Urinary B-cell-activating factor of the tumour necrosis factor family (BAFF) in systemic lupus erythematosus.

INTRODUCTION: We examined the clinical relevance of urinary concentrations of B-cell-activating factor of the tumour necrosis factor family (BAFF) and a proliferation-inducing ligand (APRIL) in systemic lupus erythematosus (SLE). METHODS: We quantified urinary BAFF (uBAFF) by enzyme-linked immunosorbent assay in 85 SLE, 28 primary Sjögren syndrome (pSS), 40 immunoglobulin A nephropathy (IgAN) patients and 36 healthy controls (HCs). Urinary APRIL (uAPRIL) and monocyte chemoattractant protein 1 (uMCP-1) were also quantified. Overall and renal SLE disease activity were assessed using the Systemic Lupus Erythematosus Disease Activity Index 2000. RESULTS: uBAFF was detected in 12% (10/85) of SLE patients, but was undetectable in HCs, IgAN and pSS patients. uBAFF was detectable in 28% (5/18) of SLE patients with active nephritis vs 5/67 (7%) of those without ( p = 0.03), and uBAFF was significantly higher in active renal patients ( p = 0.02) and more likely to be detected in patients with persistently active renal disease. In comparison, uAPRIL and uMCP-1 were detected in 32% (25/77) and 46% (22/48) of SLE patients, respectively. While no difference in proportion of samples with detectable uAPRIL was observed between SLE, HCs and IgAN patients, both uAPRIL and uMCP-1 were significantly detectable in higher proportions of patients with active renal disease. CONCLUSIONS: uBAFF was detectable in a small but a significant proportion of SLE patients but not in other groups tested, and was higher in SLE patients with active renal disease.

Elimination of mother-to-child transmission of HIV in South Africa: rapid scale-up using quality improvement.

BACKGROUND: South Africa (SA) is committed to achieving the goal of eliminating mother-to-child transmission (MTCT) of HIV by 2015. To achieve this, universal coverage of quality antenatal, labour, delivery and postnatal services for all women has to be attained. Over the past decade, the prevention of mother-to-child transmission (PMTCT) programme has been scaled up to reach all healthcare facilities in the country. However, challenges persist in achieving 100% coverage and access to the programme. OBJECTIVES: We describe the process undertaken by the National Department of Health (NDoH), in collaboration with partners, to develop, implement and monitor a data-driven intervention to improve facility, district, provincial and national PMTCT-related performance. METHODS: Between 2011 and 2013, the NDoH developed and implemented an intervention using data-driven participatory processes to understand facility-level bottlenecks to optimise PMTCT implementation and to scale up priority PMTCT actions nationally. RESULTS: There was remarkable improvement across all key indicators in the PMTCT cascade over the 3 years 2011-2013. Simple monitoring tools such as a visual dashboard and data for action reports were successfully used to improve the performance of the PMTCT programme across SA. MTCT has shown a significant downward trend. CONCLUSIONS: It is feasible to implement district-level, data-driven quality improvement processes at a national scale to improve the performance of the PMTCT programme at the local level.

Are mesh anchoring sutures necessary in ventral hernioplasty? Multicenter study.

BACKGROUND: Avoiding mesh fixation to the surrounding tissue in ventral hernioplasty would simplify the operation, decrease the time of the procedure, and decrease the risk of suture-related complications. METHODS: Four hospitals included 111 patients according to the common protocol for prospective clinical evaluation of sutureless ventral hernioplasty. Surgical technique involves placement of the polypropylene mesh with flat-shape memory in either the retromuscular or preperitoneal space without suture anchoring. RESULTS: Local complication rate was low (12.6%, 14 patients), postoperative pain measured according to the visual analogue scale was minimal (mean 4, range 1-8). Three recurrences (3%) were recorded. Mild scar discomfort, which did not require treatment nor limit physical activity, was recorded in 28 (25%), 18 (17%), and 11 (14%) patients at 6-month, 1- and 2-year follow-up, respectively. CONCLUSIONS: Results of the study suggest that the sutureless sublay technique is safe and effective in the treatment of ventral abdominal hernia, especially in small and medium defects.

