Partial breast irradiation (PBI) concurrent with adjuvant dose-dense doxorubicin and dyclophosphamide (ddAC) chemotherapy in early-stage breast cancer: Preliminary safety results from a feasibility trial

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Background: Adjuvant anthracycline-based chemotherapy regimens and radiation therapy as part of breast conservation therapy (BCT) are given sequentially to avoid excessive skin toxicity. PBI employs a shorter course of radiation therapy to a smaller breast field and is the subject of randomized efficacy trials. Concurrent administration of PBI and adjuvant chemotherapy would decrease duration of therapy, allow more women to pursue BCT, improve compliance, and potentially enhance local control. Methods: To examine the feasibility, safety, and short-term risk of recurrence of concurrent PBI with adjuvant ddAC, we are conducting a prospective one-stage, single-arm trial of PBI during the first 2 of 4 cycles of ddAC (60 and 600 mg/m2, respectively) delivered q14d with growth factor support. Patients (pts) with T1–2 N0–1 breast cancer and lumpectomy margins ≥ 3mm are eligible. PBI starts within 3 days of first chemo dose and treats the lumpectomy bed plus margin with 270 cGy fractions × 15 (4050 cGy total). Primary endpoints (skin/soft tissue toxicity and cosmetic outcome) are graded by a panel of physicians using commonly accepted scales. Digital images at baseline, during, and q 3–6 months after PBI are obtained for comparison. Additional chemo and endocrine Rx post ddAC given at the physician’s discretion. We report preliminary safety data. Results: Between 11/04 and 9/05, 10 pts were enrolled and received study therapy (accrual goal = 42); 2 pts also received dd paclitaxel 175 mg/m2 post ddAC. All pts received planned PBI (med. f/u 6 mos, range 3–12 mos). 2 pts missed 1 and 2 cycles of ddAC because of stomatitis (Gr 3) and diverticulitis, respectively. 3 other pts had 1–2 wk chemo delay because of hand-foot syndrome, brief pulmonary syndrome, and febrile neutropenia. No pts developed radiation dermatitis > Gr 1 or radiation recall. All pts had cosmetic outcome grades of good or excellent shortly after completion of therapy. No pts with ≥ 6 mos f/u since PBI had late skin toxicity. Conclusion: Early results suggest that PBI concurrent with ddAC appears feasible and safe. Trial enrolment continues and longer f/u is required. (Funded by The Breast Cancer Research Foundation).

No significant financial relationships to disclose.

Preferences for involvement in medical decision making: Comparing British and German views

Despite beneficial outcomes of patients' involvement in medical decision processes, it has been claimed that patients are generally not interested in medical decision making (MDM). Whereas current research focuses on actual MDM, this research explored the impact of nationality and perceptual processes of MDM. Preferences for involvement in decision making were examined in a sample of 204 German and 143 British university students. Hierarchical multiple regressions were employed to explore the link between socio-demographic information, individuals' perceived relationship with their GP, Health Locus of Control - Powerful Others, perceptions regarding the frequency and sufficiency of information provision and involvement in MDM, and individuals' preferred level of involvement and information. A significant amount of the variance in individuals preferences for involvement could be explained (Adjusted R2 = .59, p < .001). Independent t-test analyses showed that British and German perceptions of care differed significantly on a variety of different measures. Separate analyses for the German and British group highlighted cross-national differences in care and preferences for involvement. The study suggests that preferences to become involved might depend more on perceptual processes than actual involvement in decision making, and that communication and national health policy could play an important role.

A systematic review of cancer waiting time audits

A summary of a systematic review of clinical audits of cancer referrals in England and Wales.

Multiphasic helical computerized tomography for the assessment of microscopic hematuria: a prospective study

PURPOSE

We evaluated multiphasic helical computed tomography for the detection and characterization of lesions responsible for hematuria not diagnosed on prior urological surveillance studies.

MATERIALS AND METHODS

A total of 393 men and 207 women with recurrent microscopic hematuria but negative urological surveillance studies were examined at 4 participating institutions by multiphasic helical computerized tomography, consisting of pre-enhancement, arterial corticomedullary, parenchymal and excretory phase sequences generating 2 to 5 mm slices through the kidney and lower pelvis.

RESULTS

The cause of microscopic hematuria was established in 256 of 600 patients with prior negative urological surveillance examinations with 0.91 sensitivity and 0.94 specificity. The diagnosis was correct in all subsequently proven cases of calculous and renal vascular disease. A total of 67 of 70 inflammatory kidney lesions, 24 of 25 renal neoplasms, 15 of 16 bladder neoplasms, 27 of 35 inflammatory bladder conditions and 21 of 23 ureteral lesions were also correctly diagnosed. The diagnosis of renal medullary and papillary necrosis, and neoplastic lesions of the kidney and bladder allowed the early institution of medical therapy or appropriate surgery.

CONCLUSIONS

Multiphasic helical computerized tomography diagnosed lesions responsible for microhematuria in 42.6% of 600 patients with negative urological surveillance examinations. This relatively low cost and low co-morbidity examination is advocated for patients with negative urological surveillance examinations or even as a first examination.

Sex differences in the experience of testing positive for genital chlamydia infection: a qualitative study with implications for public health and for a national screening programme

OBJECTIVES

To explore men's and women's accounts of chlamydia testing, with a view to understanding sex differences in attitudes and in behaviours of public health importance.

METHODS

Semistructured interviews with 24 heterosexual patients (12 men; 12 women) diagnosed with genital chlamydia infection, at a large sexual health clinic in central London were transcribed and analysed using qualitative thematic analysis.

RESULTS

Participants' expressions revealed important sex differences. Women felt anxious about their future reproductive health, feared stigmatisation, and blamed themselves for contracting chlamydia; whereas men generally reported less concern, were unwilling to disclose their condition to sexual partners, and some men projected attributions of blame onto their partners. Delays in seeking care appeared to be related to perceptions of chlamydia as a relatively minor infection, particularly in men.

CONCLUSIONS

Health promotion needs to reflect sex and age differences, emphasising the negative consequences of delayed clinic attendance and exposure to repeat infections. For health professionals to respond appropriately and effectively to increasing numbers of chlamydia infections, there is a need to understand men's avoidant attitudes and behaviours in relation to sexual and reproductive health.

