Extent of satisfaction with tablets and food-timing in sulphonylurea-treated diabetes

This study measured patient views about following tablet-taking and food-timing recommendations in Type 2 diabetes. Two new questionnaires were validated. Outpatients with Type 2 diabetes treated with sulphonylurea agents (n=131) completed the seven-item Diabetes Tablet Treatment Questionnaire (DTTQ) and nine-item Diabetes Food Timing Questionnaire (DFTQ). Mean glycosylated haemoglobin (HbA1c) was 7.8% (S.D. 1.8%). At least 74% had optimal DTTQ item scores for tablet-taking as recommended, difficulty taking tablets, side effects, perceived hypoglycaemia and willingness to continue current tablets, but 71% scored sub-optimally regarding recent hyperglycaemia. Under half scored optimally on DFTQ items concerning eating at recommended times, difficulty with food-timing, denying oneself food and guilt about eating. Principal components and reliability analyses identified a two-item tablet problem scale within the DTTQ (alpha 0.72) and a seven-item food-timing problem scale in the DFTQ (alpha 0.77). Satisfaction and adherence were not closely related to glycaemic control. Only scores for perceived hyperglycaemia (r=0.38), perceived hypoglycaemia (r=-0.24) and satisfaction to continue current tablets (r=-0.20) correlated significantly with HbA1c. Clinicians found that the DTTQ helped to raise tablet-taking issues otherwise missed in consultations. Both questionnaires can be used to guide the need for focussed discussion, educational intervention and/or treatment change and to evaluate their impact.

Distributed modal command for a two-deformable-mirror adaptive optics system

The design of future single-altitude conjugated adaptive optics (AO) systems may include at least two deformable mirrors (DMs) instead of one as in the current AO system. Each DM will have to correct for a specific spatial frequency range. A method is presented to derive a DM modal basis based on the influence functions of the DM. The modal bases are derived such that they are orthogonal to a given set of modes that restrict the DM correction to a spatial frequency domain. The modal bases have been tested on the woofer-tweeter test bench at the University of Victoria. It has been shown that the rms amplitude of the woofer DM and tweeter DM stroke can be reduced by factors of 3 and 9, respectively, when making the transition from a zonal-driven closed loop to a modal-driven closed loop with the same performance in both cases.

Effect of age related macular degeneration on the Eger macular stressometer photostress recovery time

AIM

To assess the repeatability of Eger macular stressometer (EMS) measures of photostress recovery and determine their association with other measures of visual function.

METHODS

EMS photostress recovery time was measured in 90 patients with bilateral exudative age related macular degeneration (AMD), 19 with bilateral atrophic AMD and 47 with both forms of the condition (mean age 79 (SD 13) years). Measurements were made on two occasions separated by 1 year. Intrasession repeatability was assessed by repeating the measures after a 10 minute recovery period at the first visit. Distance visual acuity was measured with a logMAR chart, near visual acuity with a MNRead chart at 25 cm, contrast sensitivity with a Pelli-Robson chart, and the presence of central visual disturbance assessed with an Amsler grid. A questionnaire was used to assess self reported difficulties with glare recovery.

RESULTS

The average EMS recovery time was 11.0 (SD 8.9) seconds, decreasing by 1.6 (5.2) seconds on repeated measurement (p<0.05). EMS photostress recovery was not correlated with visual function measures or subjective difficulties with lights (p>0.05). EMS photostress recovery time did not predict those whose vision decreased over the following year compared with those among whom it remained stable.

CONCLUSIONS

The EMS test is not a useful tool in determining the severity or progression of AMD.

Measuring the appropriateness of prescribing in primary care: are current measures complete?

BACKGROUND AND OBJECTIVES

Appropriateness of prescribing is often assessed by standard instruments. We wished to establish whether judgements of appropriateness that included patients' perspectives and contextual factors could lead to different conclusions when compared with commonly used instruments. To explore the predictive accuracy of these instruments.

METHODS

The design was interviews of patients, audio recordings of the consultation and interviews of the doctors, in varied primary care practices in England. Participants were patients who were likely to discuss a medication issue. The outcome measures were judgements of appropriateness made by the researchers and by two instruments: the Prescribing Appropriateness Index and the Medication Appropriateness Index. Implications for the predictive accuracy of the measures was also investigated.

RESULTS

From 35 cases there was agreement between the judges and the instruments in 22 cases, 16 were appropriate and 6 inappropriate. Of 10 cases classified as inappropriate by the instruments the judges thought four were appropriate. Of 18 cases classified as appropriate by the instruments, two were considered inappropriate by the judges. In seven cases the prescribing decisions could not be classified by the instruments because the decision was to not prescribe.

