Search

Background: Case report, in a patient with a history of diabetes and hypertension, treated with metformin, gliclazide, enalapril + hydrochlorothiazide, amlodipine, aspirin and diazepam, recently medicated for a gouty crisis with colchicine and clonixin without improvement. Believing it could help in the treatment of gouty crisis symptoms he took about 1.5 L of artichoke infusion (Cynara cardunculus). He felt better and did agriculture work but developed a distal muscle pain, severe anemia, standard biochemical liver cholestasis, increase of alkaline phosphatase and marked increase of inflammatory parameters (hyperleucocytosis) and enters in the emergency department at the hospital. Objective: Evaluation of the cause of complaints and laboratory abnormalities and the involvement of artichoke infusion. Results: The prominence of the inflammatory parameters was ruled out because of exhaustive autoimmune, infectious or para-neoplastic syndrome (blood cultures, serology, diagnostic imaging, bone marrow and bone biopsy, muscle biopsy and nerve, abdominal angiography) were carried out showing normal results. The evaluation pointed out that the concomitant intake of artichoke infusion may have been involved in the framework developed, since the drugs which were being administered to/by the patient have a metabolism mainly mediated by CYP450 3A4 and 2C9 that could be compromised when these isoenzymes are inhibited by phenolic and flavonoid compounds from plants. Colchicine was one of the last drugs took that have as side effects most of the symptoms felt by patient including diarrhea and anemia. Conclusion: The spontaneous and complete recovery of the patient and the negativity of research looking for other causes, conduce to a strong possibility of the interaction between artichoke and the drugs in the clinical presentation of this case.

The article discusses alternative fee arrangements (AFAs) also known as billing arrangements that allow the client and attorney to create a customizable billing framework to fit the needs of the client, attorney and matter. It mentions how AFAs has improved communication with clients as the attorney fees are disclosed at the inception of the representation.

Many executives may be wondering whether their insurance policies offer any relief for the loss of business they experienced following the Sept. 11 terrorist attacks. Business interruption insurance is one [...]

Osteogenic cultures of embryonic stem cells (ESCs) are predominately derived from three‐dimensional cell spheroids called embryoid bodies (EBs). An alternative method that has been attempted and merits further attention avoids EBs through the immediate separation of ESC colonies into single cells. However, this method has not been well characterized and the effect of omitting the EB step is unknown. Herein, we report that culturing human embryonic stem cells (hESCs) without the EB stage leads to a sevenfold greater number of osteogenic cells and to spontaneous bone nodule formation after 10–12 days. In contrast, when hESCs were differentiated as EBs for 5 days followed by plating of single cells, bone nodules formed after 4 weeks only in the presence of dexamethasone. Furthermore, regardless of the inclusion of EBs, bone matrix formed, including cement line matrix and mineralized collagen, which displayed apatitic mineral (PO4) with calcium‐to‐phosphorous ratios similar to those of hydroxyapatite and human bone. Together these results demonstrate that culturing hESCs without an EB step can be used to derive large quantities of functional osteogenic cells for bone tissue engineering.

In this article, the author offers suggestion for attorneys of Colorado for avoiding the mistakes when facing the legal malpractice claim including need to keep clients informed includes self-reporting, attorney unpaid fees or expenses and to make a settlement offer without the insurance consent.

The article explores the ways to reduce the risk of law malpractice claims in the U.S.; reports attorney's breach of a professional duty proximately causes damages; and suggests recognizing the difference between actual legal malpractice and a legal malpractice claims.

The article offers suggestions for the lawyers when a sue a client for unpaid fees for the prevention of legal malpractice. Topics discussed need to adopt the strategies which increase client compliance with payment requests, attorney and law firm will need to evaluate the benefit-to-risk ratio before filing a claim, and Colorado Rules of Professional Conduct permit an attorney to acquire a lien to secure the lawyer's fee or expenses.

The article discusses motions to disqualify addressed by Colorado courts against Colorado lawyers. Topics discussed include Colorado Rules of Professional Conduct that regulates client confidences, use of disqualification motions by an opposing party as litigation tactic, and disqualification motions involving a former client. It mentions disqualification motion addressed by Supreme Court and rules regulating attorneys from representing clients standing in court against former clients.

The article reflects on ethical and legal issues surrounding Colorado attorneys who conduct mediation. Topics discussed include the Colorado Model Standards of Conduct for Mediators that provides ethical guidance to attorneys who act as mediators, a duty imposed on a mediator under the Model Standards to conduct a mediation in an impartial manner and the Colorado Rules of Professional Conduct that provides guidance to attorney-mediators, and establishment of training standards for mediators.

