Direct medical costs of adverse events in Dutch hospitals

Background  

Up to now, costs attributable to adverse events (AEs) and preventable AEs in the Netherlands were unknown. We assessed the total direct medical costs associated with AEs and preventable AEs in Dutch hospitals to gain insight in opportunities for cost savings.     

Erratum: informant based measures may overestimate cognitive impairment in elderly patients

International Journal of Geriatic Psychiatry 2007; 22: 1169–1170. DOI: 10.1002/gps.1900 If has come to our attention that this Letter to the Editor was published without an accompanying Table. We now publish below, the entire Letter as first intended. We apologise for this anomaly.     

Platelet turnover and kinetics in immune thrombocytopenic purpura: results with autologous 111In-labeled platelets and homologous 51Cr- labeled platelets differ

Mean platelet survival and turnover were simultaneously determined with autologous 111In-labeled platelets (111In-AP) and homologous 51Cr- labeled platelets (51Cr-HP) in ten patients with chronic immune thrombocytopenic purpura (ITP). In vivo redistribution of the 111In-AP was quantitated with a scintillation camera and computer-assisted image analysis. The patients were divided into two groups: those with splenic platelet sequestration (spleen-liver 111In activity ratio greater than 1.4), and those with diffuse sequestration in the reticuloendothelial system. The latter patients had more severe ITP reflected by pronounced thrombocytopenia, decreased platelet turnover, and prominent early hepatic platelet sequestration. Mean platelet life span estimated with 51Cr-HP was consistently shorter than that of 111In-AP. Platelet turnover determined with 51Cr-HP was thus over-estimated. The difference in results with the two isotope labels was apparently due to greater in vivo elution of 51Cr. Although the limitations of the techniques should be taken into account, these findings indicate that platelet turnover is not always normal or increased in ITP, but is low in severe disease. We suggest that this may be ascribed to damage to megakaryocytes by antiplatelet antibody. The physical characteristics in 111In clearly make this radionuclide superior to 51Cr for the study of platelet kinetics in ITP.     

生命科学仪器中光电倍增管偏置电路分压精度的提高

目的:分析光电倍增管电压偏置电路对光电倍增管性能的影响,并采取相应措施提高光电倍增管电压偏置电路的精度,以改善光电倍增管的性能。方法:在电阻型光电路倍增管偏置电的基础上,增加双极型晶体管或场效应晶体管构成有源光电倍增管偏置电路;并采用可调恒流技术,以解决温度对电路的影响。结果:在阳极电流为50μA,电阻型光电倍增管偏置电路的线性偏离度已达40%,而用双极性晶体管或场效应晶体管的有源偏置电路的线性偏离度分别为≤7%,≤3%,采用可调恒流技术后,电路的线性偏离度≤1%;如果要求阳极电流为100μA时线性偏离度≤1%时,电阻型光电倍增管偏置电路的功耗为11W,而用双极性晶体管或场效应晶体管的有源偏置电路的总功耗分别在0.18～0.95W,0.12～0.75W。结论:采用场效应晶体管的有源偏置电路显著提高了偏置电压的线性度和稳定性,减少了功耗和体积,加入可调恒流技术后,进一步降低偏置电路的线性偏置度,从而改善了光电倍增管的性能。     

Relationship among serotype G3P5A rotavirus strains isolated from different host species

The relationship among G3P5A rotavirus strains was analysed by restriction endonuclease assay of the VP4, VP6 and VP7 encoding genes, neutralization assay and phylogenetic analysis. The restriction patterns of the capsid encoding genes were species specific allowing the differentiation among the strains of different origin. The VP7 profiles differentiated human from animal strains more efficiently. The phylogenetic analysis of the VP4 gene demonstrated that HCR3A and K9 are closer related to each other than to other P5A strains. The same occurs to strains Ro1845 and Cat 97. The CU-1 virus appears to be an ancestor of the P5A strains by neutralization and phylogenetic analysis. The results placed the RRV strain definitely in a separate VP4 serotype and genotype from that of P5A strains. Restriction endonuclease assay of the capsid encoding genes seems to be a useful tool to identify the host species of rotavirus strains belonging to the same serotype and/or genotype.     

