Measurements of the angular distributions of muons from Υ decays in pp collisions at sqrt[s] = 1.96 TeV

The angular distributions of muons from Υ(1S,2S,3S) → μ+ μ- decays are measured using data from pp collisions at sqrt[s] = 1.96  TeV corresponding to an integrated luminosity of 6.7  fb(-1) and collected with the CDF II detector at the Fermilab Tevatron. This analysis is the first to report the full angular distributions as functions of transverse momentum p(T) for Υ mesons in both the Collins-Soper and s-channel helicity frames. This is also the first measurement of the spin alignment of Υ(3S) mesons. Within the kinematic range of Υ rapidity |y|<0.6 and p(T) up to 40  GeV/c, the angular distributions are found to be nearly isotropic.

Precise measurement of the W-boson mass with the CDF II detector

We have measured the W-boson mass M(W) using data corresponding to 2.2  fb(-1) of integrated luminosity collected in pp collisions at sqrt[s] = 1.96  TeV with the CDF II detector at the Fermilab Tevatron collider. Samples consisting of 470,126 W → eν candidates and 624,708 W → μν candidates yield the measurement M(W) = 80,387 ± 12(stat.) ± 15(syst.) = 80,387 ± 19  MeV/c2. This is the most precise measurement of the W-boson mass to date and significantly exceeds the precision of all previous measurements combined.

Measurement of ZZ production in leptonic final states at sqrt[s] of 1.96 TeV at CDF

In this Letter, we present a precise measurement of the total ZZ production cross section in pp collisions at sqrt[s]=1.96  TeV, using data collected with the CDF II detector corresponding to an integrated luminosity of approximately 6  fb(-1). The result is obtained by combining separate measurements in the four-charged (ℓℓℓ' ℓ') and two-charged-lepton and two-neutral-lepton (ℓℓνν) decay modes of the Z boson pair. The combined measured cross section for pp → ZZ is 1.64(-0.38)(+0.44)  pb. This is the most precise measurement of the ZZ production cross section in 1.96 TeV pp collisions to date.

Observation of exclusive γγ production in pp¯ collisions at √s=1.96 TeV

We have observed exclusive γγ production in proton-antiproton collisions at √s=1.96 TeV, using data from 1.11±0.07 fb(-1) integrated luminosity taken by the Run II Collider Detector at Fermilab. We selected events with two electromagnetic showers, each with transverse energy E(T)>2.5 GeV and pseudorapidity |η|<1.0, with no other particles detected in -7.4<η<+7.4. The two showers have similar E(T) and azimuthal angle separation Δφ~π; 34 events have two charged particle tracks, consistent with the QED process pp¯→p+e(+)e(-)+p¯ by two-photon exchange, while 43 events have no charged tracks. The number of these events that are exclusive π(0)π(0) is consistent with zero and is <15 at 95% C.L. The cross section for pp¯→p+γγ+p¯ with |η(γ)|<1.0 and E(T)(γ)>2.5 GeV is 2.48(-0.35)(+0.40)(stat)(-0.51)(+0.40)(syst) pb.

Search for a Higgs boson in the diphoton final state in pp collisions at sqrt[s]=1.96 TeV

A search for a narrow Higgs boson resonance in the diphoton mass spectrum is presented based on data corresponding to 7.0  fb{-1} of integrated luminosity from pp collisions at sqrt[s]=1.96  TeV collected by the CDF experiment. No evidence of such a resonance is observed, and upper limits are set on the cross section times branching ratio of the resonant state as a function of Higgs boson mass. The limits are interpreted in the context of the standard model and one fermiophobic benchmark model where the data exclude fermiophobic Higgs bosons with masses below 114  GeV/c{2} at a 95% Bayesian credibility level.

Invasive markers identified by gene expression profiling in pancreatic cancer

BACKGROUND

Molecular profiling has proven utility as a diagnostic and predictive tool in clinical oncology. However, a clinically relevant gene expression profile in pancreatic cancer remains elusive.

