Dissemination of the work of public health medicine trainees inpeer-reviewed publications: an unfulfilled potential

Objective:

To assess the extent to which work undertaken during training in public health medicine was formally disseminated in peer-reviewed publications.

Setting:

An English Health Region.

Methods:

A postal questionnaire survey of former and current senior trainees.

Results:

The response rate was 75% (38/51). Thirty per cent (11/37) had no publications arising from any workundertaken during training and specifically 49% (18/37) had no publications arising from submissions made for the Part II examination for Membership of the Faculty of Public Health Medicine, Major perceived barriers to publication were: lack of priority accorded to publication by the training department; lack of time and lack of a supervisor or mentor to facilitate preparation of material.

Conclusions:

Overcoming these perceived barriers will require action at trainee, trainer and organisationallevel. Skills training in writing could be included in academic courses and publication could be identified as a training goal for appropriate pieces of work. Health authorities could be more active in encouraging publication of work undertaken by trainees on their behalf.     

Quality of life of patients with end stage renal disease: a structural equation model

In this study, the perceived quality of life (QOL) of 215 patients with end stage renal disease (ESRD) was examined. A LISREL model describing the patients' perceptions of their QOL was tested and, after some revisions, was found to be consistent with the data ( ²=33.76, df=25, p=0.113). QOL was measured by: the Self-Anchoring Striving Scale, the index of Well-Being, and the Time Trade-Off Technique. The model includes the patients' medical characteristics, their health status, functional status, support and outlook. Outlook, functional status and treatment modality had significant direct effects on QOL. Support influenced QOL through the mediating variable, outlook. This study suggests that a theoretical reexamination of the measurement structure of QOL is warranted.     

X inactivation analysis and DNA methylation studies of the ubiquitin activating enzyme E1 and PCTAIRE-1 genes in human and mouse

Previously reported data on the X inactivation status of the ubiquitin activating enzyme E1 (UBE1) gene have been contradictory, and the issue has remained unsettled. Here we present three lines of evidence that UBE1 is expressed from the inactive X chromosome and therefore escapes X inactivation. First, by RNA in situ hybridization, UBE1 RNA is detected from both the active and inactive X chromosomes in human female fibroblasts. Second, UBE1 is expressed in a large panel of somatic cell hybrids retaining inactive human X chromosomes, including two independent hybrids that did not require UBE1 expression for survival. And third, sites at the 5' end of UBE1 are unmethylated on both active and inactive X chromosomes, consistent with the gene escaping inactivation. In order to address whether other genes that escape inactivation map to the same region of the X chromosome, we have also examined the expression of genes mapping adjacent to UBE1. The gene for PCTAIRE-1 (PCTK1) maps within 5 kb of UBE1 and similarly escapes X inactivation by the somatic cell hybrid assay, whereas six other genes that are within 1 Mb of UBE1 in Xp11.23 are silenced on the inactive X chromosome. Comparative mapping studies of the homologous loci in mouse establish that Ube1-x and Pctk1 are also within close physical proximity on the murine X chromosome, and expression studies of the Pctk1 gene determine that, similar to Ube1-x, it is subject to X inactivation in mouse. Methylation of CpG residues at restriction sites at the 5' end of both genes on the murine inactive X chromosome is consistent with both genes being subject to X inactivation in mouse, in contrast to their expression status in humans.      

Influence of the vascular endothelium on angiotensin II-induced contractions in rabbit renal artery

Summary— The influence of vascular endothelium on angiotensin II-induced contraction and the underlying mechanisms in the rabbit renal artery were investigated. In endothelium-intact preparations, angiotensin II (3–100 nM) caused a concentration-dependent increase in tension by maximally (E_max) 0.74 ± 0.05 g. Removal of the endothelium significantly enhanced the angiotensin II-induced contractions (E_max: 3.91 ± 0.19 g). Indomethacin (10 μM) did not influence the angiotensin II-induced contractions. Methylene blue (10 μM) and N^G-methyl-1-arginine (L-NMMA, 5 μM) significantly enhanced angiotensin II-induced contractions by 418 ± 29% and 200 ± 14%, respectively, in endothelium intact preparations, but not in those devoid of endothelium. L-arginine (1 mM), but not D-arginine, reversed the L-NMMA-induced enhancement of the angiotensin II-induced contraction. The present results suggest that angiotensin II-induced contractions in rabbit renal artery are largely subject to the influence of the endothelium. The endothelium-derived relaxant factor (EDRF), rather than cyclo-oxygenase products, appears to be involved in mediating the inhibitory effects of the endothelium. Nitric oxide (NO) derived from endothelium may play a major role in inhibiting angiotensin II-induced contractions in this preparation.     