Gone but not forgotten: the search for the lost surgical specimens: application of quality improvement techniques in reducing medical error.

A lost surgical specimen prompted an investigation of both the human processes and the systemic factors involved in surgical specimen handling regarding how health care organizations approach medical error prevention and patient safety promotion. Quality improvement techniques and the conceptual error model of James Reasons were employed to understand the interaction between the local process of specimen handling and the systemic influences to medical error management. Error management recognizes the inevitability of both individual and systemic error. Through the use of quality improvement techniques and models of error analysis, health care organizations can investigate the error potential of health care delivery and address the human and organizational interaction necessary to improve patient safety and manage medical error.

Platinum(II)-adenosine phosphothiorate complexes: kinetics of formation and phosphorus-31 NMR characterization studies.

Reactions of chloro(diethylenetriamine)platinum(II) chloride with adenosine 5'-O-thiomonophosphate, adenosine 5'-O-(2-thiodiphosphate), and adenosine 5'-O-(3-thiotriphosphate) yielded exclusively (phosphothiorato)platinum(II) complexes. Phosphorus-31 NMR data for the coordinated phosphothiorate phosphorus atom exhibited about 15-20 ppm upfield chemical shift compared to chemical shifts for free nucleotides. Uncoordinated phosphate groups exhibited insignificant changes in the chemical shift upon complexation. Likewise, proton NMR data indicate no significant changes in chemical shift for the purine or ribose protons. Reactions between phosphothiorates and the platinum complex predominately take place through a second-order process, first order with respect to each of the reactants indicating that the aquated pathway contributes insignificantly toward complexation. The second-order rate constants, 1.9 +/- 0.1 M-1 s-1 for the AMP-S, 2.4 +/- 0.2 M-1 s-1 for the ADP-beta-S, and 2.7 +/- 0.2 M-1 s-1 for the ATP-gamma-S reactions were evaluated at pH 6.5 and at 25 degrees C. These rate data were compared with those reactions of adenosine 5'-monophosphate (AMP) and guanosine 5'-monophosphate (GMP) with the same platinum(II) complex. These reactions proceed through the direct interaction between the starting platinum complex and nucleotides as well as through the reaction between the aquaplatinum complex and nucleotides. The rate constant for the aquation process was evaluated to be (2.0 +/- 0.1) x 10(-4) s-1 for both AMP and GMP reactions.(ABSTRACT TRUNCATED AT 250 WORDS)

Phosphonato complexes of platinum(II): kinetics of formation and phosphorus-31 NMR characterization studies.

Reactions of cis-diamminedichloroplatinum(II) with phosphonoformic acid (PFA), phosphonoacetic acid (PAA), and methylenediphosphonic acid (MDP) yield various phosphonatoplatinum(II) chelates which were characterized by phosphorus-31 NMR spectroscopy. The P-31 resonances for the chelates appear at 6-12 ppm downfield as compared to the uncomplexed ligands. All complexes exhibit monoprotic acidic behavior in the pH range 2-10. The chemical shift-pH profiles yielded acidity constants, 1.0 x 10(-4), 1.5 x 10(-4), and 1.3 x 10(-6) M-1, for the PFA, PAA, and MDP chelates. In addition to the monomeric chelate, MDP formed a bridged diplatinum(II,II) complex when it reacted with cis-Pt (NH3)2(H2O)2(2)+. The P-31 resonance for this binuclear complex appears at 22 ppm downfield from the unreacted ligand. Rate data for the complexation reactions of the phosphonate ligands with the dichloroplatinum complex are consistent with a mechanism in which a monodentate complex is formed initially through rate-limiting aquation process of the platinum complex, followed by a rapid chelation. For the PFA and PAA complexes, initial binding sites are the carboxylato oxygens. Implications of the various binding modes of the phosphonates in relationship to their antiviral activities are discussed.

Gender differences in emotional support and depressive symptoms among adolescents: a prospective analysis.

