The effect of acidic fibroblast growth factor and live yeast cell derivative on tympanic membrane regeneration in a rat model

The current treatment of choice for chronic tympanic membrane perforations is surgery. Recent studies using various polypeptide growth factors to accelerate closure of tympanic membrane perforations in model systems have produced mixed results. This study evaluates the effect of acidic fibroblast growth factor (AFGF) and live yeast cell derivative (LYCD) on the rate of healing of acute tympanic membrane perforations in a rat model. Thirty-seven rats had both ears separately randomized in a blinded fashion to receive AFGF in one of three concentrations, LYCD, or a control solution. The rats initially underwent subtotal removal of the tympanic membranes bilaterally. Solutions were applied to the randomized ears daily for 3 days, starting at the time of the surgical perforation. The ears were photographed every 3 to 8 days for 35 days. The photographs were digitally scanned and a computer analysis was used to calculate the percentage of residual perforation. No significant difference in the rate of healing was observed for ears treated with AFGF or LYCD versus the controls. Given the potential advantages of medical treatment of tympanic membrane perforations and the established efficacy of growth factors in other model systems, however, further research is warranted. (Otolaryngol Head Neck Surg 1997;117:616-21.)     

Effects of Dihydrotestosterone and Estradiol on Experimental IgA Nephropathy Induced by Vomitoxin

Ingestion of the trichothecene vomitoxin (VT) by mice induceseffects that mimic the common human glomerulonephritis, IgAnephropathy (IgAN). These include elevation of serum IgA, IgAimmune complexes, and mesangial IgA deposition. Based on previousobservations that male mice are more prone to VT-induced IgAN,the effects of castration of male and female B6C3F1 mice andsex hormone supplementation on several immunopathologic indicatorsof the disease were compared. In the first study, castratedand intact male and female mice were fed control AIN-76A dietor the same diet containing 10 ppm VT for 12 weeks. At Week12, all but the intact female group fed VT exhibited increasedserum IgA, with castrated female mice having greater levelsthan intact females. When microscopic hematuria was used asan indicator of disease severity in intact VT-fed mice, erythrocytecounts for males exceeded those for females at weeks 4 and 12.VT-fed, castrated females exhibited greater hematuria than intactcounterparts, whereas VT-fed, castrated males had lower urinaryerythrocyte counts than intact counterparts. In a second study,castrated male and female mice were implanted with controlledrelease pellets of placebo, 5-dihydrotestosterone (DHT), or17ß-estradiol (E₂) and then were fed either controldiet or a 10 ppm VT diet for 8 weeks. Castrated male and femalemice treated with VT and DHT pellet exhibited more severe hematuria,higher IgA levels, and greater mesangial IgA deposition thanmice exposed to the same diet with placebo or E₂ pellet at Week8. While VT-fed animals with an E₂ pellet exhibited greaterhematuria and mesangial IgA deposition at Week 8 than the placebogroups, their IgA levels were not significantly elevated overthose for VT-fed mice with a placebo pellet. Relative to twoother pathologic markers for IgAN, the aforementioned effectsin both studies were generally consistent with mesangial depositionof complement component C₃ but not IgG. The results suggestthat (1) enhanced male susceptibility to VT-induced IgAN maybe related to modulation by the biologically active androgenDHT and (2) while castration of females increased severity ofVT-induced IgAN, supplementation of castrated male or femalemice with E₂ did not reverse this effect but rather increaseddisease severity.     

DIFFERING EFFECTS OF CARBOHYDRATE, FAT AND PROTEIN ON THE RATE OF ETHANOL METABOLISM

The rate of metabolism of ethanol in humans has been assessedby intravenous infusion of ethanol/saline under feedback controlto maintain a constant blood alcohol concentration. After equilibration,meals consisting predominantly of carbohydrate, fat or proteinwere eaten and changes in ethanol metabolic rate were found.Carbohydrate caused a significant increase in this rate andfat or protein caused small but non-significant decreases. Infusionof ethanol/saline resulted in a temporary fall in plasma freefatty acid levels and a steady rise in plasma triglycerides.The changes in alcohol metabolism following carbohydrate cannotbe accounted for by changes in insulin, free fatty acid or lactate/pyruvatelevels.     

