GHR and VDR genes do not contribute to the growth hormone (GH) response in GH deficient and Turner syndrome patients

We have prospectively assessed the influence of GHR and VDR gene polymorphisms on the response to rhGH therapy in Venezuelan children with growth hormone deficiency (GHD, n=28) and Turner syndrome (TS, n=25). Clinical data during rhGH treatment were compared in GH and TS patients with different genotypes. PCR amplifications were performed to obtain the genotype frequencies of the polymorphisms. Clinical data at the start of treatment and rhGH doses were indistinguishable among patients with GHD or TS with different GHR or VDR genotypes. After the first two years of rhGH treatment, clinical data in both GHD and TS patients were not different according GHR or VDR genotypes. In addition, there was no significant difference among the subjects when both these genotypes were combined. Gene polymorphisms in low penetrance genes do not contribute to the rhGH therapy response in patients with GHD and TS.     

Antibody Response Specific to the Capsular Polysaccharide Is Impaired in Streptococcus suis Serotype 2-Infected Animals

Streptococcus suis serotype 2 is an extracellular encapsulated bacterium that causes severe septicemia and meningitis in swine and humans. Albeit crucial in the fight against encapsulated bacteria, the nature of the capsular polysaccharide (CPS)-specific antibody (Ab) response during S. suis type 2 infection is unknown. We compared for the first time the features of CPS-specific versus protein-specific Ab responses during experimental infections with live virulent S. suis type 2 in mice. The primary protein-specific Ab response was dominated by both type 1 and 2 IgG subclasses, whereas IgM titers were more modest. The secondary protein-specific Ab response showed all of the features of a memory response with faster kinetics and boosted the titers of all Ig isotypes. In contrast, the primary CPS-specific Ab response was either inexistent or had titers only slightly higher than those in noninfected animals and was essentially composed of IgM. A poor CPS-specific memory response was observed, with only a moderate boost in IgM titers and no IgG. Both protein- and CPS-specific Ab responses were Toll-like receptor 2 independent. By using S. suis type 2 strains of European or North American origin, the poor CPS-specific Ab response was demonstrated to be independent of the genotypic/phenotypic diversity of the strain within serotype 2. Finally, the CPS-specific Ab response was also impaired and lacked isotype switching in S. suis-infected pigs, the natural host of the bacterium. The better resistance of preinfected animals to reinfection with the same strain of S. suis type 2 might thus more likely be related to the development of a protein rather than CPS Ab response.     

Laparoscopic surgery in urologic oncology.

BACKGROUND: Techniques in genitourinary oncologic surgery have evolved over the past several years, shifting from traditional open approaches toward minimally invasive routes by laparoscopy. METHODS: We reviewed the literature on laparoscopic surgery for genitourinary cancer, with emphasis on contemporary indications, complications, and oncologic outcome of laparoscopic surgery for urologic malignancies. RESULTS: All urologic oncology procedures have been performed laparoscopically. Laparoscopic radical nephrectomy is becoming the preferred approach for managing kidney cancer. The initial experience with nephroureterectomy is encouraging. Laparoscopic radical prostatectomy is rapidly becoming the standard in Europe and is the procedure of choice in many centers in the United States. CONCLUSIONS: When following the open oncologic principles for the surgical treatment of malignancies, laparoscopy offers similar oncologic clinical outcomes, less morbidity, improved operative precision, and reduced convalescence time.     

The Working Alliance in Psychiatric Care: Agreement Communication and Trust in Action

The physician-patient working alliance has been associated with improved patient satisfaction and adherence. However, up until now there has only been a patient form with which to assess the working alliance in medicine. The current study presents the provider form of the physician-patient working alliance, along with psychometric evidence and support. Participants were 106 psychiatrists (61 men and 45 women). They were selected from a database of providers in the Northeast of the U.S. and were asked to complete a mailed survey and to return it in stamped addressed envelope. We found evidence that the provider form is reliable and valid, and that the providers’ ratings’ of the working alliance were closely and significantly associated with their satisfaction with the treatment and with ratings of treatment outcome. The provider form of the physician-patient working alliance appears to be a reliable and valid measure of the working alliance. Providers’ ratings of the working alliance can now be assessed and examined along with patients’ ratings of the working alliance. Use of the measures may inform the relationship in medical treatment and advance the quality of care provided to patients.     

Resident evaluations: what are the predictors of future negative outcomes in surgical education?

European Surgery - Evaluation variables that correlate with future negative outcomes in surgery allow for actionable steps and early intervention. Diverse evaluation systems have been used to...