Tagraxofusp Treatment: Implications for Patients With Blastic Plasmacytoid Dendritic Cell Neoplasm

BACKGROUND

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, clinically aggressive, and often fatal hematologic malignancy. BPDCN is not a new entity, but it has been renamed and reclassified, which, in part, contributes to it being underrecognized. In 2018, tagraxofusp became the first U.S. Food and Drug Administration-approved therapy for BPDCN.

OBJECTIVES

This article aims to educate oncology nurses about tagraxofusp's dosing regimen, side effects, and how to manage patients undergoing treatment in inpatient and outpatient settings.

METHODS

The authors reviewed content related to the safety and clinical management of tagraxofusp, as well as content that supports patient and provider education.

FINDINGS

Capillary leak syndrome (CLS) is the most serious adverse event reported with tagraxofusp; therefore, nurses should stop tagraxofusp administration until all CLS-related symptoms have resolved. Hypersensitivity reactions and hepatotoxicity have also been observed in patients treated with tagraxofusp and should be monitored during treatment cycles.

The effect on consent rates for deceased organ donation in Wales after the introduction of an opt-out system

Organ transplantation saves and transforms lives. Failure to secure consent for organ retrieval is widely regarded as the single most important obstacle to transplantation. A soft opt‐out system of consent for deceased organ donation was introduced into Wales in December 2015, whilst England maintained the existing opt‐in system. Cumulative data on consent rates in Wales were compared with those in England, using a two‐sided sequential procedure that was powered to detect an absolute difference in consent rates between England and Wales of 10%. Supplementary risk‐adjusted logistic regression analysis examined whether any difference in consent rates between the two nations could be attributed to variations in factors known to influence UK consent rates. Between 1 January 2016 and 31 December 2018, 8192 families of eligible donors in England and 474 in Wales were approached regarding organ donation, with overall consent rates of 65% and 68%, respectively. There was a steady upward trend in the proportion of families consenting to donation after brain death in Wales as compared with England and after 33 months, this reached statistical significance. No evidence of any change in the donation after circulatory death consent rate was observed. Risk‐adjusted logistic regression analysis revealed that by the end of the study period the probability of consent to organ donation in Wales was higher than in England (OR [95%CI] 2.1 [1.26–3.41]). The introduction of a soft opt‐out system of consent in Wales significantly increased organ donation consent though the impact was not immediate.

DHEA treatment of Alzheimer's disease: a randomized, double-blind, placebo-controlled study

OBJECTIVE

To compare the efficacy and tolerability of dehydroepiandrosterone (DHEA) vs placebo in AD.

METHOD

Fifty-eight subjects with AD were randomized to 6 month's treatment with DHEA (50 mg per os twice a day; n = 28) or placebo (n = 30) in a multi-site, double-blind pilot trial. Primary efficacy measures assessed cognitive functioning (the AD Assessment Scale-Cognitive [ADAS-Cog]) and observer-based ratings of overall changes in severity (the Clinician's Interview-Based Impression of Change with Caregiver Input [CIBIC-Plus]). At baseline, 3 months, and 6 months, the ADAS-Cog was administered, and at 3 and 6 months, the CIBIC-Plus was administered. The 6-month time point was the primary endpoint.

RESULTS

Nineteen DHEA-treated subjects and 14 placebo-treated subjects completed the trial. DHEA was relatively well-tolerated. DHEA treatment, relative to placebo, was not associated with improvement in ADAS-Cog scores at month 6 (last observation carried forward; p = 0.10); transient improvement was noted at month 3 (p = 0.014; cutoff for Bonferroni significance = 0.0125). No difference between treatments was seen on the CIBIC-Plus at either the 6-month or the 3-month time points.

CONCLUSIONS

DHEA did not significantly improve cognitive performance or overall ratings of change in severity in this small-scale pilot study. A transient effect on cognitive performance may have been seen at month 3, but narrowly missed significance.

