Supporting clients on methadone maintenance treatment: a systematic review of nurse's role

This paper discusses findings from a systematic review of literature pertaining to methadone maintenance in relation to the role of the nurse working in a general practice setting. Five electronic databases were searched for period of 2000-2008: Medline, CINAHL, Embase, PsycINFO and Cochrane Database of Systematic Reviews. Included studies were peer-reviewed literature articles that: (1) were dated no earlier than the year 2000; (2) represented a primary study (qualitative and quantitative), systematic review or meta-analysis; (3) focused on methadone maintenance for treatment of opiate dependence, not for pain; and (4) were published in English. In this review, three broad themes emerged as being significant to the role of the nurse in relation to methadone maintenance treatment (MMT) programming. These themes included: (1) identifying the client's personal characteristics; (2) having knowledge about methadone; and (3) supporting clients in MMT programmes. In conclusion, it is important to address the needs of health professionals working with clients on MMT, in order for them to provide the necessary care for this patient population. In particular, nurses need to gain knowledge about MMT to assist them in carrying out their nursing role competently when caring for this vulnerable population.

Short communication: contribution of the immunovirological state and traditional cardiovascular risk factors to low HDL-cholesterol in HIV patients

The prevalence of low HDL-C levels in an HIV population and its related factors was investigated. We undertook a multicenter, cross-sectional study of all HIV patients on regular follow-up in five hospitals (Southern Spain). A physical examination and fasting laboratory analysis were performed and a questionnaire about cardiovascular risk factors was provided. One thousand and seventy-two patients were included, 43.8% of whom had low HDL-C levels. The prevalence of low HDL-C was higher among patients diagnosed with AIDS, those not on antiretroviral therapy, those with a detectable HIV viral load, those with CD4 cell counts ≤350 cells/μl, smokers, and those with hypertriglyceridemia. For patients on antiretroviral therapy, the prevalence of low HDL-C was higher for those on protease inhibitors than those taking nonnucleoside reverse transcriptase inhibitors. In the multivariate analysis, low HDL-C levels were associated with tobacco use (OR 1.37, 95% CI 1.04-1.8; p = 0.04), hypertriglyceridemia (OR 2.94, 95% CI 2.2-3.8; p < 0.00001), CD4 cells count ≤350 cells/μl (OR 1.74, 95% CI 1.2-2.3; p < 0.0001), and a detectable HIV viral load (OR 1.85, 95% CI 1.3-2.5; p < 0.0001). The immunological and virological conditions, in addition to traditional cardiovascular risk factors such as tobacco use and hypertriglyceridemia, affect HDL-C levels in HIV-infected patients. For patients on antiretroviral therapy, the use of protease inhibitors is associated with a higher probability of low levels of HDL-C. Although it is not clear if the higher HDL-C levels associated with antiretroviral use are surrogates for decreased cardiovascular disease risk, this may be another reason to start antiretroviral therapy earlier.

Real-time reflectometry measurement validation in H-mode regimes for plasma position control

It has been shown that in H-mode regimes, reflectometry electron density profiles and an estimate for the density at the separatrix can be jointly used to track the separatrix within the precision required for plasma position control on ITER. We present a method to automatically remove, from the position estimation procedure, measurements performed during collapse and recovery phases of edge localized modes (ELMs). Based on the rejection mechanism, the method also produces an estimate confidence value to be fed to the position feedback controller. Preliminary results show that the method improves the real-time experimental separatrix tracking capabilities and has the potential to eliminate the need for an external online source of ELM event signaling during control feedback operation.

The stromal gene encoding the CD274 antigen as a genetic modifier controlling survival of mice with γ-radiation-induced T-cell lymphoblastic lymphomas

Using an inter-specific subcongenic strain, Nested Recombinant Haplotype 3 (NRH3), generated between two mouse strains showing extreme differences in γ-radiation-induced thymic lymphoma susceptibility (SEG/Pas and C57BL/6J), we have identified a critical region on chromosome 19 that regulates survival of mice suffering from T-cell lymphoblastic lymphomas. Mapped on this region, the gene encoding the Cd274 ligand is able to trigger an inhibitory effect that modulates T-cell receptor (TCR) signalling and affects thymocyte maturation. Interestingly, this gene shows differential expression between thymic stromal cells from both strains in early response to a single sublethal γ-ray dose, but is inhibited in T-cell lymphoblastic lymphomas. Furthermore, we have identified several polymorphisms in the complementary DNA sequence of this gene that affect the affinity for its Cd279 receptor and are able to induce a differential rate of thymocyte apoptosis. Taken together, our data are consistent with Cd274 acting as a genetic modifier that influences the survival of γ-radiation-induced T-cell lymphoma-bearing mice. The data similarly support the idea of a co-evolution of tumour cells and associated stromal cells to generate a favourable microenvironment for T-cell lymphoma growth.

Towards optimization of time modulated chemical vapour deposition for nanostructured diamond films on Ti6Al4V

In this paper, we report the use of the TMCVD technique for the optimisation of deposited diamond films onto Ti6Al4V substrates. A number of samples were made varying the experimental parameters. The specimen surfaces were characterised using micro Raman spectra and SEM analyses. Results show that very different surface finish (from micro to nanostructures) and film characteristics can be obtained from the experimental parameters used. The quality of deposited diamond is very dependant on the experimental settings and process. It was found that lower residual stresses are developed using the TMCVD technique than with conventional CVD but depend on the structural diamond growth during the process. The quality of the deposited film was evaluated as a function of diamond to amorphous carbon ratio but showed no direct relation with the surface finish since it characterises the quality of the deposited diamond but not the quality of the film surface.

