In-vitro evaluation of the PALL Leukotrap Affinity Prion Reduction Filter as a secondary device following primary leucoreduction

BACKGROUND AND OBJECTIVES

A filter (PRF1) designed to remove abnormal prion proteins from red-cell units has been developed. The purpose of this study was to evaluate the quality of red cells produced using this device.

MATERIALS AND METHODS

Leucocyte-depleted red-cell units (CPD, CPD-A1 and CPD/SAGM) processed according to standard UK practices were filtered using PRF1. Filtered and control units were stored and sampled on day 1, day 7 and on the date of expiry and were tested using standard measures of red-cell quality.

RESULTS

Filtered units were found to have significantly higher percentage haemolysis levels, lower haemoglobin levels and a smaller volume compared with controls. All results, however, were well within the permitted 0.8% haemolysis level at the end of storage and all units met the UK guidelines for haemoglobin and volume. The other test parameters measured showed no significant differences between the test and control units.

CONCLUSIONS

The PRF1 filter was found to be easy to use and resulted in red-cell units that met all relevant UK and European Guidelines.

A role for the endogenous opioid beta-endorphin in energy homeostasis

Proopiomelanocortin (POMC) neurons in the hypothalamus are direct targets of the adipostatic hormone leptin and contribute to energy homeostasis by integrating peripheral and central information. The melanocortin and beta-endorphin neuropeptides are processed from POMC and putatively coreleased at axon terminals. Melanocortins have been shown by a combination of pharmacological and genetic methods to have inhibitory effects on appetite and body weight. In contrast, pharmacological studies have generally indicated that opioids stimulate food intake. Here we report that male mice engineered to selectively lack beta-endorphin, but that retained normal melanocortin signaling, were hyperphagic and obese. Furthermore, beta-endorphin mutant and wild-type mice had identical orexigenic responses to exogenous opioids and identical anorectic responses to the nonselective opioid antagonist naloxone, implicating an alternative endogenous opioid tone to beta-endorphin that physiologically stimulates feeding. These genetic data indicate that beta-endorphin is required for normal regulation of feeding, but, in contrast to earlier reports suggesting opposing actions of beta-endorphin and melanocortins on appetite, our results suggest a more complementary interaction between the endogenously released POMC-derived peptides in the regulation of energy homeostasis.

Management issues surrounding the United Kingdom health services' ability to deal effectively with major incidents involving bioterrorism

AIM

This paper aims to explore the management structures and issues surrounding the United Kingdom (UK) health services' preparedness and ability to effectively deal with major incidents involving bioterrorism.

BACKGROUND

Recent reports and expert opinion have suggested that the health service response to terrorist incidents involving weapons of mass destruction are insufficient and ill-prepared.

KEY ISSUES

Lack of clear guidance and parity across the UK, poor targeting of information, inadequate and insufficient equipment, under-resourcing, and unsatisfactory training are key factors that contribute to a worrying state of frontline unpreparedness.

CONCLUSIONS

Health service managers need to capitalize on the Government's current concern about the threat of a bioterrorist attack and ensure that their departments are sufficiently equipped, and that their personnel are adequately educated and trained, to deal with any such incident. Better guidance needs to be produced and distributed to front line healthcare workers.

Pre-hospital response to major incidents

Since the attacks of September 11, 2001 in the United States, and the subsequent anthrax scares, the approach to preparing for and dealing with major incidents has had to be re-thought. Major incident planning, training and preparedness, once the domain of NHS senior managers and frontline A&E staff, is now the business of all NHS nurses. This article provides the theoretical knowledge needed by nurses to operate at the scene of a pre-hospital major incident.

