Human papillomavirus 16 and head and neck squamous cell carcinoma

Evidence suggests that human papillomavirus (HPV)16 seropositivity reflects past HPV16 exposure and is associated with risk for head and neck squamous cell carcinoma (HNSCC). Our objectives were to test the hypothesis that HPV16 seropositivity is associated with risk for HNSCC, to correlate HPV16 seropositivity with HPV16 tumor DNA, and to correlate HPV16 seropositivity and HPV16 DNA with sexual history and patient survival. In a case-control study of approximately 1,000 individuals, we assessed serology to the HPV16 L1 protein and in cases only, assayed tumors for HPV16 DNA. HPV16 seropositivity was associated with 1.5- and 6-fold risks for tumors of the oral cavity and pharynx, respectively. There was a dose response trend for HPV16 titer and increasing risk of HNSCC (p < 0.0001) and HPV16 tumor DNA (p < 0.0001). In cases, HPV16 DNA and seropositivity were significantly associated with sexual activity; odds ratios (ORs) of 12.8 and 3.7 were observed for more than 10 oral sexual partners and ORs of 4.5 and 3.2 were associated with a high number of lifetime sexual partners, respectively. Finally, HPV16 seropositivity and HPV16 tumor DNA were associated with hazard ratios of 0.4 and 0.5, respectively, indicating better survival for HPV positive individuals. HPV16 seropositivity was associated with risk for HNSCC, with greatest risk for pharyngeal cancer. We observed dose response relationships between serology titer and both risk for HNSCC and HPV16 tumor DNA. In cases, HPV16 tumor DNA and positive serology were associated with sexual history and improved disease free survival.

Higher log position is not associated with better physical fitness in professional soccer teams in South Africa

Objective. To assess the difference in physical fitness of players in successful versus less-successful professional soccer teams in South Africa. Design. Professional soccer players (N = 140) underwent a battery of tests assessing important physiological components during the early part of their competitive season. Players were then separated into two groups on the basis of their teams' final log position in the Premier Soccer League (PSL) in South Africa. Players in successful (N = 70) and less-successful (N = 70) teams were in the top four or bottom six positions on the log respectively. Descriptive statistics (mean ± standard deviation (SD)) were calculated for each group, and independent t-tests were used to compare the means of the groups for each of the physical tests. Main outcome measures. Body composition, flexibility, muscle strength-endurance, power, speed, agility, aerobic endurance, and repeat sprint distance. Results. There were no significant differences between groups for all measures of body composition, flexibility, repeat sprint distance, and agility. Significant differences (p < 0.05) were found for sit-ups, aerobic endurance, and speed, but these were generally small, not meaningful differences in performance. Players in successful squads were significantly (p < 0.01) older than those in less-successful teams. Conclusions. The results demonstrate that in South Africa level of physical fitness is not higher in more-successful compared with less-successful teams in the PSL. Factors other than physical fitness may be more important in determining successful league performance and discrimi-nate better between players in teams with different levels of success. Improving professional soccer performance may require coaches and trainers to focus more attention on technical and tactical skill development in sport-specific training once an acceptable standard of fitness has been attained.. South African Journal of Sports Medicine Vol. 19 (2) 2007: pp. 40-45

Recovery of Four Novel Potato spindle tuber viroid Sequence Variants from Russian Seed Potatoes