Impaired intestinal gas propulsion in manometrically proven dysmotility and in irritable bowel syndrome

BACKGROUND

Intestinal manometry is the current gold standard for diagnosing small bowel dysmotility; however, the functional significance of abnormal manometry is unknown. Our aim was to determine whether, and to what extent, intestinal gas propulsion is impaired in patients with manometrically proven dysmotility compared with healthy controls and patients with IBS.

METHODS

Clearance and tolerance of a jejunal gas load (12 mL min(-1) for 2 h) were measured in 15 patients with severe abdominal symptoms and intestinal dysmotility evidenced by manometry, 15 patients with IBS and 15 healthy subjects. Thereafter, the effect of neostigmine (0.5 mg i.v. bolus) vs placebo (i.v. saline) was tested in six dysmotility patients.

KEY RESULTS

After 2-h gas infusion, patients with dysmotility developed significantly more gas retention (717 +/- 91 mL) than IBS patients (372 +/- 82 mL; P = 0.0037) and healthy subjects (17 +/- 67 mL; P < 0.0001 vs dysmotility; P = 0.0060 vs IBS). Despite the greater retention in dysmotility patients, abdominal perception (2.5 +/- 0.6 score) and distension (7 +/- 2 mm girth increment) were similar to IBS (3.9 +/- 0.6 score and 7 +/- 2 mm, respectively). In dysmotility patients, neostigmine produced immediate clearance of gas, and by 30 min had reduced gas retention (by -552 +/- 182 vs 72 +/- 58 mL after saline; P = 0.008), abdominal symptoms (by -0.8 +/- 0.3 score vs 0.3 +/- 0.2 after saline; P = 0.019) and distension (girth change -5 +/- 1 mm; P = 0.003 vs-2 +/- 2 mm after saline).

CONCLUSION & INFERENCES

Patients with manometric dysmotility have markedly impaired intestinal gas propulsion. In IBS patients, impaired gas propulsion is less pronounced but associated with concomitant sensory dysfunction and poor tolerance of gas retention.

Impaired intestinal gas propulsion in manometrically proven dysmotility and in irritable bowel syndrome

BACKGROUND

Intestinal manometry is the current gold standard for diagnosing small bowel dysmotility; however, the functional significance of abnormal manometry is unknown. Our aim was to determine whether, and to what extent, intestinal gas propulsion is impaired in patients with manometrically proven dysmotility compared with healthy controls and patients with IBS.

METHODS

Clearance and tolerance of a jejunal gas load (12 mL min(-1) for 2 h) were measured in 15 patients with severe abdominal symptoms and intestinal dysmotility evidenced by manometry, 15 patients with IBS and 15 healthy subjects. Thereafter, the effect of neostigmine (0.5 mg i.v. bolus) vs placebo (i.v. saline) was tested in six dysmotility patients.

KEY RESULTS

After 2-h gas infusion, patients with dysmotility developed significantly more gas retention (717 +/- 91 mL) than IBS patients (372 +/- 82 mL; P = 0.0037) and healthy subjects (17 +/- 67 mL; P < 0.0001 vs dysmotility; P = 0.0060 vs IBS). Despite the greater retention in dysmotility patients, abdominal perception (2.5 +/- 0.6 score) and distension (7 +/- 2 mm girth increment) were similar to IBS (3.9 +/- 0.6 score and 7 +/- 2 mm, respectively). In dysmotility patients, neostigmine produced immediate clearance of gas, and by 30 min had reduced gas retention (by -552 +/- 182 vs 72 +/- 58 mL after saline; P = 0.008), abdominal symptoms (by -0.8 +/- 0.3 score vs 0.3 +/- 0.2 after saline; P = 0.019) and distension (girth change -5 +/- 1 mm; P = 0.003 vs-2 +/- 2 mm after saline).

CONCLUSION & INFERENCES

Patients with manometric dysmotility have markedly impaired intestinal gas propulsion. In IBS patients, impaired gas propulsion is less pronounced but associated with concomitant sensory dysfunction and poor tolerance of gas retention.

Local B cells and IgE production in the oesophageal mucosa in eosinophilic oesophagitis

BACKGROUND

Eosinophilic oesophagitis (EO) is an emerging yet increasingly prevalent disorder characterised by a dense and selective eosinophilic infiltration of the oesophageal wall. While EO is considered an atopic disease primarily triggered by food antigens, disparities between standard allergen testing and clinical responses to exclusion diets suggest the participation of distinct antigen-specific immunoglobulin E (IgE) in the pathophysiology of EO.

AIM

To find evidence for a local IgE response.

METHODS

Endoscopic biopsies of the distal oesophagus of atopic and non-atopic EO and control individuals (CTL) were processed for immunohistochemistry and immunofluorescence to assess the presence of B cells, mast cells, and IgE-bearing cells. Oesophageal RNA was analysed for the expression of genes involved in B cell activation, class switch recombination to IgE and IgE production, including germline transcripts (GLTs), activation-induced cytidine deaminase (AID), IgE heavy chain (Cepsilon) and mature IgE mRNA using polymerase chain reaction and microarray analysis.

RESULTS

Regardless of atopy, EO showed increased density of B cells (p<0.05) and of IgE-bounded mast cells compared to CTL. Both EO and CTL expressed muGLT, epsilonGLT, gamma4GLT, AID, Cepsilon and IgE mRNA. However, the frequency of expression of total GLTs (p = 0.002), epsilonGLT (p = 0.024), and Cepsilon (p = 0.0003) was significantly higher in EO than in CTL, independent of the atopic status.

CONCLUSION

These results support the heretofore unproven occurrence of both local immunoglobulin class switching to IgE and IgE production in the oesophageal mucosa of EO patients. Sensitisation and activation of mast cells involving local IgE may therefore critically contribute to disease pathogenesis.