Waiting Times for Treatment of Rectal Cancer in North West England

An interim goal of the NHS National Cancer Plan is that, by 2005, patients with cancer should be treated within one month of diagnosis and within two months from urgent general practitioner referral. Preoperative radiotherapy for rectal cancer reduces the risk of local recurrence and may translate into improved patient survival. We conducted a prospective audit of existing waiting times for preoperative radiotherapy experienced by 65 patients with rectal cancer referred to the Christie Cancer Centre, Manchester, UK, between May and November 2002. The median time between referral from the surgeon to the start of radiotherapy was 40 days (range 11-85). Only 4 patients (6%) received radiotherapy within 28 days of referral by the surgeon. 62 patients (95%) underwent surgery within 14 days of completing radiotherapy. Delays in the provision of preoperative radiotherapy were primarily due to shortages of radiography staff and equipment. Lack of such infrastructure will prove a major stumbling block to achieving the targets of the NHS Cancer Plan.

The Social Validity of Telepractice among Spanish-Speaking Caregivers of English Learners: An Examination of Moderators

The purpose of the present paper was to examine the social validity of telepractice as a service delivery model for Spanish-speaking families of English learners. Quantitative survey methodology was employed to examine 79 caregivers’ opinions regarding telepractice and to obtain background information about participants’ home environments. Findings revealed that approximately 46% of the participant sample reported being interested in their children receiving services via telepractice. Caregivers reported limited familiarity with telepractice as an option, but were likely to express interest if their child had an identified speech or language disorder or if they were interested in increased access to Spanish language support for their children. In conclusion, although telepractice is not universally accepted among Spanish-speaking families, it appears to be a promising service delivery model. It is recommended that service providers offer thorough information and address common myths when considering telepractice as a service delivery model for families.

An Investigation of Language Environment Analysis Measures for Spanish-English Bilingual Preschoolers From Migrant Low-Socioeconomic-Status Backgrounds

PURPOSE

The current study was designed to (a) describe average hourly Language Environment Analysis (LENA) data for preschool-age Spanish-English bilinguals (SEBs) and typically developing monolingual peers and (b) compare LENA data with mean length of utterance in words (MLUw) and total number of words (TNW) calculated on a selected sample of consecutive excerpts of audio files (CEAFs).

METHOD

Investigators examined average hourly child vocalizations from daylong LENA samples for 42 SEBs and 39 monolingual English-speaking preschoolers. The relationship between average hourly child vocalizations, conversational turns, and adult words from the daylong samples and MLUw from a 50-utterance CEAF was examined and compared between groups.

RESULTS

MLUw, TNW, average hourly child vocalizations, and conversational turns were lower for young SEBs than monolingual English-speaking peers. Average hourly child vocalizations were not strongly related to MLUw performance for monolingual or SEB participants (r = .29, r = .25, respectively). In a similar manner, average hourly conversational turns were not strongly related to MLUw for either group (r = .22, r = .21, respectively).

CONCLUSIONS

Young SEBs from socioeconomically disadvantaged backgrounds showed lower average performance on LENA measures, MLUw, and TNW than monolingual English-speaking peers. MLUw from monolinguals were also lower than typical expectations when derived from CEAFs. LENA technology may be a promising tool for communication sampling with SEBs; however, more research is needed to establish norms for interpreting MLUw and TNW from selected CEAF samples.

Equimolar mixture of nitroux oxyde and oxygen during post-operative physiotherapy in patients with cerebral palsy: A randomized, double-blind, placebo-controlled study

BACKGROUND

The administration of an equimolar mixture of nitrous oxide and oxygen (N2O) is recommended during painful procedures. However, the evaluation of its use during physiotherapy after surgery has not been reported, although pain may hamper physiotherapy efficiency. This study investigated whether the use of N2O improves the efficacy of post-operative physiotherapy after multilevel surgery in patients with cerebral palsy.

METHOD

It was a randomized 1:1, double-blind, placebo-controlled study. All patients had post-operative physiotherapy starting the day after surgery. Patients received either N2O or placebo gas during the rehabilitation sessions. All patients had post-operative pain management protocol, including pain medication as needed for acute pain. The primary objective was to reach angles of knee flexion of 110° combined with hip extension of 10°, with the patient lying prone, within six or less physiotherapy sessions. Secondary evaluation criteria were the number of sessions required to reach the targeted angles, the session-related pain intensity and the analgesics consumption for managing post-operative pain.

RESULTS

Sixty-four patients were enrolled. Targeted angles were achieved more often in the N2O group (23 of 32, 72%, vs. Placebo: 13/ of 32, 41%; p = 0.01).

CONCLUSION

The administration of N2O during post-operative physiotherapy can help to achieve more quickly an improved range of motion, and, although not significant in our study, to alleviate the need for pain medication. Further studies evaluating the administration of N2O in various settings are warranted.

