Thymidylate synthase expression in stage II and III colon cancer: a retrospective review

This study is a retrospective analysis of thymidylate synthase (TS) levels in patients with stage II (T3 or T4) and III colon cancer. Two groups of patients were identified: one undergoing surgery alone (98 patients) and the second receiving adjuvant 5-fluorouracil chemotherapy (112 patients). TS analyses were carried out using the 106 monoclonal antibody and a published grading system dividing staining into high and low intensity. The distribution of patients with low versus high TS levels was similar in the two groups. There was no association between TS staining intensity and grade, stage or location of primary. Seventy-nine patients have relapsed: 46 (48%) in the surgery only group, 33 (30%) in the adjuvant therapy group (median follow-up: 51 and 61 months). Similar proportions relapsed when analyzed according to TS: in the surgery only group, 41% of patients with low TS, 48% with high TS; in the adjuvant group, 31% with low TS, 30% with high TS. In the surgery only group, a trend toward improved disease-free survival (DFS) was seen in the low TS group (84 versus 63% at 2 years, p = 0.08). No difference was seen in overall survival. There were no differences in DFS or overall survival in patients receiving adjuvant therapy according to TS intensity. The trend for worse outcome in patients with high TS is consistent with previous reports. The lack of difference in outcome for patients with low and high TS receiving chemotherapy suggests that high TS levels may predict greater benefit from adjuvant treatment.

A randomized controlled trial of the effect of antihelminthic treatment and micronutrient fortification on health status and school performance of rural primary school children

Single interventions for helminthic infections and micronutrient deficiencies are effective, but it is not clear whether combined interventions will provide equal, additive or synergistic effects to improve children's health. The study objective was to determine the impact of single and combined interventions on nutritional status and scholastic and cognitive performance of school children. A double-blind, randomized, placebo-controlled trial in 11 rural South African primary school randomly allocated 579 children aged between 8 and 10 years into six study groups, half of whom received antihelminthic treatment at baseline. The de-wormed and non-de-wormed arms were further divided into three groups and given biscuits, either unfortified or fortified with vitamin A and iron or with vitamin A only, given daily for 16 weeks. The outcome measures were anthropometric, micronutrient and parasite status, and scholastic and cognitive test scores. There was a significant treatment effect of vitamin A on serum retinol (p < 0.01), and the suggestion of an additive effect between vitamin A fortification and de-worming. Fortified biscuits improved micronutrient status in rural primary school children; vitamin A with de-worming had a greater impact on micronutrient status than vitamin A fortification alone and antihelminthic treatment significantly reduced the overall prevalence of parasite infection. The burden of micronutrient deficiency (anaemia, iron and vitamin A) and stunting in this study population was low and, coupled with the restricted duration of the intervention (16 weeks), might have limited the impact of the interventions.

An exception to the rule: ectopic ACTH production from functional neuroendocrine tissue in an ovarian dermoid cyst

Ectopic ACTH production accounts for 15% of Cushing's syndrome presentations and is characterized by the presence of an excess of ACTH precursors. However in the case presented here ectopic ACTH production was from functional pituitary tissue within an ovarian dermoid cyst. Endocrine investigations showed that the problem behaved more like pituitary-dependent Cushing's disease and this is discussed. Furthermore, this case is one of familial dermoid cysts, another unusual phenomenon.

Viral and chemical tracer movement through contrasting soils

Land treatment of animal or human waste can result in chemical and microbial contamination of shallow ground water and/or water-ways. We investigated the fate of a host-specific Salmonella bacteriophage and a nonreactive chemical (Br-) tracer when applied to large intact lysimeter soil cores (500 mm diam. by 700 mm high). The soils included a poorly drained Gley Soil and well-drained Pumice, Allophanic, and Recent Soils. A depth of 30 mm of water containing the bacteriophage and Br- was applied to the soil at a rate of 5 mm h(-1) followed by up to about 1.8 pore volumes of simulated rainfall. Resulting leachates, collected continuously over at least one pore volume were analyzed for the bacteriophage and bromide (Br-) tracers. Bromide moved uniformly through the Pumice and Allophanic Soils with peak concentrations at about 1 pore volume, while the bacteriophage was detected only at trace levels or not at all. In contrast, both Br- and bacteriophage tracers moved rapidly through Gley and Recent Soils, appearing early in the leachate and then tailing off. Such flow patterns in the Gley and Recent Soils are indicative of bypass flow. Coarse soil structure in the Gley Soil, and finger-flow due to water repellency in the sandy Recent Soil are considered responsible for the observed bypass flow in these two soils. Allophanic and Pumice Soils have finer, more porous soil structure leading to a predominance of matrix flow over bypass flow. This study suggests vertical movement of viruses varies significantly with soil type.

The effect of sequential use of vacuum and forceps for assisted vaginal delivery on neonatal and maternal outcomes

OBJECTIVE

To determine the risk of neonatal and maternal disease associated with the sequential use of vacuum and forceps compared with spontaneous vaginal delivery.

STUDY DESIGN

Using Washington state birth certificate data linked to hospital discharge records, we compared 3741 vaginal deliveries by both vacuum and forceps, 3741 vacuum deliveries, and 3741 forceps deliveries to 11,223 spontaneous vaginal deliveries.

