Standardizing dopamine solution calculations

A procedure for standardizing dopamine solution calulations in the intensive care unit is presented. Dopamine solutions were standardized into two preparations: (1) 1 mg/ml, a concentration to be used for most patients, and (2) 2 mg/ml, for fluid-restricted patients. Both concentrations were prepared in dextrose 5% in water. Nomograms were prepared for each standard concentration to facilitate dosage and infusion rat calculations for patients of various body weight.     

Standardizing work injury care in aligned systems

Standardizing work injury care in aligned systems requires commitment toward the same goal from all system entities. One of the keys to the success of this process improvement is involvement of all stakeholders, including external customers, in the improvement process. Strengthening the communication processes between providers and company representatives is one step in helping employers to manage the high cost of health care for their employees.     

Standardizing the physical properties of precision alloys

The standardization of the physical properties of precision alloys to ensure their reliable operation in electronic, electrical-engineering, and radio equipment is considered.     

Compliance with medication regimens for mental and physical disorders

Although the central nervous system (CNS) is often regarded as an immunologically privileged site, it is well established that specific CNS immunoreactivity can be generated through peripheral vaccination with CNS antigens. Dendritic cells (DC) are potent antigen presenting cells of hematopoietic origin that have emerged as a promising tool for cancer immunotherapy capable of evoking significant anti-tumor immunity when pulsed with tumor-associated peptides. To explore a role for DC-based immunization strategies for the treatment of CNS tumors, we developed a brain tumor model using the C3 sarcoma cell line which expresses the tumor-specific, major histocompatibility complex (MHC) class I-restricted peptide epitope E7(49-57). Syngeneic C57Bl/6 mice receiving intravenous (i.v.) injections of bone marrow-derived DCs pulsed with E7 peptide were effectively protected against a subsequent intracerebral challenge with C3 tumor cells. More importantly, this systemic immunization strategy was effective in a therapy model as 67% of animals (10 of 15) with established (day 7) intracerebral C3 tumors treated with 3 weekly injections of E7 peptide-pulsed DCs achieved a long-term survival (>90 days) while no control animals survived beyond day 41. In vivo depletion of CD8+ cells, but not CD4+ or asialo-GM1+ cells, abrogated the efficacy of E7 peptide-pulsed DC therapy of established tumors, indicating a pivotal role of specific CD8+ T-cell responses in mediating the anti-tumor effect. Our findings support the hypothesis that effective CNS anti-tumor immunoreactivity can be generated with DC-based tumor vaccines.     

Low back exercises: evidence for improving exercise regimens

Despite the wide variety of exercises that are prescribed for the low back, the scientific foundation to justify their choice is not as complete as one may think, or expect. Thus, the clinician must often call upon "clinical opinion" when selecting exercise. Given that low back tissues may need stressing to enhance their health but too much loading can be detrimental, choosing the optimal exercise requires judgment based on clinical experience and scientific evidence. To assist in developing better exercise programs, this review documents some recent biomechanical evidence from my laboratory and from laboratories of other researchers that has been reported in various publications in an attempt to update clinicians on issues of low back exercise. Among the issues examined are mechanisms of injury; the relative importance of "strength" (ie, maximum force a muscle can produce during a single exertion to create joint torque), "flexibility," and "endurance"; and training to enhance stability. Finally, some specific exercises are described that have been shown to challenge muscle and enhance performance but that are performed in such a way as to minimize loading of the spine to reduce the risk of injury exacerbation. These exercises form a basic program for rehabilitation and maintenance of low back health.     

Comparison of two regimens for ciprofloxacin treatment of enteric infections

An understanding of the functional significance of the newly identified estrogen receptor (ER beta) in the brain will require definition of its expression pattern and relationship to ER alpha. Using an antibody generated against the C-terminus of rat ER beta, we report the presence of ER beta immunoreactivity in the lateral septum, medial amygdala, hippocampus and paraventricular nucleus (PVN) of ovariectomized rats. Double labelling studies in the PVN revealed that approximately 35% of oxytocin neurons located principally in the medial and lateral parvocellular divisions of the caudal PVN were immunoreactive for ER beta while vasopressin, somatostatin and magnocellular oxytocin neurons exhibited no ER beta staining with this antibody. No ER alpha immunoreactive cells were identified in the caudal PVN. These observations provide direct evidence for the differential expression of ER sub-types within neurons and indicate that ER beta may be of physiological significance in the regulation of hypothalamic parvocellular oxytocin neurons by estrogen.     

