A pooled analysis of extremely low-frequency magnetic fields and childhood brain tumors

Pooled analyses may provide etiologic insight about associations between exposure and disease. In contrast to childhood leukemia, no pooled analyses of childhood brain tumors and exposure to extremely low-frequency magnetic fields (ELF-MFs) have been conducted. The authors carried out a pooled analysis based on primary data (1960-2001) from 10 studies of ELF-MF exposure and childhood brain tumors to assess whether the combined results, adjusted for potential confounding, indicated an association. The odds ratios for childhood brain tumors in ELF-MF exposure categories of 0.1-<0.2 μT, 0.2-<0.4 μT, and ≥0.4 μT were 0.95 (95% confidence interval: 0.65, 1.41), 0.70 (95% CI: 0.40, 1.22), and 1.14 (95% CI: 0.61, 2.13), respectively, in comparison with exposure of <0.1 μT. Other analyses employing alternate cutpoints, further adjustment for confounders, exclusion of particular studies, stratification by type of measurement or type of residence, and a nonparametric estimate of the exposure-response relation did not reveal consistent evidence of increased childhood brain tumor risk associated with ELF-MF exposure. These results provide little evidence for an association between ELF-MF exposure and childhood brain tumors.

Seeding cumulus in Florida: new 1970 results

In the Florida single cloud experiments, the main result of the statistical analyses is that the dynamic seeding effect on rainfall is large, positive, and significant. From all the 1968 and 1970 data together, the seeding effect is estimated to be larger than a factor of 3; that is, the seeded clouds rained more than three times as much as the controls after the seeding run. On fair days, defined objectively by percentage of area covered by showers, the seeding effect is shown to be larger than the overall average, but it may be negative on rainy days. Rainy days in the tropics are about 10 percent of the days with rain, but they produce about half the total rainfall. The applicability of our single cloud results to other areas is not established but seems hopeful for many tropical and subtropical regions. It can be assessed by cloud population studies together with our numerical model (25). Guidance for the next steps toward practical rainfall enhancement and toward the understanding and modification of cloud systems in storms may be provided by our study of merger clouds. Mergers are shown often to produce more than an order of magnitude more rain than isolated clouds on the same day, probably owing to dynamic invigoration of the merged cloud circulations. Results of our first small attempt toward inducing and documenting mergers in a multiple cloud seeding experiment appear promising. Although far from statistically conclusive, they have opened a new frontier in the science and technology of dynamic cloud modification. It is also hoped that the multiple cumulus seeding experiments will help to clarify the formation of "cloud clusters" and their role in large-scale circulations, thus contributing to the focal subject of the Global Atmospheric Research Program in the tropics.

Photosynthesis-associated gene families: differences in response to tissue-specific and environmental factors

The endogenous small subunit of the ribulose-1,5-bisphosphate carboxylase gene rbcS and the light-harvesting chlorophyll a/b-binding protein gene (LHCP) of pea are expressed in a light-inducible manner and are active mainly in green chloroplast-containing tissue. Chimeric genes under control of the 5'-flanking sequences of the rbcS ss3.6 or LHCP AB80 genes from pea were used to study the factors relating to the issue-specific and lightinducible expression of these nuclear-encoded genes in transgenic tobacco plants. The results show that plastid development plays a crucial role in the activation of expression of these chimeric genes. Particular members of each of the above gene families respond differently to tissue-specific and environmental factors. Furthermore, the light-inducible expression directed by the 5'-flanking sequence of ss3.6 rbcSgene is not exclusively mediated by phytochrome, but probably is controlledin large part by another photoreceptor.

Rainfall results, 1970-1975: Florida area cumulus experiment

The latest rainfall results of the Florida Area Cumulus Experiment (FACE) are discussed after a review of the background, design, and early results of this experiment. Analysis without the benefit of data stratification and appropriate covariates of the 48 random experimentation days obtained through 1975 provided no evidence that dynamic seeding appreciably altered the rainfall over the fixed target area (1.3 x 10(4) square kilometers). Partitioning of the experimentation days according to whether the convective echoes moved across the Florida peninsula or developed in situ was more informative. Use of this echo motion covariate with five meaningful predictor models of natural rainfall in a stepwise regression program produced persuasive evidence for an effect of seeding in both echo motion categories. For days with moving echoes, there is evidence for a positive, statistically significant treatment effect on the rainfall from the subject clouds (the floating target) and in the overall target area. The results for days with stationary echoes, although considerably more tentative, suggest that seeding produces more rainfall in the floating target but with no net change of the precipitation in the overall target area. The ramifications of this result and a possible explanation are discussed. Corroborative statistical analyses and discussion are presented, including a discussion of the physical bases and history of the echo motion covariate and the meteorological predictors, analysis that is supportive of the rain-gage-adjusted radar measurements of precipitation in FACE and results of relevant cloud physics measurements in Florida.