The effect of head position, electrode site, movement and smoothing window in the determination of a reliable maximum voluntary activation of the upper trapezius muscle

Quantitative measures derived from raw myoelectric signal (MES) data must be normalized to allow for comparisons both within and between subjects. The most common method of normalization involves dividing the root mean square (RMS) amplitude of the MES recorded during a given activity by the RMS of the MES elicited during a maximal voluntary isometric contraction (MVIC) of that particular muscle. The objective of this study was to use surface-recorded MES amplitude to determine the combination of electrode site, test position, head posture, and smoothing window that elicits the highest and most reliable MES amplitudes during an MVIC of the upper trapezius (UT) muscle. Ten volunteers had surface electrodes positioned at five sites on the UT of their dominant side. Three trials of each of three MVIC test positions were performed both with the head in neutral and rotated 45 degrees to the contralateral side. A repeated-measures ANOVA was used for statistical hypothesis testing. Coefficients of variation were used to quantify the between-factor variability introduced in each case. In addition, the data were re-analyzed using moving windows of 100 to 500 ms in length, and an ANOVA was used to determine the effect of window length on both the amplitude and variability of the estimates of maximum voluntary activation (MVE). Head position had no significant effect on RMS amplitude of the MVIC in any of the test positions. There was a significant electrode site by test position interaction effect. Bonferroni post-hoc analyses were performed on this interaction by fixing test position and testing electrode site, revealing that Sites 1 (2 cm lateral to the midpoint between C7 spinous process and the posterolateral border of the acromion) and 4 (2 cm posterior to Site 1) recorded significantly higher RMS values for all test positions, and were not significantly different from each other. Fixing electrode site, the test position analysis revealed that abduction of the humerus, and abduction with external rotation of the humerus produced significantly higher RMS values than shoulder elevation at both Sites 1 and 4, and that abduction produced a significantly higher RMS amplitude than abduction in external rotation at Site 1. The results confirmed that Sites 1 and 4 consistently produced the highest MES amplitudes for all movements. Pure abduction consistently elicited maximal RMS values; however there is concern regarding supraspinatus cross talk during this movement. Site 1 was found to produce the most reliable data. A moving window of 100 ms was found to generate MVE estimates that were significantly higher than windows ranging from 200 ms to 500 ms in length. There was no effect of window length on the reliability of the MVEs. Based on this study, it was concluded that abduction or abduction with the arms in lateral rotation should be used as normalization contraction positions for the upper trapezius muscle. During this movement, Site 1 data smoothed with a moving window of 100 ms produces the highest amplitude MVE data but window lengths greater than 200 ms produce more stable estimates in terms of being able to compare studies in which moving windows are used to compute RMS.

In situ measurements of the pH of mammalian peroxisomes using the fluorescent protein pHluorin

Peroxisomes are metabolically active organelles that participate in the oxidation of long-chain fatty acids and in the biosynthesis of bile acids, cholesterol, and ether phospholipids. Even though maintenance of a stable acid-base milieu is essential for proper peroxisomal function, the determination of the peroxisomal pH (pH(p)) remains inconclusive, and little is known about its regulation. To measure the pH of intact peroxisomes in situ, we used the peroxisome-specific carboxyl-terminal targeting sequence, SKL, to deliver a pH-sensitive mutant of the green fluorescent protein (pHluorin-SKL) selectively into peroxisomes. Proper targeting was verified by colocalization with the peroxisomal marker catalase. Peroxisomes were visualized by imaging fluorescence microscopy, and ratiometric measurements were combined with calibration using ionophores or a null-point method to estimate pH(p). The pH(p) was between 6.9 and 7.1, resembling the cytosolic pH. Manipulation of the cytosolic pH in intact cells or after permeabilization of the plasmalemma with streptolysin O revealed that pH(p) changed in parallel, suggesting that the peroxisomal membrane is highly permeable to H(+) (equivalents). We conclude that peroxisomes do not regulate their pH independently, but instead their large H(+) permeability effectively connects them with the buffer reservoir of the cytoplasm and with the homeostatic mechanisms that control cytosolic pH.

