First observation of the Greisen-Zatsepin-Kuzmin suppression

The High Resolution Fly's Eye (HiRes) experiment has observed the Greisen-Zatsepin-Kuzmin suppression (called the GZK cutoff) with a statistical significance of five standard deviations. HiRes' measurement of the flux of ultrahigh energy cosmic rays shows a sharp suppression at an energy of 6 x 10(19) eV, consistent with the expected cutoff energy. We observe the ankle of the cosmic-ray energy spectrum as well, at an energy of 4 x 10(18) eV. We describe the experiment, data collection, and analysis and estimate the systematic uncertainties. The results are presented and the calculation of the statistical significance of our observation is described.

Polymorphisms in the PTPN22 region are associated with psoriasis of early onset

Background

Psoriasis, a chronic inflammatory skin disease, affects approximately 2% of the population worldwide. Although the aetiology of psoriasis is poorly understood, patients with disease of early onset (Type I, age of onset ≤ 40 years) usually have a strong genetic component to the disease.

Objectives

The purpose of this study was to investigate the role of the protein tyrosine phosphatase nonreceptor type 22 (PTPN22) gene region in susceptibility to Type I psoriasis.

Patients and methods

Thirteen single nucleotide polymorphisms (SNPs) mapping to the PTPN22 region were genotyped in 647 patients with Type I psoriasis and 566 normal controls.

Results

The rs2476601 (R620W) SNP, widely associated with other inflammatory autoimmune diseases, showed no evidence of association with susceptibility to Type I psoriasis. Two SNPs (rs1217414 and rs3789604) demonstrated significant association with Type I psoriasis and were subsequently genotyped in a further 253 unrelated patients and 2024 normal controls. rs1217414 and rs3789604 were also significantly associated with Type I psoriasis in the combined datasets (P = 0·003 and P = 0·0002, respectively); furthermore carriage of both risk alleles was also significantly associated (P = 0·002).

Conclusions

This study demonstrates evidence of association of two SNPs (rs1217414 and rs3789604) in the PTPN22 region with Type I psoriasis, providing evidence for a role of this gene in Type I psoriasis that is not conferred by the R620W variant previously associated with a number of inflammatory diseases.

Mesenteric artery occlusion secondary to activated protein C resistance: a life-threatening combination

We present a case of mesenteric ischemia in a 32-year-old woman. The rarity of this potentially fatal condition in this age group, the diagnostic and therapeutic challenges associated with such a condition, and secondary causes that must always be investigated are highlighted. In this case, activated protein C resistance resulted in thrombosis of the superior mesenteric artery and subsequent bowel ischemia.

Psoriasis is associated with pleiotropic susceptibility loci identified in type II diabetes and Crohn disease

BACKGROUND

Psoriasis is an immune-mediated skin disorder that is inherited as a multifactorial trait. Linkage analyses have clearly mapped a primary disease susceptibility locus to the major histocompatibility complex (MHC) region on chromosome 6p21. More recently, whole-genome association studies have identified two non-MHC disease genes (IL12B and IL23R), both of which also confer susceptibility to Crohn disease (CD).

OBJECTIVE AND METHODS

To ascertain the genetic overlap between these two inflammatory conditions further, we investigated 15 CD-associated loci in a psoriasis case-control dataset.

RESULTS

The analysis of 1256 patients and 2938 unrelated controls found significant associations for loci mapping to chromosomes 1q24 (rs12035082, p = 0.009), 6p22 (rs6908425, p = 0.00015) and 21q22 (rs2836754, p = 0.0003). Notably, the marker showing the strongest phenotypic effect (rs6908425) maps to CDKAL1, a gene also associated with type 2 diabetes.

CONCLUSIONS

These results substantiate emerging evidence for a pleiotropic role for s genes that contribute to the pathogenesis of immune-mediated disorders.

Cardiac risk factors for dental procedures: knowledge among dental practitioners in Wales

OBJECTIVES

To determine knowledge and educational needs of dental practitioners in Wales regarding congenital or acquired cardiac disease and the provision of antibiotic prophylaxis.

DESIGN

Self-administered postal questionnaire.

SETTINGS

Cardiff University Dental Hospital, district general hospitals (HDS), all general dental practices (GDP) and community dental service (CDS) clinics throughout Wales. Methods A questionnaire sent to 1,182 dentists in Wales in 2004-5.