CONCLUSIONS

Current measures of appropriateness of prescribing depend predominantly on pharmacological criteria, and so do not represent cases that would be judged appropriate when including the patient's views and contextual factors. If most prescribing is appropriate then use of these measures may lead to more false negatives than real negatives. The instruments should be renamed as measures of 'pharmacological appropriateness' and are useful where the incidence of this type of inappropriate prescribing is relatively high.

Abacavir compared to protease inhibitors as part of HAART regimens for treatment of HIV infection: patient satisfaction and implications for adherence

The purpose of this study was to compare treatment satisfaction with triple nucleoside reverse transcriptase inhibitor (NRTI) highly active antiretroviral treatment (HAART) regimens including abacavir (ABC) to HAART regimens that include protease inhibitors (PIs) and to estimate the relationship between patient satisfaction and adherence to HAART. Three open-label clinical trials comparing ABC-including HAART regimens with PI-including HAART regimens were completed, two with patients previously untreated with antiretroviral therapy and one with patients successfully treated with PI-including HAART regimens. The HIV Treatment Satisfaction Questionnaire (HIVTSQ) was completed at several time points during each trial. Levels of patient satisfaction with the ABC and PI regimens were compared for all three trials. The correlation between adherence and patient satisfaction scores was measured using data from an adherence questionnaire in one of the studies. In all three clinical trials, patient satisfaction scores were significantly higher with an ABC-including triple NRTI HAART regimen than with a PI-including HAART regimen. The difference was apparent by week 4 of the trial and was maintained throughout the trial time period. Inspection of the item responses in the patient satisfaction questionnaire indicated that treatment convenience, flexibility, impact on lifestyle, and side effects were key factors in the difference in satisfaction between the treatment groups. In addition, patient satisfaction was shown to be significantly correlated with adherence defined as taking 95% or more of prescribed doses. Greater satisfaction was reported by patients given an ABC-including HAART regimen than those given a PI-including HAART regimen. Patient satisfaction may be an indicator for better treatment adherence.

Design of new questionnaires to measure quality of life and treatment satisfaction in hypothyroidism

INTRODUCTION

This paper reports work undertaken to design two new condition-specific questionnaires for use in hypothyroidism: the Underactive Thyroid-Dependent Quality of Life Questionnaire (ThyDQoL) and the Underactive Thyroid Treatment Satisfaction Questionnaire (ThyTSQ).

METHODS

Semistructured interviews exploring quality of life (QoL) and experiences of treatment were conducted with 30 women and 8 men with hypothyroidism, (mean age, 51.9; range, 29-79 years), 37 of 38 treated with thyroxine, recruited from hospital clinics and primary care.

RESULTS

Despite thyroxine treatment, most interviewees reported negative impact of hypothyroidism on QoL, particularly on energy, physical capabilities, motivation, physical appearance, and weight. The newly designed ThyDQoL has 18 domains covering these and other aspects of life affected by hypothyroidism. It is an individualized measure of patients' perceived impact of hypothyroidism on their QOL, which takes into account the importance of personally applicable life domains to the patient. A 7-item measure of satisfaction with current treatment was designed (ThyTSQ-Present) but interviews also indicated the need for a separate 4-item section measuring satisfaction with past treatment around the time of diagnosis (ThyTSQPast).

CONCLUSIONS

The ThyDQoL and ThyTSQ questionnaires have good face validity and content validity for adults with hypothyroidism. They are now ready for use in clinical research and psychometric evaluation.

Phase II study of docetaxel in combination with epirubicin and protracted venous infusion 5-fluorouracil (ETF) in patients with recurrent or metastatic breast cancer. A Yorkshire breast cancer research group study

This study was originally designed as a phase I/II study, with a dose escalation of docetaxel in combination with epirubicin 50 mg m⁻² and 5-fluorouracil (5-FU) 200 mg m⁻² day⁻¹. However, as dose escalation was not possible, the study is reported as a phase II study of the combination to assess response and toxicity. A total of 51 patients with locally advanced or metastatic breast cancer were treated on this phase II study, with doses of docetaxel 50 mg m⁻², epirubicin 50 mg m⁻² and infusional 5-FU 200 mg m⁻² day⁻¹ for 21 days. The main toxicity of this combination was neutropenia with 89% of patients having grade 3 and 4 neutropenia, and 39% of patients experiencing febrile neutropenia. Nonhaematological toxicity was mild. The overall response rate in the assessable patients was 64%, with median progression-free survival of 38 weeks, and median survival of 70 weeks. The ETF regimen was found to be toxic, and it was not possible to escalate the dose of docetaxel above the first dose level. This regimen has therefore not been taken any further, but as a development of this a new study is ongoing, combining 3-weekly epirubicin, weekly docetaxel and capecitabine, days 1–14.

