Exploratory Study of Low Resolution Electromagnetic Tomography (LORETA) Real-Time Z-Score Feedback in the Treatment of Pain in Patients with Head and Neck Cancer.

Acute pain from mucositis in patients with head and neck cancer (HNC) undergoing radiation therapy (RT) is common, and may not respond well to narcotics. We used low resolution electromagnetic tomography z-score neurofeedback (LFBz) to investigate whether patients could modify brain wave activity associated with acute pain and whether this would reduce the experience of pain. HNC patients scheduled for RT had baseline pre-pain onset measures (EEG and numeric rating scale) collected before RT and then at pain onset before using analgesics, after each LFBz session and at the end of RT. Up to six sessions of LFBz training were offered over the remaining RT. Up to six 20-min sessions of LFBz were offered over the remaining RT. Data were collected before and after each LFBz session and at the end of RT. Seventeen patients recruited; fourteen were treated and reported decreased pain perception. LFBz allowed patients to modify their brain activity in predesignated areas of the pain matrix toward the direction of their baseline, pre-pain condition (including Brodmann areas (BAs) 3, 4, 5, 13, 24, and 33). LFBz can modify brain regions relevant for pain and these changes were associated with self-reported decreases in pain perception.

Discapacidad en Chile: pasos hacia un modelo integral del funcionamiento humano / Disability in Chile: steps towards a comprehensive model of human functioning

Definitivamente, la aparición del Primer Estudio Nacional de la Discapacidad ENDISC 2004 marcó un antes y un después, un avance histórico en el nivel de los instrumentos disponibles para que nuestra sociedad asuma, desde todos los sectores, el compromiso de lograr la plena inclusión y participación social de las personas con discapacidad. Con la realización de este estudio, Chile avanza significativamente a obtener un panorama más cercano a la realidad, en términos de los diferentes ámbitos en que se desenvuelven los chilenos que tienen o no una discapacidad. Este último punto es central en estos nuevos enfoques. Trabajar en favor de las personas con discapacidad, es trabajar también en favor de un país más justo, solidario y saludable. Disponer de la mejor información para enfrentar las tareas de la inclusión, junto con los nuevos desafíos y requerimientos, nos permiten dar un salto en el enfoque de la discapacidad. Hoy contamos con un nuevo escenario, que nos exige avanzar con las mejores herramientas teóricas y empíricas, para difundir los nuevos paradigmas y los conceptos más avanzados en el tratamiento de la discapacidad. El texto Discapacidad en Chile: pasos hacia un modelo integral del funcionamiento humano, que hoy ponemos a disposición de todos los chilenos, representa una pieza de vital importancia en el desarrollo de esta nueva forma de entender la discapacidad. Este trabajo, que nació al interior de la Unidad de Estudios de FONADIS, entrega las claves para avanzar en el cambio cultural, donde las personas con discapacidad se constituyen en ciudadanos con autonomía personal y reales oportunidades en salud, educación, trabajo, accesibilidad física y tecnológica. Los líderes de organizaciones de la discapacidad, los estudiantes, académicos y todo aquel que trabaje en el ámbito de las políticas sociales, cuentan ahora con un nuevo instrumento para desarrollar el proceso de incluir, en igualdad de oportunidades, a las personas con discapacidad...

Molecular modulation of calcium oxalate crystallization by osteopontin and citrate.

Calcium oxalate monohydrate (COM), which plays a functional role in plant physiology, is a source of chronic human disease, forming the major inorganic component of kidney stones. Understanding molecular mechanisms of biological control over COM crystallization is central to development of effective stone disease therapies and can help define general strategies for synthesizing biologically inspired materials. To date, research on COM modification by proteins and small molecules has not resolved the molecular-scale control mechanisms. Moreover, because proteins directing COM inhibition have been identified and sequenced, they provide a basis for general physiochemical investigations of biomineralization. Here, we report molecular-scale views of COM modulation by two urinary constituents, the protein osteopontin and citrate, a common therapeutic agent. Combining force microscopy with molecular modeling, we show that each controls growth habit and kinetics by pinning step motion on different faces through specific interactions in which both size and structure determine the effectiveness. Moreover, the results suggest potential for additive effects of simultaneous action by both modifiers to inhibit the overall growth of the crystal and demonstrate the utility of combining molecular imaging and modeling tools for understanding events underlying aberrant crystallization in disease.