SIGNIFICANCE

During this randomized placebo-controlled double-blind study, children receiving nitrous oxide and oxygen (N2O) achieved more often the targeted range of motion during physiotherapy sessions after multilevel surgery. Compared to placebo, nitrous oxide and oxygen (N2O) enabled a better management of acute pain related to physiotherapy procedures.

Grade Level Expectations in Lexical Measures and Accuracy of Written Narrative Samples

This project aimed to describe selected micro structural aspects of written narratives of school age children and examine the relationship between narrative measures and performance on standardized assessments. Investigators utilized written personal narratives of 907 children in 1st-8th grade. Children's responses were described in terms of lexical diversity, productivity, and accuracy (grammatical, spelling, and conventions) by grade. The relationship between written narrative measures and performance on statewide assessments was analyzed through correlational and regression analyses. Findings demonstrated an upward trend in lexical measures across grades and a decrease in the proportion of errors. Children's performance on written language sample measures were significantly correlated to performance on standardized language and literacy assessments. The proportion of errors in written samples appeared to explain more unique variance than lexical measures. Findings substantiate that lexical measures and accuracy of written narrative measures are educationally relevant tools in first through eighth grade for predicting performance on standardized statewide language and literacy assessments. Results provide additional resources for educators on expected distribution of performance of school age children on written narrative measures. Findings further affirm the construct validity of using written narrative sample measures as a developmental index of language acquisition.

Neonatal outcomes following planned preterm delivery in diabetic mothers

OBJECTIVE

Women with diabetes may need elective preterm delivery due to pregnancy or diabetes related complications. The aim of this study was to describe the neonatal outcomes arising from elective preterm delivery in diabetic women.

METHOD

Suitable patients were identified by the obstetric team at Hull Royal Infirmary Women and Children's Hospital and data was extracted from their case notes. 45 diabetic women with planned preterm delivery were identified within a set time frame, resulting in 48 babies.

RESULTS

Of the 48 babies born, 47 survived. 36 out of 48 were delivered via caesarean section. Gestational ages ranged from 29+3 to 36+6 weeks, and 24 out of 48 (50%) had a birth weight greater than the 90th centile for gestational age.34 out of the 48 babies experienced some form of neonatal complication and were admitted to the neonatal unit. The median duration of stay in the neonatal unit was 7 days. 14 of the surviving neonates suffered from respiratory distress, although only 4 required surfactant therapy to regain respiratory function. However, the incidence of serious neonatal complications in those born after 34 weeks was shown to be low.

CONCLUSIONS

Elective preterm delivery after 34 weeks had little effect on overall neonatal outcome. Therefore it could be proposed that elective preterm delivery after 34 weeks gestation may be an acceptable option in diabetic women if there are maternal or obstetric complications.

Using Experience Books to Foster the Narrative Skills of English Learners

The need to address the language and literacy development of children from culturally and linguistically diverse (CLD) backgrounds continues to rise with the increasing number of English learners (ELs) in schools throughout the United States. One area of concern is the need for culturally sensitive methods of assessment and intervention for ELs with language disorders. Oral language skills are widely considered an essential component of later reading success. Although narratives are commonly used to foster children's oral language skills, narrative development in children from CLD backgrounds can be highly variable. Broader socialization and cultural practices can influence and shape the way children tell stories (Melzi, Schick, & Kennedy, 2011). One approach to facilitate the development of narrative skills in ELs with language disorders is the use of experience books, which are personalized stories that depict daily routines or meaningful events situated from the child's perspective. Experience books can provide a natural foundation of rich linguistic interactions between children and caregivers, increase children's exposure to print and enjoyment of books, and encourage family involvement. The following tutorial will guide speech-language pathologists on how to adapt experience books as culturally sensitive tools to help meet the needs and interests of CLD children and families.

l-Lysine supplementation does not affect the bioavailability of copper or iron in rats

l-lysine (Lys) is an essential amino acid that is added to foods and dietary supplements. Lys may interact with mineral nutrients and affect their metabolism. This study examined the effect of dietary Lys supplementation on the bioavailability of copper (Cu) and iron (Fe). Weanling male Sprague-Dawley rats were fed one of five diets (20% casein) for 4 weeks containing normal Cu and Fe (control) or low Cu or Fe without (LCu, LFe) or with (LCu+Lys, LFe+Lys) addition of 1.5% Lys. Final body weights, body weight gains and food consumption of the rats did not differ (P≥0.05) among diet groups. Rats fed the low Cu or Fe diets showed changes in nutritional biomarkers compared to control rats, demonstrating reduced Cu and Fe status, respectively. Hematological parameters, serum ceruloplasmin activity and Cu and Fe concentrations in serum, liver, kidney and intestinal mucosa were unaffected (P≥0.05) by Lys supplementation. These results indicate that in the context of an adequate protein diet, Lys supplementation at a relatively high level does not affect Cu or Fe bioavailability in rats.

