Responses of the Denervated Rat Urinary Bladder to Alfa Adrenoceptor Stimulation

Elmér , M. Responses of the denervated rat urinary bladder to alfa adrenoceptor stimulation. Acta physiol. scand. 1976. 98. 440–444. The contractile responses of the rat detrusor muscle to noradrenaline were increased 2–3 weeks after partial denervation but had returned to control values 6–9 weeks after the denervation, probably because of reinnervation of denervated muscle cells. 6–9 weeks after partial denervation the excitatory cr-adreno-ceptor mediated response to stimulation of the remaining intact nerves was predominant, masking the subsequent inhibitory β-receptor response, which at this time was seen only after α-receptor blockade. The possibility of an outgrowth of adrenergic fibres activating a-receptors in muscle cells normally not innervated by adrenergic nerves is discussed.     

Efficacy of Random-start Controlled Ovarian Stimulation in Cancer Patients

This study aimed to evaluate the efficacy of random-start controlled ovarian stimulation (COS) in cancer patients for emergency fertility preservation. In this retrospective comparative study, 22 patients diagnosed with cancer and 44 infertile women undergoing conventional in vitro fertilization (IVF) were included. In cancer patients, ovarian stimulation was started on the day of referral, irrespective of their menstrual cycle date. The control group was selected by age matching among women undergoing conventional IVF. COS outcomes were compared between groups. The number of total and mature oocytes retrieved and the oocyte maturity rate were higher in the random-start group than in the conventional-start group. However, duration of ovarian stimulation was longer in the random-start group (11.4 vs. 10.3 days, P = 0.004). The addition of letrozole to lower the estradiol level during COS did not adversely affect total oocytes retrieved. However, oocyte maturity rate was lower in cycles with letrozole than in cycles without letrozole (71.6% vs. 58.2%, P = 0.019). Our study confirms the feasibility and effectiveness of random-start COS in cancer patients.

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阿胶对诱导排卵周期子宫内膜容受性的作用

目的探讨阿胶对诱导排卵助孕周期子宫内膜容受性的作用。方法将56例68周期在诱导排卵周期中接受夫精人工授精（AIH）或指导同房助孕治疗的患者随机分为A、B两组,A组为对照组,B组自月经周期第7天开始给予阿胶口服治疗,每天用生胶量30g,至下次月经或证实临床妊娠为止。结果月经周期第7天至排卵日的子宫内膜厚度增长值A组为（3．10±1．32）mm,B组为（3．88±1．54）mm,两组之间差异有统计学意义（P〈0．05）。两组子宫内膜厚度每日增加数分别为（0．49±0,23）mm和（0．62±0．26）mm,差异有统计学意义（P〈0．05）。阴道彩色B超监测排卵日的子宫动脉血流阻力指数和搏动指数B组较A组明显下降（P〈0．05）。结论阿胶能增加诱导排卵助孕周期子宫内膜的厚度,加速子宫内膜的增长并改善子宫动脉血供。     

Ovarian Stimulation Affects the Levels of Regulatory Endometrial NK Cells and Angiogenic Cytokine VEGF

Citation Junovich G, Mayer Y, Azpiroz A, Daher S, Iglesias A, Zylverstein C, Gentile T, Pasqualini S, Markert UR, Gutiérrez G. Ovarian stimulation affects the levels of regulatory endometrial NK cells and angiogenic cytokine VEGF. Am J Reprod Immunol 2011; 65: 146–153 Problem Endometrial NK cells play a critical role in uterine vascularization producing angiogenic factors. Impact of ovarian stimulation on endometrial expression of NK cells and VEGF in normal fertile oocyte donors and the effect of endometrial injury treatment on these parameters have been investigated. Method of study Endometrial tissue was obtained from oocyte donors during natural and stimulated cycles. NK cell subsets were measured by flow cytometry. VEGF was determined by ELISA and flow cytometry. Endometrial angiogenic parameters were determined by ultrasound Doppler. Local injury was induced by scratching endometrial tissue previous to implantation window. Results Ovarian stimulation decreased endometrial levels of NK cells and vascularization index but increased VEGF levels. Local injury normalized only the CD56⁺ NK cell count. Conclusion Hormonal therapy for ovarian stimulation may be associated with poor endometrial vascularization. Local injury before the implantation window seems not to influence endometrial angiogenic parameters altered by ovarian stimulation.     