First described in the early 1930s, the limited distribution of potato "gothic" disease made it of little economic significance in European Russia until the early 1970s when meristem-tip culture was widely adopted throughout the former USSR to increase production of virus-free seed potatoes. Shortly thereafter, the yield and quality of Russian seed potatoes began a dramatic decline. Symptoms of potato "gothic" resemble those of Potato spindle tuber viroid (PSTVd) (3), and initial suspicions that in vitro plantlets and seed potatoes might be viroid-infected were later proved correct when Kastalyeva et al. (2) showed that approximately 50 to 70% of in vitro plantlets and tubers collected from different regions of Russia as well as the in vitro germplasm collection maintained by the All-Russian Potato Research Institute (ARPRI) were infected with PSTVd. Measures have since been taken to reduce the incidence of PSTVd infection, and numerous PSTVd isolates were collected from territories of the former USSR; however, none of these isolates have been characterized at the molecular level. Overlapping reverse transcription (RT)-PCR products (1) were generated from four PSTVd isolates maintained in field-grown tubers at the VNIIF using two pairs of primers; PSTVd180F (5'-TCACCCTTCCTTTCTTCGGGTGTC-3') + PSTVd179R (5'-AAACCCTGTTTCGGCGGGAATTAC-3') and PSTVd112F (5'-ACT GGCAAAAAAGGACGGTGGGGA-3') + PSTVd359R (5'-AGGAACC AACTGCGGTTCCAAGGG-3'). Automated sequence analysis of the resulting uncloned PCR products revealed the presence of four previously unknown PSTVd variants (GenBank Accession Nos. EF044302-EF044305). All four tubers were also infected with Potato virus M and Potato virus Y and one tuber also contained Potato virus S. ELISA tests for Potato leaf roll virus were negative. Each isolate appeared to contain only a single 358-359 nt variant differing from PSTVd-intermediate strain (GenBank Accession No. V01465) at 2-5 positions. The three closely related variants originating from Leningradskaya Province (Northwest Russia) contain two to three changes in the variable domain and central conserved region and induced intermediate symptoms in Rutgers tomato. The fourth variant originating from Samarskaya Province (Volga River Region) contains additional changes in the pathogenicity domain and induced mild symptoms. Minor differences among the Leningradskaya variants may represent sequence drift during extended (9 to 11 year) tuber passage. The presence of additional sequence changes in the variant from Samarskaya is consistent with independent origin and/or prolonged separation. Additional studies with a wider range of Russian isolates of PSTVd are currently underway to develop diagnostic methods suitable for future large-scale screening programs. References: (1) Y. Hu et al. Virology 219:45, 1997. (2) T. B. Kastalyeva et al. Vestn. RASKHN 3:22, 1992. (3) Y. A. Leontyeva. Potato spindle tuber ('gothic') as one of the most important diseases in the Volga region. (In Russian.) Ph.D. thesis. Agricultural University of Leningrad, Pushkin, 1971.

High-intensity exercise and recovery during short-term supplementation with creatine plus a protein-carbohydrate formula

Objective. To determine the effect of short-term creatine supplementation plus a protein-carbohydrate formula on high-intensity exercise performance and recovery. Design. A repeated-measures, experimental study, employing a randomised, double-blind, placebo-controlled, group comparison design was used. Interventions. Thirty active but not sprint-trained male subjects were randomly assigned to 1 of 3 groups: creatine plus protein-carbohydrate formula (CRF); creatine only (CRE); and control (CON). All groups were exposed to the same high-intensity sprint exercise programme, 3 times per week for 30 days. Main outcome measures. Dependant variables included total repeat sprint distance, fatigue index, perceived muscle pain, and blood lactate, urea, creatine kinase, and cortisol concentrations. Results. All groups significantly (p ≤ 0.05) increased total sprint distance and decreased blood urea concentrations. There were no significant changes in blood lactate or cortisol concentrations in any group. CRF showed significant decreases (p ≤ 0.05) in fatigue index, muscle pain, and creatine kinase concentration. However, no significant differences were found between groups. Conclusion. Short-term creatine supplementation with or without protein-carbohydrate supplementation does not appear to enhance performance or recovery significantly over high-intensity exercise training alone in non-sprint-trained individuals. A longer trial period may be required to evaluate effect on recovery more conclusively. In addition, the prime importance of physical conditioning, and in particular task-specific exercise training, in stimulating performance and recovery adaptations is highlighted. South African Journal of Sports Medicine Vol. 18 (4) 2006: pp. 136-140

Response of some head and neck cancers to epidermal growth factor receptor tyrosine kinase inhibitors may be linked to mutation of ERBB2 rather than EGFR

PURPOSE

Small-molecule tyrosine kinase inhibitors (TKI) of the epidermal growth factor receptor (EGFR) have shown modest yet reproducible response rates in patients with squamous cell carcinoma of the head and neck (SCCHN). Somatic mutations in EGFR have recently been shown to be predictive of a clinical response in patients with non-small cell lung cancer (NSCLC) treated with these inhibitors. The objective of this study was to determine if such mutations, or recently reported mutations in ERBB2, also underlie EGFR-TKI responsiveness in SCCHN patients.

