Incidence of tricyclic antidepressant-like complications after cyclobenzaprine overdose

Background: The cyclobenzaprine structure is similar to amitriptyline; however, tricyclic antidepressant (TCA)-like wide complex dysrhythmia has not been reported. Our objective was to determine the incidence of TCA-like effects in cyclobenzaprine overdoses as reported to 6 poison centers for 2 years. We compared the incidence of these effects to amitriptyline overdoses collected during the same period. Methods: We performed a retrospective review of 2 years of cases as reported to the Texas Poison Center Network. We identified sole ingestions of cyclobenzaprine and of amitriptyline. Cases had a recorded clinical outcome and clinical effect. A trained reviewer used a standard data collection sheet within a secured electronic database. One investigator audited a random sample of charts. Results: We identified 3974 cases of cyclobenzaprine calls. Of these, we collected 209 cases of acute overdoses without coingestions. There were no deaths. No cases of cyclobenzaprine ingestions were reported to have died or have a wide QRS or ventricular dysrhythmia. Seizures were reported in 2 cases; however, both were unrelated to cyclobenzaprine. Hypotension was reported in 1.4% (3/209) of cases, and a vasopressor was used in one case (0.5%). Patients with an amitriptyline overdose were more likely to have seizure, coma, tachycardia, a wide QRS or ventricular dysrhythmia, and have received sodium bicarbonate or be intubated. Conclusions: Cyclobenzaprine overdoses were not reported to cause widened QRS, ventricular dysrhythmias, or seizures, and hypotension was rarely reported. Tricyclic antidepressant-related effects occurred more often in our comparison group of amitriptyline overdoses

Integrating multicriteria decision analysis and scenario planning : review and extension

Scenario planning and multiple criteria decision analysis (MCDA) are two key management science tools used in strategic planning. In this paper, we explore the integration of these two approaches in a coherent manner, recognizing that each adds value to the implementation of the other. Various approaches that have been adopted for such integration are reviewed, with a primary focus on the process of constructing preferences both within and between scenarios. Biases that may be introduced by inappropriate assumptions during such processes are identified, and used to motivate a framework for integrating MCDA and scenario thinking, based on applying MCDA concepts across a range of "metacriteria" (combinations of scenarios and primary criteria). Within this framework, preferences according to each primary criterion can be expressed in the context of different scenarios. The paper concludes with a hypothetical but non-trivial example of agricultural policy planning in a developing country

Women, know your limits: Cultural sexism in academia

Despite the considerable advances of the feminist movement across Western societies, in Universities women are less likely to be promoted, or paid as much as their male colleagues, or even get jobs in the first place. One way in which we can start to reflect on why this might be the case is through hearing the experiences of women academics themselves. Using feminist methodology, this article attempts to unpack and explore just some examples of ‘cultural sexism’ which characterise the working lives of many women in British academia.This article uses qualitative methods to describe and make sense of just some of those experiences. In so doing, the argument is also made that the activity of academia is profoundly gendered and this explicit acknowledgement may contribute to our understanding of the under-representation of women in senior positions

Interleukin-7 deficiency in rheumatoid arthritis: consequences for therapy-induced lymphopenia