An evaluation of the clinical performance of newly qualified nurses: a competency based assessment

The clinical performance of newly qualified staff nurses, or their 'fitness for purpose' has become a central professional and corporate issue and highlighted as a central causes for the reforms recommended by the Peach report (Peach 1999). However the ability to gauge the performance of newly qualified nurses remains a largely subjective exercise relying upon anecdotal evidence or general statements of newly qualified nurses' feelings of inadequacy on qualification. This article seeks to address this issue by reporting the findings of project that sought to compare the expectations of senior nurses regarding the level of competence of newly qualified nurses with that of the actual level of competency as assessed by the preceptors after 8 weeks in post. Using a specifically designed instrument to assess clinical competency a comparison has been made between 139 senior nurses' expectations of the competency of newly qualified nurses and the actual competence as assessed by preceptors of 36 newly qualified nurses after 8 weeks in post. The findings indicate that the senior nurses have clear subjective expectations of the competence level of newly qualified nurses. However these expectations are consistently lower than the actual level of competency demonstrated by the newly qualified nurses as assessed by their preceptors. This research demonstrates that through the use of a validated tool newly qualified nurses consistently perform at a higher level of competency than that expected by senior nurses. The ability to estimate competency levels by objective means should be developed. Further research is needed involving a larger sample of Trusts and Schools of Nursing to replicate the results of this study and to compare methods of the assessment of performance in terms of competency in practice on qualification. It is through developments based upon research such as this that a systematic evaluation of the contribution of Schools of Nursing to the competence of newly qualified nurses can be addressed.

Growth hormone stimulation testing in both short and normal statured children: use of an immunofunctional assay

Accurate interpretation of the results of GH stimulation tests is of pivotal importance not only in the evaluation of the etiology of growth retardation in children but also in the selection of the best candidates for GH therapy. We performed this study to test a novel immunofunctional GH ( IFGH) assay that makes use of the concept that one GH molecule dimerizes two GH receptors and compared the results with those obtained using two GH assays, the Diagnostic Systems Laboratories ELISA and a Hybritech immunoradiometric assay in 19 children with short stature undergoing routine GH stimulation testing. We also tested 13 normally statured control children to revisit the issue of what constitutes normal GH responses to stimuli, using all three assays and arginine and either L-dopa or insulin-induced hypoglycemia as secretagogues. Concentrations of IGF-I, IGF binding protein-3, and acid labile subunit were measured as well. There was a significant correlation between peak IFGH and Diagnostic Systems Laboratories ELISA GH responses to stimuli (r(2) = 0.93) as well as between the Diagnostic Systems Laboratories ELISA and Hybritech immunoradiometric assay (r(2) = 0.91). There were no significant differences between the short stature and normal group in peak or mean GH concentrations regardless of the assay used; however, the IGF-I, IGF binding protein-3, and acid labile subunit concentrations were substantially lower in the short stature group. There was a wide spectrum of GH concentrations in the normal group; approximately 50% of the children had peak GH concentrations <7 ng/mL, approximately 30% <5 ng/mL, and two pubertal normal subjects peaked to only 2 ng/mL with use of both the ELISA and IFGH assays. We conclude that 1) sensitive GH assays, ELISA and immunoradiometric assay, accurately detect a GH capable of generating a biologic signal comparable to an IFGH and 2) that normal GH stimulation test results can be substantially lower than previously accepted. GH-dependent growth factors may be more sensitive indicators of GH sufficiency than GH concentrations in response to pharmacologic stimuli.

Serum leptin concentrations in hyperinsulinemia in the sets of obese, lipodystrophic and/or non-obese patients

OBJECTIVE

To study the relationship between serum leptin and circulating insulin under basal and in response to oral glucose administration in hyperinsulinemic patients with or without obesity.

MATERIAL AND METHOD

Fifteen female patients of known hyperinsulinemia provided material for the study. Leptin and insulin in sera were estimated by radioimmunoassay methods.

