Hairy cell leukemia has a B-cell genotype

The phenotype and, by inference, the cell of origin of some lymphocytic neoplasms has been defined by surface marker studies; however, the precise cellular origin of other neoplasms of the lymphoid system is still unknown. For example, with reference to hairy cell leukemia (HCL), cell marker data has been used in support of a monocytic, a T cell, or a B cell origin. If hairy cell leukemia is a B cell-derived neoplasm, the controversy may be resolved by genotyping the cells, using the rearrangement of immunoglobulin genes as a marker of the B cell nature of the process. Rearrangement of these genes is detected using the Southern blot technique and cloned probes specific for the JH segment of the immunoglobulin genes. In this study, the arrangement of the immunoglobulin genes was analysed in normal tissue, in two accepted B cell lymphomas and in nine cases of hairy cell leukemia. DNA from peripheral blood leukocytes (two patients) and from the spleen (seven patients) revealed a discrete new JH restriction fragment length in the leukocytes of hairy cell leukemia cases. The presence of rearranged restriction fragments is interpreted as evidence of the existence of clonal B cell populations. Three of six samples had rearranged kappa light chain fragments. We conclude that most cases of hairy cell leukemia have a B cell genotype. The use of genotyping has wider application in the analysis of hematological malignancies.     

Case report of an anomalous arrangement of the pancreaticobiliary ducts and nuclear DNA ploidy analysis

Two cases with an anomalous arrangement of the pancreaticobiliary ducts (APBD) are reported in order to investigate the mechanism of carcinogenesis of the extrahepatic biliary tract from the aspect of DNA ploidy analysis. Highly elevated biliary enzymes were found in both cases. Although inflammatory changes without any metaplasia or neoplasia were observed histologically, a cytofluorometric nuclear DNA ploidy analysis showed an aneuploid low ploidy pattern in a histogram of the gall bladder, an aneuploid high ploidy pattern in a histogram of the common bile duct in one patient, and a diploidy pattern in the gall bladder, an aneuploid low pattern in the common bile duct in another case. These results may show that APBD may play a role in the development in DNA ploidy abnormality with refluxed pancreatic juice which may induce repeated irritation and inflammation. Radical surgery including a complete excision of the extrahepatic biliary tract followed by reconstruction may achieve better results with regard to undesirable consequences with an abnormal nuclear DNA ploidy pattern and decrease the likelihood of developing carcinoma.     

Public and private funding of general practice services for children and adolescents in New Zealand

Objective

To measure public and private funding of general practice services for New Zealand children.

Methods

Computerized records from 111 general practices provided private payments for 118,905 general practice services to children aged 6-17 years. Government subsidies and public insurance payments provided public funding amounts for seven services. Overall and for each service we estimated the ratio of public:private payments (RPPP).

Results

64.0% of annual expenditure was public, 36.0% private, (RPPP = 1:0.56). General medical consultations were 67.2% of services (RPPP = 1:0.57); 15.3% were injury-related (RPPP = 1:0.36); 5.2% were prescribing services (all private); 4.9% were immunizations (RPPP = 1:0.12); 2.9% were nursing (RPPP = 1:1.33); 4.4% were administration (all private); and 0.1% were for maternity care (RPPP = 1:0.007). Before capitation funding, public and private funding levels for general medical consultations were similar (RPPP = 1:0.93) but after capitation public payments more than doubled (RPPP = 1:0.40).

Conclusion

There is a complex of pattern of public and private payments for general practice services for children and adolescents in New Zealand. Both funding sources are critical. Capitation funding changed the balance substantially but did not remove ongoing reliance on private funding to support general practice care for children.     

Sustaining GAVI-supported vaccine introductions in resource-poor countries

Since 2000, GAVI provided essential support for an unprecedented increase in the use of hepatitis B (HepB) and Haemophilus influenzae (Hib) containing vaccines in resource poor countries. This increase was supported with significant funding from international donors, intended to be time-limited. To assess the sustainability of this important expansion of the global access to vaccines, we reviewed supply chains, financial resources for procurement and decision-making in countries that introduced hepatitis B or Hib vaccines with GAVI support. During the period studied, the types of vaccine products supplied fluctuated rapidly in relationship with the number of suppliers and availability of more combination products. The price of the cheaper vaccines decreased while that of pentavalent DTwP-HepB-Hib remained stable. In average, vaccine introduction was associated with an increase of national programs budget, with new vaccines representing more than half of that increase, while the part of GAVI contributions to the budget went from 25% to 46%. Less than 20% of the vaccine introductions were decided by a national advisory body. Strengthening supply chains, adjusting funding schemes and increasing national ownership will be key to the sustained use of hepatitis B and Hib vaccines and the eventual addition of other important vaccines where they are the most needed.     

Clinical significance of the confluence of the cystic duct in patients with anomalous arrangement of the pancreaticobiliary duct

Background/Purpose

In anomalous arrangement of the pancreaticobiliary duct (AAPBD), there is anatomical diversity of the cystic duct. In this study, we evaluated the influence of the level of insertion of the cystic duct into the extrahepatic bile duct on the pathophysiology of AAPBD.

Methods

Thirty-two children with AAPBD were examined using cholangiopancreatography. If the cystic duct entered the hepatic duct at the lower middle point of the extrahepatic bile duct, it was defined as low confluence; otherwise, it was considered as high confluence. Clinical details and radiological variables were compared between these 2 groups.