Nurse-led case management for community dwelling older people: an explorative study of models and costs

Aim To compare community matrons with other nurses carrying out case management for impact on service use and costs. Background In England, nurses working in general practice, as district nurses and disease-specific nurses, undertake use case management. Community matrons were introduced to case management to reduce unplanned hospitalizations of people with complex conditions. Methods Managers in three Primary Care Trusts (PCTs) identified four nurses/matrons engaged in case management. Nurses/matrons recruited five community-dwelling patients referred to them for case management. Patients reported use of health/social services for 9 months, 2008 to 2009. Nurses/matrons completed activity diaries. Results Service use data were available for 33 patients. Compared with other nurse case managers, community matrons had: smaller caseloads; more patient contact time (mean 364 vs. 80 minutes per patient per month); and older patients (mean age 81 vs. 75 years, P = 0.03) taking more medications (mean 8.9 vs. 5.6, P = 0.014). Monthly costs were significantly higher for patients managed by community matrons (add £861), and who lived alone (add £696). Hospitalizations were not associated with patient or service delivery factors. Conclusion Further research on cost-effectiveness of case management models is required. Implications for Nursing Management The case for continued investment in community matrons remains to be proven.     

Professional integration within health centre pharmacies

□ The National Health Service plan proposes 500 new one‐stop centres to include pharmacy □ Little is known about current activities in health centre pharmacies □ A self‐completion survey of a sample of identifiable health centre pharmacies has been carried out □ There is some evidence of integration of pharmacists within the practice team □ Increased integration will require proactive external input     

MALIGNANCY GRADE and LONG-TERM SURVIVAL IN BRAIN TUMOURS of INFANCY and CHILDHOOD

281 histologically verified brain tumours in children were revised and reclassified according to degree of histological malignancy. Survival graphs based on 100 per cent follow-up after 15-40 years show that, of those who survived for more than 1 month after diagnosis and possible operation, 40 per cent were still alive more than 15 years later. There was a clear correlation between survival and degree of malignancy. Sixty-five per cent of those with tumours of malignancy grade I and only 3 per cent of those with malignancy grade IV were alive after 15 years.     

Healthcare provider–child–parent communication in the preoperative surgical setting

Objectives:  Although preoperative preparation programs were once common, most children currently undergoing outpatient surgery are first exposed to the hospital on the day of the procedure. It is advocated that these outpatient children undergo the preparation just prior to surgery.
Aim:  To assess the amount of time that healthcare providers spend with children and families on the day of surgery in the preoperative area.
Materials and Methods:  The study used video infrastructure in the preoperative holding area of Yale New Haven Children's Hospital to record all interactions between children, families, and healthcare providers. Videotapes were coded to characterize and quantify behaviors of healthcare professionals.
Results:  On the day of surgery, healthcare providers spent medians of 2.75–4.81 min interacting with children and parents in the preoperative area. Families spent a median of 46.5 min in the preoperative area. Healthcare professionals spent the most time in medical talk (averages of 42.5–48.2% of time spent with family) and little time was spent in nonmedical talk (range of 6.2–6.9% of time spent with family). Anesthesiologists and surgeons spent 28% and 18% of the interview in talk to children; admitting nurses spent more of the interview talking to children (43%).
Conclusions:  Families interact with healthcare providers for only a small proportion of the time they spent in the preoperative area. This is likely to be a result of increased production pressure in the perioperative settings and has implications for providing preparation for surgery on the morning of the procedure.     

《感受nurse的爱抚》之十:《MaMoRu》

在日本的一个大城市里,有一家拥有637张病床的城市医院,我帮助那家医院创建了一个心理咨询联络护理的岗位,因此,我成了那家医院的第一个也是唯一的一个心理咨询联络护理专家。 一天,内科病室的护士请我去看一个叫MaMoRu的病人。MaMoRu已经71岁了,患了胃癌和肺炎。对临床护士的要求做出反应是我的职责的一部分。 MaMoRu坐在轮椅上,由他的妻     

RENIN, ANGIOTENSIN, CORTICOSTEROIDS, AND ELECTROLYTE BALANCE IN ADDISON'S DISEASE

Two patients with previously untreated Addison's disease werestudied. Both showed defective adrenal responsiveness to infusionsof corticotrophin and angiotensin, and both had abnormally lowplasma sodium and high plasma renin concentrations. Plasma potassiumwas elevated in one and normal in the other. Steroid replacement therapy was accompanied by an increase inNa_E, correction of plasma electrolyte concentrations, and areduction of plasma renin concentration to normal. K_E was virtuallyunchanged in the first weeks of treatment in either patient. In Case 1 treatment caused a movement of water and sodium fromICF to ECF, and probably of potassium from ECF to ICF. ECF volumeincreased more than TBW. Angiotensin infusion caused abdominal pain in this man, suggestingthat the elevated plasma renin may contribute to the characteristicabdominal pain of Addison's disease. In Case 2 treatment restored the normal nyothemeral rhythm ofurine flow, and caused a slight initial loss of TBW and weight.