Transitional cell carcinoma of the urinary bladder: histologic clearance with combined 5-FU chemotherapy and radiation therapy. Preliminary results of a bladder-preservation study

Fourteen patients with transitional cell carcinoma of the urinary bladder were treated with 4,000 cGy of pelvic irradiation concurrent with two 96-hour infusions of 5-fluorouracil (5-FU). Three weeks after completion of this regimen, patients underwent repeat cystoscopy and deep-muscle biopsy at the site of their original neoplasms. Eight of 14 (57%) had no tumor left in the biopsy specimen, and they received an additional course of chemotherapy and radiation therapy to a total dose of 4,400 cGy to the pelvis and 6,000 cGy to the bladder. Five of the 14 had residual tumor in the biopsy specimen (one did not undergo biopsy) and went on to planned cystectomy. Two of the five had no tumor in the cystectomy specimen. Overall, ten of the 14 patients (71%) have been downstaged to a condition of P0 (no tumor) following 4,000 cGy and two courses of 5-FU. Of eight patients with retained bladders, seven remain well at a median follow-up of 7 months. At a range of follow-up of 3-21 months and a median of 7 months, 13 of 14 patients remain tumor-free. This regimen results in a greater percentage of downstaging than conventional irradiation alone, and may allow bladder preservation for those with radiation therapy- and chemotherapy-responsive tumors.     

Radionuclide thyroid studies: a survey of practice in the United States in 1981. Special report

A survey was conducted to determine the radiopharmaceuticals and radionuclide imaging methods used for thyroid studies in the U.S. in 1981. The final sample, made up of 299 hospitals, was taken from a random sample consisting of 10% (337) of U.S. hospitals performing nuclear medicine studies. The survey showed that over one half of thyroid scans were obtained with Tc-99m pertechnetate and over one half of uptake studies were performed with I-131. Uptake determinations accompanied 78% of scans. Only 8% of the uptake studies were performed without scans. I-123 was more commonly used on the west coast and in the northeast, and there was interest in a more readily available and less expensive supply of I-123. Thyroid studies accounted for 6.7% of all nuclear imaging procedures. Approximately 7,760,000 nuclear medicine imaging procedures were performed in the U.S. in 1981.     

PMD6 Chronic Care Costs of New Medicare HMO Enrollees: Implications for Disease Management

Cost-effective care for chronic conditions is a growing concern of health plans enrolling increasing numbers of the elderly and disabled under Medicare risk contracts. This study provides evidence of the prevalence, patterns of care, and costs of chronic illnesses among new Medicare HMO enrollees. The results provide a foundation for estimates of the cost-effectiveness of drug therapy and care management programs that serve this group.
METHODS: We used national Medicare claims data to examine chronic care services and associated costs for a sample of 19,084 beneficiaries who enrolled in an HMO in 1995. We constructed three measures of cost: the total Medicare-covered cost, the cost of medical claims with the chronic condition coded as a diagnosis, and the regression-estimated effect of the chronic condition on cost.
RESULTS: 58% of the new Medicare HMO enrollees in our sample were treated for at least one of the selected chronic conditions in the six months before enrollment. One-third of the new enrollees had multiple conditions represented by diagnoses in more than one of eighteen chronic-condition groups. Persons with chronic conditions accounted for 93% of pre-enrollment Medicare costs among new HMO enrollees. Per 1,000 enrollees, pre-enrollment Medicare costs were greatest for those with hypertensive disease, coronary heart disease, heart failure, and diabetes.
CONCLUSIONS: The concentration of utilization and costs in those with chronic conditions suggests that appropriate drug therapy and care management for those with chronic conditions should be a top priority for HMOs with Medicare risk contracts. These estimates of prevalence suggest a need for HMOs to screen new Medicare HMO enrollees for chronic conditions immediately upon enrollment to ensure continuity of care.     

