Everolimus is a mTOR inhibitor that has been increasingly used in high-risk cardiac rhabdomyomas in recent years. There are questions regarding the optimal dose and duration of therapy with everolimus for cardiac rhabdomyomas. The purpose of this study was to examine retrospectively the dosage-efficacy relationship in seven babies diagnosed with rhabdomyoma treated with different everolimus dose regimens retrospectively. Cardiac rhabdomyoma diagnosis was made in six of seven babies during the prenatal period. Indication of everolimus was an obstruction in six patients and supraventricular tachycardia which is resistant to antiarrhythmic drugs in the remaining one patient. The median age was 8 days (range; 2–105 days) at the time of starting everolimus. It was administered at a dose of 0.25 mg twice a day for two days a week in four patients; 0.1 mg/day in two and 0.4 mg/day in one patient. Serum everolimus level was kept between 5 and 15 ng/ml. All seven cases showed significant regression of cardiac rhabdomyoma within four weeks, and supraventricular tachycardia was controlled in two weeks after everolimus administration.

This study demonstrates that everolimus was effective in accelerating regression of the cardiac rhabdomyoma. Dose with 2 × 0,25 mg/day, 2 days a week, seems appropriate. However, lower doses such as 0.1 mg/day are also effective. But dose adjustment should be made according to serum level monitoring.

The recommended daily dose of vitamin D is 2000 IU was found to be insufficient in many patients. The objective of the present study is to find whether the daily dose of vitamin D should be based on BMI. Two hundred and thirty patients with an established vitamin D deficiency (serum level of 25 Hydroxy vitamin D3 (25OHD3) of ≤20 ng/ml) and patients with BMI ≥30 kg/m2 were included in the study. Demographic data, comorbidities and BMI were recorded. Pre-treatment and post-treatment serum 25OHD3, calcium, phosphorus and parathyroid hormone (PTH) were tested at 0-, 3- and 6-month periods. Patients were treated with a standard dose of 50 000 IU of vitamin D weekly and 600/1200 mg of calcium a day. Once their level of 25OHD3 reached ≥30 ng/ml, patients were randomised into two groups. Group A received a standard recommended maintenance dose of 2000 IU daily and Group B patients received 125 IU/kg/m2 of vitamin D3. The data were entered in the database and analysed. The mean age of Group A was 50⋅74 ± 7⋅64 years compared to 52⋅32 ± 7⋅21 years in Group B. In both groups, pre-treatment vitamin D level was ≤15 ng/ml and increased to 34⋅6 ± 2⋅6 and 33⋅7 ± 2⋅4 ng/ml at the end of 3 months treatment with a dose 50 000 IU of vitamin D3 and calcium 600/1200 mg once a day for group A and group B, respectively. At 6 months, patients in Group A 25OHD3 level was 22⋅8 ± 3⋅80 and in Group B was 34⋅0 ± 1⋅85 ng/ml (P < 0⋅001). This preliminary study suggests that obese patients need higher dosage of vitamin D than the recommended dose. It is prudent that the dosage should be based on the BMI to maintain normal levels for a healthy musculoskeletal system.

Riot control agents and expanding bullets are the only two kinds of weapon and ammunition that are used for law enforcement purposes but are explicitly prohibited in the conduct of hostilities. This article justifies this difference in treatment with two arguments. First, riot control agents and expanding bullets have different effects on the human body depending on their specific types and the circumstances in which they are deployed. Second, the issues raised by their use differ according to whether they are employed for law enforcement purposes or in the conduct of hostilities.

Several regulatory bodies have approved a health claim on the cholesterol-lowering effects of oat β-glucan at levels of 3·0 g/d. The present study aimed to test whether 1·5 g/d β-glucan provided as ready-to-eat oat flakes was as effective in lowering cholesterol as 3·0 g/d from oats porridge. A 6-week randomised controlled trial was conducted in eighty-seven mildly hypercholesterolaemic ( ≥ 5 mmol/l and < 7·5 mmol/l) men and women assigned to one of three diet arms (25 % energy (E%) protein; 45 E% carbohydrate; 30 E% fat, at energy requirements for weight maintenance): (1) minimal β-glucan (control); (2) low-dose oat β-glucan (1·5 g β-glucan; oats low – OL) or (3) higher dose oat β-glucan (3·0 g β-glucan; oats high – OH). Changes in total cholesterol and LDL-cholesterol (LDL-C) from baseline were assessed using a linear mixed model and repeated-measures ANOVA, adjusted for weight change. Total cholesterol reduced significantly in all groups ( − 7·8 (sd 13·8) %, − 7·2 (sd 12·4) % and − 5·5 (sd 9·3) % in the OH, OL and control groups), as did LDL-C ( − 8·4 (sd 18·5) %, − 8·5 (sd 18·5) % and − 5·5 (sd 12·4) % in the OH, OL and control groups), but between-group differences were not significant. In responders only (n 60), β-glucan groups had higher reductions in LDL-C ( − 18·3 (sd 11·1) % and − 18·1 (sd 9·2) % in the OH and OL groups) compared with controls ( − 11·7 (sd 7·9) %; P = 0·044). Intakes of oat β-glucan were as effective at doses of 1·5 g/d compared with 3 g/d when provided in different food formats that delivered similar amounts of soluble β-glucan.

