Education to achieve symptom control for patients with cancer

This project evaluated whether shared interprofessional education across primary and secondary care could improve symptom control for patients with cancer. An action learning group of 16 health care professionals and patients from the community and hospital took part in an initial three-month learning and change process and an evaluation at the end of one year. Both participants and facilitators developed skills in working with other health care settings, as well as experience of using a continuous quality improvement tool. Participants developed a greater understanding of how the NHS worked and what was required to enable patients to receive improved care. The project enabled professionals to work more effectively with both primary and secondary services, agencies, and helped patients to enhance symptom control.     

Mechanisms underlying transition from acute glomerular injury to late glomerular sclerosis in a rat model of nephrotic syndrome.

Functional and morphologic measurements were performed in Munich-Wistar rats after a single central venous injection of puromycin aminonucleoside (PA) or saline vehicle (sham). During phase I, PA rats exhibited overt nephrotic syndrome and impaired glomerular filtration, primarily due to a reduction in the glomerular capillary ultrafiltration coefficient. The morphologic counterpart of the latter consisted of effacement of glomerular epithelial cell foot processes and decrease in the number of filtration slit diaphragms. Administration of the angiotensin I converting enzyme inhibitor (CEI) enalapril to PA rats did not ameliorate glomerular dysfunction. During phase II, PA rats exhibited spontaneous resolution of proteinuria, impaired function, and morphologic abnormalities. However, PA rats now demonstrated marked glomerular capillary hypertension and continued, albeit lesser, reductions in the ultrafiltration coefficient. Concurrent CEI administration modestly lowered systemic arterial pressure, and normalized the glomerular capillary hydraulic pressure and ultrafiltration coefficient. Additional rats were studied during phase III, 70 wk after injection. In PA rats, prior glomerular hypertension was associated with development of recurrent proteinuria and extensive glomerular sclerosis, whereas concurrent CEI administration limited these parameters to values comparable to those in sham rats. Glomerular hypertension thus may explain the development of glomerular sclerosis and renal failure long after an episode of acute glomerular injury.     

Pharmacokinetics of drugs in patients with the nephrotic syndrome.

Since the binding of drugs to plasma proteins can significantly after the intensity of pharmacological and toxicological effects of drugs, we studied the pharmacokinetics of three drugs in patients with hypoalbuminemia secondary to the nephrotic syndrome, but with relatively normal renal function. No significant differences were seen in the pharmacokinetic parameters observed for antipyrine, a drug which is less than 10% bound to plasms proteins. The percentage of unbound diphenylhydantoin, a highly plasms protein-bound drug, was found in patients with the nephrotic syndrome to be twice that of healthy individuals (19,2 vs. 10.1%, P smaller than 0.001). However, there was also a lower steady-state plasma concentration of diphenylhydantoin (2.9 plus or minus 0.6 vs. 6.8 plus or minus 0.6 mug/ml, P smaller than 0.001) secondary to an increase in the plasms clearance (0.048 plus or minus 0.019 vs. 0.022 plus or minus 0.006 liter/kg.h, P smaller than 0.001) in the nephrotic patients. The net effect is no difference in the absolute concentration of unbound diphenylhydantoin in healthy individuals (0.69 plus or minus 0.05 mug/ml) and patients with the nephrotic syndrome (0.59 plus or minus 0.06 mug/ml). Qualitatively, similar differences were observed with clofibrate. The dose of these drugs need not be routinely reduced in patients with the nephrotic syndrome as long as they have reasonably normal renal function (creatinine clearance greater than 50 ml/min). With all highly bound acidic drugs, knowledge of the concentration of unbound drug is essential to the proper interpretation of total blood levels and subsequent treatment of the patient.     

How to achieve a work-life balance

Understanding who you are in terms of your values, skills, passions and motivations will help you to make the most of your abilities and improve your work-life balance. This article sets out steps to achieve this.     

A circadian rhythm of proteinuria in patients with a nephrotic syndrome

Circadian variations in proteinuria were studied in 17 patients with different types of glomerulopathies. During 3-4 successive days urine was collected over periods of 3 h under standardized conditions. Thirteen of the 17 patients showed a circadian rhythm of their proteinuria with a maximum excretion in daytime around 16.00 hours and a minimum excretion at night around 03.00 hours. In the majority of patients the urinary excretory rhythms of albumin, transferrin and immunoglobulin G were 'in phase' with each other and with the circadian rhythm of total protein excretion. Nine patients had a larger degree of rhythmicity for immunoglobulin G than for transferrin excretion. In eight of them a circadian rhythm of the selectivity index of proteinuria was seen with the lowest index at night. No relation was observed between the circadian rhythm of proteinuria and the type of glomerulopathy.     