Modified de Gramont with oxaliplatin in the first-line treatment of advanced colorectal cancer

We previously reported high activity for oxaliplatin and a modified de Gramont regimen (OxMdG) in a single centre study of patients with metastatic colorectal cancer. We now report results with a further 56 patients treated at 14 centres. Low rates of grade 3 and 4 toxicity were seen, with no toxic deaths. Objective response rates were CR/PR=53%; NC=34.7%; PD=12.2%. Median time to progression was 8.3 months and overall survival was 14.5 months. This regimen is more convenient than those based around the conventional de Gramont regimen but is highly active and well tolerated; it forms part of a current UK MRC phase 3 trial.

Psychological effects of withdrawal of growth hormone therapy from adults with growth hormone deficiency

OBJECTIVE

Growth hormone (GH) is known to be required for physical well-being. Although it is also widely believed to be important for quality of life (QoL) and psychological health, there is less supportive evidence. The objective of this study was to investigate the psychological effects of discontinuation of GH replacement from adults with severe GH deficiency (GHD).

DESIGN

A double-blind, placebo-controlled trial in which GH replacement therapy was discontinued for 3 months from 12 of 21 GH-deficient adults, where nine continued with GH replacement.

PATIENTS

GH-treated adults (10 men, 11 women), all with severe GHD (peak GH < 7.7 mU/l on provocative testing), mean age 44.9 years (range 25-68 years).

MEASUREMENTS

Semi-structured interviews were given at baseline and end-point plus questionnaires that included a new hormone-deficiency specific, individualized, QoL questionnaire (HDQoL), the General Well-being Index (GWBI), the Well-being Questionnaire (W-BQ12), the Short-Form 36 health status questionnaire (SF-36), the Nottingham Health Profile (NHP) and the General Health Questionnaire (GHQ).

RESULTS

Three months after baseline the serum total IGF-I of placebo-treated patients fell from normal, age-related levels (mean 26.6 +/- 13.2 nmol/l) to levels indicative of severe GHD (11.6 +/- 6.6 nmol/l) (P<0.001). Psychological symptoms of GH withdrawal, reported in interviews at end-point by placebo-treated patients, included decreased energy, and increased tiredness, pain, irritability and depression. Patients who believed they knew which treatment they had received correctly identified the treatment (GH or placebo) at end-point (chi2=11.25, P<0.01). Significant between-treatment-group differences in change scores were found for SF-36 General Health (P<0.01), W-BQ12 Energy (P<0.01) and HDQoL do physically (P<0.05), indicating reduced general health, reduced energy and greater perceived impact of hormone deficiency on physical capabilities in the placebo-treated group at end-point relative to GH-treated patients.

CONCLUSION

Withdrawal of GH treatment from adults with severe GH deficiency has detrimental psychological effects.

Developing a measure for the appropriateness of prescribing in general practice

OBJECTIVE

To explore the feasibility of using a broader definition of the appropriateness of prescribing in general practice by developing ways of measuring this broader definition and by identifying possible relationships between different aspects of appropriateness and patient outcomes.

DESIGN

A questionnaire study of patients and general practitioners before and after study consultations, supplemented by data collected from patients' medical records and telephone interviews with patients 1 week later.

SETTING

General practices in the south of England.

PARTICIPANTS

24 general practitioners and 186 of their consulting patients.

MAIN OUTCOME MEASURES

Unwanted, unnecessary, and pharmacologically inappropriate prescriptions; patients' adherence.

RESULTS

Before the consultation 42% of patients said they wanted or expected a prescription for their main problem. Prescriptions were written in two thirds (65%) of study consultations, and 7% of these had not been wanted or expected beforehand. Doctors recorded that one in five prescriptions they wrote were not strictly indicated. Of the 92 independent assessments of these prescriptions, four were judged to be inappropriate and in 19 cases the assessors were uncertain. 41% of prescriptions written were wanted, necessary, and appropriate. Subsequently, 18% of patients for whom a prescription had been written were potentially non-adherent and 25% had worries or concerns about their medication.