Stiffness and strength of bone in osteoporotic patients treated with varying durations of oral bisphosphonates

Apparent modulus and failure stress of trabecular bone structure from 45 women with osteoporosis treated with bisphosphonates for varying durations were studied using finite element analyses and statistical modeling. Following adjustments for patient age and bone volume, increasing bisphosphonate treatment duration for up to 7.3 years was associated with treatment-time-dependent increases in bone apparent modulus and failure stress. Treatment durations exceeding 7.3 years were associated with time-dependent decreases in apparent modulus and failure stress from the peak values observed.

INTRODUCTION

The purpose of this study was to clarify the relationship between bisphosphonate (BP) treatment duration and human bone quality. This study quantified changes in the apparent modulus and failure stress of trabecular bone biopsied from patients with osteoporosis who were treated with BPs for widely varying durations.

METHODS

Forty-five iliac crest bone samples were obtained from women with osteoporosis who were continuously treated with oral BPs for varying periods of up to 16 years. Micro-CT imaging was used to develop three-dimensional virtual models of the trabecular bone from these samples. Apparent modulus and failure stress of these virtual models were determined using finite element analyses (FEA). Polynomial regression and cubic splines, adjusted for relevant (age and BV/TV) covariates, were used to statistically model the data and quantify the relationships between BP treatment duration and apparent modulus or failure stress.

RESULTS

Second-order polynomial models were needed to relate apparent modulus or failure stress to BP treatment duration. These models showed that these bone quality parameters (a) increased with increasing BP treatment duration up to approximately 7.3 years, (b) reached a maximum at this (~7.3 years) time, and then (c) declined with BP treatment durations exceeding ~7.3 years. A similar result was obtained by modeling with cubic splines.

CONCLUSIONS

Changes in FEA-derived apparent stiffness and failure stress are attributable to changes in trabecular bone structure, which in turn are related to the duration of BP treatment. These relationships are evident even after adjustments are made in the statistical models for changes in age and BV/TV. According to these models, increases in trabecular bone apparent stiffness and failure stress linked to BPs cease and appear to reverse after approximately 7.3 years of treatment. Conclusions regarding optimal BP therapy duration await study of additional bone quality parameters.

Core vocabulary in written personal narratives of school-age children

This study aimed to describe core words of written personal narratives to inform the implementation of AAC supports for literacy instruction. Investigators analyzed lexical diversity, frequency of specific word use and types of words that made up 70% of the total words used in 211 written narrative samples from children in first grade (n = 94) and fourth grade (n = 117). Across grades, 191 different words made up 70% of the total words used in the 211 written narrative samples. The top 50 words were comprised of content words (64%) and function words (36%). Grade differences were noted in diversity and types of words, including differences in the number of words comprising the core (132 words for children in first grade and 207 for fourth grade) and a higher proportion of abstract nouns for children in fourth grade based on the 200 most frequently occurring words for each grade.

Factors associated with HIV prevalence in a pre-partum cohort of Zambian women

An ongoing study of mother-to-child human herpes virus-8 (HHV-8) transmission in Zambian women ( n = 3160) allowed us to examine the association of medical injections with HIV serostatus while simultaneously accounting for other factors known to be correlated with HIV prevalence. Multi-method data collection included structured interviews, medical record abstraction, clinical examinations, and biological measures. Medically administered intramuscular or intravenous injections in the past five years (but not blood transfusions) were overwhelmingly correlated with HIV prevalence, exceeding the contribution of sexual behaviours in a multivariable logistic regression. Statistically significant associations with HIV also were found for some demographic variables, sexual behaviours, alcohol use, and sexually transmitted diseases (STD). The results confirmed that iatrogenic needle exposure, sexual behaviour, demographic factors, substance use, and STD history are all implicated in Zambian women's HIV+ status. However, the disproportionate association of medical injection history with HIV highlights the need to investigate further and prospectively the role of health-care injection in sub-Saharan Africa's HIV epidemic.

