Stimulation of persisting colonies in agar cultures by sera from patients with CML and AML

Cord plasma contains colony-stimulating activity (CSA) which stimulates the in vitro clonal growth of neutrophils, eosinophils, macrophages, erythrocytes, and persisting mast cells in semisolid cultures. Analysis of day 35 colonies in agar cultures was found to be a suitable means of demonstrating this activity and discriminating between it and granulocyte-macrophage colony-stimulating factor (GM-CSF). Serum (10%) from patients with acute and chronic myeloid leukemia (AML and CML) was added to normal human bone marrow cultures to search for similar activity in these patient's serum. Although the number of colonies on day 12 (predominantly neutrophils and macrophages) was not significantly different from the number of colonies in cultures containing normal serum, the number of colonies increased 500% in cultures containing CML serum on day 35. Serum from patients with AML during regeneration also stimulated an increased number of colonies on day 35. Although both eosinophil and mast cell colonies were still present on day 35, only mast cell colonies persisted for 150 days. On day 35, cultures containing 10% CML serum contained predominantly eosinophil colonies (84%), whereas cultures containing AML serum contained predominantly mast cell colonies (76%). Although serum contains various CSFs, the specific factor which stimulates persisting mast cell colonies may be the human equivalent of murine persisting (P) cell-stimulating factor (Multi-CSF).     

The difficulties faced by informal caregivers of patients with terminal cancer in Hong Kong and the available social support

This study aimed to explore the difficulties experienced by primary informal caregivers of Chinese patients with terminal cancer in Hong Kong and the social support available for such caregivers. For this exploratory study, 21 primary informal caregivers of patients with terminal cancer were recruited from a hospice home service to complete a questionnaire. The results show that all but one of the caregivers (95.2%) perceived difficulties in rendering care. They reported experiencing four major kinds of difficulties: relationship with the care receiver (n = 11, 52.4%), emotional reactions to caring (n = 9, 42.9%), physical demands (n = 10, 47.6%), and restricted social life (n = 11, 52.4%). Of the 21 caregivers, 20 (95.2%) felt that the support received from hospice home care nurses was useful, especially in skill training (n = 16, 76.2%), informational support (n = 20, 95.2%), and emotional support (n = 20, 95.2%). Informal caregivers also indicated that home care nurses provided more useful overall support than family members and friends (chi2 = 11.35; P =.003). With a better understanding of the difficulties experienced by caregivers and the support they receive, hospice home care nurses will be in a better position to identify effective strategies for helping informal caregivers cope with their difficult circumstances.     

Prognostic use of circulating plasma nucleic acid concentrations in patients with acute stroke

BACKGROUND: At present there is no simple, accurate blood test that may be used to determine the severity of stroke or to predict mortality and morbidity in stroke patients presenting to emergency departments. METHODS: Patients with stroke-like symptoms who presented to an emergency department of a university hospital in Hong Kong were recruited for the study. DNA extracted from patients' plasma was analyzed for the beta-globin gene with a fluorescent-based PCR test. The primary outcome measures were in-hospital and 6-month mortality and morbidity using the post-stroke modified Rankin Score. RESULTS: Among the 88 consecutive patients recruited to the study, 70 (80%) had ischemic stroke, 11 (13%) had intracerebral hemorrhage, and 7 (8%) had transient ischemic attacks. Median plasma DNA concentrations taken within 3 h of symptom onset were higher in patients who died compared with those who survived at discharge (6205 vs 1334 kilogenome-equivalents/L; P = 0.03). Among patients with NIH Stroke Scale scores >8, median plasma DNA concentrations were higher in patients who died compared with those who survived to 6 months (2273 vs 968 kilogenome-equivalents/L; P = 0.002). Plasma DNA concentrations correlated with the volume of cerebral hematoma (r = 0.66; P = 0.03). Plasma DNA concentrations >1400 kilogenome-equivalents/L had a sensitivity of 100% and a specificity of 74.4% for predicting hospital mortality after stroke, and the area under the ROC curve was 0.89 (95% confidence interval, 0.80-0.94). The adjusted odds ratio for plasma DNA concentrations predicting 6-month mortality was 1.6 (1.1-2.4; P = 0.03) and for predicting 6-month post-Rankin Score >2 was 1.8 (1.0-3.3; P = 0.05). CONCLUSION: Plasma DNA concentrations correlate with stroke severity and may be used to predict mortality and morbidity in the emergency room.     

Baerveldt glaucoma implant with Supramid© ripcord stent in neovascular glaucoma: a case series

AIM: To report the outcome of Baerveldt glaucoma implant (BGI) with Supramid© ripcord use in neovascular glaucoma (NVG). METHODS: We retrospectively evaluated the surgical outcome of the BGI with Supramid© 3/0 ripcord stent in patients with NVG. No tube ligation or venting slits were performed. Supramid was removed after 3mo if the target intraocular pressure (IOP) was not achieved. Surgical success was defined as IOP≤21 mm Hg with (qualified success) or without IOP-lowering medications (complete success). RESULTS: Twenty-six eyes from 24 patients were included in the study. The median duration of follow-up was 4 [interquartile range (IQR)=1-5]y, ranging from 0.5 to 5y. IOP decreased by a mean of 24.2 mm Hg (59.7%); from a mean of 40.5±12.6 mm Hg at baseline to 16.3±11.9 mm Hg, P≤0.001. The number of glaucoma medications reduced from a median of 5 (IQR=5-6) to 1 (IQR=0-2, P≤0.001) at the final follow-up. Overall success rates were 88.0% at 1y, 34.8% at 3y, 66.7% at 4y, and 50% at 5y. Hypertensive phase (HP) in the first 3mo occurred in 15/26 eyes (57.7%) with a mean IOP of 31.1 mm Hg. CONCLUSION: BGI with Supramid© ripcord stent gives close to 90% of the overall survival rate at the final follow-up without significant early hypotony. However, early HP is still a challenge.     