Leptin, body composition, adrenal and gonadal hormones among captive male baboons

Morphometric and hormonal measures were collected from 21 captive savanna baboons (Papio cynocephalus) maintained at the Tulane National Primate Research Center in order to determine age-related patterns in leptin levels over the life course as well as their relationships to body composition and adrenal and gonadal steroids. Comparison of leptin levels between peri-pubertal, adolescent, young adult, and fully mature males show lower levels among adolescent as compared with young adult males (P = 0.05 by Kruskal-Wallis ANOVA). In addition, abdominal fat varied among age groups (P = 0.003 by Kruskal-Wallis ANOVA) with the peri-pubertal animals lower than the adolescents, young adults, and prime adults. However leptin was not related to any measure of body composition, including abdominal fat, or to adrenal hormones (dehydroepiandrosterone, dehydroepiandrosterone-sulfate, and cortisol) or gonadal hormones (testosterone and estradiol). Age-related changes in leptin appear similar to those reported for captive rhesus macaques, while the failure to find an association between leptin and abdominal fat is interestingly different. These results confirm elevated levels of leptin in captive baboons compared with their wild counterparts and suggest that they result from changes in fetal development.

Screening for diabetic retinopathy: a cause for concern in people who drive

AIMS

To report a case of a road traffic accident in a lady driving home from a diabetes clinic after pupillary dilatation. We also present the findings of a questionnaire survey of health professionals to elicit their practice in dealing with such patients.

METHODS

We present the case report of a lady having a road traffic accident on her way back from a retinal screening appointment after having had pupillary dilatation. A subsequent postal questionnaire survey was undertaken to find out current practice in screening patients who drive on the day of their retinal screening.

RESULTS

A lady was involved in a road traffic accident whilst returning home after retinal screening. Her motor insurance company refused to cover subsequent claims for damage because her pupils had been dilated. She was also prosecuted by the police for driving without valid motor insurance. We conducted a postal survey of 500 health care workers including ophthalmologists, optometrists, diabetologists and general practitioners regarding the use of dilating drops in people with diabetes who intend to drive. Analysis of 320 valid responses confirmed that there is no consistent practice with regard to either the use of dilating drops in drivers or in ensuring that arrangements are made for subsequent adequate visual inspection in those whom dilatory drops are not instilled.

CONCLUSIONS

Guidelines, for use by health care professionals and people with diabetes, are clearly required regarding the use of pupillary dilating drops in drivers.

Anterior/posterior lumbar fusion versus transforaminal lumbar interbody fusion: analysis of complications and predictive factors

No previous study has compared the complications between anterior/posterior and transforaminal interbody fusions. We performed a retrospective analysis of 164 patients to compare the complications and associated predictive factors of the two techniques of circumferential lumbar fusion. Fifty-three had same-day anterior/posterior fusion (group 1), and 111 had transforaminal interbody fusion (group 2). Mean operating time (p < 0.0001) and hospital stay (p < 0.0001) was significantly longer for group 1 patients. Average blood loss was greater for group 1 patients (p < 0.01). Higher complication rates were found in group 1 patients (p < 0.004). Wound infection occurred more frequently in patients with adjunctive treatment (p < 0.04). Hospital stay was an independent predictor of complications in both groups. In group 1, body mass index was independently associated with complications. In group 2, both hospital stay and adjunctive treatment were predictive of complications. Transforaminal lumbar interbody fusion is the preferred technique because it is associated with shorter operating time, less blood loss, shorter hospital stay, and lower incidence of complications.

The NHS--a patient's perspective

A narrative account, from a user's perspective, of NHS service and procedures. Whilst there is much to applaud in the service and communications between staff and patients, some practices do not foster patient empowerment.

Legume consumption and risk of coronary heart disease in US men and women: NHANES I Epidemiologic Follow-up Study

BACKGROUND

Soybean protein and dietary fiber supplementation reduce serum cholesterol in randomized controlled trials. Consumption of legumes, which are high in bean protein and water-soluble fiber, may be associated with a reduced risk of coronary heart disease (CHD).

METHODS

A total of 9632 men and women who participated in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study (NHEFS) and were free of cardiovascular disease (CVD) at their baseline examination were included in this prospective cohort study. Frequency of legume intake was estimated using a 3-month food frequency questionnaire, and incidence of CHD and CVD was obtained from medical records and death certificates.

RESULTS

Over an average of 19 years of follow-up, 1802 incident cases of CHD and 3680 incident cases of CVD were documented. Legume consumption was significantly and inversely associated with risk of CHD (P =.002 for trend) and CVD (P =.02 for trend) after adjustment for established CVD risk factors. Legume consumption 4 times or more per week compared with less than once a week was associated with a 22% lower risk of CHD (relative risk, 0.78; 95% confidence interval, 0.68-0.90) and an 11% lower risk of CVD (relative risk, 0.89; 95% confidence interval, 0.80-0.98).

CONCLUSIONS

Our study indicates a significant inverse relationship between legume intake and risk of CHD and suggests that increasing legume intake may be an important part of a dietary approach to the primary prevention of CHD in the general population.

Component rotation and anterior knee pain after total knee arthroplasty

All patients undergoing cruciate-retaining primary total knee arthroplasty for degenerative osteoarthritis at one center were studied prospectively. Clinical and radiographic followup was obtained at a minimum 5 years in 102 knees in 73 patients. Patients were asked specifically about the presence of the pain in the anterior aspect of the knee in the vicinity of the patella and rated the severity of the pain on a visual analog scale. Significant anterior knee pain rating at least 3 of 10 on the visual analog scale was present in 16 knees (13 patients). Eleven patients with 14 symptomatic knees agreed to undergo computed tomography scanning to accurately determine the rotation of the tibial and femoral components. The epicondylar axis and tibial tubercle were used as references using a previously validated technique. A control group of 11 asymptomatic patients (14 knees), matched for age, gender, and length of followup also underwent computed tomography scanning. All patients in both groups had normal axial alignment. There was a highly significant difference in tibial component rotation between the two groups with the patients with anterior knee pain averaging 6.2 degrees internal rotation compared with 0.4 degrees external rotation in the control group. There also was a significant difference in combined component rotation with the patients with anterior knee pain averaging 4.7 degrees internal rotation compared with 2.6 degrees external rotation in the control group. There was no significant difference in the degree of radiographic patellar tilt or patellar subluxation between the two groups. Patients with combined component internal rotation were more than five times as likely to experience anterior knee pain after total knee arthroplasty compared with those with combined component external rotation. Component malrotation is a significant factor in the development of anterior knee pain after total knee arthroplasty.

Reproductive maturation in a sample of captive male baboons

Though baboons have been considered an appropriate non-human primate model for studying human reproductive and endocrine development. the overall similarity of reproductive maturation between the two species is unclear. This paper examines the role of testicular and adrenal hormones for pubertal changes in a cross-sectional sample of 21 captive male savanna baboons. Morphometric and hormonal indices demonstrate changes in size and gonadal function, but not adrenal function, during pubertal maturation among baboons. Results also indicate that gonadal, but not adrenal, androgens are related to morphometric variables. We conclude that savanna baboons do not make an appropriate evolutionary model of human pubertal maturation.

