Long-acting inhaled beta 2-agonists in the management of asthma: recent advances and current recommendations.

Salmeterol and formoterol belong to a new class of inhaled beta 2-agonists with a prolonged duration of action. At the time these agents were introduced, there was uncertainty regarding the safety of beta 2-agonist therapy in asthma and concern that they might lead to a deterioration in asthma control. Recent studies, in contrast, have demonstrated both their safety and therapeutic efficacy.

What do general practice receptionists think and feel about their work?

Background: Although there is some published work acknowledging that the general practice receptionist's role is both important and difficult, receptionists' own views have rarely been sought.

Aim: To explore general practice receptionists' ideas and feelings about their work.

Method: A questionnaire was distributed to all 150 receptionists in a representative sample of 26 practices in the area covered by Leeds family health services authority.

Correlation of SMNt and SMNc gene copy number with age of onset and survival in spinal muscular atrophy.

Childhood-onset autosomal recessive spinal muscular atrophy (SMA) is associated with absence of the telomeric survival motor neuron gene (SMNt) in most patients, and deletion of the neuronal apoptosis inhibitory protein (NAIP) gene in the majority of severely affected patients. Analysis of SMNt has been complicated by the existence of a centromeric copy, SMNc, which is almost identical to SMNt but which can be distinguished from it by restriction enzyme analysis. In this study 143 SMA patients have been genotyped for the presence or absence of the SMNt, SMNc and NAIP genes, and the data correlated with quantifiable clinical variables.

Developing, validating and consolidating the doctor-patient relationship: the patients' views of a dynamic process.

Background: Previous research has examined the doctor-patient relationship in terms of its therapeutic effect, the need to consider the patients' models of their illness, and the patients' expectations of their doctor. However, to date, no research has examined the patients' views of the doctor-patient relationship.

Aim: To examine patients' views of the process of creating a relationship with their general practitioner (GP).

A browser based image bank, useful tool or expensive toy?

DIBS, the Digital Image Banking System, is a web browser based environment for depositing and withdrawing generic medical images. These can be annotated or modified on an individual's computer for use in talks and lectures. DIBS is programmed in 'C', to query and update a database as well as producing web pages on the 'fly'.

A helical region on human lactoferrin. Its role in antibacterial pathogenesis.

Human lactoferrin contains a 47 amino acid peptide, named lactoferricin H, which is thought to be responsible for its antimicrobial activity. Lactoferricin includes a loop region, which resides on the outer surface of the N-lobe of lactoferrin, adopting an alpha helix with a hydrophobic tail. Peptides have been synthesised corresponding to the highly charged alpha helix (HLP 2) and hydrophobic tail region (HLP 5).

A single exposure of solar simulated radiation suppresses contact hypersensitivity responses both locally and systemically in humans: quantitative studies with high-frequency ultrasound.

Ultraviolet radiation (UVR)-induced suppression of cutaneous cell-mediated immunity plays an important role in the development of photocarcinogenesis in the mouse and a similar role is suspected in humans. Cell-mediated immunity is readily tested in vivo by measuring the contact hypersensitivity (CHS) response to topically applied haptens. CHS in humans is usually determine clinically, with a subjective scoring system.

Extracorporeal photopheresis in Sézary syndrome. No significant effect in the survival of 44 patients with a peripheral blood T-cell clone.

Background: Several retrospective studies have claimed that extracorporeal photopheresis (ECP) prolongs survival in patients with erythrodermic cutaneous T-cell lymphoma. In a retrospective study of 44 patients with Sézary syndrome, we compared survival in patients treated with ECP with that of patients treated conventionally at the same institute. All patients had genotypic evidence of a peripheral blood T-cell clone.

Adjunctive systemic and locally delivered metronidazole in the treatment of periodontitis: a controlled clinical study.

Objective: To compare clinical and microbiological responses following non-surgical treatment of moderate to advanced adult periodontitis using subgingival scaling with and without adjunctive topical or systemic metronidazole.

Design: A single blind randomised clinical trial of 90 subjects, stratified for periodontitis disease severity and smoking status, divided into three treatment groups: 1. Subgingival scaling using ultrasonic scalers and local anaesthesia; 2.

Subjective memory evaluations in patients with focal frontal, diencephalic, and temporal lobe lesion.

This paper examines subjective memory evaluations and their correlates in patients with focal frontal, diencephalic, or temporal lobe lesions. Although all patient groups showed significantly lower subjective memory evaluations than healthy subjects, the temporal lobe group rated themselves significantly lower than the frontal lobe or diencephalic groups despite comparable severity of amnesia, implying more severely impaired 'insight' in the latter two groups. There was a 'temporal gradient' such that patients rated their memory for 'old' (premorbid) items better than their memory for 'new' (recent) or prospective items.