Nucleolar targeting of RelA(p65) is regulated by COMMD1-dependent ubiquitination

Stimulation of the NF-kappaB pathway can have proapoptotic or antiapoptotic consequences, and one mechanism that determines the outcome is the nuclear distribution of RelA. Certain stress stimuli induce nucleolar accumulation of RelA thereby mediating apoptosis, whereas others induce nucleoplasmic accumulation and inhibition of apoptosis. Here we investigated the mechanisms that regulate the nuclear distribution of RelA, specifically, the role of the ubiquitin/proteasome system. We found that stress-induced nucleolar translocation of RelA is preceded by ubiquitination of the protein. We also found that chemical proteasome inhibitors induce the ubiquitination and nucleolar translocation of RelA and that this is required for the apoptotic response to these agents. We show that the RelA nucleolar localization signal (amino acids 27-30) is a critical domain for ubiquitination of the protein but that the lysine residue within this motif is not a direct target. We show that RelA binds COMMD1, the rate-limiting component of the RelA ubiquitin ligase complex, in response to stress. Furthermore, we show that overexpression of COMMD1 promotes stress-mediated nucleolar targeting of RelA, whereas knockdown of COMMD1 blocks this effect, causing RelA to remain in the nucleoplasm. These data identify a new role for COMMD1 in regulating the nuclear/nucleolar distribution of RelA and suggest that ubiquitination acts as a signal for transport of RelA to the nucleolus. These findings have relevance to the design of chemopreventative/anticancer agents that act by targeting RelA to the nucleolar compartment.

Is a Weekly Supervised Upper Limb Exercise Program of Value for Women with Early Breast Cancer?

The aim of this randomised single blinded study was to determine whether an upper limb exercise program, commencing 4-weeks after surgery for early breast cancer, prevents upper limb symptoms, such as pain, swelling, stiffness and weakness.Methods: 156 women, aged 52.5 ± 11.7 y, who had undergone either axillary node dissection (AND; n=94) or sentinel node biopsy (SNB; n=62) for unilateral breast cancer in combination with either mastectomy (n=74) or wide local excision (n=82) within the previous 4 weeks, participated. Women were randomised to either an 8-week exercise program (n=79) or to usual care (n=77); participants were stratified for type of axillary surgery (SNB or AND) and treatment site. The exercise program comprised a home program of daily passive stretching for shoulder muscles and resistance training using Thera-Band® on alternate days for muscles about the shoulder. Women also attended a weekly exercise session. Usual care included routine follow-up with their medical specialists, a breast nurse and a post-operative visit with the physiotherapist and occupational therapist who provided instructions about exercises. The primary outcome was self-reported arm and chest symptoms derived from the EORTC breast cancer specific questionnaire (BR23) which was scored out of 100 with a low score indicative of fewer symptoms. The secondary outcomes included physical measures of shoulder range of motion, strength, and swelling. Presence of lymphoedema (LE) was determined by the inter-limb impedance ratio, using bioimpedance spectroscopy.Results: After the 8-week intervention period, there was no significant difference between groups in either the self-reported or the physical measurements (Table 1).Table 1. Baseline and 8 weeks data (mean ± SD). Usual care group Exercise group  Baseline8 weeksBaseline8 weeksSelf-report symptoms (max 100)    Arm24.5 ± 14.514.6 ± 14.225.9 ± 18.512.5 ± 12.9Breast25.8 ± 16.219.2 ± 17.725.6 ± 19.217.1 ± 16.7Range of motion interlimb difference (deg)    Flexion19.8 ± 19.06.9 ± 7.023.9 ± 19.05.4 ± 7.3Abduction14.5 ± 14.04.7 ± 8.821.1 ± 18.43.8 ± 8.1Inter-limb strength difference (Newtons)    Flexion15.9 ± 21.55.6 ± 19.417.0 ± 21.84.0 ± 15.8Abduction20.0 ± 25.85.7 ± 19.725.2 ± 28.61.0 ± 19.3Swelling (n)    Prevalence of LE (by impedance)7/7714/745/789/74 Conclusion: A weekly, supervised, 8-week upper limb exercise program is not warranted for all women with early breast cancer treated with surgery to the axilla. Usual care in which women are seen post-operatively by a physiotherapist, occupational therapist, and breast nurse with ongoing monitoring by the specialists is sufficient for most women.Acknowledgement: Supported by NSW Cancer Council

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 811.

