Prediction of neurological outcome after cardiopulmonary resuscitation by serial determination of serum neuron-specific enolase

AIMS

Data on the diagnostic accuracy of neuron-specific enolase (NSE) as marker of hypoxic brain damage are conflicting. The purpose of this prospective observational cohort study was to explore the prognostic value of serum NSE after cardiopulmonary resuscitation (CPR) and to define the most sensitive cutoff value with a specificity of 100% for the prediction of persistent coma.

METHODS AND RESULTS

Serum NSE concentrations were serially determined in 227 consecutive unconscious patients after CPR who were classified according to the best Glasgow-Pittsburgh cerebral performance categories (CPC, 1-4) achieved within 6 months follow-up. Sixteen patients were excluded due to incomplete NSE data and 34 due to death under analgesia sedation. The prevalence of poor neurological outcome (persistent coma, CPC 4) in our 177 analysed patients was 33%. At a specificity of 100%, a peak NSE concentration above 80 ng/mL predicted persistent coma with a sensitivity of 63%, a positive predictive value of 100%, a negative predictive value of 84%, and a predictive accuracy of 88%.

CONCLUSION

A peak serum NSE concentration exceeding 80 ng/mL is a highly specific but only moderately sensitive marker for a poor neurological outcome after CPR.

A locus for spondylocarpotarsal synostosis syndrome at chromosome 3p14

Spondylocarpotarsal synostosis syndrome is a rare autosomal recessive disorder characterised by vertebral fusions, frequently manifesting as an unsegmented vertebral bar, as well as fusions of the carpal and tarsal bones. In a study of three consanguineous families and one non-consanguineous family, linkage analysis was used to establish the chromosomal location of the disease gene. Linkage analysis localised the disease gene to chromosome 3p14. A maximum lod score of 6.49 (q = 0) was obtained for the marker at locus D3S3532 on chromosome 3p. Recombination mapping narrowed the linked region to the 5.7 cM genetic interval between the markers at loci D3S3724 and D3S1300. A common region of homozygosity was found between the markers at loci D3S3724 and D3S1300, defining a physical interval of approximately 4 million base pairs likely to contain the disease gene. Identification of the gene responsible for this disorder will provide insight into the genes that play a role in the formation of the vertebral column and joints.

Healthcare providers' sun-protection promotion and at-risk clients' skin-cancer-prevention outcomes

BACKGROUND

This study aims to determine whether healthcare providers' (HCPs') communication dealing with sun-protection (i.e., counseling) is associated with clients' skin-cancer-related prevention practices, detection self-efficacy, and knowledge.

METHODS

Secondary analysis of two surveys of 1,469 randomly sampled farmers and soccer participants from southeast and coastal Georgia.

RESULTS

Farmers and soccer participants who report ever having been counseled by a HCP about how to protect their skin from the sun report being more likely to wear sunscreen (P < 0.05), get clinical exams of their skin (P < 0.001), be certain that they can recognize unhealthy changes in their skin (P < 0.001), be certain that they know how to perform a skin exam (P < 0.001), and be knowledgeable about skin cancer prevention (P < 0.05 and P < 0.001, respectively); soccer participants are additionally more likely to wear protective headgear (P < 0.05) and perform monthly self-exams of their skin (P < 0.001). All analyses incorporated three control variables: participants' prior history of skin cancer, age, and non-HCP-derived skin-cancer awareness.

CONCLUSIONS

Findings suggest that HCPs' counseling can positively shape skin-cancer-related prevention practices, detection self-efficacy, and knowledge. Additional research is needed on HCPs' actual communication about skin cancer and sun protection and its influence on client outcomes.

Albumin dialysis in cirrhosis with superimposed acute liver injury: possible impact of albumin dialysis on hospitalization costs