RESULTS

528 questionnaires were returned (a response rate of 45%). These were analysed using one-way analysis of variance to compare summary scores between the occupation groups. Significant differences in knowledge of cardiac risk factors for infective endocarditis and for dental procedures requiring cover were observed between the occupation groups. The majority of dentists (92% GDPs, 94% CDS and 77% HDS) requested postgraduate education in cardiac risk factors and laminated flow diagrams for their surgeries as the preferred educational format.

CONCLUSION

The knowledge of Welsh dentists regarding cardiac conditions or procedures which are risk factors for paediatric and adult patients varied according to place of work. The study identified potential for under- and over-prescription of antibiotic prophylaxis within the current guidance. There was confusion as to which patient groups and cardiac conditions required prophylaxis and for which particular dental procedures. Postgraduate education detailing advances in cardiology practice is necessary for dentists.

No-touch taps help combat C. diff spread

Dart Valley's Mike Allen explains how no-touch taps can assist in the fight against an organism which continues to attract much attention.

Nuclear and mitochondrial DNA quantification of various forensic materials

Due to the different types and quality of forensic evidence materials, their DNA content can vary substantially, and particularly low quantities can impact the results in an identification analysis. In this study, the quantity of mitochondrial and nuclear DNA was determined in a variety of materials using a previously described real-time PCR method. DNA quantification in the roots and distal sections of plucked and shed head hairs revealed large variations in DNA content particularly between the root and the shaft of plucked hairs. Also large intra- and inter-individual variations were found among hairs. In addition, DNA content was estimated in samples collected from fingerprints and accessories. The quantification of DNA on various items also displayed large variations, with some materials containing large amounts of nuclear DNA while no detectable nuclear DNA and only limited amounts of mitochondrial DNA were seen in others. Using this sensitive real-time PCR quantification assay, a better understanding was obtained regarding DNA content and variation in commonly analysed forensic evidence materials and this may guide the forensic scientist as to the best molecular biology approach for analysing various forensic evidence materials.

Decoding the ancient Greek astronomical calculator known as the Antikythera Mechanism

The Antikythera Mechanism is a unique Greek geared device, constructed around the end of the second century bc. It is known that it calculated and displayed celestial information, particularly cycles such as the phases of the moon and a luni-solar calendar. Calendars were important to ancient societies for timing agricultural activity and fixing religious festivals. Eclipses and planetary motions were often interpreted as omens, while the calm regularity of the astronomical cycles must have been philosophically attractive in an uncertain and violent world. Named after its place of discovery in 1901 in a Roman shipwreck, the Antikythera Mechanism is technically more complex than any known device for at least a millennium afterwards. Its specific functions have remained controversial because its gears and the inscriptions upon its faces are only fragmentary. Here we report surface imaging and high-resolution X-ray tomography of the surviving fragments, enabling us to reconstruct the gear function and double the number of deciphered inscriptions. The mechanism predicted lunar and solar eclipses on the basis of Babylonian arithmetic-progression cycles. The inscriptions support suggestions of mechanical display of planetary positions, now lost. In the second century bc, Hipparchos developed a theory to explain the irregularities of the Moon's motion across the sky caused by its elliptic orbit. We find a mechanical realization of this theory in the gearing of the mechanism, revealing an unexpected degree of technical sophistication for the period.

Pacemakers and implantable cardioverter defibrillators

An increasing number of patients are now treated cardiac pacemakers and implantable cardioverter defibrillators and the technology of these is constantly changing. It is vital to have a good understanding of how they function and what the real risks are. Understanding how the device should work when functioning normally, and the possible effects of electromagnetic interference, is paramount to their safe management in the peri-operative period. Knowing when a device should be disabled or reprogrammed requires careful consideration. Information from the patient's pacemaker clinic should be sought whenever possible and can be invaluable. In addition, the Medicines Healthcare products Regulatory Agency have published the first set of UK guidelines on the management of implantable devices in the presence of surgical diathermy and this will undoubtedly provide a firm foundation on which anaesthetists can base much of their practice.

What can we glean from linking registry and Medicaid claims data?

