Radiation-related arterial disease

Arterial occlusive disease has been recognized in association with radiation arteriopathy and, rarely, with spontaneous arterial disruption. This association results from the greater role of radiation therapy in the current management of malignant diseases coupled with longer patient survival and the lengthy latency period between radiation and clinical manifestations of radiation arteriopathy. Experience with six patients having radiation-associated arterial disease was retrospectively reviewed. There were four men and two women, with a mean age of 51 years (range, 36-74). Arteries exposed to radiation include two carotids, three subclavians, one coronary, and one femoral. The time from radiation therapy until clinical arterial disease was a mean of 14.3 years (range, 4-30). Operative repairs with polytetrafluoroethylene and saphenous vein bypass grafts were performed in four patients, stent placement in one patient, and one patient had spontaneous carotid disruption that ultimately was treated with ligation. In conclusion, elective bypass can be performed safely and successfully for arterial occlusive disease in a previously irradiated artery. In contrast, life-threatening arterial disruption secondary to radiation arteriopathy usually requires concomitant exposure to a source of bacterial contamination, and ligation may be the best choice to prevent recurrent hemorrhage.

Lack of effect of cimetidine on the pharmacokinetics of sustained-release bupropion

The objective of this study was to assess whether cimetidine affects the pharmacokinetics of sustained-release (SR) bupropion hydrochloride and the active metabolite, hydroxybupropion. This randomized, open-label, two-period crossover study was conducted in 24 healthy volunteers 18 to 45 years of age. ANOVA showed that administration of two 150 mg bupropion SR tablets with one 800 mg cimetidine tablet following an overnight fast did not change values for AUC infinity, Cmax, tmax, t1/2, and CL/F (CL/F calculated for bupropion only) for either bupropion or hydroxybupropion as compared with two 150 mg bupropion SR tablets alone. In this study, it appears that there is no effect of cimetidine on the pharmacokinetics of bupropion SR.

Health care coverage of high school athletics in South Carolina: does school size make a difference?

Despite an apparently high injury rate, medical coverage available to these high school athletes is often not immediately present during practice and games. The purpose of the present study was to examine the current conditions of health care coverage and delivery to the football program and associated athletic departments in the public and private high schools in South Carolina. Additionally, the relationship between student enrollment and medical coverage was examined. A survey, based upon previously utilized instruments, was sent to the athletic directors at the public and private high schools with interscholastic football programs in South Carolina. The survey included questions pertaining to the medical coverage, including personnel, equipment, and record systems, for football practices and games. Based upon the results of the survey, a majority of high schools in South Carolina appear to have adequate sports medicine coverage and compare favorably with the results of similar data from other states. The medical coverage does significantly vary depending upon the enrollment size of the high school. In spite of this finding, the health care provided high school athletes is often inconsistent and training and equipment required for basic first aid is often absent.

Siblings, parents, and partners: family relationships within a longitudinal community study. ALSPAC study team. Avon Longitudinal Study of Pregnancy and Childhood

Links between sibling relationships, mother-partner, and parent-child relationships were studied in a longitudinal community sample of 3681 sibling pairs. Individual differences in sibling relationship quality were related to mother-partner affection and hostility assessed 4 years earlier, to contemporary parent-child negativity, and to indices of social adversity. Evidence for both direct and indirect pathways (via parent-child relations) linking mother-partner and sibling relations were found. Comparisons of prediction for non-stepfamilies and stepfather families showed similarities in patterns of association, but also differences: In stepfather families, mother-partner hostility was unrelated to parent-child negativity and sibling relationship quality. Both positivity and negativity towards young siblings decreased with the age of older siblings, and older sisters were more positive than older brothers.

Survey of neonatal hepatitis B vaccination in Leicestershire

Some 121,390 live and still births were recorded in Leicestershire between June 1986 and May 1995. All mothers were offered antenatal screening for hepatitis B and 161 were positive for hepatitis B surface antigen. Examination of case notes from 113 mother and baby pairs identified 70 infants who fulfilled criteria for vaccination in place at the time, 47 of whom (67%) had received the three doses of hepatitis B vaccine then recommended for prevention of neonatal infection.

