Development of Patient Decision Aids for Plaque Psoriasis and Acne

INTRODUCTION

Despite proven benefits in other medical specialties, there is a paucity of patient decision aids (PDAs) in dermatology. The present study developed online PDAs for acne and psoriasis, incorporating iterative patient and physician feedback, in accordance with International Patient Decision Aid Standards (IPDAS).

DESIGN AND METHOD

Content was adapted from clinical practice guidelines and primary research and formatted for an 8th grade reading level. Feedback on content and format was obtained through focus groups with 15 psoriasis patients and survey with 34 acne patients. Feedback on presentation and clinical utility of the PDAs was gathered by survey from 51 physicians in Canada and the United States. Each data collection stage informed further development.

RESULTS

Demand for decision support, and satisfaction with the PDAs was high among patients. Physicians were approving of content and expressed a strong interest in PDA use.

CONCLUSION

Patients and physicians approve of the PDAs' content, format, and intended use. Online PDAs allow accessibility for patients and may reduce barriers to use for physicians.

Upper and lower body anaerobic performance of semi-elite Rugby League players

AIM

The aim of this study was to measure the upper and lower body anaerobic performance of semi-elite Rugby League (RL) players.

METHODS

Twenty-two semi-professional RL players and 24 physically active but untrained men completed two Wingate anaerobic tests (WAnT) on an electronic arm ergometer and a cycle ergometer separated by three days. Percent body fat was used determined from the sum of six skinfolds and upper and lower muscle cross-sectional area (CSA) was calculated from anthropometric data.

RESULTS

Upper and lower body absolute peak (P=0.035, P=0.002) and mean (P=0.005, P=0.031) power were higher in the RL group compared to the control group. Upper and lower body relative peak power was higher (P=0.022, P=0.047) in the control group compared to the RL group. Peak and mean power (relative and absolute) were higher (P≤0.05) in the lower body compared to the upper body. Peak and mean power relative to upper and lower muscle CSA was higher (P≤0.001) in the upper body compared to the lower body for both groups.

CONCLUSION

Semi-elite Rugby League players have well developed absolute anaerobic power, but relative to body weight upper and lower body anaerobic power is not well developed. The upper body is able to generate more power relative to body weight and muscle CSA compared to the lower body during the WAnT. Future studies should examine the upper body anaerobic performance of elite RL players and other sports that have similar upper body demands.

Testing the long term stability of vancomycin ophthalmic solution

Some patients with a keratoprosthesis (artificial cornea) are required to use prophylactic vancomycin ophthalmic solution daily for life to prevent infection, a regimen which has proven to be highly successful. The objective of this study was to determine whether such vancomycin solutions would remain stable at room temperature for an extended period of time, beyond that suggested by available published stability data and used in current practice. By relaxing the storage requirement and extending the expiration date of this solution, it was hoped that patient adherence and satisfaction would increase. The studied vancomycin ophthalmic solutions were compounded at the Massachusetts Eye and Ear Infirmary, Department of Pharmacy Services, Boston, Massachusetts, and were sent to an outside laboratory for high-performance liquid chromatography potency testing at predefined time points. Vancomycin 14-mg/mL ophthalmic solution compounded with 0.005% benzalkonium retains potency for at least 60 days at room temperature and 6 months frozen. Extending the beyond-use dating of vancomycin may lead to improved patient adherence by lowering costs and increasing convenience of storage and shipment of the medication.

Spatial glutathione and cysteine distribution and chemical modulation in the early organogenesis-stage rat conceptus in utero