Post-Operative Resistance Training for Early Breast Cancer Survivors Is Not Associated with Increased Prevalence of Lymphedema

Introduction: Women treated for early breast cancer are routinely advised against lifting heavy objects on the affected side as it may precipitate lymphedema (LE). Women often therefore report that their arm feels weak. As part of a single-blinded randomised trial, we investigated whether an exercise program that included resistance training, commencing 4 weeks post-operatively, was associated with higher prevalence of LE.Methods: Women (mean age: 52.5 ± 11.7 y) who had undergone either axillary node dissection (AND; n=94) or sentinel node biopsy (SNB; n=62) in combination with mastectomy (n=74) or wide local excision (n=82) within the previous 4 weeks for unilateral early stage breast cancer were randomised to an exercise group (79) or usual care group (n=77). Women were stratified for axillary surgery (AND or SNB) and treatment site. The exercise group received a weekly supervised program that comprised resistance training and passive stretching for muscles about the shoulder. The muscles targeted for resistance training included the flexors, abductors, external rotators and horizontal flexors. Women completed two sets of 8 to 12 repetitions for each muscle group. For weekly supervised sessions, the resistance was provided by free weights; for the home program, women were provided with an appropriate grade of elastic Thera-Band®. Each week, the exercises were monitored, and progressed as required, aiming to achieve 'Hard' (15) on the 6 – 20 Borg Effort Scale. Presence of swelling was assessed by self-report, and by circumferential measurements at 10 cm-intervals, commencing at the ulnar styloid and by bioimpedance spectroscopy. Women in the usual care group received advice regarding active stretching.Results: Following an 8-week exercise program, women in the exercise group were not more likely to have LE or changes suggestive of LE. The results for women who had undergone AND are shown in Table 1; results are similar for women who underwent SNB. At baseline, more women in the exercise group had signs and symptoms indicative of LE but at 8 weeks, they had similar or fewer signs.Table 1. Prevalence of lymphoedema in women treated with AND Usual Care Exercise  Baseline (n=46)8 weeks (n=44)Baseline (n=48)8 weeks (n=46)SELF REPORTED    a) on exertion6 (13)4 (9)6 (12)4 (9)b) During ADL's2 (4)1 (2) 1 (2)c) Consistent, minor disability10 (22)3 (7)13 (26)7 (15)d) Consistent, major disability  4 (8)1 (2)ARM CIRCUMFERENCE (&gt;2cm interlimb diff)    a) 1 measure &gt;2 cm1 (2)5 (11)8 (16)3 (7)b) 2+ measures &gt;2 cm2 (4)3 (7) 5 (11)BIOIMPEDANCE SPECTROSCOPY    a) Above interlimb ratio cut-off5 (11)11 (25)5 (106 (13)b) &gt;10 % change from baseline to week 8 5 (11) 3 (7) Conclusion: An 8-week resistance training program for women at risk of LE did not result in greater numbers of women having measures associated with LE than those who did not participate in the training program. Weakness, following surgery for breast cancer, can commence early as 4 weeks post-operatively. Women will be re-assessed in 6 months to determine whether the low prevalence of LE in the exercise group is maintained.Acknowledgements: Cancer Council NSW for funding.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1057.

One-year follow-up of the outcome of a randomized controlled trial of a home-based intervention programme for children with autism and developmental delay and their families

INTRODUCTION

There is debate about the type and intensity of early childhood intervention that is most helpful for children with developmental problems. The aim of the study was to determine whether a home-based programme provided over 12 months resulted in sustained improvement in development and behaviour 12 months after the intervention ceased. The characteristics of the children and families who benefited most from the intervention were also studied.

METHOD

Randomized controlled trial. Participants A total of 59 children, aged 3-5 years, attending two early childhood intervention centres in Melbourne, Australia. Intervention Half of the subjects received an additional home-based programme consisting of 40 weekly visits.