Phytases have been used commercially since the early 1990s and have been the focus of considerable and sustained research for many decades. Despite this heroic effort there are still areas of persistent uncertainty such as the obscurity surrounding total compared with digestible calcium, appropriate modification to dietary sodium (and other electrolyte) concentrations, the usefulness of the amino acid and energy digestibility improvements and ultimately the effect of phytase on nutrient requirement. One further area which has attracted some attention recently is the effect of unconventionally high doses of phytase (i.e. >2,500 FTU/kg from Aspergillus niger or Escherichia coli) in an attempt to ostensibly ‘de-phytinise’ the diet. The effects of such ‘super’ doses of phytase can be considerable, and often beyond that which may be reasonably expected based on improvement in P digestibility per se. This review article addresses these effects and suggests mechanisms by which they may be explained.

Background: This study aimed to explore changes in patterns of use of psychotropic medication in Sydney nursing homes over recent years, and to compare current usage rates with those reported from other countries.

Methods: Data were obtained from 44 of the 48 nursing homes in a central Sydney health area. Researchers noted details from medication cards concerning residents’ age, gender and all currently prescribed drugs, checking whether medication had been given as prescribed. Frequency of administration of “as required” drugs in the previous four weeks was noted.

Results: The pattern of use of psychotropic medication changed considerably between 1993 and 2009. The number of residents taking regularly administered antipsychotics increased by 24% during 1998–2009, though mean dosages decreased. In 2009, fewer residents took hypnotic and/or anxiolytic medications than in the 1990s, and fewer than in countries from which equivalent data have been reported. Antidepressant use increased over the 16 years but only to 25.6%. Only 3% of residents in Sydney nursing homes in 2009 took cognition-enhancing drugs.

Conclusions: Compared to other countries, rates of use of hypnotic, anxiolytic and antidepressant medication in Sydney nursing homes are low. Benefits and disadvantages of these differences merit analysis. Antipsychotic medications were administered to similar percentages of survey residents in 1993 and 2009, but at lower mean dosages in 2009 compared to previous surveys, and with a change to using mainly atypical antipsychotic drugs. Compared to various other countries, cognition-enhancing and antidepressant medications are administered to proportionally fewer residents in Sydney nursing homes. Outcome analysis regarding the use and benefits of such drugs in nursing homes is desirable.

Parasite transmission dynamics are fundamental to explaining the evolutionary epidemiology of disease because transmission and virulence are tightly linked. Horizontal transmission of microsporidian parasites, e.g. Nosema bombi, may be influenced by numerous factors, including inoculation dose, host susceptibility and host population heterogeneity. Despite previous studies of N. bombi and its bumble bee hosts, neither the epidemiology nor impact of the parasite are as yet understood. Here we investigate the influence N. bombi spore dosage (1000 to 500 000 spores), spore source (Bombus terrestris and B. lucorum isolates) and host age (2- and 10-day-old bees) have on disease establishment and the presence of patent infections in adult bumble bees. Two-day-old bees were twice as susceptible as their 10-day-old sisters, and a 5-fold increase in dosage from 100 000 to 500 000 spores resulted in a 20-fold increase in the prevalence of patent infections. While intraspecific inoculations were 3 times more likely to result in non-patent infections there was no such effect on the development of patent infections. These results suggest that host-age and dose are likely to play a role in N. bombi's evolutionary epidemiology. The relatively low levels of horizontal transmission success are suggestive of low virulence in this system.

