A phase II trial of capecitabine and docetaxel in patients with previously treated pancreatic cancer

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Background: There is no accepted standard treatment for patients with advanced pancreatic cancer who progress after gemcitabine-based therapy. Capecitabine and docetaxel have single-agent activity in pancreatic cancer and have documented synergy in both pre-clinical models and in the treatment of other solid tumors. Methods: A phase II trial with a 3-stage sequential design was planned to assess the efficacy (primary end-point: response rate) and toxicity of capecitabine 800 mg/m2 PO bid on days 1–14 in combination with docetaxel 30 mg/m2 IV on days 1 and 8 of each 21-day cycle in patients with advanced pancreatic cancer who failed first-line gemcitabine-based chemotherapy. If no responses are observed after 13 patients or less than 3 responses are seen after 26 patients, accrual will stop and the combination deemed ineffective. Results: Eight patients have been enrolled (5 women, 3 men). Median age was 67 years. ECOG PS was as follows: PS 1, three patients; PS 2, five patients. All patients had adequate organ function. A total of 26 cycles have been administered (median: 2 cycles, range 1 to 8). Four patients had stable disease (median duration 9 weeks, range 6 to 24), and 3 had progressed at the time of first evaluation (2 cycles). One patient has not yet completed 2 cycles and is therefore not assessable for radiologic response. Out of 7 patients with an elevated CA 19–9, four had a decrease of 50% or greater while on chemotherapy. Grade 1 or 2 toxicity was seen in 3 patients (diarrhea, 1 patient; fatigue, 2 patients). Grade 3 or 4 toxicity was as follows: fatigue, 2 patients; dehydration, 1 patient; neuropathy, 1 patient. There were no treatment related deaths. Enrollment continues. Efficacy data fulfilling the first stage sequential design should be available at the time of the meeting. Median survival for all patients is currently 13 weeks (range 7–23 weeks) Conclusions: Capecitabine in combination with docetaxel is a well-tolerated regimen in the treatment of patients with pancreatic cancer who have failed prior gemcitabine-based therapy. Four out of 8 patients have had stable disease. Four of 7 patients have had a decrease of 50% or greater in CA 19.9 levels. Enrollment continues. Median survival of 13 weeks underscores the poor prognosis of this patient population.

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Titan Radar Mapper observations from Cassini's T3 fly-by

Cassini's Titan Radar Mapper imaged the surface of Saturn's moon Titan on its February 2005 fly-by (denoted T3), collecting high-resolution synthetic-aperture radar and larger-scale radiometry and scatterometry data. These data provide the first definitive identification of impact craters on the surface of Titan, networks of fluvial channels and surficial dark streaks that may be longitudinal dunes. Here we describe this great diversity of landforms. We conclude that much of the surface thus far imaged by radar of the haze-shrouded Titan is very young, with persistent geologic activity.

Oxalobacter sp. reduces urinary oxalate excretion by promoting enteric oxalate secretion

The primary goal of this study was to test the hypothesis that Oxalobacter colonization alters colonic oxalate transport thereby reducing urinary oxalate excretion. In addition, we examined the effects of intraluminal calcium on Oxalobacter colonization and tested the hypothesis that endogenously derived colonic oxalate could be degraded by lyophilized Oxalobacter enzymes targeted to this segment of the alimentary tract. Oxalate fluxes were measured across short-circuited, in vitro preparations of proximal and distal colon removed from Sprague-Dawley rats and placed in Ussing chambers. For these studies, rats were colonized with Oxalobacter either artificially or naturally, and urinary oxalate, creatinine and calcium excretions were determined. Colonized rats placed on various dietary treatment regimens were used to evaluate the impact of calcium on Oxalobacter colonization and whether exogenous or endogenous oxalate influenced colonization. Hyperoxaluric rats with some degree of renal insufficiency were also used to determine the effects of administering encapsulated Oxalobacter lysate on colonic oxalate transport and urinary oxalate excretion. We conclude that in addition to its intraluminal oxalate-degrading capacity, Oxalobacter interacts physiologically with colonic mucosa by inducing enteric oxalate secretion/excretion leading to reduced urinary excretion. Whether Oxalobacter, or products of Oxalobacter, can therapeutically reduce urinary oxalate excretion and influence stone disease warrants further investigation in long-term studies in various patient populations.

