From legends to legacy: the impact of fan influence on retiring athletes in premier league basketball

Introduction

This research examines the perceived age of Premier League basketball players as they near retirement, focusing on the complex interplay between players, fans, and the media in shaping perceptions of age and retirement. The study highlights the unique pressure on the basketball players to retire due to age-related expectations, rooted in the perception that athleticism is age dependent.

Methods

The research methodology applied in this study involved conducting semi-structured interviews with a sample of 11 professional Israeli basketball players and two veteran players' agents.

Results

Three themes emerged: (1) Feelings of betrayal and ingratitude; (2) A farewell tour toward disengagement from one's professional career; and (3) The media's role in shaping beliefs and attitudes. These themes illustrate how the sports environment portrays aging players, shaping fan opinions, both positively and negatively. Significantly, the findings emphasize the challenges that players must confront within an ageist environment.

Discussion

The study concludes by highlighting the cultural and social construction at work. The "coercion" to retire from professional sports is more pronounced here due to the common belief that sports success is time-bound and age-dependent, necessitating a "young body". In this reality, the audience does not merely function as a backdrop for athletes' performances, but has the power, at the collective and the individual level, to affect change on and off the court.

Coaches' Mind Games: Harnessing Technical Fouls for Psychological Momentum in Basketball

This study explored the emotional and cognitive dimensions associated with technical fouls (TFs) in basketball coaching. Using in-depth interviews with Israeli first-division basketball coaches, we aimed to uncover the emotional and cognitive intricacies involved in TFs. Through rigorous thematic content analysis, we delved into coaches' ability to perceive and manipulate psychological momentum on the court. We revealed that coaches intentionally use TFs as strategic tools. TFs were employed to elicit specific emotional responses and cognitive shifts in players, affecting their emotional states, arousal levels, motivation, and overall team performance. However, coaches approached TFs with caution due to the associated emotional and cognitive risks. They carefully weighed potential benefits against unforeseen consequences in their decision-making. Furthermore, our research highlighted coaches' belief in the immediate positive impact of TFs on referee decisions, underscoring the interplay between emotional influence and strategic advantage. Nevertheless, this advantage was perceived as short-lived, emphasizing that TFs are a two-edged sword with unpredictable outcomes.

Passionate hearts, torn loyalties: navigating the interplay between fandom and romance

Introduction

The current study presents a thorough investigation of the attitudes and emotions expressed by the spouses and girlfriends of sports fans within the context of their long-term relationships. Its primary objective is to explore the potential ramifications that surface when individuals become deeply invested in a competitive sport, demonstrating intense emotional connections, broad knowledge, unwavering loyalty, and active engagement in fan-related activities.

Methods

The research methodology applied in this study involved conducting semi-structured interviews with a sample of twelve spouses and girlfriends of fans.

Results

The principal findings elucidate four distinct themes that shed light on the intersection of fandom and romantic relationships. These themes include: "that's what I signed up for"; "fandom as a gendered activity"; "the good, the bad, and the ugly"; and "sports fandom as an addiction."

Discussion

The study concludes by highlighting the crucial cultural context at work. The social criticism expressed by the interviewees toward non-traditional gender behaviors displayed by their partners serves as a cautionary message. These criticisms aim to preserve and uphold male dominance in sports, thereby reinforcing the notion of their unquestioned supremacy. Consequently, we argue that, within this context, latent aggressive behavior in men is perceived as a strategy to maintain their monopolistic control over sports domains.

Immunologic Heterogeneity in 2 Cartilage-Hair Hypoplasia Patients With a Distinct Clinical Course

BACKGROUND AND OBJECTIVE

Cartilage-hair hypoplasia (CHH) syndrome is a rare autosomal recessive syndrome associated with skeletal dysplasia, varying degrees of combined immunodeficiency (CID), short stature, hair hypoplasia, macrocytic anemia, increased risk of malignancies, and Hirschsprung disease. To provide clinical and immunological insights obtained from 2 unrelated patients who displayed clinical characteristics of CHH.

METHODS

Two patients with suspected CHH syndrome due to skeletal dysplasia and immunodeficiency underwent an immunological and genetic work-up using flow cytometry, next-generation sequencing (NGS) of the immune repertoire, and Sanger sequencing to identify the underlying defects.

RESULTS

Patient 1 presented with low birth weight and skeletal dysplasia. Newborn screening was suggestive of T-cell immunodeficiency, as T-cell receptor excision circle levels were undetectable. Both the T-cell receptor (TCR) Vß and TCR-g (TRG) repertoires were restricted, with evidence of clonal expansion. Genetic analysis identified compound heterozygous RMRP variants inherited from both parents. Patient 2 presented with recurrent lung and gastrointestinal infections, skeletal dysplasia, failure to thrive, and hepatomegaly. The polyclonal pattern of the TCRß repertoire was normal, with only slight overexpression of TCR-ßV20 and restricted expression of Vßs. TRG expressed a normal diverse repertoire, similar to that of the healthy control sample. Genetic analysis identified biallelic novel regulatory variants in RMRP. Both parents are carriers of this mutation.

CONCLUSION

Our findings demonstrate how the immunological work-up, supported by genetic findings, can dramatically change treatment and future outcome in patients with the same clinical syndrome.

“In your face”: The transition from physical to symbolic violence among NBA players

The NBA has undergone formative changes since commissioner David Stern began his tenure. Stern has endeavored to make the NBA a consumer-friendly and marketable league by implementing sanctions on physical violence. This study takes a closer look at Stern’s efforts by examining the interplay between two forms of violence in NBA basketball players on the court: “old fashioned” physical violence (PV) and symbolic violence (SV). Of the 117 NBA finals broadcast for twenty years from 1998 to 2018, a stratified random sample (36 games or 30.8%) of the violations and commentators’ comments were coded, providing a wide perspective on forms of violence over time. The findings reveal that although the number of PV incidents decreased, SV increased starting in 2014, to the extent that SV incidents were more frequent than PV. A thematic analysis of the commentators’ remarks associated with these incidents showed that they support and encourage PV, whereas SV tends to be perceived as harmless and therefore permissible to ignore. Unlike PV, SV is not perceived to be as worthy of media coverage. The relative lack of commentator interest is indicative of the lack of “glamour” of SV in the NBA league. It is suggested that since viewers of professional sports often emulate the players, the increase of SV within the NBA is likely to be mirrored in fans in their everyday lives and in amateur basketball players. Although the rise in SV causes fewer physical injuries in professional basketball players, it nevertheless can cause psychological harm.