Albumin dialysis using the Molecular Adsorbents Recirculating System (MARS) has been found to be beneficial in the treatment of cirrhotic patients with acute decompensation to improve survival as well as reduce associated complications. The present study attempts to analyze the costs involved, and compare it to the benefit as a result of the MARS therapy, thus evaluating its cost-effectiveness. Using the results of a study by Kim et al. describing the effects of complications on the cost of hospitalization in alcoholic liver disease patients, the expenditure incurred in a group of 11 patients treated with standard medical therapy (five survivors) and a group of 12 patients treated with MARS in addition (11 survivors) (Heemann et al., Hepatology 2002) were analyzed. MARS resulted in a reduction of in-hospital deaths, as well as liver disease-related complications. Both these factors led to a substantial reduction of costs in the MARS group, which was enough to counterbalance the extra costs associated with extra-corporeal therapy. In the control group, the total hospitalization cost per survivor were calculated to be at $35,904. In the MARS group, the overall expenditure per survivor including standard medical therapy plus additional MARS liver support therapy were $32,036--a saving of nearly $4000 compared to the control group. Therefore, it appears that the benefits of MARS therapy are enough to justify the cost of treatment and safe hospital costs, at least in the described population. However, further studies are needed to confirm these results.

Initial in vitro toxicity testing of functional foods rich in catechins and anthocyanins in human cells

Functional foods need to be assessed for beneficial effects to support claims, but also for toxic effects. This report describes two examples of how complex food samples are initially characterized in human cells in vitro. Water extracts of green tea (GT) and black carrots (BC) were analyzed for key ingredients (catechins and anthocyanidins, respectively). Extracts, reconstituted mixtures of the major ingredients or individual compounds [(-)-epigallocatechin gallate or cyanidin, respectively] were evaluated in parallel using human colon cells (HT29 clone 19A). End points of cytotoxicity included determination of membrane integrity, proliferation inhibition, and genetic damage. Cells were pretreated with plant compounds at sub-toxic concentrations, and their resistance to toxicity of H2O2 was evaluated as a parameter of protection. The extracts reduced cell viability (BC) and cell growth (BC, GT) and caused DNA damage (BC, GT). They were more toxic than their key ingredients. Neither GT-samples nor BC protected against H2O2-induced DNA damage, whereas cyanidin did. In vitro analysis of extracts from functional foods firstly aims at defining the sub-toxic concentrations at which protective activities are then further characterized. It also allows comparing responses of complex samples and individual compounds, which is important since effects from protective food ingredients can be masked by accompanying toxic components.

Evolutionary history and phylogeography of the schistosome-vector freshwater snail Biomphalaria glabrata based on nuclear and mitochondrial DNA sequences

The phylogeography of the freshwater snail Biomphalaria glabrata remains poorly known, although this species is the major vector of schistosomiasis in the New World. It was here investigated in South America and the Lesser Antilles, based on partial mitochondrial large ribosomal subunit (16S rDNA) and nuclear internal transcribed spacer-2 (ITS-2) gene sequences. Sampling included 17 populations from a large part of the current geographic range of the species (Brazil, Venezuela and Lesser Antilles). Substantial variability was detected, as well as a high amount of phylogenetically informative signal. The molecular phylogeny inferred splits B. glabrata into Northern and Southern clades separated by the Amazon river, and may even suggest a supra-specific status for B. glabrata. Brazilian populations were the most diverse and appeared basal to the other populations. Venezuelan haplotypes formed a single clade, albeit not strongly supported. Two Venezuelan haplotypes appear rather similar to Brazilian haplotypes. Similarly, Lesser Antilles haplotypes clustered in the same monophyletic clade, which suggests that the recent colonisation of the Antilles has a northern South American origin. However, the estimated divergence time between Antilles and Venezuelan sequences is extremely large (conservatively higher than 10(5) years). These results are discussed in the light of (i) phylogeographic patterns at South American scale, and (ii) recurrent introduction of molluscs, especially in the Antilles, as a consequence of human activities.

Outpatient mastectomy: clinical, payer, and geographic influences

OBJECTIVE

To determine (1) the use of outpatient services for all surgical breast procedures for breast cancer and (2) the influence of payer and state on the use of outpatient services for complete mastectomy in light of state and federal length-of-stay managed care legislation.

DATA SOURCES

Healthcare Cost and Utilization Project representing all discharges from hospitals and ambulatory surgery centers for five states (Colorado, Connecticut, Maryland, New Jersey, and New York) and seven years (1990-96).

STUDY DESIGN

Longitudinal, cross-sectional analyses of all women undergoing inpatient and outpatient complete mastectomy (CMAS), subtotal mastectomy (STMAS), and lumpectomy (LUMP) for cancer were employed. Total age-adjusted rates and percentage of outpatient CMAS, STMAS, and LUMP were compared. Independent influence of state and HMO payer on likelihood of receiving an outpatient CMAS was determined from multivariate models, adjusting for clinical characteristics (age < 50 years, comorbidity, metastases, simple mastectomy, breast reconstruction) and hospital characteristics (teaching, ownership, urban).