The efficacy of three microbial phytases to increase the amount of digestible phosphorus (dP) was studied in pigs. A basal diet was prepared meeting the requirements of 30-kg pigs with the exception of P. Concentrations (in g/kg dry matter) were: P 2·9, phytate P 1·3, calcium (Ca) 6·9, and crude protein 208. Intrinsic phytase activity was below detection limit. Microbial phytase was supplemented from three sources (Aspergillus niger (Asp), Peniophora lycii (Pen), and consensus phytase (Con)) at the following levels (phytase units (FTU) per kg diet): 150, 300, 450, 600 and 900. Diets were pelleted without steam. Forty-eight male castrated crossbred pigs ((Large White X German Landrace) X Pietrain) initially weighing, on average, 28 kg were individually penned. Each of the 16 diets was offered to three pigs in three consecutive periods of 17 days each, resulting in nine replicates per treatment. No animal received the same diet twice. Faeces were spot-sampled for each individual pig twice daily for the last 7 days of each period. TiO2 was used as an indigestible marker. An exponential function was fitted to the data, and both marginal and cumulative efficacies of phytases were described on the basis of the resulting functions.

No significant period effect was detected for any of the obtained data. On overall average, daily live-weight (LW) gain was 730 g, and 2.57 kg food were needed per kg LW gain. Neither criterion was significantly affected by source or level of supplementary phytase. Digestibility of organic matter and crude protein averaged 0.90 and 0.84, respectively, again without a significant treatment effect. Digestible P concentration in no case exceeded 1.5 g/kg DM, indicating that P supply to pigs was marginal in all treatments. Digestibility of P from the basal diet was 0.22. P digestibility was significantly affected (P = 0.001) both by the source and by the level of supplementary phytase. It responded in a non-linear fashion to increasing phytase supplementation, this course being less clear for Pen than for Asp and Con phytase. In no case was a clear plateau in P digestibility reached within the range studied. For Asp and Con, marginal efficacy decreased from about 2 mg dP per incremental FTU at low supplementary level to roughly 0.6 mg dP per incremental FTU. This clear dose dependent effect was not present for the Pen phytase, where about 0.6 to 0.7 mg dP per incremental FTU were released almost irrespective of the level of supplementation. It is concluded that phytases of different origin rank differently from each other regarding their efficacy, depending on the level of supplementation. Dose-response studies are recommended in cases where different phytases are to be compared.

The target for the efficacy of energizing neuroleptics on negative symptoms in schizophrenic patients may be the schizophrenic illness itself, or the existence ol a subgroup of negative symptoms. We searched for a non-psychotic population presenting a negative syndrome. A group of patients complaining of loss of interest, anhedonia, anergia, fatigue but with no painful mood, who did not meet the criteria for primary depression (Feighner 1972) and who had never presented psychotic symptoms seemed appropriate to answer this question. We Present here the results of a double-blind therapeutic trial in 93 outpatients, comparing the effects of 2 dosages of amisulpride, a neuroleptic of the benzamide substitute group, with a placebo. In these non-psychotic subjects, the 50 mg daily dose produced a significantly greater improvement in the negative syndrome than the placebo, and a non-significant intermediary improvement with the dose of 100 mg. The encouraging results must nevertheless be interpreted witli prudence, and confirmed by further studies due to the high number of drop-outs in the 50 mg group. This resuit indicates a transnosological effect of energizing neuroleptics on negative symptoms.

Two questionnaire-based surveys were carried out amongst the small vegetable planting community in order to evaluate the effectiveness with which pesticides are being used and the ensuing health and environmental hazards. Good practice was assessed by a certain number of indicators based on various parameters. Data on health hazards were obtained from cases of poisoning and from surveys on blood cholinesterase levels.

The results give pertinent indications on pesticide flow, usage and perception. Generally, aged planters tend to adopt good practice, especially if they have had at least primary education, in which case they would seek advice. Many planters however do not get advice from the right source with regards choice of pesticides and dosage, although a significant proportion of planters do not follow recommended dosages. About three-fourths of the planters frequently resort to cocktails of two or more pesticides. Safety intervals are simply not observed by a good majority of growers. Measuring and protective devices, washing of spraying equipment, disposal of empty containers, and the types of pesticides stores leave much to be desired. The practice of mixed cropping leads to the use of a wide range of pesticides for the control of a single pest on various crops. There has recently been a general shift in pesticide usage with the introduction of synthetic pyrethroids. The misuse and/or abuse of pesticides has serious repercussions on the health of those exposed to such toxic chemicals, and cases of poisoning too are increasing. Remedial measures are suggested.