MAIN OUTCOME MEASURES

Bayley Scales of Infant Development and Wechsler Preschool and Primary Scale of Intelligence Revised, Preschool Behaviour Checklist, Bayley Behaviour Rating Scale and Behaviour Screening Questionnaire. All tests administered pre-intervention, following the intervention and 12 months later. Secondary outcome measures Family stress, support and empowerment.

RESULTS

Fifty-four children completed the assessments 12 months after conclusion of the intervention. Compared with the control group, improvement in aspects of cognitive development in the children who received the extra intervention was sustained 1 year later (P= 0.007) while significant behavioural differences post intervention were not. Analyses of the data by the Reliable Change Index indicated improvement of clinical significance occurred in non-verbal areas. In contrast to the control group who deteriorated, language skills in the intervention group remained stable. Improvements were significantly associated with higher stress in the families.

CONCLUSION

Improvements following the provision of a home-based programme to preschool children with developmental disabilities were sustained 1 year later. Children from highly stressed families appeared to benefit most, reinforcing the importance of involving families in early childhood intervention programmes.

Post inflammatory damage to the enteric nervous system in diverticular disease and its relationship to symptoms

Some patients with colonic diverticula suffer recurrent abdominal pain and exhibit visceral hypersensitivity, though the mechanism is unclear. Prior diverticulitis increases the risk of being symptomatic while experimental colitis in animals increases expression of neuropeptides within the enteric nervous system (ENS) which may mediate visceral hypersensitivity. Our aim was to determine the expression of neuropeptides within the ENS in diverticulitis (study 1) and in patients with symptomatic disease (study 2). Study 1 - Nerves in colonic resection specimens with either acute diverticulitis (AD, n = 16) or chronic diverticulitis (CD, n = 16) were assessed for neuropeptide expression recording % area staining with protein gene product (PGP9.5), substance P (SP), neuropeptide K (NPK), pituitary adenylate cyclase activating polypeptide (PACAP), vasoactive intestinal polypeptide (VIP) and galanin. Study 2 - Seventeen symptomatic and 15 asymptomatic patients with colonic diverticula underwent flexible sigmoidoscopy and multiple peridiverticular mucosal biopsies. Study 1- Neural tissue, as assessed by PGP staining was increased to a similar degree in circular muscle in both AD and CD. The CD specimens showed significant increases in the immunoreactivity of SP, NPK and galanin in both mucosal and circular muscle layer compared with controls. Study 2 - Mucosal histology was normal and PGP9.5 staining was similar between groups however patients with symptomatic diverticular disease demonstrated significantly higher levels of SP, NPK, VIP, PACAP and galanin within the mucosal plexus. Patients with symptomatic diverticular disease exhibit increased neuropeptides in mucosal biopsies which may reflect resolved prior inflammation, as it parallels the changes seen in acute and chronic diverticulitis.

Using treated wastewater to save wetlands impacted by climate change and pumping

Wetlands occur where the watertable which underlies much of Perth intersects the land surface. Regional groundwater levels have been falling since the 1970s as a result of lower rainfall and increased extraction causing a loss of environmental and social values. This paper examines a scheme to add almost 2 GL/yr of treated wastewater to infiltration galleries immediately down-gradient of Perry Lakes so that the wetlands may be restored. Modelling suggest that groundwater levels would be raised up-gradient of the galleries, increasing both lake levels and groundwater supplies in the vicinity. It is not envisaged that wastewater will enter the lakes. Adding treated wastewater to nearby trial galleries has shown that phosphorus, pathogens and organic carbon are greatly reduced within 5 to 50 m. Nitrogen levels are less reduced but are similar to those in the lakes and nearby aquifer. It is estimated that the wetlands add about $54 m to land prices near the lakes and would add more than $24M to the sale price of proposed nearby land if they contain water. If successful, the proposal could be a test case for the use of treated wastewater to create hydraulic barriers against salt water intrusion into coastal areas.

Acute appendicitis--a benign disease?

INTRODUCTION

Appendicitis is the most common cause of the acute abdomen and can affect all age groups. Most patients recover quickly but a minority can suffer postoperative complications. This case-note review was undertaken to assess the frequency of these complications.

