Erythema nodosum as a result of estrogen patch therapy for prostate cancer: a case report.

© 2015 Coyle et al.Introduction: Erythema nodosum is often associated with a distressing symptomatology, including painful subcutaneous nodules, polyarthropathy, and significant fatigue. Whilst it is a well-documented side-effect of estrogen therapy in females, we describe what we believe to be the first report in the literature of erythema nodosum as a result of estrogen therapy in a male. Case presentation: A 64-year-old Afro-Caribbean man with locally advanced carcinoma of the prostate agreed to participate in a randomized controlled trial comparing estrogen patches with luteinizing hormone-releasing hormone analogs to achieve androgen deprivation, and was allocated to the group receiving estrogen patches. One month later he presented with tender lesions on his shins and painful swelling of his ankles, wrists, and left shoulder. This was followed by progressive severe fatigue that required hospital admission, where he was diagnosed with erythema nodosum by a rheumatologist. Two months after discontinuing the estrogen patches the erythema nodosum, and associated symptoms, had fully resolved, and to date he remains well with no further recurrence. Conclusion: Trial results may establish transdermal estrogen as an alternative to luteinizing hormone-releasing hormone analogs in the management of prostate cancer, and has already been established as a therapy for male to female transsexuals. It is essential to record the toxicity profile of transdermal estrogen in men to ensure accurate safety information. This case report highlights a previously undocumented toxicity of estrogen therapy in men, of which oncologists, urologists, and endocrinologists need to be aware. Rheumatologists and dermatologists should add estrogen therapy to their differential diagnosis of men presenting with erythema nodosum

The Influence of Fines on an Alkyl Ketene Dimer Synthetic Sizing Agent

It is the purpose of this thesis to attempt to evaluate the influence of fines on a alkyl ketene dimer (AKD) synthetic sizing agent and to study the role of fines on sizing. It was found that the addition of fines lowered the degree of sizing in the sheet. Since there was more surface area available when fines were increased, more sizing agent was necessary in order to obtain the same level of sizing with a Hercules or Cobb Size Test. Since the amount of sizing agent was held constant, sizing decreased as a result of the addition of fines. A sheet produced from longer fibers reacted with the sizing agent prior to the fines addition resulted in a lower degree of sizing than a sheet made from reacting the sizing agent with the fines first. It is believed that the unsized fines had a greater ability to block off the hydrophobic ends of the sized longer fibers and therefore decreased sizing efficiency. In a sheet containing an insignificant amount of AKD, fines tended to increase sizing in the sheet. The Washburn equation predicts the rate of penetration since rate of penetration is proportional to pore size. By increasing the amount of fines the pore size of the sheet was decreased and therefore, rate of liquid penetration decreased

Stabilization, pointing and command control of a balloon-borne 1-meter telescope

A 1-meter balloon-borne telescope has been constructed and flown to observe far-infrared radiation from celestial sources. The attitude control systems must perform to the diffraction limit of the telescope for stabilization and have positioning capability for source acquisition. These and associated systems are discussed in detail, as is the command control of the payload as a whole

PRM93 Assesing parameter importance in health economics models. Can we make it faster?

Pla general del monument en commemoració de la visita del rei Alfons XIII i la reina Victòria Eugènia. Marbre blanc. Parc del Laberint d'Horta. 1908. Inaugurat 197

Imagined Futures in Living with Multiple Conditions: Positivity, Relationality and Hopelessness

Hope serves as an overarching concept for a range of engagements that demonstrate the benefits of a positive outlook for coping with chronic conditions of ill-health and disability. A dominant engagement through medicine has positioned hope as a desirable attribute and its opposite, hopelessness, as pathological. In this engagement hope is individual, internally located and largely cognitive and able to be learned. Attaining hope reflects a process of coming to terms with the losses associated with long-term conditions and of imagining new meanings and purposes for the future ahead. This process is characterised by a set of linear temporal stages, from loss and denial to acceptance and reappraising the life-course, by an emphasis on the morally desirable exercise of self-care and by a desired outcome that, in the absence of cure, is hope. Through interviews, we aim to unsettle the privileged status given to a positive outlook through examining the expressions, contexts and negotiations of hopelessness of people living with multiple conditions of ill-health and/or disability. These narratives of hopelessness disclose the ways in which realistic imagined possibilities for the future are constrained by external structures of time and function that demand complex negotiations with places, bodies and other people. As a situated and relational narrative, hopelessness draws our attention to the need to rebalance the exclusive attention to individual, internal resources with a renewed attention to contexts and settings. Moreover, hopelessness can be generative for those living with multiple conditions in shaping alternatively framed priorities with respect to their temporal and interpersonal relations

