A constructivist approach to teaching patients with heart failure: results from an intervention study.

AIMS: Despite published guidelines emphasizing the importance of education in the management of heart failure (HF), the most effective method of education remains unknown. The aim of this study was to test the efficacy of constructivist teaching method (CTM) on the patients with HF. METHODS AND RESULTS: This is a single-centre, randomized controlled trial. Patients in the intervention group were educated using the CTM in five phases: orientation, elicitation, restructuring, application, and review. The duration of intervention was 6 months. For the study outcome measures, five questionnaires were used: Atlanta Heart Failure Knowledge Test (AHFK), Minnesota Living with Heart Failure (HMLHFQ), Self-Efficacy for Appropriate Medication Use Scale (SEAMS), European Heart Failure Self-care Behaviour Scale (EHFScBS-9), and Duke Activity Status Index (DASI). A total of 122 adults (83.6% male, mean age ± standard deviation 67.1 ± 12.3 years) were enrolled in the study; 61 in the intervention group and 61 in the control group. At 6 months, the knowledge, the quality of life, the self-efficacy for appropriate medication use, the self-care behaviour, and the activity were improved in both groups but the degree of change was greater in the intervention group as indicated from the results of repeated measurements analysis of variance (P < 0.001). Significantly lower proportion of readmission at hospital at 1 month (8.2% vs. 23%, P = 0.025), and 6 months (13.1% vs. 36.1%, P = 0.003) were found for the intervention group. CONCLUSIONS: Training of HF patients through the CTM helps effectively manage the disease while significantly reducing hospital readmissions due to decompensation.

Building Bridges for Innovation in Ageing: Synergies between Action Groups of the EIP on AHA.

The Strategic Implementation Plan of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) proposed six Action Groups. After almost three years of activity, many achievements have been obtained through commitments or collaborative work of the Action Groups. However, they have often worked in silos and, consequently, synergies between Action Groups have been proposed to strengthen the triple win of the EIP on AHA. The paper presents the methodology and current status of the Task Force on EIP on AHA synergies. Synergies are in line with the Action Groups' new Renovated Action Plan (2016-2018) to ensure that their future objectives are coherent and fully connected. The outcomes and impact of synergies are using the Monitoring and Assessment Framework for the EIP on AHA (MAFEIP). Eight proposals for synergies have been approved by the Task Force: Five cross-cutting synergies which can be used for all current and future synergies as they consider overarching domains (appropriate polypharmacy, citizen empowerment, teaching and coaching on AHA, deployment of synergies to EU regions, Responsible Research and Innovation), and three cross-cutting synergies focussing on current Action Group activities (falls, frailty, integrated care and chronic respiratory diseases).

Superolateral dislocation of the condyle: report of a rare case.

Anterior dislocation of the mandibular condyle is commonly seen in patients with chronic dislocation of their temporomandibular joints. Posterior, superior and lateral dislocation is rare. Superolateral dislocation of an intact condyle, let alone intact mandible is uncommon, usually occurring after a traumatic insult to the mandible. The authors report on such a case, and its management.

A stromal myoid cell line provokes thymic T-cell immigration at the second and third gestational trimesters.

UNLABELLED: Once lymphoid precursors enter the thymus form the blood stream, they come into contact with thymic stromal cells that guide their maturation into functionally competent T cells. Thymic myoid cells are one such cell type. They have been described as a regular constituent of the thymus of embryonic and young vertebrates and express muscle proteins including myosin, desmin, acetylcholine receptor (AChR), C-protein, MyoD, troponin T, rapsyn, and utrophin. It has been emphasized recently that the thymic myoid cells play an important role in the protection of thymocytes from apoptosis, and in the process of T-cell differentiation and maturation. AIM: To provide a quantitative estimation of thymic myoid cells and T-cell population in different stages of development. A probable interaction between these two populations could explain an additional mechanism to the active T-cell migration from the thymus that is a direct contact to a specific myoid cell line. MATERIALS AND METHODS: Paraffin-embedded specimens from the thymus of forty five human embryos at the first, second and third trimester of gestation respectively, were investigated by conventional histology, and immunohistology for the presence in the stroma of the thymic medulla, of myosin in the myoid cells, and UCHL1 (pan T-cell) antigen in the medullary thymocytes. RESULTS: Our results demonstrated a quantitative difference in the second and third trimester of development concerning the expression of myosin in the stromal myoid cells of the thymic medulla over the equivalent expression of the protein in the first trimester. Similar changes in the above periods were found concerning the population of medullary thymocytes expressing UCHL1 antigen. CONCLUSIONS: Our results indicate that: (1) Thymic myoid cells play an important role in the thymic microenvironment as they are well conserved throughout species evolution. (2) The increased population of myoid cells in the medullary area during mid and late gestational age, in comparison with first trimester, probably reflects the increased demand of the growing fetus for mature T lymphocytes. Contractions of myoid cells mediated by their cytoplasmic structural proteins, including myosin which is well preserved during development, might aid the movement of thymocytes expressing UCHL1 antigen, across or out of the gland, suggesting a potential involvement of myoid cells in the thymic function. Further studies on larger series are needed to corroborate this.