Mild Thyroid Hormone Insufficiency During Development Compromises Activity-Dependent Neuroplasticity in the Hippocampus of Adult Male Rats

Severe thyroid hormone (TH) deficiency during critical phases of brain development results in irreversible neurological and cognitive impairments. The mechanisms accounting for this are likely multifactorial, and are not fully understood. Here we pursue the possibility that one important element is that TH affects basal and activity-dependent neurotrophin expression in brain regions important for neural processing. Graded exposure to propylthiouracil (PTU) during development produced dose-dependent reductions in mRNA expression of nerve growth factor (Ngf) in whole hippocampus of neonates. These changes in basal expression persisted to adulthood despite the return to euthyroid conditions in blood. In contrast to small PTU-induced reductions in basal expression of several genes, developmental PTU treatment dramatically reduced the activity-dependent expression of neurotrophins and related genes (Bdnft, Bdnfiv, Arc, and Klf9) in adulthood and was accompanied by deficits in hippocampal-based learning. These data demonstrate that mild TH insufficiency during development not only reduces expression of important neurotrophins that persists into adulthood but also severely restricts the activity-dependent induction of these genes. Considering the importance of these neurotrophins for sculpting the structural and functional synaptic architecture in the developing and the mature brain, it is likely that TH-mediated deficits in these plasticity mechanisms contribute to the cognitive deficiencies that accompany developmental TH compromise.

Facilitating Vocabulary Acquisition of Children With Cochlear Implants Using Electronic Storybooks

The present intervention study explored the word learning of 18 children with cochlear implants in response to E-book instruction. Capitalizing on the multimedia options available in electronic storybooks, the intervention incorporated videos and definitions to provide a vocabulary intervention that includes evidence-based teaching strategies. The extent of the children's word learning was assessed using three assessment tasks: receptive pointing, expressively labeling, and word defining. Children demonstrated greater immediate expressive labeling gains and definition generation gains for words taught in the treatment condition compared to those in the comparison condition. In addition, the children's performance on delayed posttest vocabulary assessments indicated better retention across the expressive vocabulary task for words taught within the treatment condition as compared to the comparison condition. Findings suggest that children with cochlear implants with functional speech perception can benefit from an oral-only multimedia-enhanced intensive vocabulary instruction.

Nipple-sparing mastectomy in patients with BRCA1/2 mutations and variants of uncertain significance

BACKGROUND

Nipple-sparing mastectomy (NSM) is associated with improved cosmesis and is being performed increasingly. Its role in BRCA mutation carriers has not been well described. This was a study of the indications for, and outcomes of, NSM in BRCA mutation carriers.

METHODS

BRCA mutation carriers who underwent NSM were identified. Details of patient demographics, surgical procedures, complications, and relevant disease stage and follow-up were recorded.

RESULTS

A total of 177 NSMs were performed in 89 BRCA mutation carriers between September 2005 and December 2013. Twenty-six patients of median age 41 years had NSM for early-stage breast cancer and a contralateral prophylactic mastectomy. Mean tumour size was 1·4 (range 0·1-3·5) cm. Sixty-three patients of median age 39 years had prophylactic NSM, eight of whom had an incidental diagnosis of ductal carcinoma in situ. There were no local or regional recurrences in the 26 patients with breast cancer at a median follow-up of 28 (i.q.r. 15-43) months. There were no newly diagnosed breast cancers in the 63 patients undergoing prophylactic NSM at a median follow-up of 26 (11-42) months. All patients had immediate breast reconstruction. Five patients (6 per cent) required subsequent excision of the nipple-areola complex for oncological or other reasons. Skin desquamation occurred in 68 (38·4 per cent) of the 177 breasts, and most resolved without intervention. Debridement was required in 13 (7·3 per cent) of the 177 breasts, and tissue-expander or implant removal was necessary in six instances (3·4 per cent).

CONCLUSION

NSM is an acceptable choice for patients with BRCA mutations, with no evidence of compromise to oncological safety at short-term follow-up. Complication rates were acceptable, and subsequent excision of the nipple-areola complex was rarely required.

Lopinavir and atazanavir in pregnancy: comparable infant outcomes, virological efficacies and preterm delivery rates

OBJECTIVES

The aim of the study was to identify differences in infant outcomes, virological efficacy, and preterm delivery (PTD) outcome between women exposed to lopinavir/ritonavir (LPV/r) and those exposed to atazanavir/ritonavir (ATV/r).

METHODS

A retrospective case note review was carried out. The case notes of 493 women who conceived while on LPV/r or ATV/r or initiated LPV/r or ATV/r during pregnancy and who delivered between 1 September 2007 and 30 August 2012 were reviewed. Data collected included demographics, antiretroviral use, HIV markers, and pregnancy and infant outcomes. Infant outcomes, virological efficacies and PTD rates for LPV/r and ATV/r were compared.

RESULTS

A total of 306 women received LPV/r (82 conceiving while on the drug and 224 commencing it post-conception) and 187 received ATV/r (96 conceiving while on the drug and 91 commencing it post-conception). Comparing the two protease inhibitors (PIs), viral suppression rates were similar and, in women starting antiretroviral therapy (ART) post-conception, the median times to first undetectable HIV viral load were not significantly different (P = 0.64). PTD rates did not differ by therapy overall (ATV/r, 13%; LPV/r, 14%) or when considering the timing of first exposure (conceiving on ART, P = 0.81; commencing ART in pregnancy, P = 0.08). Poor fetal outcomes were very uncommon. There were two transmissions, giving a mother-to-child transmission (MTCT) rate of 0.4% (95% confidence interval 0.05-1.5%).

