Cross-cultural adaptation and implementation of Good Life with osteoarthritis in Denmark (GLA:D™): group education and exercise for hip and knee osteoarthritis is feasible in Canada

OBJECTIVE

Adapt and evaluate the feasibility of implementing Good Life with osteoArthritis in Denmark (GLA:D^TM) in Canada for people with mild to severe hip/knee osteoarthritis.

METHODS

Patients triaged to non-surgical management participated in two education sessions and 12 supervised, neuromuscular exercise classes. We used the RE-AIM implementation framework evaluating outcomes of Reach, Effectiveness/Efficacy, Adoption, Implementation and Maintenance. Patients completed surveys pre-program and at 3 months follow-up. Program fidelity was evaluated at four observations against a priori criteria. We conducted semi-structured interviews with therapists post-program.

RESULTS

72 patients consented to participate, 59 started the program and one withdrew on physician advice. The remaining 58 provided follow-up data. Mean age was 67 years; 78% were female and 52% had body mass index (BMI) >25. The effect of the program was demonstrated: 40% improvement in pain with 59% achieving a clinically important improvement of ≥2 points on the Numeric Pain Rating scale. Statistically significant improvement also occurred in the Hip disability/Knee injury and Osteoarthritis Outcome Score subscales. 24% reported increased physical activity. Program fidelity was demonstrated with all criteria met. Therapists emphasized that rolling recruitment allowed appropriate supervision and resulted in participants encouraging each other. 99% of participants indicated they benefitted from and were satisfied with the program and 90% reported using the knowledge daily. 52% were willing to pay >$250 Cdn for the program.

CONCLUSION

GLA:D^TM implementation was feasible in the Canadian context with results similar to those of >7,000 participants in Denmark. Implementation and evaluation of GLA:D^TM Canada is now occurring nationally.

Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases

Background

The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.

Methods

Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).

Results

Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.

Conclusion

Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.

DNA Methylation and microRNA patterns are in association with the expression of BRCA1 in ovarian cancer

Ovarian cancer is the sixth most prevalent cancer in women and is considered the most lethal gynecological malignancy. It can be inherited as a familial disease but also has a strong spontaneous occurrence. Although the disease is associated with genome instability brought on by genetics and environmental factors there is evidence that mutations in the gene encoding for the breast cancer type 1 susceptibility protein (BRCA1) or its down-regulation are involved in its development. Down-regulation of BRCA1 expression by hypermethylation of its promoter may account for some cases of ovarian cancer but this does not explain the cause of the majority of the disease. This review explores the role of BRCA1 promoter hypermethylation and micro-RNAs (miRNA) involved in the regulation of BRCA1 and their role in ovarian cancer development as well as some of the exciting discoveries which could lead to targeting miRNA with a view to restoring BRCA1 expression in diseased tissues.

Toll-like receptor 4 plays significant roles during allergic rhinitis

Allergic rhinitis is a nasal hypersensitivity and allergic disease which leads to inflammation of nasal mucosa. Previous investigations revealed that innate immune receptors play a key role in the pathogenesis of inflammatory diseases including allergic diseases. Toll-like receptors (TLRs), which are important innate immune receptors, play crucial roles in the recognition of foreign antigens, including allergens, and subsequently for the induction of immune responses such as inflammation. There are several controversial reports regarding the roles of TLR4 in the pathogenesis of allergic rhinitis. This review presents current information regarding the roles of TLR4 in the pathogenesis of allergic rhinitis and the plausible mechanisms which lead to the expression and function of TLR4 in this disease.

TLR3 and its roles in the pathogenesis of type 2 diabetes

Type 2 diabetes (T2D) is the most prevalent non—infectious disease and leads to several complications including nephropathy and retinopathy. The mechanisms and signaling molecules responsible for the development and progression of T2D, as well as its associated complications are yet to be identified. It would appear that genetic backgrounds and immunological parameters of people susceptible to T2D may play important roles in induction of T2D. TLRs participate in several cellular pathways which can induce activation of proliferation. However, in contradiction, these pathways can also be associated with apoptosis. The multiple roles of TLRs and their signaling molecules associated with T2D pathways makes them candidates for the induction of immune—regulated diseases like T2D. TLR3 has been identified as an intracellular ligand and subsequently activates signaling molecules via the TRIF pathway. Therefore, the alteration of expression of TLR3 and their functions may lead to inappropriate induction of immune system functions that are related to T2D disease. The aim of this review was to collect recent data regarding the roles of TLR3 in the progression and pathogenesis of T2D.