Cocaine--profiles, drug histories, and patterns of use of patients from Brazil

We studied profiles and drug histories of 294 cocaine users from 15 treatment services in São Paulo, Brazil during 1996-1997. Mean age of subjects was 27 years, and 90% were male. Over 50% had used five different substances apart from cocaine, usually tobacco, alcohol, cannabis, tranquilizers, and solvents. Mean age at first cocaine use was 18.9 years by which time 87% had snorted the drug. Thirty-two percent had injected cocaine, 82% had smoked crack, and 74% reported a full route transition. Sixty-three percent reported daily cocaine use. Median duration of cocaine use was 6.3 years. Acts of acquisitive crime were common, and 56% had been arrested. Our finding are discussed in terms of implications for prevention and treatment.

Psychostimulant prescriptions by psychiatrists higher than expected: a self-report survey

OBJECTIVE

To survey Alberta psychiatrists on their prescribing of psychostimulants to adults.

METHOD

A questionnaire was mailed to all 245 registered psychiatrists in Alberta. The respondents were requested to anonymously report, for the previous year, the number of adult patients to whom they prescribed pemoline, methylphenidate, amphetamines, or other psychostimulants for the treatment of adult attention-deficit hyperactivity disorder (ADHD), narcolepsy, unipolar depression, bipolar disorder, dementia, and other disorders.

RESULTS

The response rate was 93.9%; 88.7% treated adults. Of these, 46.6% prescribed psychostimulants to 1238 patients. The greatest proportion of prescriptions of psychostimulants was for adult ADHD, depression, and narcolepsy.

CONCLUSIONS

Psychostimulants are more widely prescribed by psychiatrists than indicated in earlier studies and in recommendations for treatment.

Theory of mind, emotion understanding, language, and family background: individual differences and interrelations

Individual differences in young children's social cognition were examined in 128 urban preschoolers from a wide range of backgrounds. comprehensive assessments were made of children's false-belief understanding, emotion understanding, language abilities, and family background information was collected via parent interview. Individual differences in children's understanding of false-belief and emotion were associated with differences in language ability and with certain aspects of family background, in particular, parental occupational class and mothers' education. The number of siblings that children had did not relate to their social cognition. Individual differences in false-belief and emotion understanding were correlated, but these domains did not contribute to each other independently of age, language ability, and family background. In fact, variance in family background only contributed uniquely to false-belief understanding. The results suggest that family background has a significant impact on the development of theory of mind. The findings also suggest that understanding of false-belief and understanding of emotion may be distinct aspects of social cognition in young children.

Parental divorce and adjustment in adulthood: findings from a community sample. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood

The current study examines the link between the experience of divorce in childhood and several indices of adjustment in adulthood in a large community sample of women. Results replicated previous research on the long-term correlation between parental divorce and depression and divorce in adulthood. Results further suggested that parental divorce was associated with a wide range of early risk factors, life course patterns, and several indices of adult adjustment. Regression analyses indicated that the long-term correlation between parental divorce and depression in adulthood is explained by quality of parent-child and parental marital relations (in childhood), concurrent levels of stressful life events and social support, and cohabitation. The long-term association between parental divorce and experiencing a divorce in adulthood was partly mediated through quality of parent-child relations, teenage pregnancy, leaving home before 18 years, and educational attainment.

Analysis of CD34 populations in mobilised peripheral blood stem cell harvests and in bone marrow by fluorescent in situ hybridisation for the bcr/abl gene fusion in patients with chronic granulocytic leukaemia

For those patients ineligible for allogeneic bone marrow transplant and who are non-responsive to interferon, autotransplant with peripheral blood stem cells (PBSC) mobilised after intensive chemotherapy, may provide a novel approach to improve prognosis in patients with chronic granulocytic leukaemia. PBSC harvests are assessed for CD34-positive cell numbers, which serve as an indicator of engraftment potential, and are also analysed cytogenetically to ascertain tumour cell contamination. However, a more accurate assessment of PBSC harvest contamination requires investigation of the Philadelphia (Ph) status of the CD34pos population, in which the cells that provide long-term engraftment are contained. In this study, we have analysed these levels in mobilised PBSC and also in bone marrow (BM) harvests, taken several weeks prior to mobilising chemotherapy. Using fluorescent in situ hybridisation for the bcr/abl gene fusion, we have shown that the median number of Ph negative cells in CD34pos isolated populations was 14.95% in BM compared to 79.05% in PBSC harvests and that in all PBSC samples tested, Ph positivity in CD34pos populations was always detectable either by FISH or one round PCR methods. In paired assessments of both PBSC and BM harvests, higher levels of Ph negative CD34pos cells (> or = 14%) isolated from BM harvests, taken prior to intensive chemotherapy, correlated with higher levels of Ph negative CD34pos cells (> or = 78.5%) in PBSC harvests. These data may aid in the selection of patients for whom PBSC harvesting, after mobilisation, is more likely to achieve an autograft product containing predominantly Ph negative CD34pos cells and may exclude those patients for whom the risk, morbidity and expense of stem cell harvesting may have no apparent benefit over a chronic phase BM harvest.