Ber-H2 (CD30) immunohistochemical staining of human fetal tissues.

OBJECTIVE: CD30 antigen has long been considered to be restricted to the tumour cells of Hodgkin's disease and of anaplastic large cell lymphoma as well as to T and B activated lymphocytes. It is now apparent that the range of normal and neoplastic cells, which may express CD30 antigen, is much wider than was at first thought. In order to gain insight into the physiological function of CD30 antigen, we studied the distribution of its expression in the tissues of fetuses from week 8th to week 16th. MATERIALS AND METHODS: We investigated the immunohistochemical expression of CD30 antigen in paraffin-embedded tissue samples representing all systems from 30 fetuses after therapeutic abortion at 8th to 10th and 12th to 16th week of gestation, respectively, using the monoclonal antibody Ber-H2. RESULTS: Our results demonstrated that CD30 is expressed early in human fetal development (8th to 10th week of gestation) in several fetal tissues derived from all three germ layers (gastrointestinal tract, special glands of the postpharyngeal foregut, urinary, musculoskeletal, reproductive, nervous, endocrine systems), with the exception of the skin and hematolymphoid system (thymus), in which the antigen is expressed later on (10th week onwards). Expression of CD30 was restricted to the hematolymphoid system in the 12-16 weeks of gestation. No expression of the marker was observed in the respiratory and cardiovascular systems during the entire period examined. CONCLUSIONS: CD30 antigen is of importance in cell development, and proliferation. It is also pathway-related to terminal differentiation in many fetal tissues and organs.

Effects of cotinine on sperm motility, membrane function, and fertilizing capacity in vitro.

We evaluated the effect of cotinine on sperm fertilizing capacity in vitro. Human spermatozoa were washed and re-suspended in medium containing albumin and various concentrations of cotinine (0, 100, 200, 400, or 800 ng/ml). After an 8-h incubation period, sperm motility, hypoosmotic swelling test (HOST) outcome, and the percentage of hyperactivated spermatozoa were assayed. Aliquots of spermatozoa were then processed for the zona-free hamster oocyte sperm penetration assay (SPA) or hamster ooplasmic injections. Spermatozoa exposed to concentrations of cotinine equal to 400 or 800 ng/ml demonstrated significantly smaller outcomes for all of the above with the exception of after hamster ooplasmic injections, where high cotinine concentrations did not affect sperm viability or sperm capacity to undergo decondensation and activate hamster oocytes. It appears that cotinine concentrations of 400 or 800 ng/ml exert a detrimental effect on sperm motility, membrane function, and the ability to undergo capacitation. In addition, the current findings suggest that smokers with a high seminal plasma cotinine concentration who participate in assisted reproduction programs may be treated with intracytoplasmic sperm injections (ICSI) rather than conventional in vitro fertilization (IVF) trials.

Influence of the male reproductive tract on the reproductive potential of round spermatids abnormally released from the seminiferous epithelium.

Round spermatids can be collected from testicular biopsy material or occasionally from semen samples. We evaluated the influence of the passage of round spermatids through the male reproductive tract on their reproductive potential. A model of abnormal release of round spermatids from the seminiferous epithelium was created in mature male rats (group A). Additional sham-treated rats of the same age served as a control group (group B). Round spermatids were collected from the testicles of rats of both groups, the epididymides of rats of group A, and the vaginae of mature female rats mated with rats of group A. Isolated round spermatids were processed for ooplasmic injections. Injected oocytes were cultured. At 96 h post-injection, the blastocyst development rate was significantly higher in the groups of oocytes injected with testicular spermatids than the groups of oocytes injected with spermatids recovered from the vaginae, or the head, body, or tail of the epididymides. It appears that round spermatids recovered from testicular biopsy material have larger reproductive capacity than ejaculated round spermatids, due to mechanical or chemical detrimental influences of storage/passage through the male reproductive tract (outside the testicle) on the capacity of round spermatids to induce optimal early embryonic development.