The Sand Seas of Titan: Cassini RADAR Observations of Longitudinal Dunes

The most recent Cassini RADAR images of Titan show widespread regions (up to 1500 kilometers by 200 kilometers) of near-parallel radar-dark linear features that appear to be seas of longitudinal dunes similar to those seen in the Namib desert on Earth. The Ku-band (2.17-centimeter wavelength) images show approximately 100-meter ridges consistent with duneforms and reveal flow interactions with underlying hills. The distribution and orientation of the dunes support a model of fluctuating surface winds of approximately 0.5 meter per second resulting from the combination of an eastward flow with a variable tidal wind. The existence of dunes also requires geological processes that create sand-sized (100- to 300-micrometer) particulates and a lack of persistent equatorial surface liquids to act as sand traps.

The vertical profile of winds on Titan

One of Titan's most intriguing attributes is its copious but featureless atmosphere. The Voyager 1 fly-by and occultation in 1980 provided the first radial survey of Titan's atmospheric pressure and temperature and evidence for the presence of strong zonal winds. It was realized that the motion of an atmospheric probe could be used to study the winds, which led to the inclusion of the Doppler Wind Experiment on the Huygens probe. Here we report a high resolution vertical profile of Titan's winds, with an estimated accuracy of better than 1 m s(-1). The zonal winds were prograde during most of the atmospheric descent, providing in situ confirmation of superrotation on Titan. A layer with surprisingly slow wind, where the velocity decreased to near zero, was detected at altitudes between 60 and 100 km. Generally weak winds (approximately 1 m s(-1)) were seen in the lowest 5 km of descent.

Cassini Radar Views the Surface of Titan

The Cassini Titan Radar Mapper imaged about 1% of Titan's surface at a resolution of approximately 0.5 kilometer, and larger areas of the globe in lower resolution modes. The images reveal a complex surface, with areas of low relief and a variety of geologic features suggestive of dome-like volcanic constructs, flows, and sinuous channels. The surface appears to be young, with few impact craters. Scattering and dielectric properties are consistent with porous ice or organics. Dark patches in the radar images show high brightness temperatures and high emissivity and are consistent with frozen hydrocarbons.

The incidence and epidemiology of congenital upper limb anomalies: a total population study

An 11-year total population study of Western Australia examined the prevalence and epidemiology of congenital upper limb anomalies. All anomalies were classified according to the International Federation of Surgical Societies of the Hand classification. We found the prevalence of babies born with upper limb anomalies to be 1 in 506. Forty-six percent of those affected had another nonhand congenital anomaly. Fifty-one percent had bilateral hand anomalies, and 17% had multiple different hand anomalies. The most common anomalies were failures of differentiation (35%), duplications (33%), and failures of formation (15%). Congenital upper limb anomalies were more common in boys; preterm, postterm, and multiple births; and older mothers. No significant differences in prevalence or frequency of anomalies were found between whites and nonwhites, left and right sides, and in babies that survived and those who died shortly after birth.

An audit of phase II cardiac rehabilitation at Auckland hospital

AIM

To audit Phase II cardiac rehabilitation services available to patients admitted to Auckland Hospital in order to assess patient uptake and to identify problems with patient recruitment to the service.

METHODS

We performed a retrospective review from 1/8/ 97 to 30/9/97 of all patients admitted to the coronary care/ cardiology departments in Auckland Hospital.

RESULTS

There were 289 patient admissions in this two month period, of which 22 (8%) were readmissions. 154 (54%) were admissions with provisional diagnoses of chest pain, of whom eight were readmissions. A total of 113 (39%) patients were felt to be suitable for the rehabilitation programme, of whom 50 (44%) attended one or more sessions and 22 (19%) completed the six week programme. 63 (56%) of the eligible patients did not attend any session. Reasons for non-attendance included the distance to be travelled, availability of transport and problems associated with taking time off work. A major finding of the audit was that the systems currently in place to follow patients are inadequate to allow formal audit and evaluation of the rehabilitation service.

CONCLUSIONS

Although a reasonable rehabilitation service exists for Auckland Hospital patients, less than half of suitable patients attend a single session. There is a need for better collection and recording of patient data in order to facilitate the development of evaluation and audit tools.