CONCLUSION

The attempt to measure appropriateness of prescribing along the three dimensions of patients', prescribers', and pharmacological perspectives is both feasible and likely to yield valuable insights into the nature of general practice prescribing and patients' use of medicines.

5,6-dimethylxanthenone-4-acetic acid (DMXAA), a novel antivascular agent: phase I clinical and pharmacokinetic study

The purpose of this phase I, dose-escalation study was to determine the toxicity, maximum tolerated dose, pharmacokinetics, and pharmacodynamic end points of 5,6-dimethylxanthenone acetic acid (DMXAA). In all, 46 patients received a total of 247 infusions of DMXAA over 15 dose levels ranging from 6 to 4900 mg x m(-2). The maximum tolerated dose was established at 3700 mg x m(-2); dose-limiting toxicities in the form of urinary incontinence, visual disturbance, and anxiety were observed at the highest dose level (4900 mg x m(-2)). The pharmacokinetics of DMXAA were dose dependent. Peak concentrations and area under the curve level increased from 4.8 microM and 3.2 microM h, respectively, at 6 mg x m(-2) to 1290 microM and 7600 microM h at 3700 mg x m(-2), while clearance declined from 7.4 to 1.7 l h(-1) x m(-2) over the same dose range. The terminal half-life was 8.1+/-4.3 h. More than 99% of the drug was protein bound at doses up to 320 mg x m(-2); at higher doses the percent free drug increased to a maximum of 6.9% at 4900 mg x m(-2). Dose-dependent increases in the serotonin metabolite 5-hydroxyindoleacetic acid were observed at dose levels of 650 mg x m(-2) and above. There was one unconfirmed partial response at 1300 mg x m(-2). In conclusion, DMXAA is a novel vascular targeting agent and is well tolerated.

Evaluation of two health status measures in adults with growth hormone deficiency

OBJECTIVE

To evaluate the psychometric properties of two health status measures for adults with growth hormone deficiency (GHD): Nottingham Health Profile (NHP) and Short-Form Health Survey (SF-36).

DESIGN

(1) A cross-sectional survey of adults with treated or untreated GHD to assess reliability and validity of the questionnaires. (2) A randomized, placebo-controlled study of 3 months' GH withdrawal from GH-treated adults to assess the sensitivity of the questionnaires to change.

PATIENTS

(1) A cross-sectional survey of 157 patients with severe GHD (peak GH < 10 mU/l on provocative testing), mean age 48.9 years (range 23-70 years), who had either received GH replacement therapy for at least 6 months immediately prior to the study or had not received GH treatment in the previous 6 months. (2) GH treatment was withdrawn from 12 of 21 GH-treated adults, all with severe GHD (peak GH < 7.7 mU/l on provocative testing), mean age 44.9 years (range 25-68 years).

MEASUREMENTS

The NHP and SF-36 were used once in the cross-sectional survey, but twice in the GH-withdrawal study, at baseline and end-point (after 3 months).

RESULTS

(1) Cross-sectional survey. Both questionnaires had high internal consistency reliability with subscale Cronbach's alphas of > 0.73 (NHP) and > 0.78 (SF-36). Calculation of an NHP Total Score, occasionally reported in the literature, was shown to be inadvisable. Overall, patients with GHD were found to have significantly worse perceived functioning than the UK general population in SF-36 subscales of General Health, Bodily Pain, Social Functioning, Physical Functioning, Role-Emotional, Role-Physical, and Vitality. Although neither questionnaire found significant differences between GH-treated and non-GH-treated patients, there were correlations with duration of GH treatment (P < 0.01) for GH-treated patients in SF-36 Mental Health (r = 0.29, N = 87) and SF-36 Vitality (r = 0.33, N = 88), indicating improvement with increasing treatment duration. The SF-36 was also more sensitive than the NHP to sex differences: men had significantly better health status compared with women (P < 0.05) in all SF-36 subscales but Mental Health, but only in one NHP subscale (Physical Mobility). (2) GH-withdrawal study. Significant between-group differences in change were found in SF-36 General Health [t(17) = 2.76, P = 0.013, two-tailed] and SF-36 Mental Health [t(17) = 2.41, P = 0.027, two-tailed]: patients withdrawn from GH reported reduced general health and mental health at end-point. The NHP found no significant change.