Antiretroviral prescribing patterns in the Texas prison system.

Although the prevalence of human immunodeficiency virus (HIV) infection among prison inmates is reported to be high, little is known about anti-HIV treatment patterns in correctional institutions. The present study assessed antiretroviral prescribing patterns for 2360 Texas Department of Criminal Justice (TDCJ) inmates infected with HIV. In 1998, 66.8% of all TDCJ inmates infected with HIV who had CD4 lymphocyte counts < 500 cells/mm(3) were treated with highly active antiretroviral therapy (HAART). However, no substantial differences in the use of HAART were exhibited according to the sociodemographic factors under study. While the majority of inmates receiving HAART in 1998 were prescribed a combination of 2 nucleoside reverse transcriptase inhibitors (NRTIs) and 1 protease inhibitor, 11.2% were prescribed a combination of 2 NRTIs and 1 non-NRTI. In view of the elevated rate of HIV infection in correctional settings, it will be important to continue to document the pharmacotherapy patterns among prison inmates, both during and following incarceration.

Antiretroviral prescribing patterns in the texas prison system.

PURPOSE: Although prison inmates are reported to exhibit substantially elevated rates of HIV infection, little is known about HIV treatment patterns, particularly pharmacotherapy, in correctional institutions. The purpose of the present study, therefore, was to describe antiretroviral prescribing patterns in one of the nation's largest prison populations.METHODS: The study population consisted of all known (n = 2,360) HIV-infected inmates incarcerated in the Texas prison system in 1998. Information on medical conditions, sociodemographic factors, and pharmacotherapy was obtained from an institution-wide medical information system. Inmates who received more than one type of pharmacotherapy in 1998 were included in the appropriate number of categories.RESULTS: In 1998, 66.8 percent (95% CI = 64.0-69.4) of all HIV-infected inmates with CD4 counts below 500 were treated with highly active antiretroviral therapy (HAART); and 31.1 percent (95% CI = 29.3-33.0) were given no antiretroviral therapy. Logistic regression results showed that HAART treatment decreased monotonically as a function of patient CD4 count category.CONCLUSIONS: A substantial proportion of HIV-infected TDCJ inmates were placed on therapies that were not consistent with the generally recommended DHHS guidelines for their disease stage. It will be important to for future investigations to assess whether such patterns continue to exist among prison populations, and to assess the determinants of these patterns.

La inversión precoz de la onda T en el electrocardiograma contribuye a predecir permeabilidad coronaria post trombolisis en el infarto agudo al miocardio / Early T wave inversion in electrocardiogram is a significant predictor of late coronary artery patency after thrombolysis in acute myocardial infarction

En el IAM los criterios de clásicos de reperfusión son la disminución del dolor, la reducción del supradesnivel del ST, las arritmias de reperfusión y la elevación precoz de CPK. Sin embargo, el valor predictivo de ellos es bajo. Evaluamos si la inversión precoz de la onda T (* 24 hrs) en (* 2) derivaciones ECGs contiguas contribuye a predecir permeabilidad de la arteria coronaria del área infartada. Analizamos 60 pacientes consecutivos con IAM y trombólisis sistémica, 33 pts. con IAM anterior y 27 con IAM inferior, estudiados con coronariografía dentro de 5 días de evolución del IAM. La arteria coronaria se encontró permeable en 40 pts. (66,6%) y obstruida en 20 pts. (33,3%). En el análisis univariado los criterios se asociaron a reperfusión fueron la inversión precoz de la onda T (p < 0,001), la reducción del supradesnivel de ST (p = 0,01) y la elevación precoz de CPK (p = 0,015). En el análisis multivariado mediante regresión logística paso a paso sólo la inversión precoz de la onda T fue significativa para predecir permeabilidad de la arteria coronaria del IAM. Concluimos que la inversión precoz de la onda T contribuye a predecir permeabilidad de la arteria coronaria post trombólisis sistémica

[Early systemic thrombolysis in acute myocardial infarction: clinical and angiographic results]. / Trombólisis sistémica precoz en el infarto agudo del miocardio: resultados clínicos y angiográficos.

