A retrospective analysis of the GDC's performance against its newly-approved fitness to practise guidance.

OBJECTIVES: To assess if the GDC considers relevant factors at all stages of its deliberations into misconduct, as required by the determinations in the cases of Cohen, Zygmunt, and Azzam; and to assess whether those circumstances described in the Indicative Sanctions Guidance as warranting erasure from GDC registers led to that outcome. DESIGN Retrospective analysis of practise committee transcripts. MATERIALS AND METHODS: The consideration of specific factors in determining impairment of fitness to practise was compared with their subsequent consideration when determining the severity of sanction. Additionally, cases that highlighted aggravating circumstances deemed as serious enough to warrant erasure were monitored. Pearson's Χ test was used to detect any variation from the expected distribution of data. RESULTS: Sixty-six cases met with the inclusion criteria. Of the five factors considered, all but one was more likely to be heard when determining sanction having first been factored in to the consideration of impairment. Additionally, there was a statistically significant correlation between the aggravating factors and erasure from the registers. CONCLUSIONS: The GDC do, in general, consider relevant factors at all stages of their deliberations into practitioner misconduct, and act in a manner that is consistent with their own guidance when determining sanction.

Heat shock protein 27 is associated with freedom from graft vasculopathy after human cardiac transplantation.

Experimental studies have suggested that protective genes protect allografts from cardiac allograft vasculopathy (CAV), the major complication after cardiac transplantation. Here we have sought to confirm this hypothesis using long-term heart transplant recipients. Twenty-two patients that were 9 years or older after transplant were investigated; 11 of these were without angiographic evidence of CAV; 11 had developed early CAV at 1 to 3 years after transplant. To identify proteins that may act as protectors from CAV, a global proteomic approach was used comparing cardiac biopsies from 12 patients taken within the first 2 weeks after transplant and those taken after 9 years from the same patient. Proteins were separated by 2-D gel-electrophoresis, detected by silver staining, and analyzed using Progenesis software. A particular protein spot was found in 4/6 biopsies from patients without CAV, but absent from 5/6 biopsies from those with CAV (P=0.24); however, quantitative analysis of spot intensity showed a significant difference (0.061+/-0.05 versus 0.003+/-0.01, P=0.04). This spot was identified by mass spectrometry and a combination of techniques as a diphosphorylated form of HSP27. Immunohistochemistry of further biopsies not only validated that HSP27 was more abundantly expressed on biopsies without CAV but also showed it to be localized to blood vessels. In contrast, vessels from patients with CAV did not express HSP27 (P=0.028x10(-4)). Immunohistochemistry of 12 further early biopsies and nontransplanted heart showed HSP27 to be present in normal blood vessels. These findings suggest that expression of a specific diphosphorylated form of HSP27 is associated with healthy blood vessels; it appears to be lost from vessels of patients with graft vasculopathy.

Relative importance of SR load and cytoplasmic calcium concentration in the genesis of aftercontractions in cardiac myocytes.

OBJECTIVE: To determine whether calcium overload of the sarcoplasmic reticulum underlies drive train-induced aftercontractions in cardiac myocytes. METHODS: Sarcoplasmic reticulum calcium contents were measured immediately prior to drive train-induced aftercontractions in isolated guinea pig cardiac myocytes, using caffeine application under voltage clamp conditions. Cell shortening during caffeine exposure and cell shortening during the final stimulated beat of the drive train and the delay between caffeine exposure and the onset of inward current were also used as indirect measures of sarcoplasmic reticulum load. RESULTS: At the threshold for aftercontractions, all four measures of sarcoplasmic reticulum load showed interruption of the positive relationship between stimulation frequency and sarcoplasmic reticulum content, the sarcoplasmic reticulum being no more loaded prior to an aftercontraction than following subthreshold drive trains. Intracellular calcium concentration, estimated with the calcium-sensitive dye indo-1, was higher in cells showing aftercontractions than those not. CONCLUSIONS: We conclude that calcium overload of the sarcoplasmic reticulum does not underlie spontaneous calcium release in this situation and the primary trigger for spontaneous release may instead be raised cytoplasmic calcium concentration.

Reasons for hospitalization due to abortion and pregnancy termination.

The aim of this study was to identify the reasons for hospitalization associated with abortion and pregnancy termination among women attending the Maternity Unit of IMIP, Recife, Brazil. In a case-control study, 230 women who were hospitalized consecutively between August 1994 and June 1995 due to causes related to pregnancy termination or abortion were chosen as cases. Four controls per case were selected randomly out of a total of 920 women who delivered at the same hospital. For each potential cause considered, the odds ratio (OR) and respective 95 per cent confidence interval (CI) were calculated. Multiple logistic regression analysis was then used to control for confounders. Among all potential causes studied, those that showed significant association with pregnancy termination or abortion were: being single, absence of emotional support from partner, being a working woman, literacy up to the fourth year of school, failure of contraceptive method employed, and experience of previous pregnancies, children, and abortions.