CONCLUSIONS

The SF-36 is a better measure than the NHP of health status of people with GH deficiency because of its greater discriminatory power, with ability to detect lesser degrees of disability. It also has superior sensitivity to some subgroup differences and superior sensitivity to change compared with the NHP. The SF-36 is highly acceptable to respondents, and has very good internal consistency reliability. The SF-36 is recommended to measure the health status of adults with GH deficiency.

A comparison of the metal content of some benthic species from coastal waters of the Florida panhandle using high-resolution inductively coupled plasma mass spectrometry (ICP-MS) analysis

Benthic marine invertebrates, sediment, and water from several locations along the Florida panhandle coast from St. Joseph Bay in the west to the mouth of the Wakulla River in the east, including from several river estuaries, were analyzed by double focusing ICP-MS (Finnigan MAT ELEMENT) for Cd, Hg, Pb, Cu, Zn, and As. All were detected in all samples. Sponges generally contained higher levels of Cd than other species. Microciona prolifera sponges from St. Joseph Bay had higher As levels (8.1-13.6 microg/g dry weight) than sponges collected from Dickerson Bay or Appalachee Bay (2.20-9.7) and higher Cd levels (0.43-0.73) than that of a single Microciona specimen collected from Dickerson Bay (0.29). Water content of As was about 20-30x higher in St. Joseph Bay than in any other location, and sediment levels of Cd were about 9x higher. Cu and Zn were higher in organic sediment from St. Joseph Bay than they were in other areas. The Pb content of several sponge species and two of tunicates was considerably higher than in other species. The uptake of most metals in this study (except As) appeared to be affected by the metal, genus, species, and location as much as by levels in either water or sediment. In general, sponges and tunicates seemed to accumulate higher levels than most other species, possibly a function of high filtration rates. The ICP-MS method is useful for environmental studies, but the instrument requires considerable maintenance.

Perceived quality of health care in macular disease: a survey of members of the Macular Disease Society

AIM

To investigate the experiences of people with macular disease within the British healthcare system.

METHOD

The Macular Disease Society Questionnaire, a self completion questionnaire designed to survey the experiences of people with macular disease, was sent to 2000 randomly selected members of the Macular Disease Society. The questionnaire incorporated items about people's experiences with health professionals and the information and support provided by them at the time of diagnosis and thereafter.

RESULTS

Over 50% thought their consultant eye specialist was not interested in them as a person and 40% were dissatisfied with their diagnostic consultation. 185 people thought their general practitioner (GP) was well informed about macular disease but twice as many people thought their GP was not well informed. About an equal number of people thought their GP was supportive as those who thought their GP was not supportive. A total of 1247 people were told "nothing can be done to help with your macular disease." A number of negative emotional reactions were experienced by those people as a result, with 61% of them reporting feeling anxious or depressed. Of 282 people experiencing visual hallucinations after diagnosis with macular disease, only 20.9% were offered explanations for them.

CONCLUSIONS

Many people with macular disease have unsatisfactory experiences of the healthcare system. Many of the reasons for dissatisfaction could be resolved by healthcare professionals if they were better informed about macular disease and had a better understanding of and empathy with patients' experiences.

Psychometric evaluation of the 12-item Well-being Questionnaire for use with people with macular disease

This paper reports the evaluation of a generic measure of psychological well-being, the 12-item Well-being Questionnaire (W-BQ12), for use with people who have the chronic eye condition, macular disease (MD). The W-BQ12 was incorporated in a self-administered questionnaire which was completed by 1421 members of the Macular Disease Society (MD Society). Unforced factor analysis elicited the expected three factors representing constructs of positive well-being, energy and negative well-being. A forced single-factor solution supported use of the whole scale to measure total general well-being. High Cronbach's alpha coefficients demonstrated good internal consistency reliability in the entire scale (alpha = 0.87) and in subscales (alpha > 0.78). The factor structure matched that found in samples of people with diabetes for whom the W-BQ12 was first developed, indicating construct validity. Expected subgroup differences in the MD sample indicated significantly poorer well-being in women than in men and also in participants who were registered blind or partially sighted compared to those who were not registered. The W-BQ12 will be useful in measuring outcomes in rehabilitative and medical interventions and in researching factors affecting adjustment to MD.

