Comparison of self-report, video observation and direct measurement methods for upper extremity musculoskeletal disorder physical risk factors

The prevention of work-related musculoskeletal disorders has become a national priority in many countries. Increasingly, attempts are made to quantify those exposures that increase risk in order to set exposure limit values. This study used commonly employed field measurement methods and tools in order to perform an inter-method comparison between three primary methods of risk factor exposure assessment: self-report questionnaires, observational video analysis and direct measurement. Extreme posture duration, repetition, hand force (estimated from electromyography) and movement velocity were assessed for 18 subjects while performing each of three jobs processing tree seedlings. Results indicated that self-reports were the least precise assessment method, which consistently overestimated exposures for each of the measured risk factors. However, adjustment of the reports as psychophysical scales may increase agreement on a group level. Wrist flexion/extension duration and repetition were best measured by electrogoniometer. Electrogoniometric measures of wrist deviation duration and frequency were less precise than video analysis. Forearm rotation duration and repetition, grip force and velocity appeared to be best quantified by direct measurement as measured by electrogoniometer and electromyography (EMG) (as root-mean-square amplitude). The results highlight the fact that it is as important to consider and report estimated measurement error in order to reduce potential exposure misclassification in epidemiologic studies.

Biodegradable block copolymers for delivery of proteins and water-insoluble drugs

Release of several drugs from new ABA-type biodegradable thermal gels, ReGel, including proteins and conventional molecules, are presented. These are biodegradable, biocompatible polymers that demonstrate reverse thermal gelation properties. Organic solvents are not used in the synthesis, purification, or formulation of these polymers. The unique characteristics of ReGel hinge on the following two key properties: (1) ReGel is a water soluble, biodegradable polymer at temperatures below the gel transition temperature; (2) ReGel forms a water-insoluble gel once injected. This is consistent with a hydrophobically bonded gel state where all interactions are physical, with no covalent crosslinking. An increase in viscosity of approximately 4 orders of magnitude accompanies the sol--gel transition. The gel forms a controlled release drug depot with delivery times ranging from 1 to 6 weeks. ReGel's inherent ability to solubilize (400 to >2000-fold) and stabilize poorly soluble and sensitive drugs, including proteins is a substantial benefit. The gel provided excellent control of the release of paclitaxel for approximately 50 days. Direct intratumoral injection of ReGel/paclitaxel (OncoGel) results in a slow clearance of paclitaxel from the injection site with minimal distribution into any organ. Efficacies equivalent to maximum tolerated systemic dosing were observed at OncoGel doses that were 10-fold lower. Data on protein release (pGH, G-CSF, insulin, rHbsAg) and polymer biocompatibility are discussed.

Loss of heterogeneous ribonucleoprotein A(2)/B(1) expression in thyroid neoplasms

OBJECTIVE

To determine whether a difference exists in the immunohistochemical expression of heterogeneous ribonucleoprotein (hnRNP) A(2)/B(1) between benign and malignant thyroid lesions and to assess whether a gradient of expression could be found in normal thyroid, adenomas, and thyroid malignant tumors.

METHODS

Formalin-fixed, paraffin-embedded archival tissues from 32 cases (8 nodular goiters, 8 follicular adenomas, 8 follicular carcinomas, and 8 papillary carcinomas) were immunostained with monoclonal antibody 703D4, directed against hnRNP A(2)/B(1), applied at a concentration of 10 microg/mL. The streptavidin-biotin peroxidase method was used to label bound monoclonal antibody. Positivity was independently scored by two pathologists, who used a three-tiered scale.

RESULTS

The benign thyroid tissues, including the hyperplastic and adenomatous lesions, demonstrated 3+ granular cytoplasmic staining for hnRNP A(2)/B(1), except in two cases (one nodular goiter and one follicular adenoma) in which 2+ staining intensity was noted. In contrast, the papillary and follicular carcinomas failed to stain with the antibody, except in two cases that showed weak (1+) staining.

CONCLUSION

hnRNP A(2)/B(1) immunostaining appears to distinguish benign from malignant thyroid lesions. Loss of hnRNP A(2)/B(1) expression seems to be a characteristic feature of thyroid malignant lesions.