Internal fixation of hip osteotomy in children. Successful healing in 26 children without postoperative casting.

We assessed the necessity of postoperative casting when a plate was used for fixation of a proximal femoral varus osteotomy. 26 children without postoperative immobilization were compared to 17 children with a cast. No complications were encountered in either group of children and all osteotomies showed similar healing. Our findings indicate that plate fixation provides adequate stability for healing of the osteotomy.

Modification of severe behaviour problems following herpes simplex encephalitis.

Violent and sexually disinhibited behaviour together with poor self-care developed in a 38-year-old teacher following herpes simplex encephalitis. These behaviours were sufficiently severe to make rehabilitation difficult and return to the community impossible. Initially, only violent behaviour was treated, both by medication and a behaviour programme, and sexual disinhibition subsequently by the latter. In order to implement the programme a special (psychiatric) nurse was required on a 24 h basis. The incidence of violent behaviour was reduced from up to 55 times per day to zero over a period of 2 months. Whether this was affected by medication or behaviour management, or by spontaneous recovery, is discussed. Sexual disinhibition was eliminated in supervised settings, but continued to occur if left unsupervised and this improvement resulted from behaviour management. Poor personal hygiene also improved markedly over the 6-month period. The goal of returning the patient home to live with her family was achieved and she remained there at follow-up. This intervention was carried out in a rehabilitation unit that does not specialize in the treatment of such cases; clearly this has implications for cost and quality of care.

Effect of 5% galactose diet on galactose and dulcitol in plasma and lens of male and female pigs.

The study was performed to compare the galactose tolerance of male and female pigs to 5% galactose and 25% hydrolysed whey (HW; containing 5% galactose) diets. Plasma galactose and dulcitol levels were measured throughout the diet period and correlated with the lens dulcitol contents at the end of the period. On the first day of the diet there was no significant difference between male and female blood galactose levels after galactose ingestion. The consumption of HW resulted in a significant 30% decrease in the blood galactose peak in females; there was no parallel difference in males on the HW diet. The 30-day diet induced a significant decrease in galactosaemia peaks resulting from galactose ingestion in both males and females, indicating an activation of galactose metabolism. The HW diet resulted in an equivalent decrease in peak galactosaemia only in males, cancelling the initial differences observed between males and females. The final dulcitol content in the lenses appeared to be correlated with plasma galactose but not with plasma dulcitol. However, the differences in plasma galactose between males and females, or between the two diets, resulted in smaller and often non-significant differences in lens dulcitol.

Neurofibroma of the mandible. Review of the literature and report of a case.

Neurofibroma is a tumor deriving from elements of neural tissue of the peripheral nerves. Its localization in the jaws is rather rare. A case of mandibular neurofibroma is presented.

Long acting methadone.

Tablets were prepared using pan-coating, congealing, plasticization with organic solvents and direct compression methods. The tablets were evaluated using the official dissolution test, and an analysis of the active ingredient was accomplished by employing gas-liquid chromatography. The formulation and dissolution characteristics of sustained release tablets, employing the matrix concept to regulate drug release, were studied. Particle size distribution of plastic material influenced the release rates from porous inert matrices, and it was found that incomplete drug release occurred from these preparations. Three-layer slowly-eroding sustained release tablets, using a swellable gum (carbomer) were formulated; by adjusting the proportion of the gum quantitative release of the drug was attained. Approximation of linearity for drug release-time relationship was achieved from three-layer slowly-eroding tablets containing different concentrations of drug in the middle and outer layers. Administration of the above tablets, containing 30 mg of methadone, produced analgesia in male albino rats for approximately 60 h, without undesirable effects.

Timed-release tablets containing quinine sulfate.

The release rates of quinine sulfate from slowly eroding, timed-release tablets prepared with various amounts of a swellable gum, carbomer, and cellulose acetate hydrogen phthalate at different compaction pressures were attained. For the dissolution test of the prepared tablets, the method described in NF XIII was followed. The concentration of the released quinine sulfate was determined spectrophotometrically.

Factors effecting drug release from inert matrices. Part 1: effects of surfactants on the release of quinine sulfate.

Dissolution rate studies of quinine sulfate from polyamide matrices, in simulated gastric and intestinal fluids, are carried out in the presence of hexadecyltrimethylammonium bromide, sodium lauryl sulfate and polyoxyethylene (50) stearate surfactants. The results obtained show that dissolution rate is dependent upon the pH of the disolution media and the type and concentration of surfactant. The solubilization effect of surfactants is also examined and the findings are discussed.