Alterations of the X-linked lymphoproliferative disease gene SH2D1A in common variable immunodeficiency syndrome

X-linked lymphoproliferative (XLP) disease is a primary immunodeficiency caused by a defect in the SH2D1A gene. At least 3 major manifestations characterize its clinical presentation: fatal infectious mononucleosis (FIM), lymphomas, and immunoglobulin deficiencies. Common variable immunodeficiency (CVID) is a syndrome characterized by immunoglobulin deficiency leading to susceptibility to infection. In some patients with CVID, a defective btk or CD40-L gene has been found, but most often there is no clearly identified etiology. Here, 2 unrelated families in whom male members were affected by CVID were examined for a defect in the XLP gene. In one family previously reported in the literature as having progressive immunoglobulin deficiencies, 3 brothers were examined for recurrent respiratory infections, whereas female family members showed only elevated serum immunoglobulin A levels. A grandson of one of the brothers died of a severe Aspergillus infection secondary to progressive immunoglobulin deficiency, FIM, aplastic anemia, and B-cell lymphoma. In the second family, 2 brothers had B lymphocytopenia and immunoglobulin deficiencies. X-linked agammaglobulinemia syndrome was excluded genetically, and they were classified as having CVID. The occurrence of FIM in a male cousin of the brothers led to the XLP diagnosis. Because the SH2D1A gene was found altered in both families, these findings indicate that XLP must be considered when more than one male patient with CVID is encountered in the same family, and SH2D1A must be analyzed in all male patients with CVID. Moreover, these data link defects in the SH2D1A gene to abnormal B-lymphocyte development and to dysgammaglobulinemia in female members of families with XLP disease.

Patellar resurfacing in total knee arthroplasty. A prospective, randomized, double-blind study with five to seven years of follow-up

BACKGROUND

Whether to resurface the patella during a primary total knee arthroplasty performed for the treatment of degenerative osteoarthritis remains a controversial issue. Parameters that have been suggested as being useful in guiding this decision include patient height and weight, the presence of anterior knee pain preoperatively, and the grade of chondromalacia encountered intraoperatively. The purpose of this study was to determine whether these parameters were predictive of the clinical result following total knee arthroplasty with or without patellar resurfacing.

METHODS

Eighty-six patients (118 knees) undergoing primary total knee arthroplasty for the treatment of osteoarthritis were enrolled in a prospective, randomized, double-blind study. All patients received the same posterior-cruciate-sparing total knee prosthetic components. Patients were randomized to treatment with or without resurfacing of the patella. Evaluations consisted of the determination of a Knee Society clinical score, the completion of a patient satisfaction questionnaire, specific questions relating to patellofemoral symptoms, and radiographs. Sixty-seven patients (ninety-three knees) were followed for a minimum of five years (range, sixty to eighty-four months; average, 70.5 months).

RESULTS

With the numbers available, there was no significant difference between the groups treated with and without resurfacing with regard to the overall Knee Society score or the pain and function subscores. Obesity, the degree of patellar chondromalacia, and the presence of preoperative anterior knee pain did not predict postoperative clinical scores or the presence of postoperative anterior knee pain.

CONCLUSIONS

The occurrence of anterior knee pain could not be predicted with any clinical or radiographic parameter studied. On the basis of these results, it seems likely that postoperative anterior knee pain is related either to the component design or to the details of the surgical technique, such as component rotation, rather than to whether or not the patella is resurfaced.

Predictors of outcome of floating knee injuries in adults: 89 patients followed for 2-12 years

Of the 98 floating knee injuries that were consecutively treated from 1987 to 1997, 89 patients were available for analysis. There were 80 males and 9 females, ranging from 15 to 70 years old. Average follow-up was 5 (2-12) years. Injury severity scores ranged from 18 to 45. 21 fractures were intra-articular. 55 fractures were open. Substantial comminuted and segmental fractures occurred in 57 cases and 35 cases, respectively. Multivariate analysis showed that increasing age was associated with delays in bony union and full weight bearing ability. An increase in the number of pack years smoked at the time of injury predicted the likelihood of knee stiffness, delays in bony union and full weight bearing ability. Higher injury severity scores were associated with delayed full weight bearing ability. The presence of open fractures predicted the likelihood of knee stiffness and delayed full weight bearing ability. Comminuted fractures were associated with malunion, and segmental fractures with delayed bony union. Using the outcome of floating knee injuries as fair or poor, according to Karlström and Olerud's criteria, we constructed a preoperative prognostic scoring scale which showed a sensitivity of 0.72 and a specificity of 0.90.

Chemoprevention of NMU-induced rat mammary carcinoma with the combination of melatonin and 9-cis-retinoic acid

In experimental trials using the N-nitroso-N-methylurea (NMU)-induced rat mammary tumor model, a significant decrease in tumor incidence (to 5%) was observed in rats treated with melatonin and 9-cis-retinoic acid (9 cRA) compared to controls (55%). Although 9cRA alone decreased tumor incidence to 26%, this response did not reach statistical significance. Tumor incidence was significantly inhibited to 20% in the animals that received melatonin and 9cRA on alternating days. Latency to tumor onset was prolonged in animals receiving either of the combination treatments compared with controls, and tumor multiplicity was also significantly decreased.

Dietary potassium intake and risk of stroke in US men and women: National Health and Nutrition Examination Survey I epidemiologic follow-up study

BACKGROUND AND PURPOSE

The few prospective studies that have explored the association between dietary intake of potassium and risk of stroke have reported inconsistent findings. This study examines the relationship between dietary potassium intake and the risk of stroke in a representative sample of the US general population.

METHODS

Study participants included 9805 US men and women who participated in the first National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-Up Study. Dietary potassium and total energy intake were estimated at baseline by using a 24-hour dietary recall. Incidence data for stroke and coronary heart disease were obtained from medical records and death certificates.

RESULTS

Over an average of 19 years of follow up, 927 stroke events and 1847 coronary heart disease events were documented. Overall, stroke hazard was significantly different among quartiles of potassium intake (likelihood ratio P=0.03); however, a test of linear trend across quartiles did not reach a customary level of statistical significance (P=0.14). Participants consuming a low potassium diet at baseline (<34.6 mmol potassium per day) experienced a 28% higher hazard of stroke (hazard ratio 1.28, 95% CI 1.11 to 1.47; P<0.001) than other participants, after adjustment for established cardiovascular disease risk factors.

CONCLUSIONS

These findings suggest that low dietary potassium intake is associated with an increased risk of stroke. However, the possibility that the association is due to residual confounding cannot be entirely ruled out in this observational study.

