The rheological properties of self-emulsifying systems, water and microcrystalline cellulose.

The rheological properties of mixtures of equal parts of a range of ratios of a self-emulsifying system (MP) and water (W) added to microcrystalline cellulose (MCC), have been measured by an extrusion capillary rheometer. These measurements allow assessment of both the shear and tension components of flow plus the elastic behaviour of the wet powder masses, although the results for the estimation of shear stress require careful interpretation due to the limitation of the measuring system and the assumptions made in their derivation. The results indicate that there are three regions of behaviour of the systems, which are all significantly different from the mixtures containing only W and MCC. At low MP contents (1.5--23%), the masses increase in their resistance to shear and elongational flow and have lower elasticity. These similarities in behaviour occur in spite of considerable increase in the viscosity of the MPW mixtures and a change to non-Newtonian flow of the fluid. The behaviour of the 46% MP system is intermediate between these systems and the high MP concentrations (69, 80 and 92%). These latter systems show less resistance to shear and elongational flow than the first group of concentrations, but show considerably higher levels of elasticity. As the resistance to shear decreases, so does the impairment of the surface of the extrudate. There is clear evidence of a systematic change in behaviour of the wet powder masses as the values for the angle of entry of the wet mass into the die when plotted against the ratio of the resistance to die entry (upstream pressure loss) to the shear stress within the die, is linear on a log/log scale. Also, the values of compliance of the systems as a function of shear stress fall on a common curve. Changes in the ratio of the MPW to MCC for a system for a single level of MP (46%) resulted in a change in the values of the rheological parameters but not the type of behaviour. As all these wet powder masses had been shown previously to form pellets by the process of extrusion/spheronization, it is clear that systems with a wide range of rheological characteristics can be processed and no single rheological parameter can be used to provide complete characterisation of the processability of such systems.     

High nevus counts confer a favorable prognosis in melanoma patients

A high number of nevi is the most significant phenotypic risk factor for melanoma and is in part genetically determined. The number of nevi decreases from middle age onward but this senescence can be delayed in patients with melanoma. We investigated the effects of nevus number count on sentinel node status and melanoma survival in a large cohort of melanoma cases. Out of 2,184 melanoma cases, 684 (31.3%) had a high nevus count (>50). High nevus counts were associated with favorable prognostic factors such as lower Breslow thickness, less ulceration and lower mitotic rate, despite adjustment for age. Nevus count was not predictive of sentinel node status. The crude 5‐ and 10‐year melanoma‐specific survival rate was higher in melanomas cases with a high nevus count compared to those with a low nevus count (91.2 vs. 86.4% and 87.2 vs. 79%, respectively). The difference in survival remained significant after adjusting for all known melanoma prognostic factors (hazard ratio [HR] = 0.43, confidence interval [CI] = 0.21–0.89). The favorable prognostic value of a high nevus count was also seen within the positive sentinel node subgroup of patients (HR = 0.22, CI = 0.08–0.60). High nevus count is associated with a better melanoma survival, even in the subgroup of patients with positive sentinel lymph node. This suggests a different biological behavior of melanoma tumors in patients with an excess of nevi.     

The effect of aminophylline on renin release from human chorio-decidua

The effect of aminophylline on renin release from human chorion was investigated by perfusing the tissue with various concentrations of the drug. Buffer containing aminophylline (2 X 10(-6) mol/l) doubled the rate of active and total renin secretion, but a more concentrated solution (10(-5) mol/l) released proportionately less active and total renin although the result was statistically significant. Renin secretion was not altered by aminophylline (5 X 10(-5) mol/l). The pattern of renin release was modulated by concentrations of aminophylline which were at least a 100-fold lower than those required to inhibit cyclic adenosine 3',5'-monophosphate phosphodiesterase. However, as the methylxanthines are potent adenosine receptor antagonists, we suggest that in the human chorion adenosine is a mediator of renin release.     

Penetration of imipenem into human aqueous and vitreous humor

Twenty-five patients about to undergo cataract surgery and ten patients about to undergo vitrectomy received a 1-g intravenous dose of imipenem before surgery. Specimens of aqueous or vitreous humor were then obtained and assayed for antibiotic content with a microbiologic disk agar technique. A mean peak aqueous humor level of 2.99 micrograms/ml was found at approximately two hours after administration, and a mean vitreous level of 2.53 micrograms/ml was found from two hours to three hours 15 minutes after administration. These concentrations were well above the minimum inhibitory concentration of imipenem for 90% (MIC90) of Staphylococcus epidermidis, S. aureus, and the Enterobacteriaceae commonly involved in bacterial endophthalmitis.     

Psychosomatic pathology in coronary sclerosis

Psychiatric Quarterly -     

Is ignorance bliss,or is knowledge power? When cancer healthcare professionals become cancer patients

Cancer healthcare professionals who are diagnosed with cancer enter the patient journey with considerable illness‐specific and healthcare expertise, which may influence the nature of their experience. Insights gained from having personal cancer experience may also lead to changes in professionals' subsequent clinical practice. This study explored cancer professional‐patients' experiences of their own cancer diagnosis, changes in practice, and recommendations for cancer care improvements. Participants were current or former cancer healthcare professionals who had ever received a cancer diagnosis. Semi‐structured interviews were conducted with 26 participants. Thematic analysis with an inductive approach was used for data analysis. Cancer professional‐patients faced unique needs, benefits and disadvantages due to their professional background, which both aided and marred their personal cancer experience. Individuals reported subjective practical and emotional‐related improvements in their clinical practice, although adverse emotional consequences upon returning to work were also prevalent. Care recommendations highlighted the importance of communication skills training for professionals, integrating psychological support, and providing patient‐centred care. In order to provide optimal care for cancer professional‐patients, providers must acknowledge their distinct challenges. Findings may help to foster improvements in cancer care practices through developing guidelines for treating cancer professional‐patients, and as part of narrative‐based medicine.     

Platelet-induced autoagglutination of Plasmodium falciparum-infected red blood cells and disease severity in Thailand

The relationship of the platelet-mediated autoagglutination of Plasmodium falciparum-infected red blood cells (IRBCs) to disease severity was investigated in 182 Thai patients with falciparum malaria; it was evident in 43% of uncomplicated malaria (n=63), 41% of severe malaria (n=104), and 100% of cerebral malaria (n=15; P=.001) isolates. The median (range) number of IRBCs in agglutinates per 1000 IRBCs was significantly higher in cerebral malaria (6 [3-42]) than in severe (0 [0-52]) and uncomplicated (0 [0-24]) malaria (P=.01). In multivariate analyses, high parasitemia and cerebral malaria were associated independently with parasite agglutination.