Integration of Publicly Reported Center Outcomes into Standards and Accreditation: The FACT Model

The rapid evolution of blood and marrow transplantation (BMT), coupled with diverse outcomes associated with heterogeneous groups of patients, led to the formation of 2 important organizations early in the development of the field: the Center for International Blood and Marrow Transplant Research (CIBMTR) and the Foundation for the Accreditation of Cellular Therapy (FACT). These organizations have addressed 2 of the 9 elements identified by the National Quality Strategy (NQS) for achieving better health care, more affordable care, and healthy people and communities: a registry that promotes improvement of care and accreditation based on quality standards. More recently, a federally mandated database in the United States addresses the third element of the NQS: public reporting of treatment results. Here we describe the current process by which FACT incorporates patient outcomes reported by the CIBMTR into standards for accreditation, the requirements for accredited programs with performance below expected outcomes to maintain accreditation, and preliminary findings of an assessment of corrective action plans intended to improve outcomes.     

Refractoriness of Rhesus Monkeys to Repeated Ovarian Stimulation by Exogenous Gonadotropins is Caused by Nonprecipitating Antibodies

ABSTRACT: Oocytes obtained from superstimulated rhesus monkeys are needed for in vitro fertilization experiments. The animals become refractory to repeated ovarian stimulation by pregnant mare serum gonadotropin (PMSG). Production of antibodies against PMSG was suspected. Antibodies were not detected by gel-diffusion tests, but were found using ELISA procedures in sera from all monkeys that had been treated with PMSG. Sera from seven of nine treated monkeys had antibodies that cross-reacted with FSH-P. An ovarian stimulation test using golden hamsters showed that sera from PMSG-treated rhesus monkeys completely blocked superstimulation of follicle development and ovarian weight gain by PMSG. This study demonstrates that the refractoriness of rhesus monkeys to repeated ovarian stimulation by PMSG is due to the production of nonprecipitating antibodies to PMSG that effectively block the activity of PMSG on the ovary. Formation of these antibodies may preclude use of other gonadotropin preparations in refractory monkeys. Alternative ovarian stimulation procedures avoiding use of gonadotropin preparations need to be developed to permit repeated treatment of rhesus monkeys for multiple oocyte collection.     

卵巢癌病人化疗期间生存质量的动态研究

目的：描述卵巢恶性肿瘤病人化疗期间的生存质量，并探讨生存质量的动态变化和影响因素。方法：采用卵巢癌治疗功能评价系统(FACT-O)分别在第二、四、六次化疗三个阶段对复旦大学妇产科医院的卵巢恶性肿瘤病人进行有关生存质量问卷调查。结果：在化疗期间，总体生存质量呈上升趋势，三次测量结果差异有统计学意义。生理方面、卵巢癌特异性方面、心理方面和生活功能方面三次测量结果呈上升趋势，其中前两者差异有统计学意义，后两者差异无统计学意义。社交方面的得分呈下降趋势，并且三次测量结果差异有统计学意义。“和医生的关系”方面的变化趋势不明显，但第三次测量结果和前两次测量结果之间差异有统计学意义。结论：在化疗过程中，在没有复发和疾病进展的前提下，卵巢恶性肿瘤病人的生存质量为中、上水平，变化趋势基本上是逐渐提高。经济状况、家庭内支持和临床分期对生存质量的预测能力较强。     

New Strategy for Overcoming Resistance to Chemotherapy of Ovarian Cancer

Background

Ovarian cancer is one of the most sensitive solid tumors, with objective responses ranging from 60 to 80% even in patients with advanced stage. However, most patients ultimately recur and develop resistance to chemotherapy. As a result, the survival rate for patients with ovarian cancer has not improved over the past 20 years. Resistance to chemotherapy presents a major obstacle to attempt to improve the prognosis of patients with ovarian cancer. A new strategy is necessary to improve the prognosis of patients with ovarian cancer.

Methods

The mechanism of chemoresistance was reviewed to get over the resistance. Additionally, the biological characteristics of ovarian cancer and molecular-targeted agents including signal-transduction inhibitors and anti-angiogenesis were discussed.

Results

Genetic diagnosis for chemosensitivity with drug-resistance genes may be a useful predictor. Unfortunately, molecular-targeted therapy alone has been insufficient to improve the prognosis for patients with advanced ovarian cancer. Molecular molecular-targeted therapy should be carried out together with conventional cytotoxic agents. On the occasion of the use of the molecular targeted-agents, care of the appearance of the unexpected adverse effect should be important.