SF-36 health status of workers compensation cases with spinal disorders

BACKGROUND CONTEXT

Poorer outcomes of treatment are reported in patients with spinal disorders who receive workers compensation. The reason for their suboptimal outcomes is unclear. No study has examined the relationship between workers compensation and the Short Form Health Survey (SF-36) health status of patients with spinal disorders.

PURPOSE

To compare the self-perceived health status of spinal disorder patients receiving workers compensation with those not receiving workers compensation.

STUDY DESIGN/SETTING

A cross-sectional study on 18,389 patients who were evaluated in the 28 centers comprising the National Spine Network.

PATIENT SAMPLE

The study data were derived from patients when first evaluated for back or neck pain between January 1998 and April 2000.

OUTCOME MEASURES

The outcome measures used were the eight individual and two component scores of the SF-36.

METHODS

All first-visit patients enrolled in the National Spine Network from January 1998 to April 2000 were reviewed. Eight individual scores and two component scores of the SF-36 were compared.

RESULTS

Of the 18,389 patients, 1,535 (8%) were receiving workers compensation. Bivariate analyses showed all eight individual scores, and two summary scores of the SF-36 were significantly lower (p<.0001) in patients receiving workers compensation. After controlling for confounding covariates, workers compensation status was a significant predictor of lower SF-36 scores for General Health (p<.0001), Physical Functioning (p<.0001), Role Physical (p<.01), Social Functioning (p<.05), and Mental Health (p<.05).

CONCLUSIONS

Workers compensation status is associated with poorer physical and mental health of patients with spinal disorders. Because the workers compensation group is younger, has a shorter duration of symptoms, and fewer comorbid medical problems, the lower SF-36 scores most likely reflect psychological factors and not ill health per se. The lower SF-36 scores may also reflect premorbid personality differences in the workers compensation patients, compared with those not receiving workers compensation. SF-36 is a validated tool that can be used to objectively identify the patient at risk for delayed recovery. Future treatment protocols should pay special attention to improve the health-related quality of life, especially general health and physical functioning of spinal patients receiving workers compensation.

Rate of change in adiposity and its relationship to concomitant changes in cardiovascular risk variables among biracial (black-white) children and young adults: The Bogalusa Heart Study

To assess the annual rate of change in adiposity and its relationship to concomitant changes in cardiovascular risk variables during childhood and young adulthood, serial data on black and white children (n = 3,459; initial and follow-up mean age, 8.1 and 14.4 years) and young adults (n = 1,263; initial and follow-up mean age, 22.5 and 30.9 years) enrolled in the Bogalusa Heart Study were examined. Body mass index (BMI) and sum of subscapular and triceps skinfolds were used as indicators of adiposity. In addition, measurements were made of systolic and diastolic blood pressure and fasting levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, insulin, and glucose. Annualized rate of change for each variable was estimated. The rate of increase in adiposity was significantly more pronounced during childhood versus adulthood. Race difference (blacks > whites) in the rate of increase in adiposity was seen only among females. Females, black females in particular, displayed greater rate of increase in adiposity than males. In a multivariate analysis, the rate of increase in adiposity was related independently of baseline age and baseline adiposity to adverse changes in measured cardiovascular risk variables, except glucose. Many of these associations were modulated significantly by race, sex, and age group. The impact was relatively greater for blood pressure and LDL cholesterol in adults and for triglycerides in children. The changes in blood pressure, LDL cholesterol, and HDL cholesterol were greater in whites, while the rate of increase in insulin was greater in blacks. Females displayed greater changes in blood pressure, HDL cholesterol, and insulin. On the other hand, the rate of increase in triglycerides was greater in males. These results indicate that increases in adiposity regardless of initial status of body fatness alter cardiovascular risk variables towards increased risk beginning in childhood, and that this deleterious trend underscores the importance of weight control early in life.

An outbreak of viral gastro-enteritis at a charity function

One hundred and thirty-eight people of 431 who attended a charity function fell ill with gastro-enteritis mainly between 12 and 72 hours later. Three people were ill at the event, and a further three became ill within two hours of the event. A cohort study undertaken using a postal questionnaire showed that illness was statistically associated with having eaten cream, mints, or profiteroles. The duration of illness ranged from two to 120 hours, with a median of 48 hours. Twenty-three of the cases sent a stool sample to the laboratory. Six of these were taken to the laboratory within three days of the onset of illness and examined for bacteria before being sent for virological examination by electron microscopy (EM) and polymerase chain reaction (PCR). All six were positive for small round structured virus (SRSV) on PCR, and negative on EM. The illness was likely to have been transmitted both by foodborne transmission and person to person spread at the event.

Optimization of multiple-isocenter treatment planning for linac-based stereotactic radiosurgery

OBJECTIVE

Computer-assisted treatment planning for linac-based radiosurgery is still an open research problem, especially for multiple-isocenter procedures, primarily due to its high complexity and computational requirements. This paper focuses on the optimization of multiple-isocenter treatment planning for linac systems, and addresses several important issues associated with multiple isocenters, such as dose conformality, homogeneity, and optimization of isocenter position and dose.

METHODS

The key idea behind our approach is that the desired dose distribution can be decomposed into a number of fundamental components. In the current paper, an analytical form, the so-called Ellipsoidal Dose Distribution Estimation (EDDE) model, represents each component. We establish ways (arc configurations) to achieve such ellipsoidal doses of arbitrary position, orientation, and size. Since the EDDE model is described by relatively few parameters, it allows very quick estimation of the dose distribution corresponding to a particular isocenter and thus makes the optimization of isocenter position very efficient. It is further used in a framework for optimal treatment planning, in which a number of ellipsoidal dose distributions, each corresponding to a different isocenter, are optimally placed to cover the target while sparing healthy tissue.

RESULTS

The general ellipsoidal dose distribution of linac-based radiosurgery is summarized as a mathematical model with the aid of supporting experiments. Comparisons between the EDDE-optimized and clinically implemented plans are made, revealing the superior performance of the former. In addition, a dramatic reduction in planning time is achieved using the EDDE model.

CONCLUSION

The proposed EDDE model is a useful and effective dose model in multiple-isocenter treatment planning for linac-based radiosurgery.