Jinx, Control, and the Necessity of Adjustment: Superstitions Among Football Fans

Superstitions are behaviors human beings use to gain a sense of control over certain events in their lives. Thus, sport and its inherent uncertainty provide fertile ground for superstitious behavior. Research on this subject has focused mainly on athletes while examining the behavioral expressions, motivations, and characteristics of fans' superstitions that have remained marginal; therefore, the present paper aims to address this lacuna by analyzing these behaviors as part of sports fandom and fans' daily routines. Semi-structured interviews were carried out with 24 Israeli football fans of local teams. Key findings illustrate two themes: time dependent acts of superstition; and place. It is argued that superstitious behavior serves fans in two ways. First, making them feel their actions influence the match outcomes and helping their favorite team beyond simply cheering in the stands. Second, reducing the level of uncertainty and subsequent stress level characteristic of being a sports fan. Furthermore, following the outbreak of the COVID-19 pandemic when fans' access to stadiums was restricted, the results show that the fans' absence from the stadiums led to a reduction in the quantity and frequency of their superstitious behaviors, pointing to the significance of sporting venues in fan behavior.

Morality and Values in Sports Among Young Athletes: The Role of Sport Type and Parenting Styles - A Pilot Study

Given the great importance of morality and values in modern sports, especially among young athletes, in this pilot study, we sought to broaden the exploration of the factors that may play role in these contexts, which have not been widely researched to date. Accordingly, the study tested the relationships between sport type (team or individual) and parenting styles (authoritative vs. non-authoritative), and moral decision-making in sport and sport values among 110 adolescent athletes whose age ranges from 11 to 22 (M = 16.04, SD = 2.86). The findings indicated that participants with authoritative parents, as compared to those with non-authoritative parents, are significantly less accepting of cheating in sport, while they also tend more to keep winning in proportion and hold significantly stronger moral values toward sports. Moreover, participants whose main sport is a team sport type tend to accept more cheating and gamesmanship than participants whose main sport is an individualistic sport type. While no differences were recorded between these groups in moral values, team athletes tend to value status in sport more than individual athletes, while the latter tend to value competence regarding their sport. The implications of the findings are discussed in light of no interaction between the effects of parenting styles and sport type on moral and sport values.

No Cutting Corners: The Effect of Parental Involvement on Youth Basketball Players in Israel

This paper explores the nature of parental involvement in youth basketball in Israel with regard to parenting style and in the context of dilemmas and ethical issues. It is well established that parental involvement in their child's sporting activity has vast implications on the child's motivation and enjoyment. With reference to Israeli society, only a few studies have focused on this subject. In order to address this lacuna, we used two questionnaires, given to 173 youth basketball players (child questionnaire) and their parents (parent questionnaire). Key findings illustrate three main themes. First, a higher level of satisfaction and contentment among basketball players whose parents demonstrated greater involvement; second, that parental emotional involvement is the most important variable for young athletes' satisfaction; and finally, differences in gender roles reveal that fathers are more involved with logistics, while mothers are more dominant in emotional involvement. Moreover, the findings demonstrate that parents should mainly place emphasis on emotional involvement. However, we suggest that parents do not bypass logistical care as this may create opportunities for greater emotional support and therefore greater child satisfaction.

Deconstructing celebratory acts following goal scoring among elite professional football players

Goal celebration in sport is mostly spontaneous and is manifested via vocal expressions and bodily gestures aimed at communicating emotions. The aim of this study is to deconstruct the celebratory acts among elite professional football players in the European Champions League following scoring a goal, and to capture the multiple acts and functions of the celebrations. In examining the 2018/19 season of the European Champions League tournament, we draw attention to the players' celebrations and their corresponding social and individual functions. All goals/celebrations (K = 366) were used for the analyses. To analyze the goal celebration acts, a socio-psychological model was established which is comprised of several theories. To describe the goal celebration acts across the competition stages (e.g., preliminary and final), match location (i.e., home or away), time phase (0-15, 15-45, 45-75, 75-90, 90+ minutes), scoring mode (i.e., prior to the goal, after the goal), and players' continent origin (Europe, Africa, Asia, South/Central, and North America), the number and percent of all the celebratory acts were counted and presented in their respective mode (i.e., single, double, and team). The main findings indicate that (a) most of the goal celebration acts were performed interactively by the scoring player and his teammates, (b) the interactive modes of celebration lasted longer than the modes which were performed non-interactively, (c) the celebration lasted longer following goal scoring in the final stage than in the preliminary stage, (d) the celebration duration lasted the longest time when the goal was scored during the overtime phase (90+ min) of the final but not the preliminary stage, and (e) players from Africa and South America demonstrated religious acts more than their European counterparts. We assert that our conceptual model enables the categorization of a variety of personal and social meanings to the celebrations on the field during the most thrilling moments of the game.

Exogenous interleukin-2 can rescue in-vitro T cell activation and proliferation in patients with a novel capping protein regulator and myosin 1 linker 2 mutation

Capping protein regulator and myosin 1 linker 2 (CARMIL2) deficiency is characterized by impaired T cell activation, which is attributed to defective CD28-mediated co-signaling. Herein, we aimed to analyze the effect of exogenous interleukin (IL)-2 on in-vitro T cell activation and proliferation in a family with CARMIL2 deficiency. This study included four children (one male and three females; aged 2·5-10 years at presentation). The patients presented with inflammatory bowel disease and recurrent viral infections. Genetic analysis revealed a novel homozygous 25-base pairs deletion in CARMIL2. Immunoblotting demonstrated the absence of CARMIL2 protein in all four patients and confirmed the diagnosis of CARMIL2 deficiency. T cells were activated in-vitro with the addition of IL-2 in different concentrations. CD25 and interferon (IFN)-γ levels were measured after 48 h and 5 days of activation. CD25 surface expression on activated CD8⁺ and CD4⁺ T cells was significantly diminished in all patients compared to healthy controls. Additionally, CD8⁺ T cells from all patients demonstrated significantly reduced IFN-γ production. When cells derived from CARMIL2-deficient patients were treated with IL-2, CD25 and IFN-γ production increased in a dose-dependent manner. T cell proliferation, as measured by Cell Trace Violet, was impaired in one patient and it was also rescued with IL-2. In conclusion, we found that IL-2 rescued T cell activation and proliferation in CARMIL2-deficient patients. Thus, IL-2 should be further studied as a potential therapeutic modality for these patients.

