Relationship of the clinical response and binding of recombinant interferon alpha in patients with lymphoproliferative diseases

Patients with hairy cell leukemia (HCL) and chronic lymphocytic leukemia (CLL) were treated with recombinant interferon alpha A (rIFN- alpha A). The binding of iodinated recombinant interferon-alpha to baseline samples of peripheral blood mononuclear cells (PBMCs) from the leukemia patients was compared with clinical responsiveness to rIFN- alpha A. HCL patients (8/10) responded to rIFN-alpha A therapy, whereas none (0/10) of the CLL patients studied responded. The PBMCs from the eight responsive HCL patients bound approximately twice as much iodinated interferon as the PBMCs from nonresponsive CLL patients. This difference was due to more high-affinity receptors per cell with no difference in the affinity of the interferon-receptor interaction. However, because PBMCs from HCL patients were larger than PBMCs from CLL patients, the cell surface receptor density was similar. The leukemic cells from one of the two nonresponsive HCL patients bound iodinated interferon similarly to the cells from the responsive HCL patients, whereas the leukemic cells from the other nonresponsive HCL patient bound considerably less. The rapidity of response of the HCL patients did not correlate with the level of binding of iodinated interferon. Our results suggest that the absolute number of interferon receptors per cell may be only one of several important parameters in the response to rIFN-alpha A therapy, and that the responsiveness of a particular lymphoproliferative disease or a particular patient to rIFN- alpha A therapy cannot be predicted or explained solely by the degree of interaction between IFN and its cell surface receptor.     

药师参与模式下肠镜检查术前肠道准备的药学服务实践

<正>电子结肠镜检查是诊断和筛查肠道疾病常用、有效的检查方法之一,而进行结肠镜检查的基本条件是清洁良好的肠道准备。虽然近年来肠道清洁剂的商品化和肠道准备方法的标准化不断完善,但仍有约30%的患者肠道准备不充分[1-3]。不充分的肠道准备会导致检查时间延长、操作难度增加、病变检出率降低、漏诊及检查费用增加等。肠道准备的质量多与患者的依从性有关,加强对患者肠道准备相关知识的教育,增强患者对肠道准备方法的认识和理解,可以提高检查前的肠道准备质量[4     

The activation of the contact phase of coagulation by physiologic surfaces in plasma: the effect of large negatively charged liposomal vesicles

The endogenous, negatively charged surface that induces activation of the contact coagulation factors was investigated in plasmas taken from women in late pregnancy and control subjects of child-bearing age. The plasmas from the two groups of subjects were incubated at 4 degrees C for 24 hours either in plastic or in glass tubes and the factor VII coagulant activity (VIIc) was assayed in the treated plasmas. The activation of factor VII under these conditions involves the generation of enzymes derived from factor XII (XIIa). The contact surface is rate- limiting for the activation of factor VII in the plasmas in both groups of subjects and can be supplemented by large multilamellar liposomal vesicles carrying the appropriate density of negative charge. The size of these vesicles is within the range of sizes of the large lipoprotein particles (chylomicrons, very low and intermediate-density lipoproteins). The relationship between the density of negative charge on the liposomal vesicles and VIIc was similar in the late pregnancy and the control plasmas incubated in plastic tubes. At a saturating density of negative charge the observed relative VIIc was similar in both sets of plasmas. The incubation of late pregnancy or control plasma in plastic tubes in the presence of sodium stearate caused VIIc to increase with increasing concentration of the added fatty acid. These results suggest that large lipoprotein particles carrying the appropriate free fatty acid at a sufficient density of negative charge could provide the contact surface that induces the generation of factor XIIa and the subsequent activation of factor VII. Moreover, plasmas from women in late pregnancy have a higher concentration of potential surface and a higher density of negative charge than the plasmas from nonpregnant women.     

Serological studies on patients with suspected legionellosis in New Zealand

Summary Specimens from 490 patients with suspected legionellosis from many parts of New Zealand were studied. Most of these were sera, but 36 specimens including material from lungs, pleural fluid and sputa were also examined. The sera were tested for the presence of antibodies toLegionella pneumophila serogroups 1 to 6 andLegionella micdadei. Serological evidence of legionellosis was found in 49 patients. Antibodies toL. pneumophila serogroup 6 predominated, while those toL. micdadei andL. pneumophila serogroup 1 were noted in smaller numbers. Antibodies to serogroups 2, 3, 4 and 5 ofL. pneumophila were not often encountered.

