Promoting oral potassium administration in a tertiary care hospital: An eleven-year study.

INTRODUCTION: Potassium is used to treat or prevent hypokalemia and exhibits all the characteristics of an intravenous to oral therapy conversion program. Despite this, the intravenous route for potassium replacement seems frequently unjustified. OBJECTIVES: To determine the impact of a conversion program on the use of intravenous and oral galenic forms in a university tertiary care hospital. METHODS: Two promotion campaigns were conducted in 2006 and 2009. The following years this was completed by pharmacist interventions during prescription analysis and face-to-face discussions with physicians during ward rounds. The consumption of products containing potassium was obtained by analyzing the hospital's financial database. RESULTS: The proportion of the oral route increased from 18% in 2006 to 22% in 2011, and from 25% in 2012 to 44% in 2016; the increase was significantly greater in the second period (P<0.0001). In 2016, in emergency, pulmonology, infectious diseases, and cardiology departments, the proportion of oral use ranged from 57% and 82%. The greatest progression from 2006 to 2016 was found for intensive care (4% vs. 12%) and visceral surgery departments (9% vs. 34%) that increased approximately four-fold, followed by the emergency department (28% vs. 57%) that increased approximately two-fold. CONCLUSION: Promoting the oral route for potassium replacement modifies prescriber habits and is followed by a notable increase in the proportion of potassium administered orally irrespective of department type.

A clinical trial and molecular study of photoadaptation in vitiligo.

BACKGROUND: Photoadaptation to ultraviolet (UV) B phototherapy is due to both pigmentary and nonpigmentary influences. OBJECTIVES: To measure photoadaptation in vitiliginous skin and to compare it with normal pigmented skin. METHODS: Seventeen patients with Fitzpatrick skin phototypes III-VI with vitiligo received six to nine UVB treatments, two to three times weekly. Minimal erythema dose (MED) testing was done at baseline and after all treatments; the percentage change in MED was analysed as a measure of photoadaptation. The percentage decrease in cyclobutane pyrimidine dimers (CPDs) over 24 h after a single exposure of 1 MED was analysed on vitiliginous and normal skin. RESULTS: The mean +/- SD percentage change in MED from before to after treatments was: treated vitiliginous skin 28.5 +/- 39.9% (P = 0.015), treated normal skin 35.9 +/- 49.9% (P = 0.015), untreated vitiliginous skin 11.9 +/- 22.6% (P =0.070), untreated normal skin 25.1 +/- 41.3% (P = 0.041). Of these patients, two-thirds had a positive percentage change in MED (photoadaptation). The mean amount of CPDs induced per megabase of DNA immediately after exposure was significantly higher in vitiliginous skin. The mean +/- SD percentage decrease in CPDs (rate of repair) in 24 h was 35.7 +/- 26.8% in vitiliginous skin (P = 0.027) and 46.2 +/- 19.5% in normally pigmented skin (P = 0.001); no difference was noted in the repair in vitiliginous skin compared with normal skin (P = 0.4). CONCLUSIONS: Photoadaptation in vitiliginous and normal skin was observed in two-thirds of patients. Vitiliginous skin had significantly more CPDs following UVB exposure; the rate of repair of UVB-induced DNA damage was equivalent to that in normal skin.

Acute dissociative responses in law enforcement officers involved in critical shooting incidents: the clinical and forensic implications.

The authors examine the prevalence of acute traumatic dissociative responses in a group of 115 law enforcement officers involved in critical incidents. Law enforcement officers were retrospectively surveyed for the presence of dissociative symptoms at the time of the critical incident, as well as for the presence of acute stress symptoms and posttraumatic stress symptoms. Results show that 90% of the officers reported experiencing a dissociative response during the critical incident. Thirty percent meet the Dissociative Criterion B of acute stress disorder under the DSM-IV. The mean number of dissociative symptoms in this group was two and one-half. In addition, 19% of the law enforcement officers reported varying forms of memory impairment for details of the incident. There were no reports of amnesia for the entire event. The clinical, forensic, and legal implications of these preliminary findings are discussed in this paper.