Investigated components of perceived emotional support, including support from family members, nonfamily adults, and peers, as predictors of depressive symptoms in a sample of 333 high school students (age 14-18) using a prospective design. Analyses of panel questionnaire data at two points in time suggest there are significant gender differences both in the quality of perceived support reported by adolescents and in the importance of support variables as predictors of depressive symptoms. Although there are no gender differences in the magnitude of perceived support from family members, girls report higher emotional support from both nonfamily adults and peers than boys report. Simple correlations between family support and depression are significantly stronger for girls than for boys. Results of hierarchical regression analyses, controlling for initial level of symptoms, reveal that whereas both nonfamily adult and friend components of perceived support are significant predictors of changes in symptoms for girls, none of these variables significantly predicts changes in symptoms for boys in this sample. In addition, initial symptoms predict changes in family support for girls but not for boys.

The problem of confounding social support and depressive symptoms: a brief report on a college sample.

The problem of confounding social support and depressive symptoms was addressed by examining the convergent and discriminant validity of interview and questionnaire measures of social support and depression using the multitrait-multimethod matrix approach. Participants were 40 late-adolescent college students with half the sample selected on the basis of mild to moderate scores on self-reported depressive symptoms. Measures of depression displayed excellent convergent and discriminant validity, and measures of objective features of social networks were found to have moderate convergent and discriminant validity. However, the subjective measures of satisfaction with social support used were found to have neither adequate convergent nor discriminant validity. Implications for the conceptualization and assessment of social support are highlighted.

A prospective study of life events, social support, and psychological symptomatology during the transition from high school to college.

Life events, perceived social support, and psychological symptoms were studied prospectively among older adolescents during the transition from high school to college. These variables were reciprocally related to one another in patterns which changed over a period of 6 months. The findings are supportive of a transactional model of stress that emphasizes reciprocal, rather than linear, paths of influence. Further, the study highlights the importance of studying stress and social support during life transitions that may constitute periods of greater vulnerability to life events.

Relationship of life events and social support with psychological dysfunction among adolescents.

Relationships among major life events, perceived social support, and psychological disorder were assessed in a sample of older adolescents. Negative life events and satisfaction with social support were significantly and independently related to a range of psychological symptoms. Further, the relationship between negative events and disorder was moderated by gender, the types of events experienced, and anticipated change in the psychosocial environment. The importance of the use of standardized and psychometrically sound measures of life events, social support, and psychological disorder is highlighted.

Comparison of attitudes toward transsexuality and homosexuality.

Attitudes toward transsexuality and homosexuality were compared in a sample of 318 university students. More people felt that homosexuality was "wrong" than felt that transsexuality was "wrong". This difference in favor of transsexuality was more pronounced in female than in male respondents. In addition, more people rejected the notion that biological factors were responsible for homosexuality than was the case for transsexuality. General attitudes about the morality of transsexuality and homosexuality, however, were not mirrored in response to questions pertaining to job discrimination. To the contrary, male respondents, especially, were more inclined toward equal opportunity for homosexuals than for transsexuals. One hypothesis supported by this study was that homosexual denial and "homophobia" in some transsexuals may, in part, be a reflection of society's greater moral condemnation of homosexuality relative to transsexuality.

Psychological aspects of artificial feeding in cancer patients.

Anorexia and weight loss are major physical and psychological problems for patients with cancer, and nutritional support has become an increasingly important part of cancer treatment. Reports discussing the psychological aspects of parenteral feeding have emphasized the importance of the nature of the underlying illness, but special problems surrounding the use of artificial feeding in patients with cancer have not been described. Patterns of emotional response to artificial feeding in such patients are most directly influenced by two interacting sets of variables: the diagnosis and prognosis of cancer, and personality characteristics of patients and family members involved. Typically, management problems result when demoralized patients respond to artificial feeding by becoming more passive, when independent patients struggle over artificial feeding in order to maintain a sense of control, or when anxious patients or families express fears about dying in the form of extreme preoccupation with eating and maintaining weight. An understanding of these patterns has specific implications for improving the patient's cooperation and quality of life.