PRINCIPAL FINDINGS

In 1993, 1 to 2 percent of CMASs were outpatient in all states. By 1996, 8 percent of CMASs were outpatient in Connecticut, 13 percent were outpatient in Maryland, and 22 percent were outpatient in Colorado. In comparison, LUMPs were 78 to 88 percent outpatient, and by 1996, 43 to 72 percent of STMASs were outpatient. In 1996, women were 30 percent more likely to receive an outpatient CMAS in New York, 2.5 times more likely in Connecticut, 4.7 times more likely in Maryland, and 8.6 times more likely in Colorado compared to New Jersey. In addition, women with Medicare, Medicaid, or private commercial insurance were less likely to receive an outpatient CMAS compared to women with an HMO payer.

CONCLUSIONS

LUMP is an outpatient procedure, and STMAS is becoming primarily outpatient. CMAS, while still primarily inpatient, is increasingly outpatient in some states. Although clinical characteristics remain important, the state in which a woman receives care and whether she has an HMO payer are strong determinants of whether she receives an outpatient CMAS.

Racial and ethnic disparities in infant mortality: risk in social context

This article presents the multifaceted efforts of Syracuse Healthy Start, a federally funded initiative of the Onondaga County Health Department and over 20 partnering agencies to reduce racial and ethnic disparities in infant mortality. The analyses presented in this article demonstrate that many women--Caucasian, African American, and Hispanic--have serious risks for low birth weight and infant death. In many cases, multiple, simultaneous risks complicate a pregnant woman's situation and in other cases the longitudinal cumulative risks impact health across generations. Infant mortality decreased overall, and for both Caucasian and African American infants during the first 3 years of the project.

Molecular characterization and mitochondrial sequence variation in two sympatric species of Proechimys (Rodentia: Echimyidae) in French Guiana

Variations in mitochondrial DNA characters were used to characterize two morphologically similar and sympatric species of Neotropical terrestrial rodents of the genus Proechimys (Mammalia: Echimyidae). We sequenced both cytochrome b (1140pb) and part of the control region (445pb) from four individuals of P. cuvieri and five of P. cayennensis from French Guiana, which allowed us to depict intra- and inter-specific patterns of variation. The phylogenetic relationships between the nine sequences evidence the monophyly of each species, and illustrate that more polymorphism might exist within P. cuvieri than within P. cayennensis. By developing species-specific primers to amplify a fragment of the cytochrome b gene, we were able to identify 50 individuals of Proechimys spp. caught in two localities of French Guiana. In both sites of primary rainforests, we showed that the two species live in syntopy, and this observation emphasizes the need to document ecological differences which should exist in order to diminish inter-specific competition.

Stromelysin-3 expression in noninvasive and invasive neoplasms of the urinary bladder

Stromelysin-3 (ST-3) is a protease frequently expressed by fibroblasts surrounding invasive carcinomas. Based on its expression in some cases of breast carcinoma-in-situ, it has been thought to indicate a higher likelihood for subsequent invasion in preinvasive lesions. Carcinoma-in-situ (pTis) and noninvasive papillary tumor (pTa) of the urinary bladder are preinvasive lesions with an uncertain potential to become invasive. We studied the expression of ST-3 in pTis, pTa, and invasive bladder tumors to see whether it had an association with any established histopathologic variables and whether its expression might be an indicator of incipient invasion in the preinvasive lesions. Twenty-seven pTis, 27 pTa tumors, and 56 invasive bladder carcinomas were studied for ST-3 expression with immunohistochemistry and, in selected cases, with in situ hybridization. Staining for ST-3 was evaluated semiquantitatively. None of 27 pTis lesions, 4 of 27 pTa tumors, and 41 of 56 (73.2%) invasive carcinomas were positive for ST-3. Statistically significant associations were found in the invasive carcinomas between ST-3 expression and lymphatic vessel invasion, an infiltrative invasive pattern, and invasion into at least the muscle layer (pT2,3,4 v pT1). The expression of ST-3 in frankly invasive tumors was associated with a more aggressive tumor phenotype. Its expression in a small subgroup of pTa lesions may be indirect evidence that some tumors diagnosed as pTa have invasive potential.

