MANAGEMENT OPTIONS FOR HYPERTENSION SYNDROME

Hypertension is usually managed on a case-finding basis, and yet continued blood pressure control can be inadequate. Furthermore, hypertension is often a ‘silent’ condition until comorbid events, target organ damage and subsequent heart failure become manifest, leading to a reactive rather than a proactive approach. Management of the hypertension syndrome becomes complex, because blood pressure control may not be just an isolated concern. This review considers the various options, in addition to existing guidelines, that can help to reduce hypertension-related morbidity and mortality.     

Glioma Pathophysiology: Insights Emerging from Proteomics

Proteomics is increasingly employed in both neurological and oncological research to provide insight into the molecular basis of disease but rarely has a coherent, novel pathophysiological insight emerged. Gliomas account for >50% of adult primary intracranial tumors, with malignant gliomas (anaplastic astrocytomas and glioblastoma multiforme) being the most common. In glioma, the application of proteomic technology has identified altered protein expression but without consistency of these alterations or their biological significance being established. A systematic review of multiple independent proteomic analyses of glioma has demonstrated alterations of 99 different proteins. Importantly 10 of the 99 proteins found differentially expressed in glioma [PHB, Hsp20, serum albumin, epidermal growth factor receptor (EGFR), EA-15, RhoGDI, APOA1, GFAP, HSP70, PDIA3] were identified in multiple publications. An assessment of protein–protein interactions between these proteins compiled using novel web-based technology, revealed a robust and cohesive network for glioblastoma. The protein network discovered (containing TP53 and RB1 at its core) compliments recent findings in genomic studies of malignant glioma. The novel perspective provided by network analysis indicates that the potential of this technology to explore crucial aspects of glioma pathophysiology can now be realized but only if the conceptual and technical limitations highlighted in this review are addressed.     

Routine outcomes monitoring as part of children and young people's Improving Access to Psychological Therapies (CYP IAPT) – improving care or unhelpful burden?

This brief commentary article considers the implications of intensive outcome monitoring which is central to children and young people's Improving Access to Psychological Therapies (CYP IAPT) in England and Wales. Services are being provided with a range of free software solutions to enable data collection, and guidance on interpretation of the measures, but there will still be some burden of data entry and collation for already overstretched services. It may be that the utility of the feedback will go some way to offset the sense of burden but this remains to be seen. Whether commissioners and others will rise to the challenge of supporting this aspect may prove crucial to the success or otherwise of such intensive ROM use. Many aspects of the CYP IAPT approach are new and whilst drawing on experience from earlier pilots of session by session monitoring in CAMHS both in the UK and abroad, and from Adult IAPT, there is likely to be much for us to learn. Time will tell whether the approach helps to improve the care children and young people receive but we are cautiously optimistic.     

Lactic acid bacteria in the gut in normal and disordered states.

The human gut flora is a complex and finely balanced ecosystem which plays an important protective role in humans. Although relatively stable, its composition may be altered in various disease states and by the administration of antimicrobial agents. Preparations containing viable lactic acid bacteria of human origin appear to have value in restoring normal microbial function and alleviating symptoms in some patients with gastrointestinal infection and other conditions.