Is ultra-rapid opioid detoxification a viable option in the treatment of opioid dependence?

Ultra-rapid opioid detoxification (UROD) involves the acceleration of opioid withdrawal hv administering thp opioid receptor antagonist naltrexone under general anaesthesia. There is evidence from uncontrolled and a few controlled studies that UROD accelerates opioid withdrawal and that it achieves high rates of completion of acute opioid withdrawal. However, there is clear evidence that the use of a general anaesthetic is not required to accelerate withdrawal or to achieve high rates of completion of acute opioid withdrawal. These goals can be achieved by using naltrexone or naloxone to accelerate withdrawal under light sedation, a procedure known as rapid opioid detoxification under sedation (ROD). There is also evidence that use of an opioid antagonist is not required to achieve a high rate of completion of acute opioid withdrawal. The mixed agonist-antagonist buprenorphine has achieved comparable rates of completion in similarly selected patients with fewer withdrawal symptoms. There is no evidence from controlled trials that either UROD or ROD increases the rate of abstinence from opioids 6 or 12 months after withdrawal. UROD and ROD may increase the number of patients who are inducted onto naltrexone maintenance (NM) therapy but extensive experience with NM therapy suggests that it only has a limited role in selected patients. Given the lack of evidence of substantially increased rates of abstinence, and the need for anaesthetists and high dependency beds, UROD has at best a very minor role in the treatment of a handful of opioid dependent patients who are unable to complete withdraw in any other way. ROD may have more of a role as one option for opioid withdrawal in well motivated patients who want to be rapidly inducted onto NM therapy or who want to enter other types of abstinence-oriented treatment.

Liver transplantation as a therapeutic option for hepatocellular carcinoma

Better outcomes of the patients receiving liver transplantation for viral hepatitis and hepatocellular carcinoma (HCC) are achieved by improved patient selection and perioperative treatment with antiviral agents including lamivudine, ribavirin and interferon. Patient selection is accomplished by high-quality imaging as well as exclusion of patients with large tumors, obvious extrahepatic disease or macroscopic vascular invasion. Using such criteria, a 5-year survival of 92% has been reached in the Queensland Liver Transplant Service on a small number of highly selected patients with HCC. The treatment algorithm of Makuuchi has guided us in recommending resection, estimating to what extent the liver resection can be performed safely, and timing liver transplantation when it is the only option. Adult-to-adult living-donor liver transplantation is being performed safely in many centers worldwide. The transplantation of liver from living donors to HCC patients, when standard criteria for the likelihood of good outcomes are fulfilled, will increase in Japan in the near future. Copyright (C) 2002 S. Karger AG, Basel.

Australia and New Zealand satellite coverage using a microstrip patch reflectarray

This paper presents the design of Ku-band (12.25 12.75 GHz) dual-polarized reflectarrays for Optus BI satellites to obtain a contoured beam for Australia and New Zealand. The specified radiation pattern is synthesized using a phase-only synthesis method based on the concept of intersection approach. Having determined the phasing data, single- and double-layer reflectarrays ore designed using variable-size rectangular patches. The performances of the two reflectarrays are assessed by comparing their radiation patterns with the assumed pattern. (C) 2003 Wiley Periodicals, Inc. Microwave Opt Technol Lett 37: 321-325, 2003; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10. 1002/mop. 10907.

International images and mass media: The effects of media coverage on Canadians' perceptions of ethnic and race relations in Australia

Recently, there has been much speculation about the impact of international media coverage of Australia's position on Indigenous people, migrants and asylum seekers on other nations' images of Australia. In this experiment we examined whether there was any basis for such concerns by considering the short-term impact of negative TV coverage of Australians on Canadian viewers. A questionnaire provided baseline data on Canadian students' perceptions of Australians and Australian race relations. Four months later, the students were assigned to one of three conditions that varied media contact with Australians. Students viewed one of two television programs (about right-wing political independent, Pauline Hanson, and her emotive criticisms of Aborigines and Asian immigrants or about an ethnically-mixed group of young Australians and their positive sense of cultural identity), or they viewed no program (no contact control). Results indicated that both positive and negative media coverage of Australians affected Canadians' views of Australia in the short-term. In particular, negative coverage (of Hanson) promoted less favourable views of Australians and Australian race relations over time and relative to the positive media and no media control conditions. The media's role in shaping international images is discussed.

Toward the development of a synthetic group A streptococcal vaccine of high purity and broad protective coverage

Using native chemical ligation, we synthesized a group A streptococcal. (GAS) vaccine that contained three different GAS M protein peptide epitopes in a chemically well-characterized construct in high purity. Two of the peptide epitopes represented variable amino terminal serotype determinants, and the third represented a carboxyl terminal conserved region determinant of the GAS M protein. We also synthesized a lipid core peptide (LCP) construct containing the same three peptides. Upon immunization of mice, the non-LCP construct only elicited antibody responses to all three epitopes with the use of adjuvant. The LCP construct, however, elicited excellent antibody responses to all three epitopes without the need for any additional adjuvant or carrier. We have synthesized the LCP synthetic vaccine system with good reproducibility.