Phenotypic alteration of vascular smooth muscle cells precedes elastolysis in a mouse model of Marfan syndrome

Marfan syndrome is associated with early death due to aortic aneurysm. The condition is caused by mutations in the gene (FBN1) encoding fibrillin-1, a major constituent of extracellular microfibrils. Prior observations suggested that a deficiency of microfibrils causes failure of elastic fiber assembly during late fetal development. Mice homozygous for a targeted hypomorphic allele (mgR) of Fbn1 revealed a predictable sequence of abnormalities in the vessel wall including elastic fiber calcification, excessive deposition of matrix elements, elastolysis, and intimal hyperplasia. Here we describe previously unrecognized concordant findings in elastic vessels from patients with Marfan syndrome. Furthermore, ultrastructural analysis of mgR mice revealed cellular events that initiate destructive changes. The first detectable abnormality was an unusually smooth surface of elastic laminae, manifesting the loss of cell attachments that are normally mediated by fibrillin-1. Adjacent cells adopted alteration in their expression profile accompanied by morphological changes but retained expression of vascular smooth muscle cell markers. The abnormal synthetic repertoire of these morphologically abnormal smooth muscle cells in early vascular lesions included elastin, among other matrix elements, and matrix metalloproteinase 9, a known mediator of elastolysis. Ultimately, cell processes associated with zones of elastic fiber thinning and fragmentation. These data suggest that the loss of cell attachments signals a nonproductive program to synthesize and remodel an elastic matrix. This refined understanding of the pathogenesis of vascular disease in Marfan syndrome will facilitate the development of therapeutic strategies.

Challenges and opportunities for speech and language therapists in secondary schools

Language and communication difficulties experienced by secondary school students are outlined. The challenges that the secondary school environment presents for both children and speech and language therapy services are discussed. Two case studies illustrate how speech and language therapists (SLTs) working for the Newham Education Authority Language and Communication Support Service support students in their secondary schools.

Risk variables of insulin resistance syndrome in African-American and Caucasian young adults with microalbuminuria: the Bogalusa Heart Study

Microalbuminuria is a strong predictor of cardiovascular disease. Previous studies are inconsistent regarding the relationship between microalbuminuria and insulin resistance syndrome. Therefore, we examined this relationship in 1031 young adults (61% Caucasian, 39% African-American) aged 19 to 32 years. Individuals with either urinary albumin to creatinine ratio at or above the 90th percentile (age, race, and gender specific) or urinary albumin level at or above 30 mg/L were considered as having slightly elevated albumin excretion (microalbuminuria). The multiple risk variables of insulin resistant syndrome measured include body mass index, waist circumference, blood pressure (BP), triglycerides, high-density lipoprotein (HDL) cholesterol, glucose, insulin, insulin resistance index (calculated from a homeostasis model assessment equation), and uric acid. After controlling for age and gender, African-Americans with microalbuminuria by either measure had higher mean systolic (P < .001) and diastolic (P < .05) BP, prevalence of hypertension (P < .05), and, contrary to expectations, HDL cholesterol (P < .05) than those without this condition. On the other hand, Caucasians showed no such associations. In African-Americans, the above differences in BP levels persisted when hypertensive subjects were excluded. None of the other risk variables displayed any relation to microalbuminuria in both races. These results suggest that microalbuminuria is not necessarily an intrinsic component of the insulin resistance syndrome, at least in the young adult age. Furthermore, the observed association between hypertension and microalbuminuria among young African-Americans may reflect early evidence of renal dysfunction due to the burden of elevated BP in this group.

Breakfast consumption with and without vitamin-mineral supplement use favorably impacts daily nutrient intake of ninth-grade students

PURPOSE

To assess the contribution of breakfast consumption (with and without dietary supplement intake) on total daily nutrient intake of ninth-grade students.

METHODS

Twenty-four-hour recall of dietary intake was collected from a random sample of 711 ninth-grade students attending 12 Archdiocesan high schools in New Orleans, Louisiana. Analysis of variance techniques, Pearson's Chi-square statistic, and Breznahn-Shapiro method with Scheffé probabilities were used to analyze nutrient intake data, dietary adequacy, and nonorthogonal comparisons, respectively.

RESULTS

Nineteen percent of 15-year-olds skipped breakfast, with more females skipping breakfast than males (23% vs. 14%, respectively). Thirty-six percent of nonwhite females versus 20% white females skipped breakfast. Eleven percent of subjects took some type of dietary supplement, most commonly a multivitamin and mineral supplement. Among those who ate breakfast, average energy intake from breakfast was 437 kcal. Percentage of total daily energy intake was higher from fats and lower from carbohydrates for adolescents who skipped breakfast, compared with adolescents who consumed breakfast. The percentage of subjects consuming at least two-thirds of the Recommended Dietary Allowance was significantly lower among adolescents skipping breakfast than those consuming breakfast.

CONCLUSION

Regardless of supplement use, breakfast consumption makes an important nutritional contribution to total daily intake of ninth-grade students. Encouraging breakfast consumption and healthful breakfast choices is an important step toward improving the nutritional quality of diets of this age group.

Patients' perception of pain after total hip arthroplasty

A study was undertaken to determine the frequency with which patients had pain that they attributed to their hip after total hip arthroplasty. Pain drawings were used to allow patients to localize the area of their symptoms, and the degree of pain was quantified with visual analog scales. Complete clinical and radiographic data were collected on all patients so that the occurrence of pain could be correlated with a number of parameters previously reported to affect the incidence of pain, including age, sex, activity level, length of follow-up, stem size, bone type (Dorr index), and type of stem fixation (proximally coated, fully coated, or cemented). Results indicated that type of stem fixation was the only parameter statistically correlated with a higher incidence of thigh pain. Patients with proximally coated stems were more than twice as likely to complain of pain than patients with fully coated or cemented hips (P < .01). Although the incidence of thigh pain was significantly higher with proximally coated stems, the severity was not, averaging 3.0 to 3.5 out of 10 on visual analog scale in all 3 groups. The results indicate that patients perceived pain as originating in the hip in a high percentage of cases, particularly when proximally coated stems were used.

Upregulation of myogenin by N-cadherin adhesion in three-dimensional cultures of skeletal myogenic BHK cells

Cells of the baby hamster kidney (BHK) line express the skeletal muscle determining transcription factor MyoD but fail to differentiate. Unlike most skeletal myogenic cells, which express multiple members of the cadherin family of cell-cell adhesion proteins, the BHK cells lack a robust cadherin adhesion system. We previously published that forced expression of N- (or E)-cadherin in BHK cells increases the level of endogenous catenins, mediates strong cell-cell adhesion, and enhances differentiation of BHK cells induced to differentiate by placing them in three-dimensional (3-D) culture (Redfield et al. [1997] J. Cell. Biol. 138:1323-1331). This report demonstrates that N-cadherin adhesion upregulates the protein level of nuclear myogenin in cells induced to differentiate by 3-D culture. Myogenin is a transcription factor required for differentiation of skeletal muscle. It was not detected in monolayer culture, whether the cells expressed N-cadherin or not, nor was it upregulated in 3-D cultures of cells lacking N-cadherin. The activity of two myogenin-chloramphenicol acetyltransferase (CAT) reporter constructs containing 3.7 or 1.1 kb upstream regulatory region of the mouse myogenin gene was increased significantly in N-cadherin-expressing cells induced to differentiate by 3-D culture. Our observations indicate that N-cadherin adhesion stimulates skeletal myogenesis by upregulating myogenin.

