In well-controlled hypophosphataemic rickets patients receiving conventional therapy, adjunctive therapy with standard dose rhGH offers no benefits in linear growth or rachitic disease markers.
Summary: In a prospective survey of the nephrotic syndrome due to primary renal disease in adult patients in the South-east Metropolitan Region of England 50 patients were seen in a two-year period-a minimum annual incidence of 9-0 new cases per million adult population. The frequency distribution of the three main histological groups was " minimal change " 30%, membranous nephropathy 12%, and proliferative glomerulonephritis 58%. The higher proportion of patients with minimal histological change compared with that found in most previously published series may be explained by the avoidance of selection of patients for inclusion. The much lower incidence of membranous nephropathy probably reflects the use of stricter histological criteria for this diagnosis.
With our aging population, chronic diseases that compromise skin integrity such as diabetes, peripheral vascular disease (venous hypertension, arterial insufficiency) are becoming increasingly common. Skin breakdown with ulcer and chronic wound formation is a frequent consequence of these diseases. Types of ulcers include pressure ulcers, vascular ulcers (arterial and venous hypertension), and neuropathic ulcers. Treatment of these ulcers involves recognizing the four stages of healing: coagulation, inflammation, proliferation, and maturation. Chronic wounds are frequently stalled in the inflammatory stage. Moving past the inflammation stage requires considering the bacterial burden, necrotic tissue, and moisture balance of the wound being treated. Bacterial overgrowth or infection needs to be treated with topical or systemic agents. In most cases, necrotic tissue needs to be debrided and moisture balance needs to be addressed by wetting dry tissue and drying wet tissue. Special dressings have been developed to accomplish these tasks. They include films, hydrocolloids, hydrogel dressings, foams, hydrofibers, composite and alginate dressings.
Negotiators for powerful, self-reliant states tend to be less responsive to weak states relative to domestic constituents, while negotiators for states entangled in ties of asymmetric interdependence with more powerful states tend to be more responsive to the demands of powerful states than to the demands of domestic constituents. Asymmetrical power does not necessarily lead to asymmetrical results, however, because negotiators in weaker states may, nevertheless, have more attractive non-agreement alternatives and a longer shadow of the future. Negotiators with attractive non-agreement alternatives will be more willing to put agreement at risk by withholding concessions in the negotiation process. Centralized and vertical institutions are often a bargaining liability precisely because weak states tend to be less responsive to domestic constituents, whereas divided government can be a major asset. These propositions are demonstrated through an analysis and reconstruction of the North American Free Trade negotiation process.A casual examination of the NAFTA negotiations suggests that the results were critically shaped by three factors: (1) asymmetries of power between the three states; (2) sharply contrasting domestic political institutions; and (3) differences in the non-agreement alternatives and risk orientations of the chiefs of government.
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