Effect of cigarette menthol content on mainstream smoke emissions.

The 2009 Family Smoking Prevention and Tobacco Control Act empowered the U.S. Food and Drug Administration to study "the impact of the use of menthol in cigarettes on the public health, including such use among children, African Americans, Hispanics and other racial and ethnic minorities," and develop recommendations. Current scientific evidence comparing human exposures between menthol and nonmenthol smokers shows mixed results. This is largely because of the many differences between commercial menthol and nonmenthol cigarettes other than their menthol content. We conducted an innovative study using two types of test cigarettes: a commercial nonmenthol brand that we mentholated at four different levels, and Camel Crush, a commercial cigarette containing a small capsule in the filter that releases menthol solution into the filter when crushed. Cigarettes were machine-smoked at each of the menthol levels investigated, and the total particulate matter (TPM) was collected on a quartz fiber filter pad and analyzed by gas chromatography/mass spectrometry for menthol, nicotine, tobacco-specific nitrosamines (TSNAs), polycyclic aromatic hydrocarbons (PAHs), cotinine, and quinoline. The mainstream smoke was also monitored continuously in real time on a puff-by-puff basis for seven gas-phase constituents (acetaldehyde, acetonitrile, acrylonitrile, benzene, 1,3-butadiene, isoprene, and 2,5-dimethylfuran), using a proton transfer reaction-mass spectrometer. Average yields (in micrograms/cigarette) for the analytes were determined. Menthol in the TPM samples increased linearly with applied menthol concentration, but the amounts of nicotine along with the target TSNAs, PAHs, cotinine, and quinoline in the cigarettes remained essentially unchanged. Similarly, yields of the targeted volatile organic compounds (VOCs) in whole smoke from the mentholated nonmenthol cigarettes that were measured in real-time were largely unaffected by their menthol levels. In the Camel Crush cigarettes, however, the VOC yields appeared to increase in the presence of menthol, especially in the gas phase. Although we succeeded in characterizing key mainstream smoke constituents in cigarettes that differ only in menthol content, further study is needed to definitively answer whether menthol affects exposure to selected cigarette constituents and thereby influences harm.

Pharmacy services in a Federal extended care facility, as provided by a pharmacy student.

The objective of this study was to identify the role of the pharmacy student in providing health care to a Federal Nursing Home Care Unit. Under the supervision of a graduate pharmacy resident, the student was responsible for monitoring compliance in drug therapy, providing consultation services, and developing several research projects. A detailed study of allergy documentation in 78 patients showed that 25.6 percent of their records indicated drug allergies, but upon further investigation only 5.1 percent could be confirmed. Fourteen (41 percent) of the 34 reported allergy-producing substances had been administered again after the initial allergic incident, without ensuing difficulties. Evaluation of the self-medication program indicated that 71.4 percent of 14 study patients could not easily open their child-proof medicine container. A change to "tight" containers enhanced the patients' ability to open them. However, no significant conclusions could be drawn regarding improvement in the patients' compliance with prescription directions. Pharmacy students can be a valuable resource in improving documentation, testing drug prescription compliance, and participating in the general care of patients in long-term facilities.

Ureteral stents. Materials.

There is no "ideal" ureteral stent material at this time, yet these devices are very useful endourologic tools. One can utilize the physical data presented herein, as well as personal preference and experience, to select a stent best suited for the problem presented by the patient. The hydrogels, a new class of ureteral stent material, promise to enhance the applicability and utility of the self-retained internal ureteral stent.

Comparative evaluation of materials used for internal ureteral stents.

The materials used in the fabrication of self-retained internal ureteral stents should provide strength, flexibility, low surface friction, radiopacity, biodurability, biocompatibility, and reasonable unit cost. Polymeric biomaterials currently used for stent construction include polyurethane, silicone, Silitek, C-Flex, and Percuflex. Comparative evaluation of these materials in the context of the requirements for stent structure and function suggests advantages and disadvantages for all of them. We believe that the most important attributes for an internal ureteral stent are ease of insertion, effective restoration and maintenance of flow, resistance to migration, significant biodurability, and biocompatibility. Based on our physical testing of stents fabricated from these materials, as well as clinical and laboratory experience, we believe that C-Flex and Percuflex are the most suitable materials for stent construction.

Evaluating a behavioral method to manage dental fear: a 2-year study of dental practices.

Eleven private general practices and a university clinic formed a network to treat dental fear. The practices located in four states learned a method of treating dental fear using dental staff members and audiovisual materials. This study is an evaluation of the network's effectiveness. In 15 months, 111 patients were treated by the network. The dentists reported providing substantial dental treatment to 77% (n = 86) of the patients. The study showed that private general practices can effectively treat strong dental fear.

Increased portal venous resistance hinders portal pressure reduction during the administration of beta-adrenergic blocking agents in a portal hypertensive model.