Transitions in the route of cocaine administration--characteristics, direction and associated variables

AIMS

To examine transitions in the route of administration of cocaine and the variables associated with them.

DESIGN

A cross-sectional study undertaken between January 1996 and October 1997.

SETTING

Fifteen different services that offer treatment, counselling or assistance to drug users or HIV-positive patients in the State of São Paulo, Brazil.

PARTICIPANTS

Two hundred and ninety-four current or ex-cocaine and crack cocaine users.

MEASUREMENTS

A structured interview schedule was developed consisting of 246 questions covering socio-demographic details, drug history, cocaine transitions and HIV-risk behaviours.

FINDINGS

Eighty-seven per cent of patients began using cocaine by snorting and 74% subsequently underwent a transition of route--68% towards smoking and 20% to injecting. Half of all transitions occurred in the first 3 years following initiation into cocaine use. Factors associated with transitions were: younger age at cocaine initiation, more frequent use at peak usage, initial use of cocaine by snorting or injecting, a lower level of scholastic attainment and experience with a wider range of drug classes. A cohort effect was apparent with younger cocaine users and those who had begun using after 1990 being more likely to undergo a transition to smoking crack and less likely to start injecting.

CONCLUSIONS

Cocaine transitions are very common and are usually towards routes associated with a higher dependency potential and increased HIV-risk behaviour. Further research is needed to see if transitions can be prevented by early identification of potential cases.

Relation of genetic polymorphisms of apolipoprotein E, angiotensin converting enzyme, apolipoprotein B-100, and glycoprotein IIIa and early-onset coronary heart disease

OBJECTIVE

Apolipoprotein E (APOE) E4, apolipoprotein B-100 (APOB) Q3611 allele, the angiotensin converting enzyme (ACE) deletion (D) allele and glycoprotein IIIa (GP3A) P33 mutant allele are reported to predispose to early-onset coronary heart disease (CHD). These associations were not all confirmed in more recent studies. To determine the impact of these alleles on CHD, we examined the prevalence of these mutations in patients presenting with early-onset CHD and compared them to those manifesting CHD later in life. The delayed-onset was considered a sign of longevity and would serve as a comparative group to assess prevalence of the biochemical and genetic risk factors.

METHODS

300 patients with a history of myocardial infarction or angina pectoris and angiographically documented CHD were studied. Patients were divided into two groups: group 1 (G1 = 150 patients) presenting with these findings under the age of 50 years; while group 2 (G2 = 150 patients) were patients presenting for the first time over the age of 65 years. Prevalence of the alleles of APOE, APOB, ACE and GP3A was assessed by molecular analysis. An association of any of these genotypes with early onset CHD could lead to a higher prevalence in the younger age group.

RESULTS AND CONCLUSIONS

None of the suspected alleles namely APOB Q3611 [G1: 10.7% vs. G2: 9.0%, p = 0.57], ACE D (G1: 52.0% vs. G2: 49.7%, p = 0.57), or the GP3A P33 (G1: 17.3% vs. G2: 15.7%; p = 0.58) showed any significant difference between the two groups. Subjects with APOE E4 were more frequent in the younger age group (G1: 18.3% vs. G2: 13.7%; p = 0.047), while APOE E2 was more frequent in G2 (G2: 10.0% vs. G1: 2.7%; p = 0.0002). Multivariate analysis showed an odds ratio of APOE E2 allele in G1 of 0.27 with a confidence interval of 0.10-0.73.