Geared to achieve with lifelong learning

There's a direct relationship between management's behavior and staff's sense of professionalism.     

黄芪鲤鱼汤食疗方辅助治疗肾病综合征水肿的临床观察

肾病综合征(nephrotic syndrome,NS)是以大量蛋白尿、低蛋白血症、高脂血症及水肿为特征的一组临床症候群,是临床常见肾脏病。对于难治性肾病综合征,如何提高病人的血浆白蛋白,控制和改善水肿是临床难题之一。我院自20世纪80年代     

Antithrombin III loss in patients with nephrotic syndrome or receiving continuous ambulatory peritoneal dialysis. Evidence of inactive antithrombin III in urine of patients with nephrotic syndrome

Antithrombin III (AT III) was measured as antigen (Ag) and as heparin cofactor (HC) in plasma and urine or dialysate from nine patients with nephrotic syndrome and nine patients receiving continuous ambulatory peritoneal dialysis (CAPD), respectively. Crossed immunoelectrophoresis on heparin-agarose (H-CIE) and crossed immunoelectrofocusing (CIEF) runs were carried out on plasma and urine or dialysate samples. AT III plasma levels of the patients receiving CAPD were in the normal range, whereas levels in the patients with nephrotic syndrome showed a significant reduction. Nevertheless the AT III Ag daily loss was the same in both patient groups, so that an additional AT III loss caused by renal metabolism was suggested in patients with nephrotic syndrome. No alteration in the isoantithrombin plasma distribution was found in any patient. The AT III recovered in urine was almost all inactive, as demonstrated by the quantitative assays and by the H-CIE runs; on the contrary, the findings obtained by functional assays, H-CIE, and CIEF runs on dialysate samples failed to demonstrate any major alteration in the AT III molecule. In urine the AT III CIEF pattern displayed a more acid distribution (pH 4.9 to 4.5) in respect to the plasma AT III (pH 5.2 to 4.6); this pattern was suggested to be related to the renal AT III functional inactivation, whose exact mechanism remains to be clarified.     

Purification and properties of urinary alkaline ribonucleases from patients with nephrotic syndrome.

Four urinary alkaline ribonucleases (RNase, EC 3.1.4.22) were purified from patients with nephrotic syndrome using phosphocellulose, DEAE-cellulose and Sephadex G-75 chromatographiy. These enzymes were designated as RNases 1--4, respectively, in order of elution on phosphocellulose chromatography. The respective purification of each fraction was 41-, 23-, 34- and 27-fold with a total recovery of 25%. The pH optima of these RNases were around 8.5 with Tris/HCl buffer and the reaction was activated by mono- and divalent cations, such as Na+, K+, Mg2+ and Ca2+, but inhibited by Fe2+, Cu2+ and Zn2+. EDTA had little effect on the velocity of reaction. The molecular weights of RNases 1--4 were estimated by gel filtration as 45 000, 32 000, 20 000, and 13 000, respectively. Each enzyme hydrolyzed pyrimidine nucleotides preferentially with higher affinity for poly(C) than poly (U) as determined with synthetic polymers and was free from other nucleolytic enzymes. The patients with renal disorders excreted one to four RNases in urine and the number of enzymes increased as the concentration of urinary protein increased. On the other hand, normal subjects excreted a single fraction essentially identical to RNase 1.     

肾病综合征患者血清甲状腺激素水平临床观察

目的：观察肾病综合征（NS）患者继发性甲状腺激素水平下降的发生率，并探讨其发病机制。方法：分别用全自动免疫分析仪和全自动生化分析仪检测52例中、重度水肿的NS患者治疗前后及22例原发性甲状腺功能减退症患者、18例健康者的血清FT3，FT4、促甲状腺激素（TSH）、总蛋白、白蛋白及尿总蛋白、白蛋白水平，并分析其血清甲状腺激素与血、尿蛋白间的相关性。结果：52例NS患者中41例甲状腺激素水平较正常值有不同程度下降，其中FT3为（1．72±0．59）pg／mL，FT4为（8．63±1．92）pg／mL，TSH（7．32±3．05）μIU／mL。NS组患者治疗前血清FT3与血清白蛋白水平呈正相关（r=0．387，t=2．523，P〈0．05），FT4与血清白蛋白水平呈正相关（r=0．359，t=2．369，P〈0．05），与尿蛋白（尿总蛋白及尿白蛋白）间无相关性：TSH与血清白蛋白及尿蛋白间无相关性。结论：中、重度水肿的NS患者易出现继发性甲状腺激素水平下降，甲状腺激素改变水平与血清白蛋白水平相关。