Comparison of effectiveness of pressure threshold and targeted resistance devices for inspiratory muscle training in patients with chronic obstructive pulmonary disease.

BACKGROUND AND PURPOSE: Previous studies have provided little information about the comparative efficacy of treatment with pressure threshold and targeted resistive inspiratory muscle training devices. This study compared the efficacy of these two types of inspiratory muscle training (IMT) devices on inspiratory muscle function, exercise capacity, and quality of life in patients with chronic obstructive pulmonary disease (COPD). METHODS: Forty two patients with moderate to severe COPD were randomly assigned to either a control group, a group receiving pressure threshold inspiratory muscle training, or a group receiving targeted resistive inspiratory muscle training. The training intensity was 50% of patients' maximal inspiratory pressure (MIP). Home-based training comprised two 15-minute sessions a day, 5 days a week for 8 weeks. Inspiratory muscle function measurement included MIP and inspiratory muscle endurance. RESULTS: Thirty patients completed the program, 10 from each group. Twelve patients were excluded because of changes in pharmacological regimen or admission to the hospital (n = 5), study withdrawal (n = 4), or poor compliance with the training program (n = 3). After training, a significant increase in endurance time was found for the threshold group and targeted resistive group (4.4 +/- 3.2 min and 3.0 +/- 2.9 min, respectively, both p < 0.05 vs control), with no significant difference between the 2 training groups. The 6-minute walking distance also increased significantly in both training groups (p < 0.05). CONCLUSIONS: Targeted resistive IMT with a controlled training load has a similar efficacy to the more popularly used pressure threshold IMT and can be incorporated in the treatment of COPD patients. The targeted resistance device offers a less expensive and easily used treatment choice.     

Contribution of high-performance thin-layer chromatography to a pharmaceutical quality assurance programme in a hospital chemotherapy manufacturing unit.

The Department of Clinical Pharmacy (DCP) in the Institut Gustave-Roussy (IGR) is equipped with a high-performance thin-layer chromatography (HPTLC) analytical platform. One of the numerous possible uses of HPTLC is post-production quality control of chemotherapy manufacturing. After 3 years of existence, routine validation of manufactured batches has attained considerable maturity: 24 cytotoxic agents can be controlled in terms of identity, purity and concentration. Approximately 50% of the sampled preparations are assessed. More than 97% were within specifications, 1.6% were not, probably due to incorrect homogenization before sampling; and 1% were not evaluable. Using HPTLC in a hospital manufacturing unit contributes to quality assurance programmes such as accreditation to which the IGR DCP is now committed but also ISO 9001:2000 certification concerning the chemotherapy manufacturing unit.     

Human monocytes produce IL-1 and an inhibitor of IL-1 in response to two different signals

Recently, IL-1 inhibitors from urine, monocytes, or monocyte lines have been described. The relationship of these inhibitors to the production, release, and immunological effects of IL-1 is unclear. The present studies were initiated to describe and quantitate the production of IL-1 and a 23 to 45-kDa IL-1 inhibitor from human monocytes in response to certain stimuli using a mouse thymocyte system responsive to IL-1. Zymosan stimulated monocytes to produce IL-1 but not IL-1 inhibitor. Adherent immune complexes, human IgG1-4, and Fc fragments, but not F(ab')2, stimulated monocyte production of IL-1 inhibitor and little if any IL-1. Fibronectin and three of its fragments had neither effect. These observations suggest that monocytes produce IL-1 or IL-1 inhibitor in response to two different signals, through "endotoxin or beta-glucan" and Fc receptors, respectively. The inhibitor decreases IL-1-induced CD-1, C3H/HeJ, and D10 G4.1 cells but not IL-2-induced CD-1, C3H/HeJ, or CTLL-2 proliferation. The inhibitor competitively blocked binding of radiolabeled rIL-1 to the IL-1 receptor on murine thymoma cells. Preincubation of thymocytes with the inhibitor prevented IL-1-induced proliferation; however, this effect was reversed by washing thymocytes and inhibitor activity was markedly reduced when added 24 hr after stimulation with IL-1. These observations suggest that the inhibitor acts on IL-1 receptors to prevent thymocyte proliferation. Monocytes from patients with systemic lupus erythematosus produced less IL-1 inhibitor than cells from normal volunteers. The decrease in IL-1 inhibitor production may play a role in disease states.     

Clinical programme management: a model of promise?

As professionals working within a rapidly changing health care environment, it becomes critical to recognize alternatives for the management of clinical services to maximize the use of resources. However, it is also critical to remain constantly aware of the needs of valued and valuable employees, ensuring that the quality of working life is considered whenever any decisions are being made which will affect the work place. This paper reviews some of the literature related to decentralized structural models for health care institutions, and details the selection and implementation of one model in a major teaching hospital. The process of development from the initial idea through to the actual operationalization of a clinical programme management model is outlined, providing a critique of strengths and weaknesses of the model in the context of this particular organization.     

Technique of open laparoscopy for supramesocolic surgery in obese patients

Background  

Incidence of obesity and related diseases are increasing in the world. Visceral surgeons are more often confronted with laparoscopic surgery in obese patients. Besides validated surgery procedures, such as cholecystectomy and gastroesophageal reflux surgery, bariatric procedures are increasingly performed. In obese patients, the thickness of adipose panicle makes open laparoscopy hazardous.     

Racial disparities in young women with endometrial cancer

Objective

Although racial disparities in treatment and outcome for endometrial cancer are well recognized, little work has explored disparities in young women. We performed a population-based analysis to compare survival between black and white women with endometrial cancer at < 50 years of age.

Assessement of Awareness of,Concerns and Attitudes Towards HIV-Related Court-Case Sentences in France in a Representative Sample of People Living with HIV (ANRS VESPA2 Survey)

Some of the 12 criminal trials and sentences in France for HIV transmission in 1998–2011 attracted substantial public attention, with a possible negative impact on people living with HIV (PLWH) through reinforced stigma and discrimination. This analysis aimed to characterize PLWH enrolled in the representative ANRS-VESPA2 survey, aware of and concerned about convictions for HIV transmission. Being a migrant from Sub-Saharan Africa, having difficult socio-economic conditions, having unprotected sex with one’s main partner and concealing one’s HIV status were all factors statistically associated with concern about the sentences. Participants tempted to press charges against someone for infecting them were more likely to be younger, women, not living in a couple, unemployed, and to report a major depressive disorder. Concern about HIV-related criminal proceedings among the most vulnerable PLWH do not reflect the actual risk of prosecution they are exposed to.