CONCLUSIONS

Both ART regimens were well tolerated and successful in preventing MTCT. No significant differences in tolerability or in pregnancy or infant outcomes were observed, which supports the provision of a choice of PI in pregnancy.

Lower serum magnesium concentration is associated with diabetes, insulin resistance, and obesity in South Asian and white Canadian women but not men

Background

A large proportion of adults in North America are not meeting recommended intakes for magnesium (Mg). Women and people of South Asian race may be at higher risk for Mg deficiency because of lower Mg intakes relative to requirements and increased susceptibility to diabetes, respectively.

Objective

This study compared serum Mg concentrations in South Asian (n=276) and white (n=315) Canadian women and men aged 20–79 years living in Canada's Capital Region and examined the relationship with diabetes, glucose control, insulin resistance, and body mass index.

Results

Serum Mg concentration was lower in women of both races and South Asians of both genders. Racial differences in serum Mg were not significant after controlling for use of diabetes medication. A substantial proportion of South Asian (18%) and white (9%) women had serum Mg <0.75 mmol/L indicating hypomagnesemia. Use of diabetes medication and indicators of poorer glucose control, insulin resistance, and obesity were associated with lower serum Mg in women, but not in men.

Conclusions

These results suggest that the higher incidence of diabetes in South Asians increases their risk for Mg deficiency and that health conditions that increase Mg requirements have a greater effect on Mg status in women than men.

Abstract LB-86: Dependent and independent tumor suppression function of ARF and p53 in murine BCC carcinogenesis in Ptch1+/- mice

Basal cell carcinoma (BCC), the most commonly diagnosed human cancer, is driven by aberrant activation of hedgehog (HH) signaling. In addition, we have found that p53 is a potent inhibitor of HH-driven BCC carcinogenesis - ablation of p53 in Ptch1+/- K14CreER2 p53fl/fl (PF mice) dramatically accelerates BCC formation with a shorter tumor latency and a 10 fold increase of tumor burden. To begin to determine how p53 is activated in this Ptch1+/- murine BCC model, we investigated the role of p19ARF in translating oncogene-induced stress (OIS) into p53 activation.

We bred Ptch1+/- mice with ARFGFP/GFP to generate Ptch1+/- ARFGFP/GFP (ARF mice), lacking functional ARF. In addition, we crossed ARF mice and PF mice to generate ARF/p53 double deletion mice (DD mice), treated ARF, PF and DD mice as well as Ptch1+/- (ARF+/+, p53+/+) with IR at mouse age 8w, and quantified BCC formation. .As assessed in age 5m skin biopsies, PF and DD mice had a significantly higher microscopic BCC tumor burden than did ARF and Ptch1+/- mice. There was no significant difference between PF and DD or between ARF and Ptch1+/-. ARF and PF mice developed visible BCC starting at 5-6 m. By contrast, DD mice had visible BCCs as early as age 4m, a statistically different age of onset. Consistent with our previous findings, Ptch1+/- mice did not form any visible BCCs until age 9 m or later. These data indicate that loss of functional ARF or of p53 promotes malignant conversion of microscopic BCCs to visible BCCs. However, only loss of p53, but not loss of ARF, enhances tumor initiation. To gain further insights in the molecular mechanisms differentiating these tumors, we examined the whole genome expression analysis by RNA-seq.

Taken together, our findings suggest that both ARF-dependent and -independent activation of p53 is involved in BCC carcinogenesis. ARF-mediated p53 activation, presumably via the OIS pathway, appears to be crucial in regulating malignant transformation of BCC, while ARF-independent p53 activation inhibits tumor initiation.

Citation Format: Grace Y. Wang, Carla Wood, Hiroe Hu, John Dolorito, Eileen Libove, Ervin H. Eptein. Dependent and independent tumor suppression function of ARF and p53 in murine BCC carcinogenesis in Ptch1+/- mice. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr LB-86. doi:10.1158/1538-7445.AM2014-LB-86

How to replace codeine after tonsillectomy in children under 12 years of age? Guidelines of the French Oto-Rhino-Laryngology--Head and Neck Surgery Society (SFORL)

The authors present the guidelines of the French Oto-rhino-laryngology--Head and Neck Surgery Society (SFORL) regarding pain management in children and adults following tonsillectomy. A multidisciplinary work group was entrusted with a literature review. Guidelines were drawn up based on the articles retrieved and the group members' experience. They were read over by an editorial group independent of the work group. A coordination meeting drew up the final version. Guidelines were graded A, B or C or as professional agreement in decreasing order of level of evidence. At home, non-steroid anti-inflammatory drugs (NSAIDs) are recommended in association with paracetamol in elevated respiratory risk and especially obstructive sleep apnea syndrome; in elevated hemorrhagic risk (hemostasis disorder, surgical problems, etc.), tramadol is recommended. Two other treatment schedules (modified NSAIDs and corticosteroids) have not undergone dedicated study and should be assessed. Management of post-tonsillectomy pain in children is founded on individual risk/benefit analysis.

