Radiofrequency ablation in the management of liver metastases from breast cancer

OBJECTIVE

Systemic chemotherapy remains the standard treatment for patients with breast cancer hepatic metastases. Resection of metastases has survival advantages in a small percentage of selected patients. Radiofrequency ablation has been used in small numbers of selected patients. This small series was undertaken to review our experience with radiofrequency ablation in the management of patients with breast cancer hepatic metastases.

CONCLUSION

Radiofrequency ablation of breast cancer hepatic metastases is safe and may be used to control hepatic deposits in patients with stable or no extrahepatic disease.

Application of portfolio theory to risk-based allocation of surveillance resources in animal populations

Distribution of finite levels of resources between multiple competing tasks can be a challenging problem. Resources need to be distributed across time periods and geographic locations to increase the probability of detection of a disease incursion or significant change in disease pattern. Efforts should focus primarily on areas and populations where risk factors for a given disease reach relatively high levels. In order to target resources into these areas, the overall risk level can be evaluated periodically across locations to create a dynamic national risk landscape. Methods are described to integrate the levels of various risk factors into an overall risk score for each area, to account for the certainty or variability around those measures and then to allocate surveillance resources across this risk landscape. In addition to targeting resources into high risk areas, surveillance continues in lower risk areas where there is a small yet positive chance of disease occurrence. In this paper we describe the application of portfolio theory concepts, routinely used in finance, to design surveillance portfolios for a series of examples. The appropriate level of resource investment is chosen for each disease or geographical area and time period given the degree of disease risk and uncertainty present.

Managing high-density commercial scale wine fermentations

AIMS

To investigate the effects of grape juice dilution and different temperature/nitrogen addition regimes on commercial-scale, high-density Shiraz and Chardonnay fermentations.

METHODS AND RESULTS

Duplicated fermentations (30 hl) were conducted at two temperatures for Shiraz and for Chardonnay. Two additional tanks of Chardonnay and Shiraz were diluted. Nitrogen was added once at inoculation or in aliquots over several days. Yeast concentration and viability was determined by flow cytometry. Fermentation chemistry was monitored by Fourier transform infrared spectroscopy. Fermentations arrested in both of the undiluted, higher temperature duplicate tanks of Shiraz. Different fermentation temperature resulted in sensorially different Shiraz, but not Chardonnay, wines made from undiluted musts. The converse was observed for wines made from diluted musts.

CONCLUSIONS

High-density musts can be fermented completely using reduced fermentation temperature coupled with incremental nitrogen addition.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first study in duplicated, commercial-scale, high-density grape juice fermentations to address temperature, nitrogen addition, and juice dilution effects on stuck fermentation potential and wine sensory properties.

Chemical, biological, radiological and nuclear terrorism: an introduction for occupational physicians

BACKGROUND

Chemical, biological, radiological and nuclear terrorism poses considerable threat throughout the world.

AIM

To provide occupational physicians with an understanding of this threat and its main forms and what action can be taken to counter this threat.

METHODS

Presenters at a conference on chemical, biological, radiological and nuclear terrorism were asked to contribute their evidence-based opinions in order to produce a review article.

RESULTS

This paper presents a summary of the different forms of chemical, biological, radiological and nuclear terrorism and the effective counter-measures and also provides a review of current scientific literature.

CONCLUSION

The threat of chemical, biological, radiological and nuclear terrorism is present throughout the world and is one that occupational physicians should be aware of, as well as the action that can be taken to counter it.

Calorific restriction: can we extrapolate from animals to humans?

Dietary restriction in animals results in a dramatic reduction of cancer incidence. Several attempts have been made to extrapolate this observation to the human situation. Recent developments in our knowledge of gene-dietary interactions, particularly in relation to vitamins, have been taken into account in a new examination of the likely effects of dietary restriction in humans, but this is a relatively new area of research. Epidemiological studies in relation to diet have also been considered, but probably need to be refined further because of the subtle effects of dietary interactions. Until more detailed information is available the extrapolation can still only be made with the utmost caution.

False positives in universal neonatal screening for permanent childhood hearing impairment

High rates of false-positive neonatal screens for permanent childhood hearing impairment (PCHI) associated with raised hearing thresholds lead to unnecessary assessments of the baby, which may worry parents. False-positive rates need to be reduced, especially in view of the UK government's announcement that national neonatal screening will be introduced. We report screening criteria that give a six-fold reduction in false-positive rates.