6055

Background: Cancer quality of care problems are concentrated among the indigent. Although Medicare claims linked to tumor registry data have become an important source for evaluating cancer care, parallel efforts to use Medicaid claims are not well developed. Objective: To evaluate the feasibility and potential value of linking the California state cancer registry with Medicaid claims for health services research. Methods: Cases reported to the California Cancer Registry (CCR) between 1988 and 2000 were matched with California Medicaid enrollment and claims data. We assessed the number of cancer cases that appeared in the Medicaid enrollment data. We evaluated the sensitivity of Medicaid claims to capture cancer diagnoses and treatments reported in the registry data. Results: 6,800 patients ages 18–64 had records in the 1998 CCR data that were matched to the 1998 Medicaid enrollment file; Medicaid enrollees accounted for 34.4% of patients with hepatoma and 21.1% of patients with cervix cancer, but only 8.9% of breast and 8.9% of testicular cancer patients in this age bracket. Medicaid data had only modest sensitivity to capture cancer diagnoses and procedures. For 5 cancers, Medicaid claims included procedure codes for about 70% of surgeries reported in the registry data. Missing diagnoses and procedures could be attributed to discontinuous enrollment, Medicare crossover and enrollment in pre-paid health plans. Conclusion: Linkage of CCR and Medicaid enrollment data identified sizable populations of indigent patients. However, the modest sensitivity of Medicaid claims to capture cancer diagnoses and procedures currently limits the utility of Medicaid data to assess cancer treatment and outcomes.

No significant financial relationships to disclose.

Quantification of mtDNA mixtures in forensic evidence material using pyrosequencing

Analysis of mtDNA variation using Sanger sequencing does not allow accurate quantification of the components of mtDNA mixtures. An alternative method to determine the specific mixture ratios in samples displaying hetero-plasma, consisting of DNA contributions from several individuals, or containing contamination would therefore be valuable. A novel quantification system for mtDNA mixture analysis has been developed based on pyrosequencing technology, in which the linear relationship between incorporated nucleotides and released light allows quantification of the components of a sample. Within five polymerase chain reaction fragments, seven variable positions in the mtDNA control and coding region were evaluated using this quantification analysis. For all single nucleotide polymorphisms quantified in this study, a linear relationship was observed between the measured and expected mixture ratios. This mtDNA quantification assay is an easy to use, fast and accurate quantification system, with the ability to resolve and interpret major and minor mtDNA components in forensic mixture samples.

Alternative splicing of IL-24 in melanocytes by deletion of exons 3 and 5

Two novel interleukin-24 (IL-24) splice variants were identified in normal human melanocytes by sequencing cloned polymerase chain reaction (PCR) products that are not expressed in metastatic melanoma. These gene products have been generated by differential skipping of exons 3 (IL-24 delE3) and 5 (IL-24 delE5). IL-24 delE3 has limited sequence identity to the IL-24-interacting protein mda-7s, and IL-24 delE5 is homologous to IL-24.

A series of bisaryl imidazolidin-2-ones has shown to be selective and orally active 5-HT2C receptor antagonists

Bisaryl cyclic ureas have been identified as high affinity 5-HT2C receptor antagonists with selectivity over 5-HT2A and 5-HT2B. Compounds such as 8 and 22 have shown oral activity in a centrally mediated pharmacodynamic model of 5-HT2C function in rodents.

Management of twin-twin transfusion syndrome in pregnancies with iatrogenic detachment of membranes following therapeutic amniocentesis and the role of interim amniopatch

OBJECTIVE

Detachment of membranes may occur after therapeutic amniocentesis for twin-twin transfusion syndrome (TTTS). Subsequent amniocenteses or endoscopic fetal therapy may be hindered or made altogether impossible by this complication. The purpose of this study was to describe our experience in the assessment and management of TTTS patients with iatrogenic detached membranes (IDM).

METHODS

Patients with IDM referred for fetal surgery for TTTS were considered ineligible for standard surgery and were offered different alternatives, including expectant management, serial amniocentesis, or an attempt at surgery with or without prior amniopatch. Pregnancy outcomes were compared between surgical and non-surgical patients.

RESULTS

Nine hundred and forty-four patients with a diagnosis of TTTS were referred between July 1997 and December 2004, of whom 322 (34.1%) had a prior therapeutic amniocentesis. Twenty-six of the 322 patients (8%) had IDM. Ten patients opted to be managed with subsequent amniocenteses, two of which had an amniopatch. One patient had voluntary interruption of pregnancy. Fifteen patients underwent surgery, 10 of whom underwent an amniopatch. Overall, resealing of membranes occurred in 8/12 (66%) patients treated with an amniopatch. Survival of at least one fetus was greater in patients treated surgically with or without an amniopatch (12/15, 80% vs. 4/11, 36%, P = 0.04).

