Determining the cost of tuberculosis case management in a low-incidence state

OBJECTIVE

To establish the average cost per patient of nurse case management for tuberculosis (TB) in Oregon State and so facilitate estimates of the overall cost of TB treatment. TB treatment is currently funded by a combination of local, state and federal public health dollars.

DESIGN

A longitudinal survey was used to assess the amount of case management time patients required per week. Additional patient information was collected from public health records. Mixed effects modeling techniques were used to identify important factors associated with case management time and to make predictions.

RESULTS

The following variables were significantly associated with case management time: non-adherence to treatment, the use of incentives, the phase of treatment and the presence of complicating factors, including human immunodeficiency virus infection, antibiotic resistance, homelessness and adverse reaction to drugs. The mean case management cost was $4831 per patient for a standard 28-week treatment course, and ranged from $3386 for a simple case to $7542 for a case with multiple complications.

CONCLUSIONS

These estimates are substantially higher than the current state funding for case management. Using these data, health officials can make better informed budget decisions and provide more appropriate support for TB control.

Systems biology of the neurospora biological clock

A major challenge of systems biology is explaining complex traits, such as the biological clock, in terms of the kinetics of macromolecules. The clock poses at least four challenges for systems biology: (i) identifying the genetic network to explain the clock mechanism quantitatively; (ii) specifying the clock's functional connection to a thousand or more genes and their products in the genome; (iii) explaining the clock's response to light and other environmental cues; and (iv) explaining how the clock's genetic network evolves. Here, the authors illustrate an approach to these problems by fitting an ensemble of genetic networks to microarray data derived from oligonucleotide arrays with approximately all 11 000 Neurospora crassa genes represented. A promising genetic network for the clock mechanism is identified.

Prohibitin interacts with RNF2 and regulates E2F1 function via dual pathways

Prohibitin, a tumor suppresser protein, plays an important role in the transcriptional regulation of various genes involved in cell-cycle control and proliferation. Recent studies have reported that the growth-suppressive property of the prohibitin protein is exhibited in its physical interaction with E2F family proteins and its subsequent repression of their transcriptional activity. Herein, we report that prohibitin interacts with RING finger protein 2 (RNF2), a member of the PcG (polycomb-group) family of proteins, and that the two proteins regulate the activity of E2F1 via dual pathways: the direct, prohibitin-mediated pathway and the indirect, p16-mediated pathway of E2F1 transcriptional regulation. Co-immunoprecipitation experiments showed that endogenous prohibitin interacts with endogenous RNF2. Interestingly, the expressed amounts of RNF2 and prohibitin were interdependently affected at the post-translational level. Furthermore, the depletion of either endogenous RNF2 or prohibitin using the RNA interference technique increased the level of p16 protein expression, resulting in a decrease in the transcriptional activity of E2F1 via the p16-CDK4-Rb pathway. In addition, chromatin immunoprecipitation assays showed that RNF2 was recruited to E2F1-response promoters along with prohibitin to inhibit the transcriptional activity of E2F1. Cell proliferation was also regulated by the prohibitin-RNF2 interaction. These results suggest that the RNF2-prohibitin complex regulates the activity of E2F1 via dual pathways.

Hepatic intra-arterial injection of 3-bromopyruvate in rabbit VX2 tumor

PURPOSE

To evaluate the antitumoral effects of an intra-arterial injection of 3-bromopyruvate (3-BrPA) on liver VX2 tumor in rabbits.

MATERIAL AND METHODS

Twenty rabbits with surgically implanted liver VX2 tumors were used. The rabbits were divided into three groups: a control, a saline, and a 3-BrPA group. Four rabbits were not treated at all, and they served as the control group. The saline group (n = 6) received only intra-arterial saline injection. The 3-BrPA group (n = 10) received an intra-arterial injection of 3-bromopyruvate through the hepatic artery. The delivered amounts of 3-bromopyruvate were as follows: 25 ml of 0.5 mM in six rabbits, 25 ml of 1.0 mM in two rabbits, and 25 ml of 2.0 mM in two rabbits. Four days after intra-arterial injection, the rabbits were sacrificed and histopathologic analysis of the explanted livers was performed with comparison of the tumor necrosis ratio (a percentage of the necrotic area versus the entire tumorous area) in each group.