PATIENTS AND METHODS

Adult patients (> 16 years) undergoing an emergency appendicectomy at a University teaching hospital between February 2004 and January 2005 were identified from pathology records. Details of operative procedure, histology and postoperative complications were noted from the hospital case notes

RESULTS

A total of 199 patients with a median age of 31 years (range, 16-89 years) were identified. Of these, 58 (29%) patients experienced a postoperative complication. Eight (4%) patients were admitted to the surgical high dependency unit or intensive care unit postoperatively and there was one death (0.5%). Re-operation for a postoperative complication was required in 9 (4.5%) patients and there was a 13% re-admission rate (26 patients). Comparison between patients with histologically proven appendicitis (164 patients; 82%) and those patients having a negative appendicectomy (35 patients; 18%) showed no significant difference in the rate of complications as defined (43 of 164, 26% versus 15 of 35, 43%; P = 0.08). However, patients with positive histology were more likely to experience a septic complication (29 of 164, 18% versus 1 of 35, 3%; P = 0.028) and all re-operations came from this group. Despite this, patients with a negative appendicectomy were more likely to be re-admitted (12 of 35, 34% versus 14 of 164, 8.5%; P = 0.0002), predominantly with persistent abdominal pain.

CONCLUSIONS

Appendicectomy is associated with a significant morbidity. Patients with an inflamed appendix were more likely to experience a septic complication but re-admission was more common in patients with a histologically normal appendix because of unresolved abdominal pain.

Prolonged elevation of galanin and tachykinin expression in mucosal and myenteric enteric nerves in trinitrobenzene sulphonic acid colitis

Diverticulitis causes recurrent abdominal pain associated with increased mucosal expression of mucosal galanin and substance P (SP). We studied changes in mucosal and myenteric plexus neuropeptides in adult rats using a model of colonic inflammation, trinitrobenzenesulphonic acid colitis. We assessed the effects on the pan-neuronal markers protein gene product 9.5 (PGP9.5) and neurofilament protein, as well as specific neuropeptides at 1, 2, 3, 4, 6, 8, 10 and 14 weeks. Following the acute injury there was macroscopic resolution of inflammation but minor microscopic abnormalities persisted. Percent area stained of mucosal PGP9.5 fell initially but average levels on days 21 and 28 levels were significantly elevated (P < 0.001), returning to normal by day 42. Percent area staining of PGP9.5 in the muscle rose immediately and remained significantly elevated at 70 days (P < 0.001). SP, neuropeptide K and galanin followed a similar overall pattern. SP to PGP9.5 ratio was significantly increased in the muscle both acutely (days 1-28) and in the long term (days 70 and 98), whereas the galanin to PGP9.5 ratio was significantly increased in the mucosa throughout the study. Low-grade chronic inflammation after an acute initial insult causes a persistent increase in the expression of galanin in the mucosa and SP in muscle layer.

Referral of patients with iron deficiency anaemia under the lower gastrointestinal two-week wait rule

OBJECTIVE

One of the 2-week wait (2WW) criteria for suspected lower gastrointestinal cancer states that patients should be referred who have iron deficiency anaemia (IDA) without obvious cause [Haemoglobin (Hb) <11 g/dl men, <10 g/dl postmenopausal women].

AIM

Our aim was to find the proportion of patients referred as a 2WW not meeting the criteria, and the cost accrued by unnecessary referral.

METHOD

Patients referred over 1 year were identified using the hospitals cancer database. Haematology, haematinics, coeliac serology and cancer status were recorded for each patient.

RESULTS

A total of 204 patients were referred. In total, only 22/204 patients (10.8%) met all the necessary criteria for diagnosis and investigation of IDA prior to referral. As only 43/204 (21.1%) had been assessed for coeliac serology, this accounted for the majority of incomplete referrals. Excluding coeliac serology, only 127 (62.3%) met 2WW criteria for IDA. Of the remaining 77 patients, 57 (74%) patients did not meet the 2WW criteria on Hb alone and 35/77 were referred with no evidence of IDA. 12/127 (9.4%) patients were diagnosed with colorectal cancer. No cancers were detected in patients without BSG evidence of IDA, although one patient did not meet the criteria on Hb level alone.

CONCLUSION

Although iron deficiency is a good marker for gastrointestinal cancer, it is evident that 2WW referral guidelines are not being followed. 89.2% of referrals are inappropriate according to guidelines. This not only has considerable workload and financial implications but could be potentially detrimental to patient health.

Psychological and colonic factors in painful diverticulosis

BACKGROUND

The importance of psychological factors in symptom expression in diverticulosis is unknown. This follow-up study assessed the relative importance of colonic and psychological factors in symptom expression.