Altered T cell receptor beta repertoire patterns in pediatric ulcerative colitis

The antigenic specificity of T cells occurs via generation and rearrangement of different gene segments producing a functional T cell receptor (TCR). High-throughput sequencing (HTS) allows in-depth assessment of TCR repertoire patterns. There are limited data concerning whether TCR repertoires are altered in inflammatory bowel disease. We hypothesized that pediatric ulcerative colitis (UC) patients possess unique TCR repertoires, resulting from clonotypical expansions in the gut. Paired blood and rectal samples were collected from nine newly diagnosed treatment-naive pediatric UC patients and four healthy controls. DNA was isolated to determine the TCR-β repertoire by HTS. Significant clonal expansion was demonstrated in UC patients, with inverse correlation between clinical disease severity and repertoire diversity in the gut. Using different repertoire variables in rectal biopsies, a clear segregation was observed between patients with severe UC, those with mild-moderate disease and healthy controls. Moreover, the overlap between autologous blood-rectal samples in UC patients was significantly higher compared with overlap among controls. Finally, we identified several clonotypes that were shared in either all or the majority of UC patients in the colon. Clonal expansion of TCR-β-expressing T cells among UC patients correlates with disease severity and highlights their involvement in mediating intestinal inflammation.

T and B cell clonal expansion in Ras-associated lymphoproliferative disease (RALD) as revealed by next-generation sequencing

Ras-associated lymphoproliferative disease (RALD) is an autoimmune lymphoproliferative syndrome (ALPS)-like disease caused by mutations in Kirsten rat sarcoma viral oncogene homologue (KRAS) or neuroblastoma RAS viral (V-Ras) oncogene homologue (NRAS). The immunological phenotype and pathogenesis of RALD have yet to be studied extensively. Here we report a thorough immunological investigation of a RALD patient with a somatic KRAS mutation. Patient lymphocytes were analysed for phenotype, immunoglobulin levels and T cell proliferation capacity. T and B cell receptor excision circles (TREC and KREC, respectively), markers of naive T and B cell production, were measured serially for 3 years. T and B cell receptor repertoires were studied using both traditional assays as well as next-generation sequencing (NGS). TREC and KREC declined dramatically with time, as did T cell receptor diversity. NGS analysis demonstrated T and B clonal expansions and marked restriction of T and B cell receptor repertoires compared to healthy controls. Our results demonstrate, at least for our reported RALD patient, how peripheral T and B clonal expansions reciprocally limit lymphocyte production and restrict the lymphocyte receptor repertoire in this disease. Decreased naive lymphocyte production correlated with a clinical deterioration in our patient's immune status, suggesting that TREC and KREC may be used as an aid in monitoring disease progression. Both the methodologies used here and the conclusions regarding immune homeostasis may be applicable to the research of ALPS and other immune dysregulation syndromes.

Co-existence of clonal expanded autologous and transplacental-acquired maternal T cells in recombination activating gene-deficient severe combined immunodeficiency

It is commonly accepted that the presence of high amounts of maternal T cells excludes Omenn syndrome (OS) in severe combined immunodeficiency (SCID). We report a SCID patient with a novel mutation in the recombination activating gene (RAG)1 gene (4-BP DEL.1406 TTGC) who presented with immunodeficiency and OS. Several assays, including representatives of specific T cell receptors (TCR), Vβ families and TCR-γ rearrangements, were performed in order to understand more clearly the nature and origin of the patient's T cells. The patient had oligoclonal T cells which, based on the patient-mother human leucocyte antigen (HLA)-B50 mismatch, were either autologous or of maternal origin. These cell populations were different in their numbers of regulatory T cells (T(reg)) and the diversity of TCR repertoires. This is the first description of the co-existence of large amounts of clonal expanded autologous and transplacental-acquired maternal T cells in RAG1-deficient SCID.

Selective clinical and immune response of the oligoclonal autoreactive T cells in Omenn patients after cyclosporin A treatment

The immunological hallmark of Omenn syndrome (OS) is the expansion and activation of an oligoclonal population of autoreactive T cells. These cells should be controlled rapidly by immunosuppressive agents, such as cyclosporin A (CsA), to avoid tissue infiltration and to improve the general outcome of the patients. Here we studied the clinical and the immune response to CsA in two Omenn patients and also examined the gene expression profile associated with good clinical response to such therapy. T cell receptor diversity was studied in cells obtained from OS patients during CsA therapy. Characterization of gene expression in these cells was carried out by using the TaqMan low-density array. One patient showed complete resolution of his symptoms after CsA therapy. The other patient showed selective response of his oligoclonal T cell population and combination therapy was required to control his symptoms. Transcriptional profile associated with good clinical response to CsA therapy revealed significant changes in 26·6% of the tested genes when compared with the transcriptional profile of the cells before treatment. Different clinical response to CsA in two OS patients is correlated with their immunological response. Varying clonal expansions in OS patients can cause autoimmune features and can respond differently to immunosuppressive therapy; therefore, additional treatment is sometimes indicated. CsA for OS patients causes regulation of genes that are involved closely with self-tolerance and autoimmunity.

Cat scratch disease encephalopathy in an immunocompetent patient

Cat scratch disease (CSD) is typically a self-limited regional lymphadenopathy in children and young adults that is caused by Bartonella henselae. The majority of CSD cases resolve spontaneously; however, many systemic complications have been described. We report an unusual case of CSD presenting as an epitrochlear arm mass and complicated by encephalopathy. Identification of B. henselae DNA in the affected lymph node and cerebrospinal fluid confirmed the diagnosis of CSD. Systemic antibiotic therapy was administered and the patient improved without any neurological deficit.