CONCLUSION

Membrane detachment is an important complication of therapeutic amniocentesis in the treatment of TTTS. Although successful treatment of IDM can be achieved with an interim amniopatch, this alternative is not without risks. Therapeutic amniocenteses should be discouraged in patients considering endoscopic fetal surgery for TTTS.

Measurement of the branching fraction of Gamma(4S) --> B0B0

We report the first measurement of the branching fraction f(00) for Gamma(4S) --> B(0)B(0). The data sample consists of 81.7 fb(-1) collected at the Gamma(4S) resonance with the BABAR detector at the SLAC PEP-II asymmetric-energy e(+)e(-) storage ring. Using partial reconstruction of the decay B(0) --> D(*+) l(-)nu(l) in which only the charged lepton and the soft pion from the decay D(*+) --> D(0)pi(+) are reconstructed, we obtain f(00) = 0.487 +/- 0.010(stat) +/- 0.008(syst). Our result does not depend on the branching fractions of B(0) --> D(*+)l(-)nu(l) and D(*+) --> D(0)pi(+) decays, on the ratio of the charged and neutral B meson lifetimes, nor on the assumption of isospin symmetry.

Branching fractions and CP asymmetries in B0-->pi0pi0, B+-->pi+pi0, and B+-->K+pi0 decays and isospin analysis of the B-->pipi system

Based on a sample of 227 x 10(6) BB pairs collected by the BABAR detector at the PEP-II asymmetric-energy B Factory at SLAC, we measure the branching fraction B(B0-->pi(0)pi(0))=(1.17+/-0.32+/-0.10)x10(-6), and the asymmetry Cpi(0)(pi(0))=-0.12+/-0.56+/-0.06. The B0-->pi(0)pi(0) signal has a significance of 5.0 sigma. We also measure B(B+-->pi(+)pi(0))=(5.8+/-0.6+/-0.4)x10(-6), B(B+-->K+pi(0))=(12.0+/-0.7+/-0.6)x10(-6), and the charge asymmetries Api(+)(pi(0))=-0.01+/-0.10+/-0.02 and AK+(pi(0))=0.06+/-0.06+/-0.01. Using isospin relations, we find an upper bound on the angle difference |alpha-alpha(eff)| of 35 degrees at the 90% C.L.

Search for factorization-suppressed B-->chi(c)K(*) decays

We search for the factorization-suppressed decays B-->chi(c0)K(*) and B-->chi(c2)K(*), with chi(c0) and chi(c2) decaying into J/psi gamma, using a sample of 124 x 10(6) BB events collected with the BABAR detector at the PEP-II storage ring of the Stanford Linear Accelerator Center. We find no significant signal and set upper bounds for the branching fractions.

Diabetes care provision and glycaemic control in Northern Ireland: a UK regional audit

AIMS

To assess the care received, compared to national guidelines, and to investigate factors associated with glycaemic control in children and adolescents with type 1 diabetes attending clinics in Northern Ireland.

METHODS

An audit of the care provided to all patients attending 11 paediatric diabetes clinics commenced in 2002. A research nurse interviewed 914 patients completing a questionnaire recording characteristics, social circumstances, and aspects of diabetes management, including the monitoring of complications and access to members of the diabetes team. Glycaemic control was measured by glycosylated haemoglobin (HbA1c), determined at a DCCT aligned central laboratory.

RESULTS

The average HbA1c concentration was 8.8% (SD 1.5%), with 20% of patients achieving recommended HbA1c levels of less than 7.5%. In the year prior to the audit, 76% of patients were reviewed by a diabetes specialist nurse and 42% were tested for microalbuminuria. After adjustment for confounding factors, better glycaemic control was identified, particularly in patients who had attended exactly four diabetes clinics in the previous year, were members of the patient association Diabetes UK, and lived with both natural parents.

CONCLUSIONS

In Northern Ireland only a minority of patients achieved recommended HbA1c levels. Furthermore, children and adolescents with diabetes were reviewed by fewer specialists and were less intensively monitored for microvascular complications than recommended. There was evidence of better control in children who were members of Diabetes UK, suggesting that parental attitude and involvement could lead to benefits.