Clinical recommendations for management of mesiodens and unerupted permanent maxillary central incisors

BACKGROUND

Un-erupted maxillary incisors may result secondary to supernumerary teeth. Despite the removal of such mesiodentes, orthodontic traction of a permanent un-erupted maxillary incisor may be required.

REVIEW

The literature regarding the impacted maxillary central incisor(s) was reviewed and all pertinent publications on the subject assessed. The review specifically relative to mesiodentes, surgical exposure and orthodontic management was interpreted together with the clinical experience of a number of the authors' cases. From this analysis a set of recommendations was developed.

RECOMMENDATIONS

(1) A sufficient arch space has to be ensured or orthodontically created for permanent maxillary central incisor(s). (2) Early surgical extraction of a mesiodens or mesiodentes (ideally before 7 years of age), with simultaneous closed surgical exposure of the permanent impacted maxillary incisor with bonding of an attachment with gold chain. (3) Re-evaluation after 2-3 months to assess for any natural eruption of the maxillary central incisor. (4) Application of orthodontic traction in the event of non-eruption.

CONCLUSION

Early diagnosis of the presence of mesiodentes is imperative. Appropriate surgical and/or orthodontic traction is often indicated with regular post-surgical follow-up assessments.

Medication use in pregnancy: a cross-sectional, multinational web-based study

OBJECTIVES

Intercountry comparability between studies on medication use in pregnancy is difficult due to dissimilarities in study design and methodology. This study aimed to examine patterns and factors associated with medications use in pregnancy from a multinational perspective, with emphasis on type of medication utilised and indication for use.

DESIGN

Cross-sectional, web-based study performed within the period from 1 October 2011 to 29 February 2012. Uniform collection of drug utilisation data was performed via an anonymous online questionnaire.

SETTING

Multinational study in Europe (Western, Northern and Eastern), North and South America and Australia.

PARTICIPANTS

Pregnant women and new mothers with children less than 1 year of age.

PRIMARY AND SECONDARY OUTCOME MEASURES

Prevalence of and factors associated with medication use for acute/short-term illnesses, chronic/long-term disorders and over-the-counter (OTC) medication use.

RESULTS

The study population included 9459 women, of which 81.2% reported use of at least one medication (prescribed or OTC) during pregnancy. Overall, OTC medication use occurred in 66.9% of the pregnancies, whereas 68.4% and 17% of women reported use of at least one medication for treatment of acute/short-term illnesses and chronic/long-term disorders, respectively. The extent of self-reported medicated illnesses and types of medication used by indication varied across regions, especially in relation to urinary tract infections, depression or OTC nasal sprays. Women with higher age or lower educational level, housewives or women with an unplanned pregnancy were those most often reporting use of medication for chronic/long-term disorders. Immigrant women in Western (adjusted OR (aOR): 0.55, 95% CI 0.34 to 0.87) and Northern Europe (aOR: 0.50, 95% CI 0.31 to 0.83) were less likely to report use of medication for chronic/long-term disorders during pregnancy than non-immigrants.

CONCLUSIONS

In this study, the majority of women in Europe, North America, South America and Australia used at least one medication during pregnancy. There was a substantial inter-region variability in the types of medication used.

The response to testosterone undecanoate in men with type 2 diabetes is dependent on achieving threshold serum levels (the BLAST study)

BACKGROUND

The association between testosterone deficiency and insulin resistance in men with type 2 diabetes is well established. Current Endocrine Society and European Association of Urology guidelines recommend the measurement of testosterone levels in all men with type 2 diabetes and in men suffering from erectile dysfunction. It is recognised that a range of physical symptoms appear as the testosterone level falls but few studies have addressed the threshold at which symptoms improve with physiological replacement. We report the first double-blind placebo-controlled study conducted exclusively in a male type 2 diabetes population to assess the metabolic changes with testosterone replacement.

METHODS

The type 2 diabetes registers of seven general practices were screened to establish the prevalence of low testosterone and the associations with diabetes control. Of 550 eligible patients approached, 488 men (mean age 62.6) consented to take part in screening with a morning testosterone level, assessed between 8 and 11 am. This identified 211 patients for a double-blind placebo-controlled study of long acting testosterone undecanoate (TU) 1000 mg lasting 30 weeks followed by 52 weeks of open label use. The population was divided into a SEVERE group with either total testosterone (TT) of 8 nmol/l or less or free testosterone (FT) 180 pmol/l or less or a MILD group with TT 8.1-12 nmol/l or FT 181-250 pmol/l.

