Creutzfeldt--Jakob Disease in Recipients of Human Growth Hormone in the United Kingdom: A Clinical and Radiographic Study

In the past 3 years there have been five further cases, in additionto one case reported in 1985, of Creutzfeldt-Jakob disease inrecipients of human growth hormone in the United Kingdom. Theclinical findings of two of these cases are described, demonstratinga typical presentation with a predominantly cerebellar syndromeat onset which is not commonly a presenting feature of sporadicCreutzfeldt-Jakob disease. In one case a ^99mTc hexamethylpropylenaminesingle photon emission tomographic scan showed marked impairmentof tracer uptake in the basal ganglia and cerebral cortex ata time when the clinical picture was predominantly cerebellar.This technique may be useful in early diagnosis. In the othercase post mortem examination of the brain showed prominent amyloiddeposition in the cerebellum, which has not been described previouslyin pituitary-hormone related Creutzfeldt-Jakob disease. Thepreviously published cases of growth hormone-related Creutzfeldt-Jakobdisease are reviewed and reasons for the particular clinicalpattern seen are discussed.     

番茄红素与成骨细胞、破骨细胞及骨质疏松症

学术背景:骨质疏松症是较易发生的疾病,研究骨质疏松的发病机制寻找治疗骨质疏松的药物是预防老年性骨质疏松症的理想选择。目的:综述近几年来国内外关于氧化应激及番茄红素在骨质疏松发病中的作用的相关研究,为开发预防和治疗骨质骨质疏松的药物提供理论依据。检索策略:应用计算机检索Medline和Science Direct Online数据库1989-01/2007-04期间的相关文章,检索词为"oxidative stress,osteoclast,osteoblast,lycopene,osteoporosis",限定文章语言种类为English。同时计算机检索中国期刊全文数据库2000-01/2007-04期间的相关文章,检索词为"氧化应激,骨质疏松,成骨细胞,破骨细胞,番茄红素",限定文章语言种类为中文。对资料进行初审,选择有关人体内氧化应激形成机制、氧化应激与成骨细胞、氧化应激与破骨细胞、氧化应激与抗氧化剂、番茄红素与成骨细胞及破骨细胞和番茄红素与骨质疏松症关系的最新进展文献,共收集到121篇,排除综述类及重复研究。文献评价:符合纳入标准的31篇文献中,5篇涉及骨质疏松症的概述,20篇涉及氧化应激和抗氧化剂在骨质疏松症发病中作用的相关研究,6篇涉及番茄红素与氧化应激、成骨细胞、破骨细胞及绝经后骨质疏松关系的相关研究。资料综合:氧化应激是骨质疏松发病的一个危险因素。氧化应激不但作用于成骨细胞还作用于破骨细胞。国内外学者对于番茄红素的抗氧化性能研究取得了很大进展,已通过细胞培养观察到其对成骨细胞和破骨细胞均有作用,通过临床研究发现,番茄红素通过其抗氧化功能而影响成骨细胞和破骨细胞的功能,从而能够对骨质疏松症发生发展的病理过程进行有效干预,最终阻止和减缓骨质疏松症的发生。结论:番茄红素具有的抗氧化功能使其在骨质疏松的预防及治疗方面起着重要的作用。     

Strategies to recruit plateletpheresis donors from a registry of HLA- typed, unrelated, bone marrow donors

Rising demand for single-donor platelet components–from random donors, to maintain platelet inventories, or from HLA-compatible donors, to support alloimmune platelet-refractory patients–necessitated increasing the size of a community plateletpheresis donor registry. This study compares two strategies for recruiting whole-blood donors into a plateletpheresis program. The whole-blood donors who were asked to participate in this study had recently joined an unrelated bone marrow donor registry and had been HLA-typed as part of that process. An in-person recruitment strategy, which was time-intensive for the apheresis donor coordinator, served as the standard. A by-mail strategy involved the mailing of recruitment materials to marrow-donor registry participants. Marrow-donor registry participants were approached about apheresis participation after they had indicated an interest in the plateletpheresis program by returning a tear-off section of an informational brochure that was sent to them along with their marrow- donor registry materials. A total of 852 marrow-donor registry participants were randomly assigned to one of two recruitment strategies, and the recruitment rates were the same (46%) for both methods. In addition, levels of apheresis participation and attrition rates of donors recruited by either strategy were comparable. Thus, the simple strategy of mailing information about a plateletpheresis program is a very cost-effective method of recruiting donors.     

Effect of sodium taurolithocholate on bile flow and bile acid excretion

Sodium taurolithocholate and sodium taurocholenate were infused intravenously into rats and hamsters. Each bile acid salt was given alone or in combination with varying amounts of a primary bile salt, either sodium taurocholate or sodium taurochenodeoxycholate. Bile flow, total bile acid salt excretion, and the excretion of sodium taurolithocholate were quantitatively determined. In addition, mannitol excretion in bile was determined at various flow rates.Sodium taurolithocholate was found to be rapidly excreted in bile in concentrations greater than its aqueous solubility. When the endogenous excretion rate of bile salt or the infusion of primary bile salt was less than the molar amount of administered sodium taurolithocholate, cholestasis always occurred. Increasing molar amounts of primary bile salt prevented cholestasis and enhanced the excretion rate of sodium taurolithocholate.Infusion of sodium taurocholenate, a nonhemolytic bile salt, caused an effect on bile flow and bile acid salt excretion qualitatively similar to sodium taurolithocholate.The induction of cholestasis can be attributed to the physical properties of these poorly water soluble bile salts. The reduction in bile flow could not be shown to be related to water reabsorption from the biliary tree since there was no increase in mannitol concentration in bile during cholestasis. Reduction in bile flow may be related to obstruction of segments of the biliary tree by precipitates of sodium taurolithocholate and possibly to a decrease in water entry into the biliary tree during infusion of this bile acid salt.     

Patient satisfaction with chiropractic physicians in an independent physicians'' association

BACKGROUND: Satisfaction with care is one of the variables that can be used in determining the results of medical care. Patient satisfaction surveys allow managed care plans to determine how well their providers meet certain standards. OBJECTIVE: To determine the level of satisfaction with chiropractic care in a random sample of patients seen by physician members of a chiropractic independent physicians' association. DESIGN: A visit-specific questionnaire was mailed to a random sample of 150 patients from health insurance claims filed in the first two months of 2000. RESULTS: The rate of return was 44%. Various aspects of chiropractic care were given a rating of "excellent" by the following percentage of respondents: Length of time to get an appointment (84.9%); convenience of the office (57.7%); access to the office by telephone (77.3%); length of wait at the office (75.7%); time spent with the provider (74.3%); explanation of what was done during the visit (72.8%); technical skills of the chiropractor (83.3%); and the personal manner of the chiropractor (92.4%). The visit overall was rated as excellent by 83.3% of responders, and 95.5% stated they would definitely recommend the provider to others. CONCLUSION: The study demonstrated a high satisfaction rate among managed-care patients.