Measurement of branching fractions and charge asymmetries for exclusive B decays to charmonium

We report measurements of branching fractions and charge asymmetries of exclusive decays of neutral and charged B mesons into two-body final states containing a charmonium state and a light strange meson. The charmonium mesons considered are J/psi, psi(2S) and chi(c1), and the light meson is either K or K(*). We use a sample of about 124x10(6) BB pairs collected with the BABAR detector at the PEP-II storage ring at the Stanford Linear Accelerator Center.

Statistical processing of large image sequences

The dynamic estimation of large-scale stochastic image sequences, as frequently encountered in remote sensing, is important in a variety of scientific applications. However, the size of such images makes conventional dynamic estimation methods, for example, the Kalman and related filters, impractical. In this paper, we present an approach that emulates the Kalman filter, but with considerably reduced computational and storage requirements. Our approach is illustrated in the context of a 512 x 512 image sequence of ocean surface temperature. The static estimation step, the primary contribution here, uses a mixture of stationary models to accurately mimic the effect of a nonstationary prior, simplifying both computational complexity and modeling. Our approach provides an efficient, stable, positive-definite model which is consistent with the given correlation structure. Thus, the methods of this paper may find application in modeling and single-frame estimation.

A helping hand for infection control

Despite considerable awareness amongst the healthcare community about the importance of hand hygiene in controlling Healthcare Acquired Infections (HAIs), the problem persists. Mike Allen of Dart Valley Systems explores the issues surrounding good hand hygiene practice in UK hospitals.

Internationalization of higher education: potentials and pitfalls for nursing education

BACKGROUND

Internationalization, an integral part of strategic planning initiatives in universities around the world, is occurring within the context of globalization. As we move toward greater internationalization in nursing education, we must understand the ideologies that currently underpin globalization and their fit with the vision and mission of nursing.

AIM

To outline the current debates surrounding internationalization and globalization and their potential consequences for universities.

METHODS

The historical and current interest in internationalization and globalization are reviewed briefly in order to set the context for this discussion.

CONCLUSIONS

What emerges from an analysis of current internationalization directions is the complexity of the relationship between internationalization and the conflicting ideologies underpinning globalization. Nursing can play a key role within universities to ensure that varying viewpoints are debated and the implications of varying internationalization decisions are understood.

Quantification of polynuclear aromatic hydrocarbons in transformer oils by enzyme immunoassay

Many polynuclear aromatic hydrocarbons (PAHs) are either known or suspected carcinogens and are a common constituent of mineral oils. Due to the large number of possible PAH structures, standard quantification methods fail since they either lack specificity or are too complex, requiring individual fractionation, identification, and quantification. A rapid, low-cost, novel analytical screening method, incorporating a silica-based solid-phase extraction (SPE) method linked to co-solvent dilution and quantification of total and carcinogenic PAH levels by immunoassay, is reported here. The method yielded high extraction efficiencies and minimal matrix effects. This novel approach yielded total and carcinogenic PAH levels x 5.7 and x 126, respectively, lower than that recorded by the industry-recognised BS2000 Pt. 346 (IP346) method which estimates the polyaromatic carbon (PAC) content of oils by gravimetry. The method is expected to be of benefit where an indication of PAH levels in oils is important for purchasing, management or disposal purposes and also for risk assessment and for appropriate labelling of oils in line with current legislation.

Compliance with prenatal care visits in substance abusers

OBJECTIVE

We sought to determine whether pregnant, inner-city substance abusers, cared for in a multidisciplinary setting, had comparable numbers of missed appointments and similar outcomes in comparison with a low-risk patient population.

METHODS

A retrospective review was conducted on a sample of 97 patients with uncomplicated prenatal care over a 7-year period (1994-2001). They were compared to a sample of 88 substance abusers cared for and delivered at Bellevue Hospital over the same period. Demographic information was recorded, as well as frequency of prenatal visits, number of missed appointments, birth weight, and gestational age at delivery.

RESULTS

In our population, substance abusers were found to be significantly older (28.9 vs. 25.6 years, p < 0.0001), had had more pregnancies (4.3 vs. 2.4, p < 0.0001) and had had more children (2.0 vs. 0.7, p < 0.0001) than controls. Both substance abusers and control patients had a similar number of scheduled appointments (11.4 in each group, p = 0.99), but substance abusers missed more appointments (1.6 vs. 0.7, p < 0.0005).

