Attitudes and Concerns of Pre-Pubescent and Pubescent Girls about Breast Health and Breast Cancer: An Unmet Need

Background: Prior research has indicated that girls have unaddressed fears about breast health and breast cancer. In a Breastcancer.org online survey (SABCS 2008 Abstract#5078), 26% of girls have already worried they may have breast cancer and 73% reported that a relative or close acquaintance had already been diagnosed. Their fears are magnified by the current trend of early onset of breast development and their sensitivity to high media coverage of breast cancer. We hypothesize that girls have limited opportunities and are without the emotional capacity and communication skills necessary to gather and process this information at home, in school, and in the doctor's office.Methods: Breastcancer.org, the Taking Care of Your “Girls” book project, and the Lankenau Hospital Health Education Center conducted an online survey of girls in middle and high schools prior to the delivery of its in-school Basic Breast Health Assembly Program in 13 Philadelphia, Atlanta, Washington, and Los Angeles area schools. 4246 girls attended an assembly, of which 3397 participated in the student survey. 1067 adult female family members (AFFM)—mostly mothers—completed the family member survey.Results: In total, 33% of girls had already learned about breast health and breast cancer in school. 48% of girls wanted to attend the Assembly Program; 93% of AFFMs wanted their girls to participate in the Assembly Program. 50% of girls said they felt uneasy starting the conversation about these topics with their AFFM, 97% of AFFMs said they felt comfortable starting the conversation with their girls, but only 43% of the girls report having the conversation. Of the girls who talked to a parent, 91% talked to their mothers and only 1% talked with their fathers. Girls and AFFMs offered many tips on how to start and sustain a healthy dialogue on these topics: listen, be open, make it fun, pick a private place and time, share experiences, provide facts, and call in experts when you need more information.42%, 18%, and 23% of girls, respectively, have talked to a doctor, sister, or friend about these topics. 50% of girls want to learn breast self-exams from their doctors.Discussion: This survey indicates that girls have unmet informational needs on breast health and breast cancer. This was a source of anxiety for both girls and their AFFMs. There was a willingness to engage in educational activities by both girls and AFFMs, but the dialogue opportunities and communication skills were seen as lacking. Girls identified AFFMs, schools, and doctors as their preferred sources of this information.Girls' ability to express their anxiety, replace fears with facts, learn breast healthy behaviors, and deal with a loved ones' diagnosis requires education, modeling, and an ongoing dialogue. This survey provides guidance for educators and healthcare professionals regarding research into interventions seeking to correct this previously underappreciated gap in public health education.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1037.

[Intraosseous infusion. An important technique also for paediatric anaesthesia]

Timely establishment of venous access in infants and toddlers can prove a particularly challenging task. Since the 1940s the technique of intraosseous infusion has established itself as a valuable alternative means for rapid, efficient and safe delivery of drugs and fluids to critically ill children. Whereas international guidelines for paediatric emergency medical care have assigned intraosseous infusion a high priority, most anaesthetists utilize this well-proven technique with great reluctance. This article describes the technique of intraosseous infusion, introduces two different cannulation systems, and discusses its potential indications in paediatric anaesthesia, based on current emergency medical care guidelines as well as some of our own case studies. In particular, children with acutely life-threatening conditions, such as circulatory arrest, laryngospasm, acute airway haemorrhage, hypovolaemic shock or hypothermia secondary to extensive burns, should receive an intraosseous cannula if intravenous access cannot be rapidly established. Future discussion may reveal whether a transiently inserted intraosseous infusion would also be indicated if the child with difficult or impossible venous access presents without acute life-threatening conditions for anaesthesia. Successful application of the intraosseous infusion technique requires immediate access to the necessary equipment, intensive education, continuous training and clear guidelines for its application in an anaesthesia department.

Cardiac risk assessment before the use of stimulant medications in children and youth: A joint position statement by the Canadian Paediatric Society, the Canadian Cardiovascular Society, and the Canadian Academy of Child and Adolescent Psychiatry

Regulatory decisions and scientific statements regarding the management of attention-deficit hyperactivity disorder (ADHD) raise questions about the safety of medications and the appropriate pretreatment evaluation to determine suitability for treatment with medication. This is particularly true in the setting of known structural or functional heart disease. The present paper reviews the available data, including peer-reviewed literature, data from the United States Food and Drug Administration Web site on reported adverse reactions in children using stimulant medication, and Health Canada data on the same problem. A consensus-based guideline on appropriate assessment is provided, based on input from members of the Canadian Paediatric Society, the Canadian Cardiovascular Society and the Canadian Academy of Child and Adolescent Psychiatry, with specific expertise and knowledge in the areas of both ADHD and pediatric cardiology. The present statement advocates a thorough history and physical examination before starting stimulant medications, with an emphasis on the identification of risk factors for sudden death, but does not routinely recommend electrocardiographic screening or cardiac subspecialist consultation unless indicated by history or physical examination findings. A checklist for identifying children who are potentially at risk of sudden death (independent of ADHD or medications used to treat it) is provided. Although recommendations are based on the best evidence currently available, the committee further agrees that more research on this subject is necessary to optimize the approach to this common clinical scenario.