The α' subunit of β-conglycinin and the A1-5 subunits of glycinin are not essential for many hypolipidemic actions of dietary soy proteins in rats

PURPOSE

This study examined the effects of dietary soy protein (SP) lacking different storage protein subunits and isoflavones (ISF) on the abdominal fat, blood lipids, thyroid hormones, and enzymatic activities in rats.

METHODS

Weanling Sprague-Dawley rats (8 males and 8 females/group) were fed diets containing either 20 % casein without or with supplemental isoflavones or alcohol-washed SP isolate or SP concentrates (SPC) prepared from 6 different soy bean lines for 8 weeks.

RESULTS

Feeding of diets containing SPC regardless of their subunit compositions significantly lowered relative liver weights, blood total, free, and LDL cholesterol in both genders (P < 0.05) and also reduced serum free fatty acids (FFA) and abdominal fat in females (P < 0.05) compared to the casein or casein + ISF diets. Dietary SPC significantly elevated the plasma free triiodothyronine (T3) in both genders and total T3 in females compared to the casein diet (P < 0.05). The SPC lacking β-conglycinin α' and either the glycinin A1-3 or A1-5 subunits increased total T3 in males and reduced plasma enzymatic activities of creatine kinase and lactate dehydrogenase compared to casein or casein + ISF diet (P < 0.05).

CONCLUSIONS

Soy isoflavones were mainly responsible for the hypocholesterolemic effects and increased plasma free T3, whereas reduction in FFA, abdominal fat, liver weight and increased plasma total T3 were the effects of the soy proteins. Neither the α' subunit of β-conglycinin nor the A1-5 subunits of glycinin are essential for the hypolipidemic properties of soy proteins.

Dietary soy isoflavones increased hepatic protein disulfide isomerase content and suppressed its enzymatic activity in rats

Protein disulfide isomerase (PDI) is a multifunctional protein and plays important roles in protein folding, triglyceride transfer, insulin degradation, and thyroid hormone transportation. This study examined the modulation of PDI expression by soy consumption using rat as a model. Sprague-Dawley male and female rats at 50 days (d) of age were fed diets containing either 20% casein or alcohol-washed soy protein isolate (SPI, containing 50 mg isoflavones (ISFs)/kg diet) or SPI plus ISF (250 mg/kg diet) and mated at age of 120 d. The offspring (F1) were fed the same diets as their parents. Addition of ISF to SPI diet markedly increased PDI protein content in the liver and testis of the adult rats compared with the casein or SPI diet. PDI mRNA abundance in the liver and protein content in the brain, thyroid, heart, and uterus were unchanged by the diets. Two-dimensional Western blot showed that the rats fed diets containing SPI had a diminished hepatic PDI protein with an isoelectric point (pI) of 6.12, a dephosphorylated form, compared with the rats fed diets containing either casein or SPI with supplemental ISF. Soy ISF added into SPI diet remarkably suppressed hepatic PDI activity of the rats compared with the casein diet. Moreover, soy ISF dose-dependently increased PDI and thyroid hormone receptor (TR) β protein content, whereas reduced TR DNA binding ability in human hepatocytes. Overall, this study shows that soy ISF increased hepatic PDI protein content, but addition of ISF into SPI diet inhibited its enzymatic activities and this effect may be mediated through a post-transcriptional mechanism.

Synthesis and properties of a meso- tris–ferrocene appended zinc(ii) porphyrin and a critical evaluation of its dye sensitised solar cell (DSSC) performance

A zinc(ii) porphyrin derivative, F3P, was prepared containing a single ferrocene group appended at three of the meso positions.

The associations between diet quality, Body Mass Index (BMI) and Health and Activity Limitation Index (HALex) in the Geisinger Rural Aging Study (GRAS)

OBJECTIVES

To determine the associations between diet quality, body mass index (BMI), and health-related quality of life (HRQOL) as assessed by the health and activity limitation index (HALex) in older adults.

DESIGN

Multivariate linear regression models were used to analyze associations between Dietary Screening Tool (DST) scores, BMI and HALex score, after controlling for gender, age, education, living situation, smoking, disease burden and self-vs. proxy reporting.

SETTING

Geisinger Rural Aging Study, Pennsylvania.

PARTICIPANTS

5,993 GRAS participants were mailed HRQOL and DST questionnaires with 4,009 (1,722 male, 2,287 female; mean age 81.5 ± 4.4) providing complete data.