Subunit interactions in yeast transcription/repair factor TFIIH. Requirement for Tfb3 subunit in nucleotide excision repair

A yeast strain harboring a temperature-sensitive allele of TFB3 (tfb3(ts)), the 38-kDa subunit of the RNA polymerase II transcription/nucleotide excision repair factor TFIIH, was found to be sensitive to ultraviolet (UV) radiation and defective for nucleotide excision repair in vitro. Interestingly, tfb3(ts) failed to grow on medium containing caffeine. A comprehensive pairwise two-hybrid analysis between yeast TFIIH subunits identified novel interactions between Rad3 and Tfb3, Tfb4 and Ssl1, as well as Ssl2 and Tfb2. These interactions have facilitated a more complete model of the structure of TFIIH and the nucleotide excision repairosome.

Impact of dietary fat and fiber intake on nutrient intake of adolescents

OBJECTIVE

To evaluate the impact of fat and fiber intake on energy and nutrient intake of 15-year-old adolescents.

STUDY DESIGN

Twenty-four-hour dietary recalls were collected on a random sample of 15-year-olds. Subjects were then categorized into groups based on fat and fiber intake, with 319 students meeting criteria for 1 of 4 dietary intake quadrants: low fat, low fiber; low fat, high fiber; high fat, low fiber; and high fat, high fiber. Students with medium fat or fiber intakes were excluded from the study. Low-fat and high-fat intake were defined as <30% and >40% of total energy intake, respectively. Low- and high-fiber intake were defined as <15 g/day and >20 g/day, respectively.

RESULTS

Low-fat and high-fiber intake had a minimal impact on energy intake and did not adversely affect nutrient intake. High-fiber intake was associated with greater likelihood of adequate intake of vitamins A, B6, B12, and C; niacin; thiamin; riboflavin; folacin; magnesium; iron; zinc; phosphorus; and calcium. High-fat intake was associated with greater likelihood of adequate vitamin B12 intake. Significant differences in fat and fiber intake distributions were found for ethnic background and gender, with more non-white than white students in the high-fat groups and more males than females in the high-fiber groups.

CONCLUSIONS

A low-fat and high-fiber diet meeting current nutrition recommendations does not adversely affect energy or nutrient intake, increases nutrient density of the diet, and increases the likelihood of adequate intake for several key nutrients.

The effect of modest monetary incentives on follow-up rates in sexually transmitted disease studies

The purpose of the study was to determine if follow-up rates in sexually transmitted disease (STD) research could be improved by offering modest monetary incentives. Women aged 14-34, infected with Chlamydia trachomatis, and enrolled in either of 2 studies between May 1995 and January 1999 were included. Beginning in March 1996 participants were offered a $20 incentive to return to both the one- and four-month follow-up visits. Data were analysed using polychotomous logistic regression. Of 962 women followed, the majority (74.7%) received monetary incentives and 66% returned for at least one visit. Women who received the incentive were more likely (OR 1.9, CI 1.2-2.9) to return for either one or both of their follow-up visits after adjusting for interviewer and the months of work experience of that interviewer. Age and method of birth control were not associated with return rates. The study provides evidence that modest monetary incentives can improve follow-up rates.

Remote infrared signage evaluation for transit stations and intersections

Opportunities for education and employment depend upon effective and independent travel. For mainstream society, this is accomplished to a large extent by printed signs. People who are print disabled, visually impaired, or totally blind are at a disadvantage because they do not have access to signage. Remote infrared signage, such as the Talking Signs (TS) system, provides a solution to this need by labeling the environment for distant viewing. The system uses a transmitting "sign" and a hand-held receiver to tell people about their surroundings. In a seamless infrared signage environment, a visually impaired traveler could: walk safely across an intersection to an ATM or fare machine, from fare machine to bus stop, from bus stop to bus; from bus to building, from building to elevator, from elevator to office, from office to restroom, and so forth. This paper focuses on two problems that are among the most challenging and dangerous faced by blind travelers: negotiating complex transit stations and controlled intersections. We report on human factors studies of TS in these critical tasks, examining such issues as how much training is needed to use the system, its impact on performance and safety, benefits for different population subgroups and user opinions of its value. Results indicate that blind people can quickly and easily learn to use remote infrared signage effectively, and that its use improves travel safety, efficiency, and independence.

Temporal association between obesity and hyperinsulinemia in children, adolescents, and young adults: the Bogalusa Heart Study

Obesity is generally associated with hyperinsulinemia. However, whether obesity precedes or follows hyperinsulinemia is not clear. The present study examined the temporal nature of the association between obesity and hyperinsulinemia in a biracial (black-white) community-based population enrolled in the Bogalusa Heart Study. Three longitudinal cohorts of children (n = 427; baseline age, 5 to 7 years), adolescents (n = 674; baseline age, 12 to 14 years), and young adults (n = 396; baseline age, 20 to 24 years) were selected retrospectively, with a follow-up period of approximately 3 years. In general, longitudinal changes in the mean body mass index (kilograms per meter squared), an indicator of adiposity, and fasting insulin level did not parallel each other. In a bivariate analysis, baseline insulin levels correlated significantly with the follow-up body mass index in adolescents and adults, but not in children. On the other hand, the baseline body mass index correlated significantly with follow-up insulin levels in all cases. Logistic regression analysis showed that the proportion of subjects who developed obesity (body mass index > 75th percentile, specific for age, race, gender, and survey year) at follow-up study increased significantly across baseline quintiles (specific for age, race, gender, and survey year) of insulin only among adolescents, irrespective of race and gender. This relationship disappeared after adjusting for the baseline body mass index. By contrast, a significant positive trend between baseline quintiles of the body mass index and incidence of hyperinsulinemia (> 75th percentile) at follow-up study was noted among all age groups independent of race, gender, and baseline insulin levels. Further, in a multiple stepwise regression model, the best predictor of the follow-up insulin level was the baseline body mass index in children and adults and the baseline insulin in adolescents. The baseline body mass index was the best predictor of the follow-up body mass index in all three age groups. These results, by showing the temporal nature of the relation between obesity and hyperinsulinemia beginning in childhood, support the role of obesity in the development of hyperinsulinemia.

Disclosure of HIV status to sexual partners: predictors and temporal patterns

BACKGROUND AND OBJECTIVES

Failure to disclose human immunodeficiency virus (HIV) infection to sexual partners interferes with risk reduction.

