The use and safety of Ibuprofen in the hemophiliac

After demonstrating initial safety of Ibuprofen administered to hemophiliacs, a 16-wk double-blind individual crossover trial was designed to test the safety and, to a more limited extent, the efficacy of 1600 mg of Ibuprofen or placebo given daily to 20 hemophiliacs with hemophiliac arthropathy. The trial was completed with no evidence of increased frequency or severity of hemophiliac bleeding episodes or clinical or laboratory evidence of bleeding secondary to Ibuprofen. There were five treatment failures, none associated with hemorrhage or lack of compliance. A benefit was obtained in reduction of early morning stiffness and pain. Ibuprofen should be considered as a safe and potentially beneficial antiinflammatory agent in the treatment of carefully monitored hemophiliacs eligible for such therapy.     

The role of leptin in breast cancer

Leptin, the protein hormone produced mainly by adipocytes, placenta and mammary epithelium plays a significant role in, e.g., control of metabolism, reproductive processes, immune processes, angiogenesis, haemopoiesis and oxidation of lipids. Since some authors link leptin to mechanisms of mammary cancer development, the clinical data has been screened to allow evaluation of the hypothesis.     

Noninvasive methods used in prenatal diagnosis

Research in developing methods for noninvasive prenatal diagnosis has focused on the following: the isolation of fetal cells from the cervix, from the blood of pregnant women and the isolation of the fetal DNA. In the paper authors review the potential clinical diagnostic applications of fetal cells and fetal DNA analysis in maternal plasma or serum and fetal cells in cervical mucus for noninvasive prenatal diagnosis and screening of fetal aneuploidy, gene mutations, preeclampsia and preterm labor.     

Seal of transparency heritage in the CISMeF quality-controlled health gateway

Background  

It is an absolute necessity to continually assess the quality of health information on the Internet. Quality-controlled subject gateways are Internet services which apply a selected set of targeted measures to support systematic resource discovery.     

Cancer stage at diagnosis and survival among persons with Social Security Disability Insurance on Medicare

OBJECTIVE: To examine stage at diagnosis and survival for disabled Medicare beneficiaries diagnosed with cancer under age 65 and compare their experiences with those of other persons diagnosed under age 65. DATA SOURCES: Surveillance, Epidemiology, and End Results (SEER) Program data and SEER-Medicare linked data for 1988-1999. SEER-11 Program includes 11 population-based tumor registries collecting information on all incident cancers in catchment areas. Tumor registry and Medicare data are linked for persons enrolled in Medicare. STUDY DESIGN: 307,595 incident cases of non-small cell lung (51,963), colorectal (52,092), breast (142,281), and prostate (61,259) cancer diagnosed in persons under age 65 from 1988 to 1999. Persons who qualified for Social Security Disability Insurance and had Medicare (SSDI/Medicare) were identified from Medicare enrollment files. Ordinal polychotomous logistic regression and Cox proportional hazards regression were used to estimate adjusted associations between disability status and later-stage diagnoses and mortality (all-cause and cancer-specific). PRINCIPAL FINDINGS: Persons with SSDI/Medicare had lower rates of Stages III/IV diagnoses than others for lung (63.3 versus 69.5 percent) and prostate (25.5 versus 30.8 percent) cancers, but not for breast or colorectal cancers. After adjustment, they remained less likely to be diagnosed at later stages for lung and prostate cancers. Nevertheless, persons with SSDI/Medicare experienced higher all-cause mortality for each cancer. Cancer-specific mortality was higher among persons with SSDI/Medicare for breast and colorectal cancer patients. CONCLUSIONS: Disabled Medicare beneficiaries are diagnosed with cancer at similar or earlier stages than others. However, they experience higher rates of cancer-related mortality when diagnosed at the same stage of breast and colorectal cancer.     