Epidemiological methods for research with drug misusers: review of methods for studying prevalence and morbidity

Epidemiological studies of drug misusers have until recently relied on two main forms of sampling: probability and convenience. The former has been used when the aim was simply to estimate the prevalence of the condition and the latter when in depth studies of the characteristics, profiles and behaviour of drug users were required, but each method has its limitations. Probability samples become impracticable when the prevalence of the condition is very low, less than 0.5% for example, or when the condition being studied is a clandestine activity such as illicit drug use. When stratified random samples are used, it may be difficult to obtain a truly representative sample, depending on the quality of the information used to develop the stratification strategy. The main limitation of studies using convenience samples is that the results cannot be generalised to the whole population of drug users due to selection bias and a lack of information concerning the sampling frame. New methods have been developed which aim to overcome some of these difficulties, for example, social network analysis, snowball sampling, capture-recapture techniques, privileged access interviewer method and contact tracing. All these methods have been applied to the study of drug misuse. The various methods are described and examples of their use given, drawn from both the Brazilian and international drug misuse literature.

Expression of doublecortin correlates with neuronal migration and pattern formation in diverse regions of the developing chick brain

The development of functional layers in the brain involves spatially and temporally regulated gene expression. Through cDNA library screening, we have identified genes that are expressed in a neural-specific manner during brain development. Sequencing and expression data indicate that one of the clones, 18C15, is the chick homologue of doublecortin, a human X-linked gene found to be mutated in subcortical laminar heterotopia (double cortex syndrome) and lissencephaly. The 18C15 mRNA contains multiple motifs that are known to regulate mRNA stability in response to inductive signals, and these motifs are conserved between the chick and human sequences. Doublecortin is found to be expressed at peak levels during early development of the cerebellum and forebrain, and is expressed in other regions including the tectum, spinal cord, and dorsal root ganglia. This study demonstrates both spatial and temporal regulation of doublecortin expression in the chick, which is associated with early events in brain development, including neuronal migration.

Pre-conception diabetes care in insulin-dependent diabetes mellitus

Prospective studies of pre-conception diabetes care have confirmed its positive impact on the incidence of malformations by improving glycaemic control. Less information is available on the impact of pre-conception care on maternal and neonatal morbidity. This audit addresses its impact on timing and mode of delivery, incidence of macrosomia and rate of admission to neonatal unit care in addition to sociodemographic factors which may influence attendance at such a service. Attenders were more likely to be in a stable relationship and be non-smokers. They were more likely to book for antenatal care earlier and with a lower glycated haemoglobin. There were no early deliveries (i.e. < 30 weeks) or small for gestational age (SGA) babies in those who attended for pre-conception care and no neonatal deaths. Admission to NNU care was reduced by 50% in those who attended for pre-conception care. Although the rate of macrosomia was reduced, there was no impact on the Caesarian section rate. A pre-conception diabetes clinic may have a positive impact on neonatal morbidity.

Multiple target sites of allelic imbalance on chromosome 17 in Barrett's oesophageal cancer

Twelve Barrett's adenocarcinomas have been analysed for the occurrence of allelic imbalance (LOH) on chromosome 17 using 41 microsatellite markers. This study provides evidence for 13 minimal regions of LOH, six on 17p and seven on 17q. Four of these centre in the vicinity of the known tumour suppressor genes (TSGs) TP53 (17p13.1), NFI (17q11.2), BRCA1 (17q21.1), and a putative TSG (17p13.3). The tumours all displayed relatively small regions of LOH (1-10 cM), and in several tumours extensive regions of LOH were detected. One tumour displayed only two very small regions of LOH; 17p11.2 and 17p13.1. The frequency of allelic imbalance has been calculated based on the LOH encompassing only one minimal region, and based on all the LOH observations. By both evaluations the highest LOH frequencies were found for regions II (p53), III (17p13.1 centromeric to p53), IV (17p12), V (17p11.2) and VII (NF1, 17q11.2). Our data supports the existence of multiple TSGs on chromosome 17 and challenges the view that p53 is the sole target of LOH on 17p in Barrett's adenocarcinoma.

