Inhibin A (alpha-betaA) and activin A (betaA-betaA) are biochemically similar proteins that generally have opposite biologic functions. For example, while inhibin (alpha subunit) is proposed to be a tumor suppressor in some types of ovarian cancer, activin appears to stimulate tumor development. Previous reports suggest that a loss of alpha inhibin subunit expression and elevated serum activin levels are associated with human epithelial ovarian cancer (EOC). Our objective was to examine the alpha inhibin subunit gene locus on chromosome 2q for evidence of loss of heterozygosity (LOH) in cases of EOC and to correlate these results with serum activin A levels measured in the same patients. Ovarian tumor and matched healthy tissue samples were collected from 22 women with EOC. DNA was extracted and subjected to PCR analysis using 10 primers, seven from chromosome 2q (alpha inhibin subunit locus) and, as a control, three from chromosome 7p (inhibin/activin betaA subunit). In addition, each patient had a preoperative serum activin A measurement using an ELISA assay. One (1/22) case of EOC demonstrated LOH for one microsatellite marker at the alpha inhibin gene locus. Thirty-six percent (8/22) of patients had an activin A level that was increased above the normal range. We conclude that loss of heterozygosity at the inhibin/activin alpha subunit locus is not frequently associated with EOC. More direct molecular analyses of the inhibin and activin genes are warranted to rule out mutations in cases of epithelial ovarian cancer.

Activins↗

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The CAPD peritonitis rate is not improving with time.

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Adolescent↗

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Hospital management. The reflective practitioner.

Ian Campbell's paper, originally delivered at a conference on the development of 'The reflective practitioner' while he was Unit General Manager of Sunderland Royal Infirmary, describes the liaison between general and nurse managers in the hospital. Management must give a hospital organisation direction and must set the parameters of corporate and individual performance, but it must also be responsive to the feedback received from practising clinicians. The key concept is quality of service, and in this managers and practitioners can work together towards a common goal.

Hospital Administrators↗

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Under dual control.

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Blood Glucose↗

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Design quality--the key to product success.

Design control represents the essential difference between classical and modern quality assurance. Not only the product characteristics but also the basic product quality are determined during the design phase, and it is here that costly errors affecting the ultimate success of a product are avoided. These can be self-determined activities, requiring no intervention by third parties. In this article, the author urges medical device manufacturers to ensure product quality by implementing a design control from the very inception of a product.

Equipment Design↗

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Patient management in the subacute unit.

Social and economic forces have driven the health care industry to devise new venues and models of care for the growing number and medical complexity of elderly patients. One such venue is the subacute unit in skilled nursing facilities, which was designed to provide comprehensive, interdisciplinary, and skilled nursing, medical, and rehabilitative care to the elderly patient with potential for return to his or her previous level of function. The challenges in these units are to prevent iatrogenic consequences and prolonged, expensive stays for the patient. Gerontologic nurse practitioners with their advanced clinical skills and knowledge of geriatric primary care are uniquely suited to meet these challenges. This article describes the process of care in the subacute unit and the role of the nurse practitioner to lead the interdisciplinary team in achieving effective and timely outcomes for this fragile population.

Aged↗

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Disposable contact lenses vs. contact lens maintenance for extended wear.

We compared a disposable extended wear contact lens modality with conventional extended wear over a 6-week period. To do so, we refit 31 patients who had successfully worn conventional extended wear contact lenses for more than 1 year. One eye was fit with the AcuvueR disposable contact lens, and a new extended wear lens of the type the patient had been wearing was placed on the other eye. At weekly intervals the disposable lens was discarded and a new disposable lens inserted. At the same time, the conventional lens on the fellow eye was cleaned, disinfected, and reinserted. After 6 weeks the ocular response, subjective impressions, and condition of the lenses in the two eyes were compared. Both lenses were then cultured. Three subjects had to discontinue disposable lens wear because of adverse reactions to trapped cellular debris and corneal microcysts. Although the results were not statistically significant, the Acuvue lens appeared to perform better than or equal to the conventional lens in biomicroscopic observation, visual acuity measurement, and subjective patient preference. Eighty-seven percent of patients preferred to continue with the disposable system. There were no differences found in the type or degree of microbial contamination of the lenses.

Bacteria↗

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Midwifery in Alberta.

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Alberta↗

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p53 status has no prognostic significance in glioblastomas treated with radiotherapy.

Mutation of the tumor suppressor gene TP53 and accumulation of the p53 protein are common events in the range of cerebral astrocytic tumors, including glioblastomas, but it is uncertain whether these events are associated with prognosis. Evidence suggests that the response of various tumors to radiotherapy may be influenced by the status of p53 which is involved in control of the cell cycle and apoptosis. This study tests the hypothesis that p53 governs survival in patients (n = 62) with glioblastomas who have received radiotherapy. Analysis of TP53 and p53 immunohistochemistry were undertaken using standard methods. TP53 mutations were present in 27% tumors, while 50% were p53-immunopositive (LI > 3%). A strong correlation (p < 0.0001) was found between a high p53 LI (> 50%) and the presence of a mutation, but p53 status at the level of gene or protein was unrelated to survival. Radiation-induced apoptosis that is independent of p53, and the presence in glioblastomas of genetic abnormalities that are also involved in the cellular response to radiation, such as deletions and mutations of pRb, are possible explanations of this result.

Adult↗