Personality differences between doctors and their patients: implications for the teaching of communication skills.

Objective: To establish, as part of a wider study into specialty choice and job satisfaction, whether the personality profiles of a sample of doctors differed from those of the UK population at large, i.e. their potential patients, and the implications this might have for the doctor/patient consultation process.

Differentially expressed genes in adult familial myelodysplastic syndromes.

The precise genetic events leading to myelodysplastic syndromes (MDSs) and leukemic transformation remain poorly defined. Even less is known about adult familial MDS. We report an adult MDS family in whom enriched tissue-specific transcripts were derived by subtractive hybridization of cDNA from the mononuclear and CD34+ cells of affected and unaffected family members.

Insulin-like growth factor I has a direct effect on glucose and protein metabolism, but no effect on lipid metabolism in type 1 diabetes.

There is evidence of a metabolic role for IGF-I in type 1 diabetes, but it is unclear whether IGF-I acts indirectly by reducing GH secretion or has direct effects. Using stable isotopes we have investigated, on three separate occasions, the effect of a pulse of recombinant human GH, a sc injection of recombinant human IGF-I, and a placebo on glucose, lipid, and protein metabolism in subjects with type 1 diabetes during a basal insulin infusion and a hyperinsulinemic euglycemic clamp. Endogenous GH secretion was suppressed with octreotide.

DNA variation in a 13-Mb region including the F9 gene: inferring the genealogical history and causal role of a hemophilia B mutation (IVS 5+13 A-->G).

About 5.5% of all UK hemophilia B patients have the base substitution IVS 5+13 A-->G as the only change in their factor (F)IX gene (F9). This generates a novel donor splice site which fits the consensus better than the normal intron 5 donor splice.

Preimplantation genetic diagnosis as a novel source of embryos for stem cell research.

The generation of human embryonic stem (hES) cells has captured the public and professional imagination, largely due their potential as a means of overcoming many debilitating and degenerative diseases by cell replacement therapy. Despite this potential, few well-characterized hES cell lines have been derived. Indeed, in the UK, despite several centres having been active in this area for more than 2 years, there are as yet no published reports of human embryonic stem cells having been generated.

The role of ATP and adenosine in the control of hepatic blood flow in the rabbit liver in vivo.

BACKGROUND: The role of adenosine and ATP in the regulation of hepatic arterial blood flow in the "buffer response" was studied in vitro and in a new in vivo model in the rabbit. The model achieves portal-systemic diversion by insertion of a silicone rubber prosthesis between the portal vein and inferior vena cava and avoids alterations in systemic haemodynamics. RESULTS: Hepatic arterial (HA) blood flow increased in response to reduced portal venous (PV) blood flow, the "buffer response", from 19.

Support for breastfeeding mothers: a systematic review.

Although the benefits of breastfeeding are widely accepted, the effectiveness of different strategies to promote the continuation of breastfeeding once initiated are less clear. The objective of this systematic review was to describe studies comparing standard care with the provision of extra breastfeeding support and to measure its effectiveness. Outcome measures used were rates of cessation of any breastfeeding or exclusive breastfeeding at chosen points in time.

High dose growth hormone exerts an anabolic effect at rest and during exercise in endurance-trained athletes.

The anabolic actions of GH in GH-deficient adults and children are well documented. Replacement with GH in such individuals promotes protein synthesis and reduces irreversible loss of protein through oxidation. Although GH is known to be self-administered by athletes, its protein metabolic effects in this context are unknown.

Nitric oxide generation mediated by beta-adrenoceptors is impaired in platelets from patients with Type 2 diabetes mellitus.

Aims/hypothesis: Type 2 diabetic patients have been shown to have reduced basal platelet nitric oxide synthase activity, which is a possible contributor to the vascular complications seen in the disease. We investigated platelet nitric oxide generation stimulated by beta-adrenoceptors and adenylyl cyclase in Type 2 diabetic patients and control subjects.