METHODS

Patients with barium enema-proven diverticula were sent a bowel symptom questionnaire in 1999 and again in 2006 with additional psychological questionnaires included.

RESULTS

Some 170 of 261 initial responders were eligible for follow-up and 124 (72.9 per cent) provided complete replies. Forty-two (33.9 per cent) of 124 respondents experienced recurrent abdominal pain a median of 3.5 (interquartile range (i.q.r.) 2.00-9.25) days per month, with a median duration of 1 (i.q.r. 0.7-2) h. Multivariable analysis identified a history of acute diverticulitis (odds ratio 3.98; P = 0.010) and a raised score on the Hospital Anxiety and Depression Scale (odds ratio 2.53; P = 0.030) as the best predictors of recurrent pain.

CONCLUSION

Psychological and colonic factors are important in symptom expression in diverticulosis.

Hodgkin's lymphoma and infection: findings from a UK case-control study

Between 1998 and 2003, 214 people with Hodgkin's lymphoma and 214 controls randomly selected from population registers in the north of England (after matching for age and sex) were recruited and their primary care medical records examined for details of clinical diagnoses due to infectious and non-infectious conditions in the preceding 15 years. In the year before diagnosis of Hodgkin's lymphoma, almost all cases (99%) visited their general practitioner (GP) at least once. In comparison with controls, the excess was evident both for visits with an infection (odd's ratio (OR)=2.1; 95% confidence interval (CI) 1.4–3.2) and for visits with non-infectious problems (OR=17.2; 95% CI 6.7–43.9). During the rest of the 15-year period prior to diagnosis, the proportion of people visiting their GP with a non-infectious condition did not differ between cases and controls. In contrast, compared to controls, there was an excess of cases visiting the GP with an infection, a finding that was evident for at least a decade prior to diagnosis and increased linearly with time (P=0.02). This excess was not due to a specific infection(s) and may reflect underlying immune abnormality. Alternatively, infection may cause B-cell proliferation from which a malignant clone may evolve.

Birth order and sibship size: evaluation of the role of selection bias in a case-control study of non-Hodgkin's lymphoma

Substantial heterogeneity has been observed among case-control studies investigating associations between non-Hodgkin's lymphoma and familial characteristics, such as birth order and sibship size. The potential role of selection bias in explaining such heterogeneity is considered within this study. Selection bias according to familial characteristics and socioeconomic status is investigated within a United Kingdom-based case-control study of non-Hodgkin's lymphoma diagnosed during 1998-2001. Reported distributions of birth order and maternal age are each compared with expected reference distributions derived using national birth statistics from the United Kingdom. A method is detailed in which yearly data are used to derive expected distributions, taking account of variability in birth statistics over time. Census data are used to reweight both the case and control study populations such that they are comparable with the general population with regard to socioeconomic status. The authors found little support for an association between non-Hodgkin's lymphoma and birth order or family size and little evidence for an influence of selection bias. However, the findings suggest that between-study heterogeneity could be explained by selection biases that influence the demographic characteristics of participants.

Enhanced implant stability with a chemically modified SLA surface: a randomized pilot study

PURPOSE

Chemical modification to a sandblasted, large-grit, acid-etched (SLA) implant surface has been shown to enhance the rate of osseointegration. The goal of the present study was to examine changes in stability for implants with a chemically modified SLA surface and to compare their outcomes to those of control implants.

MATERIALS AND METHODS

A randomized controlled trial was conducted with 31 patients. Each patient received 2 implants with the same physical properties but with surfaces that were chemically different. The control implants had a standard SLA surface, while the test implants had a chemically modified surface. Resonance frequency analysis was assessed weekly over the first 6 weeks following implant placement.

RESULTS

All implants proved clinically successful, allowing for restoration. Most implants were placed in the mandible (50 of 62). A shift in implant stability from decreasing stability to increasing stability (P < .001), occurred after 2 weeks for the test implants and after 4 weeks for the control implants.

CONCLUSION

The findings from this pilot study provide clinical support for the potential for chemical modification of the SLA surface to alter biologic events during the osseointegration process and demonstrate levels of short-term clinical success similar to those observed for implants with an SLA surface.

Evaluation of two different resonance frequency devices to detect implant stability: a clinical trial

BACKGROUND

Resonance frequency analysis (RFA) provides a non-invasive assessment of implant stability. The established RFA device uses electronic technology, whereas a recently developed device uses magnetic technology. The goal of this clinical trial was to evaluate the ability of the magnetic RFA device to detect changes in stability during early healing following implant placement and to determine whether the implant stability quotient (ISQ) values obtained correlated with those made with the electronic device.

