Taking stock: UK national antidote availability increasing, but further improvements are required.

BACKGROUND: A 2010/2011 audit of the Royal College of Emergency Medicine (RCEM) National Poisons Information Service (NPIS) UK guidelines on antidote availability demonstrated variable stocking of antidotes for the management of poisoned patients; the guidelines were updated and republished in 2013. AIM: To assess if antidote stocking has improved since the 2010/2011 audit and introduction of the 2013 guidelines. METHODS: Questionnaires were sent to Chief Pharmacists at all 215 acute hospitals in England, Wales and Northern Ireland in October 2014. Data were collected on the timing of availability (category A antidotes should be available immediately, category B within 1 h and category C can be held supraregionally) and stock levels. RESULTS: 169 (78.6%) responses were received. Atropine, calcium gluconate and flumazenil (category A) were the only antidotes available in all hospitals within the recommended time and stock levels. Forty-one (24.3%) hospitals held every category A antidote; this increased to 81 (47.9%) for those holding at least one cyanide antidote and all other category A antidotes. The proportion of hospitals stocking category A/B antidotes within the recommended time increased for 20 (90.9%) category A/B antidotes. Fomepizole (category B) availability increased to 62.1% of hospitals from 11.4% in 2010/2011. Other than penicillamine (63.3% hospitals), there was poor availability (2.4%-36.1%) of category C antidotes. CONCLUSIONS: Availability of category A and B antidotes has improved since the 2010/2011 audit and 2013 guidelines. However, there remains significant variability particularly for category C antidotes. More work is required to ensure that those treating poisoned patients have timely access to antidotes focusing particularly on category C antidotes.

Malignant proliferating trichilemmal tumor.

Proliferating trichilemmal tumors are uncommon neoplasms that are usually benign, but characterized by frequent local recurrence. In this report, we describe a patient who sought treatment at our clinic for a right occiput scalp nodule measuring 1 cm in diameter. The subcutaneous lesion was mobile and without overlying skin ulceration. Excisional biopsy of the mass was performed and the pathologic diagnosis returned as malignant, proliferating trichilemmal (pilar) tumor. Resection margins were free of tumor. On further examination the patient had no evidence of metastatic disease. A schedule of routine follow-up visits was arranged to monitor the site for recurrent disease.

Telomere associations in interphase nuclei: possible role in maintenance of interphase chromosome topology.

The relative sizes of individual telomeres in cultured human cells under conditions of cell cycling, replicative quiescence, cell transformation and immortalization were determined using quantitative fluorescence in situ hybridization (Q-FISH) with a telomere-specific peptide nucleic acid (PNA) probe. Results obtained from analysis of telomere length profiles (TLPs), which display the distribution of relative telomere lengths for individual cells, confirmed telomere length heterogeneity at the single cell level and proportional shortening of telomere length during replicative aging of virus-transformed cells. TLPs also revealed that some telomeric ends of chromosomes are so closely juxtaposed within interphase nuclei that their fluorescent signals appear as a single spot. These telomeric associations (TAs) were far more prevalent in interphase nuclei of noncycling normal and virus-transformed cells than in their cycling counterparts. The number of interphase TAs per nucleus observed in late-passage E6/E7-transformed cells did not increase during progression to crisis, suggesting that telomere shortening does not increase the frequency of interphase TAs. Furthermore, interphase TAs were rarely observed in rapidly cycling, telomerase-positive, immortalized cells that exhibit somewhat shortened, but stabilized, telomere length through the activity of telomerase. Our overall results suggest that the number of interphase TAs is dependent more on whether or not cells are cycling than on telomere length, with TAs being most prominent in the nuclei of replicatively quiescent cells in which nonrandom (even preferred) chromosome spatial arrangements have been observed. We propose that interphase TAs may play a role in the generation and/or maintenance of nuclear architecture and chromosome positional stability in interphase nuclei, especially in cells with a prolonged G(1)/G(0) phase and possibly in terminally differentiated cells.

Chromosomes exhibit preferential positioning in nuclei of quiescent human cells.

The relative spatial positioning of chromosomes 7, 8, 16, X and Y was examined in nuclei of quiescent (noncycling) diploid and triploid human fibroblasts using fluorescence in situ hybridization (FISH) with chromosome-specific DNA probes and digital imaging. In quiescent diploid cells, interhomolog distances and chromosome homolog position maps revealed a nonrandom, preferential topology for chromosomes 7, 8 and 16, whereas chromosome X approximated a more random distribution. Variations in the orientation of nuclei on the culture substratum tended to hinder detection of an ordered chromosome topology at interphase by biasing homolog position maps towards random distributions. Using two chromosome X homologs as reference points in triploid cells (karyotype = 69, XXY), the intranuclear location of chromosome Y was found to be predictable within remarkably narrow spatial limits. Dual-FISH with various combinations of chromosome-specific DNA probes and contrasting fluorochromes was used to identify adjacent chromosomes in mitotic rosettes and test whether they are similarly positioned in interphase nuclei. From among the combinations tested, chromosomes 8 and 11 were found to be closely apposed in most mitotic rosettes and interphase nuclei. Overall, results suggest the existence of an ordered interphase chromosome topology in quiescent human cells in which at least some chromosome homologs exhibit a preferred relative intranuclear location that may correspond to the observed spatial order of chromosomes in rosettes of mitotic cells.

[Diagnosis of aphasia in clinical practice--results of a written survey]. / Zur Aphasiediagnostik in der klinischen Praxis--Ergebnisse einer schriftlichen Befragung.

A mail survey of clinics in the Federal Republic of Germany revealed that aphasia assessment is performed primarily by speech & language pathologists, and medical specialists. Psychologists, linguists, and speech educators, on the other hand, are involved to a much lesser degree in the process of aphasia diagnosis. Diagnosticians primarily rely on psychometric aphasia testing. Utilization of these procedures appears to be motivated by their high degree of formalization, which facilitates diagnostic objectivity, and by the good selection, syndrome classification, and severity determination this entails. Criticism is directed at the structural complexity of the tests, insufficient economy, their restricted scope, and insufficient coverage of non-language defect syndromes. Psychometric aphasia testing in many cases is used in combination with other, clinical (i.e. non-standardized) aphasia testing procedures, the advantages of the latter appearing to make up for the disadvantages in the psychometric procedures. Despite their shortcomings of not permitting adequate checks on aphasia course, use of these other procedures is held to be justified in that they are economical to administer; have a broad range of application, i.e. are useable also in acute or very severe conditions; cover non-language disorders, and, finally, are therapy-oriented. Field workers in the survey sample insist on having available both the psychometric and clinical procedures. For those involved in constructing aphasia assessment procedures, this indicates a need for developments in both "directions", which obviously are complementary to each other. Action theoretical criteria may be useful in elaborating clinical procedures.