The Hong Kong Society of Rheumatology consensus recommendations for the management of gout

Clinical Rheumatology - Gout is one of the most common noncommunicable diseases in Hong Kong. Although effective treatment options are readily available, the management of gout in Hong Kong remains...     

Stressors in the ICU: a comparison of patients' and nurses' perceptions

Aims and objectives. The aim of the study was to compare the stressors as perceived by patients in an intensive care unit (ICU) against those of nurses on the basis of their perceptions of patients’ stressors. Background. Getting admitted to an ICU is viewed as a stressful event by patients. However, numerous studies have indicated that nurses do not always accurately perceive the stressors of their clients. Therefore, it is important for nurses to know what seems most stressful from the patients’ perspective so that appropriate nursing measures can be directed towards minimising such stressors. Design. Survey. Methods. As a convenience sample, 60 patients and 54 critical care nurses were recruited. The Intensive Care Unit Stressor Questionnaire (Chinese) (ICU‐CSQ) was used to collect the perceptions of stressors by the patients. Nurses were also asked to rate the items in the said questionnaire according to how they believe patients would rate them. Results. In every comparison, nurses evaluated the items to be significantly more stressful than patients did. Overall perceived stress levels of nurses were also significantly higher than those of their patients (z = ?8·78, p < 0·001). Conclusions. Nurses tended to rate the items as more stressful than did the patients, perhaps over‐emphasising the stressful nature of the ICU. The findings also highlight the importance of cultural beliefs on the perceived stress levels among the Chinese population. Relevance to clinical practice. Findings in this study have strong implications in clinical practice, especially in a critical care setting. Nurses must attempt to identify and endeavour to cope with the situations that patients listed as most stressful. Moreover, attention must be drawn towards measures aimed at relieving the stress of patients by taking into account their cultural values so that culture‐specific interventions for reducing their stress can be established.     

Clinical experience with HLA-B7 plasmid DNA/lipid complex in advanced squamous cell carcinoma of the head and neck.

OBJECTIVE: To investigate the safety and efficacy of alloantigen plasmid DNA therapy in patients with advanced head and neck squamous cell carcinoma using Allovectin-7 (Vical Inc, San Diego, Calif), a DNA/lipid complex designed to express the class I major histocompatibility complex antigen HLA-B7. DESIGN: Multi-institutional prospective trial. SETTING: Academic medical setting. PATIENTS: A total of 69 patients were enrolled in 3 sequential clinical trials: a single-center phase 1 trial and 2 multicenter phase 2 trials. Eligibility criteria included unresectable squamous cell carcinoma that failed conventional therapy, Karnofsky performance status score of 70 or greater, and no concurrent anticancer or immunosuppressive therapies. INTERVENTION: Patients received 2 biweekly intratumoral injections of 10 microg (phase 1 and first phase 2 trials) or 100 microg (second phase 2 trial) of Allovectin-7 followed by 4 weeks of observation. Patients with stable or responding disease after the observation period were given a second treatment cycle identical to the first. MAIN OUTCOME MEASURES: Patients were assessed for toxic effects, and tumor size was measured after cycles 1 (at 6 weeks) and 2 (at 16 weeks). RESULTS: Allovectin-7 treatment was well tolerated, with no grade 3 or 4 drug-related toxic effects. Of 69 patients treated, 23 (33%) had stable disease or a partial response after the first cycle of treatment and proceeded to the second cycle. After the second cycle, 6 patients had stable disease, 4 had a partial response, and 1 had a complete response. Responses persisted for 21 to 106 weeks. CONCLUSIONS: Intratumoral plasmid DNA immunotherapy for head and neck cancer with Allovectin-7 is safe, and further investigations are planned in patients with less advanced disease, where it could potentially improve patient survival and reduce the need for radical high-morbidity treatments.     

克泻灵片中苦参碱类生物碱的HPLC分析

目的:对克泻灵片中主要有效生物碱定性、定量。完善产品的质量控制及评价手段。方法:采用HPLC,紫外测定波长:220nm。结果:片剂中有有效生物碱以苦参碱类生物碱为主,其中苦参碱和槐定碱含量高,分别占总生物碱的14.2％～31.6％和22.6％～62.7％,其次为槐颗碱和槐胺碱,氧化苦参碱的含量很低。结论:建立了HPLC测定克泻灵片中主要生物碱,方法简便快捷,精密度好,回收率高,可用于制剂及原料的质量控制。     

Adrenal cortical cells mimicking small cell anaplastic carcinoma in a fine-needle aspirate.

Fine-needle aspiration of an adrenal mass was performed to rule out metastatic disease in a patient with a bronchogenic carcinoma. The aspiration was misinterpreted as metastatic small cell anaplastic carcinoma. Review of the aspirate by the authors revealed the atypical small cells to be aggregates of bare nuclei of benign adrenocortical cells. Interpretation of these bare nuclei in isolation and unfamiliarity with the aspiration cytology of the adrenal gland led to the initial misdiagnosis.