NHS Trust Boards and Health and Well-being Boards: Do they play any role in the management of disparate levels of care for South Asian patients with Inflammatory Bowel Disease?

Aims:There is evidence of disparate levels of care for members of ethnic minority communities with inflammatory bowel disease in various NHS Trusts and Health Boards in England and Scotland. The purpose of this study was to investigate whether there was any association between the existence of disparate levels of care and the ethnic composition of the management boards of NHS Trusts and Health Boards. It also examined the ethnic composition of Health and Wellbeing Boards associated with these Trusts in EnglandMethod:NHS Trusts in England and Health Boards in Scotland, which had been involved in previous studies of disparate levels of care, were identified through a review of the relevant published papers. Health and Wellbeing Boards associated with these Trusts were then identified. Executive and non-executive membership of the NHS Trust, Health Boards and Health and Wellbeing Boards was determined through scrutiny of their web pages.Results:The proportion of Asians, who were executive officers, was significantly lower than the proportion who were non-executive board members both for trusts who offered disparate care (z = 2.22; p < 0.03) and those which did not (z = 2.24; p < 0.03). There was no significant difference in the proportion of Asians who were non-executive board members between the two types of trust. The proportion of ethnic minority members of English Health and Well-Being Boards, where there was evidence of disparate levels of care received by South Asian patients was significantly greater than on Boards where this was not the case. (z = 2.8. p < 0.005).Conclusions:The relation of these findings to disparate levels of care is unclear. However, it may point to a culture of tokenism, where either the members are not truly representative of underserved communities or they are unable to have any influence on local policy decisions. In either case there is an urgent need to develop better links with minority communities who are underserved so that issues can be effectively identified and remedied.     

Systemic 5-fluorouracil producing an inflammatory response in porokeratosis

Topical 5-fluorouracil has been used as an effective treatment for porokeratosis. Upon its treatment, an inflammatory effect occurs with the topical 5-fluorouracil. We report a case of a patient with disseminated superficial actinic porokeratosis displaying a comparable inflammatory process following therapy with systemic 5-fluorouracil used to manage a metastatic breast cancer.     

人脐带内皮细胞与平滑肌细胞的分离培养特照

目的：如何便捷有效地获取种子细胞是构建组织工程皮肤、角膜、血管等成功与否的关键，实验对人胎儿脐带内皮细胞和平滑肌细胞的分离、纯化、培养扩增技术进行探讨。方法：实验于2006—11在暨南大学医学院完成。①实验材料：剖宫产正常胎儿脐带由暨南大学第一临床学院提供，产妇均知情同意。②实验方法：配制培养液，A液为在M199培养液中加入20％胎牛血清、20mg，L肝素、10μg／L碱性成纤维细胞生长因子，B液为在M199培养基中加入10％胎牛血清、250mg／L G418。取脐带15-20cm，采用胶原酶“灌注消化法”获取脐带内皮细胞制成悬液，静置0．5h后利用成纤维细胞短时间内贴壁的特点，把尚未贴壁细胞吸出重新接种于含有A液的培养瓶，初步去除部分成纤维细胞，细胞贴壁24h后将培养液换为B液，继续培养3d，去除成纤维细胞，然后再用A液扩大培养。从消化完脐静脉内皮细胞的脐带中剥取脐动脉，刮除内皮细胞，将血管条剪成小块均匀贴于培养瓶底，培养瓶内加入含20％小牛血清的DMEM培养液2mL，缓慢竖直培养瓶，以培养液刚未浸没培养块为最佳，放入37℃、体积分数为0．05的CO2培养箱内干涸8h后，将培养瓶轻轻翻转，使植块刚浸入培养液中，绝对静置3d，以后每3d换液1次，待植块周围生长晕的细胞融合成片时，即可传代，传代后DMEM培养液的血清浓度由原来的20％改为5％，且在培养液中加入0．2L肝素。⑧实验评估：通过倒置相差显微镜观察细胞生长情况，分别以第Ⅷ因子、α-肌动蛋白免疫组织化学染色法鉴定内皮细胞和平滑肌细胞。结果：①内皮细胞的生长观察：接种24h后，镜下可见刚贴壁的细胞呈圆形，逐渐转变为多角形或梭形，胞间可见有成纤维细胞混杂，加入B液3d后成纤维细胞逐渐死亡。传代细胞呈“铺路石”样，细胞周围特别是近胞核处可见明显光晕，为典型的内皮细胞生长特点。②内皮细胞第Ⅷ因子相关抗原的检测：胞浆丰富且有棕黄色颗粒，细胞核不着色，呈阳性反应。⑧平滑肌细胞的生长观察：镜下组织块贴壁后5～7d可见有少数细胞从植块边缘游出，第10-15天植块周围形成明显的细胞生长晕．细胞呈长梭形、带状或三角状，有1-4个细胞核，可见半透明颗粒，第20-25天细胞密集、平行排列，形成“峰谷样”结构，是平滑肌细胞的特征性生长表现。④平滑肌细胞特异性α-肌动蛋白单克隆抗体检测：胞浆内可见棕黄色细丝，为特异性α-平滑肌肌动蛋白，细胞核不着色。结论：以胎儿脐带作为种子细胞的来源，成功分离后通过调节培养液的成分，既能排除成纤维细胞的污染又可以令内皮细胞和平滑肌细胞快速增殖。     

