HOW DO GENERAL PRACTITIONERS MANAGE PATIENTS AT RISK FROM STROKE?

SUMMARY This study assessed by means of a postal questionnaire how general practitioners (GPs) manage patients at risk from stroke. Of the 640 GPs sent a questionnaire, 294 (46%) replied. In patients with a recent transient ischaemic attack or minor ischaemic stroke, 24% of responding GPs would not arrange any investigations. Sixty-one per cent refer under half of their patients for further investigation, although 99% of GPs would commence aspirin. Seventy-seven per cent of GPs were aware of the benefits of carotid surgery. For patients in atrial fibrillation, most GPs (77%) thought that warfarin reduced stroke rates, but only 20% would consider commencing warfarin, although 26% would commence aspirin. In hypertensive patients, the GPs' threshold for treatment ranged from 135 to 200mmHg systolic (median 160mmHg), and from 90 to 110mmHg diastolic (median 100mmHg). Most GPs (84%) would treat isolated systolic hypertension with a median threshold of 180mmHg (range 140-240mmHg). The results of this study suggest that some patients at risk from stroke may not receive optimal investigation and treatment in the community.     

The fractionation, characterization, and subcellular localization of colony-stimulating activities released by the human monocyte-like cell line, GCT

GCT, a human monocyte-like cell line, has been shown to release biochemically distinct colony-stimulating activities (CSAs) for mouse and human marrows. These appear to be periodate-sensitive proteins with critical disulfide bonds. One, of molecular weight 145,000 daltons, stimulates macrophagic colony growth and is related to a 30,000-dalton molecule that also stimulates mouse growth. A 30,000-dalton CSA for human marrow can be separated from the 30,000-dalton mouse CSA by isoelectric focusing and gradient polyacrylamide gel electrophoresis. This distinction agrees with our previous finding of differential neutralization with anti-human urinary CSF antibody. The 30,000-dalton CSAs stimulate neutrophil, neutrophil-monocyte, and eosinophil colony growth in human marrow but only neutrophil and neutrophil-monocyte colonies in the mouse. Subcellular fractionation of GCT cells indicates that there are pools of preformed CSAs primarily associated with the cell cytosol that have similar apparent molecular weights to their secreted counterparts.     

Hepatocellular carcinoma: US evolution in the early stage

To study the sonographic evolution of hepatocellular carcinoma (HCC) in its early stage, 26 HCCs in 24 patients were observed regularly with real-time ultrasound for a period of 90 to 691 days. In the beginning, 21 tumors were hypoechoic, two isoechoic, and three diffusely hyperechoic. On follow-up, two of the 21 initially hypoechoic HCCs remained the same echodensity, 12 increased in internal echoes but were still hypoechoic, one became isoechoic, four changed to hyperechoic, and the remaining two shifted from hypoechoic to isoechoic and then to hyperechoic. The two initially isoechoic HCCs also gained echogenicity and became hyperechoic. By contrast, the three initially hyperechoic HCCs kept the same echo patterns. The "acquired" hyperechoic HCCs were inhomogeneous in echodensity and larger in size whereas the three originally hyperechoic HCCs were homogeneous and smaller. It is concluded that most small HCCs evolve progressively from hypoechoic to isoechoic and then to inhomogeneously hyperechoic patterns as they grow; a few HCCs have diffusely high echogenicity from the beginning and retain the same features thereafter.     

Treatment of human spermatozoa with seminal plasma inhibits protein tyrosine phosphorylation

It has long been known that seminal plasma contains factors that influence the fertilizing capacity of spermatozoa in many different ways. However, little is understood of the biochemical cascades triggered when spermatozoa and seminal plasma interact. In this study, we examined how incubation with seminal plasma affected protein tyrosine phosphorylation in human spermatozoa. Increased protein tyrosine phosphorylation is a hallmark of sperm capacitation in several mammalian species, including human. Seminal plasma blocks protein tyrosine phosphorylation when added to washed, non-capacitated spermatozoa. Removal of seminal plasma and incubation in capacitating medium led to partial recovery of the tyrosine phosphorylation cascade. Addition of seminal plasma to a suspension of spermatozoa previously incubated for 5 h under capacitating conditions decreased the level of tyrosine phosphorylation on all proteins in a dose-dependent manner. In this case, the phosphotyrosine signal did not increase upon removal of seminal plasma followed by overnight incubation in fresh capacitating media, indicating that removal of seminal plasma was necessary but not sufficient for protein tyrosine phosphorylation to occur. These results indicate that human seminal plasma contains factors that influence the tyrosine phosphorylation status of human spermatozoa.      