METHODS

RFA assessments were performed using electronic- and magnetic-based devices on 34 non-submerged titanium dental implants in 17 patients. Each patient received two implants in the posterior maxilla or mandible. Implant stability was measured at placement and weekly until week 6, when implants received provisional crowns, and at 12 weeks, when definitive crowns were cemented. During each visit, measurements were taken three times and averaged to obtain a single representative ISQ for each device.

RESULTS

At placement, the mean ISQ obtained with the electronic device was 61.9 (95% confidence interval [CI], 59.4 to 64.3); it increased to 63.2 (95% CI, 61.2 to 65.2) at 12 weeks. With the magnetic device, the mean ISQs were 70.6 (95% CI, 68.4 to 72.8) and 75.9 (95% CI, 74.2 to 77.7), respectively. Both devices indicated a pattern of decreased mean stability from 1 to 3 weeks post-placement, small fluctuations in mean ISQ from 3 to 6 weeks, and significantly increased mean stability from 6 to 12 weeks. For the complete set of implant measures across all weeks, the paired electronic and magnetic ISQ values correlated significantly (r = 0.52; P <0.001).

CONCLUSIONS

This study demonstrates that changes in implant stability measured with the newer magnetic device correlate well with those found with the electronic device. Both devices confirmed the initial decreases in implant stability that occur following placement and identified an increase in stability during the first 6 weeks of functional loading.

Investigation of the sources of residential power frequency magnetic field exposure in the UK Childhood Cancer Study

There is an unexplained association between exposure to the magnetic fields arising from the supply and use of electricity, and increase in risk of childhood leukaemia. The UK Childhood Cancer Study (UKCCS) provides a large and unique source of information on residential magnetic field exposure in the UK. The purpose of this supplementary study was to investigate a sample of UKCCS homes in order to identify the particular sources that contribute to elevated time-averaged exposure. In all, 196 homes have been investigated, 102 with exposures estimated on the basis of the original study to be above 0.2 microT, and 21 higher than 0.4 microT, a threshold above which a raised risk has been observed. First, surveys were carried out outside the property boundaries of all 196 study homes, and then, where informed consent had been obtained, assessments were conducted inside the properties of 19 homes. The study found that low-voltage (LV) sources associated with the final electricity supply accounted together for 77% of exposures above 0.2 microT, and 57% of those above 0.4 microT. Most of these exposures were linked to net currents in circuits inside and/or around the home. High-voltage (HV) sources, including the HV overhead power lines that are the focus of public concern, accounted for 23% of the exposures above 0.2 microT, and 43% of those above 0.4 microT. Public health interest has focused on the consideration of precautionary measures that would reduce exposure to power frequency magnetic fields. Our study provides a basis for considering the options for exposure mitigation in the UK. For instance, in elevated-exposure homes where net currents are higher than usual, if it is possible to reduce the net currents, then the exposure could be reduced for a sizeable proportion of these homes. Further investigations would be necessary to determine whether this is feasible.

Childhood acute lymphoblastic leukemia and infections in the first year of life: a report from the United Kingdom Childhood Cancer Study

The United Kingdom Childhood Cancer Study was designed to examine the relation between childhood cancer and preceding exposure to infectious diseases. The authors analyzed the relation between diagnosis (1991-1996) of acute lymphoblastic leukemia (ALL) at ages 2-5 years and clinically diagnosed infections in infancy. Almost all study children (96% of both cases and controls) were taken to a general practitioner for a non-immunization-associated visit at least once before their first birthday. Children diagnosed with ALL had significantly more clinically diagnosed infectious episodes in infancy than did controls; the average number of episodes was 3.6 (95% confidence interval (CI): 3.3, 3.9) versus 3.1 (95% CI: 2.9, 3.2). This case-control difference was most apparent in the neonatal period (< or =1 month); 18% of controls and 24% of ALL cases were diagnosed with at least one infection (odds ratio = 1.4, 95% CI: 1.1, 1.9; p < 0.05). Cases who had more than one neonatal infectious episode tended to be diagnosed with ALL at a comparatively young age; the mean age at ALL diagnosis was 37.7 months for cases with two or more episodes versus 45.3 months for cases with only one episode or none (p < 0.01). These findings support the hypothesis that a dysregulated immune response to infection in the first few months of life promotes transition to overt ALL later in childhood.

