In Response: Maintenance ECT

Therapy resistance, relapsing illness, and rapid cycling are aspects of chronic affective illness that continue to frustrate us. ECT was re-introduced to answer the problem of therapy resistant depression. In their recent review, Matzen et al. (I), report their experience in eight cases treated with maintenance ECT. They argue that maintenance ECT should also be considered for relapsing depressive illness. No systematic study of maintenance ECT has been undertaken since the early I950s, and yet, as reported by Kramer (2) it continues to be used. Kramer directed inquiries to members of the International Association for the Advancement of Electrotherapy. Of 86 respondents, 51 reported they used maintenance treatments in 1986. Usage was small, however, approximately three patients per practitioner in a year. Despite the lack of experimentally derived guidelines, the procedures were relatively uniform. After an illness had responded to a course of ECT, treatments were given at weekly intervals, followed after a few weeks by bi-weekly, then monthly treatments. The treatment practice described by Matzen et al. are similar

The History of Urological Care and Training at Thomas Jefferson University

The Department of Urology at Thomas Jefferson University and Thomas Jefferson University Hospital is generally acknowledged as the oldest formal Department of Urology in the US, formally designated as the Department of Genitourinary Surgery in 1904. The Department has been under the direction of 8 chairmen and has trained over 144 residents and 25 fellows with over 200 Jefferson Medical College graduates specializing in urology. Thomas Jefferson University was originally founded as Jefferson Medical College in 1824. Dr. George McClelland petitioned Jefferson College at Cannonsburg (now Washington and Jefferson College) to add a medical school to their institution. While technically part of Jefferson College in western Pennsylvania, Jefferson Medical College was to be located in Philadelphia under the direction of the medical faculty. By 1838, Jefferson Medical College gained its own charter and was no longer affiliated with Jefferson College. As a proprietary school, the faculty administrated and managed all the finances of the school. This included the sale of “tickets” to attend lectures. An infirmary to treat the poor was established in 1825. This dispensary to treat indigent patients under student observation was the first instituted by any medical school in the United States. Eventually, all medical schools in the United States adopted Jefferson’s example of combining lectures with practical patient experience. In 1969 Thomas Jefferson University was established that incorporated Jefferson Medical College, the College of Allied Health Sciences, the College of Graduate Studies and the Jefferson Medical College Hospital

Spinal anesthesia: should everyone receive a urinary catheter?: a randomized, prospective study of patients undergoing total hip arthroplasty.

BACKGROUND: The objective of this randomized prospective study was to determine whether a urinary catheter is necessary for all patients undergoing total hip arthroplasty under spinal anesthesia. METHODS: Consecutive patients undergoing total hip arthroplasty under spinal anesthesia were randomized to treatment with or without insertion of an indwelling urinary catheter. All patients received spinal anesthesia with 15 to 30 mg of 0.5% bupivacaine. The catheter group was subjected to a standard postoperative protocol, with removal of the indwelling catheter within forty-eight hours postoperatively. The experimental group was monitored for urinary retention and, if necessary, had straight catheterization up to two times prior to the placement of an indwelling catheter. RESULTS: Two hundred patients were included in the study. There was no significant difference between the two groups in terms of the prevalence of urinary retention, the prevalence of urinary tract infection, or the length of stay. Nine patients in the no-catheter group and three patients in the catheter group (following removal of the catheter) required straight catheterization because of urinary retention. Three patients in the catheter group and no patient in the no-catheter group had development of urinary tract infection. CONCLUSIONS: Patients undergoing total hip arthroplasty under spinal anesthesia appear to be at low risk for urinary retention. Thus, a routine indwelling catheter is not required for such patients

Antihypercholesterolemic and antioxidant efficacies of zerumbone on the formation, development, and establishment of atherosclerosis in cholesterol-fed rabbits

Owing to the high incidence of cholesterol-induced cardiovascular disease, particularly atherosclerosis, the current study was designed to investigate the preventive and therapeutic efficacies of dietary zerumbone (ZER) supplementation on the formation and development of atherosclerosis in rabbits fed with a high cholesterol diet. A total of 72 New Zealand white rabbits were divided randomly on two experimental studies carried out 8 weeks apart. The first experiment was designed to investigate the prophylactic efficacy of ZER in preventing early developed atheromatous lesion. The second experimental trial was aimed at investigating the therapeutic effect of ZER in reducing the atherosclerotic lesion progression and establishment. Sudanophilia, histopathological, and ultrastructural changes showed pronounced reduction in the plaque size in ZER-medicated aortas. On the other hand, dietary supplementation of ZER for almost 10 weeks as a prophylactic measure indicated substantially decreasing lipid profile values, and similarly, plaque size in comparison with high-cholesterol non-supplemented rabbits. Furthermore, the results of oxidative stress and antioxidant biomarker evaluation indicated that ZER is a potent antioxidant in suppressing the generation of free radicals in terms of atherosclerosis prevention and treatment. ZER significantly reduced the value of malondialdehyde and augmented the value of superoxide dismutase. In conclusion, our data indicated that dietary supplementation of ZER at doses of 8, 16, and 20 mg/kg alone as a prophylactic measure, and as a supplementary treatment with simvastatin, significantly reduced early plague formation, development, and establishment via significant reduction in serum lipid profile, together with suppression of oxidative damage, and therefore alleviated atherosclerosis lesions