We previously demonstrated prolonged, profound CD4+ T-lymphopenia in rheumatoid arthritis (RA) patients following lymphocyte-depleting therapy. Poor reconstitution could result either from reduced de novo T-cell production through the thymus or from poor peripheral expansion of residual T-cells. Interleukin-7 (IL-7) is known to stimulate the thymus to produce new T-cells and to allow circulating mature T-cells to expand, thereby playing a critical role in T-cell homeostasis. In the present study we demonstrated reduced levels of circulating IL-7 in a cross-section of RA patients. IL-7 production by bone marrow stromal cell cultures was also compromised in RA. To investigate whether such an IL-7 deficiency could account for the prolonged lymphopenia observed in RA following therapeutic lymphodepletion, we compared RA patients and patients with solid cancers treated with high-dose chemotherapy and autologous progenitor cell rescue. Chemotherapy rendered all patients similarly lymphopenic, but this was sustained in RA patients at 12 months, as compared with the reconstitution that occurred in cancer patients by 3–4 months. Both cohorts produced naïve T-cells containing T-cell receptor excision circles. The main distinguishing feature between the groups was a failure to expand peripheral T-cells in RA, particularly memory cells during the first 3 months after treatment. Most importantly, there was no increase in serum IL-7 levels in RA, as compared with a fourfold rise in non-RA control individuals at the time of lymphopenia. Our data therefore suggest that RA patients are relatively IL-7 deficient and that this deficiency is likely to be an important contributing factor to poor early T-cell reconstitution in RA following therapeutic lymphodepletion. Furthermore, in RA patients with stable, well controlled disease, IL-7 levels were positively correlated with the T-cell receptor excision circle content of CD4+ T-cells, demonstrating a direct effect of IL-7 on thymic activity in this cohort

A Guide to Simple and Informative Binding Assays

The aim of binding assays is to measure interactions between two molecules, such as a protein binding another protein, a small molecule, or a nucleic acid. Hard work is required to prepare reagents, but flaws in the design of many binding experiments limit the information obtained. In particular many experiments fail to measure the affinity of the reactants for each other. This essay describes simple methods to get the most out of valuable reagents in binding experiments

Use of small animal PET-CT imaging for in vivo assessment of tendon-to-bone healing: A pilot study.

BACKGROUND The availability of non-invasive means to evaluate and monitor tendon-bone healing processes in-vivo is limited. Micro Positron-Emission-Tomography (µPET) using 18F-Fluoride is a minimally invasive imaging modality, with which osteoblast activity and bone turnover can be assessed. The aim of this study was to investigate the use of serial in-vivo µPET/CT scans to evaluate bone turnover along the graft-tunnel interface in a rat ACL (anterior cruciate ligament) reconstruction model. METHODS Unilateral autograft ACL reconstruction was performed in six rats. µPET/CT-scans using 18F-Fluoride were performed 7, 14, 21, and 28 days postoperatively. Standard uptake values (SUV) were calculated for three tunnel regions (intraarticular aperture (IAA), mid-tunnel, and extraarticular aperture (EAA)) of the proximal tibia. Animals were sacrificed at 28 days and evaluated with µCT and histological analysis. RESULTS SUVs in both bone tunnels showed an increased 18F-Fluoride uptake at 7 days when compared to 14, 21, and 28 days. SUVs showed a gradient on the tibial side, with most bone turnover in the IAA and least in the EAA. At 7, 14, 21, and 28 days, there were significantly higher SUV values in the IAA compared to the EAA (p = .01, < .01, < .01, < .01). SUVs positively correlated with new bone volumetric density obtained with μCT (r = 0.449, p = .013). Volumetric density of newly formed bone detected on μCT correlated with osteoblast numbers observed along the tunnels in histological sections (r = 0.452, p < .016). CONCLUSIONS Serial in-vivo µPET/CT-scanning has the potential to provide insight into bone turnover and therefore osteoblastic activity during the healing process. As a result, it allows us to directly measure the effect of interventional strategies in tendon-bone healing

Single-balloon enteroscopy: results from an initial experience at a U.S. tertiary-care center

Single Balloon Enteroscopy (SBE) is a novel deep enteroscopy modality for diagnosis and treatment of disorders of the small bowel

Opportunistic decision-making in government: concept formation, variety and explanation

The notion of opportunism is too often used loosely in policy and administrative research on executive decision-making: its various meanings are too rarely clearly distinguished. To make it useful for explanation, this article presents fresh concept formation work, clarifying the concept to recognize different kinds and degrees of opportunism. To illustrate the use of the refined concept, the article examines key decisions by British cabinets and core executives between 1945 and 1990. It proposes that neo-Durkheimian institutional theory can help to explain why different kinds of opportunism are cultivated in differently ordered administrations, so providing new insight into decision-making.This work was supported by the Leverhulme Trust (grant number: F01374I