Glutathione (GSH), cysteine, and other low-molecular-weight thiols (LMWT) play a vital role in the detoxication of xenobiotics and endogenous chemicals. Differential alterations of LMWT status in various cell types of the developing embryo may underlie cell-specific sensitivity or resistance to xenobiotics and contribute to embryotoxicity. This study describes the spatial and temporal distribution of LMWTs in rat conceptuses and alterations produced by the non-teratogenic GSH modulator, acetaminophen (APAP). Pregnant female rats were given 125, 250, or 500 mg/kg APAP (po) on gestational day 9. Conceptal LMWT was localized histochemically using mercury orange in cryosections, and GSH and cysteine concentrations were measured by HPLC analysis. Mercury orange histofluorescence revealed a non-uniform distribution of LMWT in untreated conceptal tissues, with strongest staining observed in the ectoplacental cone (EPC), visceral yolk sac (VYS), and embryonic heart. Less intense staining was observed in the neuroepithelium. Following treatment with APAP, tissue-associated LMWT decreased dramatically except in the EPC, while exocoelomic fluid LMWT, and LMWT within embryonic lumens, increased. Exposure to 250 mg/kg APAP decreased embryonic GSH after 6 and 24 h by 46% and 38%, respectively. Acetaminophen (500 mg/kg) decreased embryonic and VYS cysteine content by 54% and 83%, respectively, after 24 h. Acetaminophen alters the spatial distribution of LMWT in rat conceptuses, particularly with respect to cysteine. The mobilization of cysteine following chemical insult may influence the ability of conceptal cells to maintain normal GSH status due to reduced availability of cysteine for de novo GSH synthesis.

Analysis of the maternal components of the AIDS clinical trial group 076 zidovudine regimen in the prevention of mother-to-infant transmission of human immunodeficiency virus type 1

To gain insight into the protective effects of the three components of the zidovudine regimen used in AIDS Clinical Trial Group (ACTG) 076 on mother-to-infant transmission of human immunodeficiency virus (HIV) type 1, 188 zidovudine-treated women and their untreated infants from five HIV-1 obstetric centers were retrospectively studied. The overall rate of mother-to-infant transmission was 12.3% (95% confidence interval [CI], 7.9%-18.0%). When the 38 women with <200 CD4 cells/microL were excluded, the mother-to-infant transmission rate was 8.8% (95% CI, 4.6%-14.8%). This rate compares favorably with the 8.3% transmission in the zidovudine arm of the ACTG 076 study. Apart from low (<200/microL) maternal CD4 cells (P = .016), no factors, including the duration of zidovudine therapy during gestation and intravenous administration of zidovudine during labor, affected the rate of mother-to-infant transmission. These findings suggest that antenatal oral zidovudine may be as effective as antenatal oral plus intravenous zidovudine during labor and the three-component ACTG 076 regimen in decreasing mother-to-infant HIV-1 transmission.

Preparation and biological evaluation of 18F-labeled benzamide analogs as potential dopamine D2 receptor ligands

Three 18F-labeled benzamide derivatives were prepared and evaluated as potential ligands to study the dopamine D2 receptor phenomenon. The compounds are analogs of iodobenzamide, eticlopride and raclopride and are labeled with an N-2-[18F]fluoroethyl functionality on the pyrrolidine ring. The compounds were tested in vitro for binding affinity and found to exhibit somewhat lower affinity than the non-fluorinated analog. In vivo distribution studies revealed that all compounds were more highly bound to plasma proteins than was raclopride. In addition, compartmentation of radioactivity demonstrated nonspecific binding to be the predominate retention in the brain as reflected by the low caudate to cerebellum ratios for these compounds. These three 18F-labeled benzamide derivatives are inferior to raclopride and iodobenzamide for studies of the D2 receptor system using positron emission tomography.

In vitro binding properties and autoradiographic imaging of 3-iodobenzamide ([125I]-IBZM): a potential imaging ligand for D-2 dopamine receptors in SPECT