RESULTS

HALex scores were significantly lower for participants with dietary intakes categorized as unhealthy (<60) (0.70, 95% CI 0.69, 0.72, p<0.05) or borderline (60-75) (0.71, 95% CI 0.70, 0.73, p<0.05) compared to those scoring in the healthy range (>75) (0.75, 95% CI 0.73, 0.77) based on DST scores. HALex scores were significantly lower for underweight (0.67, 95% CI 0.63, 0.72, p<0.05), obese class II (0.68, 95% CI 0.66, 0.71, p<0.05) and class III participants (0.62 95% CI 0.57, 0.67, p<0.05) compared to those with BMI 18.5-24.9.

CONCLUSIONS

Poor diet quality, as assessed by the DST, is associated with lower HRQOL in adults ≥ 74 years of age.

High prevalence of early childhood infection by Kaposi's sarcoma-associated herpesvirus in a minority population in China

In China, KSHV seroprevalence varies considerably among different regions and ethnicities. But in Xinjiang province, located in the northwestern China, there is a very high seroprevalence of KSHV in adults of Kazak and Ughur ethnicities. However, KSHV prevalence in children and the risk factors associated with the acquisition of infection are currently not known. The aim of this study was to investigate the prevalence of KSHV infection and identify associated socioeconomic or behavioural risk factors and the humoral immune response among children in this population. This is a cross-sectional study (N = 178) to screen children and their caregivers from Xinjiang for total KSHV antibodies, KSHV neutralizing antibodies and HIV infection. Structured questionnaires were utilized to investigate risk factors associated with KSHV prevalence. KSHV seroprevalence in children and caregivers in Xinjiang was 48.3% and 64.7%, respectively. Neutralizing antibody was detected in most seropositive caregivers (93.8%) but was detected in only 5.8% of the infected children. A significant association was observed between child KSHV seroprevalence and sharing of food among family members. These results suggest that similar to other endemic areas in Africa, KSHV infection in the minority populations of Xinjiang is likely to be occurring during early childhood, probably via horizontal transmission through saliva, and results in high seroprevalence in the adult population.

Soy extracts suppressed iodine uptake and stimulated the production of autoimmunogen in rat thyrocytes

Soy consumption is associated with thyroid disorders such as hypothyroidism, goiter, and autoimmune thyroid disease (ATD) as well as increased iodine requirement in certain cases. However, the anti-thyroid component(s) in soy are yet to be identified and the molecular mechanism(s) involved remain unclear. This study examined the effects of soy isoflavones (ISF) on iodide uptake and expression of thyroglobulin (Tg) and sodium/iodide symporter (NIS) in thyrocytes. Fischer rat thyroid cells (FRTL) were treated with Novasoy (a soy alcohol extract containing 30% ISF) or major ISF aglycones or glycosides for 24 h. Iodide uptake was measured by a colorimetric assay. The protein level of Tg and NIS was measured by Western blotting. Cytotoxicity of tested compounds was determined by the MTT cell proliferation assay. Iodide uptake in FRTL cells was dose-dependently suppressed by Novasoy added into the cell culture (10, 25, or 50 µg/mL, P < 0.05). However, neither the major ISF aglycones nor glycosides alone or in combination had similar effects. Novasoy (up to 200 µg/mL) had no cytotoxic effect. Novasoy (1, 10, and 50 µg/mL) and genistein (1 and 10 µM) markedly increased the protein content of a 40 kDa Tg fragment (P40, a known autoimmunogen) and non-glycosylated NIS in the FRTL cells (P < 0.05). Overall, this study demonstrated that the alcohol soluble component(s) other than the major ISF in soy remarkably inhibited iodide uptake in the FRTL cells. Soy ISF, particularly genistein, induced the production of P40, which might be responsible for the higher incidence of ATD reported in soy infant formula-fed children.

[Opioid-sparing effect of ketamine during tonsillectomy in children]

INTRODUCTION

In the adult population, Ketamine is currently used as an antihyperalgesic and opioid-sparing agent during the perioperative period. However, for doses of ketamine up to 0.5mg/kg, these effects have not been found in pediatric population. The aim of the present study was to evaluate the efficacy of a preoperative bolus of 1mg/kg of ketamine on postoperative pain intensity and morphine consumption in children undergoing tonsillectomy.

METHODS

We have undertaken a retrospective comparison of 60 consecutive children operated for tonsillectomy in our institution before (first 30 patients) and after (last 30 patients) the introduction of a preoperative bolus of 1mg/kg of ketamine. Data collected were: age, ASA score, dose of intraoperative sufentanil, OPS score during PACU stay and the first postoperative day, morphine consumption during PACU stay and the first postoperative day, psychodysleptic manifestations, pain at first solid oral intake and postoperative respiratory complications or haemorrhage.

