L'accessibilité à des traitements pour les troubles anxieux au Canada: Un commentaire.

Responds to Gauthier (see record 2004-17185-003) who commented on the two articles by Koerner et al (see record 2004-17185-001) and by Roberge et al (see record 2004-17185-002. The purpose of this response is to discuss the issue of limited availability of mental health services for anxiety disorders in Canada. From a public health perspective, the authors emphasize the importance of gathering Canadian empirical data on the organization of mental health services for anxiety disorders. Specifically more research is needed on care requirements, and the financial and structural barriers that restrict access to mental health services at the regional, provincial and national levels. The authors also discuss the role of psychologists in improving mental health care in Canada. Cost-effectiveness studies conducted in interdisciplinary practice environments could demonstrate the value added by psychology in the organization of mental health care for anxiety disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quadrature Mismatch Shaping for Digital-to-Analog Converters

Quadrature sigma-delta analog-to-digital converters require a feedback path for both the I and the Q parts of the complex feedback signal. If two separate multibit feedback digital-to-analog converters (DACs) are used, mismatch among the unit DAC elements leads to additional mismatch noise in the output spectrum as well as an I/Q imbalance. This paper proposes new quadrature bandpass (QBP) mismatch shaping techniques. In our approach, the I and Q DACs are merged into one complex DAC, which leads to near-perfect I/Q balance. To select the unit DAC elements of the complex multibit DAC, the well-known butterfly shuffler and tree structure are generalized towards a complex structure, and necessary constraints for their correct functioning are derived. Next, a very efficient first-order QBP shaper implementation is proposed. Finally, the newly presented complex structures are simulated to prove their effectiveness and are compared with each other with respect to performance     

Polymeric prodrugs of mitomycin C designed for tumour tropism and sustained activation

Prodrugs of mitomycin C (MMC) based on soluble poly-[N-(2-hydroxyethyl)-L-glutamine] (pHEG) polymers have been evaluated as tumour-targeted drugs. These materials are designed to exploit the enhanced permeability of tumour vasculature, combining a passive tumour tropism with decreased systemic liberation of free MMC. A tri- or tetrapeptide linkage (e.g. Gly-Phe-Ala-Leu) between pHEG and the aziridine nitrogen of MMC can combine good hydrolytic stability with rapid cleavage by lysosomal enzymes, releasing free MMC. The conjugates showed decreased systemic toxicity and could be administered to mice at a total MMC dose of 15 mg/kg i.v., compared with just 6 mg/kg for free MMC. Conjugates also showed better activity against animal models of established tumours, achieving up to 77% increased life span (ILS) against solid P388 leukaemia, compared with only 23% for free MMC, and up to 121% ILS against solid C26 colorectal carcinoma, compared with no activity for the free drug. Improving the therapeutic index of anticancer drugs by combining tumour tropism with decreased systemic toxicity is a versatile approach that should produce a new generation of improved anticancer agents.     

The association of gonorrhoea and syphilis with premature birth and low birthweight

The indications and results of single and double lung transplantation are described on the basis of 66 operations performed by the authors and on the background of the world literature. Lung transplantation is considered a new and promising therapeutic mode for treating patients with end-stage pulmonary failure related to fibrosis, emphysema, infective conditions, and pulmonary hypertension yielding satisfactory early results. The long-term prognosis of patients undergoing lung transplantation, like that of any other organ transfer, remains guarded.     

Evaluation of hydroxylapatite/poly(l-lactide) composites: physico-chemical properties

