Electroconvulsive therapy as a treatment for refractory neuropsychiatric lupus with catatonia: three case studies and literature review.

Neuropsychiatric disorders associated with systemic lupus erythematosus are very common. Treatment generally consists of glucocorticoids and immunosuppressive therapy; however, some cases are unresponsive. Electroconvulsive therapy (ECT) is a recognized treatment modality in psychiatry and is an option for refractory cases of neuropsychiatric lupus. This report describes three cases of neuropsychiatric lupus that improved with ECT after failure of antipsychotics and immunosuppressive therapy. All cases met DSM-5 criteria for catatonia (case 1: agitation, stereotypies, and grimacing; case 2: stupor, mutism, and grimacing; case 3: agitation, mutism, and stereotypies); therefore, ECT was indicated. This case series shows that ECT can be a therapeutic option in patients with neuropsychiatric lupus, especially when associated with catatonia and unresponsive to conventional treatment.

A role for codon order in translation dynamics.

The genetic code is degenerate. Each amino acid is encoded by up to six synonymous codons; the choice between these codons influences gene expression. Here, we show that in coding sequences, once a particular codon has been used, subsequent occurrences of the same amino acid do not use codons randomly, but favor codons that use the same tRNA. The effect is pronounced in rapidly induced genes, involves both frequent and rare codons and diminishes only slowly as a function of the distance between subsequent synonymous codons. Furthermore, we found that in S. cerevisiae codon correlation accelerates translation relative to the translation of synonymous yet anticorrelated sequences. The data suggest that tRNA diffusion away from the ribosome is slower than translation, and that some tRNA channeling takes place at the ribosome. They also establish that the dynamics of translation leave a significant signature at the level of the genome.

Graph kernels for disease outcome prediction from protein-protein interaction networks.

It is widely believed that comparing discrepancies in the protein-protein interaction (PPI) networks of individuals will become an important tool in understanding and preventing diseases. Currently PPI networks for individuals are not available, but gene expression data is becoming easier to obtain and allows us to represent individuals by a co-integrated gene expression/protein interaction network. Two major problems hamper the application of graph kernels - state-of-the-art methods for whole-graph comparison - to compare PPI networks. First, these methods do not scale to graphs of the size of a PPI network. Second, missing edges in these interaction networks are biologically relevant for detecting discrepancies, yet, these methods do not take this into account. In this article we present graph kernels for biological network comparison that are fast to compute and take into account missing interactions. We evaluate their practical performance on two datasets of co-integrated gene expression/PPI networks.

Gradient-based manipulation of nonparametric entropy estimates.

This paper derives a family of differential learning rules that optimize the Shannon entropy at the output of an adaptive system via kernel density estimation. In contrast to parametric formulations of entropy, this nonparametric approach assumes no particular functional form of the output density. We address problems associated with quantized data and finite sample size, and implement efficient maximum likelihood techniques for optimizing the regularizer. We also develop a normalized entropy estimate that is invariant with respect to affine transformations, facilitating optimization of the shape, rather than the scale, of the output density. Kernel density estimates are smooth and differentiable; this makes the derived entropy estimates amenable to manipulation by gradient descent. The resulting weight updates are surprisingly simple and efficient learning rules that operate on pairs of input samples. They can be tuned for data-limited or memory-limited situations, or modified to give a fully online implementation.

Fast curvature matrix-vector products for second-order gradient descent.

We propose a generic method for iteratively approximating various second-order gradient steps - Newton, Gauss-Newton, Levenberg-Marquardt, and natural gradient - in linear time per iteration, using special curvature matrix-vector products that can be computed in O(n). Two recent acceleration techniques for on-line learning, matrix momentum and stochastic meta-descent (SMD), implement this approach. Since both were originally derived by very different routes, this offers fresh insight into their operation, resulting in further improvements to SMD.

Managing atopic dermatitis in children and adults.

Although the etiology of atopic dermatitis is not well understood, it appears to be linked to a combination of genetic and environmental factors, and it is usually associated with other atopic diseases such as asthma and hay fever. A definitive diagnosis in children and adults depends on identifying the nature and distribution of the lesions and on eliciting a personal or family history of the disease. Although no cure exists, atopic dermatitis often resolves spontaneously and can be controlled through proper management. Avoiding factors that precipitate or exacerbate inflammation is key to preventing disease flares. In children and adults, hydration and topical corticosteroids are the mainstays of therapy. Current advances in understanding the immunologic basis of the disease have led to the development of highly effective new treatments. Using patient education and support, the clinician can help adults and children successfully manage their disease.

Whither nursing in the 21st century?

There is no doubt that the role of the nurse in New Zealand will continue to evolve. Developments in the US where clinical nurse specialists and advanced nurse practitioners are taking on roles and responsibilities that in New Zealand are undertaken by other health professionals, mainly medical, will ultimately permeate the New Zealand health care system. Today the nurse practitioner has a greater degree of professional independence than at any time in the history of the profession, and, if the recommendations of the taskforce are accepted and nurse prescribing eventuates, the nurse will have even greater independence and autonomy. With this increased professional independence comes a greater emphasis on the responsibilities of the nurse and professional accountability. The acceptance of greater responsibility will inevitably result in a proliferation of nurse "specialists". Postgraduate programmes must be established with carefully planned curricula to accommodate the requirements of these nurse specialists. Planning, content and design of these programmes must come from nurses in consultation with the Nursing Council, the Ministries of Health and Education, and health agencies. The functioning of the human species within their environment, in both wellness and illness, can only be adequately explained or explored with a sound knowledge of biological systems. It is for this reason that the study of biological sciences must be undertaken by nursing students to prepare them for the advanced role they are likely to play in the health care system of the 21st century.