Ultrasound-modulated light tomography assessment of osteoporosis

We present a preliminary series of clinical experiments showing that ultrasound modulation of light in tissues allows tissue properties to be determined well inside the tissue. In this series of clinical experiments the optical scattering coefficient determined by the optical technique is compared with the bone density obtained by dual x-ray absorption. A correlation of 0.84 (p = 0.005) was found for a limited number of patients, showing the potential of this technique for the assessment of osteoporosis.

Increased risk of bloodstream and urinary infections in intensive care unit (ICU) patients compared with patients fitting ICU admission criteria treated in regular wards

Critically ill patients, eligible for admission into intensive care units (ICUs), are often hospitalized in other wards due to a lack of ICU beds. Differences in morbidity between patients managed in ICUs and elsewhere are unknown, specifically the morbidity related to hospital-acquired infection. Patients fitting ICU admission criteria were identified by screening five entire hospitals on four separate days. Hospital infections within a 30-day follow-up period were compared in ICU patients and in patients on other wards using Kaplan-Meier curves. Residual differences in the patients' case mix between ICUs and other wards were adjusted for utilizing multivariate Cox models. Of 13415 patients screened, 668 were critically ill. The overall infection rates (per 100 patient-days) were 1.2 for bloodstream infection (BSI) and 1.9 for urinary tract infection (UTI). The adjusted hazard ratios in ICU patients compared with patients on regular wards were 3.1 (P<0.001) for BSI and 2.5 (P<0.001) for UTI. This increased risk persisted even after adjusting for the disparity in the number of cultures sent from ICUs compared with ordinary wards. No interdepartmental differences were found in the rates of pneumonia, surgical wound infections and other infections. Minimizing the differences between characteristics of patients hospitalized in ICUs and in other wards, and controlling for the higher frequency of cultures sent from ICUs did not eliminate the increased risk of BSI and UTI associated with admission into ICUs.

Pulsed ultrasound-modulated light tomography

Ultrasound-modulated light tomography is a new technique that combines laser light and ultrasound to provide a representation of the light density inside turbid media. We present a method that can produce two- or three-dimensional light density representations with standard ultrasonic pulses. This technique should allow simple, direct fusion of ultrasonic images with optical tomography.

Non invasive local cerebral oxygenation monitoring using a combination of light and ultrasound

OBJECTIVES

We present a new imaging technology that will allow to obtain three-dimensional maps of oxygen saturation in the brain tissues. This technology is not invasive and not ionizing, and can lead to small, portable device that can be brought to bedside.

METHODS

The technology uses a combination of near-infrared laser light and ultrasound. Like for other near-infrared spectroscopy techniques, light gives the information on the hemoglobin species present in the tissues. However, since tissues are turbid media, light alone cannot give precise local information. In the technique that we demonstrate, localization is obtained using a focussed ultrasound that locally shifts the laser wavelength, similarly to laser doppler techniques. The frequency-shifted light can be precisely detected and attributed without ambiguities to a specific location. By scanning the ultrasound focus, we can obtain a mapping of the oxygen saturation.

RESULTS

We present preliminary results on a phantom showing the detection of an absorbing object buried more than two centimeters within the phantom. Scanning the ultrasound on the phantom allows to determine precisely the object position and absorption. Scattering and absorption parameters of the phantom are similar to the brain's. The probe works in the reflection mode, meaning that no transillumination is needed. The ultrasound frequency is 1.25 MHz, ensuring relatively good ultrasound penetration within the skull.

CONCLUSIONS

The method is very promising for brain imaging of trauma or tumors. It is particularly suited for monitoring, since the use of the ultrasound removes the well-recognized problem of light propagation in the CSF.

Duodenal necrosis as the presenting manifestation of polyarteritis nodosa

Polyarteritis nodosa involves necrotising vasculitis of small and medium-sized arteries. Multiple organ systems are involved. A non-specific and slow course of disease is common. Gastrointestinal involvement is characterised by abdominal pain, nausea and vomiting. Bowel infarction and perforation, cholecystitis and hepatic infarction are well known complications. However, bowel infarction as the presenting symptom of the disease is rare. The case of a 20-year-old male with necrosis of the duodenum heralding polyarteritis nodosa is reported. The patient made a slow recovery after extensive abdominal surgery and a stormy course. The postoperative management and treatment of polyarteritis nodosa are discussed. A high index of suspicion and prompt multidisciplinary approach are needed in order to improve survival in these rare but potentially fatal conditions.

Direct, noninvasive detection of photon density in turbid media

Ultrasound tagging of light provides a unique way to probe photon density inside turbid media. We show that this technique allows one to probe the well-known banana-shaped photon density noninvasively, giving rise to a new tool for modeling diffusive photon propagation. Moreover, we show that this technique is quantitative and allows one to get a precise determination of the absorbing constituents inside the turbid medium.

Effect of local hyperthermia of the bladder on mitomycin C pharmacokinetics during intravesical chemotherapy for the treatment of superficial transitional cell carcinoma

AIMS

To assess the effect of local hyperthermia on the systemic absorption of mitomycin C (MMC) during intravesical chemotherapy for the treatment of superficial transitional cell carcinoma of the bladder, and to establish the likely safety of this procedure.

METHODS

Group 1 (n = 12) received 20 mg intravesical MMC plus local hyperthermia, group 2 (n = 13) 20 mg MMC alone, group 3 (n = 16) 40 mg MMC plus local hyperthermia and group 4 (n = 10) 40 mg MMC alone. Patients in groups 1, 2, and 4 underwent post-tumour resection adjuvant treatment, whereas those in group 3 still had tumour present and were treated to eradicate it. Intravesical instillation lasted 60 min, with the solution (50 ml) being replaced after the first 30 min. Blood samples were taken before, and every 15 min during instillation. MMC concentrations in plasma and in urine were determined by h.p.l.c.

RESULTS

The highest MMC plasma concentration (67.9 ng ml(-1)) occurred in a patient in group 3. This value was well below the threshold concentration (400 ng ml-1) for myelosuppression. Local hyperthermia associated with the intravesical chemotherapy enhanced plasma MMC concentrations at 30, 45 and 60 min compared with chemotherapy alone (Group 1 vs 2, P < or = 0.008). Systemic exposure to MMC was not significantly increased by doubling the intravesical dose when intravesical chemotherapy alone was administered. Patients in group 3 displayed the highest degree of MMC absorption and the greatest variability in pharmacokinetics between patients.