Tracking the State Children's Health Insurance Program with hospital data: national baselines, state variations, and some cautions

State and federal agencies are concerned with the impact of the State Children's Health Insurance Program (CHIP) on the health care of enrolled children. As part of a broad program evaluation, and at relatively low cost, analysts can track data on hospital admissions for ambulatory care sensitive (ACS) conditions. This article uses hospital data for 19 states to calculate baseline ACS rates and to discuss trends and cross-state variations just prior to the start of the CHIPs. A few cautions and limitations are discussed. An unexpected result in the exploration was a substantial increase in the rate of ACS admissions for self-pay and Medicaid-enrolled children during the period of 1990-1995. During that same period, the admission rate for other insured children fell by more than a third. The comparisons across states are meant to be illustrative; they do reveal a relationship between the rate of asthma admissions and the proportion of self-pay plus Medicaid-enrolled cases.

Pht2;1 encodes a low-affinity phosphate transporter from Arabidopsis

An Arabidopsis genomic sequence was recently shown to share similarity with bacterial and eukaryotic phosphate (Pi) transporters. We have cloned the corresponding cDNA, which we named Pht2;1, and subsequently performed gene expression studies and functional analysis of the protein product. The cDNA encodes a 61-kD protein with a putative topology of 12 transmembrane (TM) domains interrupted by a large hydrophilic loop between TM8 and TM9. Two boxes of eight and nine amino acids, located in the N- and C-terminal domains, respectively, are highly conserved among species across all kingdoms (eubacteria, archea, fungi, plants, and animals). The Pht2;1 gene is predominantly expressed in green tissue, the amount of transcript staying constant in leaves irrespective of the Pi status of the shoot; in roots, however, there is a marginal increase in mRNA amounts in response to Pi deprivation. Although the protein is highly similar to eukaryotic sodium-dependent Pi transporters, functional analysis of the Pht2;1 protein in mutant yeast cells indicates that it is a proton/Pi symporter dependent on the electrochemical gradient across the plasma membrane. Its fairly high apparent K(m) for Pi (0.4 mM) and high mRNA content in the shoot, especially in leaves, suggest a role for shoot organs in Pi loading. Pht2;1 thus differs from members of the recently described plant Pi transporter family in primary structure, affinity for Pi, and presumed function.

Pht2;1 encodes a low-affinity phosphate transporter from Arabidopsis

An Arabidopsis genomic sequence was recently shown to share similarity with bacterial and eukaryotic phosphate (Pi) transporters. We have cloned the corresponding cDNA, which we named Pht2;1, and subsequently performed gene expression studies and functional analysis of the protein product. The cDNA encodes a 61-kD protein with a putative topology of 12 transmembrane (TM) domains interrupted by a large hydrophilic loop between TM8 and TM9. Two boxes of eight and nine amino acids, located in the N- and C-terminal domains, respectively, are highly conserved among species across all kingdoms (eubacteria, archea, fungi, plants, and animals). The Pht2;1 gene is predominantly expressed in green tissue, the amount of transcript staying constant in leaves irrespective of the Pi status of the shoot; in roots, however, there is a marginal increase in mRNA amounts in response to Pi deprivation. Although the protein is highly similar to eukaryotic sodium-dependent Pi transporters, functional analysis of the Pht2;1 protein in mutant yeast cells indicates that it is a proton/Pi symporter dependent on the electrochemical gradient across the plasma membrane. Its fairly high apparent K(m) for Pi (0.4 mM) and high mRNA content in the shoot, especially in leaves, suggest a role for shoot organs in Pi loading. Pht2;1 thus differs from members of the recently described plant Pi transporter family in primary structure, affinity for Pi, and presumed function.

[Efficacy of ultrasound screening in pregnancy]

OBJECTIVE

The purpose of this study was to examine the effectiveness of ultrasound screening in pregnancy.

MATERIAL AND METHODS

Therefore, it was registered whether fetal malformations in a study population of 11,172 deliveries were already diagnosed before birth.