The relationship between fat distribution and coronary risk factors in sedentary postmenopausal women on and off hormone replacement therapy

The purpose of this study was to examine the relationship between fat distribution and coronary risk factors (CRF) in sedentary overweight postmenopausal women both on and off hormone replacement therapy (HRT). Medical records and information were abstracted from nonsmoking women entering a weight loss program. A total of 33 women on HRT (mean age=50.12+/-5.2) and 51 nonusers (mean age=52.52+/-7.8) fulfilled subject eligibility requirements and were included in the data analysis. Results showed a significantly lower waist-to-hip ratio (WHR) (p=0.009) and waist (p=0.010) and greater levels of high-density lipoprotein cholesterol (HDL-C) (p=0.035) in HRT users than in nonusers. After converting correlations to standard Z-scores and performing z-tests, the correlation between total cholesterol (T-Chol) and WHR was significantly greater in nonusers than in HRT users (p=0.038). A multiple regression analysis showed differences between groups in the ability of age and anthropometric variables to predict CRF. Although T-Chol could be predicted in nonusers (r2=0.24; p=0.011), very low-density lipoprotein cholesterol (VLDL-C) and systolic blood pressure (SBP) could be significantly predicted in HRT users only (r2=0.28, p=0.055 and r2=0.40, p=0.005 for VLDL-C and SBP, respectively). These data suggest that there are differences between HRT users and nonusers in predictors of CRF, central adiposity, HDL-C, and the relationship between WHR and T-Chol. It is concluded that the significantly lower levels of central adiposity observed in HRT users may have clinical benefits with regard to CRF.

Pragmatic assessment of physical activity

Nurse practitioners are confronted with the need to measure the physical activity levels of clients. There is no "gold standard" for measurement in the field. Nurses increasingly use physical activity for assessment, intervention, and evaluation. Selection of the appropriate tool depends on the purpose of the assessment, the client population, practicality, and psychometric properties of the instrument. Nine physical activity instruments with good psychometric properties, economy, and acceptability are presented to assist with instrument selection.

Physical activity in the elderly: benefits and intervention strategies

In spite of the well-documented evidence that physical activity is beneficial, only 30% of individuals over the age of 65 report exercising regularly. Regular physical activity can minimize and prevent chronic problems and increase functional ability in the elderly. Designing physical activity for the elderly requires initial assessment of functional ability, exercise tolerance, physical limitations, and psychologic and social support of the individual. The exercise prescription should address the intensity, frequency, and duration of the exercise. Several factors affect the elderly's initiation and adherence to a physical activity program. These include the elder's perception of factors preventing physical activity, individual goal setting, and personal and therapist support in the effort.

Identification and classification of Oxalobacter formigenes strains by using oligonucleotide probes and primers

Genomic DNAs of various strains of Oxalobacter formigenes were subjected to restriction endonuclease fragment length polymorphism- and PCR-based amplification analyses with DNA probes and primers complementary to sequences within either the oxc gene, encoding oxalyl coenzyme A (oxalyl-CoA) decarboxylase, or the frc gene, encoding formyl-CoA transferase. Oligonucleotide probes based on nonconserved sequences of oxc or frc were able to divide O. formigenes strains into at least two groups, consistent with the current separation of O. formigenes strains into groups I and II on the basis of 16S rRNA sequence similarities and lipid content. In contrast, an oligonucleotide probe based on the conserved 5' end of oxc appeared to bind all group I and the majority of group II strains. PCR amplification of the oxc gene showed even greater sensitivity in detecting O. formigenes and provided support for further division of the strains into subgroups. In addition, these oligonucleotides failed to hybridize to or amplify PCR products from whole fecal DNA isolated from fresh stool samples from an individual not colonized with O. formigenes, indicating unique specificity. Thus, these DNA analyses permit both detection as well as classification of O. formigenes strains.

Psychiatric disorder and outcome in irritable bowel syndrome

A link between irritable bowel syndrome (IBS) and psychiatric illness is well recognized. The authors set out to establish whether a group with a risk of poor outcome IBS could be identified at presentation to a general hospital clinic in a prospective series of 70 subjects. Potential risk factors showed no correlation with IBS outcome at 6-9 months. There was a high rate of persistent mental illness. Clinicians offering specialist care for IBS should consult with psychiatric services to provide assessment irrespective of IBS outcome if major psychopathology is not to be neglected.

