Interaction of complement-solubilized immune complexes (IC) with CR1 receptors on human erythrocytes. Polysulfated compounds inhibit IC binding and induce IC-release from CR1

The effect of the polysulfated compounds heparin, dextran sulfate, chondroitin sulfate and suramin, and non-sulfated poly-, oligo-, and monosaccharides on binding and release of complement-solubilized 125I BSA-anti BSA immune complexes (IC) reacting with complement C3b receptors (CR1) on human erythrocytes (E) was investigated. Following presolubilization of IC in normal autologous human serum (NHS) a clear dose-dependent inhibition of IC-binding to E-CR1 was obtained by addition of polysulfated compounds. The inhibitory effect was dependent on the sulfate content of the reagents used but independent of their anticoagulant activity as heparin preparations with high and low affinity for antithrombin III inhibited IC binding to E-CR1 to approximately the same extent. Dextran sulfate caused a stronger inhibition than heparin while chondroitin sulfate was inhibitory only at high concentrations. The inhibitory effect was exerted at the IC-C3b level as normal IC-binding occurred following preincubation of E with the polysulfated compounds. Non-sulfated saccharides showed no inhibition of IC binding to E-CR1. All polysulfated compounds, apart from chondroitin sulfate, induced a dose-dependent release of E-CR1 bound IC in the absence of NHS. No release was obtained by use of non-sulfated saccharides. Heparin induced IC-release was rapid (40-45% after 3 min) and incubation beyond 30 min caused only an insignificant further release of IC from E-CR1. Following release of IC the E-CR1 retained full binding capacity for freshly added IC-C3b.     

Multiple sclerosis: serial study of gadolinium-enhanced MR imaging

Thirteen patients with definite multiple sclerosis (MS), studied 16-24 months previously with magnetic resonance (MR) imaging with and without enhancement by intravenously administered gadolinium diethylenetriaminepentaacetic acid (DTPA) dimeglumine, were reexamined with a similar protocol. Assessment of enhancement and clinical activity in both studies revealed that enhancement was observed in 13 of 14 cases in which clinical activity had changed within 4 weeks of the study and thus appeared more sensitive than clinical examination in determining active disease. The 3-minute postinjection, short repetition time image (TR) was the most efficient for depicting enhancement. Enhancing lesions (active plaques) arose from previously hyper- or isointense regions on long TR images. Previously active lesions reverted to areas of iso- or hyperintensity on long TR images. Serial comparison of long TR images in this population reveals a decrease in high-intensity lesions on long TR images in some cases and an increase in others. The findings of high-intensity regions on long TR images and previously enhancing lesions both becoming isointense suggests that transient inflammatory changes with concomitant edema without demyelination and/or with significant remyelination may occur in some MS lesions. MS lesions are dynamic; both active and inactive lesions may show dramatic change on longitudinal MR imaging studies.     

New and emerging roles in out of hospital emergency care: A review of the international literature

AimsThe aim of the literature review was to identify new and emerging out of hospital emergency care roles and to describe their activity and impact.BackgroundDemographic changes, increased demands for health services, altered working practices, and health system economic pressures have led to the development of a disparate set of new health care roles.Data sourcesMEDLINE, EMBASE and CINAHL databases, and the two search engines Google and Google Scholar were searched for contemporary studies in the identified study area.Review methodsAll publications identified through the search were assessed for relevance. Those that discussed new roles were included (n = 34) and empirical studies (n = 14) analysed in detail.ResultsEmergency care and paramedic practitioner roles (ECP & PP) are having an impact on patient care, including an average 25% reduction in the conveyance rate to hospital, improved inter-professional working, immediacy of treatment and referral, and high patient satisfaction. Limited economic data suggests savings of between £31 (USD 55) and £37 (USD 65) per case when ECPs replace standard ambulance responders. Concerns have been expressed about patient safety, recruitment and training levels, regulatory and role implementation issues.ConclusionFurther work is required to fully understand the patient safety, clinical practice, professional role and financial implications of these new roles.     