METHODS

Primary and metastatic pancreatic cancer cell lines (BxPC-3 and AsPC-1), were stimulated with phorbol-12-myristate 13-acetate (PMA), a known inducer of cell invasion. Affymetrix gene expression microarray analysis was performed, comparing gene expression to unstimulated controls. Differential expression was identified using ArrayAssist, and confirmed using quantitative real-time PCR. Bioinformatic analysis was performed using Pathway Studio and GOstat. The derived gene expression was further validated in fresh frozen pancreatic tumour samples. The ability of the derived 3 gene expression markersto differentiate between pancreatic adenocarcinoma (PDAC) and other neoplasms, and its association with clinicopathological variables was examined.

RESULTS

PMA-induced significant changes in cell line gene expression, from which distinctive 3 potential invasive markers were derived. Expression of these genes, uPA, MMP-1 and IL1-R1 was confirmed in human pancreatic tumours, and was found to differentiate PDAC from other pancreatic neoplasms. The expression of IL1-R1 in PDAC is a novel finding. We found that the expression of MMP-1 was associated with high-grade PDAC (p = 0.035, Wilcoxon rank sum).

CONCLUSION

We have identified three potential invasive markers, uPA, MMP-1 and IL1-R1, whose gene expression may differentiate PDAC from other pancreatic neoplasms, and potentially reflect a more invasive phenotype.

Measurement of polarization and search for CP violation in B(s)0→φφ decays

We present the first measurement of polarization and CP-violating asymmetries in a B(s)(0) decay into two light vector mesons, B(s)(0)→φφ, and an improved determination of its branching ratio using 295 decays reconstructed in a data sample corresponding to 2.9 fb(-1) of integrated luminosity collected by the CDF experiment at the Fermilab Tevatron collider. The fraction of longitudinal polarization is determined to be f(L)=0.348±0.041(stat)±0.021(syst), and the branching ratio B(B(s)(0)→φφ)=[2.32±0.18(stat)±0.82(syst)]×10(-5). Asymmetries of decay angle distributions sensitive to CP violation are measured to be A(u)=-0.007±0.064(stat)±0.018(syst) and A(v)=-0.120±0.064(stat)±0.016(syst).

Top-quark mass measurement using events with missing transverse energy and jets at CDF

We present a measurement of the top-quark mass using a sample of t ̄t events in 5.7 fb(-1) of integrated luminosity from p ̄p collisions at the Fermilab Tevatron with √s=1.96 TeV and collected by the CDF II Detector. We select events having large missing transverse energy, and four, five, or six jets with at least one jet tagged as coming from a b quark, and reject events with identified charged leptons. This analysis considers events from the semileptonic t ̄t decay channel, including events that contain tau leptons. The measurement is based on a multidimensional template method. We fit the data to signal templates of varying top-quark masses and background templates, and measure a top-quark mass of M(top)=172.32±2.4(stat)±1.0(syst)  GeV/c(2).

Search for B(s)(0) → μ+ μ- and B(0) → μ+ μ- decays with CDF II

A search has been performed for B(s)(0) → μ+ μ- and B(0) → μ+ μ- decays using 7 fb(-1) of integrated luminosity collected by the CDF II detector at the Fermilab Tevatron collider. The observed number of B(0) candidates is consistent with background-only expectations and yields an upper limit on the branching fraction of B(B(0) → μ+ μ-) < 6.0 × 10(-9) at 95% confidence level. We observe an excess of B(s)(0) candidates. The probability that the background processes alone could produce such an excess or larger is 0.27%. The probability that the combination of background and the expected standard model rate of B(s)(0) → μ+ μ- could produce such an excess or larger is 1.9%. These data are used to determine B(B(s)(0)→ μ+ μ-) = (1.8(-0.9) (+1.1)) × 10(-8) and provide an upper limit of B(B(s)(0) → μ+ μ-) < 4.0 × 10(-8) at 95% confidence level.