Estimated potassium content in Hanford workers.

Potassium content in male and female workers at the US Department of Energy Hanford Site was estimated based on measurements made in 2002 of 40K activity in the body. The 40K activity in females ranged from 2.1 to 4.1 kBq with an average of 3.1 +/- 0.02 kBq. The total body potassium (TBK) content in females averaged 98 +/- 0.6 g. The 40K activity in males ranged from 2.8 to 6.6 kBq with an average of 4.2 +/- 0.01 kBq and the average TBK was 136 +/- 0.3 g. The average TBK value for males aged 20-49 y was 140 g. The average TBK values for both genders decreased with age. The average potassium concentrations calculated for the different age ranges for males were 15-25% less than the value (1.9 gK per kg) obtained using the reported ICRP reference potassium and reference weight values. Potassium concentrations were inversely correlated with body-build index, body-mass index and body weight. These correlations could possibly be utilised to help assess the risk for disease. Future work is planned to evaluate whether monitoring of potassium concentrations could be used as a tool for the detection of diabetes and hypertension.

Fabrication, morphology and mechanical properties of Ti and metastable Ti-based alloy foams for biomedical applications.

Metallic foams with porosity ranging from 0.25 to 0.65 have been produced from TiCp, Ti-Nb-Zr and Ti-Nb-Ta prealloyed powder by using the space-holder technique, and analysed from both the pore morphology and mechanical properties' points of view. For all the foams, the most suitable porosity range for bone ingrowth appears to be 0.35 to 0.45, since these porosities lead to a pore size that is globally encompassed in the recommended 100-600 µm range. From the mechanical behavior point of view, all of the as-sintered foams demonstrate similar compression behavior in terms of their apparent Young's modulus and critical stresses. In the recommended 0.3-0.45 porosity range, their Young's modulus varies from 15 to 8 GPa, whilst their yield stress varies from 300 to 150 MPa. The first characteristic comes close to that of cortical bone, whilst the second significantly exceeds bone resistance. Compared to Ti foams, the mechanical properties of metastable TNZ and TNT alloy foams can also be regulated within a ±20% range, by selecting an appropriate post-sintering thermal treatment. This effect, which is initiated by activating reversible stress-induced ß to α″ martensitic transformation, is strongly perceptible for TNZ foams, whilst much less pronounced for TNT foams.

Determination of an environmental background level of 90Sr in urine for the Hanford bioassay program.

During the decommissioning and maintenance of some of the facilities at the U.S. Department of Energy Hanford Site in Washington State, workers have potential for a Sr intake. However, because of worldwide radioactive fallout, Sr is present in our environment and can be detectable in routine urine bioassay samples. It is important for the Hanford Site bioassay program to discriminate an occupational intake from a non-occupational environmental one. A detailed study of the background Sr in the urine of unexposed Hanford workers was performed. A survey of the Hanford Site bioassay database found 128 Hanford workers who were hired between 1997 and 2002 and who had a very low potential for an occupational exposure prior to the baseline strontium urinalysis. Each urinalysis sample represented excretion during an approximate 24-h period. The arithmetic mean value for the 128 pre-exposure baselines was 3.6 +/- 5.1 mBq d. The 99 percentile result was 17 mBq d, which was interpreted to mean that 1% of Hanford workers not occupationally exposed to strontium might exceed 17 mBq d.

Clinical experience in using elemental diet in the management of various surgical nutritional problems.

The clinical results obtained in 30 patients treated with elemental diet are reviewed and discussed. The majority of patients were adequately maintained nutritionally and recovered from various severe catabolic conditions while receiving a modest caloric intake supplied from one commercially available elemental diet.

Improved parameters of lactose maldigestion using lactulose.