EXPERIMENTAL DESIGN

We sequenced the kinase domain of EGFR and exon 20 of ERBB2 in tumor specimens from eight responsive patients. In addition, mutational analysis was done on tumor specimens from nine gefitinib nonresponders and 65 unselected cases of SCCHN.

RESULTS

None of eight TKI-responsive specimens had mutations within the kinase domain of EGFR. EGFR amplification was also not associated with drug responsiveness. However, a single responsive case had a somatic missense mutation within exon 20 of ERBB2.

CONCLUSION

Our data indicate that unlike NSCLC, EGFR kinase mutations are rare in unselected cases of SCCHN within the United States and are not linked to gefitinib or erlotinib responses in SCCHN. Alternative mechanisms, including ERBB2 mutations, may underlie responsiveness in this tumor type.

First Report of Sclerotinia Blight Caused by Sclerotinia sclerotiorum on Peanut in Georgia

Sclerotinia blight is one of the most economically important diseases of peanut (Arachis hypogaea L.) in Oklahoma and Virginia. Yield losses of 10% are common in these areas; however, losses may exceed 50% in highly infested fields (1). While Sclerotinia minor is considered the primary causal agent, S. sclerotiorum may also incite the disease. Symptoms typically appear late in the season and are favored by cool temperatures and high relative humidity (RH). Initial symptoms include wilting and yellowing of main or lateral branches. Dense mats of white mycelium develop on diseased areas, and small water-soaked lesions are apparent near the soil line. Lesions become bleached and infected tissues have a shredded appearance. Sclerotia are produced on and inside infected plant parts (2). During October 2004, following a period of heavy rainfall and cool temperatures, peanut plants (cv. Tifrunner) with these symptoms were observed in a field near Surrency, GA. The field had been planted to cotton (Gossypium hirsutum L.) for many years and peanut was strip-tilled into a heavy rye (Secale cereale L.) cover. Disease foci were found throughout the field and final incidence was 20%. Stem sections were surface disinfested in 0.5% sodium hypochlorite for 1 min and plated on potato dextrose agar (PDA). Cultures of S. sclerotiorum (2) were recovered after incubation at 20°C for 2 weeks. Pathogenicity tests were conducted by inoculating wounded peanut mainstems with PDA plugs either with or without the fungus. Inoculation sites were wrapped with moistened cheesecloth, and plants were incubated in a dew chamber at 20°C and 95% RH. There were a total of four replications and the experiment was repeated once. Symptoms consistent with those observed in the field appeared after 3 days and lesion lengths were measured after 5 days. Average lesion lengths were 1.4 and 1.6 cm for cvs. Georgia Green and Tifrunner, respectively Controls remained symptomless. Sections of symptomatic tissue were plated on PDA, and S. sclerotiorum was reisolated from 100% of symptomatic tissue. Although S. sclerotiorum is a common pathogen of various winter crops and weeds found in the southeast, to our knowledge, this is a first report of Sclerotinia blight on peanut in the region. No other occurrences of the disease have been reported since the initial discovery; however, potential losses could be incurred if peanuts are planted in infested fields and harvest is delayed. References: (1) H. A. Melouk and P. A. Backman. Management of soilborne fungal pathogens. Pages 75-85 in: Peanut Health Management. H. A. Melouk and F. M. Shokes, eds. The American Phytopathologicial Society, St. Paul, MN, 1995. (2) D. M. Porter and H. A. Melouk. Sclerotinia blight. Pages 34-36 in: Compendium of Peanut Diseases. 2nd ed. N. Kokalis-Burelle et al., eds. The American Phytopathologicial Society, St. Paul, MN, 1997.

Phase I trial and pharmacokinetics of escalating doses of paclitaxel and concurrent hyperfractionated radiotherapy with or without amifostine in patients with advanced head and neck carcinoma

BACKGROUND

Amifostine was developed to protect normal tissues from radiation exposure. The current study was undertaken to determine whether amifostine would allow the delivery of greater numbers of weekly paclitaxel treatments with concomitant, hyperfractionated radiotherapy in patients with advanced head and neck carcinoma.