Search for new physics in high pT like-sign dilepton events at CDF II

We present a search for new physics in events with two high pT leptons of the same electric charge, using data with an integrated luminosity of 6.1 fb(-1). The observed data are consistent with standard model predictions. We set 95% C.L. lower limits on the mass of doubly charged scalars decaying to like-sign dileptons, m(H±±) > 190-245 GeV/c(2), assuming 100% BR to ee, μμ or eμ.

Observation of the Ξ(b)(0) baryon

The observation of the bottom, strange baryon Ξ(b)(0) through the decay chain Ξ(b)(0)→Ξ(c)(+)π-, where ΞΞ(c)(+)→Ξ- π+ π+, Ξ-→Λπ-, and Λ→pπ-, is reported by using data corresponding to an integrated luminosity of 4.2  fb(-1) from pp collisions at square root(s)=1.96  TeV recorded with the Collider Detector at Fermilab. A signal of 25.3(-5.4)(+5.6) candidates is observed whose probability of arising from a background fluctuation is 3.6×10(-12), corresponding to 6.8 gaussian standard deviations. The Ξ(b)(0) mass is measured to be 5787.8±5.0(stat)±1.3(syst)  MeV/c2. In addition, the Ξ(b)- baryon is observed through the process Ξ(b)-→Ξ(c)(0)π-, where Ξ(c)(0)→Ξ- π+, Ξ-→Λπ-, and Λ→pπ-.

Invariant mass distribution of jet pairs produced in association with a W boson in pp collisions at sqrt[s]=1.96 TeV

We report a study of the invariant mass distribution of jet pairs produced in association with a W boson using data collected with the CDF detector which correspond to an integrated luminosity of 4.3  fb(-1). The observed distribution has an excess in the 120-160  GeV/c(2) mass range which is not described by current theoretical predictions within the statistical and systematic uncertainties. In this Letter, we report studies of the properties of this excess.

Distribution of ceftiofur into Mannheimia haemolytica-infected tissue chambers and lung after subcutaneous administration of ceftiofur crystalline free acid sterile suspension

The objective of this study was to evaluate the penetration of ceftiofur- and desfuroylceftiofur-related metabolites (DCA) into sterile and infected tissue chambers, lung tissue and disposition of DCA in plasma across four different sacrifice days postdosing. Twelve healthy calves were utilized following implantation with tissue chambers in the paralumbar fossa. Tissue chambers in each calf were randomly inoculated with either Mannheimia haemolytica or sterile PBS. All calves were dosed with ceftiofur crystalline free acid sterile suspension (CCFA-SS) subcutaneously in the ear pinna. Calves were randomly assigned to 4 groups of 3 to be sacrificed on days 3, 5, 7 and 9 postdosing. Prior to euthanasia, plasma and tissue chamber fluid were collected, and immediately following euthanasia, lung tissue samples were obtained from four different anatomical sites DCA concentration analysis. Results of our study found that, in general, DCA concentrations followed a rank order of plasma > infected tissue chamber fluid > noninfected tissue chamber fluid > lung tissue. Data also indicated DCA concentrations remained above the therapeutic threshold of 0.2 microg/mL for plasma and chamber fluid and 0.2 microg/g for lung tissue for at least 7 days post-treatment.

Mortality and cost outcomes of elderly trauma patients admitted to intensive care and the general wards of an Australian tertiary referral hospital