RESULTS

Eight of the 15 hyperinsulinemic patients with high body mass index (BMI) (31 +/- 0.94 kg/m2) had significantly (p < 0.01) elevated serum leptin concentrations (26.1 +/- 2 ng/ml) as compared to the levels in the remaining seven non-obese hyperinsulinemic patients with BMI of 20 +/- 1.0 kg/m2; their mean levels of serum leptin were low 5.7 +/- 1.1 ng/ml. Four of the latter group had face-sparing partial lipodystrophy. The mean circulating leptin concentrations in the control group of seven healthy normoinsulinemic and regularly menstruating women with normal BMI (19 +/- 0.95 kg/m2) were 13.7 +/- 1.8 ng/ml.

DISCUSSION

The results of the present study in 15 hyperinsulinemic patients show that circulating levels of leptin are not related to serum insulin. However, there was a positive correlation with BMI. An interesting observation of the study is that, notwithstanding the normal BMI, the group of hyperinsulinemic patients with face-sparing partial lipodystrophy had the lowest levels of circulating leptin concentrations. They were closer to the values found in prepubertal girls.

Monitoring the quality of pre-registration education: development, validation and piloting of competency based performance indicators for newly qualified nurses

The clinical competence or 'fitness for purpose' of newly qualified nurses continues to be an important professional and corporate issue that as yet has no objective means of assessment. A mixed group of managers, clinicians and educationalists was commissioned to develop a method for the measurement and evaluation of performance during the first year of employment of newly qualified nurses. Two instruments were developed and the results of the initial pilot study are demonstrated in this article. The results are preceded by a review of the relevant literature. The initial pilot study results indicate that in the case of both instruments the tests designed do give clear results on the small numbers used. A complete picture of the validity of the audit tool will not be seen until the results of the full validation study, including the above exercise, are known. However, the results to date indicate that the instruments have the potential to demonstrate the clinical competency of newly qualified staff on employment in their first post and their development over the first year of employment.

Conceptualization and measurement of quality of life in dementia: the dementia quality of life instrument (DQoL)

Direct assessment of quality of life (QoL) of persons with dementia has largely been ignored due to logistical, conceptual and practical issues. This article presents a disease-specific conceptual framework of QoL for dementia. Based on this conceptualization, a 29-item instrument designed to assess QoL by direct interview with dementia patients was developed and tested on 99 participants. The data show that the instrument is reliable and shows evidence of validity. Nearly all participants (96%) were able to respond to questions appropriately. Thus, persons with mild to moderate dementia can be considered good informants of their own subjective states, paving the way to consider patient responses rather than proxy measures as the gold standard for assessing QoL for persons with dementia.

Avian diving, respiratory physiology and the marginal value theorem

Behavioural studies of diving birds have reported that the ratio of dive duration to the duration of the subsequent period on the surface displays a characteristic relation to dive duration. For short dives, the dive to surface ratio increases with dive duration, whereafter the relation peaks, and for longer dives decreases with increasing dive duration. Such a relationship is not a general prediction of existing marginal value models which have been used to predict optimal diving behaviour. This may be because the smooth curve used to describe the oxygen gain rate of individuals after surfacing is not a good reflection of the respiratory physiology of birds. Here we argue that on physiological grounds, the oxygen gain curve for avian divers will not be smooth, but will have two distinct regions (representing oxygen recovery in the respiratory tract, and in haemoglobin and myoglobin, respectively). Modifying two of the classical diving models by incorporating such a kinked curve causes them to predict the humped relationship between dive to surface ratio and dive duration under many circumstances. We also present data on the duration of dives and surface periods from three species of diving seabirds: the shag, Phalacrocorax aristotelis, the black guillemot, Cepphus grylle and the common guillemot, Uria aalge. All three species showed a humped relationship for dive to surface ratio as a function of dive duration. In line with the predictions of our model, when oxygen stores on surfacing were greatly depleted, the dive to surface ratio peaked at short dive durations. Copyright 1998 The Association for the Study of Animal Behaviour.