Vulnerability as practice in diagnosing multiple conditions

The paper contributes to contemporary understandings of vulnerability by expanding their scope with an understanding of vulnerability as generated through institutionalised practices. The argument draws on experiential accounts of navigating the practices of diagnosis by people living with multiple conditions of ill-health and disability. Vulnerability as a concept is used widely across different domains and conveys a multitude of meanings. Contemporary biomedicine, and its associated health systems and services, understands vulnerability mostly as inherent to particular physical and mental bodily conditions that put people at risk of ill-health or emotionally fragility. This may combine with a more epidemiological understanding of vulnerability as the experience of certain population groups subject to entrenched structural inequalities. Philosophers and feminists have argued that vulnerability is a universal experience of being human while political commentators have explored its potential as a resource for resistance and action. Diagnosis within medicine and psychiatry has been the subject of extensive social analysis, critique and activism. The paper draws on first-hand experiential accounts collected through face-to-face interviews with people living with multiple conditions about their experiences of diagnosis, mostly at the primary care level. We identify five aspects to diagnostic practice that are harmful and exacerbate the experience of vulnerability: temporal sequencing; diagnostic authority; medical specialisation; strategic symptom selection; medical isolation. However, these diagnostic practices are not best understood only in terms of the power asymmetries inherent to the medical consultation, but are embedded into the very institution of diagnosis. The paper thus proposes a combined approach to vulnerability that recognises it as a universal condition of humanity but one that becomes animated or amplified for some bodies, through their own inherent incapacities or the external structures of inequality, and through the practices of medicine as situated in particular times and places

Solar array construction

An interconnect tab on each cell of a first set of circular solar cells connects that cell in series with an adjacent cell in the set. This set of cells is arranged in alternate columns and rows of an array and a second set of similar cells is arranged in the remaining alternate columns and rows of the array. Three interconnect tabs on each solar cell of the said second set are employed to connect the cells of the second set to one another, in series and to connect the cells of the second set to those of the first set in parallel. Some tabs (making parallel connections) connect the same surface regions of adjacent cells to one another and others (making series connections) connect a surface region of one cell to the opposite surface region of an adjacent cell; however, the tabs are so positioned that the array may be easily assembled by depositing the cells in a certain sequence and in proper orientation

Influence of Subinhibitory Concentrations of Honey on Toxic Shock Syndrome Toxin -1 (TSST-1) Production by Two Strains of Staphylococcus Aureus