Mortality and cost outcomes of elderly intensive care unit (ICU) trauma patients were characterised in a retrospective cohort study from an Australian tertiary ICU Trauma patients admitted between January 2000 and December 2005 were grouped into three major age categories: aged > or =65 years admitted into ICU (n = 272); aged -65 years admitted into general ward (n = 610) and aged < 65 years admitted into ICU (n = 1617). Hospital mortality predictors were characterised as odds ratios (OR) using logistic regression. The impact of predictor variables on (log) total hospital-stay costs was determined using least squares regression. An alternate treatment-effects regression model estimated the mortality cost-effect as an endogenous variable. Mortality predictors (P < or = 0.0001, comparator: ICU > or = 65 years, ventilated) were: ICU < 65 not-ventilated (OR 0.014); ICU < 65 ventilated (OR 0.090); ICU age > or = 65 not-ventilated (OR 0.061) and ward > or = 65 (OR 0.086); increasing injury severity score and increased Charlson comorbidity index of 1 and 2, compared with zero (OR 2.21 [1.40 to 3.48] and OR 2.57 [1.45 to 4.55]). The raw mean daily ICU and hospital costs in A$ 2005 (US$) for age < 65 and > or = 65 to ICU, and > or = 65 to the ward were; for year 2000: ICU, $2717 (1462) and $2777 (1494); hospital, $1837 (988) and $1590 (855); ward $933 (502); for year 2005: ICU, $3202 (2393) and $3086 (2307); hospital, $1938 (1449) and $1914 (1431); ward $1180 (882). Cost increments were predicted by age < or = 65 and ICU admission, increasing injury severity score, mechanical ventilation, Charlson comorbidity index increments and hospital survival. Mortality cost-effect was estimated at -63% by least squares regression and -82% by treatment-effects regression model. Patient demographic factors, injury severity and its consequences predict both cost and survival in trauma. The cost mortality effect was biased upwards by conventional least squares regression estimation.

Family history of haematopoietic malignancies and non-Hodgkin's lymphoma risk in the California Teachers Study

Family history of haematopoietic malignancies appears to be a risk factor for non-Hodgkin's lymphoma (NHL), but whether risk varies by family member's gender is unclear. Among 121 216 women participating in the prospective California Teachers Study, NHL risk varied by type of haematopoietic malignancy and gender of the relative.

Should we be 'pushing meds'? The implications of pharmacogenomics

Medication continues to be the most widely prescribed treatment in the NHS for mental health problems. It has been known for many years that individuals differ in the way they respond to a given pharmaceutical therapy, and one reason for this lies in the genetic variation between individuals. This paper recognizes the impact that pharmacogenomics and pharmacogenetics are having in the field of mental health. Variants in genes that code for the drug metabolizing enzymes in the liver have been found to influence the way in which these enzymes handle psychotropic medication. Individuals can be classified as poor, moderate or extensive metabolizers when standard regimes are used, and this can lead to huge differences in therapeutic effect and toxicity. There are now genotyping tests available which provide information on the individual's ability to metabolize psychotropic medication. One author provides an account of the effects of medication on her son's physical and psychological well-being. Genotyping provided evidence for his poor metabolism of psychotropic medication, and his life is now changing as he is being very gradually weaned off this medication. This emerging field of work has implications for the way in which practitioners consider medication adherence.

Measurements of partial branching fractions for B-->Xulnu and determination of |Vub|

We present partial branching fractions for inclusive charmless semileptonic B decays B[over ]-->X_{u}lnu[over ], and the determination of the Cabibbo-Kobayashi-Maskawa matrix element |V_{ub}|. The analysis is based on a sample of 383 x 10;{6} Upsilon(4S) decays into BB[over ] pairs collected with the BABAR detector at the SLAC PEP-II e;{+}e;{-} storage rings. We select events using the invariant mass M_{X} of the hadronic system, the invariant mass squared, q;{2}, of the lepton and neutrino pair, the kinematic variable P+, or one of their combinations. We then determine partial branching fractions in limited regions of phase space: DeltaB=(1.18+/-0.09_{stat}+/-0.07_{syst}+/-0.01_{theor})x10;{-3} (M_{X}<1.55 GeV/c;{2}), DeltaB=(0.95+/-0.10_{stat}+/-0.08_{syst}+/-0.01_{theor})x10;{-3} (P+<0.66 GeV/c), and DeltaB=(0.81+/-0.08_{stat}+/-0.07_{syst}+/-0.02_{theor})x10;{-3} (M_{X}<1.7 GeV/c;{2}, q;{2}>8 GeV;{2}/c;{4}). Corresponding values of |V_{ub}| are extracted using several theoretical calculations.