Oral contraceptives, other methods of contraception, and risk reduction for ovarian cancer

Oral contraceptives reduce the risk of ovarian cancer, but the impact of other methods of contraception has not been fully explored. This population-based, case-control study involved women 20-69 years of age who had ever had intercourse. We compared cases with a recent diagnosis of ovarian cancer (N = 727) with community controls (N = 1,360). All methods of contraception evaluated were associated with a reduced risk for ovarian cancer. After adjustment for age, race, pregnancies, and family history of ovarian cancer, the odds ratios for ever-use of each method as compared with never-use were: oral contraceptives for contraception, 0.6 (95% confidence interval = 0.5-0.8); intrauterine device, 0.8 (95% confidence interval = 0.6-1.0); barrier methods, 0.8 (95% confidence interval = 0.6-0.9); tubal ligation, 0.5 (95% confidence interval 0.4-0.7); and vasectomy, 0.8 (95% confidence interval = 0.6-1.1). Nulligravid women were not protected by any of these contraceptive methods. Multigravid women, however, were protected by all methods. We conclude that various methods of contraception reduce ovarian cancer risk. This effect does not appear to result from contraceptive use being a nonspecific marker of fertility. The results imply mechanisms other than hormonal or ovulatory by which ovarian cancer risk is reduced.

Haemodynamics of arteriovenous malformations of the brain and consequences of resection: a review

The physiological manifestations of arteriovenous fistulae in humans have been studied since the 18th century. However, confusion regarding concepts of cerebral 'steal', 'normal perfusion breakthrough', and 'congestive hyperaemia' continue. Although the advent of more accurate monitoring of pressures and flows within the brain has provided useful information to help understand some of these proposed pathological hypotheses, disagreement still exists. The purpose of this review is to examine the current physiological data in attempt to explain the clinicopathological manifestations of arteriovenous malformations of the brain and the consequences of their removal.

Ethnic differences in behavioural risk factors for stroke: implications for health promotion

OBJECTIVES

Ethnic minority groups are at a higher risk of stroke and heart disease. However, designing effective prevention strategies requires responding to the needs of different ethnic groups. The aims of this study were to estimate the prevalence of four behavioural risk factors (smoking, drinking, exercise and weight) for stroke among Black Caribbeans, Black Africans and Whites, and also to examined reported willingness to change these behaviours.

DESIGN

A random sample of 311 Black Caribbean, 300 White, and 105 Black Africans aged 45-74 registered with 16 practices in south London were surveyed in 1995. Information was obtained on smoking, drinking and exercise patterns, body mass index and perceptions of being at risk of stroke, and willingness to change risk behaviour.

RESULTS

White respondents (31% age and sex standardised prevalence) were more likely to smoke than Black Caribbeans (23%) and Black Africans (10%) (p < 0.001). Self reported rates of drinking were higher than the government's 'sensible drinking levels' for 19% of Whites, 11% of Black Caribbeans and 4% Black Africans (p < 0.001). In contrast, fewer Whites (51%) were overweight (BMI > 27) than Black Caribbeans (60%) and Black Africans (68%) (p = 0.001). A high proportion of smokers wished to give up (89% Black African; 83% Black Caribbean; 74% White). A higher proportion of Black Caribbeans (35%) reported a willingness to reduce their alcohol intake compared to only 15% of Whites (p = 0.040). There was a difference between groups in attitudes to weight reduction with 69% Black Caribbean women expressing a desire to be thinner compared to 86% Whites and 82% Black Africans (p = 0.051).

CONCLUSION

Strategies to reduce behavioural risk factors for heart attack and stroke need to emphasise different risk foctors among ethnic groups, especially in relation to alcohol use in the White population and weight in the Black Caribbean population. Influencing the change of these behaviours requires working in partnership with local community' groups.

Use of a portable bladder scanner to reduce the incidence of bladder catheterisation prior to laparoscopy

The aim of this study was to evaluate the usefulness of estimating bladder volume with a dedicated portable ultrasound device immediately prior to gynaecological laparoscopy. Catheterisation was performed if the estimated volume was greater than 100 ml. Forty consecutive women were studied prospectively. Twenty-six women did not require catheterisation. The procedure was quick and effective in safely reducing the frequency of pre-operative catheterisation.