METHODS

Patients received radiation therapy twice daily using 1.6-gray (Gy) fractions up to a total of 70.4 Gy over an elapsed time of 6.5 weeks. All patients received paclitaxel 60 mg/m(2) once weekly starting on Day 1. The number of doses of paclitaxel was escalated from three to a maximum of six in groups of three patients. For the patients who received amifostine, a dose of 400 mg/m(2) was given intravenously over 15 minutes on Days 1-5, 8, 29-33, and 36. Patients underwent surgery for persistent tumor after radiotherapy. The plasma pharmacokinetics of paclitaxel were characterized during treatment with the first weekly dose to determine the effect of concurrently administered amifostine.

RESULTS

Thirty-six patients were evaluable for this study. In the absence of amifostine, a maximum of four doses of paclitaxel were tolerated in combination with the radiotherapy. With amifostine, up to five doses of paclitaxel could be given. Generally, the treatment resulted in Grade 2 and 3 stomatitis. Overall, 69% of patients had a complete remission, and 29% had a partial remission. Both progression-free survival and overall survival were 66% at 30 months. Amifostine had no effect on the pharmacokinetics of paclitaxel.

CONCLUSIONS

The administration of amifostine allowed the authors to give an additional dose of paclitaxel to patients who were undergoing hyperfractionated radiotherapy for head and neck carcinoma. This treatment regimen resulted in a high frequency of complete remissions and an excellent progression-free survival pattern without compromising the plasma kinetics of paclitaxel.

First Report of Botrytis Blight of Peanut Caused by Botrytis cinerea in Georgia

Because of the importance of spotted wilt caused by Tomato spotted wilt virus (TSWV), most peanut (Arachis hypogaea L.) breeding programs in the southeastern United States are focusing on developing resistance to TSWV. Many of the cultivars with improved resistance to TSWV are late maturing, requiring 150 days to reach optimum maturity. This factor could greatly impact disease problems at harvest. During November of 2004, an unknown disease was observed on peanut cvs. Georgia 02-C and Hull in a commercial field in Appling County. Symptoms included wilting stems with water-soaked lesions and a dense, gray mold growing on infected tissues. Final disease incidence was less than 5%. For isolation, diseased tissue was surface sterilized by soaking in 0.5% sodium hypochlorite for 1 min, air dried, plated on potato dextrose agar (PDA), and incubated at 20°C. Botrytis cinerea Pers.:Fr., causal agent of Botrytis blight, was isolated from the margins of infected tissue. Mycelia were initially white but became gray after 72 h at which time tall, branched, septate conidiophores formed. Mature, unicellular, ellipsoid, hyaline conidia (8.9 × 10.4 μm) formed in botryose heads (1). Hard, black, irregular-shaped sclerotia formed after 2 weeks. Stems of greenhouse-grown peanut plants (cv. Georgia Green) were inoculated with PDA plugs colonized with either B. cinerea or B. allii Munn. Inoculations were made 3 cm below the last fully expanded leaf on wounded and nonwounded tissue. Noncolonized PDA plugs served as controls (n = 9). Plants were arranged in a dew chamber at 20°C in a randomized complete block design. Lesions and spore masses identical to those observed in the field appeared 3 to 5 days after being inoculated with B. cinerea. The B. allii inoculations caused only superficial lesions. After 5 days, mean lesion lengths for B. cinerea were 59 and 37 mm for wounded and nonwounded inoculations, respectively. B. cinerea was recovered from 100% of the symptomatic tissues. Botrytis blight is considered a late-season disease that occurs in cool, wet weather (3). Symptoms similar to those of Botrytis blight were observed on mature and over-mature peanut in Georgia and have been cited as "unpublished observations" (2); however, to our knowledge, this is the first report of the disease in Georgia. Although Botrytis blight is not considered a major peanut disease, it may become more prevalent at harvest as producers utilize late-maturing cultivars to manage spotted wilt. References: (1) H. L. Barnett and B. B. Hunter. Illustrated Guide of Imperfect Fungi. 4th ed. The American Phytopathological Society, St. Paul, MN, 1998. (2) K. H. Garren and C. Wilson. Peanut Diseases. Pages 262-333 in: The Peanut, the Unpredictable Legume. The National Fertilizer Assoc. Washington D.C. 1951. (3) D. M. Porter. Botrytis blight. Pages 10-11 in: Compendium of Peanut Diseases. 2nd ed. N. Kokalis-Burelle et al., eds. The American Phytopathological Society, St. Paul, MN. 1997.