Understanding and treating atopic dermatitis.

Atopic dermatitis is a chronic, relapsing inflammatory pruritic skin disease commonly associated with respiratory allergy. The keys to successful management of this disease continue to include accurate diagnosis, hydration of the skin, control of pruritus and infections, appropriate use of topical corticosteroids and emollients, and identification and elimination of exacerbating factors. Treatment can be complicated and educating the patient regarding disease and therapy is critical for success.

Acute infection with Trichophyton rubrum associated with flares of atopic dermatitis.

Trichophyton rubrum has been implicated as a potential trigger in flares of atopic dermatitis. We describe a patient with atopic dermatitis who presented with a history of multiple flares and concurrent acute tinea pedis and onychomycosis. Symptoms of atopic dermatitis and culture-positive acute infection with T. rubrum resolved during each flare using systemic antifungals. Flares of atopic dermatitis may be triggered by acute T. rubrum infections. Antifungal therapy should be considered in these patients.

Sunscreen use: an overview.

Even to well-educated health care providers, sunscreen information continues to be confusing in regard to adequate level of sun protection factor (SPF), appropriate age of users, and whether sunscreen agents truly do prevent skin cancers. The intent of this article is to present some of the current information and controversies related to sunscreen use. It is strongly recommended that nurses teach sunscreen use and sun avoidance strategies at every health care opportunity. The message must be delivered that there is no such thing as a "healthy tan."

Topical corticosteroid therapy. Considerations for prescribing and use.

Several points should be considered when one is prescribing topical corticosteroids: The correct assessment of the underlying skin condition. A good understanding of the action of the active ingredients. Knowledge of different drug vehicles and proper application methods. Adequate patient education of correct usage and potential side effects. When health care providers and patients are aware of the use and misuse of topical corticosteroids, the agents can safely be prescribed with beneficial results.

Pediatric lupus and the role of sun protection.

Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect many organs of the body. The skin is commonly targeted by the inflammatory process of SLE, and exposure to sunlight is known to be a potential cause of dermatologic as well as systemic manifestations of SLE. Sun protection is a critical part of treating the disease and preventing sequelae. While other manifestations of the disease are important, discussion will be limited to ultraviolet light (UVL) and the resulting abnormal response to light exposure that may occur in lupus. Education about the importance of sun protection is an integral part of the treatment of children with lupus.

Photodamage: cause, clinical manifestations, and prevention.

It is now recognized that intrinsic aging changes are distinct from those caused by habitual exposure to the sun (photoaging). Not only are these sun-induced alterations unsightly, but they also serve as a marker for patients at risk for developing skin cancer. Because of increased leisure time and affluence in our society, and an emphasis on sunbathing and other outdoor recreational activities during the last few decades, photoaging and skin cancer are becoming an ever-increasing problem and source of concern for health care professionals. The purpose of this article is to review the cause, clinical manifestations, and implications of photodamage. Photoprotection and other preventive measures to minimize photoaging and the risk of skin cancer will be discussed.

Essentials of occupational contact dermatitis.

Occupational skin disease constitutes a disproportionately large percentage of all occupational illnesses. It is beneficial for the nurse to have a clear understanding of the relationship between the worker and occupational contact dermatitis. This article describes background information, diagnostic testing, and preventive measures.

[Diagnosis of coronary artery disease by thallium 201 myocardial scintigraphy during atrial pacing]. / Diagnostic de l'insuffisance coronaire par tomoscintigraphie myocardique au thallium 201 sous stimulation auriculaire.

Rapid atrial pacing may reveal myocardial ischemia but the sensitivity for the diagnosis of coronary artery disease is not high enough for routine use. Therefore, the value of atrial pacing coupled with Thallium 201 scintigraphy was evaluated. Sixty-two patients (53 men and 9 women) referred for investigation of angina or chest pain were divided into two groups: a control group of 13 patients (9 men and 4 women, average age: 57.1 years) with insignificant coronary lesions (less than 50%) (N = 5) or normal coronary angiography (N = 8), and a group of 49 patients (44 men and 5 women, average age: 55.5 years) 27 of whom had a history of myocardial infarction (17 posterior, 10 anterior). Coronary angiography showed single vessel disease in 44.9% of cases, double vessel disease in 34.7% and triple vessel disease in 18.4% of cases, and 1 patient with left main stem disease. All 62 patients underwent the same study protocol which comprised: incremental atrial pacing (to the calculated maximal heart rate), Thallium 201 myocardial scintigraphy immediately after pacing and during the redistribution phase, and coronary angiography. The sensitivities of anginal pain (36.7%) and ECG changes during atrial pacing (57.1%) were too low for the diagnosis of myocardial ischemia. On the other hand, Thallium 201 scintigraphy with atrial pacing was more sensitive (87.8%) and specific (84.6%) for coronary artery disease. Stenosis of the left anterior descending artery was diagnosed with a sensitivity of 96.4% and that of the right coronary artery with a sensitivity of 90.9%.(ABSTRACT TRUNCATED AT 250 WORDS)

Current considerations and management of atopic dermatitis.

Atopic dermatitis is a common, chronic, and relapsing disease. This continuing education article outlines the key therapy points to be considered for all patients with atopic dermatitis, although each patient requires individualized therapy.