Reported dental attendance and perceived barriers to care in frail and functionally dependent older adults.

Objectives: This study was designed to investigate the reported dental attendance and the perceived barriers to dental care for frail and functionally dependent older adults.

Design: A single centre study of a housebound group of more than 60 years of age and their personal carers.

Setting: The study was carried out from a general dental practice in Ware, Hertfordshire, a market town 20 miles north of London.

Who and what influences delayed presentation in breast cancer?

This study aimed to examine the extent and determinants of patient and general practitioner delay in the presentation of breast cancer. One hundred and eighty-five cancer patients attending a breast unit were interviewed 2 months after diagnosis. The main outcome measures were patient delay in presentation to the general practitioner and non-referral by the general practitioner to hospital after the patient's first visit.

Protective mucosal immunity elicited by targeted lymph node immunization with a subunit SIV envelope and core vaccine in macaques.

Prevention of sexually transmitted HIV infection was first investigated in non-human primates by mucosal immunization via the rectal, vaginal or male urethral route. This was compared with subcutaneous targeted iliac lymph node (TILN) and systemic intramuscular immunization in non-human primates. TILN immunization elicited the most consistent mucosal sIgA and IgG antibody response in the rectum, vagina, urine and seminal fluid, as well as in blood.

The emotional effects of tooth loss in edentulous people.

Aim: To explore the range of reactions to, and feelings about, tooth loss.

Method: In this qualitative study, 50 edentulous people undergoing routine prosthetic dental care were interviewed privately using a reflexive, in-depth technique. All the interviews were tape-recorded and transcribed.

Variations in the management and survival of women with endometrial cancer in south east England.

Objectives: To compare the management of women with endometrial cancer to locally developed clinical guidelines, and to examine the factors influencing their survival.

Study Design: Observational study in seven districts of the South East Thames Regional Health Authority.

Results: 133 women were diagnosed with endometrial cancer.

Molecular typing of enteroviruses: current status and future requirements. The European Union Concerted Action on Virus Meningitis and Encephalitis.

Human enteroviruses have traditionally been typed according to neutralization serotype. This procedure is limited by the difficulty in culturing some enteroviruses, the availability of antisera for serotyping, and the cost and technical complexity of serotyping procedures. Furthermore, the impact of information derived from enterovirus serotyping is generally perceived to be low.

A one-stop vascular clinic: a practical proposition with non-invasive assessment.

One-stop clinics are becoming increasingly popular with both patients and their general practitioners. Traditionally, vascular patients have needed to attend hospital two or three times for clinical examination and investigations. We have introduced a one-stop clinic for patients with lower limb arterial disease (LLAD) and aortic aneurysms.

Randomised controlled trial to evaluate early discharge scheme for patients with stroke.

Objective: To assess the clinical effectiveness of an early discharge policy for patients with stroke by using a community based rehabilitation team.

Design: Randomised controlled trial to compare conventional care with an early discharge policy.

Setting: Two teaching hospitals in inner London.

Flow cytometric analysis of chlorhexidine action.

The mechanism by which chlorhexidine kills bacteria is still ill defined. We have investigated the action of chlorhexidine on Escherichia coli JM101/psb311 using a combination of flow cytometry and traditional methods. Chlorhexidine-induced uptake by E.

Expression of tissue type plasminogen activator and type 1 plasminogen activator inhibitor, and persistent fibrin deposition in chronic renal allograft failure.

Persistent fibrin deposition has been observed in kidneys undergoing chronic rejection, and has been suggested to contribute to the obliteration of the vasculature in these grafts. The mechanisms leading to it are not clear. Fibrinolysis, the process to remove fibrin in tissues, is initiated by tissue type plasminogen activator (tPA) and suppressed by type 1 plasminogen activator inhibitor (PAI-1).

T-cell epitopes recognized within the 65,000 MW hsp in patients with IgA nephropathy.

IgA nephropathy (IgAN) is the commonest cause of glomerulonephritis and clinical exacerbation of IgAN is frequently associated with mucosal infection. T-cell receptor gamma delta (TCR gamma delta+) cells are increased in both the circulation and in renal biopsies of patients with progressive IgAN. We examined the hypothesis that specific peptides within the 65,000 MW heat-shock protein (hsp) might stimulate TCR gamma delta cells and play a part in the immunopathogenesis of IgAN.

Immune memory in CD4+ CD45RA+ T cells.

This study addresses the question of whether human peripheral CD4+ CD45RA+ T cells possess antigen-specific immune memory. CD4+ CD45RA+ T cells were isolated by a combination of positive and negative selection. Putative CD4+ CD45RA+ cells expressed CD45RA (98.