Benign keratosis with a spectrum of follicular differentiation: a case series and investigation of a potential role of human papilloma virus

BACKGROUND

A variety of dermatopathologic entities are histologically defined by the presence of follicular differentiation. Follicular differentiation confined to the epidermis may follow induction from dermal mesenchymal proliferations, as in a nevus sebaceus of Jadassohn, or represent endogenous proliferations such as the tumor of the follicular infundibulum or trichilemmoma.

METHODS

We report on five cases of a histologically distinct form of benign keratosis showing variable follicular differentiation. Clinicopathologic correlation and analysis of a potential human papilloma virus pathogenesis was investigated.

RESULTS

Each of the cases arose on the trunk or extremities of three men and two women with a mean age at presentation of 66.6 years. All of the lesions showed variable follicular differentiation, with germinative basaloid cells, matrical cells with matrical keratinization, inner root sheath with trichohyalin granules, or glycogenated lower outer root sheath. Immunohistochemical staining for human papilloma virus was negative in each case.

CONCLUSIONS

There exists a distinct entity, histologically defined as a keratosis with variable follicular differentiation, which has not been previously described. These lesions do not appear to be pathogenically related to human papilloma virus infection.

Assessment of the in vitro and in vivo genotoxicity of Thalomid (thalidomide)

Thalomid is the FDA-approved commercial formulation of thalidomide currently used in the US to treat erythema nodosum leprosum, a complication of leprosy. The genotoxicity of Thalomid thalidomide was assessed in the Ames reverse mutation, AS52/XPRT mammalian cell forward gene mutation, and mouse bone marrow micronucleus assays. The Ames and AS52 assays were performed with and without S9. In the Ames, Salmonella typhimurium strains TA1535, 1537, 98, 100, and 102 and Escherichia coli strain WP2 uvrA were used. Assays were performed by using plate incorporation and liquid pre-incubation systems at thalidomide doses of 50-10,000 microg/plate. In the AS52 assay, Chinese hamster ovary cells were plated with fortified Ham's F12 medium and incubated overnight. The medium was then incubated with 1-1000 microg/ml thalidomide. After a series of aspirations, washings, reconstitutions, and incubations, mutant AS52 cells were fixed and stained. Colonies were then counted and the relative survival frequencies compared to negative controls. In the mouse micronucleus assay, Crl:CD-1 albino mice were dosed with 500, 2,500, and 5,000 mg/kg thalidomide and sacrificed over 72 h. Femurs were flushed with fetal bovine serum and the suspensions centrifuged. The supernatant was aspirated and the cell pellet resuspended and stained. Polychromatic erythrocytes were scored for micronucleated polychromatic and normochromatic erythrocytes. Thalidomide did not increase revertant frequencies in all bacterial strains. It also did not produce any significant increase in the average mutant frequencies of AS52 cells and mouse micronucleated polychromatic erythrocytes. We conclude that Celgene's Thalomid thalidomide is non-genotoxic.

Female preproenkephalin-knockout mice display altered emotional responses

The endogenous opioid system has been implicated in sexual behavior, palatable intake, fear, and anxiety. The present study examined whether ovariectomized female transgenic preproenkephalin-knockout (PPEKO) mice and their wild-type and heterozygous controls displayed alterations in fear and anxiety paradigms, sucrose intake, and lordotic behavior. To examine stability of responding, three squads of the genotypes were tested across seasons over a 20-month period. In a fear-conditioning paradigm, PPEKO mice significantly increased freezing to both fear and fear + shock stimuli relative to controls. In the open field, PPEKO mice spent significantly less time and traversed significantly less distance in the center of an open field than wild-type controls. Further, PPEKO mice spent significantly less time and tended to be less active on the light side of a dark-light chamber than controls, indicating that deletion of the enkephalin gene resulted in exaggerated responses to fear or anxiety-provoking environments. These selective deficits were observed consistently across testing squads spanning 20 months and different seasons. In contrast, PPEKO mice failed to differ from corresponding controls in sucrose, chow, or water intake across a range (0.0001-20%) of sucrose concentrations and failed to differ in either lordotic or female approach to male behaviors when primed with estradiol and progesterone, thereby arguing strongly for the selectivity of a fear and anxiety deficit which was not caused by generalized and nonspecific debilitation. These transgenic data strongly suggest that opioids, and particularly enkephalin gene products, are acting naturally to inhibit fear and anxiety.