Nursing students’ knowledge,attitude and readiness to work for clients with sexual health concerns

Aims. To investigate nursing students’ knowledge, attitude and readiness to work for clients with sexual health concerns and to identify strategies to help students develop as they take up their role in sexual health‐related care. Background. There is an increasing global demand for improving sexual health. A better understanding of nursing students’ attitude and readiness to work for clients with sexual health concerns is the beginning of this endeavour. The need to explore strategies for developing competent health care practitioners is timely. Design. A cross‐sectional survey. Methods. Nursing students (n = 377) studying in pre‐ and postregistration programmes were surveyed at a university in Hong Kong using a questionnaire with open‐ and closed‐ended questions about their knowledge, attitude and self‐perception on readiness to work for clients with sexual health concerns. Results. Students’ knowledge of sexual health was satisfactory. They were positive in acknowledging the nursing role in sexual health care, but hesitant in taking up an active role in practice. Students’ readiness to participate in related activities was below satisfactory. Their perception of inadequate knowledge, feelings of anxiety, worries about colleagues’ and clients’ possible adverse responses and inadequate exemplars were major factors affecting their readiness. This paper also highlighted some important learning areas and strategies that could help in enhancing students’ knowledge and confidence in sexual health care practices. Conclusion. Improving the educational programme and clinical practice for nursing students is necessary but may not be adequate. Valuing the affective aspect of education, formal recognition of this extended role and advancing related education to a postexperience level would also benefit the development of sexual health care. Relevance to clinical practice. Preparing more mentors as exemplars, inviting clinicians and managers as partners in sexual health‐related care would help nursing students to work efficiently for clients with sexual health concerns.     

Characterization of Cryptosporidium parvum in human and animal feces by single-tube nested polymerase chain reaction and restriction analysis

A DNA isolation and purification method is described that produced DNA free of inhibitory substances in 148 of the 159 analyzed fecal samples. The polymerase chain reaction (PCR) product from a sensitive single-tube nested PCR that amplifies a part of an oocyst protein was used to characterize Cryptosporidium parvum genotypes by a simple restriction analysis. Genotype 1 was solely detected in human-derived oocysts, genotype 2 was present in both animal and human-derived oocysts. The ratio between both genotypes in humans in The Netherlands varied markedly between samples obtained during a period of augmented cases of cryptosporidiosis in the western part of the country and randomly selected samples from gastroenteritis patients. Sequence analysis of a 581-bp fragment from the nested PCR product revealed 12 nucleotide substitutions between the two genotypes. Sequences from isolates in each genotype group were identical. Received: 18 January 1999 / Accepted: 9 March 1999     

Technique,outcome and changes in prostate dimensions in patients with urinary retention managed by aquablation

International Urology and Nephrology - This study aimed to investigate the functional and urodynamic outcome of Aquablation in patients with acute urinary retention (AUR) on catheters. Men aged...     

Small Intestinal Motility: Normal and Abnormal Function

This review outlines the properties and function of intestinal smooth muscle and the mechanisms that underlie contraction and relaxation. Both tonic and phasic (rhythmic) contraction are mediated by an increase in intracellular calcium. Phasic contraction is paced electrically by rhythmic changes in membrane potential (slow waves) which, upon reaching a threshold, lead to opening of membrane calcium channels and the entry of calcium into muscle cells; this inwardly directed calcium current or spike initiates a cascade of events resulting in contraction. Slow waves and spike potentials and, thus, phasic contraction, are influenced by neurotransmitters, hormones, and drugs. In circular muscle, these agents can also increase calcium by releasing it from intracellular stores, thus inducing tonic contraction. Ingestion of food initiates peristaltic propulsive activity which, in its rhythm, is superimposed on spontaneous phasic activity. The peristaltic reflex consists of two successive phases: relation of circular muscle distal to the distending bolus (descending relaxation) and contraction proximal to the bolus (ascending contraction). In-between meals, a different, slower pattern of muscle activity prevails, known as the migrating motor complex, which helps to maintain the lumen of the intestine free of contents. Improved understanding of normal muscle function is beginning to reflect itself in improved management of patients with motility disorders.     

Echocardiographic evaluation of cardiac function in paediatric oncology patients treated with or without anthracycline

Using Doppler echocardiography, we studied the left ventricular systolic and diastolic function in 124 healthy control children (group C), 110 oncology patients who had received anthracycline (group A), and 76 oncology patients who had received chemotherapy not including anthracycline (group N), at rest and after supine bicycle exercise. The mean dosage of anthracycline that group A patients received was 219 ± 95 mg/m². Impaired systolic function was detected in 29% of the patients in group A and 4% in group N. Figures for impaired diastolic function for group A and N were 27% and 28% respectively. Abnormal diastolic function was detected more frequently in the first two years after chemotherapy in both groups. Four parameters measured at rest appeared to be specifically abnormal in group A but not in group N. These were ejection fraction, fractional shortening, rate-corrected velocity of circumferential fiber shortening (VCFC) and left ventricle peak systolic wall stress (LVWS). After exercise more parameters were abnormal in group N patients when compared to normal children, but abnormalities of VCFC and LVWS remained specific for group A. In conclusion, abnormalities of diastolic function were common among paediatric oncology patients no matter whether they had received anthracycline treatment or not. Abnormalities of systolic function were more specific to anthracycline toxicity. VCFC and LVWS were the most sensitive measurements for differentiating group N patients from group A patients.