The aim of this in vitro study was to examine the physico-chemical behaviour of hydroxylapatite/poly(l-lactide) (HA/PLLA) composites in solution tests. The polymer PLLA, the composites 30 wt% HA/PLLA (C30) and 50 wt% HA/PLLA (C50) and a one-side HA-coated PLLA (HAcP) were evaluated. Rectangular specimens were incubated in various acellular aqueous buffer solutions [citrate, Gomori's and phosphate-buffered saline (PBS)] up to 24 weeks. Data for cumulative release of calcium, phosphate and l-lactate release in solutions containing C30 or C50 showed linear patterns. Release data for solutions containing HAcP combined with scanning micrographs, X-ray microanalysis and X-ray diffraction patterns of the specimens in time showed that the plasma-sprayed HA coating on PLLA dissolves significantly, progressively in the first weeks and almost completely within the tested period of 24 weeks in vitro. A precipitate of scaly crystallites (calcium phosphates) was observed at the HA coating-PBS interface. After 24 weeks incubation all materials were still above their initial weight, indicating that swelling still exceeded dissolution. Application of C30, C50 and HAcP as implant materials seems interesting where initial stabilization through bone bonding is needed or where the linear release of constituents is a requirement. HAcP has the advantage that the HA coating acts as a hydrolysis barrier and consequently delays the degradation of PLLA in vitro.     

Percutaneous endoscopic gastrostomy (PEG) in upper gastrointestinal tract occlusion in gynecologic oncology

BACKGROUND AND AIMS: Intestinal obstruction is a frequent cause of death in patients suffering from gynecological cancer, who have undergone multiple treatment in the form of surgery and/or chemotherapy and/or radiotherapy. The usual form of rescue treatment consists in the use of a nasogastric tube to administer support and analgesic treatment. Surgical gastrostomy is not a viable proposition in these extremely weak patients with large masses compressing and displacing the stomach. Percutaneous endoscopic gastrostomy (PEG), a technique first introduced for nutritional purposes, can be beneficially used to achieve decompression in these patients. METHODS: PEG was performed in a total of 67 patients who had already undergone multiple treatment for abdominal-pelvic neoplasia with upper gastrointestinal obstruction, who could no longer be operated and who had a life expectancy of less than sixty days. In three cases positioning was not possible owing to the lack of transillumination of the gastric and abdominal wall. 54/64 patients had previously undergone at least two operations. RESULTS: Esophagogastric lesions were found in 29% of patients, some of which were attributed to the nasogastric tube. Symptomatic wellbeing was obtained in 76.5% a few days after PEG. PEG remained in situ from 4 to 472 days. Slight peristomal infection was observed in 9% of cases. In seven cases it was necessary to add octreotide owing to the reappearance of symptoms. CONCLUSIONS: PEG is relatively easy to use and allows obstructive symptoms to be resolved in the majority of patients. Special medical skills are not required and the patient may be easily managed at home together with support therapy and pain management. Once PEG has been performed, it is possible to take fluids and semi-liquid foods, offering the patient a chance to taste flavours which have often been forgotten. PEG enables neoadjuvant chemotherapy to be performed in patients with previously untreated intestinal obstruction.     

The effects of growth hormone in children with a GH deficiency: a report of 5 cases

The authors describe 5 cases, 3 boys and 2 girls, with idiopathic growth hormone deficiency in prepubertal age, treated with human growth hormone. In four of five cases the response to treatment with GH was relevant. Only in one case (F1) the response was negative. The results of this study confirm that rhGH is a safe and effective therapy in children with GHD.     

Photoelectrochemistry of poly(3-methylthiophene), I: Surface morphology and thickness effect

Photocyclovoltammetric experiments with films of poly(3-methylthiophene) under polychromatic light irradiation show a p-type semiconductor behavior in the reduced state, with a flat band potential of 0.18 V. The photocurrent depends on film thickness and surface morphology. Films with different thickness were characterized by scanning electron microscopy, indicating a globular morphology with globule sizes changing according to the charge density used during polymer deposition. The highest photocurrent is observed for the lowest globule diameter. These films were also irradiated with monochromatic light from the electrolyte side and from the substrate side. A higher photocurrent and a photocurrent spectrum matching the absorption spectrum of the reduced form of the polymer is observed on irradiation from the electrolyte side of a 0.7 μm thick film. In contrast, for irradiation from the electrode side, the photocurrent is lower and the spectrum shows a peak at lower energy. These results were interpreted in terms of a delocalized space charge zone, different kinetics for charge transfer and mass transport across the solvent swollen polymer film and different depth of penetration of the light as a function of wavelength.