Prospective randomized controlled multi-centre trial of cuffed or uncuffed endotracheal tubes in small children

BACKGROUND

The use of cuffed tracheal tubes (TTs) in small children is still controversial. The aim of this study was to compare post-extubation morbidity and TT exchange rates when using cuffed vs uncuffed tubes in small children.

METHODS

Patients aged from birth to 5 yr requiring general anaesthesia with TT intubation were included in 24 European paediatric anaesthesia centres. Patients were prospectively randomized into a cuffed TT group (Microcuff PET) and an uncuffed TT group (Mallinckrodt, Portex, Rüsch, Sheridan). Endpoints were incidence of post-extubation stridor and the number of TT exchanges to find an appropriate-sized tube. For cuffed TTs, minimal cuff pressure required to seal the airway was noted; maximal cuff pressure was limited at 20 cm H(2)O with a pressure release valve. Data are mean (SD).

RESULTS

A total of 2246 children were studied (1119/1127 cuffed/uncuffed). The age was 1.93 (1.48) yr in the cuffed and 1.87 (1.45) yr in the uncuffed groups. Post-extubation stridor was noted in 4.4% of patients with cuffed and in 4.7% with uncuffed TTs (P=0.543). TT exchange rate was 2.1% in the cuffed and 30.8% in the uncuffed groups (P<0.0001). Minimal cuff pressure required to seal the trachea was 10.6 (4.3) cm H(2)O.

CONCLUSIONS

The use of cuffed TTs in small children provides a reliably sealed airway at cuff pressures of <or=20 cm H(2)O, reduces the need for TT exchanges, and does not increase the risk for post-extubation stridor compared with uncuffed TTs.

Investigation of the exclusive 3He(e,e' pn)1H reaction

Cross sections for the 3He(e,e' pn)1H reaction were measured for the first time at energy transfers of 220 and 270 MeV for several momentum transfers ranging from 300 to 450 MeV/c. Cross sections are presented as a function of the momentum of the recoil proton and the momentum transfer. Continuum Faddeev calculations using the Argonne V18 and Bonn-B nucleon-nucleon potentials overestimate the measured cross sections by a factor 5 at low recoil proton momentum with the discrepancy becoming smaller at higher recoil proton momentum.

A controlled rapid-sequence induction technique for infants may reduce unsafe actions and stress

BACKGROUND

Classic rapid-sequence induction of anaesthesia (RSI-classic) in infants and small children presents a time-critical procedure, regularly associated with hypoxia. This results in high stress levels for the provider and may trigger unsafe actions. Hence, a controlled induction technique (RSI-controlled) that involves gentle mask ventilation until full non-depolarizing muscular blockade has become increasingly popular. Clinical observation suggests that RSI-controlled may reduce the adverse effects noted above. We aimed to evaluate both techniques with respect to unsafe actions and stress.

METHODS

In this controlled, randomized simulator-based study, 30 male trainees and specialists in anaesthesiology performed a simulated anaesthesia induction in a 4-week-old infant with pyloric stenosis. Two different RSI techniques, classic and controlled, were applied to 15 candidates each. We recorded the incidence of hypoxaemia, forced mask ventilation, and intubation difficulties. In addition, we measured individual stress levels by ergospirometry, salivary cortisol, and alpha-amylase, as well as a post-trial questionnaire.

RESULTS

Hypoxaemia always occurred in RSI-classic but not in RSI-controlled, repeatedly resulting in unsafe actions. Subjective stress perception and some objective stress levels were lower in the volunteers performing RSI-controlled.

CONCLUSIONS

Our data suggest that RSI-controlled, as compared with RSI-classic, leads to fewer unsafe actions and may reduce individual stress levels.