Methods: Platelets isolated from blood taken from nine Type 2 diabetic patients and nine healthy control subjects of similar age were treated with isoproterenol 1 micro mol/l, forskolin 1 micro mol/l or vehicle.

Chronic fatigue syndrome in children: a cross sectional survey.

Background: Chronic fatigue syndrome (CFS) in children is a controversial diagnosis with unclear aetiology, ill defined but likely increasing incidence, and debatable clinical management options. However these children experience real and considerable suffering. Appropriate research in this clinical population is sparse and usually occurs in tertiary referral units.

Relation of neurological soft signs to nonverbal memory performance in obsessive-compulsive disorder.

Few studies have examined the relation between neurological soft signs (NSS) and neuropsychological performance in Obsessive-Compulsive Disorder (OCD). Thirty outpatients with primary OCD and 30 matched normal controls were administered the Cambridge Neurological Inventory and the Rey-Osterrieth Complex Figure Test (RCFT). A series of multiple regression models tested the relationship between NSS and performance on the RCFT.

Declarative and procedural learning in individuals with subclinical obsessive-compulsive symptoms.

Previous neuropsychological research suggests that psychometrically defined subclinical obsessive-compulsive (OC) individuals perform worse than non-OC controls on specific tests of executive functioning. This study aimed to extend these findings by comparing the performance of 25 subclinical OC and 28 non-OC control subjects on measures of declarative learning (Rey Auditory Verbal Learning Test), motor procedural learning (star maze), spatial problem solving (single administration of the 3-disk version of the Tower of Hanoi; TH3), and "cognitive" procedural learning (repeated administrations of the 4-disk version of the Tower of Hanoi; TH4). In addition, the subjects were administered measures of general intelligence, anxiety and depression.

Capacitative calcium entry as a pulmonary specific vasoconstrictor mechanism in small muscular arteries of the rat.

(1) The effect of induction of capacitative Ca2+ entry (CCE) upon tone in small (i.d. 200-500 microm) intrapulmonary (IPA), mesenteric (MA), renal (RA), femoral (FA), and coronary arteries (CA) of the rat was examined.

A prognostic index to predict long-term mortality in patients with mild to moderate chronic heart failure stabilised on angiotensin converting enzyme inhibitors.

Background: Mortality in patients with mild to moderate chronic heart failure remains high. At present there is no easy way of identifying patients within this population at increased risk of death in the medium to long term.

Aims: To develop a prognostic index to identify outpatients with mild to moderate chronic heart failure at increased risk of death.

Hereditary haemorrhagic telangiectasia: a questionnaire based study to delineate the different phenotypes caused by endoglin and ALK1 mutations.

Background: Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant vascular dysplasia characterised by mucocutaneous telangiectasis, epistaxis, gastrointestinal haemorrhage, and arteriovenous malformations in the lung and brain. Causative mutations for HHT have been identified in two genes, endoglin and ALK1, which encode proteins involved in serine-threonine kinase signalling in the endothelial cell.

Methods: A number of people affected with HHT had completed a postal questionnaire as part of an international study to delineate the HHT phenotype.

Transgenes encompassing dual-promoter CpG islands from the human TBP and HNRPA2B1 loci are resistant to heterochromatin-mediated silencing.

The genetic elements that are responsible for establishing a transcriptionally competent, open chromatin structure at a region of the genome that consists only of ubiquitously expressed, housekeeping genes are currently unknown. We demonstrate for the first time through functional analysis in stably transfected tissue culture cells that transgenes containing methylation-free CpG islands spanning the dual divergently transcribed promoters from the human TATA binding protein (TBP)-proteasome component-B1 (PSMB1) and heterogeneous nuclear ribonucleoprotein A2/B1 (HNRPA2B1)-heterochromatin protein 1Hs-gamma (chromobox homolog 3, CBX3) gene loci are sufficient to prevent transcriptional silencing and a variegated expression pattern when integrated within centromeric heterochromatin. In addition, only transgene constructs extending over both the HNRPA2B1 and the CBX3 promoters, and not the HNRPA2B1 promoter alone, were able to confer high and stable long-term EGFP reporter gene expression.