Cytotoxic effects of bio-synthesized zinc oxide nanoparticles on murine cell lines

Zinc oxide nanoparticles (ZnO-NPs) are among the most appropriate metal oxide nanoparticles to exhibit significant potential for treatment properties in a broad spectrum of applications in biomedicine, such as in the treatment of various cancers. The aim of this study was to evaluate the in vitro cytotoxic activity and cellular effects of previously prepared ZnO-NPs using brown seaweed (Sargassum muticum) aqueous extract. Consequently, In vitro anticancer activity was demonstrated in murine cancer cell lines of breast cancer (4T1), lung adenocarcinoma (CRL-1451), colon cancer (CT-26), and acute myelocytic leukemia (WEHI-3). Treated cancer cells with ZnO-NPs for 72 hours demonstrated various levels of cytotoxicity based on calculated IC50 values using MTT assay as follows: 21.7 ± 1.3 μg /mL (4T1), 17.45 ± 1.1 μg /mL (CRL-1451), 11.75 ± 0.8 μg /mL (CT-26) and 5.6 ± 0.55 μg /mL (WEHI-3), respectively. On the other hand, ZnO-NPs treatments for 72 hours showed no toxicity against normal mouse fibroblast (3T3) cell lines. Furthermore, distinct morphological changes were found by utilizing flourescent dyes, as apoptotic population were increased via flowcytometry, while cell cycle block and stimulation of apoptotic proteins were also observed. Additionally, the present study showed that the caspase activations contributed to ZnO-NPs triggered apoptotic death in WEHI-3 cells. Thus, the nature of biosynthesis and the therapeutic potential of ZnO-NPs could prepare the way for further research on the design of green synthesis therapeutic agents, particularly in nanomedicine, for the treatment of cancer

Correspondence: From Max Michael, Jr. to G. Dekle Taylor on Jacksonville Hospitals Educational Program, Inc. Letterhead, 1968-11-20

This letter contains a discussion on the proposed survey and the future of the Duval Medical Cente

Patient Perception of Empathy from Emergency Medicine Residents

Background and Hypothesis: This project analyzes the effect of years of training and gender of ED providers on patients’ perception of empathy from them. The project will also explore how patient characteristics may impact the patients’ perception of empathy from the ED providers.  It is expected that women providers in their third year of training will exhibit higher scores of empathy. It has been previously demonstrated that white women with a college education have the worst perceptions of empathy from their ED providers.  Experimental Design or Project Methods: Eligible patients from Eskenazi/Methodist Hospital, who have had a CT scan ordered, will be enrolled via convenience sample. Patient perceptions of physician empathy will be assessed via the “Empathy Behavior Survey for Patients” (EBS) and “Jefferson Scale of Patient Perceptions of Physician Empathy” (JSPPPE). Patient demographic data and information about the provider ordering the CT scan will be recorded as well.   Results: On the EBS/JSPPE, 1st, 2nd, and 3rd year residents were given scores of 51/31.5, 51/31, and 51.5/33 respectively. Male residents were given a median score of 51 on the EBS and 32 on the JSPPPE. Female residents were given a median score of 50.5 and 31 on the JSPPPE. White female patients with a college education gave a score of 50.5 on the EBS and a 32.5 on the JSPPPE.  Conclusion and Potential Impact: Years of training or gender do not seem to have an impact on patient perception of empathy nor do White female patients with a college education

Improving Safety of Direct Oral Anticoagulant (DOAC) Dosing in Patients with Severe Chronic and End-Stage Renal Disease

The significance of this study is to determine the degree of inconsistency in dosing practice of DOACs at a quaternary care institution such as Thomas Jefferson University Hospital. What is the primary indication for anticoagulation in out population? What percentage is dosed correctly? Are patients primarily over or underdosed

Gravitational Waves from Gravitational Collapse

Gravitational wave emission from the gravitational collapse of massive stars has been studied for more than three decades. Current state of the art numerical investigations of collapse include those that use progenitors with realistic angular momentum profiles, properly treat microphysics issues, account for general relativity, and examine non--axisymmetric effects in three dimensions. Such simulations predict that gravitational waves from various phenomena associated with gravitational collapse could be detectable with advanced ground--based and future space--based interferometric observatories.Comment: 68 pages including 13 figures; revised version accepted for publication in Living Reviews in Relativity (http://www.livingreviews.org