RESULTS

The mean tumor necrosis ratio was 12.5+/-4.2%, 44.8+/-24.7%, and 49.4+/-14.3% in the control, saline, and 3-BrPA groups, respectively. Between the control and the saline group, and between the control and the 3-BrPA group the mean tumor necrosis ratio appeared to be significantly different (P<0.05). However, there was no statistical difference in the mean tumor necrosis ratio between the saline and the 3-BrPA group (P = 0.416).

CONCLUSION

A single session of intra-arterial injection of 3-BrPA showed no better results in terms of tumor necrosis than that of saline injection in a rabbit VX2 tumor model.

Transport of living cells with magnetically assembled nanowires

We present a technique of transporting and positioning living cells internalized by nickel (Ni) nanowires guided by magnetic field. Nanoscale magnetic nanowires are internalized by the Rat Neuroblastoma (ATCC number CRL-2754) and the cells are transported and positioned by magnetic fields from the magnetic material-coated electrodes. This technique may enable the interfacing between neurons and electronic devices to empower investigations pertaining to non-invasive neuron probing as well as nanofabricated neural pharmacological technologies.

Tissue factor serum levels and the risk of future coronary artery disease in apparently healthy men and women: the EPIC-Norfolk prospective population study

INTRODUCTION

Tissue factor (TF) has been implicated in coronary artery disease (CAD). High levels of circulating TF are found in patients with acute atherothrombotic events. Whether high serum TF levels predict risk of future CAD independent of known risk factors remains unknown.

METHODS

We conducted a prospective case-control study nested in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk population study. Cases (n=1037) were apparently healthy men and women, aged 45-79 years, who developed fatal or non-fatal CAD during follow-up. Controls (n=2005) were matched by age, sex, and enrolment time. Serum TF levels were measured using high-affinity antibodies.

RESULTS

In men, median TF levels were not significant higher in cases than in controls (59.0 pg mL-1, range: 16.7-370.4 vs. 54.9 pg mL-1, range: 16.2-452.4). In women, median TF levels were not significant higher in controls than in cases (73.4 pg mL-1, range: 16.7-492.3 vs. 50.5 pg mL-1, range: 16.5-376.7). The incidence of smoking was about double in the lowest compared with the highest TF quartile. Correcting for sex, age, body mass index, smoking, diabetes, systolic blood pressure, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol and C-reactive protein levels, the risk of future CAD was 1.05 (95% CI: 0.81-1.36) for people in the highest TF quartile, compared with those in the lowest (P-value for linearity=0.8).

CONCLUSION

High levels of serum TF were not independently associated with an increased risk of future CAD in apparently healthy individuals.

Age is not a prognostic factor in Korean women with breast cancer treated with breast conservative surgery and radiotherapy

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Background: The median age of the breast cancer at diagnosis in Korean women is 45 years and a quarter of the patients are at age 40 or younger. The purpose of this study was to analyze the prognostic factors including age for patients treated with breast conserving surgery and radiotherapy. Methods: Two hundred and eleven breast cancer patients were treated with breast conserving therapy at Soonchunhyang University Hospital, Seoul, Korea, between May 1991 and May 2003. The radiation dose to the whole breast was 50.4 Gy over 5 weeks and boost doses of 10–14 Gy administered to the tumor bed in the majority of the patients (180/211). Nodal radiotherapy was delivered in patients with 4 or more node metastasis. Adjuvant chemotherapy was performed in most of the patients with node metastasis or tumors larger than 1cm, or younger patients. One hundred and thirty four patients received CMF regimen, 14 patients treated with CEF regimen. The median and minimum follow-up periods were 58 and 30 months respectively. Results: The average age at the time of operation was 41.9 years (median 42 years, range 23–67 years), and the mean tumor size was 2.03 cm (median 1.80 cm). One hundred and forty seven patients (69.7%) had pathologically node negative disease and fifteen patients had 4 or more lymph node metastasis. Local, regional relapse and distant metastasis occurred in 7, 3 and 10 patients respectively. The 5 year disease free, loco-regional relapse free and overall survival rate were 89.5%, 93.4%, 95.6%, respectively. Three patients among the 31 patients who received 50.4Gy or incomplete radiotherapy to the breast experienced loco-regional relapse. Age (40 years or less versus more than 40 years old) was not a prognostic factor in univariate analysis. T stage (p = 0.027), lymph node metastasis (p < 0.01) were significant factors for recurrences. By multivariate analysis, only lymph node status was a significant prognostic factor for treatment related failure. Conclusions: A breast conserving procedure is effective for patients with early stage breast cancer regardless of age in Korean women. Axillary lymph node status was the most important independent predictor for a recurrence, and more efficient treatment is required for these patients with lymph node metastasis.