Twenty-four hour ECG Holter and blood-pressure monitorings were performed in eight patients suffering from cluster headache. Spectral analysis of heart-rate fluctuation was used to assess the autonomic balance under basal conditions, after head-up tilt, and during a spontaneous attack. Normal autonomic balance was found at rest and during sympathetic activation obtained with head-up tilt in the interparoxysmal period. Before the onset of headache, an increase in the low-frequency (LF) component of the power spectrum was apparent in all patients. This sign of sympathetic activation was followed by an increase in the high-frequency (HF) component that developed about 2000 beats after the onset of headache and rapidly overcame the LF component until the end of pain. Significant differences were found when comparing the spectral parameters [total spectral values (TP), power of the LF and HF components and LF/HF ratio] obtained before, during and after headache. During the attack, blood pressure increased and heart rate decreased in all subjects. There appears to be a primary activation of both sympathetic and parasympathetic functions in cluster headache attacks. The sympathetic component seems to be involved mostly in the development of the attack, whereas the parasympathetic activation seems to occur, following the onset of the attack, independently of the pain.

Testosterone metabolism, androgen receptors, and the androgen binding protein (ABP) were studied in male albino rats injected with 1 mg of testosterone propionate (TP) on Day 2 of life. The epididymal content of ABP was diminished in immature but not in adult animals treated neonatally with androgen. No changes were detected in the testicular levels of this protein in 27-day-old rats. In adult animals atrophic lesions were seen in 3% of the seminiferous tubules. Androgen treatment of neonates led to a substantial decrease in the 5α-reductase activity in homogenates of prostate gland and epididymis from adult rats with a concomitant decline in the 3α-β-hydroxysteroid dehydrogenase activities in both tissues. These animals did not show any change in the number of available or total androgen receptor sites as measured by incubating prostatic cytosol with [3H]R1881. The present findings suggest that the impaired development of the male genital tract could be partially due to a diminished peripheral conversion of testosterone to its active, 5α-reduced metabolites.

The article focuses on the significance of waivers in resolving conflicts of interest. Topics discussed include a writing required by conflict waivers confirming the affected clients' informed consent, the difference between general waivers and limited waiver, and the Colorado Rules of Professional Conduct that regulates the use of informed consent for resolving conflicts. It also mentions the role of lawyers in seeking a client's waiver.

The article focuses on the importance of screening the clients first before their representation for avoiding the legal malpractice claims. Topics discussed include various standards of law practice for screening of clients, importance of proper questioning and cross examination in client's screening, and the role of the Standards of Professional Conduct as discussed by the U.S. District Court for the District of Colorado.

The article explore the ways to enforce alternative dispute resolution (ADR) provisions, including mandatory arbitration clauses, in retainer agreements and engagement letters in fee agreements. Topics discussed include advantages of ADR, the American Bar Association (ABA) ethical guidance for law firm use of mandatory arbitration clauses, and adding a severability clause in mandatory arbitration provisions.

The article discusses best practices considered by law firms to address issues of attorney's fees in Colorado. Topics discussed includes the advantages and disadvantages of arbitration to resolve fee dispute of attorney, an informal meeting between the client and law firm and proposing mediation by law firm before filing an action for attorney fees. Other topics include the fee arbitration offered by the Colorado Bar Association and importance of attorney-client relationship.

The article looks at the ways for effective billing and collection of fees for attorneys. Topics discussed include negotiating the fee before the client, documenting the fee arrangement, and sending bills regularly. It also suggests lawyers following up the unpaid bills and setting up law practice payments.

The article discusses problems to attorneys due to conflicts of interest, and challenges faced by them in resolving conflicts issues, and expands on the impact of conflicts of interest violations to attorneys including disqualification from client representation and unfavorable jury verdict and punitive damages to pay. Topics include identification of conflict prior to representation, considering both actual and potential conflicts, and conflict analysis ensuring compliance without exception.

The article focuses on various ways for reducing down the risks of legal malpractice claims. Topics discussed include various tips for reducing down the risk which include proper evaluation of the conflict for conflict management, importance of engagement letters for the protection of future claims, and the importance of maintaining client's confidence.

A light-activated, biodegradable adhesive seals cardiovascular defects in the presence of blood flow and could be useful during minimally invasive surgery.