Demonstration of transient gain x-ray lasers near 20nm for nickellike yttrium, zirconium, niobium, and molybdenum

We demonstrate strong lasing on the Ni-like 4d(1)S(0)?4p(1)P(1) transition at 18.9, 20.3, 22.0, and 24.0 nm for Mo, Nb, Zr, and Y ions, respectively, using the transient collisional excitation scheme. Approximately 5 J of laser energy in a combination of a 600-ps pulse and a 1-ps pulse from the Compact Multipulse Terawatt (COMET) tabletop laser system is used to irradiate slab targets of these materials. Small-signal gains of 17-26cm (-1) are determined on the 4d?4p transition, with overall gain-length products gL of 11-12. Lasing is observed and gain is measured on the 4f(1)P(1)?4d(1)P(1) transition, which is pumped by collisional excitation combined with self-photopumping, for what is to our knowledge the first time.

Cellular alloreactivity of human cord blood cells detected by T-cell frequency analysis and a human skin explant model

BACKGROUND

Recent clinical data have demonstrated the success of allogeneic stem cell transplantation using HLA-mismatched unrelated human umbilical cord blood (CB). The incidence and severity of acute graft-versus-host disease (GVHD) in these mainly pediatric transplants is low. The immunological mechanisms by which CB transplants may result in reduced GVHD is not completely clear. In this study, the functional cellular alloreactivity of CB cells was investigated, by measuring the frequency of alloreactive helper and cytotoxic T lymphocyte precursors (HTLp and CTLp, respectively) in CB and detecting the ability of CB cells to induce graft-versus-host (GVH) type alloreactivity in vitro.

METHODS

A human skin explant model was used to measure GVH type alloreactivity in vitro. A combined limiting dilution assay was carried out in parallel to determine alloreactive HTLp and CTLp frequencies. The cellular alloreactivity was compared between cord and HLA-haploidentical parental blood cells against the same HLA-mismatched unrelated stimulator.

RESULTS

The results demonstrated that alloreactive CTLp frequency in CB mononuclear cells (CBMCs) was significantly lower (mean, 1:35,694, range, 1:1,667-<1:500,000) than that in adult peripheral blood mononuclear cells (PBMCs) (mean, 1:5,333, range, 1:544-1:47,619). Alloreactive HTLp frequencies, however, were comparable for CBMCs and PBMCs (mean, 1:7,586, range, 1:1,359-1:200,000; and mean, 1:5,976, range, 1:385-1:50,000, respectively). A significantly decreased ability to induce in vitro GVH type alloreactivity was observed for CBMCs and that was strongly associated with low alloreactive CTLp frequencies (P=0.001).

CONCLUSIONS

The present study provides the first clear in vitro evidence to suggest that CBMCs are less able than PBMCs to induce skin GVH type alloreactivity in HLA-mismatched pairs. The severity of in vitro GVH type alloreactivity (graded as I-IV) was strongly associated with the levels of alloreactive CTLp frequencies. The low cellular alloreactivity of CBMCs detected in vitro suggests that in a proportion of cases HLA-mismatched unrelated CB may not give rise to severe GVHD in vivo after transplantation.

Trick or treat?: uneven understanding of mind and emotion and executive dysfunction in "hard-to-manage" preschoolers

It is widely recognised that impaired social relations are characteristic of school-aged children with behavioural disorders, and predict a poor long-term outcome (Parker & Asher, 1987). However, little is known about the early antecedents of social impairment in behaviourally disturbed children. The aim of the present study was to explore three areas of potential dysfunction in younger children: theory of mind, emotion understanding, and executive function. Forty preschoolers, rated by their parents on the Strengths and Difficulties Questionnaire (Goodman, 1994) as "hard to manage" (H2M) were compared with a control group on a set of: (1) theory of mind tasks (including an emotion prediction task involving either a nice or a nasty surprise); (2) emotion understanding stories (that required affective perspective-taking skills as well as situational understanding); and (3) simple executive function tasks (adapted for preschoolers, and tapping inhibitory control, attentional set-shifting, and working memory). Small but significant group differences were found in all three cognitive domains. In particular, hard-to-manage preschoolers showed poor understanding of emotion and executive control, poor prediction or recall of a false belief, and better understanding of the belief-dependency of emotion in the context of a trick than a treat. Moreover, executive function was associated with performance on the theory of mind tasks for the hard-to-manage group alone, suggesting both direct and indirect links between executive dysfunction and disruptive behaviour.

