Impact of a nurse-led intervention to improve screening for cardiovascular risk factors in people with severe mental illnesses. Phase-two cluster randomised feasibility trial of community mental health teams

Background  

People with severe mental illnesses (SMI) are at increased risk of cardiovascular disease (CVD). Clinical guidelines recommend regular screening for CVD risk factors. We evaluated a nurse led intervention to improve screening rates across the primary-secondary care interface.     

人血清脱金属铁传递蛋白裂解焦磷酸键的研究

目的:测定人血清脱金属铁传递蛋白裂解焦磷酸键的反应速率常数.方法:应用31P NMR技术,在不同pH值及不同浓度MgCl2存在条件下,测定了脱金属铁传递蛋白与焦磷酸二钠反应的核磁共振图谱,根据焦磷酸盐的摩尔浓度(对应于其谱峰强度)随时间的变化情况,应用动力学公式对数据进行拟合.结果:当人血清脱金属铁传递蛋白(0.5～1.0 mmol/L)与焦磷酸盐的反应摩尔浓度比为15时,在312 K条件下,反应速率常数分别为:8.83×10-4 L·mmol-1·h-1(pH 6.85)、9.59×10-4 L·mmol-1·h-1(pH 7.40)和1.38×10-3 L·mmol-1·h-1(pH 8.15).在2 mmol/L MgCl2存在时,pH 7.40、312 K条件下,反应速率常数为1.21×10-3L·mmol-1·h-1.结论:人血清脱金属铁传递蛋白能缓慢地将焦磷酸根裂解为磷酸根,反应具有二级反应动力学性质,Mg2 对该裂解反应有弱催化作用.     

18F‐fluoro‐2‐deoxy‐D‐glucose positron emission tomography and positron emission tomography/computed tomography imaging of malignant pleural mesothelioma*

Malignant pleural mesothelioma (MPM) is the most common primary pleural tumor and its incidence is rising. Its diagnosis, staging and response assessment are challenging for imaging. Integrated positron emission tomography (PET)/CT increases the accuracy of overall staging in patients with mesothelioma and improves the selection of patients for curative surgical resection. It is particularly useful in identifying occult distant metastases. It may be used to predict prognosis and to assess the metabolic response to therapy.     

Cell salvage at caesarean section: the need for an evidence-based approach

Haemorrhage, a leading cause of maternal morbidity and mortality, is frequently associated with caesarean section. Allogeneic blood is an increasingly rare and scare resource. Intraoperative Cell Salvage (IOCS) offers the possibility of improving outcome and reducing allogeneic blood transfusion in cases of haemorrhage at caesarean section. The available literature on the use of IOCS in obstetrics demonstrates that there is limited evidence to support or refute the use of IOCS at caesarean section. However, this procedure has been introduced into obstetric practice. Before opinions about its use become solidified, there is a window of opportunity to launch a large multicentre randomised controlled trial to address the current equipoise.     

The effect of exclusion of cases with unrecorded best estimate of gestational age on the estimates of preterm birth rate

Objectives  To investigate the effect of excluding cases with unrecorded best estimate of gestational age at birth on pregnancy outcome reporting and to determine the reasons for unrecorded gestational age data.
Design  Prospective study.
Setting  Fifteen maternity units in North West London.
Population  497 105 women who booked for antenatal care from 1988 to 1998.
Method  Multiple logistic regression analysis.
Main outcome measures  Preterm birth rate of, and the factors associated with, cases with unrecorded best estimate of gestational age at birth.
Results  Of the 53 981 cases with an unrecorded best estimate of gestational age at birth, by using additional data, it was possible to compute a new best estimate of gestational age in 80%. In this latter group, the preterm birth rate was 42% (95% CI 41.5–42.6). The corrected, overall preterm birth rate in North West London (9.8%, 9.7–9.9) was higher than the original estimate (7.6%, 7.5–7.7), which included only cases with recorded data on gestational age at birth. The most significant factors associated with an unrecorded gestational age were no ultrasound scan (OR 49, P  <   0.001), and preterm birth <31 weeks (OR 30, P  <   0.001).
Conclusions  The incidence of preterm birth are likely to be under-reported in studies where only cases with readily available gestational age data are included. In routinely collected maternity data, human omission is an important contributing factor for an unrecorded best estimate of gestational age at birth. This is associated with the urgent transfer of babies to the neonatal intensive care unit.     

First use of preimplantation genotyping in prevention of recurrent diandric complete hydatidiform mole

Complete hydatidiform moles have a diploid chromosome constitution, generally with only paternal genetic material present (diandry). Diandric complete moles are thought to arise either by fertilization of an anucleate oocyte by two spermatozoa or, more commonly, doubling of a single sperm genotype. Molar pregnancies are usually sporadic, and may be accompanied by malignant transformation; however, recurrence is associated with increased risk of further affected pregnancies and of persistent trophoblastic neoplasia or choriocarcinoma. This study presents the first use of preimplantation genotyping to ensure biparental inheritance in a woman presenting with recurrent diandric complete hydatidiform mole. Following an IVF cycle, a single cell from each of 11 embryos was tested by whole genome amplification and genotyping at 16 different simple tandem repeat loci. All embryos showed normal biparental inheritance; one blastocyst was transferred, resulting in the delivery of healthy monozygotic twin girls.     

Concerns about anti-angiogenic treatment in patients with glioblastoma multiforme

Background  

The relevance of angiogenesis inhibition in the treatment of glioblastoma multiforme (GBM) should be considered in the unique context of malignant brain tumours. Although patients benefit greatly from reduced cerebral oedema and intracranial pressure, this important clinical improvement on its own may not be considered as an anti-tumour effect.     

Efficacy of plain abdominal radiography in patients with gastrointestinal bleeding

To assess the value of plain abdominal radiography in cases of gastrointestinal hemorrhage, the records of 100 such consecutive patients were reviewed. Seventy-eight of the patients had presented to the emergency department, and 22 were inpatients. The radiologic and clinical records were scrutinized to determine the actual effect of the radiologic examination on management of the patient. Three patients had pneumoperitoneum attributed to bowel perforation, and two had confirmed bowel obstruction. In each, the clinical findings suggested the diagnosis. We found no instance of silent gastrointestinal bleeding in which plain radiography contributed important diagnostic information. We conclude that gastrointestinal bleeding is not, in itself, a valid indication for abdominal radiography.