High-level resistance of cytomegalovirus to ganciclovir is associated with alterations in both the UL97 and DNA polymerase genes

The study describes rates of coronary heart disease death and nonfatal coronary events over five years in a cohort of random sample population and relates them to levels of three major risk factors. It is based on a longitudinal follow-up of survey conducted initially in 1990 in all geographic regions of Turkey. Two-thirds of the original cohort aged 20 years or over 2259 adults comprising 1146 women was followed up by physical examination and an ECG recording at rest. New coronary events were defined to include myocardial infarction and stable angina with or without associated myocardial ischemia developed during the follow-up period. Overall annual death rate was nine per 1000 adults. Coronary deaths numbered 55 (of which 26 were women) representing 4.1 per year and were found high in women. New coronary events were registered in 37 men and 32 women (annual rates 7.2 and 5.8 per 1000, respectively). Among male participants aged initially 40 years or over, high systolic blood pressure (> or = 130 mmHg) at baseline significantly predicted coronary death (age-adjusted risk ratio (RR) 3.3) while high cholesterol concentrations (> or = 5.2 mmol l-1) predicted new coronary events alone (RR almost 2). In women systolic pressure again strongly predicted coronary death (age-adjusted RR 3.9), whereas abnormal cholesterol levels discriminated for coronary death and new coronary events (RR around 2.3 for each). High diastolic pressure (> or = 85 mmHg) was of predictive value for the combined outcome of coronary death and events in women (RR 1.9) but not in men. Multivariate analysis by logistic regression identified systolic blood pressure in men as significant independent predictor of coronary death, while total cholesterol concentration in both genders and systolic blood pressure in men were independent predictors of the combined outcome of coronary death or nonfatal coronary events. It was concluded that known major risk factors act in similar magnitudes commensurate with the specific risk increments also in populations with essentially low cholesterol levels. The relatively high coronary morbidity and mortality in Turkish women approaching that in men may be accounted for by an inherent greater risk burden.     

The origin and mode of fibroblast migration and proliferation in granulation tissue

The professions of nursing and medicine are committed to interprofessional education, in the belief that through this, patient care and satisfaction will be improved. Most initiatives involving nurses have been at post-qualification level, in primary health care, and concerning interpersonal or information management skills. Much of this collaboration has been with professions allied to medicine or social services. This paper discusses an innovative programme of shared learning in acute care, involving final year medical students and newly qualified staff nurses. The programme, developed in response to the blurring of professional roles between nurses and junior doctors, took place in our interprofessional Clinical Skills Centre. It was based around a developing patient scenario which was pertinent to the participants' area of practice. Each session was led by an experienced nurse lecturer and doctor, supported by specialist contributors. The style of learning was participative, with small interprofessional groups addressing a range of patient management issues. In this way, relevant clinical and communication skills were integrated within the context of holistic patient care. The course was well evaluated by both professional groups of participants and their managers. Subsequent research and curriculum development are leading to the expansion of this successful initiative.     

Psychosocial stressors and well-being in health care workers. The impact of an intervention program

There have been few prospective studies of the impact of workplace interventions on employee and organizational well-being within health care settings. This study was conducted at a large regional hospital in Sweden in 1994 with a follow-up in 1995. Effects of a structured organizational and staff intervention program on perceived psychosocial work quality, supporting resources and self-reported health and well-being were evaluated. Based on department-specific results from the baseline assessment in 1994, each department formulated their own improvement goals. They also made their own decisions on relevant improvement activities. Since there was no formal reference group in this study, departments with high and low rating levels, respectively, with regard to intervention activities were compared. Despite an overall worsening in most of the measures most likely due to a notice of 20% staff reduction prior to the follow-up assessment, the intervention appeared to have attenuated negative changes in the high as compared with the low activity group. Manager-rated impact of the program as well as positive staff attitudes and staff involvement in the enhancement process were identified as important determinants for more favourable changes. The study points out the relevance of structured workplace interventions for organizational and employee well-being especially in times of cut-backs and organizational turmoil. Department-specific factors will determine the impact of such programs. The study indicates that the psychosocial impact of personnel cut-backs in health care may be attenuated through management initiatives.     

Is vertical vein ligation necessary in repair of total anomalous pulmonary venous connection?

BACKGROUND: In the repair of total anomalous venous connection, vertical vein ligation is recommended to eliminate left-to-right shunting. However, the small left heart chambers may not always tolerate the immediate increase in blood flow after combined repair and vein ligation. METHODS: A retrospective review of 23 infants and children undergoing correction of total anomalous pulmonary venous connection was undertaken to determine whether vertical vein ligation is a necessary component of successful surgical repair. In 14 patients this vein was ligated, whereas in 9 it was left patent. Six patients who underwent ligation and 5 who did not had pulmonary venous obstruction before operation. RESULTS: The operative mortality rate was 36% (5 of 14 patients) for the ligated group compared with 0% (0 of 9 patients) for the nonligated group (p = 0.06). All deaths occurred in patients with preoperative obstruction and a low mean left atrial pressure, and four of the deaths were directly attributable to left heart failure. Follow-up echocardiography in patients in whom the vertical vein was not ligated revealed adequate cardiac function and no residual left-to-right flow through the previously patent venous conduit. CONCLUSION: Vertical vein ligation during the repair of total anomalous pulmonary venous connection is not routinely necessary and actually may be undesirable in patients with preoperative obstruction, in whom the left heart chambers are particularly small.     

Cytotoxic lignans from Formosan Hernandia nymphaeifolia

The autolytic site Arg105 of rat trypsin was replaced with Cys by DNA site-directed mutagenesis method. Comparison of expression and purification of R105C trypsin along with the wild type and some other Arg105 mutants indicates that R105C trypsin could be expressed as well but with a lower expression level. It is unexpected that R105C trypsin has no detectable activity toward trypsin substrate TAME, quite different from the wild type and other Arg105 mutants. Native gel electrophoresis analysis indicates that R105C trypsin has a similar mobility rate to that of wild type trypsin. FPLC also gives similar retaining time. The loss of activity of R105C trypsin may result from the conformational change around active site, but not the dimer formation.     

Urinary calcium excretion in Swedish children

In order to determine whether serum anti-human T-cell lymphotropic virus type I (HTLV-I) antibody concentration is correlated with cellular viral DNA load, these 2 biological parameters were established in 22 symptomless HTLV-I carriers. The proviral copy (PVC) number was determined through quantificative polymerase chain reaction. Specific antibody titers were determined by Western blot with the end-point dilution method; the quantification of each antibody was performed through ScanBlot by determination of the peak height of each Western-blot band. A positive correlation was observed between the PVC number and the titer of total antibodies. When the association between the peak height of each antibody and the PVC number was studied, a significant positive correlation was observed only with anti-p 19. Further evaluation through follow-up studies of symptomless HTLV-I individuals is needed to clarify the value of anti-HTLV-I antibody titer as a predictor of disease progression.