Conclusion

The future research in this field will enable to develop an effective strategy for conquest of chemoresistance in ovarian cancer.     

Cutaneous Mechanical Stimulation Regulates Ovarian Blood Flow via Activation of Spinal and Supraspinal Reflex Pathways in Anesthetized Rats

The reflex effects of noxious mechanical stimulation of a hindpaw or abdominal skin on ovarian blood flow, and the reflex pathways involved in those responses were examined in anesthetized rats. Blood flow in the left ovary was measured using a laser Doppler flowmeter, and the activity of the left ovarian sympathetic nerve and mean arterial pressure (MAP) of the common carotid artery were recorded. Stimulation of the left or right hindpaw for 30 s produced marked increases in ovarian sympathetic nerve activity and MAP. Ovarian blood flow slightly decreased during the stimulation and then slightly increased after the stimulation. After the left ovarian sympathetic nerves were severed, the same stimulus produced a remarkable monophasic increase in ovarian blood flow that was explained by passive vasodilation due to a marked increase in MAP. After spinal transection at the third thoracic (T3) level, the responses of MAP, ovarian sympathetic nerve activity, and ovarian blood flow to hindpaw stimulation were nearly abolished. Stimulation of the abdomen at the right or left side for 30 s produced slight increases in ovarian sympathetic nerve activity and MAP. Ovarian blood flow slightly decreased during the stimulation and then slightly increased after the stimulation. After the ovarian sympathetic nerves were severed, the response of the ovarian blood flow changed to a monophasic increase due to an increase in MAP. After spinal transection, stimulation of the left abdomen produced a moderate increase in MAP, a remarkable increase in ovarian sympathetic nerve activity and a slight decrease in ovarian blood flow during the stimulation. In contrast, stimulation of the right abdomen produced a smaller response in ovarian sympathetic nerve activity during the stimulation while it increased the MAP to a similar degree. Ovarian blood flow slightly increased after the end of stimulation, which was explained as passive vasodilation due to the increase in MAP. In conclusion, stimulation of somatic afferents affects ovarian blood flow by inducing changes in ovarian sympathetic nerve activities and blood pressure. When stimulation was applied to a hindpaw whose segment of afferent input is far from the segment of the ovarian sympathetic nerves, it took a supraspinal reflex pathway. However, when stimulation was applied to the abdomen whose spinal segment of the afferent is close to the segment of the ovarian sympathetic nerve output, there are spinal segmental reflex pathways. The present results demonstrate that spinal reflexes depend on the laterality of the stimulus, while supraspinal reflexes do not depend on the laterality of the stimulus.     

从卵巢癌cDNA文库中筛选新的肿瘤标志物

采用SEREX法筛选了自行构建的中国人卵巢癌cDNA表达文库 ,得到 2 7个阳性克隆 ,其中 3个为全长cDNA。序列分析和同源性比对结果表明所获得的 2 7个克隆分属于分化抗原、细胞结构蛋白及功能未知三类。选择其中一个全长cDNAMY OVA 13(该基因编码的蛋白是MAD2 ) ,利用基因工程方法克隆、表达和纯化得到目的蛋白 ,采用点杂交方法检测了MY OVA 13目的蛋白与正常人和肿瘤患者中的血清学反应。MY OVA 13抗体只在肿瘤组中检测到 (5 / 74 ) ,在正常组中均为阴性 ;间接ELISA测定结果显示 ,MY OVA 13抗体的水平在肿瘤组中均高于正常组 ,其中肝癌和前列腺癌组与正常组相比 ,在统计学上有显著差异 ,P值分别 <0 0 1和 <0 0 5。我们的初步结果表明MY OVA 13及其抗体具有一定的肿瘤特异性 ,有可能作为肿瘤诊断的标志物     

Overall Quality of Outcomes Framework scores lower in practices in deprived areas

BACKGROUND: There has been much debate as to whether quality points allocated through the new general medical services contract are more difficult to achieve for practices in deprived and rural areas. We used multiple regression to assess the relationships between deprivation, rurality and the number of overall quality points achieved by each practice. Multiple deprivation was significantly inversely related to quality points achieved. Practices in villages and towns gained 2% more quality points than urban areas and hamlets.     