Endoscopic transnasal craniotomy and the resection of craniopharyngioma

OBJECTIVES/HYPOTHESIS： To describe the utility of a large transnasal craniotomy and its reconstruction in the surgical management of patients with craniopharyngioma. STUDY DESIGN： Observational, retrospective cohort study. METHODS： Retrospective review of patients treated in an academic neurosurgery/rhinology practice between 2000 and 2007. Patient characteristics （age, sex, follow-up）, tumor factors （size, position extension, previous surgery）, type of repair （pedicled mucosal flaps, free mucosal grafts）, and outcomes （visual, endocrine, and surgical morbidity） were defined and sought in patients who had an entirely endoscopic resection of extensive craniopharyngioma （defined as requiring removal of the planum sphenoidale in addition to sella exposure in the approach）.     

Introduction to Tissular and Cellular Engineering

Most human tissues do not regenerate spontaneously, which is why cellular therapies and tissular engineering are promising alternatives. The principle is simple: cells are sampled in a patient and introduced in the damaged tissue or in a tridimentional porous support and cultivated in a bioreactor in which the physico-chemical and mechanical parameters are controlled. Once the tissues (or the cells) are mature they may be implanted. In parallel, the development of biotherapies with stem cells is a field of ...     

037 TNF-α导致细胞骨架重排和当归的逆转作用

目的: 探讨TNF-α导致细胞骨架重排和当归的逆转作用. 方法: 常规培养人脐静脉内皮细胞, 分成下列各组: ①对照组: 常规培养; ②当归组: 培养液中加入当归注射液20 mg/ml; ③ TNF-α组: 培养液中加入TNF-α 100 U/ml; ④ TNF-α+当归组: 培养液中同时加入TNF-α 100 U/ml和当归20 mg/ml. 4 h后用Phalloidine rhodamine标记骨架蛋白F-actin, 用Olympus LX70荧光显微镜(CellScan, Scanalytics-Bionis)检测细胞骨架分布. 结果: 荧光显微镜下, 在内皮细胞的每一个横切面, 对照组细胞骨架均排列在细胞周围, Factin分布均匀, 粗细匀称; 当归注射液不影响正常内皮细胞的细胞骨架排列, 但可见部分actin肌丝增粗; TNF-α作用后整个细胞腔面细胞骨架排列紊乱, 在细胞中部横切面, 增粗的actin肌丝横跨整个细胞; 将当归注射液与TNF-α共同作用于内皮细胞, 可见细胞骨架排列在细胞周围, 但与正常细胞状态略有不同. 结论: TNF-α可以导致细胞骨架重排, 这种重排与剪切力导致的重排相似. 当归能逆转TNF-α导致的细胞骨架重排, 使F-actin排列在细胞周围. 这种作用的意义及信号转号途径目前还不完全清楚. 本室的其他实际显示, 当归注射液可以降低氧化低密度脂蛋白导致的ICAM-1表达增加, 逆转TNF-α导致的ICAM-1重排. 当归抗动脉粥样硬化可能与这些作用有关.