Molecular cloning and characterization of a lipid phosphohydrolase that degrades sphingosine-1- phosphate and induces cell death

Sphingosine and sphingosine-1-phosphate (SPP) are interconvertible sphingolipid metabolites with opposing effects on cell growth and apoptosis. Based on sequence homology with LBP1, a lipid phosphohydrolase that regulates the levels of phosphorylated sphingoid bases in yeast, we report here the cloning, identification, and characterization of a mammalian SPP phosphatase (mSPP1). This hydrophobic enzyme, which contains the type 2 lipid phosphohydrolase conserved sequence motif, shows substrate specificity for SPP. Partially purified Myc-tagged mSPP1 was also highly active at dephosphorylating SPP. When expressed in yeast, mSPP1 can partially substitute for the function of LBP1. Membrane fractions from human embryonic kidney HEK293 cells transfected with mSPP1 markedly degraded SPP but not lysophosphatidic acid, phosphatidic acid, or ceramide-1-phosphate. Enforced expression of mSPP1 in NIH 3T3 fibroblasts not only decreased SPP and enhanced ceramide levels, it also markedly diminished survival and induced the characteristic traits of apoptosis. Collectively, our results suggest that SPP phosphohydrolase may regulate the dynamic balance between sphingolipid metabolite levels in mammalian cells and consequently influence cell fate.

Student Voice in Curriculum Making

Undergraduate student nurses (n = 117) were asked to reflect critically on their psychiatric clinical learning experience and identify strengths and weaknesses not only in the actions and behaviors of others, but also in their own. A questionnaire was specifically constructed to encourage the voicing of issues, concerns, actions, and behaviors that centered around the concept of quality in relation to four predetermined categories: clinical practice, clinical nursing staff, clinical facilitators, and students. Themes, inductively derived from the collected information within each category, were organized into clusters and then into frequency distributions to facilitate interpretation. The study generated information that should be useful in planning and supervising effective and mutually satisfying clinical practicums in any psychiatric context. Moreover, the responses gave voice to matters that otherwise may have gone unrecognized in the curriculum. The study confirms that student voice must become an integral part of the alternatives from which curriculum-making choice is made.

The concomitant effects of phrase length and informational content in sentence comprehension

Recent evidence suggests that phrase length plays a crucial role in modification ambiguities. Using a self-paced reading task, we extended these results by examining the additional pragmatic effects that length manipulations may exert. The results demonstrate that length not only modulates modification preferences directly, but that it also necessarily changes the informational content of a sentence, which itself affects modification preferences. Our findings suggest that the same length manipulation affects multiple sources of constraints, both structural and pragmatic, which can each exert differing effects on processing.

Sphingoid base 1-phosphate phosphatase: a key regulator of sphingolipid metabolism and stress response

The sphingolipid metabolites ceramide and sphingosine-1-phosphate are second messengers with opposing roles in mammalian cell growth arrest and survival; their relative cellular level has been proposed to be a rheostat that determines the fate of cells. This report demonstrates that this rheostat is an evolutionarily conserved stress-regulatory mechanism that influences growth and survival of yeast. Although the role of sphingosine-1-phosphate in yeast was not previously examined, accumulation of ceramide has been shown to induce G1 arrest and cell death. We now have identified a gene in Saccharomyces cerevisiae, LBP1, that regulates the levels of phosphorylated sphingoid bases and ceramide. LBP1 was cloned from a yeast mutant that accumulated phosphorylated long-chain sphingoid bases and diverted sphingoid base intermediates from sphingolipid pathways to glycerophospholipid biosynthesis. LBP1 and its homolog, LBP2, encode very hydrophobic proteins that contain a novel-conserved sequence motif for lipid phosphatases, and both have long-chain sphingoid base phosphate phosphatase activity. In vitro characterization of Lbp1p shows that this phosphatase is Mg2+-independent with high specificity for phosphorylated long-chain bases, phytosphingosine and sphingosine. The deletion of LBP1 results in the accumulation of phosphorylated long-chain sphingoid bases and reduced ceramide levels. Moreover, deletion of LBP1 and LBP2 results in dramatically enhanced survival upon severe heat shock. Thus, these phosphatases play a previously unappreciated role in regulating ceramide and phosphorylated sphingoid base levels in yeast, and they modulate stress responses through sphingolipid metabolites in a manner that is reminiscent of their effects on mammalian cells.