RESULTS

Men in the SEVERE group increased mean through TT from 7.73 nmol/l at baseline to 9.93 at 30 weeks and the MILD group from 10.47 to 11.94. The SEVERE group showed marked improvement in sexual function, but no significant improvement in metabolic parameters. The MILD group showed no improvement in sexual function, but significant improvement in weight, body mass index, waist circumference and Hospital Anxiety and Depression Scale. Improvement was seen in all parameters during 52 weeks open label treatment where trough TT levels approached 15 nmol/l. Baseline prostate-specific antigen (PSA) was lower in the SEVERE group and increased with TU for 30 weeks and then stabilised. There was no increase in PSA with treatment in the MILD group.

CONCLUSIONS

Testosterone undecanoate significantly improves sexual parameters and Ageing Male Symptom Score, but not metabolic factors at 30 weeks in men with SEVERE testosterone deficiency syndrome (TDS). In men with MILD TDS, significant improvements in metabolic but not sexual parameters were seen, suggesting that there are threshold levels for response to testosterone replacement therapy and that trials of therapy need to achieve sustained therapeutic levels to be effective. PSA showed minor rises, but only for 30 weeks in the SEVERE group.

Abstract P3-09-17: One year of adjuvant hormone therapy does not increase patient fatigue: Results of a prospective early stage breast cancer trial

INTRODUCTION: The diagnosis and treatment of breast cancer may alter a patient's mental and physical quality of life. Estrogen effects on the brain may be neuroprotective or detrimental, and adjuvant endocrine therapy may influence cognitive functions including fatigue. We previously reported that three months of adjuvant hormone therapy was not associated with change in fatigue. The purpose of this study was to prospectively determine the incidence of fatigue in early stage breast cancer patients during one year of adjuvant hormone therapy. METHODS: Seventy-four consecutive patients of a single medical oncologist with newly diagnosed hormone dependent breast cancer prescribed adjuvant hormone therapy enrolled in this prospective study. Data collected included age, race, menopausal status, breast cancer stage, body mass index, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT)-F, Fatigue Assessment Scale (FAS), short form 36 (SF-36), and cognitive failure questionnaire (CFQ). All tests were administered by one nurse prior to hormone initiation (0 mo) and after 3, 6, 9, and 12 months (mo) of therapy. Statistical analysis was performed using Student t test for paired data with a p value of <0.05 considered significant. RESULTS: Prior to starting therapy, a third of patients had a FAS score of >22, consistent with moderate to severe fatigue. After 12 months of therapy, 52 patients (13 premenopausal, 39 postmenopausal) were still receiving adjuvant hormone therapy and had completed serial testing. Twenty patients received chemotherapy prior to institution of hormone treatment. There were no significant changes in FACIT-F, FAS, SF-36, or CFQs scores during the first 12 months of treatment.

 0 mo3 mo6 mo9 mo12 moFACIT-F44 (7-52)*42 (3-52)43 (3-52)43 (2-52)44 (6-52)FAS17 (10-43)18 (10-48)17 (10-48)20 (10-48)19 (10-50)Weight, lb.159 (102-256)162 (102-258)161 (102-258)163 (102-263)164 (101-258)SF-36 Total72 (12-100)68 (15-99)83 (15-99)76 (15-99)82 (7-100)CFQ70 (39-94)69 (34-92)68 (34-94)67 (28-96)70 (20-96)* Median (Range)

Although during the first six months, a small but significant increase in body weight occurred, there was no significant difference between the initial and 12 month body weight. CONCLUSION: Prior to adjuvant hormone therapy institution, breast cancer patients often have significant problems with fatigue. However, the first 12 months of adjuvant hormone therapy does not appear to affect fatigue or cognitive failure.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-09-17.

Genome-wide association study of shared components of reading disability and language impairment

Written and verbal languages are neurobehavioral traits vital to the development of communication skills. Unfortunately, disorders involving these traits-specifically reading disability (RD) and language impairment (LI)-are common and prevent affected individuals from developing adequate communication skills, leaving them at risk for adverse academic, socioeconomic and psychiatric outcomes. Both RD and LI are complex traits that frequently co-occur, leading us to hypothesize that these disorders share genetic etiologies. To test this, we performed a genome-wide association study on individuals affected with both RD and LI in the Avon Longitudinal Study of Parents and Children. The strongest associations were seen with markers in ZNF385D (OR = 1.81, P = 5.45 × 10(-7) ) and COL4A2 (OR = 1.71, P = 7.59 × 10(-7) ). Markers within NDST4 showed the strongest associations with LI individually (OR = 1.827, P = 1.40 × 10(-7) ). We replicated association of ZNF385D using receptive vocabulary measures in the Pediatric Imaging Neurocognitive Genetics study (P = 0.00245). We then used diffusion tensor imaging fiber tract volume data on 16 fiber tracts to examine the implications of replicated markers. ZNF385D was a predictor of overall fiber tract volumes in both hemispheres, as well as global brain volume. Here, we present evidence for ZNF385D as a candidate gene for RD and LI. The implication of transcription factor ZNF385D in RD and LI underscores the importance of transcriptional regulation in the development of higher order neurocognitive traits. Further study is necessary to discern target genes of ZNF385D and how it functions within neural development of fluent language.