Performance of small general practices under the UK's Quality and Outcomes Framework

Background

Small general practices are often perceived to provide worse care than larger practices.

Aim

To describe the comparative performance of small practices on the UK''s pay-for-performance scheme, the Quality and Outcomes Framework.

Design of study

Longitudinal analysis (2004–2005 to 2006–2007) of quality scores for 48 clinical activities.

Setting

Family practices in England (n = 7502).

Method

Comparison of performance of practices by list size, in terms of points scored in the pay-for-performance scheme, reported achievement rates, and population achievement rates (which allow for patients excluded from the scheme).

Results

In the first year of the pay-for-performance scheme, the smallest practices (those with fewer than 2000 patients) had the lowest median reported achievement rates, achieving the clinical targets for 83.8% of eligible patients. Performance generally improved for practices of all sizes over time, but the smallest practices improved at the fastest rate, and by year 3 had the highest median reported achievement rates (91.5%). This improvement was not achieved by additional exception reporting. There was more variation in performance among small practices than larger ones: practices with fewer than 3000 patients (20.1% of all practices in year 3), represented 46.7% of the highest-achieving 5% of practices and 45.1% of the lowest-achieving 5% of practices.

Conclusion

Small practices were represented among both the best and the worst practices in terms of achievement of clinical quality targets. The effect of the pay-for-performance scheme appears to have been to reduce variation in performance, and to reduce the difference between large and small practices.     

Updated Clinical Outcomes of Hematopoietic Stem Cell Transplantation Using Myeloablative Total Body Irradiation with Ovarian Shielding to Preserve Fertility

Myeloablative conditioning regimens are associated with severe gonadal toxicity. To preserve ovarian function, we have been investigating ovarian shielding during total body irradiation (TBI) with a myeloablative dose. In this report, we update the clinical outcomes. Female patients with standard-risk hematologic diseases, aged 40 years or younger, who desired to have children, were included (n = 19). The conditioning regimen consisted of TBI at 12 Gy with ovarian shielding and cyclophosphamide (120 mg/kg) or cytarabine (24 g/m²). Ovarian shielding reduced the actual irradiation dose applied to the ovaries from 12 Gy to 2 to 3 Gy. The median age at hematopoietic stem cell transplantation (HSCT) was 24 years (range, 19 to 33 years). With a median follow-up period of 1449 days (range, 64 to 3694) after HSCT, 5-year overall survival and 1- and 5-year relapse rates were 67%, 17%, and 31%, respectively. Only 2 of 14 patients with acute myeloid or lymphoid leukemia in remission have relapsed thus far. The 6-month and 1-year cumulative rates of menstrual recovery were 42% and 78%, respectively. In all patients with menstrual recovery, menstruation recovered within 1 year. The serum anti-Müllerian hormone (AMH) level tended to gradually increase after menstrual recovery. Three patients with extensive chronic graft-versus-host disease experienced delayed recovery of menstruation and serum AMH. Five pregnancies in 3 patients resulted in normal delivery in 1, selective cesarean operation in 1, current pregnancy in 1, and natural abortion in 2. These results suggest that a myeloablative TBI regimen with ovarian shielding could preserve fertility after HSCT without an apparent increase in relapse in standard-risk patients. Because serum AMH recovered gradually over time, the AMH level during the early phase after HSCT may have little value as a marker of ovarian reserve.     

Spotlight on Darbepoetin Alfa in the Treatment of Anemia in Patients with Cancer Receiving Chemotherapy

Darbepoetin alfa (Aranesp) is an analog of recombinant human erythropoietin (rHuEPO) produced using recombinant DNA technology. The high number of sialic acid moieties in darbepoetin alfa results in a prolonged half-life and enhanced in vivo biologic activity compared with rHuEPO (as demonstrated in animal studies), and permits a reduction in the frequency of administration.Subcutaneous darbepoetin alfa 2.25 microg/kg once weekly or 500microg once every 3 weeks (with a provision for dosage adjustments) is an effective and well tolerated erythropoietic agent in anemic patients with cancer receiving chemotherapy. In randomized, controlled clinical trials, the drug increased hemoglobin levels and reduced the need for blood transfusions in patients with various types of nonmyeloid malignancies, and also ameliorated anemia-related fatigue, thereby improving their health-related quality of life scores. The once-every-3-weeks dosage regimen provides further convenience by offering the possibility of synchronizing its administration with most chemotherapy regimens. Direct comparisons between approved dosages of darbepoetin alfa and other erythropoietic agents have not been conducted. Such comparisons would be very helpful in formulating definitive conclusions about their relative efficacy and cost effectiveness. Darbepoetin alfa provides an effective and well tolerated treatment option for the treatment of anemia in patients with cancer receiving chemotherapy.     