Acute paraplegia in a patient with AIDS and a normal CSF examination

We report a case of tuberculous myeloradiculitis in a patient with AIDS. The case highlights the difficulty in reaching a diagnosis for the neurological symptoms of a patient with a normal CSF examination and the need for HIV screening of immune-compromised patients with myeloradiculitis.

Dopamine agonist therapy in early Parkinson's disease

BACKGROUND

Dopamine agonists are being used increasingly as first line treatment for Parkinson's disease, but there remains uncertainty about their clinical and cost-effectiveness relative to levodopa.

OBJECTIVES

This meta-analysis aims to quantify more reliably the benefits and risks of dopamine agonists compared to placebo or levodopa in early Parkinson's disease.

SEARCH STRATEGY

We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, PubMed, LILACS and Web of Science, plus major journals in the field, abstract books, conference proceedings and reference lists of retrieved publications.

SELECTION CRITERIA

Randomised trials comparing an orally administered dopamine agonist (with or without levodopa) versus placebo or levodopa or both placebo and levodopa in participants with early Parkinson's disease.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data on clinician-rated disability, motor complications, other side-effects, treatment concordance, levodopa dose and mortality.

MAIN RESULTS

Twenty-nine eligible trials, involving 5247 participants, were identified. Participants randomised to a dopamine agonist were less likely to develop dyskinesia (odds ratio (OR) 0.51, 95% confidence interval (CI) 0.43 to 0.59; P < 0.00001), dystonia (OR 0.64, 95% CI 0.51 to 0.81; P = 0.0002) and motor fluctuations (OR 0.75, 95% CI 0.63 to 0.90; P = 0.002) than levodopa-treated participants. However, various 'non-motor' side-effects, including oedema (OR 3.68, 95% CI 2.62 to 5.18; P < 0.00001), somnolence (OR 1.49, 95% CI 1.12 to 2.00; P = 0.007), constipation (OR 1.59, 95% CI 1.11 to 2.28; P = 0.01), dizziness (OR 1.45, 95% CI 1.09 to 1.92; P = 0.01), hallucinations (OR 1.69, 95% CI 1.13 to 2.52; P = 0.01) and nausea (OR 1.32, 95% CI 1.05 to 1.66; P = 0.02) were all increased in agonist-treated participants (compared with levodopa-treated participants). Agonist-treated participants were also significantly more likely to discontinue treatment due to adverse events (OR 2.49, 95% CI 2.08 to 2.98; P < 0.00001). Finally symptomatic control of Parkinson's disease was better with levodopa than with agonists, but data were reported too inconsistently and incompletely to meta-analyse.

AUTHORS' CONCLUSIONS

This meta-analysis confirms that motor complications are reduced with dopamine agonists compared to levodopa, but also establishes that other important side-effects are increased and symptom control is poorer with agonists. Larger, long-term comparative trials assessing patient-rated quality of life are needed to assess more reliably the balance of benefits and risks of dopamine agonists compared to levodopa.

Dopamine agonist therapy in early Parkinson's disease

BACKGROUND

Dopamine agonists are being used increasingly as first line treatment for Parkinson's disease, but there remains uncertainty about their clinical and cost-effectiveness relative to levodopa.

OBJECTIVES

This meta-analysis aims to quantify more reliably the benefits and risks of dopamine agonists compared to placebo or levodopa in early Parkinson's disease.

SEARCH STRATEGY

We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, PubMed, LILACS and Web of Science, plus major journals in the field, abstract books, conference proceedings and reference lists of retrieved publications.

SELECTION CRITERIA

Randomised trials comparing an orally administered dopamine agonist (with or without levodopa) versus placebo or levodopa or both placebo and levodopa in participants with early Parkinson's disease.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data on clinician-rated disability, motor complications, other side-effects, treatment concordance, levodopa dose and mortality.