Bovine herpesvirus 5 induces an overproduction of nitric oxide in the brain of rabbits that correlates with virus dissemination and precedes the development of neurological signs

We herein report an investigation of nitric oxide (NO) levels, a candidate molecule for neuronal toxicity and dysfunction, in the brain of rabbits during experimental neurological infection by bovine herpesvirus 5 (BoHV-5). Spectrophotometry for NO products (NO(2) and NO(3)) revealed that NO levels were significantly increased (F(4, 40) = 3.33; P <.02) in several regions of the brain of rabbits with neurological disease, correlating with moderate to high BoHV-5 titers. Immunohistochemistry of brain regions revealed a group of cells with neuronal and astrocyte morphology expressing the enzyme inducible NO synthase (iNOS) close to virus antigen-positive neurons. In addition, the investigation of nitric oxide levels between 2 and 6 days post infection (d.p.i.) revealed an initial increase in NO levels in the olfactory bulb and cortex (OB/OC) and anterior cortex (AC) at day 3 p.i., correlating with the initial detection of virus. As the infection proceeded, increased NO levels-and infectivity-were progressively being detected in the OB/CO and AC at day 4 p.i. (F(12, 128) = 2.82; P <.003); at day 5 p.i. in several brain regions (P <.003 in the OB/OC); and at day 6 p.i. in all regions (P <.003) but the thalamus. These results show that BoHV-5 replication in the brain of rabbits induces an overproduction of NO. The increase in NO levels in early infection correlated spatially and temporally with virus dissemination within the brain and preceded the development of neurological signs. Thus, the overproduction of NO in the brain of BoHV-5-infected rabbits may be a component of the pathogenesis of BoHV-5-induced neurological disease.

Neuroprotective effect of SSRI among 781 cancer patients receiving chemotherapy: A URCC CCOP Study

9512

Background: Cancer and its treatment impact important areas of cognitive function such as attention and memory, which are essential to patients effective psychosocial functioning and quality of life. Previous studies reported that 17% to 75% of cancer patients reported cognitive dysfunction during and after treatment. Few studies, however, have examined the effectiveness of pharmacological interventions to control cancer-related cognitive dysfunction (CRCD). The present study examines the effect of paroxetine hydrochloride (Paxil, P) on CRCD. Methods: The sample included 574 female and 207 male cancer patients between 22 and 87 years. Memory Problems was assessed using a Self-Reported Memory Problem (SRMP) measures derived from the Fatigue Symptom Checklist that relate to memory dysfunction. Cronbach coefficient alpha (α) and a principal components analysis (PCA) were conducted to determine reliability and appropriateness of the SRMP for this sample. A repeated measure ANOVA (r-ANOVA) and t-tests were used to assess changes in mean scores on the SRMP and the effect of P versus placebo. Depression was assessed using the CESD. Results: Scale reliability assessment showed α = .90, supporting the reliability of the SRMP. The PCA revealed a one-component structure that explained 72% of the variance. The r-ANOVA showed a significant difference between scores on the SRMP at baseline (after first chemotherapy cycle, and before P) and follow-up (after four cycles of chemotherapy, after P) (Wilks' Lambda = .99, F (1, 583) = 5.52, p = 0.02). The t-tests also showed a significant effect of P on CRMP (p < 0.05). P had a significant effect after controlling for depression (p < 0.001) Conclusions: CRCD is a serious problem for patients that can be alleviated by P. Future studies should examine the usefulness of other psychotropic agents and combined behavioral and pharmacologic interventions to control CRCD. Supported by NCI Grants U10CA37420, R25CA102618, and 3U01CA116924–04S1.

No significant financial relationships to disclose.

A phase III randomized prospective trial of the effect of psychotherapy on distress in 287 prostate cancer patients: A URCC CCOP Study

9637

Background: Cancer patients suffer from significant psychological distress, including mood and anxiety disorders. Psychiatric disorders are common in cancer and affect 22 to 43% of cancer patients. We previously showed that Supportive Expressive Group Therapy (SET) was effective in reducing distress in women with metastatic breast cancer. The current study expands our earlier research and examines the effect of SET on mood disturbance in prostate cancer patients. Methods: A sample of 318 cancer patients diagnosed with prostate cancer was assessed for mood disturbances by 9 geographically distinct URCC CCOP affiliates. The patients were randomly assigned to receive either 12 weeks of SET or education materials as a control. Patient-reported mood disturbance was assessed using the Profile of Mood States (POMS), a psychometrically valid and reliable measure of mood states, at baseline, 3, 6, 12, 18 and 24 months. Differences between treatment and control groups at follow-up were tested using a mixed-ANOVA model. The dependent variable was individual slopes on the POMS. Results: 287 patients (142 SET and 145 controls) provided complete data. No significant overall effect of intervention on mood was found (p=0.49) and the interaction between baseline mood scores and treatment arm was non-significant (p=0.075). There was a significant main effect for baseline mood (p<0.0001) suggesting that those who have the greatest mood disruption at baseline improve with time independently of treatment arm. Conclusions: This is the first large randomized clinical trial using group psychotherapy among men with prostate cancer. Results suggest that a brief SET intervention does not improve distress among men with prostate cancer. Future studies might consider recruiting patients with particular psychosymptomatology and tailoring interventions. Supported by U10 CA37420 and NCI 1R25CA102618.