Definitive radiotherapy with interstitial implant boost for squamous cell carcinoma of the tongue base

BACKGROUND

The purpose of this study was to examine the long-term outcome of a cohort of patients with unresected base of tongue carcinoma who received interstitial brachytherapy after comprehensive external beam radiation therapy.

METHODS

Between 1983 and 2000, 122 patients with primary or recurrent squamous cell carcinoma of the oropharynx or oral cavity received interstitial brachytherapy as part of their overall management. Forty patients had primary, unresected carcinoma of the base of tongue and are the subjects of this analysis. The median age was 54 years. Fifty-four percent had T3 or T4 disease, and 70% had clinical or radiographic lymphadenopathy. Twenty-four (60%) received two to three cycles of neoadjuvant chemotherapy. The oropharynx, bilateral neck, and supraclavicular fossae were comprehensively irradiated, and the tongue base received a median external beam dose of 61.2 Gy (50-72 Gy). The primary site was then boosted with an interstitial 192Iridium implant by use of a gold-button single-strand technique and three-dimensional treatment planning. The dose rate was prescribed at 0.4 to 0.5 Gy/hr. The median implant dose was 17.4 Gy (9.6-24 Gy) and adjusted to reach a total dose to the primary tumor of 80 Gy. N2 to 3 disease was managed by a planned neck dissection performed at the time of the implant.

RESULTS

The median follow-up for all patients was 56 months, and the overall survival rates were 62% at 5 years and 27% at 10 years. The actuarial primary site control was 78% at 5 years and 70% at 10 years. The overall survival and primary site control were independent of T classification, N status, or overall stage. Systemic therapy was associated with an improvement in overall survival (p = .04) and a trend toward increased primary site control with greater clinical response. There were seven documented late effects, the most frequent being grade 3 osteonecrosis (n = 2), grade 2 swallowing dysfunction (n = 2), trismus (n = 2), and chronic throat pain (n = 1).

CONCLUSIONS

In an era of greatly improved dose distributions made possible by three-dimensional treatment planning and intensity-modulated radiation therapy, brachytherapy allows a highly conformal dose to be delivered in sites such as the oropharynx. If done properly, the procedure is safe and delivers a dose that is higher than what can be achieved by external beam radiation alone with the expected biologic advantages. The long-term data presented here support an approach of treating advanced tongue base lesions that includes interstitial brachytherapy as part of the overall management plan. This approach has led to a 78% rate of organ preservation at 5 years, with a 5% incidence of significant late morbidity (osteonecrosis) that has required medical management.

Dosimetric characteristics of the new RadioCoil™ Pd103 wire line source for use in permanent brachytherapy implants

Recently, a novel linear brachytherapy source in the form of a coiled wire has become available for use in interstitial implants of various treatment sites such as prostate gland. This source type employs a design completely different from that of most "seed" sources currently on the market, one which improves upon or eliminates several common problems with such sources. Dosimetric characteristics of these sources with active lengths 0.5 cm to 5.0 cm were determined for clinical application. For 0.5 cm and 1.0 cm active length sources, the dose rate constant, radial dose function, and two-dimensional (2D) anisotropy function were experimentally and theoretically determined following the updated AAPM Task Group 43 (TG-43U1) recommendations. Radial dose functions and/or "along-away" matrix functions were also obtained for sources with active lengths 2.0 cm to 5.0 cm. Measurements were performed with LiF thermoluminescent dosimeters in Solid Water phantoms. Measured data was compared to Monte Carlo simulated data in Solid Water utilizing the PTRAN code, version 7.43. After finding the data to be in agreement, Monte Carlo calculations were performed in liquid water to obtain clinically applicable dosimetric data as per TG-43U1 recommendations. The results indicated the dose rate constant of the 0.5 cm long RadioCoil 103Pd source in Solid Water to be 0.641 cGy h(-1) U(-1) when measured, and 0.636 cGy h(-1) U(-1) when simulated by Monte Carlo. The calculated dose rate constant in liquid water was found to be 0.650 cGy h(-1) U(-1). These values are comparable to other commercially available sources. Complete dosimetric data and simulation results are described in this paper. Per TG-43U1, clinical treatment planning systems should utilize the values reported for liquid water.