Understanding mind and emotion: longitudinal associations with mental-state talk between young friends

Developmental changes in children's understanding of mind and emotion and their mental-state talk in conversations with friends were examined in a longitudinal study of 50 children (M age at each time point = 3 years 11 months, 4 years 6 months, 5 years 0 months). Significant and related improvements over time were found for both theory-of-mind task performance and affective perspective taking. Associated with these cognitive developments were quantitative and qualitative changes in children's references to mental states in their conversations with friends. Individual differences in theory of mind, emotion understanding, and mental-state talk were strikingly stable over the 13-month period. Although there were no gender differences in children's task performances, girls showed more frequent and more developed mental-state talk than boys.

Domains of distress: the experience of breast cancer in Australia

PURPOSE/OBJECTIVES

To describe difficulties experienced by women after treatment for primary breast cancer.

DESIGN

Descriptive and exploratory.

SETTING

Queensland, Australia.

SAMPLE

245 women (70% response rate) less than 16 weeks postsurgery for breast cancer completed a survey. The mean age for this sample was 55 years; 71% had undergone mastectomy, and 29% had undergone conservative breast surgery.

METHODS

Focus groups were used to generate items for the survey, "Experience of Breast Cancer Questionnaire" (EBCQ). The EBCQ and the psychological subscale of the Rotterdam Symptom Checklist (RSCL) were administered by mail to the sample.

MAIN RESEARCH VARIABLES

Psychological distress, fear of recurrence, decisional uncertainty, informational support, self-image and social relationships, sexual morbidity, and physical effects of treatments.

FINDINGS

Factor analysis of the EBCQ identified five factors, accounting for 60% of the variance. These included psychological effects, treatment concerns, physical effects, self-image, and chemotherapy effects. Four of the five subscales had reliability coefficients of greater than 0.80. Psychological effects included cognitive and emotional effects. Treatment concerns included decisional uncertainty and poorly perceived informational support. Physical effects reflected the symptom pattern of axillary dissection. Self-image included breast loss and social isolation.

CONCLUSIONS

Nurses who assist women in adjusting to breast cancer should consider the effect of fear of recurrence and perceptions of body image on the recovery process. Because participation in treatment decisions may increase the demands on women at diagnosis, informational support appropriate to each woman's needs is essential. How self-esteem can affect self-image and social relationships after breast cancer requires further investigation.

IMPLICATIONS FOR NURSING PRACTICE

Understanding the experience of illness from the perspective of the patient assists nurses in validating their nursing practice and provides clinically relevant information to guide intervention. In particular, supportive psychological care should target both emotional and cognitive responses to breast cancer. Informational support is integral to a patient's satisfaction with treatment decisions and is likely to predict adjustment. When assisting women to adjust to self-image changes, nurses may need to target women's perceptions about their body image.

Five-year follow-up of a prospective randomised multi-centre trial of weekly chemotherapy (CAPOMEt) versus cyclical chemotherapy (CHOP-Mtx) in the treatment of aggressive non-Hodgkin's lymphoma. Central Lymphoma Group

BACKGROUND

Weekly alternating regimen known as CAPOMEt is compared to standard cyclical chemotherapy (CHOP-Mtx) in aggressive non-Hodgkin's lymphoma (NHL).

PATIENTS AND METHODS

Three hundred and eighty-one patients with aggressive NHL were randomised to receive either cyclophosphamide, doxorubicin, vincristine, prednisone and methotrexate (CHOP-Mtx) on a cyclical basis or a weekly regimen incorporating the same drugs with the addition of etoposide (CAPOMEt).

RESULTS

After pathological review, 281 patients were deemed eligible. At the census date of 31 March 1994, 158 patients were alive with a median follow up of 5.9 years (minimum 3.0 years). Analysis of all patients and eligible patients showed no significant treatment differences in the rates of complete remission (CR), failure free survival (FFS) or overall survival (OS) between the two arms. The actuarial median OS was 24 months for CAPOMEt compared with 31 months for CHOP-Mtx, with five-year actuarial survival rates of 37% and 43%, respectively. Myelosuppression was significantly more severe with CHOP-Mtx and neurotoxicity was much more common with CAPOMEt.

CONCLUSION

Weekly CAPOMEt is equally effective as standard cyclical CHOP-Mtx treatment in aggressive NHL.