Consumption of blood products during mechanical circulatory support in children: comparison between ECMO and a pulsatile ventricular assist device

Objective Different mechanical circulatory support (MCS) systems are used in children with intractable heart failure. However, the need for anticoagulation leads to hemorrhage with subsequent use of blood products. We compared the coagulation disorders and the need for blood products in children treated either with extracorporeal membrane oxygenation (ECMO) or with the Berlin Heart pulsatile pneumatic ventricular assist device.Patients We retrospectively reviewed the first 8-day course of 64 children who were on MCS for more than 2 days between 1990 and 2002. Thirty children (median age 7.4 years, weight 25.5 kg) received Berlin Heart support and 34 children (median age 1.8 years, weight 9.2 kg) ECMO. Anticoagulation was accomplished by continuous infusion of heparin. Red blood cell count, platelet count, aPTT, AT III, fibrinogen, and ACT were measured regularly. Depending on blood loss and the coagulation disorder, red blood cells, fresh frozen plasma, platelets, and AT III were substituted.Results There were no preoperative differences in hematological parameters between the two groups. In the Berlin Heart group platelet transfusion was 4.3 ml·kg·day vs 24.6 ml·kg·day in the ECMO group. Red blood cell substitution was 17.2 vs 60.3 ml·kg·day. Fresh frozen plasma substitution was 8.5 ml·kg·day vs 46.9 ml·kg·day (P<0.001). Even in the congenital heart defect subgroups, when MCS was implanted without recent cardiotomy, the differences were significant. Nevertheless, the mean daily values for hemoglobin, platelets, and fibrinogen were lower in the ECMO group. There was lower overall mortality in the Berlin Heart group.Conclusions Compared to ECMO, use of the Berlin Heart in children results in less blood loss and lower consumption of red blood cells, platelets, and fresh frozen plasma.Conflict of interest: Dr. Roland Hetzer received 4,000 Euros per year as consultant from the company Berlin Heart     

Perceptions and preferences of autologous blood donors

BACKGROUND: The public's perception of autologous blood donation and transfusion as a worthwhile alternative to allogeneic blood transfusion increased dramatically with discovery of the human immunodeficiency virus. However, new concerns are being raised about the health outcomes and cost-effectiveness of the procedure. As more restrictive guidelines for autologous blood donation evolve, opposition from patients concerned about exposure to allogeneic blood may arise. Physicians' ability to reassure patients and garner their support for more restrictive policies requires an understanding of patients' concerns. The motivations, perceptions, and preferences of patients currently participating in autologous blood donation programs were investigated in this study. STUDY DESIGN AND METHODS: Results from two questionnaire studies of 647 autologous blood donors are presented. The questionnaires assessed demographics, risk perceptions, preferences, willingness to pay, and reactions to different interventions designed to decrease patient preference for autologous blood donation. RESULTS: Patients expressed a strong preference for the availability of autologous blood and indicated that they would be willing to pay substantial amounts of money even if the procedure were not covered by insurance. Despite education about the low risks of complications from allogeneic transfusions, an aversion to allogeneic transfusion and a willingness to pay for autologous blood donation persisted. Patients were not reassured by information on better infectious disease testing or physician recommendation against autologous blood donation. CONCLUSION: Patients currently participating in autologous blood donor programs strongly prefer continued access to this procedure, primarily because they remain concerned about the complications of allogeneic transfusions. They may not be significantly reassured despite increasingly rigorous and costly improvements in donor and component screening.     

低频弱脉冲电磁场作用下成骨细胞的实时表面增强拉曼光谱研究

目的:弱强度的低频电磁场可促进成骨细胞的增殖、分化和钙盐分泌,进而加速伤骨愈合、加快骨组织代谢,为揭示低频弱脉冲电磁场影响成骨细胞的初始效应,应用表面增强拉曼光谱技术探索电磁场对成骨细胞的作用机制。方法:用出生5d的Wistar品系小鼠的颅骨接种成骨细胞并传代。应用表面增强拉曼光谱技术实时的方法采集不同磁场作用时间内低频率(50Hz)、低强度(0.30mT)脉冲电磁场作用下的成骨细胞的拉曼光谱。每隔1min采集一次,至作用8min止;并与电磁场作用前采集的拉曼光谱做比对。结果:比较电磁场作用前后和作用8min内不同时刻的拉曼光谱,可知其对成骨细胞膜蛋白和磷脂分子的构象有一定影响:表征膜蛋白中氨基酸侧链和磷脂C-C键骨架的特征峰的位移只发生了小幅变化,说明实验电磁场对细胞膜无损伤作用;在其作用之初的4.0～5.0min内,表征蛋白质构象信息的6个拉曼特征峰的相对强度随时间逐渐增加,揭示了构象发生改变的膜蛋白数量随电磁场作用时间的延长而增多。结论:实验探测到成骨细胞对低频脉冲电磁场的最初响应机制,表现为膜蛋白构象的有序变化。这为进一步探索由电磁刺激而激活的成骨细胞一系列信号转导通路的上游机制提供了有力的依据。