gp/MRP inhibitors. Indinavir (10 nM) gave 14% inhibition alone and 81% in combination. The increase in anti-HIV activity of AZT was correlated with an increase in intracellular AZT-TP concentration. However, unlike PIs, neither AZT nor its metabolites interacted with P-gp. CONCLUSION: AZT increases the expression of multidrug transporters, thereby decreasing its pharmacological activity. The cellular efflux of AZT probably involves MRP4 or MRP5. In contrast, increases in indinavir anti-HIV activity require the inhibition of both P-gp and MRP1.
ATP Binding Cassette Transporter, Subfamily B↗
One vision of academic nursing centers.
Reconciling vision, mission, and financial realities into a successful socially responsive endeavor is a challenge for academic nursing centers. A financially viable faculty practice enterprise is a response to this challenge. Entrepreneurial management and strategy assist in establishing financial sustainability.
Community Health Centers↗
[Genito-sexual dysfunction in patients with a medullary lesion].
Multiple dramatic consequences follow medullary lesions. Not only are voluntary motor control and sensitivity of the body segment below the lesion lost, but it also becomes impossible to control erection and ejaculation as well as urinary and faecal continency. The first investigations into genito-sexual function in paraplegics have brought about the idea, commonly admitted in the medical world, that this kind of patient is impotent and sterile. Fortunately this idea is disappearing gradually and many data have demonstrated that appropriate treatment is required and some therapies efficient. This is particularly important in the case of the population concerned, namely young men in 70% of the cases, since the usual age bracket at trauma is between 25 and 35 years old. At this time of life, sexual activity is often at its peak, so that the fertility potential becomes erased.
Adult↗
Bone lengthening for correction of limb length discrepancy in a patient with Klippel-Trenaunay syndrome: a case report.
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Adult↗
[Neurogenic bladder: pathophysiology of the disorder of compliance].
Bladder compliance is defined by the ratio of the increase of intravesical pressures to the increase of volume (_V/_P). The pathophysiology of disorders of compliance in neurogenic bladder is still poorly elucidated. It can be evaluated in terms of three elements: 1) The natural history of the appearance of these disorders in neurogenic bladders. Clinical experience shows the existence of prognostic factors that determine the development of these disorders, such as the voiding mode adopted (self-catheterization/hetero-catheterization versus indwelling catheter), the level of the spinal cord lesion (suprasacral versus sacral, incomplete versus complete, and cauda equina lesions), and the presence of meningomyelocele. 2). Data derived from conservative management of these disorders in neurogenic bladders: urethral dilatation, various sphincterotomies, bladder disafferentation, alpha-blockers, vanilloids (resiniferatoxin and capsaicin), intra-detrusor botulinum toxin and intrathecal baclofen, have demonstrated a marked improvement of disorders of compliance associated with neurogenic bladder 3). Data derived from experimentations. Morphometric studies on animal or human bladder strips have demonstrated an increased expression of proteolytic enzymes and endogenous tissue inhibitors of metalloproteinases (MMP-1) and type III collagen mRNA in hypocompliant neurogenic bladders. Reduction of bladder wall blood flow, bilateral section of hypogastric nerves in rats, study of the bladders of spinalized rats, and reduction of oestrogenic hormone impregnation, show that these conditions induce loss of the viscoelastic properties of the bladder With the arrival of new treatments, active on afferent and/or efferent pathways or even on the central nervous system, it is very important to further our understanding of the pathophysiology of disorders of compliance in neurogenic bladders. Reversibility of these disorders constitutes a major therapeutic challenge and its functional consequences make it a critical prognostic factor for the outcome of neurogenic bladder
Animals↗
Evidence suggesting the existence of stem cells for the human corneal endothelium.
PURPOSE: The well-known reluctance of human corneal endothelial cells (HCECs) to divide has continually intrigued investigators. Related to this, the discovery of an increased endothelial cell population in the periphery of the human cornea has prompted an investigation for evidence of the existence of stem-like cells in the endothelial periphery. Showing that stem cells or transient amplifying cells may exist in the periphery might explain the origin of HCECs and indicate a source for these cells in wound repair. In addition, these cells might be of value in culturing or as a source for the synthesis of artificial corneas. METHODS: Human corneas with attached scleral rims were obtained from eye banks and were assayed for telomerase activity and BrdU (bromodeoxyridine) incorporation to determine, respectively, the presence of a stem-like cell marker and replicative activity. In the case of telomerase activity, the tissues were divided into central, intermediate and peripheral areas by the use of trephines. BrdU staining (using alkaline phosphatase bound secondary antibody) was performed on whole corneas plus scleral rims exposed to BrdU antibodies on the endothelial side whereas BrdU fluorescence (using fluorescein bound secondary antibody) was obtained from transverse sections of the these tissues by the same procedure. Some corneas were wounded to determine whether the wounded areas stimulated BrdU (by staining or fluorescence) followed by the synthesis of transforming growth factor beta (TGFbeta). The latter was determined by quantitative ELISA. Rabbit corneas were also assayed for BrdU incorporation to compare their evidence of cell division with that of humans. RESULTS: After dividing corneas into central, intermediate, and peripheral sections, the dissected endothelial tissues exhibited positive telomerase activity in the peripheral and intermediate sections. No activity was observed in the central endothelial tissues or the limbus between the trabecular meshwork and Schwalbe's line. BrdU staining with alkaline phosphatase was occasionally observed in the wounded area's human corneal endothelial cells after wounding. When BrdU fluorescence assays were made on corneal transverse sections with fluorescein, fluorescence occurred in an area just at and adjacent to the trabecular meshwork, but was not seen at the corneal endothelium. After wounding, BrdU fluorescence extended into the corneal endothelium. TGF-beta levels were increased in fluids bathing the endothelium following wounding, but the increases lagged behind the wounding event. CONCLUSIONS: It is suggested stem-like cells may be sequestered in a niche at the junctional region where the corneal endothelial cells and the trabecular meshwork come together. These putative stem cells may supply new cells for both the corneal endothelium and the trabeculae. Evidence suggests that cells from this area migrate (perhaps as transient amplifying cells) to the endothelial periphery and, perhaps, to wounded areas of the corneal endothelium when needed. The migration may not be constant and may be age dependent.