RESULTS

341 defects were found in 297 children from mothers who had had prenatal care. Most anomalies were seen in the urogenital tract (n = 98; 28.7%), the heart (n = 67; 19.6%), the connective tissue (n = 39; 11.4%), the gastrointestinal tract (n = 32; 9.4%), and in the central nervous system (n = 33; 9.7%). Chromosomal anomalies (n = 22; 6.5%) and orofacial defects (n = 21; 6.2%) were more rare. 8.8% of all defects were lethal, 37% severe. 237 (69.5%) were classified as "diagnosable by ultrasound prenatally". 125 of them (53%) were identified prenatally, with high rates of 71% in central nervous system, 65.5% in intestinal and 54% in urogenital tract, while the detection rate was only 13.6% in chromosomal and 3.3% in cardiac defects. Only 14.3% were found before 24 weeks of gestation.

CONCLUSIONS

Thus, the effectiveness of ultrasound screening has to be improved by adequate measures.

Readability of skin cancer prevention brochures targeting parents of young children

Long-term exposure to UV radiation and severe sunburns increase one's risk of experiencing malignant melanoma later in life, so parents need to be informed about how to protect children from overexposure to the sun. We attempted to determine readability of skin cancer brochures targeted toward parents of young children. SMOG and FOG readability formulas were applied to 8 brochures published by the American Cancer Society, Skin Cancer Foundation, American Academy of Dermatology, and the Anti-Cancer Council. Readability levels of the brochures ranged between the 8th and 12th grade levels. To reduce the incidence of skin cancer, sun-safe knowledge and behavior should start in childhood. Pediatricians need access to brochures written at readability levels for the average parent. Skin cancer brochures written at the eighth or ninth grade comprehension levels may allow pediatricians to educate more parents about the importance of skin cancer prevention in childhood.

Communicating about youth's sun exposure risk to soccer coaches and parents: a pilot study in Georgia

Efforts to increase the sun-protective behaviors of children were extended to outdoor recreational sports and youth soccer settings in this study. The pretest results of a pilot survey of coaches (n = 12), parents (n = 50), and youths (n = 61) on eight soccer teams in south Georgia were used to guide the development of a health education program for coaches. In the pilot programs, half the coaches were trained to be involved in soccer-playing youths' sun protection by acting as positive role models and promoting sun protection to youths and their parents. The pilot demonstrated coaches' willingness to participate in sun protection promotion to youth: Youths indicated that coaches and parents were more likely to tell youths to wear sunscreen after the training than before, and coaches perceived getting youths to wear sunscreen to be less difficult than before.

Does managed care affect the supply and use of ICU services?

This paper analyzes use of hospital intensive care units (ICUs) by adult patients who are under age 65 and not covered by Medicaid; it allows for variation in indicators of the patient's condition, severity of illness, type of admission, emergency status, and degree of constraint on the total hospital ICU supply. We use data for Massachusetts and Florida in 1992. In neither state is there a significant difference in ICU admission rates between managed care patients and other privately insured patients. In Massachusetts, we find that the length of stay in the ICU is somewhat less for managed care and uninsured patients than for other privately insured patients. In both states, a hospital's ratio of total annual supply of ICU services to expected demand has a strong effect. In Massachusetts, the differences across payer groups in length of stay disappear for hospitals where the total ICU supply is relatively constrained.

Georgia's harvesting healthy habits: a formative evaluation

Occupational safety and health researchers seek to conduct effective cancer awareness campaigns to increase agricultural workers' skin cancer prevention and detection behaviors. Georgia undertook such a project using a social cognitive theory (Bandura, 1986) conceptual model, with its objectives focusing on personal determinants of and environmental influences on farmers' behavior. One underused strategy to increase the success of health campaigns, formative evaluation, was undertaken during year one of the demonstration project, with four goals. These included an assessment of: (1) the availability of societal resources to support farmers' practices, (2) the affordability for farmers to follow through with behaviors being promoted, (3) the social support for behaving in ways that reduce farmers' skin cancer risk, and (4) farmers' current knowledge, outcome expectations, and self-efficacy in this regard. Formative evaluation revealed an absence of information, products, services, and social support for farmers' skin cancer prevention and detection. As a result, the Georgia project's plan was refined to include specific activities aimed at increasing the environmental support for health promotion activities relating to farmers' skin cancer prevention and detection. These include a seminar for rural primary care physicians and public health nurses to increase knowledge and skills relating to conducting clinical skin exams; programs for agricultural extension agents, cotton scouts, and 4-H groups to provide opportunities to learn more about and practice sun safety; and a feed and seed store campaign.