GOAL OF THIS STUDY

The purpose of this study was to identify factors associated with disclosure and failure to disclose HIV infection to sexual partners and to describe condom use with nondisclosure.

STUDY DESIGN

A longitudinal survey study of HIV seropositive persons recruited at a public STD clinic.

RESULTS

Approximately 76% of the study population (n = 147) reported disclosing their HIV status to their last sex partner at baseline. Predictors of disclosure included consistent condom use and being in a monogamous relationship. Twenty-two percent of those who disclosed at baseline reported nondisclosure during follow-up. Approximately 23% reported not using a condom with a person to whom their status was not disclosed.

CONCLUSIONS

These results suggest that ongoing partner notification may be necessary to increase disclosure of HIV status to sex partners over time.

Plasma homocysteine distribution and its association with parental history of coronary artery disease in black and white children: the Bogalusa Heart Study

BACKGROUND

Elevated homocysteine is associated with increased risk for coronary artery disease (CAD) in adults, but its distribution in children is not well documented. We examined the distribution of homocysteine in children and its relation to parental history of CAD.

METHODS AND RESULTS

A subsample of 1137 children (53% white, 47% black) aged 5 to 17 years in 1992 to 1994 examined in the Bogalusa Heart Study (n=3135), including all with a positive parental history of CAD (n=154), had plasma homocysteine levels measured. Homocysteine correlated positively with age (r=0.16, P=0.001). No race or sex differences in homocysteine levels were observed; geometric mean (GM) levels were 5.8 micromol/L (95% CI, 5.6 to 6.1) among white males, 5.8 micromol/L (95% CI, 5.5 to 6.0) among white females, 5.6 micromol/L (95% CI, 5.4 to 5.8) among black males, and 5.6 micromol/L (95% CI, 5.4 to 5.9) among black females. Children with a positive parental history of CAD had a significantly greater age-adjusted GM homocysteine level (GM, 6.7 micromol/L; 95% CI, 6.4 to 7.1) than those without a positive history (GM, 5.6 micromol/L; 95% CI, 5.4 to 5.7); this relation was observed in each race-sex group.

CONCLUSIONS

Higher homocysteine levels were observed among children with a positive family history of CAD. Additional studies should elucidate the contribution of genetic, dietary, and other factors to homocysteine levels in children.

Knowledge, attitudes, and practices related to fruit and vegetable consumption of high school students

PURPOSE

To assess the level of nutrition knowledge, attitudes and practices related to fruit and vegetable consumption of high school students attending participating parochial schools in the New Orleans area.

METHODS

The baseline data reported in this study, "Gimme 5: A Fresh Nutrition Concept for Students," represents one of the nine National Cancer Institute-funded projects from the national "5-A-Day for Better Health Program" initiated in 1991. A survey containing 22 nutrition-related items about fruit and vegetables was used to assess knowledge in 2213 students.

RESULTS

On average, adolescents reported 39% correct knowledge scores. A significant ethnic effect (p < .001) was noted, with White adolescents scoring higher than African American adolescents. Significant ethnic differences in the frequency of fruit and vegetable consumption were also observed, with African-American adolescents reporting a lower mean consumption (2.17 servings) than white adolescents (2.69 servings). Consumption by Hispanic youth (2.48 servings) was similar to those in the "other" ethnic category (2.55 servings). Girls reported being more confident in their ability to eat five servings of fruits and vegetables per day than did boys (p < .05).

CONCLUSIONS

Although the knowledge and consumption levels of adolescents with regard to fruits and vegetables were low, their attitudes toward learning about healthier eating practices were favorable.

Impact of breakfast consumption on nutritional adequacy of the diets of young adults in Bogalusa, Louisiana: ethnic and gender contrasts

OBJECTIVE

To evaluate the impact of breakfast consumption patterns on the nutritional adequacy of diets of young adults and determine possible ethnic and gender differences.

DESIGN AND SETTING

Cross-sectional survey of young adults in Bogalusa, La.

SUBJECTS

Twenty-four-hour dietary recalls were collected from October 1988 through October 1991 on 504 young adults (mean age=23 years, 58% women, 70% white).

STATISTICS

Analysis of variance and logistic regression techniques were used to investigate the relationship of breakfast consumption, ethnicity, and gender on dietary adequacy. The P values are from an analysis of variance model that adjusted for gender and ethnicity.

RESULTS

Thirty-seven percent of young adults skipped breakfast. Of those who ate breakfast, 75% ate at home, 10% ate a fast-food breakfast, and 15% reported other sources. Mean energy intake from breakfast was 485 kcal; men consumed more energy than women (P<.001), and blacks consumed more energy than whites (P<.01). The breakfast meal provided an average of 13% of energy from protein, 55% from carbohydrate, 14% from sucrose, 34% from fat, and 12% from saturated fat. Whites consumed a breakfast higher in carbohydrate and sucrose than blacks, who consumed a breakfast higher in fat and saturated fat. Variations in breakfast foods consumed explained the racial differences in the nutrient composition of the breakfast meal. Young adults who skipped breakfast had lower total daily intakes of energy (P<.0001), protein per 1,000 kcal (P<.05), and saturated fat per 1,000 kcal (P<.01) than those who consumed breakfast. For all vitamins and minerals studied, a higher percentage of young adults who skipped breakfast did not meet two thirds of the Recommended Dietary Allowance than those who consumed a breakfast.

APPLICATIONS

Encouraging consumption of breakfast, along with selection of more healthful breakfast food choices or snacks that are culturally appropriate, may be important strategies for improving the nutritional quality of young adults' diets.

Nutrient intake and food group consumption of 10-year-olds by sugar intake level: the Bogalusa Heart Study

OBJECTIVE

The effect of total sugar intake on nutrient intake and food group consumption was examined in children.

METHODS

Twenty-four hour dietary recalls were collected on a sample of 568 ten-year-olds from two cross-sectional surveys. The population was stratified according to total sugar intake quartiles: < or = 25th (46 g/1000 kcal), 25-50th (67 g/1000 kcal), 50-75th (81 g/1000 kcal) and > or = 75th (106 g/1000 kcal).

RESULTS

No significant difference was shown in energy intakes across the quartiles and no significant race or gender differences were observed in mean total sugar intakes. However, with increasing total sugar intake, there was a significant linear decrease in mean intakes of protein, fat, saturated fat, starch, cholesterol, sodium, vitamins B6 and E, thiamin, niacin, iron, and zinc; and a significant linear increase in mean intakes of carbohydrate, fructose, lactose, sucrose, vitamin D, and calcium. Eating patterns reflected the differing nutrient intakes, with high sugar consumers having significantly higher intakes of total g of candy, beverages and milk and lower intakes of total g of meats, and cheese than lower sugar consumers. The nutritional quality of children's diets high in total sugar appear to be adequate regarding vitamin and mineral intakes and are closer to meeting current dietary fat recommendations.