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Serologische Studien bei Patienten mit Verdacht auf Legionellose in Neuseeland

Zusammenfassung Proben von 490 Patienten mit Verdacht auf Legionellose aus zahlreichen Gegenden von Neuseeland wurden untersucht. Es handelte sich vorwiegend um Seren, in 36 Fällen konnten auch Proben von Lunge, Pleuraflüssigkeit und Sputum untersucht werden. Die Seren wurden auf Antikörper gegen die Serogruppen 1–6 vonLegionella pneumophila und vonLegionella micdadei geprüft. Bei 49 Patienten lag der serologische Beweis für eine Legionellose vor. Vorwiegend fanden sich Antikörper gegen die Serogruppe 6 vonL. pneumophila, seltener wurden Antikörper gegenL. micdadei und die Serogruppe 1 vonL. pneumophila nachgewiesen. Antikörper gegen die Serogruppen 2, 3, 4 und 5 vonL. pneumophila wurden nicht oft gefunden.

     

Depth of the patient–doctor relationship and content of general practice consultations: cross-sectional study

Background

Patient–doctor continuity is valued by both parties, yet the effect of the depth of the patient–doctor relationship on the content of consultations in general practice is unknown.

Aim

To assess whether differences in the depth of relationship between a patient and their GP affects the length of consultations, and the number and type of problems and issues raised during a consultation.

Design and setting

Cross-sectional study in 22 GP practices in the UK.

Method

GP consultations (n = 229) were videotaped and the number of problems and aspects of those problems and issues identified. Patients completed the Patient–Doctor Depth of Relationship (PDDR) and General Practice Assessment Questionnaire-communication (GPAQc) scales. Associations were explored using multivariable linear and logistic regression.

Results

Complete data were available on 190 participants consulting 30 GPs. In unadjusted analysis, patients with a deep relationship with their GP discussed more problems (mean 2.8) and issues (mean 4.7) compared with those with a moderate (2.4 problems; 4.0 issues) or shallow (2.3 problems; 3.8 issues) relationship. Patients with deep relationships had consultations that were on average 118 seconds (95% CI = 1 to 236) longer than those with shallow relationships. Adjustment for participant and GP factors attenuated these relationships, although the main trends persisted.

Conclusion

A greater number of problems and issues may be raised in a consultation when patients have a deeper relationship with their GP. Over several clinical encounters each year, this may be associated with significant benefits to patients and efficiencies in GP consultations and warrants further investigation.     

Postnatal changes in blood respiratory characteristics in an American opossum (Didelphis virginiana).

The oxygen affinity of opossum blood changes in the postnatal period. The youngest opossums studied were 53 days of age (dated from the day of transit from vagina to pouch) and still confined to the maternal pouch: they had a blood P50 of 32.6 +/- 2.9 mm Hg. The blood P50 value then increased significantly, in two steps. First, while the young were still in the pouch, blood P50 rose secondary to a rise in the concentration of 2,3-diphosphoglycerate (DPG). Blood P50 and DPG concentration then remained stable until the animals left the maternal pouch, when DPG rose again, causing a further increment in the blood P50 which peaked at 48.7 +/- 4.5 mm Hg in animals 148 days old. Blood P50 subsequently decreased significantly, reaching the adult value (42.0 +/- 1.9 mm Hg) at about 250 days.     

Suprasellar germ cell tumours: specific problems and the evolution of optimal management with a combined chemoradiotherapy regimen

OBJECTIVE: Suprasellar germ cell tumours are rare, and there are few series of patients outlining the problems in diagnosis and management, and providing clear guidelines for optimal therapy. We have therefore reviewed our own series of 11 such patients who were managed in a joint endocrinology/clinical oncology setting. PATIENTS AND DESIGN: A retrospective case review assessment of all patients seen within a given time. Clinical, biochemical and radiological findings were reviewed, the types of therapy administered noted, and the responses to treatment analysed. RESULTS: In the years 1977-2001, 11 patients with suprasellar (SS) germ cell tumours (GCT) were seen (germinomatous : nongerminomatous = 8 : 3). SSGCT had an approximately equal sex incidence (M : F, 6 : 5), in contrast to pineal tumours, the commonest site of origin of intracranial GCT and which occur predominantly in men. The median age at presentation was 20 years (range 6-49 years) with a median duration of symptoms before diagnosis of 17 months (range 1-35 months). Polyuria was the commonest presenting symptom (10 patients). Diabetes insipidus occurred in all patients, as did partial or complete anterior pituitary failure. Visual failure was present in 55% of cases. Anorexia, weight loss and disturbed thirst sensation were also common. Positron emission tomography scanning was occasionally useful in the evaluation of suprasellar tumours/pituitary stalk lesions deemed too risky to biopsy. A "central nervous system-friendly" chemoradiotherapy regimen comprising vincristine, etoposide and carboplatin and differential daily dose irradiation, usually administered using a partial transmission block technique, produced a 5-year survival of 100% with low morbidity. Treatment did not correct previously abnormal endocrine function although it did improve vision in three of six patients. CONCLUSIONS: We therefore emphasize the use of techniques other than biopsy in the diagnosis of these patients, note the problems in the management of their fluid control, and highlight the favourable response to a combined chemotherapy-radiotherapy protocol.