CONCLUSIONS

Local hyperthermia enhances the systemic absorption of MMC during intravesical chemotherapy for bladder cancer. In the doses used, plasma MMC concentrations were always more than six times lower than those shown to cause toxicity.

Detection of inhomogeneities with ultrasound tagging of light

Ultrasound modulated light for optical tomography is very useful, since it can provide three-dimensional data with minimal mathematical processing. Although several experimental studies have shown the potential of this method, the link between the ultrasound location and the modulated signal intensity at the detector is not yet fully understood. We derive an analytical formula relating the position of the ultrasound transducer and the optical signal at the detector. We also derive an expression for the signal-to-shot-noise ratio as a function of the transducer position. We show that in certain conditions this ratio is only slowly decreasing as a function of the light penetration depth, which makes this technique attractive for optical tomography.

Ultrasound tagged light imaging in turbid media in a reflectance geometry

A combination of light and focused ultrasound waves provides a unique way to obtain directly three-dimensional absorption data in a turbid medium. We present the combination of an ultrasound wave and light in which both the input and the output optodes are on the same side of the sample (reflectance geometry). This technique permits local detection in depth of the presence of a purely absorbing object, without further mathematical processing. It is a promising technique for medical imaging and monitoring of tissues.

1D dynamic beam modulation: methods to counteract inertia effects

Dynamic modulation can be affected by inaccuracies when the required acceleration is larger than the highest allowed by the mechanical characteristics of the whole apparatus. In this study, inertia effects have been investigated with regard to the single absorber 1D modulation, analysing primarily how the acceleration performed by the modulating system affects the realization of 'single absorber' fluence profiles and the type of correction which could be devised. The observed percentage deviations from desired modulation at the lowest fluence coordinate of single minimum fluence profiles, when no correction is applied, were almost negligible for 'easy' modulations of the incident fluence (i.e. slow gradients); deviations became increasingly relevant as the moving absorber executed steeper gradients (a 17.6% higher dose being delivered in the minimum position when a 0.2 modulation is required). By applying the proposed corrections, the single absorber performances were improved to a satisfactory level, with a maximum deviation from desired modulation in the minima within 1.6%.

Cell cycle inhibition in human BE-13 T cell leukemia cells by haptoglobin-related (HPR) antisense cDNA

We have recently cloned and sequenced a human haptoglobin-related cDNA. Hpr expression was found in various tumor cell lines. To determine whether the haptoglobin related protein (hpr) affects the growth of an established T-cell leukemia cell line, an Hpr antisense expression vector that specifically reduces hpr production was constructed. The vector was transfected into BE-13 cells, an established T-cell leukemia cell line in which Hpr is expressed. Three stable clones were isolated in which hpr protein expression was reduced. These established cell lines proliferated more slowly than vector transfected cells in proportion to Hpr antisense mRNA expression and the reduction in hpr protein production. Following a BrdU pulse, flow cytometric analysis was performed to estimate the fraction of cells in S phase. Hpr antisense transfected cells contained less cells in S phase compared to vector transfected cells. Also in soft agar, cells expressing the antisense cDNA insert, formed on average at least 7-fold fewer colonies than cells transfected with the vector alone. The data suggest that Hpr inhibitors might be of therapeutic value for T-cell leukemia.

Local microwave hyperthermia and intravesical chemotherapy as bladder sparing treatment for select multifocal and unresectable superficial bladder tumors

PURPOSE

The role of a combined regimen of local hyperthermia and topical chemotherapy in patients with multifocal and recurrent superficial bladder tumors not curable by transurethral resection was evaluated in a neoadjuvant organ sparing clinical study.

MATERIALS AND METHODS

A total of 19 patients with multifocal, superficial grades 1 to 3 bladder tumors that recurred after intravesical chemoprophylaxis or immunoprophylaxis underwent local combined administration of microwave induced hyperthermia and intravesical chemotherapy as a debulking approach. Due to extensive superficial involvement of the bladder walls complete transurethral resection of all tumors seemed technically unfeasible in all cases and radical cystectomy was considered the treatment of choice. Endovesical hyperthermia at 42.5 to 46C was delivered using the SB-TS 101 system, based on a microwave transurethral applicator that irradiates the bladder filled with a circulating solution of mitomycin C. Patients underwent 8 weekly 1-hour sessions on an outpatient basis without anesthesia. When possible, after treatment patients underwent transurethral resection of residual tumors and all suspicious areas.

RESULTS

After treatment transurethral resection appeared to be feasible and curative in 16 patients (84%). Histological study revealed complete and partial responses in 9 (47%) and 7 (37%) cases, respectively. Due to extensive residual tumors radical cystectomy was performed in 3 patients (16%). At a median 33-month followup 8 superficial transitional tumor recurrences were documented and easily eradicated by transurethral resection or laser therapy in patients in whom the bladder had been saved.

CONCLUSIONS

Microwave induced hyperthermia combined with intravesical mitomycin C seems to be a feasible, safe and elective approach for conservative treatment of multifocal and recurrent superficial bladder tumors when other treatment strategies have failed.

Local microwave hyperthermia and intravesical chemotherapy as bladder sparing treatment for select multifocal and unresectable superficial bladder tumors

PURPOSE

The role of a combined regimen of local hyperthermia and topical chemotherapy in patients with multifocal and recurrent superficial bladder tumors not curable by transurethral resection was evaluated in a neoadjuvant organ sparing clinical study.

MATERIALS AND METHODS

A total of 19 patients with multifocal, superficial grades 1 to 3 bladder tumors that recurred after intravesical chemoprophylaxis or immunoprophylaxis underwent local combined administration of microwave induced hyperthermia and intravesical chemotherapy as a debulking approach. Due to extensive superficial involvement of the bladder walls complete transurethral resection of all tumors seemed technically unfeasible in all cases and radical cystectomy was considered the treatment of choice. Endovesical hyperthermia at 42.5 to 46C was delivered using the SB-TS 101 system, based on a microwave transurethral applicator that irradiates the bladder filled with a circulating solution of mitomycin C. Patients underwent 8 weekly 1-hour sessions on an outpatient basis without anesthesia. When possible, after treatment patients underwent transurethral resection of residual tumors and all suspicious areas.