Identifying neuropathic pain in patients with head and neck cancer: use of the Leeds Assessment of Neuropathic Symptoms and Signs Scale.

The Leeds Assessment of Neuropathic Symptoms and Signs Scale (LANSS) is a simple bedside test in two parts-a patient-completed questionnaire and a brief clinical assessment. Its diagnostic capabilities have never been tested in patients with cancer pain. To determine these we conducted a prospective study in outpatients with head and neck cancer.

Attitudes to timeliness of death and euthanasia among first generation black Caribbean and white patients and their families living in the United Kingdom.

Attitudes to timeliness of death and euthanasia are little researched among people from different ethnic backgrounds or in socioeconomically deprived areas. We interviewed 50 bereaved family members of people from the black Caribbean community and 50 from the white community in the United Kingdom, using an established questionnaire, and compared reports of their and the reported patient views. In both groups more than two thirds of patients knew they might die, although in more than half of these cases no one had actually told them this.

Effect of Tin-mesoporphyrin, an inhibitor of haem catabolism, on intestinal iron absorption.

Haem biosynthesis is the most important destination for absorbed iron, hence it can be hypothesized that iron absorption regulation should be integrated with haem metabolism. As an initial step to test this hypothesis, the effect on iron absorption of Tin-mesoporphyrin (SnMP), inhibitor of haem oxygenase, altering haem and its biosynthetic intermediates, was studied. Mice injected with SnMP (5-25 micro mol/kg daily for up to 3 d) showed dose-dependent increases in intestinal iron absorption measured in vivo and in vitro.

Increased expression of erythropoiesis inhibiting cytokines (IFN-gamma, TNF-alpha, IL-10, and IL-13) by T cells in patients exhibiting a poor response to erythropoietin therapy.

Resistance to recombinant human erythropoietin occurs in a small but important proportion of hemodialysis patients. This may be due to increased immune activation because pro-inflammatory cytokines inhibit erythropoiesis in vitro. Using FACScan flow cytometry, the proportion of PMA/ionomycin-stimulated T cells expressing cytokines ex vivo was compared in 18 poor responders to erythropoietin, 14 good responders to erythropoietin, and 14 normal controls.

The lipid and non-lipid effects of statins.

The 3-hydroxy-3-methyl glutaryl coenzyme A (HMG-CoA) reductase inhibitors, more commonly known as statins, are a class of drug widely used for the treatment of hypercholesterolaemia in patients with established cardiovascular disease as well as those at high risk of developing atherosclerosis. Their predominant action is to reduce circulating levels of low-density lipoprotein (LDL) cholesterol; to a smaller degree, they also increase high-density lipoprotein (HDL) cholesterol and reduce triglyceride concentrations. In recent years, however, there has been an increasing body of evidence that their effects on lipid profile cannot fully account for their cardiovascular protective actions: their beneficial effects are too rapid to be easily explained by their relatively slow effects on atherogenesis and too large to be accounted for by their relatively small effects on plaque regression.

Combination of microdissection and microarray analysis to identify gene expression changes between differentially located tumour cells in breast cancer.

Comparison of gene expression changes between cancer cells at the periphery and in the centre of breast cancers was performed using a combination of microdissection and microarray analysis. Cancer cells from the two areas were pooled separately from five patients with ductal carcinoma in situ and separately from five patients with frankly invasive cancer. Limited total RNA, 100-200 ng, from this microdissected tissue required use of the Atlas SMART trade mark Probe Amplification Kit to synthesize and amplify cDNA and make (33)P-labelled probes.

Optimal medical management of angina.

Coronary artery disease remains one of the principal causes of disability worldwide. Its most common manifestation is angina pectoris. Angina occurs due to an imbalance between myocardial oxygen demand and supply; it is classically precipitated by physical activity, emotion, eating, or cold weather.