Long-term use of the low molecular weight heparin tinzaparin in haemodialysis

Fifty-two patients with chronic renal failure undergoing hospital haemodialysis were given a single bolus dose of tinzaparin (Innohep, Leo Laboratories, UK) into the arterial side of the dialyser, for up to 43 consecutive dialyses. The mean tinzaparin dose at the beginning was 2,139 IU anti-Xa and at the end 2,186 IU anti-Xa. Overall, tinzaparin proved a satisfactory anticoagulant for 1,370 (96.0%) out of 1,427 dialyses. Significant clot formation was prevented in 1,326 (92.8%) out of 1,429 dialyses. The clinically effective dose was associated with a mean plasma anti-Xa activity 1 h after dosing of 0.4 IU/ml and suppressed fibrinopeptide A formation for up to 4 h. Bleeding, from the skin or mucous membranes, was recorded at 27 (1.9%) of 1,408 dialyses. Prolonged fistula bleeding on completion of dialysis was recorded on only 20 occasions. Other haemorrhagic events included haematemesis, bruising and subconjunctival haemorrhage (each in 1 patient) and epistaxis (2 patients). Three patients died during the study of causes considered unrelated to tinzaparin therapy, myocardial infarction (2 patients) and multiple myeloma. Other adverse events reported included vomiting (3 patients) and hypotension (3 patients). Three patients ceased treatment due to haematemesis, prolonged bleeding from fistula puncture and thrombosis of the arteriovenous access, respectively. A small, but statistically significant, increase within the normal reference range was recorded in the mean values for aspartate aminotransferase and alanine aminotransferase.

Environmental factors and nutritional status of rural children

The nutritional status of school-aged children is a growing concern of health care professionals today. In collaboration with a Kellogg Project in the deep south, students from a large university school of nursing participated in a project to improve the nutritional status of rural school-aged children. The project goals focused on educating thd children about the U.S. Department of Agriculture (USDA) Food Guide Pyramid, reading nutritional labels and recognizing foods with high fat content, and the importance of exercise along with diet. The nursing students created a nutritional assessment tool to use with each child to determine their educational needs. The project involved lecture, interactive class discussion, and hands-on activities. Information from the assessment tool revealed that fast food and foods high in fat were the most popular with the children. After project completion, the posttest revealed an increase in cognitive knowledge of nutrition among all the children. In addition to this positive learning experience for the children, improving the health status of children in the community was an excellent educational opportunity for the nursing students.

Self-renewal of B-1 lymphocytes is dependent on CD19

The B-1 subset of B lymphocytes is maintained by self-renewal of mature cells, and this process may involve signaling through membrane immunoglobulin (mIg). We determined whether CD19, a membrane protein that co-stimulates B cells by mIg, has a role in this process. Pre-natal treatment of mice with 1D3, a rat anti-mouse CD19 monoclonal antibody, down-regulated CD19 expression and reduced by sixfold the number of B-1a cells at birth; B-2 cells were relatively unaffected. Prolonged treatment of adult mice with 1D3 caused the loss of approximately 2% per day of peritoneal B-1a cells, without diminishing the recovery of splenic B-2 cells. The loss of B-1a cells was associated with inhibition of their replication rather than with accelerated turnover. Therefore, CD19 is involved in the development and self-renewal of B-1a cells, perhaps through its ability to amplify signaling through mIgM.

Education and professional development in specialist practice

This article explores issues of particular relevance to nurses involved in stoma care, including formal additional education and preparation, and continuing professional development for those already in practice.

Comparing methods of stoma formation

Stoma care nurses have a key role in promoting discussion of anticipated problems and have a unique insight into the needs and difficulties of patients with temporary stomas. This article reviews the different management problems presented by temporary colostomies and ileostomies, and advocates a multidisciplinary approach to care.

A user-friendly instrument for rating agitation in dementia patients

There are many rating instruments designed to assess symptoms of agitation in patients with dementia. Most scales require that raters assess multiple specific behaviors over several days, limiting the use of such scales to clinical staff who have direct contact with patients but do not have the time to complete a comprehensive assessment following each period of observation. Also, scales that assess behavior over several days must rely on "secondhand" information describing behaviors not directly observed by the rater. The Pittsburgh Agitation Scale (PAS) is an easy-to-use instrument, based on direct observations of the patient, that was developed to monitor the severity of agitation associated with dementia. Interrater reliability and measures of validity have been established with clinical staff on a busy psychogeriatric inpatient unit and with research personnel in a nursing home setting.