Tolerability of prophylactic Lariam regimens

Three hundred and fifty-nine US Marines participated in a randomized double-blind clinical trial to assess tolerance of two prophylactic mefloquine regimens [250 mg salt weekly (n = 157) or 250 mg daily for 3 days followed by 250 mg weekly (n = 46)] compared with 300 mg weekly chloroquine (n = 156) over a 12-week period. The study participants were seen daily for four days, then weekly for 11 weeks. On each visit, the subject answered two computerized questionnaires (a review of body systems and an evaluation of mood states), participated in a physician interview, and was administered medications under supervision. A random sample of each group was assigned to either pharmacokinetic sampling or two wear a wrist watch size computerized sleep monitor (actigraph). The frequencies of intercurrent illness and other concomitant medications were tabulated. End study mefloquine plasma levels were obtained on all study participants. The results obtained showed no compromise in function due to dizziness or incoordination in the mefloquine groups. Overall, both weekly mefloquine and loading dose mefloquine were well tolerated. Sleep disturbance and increased dream activity were detected in the mefloquine groups. Depressive feelings were noted in two to three times more individuals in the mefloquine groups than in the chloroquine group early in the course of the study, and resolved in the majority of subjects as tolerance developed. Steady state mefloquine plasma levels were attained rapidly with the loading dose regimen in four days versus seven weeks with weekly mefloquine.(ABSTRACT TRUNCATED AT 250 WORDS)     

How good a marker is insulin level for insulin resistance?

Epidemiologic studies have correlated fasting and postload insulin levels with the risk of coronary heart disease, assuming that insulin levels are reliable markers of insulin resistance. However, this assumption has not been systematically studied. The author measured insulin response to an oral glucose load and quantitated insulin resistance using the euglycemic hyperinsulinemic clamp technique to evaluate the correlation between insulin level and the degree of insulin resistance in individuals with varying degrees of glucose tolerance. Subjects were randomly selected from previous population studies done in 1987-1989 at the Department of Medicine of the University of Kuopio in east Finland. Altogether, 50 subjects with normal glucose tolerance, 28 with impaired glucose tolerance, and 54 with non-insulin-dependent diabetes mellitus were studied. Correlations of insulin resistance (whole-body glucose uptake in clamp studies) with fasting or postload insulin levels were remarkably consistent, ranging from -0.58 to -0.74 (p < 0.01) in subjects with normoglycemia. In contrast, corresponding correlations were substantially weaker in subjects with impaired glucose tolerance and non-insulin-dependent diabetes. Among these subjects, only the fasting insulin level correlated significantly with insulin resistance (-0.47, p < 0.05 and -0.48, p < 0.01, respectively). The authors conclude that in population studies, only the fasting insulin level should be used as a marker of insulin resistance, particularly in subjects with abnormal glucose tolerance.     

Nocturnal blood glucose profiles in patients with type 1 diabetes mellitus on multiple (> or = 4) daily insulin injection regimens

The aim of the study was to examine nocturnal blood glucose profiles in Type 1 diabetic patients on multiple (> or = 4) daily insulin injections. Nocturnal blood glucose profiles were evaluated in 31 patients collecting blood samples half-hourly from 23.00 till 07.30 h, while they were asleep. Nocturnal episodes of hypoglycaemia (blood glucose < 3.0 mmol l-1 occurred in 29% of these nights; 67% of episodes were asymptomatic. In the early night (23.00-01.00 h), five episodes occurred with a median duration of 1 h. In the early morning (04.00-07.30 h) seven episodes occurred with a median duration of 3 h. No hypoglycaemia was noted from 01.00 to 04.00 h. Bedtime glucose levels appeared to predict 'early night' hypoglycaemia but not 'early morning' hypoglycaemia. Fasting glucose levels < 5.5 mmol l-1 were indicative of preceding 'early morning' hypoglycaemia. There was a large intra-individual variation in nocturnal blood glucose profiles. It is concluded that daily monitoring of bedtime and fasting blood glucose levels may be both more reliable and convenient for the prevention of nocturnal hypoglycaemia than periodic testing of blood glucose at 03.00h as is often advised. Setting a target of > 5.5 mmol l-1 for fasting blood glucose may decrease the frequency of nocturnal hypoglycaemia.     