Outcomes of a high school program to increase fruit and vegetable consumption: Gimme 5--a fresh nutrition concept for students

This paper describes an intervention to increase high school students' fruit and vegetable consumption. Twelve schools were randomized to intervention or control conditions. The cohort (2,213 students; 56% females, 84% Caucasian) were followed from 9th to 12th grades. Interventions comprised a media campaign, classroom workshops, school meal modification, and parental support. Usual daily servings of fruit/vegetables increased 14% in the intervention compared to the control group (p > 0.001) the first three years. At follow-up, consumption within the control group also increased, resulting in no significant difference between groups. Intervention group knowledge scores and awareness indicators were significantly higher than those of the control group (p < 0.0001). Gimme 5 provided a first model to show that dietary habits of high school students can be influenced by positive media messages relative to that age group, increased exposure to a variety of tasty products, and minimal classroom activity.

Standardising health outcome measurements in general practice

BACKGROUND

Outcome measures are gaining importance especially in areas such as divisions of general practice. The plethora of outcome measurements and the rhetoric surrounding this may make it difficult for doctors to decide the place of such measures in daily practice. An understanding of outcomes and their indicators is emerging as an essential requirement for good practice.

OBJECTIVE

The aim of this paper is to propose a practical framework for describing health outcome measurements that may be applied to general practice.

METHODS

This paper outlines the key features of outcomes measurements and proposes a model for understanding health outcome indicators using a set of indicators relevant to clinical practice.

RESULTS

Pertinent to developing outcome terminology for use with patients in general practice are the four key features: a clear description of the indicator utility in practice comparability between practices endurance over time.

CONCLUSION

To have reliability and validity and be able to deliver outcomes with practical and clinical significance, we need to be sure that the instruments we use are precisely defined. It is also important that the meaning is universally understood by all who might want to use the instruments. The product should also have cultural applicability beyond English. In clinical practice, the definition of the instrument aims not only to give the general practitioner a clear understanding of what is being measured but how it is used and the implications for its future use.

Relationship of adolescent self-esteem to selected academic variables

This study investigated whether self-esteem precedes various academic behaviors and beliefs among 593 high school students (63.7% female, 60.9% African American). Measures of home and school self-esteem, grade point average, perceived academic standing and progress, and educational plans were collected by survey and archival review of grade and attendance records at the beginning (pre-test) and end of the school year (post-test). Self-esteem and academic variables differed by gender, race, and guardianship. Self-esteem related significantly to academics and absenteeism. Results suggest selected academic variables predict self-esteem even when the effects of gender, race, and guardianship are removed and pretest self-esteem scores are controlled. In conclusion, student academic performance influences subsequent academic and home self-esteem. Creation of positive academic experiences for youth may be a critical activity, since experts contend that low self-esteem is associated with subsequent behavioral problems. The markedly lower self-esteem of Native American and Hispanic youth warrants further investigation.

Cardiovascular risk factors and behavior lifestyles of young women: implications from findings of the Bogalusa Heart Study

The primary purposes of this article are to highlight important issues related to cardiovascular risk factors and behavior life-styles in young women and to examine racial (black-white) differences in risk factors that relate to cardiovascular disease. In childhood, some girls show cardiovascular risk factors of higher blood pressure levels, dyslipidemia, and obesity, all of which continue into young adulthood. Factors that contribute to abnormal risk factors are a high-saturated fat diet, excess energy intake related to inactivity, and cigarette smoking. Trends of obesity are documented; and young white girls are continuing to use tobacco, more so than boys and black girls. Although the onset of clinical cardiovascular disease is delayed in women, the stage is set in childhood for the development of early cardiovascular risk.

Bupropion and sexual function: a placebo-controlled prospective study on diabetic men with erectile dysfunction

Many antidepressant agents interfere with sexual function. The purpose of this single-blind, prospective study was to determine sexual side effects, both positive and negative, of the amino-ketone antidepressant bupropion in a group of nondepressed diabetic men with somatic erectile dysfunction. Fourteen men participated in a 10-week protocol consisting sequentially of 2 weeks of baseline testing, 2 weeks of placebo, and 6 weeks of bupropion. Participants also completed daily and weekly questionnaires concerning sexual functioning, and a team of investigators rated various dimensions of sexual function every 2 weeks. In addition, a variety of physiologic measures, relevant either to erectile function or to neural/vascular systems that underlie sexual response, were assessed during baseline and bupropion treatment. Results indicated that neither subjective nor objective measures of erectile and overall sexual functioning worsened during bupropion. In fact, several measures suggested a trend toward improved sexual functioning. Furthermore, diabetic control was unaffected by bupropion administration. Given the lack of adverse effects on sexual function, along with the potential for improved erectile response, bupropion may provide an attractive choice for the treatment of depression in diabetic men or others for whom sexual dysfunction is a concern.

Stabilities of free and complexed human immunodeficiency virus p24 antigens during short- and long-term storage

By the standard p24 assay there was a 25 to 27% decrease in free p24 antigen in serum after storage at 4 degrees C over 14 days but no loss at -70 degrees C. There was no loss at either temperature by the immune complex dissociation (ICD) procedure. Furthermore, there was no significant loss of detectable p24 in serum by either the ICD or the standard p24 assay after 700 days of storage at -70 degrees C.

Design and construction of a hybrid immunoglobulin domain with properties of both heavy and light chain variable regions

The complementarity-determining regions (CDRs) of a human kappa light chain were replaced with CDRs from a murine gamma-1 heavy chain and, by use of molecular modeling, key heavy chain framework residues were identified and thus included to preserve the native conformation of the heavy chain CDRs. Co-expression of this hybrid human kappa chain (V[HB]C[L]) with a human kappa chain counterpart (V[L]C[L], engineered to contain murine light chain CDRs) resulted in the secretion of high levels of a heterodimeric protein (V[HB]C[L]::V[L]C[L]) termed 'kappabody'. This protein also had equivalent affinity for antigen as the Fab' of the parent murine IgG1. High-level secretion was also observed for the hybrid chain as homodimers (V[HB]C[L]::V[HB]C[L]), which is not observed for chimeric chains consisting of a heavy chain variable region and light chain constant region, i.e. V[H]C[L] homodimers or single chains are not secreted. This indicates that regions within the variable domain, required for secretion of light chains, reside outside of the hypervariable regions (CDRs) and that the heavy chain CDRs and supporting residues do not prevent secretion. These results demonstrate the possibility of designing small, single-domain molecules possessing a given binding activity which may be secreted at high levels from mammalian cells.