RESULTS

No difference was found between the two groups in terms of demographic characteristics. Perioperative doses of sufentanil, postoperative opioid consumption or pain score in PACU or during 24hours were similar between the two groups. The two groups did not differ in terms of pain at first oral intake, or other adverse effects.

CONCLUSION

These results suggest that 1mg/kg of ketamine administered right after anaesthesia induction in children undergoing tonsillectomy did not result in an opioid sparing effect.

Antibody responses to lytic and latent human herpesvirus 8 antigens among HIV-infected patients in central China

Human herpesvirus 8 (HHV8) is an important opportunistic infection of HIV/AIDS. However, very little is known about antibody seropositivities to HHV8 lytic and latent antigens among HIV-infected patients in China. Therefore, a cross-sectional study was conducted to explore HHV8 serostatus among 316 HIV-infected patients in a rural area of central China. The antibody seropositivity to HHV8 ORF65 (lytic) and LANA (latent) antigens was 12.7% and 10.4%, respectively. Patients who were naïve to antiretroviral therapy (ART) were more likely to be seropositive for antibodies to ORF65 (OR: 3.79; 95% CI: 1.71-8.42) and LANA (OR: 3.77; 95% CI: 1.55-9.14) than patients receiving ART. Patients having CD4+ cell counts less than 200 cells/mm3 were more likely to be seropositive for LANA antibody (OR: 3.53; 95% CI: 1.44-8.64) and to have lower LANA antibody titer (p = 0.007). They were also more likely to be seropositive for ORF65 antibody (OR: 2.12; 95% CI: 0.94-4.78) and to have a lower ORF65 antibody titer (p = 0.065), though the difference was marginally significant. No associations between other viral coinfections studied and antibody seropositivity to either latent or lytic HHV8 antigens were identified. Study findings suggest that antibody responses to both lytic and latent HHV8 antigens among HIV patients in China were fairly high and were associated with immunodeficiency status and ART.

Kaposi's sarcoma in pregnancy after initiation of highly active antiretroviral therapy: a manifestation of immune reconstitution syndrome

A case of Kaposi's sarcoma (KS) presenting as an immune reconstitution inflammatory syndrome in pregnancy with conservative management is reported. Successful outcomes for mother and baby were achieved. HIV was diagnosed at antenatal booking and highly active antiretroviral therapy commenced at 20 weeks. Multiple lymphadenopathies developed two months later. Excision biopsy of a node confirmed KS. In the absence of advanced disease, she was managed conservatively until delivery. The placenta showed no evidence of KS or human herpes virus 8 (HHV-8). The baby had negative HIV and HHV-8 polymerase chain reaction tests at zero, six and 12 weeks of life. Six months postpartum, the KS had regressed and HHV-8 viral load was undetectable.

Achieving Meaningful Use and Operational Efficiency

PURPOSE

The Centers for Medicare and Medicaid Services (CMS), through the Electronic Health Record (EHR) Incentive Program, are providing incentive payments to eligible professionals as they demonstrate meaningful use of certified EHR technology. Eligible professionals can receive up to $44,000 over a 5-year period for Medicare participation if they successfully demonstrate the ability to automatically generate, transmit, and meet thresholds for specific reporting elements from the EHR. Meeting the meaningful use requirement involves a reorganization of workflow within the clinical setting so that the data elements necessary to produce the relevant measurements are documented in the electronic medical record (EMR) as they are delivered. A by-product of this is operational efficiency improvement in three areas: coordination of data input throughout the care team to reduce or remove bottlenecks, assignment of responsibility for specific activity, and real-time objective monitoring of the work process.

METHODS

Using the reporting system functionality of a certified EMR deployed in a two-physician medical oncology practice at the New London Cancer Center, the objective measurement of the ability of each of the eligible providers in the clinic to improve their individual MU scores was tracked. Analysis of the progress of each provider revealed gaps. Process issues were identified by work group: secretaries, laboratory preparation and phlebotomy staff, nurses, and clinicians. The designated physician leader met with each group to discuss the sections relevant to that particular group.

RESULTS

By discovering and addressing work processes that were not utilizing the ability of the EHR to capture and document (ie, meaningful use of the EHR), rapid progress that affected all of the eligible providers and all patients cared for was made. Changes resulted in increased clarity of clinical and administrative responsibilities during patient processing and clinical care provision. Meaningful use attestation was completed in 14 weeks.

CONCLUSION

Completion of the documentation necessary to meet the requirements of the EHR Incentive Program led to the discovery of systemic inefficiencies in administrative and clinical workflows. Addressing these bottlenecks, along with using the reporting capability of the EHR to measure the impact of workflow changes, enabled the administrative and care teams to make changes quickly and effectively. The certified EHR provided guidance and status-reporting capabilities that allowed the practice to achieve the meaningful use requirement.