玻璃化保存工程化组织产品的实验与技术

目的:总结近年来玻璃化保存技术的新进展和多种工程化组织玻璃化保存的实验研究。探讨影响工程化组织低温保存的主要因素、评价指标等,以期指导玻璃化保存工程化组织的实验研究。资料来源:应用计算机检索Medline,EBSCO,ScienceDirect Onsite以及google scholar引擎中1980-02/2006-05关于细胞和组织低温保存的文献,检索词“tissue engineering,engineered tissue,cryopreservation,vitrification,ice-free cryopreservation,vitreous cryopreservation”,检索词被分别组合进行检索,限定文献语言种类为English。同时计算机检索万方数据库1980-02/2006-05关于细胞和组织低温保存的文献,检索词“组织工程,工程化组织,冻存,玻璃化保存”,限定文献语言种类为中文。资料选择:对资料进行初审,选出与研究关系密切的文献。纳入标准:研究对象为动物或人,包括基础与临床研究内容。重点选取与玻璃化保存技术基本原理相关以及具体的工程化构建物玻璃化保存相关的文献。排除标准:关于配子,胚胎和植物,食品等的玻璃化保存文章。资料提炼:共检索到122篇关于细胞和组织低温保存的文献,其中与本实验关系密切的文献17篇,间接相关的文献42篇,最终纳入31篇符合标准的文献。资料综合:组织工程产业化要求长期而稳定的保存包含活细胞的工程化组织产品,以及产品中细胞与材料的黏附。相对于传统的低温冻存技术而言,玻璃化保存因在保存过程中无细胞内外冰晶形成,可以改善复温后的细胞活力,并能保护细胞和支架材料之间的黏附。本文从近年来玻璃化保存技术的新进展和多种工程化组织玻璃化保存的实验研究进行综述,分析了玻璃化保存液要求高浓度,对细胞有非特异毒性损伤,对悬浮单细胞的玻璃化保存能得到较高的细胞存活,而与支架材料结合的种子细胞存活除受到冻存试剂和流程的影响外还受到自身结构的影响。结论:玻璃化保存是较好的生物系统保存方法,可以为工程化组织产品提供可靠的保存,但急需发现新的低毒高效的玻璃化试剂以及优化保存流程。     

Factors predicting the use of therapeutic hypothermia and survival in unconscious out-of-hospital cardiac arrest patients admitted to the ICU

Introduction

Therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA) was adopted early in Norway. Since 2004 the general recommendation has been to cool all unconscious OHCA patients treated in the intensive care unit (ICU), but the decision to cool individual patients was left to the responsible physician. We assessed factors that were associated with use of TH and predicted survival.

Method

We conducted a retrospective observational study of prospectively collected cardiac arrest and ICU registry data from 2004 to 2008 at three university hospitals.

Results

A total of 715 unconscious patients older than 18 years of age, who suffered OHCA of both cardiac and non-cardiac causes, were included. With an overall TH use of 70%, the survival to discharge was 42%, with 90% of the survivors having a favourable cerebral outcome. Known positive prognostic factors such as witnessed arrest, bystander cardio pulmonary resuscitation (CPR), shockable rhythm and cardiac origin were all positive predictors of TH use and survival. On the other side, increasing age predicted a lower utilisation of TH: Odds Ratio (OR), 0.96 (95% CI, 0.94 to 0.97); as well as a lower survival: OR 0.96 (95% CI, 0.94 to 0.97). Female gender was also associated with a lower use of TH: OR 0.65 (95% CI, 0.43 to 0.97); and a poorer survival: OR 0.57 (95% CI, 0.36 to 0.92). After correcting for other prognostic factors, use of TH remained an independent predictor of improved survival with OR 1.91 (95% CI 1.18-3.06; P <0.001). Analysing subgroups divided after initial rhythm, these effects remained unchanged for patients with shockable rhythm, but not for patients with non-shockable rhythm where use of TH and female gender lost their predictive value.

Conclusions

Although TH was used in the majority of unconscious OHCA patients admitted to the ICU, actual use varied significantly between subgroups. Increasing age predicted both a decreased utilisation of TH as well as lower survival. Further, in patients with a shockable rhythm female gender predicted both a lower use of TH and poorer survival. Our results indicate an underutilisation of TH in some subgroups. Hence, more research on factors affecting TH use and the associated outcomes in subgroups of post-resuscitation patients is needed.     

International comparative field study of N8 evaluating factor VIII assay performance

Summary. Discrepancies between the one‐stage clotting assay and the chromogenic method, and also among different variations of each method, have been a significant challenge for one B‐domain deleted FVIII product. N8 is a B‐domain truncated FVIII product developed by Novo Nordisk. The comparison of N8 and Advate^® was performed in an international, multicentre, randomized and blinded field study of simulated postinfusion samples. Overall, Advate^® and N8 performed similarly in the one‐stage assay. In the one‐stage clotting assay, the measured mean FVIII levels of Advate^® vs. N8 were 0.046/0.047, 0.24/0.24, 0.58/0.60 and 0.82/0.83 IU mL^?1 for the target values of 0.03, 0.2, 0.6 and 0.9 IU mL^?1, respectively. In the chromogenic assays, the concentration estimates showed a tendency towards higher N8 values as compared with Advate^®; the measured FVIII levels of Advate^® vs. N8 were 0.030/0.032, 0.22/0.24, 0.65/0.74 and 0.98/1.08 IU mL^?1 for the target values of 0.03, 0.2, 0.6 and 0.9 IU mL^?1, respectively. In the one‐stage assays, the measured values were above 150% of target at the lowest concentration, decreasing to around 90% of target at the highest concentration. In contrast, the chromogenic assays were close to target at the lowest concentration and consistently above target at the three highest concentrations. Therefore, the ratio of chromogenic/one‐stage potencies was concentration dependent, ranging from 0.66 to 1.30. The SSC plasma standard was similar in both. Assay variability was similar for both compounds. The results show that N8 can be reliably measured in plasma without the need for a separate N8 standard.