Management of hepatocellular carcinoma with portal vein tumor thrombosis: Review and update at 2016

Portal vein tumor thrombosis(PVTT) is a common phenomenon in hepatocellular carcinoma(HCC). Compared to HCC without PVTT, HCC with PVTT is characterized by an aggressive disease course, worse hepatic function, a higher chance of complications related to portal hypertension and poorer tolerance to treatment. Conventionally, HCC with PVTT is grouped together with metastatic HCC during the planning of its management, and most patients are offered palliative treatment with sorafenib or other systemic agents. As a result, most data on the management of HCC with PVTT comes from subgroup analyses or retrospective series. In the past few years, there have been several updates on management of HCC with PVTT. First, it is evident that HCC with PVTT consists of heterogeneous subgroups with different prognoses. Different classifications have been proposed to stage the degree of portal vein invasion/thrombosis, suggesting that different treatment modalities may be individualized to patients with different risks. Second, more studies indicate that more aggressive treatment, including surgical resection or locoregional treatment, may benefit select HCC patients with PVTT. In this review, we aim to discussthe recent conceptual changes and summarize the data on the management of HCC with PVTT.     

4-O-卤代酰基-4′-去甲基表鬼臼毒素类似物的合成与抗肿瘤活性

为考察4′-去甲表鬼臼毒素C_4位上联结含卤素原子的酯化侧链时对化合物抗肿瘤活性的影响,设计并采用选择性酯化方法合成了9个新的4′-去甲基表鬼臼毒素酯化产物。其中标题化合物在L_(1210)白血病肿瘤细胞与KB细胞的体外生长抑制试验中普遍表现出显著的抑制活性,大部分化合物活性超过依托泊甙。而普通脂酸酯的活性较弱。     

4-酰胺基-4-脱氧-4′-去甲表鬼臼毒素衍生物的合成和抗肿瘤活性

4′-去甲表鬼臼毒素与叠氮酸在三氟化硼乙醚存在下缩合,并经还原得4-氨基-4-脱氧-4′-去甲表鬼臼毒素。该中间体与酸或酸酐反应得相应酰胺化合物24个。经体外筛选,多数化合物抑制L_(1210)和KB细胞活性相当或超过依托泊甙。与相应的醚、酯、胺等类型相比,这一类化合物活性最强。     

4-(2-酰胺基-2-乙氧羰基)乙硫基-4-脱氧-4′-去甲表鬼臼毒素衍生物的合成与抗肿瘤活性

为考察4′-去甲基表鬼臼毒素4位上取代基结构变化与抗肿瘤活性的关系,设计并合成了23个标题化合物。体外L_(1210)白血病细胞与KB细胞生长抑制试验的结果表明,化合物11,16和18的抗肿瘤活性超过依托泊甙,化合物8的活性与依托泊甙相当。     

Arthroscopic surgery of the metatarsophalangeal first joint

Arthroscopic surgery of the metatarsophalangeal first joint was used to treat a dorsal impingement syndrome of the hallux by removing the dorsally located osteophytes. Also, osteochondritis dissecans, painful sesamoid bones resistant to conservative therapy, and hallux rigidus were arthroscopically treated in a prospective study enrolling 24 consecutive patients. Seventeen patients were high-level athletes. Pain, swelling, sports, and work involvement were recorded. The operative technique is described. There was one persistent loss of sensitivity of the hallux. In the dorsal impingement group, 8 of 12 patients had a good or excellent result after a minimum follow-up of 2 years. In patients with osteochondritis dissecans, 3 of 4 showed good or excellent results. In hallux rigidus and sesamoid bone removal the results were less favorable. As in all arthroscopic procedures there was a fast rehabilitation and work resumption. Especially in athletes arthroscopically, treatment of a dorsal impingement syndrome or osteochondritis dissecans can be recommended because of the diminished chance of scar fibrosis. (Arthroscopy 1998 Nov-Dec;14(8):851-5.)