Use of mortality within 30 days of a COPD hospitalisation as a measure of COPD care in UK hospitals.

Mortality rate has been proposed as a metric of hospital chronic obstructive pulmonary disease (COPD) care in light of variation seen in national COPD audits. Using Hospital Episode Statistics (hospital 'coding') we examined 30-day mortality after COPD hospitalisation in 150 UK hospitals during 2006-2007 and 2007-2008. Mean and median 30-day mortalities were similar each year but the coefficient of variation was >20% and hospitals could change from a low or high quartile to the median by chance. We could not detect any reasons for hospitals being at the extremes. 30-day mortality after COPD hospitalisation is a complex variable and unlikely to be useful as a primary annual COPD metric.

Local NSAID gel (eltenac) in the treatment of osteoarthritis of the knee. A double blind study comparing eltenac with oral diclofenac and placebo gel.

In a randomized, double blind, multicentre study with 4 weeks follow-up of 290 patients with osteoarthritis of the knee joint, a topical NSAID (eltenac) was compared with oral diclofenac and placebo. The main outcome, Lequesne's Index and pain by VAS showed no statistically significant differences between neither of the active treatments and placebo for the total study population. However, in patients with more severe symptoms, both active groups showed statistically significant differences to placebo. No severe adverse drug reactions were seen but the number of GI reactions were three times higher in the diclofenac group compared to the topical treatment. Local skin reactions were twice as frequent in the eltenac than in the placebo group. Taking into account the nature of the treatment for a chronic disease like OA, our results indicate that eltenac gel could be a safe alternative to oral NSAIDs.

Glycosaminoglycan polysulfate injections in lateral humeral epicondylalgia: a placebo-controlled double-blind trial.

The purpose of this study was to investigate the therapeutic benefit of local Glycosaminoglycan polysulfate (GAGPS) injections in the treatment of chronic epicondylalgia. The study was conducted as a prospective, placebo-controlled double-blind trial. Sixty patients with a typical history of pain for at least 3 months who attended two private orthopaedic clinics in Stockholm received 50 mg GAGPS or placebo injections, one injection a week, for five weeks. The main outcome measures were the patients' evaluation of pain in connection with daily activities with a visual analogue scale and the number of treatment failures. The follow-up period was six months. The difference in reduction of painscore (VAS) ranging between 11.1 percentage units at the half-year follow-up and 20.9 percentage units 2 weeks after the treatment period is clinically good. The number of treatment failures in the GAGPS treatment groups at the 6 week follow-up was only 4 (13%) compared with 12 (40%) of the placebo treated patients. At the half-year follow-up 5 of those who received GAGPS had experienced a recurrency. The recurrency rate is thus smaller than most of those reported in controlled studies with corticosteroids. In the GAGPS treated group 13 patients reported on local pain after some injections, 2 cases combined with local haematomas, compared with 5 cases of local pain in the placebo group. The results confirm previous good results of GAGPS injection therapy in subchronic and chronic peritendinitis.

Linkage relations of JK, CO, KEL and IGK with each other and with AHCY.

Linkage analyses of locus pairs involving IGK, JK, CO, KEL and AHCY resulted in altogether negative lod scores, thereby dwindling the reported linkage relations.

A comparison of the effects of ionic strength on three preparations of acetylcholinesterase in the presence and absence of gallamine.

The kinetic behaviour of three forms of acetylcholinesterase as a function of ionic strength of the medium was investigated. The forms of enzyme were that bound to human erythrocyte membranes, acetylcholinesterase solubilized from these by Triton X-100, and a commercial preparation of the enzyme from bovine erythrocytes. The properties investigated were hydrolysis of the substrate acetylthiocholine, decarbamylation of dimethylcarbamyl-acetylcholinesterase and ageing of isopropylmethylphosphonyl-acetylcholinesterase. The effect of 10(?5) M gallamine triethiodide on these properties was also examined as a function of ionic strength. Detailed results for the variation of kinetic behaviour with ionic strength and the presence of gallamine are presented. No unified theory to predict the influence of these variables on all three forms of the enzyme could be formulated. Thus, the enzyme conformation stabilized by gallamine at low ionic strength was not necessarily similar to that of the gallamine-free enzyme at physiological ionic strength. Nor was it useful to consider the free enzyme at low ionic strength to be a model of the membrane-bound enzyme in vivo (Crone, 1973). It was concluded that kinetic results for solubilized and partially or wholly purified acetylcholinesterase cannot be extrapolated to the membrane-bound enzyme. Prediction of the effect of drugs on the system in vivo requires the use of the membrane-bound enzyme.

Residual anionic properties of a covalently substituted controlled-pore glass, glyceryl-CPG.

A commercial controlled-pore glass medium for exclusion chromatography which is substituted with glycerol to eliminate non-specific adsorption (Glyceryl-CPG) was examined. Experiments on the elution of acetylcholinesterase and ganglioside micelles at varied ionic strength and pH showed that a slight anionic character still persisted on the glass matrix. At ionic strengths above 0.1, this had no effect on the elution of proteins. The material was found to have no tendency to adsorb proteins and other compounds, and was judged an excellent medium for exclusion chromatography. As a support for affinity chromatography, Glyceryl-CPG could be activated by periodate to form a virtually neutral matrix-ligand system.

Ion-exclusion chromatography of compounds of biological interest.

The principle of ion exclusion was examined as a method for the separation of small ionic compounds. The systems employed consisted of very porous column packings, substituted with fixed charges, which were eluted by buffer solutions of low ionic strength. DEAE-Sephadex A-50 was principally employed, and it was shown that there was a linear relationship between the net charge on a cation and its partition coefficient into the gel phase. A similar relationship existed in the chromatography of amino acids on various columns bearing fixed negative charges. It was concluded that this was an efficient form of chromatography, which gave results directly related to the ionic charge of the sample being examined. The charge characteristics of biologically active compound could be determined by this method.

Ionic effects in the chromatography of proteins on columns of controlled-pore glass.

Bovine serum albumin, acetylcholinesterase and two non-protein markers were chromatographed on columns of controlled-pore glasses in buffer solutions of varied ionic strengths. Adsorption of protein to the glass and ionic effects due to repulsion of the negatively-charged solutes from the glass matrix were observed. When glasses were treated with Carbowax 20M, the adsorption disappeared but ion exclusion effects persisted. The ionic behavior of Carbowax-treated glasses was similar to that observed by one of the authors when using agarose columns.