New Aspects of the Influence of Quadriceps Femoris Muscle Stimulation Course on Functional Capabilities of the Organism

We studied the effect of a course of electrical stimulation of the quadriceps femoris muscle with submaximal contraction under biofeedback conditions on functional capabilities of the organism. In addition to the known effects, electrostimulation course modulated the content of intra- and extracellular fluid and increases MDA content and creatine phosphokinase activity, which can be a manifestation of overtreatment. Impairment of body static balance after the course was revealed. Thus, monitoring of the effects of electrostimulation is required during the course.     

Effects of Auditory Stimulation on Respiration

Each of 40 college students received 6 presentations of white noise at an intensity of either SO or 110 dB during either inspiration or expiration. Changes in tidal volume, inspiratory period, and expiratory period elicited by that stimulation were studied. Auditory stimulation produced respiratory changes which could be regarded conveniently as two phasic responses. We labeled these responses the initial phasic response and the delayed phasic response. The initial response was limited to the respiratory period during which stimulation was delivered, it consisted of a brief inspiratory movement which increased the speed of inspiratory periods during which it occurred but decreased the speed of expiratory periods during which it occurred. In either case, the initial phasic response increased ventilation. The delayed phasic response was an increase both in speed and tidal volume of respiratory cycles subsequent to the period during which stimulation was delivered. Like the initial response, the delayed response increased ventilation. The effects of the delayed response were more widespread when stimulation was delivered during expiration rather than during inspiration. Stimulus intensity and stimulus repetition respectively potentiated and attenuated both the initial and the delayed phasic response. The findings are compared with those of earlier research on respiratory changes elicited by auditory stimulation.     

卵巢类固醇激素与癫痫

癫痫是由多种病因引起的慢性脑部疾患 ,以脑部神经元过度放电所致的突然、反复和短暂的中枢神经系统功能失常为特征。而大脑神经元的兴奋性与性激素关系密切 ,如雌二醇增加大脑的兴奋性 ,孕激素和它的代谢物则有很强的抑制作用。本文总结了近年来与之有关的动物实验结果和临床资料 ,对卵巢类固醇激素如何影响癫痫发作及其作用机制进行综述。     

The Effect of Patient Portals on Quality Outcomes and Its Implications to Meaningful Use: A Systematic Review

Background

The Health Information Technology for Economic and Clinical Health (HITECH) Act imposes pressure on health care organizations to qualify for “Meaningful Use”. It is assumed that portals should increase patient participation in medical decisions, but whether or not the use of portals improves outcomes remains to be seen.

Objective

The purpose of this systemic review is to outline and summarize study results on the effect of patient portals on quality, or chronic-condition outcomes as defined by the Agency for Healthcare Research and Quality, and its implications to Meaningful Use since the beginning of 2011. This review updates and builds on the work by Ammenwerth, Schnell-Inderst, and Hoerbst.

Methods

We performed a systematic literature search in PubMed, CINAHL, and Google Scholar. We identified any data-driven study, quantitative or qualitative, that examined a relationship between patient portals, or patient portal features, and outcomes. We also wanted to relate the findings back to Meaningful Use criteria. Over 4000 articles were screened, and 27 were analyzed and summarized for this systematic review.

Results

We identified 26 studies and 1 review, and we summarized their findings and applicability to our research question. Very few studies associated use of the patient portal, or its features, to improved outcomes; 37% (10/27) of papers reported improvements in medication adherence, disease awareness, self-management of disease, a decrease of office visits, an increase in preventative medicine, and an increase in extended office visits, at the patient’s request for additional information. The results also show an increase in quality in terms of patient satisfaction and customer retention, but there are weak results on medical outcomes.

Conclusions

The results of this review demonstrate that more health care organizations today offer features of a patient portal than in the review published in 2011. Articles reviewed rarely analyzed a full patient portal but instead analyzed features of a portal such as secure messaging, as well as disease management and monitoring. The ability of patients to be able to view their health information electronically meets the intent of Meaningful Use, Stage 2 requirements, but the ability to transmit to a third party was not found in the review.