RESULTS

After treatment transurethral resection appeared to be feasible and curative in 16 patients (84%). Histological study revealed complete and partial responses in 9 (47%) and 7 (37%) cases, respectively. Due to extensive residual tumors radical cystectomy was performed in 3 patients (16%). At a median 33-month followup 8 superficial transitional tumor recurrences were documented and easily eradicated by transurethral resection or laser therapy in patients in whom the bladder had been saved.

CONCLUSIONS

Microwave induced hyperthermia combined with intravesical mitomycin C seems to be a feasible, safe and elective approach for conservative treatment of multifocal and recurrent superficial bladder tumors when other treatment strategies have failed.

Transcriptionally active haptoglobin-related (Hpr) gene in hepatoma G2 and leukemia molt-4 cells

The aim of the present study was to answer the question: Is the haptoglobin-related (Hpr) gene expressed in tumor cells? Our strategy of cloning the cDNA was to screen a human hepatoma G2 cDNA expression library in lambda gt11 using three different probes complementary to the coding strands of regions of the Hpr gene that contain codon changes permitting a discrimination from haptoglobin gene Hp1F. Among 8 x 10(5) recombinant phages screened, 2 hybridized to all three probes under stringent conditions. A 1.5 kb cDNA designated ST-1 was subcloned and sequenced. Almost total identity was found with the Hpr predicted exons 2-5, although exon 1 was missing. The ST-1 partial cDNA clone was used as a probe to screen a human leukemia molt-4 cDNA expression library in lambda gt11. Among 10(6) recombinant phages screened, 1 hybridized under stringent conditions. A 1.5 kb cDNA designated ST-2 was subcloned and sequenced. ST-1 and ST-2 cDNA were identical except for an insert of A at position 500 of ST-1 cDNA. Two different nucleotide changes were observed in the ST-1 and ST-2 sequences as compared with the expected Hpr cDNA sequence. An alternative processing of Hpr pre-mRNA was found in both cDNA clones that included 126 bp of the 3'-region of intron 1. This intronic sequence is thereby retained in the mature mRNA. cDNA analysis revealed an in-frame ATG in intron 1. Transcription/translation assay was used to demonstrate that the Hpr message could be translated from the internal methionine codon. We have thus shown for the first time that the Hpr gene is expressed in the human hepatoma G2 and leukemia molt-4 cell lines.

Neoadjuvant combined microwave induced local hyperthermia and topical chemotherapy versus chemotherapy alone for superficial bladder cancer

PURPOSE

We evaluated the effectiveness of local bladder hyperthermia and intravesical chemotherapy compared to intravesical chemotherapy alone in the treatment of superficial transitional cell carcinoma.

MATERIALS AND METHODS

A new system designed to deliver simultaneously local bladder hyperthermia and intravesical chemotherapy has been developed at our institute. The system consists of a computerized 915 MHz. microwave source that directly heats the bladder walls (within a temperature range of 42.5 to 45.5C) using a transurethral catheter. From February 1989 to December 1993, 52 patients 44 to 81 years old (mean age 64.3) with superficial stages Ta to T1, grades 1 to 3 transitional cell carcinoma of the bladder were selected for neoadjuvant intracavitary treatment. Tumors were left intact as marker lesions. Of the patients 29 were randomly assigned to receive combined neoadjuvant intravesical chemotherapy and local hyperthermia (group 1), while 23 received intravesical chemotherapy alone (group 2). The treatment protocol included multiple sessions performed on an outpatient basis. Mitomycin C (40 mg. in 50 cc distilled water) was used for intravesical chemotherapy in both groups. All patients underwent transurethral resection of residual tumors and of all suspicious areas 7 to 10 days after completion of treatment. Only a complete response was considered for statistical analysis.

RESULTS

A pathological complete response was documented in 19 cases (66%) in group 1 and 5 (22%) in group 2 (chi-square p< 0.01).

CONCLUSIONS

According to these preliminary data, microwave induced hyperthermia combined with local intravesical chemotherapy seems to be a feasible, safe and promising approach for neoadjuvant and minimally invasive treatment of superficial bladder cancer.

A new approach using local combined microwave hyperthermia and chemotherapy in superficial transitional bladder carcinoma treatment

For some time hyperthermia, alone or in combination with radiotherapy or chemotherapy, has proved to be a promising method for treating several kinds of solid tumors. After intensive laboratory investigations a new device, based on a microwave source delivering local bladder hyperthermia together with intravesical mitomycin C chemotherapy has been clinically tested as a neoadjuvant approach in 44 patients suffering from superficial cancer of the bladder. The combined approach was administered on an outpatient basis without major complications and with acceptable local toxicity. Endoscopic and histological evaluations proved that combined local hyperthermia and chemotherapy can induce necrosis of transitional tumors. The overall response rate was 90.8%, with 70.4% complete and 20.4% partial, leaving 4 patients (9.2%) nonrespondent. Clinical and histological evaluations have confirmed the feasibility and safety of this combined treatment. Further multicentric studies have been initiated.

Treatment of surgical and non-surgical septic multiorgan failure with bicarbonate hemodialysis and sequential hemofiltration

OBJECTIVE

Hospital mortality of patients with septic multiorgan failure (MOF) is still around 95%. The present study investigates whether this high mortality could be significantly reduced by the addition of sequential hemofiltration (SH) with bicarbonate hemodialysis (HD) to the currently used life supportive measures.

DESIGN

35 (18 surgical and 17 nonsurgical) patients, with 3 or more organ failures, had daily sessions of zero balance SH, for periods ranging from 2-22 days.

MEASUREMENTS AND RESULTS

SH induced significant improvement of PaO2/100 FIO2, Apache II score, MAP, as well as blood chemistry in survivors. Dying patients had less marked improvement of blood oxygenation, non-significant changes in other variables, in addition to low MAP before and after SH, as well as marked hemodynamic unstability during the procedure. The observed hospital mortality was 38% for the surgical group, and 35.3% for the medical patients (n.s.).