MAIN RESULTS

Twenty-nine eligible trials, involving 5247 participants, were identified. Participants randomised to a dopamine agonist were less likely to develop dyskinesia (odds ratio (OR) 0.51, 95% confidence interval (CI) 0.43 to 0.59; P < 0.00001), dystonia (OR 0.64, 95% CI 0.51 to 0.81; P = 0.0002) and motor fluctuations (OR 0.75, 95% CI 0.63 to 0.90; P = 0.002) than levodopa-treated participants. However, various 'non-motor' side-effects, including oedema (OR 3.68, 95% CI 2.62 to 5.18; P < 0.00001), somnolence (OR 1.49, 95% CI 1.12 to 2.00; P = 0.007), constipation (OR 1.59, 95% CI 1.11 to 2.28; P = 0.01), dizziness (OR 1.45, 95% CI 1.09 to 1.92; P = 0.01), hallucinations (OR 1.69, 95% CI 1.13 to 2.52; P = 0.01) and nausea (OR 1.32, 95% CI 1.05 to 1.66; P = 0.02) were all increased in agonist-treated participants (compared with levodopa-treated participants). Agonist-treated participants were also significantly more likely to discontinue treatment due to adverse events (OR 2.49, 95% CI 2.08 to 2.98; P < 0.00001). Finally symptomatic control of Parkinson's disease was better with levodopa than with agonists, but data were reported too inconsistently and incompletely to meta-analyse.

AUTHORS' CONCLUSIONS

This meta-analysis confirms that motor complications are reduced with dopamine agonists compared to levodopa, but also establishes that other important side-effects are increased and symptom control is poorer with agonists. Larger, long-term comparative trials assessing patient-rated quality of life are needed to assess more reliably the balance of benefits and risks of dopamine agonists compared to levodopa.

Antigen-specific tolerance of human alpha1-antitrypsin induced by helper-dependent adenovirus

As efficient and less toxic virus-derived gene therapy vectors are developed, a pressing problem is to avoid immune response to the therapeutic gene product. Secreted therapeutic proteins potentially represent a special problem, as they are readily available to professional antigen-presenting cells throughout the body. Some studies suggest that immunity to serum proteins can be avoided in some mouse strains by using tissue-specific promoters. Here we show that expression of human alpha1-antitrypsin (AAT) was nonimmunogenic in the immune-responsive strain C3H/HeJ, when expressed from helper-dependent (HD) vectors using ubiquitous as well as tissue-specific promoters. Coadministration of less immunogenic HD vectors with an immunogenic first-generation vector failed to immunize, suggesting immune suppression rather than immune stealth. Indeed, mice primed with HD vectors were tolerant to immune challenge with hAAT emulsified in complete Freund's adjuvant. Such animals developed high-titer antibodies to coemulsified human serum albumin, showing that tolerance was antigen specific. AAT-specific T cell responses were depressed in tolerized animals, suggesting that tolerance affects both T and B cells. These results are consistent with models of high-dose tolerance of B cells and certain other suppressive mechanisms, and suggest that a high level of expression from HD vectors can be sufficient to induce specific immune tolerance to serum proteins.

Development of the Diet Habits Questionnaire for Use in Cardiac Rehabilitation

The objective of this study is to design a tool that could be used in the cardiac rehabilitation setting to quickly assess dietary habits and identify individual participants? dietary education requirements. An initial study compared a research diet history of 4 0 participants against the results of the Diet Habits Questionnaire. Concurrent validity has been established as there was a significant difference between mean (95% CI) intake of 5 .7 (0.6 - 10.7) g saturated fat 6.8 (2.9 - 10.8) g fibre and 417 (5 - 838) mg sodium between participants requiring additional dietary advice and those who do not require additional intervention based on the DHQ score. The inter-rater reliability of the DHQ was high with strength of agreement rated as moderate for fat and substantial for fibre and sodium. The Diet Habits Questionnaire was found to be a valid and reliable screening tool for the assessment of dietary habits in cardiac rehabilitation programs. Further research may establish its usefulness not just in cardiac rehabilitation, but in other health centres such as general practice and community health settings.