Results

Low confluence was noted in 8 of the 32 patients. Seven of the 8 had fusiform-type or nondilatation-type choledochus, and the cystic-type was significantly less frequent than in the high-confluence group. The diameter of the common bile duct was significantly smaller and the main pancreatic duct was significantly greater than in the high-confluence group. Pancreatitis was more common and biliopancreatic reflux on computed tomography combined with intravenous infusion cholangiography was more often seen in the low-confluence group than in the high-confluence group.

Conclusions

Bile juice could regurgitate into the pancreatic duct via the low confluence of the cystic duct, resulting in severe pancreatitis in patients with AAPBD.     

International Study of Health Care Organization and Financing of renal services in England and Wales

In England and Wales, the quantity and quality of renal services have improved significantly in the last decade. While acceptance rates for renal replacement therapy appear low by international standards, they are now commensurate with many other northern European countries. The major growth in renal services has been in hemodialysis, especially at satellite units. Health care is predominantly publicly funded through a tax-based National Health Service, and such funding has increased in the last 10 years. Improvements in health outcomes in England and Wales are expected to continue due to the recent implementation of standards, initiatives, and monitoring mechanisms for renal transplantation, vascular access, and patient transport.      

Service use in family caregivers of persons with dementia in Belgium: psychological and social factors

This study aims to investigate whether selected social and psychological characteristics of family caregivers of persons with dementia are related to community-based service use in Belgium. Two aspects were distinguished in service utilisation: volume (number of contacts) and diversity (number of services). Within a selected region, dementia caregivers were traced via the detection of persons with dementia known to community health or social services. A probability diagnosis was made with the Geriatric Mental State and the computer algorithm AGECAT. Family caregivers of persons with dementia (N = 168) were interviewed at home by means of a structured questionnaire. Data were analysed with multiple regression analysis. Co-residence, a positive attitude towards home service use, and increased problem-solving coping were found to be direct predictors of increased diversity of services used, whereas a lower burden of behaviour problems, living apart, and increased avoidance coping were found to be direct predictors of increased volume of service use. Care recipients' behaviour problems and functional status were not found to be related to service use. The results suggest that social and psychological factors have a larger impact on service use in family caregivers of persons with dementia, compared to objective or subjective burden. Interventions to increase awareness of relevant services, to improve attitudes towards their use and support problem-solving coping in family caregivers may be considered to increase the use of appropriate services.     

儿童正畸治疗中早期功能矫治措施对面型变化与牙列排列的影响

探讨早期功能矫治应用于儿童正畸治疗中的效果及对面型变化、牙列排列的影响。方法 选 择2022年2月-2023年5月黄骅市中医医院口腔科接受正畸治疗的儿童58例,以随机数字表法将其分为 常规组和试验组,各29例。常规组应用无肌功能训练矫治,试验组在常规组基础上增加早期功能矫 治,比较两组治疗效果、面型变化和牙列排列状况、治疗效果满意率。结果 试验组治疗总有效率为 96.55%,高于常规组的82.76%（P＜0.05）;试验组治疗后上中牙的凹距、倾角、SNA角、SNB角、 ANB角、LI-NB角、UI-NA角、NP-FH角、ANS-Me高度优于常规组（P ＜0.05）;试验组治疗效果 满意率高于常规组（P＜0.05）。结论 儿童正畸治疗期间予以早期功能矫治的效果良好,能够有效调整儿 童面型与牙列排列状况,且患者及其家属对治疗满意度较高。     

我国建立基本药物独立筹资机制的必要性分析

目的：探讨建立基本药物独立筹资机制的必要性。方法：从国家基本药物制度框架的全面性出发,基于整个基本药物的价值链,总结基本药物生产、使用和付费过程中存在的问题,提出建立基本药物独立筹资机制的必要性。结果与结论：国家基本药物制度运行过程中存在基本药物生产与创新能力不足、医疗卫生机构基本药物配备率低、医师基本药物处方率低以及基本药物实际补偿水平不高且存在差异等问题。建立基本药物独立筹资机制可有效补偿基本药物生产企业、医疗卫生机构与医师、患者,确保基本药物的可及性,从而进一步完善国家基本药物制度。     

The C-->G transition in the alpha 2-globin gene of a normal alpha alpha-chromosome is responsible for the Hb G-Philadelphia variant in Sardinians

Sequencing of alpha-globin genes of 18 Sardinian heterozygotes for the Hb G-Philadelphia [alpha 68(E17)Asn-->Lys] variant, with four active alpha genes and circulating level of the variant of about 27%, showed the AAC-->AAG change at codon 68 of the alpha 2-globin gene (alpha(G)alpha/alpha alpha). Two heterozygotes with level of about 37% were the carriers of the same mutation on the same alpha 2 gene, and of the alpha 2 alpha 1 hybrid gene, because of the 3.7-kb deletion, in trans (alpha(G)alpha/-alpha(3.7)). In Black people, the same C-->G mutation occurs on the hybrid gene (-alpha(G)3.7), whereas in Caucasians the Lys for Asn change is because of the C-->A transversion occurring on the alpha 2 gene of a normal alpha alpha arrangement. The identification of the C-->G mutation on the normal alpha alpha chromosome points to an undescribed genotype for this rather common variant, which is probably because of the high rate of recombination between the duplicated alpha-globin genes.