Platform switching and marginal bone‐level alterations: the results of a randomized‐controlled trial

Objectives: This randomized‐controlled trial aimed to evaluate marginal bone level alterations at implants restored according to the platform‐switching concept, using different implant/abutment mismatching. Material and methods: Eighty implants were divided according to the platform diameter in four groups: 3.8 mm (control), 4.3 mm (test group₁), 4.8 mm (test group₂) and 5.5 mm (test group₃), and randomly placed in the posterior maxilla of 31 patients. After 3 months, implants were connected to a 3.8‐mm‐diameter abutment and final restorations were performed. Radiographic bone height was measured by two independent examiners at the time of implant placement (baseline), and after 9, 15, 21 and 33 months. Results: After 21 months, all 80 implants were clinically osseointegrated in the 31 patients treated. A total of 69 implants were available for analysis, as 11 implants had to be excluded from the study due to early unintentional cover screw exposure. Radiographic evaluation showed a mean bone loss of 0.99 mm (SD=0.42 mm) for test group₁, 0.82 mm (SD=0.36 mm) for test group₂ and 0.56 mm (SD=0.31 mm) for test group₃. These values were statistically significantly lower (P<0.005) compared with control (1.49 mm, SD=0.54 mm). After 33 months, five patients were lost to follow‐up. Evaluation of the remaining 60 implants showed no difference compared with 21 months data except for test group₂ (0.87 mm) and test group₃ (0.64 mm). There was an inverse correlation between the extent of mismatching and the amount of bone loss. Conclusions: This study suggested that marginal bone level alterations could be related to the extent of implant/abutment mismatching. Marginal bone levels were better maintained at implants restored according to the platform‐switching concept. To cite this article:
Canullo L, Fedele GR, Iannello G, Jepsen S. Platform switching and marginal bone‐level alterations: the results of a randomized‐controlled trial.
Clin. Oral Impl. Res. 21 , 2010; 115–121.     

New radiological typing system for rhinosinusitis and comparison with existing system: Initial finding

The objective of this study was to determine whether the proposed Malan radiological sinusitis typing (RST) system facilitated a level of agreement and ease of use comparable with the Lund–Mackay (LM) system for chronic rhinosinusitis. Ten observers (one otolaryngologist and nine radiologists), in two separate centres (regional and tertiary), blinded to all clinical data, used these two systems to independently and randomly score and type 15 sets of scans, recording the time to score each film. Using unweighted kappa scores, both methods facilitated a moderate level of agreement, slightly better with the LM system. The Malan system is more time efficient. Preliminarily, this study shows that the Malan RST system is easy to apply with a comparable level of agreement. The Malan RST system is a focused attempt at classifying disease extent radiologically and correlating it to a surgical approach. It emphasizes that scoring systems are vulnerable and proves to be superior to the LM system as a surgical planning tool. To score sinus disease, a Quality‐of‐Life questionnaire in association with this typing method is more appropriate.     

亚临床甲状腺疾病

亚临床甲状腺功能亢进和甲状腺功能减退属于试验诊断。2002年美国甲状腺协会、美国临床内分泌医师协会和内分泌腺协会的委员组成的一个专家小组，明确了亚临床甲状腺疾病的概念，回顾了涉及风险和治疗益处的文献，并且建议进行评估和人口筛查。     

Efficacy and tolerability of lower-dose topotecan in recurrent ovarian cancer: a retrospective case review

Topotecan (1.5 mg/m(2)/day for 5 consecutive days of a 21-day cycle) is an established recurrent ovarian cancer treatment, but myelosuppression can be dose limiting. This study evaluates the activity and tolerability of low-dose topotecan in our clinical experience. Case records were reviewed for patients with recurrent ovarian cancer in first through third relapse. Eligible patients had received > or =2 cycles of < or =1.25 mg/m(2) topotecan. Adverse events were evaluated using laboratory and clinical evaluation data. Twenty-seven eligible patients, most with advanced disease, received a total of 209 cycles (median, six cycles). Grade 3 or 4 hematologic toxicities during 184 cycles in 24 assessed patients were neutropenia, leukopenia, thrombocytopenia, and anemia in 35%, 28%, 36%, and 11% of cycles, and 21, 19, 16, and 10 patients, respectively. Only four grade 4 toxicities occurred: anemia (one) and thrombocytopenia (three). Myelosuppression was reversible, noncumulative, and manageable. Moreover, nonhematologic toxicity was generally mild to moderate, and the only two grade 3 events were constipation and deep vein thrombosis. Low-dose topotecan was active in this setting. Lower-dose topotecan is generally well tolerated and active in patients with pretreated ovarian cancer. Prospective clinical trials of low-dose topotecan in recurrent ovarian cancer are warranted.     

A changing paradigm of glioma biology

The past 30 years have witnessed a major paradigm shift in brain tumor research with the development of a wide variety of molecular