Cell-type-specific transactivation of the parathyroid hormone-related protein gene promoter by the human T-cell leukemia virus type I (HTLV- I) tax and HTLV-II tax proteins

The human T-cell leukemia virus type I (HTLV-I) and HTLV-II Tax proteins are potent transactivators of viral and cellular gene expression. Using deletion mutants, the downstream parathyroid hormone- related protein (PTHrP) promoter is shown to be responsive to both HTLV- I and HTLV-II Tax as well as the AP1/c-jun proto-oncogene. Transactivation of PTHrP by Tax was seen in T cells but not in B-cell lines or fibroblasts. A carboxy terminal Tax deletion mutant was deficient in transactivation of both the PTHrP and IL2R alpha promoters but not the HTLV-I long terminal repeat (LTR). Exogenous provision of NFkB rescued IL2R alpha expression but not the PTHrP promoter. Thus, HTLV-I Tax, HTLV-II Tax, and c-jun transactivate PTHrP and may contribute to the pathogenesis of hypercalcemia in adult T-cell leukemia.     

Cost-effectiveness of continuous positive airway pressure therapy in patients with obstructive sleep apnea-hypopnea in British Columbia

BACKGROUND:

Obstructive sleep apnea-hypopnea (OSAH) is a common disorder characterized by recurrent collapse of the upper airway during sleep. Patients experience a reduced quality of life and an increased risk of motor vehicle crashes (MVCs). Continuous positive airway pressure (CPAP), which is the first-line therapy for OSAH, improves sleepiness, vigilance and quality of life.

OBJECTIVE:

To assess the cost-effectiveness of CPAP therapy versus no treatment for OSAH patients who are drivers.

METHODS:

A Markov decision analytical model with a five-year time horizon was used. The study population consisted of male and female patients, between 30 and 59 years of age, who were newly diagnosed with moderate to severe OSAH. The model evaluated the cost-effectiveness of CPAP therapy in reducing rates of MVCs and improving quality of life. Utility values were obtained from previously published studies. Rates of MVCs under the CPAP and no CPAP scenarios were calculated from Insurance Corporation of British Columbia data and a systematic review of published studies. MVCs, equipment and physician costs were obtained from the British Columbia Medical Association, published cost-of-illness studies and the price lists of established vendors of CPAP equipment in British Columbia. Findings were examined from the perspectives of a third-party payer and society.

RESULTS:

From the third-party payer perspective, CPAP therapy was more effective but more costly than no CPAP (incremental cost-effectiveness ratio [ICER] of $3,626 per quality-adjusted life year). From the societal perspective, the ICER was similar ($2,979 per quality-adjusted life year). The ICER was most dependent on preference elicitation method used to obtain utility values, varying almost sixfold under alternative assumptions from the base-case analysis.

CONCLUSION:

After considering costs and impact on quality of life, as well as the risk of MVCs in individuals with OSAH, CPAP therapy for OSAH patients is a highly efficient use of health care resources. Provincial governments who do not provide funding for CPAP therapy should reconsider.     

Functional anatomy of the retro- and suprahepatic portions of the human inferior vena cava and their main affluents

Summary The arrangement of muscle, collagen and elastic fibers was studied in the retro- and suprahepatic (subdiaphragmatic) portions of the inferior vena cava, the hepatic veins and their main affluents. Distinctive features of the longitudinal and transverse muscle bundles are described. In these portions of the vena cava, both bundle systems are clearly separate and any continuity was observed only at the entrances of the hepatic veins. A musculo-venulolymphatic complex was noted in spurs formed by the vascular junctions. The hepatic veins and their main affluents exhibit an elliptical contour in transverse section, which apparently results from cranial and caudal thickenings of the longitudinal muscle layer. Many of these bundles are in continuity with those of the transverse muscle layer. Terminal elastic tendons were rarely observed in connection with muscle fibers of the inferior vena cava and are not present in the hepatic veins and their main affluents. In terms of form and function, the relatively thin muscular layer has a dilating action on the hepatic venous system because of the external fixed insertion point of the muscle bundles. Such an arrangement and a polar disposition of the muscle bundles in the hepatic venous system may assists in suction of the blood toward the heart. A sphincteric control of the ostia by means of crossed muscular loops supported by venulo-lymphatic micropads is a possibility.

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Anatomie fonctionnelle des segments rétro et supra-hépatiques de la veine cave inférieure et de leurs principaux affluents

Résumé La disposition des fibres collagènes et élastiques des muscles de la paroi veineuse a été étudiée dans les segments rétro et suprahépatiques (sub-diaphragmatique) de la veine cave inférieure, des veines hépatiques et de leurs principaux affluents. Des caractéristiques de groupes musculaires longitudinaux et transversaux sont décrits. Dans ces portions de la veine cave, les deux groupes sont distinctement séparés et une continuité n'a pu etre observée qu'aux abouchements des veines hépatiques. Un complexe musculoveino-lymphatique a été décrit sous forme d'éperons aux jonctions vasculaires. Les veines hépatiques et leurs principaux affluents présentent un contour elliptique en section transversale, qui résulte apparemment d'épaississements crânio-caudaux de la couche musculaire longitudinale. De nombreux groupes sont en continuité avec ceux de la couche musculaire transversale. Des tendons élastiques terminaux ont été rarement observés en connection avec les fibres musculaires de la veine cave. Ils sont absents dans les veines hépatiques et leurs principaux affluents. Les analyses morpho-fonctionnelles confèrent à la couche musculaire relativement fine une action d'expansion sur le système de veines hépatiques en fonction du point d'insertion fixe externe des groupes musculaires. Un tel arrangement et une disposition polaire de groupes de muscles dans le système veineux hépatique peut favoriser une aspiration du sang vers le coeur. Un contrôle sphinctérien au niveau des abouchements par un système d'anneaux musculaires croisés supportés par des microbourrelets veinolymphatiques est analysé.