Survey of occupational health problems in an operational military environment

16 Armoured Field Ambulance provided primary and secondary medical care to British troops in Bosnia from April to October 1996. Patients presenting at both levels were reviewed and categorized into occupational illness, non-occupational disease and non-occupational injury. The results show that occupational illness was a small but significant component of primary care (8%) with non-occupational injury accounting for < 1%. In secondary care, the more serious nature of the occupational disease seen is shown in that it accounted for 38% of all admissions and 44% of the 149 patients who had to be evacuated from theatre for further treatment. Non-occupational injury represented 8% of admissions and 13% of evacuations.

Humanitarian aid operations in Republica Srpska during Operation Resolute 2

The humanitarian aid experience of a unit in Bosnia is described. Data are presented for primary care clinics undertaken, showing the range of conditions and age of patients seen. The role of the civilian aid agencies involved is described, together with recommendations for future training requirements for similar operations.

The physiological consequences of simulated helicopter flight in NBC protective equipment

The physiological effects of wearing U.S. Army aviator nuclear-biological-chemical (NBC) individual protective equipment (IPE) were evaluated in the USAARL UH-60 research flight simulator. There were 16 male aviators who flew the simulator in 4 test conditions: standard flight suit and cool cockpit, standard flight suit and hot cockpit, NBC IPE and cool cockpit, NBC IPE and hot cockpit. The cool condition was a WBGT of 17.9 degrees C, the hot 30.6 degrees C. Rectal temperature, mean skin temperature, and heart rate were monitored and showed significant increases for the NBC hot condition compared with the other three. Seven subjects failed to complete the sortie in the NBC hot condition, with a mean survival time of 298 min. All subjects flew for the target 6 h in the other conditions.

Evaluation of differing staffing patterns on an assembly line for unit dose filling

An assembly line process for filling 24-hour unit dose medications in a 699-bed hospital is evaluated. Time studies are reported on different numbers of technicians and different rotational assignment alternatives. The data support evidence that too many technicians involved with the 24-hour fill process results in a less efficient and more costly process.

Changing patterns of hypertension, diabetes, obesity and diet among Melanesians and Micronesians in the Solomon Islands

A cross-sectional survey of diabetes, hypertension, obesity and dietary patterns has been conducted in the Western Province of the Solomon Islands. Three groups--traditional and more urbanized Melanesians and semitraditional Micronesians--were compared. Abnormal glucose tolerance was rare (less than 1% over all) in Melanesians regardless of acculturation, but was present in 9.7% of adult Micronesians in whom it was associated with age; obesity; female sex; and a diet that was high in energy and refined carbohydrates. Hypertension, which was associated with advancing age and obesity, was recorded in 6.0% and 8.3% of traditional and partly urbanized Melanesians, respectively, and in 4.8% of Micronesians. Systolic and diastolic blood pressures correlated significantly with age for all except traditional Melanesian women among whom the association was limited to the systolic blood pressure only. Significant correlation coefficients were recorded between diastolic blood pressure and body mass index for both sexes and all groups, and between systolic blood pressure and body mass index for all women but only for Micronesian men. Dramatic differences in life-style and dietary patterns are described for rural and more urbanized Melanesians among whom the mean daily urinary sodium outputs were 67 and 119 mmol/L, respectively.

The effect of the UK aircrew chemical defence assembly on thermal strain

The thermal strain imposed on helicopter aircrew by chemical protective (NBC) clothing in summer in Germany has been assessed in a laboratory simulation. The environmental conditions used were dry bulb temperature 35 degrees C, wet bulb temperature 19 degrees C and a wind speed of 2.0 m X s-1. The NBC equipment imposed a significant thermal strain on the crewman when compared with standard summer flying clothing, but not on the pilot whose tasks involve lower energy expenditures. Deep body temperature exceeded 37.6 degrees C and a significant degree of dehydration (1% of body weight) also occurred, despite the availability of a drinking facility in the respirator. It is recommended that the only practical way of preventing thermal strain in helicopter crewmen under NBC conditions is by providing personal conditioning.

Helicopter accident survivability

Army Air Corps accident and fatality rates have now reached levels which compare favourably with data from other civilian and military sources. This improvement is the result of enhanced helicopter design and parallel progress in aircrew training. The introduction of new generations of turbine powered rotor craft has largely eliminated mechanical failure as the cause of accident. As a result 75% of Army Air Corps accidents are due to pilot error. This contribution is likely to increase in the future as the pilot's task is made more difficult by the incumberance of personal equipment. Methods whereby occupant protection and aircraft crashworthiness can be improved are reviewed and it is concluded that it would make sound economic sense to implement some of these well proven design features.