Antibiotic resistant bacteria are a worldwide health concern and it is essential to develop new antimicrobial agents to kill these bacteria and to reduce the use of antibiotics. Staphyloccus aureus (S.aureus) an important medical pathogen is responsible for many wound infections and up to 25% of all strains produce the toxic shock syndrome toxin (TSST-1) which stimulates the release of inflammatory cytokines which cause fever and shock. Here we report on the inhibition of two penicillin resistant TSST-1 producing strains of S.aureus by seven different honeys. Bacterial growth was reduced after 24 hours at 37oC, from 10.0 log 10 in the TSB growth control to less than 1.0 log 10 in Highland, Chilean and Manuka honey. TSST-1 production was reduced from 256ng/ml in the TSB growth control to less than 30 ng/ml in sub inhibitory concentrations of all honeys.sch_die[1] Lowy, F.D. 1998. Staphylococcus aureus infections. New England Journal of Medicine, 339 (8) pp.520-532. [2] Andrey, D.O., Renzoni, A., Monod, A.,Lew, D.P.,Ambrose.L.C and Kelly, W.L. 2010. Control of the Staphyloccocus aureus toxic shock tst promoter by the global regulator SarA. J of Bacteriology, 192 (22),pp 6077-6085. [3] Boyle-Vavra, S., Carey, R.B. and Daum, R.S. 2001. Development of vancomycin and lysostaphin resistance in a methicillin-resistant Staphylococcus aureus isolate. The Journal of Antimicrobial Chemotherapy, 48 (5) Nov, pp.617-625 [4] Qiu, J., Wang, D., Xiang, H., Feng, H., Jiang, Y., Xia, L., et al 2010. Subinhibitory concentrations of thymol reduce enterotoxins A and B and -hemolysin production in Staphylococcus aureus isolates. PLoS one, 5 (3) pp.e9736. [5] Werner, G., Strommenger, B. and Witte, W. 2008. Acquired vancomycin resistance in clinically relevant pathogens. Future Microbiology(95) 547-562. [6] Dinges, M.M., Orwin, P.M. and Schlievert, P.M. 2000. Exotoxins of Staphylococcus aureus. Clinical microbiology reviews, 13 (1) Jan, pp.16-34, table of contents. [7] Lappin.E and Ferguson.A.J .2009. toxic shock syndrome (TSS) is an acute , multi- system toxin-mediated illness . Lancet. Infectious diseases 9.(5) pp 281-290 [8] Miethke, T., Duschek, K., Wahl, C., Heeg, K. and Wagner, H. 1993. Pathogenesis of the toxic shock syndrome: T cell mediated lethal shock caused by the superantigen TSST-1. European Journal of Immunology, 23 (7) pp.1494-1500. [9] Kramer, S. 1954. Levey. An older pharmacopoeia. JAMA, 155 (1) pp.26. [10] George, N.M. and Cutting, K.F. 2007. Antibacterial honey (Medihoney): in-vitro activity against clinical isolates of MRSA, VRE, and other multiresistant Gram-negative organisms including Pseudomonas aeruginosa. Wounds, 19 (9) pp.231. [11] Molan, P.C. 2006. The evidence supporting the use of honey as a wound dressing. The international Journal of Lower Extremity Wounds, 5 (1) Mar, pp.40-54. [12] Kwakman, P.H., Te Velde, A.A., De Boer, L., Vandenbroucke-Grauls, C.M. and Zaat, S.A. 2011. Two major medicinal honeys have different mechanisms of bactericidal activity. PLoS One, 6 (3) pp.e17709. [13] Schneider, M., Coyle, S., Warnock, M., Gow, I. and Fyfe, L. 2012. Anti-Microbial Activity and Composition of Manuka and Portobello Honey. Phytotherapy Research, 27 (8) pp.1162-1168. [14] White Jr, J.W. 1957. The composition of honey . Bee World, 38 (3) pp57-66 [15] Adenekan,M.O., Amusa,N.A, Lawal,A.O and Okpeze,V.E. 2010. Physico-chemical and microbiological properties of honey samples .J of Microbiol Antimicrobiol ,2, (8),pp100-104 [16] Kwakman, P.H., te Velde, A.A., de Boer, L., Speijer, D., Vandenbroucke-Grauls, C.M. and Zaat, S.A. 2010. How honey kills bacteria. FASEB journal : official publication of the Federation of American Societies for Experimental Biology, 24 (7) Jul, pp.2576-2582. [17] Khan, F., Hill, J., Kaehler, S., Allsopp, M. and Vuuren, S. 2014. Antimicrobial properties and isotope investigations of South African honey. Journal of Applied Microbiology, [18] Carnworth.R., Graham.E.M., Reynolds.K and Pollock.P.J 2013. The antimicrobial activity of honey against common would isolates. The Veterinary Journal.10.1016. [19] Fyfe,L, Armstrong.F and Stewart. J 1998. Inhibition of Listeria monocytogenes and Salmonella enteridits by combinations of plant essential oils and derivatives of benzoic acid ; the development of synergistic antimicrobial combinations. International Journal of Antimicrobial Agents .9. 