CONCLUSIONS

When cared for in a multidisciplinary setting, substance abusers will attend an adequate number of prenatal visits. However, they are still more likely than non-substance abusers to miss visits, although the difference may not be clinically significant.

Spatial uniformity of laser-accelerated ultrahigh-current MeV electron propagation in metals and insulators

The evolution of laser-generated MeV, MA electron beams propagating through conductors and insulators has been studied by comparing measurement and modeling of the distribution of MeV protons that are sheath accelerated by the propagated electrons. We find that electron flow through metals is uniform and can be laser imprinted, whereas propagation through insulators induces spatial disruption of the fast electrons. Agreement is found with material dependent modeling.

Isochoric heating of solid-density matter with an ultrafast proton beam

A new technique is described for the isochoric heating (i.e., heating at constant volume) of matter to high energy-density plasma states (>10(5) J/g) on a picosecond time scale (10(-12)sec). An intense, collimated, ultrashort-pulse beam of protons--generated by a high-intensity laser pulse--is used to isochorically heat a solid density material to a temperature of several eV. The duration of heating is shorter than the time scale for significant hydrodynamic expansion to occur; hence the material is heated to a solid density warm dense plasma state. Using spherically shaped laser targets, a focused proton beam is produced and used to heat a smaller volume to over 20 eV. The technique described of ultrafast proton heating provides a unique method for creating isochorically heated high-energy density plasma states.

Long-term safety analysis of preventive HIV-1 vaccines evaluated in AIDS vaccine evaluation group NIAID-sponsored Phase I and II clinical trials

This report evaluates long-term safety data from 3189 human immunodeficiency virus type 1 (HIV-1) uninfected, healthy volunteers who were enrolled into 51 National Institute of Allergy and Infectious Diseases (NIAID)-sponsored Phase I and II multicentred, randomized, double-blind trials of recombinant HIV-1 subunit vaccines (23 studies), synthetic peptide vaccines (7 studies), live vaccinia-vector recombinant envelope vaccines (7 studies), canarypox vector recombinant vaccines (13 studies), a DNA vaccine (1 study), and a Salmonella-vector vaccine (1 study). During the 12,340 person-years of follow-up, participants were monitored for adverse events including immune dysfunction/autoimmunity, anaphylaxis, cancer, death, and vaccine allergy. The analysis provides evidence that a preparation of a C4-V3 polypeptide vaccine emulsified in incomplete Freund's caused serious toxicity, but otherwise no safety problems considered serious were identified for any of the vaccines and adjuvants studied. These data serve to solidify the growing safety base of current vaccine technologies utilized in candidate vaccines for HIV-1 infection.

Analysis of the time course and prognostic factors determining toxicity due to infused fluorouracil

This study used a prospectively managed clinical database in order to identify 1470 patients with gastrointestinal cancers receiving protracted venous infusion (PVI) fluorouracil (5FU). It aimed to determine the time course of toxicity due to PVI 5FU and to analyse factors predicting toxicity. The initial development of stomatitis occurred more rapidly than diarrhoea or palmar plantar erythema (PPE). The percentage of patients with National Cancer Institute Common Toxicity Criteria (CTC) grade 2 or worse PPE peaked at 9% between weeks 8 and 17, whereas this peak occurred earlier for stomatitis and diarrhoea. The development of CTC grade 1 toxicity in the first 28 days after commencement of chemotherapy was classified as early grade 1 toxicity. Multivariate Cox regression analysis showed that female sex, better performance status, elevated bilirubin, early grade 1 PPE and early grade 1 diarrhoea were independent prognostic factors for the development of CTC grade 2 or worse PPE (P<0.01). Female sex, increased age, elevated alanine transaminase and urea and early grade 1 PPE were significant independent prognostic factors for the development of CTC grade 2 or worse stomatitis (P<0.01). Early CTC grade 1 diarrhoea predicted CTC grade 2 or worse diarrhoea (P<0.01). Older, female patients with good performance status and impaired liver and renal function who develop early grade 1 PPE alone or in combination with diarrhoea are at highest risk of subsequently developing grade 2 or worse PPE or stomatitis during treatment with PVI 5FU. Reduction of infused 5FU dose should be considered for these patients. Such an approach could both reduce severe toxicity owing to chemotherapy and minimise treatment delays, and should be evaluated prospectively.