一种用于筛选降血糖及降血脂药物的动物模型

一种用于筛选降血糖及降血脂药物的动物模型刘京，申竹芳，刘海帆，叶菲，谢明智（中国医学科学院药物研究所，中国协和医科大学北京１０００５０）糖尿病为常见病和多发病，同时伴有多方面的并发症，脂质代谢紊乱即其中之一。这就要求治疗糖尿病时，除控制病人的血糖外，...     

Subunit assembly of hemoglobin: an important determinant of hematologic phenotype

Hemoglobin's physiologic properties depend on the orderly assembly of its subunits in erythropoietic cells. The biosynthesis of alpha- and beta-globin polypeptide chains is normally balanced. Heme rapidly binds to the globin subunit, either during translation or shortly thereafter. The formation of the alpha beta-dimer is facilitated by electrostatic attraction of a positively charged alpha-subunit to a negatively charged beta-subunit. The alpha beta-dimer dissociates extremely slowly. The difference between the rate of dissociation of alpha beta- and alpha gamma-dimers with increasing pH explains the well-known alkaline resistance of Hb F. Two dimers combine to form the functioning alpha 2 beta 2-tetramer. This model of hemoglobin assembly explains the different levels of positively charged and negatively charged mutant hemoglobins that are encountered in heterozygotes and the effect of alpha-thalassemia and heme deficiency states in modifying the level of the variant hemoglobin as well as Hb A2. Electrostatic interactions also affect the binding of hemoglobin to the cytoplasmic surface of the red cell membrane and may underlie the formation of target cells. Enhanced binding of positively charged variants such as S and C trigger a normally dormant pathway for potassium and water loss. Thus, the positive charge on beta c is responsible for the two major contributors to the pathogenesis of Hb SC disease: increased proportion of Hb S and increased intracellular hemoglobin concentration. It is likely that electrostatic interactions play an important role in the assembly of a number of other multisubunit macromolecules, including membrane receptors, cytoskeletal proteins, and DNA binding proteins.     

Erythropoietin structure-function relationships: high degree of sequence homology among mammals

To investigate structure-function relationships of erythropoietin (Epo), we have obtained cDNA sequences that encode the mature Epo protein of a variety of mammals. A first set of primers, corresponding to conserved nucleotide sequences between mouse and human DNAs, allowed us to amplify by polymerase chain reaction (PCR) intron 1/exon 2 fragments from genomic DNA of the hamster, cat, lion, dog, horse, sheep, dolphin, and pig. Sequencing of these fragments permitted the design of a second generation of species-specific primers. RNA was prepared from anemic kidneys and reverse-transcribed. Using our battery of species-specific 5' primers, we were able to successfully PCR- amplify Epo cDNA from Rhesus monkey, rat, sheep, dog, cat, and pig. Deduced amino acid sequences of mature Epo proteins from these animals, in combination with known sequences for human, Cynomolgus monkey, and mouse, showed a high degree of homology, which explains the biologic and immunological cross-reactivity that has been observed in a number of species. Human Epo is 91% identical to monkey Epo, 85% to cat and dog Epo, and 80% to 82% to pig, sheep, mouse, and rat Epos. There was full conservation of (1) the disulfide bridge linking the NH2 and COOH termini; (2) N-glycosylation sites; and (3) predicted amphipathic alpha- helices. In contrast, the short disulfide bridge (C29/C33 in humans) is not invariant. Cys33 was replaced by a Pro in rodents. Most of the amino acid replacements were conservative. The C-terminal part of the loop between the C and D helices showed the most variation, with several amino acid substitutions, deletions, and/or insertions. Calculations of maximum parsimony for intron 1/exon 2 sequences as well as coding sequences enabled the construction of cladograms that are in good agreement with known phylogenetic relationships.     

Outpatient lumbar myelography. Initial results in 79 examinations using a low-dose metrizamide technique

Seventy-nine patients underwent lumbar myelography on an outpatient basis, with a low (3.75 g) dose of metrizamide as the radiocontrast agent and a 25-gauge spinal needle used for lumbar puncture. No patient experienced significant neurotoxicity following the examination; 70.8% (56 of 79) experienced minimal (23%) or no (48%) side effects. Three patients (3.8%) were admitted to the hospital for management of common side effects (headache, nausea/vomiting, back pain). We obtained postmyelographic computed tomographic scans on 96% (76 of 79) of the patients. Our initial results suggest that outpatient lumbar myelography is safe and can be performed with a very acceptable incidence of side effects.