No significant financial relationships to disclose.

Modelling of alpha1-adrenoceptor-mediated temporal dynamics of inotropic response in rat heart to assess ligand binding and signal transduction parameters

BACKGROUND AND PURPOSE

In order to use the transient response to an antagonist (prazosin) to evaluate properties of agonist interactions with the alpha(1)-adrenoceptor system, an integrative mechanistic model of cardiac uptake of prazosin and its competitive interaction with phenylephrine at the receptor site was developed. Based on the operational model of agonism, the aim was to evaluate both the receptor binding and signal transduction process as determinants of the inotropic effect of phenylephrine.

EXPERIMENTAL APPROACH

In Langendorff-perfused rat hearts, prazosin outflow concentration and left ventricular developed pressure were measured, first in the presence of 12.3 micromol x L(-1) phenylephrine following a 1 min infusion of 1.27 nmol [(3)H]-prazosin, and second, when after 30 min the phenylephrine concentration in perfusate was reduced to 6.1 micromol x L(-1), the 1 min infusion of 1.27 nmol [(3)H]-prazosin was repeated.

KEY RESULTS

The kinetic model accounted for cardiac uptake and receptor binding kinetics of prazosin (dissociation constant, mean +/- SD: 0.057 +/- 0.012 nmol.L(-1)), assuming that the competitive displacement of phenylephrine (dissociation constant: 101 +/- 13 nmol x L(-1)) reduced the receptor occupation by the agonist and, consequently, contractility. This competitive binding process appeared to be the rate-determining step in response generation. The relationship between receptor occupancy and inotropic response was described by an efficacy parameter (tau, ratio of receptor density and coupling efficiency) of 4.9.

CONCLUSIONS AND IMPLICATIONS

Mechanistic pharmacodynamic modelling of the kinetics of antagonism by prazosin allows quantitative assessment of the alpha(1)-adrenoceptor system both at the receptor and post-receptor levels.

Influence of phosphatidylserine on cognitive performance and cortical activity after induced stress

The aim of this study was to investigate the effect of phosphatidylserine (PS) on cognition and cortical activity after mental stress. After familiarization, 16 healthy subjects completed cognitive tasks after induced stress in a test-re-test design (T1 and T2). Directly after T1, subjects were assigned double-blind to either PS or placebo groups followed by T2 after 42 days. At T1 and T2, cortical activity was measured at baseline and immediately after stress with cognitive tasks using electro-encephalography (EEG). EEG was recorded at 17 electrode positions and fast Fourier transforms (FFT) determined power at Theta, Alpha-1, Alpha-2, Beta-1 and Beta-2. Statistics were calculated using ANOVA (group x trial x time). The main finding of the study was that chronic supplementation of phosphatidylserine significantly decreases Beta-1 power in right hemispheric frontal brain regions (F8; P < 0.05) before and after induced stress. The results for Beta-1 power in the PS group were connected to a more relaxed state compared to the controls.

Fibrillary glomerulonephritis mimicking membranous nephropathy--a diagnostic pitfall

Kidney biopsies in 2 females with nephrotic syndrome were suggestive of membranous nephropathy at routine light microscopy and immunohistochemistry. Electron microscopy on re-embedded paraffin tissue, however, revealed that the light microscopic pattern was due to a fibrillary glomerulonephritis with a dominant membranous manifestation. These findings suggest that (a) fibrillary glomerulonephritis may be mis-/under-diagnosed at light microscopy; and (b) in reality, a subset of therapy refractory membranous nephropathies might represent fibrillary glomerulopathies. Therefore, electron microscopy is mandatory in any case of membranous nephropathy with therapy refractory nephrotic syndrome or an unusual immunohistological staining pattern, e.g. with mesangial immunoreactivity.