Distinguishing worry from rumination in older people: a preliminary investigation

Anxiety and depression are common mental health problems in later life. Since worry and rumination are thought to underpin the respective primary cognitive processes in anxiety and depression, we developed a measure to distinguish worry from rumination in later life. The Ruminative Response Scale was adapted to include items that characterise the cognitive features of worry. We examined its properties using 92 clinical and non-clinical participants, aged over 65. Factor analysis demonstrated a three-factor structure: brooding, reflection and worry with internal consistencies of alpha = 0.72, alpha = 0.67 and alpha = 0.55 respectively. We found no evidence for concurrent validity of these factors using the Penn State Worry Questionnaire. Modest but significant associations between reflection and brooding (r = 0.36) and reflection and worry (r = 0.2) were found. Brooding and worry sub-scales remained unrelated. We suggest that it is possible to distinguish worry from rumination in older people and that differentiating between their key underlying characteristics in the assessment of mood problems may enhance the targeting and evaluation of cognitive-behavioural therapy for anxiety and depression in later life. Future research with a substantial clinical sample is needed to explore the underlying dimensions and correlates of worry in later life.

Demystifying basal-like breast carcinomas

"Basal" breast cancers are dominating the breast research literature at present and pathologists are under increasing pressure to evaluate for such a phenotype by their surgical and oncological colleagues. There is also much confusion about how to assess cancers, which immunohistochemical markers to use, what meaning and benefit this provides, and what the surgeons and oncologists will do with the information. Much remains to be done to answer all these questions but here we try to shed light on some of the issues and suggest what is still to come.

Acute mountain sickness: medical problems associated with acute and subacute exposure to hypobaric hypoxia

This article summarises the medical problems of travel to altitudes above 3000 m. These are caused by chronic hypoxia. Acute mountain sickness (AMS), a self limiting common illness is almost part of normal acclimatisation--a transient condition lasting for several days. However, in <2% of people staying above 4000 m, serious illnesses related to hypoxia develop--high altitude pulmonary oedema and cerebral oedema. These are potentially fatal but can be largely avoided by gradual ascent. Short vacations, pressure from travel companies and peer groups often encourage ascent to 4000 m more rapidly than is prudent. Sensible guidelines for ascent are outlined, clinical features, management and treatment of these conditions.

Relating with professionals

This paper addresses my difficulties as a carer in engaging with many professionals in mental health, both locally associated with my son's acute inpatient care, and nationally where policies are being developed and their implementation is pursued. All of us are affected by The Department of Health (DoH) Mental Health policies and their implementation by professionals has formed the way in which professionals relate with my son and myself. The way in which my son is impacted inextricably affects the way I relate to professionals. I think my difficulty in engaging lies in the relationships we all have with each another. In focusing on the process within our relationships, I attempt to raise professionals' awareness of what constitutes a relationship when we dialogue. As it takes two to engage in a dialogue, I perceive my difficulty is also the difficulty of the professionals. Carers are becoming increasingly involved in the training of mental health professionals and our combined difficulty needs to be resolved, so that we all benefit. In order to achieve positive progression, there needs to be a radical change within our relationship to provide ease of engagement from all parties. In this paper I tentatively suggest how this process can be achieved.

Modulation of TNFalpha, a determinant of acute toxicity associated with systemic delivery of first-generation and helper-dependent adenoviral vectors