CONCLUSIONS

Mortality observed in this retrospective, uncontrolled study was significantly lower than that currently observed with conventional supportive therapy, with or without the addition of other forms of blood purification, e.g. CAVH and CAVHD. This improvement in results appears to be related to the property of SH to completely clear 90% of the blood from mediators of inflammation in only one passage through the hemofilter, and to better tolerance of HD done using bicarbonate buffer. A definite evaluation of this technique will be eventually reached by a programmed, appropriate sample size study, which is out of reach for one individual ICU.

Dynamic beam modulation by using a single computer-controlled absorber

The authors have developed an apparatus able to generate ID intensity-modulated beams, using only one moving absorber within the irradiation field. A procedure for deriving optimized absorber-speed profiles in order to produce the desired fluence/dose profiles has been suggested. Experimental tests show that the system should be sufficiently reliable in reproducing modulated beam profiles of different shape: expected relative doses against measured relative doses have been found to be in agreement in a number of situations within 3% using a nonfocused device. A better agreement should be expected using a focused apparatus (which is currently being developed). Beam modulation by single absorber cannot modulate the beam fluence in any was one wishes, due to physical constraints, which depend on the absorber and field widths and on the shape of the desired fluence profile. However, the authors show that this simple and low-cost tool could offer, with a sufficient degree of accuracy, the possibility of modulating the beam fluence with a high degree of versatility. In particular, a procedure or performing tissue-missing compensation by single-absorber dynamic beam modulation is suggested. Moreover, 'strongly' modulated beam profiles can be created, showing that this simple technique could also have some interesting applications in the field of conformal radiotherapy by non-uniform dose delivery.

[Death from fluoro-silicate in floor polish]

A fatal case of poisoning due to ingestion of an apparently innocuous household product is described. A healthy 28-year-old man accidentally drank floor polish (Cristalizador, a Spanish import). On arrival at the emergency room a few hours later he passed large amounts of bloody stool and lost consciousness. A call to the Spanish Poison Center revealed that although not indicated on the label, the polish contained a highly poisonous salt, fluoro-silicate. Blood gas analysis revealed severe metabolic acidosis. Serum calcium was 3.8 mg/dL. The post-resuscitation ECG showed subendocardial ischemia and ST-elevation in the anteroseptal wall and prolonged QT-interval. In the intensive care unit he received large amounts of fluids, dopamine, sodium bicarbonate and calcium. Despite the treatment, his condition continued to deteriorate: VPB's appeared, there was a short run of ventricular tachycardia and then atrial fibrillation developed. Further treatment included lidocaine, verapamil, amiodarone, and electrical cardioversion. Blood pressure remained low and 11 hours after admission he died of myocardial infarction, severe arrhythmia and multi-organ failure.

Primary abdominal actinomycosis in a diabetic woman--an intractable disease

Primary abdominal actinomycosis is very unusual. Only five previous cases have been reported in the English literature. We describe the case of a 57-year-old diabetic woman with primary abdominal actinomycosis, refractory to several antimicrobial regimens and surgical procedures. We conclude that primary abdominal actinomycosis in such a diabetic woman is an intractable disease.

Rabbit trachealis tension responses to receptor-mediated agonists are diminished by elastase

The present study examined the effects of elastase, in concentrations present in respiratory secretions, on airway smooth muscle contractile responses in vitro and the magnitude of the airway epithelial inhibition of smooth muscle tension. Experiments were performed on 126 full-thickness tracheal strips from 25 rabbits. Isometric tension responses to acetylcholine (10(-8) to 10(-4) M) and potassium chloride (10 to 110 mM) were examined before and after a 5-min exposure to either porcine pancreatic elastase (PPE) or human neutrophil elastase (HNE). PPE (5 to 40 micrograms/100 microliters) reduced the tension response to acetylcholine but had no effect on the tension response to potassium chloride. PPE and HNE (20 micrograms/100 microliters) produced similar effects. Mechanical removal of the epithelium per se significantly (P less than 0.005) decreased the ED50 response to acetylcholine but did not affect maximal tension. However, the airway epithelial inhibitory effect on the acetylcholine tension response was similar in the presence and absence of PPE (20 micrograms/100 microliters). These data suggest that the diminution of tracheal smooth muscle tension responses to receptor-mediated agonists induced by elastase is a direct effect on the muscle and is not mediated by an effect of elastase on the respiratory epithelium.

Combined intravesical chemotherapy with mitomycin C and local bladder microwave-induced hyperthermia as a preoperative therapy for superficial bladder tumors. A preliminary clinical study

Twelve patients suffering from superficial transitional cell carcinoma of the bladder underwent treatment combining simultaneous mitomycin C topical instillation and local endocavitary hyperthermia as a preoperative adjunct to transurethral resection in a preliminary clinical study. A specifically designed system to deliver and monitor local bladder hyperthermia was used. The feasibility, the subjective tolerance and the side effects of the combined treatment were the main target of our investigation. Endoscopic and histologic features, assessed before, during and after this combined approach, showed selective damage to neoplastic areas with minimal changes in the normal urothelium. Local intravesical concurrent chemotherapy and hyperthermia administration is found to be a safe and well-tolerated approach for superficial bladder tumor treatment. The preliminary results encourage further studies to define the limits and prospects of this regimen, in both superficial bladder tumor ablation and prophylaxis of recurrences.

The effect of local deep microwave hyperthermia on experimental zymosan-induced arthritis in rabbits

The effect of local deep microwave hyperthermia (LDMWH) on normal and Zymosan-induced arthritis has been evaluated in 12 rabbits (24 joints). LDMWH, four treatments to each joint (twice weekly for a period of 2 wk), was generated by an antenna operating at 915 MHz for 60 min, reaching an intraarticular temperature of 42.5 +/- 0.5 degrees C. A surface cooling system was used with the microwave apparatus. Two weeks after the last treatment, all animals were sacrificed. The application of LDMWH on normal joints induced a limited proliferation of the synovial lining cells with a minimal perivascular infiltration of mononuclear and neutrophil cells. However, no histologic damage to the skin, muscles, bone, cartilage or bone marrow adjacent to the heated joints could be noted. Induction of Zymosan arthritis (2 wk before LDMWH) was characterized by pannus formation and granulomatous reaction accompanied by fibrinoid deposits and disseminated necrotic foci in the synovial intima. The LDMWH treatment on the examined arthritic joints brought about a reduction in the degree of granulomatous reaction concomitant with the appearance of some fibrocytes and fine collagen fibrils. These findings suggest that LDMWH can be safely applied, even repeatedly, without morphologic evidence of damage to any normal mesenchymal tissue. Moreover, it reduces the inflammatory process in experimentally induced synovitis.

