Summary. Background: BB‐10153 is an engineered variant of human plasminogen, modified to be activated to plasmin by thrombin. Thrombin‐activatable plasminogen was designed as a novel thrombolytic agent which would persist in the blood as a prodrug and be activated to plasmin only at fresh or forming thrombi by the thrombin that is tightly localized there. We previously described the construction of several thrombin‐activatable plasminogens and their in vitro clot lysis activity. Objectives and methods: The current study was an examination of the thrombolytic properties of BB‐10153 in vivo; comparison was made with tissue‐type plasminogen activator (t‐PA) in a femoral artery copper coil thrombosis model in the anesthetized dog and rabbit. Heparin was not coadministered so that the fundamental activity of the agents could be compared. Results: BB‐10153, administered as an intravenous bolus of 5 mg kg−1 in the dog and 10 mg kg−1 in the rabbit, produced a comparable incidence of reperfusion to 3 mg kg−1 t‐PA. Reocclusion at these doses occurred in 4/4 dogs and 5/7 rabbits treated with t‐PA and in 2/6 dogs and 0/10 rabbits treated with BB‐10153. There was no reocclusion in three dogs dosed with 10 mg kg−1 BB‐10153. BB‐10153 did not affect plasma α2‐antiplasmin levels or the bleeding time, whereas 3 mg kg−1 t‐PA caused marked depletion of α2‐antiplasmin and fibrinogen and increased the bleeding time. The plasma half‐life of BB‐10153 was 3–4 h. Conclusions: The long half‐life and thrombus‐selective thrombolytic activity of BB‐10153 might allow it to overcome the bleeding and reocclusion shortfalls in the performance of current thrombolytics.
Up to one third of patients referred for psychotherapy fail to attend for their first appointment (O'Loughlin, 1990). Psychotherapy assessments are usually allocated a considerable portion of uninterrupted time, and an unexpected non-attendance wastes significant clinical resources. A variety of strategies have been used to ensure that assessors are not left waiting for a patient who never comes. One method is to send out forms which must be completed and returned before a first appointment date is given. In O'Loughlin's study, in which a similar questionnaire to that detailed in this paper was used, it was suggested that sending a pre-appointment questionnaire reduced the default rate.
Assessment of patients referred for psychotherapy has more commonly consisted of a psychodynamic assessment with less emphasis on a formal psychiatric diagnosis, whereas the reverse tends to be the case in the general psychiatric services. Within the National Health Service there are close links between the two services. A common frame of reference regarding the definition of the patient groups using the services could Improve communication, the planning and evaluation of specific treatment programmes, and outcome studies. A retrospective case-note study was carried out at a regional psychotherapy unit in order to define the population referred between 1991 and 1992 according to ICD–10 (WHO, 1992).
The range of detailed case studies is impressively rich and diverse and would provide excellent teaching material. There is a sensitive and sympathetic chapter on working with abusing parents, with much thought given to the difficulties ofinitial contact. The book is written within the framework of an informed, critical, but largely positive understanding of the Children Act. There is a serviceable index and a useful bibliography. The text does not sparkle, but it offers nevertheless a rich seam of valuable ideas for anyone involved in the training ofchild-care professionals at all levels.
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