Myocardial infarction and other major vascular events during chemotherapy for testicular cancer

BACKGROUND

Chronic vascular morbidity resulting from chemotherapy for testicular germ-cell cancer (TGCC) is recognized. Cardiovascular events (CVEs) occurring early during chemotherapy are less understood. We evaluated the incidence and clinical features of CVEs associated with chemotherapy of TGCC.

PATIENTS AND METHODS

A questionnaire was sent to 355 institutions in Germany to explore for early CVEs occurring during 1996-2008. To assess the relative incidence of CVEs, the number of events was put into relation to the total number of patients treated during the time span (n = 8233, calculated from national database). The response rate was 79%.

RESULTS

Twenty cases with myocardial infarction (MI), 3 with cerebral stroke, and 2 with arterial thrombosis were recorded. The estimated incidence of MI and of all CVEs during chemotherapy is 0.24% [95% confidence intervals (CIs) 0.137% to 0.349%] and 0.30% (95% CI 0.188% to 0.423%), respectively. This estimate represents a minimum figure because the calculation is on the basis of simplifications. Six MI patients had no risk factors. Coronary angiography was indicative of thromboembolic rather than atherosclerotic origin of MI.

CONCLUSIONS

There is a small but definite risk of major early CVE associated with chemotherapy of TGCC. Physicians caring for TGCC patients must be aware of this hazard.

Does a gatekeeper suicide prevention program work in a school setting? Evaluating training outcome and moderators of effectiveness

The current study sought to evaluate the suicide prevention gatekeeper training program QPR (Question, Persuade, and Refer) among school personnel using a non-equivalent control group design. Substantial gains were demonstrated from pre- to post-test for attitudes, knowledge, and beliefs regarding suicide and suicide prevention. Exploratory analyses revealed the possible moderating effects of age, professional role, prior training, and recent contact with suicidal youth on QPR participants' general knowledge, questioning, attitudes toward suicide and suicide prevention, QPR quiz scores, and self-efficacy. The need for replication using a more rigorous experimental design in the context of strong community collaboration is discussed.

Three-dimensional CT analysis to determine acetabular retroversion and the implications for the management of femoro-acetabular impingement

This study examined the relationship between the cross-over sign and the true three-dimensional anatomical version of the acetabulum. We also investigated whether in true retroversion there is excessive femoral head cover anteriorly. Radiographs of 64 hips in patients being investigated for symptoms of femoro-acetabular impingement were analysed and the presence of a cross-over sign was documented. CT scans of the same hips were analysed to determine anatomical version and femoral head cover in relation to the anterior pelvic plane after correcting for pelvic tilt. The sensitivity and specificity of the cross-over sign were 92% and 55%, respectively for identifying true acetabular retroversion. There was no significant difference in total cover between normal and retroverted cases. Anterior and posterior cover were, however, significantly different (p < 0.001 and 0.002). The cross-over sign was found to be sensitive but not specific. The results for femoral head cover suggest that retroversion is characterised by posterior deficiency but increased cover anteriorly.

The short-term effectiveness of a suicide prevention gatekeeper training program in a college setting with residence life advisers

Although the college years prove to be a vulnerable time for students and a critical period for suicide prevention, few school-based prevention strategies have been empirically evaluated. The current study examined the short-term effects of Question, Persuade, and Refer (QPR), a gatekeeper training program that teaches how to recognize warning signs, question suicidal intent, listen to problems, and refer for help. One hundred twenty-two residence advisers (RAs) who were trained in QPR demonstrated significant post-training gains across a variety of domains relevant to suicide and suicide prevention, with 60 who completed the follow-up assessment showing sustained knowledge and appraisals into the following semester. Although these gains were generally more substantial for RAs trained in QPR, 86 controls who completed both baseline and follow-up assessments also demonstrated changes in appraisals relevant to suicide and suicide prevention, despite having not received QPR training. Editors' Strategic Implications this study provides some promising evidence on gatekeeper training for RAs in terms of suicide prevention knowledge and attitudes. As the authors note, replication, rigorous evaluation, and studies of systemic efforts and behavioral outcomes are needed.

OFSETH: smart medical textile for continuous monitoring of respiratory motions under magnetic resonance imaging

The potential impact of optical fiber sensors embedded into medical textiles for the continuous monitoring of the patient during Magnetic Resonance Imaging is presented. We report on two pure optical sensing technologies for respiratory movements monitoring - a macro bending sensor and a Bragg grating sensor, designed to measure the elongation due to abdominal and thoracic motions during breathing. We demonstrate that the two sensors can successfully sense textile elongation between, 0% and 3%, while maintaining the stretching properties of the textile substrates for a good comfort of the patient.

