Visualisation of uric acid renal calculi (UARC) using computed radiography (CR)

AimTo investigate the capability of CR to visualise UARC through inverse image post-processing technique.Methods. A patient-equivalent phantom (PEP) consisting of six 2.5-cm thick Perspex layers and one 1-mm thick aluminium layer was used to represent human tissues and bones respectively. A total of eight exposures were made on PEP to radiograph 1 mm, 2 mm and 3 mm UARC located between three layers of 2-cm thick cattle muscle, positioned inside the PEP. After each exposure, a layer of Perspex was removed, and another exposure was made until only one Perspex layer and one layer of muscle (containing the three UARC) remained. For each exposure, two images (a positive and an inverse image) were produced for comparison using Fuji XG1 computed radiography system with IP0 type C-ST-VI Fuji imaging plate (equivalent to 400 speed radiographic screen-film systems).ResultsIn positive image, UARC of all three sizes (1 mm, 2 mm and 3 mm) located in the cattle muscle, cannot be visualised when the PEP consists of more than one layer of Perspex. In inverse image, the 3-mm UARC can be seen even when the PEP consists of five layers of Perspex.ConclusionThis study revealed the post-processing capability of CR to increase the visualisation of UARC which has been categorised as radiolucent. A further study of clinical image quality should be performed using blinded observers to test diagnostic accuracy, which was not included in this study.     

Coping as a mediator of psychosocial impediments to optimal management and control of asthma

Adherence to asthma medication regimens by asthma patients is often poor and contributes to the continued and substantial burden of asthma in the community. There is evidence of increased rates of behavioural problems, anxiety and depression in people with moderate-to-severe asthma and these factors may interfere with adherence and contribute to poor asthma control. An alternative explanation is that the relationship between feelings of anxiety and depression, and adherence to the treatment regimen may be more accurately predicted from the coping styles used, rather than the experience of asthma itself. The objective of this paper was to review evidence for associations between coping strategies used by asthma patients, asthma management and health outcomes. The Medline and PsychInfo databases were searched for articles containing the terms "asthma" and "coping". Patients with asthma tended to use different strategies for coping with stress and illness compared to healthy participants and individuals with other chronic illnesses. Emotion-focussed coping strategies such as denial were commonly used by patients with poor medication adherence, those who attended emergency departments for asthma, were admitted to hospital for asthma, or suffered near-fatal asthma attacks. Interventions to improve coping strategies have been effective in reducing symptoms and psychological distress. The availability of coping resources to patients and/or their caregivers and the coping strategies that are used are likely to mediate the influence of psychosocial factors on the management of asthma. Further studies exploring the ways in which individuals cope with asthma will improve our understanding of the mechanisms linking psychological and social status to asthma morbidity and mortality.     

Mechanical properties of resin-based cements with different dispensing and mixing methods

Statement of problem

Resin-based cements are frequently used in clinical practice. To reduce time and technique sensitivity, manufacturers have introduced the same brand of cement with different dispensing methods. The effect of this change on properties of the cement is unknown.

Randomized comparison of etanercept with usual therapy in an Asian population with active rheumatoid arthritis: the APPEAL trial

Aim: Rheumatoid arthritis (RA) is an important rheumatologic disease in Asia‐Pacific countries, as in other parts of the world. However, limited information is available regarding RA therapy in this region. The Asia‐Pacific Study in Patients to be Treated With Etanercept or an Alternative Listed DMARD (APPEAL) compared efficacy and safety of etanercept (ETN) + methotrexate (MTX) versus usual disease‐modifying anti‐rheumatic drugs (DMARDs) + MTX (reflecting regional practice) in subjects with moderate to severe RA from multiple Asia‐Pacific countries. Method: In this open‐label, active‐comparator, parallel‐design, multicenter study, subjects (n = 300) in the Asia‐Pacific region were randomized to ETN + MTX (n = 197) or DMARD + MTX (n = 103). The primary efficacy endpoint was the American College of Rheumatology (ACR) response (ACR‐N) area under the curve (AUC) over 16 weeks. Results: Baseline characteristics were similar between groups. At Week 16, ACR‐N AUC indicated a significantly greater response with ETN + MTX compared with DMARD + MTX (mean difference –145.3; P < 0.001). Significantly greater proportions of subjects achieved ACR 20, 50 and 70 responses with ETN + MTX versus DMARD + MTX at Week 16 (P < 0.05). Low Disease Activity Score based on a 28‐joint count (DAS28 < 3.2) was also achieved by significantly more subjects in the ETN + MTX group versus the DMARD + MTX group (P < 0.001). Greater improvements were shown for DAS28, pain visual analogue scale, health assessment questionnaire, and physician and patient global assessments (P < 0.05) for ETN + MTX versus DMARD + MTX. No new safety signals were found. Conclusion: In this Asia‐Pacific population of subjects with moderate to severe RA, ETN + MTX showed superior efficacy versus usual DMARD + MTX regimens, with similar safety profiles.     