Breast cancer fear in girls: a major “side effect” of breast cancer in loved ones and a backlash of ubiquitous media coverage

Abstract #5078

Background: Breast cancer significantly impacts girls' lives: it affects 1:8 women and directly impacts those most influential in girls' lives (e.g. mothers, friends' mothers, teachers, coaches). Plus, girls are often exposed to powerful media messages meant to raise breast cancer awareness. Our hypothesis is that these factors could generate significant fear and misunderstanding in adolescent and pre-adolescent girls.&#x2028; Methods: To better understand the impact of breast cancer fear in girls, the nonprofit organization Breastcancer.org and the Taking Care of Your “Girls” book project, together with the Lankenau Hospital Health Education Center, conducted an in-school online survey in girls ages 8 to 18 years (median 15), prior to the delivery of a Breast Health Assembly in 7 Philadelphia and Atlanta areas schools. 2450 girls attended the assemblies, of which 1709 participated in the survey (about 70% question completion rate).&#x2028; Results: In total, 73% of girls had a relative or close acquaintance who had had breast cancer (most often: a friend's mother [49% n=580/1201]). Although only 3.34% (n=40/1196) of girls' mothers had had breast cancer, girls were most fearful of breast cancer affecting their mothers. While only 46% (n=768/1573) thought breast cancer was common in grandmothers, 76% (n=1192/1572) reported it was most common in mothers. Although only 3.35 % (n=53/1580) believed that breast cancer was common in teens, 26% (477/1554) said that they've already feared having breast cancer themselves. The most common triggers for this fear were a misinterpretation of a normal breast finding, a news report on breast cancer, or a new breast cancer diagnosis in someone they knew. Over 20% believed that infection, drug use, stress, and tanning could cause breast cancer; and 10-20% reported their belief that caffeine, getting bumped or bruised in the breast, and antiperspirants could cause it. In addition, 8.5% thought that breast-feeding increased breast cancer risk.&#x2028; Discussion: 73% of the girls in this study have one or more women close to them who've had breast cancer and all girls are sensitive to the media. These factors seem to contribute to their fear of the disease and their tendency to overestimate breast cancer risk (in themselves and their mothers). Furthermore, they were un- or misinformed about true breast cancer risk factors and effective breast health measures. The impact of a girl's unrealistic fear of breast cancer is unknown. We are concerned that it may deter rather than motivate healthy behaviors. Breast health programs are necessary to replace fear and inaccurate information with facts and reassurance. These results might be useful in the design of education and intervention strategies to improve psychological wellbeing and the achievement of long-term public health goals.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5078.

Primary hyperparathyroidism: role of the preoperative oral calcium loading test in the differential diagnosis between adenoma and hyperplasia

Whereas the sensitivity of the membrane calcium receptors is decreased in parathyroid adenoma, extracellular calcium may reduce parathyroid hormone (PTH) secretion through the protein kinase C pathway in parathyroid hyperplasia. The aim of this study was to determine the role of a preoperative oral calcium loading test in the differential diagnosis between adenoma and hyperplasia. Twenty-two subjects with adenoma (group A, age +/- standard error 56 +/-2 years, female/male 15/7), 10 individuals with hyperplasia (group H, age 54 +/-3, female/male 8/2), and 32 age and gender pair-matched controls (group C) underwent the test. Calcium and PTH were measured before and 60, 120, and 180 min after oral administration of 1 g of calcium (as gluconolactate). Product P was defined as minimal PTH concentration (pg/mL) x maximal calcium concentration (mg/dL) during the test. Ratio R was defined as relative PTH decline/relative calcium increase. The PTH decline during the test in group H was comparable to that of the controls. PTH decline <30%, Product P > 1,100, and Ratio R < 4 diagnosed adenoma with specificity of 100%, 90%, and 100%, respectively. PTH decline >60% diagnosed hyperplasia with specificity of 100%. The total accuracy of the test (65%) was comparable to that of technetium-99 m sestamibi scintigraphy (66%) and better than that of ultrasonography (58%). The test may discriminate patients with sporadic diffuse hyperplasia from individuals with solitary adenoma in cases of primary hyperparathyroidism with an indication for surgery.

Regional cerebral oxygenation by NIRS does not correlate with central or jugular venous oxygen saturation during interventional catheterisation in children

PURPOSE

To evaluate whether regional cerebral oxygenation (rSO(2)) by near-infrared spectroscopy correlates with central venous (SvO(2)) or internal jugular (SjO(2)) oxygen saturation, and whether changes over time (Delta) in rSO(2) (DeltarSO(2)) predict changes in SvO(2) (DeltaSvO(2)) and SjO(2) (DeltaSjO(2)).