Prospective Phase II Trial of PFL-Induction Chemotherapy Followed by Definitive Local Treatment for Advanced Squamous Cell Carcinoma of the Head and Neck

Reported is an analysis of overall survival at 10 years of 102 patients with advanced squamous cell carcinoma of the head and neck (SCCHN) who were enrolled in a prospective phase II trial of high-dose cisplatin, 5-fluorouracil (5-FU), and high-dose leucovorin (PFL) induction chemotherapy followed by surgery and/or definitive radiation therapy (RT) between 1987 and 1991. Initially, 14 patients underwent primary site (PS) and neck surgery irrespective of the clinical response to PFL. The high rate of clinical and pathologic complete response (CR) to PFL prompted a switch from PS surgery to definitive RT. Of 102 patients, 18 (17.6%) who completed PFL and local-regional treatment for SCCHN between 1988 to 1991 were alive in December 2000. Among these, 1 of 14 patients (7%) who had undergone PS resection and 17 of 85 (20%) who were treated after PFL with definitive RT but without PS surgery were alive at 10 years. Median survival time was higher in the nonsurgical group (98.9 vs. 51.9 months). Subset analysis suggested that patients with oropharyngeal PS had the longest median survival (108.6 months). The oropharyngeal patients represented the 61% (11/18) of the long-term survivors with organ preservation. An organ preservation approach for patients with advanced SCCHN who demonstrated PS CR to chemotherapy demonstrated a trend to improved overall survival.

The Kenneth B. Schwartz Center at Massachusetts General Hospital Hematology‐Oncology Department: Hope for the Homeless

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded the Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient and support to caregivers and encourages the healing process. The Center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum during which caregivers discuss a specific cancer patient, reflect on the important psychological issues faced by patients, their families, and their caregivers, and gain insight and support from their fellow staff members. A homeless man with head and neck cancer presents to the emergency room: a sad and familiar story. But this story is redeemed by his 35-year friendship with a priest, a man whose unconditional love and support became critical to the patient's care and treatment. The patient had lived for 30 years in homeless shelters, had problems with alcohol abuse, and was notoriously noncompliant with medical caregivers. He could not speak due to his disease, was illiterate with limited intellectual capacity, and had neither a job nor a family. Despite huge and apparently insurmountable problems for the patient, the oncology team was able to carve out a package of care, successfully communicate, and mobilize a support network to allow successful completion of chemoradiation therapy. The team developed a strong commitment to his care and an affectionate bond, which very positively affected all of those involved. We discuss issues of access to cancer care, and the special problems presented by homeless patients.

Tobacco use and degenerative joint disease of the spine

PURPOSE

To examine differences between tobacco users and nonusers who required surgical treatment for degenerative joint disease (DJD) of the spine.

DATA SOURCES

Two hundred randomly selected medical records of patients who had undergone surgery for DJD of the spine.

CONCLUSIONS

The number of tobacco users in the sample was significantly higher than the number of tobacco users in the general population, indicating greater incidence of DJD among tobacco users. The study demonstrated significant differences between tobacco users and nonusers regarding age, gender, type of occupation, number of imaging studies to diagnosis, and needs for pain management.

IMPLICATIONS FOR PRACTICE

Nurse practitioners who deal with education and treatment of patients at risk for spinal degenerative joint disease must consider tobacco use as a significant factor, especially regarding diagnostic studies and pain management.