RESULTS

Compared with spontaneous vaginal deliveries, deliveries by sequential use of vacuum and forceps had significantly higher rates of intracranial hemorrhage (relative risk [RR], 3.9; 95% confidence interval [CI], 1.5 to 10.1), brachial plexus (RR, 3.2; 95% CI, 1.6 to 6.4), facial nerve injury (RR, 13.3; 95% CI, 4.7 to 37.7), seizure (RR, 13.7; 95% CI, 2.1 to 88.0), depressed 5-minute Apgar score (RR, 3.0; 95% CI, 2.2 to 4.0), assisted ventilation (RR, 4.8; 95% CI, 2.1 to 11.0), fourth-degree (RR, 11.4; 95% CI, 6.4 to 20.1 among multiparous women) and other lacerations, hematoma (RR, 6.2; 95% CI, 2.1 to 18.1 among multiparous women), and postpartum hemorrhage (RR, 1.6; 95% CI, 1.3 to 2.0). The relative risk of sequential vacuum and forceps use was greater than the sum of the individual relative risks of each instrument for intracranial hemorrhage, facial nerve injury, seizure, hematoma, and perineal and vaginal lacerations.

CONCLUSION

Sequential use of vacuum and forceps is associated with increased risk of both neonatal and maternal injury.

Interstitial laser: a new surgical technique for twin reversed arterial perfusion sequence in early pregnancy

Current treatments for twin reversed arterial perfusion sequence are associated with significant morbidity and most are not feasible in early gestation. We report the use of an interstitial laser in two pregnancies complicated by this sequence at 14 and 15 weeks, respectively. A 600 microm laser fibre was introduced via a 17 gauge needle into the abdomen of the perfused twin close to the vitelline artery and umbilical vein, which were occluded by neodymium:yttrium aluminium garnet (Nd:YAG) laser. Both pregnancies continued uneventfully and each resulted in the birth of a healthy baby at term.

Pharmacologic rescue of lethal seizures in mice deficient in succinate semialdehyde dehydrogenase

Succinate semialdehyde dehydrogenase (ALDH5A1, encoding SSADH deficiency is a defect of 4-aminobutyric acid (GABA) degradation that manifests in humans as 4-hydroxybutyric (gamma-hydroxybutyric, GHB) aciduria. It is characterized by a non-specific neurological disorder including psychomotor retardation, language delay, seizures, hypotonia and ataxia. The current therapy, vigabatrin (VGB), is not uniformly successful. Here we report the development of Aldh5a1-deficient mice. At postnatal day 16-22 Aldh5a1-/- mice display ataxia and develop generalized seizures leading to rapid death. We observed increased amounts of GHB and total GABA in urine, brain and liver homogenates and detected significant gliosis in the hippocampus of Aldh5a1-/- mice. We found therapeutic intervention with phenobarbital or phenytoin ineffective, whereas intervention with vigabatrin or the GABAB receptor antagonist CGP 35348 (ref. 2) prevented tonic-clonic convulsions and significantly enhanced survival of the mutant mice. Because neurologic deterioration coincided with weaning, we hypothesized the presence of a protective compound in breast milk. Indeed, treatment of mutant mice with the amino acid taurine rescued Aldh5a1-/- mice. These findings provide insight into pathomechanisms and may have therapeutic relevance for the human SSADH deficiency disease and GHB overdose and toxicity.

Failure of blue-tinted lenses to change reading scores of dyslexic individuals

BACKGROUND

This study was designed to address a perceived major flaw in past studies investigating tinted lenses and dyslexia; i.e., the lack of a direct, scientifically validated means of diagnosing the type and severity of dyslexia.

METHODS

Sixteen 5th and 8th grade students, found to be dyslexic based on testing via the Dyslexia Determination Test (DDT), were randomly divided into two groups of eight. One group was tested first with blue filters (then, 2 to 5 weeks later, no filters) using the Gates MacGinitie Reading Test for reading comprehension. The other group of eight was tested in the same way, first with no filters, then 2 to 5 weeks later with blue filters. The grade level of the test used for each subject was in accord with the DDT decoding level.

RESULTS

There was no significant difference in reading comprehension level or reading speed when the blue filter condition was compared to the no filter condition.

CONCLUSIONS

Using DDT classification, subjects were found to have mostly dysphoneidetic (mixed pattern) dyslexia. Among this population of dyslexic students, tinted lenses appeared to provide no beneficial effect. We offer an explanation based on neuro-anatomical relationships between the visual system and reading centers in the brain. The hypothesis states that the transient system defect may be an epiphenomenon, which can coincidentally occur in cases of reading disability.

Child seduction and self-representation on the Internet

This paper presents a case study of a man charged with the offense of downloading child pornography from the Internet. He had used the Internet to traffic child pornography, and, in addition, to locate children to abuse, to engage in inappropriate sexual communication with children, and to communicate with other pedophiles. Such offenses were facilitated by self-representing in Chat rooms as both a child and an adult. The case study illustrates how such offenders move through a repertoire of offending behavior and discusses the role that the Internet can play in supporting inappropriate and disinhibited sexual behavior that victimizes children through the trading of child pornography and possible child seduction. The Internet is seen to play a unique role in allowing individuals to self-represent aspects that might otherwise remain hidden or dormant.