Making local pay helpful--Part 2: Using action research to address the challenge

Second part of an item featuring action research with four different trusts to investigate factors relating to the implementation of the local pay policy. Describes methodologies used, such as clinical team diagnosis and cognitive mapping. Looks at the way forward, listing critical factors in ensuring successful implementation.     

Optimal immobilization of penicillinase for lon-selective electrode

Penicillin sensor was prepared by immobilizing penicillinase (Pcase) on H⁺-selective carboxylated poly (vinyl chloride) (PVC-COOH) membrane or cellulose filter membrane. The immobilization techniques are as follows. Pcase was immobilized with GTH on H⁺-selective PVC-COOH membrane or some amount of BSA was dropped on that membrane. Another method to make immobilization is to mix type I Pcase with GTH and drop on a cellulose filter membrane. According to immobilization techniques, there were some differences in response properties of enzyme electrodes, however, all electrodes responded to Pcase-resistant penicillin derivatives. Pcase immobilized on cellulose filter membrane with H⁺-selective PVC membrane eletrode was more stable and more sensitive to penicillinase-resistant penicillin derivatives than any other immobilization techniques.     

Changes of nitric oxide synthase activity and free methylarginines contents in regenerating rat liver after partial hepatectomy

In the present study, liver regeneration rate (%) was increased up to 70% 3 days after partial hepatectomy (PH). Nitric oxide synthase (NOS) activity in liver tissue as well as serum nitrite/nitrate content had no timed response, revealing no significant difference between shamoperated and partially hepatectomized rat liver. Contents of free methylarginines in liver tissue were increased biphasically in a time-dependent manner after PH. However, those in serum did not exhibit the same patterns as in liver. Taken together, the results suggest that N^G-monomethyl-L-arginine (MMA) and N^G, N^G-dimethylarginine (DMA) play a role in inhibiting nitric oxide (NO) synthesis in regenerating rat liver because the increase of their contents was synchronized with NOS expression.     

Two novel abietane diterpenes from Salvia miltiorrhiza

Two new abietane-type pigments named tanshinol A (1) and tanshinol B (2) have been isolated from the roots of Salvia miltiorrhiza B. (Labiatae) as minor components together with sixteen other related tanshinone pigments 3-18. The structures of the two novel components 1 and 2 were established by means of spectral analyses.     

Purification of the NADH reductase component of the steroid 9α-hydroxylase fromMycobacterium fortuitum

The NADH reductase component of the steroid 9α-hydroxylase fromMycobacterium fortuitum was purified to homogeneity. Recovery of the enzyme from the 50≈60% ammonium sulfate saturated fraction was 49%, with a purification factor of 100-fold. The NADH reductase has a relative molecular mass of 60 KDa as determined by SDS-PAGE. The absorption maxima at 410 and 450 nm indicate the presence of iron-sulfur group and flavin. These prosthetic groups seemed to function as redox groups that transfer electrons from NADH to the following protein. The K_M value for NADH as substrate was 68 μM. The NH₂-terminal amino acid sequence of the reductase was determined as Met-Asp-Ala-Ile-Thr-Asn-Val-Pro-Leu-Pro-Ala-Asn-Glu-Pro-Val-His-Asp-Tyr-Ala-Thr. This sequence does not show a homology with the NH₂-terminal sequences reported for the reductase component of other monooxygenases, suggesting that the NADH reductase component of the steroid 9α-hydroxylase system is novel.     

Anti-cell adhesive effect of phenylacetylshikonin analogues related to their cytotoxicity in A549 cells

An attempt to estabilish the relationship between anti-cell adhesive action of phenylacetylshikonin anallogues and their cytotoxicity against A549 cells was done. In the one hour incubation with A549 cells, alpha-methoxyphenylacetyl-(9), alpha-acetoxyphenylacetyl-(13), 3,4-methylen-edioxyphenylacetyl-(15) and 4-(N,N-dimethylamino)-phenylacetylshikonin (17) analogues showed a high anti-cell adhesive activity (IC(100) value, 4-8 mug/ml), while halophenylacetyl-and dimethoxy-or trimethoxyphenylacetyl analogues expressed no activity at 40 mug/ml, indicating that the presence of a bulky group at C'-alpha and a polar group at C-4 of phenylacetyl moiety may be important. A similar structure activity relationship exists for the 48 hr cytotoxocity (ED(50)) of phenylacetylshikonin analogues in A 549 cells, but not in either K562 or L1210 cells. Furthermore, the difference between IC(100) values for anti-cell adhesive activity and ED(50) values for cytotoxicity of potent compound in A549 cells was not so great (1.5 to 3 times). Based on these observations, it is proposed that the anti-cell adhesive action of phenylacetylshikonins might be responsible for their cytotoxicity in A549 cells.     

Topical anti-inflammatory activity of dianemycin isolated fromStreptomyces sp. MT 2705-4

In order to develop new anti-inflammatory agents having different action mechanisms compared with nonsteroidal and steroidal anti-inflammatory drugs, the culture broths of various actinomycetes isolated from soil were screened using anin vivo mouse ear edma assay and one strain (Streptomyces sp. MT 2705-4: KCTC 8651P) was selected. Activity-guided purification led to the isolation of a polyether compound, dianemycin. Topically, dianemycin showed a potent anti-inflammatory activity in mouse ear edema induced by croton-oil or arachidonic acid. ED(50) value of dianemycin was found to be 0.8 mg/ear compared to 0.4 mg/ear of prednisolone in croton-oil ear edema. However, dianemycin did not show the inhibitory activity in UV-erythema and delayed hypersensitivity reaction. These results indicate that dianemycin is a potential topical anti-inflammatory agent.     

Estimation of a common odds ratio under binary cluster sampling

We present results from a simulation study for the estimation of a common odds ratio in multiple 2 × 2 tables when the data are correlated within clusters. We model the correlation of the data by the beta-binomial distribution. Through a simulation study, we compare the Mantel—Haenszel estimator with Rao and Scott'S estimator in terms of their biases, observed variances, relative efficiencies of their variances and 95 per cent coverage proportions. We limit the simulation study to the case where there are the same number of subjects in each cluster and the same number of observations in each row of each stratum. When ρ = 0, we recommend use of the Mantel—Haenszel estimator γ_MH with an unadjusted variance and Rao and Scott'S estimator γ with a pooled design effect. In general, when ρ >0, we recommend the Mantel—Haenszel estimator γ_MH with an adjusted variance and Rao and Scott'S estimator γ with a pooled design effect.     

Varus deformity of the distal end of the femur secondary to a focal fibrous lesion

Severe unilateral varus deformity of the distal end of the femur secondary to a focal fibrous lesion is reported. It is a malformative process rare at this level, this being the first report of it in the radiological literature. The conventional radiograph is pathognomonic and CT is useful in the confirmation of the fibrous tissue. Osteotomy is indicated only if the deformity progresses or the angle of varus is severe.     

A case of prominent epicardial fat mimicking a tumor on echocardiography

Epicardial fat may anteriorly produce an echo-free space that can be mistaken for pericardial fluid. We recently experienced a 67-year-old woman with prominent epicardial fat which was presented as an echogenic tumor-like mass. She underwent open pericardiostomy to relieve large amount of pericardial effusion. Operative findings revealed only prominent epicardial fat. Biopsy of the pericardial and fat tissues revealed an inflammation and normal fat cells without any malignant cell infiltration.