Endoneurial microvascular abnormalities of sural nerve in non-diabetic chronic atherosclerotic occlusive disease

Neuropathic abnormalities are found in chronically ischaemic limbs associated with non-diabetic atherosclerotic peripheral vascular disease (PVD). In chronic ischaemic neuropathy, microvascular alterations play a key role in its development. We undertook morphometric assessment of endoneurial microvessels in the sural nerves, taken from severely ischaemic amputated legs in nine chronic non-diabetic PVD. These subjects had threatened ischaemic limbs and revealed clinical, physiological and pathological evidence of neuropathy. For comparison, sural nerves taken from amputated legs due to non-ischaemic disorders (n=4) and chronic PVD associated with diabetes (n=3) were also assessed. We evaluated the areas of vascular lumen, endothelial cells and whole vessel, as well as the percentage of closed capillaries. Endothelial area of sural nerve microvessels in non-diabetic PVD nerves was significantly greater than in non-ischaemic control nerves. Periendothelial cell area containing pericytes and basement membranes was also significantly increased in non-diabetic PVD nerves when compared with control nerves. Vascular lumen area was significantly less in non-diabetic PVD nerves than in non-ischaemic control nerves. Endoneurial microvessels in diabetic PVD nerves showed similar results: thickened vessel wall and smaller lumen. Periendothelial area in diabetic nerves was significantly greater than in non-diabetic PVD nerves. We demonstrated swollen endothelial cells and increased periendothelial area associated with narrowed lumen in sural nerve endoneurial microvessels of severe chronic PVD. Basement membrane reduplication of endoneurial capillaries was seen in non-diabetic PVD nerves. These microvascular abnormalities could play an important role in the development of chronic ischaemic neuropathy in PVD limbs.     

Critical thinking in health care supervision

Henry Ford is reputed to have said that thinking is the hardest work there is, which is probably why so few people engage in it. Perhaps many people have felt this way sometimes, especially when they viewed the foibles of the human race displayed prominently on the evening television news. Some people do stupid things; some people seem to be mindless in what they do. This applies also to some in managerial and supervisory positions in health care organizations. The percentage of these thoughtless managers and supervisors is probably comparable to the percentage of the thoughtless people in the general population. Fortunately every normal functioning human being is capable of becoming a more critical thinker. Of course, no amount of effort is adequate to the development of critical thinking when a person lacks fundamental good sense. On the other hand, no amount of genius suffices when someone does not put forth adequate effort to become a more critical thinker.     

Local secretion of a chimeric anti-CD4 antibody protects against graft rejection in the NOD mouse

BACKGROUND: Engineering a graft to secrete its own immunosuppressive antibodies may minimize the risks associated with current high dose systemic immunosuppression. METHODS AND RESULTS: A beta cell insulinoma cell line (NIT-1) was transfected with genes encoding a chimeric anti-CD4 antibody. The NIT-1 cells secreted functional chimeric anti-CD4 antibody that bound to the CD4 molecule on mouse thymocytes and inhibited in vitro proliferation of CD4+ve T cells. Both test and control transfected cell lines grew at a similar rate in immunodeficient mice. In immunocompetent NOD mice, NIT-1 cells are normally rejected by a cellular immune response against the SV40 T antigen. Although control transfected NIT-1 cells were rapidly rejected by NOD mice, anti-CD4 secreting NIT-1 cells grew significantly better and were able to form tumors at the site of injection. CONCLUSIONS: The local secretion of chimeric anti-CD4 antibody from transfected cells can contribute to graft survival in our transplantation model.     

National Data Sources on the Care and Outcomes of Patients with Community Acquired Pneumonia

Despite improved understanding and treatment of community acquired pneumonia (CAP), variations in clinical practice and patient outcomes still exists, resulting in excess healthcare dollars spent and decreased patient satisfaction. The use of treatment and outcomes research data can help providers improve their methods and standardize techniques to control costs and provide the best care for their patients. To better understand the utility and capabilities of this research, this article will compare several administrative and clinical databases. Two, data sources in particular, the EPI-Q Inc. CAP-Compare database and the University HealthSystem Consortium's (UHC) CAP Benchmarking Program contain clinical and utilization data specific to CAP. In addition there are several government and non-government sponsored data sources that include administrative data on many diagnosis including CAP. These include: Healthcare Benchmarking Systems International's EXPLORE database, the Center for Healthcare Industry Performance Studies database, the National Center for Health Statistics'--National Hospital Discharge Survey, and the Medicare Provider Analysis and Review data files.     

Can we improve the diagnostic efficiency and predictive power of prodromal symptoms for schizophrenia?

Prodromal symptoms and other variables for a sample of 200 young people who had experienced a first-onset functional psychosis, were analyzed to examine their diagnostic efficiency and predictive power in relation to a diagnosis of schizophrenia. Two different techniques were utilized to generate optimal cut-off points for a number of prodromal symptoms, and optimal decision rules to maximize diagnostic efficiency. The product of the chance-corrected sensitivity and specificity, or the area under the QROC curve, was used to assess the predictive efficiency of a number of prodromal variables, DSM-III-R prodromal variables, pre-psychotic deterioration, pre-morbid functioning, and prodromal duration. The SPAN technique generated a decision rule that performed equivalently to the single variable 'duration of prodrome'. Implications of these results for future research are discussed.     

Practitioner Review: Unguided and guided self-help interventions for common mental health disorders in children and adolescents: a systematic review and meta-analysis

Mental health problems are common in children and adolescents, yet evidence-based treatments are hard to access. Self-help interventions can increase such access. The aim of this paper was to conduct a systematic review and meta-analysis of the use of guided and unguided self-help for children and young people with symptoms of common mental health disorders. In contrast to previous reviews of self-help in children, all types of self-help and multiple mental health disorders were investigated in order to increase power to investigate potential moderators of efficacy. Importantly, studies with control arms as well as those comparing against traditional face-to-face treatments were included. Fifty studies (n = 3396 participants in self-help/guided self-help conditions) met the inclusion criteria. Results demonstrated a moderate positive effect size for guided and unguided self-help interventions when compared against a control group (n = 44; g = 0.49; 95% CI: 0.37 to 0.61, p < .01) and a small but significant negative effect size when compared to other therapies (n = 15; g = −0.17; 95% CI: –0.27 to –0.07, p < .01). Few potential moderators had a significant effect on outcome. Most comparisons resulted in significant heterogeneity and therefore results are interpreted with caution.