Validation of the HIV treatment satisfaction questionnaire (HIVTSQ)

Human immunodeficiency virus (HIV) therapies need to be both effective and acceptable. The 10-item HIV Treatment Satisfaction Questionnaire (HIVTSQ) was validated amongst 150 HIV-1 sero-positive individuals, receiving one of two protease inhibitors as part of combined therapy in an open-label randomised trial. Scale and subscale scoring was determined psychometrically. It was hypothesised that satisfaction with control would be greater amongst those with lower viral loads, satisfaction with side-effects would be inversely related to severity of adverse events and satisfaction with the new treatment would be greater than with the control treatment. Principal components analyses suggested that patient ratings of nine items can be summed to compute the total satisfaction scale (Cronbach's alpha 0.82), and/or divided into subscales: general satisfaction/clinical (alpha 0.80) and lifestyle/ease (alpha 0.74). One item (asking how demanding the treatment was) needs modification before inclusion. The HIVTSQ showed construct validity: viral load correlated negatively (Spearman's r - 0.33 p < 0.01) with satisfaction with HIV control; those with <400 copies HIV-1 RNA/ml were more satisfied with HIV control than those with higher viral loads (Mann-Whitney p < 0.01); adverse event grade correlated r - 0.18 (p < 0.05) with satisfaction with side-effects. The HIVTSQ was sensitive to differences between groups: compared with patients in the control group, those receiving the new treatment had significantly higher perceived flexibility and lifestyle/ease scores at week 8 (Mann-Whitney p < 0.01). Patient perceptions did not simply mirror clinical measures, highlighting the importance of measuring patient views.

Risk assessment for developing type 1 diabetes: intentions of behavioural changes prior to risk notification

BACKGROUND

Recent progress in predictive techniques allows people at risk of developing type 1 diabetes to be identified in a pre-symptomatic stage and prevention trials to be implemented. The present study examined prospectively whether participants in a screening programme anticipated behavioural changes in the event of having a high risk.

METHODS

Four hundred and three first-degree relatives of people with type 1 diabetes completed a self-administered questionnaire about their views on screening and diabetes, and questionnaires on well-being and locus of control.

RESULTS

Prior to risk notification, 73% reported that they intended to introduce lifestyle changes if at high risk. The vast majority of the respondents (87%) reported that eating habits would be the main changes made. Those anticipating changes believed they could take actions to reduce their risk of type 1 diabetes (p<0.001) and to have personal control over diabetes onset (p<0.001). They were also more worried about developing diabetes (p<0.01) and preoccupied with diabetes-related symptoms (p<0.01).

CONCLUSIONS

Prior to risk notification, the process of being screened raised concerns and expectations about future changes. Despite the lack of any evidence, people believed lifestyle changes would be effective in reducing their risk. Since the impact of lifestyle in the development of type 1 diabetes is not yet established, accurate information about the role of health behaviour in the progression to overt diabetes is needed to avoid unrealistic expectations on the benefit of these changes and unnecessary impairment to quality of life. Personally initiated changes should be monitored since they could importantly influence the progress and outcome of prevention trials.

[Annexin V for flow cytometric detection of phosphatidylserine expression on lymphoma cells undergoing apoptosis]

OBJECTIVE

To quantitatively analyze apoptotic and secondary necrotic cells under apoptosis conditions.

METHODS

The cells of Burkitt lymphoma cell line Raji were incubated with 1.0 mumol/L dexamethasone (DEX) for 2, 4 and 8 h, then stained with Annexin V-FITC (fluorescein isothiocyanate conjugated) which was used to detect the exposure of phosphatidylserine (PS) on the out membrane resulting from a loss of phospholipid asymmetry in the early stage of apoptosis, and also stained with propidium iodide (PI) which allows the analysis of secondary necrotic cells related with cell membrane and DNA damage, then apoptotic cells was quantified by flow cytometry (FMC). Furthermore, Annexin+/PI- and Annexin+/PI+ cells were sorted by fluoresence-activated cell sorter (FACS), and identified by electron microscopy (EM) and DNA gel electrophoresis.

RESULTS

The results revealed that the percentage of apoptotic cells was increased and correlated well with incubation time (r = 0.97). The sensitivity of this method was shown by its detection limit 0.02%; the method was reproducible, and the coefficient variance (CV) was 4.2%. Meanwhile, the Annexin+/PI- and Annexin+/PI+ cells were identified as apoptotic and necrotic cells under EM, and the DNA extracted from the Annexin+/PI- cells was characterized by "ladder pattern".

CONCLUSION

Annexin V assay for analyzing apoptotic cells is specific, sensitive, accurate, reproducible and quantitative for apoptosis investigation.

Clopidogrel--a myocardial infarction CURE?

Recently the anti-platelet drug clopidogrel has been publicized in the press as a breakthrough in the treatment of myocardial infarction.