Readability of informed consent documents used in the hospitals of Asturias

OBJECTIVE: To evaluate the readability of the informed consent documents (ICD) used in the health centers of Asturias (Spain) with the aim of verifying whether the ICD are understandable and sufficient as a vehicle of information to empower patients to participate in decisions related to their diagnosis and treatment. METHOD: A total of 1114 ICD were gathered from the health centers in Asturias. A representative random sample from each hospital was selected and the following readability indexes were obtained: the Flesch index, the sentence complexity index, and the integrated legibility index. RESULTS: Of the ICD in the sample studied, legibility was acceptable in 77.3% (221 out of 286) according to the integrated legibility index, in 75.2% (215 out of 286) according to the sentence complexity index and in 3.5% (10 out of 286) according to the Flesch index. The mean values of the indexes differed among hospitals (p < 0.001, ANOVA test). CONCLUSIONS: ICD written in Spanish achieved low readability scores in the Flesch index and require corrective measures. Three quarters of the ICD were acceptable due to the use of simple sentences in the text. We believe that readability indexes should be used when drafting or improving informed consent documents.     

Perioperative nutrition prevents the early protein losses in patients submitted to gastrointestinal surgery

BACKGROUND & AIMS: The metabolic response to surgery includes a net loss of proteins that influences negatively the clinical evolution of the patients. We investigated the effect of perioperative nutrition on protein metabolism alterations immediately after surgery. METHODS: A control group of 21 surgery patients were submitted to conventional perioperative nutritional protocol (18 h of fasting plus low-dose glucose after surgery). An experimental group of eight similar patients was given complete parenteral nutrition during 24 h before and 24 h after surgery. Nitrogen balance, whole body protein synthesis, breakdown, and 3-methylhistidine were determined before surgery and 24 h after surgery. RESULTS: The immediate response to surgery with conventional nutritional management was a net protein loss (-1.023 g prot. kg(-1) day(-1)), caused by an increase in the protein breakdown (137.9% of preoperative values), while the protein synthesis remained unchanged (98.4%). The 3-methylhistidine excretion was not increased in respect to perioperative values, suggesting that the degraded protein was not from muscular origin. The experimental group with perioperative nutrition showed neither protein loss (+0.075 g prot. kg(-1) day(-1)) nor changes in protein synthesis or breakdown vs. preoperative values (96.3% and 88.0%, respectively). CONCLUSION: Perioperative nutrition prevents the early protein losses after gastrointestinal surgery.     

Regulation of lactate production and glucose transport as well as of glucose transporter 1 and lactate dehydrogenase A mRNA levels by basic fibroblast growth factor in rat Sertoli cells

By using cultured rat Sertoli cells as a model, both the action of basic fibroblast growth factor (bFGF) on lactate production and the site of this action were studied. bFGF stimulated Sertoli cell lactate production in a dose-dependent manner (basal: 7.3+/-0.5; 0.1 ng/ml bFGF: 7.5+/-0.5; 1 ng/ml bFGF: 7.5+/-0.6; 10 ng/ml bFGF: 10.3+/-1.0; 30 ng/ml bFGF: 15.2+/-1.5; 50 ng/ml bFGF: 15.4+/-1.6 microg/microg DNA). Two major sites for the action of this growth factor were identified. First, bFGF was shown to exert short- and long-term stimulatory effects on glucose transport (basal: 1170+/-102; 30 ng/ml bFGF for 120 min: 1718+/-152 and basal: 718+/-64; 30 ng/ml bFGF for 48 h: 1069+/-69 d.p.m./microg DNA respectively). Short-term bFGF stimulation of glucose transport was not inhibited by the protein synthesis inhibitor cycloheximide. These results indicate that short-term bFGF stimulation of glucose uptake does not involve an increase in the number of glucose transporters. On the other hand, stimulation with bFGF for periods of time longer than 12 h increased glucose transporter 1 (GLUT1) mRNA levels. These increased mRNA levels were probably ultimately responsible for the increments in glucose uptake that are observed in long-term treated cultures. Secondly, bFGF increased lactate dehydrogenase (LDH) activity (basal: 31.0+/-1.4; 30 ng/ml bFGF: 45.7+/- 2.4 mIU/microg DNA). The principal subunit component of those LDH isozymes that favors the transformation of pyruvate to lactate is subunit A. bFGF increased LDH A mRNA levels in a dose- and time-dependent manner. In summary, the results presented herein show that glucose transport, LDH activity and GLUT1 and LDH A mRNA levels are regulated by bFGF to achieve an increase in lactate production. These observed regulatory actions provide unequivocal evidence of the participation of bFGF in Sertoli cell lactate production which may be related to normal germ cell development.     

Percutaneous endoscopic gastrostomy in head and neck cancer patients

OBJECTIVE: To present our experience with the indications and complications of percutaneous endoscopic gastrostomy (PEG) in head and neck cancer patients. MATERIALS AND METHODS: In a retrospective study of the patients treated, we reviewed the records of 43 patients diagnosed with head and neck cancer at the Otorhinolaryngology Department, in which a PEG was performed by the Unit of Digestive Endoscopy. RESULTS: All cases had squamous cell carcinoma. Larynx was the most frequent primary site, with 21 cases (49%), followed by hypopharynx, 12 patients (28%). Indications for PEG were: dysphagia (53.5%) and pharyngocutaneous fistula (43.5%). The most frequent complication was a local infection. CONCLUSION: PEG is a good choice for long-term enteral feeding in head and neck cancer patients due to its low complication rate and easy handling.     