Local hyperthermia of the prostate gland for the treatment of benign prostatic hypertrophy and urinary retention

Local hyperthermia of the prostate was used to treat 72 patients who had an indwelling catheter because of urinary retention caused by benign prostatic hypertrophy. One month after completion of treatment 50% of patients were able to dispense with the catheter and 1 year later 40% remained catheter-free. The best results were achieved in patients who underwent 6 to 10 treatment sessions in conjunction with cyproterone acetate 50 mg tid administered during the treatment period only.

Epithelial effects on tracheal smooth muscle tone: influence of muscarinic antagonists

The tracheobronchial epithelium produces factor(s) that modulate the constrictor and relaxant response of airway smooth muscle. The present study sought to determine whether the tracheobronchial epithelial inhibitory effect on trachealis smooth muscle tension is under muscarinic receptor control. Studies were performed on 195 strips from 13 rabbits. In strips in which the epithelium was intact, pirenzepine (an M1 receptor antagonist) produced a dose-related (10(-8) and 10(-7)M) rightward shift (P less than 0.01 for each) and gallamine (an M2 antagonist) produced a progressive (10(-8) and 10(-7)M) leftward shift of the acetylcholine concentration responses (P less than 0.01 for each). In strips in which the epithelium was removed mechanically, neither pirenzepine nor gallamine had any effect on the acetylcholine responses. In acetylcholine precontracted (5 x 10(-6) M) muscle strips with epithelium intact, addition of pirenzepine (10(-7)M) produced a significant (P less than 0.01) reduction in steady-state tension, whereas administration of gallamine tended to increase tension, (P = NS). Neither pirenzepine nor gallamine had any effect on steady-state tension in strips in which the epithelium was removed. These results indicate that the magnitude of the tracheobronchial epithelial inhibitory effect on smooth muscle tension is under muscarinic control. Specifically, M1 receptor blockade augments and M2 receptor blockade inhibits the magnitude of the tracheobronchial epithelial effect.

Local hyperthermia to canine prostate. A pilot study

Repeated treatments of localized deep microwave hyperthermia were given to a series of dogs by means of a 915 MHz, water-cooled skirt-type applicator. The applicator was inserted into the rectum and directed toward the prostate in order to heat it by means of the absorbed microwaves while keeping the rectal wall at a lower temperature by surface cooling of the applicator itself. Sessions were given for different lengths of time ranging between ninety minutes and five hours, during which the prostate temperature was kept at 42.5 degrees C (+/- 0.5 degrees C) or 44.5 degrees C (+/- 0.5 degrees C). Three-dimensional temperature distributions in the prostate were measured accurately and verified by a Luxtron Fluoroptic Unit. Temperatures were constantly monitored in the rectal wall and in the prostatic urethra. Thorough and systemic follow-up was done before, during, and after each treatment, and the observations are reported. Two interesting preliminary observations were made: (1) differential blood counts showed significantly monocytosis following the treatments and lasted for at least one week, and (2) values of creatinine phosphokinase (CPK) and serum glutamic oxaloacetic transaminase (SGOT) were found to rise irreversibly in those animals which were later found to have definite histopathologic evidence of localized necrotic damage.

Treatment of articular effusions with local deep microwave hyperthermia

Local deep microwave hyperthermia (LDMWH) may be considered as a therapeutic tool for joint diseases because it has the advantage of heating the target organ e.g. synovium, while sparing the adjacent tissues, as demonstrated in animals. The effect of this new microwave device has been evaluated on seven rheumatoid arthritis patients with knee effusion. The hyperthermia apparatus consists of a 915 MHz power source with a cooling system to the skin. LDMWH was operated for one hour, twice a week for two weeks. Intra-articular knee temperature reached the level of 40.6 +/- 1.1 degrees C within 15 minutes, raised to 41.2 +/- 0.7 degrees C after 30 minutes and to 41.3 +/- 0.9 degrees C at one hour. The skin temperature over the heated knee joints remained at 24.3 +/- 1.1 degrees C during treatment. All patients noted a sensation of warmth in the treated knee. Aspiration of synovial fluid was performed before and immediately after each treatment. Walking time was improved (p = 0.04) and significant decrease in pain (p = 0.01) was noted following treatment. Synovial fluid leukocyte count and prostaglandin E2 level, knee circumference and range of motion did not change. Severity of pain, walking time, knee circumference and range of motion remained stable in the six weeks following the last hyperthermia application. No adverse reaction could be observed. These results suggest LDMWH to be safe and successful as an adjuvant treatment of chronic inflammatory joint effusions.

Epithelial modulation of trachealis muscle tension is calcium and temperature dependent

The tracheobronchial epithelium produces inhibitory substance(s) that alter the tracheal smooth muscle tension. This study examined the effect of changes in extracellular Ca2+ and temperature in vitro on the tension response of rabbit trachealis muscle to mechanical removal of the epithelium. Tension during acetylcholine- and KCl-induced contractions was examined at 0, 0.75, 1.5, 2.5, and 5 mM bath Ca2+ concentrations and at 37, 30, 23, and 41 degrees C bath temperature. At most extracellular Ca2+ concentrations (i.e., 0.75, 1.5, 2.5, and 5 mM), epithelial removal shifted the acetylcholine concentration response approximately one-half log to the left (P less than 0.001 for each condition) but had no effect on the responses to KCl (P = NS). Reductions in bath Ca2+ to 0 mM eliminated the epithelial inhibitory effect on the acetylcholine response. In contrast to the effects of reductions in Ca2+, cooling the airway to 30 and 23 degrees C progressively diminished the magnitude of the epithelial inhibitory effect. Our results indicate that the influence of the tracheal epithelium on tracheal smooth muscle responses to constrictor agonists is substance specific and can be diminished by reductions in tracheal temperature and extracellular Ca2+ concentration.