The direct approach

In the following excerpt from Dealing Direct: A Strategy for Business-Provider Partnerships, published in February by American Hospital Publishing, authors Gee and Fine discuss the right and wrong reasons for considering one of health care's most talked about new relationships.     

New techniques and instruments for lens implantation

Although most of the new techniques and new instrumentation for intraocular lens implantation are related to foldable intraocular lenses or sutured posterior chamber lenses, there are some intriguing new concepts in intraocular lens techniques unrelated to these two areas.     

Recombinant human growth hormone in infants and young children with chronic renal insufficiency

Children with chronic renal insufficiency (CRI) secondary to congenital structural abnormalities frequently have significant growth retardation by 2 years of age. In a multicenter placebo-controlled study of the use of recombinant human growth hormone (rhGH), 30 of 125 (24%) participants were<2.5 years of age at enrollment. Since the treatment arms of the study were balanced for age at randomization, data for these patients were examined for efficacy and safety. During the first 2 years of the study, approximately two-thirds of the patients (n=19) received rhGH 0.05 mg/kg per day subcutaneously and one-third (n=11) received placebo injections. At entry into the study, the mean (± SD) calculated creatinine clearance was 29.2±14.3 (range 12.0–63.7) ml/min per 1.73 m² in the rhGH-treated group and 23.3±15.1 (range 8.0–59.4) ml/min per 1.73 m² in the placebo-treated group. The 1st year growth rate was 14.1±2.6 cm/year for the rhGH-treated group and 9.3±1.5 cm/year in the placebo-treated group (P<0.00005). During the 2nd year of the study, the growth rate was 8.6±1.2 cm/year in the rhGH-treated group compared with 6.9±1.0 in the placebo groupP=0.025). The height standard deviation score was +2.0±0.7 for the rhGH-treated group compared with –0.2±1.1 in the placebo-treated group (P<0.00005) during the 2 years of the study. Minor adverse events occurred with similar frequency in both groups. These data suggest that rhGH is efficacious and safe in children with CRI under age 2.5 years. rhGH therapy may correct significant loss of growth at this age when used in conjunction with optimal medical management.     

Calreticulin is transported to the surface of NG108-15 cells where it forms surface patches and is partially degraded in an acidic compartment

Although calreticulin (Crt) is primarily localized to the endoplasmic reticulum (ER), our results using biotinylation and immunocytochemical methods indicate that a small but significant amount of Crt is present and forms large patches on the surface of NG108-15 cells (a mouse neuroblastoma-rat glioma hybrid cell line). (35)S-labelled Crt molecules begin to reach the cell surface after only 10 min of labelling and disappear slowly from the cell surface. After 4 hr of labelling, approximately half of the newly synthesized Crt molecules are on the cell surface. We believe that some Crt molecules may escape from the KDEL receptor-mediated salvage pathway as they are synthesized and proceed through the secretory pathway to the cell surface. Immunoprecipitation from the culture medium shows that Crt is not released from the cell surface to the medium, suggesting tight binding to surface molecules. NH(4)Cl can block the degradation of Crt; therefore, Crt is presumably degraded in the lysosome pathway. However, blockage of the disappearance of surface Crt is less efficient than that of internal Crt. This suggests that the disappearance of Crt from the cell surface may not be due solely to its degradation, but may reflect transport into another cell compartment such as the ER.     

Effects of cataract and scotoma on visual acuity: a simulation study.

Central field loss (CFL) and cataract both decrease visual acuity. For patients with CFL, visual acuity is further reduced when the acuity target is more visually complex. We tested visual acuity for targets of varying complexity (letters alone, letters flanked by one or two x's on each side, and words) in subjects with normal vision and in the presence of a simulated cataract, simulated scotoma, and their combination (scotoma + cataract). Visual acuity was best with normal vision and worst with scotoma + cataract for all of the acuity targets. There was little difference in visual acuity between the letters alone and flanked letters, and visual acuity was best for words under all vision conditions. The cataract had a greater impact on visual acuity when the subject's central visual field was clear (normal vision) than when it was occluded by the simulated scotoma.