Statistical analysis of measures of arousal in ovariectomized female mice

In preparation for evaluating hormone effects and hormone receptor gene influences on fundamental processes of behavioral arousal, we subjected 48 ovariectomized female mice to a rigid protocol of several tests bearing on arousal concepts. The central hypothesis was that results would organize themselves according to capacities for sensory alertness, motor activity, and emotional reactivity. The large table of across-mouse correlation was subjected to factor analysis and cluster analysis. Results provided evidence for a general arousal (one-factor solution) which, however, accounted for only 29.72% of the variance. Four-factor (72.03%) matched four-cluster and six-factor (84.38%) matched six-cluster lineups of behavior components quite well, but did not conform to the main hypothesis; e.g., home cage exploration frequency and duration variables did not covary, and locomotor wheel activity grouped with fear indices. Besides providing a baseline for ongoing estrogen/thyroid and related genetic experiments, this statistical approach should be useful for a variety of hormonal studies of complex behaviors in mice.

Effect of vancomycin and rifampicin on meticillin-resistant Staphylococcus aureus biofilms

Decolonisation of patients with urinary catheter colonisation by meticillin-resistant Staphylococcus aureus (MRSA) is often difficult. Replacement of the catheter after prophylactic vancomycin administration has been one approach that is often unsuccessful in clinical practice. We suspected that formation of MRSA biofilms might account for the persistence of infection, and our study confirms this, also showing that MRSA is able to colonise a silastic rubber surface even in the presence of prophylactic vancomycin or rifampicin.

Impact of illness and its treatment on workplace costs: regulatory and measurement issues

In an attempt to document a broader spectrum of the benefits of their pharmaceutical products, drug companies increasingly seek to include productivity claims in their promotional campaigns. We describe the existing regulatory framework of the Food and Drug Administration (FDA) for considering productivity claims, distinguishing between the traditional "substantial evidence" standard and the "competent and reliable scientific evidence" standard. But the notion of competent and reliable scientific evidence may itself be problematic, even when it is the appropriate regulatory standard, because there exists no consistent measurement approach across diseases, workplaces, jobs, and worker capabilities that is widely accepted in this emerging area of health outcomes research. We examine the various measurement approaches that have been used to quantify the impact of illness and its treatment on workplace productivity, and we describe some of the shortcomings associated with each alternative. This discussion highlights the possible difficulties faced by the FDA in reviewing productivity-based promotional claims. Finally, we suggest possible strategies for furthering this field of investigation.

Candida lusitaniae as an unusual cause of recurrent vaginitis and its successful treatment with intravaginal boric acid

Increasing use of short-course antifungal therapies in patients with recurrent vulvovaginitis may enable the emergence of less-common, more resistant yeast strains as vaginal pathogens. We report the case of a patient with chronically symptomatic and repeatedly treated vaginal candidiasis whose infection was attributable to Candida lusitaniae, a previously unreported cause of candidal vaginitis.

Antibiotic resistance patterns of group B streptococcus in antenatal genital cultures

OBJECTIVE

To identify the antibiotic susceptibility patterns of group B streptococcus (GBS) isolated from antenatal genital screening cultures.

STUDY DESIGN

One hundred thirty-five sequential GBS isolates underwent susceptibility testing by Kirby-Bauer disk diffusion to a variety of commonly used antibiotics.

RESULTS

All isolates were susceptible to cefazolin, chloramphenicol and vancomycin. Resistance to clindamycin and erythromycin, the currently recommended alternative antibiotics for intrapartum GBS prophylaxis in penicillin-allergic women, was found in 8.2% and 9.6% of GBS isolates tested, respectively.