Dynamic assessment of parathyroid function in acute malaria

Davis TME, Singh B, Choo KE, Ibrahim J, Sulaiman SA, Kadir ZA, Ismail R (University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia. Universiti Sains Malaysia, Kubang Kerian, Kota Bharu; General Hospital, Kota Bharu, Kuala Krai Hospital, Kuala Krai; Kelantan, Malaysia) Dynamic assessment of parathyroid function in acute malaria. J Intern Med 1998; 243 : 349–54.

Objectives

To investigate the dynamic parathyroid response to rapidly induced, sustained hypocalcaemia in patients with acute malaria and in healthy volunteers.

Design

Serum intact parathormone (PTH) concentrations were measured on samples taken before and during a variable-rate tri-sodium citrate infusion designed to ‘clamp’ the whole blood ionised calcium concentration 0.20 mmol L^?1 below baseline for 120 min.

Subjects

Six Malaysian patients aged 17–42 years with acute malaria, four of whom were restudied in convalescence, and 12 healthy controls aged 19–36 years.

Main outcome measures

Whole-blood ionised calcium and serum intact PTH concentrations.

Results

The mean (SD baseline ionised calcium was lower in the malaria patients than in controls (1.09 ± 0.06 vs. 1.18 ± 0.03 mmol L^?1, respectively; P= 0.01) but PTH concentrations were similar (3.0 ± 1.8 vs. 3.3 ± 1.3 pmol L^?1; P= 0.33). Target whole-blood ionised calcium concentrations were achieved more rapidly in the controls than the patients (within 15 vs. 30 min) despite significantly more citrate being required in the patients (area under the citrate infusion-time curve 0.95 (0.25 vs. 0.57 ± 0.09 mmol kg^?1; P < 0.01). The ratio of the change in serum PTH to that in ionised calcium (δPTH/δCa²⁺), calculated to adjust for differences in initial rate of fall of ionised calcium, was similar during the first 5 min of the clamp (132 ± 75 × 10^?6 vs. 131 ± 43 × 10^?6 in patients and controls, respectively, P > 0.05), as were steady-state serum PTH levels during the second hour (7.0 ± 2.2 pmol L^?1 in each case). Convalescent patients had normal basal ionised calcium levels but the lowest serum intact PTH levels before and during the clamp, consistent with an increase in skeletal PTH sensitivity after treatment.

Conclusions

There is a decreased ionised calcium ‘set point’ for basal PTH secretion but a normal PTH response to acute hypocalcaemia in malaria. Skeletal resistance may attenuate the effects of the PTH response but patients with malaria appear relatively resistant to the calcium chelating effects of citrated blood products.

     

维吾尔族妇女宫颈癌及癌前病变组织中 EGR1和 ID4基因表达下调与 HPV 感染的关系

目的：探讨宫颈癌及癌前病变组织中基因下调表达调控与人乳头状瘤病毒（human papillomavirus, HPV）感染的依存关系,为建立 HPV 筛查预警的宫颈癌辅助诊断指标提供依据。方法收集维吾尔族妇女宫颈鳞癌（cervical squamous cell carcinoma,CSCC）、宫颈上皮内瘤变（cervical intraepithelial neoplasia,CIN）Ⅱ～Ⅲ及宫颈炎患者的新鲜宫颈上皮组织标本共100例,提取组织 DNA 和 RNA,鉴定 HPV 阳性和型别,选择 HPV 阳性CSCC 和 CINⅡ～Ⅲ及 HPV 阴性宫颈炎组织 RNA,利用荧光定量 RT-PCR 方法鉴定早期生长反应基因-1（EGR1）、DNA 结合抑制因子4（ID4）、FBJ 鼠科骨肉瘤病毒原癌基因（FOS）和早期应急蛋白2（IER2）基因的转录表达水平。结果通过 HPV 阳性鉴定和分型,鉴别出 HPV16、18、45、31等8种 HPV 感染型别,宫颈癌、CIN 和宫颈炎组织的 HPV 阳性率分别为94．4％、75．0％和31．3％,其中 HPV16阳性率为66．6％、68．7％和31．3％;HPV 阳性的 CSCC 组织中 EGR1、ID4、FOS 和 IER2基因的 mRNA 表达水平低于 HPV 阳性的 CIN 和 HPV 阴性宫颈炎,且 CSCC 与 CIN 或 NC 比较差异均有统计学意义（P ＜0．05）,而 HPV 阳性的 CIN 组织中4种基因的表达水平均低于 HPV 阴性的宫颈炎组织,两者 EGR1和 ID4基因表达水平差异有统计学意义（P ＜0．05）;从 HPV16感染的角度分析,CSCC 或 CIN 与宫颈炎 EGR1和 ID4表达水平差异有统计学意义（P ＜0．05）,但是 CSCC 与 CIN 相比较,只有 EGR1基因表达水平差异有统计学意义（P ＜0．05）,而 ID4基因差异无统计学意义（P ＞0．05）。结论宫颈癌及癌前病变与依赖于 HPV 感染的 EGR1和 ID4基因表达下调有关,其中 EGR1基因表达水平变化可能与癌前病变和 HPV16感染的关系更为密切,可能成为 HPV 筛查预警的宫颈癌辅助诊断指标,并为揭示 HPV感染的致病和致癌分子机制提供了重?