MedGenMed : Medscape general medicine最新文献

Unlabelled: The World Health Organization (WHO) can be considered the primary agency of the United Nations that promotes global public health. This article provides a general overview of WHO by exploring the history, current, and future practices of the organization, and by addressing its major roles and functions in the present day.

Background: Srimathy Vijayan is a fourth-year medical student at the University of East Anglia, Norwich, United Kingdom. She interned at the WHO headquarters in Geneva during the summer of 2007.

Background: The realization that angiotensin-converting enzyme (ACE) inhibitors do not provide complete blockade of angiotensin II synthesis has resulted in an increased use of combinations of ACE inhibitors and angiotensin receptor blockers (ARBs). This study examines the characteristics of patients in whom this combination was prescribed.

Methods: Seventy-two patients diagnosed with primary hypertension and receiving an ACE inhibitor, an ARB, or their combinations were included. A retrospective review using outcome variables of mean arterial pressure (MAP), and changes between pretreatment MAP and post-treatment MAP were compared between groups. Statistical analysis was performed with SPSS statistical software. Analysis of variance (ANOVA) with Tukey's post hoc analysis was performed on continuous variables. Chi-square analysis was performed on categorical variables. Multivariate linear regression was performed to determine the best predictors of post-treatment MAP.

Results: There were no significant differences between the groups in pre- or post-treatment MAP. Patients on combination therapy with an ACE and ARB agent tended to be on more antihypertensive medications and tended to be diabetic.

Conclusion: All treatment groups had similar blood pressure control and changes in MAP regardless of treatment. These findings suggest that combination ARB and ACE inhibitor therapy is a strategy being used for diabetics with difficult-to-control hypertension, although we cannot determine from our study whether this is primarily for blood pressure control or for renal protection. Whether combining an ACE inhibitor and ARB for blood pressure control alone is supported by the literature may be debatable. Further studies should evaluate the efficacy of such intervention to control hypertension.

Key points: 1. Antihypertensive therapies using ACE inhibitors with ARBs are gaining popularity. 2. This retrospective chart review was completed to examine the characteristics of patients on monotherapy and of patients on combination therapy with ACE inhibitors and ARB agents. 3. This study suggests a tendency toward combined ARB and ACE inhibitor therapy in patients with diabetes who are on multiple antihypertensive medications.

Major advances have occurred in understanding the biology, immunology, and modalities of treatment of chronic lymphocytic leukemia (CLL) in the last decade. B-cell CLL is the most common type of leukemia occurring in the US and Western nations. B-cell CLL is characterized by progressive defects in both cell-mediated and humoral-mediated immunity. B-lymphocyte defects, low gammaglobulin levels, and quantitative and functional T-cell defects have been documented in the setting of CLL. In concert with each other, they account for the increased susceptibility of the CLL patients to infectious agents. Moreover, several recent surveys have pointed out that CLL patients are at high risk of developing a large variety of second malignant neoplasms. Different therapeutic modalities used for CLL may further exacerbate immunosuppression by depleting both T- and B-immune effectors, thus favoring various infectious diseases and perhaps altering the immune surveillance. The occurrence of 2 or more second cancers is increasingly reported in the context of CLL. Increased awareness of this association is warranted. Future development of surveillance strategies may be needed for a growing population of surviving patients who are at risk for second nonlymphoid neoplasms.

Background: Tumor cells have numerous immune surveillance escape mechanisms as well as means of resistance to apoptosis. This study tried to clarify one of these mechanisms in bladder cancer with the hope of being able to develop targeted therapy that will sensitize the tumor cells to immune-mediated apoptosis.

Methods: In this study, electron microscopic examination and expression of TGF-beta-1 protein and TGF-beta-R-1 receptor using immunoelectronmicroscopic and immunocytochemical techniques were investigated in urine and peripheral blood mononuclear cells (PBMNCs). Samples were obtained from 5 healthy controls (Group 1) and 60 study patients who were classified according to the cytopathologic examination of their urine into 2 main subgroups: chronic cystitis (bilharzial and nonbilharzial, Group 2, n = 15) and bladder cancer (transitional cell carcinoma and squamous cell carcinoma, Group 3, n = 45).

Results: Examination of PBMNCs by immunoelectronmicroscopic and immunocytochemical techniques showed a significant increase in the percentage of positive cases expressing both TGF-beta-1 protein and TGF-beta-R-1 receptors in bladder cancer in comparison with the control (P < .01 and P < .05, respectively) and with chronic cystitis (P < .05). By electron microscopic examination, 42 out of 45 bladder cancer cases (93.3%) revealed remarkable apoptotic changes represented by cell shrinkage, surface blebs, nuclear chromatin condensation, and vacuolated cytoplasm. Urine examination by immunoelectronmicroscopic and immunocytochemical techniques revealed a statistically significant decrease in the percentage of positive cases expressing TGF-beta-R1 receptor in bladder cancer in comparison with either chronic cystitis cases or controls (P < .01), while TGF-beta-1 protein was significantly increased (P < .01). By electron microscopic examination, exfoliated necrotic malignant epithelial (urothelial) cells and many inflammatory cells were detected.

Conclusions: This work helps researchers and clinicians to better understand one of the escape mechanisms in bladder cancer that may facilitate the reverse of tumor escape from the immune system. It also draws attention to TGF-beta-1 protein and TGF-beta-R1 receptor; TGF-beta-1 protein can be used as an attractive target for anticancer therapy, and the absence of TGF-beta-R1 can be considered a marker for malignant transformation of urothelial cells in bladder cancer.