The evidence for insulin lispro

Gastric mucosal prolapse occurs when a portion of the mucosa of the stomach herniates into the esophagus, resulting in massive hemorrhage. A 19-year-old man presented on two occasions with an upper gastrointestinal hemorrhage as a result of this syndrome. He was definitively treated with a laparoscopic Nissen fundoplication. This case report outlines his presentation, defines and details gastric mucosal prolapse, and discusses the treatment of this syndrome with laparoscopic Nissen fundoplication.     

Recent advances in antibiotic regimens for the treatment of obstetric-gynecologic infections

This paper reviews new information on antimicrobial agents for the treatment of obstetric-gynecologic infections. The bacteriology of these infections is complex, reflecting the bacteria that usually colonize the vagina and cervix. In general, these infections are polymicrobial in nature: the most frequently isolated microorganisms are gram-negative facultative aerobes, anaerobes, Chlamydia trachomatis, and Neisseria gonorrhoeae. Antibiotic regimens that do provide coverage of these pathogens showed unacceptably high failure rates. A review of the studies recently published confirmed the recommendations of the US Centers for Disease Control and Prevention for severe (inpatients) and mild-to-moderate (outpatients) pelvic inflammatory disease infections. In the case of severe infections, two regimens are recommended: a second-generation cephalosporin like cefoxitin or cefotetan, plus doxycycline or clindamycin/gentamicin. In the case of mild-to-moderate infection, a second- or third-generation cephalosporin plus doxycycline, or oral clindamycin plus an oral quinolone are recommended. Such studies produce high bacteriologic and clinical success rates. New studies indicate that gentamicin may be replaced with a monobactam such as aztreonam; this regimen leads to slightly better efficacy and less toxicity. The possibility of using clindamycin and a quinolone antibiotic is also discussed.     

Comparative studies of various antiemetic regimens

Since 1981, when high-dose intravenous metoclopramide was demonstrated to be efficacious, slow but constant improvement in the prevention of chemotherapy-induced emesis has been achieved. Today, a combination of a serotonin receptor 3 (5-HT3) antagonist plus dexamethasone can be considered the most efficacious treatment for the prevention of emesis induced by cisplatin and by moderately emetogenic chemotherapy. Which 5-HT3receptor antagonist should be used? Preclinical differences among 5-HT3receptor antagonists have been reported with regard to selectivity of receptor binding, potency, dose response, and duration of action. Twelve comparative studies among 5-HT3receptor antagonists have been carried out. Unfortunately, all these trials have some important shortcomings (patient population not large enough to show small but clinically important differences; not blinded studies; no association with steroids to maximize treatment efficacy) and, therefore, no definitive conclusions can be drawn. Very recently three large, well-conducted double-blind comparative studies have been published. All three showed that 5-HT3receptor antagonists have almost identical antiemetic efficacy and tolerability. Therefore, the choice among the 5-HT3receptor antagonists should be based only on the acquisition cost of the prescribed dose in each country for each compound.     

Two-year follow-up of directly-observed intermittent regimens for smear-positive pulmonary tuberculosis in China

SETTING: The tuberculosis component of the Infectious and Endemic Disease Control Project in the People's Republic of China is the largest single tuberculosis control project in the world using directly-observed therapy and standardized intermittent regimens. OBJECTIVE: To determine the two-year relapse and mortality rates following completion of treatment. DESIGN: A prospective cohort study of 649 cases cured in this project. The 306 new and 343 retreatment cases were treated under field conditions with 2H3R3Z3S3/4H3R3 and 2H3R3Z3E3S3/6H3R3E3, respectively. Following treatment completion, two sputum samples were collected every six months for two years and examined for acid-fast bacilli. Causes of death were identified. RESULTS: The two-year relapse rates for new and retreatment cases were 3.3% and 5.6%, respectively. Retreatment cases with delayed sputum conversion had a greater risk for subsequent relapse. The two-year mortality rate for new and retreatment cases was 3.3% and 8.5%, respectively. The higher mortality rate in retreatment cases was not attributable to relapse of disease, but rather to non-infectious sequelae of tuberculosis. CONCLUSION: The use of directly-observed intermittent regimens is effective in permanently removing infectious tuberculosis cases from the community.     

热轧板宽控制静态预设定及立辊标定

介绍了宝钢２０５０热轧粗轧机组立辊轧机板宽控制静态预设定，以及对原立辊轧机标定方法上做的一些改进，立辊实测标定准确性达１ｍｍ以内，静态预设定精度大大提高