HANDLING AND ACCEPTABILITY OF THE EASI-BREATHE DEVICE COMPARED WITH A CONVENTIONAL METERED DOSE INHALER BY PATIENTS AND PRACTICE NURSES

This study compared the handling and acceptability of the Easi-Breathe^TM, a breath-actuated metered dose inhaler (MDI), with that of a conventional MDI. A total of 104 patients and 14 practice nurses took part in interviews at a central location. An additional 100 practice nurses were interviewed in a telephone study. Significantly more patients (86%) found Easi-Breathe easier than a conventional MDI to use correctly (p<0.001). Overall, more patients preferred Easi-Breathe (82% vs 18%; p<0.001), ease of use and confidence in successful dose delivery being the main reasons for their preference. Nurses thought that Easi-Breathe was easier for the vast majority of patients (97%) to use correctly, as well as being easier to teach and to use correctly in a crisis (p<0.001). Overall, 79% of nurses preferred the Easi-Breathe to the conventional MDI (p<0.001), ease of use and ease of teaching being the main reasons for their preference.     

激光特征与其诱导骨肉瘤多药耐药细胞凋亡的生物学效应

目的:探讨激光诱导骨肉瘤多药耐药细胞凋亡的分子机制。资料来源:应用计算机检索Pubmed1996/2006的相关文章,检索词为“laser,osteosarcoma,apoptosis”并限定语种为“English”,应用计算机检索“中国期刊网CNKI数字图书馆”1996/2006的中文文章,检索词为“激光,骨肉瘤,凋亡”。资料选择:对资料进行初审,查找全文的文献。纳入标准为:与激光诱导肿瘤凋亡的机制有关。排除标准为较陈旧和重复研究的文章。资料提炼:共收集到72篇文章,其中31篇文献符合纳入标准,其中关于氧自由基方面的文章5篇,关于细胞内钙离子浓度的文章5篇,关于蛋白激酶C的文章6篇,关于Bcl-2的文章5篇,关于P53的文章8篇。资料综合:激光诱导肿瘤细胞凋亡的机制主要包括以活性氧簇为主的自由基、细胞内Ca2 浓度、蛋白激酶C家族、Bcl-2家族、p53基因等。目前的报道多侧重于低强度激光对正常细胞的促增殖作用,而对肿瘤细胞,特别是多药耐药骨肉瘤细胞及其动物模型生物效应的研究很少,推测也可能与以上机制有关。结论:激光诱导骨肉瘤凋亡的分子机制还不清楚,可能与细胞内活性氧自由基、钙离子浓度、蛋白激酶C、bcl-2和p53基因等相关。     

在医学教育中使用模拟技术能显著提高医生实践水平:一项病例对照研究

随着现代制造工艺、电子技术的水平提升,医学模拟技术在功能性和仿真性方面日趋完善,种类也极大丰富,在医学教育中有越来越广泛的应用前景.为了验证在医学教育中应用模拟教育是否可以直接提高医生在实际临床工作中的医疗水平,美国西北大学Feinberg医学院的研究人员进行了一项针对其附属医院的心脏停搏诊疗团队的回顾性病例对照研究.     

In-hospital resource utilization in coronary angioplasty: the impact of increased coronary stenting rates and antiplatelet therapy

BACKGROUND: The technique of coronary stenting has evolved over recent years, with improved stent technology and effective antiplatelet therapies to prevent stent thrombosis. In Europe, reductions in stent and equipment costs have resulted from increased market competition. The impact changes on the in-hospital procedural cost of percutaneous coronary intervention (PCI) in the current clinical setting is not known. METHODS: We compared the initial equipment and pharmaceutical costs of one hundred consecutive, unselected patients undergoing PCI in 1998 to a similar population who underwent PCI in 1994. RESULTS: Similar patient characteristics were noted, yet more complex disease (multivessel, AHA type B2/C lesions) was treated in the 1998 population. The stent utilization rate (83% vs 15%, p < 0.0001) and use of intravenous and/or oral antiplatelet therapy (abciximab, ticlopidine) (64% vs 4%, p < 0.0001) was higher in 1998. Similar angiographic success was achieved in each group with low complication rates. Mean hospital stay was reduced in the 1998 group of these (2.6 &#45 2.8 vs 4.3 &#45 3.8 days, p < 0.001). Repeat PCI was required more frequently in the 1994 population (26% vs 9%, p < 0.001). Overall there was no significant difference in the mean equipment cost between the two groups ( 1551 vs 1422, p =ns). CONCLUSION: Despite the widespread use of coronary stenting and antiplatelet therapies there appears to be no difference in current in-hospital equipment costs for PCI compared to 1994. Improved clinical outcomes in the 1998 population imply that stenting is a cost-effective therapy. (Int J Cardiovasc Intervent 2000; 3: 161-165)     

Intravesical chondroitin sulphate for interstitial cystitis/painful bladder syndrome

Introduction

Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic inflammatory condition of the bladder. Bladder instillation is one avenue of treatment but evidence for its effectiveness is limited. Chondroitin sulphate solution 2.0% (Urocyst) is a glycosaminoglycan (GAG) replenishment therapy instilled for patients with IC/PBS. We assessed its effectiveness for treating IC/PBS in Northern Ireland.

Methods

Patients with IC/PBS were assessed with the O''Leary-Sant interstitial cystitis index score and global response assessment questionnaire prior to commencing treatment. Assessment with these questionnaires was performed after 6 treatments (10 weeks) and again after 10 treatments (24 weeks). Assessment end points were pain, urgency, symptom score and problem score.

Results

Data was collected on 10 patients, 9 female and 1 male. 6 patients had failed RIMSO-50 dimethyl sulphoxide (DMSO) 50% treatment prior. At baseline the mean pain score was 6.6, urgency score 7.00, symptom score 13.5 and problem score 12.5. After 24 weeks the mean pain score fell to 2.0, urgency score to 1.80, symptom score to 6.89 and problem score to 5.67. At 10 weeks the global response to treatment was 100%. Nocturia was the first symptom to improve with urgency and pain following. No side effects were noted during instillation and all patients tolerated the treatments.

Conclusion

IC/PBS is a difficult disease to treat. It requires a multimodal approach. We found that intravesical chondroitin sulphate reduced pain, urgency and O''Leary-Sant symptom and problem scores in patients with IC/PBS. All patients tolerated the treatment and no side effects were reported.     

Cross-reactivity between H-2K and H-2D products. I. Evidence for extensive and reciprocal serological cross-reactivity

Serological cross-reactivity between the products of the H-2K and H-2D genes has been demonstrated by a design in which antibody was produced against determinants controlled by one locus (e .g . H-2K(k)), and then tested against the product of the opposite locus (e .g . H-2D(d)). A total of 13 out of 18 such test combinations exhibited H-2K-H-2D cross-reactivity. The presence or absence of cross-reactivity was reciprocal in most cases (i.e. antibody directed against the H-2K(k) gene product reacted with H-2(d) determinants, and antibody directed against the H-2D(d) gene product reacted with H-2K(k) determinants). An Ia-like reaction was detected with one antiserum which implied possible cross-reactivity between the products of two discrete la genes.