An in vivo and ex vivo study to evaluate the use of a glass polyphosphonate cement in orthodontic banding

The purpose of this study was to examine the effectiveness of a new glass polyphosphonate cement (Diamond) for orthodontic banding. Thirty-one subjects underwent in vivo testing to compare the failure rate of bands cemented using the test cement and bands cemented using a conventional glass polyalkenoate cement (Ketac-Cem) over a 6-month period at the beginning of active appliance therapy. In an ex vivo experiment 60 extracted teeth were banded using either the test cement or a glass polyalkenoate cement, and subjected to a debanding force using a Lloyd universal testing machine until failure. In the in vivo study the overall proportion of failure of the bands cemented with each cement was identical at 0.048. However, in the ex vivo study the probability of failure for the glass polyphosphonate cement was significantly higher than for the glass polyalkenoate cement, and the force to deband the glass polyalkenoate cement was greater than that of the glass polyphosphonate cement. In the clinical setting the new glass polyphosphonate cement performed as well as a conventional glass polyalkenoate cement, and these results suggest that it could be used as an alternative cement for orthodontic banding. The results of the ex vivo test bring into question the usefulness of this laboratory test as an indicator of clinical performance.

Gastroduodenal ulceration following hepatic arterial chemotherapy: the role of methylene blue endoscopy in the investigation of pain

BACKGROUND

Unintended perfusion of the gastroduodenum may complicate hepatic arterial chemotherapy leading to mucosal ulceration.

PATIENTS AND METHODS

In a review of 233 consecutive hepatic artery catheters placed, 61 patients were investigated for chemotherapy-related epigastric pain. Investigations included catheter imaging, upper gastrointestinal endoscopy with methylene blue injection via the hepatic artery catheter and angiography.

RESULTS

Twenty patients (33%) demonstrated blue staining of the gastroduodenum. Angiography performed in 15 of these patients confirmed a misperfusing vessel in 13.The aberrant artery was successfully embolised and infusional chemotherapy recommenced in 11 patients. Forty-one patients had a negative dye test, of whom three had gastroduodenal ulcers, 14 had oesophagitis or gastroduodenitis, ten had catheter complications (leak n=2, arteritis n=5, pseudoaneurysm n=1, sepsis n=1), three had liver collections, five had floxuridine cholangitis and one had myocardial ischaemia. No cause could be found in 8 patients. No patient with a negative dye test developed unintended perfusion on repeat investigation.

Functional occlusion: II. The role of articulators in orthodontics

Opinion is divided on whether there is a place for the use of semi-adjustable dental articulators in orthodontics. In this review we explore the validity and reproducibility of the techniques involved in mounting study models on a semi-adjustable dental articulator. We also look at the role of articulated study models in orthodontic diagnosis and treatment planning, in the finishing stages of orthodontics and in planning for orthognathic surgery. We report that each of the many stages involved in mounting study models on a semi-adjustable articulator is a potential source of error and that only if the technique is carried out with a high degree of accuracy is it worth the additional chairside time.

Cirrhosis and laparoscopic cholecystectomy

Although cirrhosis has been regarded as a contraindication to laparoscopic cholecystectomy, there is increasing evidence that patients with mild to moderate cirrhosis may safely undergo laparoscopic cholecystectomy with results superior to those of open cholecystectomy. A prospective evaluation and comparison of outcome in 25 consecutive patients with cirrhosis and 1275 patients without cirrhosis undergoing laparoscopic cholecystectomy was undertaken. Fourteen patients with Child's A cirrhosis, nine with Child's B, and two with Child's C underwent laparoscopic cholecystectomy. After surgery, one patient with Child's C cirrhosis died. The median length of stay was 4 days. Postoperative morbidity occurred in 52% of patients and included hemorrhage (8%), thromboembolism (4%), wound complications (24%), intraabdominal collections (12%), and cardiopulmonary complications (8%). Major comorbidity was present in 60% of patients and contributed to complication rate and prolonged stay. Hemorrhage (P = 0.04) and wound complications (P = 0.02) occurred more frequently in patients with cirrhosis than in patients without cirrhosis. Laparoscopic cholecystectomy in patients with cirrhosis is associated with significant but acceptable morbidity and mortality rates, and complications are frequently related to comorbid conditions.