CONCLUSION

These findings raise concerns regarding the need for both confirmation of a history of penicillin allergy in pregnant women and performance of antibiotic susceptibility testing on GBS isolated in genital screening cultures from penicillin-allergic patients.

Phase II trial of CI-958 in recurrent platinum-refractory ovarian carcinoma. A Gynecologic Oncology Group Study

OBJECTIVES

The objectives of this study were twofold: (1) to estimate the anti-tumor efficacy of CI-958 in patients with measurable platinum-resistant ovarian cancer; (2) to determine the nature and degree of toxicity of CI-958 in these patients.

METHODS

Patients received CI-958 560 mg/m(2) intravenously every 3 weeks and tumor measurements were performed every one to two cycles.

RESULTS

In 25 cases with recurrent platinum-resistant disease, there was one partial response (PR) and six patients had stable disease (SD).

CONCLUSIONS

CI-958 has minimal activity in platinum-resistant ovarian cancer at the dose and schedule tested.

Estrogens, brain and behavior: studies in fundamental neurobiology and observations related to women's health

Mechanisms and consequences of the effects of estrogen on the brain have been studied both at the fundamental level and with therapeutic applications in mind. Estrogenic hormones binding in particular neurons in a limbic-hypothalamic system and their effects on the electrophysiology and molecular biology of medial hypothalamic neurons were central in establishing the first circuit for a mammalian behavior, the female-typical mating behavior, lordosis. Notably, the ability of estradiol to facilitate transcription from six genes whose products are important for lordosis behavior proved that hormones can turn on genes in specific neurons at specific times, with sensible behavioral consequences. The use of a gene knockout for estrogen receptor alpha (ERalpha) revealed that homozygous mutant females simply would not do lordosis behavior and instead were extremely aggressive, thus identifying a specific gene as essential for a mammalian social behavior. In dramatic contrast, ERbeta knockout females can exhibit normal lordosis behavior. With the understanding, in considerable mechanistic detail, of how the behavior is produced, now we are also studying brain mechanisms for the biologically adaptive influences which constrain reproductive behavior. With respect to cold temperatures and other environmental or metabolic circumstances which are not consistent with successful reproduction, we are interested in thyroid hormone effects in the brain. Competitive relations between two types of transcription factors - thyroid hormone receptors and estrogen receptors have the potential of subserving the blocking effects of inappropriate environmental circumstances on female reproductive behaviors. TRs can compete with ERalpha both for DNA binding to consensus and physiological EREs and for nuclear coactivators. In the presence of both TRs and ERs, in transfection studies, thyroid hormone coadministration can reduce estrogen-stimulated transcription. These competitive relations apparently have behavioral consequences, as thyroid hormones will reduce lordosis, and a TRbeta gene knockout will increase it. In sum, we not only know several genes that participate in the selective control of this sex behavior, but also, for two genes, we know the causal routes. Estrogenic hormones are also the foci of widespread attention for their potential therapeutic effects improving, for example, certain aspects of mood and cognition. The former has an efficient animal analog, demonstrated by the positive effects of estrogen in the Porsolt forced swim test. The latter almost certainly depends upon trophic actions of estrogen on several fundamental features of nerve cell survival and growth. The hypothesis is raised that the synaptic effects of estrogens are secondary to the trophic actions of this type of hormone in the nucleus and nerve cell body.

Lack of peripheral neuropathy in Beagle dogs after 53 weeks oral administration of thalidomide capsules

Thalidomide (Thalomid) is approved for use in the US to treat complications from leprosy. Peripheral neuropathy is a dose-limiting adverse event in humans. As part of a nonrodent regulatory toxicology study, Beagle dogs were fed orally via encapsulation for 53 weeks. A component of this study was to determine if the dogs developed peripheral neuropathy. Twenty-eight male and 28 female Beagle dogs approximately 8-10 months of age were used. They were dosed at 43, 200 or 1000 mg/kg for 53 weeks followed by a 4-week treatment-free recovery period. Nerve function was assessed by electrophysiological measurements of the tibial nerve prior to dosing and at weeks 13, 27, 38 and 51. Representative dogs from each group were sacrificed at 26, 53 and 58 weeks and histologic and ultrastructural evaluations were performed on the sural nerve. Thalidomide had no effect on sensory nerve conduction velocity, duration or amplitude of the action potential. At 27 weeks, mean sensory nerve action potential amplitude for females at 43 mg/kg was significantly greater than control but was not evident at 39 weeks. Mean duration of sensory nerve action potential seemed to increase with similar magnitude over time in all dose groups including controls. Histological and ultrastructural evaluation of sections of sural nerve did not identify treatment-induced differences between control and thalidomide-dosed animals after 26 and 53 weeks of treatment. Additionally, no differences were observed following a 5-week treatment-free period at week 58. In contrast to humans, Beagle dogs did not develop thalidomide-induced peripheral neuropathy under conditions of the study.