Glycaemic index and optimal performance

It is widely documented that athletes should consume carbohydrates prior to, during and after exercise. Ingestion of carbohydrates at these times will optimise performance and recovery. In spite of this knowledge, there is a paucity of information available to athletes concerning the types of carbohydrate foods to select. Therefore, it is suggested that the glycaemic index may be an important resource when selecting an ideal carbohydrate. The glycaemic index categories foods containing carbohydrates according to the blood glucose response that they elicit. Carbohydrate foods evoking the greatest responses are considered to be high glycaemic index foods, while those producing a relatively smaller response are categorised as low glycaemic index foods. Athletes wishing to consume carbohydrates 30 to 60 minutes before exercise should be encouraged to ingest low glycaemic index foods. Consuming these types of foods will decrease the likelihood of creating hyperglycaemia and hyperinsulinaemia at the onset of exercise, while providing exogenous carbohydrate throughout exercise. It is recommended that high glycaemic index foods be consumed during exercise. These foods will ensure rapid digestion and absorption, which will lead to elevated blood glucose levels during exercise. Post-exercise meals should consist of high glycaemic index carbohydrates. Low glycaemic foods do not induce adequate muscle glycogen resynthesis compared with high glycaemic index foods.

Influence of anastrozole (Arimidex), a selective, non-steroidal aromatase inhibitor, on in vivo aromatisation and plasma oestrogen levels in postmenopausal women with breast cancer

The effect of anastrozole ('Arimidex', ZD1033), a new, selective, non-steroidal aromatase inhibitor on in vivo aromatisation and plasma oestrogen levels was evaluated in post-menopausal women with breast cancer. Twelve patients progressing after treatment with tamoxifen were randomised to receive anastrozole 1 mg or 10 mg once daily for a 28 day period in a double-blinded crossover design. In vivo aromatisation and plasma oestrogen levels were determined before commencing treatment and at the end of each 4-week period. Treatment with anastrozole 1 and 10 mg reduced the percentage aromatisation from 2.25% to 0.074% and 0.043% (mean suppression of 96.7% and 98.1% from baseline) and suppressed plasma levels of oestrone, oestradiol and oestrone sulphate by > or = 86.5%, > or = 83.5% and > or = 93.5% respectively, irrespective of dose. Notably, several patients had their oestrone and oestradiol values suppressed beneath the sensitivity limit of the assays. In conclusion, anastrozole was found to be highly effective in inhibiting in vivo aromatisation with no difference in efficacy between the two drug doses. Contrary to previous studies on other aromatase inhibitors, this study revealed an internal consistency between the percentage aromatase inhibition and suppression of plasma oestrone sulphate.

Pharmacokinetics, pharmacological and anti-tumour effects of the specific anti-oestrogen ICI 182780 in women with advanced breast cancer

We have assessed the pharmacokinetics, pharmacological and anti-tumour effects of the specific steroidal anti-oestrogen ICI 182780 in 19 patients with advanced breast cancer resistant to tamoxifen. The agent was administered as a monthly depot intramuscular injection. Peak levels of ICI 182780 occurred a median of 8-9 days after dosing and then declined but were above the projected therapeutic threshold at day 28. Cmax during the first month was 10.5 ng/ml-1 and during the sixth month was 12.6 ng ml-1. The AUCs were 140.5 and 206.8 ng day ml-1 on the first and sixth month of dosing respectively, suggesting some drug accumulation. Luteinising hormone (LH) and follicle-stimulating hormone (FSH) levels rose after withdrawal of tamoxifen and then plateaued, suggesting no effect of ICI 182780 on the pituitary-hypothalamic axis. There were no significant changes in serum levels of prolactin, sex hormone-binding globulin (SHBG) or lipids. Side-effects were infrequent. Hot-flushes and sweats were not induced and there was no apparent effect of treatment upon the endometrium or vagina. Thirteen (69%) patients responded (seven had partial responses and six showed "no change' responses) to ICI 182780, after progression on tamoxifen, for a median duration of 25 months. Thus ICI 182780, given by monthly depot injection, and at the drug levels described, is an active second-line anti-oestrogen without apparent negative effects on the liver, brain or genital tract and warrants further evaluation in patients with advanced breast cancer.