Animals↗
Managing resources and ensuring accountability: understanding return on investment.
Leaders of colleges of nursing face increasing challenges associated with insufficient resources coupled with growing market demands. Managing financial resources and ensuring accountability are essential leadership skills for deans and academic leaders across the nation. An understanding of "return on investment" or "ROI" analysis as a mechanism to negotiate and validate outcomes with varied stakeholders is critical to building a financial business case. ROI analysis is one component of metrics for knowledge management and must be understood from a business perspective. Providing leadership to a resilient college of nursing requires a willingness to utilize innovative strategies and effective metrics to measure outcomes. By raising the effectiveness of base spending, thereby increasing ROI, an academic leader is better positioned to innovate, which is crucial to the future success of nursing education.
Administrative Personnel↗
Assessment of quality of life in a randomized clinical trial of candesartan only or in combination with DASH diet for hypertensive patients.
OBJECTIVES: A randomized clinical trial was used to compare the effects of an angiotensin II type 1 receptor inhibitor, candesartan, singly or in combination with a reducing sodium diet, the DASH diet, on the quality of life (QOL) in outpatients with hypertension. METHODS: After a 2-week wash out period with placebo, 102 patients with mild to moderate hypertension were randomly assigned to receive candesartan (8 to 16mg per day), and 99 patients were assigned to follow the DASH diet in addition to the same dose of candesartan, both for 16 weeks. Patients completed the Subjective Symptoms Assessment Profile questionnaire, just before treatment and at the end of treatment. ANOVA was used to analyze the QOL-score changes over time and compare treatments. RESULTS: Resting blood pressures were significantly reduced by the combination of candesartan and DASH diet (p < 0.005). Significant improvement was demonstrated for the mental component scores after 16 weeks of treatment with the combination of candesartan and DASH diet (p < 0.03). CONCLUSIONS: Angiotensin II type 1 receptor blockade with a therapeutic dosage of candesartan maintains significant control of blood pressure and may improve QOL-scores, especially when combined with a reducing sodium diet.
Angiotensin II Type 1 Receptor Blockers↗
Asymptomatic calcitonin-secreting tumor of the pancreas. A case report.
CONTEXT: Pancreatic endocrine tumors are unusual tumors arising from cells belonging generically to the amine precursor uptake and decarboxylation system. CASE REPORT: We present a case of a calcitonin-secreting pancreatic endocrine tumor in a 59-year-old male who presented at our Center with elevated calcitonin values. The patient was asymptomatic. Further investigation revealed a tumor, 80 mm in diameter, in the pancreatic body and tail along with three metastatic lesions in segments III, V, and VIII of the liver. Following a distal pancreatectomy, splenectomy and wedge resection of segments III and V along with radiofrequency ablation of the segment VIII lesion, his serum calcitonin reached normal values. CONCLUSIONS: Calcitonin-secreting pancreatic endocrine tumors are often malignant and have a poor prognosis. We believe that an aggressive surgical approach may improve survival.
Calcitonin↗
Proliferative high-risk lesions of the breast: contribution and limits of US-guided core biopsy.