We have recently shown that maintenance of portal hypertension in rats is highly dependent on high portal blood flow. This study attempts to determine whether portal hypertension, induced in the rat by partial constriction of the portal vein, can be reduced by lowering portal blood flow with a beta blocking agent. Portal hypertensive rats treated with propranolol had a reduction in portal blood flow to 0.89 +/- 0.13 ml X min-1 X gm-1 accompanied by reduction in portal pressure to 12.6 +/- 1.00 mm Hg, disproportionately small because of a rise in portal-collateral vascular resistance to 12.52 +/- 1.63 dyne X sec X cm-5 X gm X 10(5) accompanying the portal blood flow reduction. Similarly, portal hypertensive rats receiving beta-blockade with H35-25, an experimental beta-blocker, demonstrated a 49% reduction in portal blood flow accompanied by only a 14% reduction in portal pressure, also disproportionately low because of a complicating 77% rise in portal-collateral vascular resistance. Normal rats were then given saline infusion to achieve similar blood flow elevations to that of portal hypertensive animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of selective blockade of beta 2-adrenergic receptors on portal and systemic hemodynamics in a portal hypertensive rat model.

Propranolol, a nonselective beta-adrenergic blocker, appears to reduce portal pressures in portal hypertension by reducing portal blood flow. The aim of this study was to investigate the relative role of selective beta 1- and beta 2-blocking properties of propranolol participating in portal blood flow reduction. Portal hypertensive rats receiving placebo exhibited elevated portal blood flow of 1.31 +/- 0.4 ml/min per g splanchnic tissue and portal pressure of 15.4 +/- 0.43 mmHg, with elevated cardiac index of 358 +/- 20 ml/min per kg. Portal hypertensive rats were divided into groups receiving propranolol nonspecific beta-blockade, atenolol selective beta 1-blockade, and ICI 118551 selective beta 2-blockade. Significant (p less than 0.05) reductions in portal blood flow of 32%, 27%, and 21% were achieved in all three groups, respectively, accompanied by significant (p less than 0.05) reductions in portal pressure of 1.7 +/- 0.3, 0.9 +/- 0.2, and 0.8 +/- 0.2 mmHg, respectively. Cardiac index was significantly reduced in the propranolol-treated (25%) and atenolol-treated (20%) groups, but remained unchanged in the ICI 118551-treated group. We conclude that propranolol appears to achieve its therapeutic reduction in portal blood flow and portal pressure through combined participation of beta 1- and beta 2-adrenergic blockade. Furthermore, ICI 118551 selective beta 2-adrenergic blockade offers portal blood flow and portal pressure reduction independent of reduction in cardiac output, which could be uniquely advantageous in situations where impairment of cardiac compensatory mechanisms might prove deleterious.

The effect of the combination of nitroglycerin and propranolol on splanchnic and systemic hemodynamics in a portal hypertensive rat model.

Present investigations support major contributions from increases in both portal blood flow and portal vascular resistance in the mechanism that maintains portal hypertension. beta-Adrenergic blockers have been shown to reduce the elevated portal blood flow component. The possibility that nitroglycerin administration could reduce the elevated portal vascular resistance component is investigated here. Portal hypertension was induced in rats by a calibrated constriction of the portal vein. Portal hypertensive rats receiving placebo exhibited significant (p less than 0.05) elevations over normal rats receiving placebo in cardiac index, portal venous inflow and portal pressure. Portal hypertensive rats were then divided into groups receiving nitroglycerin infusion, propranolol (beta-adrenergic blockade) and combined administration of nitroglycerin and propranolol. Significant reductions (p less than 0.05) in portal blood flow of 30, 32 and 44%, respectively, were accompanied by significant portal pressure reductions of 2.7 +/- 0.2, 1.7 +/- 0.3 and 3.6 +/- 0.4 mm Hg in all groups, respectively (p less than 0.05). Nitroglycerin failed to prevent a 46% rise in portal-collateral resistance accompanying the portal blood flow reduction, similar to resistance rises also found in propranolol-treated (33%) and combination nitroglycerin-propranolol-treated (49%) groups. We conclude that nitroglycerin infusion can significantly reduce portal pressure, alone or in combination with beta-blockade, by reducing portal venous inflow. It appears that nitroglycerin reduces portal blood flow through the effect of baroreceptor sympathetic reflexes that constrict the splanchnic bed in response to vasodilatation and venous pooling.

Effect of purification on the accumulation of radioactive gallium labeled leukocytes in abscesses.

In rabbits, autologous peripheral blood leukocytes labeled in vitro with 67Ga citrate have been purified in vitro by the processes of dialysis and cell washing to determine the effect of purification on the accumulation of the labeled cells in abscesses of the abdominal wall. Dialysis was found to be ineffective, but cell washing produced a population of labeled leukocytes that was essentially free of noncell bound radioactivity. The purification process minimally altered the recirculating capacity of the leukocytes but significantly enhanced the relative accumulation of radioactivity in the septic area. Thus, the use of an essentially pure population of labeled leukocytes should offer a significant potential in the definitive scintiscan demonstration of hidden abscesses.

Determining intensity of need of high-risk maternal and infant clients.

Sound funding decisions by policymakers require data that relate health care services to both client need and client outcome. However, client need for care is not easy to express quantitatively, particularly in the realm of preventive and health promotion services. Application of the Community Health Intensity Rating Scale (CHIRS) with high-risk infants and prenatal clients revealed that differences in intensity of need, particularly in contextual and behavioral domains, helped to explain variation in amount of care received. The CHIRS holds promise of providing the language and measurement with which to articulate client need as the basis for cost-effective multidisciplinary care.

Recurrent urinary calculi associated with toluene sniffing.

A young man who presented initially with a ureteral stone was found to have toluene-induced renal tubular acidosis. Persistent toluene sniffing resulted in recurrent calculi and life-threatening hypokalemic paralysis. The pathophysiology, classification and treatment of renal tubular acidosis are discussed.