Analysis of cover of the femoral head in normal and dysplastic hips: new CT-based technique

We present a new CT-based method which measures cover of the femoral head in both normal and dysplastic hips and allows assessment of acetabular inclination and anteversion. A clear topographical image of the head with its covered area is generated. We studied 36 normal and 39 dysplastic hips. In the normal hips the mean cover was 73% (66% to 81%), whereas in the dysplastic group it was 51% (38% to 64%). The significant advantage of this technique is that it allows the measurements to be standardised with reference to a specific anatomical plane. When this is applied to assessing cover in surgery for dysplasia of the hip it gives a clearer understanding of where the corrected hip stands in relation to normal and allows accurate assessment of inclination and anteversion.

Comparison of the effects of cetylpyridinium chloride with an essential oil mouth rinse on dental plaque and gingivitis ? a six-month randomized controlled clinical trial

OBJECTIVE

To compare the effects of an experimental mouth rinse containing 0.07% cetylpyridinium chloride (CPC) (Crest Pro-Health) with those provided by a commercially available mouth rinse containing essential oils (EOs) (Listerine) on dental plaque accumulation and prevention of gingivitis in an unsupervised 6-month randomized clinical trial.

MATERIAL AND METHODS

This double-blind, 6-month, parallel group, positively controlled study involved 151 subjects balanced and randomly assigned to either positive control (EO) or experimental (CPC) mouth rinse treatment groups. At baseline, subjects received a dental prophylaxis procedure and began unsupervised rinsing twice a day with 20 ml of their assigned mouthwash for 30 s after brushing their teeth for 1 min. Subjects were assessed for gingivitis and gingival bleeding by the Gingival index (GI) of Löe & Silness (1963) and plaque by the Silness & Löe (1964) Plaque index at baseline and after 3 and 6 months of rinsing. At 3 and 6 months, oral soft tissue health was assessed. Microbiological samples were also taken for community profiling by the DNA checkerboard method.

RESULTS

Results show that after 3 and 6 months of rinsing, there were no significant differences (p=0.05) between the experimental (CPC) and the positive control mouth rinse treatment groups for overall gingivitis status, gingival bleeding, and plaque accumulation. At 6 months, the covariant (baseline) adjusted mean GI and bleeding sites percentages for the CPC and the EO rinses were 0.52 and 0.53 and 8.7 and 9.3, respectively. Both mouth rinses were well tolerated by the subjects. Microbiological community profiles were similar for the two treatment groups. Statistically, a significant greater reduction in bleeding sites was observed for the CPC rinse versus the EO rinse.

CONCLUSION

The essential findings of this study indicated that there was no statistically significant difference in the anti-plaque and anti-gingivitis benefits between the experimental CPC mouth rinse and the positive control EO mouth rinse over a 6-month period.

Single center experience of a new intensive induction therapy for ewing's family of tumors: feasibility, toxicity, and stem cell mobilization properties

PURPOSE

To examine the feasibility, tolerability, and toxicity of an intensified induction regimen (vincristine, ifosfamide, doxorubicin, and etoposide [VIDE]) in patients with newly diagnosed Ewing's family of tumors (EFT); to assess ability to maintain dose-intensity, and predictability of peripheral-blood stem cell mobilization.

PATIENTS AND METHODS

Thirty patients were treated with vincristine 1.4 mg/m2 (maximum 2 mg) on day 1, doxorubicin 20 mg/m2, ifosfamide 3 g/m2 plus mesna and etoposide 150 mg/m2 on days 1 to 3. Cycles were given every 21 days for up to six cycles.

RESULTS

One-hundred and seventy cycles of VIDE were given. The median treatment interval was 21 days (21 to 42) and nadir count: hemoglobin 8.3 (6.3 to 11.9), neutrophils 0.045 (0.0 to 2.1), and platelets 45 (3 to 343). There were 96 episodes of infection requiring hospitalization (56%). Growth factor support reduced infectious complications by 34%. Etoposide dose was reduced, or omitted, in 24% of cycles. Four patients did not complete six cycles due to unacceptable toxicity and one patient progressed on treatment. Twenty patients underwent peripheral-blood stem cell harvesting, 15 after cycle 3, and five after cycle 4. Median CD34+ yield was 4.6 x 106/kg per patient (1.8 to 14.5). Overall response to treatment, measured in 24 patients, was 88%. Seven of 11 patients undergoing surgery achieved greater than 90% necrosis of tumor (64%).

CONCLUSION

VIDE is an effective induction regimen with substantial but acceptable toxicity that allows predictable mobilization of stem cells. Maintenance of dose-intensity is feasible in the majority of patients. Growth factors play a role in maintaining dose-intensity and reduce infectious complications.

Teaching nursing students to critically evaluate electronic fetal monitor tracings

Evaluation of electronic fetal monitor (EFM) tracings is challenging for nursing students and novice perinatal nurses. Use of a standardized nursing process tool facilitates recognition of electronic fetal monitoring patterns and application of appropriate nursing interventions. Feedback from expert nurses and nursing instructors validates students' critical thinking skills.