Response to a specific antioestrogen (ICI 182780) in tamoxifen-resistant breast cancer

We treated 19 patients with advanced breast cancer resistant to tamoxifen with a new specific antioestrogen (ICI 182780) which, in animal studies, has no agonist activity. 13 (69%) patients responded (7 had partial responses and 6 showed no change) to monthly intramuscular injections of ICI 182780 after progression on tamoxifen, for a median duration of 18 months with minimum side effects. Preliminary evidence suggests that the agent is without effects on the liver or the hypothalamic-pituitary axis. ICI 182780 appears to be a promising new agent for treatment of advanced and early breast cancer.

Fetal plasma insulin-like growth factor-binding protein-3 concentrations are elevated following bilateral nephrectomy in fetal sheep

Insulin-like growth factors mediate many of the effects of growth hormone and are important in the regulation of growth, especially in the fetus where growth is less dependent on circulating growth hormone. In the ovine fetus, insulin-like growth factor-I (IGF-I) is bound mainly to the low molecular weight insulin-like growth factor-binding proteins (IGFBP), IGFBP-1 and IGFBP-2, with little binding to IGFBP-3 until near term at 147 days gestation. To determine if there was any difference in plasma IGF-I and IGFBP-3 concentrations in growth-retarded fetal sheep with altered renal status, concentrations were measured by specific radioimmunoassay from bilaterally nephrectomized fetal sheep between Days 113 and 135 gestation. Plasma IGFBP-3 concentrations were significantly (P < 0.001) increased in bilaterally nephrectomized fetuses (4.19 +/- 0.19 micrograms mL-1, n = 7) compared with control fetuses (2.33 +/- 0.10 micrograms mL-1, n = 7). There was no change in plasma IGFBP-3 concentration with gestational age in either experimental group. Maternal plasma IGFBP-3 concentrations did not differ between the bilateral nephrectomy group (3.11 +/- 0.09 micrograms mL-1, n = 7) and the control group (3.25 +/- 0.11 micrograms mL-1, n = 7) and showed no change within groups over the experimental period. Total plasma IGF-I concentrations in bilaterally nephrectomized fetuses and ewes were similar to those in control fetuses and ewes. The results indicate that the profile of IGF binding in fetal plasma is altered in the anephric fetal sheep. In nephrectomized fetal sheep, increased IGFBP-3 concentrations, and therefore increased IGF-binding capacity in fetal plasma, may have contributed to a decrease in free IGF in plasma and decreased IGF-I bioactivity. This would provide a possible mechanism for the growth retardation reported in bilaterally nephrectomized fetal sheep.

Twenty five years of case finding and audit in a socially deprived community

OBJECTIVE

To evaluate audit and case finding (whole population care) in a community over 25 years.

DESIGN

Contemporary screening for and audits of care of chronic disease and risk factors; retrospective review of computerised practice records; and comparisons of mortality and social indices with neighbouring communities.

SETTING

One general practice in Glyncorrwg, West Glamorgan.

SUBJECTS

1800 people registered with the practice in 1987 and 558 people who died from 1964 to 1987, whose records had been retained.

MAIN OUTCOME MEASURES

Detection of high blood pressure, smoking, airways obstruction, obesity, diabetes, and alcohol problems in adults aged 20-79; prevalence of smoking in this population and in hypertensive and diabetic groups; age standardised mortality ratios in relation to indices of social deprivation.

RESULTS

In the population aged 20-79 (1207 patients) 249 (21%) had peak expiratory flow rate less than 50% of expected value or which improved by 15% or more with an inhaled beta agonist, 207 (17%) had body mass index at or over 30 kg/m2, 118 (10%) had untreated mean arterial pressures greater than 159/104 mm Hg (three readings), 80 (7%) (65 (16%) men, 15 (4%) women) had recognised alcohol problems, and 35 (3%) had diabetes. The proportion of men aged 20-64 who said they smoked fell from 61% (290/476) in 1968-70 to 36% (162/456) in 1985 whereas that of women who smoked was unchanged (43%, 187/436 v 42%, 190/448 respectively). In 116 screened hypertensive patients group mean blood pressure fell from 186/110 mm Hg before treatment to 146/84 mm Hg at 1987 audit, as did the proportion of smokers (56% v 20%), but body mass index and total cholesterol concentration showed no significant change. In 34 diabetic patients mean blood pressure and the proportion of smokers fell (171/93 mm Hg v 155/81 mm Hg; 44% v 12%). The age standardised mortality ratio in 1981-6 was lower than in a neighbouring village without a developed case finding programme (actual to expected deaths less than 65 = 21 to 22 in Glyncorrwg, 48 to 30 in control village).