Analysis of the structure and activity of A and A,B immunoglobulin A monoclonal antibodies

A study of the serologic activity and molecular structures of three spleen-derived mouse IgA monoclonal human blood group-specific supernatants was undertaken; this was part of an evaluation of these monoclonals as blood typing reagents. The monoclonal antibodies were eluted through a precalibrated size-exclusion column, and fractions were analyzed by immunoblotting, heavy and light chain-specific enzyme-linked immunosorbent assay, and liquid- and solid-phase serologic tests. Results indicated that one of the supernatants (anti-A specificity) contained tetrameric and monomeric forms of IgA, while the other two (anti-A,B specificity) contained three higher polymeric forms (1000-4000 kDa) and one dimeric form. The tetrameric and polymeric forms showed red cell agglutinating activity, whereas the dimeric and monomeric forms did not. All forms contained heavy and light chains. The monomeric anti-A showed specific binding to appropriate red cells in a solid-phase assay, but the dimeric anti-A,B fractions did not. Purified fractions stored at 4 degrees C did not show any equilibration toward other forms, which indicated that the molecules are stable once secreted. The use of such antibodies as blood grouping reagents requires careful monitoring to ensure that high proportions of nonagglutinating molecular weight forms are not produced, as they could compromise the performance of the reagent by binding to red cell antigen in competition with the agglutinating forms.     

Focal segmental necrotizing glomerulonephritis in rheumatoid arthritis

We report ten patients with rheumatoid arthritis (RA) who developed a focal segmental necrotizing glomerulonephritis (FSNGN) and extracapillary proliferation typical of vasculitic glomerulonephritis. Five patients also had extrarenal vasculitis. Renal presentation was with renal impairment (n = 9) (median creatinine 726 mumol/l, range 230- 1592 mumol/l), microscopic haematuria (n = 8) and proteinuria (n = 10). Nine patients were seropositive for rheumatoid factor and nine had bone erosions. Serum from four of five patients tested by indirect immunofluorescence was positive for antineutrophil cytoplasmic antibody (ANCA) with perinuclear staining. Only three patients had penicillamine or gold therapy. Treatment was with prednisolone and cyclophosphamide (six patients, two of whom were also plasma-exchanged), prednisolone and azathioprine (two patients) and prednisolone alone (two patients). There was a marked improvement in renal function in eight patients. Two patients with dialysis-dependent renal failure recovered renal function, although in one patient this was transient and she required further dialysis 4 months later. Two other patients progressed to dialysis at 3 months and 1 year respectively. Four patients died, one remains dialysis-dependent, and four continue to have good renal function at 5 year follow-up (median creatinine 148.5 mumol/l, range 120-193 mumol/l). One patient was lost to follow-up at 5 years. FSNGN should be considered in all patients with RA and renal impairment, proteinuria and/or microscopic haematuria. This diagnosis appears to be more likely in patients with clinical extrarenal vasculitis, bone erosions or who are seropositive. In these cases, an urgent renal biopsy is indicated.      

Simultaneous acute splenic sequestration and transient aplastic crisis in children with sickle cell disease

Acute splenic sequestration crisis (ASSC) is a hematological emergency in young children with sickle cell disease (SCD), characterized by worsening anemia and splenomegaly, usually with reticulocytosis and thrombocytopenia. Transient aplastic crisis (TAC) due to parvovirus B19 infection occurs in older children with SCD, and typically manifests as worsening anemia with reticulocytopenia and no splenomegaly. Five older children with SCD (4 HbSC, 1 HbSS on hydroxyurea) developed ASSC concurrent with TAC and had a severe clinical course. Our cases suggest that older children with SCD and acute parvovirus infection should be monitored closely for splenomegaly and multi‐system dysfunction. Pediatr Blood Cancer 2009;53:479–481. © 2009 Wiley‐Liss, Inc.     

多排螺旋CT对儿童主动脉缩窄的诊断价值

目的 探讨多排螺旋CT以其后处理图像对儿童主动脉缩窄的诊断价值.方法 临床怀疑为主动脉缩窄的患者26例,平均年龄7.5 个月(5天～4岁),进行多排螺旋CT增强扫描.对所有病例的CT轴位图像按需要进行多平面重组及容积再现、最大密度投影.结果 26例患儿顺利完成MDCT成像检查,均确诊为主动脉缩窄,其中11例主动脉弓发育不良,CT诊断与手术结果相一致.主动脉靶重建直观地显示主动脉缩窄的部位及程度.结论 MDCT是一种有用的无创伤性检查方法,结合二维与三维图像有助于主动脉缩窄的诊断以及治疗方案的制定.     

小脑扁桃体下疝畸形合并脑室扩张的外科治疗

目的 探讨小脑扁桃体下疝畸形合并脑室扩张的手术方法及其效果。方法 回顾性分析20例小脑扁桃体下疝畸形合并脑室扩张病人的临床资料,全部病例均采用后正中入路小骨窗枕下减压加自体筋膜减张缝合术。结果 全部病例术后MRI显示延颈髓压迫解除、枕大池形态恢复;术后20例病人均获得随访,平均随访24个月,2例症状完全消失,12例症状明显改善,5例症状无明显改变,1例症状加重;20例病人脑室大小均未见明显改变,无脑室扩张加重病例。结论 脑室扩张是小脑扁桃体下疝畸形先天畸形的一部分,而不是由于枕大孔区梗阻造成的梗阻性脑积水;小脑扁桃体下疝畸形合并脑室扩张患者颅内压多正常,在行枕下减压术前一般不需要行脑室外引流术,后正中入路小骨窗枕下减压术可取得良好效果,术后未发现有脑室进行性扩大或颅内压增高的现象。