Lactulose is a disaccharide derived from lactose. There has been recent rekindling of interest in the possible benefits of pro- and prebiotics: mainly, lactic acid-producing bacteria and lactulose for the lower intestine. Since lactose maldigestion is a common genetic trait, we undertook this study to delineate similar effects between these two disaccharides. Nine healthy lactose maldigesting subjects underwent two separate periods of three weeks adaptation, first with 10 g twice daily lactulose and then 1.5 g twice daily lactose (in milk). Adaptation was defined by reduced breath Hydrogen (BH2) and symptoms after 50 g lactose challenges. In six subjects fecal beta-galactosidase was measured. All subjects consumed some lactose daily. In the first period, eight subjects improved symptoms and reduced BH2 significantly, while in the second period they did not. Fecal beta-galactosidase significantly increased after lactulose. This study supports the notion that lactulose and lactose may have similar clinical effects.

Colonic neoplasms following ureterosigmoidostomy.

Attention is drawn to the occurrence of colonic tumors at the site of ureterosigmoidostomy. A case of carcinoma is described, the literature is reviewed and regular long-term followup is emphasized.

Administrative tools for operationalizing a continuum of care for children and youth with severe emotional disturbance.

Critical administrative functions in operationalizing a system of care approach to service delivery include: defining and selecting clients to be served, planning and developing responsive services, and ensuring that services are provided in the most therapeutic and least restrictive family and community-based environments. This article presents an overview of several administrative strategies and mechanisms developed by the Continuum of Care for Emotionally Disturbed Children in South Carolina to carry out these functions. Administrative tools are described, as well as the assumptions underlying their development. Evaluation methods, which include analyzing existing client data, surveying parents, and conducting research within a public/academic partnership, are also briefly described.

Drosophila virilis histone gene clusters lacking H1 coding segments.

Approximately 30-40% of Drosophila virilis DNA complementary to cloned Drosophila histone genes is reduced to 3.4-kilobase-pair (kbp) segments by Bgl I or Bgl II digestion. The core histone genes of a 3.4-kbp Bgl II segment cloned in the plasmid pDv3/3.4 have the same order as the D. melanogaster core histone genes in the plasmid cDm500: H2B H3 H4 H2A. Nonetheless, pDv3/3.4 and cDm500 have different histone gene configurations: In pDv3/3.4, the region between the H2B and H3 genes contains 0.35 kbp and cannot encode histone H1; in cDm500, the region contains 2.0 kbp and encodes histone H1. The lack of an H1 gene between the H2B and H3 genes in 30-40% of D. virilis histone gene clusters suggests that changes in histone gene arrays have occurred during the evolution of Drosophila. The ancestors of modern Drosophila may have possessed multiple varieties of histone gene clusters, which were subsequently lost differentially in the virilis and melanogaster lineages. Alternatively, they may have possessed a single variety, which was rearranged during evolution. The H1 genes of D. virilis and D. melanogaster did not cross-hybridize in vitro under conditions that maintain stable duplexes between DNAs that are 75% homologous. Consequently, D. virilis H1 genes could not be visualized by hybridization to an H1-specific probe and thus remain unidentified. Our observations suggest that the coding segments in the H1 genes of D. virilis and D. melanogaster are greater than 25% divergent.(ABSTRACT TRUNCATED AT 250 WORDS)

Cloning and molecular characterization of mouse bcl-x in B and T lymphocytes.

We report the cloning and initial characterization of the mouse homologues of the bcl-2-related gene, bcl-x. We compare these to the two major isoforms of human bcl-x that were previously identified, bcl-xLong (bcl-xL) which has death repressor activity similar to bcl-2, and bcl-xShort (bcl-xS), an alternative mRNA splice product that deletes a highly conserved domain shared by bcl-2 family members and promotes cell death in transfection studies. In addition to murine (m) bcl-xL and mbcl-xS, we have cloned a novel cDNA isoform that we designate mbcl-x delta TM. This cDNA deletes, by means of alternative splicing, the carboxy terminal transmembrane domain of bcl-x and is predicted to be a soluble, rather than membrane-bound, protein. We found that mbcl-x mRNA is highly inducible in splenocytes stimulated with either anti-CD3 Abs or LPS/dextran sulfate, and that the major species of mbcl-x mRNA in a variety of cell lines and tissues was the xL isoform. Transfection of mbcl-xL or mbcl-xS into Hela cells resulted in targeting primarily to mitochondria, whereas mbcl-x delta TM localized diffusely throughout the cytosol. Overexpression of the novel delta TM isoform in an IL-3-dependent cell line delayed the onset of apoptosis induced by growth factor withdrawal. Thus, a naturally-occurring form of mbcl-x present in lymphocytes that does not localize to the mitochondrial membrane is functional in preventing apoptotic cell death. Moreover, these data suggest that bcl-x provides a life signal in activated lymphocytes.