METHODS

The rSO(2) values were measured using the INVOS 5100 cerebral oximeter in children undergoing interventional cardiac catheterization and were compared with the oxygen saturation of analysed central venous and internal jugular blood samples. Changes over time (Delta) were calculated as the difference between the values before and after catheter intervention for rSO(2).(DeltarSO(2)), SvO(2).(DeltaSvO(2)) and SjO(2).(DeltaSjO(2)). Simple regression and Bland-Altman analysis were performed. Data are presented as median (range).

RESULTS

Sixty patients aged 4.3 (0.2-16.0) years were investigated. A closer correlation was found between rSO(2) and SvO(2) (r=0.728, P<0.0001) than between rSO(2) and SjO(2) (r=0.665, P<0.0001). The bias between rSO(2) and SvO(2).(SjO(2)) was 0.17% (-0.60%), with limits of agreement from -15.5% to 15. 9% (-18.6-17.4%). The sensitivity/specificity for DeltarSO(2) to indicate a fall in SvO(2) or in SjO(2) was 70.3%/65.2% and 68.6%/60.0%, respectively.

CONCLUSION

Neither absolute values nor changes in rSO(2) using the INVOS 5100 allowed reliable estimation of SvO(2) or SjO(2) and their trends.

[Cost of intensive care in a German hospital: cost-unit accounting based on the InEK matrix]

OBJECTIVE

The aim of this study was to determine the actual cost per intensive care unit (ICU) day in Germany based on routine data from an electronic patient data management system as well as analysis of cost-driving factors. A differentiation between days with and without mechanical ventilation was performed.

METHODS

On the ICU of a German focused-care hospital (896 beds, 12 anesthesiology ICU beds), cost per treatment day was calculated with or without mechanical ventilation from the perspective of the hospital. Costs were derived retrospectively with respect to the period between January and October 2006 by cost-unit accounting based on routine data collected from the ICU patients. Patients with a length of stay of at least 2 days on the ICU were included. Demographic, clinical and economical data were analyzed for patient characterization.

RESULTS

Data of 407 patients (217 male and 190 female) were included in the analysis, of which 159 patients (100 male, 59 female) were completely or partially mechanically ventilated. The mean simplified acute physiology (SAPS) II score at the onset of ICU stay was 28.2. Average cost per ICU day was 1,265 EUR and costs for ICU days with and without mechanical ventilation amounted to 1,426 EUR and 1,145 EUR, respectively. Personnel costs (50%) showed the largest cost share followed by drugs plus medicinal products (18%) and infrastructure (16%).

CONCLUSIONS

For the first time, a cost analysis of intensive care in Germany was performed with routine data based on the matrix of the institute for reimbursement in hospitals (InEK). The results revealed a higher resource use on the ICU than previously expected. The large share of personnel costs on the ICU was evident but is comparable to other medical departments in the hospital. The need for mechanical ventilation increases the daily costs of resources by approximately 25%.

Microscopic wire guide-based orotracheal mouse intubation: description, evaluation and comparison with transillumination

Airway access is needed for a number of experimental animal models, and the majority of animal research is based on mouse models. Anatomical conditions in mice are small, and the narrow glottic opening allows intubation only with a subtle technique. We therefore developed a microscopic endotracheal intubation method with a wire guide technique in mice anaesthetized with halothane in oxygen. The mouse is hung perpendicularly with its incisors on a thread fixed on a vertical plate. The tongue is placed with a pair of forceps between the left hand's thumb and forefinger and slightly pulled, while the neck and thorax are positioned using the third and fourth fingers. By doing so, the neck can be slightly stretched, which allows optimal visualization of the larynx and the vocal cords. To ensure a safe intubation, a fine wire guide is placed under vision between the vocal cords and advanced about 5 mm into the trachea. An intravenous 22G x 1 in. plastic or Teflon catheter is guided over this wire. In a series of 41 mice, between 21 and 38 g, the success rate for the first intubation attempt was >95%. Certainty of the judgement procedure was 100% and success rate was higher using the described method when compared with a transillumination method in a further series. The technique is safe, less invasive than tracheostomy and suitable for controlled ventilation and pulmonary substance application.

High responsivity GaNAsSb p-i-n photodetectors at 1.3 microm grown by radio-frequency nitrogen plasma-assisted molecular beam epitaxy

GaNAsSb/GaAs p-i-n photo notdetectors with an intrinsic GaNAsSb photoabsorption layer grown at 350 degrees C, 400 degrees C, 440 degrees C and 480 degrees C, have been prepared using radio-frequency nitrogen plasma-assisted molecular beam epitaxy in conjunction with a valved antimony cracker source. The i-GaNAsSb photoabsorption layer contains 3.3% of nitrogen and 8% of antimony, resulting in DC photo-response up to wavelengths of 1350 nm. The device with i-GaNAsSb layer grown at 350 degrees C exhibits extremely high photoresponsivity of 12A/W at 1.3 microm. These photodetectors show characteristics which strongly suggest the presence of carrier avalanche process at reverse bias less than 5V.