PURPOSE: To retrospectively correlate high-risk proliferative breast lesions (radial scar, atypical lobular hyperplasia, lobular carcinoma in situ and papillary lesions) diagnosed on core biopsy with the definitive histopathological diagnosis obtained after surgical excision or with the follow-up, in order to assess the role of core biopsy in such lesions. To discuss the management of the patient after a core biopsy diagnosis of high-risk proliferative breast lesion. MATERIAL AND METHODS: We evaluated 74 out of 1776 core biopsies consecutively performed on 67 patients. The histopathologic findings were as follows: 11 radial scars (RS), 3 atypical lobular hyperplasias (ALH), 3 lobular carcinomas in situ (LCIS), 57 benign papillary lesions. All patients underwent bilateral mammography, whole-breast ultrasound with a linear-array broadband transducer, and core biopsy with a 14 Gauge needle and a mean number of samples of 5 (range 4-7). Sixty-two of 67 patients, for a total of 69/74 lesions, underwent surgical biopsy despite benign histopathologic findings, mostly because of highly suspicious imaging for malignancy (BIRADS 4-5), whereas 5 patients refused surgery and have been followed up for a least 18 months and are still being followed up (2 with RS, 1 with ADH and 2 with papillary lesions). RESULTS: Among the core biopsied lesions with a diagnosis of RS (n = 11) pathology revealed one ductal carcinoma in situ (DCIS) (this case was characterized by granular microcalcifications on mammography and by a mass with irregular margins on ultrasound). Also in the group of ADH (n = 3) pathology revealed one DCIS (lesion not visible on mammography but depicted as a suspicious mass on US). In the group of LCIS (n = 3) pathologists found an invasive lobular carcinoma (ILC). Among the benign papillary lesions (n = 57) histopathologic analysis of the surgical specimen revealed 7 malignant lesions (4 papillary carcinomas and 3 DCIS), whose mammographic and ultrasound findings were indistinguishable from benign lesions. Altogether there were 10 false negative results (underestimation) out of 74 core biopsies with a diagnosis of high-risk proliferative breast lesions. CONCLUSION: The high rate of histological underestimation after core biopsy (10/74) (13.5%) demands a very careful management of patents with a core biopsy diagnosis of high-risk proliferative breast lesions, especially in the case of RS, lobular neoplasia and papillary lesions. However, the high imaging suspicion for malignancy prompts surgery. It is possible to assume that, when there is a low imaging suspicion for malignancy, when enough tissue has been sampled for pathology and no atypia is found within the lesions, surgery is not mandatory but a very careful follow-up is recommended. We must underline that there is no agreement regarding the quantity of tissue to sample. Vacuum-assisted biopsy may lead to better results, although there is as yet no proof that it can actually replace surgery in this group of lesions, since it seems only to reduce but not abolish the histological underestimation.
Adult↗
Bactericidal/permeability-increasing protein antineutrophil cytoplasmic antibodies (ANCA) and associated diseases: clinical relevance of an emerging ANCA target antigen.
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Antibodies, Antineutrophil Cytoplasmic↗
[Contribution of magnetic resonance cholangiopancreatography to the diagnosis of biliary tract disease].
The aim of the study was to assess the role of magnetic resonance cholangiopan-creatography (MRCP) in the diagnosis of biliary tract and pancreatic duct diseases, also in relation to the data reported in the literature. Over the period from Februrary 2002 to July 2004, 252 consecutive patients, with a clinical or instrumental suspicion of biliary disease were submitted to magnetic resonance to investigate the biliary tract. The definitive diagnosis of disease was obtained by surgery and/or endoscopic retrtograde cholangiopancreatography (ERCP) in patients with clinical or diagnostic evidence of disease and by means of follow-up in the remaining cases. MRCP, combined with T2-weighted FSE sequence on the axial plane yielded positive findings in 191/252 patients (75.79%); in 75/191 (39.26%) either ERCP was indispensable (n = 33) or surgery proved necessary (n = 42). MRCP and surgical sample findings proved discordant in 3/42 cases operated on (7.14%); MRCP and ERCP yielded discordant findings in 11/33 cases (33.33%) submitted to ERCP. With the exception of the limitations associated with the difficulty in obtaining dynamic information relating to functional diseases of Oddi's sphincter, for which, moreover, a progressive tecnological updating is underway, MRCP is the diagnostic reference procedure in biliopancreatic disease, reserving a therapeutic role for ERCP.
Adolescent↗
Seroprevalence of West Nile virus in Saskatchewan's Five Hills Health Region, 2003.
BACKGROUND: The Five Hills Health Region of Saskatchewan reported the highest West Nile virus (WNV) case rates in the 2003 outbreak. A serologic and telephone survey was undertaken to assess the seroprevalence of the virus and the knowledge, attitudes and behaviours of the residents. METHODS: Respondents had to be at least 18 years of age, and residents of the Five Hills Health Region between July 1st and September 15th, 2003. Blood samples of respondents were tested at the National Microbiology Laboratory for flavivirus immunoglobulin using a WNV IgG ELISA and plaque reduction neutralization test. Descriptive analyses performed related to respondents' demographics, knowledge, attitudes, behaviours, and seropositivity. WNV infection risk was assessed using odds ratio. RESULTS: There were 619 questionnaire respondents, of whom 501 donated a blood sample. The seroprevalence of WNV in the Five Hills Health Region was 9.98% (95% CI 7.37-12.59%). Seropositivity of rural areas was 16.8% and urban was 3.2%. Most (97%) of participants thought WNV was an important health issue. Forty-eight percent of the participants used insect repellents containing DEET most of the time. There was good knowledge regarding WNV transmission and prevention of the spread of WNV. Rural compared to urban residents were six times more likely to be positive for WNV (OR=6.13, 95% CI 2.82-13.34). INTERPRETATION: This is the highest seroprevalence rate of West Nile virus recorded in North America thus far. Many factors could have influenced this outbreak, such as eco-region, early prolonged hot weather, level of mosquito control programs, urban and rural community differences, and personal protective behaviours.
Adolescent↗