Comparison of the protective effects against chronic doxorubicin cardiotoxicity and the rates of iron (III) displacement reactions of ICRF-187 and other bisdiketopiperazines

Histologic and biochemical studies were carried out to compare the protective activity of various bisdiketopiperazines against the cardiac and renal toxicity induced by doxorubicin in spontaneously hypertensive rats (SHR), a well-established animal model of this disorder, with: (1) the rates of hydrolysis of these agents to form the iron-chelating derivatives (which are considered to cause a decrease in the formation of reactive oxygen intermediates) and (2) the ability of these derivatives to bind iron. SHR were given 12 weekly injections of doxorubicin, 1 mg/kg i.v. either alone or 30 min after the administration of ICRF-154, ICRF-187, ICRF-192, ICRF-197, ICRF-198, ICRF-239 and ADR-559. Semiquantitative grading of the severity of the resulting cardiac and renal lesions showed that ICRF-187, ICRF-154 and ADR-559 were the most protective, whereas ICRF-197 and ICRF-239 provided intermediate degrees of protection, and ICRF-192 and ICRF-198 were not protective. Quantitative measurements in vitro revealed only relatively small differences in the rates of opening of the two diketopiperazine rings of the various agents to form the corresponding iron-chelating diacid diamide derivatives, and in the ability of these various derivatives to remove iron from the iron-doxorubicin complex. Such differences showed no relationship with cardioprotective activity. Some bisdiketopiperazines (including ICRF-154 and ICRF-187) with cardioprotective activity also are inhibitors of DNA topoisomerase II; however, the significance of this relationship remains uncertain, since ADR-925, the open-ring derivative of ICRF-187, does not inhibit DNA topoisomerase II.

Functional occlusion: I. A review

The features that constitute an "ideal" functional occlusion have not been conclusively established. Orthodontic treatment has the capacity to change static and functional occlusal relationships fundamentally. In this article, we present the evidence on which features of the occlusion are reported to be detrimental to the teeth and masticatory system Deficiencies in this research area are highlighted, together with the need for prospective longitudinal trials to clarify the requirements of an ideal functional occlusion Based on the existing evidence this paper suggests which occlusal features may be significant in producing an "ideal" functional occlusion As no long-term studies exist to measure the impact of non-ideal occlusal relationships on the dentition, it is debatable whether orthodontic treatment should be prolonged in order to ensure that "ideal" occlusal contacts are achieved As the occlusion tends to "settle" in the period following appliance removal, we propose that it may be more appropriate to examine the functional occlusal relationships after retention has ceased rather than prolong active orthodontic treatment to achieve "ideal" functional occlusal goals.

The use of outdoor freshwater pond microcosms. III. Responses of phytoplankton and periphyton to pyridaben

An outdoor freshwater microcosm study was conducted in which pyridaben, an insecticide-miticide, was directly applied to water to determine its biological effects on phytoplankton and periphyton. Twenty-four microcosms (24 m3 each) were monitored for 11 months, then four treatments of pyridaben were applied two times at three concentrations (0.34, 3.4, 34.0 micrograms/L), including an untreated control. The succession of algal groups observed and the major genera found in microcosms during the baseline phase of the study were typical of oligo-mesotrophic systems in Florida. Following application of pyridaben, the most remarkable effect was a positive correlation of phytoplankton abundance with pyridaben concentrations in water; indicating increased abundance as a result of exposure. Both Chlorophyta and Pyrrophyta exhibited a significant increase (p = 0.05) in population abundance at 3.4 and 34.0 micrograms/L pyridaben. Chrysophyta also elicited a trend of increased abundance at 34.0 micrograms/L, although the effect was not significant. The effects on phytoplankton populations were associated with the decline of zooplankton populations as a result of a direct effect of pyridaben exposure. There were no effects of pyridaben on periphyton communities or on functional endpoints.

Aquatic toxicity of two Corexit dispersants

The oil spill dispersants, Corexit 9500 and Corexit 9527 have low to moderate toxicity to most aquatic species in laboratory tests. Toxicity estimates are significantly affected by test variables such as species, lifestage, exposure duration, and temperature. Aquatic toxicity data generated from spiked, declining exposures (107 min half-life) are more reflective of actual dispersant use conditions. Decisions to use oil spill response chemicals should not be based solely on aquatic toxicity. Factors to consider include product effectiveness, toxicity of dispersed oil, species/habitats requiring priority protection, and recovery potential of sensitive habitats and populations. An environmental risk assessment approach is recommended where dispersant toxicity data generated under environmentally relevant exposures are compared to estimated environmental concentrations of dispersants.