Understanding the determinants of the host innate immune response to systemic administration of adenoviral (Ad) vectors is critical for clinical gene therapy. Acute toxicity occurs within minutes to hours after vector administration and is characterized by activation of innate immune responses. Our data indicate that in mice, indicators of vector toxicity include elevations of cytokine levels, liver transaminase levels and thrombocytopenia. To discern potential targets for blunting this host response, we evaluated genetic factors in the host response to systemically administered first-generation Ad vectors (FGV) and helper-dependent Ad vectors (HDV) containing beta-galactosidase expression cassettes. A preliminary screen for modulation of vector-induced thrombocytopenia revealed no role for interferon-gamma, mast cells or perforin. However, vector-induced thrombocytopenia and interleukin 6 (IL-6) expression are less evident in tumor necrosis factor alpha (TNFalpha)-deficient mice. Moreover, we also demonstrated that TNFalpha blockade via antibody or huTNFR:Fc pretreatment attenuates both thrombocytopenia (>40% increase in platelet count) and IL-6 expression (>80% reduction) without affecting interleukin 12 , liver enzymes, hematological indices or vector transduction in a murine model. Our data indicate that the use of HDV, in combination with clinically approved TNFalpha immunomodulation, may represent an approach for improving the therapeutic index of Ad gene therapy for human clinical trials.

Development of a zona-free method of nuclear transfer in the mouse

In the present study, a zona-free nuclear transfer (NT) technique, which had been originally developed in cattle, was modified for the mouse. Steps involved in this approach include removing the zona pellucida and enucleating without a holding pipette; sticking donor cells to the cytoplast before electric pulses are applied to fuse them and culturing reconstructed embryos individually in single droplets, to prevent aggregation. Control zona-free and zona-intact embryos from mated donors showed no significant difference in development to blastocyst, but did show reduced development to term. Removal of the zona pellucida affected the response to activation by strontium in the absence of calcium as a significant proportion of zona-free control oocytes and embryos reconstructed by NT lysed during this treatment. A comparison between cumulus and ES cells as donor cells revealed significant differences in fusion efficiency (58.1 +/- 4.0%, n = 573 vs. 42.9 +/- 2.2%, n = 2064, respectively, p < 0.001), cleavage (77.2 +/- 3.4%, n = 334 vs. 40.8 +/- 2.7%, n = 903, respectively, p < 0.001) but not for development to morula/blastocyst (8.7 +/- 2.1%, n = 334 vs. 13.9 +/- 1.8%, n = 903, respectively, p < 0.1). The stage at which embryo development arrested was also affected by donor cell type. A majority of embryos reconstructed from cumulus cells arrested at two-cell stage, usually with two nuclei, whereas those reconstructed from ES cells arrested at one-cell stage, usually with two pseudo-pronuclei. After transfer of ES cell-derived NT embryos, a viable cloned mouse was produced (3.0% of transferred embryos developed to term). These observations establish that a zona-free cloning approach is possible in the mouse, although further research is required to increase the efficiency.

Views of bereaved relatives about quality of survival after radiotherapy for malignant cerebral glioma

OBJECTIVE

To explore the views of bereaved relatives about quality of survival after radiotherapy for malignant cerebral glioma.

DESIGN

Semistructured interviews with the bereaved relatives of 56 previously studied patients with glioma.

SETTING

Patients treated at six London hospitals from 1990 to 1992 surviving between one and 46 months (median, eight).

SUBJECTS

Fifty six relatives (44 spouses, 12 others) seen four to six months after bereavement and 20 again at 13 months.

MAIN OUTCOME MEASURES

Views about quality of life and satisfaction with radiotherapy.

RESULTS

Relatives described quality of life as "good or acceptable" when patients carried on some normal activities or enjoyed social relationships. They described restricted and dependent states, constant deterioration, or loss of social interaction as giving "poor or unacceptable" quality of life. Length of time lived in such states also appeared important. Relatives' views of good or acceptable quality of life were independently related to low initial cognitive or personality change or low distress in the patient after diagnosis, and to their subsequent survival free from physical disability for at least one month. Satisfaction with radiotherapy was related to low initial distress, some degree of surgical resection, and overall length of survival longer than six months.

CONCLUSIONS

Carefully exploring the views of bereaved relatives can bring a useful perspective to difficult treatment decisions. Their values support including disability and distress in quality of life measures, but cast doubt on the QALY-type approach of using full years of survival or time free from disability to judge whether treatments are worthwhile.