No significant financial relationships to disclose.

Exercise during late-follicular menstrual phase: influence on immune parameters

AIM

The purpose of this study was to examine whether training status and plasma hormones (estradiol--E2, progesterone--P, luteinizing hormone--LH, and follicle-stimulating hormone--FSH) have an effect on selected immune indexes during or following an acute bout of exercise.

METHODS

Seven female triathletes (TRI) and 7 recreationally active (REC) females were randomly assigned to rest (RE) and exercise (EX) trials during the late-follicular menstrual phase (LF). The EX was 1 hour of cycling at 63.1+/-6% VO2peak (TRI) and 61+/-5.1% VO2peak (REC) and RE was 1 hour of sitting. Blood was drawn for both trials at baseline (0H), 1 hour (1H), and at 3 hours (3H).

RESULTS

Positive correlations were found between E2 and CD19+ cells for both groups as well as P and CD8+ cells for the REC group. E2 increased during EX and returned to baseline at 3HEX for both groups, however, LH remained elevated at 3HEX for REC. There were significant exercise time effects for CD3+, CD4+, CD8+, and CD3- CD16+ CD56+ cells. The NCMC and 1:1 were elevated at 1HEX for both groups and returned to baseline by 3HEX. During RE, CD3- CD16+ CD56+ cell numbers for both groups and NCMC for REC remained elevated at 3HRE.

CONCLUSIONS

E2 and P correlated with CD19+ and CD8+ cells, respectively. Although there were transient exercise-induced changes in immune indexes and E2 and LH, with LH remaining elevated at 3HEX for REC, both training groups elicited similar responses for plasma hormones, lymphocyte subpopulations, and NCMC.

Exercise during late-follicular menstrual phase: influence on immune parameters

AIM

The purpose of this study was to examine whether training status and plasma hormones (estradiol--E2, progesterone--P, luteinizing hormone--LH, and follicle-stimulating hormone--FSH) have an effect on selected immune indexes during or following an acute bout of exercise.

METHODS

Seven female triathletes (TRI) and 7 recreationally active (REC) females were randomly assigned to rest (RE) and exercise (EX) trials during the late-follicular menstrual phase (LF). The EX was 1 hour of cycling at 63.1+/-6% VO2peak (TRI) and 61+/-5.1% VO2peak (REC) and RE was 1 hour of sitting. Blood was drawn for both trials at baseline (0H), 1 hour (1H), and at 3 hours (3H).

RESULTS

Positive correlations were found between E2 and CD19+ cells for both groups as well as P and CD8+ cells for the REC group. E2 increased during EX and returned to baseline at 3HEX for both groups, however, LH remained elevated at 3HEX for REC. There were significant exercise time effects for CD3+, CD4+, CD8+, and CD3- CD16+ CD56+ cells. The NCMC and 1:1 were elevated at 1HEX for both groups and returned to baseline by 3HEX. During RE, CD3- CD16+ CD56+ cell numbers for both groups and NCMC for REC remained elevated at 3HRE.

CONCLUSIONS

E2 and P correlated with CD19+ and CD8+ cells, respectively. Although there were transient exercise-induced changes in immune indexes and E2 and LH, with LH remaining elevated at 3HEX for REC, both training groups elicited similar responses for plasma hormones, lymphocyte subpopulations, and NCMC.

Ultrasonographic detection of hepatocellular carcinoma: correlation of preoperative ultrasonography and resected liver pathology

AIM

The aim of this study was to determine the sensitivity of ultrasonography for detecting hepatocellular carcinoma in patients who underwent surgical liver resection.

MATERIALS AND METHODS

The preoperative ultrasonography reports of 103 patients who underwent hepatic resection surgery were retrospectively reviewed. The patients had chronic liver disease with good liver function and a relatively normal liver echo-texture. The presence of a mass or masses in the resected part of the liver segments on preoperative ultrasonography was regarded as possible hepatocellular carcinoma, and these results were compared with the surgically resected hepatic lobes or segments. Accuracy for detection was assessed on a lesion-by-lesion basis, on a segment-by-segment basis, and on a patient basis.