Back pain as the presenting symptom of generalised tetanus

Back pain is a common presenting symptom in emergency departments and primary care across the UK. The extensive differential diagnosis includes mechanical, infective, thoracic, abdominal and vascular causes. This case report describes a patient who presented with lower back pain with a rare diagnosis, which is becoming more common in certain population groups, and emphasises the importance of clinical skills and insuring adequate tetanus prophylaxis.

Home safety education and provision of safety equipment for injury prevention

BACKGROUND

In industrialised countries injuries are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home, but there is little meta-analytic evidence that child home safety interventions improve a range of safety practices or reduce injury rates and little evidence on their effect by social group.

OBJECTIVES

We evaluated the effectiveness of home safety education, with or without the provision of low cost, discounted or free equipment in increasing home safety practices or reducing child injury rates and whether the effect varied by social group.

SEARCH STRATEGY

We searched The Cochrane Library, MEDLINE, EMBASE, CINAHL, DARE, ASSIA, Psychinfo and Web of Science, plus a range of relevant web sites, conference proceedings and bibliographies. We contacted authors of included studies and surveyed a range of organisations.

SELECTION CRITERIA

Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, which reported safety practices, possession of safety equipment or injury.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed study quality and extracted data. We attempted to obtain individual participant level data (IPD) for all included studies and summary data and IPD were simultaneoulsy combined in meta-regressions by social and demographic variables.

MAIN RESULTS

Eighty studies were included; 37 of which were included in at least one meta-analysis. Twenty-three (62%) were RCTs and 12 (32%) included in the meta-analysis provided IPD. Home safety education was effective in increasing the proportion of families with safe hot tap water temperatures (OR 1.35, 95% CI 1.01 to 180), functional smoke alarms (OR 1.85, 95% CI 1.24 to 2.75), storing medicines (OR 1.58, 95% CI 1.18 to 2.13) and cleaning products (OR 1.63, 95% CI 1.22 to 2.17) out of reach, syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) and poison control centre numbers accessible (OR 3.66, 95% CI 1.84 to 7.27), fitted stair gates (1.26, 95% CI 1.05 to 1.51), socket covers on unused sockets (OR 3.73, 95% CI 1.48 to 9.39) and storing sharp objects out of reach (OR 1.52, 95% CI 1.01 to 2.29). There was a lack of evidence that interventions reduced rates of thermal injuries, poisoning or a range of injuries. There was no consistent evidence that interventions were less effective in families whose children were at greater risk of injury.

AUTHORS' CONCLUSIONS

Home safety education provided most commonly as one-to-one, face-to-face education, in a clinical setting or at home, especially with the provision of safety equipment is effective in increasing a range of safety practices. There is a lack of evidence regarding its impact on child injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment was less effective in those at greater risk of injury.

Return of collective rotation in 157Er and 158Er at ultrahigh spin

A new frontier of discrete-line gamma-ray spectroscopy at ultrahigh spin has been opened in the rare-earth nuclei (157,158) Er. Four rotational structures, displaying high moments of inertia, have been identified, which extend up to spin approximately 65 variant Planck's over 2pi and bypass the band-terminating states in these nuclei which occur at approximately 45 variant Planck's over 2pi. Cranked Nilsson-Strutinsky calculations suggest that these structures arise from well-deformed triaxial configurations that lie in a valley of favored shell energy which also includes the triaxial strongly deformed bands in (161-167) Lu.

Cellular localisation of adenylyl cyclase: a post-genome perspective

The intracellular messenger cAMP is essential for vital processes ranging from ovulation to cognition. There are 10 genes for adenylyl cyclase (AC), the biosynthetic enzyme of cAMP. Nine of these encode membrane-bound proteins and one gives rise to soluble AC. The understanding of the biological significance of this molecular diversity is incomplete. Membrane-bound ACs conform to the same structural blueprint but have markedly different regulatory characteristics. AC mRNAs are differentially distributed in the body suggesting non-redundant physiological functions. The subcellular localisation of AC isoforms has not been examined in detail. Here we discuss the current knowledge on the intracellular targeting of AC isoforms, and highlight the technical problems of AC detection, some of which appear to be caused by the poor quality-control of commercially supplied antibodies. The principal message is that intracellular targeting of ACs may be isoform-specific and also dependent on the cellular context of expression.