195-199 [20] Smith-Palmer, A., Stewart, J. and Fyfe, L. 2002. Inhibition of Listeriolysin 0 and phosphatidylcholine specific production in Listeria monocytogenes by subinhibitory concentrations of plant essential oils, of plant essential oils on the production of enterotoxins A and B and alpha-toxin by Staphylococcus aureus. Journal of Medical Microbiology, 51 , pp567 [21] Smith-Palmer, A., Stewart, J. and Fyfe, L. 2004. Influence of subinhibitory concentrations of plant essential oils on the production of enterotoxins A and B and alpha-toxin by Staphylococcus aureus. Journal of Medical Microbiology, 53 (Pt 10) Oct, pp.1023-1027. [22] Kakonien, V., Maruka, A., Kornyova, O., Charczun, N., Ligor, M. and Buszewski, B. 2009. Quantitative and qualitative determination of phenolic compounds in honey. Chemin technologija, 52 (3) pp.74-80. [23] Benzie, I.F. and Strain, J. 1996. The ferric reducing ability of plasma (FRAP) as a measure of antioxidant power-: the FRAP assay. Analytical Biochemistry, 239 (1) pp.70-76. [24] Singleton, V. and Rossi, J.A. 1965. Colorimetry of total phenolics with phosphomolybdic-phosphotungstic acid reagents. American Journal of Enology and Viticulture, 16 (3) pp.144-158 [25] White Jr, J.W. and Subers, M.H. 1963. Studies on honey inhibine. 2. A chemical assay. J Apic Res, 2 pp.93-100. [26] Kwakman, P.H., Te Velde, A.A., De Boer, L., Vandenbroucke-Grauls, C.M. and Zaat, S.A. 2011. Two major medicinal honeys have different mechanisms of bactericidal activity. PLoS One, 6 (3) pp.e17709. [27] Jenkins, R.E., Burton, N., and Cooper, R. 2013. Proteomic and genomic analysis of methicillin-resistant Staphylococcus aureus (MRSA) exposed to manuka honey in vitro demonstrated down-regulation of virulence markers. Journal of Antimicrobial Chemtherapy, doi;10.1093. pp1-13 [28] James,J.F., Chu,M.C., Lee.L., Peck,S.A. ,McKissick,C., Sullivan, H., et al 1989. Effect of magnesium on in vitro production of toxic shock syndrome toxin-1 . Reviews in Infectious Disease .Supplement 1,S157-166. [29] Yarwood,J.M and Schlievert, P.M 2000. Oxygen and carbon dioxide regulation of toxic shock syndrome toxin1 production by Staphylococcus aureus MN8. Journal of Clinical Microbiology. 38 (5) pp1797-1803 [30] Chan,P.F and Foster.S.J 1998. The role of the environmental factors in the regulation of virulence -determinant expression in Staphylococcus aureus .Microbiology .144 (9)pp 2469-2479 [31] van Langevelde,P ., van Dissel,j.T., Meurs.C.J.C Renz,J. and Groeneveld,P.H.P 1997 Antimicrobial agents and Chemotherapy .41,(8) 1682-1685 [32] Jenkins, R.E. and Cooper, R. 2012. Synergy between oxacillin and manuka honey sensitizes methicillin-resistant Staphylococcus aureus to oxacillin. The Journal of Antimicrobial Chemotherapy, 67 (6) Jun, pp.1405-1407. [33] Cowan.M.M 1999. Plant products as antimicroibial agents . Clinical Microbiology Reviews, American Society of Microbiology, 12,(4) pp 564-582 l [34] Brudzynski, K., Abubaker, K. and Miotto, D. 2012. Unraveling a mechanism of honey antibacterial action: Polyphenol/H<sub>2</sub>O<sub>2</sub>-induced oxidative effect on bacterial cell growth and on DNA degradation. Food Chemistry, 133 (2) pp.329-336.3pub3971pub

EQUIPT: protocol of a comparative effectiveness research study evaluating cross-context transferability of economic evidence on tobacco control

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.This article has been made available through the Brunel Open Access Publishing Fund.Tobacco smoking claims 700 000 lives every year in Europe and the cost of tobacco smoking in the EU is estimated between €98 and €130 billion annually; direct medical care costs and indirect costs such as workday losses each represent half of this amount. Policymakers all across Europe are in need of bespoke information on the economic and wider returns of investing in evidence-based tobacco control, including smoking cessation agendas. EQUIPT is designed to test the transferability of one such economic evidence base-the English Tobacco Return on Investment (ROI) tool-to other EU member states

Investigation of the Critical Behavior of the Critical Point of the Z2 Gauge Lattice

We investigate, through Monte-Carlo simulations, the nature of the second order point in a $Z_2$ (Bosonic) + $Z_2$ gauge theory in four dimensions. Detailed analysis of the critical exponents point to the Ising universality class. Relevancy to extended models and possible Non-Gaussian behavior is discussed.Comment: 4 pages, 6 figures, LaTe