Peritoneal fluid interleukin-6 in women with chronic pelvic pain

OBJECTIVE

To determine the relationship between peritoneal fluid concentrations of interleukin-6 (IL-6) and chronic pelvic pain symptomatology in women with adhesions, endometriosis, or no obvious intraperitoneal pathology.

DESIGN

Clinical research study.

SETTING

Healthy volunteers in an academic research environment.

PATIENT(S)

Reproductive-aged women undergoing laparoscopy for the diagnosis of pelvic pain, infertility, or sterilization were selected.

INTERVENTION(S)

Peritoneal fluid was collected at the time of the laparoscopy and later assayed for IL-6. Subjects completed a pelvic pain questionnaire, and operative reports were used to obtain the underlying diagnosis.

MAIN OUTCOME MEASURE(S)

Interleukin-6 concentrations.

RESULT(S)

No correlation between the presence or absence of pelvic pain, findings of adhesions or endometriosis, and the concentration of peritoneal fluid IL-6 was observed.

CONCLUSION(S)

The cytokine IL-6 does not seem to play a role in the genesis of chronic pelvic pain in women with adhesions or endometriosis.

Risk of ovarian cancer in relation to estrogen and progestin dose and use characteristics of oral contraceptives. SHARE Study Group. Steroid Hormones and Reproductions

Although past studies have shown that oral contraceptives with 50 microg or more of estrogen reduce the risk of ovarian cancer, it is not clear whether newer, lower-dose formulations do as well. We conducted a population-based, case-control study in the Delaware Valley to assess the impact of dose of oral contraception on risk of ovarian cancer. Cases aged 20-69 years with a diagnosis of epithelial ovarian cancer ascertained between May 1994 and July 1999 (n = 767) were compared with community controls (n = 1,367). Compared with never users, the adjusted risk of ovarian cancer was reduced by 40% for oral contraceptive users overall, with longer duration of use affording greater protection. The ovarian cancer risk reduction was similar for women who initiated oral contraception before 1972, when high-dose pills dominated the market; between 1972 and 1980; and after 1980, when newer, lower-dose pills dominated. Oral contraceptive estrogen and progestin content were compared for cases and controls after adjustment for current age, number of pregnancies, race, and family history of ovarian cancer. Use of low-estrogen/low-progestin pills afforded an estimated risk reduction (odds ratio = 0.5, 95% confidence interval: 0.3, 0.6) that was identical to that for high-estrogen/high-progestin pills (odds ratio = 0.5, 95% confidence interval: 0.3, 0.7).

Prognostic factors in malignant gastrointestinal stromal tumors

Gastrointestinal stromal tumors are a heterogeneous group of mesenchymal neoplasms of the gastrointestinal tract in which routine histopathological evaluation fails to reveal definitive evidence of differentiation. Given the heterogeneity in clinical presentation and the frequent morphological overlap, the biological behavior of these neoplasms is difficult to predict. We have evaluated, by Cox Proportional Hazards Regression Analysis, the clinicopathological features of 51 malignant gastrointestinal stromal tumors to identify predictors of survival. In the univariate analysis, survival inversely correlated with size, number of mitoses, and patient's age. In the multivariate analysis, only the degree of necrosis and phenotypic differentiation toward smooth muscle were found to be indicators of poor prognosis. Based on these results, a simple classification scheme for gastrointestinal stromal tumors is proposed. This classification appears to have great prognostic value for these tumors, and may be useful in guiding therapeutic management.