When a celebrity contracts a disease: the example of Earvin "Magic" Johnson's announcement that he was HIV positive

This meta-analysis summarizes the available data concerning the impact that the public announcement that Earvin "Magic" Johnson, a National Basketball Association All-Star, had tested positive for HIV. The results demonstrate that the announcement increased the level of accurate knowledge in persons, the number of persons getting tested for HIV, and the desire to obtain more information about HIV and AIDS. For adults the impact of the announcement was to increase the perception of vulnerability while for children/adolescents the announcement diminished the perception of risk.

Mitomycin C, carboplatin and protracted venous infusion 5-fluorouracil in advanced oesophago-gastric and pancreatic cancer: results of two phase II studies

Cisplatin is an active palliative chemotherapy agent in advanced upper gastrointestinal cancer, but it is associated with significant non-haematological toxicity. Substitution of cisplatin by carboplatin in combination chemotherapy regimens may reduce these adverse effects. These two phase II studies evaluated the efficacy and toxicity of the combination of mitomycin C (MMC) 7 mg/m2 q 6 weekly, carboplatin area under the concentration-time curve 5 mg/ml/min q 3 weekly and protracted venous infusion 5-fluorouracil (5FU) 300 mg/m2/day (McarboF) in advanced upper gastrointestinal cancer. Between October 1998 and June 2000, 31 patients were enrolled in the studies, 23 patients in the oesophago-gastric study and eight patients in the pancreatic study. Although non-haematological toxicity was modest, both protocols were closed prematurely because of excessive haematological toxicity and frequent treatment delays. The overall incidence of grade 3/4 neutropenia and thrombocytopenia was 39 and 52%, respectively. The McarboF combination showed significant activity with an overall response rate of 52% in advanced oesophago-gastric cancer. Palliative benefit was also evident with improvement in symptoms of pain and weight loss in over 79 and 50% of patients in the oesophago-gastric study and pancreatic study, respectively. Median overall survival times were 10.6 and 6.6 months for patients with oesophago-gastric and pancreatic cancer, respectively. The McarboF regimen showed promising activity in advanced upper gastrointestinal cancer, with modest non-haematological side-effects. This combination merits further evaluation with modification of the dose and schedule of carboplatin and MMC in order to reduce the severity of haematological toxicity.

Neoadjuvant systemic fluorouracil and mitomycin C prior to synchronous chemoradiation is an effective strategy in locally advanced rectal cancer

This study was designed to evaluate the benefits of neoadjuvant chemotherapy prior to chemoradiation and surgery in patients with locally advanced rectal cancer. Patients with previously untreated primary rectal cancer, reviewed in a multidisciplinary meeting and considered to have locally advanced disease on the basis of physical examination and imaging (MRI+CT n=30, CT alone n=6), were recruited. Patients received protracted venous infusion 5-FU (300 mg m(-2) day(-1) for 12 weeks) with mitomycin C (MMC) (7 mg m(-2) i.v. bolus every 6 weeks). Starting on week 13, 5-FU was reduced to 200 mg m(-2) day(-1) and concomitant pelvic radiotherapy 45 Gy in 25 fractions was commenced followed by 5.4-9 Gy boost to tumour bed. Surgery was planned 6 weeks after chemoradiation. Postoperatively, patients received 12 weeks of MMC and 5-FU at the same preoperative doses. Between January 99 and August 01, 36 eligible patients were recruited. Median age was 63 years (range=40-85). Following neoadjuvant chemotherapy, radiological tumour response was 27.8% (one CR and nine PRs) and no patient had progressive disease. In addition, 65% of patients had a symptomatic response including improvement in diarrhoea/constipation (59%), reduced rectal bleeding (60%) and diminished pelvic pain/tenesmus (78%). Following chemoradiation, tumour regression occurred in 80.6% (six CRs and 23 PRs; 95% CI=64-91.8%) and only one patient still had an inoperable tumour. R0 resection was achieved in 28 patients (82%). When compared with initial clinical staging, the pathological downstaging rate in T and/or N stage was 73.5% and pathological CR was found in one patient. Neoadjuvant systemic chemotherapy as a prelude to synchronous chemoradiation can be administered with negligible risk of disease progression and produces considerable symptomatic response with associated tumour regression.