Carboxyl-terminal targeting and novel post-translational processing of JAW1, a lymphoid protein of the endoplasmic reticulum.

Jaw1 is a lymphoid-restricted protein localized to the cytoplasmic face of the endoplasmic reticulum (ER) and is a member of a recently recognized class of integral membrane proteins that contain carboxyl-terminal membrane anchors. The carboxyl-terminal 71 amino acids of the Jaw1 protein, which contain a hydrophobic membrane spanning region, are sufficient to target a heterologous protein to the ER. By discontinuous sucrose gradient ultracentrifugation, differential sedimentation was noted for the four major Jaw1 protein isoforms, with two of the forms predominantly soluble and two microsome-bound. Pulse-chase immunoprecipitations suggest a post-translational modification of two major isoforms of the protein resulting in an increase in mobility on SDS-polyacrylamide gel electrophoresis. In vitro translation studies are compatible with a post-translational processing event that results in cleavage of a short 36 amino acid lumenal domain. These findings define a carboxyl-terminal domain of the Jaw1 protein that is both necessary and sufficient for ER localization. In addition, the processing of the small lumenal domain of Jaw1 represents a novel post-translational protein modification performed by the endoplasmic reticulum.

Frequent aberrant immunoglobulin gene rearrangements in pro-B cells revealed by a bcl-xL transgene.

During B lymphocyte development, pro-B cells that fail to rearrange an immunoglobulin heavy (IgH) chain allele productively are thought to undergo developmental arrest and death, but because these cells are short-lived in vivo they are not well characterized. Transgenic mice expressing the apoptosis regulatory gene bcl-xL in the B lineage developed large expansions of pro-B cells in bone marrow. V(D)J rearrangements in the expanded populations were nearly all nonproductive, and DJH rearrangements were enriched for joints in DH reading frame 2 and for aberrant joints with extensive DH or JH deletions. Thus, the death of pro-B cells with failed immunoglobulin rearrangements occurs by apoptosis, and bcl-xL can deliver a strong survival signal at the pro-B stage. This analysis also demonstrated that immunoglobulin gene rearrangement is less precise than previously appreciated.

Bcl-xL rescues WEHI 231 B lymphocytes from oxidant-mediated death following diverse apoptotic stimuli.

Developing lymphocytes undergo extensive cell death during selection of the immune repertoire. We investigated the influence of bcl-xL, a member of the bcl-2 family of apoptosis regulatory genes, on apoptosis in a model system for negative selection in the B lymphoid lineage. Overexpression of bcl-xL in WEHI 231 immature mouse B cells blocked apoptosis triggered by cross-linking of surface IgM. bcl-xL-transfected cells were also resistant to apoptosis following incubation in low serum medium or exposure to gamma-irradiation, the sphingomyelin ceramide, or compounds that increase intracellular levels of oxidants. Remarkably, the addition of antioxidants (catalase, N-acetylcysteine, or pyruvate) alone rescued the native WEHI 231 cells from apoptosis while having only minor effects on the viability of cells overexpressing bcl-xL. Anti-IgM cross-linking, ceramide, and gamma-irradiation treatments elevated intracellular peroxide production, which was prevented by treatment with antioxidants. Cells overexpressing bcl-xL had a similar rise in intracellular oxidants as control cells, indicating that bcl-xL modifies the cell's response to oxidants while having no detectable influence on the endogenous production of oxidants following apoptotic stimuli. These data implicate bcl-xL as a potent death repressor in B lymphocytes and support the hypothesis that bcl-xL regulates survival decisions within susceptible cells by functioning downstream of oxidant production.