CONCLUSIONS

Whole population care through organised case finding and audit is feasible but only with a labour intensive approach combining accessibility, flexibility, and continuity, as well as a planned and structured approach, which requires substantial expansion of staff numbers and assiduous recording. It may reduce risks for at least some high risk groups. Despite their shortcomings the available data are consistent with the hypothesis that whole population care helps reduce mortality. Incentives in the new contract, which encourage the uncritical development of structured process, may diminish health outputs.

Dorsal column stimulation (DCS) in chronic pain: report of 31 cases

Thirty-one patients of chronic pain treated with dorsal column stimulation (DCS) are reported. All of them had been treated previously with drugs and multiple procedures including injections and frequently several operations. After a trial of percutaneous DCS, permanent implantations were carried out. The patients have been followed for up to eight years. Overall, sixty per cent of patients had good to fair relief of pain with DCS. Some of them had a good response for five years and more.

Dietary sodium and arterial blood pressure: evidence against genetic susceptibility

Thirty five subjects with both parents in the top third of their age specific blood pressure distributions and 31 subjects with both parents in the bottom third of their blood pressure distributions restricted their intake of sodium for eight weeks while taking part in a double blind, randomised crossover trial of supplements of sodium and placebo. A comparison of two periods of four weeks at different intakes of sodium showed no differences in blood pressure in either the groups as a whole or the subgroups who complied best with the diet and tablets. In the compliant subgroups mean urinary sodium excretions were above 120 mmol(mEq) and below 50 mmol/day. The study provides evidence against the hypothesis that people with a family history of high blood pressure are more susceptible in their blood pressure response to dietary sodium.

Epidural analgesia and instrumental delivery

In patients given epidural analgesia who had singleton vertex vaginal deliveries the normal delivery rate was 57%, compared to 80% in all this group. The increase in instrumental delivery rate could partly be accounted for by parity (primigravidae are over-represented in the epidural group), by obstetric and medical indications for epidurals, and by the need for sitting top-ups to relieve perineal pain. There remained a small population of patients in whom epidurals may have contributed to the need for instrumental delivery.

Dietary sodium restriction for mild hypertension in general practice

Eighteen patients with stable mild hypertension (mean blood pressure 144/93 mm Hg) restricted their sodium intake for eight weeks while taking part in a double blind randomised crossover trial of slow sodium and placebo tablets. Mean 24 hour urinary sodium excretion was 143 mmol(mEq) during the period on slow sodium and 87 mmol during the period on placebo. Five patients were unable to reduce their sodium intake below 120 mmol, but the others had a mean 24 hour urinary sodium excretion of 59 mmol during the period on placebo. There was no significant difference in blood pressure between the slow sodium and placebo treatment periods, although the study had a power of 99% to detect a difference of 5 mm Hg in mean arterial pressure between the two periods. Moderate dietary sodium restriction does not lower blood pressure in patients with this degree of hypertension.

Ageing Britain: we must not drag our feet

One of the essential ingredients for an active old age is healthy, comfortable feet, but there are not enough trained chiropodists to serve existing demand and the DHSS' projected three per cent growth in chiropody services won't do anything to change this.

A technique for the handling and dispensing of Xe-127: concise communication

Xenon-127, which provides photon energies better suited to the Anger camera and reduces radiation dosage to the patient compared with Xe-133, has become commercially available from Brookhaven Laboratories. Its higher cost and longer shelf-life require improved handling and dispensing of shipment ampoules containing gas of high specific activity. The technique described permits individual doses to be prepared for gaseous administration, or dissolved in saline for i.v. injection.