Vitamin B-12 abnormalities in HIV-infected patients

A prospective study of 60 consecutively admitted patients with HIV infection was performed to document the prevalence, etiology and manifestations of low serum vitamin B-12 in such patients. Low serum B-12 levels were found in 10 patients (16.7%). In 6, vitamin B-12 absorption was impaired and hog intrinsic factor addition did not improve it. Patients with low vitamin B-12 levels showed lower hemoglobin, leukocytes, lymphocytes, CD4 lymphocytes and CD4/CD8 lymphocyte ratio than HIV patients with physiological serum vitamin B-12 levels. However, bone marrow megaloblastosis was found in only 3 low vitamin B-12 patients and the deoxyuridine suppression test was pathological in only 1 case. In 7 patients, parenteral treatment was begun with variable response despite serum vitamin B-12 correction. In conclusion, low serum vitamin B-12 is often found in HIV-infected patients and it could be related to malabsorption, but clear megaloblastic abnormalities and treatment response could not be demonstrated. A decreased concentration of the serum binders due to disturbances in the leukocytes and related immunocompetent cell may play an additional role.     

蛇足石杉生物碱成分的研究

从石杉科植物蛇足石杉中分离出三个生物碱(Ⅰ～Ⅲ)。经光谱数据和衍生物的制备证明:生物碱(Ⅰ)和(Ⅲ)分别为石杉碱乙(Ⅰ)和N-甲基石杉碱乙(Ⅲ);生物碱(Ⅱ)为新化合物,命名为蛇足石杉碱(huperzinine)。本文报告碱(Ⅱ)的结构测定。(Ⅱ)的生物活性正在研究中。     

槲寄生化学成分的研究——Ⅲ.槲寄生新甙Ⅲ,Ⅴ,Ⅵ的结构

自槲寄生(Viscum coloratum(Kom.) Nakai)中分离得到五个黄酮甙。经光谱和化学分析确定Ⅰ为异鼠李素-3-O-β-D-葡萄糖甙,Ⅱ为异鼠李素-7-O-β-D-葡萄糖甙,Ⅲ为高圣草素-7-O-β-D-芹菜糖基(1→2)-β-D-葡萄糖甙;Ⅴ为高圣草素-7-O-β-D-芹菜糖(1→5)-β-D-芹菜糖(1→2)-β-D-葡萄糖甙;Ⅵ为高圣草素-7-O-β-D-(6″-乙酰)-葡萄糖甙。化合物Ⅲ,Ⅴ,Ⅵ为三个新的双氢黄酮甙,分别命名为槲寄生新甙Ⅲ(viscumneoside Ⅲ),槲寄生新甙Ⅴ(viscumneoside Ⅴ)和槲寄生新甙Ⅵ(viscumneoside Ⅵ)。Ⅰ和Ⅱ亦系首次从该植物中发现。     

Calcineurin inhibitor-free immunosuppression based on antithymocyte globulin and mycophenolate mofetil in cadaveric kidney transplantation: results after 5 years

Kidney grafts from suboptimal donors are more likely to suffer the nephrotoxic side-effects of cyclosporine than kidneys from standard donors. In an attempt to avoid the use of cyclosporine, we carried out a prospective study in low-immunological risk recipients of suboptimal kidneys, using an immunosuppressive protocol combining Thymoglobuline in induction with a bi-therapy of mycophenolate mofetil (MMF) and steroids. Patients with panel reactive antibodies (PRA) <50% receiving a first renal transplant from a suboptimal donor (age 50, non heart beating, arterial hypertension, or acute renal failure) or a kidney at risk of delayed graft function (DGF) because of a prolonged cold ischaemia time (CIT) of 24 h or more, were eligible for this trial. Between September 1996 and December 1999, 30 patients were enrolled for the trial and treated with MMF 2 g orally, pre-operatively, and 3 g daily, post-operatively; Thymoglobuline 2 mg/kg IV pre-operatively, 1.5 mg/kg IV the next day, and for doses of 1 mg/kg IV given on alternate days; and prednisolone 0.25 mg/kg per day, reduced progressively from the end of the first month to 0.1 mg/kg per day by 3 months post-transplant. Cyclosporine was added only if rejection grade II or higher, or a reduction in MMF below 1 g daily, occurred. Ten patients (30%) suffered from DGF, and one kidney suffered primary non function. Seven patients (24%) suffered acute rejection (six were biopsy proven, 3 grade I and 3 grade II). MMF dosage was reduced in 28 patients because of adverse events, and calcineurin inhibitors were introduced in 16 patients. There were 14 episodes of opportunistic infection (cytomegalovirus (CMV 10), Herpes zoster 2, Listeria monocytogenes 1, Pseudomonas aeuruginosa 1), and 7 malignancies (skin 2, thyroid 1, lung 1, Kaposi's sarcoma 2, post-transplantation lymphoproliferative disorder 1). Mean serum creatinine was 178, 199, 213, and 218 mol/l at 1, 2, 3 and 5 years after transplantation, respectively. Actuarial patient and graft (after censoring for death) survival was 94% and 83% after 1 year and 79% and 65% after 5 years, respectively. These results show that with the combination of MMF, Thymoglobuline and steroids the use of cyclosporine can be delayed, and in a few cases completely avoided, with good efficacy in terms of prevention of rejection and recovery of renal function. Regardless of acceptable patient and graft survival, side-effects of MMF at the doses used in this protocol were common and led to overimmunosuppression in the long-term. Starting MMF at low dose, MPA monitoring and probably CMV prophylaxis may improve the results of this regimen.