Measurement of tracheal wall pressure: a comparison of three different in vitro techniques

We compared three different tracheal wall pressure measuring techniques in vitro. Using a high-volume, low-pressure, cuffed tracheal tube with an internal diameter of 7.5 mm and a model trachea, the pressure difference technique, the wall pressure membrane technique and the microchip sensor probe technique with and without lubrication were studied. Wall pressures were measured after sequential injections of 0.5 ml of air into the cuff at cuff pressures ranging from 0 to 50 mmHg. The coefficient of variance was largest for the microchip sensor probe technique with lubrication (29%) and without lubrication (214%), and was lower for the wall pressure membrane technique (22%) and the pressure difference technique (19%). The wall pressure membrane and pressure difference techniques provided comparable results. The microchip sensor probe technique considerably underestimated wall pressure. These findings have an impact on the interpretation of published data on tracheal or pharyngeal wall pressure using the microchip sensor probe technique.

In vitro evaluation of the CeVOX continuous central venous oxygenation monitoring system

We investigated the in vitro performance of the CeVOX system for continuous monitoring of central venous oxygen saturation by spectrophotometry (Pulsion Medical Systems, Munich, Germany). Oxygen inflow into the system was varied, and oxygen saturation values measured by CeVOX were documented. Blood samples were simultaneously taken to assess oxygen saturation by co-oximetry, and values were compared by Bland-Altman analysis. Sixty-six data pairs were obtained at CeVOX and co-oximetry values of 16-99% and 5.5-100%, respectively. Overall, CeVOX values only slightly overestimated co-oximetry values (mean bias +2.4%), but limits of agreement (2 SD of bias) were wide (-11.8 to +16.6%). Saturation measured by CeVOX underestimated that measured by co-oximetry at higher oxygen concentrations and overestimated it at lower oxygen concentrations. There was a nearly linear correlation of the mean bias, suggesting a systematic error. We conclude that the current version of the CeVOX system does not reliably reflect oxygen saturation.

The early use of minimal enteral nutrition in extremely low birth weight newborns

OBJECTIVE

To gather information regarding the efficacy of early minimal enteral nutrition on overall feeding tolerance in extremely low birth weight infants.

STUDY DESIGN

Prospective randomized controlled trial comparing the early use of minimal enteral nutrition in extremely low birth weight infants from day 2 to day 7 vs control infants. On day 8, feeding volume in both groups were advanced by 10 ml kg(-1) day(-1) until full enteral feedings were reached. Time to full feeds, number of intolerance episodes, anthropometric measurements, peak total bilirubin levels, incidence of necrotizing enterocolitis and incidence of sepsis were compared between the two groups with t-test and chi (2) test.

RESULT

Eighty-four infants were enrolled in the study but only 61 infants completed the feeding protocol. No statistically significant differences were found between the groups with regards to growth patterns, feeding tolerance, mortality, length of hospital stay and incidence of sepsis and necrotizing enterocolitis.

CONCLUSION

Early minimal enteral nutrition use in extremely low birth weight infants did not improve feeding tolerance.

Early results of balloon dilatation of the stenotic bovine jugular vein graft in the right ventricular outflow tract in children

The aim of this study was to evaluate the early results of interventional balloon dilatation of stenotic bovine jugular vein (BJV) grafts implanted for reconstruction of the right ventricular outflow tract (RVOT) in children.

METHODS

From May 2001 to December 2005, 153 BJV grafts were implanted in children in our institution. An average of 16.9 (7.6-41.1) months after implantation, 17 balloon dilatations in a significant stenosis proximal (n = 1), distal anastomosis (n = 8), BJV valve (n = 3), or at multiple sites (n = 5) were performed in 15 children (male:female = 9:6) with a mean age of 3.9 (0.8-13.0) years. Balloon diameter was 75-133.3% (mean 100.3) of the original BJV size. Mean follow-up was 8.8 (2 days to 22.8 months) months.