     

Weaning practice in the Glasgow Longitudinal Infant Growth Study

AIMS: To assess compliance with Department of Health guidelines on weaning practice in a representative sample of 127 infants from Glasgow, and to identify factors influencing timing of weaning. METHODS: Questionnaires on feeding and weaning were completed during home visits. Ninety eight mothers completed a further questionnaire on attitudes to weaning. RESULTS: Median age at introduction of solid food was 11 weeks (range 4-35 weeks); only 7% of infants had not been weaned before age 4 months. There was no difference in timing of weaning between boys and girls. Younger mothers (< 20 years old), those of lower socioeconomic status, and those who formula fed their infants tended to introduce solids earlier. Infants who were heaviest before weaning were weaned earlier. Seventy three of 98 mothers reported that they weaned their babies because they felt that they required more food. Sources of information influencing time of weaning were previous experience (53/98), books and leaflets (43/98), advice from the health visitor (31/98), and family and friends (15/98). Sixty five of 98 mothers reported receiving formal information on weaning, in most cases (54) this was from the health visitor. Mothers who received formal information tended to wean their infants later. Two per cent of infants had been given cow's milk as a main drink by age 6 months, 17% by 9 months, and 45% by the end of the first year. CONCLUSION: Compliance with recommendations on timing of weaning (not before 4 months), weaning foods, and cow's milk consumption in Glasgow is poor, although no poorer than in many other areas of the UK as found by Office of Population, Censuses and Surveys. Public health messages in relation to weaning may not be reaching their target audience.     

Late effects of radiation therapy for prostate carcinoma: The patient's perspective of bladder,bowel and sexual morbidity

The patients’perceptions of the late effects of radiation therapy for carcinoma of the prostate on bladder, bowel and sexual function were determined by using a self-administered questionnaire which was posted in June 1996 to patients who had been treated for carcinoma of the prostate between February 1993 and April 1994 at the Htrston centre of the Queensland Radium Institute. The questions were based on the SOMA-LENT subjective scales. Moderate bladder morbidity was reported by 15% of patients, with 2% reporting major morbidity. Moderate bowel morbidity was reported by 19% of patients with 2% reporting major morbidity, the major symptoms being bowel urgency and mucus discharge. Sexual function was a problem, with 72% of patients reporting dissatisfaction with their current level of sexual activity.     

男护士在妇产科实习体验的质性研究

目的探讨男护士在妇产科的实习体验。方法采用现象学研究方法,深入访谈2012年3月~2013年5月在妇产科实习的男护士12名,并用Colaizzi的7步分析法分析访谈资料。结果男护士在妇产科实习的主要体验有：得不到患者的理解与支持、失落感、学习积极性下降、生活学习不方便、对专科操作不满意等。结论男护士在妇产科实习期间有着多种不良体验,临床带教老师要积极采取措施帮助他们顺利完成在妇产科的实习。     

膳食干预对围绝经期妇女围绝经期症状的影响

目的探讨围绝经期妇女增加膳食中的大豆及其大豆制品含量对改善围绝经期症状的效果。方法对2008年1至2月来本院进行健康查体的30～45岁女性,由医疗确诊已存在围绝经期症状的156例妇女,随机分为膳食干预组、结合雌激素组和对照组,对膳食干预组给予量化进食大豆或大豆制品,结合雌激素组给予结合雌激素口服,对照组保持原饮食习惯不变。经一年干预,采用Kuppennun评分观察各组症状改善情况。结果对照组干预后Kuppermun评分为（20．54±7．94）分,膳食干预组为（15．10±6．20）分,雌激素组为（15．31±6．62）分;对照组与膳食干预组比较差异有统计学意义（P〈0．05）;结合雌激素组与膳食干预组比较,差异无统计学意义（P〉0．05）。结论围绝经期妇女经增加膳食中的大豆或大豆制品的含量可以替代激素作用,能有效地改善围绝经期症状。     

Efficacy and safety of caspofungin for treatment of invasive aspergillosis in patients refractory to or intolerant of conventional antifungal therapy

BACKGROUND: Invasive aspergillosis (IA) is an important cause of morbidity and mortality among immunocompromised patients. Echinocandins are novel antifungal molecules with in vitro and in vivo activity against Aspergillus species. METHODS: We investigated the efficacy and safety of caspofungin in the treatment of IA. Ninety patients with IA who were refractory to or intolerant of amphotericin B, lipid formulations of amphotericin B, or triazoles were enrolled to receive caspofungin. RESULTS: Efficacy was assessed for 83 patients who had infection consistent with definitions of IA and who received >or=1 dose of study drug. Common underlying conditions included hematologic malignancy (48% of patients), allogeneic blood and marrow transplantation (25% of patients), and solid-organ transplantation (11% of patients). Seventy-one patients (86%) were refractory to and 12 patients (14%) were intolerant of previous therapy. A favorable response to caspofungin therapy was observed in 37 (45%) of 83 patients, including 32 (50%) of 64 with pulmonary aspergillosis and 3 (23%) of 13 with disseminated aspergillosis. Two patients discontinued caspofungin therapy because of drug-related adverse events. Drug-related nephrotoxicity and hepatotoxicity occurred infrequently. CONCLUSION: Caspofungin demonstrated usefulness in the salvage treatment of IA.