The in vitro binding properties of the [125I] labeled benzamide (S(-)-N-[(1-ethyl-2-pyrrolidinyl)-methyl]-2-hydroxy-3-iodo-6-methoxy- benzamide, IBZM) were determined in bovine and mouse caudate membrane homogenates and by autoradiography of mouse brain slices. [125I]-IBZM binding is saturable and reversible with a Bmax of 373 +/- 51 fmol/mg protein and a Kd of 3.1 +/- 0.62 nM (mean +/- SD, Scatchard analyses) and 0.56 nM as calculated by association and dissociation time constants. In competition experiments, Ki values for the D-2 antagonists YM-09151-2 and spiperone are 4 orders of magnitude lower than the Ki value for the D-1 antagonist SCH-23390 and S(-)-IBZM is ten-fold more potent than R(+)-IBZM. [125I]-IBZM has a low affinity for serotonin S-2 and for alpha receptors. Therefore, it is a highly selective ligand for dopamine D-2 receptors. Autoradiographic images of brain sections incubated with [125I]-IBZM show the dopamine D-2 receptors of the striatum, nucleus accumbens and olfactory tubercle with a high ratio of specific to nonspecific binding. Thus, S(-)-IBZM, when labeled with [123I], may be useful for in vivo imaging of dopamine D-2 receptors by single photon emission computerized tomography (SPECT).

The effects of glutaraldehyde cross-linking on the function of the adenylate cyclase complex of turkey erythrocytes

Glutaraldehyde appears to preferentially effect the activation processes of the adenylate cyclase complex of turkey erythrocyte membranes. The primary effect of low concentration (0.01 percent, 0.05 percent, and 0.1 percent) glutaraldehyde membrane treatment is to decrease catecholamine-stimulated cAMP formation. The effect can be blocked by prior activation of the system with isoproterenol + p[NH]ppG. 0.6 percent glutaraldehyde treatment of membranes has substantial effects on both F(-)- and catecholamine-stimulated cAMP production. The effects are blocked by prior activation of the adenylate cyclase complex with NaF, but not by isoproterenol + p[NH]ppG. Glutaraldehyde at these concentrations has no effect on Mn++-stimulated cAMP formation. The data is discussed with respect to the organization of the major macromolecular components of the adenylate cyclase complex as it exists within the native membrane prior to and following activation of the system.

Hormonal effects of high dose naloxone in humans

Utilizing a double-blind crossover design, the hormonal effects of high dose, 2 mg/kg, were compared to low dose, 0.4 mg (approx. 5 micrograms/kg), naloxone administration in physically healthy humans. A significant naloxone dose effect on plasma cortisol levels was found (p less than 0.001), but no significant effect on plasma or serum levels of prolactin, follicle stimulating hormone, luteinizing hormone, norepinephrine or epinephrine. These results confirm involvement of the endogenous opioid system (EOS) in the tonic regulation of the hypothalamicpituitary-adrenal axis, but fail to find evidence of EOS involvement in the regulation of adrenal medullary function or the gonadotrophic axis in man. The results are however consistent with a continuing action of naloxone as an EOS antagonist even at high doses in man.

Glutaraldehyde pretreatment blocks phospholipase A2 modulation of adrenergic receptors

Treatment of rat cerebral cortical membranes with phospholipase A2 affects, in a parallel fashion, beta-, alpha 1- and alpha 2-adrenergic receptor binding, but not the affinity of these receptors for their respective ligands. Pretreatment of membranes with 0.1 percent glutaraldehyde blocks the effects of phospholipase A2 on adrenergic receptor binding. The results support the hypothesis that desensitization or "masking" of adrenergic receptors may involve changes in membrane lipid composition. Furthermore, glutaraldehyde may prove a useful tool in the investigation of the dynamic roles of lipids in receptor function and more specifically, their regulation and coupling to physiological events.

Correlation of changes in alpha 2-adrenoceptor number and locomotor responses to clonidine following clorgyline discontinuation

[3H]-clonidine binding in vitro and the locomotor response to clonidine in vivo were studied over an eight week period following four weeks of treatment with the monoamine oxidase-inhibiting antidepressant, clorgyline (1 mg kg-1 day-1). Long-term clorgyline administration caused decreases in responsiveness to clonidine and in the number of alpha 2-adrenoceptors; these changes reverted towards pretreatment values very gradually over an eight week period following discontinuation of the drug. This study provides some of the first detailed evidence regarding the slow return of adaptional changes following discontinuation of an antidepressant drug in animals and has implications for understanding some delayed drug interactions associated with MAO-inhibiting antidepressants in man.