The pelvic C-clamp for the emergency treatment of unstable pelvic ring injuries. A report on clinical experience of 30 cases

An unstable pelvic ring injury was stabilized with the AO C-clamp in thirty multiply injured patients. The average ISS was 29 (19-57). Transfusions totalled 24 units of blood/fresh frozen plasma/platelets (0-117) on average. In 12 cases, the application was for an unstable fracture alone, in 18 patients there was an unstable haemodynamic situation in addition. The application was haemodynamically effective in 10 cases. In 66% of cases, the initial reduction was good and the anatomy of the pelvic ring was adequately restored. Ten patients (33%) died; five during the first hours after admission due to haemorrhagic shock; the remaining five from multiple organ failure, fat embolism and head injury. Definitive stabilization was accomplished after 4.5 days on average (0-15). Complications relating directly to the clamp did not occur. The application of the C-clamp has a clear place in the management of polytraumatized patients with linear unstable pelvic ring injuries.

Injuries in windsurfing due to foot fixation

Two cases are reported: a 27-year-old man fractured the lower leg and an 18 year-old man sustained a rupture of the anterior cruciate ligament and medial collateral ligament during windsurfing. Both injuries may be ascribed to the fact that the patients' feet were fixed in footstraps and that their legs were twisted during the fall. Footstraps evidently represent a hazard, and action should be taken towards solving this problem. We suggest that either the footstraps be fitted with a release mechanism or surfers avoid using them.

Treatment with acarbose, an alpha-glucosidase inhibitor, reduces increased albumin excretion in streptozotocin-diabetic rats

1. We examined the effect of the alpha-glucosidase inhibitor acarbose on urinary albumin excretion (UAE) in streptozotocin diabetic rats. 2. Treatment with acarbose for 8 weeks after induction of diabetes prevented the significant increase in UAE observed in untreated diabetic rats relative to nondiabetic controls. 3. Acarbose significantly reduced integrated glycemia, which correlated with albumin excretion rates, and exerts a salutary effect on diabetic renal dysfunction.

The stability of children's physical activity as measured by accelerometry and self-report

The Computer Science Application (CSA) accelerometer uses integrated circuitry and memory to provide a continuous recording of minute-by-minute movement counts. It has been previously validated as an objective monitor of children's physical activity in field and laboratory settings. Our purpose was to derive accelerometry summary variables reflective of different physical activity intensity levels, evaluate the stability of these summary variables, and define the number of days needed to adequately measure usual physical activity. A secondary study purpose was to compare three self-report questionnaires to accelerometry. Thirty children (7-15 yr) wore accelerometers for 12 h.d-1 for 6 d. Daily summary variables of average movement count (total physical activity) and daily frequency of sedentary through vigorous activity were constructed. Intraclass correlation coefficients (R) and 95% confidence intervals (CI) were used to analyze the data. Accelerometry stability using 1 monitored day to represent usual physical activity was R = 0.42-0.47. When 6 d were used, stability increased to R = 0.81-0.84. Acceptable intraclass correlations and CI were achieved with 4 d of monitoring (R = 0.75-0.78, CI = 0.60-0.88). The self-report questionnaires were poorly to moderately correlated to accelerometry variables (r = -0.03-0.51). Data indicate that in field settings: 1) accelerometry can be used to assess the intensity of children's activity and 2) 4 or more days of activity monitoring are needed to achieve satisfactory reliability.

Biochemical characterization of basilase, a fibrinolytic enzyme from Crotalus basiliscus basiliscus

Snake venoms, especially from the Crotalidae family, contain a variety of enzymes that prevent blood coagulation by virtue of their fibrinolytic enzymes. Nineteen snake venoms were screened for fibrinolytic activity and the highest activity was found in the venom of Crotalus basiliscus basiliscus venom. The active principle, basilase, was isolated, purified, and found to have fibrinolytic and fibrinogenolytic activity. It had a molecular weight of 22,000 and 1 mol of zinc per mole of protein associated with it. The proteolytic activity of the enzyme against dimethyl casein was inhibited by ethylenediaminetetraacetic acid and alpha 2-macroglobulin. It did not inactivate alpha 2-macroglobulin. Basilase did not have any of the following activities: thrombin-like, factor X-like, protein C activating, or urokinase-like. It caused neither hemorrhage nor platelet aggregation. In spite of its proteolytic activity, basilase did not hydrolyze the membranes of platelets. Basilase had 24% alpha-helix, 31% beta-sheet, 25% turns, and 20% unordered structure, as determined by Fourier Transform Infrared spectroscopy. Basilase is an enzyme that hydrolyzes fibrin directly without activation of plasminogen.

[Colloid carcinoma of the urachus. Cytologic diagnosis and differential diagnostic classification]

We report a rare case of colloid carcinoma apparently of urachal derivation. In a patient presenting with nycturia cytological analysis of urine led to a tentative diagnosis of colloid carcinoma of urachal origin. Endoscopic and radiological investigations confirmed this provisional diagnosis. For this reason, the surgical procedure could be properly planned and restricted to the removal of the apex of the bladder and urachus.