How informed is consent in a modern ENT department

The Department of Health issued a model consent form for use throughout the NHS from the 1st April 2002. Details of benefits and serious or frequent risks should be included on the form. We undertook a study to identify what proportion of complications from otolaryngology procedures were being recorded. Local morbidity and mortality records and case notes were examined from March to November 2004. Complications were identified and recorded. The consent forms for these operations were examined to identify if these complications had been recorded on the form prior to surgery. Complications were classified as “serious”, causing significant morbidity or increasing length of hospital stay or “frequent”, occurring in 1% or more of cases. A total of 2,978 operations were performed between March and November 2004. Seventy complications were identified in 60 patients (2% of operated patients). Twenty-three complications were not recorded on the consent forms in 20 (33%) patients. A total of 67% of all the complications were documented on the form as potential problems resulting from planned operations. Seven (74%) of complications that occurred but were not recorded on the consent forms were judged as “serious” or “frequent”. A significant proportion of serious or frequent complications are not being documented on the national consent forms before otolaryngological procedures and may not have been discussed. This may reflect a lack of openness during the consent process. In the current medical climate, this has serious ethical and medico-legal ramifications. It may also reflect a problem with the form and a need for a re-think of its design.     

半肢骨骺发育异常1例

１　病例报告　男,７岁．因双下肢不等长,右膝及右踝关节骨性肿大就诊．无明显外伤史,亦无红、肿、热、痛病史．查体：发育正常,营养良好．双下肢不等长,左６０ｃｍ,右６４ｃｍ,有跛行．右膝及右踝内侧肿大,肤色正常,关节活动无异常．Ｘ线：右侧半身诸关节（肩、肘、腕、髋、膝、踝）骨骺及干骺发育均较左侧增大,肢体较长,骨骺出现亦较对侧提早．如右尺骨茎突骨骺较左侧提早出现（图１）．右肘关节肱骨小头骨骺较左侧增大（图２）．右髋臼发育浅平,边缘毛糙,右股骨头骨骺较左侧明显增大,其距泪滴之距离较左侧大１．０ｃｍ,呈…     

Chick alpha-tectorin: molecular cloning and expression during embryogenesis.

The avian and mammalian tectorial membranes both contain two non-collagenous glycoproteins, alpha and beta-tectorin. To determine whether variations in the primary sequences of the chick and mouse alpha-tectorins account for differences in subunit composition and matrix structure of the tectorial membranes in these two species, cDNAs spanning the entire open reading frame of chick alpha-tectorin were cloned and the derived amino acid sequence was compared with that of mouse alpha-tectorin. Chick alpha-tectorin shares 73% amino acid sequence identity with mouse alpha-tectorin and, like mouse alpha-tectorin, is composed of three distinct modules: an N-terminal region similar to the G1 domain of entactin, a central region that shares identity with zonadhesin and contains three full and two partial von Willebrand factor type D repeats, and a C-terminal region containing a zona pellucida domain. The central region of chick alpha-tectorin contains fewer potential N-glycosylation sites than that of mouse alpha-tectorin and is cleaved at two additional sites. Differences in the glycosylation and proteolytic processing of chick and mouse alpha-tectorin may therefore account for the variation observed in the composition and structure of the collagenase-insensitive matrices of the avian and mammalian tectorial membranes. In situ hybridisation and Northern blot analysis of chick inner ear tissue indicate that the spatial and temporal patterns of alpha and beta-tectorin mRNA expression in the developing chick inner ear are different, suggesting the two tectorins may each form homomeric filaments.     

丁公藤碱Ⅱ类似物的合成及其生物活性

本文设计合成了丁公藤碱Ⅱ的C_2脱氧和C_8电子等排类似物。药理结果表明,丁公藤碱Ⅱ的C_2羟基是保持其缩瞳活性的关键部分之一;目的物2和4各自分别具有拟和抗胆碱活性;电子等排目的物16和17既无拟也无抗胆碱作用。     

Mass discrimination under Gz acceleration

The purpose of this study was to assess how the perception of mass discrimination is affected by elevated Gz acceleration. Previous experiments studied mass discrimination under weightless conditions. Ten subjects were tested with the Dynamic Environment Simulator (DES) at Wright-Patterson Air Force Base. Masses of 105, 110, 115, 120, and 125 g were compared to a 100-g standard for delta Ms of 5, 10, 15, 20, and 25 g. The subject had to choose which mass felt heavier. This was done at 1, 2, and 4 Gz. Significant differences were found between each of the G levels, and the subjects made more errors at higher Gz. Significant differences were also found between each of the delta Ms, except between delta Ms of 20 and 25 g. Using regression lines, the difference limen was calculated at the 75% correct response level for each Gz. The Weber fraction was found by dividing the difference limen by the 100-g standard. Weber fraction of 0.085, 0.116, and 0.145 were found at 1, 2, and 4 Gz, respectively. Impairment to discrimination was shown by calculating the ratio of the Weber fraction of the elevated Gz to 1 Gz. This demonstrated an impairment to mass discrimination at 1.36 at 2 Gz and 1.71 at 4 Gz. Impairment of mass discrimination under elevated G indicates that loss of adaptation is more important than weight or mass constancy or any other factors which would increase gravitational sensory cues. This study attempted to show adaptation by comparing runs done on different days. To show aftereffect, intervals of 1 G were compared to each other. The study did not find any adaptation or aftereffect. When compared to previous studies done in weightlessness, microgravity was found to be more detrimental to mass discrimination than macrogravity, at least up to 4 Gz.     

Early signs and symptoms of preterm labor

Patient and staff education concerning the subtle signs and symptoms that precede a clinical diagnosis of preterm labor have not been well established. Therefore we interviewed 100 patients for the presence or absence of various symptoms and signs during the 7 days preceding diagnosis of preterm labor. An additional 100 patients without preterm labor matched for gestation were chosen at random as control subjects. A history of increased uterine contractions, menstrual cramps, constant backache, constant pelvic pressure, increased amount and consistency and color change of vaginal discharge, and increased frequency of urination were present with a statistically significant higher frequency in patients with preterm labor compared with controls. Twenty-nine percent of patients did not report any uterine contractions and only half described them as painful. Fewer than 50% of the women reported contractions as frequently as every 10 minutes or more.     

Identification of the Hair Cell Soma-1 Antigen, HCS-1, as Otoferlin

Hair cells, the mechanosensitive receptor cells of the inner ear, are critical for our senses of hearing and balance. The small number of these receptor cells in the inner ear has impeded the identification and characterization of proteins important for hair cell function. The binding specificity of monoclonal antibodies provides a means for identifying hair cell-specific proteins and isolating them for further study. We have generated a monoclonal antibody, termed hair cell soma-1 (HCS-1), which specifically immunolabels hair cells in at least five vertebrate classes, including sharks and rays, bony fish, amphibians, birds, and mammals. We used HCS-1 to immunoprecipitate the cognate antigen and identified it as otoferlin, a member of the ferlin protein family. Mutations in otoferlin underlie DFNB9, a recessive, nonsyndromic form of prelingual deafness characterized as an auditory neuropathy. Using immunocytochemistry, we find that otoferlin is associated with the entire basolateral membrane of the hair cells and with vesicular structures distributed throughout most of the hair cell cytoplasm. Biochemical assays indicate that otoferlin is tightly associated with membranes, as it is not solubilized by alterations in calcium or salt concentrations. HCS-1 immunolabeling does not co-localize with ribeye, a constituent of synaptic ribbons, suggesting that otoferlin may, in addition to its proposed function in synaptic vesicle release, play additional roles in hair cells.