RESULTS

In 10 interventions (58.8%) the instantaneous peak gradient was reduced below 50 mmHg. A balloon diameter > or =100% of the original BJV size correlated significantly with a successful intervention. No major complications, two minor (nonobstructive floating membranes at the dilatation site and one septicemia) occurred afterward. Freedom from reintervention after 6 months was 58.2% for all, 77.8% for dilatations of the proximal anastomosis and mixed stenotic lesions, and 33.3% for the distal anastomosis.

CONCLUSION

Balloon dilatation of stenotic BJV grafts is safe and can significantly reduce the pressure gradient in two-thirds of interventions. Balloon diameters above the original graft size should be aimed for. The most frequent stenosis of the distal anastomosis tends to renarrow early after dilatation. Nevertheless, balloon dilatation should be considered in nearly every stenotic graft to gain time until a surgical or interventional graft exchange.

Cardiac output measurement in children: comparison of Aesculon cardiac output monitor and thermodilution

BACKGROUND

We compared cardiac output (CO) measurements by the non-invasive electrical velocimetry (Aesculon) monitor with the pulmonary artery catheter (PAC) thermodilution method in children.

METHODS

CO values using the Aesculon monitor and PAC thermodilution were simultaneously recorded during cardiac catheterization in children. Measurements were performed under general anaesthesia. To compare, three consecutive measurements for each patient within 3 min were obtained. The means of the three values were compared using simple regression and Bland-Altman analysis. Data were presented as mean (sd). A mean percentage of <30% was defined to indicate clinical useful reliability of the Aesculon monitor.

RESULTS

A total of 50 patients with a median (range) age of 7.5 (0.5-16.5) yr were enrolled in the study. Mean CO values were 3.7 (1.5) litre min(-1) (PAC thermodilution) and 3.1 (1.7) litre min(-1) (Aesculon) monitor). Analysis for CO measurement showed a good correlation between the two methods (r=0.894; P<0.0001). The bias between the two methods was 0.66 litre min(-1) with a precision of 1.49 litre min(-1). The mean percentage error for CO measurements was 48.9% for the Aesculon monitor when compared with PAC thermodilution.

CONCLUSIONS

Electrical velocimetry using the Aesculon monitor did not provide reliable CO values when compared with PAC thermodilution. Whether the Aesculon monitor can be used as a CO trend monitor has to be assessed by further investigations in patients with changing haemodynamics.

Quantitative trait loci for water-soluble carbohydrates and associations with agronomic traits in wheat

Several environmental factors including drought and disease can reduce leaf area and photosynthesis during grain-filling to decrease grain yield and kernel weight of cereal crops. Water-soluble carbohydrates (WSC) accumulated around anthesis can be mobilised to assist in filling of developing grains when post-anthesis assimilation is low. Cultivar differences support opportunities to select for high WSC but little is known of the extent or nature of genetic control for this trait in wheat. Three wheat mapping populations (Cranbrook/Halberd, Sunco/Tasman, and CD87/Katepwa) were phenotyped for WSC and other agronomic traits across multiple environments. The range for WSC concentration (WSC-C) was large among progeny contributing to moderate-to-high narrow-sense heritabilities within environments (h2 = 0.51–0.77). Modest genotype × environment interaction reduced the correlation of genotype means across environments (rp = 0.37–0.78, P < 0.01) to reduce heritability on a line-mean (h2 = 0.55–0.87) basis. Transgressive segregation was large and genetic control complex, with 7–16 QTLs being identified for WSC-C in each population. Heritability was smaller (h2 = 0.32–0.54) for WSC mass per unit area (WSC-A), reflecting large genotype × environment interaction and residual variance with estimating anthesis biomass. Fewer significant QTLs (4–8) were identified for this trait in each population, while sizes of individual genetic effects varied between populations but were repeatable across environments. Several genomic regions were common across populations including those associated with plant height (e.g. Rht-B1) and/or anthesis date (e.g. Ppd1). Genotypes with high WSC-C were commonly shorter, flowered earlier, and produced significantly (P < 0.01) fewer tillers than those of low WSC-C. This resulted in similar yields, lower final biomass, and fewer grains per m2, but greater dry weight partitioning to grain, kernel weight, and less grain screenings in high compared with low WSC-C genotypes. By contrast, lines high for WSC-A produced more fertile tillers associated with similar or greater anthesis and maturity biomass, grain number, and yield, yet similar kernel weight or size compared with genotypes with low WSC-A. The data support an important role for WSC-A in assuring stable yield and grain size. However, the small effects of many independent WSC QTLs may limit their direct use for marker-aided selection in breeding programs. We suggest using molecular markers to enrich populations for favourable height and anthesis date alleles before the more costly phenotypic selection among partially inbred families for greater WSC-A.