A Structured Review and Classification of Demolding Issues and Proven Solutions

The demolding of replicated parts can result in damage to both the replication tooling and finished parts and is a particular problem for the replication of smaller parts which can be quite fragile. Various techniques have been proposed in the literature to solve such problems by reducing the overall demolding force. This paper presents the challenge of demolding replicated parts and reviews the proven solutions from the literature which have been developed. A summary chart of these solutions is presented which may be used to implement plans to solve demolding problems with replicated parts. Such a rationalization of existing knowledge will enable replication tool developers to systematically select and apply proven solutions to solve, and ultimately prevent, demolding problems.

Abstract P6-08-08: Three months of adjuvant hormone therapy does not increase fatigue or cognitive failure: results of a prospective early stage breast cancer trial

INTRODUCTION: The diagnosis and treatment of breast cancer may alter a patient's mental and physical quality of life. Fatigue and impaired cognition have been reported after chemotherapy and hormone therapy. The purpose of this study was to prospectively determine the incidence of fatigue and cognitive changes in early stage breast cancer patients during adjuvant hormone therapy and to evaluate the relationship of dysfunction with other risk factors.

METHODS: Fifty-four consecutive patients of a single medical oncologist with newly diagnosed hormone dependent breast cancer prescribed adjuvant hormone therapy enrolled in this prospective study. Data collected included age, race, menopausal status, breast cancer stage, body mass index, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT)-F, Fatigue Assessment Scale (FAS), short form 36 (SF-36), cognitive failure questionnaire (CFQ), Beck depression inventory (BDI-2), Epworth sleepiness scale, and facial recognition (FR) and sheep dash time (SDT) to assess executive functioning. All tests were administered by one nurse prior to hormone initiation (0 mo) and after 3 months (3 mo) of therapy. Statistical analysis was performed using Student t test for paired data with a p value of <0.05 considered significant.

RESULTS: After 3 months of therapy, 52 of 54 patients were reevaluated (1 patient dropped out and 1 excluded for metastatic disease). Of the remaining 52 patients, the mean age was 54 years (range 30–76) with self-reported race of white 38, black 13 and Indian 1 patient and 39 (75%) patients were postmenopausal. Initial tumor stage was 0 in 8 patients, 1 in 23, 2 in 20, and 3 in 1. Although the baseline mental health of patients assessed by SF-36 mental health (MH) domain was low (70 ±22.0 [mean ±SD]) after 3 months it improved to 55 ±8.1, P < 0.0001. No change was found in the SF-36 domains of physical health or vitality. At baseline, 15 of 52 patients (36%) reported significant fatigue (FAS score ≥22). After 3 months of therapy fatigue as measured by either the FACIT-F (0 mo:30 ±11.2; 3 mo:31 ±9.5, p = 0.37) or FAS (0 mo:20 ±8.5; 3 mo: 20 ±7.6, p = 0.53) remained unchanged. No change was noted in depression as determined by the BDI-2 score (0 mo: 9 ±8.1 versus 3 mo:9 ± 9, p = NS) or Epworth sleepiness scores (0 mo:7 ±4.5 versus 3 mo:8 ±4.7, p = NS). The initial CFQ was considered positive (>43) in 48 (92%) of patients. There was no significant change in the CFQ, SDT, or FR (CFQ 0 mo:67±12.9, 3 mo:67±13.0, p = 0.453; SDT: 0 mo:0.56±0.292 secs, 3 mo:0.52±0.223 secs, p = 0.144). BMI rose minimally after hormone therapy (0 mos:28.8 ±6.41; 3 mo:29.1 ±6.43, p = 0.0498).

CONCLUSION: Prior to adjuvant hormone therapy institution, breast cancer patients often have significant problems with fatigue, cognitive failure, and overall mental health. Overall mental health improved during the first three months of hormone therapy. However, there was no significant change in fatigue, cognitive failure, depression score, reaction time, or facial recognition. Longer follow–up will be performed to assess the possible cumulative effects of hormone therapy on fatigue or cognitive function. Supported by Ride Cincinnati

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-08-08.