Of 19,994 percutaneous transluminal coronary angioplasty procedures performed in The Netherlands between April 1980 and January 1989, the long-term follow-up of 454 patients who underwent angioplasty of ≥1 saphenous vein bypass graft was reviewed. In 46% of patients single graft angioplasty was attempted, and in 54% of patients sequential graft angioplasty was attempted. The clinical primary success rate was 90%. In-hospital mortality was 0.7%, 2.8% of patients sustained a procedural myocardial infarction, and 1.3% of patients underwent emergency bypass surgery. After a follow-up period of 5 years, 74% of patients were alive, and 26% were alive and event-free (no myocardial infarction, no repeat bypass surgery or repeat angioplasty). In patients in whom the initial angioplasty attempt was unsuccessful, only 3% were event-free at 5 years, versus 27% of successfully dilated patients. The time interval between the angioplasty attempt and previous surgery was a significant predictor for 5-year event-free survival. The event-free survival rates for patients who had bypass surgery 1 year before, between 1 and 5 years, and 5 years before angioplasty, were 45, 25 and 19%, respectively. Less than one-third of patients with previous bypass surgery who had angioplasty of the graft remained event-free after 5 years. In patients needing angioplasty within 1 year after bypass surgery, better long-term results were achieved.
Rationale: A characteristic of COPD is bacterial colonisation in the lower airway, possibly due to defective macrophage phagocytosis. This is associated with macrophage activation and increased cytokine release. JQ-1, a bromodomain inhibitor, down-regulates inflammatory protein transcription and may be anti-inflammatory. However, it may have other effects. This study compares the effect of JQ-1, on phagocytosis of bacteria in an MDM model using cells cultured from non-smokers, smokers and COPD subjects. Methods: Human monocyte-derived macrophages (MDMs) cultured (12 days + GMCSF) from non-smokers, smokers and COPD subjects were pre-treated with JQ-1 (1x10 -12 - 1x10 -5 M) for 4 or 24hrs. Phagocytosis of labelled H. Influenzae (HI) and S. Pneumoniae (SP) was measured by Fluorimetry. Cytokines TNF-α and CXCL-8 were measured by ELISA. Results: JQ-1 did not attenuate HI and SP stimulated release of CXCL-8 or TNF-α at 4 or 24hrs. MDM survival + JQ-1 (1μM): 4h = 156% and 24hr = 85% (relative to bacteria treated MDMs = 100%) Conclusions: JQ-1 had no effect on phagocytosis until high concentration (1μM). However, JQ-1 did not suppress CXCL-8 or TNF-.α release in this model. MDMs may not be a good model for study of bromodomain inhibitor effects and investigation of JQ-1 effects in other macrophage phenotypes is required.
The optimal treatment for mild asthma is uncertain. We assessed the effects of adding a long-acting inhaled beta-agonist, formoterol, to low doses of an inhaled corticosteroid, budesonide, for 1 yr in subjects with mild asthma, receiving no or only a small dose of inhaled corticosteroid. The 698 corticosteroid free patients (Group A) were assigned to twice daily treatment with 100 μ g budesonide, 100 μ g budesonide plus 4.5 μ g formoterol, or placebo. The 1,272 corticosteroid-treated patients (Group B) were assigned to twice daily treatment with 100 μ g budesonide, 100 μ g budesonide plus 4.5 μ g formoterol, 200 μ g budesonide, or 200 μ g budesonide plus 4.5 μ g formoterol. The main outcome variables were time to the first severe asthma exacerbation and poorly controlled asthma days. In Group A, budesonide alone reduced the risk for severe exacerbations by 60% and poorly controlled days by 48%; adding formoterol increased lung function with no change in other end points. By contrast, in Group B, adding formoterol reduced the risk for the first severe exacerbation and for poorly controlled days by 43 and 30%, respectively. Thus, in corticosteroid-free patients, low dose inhaled budesonide alone reduced severe exacerbations and improved asthma control, and in patients already receiving inhaled corticosteroid, adding formoterol was more effective than doubling the corticosteroid dose.
No abstract is provided for this article.
<h3>Background</h3> At 18 weeks duration, University of Limerick — Graduate Entry Medical School (UL–GEMS) has the longest general practice clinical attachment for medical students in Ireland and fulfils the educational criteria for a Longitudinal Integrated Clerkship (LIC).The longer the clinical placement the greater the imperative to see that these practices achieve satisfactory educational standards. <h3>Aim</h3> This project describes a quality assurance initiative of general practices that participate in the education of medical students at GEMS. <h3>Method</h3> A literature review of previous quality assurance initiatives in relation to general practices that teach medical students was performed. Information gained from this process was then compared with UL-GEMS own criteria for teaching general practices. A set of criteria by for assessing teaching general practices was devised. The assessment process included a combination of self-assessment by the GP tutors and practice visits by the UL-GEMS teaching staff. <h3>Results</h3> Nearly 100% of teaching practices had the correct teaching facilities, such as own room for the student or own computer. Suggested teaching methods, such as parallel consulting, as advised by the Department of General Practice were carried by 100% of practices. Use of the two-way feedback form and the GP/Student manual was poor. GP tutors requested more regular visits form the GP teaching staff as well as more guidance on content for formal tutorials so that a consistency teaching approach could be achieved. <h3>Conclusion</h3> This was the first quality assurance initiative on an extended clinical placement. The knowledge gained will lead to a more inclusive standard setting process for teaching medical students in general practice settings.