Endurance enhancement related to the human angiotensin I-converting enzyme I-D polymorphism is not due to differences in the cardiorespiratory response to training

Human physical performance is strongly influenced by genetic factors. We have previously reported that the I variant of the human angiotensin I-converting enzyme (ACE) gene is associated with greater endurance performance in mountaineers and Olympic runners and improved performance in army recruits. In this study we examined whether this effect is mediated by improvements in cardiovascular fitness with training in 58 army recruits homozygous for the insertion (I, ACE genotype II) or deletion (D, ACE genotype DD) allele. A submaximal and maximal exercise protocol was used to calculate both the heart rate/oxygen uptake (VO2) relationship and changes in maximal oxygen uptake (VO2max), respectively. There was no significant intergroup difference in VO2max at baseline (P=0.19) or after training (P=0.22). There was no difference between genotypes with training in the heart rate/VO2 elevation (P = 0.79 for the mean difference in mean adjusted heart rates). However, VO2 at all exercise intensities in the submaximal test was lower for all subjects after training and at 80 W the reduction in VO2 was greater for the II subjects compared to DD subjects [mean(SEM)] [1.6 (0.27) and 0.68 (0.27) ml kg(-1) min(-1), respectively; P = 0.02 for mean difference]. The I/D polymorphism may play a role in enhanced endurance performance but this is not mediated by differences in VO2max or the heart rate/VO2 relationship in response to training.

Paradoxical embolism: computed tomography demonstration

Paradoxical emboli are rare and often presumptively diagnosed. A case of paradoxical embolism, in which both the arterial and venous emboli were documented on CT, is described.

A five way crossover human volunteer study to compare the pharmacokinetics of paracetamol following oral administration of two commercially available paracetamol tablets and three development tablets containing paracetamol in combination with sodium bicarbonate or calcium carbonate

This report concerns a single dose randomized five way crossover study to compare the pharmacokinetics of paracetamol from two commercially available paracetamol (500 mg) tablets and three different development paracetamol (500 mg) tablet formulations containing either sodium bicarbonate (400 mg), sodium bicarbonate (630 mg) or calcium carbonate (375 mg). The results demonstrated that addition of sodium bicarbonate (630 mg) to paracetamol tablets, increased the rate of absorption of paracetamol relative to conventional paracetamol tablets and soluble paracetamol tablets. Addition of sodium bicarbonate (400 mg) to paracetamol tablets increased the absorption rate of paracetamol relative to conventional paracetamol tablets, but there was no difference in the rate of absorption compared to soluble paracetamol tablets. Inclusion of calcium carbonate (375 mg) to paracetamol tablets had no effect on absorption kinetics compared to the conventional paracetamol tablet. The faster absorption observed for the sodium bicarbonate formulations may be as a result of an increase in gastric emptying rate leading to faster transport of paracetamol to the small intestine where absorption takes place.

The virtual mole clinic: preliminary results from the Plymouth skin cancer screening study using telemedicine

This study evaluated a skin cancer screening service between primary and secondary care in Plymouth using a store and forward telemedicine system. The primary objective was to minimize the time from a patient presenting to a GP with a suspicious lesion to the lesion being assessed and diagnosed by a plastic surgeon. This study retrospectively assessed the practical, technical and operational aspects of incorporating telemedicine into everyday practice and patient satisfaction. Both the GP practice and plastic surgeons were equipped with the appropriate technology for creating, transmitting and accessing an electronic telemedicine record (ETR) via an ISDN 2 line. Patients with suspicious lesions accessed the GP via Mole Check Clinics. The GP captured and transmitted an ETR consisting of digital images and relevant clinical data. In a virtual mole clinic, the plastic surgeon accessed and reviewed the ETR. The expert opinion was entered directly into the ETR and transmitted to the GP within 48 hours. All patients were offered a face-to-face consultation at a real mole clinic within 7 days. Outcomes demonstrated patient and clinician satisfaction and the ability to deliver high quality diagnostic images and resulting expert opinion. This study informed a larger study for future applications of telemedicine.

Cardiopulmonary resuscitation: are practitioners being realistic?

Cardiopulmonary resuscitation (CPR) is now established medical practice for all in-hospital cardiac arrests except where a specific 'do not resuscitate' (DNR) order is in place. This article explores many of the ethical and moral issues surrounding CPR and the use of DNR orders. It examines the success rate of in-hospital CPR and raises the question of what constitutes outcome success by illustrating that at best only 15% of resuscitated patients survive to hospital discharge. The article proposes that both patients and healthcare professionals grossly overestimate the success of CPR and suggests that many elderly patients might choose not to be resuscitated if they were allowed to make an informed choice. It concludes by suggesting that further work needs to be undertaken with regard to early assessment of all in-hospital patients, combined with realistic and frank communication between healthcare professionals and patients if futile, undignified and costly deaths are to be avoided.