Systemic thrombolysis is an effective therapy for acute myocardial infarction, since it restores coronary flow and contributes to preserve left ventricular function. We analyze our experience with intravenous thrombolytic therapy in 45 cases with acute myocardial infarction treated within 6 hours of onset of symptoms. 28 patients had anterior and 17 inferior myocardial infarction. We treated 38 patients with streptokinase 1 to 1.5 million units infused during a 30 to 60 minute period and 7 patients with tissue plasminogen activator factor, 100 mg infused during 2 hours. Regression of chest pain and ST segment elevation and early CPK peaking (less than 4 hours) were utilized as criteria for reperfusion. Accordingly 29 patients (64%) met these criteria. Coronary angiogram was performed within 7 days in 38 patients. It disclosed a patent coronary artery in the infarcted area in 28 cases (74%). Transient hypotension with thrombolytic therapy was observed in 17 patients (38%) and bleeding complications in 3 cases (7%). Two patients (4%) died early after therapeutic failure. In summary we have confirmed that intravenous thrombolytic therapy is safe and effective in the early period of myocardial infarction and that is associated with a high incidence of clinical and angiographic reperfusion.

Alcohol and trauma. An endemic syndrome.

Injuries are a pervasive and costly problem, and alcohol use appears to be an important risk factor for injury. We examined the blood alcohol levels and selected demographic and epidemiologic variables recorded on trauma patients by 1 trauma center for a 28-month period. A total of 2,262 trauma patients were admitted to the trauma center during this period, of whom 75% were male and 72% were injured in vehicle-related incidents. Blood alcohol levels of 2,095 patients (93%) were measured, and alcohol was present in the blood of 855 (41%). Of those patients with a blood alcohol level done, 32% had a level higher than 100 mg per dl. We conclude that the level of alcohol involvement in trauma is high and that this involvement must be addressed by the medical community and the health care system.

NADP(+)-dependent D-xylose dehydrogenase from pig liver. Purification and properties.

An NADP(+)-dependent D-xylose dehydrogenase from pig liver cytosol was purified about 2000-fold to apparent homogeneity with a yield of 15% and specific activity of 6 units/mg of protein. An Mr value of 62,000 was obtained by gel filtration. PAGE in the presence of SDS gave an Mr value of 32,000, suggesting that the native enzyme is a dimer of similar or identical subunits. D-Xylose, D-ribose, L-arabinose, 2-deoxy-D-glucose, D-glucose and D-mannose were substrates in the presence of NADP+ but the specificity constant (ratio kcat./Km(app.)) is, by far, much higher for D-xylose than for the other sugars. The enzyme is specific for NADP+; NAD+ is not reduced in the presence of D-xylose or other sugars. Initial-velocity studies for the forward direction with xylose or NADP+ concentrations varied at fixed concentrations of the nucleotide or the sugar respectively revealed a pattern of parallel lines in double-reciprocal plots. Km values for D-xylose and NADP+ were 8.8 mM and 0.99 mM respectively. Dead-end inhibition studies to confirm a ping-pong mechanism showed that NAD+ acted as an uncompetitive inhibitor versus NADP+ (Ki 5.8 mM) and as a competitive inhibitor versus xylose. D-Lyxose was a competitive inhibitor versus xylose and uncompetitive versus NADP+. These results fit better to a sequential compulsory ordered mechanism with NADP+ as the first substrate, but a ping-pong mechanism with xylose as the first substrate has not been ruled out. The presence of D-xylose dehydrogenase suggests that in mammalian liver D-xylose is utilized by a pathway other than the pentose phosphate pathway.