RESULTS

One hundred and fifty-seven hepatocellular carcinomas were found in 244 hepatic segments of 103 patients. One hundred and one of 157 hepatocellular carcinomas were detected using ultrasonography in 97 patients resulting in a sensitivity of 64%. In six patients, a solitary hepatocellular carcinoma was missed in each patient, a patient sensitivity being 94%. Using ultrasonography, 87 of 100 (87%) hepatocellular carcinomas larger than 2 cm in diameter, and 14 of 57 (25%) hepatocellular carcinomas 2 cm or smaller in diameter were revealed. On the basis of segment-by-segment analysis, the sensitivity was 78% (99 of 127 segments), specificity was 97% (114 of 117 segments), accuracy was 87% (213 of 244 segments), positive predictive value was 97% (99 of 102 segments), and negative predictive value was 80% (114 of 142 segments).

CONCLUSION

In patients with chronic liver disease and good hepatic function, ultrasonography has a sensitivity of 94% in the identification of affected patients, but for individual lesions, the sensitivity is only 64%.

Post-interventional immunosuppressive treatment and vascular restenosis in Takayasu's arteritis

OBJECTIVE

To investigate the outcome of vascular interventions and the effect of post-interventional immunosuppressive treatment on the occurrence of vascular restenosis in patients with Takayasu's arteritis (TA).

METHODS

Forty-two patients with TA who had undergone vascular intervention and had serial angiographies before and after intervention were enrolled. The demographic and clinical data were collected at the time when the interventions were performed, and the intervention modalities and post-interventional medical treatments were evaluated.

RESULTS

Sixty-three interventions were performed in 42 patients. Twenty (31.7%) interventions restenosed 24.0 +/- 21.9 months after intervention; the likelihood decreasing as time passed. Estimates of arterial patency after intervention were 90.1% at 1 yr, 75.5% at 2 yr, 68.4% at 3 yr, 61.6% at 5 yr and 49.3% at 10 yr. According to the log rank test, interventions that were performed during the stable stage of the disease (P = 0.039) and those that were followed by treatment with glucocorticoids and immunosuppressive agents (P = 0.044) were independent variables for the maintenance of arterial patency. Their hazard ratios were 0.30 and 0.41, respectively.

CONCLUSION

Restenosis occurred in 31.7% of TA patients after intervention. A lower restenosis rate was observed when the vascular interventions were performed at the stable stage and when post-interventional immunosuppressive treatment was implemented.

Decreased insulin sensitivity is associated with the extent of coronary artery disease in patients with angina

BACKGROUND

Insulin resistance has been proposed as an important risk factor in the development of atherosclerosis.

AIM

To evaluate the association of insulin resistance and coronary atherosclerosis, we investigated the correlation between insulin sensitivity and the degree of coronary stenosis in patients with angina pectoris.

METHODS

The study population consisted of 74 subjects with angina (54 men and 20 women) aged from 31 to 73 years. Coronary angiograms were evaluated by three semiquantitative scoring systems (vessel score, stenosis score and extent score) to estimate the extent of focal and diffuse coronary artery disease (CAD). Insulin sensitivity (K(ITT)) was determined by the insulin tolerance test.

RESULTS

There were significant correlations existed between K(ITT) and all three coronary scores. Multivariate analysis revealed significant and independent correlations of all three coronary scores with K(ITT) (vessel score: beta = -0.349, p = 0.004; stenosis score: beta = -0.487, p < 0.001; extent score: beta = -0.481, p < 0.001), even in patients without diabetes mellitus (vessel score: beta = -0.387, p = 0.008; stenosis score: beta = -0.469, p < 0.001; extent score: beta = -0.559, p < 0.001). K(ITT) was significantly lower in patient with diffuse CAD than without diffuse CAD (2.13 +/- 0.66 vs. 2.57 +/- 0.79%/min, p < 0.05). However, K(ITT) was not different between patients with and without focal CAD.

CONCLUSIONS

Insulin sensitivity has statistically significant and independent associations with the extent of coronary stenosis. These results suggest that insulin resistance may play a major role in the development of diffuse coronary artery stenosis.